AIS WEBSITE FACT SHEET – AIS SPORTS SUPPLEMENT PROGRAM

Iron Supplement
Supplement Overview
Iron is important for optimal function of many body systems including the brain, muscle and the
immune system. Iron is an essential component of the haemoglobin and myoglobin proteins
which are integral to oxygen transport in the blood and muscle, respectively. As such, iron levels
affect exercise capacity and performance, as well as influencing an athlete’s training capacity and
health.
Iron deficiency is the most frequently occurring nutrient deficiency worldwide, and occurs in
athletes for the same reason as in the general community: when dietary intake fails to meet iron
requirements. Iron deficiency is a continuous process with 3 recognised stages of development
marked by changes in hematological markers of iron status.
Frank anemia (Stage 3) is marked by haemoglobin concentrations below laboratory reference
ranges and a reduction in the mean cell volume of red blood cells. It is easily diagnosed, has a
clear effect on training and competition performance but is relatively uncommon in athletes.
The most common presentation of iron deficiency in healthy athletes is the depletion of iron
stores (stage 1, characterised by low serum ferritin concentrations which indicate reduced body
iron stores) and early functional iron deficiency (stage 2, characterized by an increase in serum
transferrin receptors [sTfR] and a reduction in transferrin saturation).
It is difficult to set the cut-offs for 'ideal' levels of haemoglobin and serum ferritin in athletes or
the level at which reduced iron status is problematic and requires intervention. The individual
history of each athlete and the presence of risk factors for reduced iron status should be
considered in making a diagnosis. Evidence for impaired performance and recovery is another
important consideration while steps should be taken to minimise the fluctuations in the blood
markers of iron status simply due to the effect of exercise.
There is some evidence that even Stage 1 iron depletion can impair performance:
supplementation of female athletes with serum ferritin levels less than ~ 20 ng/ml, in the
absence of anemia has been shown to enhance some parameters of exercise performance
Iron supplementation may assist in the treatment or prevention of reduced iron status in athletes
but should be considered part of a treatment package. Identification of the cause of iron
deficiency is an essential element of this process.

Supplement Profile
Iron supplements typically contain ferrous salts – fumarate, sulphate and gluconate – which are
better absorbed than the ferric iron form.
A typical supplementation protocol involves a daily dose of ~ 100 mg of elemental iron. It may
require 3 months of supplementation to restore depleted iron stores.
Iron supplements are best absorbed when taken without food or in the presence of dietary
factors that enhance iron absorption (e.g. vitamin C). However, gastrointestinal side-effects are
often reported with iron supplements including cramping, constipation and black stools. These
symptoms usually subside if the supplement is consumed with food
 Iron supplements should only be taken under medical supervision as part of an integrated iron
management program which includes dietary assessment.
Consultation with a dietitian to assess dietary iron intake (and other micronutrient intake) should
be included in the early stages of assessing an athlete’s iron status.

Table 1: Iron content of common foods.

Food Serving Size Iron (mg/serve)
Haem iron
Lean beef steak 100g 3.8
Lean lamb steak 100g 3.2
Lean pork fillet 100g 1.5
Lean chicken breast 100g 0.8
Egg 1 (60g) 1.7
Tuna, dark skinned 100g 1.1
Fish, white flesh 100g 0.4
Non haem iro
Iron fortified breakfast cereal 60g 4.2 – 6.6
Muesli 100g 6.1
Milo 3 teaspoons 6
Baked beans 1 cup 4.4
Bread (regular) 2 slices 4
Bread (iron fortified) 2 slices 2.8
Nuts (cashew/almond) 50g 1.6 – 3.8
Sweat corn ½ cup 2.1
Pasta 1 cup 0.5 –2.0
Rice 1 cup 1.0
Dried fruit (apricots) 5 – 6 pieces 0.7
Green leafy vegetables (broccoli, spinach, ½ cup 0.6
sliverbeet, cabbage)
th
(Adapted from Clinical Sports Nutrition 4 Edition)

Situations for Use in Sport

Low serum ferritin as determined by a sports physician.
Factors that increase the risk of reduced iron status:
o Poorly balanced vegetarian diets, chronic low-energy diets, and other dietary patterns
which see infrequent intake of red meat and inadequate substitution with other
foods/combinations providing bioavailable iron.
o Increased iron requirements; female athletes (menses), adolescent athletes undergoing
growth spurts, pregnant athletes, athletes adapting to altitude or heat training.
o Increased iron losses due to gastrointestinal bleeding (e.g. ulcers, some non-steroidal anti-
inflammatory drugs (NSAIDs)), excessive haemolysis due to increased training stress (e.g.
footstrike haemolysis in runners), and other blood losses (e.g. surgery, nosebleeds, contact
sports).
o Poor dietary iron absorption due to clinical disorders such as coeliac disease.
 Concerns Associated with Supplement Use
Iron supplementation does not address dietary issues. Dietary counseling in the early investigate
phase of treatment should be provided via a referral to a sports dietitian.
Excessive iron intake in some athletes may lead to iron over load.
People with haemochromatosis should avoid iron supplementation. Discuss with a sports
physician for more information.
Some iron preparations cause gastrointestinal upsets including constipation.
Intravenous and intramuscular iron supplementation carries a risk of anaphylactic shock,
problems due to use of needles and iron overload and should only be performed by a physician.

Last updated August 2011

This Fact Sheet was prepared by AIS Sports Nutrition as part of the AIS Sports Supplement Program (www.ausport.gov.au/ais/nutrition/supplements).
Note that a Fact Sheet with additional information on this topic is available for Members of the AIS Sports Supplement Program at this site.

The AIS Sports Supplement Program has been designed for the specific needs of AIS athletes and all attempts are made to stay abreast of
scientific knowledge and of WADA issues related to anti-doping. It is recommended that other athletes and groups should seek independent
advice before using any supplement, and that all athletes consult the WADA List of Prohibited Substances and Methods before making decisions
about the use of supplement products. © Australian Sports Commission 2012