IRON DEFICIENCIES IN FEMALE

COLLEGIATE ATHLETES
Leilah Absi, Ally Gargiulo, Addie Hastings, Sarah Sakian

Functions of Iron
Blood production
Transferring oxygen
Hemoglobin = moving O2 from blood from lungs to
tissue
Myoglobin = stores, transports and releases O2 in the
muscle cell.
Respiration and energy breakdown
Production of collagen with certain enzymes
Immune function

Iron in the Body

>65% of body iron is found in
hemoglobin
~10% myoglobin
~1-5% parts of enzymes
The remaining body iron found in
the blood or in storage

20%

5%

10%

65%

Hemoglobin

Myoglobin

Part of Enzymes

Blood/Storage

Dietary Sources
Heme
Meat products
Fish
Liver

Nonheme
Plant product
Kidney beans
Green leafy
vegetables
Spinach
Nuts
Fruits
Grains

RDA and UL
RDA
Males: 8 mg/day
Females: 18 mg/day
Pregnancy: 27 mg/day

UL
45 mg/day

Toxicity of Iron
Common in Caucasian people
Hemochromatosis
Genetic disorder
Failure of regulation increased absorption
Symptoms
Early: fatigue, mental depression, abdominal pain
Later: liver failure, abnormal heartbeats, diabetes, infections

Iron supplements are the leading cause of fatal

accidental poisonings among children

Digestion and Absorption of Iron

Steps1. Heme iron has to be released from its bond to
hemoglobin and myoglobin for absorption by proteases in
the stomach and small intestines.
2. Nonheme iron must be released from its food matrix by
HCl and proteases as well. Dietary nonheme iron has to
be reduced from ferric form to ferrous form.
3. Free heme is absorbed with the help of HCP (heme carrier
protein) which is in the SI.

Digestion and Absorption of Iron

4. Inside the intestinal cell ferrous form turns to ferric form
again
5. Iron will bind with mucosal protein called ferritin when
needing to store iron.
6. If iron enters the blood, it will bind to transferrin for
transport to the liver, muscles, bone marrow, and other
body tissues.

Factors affecting Absorption

Iron content of food
Bioavailability of dietary iron
Amount of storage
Ferritin production

High body demands for red blood cells

Based on physical status

Consumption of other minerals

Calcium
Zinc
Magnesium

Enhancing and Inhibiting

factors

Deficiency of Iron
Associated with altered
metabolic processes
Mitochondrial electron
transport
Neurotransmitter
synthesis
Protein synthesis
Organogenesis

Fatigue
Lightheaded

Shortness of breathe
Glossitis
Angular stomatitis
Koilonychia (spoon nails)
Blue sclera
Espohageal webbing
(Plummer-Vinson
syndrome)
Pica

Why are athletes at risk of

iron deficiency?
Women

Athletes

Blood loss (menstruation)

Chronically exercising =
negatively alters iron
status

During pregnancy
Womens
multivitamins/supplements
contain calcium

Athletes need more oxygen

= more transferring of O2
= more iron!
Affects performance

Consequences of low iron in

female athletes
~2/3 of all women of children bearing ages have some sort of an
iron deficiency
Being a female athletes increases your chances of an iron
deficiency
Studies show its not too much of an increase, but enough to study
Female deficiencies:

Fatigue
Dizziness
Overall poor performance

Dr. Amy Miracle

Nutrition professor at Kent State
Registered dietitian/sports dietitian
Studied nutrition at KSU (BS, MS, MA)
PhD in kinesiology
Works at KSU for past three years
Works with all sports team (~425 student athletes)
One-on-one with ~125-150 student athletes

Interview with Dr. Amy Miracle

2 out of ~400 athletes at KSU that Dr. Miracle has seen
Mostly female runners and gymnasts are at the highest risk
Amy works with a runner and basketball player
Men can be at risk too, cross country most prevalent
Many tend to be vegetarian
Hard to detect
Bigger pool than we realize, many are not recorded or
treated (iron deficiencies are often ignored)
Most common symptoms: poor performance and practice
ability, extreme exhaustion, pale appearance, often
recommended by their doctor/coach

Interview with Dr. Amy Miracle

Recommends supplements often hard to get required
iron intake through food alone (ex: allergies, picky eaters)
Always have the goal to enhance iron rich foods first
Supplement timing very important
Increase fiber intake at other times of day, not with
supplement

Interview with Kent State female

Basketball Player
Age: 19 years old, African American
Sophomore business/HRM major
Gymnastics, basketball, track
Symptoms:

Exhausted and very dehydrated, woke up tired after sleeping a

full nights sleep, shortness of breath walking up/down stairs,
thought she had mono

Diagnosed as anemic 7-8 years old (runs in the family)

Took 1 iron supplement/day
Started shots when she was 11
Stopped getting the shots/taking pills in high

Interview with Kent State

Female Basketball Player
Started collegiate basketball practices in the summer of 2014
Fasted for Ramadan
Became extremely dizzy and couldnt see during practice
Symptoms returned, they tested her blood for iron and she was
deficient
(3.74 mg)
Referred to Dr. Miracle for nutrition counseling
Food preferences before meeting with Amy: lots of sugar,
lemonade, fruit punch, all drinks with high sugar, candy (Swedish
fish), fried chicken

Interview with Kent State Female

Basketball Player
Couldnt take supplements an hour within having dairy
products
Take one supplement twice a day: breakfast and
dinner

NCAA does not allow iron shot

Lives on campus hard to find healthy food

Only one on her team who has iron deficiency anemia
Gained a lot of muscle after taking supplement

2800

Athletes Sample Diet

Day 1

Day 2

Day3

Breakfast
2 grains
4 oz protein
1 cup of fruit
1 cup of dairy

2 slice whole grain toast

2 T. butter
3 eggs
1/3 cup shredded cheese
1 medium orange
2 small turkey sausage links

2 whole grain waffle (7 in diameter)

2 T. peanut butter

2 eggs
1/2 cup applesauce
1 cup milk

2 cups oatmeal
22 almonds/cashews
cup raisins/craisins
8 oz yogurt
2 slices turkey bacon

Snack
2 oz protein
1 cup of fruit
2 grains

22 almonds/cashews
1 banana
1 cup milk
2 cups whole grain cereal (cheerios,
shredded wheat, Kashi, brown rice Rice
Krispies)
2 slices whole grain b read
2 slices roast beef
1 slice swiss cheese
1 T. light mayo
2 cups salad
12 baby carrots
2 T. light ranch
Spinach on the sandwich
2 granola bars (43 g each)
8 oz yogurt
32 grapes/dried prunes

1
1
2
2

cup cottage cheese

cup of pineapple
slice whole grain toast
T. butter

1 orange/dried apricots
1 protein bar

2
4
1

1
1

slices whole grain bread

oz tuna
T. light mayo

3 cups salad (lettuce/spinach and

mixed vegetables)
4 oz chicken breast
1 T. salad dressing/orange, lemon or
lime juice squeezed on top of salad
1 cup whole grain pasta
cup tomatoes

10 pretzel sticks
1 string cheese

16 wheat thins
1 oz cheese
12 strawberries

5 oz chicken
1.5 cup mixed vegetables
1 cup whole-grain pasta
1/3 cup shredded cheese
1/2 cup marinara sauce

5 oz steak
2 whole grain roll
1 T. butter
1 sweet potato
cup spinach/soybeans
1 cup milk

5
1
2
1

Lunch
2 grains
4 oz protein
2 cups of vegetables

Snack
2 grains
1 cup of dairy
1 fruit
Dinner
2 grains
5 oz protein
1.5 cup of vegetables
1 cup of dairy

cup of celery
cup cooked broccoli

oz fish/shrimp/clams etc.
cup brown rice/lentils
cups cooked broccoli
cup milk

Day 1

Day 2

Day 3

Diet Analysis Conclusion

Iron located in:
Day 1: Cheerios
Day 2: Steak
Day 3: Clams
Difficulties for athlete
Had to eliminate some favorite foods
Somewhat picky eater

Conclusion
Iron deficiency is common in female athletes
Iron supplementation may be dangerous if not regulated
properly
It is important for female athletes to have proper nutrition
counseling who have an iron deficiency

References
Beard, J. and Tobin, B. Iron status and exercise (n.d.) The American journal of
clinical nutrition. Pages 594S-597S
Doyle, J.A., and Dunford, M. Nutrition for sport and fitness. Third edition. 2015.
Gropper, S. S., Smith, J. L., Groff, J. F. Advanced nutrition and human
metabolism. 5th edition. 2009.
Ha, A. Iron. PowerPoint slides. 2015
Hemoglobin and Functions of Iron. (n.d.). Retrieved November 16, 2015, from
http://www.ucsfhealth.org/education/hemoglobin_and_functions_of_ir on/
Miracle, A. Interview. 2015
Price. N. Interview. 2015

Activity
Diet plan
When should you take iron supplement
Pay attention to food choices/workout time

**Remember: focus on iron!**