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Iron Deficiency: What They Don't Tell You and What You Don't Know!

Iron is a key mineral for athletes and non athletes, and despite this, iron deficiency is more and more common these days, specially among endurance, females, teenagers, and plant based athletes. Iron has very important roles in the body, including oxygen transport and delivery, and energy production in the mitochondria. Additionally, it plays an important role in immunity and cognition. Since iron supports so many essential body functions, deficiency must have a clear negative impact on performance and recovery.

What are some of the symptoms of iron deficiency?

  • Fatigue and lack of energy

  • Shortness of breath during training

  • Cold intolerance

  • Brittle and spoon like nails

  • Poor recovery and inability to perform

  • Pale skin

  • Headaches and dizziness


What causes iron deficiency and who is at a HIGHER RISK?


Iron deficiency can be caused by:

  • Decreased intake. Depending on the source of iron consumed, bioavailability will change. There are 2 forms of Iron: heme and non heme, with the first one been more readily absorbed. Animal products contain a mix of these iron forms, however plant based foods are almost 100% non-heme iron. The absorption of heme iron is 40% vs non heme iron been 5%! This is why PLANT BASED ATHLETES might be at a higher risk!

  • Increased iron losses: sweating, GI bleed, menstrual cycle, and also through a phenomenon called 'foot strike hemolysis' in runners! This puts FEMALE ATHLETES and RUNNERS at a higher risk as well.

  • Reduced Energy Availability Syndrome (REDs) due to decrease intake or increase needs with inability to meet these needs. YOUNG ATHLETES are at an increase risk as they try to meet the increased demands of growth and training.

  • Post exercise inflammatory response. This increases the hormone HEPCIDIN what plays a key role in iron absorption and regulation! The body's ability to absorb iron can be affected 3-6 hours post training.

WOW, but i have some symptoms but my doctor said my iron level was normal?


There are different stages of iron deficiency.

  • Stage 1: low ferritin due to a reduction of total iron stores, but iron and hemoglobin remain normal

  • Stage 2: low ferritin, low serum iron or decreased transferrin saturation and increased total iron binding capacity (TIBC).

  • Stage 3: all of the above, and as iron stores and transport became sufficiently depleted, hemoglobin synthesis decreases as well.

So if I am experiencing any of the symptoms, what are some recommendations?


  • Have an annual check up and consider having certain markers reviewed: iron, hemoglobin, serum ferritin, transferrin saturation, and TIBC.

  • Consult a dietitian to make sure you are consuming sufficient iron sources daily. EAT ENOUGH!

  • Add a source of vitamin C (oranges, strawberries, kiwis, peppers) when consuming iron rich foods as this will aid with absorption.

  • If taking supplements, avoid taking them with tannin containing products (tea, coffee, wine) and calcium containing products (milk, cheese, yogurt) as this might affect absorption.

  • If you are going to train in high altitude, remember iron needs are increased! Consider checking your levels and possibly supplementing a week prior and during training.

  • Female athletes with heavy menstrual cycles can adjust dietary intake and supplement as needed to compensate for the increased losses.

  • Check your gut health! Gut inflammation can raise hepcidin levels what might have an effect on iron absorption. Also there is undergoing research working on understanding the interactions between gut microbiota and iron absorption, showing that administration of specific pre and probiotics during iron supplementation might aid to optimize absorption.

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