Iron balance and iron supplementation for the female athlete: A practical approach

Abstract

Maintaining a positive iron balance is essential for female athletes to avoid the effects of iron deficiency and anaemia and to maintain or improve performance. A major function of iron is in the production of the oxygen and carbon dioxide carrying molecule, haemoglobin, via erythropoiesis. Iron balance is under the control of a number of factors including the peptide hormone hepcidin, dietary iron intake and absorption, environmental stressors (e.g. altitude), exercise, menstrual blood loss and genetics. Menstruating females, particularly those with heavy menstrual bleeding are at an elevated risk of iron deficiency. Haemoglobin concentration [Hb] and serum ferritin (sFer) are traditionally used to identify iron deficiency, however, in isolation these may have limited value in athletes due to: (1) the effects of fluctuations in plasma volume in response to training or the environment on [Hb], (2) the influence of inflammation on sFer and (3) the absence of sport, gender and individually specific normative data. A more detailed and longitudinal examination of haematology, menstrual cycle pattern, biochemistry, exercise physiology, environmental factors and training load can offer a superior characterisation of iron status and help to direct appropriate interventions that will avoid iron deficiency or iron overload. Supplementation is often required in iron deficiency; however, nutritional strategies to increase iron intake, rest and descent from altitude can also be effective and will help to prevent future iron deficient episodes. In severe cases or where there is a time-critical need, such as major championships, iron injections may be appropriate.

Identification of Factors Associated with Potential Doping Behavior in Sports: A Cross-Sectional Analysis in High-Level Competitive Swimmers

“…In some circumstances, it is strongly suggested even by medical staff (i.e., iron supplementation in female athletes, vitamin-mineral supplementation in youth athletes, and/or protein supplementation in vegans) [54,55,56,57]. Therefore, our results on the higher likelihood of PDB in those who use dietary supplements do not necessary mean that the usage of dietary supplements will later result in doping behavior.…”

High-intensity Interval Training Promotes the Shift to a Health-Supporting Dietary Pattern in Young Adults

“…Bellisle [2] highlighted that active persons eat more and ingest more fruits and vegetables than less active ones, even though it is not known whether these food choices are driven by biological needs (e.g., replacement of glycogen) or elicited by social and psychological factors. Furthermore, maintaining a positive iron balance is essential to avoid the effects of iron deficiency and anaemia, and to support performance in athletes [46].…”

Nutrition for Special Populations: Young, Female, and Masters Athletes

“…Female athletes may also want to consider the effects of heavy menstrual bleeding and iron status (Pedlar, Brugnara, Bruinvels, & Burden, 2018) and fluctuations in basal body temperature during the menstrual cycle and their effect on thermoregulation and fluid intake (Hashimoto, Ishijima, Suzuki, & Higuchi, 2016), which may influence their nutritional practices. In addition, pregnant athletes may need to redress their energy intake (adding >300 kcal/day depending on exercise energy expenditure), especially carbohydrate intake, as carbohydrate usage is increased at rest and during weight-and non-weight-bearing exercise during pregnancy (Artal & O'Toole, 2003).…”