Robertset al. 1988). Finally, in the South Carolina
study of female runners and non-runners, the
runners (who had lower ferritins than the non-
runners) consumed less meat, more carbohy-
drate, more fibre and more coffee or tea (Pate
et al. 1993).
Iron supply can be increased by:
1 eating more lean red meat;
2 not consuming tea or coffee with meals
3 drinking orange juice with breakfast;
4 cooking in cast-iron cookware;
5 frequently eating mixed meals;
6 the wise use of iron supplements.
The best way is to consume some red meat—
say, 80 g of lean beef three to four times a week.
Poultry and fish also contain haem iron, but less
than red meat. Meat, fish, poultry and ascorbic
acid enhance non-haem iron absorption. Con-
versely, inhibitors include tea (tannins), coffee
(polyphenols), eggs and cow’s milk (calcium and
phosphoproteins), wheat bran (phytate), soy
products and fibre. The threat of inhibitors,
however, seems overblown. For example, any
inhibition of fibre on non-haem iron absorption
is modest (Cook et al. 1983), and with a varied
Western diet, the net effect of inhibitors (or
enhancers) is small, because no given inhibitor
(or enhancer) is contained within enough meals
to shape iron balance (Cook et al. 1991a, 1991b).
Avoiding tea or coffee with breakfast (they can
be drunk 1–2 h before or after) and taking a
source of vitamin C (orange juice) can triple the
amount of iron absorbed from the meal
(Rossanderet al. 1979). Cooking occasionally in
cast-iron (vs. stainless steel) skillets and pots,
especially when simmering acidic foods like
vegetable soup or tomato sauce, can leach
absorbable iron into the food. Eating mixed
meals is key, because meat, fish and poultry
contain enhancers, so when meat and vegetables
are eaten together, more non-haem iron is
absorbed from the vegetables than if the vegeta-
bles had been eaten alone.
It is preferable for female athletes to meet their
iron need by consuming iron-rich foods, but for
such women who repeatedly develop iron defi-
ciency anaemia and are unable to follow dietary
advice, one can prescribe supplementary iron
(e.g. ferrous sulphate, 325 mg three times a
week). As for other common supplements,
women who take calcium supplements should
avoid them with meals (because they inhibit non-
haem iron absorption), whereas women who
take vitamin C supplements should take them
with meals to enhance iron absorption (Cook &
Monsen 1977; Cook et al. 1991a, 1991b).
Vegetarians need to heed their supply of iron
(and zinc) because plants are paltry providers. So
vegetarians should eat iron-rich foods such as
dried fruit (apricots, prunes, dates), beans, peas,
tofu, kale, spinach (a recent report claims spinach
has only one tenth the iron as formerly thought),
collard greens, and blackstrap molasses. Vegetar-
ians should also consider taking a multivitamin
and mineral supplement that provides the RDA
for iron (and zinc).
Finally, among male athletes especially, injudi-
cious use of iron supplements is a potential
hazard. In the USA at least, one person in 200 is
genetically programmed to develop hereditary
haemochromatosis; over the years, he or she
becomes iron-overloaded because daily absorp-
tion of dietary iron is about twice normal. In men,
who have no physiological means to excrete
excess iron (i.e. no menses), problems from iron
overload in hereditary haemochromatosis
develop earlier in life (than in women). In such
men, iron supplements accelerate haemochro-
matosis. As a concluding rule of thumb, if many
female athletes need more iron than they get,
many male athletes get more iron than they need.References
Balaban, E.P., Cox, J.V., Snell, P., Vaughan, R.H. &
Frenkel, E.P. (1989) The frequency of anemia and iron
deficiency in the runner. Medicine and Science in
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Baynes, R.D. (1996) Refining the assessment of body
iron status. American Journal of Clinical Nutrition 64 ,
793–794.
Blum, S.M., Sherman, A.R. & Boileau, R.A. (1986) The
effects of fitness-type exercise on iron status in adult
women.American Journal of Clinical Nutrition 43 ,
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