From the Guidelines
Iron deficiency without anemia can indeed cause symptoms, as iron plays a crucial role in various bodily functions beyond red blood cell production, including energy metabolism and immune function. According to the study published in the British Journal of Sports Medicine in 2021 1, iron deficiency, even without anemia, can have negative implications for aerobic performance and may present as lethargy and reduced performance.
Common Symptoms of Iron Deficiency without Anemia
- Fatigue
- Weakness
- Difficulty concentrating
- Headaches
- Hair loss
- Brittle nails
- Restless legs syndrome
- Increased susceptibility to infections
These symptoms occur because iron is an essential component of non-haem sulphur enzymes and haem-containing cytochromes involved in oxidative ATP production, as noted in the study 1. The study also highlights that postpubertal female players are at the highest risk of iron deficiency due to regular blood loss during menstrual bleeding and possibly due to a diet less rich in meat.
Diagnosis and Treatment
Iron deficiency is defined as low serum ferritin (<35 μg/L) and normal blood haemoglobin values, as stated in the study 1. A reasonable time frame for assessment of iron status is once per year in male players and twice per year in female players. For individuals with iron deficiency without anemia, a diet rich in iron, particularly red meat, is recommended to avoid the development of overt anemia and ensure that other haem-containing proteins/enzymes can be maintained at a sufficient level. Additionally, a period of iron supplementation may be considered at levels above the RDA after consultation with qualified medical and dietetic practitioners.
Dietary Recommendations
It is essential to consume iron from highly bioavailable sources, including meat and seafood, and to co-ingest vitamin C with non-haem iron sources to enhance absorption, as suggested in the study 1. Foods or fluids that impair iron absorption, such as tea and coffee, should be avoided around meal times. By prioritizing iron-rich foods and considering supplementation when necessary, individuals with iron deficiency without anemia can help alleviate symptoms and improve their overall quality of life.
From the Research
Iron Deficiency Without Anemia
Iron deficiency without anemia can cause various symptoms, including:
- Fatigue
- Reduced physiological endurance
- Difficulty in regulating temperature
- Decreased cognitive performance
- Unpleasant symptoms such as unexplained, non-specific symptoms 2, 3, 4, 5
Diagnosis and Treatment
Diagnosing iron deficiency without anemia relies on a combination of tests, including:
- Haemoglobin and ferritin levels
- Transferrin saturation 2 Treatment options include:
- Oral iron supplements as the first-line treatment 2, 5
- Intravenous iron supplementation for chronic inflammatory conditions, or when oral therapy is poorly tolerated or ineffective 2, 5
Clinical Features and Awareness
Iron deficiency without anemia is poorly recognized by clinicians despite its high prevalence 2 It is necessary to identify and manage the cause of the iron deficiency 5 Regular iron status assessment and awareness of the clinical consequences of impaired iron status are critical 4