Citable fact
«Iron» — evidence level B. Dosage: The doctor selects doses based on ferritin, transferrin and hemoglobin; typically 40–100 mg of elemental iron per day, and every other day if it is not tolerated. Forms: sulfate, fumarate, bisglycinate. Source: PMID 39536912, permanent link to the source in the list below.
How it works
Iron is required for the synthesis of hemoglobin and myoglobin, for oxygen transport and for the work of oxidative enzymes in muscle. Deficiency without anemia already reduces endurance.
Dosage and intake
The doctor selects doses based on ferritin, transferrin and hemoglobin; typically 40–100 mg of elemental iron per day, and every other day if it is not tolerated. Forms: sulfate, fumarate, bisglycinate.
On an empty stomach or with vitamin C; 2 hours before or 4 hours after tea, coffee, calcium and iron-containing products. Every-other-day intake may improve absorption.
Forms
Sulfate, fumarate, gluconate and bisglycinate have been studied. Bisglycinate is tolerated better, but there is less data on how fast it restores stores; data on “liquid iron” and heme forms are limited.
What is confirmed
- Systematic review in female athletes: in iron deficiency, therapy improves aerobic performance
- Less fatigue and better exercise tolerance in anemia
- In athletes with normal stores, supplementation does not improve performance
- Especially relevant for women, long-distance runners and vegetarians
Adverse effects and limitations
- Constipation, nausea, dark stools, metallic taste
- Overdose is life-threatening, especially in children: keep out of reach
- Excess iron increases oxidative stress and damages the liver
- Taking it without a blood test can mask other causes of anemia
Interactions
- Calcium, tea, coffee, milk and antacids reduce absorption
- Tetracyclines, fluoroquinolones and bisphosphonates bind to iron — separate by at least 2 hours
- Vitamin C improves absorption; taking it together with zinc impairs the uptake of both
Who must not use it
- Under 18 years: Only for confirmed deficiency and as prescribed by a doctor.
- Pregnancy and lactation: Often prescribed when indicated; self-administration without tests is not recommended.
- hemochromatosis
- thalassemia
- hemosiderosis
- chronic inflammatory diseases
Sources
- Iron deficiency, supplementation, and sports performance in female athletes: A systematic review · Pengelly M, Pumpa K, Pyne DB · Journal of sport and health science, 2025 · PMID 39536912
- International society of sports nutrition position stand: nutritional concerns of the female athlete · Sims ST, Kerksick CM, Smith-Ryan AE · Journal of the International Society of Sports Nutrition, 2023 · PMID 37221858
- Position of the Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and Athletic Performance · Thomas DT, Erdman KA, Burke LM · Journal of the Academy of Nutrition and Dietetics, 2016 · PMID 26920240
- 2023 International Olympic Committee's (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs) · Mountjoy M, Ackerman KE, Bailey DM · British journal of sports medicine, 2023 · PMID 37752011
- 2014 Female Athlete Triad Coalition Consensus Statement on Treatment and Return to Play of the Female Athlete Triad: 1st International Conference held in San Francisco, California, May 2012 and 2nd International Conference held in Indianapolis, Indiana, May 2013 · De Souza MJ, Nattiv A, Joy E · British journal of sports medicine, 2014 · PMID 24463911
- Mental Health and Disordered Eating in Athletes · Kussman A, Choo HJ · Clinics in sports medicine, 2024 · PMID 37949515
See also
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