Student-Athlete Advocacy Project

Test Your Metal

Iron deficiency affects nearly 1 in 3 female highschool athletes. It degrades athletic preformance, damages academic ability, and brings extreme energy loss, all of which may create lifelong consequences. Despite this, very few individuals and groups screen for this condition, our goal is to combat and adress this disregard.

See What We're Asking For My Experience
25%
of female athletes are iron deficient
60%
of female athletes in endurance sports are iron defficient
$20
the approximate cost of a ferritin test that could catch this condition
28 mg
the daily iron recomendation for a female athlete, which is often not reached
30%
of females of childbearing age worldwide experience iron defficiency
13%
of females worldwide are estimated to have iron defficiency anemia
The Problem

A common condition frequently overlooked

Iron deficiency is the most common nutritional deficiency in the United States. Adolescent girls are among the most vulnerable, and female athletes face an even higher risk. Still under 3% of female athletes test for iron deficiency despite an estimated 45% experiencing this condition.

Menstruation + Athletics = a significantly higher risk

Monthly blood loss diminishes iron stores, leading to iron deficiency. Rigorous training means your muscles need more oxygen and you need more energy. Iron has the job of helping build the proteins in red blood cells that bring oxygen to your muscles. Inflammation from exercise reduces iron absorption, often leading to iron deficiency.

You don't need to be anemic to suffer

Anemia is a severe form of iron deficiency. Low iron impairs endurance, cognition, mood, and recovery ability long before iron and hemoglobin drop to levels of anemia. Research shows that supplementing non-anemic, low-iron athletes improves their performance significantly.

Symptoms Get Dismissed

Fatigue, slow recovery, brain fog, and lethargy are frequently written off as overtraining, stress, or just “being a teenager”. This disregarding means the cause behind these symptoms may remain hidden for far too long.

The Sports Physical Doesn't Look

Anemia testing is not required as part of a pre-participation physical evaluation in nearly all areas. This means anemia goes unnoticed throughout the current examination process.

My Story

I lived it and I don't want anyone else to

"During my Freshaman and Sophmore year in High School, I began to struggle to make it through a single training without overwhelming fatigue. I used to breeze through, and have fun, but this feeling changed it all. My times got slower, I lost focus, and I began to fall behind my teammates. Soccer wasn't the only thing I fell behind in. I began to drop grades in school, spend less time with friends, and lose out on countless moments. I was sleeping ten hours a night, tried to fuel well and still struggled to stay awake or even feel like myself. I was told I needed to try harder, eat better, manage my stress. But nobody suggested a blood test. It took two years and over 10 doctors visits before a simple blood test revealed what was really going on: severe iron-deficiency anemia. I had been running my life on ferretin levels of 3 ng/ml and heimoglobin levels of 4 g/dL (the recomended levels for NON athletes is 30-250 ng/ml and 12-16 g/dL respectively). Within 2 weeks of starting treatment, I felt like a completely different person and this change was noticed by all around me. But I had already lost a year of school and soccer, and may have suffered damage to my heart and other organs. I am forever greatful that a coach who saw me stuggling recomended I get tested at the hospital, but I always wish I had known that a $20 blood test could have caught this before it ever got that bad.
— Stella Eisen, Soccer
What We're Asking For

Three simple, low-cost changes

We hope schools and physicians include a simple, well-established iron deficiency screening test into the conversation of physical readiness.

1

Add ferritin screening to sports physicals for female athletes

Recommending that female athletes request a serum ferritin test from their physician during their annual physical. Not required for all individuals getting a check-up but required in these circumstances.

2

Use a meaningful threshold

The “normal” ranges of ferritin and hemoglobin are set below the optimal range for an active athlete. A ferritin level below 30ng/mL is recommended to trigger a follow up visit with a healthcare provider, as this is the lowest level of ferritin an athlete should have according the current sports medicine research.

3

Educate athletes, families, and coaches

Provide information about the signs, risks, and methods of prevention to help early symptoms be both recognized and treated.

The Evidence

Research on the matter is clear and concrete

Decades of published research support screening for iron deficiency in female athletes. Here are some of the key findings:

Iron supplementation improves endurance performance even in women who are iron-depleted but not yet anemic — proving that you don't need to be severely ill to be harmed by low iron. Brownlie et al., American Journal of Clinical Nutrition, 2004
Iron-depleted female collegiate rowers showed measurably impaired performance at the start of their training season compared to iron-sufficient teammates. DellaValle & Haas, Int'l J of Sport Nutrition and Exercise Metabolism, 2011
The International Olympic Committee recognizes iron status as a key health parameter that should be monitored in athletes at risk of Relative Energy Deficiency in Sport (RED-S). IOC Consensus Statement, British Journal of Sports Medicine, 2018
Exercise triggers increases in hepcidin — a hormone that blocks iron absorption — for hours after training, making it harder for athletes to maintain iron stores through diet alone. Sim et al., European Journal of Applied Physiology, 2019
Most adolescent girls fail to meet the recommended 15 mg/day of dietary iron — a target that increases during puberty precisely when many girls begin restricting their diets. NIH Office of Dietary Supplements — Iron Fact Sheet for Health Professionals
Take Action

Help combat iron defficiency

Decades of published research supports screening for iron deficiency in female athletes, here are some of the key findings:

If you're a student-athlete

if you feel any of the common symptoms of iron deficiency, ask your doctor for a ferritin test at your next physical. Talk to friends and teammates about iron and if you have experienced this deficiency, share your story!

If you're a parent

Request a ferritin test for your child, especially if they are participating in an endurance sport. Learn about ways to spot iron deficiency and help educate those around you.

If you're a coach or trainer

Learn the signs of iron deficiency well. When an athlete’s performance drops or fatigue seems disproportionate to those around them, consider referring them to a ferritin test.

If you're an administrator

recommend ferritin screening to you’re district’s athletics physical requirements. Help provide resources in the area for this testing to be more accessible. We’d love to discuss the logistics!

Take Action

Quick things to keep in mind

In the case you, or someone close to you finds themselves in the situation of iron defficiency there are many easily recognizable symptoms and things to do if you notice them:

If you experience any of these symptoms look to get tested

External

Pale or yellow skin/lack of color in the face, inner iyelids, or nail beds. Unexplained hair loss or cracks at the corners of the mouth. Frequently cold hands and feet, espessially when others are not feeling this way.

Internal

Moderate to extreme fatigue or weakness, headaches, lightheadedness, difficulty concentrating and thinking clearly, abnormally rapid heart rate, chest pain, and shortness of breath.

Ask your phisician about taking an iron supplement and try to implement iron rich foods into your diet

Meats

Organs, shellfish (clams, oysters, mussels), red meat (beef, bison, lamb), and various forms of fish

Other foods

legumes (lentils, chickpeas, black beans, kidney beans), soy products (tofu, tempeh), seeds/nuts (pumpkin, sesame, cashews, almonds), greens (spinach and kale), and fortified breakfast cereals that can have 90-100% of the DV of iron including cheerios, soecial K and quaker oatmeal.

Get in Touch Read the Research
Resources

Learn more

NIH Iron Fact Sheet

Comprehensive overview of iron requirements, deficiency, and health impacts from the Office of Dietary Supplements.

Read at NIH.gov →

IOC RED-S Consensus (2018)

The International Olympic Committee's framework for understanding energy deficiency in sport, including iron status.

Read at BJSM →

Iron and Endurance Performance

The landmark Brownlie et al. study showing that iron depletion impairs performance even without anemia.

Read at AJCN →

Iron Considerations for Athletes

A comprehensive narrative review of iron metabolism, loss mechanisms, and management in athletic populations.

Read at EJAP →