Iron supplementation for the iron-depleted nonanemic athlete is a controversial issue. Athletes may be iron deficient due to poor dietary intake, significant or obligatory blood loss, or deficiency via increased need secondary to intense physical activity. Athletes who are found to be anemic secondary to iron deficiency do benefit and show improved performance with appropriate iron supplementation. There is contradictory evidence for iron supplementation and improving performance in the iron-depleted nonanemic athlete. An athlete’s iron status is usually monitored via serum ferritin. Currently, there is no standardized ferritin level at which supplementation is recommended, nor is there a consensus as to the appropriate maintenance of ferritin. Screening endurance athletes or female athletes in general for iron deficiency and also educating these athletes regarding the importance of a balanced diet to maximize performance would seem prudent and beneficial. Based on the literature, supplementation for the iron-depleted nonanemic athlete does not appear to be justified to solely improve performance.
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References and Recommended Reading
Hahn JU: Ironclad Evidence. Runner’s World 2006. Available at http://www.runnersworld.com/article/0,7120,s6-238-275-5020-0,00.html. Accessed May 16, 2007.
Fallon KE: Blood tests in tired elite athletes: expectations of athletes, coaches and sport science/sports medicine staff. Br J Sports Med 2006, 41:41–44.
Fallon KE: Utility of hematological and iron-related screening in elite athletes. Clin J Sport Med 2004, 14:145–152.
Fallon KE: Clinical utility of blood tests in elite athletes with short term fatigue. Br J Sports Med 2006, 40:541–544.
Unnithan VB, Goulopoulou S: Nutrition for the pediatric athlete. Curr Sports Med Rep 2004, 3:206–211.
Petirie HJ, Stover EA, Horswill CA: Nutritional concerns for the child and adolescent competitor. Nutrition 2004, 20:620–631.
Zoller H, Vogel W: Iron supplementation in athletes-first do no harm. Nutrition 2004, 20:615–619.
Eichner ER: Sports anemia, iron supplements, and blood doping. Med Sci Sports Exerc 1992, 24:S315–S318.
Dietary Supplement Fact Sheet: Iron. Office of Dietary Supplements/National Institute of Health, 2006. Available at http://www.ods.od.nih.gov. Accessed May 16, 2007.
Panel on Micronutrients, Subcommittees on Upper Reference Levels of Nutrients and of Interpretation and Use of Dietary Reference Intakes, and the Standing Committee on the Scientific Evaluation of Dietary Reference Intakes from the Food and Nutrition Board (FNB) and Institute of Medicine: Iron. In Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press; 2001:290–393.
Garza D, Shrier I, Kohl HW 3rd, et al.: The clinical value of serum ferritin tests in endurance athletes. Clin J Sport Med 1997, 7:46–53.
Schumacher YO, Schmid A, Grathwohl D, et al.: Hematological indices and iron status in athletes of various sports and performances. Med Sci Sports Exerc 2002, 34:869–875.
Heinrich HC: Falsely low normal values for serum ferritin? Clin Chem 1981, 27:768.
Neilsen P, Nachtigall D: Iron supplementation in athletes. Sports Med 1998, 26:207–216.
Douglas S: Doc on Board. Runner’s World 2006. Available at http://www.runnersworld.com/article/0,7120,s6-241-285—11460-0,00.html. Accessed February 6, 2007.
Fallon KE, Fallon SK, Boston T: The acute phase response and exercise: court and field sports. Br J Sports Med 2001, 35:170–173.
Ciocca M: Medication and supplement use by athletes. Clin Sports Med 2005, 24:719–738.
Joint Position Statement: nutrition and athletic performance. American College of Sports Medicine, American Dietetic Association, and Dietitians of Canada. Med Sci Sports Exerc 2000, 32:2130–2144.
Barr SI, Rideout CA: Nutritional considerations for vegetarian athletes. Nutrition 2004, 20:696–703.
Clarkson PM, Haymes EM: Exercise and mineral status of athletes: calcium, magnesium, phosphorus, and iron. Med Sci Sports Exerc 1995, 27:831–843.
Klingshirn LA, Pate RR, Bourque P, et al.: Effect of iron supplementation on endurance capacity in iron-depleted female runners. Med Sci Sports Exerc 1992, 24:819–824.
Schwenk TL, Costley CD: When food becomes a drug: nonanabolic nutritional supplement use in athletes. Am J Sports Med 2002, 30:907–916.
Fogelholm M: Indicators of vitamin and mineral status in athlete’s blood cell count. Intl J Sport Nutr 1995, 5:267–284.
Lukaski HC: Vitamin and mineral status: effects on physical performance. Nutrition 2004, 20:632–644.
Hinton PS, Giordano C, Brownlie T, Haas JD: Iron supplementation improves endurance after training in iron-depleted, nonanemic women. J Appl Physiol 2000, 88:1103–1111.
Friedmann B, Weller E, Mairbaurl H, Bartsch P: Effect of iron repletion on blood volume and performance capacity in young athletes. Med Sci Sports Exerc 2001, 33:741–746.
Matter M, Sittfall T, Graves J, et al.: The effect of iron and folate therapy on maximal exercise performance in female marathon runners with iron and folate deficiency. Clin Sci 1987, 72:415–422.
Rowland TW, Deisroth MB, Green GM, Kelleher JF: The effect of iron therapy on the exercise capacity of nonanemic iron-deficient adolescent runners. Am J Dis Child 1988, 142:165–169.
Tsalis G, Nikolaidis MG, Mougios V: Effects of iron intake through food or supplement on iron status and performance of healthy adolescent swimmers during a training season. Int J Sports Med 2004, 25:306–313.
Mast AE, Blinder MA, Gronowski AM, et al.: Clinical utility of the soluble transferrin receptor and comparison with serum ferritin in several populations. Clin Chem 1998, 44:45–51.
Brittenham GM: Disorders of iron metabolism: iron deficiency and overload. In Hematology: Basic Principles and Practice, edn 4. Edited by Hoffman R. Philadelphia: Churchhill Livingstone; 2005.
Deugnier Y, Loreal O, Carre F, et al.: Increased body iron stores in elite road cyclists. Med Sci Sports Exerc 2002, 34:876–880.
Zotter H, Robinson N, Zorzoli M, et al.: Abnormally high serum ferritin levels among professional road cyclists. Br J Sports Med 2004, 38:704–708.
Elliot DL, Goldberg L, Loprinzi M: Management of suspected iron deficiency: a cost-effective model. Med Sci Sports Exerc 1991, 23:1332–1337.
Pitsis GC, Fallon KE, Fallon SK, Fazakerley R: Response of soluble transferrin receptor and iron-related parameters to iron supplementation in elite, iron-depleted, nonanemic female athletes. Clin J Sport Med 2004, 14:300–304.
Suedekum NA, Dimeff RJ: Iron and the athlete. Cur Sports Med Rep 2005, 4:199–202.
Crosby WH: The rationale for treating iron deficiency anemia. Arch Intern Med 1984, 144:471–472.
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Rodenberg, R.E., Gustafson, S. Iron as an ergogenic aid: Ironclad evidence?. Curr Sports Med Rep 6, 258–264 (2007). https://doi.org/10.1007/s11932-007-0042-7