Archive for the ‘Iron & Anemia’ Category
Last night I made Pumpkin Seed butter. I needed an iron boost… (this will be a whole other post) and pumpkin seeds are an excellent source of iron! So you may be asking yourself, what do you do with pumpkin seed butter? Well, just about anything that you would normally do with peanut or almond butter. I have a terrible habit of eating nut butters out of jars with spoons. I’ve been doing this since I was little. And I’ve gotten more than a few friends and roommates begrudgingly hooked on the habit over the years.
This pumpkin seed butter is an excellent additive to smoothies and also a great ingredient in raw energy bars like the ones in the Thrive Diet book. I like to make variations on Brendan Brazier’s bar recipes and keep them wrapped in wax paper in the freezer for snacking and quick breakfasts.
So to make the pumpkin seed butter…
Soak the desired amount of seeds for at least an hour. (you don’t HAVE to soak them, but they will blend easier and break down more easily in your digestive system).
- Add pumpkin seeds (2-3 cups) to food processor or high powered blender. (I love my 3HP K-Tech)
- Add sweetener to taste (suggestions include: local raw honey, raw agave, grade B maple syrup, or stevia)
- Add a few pinches of salt (use Celtic sea salt or Himalayan pink salt for added minerals)
- You may need to add a little coconut oil or water for added creaminess when blending especially if using stevia.
The chart above is from the World’s Healthiest Foods, they are a great resource for nutrition information on plant-based foods: www.whfoods.com
Selling the bakery has really been an impetus for me to address some underlying health issues that I have been let sliding for some time. Yesterday I had an appointment with a naturopathic doctor here in Portland to talk about solutions to my low iron levels, digestive troubles, and fatigue. I also have an appointment with a new endocrinologist next week!
I know it might seem like anyone who is able to run 70 mpw should have plenty of energy, but it’s all relative. I used to have energy coming out of every pore of my body… I never sat still!
Any athlete who is trying to push their body in any capacity, even if it is just recreationally, knows when something is off. As athletes we demand more from our bodies and frankly require a higher level of health. Having a doctor or health care provider that understands this is IMPERATIVE. I always try to get referrals or interview a doctor before I see him/her to make sure that they work with athletes, or in the very least understand the increased demands that training places on the body. This goes for Primary Care Providers, ND’s, Acupuncturists, Masseuses, OB’s, Endocrinologists, Allergists, etc. They have to be willing to treat your symptoms and not treat to a broad desired range that might work for the general public.
For instance, some doctors consider a “normal” serum ferritin (shows how much iron is stored in the body) range to start as low as 18 mcg/L and I’ve even seen ranges starting as low as 3 mcg/L! A common recommendation is for runners to be over 30, however, many top athletes and coaches strive for ferritin levels over 100 mcg/L. It’s one of those things that is very dependent on the athlete. We have a girl on our team who has naturally high iron, and she starts to feel terrible when her ferritin gets down to the 60′s. This is why regular blood tests are a good idea, so you have a health history and can see changes over time. We test our team 2 x per year to establish baseline levels and make sure that everyone is staying on top of things.
The increased demands that endurance sports place on the body just mean that we have to pay extra attention and make it important to find great partners in your health. If you aren’t receiving the treatment that you need, don’t be afraid to show your doctor research and get second or third opinions. Be your own advocate!
It’s June! And this is the first post on this beautiful new website courtesy of Rebecca Churt’s awesome design skills. She has a great blog called Food for Thought where she explores cutting edge ideas for marketing, blogging, and social media.
This Spring has just felt like a time of constant change on so many levels. With the current climate of uncertainty so many people are stepping back to take stock of their lives. The recession has had far-reaching consequences already, and I would argue that they are not all necessarily negative. For me, it has meant a re-evaluation of my habits, possessions, activities and occupational trajectory.
May marked the sale of my gluten free & vegan cookie business called Sift Bakery. It was a nice end to a year and half long balancing act of obligations that taught me an enormous amount about the food industry and many aspects of business, including what I do and don’t want out of my next venture. The cookies are now being produced by the wonderful vegan distributors Earthly Gourmet. And they can still be found at Whole Foods and local food co-ops around Portland, as well as many other locations that will be listed on their website.
Selling the business has given me the energy to really try to resolve some of my long standing health issues…. especially my iron levels. I have even been running with a little more direction lately, since my husband has decided that I should attempt to get back into racing shape. We’ll see. If I can get my iron up, I will think that anything is possible. I ran the Phoenix Rock N’ Roll marathon with a friend for fun in January and managed an easy 3 hours without much training. After a string of incidences including illness, a Mexican vacation, and a 2-week snow storm, I opted to run with a pace group- which made the effort feel like a hard training run!
The weather recently has made everything feel lighter. And I’m intending on continuing my “Spring Cleaning” well into the summer… detoxing my home and cleansing my body with a focus on intention.
Wishing you health, lightness, and energy.
I feel that my situation was pretty typical of what a number of female athletes go through. I was prescribed Ortho Tri Cyclen* when I was 17 because I hadn’t had a period for more than two years. Not wanting to put anything artificial in my body and being scared about the hormones, I didn’t actually start taking the pills until I sustained a stress fracture in my foot during my freshman cross-country season at college.
After the fracture, a doctor convinced me that it occurred because my bone density was low. He said my bones were suffering because I didn’t have periods. This was the case because the absence of menses meant that my body didn’t have enough estrogen… and estrogen was the key to calcium being absorbed by my bones. He told me that my estrogen was low because I ran so much. And he said all this could be corrected by taking the birth control pill because it would supply my body with artificial estrogen that would keep my bones strong.
The Female Athlete Triad- of disordered eating, amenorrhea, and osteoporosis- was a relatively new buzzword ten years ago and doctors, trainers, and coaches were quick to jump to the conclusion that the birth control pill was the easiest, quickest-fix band-aid solution to the most bothersome part of it. I wish that I could say that as a community, sports medicine has made tremendous progress – that doctors, coaches, and trainers know a great deal more about how to address these situations with their athletes, but I don’t really believe it’s much better. Birth control pills are more than ever being prescribed to young athletes (and non-athletes alike) as a quick-fix solution to problems that require a much deeper and more comprehensive look at the whole system.
When I look back at my own situation, I realize that the Doctor made a lot of assumptions in his hypothesis. First, he assumed that my stress fracture was due to having low bone density, though he never measured the density of my bones. In reality it was my training that changed significantly – I had gone from running maybe 40 miles per week on dirt roads in high school in Colorado to running 70+ miles per week in college mostly on pavement.
The other reality about my situation was that running or body fat percentage wasn’t the cause of my amenorrhea. I was always a very active teenager and a “late bloomer.” I played 3-4 varsity level sports during high school. I only had a couple “regular periods” when I was 15 years old and they ceased when I left to be an exchange student in southern Brazil. In Brazil I wasn’t allowed outside of the house alone. It was, by far, the most sedentary I have ever been at any time in my life. And like all exchange students, I gained a few pounds. And yet this is the time in my life when my periods stopped. When I returned from Brazil, I embarked on a 30-day wilderness education course backpacking across Colorado’s San Juan Range. But still my cycle didn’t return.
Over the years I stopped taking birth control twice for several months at time to see if my period would return on its own. Each time I noticed a marked improvement in my mood and digestion, but each time a friend or doctor encouraged me to go back on the pill because I needed it for my bones. I remained on a mono-phasal birth control pill until the age of 25. At that point, my digestive problems and allergies were so bad that I wanted to try anything to alleviate the situation. I read as much as I could find on the subject, scheduled a bone density scan that came back on the low side of normal, and quit the pill for good. It was a liberating feeling!
Eventually, about 7 months later, my cycle returned naturally for the first time in over 10 years. For the first year or two it was not consistent- some months it wouldn’t come, some months it would only last a day. However, the overall trend was one of progress.
Acupuncture has been the single most helpful tool for me in finding hormonal balance and regulating my periods. I highly recommend it!
To go long distances, especially those longer than 10,000m, runners place a premium on relying primarily on aerobic metabolic pathways during the majority of the run. Runners who are capable of doing this rely mainly on fat for the majority of fuel, enabling them to limit the usage of carbohydrate. Carbohydrate storage is finite, but fat storage is, from a practical standpoint, limitless. The higher reliance on fat enables long-distance runners to run very long distances. It also enables them to preserve carbohydrate for moments during the race when they require fast acceleration (e.g., at the end of the race or while passing another runner). According to one study, only 2 to 7 percent of the total energy burned in aerobic activity is derived anaerobically.24 A small amount of carbohydrate is used even when maintaining aerobic activity, so distance runners must develop strategies for delivering carbohydrate during the run. A failure to do so will result in either low blood sugar or low muscle glycogen, both of which impair endurance by leading to premature muscle fatigue.
Keeping this in mind, distance runners must consider the following nutritionally relevant factors for their sport.
Long-distance runners are at risk of amenorrhea, low bone density, and stress fractures. The distances that these athletes run weekly to train may predispose them to stress fractures, despite the potential stimulating impact of running on skeletal mass.25 Although stress fractures occur more frequently in women runners than in men, all runners should ensure that their calcium intake is adequate to reduce the risk of fracture. Female runners are at higher risk of stress fractures because hard endurance training is often associated with cessation of the menstrual cycle. The reduced estrogen associated with amenorrhea is linked to lower bone density. Therefore, runners who experience either primary or secondary amenorrhea should seek appropriate medical advice to determine if rea son able steps can be taken to return to normal menstrual status.26
Female runners should take the following steps to reduce the risk of osteoporosis:
Consume calcium (1,500 milligrams per day) from food or a combination of food and supplements.
Avoid overconsumption of protein because excess protein is associated with higher urinary calcium losses.
Control the production of stress hormones (particularly cortisol) by maintaining hydration and blood sugar during exercise.
Avoid overtraining, which is associated with amenorrhea.
Inadequate energy intake is a red flag that the intake of vitamins and minerals may also be low. A study comparing the nutrient intakes of trained female runners who were amenorrheic, oligomenorrheic, or menstruating normally found clear nutrition differences between these groups, despite being matched on height, weight, training distance, and body fat percentage.27 The runners who were not menstruating had zinc intakes well below the recommended level of intake and lower than those found in the runners who had normal menses. In addition, the runners who had normal menses had higher intakes of fat and a more adequate total energy consumption. This suggests that high-carbohydrate diets, which are preferred for optimal performance, make it more difficult to consume the needed level of energy because carbohydrates have a lower caloric density than high-fat foods. Therefore, athletes should concentrate on consuming more food when carbohydrates constitute the main energy source. A failure to menstruate normally is a strong risk factor in the development of weaker bones and resulting stress fractures. Female runners have good cause to be fully aware of the adequacy of their energy and nutrient intakes because almost no injury is more frustrating or potentially career ending than the development of frequent stress fractures. Endurance runs require enormous amounts of energy (a marathon requires about 2,900 calories); they cannot be adequately trained for or run without an adequate total energy consumption. Food intake strategies, including eating snacks between meals and consuming snacks or sports beverages before, during, and after exercise, are important for ensuring that fuel consumption matches need.
Elite runners depend heavily on both fat and carbohydrate for fuel to accelerate and vary speed over the course of a long-distance race.
Surveys of distance runners confirm that total energy and carbohydrate intakes are below the recommended levels, suggesting that runners must make a concerted effort to consume the recommended amounts before, during, and after exercise.28,29 In a case study assessing the nutrient intake of an ultraendurance runner during a race, it was found that if the pre-event and during-event guidelines for food and beverage are followed, then athletes will have sufficient energy and fluids to successfully complete the event.30
Tapering activity before a competition improves competition performance.31 It does so by increasing glycogen stores, but it also makes the runner calmer, which gives the athlete an improved economy of running motion that enhances endurance. The importance of tapering exercise and of carbohydrate loading before an important event cannot be overemphasized.
Fluids are crucial. Fluid consumption should be on a fixed time schedule (every 10 to 15 minutes) to avoid underhydration and thirst. Perhaps no single factor is more important for ensuring a long-distance runner’s success than maintaining an optimal hydration state. Athletes should drink now, drink again in 10 to 15 minutes, and when they believe they’ve had enough, they should drink
more. Of course, the type of beverage consumed is also important.
A great deal of body heat is generated over the course of an endurance run, and this heat is liberated through sweat evaporation. Studies strongly suggest that a 6 to 7 percent carbohydrate solution with electrolytes is most effective in maintaining exercise endurance.31 It has been firmly concluded that acute heat exposure is detrimental to muscular endurance.32 Therefore, long-distance runners should develop the habit of frequent fluid consumption to maintain body water status, whether they are thirsty or not. A fluid intake of .5 to 1 liter per hour is sufficient to prevent significant dehydration in most athletes in mild environmental conditions, but a greater intake of fluids is needed for athletes running at higher intensities or in more severe environmental conditions in order to avoid heat stress.33
Distance runners typically have relatively low body fat levels. Successful long-distance runners are commonly thin, and this body profile may be advantageous to them in dissipating heat during long runs.34 However, since very low body fat levels are associated with amenorrhea, female athletes should seek a balance between low body fat levels and normal hormone function.
A critical factor in the performance of all endurance athletes is iron status, and evidence exists that endurance runners have reduced hemoglobin, hematocrit, and red blood cell counts when compared with strength and mixed-trained athletes.35 Iron status is sufficiently important that one of the more common illegal ergogenic aids used by endurance runners is erythropoietin (EPO),36 which stimulates the production of red blood cells, thereby enhancing oxygen-carrying capacity.37 Iron is an essential oxygen-carrying component of hemoglobin (red blood cell iron), myoglobin (muscle cell iron), and ferrochromes (oxygen-carrying enzymes essential for making ATP) in the mitochondria. It appears that hemoglobin status is of highest priority, so iron from other cells is cannibalized to support a normal hemoglobin production when iron stores (ferritin) and intake are inadequate. Therefore, a standard blood test measuring hemoglobin may appear normal while other iron-containing cells are depleted. For this reason, it is important that blood tests in endurance athletes always include a measure of ferritin, which should be at the level of a minimum of 20 nanograms per deciliter. Besides having an inadequate dietary intake, which is most common in runners who do not eat red meat or who are vegetarian, there are several other common causes of low iron status in runners:38-40
Excess iron loss in sweat
Excess loss of blood through the GI tract
Excess loss of blood in the urine (hematuria)
Excess menstrual blood loss in female runners
Poor absorption of iron
Today is the first day of my “fall cleaning” detox. Yesterday on my run home from downtown, I decided that I needed to take some action and be proactive about changing how lousy I’ve been feeling. I don’t want to put the entire blame on the iron pills, because it might have been a little before that… but they are an easy scapegoat.
A few weeks ago I purchased a copy of the Raw Food Detox Diet and have been contemplating making some changes to my diet. I eat far too much imitation cheese, tortilla chips, cashews, dried fruit and energy bars. And not enough fresh produce. The ironic thing to me is that I am the OPPOSITE of constipated all the time… and I’m drawn to these foods that are dense, both literally and calorically. And yet, I have NEVER remotely had problems with elimination.
In fact, this last spring I went in for a colonic and the therapist told me that I was probably not a good candidate for colon hydrotherapy because of my “constitution”… saying that I have a tendency toward coldness and watery stools, etc. (sorry to be graphic) I do simply just HATE the idea of old putrid waste lining the walls of my intestines and allowing toxins to absorb back into my tissue. yuck!
Last weekend I purchased a new juicer, the one that the author of the book recommends for its ability to handle a large quantity of greens. I’ve been scared away from so many of the “green” drinks and powders since going gluten-free. You see, wheat grass or barley grass shouldn’t contain gluten, BUT it could. The “could” comes from the fact that once it is processed we have no way of knowing whether the grass sprouted first. If it did- then the juice could contain gluten. ugggh, it is another one of those huge gray areas for me.
So I decided, that I should juice my own green goodness from veggies- hence the new juicer.
I know what you’re thinking: “what about the fiber?” Well, I have three answers for this:
1) I could never handle tough greens like Kale, period.
2) Myself, and most people, would be hard pressed to eat the vast quantity of veggies it takes to make a couple glasses of juice
3) Since our bodies have a difficult time processing much of this hard plant matter, we are probably not absorbing all the vitamins and minerals that are locked inside.
So, I’m going to start juicing again regularly. I’m even going to try to stomach beet juice, it is such a good blood builder.
More on my progress later. Off to the lab to get some blood drawn.
OK- started another iron pill this weekend…. and I think this one will be relegated to the “Ian” pile once again. Although he has his own digestive issues, he seems to have a much easier time with the iron varieties than I do and he’s not gluten intolerant…. (or so he insists).
This one was from Wild Oats- their brand- and it said gluten free on the label. It is seriously the craziest capsule I’ve seen. The outside is clear and it is filled with different brightly colored beads. The nice thing is that it said slow-release, and the capsule contains vitamin C, folic acid and b12 to aid absorption… so I was thinking it would cut down on the amount of pills I take at night. (Although I do enjoy my chewable vitamin Cs!)
I might give these the benefit of the doubt… since it is almost that time of the month and my stomach might be ultra sensitive. I even had to stop doing the mile repeats in the workout yesterday because my tummy was making so much noise… PAINFUL!
So, I’ll give them to till the end of the week…maybe I won’t take any Friday night since I’ve got a tempo Saturday morning. Then it is back to the Gentle Iron for me.
Last night while getting into bed, I had an overwhelming wish that I could snap my fingers and make my iron count sky-rocket. It is hard not to wonder what it would be like to have a ferritin of over 100.
Part of the frustration is that I have had a stomach ache that will be approaching two months next week. Not only that, but I stopped taking any iron about 5 days ago to see if I could get it to go away and it hasn’t. So… I took 2 of the gentle iron capsules last night (50mg) and I can’t say that I feel any worse this morning.
My hypothesis is that the iron “binge” that I’ve been on has further destroyed my intestinal villae and I’m having trouble digesting things again. I’m not sure what to do to make it go away right now.
This last month I’ve done a lot of reading about the Specific Carbohydrate Diet, and while it looks really interesting…. I have two main problems with applying it:
1) I don’t eat meat.
2) I run a lot.
I also think it is very strange that it allows some hard cheeses. They seem like they would be very hard on the system. At least I know that cheese is very hard on mine and can only be tolerated in small doses. It also seems like soluble fiber would be a good thing, like it is for most people with IBS. But the SCD people want to limit many of those sources including potatoes and sweet potatoes. Perhaps they are going for a lower glycemic index, but I haven’t read that.
I am thinking another food elimination diet might be in order, perhaps I’m being triggered by something else.
Levoxyl- on empty stomach of course… sometimes I’ll set my alarm and go back to sleep.
Midday or later morning:
L-Tyrosine (Thyroid support)
Kelp (Thyroid support)
Before Bed at Night:
Rhinocort Aqua Nasal Spray (for my allergies)
I don’t take a multi because I don’t like having everything in one pill. It is convenient though! I just want to make sure that I give myself a fighting chance at absorbing everything… especially since my intestines are in a rough shape.
Any to add?
This morning felt so cold, I couldn’t believe it. And all day has been cloudy so far. Just another reminder to swallow those Vitamin D pills when I get home tonight from my long day up on the hill.
Up until about a year ago, I never paid Vitamin D much attention. All I really knew was the basics:
- it works along with calcium and magnesium for bone health
- your body makes it from sunshine
- it’s added to pasteurized milk in this country
- it’s fat soluble like Vitamin A- which means you can overdose because your body stores it instead of excreting it through sweat/urine.
Pretty much all common knowledge. It wasn’t until I went down to see the Endo in Houston that I learned that I had a severe vitamin D deficiency. (I found this very ironic, since until I moved to the Pacific Northwest, I felt like I spent my life baking in the sun.) That news meant, of course, that I had to find out more. And much to my surprise, this is one fascinating nutrient.
I’ve read that Vitamin D deficiency has been linked to iron deficiency. The reason may be that individuals who are iron deficient have trouble metabolizing Vitamin D…. but I think that it is likely more of a correlation than causal relationship. Persons with fat malabsorption often have Vitamin D deficiencies, meaning that it requires some dietary fat for absorption. Symptoms of fat malabsorption include diarrhea and oily stools… (sorry again to be graphic). Fat malabsorption is associated with a variety of medical conditions including… drum roll please: CELIAC DISEASE. And, like I mentioned before, people with celiac or other malabsorption problems (like Crohns, etc.) are also very likely to have iron deficiency.
On another point high caffeine intake (300mg/day, which is equivalent to 18 oz of regular coffee) inhibits both vitamin d and iron absorption from the diet. Just another reason for me to cut back… (it is just sooo hard! Starting tomorrow!)
BUT… diet is not the best way to get vitamin D anyways. Our bodies prefer to make it from the sun. 10 to 15 minutes of sun exposure at least two times per week to the face, arms, hands, or back without sunscreen is usually sufficient to provide adequate vitamin D. Of course, this news flies in the face of the recommendations of your dermatologist- all of whom push the sunscreen. Unfortunately, if you are slathering on the sunscreen (spf 8 and higher) you’re blocking the UV rays that your skin needs to produce the required amounts of Vitamin D.
Hmmmm…. skin cancer or rickets?
What makes the sunlight issue more difficult is that many of us live in Northern latitudes where the angle of the sun and weather patterns hamper our best efforts to tan. Also playing a role are season, time of day, cloud cover, and smog, affect UV ray exposure and vitamin D synthesis. For example, sunlight exposure from November through February in Boston is insufficient to produce significant vitamin D synthesis in the skin. Complete cloud cover halves the energy of UV rays, and shade reduces it by 60%.
According to the National Weather Service’s data for the period between 1951-1995. There was an average of 67 clear days per year. That’s it. 71 days were partly cloudy and a whopping 227 days were ENTIRELY CLOUDY!!!!
I am severely deficient in Vitamin D and I get outside to run every day, and I’m fair-skinned (the more pigment in your skin, the more sun it takes to make adequate amounts of vit D). It is hard to imagine how anyone here could be high without a supplement.
So, why does any of this matter?
There have been hosts of more recent studies that have linked high levels of vitamin D in the body to much decreased incidences of cancer, autoimmune diseases, and Alzheimer’s, among others. What is very interesting is that the levels needed for this kind of disease prevention are far above those needed merely for optimal bone health. These findings have led to an increased awareness of the nutrient and talks to increase the federal government’s RDA, which is currently a pathetic 200 IUs for adults under 50.
One of the most interesting tidbits for me is that Vitamin D functions more like a hormone in your body than it does like an actual vitamin. It affects your calcium absorption, thyroid, and immune system.
There are two types of Vitamin D commonly available in pill form: D2 and D3. D3, or cholecalciferol, has been found to be up to 10 times more potent that equal amounts of D2. The problem for vegans is that D3 is made from an animal source (Lanolin, which is derived from sheep’s wool). D2, on the other hand, is made from yeast and perfectly suited to vegans.
The upper limit for consumption of Vitamin D (D3) is about 2,000 IUs per day for adults. If you are deficient, your doctor will probably tell you to take more, or prescribe a 25,000 IU tablet that you take once per week.
In order to achieve the full benefit of the nutrient, many experts are recommending supplementing with 1,000 IUs of D3 per day.
Just please don’t use it as an excuse to drink more gross cow’s milk. The benefits of your increased vitamin D intake would come no where near to outweighing the health risks…. not to mention the acne and phlegmy mucus… but that is another post entirely.