FAQ

What can you learn from blood analysis now? What are the main things that you’re looking at and what information do you get out of it?

The very basic things that we are testing are the red blood cell status, the body’s ability to deliver oxygen to muscles, training tolerance and recovery needs and nutritional needs. We determine if you need supplements and what should your diet be from a micronutrient standpoint. These are the pillars of blood testing.

Can you learn all these things from a regular blood test at your local hospital or do you need special analysis?

If you have a right person reading the test at your hospital you can learn a fair amount of information. But the real difference between primary care tests and athlete specific tests is in what you are testing and the ranges by which you are analyzing. To give an example with iron testing, it is very common in clinical practice to only measure ferritin levels but when testing an athlete you must include a serum iron test. If you’re only testing ferritin, which means stored iron, you’re missing what’s happening in the blood. And we want to know what utilization looks like. If we see high ferritin and low iron, we know that your training in the last couple of weeks has led to a really high iron utilization rate and your body has not yet pulled iron out of storage. Or, vice versa, if we see high serum iron and low ferritin then even though the test numbers might fall within normal ranges we have to take into consideration that your body is not storing iron, and that’s suggestive that your body does not have enough iron in it. The ranges for athletes are also very different from what’s considered normal ranges for the general population. Most endurance athletes can hardly be considered normal.

The ranges that come out of a hospital lab are pathology driven, their aim is to determine if you have a disease or not when you are below or above a certain value. But the low ends and top ends are usually different for athletes. To go back to the example of iron, normal ferritin in most labs is considered 9 to 15 on the low end. But in an athlete 9 to 15 is undoubtedly going to be causing symptoms of fatigue, or what’s called “silent anemia”. So that athlete is not going to be able to achieve their potential. Again, you have to factor in age, gender, training frequency, intensity and duration into the values that you’re comparing.

How often should an athlete get tested?

Each one has an individual schedule, but normally they get tested early in the season before they start the high volume training, that’s when we want to get the base line panel. And that base line panel is something that we compare our findings to for the rest of the season. After they do their first big ramp up in training we’re going to have another panel and see how that influenced their physiology in comparison to the base line panel and also compare the results to previous years if we’ve worked with that athlete before. Afterwards we’re testing after all the big training blocks and before all the key races to make sure they’re going into the race with the right taper and that their nutritional plan is well optimized. Usually we test 6 weeks before the race.

Why can’t I go to my General Practitioner for this blood work?

If you have a right person reading the test at your hospital you can learn a fair amount of information. But the real difference between primary care tests and athlete specific tests is in what you are testing and the ranges by which you are analyzing. To give an example with iron testing, it is very common in clinical practice to only measure ferritin levels but when testing an athlete you must include a serum iron test. If you’re only testing ferritin, which means stored iron, you’re missing what’s happening in the blood. And we want to know what utilization looks like. If we see high ferritin and low iron, we know that your training in the last couple of weeks has led to a really high iron utilization rate and your body has not yet pulled iron out of storage. Or, vice versa, if we see high serum iron and low ferritin then even though the test numbers might fall within normal ranges we have to take into consideration that your body is not storing iron, and that’s suggestive that your body does not have enough iron in it. The ranges for athletes are also very different from what’s considered normal ranges for the general population. Most endurance athletes can hardly be considered normal.

The ranges that come out of a hospital lab are pathology driven, their aim is to determine if you have a disease or not when you are below or above a certain value. But the low ends and top ends are usually different for athletes. To go back to the example of iron, normal ferritin in most labs is considered 9 to 15 on the low end. But in an athlete 9 to 15 is undoubtedly going to be causing symptoms of fatigue, or what’s called “silent anemia”. So that athlete is not going to be able to achieve their potential. Again, you have to factor in age, gender, training frequency, intensity and duration into the values that you’re comparing.

What are the ways how an athlete today can use blood value testing to maximize their training potential?

Blood testing does not have the ability to increase performance potential. What blood testing really does is it identifies areas where you might not be able to reach your potential because your physiology is compromised. Research shows that up to 50% of female endurance athletes training over 12 hours per week are very likely to have inadequate iron status, low enough to influence performance. 30% are likely to have folate levels low enough to influence performance. And then when you get into training tolerance and hormones, your training and recovery strategies, over 50% of people are not optimizing their training based on their unique physiology. Once you get over 8 hours of training per week it’s really a bell curve, the incidents rise quickly.

How often should athletes get their blood tested?

Each one has an individual schedule, but normally they get tested early in the season before they start the high volume training, that’s when we want to get the base line panel. And that base line panel is something that we compare our findings to for the rest of the season. After they do their first big ramp up in training we’re going to have another panel and see how that influenced their physiology in comparison to the base line panel and also compare the results to previous years if we’ve worked with that athlete before. Afterwards we’re testing after all the big training blocks and before all the key races to make sure they’re going into the race with the right taper and that their nutritional plan is well optimized. Usually we test 6 weeks before the race. Is 6 weeks enough time for a Tune Up?

What’s interesting about iron is that as soon as you start replacing it the body responds quickly even if the red blood cells continue to indicate disorder. Even for somebody who has a diagnosed anemia, if you give them an iron IV they feel significantly better in three or four days. It doesn’t make sense, but that is the case most often. And the opposite might happen as well, the red blood cells numbers might not indicate a problem, but athletes who have low iron and ferritin levels might experience symptoms of anemia

Is it true that sometimes your iron stores can be quite low because of intense training, but that’s not necessarily a bad thing?

All the tests should be cross referenced, that requires quite a bit of experience and that’s why it’s often a problem when athletes are trying to read their own tests. You might look at the complete blood count and see hemoglobin and hematocrit that are less than ideal and mistake it as anemia, but to get a true diagnosis you have to cross reference it to your hydration status test, to your blood urea nitrogen test, your albumin/creatinine ratio, because those things can influence and create false findings within the red blood cells. You have to look at the micronutrients to see if they match up with the story that you are seeing in the blood cells. So it’s a somewhat complicated process. What are the other areas where athletes use blood testing?

Besides their diets and nutritional strategies, probably the other big topic is training tolerance and recovery needs. And that has to do with hormones. By doing blood analysis you can assess one’s cortisol, total testosterone, free testosterone, DHEA, sex hormone binding globulin, thyroid hormones and muscle enzymes. Those are really important findings to understand how well you are tolerating your current training plan, can you push it a little harder and add more intensity to your training or if you need to back off a little and recover.

Can you tell if someone has developed an overtraining syndrome from the blood analysis?

Yes, you can diagnose overtraining and overreaching. And you can predict who is prone to overtraining and try to adapt their training plan accordingly.

Why aren’t hormones included in your Panels?

We do not offer testing for LH, estrogen, FSH, or progesterone for a few reasons. The first is the difficulty in coming to reliable determinations about performance influence. This is the cornerstone. If we cannot consistently correlate specific findings (levels of individual hormones or ratios) to specific performance influence we cannot act upon the findings. These particular hormones are particularly difficult to pin down. Maybe we’ll get there in the future.

We have been able to correlate SHBG, DHEA-s, Total and Free Testosterone, TSH, and Cortisol with consistently seen performance deficits, or perceived performance deficits (as subjectively reported by the athlete), and gains. As you eluded, there is a connection here, and we know that those hormones influence the others. It’s all a collaborative system. But, in the quest for cost versus benefit we have to ask ourselves the following questions;
● Do the findings predict performance or symptoms commonly seen in athletes?
● Are the findings actionable? Are those actions legal in sport?
● Can we provide results that have a positive influence on athletic performance at a reasonable cost?

Our early research, which included LH, FSH, and estrogens (estradiol, estrone, estriol), did not provide favorable answers to these questions. Regarding the last question, the cost of interpretation of a complex system makes adding these tests high. We find ourselves in a gray area, interpreting a lot of theory and “what if?” scenarios, and providing recommendations with relatively poor reliability. We do not algorithm responses, as no two athletes are the same. Therefore, adding these hormones, with the flux in which levels exist, and the variability in interpretation adds significant cost in the form of provider time.