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Old 01-12-2009, 05:41 AM   #11
Garrett Smith
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Red blood cells have a 2-3 month "lifespan" (I forget exactly), so there really aren't things like "off" days in the RBC count.

Overhydration is one short-term thing that could lower the RBC count very temporarily.

Your symptoms sound anemic to me. You may want to check your mentioned symptoms (plus any others you have) against this list: http://en.wikipedia.org/wiki/Lead_po...ms_and_effects
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Old 01-13-2009, 06:35 AM   #12
Darryl Shaw
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Originally Posted by Scott Kane View Post

Looking at this chart and having looked at a few random entries in your Fitday log I can see two obvious dietary explanations for your lack of energy besides your mild anemia.

1: It's too low in calories. Your BMR is ~1870 and you're only allowing yourself ~200 kcals for all other activities; that just ain't enough.

2: It's too low in carbs which means you're unable to replenish glycogen stores between workouts and this combined with the lack of kcals is the main reason you're running out of gas during workouts.

Solution: Replace some of the high fat foods you're eating with healthy high carb foods such as fresh fruit (increased vit. C should help with your anemia) and starchy root vegetables and increase your total calorie intake.
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Old 01-13-2009, 05:35 PM   #13
Emily Mattes
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Is it too low in carbs? I dunno, that seems like an OK level of carbs to me.
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Old 01-14-2009, 06:49 AM   #14
Darryl Shaw
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Originally Posted by Emily Mattes View Post
Is it too low in carbs? I dunno, that seems like an OK level of carbs to me.
Weightlifting and Crossfit type workouts are typically short high intensity affairs which are dependent on aerobic/anaerobic glycolytic energy systems with the principal fuel source being glycogen so the fact that Scott is running out of gas during his workouts combined with the evidence of his fitday log clearly indicates that he isn't eating enough carbs to adequately replenish his glycogen stores between workouts.


Quote:
The Effect of Carbohydrates and Fats on 24 Hour Nitrogen Balance
As has been discussed, energy has a tremendous nitrogen sparing effect [34]. However, a related topic concerns the differential effects of fats and carbohydrates on nitrogen balance. In this context, McCarger [83] investigated the effects of a high carbohydrate or high fat diet on nitrogen retention, substrate utilization, and serum hormone concentrations in six healthy male participants. The diets were administered at maintenance and at 75% of maintenance calories. Results indicated that the high fat diet produced slightly greater nitrogen retention in the 75% restricted diet than the high carbohydrate diet, while no differences existed between diets at maintenance. Results such as this have led Millward to suggest that "for now energy intakes can be considered independently from the composition of that energy as determinants of NB, thus simplifying the issue [34]." However, these results need to be replicated; particularly, in the context of exercise training.

Carbohydrates and Fats in Resistance training exercise
While carbohydrates and fats may spare nitrogen in a similar manner, it is important to recognize that carbohydrates are critical for high intensity exercise. As an illustration Jacobs et al. [84] investigated the effect of depleting muscle fibers of glycogen on strength levels. It was found that glycogen depletion in both fast and slow fiber types in the vastus lateralis was associated with impaired maximal muscular strength produced during a single dynamic contraction, as well as with increased muscle fatigue patterns. Further, it has been well established that a decrease in intensity can cause a significant loss of adaptation [43,85-88]. These results suggest that a decrease in carbohydrates may indirectly decrease muscle tissue, or impair further adaptations.

Interaction between carbohydrates and protein/amino acid intake
Koopman and colleagues [89] investigated the effects of carbohydrate (0.3 g per kg-per hour) (CHO), carbohydrate and protein (0.2 g per kg-h) (CHO-PRO) and carbohydrates, protein and leucine (0.1 g per kg-h) (CHO-PROL) on net protein balance, and amino acid oxidation rates. Results indicated that net balance was negative in the CHO condition, and positive in the CHO-PRO and CHO-PROL conditions, with the latter attaining the highest values. These results paralleled plasma insulin concentrations, with insulin being highest in the CHO-PROL condition, intermediate in the CHO-PRO condition, and lowest in the CHO condition. The net balance was improved through increased protein synthesis and decreased protein breakdown in the CHO-PROL condition relative to the other two conditions. Further protein oxidation was lowest in the CHO-PROL condition. The rationale may be that leucine intake enhances insulin secretion [89], and independently increases protein synthesis [90,91]. It is generally thought that insulin enhances protein balance through hindering protein degradation [40,92], which was supported by this study.

However, the role of insulin in stimulating protein synthesis is in debate [89]. In vitro studies [93-95] have supported insulin's role in regulating protein synthesis, while a number of in vivo studies have shown discrepancies in protein synthesis [96]. As an illustration Biolo et al. [92] found that insulin infusion increased protein synthesis at rest, but not after resistance training exercise. The authors concluded that it was the decreased amino acid availability which depressed the stimulatory effect of insulin. This was supported by Biolo et al. [97] when they found that maintained amino acid levels in the presence of hyperinsulemia increased protein synthesis. Further, Hiller and colleagues [96] suggested that discrepancies seen between in vitro studies and in vivo studies centered around plasma concentrations of insulin. To test this question, Hiller et al. [96] raised plasma insulin levels to concentrations similar to studies conducted in vitro, while maintaining amino acid concentrations. It was found that hyperinsulemia increased protein synthesis greatly. Therefore, mechanisms which enhance the insulin response to food may enhance protein accretion. The efficacy of combining carbohydrates and protein on insulin secretion was demonstrated by Ivy et al. [98] who found that the combined effects of protein and a high glycemic carbohydrate were greater on stimulating insulin secretion than their independent effects.

Summary of the effect of carbohydrates and fats on protein balance
In summary it appears that both carbohydrates and proteins have similar nitrogen sparing effects [34,83]. In this context it may be advisable to increase fats when carbohydrates are lowered. However because carbohydrates are critical to athletic performance [84] the athlete should be conscious of decreased intensity and performance with decreased carbohydrate intakes. Finally, there appears to be an interaction effect between protein and carbohydrates in stimulating insulin secretion [98-100]. This latter effect may be beneficial when manipulated for protein accretion purposes.
http://www.jissn.com/content/3/1/7

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Abstract

Quantification of the metabolic response aids in ascertaining the nature and extent of the energy requirements imposed by exercise. During high intensity exercise, virtually all of the energy is supplied by the net oxidation of glycogen while fat oxidation plays a more prominent role during lower intensity exercise. Therefore, the lower limit of carbohydrate required above resting needs is equal to the portion of the total energy cost derived from carbohydrate sources. There is no upper limit of additional carbohydrate intake that could be eaten to satisfy the extra caloric requirement since carbohydrate intake will restore any endogenous energy stores that were used during exercise, regardless of the intensity of exercise. The recommendation of a high carbohydrate intake to provide caloric balance in exercising individuals is supported by the observation that exercise performance at high intensity is improved by a high carbohydrate diet, and exercise performance at low intensity is relatively insensitive to the source of the caloric intake. Limited dietary studies are consistent with predictions based on the metabolic response. At exercise intensities below 65% VO2 max, the percent fat and carbohydrate in the diet makes little difference on exercise performance, provided adequate time is allowed to adapt to a high-fat diet. On the other hand, exercise ability during high-intensity exercise is significantly limited by a high-fat diet. A consideration of importance beyond the aspect of energy balance is the anabolic effect of insulin on muscle protein synthesis after exercise. Provision of carbohydrate after exercise is likely to stimulate muscle protein synthesis to a greater extent than a corresponding amount of fat. Dietary fats may offer practical advantages to the athlete but if fats are consumed at the expense of carbohydrate intake, many established benefits of high carbohydrate intake in terms of performance may be sacrified.
http://www.nature.com/ejcn/journal/v.../1600751a.html

(Bold = my emphasis.)
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Old 01-15-2009, 01:26 PM   #15
Greg Battaglia
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Darryl

He's not doing Crossfit. He said he hasn't been doing any met-cons at all. That being said, if all he is doing is strength work 75 grams of carbohydrate/day is more than enough. I've made significant strength gains while on a ketogenic diet in the past. Strength work does indeed require glycogen, but strength workouts typically are not very glycogen depleting due to the lower reps and higher weights. You'd have to be lifting all day long to deplete glycogen stores doing strength work. Gluconeogenesis does a fine job of filling gaps in glycogen stores when strength training is the only training being done. Considered that he's not even low enough in carbs to be fully ketogenic, he's getting plenty of carbs to fuel his efforts from both gluconeogenesis and from the amounts provided in his daily diet.


Scott, Here's my take, for what it's worth:

Based on your overall symptoms and blood work, your probably having some problems with the b-vitamins. Your scaling around the mouth is indeed a sign that you may be deficient in one or more of the b-vitamins, which could indirectly interfere with metabolism of other b-vitamins. It's tricky with b-vitamins, and pretty complex. When your short on one b-vitamin the others are affected adversely and it can become difficult to identify the root of the problem. Your anemia could be caused indirectly by a deficiency which is screwing with b-vitamin metabolism or it could be caused by digestive issues, or maybe both. You need both hydrochloric acid and intrinsic factor to active vitamin B12. If either is lacking you can eat all the B12 in the world and you won't use any of it, because it must first be activated by HCL in the stomach and then by intrinsic factor in the small intestines. Deficiencies in HCL or intrinsic factor can be caused by stomach issues like atrophic gastritis or by infections like h. pylori. That being said if I were in your situation I would do the following:

1. Get a quality B-complex without folic acid (taking folic acid when B12 is really what you need can result in serious nerve damage. Plus the folic acid could mask the blood markers for B12 deficiency.)
2. get some B12

If the above 2 don't work then get checked out for h. pylori infection and see if you have any digestive issues going on.

Note: I'm not a medical professional. I'm a Dietetics college student who hasn't earn his RD yet. The information above is based on my current knowledge of B-vitamin deficiency and factors affecting such conditions. See a doctor and run these ideas by him/her.
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Old 01-16-2009, 07:39 AM   #16
Darryl Shaw
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Greg,

As you are studying dietetics perhaps you could answer a couple of questions:

1: Is it sensible for an athlete engaged in a strength training program to rely on gluconeogenesis for energy in order to make up for a low energy low carbohydrate diet given the proven and well documented protein sparing effects of carbohydrates?

2: If an athlete came to you complaining of fatigue and of having legs that feel "heavy and slow" and "lack explosiveness" would you -

a/ Address the well known problems associated with athletes consuming diets that are low in both energy and carbohydrates by advising them on how they could improve their performance through dietary changes eg. increasing their calorie and carbohydrate intake then if that failed to improve matters in 4 - 6 weeks order further tests.

or

b/ Ignore the well known problems associated with athletes consuming diets that are low in both energy and carbohydrates and prescribe vitamin supplements.
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Old 01-17-2009, 09:50 AM   #17
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Quote:
As you are studying dietetics perhaps you could answer a couple of questions:

1: Is it sensible for an athlete engaged in a strength training program to rely on gluconeogenesis for energy in order to make up for a low energy low carbohydrate diet given the proven and well documented protein sparing effects of carbohydrates?

2: If an athlete came to you complaining of fatigue and of having legs that feel "heavy and slow" and "lack explosiveness" would you -

a/ Address the well known problems associated with athletes consuming diets that are low in both energy and carbohydrates by advising them on how they could improve their performance through dietary changes eg. increasing their calorie and carbohydrate intake then if that failed to improve matters in 4 - 6 weeks order further tests.

or

b/ Ignore the well known problems associated with athletes consuming diets that are low in both energy and carbohydrates and prescribe vitamin supplements.

Wow, ok.......

1. First of all I think I addressed that quite clearly above, so i won't waste any time commenting on why he (probably) doesn't need to increase his carbohydrate intake. Secondly, Scott has made no indication that he is an "athlete". Saying that Scott is an "athlete engaged in a strength training program" is misleading and not an assumption that you could make based on his post. Suggesting that he is an athlete suggests that he is doing other vigorous sport-specific training on top of his strength program. That may be the case, but he didn't include those details in his post, so there is no way to come to that conclusion. Perhaps Scott could fill us in more on the specifics of his activity level to help clear that up. But until then, all we can assume is that Scott is an everyday guy who does some recreational strength training.

That being said, he should have plenty of glycogen from both dietary sources and gluconeogenesis (I never said he would get ALL of his glycogen from gluconeogenesis, as you've suggested). And that's not even to mention that he clearly stated that he eats cheat meals (which most likely are on the higher carb side) on the weekends.

Carbohydrates are indeed protein sparing, but so is fat, and Scott has an appropriately high fat intake given his lower carb intake.

2. Your critique of my response is completely misguided and out of context, especially considering that Scott has received blood results that indicate that he's low on hemoglobin, which is implicated in anemia. Combine that with the fact that he's presenting symptoms of anemia (you should know that heavy, stiff limbs can be a sign of B12 deficiency) and it becomes obvious that carb intake isn't the main factor here, if at all.

Quote:
If an athlete came to you complaining of fatigue and of having legs that feel "heavy and slow" and "lack explosiveness" would you -
If the person was an athlete and those were the only symptoms, then yes, I would consider glycogen depletion, but they're not. I already stated the obvious: Scott has blood results to suggest anemia. His symptoms suggest anemia. He probably has anemia.

The reason I suggested a supplement was to help identify the problem. If the supplement corrected the problem then we would know that b-vitamins were the issue and use specific dietary changes to get him back to where he needs to be. If the supplements fail, then we know that it's something else.

Dr. G suggested lead poisoning. I'm not too familiar with lead poisoning and anemia, so I can't comment on that, but I'm sure Dr. G knows more about it than me. I offered my response to Scott in hopes that it may help him if it turns out that lead wasn't the issue. In that case he could look to his digestive system and check for stomach problems or h. pylori.
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Old 01-17-2009, 03:48 PM   #18
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Hypochlorhydria (low stomach acid) could be an issue. Lack of proper stomach acid will lead to lack of absorption of B12 through intrinsic factor activation as well as poor digestion of the meat where you would get the iron from. That being said, with most people I see on good diets like you are on, any anemia is usually corrected barring other problems. Hence my concern about lead.

Scott, for you and anyone else interested, if you want to know what metals could be problems in your area or in areas you may have lived previously, see http://www.scorecard.org/. Specific section on lead here: http://www.scorecard.org/env-releases/lead/.

For more on lead and anemia, here's a couple of studies I found, you're welcome to decide whether they are potentially applicable in your situation or not.

Blood lead and hemoglobin levels in Andean children with chronic lead intoxication.


Should all patients with unexplained anaemia be screened for chronic lead poisoning?

When I've tested patients for toxic metals who have amalgam/mercury fillings, I nearly always find elevated lead (along with mercury). FWIW. Note that this is not the conventional blood test (which tends to miss chronic toxicity), it is a multi-hour urine test.
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Old 01-17-2009, 07:04 PM   #19
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Hypochlorhydria (low stomach acid) could be an issue.
That's what I said.
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Old 01-19-2009, 06:47 AM   #20
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Originally Posted by Greg Battaglia View Post
Wow, ok.......

1. First of all I think I addressed that quite clearly above, so i won't waste any time commenting on why he (probably) doesn't need to increase his carbohydrate intake. Secondly, Scott has made no indication that he is an "athlete". Saying that Scott is an "athlete engaged in a strength training program" is misleading and not an assumption that you could make based on his post. Suggesting that he is an athlete suggests that he is doing other vigorous sport-specific training on top of his strength program. That may be the case, but he didn't include those details in his post, so there is no way to come to that conclusion. Perhaps Scott could fill us in more on the specifics of his activity level to help clear that up. But until then, all we can assume is that Scott is an everyday guy who does some recreational strength training.

That being said, he should have plenty of glycogen from both dietary sources and gluconeogenesis (I never said he would get ALL of his glycogen from gluconeogenesis, as you've suggested). And that's not even to mention that he clearly stated that he eats cheat meals (which most likely are on the higher carb side) on the weekends.

Carbohydrates are indeed protein sparing, but so is fat, and Scott has an appropriately high fat intake given his lower carb intake.

2. Your critique of my response is completely misguided and out of context, especially considering that Scott has received blood results that indicate that he's low on hemoglobin, which is implicated in anemia. Combine that with the fact that he's presenting symptoms of anemia (you should know that heavy, stiff limbs can be a sign of B12 deficiency) and it becomes obvious that carb intake isn't the main factor here, if at all.



If the person was an athlete and those were the only symptoms, then yes, I would consider glycogen depletion, but they're not. I already stated the obvious: Scott has blood results to suggest anemia. His symptoms suggest anemia. He probably has anemia.

The reason I suggested a supplement was to help identify the problem. If the supplement corrected the problem then we would know that b-vitamins were the issue and use specific dietary changes to get him back to where he needs to be. If the supplements fail, then we know that it's something else.

Dr. G suggested lead poisoning. I'm not too familiar with lead poisoning and anemia, so I can't comment on that, but I'm sure Dr. G knows more about it than me. I offered my response to Scott in hopes that it may help him if it turns out that lead wasn't the issue. In that case he could look to his digestive system and check for stomach problems or h. pylori.
An interesting response Greg but you're not getting the point I'm trying to make; sure Scott is slightly anemic but that isn't his biggest problem, his biggest problem is his low energy diet.

If you look at the chart he posted you'll see that for the past two months his average daily calorie intake was just 2022 kcals/day and if you calculate his BMR (~1870 kcals/day) you'll see that he's only allowing himself 152 kcals/day for all other activities besides simply existing. The occasional cheat day meal of beer and pizza or whatever is never going to be enough to make up for such a chronic low energy intake so it's hardly surprising he's complaining that he's feeling fatigued.

If Scott can be persuaded to start eating more carbs in the form of fresh fruit and starchy root vegetables he'll see an immediate improvement in performance and as more food means more nutrients he'll start correcting any minor vitamin and mineral deficiencies he may have. If after a month or two he hasn't seen any improvement in performance that's when you should start doing further tests and if necessary prescribe any vitamin or mineral supplements he may need.
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