Iron deficiency and hydration status in athletes -
Int J Sport Nutr Exerc Metab ;16 3 — Beals KA, Manore MM. Nutritional status of female athletes with subclinical eating disorders, J Am Diet Assoc ;98 4 — Janelle KC, Barr SI. Nutrient intakes and eating behavior sores of vegetarian and nonvegetarian women.
J Am Diet Assoc ;95 2 —6, Lukaski HC. Vitamin and mineral status: Effects on physical performance. Volpe S. Vitamins, minerals, and exercise. In: Dunford M, ed. Sports Nutrition: A Practice Manual for Professionals.
Chicago, IL: American Dietetic Association; Whiting SJ, Barabash WA. Dietary Reference Intakes for the micronutrients: Considerations for physical activity. Appl Physiol Nutr Metab. Institute of Medicine, Food and NutritionBoard.
Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academies Press; Haymes E.
In: Driskell J, Wolinsky I, eds. Sports Nutrition; Vitamins and Trace Elements. Brownlie T, Utermohlen V, Hinton PS, Haas JD. Tissue iron deficiency without anemia impairs adaptation in endurance capacity after aerobic training in previously untrained women.
Am J Clin Nutr. Benardot D. Advanced Sports Nutrition. Champagne, IL: Human Kinetics; Cowell BS, Rosenbloom CA, Skinner R, Summers SH. Policies on screening female athletes for iron deficiency in NCAA division I-A institutions.
Int J Sport Nutr Exerc Metab. Ad Blocker Detected. Thanks for visiting! Oral iron Usually dietary counselling and oral iron therapy are combined. Novel products combine iron with vitamin C. In a dosage finding study in elderly patients with IDA Rimon et al compared three dosages of oral iron: 15mg, 50mg and mg.
They were able to show that iron supplementation at a level of the Recommended Daily Allowances RDA,15mg of elementary iron already led to significant increases of the iron status. In these anaemic elderly patients the dosages of 50mg, respectively mg of elementary iron did not show further benefit, but had significantly more side effects particularly in the highest dose group [96].
In a recent comparison of oral iron supplementation in a randomised controlled trial looking at iron status and performance in active women, mg of FeSO4 approximately 20mg of elementary iron was shown to be effective [98].
We therefore recommend a supplementation of 40 to 60mg of elementary iron once daily. Oral iron is in general well tolerated and efficient [99]. Side effects of oral therapy are mainly gastrointestinal including nausea, dyspepsia, constipation or diarrhoea [83,84,].
They are usually not severe. Some individuals with an existing tendency to constipation benefit from drinking additional fruit juice to prevent heavy constipation. Otherwise compliance will be seriously affected. Intravenous iron When oral therapy fails or immediate restoration is needed iv-therapy should be considered.
At the moment two different preparations are available in Switzerland including iron saccharose-complex and ferric carboxymaltose-complex. The dosage is dependent on the severity of the iron deficiency.
In one application usually mg Fe-saccharose, to mg Fe-carboxymaltose can be administered. The main advantage of the i. Generally, compliance with i. iron supplements is good. Side effects may encompass the following symptoms: a transient disturbance of taste, headache, dizziness, myalgia, fever but also severe adverse reactions such as hypotonic and anaphylactoid reactions, tachycardia and arrhythmia, dyspnoea and bronchospasm might be observed, albeit very rarely [].
Moreover, transient and usually asymptomatic hypophosphatemia is frequently observed after the administration of Fe-carboxymaltose. It is still under discussion whether hypophosphataemia may possibly be a cofactor for cardiac events [].
Nowadays severe side effects are rare. For Fe-saccharose and Fe-carboxymaltose there is no fatal outcome reported in Switzerland.
Internationally there is just one case with an already severely ill patient reported who had a treatment with Fe-carboxymaltose. This is in contrast to the previously used iron-dextran products with a much higher rate of severe and fatal side effects.
In , another type of i. Even with the use of the new preparations, severe adverse reactions cannot be excluded, and the administration of i. iron preparations is only recommended in settings where resuscitation skills are available and observation of the patient for 30 minutes after the end of the i.
In general, the frequency of side effects seems to be lower when the i. iron is applied by infusion instead of slow bolus injection. Importantly, the exact dilution given by the manufacturer needs to be respected. Control of adequate iron stores In sports a regular control of blood parameters is necessary, especially in endurance athletes.
To monitor efficacy of therapeutic measures we recommend repeating the basic blood tests 6 to 8 weeks after the start of the nutritional measures, oral therapy or i.
Depending on the blood results therapy will be continued or modified with the aim of reaching and keeping the iron stores in the regular range.
Treatment approaches may be combined and athletes with repeatedly low iron stores may besides the nutritional counselling benefit from an intermittent oral substitution to preserve iron stores, e.
substitution with 14 or 28mg elemental iron per day or 40—60mg elemental iron two to three times per week. As iron homeostasis is exclusively and meticulously controlled by the iron uptake through the intestinal tract [] and as there is no pathway to eliminate iron in cases of overload, iron supplementation has to be done always carefully.
In extreme cases, the chronic iron overload may lead to secondary haemochromatosis. Furthermore, excessive supplementation of oral or i.
iron is thought to increase oxidative stress and production of free radicals [,] and oxidative stress is suggested to play a role in cancer genesis [,]. This must be critically appraised as acute exercise leads to oxidative stress [,].
It has been shown in mice that oral iron supplementation enhances colonic tumor development []. Data in humans suggest that iron may increase the risk for colorectal cancer []. A recent meta-analysis showed on the one hand a tendency toward a positive association between high intake of haem iron and cancer risk.
On the other hand high levels of biomarkers of iron stores implied a lower cancer risk []. Further prospective and experimental studies are needed to evaluate the possible influence of iron in carcinogenesis.
Although likely to be higher in the athletic population, data about young athletes concerning iron deficiency are sparse [,,]. Total iron requirements in children and adolescents are distinctly increased because of additional iron needs for the expansion of the total blood volume, mean haemoglobin mass as well as for the enhancement in lean body mass during growth [].
In adolescent females the onset of menarche is associated with an increase of iron requirement. The mean total iron requirement for adolescents reaches 1. Otherwise risk factors for iron deficiency, both in younger and older athletes, are the same [20,23,24,].
Haematological norm values in children and adolescents are different from adults and should always be considered see table 3. As in adults in a case of an NAID, dietary counselling is the first step often combined with oral therapy.
Careful management especially of the menstruating teenage girl and the vegetarian athlete is warranted []. If the iron deficiency results in IDMH or IDA, further supplementation should be considered. As in adult athletes measurement of haemoglobin, red cell indices, ferritin and the CRP after 6—8 weeks of treatment is necessary in order to observe responsiveness and compliance with the treatment.
Iron deficiency in sports is frequent and relevant as all stages of iron deficiency IDA, IDMH and NAID affect physical performance. To diagnose iron deficiency haemoglobin, haematocrit, MCV, MCH and ferritin are first line parameters to assess. For a valid interpretation of the results it is necessary to exclude acute phase reactions that may interfere such as training sessions and infectious diseases patient history and measurement of CRP.
In unclear situations a second measurement of the same parameters or the additional measurement of zinc-protoporphyrin, soluble transferrin receptor and transferrin saturation may be helpful. In high level endurance athletes basic blood examinations should be made two to three times a year.
In adult elite sports altitude training represents a special situation with an increased need for iron. Every case of severe iron deficiency warrants an extended work up, and this is also true in sports.
spinach, fennel usually combined with oral iron supplementation. Daily oral iron preparations in a dosage of 40 to 60mg of elementary iron are appropriate, as the not severe but disturbing gastrointestinal side effects are related to iron dosage and preparation.
Consider enhancers vitamin C and prevent inhibitors coffee, black tea, phytates, calcium of iron uptake to increase absorption.
Athletes and patients with repeatedly low ferritin values profit from an intermittent oral substitution to preserve iron stores, e. In cases of plausible non-responders, incompatibility with oral therapy, a concomitant disease e. depression or low iron stores before an altitude training camp, i.
iron therapy should be considered. Long-term daily oral iron intake or iv-supplementation in the presence of normal or even high ferritin values is not recommended and may be harmful.
La carence en fer est fréquente chez les sportifs. Tous les stades de la carence en fer ont un effet sur la performance et doivent être traités. Les examens sanguins de base recommandés comprennent : hémoglobine, hématocrite, indices érythrocytaires, protéine C-réactive et ferritine.
Le traitement de la carence en fer se base sur des conseils nutritionnels et une supplémentation per os ou, dans des cas exceptionnels, par voie intraveineuse.
Il est important de suivre les athlètes de manière individuelle par un contrôle sanguin de routine biannuel. Un traitement de fer per os à long terme ou un traitement par voie intraveineuse en présence de valeurs de ferritine normales ou élevées ne fait aucun sens et peut même être dommageable.
We thank all those who supported us to write this article. These include Prof. Arno Schmidt-Trucksäss, Prof. Roland von Känel, Dr. Kerstin Warnke and Dr. Christian Schlegel.
German E. Clénin Sportmedizinisches Zentrum Ittigen bei Bern Haus des Sports Ittigen, Switzerland german. Subscribe now to keep reading and get access to the full archive.
Type your email…. Continue reading. Position stand. published online on Consensus statement of the Swiss Society of Sports Medicine Clénin GE 1 , Cordes M 1 , Huber A 2 , Schumacher YO 3 , Noack P 4 , Scales J 5 , Kriemler S 6 1 Sportmedizinisches Zentrum Ittigen bei Bern, Haus des Sports, Ittigen, Switzerland; german.
ch 2 Zentrum für Labormedizin, Kantonsspital Aarau, Tellstrasse, Aarau, Switzerland 3 Aspetar Orthopedic and Sports Medicine Hospital, Doha, Quatar 4 Zentrum für Medizin und Sport im Säntispark, Abtwil, Switzerland 5 Bannockburn Health Centre, Stirling, Scotland 6 Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Switzerland This article was first published in October in Swiss Medical Weekly SMW.
Abstract Iron deficiency is frequent among athletes. Zusammenfassung Eisenmangel im Sport ist häufig und relevant. Introduction Iron deficiency among athletes, in males and more often in females, is a commonly encountered condition for the sports medicine physician.
Definition of iron deficiency and general function of iron Iron is a transition metal and has multiple functions in more than biochemical reactions in the human body including electron transport in redox reactions cytochromes, sulphuric proteins , redox catalytic functions cytochrome p, catalase, peroxidase and reversible storage and transport of O2 haemoglobin, myoglobin.
Figure 1: Iron compartments The absorbed iron is stored in ferritin in the cytoplasm of the enterocytes [12]. Table 1: Relevant tests to define anaemia, NAID, IDMH and IDA Ferritin is the most widely used parameter in the evaluation of iron deficiency.
Figure 4: Overview of diagnosis and indications for treatment in adults. In the column of the red cell mass the haematocrit in percentage is shown in white letters. Iron deficiency in sports — influence on performance Dilutional pseudoanaemia Anaemia is defined by a lowered haemoglobin concentration in the venous blood sample.
Table 3: Critical cut-offs for differentiation of iron deficiency in children and adolescents. Adapted from Herklotz et al. Conclusions and recommendations Iron deficiency in sports is frequent and relevant as all stages of iron deficiency IDA, IDMH and NAID affect physical performance.
Résumé La carence en fer est fréquente chez les sportifs. Acknowledgements We thank all those who supported us to write this article. Corresponding author German E. ch Literature Proposed nutrient and energy intakes for the European community: a report of the Scientific Committee for Food of the European community.
Egli, I. MARIA ANDERSSON , INES M. EGLI , MICHAEL B. pdf Schleiffenbaum, B. et al. Unexpected high prevalence of metabolic disorders and chronic disease among young male draftees — the Swiss Army XXI experience.
Swiss Med Wkly , — Sandström, G. Iron deficiency in adolescent female athletes — is iron status affected by regular sporting activity?
Clin J Sport Med 22, — Latunde-Dada, G. Iron metabolism in athletes- achieving a gold standard. High prevalence of iron deficiency and anemia in female military recruits.
Mil Med , — Cippa, P. Eisenmangel: Es geht nicht nur um Anämie. Schweiz Med Forum 11—12 Martius, F. Eisenmangel ohne Anämie — ein heisses Eisen. in Schweiz Med Forum 9, —9 Streuli, R.
Ferrum bonum et laudabile lucrosumque. in Schweiz Med Forum 8, Colombani, P. Energie- und Nährstoffaufnahme im Schweizer Spitzensport — eine erste Bestandsaufnahme zu Beginn des zweiten Jahrtausends.
Mettler, S. Iron excess in recreational marathon runners. Eur J Clin Nutr 64, — Ganz, T. Molecular Control of Iron Transport. JASN 18, — Löffler, G. in Biochemie mit Pathobiochemie. Komplett überarbeitete Auflage.
Springer Verlag. Iron metabolism: interactions with normal and disordered erythropoiesis. Cold Spring Harb Perspect Med 2, a Yip, R. in Present Knowledge in Nutrition, Bowman BA, Russell RM — ILSI Press, Washington DC, Nemeth, E.
Regulation of iron metabolism by hepcidin. Young, B. Hepcidin for clinicians. Clin J Am Soc Nephrol 4, — Taylor, C. Hematologic, iron-related, and acute-phase protein responses to sustained strenuous exercise. Peeling, P. Athletic induced iron deficiency: new insights into the role of inflammation, cytokines and hormones.
Exercise as a mediator of hepcidin activity in athletes. Hepcidin, a key regulator of iron metabolism and mediator of anemia of inflammation. Blood , — Newlin, M. The effects of acute exercise bouts on hepcidin in women.
Int J Sport Nutr Exerc Metab 22, 79—88 Gaudin, C. Gastric lesions secondary to long-distance running. Peters, H. Potential benefits and hazards of physical activity and exercise on the gastrointestinal tract.
Gut 48, — Waller, M. The effects of heat and exercise on sweat iron loss. Med Sci Sports Exerc 28, — Jones, G. Sport-related hematuria: a review. Clin J Sport Med 7, — Miller, B. Foot impact force and intravascular hemolysis during distance running. Int J Sports Med 9, 56—60 Telford, R.
Footstrike is the major cause of hemolysis during running. Herklotz, R. Labordiagnose von Eisenstoffwechselstörungen.
in Schweiz Med Forum 10, — Brugnara, C. Reticulocyte hemoglobin content CHr : early indicator of iron deficiency and response to therapy. Blood 83, — Thomas, C.
Biochemical markers and hematologic indices in the diagnosis of functional iron deficiency. Macdougall, I. What is the most appropriate strategy to monitor functional iron deficiency in the dialysed patient on rhEPO therapy?
Merits of percentage hypochromic red cells as a marker of functional iron deficiency. Automated measurement of red blood cell microcytosis and hypochromia in iron deficiency and beta-thalassemia trait. Simultaneous measurement of reticulocyte and red blood cell indices in healthy subjects and patients with microcytic and macrocytic anemia.
Blood 85, — Reticulocyte hemoglobin content to diagnose iron deficiency in children. JAMA , — Franck, S.
Potential utility of Ret-Y in the diagnosis of iron-restricted erythropoiesis. Schumacher, Y. Effects of exercise on soluble transferrin receptor and other variables of the iron status.
Br J Sports Med 36, — Magge, H. Zinc protoporphyrin and iron deficiency screening: trends and therapeutic response in an urban pediatric center. JAMA Pediatr , — Baart, A. High prevalence of subclinical iron deficiency in whole blood donors not deferred for low hemoglobin. Transfusion 53, — Voss, S.
Variability of serum markers of erythropoiesis during 6 days of racing in highly trained cyclists. Int J Sports Med 35, 89—94 Cordova, A. Effects of AM3 Inmunoferon on increased serum concentrations of interleukin-6 and tumour necrosis factor receptors I and II in cyclists.
J Sports Sci 24, — Dickson, D. Effects of ultra-marathon training and racing on hematologic parameters and serum ferritin levels in well-trained athletes.
Int J Sports Med 3, — Fallon, K. The biochemistry of runners in a km ultramarathon. Br J Sports Med 33, — Friedmann, B. Standards der Sportmedizin Sportleranämie.
Shaskey, D. Sports haematology. Sports Med 29, 27—38 Bärtsch, P. Ther Umsch 55, — Nichols, A. Nonorthopaedic problems in the aquatic athlete. Clin Sports Med 18, —, viii Heinicke, K. Blood volume and hemoglobin mass in elite athletes of different disciplines. Int J Sports Med 22, — Steiner, T.
Does hemoglobin mass increase from age 16 to 21 and 28 in elite endurance athletes? Med Sci Sports Exerc 43, — Comparability of haemoglobin mass measured with different carbon monoxide-based rebreathing procedures and calculations. Hinrichs, T. Total hemoglobin mass, iron status, and endurance capacity in elite field hockey players.
J Strength Cond Res 24, — Wehrlin, J. Live high-train low for 24 days increases hemoglobin mass and red cell volume in elite endurance athletes. Journal of Applied Physiology , — Garvican, L. Intravenous Iron Supplementation in Distance Runners with Low or Suboptimal Ferritin.
Med Sci Sports Exerc Hormonal and plasma volume alterations following endurance exercise. A brief review. Sports Med 13, 37—49 Hamilton, T. Die Radsport-Mafia und ihre schmutzigen Geschäfte: Der Insiderbericht über die Welt des Profiradsports: eine minutiöse Beichte, die erstmals das ganze … Armstrongs Schlüsselrolle darin aufzeigt.
at Athlete Biological Passport ABP Operating Guidelines, World Anti-Doping Agency. Monitoring of biological markers indicative of doping: the athlete biological passport.
Br J Sports Med 48, — Davies, K. Muscle mitochondrial bioenergetics, oxygen supply, and work capacity during dietary iron deficiency and repletion. Distinguishing effects of anemia and muscle iron deficiency on exercise bioenergetics in the rat.
Finch, C. Iron deficiency in the rat. Physiological and biochemical studies of muscle dysfunction. Burden, R. Impact of Intravenous Iron on Aerobic Capacity and Iron Metabolism in Elite Athletes. Intravenous iron supplementation in distance runners with low or suboptimal ferritin.
Med Sci Sports Exerc 46, — DellaValle, D. Iron supplementation improves energetic efficiency in iron-depleted female rowers. Waldvogel, S. Clinical evaluation of iron treatment efficiency among non-anemic but iron-deficient female blood donors: a randomized controlled trial. BMC Med 10, 8 McClung, J.
Randomized, double-blind, placebo-controlled trial of iron supplementation in female soldiers during military training: effects on iron status, physical performance, and mood.
Hinton, P. Iron supplementation maintains ventilatory threshold and improves energetic efficiency in iron-deficient nonanemic athletes. Eur J Clin Nutr 61, 30—39 Brownlie, T. Tissue iron deficiency without anemia impairs adaptation in endurance capacity after aerobic training in previously untrained women.
Marginal iron deficiency without anemia impairs aerobic adaptation among previously untrained women.
Immune system support Scott Tsatus. Koehler, M. We recommend considering Cardiovascular workouts for better posture ferritin lab test or nutritional screening for iron edficiency incoming hydragion to evaluate for Iron deficiency and hydration status in athletes athletes with hgdration iron stores. Adolescent athletes, female athletes, endurance athletes, vegetarian athletes, and athletes that lose weight are especially at risk. The consensus statement from the American Dietary Association and American College of Sports Medicine states that athletes should be periodically screened for iron status. The amount of stored iron can be assessed by measuring serum ferritin levels. Athletes may begin to have symptoms fatigue, decreased performance, etc. Injuries are athletfs an unavoidable aspect of participation in physical activity. Nutrition may not hydrafion able Irno prevent injuries related Bone health and vitamin C overuse eeficiency improper training; however, nutrition can Immune system support a role in how fast a student-athlete recovers. Exercise related fatigue, which is characterized by an inability to continue exercise at the desired pace or intensity, is just one example. Nutritional causes of fatigue in athletes include inadequate total energy intake, glycogen depletion, dehydration and poor iron status. For nutrition to aid in injury prevention, the body must meet its daily energy needs.
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