Monday, June 24, 2013

Blood Tests For Runners

As distance runners we are diligent with our training routines and try and make sure we are doing all the little things we need to in order to make sure our body is fit and ready to train and race hard.  But it isn't always as simple as it sounds to make sure that you are adequately or optimally doing everything .  In blocks of hard training the things we need to keep up with and monitor go up, and the things we do in easier training may not be adequate any longer.   

Specifically in this blog I am referring to the level of hydration, electrolytes, vitamins, minerals, enzymes and hormones that our body needs in order to perform at its maximum.    In order to monitor and ensure these areas are at optimal (or at least sufficient) levels I am recommending that competitive runners, especially those running higher mileage levels, have some simple and relatively inexpensive blood tests performed on a periodic basis.   The benefits of doing so is 2 fold – first it helps us determine if there is any area of immediate concern that may be derailing or jeopardizing our current ability train and race optimally; and secondly by tracking our test results over time, we can see pick out any potential troubling trends and better learn our body and at what score in various areas do we usually perform our best.  These periodic tests can help us fine tune our ancillary (non-running) routines in order to help us perform at our best. 

OK so how often and what should I test?  Good questions and like most things on our sport the answer is “it depends”.   But I do have some basic recommendations that are a good start and something I think will be sufficient for the vast majority of serious runners.  Then as we follow these recommendations we can tweak what do to optimize it for our specific situation. 

What Tests To Have
Here is what I recommend that you get tested as part of your periodic testing program:

CBC – Complete Blood Count:  this will give you the white blood cell count, red blood cell count, hemoglobin levels, hematocrit levels, white blood cell types, red blood cell density and blood platelet counts.   Several important things in here to track and some that provide indications of infections, and other problems.

TSH Levels – This gives you a basic indication if your thyroid gland is working appropriately or at least indicate if a more thorough tests should be done in this area. Some runners have problems in this area.

Ferritin Levels – this is a good indicator of the iron stores available in your bone marrow to make new red blood cells.  Many runners, especially higher mileage runners, tend to be too low in this area if they don’t supplement iron intake.   Olympic Marathon Champ Joan Benoit Samuelson, a notoriously good eater, says that iron was the only thing she had to regularly supplement. 

Chemistry Panel – this is a test for many mineral levels in your blood, including key electrolytes such as sodium and potassium.  Also can give you a good indication if you are dehydrated and if you are high or low in any of these key minerals.   

Additional tests can be included such as glucose levels, iron and vitamin D, or others if desired or if you have reason to suspect something may be up or need to be tracked based on personal or family history. 

You can request these tests from your primary care physician or go to an independent lab testing facility, such as “Any Lab Test Now”, and have these tests run.   It is simple and the results are usually back within 48 hrs.   The cost will vary based on if you go through your doctor, what your insurance is,  or if you use an independent facility.  I know that I can get all of the above tests done through “Any Lab Test Now” for a total of $129 (their “Basic Check-up Panel” with Ferritin substituted in place of the Lipids test).

Reading The Test Results
All of these test results will come with a list of what is considered the “normal range” and what your score is.  But keep in mind that what is optimal for an athlete in serious training and what is “normal” may not coincide perfectly.  I recommend that you either find a reputable person in sports medicine who is use to working with athletes and reading blood tests results, to go over your results with you; or you take some time to do some research and reading and educate yourself on how to interpret the results yourself. 

Once you get your results start a spreadsheet and enter your results for each test and the date of the test.  Then when you get the test done again, note your new levels on the next column/row.  This way you will have an easy place to see any trends and possibly catch some potential problems before they fully manifest themselves.   In certain tests you will notice certain levels at which you feel best and what you need to do to get there (such as ferritin and what level of iron supplementation you need to achieve that ferritin level). 

How Often To Test
I recommend having the complete battery of tests done 2 to 3 times per year, with a follow-up test in-between on any area that is outside of the desired range.  For example, if I get the full run of tests done in January and everything looks good except for my ferritin levels, I may make some changes to my iron supplementation routine and then just have just my ferritin levels tested again in March to make sure my changes are working.  Then have the whole battery of tests done again in May or June.   Additionally if you run into a period of a few weeks in which we aren't feeling well and something seems off, by getting the full battery of tests it may help you isolate the problem. 

As serious runners, we want to leave no stone un-turned as we seek to achieve our goals, and these test can help us make sure we are doing what we need in terms of hydration, nutrition, vitamins and minerals, as well as point out any issues that may be lurking. 

Return on Investment
While following this recommendation can costs a few hundred dollars per year, it can also help make sure that you are getting the most out of the hundreds of hours you are putting into training and often the thousands of dollars you are investing in race entries and travel to races.  In all a very good return on your money in addition to the invaluable peace of mind it can bring.

Happy Running,

Coach Mark Hadley