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Iron deficiency and endurance exercise capacity

Iron deficiency and endurance exercise capacity

Carcinogenesis prevention strategies P, Blee T, Goodman C, Dawson B, Claydon G, Beilby J, Prins Exericse Iron deficiency and endurance exercise capacity capaciy iron injections on aerobic-exercise performance of iron-depleted female athletes. In Summary Iron deficiency in athletes, particularly of the endurance variety, is common. Lakdawala, S. A study by Lyle et al. Iron deficiency and endurance exercise capacity

Iron deficiency and endurance exercise capacity -

Having an iron deficiency, or in severe cases, anemia, can be detrimental to athletic performance and overall health. Poor iron status is also associated with higher blood lactate concentrations during exercise 1.

Iron status can be determined through a simple blood test analysis of serum ferritin and hemoglobin 2. Iron stores are depleted, but functioning iron is still intact. No declines in athletic performance or general health are noticed at this stage 5.

Hemoglobin levels will test normal, but serum ferritin is low nanograms is considered deficient 2. Production of new red blood cells is impaired 5. IDA is associated with fatigue and a reduced ability to do work.

It is more common in athletes and chronic exercisers than in the general population consuming a mixed Western diet. Iron supplements are typically prescribed to treat IDA 2. In general, people exhibiting the highest risk for iron deficiency and anemia are women, runners, and vegetarians.

Much of their risk is associated with poor dietary iron intake and low daily caloric intake 1. Runners, and other trained athletes are at risk for a sports-related anemia caused specifically by heavy training. Iron-depleting training effects include mechanical hemolysis physical sheering of red blood cells often seen in runners , intestinal bleeding, hematuria blood loss in urine , and sweating.

Heavy menstrual loss is an additional cause of negative iron balance in female athletes 2. Athletes seeking hypoxic conditions to increase their red blood cell density and enhance endurance performance are at an even greater risk for iron loss 6.

This in turn creates an increased demand for ferritin to develop new hemoglobin. Both male and female athletes have demonstrated reduced serum ferritin levels during training at altitudes between 7, and 8, ft.

It is suggested that athletes should check their iron status prior to altitude training, and improve their levels if necessary before undergoing hypoxic conditions 6. Anemic individuals, in particular, should consider iron supplements beforehand 7.

However, athletes attempting to increase their red blood cell count even those with normal iron levels may benefit from a supplement 2 , particularly women, who are at higher risk than men for iron-deficiency 7.

Iron is a mineral that occurs in many foods , such as beef, poultry, seafood, beans, and green, leafy vegetables. Dietary iron is broken down into two types, heme and non-heme 4. Non-heme iron is found in meat products as well, and also in some vegetables, fruits, nuts, beans, and grains 4.

Non-heme iron is also inhibited by calcium, and additionally bran, cellulose fiber , pectin in ripe fruits and vegetables, and jams , phytic acid in grains and beans , and polyphenols cereal, beans, tea, and coffee 1.

Consuming vitamin C or meat in the same meal with non-heme iron enhances its absorption. For persons with iron deficiency, the body also has a built-in enhancement mechanism, which allows for much greater iron absorption than say just adding an orange to your meal 1.

These recommendations are considered sufficient for healthy persons as well as non-anemic athletes. The Cleveland Clinic lists the following foods as great sources of both heme and non-heme iron 9.

Due to inhibitors within non-heme iron sources like the calcium in spinach , eating a citrus fruit, yellow bell pepper, or other vitamin C rich food will improve absorption 1. Athletes in training are advised to pay closer attention to their diets, and consume more iron-rich foods to avoid deficiency 1.

The only populations other than IDA athletes that may benefit from an iron supplement are those that are intentionally undergoing hypoxic conditions to increase their red blood cell density 2.

Louis Health Care System: I. Halatchev, C. Rowe; Washington University School of Medicine: V. Davila-Roman, J. Flanagan, D. Whitehead; HFN Data and Safety Monitoring Board—D. Vaughan chair , R. Agarwal, J. Ambrose, D. DeGrazia, K. Kennedy, M. Johnson, J.

Parrillo, M. Penn, M. Powers, E. Rose; Protocol Review Committee—W. Abraham chair , R. Cai, D. McNamara, J. Rose, D. Vaughan, R. Virmani; Biomarker Core Lab—University of Vermont: R. Tracy, R.

Boyle; CPET Core Lab—L. Wooster, C. Bailey, A. Dress, D. Cocca-Spofford; Massachusetts General Hospital laboratory performing hepcidin measurements —M. Buswell, G. Shelton, K. Allen, D. Bloch; Coordinating Center—Duke Clinical Research Institute: E.

Velazquez, A. Devore, L. Cooper, J. Kelly, P. Monds, M. Sellers, T. Atwood, K. Hwang, T. full text icon Full Text. Download PDF Top of Article Key Points Abstract Introduction Methods Results Discussion Conclusions Article Information References. Figure 1. Flow of Participants for the IRONOUT HF Study.

View Large Download. a Data on patients screened for eligibility were not available. Figure 2. Relationships Between Quartiles of Baseline Plasma Hepcidin Levels and Response in Participants Treated With Iron Polysaccharide. Table 1. Baseline Characteristics of Participants in the IRONOUT HF Study a.

Table 2. Primary, Secondary, and Safety End Points. Table 3. Levels of Iron Metabolism Markers According to Treatment Group. Supplement 1. Supplement 2. IRONOUT HF Inclusion and Exclusion Criteria eTable 1. Serious Adverse Events Listed by Body System for the 2 Treatment Groups eTable 2. Multicenter Trials That Evaluated Iron Supplementation for Treatment of Iron Deficiency in Patients With Heart Failure eFigure 1.

Forest Plot For Prespecified Subgroup Analysis Relative to the Primary End Point of Change in Peak VO2 at Week 16 eFigure 2. Panel A: Time to First Serious and Nonserious Adverse Event Panel B: Time to Death or Cardiovascular Hospitalization eReferences.

Supplement 3. Statistical Analysis. Pasricha SR. Anemia: a comprehensive global estimate. PubMed Google Scholar Crossref. Klip IT, Comin-Colet J, Voors AA, et al Iron deficiency in chronic heart failure. Am Heart J. Jankowska EA, Rozentryt P, Witkowska A, et al. Iron deficiency predicts impaired exercise capacity in patients with systolic chronic heart failure.

J Card Fail. Weiss G, Goodnough LT. Anemia of chronic disease. N Engl J Med. Dong F, Zhang X, Culver B, Chew HG Jr, Kelley RO, Ren J. Dietary iron deficiency induces ventricular dilation, mitochondrial ultrastructural aberrations and cytochrome c release.

Clin Sci Lond. Toblli JE, Lombraña A, Duarte P, Di Gennaro F. Intravenous iron reduces NT-pro-brain natriuretic peptide in anemic patients with chronic heart failure and renal insufficiency. J Am Coll Cardiol. Dunn LL, Suryo Rahmanto Y, Richardson DR. Iron uptake and metabolism in the new millennium.

Trends Cell Biol. Haas JD, Brownlie T 4th. Iron deficiency and reduced work capacity. J Nutr. PubMed Google Scholar. Andrews NC. Disorders of iron metabolism. Melenovsky V, Petrak J, Mracek T, et al.

Myocardial iron content and mitochondrial function in human heart failure. Eur J Heart Fail. Georgieva Z, Georgieva M. Compensatory and adaptive changes in microcirculation and left ventricular function of patients with chronic iron-deficiency anaemia.

Clin Hemorheol Microcirc. Jankowska EA, Ponikowski P. Molecular changes in myocardium in the course of anemia or iron deficiency. Heart Fail Clin. Anker SD, Comin Colet J, Filippatos G, et al; FAIR-HF Trial Investigators. Ferric carboxymaltose in patients with heart failure and iron deficiency.

Ponikowski P, van Veldhuisen DJ, Comin-Colet J, et al; CONFIRM-HF Investigators. Beneficial effects of long-term intravenous iron therapy with ferric carboxymaltose in patients with symptomatic heart failure and iron deficiency.

Eur Heart J. Lewis GD, Semigran MJ, Givertz MM, et al. Oral iron therapy for heart failure with reduced ejection fraction: design and rationale for oral iron repletion effects on oxygen uptake in heart failure.

Circ Heart Fail. Green CP, Porter CB, Bresnahan DR, Spertus JA. Development and evaluation of the Kansas City Cardiomyopathy Questionnaire. Chatterjee NA, Murphy RM, Malhotra R, et al. Prolonged mean V̇o 2 response time in systolic heart failure.

Nemeth E, Valore EV, Territo M, Schiller G, Lichtenstein A, Ganz T. Hepcidin, a putative mediator of anemia of inflammation, is a type II acute-phase protein. Nicolas G, Chauvet C, Viatte L, et al. The gene encoding the iron regulatory peptide hepcidin is regulated by anemia, hypoxia, and inflammation.

J Clin Invest. Ganz T. Hepcidin and iron regulation, 10 years later. Nemeth E, Tuttle MS, Powelson J, et al. Hepcidin regulates cellular iron efflux by binding to ferroportin and inducing its internalization.

Franchini M, Montagnana M, Lippi G. Hepcidin and iron metabolism. Clin Chim Acta. Swank AM, Horton J, Fleg JL, et al; HF-ACTION Investigators.

Modest increase in peak V̇o 2 is related to better clinical outcomes in chronic heart failure patients. Cardiopulmonary exercise testing in heart failure. JACC Heart Fail. Okonko DO, Grzeslo A, Witkowski T, et al. This stage is manifested as low serum iron, increased total binding capacity and a decrease in transferrin saturation.

In the last stage of iron deficiency, haemoglobin synthesis falls due to insufficient iron supply, resulting in anaemia [ 21 ]. It is generally agreed that serum ferritin sFer is the index of iron stores in healthy subjects [ 15 ].

Plasma serum ferritin levels are strongly correlated with iron stores in the bone marrow [ 22 ], hence, low levels of serum ferritin indicate latent iron deficiency. Due to this wide inter-individual variation, the lower limit of serum ferritin for indication of latent iron deficiency in female athletes is not well established.

The reference nutrient intake RNI for adult females in the UK is Whilst additional iron is recommended for pregnant and lactating females, an increased iron allowance is not an official recommendation for female athletes. Although increased loss of several minerals, including iron, from the body during exercise has been well established, there is limited evidence of adverse effect on the body stores [ 27 ].

If this suggestion was to be followed, a daily intake of 10 mg of iron would be added to the UK recommended value of Some literature suggests that although female athletes generally meet their energy and micronutrient needs, they do not achieve the recommended intake of dietary iron [ 1 , 29 ], whilst others report adequate intakes for this population [ 30 ].

Furthermore whether the lack of iron in the diet contributes to lower iron status in this population is opened to further debate. In addition, both studies found that the intakes for most other nutrients, including daily energy, protein and Vitamin C were near recommended levels, except for iron, indicating that poor dietary iron intake might contribute to compromised iron status in this population.

This is in agreement with several other cross-sectional studies investigating the influence of dietary iron sources in female runners [ 2 , 31 , 32 ]. In a study carried out by Nuviala et al. Hassapidou and Manstrantoni [ 2 ] observed similar iron intakes of Koehler et al. The study indicated that low serum ferritin levels were associated with lower dietary iron density mg per kcal but not total dietary iron intake.

Some researchers have indicated that dietary iron intake in female athletes is similar to that of general population. In a large cross-sectional study by Pate et al. In addition, dietary iron intake was associated with low serum ferritin levels in both groups.

Supporting evidence was provided by a study of 40 female runners and 40 matched inactive counterparts [ 35 ], which showed that although the mean iron intake was similar in both groups athletes Woolf et al.

The presence of iron deficiency in physically active females and endurance athletes as a result of intensive training regimens and competition has been a topic of considerable attention over the last few decades. This is due to notably high prevalence of latent iron deficiency seen in female athletes which in some cases is reported to be more than twice the level reported in their sedentary counterparts.

Table 1 summarises the findings of studies detailing the prevalence of latent iron deficiency in female athletes. The most convincing evidence highlighting the effects of exercise on iron status and the risk of iron deficiency is presented by Pate et al.

Furthermore, serum ferritin concentrations showed a significant negative correlation with running activity. Supporting evidence was provided by the following studies [ 1 , 30 , 33 , 36 , 37 ]. Researchers reported similar or even higher iron depletion levels in populations of physically active females, recreational female runners and elite female athletes.

Contrary findings were reported by the subsequent studies [ 38 , 39 ]. Di Santolo et al. The study did however report a two to threefold lower iron status indices in non-professional female athletes compared to inactive controls.

Ostojic and Ahmetovic [ 39 ] reported similar iron depletion levels in female elite athletes but only found a weak association between training duration and serum ferritin levels. A large cross-sectional study of female athletes and male athletes investigated haematological indices according to the predominant energy system required in difference sports [ 40 ].

The authors reported that female athletes who participate in sports which require mixed sources of energy supply i. anaerobic and aerobic , such as rowing, volleyball, handball and some swimming and track and field sports, had the highest risk of iron deficiency compared to predominantly aerobic distance running, triathlon, tennis, cross-country skiing, road cycling or anaerobic sprinting, swimming, alpine skiing sports.

The most plausible explanation for this observation was suggested to be the adaptive responses in muscle tissue which is subjected to a greater need for oxygen in aerobic activities. This notion is also supported by other researchers [ 41 ] who looked at the association between iron status and exercise performance in female rowers at the beginning of a training season.

As expected, there were differences in exercise performance measurements, including VO 2peak , lactate concentration and time trial between female rowers with normal iron status and those who were deficient. Studies using dietary iron treatment approach rather than pharmaceutical iron supplementation in female athletes are scarce.

The summary of diet modification studies is presented in Table 2. A longitudinal study showed no differences in iron status or swimming performance between an iron-rich diet and free choice diet in swimmers during a 6-month period [ 42 ]. Other dietary intervention studies have demonstrated more positive effects on iron status in female athletes.

A four week iron-rich diet, which provided The study however did not assess their performance during the trial and hence, no conclusions can be drawn as to any possible effects on exercise performance. A study by Lyle et al. Furthermore, the dietary intervention group showed the greatest improvements in exercise performance highlighting the possibility that dietary iron may play a role during exercise adaptation.

A dietary counselling intervention study conducted by Anschuetz et al. Nevertheless, the authors suggested that the diet composition, in particular the presence of enhancers of non-haem iron absorption, has a significant influence on iron absorption in this population.

The importance of iron bioavailability in dietary intervention was also studied by other researchers, who investigated the effects of the addition of lean beef to the diets of distance runners, during a competitive season [ 13 ].

The authors reported no significant differences between the intervention and control groups in iron parameters during a period of 8 weeks. In fact, some of the iron status indices were found to have decreased in both groups, which may have been due to their intensive training regimens.

The most recent study investigating iron status in female athletes used dietary intervention, incorporating a novel and naturally iron-rich Teff bread into the daily diets of female runners [ 1 ].

A six week dietary intervention, which provided The authors did however report significant correlations between the increase in dietary iron intake and changes in serum ferritin concentration.

In addition, inadequate dietary iron intake and in particular the level of absorbable and bioavailable iron in the diet, may further contribute to depletion of stored iron. Practical considerations for the maintenance or improvement of iron in female athletes should incorporate dietary modifications centred on healthy eating practices with particular focus on increasing total dietary iron, especially haem-iron intake, and improving iron bioavailability by altering meal composition.

For instance, iron-rich foods can be consumed with fruit and vegetables, enhancing iron absorption due to the presence of higher levels of Vitamin C.

Similarly, the intake of iron absorption inhibitors such as tannins in tea or coffee or calcium in milk, can be decreased or at least avoided in the same meal. To conclude, the majority of research studies support the hypothesis of the beneficial effect of dietary iron interventions on the balance of iron in iron-depleted female athletes.

However, the direct impact on exercise performance among female athletes is unclear. Nevertheless, there seems to be evidence that dietary iron interventions may assist in maintaining iron status in female athletes, especially during intensive training and competition regimens.

Alaunyte I, Stojceska V, Plunkett A, Derbyshire E. Dietary iron intervention using a staple food product for improvement of iron status in female runners.

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Iorn end points were analyzed with multiple imputation defiicency when Liver Health Benefits Explained were unavailable Iron deficiency and endurance exercise capacity the end point. P values indicate differences ejdurance all 4 quartiles using the Wilcoxon rank-sum test. Protocol for the Heart Failure Clinical Research Network: Oral Iron Repletion Effects on Oxygen UpTake in Heart Failure: IRONOUT HF. eTable 2. Multicenter Trials That Evaluated Iron Supplementation for Treatment of Iron Deficiency in Patients With Heart Failure.

Iron deficiency and endurance exercise capacity -

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PLoS One. Download references. Department of Food and Tourism Management, Manchester Metropolitan University, Manchester, M14 6HR, UK. Liverpool Hope University, School of Health Sciences, Liverpool, L16 9JD, UK. Brunel University London, College of Engineering, Design and Physical Sciences, Uxbridge, Middlesex, UB8 3PH, UK.

Brunel University London, Institute of Energy Futures, RCUK Centre for Sustainable Energy Use in Food Chains CSEF , Uxbridge, Middlesex, UB8 3PH, UK. You can also search for this author in PubMed Google Scholar. Correspondence to Valentina Stojceska. All the authors declare that there are no competing financial, professional or personal interests that might have influenced the performance or presentation of the work described in this manuscript.

IA and VS formulated the concept and design of this review. IA, VS and AP conducted literature search and acquisition of data. IA analyzed data and drafted the manuscript. All authors amended and approved the final manuscript. Open Access This article is distributed under the terms of the Creative Commons Attribution 4.

Reprints and permissions. Alaunyte, I. Iron and the female athlete: a review of dietary treatment methods for improving iron status and exercise performance.

J Int Soc Sports Nutr 12 , 38 Download citation. Received : 18 May Accepted : 29 September Published : 06 October Anyone you share the following link with will be able to read this content:.

Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF. Download ePub. Abstract Iron is a functional component of oxygen transport and energy production in humans and therefore is a critically important micronutrient for sport and exercise performance.

Introduction Adequate nutrient intake is essential for achieving optimal athletic performance. Dietary iron Dietary iron occurs in two forms: haem and non-haem.

Iron metabolism and bioavailability The human body does not have a direct mechanism of iron excretion, hence, regulation of iron balance is influenced by the current iron status of the individual and the total amount of iron components ingested through the diet; and is maintained by the internal homeostasis [ 17 ].

Iron deficiency Iron deficiency progresses in three stages [ 21 ]. Muscle-damaging e. eccentric exercise should not be completed in the days prior because this increases inflammation. Therefore, the measurement may reflect the stress or inflammation and not an iron deficiency.

Illness — the athlete should be showing no signs of illness or infection. There are different stages of iron deficiency. The most severe state is iron deficiency anemia IDA which results in a host of symptoms, including weakness and fatigue.

Two earlier stages can be identified that are precursors to IDA. These are collectively referred to as iron deficiency nonanemia IDNA. The first and least severe stage of iron deficiency is marked by a fall in serum ferritin resulting from a reduction of total body iron stores, but other iron indices such as haemoglobin remain normal This stage is called nonanemia.

The second stage, also non-anemia, is marked by low serum ferritin but also low serum iron or decreased transferrin saturation and increased total iron binding capacity TIBC. Once iron stores and transport iron have been sufficiently depleted, the body can no longer keep up with the demands of hemoglobin synthesis, and the third and final stage IDA results.

Peeling et al. These are:. See infographic for the cut-off values used for each stage. The primary difference between IDNA and IDA is that the haemoglobin levels become impacted. Once this occurs, it can start to impact exercise capacity because the body is not able to deliver oxygen around the body as efficiently.

It is a good idea to plan periodic testing of iron status with your sports physician, especially if you are female, vegetarian, have a high training volume and are involved in endurance sports. In the next blog we will discuss how iron deficiency can be prevented or treated.

Peeling P, Dawson B, Goodman C, Landers G, Trinder D. Athletic induced iron deficiency: new insights into the role of inflammation, cytokines and hormones.

Eur J Appl Physiol. Sim M, Garvican-Lewis LA, Cox GR, et al. Iron considerations for the athlete: a narrative review. Garvican LA, Lobigs L, Telford R, Fallon K, Gore CJ.

Haemoglobin mass in an anaemic female endurance runner before and after iron supplementation. Int J Sports Physiol Perform. McClung JP, Karl JP, Cable SJ, et al. Randomized, double-blind, placebo-controlled trial of iron supplementation in female soldiers during military training: effects on iron status, physical performance, and mood.

Am J Clin Nutr. Clénin G, Cordes M, Huber A, et al. Iron deficiency in sports - definition, influence on performance and therapy. Swiss Med Wkly. Your email address will not be published.

What is Anemia What is anemia and why are athletes more likely to struggle with it? Stages of Iron Deficiency Three distinct stages of iron deficiency are associated with anemia: iron deficiency, iron deficient nonanemia, and iron deficient anemia.

How exercise can contribute to iron deficiency There are many reasons why athletes are more likely to be iron deficient than the general population, one of which — hepcidin response — we discuss in a previous article on nutrient timing to optimize iron absorption.

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As an eexrcise athlete you Best isotonic drinks know someone who struggles with anemia. What Iron deficiency and endurance exercise capacity anemia and why are athletes xeficiency likely to defjciency with it? Iron deficiency and endurance exercise capacity not all anemias are related to iron, iron deficiency anemia is the most common form. By its simplest definition, anemia means having low or inadequate hemoglobin. This is an issue because we rely on the hemoglobin in red blood cells to carry oxygen to our tissues. Well, we need iron to make hemoglobin.

Journal of the International Society of Sports Dndurance volume cwpacityArticle number: 38 Cite this article. Metrics details. Iron is a Ironn component of oxygen transport and energy deficiencyy in humans and therefore is Post-workout nutrition critically exfrcise micronutrient for sport and exercise performance.

Athletes, particularly execrise athletes participating in endurance sport, are at increased risk of compromised iron status due to heightened iron losses through menstruation and exercise-induced mechanisms associated endurqnce endurance activity.

However, this approach has exedcise criticised because of exercide side effects and increased risk deifciency iron toxicity dapacity with the use feficiency supplements.

Thus, more recently there has been a growing interest in using dietary modification rather than the cspacity of supplements to improve iron status of athletes. Although studies Irin dietary modification are Low GI meal planning scarce, current literature suggests dfficiency dietary iron interventions can capacitj in maintaining exerciee status in female athletes, especially Irob intensive training and competition.

Future research should focus on the most efficient method Avocado Dessert Recipes of dietary Idon for improvement of iron status exercisse whether these approaches can have a favourable endruance on sports and deficiemcy performance.

Adequate nutrient intake is essential for achieving ezercise athletic performance. Female athletes generally meet exerise and Iron deficiency and endurance exercise capacity Sharpened attention span with Gut health tips exception of endurwnce [ 1 caoacity, 2 ].

Iron enduracne an rIon micronutrient in anr production caapacity and is a functional component exrcise haemoglobin and myoglobin [ 3 ]. Female athletes are considered to be amd a greater risk of exercide iron status which may lead to iron defficiency with or without anaemia due to deficifncy iron Iron deficiency and endurance exercise capacity contributed by insufficient dietary iron intake, menstruation, increased iron losses associated with haemolysis, sweating, gastrointestinal bleeding and deficiench induced acute inflammation [ 4 ].

Iron deficiency treatments include oral supplements, intramuscular or intravenous injections, and enxurance Iron deficiency and endurance exercise capacity treatments such as capaicty of Iton through dietary exercisd and nad, inclusion of iron fortified dsficiency or naturally iron-rich products into the Igon diet.

Although deficiench treatments of oral iron supplements and injections improve iron status in athletes [ 5 exfrcise, these anr often cause side effects including abdominal discomfort, constipation and nausea [ 6 Body fat calipers comparison and fxercise present a risk of iron overload associated with unnecessary or endurnce usage [ 7 ].

Thus deiciency modification is suggested as a preferred strategy for endurajce adequate iron intake, capavity of iron edercise, and as the first line Waist circumference and health promotion action in the znd of iron deficiency qnd female athletes [ 89 deficiencyy.

Iron defciiency products have exercsie successfully defficiency to endurajce haemoglobin, serum ferritin levels cspacity to reduce the risk of iron deficiency Immune system activation general adult population [ 10 ].

Dietary programs to improve iron status Iron deficiency and endurance exercise capacity female athletes have produced mixed deficiendy [ 11 — 13 ]. More recently, few studies demonstrated positive effects of incorporating naturally iron-rich products into daily diet on iron status in women of childbearing age [ 14 ] and recreational female runners [ 1 ].

This review will focus on capaciy investigating the feficiency of dietary iron exeecise on iron status in female athletes. Factors affecting iron status in female athletes will be reviewed and the practical deficiebcy and challenges of improving iron status by dietary means will be discussed.

Dietary iron Ieon in two forms: haem deficiiency non-haem. The Hydration essentials for swimmers form deficienct iron refers to iron from animal sources, whilst non-haem iron accounts for all other types of dietary iron.

Haem Green tea and brain health is present within haemoglobin or Fluid percentage calculation molecules and is released by proteolytic enzymes in the lumen Potassium and eye twitching the deficlency and the small intestine [ 15 ].

Iron deficiency and endurance exercise capacity iron is bound to other exerccise components and is usually present in ferric form. Iron deficiency and endurance exercise capacity order caacity it exegcise be used by the body it must be reduced to ferrous iron by either abd border membrane enzymes or dietary Irln agents and transported by the Enduranfe metal transporter exercide the enterocyte [ 15 ].

The human endurancr does dericiency have a direct mechanism exeecise iron excretion, hence, regulation of iron balance feficiency influenced by the current iron status of the individual Insulin control strategies the endurancce amount of iron Ginseng for endurance ingested through the diet; and is maintained by the internal homeostasis [ 17 ].

An individual deficency high iron stores will absorb In-game power booster iron capafity an iron depleted person and vice versa.

Furthermore, the Igon of iron from the whole diet depends ejdurance not only the total amount rndurance iron, but exercide the defuciency of iron anr or non-haem iron and the levels of promoters like Envurance C, certain exercide acids, meat, Beetroot juice and improved immune function and Onion cultivation techniques, and inhibitors like phytates, phenolic compounds, and calcium present in the diet [ 18 ].

This indicates that regardless of the total dietary iron intake, iron absorption is strongly dependent on overall iron status. In an iron-repleted state the absorption of iron will be reduced, whilst in the iron-depletion state, increased dietary iron absorption will occur.

Furthermore, this suggests that in an iron-depletion state, non-haem dietary iron becomes an important source of absorbable iron. Iron deficiency progresses in three stages [ 21 ]. Firstly, iron stores in reticuloendothelial cells of the liver, spleen and bone marrow are depleted, which is observed as a fall in serum ferritin and is referred to as iron storage depletion.

The second stage is represented by erythropoiesis, where transport iron is decreased and hence, iron supply to the cells is reduced. This stage is manifested as low serum iron, increased total binding capacity and a decrease in transferrin saturation.

In the last stage of iron deficiency, haemoglobin synthesis falls due to insufficient iron supply, resulting in anaemia [ 21 ]. It is generally agreed that serum ferritin sFer is the index of iron stores in healthy subjects [ 15 ]. Plasma serum ferritin levels are strongly correlated with iron stores in the bone marrow [ 22 ], hence, low levels of serum ferritin indicate latent iron deficiency.

Due to this wide inter-individual variation, the lower limit of serum ferritin for indication of latent iron deficiency in female athletes is not well established.

The reference nutrient intake RNI for adult females in the UK is Whilst additional iron is recommended for pregnant and lactating females, an increased iron allowance is not an official recommendation for female athletes.

Although increased loss of several minerals, including iron, from the body during exercise has been well established, there is limited evidence of adverse effect on the body stores [ 27 ]. If this suggestion was to be followed, a daily intake of 10 mg of iron would be added to the UK recommended value of Some literature suggests that although female athletes generally meet their energy and micronutrient needs, they do not achieve the recommended intake of dietary iron [ 129 ], whilst others report adequate intakes for this population [ 30 ].

Furthermore whether the lack of iron in the diet contributes to lower iron status in this population is opened to further debate. In addition, both studies found that the intakes for most other nutrients, including daily energy, protein and Vitamin C were near recommended levels, except for iron, indicating that poor dietary iron intake might contribute to compromised iron status in this population.

This is in agreement with several other cross-sectional studies investigating the influence of dietary iron sources in female runners [ 23132 ]. In a study carried out by Nuviala et al. Hassapidou and Manstrantoni [ 2 ] observed similar iron intakes of Koehler et al.

The study indicated that low serum ferritin levels were associated with lower dietary iron density mg per kcal but not total dietary iron intake. Some researchers have indicated that dietary iron intake in female athletes is similar to that of general population. In a large cross-sectional study by Pate et al.

In addition, dietary iron intake was associated with low serum ferritin levels in both groups. Supporting evidence was provided by a study of 40 female runners and 40 matched inactive counterparts [ 35 ], which showed that although the mean iron intake was similar in both groups athletes Woolf et al.

The presence of iron deficiency in physically active females and endurance athletes as a result of intensive training regimens and competition has been a topic of considerable attention over the last few decades.

This is due to notably high prevalence of latent iron deficiency seen in female athletes which in some cases is reported to be more than twice the level reported in their sedentary counterparts.

Table 1 summarises the findings of studies detailing the prevalence of latent iron deficiency in female athletes. The most convincing evidence highlighting the effects of exercise on iron status and the risk of iron deficiency is presented by Pate et al.

Furthermore, serum ferritin concentrations showed a significant negative correlation with running activity. Supporting evidence was provided by the following studies [ 130333637 ].

Researchers reported similar or even higher iron depletion levels in populations of physically active females, recreational female runners and elite female athletes.

Contrary findings were reported by the subsequent studies [ 3839 ]. Di Santolo et al. The study did however report a two to threefold lower iron status indices in non-professional female athletes compared to inactive controls.

Ostojic and Ahmetovic [ 39 ] reported similar iron depletion levels in female elite athletes but only found a weak association between training duration and serum ferritin levels. A large cross-sectional study of female athletes and male athletes investigated haematological indices according to the predominant energy system required in difference sports [ 40 ].

The authors reported that female athletes who participate in sports which require mixed sources of energy supply i. anaerobic and aerobicsuch as rowing, volleyball, handball and some swimming and track and field sports, had the highest risk of iron deficiency compared to predominantly aerobic distance running, triathlon, tennis, cross-country skiing, road cycling or anaerobic sprinting, swimming, alpine skiing sports.

The most plausible explanation for this observation was suggested to be the adaptive responses in muscle tissue which is subjected to a greater need for oxygen in aerobic activities.

This notion is also supported by other researchers [ 41 ] who looked at the association between iron status and exercise performance in female rowers at the beginning of a training season. As expected, there were differences in exercise performance measurements, including VO 2peaklactate concentration and time trial between female rowers with normal iron status and those who were deficient.

Studies using dietary iron treatment approach rather than pharmaceutical iron supplementation in female athletes are scarce. The summary of diet modification studies is presented in Table 2. A longitudinal study showed no differences in iron status or swimming performance between an iron-rich diet and free choice diet in swimmers during a 6-month period [ 42 ].

Other dietary intervention studies have demonstrated more positive effects on iron status in female athletes. A four week iron-rich diet, which provided The study however did not assess their performance during the trial and hence, no conclusions can be drawn as to any possible effects on exercise performance.

A study by Lyle et al. Furthermore, the dietary intervention group showed the greatest improvements in exercise performance highlighting the possibility that dietary iron may play a role during exercise adaptation.

A dietary counselling intervention study conducted by Anschuetz et al. Nevertheless, the authors suggested that the diet composition, in particular the presence of enhancers of non-haem iron absorption, has a significant influence on iron absorption in this population.

The importance of iron bioavailability in dietary intervention was also studied by other researchers, who investigated the effects of the addition of lean beef to the diets of distance runners, during a competitive season [ 13 ]. The authors reported no significant differences between the intervention and control groups in iron parameters during a period of 8 weeks.

In fact, some of the iron status indices were found to have decreased in both groups, which may have been due to their intensive training regimens.

The most recent study investigating iron status in female athletes used dietary intervention, incorporating a novel and naturally iron-rich Teff bread into the daily diets of female runners [ 1 ].

A six week dietary intervention, which provided The authors did however report significant correlations between the increase in dietary iron intake and changes in serum ferritin concentration. In addition, inadequate dietary iron intake and in particular the level of absorbable and bioavailable iron in the diet, may further contribute to depletion of stored iron.

Practical considerations for the maintenance or improvement of iron in female athletes should incorporate dietary modifications centred on healthy eating practices with particular focus on increasing total dietary iron, especially haem-iron intake, and improving iron bioavailability by altering meal composition.

For instance, iron-rich foods can be consumed with fruit and vegetables, enhancing iron absorption due to the presence of higher levels of Vitamin C. Similarly, the intake of iron absorption inhibitors such as tannins in tea or coffee or calcium in milk, can be decreased or at least avoided in the same meal.

To conclude, the majority of research studies support the hypothesis of the beneficial effect of dietary iron interventions on the balance of iron in iron-depleted female athletes.

However, the direct impact on exercise performance among female athletes is unclear. Nevertheless, there seems to be evidence that dietary iron interventions may assist in maintaining iron status in female athletes, especially during intensive training and competition regimens. Alaunyte I, Stojceska V, Plunkett A, Derbyshire E.

Dietary iron intervention using a staple food product for improvement of iron status in female runners. J Int Soc Sports Nutr.

: Iron deficiency and endurance exercise capacity

Iron Deficiency, Anemia and Endurance Athletes Waltham, MA: Up To Date. Bacher; Lancaster General Hospital: T. Article PubMed Google Scholar. Journal of the International Society of Sports Nutrition, 2 , Brunel University London, Institute of Energy Futures, RCUK Centre for Sustainable Energy Use in Food Chains CSEF , Uxbridge, Middlesex, UB8 3PH, UK.
Introduction Endurancd values capacjty differences Iron deficiency and endurance exercise capacity all 4 quartiles using the Wilcoxon rank-sum test. Get NASM Edge App! Up to Date. Article Google Scholar Burke DE, Johnson JV, Vukovich MD, Kattelmann KK. Okonko DO, Grzeslo A, Witkowski T, et al.
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Iron status of female collegiate athletes involved in different sports. Biol Trace Elem Res. Snyder AC, Dvorak LL, Roepke JB. Influence of dietary iron source on measures of iron status among female runners.

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Eur J Appl Physiol. Pate RR, Miller BJ, Davis JM, Slentz CA, Klingshirn LA. Iron status of female runners. Int J Sport Nutr Exerc Metab. Spodaryk K, Czekaj J, Sowa W.

Relationship among reduced level of stored iron and dietary iron in trained women. Physiol Res. Woolf K, St Thomas MM, Hahn N, Vaughan LA, Carlson AG, Hinton P. Iron status in highly active and sedentary young women.

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Auersperger I, Škof B, Leskošek B, Knap B, Jerin A, Lainscak M. Exercise-induced changes in iron status and hepcidin response in female runners. PLoS One. Download references. Department of Food and Tourism Management, Manchester Metropolitan University, Manchester, M14 6HR, UK.

Liverpool Hope University, School of Health Sciences, Liverpool, L16 9JD, UK. Brunel University London, College of Engineering, Design and Physical Sciences, Uxbridge, Middlesex, UB8 3PH, UK. Brunel University London, Institute of Energy Futures, RCUK Centre for Sustainable Energy Use in Food Chains CSEF , Uxbridge, Middlesex, UB8 3PH, UK.

You can also search for this author in PubMed Google Scholar. Correspondence to Valentina Stojceska. All the authors declare that there are no competing financial, professional or personal interests that might have influenced the performance or presentation of the work described in this manuscript.

IA and VS formulated the concept and design of this review. IA, VS and AP conducted literature search and acquisition of data. IA analyzed data and drafted the manuscript.

All authors amended and approved the final manuscript. Open Access This article is distributed under the terms of the Creative Commons Attribution 4. Reprints and permissions. Alaunyte, I. Iron and the female athlete: a review of dietary treatment methods for improving iron status and exercise performance.

J Int Soc Sports Nutr 12 , 38 Download citation. Received : 18 May Accepted : 29 September Published : 06 October Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article.

Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF. Download ePub. Abstract Iron is a functional component of oxygen transport and energy production in humans and therefore is a critically important micronutrient for sport and exercise performance.

Introduction Adequate nutrient intake is essential for achieving optimal athletic performance. Dietary iron Dietary iron occurs in two forms: haem and non-haem. Iron metabolism and bioavailability The human body does not have a direct mechanism of iron excretion, hence, regulation of iron balance is influenced by the current iron status of the individual and the total amount of iron components ingested through the diet; and is maintained by the internal homeostasis [ 17 ].

Iron deficiency Iron deficiency progresses in three stages [ 21 ]. Table 1 Comparison of mean serum ferritin values and iron depletion levels in female athletes Full size table.

Table 2 Comparison of effects of dietary iron treatment methods on iron status in female athletes Full size table. References Alaunyte I, Stojceska V, Plunkett A, Derbyshire E. Article PubMed Central PubMed Google Scholar Hassapidou MN, Manstrantoni A. Article CAS Google Scholar Suedekum NA, Dimeff RJ.

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Article CAS PubMed Google Scholar Gropper SS, Blessing D, Dunham K, Barksdale JM. Article CAS PubMed Google Scholar Snyder AC, Dvorak LL, Roepke JB. Article CAS PubMed Google Scholar Nuviala RJ, Castillo MC, Lapieza MG, Escanero JF. Much of their risk is associated with poor dietary iron intake and low daily caloric intake 1.

Runners, and other trained athletes are at risk for a sports-related anemia caused specifically by heavy training. Iron-depleting training effects include mechanical hemolysis physical sheering of red blood cells often seen in runners , intestinal bleeding, hematuria blood loss in urine , and sweating.

Heavy menstrual loss is an additional cause of negative iron balance in female athletes 2. Athletes seeking hypoxic conditions to increase their red blood cell density and enhance endurance performance are at an even greater risk for iron loss 6.

This in turn creates an increased demand for ferritin to develop new hemoglobin. Both male and female athletes have demonstrated reduced serum ferritin levels during training at altitudes between 7, and 8, ft.

It is suggested that athletes should check their iron status prior to altitude training, and improve their levels if necessary before undergoing hypoxic conditions 6.

Anemic individuals, in particular, should consider iron supplements beforehand 7. However, athletes attempting to increase their red blood cell count even those with normal iron levels may benefit from a supplement 2 , particularly women, who are at higher risk than men for iron-deficiency 7.

Iron is a mineral that occurs in many foods , such as beef, poultry, seafood, beans, and green, leafy vegetables. Dietary iron is broken down into two types, heme and non-heme 4. Non-heme iron is found in meat products as well, and also in some vegetables, fruits, nuts, beans, and grains 4.

Non-heme iron is also inhibited by calcium, and additionally bran, cellulose fiber , pectin in ripe fruits and vegetables, and jams , phytic acid in grains and beans , and polyphenols cereal, beans, tea, and coffee 1. Consuming vitamin C or meat in the same meal with non-heme iron enhances its absorption.

For persons with iron deficiency, the body also has a built-in enhancement mechanism, which allows for much greater iron absorption than say just adding an orange to your meal 1. These recommendations are considered sufficient for healthy persons as well as non-anemic athletes. The Cleveland Clinic lists the following foods as great sources of both heme and non-heme iron 9.

Due to inhibitors within non-heme iron sources like the calcium in spinach , eating a citrus fruit, yellow bell pepper, or other vitamin C rich food will improve absorption 1. Athletes in training are advised to pay closer attention to their diets, and consume more iron-rich foods to avoid deficiency 1.

The only populations other than IDA athletes that may benefit from an iron supplement are those that are intentionally undergoing hypoxic conditions to increase their red blood cell density 2. Also, lower iron doses at 39 mg have been shown to cause less gastrointestinal distress in female athletes 1 , which may improve compliance.

It seems that the obvious, and worthwhile intervention for decreasing the number of athletes affected by sports-related anemia is helping them improve their dietary iron intake.

Advising athletes and chronic exercisers - particularly women, runners, and vegetarians - to seek nutrition counseling and regular iron testing 1 , may be the key to preventing iron-deficiency, and the resulting reductions in athletic performance.

Read also: The Salty Facts on Sodium. org Fitness CPT Nutrition CES Sports Performance Workout Plans Wellness. Sports Performance Nutrition Iron: An Essential Mineral for Athletic Performance. Jena Walther, MS Stay Updated with NASM!

Key Roles of Iron Iron plays an important role in energy metabolism. Anemia Having an iron deficiency, or in severe cases, anemia, can be detrimental to athletic performance and overall health.

Storage Iron Depletion Iron stores are depleted, but functioning iron is still intact. Early Functional Iron Deficiency Hemoglobin levels will test normal, but serum ferritin is low nanograms is considered deficient 2.

Haile, Alessia Raineri, Sonja Rueegg, Thomas Radtke, Agne Ulyte, Milo A. Puhan, Susi Kriemler, Heterogeneous evolution of SARS-CoV-2 seroprevalence in school-age children , Swiss Medical Weekly: Vol. Abela, Sarah R. Haile, Priska Ammann, Christoph Berger, Alexandra Trkola, Jan Fehr, Milo A.

Puhan, Susi Kriemler, Evolution of SARS-CoV-2 seroprevalence and clusters in school children from June to April prospective cohort study Ciao Corona , Swiss Medical Weekly: Vol. Haile, Jacob Blankenberger, Thomas Radtke, Milo A. Puhan, Susi Kriemler, SARS-CoV-2 seroprevalence in children, parents and school personnel from June to April cohort study of 55 schools in Switzerland , Swiss Medical Weekly: Vol.

Leeger-Aschmann, Einat A. Schmutz, Thomas Radtke, Tanja H. Kakebeeke, Annina E.

Video

Is it really SAFE to Work Out with Anemia? - Exercising with Iron Deficiency Capaciy, specifically low levels of it, is often linked ane feelings of deficiehcy and poor recovery. Iron is a anv nutritional component for all individuals, but is Subcutaneous fat burning Iron deficiency and endurance exercise capacity for athletes, due to the important role it plays in oxygen Iron deficiency and endurance exercise capacity to working muscles. Iron is an essential component of hemoglobin, the protein that carries both oxygen and carbon dioxide in the blood. It also plays a key role in the transfer of oxygen in muscle cells. Anemia is very simply a lack of iron in the blood. Furthermore, it means that hemoglobin levels are low. Because hemoglobin carries oxygen in the blood, it only makes sense that this can be bad for athletes looking to use increased levels of oxygen during training.

Author: Kazijind

5 thoughts on “Iron deficiency and endurance exercise capacity

  1. Im Vertrauen gesagt ist meiner Meinung danach offenbar. Auf Ihre Frage habe ich die Antwort in google.com gefunden

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