Got Iron?


Iron Loop

An iron loop

In “The Risk of Training,” we talked about the stress of exercise, and how fitness and health are not synonymous terms. This time we’re going to look at some evidence of how training can have detrimental effects without careful management, and we’re going to start with a substance that is crucial to your existence: oxygen.

Most athletes understand that they must have oxygen in plentiful supply to fuel their training and racing endeavors. Aside from the important issue of training intensity and how it impacts our ability to use oxygen, what about the baseline ability of our body to carry oxygen?

Oxygen is carried in our red blood cells (RBCs), and when our RBCs get low in number it is referred to as anemia. Hemoglobin is the iron-containing molecule found within our RBCs that is largely responsible for transporting oxygen in the blood. Thus, if the number (or percentage) of RBCs in our blood declines, so does our ability to transport and utilize oxygen.

We’ve already talked about the fact that exercise is a stress, and like any other stress, it has its consequences. For athletes, one of the many consequences of regular training is a higher rate of iron deficiency. This can directly impact the ability to form hemoglobin and carry oxygen.

There are many reasons why athletes might be more susceptible to this problem. Chief among them is the fact that during exercise, RBCs shoot through our capillaries at high speed. A capillary is about the size of one RBC, so many RBCs actually break open, or lyse, due to the mechanical stress. When the RBC lyses, the iron-containing hemoglobin within it spills out into the bloodstream.

Athletes produce many acidic substances. One is lactic acid, and another, as a byproduct of aerobic energy production, is excess hydrogen ions (where the “H” in pH comes from, as a measure of your acid/base status).

Guyton’s Textbook of Medical Physiology (a bible of the field if ever there was one) identifies hemoglobin as an extremely potent buffer of acidity. As a result, one idea about why athletes tend to be more iron deficient is that the hemoglobin gets used up as an acid buffer in the normal course of exercise, to be later excreted in the urine.

So how do you know if you’re deficient? A standard check of iron in the blood — your serum iron status — is insufficient. Bodies do a very good job of keeping readily available mineral markers like this steady, making them poor indicators of developing problems until things are really out of hand.

Ferritin, or stored iron, is a much more useful measure. Even with this marker, however, the stated “normal” ranges as listed on laboratory paperwork are much too broad. The ranges you see coming straight from the lab itself are, generally speaking, statistical averages of the entire pool of tests performed.

I know of no athlete who is satisfied with being average. The local office of the mega-lab we send patients to for blood work lists “normal” ranges for ferritin from a low of 10 ng/ml to a high of 291 ng/ml. This range is so wide that you’ll come crawling into your doctor’s office if you fall outside it.

In checking athletes in my office and in work with the University of Texas athletic department, we’ve found that people tend to be symptomatic with ferritin levels below 30 ng/ml. For optimal health and performance, we like to see values above 60 ng/ml.

If you’re an athlete, you owe it to yourself to get this checked. There are many other things that could contribute to an anemic state, impacting your ability to feed much-needed oxygen to your tissues. However, iron status is one of the easiest and cheapest to both check and correct. A simple CBC (complete blood count) along with ferritin shouldn’t set you back more than about $50 at your doctor’s office.

Your doctor should be able to help you select a high-quality, easily absorbed form of iron that will allow you to quickly correct the condition. Getting this checked is doubly important for premenopausal females, who are at an increased risk due to regular blood loss from menstrual cycles.

No matter what you do, keep in mind that your training has consequences! Staying on top of your health and respecting the stress that exercise causes is the best way to ensure longevity in both training and life.

Slow Weigh Down


So here you are, caught in the weight loss abyss somewhere between the the culinary onslaught that was Thanksgiving, and the approaching diet-destroying duo of the Christmas and New Year’s celebrations.

Time for exercise is in short supply. You figure that your best bet is to workout even harder than ever for the little time you have in order to maximize your calorie-burning hours.

Losing weight is all about burning more calories than you take in, right?

Well, no. It’s not quite that simple.

That idea leaves a lot unsaid about the overall effects of exercise on our bodies. There are lots of technical details involving fats, carbohydrates, and number crunching to illustrate why this doesn’t completely add up.

For now, though, I’ll spare you the mumbo-jumbo so we can get right down to understanding how different exercise intensities can impact our ability to get rid of those unwanted pounds. We can also use this knowledge to exercise in a way that helps you become more fit and stay healthy in the process.

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You Ate What?


I want to talk to you today about a really insidious little substance that may be significantly affecting your health. Here are some hints: It’s not just in Chinese food, it causes more than just headaches, and there’s a really good chance that you had some today.

Yep, I’m talking about MSG, also known as monosodium glutamate. What’s the big deal? Well, glutamate is an excitatory neurotransmitter that can have effects in areas much more far reaching than just your taste buds.

Excitatory neuro-whatever, you say? I know it sounds like mumbo jumbo, but allow me to explain…

A Little Physiology

A neurotransmitter is a substance that your nervous system uses to transmit a signal from one nerve, or neuron, to another. Your brain, and the rest of your nervous system, is made up of literally billions of neurons, and they each use various kinds of neurotransmitters to convey different signals to each other.

Glutamate is excitatory in that it stimulates any nerve that it acts upon, causing it to have a higher propensity to stimulate other neurons to perform functions that are as widely varying as your nervous system itself. This could be anything from causing a muscle to contract to getting your heart to beat a little faster.

Conversely, an inhibitory neurotransmitter is one that would cause the neuron it acts upon to be less likely to fire. It’s this balance of excitatory and inhibitory signals that determines what nerves fire, what signals are received, and the balance of your brain chemistry.

The actual molecule glutamate is an amino acid. Amino acids are the building blocks of protein. Put a bunch of them together and you have a strand of protein, which might be a muscle fiber or a pigment that makes your eyes a certain color. Individually, however, amino acids have varying roles and functions in the body.

The sodium part of monosodium glutamate is added to make the entire MSG molecule more stable, so that the effects of glutamate are more long lasting.

So What’s the Problem?

MSG stimulates the nerve endings in your taste buds, making the food you eat seem to have a more intense flavor. If you were part of a food study, being asked to rate the taste of a food on a scale of 1 to 10, you’d say the MSG-laced food might rate a 7 or 8, while the one without it would be down around 3 or 4.

The problem is that the effects are not confined to your taste buds. After you swallow it, MSG can go on to stimulate neurons all over your body, causing anything from headaches and heart palpitations, to numbness and shortness of breath.

Being a basic amino acid, glutamate obviously exists in nature, so you might think it’d be a relatively harmless substance. The form of glutamate we get with MSG is not the same as what you find in nature, however.

The processed MSG you consume actually ends up having a high percentage of molecules that have a geometric shape that is a mirror image of that found in nature. This is problematic for the body in much the same way that left-handed people have trouble from time to time working in a world that is dominated by right-handers.

Even though our two hands are identical in design and function, trying to use your left hand on a device designed for the other can be an exercise in frustration.

This simple difference in the MSG created in the food lab can make a big difference in how our bodies react to and process the substance. Additionally, there are many contaminants that come along in the typical MSG creation process that are known carcinogens.

The Labeling Game

On your average food label, you don’t see the phrase “monosodium glutamate” on too many things. This is because that particular phrase is reserved by the FDA for use by a product that has at least 99% processed freeglutamic acid (PFGA). PFGA is a term used to describe the processed, synthetic variety of glutamate mentioned above.

This means that a product can be 98% PFGA, with essentially all of the problems and side effects of MSG, without ever being listed as such on a food label. Instead, what you get are label names like “yeast extract”, “yeast nutrient”, “textured protein”, “hydrolyzed protein”, “gelatin”, and dozens of others. Additionally, labels like “flavor”, “flavoring”, and “natural flavors” may also contain high amounts of processed glutamate.

Regardless of the reason for its use, these products most likely carry all the inherent problems and sensitivity issues of run-of-the-mill MSG. (There is a much more comprehensive list of all the names under which processed glutamate might be hidden at http://www.truthinlabeling.org/hiddensources.html.)

Furthermore, any item on a food label that you know has ingredients, but does not list them, should be suspect. A classic example is a from a popular brand of canned tuna. The ingredients listed are “tuna, water, vegetable broth, salt”.

We know “vegetable broth” has ingredients. In this case, the “vegetable broth” is simply “hydrolyzed vegetable protein” (see our list above) and water. In other words, the only reason “vegetable broth” is added is to get MSG (orPFGA) into the product.

The intent of most of these products is the same: to enhance flavor based upon the properties of the excitatory neurotransmitter glutamate. There is also a percentage of products that add in PFGA or MSG for their preservative and stabilizing properties, making foods or chemicals less susceptible to the effects of things like heat, light, or acidity.

The common flu vaccine FluMist, according to the CDC, includes MSG as a stabilizer. I don’t know about you, but I’d rather not shoot something into my nostrils, to be absorbed by blood vessels just inches from my brain, that includes anything like MSG in it.

The Effects

By far the most common symptom I see in the office from MSG is headaches, particularly migraines. If I mention the possibility of MSG, the usual response I get is, “But I haven’t had any Chinese food recently!” Education about just how many places you can find MSG then begins.

Rashes, redness, stomach discomfort, or “brain fog” are examples of just a few, varied symptoms patients notice that they stop having once they make a concerted effort to eliminate their MSG intake. Once you know MSG is the problem, anytime your particular symptom crops up again, the question to ask isn’t so much “why am I having this headache?”, but rather “what new thing did I eat recently?”

Taking this approach allows you to get better and better at keeping MSG out of your system, keeping you where you want to be: pain free.

Regardless of whether you experience clear symptoms from MSG exposure, my recommendation is to stay away from the stuff. The health of your brain and nervous system isn’t worth a food company’s experiment to try and make their snacks tastier!

You Didn’t Sleep Wrong


Referred Pain Can Be A Pain In The Neck

How many times have you awakened some morning in the not-too-distant past to find that you have a new ache or pain? Trouble turning your neck. Pain around your shoulder blade. An uncomfortable lower back.

Where does this pain come from? Did you “sleep wrong”? Was the bed too hard? Too soft? Why, of all mornings, is it bothering you on this one?

The sensations we have in our bodies are not random. The perhaps unimaginable complexity of the human system can make what we experience seem random. But just because the pattern is too difficult for us to figure out doesn’t mean that there isn’t one.

So when we wake up with pain in a muscle, a common assumption is that the problem is right there with that muscle. This may seem self-evident, but it’s not quite so easy. Let me explain.

If your phone keeps ringing over and over from an annoying prank caller, the “symptom” you experience is your discomfort from the phone constantly ringing, disturbing your peace. The problem doesn’t start with the phone, though. It started with the prank caller on the other end of the line.

Bodies have a similar mechanism, where a problem in one area can send a signal that shows up elsewhere.

Take heart attacks, for example. You might have heard that a common symptom experienced during a heart attack is pain in your chest that can spread into your left arm and shoulder.

What does your arm and shoulder have to do with your heart? Not much, except that they share part of their nerve supply from similar levels in your spinal cord.

A common explanation for the shoulder and arm pain experienced by heart attack sufferers is that your brain misinterprets the flood of information it receives from an organ in trouble.

Instead of having us perceive this influx of information as a problem with the organ itself, our brains interpret the signals as pain and discomfort in a part of our bodies that are much more accustomed to those sensations. This kind of discomfort is called referred pain, since the pain is originating one place, but showing up in another.

What makes things interesting is that just about every organ we have seems to have a referred pain pattern.

You might have gotten up one morning, for example, with a “crick in your neck”. Pain into one side of the neck — typically, but not always, the right side — that might radiate down around your shoulder blade.

Patients come in from time to time with this kind of pain. The usual explanation goes something like, “Well, I must have slept wrong or something.” In many cases they’re surprised to find out that the source of their pain has little to do with how they slept, and a lot to do with their gall bladder!

The gall bladder has a referred pain area that usually covers the right side of the neck and shoulder, down around the shoulder blade. As such we have to rule out gall bladder trouble as a source of their pain anytime a patient presents with this kind of pattern.

It’s likely that the crick in your neck is more highly correlated with what you ate the night before than the position in which you happened to fall asleep. Fatty foods, spicy foods, or foods to which you may be allergic can frequently irritate the gall bladder.

After a good physical exam, if gall bladder irritation turns out to be the source of the problem, I have to advise the patient to avoid re-irritating the area with the foods mentioned above. Bile salts and pancreatic enzymes can also be helpful to reduce the load on the gall bladder while it recovers from the episode.

In short, if pain around the shoulder and neck turns out to be referred from the gall bladder, no amount of soft-tissue work will resolve the problem alone.

Since most organs appear to have a referred pain pattern, the gall bladder example used above is just one scenario where a visceral, or organ-related, source must be considered for what might appear to be a structural problem.

Seemingly structural problems can have visceral components. Likewise, a structural problem can have a very direct impact on our organ function.

The job of a truly holistic practitioner is to evaluate all facets of your well-being to help you improve your complete health.