Iron Deficiency + The Athlete: Part II

August 30, 2022by RebeccaLeave a Comment

If you recognize the food on the left side of the plate above as red lentils (a red lentil soup), then you may also know it to be a rich source of the mineral iron.

I’ve written about iron in detail before, but a recent research paper on impaired iron and endurance athletes reminded me that I need to periodically review this topic.

Nearly all of my female clients in the past few years have come to me with iron deficiency, iron-deficiency non anemia, or iron-deficiency anemia. This has been true whether they are endurance athletes or not. And whether they’re highly active or not.

Here’s a refresher on the difference between those three:

Stage 1: Iron Deficiency: Iron stores in the bone marrow, liver, and spleen are depleted, indicated by ferritin values less than 35 ng/mL, Hemoglobin values > 11.5 g/dL and transferrin saturation >16%

Stage 2: Iron-Deficient Non-Anemia: Red blood cell production decreases as the iron supply to the bone marrow is reduced, indicated by ferritin values less than 20 ng/mL, Hemoglobin >11.5 g/dL, and transferrin saturation < 16%

Stage 3: Iron Deficiency Anemia: Hemoglobin production falls, resulting in anemia, indicated by ferritin values less than 12 ng/mL, Hemoglobin <11.5 g/dL, transferrin saturation less than 16%.

While iron deficiency may be much more likely in women, it’s not a female-only issue.

It used to be that when there were signs, symptoms, and laboratory results indicating deficiency of a nutrient, I did just the typical nutritionist thing of recommending eating more foods rich in that nutrient, increasing bioavailable co-factors in the diet, adjusting timing of nutrient intake so absorption increases, and according to the circumstances, recommending varying amounts of supplementation.

Generally, that’s a pretty good and standard game plan. But to a certain extent in many cases, it was band-aiding the real issue. Or at least not getting all the way there.

Why is nutrient absorption impaired in the first place? Did the individual merely need to increase nutrient intake and we’d solve the problem? Was it just an issue of increased demand or not eating foods rich in that nutrient?

What I started finding was that even with continued intake of iron-rich foods, or in some cases high-dose supplementation, we’d still have low levels of iron (and often of other nutrients).

So what’s happening here?

It wasn’t until I had continued professional training on gut health and malabsorption that I began having some personal aha moments.

When I began addressing the issue of nutrient deficiency from the standpoint of improving the person’s digestion and absorption and calming the nervous system (which is so incredibly entwined with gut health), absorption of iron and many other nutrients drastically improved.

We were finally treating the issue.

Which is to say, that still doesn’t mean it’s easy. Figuring out which puzzle piece or perhaps multiple puzzle pieces of the GI system are impairing absorption of nutrients and digestibility of food can take some time and it can take some persistence. But it’s so worth addressing.

Here are some factors that might be causing impaired absorption of dietary and supplementary iron and/or increased need. Check all that apply for you. The more that apply, the more likely absorption and/or intake of iron will need addressed.

Female of menstruating years
Endurance athlete
Digestive Symptoms – Pain, Bloating, Gas, Loose Bowel Movements, Undigested Food in Stool, etc.
Have low stomach acid (quite common and most people are completely unaware)
Follow a vegetarian, vegan, or plant-based dietary pattern
Omnivore who avoids red meat
Fast eater or eats while distracted or stressed
Low estrogen or testosterone levels
Supplemental intake of other minerals at the same time as iron, not-including nutrient cofactors when consuming iron rich foods or supplements, and/or consuming foods and beverages that prevent absorption at meals rich in iron
Taking prescription medication(s) – depending on the medication if may impact nutrient absorption or change physiology so there’s an increased need
Lack of knowledge about how to eat a balanced diet or poorly planned dietary pattern
INFLAMMATION! – Particularly inflammation of the gut (may be asymptomatic or not obvious)

Want to Know More?

If you’d like a refresher on iron, check out my first article on this topic.

Need help with iron or absorption of other nutrients? Within my nutrition practice, I specialize in endurance athletes and digestive imbalances. If you’ve struggled with chronically low iron or poor absorption of other nutrients, I encourage you to reach out to me for more personalized support.

Nutrition + Health, Running

Experiencing Fatigue and Poor Exercise Recovery?

April 27, 2022by Rebecca1 Comment

Depending on your exercise or training load, it’s sometimes “normal” to experience fatigue in the hours and days after a workout or strength session. But what about when you routinely feel fatigued, more than your normal or chronically? Or when you realize you’re not recovering from workouts as well as in the past?

There are many reasons why you might be more fatigued than ideal, or not recovering well from training. Below are a few of the most common.

Reasons For Excessive Fatigue and Poor Training Recovery

Sleep

Sleep is probably the number one thing that can help you recover better from exercise and stressful phases of life. Typically, most adults need about seven to nine hours of sleep per night, but it’s not just the number of hours that matters. The quality and timing of sleep can be equally important.

Do you fall asleep after 10 pm, or closer to midnight or 1am? Or later?

If so, you’ve already missed out on crucial hours of recovery. This is because your body’s internal clock–it’s circadian rhythm–is programmed for what we’ll call the “night janitor” to come between the hours of 10pm to 2am each night. These are the hours that the brain and body does most of its deep cleaning internally. Just like at school or a workplace, if you work late and the night janitor shows up, they often say “I’ll come back later.” In this case, later means another day. Practiced routinely, and your missed hours or nights of deep cleaning and cellular repair start to add up, adding to your fatigue and poor recovery.

High Stress

Stress, no matter whether it’s perceived or actual, wreaks havoc on your hormonal response and puts extra strain on your recovery process. Habitual high stress also often impacts sleep, causes anxiety, burn-out, depression, and excessive inflammation. Nutritionally, inflammatory foods are a major stress to the metabolic process and can be treated as “high stressors” at the metabolic level. See more about this below.

Overtraining

Overtraining can be looked at from a number of angles, but ultimately, it’s about too much stress and not enough rest. That’s an extremely broad way of differentiating it from the Stress category above or from the nutritional categories below.

Snacking all day / improper meal planning or amount

If you’re quite active, aim for four balanced meals with no snacking in between. Giving the digestive system time to rest by about four to six hours after each meal really supports its ability to fully digest the last meal before the body has to begin digestion again. This habit can go a long way towards enabling proper nutrient utilization and improved recovery.

Inadequate Macro or Micronutrient Status

Either an improper ratio or amounts of the macronutrients (Carbohydrates, Protein, and Fats), or of any number of Micronutrients can cause poor exercise recovery. The micronutrients that are most often implicated for chronic fatigue and poor workout recovery include:
Magnesium,
Thiamin (B1),
Riboflavin (B2),
Niacin (B3),
Pantothenic Acid (B5),
Pyroxidine (B6),
Folate,
Vitamin B12,
Biotin,
Iron,
Copper,
Vitamin D,
Vitamin E,
Vitamin C,
Carotenoids,
Coenzyme Q10,
Selenium,
Zinc,
and other antioxidants such as Glutathione, N-Acetyl Cysteine, and Alpha-Lipoic Acid.

As you can see, this is quite the list. Any one of these can be the cause of poor recovery. Some of these nutrients can be toxic if supplemented with more than is needed, or they can negatively impact the status of other micronutrients. So it’s always best to confer with an experienced nutrition professional before adding supplement nutrients to your regime. This also makes sure you get the right nutrients for you– and not guessing at what might help.

Poor Digestion / not absorbing nutrients from food

I’ve written extensively about poor absorption and digestion so I encourage you to learn more by reading other articles on this topic. But it’s safe to say if your digestion is compromised, which also may not be obvious to you, then you’re not going to be recovering well and will frequently experience fatigue as a result.

Excessive Ingestion of Inflammatory Foods

Think of inflammatory foods as anti-nutrients for the body. They take more nutrients to break down and clear from the body than they provide, and cause excessive cellular inflammation before doing so. Foods or beverages in this category include refined sugars, refined/processed grains, rancid oils, alcohol, ultra-processed foods (most foods that have more than eight to ten ingredients, or ingredients that you’d never add to the food from your pantry if making a homemade version), and in cases where you also have compromised digestion (which may not be immediately obvious), whole foods that can be inflammatory and difficult to digest for certain individuals, such as wheat, barley, spelt, farro, dairy products, nuts, soy, eggs, and fish.

Next Steps

Unfortunately, I am all too familiar with many of these personally, and have had whole training blocks and races thrown off by them. For me, the most common culprits are poor digestion and nutrient assimilation, micronutrient deficiencies due to poor digestion, and high stress. Additionally, the factors that can contribute to fatigue often work interchangeably and compound on themselves.

Within my nutrition practice, I specialize in endurance athletes and digestive imbalances. If you’ve struggled with poor exercise recovery or extra fatigue that you’d like to figure out, I encourage you to reach out to me for more personalized support.

Nutrition + Health, Spring

Making Beans More Digestible – And the Fiber Connection

March 15, 2022by Rebecca1 Comment

When it comes to digesting beans and legumes, complaints about not being able to digest them, or suffering with a painful balloon belly is a common concern.

One of the common reasons for this has to do with your gut microbiome — all those microorganisms that live in the GI tract.

Your digestive system is home to trillions of beneficial bacteria that ideally live in a symbiotic relationship with you. This means you and they both benefit from them being there. Just like you, the microbes need to eat to live and grow, so they obtain nourishment from the food you eat. In the case of beneficial bacteria, they feed on the undigested part of the food, (fiber,) that is passing through your large intestine by fermenting it into short chain fatty acids such as Butyrate. And beans and legumes are rich in fiber.

When we introduce any food that we haven’t routinely been eating into our diet, what often occurs is a readjustment period at the microbiome level. Think of it like the first day of a new job or school year. There’s going to be some shakeup to the internal routine and homeostasis. This means there might be more uncomfortable symptoms before optimal digestion occurs because the type of bacteria that eat the food you’re eating is growing its population, while die off of the type that no longer has a food source is also happening.

But if we can make that transition smoother and get to the optimal digestion that occurs when we can tolerate eating beans and other fiber-rich foods, we’re setting ourselves up for increased intestinal health. This is because short chain fatty acids, produced by those beneficial bacteria in the intestine, play an important role in the maintenance of the intestinal barrier.

Whereas we don’t want an overgrowth of bad bacteria, having ample and diverse beneficial bacteria is a hallmark for optimal health. Low beneficial bacteria can impact your protective mucus lining in the intestinal tract, which supports up to 80% of our immunity. The commonly used phrase “leaky gut” comes into play here when the interplay between a low fiber diet, low beneficial bacteria count, and difficult to digest macromolecules poke holes in the cheesecloth-like fragility of the intestinal lining and then opens the way for the immune system to do its job –in overdrive – resulting in sensitivities, intolerances, and allergies to many foods that are in your normal routine.

Tips for Increasing Digestibility of Beans and Legumes

If you struggle with tolerating beans and legumes, first try out the smallest, quick-cook split mung beans, red lentils, and whole green mung beans. They are easiest to digest. The larger beans are more drying in nature, and tougher for the body to break down. Red lentils and split mung beans break down and cook quickly in 20-30 minutes, and they don’t usually need soaking or planning ahead. However, if you are already having tummy troubles, soaking is a good idea.

Below are a few more tips to help make lentils and beans more digestible:

– Introduce beans and lentils into your diet slowly. Because beans are rich in fiber and will take a few days or couple weeks to repopulate the type of bacteria in your gut that will break them down and digest them, introduce them in small amounts. If you’re particularly sensitive, start with 1-2 tablespoons per meal, and work up from there to a standard ½ – ¾ cup serving.

– Soak and rinse in a big bowl of water, overnight or for 1-6 hours, depending on the type of legume. For large beans, you’ll need an overnight soak. For smaller beans such as adzuki and mung beans, a six hour soak will do. And for lentils and split mung, a soak of an hour is sufficient. Discard the soaking water before using in your recipe.

– If there is foam that rises to the top of the pot while cooking, skim it off. The foam contains a type of protein that is hard on your digestive system. When in nutrition school, my cooking instructor Eleonora constantly repeated, ‘skim your beans’ so often that I hear her voice every time I see foam!

– Make sure the lentils – or other beans – are cooked thoroughly. This means they are soft, not al dente. One of the biggest challenges with digesting canned canned beans is that most of them are not actually cooked as well as they should be for proper digestion. Cooking until the lentils or beans begin to break apart, or in the case of red lentils and split mung, turn into mush completely, is the best way to know they’re done.

– Add spices! Carminative spices, meaning they boost the digestive capacity, makes meals more digestible. This is why a big soup pot with beans and meat often contains a bay leaf. Other carminative spices include ginger, cumin, coriander, fennel seed, thyme, rosemary, oregano, basil, allspice, black pepper, cardamom, cloves, and more. Virtually every cuisine of the world is ripe with carminatives in the traditional recipes for the exact purpose of not only adding flavor, but also boosting digestion!

– Add a squeeze of lemon, lime juice, or vinegar. Ideally every meal contains a slightly sour flavor addition, since sour helps to activate digestive enzymes. Most meals don’t need to taste outright sour, however. A little addition at the end of cooking goes a long way and often balances the recipe that’s missing ‘just a little something.’

– Eat your foods warm. If you think of an ideal digestive scenario as a nice little cozy fire in the digestive system, eating cold foods is like throwing cold water on it. Not so great for turning food into nutrients and energy!

– Reduce stimulus during mealtime. Eating while multitasking with your phone, computer, while reading or watching a video, and eating in a loud, overstimulated environment or while upset or anxious is a recipe for continued GI problems. Our gut and brain are incredibly closely linked. We can go a long way to improve tolerance to the foods we eat just by eating slowly, chewing each bite upwards of 30 times (yes, really!), and not doing anything else while eating, other than eating. If you try these tips, you might also find you enjoy your food more, which is always an added bonus.

Signs of Balance and Imbalance

Ultimately, the goal is to feel good in your body and mind. Signs of imbalance include lack of appetite, bloating or gas, pain or cramps, chronic fatigue, sluggish or rapid digestion, extreme Appetite, bodily aches, skin irritations, itching and rashes, brain fog, and irritability.

Reach Out

If you’re ready for more individualized nutritional guidance, I invite you to reach out to me for more personalized support on digestion, sports nutrition, or both.