Sleep plays an important role not only in recovery, but also in regulating the menstrual cycle. If we rule out pregnancy, active females, can have many factors collectively contributing to lighter or irregular menstraul cycles, all of which are important to understand but also address. Let's recap some of the most common issues that contribute to lighter or delayed periods.

Why Periods May Stop or Become Irregular

High exercise volume or intensity. When training volume or intensity increases, the body may shift priorities and redirect energy away from reproduction and toward survival and performance. In simple terms, the brain tells the ovaries to take a break and periods can become irregular, delayed, or stop altogether. A recent systematic review found that approximately 32.3% of female athletes are impacted in this way.

Nutritional factors. Low energy availability (not eating enough to match output) and restrictive eating are the most common nutritional issues which impact the cycle.  When calorie intake does not match the high energy expenditure of training, the body conserves fuel by slowing reproductive function, and hormones such as oestrogen and progesterone start to decline. While many women boast a quality nutritional profile on the surface, the calorie intake or density can still be insufficient to match the demands of the individual.

Skipping snacks or having lighter meals can easily tip athletes into the red. Prolonged energy depletion can lead to issues such as Relative Energy Deficiency in Sport. Athletes with or without an eating disorder may choose to restrict food intake during a determined window to make weight or enhance performance for a key event. This can impact body fat, hormone signalling and extend the cycle, lighten cycles or stop them altogether.

Emotional stress and anxiety

Emotional stress, travel, competition anxiety, or personal challenges can elevate cortisol and disrupt the hypothalamic-pituitary-ovarian (HPO) axis. The pressure to perform, coupled with life stressors, can compound physical strain, further suppressing hormones that regulate menstruation. Stress of any kind raises cortisol, directly suppresses the HPO axis, and reduces hormones such as progesterone, leading to missed cycles and functional hypothalamic amenorrhea. A condition where the brain suppresses reproductive function due to perceived stress or energy deficiency.

Low Iron

Iron deficiency can indirectly contribute to lighter cycles. Iron deficiency elevates cortisol and inflammatory markers and has effects on the HPO axis as explained above. Estrogen levels may then drop, especially if iron deficiency is paired with low energy availability. The cycle can then start to pitter out. Energy production can also be impacted despite meeting calorie needs.

Poor sleep and recovery habits

Sleep is when the body recalibrates its hormonal systems. During deep sleep, the HPO axis relies on stable circadian rhythms to regulate the release of gonadotropin-releasing hormone (GnRH). This hormone triggers the production of luteinizing hormone (LH) and follicle-stimulating hormone (FSH), which are essential for ovulation and menstrual regularity.

When sleep is fragmented or insufficient, cortisol levels rise, melatonin drops, and GnRH pulsatility becomes irregular, disrupting circadian rhythm and impairing ovulation. This vicious cycle contributes to irregular cycles. Poor recovery from poor sleep also dysrupts the HPO axis and cases light or missed periods.

This feedback loop can persist unless addressed through improved sleep hygiene, balanced nutrition, and structured recovery strategies.

Why It Matters

Menstrual irregularities are not just about missed periods. They can affect bone density, cardiovascular health, mood, and fertility. For sportswomen, understanding this connection is empowering. It allows for proactive choices such as adjusting training, improving nutrition, and seeking guidance when needed.

A delayed period is useful feedback. It is the body’s way of saying, “I need more care.” By listening, adjusting, and supporting our hormones, we create space for both strength and sustainability.

At Athlete Sanctuary, we believe that performance and health are not opposing forces. They are partners. If you would like to improve your report card, we are here to help.

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

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.

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. 

Vegetarian and vegan athletes are at greater risk of anaemia due to reduced intake of animal products containing iron and B12.

It is important to remember there are two different forms of dietary iron.

Heme iron is found in animal meats such as liver, lamb, beef and kangaroo.
Non-heme iron is derived from plant sources such as legumes, dried fruits, nuts and leafy green vegetables, tofu and eggs.

Heme- iron is the more readily absorbed form of iron. Eggs and many plant foods also contain non-heme iron, but have reduced bio-availability compared to meat sources. Vegetarians and non-meat eaters need to be mindful to consume adequate amounts of non-heme iron along with foods that enhance iron absorption

The key to maintaining iron adequacy is to consume non- heme rich foods at every meal and load your diet with healthy wholefood plant sources that are packed in all the co-factors such as vitamin C, bioflavonoids and folate. These co-factors help extract and absorb iron at every opportunity throughout the day. Avoidance of foods that contain nutrients which inhibit iron absorption is even more important for vegetarians and vegans as they have less room to move.

Iron absorption will be decreased by up to 60% if you have tannin-containing drinks or foods such as teas, coffee, red wine, peppermint tea and chocolate within two hours of an iron-rich meal.

This doesn’t mean you have to go completely without your treats, it just means you are best to have them in moderate amounts and avoid having them at the same time.

Mother nature also provides a reminder of blood-building foods in red-coloured plant foods. Beetroot, rhubarb, berries, dried figs and plums all contain iron.

Vegetarian Meal Plan

Breakfast: scrambled eggs (2), ½ cup spinach (cooked) plus 1 grilled tomato and 2 slices wholemeal toast with butter.  Include a large glass of freshly squeezed orange, parsley and kiwi juice.

Morning tea: 50g dried apricots plus 50g activated almonds

Lunch: cooked lentils (1 cup) with 1/2 cup quinoa, ½ cup fresh tomato added at last minute, 1 cup salad greens including capsicum, grated carrot, shredded cabbage and 1 tablespoon of tahini dressing

Afternoon tea: 1 bowl of Beet Berry smoothie bowl with coconut and cereal topping. For other great snack ideas see our Healthy Snacks for Busy Athletes or Iron Rich Snacks e-recipe books.

Dinner: 1 cup grilled tempeh (fermented tofu) with 1/2 cup steamed broccoli, 1/2 cup baked pumpkin and 1 beetroot with lemon, parsley and olive oil dressing

About the Author:

Kate Smyth provides sports naturopathy and nutrition advice and is a female-centric running coach. She founded the Athlete Sanctuary- a holistic healthcare clinic for athletes of all levels and sporting codes. She has been involved in sports for many decades and competed for Australia in the Commonwealth Games and Olympic Games marathons.

Iron is also needed for protein metabolism, collagen and antioxidant synthesis, as a co-factor for key enzymes involved in energy production, muscles, DNA and hormone synthesis; and immune function. Iron plays a key role in forming hemoglobin in red blood cells. Haemoglobin is necessary for the transportation of oxygen around the body and is critical to athletic performance.

If left untreated, iron deficiency and anaemia may contribute to decreased endurance; reduced training capacity and recovery lead to more frequent colds and other infections.

Why athletes have an increased risk of iron deficiency or anaemia

• Greater iron utilisation and requirements of iron
• Inflammation reduces the body's ability to store iron,
• Gastrointestinal tract stress limiting the absorption of iron through nutrition and blood loss,
• Loss of iron through sweat 
• Haemolytic breakdown of red blood cells through footstrike
• Blood loss may also occur through urine 
• Insufficient intake of iron-rich foods  and more plant-based foods
• Heavy periods in female athletes

In the general population, anaemia most commonly results from nutrient deficiencies due to low intake of iron-rich foods and blood loss, such as with heavy periods, haemorrhoids or gastric ulcers. Surgery, eating disorders, exposure to viruses (e.g. Malaria), toxins (e.g. lead) or renal disease, and some drugs reduce iron absorption. Low stomach acid, diarrhoea, Coeliac’s and Crohn’s disease and gastric bypass also decrease iron absorption. Increased requirements, such as in pregnancy, can also lead to deficiencies.

Iron is found in plants and animal meats
It is important to remember there are two different forms of dietary iron.

Heme iron is found in animal meats such as liver, lamb, beef and kangaroo.
Non-heme iron is derived from plant sources such as legumes, dried fruits, nuts and leafy green vegetables, tofu and eggs.

As the body must change the structure of the non-heme iron before it can be absorbed, heme iron from animal products is more bioavailable for the body. This doesn’t mean a vegetarian will always be low in iron, it just means they need to be smart about where they get their iron, and ensuring they include high amounts of other nutrients that aid absorption of iron.

[/mk_table][mk_table]

TOP 10 TIPS - To increase your iron absorption

*Consume foods high in vitamin C such as capsicum, berries, citrus and guava and malic acid-rich foods such as watermelon, berries, kiwi, apricots and mango in the same meal to enhance non-heme iron absorption. Don't forget nature's wonders, such as parsley and beetroot, which are also great blood builders.

*Eat fresh wholefoods. Consume 2 serves of fruits mentioned above per day plus 5-7 serves of vegetables and 2-3 serves of wholegrains per day. These foods provide nutrients that aid iron metabolism such as copper, vitamin A, vitamin B2, B12, folic acid, molybdenum, selenium and amino acids.

*Eat red meat, fish or chicken with vegetables. Consuming meat at the same time as plant-based sources of iron can enhance the non-heme absorption from plants by 85%. Consume a palm-size portion of iron-rich foods 4-5 times per week to maintain iron levels.

*Cook your iron-rich vegetables. Cooking plant-based iron foods such as spinach may improve iron bioavailability.

*Improve your digestion and boost your hydrochloric acid levels by drinking freshly squeezed lemon juice or apple cider vinegar in water 15 minutes before meals so you break down foods efficiently.

*Use pots and pans made from iron while cooking.

*Separate iron from calcium-rich foods. Consume foods containing substances that inhibit iron at least 2 hours away from an iron-rich meal or iron supplements. Calcium, oxalic acid, tannins and phytate-containing foods may all reduce iron absorption when consumed together.

• • Calcium-rich foods such as cow’s milk, cheese, yogurt and calcium supplements.
  • Oxalic acid s can be found in chocolate, tea, uncooked spinach and chard.
  • Tannins can be found in coffee, cocao, red wine, peppermint tea, and cranberries.

*Include iron-rich snacks and recipes like the ones we prepared for you in our Iron Rich Snacks e-recipe book.

*Soak, sprout, ferment and cook (where appropriate) foods containing phytic acid found in legumes (beans, lentils, chickpeas) and other wholegrains, nuts and seeds to limit phytates' effect on reducing iron absorption.

*Be aware of drugs such as antacids like Mylanta, antibiotics, and aspirin, which decrease iron absorption: separate iron supplements and iron rich foods from medications.

*Avoid self-prescribing supplements as too much iron can be toxic! See your naturopath for testing, advice on your iron status, and the quantity and best form of iron to take.

About the Author:

Kate Smyth provides sports naturopathy and nutrition advice and is a female-centric running coach. She founded the Athlete Sanctuary- a holistic healthcare clinic for athletes of all levels and sporting codes. She has been involved in sports for many decades and competed for Australia in the Commonwealth Games and Olympic Games marathons.