Sports Anemia: A Common Problem Among New Athletes

Red PillWhen you first start working out you may be surprised to find your hemoglobin level has dropped. You eat a healthy diet and get adequate amounts of iron. What gives? This isn’t uncommon among new athletes. It’s sometimes referred to as sports anemia to distinguish it from iron deficiency anemia, a type of anemia that comes from low iron levels.

What is Sports Anemia?

When you first start exercising, your body responds to strenuous workouts by increasing the fluid portion of your blood called the plasma. This increase in plasma volume dilutes out the number of red blood cells per volume of blood leading to a pseudo-anemia. It’s called a pseudo-anemia because you still have adequate red blood cells. They’re just in a more dilute environment.

Sports anemia is a physiological adaptation to a strenuous conditioning program. Unlike other types of anemia, such as iron deficiency anemia, it doesn’t affect sports performance. It usually goes away once you’ve trained for a while and doesn’t cause symptoms.
The best way to “treat” sports anemia is not to get more iron but more protein. Sports anemia has been linked with inadequate protein intake. So make sure you’re getting between 1-1.5 grams per kilogram of protein in your diet if you’re doing a strenuous workout.

Iron Deficiency Anemia in Athletes

Iron deficiency is a more serious kind of anemia that can adversely affect your performance and cause you to feel fatigued with only minimal exertion. Long-distance runners are at a greater risk of iron deficiency anemia because they destroy red blood cells when their feet strike the ground repeatedly.

Female athletes and vegetarians are also at higher risk for iron deficiency. Female athletes lose iron through menstrual bleeding, and vegetarians don’t always get adequate amounts of iron in their diet. Plant sources of iron aren’t as easily absorbed by the body even when a vegetarian eats plenty of plant-based foods high in iron. Some athletes also restrict calories, which can further reduce iron stores and contribute to iron deficiency anemia.

The Bottom Line?

Sports anemia is usually a temporary phenomenon that goes away with time on its own. It won’t affect performance and doesn’t require treatment. Iron deficiency anemia is also not uncommon, especially among female athletes and those that eat a vegetarian diet or restrict calories. It does affect performance and needs to be treated by replenishing the body’s iron stores.

If there’s a question as to which type of anemia you have, your doctor can check a ferritin level using a simple blood test. This is a measure of your body’s iron stores. If your iron stores are low or if you have iron deficiency anemia, your doctor may recommend a supplement. Don’t take an iron supplement without consulting your doctor. Too much iron is bad for your health too.


Int. J. Sports Med. 1992. May; 13(4): 344-7.
Hospital for Special Surgery. “Preventing Athletic Anemia”

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