Journal CME, May 2022: Iron Deficiency in Athletes: A Narrative Review-Article.pdf

Article.pdf

Pdf Summary

The narrative review focuses on the issue of iron deficiency in athletes, emphasizing its impact on performance, particularly among endurance athletes. Iron is critical for various metabolic, respiratory, and immune functions, including oxygen transport in the blood and muscles. A significant portion of athletes, especially females, experience iron deficiency, affecting as many as 15-35% of female athletes and 3-11% of males.<br /><br />Various factors can contribute to iron deficiency in athletes, including exercise-induced inflammation, decreased dietary iron intake, menstruation in women, and specific training conditions that increase iron demands. For example, prolonged exercise can increase levels of hepcidin, a hormone that inhibits iron absorption, which can persist for hours post-exercise.<br /><br />The review also outlines differential diagnoses for sports-related anemia, such as dilutional anemia, which results from plasma volume expansion rather than a genuine decrease in red blood cells. Exercise-induced hemolysis, or the destruction of red blood cells, is another cause, seen in activities with repetitive foot strikes and other sports.<br /><br />Clinical symptoms of iron deficiency include fatigue, reduced performance, and in severe cases, more critical symptoms like tachycardia or shortness of breath. Diagnosis typically involves laboratory tests to measure ferritin, hemoglobin, and other iron-related parameters, ideally taken in a well-rested and hydrated state.<br /><br />Treatment approaches vary based on severity and may include dietary adjustments, oral iron supplementation, or intravenous iron for those with absorption issues or severe deficiencies. Oral iron should ideally be taken early in the morning and not with food to enhance absorption. <br /><br />Gender, diet, and training specifics play roles in iron needs and supplementation strategies. Female athletes, especially those planning altitude training where iron demand increases, should be regularly screened and might need pre-altitude iron supplementation.<br /><br />Regular monitoring and appropriate intervention can mitigate performance impacts and maintain overall health in athletes with iron deficiency. The review calls for further studies to refine diagnosis and treatment strategies, especially for iron deficiency without anemia (IDNA).

Keywords

iron deficiency

athletes

endurance performance

female athletes

exercise-induced inflammation

hepcidin

differential diagnoses

iron supplementation

altitude training

iron deficiency without anemia