Imagine feeling constantly exhausted, heavy, and unable to perform at your peak, despite being a professional athlete. This is the harsh reality for many female athletes, including Super Netball star Zara Walters, who battled these symptoms for years before discovering the root cause: iron deficiency. But here's where it gets controversial: while iron deficiency is often associated with diet, for athletes, the issue runs much deeper, involving physiological responses to intense training and even menstrual health. Could our current understanding of athlete nutrition be overlooking a critical piece of the puzzle?
Zara Walters, a Melbourne Vixens player, vividly recalls the relentless fatigue and heaviness in her legs that made training sessions feel like an uphill battle.
'I just didn’t feel right,' Walters shared with ABC Sport. 'Even resting was a struggle—I’d be trying to nap every 10 minutes. Recovery felt impossible.'
It wasn’t until blood tests at the Victorian Institute of Sport (VIS) revealed her iron deficiency that Walters found answers. 'It was such a relief to know it wasn’t about my fitness level,' she said. 'And even more relieving was learning that it’s manageable.'
Maintaining healthy iron levels is a constant challenge for athletes. Iron is essential for energy production, immune function, and cognitive sharpness. When levels drop, fatigue and poor performance follow. And this is the part most people miss: athletes, especially females, are at higher risk due to increased exercise, which can deplete iron stores, and menstrual blood loss. A recent study found that a staggering 35% of female athletes have low iron levels, compared to just 5% of the general population.
Dr. Susan White, VIS medical director, explains that exercise increases hepcidin, a substance that reduces iron absorption. 'Menstrual blood loss further compounds this issue for females,' she adds. Three years ago, VIS began proactively monitoring iron levels in female athletes, long-distance runners, and those in weight-controlled sports. The results were eye-opening: over 50% were iron deficient, far exceeding the expected 25-30%.
VIS implemented individualized plans, prioritizing a food-first approach with iron-rich foods like red meat, leafy greens, and lentils. Supplements and, in severe cases, iron infusions followed. Yet, restoring optimal iron levels took longer than anticipated—12 to 18 months for most athletes. 'It’s not a quick fix,' Dr. White emphasizes. 'Ongoing monitoring is crucial, as symptoms can be subtle and easily dismissed.'
Walters agrees, noting, 'It’s a slow build, but I can feel when my levels are dropping. I get heavy during sessions and feel weak in the gym—that’s when I know it’s time for another blood test.'
VIS’s proactive approach is paying off. They now test athletes annually, with high-risk individuals like Walters tested every three to six months. Over the past three years, they’ve averaged 30 iron infusions annually, mostly for females. While infusions carry risks like anaphylaxis and skin staining, athletes and coaches report significant improvements. 'Within a week, they’re training better, more alert, and no longer needing afternoon naps,' Dr. White notes.
But here’s the kicker: despite progress, some athletes still require infusions because diet and supplements alone aren’t enough. This raises questions: Are we doing enough to address this silent epidemic? Should iron deficiency screening be mandatory for all athletes? And what role should coaches and sports organizations play in prioritizing athlete health?
VIS is collaborating with La Trobe University to publish their findings, shedding light on the prevalence and persistence of iron deficiency. Dr. White’s key takeaway? 'It’s more common and harder to correct than we thought. It takes a village—doctors, nurses, nutritionists—and relentless follow-up.'
For Walters, proper management has been life-changing. 'My quality of life and training have improved dramatically,' she says. 'If you’re experiencing symptoms, get a blood test. It could be the game-changer you need.'
So, what’s your take? Is iron deficiency in athletes a neglected issue? How can we better support athletes in maintaining their health and performance? Share your thoughts below—let’s spark a conversation that could change the game.
