Iron deficiency affects as many as one in two healthy South African women, and women who do sport are at special risk, particularly endurance athletes.
“Iron deficiency occurs when iron reservoirs in the body become depleted ,” explains Dr Jarrad van Zuydam, a sports medicine physician with a special interest in the medicine of cycling and other endurance sports. “The most common cause is inadequate dietary intake of iron. Iron is a micronutrient needed for the synthesis of the protein haemoglobin in the body. Haemoglobin in the blood carries oxygen from the lungs around the body, cells use the oxygen delivered to them to generate the energy needed for cellular processes.”
If your iron levels are low, your cells receive less oxygen, leaving them less able to generate energy. When iron levels become so low that your body depletes its iron stores and the level of red blood cells is lower than normal, you have full-blown iron deficiency anaemia (IDA).
“Women are particularly vulnerable, because when they menstruate they lose blood, and with it, red blood cells and iron,” says Van Zuydam.
Women who do sport are at additional risk. They have greater iron requirements than non-athletes – their dietary iron recommendations are 1,3 to 1,7 times higher, and meeting them is often difficult, notes the organisation Sports Dietitians Australia (SDA) (3). And the idea that women athletes lose their menstrual cycle is a myth – heavy menstrual bleeding is common even in elite athletes.
In addition, iron can be lost through sweat, and repeated strenuous movement such as running can lead to red blood cell destruction or haemolysis and blood loss. Blood loss has also been reported from the digestive tract and through urine after extreme events like marathons.
Iron deficiency expert Professor Toby Richards, a consultant surgeon at University College, London, tested 257 women doing a half-marathon and found 17% had iron deficiency, although most were unaware of it.
SDA notes that recent evidence suggests that even early iron depletion or low levels can reduce oxygen uptake into cells, reducing sports performance capacity. Untreated, this can develop into iron deficiency anaemia, leaving you lethargic and incapable of any effort in training, prone to injury and loss of endurance, and at increased risk of infection.
And it’s not just elite athletes who are at risk: a study in the British Journal of General Practice has noted that ‘exercise-induced anaemia is a forgotten cause of iron deficiency anaemia’, particularly in young women, and concludes ‘exercise-induced anaemia must be considered in young female adults with unexplained IDA. A thorough history-taking is warranted in order to uncover this often forgotten cause of anaemia and may prevent unnecessary diagnostic invasive procedures’.
Signs of iron deficiency include, along with fatigue and weakness, pallor, brittle nails and hair loss, progressing to chest pain, irregular or fast heartbeat, shortness of breath, headache, lightheadedness, cold hands and feet, tingling legs, poor appetite and unusual cravings for things like ice or dirt as you develop anaemia.
If you have any of these signs, it’s important to have iron deficiency confirmed, says Van Zuydam. You can now get tested with a new rapid self-screening test, Ferricheck®, available at all leading pharmacies. If it shows positive for iron deficiency, it’s important to consult your healthcare provider, who will recommend treatment.
“Medical care involves identifying the cause,” Van Zuydam says. “This will involve a thorough medical history and may encompass tests.” Apart from a diet with iron-rich foods (red meat, and to a lesser extent, chicken, eggs, shellfish, beans, dark green leafy vegetables, and fortified cereals and breads), an iron treatment will often be prescribed.