Dr Adam Castricum, Athletics Australia Chief Medical Officer and Sports and Exercise Physician at Olympic Park Sports Medicine Centre explains how iron levels may contribute to fatigue and potentially affect an athlete's performance.

Fatigue and the Athlete: The Importance of Iron Studies

Fatigue is a common symptom experienced by athletes whether at the elite or recreational level. It can also manifest as lethargy, poor recovery and sleep and most notably poor performance.

There are numerous causes for fatigue. The most common is not enough rest! However, where there is a pathological reason, the most common is a deficiency in iron. There are numerous other causes, including infective, respiratory, cardiovascular and other nutritional causes which can be ruled out with various special tests. These can be determined after seeing your Sports Physician. The first test you have will often be for your iron studies.

So why are iron studies important?

The level of iron and especially ferritin is important as it represents the amount of iron the athlete has available for the production of haemoglobin. Haemoglobin is the part of blood that carries oxygen from the lungs to the muscles to allow the muscles to work. This is most important during aerobic exercise, where the muscles rely on oxygen to generate the energy to work. Haemoglobin also plays a role in clearing lactic acid from the muscles during anaerobic exercise such as 200-400m events.

It is important that athletes have enough iron and ferritin to produce enough haemoglobin so that they can efficiently get oxygen to the muscles so that they can function at their best, thus allowing the best performance. If ferritin levels are low, the body cannot produce enough haemoglobin and therefore, oxygen cannot be readily delivered to the muscles and so athletic performance drops – times slow, and can by 1-2% - the difference between a heat and a final and then a medal. A low ferritin or low iron stores can also be felt as poor recovery from training, lethargy and tiredness, even falling asleep during studies or work.

What level is considered low?

The most important marker on the “Iron studies” test is the ferritin level. A level below 30 is considered low enough to affect athletic performance, especially in endurance events. In the boys, a level below 50 may be significant, especially in the distance athletes. You should talk to your Sports Physician about this so that treatment can be started.

What causes low ferritin?

There are many causes of a low ferritin, with the main reason being poor intake of foods containing Iron. This is especially so in growing athletes as their bodies are growing at a rapid rate and need a lot of iron just to fuel the energy required to grow, as well as exercise. It is more common in girls and can also be related to other causes. Anyone with a low ferritin should see their Sports Physician to work out the exact cause.

How common is a low ferritin?

Looking at the number of athletes who had low ferritins on the blood tests conducted before the 2007 Word Youth, 2008 World Junior and 2009 World Athletics Championships, this condition is quite common. Up to 50% of girls had low ferritins prior to these major Championships and 20% of the boys.

Can low ferritin be treated?

Yes, it can and the treatment is often simply increasing the amount of Iron containing foods in your diet. Other things can also be added to the treatment plan to help your ferritin levels improve before competition. If your Sports Physician thinks it is appropriate, you may be referred to a Sports Dietitian.

What are the effects of treatment?

After a few weeks, the athlete will notice an improvement in the energy levels. They won’t feel so tired. They will be able to train and recover better. Hopefully this will translate into better performances and personal bests. At the World Juniors in 2008, at least two of the distance athletes with low ferritins going into the competition, benefited from having treatment for this. They both made finals and set big personal bests. One of these has now gone on to be Australia’s current National 1500m champion.

How often should I have my Iron levels checked?

As an elite athlete, you should have your Iron levels checked once a year, especially if you feel tired with training or lethargic. Distance athletes should have their levels checked every 6 months. It is often good to get your levels checked 2-3 months out from the major meets or events, to make sure your performances will be the best they can be.