We have found that sports anemia is common is the greater Denver and Boulder area. Low ferritin is ten times more common in women than men. We use a very high quality, highly absorbable iron as the source of intravenous iron because it is typically well tolerated. Intravenous iron must be approved by our medical doctor.

Importance of Adequate Iron for Optimal Athletic Performance in the Athlete

Role of iron in the body:
• Iron is a mineral that the body needs to produce hemoglobin in red blood cells.
• Hemoglobin is responsible for carrying oxygen in the blood and delivering it to all tissues
What is Iron deficiency anemia?
• When the body does not get enough iron, it cannot produce the number of normal red blood cells needed to keep you in good health. This condition is called iron deficiency (iron shortage) or iron deficiency anemia.

Symptoms of iron deficiency:
• Unusual tiredness
• Shortness of breath
• Decrease in physical performance
• Learning problems in children and adults
• Increased chance of getting an infection
• Hair loss and depression
• Restless legs

Conditions that increase your need for iron:
• Bleeding problems or regular/irregular menses in women
• Burns
• Hemodialysis
• Intestinal diseases
• Stomach problems
• Use of medicines to increase your red blood cell count
• Intense exercise

Incidence of iron deficiency:
• Sports anemia is seen in endurance athletes, particularly long distance runners. The causes for this are foot strike hemolysis (red blood cell breakdown), poor dietary habits, and increased iron loss in sweat, feces, and malabsorption from the intestine.
• About 20% of women, 50% of pregnant women, and 3% of men do not have enough iron in their body.
• Iron is absorbed in the proximal small intestine and about 10% of dietary iron is absorbed.

Does increasing ferritin improve performance? YES
One of many positive studies: Eur J Clin Nutr. 2007 Jan;61(1):30-9. Epub 2006 Jul 12. Iron supplementation maintains ventilatory threshold and improves energetic efficiency in iron-deficient Non anemic athletes. CONCLUSIONS: Iron supplementation significantly improves iron status and endurance capacity in iron-deficient, nonanemic trained male and female subjects.

Lab Tests for Iron Deficiency:
• Hb

Red Blood Cell Count:
• The number of red blood cells in a given volume of blood. The normal range varies slightly between laboratories but is generally between 4.2 – 5.9 million cells/cmm.

Hemoglobin (Hb):
• The oxygen-carrying protein pigment in the blood, specifically in the red blood cells.
• In the very common laboratory test for hemoglobin (Hb), it is measured as total hemoglobin and the result is expressed as the amount of hemoglobin in grams (gm) per deciliter (dl) of whole blood, a deciliter being 100 milliliters.
• The normal ranges for hemoglobin depend on the age and, beginning in adolescence, the sex of the person. The normal ranges are:
• Adult men: 14-18 gm/dl
• Adult women: 12-16 gm/dl

• The proportion of the blood that consists of packed red blood cells. The hematocrit is expressed as a percentage by volume. The red cells are packed by centrifugation.
• For example, an hematocrit of 25% means that there are 25 milliliters of red blood cells in 100 milliliters of blood. The red cells make up a quarter of the blood.
• The normal ranges for the hematocrit are dependent on the age and, after adolescence, the sex of the individual. The normal ranges for the hematocrit are:
• Ten (10) years of age: 36-40%
• Adult males: 42-54%
• Adult women: 38-46%

• Ferritin is a storage form of iron and the most sensitive marker of iron reserves. It is a protein containing 20% iron that is found in the intestines and liver and spleen; it is one of the chief forms in which iron is stored in the body. This iron reserve is not tapped into until circulating levels of iron become too low to support demands. Because iron is toxic to cells, the body has created this protein complex to store iron in the cells. A serum ferritin level less than or equal to 15 micrograms per liter confirms iron deficiency anemia in women, and suggests a possible need for iron supplementation

Normal blood levels are:
o —30-300 ng/mL for males
o —15-200 ng/mL for females

Definition of iron deficiency:
• Defined as low ferritin with hemoglobin within the normal range. An athlete whose ferritin level is below 50 mg/L may not be optimizing his/her potential to perform

Dietary Source:
• Heme (animal)
• Non-heme (vegetarian)

The best dietary source of heme iron:
• Lean red meat
• Chicken
• Turkey
• Fish are also sources of iron, but they contain less than red meat

Non-heme foods:
• Cereals
• Beans
• Some vegetables contain poorly absorbed (non-heme) iron
• Foods rich in vitamin C (e.g., citrus fruits and fresh vegetables), eaten with small amounts of heme iron-containing foods, such as meat, may increase the amount of non-heme iron absorbed from cereals, beans, and other vegetables.
Foods that may inhibit iron
• Some foods (e.g., milk, eggs, spinach, fiber-containing, coffee, tea) may decrease the amount of non-heme iron absorbed from foods.
Details of oral supplemental iron
• Iron is best absorbed when taken on an empty stomach, with water or fruit juice (adults: full glass or 8 ounces; children: ½ glass or 4 ounces), about 1 hour before or 2 hours after meals.

Avoid these foods 1 hr before and 2 hrs after taking iron:

  • Cheese and yogurt
  • Eggs
  • Milk
  • Spinach
  • Tea or coffee
  • Whole-grain breads and cereals and bran

NOTE: Do not take iron supplements and antacids or calcium supplements at the same time.

What you need to know about Iron supplements:
• Supplemental iron is available in two forms: ferrous or ferric
• Ferrous iron salts (ferrous fumarate, ferrous sulfate, and ferrous gluconate) are the best absorbed forms of iron supplements
• Elemental iron is the amount of iron in a supplement that is available for absorption.

How to take your iron:
• The amount of iron absorbed decreases with increasing doses.
• Take daily iron supplement in two or three equally spaced doses.

Side effects of oral iron supplementation:
• Nausea
• Vomiting
• Constipation
• Diarrhea
• Dark colored stools and/or abdominal distress

Side effects of IV Iron:
Very rare allergic reactions

Benefits of IV Iron:
• Quick absorption
• Improvements in exercise performance and oxygen delivery within two weeks typically