Friday, November 14, 2014

The Case for Blood Tests

Thanks to multiple past PED offenders in baseball, football, cycling, track and field, and most recently the marathon world (Rita Jeptoo), the phrase blood test often conjures up negative thoughts and emotions in sports enthusiasts and everyday athletes alike. I suspect basketball would be on that list too if the NBA's drug testing policy wasn't a complete joke. We've been burned by so many cheating sports "heroes," struggling elite athletes trying to reach the apex of their spot (or perhaps just trying to keep up), and has-beens hoping to hang on for one last hurrah that it's nearly impossible not to have a visceral reaction and expect the worst when we hear or read the words blood test. 

For good reason, our faith in professional and, unfortunately, even amateur sports, and the athletes who participate in them has been tested and compromised. We've been lied to and even made to feel guilty about suspecting athletes of using PEDs even in the face of mounting evidence against them (thanks Lance, Roger, Barry, A-Rod, etc). Our hope in fair play has repeatedly been shattered, while those choosing to cheat the system have crushed the potential livelihood as well as the goals and dreams of countless clean athletes.

These lying liars and cheating cheats have ruined the sanctity and ethical code of our most cherished sports. They are the lowest of the low. The scum of the...

Wait, wait. This isn't a post about the ethics of PEDs, or the need for biological passports, or shaming those athletes and coaches who've cheated the system. This post is about the importance of getting a simple blood test, especially for aging and/or endurance athletes. Blood tests are our friends. Let's embrace them rather than shun their results. And, to highlight their simplicity and usefulness I'll share a personal experience.

I'm 38 years old now, so I must've been somewhere between 30 and 32 years old the first time I had a blood test done. I was in good physical health. I ate a varied and healthy diet fueled mostly by produce from the Portland Farmer's Market. I ran 2-3 times per week, rode my bike to work often, and stayed active on the weekends by hiking and/or walking with our dog (Carter - pictured above). Life was not stressful and I was living the classic urban Portland yuppy dream. However, for reasons I can't remember I went in to see my nurse practitioner to have a physical examination.

All things checked out tip-top as I suspected they would, but she was concerned about a low(ish) red blood cell count. Or was it low hemoglobin? Or was it low iron levels? I'm not quite sure, and I was so naive at the time I barely even asked for clarification. I do know for sure I didn't ask to look at the results, and all I left her office with were the words "borderline anemic" and dietary recommendations on how to get my "numbers" up before coming back for another test in 4-6 months. Okay, eat beef and leafy green vegetables. Remember that.

I came to find out my dad was also "slightly" anemic and took iron supplements. So, maybe this was a genetic inheritance like my receding hairline. Makes sense, but in this particular incident my numbers were "within range" (varies from lab to lab) six months later after a slight change in diet, and that was that. This was my first foray into the realm of blood tests, and I didn't give it much thought again until recently.

Over the last few years I've morphed into a bona-fide endurance athlete. I usually run six times per week and typically cover 50-60 miles (80-100km). As an endurance athlete I rely heavily on the production and transport of oxygen from my lungs to my muscle tissues. I'm not a doctor, but simply put, oxygen is transported through hemoglobin in red blood cells, and iron plays an essential role in hemoglobin function/production. Furthermore, iron plays an essential role in myoglobin function/production in the actual muscle tissue where the cells transport and release said oxygen to create the energy our muscles desire during exercise. Lastly, on a cellular level, our cell's engine is the mitochondria, which become more efficient through long bouts of aerobic training, and a key ingredient to proper mitochondria energy production (think ATP) involves a chemical reaction which hinges on...wait for it...yes, oxygen. In short, as endurance athletes our happiness, motivation, and success relies heavily on proper iron stores in the body to produce and transport oxygen to carry out these vital processes. 

In an ironic twist of fate endurance athletes are more susceptible to low iron stores (iron deficiency) due to several factors: 1) loss of iron through sweat 2) increased blood in our urine 3) gastrointestinal bleeding 4) and possibly through "foot strike hemolysis," or destruction of red blood cells in our feet due to repeated impact (this theory has been questioned). Females are even more susceptible due to blood loss during menstrual cycles. 

The primary way the body stores and transports iron is as ferritin, so when getting a blood test it's important to ask that your ferritin levels are measured as well as hemoglobin. There are multiple reasons for our hemoglobin to be low, but the most common cause is low iron levels, which is indicated by your ferritin level. Ferritin is the key, but there isn't necessarily an agreed upon definition for what a "low" ferritin level is in endurance athletes. However, generally anything below about 30 ng/mL (or 30ug/L) is concerning enough to discuss with your doctor about taking iron supplements (ferrous sulfate or ferrous fumarate) and improving ways to get iron naturally through your diet (easy to find on a basic Google search). 

Chronically low iron stores can lead to a feeling of general fatigue, decreased interest in training or racing, longer recovery times, and subpar performances, which brings me back to my story and my second foray into the world of blood tests. 

Back in July I had a 5K race in which I was definitely fit enough to set a PB and possibly dip under 18 minutes. I went out hard and detonated and had to walk for a bit around the 3K mark. In hindsight, I probably just went out a little too hard and went anaerobic too early in what was only my second 5K race ever (rookie mistake). But, it got me thinking about other possible causes. Then, in August I ran a 10K race in which I detonated around the 7K mark and had to walk yet again. This time I'm sure I was running a pace I should've been able to maintain based on my training. I still set a PB, but my time of 39:00 was about forty seconds slower than what I felt I was capable of. 

I suppose looking back on it I may have been feeling a bit fatigued as well, but I wouldn't have guessed it at the time. Regardless, based on two disappointing performances in a row I decided to change my training approach and to get my blood checked just to be safe. After all, I knew I had been "borderline anemic" in the past, and I wasn't training nearly as much at that time. 

When I got my results back I was not surprised at all to see that my ferritin levels were extremely low (16ug/L), as well as my hemoglobin and red blood cell count. By the this time I had already researched which form of iron as a supplement and which brands carried at our local health food store were the most effective, so when I met with my doctor to go over the results she could simply recommend dosage (admittedly, I had already started). I also started being more conscientious about eating an iron supportive diet as well, which includes drinking coffee more strategically. Apparently, the tannins in coffee and tea bond with iron making it harder for the small intestine to absorb. As a result, I try to take my pills and eat iron heavy food at least an hour before or after drinking the coffee I so desperately need because I have two small children. On the flip side, Vitamin C is supposed to help with iron absorption, so if possible I'll take my iron pills with C heavy fruit, or a bit of orange juice. 

By the time I became aware of my iron deficiency it was mid-September and there were still races left on my calendar. I had read that it can take as little as three weeks to start feeling more energized once iron stores start to increase in the body. My "A" goal 10K and half marathon races happened to be four and seven weeks away respectively. There was hope.

I would never have guessed I was feeling fatigued when I decided to get my blood tested and started taking iron supplements. I just wanted to stop detonating and start racing better again. Maybe it was partially a placebo effect, but I swear my energy level and overall attitude improved after just a few weeks. I went out and crushed both races and set PBs by over a minute in the 10K, and nearly three minutes in the half. 

Were increased iron stores in my body solely responsible for these results? Probably not, since I also changed my training approach by incorporating more frequent and longer tempo runs, which toughened me up and left me with more confidence in my abilities. But, I do believe increased iron stores helped provide me the energy I needed to perform well in those workouts and deliver on race day.

However, I could be totally wrong. My ferritin levels may not have changed one bit, but I'd be surprised if that were the case. I'll know for sure in mid-December when I go back for a re-test to see just how effective these changes have been. I've got a pretty important marathon coming up in Boston in April, so you better believe I'm going to stay on top of this.

Given the increased risk of becoming iron deficient as an endurance athlete, and the negative effect iron deficiency has on motivation and performance, I'm amazed by how few runners I know have even thought about having a blood test, let alone getting one done regularly. At the very least it makes sense to have one during the off season or scheduled down time to establish some baseline numbers. However, based on personal experience and from what I've read, if you're logging some heavy mileage I'd recommend a blood test at least twice a year. A simple blood test may just help you suffer better and improve your performance. Or, it could just save your life.