Commonly, athletes are diagnosed as iron deficient, however, contrasting evidence exists as to the severity of deficiency and the effect on performance. Iron losses can result from a host of mechanisms during exercise such as hemolysis, hematuria, sweating and gastrointestinal bleeding.
So Neymar has anemia and has apparently lost weight according to some reports. Anemia is a real problem with some athletes and is one of the most complicated problems with sport. I first started blood testing in the 1990s to see what is going on with my athletes internally, and found that roughly 10% of athletes were low on iron and showed symptoms of fatigue. Now the problems may be increasing due to poor suggestions by sports nutritionists. Why? Nutrition is the hardest to measure. Sure we can do body composition tests and even perform some blood panels, but unlike the heart, a stomach monitor doesn’t exist, yet. One area that I have been looking at is how athletes live outside the time we are with them. This requires many hours of contact outside the track and weight room. Talking poor iron levels isn’t easy, and the trick is to see what the athlete eats and how they train as a whole, not just iron rich foods. I mentioned earlier about how algorithms are growing in sport science, and now we are seeing them with sports nutrition.
Iron rich foods come in heme and non-heme sources, and to make things simpler heme iron is animal based and non-heme is plant based. Animal sources are absorbed easier and one of the issues is that the best sources are shellfish and liver. Most college and high school athletes don’t like liver or can afford shellfish, so red meat is a good option. Unfortunately good red meat is expensive and I usually see high ferritin status with burger boys and the blood lipid profiles reflect this.
I have had athletes who consumed 200% or more of the RDA for Iron and be low for many reasons. First iron absorption is a complicated exchange of interactions with other foods that contain substances that inhibit nutrient uptake. Iron absorption is affected by phytate, polyphenols, ascorbic acid, meat, fish and seafood, calcium, egg, soy protein, and alcohol so one must blood test to see if what they are consuming is what is working. I have had athletes fed by catered meals and watched by an assistant while living the private coaches and still nutritionally struggled to get the iron up if they were just eating the right things without eating them at the right times.
Training volumes are also a factor, and how both running and lifting interact is a mystery. I think we need more research here with inflammation to see how Hepcidin up-regulation interacts negatively. I have read only abstracts but will sit down later this month to see what I may need to do differently.
Vitamin C or ascorbic acid helps increase iron levels and fortified orange juice is sometimes including calcium so be warned. Also real orange juice may not have any vitamin C since water soluble vitamins do not last very long and I have sent too much time calling up groves in Florida to see how long they sit before being processed.
HRV scores and heart rate trends should be watched, especially when training load decreases and the numbers seem to not respond and athletes show symptoms of chronic fatigue. I suggest blood testing 4-6 times a year and test aerobic fitness to see how the body is working with both training and nutrition.
Note: For those interested in the algorithm research study on Iron, the study Prediction of dietary iron absorption: an algorithm for calculating absorption and bioavailability of dietary iron can be found here. Training loads should also be watched and other tests beyond ferritin should be considered.