Biological Trace Element Research

, Volume 188, Issue 1, pp 135–139 | Cite as

Iron, Zinc, and Physical Performance

  • James P. McClungEmail author


Iron and zinc are nutritionally essential trace elements that function through incorporation into proteins and enzymes; many of these proteins and enzymes affect physical performance. Poor iron status (iron deficiency and iron deficiency anemia) is prevalent in both developed and developing nations. Zinc deficiency has been reported in clinical and population studies, although the incidence is difficult to quantify due to the lack of a reliable zinc status indicator. The objective of this manuscript is to review the relationship between iron and zinc status and physical performance. In sum, numerous reports indicate diminished physical performance in individuals with poor iron and/or zinc status, whereas, in individuals with adequate status, evidence supporting a beneficial role of iron or zinc at levels beyond the recommended dietary allowance for optimizing physical performance is lacking.


Exercise Iron Physical performance Nutrition Zinc 



The author acknowledges Ms. Alyssa Kelley for her critical review of the manuscript.


This work was supported by the U.S. Army Medical Research Material Command’s Military Operational Medicine Research Program.

Compliance with Ethical Standards

Conflict of Interest

The author declares that there are no conflicts of interest.


The views, opinions, and/or findings in this report are those of the authors and should not be construed as official Department of the Army or Department of Defense position, policy, or decision unless so designated by other official designation.


  1. 1.
    Dallman PR (1986) Biochemical basis for the manifestations of iron deficiency. Annu Rev Nutr 6:13–40CrossRefGoogle Scholar
  2. 2.
    Institute of Medicine (2001) Iron. In: Dietary reference intakes. National Academy Press, Washington DC, pp 290–393Google Scholar
  3. 3.
    Brune M, Rossander-Hulton L, Hallberg L, Gleerup A, Sandberg AS (1992) Iron absorption from bread in humans: inhibiting effects of cereal fiber, phytate and inositol phosphates with different numbers of phosphate groups. J Nutr 122:442–449CrossRefGoogle Scholar
  4. 4.
    Wang W, Knovich MA, Coffman LG, Torti FM, Torti SV (2010) Serum ferritin: past, present and future. Biochim Biophys Acta 1800:760–769CrossRefGoogle Scholar
  5. 5.
    Looker AC, Gunter EW, Johnson CL (1995) Methods to assess iron status in various NHANES surveys. Nutr Rev 53:246–254CrossRefGoogle Scholar
  6. 6.
    Stoltzfus RJ (2001) Defining iron-deficiency anemia in public health terms: a time for reflection. J Nutr 131:565S–567SCrossRefGoogle Scholar
  7. 7.
    World Health Organization (2001) Iron deficiency anaemia: assessment, prevention, and control. A guide for programme managers WHO/NHD/01.3. World Health Organization, GenevaGoogle Scholar
  8. 8.
    Looker AC, Cogswell ME, Gunter MT (2002) Iron deficiency – United States, 1999–2000. MMWR Morb Mortal Wkly Rep 51:897–899Google Scholar
  9. 9.
    McClung JP, Murray-Kolb LE (2013) Iron nutrition and premenopausal women: effects of poor iron status on physical and neuropsychological performance. Annu Rev Nutr 33:271–288CrossRefGoogle Scholar
  10. 10.
    Yoshimura H (1970) Anemia during physical training. Nutr Rev 28:251–253CrossRefGoogle Scholar
  11. 11.
    de Wijn JF, de Jongste JC, Mosterd W, Willebrand D (1971) Hemoglobin, packed cell volume, serum iron, and iron binding capacity of selected athletes during training. J Sports Med 11:42–51Google Scholar
  12. 12.
    Stewart JG, Ahlquist DA, McGill DB, Ilstrup DM, Schwartz S, Owen RA (1984) Gastrointestinal bleeding and blood loss in runners. Ann Intern Med 100:843–845CrossRefGoogle Scholar
  13. 13.
    Brune M, Magnusson B, Persson H, Hallberg L (1986) Iron losses in sweat. Am J Clin Nutr 43:438–443CrossRefGoogle Scholar
  14. 14.
    Siegal AJ, Hennekens CH, Solomon HS, Van Boeckel BV (1979) Exercise-related hematuria: findings in a group of marathon runners. JAMA 241:391–392CrossRefGoogle Scholar
  15. 15.
    Peeling P, Dawson B, Goodman C, Landers G, Trinder D (2008) Athletic induced iron deficiency: new insights into the role of inflammation, cytokines, and hormones. Eur J Appl Physiol 103:381–391CrossRefGoogle Scholar
  16. 16.
    Hennigar SR, McClung JP, Pasiakos SM (2017) Nutritional interventions and the IL-6 response to exercise. FASEB J 31:3719–3728CrossRefGoogle Scholar
  17. 17.
    Laftah AH, Ramesh B, Simpson RJ, Solanky N, Bahram S, Schümann K, Debnam ES, Srai SK (2004) Effect of hepcidin on intestinal iron absorption in mice. Blood 103:3940–3944CrossRefGoogle Scholar
  18. 18.
    Roecker L, Meier-Buttermilch R, Brechtel L, Nemeth E, Ganz T (2005) Iron-regulatory protein hepcidin is increased in female athletes after a marathon. Eur J Appl Physiol 95:569–571CrossRefGoogle Scholar
  19. 19.
    McClung JP, Martini S, Murphy NE, Montain SJ, Margolis LM, Thrane I, Spitz MG, Blatny JM, Young AJ, Gundersen Y, Pasiakos SM (2013) Effects if a 7-day military training exercise on inflammatory biomarkers, serum hepcidin, and iron status. Nutr J 12:141CrossRefGoogle Scholar
  20. 20.
    McClung JP (2012) Iron status and the female athlete. J Trace Elem Med Biol 26:124–126CrossRefGoogle Scholar
  21. 21.
    Ashenden MJ, Martin DJ, Dobson GP, Mackintosh C, Hahn AG (1998) Serum ferritin and anemia in trained athletes. Int J Sport Nutr 8:223–229CrossRefGoogle Scholar
  22. 22.
    McClung JP, Marchitelli LJ, Friedl KL, Young AJ (2006) Prevalence of iron deficiency and iron deficiency anemia among three populations of female military personnel in the US Army. J Am Coll Nutr 25:64–69CrossRefGoogle Scholar
  23. 23.
    McClung JP, Karl JP, Cable SJ, Williams KW, Young AJ, Lieberman HR (2009a) Longitudinal decrements in iron status during military training in female soldiers. Br J Nutr 102:605–609CrossRefGoogle Scholar
  24. 24.
    McClung JP, Karl JP, Cable SJ, Williams KW, Nindl BC, Young AJ, Lieberman HR (2009b) Randomized, double-blind, placebo-controlled trial of iron supplementation in female soldiers during military training: effects on iron status, physical performance, and mood. Am J Clin Nutr 90:124–131CrossRefGoogle Scholar
  25. 25.
    Woodson RD, Wills RE, Lenfant C (1978) Effect of acute and established anemia on O2 transport at rest, submaximal and maximal work. J Appl Physiol Respir Environ Exerc Physiol 44:36–43Google Scholar
  26. 26.
    Gardner GW, Edgerton VR, Senewiratne B, Barnard RJ, Ohira Y (1977) Physical work capacity and metabolic stress in subjects with iron deficiency anemia. Am J Clin Nutr 30:910–917CrossRefGoogle Scholar
  27. 27.
    Edgerton VR, Gardner GW, Ohira Y, Gunawardena KA, Senewiratne B (1979) Iron-deficiency anemia and its effect on worker productivity and activity patterns. Br Med J 2:1546–1549CrossRefGoogle Scholar
  28. 28.
    Patterson AJ, Brown WJ, Powers JR, Roberts DCK (2000) Iron deficiency, general health and fatigue: results from the Australian Longitudinal Study on Women’s Health. Qual Life Res 9:491–497CrossRefGoogle Scholar
  29. 29.
    McKay RH, Higuchi DA, Winder WW, Fell RD, Brown EB (1983) Tissue effects of iron deficiency in the rat. Biochim Biophys Acta 757:352–358CrossRefGoogle Scholar
  30. 30.
    Finch CA, Miller LR, Inamdar AR, Person R, Seiler K, Mackler B (1976) Iron deficiency in the rat. Physiological and biochemical studies of muscle dysfunction. J Clin Investig 58:447–453CrossRefGoogle Scholar
  31. 31.
    Haas JD, Brownlie T IV (2001) Iron deficiency and reduced work capacity: a critical review of the research to determine a causal relationship. Am J Clin Nutr 131:676S–690SGoogle Scholar
  32. 32.
    Brutsaert TD, Hernandez-Cordero S, Rivera J, Viola T, Hughes G, Haas JD (2003) Iron supplementation improves progressive fatigue resistance during dynamic knee extensor exercise in iron-depleted, nonanemic women. Am J Clin Nutr 77:441–448CrossRefGoogle Scholar
  33. 33.
    Zhu YI, Haas JD (1998) Altered metabolic response of iron-depleted nonanemic women doing a 15-km time trial. J Appl Physiol 84:1768–1775CrossRefGoogle Scholar
  34. 34.
    Brownlie T IV, Utermohlen V, Hinton PS, Haas JD (2004) Tissue iron deficiency without anemia impairs adaptation in endurance capacity after aerobic training in previously untrained women. Am J Clin Nutr 79:437–443CrossRefGoogle Scholar
  35. 35.
    Zhu YI, Haas JD (1997) Iron depletion without anemia and physical performance in young women. Am J Clin Nutr 66:334–341CrossRefGoogle Scholar
  36. 36.
    Hinton PS, Giordano C, Brownlie T, Haas JD (2000) Iron supplementation improves endurance after training in iron-depleted, nonanemic women. J Appl Physiol 88:1103–1111CrossRefGoogle Scholar
  37. 37.
    DellaValle DM, Haas JD (2011) Impact of iron depletion without anemia on performance in trained endurance athletes at the beginning of a training season: a study of female collegiate rowers. Int J Sport Nutr Exerc Metab 21:501–506CrossRefGoogle Scholar
  38. 38.
    DellaValle DM, Haas JD (2012) Iron status is associated with endurance performance and training in female rowers. Med Sci Sports Exerc 44:1552–1559CrossRefGoogle Scholar
  39. 39.
    Krayenbuehl P-A, Battaegay E, Breymann C, Furrer J, Schulthess G (2011) Intravenous iron for the treatment of fatigue in nonanemic, premenopausal women with low serum ferritin concentration. Blood 118:3222–3227CrossRefGoogle Scholar
  40. 40.
    Vaucher P, Druais P-L, Waldvogel S, Favrat B (2012) Effect of iron supplementation on fatigue in nonanemic menstruating women with low ferritin: a randomized controlled trial. CMAJ 184:1247–1254CrossRefGoogle Scholar
  41. 41.
    Pompano LM, Haas JD (2017) Efficacy of iron supplementation may be misinterpreted using conventional measures of iron status in iron-depleted, nonanemic women undergoing aerobic exercise training. Am J Clin Nutr 106:1529–1538CrossRefGoogle Scholar
  42. 42.
    Institute of Medicine (2001) Zinc. In: Dietary reference intakes. National Academy Press, Washington DC, pp 442–502Google Scholar
  43. 43.
    O’Dell BL, Savage JE (1960) Effect of phytic acid on zinc bioavailability. Proc Soc Exp Biol Med 103:304–306CrossRefGoogle Scholar
  44. 44.
    Hennigar SR, Lieberman HR, Fulgoni VL III, McClung JP (2018) Serum zinc concentrations in the U.S. population are related to sex, age, and time of blood draw, but not dietary zinc. J Nutr (In Press)Google Scholar
  45. 45.
    Hennigar SR, Kelley AM, McClung JP (2016) Metallothionein and zinc transporter expression in circulating human blood cells as biomarkers of zinc status: a systematic review. Adv Nutr 7:735–746CrossRefGoogle Scholar
  46. 46.
    Prasad AS, Halsted JA, Nadimi M (1961) Syndrome of iron deficiency anemia, hepatosplenomegaly, hypogonadism, dwarfism and geophagia. Am J Med 31:532–546CrossRefGoogle Scholar
  47. 47.
    Sandstead HH, Prasad AS, Schulert AR, Farid Z, Miale A Jr, Bassilly S, Darby WJ (1967) Human zinc deficiency, endocrine manifestations and response to treatment. Am J Clin Nutr 20:422–442CrossRefGoogle Scholar
  48. 48.
    Hambidge KM, Hambidge C, Jacobs M, Baum JD (1972) Low levels of zinc in hair, anorexia, poor growth, and hypogeusia in children. Pediatr Res 6:868–874CrossRefGoogle Scholar
  49. 49.
    Sandstead HH (1995) Is zinc deficiency a public health problem? Nutrition 11:87–92Google Scholar
  50. 50.
    Dressendorfer RH, Sockolov R (1980) Hypozincemia in runners. Phys Sportsmed 8:97–100CrossRefGoogle Scholar
  51. 51.
    Chu A, Holdaway C, Varma T, Petocz P, Samman S (2018) Lower serum zinc concentration despite high dietary zinc intake in athletes: a systematic review and meta-analysis. Sports Med 48:327–336CrossRefGoogle Scholar
  52. 52.
    Lukaski HC (2000) Magnesium, zinc, and chromium nutriture in physical activity. Am J Clin Nutr 72(suppl):585S–593SCrossRefGoogle Scholar
  53. 53.
    Hennigar SR, McClung JP (2016) Hepcidin attenuates zinc efflux in Caco-2 cells. J Nutr 146:2167–2173CrossRefGoogle Scholar
  54. 54.
    Richardson JH, Drake PD (1979) The effects of zinc on fatigue of striated muscle. J Sports Med Phys Fitness 19:133–134Google Scholar
  55. 55.
    Krotkiewski M, Gudmindsson M, Backstom P, Mandroukas K (1982) Zinc and muscle stregnth and endurance. Acta Physiol Scand 116:309–311CrossRefGoogle Scholar
  56. 56.
    Van Loan MD, Sutherland B, Lowe NM, Turnlund JR, King JC (1999) The effects of zinc depletion on peak force and total work of knee and shoulder extensor and flexor muscles. Int J Sport Nut 9:125–135CrossRefGoogle Scholar
  57. 57.
    Lukaski HC (2005) Low dietary zinc decreases erythrocyte carbonic anhydrase activities and impairs cardiorespiratory function in men during exercise. Am J Clin Nutr 81:1045–1051CrossRefGoogle Scholar

Copyright information

© This is a U.S. Government work and its text is not subject to copyright protection in the United States; however, its text may be subject to foreign copyright protection 2018

Authors and Affiliations

  1. 1.Military Nutrition DivisionUS Army Research Institute of Environmental MedicineNatickUSA

Personalised recommendations