Iron Deficiency in Female Athletes

Why is Iron Important?

Iron is a mineral that has long been known to play a unique role in both health and disease. Iron has been used for healing since ancient times.

Our body needs Iron only need in small amounts for some of the important functions of the body

• Growth and development,
• To make hemoglobin, a protein in red blood cells that carries oxygen from the lungs to all parts of the body,
• To make myoglobin, ­.
• For energy production,
• To make hormones
• For enzyme activities
• For immune system

70% of iron in the body is found in the hemoglobin, 10% is bound to myoglobin in muscle tissue and the remainder is stored in ferritin protein (iron storage protein). Any drop in iron levels can affect the body’s functions.

Iron and Athletic Performance

Iron is required for optimal athletic performance and health because of iron’s essential roles in carrying oxygen and as cofactors in other enzymes related to metabolism and immunity. Athletes are in increased need of Iron than non-athletes to facilitate better oxygen uptake and transport for working muscles, especially those who compete in endurance sports, and do high-intensity exercise where there is an increase in iron losses by as much as 70% when compared to non-athletes. They also require additional iron to compensate for iron loss during internal gastrointestinal bleeding, hepcidin bursts, perspiration, hemolysis, inflammation, iron sequestration, and menstruation. Any iron loss and consequent deficit impair performance.

Iron deficiency in female athletes

Iron deficiency is a common health issue in endurance sports, and it is reported to affect up to 3–11% of male athletes and 15–35% of female athletes. Iron loss is exaggerated in athletes due to high training loads and the resulting hemolysis, hepcidin bursts due to inflammatory response, sweating, and gastrointestinal bleeding, which cause the breakdown of red blood cells and the loss of iron. Female athletes also lose blood during menstruation and, as a result, typically have higher dietary iron needs.

Research has shown that hidden bleeding like gastrointestinal bleeding, can result in a loss of 0.5 to 2mg of iron per day. Studies have indicated that gastrointestinal bleeding after endurance exercise typically lasts no longer than 72 hours. However, a daily loss of 7 to 10ml of blood through GI loss is sufficient to create an uunfavorable iron balance. Additionally, sweat loss may lead to daily iron losses of 1 to 2mg, which is approximately equal to the amount of iron absorbed from the diet.

During menstruation, iron loss is significantly higher. The menstrual cycle corresponds to a loss of 30 ml of blood per cycle. When menstrual bleeding is heavy (>60 ml) and/or the menstrual cycle lasts more than 5 days, an iron deficiency is almost inevitable. Athletes who use an intrauterine device may experience excessive menstrual bleeding. Many women are unaware that their menstrual blood losses are excessive. Even moderate or scanty periods can result in significant blood and iron loss.

Therefore, female athletes require higher daily iron requirements than male athletes. Younger female athletes who are still growing may also require higher levels of iron to stay healthy. This is because, during periods of growth, the body needs to produce more blood. To avoid the effects of iron deficiency and anemia and to maintain or improve performance, it is crucial for female athletes to maintain a positive iron balance.

Iron deficiency and the Female Athlete Triad

Iron deficiency can also interact with another prevalent and severe condition in exercising women: “the female athlete triad”. The triad is a syndrome of three interrelated conditions: poor energy status, compromised reproduction function and impaired bone health. The female athlete triad is very common among women, as the majority of them restrict dietary energy (kcal/day) by embracing calorie-restrictive diets (vegetarian and gluten-free are very common as mentioned above). This is perceived to achieve low body weight and confer a competitive advantage. However, the result is poor energy status, compromised reproduction function, and impaired bone health (female athlete triad).

Studies have suggested that low-iron status may serve as an objective clinical marker for low energy availability, the main driver of the Triad. Iron deficiency may interact with each component of the female athlete triad, that is, energy status, reproductive function, and bone health, and the interaction of these conditions can cause severe performance detriments. When this happens, consequences are impaired thyroid function, reduced fuel availability, and increased risk of under-eating, increased energy expenditure.

Who is at risk?

• Athletes who have a low dietary intake of iron especially those who are vegetarians/vegans
• Athletes who have dietary/energy intake restrictions
• Athletes who eliminate food groups from their diet
• Endurance athletes and athletes involved in heavy and intense training and competitions. Example: Distance runners
• Heavy menstruating and premenopausal female athletes
• Regular blood donors

Symptoms of Iron Deficiency

Iron deficiency usually comes with symptoms of nausea, frequent infections, shortness of breath during exercise, high exercise heart rate, respiratory illness, fatigue, lack of endurance, weakness, pale appearance, and lack of energy and endurance.

Treating iron deficiency in female athletes

Iron deficiency in female athletes can be treated through dietary modifications that include comsuming iron-fortified products or naturally iron-rich foods by receiving dietary advice and counseling in addition to oral supplements and intramuscular or intravenous injections (in severe deficit). ­

Dietary iron

Iron is primarily obtained through diet and supplements. There are two forms of dietary iron: heme iron and non-heme iron. Heme iron is the most bioavailable. Non-heme iron is found in green vegetables, legumes, nuts, and other plant sources, but is less bioavailable because they can be inhibited by other dietary components like calcium, phosphate, phytates, bran, polyphenols (found in tea), and antacids. However, with a well-planned diet once can get the adequate amount of iron from non-heme sources.

Iron supplements

Different form of Iron supplements are available over the counter to treat Iron deficiencies. One must consult and check their Iron status before taking any form of Iron supplements. Commonly available form of iron supplements ferrous sulfate, ferrous gluconate, and ferric fumarate, are known to cause GI side effects and poor bioavailability and can possibly overdose if the dosage is not regulated.

Unived Women's Iron

Unived Women’s Iron is Iron in the form of Ferrous bis-glycinate, where ferrous Iron is chelated to amino acid glycine. Ferrous bis-glycinate is shown to have better compliance because of fewer gastrointestinal tract side effects. The product also contains Vitamin C to enhance the absorption of iron in the body. Our product is designed to meet 100% RDA to take care of the daily iron requirements for women eliminating the risk of developing deficiency. It is sufficient for female athletes as iron supplementation help improve Since precaution is better than cure, for an adult female it is advisable to supplement iron along with a healthy diet to become less susceptible to anemia.

Regularly eating iron-rich foods and pairing them with foods rich in vitamin C and iron supplements to balance the iron status helps keep your iron levels healthy. If you feel like you’re getting too much or too little iron, consult a health professional.

Tips, suggested use & facts

• Always check your Iron status from a medical practitioner before taking any form of dietary iron supplements. Iron stores in the body are tightly regulated. Taking Iron supplements without checking your Iron status could lead to Iron toxicity which has detrimental effects on the body.
• If your body’s iron status is normal, then including Iron-rich foods in your diet on a regular basis is sufficient to maintain a normal iron status in the body, unless you’re an athlete who might need additional Iron supplement to keep your Iron levels balanced and optimal along with dietary modifications.
• Do not consume tea or coffee immediately before or after taking iron supplements. Tannins, polyphenols present in tea and coffee might inhibit iron absorption. FACT: Drinking tea is associated with a 62% reduction in iron absorption and drinking coffee and other caffeinated beverages with a meal is associated with a 35% reduction in iron absorption.
• Wait at least an hour before or after consuming Unived Women's Iron supplement to drink tea or coffee and wait at least 6 hours before taking zinc, calcium, magnesium-rich foods or supplements or antacids to consume Iron supplement.
• Keeping count of time can get difficult so we suggest you switch your brunch options with any citrus fruit like oranges, melons, or berries along with Unived Women's Iron supplement. This will not interfere with your routine and facilitate the absorption of Iron. FACT: Orange juice increases Iron absorption by 85%.

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