What I learned about performance blood testing – by Runner Teal

Guest post by Runner Teal

Thank you Runner Teal for allowing us to repost this blog post. Follow Runner Teal on Instagram @runnerteal or visit her at her blog milestothetrials.com to follow her story to the starting line of the olympic trials!

Blood Test Fails

Sometime this past March, frustrations about sub-par training led me to the idea that my iron levels might be low again. I’ve had low iron in the past (and excessively low ferritin, which stores iron), a condition that means muscles have a harder time getting the oxygen they need and performance suffers. 

Last month I finally got my blood tested. The long story short is that my ferritin levels are on the upswing (but likely were low and contributed to my poor training this winter) and that I have other hormonal issues that may be contributing to poor recovery. Along the way to finally discovering this, I made seemingly every mistake in the book, which is a bit embarrassing to admit. But I’m sharing them below anyway in the hopes that others will learn from my stupidity honesty. 

Mistake #1: No follow up test

I first realized my ferritin was a problem in 2012 and started taking the iron supplement Vitron-C. I started to feel better, so that was good enough for me. But I never actually tested if my iron levels improved or if it was a placebo effect/different training/some other explanation. When I thought my iron levels might be part of my problem this winter, I started taking Vitron-C again and wanted to believe it would help, but I realized I wasn’t even sure if it ever had. (Because of Mistake #3, see below, I didn’t see a doctor before I started supplementing again. This is NOT recommended, as it is dangerous to have too much iron. It turned out okay for me, but easily could have ended up in the HUGE mistake column.) 

Solution: Get a follow up test to see if your supplements/changes to diet/habits are actually working. I’ve made a calendar reminder to get tested again at the beginning of August, three months after my recent test.

Mistake #2: Not starting again

The biggest mistake I made was that I didn’t start supplementing again after I stopped breastfeeding. When I found out I was pregnant, I switched to taking prenatal vitamins (which have some iron, although not as much as Vitron-C) and continued taking those while I breastfed. I figured I didn’t need such excessive amounts of iron since I wasn’t getting my period (the main reason iron levels are such a problem for female athletes) and I wasn’t really training all that hard. (Although that last part probably stopped being true by the spring of 2018 when I was training for Pittsburgh). Last summer I stopped nursing, switched to a daily multivitamin and, because I also eat more red meat now than I used to, I thought, “Good enough.” Except it wasn’t. Just like iron levels take a long time to come back to normal, they also take a long time to drop. I was able to run really well last fall before they dropped enough to make me notice this winter. And then it was too late. 

Solution: Once again, get tested, especially if you change your supplements/diet/habits. Don’t wait until levels are so low you’ve dug a hole it will take months to get out of.

Mistake #3: Assuming I needed a doctor’s appointment

When I started thinking my ferritin might be a problem again, I tried to make an appointment with a doctor. I didn’t find a primary care doctor when I moved to Richmond three years ago (mistake #8594) and it would be months before I could see one. (I’ve fixed that problem and have my first appointment in… November.) I felt stuck. I had heard about companies like Inside Tracker but they seemed expensive and I didn’t fully understand how you’d get a blood draw without a doctor’s appointment. 

Solution: Thanks to the advice of my Oiselle team, I used Athlete Blood Test (similar to Inside Tracker though less well known) and highly recommend it. It was immediate: I signed up online and took the form to a LapCorp near me. I didn’t need an appointment, saw someone within thirty minutes, and the results came back a few days later. It was expensive (I was right about that part at least…) but the athlete-specific information and 10-page analysis they gave me was worth it. When I went to see a doctor for suspected low iron back in 2012, my doctor wasn’t entirely convinced my iron levels were the problem. (I was just running too much!! Of course I feel tired!!) Back then it was my own research that led me to the importance of ferritin and how ridiculously low my levels were. Athlete Blood Test determines athletes’ requirements, which are different than what a PCP may be used to, so this time the research was done for me.

My current lineup of “meds.” 
Glad to have an analysis that covered all of these.

Mistake #4: Not resting enough

One of the other benefits of the Athlete Blood Test is it tests a whole slew of things that a PCP might not. It turns out that I may also have been feeling sluggish because my testosterone levels are low while another hormone (sex hormone binding globulin, or SHBG) levels are high. SHBG binds testosterone making it inactive, so when SHBG levels are high, there is less free testosterone and muscles have a harder time recovering. 

The mistake here is in not resting enough. While I take a day off every week and try to go to sleep on time, I also cram my day full of activity, often up until the moment my “go the fudge to bed” alarm goes off. I do try to rest for 20 to 30 minutes during my daughter’s nap time but I feel guilty every time I do and am embarrassed to admit it, as if everyone will judge me that my stay at home mom/freelance writer gig is so easy I can lay down midday. (No one has ever said anything like that to my face, but that matters not a whit to that stupid guilt.) 

Solution: Obviously, rest more. Get over the guilt, appreciate the time I have to relax and do less (read: stop trying to do all the things!) so I can actually have some relaxing time in the evening before bed. And then go the fudge sleep when that alarm goes off! (I can also focus on eating more healthy fats (something I’ve been doing more of in the last year but still can work to improve) and addressing low vitamin D levels (which, along with my also low B12, can be fixed with supplementation). But the main thing is that elusive work/life/training balance.)

My other prescription: more rest.

I’d venture to guess this is probably the most common of these mistakes and certainly the hardest for me to correct. The solution isn’t as easy as popping a pill (or three, my current lineup). It means reorganizing and reprioritizing my day so that I can fit in rest more; like maybe finding a way to sit down to catch my breath and eat breakfast after a tough morning workout, instead of scarfing it while standing up, doing the dishes, and assuring my daughter “I’ll play with you in one minute, sweetie!” Truthfully, I’m not sure how I’m going to carve out this time but I know that I need to. Because I didn’t really need a blood test to tell me I’m exhausted. 

But it did, which turns out to be the push I needed. 

So get that dang blood test.

Dream big,
@runnerteal milestothetrials.com

Written on June 21, 2019
By Guest Post

How Margo Malone Identified This Blood Deficiency and Won The Zurich Marathon

Contributed by Margo Malone, who is a pro runner and former All-American, representing Mammoth Track Club. She recently qualified for the Olympic Trials by winning the Zurich Marathon in time of 2:42:22

The marathon had always been a distance that excited me. The host city of Zurich unites to support thousands of runners, ranging from elite to first time runners, all sharing an appreciation and respect for the challenge of finishing 26.2 miles. I wanted to join in on the fun.

Zurich Marathon Champion Margo Malone
Photo credit: Janosch Abel

After a hard fall season with some hamstring issues and overall frustration with my performances, I wasn’t so sure I could keep racing at an elite level, let alone commit to train for the novel distance. The idea to race the Zurich Marathon was inspired by my teammate, Nico, and Coach, Andrew Kastor of the The Mammoth Track Club. Nico and Coach Kastor decided that Zurich would be a great spring marathon with the duel purpose of representing On Running (our club’s main sponsor headquartered in Zurich) and competing against a consistent field.

With a “last ditch effort” mentality, I decided running a marathon was high on my goal list when deciding to pursue running post collegiately and this was the time to attack the goal (plus being in a Switzerland was an added enticement). Luckily, I was introduced to Athlete Blood Test earlier in the year and was working with their skilled team to correct some of my inefficiencies when this opportunity presented itself.

With the support of Athlete Blood Test, Mammoth Track Club, and On Running, I jumped in to marathon training excited and confident that I had all the resources needed to complete a successful buildup with the goal of the Olympic trials qualifying time in mind (2:45).  ABT provided me with blood work analysis to track progress and highlight improvements for my body to handle the workload.

Vitamin D and Performance

One of the most important blood markers to this build up was Vitamin D. When reviewing blood tests from the past three years, Vitamin D levels had been a struggle and seemed to continually decline (even after moving to California where it is sunny everyday!).  What I love about ABT is the team provides science based recommendations and summarized what can be a very confusing sheet of numbers to comprehendible takeaways.

Vitamin D has many important roles in performance. Along with bone and skeletal health, research shows its role for non-skeletal functions including skeletal muscle growth and strength, immune function, and inflammatory regulation (Larson-Meyer & Willis, 2010).  Vitamin D regulates the balance of calcium, and studies show it helps recovery muscle damage, decreasing the risk of infection due to interaction with skeletal muscles and immune system (Owens, Allison, & Close, 2018)

Photo credit: Janosch Abel

My action points from ABT were specific and focused on better absorption. With the Genetic panel, it was clear I had a below average affinity to take in the vitamin D which explained why I struggled for so many years to raise my levels.  The ABT experts developed a clear plan and in March I saw my first up-ward trend in the levels.

With the guidance of ABT I was able to line up on April 28th in Zurich feeling confident and ready to race. Mile after mile, I ran with strength and was grateful for all the support. Crossing the finish line in first was a group effort and an experience I will never forget.

Written on May 30, 2019
By Guest Post

Can Blood Tests Help Improve Running Performance?

Sports dietician, entrepreneur, triathlete, runner and mother of three, Angie Dye , shares her experience with ABT.

Have you ever started a race and right off the bat you know something isn’t exactly right?

You hope that you will relax and settle in, but it just doesn’t happen despite great preparation, solid training, good nutrition and adequate rest? This was exactly how I felt at a recent 10-mile race. I went out a bit faster than planned, but I could not understand why I felt as bad as I was feeling.  Even after pulling back my pace a bit, the effort never felt easier.

I plowed through the entire 10-miles working in my zone 5 heart rate, yet was barely able to hang on to a pace that was almost a full minute slower than I had planned. My coach was supportive, and congratulated me on a good effort. But even though it wasn’t an A-race, I felt devastated. It was an early season race to test my fitness and I felt like I flunked. I felt like all of my hard off-season training hadn’t achieved the kind of fitness that I wanted. I also felt like maybe something was wrong, because having this kind of result didn’t really make sense.

Somewhere in the misery of that 10-miles, I promised myself I would get some blood testing done after the race to see if there was anything that needed attention. After all, this is exactly what I would advise my clients in my private nutrition practice if I heard this type of story. Since I am lucky enough to have no medical problems, I rarely have the opportunity to get labs drawn.

Athlete Blood Testing

Knowing I would likely be paying out of pocket for these labs, I wanted to get them done with a company experienced in analyzing lab values of athletes. There are a few different companies that provide this service, but a dietitian I admire referred me to Athlete Blood Test  (ABT) because they would provide a customized report and analysis of my results.

I signed up to get the “Gold Panel” from ABT, which is their most popular blood test and what they recommend to establish baseline values at the beginning of the season. I was able to find a convenient location to get the labs drawn just a few minutes from the pool where I train. The next day, I was in and out of the lab testing facility in less than 10 minutes, and 3 days later, I received a thorough 11-page document explaining my results.

Vitamin D, Ferritin and Free Testosterone

The most notable findings from the report included poor iron stores, low vitamin D, low free testosterone and a high SHBG  (sex hormone binding globulin).

Vitamin D in athletes
Free testosterone and sex hormone binding globulin in athletes

I was not yet truly anemic, but my ferritin (storage form of iron) was quite low.

Ferritin in athletes

This could definitely explain some of the poor performance and elevated heart rate in my race. The vitamin D, low free testosterone and high SHBG could all affect my ability to recover properly and could also predispose me to injuries.

Action steps I took after blood testing

I received a very in-depth report, but my main take-away points were to

  1. Start an iron supplement
  2. Start a vitamin D supplement and
  3. Consider my work-life-training balance and see if I could work on quality rather than quantity of training, and perhaps incorporate a bit more rest

Starting the supplements was rather easy. As a dietitian, I am familiar with quality brands and know the specifics on when and how much to take. ABT provides specific recommendations on all of this though, which is very helpful.

Iron Supplements

Having taken iron supplements in the past, I was all too familiar with digestive side effects often caused by them, so I decided to try a liquid form of iron gluconate which I often recommend to my patients who report digestive distress with iron supplements.

Vitamin D supplements

For the vitamin D, I decided to switch back to a probiotic I had previously taken that includes 1000 IU of vitamin D3. I already take the probiotic daily, so this was simply swapping the bottle.

Lifestyle Modifications

The third recommendation is definitely the toughest to implement. With a busy private nutrition practice, 3 active teenage children, 2 dogs and training for a 70.3 and a marathon, work/life/training balance is always a challenge. Isn’t it for all of us? I knew I couldn’t make huge changes here, but clearly I needed to do my best to try to make some little ones. Sometimes this meant leaving dishes in the sink over night, sometimes this meant asking for more help than usual, or squeezing in a 20-minute catnap. It is a work in progress, but I am actively trying to not burn the candle at both ends getting everything done perfectly all the time.

And what has happened so far?

Improved heart rate after blood testing

It’s been a little over a month since I started these interventions. I can honestly say that I am feeling amazingly, incredibly better. About 2 weeks into supplementing, my running really started to turn around. I was running faster with lower heart rates almost every time I trained. I felt like I had a new body and kind of a new outlook. I’m not just feeling better physically, but my emotional health and mood seems so much better, too. I have read about this with vitamin D, as well as with iron.

I wanted to share this story because I am a dietitian who thought I was getting all the nutrients I needed from my diet. I was sitting on 2 deficiencies and didn’t know it, and within a few weeks of supplementation I feel dramatically better. The way I see it, 48-year old age group endurance athletes who work full time and have a family are kind of a newer breed. I certainly didn’t know any when I was growing up, did you?

It’s possible we have different nutritional needs than our non-endurance peers. I am sold on the benefits of Athlete Blood Test to help me to continue to navigate my health and performance going forward.

Written on May 16, 2019
By Guest Post

Blood Pressure in Athletes and Runners

It has been well established in countless studies that moderate levels of routine aerobic exercise can help decrease blood pressure in populations with high or normal blood pressure.(1) The American Academy of Family Physicians cites the prevalence of hypertension in fit individual is about half of the general population, but adds that some athletes may have an increased risk of hypertension.(2)


Other studies indicate the systolic blood pressure (top number) is elevated during exercise and after exercise for about 2 hours. After the 2 hour mark the blood pressure tends to stay lower for 1 to 3 days.  (3,4) After 3 days the effects of exercise tends to diminish. Because of the diminished effect, experts agree that moderate aerobic exercise on most days of the week is important to maximize the benefits for blood pressure reduction.

Does type and volume of exercise impact blood pressure?

A recent review paper found that endurance trained athletes have a lower blood pressure compared to strength based athletes. (5)   The National Runners’ Health Study , a cross-sectional study conducted in 1997 concluded that runners averaging 50 miles per week or more had slightly lower blood pressures levels than those running less than 50 miles per week and that running in general lowered blood pressure.(6) This type of study design shows correlation but does not prove causation.
For now, the most recent data suggest that moderate amount of aerobic exercise (including running) is beneficial for blood pressure health.


Looking to optimize your performance for your next race?
We specialize in biomarker analysis aimed directly towards improving athletic performance. Learn more about our panels here.
  1. Vasan RS, B. A. S. S. L. M. K. W. D. R. L. D. Residual lifetime risk for developing hypertension in middle-aged women and men: The Framingham Heart Study. JAMA.,2002 Feb 27;287(8):1003-10.
  2. The American Academy of Family Physicians: Managing Hypertension in Athletes and Physically Active Patients (https://www.aafp.org/afp/2002/0801/p445.html)
  3. Ruivo JA, Alcantara P. Hypertension and exercise. Rev Port Cardiol.2012 Feb;31(2):151-8. doi: 10.1016/j.repc.2011.12.012. Epub 2012 Jan 10.
  4. Whelton SP, Chin A, Xin X, He J. Effect of aerobic exercise on blood pressure: a meta-analysis of randomized, controlled trials. Ann Intern Med. 2002 Apr 2;136(7):493-503.
  5. Berge HM et al.  Blood pressure in elite athletes: A systematic review, Br J Sports Med. (2015)
  6. Williams PT,Relationship of Distance Run per Week to Coronary Heart Disease Risk Factors in 8283 Male Runners The National Runners’ Health Study, Arch Intern Med. 1997 Jan 27; 157(2): 191–198.

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Written on March 18, 2019
By Ofer

Avoid the training bonk!

We are very often counseling our athletes to not just test when they’re feeling symptomatic of something.  Sure we can help you identify why you’re symptomatic and what the proper coarse correction is, but we’d rather help you avoid the symptoms to begin with!

Thomas Gerlach is a Professional Triathlete who has been using ABT in this capacity for years and states this perfect, “As endurance athletes we push our bodies beyond what they are designed to do and it is important to be proactive and identify deficiencies. Too often as athletes we are reactionary and dig ourselves in to holes before we finally capitulate and seek answers. The reality is that it can take weeks, months, or even years to fix those issues. The goal of my blood testing is to stay proactive and identify minor cracks before they become holes.”

Using AthleteBloodTest.com as an early warning system has become a staple of his regiment.  He goes into great detail on his latest ABT findings and you can read first hand how he is proactively addressing deficiencies and making consistent tweaks to avoid the training crash:


Written on March 5, 2018
By Scott Evans

Understand the importance of knowing your physiology and how it’s directly correlated to your performance. Listen to the expert, The Happy Athlete.

Understand the importance of knowing your physiology and how it directly is correlated to your performance?  Listen to the expert, The Happy Athlete.

Dr. Joe Sheppard runs The Happy Athlete (http://www.thehappyathlete.net), which is a website dedicated solely for the athlete and provides reviews of various products and services that as athletes, we all use.  I would suggest you check it out and use as one of your key resources!

ABT was fortunate in that we were reviewed by The Happy Athlete for our Gold Panel.  In the article he states, “There are several key elements I like about ABT not only did it give you the necessary physiological information, explained that valuable information and made ideal dietary and nutritional recommendations that would change my blood chemistry over future testing protocols. Typically, the knowledge and information in Physician Blood testing was not explained in this extensive detail through a general practitioner office.”

For the full review, visit: http://www.thehappyathlete.net/product-reviews/fitness/athletes-blood-test-abt-review/

Written on January 5, 2018
By Scott Evans

How low iron ended a season

What happens when your metabolism essentially shuts down on you? “After what would be a normal work out for me and feeling the obvious fatigue I was experiencing, it became clear I had a bigger problem” says Betty Elite and AthleteBloodTest.com athlete Susan McNamee. She got into endurance sports later than most and the majority of Americans have resorted to a relatively sedentary life void of any major challenges. Not Susan McNamee!

Susan opted to challenge herself by entering her first Ironman 70.3 as well as other races. After completing her first race she put the pedal to the metal completing 4 Ironman races, several Ironman 70.3 races, running races, and much more in the next 3 years. She was having so much fun that she didn’t notice her body was slowly shutting down. It was during an open water swim prior to two key races that she realized that something was “off.” Her whole body felt like “dead weight with no energy, even mental fatigue.” She tried to see if anything would be different on her bike as this is her strongest discipline. Once things didn’t feel any better, she knew something more fundamental was going on more than just an off day.

She began seeking answers, which included seeing her primary care doctor, various specialists, and performing her own research. After it all, she was still left without answers and without improvement. Susan decided to request a blood panel through her primary care doctor. She had enough working knowledge to know what tests may provide insight into what was going on. The tests were performed and her doctor shared the results. “Everything is within normal ranges”. Susan was again left without an answer.

Ironman Canada, the race she was preparing for came. Susan decided to toe the starting line. Within the first half of the swim she could tell that she didn’t have it. She’s used to finding the dig deep zone. Susan couldn’t dig deep. There was nothing there. While holding onto a kayak she decided to pull herself from the race.

Frustrated by the inability to properly identify why she was feeling so lethargic, Susan decided to use AthleteBloodTest.com with the encouragement of her coach.

Long story short, Susan found the answers she was looking for through AthleteBloodTest.com (ABT). With the help of ABT, Susan has had her best year ever, qualifying for the Ironman World Championship 70.3, signing with Team Betty, and having more fun than she’s ever had training and racing.

Susan now realizes how important it is to consistently monitor her physiology. AthleteBloodTest.com has played a big role in her successes. By identifying special nutritional needs, recovery needs, and physiological tendencies unique to her, she has been able to find consistency in her training and racing. Susan has avoided the problems that caused her body to crash before. Most importantly, Susan is able to enjoy training and racing more because she is feeling good!

Let AthleteBloodTest.com provide you insights into your own unique physiology: http://www.athletebloodtest.com/our-test-panels/


Written on November 2, 2017
By Scott Evans

Ever wondered how a pro triathlete such as Thomas Gerlach processes AthleteBloodTest.com insights?!

AthleteBloodTest.com athlete, Thomas Gerlach lifts the hood on his own personal physiology and invites everyone in to see how he consumes the critical insights we provide him through our Performance Panels (http://www.athletebloodtest.com/our-test-panels/).

For him, it is very critical to his training and race performances that he is able to identify anything that is going on BEFORE it becomes a major issue.  See his full post for details:


Written on October 18, 2017
By Scott Evans

Ladies, Know Your Iron Levels!

Female Runner

Iron deficiencies occur in up to 50% of female endurance athletes. Yes, 1 in 2 of you will have inadequate iron levels and may experience some of the consequences commonly associated with iron deficiency; performance declines, fatigue, dizziness, higher than normal heart rates during exercise, delayed recovery from workouts, muscle cramps, sleep problems…all the symptoms you don’t want to feel during training!
This has been well reported and has led to widespread blind supplementation of iron. The result? Many athletes are making fundamental errors when treating themselves. First and foremost, identifying whether you need an iron supplement is very important. A recent study concludes that 11% of elite female runners have iron overload! This carries unnecessary general health risks. Secondly, if iron supplementation is needed identifying the appropriate dose of iron and form best suited for you is critical to getting benefit from your supplement.

What Causes Iron Deficiency?
Many factors influence iron levels. In athletes, some of the most influential factors include training volume, food preferences, food intake, menstrual cycle, and food quality. Although some of these factors can be partially controlled, other big factors cannot. For example, the food we eat nowadays is deficient in vitamins and minerals. According to Kushi Institute, analysis of nutrient data from 1975 to 1997 found that average calcium levels in 12 fresh vegetables dropped 27 percent; iron levels 37 percent; vitamin A levels 21 percent, and vitamin C levels 30 percent. The cause appears to be reductions in soil quality and vitamin and mineral levels secondary to “over-farming”. Another example of a factor that is not easily controlled is iron absorption rate. Absorption rates of iron are influenced by genetics, gut flora, intestinal health, and even psychological factors like stress.
Given the variables associated with an athlete’s physiology and the variables in foods/supplements, it is critical that you get your blood reviewed by a Sport Science expert.

“If you are a woman and train more than 5 hours per week you should have your serum iron and ferritin levels checked.” Susan McNamee, Betty squad 2017

Have questions, contact us: results@athletebloodtest.com


Written on October 10, 2017
By Scott Evans