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Final Assignment
Iron deficiency is common in athletes due to their high demand for the mineral which stems from Hepcidin bursts due to inflammation caused by exercise decreasing iron absorption and causes iron uptake by macrophages. Clénin, G; Cordes, M; Huber, A; Schumacher, YO; Noack, P; Scales, J; Kriemler, S. "Iron deficiency in sports – definition, influence on performance and therapy". Swiss Medical Weekly. doi:10.4414/smw.2015.14196. McClung, James P. "Iron status and the female athlete". Journal of Trace Elements in Medicine and Biology. 26 (2-3): 124–126. doi:10.1016/j.jtemb.2012.03.006 Deficiency is especially prevalent in high endurance sports and those in which competitors are likely to develop eating disorders. Young female athletes are at up to a 52% greater risk of iron deficiency than their male counterparts because of increased iron loss during menstruation. Alaunyte, Ieva; Stojceska, Valentina; Plunkett, Andrew (2015/12). "Iron and the female athlete: a review of dietary treatment methods for improving iron status and exercise performance". Journal of the International Society of Sports Nutrition. 12 (1): 38. doi:10.1186/s12970-015-0099-2. ISSN 1550-2783 Females are at a greater risk for iron deficiency anemia due to menstrual bleeding which increases iron turnover, or the rate at which iron is lost from the body. Bruinvels, G., Burden, R., Brown, N., Richards, T., & Pedlar, C. (2016). The prevalence and impact of heavy menstrual bleeding among athletes and mass start runners of the 2015 london marathon. British Journal of Sports Medicine, 50(9), 566. http://dx.doi.org/10.1136/bjsports-2015-095505 Petkus, D. L., Murray-Kolb, L. E., & Souza, M. J. (2017). The Unexplored Crossroads of the Female Athlete Triad and Iron Deficiency: A Narrative Review. Sports Medicine, 47(9), 1721-1737. doi:10.1007/s40279-017-0706-2 This iron is a necessary component for oxygen transport and the creation of enzymes used in the citric acid cycle and oxidative phosphorylation, especially in athletes who require readily available energy during training. Bruinvels, G., Burden, R., Brown, N., Richards, T., & Pedlar, C. (2016). The prevalence and impact of heavy menstrual bleeding among athletes and mass start runners of the 2015 london marathon. British Journal of Sports Medicine, 50(9), 566. http://dx.doi.org/10.1136/bjsports-2015-095505 Similarly, blood glucose levels decrease and growth hormone is suppressed as well as ghrelin when iron is low. Decreased levels of ghrelin and greater body image dissatisfaction that occurs in female athletes cause a loss of appetite inducing lowered energy intake which further perpetuates iron deficiency. Petkus, D. L., Murray-Kolb, L. E., & Souza, M. J. (2017). The Unexplored Crossroads of the Female Athlete Triad and Iron Deficiency: A Narrative Review. Sports Medicine, 47(9), 1721-1737. doi:10.1007/s40279-017-0706-2 It is unclear as to whether or not supplementation in mildly iron deficient female athletes has positive effects on physical performance but, there is evidence indicating that supplementation improves iron status in these women. Alaunyte, I., Stojceska, V., & Plunkett, A. (2015). Iron and the female athlete: A review of dietary treatment methods for improving iron status and exercise performance. Journal of the International Society of Sports Nutrition, 12(1). doi:10.1186/s12970-015-0099-2 Yet, supplementation has a lesser effect on the iron status of exercising women when compared to the effects on their non-exercising counterparts. Pompano, L. M., & Haas, J. D. (2017). Efficacy of iron supplementation may be misinterpreted using conventional measures of iron status in iron-depleted, nonanemic women undergoing aerobic exercise training. The American Journal of Clinical Nutrition, 106(6), 1529-1538. doi:10.3945/ajcn.117.152777 Still, there are studies that show supplementation in iron deficient and anemic female athletes improves performance. Pasricha, S., Low, M., Thompson, J., Farrell, A., & De-Regil, L. (2014). Iron Supplementation Benefits Physical Performance in Women of Reproductive Age: A Systematic Review and Meta-Analysis. The Journal of Nutrition, 144(6), 906-914. doi:10.3945/jn.113.189589 Matsumoto, M., Hagio, M., Katsumata, M., & Noguchi, T. (2015). Combined Heme Iron Supplementation and Nutritional Counseling Improves Sports Anemia in Female Athletes. SciMed Central. Retrieved from https://www.researchgate.net/publication/283712280_Annals_of_Sports_Medicine_and_Research_Combined_Heme_Iron_Supplementation_and_Nutritional_Counseling_Improves_Sports_Anemia_in_Female_Athletes?enrichId=rgreq-6b7eab2c217dc0682b9b6208bf716749-XXX&enrichSource=Y292ZXJQYWdlOzI4MzcxMjI4MDtBUzoyOTQ3OTA4MzYwNDc4NzZAMTQ0NzI5NTAyMDE0NQ==&el=1_x_3&_esc=publicationCoverPdf. However, it is recommended that dietary and lifestyle changes such as more iron rich foods and different training programs be made for long term maintenance of this deficiency in order to avoid iron toxicity. Matsumoto, M., Hagio, M., Katsumata, M., & Noguchi, T. (2015). Combined Heme Iron Supplementation and Nutritional Counseling Improves Sports Anemia in Female Athletes. SciMed Central. Retrieved from https://www.researchgate.net/publication/283712280_Annals_of_Sports_Medicine_and_Research_Combined_Heme_Iron_Supplementation_and_Nutritional_Counseling_Improves_Sports_Anemia_in_Female_Athletes?enrichId=rgreq-6b7eab2c217dc0682b9b6208bf716749-XXX&enrichSource=Y292ZXJQYWdlOzI4MzcxMjI4MDtBUzoyOTQ3OTA4MzYwNDc4NzZAMTQ0NzI5NTAyMDE0NQ==&el=1_x_3&_esc=publicationCoverPdf. Alaunyte, I., Stojceska, V., & Plunkett, A. (2015). Iron and the female athlete: A review of dietary treatment methods for improving iron status and exercise performance. Journal of the International Society of Sports Nutrition, 12(1). doi:10.1186/s12970-015-0099-2

Assignment 5
'''Why do women use dietary supplements? The use of the theory of planned behaviour to explore beliefs about their use''' In this study a questionnaire was sent to 400 of the 15,000 random women in the UKWCS database. The questionnaire found that the women who took supplements were more likely to believe that what they were doing had some health benefit, by either combating a preexisting condition or preventing an ailment from developing. The researchers attributed this effect for those that use iron supplements to the well-known concept that iron supplementation can prevent anemia. The study received good data from a multitude of subjects. However, the data found cannot be assumed to be the perspectives of the general public as self-selection should be factored in as not all of those who received a questionnaire returned one and all of the subjects were women. This article supports the concept that iron supplementation is important to the health of individuals.

Conner, M., Kirk, S. F., Cade, J. E., & Barrett, J. H. (2001). Why do women use dietary supplements? The use of the theory of planned behaviour to explore beliefs about their use. Social Science & Medicine,52(4), 621-633. doi:10.1016/s0277-9536(00)00165-9

Dietary Supplements and Sports Performance: Minerals This article is a review of the literature that focuses on the effects of mineral supplementation on athletic performance. The author is reputable and draws on information from many sources. However, the reader must trust that the sources this author references are good sources. This article upholds the concept that iron supplementation in athletes can be very beneficial yet, it warns about the possible side effects of over supplementation.

Williams, M. H. (2005, June 11). Dietary Supplements and Sports Performance: Minerals. Retrieved from https://jissn.biomedcentral.com/articles/10.1186/1550-2783-2-1-43

'''Is iron treatment beneficial in, iron-deficient but non-anaemic (IDNA) endurance athletes? A systematic review and meta-analysis''' This review article compared the data from various studies on IDNA athletes to determine if iron supplementation had any benefit on them. The researchers found 26 studies out of 5,715 that met their criteria. However, in their criteria they did not mention that they checked to ensure the reputability of these studies. This review confirms that iron supplementation can have a beneficial effect on those who are only iron deficient.

Burden, R. J., Morton, K., Richards, T., Whyte, G. P., & Pedlar, C. R. (2014). Is iron treatment beneficial in, iron-deficient but non-anaemic (IDNA) endurance athletes? A systematic review and meta-analysis. British Journal of Sports Medicine,49(21), 1389-1397. doi:10.1136/bjsports-2014-093624

Progressive Increases in Dietary Iron Are Associated with the Emergence of Pathologic Disturbances of Copper Homeostasis in Growing Rats. This study demonstrates one of the possible side effects of iron supplementation. The study split rats into groups with varying iron content in their food. The experiment contained a good method including a control group and multiple test groups. Yet, mice were used as the test subjects, therefore relating the study to humans can be a stretch given large differences in anatomy. The experiment indicated that copper depletion can be a side effect of over supplementation, indicating that people who are taking large doses of iron or supplementing when their iron levels are normal or high could be at risk of developing copper deficiency.

Ha, J., Doguer, C., Flores, S. R., Wang, T., & Collins, J. F. (2018). Progressive Increases in Dietary Iron Are Associated with the Emergence of Pathologic Disturbances of Copper Homeostasis in Growing Rats. The Journal of Nutrition,148(3), 373-378. doi:10.1093/jn/nxx070

Assignment 3
Brooks, M. A., Hetzel, S. J., & Parks, R. B. (2016). Iron Deficiency Anemia Among Collegiate Athletes. Medicine & Science in Sports & Exercise, 48, 231-232. doi:10.1249/01.mss.0000485696.39635.d8

Petkus, D. L., Murray-Kolb, L. E., & Souza, M. J. (2017). The Unexplored Crossroads of the Female Athlete Triad and Iron Deficiency: A Narrative Review. Sports Medicine, 47(9), 1721-1737. doi:10.1007/s40279-017-0706-2

Bruinvels, G., Burden, R., Brown, N., Richards, T., & Pedlar, C. (2016). The prevalence and impact of heavy menstrual bleeding among athletes and mass start runners of the 2015 london marathon. British Journal of Sports Medicine, 50(9), 566. http://dx.doi.org/10.1136/bjsports-2015-095505

Garvican, L. A., Saunders, P. U., Cardoso, T., Macdougall, I. C., Lobigs, L. M., Fazakerley, R.,. . . Gore, C. J. (2014). Intravenous Iron Supplementation in Distance Runners with Low or Suboptimal Ferritin. Medicine & Science in Sports & Exercise, 46(2), 376-385. doi:10.1249/mss.0b013e3182a53594

Assignment 2b
Under the ”Athletes” section of the Iron supplementation article I would elaborate on how athletes are more prone to iron deficiency, how the risk is greater for female athletes, and iron supplementation’s effects on athletic performance.

Iron deficiency is common in athletes due to their high demand for the mineral. This high demand s from Hepcidin bursts due to inflammation caused by exercise Deficiency is especially prevalent in high endurance sports and those in which competitors are likely to develop eating disorders. Young female athletes are at up to a 52% greater risk of iron deficiency than their male counterparts because of increased iron loss during menstruation.

Females are at a greater risk for iron deficiency anemia due to menstrual bleeding which increases iron turnover, or the rate at which iron is lost from the body. This iron is a necessary component for oxygen transport and the creation of enzymes used in the citric acid cycle and oxidative phosphorylation, especially in athletes who require readily available energy during training. Similarly, blood glucose levels decrease and growth hormone is suppressed as well as ghrelin when iron is low. Decreased levels of ghrelin and greater body image dissatisfaction that occurs in female athletes cause a loss of appetite inducing lowered energy intake which further perpetuates iron deficiency.

It is unclear as to whether or not supplementation in mildly iron deficient female athletes has positive effects on physical performance but, there is evidence indicating that supplementation improves iron status in these women. Yet, supplementation has a lesser effect on the iron status of exercising women when compared to the effects on their non-exercising counterparts. There are studies that show supplementation in iron deficient and anemic female athletes improves performance. It is recommended that dietary and lifestyle changes such as more iron rich foods and different training programs be made for long term maintenance of this deficiency in order to avoid iron toxicity.

Assignment 2a
Article 1: https://en.wikipedia.org/wiki/Iron_supplement “Iron Supplement”

Article 2: https://en.wikipedia.org/wiki/2017_Patient_Protection_and_Affordable_Care_Act_replacement_proposals “Patient Protection and Affordable Care Act replacement proposals”

Article 3: https://en.wikipedia.org/wiki/Talk:Yoga_as_exercise “Yoga as exercise”

I found these articles under WikiProject: Medicine (Patient Protection and Affordable Care Act replacement proposals), WikiProject: Alternative Medicine (Yoga as exercise), and WikiProject: Dietary Supplements (Iron Supplement). All were listed under the “start” category of their respective projects.

I found the Patient Protection and ACA article interesting because I remember hearing about the repeal of Obamacare, but I never heard any of the replacement options. As for the yoga article, I enjoy doing yoga and exercise science is one of my interest so I thought this might be a good topic to learn more in depth. The iron supplementation article also drew my attention because I have heard about the benefits of iron supplementing, especially in female athletes, but I have also learned that iron in the body is a closed system.

I did my preliminary research for the articles on google scholar.

For article 1 I found that up to 25% of young girls have iron deficiency which could negatively affect learning and memory as well as attention (Bruner et. al). Also, it is possible to have iron deficiency even if one’s iron levels are considered “normal” (Verdon et. al).

For article 2 I learned that fully repealing the ACA would allow insurers to deny people with pre-existing conditions insurance. The repeal and block grant proposal would provide states with a specific budget to spend on those who have Medicaid or the Children’s Health Insurance Program. Furthermore, repealing the ACA would cause 19.7 million more people to be without health insurance (Saltzman and Eibner).

For article 3 I found that yoga has the same if not more health benefits when compared to exercise and meditation (Ross and Thomas). It has numerous musculoskeletal benefits including decreased joint tenderness and increased mobility in individuals with arthritis as well as cardiopulmonary benefits such as an increase oxygen transportation to tissues due to breathing techniques and increased lung capacity (Evans et. al).

I found it surprising that iron deficiency in girls was so high and that it had such big effect on the body. I did not make any changes to the articles.

A.B. Bruner, A. Joffe, A.K. Duggan, J.F. Casella, J. BrandtRandomised study of cognitive

effects of iron supplementation in non-anaemic iron-deficient adolescent girls

Lancet, 348 (1996), pp. 992-996

Evans, Subhadra, Jennie CI Tsao, Beth Sternlieb, et al. "Using the Biopsychosocial Model to

Understand the Health Benefits of Yoga" Journal of Complementary and Integrative Medicine, 6.1 (2009): -. Retrieved 24 Feb. 2018, from doi:10.2202/1553-3840.1183

Alyson Ross and Sue Thomas. The Journal of Alternative and Complementary Medicine.

January 2010, 16(1): 3-12. https://doi.org/10.1089/acm.2009.0044

Saltzman, Evan, and Christine Eibner. Donald Trump’s Health Care Reform Proposals:

Anticipated Effects on Insurance Coverage, Out-of-Pocket Costs, and the Federal Deficit

Presidential candidate Donald Trumps health care reform proposals - The Commonwealth Fund, The Commonwealth Fund, 23 Sept. 2016, www.commonwealthfund.org/Publications/Issue-Briefs/2016/Sep/Trump-Presidential-Health-Care-Proposal.

F. Verdon, B. Burnand, C.L. Stubi, et al. Iron supplementation for unexplained fatigue in

nonanaemic women: double blind randomised placebo controlled trial

Br Med J, 326 (2003), p. 1124