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  Iron Deficiency Anemia   

Michelle Baldwin



I.                Introdcution


II.              What Is Iron Deficiency Anemia

III.            Causes of Iron Deficiency Anemia

IV.            Symptoms of Iron Deficiency Anemia


V.              Athletes and Anemia


VI.            How to Treat and Prevent


VII.          Conclusion



I.               Introduction


Iron Deficiency Anemia affects millions of individuals across the world.  This disease strikes many more women than men and has harmful effects on all who suffer from this deficiency that causes oxygen-carrying capacity to decrease.  The causes can vary amongst different groups, but the aggravating symptoms remain constant.  Much of the research on Iron Deficiency Anemia concentrates on not only the treatment of this disease, but also the prevention of it.  To attain a better understanding of how to treat this problem, one must clearly know what Iron Deficiency Anemia means, what causes this disease, the effects of it, and finally how to cure it.



II.            What Is Iron Deficiency Anemia?


Iron is a mineral that is found the in hemoglobin of the Red Blood Cells.  It facilitates in the transport of oxygen all over the body.  Without this mineral, oxygen cannot be carried to its full capacity.  1 out of 10 women and small children have iron deficiencies.  Lacking iron causes lethargy and a weakened immune system.  Children who do not have an adequate intake of iron put themselves at risk for intellectual developmental problems.  However, an iron deficient person is not necessarily anemic.  7.8 million women are iron deficient, while only 3.3 million women are anemic (  When the deficiency becomes so severe that the circulating Red Blood Count and the minerals Ht, Hg, and Hem drop below normal, anemia occurs (See Figure 1).  The hormone androgen causes men and women to have different normal values of the hemogram (  Low ferritin (iron storage molecule) and high TIBC (total iron binding capacity) levels also indicate Iron Deficiency Anemia (

As the concentration of hemoglobin in the Red Blood Cells falls below normal, the total Red Blood Cell count consequently decreases.  Therefore, oxygen cannot be adequately carried.  ( 


Normal Values of the hemogram (Figure 1)





Ht (%)



Hg (g/dl)


13, 5-17, 7


4, 0-5, 4

4, 5-6, 0





III.           Causes of Iron Deficiency Anemia


The most prominent cause of Iron Deficiency Anemia is bleeding.  Blood loss from the Gastrointestinal Tract is a significant cause of anemia for both men and women.  When blood is present in excrement, a gastrointestinal problem exists.  Many times, people are unaware of these problems with their waste products.  When they begin to feel the symptoms of anemia and undergo tests that determine that they are anemic, it begins the process of discovering more health problems.  Anemia can serve as the precursor of certain diseases.  There are many instances when it is merely a sign of severe disease such as a peptic ulcer disease, gastritis, hemorrhoids, angiodysplasis of the colon, and colonic adenocarcinoma (



Females experience blood loss monthly during their menstrual cycle.  This fact accounts for why women have a much higher rate of anemia than men.  All women have a constant form of blood loss that men do not have.  Poor intake of iron in the diet is totally unacceptable for the women’s body to tolerate, since she already produces a deficit.  Men can get away with consuming less iron-rich foods than women.  When females fail to eat the proper foods, their chances of developing an iron deficiency or Iron Deficiency Anemia are great (



Some bodies fail to absorb iron properly.  No matter how much of the mineral they consume, it will merely pass through the urine unused ( 



Increased utilization of iron is another cause of Iron Deficiency Anemia.  More of the mineral is used when adolescents are growing or a woman is pregnant.  During pregnancy, the body requires more iron for both the woman and the fetus.  (




IV.         Symptoms of Iron Deficiency Anemia



Mild Iron Deficiency can go undetected.  However, Iron Deficiency Anemia has clear signs that interfere with a person’s life.  People suffering from anemia feel fatigued often and easily.  They have a constant desire to sleep and rest.  The thought of physical activity has no appeal.  They experience a shortness of breath; very small activity causes them to strain.  Walking up the stairs, for example, seems like a large task for individuals who do not have enough circulating Red Blood Cells to carry oxygen adequately.  Their energy level is extremely low.  Pallor is another sign of anemia.  This change in a person’s skin color is noticeable.  The pale yellowish tone does not resemble a healthy individual.  Anemia also hampers the body’s ability to fight infections.  A person who constantly picks up illnesses could quite possibly be suffering from anemia (



    V. Athletes and Anemia



Athletes run a very high risk of developing Iron Deficiency Anemia.  With their tough workouts, they place many excess strains on their body.  These strains add to their risk for anemia.  In some instances, runners develop “foot-strike hemolysis” which causes anemia.  This problem occurs because of the runner’s pounding on a hard surface.  This pounding causes Red Blood Cells in the vessels of the feet to burst.  Much of these cells can be reclaimed, but some travel to the bladder where they are filtered out through the urine causing blood loss.  Rhabdomyolysis is another exercise-induced condition.  Unusually severe exercise (not uncommon to any competitive athlete) causes damaged muscle cells to split myoglobin into the blood.  From that point, the kidneys excrete that blood into the urine.  A more common incidence of blood loss seen in athletes is the significant % of runner who experience small amounts of Gastrointestinal bleeding after runs that are longer than 10 kilometers (



All people who have Iron Deficiency Anemia suffer, but athletes with the disease have even more noticeable symptoms that adversely affect their performance.  The main reason for their acute observation of a problem is the decrease in VO2 max, which is a “direct measurement of how much oxygen a person uses in a set period of time” (  An athlete’s VO2 max is something he/she constantly wants to improve.  With anemia, by no fault of the athlete, it decreases drastically.  VO2 max is composed of 3 parts:  macroscopic (heart and lungs), microscopic (capillaries, muscle, and tissue type), and molecular (hemoglobin).  Hemoglobin determines 1/3 of a person’s VO2 max.  Its importance means that the decrease in hemoglobin in anemic people has a proficient affect on the total VO2 max.  That amount of oxygen that an athlete can use in a given period of time decreases by a significant amount (  Doubtlessly, anemia will affect athletic performance.  Exercise dyspnea is a result of VO2 max decrease.  The athlete loses breath after a much less intense and shorter duration of exercise.  The fatigue and weakness also hurt the athlete’s ability to perform in sports.  Even a slight decrease in hemoglobin causes a considerable effect.  A comparison of marathoners with high hematocrit to those with low hematocrit shows that a higher hematocrit was associated with faster times (



          Several studies provide us with insights on how iron helps the athlete function and perform well.  Kelvin J.A. Davies ran an experiment on rats that is published by the American Journal of Physiology.  He gave 38 males an iron-deficient diet (2 mg/day) for 22 days, while a control group of 38 rats received the standard of 50 mg of iron.  The rats were given VO2 Max and endurance capacity tests, using a custom-made treadmill.  The progressive treadmill test commenced with 2 minutes at 13.45 m/min with consecutive 6.7 m/min increments every 2 minutes at a constant grade of 15%.  This exercise tested their VO2 Max (maximum amount of oxygen uptake).  24 hours later, endurance capacity tests were performed, where the rats ran until exhaustion.  Treadmill speed and grade were held constant.  The mean value of the VO2 max in the iron deficient rats was 48% lower than the normal ones.  After establishing this fact, the rats’ iron supplement was replenished using oral iron supplements.  By day 3, the formerly deficient ones’ VO2 max had risen 35%, and by day 7, no difference in the two groups could be detected.  Endurance capacity difference between the deficient and normal rats was even more astonishing.  The lack of iron caused the rats to have a 93% lower endurance capacity than the healthy rats.  7 days after treating the rats with iron supplements, their endurance was comparable to the control groups’.  This study is important to athletes, because it demonstrates the significant danger of having low iron.  These rats were not anemic, but the deficiency caused both their oxygen uptake maximum (VO2 max) and their endurance to diminish.  Quite notably, the problem was solved by giving them supplements of iron.  However, in the human body, curing is not as simple.  It is easier for the rats’ small bodies to absorb iron than for the complex human body.  (1)



Another study echoes the studies in the rats by confirming that lack of iron has adverse consequences on VO2 max, an essential component to successful performance.  The treatment of oral iron helps those people who were anemic, but shows less of an effect in the iron deficient group.  Most likely, this lessened effect in the latter group was caused by the effect that I described above; it is harder for the human body to react as positively to treatment as the rat reacts.  The Department of Cardiovascular Medicine in Japan takes 29 female subjects and divides them into 3 groups:  1.  Iron deficiency anemia (Hb < 11 and ferritin < 10), consisting of 4 athletes and 6 non-athletes, 2. Latent iron deficiency (Hb > 11, and ferritin < 10), consisting of 4 athletes, and 3. Normal group (Hb > 11, and ferritin > 10), consisting of 15 athletes and 6 non-athletes.  Their VO2 max and anaerobic threshold (AT) were tested using a bicycle ergometer.  The VO2 max and AT of group 1 was significantly lower than the other 2 groups.  Group 2 was also lower than group 3.  After this test, groups 1 and 2 received oral iron treatment for 1 to 1.5 months.  Then, the second exercise test occurred.  Iron administration caused Hb to increase, the anemic group, from 9 to 12 +/- 1.8, accompanied by an improvement in peak VO2 max and AT (VO2 from 34.2 to 40.0 and AT from 34.2 to 40.0).  The Latent iron deficient persons saw no significant changes (7).  The Department of Kinesiology and Healthy Science agrees with these findings.  They concur that alterations in Hb have a significant effect on VO2 max and aerobic performance.  Therefore, correct amounts of iron in the body are vital to endurance performance (2).  Having either an iron deficiency or full-blown anemia is a condition that harms the athlete’s performance by diminishing his or her maximal oxygen uptake and endurance.





Iron in red meat and              iron in cereal and fruit is absorbed less

                                        chicken is absorbed         effectively because of less heme

better because of heme



The bad new for athletes is that their lifestyles “predispose” them to becoming anemic.  In a study by TW Rowland from Tufts University, we learn several interesting facts about iron deficiency in the young athlete.  He found that 40-50% of young female athletes demonstrate non-anemic iron deficiency.  Young people’s growth compounds the average athlete’s risk, because their body requires even more iron for that natural process to occur.  Iron deficiency is associated with fatigue and impaired work capacity.  Oxygen does not flow to all of the muscles adequately.  With less oxygen going to the heart, resting cardiac output also rises, causing cardiac reserve for exercise to fall.  Rowland demonstrates that even small decreases add up.  He experiments with 4 groups of rats for 4 weeks.  (A. Fed an iron deficient diet, B. normal diet, C. iron deficient diet and supplement, and D. iron deficient diet, but given supplements at the beginning of exercise).  Groups A and D sustain exercise on the treadmill for 4 minutes, while B and C can sustain exercise for 20 minutes.  He also studies 44 track athletes who are female.  4 are anemic, and 14 have latent iron deficiency.  After 4 weeks of iron treatment in the runners, who continued to run, ferritin levels went from 8.7 to 26.6, contrasting the placebo’s fall from 10.7 to 8.6.  Similarly, he looks at high school boys and girls who participate in Cross Country.  After completing a season, there are 45% female anemics and 17% male anemics, as compared to  mid-season reports of 40% and 3%, respectively.  Rowland’s data strongly shows the correlation between athletics and iron deficiency, and again supports the conclusion that iron deficiency substantially harms athletic performance (5).



Nachtigall published an interesting study in the International Journal of Sports Medicine, reconfirming our findings of the vicious cycle of athletic predisposition to iron deficiency and the ill effects upon the athlete’s performance.  He offers some potent reasons about the causes of athlete’s anemia.  He takes 45 regional or national class runners and runs a variety of tests on them.  Serum ferritin levels were low in 51% of the group of runners; out of the 45 members of the control group, only 4 % saw low levels.  Nachtigall postulates that gastrointestinal bleeding is the cause of the blood loss in runners that leads to iron deficiency.  He used a germanium spectroscopy to measure iron contained in stool samples each day for 5 weeks.  On average, the runners lost 4.9-6.6 mL of blood each day in their stools.  The non-runners mean loss of 1.8 mL per day in their feces is significantly less.  Another interesting observation occurred on race days; the runners GI blood loss would shoot up to 9 mL for the day.  This causes the author to conclude that the intensity of an athlete’s training plays a role in their likelihood to become anemic.  Intensity makes a larger difference than length of exercise.  After treatment with oral doses of iron (125 mg 2X/day), each athlete saw improvement in his or her performance and felt healthier (3).




V.            How to Treat and Prevent




If a person has any symptoms of iron deficiency, basic lab exams should be run immediately.  These tests include a complete blood count.  This complete count includes reticulocyte count, platelet count, mean cellular volume, and differential leukocyte count.  A peripheral blood smear needs to be run to confirm size and color of Red Blood Count.  The smear will also show variation in the red cell size (anisocytosis) or shape (poikilocytosis).  This test is particularly important when evaluating a patient with hemolysis.  Other critical tests are of the serum ferritin level, serum iron level, and the TIBC.  These tests will conclusively determine whether a person has a deficiency and the degree of its severity (



The most important step in preventing and treating anemia is taking in at least the Recommended Daily Allowances of iron.  Men need 10 mg., while women need 15 mg.  It is not easy for the body to absorb dietary iron.  Animal sources only have a 10-25% absorption rate, and plant sources have a 2-5% rate.  Tannic acid, which is found in tea and coffee, hinders the ability for the body to absorb iron (  Eating red meet will also increase iron absorption from other food sources.  Additionally, it is best to avoid antacids, phosphates (found in soft drinks, beer, ice cream, and candy bars), and aspirin (  Certain foods have more iron than others and are better sources to get in a good supply or iron (See Figure 2).





Another option for treating Iron Deficiency Anemia is to take supplements.  Dosage will vary among individuals depending on the severity of their case.  Almost anyone who has an iron deficiency needs to be on a supplement.  Glucose, fructose, amino acids, and ascorbic acid are helpful for absorbing these supplements, because of their ability to reduce ferric iron to the ferrous state; the body absorbs iron in the ferrous state.  Consuming iron-rich foods and supplements is the key way to prevent and treat iron deficiency.  Some vitamins and minerals help absorption.  One study tested 2 iron deficient groups that were receiving therapy.  Group A took iron supplements (6mg) with Vitamin C (500 mg), while group B just took iron supplements (6 mg).  Serum iron reached a peak in the group A of 60-65 ug/100mL, while group B’s peak was only 20-30 ug (6).  High levels of Zinc also lead to an increased in iron.  In a study of 21 women runners, there is a strong positive association between low or high levels of both Zinc and Iron.  These minerals are absorbed similarly and help each other get into the bloodstream (4).  Iron supplementation should not be used as a preventative matter, because the mineral can be toxic when a substantial amount more than needed is consumed.  After combining supplements with dietary changes, it normally takes a person about 3 to 6 months to recover from anemia (



Iron Content of Foods (mg)

Figure 2




Meats (per 3 ounce portions)



Clams (12-24)

Iron-Fortified Cereals (vary)


Oysters (6-12)

Whole Grain or Enriched Bread

(1 per slice)

Liver and Other Organ Meats (5-6)

Pasta Products (2 per cup)



Beef, Pork, Lamb, and Veal (2-3)

Dark Green Veggies:  Spinach, Swiss Chard, Mustard Greens, Kale (1-3 per ½ cup)



Poultry (1-2)

Dried Fruits:  Raisins, Figs, Prunes, Apricots, Peaches, Pears

(1-3 per ½ cup)


Fish (.5-1)

Nuts:  almonds, cashews, peanuts, pecans (1 per ounce)



VI.         Conclusion


Increasing iron intake by consuming more iron-rich foods or taking supplements can cure Iron Deficiency Anemia by getting to the root of the problem and replenishing stores of iron in the blood.  This allows the Ht, Hg, and Hem minerals to increase to their normal levels.  The circulating Red Blood Count mass also increases.  Finally, the oxygen-carrying capacity of the blood returns rejuvenating the individual who suffered with the disease.  People will notice a return of color and energy.  Shortness of breath will disappear, as will the need to sleep for excessive periods of time.  The athlete will see his ability to perform return to him/her.



Not much debate exists about how to treat anemia.  Nearly all experts agree that taking supplements and increasing iron from food sources are the most effective ways.  Being conscious of how other foods and drinks interact with absorption of iron is also important.



While Iron Deficiency Anemia has many aggravating symptoms, its causes are fixable, and a person suffering from this disease can be cured by some relatively simple treatments.  Once conscious of the causes of anemia, it is not difficult to prevent the disease from the on-set.





Works Cited


  1. Davies, KJ.  American Journal of Physiology, “Muscle mitochondrial bioenergetics, oxygen supply, and work capacity during dietary iron deficiency and repletion.”  June 242 (6), page E418-27.  1982.
  2. Department of Kinesiology and Health Science at York University, Canadian Journal of Applied Physiology, “Haemoglobin, blood volume, cardiac funcion, and aerobic poewr.”  Feb 1999; 24 (1) 54-65.
  3. Nachtigall, D.  International Journal of Sports Medicine, “Iron deficiency in distance runners.”  October 1996; 17 (7):  473-9.
  4. Nakamura T, Journal of Amercian College Nutrition, “Zinc status relates to hematological deficits in women.”  August 1996; 15(4):  323-4
  5. Rowland, TW, Pediatric Clinic of North America, “Iron deficiency in the young athlete.”  October 1990; 37 (5):  1153-63.
  6. Taniguchi M., Journal of Nutrition of Sciecne and Vitaminol, “Improvement in iron deficiency anemia through therapy with ferric ammonium citrate and vitamin C.”  April 1991; 37 (2):  161-71.
  7. Yonezawa, K, Hokkaido Igaku Zasshi, “Effect of blood hemoglobin on concentration on anaerobic threshold.”  July 1991; 66(4):  pages 458-67.
  12. (


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