Some of you will know Stuart’s work as he runs a gym in Manchester as well as an awesome platform for fighters, learning new techniques and combinations. You can find his stuff at www.warriorcollective.com and on Instagram at @warriorcollective
We’re working together on Stuart's performance plans and here are some of the 1st steps we’ve taken – including details of Stuart’s blood work and how we’re going to fix some of the missing nutrients.
Stuart is a pretty strict vegetarian and eats as close to vegan as he can when possible. So, some of the results below are understandable given some of the restrictions we get from filtering out foods on different diets.
One of the most valuable types of testing you will need to carry out for athletes is blood screening for levels of key nutrients. Particularly important are:
Iron (including serum ferritin)
Magnesium (red blood cell levels)
Vitamin D (25(OH)D)
Active vitamin B12 (red blood cell levels)
Folate (red blood cell levels)
Omega 3:6 ratio (red blood cell)
HOMA (glucose tolerance and pancreas function)
As with all blood results any abnormalities should be discussed with GP and results should be shown to GP.
Vitamin D: Vital for immunity and bone, ligament and tendon strength.
Ferritin: Indicates the amount of iron stored in your body. Iron is vital for energy and immunity. Either too high or too low can cause a problem.
Folate: Folate is a B vitamin essential for DNA repair and building healthy blood.
Vitamin B12: Needed for energy and delivering oxygen to your muscles.
RAMAN: An indication of your antioxidant status and whether you’re getting enough vegetables and fruit in your diet. Above 45,000 is good. NB This test needs to be conducted face to face via a Raman spectrometry machine.
Omega 6:3 ratio: A higher level (above 5) indicates you have too much omega-6 fat in your blood relative to omega-3.Omega-3s help to reduce inflammation, but omega-6s can make it worse.
Magnesium: Needed for muscle function and energy, and helps build protein for your muscles. Magnesium is often highest after the summer break, and levels can go down the harder you train.
Copper: Helps to make collagen for repairing ligaments, tendons and other tissues. Essential to help recover from injury.
Manganese: Like copper, helps make collagen for healing.
Zinc: Essential for immunity, healing from injury, and building protein for muscles. Also vital for testosterone!
Selenium: Needed for immunity and has antioxidant activity, helping reduce damage in your body when you’re injured.
I can set these blood tests up for you the current costs are massively reduced. £258.50 down from £460 for separate tests plus £91 down from £171 for the trace mineral screen. There’s a lab admin fee of £74.99 – but you will be getting cost price tests at a central London Lab.
Email me at firstname.lastname@example.org if this is of interest.
Stuart’s Results Summary
Stuart’s red and white cells are all in the normal range. I’m particularly interested in Haemoglobin, often higher levels can indicate higher levels of potential fitness. Stuart’s haemoglobin is in the higher end of normal, however his ferritin (stored iron) is in the lower end of normal 35 with a range of 30-400. Whilst this is allowing normal function, if Stuart goes into a full fight camp or intensive training routine, which he’s planning on doing the ferritin levels can drop quickly, possibly resulting in increased fatigue or anaemia. As such I prefer male athlete’s ferritin to be above 75ug/l. He can both increase vegetarian sources of iron, whilst supplementing for a short period to improve these results.
Stuart’s magnesium levels are very good. A vegetarian / vegan diet should provide high levels of magnesium as its rich in green leafy vegetables, nuts, seeds, beans and pulses. If we look at the mid-range of 35mg/l then Stu’s results are coming in slightly higher than that at 36.7mg/l.
OMEGA 3/6 RATIO
Stuart’s ratio is out of balance, 16.78/1 – the average ratio in the UK is 20-25:1. The ideal ratio is less than 3:1.
This is a balance between how much omega 3 you consume in relation to omega 6 fats and can influence inflammatory processes in the body. You often see vegetarians with poor omega ratios as they don’t often eat fish, or take fish oils – although some do make exceptions. Also, a high grain intake, most nuts and seeds, even when healthy are also high in omega 6 fats compared to omega 3. The best way for vegetarians to increase omega 3 is to combine flaxseed oil with quark as this dramatically increases absorption of the omega 3 fats.
Improving this ratio often improves symptoms of inflammation which improve recovery. Personally, I’ve also found higher levels of omega 3 intake to help with cognitive symptoms like anxiety, sleep and memory. Not surprising when over 60% of the brain is made from these vital fats.
Stuart appears to have good levels of glucose tolerance according to the HOMA calculator. This is good news and I’d expect that in someone with good levels of fitness, low body fat and a healthy plant-based diet. https://www.thebloodcode.com/homa-ir-know/
Glucose 5.1 mmol/l
Insulin 5.6 µU/ml
HOMA2 %B 73.8
HOMA2 %S 136.2
HOMA2 IR 0.73
Given the current climate and immune system function having never been more on people’s minds vitamin D is a vital nutrient to check. Stuart’s levels of vitamin D are too low. This can cause various symptoms, fatigue, lowered immune response, seasonal affective disorder, sleep problems and even serotonin problems too. There’s not many processes in the body which are not affected by vitamin D with every cell having a vitamin D receptor. The fastest way to correct this is to supplement with vitamin D you can also sunbathe without burning – sun lotion blocks vitamin D so there’s a fine line.
Normally with low levels I’ll target supplementation then during the summer you can back off supplements as long as you are outside enough.
TRACE MINERAL PROFILE
Stuart has good levels of trace minerals, specifically selenium is optimal. Zinc is on the high side so we’d need to see if there was an external source of zinc causing this, although many athletes I’ve tested in Manchester are high in zinc. There are a few possible causes, electrolyte tablets – water sources, multi vitamins. All minerals work together and can compete for absorption. High zinc can suppress copper and manganese uptake. Stuart’s copper is good but his manganese in on the bottom of the normal range. Boosting manganese can be done easily with drinking strongly brewed black tea (builders tea) you can have it with milk. 2-3 cups per day. One key role for manganese is to help with collagen formation.
These nutrients are well established in the literature for their importance for health and performance and can be influenced through food choices and supplementation. Athletes may benefit from having optimum levels of these nutrients above the population norms in order to perform at their maximum.
Regularly measuring your client’s levels of these nutrients is a good way to track the effectiveness of your support programme, and also (especially if the person is taking supplements) to make sure they are not getting too much of anything.
We’ll look at the importance of each of these nutrients in more detail below.
Red blood cell testing
Red blood cell (RBC) testing is more reliable than serum testing for many nutrients (those noted above). This is because the red cell has a 120-day life cycle, and so it provides a picture of nutrient intake across a 3-4 month period, rather than just the amount of the nutrient present in the blood on that specific day.
RBC testing is not often available through the NHS, and so it will nearly always need to be done through a private lab.
The importance of individual nutrients
Iron is needed for:
- Formation of haemoglobin for oxygen transport around the body
- Energy production in cells (independent of oxygen transport)
- Immune system function
- Cognitive function
Haemoglobin is tested as part of a standard full blood count that can be done with the client’s GP, and is an indicator of iron levels in the body. However, haemoglobin will only start to decline when iron deficiency is quite severe.
Ferritin is a protein that complexes with iron; around 25 per cent of the body’s iron is stored in ferritin. Levels of ferritin start to decline before haemoglobin declines, and therefore a serum ferritin test can be a better indicator of the primary stages of iron deficiency. This test can also be done through the client’s GP.
Reference range: 30–400 µg/L
Optimal level: 75–150 µg/L
- Magnesium (RBC)
Magnesium is essential for:
- Nervous system function – transmission of nerve impulses, and neurotransmitter production
- Energy production in the cells
- Muscle function – most specifically, muscle contraction and relaxation. Deficiency is linked to muscle cramping, weakness and muscle twitches.
- Protein synthesis
- Bone strength
- Hormone balance
Magnesium is easily used up during exercise, and is also lost through sweat. As noted elsewhere in the course, magnesium deficiency is common in the general population and often found to be low in athletes, especially during periods of intense training or activity (e.g. the football season for players).
Magnesium can also support sleep and therefore aid recovery.
Reference range: 29–42 mg/L
Optimal level: >35 mg/L
- Vitamin D
Vitamin D is the most prevalent deficiency, as we have seen.
Vitamin D is essential for:
- Supporting normal blood calcium levels
- Bone strength
- Immune function, including regulating the immune system to prevent over-activation
- Muscle function
- Brain protection
Accurate vitamin D testing (25(OH)D, which is the standard method of testing) can be done through the client’s GP and does not need to be a private test if funds are a problem.
Reference range: 50–200 nmol/L
Optimal level: 100–150 nmol/L
- Active B12 (RBC)
Vitamin B12 is essential for:
- Brain and nervous system function, including neurotransmitter production and nerve formation
- Red blood cell formation, to carry oxygen around the body
- Methylation cycle and homocysteine metabolism
- Immune system function
- Cell regeneration
Vitamin B12 is exclusively found in animal foods, and so vegetarians and vegans are particularly prone to deficiencies.
The most common symptom of B12 deficiency is anaemia and a drop in energy levels; more serious long-term symptoms can include neuropathy, nerve damage, and cognitive impairment. However, B12 levels can run low long before symptoms appear.
Reference range: 25–165 pmol/L
Optimal level: >95 pmol/L
- Folate (RBC)
Folate is essential for:
- Red blood cell formation – in conjunction with vitamin B12
- Methylation cycle and homocysteine metabolism
- Cell division and DNA repair
- Immune system function
Note that taking high-dose folate on its own may ‘mask’ a vitamin B12 deficiency, which is one of the reasons why it’s important to test regularly for both if the person is using a supplement.
Note about folate supplements: If an individual needs to take a folate supplement, the best forms to give are either folinic acid or methylfolate (full name 5-methyl tetrahydrofolate). Folic acid is a synthetic form of folate that some people do not metabolise very well and should not be given in high doses.
Reference range: 158–1099 nmol/L
Optimal level: at least mid-range + 20% (approx. 750 nmol/L)
Like magnesium, zinc is a cofactor in hundreds of biological processes throughout the body.
Zinc is essential for:
- Immune function
- DNA synthesis, cell division, growth and development
- Wound healing
- Maintenance of good testosterone levels in the blood
- Thyroid hormone function, which controls metabolism
- Acid-alkaline balance
- Metabolism of carbohydrates, fats and proteins
- Cognitive function
- Bone strength
- Protecting cells against oxidative stress (free radical damage)
- Fertility and reproduction
- Taste and smell
We can see why it’s so vital to get enough!
Optimal level: 11–19.5 μmol/L
- Omega 3:6 ratio (RBC)
One of the keys to regulating and measuring potential inflammation is the ratio of omega 3 (primarily from oily fish) and omega 6 (primarily from vegetable oil) in the cells. These fats are incorporated into cell membranes and then affects how that cell functions, including how many pro-inflammatory (omega 6) or anti-inflammatory (omega 3) eicosanoids (hormones which regulate inflammation) we make from the fats. There’s not much the ratio of these essential fats will not influence in the body as they are incorporated into every cell and are also used to build hormones which regulate inflammation.
If you’ve eaten too many omega 6s (most of us) and not enough 3s you are likely to have an imbalance in this critical ratio. Humans are deemed to function best with a ratio close to 2:1 omega 6s to 3s. The average UK diet is 20:1 (not optimal). In practise if you can get 4:1 or less you are doing pretty well.
For more comprehensive information on the omega 3 and 6 ratio, see Week 21 Supplements 1.
Healthy ratio: 4:1 omega 6:3
Optimal ratio: 2:1 omega 6:3
Topic 07: Full Nutritional/Metabolic Profile
On occasions you may want to do a full nutritional/metabolic profile for your clients, to give a more complete picture of the person’s health. Full nutritional profiles can measure minerals, vitamins, amino acids, fatty acids, toxic elements, oxidative stress markers, energy production markers and more. A primary example is Genova’s Nutreval profile: https://www.gdx.net/uk/product/35.
Primary reasons for using this type of test would be:
- If your primary interventions to support the client do not work and you need to know more about their health picture
- For a complex client with a history of health conditions
- If the client specifically comes to you asking for this type of test to be done.
Topic 08 Heart Rate Variability
Rather than a specific functional test you would send off for, testing heart rate variability (HRV) is something that can be done every day by an athlete, using a monitor and an app.
What is heart rate variability, and what does it indicate?
Heart rate variability is basically the interval between your heartbeats. Contrary to what you may think, if the interval between every heartbeat is identical or very similar, this is not good. It can indicate that you’re fatigued, not well recovered, or under stress. It is indicative of the body’s sympathetic response, the ‘fight or flight’ response. Greater variability between heartbeats is associated with the parasympathetic response, which kicks in to promote rest, recovery, sleep and good digestion.
HRV has been used for many years to track the recovery and health of cardiac patients. In general a low HRV is associated with greater risk of coronary heart disease  and a high HRV is linked to longevity.
How to use HRV for training
In basic terms, HRV measurements can tell you whether or not you should train that day, and how hard you can push yourself. It can help to prevent overtraining and injury by training on days you should be resting, or pushing yourself too hard on days you should be taking it easy.
- Low HRV (identical interval between heartbeats): avoid training – focus on rest and recovery
- Medium HRV: training should be lighter and less intensive
- High HRV: training can be hard and more intensive
Basically, HRV measurements can allow athletes to ‘train smarter, not harder’.
What equipment do you need?
- An HRV monitor. Various monitors are available, in the form of finger sensors, wrist monitors and chest straps. One of the most well-known is the Polar H7 monitor: http://www.polar.com/uk-en/products/accessories/H7_heart_rate_sensor
- An app that works with the monitor to display your measurements and track your progress. A good example is ‘ithlete’ on ios. http://appcrawlr.com/ios/ithlete
- Liao D. Lower heart rate variability is associated with the development of coronary heart disease in individuals with diabetes: the atherosclerosis risk in communities (ARIC) study. Diabetes. 2002 Dec;51(12):3524-31.
- Zulfiqar U et al. Relation of high heart rate variability to healthy longevity. Am J Cardiol. 2010 Apr 15;105(8):1181-5. doi: 10.1016/j.amjcard.2009.12.022. Epub 2010 Feb 20.