Anemia and the Endurance Athlete: Tips to help you prevent Iron-Deficiency

                     The USS Constitution, "Old Ironsides"
                            February 2012   Boston, MA

As we head into the Base time of year for most endurance athletes, I have seen a few issues seem to be trending the last few years for endurance athletes in the region which I operate my business out of.

Amongst the issues is lack of proper nutrition (total calories in), hydration during cold rides, and perhaps the most surprising: athletes apparently being Iron-deficient.

Right now I want to focus on Anemia and Iron deficiency, as this can REALLY derail ones training for a year, or more, should it go undiagnosed for a few months, and especially if it goes on until mid-build.

If you have more questions about Iron-Deficiency or Anemia, please contact your doctor, or Sports Dietician. If you don't have a dietician, I recommend Kim Schwabenbauer of Fuel Your Passion. She is not only a (my) sports dietician, but also a professional triathlete who races for a great cause, Ballou Skies Charities, and she is a phenomenal source of knowledge. She understand the treacheries of training and racing, and has a great perspective on things.

The below questions were composed from my own knowledge, and a few of the quality sports nutrition books that I have found (Monique Ryan's "Sports Nutrition for Endurance Athletes", Nancy Clark's Sports Nutrition Guidebook", and Chris Carmichael's "Food for Fitness" --Chris is NOT a Sports Dietician, but the book is well put together), and is a small bit of the information that I talk about with Human Vortex Training Athletes whom are suspected of possibly experiencing effects of Iron-Deficiency, or anemia, before sending them over to either their PCP, Kim S., or their Sports Dietician.

Due to the nature of sports nutrition and the mass amounts of research being done, it is possible that some of the information below is outdated. Again, I am not a Dietician. The information below is not intended to diagnose, cure, or prevent any disease, or other health issues. It is here to serve as base knowledge to help the endurance athlete community to become more aware of how their diet affects their training and racing, and most importantly, their overall health.

If you suspect that you may have Iron-Deficiency Anemia, I strongly urge you to talk to your Primary Care Physician, or your sports dietician, ASAP.

                                                   
          Photo from :  http://www.english-online.at/biology/blood/blood-supply-and-blood-diseases.htm

What is Iron-Deficiency Anemia, and how does it affect me?
Iron-Deficiency Anemia defines that the body is unable to supply or carry enough oxygen to the muscles, or the body's cells. This can lead to feelings of fatigue throughout one's day, or during workouts. Some of the more common complaints heard by active individuals are "I can't seem to find the energy to workout like I used to" or "I feel so tired during my workouts".

A little about Iron...
Iron is a Micro-mineral, otherwise known as a "Trace element", which are present in the tissues of the body in small amounts, but have crucial roles in human nutrition. Iron is needed to form the Oxygen-Transporting compounds Hemoglobin & Myoglobin.
Iron Absorption is ultimately controlled by the amount that is already in storage in the body (as Ferritin, & Hemosiderin), due to the lack of an effective mechanism to expel excess Iron. However, absorption rates of Iron from ingested foods rarely exceed 10-15% of TOTAL PRESENT IN THE FOOD. (This means if you eat something that contains 30% of your daily value, you're most likely only absorbing 3-4.5% of your daily value!) This is a mechanism that helps the body maintain a relatively regular level of Iron storage.

What does this mean to me as an endurance athlete?
It is important to eat a balanced diet, ensuring that you intake adequate amounts of Iron. Although the best sources of Iron are meat, fish, poultry, legumes and dark leafy green vegetables, Iron is commonly added to help fortify foods such as breakfast cereals, and grain products.

What are the best sources of Iron? Can I absorb more from one food or another?
The most easily absorbed type of Iron is "heme" Iron, which is found in meats and other foods of animal origin. "Non-Heme" Iron can be found in fruits and vegetables, as well as cereals. Non-heme iron absorption can be enhanced by consuming vitamin C along with it.

I'm a vegetarian, am I at a higher risk of developing Iron-Deficiency Anemia?
As far as conventional wisdom goes, unfortunately yes. Vegetarian endurance athletes, and vegetarians in general are considered to be at a higher risk of developing Iron-Deficiency Anemia. However, there are a few things that one can do to help you attain enough Iron from your diet. Some of which include: Proper dietary planning, consciously eating fruits and vegetables high in Iron, eating Iron-fortified grain products, and even adding Vitamin C to vegetables by squeezing lemon or orange juice on them before eating.
There is a lot of new information coming out about vegans/vegetarians and Iron-Deficiency Anemia. If you are a vegetarian/vegan endurance athlete, I recommend consulting with a sports dietician.

I heard that I can lose Iron through sweat, is this true?
Although Iron loss through sweat is low (often the concentration is 0.2 mg/L of sweat), it can lead to Iron Deficiency in athletes with marginal Iron intake. This type of occurrence is more often associated with athletes who participate in long-duration activities, as they can sweat up to 2 Liters or more per hour.

I met with a dietician, and they told me that my Iron levels are low, but I have been taking in enough Iron in my diet...What's going on?!?!
You may have what is called "Dilutional Pseudoanemia. This occurs due to the increase in blood volume due to exercise, more often intensive in nature, which may result in a temporary dilution of the red blood cells. Ask your Dietician or Doctor about doing test for Iron at the END of a recovery week during the Pre-season (Base), Season (x2 Build & Peak), and Off (Transition)-season. Also, having a yearly blood panel is also a good idea to track your overall vitamin and mineral intakes to help ensure you have a sound, well rounded diet.

Hurricane Sandy survival guide for Endurance athletes

There is a lot of talk the last few days about the incoming hurricane Sandy, and how much of an affect it will have on life as we know it, for possibly everyone east of the Mississippi. This storm has the makings of something perhaps not ever seen before historically, with its intensity, mass, and reach.

Below are a few additions to the standard recommendations for emergency rations/supplies, and is NOT meant to be fully comprehensive. These are some last-minute items that you may be able to attain, to help make your storm wait-out a little more nutritious and perhaps even more comfortable.

If you are unsure of what the Standard recommendations are, please visit the American Red Cross website HERE. For a more detailed, or comprehensive list, you can contact your local Red Cross Chapter, or the head to the FEMA website to learn more.

REMEMBER, YOUR SAFETY AND YOUR FAMILY SAFETY IS THE NUMBER 1 PRIORITY, NOT YOUR TRAINING!!!!!!!

DO NOT ATTEMPT TO RUN/RIDE/SWIM IN HEAVY RAIN, WINDS (above 10mph), OR STRONG CURRENTS/WAVES!!!!!!!

There is only 1 YOU, there are plenty of races and events that you will be able to do! Use this time to read a book, bond with your family, or review your year.

For those HVT athletes who may be worried about stocking up and having supplies for the incoming storm/hurricane/ridiculous weather, here are a few ideas that can give you a big return on investment, and help keep you safe and fed in the occurrence of power outage/prolonged isolation: High calorie foods, that store well, and can keep you going:

 Chocolate (calorie dense, and has high fat)--eat this in moderation, but it can hold you over if everything else runs short (I learned this from one of the mountaineer I coach, when she told me how much chocolate she ate on her summit of Kilimanjaro!)

 Powdered milk- great and easy to store. all you need is a little water!

 Dried Fruit- while most have "expiration dates", they usually last past that date, if stored properly. 

Nuts- Very Calorie dense, if you have a can of beans, and a hand-full of nuts, you'll be feeling very full, and have the energy to do what may need to be done.

 Canned beans- Cheap, full of fiber to keep you full, and protein to feed those muscles

 Canned veggies- these are a great way to get your vegetables in year-round, but especially so during foul weather! 

Apples, Oranges, other citrus fruits- these store incredibly well (for up to a week or two), and are packed with vitamins, fiber, and phytonutrients

 Aside from food, we of course need water. You want to generally think along the lines of about a gallon of drinking water a day, for each person. While this is a high estimate, it's always good to have more, than less. If you think you'll be safe enough to train, you want to add another gallon a day to that, for each workout you plan on being able to execute.

If the water is gone, think soda. While not at all the best, it is a fluid that doesnt need to be refrigerated, and will last.

 Make sure to not only have enough water to drink, but also enough to flush your toilets 1-2x a day (fill up pots/ water bottles with tap water). Take a look at your toilets, and only use the lowest Water-per-flush toilet, if at all possible.

 As a back-up for more water, and also to keep your fridge and freezer cold, you can purchase bags of ice, and leave them in your freezer, until needed. Should the power go out, you can take each bag, and dump them into large pots, and leave them in the fridge and freezer, thus reverting your modern day fridge, into something similar to the original "icebox".

Keep the fridge and freezer door closed as much as possible (smallest amount of time with the door open as possible!), and try to remove items that absolutely dont need to be refrigerated, like fruits and vegetables. This will allow the food in the fridge to have a little bit of cold, so ensure to eat cooked meats, cheeses, and products with these in them first. WHEN IN DOUBT, DON'T EAT IT/DO IT!!!!

 If you're not sure about anything, throw it out. The frozen fruits and veggies can be eaten as they melt, as long as they are edible without heating.

 Other Items you may want to think about having offhand (it may be too late now) -Battery operated radio with the 24 hr weather channel available on it
-A solar charger for your Cell Phones and laptop/iPAd
-Water tablets (to make water safe to drink)
-That shiny "crinkle" blanket you got after your Ironman/ HIM/ Marathon that helps keep heat in
-Flashlights and batteries
 -Warm, DRY clothes in tupperware/waterproof containers
 -medications that you may need
-A small camping stove for outdoor use, that you can heat food with

Remember, above all else, get somewhere safe, and have your families Emergency Action Plan handy, and well practiced.

REMEMBER TO RATION!!! Don't eat large amounts of food in the first few days, but rather, just enough to keep you going each day (training takes a backseat!). To help you stay full, try not to drink anything 15 minutes before you eat, and 30 minutes after you eat. This allows the stomach to stay fuller, and you to not want to eat as much.

Stay Safe, Use your head, and keep dry!

Thinkin on your feet, for yourself

Life can be so trying. but the key is, to keep trying. As you have all noticed, I'm sure, this is my first post in over a year. In that last year, I have added a number of National Championship Qualifiers and racers, a downhill National Champion, and a few more first-timer Ironmen and women breaking into the sport with top-30 results, in very competitive age groups, with large number of competitors. On a personal side, I have added just a mere 50 miles of riding in that time, numerous hours of Physical therapy, a couple of MRI's, and a broken date with the surgeons knife. What an incredible 15 months. I've learned so much more about myself in that time, and the true effect on performance, in and out of sport, that ones psychological abilities has. While I can say that my mental strengths before this life adventure was matched extremely well to the "normal" training cycle for a competitive basketball season (for a coach) of 10 months, I can also say, that I found out a lot about myself I didn't know....like how much I truly LOVE cycling, running, and the active lifestyle that accompanies it, and while I THOUGHT I was eating a truly healthy diet, I was just a product of the advertising and mainstream media that we have all become. I don't mean this to say I've gone off the deep end and only eat things that have roots (which for a little while I did, just ask my girlfriend), but rather to say that all too often today, we just take what we hear and see as fact, and don't question it. Some of the best athletes that I coach, are ALWAYs out there, reading, researching, and looking for more information and knowledge, which they then in turn pass along to me, and challenge how I as a coach think, and change how I coach all of my athletes. I think we all need to start opening our eyes, challenge the information pushed to us, and shoved in our ears and eyes, and figure out what works for us, and WHY. There are over 7 BILLION people on this earth. What makes YOU different? Are you thinking for yourself? Are you working WITH your coach, or just taking letter as law?