Regular physical training leads to an increase of plasma volume by 10-20 percent. Therefore, hemoglobin concentration slightly below normal values in the presence of low-normal serum ferritin levels in athletes are usually due to a dilutional "pseudoanemia". Several cross sectional studies indicate that true iron deficiency anemia is not more frequent in athletes than in the general population. Since regular physical activity, especially extensive, running increases iron loss, mild iron deficiency (abnormal serum ferritin and normal hemoglobin concentration) and sometimes true iron deficiency anemia can occur especially when nutritional iron intake is insufficient and iron demand is increased because of growth (children, adolescents) or additional iron loss (menstruation). Several controlled studies indicate that iron supplementation (recommended dose 2 x 100 mg elementary iron/day) improves performance only when hemoglobin concentration increases, i.e. when iron deficiency anemia is present. On the contrary, iron supplementation has no measurable effects on performance when hemoglobin concentration cannot be increased, i.e. in mild iron deficiency.