What deficiencies are common in endurance athletes? Find out….


Monitoring Blood Work Important for Endurance Athletes


In today’s world, triathletes are dialed in. Technology is used to draw out the strongest, fastest competitor in each of us in the way of equipment, clothing, shoes, heart rate and power tracking, training zones, training plans, nutrition, hydration — the list goes on. We have the best intentions of pouring our time and energy into all the right things, yet we often miss a critical foundational step: popping the hood. Until we take a good look at our physiology to assess general health and how our bodies are responding to the training workload and recovery, we are potentially ignoring our overall health status and limiting our athletic potential.

Routine blood work analysis should be an integral aspect of an athlete’s overarching plan. Ideally, this should be analyzed by a sports medicine professional (sports doctor and/or dietitian) as the optimal ranges for athletes differ from those of the general public.


This time should be used to establish a baseline of how the body is functioning without the influence of a high training load. It is appropriate to include general markers to ensure we are in good health status — or allow us an opportunity to get into good status — prior to increasing training volume and workload.


Once you have a baseline from the preseason, blood work should be assessed prior to the competition phase of your training to determine any changes in health markers, training tolerance, inflammatory markers and recovery needs.

General health

When looking at general health markers, we need to consider risk factors for common chronic disease states such as metabolic syndrome, diabetes, hypertension and cardiovascular disease. Fasted blood glucose, a complete blood count and a lipid panel with attention placed on particle size and the ratio of triglycerides:HDL should be measured. These are generally included in standard blood work administered by your primary care physician.


For endurance athletes, a few key nutrients are of interest due to their prevalence of deficiency or depletion and/or their key role in performance and recovery. These include markers for iron status, Vitamin D, magnesium, folate, B12, cortisol, CRP, DHEA-S, testosterone and any others determined by you and your health care professional. This is not a comprehensive list, and it is advised to work with your primary care physician or sports doctor to monitor any additional labs based on your individual needs and family history.

At least one article could be dedicated to each of these micronutrients, but I will go into a very basic explanation of the most commonly deficient minerals and vitamins observed in my practice:


This mineral is required for the transport of oxygen in addition to a variety of functions in the body. For the athlete, suboptimal iron levels equals reduced oxygen delivery to working muscles. Athletes tend to have higher rates of iron depletion as compared to non-athletes.

Iron deficiency exists in three stages: iron depletion, iron deficiency non-anemia and iron-deficiency anemia. Standard blood work involving a complete blood count may not detect iron depletion. Including ferritin, transferrin saturation, and total iron binding capacity when having labs drawn will increase the likelihood of detecting suboptimal iron status before it develops into a more serious health and performance issue.

* Top food picks: oysters, beef liver, any red meat
* Tip: Non-animal sources of iron should be consumed with a source of ascorbic acid (Vitamin C) in order to enhance absorption (lime juice with beans or orange and strawberry slices atop a spinach salad).

Vitamin D

This vitamin plays a critical role in health and performance, yet is not often included in standard lab work. Athletes at higher risk for deficiency include those living at northern latitudes (above the 37th parallel), those training and competing in indoor or winter sports, darker skin color, and use of sunscreen and clothing cover when outdoors. The best source of Vitamin D is direct sun exposure to major skin surfaces such as arms and legs for 10-20 minutes a day.

* Top food picks: wild salmon (contains 10x the amount found in fortified milk!), mackerel, dairy
*Tip: Vitamin D is a fat-soluble vitamin, so choose full or low-fat over non-fat dairy to maximize absorption.

Since offering blood work analysis at eNRG Performance, we have been able to detect and address a variety of issues that were compromising the health and/or performance of our athletes. I hope this article has been informative for you, and that you will consider blood work analysis as a top priority for ensuring optimal health status and the opportunity to perform at your greatest potential.

Best wishes for an enjoyable season!

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