It’s in the Blood- Test It!

It’s easy. Go to a doctor’s office and explain you are an endurance sport athlete and you need your Ferritin, B12 and CBC levels tested. Request a copy of the results.

Ferritin (Iron)

Since the onset of my term as Ontario Ski Team coach I’ve observed that roughly 70% of my athletes have alarmingly low Ferritin levels when first tested. An emphasis is often placed on female athletes and their susceptibility to low iron [anemia] but the truth is ALL endurance athletes are susceptible to low iron levels. Remember, without enough iron in your blood, you’re getting reduced oxygen delivery from each stroke of your heart.High iron levels are required to deliver oxygen to all of your tissues and produce energy.

Deficiency Symptoms:

  • Diminished aerobic capacity, including decreased VO2max
  • General fatigue and weakness
  • Concentration trouble
  • Hair loss
  • Brittle and/or spoon-shaped (inverted) nails

Factors That Can Deplete Iron Levels:

  • Heavy training (esp. endurance exercise!)
  • Menstruation
  • Vegetarianism, veganism
  • High carb/low protein/ processed diets
  • Use of Advil, Aspirin and some antibiotics
  • Low stomach acid/use of antacids
  • Excessive bran, coffee, tea

*The CSIO has found that the ideal Ferritin level for cross country skiers is >80 ug/L*

What may be considered “normal” for the average person is unacceptable for endurance athletes. We require much higher values to meet the demands of our sport.

Vitamin B12

  • The body uses vitamin B12 to make DNA and support the nervous system
  • B12 is needed for carbohydrate metabolism (those with low levels have lactate build up in the blood)

Factors That Can Deplete B12:                        

  • Frequent antibiotic use
  • Vegetarianism, veganism
  • Malabsoption (celiac, colitis…)
  • Hypochlorhydria (low stomach acid)

Deficiency Symptoms:

•                  General fatigue and weakness
•                  Depression and memory loss
•                  Peripheral neuropathy (tingling/numbness)
•                  Impaired immune function

*The CSIO has found that the ideal B12 level for cross country skiers is >500 pmol/L*

CBC (Complete Blood Count)

This test measures immune system activity, circulation (hemoglobin), inflammation and blood clotting.Though these levels are not necessarily something we’re looking at changing, it is important to have your values on the record and make sure your blood values are ideal. In the event that you progress to an international racing level, it will be critical that you have saved documentation of your baseline CBC levels.

How to address low Ferritin & B12
Addressing Iron and B12 deficiencies will depend on how low your readings are. Ferritin levels below 15ug/L and B12 levels below 150pmol/L will require supplements to reverse the deficiency. Contact your doctor or coach for specific supplementation protocols.

It is the responsibility of the athlete to ensure that all supplements are free of prohibited substances as indicated by WADA [World Anti-Doping Agency [], or the Canadian Centre for Ethics and Sports []. Specific questions about substances are encouraged and can be directed to the CCES at 1-800-672-7775.



4 Comments on “It’s in the Blood- Test It!

  1. Brilliant. For next season Nakkertok will be ‘asking’ all its racer from the T2t level and up to have their blood tested for the above. FYI, most doctors do not know what is an appropriate Ferritin and B12 level for an endurance athlete.

  2. Very good work. This is very important for success and health. You should also look at Magnesium and Zinc levels. For ferritin recovery, consider Bitics research Fe-Zyme. Works wonders!

  3. @ Geoff – absolutely. Worse yet, doctors (non endurance sports doctors) think the appropriate level is the lab minimum, which for girls is usually 13 (versus the 80 Pav & endurance sports doctors recommend. Also, they usually say 133 for B12 which is absurdly low for most people, let alone an endurance athlete. Some doctors will make very inappropriate allusions to doping and be quite negative about needing to get iron levels higher.

    @Chiappa: Agree on the Magnesium and zinc – especially zinc. Zinc should be at least 11.5. Athletes should realize that zinc goes down in the presence of iron, so especially when you supplement iron you need to make sure your zinc doesn’t drop.

    @ Pav: thx Pav, great post! Now we need a discussion on strategies to improve iron. (Unfortunately really disagree with George – that product at that level is ok for maintenance, not great for significant improvements for athletes sitting below 30 Ferritin) Iron supplementation is not straight forward, but there are some very efficient methods that can push ferritin up as much as 20 points in 6 weeks. (without injections)

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