Wednesday, March 8, 2017

Iron Deficiency and Athletes From a Sports RD Perspective

As a sports dietitian (CSSD), I talk about iron values, iron sources and iron absorption, frequently.  Adequate iron levels, for all athletes, but especially for endurance athletes, are critical to produce oxygen transporters, hemoglobin and myoglobin.  As I describe to athletes, if you don’t have enough iron, then you don’t have enough oxygen, and NO ONE wants to be in oxygen deficit when they are trying to train and recover optimally.  For the science geeks, hemoglobin carries oxygen from the lungs to bodily tissues and myoglobin is within the muscle cells patiently storing oxygen for use when called upon during activity. 

Athletes are particularly susceptible to iron deficiency anemia due to low consumption of highly absorbable forms of iron, stress, overtraining or even hemolysis, which is the breaking of blood cells when an athlete’s foot hits the ground (impact forces) or during the constriction of blood vessels during heavy training (1).  The scary news is that it is suggested that 20%-50% of female athletes and 4% to 50% of male athletes have depleted iron stores, which suggests that many athletes could benefit from an intervention that addresses this issue (2).  Obviously, females are more susceptible than men due to monthly menses and some sports are more at risk than others, namely those in endurance sports such as swimming, running, rowing, triathlon, soccer and basketball (3).  

Additionally, athletes who partake in a vegetarian or vegan lifestyle, have low overall calorie consumption, low animal protein consumption, and those who have medication interactions that lead to less iron absorption are also at higher risk.  These athletes should be monitored more closely by health professionals and coaches for adverse symptoms.

Symptoms of Poor Iron Stores
  • ·         Early exercise fatigue
  • ·         Shortness of breath
  • ·         Decreased training adaptations
  • ·         Increased RPE (rate of perceived exertion)
  • ·         Delayed wound healing
  • ·         Poor condition of skin, hair or nails
  • ·         Difficulty swallowing or sore tongue

Requesting blood work can seem daunting.  Ideally, you will work with a professional, such as a certified sports dietitian in conjunction with your physician, to make sure that you not only order the correct markers of iron deficiency, but to also help you interpret this information.  Some key things to note are that blood should be drawn 24 hours post-training or during a recovery period to make sure it is as accurate as possible.  

The athlete should have blood and urinary markers such as:
  • ·         CBC (complete blood count)
  • ·         Serum ferritin
  • ·         Serum iron
  • ·         Transferrin saturation
  • ·         TIBC (total iron binding capacity)
  • ·         Reticulocytes
  • ·         Urine specific gravity (USG)

The intervention will depend on the results of this blood work and the specific lifestyle factors of the athlete.  Iron supplementation should never be blindly administered, as it’s toxic in high amounts or with specific conditions. 

Athletes should note, there are two types of iron within food sources, heme and non-heme, with heme iron being much readily absorbed by the body.  Heme is found in animal sources such as lean beef, eggs, lean pork/ham, tuna, salmon and chicken breast.  Non-heme iron is found in plant foods and its absorption can be improved when consuming sources of vitamin C concurrently (think strawberries, oranges, peppers or tomatoes).  The problem is most people think spinach is wonderful for iron, and while it’s a good non-heme source, certain types of fiber (oxalates) inhibit the absorption of non-heme iron, so you’re going to be hard pressed to make those sources a significant part of your diet and still meet your needs. 


The DRI (dietary reference intake) for iron is currently 18mg/day for females ages 18-50 years, and 8mg/day for males.  This is the amount needed for those who already have adequate iron status, not for those who are found to be deficient and require repletion.  Specific populations (i.e.  pregnancy, lactation, vegetarians and those out of the age ranges listed above) often require additional iron.  Obtaining this amount won’t happen by accident, so consumption of lean beef (3.5oz per serving) is an excellent option to increase your daily iron and meet your protein needs.   An easy salad is spinach, sirloin tip steak, walnuts, cranberries, blue cheese and a raspberry or balsamic vinaigrette.  I have it often and feel full and satisfied from the fiber and protein, which helps me stay on track!  Just the beef portion alone has 3.8mg, so you’re headed toward your daily needs and it tastes wonderful as well.  

Other sources of heme-iron include oysters (surprised on that one? I was!), eggs, lean pork/ham, tuna and salmon or chicken breast.  I hope you enjoyed learning a bit more about your iron needs as an athlete!  Work with a sports RD to get some specific advice and tailor your plan to meet your individualized needs!

1    (1) Selby, G. B., & Eichner, E. R. (1986). Endurance swimming, intravascular hemolysis, anemia, and iron depletion. The American Journal of Medicine,81(5), 791-794. doi:10.1016/0002-9343(86)90347-5

      (2) Malczewska, J., Raczynski, G., & Stupnicki, R. (2000). Iron Status in Female Endurance Athletes and in Non-Athletes. International Journal of Sport Nutrition and Exercise Metabolism,10(3), 260-276. doi:10.1123/ijsnem.10.3.26

       (3) Hinton, P. S. (2014). Iron and the endurance athlete 1. Applied Physiology, Nutrition, and Metabolism,39(9), 1012-1018. doi:10.1139/apnm-2014-0147

Thursday, March 2, 2017

Get to Know FYP Coach Drew Sapp

I've been working with Drew for over two years now, and he's one of the best coaches I've been lucky enough to be in close contact with for a longer period.  He's taught me so much about swim technique improvement with athletes, teaching, recovery and coaching in general.  It's been such a pleasure to continue to watch him grow as a part of the Fuel Your Passion coaching family.  He brings many talents to the table and I would never trust someone who I didn't feel had the right qualities to help athletes under our brand.  Drew was kind enough to share a bit about himself and his journey as a coach below!  Thanks Drew!  You are one of a kind and we are thankful to have you on board!!

Drew, thank you so much for chatting!  Tell us a little about your background growing up in athletics and how that translated to your triathlon career.  What are some tri career highlights for you?
I grew up a competitive swimmer starting at 6 years old.  I swam competitively all the way through college where I was eventually the captain of the Edinboro University Men’s swim team.  I swam distance freestyle with best times of 1:41:66 in the 200 freestyle and 4:38 in the 500 freestyle.  After my swimming days were over, I didn’t want to stop eating like a swimmer, so I picked up running, which then eventually lead to triathlon.  My triathlon career highlight so far has been winning the Great Western Reserve 70.3 while going a 4:11 on a day I didn’t expect to go that fast.  I lead the race from the beginning of the swim to the finish and I was able to dig deeper than I thought I could.
What prompted you to get into coaching?
I have been coaching swimming in some capacity since I was 15 years old, when I started coaching the summer team at the swimming pool where I spent my summers.  I believe coaching triathlon was just the next step for me once I got into triathlon.  It all began with coaching triathletes in the pool.  When they would show me their swim workouts, I saw little benefit to how they were training, which was long slow yards, so I started to have them train like distance swimmers and we saw results right away.  From there I became a sponge on biking and running, reading every book I could, researching all abilities levels in both sports and talking to coaches in swimming, biking, running and triathlon.
Can you tell us a bit about your coaching philosophy?
The athlete comes first, plan and simple.  The most important things for any athlete are to stay healthy, happy and to achieve long term results.  I view my objective as a coach to get the athlete across the line as fast as possible while staying in those restraints.  Because of that  I don’t like to focus on volume as one of the main factors in training.  While tracking volume is useful, I don’t like athletes to set their goals and judge their fitness by accumulated hours of training which can be detrimental to health long term.  It can lead to quick results, but eventually injuries and illness can get in the way, leading to regression. 
What type of individual is in your target market?  In other words, do you only coach elite athletes or will you take new entrants to the sport as well?  Do you have any specialties?
I like to work with people who want to work, which in the end is most triathletes.  I think this sport attracts a very specific type of person who doesn’t mind putting in the grind necessary to be successful.  However, over the years I have found a nitch of being successful with athletes with extremely busy lives due to things like a hectic work schedule.  I believe this comes down to my athlete comes first philosophy.  I am not afraid to cut back on workout stress because the body can only handle so much stress, whether it is from life or workouts.
I have also had a lot of success with coaching athletes who has a swim weakness.  I have a very unique approach to swimming which has gotten results at all levels from beginners to athletes being first out of the water.  Also, I am not afraid to cut back bike and run volume to make an athlete a better swimmer because when an athlete improves their swim fitness, their run and bike fitness get boosts.  Improving an athlete’s swim helps them to get through their swim leg easier and get onto the bike fresher, making for an all around better.
How many athletes do you take per year and how do people sign up?
Ideally I like to work with about 15 athletes.  To sign up they can email me at
What should someone look for when they are selecting a coach?
First they should talk to the coach to see if the personality of the coach is someone they would want to work with.  Sometimes personalities clash or just don’t work and that is okay!  Second, they should find out if the coach will truly personalize a plan for them or see if they are just using a cookie cutter formula.  I think the best way to do this is to talk to one of the coach’s athletes.. Finally, the athlete should consider their goals and weaknesses and discuss with the coach if they think the coach can help them achieve their goals and overcome their weaknesses.
Do you consider coaching to be more art or science?
I believe it’s more art than science.  Science is a guideline to make sure you are on the right path.  I believe one of the most important things a coach can, do is listen to their athletes and if possible, observe how they are performing, and then adjust accordingly if something doesn’t look or sound right, which I believe falls under the art category.
How is technology playing a role in coaching?  Will we all be wearing virtual reality glasses someday?
Technology allows us to coach remotely.  The use of Garmins, heart rate monitors, power meters and daily heart rates / paces / times / watts allow us to be with the athlete even when they are hundreds of miles away.  However, technology is to often viewed as the end all be  all of training, which can be detrimental to the health of an athlete.  The best indicator to how an athlete feels is to simply ask them how they feel!!!!  Many times, I look at a file and think, “Wow, they crushed it today!!” only to look at the comments and that same athlete says they feel like crap!  If you only look at the numbers they are doing great, but in reality if they keep going in that direction, they are going to dig themselves into a hole.   So, on the glasses, I would say no, but who knows, haha.
Now we know endurance athletes can be a bit...well...stubborn.  How do you make sure they are following the plan?
Many times, I start by taking what the athlete is currently doing, take their approach and slowly morph that into the training I want the athlete to do.  However, the biggest key is to build trust with the athlete, which takes time.  I personally care more about the person than the athlete.  Because of that, I have a little saying I use a lot which is, ‘Family Comes First.”  Little things like that go a long way to build trust.  Once trust is built, athletes become a lot less stubborn. 
However, some do athletes not want to give certain things up, such as group rides, trying to set a certain KOM on Stava or using Zwift.  In those scenarios, I integrate them into training the best as possible.  That group ride may replace that athlete’s tempo ride, but they will have some restrictions or specific instructions to what they need to do during the ride.  In the end, that leads to a happy athlete and a happy coach.
What’s one thing that an athlete can do RIGHT NOW to improve their training for triathlon?  What about for swimming specifically?
The number one thing almost all triathletes can do in the water to get better right now is to stop doing fluff yardage.  Too many times I see triathletes, just swimming aimlessly for 45 minutes or doing sets of 600 yards and up.  In the pool, since we don’t have constant access to our pace or other beneficial metrics without stopping, unlike biking and running, swimmers lose focus after about 3 minutes of an interval, causing them to slow down.  Because of this, I rarely give intervals over 100 or 200 yards.  The intervals are done on a time interval that has limited rest, but requires the athlete to push, thus improving their speed over the distance.
Outside of the pool, I believe athletes need to go into their season with more of an open mind.  Too many times, triathletes judge their fitness by the sheer volume of training they have done going into a race, when instead they should be focusing on quality training that they can fit into their lives.   So, I believe triathletes, need to pull back the volume to be what they can realistically hit with their life stress accounted for.
What’s one thing they should look to do DOWN THE ROAD?   

When scheduling out a season, make sure what you are planning to do is in your best interest 3 years down the road.  Big, overly ambitious goals and training volume, can get in the way of being a healthy and happy athlete over the long term.  Plan smart and build incrementally over the years.