Maximizing Your Potential: Hemoglobin and Oxygen Delivery

Marginal gains. The term “marginal gains” is being heard more and more since Mat Steinmetz, a well-known science-based triathlon coach, introduced it to the world of triathlon. The concept of marginal gains is simple. What are the little (marginal) things you can improve that cumulatively can result in big overall improvements? As a performance adviser to many of the world’s top endurance athletes, it is my job to identify where marginal gains can be made physiologically. One focus is oxygen availability, and a key player is hemoglobin, a protein in red blood cells. Hemoglobin is a micro-sized protein that has macro-sized effects on performance. And what you eat on a daily basis can affect hemoglobin levels.

Put simply, endurance exercise is largely characterized by a simple requirement; sustaining repeated muscle contraction. This criterion is fulfilled via two basic functions, the ability to consume enough oxygen and adequate fueling. Regarding fueling, that is another topic, however summarized by simply providing the right fuels at the right time during activity. Regarding oxygen, the process is a bit more complex.

Muscles require oxygen to convert sugars into energy. In the absence of replenishing oxygen, muscles reach complete exhaustion in just a few minutes. Therefore, endurance athletes require constant oxygen delivery to the muscles. It is hemoglobin that carries oxygen to the muscles.

Hemoglobin picks up oxygen in the lungs and delivers it to the tissues of the body, most notably your muscles. Hemoglobin levels have a direct impact on endurance exercise performance. Lower levels of hemoglobin causes decreased efficiency of oxygen delivery to the muscles. The result is more rapid muscle fatigue, decreased VO2max, and higher heart rates. As a dramatic example, if you have ever exercised at high altitude, you know what it feels like to have less oxygen delivered to the muscles.

Certain micronutrients are essential in the formation of hemoglobin. Because of the high turnover rate of red blood cells and hemoglobin in endurance athletes, the dietary requirements of these micronutrients are higher than the average person. Failing to replenish them can result in a decrease in hemoglobin production, and thus performance.

Iron, folate, and vitamin B12 are directly involved in hemoglobin formation. Other micronutrients, such as vitamin B9, vitamin C, copper, and vitamin A are indirectly involved in hemoglobin formation. Although the goal in replenishing micronutrients should be through dietary means, many athletes require supplementation at some point in the season.

To put this in an easily understood context, let me share a real-life case study.

A pro triathlete presents for routine monitoring. She has transitioned over the last nine months from the ITU circuit to the Ironman 70.3 and Ironman distances. She has been tolerating the training well and does not have complaints. Being new to the higher volume she does not know what to expect.

Blood work revealed low-normal hemoglobin (12.0), hematocrit (36.2), small platelets (MPV 6.5), and borderline large red blood cells (MCV 99.7). These findings are consistent with her prior test results during training. Micronutrients were tested as well and revealed a mild functional folate deficiency (within the low limits of the “normal range”, but given the high turnover rate of folate in a female endurance athlete her levels indicate a deficiency in these circumstances).

Intervention included significantly increasing dietary intake of folate and two weeks of supplementation. Follow up tests were performed each week for the following four weeks.

Follow-up #1: Folate 16.2, Hemoglobin 12.4, Hematocrit 37.7

Follow-up #2: Folate 18.8, Hemoglobin 12.7, Hematocrit 38.2

Follow-up #3: Folate >20.0, Hemoglobin 13.1, Hematocrit 40.4

Follow-up #4: Folate >20.0, Hemoglobin 14.2, Hematocrit 44.8 (following 5 days of taper)

There is little doubt that the 15% increase in hemoglobin achieved in the case study above will result in improved performance, and this particular athlete’s performance last year confirms. This big change was the result of simply making an adequate amount of micronutrients available to keep up with the high turnover of red blood cells, and thus hemoglobin.

As an endurance athlete, your dietary requirements of certain micronutrients are increased. Regarding oxygen delivery to the muscles, iron, folate, vitamins B9 and B12, vitamin C, copper, and vitamin A are critical to optimizing hemoglobin levels. Be sure you are eating ample amounts of foods high in these micronutrients. Doing so will aid in optimal oxygen delivery to the muscles, and thus help you perform at your highest potential.

The following table shows foods high in each of these essential micronutrients.

Iron	Folate (Vitamin B9)	Vitamin B12
Red Meat	Beans and Lentils	Fish
Egg Yolks	Dark, Leafy Greens	Red Meat
Dark, Leafy Greens	Asparagus and Broccoli	Cheese
Dried Fruit	Romaine Lettuce	Eggs
Beans and Lentils	Avocado	Yogurt and Milk
Tuna	Oranges and Tropical Fruits	Fortified Vegan Products
Vitamin B6	Copper	Vitamin C
Bran	Sunflower and Sesame Seeds	Peppers (Chili and Bell)
Pistachios	Nuts	Dark, Leafy Greens
Garlic	Cocoa Powder	Broccoli and Cauliflower
Fish	Sundried Tomatoes	Fruits
Sunflower and Sesame Seeds	Calamari and Lobster	Thyme and Parsley
Hazelnuts	Dried Herbs	Pine Teas