Let's be honest, copper is not exactly the mineral everyone is talking about. But maybe it should be. While iron, magnesium and zinc tend to hog the spotlight, copper is quietly doing some seriously important work in the background. For active women especially, getting enough of this trace mineral can make a real difference to how you feel, move and recover. Here are the five benefits worth knowing about.

1. It Helps Your Body Actually Use Iron

This one is a game-changer. Copper produces an enzyme called ceruloplasmin, which converts iron into the form your body can transport through the bloodstream and use to make red blood cells.¹ No copper, no iron transport, it really is that simple.

So if you have been diligently supplementing iron but your ferritin is still stubbornly low, copper could be the missing piece. Up to 35% of active women experience some form of iron deficiency,² and copper-iron dysregulation may be quietly contributing to many of those cases. Worth checking!

2. It Powers Your Energy From the Inside Out

Feeling flat even when you are sleeping well and eating right? Copper plays a direct role in ATP production, the energy your mitochondria generate to fuel every workout and every busy day.³ Without enough copper, your cellular energy engine simply does not run as efficiently as it should.

Consider it like a mechanic keeping your engine tuned. You will not necessarily feel copper working, but you will notice when it is missing.

3. It Supports Hormonal Health

Here is the link that often gets overlooked. Copper influences the balance between oestrogen and progesterone, and high oestrogen levels. Elevated copper in the body can occur from the oral contraceptive pill, perimenopause fluctuations or oestrogen dominance.⁴ Conversely, low copper has been associated with thyroid disruption and poor adrenal resilience.

For active women navigating hormonal shifts or managing symptoms like mood changes, irregular cycles or low libido, getting copper tested alongside a full hormone panel is a smart move.

4. It Keeps Your Joints and Connective Tissue Strong

If you run, lift or train regularly, your tendons, ligaments and joints take a beating. Copper activates an enzyme called lysyl oxidase, which supports the structural proteins responsible for building and maintaining strong collagen, elastin and wound healing.³

Low copper means weaker connective tissue, which can show up as niggling injuries, poor joint stability or slower recovery from training loads. Think of copper as your body's internal scaffolding crew.

5. It Speeds Up Recovery and Fights Inflammation

Hard training creates oxidative stress — essentially, free radicals that damage cells and slow recovery. Copper activates superoxide dismutase (SOD), one of the body's most powerful antioxidant enzymes, which neutralises these free radicals before they cause lasting damage.⁵

Research in athletes has shown that trace element status, including copper, is directly associated with oxidative stress markers and recovery capacity.⁵ Less oxidative damage means less soreness, faster repair and better adaptation to training over time.

So How Much Do You Need?

The Australian RDI for copper in adult women is 1.2 mg/day,⁶ which most women can meet through a varied whole-food diet. Top sources include oysters, beef liver, cashews, sunflower seeds, dark chocolate and lentils. Our apricot bliss balls are a great copper rich snack!

If you are taking high-dose zinc (which competes with copper for absorption), supplementing iron without improvement, or on the pill, it is worth asking your practitioner to check your serum copper and ceruloplasmin levels alongside your next blood test.^1,4

Small mineral, big impact. Do not overlook it.

Benefits of nondigestible fermentable carbohydrates in sports nutrition and gut health

The fermentation of nondigestible carbohydrates leads to several health benefits:

• Enhanced Digestion: SCFAs, such as butyrate, fuel the cells lining the colon, promoting efficient nutrient absorption and a robust gut barrier.
• Balanced Microbiome: Feeding beneficial bacteria helps maintain diversity, stability and a harmonious gut environment, preventing the overgrowth of harmful microbes.
• Reduced Inflammation: SCFAs possess anti-inflammatory properties, which can alleviate symptoms of gastrointestinal disorders such as irritable bowel syndrome (IBS), affecting 30% of the Australian population.
• Reduce symptoms: Fibre can significantly reduce gastrointestinal distress, such as constipation and bloating. Athletes often subject their bodies to intense physical stress, which can inadvertently impact gut health. High-protein diets, common among athletes, may alter gut microbiota composition, leading to increased production of proteolytic metabolites. This shift can exacerbate gastrointestinal distress during exercise, potentially impairing performance and recovery. Incorporating nondigestible fermentable carbohydrates can counteract these effects by fostering a more favourable gut environment.
• Enhanced mineral absorption. Undigestible carbohydrates, such as inulin and mannitol, can improve the absorption and bioavailability of essential minerals, including magnesium, calcium, zinc and iron.

Incorporating Beneficial Carbohydrates into Your Diet

To harness the gut health benefits of nondigestible fermentable carbohydrates, consider the following dietary additions:

• Whole Grains: Oats, quinoa, and brown rice are rich in dietary fibre.
• Legumes: Chickpeas, lentils, and beans provide substantial fibre and resistant starch, supporting gut bacteria.
• Fruits and Vegetables: Bananas, asparagus, and garlic contain inulin and other prebiotic fibres. Inulin is also found in chicory root, Jerusalem artichoke, onion, leeks, burdock root, wheat and wheat bran. Mannitol is in mushrooms, cauliflower, celery, snow peas, butternut squash, sweet potato, apples, watermelon, cabbage, pumpkin, Brussels sprouts and peaches.
• Psyllium husk can be taken with water for added fibre.
• Resistant Starch-Rich Foods: Cooling cooked starchy foods like potatoes and rice increases their resistant starch content, therefore benefiting gut health.

Practical Tips

• Gradual Introduction: Slowly increase fibre intake to allow your gut to adapt, minimising potential discomfort. Research suggests that 30 grams of fibre daily is recommended to provide gut health benefits.
• Stay Hydrated: Adequate water consumption aids in the digestion and fermentation of fibres.

Intense physical exertion increases the body’s need for iron, and repeated sessions that deplete the body may lead to iron deficiency anaemia with inadequate iron intake or poor absorption. As previously mentioned, iron deficiency may contribute to exhaustion and will likely have an adverse effect on training and competition.

Iron is an essential mineral that plays a vital role in metabolism and the transportation of oxygen through your body. Up to 65% of the body’s iron is found in haemoglobin. Haemoglobin is the substance found in red blood cells that delivers oxygen from your lungs to your body tissues via your bloodstream. This means that low haemoglobin levels lead to decreased oxygen delivery to the body’s tissues, working muscles and organs.

Iron is also essential for the formation of myoglobin in muscle cells, a protein that carries and stores oxygen in muscle tissue. As oxygen is needed for aerobic metabolism, it’s easy to understand how low myoglobin (oxygen transportation around the muscles) impairs your aerobic function and ultimately, physical performance. It is also essential for brain health, physical growth and the synthesis of several hormones in your body. If you aren’t sure of the common signs of iron deficiency, you may like to read our previous blog here.

Put simply, if you are suffering from anaemia or are iron deficient your muscles will receive less oxygen and produce more lactic acid during training sessions, and your health and wellbeing will be severely compromised and could lead to serious health issues.

Energy production takes place in the mitochondria as part of the electron transport chain. In this process, a charged gradient is created across the membrane, which in turn drives the synthesis of energy as adenosine triphosphate (ATP).  Both haem animal and plant-based forms of iron are important for the protein complexes within the electron transport chain.

Iron is found in mitochondria within skeletal muscles storing 10–15% of the body’s iron. Iron is particularly concentrated in type-1 slow-twitch muscle fibres. These fibres have high mitochondria concentrations, slow contraction rates and a reliance on aerobic metabolism and oxidative phosphorylation.

Endurance athletes typically have more slow twitch muscle fibres than type-2 fibres.

Vegetarian or plant-based athletes are at a much higher risk of iron deficiency and may need significantly more iron in their diet,  due to the reduced bioavailability of iron from plant-based foods. Knowledge of sources of iron-rich foods and beneficial combinations of foods can be helpful. For example: pairing plant-based iron-rich foods with a source of vitamin C can increase iron absorption.

It is important to remember that your iron deficiency may have nothing to do with your iron intake and other physiological and environmental circumstances may be contributing to iron deficiency.

Tools such as our  Anaemia Quiz may help to identify if you are at risk of iron deficiency or anaemia.

Want to know more? Contact the Athlete Sanctuary and learn how we can help.

About the Author: Kate Smyth is a Sports naturopath, nutritionist and female centric running coach. She is the founder of the Athlete Sanctuary- a holistic healthcare clinic for athletes of all levels and sporting codes. Kate has a thirst for knowledge with two bachelor’s and a master’s degree under her belt. She has been involved in sports for many decades and competed for Australia in the Commonwealth Games and Olympic Games marathons with a personal best time of 2 hours 28 minutes. For more information visit https://athletesanctuary.com.au/kate-smyth

References

Alaunyte I, Stojceska V, Plunkett A. (2015). Iron and the female athlete: a review of dietary treatment methods for improving iron status and exercise performance. J Int Soc Sports Nutr. 12. doi:10.1186/s12970-015-0099-2

Halas M. (2009): Special Considerations for Vegans and Vegetarians. The Plant-Based Boost Nutrition Solutions for Athletes and Exercise Enthusiasts. Middletown, DE: Super Kids Nutrition Incorporated.

Semenova, E. A., Miyamoto-Mikami, E., Akimov, E. B., Al-Khelaifi, F., Murakami, H., Zempo, H., ... & Ahmetov, I. I. (2020). The association of HFE gene H63D polymorphism with endurance athlete status and aerobic capacity: novel findings and a meta-analysis. European Journal of Applied Physiology, 120(3), 665-673.

Stugiewicz, M., Tkaczyszyn, M., Kasztura, M., Banasiak, W., Ponikowski, P., & Jankowska, E. A. (2016). The influence of iron deficiency on the functioning of skeletal muscles: experimental evidence and clinical implications. European Journal of heart failure, 18(7), 762-773. 

Have you ever heard of hepcidin? It’s worth understanding mainly if you are a female athlete or someone who suffers from iron deficiency anaemia.

Iron is an essential element for many biological processes. Too little iron can have many detrimental effects on your health and sports performance. We have previously discussed the impact iron deficiency and anaemia has on thyroid health and poor immunity. Excess iron can be toxic, so regulating iron levels are vital to a healthy, balanced body.

Hepcidin is an iron-regulating peptide hormone that’s produced in your liver. It works to control the delivery of iron to your blood from food through the lining of the intestines. It is the master regulator in iron metabolism and the balance between iron storage and the absorption better known as iron homeostasis. Hepcidin also tightly influences red blood cell production.

When hepcidin levels are unusually high, it reduces intestinal iron absorption and red blood cell production. Low hepcidin levels stimulate iron absorption, and iron supply to bone marrow and promote hemoglobin and red blood cell production. Iron deficiency is common among female athletes, and is much higher than their male counterparts. It is often cited as being a result of the menstrual cycle during premenopausal years. Depleted iron stores can have many adverse effects, including poor performance, low energy levels, and general well-being.

Some research has shown that active females with compromised iron possess an inherent protective mechanism once iron deficient. This adaptation allows the body to adjust to a reduced iron supply. It is proposed iron depletion may be a combination of exercise-induced losses and hepcidin accumulation.

Running is known to acutely increase hepcidin levels (peaking three hours post-exercise), therefore reducing iron absorption and recycling.

Timing iron supplementation to correlate with low hepcidin levels may enhance absorption and positively impact iron levels in the blood. In practical terms, if you exercise in the morning, you might consider taking your iron supplement straight after you exercise, before hepcidin rises.

Hundreds of athletes have used our handy anaemia quiz to help determine the likely risk of having low iron or anaemia. we encourage you to use this free tool if you have a history of iron deficiency or you are unsure if your iron stores may be declining.

Want to know more? Contact the Athlete Sanctuary to learn how we can support you further. Book an appointment here.

About the Author: Kate Smyth is a Sports naturopath, nutritionist and female-centric running coach. She is the founder of the Athlete Sanctuary- a holistic healthcare clinic for athletes of all levels and sporting codes. Kate has a thirst for knowledge with two bachelor’s and a master’s degree under her belt. She has been involved in sports for many decades and competed for Australia in the Commonwealth Games and Olympic Games marathons with a personal best time of 2 hours 28 minutes. For more information visit https://athletesanctuary.com.au/kate-smyth

References

Ganz, T. (2016). Hepcidin. Rinsho Ketsueki, 57(10), 1913-1917. DOI: 10.11406/rinketsu.57.1913.

Sim, M., Dawson, B., Landers, G., Trinder, D., & Peeling, P. (2014). Iron regulation in athletes: exploring the menstrual cycle and effects of different exercise modalities on hepcidin production. International journal of sport nutrition and exercise metabolism, 24(2), 177-187.https://pubmed.ncbi.nlm.nih.gov/24225901/

Alfaro-Magallanes, V. M., Benito, P. J., Rael, B., Barba-Moreno, L., Romero-Parra, N., Cupeiro, R. FEMME Study Group. (2020). Menopause Delays the Typical Recovery of Pre-Exercise Hepcidin Levels after High-Intensity Interval Running Exercise in Endurance-Trained Women. Nutrients, 12(12), 3866. https://pubmed.ncbi.nlm.nih.gov/33348847/

Nirengi, S., Taniguchi, H., Ishibashi, A., Fujibayashi, M., Akiyama, N., Kotani, K., & Sakane, N. (2021). Comparisons between serum levels of hepcidin and leptin in male college-level endurance runners and sprinters. Frontiers in Nutrition, 8. https://pubmed.ncbi.nlm.nih.gov/34136516/

Pagani, A., Nai, A., Silvestri, L., & Camaschella, C. (2019). Hepcidin and anemia: a tight relationship. Frontiers in physiology, 1294.  https://www.frontiersin.org/articles/10.3389/fphys.2019.01294/full

Sim, M., Dawson, B., Landers, G., Trinder, D., & Peeling, P. (2014). Iron regulation in athletes: exploring the menstrual cycle and effects of different exercise modalities on hepcidin production. International journal of sports nutrition and exercise metabolism, 24(2), 177-187.  https://pubmed.ncbi.nlm.nih.gov/24225901/[/vc_column_text][/vc_column][/vc_row]

Iron plays a crucial physiological role in your body. But despite its importance, iron deficiency anaemia is still a common problem among female athletes. Iron deficiency can have major adverse effects on your well-being and your athletic capacity.

It’s not uncommon for iron deficiency anaemia to be quite mild and go unnoticed. But women – and especially active, athletic women – are very prone to this condition. If gone untreated, the anaemia will worsen, and the signs and symptoms will intensify.

Without enough iron, your body can’t produce enough hemoglobin – the substance in red blood cells that enables them to carry oxygen – and as a result iron deficiency anaemia can leave you short of breath, headachy, tired, and unable to complete a training session or event with your usual enthusiasm. Iron deficiency is missed in 47-82% of females and 95-100% of male adolescents and young adult patients.

10 signs of iron deficiency  

*Fatigue that starts even after a good night’s sleep

*Restless legs

*Nausea

*Bruising

*Pale or itchy skin

*Hair loss

*Shortness of breath

*Poor concentration and decision-making, “foggy brain”

*Rapid heartbeat or “fluttering feeling”

*Headache, dizziness or light-headedness

Keep in mind this is just a small number of the  75 known symptoms of iron deficiency. Unusual cravings for non-nutritive substances, such as ice and dirt

CAUSES OF IRON DEFICIENCY

Low or little dietary intake of iron-rich foods is often blamed as the key factor contributing to iron deficiency. With plant-based eating increasing in popularity amongst the athlete community, this is a key factor for many athletes. Lack of awareness of how to consume foods that enhance iron absorption or knowledge on sources of plant-based iron-rich foods can render an athlete with symptoms in a matter of months.  Poor intake however is not the only cause of iron deficiency anaemia.

*Blood loss. Blood contains iron within red blood cells. If you lose blood, you lose some iron. Women with heavy periods are at risk of iron deficiency anaemia because they lose blood during menstruation. Athletes who are frequent blood donors are at increased risk for iron deficiency.¹ Athletes who regularly use nonsteroidal anti-inflammatories are likely to have increased gastrointestinal blood losses increasing their risk of iron deficiency³.

*An inability to absorb iron. Dietary iron is absorbed into the bloodstream through the small intestine. An intestinal disorder, such as celiac disease, stomach ulcers, ulcerative colitis or Crohn’s disease, which affects the intestine's ability to absorb nutrients from digested food, can lead to iron-deficiency anaemia. If part of the small intestine has been bypassed or removed surgically, the ability to absorb iron and other nutrients will be reduced. Inflammation in the digestive tract is aligned with symptoms such as bloating, gas, diarrhoea or constipation, food intolerances, or loud gurgling, and may signal the integrity of the gut lining may be compromised. Without good integrity, absorption of nutrients is also reduced.

*Low stomach acid. Adequate stomach acid (hydrochloric acid- HCL) is required to break down minerals such as iron and extract them from the food we eat. Low stomach acid is a common issue following times of prolonged physical or emotional stress and can be found alongside iron deficiency.

*Iron stealers. Bacteria overgrowth, Helicobacter pylori, and parasites within the digestive tract can impact the way iron is absorbed and may contribute to blood loss, therefore, contributing to iron deficiency over time.

*Post natal- Without iron supplementation, iron deficiency anaemia occurs in many pregnant women due to the iron requirements of the mother and baby. Post-natal iron deficiency can occur as many women are naturally preoccupied with their new arrival and forget to have adequate medical checkups for themselves. Fatigue is often experienced by mother’s and therefore iron deficiency can go undetected for many months. This depletes not only the mother but also the baby’s supply of iron who depends on the mother for iron for the first 6 months of life until solids are introduced.

Hundreds of athletes have used our handy anaemia quiz to help determine the likely risk of having low iron or anaemia. Find out if you are getting low on iron here.

Want to know more? Contact the Athlete Sanctuary to learn how we can support you further.

About the Author: Kate Smyth is a Sports naturopath, nutritionist and female-centric running coach. She is the founder of the Athlete Sanctuary- a holistic healthcare clinic for athletes of all levels and sporting codes. Kate has a thirst for knowledge with two bachelor’s and a master’s degree under her belt. She has been involved in sports for many decades and competed for Australia in the Commonwealth Games and Olympic Games marathons with a personal best time of 2 hours 28 minutes. For more information visit https://athletesanctuary.com.au/kate-smyth

References

1. Choe, Y. H., Kwon, Y. S., Jung, M. K., Kang, S. K., Hwang, T. S., & Hong, Y. C. (2001). Helicobacter pylori-associated iron-deficiency anemia in adolescent female athletes. The journal of Pediatrics, 139(1), 100-104.
2. Eiduson, R., Heeney, M. M., Kao, P.-C., London, W. B., Fleming, M. D., & Shrier, L. A. (2022). Prevalence and Predictors of Iron Deficiency in Adolescent and Young Adult Outpatients: Implications for Screening. Clinical Pediatrics, 61(1), 66–75. https://doi.org/10.1177/00099228211059647
3. Safarova, K. N., Dorogoykina, K. D., & Rebrov, A. P. (2019). Is anemia a clinical marker of NSAID-induced upper gastrointestinal lesions in patients with spondyloarthritis?. Almanac of Clinical Medicine, 47(5), 410-418. https://doi.org/10.18786/2072-0505-2019-47-037
4. Hinton P. S. (2014). Iron and the endurance athlete. Applied physiology, nutrition, and metabolism = Physiologie appliquee, nutrition et metabolism, 39(9), 1012–1018. https://doi.org/10.1139/apnm-2014-0147
5. Mayo Clinic (2022). Iron Deficiency anemia. https://www.mayoclinic.org
6. Sim, M., Dawson, B., Landers, G., Trinder, D., & Peeling, P. (2014). Iron regulation in athletes: exploring the menstrual cycle and effects of different exercise modalities on hepcidin production. International journal of sports nutrition and exercise metabolism, 24(2), 177–187. https://doi.org/10.1123/ijsnem.2013-0067

Up until 2014 RED-S was referred to as the female athlete triad – disordered eating, menstrual disturbances and low bone density. At this time the International Olympic Committee updated their position statement with the new term (RED-S) to be far more reflective of the wider-spread effects in both female and male athletes - on performance and throughout the body.

In 2018 the IOC published the RED-S Consensus Statement Update.

More than 10% of athletes experience RED-S throughout their career, yet despite its potential to have such adverse effects, RED-S is still only just becoming widely recognised and discussed within a majority of sports.

Symptoms of RED-S

There are many physical symptoms of RED-S, including:

• Fatigue
• Recurring illness
• Difficulties staying warm in the winter and cool in summer months
• Poor sleep quality
• Stress fractures and low bone mineral density, and impaired accumulation of peak bone mass (PBM)
• Weight loss, or below healthy weight
• Growth restriction in junior and teenage athletes
• Disordered eating or eating disorders such as bulimia or anorexia, orthorexia, restrictive disorders or recurrent dieting/fasting
• Digestion issues
• Vitamin and mineral deficiencies
• Metabolic disturbance
• Menstrual disfunction

But REDS can also have far-reaching behavioural and psychological effects as well, including:

• Pre-occupation and constant discussion around food
• Poor sleep patterns
• Restricting or strict control over food intake
• Overtraining or struggling to take rest days
• Impaired judgement, coordination and concentration
• Recurrent soft tissue injury
• Irrational behaviour
• Fear of food and weight gain
• Severe anxiety
• Withdrawing or becoming reclusive
• Reduction in motivation
• Depression

REDS can have an incredibly adverse long-term effect on athletic performance, including an increased risk of injury and decreased training and performance responses. These effects can include:

• Decreased muscle strength
• Decreased endurance performance
• Impaired judgement
• Decrease in coordination
• Decrease in concentration
• Decrease in glycogen stores
• Negative impacts on muscle recovery
• Poor muscle growth
• Increased risk of injury

WHAT ARE THE LONG-TERM EFFECTS OF REDS?

The majority of our bone density is formed during our teenage years. If our bone density formation is impacted during our adolescence or early in our adult years, it can lead to issues with bone weakness and osteoporosis later on in life.

Longer-term, REDS can also have a negative impact on fertility, thyroid function, cardiovascular function, and mental health.

The good news is that most of the negative consequences of RED-S can be reversed if picked up early.

WHAT ARE THE COMMON MYTHS SURROUNDING REDS?

The common perception that athletes with RED-S have an eating disorder is false.  Although eating disorders are associated with RED-S not all athletes with eating disorders have RED-S and not all athletes with RED-S have an eating disorder.

It’s true to say that athletes with RED-S can present as underweight- but this is not true in all situations. RED-S can exist without the athlete appearing to be underweight.

RED-S is also not something that just female athletes suffer from. All athletes competing in sports with higher training volumes or weight category restrictions are at a higher risk of developing RED-S. This can include athletes competing in sports that can be judged by aesthetics including figure skating, gymnastics and synchronised swimming, and body weight-dependent sports including long-distance running, mountain biking, and cycling, and weight classed sports such as lightweight rowing and marshall arts.

In one study 44% of ultra-endurance runners were identified as being at risk of developing RED-S while 39% of elite female sprinters should signs of RED-S. 

“RED-S can occur in athletes of any competitive status. Among world-class endurance athletes, 37% of females presented with amenorrhea and 40% of males with testosterone in the lowest quartile range indicative of RED-S, which is similar to the reported 40% of Australian female athletes competing at the 2016 Rio Olympic games who were identified as at risk of RED-S.  Similarly, among recreational female exercisers, 45% had risk factors associated with RED-S." (Sports Information Resource Centre).

WHAT SHOULD I LOOK OUT FOR?

The most important piece of advice when it comes to RED-S is - listen to your body. Don’t ignore niggles and definitely don’t skimp on sleep and recovery. You should also:

• Monitor menstrual cycles
• Think about your relationship with food and/or exercise
• Be mindful of your eating patterns: disordered eating to eating disorder.
• Notice your exercise dependence
• Monitor your behaviour, mood and sleep patterns
• Notice change in clothing fit
• Be aware of growth and development
• Note injuries, illness and gastrointestinal issues
• Athletic performance (stagnation-deterioration)
• Try to be flexible in your approach

WHERE TO GET HELP

We appreciate that talking about many of the symptoms associated with RED-S can be difficult.  Our Sports Naturopath and Holistic Coach Kate Smyth has extensive lived experience with REDS in elite sport and provides a discreet and confidential platform to share your concerns.

About the Author: Kate Smyth is a Sports naturopath, nutritionist and female centric running coach. She is the founder of the Athlete Sanctuary- a holistic healthcare clinic for athletes of all levels and sporting codes. Kate has a thirst for knowledge with two bachelor’s and a master’s degree under her belt. She has been involved in sports for many decades and competed for Australia in the Commonwealth Games and Olympic Games marathons with a personal best time of 2 hours 28 minutes. For more information visit https://athletesanctuary.com.au/kate-smyth

Resources

Athletes in Balance 

Train Brave 

Butterfly Foundation 

Eating Disorders 

The Sport Information Resource Centre: SIRC,

Berg, S. E. (2021). The Relationship between Eating Disorders, Weight Control Methods, and Body Satisfaction in Elite Female Runners Competing at the 2020 US Olympic Marathon Trials.

Sygo, J., Coates, A. M., Sesbreno, E., Mountjoy, M. L., & Burr, J. F. (2018). Prevalence of indicators of low energy availability in elite female sprinters. International Journal of Sport nutrition and exercise metabolism, 28(5), 490-496.

Iron deficiency is one of the most common issues athletes face.  Iron and thyroid health go hand in hand and the effects of exercise on the thyroid gland and hormones are not well understood.

Iron and thyroid function 
Undiagnosed iron deficiency presents an increased risk of impaired thyroid function. Active women have high-energy lives, managing work, family and training, and many will accept low energy and brain fog as simply a result of being overworked or as an inevitable part of hormonal changes.

However, low thyroid function, iron deficiency, overtraining and hormonal changes also present with many of the same symptoms.

Signs that your thyroid function may be underactive (hypothyroid) include fatigue, unexplained weight gain, headaches, low blood pressure, dry skin, constipation and cold intolerance. These early signs of cellular hypothyroidism can appear when blood pathology remains within standard ranges.

As with most chronic issues, there are multiple factors that may contribute to dysfunction.

The Link between Exercise and Thyroid Function

In athletes, endurance and high-volume training promotes thyroid function. During exercise, your hypothalamus stimulates the pituitary gland to secrete thyroid-stimulating hormone (TSH), which in turn signals your thyroid to synthesise and release the thyroid storage hormone T4 and active thyroid hormone T3.

These hormones influence your body’s metabolism and allow it to increase exercise intensity. Over time, this repeated, high demand of your thyroid during prolonged intense exercise may impact your thyroid function, causing it to slow down and consequently lose the ability to produce sufficient hormones.

Iron and Thyroid Function

Normal thyroid function is dependent on several nutrients to regulate the synthesis of thyroid hormones. Iodine, iron, tyrosine, selenium, and zinc are needed to facilitate the conversion of T4 to T3 . A deficiency of any one of these nutrients would result in reduced T3 production, causing you to experience hypothyroid symptoms. Vitamins A and D also play important roles in cell receptor behaviour to regulate thyroid hormone metabolism.

While iodine is the key mineral for healthy thyroid function (read more…here)  it is not uncommon to find iron deficiency in hypothyroidism. Although widely recognised for its influence on red blood cell production, iron is also an important component of thyroid peroxidase, an enzyme essential for thyroid hormone biosynthesis.

Iron deficiency interferes with the normal functioning of the thyroid, contributing significantly to fatigue, exercise intolerance and lightheadedness.

Increased menstrual bleeding can lead to iron deficiency. Many of us dismiss low energy as a symptom of a busy, active lifestyle and so iron deficiency frequently goes undiagnosed in perimenopausal women.  For athletes, iron plays a critical role in exercise performance as outlined in our blog “Increase your iron absorption and rebound from anaemia” here

The most common causes of iron deficiency include inadequate dietary iron intake, inflammation, poor iron absorption in the gut, parasites, iron loss through sweat, urination and faeces, blood loss through menstruation. Pregnancy, breastfeeding or high-volume exercise will also significantly increase iron demands. Take our free anaemia quiz to see if you may be iron deficient here

Thyroid Function and Sex Hormones in Women

Your thyroid function is sensitive to fluctuations in sex hormone levels, particularly oestrogen. Oestrogen stimulates the production of the thyroid hormone precursor, thyroglobulin, and increases the protein that carries thyroid hormones in your blood.

As oestrogen changes (such as during peri-menopause) so too does thyroid hormones, which play an important role in metabolism, muscle strength, energy production and expenditure, heart function, and temperature regulation.

As oestrogen levels rise and fall later in life, menstruation may become irregular and heavier. Peri-menopausal women may experience symptoms for over ten years as described in our blog on “Natural solutions for menopause” here .

During peri-menopause declining oestrogen may impact thyroid function and can lead to inadequate production and circulation of thyroid hormones.

Exercise During Hormonal Changes

Despite common misconceptions, women can train and perform well throughout peri-menopause, and beyond, if they listen to their bodies and be mindful of maintaining adequate dietary intake of key nutrients. It is important to recognise that both iron deficiency, thyroid function and hormonal changes can impact your ability to exercise.

Years of consistent exercise accumulate like pages in a book. As a mature you know your body very well. The pathway to success utilises your book of wisdom and skills. Mature athletes can benefit from greater recovery, individualized strength and conditioning and modified programs. Focussing on the balance between training intensity and volume will help you to achieve your desired goals.

If you suspect your symptoms are impacting on your quality of life and sport, it’s time to seek support to help you navigate the journey.

Blood serum pathology and functional tissue mineral testing can be a good starting point due to the critical role nutrients play in hormonal and thyroid function.

With the right self-care and a holistic approach to health, you can continue to achieve your life goals and physical challenges irrespective of hormonal changes.

About the Author: Kate Smyth is a Sports naturopath, nutritionist and female-centric running coach. She is the founder of the Athlete Sanctuary- a holistic healthcare clinic for athletes of all levels and sporting codes. Kate has a thirst for knowledge with two bachelor’s and a master’s degree under her belt. She has been involved in sports for many decades and competed for Australia in the Commonwealth Games and Olympic Games marathons with a personal best time of 2 hours 28 minutes. For more information visit https://athletesanctuary.com.au/kate-smyth

References

1. Kawicka, A., & Regulska-Ilow, B. (2015). Metabolic disorders and nutritional status in autoimmune thyroid diseases. Postepy Higieny i Medycyny Doswiadczalnej, 69, 80–90.
2. Luksch, J. R., & Collins, P. B. (2018). Thyroid Disorders in Athletes. Current Sports Medicine Reports, 17(2), 59–64.
3. Santin, A. P., & Furlanetto, T. W. (2011). Role of estrogen in thyroid function and growth regulation. Journal of Thyroid Research, 2011.
4. Soliman, A. T., De Sanctis, V., Yassin, M., Wagdy, M., & Soliman, N. (2017). Chronic anemia and thyroid function. Acta Biomedica, 88(1), 119–127.
5. Wouthuyzen-Bakker, M., & Van Assen, S. (2015). Exercise-induced anaemia: A forgotten cause of iron deficiency anaemia in young adults. British Journal of General Practice, 65(634), 268–269.

Mineral testing provides a wider perspective on an individual’s overall health status than just urine, blood or stool pathology testing alone although it is always useful to use both tests in conjunction with each other. Mineral testing can be used as an early detector of subclinical issues and provide useful guidelines in terms of how to best support the body when annoying symptoms such as fatigue, insomnia and digestion issues persist.

In clinical practice, test results are always accompanied by a thorough assessment of your overall health and nutritional intake to provide meaningful context to data and to give you a clear understanding of where and how deficits may be occurring.

A mineral analysis may provide insight into your current health status, identify potential areas of concern and provide suggestions around dietary and supplemental measures that may improve your health now and prevent issues in the future.

Mineral testing for athletes- useful insights

Mineral testing provides a snapshot of how the body is utilizing the nutrients obtained from your food and provides an analysis of 13 key minerals. Trends in nutrient deficiencies or excessive mineral levels may indicate poor activation and non-beneficial storage of nutrients.

To demonstrate this point, let’s take a look at calcium. Calcium will be maintained within a very narrow range in blood serum due to its life-supporting roles in managing heart rate, nerves, and muscle function. However, in a mineral analysis high or levels of calcium may be observed.  Low levels of calcium may indicate poor absorption, inadequate intake or other nutrient issues such as low vitamin D, while high levels may be suggestive of low vitamin B6 and poor calcium utilisation in the body.

High calcium levels may also contribute to underactive thyroid issues with symptoms such as weight gain, fatigue, low blood pressure and poor mood. Early detection of calcium issues is vital for the prevention of bone issues such as osteopenia, fractures, bone spurs, kidney stones and thyroid issues.

Mineral testing for athletes provides an analysis of how the body is utilizing 13 key nutrients obtained from the athlete's diet. Longer-term patterns in nutrient deficiencies or excesses may indicate poor activation and non-beneficial storage of nutrients.

To demonstrate this point, let’s take a look at calcium. Calcium will be maintained within a very narrow range in blood serum due to its life supporting roles in managing heart rate, nerves, and muscle function. However, in a mineral analysis high or levels of calcium may be observed.  Low levels of calcium in mineral testing for athletes, may indicate poor absorption, inadequate intake or other nutrient issues such as low vitamin D. High levels in mineral testing for athletes, may be suggestive of low vitamin B6 and poor calcium utilisation in the body.

High calcium levels may also contribute to underactive thyroid issues with symptoms such as weight gain, fatigue, low blood pressure and poor mood. Early detection of calcium issues is vital for the prevention of bone issues such as osteopenia, fractures, bone spurs, kidney stones and thyroid issues.

Significance of mineral testing for athletes

A clinical understanding of how an individual metabolises and utilises nutrients can be obtained through various mineral ratios included in a mineral test.  Just some of the ratios contained in the mineral analysis report are outlined below:

Immunity: Low zinc in relation to high copper levels may indicate a susceptibility to viral infections such as colds, cold sore outbreaks or poor wound healing. Zinc is critical to immune cell function and digestion and hydrochloric acid. Reduced digestive function and symptoms such as bloating, diarrhoea, malabsorption and low nutrient levels may also be observed in patients with low zinc.

Iron deficiency and anaemia: As discussed previously in relation to immunity, ceruloplasmin is a protein carrier shared by zinc, copper and iron. If zinc, copper or iron are too high, they may inhibit the absorption of the other minerals. For example -high levels of copper may be observed in women taking the oral contraceptive pill or through drinking water carried in copper pipes.  High copper levels may contribute to iron deficiency anaemia and present as shortness of breath, lethargy, dizziness and exercise fatigue.

Poor liver detoxification: Molybdenum is a key nutrient required for liver detoxification and is frequently low on test results due to reduced intake of foods rich in molybdenum such as legumes. When molybdenum is low in relation to sulfur an individual may experience sluggishness, fatigue, skin issues, and poor recovery related to reduced sulfation detoxification pathways in the liver.

Blood sugar control issues: Manganese and chromium are key nutrients required for blood sugar control. When manganese is low in relation to chromium an individual may experience energy dips, especially after meals, sugar cravings and dizziness or sweating related to poor blood sugar control and fluctuating insulin levels.

Hormone issues: Minerals play a key role in hormone modulation. When iron is low in relation to copper, individuals may complain of fatigue, poor recovery, weakness, loss of libido, irregular periods and hot flushes due to a pattern of low progesterone or testosterone.

Adrenal gland insufficiency: During times of stress, the adrenal gland utilises larger amounts of sodium and magnesium. When sodium levels are low in comparison to magnesium the adrenal gland may be underperforming as it is highly sodium dependent to produce key hormones such as cortisol.

General muscle tightness: Calcium and magnesium are required for bone health and muscle and nerve function. Stiff muscles, bladder issues and immobile joints may present when there is an issue between the ratio of calcium and magnesium in the body.

HEAVY METAL BURDEN
This form of testing may also identify heavy metal burden on the body. Despite a clean lifestyle, individuals can present with unfavourable levels of mercury, arsenic, lead, tin or aluminium largely due to living in a modern environment where exposure to heavy metals occurs on a regular basis.

Contrary to popular belief, heavy metal accumulation does not necessarily occur from occupational exposure. Frequent exposure arises from pesticides; additives and the tinning of foods; dental fillings; drinking water; products and materials used in homes and offices; personal care products and cosmetics.

Heavy metals are neurotoxins and may over time contribute to a plethora of health issues such as thyroid, reproductive and mental health issues, and cancers. Heavy metals displace other key minerals such as zinc, selenium and iron. The presence of these metals may also be indicative of other functional issues such as reduced liver detoxification pathways.

Practicalities of mineral testing for athletes

Mineral testing looks at long-term trends (over 2-3 months) and can be very useful when symptoms or health issues are ongoing and underlying contributing factors are yet to be identified.  Athletes also find mineral balance results useful before they launch a new training campaign as a measure of nutritional status and as a preventative measure against deficiencies that may inhibit performance.

Mineral testing does not require a blood draw and can be conducted in the privacy of your own home.  Test results generally take 2 weeks and are reviewed during an extended consultation.

For further information or to order a test kit email contact us or book in for your initial consultation.

Longer-term patterns of pathology results can provide a holistic picture of your overall health and the progression of underlying issues. We monitor key nutrients that provide warning signs of underlying imbalances that, if left unchecked, can contribute to ill health and disease. One abnormal blood marker in pathology tests doesn't always mean there is an issue. Pathology tests should always be considered in conjunction with your symptoms and physical appearance and discussed with your practitioner so that the context and relevance of your results can be determined.

WHAT PATHOLOGY TESTS ARE MOST USEFUL?

Your GP or naturopath can arrange pathology testing for you. Your healthcare practitioner will determine the exact pathology tests you require. The following tests may be useful for active individuals as a good starting point.

*Full blood count and haematology—these examine your white and red blood cells and provide a general picture of your immune system and overall health.

*Liver function tests (LFTs) provide some clues as to how your liver is working and whether it is under stress.

*Electrolytes- potassium, sodium, chloride and other key electrolytes required for sports performance and optimal health.

*Fasting blood glucose- is a general marker that indicates how well your body is modulating your blood sugar. Issues with blood sugar stabilisation may cause symptoms such as sugar cravings, frequent urination, fatigue, and energy drops after meals.

*Insulin helps us understand how hard your pancreas is working to maintain normal blood sugar levels. This marker is useful if you have a family history of diabetes or have been prediabetic or " insulin resistant" in the past. Insulin resistance is more common as we age. In women, it is more common over the age of 40 and in perimenopause and postmenopause.

*C- reactive protein (CRP) is an inflammatory marker. CRP is useful when interpreted in conjunction with iron studies. Iron storage may be impacted by states of high inflammation.

*Iron studies- provide information on your iron storage (ferritin), the protein carriers for iron (transferrin), and how effectively your body is saturating these carriers and transporting iron around your body (transferrin saturation).

*Thyroid hormones- TSH, T3 and T4 provide information on how your thyroid is functioning and can be an early warning sign of autoimmunity and nutrient deficiencies such as iodine, selenium, tyrosine and zinc.

*Vitamin B12 (active and inactive) is also suggested for plant-based patients or athletes who infrequently consume red meat.

* Nutrients—If you experience mental health issues (especially seasonal sadness/ low mood), autoimmunity, frequent colds or infections, bone health issues, hormonal issues, or are peri or postmenopausal, nutrients such as vitamin D, copper, and serum zinc may also be useful markers. 

Tests may be repeated every few months to ensure a patient is responding to treatment and maintaining a balanced state of health.

How to get the most accurate pathology tests

Prepare for your blood tests.

DO

•  Fast for 12 hours (have dinner and then postpone breakfast until after your blood draw).
• Sip water the morning of your blood test so you are not dehydrated when you have your test. Dehydration can make your veins more difficult to locate.
• Take a snack to have immediately after your blood draw.

AVOID

• Strenuous exercise for a minimum of 24 hours. Ideally, at least 48 hours if possible.  This includes running, cycling, or strength training. Most patients find it easiest to do a blood test the morning after a rest day. A walk or gentle exercise is ok before a blood draw.
• If you plan to check your iron levels, avoid a blood test when you are unwell or have an infection. An infection may influence your test results. Wait until you are feeling better before having your iron test.
• Stop supplements, including iron or other vitamin tablets or powders, for 24-48 hours before your blood tests.

We use a number of pathology collection centres across Australia including Clinical Laboratories, Dorevitch, and Nutripath to obtain accurate pathology results. We may also recommend functional testing such as detailed heavy metal and mineral testing and comprehensive microbiome tests during our clinical assessments.

About the Author: Kate Smyth is a Sports naturopath, nutritionist and female-centric running coach. She founded the Athlete Sanctuary- a holistic healthcare clinic for athletes of all levels and sporting codes. Kate has a thirst for knowledge, and she has two bachelor’s degrees and a master’s degree under her belt. She has been involved in sports for many decades and competed for Australia in the Commonwealth Games and Olympic Games marathons with a personal best time of 2 hours 28 minutes.