Sport Nutrition Education No. III - Learn More About Anaemia

What is Anaemia ?

Anaemia is most often manifested by a deficiency in the quantity of haemoglobin, or the size or number of red blood cells. Sports anaemia is most commonly seen in athletes, but only iron deficiency anaemia is directly related to diet.

Sports Anaemia

It is characterised by a below normal haemoglobin level. Possible causes are as follows:

plasma volume expansion,
reduced haemoglobin synthesis,
increased destruction of red blood cells (e.g. foot strike destroys red blood cells, especially in long distance running).

Other factors which increase the risk of sports anaemia include sudden increase in training volume or intensity, especially at the start of an intensive program. A diet low in iron aggravates the condition, but short term sports anaemia is an early adaptation to intense training and is not necessarily diet related.

Endurance athletes are susceptible to having a below normal haemoglobin level which may be due to an increase in plasma volume and does not always indicate the presence of anaemia.

Treatment depends on the cause and may include:

diet modification to match increased training
iron supplementation
modification of training intensity upon discussion with coach

Iron Deficiency Anaemia

The following conditions are present in individuals with this disease :

a below normal serum haemoglobin level
the average size of red blood cells are smaller than normal
blood with a lighter red colour than normal
the total haemoglobin concentration in red blood cells are fewer than normal

In addition, the following conditions may also be present :

a below normal serum ferritin
an increase in red cell protoporphyrin (RBCP)
a decrease in percent transferrin saturation

Causes of Iron Deficiency Anaemia

depleted iron stores
increased losses of iron (e.g. in urine, sweat, internal bleeding, injury, etc.)

Symptoms of Anaemia

Fatigue, paleness, increase incidence and duration of infection, mood changes, diminished appetite and decreased aerobic capacity.

Haemoglobin carries oxygen in the blood to muscles and other cells. Therefore, anaemia can affect sports performance, especially in athletes who engage in endurance events.

Sources of Dietary Iron

Haem iron	-	highly absorbable
	-	found in meat, seafood, poultry
Non-haem iron	-	less absorbable than haem iron
	-	found in cereal, beans, leafy vegetables and eggs

Major Sources of Dietary Iron

Breads and Cereals	Breakfast cereals, pasta, bread and baked goods which are made with iron fortified flour e.g. biscuits, pancakes etc.
Fruits and Vegetables	Broccoli, spinach, pak choy, Chinese kale, dried fruits like raisins, prunes
Meats, Beans and Bean Products	Red meat, liver, poultry, fish, oyster, clam, scallop, egg yolk, soybeans, tofu, kidney beans, lentils
Milk and Dairy Products	Iron fortified milk powder e.g. Carnation, Ensure, Sustacal, Enercal

Percentage of Iron in Food Absorbed by the Body

Food	Percentage of Iron Absorption
meat/seafood	10 - 20 %
eggs	1 - 3 %
rice	1 - 2 %

How to Increase Iron Intake and Absorption?

Increase iron content of food by cooking with iron cookware, e.g. an iron wok.
Limit use of foods containing inhibitors of iron absorption, e.g. tea, coffee, excessive dietary fibre, (e.g. from fibre supplements).
Increase the use of foods containing enhancers of iron absorption, e.g. vitamin C, food from animal sources.

Excessive Amounts of Iron May Have Detrimental Effects

Excessive iron intake is usually caused by taking supplements and not from food sources. Iron intake of 100 mg or more a day can interfere with the absorption of other minerals such as copper, zinc, causing deficiencies of these nutrients. Iron in excess will be deposited in liver cells causing symptoms of cirrhosis. It may also deposit in joints, pancreas, heart and lungs.

Iron is an important component in haemoglobin. A diet which is adaquate in iron can prevent iron deficiency anaemia.

If you feel abnormally tired during training and get sick easily, inform your coach and seek help from the Sport Nutritionist and Sport Biochemist to see if you are suffering from anaemia.

For more information, please contact:

Sport Nutrition Unit
Telephone: (852) 2681 6277

Sport Biochemistry Unit
Telephone: (852) 2681 6139