IRON
Q - I’m a 24 year old netball player – I train 5-6 days a week, including weight training and running, which I enjoy. I am not vegetarian, but eat mostly chicken and fish. I was feeling tired all the time and went to my doctors for a blood test. The doctor said that I was not anaemic but that my iron store was low. I’m now taking iron supplements, but how did my iron levels become so low, and what can I eat to improve things.
A - Iron deficiency anaemia is thankfully rare in the athletic and sporting population. However, sports doctors and dietitians are frequently seeing athletes with low iron stores or ferritin levels. In the UK, the normal range for ferritin is 19-236mg/l, but those working in sport generally agree that ferritin levels should be above 35mg/l. (Iron Supplementation in Athletes. Current Recommendations. Peter Nielson et al). Common symptoms are those of feeling tired all the time, waking up tired despite having 8 hours sleep; repeated coughs and colds and generally feeling below par. It is important to see your doctor however, to exclude other reasons for fatigue including “Over Training Syndrome” or, more accurately, “Unexplained Under-recovery Syndrome” (Redefining the overtraining syndrome as the unexplained underperformance syndrome. Budgett, R et al)
So why do iron stores fall to below an acceptable level? There are a number
of possible reasons:
| -
Extra iron is needed during growth spurts in adolescence - Menstrual losses in female athletes, especially if heavy - Frequent blood donations - Red blood cells being destroyed during high-impact exercise such as road running or multi sprints on a hard court; it takes 3 months for a red blood cell to reach maturity - Altitude training and perhaps training in the heat (you lose iron in sweat) - Gastro-intestinal bleeding from using some anti-inflammatory medications - Injury to the muscle where blood has been lost e.g. muscle tear - Dietary inadequacies |
Which diets are more likely to be inadequate in iron?
| -
The prolonged use of very high carbohydrate diets, where the meat has
been pushed off the plate to make room for the pasta, bread, potatoes
and carbo-drinks - A low energy diet or prolonged weight loss regimes - Fad diets, such as ‘food combining’ or other unbalanced, restricted regimes - A strict vegetarian diet, where only non-haem food sources such as eggs and beans are eaten (cheese and milk contain no iron) - Diets relying heavily on spinach and dark green vegetables. Despite being excellent sources of iron, this type of iron is less well absorbed |
Iron that you get from animal meat (heam-iron) rather than vegetables (non-haem
iron) is well absorbed by the small intestine. I often see people who have
stopped eating red meat, for a variety of reasons, and do not replace it with
adequate amounts of fish, chicken, eggs, pulses and nuts. Instead they rush
around surviving on pasta with tomato or cheese sauce, bowls of cereal, fruit,
yoghurt and toast and do not eat chicken or fish that much when I ask them
to keep a food diary!
My advice for athletes wanting to boost their iron stores would be as follows:
| -
Eat meat regularly – eat smaller amounts, but more often e.g. 3-5
times a week. Try to include some red meat. Weight for weight, lean beef
or lamb has 4 times more iron than chicken breast (white meat) and liver
has over 3 times more iron than beef or lamb! - Check out the iron content of various animal and plant foods. It is not just the amount that needs to be considered but the bioavailability (haem iron is better absorbed than non-haem even if it the amount per serve is less) - Choose meats that can be cooked quickly in stir-fries, mince (pork, lamb and beef) into bolognese, chilli, cottage and shepherd’s pie. Check-out the meat counter or ask your local butcher - Add meats to your carbohydrate rich meal, you then get both fuel and iron. Also the haem iron-rich foods contain a factor that improve total iron absorption from the meal. e.g. add a slice of lean ham into your salad sandwich. By doing this, you will add iron, from the ham, and you will also absorb more iron from the bread and salad too! Other examples include sandwich fillings such as liver pate, tinned salmon, tuna and sardines - If you are vegetarian, make sure your meals contain good sources of non-haem iron such as eggs, broccoli, greens, beans, lentils, wholegrain cereals, soya products, apricots. - Choose an iron-fortified breakfast cereal, and remember that a bowl of cereal and milk does not have to be just at breakfast – it can make a quick healthy snack anytime! - Avoid drinking tea and coffee with your meals if vegetarian or if you eat little meat. Choose a vitamin C-enriched drink such as dilute orange juice instead. Include other good sources of Vitamin C with your meals such as tomatoes (tinned or fresh) peppers and potatoes to maximise non-haem iron take up. - Do not add additional bran to your food. Like tea and coffee, bran prevents non-haem iron absorption. Likewise do not wash down your multivitamin with your favourite cuppa! |
Meal Plan to boost iron stores
Breakfast
Fortified breakfast cereal e.g. Special K, Cheerios, Cornflakes
Glass of orange juice
Slice of wholemeal toast, scrape olive-oil spread with yeast extract/honey
Snack Meal
Jacket potato with baked beans, tuna & sweetcorn or chilli beef or
Thick wholemeal toast with reduced fat liver pate or
Ham and cheese toasted sandwich or
Sardines, tinned in tomato sauce, on toast with
Salad (green, tomato, 3 bean)
Fresh fruit or fruit salad and/or
Yoghurt
Water or juice to drink
Main Meal
Spaghetti Bolognese with side salad (watercress and red peppers)
Salmon with potatoes and green beans
Stir-fry beef and cashew nuts with noodles
Meaty Tangine served with couscous (link to PB Kitchen, under bean recipes)
Stir-fry lamb’s liver with peppers (see PB Kitchen)
with
Fresh fruit or fruit salad and/or
Yoghurt
Water or juice to drink
Bedtime Snack
Homemade hot cocoa made with skimmed or semi-skimmed milk with cocoa (add
sugar to taste)
Snacks
Mixed nuts and raisins
Dark chocolate covered Brazil nuts
Dried apricots
Fresh (Medjool) dates
Fig Roll biscuits
Garibaldi biscuits (with currants)
Fruit, fruit juice
This advice should not replace that of your doctor or usual state registered dietitian. You should always discuss medical matters with your GP.