Iron Deficiency Sidelines Athletes: A Growing Concern for Peak Performance
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Maintaining optimal iron levels is crucial for athletic performance, yet a surprising number of athletes – particularly women – are competing while iron deficient. This hidden struggle can lead to debilitating fatigue, hindering training and impacting overall health.
Zara Walters, a player for the Melbourne Vixens netball team, experienced this firsthand. For a significant period, Walters battled persistent feelings of heaviness, tiredness, and lethargy. “I felt quite fatigued, I felt heavy in the legs, and it just didn’t feel right,” Walters told ABC Sport. Even recovery proved difficult, with Walters describing a constant need for naps and a struggle to bounce back after training.
It wasn’t until blood tests at the Victorian Institute of Sport (VIS) revealed an iron deficiency that Walters finally understood the root cause of her struggles. “I think it was more of a relief that I knew it wasn’t that I was unfit and I couldn’t get through sessions,” she explained. “It was [also] a relief to know that there is a management to it.” Walters’ experience underscores a broader issue: iron deficiency is often overlooked, leaving athletes to push through symptoms without a diagnosis.
The Athlete’s Iron Imbalance
Iron plays a vital role in energy production, immune function, and cognitive performance. When iron levels drop, fatigue and diminished performance inevitably follow. Athletes are particularly vulnerable to iron depletion due to the increased demands of intense training. Exercise depletes the body’s iron stores, and a recent study revealed that up to 35% of female athletes experience low iron levels, compared to just 5% of the general population.
According to Dr. Susan White, medical director at VIS, a key factor is a substance called hepcidin, which increases with exercise and inhibits iron absorption. “There is a substance called hepcidin which exercise increases. And if you increase your hepcidin, iron absorption goes down,” Dr. White stated. Furthermore, female athletes are also susceptible to iron loss through menstrual cycles.
From Reactive to Proactive: VIS’s Targeted Approach
Three years ago, VIS shifted its approach to iron management, moving from a reactive model – addressing deficiencies as they arose – to a proactive one focused on prevention and early detection. This involved targeted blood testing of female athletes, long-distance runners, and those participating in weight-controlled sports.
The results were startling. “Our expectation was that we would find 25 to 30 per cent of our female athletes being iron deficient, which is the statistics that we see in the literature,” Dr. White said. “But we found more than 50 per cent of our athletes were iron deficient.”
VIS now implements individualized plans for athletes with low iron levels, prioritizing a food-first approach. Dieticians guide athletes toward iron-rich foods like red meat, leafy greens, and lentils. Iron supplements are then introduced as needed, with iron infusions reserved for severe or persistent cases.
Walters, who has been a VIS scholarship athlete since 2024, experienced a transformative change after her first infusion. “I think it was the best I’ve felt. It was life changing,” she said. Her improved iron levels contributed to her success, as she was part of the Melbourne Vixens team that won this year’s Super Netball Grand Final.
The Long Road to Recovery & Ongoing Monitoring
Correcting iron deficiency isn’t a quick fix. VIS initially anticipated a 12-month turnaround for athletes, but Dr. White noted that it typically takes 12-18 months to reach optimal levels.
Ongoing monitoring is essential, as symptoms can be subtle and easily dismissed. “It is hard to pick up on those symptoms because you don’t just wake up one day and feel lethargic,” Walters explained. “I think it’s a slow build, but I can feel when I am getting a little bit low. I’m trying to get through sessions and I’m feeling heavy. I feel weak in the gym. And that’s probably the time where I do request a blood test again.”
VIS now tests athletes for iron levels annually, with those at higher risk – like Walters – undergoing testing every three to six months. Over the past three years, the institute has administered approximately 30 iron infusions annually, with only three given to males, primarily long-distance runners. The decreasing trend in infusion needs suggests that earlier detection and intervention are proving effective.
While iron infusions can provide rapid relief, they are not without risks, including anaphylactic reactions and skin staining, and can have anti-doping implications. However, both athletes and coaches have reported positive results, noting improved training performance and reduced fatigue. “It takes probably a week to start to notice the difference,” Dr. White said. “We get feedback from the coaches and they notice a difference, they seem to be training better, they’re a bit more alert.”
VIS is currently collaborating with La Trobe University to publish its findings, aiming to provide further insights into the prevalence and management of iron deficiency in athletes. The institute’s data highlights that iron deficiency is more common and more challenging to correct than previously understood, requiring a dedicated, multidisciplinary approach involving doctors, nurses, and nutritionists.
Walters emphasizes the importance of proactive testing. “The management of mine has been incredible and I’ve been able to live a lot better quality of life, and to train so much better as well,” she said. “If it is ongoing and you do feel some of those symptoms I think it’s worth getting a blood test to check.”
