Iron Deficiency in Vegetarian Athletes: A Narrative Review

The increasing adoption of vegetarian dietary patterns among athletes (including lacto-ovo, lacto-, ovo-vegetarian, and vegan diets) has prompted growing interest in their potential effects on health and sports performance. Iron status remains one of the key nutritional concerns in this context, given the lower bioavailability of non-heme iron and the higher physiological demands of exercise. This review aims to synthesize and critically evaluate current evidence on the prevalence, consequences, adaptive responses, and management of iron deficiency in vegetarian athletes.

Available studies do not consistently indicate a higher prevalence of iron deficiency among vegetarian athletes compared with omnivores. Despite lower iron bioavailability, total dietary iron intake in vegetarians often equals or exceeds that of omnivores, and several adaptive mechanisms (such as enhanced absorption efficiency and reduced iron losses) may help preserve iron balance. Nevertheless, methodological heterogeneity across studies and the limited inclusion of elite or female athletes constrain firm conclusions. Current data suggest that vegetarian athletes are not inherently at greater risk of iron deficiency. However, in high-performance settings, individualized and evidence-based dietary planning remains essential to ensure optimal iron status and sustain athletic performance. Future research should clarify the interplay between diet composition, adaptive physiology, sex, and training load in determining iron metabolism among vegetarian athletes.