Iron Deficiency + The Athlete: Part II

If you recognize the food on the left side of the plate above as red lentils (a red lentil soup), then you may also know it to be a rich source of the mineral iron. 

I’ve written about iron in detail before, but a recent research paper on  impaired iron and endurance athletes reminded me that I need to periodically review this topic. 

Nearly all of my female clients in the past few years have come to me with iron deficiency, iron-deficiency non anemia, or iron-deficiency anemia. This has been true whether they are endurance athletes or not. And whether they’re highly active or not.

Here’s a refresher on the difference between those three:

Stage 1: Iron Deficiency: Iron stores in the bone marrow, liver, and spleen are depleted, indicated by ferritin values less than 35 ng/mL, Hemoglobin values > 11.5 g/dL and transferrin saturation >16%

Stage 2: Iron-Deficient Non-Anemia: Red blood cell production decreases as the iron supply to the bone marrow is reduced, indicated by ferritin values less than 20 ng/mL, Hemoglobin >11.5 g/dL, and transferrin saturation < 16%

Stage 3: Iron Deficiency Anemia: Hemoglobin production falls, resulting in anemia, indicated by ferritin values less than 12 ng/mL, Hemoglobin <11.5 g/dL, transferrin saturation less than 16%. 

While iron deficiency may be much more likely in women, it’s not a female-only issue. 

It used to be that when there were signs, symptoms, and laboratory results indicating deficiency of a nutrient, I did just the typical nutritionist thing of recommending eating more foods rich in that nutrient, increasing bioavailable co-factors in the diet, adjusting timing of nutrient intake so absorption increases, and according to the circumstances, recommending varying amounts of supplementation. 

Generally, that’s a pretty good and standard game plan.  But to a certain extent in many cases, it was band-aiding the real issue. Or at least not getting all the way there. 

Why is nutrient absorption impaired in the first place?  Did the individual merely need to increase nutrient intake and we’d solve the problem? Was it just an issue of increased demand or not eating foods rich in that nutrient?

What I started finding was that even with continued intake of iron-rich foods, or in some cases high-dose supplementation, we’d still have low levels of iron (and often of other nutrients).

So what’s happening here? 

It wasn’t until I had continued professional training on gut health and malabsorption that I began having some personal aha moments. 

When I began addressing the issue of nutrient deficiency from the standpoint of improving the person’s digestion and absorption and calming the nervous system (which is so incredibly entwined with gut health), absorption of iron and many other nutrients drastically improved. 

We were finally treating the issue. 

Which is to say, that still doesn’t mean it’s easy. Figuring out which puzzle piece or perhaps multiple puzzle pieces of the GI system are impairing absorption of nutrients and digestibility of food can take some time and it can take some persistence. But it’s so worth addressing. 

Here are some factors that might be causing impaired absorption of dietary and supplementary iron and/or increased need.  Check all that apply for you. The more that apply, the more likely absorption and/or intake of iron will need addressed.

  • Female of menstruating years 
  • Endurance athlete
  • Digestive Symptoms – Pain, Bloating, Gas, Loose Bowel Movements, Undigested Food in Stool, etc.
  • Have low stomach acid (quite common and most people are completely unaware)
  • Follow a vegetarian, vegan, or plant-based dietary pattern
  • Omnivore who avoids red meat
  • Fast eater or eats while distracted or stressed
  • Low estrogen or testosterone levels
  • Supplemental intake of other minerals at the same time as iron, not-including nutrient cofactors when consuming iron rich foods or supplements, and/or consuming foods and beverages that prevent absorption at meals rich in iron
  • Taking prescription medication(s) – depending on the medication if may impact nutrient absorption or change physiology so there’s an increased need
  • Lack of knowledge about how to eat a balanced diet or poorly planned dietary pattern
  • INFLAMMATION! – Particularly inflammation of the gut (may be asymptomatic or not obvious)

Want to Know More?

If you’d like a refresher on iron, check out my first article on this topic.

Need help with iron or absorption of other nutrients? Within my nutrition practice, I specialize in endurance athletes and digestive imbalances. If you’ve struggled with chronically low iron or poor absorption of other nutrients, I encourage you to reach out to me for more personalized support.