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Iron Deficiency Anemia: Symptoms and Solutions
By Courtenay Schurman, MS, CSCS
For the weekend warrior who trains less than four hours per week, iron deficiency is generally not an issue. However, endurance performers seem to be more susceptible to iron deficiency because it’s more difficult to balance the absorption of iron with the losses incurred through demanding training. Iron deficiency anemia can be quite common for: 1) mountaineers who train aerobically for more than six hours per week; 2) active women of childbearing age who experience extreme lack of energy during heavy menstrual flow; 3) children and teenagers; 4) pregnant and/or nursing women. Women with chronic anemia may actually be asymptomatic, even with remarkably low levels of hemoglobin. Inadequate dietary intake of iron tends to be more common among athletes in sports emphasizing lean physiques, which might also include sport climbing (Harris).
Anemia often goes undiagnosed and untreated, but its detection is fairly easy IF you know what to ask for. Some coaches recommend blood tests every 3 months. A simple way to keep tabs on your iron level while doing a good deed for the day is to try to donate blood on a regular basis—one of the first tests the blood center workers perform is releasing a drop of blood in a vial of blue fluid; if it falls to the bottom, your blood has enough red blood cells to donate; if it doesn’t, it could be a sign that you’re anemic or that you’re low in red blood cells on that particular day. Healthy women suffering from modest iron deficiency -- mild enough that they fail to show typical signs of anemia -- may get less benefits from aerobic exercise than women with normal iron levels.
If you feel you tire earlier than usual during exercise, or you are at a loss as to why you’re not able to improve despite getting what you think is adequate rest, exercise, and proper nutrition, you may want to consider getting a complete blood count (CBC) or serum ferritin test to measure your iron reserves.
What is iron deficiency anemia?
Iron deficiency anemia develops from a low red blood cell count or hemoglobin level caused by too little iron in the body; it occurs when iron intake cannot keep pace with iron loss. Iron is a crucial part of the hemoglobin, a molecule in the red blood cells that carries oxygen to cells throughout the body. When the body does not have enough iron stored, too little hemoglobin is made to fill the red blood cells, causing a decrease in the size and number of red blood cells. This in turn cuts down on the body's ability to carry oxygen to the tissues, resulting in extreme fatigue with no evident cause.
How common is iron deficiency anemia?
Anemia is the most common blood condition in the U.S. affecting about 3.5 million Americans. Some sources say that as many as 80% of female athletes and 30% of male athletes show signs of iron deficiency. Women are roughly twice as likely as men to be anemic and many over-the-counter vitamin supplements for women are loaded with iron for that reason. The CDC (Center for Disease Control) estimates 1 in 10 pre-menopausal women are anemic, and recommends anemia testing for women of childbearing age at least every 5 to 10 years.
Symptoms of anemia
Iron deficiency is one of the most common deficiencies in the world. Although anemia can be caused by other deficiencies including folic acid, B12, B6 or copper, iron deficiency anemia is the most common type of anemia. Anemic people may not show any symptoms at first, then start to develop symptoms over time, including: dizziness or lightheadedness, fatigue, weakness, shortness of breath, or lack of endurance during exercise, headache, poor concentration and cognitive ability, desire to chew on ice, irritability, paleness, heart palpitations or rapid heart beat, intolerance to cold, loss of appetite, and/or reduced immunity.
Anemia and Climbing
Such symptoms are also common to other ailments, including Acute Mountain Sickness (AMS) at altitude. If a pre-menopausal woman who is otherwise asymptomatic climbs above 10,000 feet and experiences some of the above symptoms, she may suspect that she has a mild case of AMS; if the same otherwise healthy and active woman experiences these symptoms just climbing up a set of stairs at sea level, she may actually be lacking in iron, or even slightly anemic. Anemia can dramatically compound the effects at altitude, and can also increase the risks associated with altitude sickness; if left untreated, severe anemia may cause high-output heart failure, a life-threatening problem anywhere, but especially in the mountains far from emergency rescue services.
Causes of anemia
Sometimes a person will suffer from iron deficiency anemia not because of iron loss or lack specifically, but because there is a deficiency of vitamin A, which leads to defective iron transport. Even if you take in enough iron from your food, you may not get enough iron because of poor absorption or low stomach acid. Other causes include internal bleeding and excessive menstrual bleeding, which is why iron is often included in premenopausal women's multivitamins. Pregnancy and breastfeeding also increase a woman's need for iron. If you are taking antacids or other medications that may interfere with iron, taking supplemental iron might help. Finally, not only can iron deficiency result from excessive menstrual bleeding, but it can also be a cause of it!
Sources of iron
Mild anemia is thought by some to be an adaptive response to training. Correcting a mildly depressed hematocrit in female athletes will not benefit performance, per se, but WILL leave them with more energy for their usual workouts. Female athletes who are unable to correct such mild anemia through traditional dietary strategies may benefit from iron supplementation, but it’s always recommended to try getting enough iron from daily food intake before turning to multi-vitamins. Women should shoot for 15 mg/day, men for 10 mg/day. Vegan diets pose somewhat increased risk due to lower bioavailability and quantities of iron in non-meat foods; for such people, supplementation may be required (Harris).
Good food sources of iron include dried fruits such as raisins, figs and dates (try adding some to trail mix), lean red meats, spinach, asparagus, kale, broccoli, deep green leafy vegetables, dried beans and peas, seafood, poultry, and organ meats such as liver. Whole grain breads and cereals fortified with iron are also good choices. Avoid eating foods rich in calcium at the same time as iron-rich foods since calcium can reduce the absorption of iron. Iron supplements seem to be best absorbed on an empty stomach. Avoid consuming tea, coffee, milk or eggs with your iron-rich foods as they may inhibit iron absorption. On the other hand, Vitamin C (as in a glass of orange juice), which increases the absorption of iron, can be taken together with your iron supplement. Cooking in iron skillets can also be helpful. Even a healthy body does not absorb iron very easily. Because of that, a person suffering from anemia may be advised to take iron supplements for several months to a year.
Remember, if you have been very careful about consuming adequate foods, periodizing your exercise program, and getting enough rest, but still are at a loss as to why you’re feeling so tired all the time, you may benefit from a quick blood test in order to determine if you are anemic; however, other illnesses and conditions can cause fatigue as well as the other symptoms mentioned above. When in doubt, do some research on your own, see a trusted medical care provider, and share a complete health history with your physician to see if you can detect, quickly and realistically, what is going on. There’s nothing worse than trying your best to get in shape for a worthwhile goal only to have your body not respond as it should despite all of your hardest efforts.
A heartfelt thanks to one of our readers, V.M., who brought this important topic to our attention.
Brownlie, T., V Utermohlen, PS Hinton, C Giordano, JD Haas. Haas JD, Cornell Univ, Div Nutr Sci, Savage Hall, Ithaca, NY 14853 USA; presented by Gabe Mirkin, MD. “Marginal iron deficiency without anemia impairs aerobic adaptation among previously untrained women.” American Journal of Clinical Nutrition, 2002, Vol 75, Iss 4, pp 734-742.
Fisher, Thomas, MD. “Iron Deficiency Anemia.” http://atoz.iqhealth.com/HealthAnswers/encyclopedia/HTMLfiles/1593.html
Harris, Sally S. MD, MPH. “Exercise-Related Anemias.” In Medical and Orthopedic Issues of Active and Athletic Women. Ch. 35: 270-275. 1994.
United Press International. “Iron Deficiency May Impede Exercise.” April 2002, vol. 3:45.