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Iron Status and Physical Performance in Athletes
Abstract
Iron is an important mineral in the body, essential for muscle function and oxygen transport. Adequate levels of iron in the blood are necessary for athletes, as iron-deficiency anemia can reduce physical performance. Several studies have investigated iron status and supplementation in iron-deficient athletes, and determined how physical strain can change iron balance and markers related to iron status. The question of how to influence and optimize iron status, as well as other markers that can affect iron metabolism, has been less thoroughly investigated. Therefore, the aim of this review is to take a closer look at the importance of iron values, iron markers, and factors that can change iron metabolism for physical performance and the extent to which physical performance can be influenced in a positive or negative way. A systematic search of the PubMed database was performed, with the use of « iron» or «iron deficiency» or «hemoglobin» AND «athletes» AND «athletic performance» as a strategy of the search. After the search, 11 articles were included in the review after the application of inclusion and exclusion criteria. Major findings include that iron supplementation had the best effect in athletes with the lowest iron status, and effects on physical performance were mostly achieved in those who were originally in a deficit. Iron supplementation could be beneficial for optimal erythropoietic response during altitude training, even in athletes with normal iron stores at baseline, but should be performed with caution. Alteration of the hepcidin response can affect the use of existing iron stores for erythropoiesis. Energy intake, and the amount of carbohydrates available, may have an impact on the post-exercise hepcidin response. Optimal vitamin D and B12 levels can possibly contribute to improved iron status and, hence, the avoidance of anemia.
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“Iron deficiency, particularly common in adolescent females, reduces red blood cell production, leading to fatigue and decreased oxygen delivery to muscles, thus impairing recovery from physical exertion [29,30].”
From Youth and Adolescent Athlete Musculoskeletal Health: Dietary and Nutritional Strategies to Optimise Injury Prevention and Support Recovery (2024) · cites this paper as [30]
In the citing paper
“Iron supports the delivery of oxygen to muscle tissue, supporting cellular energy production and muscle repair [29,30]”
From Youth and Adolescent Athlete Musculoskeletal Health: Dietary and Nutritional Strategies to Optimise Injury Prevention and Support Recovery (2024) · cites this paper as [30]
In the citing paper
“Iron depletion, even in the absence of anemia, can impair aerobic capacity, cognitive function, and immune health [76].”
From Optimizing Performance Nutrition for Adolescent Athletes: A Review of Dietary Needs, Risks, and Practical Strategies (2025) · cites this paper as [76]
In the citing paper
“Iron and folate deficiencies can impair red blood cell production and oxygen transport, potentially leading to anaemia, fatigue and reduced endurance capacity [119–121].”
From Dietary intake, nutrition knowledge, and behavior in youth team sport athletes: a scoping review and call to advance research and practice (2026) · cites this paper as [120]
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Cites
Haas, J. D., & Brownlie, T. (2001) · The Journal of Nutrition · doi:10.1093/jn/131.2.676s · Cited by 1,186
Bone morphogenetic protein signaling by hemojuvelin regulates hepcidin expression
Babitt, J. L., Huang, F. W., Wrighting, D. M., Xia, Y., Sidis, Y., Samad, T. A., Campagna, J. A., Chung, R. T., Schneyer, A. L., Woolf, C. J., et al. (2006) · Nature Genetics · doi:10.1038/ng1777 · Cited by 1,026 · cited 1×
“HIF-activation has been shown to reduce hepcidin levels in mice [77], but other mechanisms such as EPO/erythropoiesis [78,79] or iron signaling pathways have also been shown to trigger the downregulation of hepcidin [80,81].”
Hepcidin and iron regulation, 10 years later
Ganz, T. (2011) · Blood · doi:10.1182/blood-2011-01-258467 · Cited by 962
Vitamin and mineral status: effects on physical performance
Lukaski, H. C. (2004) · Nutrition · doi:10.1016/j.nut.2004.04.001 · Cited by 587
Mountjoy, M., Sundgot-Borgen, J., Burke, L., Ackerman, K. E., Blauwet, C., Constantini, N., Lebrun, C., Lundy, B., Melin, A., Meyer, N., et al. (2018) · International Journal of Sport Nutrition and Exercise Metabolism · doi:10.1123/ijsnem.2018-0136 · Cited by 447
Suppression of iron-regulatory hepcidin by vitamin D
Bacchetta, J., Zaritsky, J. J., Sea, J. L., Chun, R. F., Lisse, T. S., Zavala, K., Nayak, A., Wesseling-Perry, K., Westerman, M., Hollis, B. W., et al. (2014) · Journal of the American Society of Nephrology · doi:10.1681/asn.2013040355 · Cited by 350
Hypoxia-inducible factor regulates hepcidin via erythropoietin-induced erythropoiesis
Liu, Q., Davidoff, O., Niss, K., & Haase, V. H. (2012) · Journal of Clinical Investigation · doi:10.1172/jci63924 · Cited by 328
Iron considerations for the athlete: a narrative review
Sim, M., Garvican-Lewis, L. A., Cox, G. R., Govus, A., McKay, A. K. A., Stellingwerff, T., & Peeling, P. (2019) · European Journal of Applied Physiology · doi:10.1007/s00421-019-04157-y · Cited by 274
Daily iron supplementation for improving anaemia, iron status and health in menstruating women
Low, M. S. Y., Speedy, J., Styles, C. E., De-Regil, L. M., & Pasricha, S.-R. (2016) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd009747.pub2 · Cited by 178
Iron deficiency in sports-definition, influence on performance and therapy
Clénin, G., Cordes, M., Huber, A., Schumacher, Y. O., Noack, P., Scales, J., & Kriemler, S. (2015) · Swiss Medical Weekly · doi:10.4414/smw.2015.14196 · Cited by 170
Research works printed but not linked: 72
- Paul, 2017, Mitochondria and Iron: Current questions, Expert Rev. Hematol., 10, 65, 10.1080/17474086.2016.1268047 · DOI · Paper page
- Perutz, 1979, Regulation of oxygen affinity of hemoglobin: Influence of structure of the globin on the heme iron, Annu. Rev. Biochem., 48, 327, 10.1146/annurev.bi.48.070179.001551 · DOI · Paper page
- Sandnes, M., Ulvik, R.J., Vorland, M., and Reikvam, H. (2021). Hyperferritinemia—A Clinical Overview. J. Clin. Med., 10. · DOI
- Ganz, 2012, Iron metabolism: Interactions with normal and disordered erythropoiesis, Cold Spring Harb. Perspect. Med., 2, a011668, 10.1101/cshperspect.a011668 · DOI
- Kong, W.N., Gao, G., and Chang, Y.Z. (2014). Hepcidin and sports anemia. Cell Biosci., 4. · DOI · Paper page
- Pedersen, 2001, Exercise and interleukin-6, Curr. Opin. Hematol., 8, 137, 10.1097/00062752-200105000-00002 · DOI · Paper page
- Peeling, P., Sim, M., Badenhorst, C.E., Dawson, B., Govus, A.D., Abbiss, C.R., Swinkels, D.W., and Trinder, D. (2014). Iron status and the acute post-exercise hepcidin response in athletes. PLoS ONE, 9. · DOI · Paper page
- Ishibashi, 2020, Effect of low energy availability during three consecutive days of endurance training on iron metabolism in male long distance runners, Physiol. Rep., 8, e14494, 10.14814/phy2.14494 · DOI
- Hennigar, 2021, Energy deficit increases hepcidin and exacerbates declines in dietary iron absorption following strenuous physical activity: A randomized-controlled cross-over trial, Am. J. Clin. Nutr., 113, 359, 10.1093/ajcn/nqaa289 · DOI
- Percy, 2017, Iron deficiency and iron deficiency anaemia in women, Best Pract. Res. Clin. Obstet. Gynaecol., 40, 55, 10.1016/j.bpobgyn.2016.09.007 · DOI
- Balendran, 2021, Non-anaemic iron deficiency, Aust. Prescr., 44, 193, 10.18773/austprescr.2021.052 · DOI
- Soppi, 2018, Iron deficiency without anemia—A clinical challenge, Clin. Case Rep., 6, 1082, 10.1002/ccr3.1529 · DOI
- Eichner, 2012, Pearls and pitfalls: Everyone needs iron, Curr. Sports Med. Rep., 11, 50, 10.1249/JSR.0b013e31824a91bd · DOI
- Yu, 2013, Meta-analysis of studies on cut-off value of serum ferritin for identifying iron deficiency, Wei Sheng Yan Jiu, 42, 228
- Fallon, 2004, Utility of hematological and iron-related screening in elite athletes, Clin. J. Sport Med., 14, 145, 10.1097/00042752-200405000-00007 · DOI
- Reinke, 2012, Absolute and functional iron deficiency in professional athletes during training and recovery, Int. J. Cardiol., 156, 186, 10.1016/j.ijcard.2010.10.139 · DOI
- Gregg, 1989, Interactive effects of anemia and muscle oxidative capacity on exercise endurance, J. Appl. Physiol. (1985), 67, 765, 10.1152/jappl.1989.67.2.765 · DOI
- Davies, 1984, Distinguishing effects of anemia and muscle iron deficiency on exercise bioenergetics in the rat, Am. J. Physiol., 246, E535
- Badenhorst, 2019, Hepcidin as a Prospective Individualized Biomarker for Individuals at Risk of Low Energy Availability, Int. J. Sport Nutr. Exerc. Metab., 29, 671, 10.1123/ijsnem.2019-0006 · DOI
- Berglund, 1992, High-altitude training. Aspects of haematological adaptation, Sports Med., 14, 289, 10.2165/00007256-199214050-00002 · DOI
- Hahn, 2001, The effect of altitude on cycling performance: A challenge to traditional concepts, Sports Med., 31, 533, 10.2165/00007256-200131070-00008 · DOI
- Okazaki, 2019, Iron insufficiency diminishes the erythropoietic response to moderate altitude exposure, J. Appl. Physiol. (1985), 127, 1569, 10.1152/japplphysiol.00115.2018 · DOI · Paper page
- Page, 2021, The PRISMA 2020 statement: An updated guideline for reporting systematic reviews, J. Clin. Epidemiol., 134, 178, 10.1016/j.jclinepi.2021.03.001 · DOI · Paper page
- Cordova, A., Mielgo-Ayuso, J., Fernandez-Lazaro, C.I., Caballero-Garcia, A., Roche, E., and Fernandez-Lazaro, D. (2019). Effect of Iron Supplementation on the Modulation of Iron Metabolism, Muscle Damage Biomarkers and Cortisol in Professional Cyclists. Nutrients, 11. · DOI
- Kasprowicz, K., Ratkowski, W., Wolyniec, W., Kaczmarczyk, M., Witek, K., Zmijewski, P., Renke, M., Jastrzebski, Z., Rosemann, T., and Nikolaidis, P.T. (2020). The Effect of Vitamin D(3) Supplementation on Hepcidin, Iron, and IL-6 Responses after a 100 km Ultra-Marathon. Int. J. Environ. Res. Public Health, 17. · DOI
- McCormick, 2019, The Impact of Morning versus Afternoon Exercise on Iron Absorption in Athletes, Med. Sci. Sports Exerc., 51, 2147, 10.1249/MSS.0000000000002026 · DOI
- Vuong, 2018, Intravenous Iron Does Not Augment the Hemoglobin Mass Response to Simulated Hypoxia, Med. Sci. Sports Exerc., 50, 1669, 10.1249/MSS.0000000000001608 · DOI · Paper page
- DellaValle, 2014, Iron supplementation improves energetic efficiency in iron-depleted female rowers, Med. Sci. Sports Exerc., 46, 1204, 10.1249/MSS.0000000000000208 · DOI · Paper page
- Woods, A., Garvican-Lewis, L.A., Saunders, P.U., Lovell, G., Hughes, D., Fazakerley, R., Anderson, B., Gore, C.J., and Thompson, K.G. (2014). Four weeks of IV iron supplementation reduces perceived fatigue and mood disturbance in distance runners. PLoS ONE, 9. · DOI
- Mielgo-Ayuso, J., Zourdos, M.C., Calleja-Gonzalez, J., Cordova, A., Fernandez-Lazaro, D., and Caballero-Garcia, A. (2018). Eleven Weeks of Iron Supplementation Does Not Maintain Iron Status for an Entire Competitive Season in Elite Female Volleyball Players: A Follow-Up Study. Nutrients, 10. · DOI
- Badenhorst, 2014, Influence of post-exercise hypoxic exposure on hepcidin response in athletes, Eur. J. Appl. Physiol., 114, 951, 10.1007/s00421-014-2829-6 · DOI
- Krzywanski, J., Mikulski, T., Pokrywka, A., Mlynczak, M., Krysztofiak, H., Fraczek, B., and Ziemba, A. (2020). Vitamin B(12) Status and Optimal Range for Hemoglobin Formation in Elite Athletes. Nutrients, 12. · DOI
- Mielgo-Ayuso, J., Calleja-Gonzalez, J., Urdampilleta, A., Leon-Guereno, P., Cordova, A., Caballero-Garcia, A., and Fernandez-Lazaro, D. (2018). Effects of Vitamin D Supplementation on Haematological Values and Muscle Recovery in Elite Male Traditional Rowers. Nutrients, 10. · DOI · Paper page
- Alon, 2002, Novel role of 1,25(OH)(2)D(3) in induction of erythroid progenitor cell proliferation, Exp. Hematol., 30, 403, 10.1016/S0301-472X(02)00789-0 · DOI · Paper page
- Thomas, 2015, Vitamin D status is inversely associated with anemia and serum erythropoietin during pregnancy, Am. J. Clin. Nutr., 102, 1088, 10.3945/ajcn.115.116756 · DOI
- Smith, 2017, High-dose vitamin D(3) reduces circulating hepcidin concentrations: A pilot, randomized, double-blind, placebo-controlled trial in healthy adults, Clin. Nutr., 36, 980, 10.1016/j.clnu.2016.06.015 · DOI · Paper page
- Hayashi, 2022, Influence of an energy deficient and low carbohydrate acute dietary manipulation on iron regulation in young females, Physiol. Rep., 10, e15351, 10.14814/phy2.15351 · DOI · Paper page
- Steensberg, 2001, Interleukin-6 production in contracting human skeletal muscle is influenced by pre-exercise muscle glycogen content, J. Physiol., 537, 633, 10.1111/j.1469-7793.2001.00633.x · DOI · Paper page
- Badenhorst, 2015, Acute dietary carbohydrate manipulation and the subsequent inflammatory and hepcidin responses to exercise, Eur. J. Appl. Physiol., 115, 2521, 10.1007/s00421-015-3252-3 · DOI · Paper page
- Barney, 2022, A Prolonged Bout of Running Increases Hepcidin and Decreases Dietary Iron Absorption in Trained Female and Male Runners, J. Nutr., 152, 2039, 10.1093/jn/nxac129 · DOI
- Zimmermann, 2009, Plasma hepcidin is a modest predictor of dietary iron bioavailability in humans, whereas oral iron loading, measured by stable-isotope appearance curves, increases plasma hepcidin, Am. J. Clin. Nutr., 90, 1280, 10.3945/ajcn.2009.28129 · DOI
- Ishibashi, A., Maeda, N., Kamei, A., and Goto, K. (2017). Iron Supplementation during Three Consecutive Days of Endurance Training Augmented Hepcidin Levels. Nutrients, 9. · DOI
- Hall, 2019, Single versus Split Dose of Iron Optimizes Hemoglobin Mass Gains at 2106 m Altitude, Med. Sci. Sports Exerc., 51, 751, 10.1249/MSS.0000000000001847 · DOI · Paper page
- Clarke, 2018, Iron monitoring of male and female rugby sevens players over an international season, J. Sports Med. Phys. Fitness, 58, 1490, 10.23736/S0022-4707.17.07363-7 · DOI
- Rodenberg, 2007, Iron as an ergogenic aid: Ironclad evidence?, Curr. Sports Med. Rep., 6, 258
- Grzywacz, 2017, Safety and Efficacy of Intravenous Administration of Iron Preparations, Acta Pol. Pharm., 74, 13
- Friedrisch, 2015, Intravenous ferric carboxymaltose for the treatment of iron deficiency anemia, Rev. Bras. Hematol. Hemoter., 37, 400, 10.1016/j.bjhh.2015.08.012 · DOI
- Girelli, 2018, Modern iron replacement therapy: Clinical and pathophysiological insights, Int. J. Hematol., 107, 16, 10.1007/s12185-017-2373-3 · DOI
- Burden, 2015, Is iron treatment beneficial in, iron-deficient but non-anaemic (IDNA) endurance athletes? A systematic review and meta-analysis, Br. J. Sports Med., 49, 1389, 10.1136/bjsports-2014-093624 · DOI · Paper page
- Karamizrak, 1996, Evaluation of iron metabolism indices and their relation with physical work capacity in athletes, Br. J. Sports Med., 30, 15, 10.1136/bjsm.30.1.15 · DOI
- Newhouse, 1989, The effects of prelatent/latent iron deficiency on physical work capacity, Med. Sci. Sports Exerc., 21, 263, 10.1249/00005768-198906000-00006 · DOI
- Magazanik, 1991, Effect of an iron supplement on body iron status and aerobic capacity of young training women, Eur. J. Appl. Physiol. Occup. Physiol., 62, 317, 10.1007/BF00634966 · DOI
- Nielsen, 1998, Iron supplementation in athletes. Current recommendations, Sports Med., 26, 207, 10.2165/00007256-199826040-00001 · DOI · Paper page
- Schechter, 2019, Iron Deficiency Anemia in Chronic Kidney Disease, Acta Haematol., 142, 44, 10.1159/000496492 · DOI · Paper page
- Eisenga, 2016, Definition of functional iron deficiency and intravenous iron supplementation, Lancet Haematol., 3, e504, 10.1016/S2352-3026(16)30152-1 · DOI
- Cullis, 2013, Anaemia of chronic disease, Clin. Med. (Lond), 13, 193, 10.7861/clinmedicine.13-2-193 · DOI
- Govus, 2017, Live high, train low—Influence on resting and post-exercise hepcidin levels, Scand. J. Med. Sci. Sports, 27, 704, 10.1111/sms.12685 · DOI
- Goetze, 2013, Adaptation of iron transport and metabolism to acute high-altitude hypoxia in mountaineers, Hepatology, 58, 2153, 10.1002/hep.26581 · DOI
- Piperno, 2009, Hepcidin modulation in human diseases: From research to clinic, World J. Gastroenterol., 15, 538, 10.3748/wjg.15.538 · DOI
- Mastrogiannaki, 2012, Hepatic hypoxia-inducible factor-2 down-regulates hepcidin expression in mice through an erythropoietin-mediated increase in erythropoiesis, Haematologica, 97, 827, 10.3324/haematol.2011.056119 · DOI
- Nemeth, 2009, The role of hepcidin in iron metabolism, Acta Haematol., 122, 78, 10.1159/000243791 · DOI · Paper page
- Hennigar, 2020, High-Altitude Acclimatization Suppresses Hepcidin Expression During Severe Energy Deficit, High Alt. Med. Biol., 21, 232, 10.1089/ham.2019.0109 · DOI
- Govus, 2014, Acute hypoxic exercise does not alter post-exercise iron metabolism in moderately trained endurance athletes, Eur. J. Appl. Physiol., 114, 2183, 10.1007/s00421-014-2938-2 · DOI · Paper page
- Basta, 2017, Effects of cranberry (Vaccinum macrocarpon) supplementation on iron status and inflammatory markers in rowers, J. Int. Soc. Sports Nutr., 14, 7, 10.1186/s12970-017-0165-z · DOI
- Denis, 2015, Prevention of oxidative stress, inflammation and mitochondrial dysfunction in the intestine by different cranberry phenolic fractions, Clin. Sci., 128, 197, 10.1042/CS20140210 · DOI
- Ceglia, 2008, Vitamin D and skeletal muscle tissue and function, Mol. Aspects Med., 29, 407, 10.1016/j.mam.2008.07.002 · DOI · Paper page
- Lappe, 2008, Calcium and vitamin d supplementation decreases incidence of stress fractures in female navy recruits, J. Bone Miner. Res., 23, 741, 10.1359/jbmr.080102 · DOI · Paper page
- Cannell, 2009, Athletic performance and vitamin D, Med. Sci. Sports Exerc., 41, 1102, 10.1249/MSS.0b013e3181930c2b · DOI · Paper page
- Castle, 1978, Megaloblastic anemia, Postgrad. Med., 64, 117, 10.1080/00325481.1978.11714952 · DOI
- Martinez, 2010, Testosterone and cortisol changes in professional basketball players through a season competition, J. Strength Cond. Res., 24, 1102, 10.1519/JSC.0b013e3181ce2423 · DOI
- Hackney, 2013, Hormonal adaptation and the stress of exercise training: The role of glucocorticoids, Trends Sport Sci., 20, 165
- Goto, K., Sumi, D., Kojima, C., and Ishibashi, A. (2017). Post-exercise serum hepcidin levels were unaffected by hypoxic exposure during prolonged exercise sessions. PLoS ONE, 12. · DOI
Cited by
Everett, S. (2025) · Nutrients · doi:10.3390/nu17172792 · Cited by 37
Alcock, R., Hislop, M., Vidgen, H. A., & Desbrow, B. (2024) · Journal of Functional Morphology and Kinesiology · doi:10.3390/jfmk9040221 · Cited by 33
Irwin, N., Ó Catháin, C., Ward, C., & Kelly, D. T. (2026) · Journal of the International Society of Sports Nutrition · doi:10.1080/15502783.2026.2671431 · Cited by 4
Metadata
- Authors
- Solberg, A., & Reikvam, H.
- Venue
- Life
- Publisher
- MDPI AG
- Published
- 2023-10-02
- Volume
- 13
- Issue
- 10
- Pages
- 2007
- ISSN
- 2075-1729
- Cited by
- 50
- References
- 20
- Language
- en
- Update notices
- correction (2023-10-02)
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