Low Hemoglobin and Chronic Sleep Issue
 

My situation is that for the over a year now I've had a brutal time getting enough sleep. It has nothing to do with having a crazy schedule and not being able to put aside enough hours (I was doing my Masters for the last 2 years with a flexible schedule). It is that I always, without fail, wake up after about 4-5 hours feeling not able to fall back asleep. My alarm is typically set for somewhere around 5:30-6:00am.. and so I usually wake up some time around 3am and just try my best to fall back asleep which usually results in a lot of laying there or short repeated sleep cycles after that. I have absolutely no problem falling asleep, and I feel tired at the appropriate bedtime (i.e. ~9-10pm).

A little over a year ago I went in to get some blood work to see if I could figure out what was going on. Everything checked out okay except my hemoglobin and free testosterone levels were at the low end of the spectrum. The doctor wasn't too concerned. We chalked up the low iron to having donated blood a bunch of times over the last few years (put a stop to that) and I wasn't too offended by the low free testosterone because I had heard that total was a better indicator.

Well I finally went back in to my new doctor (he is a great guy that I found through my girlfriend) and was like okay this sleep thing is ridiculous can we try to figure this out. We ran some blood work and yesterday he called me to say everything looks great except that my hemoglobin is really low (now apparently even below the normal range). My serum testosterone is within the normal range. I was only given my recent results verbally so I'll have to get a copy next time I'm in there to know all the details. Basically he seems stumped. He ordered me a blood ferritin test (I guess to double check on the iron), and also a stool sample to see if I might have some sort of parasite that could be the culprit. I have a feeling after those results come in we are not going to have much to go on.

I originally chalked up the sleep issue to going through a bit of a stressful time doing my Masters thesis, but was always a bit uncomfortable with making that assumption because I don't feel particularly stressed out by it and the sleep symptoms never seem to correlate with the most stressful times. As far as training goes I don't feel I've overdone anything and one step I've taken to test that is I recently took a whole month off from any lifting or jiu-jitsu; and my sleep seemed to actually get worse.

I don't think I have any signs of insulin resistance (I had my fasting insulin sensitivity tested last year and it was 6 pmol/L (I think that converts to 1.02 mcIU/mL). No signs of abdominal fat (I'm very lean and no different in that area). And in this recent blood work my fasting cortisol was at a very good level according to my doctor. I also feel like my diet is pretty solid (I've posted food logs here before).

I'm posting because here I find a good bunch of people who train/eat in a similar fashion and any chance I could get good advice on how to work with my doctor to figure this out might make a big difference!

What supplements have you tried?

Do you take ZMA? Do you take Vitamin D? How about a multi-vitamin?

I found once I started taking ZMA (along with most people) sleep was better. When I started taking ZMA +Vit D (since I was deficient in D too) I got MUCH better sleep.

What's your diet look like?

Over the last year I've tried:
theanine serene
melatonin
5-htp
enzymatic therapy's sleep formula

None have made a lick of a difference in keeping me asleep.

Yes I have tried ZMA before bed (never noticed any difference) but for the most part I take magnesium + zinc in the morning. No I don't take a multi-vitamin. But I do also take fish oil / CLO, a b complex, and vitamin d, as needed. And for the last few months I've tried taking digestive enzymes with meals.

I had my vitamin D tested in the summer and it was spot on.

Diet I think is pretty good. I did have a training log thread going for a bit. I think towards the end there I tried some PWO carbs to blackbox that to see if I was overtraining but didn't seem to make much of a difference. I've stayed away from anything resembling high volume/intensity over the last few months for fear that might have been my problem.

So just last week I've gotten back in to some BJJ training, working up to 3-4 days/week but I only go to the 1 hour 7am class that is really light. Like were talking a very light warmup, mostly technique and then 1-2 five minute rolls which I take it pretty easy in.

I now eat 3 meals a day. Typical day looks like:

BKFST ~9am
couple pieces of fruit + 3-4 eggs OR some kefir with whey and some fruit

LUNCH ~11-2pm
large salad with chicken breast or seafood /w dressing

DINNER ~6-7pm
nice big serving of meat /w a cooked vegetable, usually a nice amount of fat

maybe a snack of nuts and/or a piece of fruit somewhere in the afternoon

Really pretty clean eating. I live with my girlfriend who is down with paleo foods too .. most of our dinner meats are from our grass-fed meat share, and we've been eating lots of quality veggies from our CSA.

I spoke with my doctor again today and mentioned to him that H pylori infection has been indicated in a few studies on low hemoglobin and sleep apnea. So I went in and had a blood test for H pylori today so that result should be in next week. He said in his experience it is mostly linked to stomach ulcers but it is worth a shot. Which is interesting because this week for three days in a row been having some stomach pains. I've never had these at all before but they are pretty constant right now, seemingly independent of what and whether I've eaten.

Something that I have also noticed over the same period that I've experienced the sleep problems is that my body weight has been on the low end for what I would consider my normal range. It's been a struggle to stay at 165 lbs and I've dipped below 160 a bunch of times. This is something that I've reported to my doctor before and have had many friends and family make note of. Always assumed it was just a side effect of moving to eating a lot more cleanly. To put that in context I use to weigh ~175 lbs and when I started lifting in college I moved all the way up as high as 190 lbs (but that was eating quite a bit of carbs). So I don't know how relevant that is but might be another sign of some sort of digestion issue.

H pylori seems like a good bet. Might have some other intestinal absorption issues as well possibly.

You might ask him for an occult blood stool test, to see if there is any bleeding going on inside the digestive tract. If this were a small but chronic issue, it could slowly eat away at your hemoglobin levels.

Liver or liver powder (leviticus11.com) is good for building the blood back up.

Get some source of vitamin C when you eat red meat, which you might try eating more of.

Vitamin D levels should be at least 50, preferably around 70 IMO. Don't take your doctor's word for where he thinks it "should be".

You might try the www.hibernationdiet.com and see if that helps the sleep issue.

Let us know the test results.

Ok I wonder if the stool sample test I just did would cover this or if this is a special test. I can ask next week when the results come in.

Yeah I've looked there before seeing you recommend it but they don't ship to Canada :(

I picked up Enzymatic Therapy R.B.C and plan on taking one with dinner. It has some vitamin C, iron, B12, and "liquid liver fractions".

Yeah I actually paid to have a D test on my own. I was at 65 a few months ago so I feel like I have a good handle on how much to take. Sometimes it's easier to just pony up the $$ and pick my spots to use my (Canadian public health care) doctor. Unfortunately I'm in a bit of debt from grad school and the job I've lined up, although great, does not give me any extended health coverage. So I can't be as proactive as I'd like to be!

I took a look.. I dunno it sounds like their main recommendation is to try some honey before bed. Couldn't hurt to try and see if that helps short term.

Will do.

My doctor seems genuinely really engaged in wanting to figure it out so thats a good thing. He was like with iron levels that low you may have been operating at 50% and there is the potential to feel a lot better.

Makes me think about a lot of symptoms that I didn't think much of. For example, I feel quite dizzy when I do front and back rolls in jiu-jitsu, and have always thought it was poor form. I kept telling my instructors and they didn't quite get it.. I worked on my form, made sure I was tucking my head properly, and all that etc. but maybe it is due to the low iron.

Hibernation Diet, from what I've been able to glean from internet feedback, mainly consists of taking 1-2 tablespoons of (preferably raw IMO) honey before bed. I shake cinnamon on mine. Myself and a training buddy definitely noticed improved sleep on it, we actually both started gaining weight (good weight) pretty quickly when doing that, and all I was add to my intake was a single small whey+hemp protein shake.

Some more test results came in this week . . it has all been told to me by phone so I don't have numbers.

- ferritin test confirmed iron deficiency (assuming it was high)
- free testosterone was "low"
- h. pylori blood test came back negative

I had read a bunch of h. pylori literature that had me convinced this was causing my low iron and was surprised to hear it came back negative. We just have one last test still waiting which is a stool test (not sure what that looks for).

My doctor admits he is stumped. For now he prescribed 300mg ferrous gluconate 3 times a day. He said we'll need to get together next week to discuss how to "cast a wider net". Doesn't leave my feeling very hopeful that we'll get anywhere !

To me your diet looks like it lacks a thousand or two calories from starch.*

*or with nothing to replace it if you have something against starch.