European Journal of Applied Physiology

, Volume 119, Issue 7, pp 1463–1478 | Cite as

Iron considerations for the athlete: a narrative review

  • Marc Sim
  • Laura A. Garvican-Lewis
  • Gregory R. Cox
  • Andrew Govus
  • Alannah K. A. McKay
  • Trent Stellingwerff
  • Peter PeelingEmail author
Invited Review


Iron plays a significant role in the body, and is specifically important to athletes, since it is a dominant feature in processes such as oxygen transport and energy metabolism. Despite its importance, athlete populations, especially females and endurance athletes, are commonly diagnosed with iron deficiency, suggesting an association between sport performance and iron regulation. Although iron deficiency is most common in female athletes (~ 15–35% athlete cohorts deficient), approximately 5–11% of male athlete cohorts also present with this issue. Furthermore, interest has grown in the mechanisms that influence iron absorption in athletes over the last decade, with the link between iron regulation and exercise becoming a research focus. Specifically, exercise-induced increases in the master iron regulatory hormone, hepcidin, has been highlighted as a contributing factor towards altered iron metabolism in athletes. To date, a plethora of research has been conducted, including investigation into the impact that sex hormones, diet (e.g. macronutrient manipulation), training and environmental stress (e.g. hypoxia due to altitude training) have on an athlete’s iron status, with numerous recommendations proposed for consideration. This review summarises the current state of research with respect to the aforementioned factors, drawing conclusions and recommendations for future work.


Iron deficiency Anaemia Hepcidin Exercise 



Change in haemoglobin mass


Divalent metal transporter 1


Duodenal cytochrome b






Follicle stimulating hormone






Haemoglobin mass


Hypoxia-inducible factor








Iron deficiency


Iron deficiency anaemia


Iron deficient non-anaemia


Live high, train low


Low carbohydrate, high fat


Low energy availability


Luteinising hormone


Maximal oxygen uptake


Messenger ribonucleic acid


Oral contraceptive cycle


Oral contraceptive pill


Recommended dietary intake


Relative energy deficiency in sport


Soluble transferrin receptor


Transferrin receptor


Transferrin receptor-2


Velocity at peak oxygen uptake


Author contributions

All authors on this review contributed to each section equitably. The literature search, idea development, writing, reviewing and editing for each section were completed as a collective. Furthermore, all authors have provided specific insight on key aspects relevant to each sub-heading.

Compliance with ethical standards

Conflict of interest

The authors have no conflicts of interest to disclose.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.School of Medical and Health SciencesEdith Cowan UniversityJoondalupAustralia
  2. 2.Medical School, Royal Perth Hospital UnitThe University Western AustraliaPerthAustralia
  3. 3.Australian Institute of SportCanberraAustralia
  4. 4.Mary MacKillop Institute for Health ResearchAustralian Catholic UniversityMelbourneAustralia
  5. 5.Faculty of Health Sciences and MedicineBond UniversityGold CoastAustralia
  6. 6.Department of Rehabilitation, Nutrition and Sport, School of Allied HealthLa Trobe UniversityMelbourneAustralia
  7. 7.School of Human Sciences (Exercise and Sport Science)The University of Western AustraliaCrawleyAustralia
  8. 8.The Western Australian Institute of SportMt ClaremontAustralia
  9. 9.Canadian Sport Institute-PacificVictoriaCanada
  10. 10.Department of Exercise Science, Physical and Health EducationUniversity of VictoriaVictoriaCanada

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