Wednesday, December 30, 2009

The Cereal Aisle...duh duh dunnnn!

In the grocery stores in Canada, Monday is singles night. Guys and gals on the prowl peruse the aisles searching for groceries and the love of their life. Shoppers place a cereal box that describes their personality in the front of the cart. After reading this in the newspaper, I proceded to categorize friends and family as cereal. I became Raisin Bran for my seriousness and hard work (the bran) as well as my silly and spontaneous side (the raisins). One of my friends can be described as Rice Krispies for his constant whining but undeniable fun streak.

The cereal aisle can be overwhelming whether you are looking for a spouse or just breakfast. Stacks of brightly colored boxes grab your attention from every angle. Whatever it is that makes our final decision before placing the box in our grocery cart, it is time to make that an informed decision. There are many aspects to consider when picking your cereal; besides taste, it is important to look at the ingredients and the nutrition label. Try to avoid being convinced of health claims such as, "Can help lower cholesterol," "lose 10 pounds by replacing one meal a day with a bowl of cereal," or "made with whole grains." Health claims in general can be misleading and manufacturers are mostly just trying to sell their cereal.

Instead, turn the box around and focus on mainly two things: fiber and sugar. Cereal should have less than 8 grams of sugar per serving (which vary considerably from brand to brand and type to type) and should not be listed as one of the first three ingredients. Ingredients are listed in descending order by weight. Sugar may be disguised as corn syrup, honey, high fructose corn syrup, fruit juice, dextrose, fructose, or other words ending in -ose. Sugar can be found listed under total carbohydrates, which are also of importance if you are counting carbs (for weight loss or blood sugar control).

Also listed under total carbohydrates is fiber. Now I have often been teased for my interest in fiber (I admit it is listed as a hobby of mine on Facebook) but I can not emphasize the importance of fiber enough when it comes to cereal. Cereal can be an excellent source of fiber and since we need 25 to 30 grams of fiber per day (depending on overall calorie needs), breakfast is a great time to start gettin' it in. Also, if a cereal is high in fiber, it is most likely made from whole grains. Whole grains to look for might include whole oats, barley, rye, buckwheat, amaranth, corn, and anything followed by the word "bran." Fiber will (1) keep blood sugars regular by slowing the digestion of carbohydrates to sugar down, (2) keep "everything else" regular by creating bulk from indigestible material, and (3) keep us full longer by the above mechanisms. Search for a cereal with at least 5 grams fiber per serving.

To give you some direction, the Center for Science in the Public Interest has rated a plethora of cereals based on their nutritional value as well as taste. If you have never read their reviews, written bi-monthly in the Nutrition Action Healthletter, you are surely missing out. Although a bit outdated (April 2006) considering their are new cereals offered all the time, this should give you a good start, get you oriented to the cereal aisle, and help you meet NAN. In summary, their top picks include:
  • General Mills Fiber One Honey Clusters (a uber-fibered version of Honey Bunches of Oats)
  • Kashi Good Friends (Kashi in general does pretty well when it comes to whole grains but double check ingredients, such as in Go Lean varieties, for soy protein isolates).
  • Post Spoon Size Shredded Wheat 'n Bran
  • Weetabix Organic Crispy Flakes & Fiber
  • Kellogg's All Bran, Bran Buds and Original
  • Post 100% Bran (Try adding your own sweetness with Truvia, an herbal sweetener without calories and chemical drawbacks).
Post your favorite cereals as comments. I am personally eating a lot of oatmeal and gluten free Mesa Sunrise these days. I add flax seed and some nuts for a little added fiber and frozen fruit for extra vitamins. Don't forget to add a source of protein when sitting down for breakfast!

Wednesday, December 23, 2009

What to Eat

Driving home from Baltimore to Chicago, I had many hours to kill, or catch up on reading, depending on how you look at it. I dove in to my borrowed copy of What to Eat, written by professor of nutrition at NYU. As a food and nutrition professional, Marion Nestle helps us decifer food culture. She does her best to peel away the layers of politics and marketing mayhem to walk the average consumer through the aisles of the grocery store understanding the nutritional difference between butter and margarine, the biochemistry of high-fructose corn syrup, and the secrets of selling processed foods by adding health claims to the boxes.

Key concepts to walk away with:
  • Organic ¹ healthy - candy is candy whether the sugar is organic or not. Eat organic meat and dairy to avoid extra hormones and antibiotics. Choose organic produce for conventional fruits and vegetables that require high loads of pesticides.

  • Most cereal sends our body into a hyper insulin mania. Added vitamins and minerals do not compensate for the sugar rush, which will inherently cause weight gain. When glucose is not stored as glycogen (because the muscles and liver are already concentrated), the excess sugar is stored as fat. Choose cereals high in fiber, made with whole grains such as oats, bran, buckwheat, barley and amaranth, avoid sugar words in the ingredients especially if it is listed high in the list (a.k.a. honey, high fructose corn syrup, beet sugar, cane sugar, brown sugar, corn syrup solids, sucrose, fructose, dextrose).

  • We get 9% of our calories from bread, so choose wisely. The least amount of ingredients the better - bread does not need to be a science experiment. Go with a multi-grain high in fiber and with no added sugars or hydrogenated oils. Brands I recommend include Baker's, Vermont, French Meadow (especially their spelt or whole rye and yeast free varieties), Pepperidge Farm (some varieties), and Whole Foods and Trader Joe's whole grain varieties.

  • Margarine is made by making a liquid fat more solid by adding hydrogens to the fatty acid chain. This changes the shape of the fat from cis to trans, which basically means bending the fat and causing it to be more plastic. Think of a fat that can bend around the curves of your arteries; not too bad. Then we add hydrogens to that fat so that it will not go rancid, but in doing so, the fat can no longer slip around those curves. Instead we have clogged arteries, inflammation, and poor immunity when eating baked goods, crackers, and peanut butter made with partially hydrogenated oils. Read the ingredients; the FDA does not require food manufacturers to include trans fats in the food label if there is less than 0.5 grams per serving. Be weary of the serving size!
  • Limit soy products, especially highly processed soy. Research is not conclusive regarding the safety of soy. The studies showing the benefits - lowering cholesterol - are backed by manufacturers and other entities that benefit from soy sales. Other research demonstrates that the isoflavones in soy mimic estrogen (phytoestrogens) and may increase risks of prostate, breast, and uterine cancer in genetically sensitive individuals. Note: this may be a problem for men and women alike. If you do like soy, stick to tofu, edamame, miso, tempeh, or soy milk with limited processing. Avoid soy protein concentrates and soy protein isolates. To make these food ingredients, found in cereal, protein bars, powders, and veggie burgers, the soybean must be heated to such extreme temperatures that any benefits are destroyed. In general, high temps create problems; the same is true when heating fats or oils to high temperatures, such as in frying.

Trying to be a more conscientious grocery shopper? This book is for you. And because it is written by a noteworthy nutrition professional who did extensive research, it is a trusted source. You will also find that it is written with conversational tone with some science added in, but not too much that you need a chemistry degree to decipher (although I do have a chem degree so please post if this is not a true statement).

Friday, December 11, 2009

Does caffeine enhance athletic performance?

The fruit seed coffee beans are the mainstay of many countries economic sustainability. Furthermore, most people (52% of Americans including myself) depend on coffee for their energy daily. The popularity of caffeine is no foreign concept to athletes either. Most gu's and gels contain caffeine and I hear more and more people trying 5 Hour Energy Shots before competition and games, not to mention the $5.4 billion dollar industry of energy drinks. But is all this hype about caffeine hearsay, or is it worth downing a mug of joe before your next marathon?

Caffeine works similarly to other addictive drugs, say nicotine and cocaine, by blocking adenosine receptors. Caffeine crosses the blood-brain barrier and actually blocks blood flow by about 22-30%, thus blocking pain and decreasing feelings of fatigue. Metabolites of caffeine such as theobromine increase the amount of oxygen and blood flow to muscles and theopylline acts as a muscle relaxant that targets bronchioles (our lungs).

Caffeine's important mechanism of action as far as athletes are concerned comes with its ability to spare muscle glycogen. Glycogen is the stored form of glucose, our body's preferred source of fuel, in the liver and muscles. Experimental studies have not reached a consensus on this puzzle, but some point to caffeine elevating free fatty acids in the blood, thus allowing the body to use fatty acids as energy instead of carbohydrates. Caffeine also impacts the enzymes that break down glycogen, thus sparing the glycogen. Calcium release is necessary for muscle contraction, and since caffeine stimulates this release, it has a direct affect on muscle fatigue.

Caffeine's effects can be felt after 30 minutes of consumption and stay within the system for 4-6 hours. Actually, if you consume an afternoon latte, by bedtime only half of the caffeine has been metabolized and left your bloodstream. A good point to keep in mind if are interested in keep your sleeping habits regular, especially for training purposes. Although you may be able to fall asleep without problem, caffeine will interupt your sleep cycle and the quality of your sleep.

Overall, experts do claim caffeine consumption to be advantageous for athletic performance. Benefits are reached when more than 3 mg caffeine per kilogram body weight is consumed, with max benefits around 6 to 9 mg/kg body weight. For a point of reference, a 12 ounce mug (the size of a tall Starbucks beverage) of drip coffee contains about 200 mg caffeine. Generally speaking, gu's have 20-30 mg caffeine per packet.

Additionally, benefits of caffeine are noticed more when caffeine is consumed both before (no more than 60 minutes) and during activity, 4.3 ± 5.3% better actually. Studies also show that dehydration is not necessarily more worrisome with caffeine ingestion but that caffeine's benefits are better felt with water and carbohydrate consumption.

Caffeine still can benefit even us chronic users, but habitual caffeine drinkers will have more adenosine receptor sites, making caffeine's work a little more difficult. It may be best to abstain from caffeine up to seven days before the sporting event to feel the maximum effects the day of.

I actually participated in a study conducted by the University of Illinois that sought to determine the affects of caffeine on athletic performance. On two separate occasions, I ingested a pill - one caffeinated capsule and one placebo. There was a noticeable difference in my cycling effort. Although I am not a cyclist, I was able to exert myself to a much greater effort on the 2nd attempt. I can only assume this was after having the caffeinated capsule considering the results of the study showed that caffeine does in fact reduce leg muscle pain, allowing a greater cycling intensity because of blocked pain receptors. Titled "Effect of Caffeine on Leg-Muscle Pain During Intense Cycling Exercise," this study was published in the International Journal of Sport Nutrition and Exercise Metabolism.

How bout those 5 Hour Energy drinks? Although they do not contain the sugar of most other energy drinks, they are mostly caffeine (~138 mg) with a megadose of B vitamins and some amino acids. Amino acids can enter the Krebs cycle, the second part of ATP production. B vitamins are necessary for the metabolism of carbohydrates and proteins, thus helping with the conversion of carbs to glucose, giving us more energy. Side effects of too much B6 include nerve and muscle damage


Judelson, DA, Armstrong, LE, Sokmen, B, Roti, MW, Casa, DJ, and Kellogg, MD. Effect of chronic caffeine intake on choice reaction time, mood, and visual vigilance. Physiol Behav 85: 629-634, 2005.

O'Connor, PJ, Motl, RW, Broglio, SP, and Ely, MR. Dose-dependent effect of caffeine on reducing leg muscle pain during cycling exercise is unrelated to systolic blood pressure. Pain 109: 291-298, 2004.

Ganio, Matthew S; Klau, Jennifer F; Casa, Douglas J; Armstrong, Lawrence E; Maresh, Carl M. Effect of Caffeine on Sport-Specific Endurance Performance: A Systematic Revie. Journal of Strength and Conditioning Research 23(1), 315-324, 2009.

Clark, N. Sports Nutrition Guidebook 3rd Edition. Champaign: Human Kinetics; 2003: 102-103.

Ryan, M. Sports Nutrition for Endurance Athletes 2nd Edition. Boulder, Colorado: Velo Press; 2007: 197.

Friday, November 6, 2009

Pre-Race Dinner

The week before a big endurance race, it is time to cut back on training and focus on carbohydrates. Although it is not necessary to carbo-load before a 5k or10k, you will need glycogen, the stored form of glucose, in the liver and muscles, available for distances longer than 90 minutes of exercise. You do not want to cut back on protein since protein is still necessary for muscle growth and maintenance. Instead, limit fat calories. Keep total calorie input similar, but instead of snacking on nuts, go for whole grain cereal with dried fruit. Or instead of adding butter or sour cream to a baked potato, eat an extra potato. Use jelly instead of butter or peanut butter on toast.

Still keep in mind the overall fiber content of the food up until the night before the race. Simple carbohydrates and sugar overload will surely lead to constipation, a problem you definitely do not want to incur the last week of training. Sometimes changing your training schedule will alter your normal bowel movements as well, so aim for at least 30 grams per day of fiber.

One of the reasons we carb0-load is to hold on to extra water. Do not be surprised if you gain a few pounds the week pre-race - this is actually a good thing! The chemical structure of carbohydrates (glucose pictured to the left) holds on to water. The name carbohydrates means "watered carbon," thus explaining the need to carbo- and water-load leading up to an event.

I used the below recipe the week before the 2009 New York Marathon. My husband and I adapted a Rachael Ray recipe to make it more dietetic-friendly by using 1/4 of the butter, spelt flour, and brown rice noodles. We also used Cabot's part skim jack cheese and skim milk instead of half-and-half. We opted to use a fresh butternut squash and ended up adding the whole thing, making the sauce super creamy. All the deliciousness came from complex carb squash instead of loads of butter, cream, and fat.


  • 1 pound macaroni with lines, such as tubatini or mini penne rigate
  • Salt
  • 1 tablespoon extra-virgin olive oil, 1 turn of the pan
  • 2 tablespoons butter***No need for this much butter!
  • 1/2 medium onion
  • 2 tablespoons chopped fresh thyme leaves, plus a few sprigs for garnish
  • 3 tablespoons all-purpose flour
  • 2 cups chicken stock
  • 1 (10 ounce) box frozen cooked butter nut squash, defrosted
  • 1 cup cream or half-and-half *** I used skim milk.
  • 2 cups (8 ounces) sharp Cheddar, grated***Choose a part-skim or 2% cheese.
  • 1/2 cup grated Parmigiano-Reggiano, a couple of handfuls
  • 1/4 teaspoon ground nutmeg, eyeball it
  • Black pepper


Heat a pot of water to boil for the pasta. Salt the water then add the pasta and cook to al dente or, with a bite to it.

While pasta cooks, heat a medium heavy bottomed pot over medium heat. Add the extra-virgin olive oil and butter. When the butter melts into the oil, add the thyme and grate the onion directly into the pot with a hand held grater or Microplane. Cook the grated onion in butter and oil 1 to 2 minutes, then add flour and cook together 1 to 2 more minutes. Whisk in stock, then combine with butternut squash until warmed through and smooth. Stir in cream or half-and-half and bring sauce to a bubble. Stir in cheeses in a figure 8 motion and season the completed sauce with salt, nutmeg and pepper. Taste to adjust seasonings.

Drain cooked pasta well and combine with sauce.

This pasta worked great as a leftover also. We had it for dinner a couple nights before the race, and again for lunch the day before. 'Tis the season for squash (and marathons)!

Tuesday, October 27, 2009

Spaghetti Squash a la Microwave

Spaghetti squash is a tasty alternative or addition to a pasta recipe. It adds fiber and flavor, and another serving of veggies! Plus, it cuts down on calories (if that is your goal). Regular pasta has about 200 calories per 1 cup serving, where as the squash only carries 40 calories per cup.

Get squash (butternut, acorn, pumpkin) now while it is in season. Try roasting other varieties and even blending for a soup. Butternut squash tastes great roasted with shallots and ginger - add stock and blend! But I'll post those pics later.

For tonight, spaghetti squash with all natural chicken sausage, garbanzo beans (chickpeas), yellow onion, and yellow and green squash. Go with yellow or red onions, or even shallots, to get more bang for your buck. These varieties have more phytonutrients and help blood vessels dilate, allowing blood to flow more easily, thus helping the heart out.

Step 1 - Cut holes in the spaghetti squash with a butcher knife to let the steam escape. Microwave on high, 4min/pound of squash. Most will need about 12 - 15 minutes.

Step 2 - Using a hot pad, take the squash out. Slice in half lengthwise and scoop out the seeds and inside gunk.

Step 3 - Separate "spaghetti" strands with a fork. Season with garlic (powder or chopped fresh), olive oil, and Parmesan cheese. Top with turkey spinach meatballs, Italian chicken, or lean sausages. Enjoy!
Note - chicken sausages are a quick, weeknight meal. Most varieties come pre-cooked and with lots of yummy seasonings and flavors. I used roasted red pepper. Consider the breakfast links for added protein in the morning. Or what I will do is warm up half of the regular sized sausage and chomp on it with some cereal and fruit.

Monday, October 26, 2009

The answer is....

1.2 - 1.4 grams protein per kilogram per day

For example, if you weigh 110 lbs, this is equivalent to 50 kg (kilograms=pounds/2.2)

50 kg x 1.2 = 60 grams
50 kg x 1.4 = 70 grams

So a 110 lb runner needs somewhere between 60 and 70 grams protein per day.

Although carbs are your body's primary source of fuel, protein is crucial for endurance training. Protein is necessary for muscle growth and repair, hormone production, hair and nail health, immune function, and red blood cell production. During intense training, protein may be used for fuel as well. The carbon backbone of amino acids converts to acetyl-coA, which is able to enter the Krebs Cycle to produces ATP (fuel for muscles). This generally only occurs when there is excess protein after growth and repair or if their is insufficient energy from carbohydrates and fatty acids.

More important than overall protein intake is making sure to get some source of protein with every meal and snack. Have you ever found yourself hungry very quickly after a bagel and cream cheese or a big plate of pasta? Carbohydrates are digested very quickly, starting with the production of the salivary enzyme amylase. The carbs enter the bloodstream, blood sugars go up, and insulin is released from the pancreas to (1) shuttle glucose into cells so it can be used for energy and (2) to lower blood sugars back to a normal level. The greater carbohydrate load at a meal, the more insulin that is released and the further our blood sugars will fall. You may be hungry before actually having metabolized the carbs. Including a protein (or healthy fat) helps slow the release of the glucose into the blood, thus providing sustained energy.

You don't want to eat too much protein close to a workout because of the slower digestion (it takes about 4 hours for proteins to be completely digested), which may lead to cramping due to poor blood flow to the gut. You do want to include adequate protein at breakfast and after hard workouts. Breakfast is especially important for blood sugar balance. Your blood sugars are the most susceptible for peaks and valleys in the morning. You have essentially been fasting for 8-12 hours and blood sugars are low. You will most likely crave carbs in the morning because of low blood sugars and low serotonin levels (carbs help produce serotonin), but you must balance them with protein or you can find yourself hungry the whole day, crashing in the afternoon, and craving sweets after dinner. Next time you find yourself wanting a sweet after dinner or caffeine in the afternoon, take a look at the protein in your breakfast.

Breakfast options for protein - yogurt (look for low sugar varieties and/or higher protein Greek yogurt), cottage cheese, nut butters (all natural almond, cashew, peanut), all natural chicken breakfast sausages, nuts or seeds, whey protein powder, or eggs.

Milk does have 8grams protein per 8 ounce serving, but it also has 12grams carbs due to the milk sugar lactose. When consuming cereal and milk, look for an additional protein source.

Sunday, October 25, 2009

Baws (Boston for "Bars")

As far as bars go, I mainly stick with KIND bars. They are full of nuts and a little dried fruit. They are not super high in protein like most bars, only 5 grams, but they make a very balanced and low glycemic snack because of their combination of healthy fats, carbs, and protein. Low glycemic means the sugars enter your bloodstream slowly, providing sustained energy. They fit in a gym bag or a purse and will not melt in the sun. Delicious flavors include the above fruit and nut, nut delight, almond coconut, almond and cashew, cranberry almond, and a ton more. Some are fortified with antioxidants (great for repair of cells after a workout), others with calcium or B vitamins (for energy and metabolism). I will eat the fruit and nut pre- or post-run because of the dried fruit and chewy consistency. I like the nut delight paired with Greek yogurt for a mid-morning snack. I'll chomp on the almond coconut to shake things up a bit.

Why do I prefer KIND over other bars? Most other bars main protein source is soy. Not whole soy, but a very processed form of soy. Labels might read soy protein isolates or soy protein concentrate. The soybean has gone through heat processing and extraction, and what is left is a chemical-like bar. Soy is a phytoestrogen, meaning it mimics estrogen and can change hormone levels in both males and females. Men naturally have low levels of estrogen, which helps support bone density, but these levels should remain low. Women need to maintain a balance between progesterone and estrogen to keep a healthy cycle.

To keep estrogen levels balanced, stick with soy-free bars and protein supplements for the most part. Another bar to look for is Larabars, which are yummy chocolate flavored and made from dates (1 serving of fruit in each bar) and nuts. My go-to flavor is chocolate coconut. I like to include coconut into my diet once in a while for its multitude of benefits. Coconut has the same component as breast that provides immune enhancing properties, lauric acid. Coconut is a vary stable fat, meaning its chemical bonds can withstand high temperatures without being damaged. Once a fat changes structure, it creates inflammation in our bodies. Coconut is also very good for digestion since it is a medium chain triglyceride, a fat that is absorbed easily because of its structure. You can cook with coconut oil, add unsweetened coconut to cereal or a trail mix, or stir fry or blend light coconut milk in a smoothie.

Thursday, October 22, 2009

Close to Home

I have struggled with iron deficiency and anemia basically since I started running. I have always been a healthy eater eating lots of fruits and vegetables and anything else I was offered; I have never been picky either. I remember going for a physical as a young kid, probably my fifth grade physical, and being slightly anemic. My sister on the other hand, whose answer to the doctor's question of, "Do you eat vegetables?" was, "Yes, raisins," had perfect lab results. It seemed ironic to me the kid who ate exactly what she was supposed to was anemic, and the chicken fingers and French fries feen got a clean bill of health.

As I became more competitive in high school, I started to feel the effects of low iron counts. I couldn't finish quarter workouts and watched over 90 other runners pass me at the 1/2 mile to go of the conference race despite my fitness levels. In college I was frustrated to find that I was still anemic despite eating the prescribed red meat and taking iron supplements. I just crossed the non-anemic barrier only by consuming two pills daily. Just last summer I was feeling light-headed often, and once again, lo and behold, pronounced slightly anemic!

The happy ending to this story is that I haven't been anemic since. Soon there after, I chose to venture into the wheat-free zone. After spending many nights doubled over in pain or in the bathroom with gastrointestinal discomfort to say the least, I thought it was worth a try. After one week of avoiding my standard cereal, sandwich, pasta diet, I was symptom free. And one year later, my hematocrit is "like a man's," according to my doctor. Simply by eliminating wheat from my diet, I improved the absorption of the iron. I apparently have had a wheat sensitivity for years, contributing to my chronic anemia.

I do not have Celiac and I really am not allergic to wheat. It is more of an intolerance, or a sensitivity. Whenever I eat wheat, antibodies are released to protect against the foreign invader, wheat. A chain inflammatory reaction occurs, causing absorbance to be sacrificed and my gut to be swollen. When nutrients are not absorbed properly, vitamin and mineral deficiencies result, hence the anemia. If you have had multiple bouts of anemia and follow an iron-rich diet, consider your ability to absorb the nutrient. Look for common culprits in your diet - wheat, milk, and eggs as well as nuts, shellfish and fish, and other gluten containing grains are the most likely allergies and sensitivities to food. Other symptoms of food sensitivities may include skin problems (acne, eczema), poor immune system, chronic congestion or sinus infections, headaches or migraines, or frequent cravings or mood swings.

Wednesday, October 21, 2009

Resist the Risk of Iron Deficiency

Food sources of iron come in two forms - heme and non-heme. Heme iron is found in animal products such as dark meat poultry and red meat. Non-heme iron is found in foods such as spinach, iron-fortified cereals, beans and raisins. Heme iron is absorbed a lot better by the body - between 10 and 30 percent is absorbed. Non-heme iron, on the other hand, is only absorbed 2 to 10 percent of the time. Natural compounds called phytates in these plant foods prevent iron-uptake. Phytates are phosphorus-containing compounds that block iron absorbance. Natural occurring polyphenols and tannins found in non-herbal teas and coffee block in a similar fashion.

Heme sources (per 3 ounce serving) - Beef liver (6mg), beef (3.5mg), pork (3.4mg), shrimp (2.6mg), dark meat turkey (2mg), chicken breast (1mg), tuna (1mg), flounder (1mg)

Non-heme sources - Iron-fortified cereal (2-18mg/ounce), kidney beans (3mg/0.5 cup), molasses (2.3mg/1 Tbsp), baked beans (2mg/0.5 cup), cooked spinach (2mg/0.5 cup), enriched bread, pasta, rice (~2mg/slice or 1 cup)

Other Sources of Iron (Heme and Non-heme)

Although non-heme iron absorbancy is compromised, these foods can still be great sources of dietary iron. Consider eating non-heme sources with heme sources for best results. For example, include beans in a lean ground beef chili, or add spinach to a shrimp pasta. Also, cooking these foods in a cast iron skillet helps. Eat all iron-rich foods with a source of vitamin C. The vitamin helps chelate the iron, making it more soluble in the intestines. Good sources of vitamin C include citrus fruits, bell peppers, tomatoes, melon, papaya, broccoli, spinach, Brussel sprouts, strawberries, kale, and cauliflower.

Proton pump inhibitors such as prilosec used for acid reflux can be detrimental to iron absorbancy. The pH of the stomach influences aborbance in the intestines. Other nutrients can compete for absorbance as well. Zinc, manganese, and calcium all naturally exist with a +2 charge (review your chemistry!), so they will all compete for the same ion channels in the body. In other words, do not eat milk, dairy, oysters (zinc) , or pineapple (manganese) with iron-rich foods.

When looking for an iron supplement, look for iron in the ferric (+2) form. Ferrous (+3) iron is not absorbed as well, and must be first oxidized to its +2 form. Look for a supplement with at least 100% of the daily value (18mg for adult females, 10mg for males) and take separate from other supplements. Consider taking with a vitamin C (ascorbic or citric acid) supplement. If iron causes constipation, which it can, include more fiber in your diet or take a fiber supplement (cellulose, flax seed, psyllium husk, pectin) but remember to take at a different time than the iron since most fiber-rich food contains phytates.

Fact: On my test to become a dietitian, they asked what the best vegetarian source of iron was. Answer according to the test: Baked beans! Double check the sugar content or make your own. Most canned baked beans have lots of added sugars.

Tuesday, October 20, 2009

The Science Behind It

The hemoglobin within a red blood cell is responsible for carrying iron. Oxygen then attaches to the iron. Anemia can result from insufficient RBCs, not enough hemoglobin, or not enough iron. A hemoglobin molecule has four protein, or globulin, subunits, each with a heme group and iron atom in the center. The iron atom combines with oxygen molecules.

Oxygen binds to hemoglobin in a cooperative manner, meaning after one oxygen molecule binds, the structure changes shape, making it easier for other oxygen molecules to bind.

Fe3+ , or the ferric form of iron, cannot bind oxygen. It must first be oxidized, so it is best to take ferrous (Fe2+) form.

How much iron do we need? The Recommended Dietary Allowance (RDA) is 8 mg for adult males and 18 mg for adult females. Because of the higher levels of red blood cell destruction in runners, we can get away with supplementing with 100% of the RDA even without deficiency. Iron should be taken in the more absorbable ferrous state. There are three forms of supplemental iron - ferrous fumerate, ferrous sulfate, and ferrous gluconate. Ferrous fumerate has the highest percentage (33%) of elemental iron, meaning it is the best absorbed. Ferrous sulfate and ferrous gluconate have 20% and 12%, respectively.

If taking more than one pill to supplement, it is best to split up the pills - only a set amount of iron is absorbed at one time. When hemoglobin levels are below normal, physicians often measure serum ferritin, the storage form of iron as well.

Monday, October 19, 2009

Dinners Decoded

Chicken Parmesan
  • Natural chicken breast in an egg coating dipped in spelt (wheat-free) flour, Parmesan cheese, Italian seasonings (sage, basil, oregano, thyme, parsley), sauteed in olive oil, baked with tomato sauce (rich in lycopene), topped with part-skim organic mozzarella
  • Steamed broccoli with red pepper flakes -high in sulphoraphone, a cancer fighting component that blocks the replication of tumor cells
  • Brown rice noodles - gluten free, whole grain pasta
**Adding vitamin C rich broccoli to chicken makes the iron easier to absorb!

Sunday, October 18, 2009

Am I Anemic?

Anemia is defined as insufficient red blood cells (RBC) to carry oxygen to your tissues and brain. Anemia can be a result of disease or vitamin deficiency as well as blood loss. Besides needing iron to make red blood cells, the body must also have sufficient vitamin B12 and folate for RBC production. Females are more susceptible to an iron deficiency because of menstruation. Runners are at a greater risk for iron deficiency for many reasons.

Nutrient absorption in runners is impaired after long runs or intense workouts. With a strenuous effort, blood is predominantly flowing to the muscles, heart, lung, and brain. The gut is the bottom of the blood totem pole at this point. Unfortunately, this results in poor digestion and absorption of nutrients due to villus blunting. Villi in the small intestine are responsible for nutrient absorption. Blood flows to the top of each villus "mountain," but when the blood isn't flowing to the gut, the villus tip temporarily dies and cannot absorb nutrients. As blood returns to the villi, absorption is resumed, but in the meantime, malabsorption and diarrhea are common.

Runners also are at a higher risk of anemia as a result of iron lost through sweat and red blood cell destruction from mechanical trauma, ie the pounding of each foot strike. Training at altitude further puts an athlete at risk.

Mechanical trauma, also called foot strike hemolysis (hemo- meaning blood and -lysis meaning death of a cell) occurs from vascular and red blood cell trauma in the foot. Also, red blood cells are more prone to oxidative damage, naturally occurring during exercise, which will speed the destruction of the cells.

Pseudoanemia, common in athletes, is caused by an expansion in overall blood volume. This dilutes the red blood cells, causing a false representation of anemia in blood tests, but does not usually cause problems with athletic performance. Actually, the increased blood flow aids in oxygen delivery.

Symptoms of anemia or iron deficiency include fatigue, pale skin, shortness of breath, dizziness, cold hands and feet, and headache. These symptoms normally do not appear in pseudoanemia. It is important to still get a blood test (CBC or complete blood count) to confirm a deficiency because iron can be toxic and harmful to the liver if too much is stored. A blood test will look at the following markers and help determine the cause of anemia:
  • Serum Ferritin - levels of stored iron, 18-270 mcg/L (m), 18-160 mcg/L (f)
  • Total iron binding capacity - protein that carries iron in the blood, measures how much transferrin in the blood is not carrying iron, 20-50%
  • Red blood cell (RBC) - total number of red blood cells in that sample of blood, 4.2 - 5.6 mill/mcl (m), 3.9 - 5.2 mill/mcl (f)
  • Hemoglobin (Hb) - protein in red blood cells that carries oxygen, 14-18 g/dl (m), 12-16 g/dl (f)
  • Mass Cell Volume (MCV) - average volume of a red blood cell, clue to the cause of the anemia because cells are small in iron deficiency anemia as compared to a B12 or folate deficiency (pernicous anemia), 80-100 fl
  • Hematocrit (Ht) - proportion of red blood cells in overall blood, 42-54% (m), 38-46% (f)
  • Mean corpuscular hemoglobin (MCH) - average hemoglobin in the average red cell, 27-33 pg
  • Mean corpuscular hemoglobin concentration (MCHC) - average concentration of hemoglobin in a given volume of red cells, 32 - 36 %
Over the course of the next few days, I will further discuss iron deficiency and anemia. I will describe the red blood cell structure, ways to increase absorbency therefore preventing a deficiency, and my own personal experience with anemia. I look forward to questions and comments!