The Influence of Vegetarian Diets on Iron Metabolism and Supplementation in Female Athletes
Main Article Content
Keywords
serum ferritin, Bioavailable, deficiency
Abstract
Vegetarian diets are becoming more popular for their potential health and weight benefits along with religious, social, and environmental concerns. Many athletes have adopted vegetarian diets because they typically consist of higher intakes of fruit, vegetables, fiber, antioxidants, phytochemicals, and folic acid than traditional omnivore diets. The perception still exists though that vegetarian diets are deficient in several key nutrients, including iron. As a result, athletes consuming vegetarian diets are considered high risk for developing iron deficiency despite limited data. Research on vegetarian diets is limited and hard to synthesize and compare because of the many variations of the diet. Much of the research on iron deficiency in athletes and the general population combines all types of vegetarians into one classification and does not differentiate between the different diets. This makes it difficult to apply results and prevalence rates in a meaningful way. Regardless of diet type, total iron intake in vegetarians has been demonstrated to be similar or greater than that of non- vegetarians. Most females, including athletes, already do not reach the current RDA for iron regardless of vegetarian or omnivore diet, so nearly doubling that value could prove difficult for most female athletes to reach. The purpose of this review was to examine the potential effects a vegetarian diet can have on iron intake and metabolism to determine if vegetarian diets do impose an increased risk of iron deficiency. The focus will remain on female athletes due to the higher prevalence of iron deficiency in this population.
References
1. Yip, R. and P. Dallman, Iron, in Present Knowledge in Nutrition, E. Ziegler and L. Kiler, Editors. 1996, ILSI Press: Washington DC. p. 278- 292.
2. Abbaspour, N., R. Hurrell, and R. Kelishadi, Review on iron and its importance for human health. Journal of Research Medical Sciences, 2014. 19(2): p. 164-174.
3. Stoltzfus, R., Defining iron deficiency anemia in public health terms: a time for reflection. Journal of Nutrition, 2001. 131: p. 565S-567S.
4. Lombardi, G., G. Lippi, and G. Banfi, Iron Requirements and Iron Status of Athletes, in The Encyclopaedia of Sports Medicine. 2013. p. 229-241.
5. Risser, W.L., EJ; Poindexter, HBW; West, MS; Pivarnik, JM; Risser JMH; Hickson, JF, Iron deficiency in female athletes its prevalence and impact on performance. Medicine and Science in Sports and Exercise,
1988. 20(2): p. 116-121.
6. Rowland, T.B., SA; Kelleher, JF, Iron deficiency in adolescent
endurance athletes. Journal of Adolescent Health Care, 1987. 8(4): p.
322-326.
7. Suedekum, N.D., RJ, Iron and the Athlete. Current Sports Medicine
Reports, 2005. 4: p. 199-202.
8. Jenkinson, D. and A. Harbert, Supplements and Sports. American Family
Physician, 2008. 78: p. 1039-1046.
9. Beard, J. and B. Tobin, Iron status and exercise. The American Journal
of Clinical Nutrition, 2000. 72(Supplement): p. 594S-597S.
10. McClung, J.P., E. Gaffney-Stomberg, and J.J. Lee, Female athletes: a population at risk of vitamin and mineral deficiencies affecting health
and performance. J Trace Elem Med Biol, 2014. 28(4): p. 388-92.
11. Gropper, S.B., D; Dunham, K; Barksdale, JM, Iron status of female collegiate athletes involved in different sports. Biological Trace Element
Research, 2006. 109: p. 1-13.
12. Y asui, Y ., et al., Anemia in Female Collegiate Athletes: Association with
Hematological Variables, Physical Activity and Nutrition. British
Journal of Medicine and Medical Research, 2015. 7(10): p. 801-808.
13. Hinton, P., Iron and the endurance athlete. Applied Physiology,
Nutrition, and Metabolism, 2014. 39(9): p. 1012-1018.
14. Deldicque, L. and M. Francaux, Recommendations for Healthy Nutrition
in Female Endurance Runners: An Update. Front Nutr, 2015. 2: p. 17.
15. Coates, A.M., M; Burr, J, Incidence of Iron Deficiency and Iron Deficient Anemia in Elite Runners and Triathletes. Clin J Sport Med,
2017. 27: p. 493-498.
16. Wirnitzer, K., et al., Prevalence in running events and running
performance of endurance runners following a vegetarian or vegan diet compared to non-vegetarian endurance runners: the NURMI Study. Springerplus, 2016. 5: p. 458.
17. Larson-Meyer, D., Vegetarian Sports Nutrition. 2007, Champaign, IL: Human Kinetics.
18. Lis, D., et al., Exploring the popularity, experiences, and beliefs surrounding gluten-free diets in nonceliac athletes. International Journal of Sport Nutrition and Exercise Metabolism, 2015. 25: p. 37-45.
19. Leitzmann, C., Vegetarian nutrition: Past, present, future. American Journal of Clinical Nutrition, 2014. 100: p. 496S-502S.
20. Nieman, D., Physical fitness and veetarian diets is there a relation. American Journal of Clinical Nutrition, 1999. 70(Supplement): p. 570S- 575S.
21. Craig, W. and A. Mangels, Position of the American Dietetic Association: vegetarian diets. Journal of American Dietetic Association, 2009. 109(7): p. 1266-1282.
22. Dietetics;, A.o.N.a., D.o. Canada;, and A.C.o.S. Medicine, Position of Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and Athletic Performance. Journal of the Academy of Nutrition and Dietetics, 2016. 116: p. 501-528.
23. Cialdella-Kam, L., D. Kulpins, and M. Manore, Vegetarian, Gluten- Free, and Energy Restricted Diets in Female Athletes. Sports, 2016. 4(4).
24. Clarys, P., et al., Comparison of nutritional quality of the vegan, vegetarian, semi-vegetarian, pesco-vegetarian and omnivorous diet.
Nutrients, 2014. 6(3): p. 1318-32.
25. Pilis, W., et al., Health benefits and risk associated with adopting a
vegetarian diet. Rocz Panstw Zakl Hig, 2014. 65(1): p. 9-14.
26. Venderley, A.C., WW, Vegetarian diets nutritional considerations for
athletes. Sports Medicine, 2006. 36(4): p. 293-305.
27. Barr, S.I. and C.A. Rideout, Nutritional considerations for vegetarian
athletes. Nutrition, 2004. 20(7-8): p. 696-703.
28. Leitzmann, C., Vegetarian diets what are the advantages. Diet
Diversification and Health Promotion, 2005. 57: p. 147-156.
29. Barr, S. and T. Broughton, Relative weight, weight loss efforts and nutrient intakes among health-conscious vegetarian, past vegetarian and nonvegetarian women ages 18 to 50. Journal of the American College of
Nutrition, 2000. 19: p. 781-788.
30. Janelle, K. and S. Barr, Nutrient intakes and eating behavior scores of
vegetarian and nonvegetarian women. Journal of the American Dietetics
Association, 1995. 95(2): p. 180-189.
31. Alexander, D., M. Ball, and J. Mann, Nutrient intake and hematological
status of vegetarians and age-sex matched omnivores. European Journal
of Clinical Nutrition, 1994. 48(8): p. 538-546.
32. Haddad, E., et al., Dietary intake and biochemical, hematologic, and
immune status of vegans compared with nonvegetarians. The American
Journal of Clinical Nutrition, 1999. 70(Supplement): p. 586S-593S.
33. Larsson, C. and G. Johansson, Dietary intake and nutritional status of young vegans and omnivores in Sweden. The American Journal of
Clinical Nutrition, 2002. 76(1): p. 100-106.
34. Hunt, J., Bioavailability of iron, zinc, and other trace minerals from
vegetarian diets. American Journal of Clinical Nutrition, 2003. 78(3): p.
633S-639S.
35. Shaw, N., C. Chin, and W. Pan, A vegetarian diet rich in soybean
products compromises iron status in young students. The Journal of Nutrition, 1995. 125(2): p. 212-219.
36. Snyder, A., L. Dvorak, and J. Roepke, Influence of dietary iron source on measures of iron status among female runners. Medicine and Science
in Sports and Exercise, 1989. 21(1): p. 7-10.
37. Munoz, M., J.A. Garcia-Erce, and A.F. Remacha, Disorders of iron metabolism. Part 1: molecular basis of iron homoeostasis. J Clin Pathol,
2011. 64(4): p. 281-6.
38. McDowell, L., Minerals in Animal and Human Nutrition. 2 ed. 2003, Amsterdam: Elsevier Science.
39. Parnell, J.A., K.P. Wiens, and K.A. Erdman, Dietary Intakes and Supplement Use in Pre-Adolescent and Adolescent Canadian Athletes.
Nutrients, 2016. 8(9).
40. Koehler, K., et al., Iron status in elite young athletes: gender-dependent influences of diet and exercise. Eur J Appl Physiol, 2012. 112(2): p. 513- 23.
41. Gkouvatsos, K., G. Papanikolaou, and K. Pantopoulos, Regulation of iron transport and the role of transferrin. Biochimica et Biophysica Acta, 2012. 1820(3): p. 188-202.
42. Teucher, B., M. Olivares, and H. Cori, Enhancers of iron absorption: Ascorbic acid and other organic aids. International Journal for Vitamin and Nutrition Research, 2004. 74: p. 403-419.
43. Ballot, D., et al., The effects of fruit juices and fruits on the absorption of iron from a rice meal. British Journal of Nutrition, 1987. 57: p. 331- 343.
44. Hurrell, R. and I. Egli, Iron bioavailability and dietary reference values. Am J Clin Nutr, 2010. 91(5): p. 1461S-1467S.
45. Hunt, J. and Z. Roughead, Nonheme-iron absorption, fecal ferritin excretion, and blood indexes of iron status in women consuming controlled lactoovovegetarian diets for 8 wk. American Journal of Clinical Nutrition, 1999. 69(5): p. 944-952.
46. Oliveira, F., S. Rocha, and Fernandes, Iron Metabolism: From Health to Disease. Journal of Clinical Laboratory Analysis, 2014. 28: p. 210-218.
47. Lim, K., et al., Associations between dietary iron and zinc intakes, and between biochemical iron and zinc status in women. Nutrients, 2015.
7(4): p. 2983-99.
48. Nielsen, P. and D. Nachtigall, Iron Supplementation in Athletes. Sports Medicine, 1998. 26(4): p. 207-216.
49. Alaunyte, I., V. Stojceska, and A. Plunkett, Iron and the female athlete: a review of dietary treatment methods for improving iron status and
exercise performance. J Int Soc Sports Nutr, 2015. 12: p. 38.
50. Reinke, S., et al., Absolute and functional iron deficiency in professional athletes during training and recovery. Int J Cardiol, 2012. 156(2): p.
186-91.
51. Eichner, E., Pearls and Pitfalls: everyone needs iron. Current Sports Medicine Reports, 2012. 11(2): p. 50-51.
52. DellaValle, D., Iron Supplementation for Female Athletes Effects on Iron Status and Performance Outcomes. Current Sports Medicine Reports,
2013. 12(4): p. 234-239.
53. Parks, R.B., S.J. Hetzel, and M.A. Brooks, Iron Deficiency and Anemia among Collegiate Athletes: A Retrospective Chart Review. Med Sci
Sports Exerc, 2017. 49(8): p. 1711-1715.
54. Malczewska, J., W. Blach, and R. Stupnicki, The effects of physical exercise on the concentraions of ferritin and transferrin receptor in plasma of female judoists. International Journal of Sports Medicine, 2000. 21: p. 175-179.
55. Burden, R.J., et al., Is iron treatment beneficial in, iron-deficient but non- anaemic (IDNA) endurance athletes? A systematic review and meta- analysis. Br J Sports Med, 2015. 49(21): p. 1389-97.
56. Peeling, P., et al., Athletic induced iron deficiency: new insights into the role of inflammation, cytokines and hormones. European Journal of Applied Physiology, 2008. 103(4): p. 381-391.
57. McClung, J.P. and L.E. Murray-Kolb, Iron nutrition and premenopausal women: effects of poor iron status on physical and neuropsychological performance. Annu Rev Nutr, 2013. 33: p. 271-88.
58. Latunde-Dada, G.O., Iron metabolism in athletes--achieving a gold standard. Eur J Haematol, 2013. 90(1): p. 10-5.
59. Peeling, P., et al., Training surface and intensity: inflammation, hemolysis, and hepcidin expression. Medicine and Science in Sports and Exercise, 2009. 41(5): p. 1138-1145.
60. Brune, M., et al., Iron losses in sweat. American Journal of Clinical Nutrition, 1986. 43: p. 438-443.
61. Paulev, P.J., R; Pedersen, NS, Dermal excretion of iron in intensely training athlete. Clinica Chimica Acta, 1983. 127(1): p. 19-27.
62. Ishibashi, A., et al., Elevated Serum Hepcidin Levels during an Intensified Training Period in Well-Trained Female Long-Distance
Runners. Nutrients, 2017. 9(3).
63. Abarbanel, J., et al., Sports Hematuria. The Journal of Urology, 1990. 143(5): p. 887-890.
64. Blacklock, N., Bladder trauma in the long-distance runner. The American Journal of Sports Medicine, 1979. 7(4): p. 239-241.
65. Stewart, J., et al., Gastrointestinal Blood Loss and Anemia in Runners. Annals of Internal Medicine, 1984. 100(6): p. 843-845.
66. Fogoros, R., Runner's trot: Gastrointestinal disturbances in runners. JAMA, 1980. 243(17): p. 1743-1744.
67. Rudzki, S., H. Hazard, and D. Collinson, Gastrointestinal blood loss in triathletes: it's etiology and relationship to sports anemia. Australian
Journal of Science and Medicine in Sport, 1995. 27(1): p. 3-8.
68. Sim, M., et al., Iron regulation in athletes: exploring the menstrual cycle and effects of different exercise modalities on hepcidin production. Int J Sport Nutr Exerc Metab, 2014. 24(2): p. 177-87.
69. Chinevere, T., et al., Effect of heat acclimation on sweat minerals. Medicine and Science in Sports and Exercise, 2008. 40(5): p. 886-891.
70. Ehn, L., B. Carlmark, and S. Hoglund, Iron status in athletes involved in intense physical activity. Medicine and Science in Sports and Exercise,
1980. 12: p. 61-64.
71. Rossi, K.A., Nutritional Aspects of the Female Athlete. Clin Sports Med, 2017. 36(4): p. 627-653.
72. Nickerson, H.H., MC; Weiler, BR; Haas RG; Schwartz, S; Ellefson, ME, Causes of iron deficiency in adolescent athletes. The Journal of
Pediatrics, 1989. 114(4): p. 657-663.
73. Brown, R., et al., Iron status of adolescent female athletes. Journal of Adolescent Health Care, 1985. 6(5): p. 349-352.
74. Clement, D. and R. Asmundson, Nutritional intake and hematological parameters in endurance runners. Phys Sportsmed, 1982. 10: p. 37-43.
75. Plowman, S. and P. McSwegin, The effects of iron supplementation in female cross country runners. Journal of Sports Medicine, 1981. 21(4):
p. 407-416.
76. Nieman, D., Vegetarian dietary practices and endurance performance. American Journal of Clinical Nutrition, 1988. 48: p. 754-761.
77. Taylor, W. and J. Lombardo, Preparticipation screening of college athletes: value of complete blood cell count. The Physician and
Sportsmedicine, 1990. 18(6): p. 106-118.
78. Milic, R., et al., Haematological and iron-related parameters in male and female athletes according to different metabolic energy demands.
European Journal of Applied Physiology, 2011. 111(3): p. 449-458.
79. DellaValle, D. and J. Haas, Impact of Iron Depletion Without Anemia on Performance in Trained Endurance Athletes at the Beginning of a Training Season: A Study of Female Collegiate Rowers. International Journal of Sport Nutrition and Exercise Metabolism, 2011. 21(6): p. 501-
506.
80. Di Santolo, M., et al., Anemia and iron status in young fertile non- professional female athletes. European Journal of Applied Physiology, 2008. 102(6): p. 703-709.
81. Ostojic, S. and Z. Ahmetovic, Weekly training volume and hematological status in female top-level athletes of different sports. Journal of Sports Medicine and Physical Fitness, 2008. 48(3): p. 398- 403.
82. Seiler, D., et al., Effects of long-distance running on iron metabolism and hematological parameters. International Journal of Sports Medicine, 1989. 10: p. 357-362.
83. Waldmann, A., et al., Dietary iron intake and iron status of german female vegans: results of the German Vegan Study. Annals of Nutrition and Metabolism, 2004. 48: p. 103-108.
84. Haider, L.M., et al., The effect of vegetarian diets on iron status in adults: A systematic review and meta-analysis. Critical Reviews in Food Science and Nutrition, 2016: p. 1-16.
85. Saunders, A., et al., Iron and vegetarian diets. The Medical Journal of Australia, 2013. 199(4 Supplement): p. S11-S16.
86. Hanne, N., R. Dlin, and A. Rotstein, Physical fitness, anthropometric and metabolic parameters in vegetarian athletes. Journal of Sports Medicine and Physical Fitness, 1986. 26(2): p. 180-185.
87. Eisinger, M., et al., Nutrient intake of endurance runners with lacto-ovo- vegetarian diet and regular western diet. European Journal of Nutrition, 1994. 33(3): p. 217-229.
88. Lynch, H.M., C.M. Wharton, and C.S. Johnston, Cardiorespiratory Fitness and Peak Torque Differences between Vegetarian and Omnivore Endurance Athletes: A Cross-Sectional Study. Nutrients, 2016. 8(11).
89. Craddock, J., Y . Probst, and G. Peoples, V egetarian and Omnivorous Nutrition - Comparing Physical Performance. International Journal of Sport Nutrition and Exercise Metabolism, 2016. 26: p. 212-220.
90. Rodriguez, N., N. Di MArco, and S. Langley, American College of Sports Medicine position stand. Nutrition and athletic performance. Med Sci Sports Exerc, 2009. 41(709-731).
91. Alaunyte, I.S., V; Plunkett, A; Derbyshire, E, Dietary iron intervention using a staple food product for improvement of iron status in female runners. Journal of the International Society of Sports Nutrition, 2014. 11.
92. Peeling, P.B., T; Goodman, C; Dawson, B; Claydon, G; Beilby, J; Prins, A, Effect of Iron Injections on Aerobic-Exercise Performance of Iron- Depleted Female Athletes. International Journal of Sport Nutrition and Exercise Metabolism, 2007. 17: p. 221-231.
93. Fuhrman, J.F., DM, Fueling the Vegetarian Athlete. Current Sports Medicine Reports, 2010. 9(4): p. 233-241.
94. Leonard, A.J., et al., The effect of nutrition knowledge and dietary iron intake on iron status in young women. Appetite, 2014. 81: p. 225-31.
95. Gera, T., H.S. Sachdev, and E. Boy, Effect of iron-fortified foods on hematologic and biological outcomes: systematic review of randomized controlled trials. Am J Clin Nutr, 2012. 96(2): p. 309-24.
96. Fogelholm, M., L. Jaakkola, and T. Lampisjarvi, Effects of iron supplementation in female athletes with low serum ferritin concentration. International Journal of Sports Medicine, 192. 13(2): p. 158-162.
97. Schoene, R., et al., 1983 Iron repletion decreases maximal exercise lactate concentrations in female athletes with minimal iron-deficiency anemia. J Lab Clin Med, 1983. 102(2): p. 306-312.
98. Hinton, P.S. and L.M. Sinclair, Iron supplementation maintains ventilatory threshold and improves energetic efficiency in iron-deficient nonanemic athletes. Eur J Clin Nutr, 2007. 61(1): p. 30-9.
99. Friedmann, B.W ., E; Mairbaurl, H; Bartsch, P , Effects of iron repletion on blood volume and performance capacity in young athletes. Med Sci Sports Exerc, 2001. 33(5): p. 741-746.
100. Ljungqvist, A., et al., The International Olympic Committee (IOC) Consensus Statement on periodic health evaluation of elite athletes March 2009. British Journal of Sports Medicine, 2009. 43(9): p. 631- 643.
101. Cowell, B., et al., Policies on screening female atheltes for iron deficiency in NCAA division I-A institutions. International Journal of Sport Nutrition and Exercise Metabolism, 2003. 13(3): p. 277-285.
102. Roecker, L., et al., Iron-regulatory protein hepcidin is increased in female athletes after a marathon. Eur J Appl Physiol, 2005. 95(5-6): p. 569-71.
103. Peeling, P., et al., Iron status and the acute post-exercise hepcidin response in athletes. PLoS One, 2014. 9(3): p. e93002.
104. Sandstrom, G., et al., Increased Level of Serum Hepcidin in Female Adolescent Athletes. Clin J Sport Med, 2017.
2. Abbaspour, N., R. Hurrell, and R. Kelishadi, Review on iron and its importance for human health. Journal of Research Medical Sciences, 2014. 19(2): p. 164-174.
3. Stoltzfus, R., Defining iron deficiency anemia in public health terms: a time for reflection. Journal of Nutrition, 2001. 131: p. 565S-567S.
4. Lombardi, G., G. Lippi, and G. Banfi, Iron Requirements and Iron Status of Athletes, in The Encyclopaedia of Sports Medicine. 2013. p. 229-241.
5. Risser, W.L., EJ; Poindexter, HBW; West, MS; Pivarnik, JM; Risser JMH; Hickson, JF, Iron deficiency in female athletes its prevalence and impact on performance. Medicine and Science in Sports and Exercise,
1988. 20(2): p. 116-121.
6. Rowland, T.B., SA; Kelleher, JF, Iron deficiency in adolescent
endurance athletes. Journal of Adolescent Health Care, 1987. 8(4): p.
322-326.
7. Suedekum, N.D., RJ, Iron and the Athlete. Current Sports Medicine
Reports, 2005. 4: p. 199-202.
8. Jenkinson, D. and A. Harbert, Supplements and Sports. American Family
Physician, 2008. 78: p. 1039-1046.
9. Beard, J. and B. Tobin, Iron status and exercise. The American Journal
of Clinical Nutrition, 2000. 72(Supplement): p. 594S-597S.
10. McClung, J.P., E. Gaffney-Stomberg, and J.J. Lee, Female athletes: a population at risk of vitamin and mineral deficiencies affecting health
and performance. J Trace Elem Med Biol, 2014. 28(4): p. 388-92.
11. Gropper, S.B., D; Dunham, K; Barksdale, JM, Iron status of female collegiate athletes involved in different sports. Biological Trace Element
Research, 2006. 109: p. 1-13.
12. Y asui, Y ., et al., Anemia in Female Collegiate Athletes: Association with
Hematological Variables, Physical Activity and Nutrition. British
Journal of Medicine and Medical Research, 2015. 7(10): p. 801-808.
13. Hinton, P., Iron and the endurance athlete. Applied Physiology,
Nutrition, and Metabolism, 2014. 39(9): p. 1012-1018.
14. Deldicque, L. and M. Francaux, Recommendations for Healthy Nutrition
in Female Endurance Runners: An Update. Front Nutr, 2015. 2: p. 17.
15. Coates, A.M., M; Burr, J, Incidence of Iron Deficiency and Iron Deficient Anemia in Elite Runners and Triathletes. Clin J Sport Med,
2017. 27: p. 493-498.
16. Wirnitzer, K., et al., Prevalence in running events and running
performance of endurance runners following a vegetarian or vegan diet compared to non-vegetarian endurance runners: the NURMI Study. Springerplus, 2016. 5: p. 458.
17. Larson-Meyer, D., Vegetarian Sports Nutrition. 2007, Champaign, IL: Human Kinetics.
18. Lis, D., et al., Exploring the popularity, experiences, and beliefs surrounding gluten-free diets in nonceliac athletes. International Journal of Sport Nutrition and Exercise Metabolism, 2015. 25: p. 37-45.
19. Leitzmann, C., Vegetarian nutrition: Past, present, future. American Journal of Clinical Nutrition, 2014. 100: p. 496S-502S.
20. Nieman, D., Physical fitness and veetarian diets is there a relation. American Journal of Clinical Nutrition, 1999. 70(Supplement): p. 570S- 575S.
21. Craig, W. and A. Mangels, Position of the American Dietetic Association: vegetarian diets. Journal of American Dietetic Association, 2009. 109(7): p. 1266-1282.
22. Dietetics;, A.o.N.a., D.o. Canada;, and A.C.o.S. Medicine, Position of Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and Athletic Performance. Journal of the Academy of Nutrition and Dietetics, 2016. 116: p. 501-528.
23. Cialdella-Kam, L., D. Kulpins, and M. Manore, Vegetarian, Gluten- Free, and Energy Restricted Diets in Female Athletes. Sports, 2016. 4(4).
24. Clarys, P., et al., Comparison of nutritional quality of the vegan, vegetarian, semi-vegetarian, pesco-vegetarian and omnivorous diet.
Nutrients, 2014. 6(3): p. 1318-32.
25. Pilis, W., et al., Health benefits and risk associated with adopting a
vegetarian diet. Rocz Panstw Zakl Hig, 2014. 65(1): p. 9-14.
26. Venderley, A.C., WW, Vegetarian diets nutritional considerations for
athletes. Sports Medicine, 2006. 36(4): p. 293-305.
27. Barr, S.I. and C.A. Rideout, Nutritional considerations for vegetarian
athletes. Nutrition, 2004. 20(7-8): p. 696-703.
28. Leitzmann, C., Vegetarian diets what are the advantages. Diet
Diversification and Health Promotion, 2005. 57: p. 147-156.
29. Barr, S. and T. Broughton, Relative weight, weight loss efforts and nutrient intakes among health-conscious vegetarian, past vegetarian and nonvegetarian women ages 18 to 50. Journal of the American College of
Nutrition, 2000. 19: p. 781-788.
30. Janelle, K. and S. Barr, Nutrient intakes and eating behavior scores of
vegetarian and nonvegetarian women. Journal of the American Dietetics
Association, 1995. 95(2): p. 180-189.
31. Alexander, D., M. Ball, and J. Mann, Nutrient intake and hematological
status of vegetarians and age-sex matched omnivores. European Journal
of Clinical Nutrition, 1994. 48(8): p. 538-546.
32. Haddad, E., et al., Dietary intake and biochemical, hematologic, and
immune status of vegans compared with nonvegetarians. The American
Journal of Clinical Nutrition, 1999. 70(Supplement): p. 586S-593S.
33. Larsson, C. and G. Johansson, Dietary intake and nutritional status of young vegans and omnivores in Sweden. The American Journal of
Clinical Nutrition, 2002. 76(1): p. 100-106.
34. Hunt, J., Bioavailability of iron, zinc, and other trace minerals from
vegetarian diets. American Journal of Clinical Nutrition, 2003. 78(3): p.
633S-639S.
35. Shaw, N., C. Chin, and W. Pan, A vegetarian diet rich in soybean
products compromises iron status in young students. The Journal of Nutrition, 1995. 125(2): p. 212-219.
36. Snyder, A., L. Dvorak, and J. Roepke, Influence of dietary iron source on measures of iron status among female runners. Medicine and Science
in Sports and Exercise, 1989. 21(1): p. 7-10.
37. Munoz, M., J.A. Garcia-Erce, and A.F. Remacha, Disorders of iron metabolism. Part 1: molecular basis of iron homoeostasis. J Clin Pathol,
2011. 64(4): p. 281-6.
38. McDowell, L., Minerals in Animal and Human Nutrition. 2 ed. 2003, Amsterdam: Elsevier Science.
39. Parnell, J.A., K.P. Wiens, and K.A. Erdman, Dietary Intakes and Supplement Use in Pre-Adolescent and Adolescent Canadian Athletes.
Nutrients, 2016. 8(9).
40. Koehler, K., et al., Iron status in elite young athletes: gender-dependent influences of diet and exercise. Eur J Appl Physiol, 2012. 112(2): p. 513- 23.
41. Gkouvatsos, K., G. Papanikolaou, and K. Pantopoulos, Regulation of iron transport and the role of transferrin. Biochimica et Biophysica Acta, 2012. 1820(3): p. 188-202.
42. Teucher, B., M. Olivares, and H. Cori, Enhancers of iron absorption: Ascorbic acid and other organic aids. International Journal for Vitamin and Nutrition Research, 2004. 74: p. 403-419.
43. Ballot, D., et al., The effects of fruit juices and fruits on the absorption of iron from a rice meal. British Journal of Nutrition, 1987. 57: p. 331- 343.
44. Hurrell, R. and I. Egli, Iron bioavailability and dietary reference values. Am J Clin Nutr, 2010. 91(5): p. 1461S-1467S.
45. Hunt, J. and Z. Roughead, Nonheme-iron absorption, fecal ferritin excretion, and blood indexes of iron status in women consuming controlled lactoovovegetarian diets for 8 wk. American Journal of Clinical Nutrition, 1999. 69(5): p. 944-952.
46. Oliveira, F., S. Rocha, and Fernandes, Iron Metabolism: From Health to Disease. Journal of Clinical Laboratory Analysis, 2014. 28: p. 210-218.
47. Lim, K., et al., Associations between dietary iron and zinc intakes, and between biochemical iron and zinc status in women. Nutrients, 2015.
7(4): p. 2983-99.
48. Nielsen, P. and D. Nachtigall, Iron Supplementation in Athletes. Sports Medicine, 1998. 26(4): p. 207-216.
49. Alaunyte, I., V. Stojceska, and A. Plunkett, Iron and the female athlete: a review of dietary treatment methods for improving iron status and
exercise performance. J Int Soc Sports Nutr, 2015. 12: p. 38.
50. Reinke, S., et al., Absolute and functional iron deficiency in professional athletes during training and recovery. Int J Cardiol, 2012. 156(2): p.
186-91.
51. Eichner, E., Pearls and Pitfalls: everyone needs iron. Current Sports Medicine Reports, 2012. 11(2): p. 50-51.
52. DellaValle, D., Iron Supplementation for Female Athletes Effects on Iron Status and Performance Outcomes. Current Sports Medicine Reports,
2013. 12(4): p. 234-239.
53. Parks, R.B., S.J. Hetzel, and M.A. Brooks, Iron Deficiency and Anemia among Collegiate Athletes: A Retrospective Chart Review. Med Sci
Sports Exerc, 2017. 49(8): p. 1711-1715.
54. Malczewska, J., W. Blach, and R. Stupnicki, The effects of physical exercise on the concentraions of ferritin and transferrin receptor in plasma of female judoists. International Journal of Sports Medicine, 2000. 21: p. 175-179.
55. Burden, R.J., et al., Is iron treatment beneficial in, iron-deficient but non- anaemic (IDNA) endurance athletes? A systematic review and meta- analysis. Br J Sports Med, 2015. 49(21): p. 1389-97.
56. Peeling, P., et al., Athletic induced iron deficiency: new insights into the role of inflammation, cytokines and hormones. European Journal of Applied Physiology, 2008. 103(4): p. 381-391.
57. McClung, J.P. and L.E. Murray-Kolb, Iron nutrition and premenopausal women: effects of poor iron status on physical and neuropsychological performance. Annu Rev Nutr, 2013. 33: p. 271-88.
58. Latunde-Dada, G.O., Iron metabolism in athletes--achieving a gold standard. Eur J Haematol, 2013. 90(1): p. 10-5.
59. Peeling, P., et al., Training surface and intensity: inflammation, hemolysis, and hepcidin expression. Medicine and Science in Sports and Exercise, 2009. 41(5): p. 1138-1145.
60. Brune, M., et al., Iron losses in sweat. American Journal of Clinical Nutrition, 1986. 43: p. 438-443.
61. Paulev, P.J., R; Pedersen, NS, Dermal excretion of iron in intensely training athlete. Clinica Chimica Acta, 1983. 127(1): p. 19-27.
62. Ishibashi, A., et al., Elevated Serum Hepcidin Levels during an Intensified Training Period in Well-Trained Female Long-Distance
Runners. Nutrients, 2017. 9(3).
63. Abarbanel, J., et al., Sports Hematuria. The Journal of Urology, 1990. 143(5): p. 887-890.
64. Blacklock, N., Bladder trauma in the long-distance runner. The American Journal of Sports Medicine, 1979. 7(4): p. 239-241.
65. Stewart, J., et al., Gastrointestinal Blood Loss and Anemia in Runners. Annals of Internal Medicine, 1984. 100(6): p. 843-845.
66. Fogoros, R., Runner's trot: Gastrointestinal disturbances in runners. JAMA, 1980. 243(17): p. 1743-1744.
67. Rudzki, S., H. Hazard, and D. Collinson, Gastrointestinal blood loss in triathletes: it's etiology and relationship to sports anemia. Australian
Journal of Science and Medicine in Sport, 1995. 27(1): p. 3-8.
68. Sim, M., et al., Iron regulation in athletes: exploring the menstrual cycle and effects of different exercise modalities on hepcidin production. Int J Sport Nutr Exerc Metab, 2014. 24(2): p. 177-87.
69. Chinevere, T., et al., Effect of heat acclimation on sweat minerals. Medicine and Science in Sports and Exercise, 2008. 40(5): p. 886-891.
70. Ehn, L., B. Carlmark, and S. Hoglund, Iron status in athletes involved in intense physical activity. Medicine and Science in Sports and Exercise,
1980. 12: p. 61-64.
71. Rossi, K.A., Nutritional Aspects of the Female Athlete. Clin Sports Med, 2017. 36(4): p. 627-653.
72. Nickerson, H.H., MC; Weiler, BR; Haas RG; Schwartz, S; Ellefson, ME, Causes of iron deficiency in adolescent athletes. The Journal of
Pediatrics, 1989. 114(4): p. 657-663.
73. Brown, R., et al., Iron status of adolescent female athletes. Journal of Adolescent Health Care, 1985. 6(5): p. 349-352.
74. Clement, D. and R. Asmundson, Nutritional intake and hematological parameters in endurance runners. Phys Sportsmed, 1982. 10: p. 37-43.
75. Plowman, S. and P. McSwegin, The effects of iron supplementation in female cross country runners. Journal of Sports Medicine, 1981. 21(4):
p. 407-416.
76. Nieman, D., Vegetarian dietary practices and endurance performance. American Journal of Clinical Nutrition, 1988. 48: p. 754-761.
77. Taylor, W. and J. Lombardo, Preparticipation screening of college athletes: value of complete blood cell count. The Physician and
Sportsmedicine, 1990. 18(6): p. 106-118.
78. Milic, R., et al., Haematological and iron-related parameters in male and female athletes according to different metabolic energy demands.
European Journal of Applied Physiology, 2011. 111(3): p. 449-458.
79. DellaValle, D. and J. Haas, Impact of Iron Depletion Without Anemia on Performance in Trained Endurance Athletes at the Beginning of a Training Season: A Study of Female Collegiate Rowers. International Journal of Sport Nutrition and Exercise Metabolism, 2011. 21(6): p. 501-
506.
80. Di Santolo, M., et al., Anemia and iron status in young fertile non- professional female athletes. European Journal of Applied Physiology, 2008. 102(6): p. 703-709.
81. Ostojic, S. and Z. Ahmetovic, Weekly training volume and hematological status in female top-level athletes of different sports. Journal of Sports Medicine and Physical Fitness, 2008. 48(3): p. 398- 403.
82. Seiler, D., et al., Effects of long-distance running on iron metabolism and hematological parameters. International Journal of Sports Medicine, 1989. 10: p. 357-362.
83. Waldmann, A., et al., Dietary iron intake and iron status of german female vegans: results of the German Vegan Study. Annals of Nutrition and Metabolism, 2004. 48: p. 103-108.
84. Haider, L.M., et al., The effect of vegetarian diets on iron status in adults: A systematic review and meta-analysis. Critical Reviews in Food Science and Nutrition, 2016: p. 1-16.
85. Saunders, A., et al., Iron and vegetarian diets. The Medical Journal of Australia, 2013. 199(4 Supplement): p. S11-S16.
86. Hanne, N., R. Dlin, and A. Rotstein, Physical fitness, anthropometric and metabolic parameters in vegetarian athletes. Journal of Sports Medicine and Physical Fitness, 1986. 26(2): p. 180-185.
87. Eisinger, M., et al., Nutrient intake of endurance runners with lacto-ovo- vegetarian diet and regular western diet. European Journal of Nutrition, 1994. 33(3): p. 217-229.
88. Lynch, H.M., C.M. Wharton, and C.S. Johnston, Cardiorespiratory Fitness and Peak Torque Differences between Vegetarian and Omnivore Endurance Athletes: A Cross-Sectional Study. Nutrients, 2016. 8(11).
89. Craddock, J., Y . Probst, and G. Peoples, V egetarian and Omnivorous Nutrition - Comparing Physical Performance. International Journal of Sport Nutrition and Exercise Metabolism, 2016. 26: p. 212-220.
90. Rodriguez, N., N. Di MArco, and S. Langley, American College of Sports Medicine position stand. Nutrition and athletic performance. Med Sci Sports Exerc, 2009. 41(709-731).
91. Alaunyte, I.S., V; Plunkett, A; Derbyshire, E, Dietary iron intervention using a staple food product for improvement of iron status in female runners. Journal of the International Society of Sports Nutrition, 2014. 11.
92. Peeling, P.B., T; Goodman, C; Dawson, B; Claydon, G; Beilby, J; Prins, A, Effect of Iron Injections on Aerobic-Exercise Performance of Iron- Depleted Female Athletes. International Journal of Sport Nutrition and Exercise Metabolism, 2007. 17: p. 221-231.
93. Fuhrman, J.F., DM, Fueling the Vegetarian Athlete. Current Sports Medicine Reports, 2010. 9(4): p. 233-241.
94. Leonard, A.J., et al., The effect of nutrition knowledge and dietary iron intake on iron status in young women. Appetite, 2014. 81: p. 225-31.
95. Gera, T., H.S. Sachdev, and E. Boy, Effect of iron-fortified foods on hematologic and biological outcomes: systematic review of randomized controlled trials. Am J Clin Nutr, 2012. 96(2): p. 309-24.
96. Fogelholm, M., L. Jaakkola, and T. Lampisjarvi, Effects of iron supplementation in female athletes with low serum ferritin concentration. International Journal of Sports Medicine, 192. 13(2): p. 158-162.
97. Schoene, R., et al., 1983 Iron repletion decreases maximal exercise lactate concentrations in female athletes with minimal iron-deficiency anemia. J Lab Clin Med, 1983. 102(2): p. 306-312.
98. Hinton, P.S. and L.M. Sinclair, Iron supplementation maintains ventilatory threshold and improves energetic efficiency in iron-deficient nonanemic athletes. Eur J Clin Nutr, 2007. 61(1): p. 30-9.
99. Friedmann, B.W ., E; Mairbaurl, H; Bartsch, P , Effects of iron repletion on blood volume and performance capacity in young athletes. Med Sci Sports Exerc, 2001. 33(5): p. 741-746.
100. Ljungqvist, A., et al., The International Olympic Committee (IOC) Consensus Statement on periodic health evaluation of elite athletes March 2009. British Journal of Sports Medicine, 2009. 43(9): p. 631- 643.
101. Cowell, B., et al., Policies on screening female atheltes for iron deficiency in NCAA division I-A institutions. International Journal of Sport Nutrition and Exercise Metabolism, 2003. 13(3): p. 277-285.
102. Roecker, L., et al., Iron-regulatory protein hepcidin is increased in female athletes after a marathon. Eur J Appl Physiol, 2005. 95(5-6): p. 569-71.
103. Peeling, P., et al., Iron status and the acute post-exercise hepcidin response in athletes. PLoS One, 2014. 9(3): p. e93002.
104. Sandstrom, G., et al., Increased Level of Serum Hepcidin in Female Adolescent Athletes. Clin J Sport Med, 2017.
Article Sidebar
Published
Jan 12, 2018
Article Details
How to Cite
The Influence of Vegetarian Diets on Iron Metabolism and Supplementation in Female Athletes . (2018). Journal of Exercise and Nutrition, 1(1). https://www.journalofexerciseandnutrition.com/index.php/JEN/article/view/7
Issue
Section
Articles
This work is licensed under a Creative Commons Attribution 4.0 International License.
Copyright, 2025 by the authors. This work is licensed under the Creative Commons Attribution 4.0 International License.
How to Cite
The Influence of Vegetarian Diets on Iron Metabolism and Supplementation in Female Athletes . (2018). Journal of Exercise and Nutrition, 1(1). https://www.journalofexerciseandnutrition.com/index.php/JEN/article/view/7