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Red blood cell values and performance
I'm a 41-year old racer, in good shape, and train smart and hard (my most recent 20-minute threshold test was 297 watts average, and I weigh 164 lbs).
I've never paid much attention to my blood results until a recent annual physical revealed some slight anemia. As directed by my doctor, I started a mulit-vitamin and two months later my values were back in a range that he found acceptable.
As I looked at the results and compared them to the older numbers, I noticed that my red blood cell count, hemoglobin and hematocrit levels were each on the low side of "normal" ranges (see below). The numbers are not even close to middle of the listed ranges.
While my doctor is satisfied with my health and fitness, I cannot help but wonder if this is significantly limiting my performance? Is there anything I could or should do to increase these values? (Legally and safely, of course.) Thanks!
Dallas, TX USA
August 2010 values (slight anemia)
Red blood cell 4.08 million/uL (range 4.20-5.80)
Hemoglobin 13.1 g/dL (range 13.2-17.1)
Hematocrit 38.1% (range 38.5-50.0)
October 2010 values
Red blood cell 4.17 million/uL (range 4.20-5.80)
Hemoglobin 13.7 g/dL (range 13.2-17.1)
Hematocrit 39.1% (range 38.5-50.0)
Pamela Hinton says:
Anemia is defined by an abnormally low hemoglobin concentration. The World Health Organisation's criteria for men and women are 13.0 g/dL and 12.0 g/dL, respectively. Because hemoglobin is the molecule in red blood cells that carries oxygen from the lungs to the rest of the body, hallmark symptoms of anemia are fatigue and reduced endurance capacity.
There are many causes of anemia, including disease, medications, and nutrient deficiencies. In particular, deficiencies of vitamin B12, folate, or iron cause anemia, with iron deficiency being the most common nutrition-related cause of anemia.
One way to determine if the anemia is caused by a deficiency of vitamin B12 or folate versus iron is the appearance of the red blood cells. Both vitamin B12 and folate are needed for cell division, so without enough of these vitamins the red blood cells enlarge without dividing. Consequently, they appear abnormally large, but have normal pigmentation because iron (which gives them colour) is adequate (macrocytic or megaloblastic anemia).
By contrast, anemia that is caused by iron deficiency results in normal-sized red blood cells that are pale in colour (normocytic, hypochromic anemia). Another way to rule to out iron deficiency as the cause of anemia is to estimate body iron stores using a blood test for ferritin.
Because iron deficiency is a progressive condition, a person who has iron-deficiency anemia will have used up all of their storage iron in the body's attempt to maintain normal hemoglobin. Obviously, it is critical to determine the cause of the anemia so that the appropriate course of treatment can be followed.
You stated that your doctor recommended a multi-vitamin, which suggests treatment of a vitamin inadequacy. Because iron is toxic, i.e., the body has no way of actively excreting excess, supplemental iron to treat iron-deficiency anemia is typically prescribed by a physician.
Nutrients are needed to make red blood cells, but do not signal the bone marrow to make more red blood cells. Rather, the kidneys secrete the hormone erythropoietin in response to hypoxia, which provides the signal to make more red blood cells. Thus, unless a nutrient deficiency has been identified, you are not likely to benefit from a supplement.
Michael Brown then responded:
Thanks for the response. Given that the multi-vitamin approach has shown some success, I will continue with that and check again in a few months. As a follow-up question, should I adjust my training?
My usual "winter training" (from now until March) consists of two weekly (intense) Computrainer sessions under direct supervision of a coach, each lasting one hour, and two long (three hours or more) group rides of varying intensity on the the weekends (and an occasional short weeknight ride thrown in just for fun).
In your opinion, is it acceptable to continue with this routine? Is there any need to back off? Thanks for your time!
Scott Saifer says:
If you'll read through my responses to various previous posts, you'll find that I think you are doing too much intensity, independent of your blood status.
Winter training should be lots of aerobic base, and very little intensity until a couple of months before racing starts, and then one month with a max of two days per week of tempo (sub LT) work, followed by a month with a max of two days per week of LT work in short intervals. Doing intensity all through the winter you'll use up your peak before racing season even comes around.
You have answered some of my questions before and I'm making good progress with my bike position and performance. I have one problem left. When I stand my PT says I have a pelvic tilt and my cycling buddies say that I hang to the right a touch on the seat.
I have read your answers to other people with the same problem and my hip flexors and psoas are not tight at all. At yoga, both sides are the same flexibility or almost exacly the same. The wedging advice you gave me before helped me sit a lot straighter on the seat and I would like to be able to do better.
When I stand the right side of my pelvis is nearly an inch higher than the left side. I have had a scanogram and there is no leg length difference. Can you help me? This is driving me nuts.
Steve Hogg says:
I remember your previous questions and am happy that you are improving. Re your pelvic tilt; you probably need to see a chiropractor, physiotherapist or osteopath with some experience in Behavioural Optometry, or a behavioural optometrist with an interest in functional anatomy.
It is my experience that most people who display a pelvic tilt not associated with a leg length difference or a disparity in hip flexors tightness between sides can correct the pelvis by wearing an Irlen lens with the individually correct colour frequency over one or both eyes.
When standing, the pelvic tilt can usually be corrected with perfectly prescribed orthoses as well. However, my feeling is that asymmetric posture drives the difference in foot / ankle morphology, not the other way around, and that the asymmetric posture largely results from a non visual seeing problem.
Keeping this simple, something like 20 percent of the fibres of the eye aren't used for seeing. Rather they play a part in balance and coordination and that it is problems with these fibres and the less than perfect spacial awareness that results from the eye problem, that drives the left / right pelvic asymmetries of posture in a very high percentage of people. At least, this is my experience.
From memory you're in the U.S. on the West Coast. If you can't find anyone local, try the Human Performance Center in Santa Fe because I know that this is a topic of interest to them. You may not be able to travel there but if not, talk to them anyway as they may be able to put you in touch with someone nearer to you who can help.
Let me know what happens.
Wil then responded:
One of the guys in my team is an eye doctor and says he is not a believer in what you told me. I trust your advice as it has worked before. Is there more help you can give me as Iwant to get started on this problem. If that is my problem. Hope to hear from you soon.
Steve Hogg says:
Find another eye guy. Look up Behavioural Optometry in your area on the net. I may be wrong in my supposition regarding your pelvic tilt but the odds are against it. There is a simple test to determine whether the cause relates to vision.
You will need to see your physio. Stand in front of a mirror stripped to the waist. Have your physio kneel behind you with his fingers on the posterior iliac crest on each side. Close one eye. Is there an improvement in pelvic symmetry?
If not, open the closed eye and shut the other. Does your pelvic tilt disappear or moderate noticeably?
If it does with one eye shut, and most of the time it is the right eye, there is a spatial awareness problem driven by vision as I suggested in my original mail. If there is no difference in pelvic symmetry with one or the other eye shut, I am wrong and the root cause lies elsewhere.
If I'm correct, then find a Behavioural Optometrist or a structural health professional with an understanding of the concepts. Sometimes the solution means training of one eye and sometimes wearing glasses with an individually suitable colour frequency.
While we're talking about this, two other things that will eliminate a pelvic tilt for most people in the absence of a measurable leg length difference are perfectly prescribed orthoses ( not commonly as well prescribed as they should be) or wearing any footwear from the MBT brand.
Let me know what happens.
I am a 28-year-old competitive cyclist. I have been riding for the past three years or so. I have a high training volume both in terms of volume and intensity (average 14 hours per week) with at least three high-intensity workouts per week, in addition to one long ride every Sunday.
The long ride is more of a fartlek training. Ever since I started racing three years ago I get cramps in every event that exceeds 75km or two hours effort. These cramps were terrible at first, my entire leg used to cramp - quads, hamstrings, calves... almost everywhere. Even when I laid down (during a race) and tried to stretch my muscles I cramped. Up until I started taking magnesium.
It has been almost five months now that I am taking magnesium, they have eased a lot, I no longer cramp as much as I used to, but I am still cramping, and this month I have lost two races because of these cramps. Now these cramps are less severe in a term that I can manage to keep on riding (while in the past I had to quit).
Knowing that I hydrate well prior and during the race, and increase my sodium intake prior the race, I keep getting them. I am almost desperate, because I am among the fastest riders in the peloton but these cramps totally ruin my chances in every race. Any advice? Could it be position related? You think stretching before the race might help me?
Scott Saifer says:
There are many causes of cramps. Bike fit is certainly one of them, and your fit should be checked whether or not it is the cause of your cramps just because bike fit makes a huge difference to the power you can make and sustain. Another possibility is under-training for your event distances. If you are routinely doing 14 hours per week and racing races of 2-3 hours, that's not the problem you are having.
Another possibility is electrolyte imbalance as you have already noticed. I've had many riders get past persistent cramping problems by increasing calcium intake. If you are already taking a supplement of 1000mg (1 gram) or more of calcium per day, this is not your issue.
If you are not supplementing calcium already, start taking 1000 mg of calcium each morning and another 1000 mg each hour when you race. The easiest way to consume that calcium is as a chewable antacid tablet. Pick a flavor that you like. Try that for two weeks. If it doesn't make a difference in two weeks, it's not going to start. If it does work, keep it up of course.
Finally, you may be getting cramps because you are training too hard. This is a less common cause, but three days of high intensity per week is too much for the vast majority of athletes independent of whether they are getting cramps or not. I'd suggest you back off to 1-2 hard days per week when you don't have a race coming up. In a week with a race, the race should be the one hard day. More frequent hard rides may help you bring on good form, but once it is on, continuing them only makes you unnecessarily tired.
Good luck. Let us know if this advice helps.
Khalil then responded:
Thank you Scott,
In fact I am taking on daily basis a pill that contains 500 mg of elemental calcium, 250 mg of elemental magnesium, and 200 IU of vitamin D, knowing that during the race week I take 2 pills, one in the morning and another one at night.
I forgot to tell you thought that I am vegan, however I do watch my diet pretty closely.
Scott Saifer says:
Thanks for the clarification. I've seen lots of cases of cramps cured by calcium, far fewer where magnesium turns out to be important. Now that you've told me your magnesium pills include calcium, your experience makes more sense to me.
Given that you are vegan and not getting calcium from dairy products, and the fact that 500 mg of calcium per day helped, but didn't eliminate your cramps, I'd suggest you increase your calcium intake to 1000 mg daily, with extra on race days. See if that helps.
Upper body strength training
Your answer about the potential benefits of strength training in the latest Q&A was very interesting and very useful. I have read that strength training for the legs doesn't necessarily bring benefits because of the relatively light strength needed to turn the pedals – although the other couple of benefits you listed were interesting to hear.
But what about strength training for the upper body? I have heard sports medicine experts stress the importance of keeping the whole body in condition, even muscles that are relatively unused for the particular sport. This keeps the body 'in balance' and reduces the chances of injury. Clearly a cyclist doesn't want to develop large and hence heavy upper body muscles but should you spend some time in the gym on upper body muscles eg using light weights but multiple repetitions?
I don't include core muscles in the question and already do three sessions a week to work on them.
To provide some context, I am 45 and have been cycling regularly for a year. I stopped playing squash 4 – 5 times a week and now cycle that frequently. With cycling I do not have the problems with my back and other aches that regularly afflicted me with squash.
Sorry if you have answered this in previous Q&A sessions - if you have, please point me in the right direction!
Scott Saifer says:
Thanks for the inquiry. I do recommend upper body strength training for most riders for the reasons you suggest, plus a few more. The only people for whom I don't recommend a program of upper body strength training are those who have an injury that makes lifting uncomfortable, and those who are overweight where a part of the overweight is large upper-body muscles.
Not counting massive, body-builder or power-lifter types, It's almost impossible to lose muscle mass on a muscle thats getting any sort of regular workout, so no upper body lifting for people who are trying to lose weight from the upper body. People for whom upper body strength training is precluded by injury should actually still be doing a workout, but it should be rehabilitation under the guidance of a physical therapist.
When you are cruising along at moderate power, the upper body doesn't contribute much to the effort, but during an all out sprint or hard, low-cadence climbing, the arms and shoulder can get involved in making power so upper body workouts can help beyond simply maintaining balance and preventing injury. I agree with your idea of doing relatively long sets with lighter weights to maximise strength from existing muscles rather than adding mass.
The Cyclingnews Form & Fitness panel
Scott Saifer (www.wenzelcoaching.com) is head coach, CEO of Wenzel Coaching.com and has been coaching cyclists professionally for 18 years. He combines a master's degree in Exercise Physiology with experience in 20 years of touring and racing and over 300 road, track and MTB races to deliver training plans and advice that are both rigorously scientific and compatible with the real world of bike racing.
Scott has helped clients to turn pro as well as to win medals at US Masters National and World Championship events. He has worked with hundreds of beginning riders and racers and particularly enjoys working with the special or challenging rider. Scott is co-author of Bike Racing 101 with Kendra Wenzel and his monthly column appears in ROAD Magazine.
Steve Hogg (www.cyclefitcentre.com) has owned and operated Pedal Pushers since 1986, a cycle shop specialising in rider positioning and custom bicycles. In that time he has positioned riders from all cycling disciplines and of all levels of ability with every concievable cycling problem. Clients range from recreational riders and riders with disabilities to World and National champions.
Kelby Bethards, MD received a Bachelor of Science in Electrical Engineering from Iowa State University (1994) before obtaining an M.D. from the University of Iowa College of Medicine in 2000. Has been a racing cyclist 'on and off' for 20 years, and when time allows, he races Cat 3 and 35+.
He is a team physician for two local Ft Collins, CO, teams, and currently works Family Practice in multiple settings: rural, urgent care, inpatient and the like.
Pam Hinton has a bachelor's degree in Molecular Biology and a doctoral degree in Nutritional Sciences, both from the University of Wisconsin-Madison.
She did postdoctoral training at Cornell University and is now an associate professor of Nutrition and Exercise Physiology at the University of Missouri-Columbia where she studies the effects of energy balance on bone health. She has published on the effects of cycling and multi-day stage racing on bone density and turnover.
Pam was an All-American in track while at the UW. She started cycling competitively in 2003 and is a three-time Missouri State Road Champion.
David Fleckenstein, MPT, OCS (www.physiopt.com) is a physical therapist practicing in Eagle, ID and the president of Physiotherapy, PA, an outpatient orthopedic clinic focusing in orthopedics, spine, and sportsmedicine care.
His clients have included World and US champions, Olympic athletes and numerous professional athletes. He received his Masters degree in Physical Therapy from Emory University and is currently completing his doctorate at Regis University.
He is a board certified orthopedic specialist focusing in manual medicine and specific retraining of spine and joint stabilisation musculature. He is a former Cat I road racer and Expert mountain biker.
Carrie Cheadle, MA (www.carriecheadle.com) is a Sports Psychology consultant who has dedicated her career to helping athletes of all ages and abilities perform to their potential. Carrie specialises in working with cyclists, in disciplines ranging from track racing to mountain biking. She holds a bachelors degree in Psychology from Sonoma State University as well as a masters degree in Sport Psychology from John F. Kennedy University.
Dave Palese (www.davepalese.com) is a USA Cycling licensed coach and masters' class road racer with 16 years' race experience. He coaches racers and riders of all abilities from his home in southern Maine, USA, where he lives with his wife Sheryl, daughter Molly, and two cats, Miranda and Mu-Mu.
Dario Fredrick (www.wholeathlete.com) is an exercise physiologist and head coach for Whole Athlete™. He is a former category 1 & semi-pro MTB racer. Dario holds a masters degree in exercise science and a bachelors in sport psychology.