My weekly trip to the lab inside Sutter Health wasn’t much fun. Fluorescent lights, the waiting room, people with the flu. Needles and blood. The only thing to look forward to was technician Tracy’s welcoming smile. “How was your weekend?” she always asked. Often my reply would be “won another bike race!”. For Tracy, someone who could usually judge the severity of a person’s illness by the frequency of their visits, this was probably a bit confusing.
In December of 2012, my blood haemoglobin (a protein inside red blood cells that transports oxygen) was below the standard reference range, but my doctor didn’t seem concerned. I was, though. This was partly because I knew how critical oxygen delivery is to athletic performance, and partly because my work as a programmer at a hedge fund had taught me to leave no stone unturned. When it comes to problem solving, engineers don’t like mysteries.Two months later I requested another test. The blood work cost me a fortune (even with PPO insurance), but I was glad I did it because my haemoglobin had dropped further still. This time my doctor seemed more concerned and eventually I ended up in the hospital to have iron infused intravenously. Each of our 20-30 trillion red blood cells contain 270 million haemoglobin proteins, each with four sites to incorporate the iron that will eventually bind oxygen. Iron deficiency means less oxygen availability means less power on the bike. Or so I thought. As always, it’s a bit more complicated than that, and, unfortunately, my haemoglobin didn’t change much after the iron therapy. For the past three years, studying biochemistry and physiology has enabled me to evaluate a blood chemistry and debug it just like I would a computer program. Using nothing more than an anti-inflammatory Paleo diet, supplemental folate and vitamin B12, I’ve been able to raise my haemoglobin by 1 g/dL. That may not sound like much, but on the bike I estimate it’s worth about 26 watts (about 9%) at threshold. What could you do with 26 watts? For me, it was the difference between amateur and Pro, an upgrade I never could’ve achieved otherwise. It took me three years and many tests to figure all this out on my own, but there’s no need for it to take you that long. With the right teacher, a blood chemistry and maybe an organic acids test is all you need. Perhaps you already have the data. If so, is that data working for you? None of us has unlimited time to devote to training and recovery, and even if we did, how long would it take to achieve that 26-watt improvement? Maybe never, right? Even the best coach might not be able to get you that much improvement. Understanding what’s physically holding you back can save you countless hours of training. Sadly, your primary care physician probably isn’t going to help you improve your athletic performance. Mine certainly didn’t. Most doctors are too overworked, underpaid, and stressed out to care about your upcoming Ironman performance. So it’s up to you to order the tests and understand what the results mean. You have to take charge, because no one cares more about this problem than you do.
Three steps to critical blood chemistry evaluation
Keep these three steps in mind as you review your test results. The goal is to optimise the production, and minimise destruction and loss of red blood cells.1. Production
Red blood cell production takes place in the bone marrow under the stimulation of the hormone erythropoietin (EPO). Cells in the kidney produce EPO in response to decreased oxygen delivery and increased levels of androgens, so it’s worth thinking about low testosterone and kidney problems. Making red blood cells requires lots of nutrients, especially iron, zinc, B6, B12 and folate. Blood tests can help us determine issues with iron stores or production of haemoglobin and red blood cells, and urinary organic acid testing can be very helpful for isolating other nutrient deficiencies.
The normal lifespan of a red blood cell is 120 days. Around that time, the cell breaks down and is eaten by a type of immune cell called a phagocyte. Nutrients are recycled. Inflammation and oxidative stress can damage the red blood cell membrane leading to its premature demise. High-sensitivity C-reactive protein (hs-CRP) on a blood chemistry, and the organic acids p-Hydroxyphenyllactate and 8-Hydroxy-2-deoxyguanosine can be helpful for diagnosing inflammation and oxidative stress.
Female endurance athletes appear to be at much greater risk of developing anaemic tendencies. Mostly this is due to menstruation, but lower levels of androgen hormones may also play a part. Other common reasons for losing red blood cells are GI bleeds, bleeding ulcers, polyps and colon cancer. Ruling out a GI bleed is not easy, but you can confirm one using a home occult blood test. Consider a grain and dairy free diet, especially immediately after a race or hard workout. Exercise diverts blood away from the gut to exercising muscles, so right when you finish is not the time to dump a ton of grains and alcohol down the hatch!
What to do next
Join me, Tawnee and Dr. Tommy Wood for a live webinar event where we’ll take a deep dive into the markers on a blood chemistry. Dr. Wood is a qualified medical doctor, with a previous Bachelor’s degree in Natural Sciences and Biochemistry. Dr. Wood is now working towards a Ph.D. in neonatal brain metabolism at the University of Oslo, Norway. Tommy is a regular contributor to my podcast, and for that I am ever grateful.