Featherstone Nutrition

I’ve worked with enough athletes to suspect when someone is low on iron, especially when they’re dealing with performance shortfalls, persistent fatigue, and some of the other symptoms we mentioned in part one without any other probable explanation. But I always like to have confirmation for my hunch by having my clients get bloodwork done. We always, always, always want to check our labs prior to supplementing, so we know that we are treating and supplementing correctly. 

Your primary care doctor can order labs to be drawn, whether it’s in-office or they send you to a lab. This option will likely be the most cost-effective if you have health insurance. Other options are to order your own labs from somewhere like Quest Diagnostics or Inside Tracker. Try to make sure you wait at least 48 hours after a race or hard training session before testing so you don’t skew the numbers. Once the panel has been drawn, you should get the results fairly quickly. 

There are several iron-related labs that can be checked. While ferritin is a common indicator of iron stores, it can give a false reading if you’ve been sick or under intense training or lifestyle stress. In which case, other markers can be useful. It’s also helpful to see the “whole picture” when it comes to iron labs <aka not just looking at one stand alone lab value>, so it’s important that you ask for CBC, iron panel and ferritin.

Once you get the test results back, you’ll want to know whether your ferritin level is low, high, or just about right. The tricky thing is that the range is very broad – what’s considered to be “normal” at your doctor’s office is 10 – 120 ng/mL for females and 20 – 250 ng/mL for males. However, in running, cycling, swimming, triathlon, and other endurance disciplines, performance is usually optimized at or above 40 ng/mL, per a study by Japanese exercise scientists and other papers. At altitude, this can rise to more than 50 according to a study by Swiss researchers, as at higher elevation we need more oxygenated blood to sustain pace and power output. To make it even more complex, optimal ferritin levels can vary from person to person – Person A may feel great with a ferritin of 40 ng/mL, while person B might need theirs at 50 ng/mL.

There could be different parameters than your physician is currently not aware of – you’re probably the healthiest person they’ve treated all day, and labs within normal limits are typically a good sign. However, just because your iron levels are within normal limits for baseline health doesn’t mean that they’re optimized for endurance performance – the two goals are completely different. Your doctor isn’t wrong, but may only be looking at your ferritin and other iron markers through a lens for an average <sedentary to mildly active> adult. 

It’s this kind of contrast that shows why you might benefit from working with a registered dietitian or other specialist. Just having blood test data is only the first step – it’s what you do with the information that’s most important. So you need someone who has the right knowledge & experience to interpret the results, take into context your training and medical history, nutrition, and other factors, to help you come up with a plan. 

As levels of ferritin and other iron markers fluctuate over time, a one-off test might only give you a snapshot view of your body’s stores. Here’s a suggested frequency if you’re interested in ongoing testing that might enable you to keep tabs on your levels so you can address deficiency and even make pre-emptive changes if an initial panel shows a decline. 

Annually:  Once a year might be fine if you do not have a history of iron deficiency, and you have been feeling well during training and races.

Biannually: A test every six months might be better if you have a slightly low ferritin and are trying to increase with high iron food, are a female endurance athlete, or have the intention to increase training or head to altitude within the next 12 months.

Quarterly: Getting a panel every three months is advisable if you have a long history of iron deficiency, are currently supplementing trying to get an increase in ferritin, are vegetarian/vegan, see evidence of low energy availability, are continually training at high volume and intensity, struggle with ongoing fatigue/lethargy, or plan to train at altitude within six months.    

Ferritin is a blood protein that is your body’s preferred storage form of iron, which it releases as necessary. Around 25 percent of all the iron in your body is typically contained in ferritin. The demand for iron goes up when you’re training or racing because it’s the building block for hemoglobin in the bloodstream, which delivers oxygen from the lungs to your muscles via red blood cells. Iron is also needed to regulate myoglobin, a protein found in muscles that binds to and releases oxygen, and cytochromes, a key catalyst of energy production. It plays a part in immunity, DNA synthesis, pH balance, and many other processes too. Unlike some other micronutrients, your body cannot make its own iron, so you have to take it in through food and/or supplementation.

According to a study on female basketball players, “Athletes experience disturbances of systemic iron homeostasis, especially during training periods characterized by intense training loads.” The authors stated that iron in female athletes can be twice as low as in sedentary groups. It’s also arguably more common. A review published in the European Journal of Applied Physiology stated that five to 11 percent of male athletes tested in previous trials were low on ferritin, which is an indicator for inadequate iron. This rose to a whopping 15 to 35 percent of female athletes. Other studies have pegged these numbers even higher, suggesting that up to 56 percent of female endurance athletes have insufficient iron stores. 

So why is this? We can lose iron through sweat and urine, the GI tract, frequent use of NSAIDs, and a phenomenon known as foot-strike hemolysis. This occurs when red blood cells in the feet are destroyed as you pound the pavement or trail, which not only results in the loss of iron, but also needing to utilize more to repair the damage. That might explain why runners, basketball players, and athletes in other sports that involve a lot of ground contact have higher rates of deficiency. 

There are several reasons why low iron might affect more female athletes than males. First, some can be lost during monthly menstruation. Second, I see more women who are on vegan or vegetarian diets. While you can find iron in some plant-based sources, it’s more difficult to absorb because it’s in the non-heme form. Whereas fish, meat, and poultry all contain the more available form, heme iron. Those who eat fortified foods find it easier to boost their intake. The overall quantity of food female athletes eat may be significantly less than a larger male athlete making it harder to get sufficient iron. 

The authors of the basketball study wrote that “Insufficient reserves of iron in the body can reduce athletic performance, which may be manifested as fatigue, exercise intolerance, or even cognitive function impairment.” I often hear clients complain of not being able to hit or maintain their target paces in training, feeling like they’re exerting more effort than usual, hitting the wall sooner, and generally feeling heavy and lethargic. They might also notice decreased adaptation to their training and failure to recover fully between sessions. Increased resting and active heart rate, dizziness, and shortness of breath during exercise can become issues too. 

Certain sessions like sprints and intervals can become harder because power output declines and time-to-exhaustion is reduced when ferritin levels are low. Some athletes might experience irritability and other mood disturbances, find it hard to focus during workouts, or become apathetic and lose interest in training altogether. They could also start struggling with niggling injuries and more frequent bouts of illness. In these ways, iron deficiency can be mistaken for chronic overtraining, as many of the symptoms are the same.

How or if you respond to caffeine might seem totally random, but research shows that it’s actually hardwired into your genetics. A study published in Medicine & Science in Sports & Exercise stated that a variation in the CYP1A2 gene that regulates caffeine was likely responsible for three different outcomes in cyclists who consumed it. One group finished a time trial faster with two and four mgs per kilo of bodyweight, a second experienced no effect, and a third had a decrease in performance. The takeaway? Keep using caffeine if it helps you or you enjoy the taste of tea or coffee, but don’t force it if it doesn’t seem to do anything or makes you feel worse.

Caffeine is a central nervous system stimulant that blocks tiredness-causing adenosine from binding to receptors in your brain, while stimulating the release of adrenaline, noradrenaline, and catecholamines, which include the so-called “happy hormone” dopamine. The International Olympic Committee (IOC) includes caffeine on a very short list of supplements that it states are backed by “good evidence of benefits,” along with creatine monohydrate, nitrate, sodium bicarbonate, and beta-alanine. 

Studies have shown that caffeine helps increase time to exhaustion, improve speed, and boost power output. The ways it does this include decreasing pain and the perception of effort and fatigue, which may help you push past your usual limit and keep going harder for longer. According to the International Society of Sports Nutrition, caffeine also has cognitive benefits, including increased vigilance, attention, and overall acuity, suggesting that it helps you maintain focus on your performance.

A Journal of Strength and Conditioning Research review of previous studies discovered that the impact of caffeine on endurance performance varies greatly, from a 0.3 percent decrease to a 17.3 percent increase. In addition to the genetic factor, they explained that caffeine consumption habits, timing, dose, and method of ingestion can all contribute to this variable impact. While your response is individualized, caffeine seems to peak in your system around 60 minutes after consumption, with the beneficial effects lasting around 1 hour. With this in mind, it’s important to consider when you’re going to use it with optimal timing for training and racing. 

Before you head out the door to run, it’s best to stick to your usual daily caffeine schedule, as your body and brain will get bamboozled if you’re used to a morning and/or afternoon cup of coffee or tea and suddenly avoid it. The same goes for race day. Conversely, if you don’t normally consume caffeine before a run, it’s not best to try it out for the first time prior to a long or hard session, or right before you show up to the start line. Nor should you jack up your caffeine consumption in the belief that if some is good, more must be better, as studies show that beyond a certain point there’s no extra benefit and you might actually start to develop jitters, tummy troubles, and other unpleasant side effects. 

In the IOC position paper, the authors wrote that “Caffeine consumption during activity should be considered concurrent with carbohydrate (CHO) intake for improved efficacy.” This is where caffeinated gels can come in handy. Again, there’s no one-size-fits-all prescription here, but what I’ve found to be effective for marathons and other longer races is to alternate caffeinated and non-caffeinated products. Three to six milligrams per kilogram of bodyweight before and during training and racing is the amount many studies have found increases endurance performance by 2-4%. 

This range is really broad, but 200 mg is a sweet spot for many runners. That’s two cups of coffee or two stronger gels, like Maurten Gel 100 Caf 100. Good products like this that have been vetted by NSF Certified for Sport or Informed Sport accurately list the caffeine amount, making your trial-and-error process easier. As with any supplement, start with a low dose and carefully build up as needed. 

Remember that it takes an hour for caffeine to fully kick in and that a lot of runners need it most in the second half of a race. So, if you were running a three-hour marathon and wanted to keep pushing hard in the last 10K, take a caffeinated gel at 60 minutes. Or if you’re on pace for four hours, caffeine at the one- and two-hour marks might help you finish strong. As I advised for your overall nutrition/hydration plan in a previous post, practice your caffeine strategy on long runs so that you iron out any kinks and dial in timing and total dosage to tap into the performance benefits on race day.

The biggest mistake I see clients making with their post-injury recovery nutrition is underfueling. This is often born of the belief that “I’m not training so I need to eat way less, right?” Wrong! Although you’re not moving as much so you won’t be burning through as much energy as usual, your resting calorie needs are greater than you think. This is due to having more lean mass and a higher metabolism than a sedentary person, plus, your body has nutritional needs to help repair the damage from your injury. 

Consuming adequate nutrition is imperative so you don’t sink into a calorie deficit, which can lead to delayed recovery, weight and muscle loss, hormone disruption, and more nasty side effects. A paper published in Nutrients stated that “During rehabilitation, simultaneous carbohydrates and protein intake can inhibit muscle breakdown and muscle atrophy.” This combo will also keep your energy level high, stabilize your mood, and support your healing process. 

When you’re injured, you actually need around 20 percent more protein to promote healing, which is why the study authors recommend getting as much as two grams per kilogram of bodyweight daily. Shoot for 20 to 40 grams per meal, adding in a complete protein supplement if necessary. The amount of carbs you need might dip a little, but they’re still your primary energy source, so include them in all meals and snacks and adjust portion sizes to take into account your lower activity level, without cutting back too far. 

The researchers also mentioned getting sufficient fat during your return-to-running process. This is valuable from an energy perspective, as it contains nine calories per gram versus four for protein and carbs. Fat is also used in the repair of joints and soft tissues. While you might not need quite as much total fat as when training hard, eating more omega-3 fatty acids can be beneficial. Initially, inflammation is necessary to prompt the healing process, but if prolonged, it can hinder healing. This is when omega-3s can be beneficial. They’re found in plant sources like flax & chia seeds, walnuts, and almonds; although, fish provides higher levels of EPA and DHA, along with micronutrients involved in the healing process, such as copper. You may consider a marine-sourced supplement daily to ensure you’ll get enough. 

Once you’ve moved out of the acute inflammation phase right after injury, tart cherry juice could be another useful supplement. Its active compound, anthocyanin can help decrease inflammation and reduce joint and muscle pain.

The two most common types of acute injuries suffered by runners are bone issues such as stress fractures and injuries to soft tissues like muscles, ligaments, and tendons. Both require the fuel supplied by the balanced diet described earlier. You can support the healing of a bone injury by ensuring that you get enough calcium, vitamin D, and vitamin K, all of which are vital to bone health and growth. Dutch researchers found that low vitamin D levels delay bone injury recovery, and other studies have shown that they greatly increase the risk of stress fractures. If it’s consistently sunny where you live, then you might get enough D just by being outside, but with winter closing in, you may need 2000 IU a day in supplement form just to be sure. If you are vitamin D deficient, you will likely need a higher dosage supplement. Fatty meats, leafy greens, and broccoli are all good sources of vitamin K, and some vitamin D supplements include it. If you eat 3 serving of dairy per day on average, you’re probably getting enough dietary calcium, and if not, look for fortified non-dairy alternatives or a calcium supplement. 

Soft tissue injuries typically heal quicker than bone damage, but blood flow to ligaments and tendons is much lower than to muscles, so they can be tricky to rehabilitate. Taking a combination of collagen – which is a key component of soft tissues – and vitamin C 30 to 60 minutes before whatever exercise you’re cleared to do can help. Australian researchers found that combining this supplement with calf strengthening exercises enabled participants to recover faster from Achilles tendinopathy. Vitamin A – which you can find in sweet potatoes, carrots, and bell peppers – also plays a part in collagen formation. 

One supplement that you may need daily is protein. Yes, you can get enough from food in your diet, particularly if you eat a lot of eggs, meat, fish, and dairy. However, many people find that due to time restraints and convenience, protein supplements help to hit that recovery window right after training.  Personally, I prefer a whey product like Momentous Essential Protein (click here to get 15% off). It tastes great, mixes easily, is grass-fed, and contains enzymes that help ensure you’ll digest it without any tummy troubles. Momentous also offers a non-dairy option for those with an allergy, sensitivity, or dairy-free diet. 

The key to choosing a protein supplement is to find one that’s tasty and make sure it’s a complete source, which means that it contains all nine essential amino acids, including an adequate amount of leucine. This doesn’t include collagen, which is an incomplete protein that doesn’t contain enough of certain aminos to trigger muscle protein synthesis. (We’ll suggest a better way to utilize collagen in the next part of this series.) The timing and amount of protein is just as important as selecting the right source. A research review recommended 20 to 40 grams within an hour of finishing training.   

Another supplement you might need every day is Vitamin D. “But I always run outside!” you might say. That’s great, and sometimes during the spring, summer, and fall, you may getting all the vitamin D you need from the sun. But, during winter in the Northern Hemisphere, you’re probably not. Inadequate Vitamin D can compromise bone health, immunity, and muscle repair, which can be detrimental to runners. It is suggested to take 2,000 IUs a day, for maintenance. This dose is not adequate if you have a deficiency, so it’s a good idea for runners to check Vitamin D levels at least annually, and more frequently if a deficiency is detected, and supplement accordingly. 

There are some supplements that you’ll benefit most from occasionally to help with recovery during peek training weeks. One example is tart cherry (TC) extract, which is a potent source of antioxidants that can minimize the damage done by exercise-related oxidative stress. A meta-analysis found that taking a tart cherry supplement reduced muscle soreness and led to a greater recovery in muscle strength and power. Other research has also noted the beneficial impact tart cherry has on sleep duration and quality. This makes tart cherry an ideal evening supplement, and you could take another dose during the day to recover quicker from hard training or racing. 

A second situational supplement is omega-3s. A review published in Nutrients noted that EPA and DHA can help you delay muscle soreness, minimize inflammation, speed recovery, and even boost your immunity. You can get these fatty acids from fish like salmon, tuna, and mackerel, and plant sources such as walnuts, chia and flax seeds. But many people’s diets don’t have enough of these to take advantage of the anti-inflammatory benefits you might need when dialing up training volume and intensity, which is where a supplement is useful. 

Look for a product that’s marine-sourced, contains 2,000 mg or more of EPA and DHA. As with tart cherry, wait a few hours after training to take omega-3s, as you don’t want to blunt the acute inflammation response that prompts repair and recovery. 

There are over 85,000 supplements on the market, and they vary wildly in purity, quality, and efficacy. To ensure you’re getting a supplement that helps instead of harms and is worth the investment, look for products that have been tested by Informed Sport, NSF Certified for Sport®,or USP. These rigorous processes ensure that supplements are free from contaminants and banned substances, live up to what’s on their labels, and are produced in a responsible way. They remove the guesswork from your supplement shopping and give you peace of mind that what you’re taking is safe and effective.  

It’s important to remember that supplementation should never be a substitute for nutrition. So make sure you’re getting enough post-run carbs & protein and taking in enough energy throughout the day first. Then turn your attention to supplements we just discussed to support recovery and overall wellbeing.

Sticking to your resistance training routine is vital if you’re hoping to become a stronger, faster, and more powerful runner, and fueling beforehand is essential. But, to get the greatest benefits, you’ll also need to be refueling enough afterward for your body to repair itself and adapt to the stimuli you’re throwing at it. A lot of endurance athletes fall short because they underestimate their protein and carb needs after sessions. A review published in Frontiers in Nutrition noted that consuming post-workout protein is crucial for stimulating muscle protein synthesis (MPS), which triggers the repair of existing fibers and growth of new ones in response to strength training. 

Another reason to refuel soon after strength training is that carbs are your primary fuel source for muscle contractions. This means that you use up a lot of the glucose in your bloodstream and then start draining the stores of glycogen in your muscles and liver. So you need to restock these after you hit the gym so that you have enough glycogen for your next training session. The review authors also wrote that “Carbohydrates have been shown to have a protein sparing effect, therefore the combination of protein and carbohydrate to decrease rates of muscle protein breakdown (MPB) and increase rates of MPS may be the best strategy” if you’re trying to build or maintain muscle mass. 

As a general guideline, aim for 50 grams of carbs and 20 to 40 grams of protein within 30-60 minutes after your session. This could come in the form of a full meal, or if you don’t have time, you can break it down into a post-workout shower shake as soon as possible (nail your protein here + some carbs), followed by more carbs within 90 minutes. One of my go-to breakfast recipes for recovery nutrition is baked oatmeal with Greek yogurt, fruit, and almond butter. 

In addition to consistently nailing acute refueling right after your strength training, it’s important to know that replenishing protein later on can be beneficial too. Unlike with fat and carbs, your body doesn’t store protein, so you need to consume it regularly to recover from extra workouts. A group of Canadian researchers concluded that athletes who followed a nighttime workout with a protein shake immediately post-workout plus another in the morning scored better in both strength and plyometric tests in their next session. They also had greater whole body protein balance. 

Other research has suggested that you can maximize strength, power, and speed gains and put on more lean muscle mass if you spread out protein intake throughout the day, including before training. Doing so can also improve recovery between sessions, reduce muscle soreness, and stabilize mood. Thus, it is important to include 20 to 40 grams of protein in each of your three meals per day. It is also key to note that hitting your protein needs won’t be nearly as beneficial for muscle repair & build if you aren’t eating enough total energy (calories). So, make sure to include carbs and healthy fats in order to consume enough total calories. A good example of a well-balanced meal with adequate macronutrients is slow cooker carnitas tacos w/guacamole. 

During strength training, your body not only depletes glycogen, but also creatine. This is a peptide that is utilized by the phosphagen (ATP-PC) system to provide energy in your muscles during quick bursts of explosive power, strength, and speed lasting up to 10 seconds. So anytime you’re lifting, jumping, or sprinting, you’ll drain your store of creatine and other phosphates. This means you need to top up your creatine levels before your next workout so that you have enough ready energy for moving quickly and powerfully again. You can obtain some from grass-fed beef, poultry, and fish, but it might not be enough, and if you’re a vegetarian or vegan, obtaining creatine from your diet will be tricky. 

This is where a supplement can come in handy. Look for creatine monohydrate, the most widely studied form.The general guideline is to take 5g/d in your shake or dissolved in some other liquid. A review published in Molecular and Cellular Biochemistry concluded that creatine supplementation increases strength and sprint performance, promotes muscle mass gains, and improves high-intensity output.