Combating iron deficiency

Women in the armed forces may need to pay particular attention to proper nutrition as new research reveals that basic combat training may increase their risk of iron deficiency.

Facts about iron

Iron, an important mineral for physical and mental performance, is stored by our bodies in a protein called hemoglobin that is found inside red blood cells.

Low iron status may cause a person to feel tired or have difficulty concentrating, and may lead to anemia. Iron deficiency may result from a lack of dietary iron, poor iron absorption, or blood loss—in other words, when a person doesn’t get enough iron or loses too much iron.

In fact, as many as 16% of premenopausal women in the United States are iron deficient. The most common risk factors for iron deficiency include:

• heavy blood flow during menstruation,

• pregnancy (which causes the body to require more iron), and

• being a teenage girl (rapid growth, menstruation, and often suboptimal diet).

And now further research published in the American Journal of Clinical Nutrition shows that regular intense exercise may increase the risk.

The nutritional cost of combat training

A recent study looked at the association between basic combat training in women soldiers and iron deficiency. In this study, 219 women soldiers enrolled in basic combat training were randomly assigned to receive 15 mg of iron (from ferrous sulfate) or a placebo once a day for eight weeks. Iron status was checked through blood tests in all women before and after basic combat training.

• There were 14 iron-deficient participants in both the placebo and iron groups at the start of the study. At the end of basic training, the number of iron-deficient participants in the placebo group grew to 28 (100% increase), and the number of iron-deficient participants in the iron group grew to 19 (36% increase).

• Iron supplementation led to faster two-mile running times at the end of training among participants who had iron-deficiency anemia at the beginning of basic training. This improvement was not seen in participants who received iron supplements but who were iron deficient without anemia or who had normal iron levels.

• Scores for “vigor” increased more in the iron group compared with the placebo group as reported on a Profile of Mood States questionnaire.

The authors of this study from the Military Nutrition Division at the US Army Research Institute of Environmental Medicine in Natick, Massachusetts, comment, “…it is likely that iron status is diminished by moderate to heavy physical activity, which may affect physical performance and mood, especially in women who begin these activities with diminished iron status.” Because the physical and mental demands for women soldiers are great, the authors recommend they be screened for iron deficiency before they begin basic combat training and those found to be deficient should be appropriately treated.

More tips about iron

Talk with a doctor about iron. If you think you might be iron deficient see a doctor. He or she can determine if you lack iron through blood tests, determine the cause, and recommend treatment. Talk with a doctor first if you are thinking about taking iron supplements. Too much iron can be dangerous as you will read below.

Educate yourself about eating iron. Meat, poultry, lentils, beans, and fortified food products such as cereal are all good sources. Vitamin C may improve the absorption of iron and tannins (present in tea) and calcium may decrease absorption, which makes the timing and pairing of certain food, beverages, and supplements important.

Be aware that too much iron is dangerous. While too little iron can be harmful it is important to know that too much iron is toxic to the body and can cause serious health problems including liver disease or death. Iron is not easily removed by the body, and some people have a condition that makes their body particularly susceptible to retaining iron, so a person should only take iron supplements if their doctor recommends they do so.

(Am J Clin Nutr 2009;90:1–8)

Jane Hart, MD, board-certified in internal medicine, serves in a variety of professional roles including consultant, journalist, and educator. Dr. Hart, a Clinical Instructor at Case Medical School in Cleveland, Ohio, writes extensively about health and wellness and a variety of other topics for nationally recognized organizations, Web sites, and print publications. Sought out for her expertise in the areas of integrative and preventive medicine, she is frequently quoted by national and local media. Dr. Hart is a professional lecturer for healthcare professionals, consumers, and youth and is a regular corporate speaker.

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