Low Ferritin in Nonanemic Athlete

The common belief among coaches and endurance athletes is that a low ferritin level can cause fatigue, poor recovery, and poor performance. The ferritin level generally reflects total body iron, and 82% of female endurance athletes have a low ferritin level (Shaskey and Green, 2000). Many studies have examined whether improvements in performance seen in nonanemic athletes are caused by small increases in Hb level (from a normal to a higher normal Hb level) or by an increase in iron alone (Garza et al., 1997). A review of eight randomized, controlled trials (RCTs) indicates that iron has a positive effect on performance in iron-deficient athletes without anemia, independent of Hb increases (Fogelholm et al., 1992; Friedmann et al., 2001; Hinton et al., 2000; Klingshirn et al., 1992; LaManca and Haymes, 1993; New-house et al., 1989; Rowland et al., 1988; Zhu and Haas, 1998).

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