Pumping iron – anaemia in rowing explained

What is anaemia?

Anaemia is a condition in which the body’s ability to produce or maintain haemoglobin (and therefore red blood cells) is compromised. Although there are different types, iron-deficiency anaemia is the most common in athletes.

A reduction in haemoglobin can be a big problem for athletes. Fewer red blood cells means less capacity to transport oxygen from the lungs to muscles that are screaming out for more fuel when it matters most in training and competition.

Who is at risk?

Several factors influence iron levels including training intensity, load, hydration and even where you live and train. Your risk of iron-deficiency anaemia, however, increases just by being an athlete. “The effect of anaemia is magnified because of the oxygen requirements of exercise,” says Dr. Mike Wilkinson, a member of the World Rowing Federation’s (FISA) Medical Commission and a practising sports medicine physician.

0ne misconception about anaemia is that it is a women’s health issue, but this is actually not the case. “It happens across the board,” says Wilkinson. “It is more common in females because of lower iron stores and blood loss in menstruation. In general their haemoglobin mass is less than male athletes.”

Blood loss in any form contributes to the risk for both female and male athletes. Wilkinson uses the example of intestinal bleeding due to a condition called gut ischaemia, where blood flow is diverted from the intestinal tract to fuel the increased oxygen demands of muscles during intense exercise.

Starving the internal organs of oxygen is one reason for the gut-wrenching feeling during a hard training session and even lead to the vomiting that might follow a personal best 2000m ergo performance.

Lightweights are at greater risk

Weight class can also play an important role, with lightweights at greater risk of becoming anaemic. “Anyone who has dietary restrictions, especially if their diet is not well rounded, increases their risk,” Wilkinson says. “For female lightweights, the risk of anaemia is even higher because of the menstrual cycle.”

Amenorrhea, or the absence of a regular period for six months or more, can occur in all female athletes, but more commonly in lightweights. At first glance this may appear to be a good thing as far as iron stores are concerned, but this is not the case, explains Wilkinson. “Amenorrhea is an alarm bell that they may not be getting sufficient nutrition,” he says. “It is a symptom or sign of a relative energy deficiency or what we call RED-S [Relative Energy Deficiency in Sport].”

Symptoms and interventions

Identifying anaemia as an issue can be difficult for athletes and coaches. The most common symptoms (tiredness, shortness of breath, heart palpitations, pale complexion) could have many causes. Medical screening is often the only way to know for sure.

“When you can pick it up earlier,” says Wilkinson, “you have time to investigate and implement interventions that you might need.”

The first thing, Wilkinson suggests, “is make sure there is not a treatable medical condition causing the anaemia before jumping in and saying it is diet.” The medical causes of anaemia are broad and include blood loss due to a variety of acquired conditions, occult blood loss, genetic conditions or poor haemoglobin production.

“One thing that often gets missed,” he also points out, “is the chronic use of anti-inflammatories has been linked with anaemia. So in athletes who may be taking over-the-counter ibuprofen simply for their aches and pains, that is something to look for and exclude as a treatable cause.”

Routine blood tests will often be ordered, sometimes with additional investigations. “Once any treatable causes as well as other dietary deficiencies such as folate or vitamin B12 are ruled out,” says Wilkinson, “chances are you are dealing with an iron deficiency and supplementation may be called for.”

How the body uses iron

In mild cases, a dietary change may be all that is needed. Making sure that you are eating a well-balanced diet that includes foods rich in iron is the first step before reaching for a bottle of iron pills.

Although meat (especially red meat) is a major source of iron, there are many other iron-rich foods that you might consider adding to your diet if you don’t eat them already. Dark leafy green vegetables, rice, oats, wheat, eggs, nuts, tofu, beans, raisins and other dried fruits are all good options.

“We recommend that females of childbearing age supplement with folate and iron,” he says. “Both of those have been shown to help with anemia and folate, of course, help prevents neural tube defects in babies. These should be available in the diet, but if not I would recommend supplements.”

Impact on performance

For athletes with iron-deficiency anaemia, restoring haemoglobin levels will have a positive effect on your training. It may take some time though, says Wilkinson. “The average life span of a red blood cell is 120 days and any interventions will take that long to make an impact.”