• Iron is essential in many metabolic systems that produce energy from food for our body cells. If your iron levels are low, you can feel tired and low in energy.
• Iron, as part of hemoglobin, carries oxygen to, and carbon dioxide away from, all the cells in your body. The brain has a big demand for oxygen. Without enough iron you will find it hard to concentrate and feel tired and irritable.
• Iron is needed to maintain a healthy immune system. If you don't have enough iron you may be prone to more frequent infections.

1. Inadequate supply of dietary iron

• Poor food choices or very low energy intakes make it difficult to meet the body's needs for growth and physical activity.

• Hard training stimulates an increase in red blood cell and blood vessel production, increasing the demand for iron.
• Children and adolescents have higher iron requirements for growing.
• Iron turnover is highest for endurance athletes training at high intensity.

• Blood loss through injury, blood nose and menstruation.
• In endurance athletes, blood loss has been reported from the digestive tract and due to trauma to the bladder wall.
• ‘Foot strike’ damage to red blood cells in the feet due to running on hard surfaces with poor quality shoes leads to iron loss.
• Heavy sweating – iron is lost in sweat.

If fatigue persists and training is affected, see a Sports Dietitian or Doctor for a checkup and blood test for iron status. Blood iron levels that are below reference standards usually confirms the diagnosis. Routinely, your doctor will measure your blood (eg hemoglobin, ferritin, transferring) to determine the extent of the iron depletion. (The most definitive biochemical marker for determining iron status is transferring receptor, a new test that may not be available from your local pathology laboratory).
 

 How is iron deficiency treated?

Iron enhancers: Absorption of non-haem iron can be increased by up to four times by combining meat or a vitamin C-rich food in the same meal.

Should I take iron supplements without a diagnosis of iron deficiency anemia?

• Increase total consumption of iron-rich foods. This is especially important for people eating very little food.
• Choose a variety of iron-rich foods everyday.
• Eat lean red meat, poultry or fish preferably daily (eg in sandwiches or at an evening meal).
• Eat lean red meat (ie beef, veal, lamb) at least 3-4 times a week.
• If vegetarian, ensure food choices are iron-rich (eg eat baked beans, lentils and breakfast cereals regularly) and combine with vitamin C-rich foods. (Good sources of vitamin C include citrus fruit, fruit juice, strawberries, kiwifruit, broccoli, cabbage, cauliflower and capsicum).
• Eat iron-enriched breakfast cereals regularly. Porridge and muesli are very nutritious but are not iron-enriched.
• Avoid consumption of strong tea and coffee when you eat breakfast cereal or sandwiches as they will reduce iron absorption (the tannic acid in tea and coffee binds to iron decreasing its absorption)

Summary

• Iron depletion is common in athletes and can develop quickly into the advanced condition of anemia.
• Inadequate iron intake is often reported in vegetarian, adolescent girls and women athletes.
• Athletes have high iron requirements and losses of iron from hard training, especially endurance athletes.
• Lean red meat, one of the most readily absorbed sources of iron, should be consumed 3 - 4 times a week.
• Vegetarians need to eat iron-rich foods each day, such as iron-fortified breakfast cereal, nuts and legumes, and combine these with foods high in vitamin C.
• People with the iron storage disorder, haemochromatosis, should never use iron supplements.
• If you are rapidly growing, not eating properly, feel tired and run down, and training hard nearly every day, see your doctor to check for iron depletion.

Dietary Sources of Iron

Iron is essential to all body cells. Iron deficiency anemia occurs when there is not enough iron in the red blood cells. This is a common problem often caused by pregnancy, blood loss or a diet low in iron. There are a variety of possible symptoms of iron deficiency including lack of energy or tiredness, extreme fatigue, pale skin, light headedness, brittle nails and headaches. Because the typical symptoms of iron deficiency have many causes, diagnosis by a blood test is needed to confirm the presence of iron deficiency anemia.

If your blood iron level is low, your health care provider may refer you to a dietitian to discuss a dietary increase in iron-rich foods. He or she may also recommend a multivitamin pill or prescribe an iron supplement. Although iron is found in a variety of different foods and supplements, its availability to the body varies significantly. In general, iron is not readily absorbed by the body. Availability is partially determined by whether the iron is found in the form of HEME or NON-HEME iron.

HEME iron is found only in meat, fish and poultry and is absorbed much more easily than NON-HEME iron, which is found primarily in fruits, vegetables, dried beans, nuts and grain products.

The following factors will increase the iron absorption from non-heme foods:

• A good source of vitamin C (ascorbic acid) - i.e., oranges, grapefruits, tomatoes, broccoli, and strawberries, eaten with a NON-HEME food

• A HEME and NON-HEME food eaten together

• A NON-HEME food cooked in an iron pot, such as a cast iron skillet

The following factors will decrease non-heme iron absorption:

• Large amounts of tea or coffee consumed with a meal (the polyphenols bind the iron).

• Excess consumption of high fiber foods or bran supplements (the phytates in such foods inhibit absorption).

• High intake of calcium - take your calcium supplement at a different time from your iron supplement.

The Recommended Dietary Allowance (RDA) for iron for non-vegetarian pre-menopausal women is 18 mg/day. The RDA for non-vegetarian men and post-menopausal women is 8 mg/day. Because of iron absorption issues in a healthful, high-fiber vegetarian diet, the RDAs for vegetarians are higher - 14 mg/day for vegetarian men and 33 mg/day for vegetarian women. The upper level of intake should not exceed 45mg/day.

HEME IRON SOURCES

Food Source	Serving Size (oz.)	Iron (mg)
Beef, liver	3.0	7.5
Beef, corned	3.0	2.5
Beef, lean ground; 10% fat	3.0	3.9
*Beef, round	3.0	4.6
*Beef, chuck	3.0	3.2
*Beef, flank	3.0	4.3
Chicken, breast w/out bone	3.0	0.9
Chicken, leg w/bone	2.0	0.7
Chicken, liver	3.0	7.3
Chicken, thigh w/ bone	2.3	1.2
Cod, broiled	3.0	0.8
Flounder, baked	3.0	1.2
Pork, lean ham	3.0	1.9
*Pork, loin chop	3.0	3.5
Salmon, pink canned	3.0	0.7
Shrimp, 10 - 2 1/2 inch	1.1	0.5
Tuna, canned in water	3.5	1.0
Turkey, dark meat	3.0	2.0
Turkey, white meat	3.0	1.2

*Lean, trimmed of separable fat

NON-HEME FOOD SOURCES

Food Source	Serving Size (oz.)	Iron (mg)
Almonds, raw	10 - 12 each	0.7
Apricots, dried, med.-size	10 each	1.7
Bagel	1 whole	1.5
Baked beans, canned	1/2 cup	2.0
Bread, white	2 slices	1.4
Bread, whole wheat	2 slices	1.7
Broccoli, cooked	1/2 cup	0.6
Broccoli, raw	1 stalk	1.1
Dates	10 each	1.6
Kidney beans	1/2 cup	3.0
Lima beans	1/2 cup	1.8
Macaroni, enriched, cooked	1 cup	1.9
Molasses, blackstrap	1 tbsp.	2.3
Peas, frozen and prepared	1/2 cup	1.3
Prune juice	1/2 cup	1.5
Raisins, not packed	1/4 cup	1.0
Rice, brown, cooked	1 cup	1.0
Rice, white enriched, cooked	1 cup	1.8
Spaghetti, enriched, cooked	1 cup	1.6
Spinach, cooked	1/2 cup	2.0
Vitamin supplements	varies	varies

In addition, many breakfast cereals are iron-fortified. Check nutrition information on package label for specific iron content.