Canadian Running

Fuel Sta­tion

Why all ath­letes should get their iron checked rou­tinely

- By Rachel Han­nah Rachel Han­nah, RD, is a five-time Cana­dian cham­pion, a Cana­dian Marathon Cham­pi­onships sil­ver medal­list and a Pan Am Games bronze medal­list in the marathon. She is also a full-time reg­is­tered di­eti­tian at the Univer­sity of Guelph’s Healt Health · Health Tips · Lifestyle · Healthy Living · Healthy Food · Blood Disorders · Health Conditions · Anemia

Run­ning and Iron

Are you feel­ing fa­tigued, ex­hausted and dis­ap­pointed in your re­sults? Not sur­pris­ing, given the events of the past year, but fa­tigue and poor per­for­mance could also be point­ing to iron de­fi­ciency. Red blood cells carry oxy­gen around the body, and those cells re­quire iron to bind oxy­gen. That’s why iron is par­tic­u­larly im­por­tant for ath­letes, who may lose it through their sweat and urine, as well as from the pound­ing of their feet. Women also lose iron thanks to men­stru­a­tion. And if you’ve been di­ag­nosed with red-s (rel­a­tive en­ergy de­fi­ciency in sport) or lea (low en­ergy avail­abil­ity), that can also cause lower iron sta­tus and poor ab­sorp­tion.

All ath­letes should get rou­tine blood­work done, prefer­ably be­fore they start train­ing. Iron is one of those im­por­tant min­er­als that may need to be sup­ple­mented if you don’t get enough from your diet, since it can’t be made in the body. In ath­letes, low iron re­port­edly af­fects be­tween three and 11 per cent of males and be­tween 15 and 35 per cent of fe­males.

Iron comes in two forms: heme, from an­i­mal sources, like beef, tuna, chicken and pork, and non-heme, from plant sources, like spinach, dried fruit, legumes and al­monds. Our bod­ies can only ab­sorb around 12 per cent of the di­etary iron we con­sume, so when ath­letes are de­fi­cient, it’s very im­por­tant to sup­ple­ment. Be­cause non-heme iron is even less well ab­sorbed than heme iron, ve­gan and veg­e­tar­ian ath­letes need even more.

Nu­tri­tion can be tricky: citrus fruits, broc­coli and toma­toes and carotenoid­s from foods such as pump­kin and car­rots help max­i­mize non-heme iron ab­sorp­tion, but cer­tain com­pounds in healthy foods ac­tu­ally in­ter­fere with iron ab­sorp­tion: ex­am­ples are cal­cium, phy­tates (found in whole-grain cereals, nuts, legumes and seeds) and polyphe­nols (found in tea, cof­fee, red wine and choco­late). Zinc, high in many healthy foods, also com­petes for ab­sorp­tion. If your blood­work shows low iron, the an­swer is not to avoid th­ese foods, but to start sup­ple­ment­ing.

Serum fer­ritin is the stor­age form of iron in the body and is the most widely used marker when test­ing. Iron de­fi­ciency is de­fined as any­thing be­low 35 μg/l fer­ritin, with nor­mal he­mo­glo­bin lev­els. (He­mo­glo­bin is a pro­tein in red blood cells that car­ries oxy­gen from the lungs to the body’s or­gans and tis­sues and trans­ports car­bon diox­ide back to the lungs.) Both fer­ritin and a com­plete blood count ( cbc) should be as­sessed with blood­work.

The best iron sup­ple­ments are fer­rous salts (fer­rous sul­phate, glu­conate or fu­marate), be­cause they are ab­sorbed well and are widely avail­able and cost-ef­fec­tive. 100 mg of oral iron (fer­rous salts) taken daily is ideal. Fer­rous sul­phate is con­sid­ered the gold stan­dard, but may cause an up­set stom­ach. If this is an is­sue, new re­search shows tak­ing the sup­ple­ment on al­ter­nate days may be just as ef­fec­tive (or try switch­ing to fer­rous glu­conate, which may be eas­ier on your stom­ach). It’s best to take your sup­ple­ment in the morn­ing or within 30 min­utes of ex­er­cis­ing. If your iron sta­tus has not im­proved three or four months af­ter you be­gin oral sup­ple­men­ta­tion, par­enteral (in­tra­venous) iron sup­ple­men­ta­tion may be nec­es­sary. (Con­sult your doc­tor.)

All ath­letes can ben­e­fit from a con­sul­ta­tion with a sports di­eti­tian for nu­tri­tional anal­y­sis and coun­selling. Find­ing the right com­bi­na­tion of iron can some­times re­quire some ex­per­i­men­ta­tion with tim­ing and with dif­fer­ent types, in con­sul­ta­tion with your health­care pro­fes­sional.

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