Last April, I spoke at a conference hosted by my friends at Inside Tracker the day before running the Boston Marathon. My speech was aimed at educating endurance athletes on the tools they can use to maintain good health and fitness, and putting together a comprehensive picture on how blood tests, diet, fitness, body composition and performance are all related. For most of you reading, this may be a lot of “common knowledge” by this point, but you will find some good nuggets, like what blood markers you should be keeping a close eye on and the most common issues we see athletes facing. Plus I give recommendations on how to improve and maintain health when training, and some holistic proactive actions to take.
I’ve highlighted the most important parts in red for your convenience.
You and your coach put so much time into the training plan, but you have to monitor how the engine is running otherwise you will never get to your potential with any plan. With blood testing we can take performance to the next level; not just athletic performance but also optimizing wellness and longevity in all regards. If not careful, endurance athletes can be “fit but unhealthy.” Thankfully, taking measures to monitor health pays off largely. When your friends have to pull out because they’re so burned out, sick, fatigued or unhealthy, you can still be Mr. or Mrs. Consistency.
Most of all, this is about self-love. We are asking a lot of our bodies, so the least you can do is invest back into the machine that allows you to do what you love.
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First – Prevent, treat or monitor for common deficiencies/imbalances
- Endurance athletes should get regular blood testing to keep track of overall health and take preventative measures as needed.
- I advise getting quarterly or biannual blood tests. No more, no less. Keep a spreadsheet of results to use for comparisons, monitor trends, etc.
- Athletes ask a lot of their bodies, and we cycle through nutrients more than the average human. As such, athletes can also run themselves into deficiencies if not monitoring via blood labs.
- Common Deficiencies (low/depleted):
- Vitamin D
- Magnesium
- B12/B vitamins
- Folate (not folic acid)
- Other Common Issues—WOMEN
- Hypothyroid
- HPA axis dysregulation
- Irregular periods
- T dominant
- SIBO and/or other gut issues—if presents with low protein or other deficiencies present yet the person eats well, this can be a red flag that something is wrong in the gut and not absorbing nutrients.
- Other Common Issues—MEN
- Slightly hypothyroid
- HPA axis dysregulation
- Iron overloaded
- Low T
- Cortisol and testosterone are often elevated and depressed, respectively, as is the T:C ratio (an indicator of catabolic or anabolic state); usually related to heavy training, lack of sleep or not enough emphasis on recovery.
- High glucose
- What about heart health? This is an important topic in endurance sports. You can monitor heart health and through a marker called homocysteine, which can even assess risk for heart disease. Be sure to request homocysteine on all your blood tests.
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Second – Monitor stress load
- Stress is our friend and foe. On one hand, it’s how we gain fitness. Any training stimulus is meant to put a stress on the body, and over time you adapt to the stress—and BAM you’re fitter. However there are appropriate doses to stress for optimal results. Too little stimulus and results aren’t to one’s potential, too much of a stimulus and one risks overtraining. Often endurance athletes succumb to the latter because that’s just how we’re programmed. We can push so hard, but getting us to chill out and rest is the difficult part.
- With blood testing we can gain valuable feedback to one’s stress state. Is this person running too high cortisol or too low cortisol? Both are red flags indicating that there is or will be adrenal insufficiency going on, and/or depletion of healthy sex hormones.
- Beware of the pregnenolone steal: When the body it senses it needs more cortisol (due to your lifestyle, stress, activity level), it will produce this steroid hormone at the cost of producing other hormones like DHEA, T, progesterone, etc. With time, you become depleted of the good sex hormones you want, which ultimately has negative consequences.
- In addition to serum cortisol, I recommend doing an adrenal stress index, i.e. DUTCH urine test or saliva panel, to monitor your cortisol rhythms; these tests also take a deeper look at the HPA axis function and sex hormones. It’s not an either or—doing blood labs and an adrenal stress index are both valuable for athletes!
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Third – Individualize your training program
- Your health status can help tailor a training plan to your needs. Let’s take this relatively common scenario as an example of how to use a holistic approach for desired results.
- An endurance athlete who’s slightly overweight, showing signs of insulin resistance (IR), low T, has high fasting blood sugar and high HbA1C, etc. Dig deeper and find that this athlete is either on a “traditional” high-carb high-sugar diet, and/or has an intolerance to many carb- and sugar-based foods (even those foods deemed “healthy” by the mainstream). He is training 10-12 hours a week with lots of high intensity, on top of a full-time job, family, etc. All combined, these variables are a huge stress on the system and causing his health to deteriorate—training is not enough to mitigate the issues present and may be contributing to the problem(s)! Plus when asked we find that this athlete is not happy with his results in training, e.g. he’s not getting faster, and he can’t understand why he can’t lose weight despite putting in 10-plus hours of training in a week.
- Solution: Tweak the training plan and diet to improve both health and fitness. Here’s how step by step.
- First, lower training intensity and instead work on training in aerobic zones only! This fixes metabolic function (in addition to diet) by teaching the body to use fat more efficiently and not rely so much on glucose (carbs) for fuel. Ultimately this leads to better blood sugar management, healthier steady insulin levels and weight loss.
- A good start for finding appropriate aerobic zones is using the MAF Method, and in particular the 180 Formula. Simply subtract your age from 180 and that’s your target aerobic heart rate at which to train!
- This approach will also make you FASTER in the long run by developing proper endurance fitness (too much HIIT is not the key especially if aerobic fitness is lacking).
- Eventually HIIT can be incorporated back in, when it’s time.
- Second, assess volume and intensity and find what makes sense when looking at this person’s whole life. If health is not in a decent place and if other life obligations are demanding, there is no reason for tons of volume and/or intensity! Do what’s right for your needs. There’s a good chance you’re not a professional athlete so to be honest, you’ll be better off with less training and more life balance. This ties into health because we must avoid overtraining in order to maintain healthy hormonal status, and/or learn to scale back on training if hormones are depleted or low. Again that will be things like low T in guys, low progesterone in females and other biomarkers that are off (see above). Supplementation in this case can help but it is not a magic pill; it’s on you to make the appropriate changes in your training and life.
- Overtraining is relative to you and you alone. There are no standards. You may think 10 hours a week is ok, but maybe it’s not and is too much for you if you’re already on edge and showing red flags!
- Use your blood test results to help you see if the amount of training you’re doing is working for or against you!
- Third, consider metabolic efficiency testing as well. I’ can’t emphasize it enough: Endurance is synonymous with fat-burning and it’s required to sustain the demands of our sport. You must have control over your metabolism and use fat as an energy source!! This doesn’t mean carb burning isn’t present or valuable, it is; however, you just want to spare glycogen burning as much as possible and be an efficient fat burner. We can monitor this via blood testing, but even more effective is a metabolic efficiency test that will look at your heart rate, paces, and where you’re burning fat vs. carbs, including when you go from mostly fat burning to mostly carb burning. This can further help dial in training zones and help you understand aerobic vs. anaerobic zones.
- If your crossover point is at a relatively low heart rate (even lower than MAF) and slow pace, this shows you need to improve your metabolic health. It’s also where diet comes in.
- Fourth, get working on a clean diet and break up with your carb addiction. This is not a nutrition lecture, but so I won’t go into mega detail but diet is a key component to success. Start with a full diet analysis and overhaul as needed, including a proper education for the athlete on myths vs. truths. Ease the athlete into some intermittent fasting to accelerate fat oxidation.
- Diet also includes sports nutrition choices, and it’s where I recommend something that aids in fat burning like UCAN.
- First, lower training intensity and instead work on training in aerobic zones only! This fixes metabolic function (in addition to diet) by teaching the body to use fat more efficiently and not rely so much on glucose (carbs) for fuel. Ultimately this leads to better blood sugar management, healthier steady insulin levels and weight loss.
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Fourth – Establish a baseline
- Even if you don’t suspect anything is wrong with your health or fitness, establishing a baseline of your current health is super important. It may confirm that you have the green light to tackle a major training plan. It can also serve to help you in the future if something does go “wrong” with your health and your doctor or practitioner can use past tests to piece together the puzzle to see what happened and hopefully then how to fix it.