Failure to address dietary issues or other underlying causes of the iron deficiency

• Iron supplementation does not address dietary issues. Dietary counselling in the early investigation phase of treatment should be provided via a referral to an accredited sports dietitian.
• Where possible, the underlying cause for iron deficiency should be established so that it can be addressed. In some circumstances, a medical issue may need to be corrected.

Risk of iron overload or other medical issues

• Excessive iron intake in some athletes may lead to iron overload. People with haemochromatosis should avoid iron supplementation, since extremely high iron levels can be toxic to the body’s organs. Further information can be obtained from a sports doctor.
• Intravenous and intramuscular iron supplementation carries a risk of anaphylactic shock, and problems due to the use of needles.

Risk of gastrointestinal upset

• Some oral iron preparations cause gastrointestinal upset including constipation. Supplementation strategies such as ‘every second day’ approaches have been shown to reduce this gastrointestinal response, without compromising the supplements efficacy⁵ over time (8-12 weeks).