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People love to get some cold, hard facts. In fact, after the prequel to this post was put up, someone immediately voiced a desire to have some ?hard data? coming up in this post. Well, I hate to disappoint you, but the complex interactions that take place in an individual’s body often defy conventional wisdom and data that is, like L.L. Cool J, ?as hard as steel.

Let’s look at a real life example. A woman in her 20’s contacted me because of some serious emotional ups and downs and some general feelings of fatigue. Stuff like, you know, getting to work, staring at her desk for a minute or two, and then bursting into uncontrollable crying fits. My first question was, ?are you urinating more frequently??

The answer was yes, so she ordered a refractometer, and began closely monitoring her urine. After a week, she sent me some refractometer data?

Dec 8th:

  • 6am= 5
  • 730am= 4
  • 9:40am= 4.5
  • 11:00am= 2
  • 12:00 pm = 2
  • 1:05pm= 1
  • 2:30pm= 2
  • 4:30pm= 3.5
  • 6:00= 0
  • 7:00 = 0

Dec 9th:

  • 4:00am = 4
  • 6:30am= 4
  • 8:30am= 4
  • 9:30= 1
  • 10:15am= 0
  • 11:45= 2.5
  • 3:00= 6
  • 5:30= 0

Dec 12th:

  • 7:30a= 3
  • 9:00am= 1
  • 10:30= 0
  • 1:00p= 2
  • 3:20= 3
  • 6:00= 1.5
  • 8:00= 1

As you can see, there are some dramatic fluctuations, and she is hitting 0 at least once per day, if not twice. This probably explains why she is having unexplained emotional meltdowns at frequent intervals that don’t seem to have much to do with anything situational.

I helped her change?a few things that prevented these crashes. Emotionally she saw significant improvements. But there was a problem?

She had an extremely heavy period, and broke out with bruises all over her body. She has a long history of battling anemia and was diagnosed by a doctor as having dangerously low iron levels. This was most likely caused by a combination of some pretty harsh restricted dieting in her past (very low-carb), and a combination of marathon running and lots of hiking/cycling/skiing and other forms of long-duration, strenuous exercise. While all this activity keeps her body looking very fit and attractive by modern standards, this caused several health problems to surface (night sweats, autoimmune disease, deadly food allergies, loss of period for a year or so ? and of course this chronic battle with anemia). She made big improvements by ditching the low-carb diet ? autoimmune disease and loss of period have resolved themselves just fine. But exercise is still a big part of her life.

Hard-training athletes, and female athletes in particular, are particularly susceptible to developing anemia. This is not a news flash. It’s well known. From an article entitled ?Athletes and Iron Deficiency Anemia??

Iron deficiency is a common problem for women athletes. Studies have routinely found that athletes, especially female athletes, are often iron-deficient or anemic. Iron is essential for athletic performance. One of its major functions is to carry oxygen to and carbon dioxide away from all the cells in your body. The brain also relies on oxygen transport and without enough iron you will find it hard to concentrate and feel tired and irritable. Iron is also needed to maintain a healthy immune system. If you don’t have enough iron you may be prone to more frequent infections.

Athletes and Iron Deficiency A combination of the following factors place athletes at risk of iron deficiency:

  1. Inadequate supply of dietary iron. Athletes who avoid red meat have difficulty meeting the body’s iron needs.
  2. Increased demands for iron. Hard training stimulates an increase in red blood cell and blood vessel production, and increases the demand for iron. (Iron turnover is highest for endurance athletes training at high intensity).
  3. High iron loss. Blood loss through injury, or menstruation. In endurance athletes, ?foot strike? damage to red blood cells in the feet due to running on hard surfaces with poor quality shoes leads to iron loss. Finally, because iron is lost in sweat, heavy sweating leads to increased risk of deficiency.

Symptoms The symptoms of iron deficiency include loss of endurance, chronic fatigue, high exercise heart rate, low power, frequent injury, recurring illness, and loss of interest in exercise and irritability. Other symptoms include poor appetite, and increased incidence and duration of colds and infections.

The question is, what the hell caused her to break out with bruises and have a heavy period (both signs of low platelet formation)?? To be on the safe side, we decided to cut out gluten temporarily. That was one thing she had changed recently ? as I encouraged her to eat calorie-dense carbohydrate-rich foods with a low water content to prevent the crashes on the refractometer. Stuff like cookies, waffles, and banana bread for example. Gluten is thought to have the potential to interfere with iron absorption. It couldn’t hurt to err on the safe side.

However, I suspect this change had a lot more to do with something else ? a large increase in her sugar intake. I, as well as many others, have noted that while eating more sugar, fruit, and fruit juice especially (she was sipping grape juice throughout the day), that it is very common to start having increased bruising and bleeding gums. Why this is, I don’t fully understand. In theory, eating more vitamin C from fruit and juice should decrease bruising and bleeding gums, but in real life it seems to have the opposite effect. Fortunately, after suffering from bleeding gums for most of 2011, since I started toying around with a high sugar intake (never very severe though), I am eating craploads of sugar, juice, and fruit with absolutely no gum bleeding at all anymore. So obviously there is more to the picture, but it is an interesting observation nonetheless.

Of course, sugar doesn’t CAUSE bleeding gums, or heavy periods, or easy bruising per se (a young kid just cleared up bleeding and bruising issues eating an ice-cream based diet), a physical state in the body leads to these outwardly symptoms. And something about sugar, or fruit, or juice, or all of the above seems to be capable of triggering some changes leading to that. In some people. In some contexts.

There’s ?irony? there in terms of anemia, because fruit and juice is very rich in vitamin C. And vitamin C is supposed to increase iron absorption. Iron, irony? wow that’s awesome to use both in such close proximity. I just high-fived myself in a public place. I would be embarrassed but the guy sitting next to me is wearing stone-washed denim with holes in the knees and a multi-colored velvet jacket ? in Florida. And off to my left a scary looking woman with black lipstick is yelling at someone about Jesus? ?THERE ARE NO BUTS!!!!? So I’m good. Totally under the radar.

Whether relevant or not, I did find a very interesting article (from Florida) about research showing how harmful vitamin C can be in terms of increasing oxidative damage precisely because of its interaction with iron ? so it’s not too far out of the realm of possibility that her increased intake of vitamin C via more fruit and grape juice (fortified with vitamin C) played a role in all this too ? aside from the sugar?

If you have a bruise, a muscle sprain, an inflammatory disease or if you take iron supplements, exceeding 100 mg per day of vitamin C may be damaging to your body, according to a study by University of Florida researchers.

That’s because all of those conditions produce free iron, which reacts negatively with vitamin C in much the same way that the iron on bicycles and fences reacts with water and oxygen.

?You will rust inside, so to speak,? said Christiaan Leeuwenburgh, the senior author and an assistant professor in UF’s department of exercise and sport sciences.

In a study published this month in the journal Free Radical Biology and Medicine, several UF researchers worked with renowned vitamin C expert Barry Halliwell to test the effects of vitamin C and N-acetyl-cysteine (NAC, another water-soluble antioxidant) at the cellular level.

In this study, the researchers began with the hypothesis that vitamin C and NAC would speed the recovery of a muscle injury because of their anti-oxidant properties and ability to reach damaged cells quickly. Fourteen healthy men volunteered to have one of their arms injured by a machine that ruptured their bicep muscles and created swelling. Researchers then gave half of them a placebo and the other half a drink supplemented with about 700 mg of vitamin C and 800 mg of NAC.

?Initially, the vitamin C and NAC were given to prevent the injury, because we thought they?d have protective effects,? Leeuwenburgh said. ?Instead, they were damaging.

Anyway, no grand conclusions here as usual. Just food for thought. And this is a huge can of worms we’re opening here. It’s a very complex subject. But fixing it isn’t complex. Her bruises went away within a couple of weeks, and she held onto the improvements in her refractometer readings.

On the topic of anemia specifically (which may or may not have something to do directly with this bleeding and bruising issue), anemia rarely has anything to do directly with iron intake, vitamin C intake, or otherwise. Take for example that all 34 men in Ancel Keys’s starvation study developed anemia even though they were getting plenty of iron and vitamin C.

In my experience, the formation of hemoglobin and red blood cells and platelets and the building of overall blood volume and all that healthy blood stuff is facilitated much more by the calorie than any micronutrient, but only due to its exertion on the metabolism. This woman, as expected, has low T3 levels. So anemia will probably persist until that changes. The author of the anemia/athlete article posted above is probably not realizing that this is the connection to endurance athletes – as endurance exercise is really rough on T3. Endurance athletes in particular are often in a chronic energy deficit as this article describes.

Shockingly, her doctor told her to stop all exercise. I’m so proud. It’s one of the few things of any intelligence that I’ve ever heard uttered by a medical doctor (although I wasn’t there to confirm it? the only things I’ve directly heard from a medical doctor are? ?Pull your pants down,? ?Turn your head and cough,? ?We?re going to have to operate,? ?Take these antibiotics,? ?No that mysterious fever and liver pains you got after all 3 hepatitus B vaccinations couldn’t have been from the vaccine,? and ?Your weight is a little too high, stop eating so much.)? This is a big improvement over the last doctor she went to, who’told her she had cancer and removed one of her ovaries, then told her it had come back with a vengeance and it was time for a full hysterectomy. Turns out later, she didn’t have cancer at all, and never did. PUNK?D!!!