Iron considerations for the athlete : A narrative review

Journal article


Marc Sim, Garvican-Lewis, Laura A., Cox, Gregory R., Govus, Andrew D., McKay, Alannah K. A., Stellingwerff, T. and Peeling, Peter. (2019). Iron considerations for the athlete : A narrative review. European Journal of Applied Physiology. 119(7), pp. 1463-1478. https://doi.org/10.1007/s00421-019-04157-y
AuthorsMarc Sim, Garvican-Lewis, Laura A., Cox, Gregory R., Govus, Andrew D., McKay, Alannah K. A., Stellingwerff, T. and Peeling, Peter
Abstract

Iron plays a significant role in the body, and is specifically important to athletes, since it is a dominant feature in processes such as oxygen transport and energy metabolism. Despite its importance, athlete populations, especially females and endurance athletes, are commonly diagnosed with iron deficiency, suggesting an association between sport performance and iron regulation. Although iron deficiency is most common in female athletes (~ 15–35% athlete cohorts deficient), approximately 5–11% of male athlete cohorts also present with this issue. Furthermore, interest has grown in the mechanisms that influence iron absorption in athletes over the last decade, with the link between iron regulation and exercise becoming a research focus. Specifically, exercise-induced increases in the master iron regulatory hormone, hepcidin, has been highlighted as a contributing factor towards altered iron metabolism in athletes. To date, a plethora of research has been conducted, including investigation into the impact that sex hormones, diet (e.g. macronutrient manipulation), training and environmental stress (e.g. hypoxia due to altitude training) have on an athlete’s iron status, with numerous recommendations proposed for consideration. This review summarises the current state of research with respect to the aforementioned factors, drawing conclusions and recommendations for future work.

Keywordsiron deficiency; anaemia; hepcidin; exercise
Year2019
JournalEuropean Journal of Applied Physiology
Journal citation119 (7), pp. 1463-1478
PublisherSpringer
ISSN1439-6319
Digital Object Identifier (DOI)https://doi.org/10.1007/s00421-019-04157-y
Scopus EID2-s2.0-85065413565
Open accessPublished as green open access
Page range1463-1478
Author's accepted manuscript
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Open
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Output statusPublished
Publication dates
Online04 May 2019
Publication process dates
Accepted02 May 2019
Deposited20 Apr 2021
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Govus, Andrew D., Peeling, P., Abbiss, C R., Lawler, N. G., Swinkels, D. W., Laarakkers, C. M., Thompson, K. G., Peiffer, J. J., Gore, C. J. and Garvican-Lewis, L. A.. (2017). Live high, train low – influence on resting and post-exercise hepcidin levels. Scandinavian Journal of Medicine & Science in Sports. 27(7), pp. 704 - 713. https://doi.org/10.1111/sms.12685
The effect of training at 2100-m altitude on running speed and session rating of perceived exertion at different intensities in elite middle-distance runners
Sharma, Avish P., Saunders, Philo U., Garvican-Lewis, Laura A., Clark, Brad, Stanley, Jamie, Robertson, Eileen Y. and Thompson, Kevin G.. (2017). The effect of training at 2100-m altitude on running speed and session rating of perceived exertion at different intensities in elite middle-distance runners. International Journal of Sports Physiology and Performance. 12, pp. S2-147 - S2-152. https://doi.org/10.1123/ijspp.2016-0402
Effect of environmental and feedback interventions on pacing profiles in cycling: a meta-analysis
Davies, Michael J., Clark, Bradley, Welvaert, Marijke, Skorski, Sabrina, Lewis, Laura, Saunders, Philo and Thompson, Kevin G.. (2016). Effect of environmental and feedback interventions on pacing profiles in cycling: a meta-analysis. Frontiers in Physiology. 7, pp. 1 - 24. https://doi.org/10.3389/fphys.2016.00591
Time for a new metric for hypoxic dose?
Garvican-Lewis, Laura A., Sharpe, Ken and Gore, Christopher J.. (2016). Time for a new metric for hypoxic dose? Journal of Applied Physiology. 121(1), pp. 352 - 355. https://doi.org/10.1152/japplphysiol.00579.2015
The ventilation-corrected ParvoMedics TrueOne 2400 provides a valid and reliable assessment of resting metabolic rate (RMR) in athletes compared with the Douglas Bag Method
Woods, Amy L., Garvican-Lewis, Laura A., Rice, Anthony J. and Thompson, Kevin G.. (2016). The ventilation-corrected ParvoMedics TrueOne 2400 provides a valid and reliable assessment of resting metabolic rate (RMR) in athletes compared with the Douglas Bag Method. International Journal of Sport Nutrition and Exercise Metabolism. 26(5), pp. 454 - 463. https://doi.org/10.1123/ijsnem.2015-0315
Increased hypoxic dose after training at low altitude with 9h per night at 3000m normobaric hypoxia
Carr, A. J., Saunders, Philo, Vallance, Brent S., Lewis, Laura and Gore, Christopher J.. (2015). Increased hypoxic dose after training at low altitude with 9h per night at 3000m normobaric hypoxia. Journal of Sports Science and Medicine. 14(4), pp. 776 - 782.
Impact of altitude on power output during cycling stage racing
Lewis, Laura, Clark, Bradley, Martin, David T., Schumacher, Yorck O., McDonald, Warren, Stephens, Brian, Ma, Fuhai, Thompson, Kevin G., Gore, Christopher J. and Menaspà, Paolo. (2015). Impact of altitude on power output during cycling stage racing. PLoS ONE. 10(12), pp. 1 - 15. https://doi.org/10.1371/journal.pone.0143028
Altitude exposure at 1800 m increases haemoglobin mass in distance runners
Lewis, Laura, Halliday, Iona, Abbiss, Chris R., Saunders, Philo and Gore, Christopher J.. (2015). Altitude exposure at 1800 m increases haemoglobin mass in distance runners. Journal of Sports Science and Medicine. 14(2), pp. 413 - 417.
Relative match intensities at high altitude in highly-trained young soccer players (ISA3600)
Buchheit, M., Hammond, Kristal, Bourdon, Pitre C., Simpson, Ben M., Lewis, Laura, Schmidt, Walter F., Gore, Christopher J. and Aughey, Robert. (2015). Relative match intensities at high altitude in highly-trained young soccer players (ISA3600). Journal of Sports Science and Medicine. 14(1), pp. 98 - 102.
High altitude, prolonged exercise, and the athlete biological passport
Schumacher, Yorck O., Lewis, Laura, Christian, Ryan, Lobigs, Louisa M., Qi, Jiliang, Fan, Rongyun, He, Yingying, Wang, Hailing, Gore, Christopher J. and Ma, Fuhai. (2015). High altitude, prolonged exercise, and the athlete biological passport. Drug Testing and Analysis. 7(1), pp. 48 - 55. https://doi.org/10.1002/dta.1717
Pre-altitude serum ferritin levels and daily oral iron supplement dose mediate iron parameter and hemoglobin mass responses to altitude exposure
Govus, Andrew D., Lewis, Laura, Abbiss, Chris R., Peeling, P. and Gore, Christopher J.. (2015). Pre-altitude serum ferritin levels and daily oral iron supplement dose mediate iron parameter and hemoglobin mass responses to altitude exposure. PLoS ONE. 10(8), pp. 1 - 11. https://doi.org/10.1371/journal.pone.0135120
Lower running performance and exacerbated fatigue in soccer played at 1600 m
Lewis, Laura, Hammond, Kristal, Varley, Matthew C., Gore, Christopher J., Billaut, Francois and Aughey, Robert. (2014). Lower running performance and exacerbated fatigue in soccer played at 1600 m. International Journal of Sports Physiology and Performance. 9(3), pp. 397 - 404. https://doi.org/10.1123/IJSPP.2012-0375
Stage racing at altitude induces hemodilution despite an increase in hemoglobin mass
Lewis, Laura, Schumacher, Yorck O., Clark, Sally, Christian, Ryan, Menaspà, Paolo, Plowman, Jamie, Stephens, Brian, Qi, Jiliang, Fan, Rongyun, He, Yingying, Martin, David T., Thompson, Kevin G., Gore, Christopher J. and Ma, Fuhai. (2014). Stage racing at altitude induces hemodilution despite an increase in hemoglobin mass. Journal of Applied Physiology. 117(5), pp. 463 - 472. https://doi.org/10.1152/japplphysiol.00242.2014
Four weeks of IV iron supplementation reduces perceived fatigue and mood disturbance in distance runners
Woods, Amy L., Garvican-Lewis, Laura A., Saunders, Philo U., Lovell, Greg, Hughes, David, Fazakerley, Ruth, Anderson, Bev, Gore, Christopher J. and Thompson, Kevin G.. (2014). Four weeks of IV iron supplementation reduces perceived fatigue and mood disturbance in distance runners. PLoS ONE. 9(9), pp. 1 - 11. https://doi.org/10.1371/journal.pone.0108042
Acute hypoxic exercise does not alter post-exercise iron metabolism in moderately trained endurance athletes
Govus, Andrew D., Abbiss, Chris R., Lewis, Laura, Swinkels, Dorine W., Laarakkers, Coby M., Gore, Christopher J. and Peeling, P. (2014). Acute hypoxic exercise does not alter post-exercise iron metabolism in moderately trained endurance athletes. European Journal of Applied Physiology. 114(10), pp. 2183 - 2191. https://doi.org/10.1007/s00421-014-2938-2
Yin and yang, or peas in a pod? Individual-sport versus team-sport athletes and altitude training
Aughey, Robert J., Buchheit, Martin, Garvican-Lewis, Laura A., Roach, Gregory D., Sargent, Charli, Billaut, François, Varley, Matthew C., Bourdon, Pitre C. and Gore, Christopher J.. (2013). Yin and yang, or peas in a pod? Individual-sport versus team-sport athletes and altitude training. British Journal of Sports Medicine. 47(18), pp. 1150-1154. https://doi.org/10.1136/bjsports-2013-092764
Wellness, fatigue and physical performance acclimatisation to a 2-week soccer camp at 3600 m (ISA3600)
Buchheit, Martin, Simpson, Ben M., Garvican-Lewis, Laura A., Hammond, Kristal, Kley, Marlen, Schmidt, Walter F., Aughey, Robert J., Soria, Rudy, Sargent, Charli, Roach, Gregory D., Claros, Jesus C. Jimenez, Wachsmuth, Nadine, Gore, Christopher J. and Bourdon, Pitre C.. (2013). Wellness, fatigue and physical performance acclimatisation to a 2-week soccer camp at 3600 m (ISA3600). British Journal of Sports Medicine. 47(Suppl 1), p. i100. https://doi.org/10.1136/bjsports-2013-092749
The sleep of elite athletes at sea level and high altitude : A comparison of sea-level natives and high-altitude natives (ISA3600)
Roach, Gregory D., Schmidt, Walter F., Aughey, Robert J., Bourdon, Pitre C., Soria, Rudy, Claros, Jesus C. Jimenez, Garvican-Lewis, Laura A., Buchheit, Martin, Simpson, Ben M., Hammond, Kristal, Kley, Marlen, Wachsmuth, Nadine, Gore, Christopher J. and Sargent, Charli. (2013). The sleep of elite athletes at sea level and high altitude : A comparison of sea-level natives and high-altitude natives (ISA3600). British Journal of Sports Medicine. 47(Suppl 1), p. i114. https://doi.org/10.1136/bjsports-2013-092843
The impact of altitude on the sleep of young elite soccer players (ISA3600)
Sargent, Charli, Schmidt, Walter F., Aughey, Robert J., Bourdon, Pitre C., Soria, Rudy, Claros, Jesus C. Jimenez, Garvican-Lewis, Laura A., Buchheit, Martin, Simpson, Ben M., Hammond, Kristal, Kley, Marlen, Wachsmuth, Nadine, Gore, Christopher J. and Roach, Gregory D.. (2013). The impact of altitude on the sleep of young elite soccer players (ISA3600). British Journal of Sports Medicine. 47(Suppl 1), p. i86. https://doi.org/10.1136/bjsports-2013-092829
The effects of injury and illness on haemoglobin mass
Gough, C. E., Sharpe, K., Garvican, L. A., Anson, J. M., Saunders, P. U. and Gore, C. J.. (2013). The effects of injury and illness on haemoglobin mass. International Journal of Sports Medicine. 34(9), pp. 763-769. https://doi.org/10.1055/s-0033-1333692
The distribution of pace adopted by cyclists during a cross-country mountain bike world championships
Abbiss, Chris R., Ross, Megan L. R., Garvican, Laura A., Ross, Neil, Pottgiesser, Torben, Gregory, John and Martin, David T.. (2013). The distribution of pace adopted by cyclists during a cross-country mountain bike world championships. Journal of Sports Sciences. 31(7), pp. 787-794. https://doi.org/10.1080/02640414.2012.751118
Soccer activity profile of altitude versus sea-level natives during acclimatisation to 3600 m (ISA3600)
Aughey, Robert J., Hammond, Kristal, Varley, Matthew C., Schmidt, Walter F., Bourdon, Pitre C., Buchheit, Martin, Simpson, Ben, Garvican-Lewis, Laura A., Kley, Marlen, Soria, Rudy, Sargent, Charli, Roach, Gregory D., Claros, Jesus C. Jimenez, Wachsmuth, Nadine and Gore, Christopher J.. (2013). Soccer activity profile of altitude versus sea-level natives during acclimatisation to 3600 m (ISA3600). British Journal of Sports Medicine. 47(Suppl 1), pp. 1-7. https://doi.org/10.1136/bjsports-2013-092776
Relationship between changes in haemoglobin mass and maximal oxygen uptake after hypoxic exposure
Saunders, Philo U., Garvican-Lewis, Laura A., Schmidt, Walter F. and Gore, Christopher J.. (2013). Relationship between changes in haemoglobin mass and maximal oxygen uptake after hypoxic exposure. British Journal of Sports Medicine. 47(Suppl 1), pp. 1-6. https://doi.org/10.1136/bjsports-2013-092841
Predicting sickness during a 2-week soccer camp at 3600 m (ISA3600)
Buchheit, Martin, Simpson, Ben M., Schmidt, Walter F., Aughey, Robert J., Soria, Rudy, Hunt, Robert A., Garvican-Lewis, Laura A., Pyne, David B., Gore, Christopher J. and Bourdon, Pitre C.. (2013). Predicting sickness during a 2-week soccer camp at 3600 m (ISA3600). British Journal of Sports Medicine. 47(Suppl 1), pp. 1-4. https://doi.org/10.1136/bjsports-2013-092757
Methods of the international study on soccer at altitude 3600 m (ISA3600)
Gore, Christopher J., Aughey, Robert J., Bourdon, Pitre C., Garvican-Lewis, Laura A., Soria, Rudy, Claros, Jesus C. Jimenez, Sargent, Charli, Roach, Gregory D., Buchheit, Martin, Simpson, Ben M., Hammond, Kristal, Kley, Marlen, Wachsmuth, Nadine, Pepper, Mark, Edwards, Alistair, Cuenca, Douglas, Vidmar, Tony, Spielvogel, Hilde and Schmidt, Walter F.. (2013). Methods of the international study on soccer at altitude 3600 m (ISA3600). British Journal of Sports Medicine. 47(Supplement 1), p. i80–i85. https://doi.org/10.1136/bjsports-2013-092770
Changes in blood gas transport of altitude native soccer players near sea-level and sea-level native soccer players at altitude (ISA3600)
Wachsmuth, Nadine, Kley, Marlen, Spielvogel, Hilde, Aughey, Robert J., Gore, Christopher J., Bourdon, Pitre C., Hammond, Kristal, Sargent, Charli, Roach, Gregory D., Sanchez, Rudy Soria, Jimenez Claros, Jesus C., Schmidt, Walter F. and Garvican-Lewis, Laura A.. (2013). Changes in blood gas transport of altitude native soccer players near sea-level and sea-level native soccer players at altitude (ISA3600). British Journal of Sports Medicine. 47(Supplement 1), pp. i93-i99. https://doi.org/10.1136/bjsports-2013-092761
Altitude training and haemoglobin mass from the optimised carbon monoxide rebreathing method determined by a meta-analysis
Gore, Christopher, Sharpe, Ken, Garvican-Lewis, Laura, Saunders, Philo, Humberstone, Clare, Robertson, Eileen, Wachsmuth, Nadine, Clark, Sally, McLean, Blake and Friedmann-Bette, Birgit. (2013). Altitude training and haemoglobin mass from the optimised carbon monoxide rebreathing method determined by a meta-analysis. British Journal of Sports Medicine. https://doi.org/10.1136/bjsports-2013-092840
Time course of the hemoglobin mass response to natural altitude training in elite endurance cyclists
Garvican, L., Martin, D., Quod, M., Stephens, B. and Sassi, A.. (2012). Time course of the hemoglobin mass response to natural altitude training in elite endurance cyclists. Scandinavian Journal of Medicine & Science in Sports. 22(1), pp. 95-103. https://doi.org/10.1111/j.1600-0838.2010.01145.x
Short-term hematological effects upon completion of a four-week simulated altitude camp
Pottgiesser,Torben, Garvican, Laura A., Martin, David T., Featonby, Jesse M., Gore, Christopher J. and Schumacher, Yorck O.. (2012). Short-term hematological effects upon completion of a four-week simulated altitude camp. International Journal of Sports Physiology and Performance. 7(1), pp. 79-83. https://doi.org/10.1123/Ijspp.7.1.79
The contribution of haemoglobin mass to increases in cycling performance induced by simulated LHTL
Garvican, Laura A., Pottgiesser, Torben, Martin, David T., Schumacher, Yorck Olaf, Barras, Martin and Gore, Christopher J.. (2011). The contribution of haemoglobin mass to increases in cycling performance induced by simulated LHTL. European Journal of Applied Physiology. 111(6), pp. 1089-1101. https://doi.org/10.1007/s00421-010-1732-z
Standardising analysis of carbon monoxide rebreathing for application in anti-doping
Alexander, Anthony C., Garvican, Laura A., Burge, Caroline M., Clark, Sally A., Plowman, James S. and Gore, Christopher J.. (2011). Standardising analysis of carbon monoxide rebreathing for application in anti-doping. Journal of Science and Medicine in Sport. 14(2), pp. 100-105. https://doi.org/10.1016/j.jsams.2010.07.007
Quality control technique to reduce the variability of longitudinal measurement of hemoglobin mass
Gough, C. E., Sharpe, K., Ashenden, M. J., Anson, J. M., Saunders, P. U., Garvican, L. A., Bonetti, D. L., Gore, C. J. and Prommer, N.. (2011). Quality control technique to reduce the variability of longitudinal measurement of hemoglobin mass. Scandinavian Journal of Medicine & Science in Sports. 21(6), pp. e365-e371. https://doi.org/10.1111/j.1600-0838.2011.01316.x