An Athlete’s Guide to Advanced Nutrition Testing

August 23, 2011

As a scientist, one tends to gravitate to numerical, quantifiable results, which may explain a preference for sports with a finish line rather than a panel of judges.

Diet and nutrition can feel a lot like facing than panel of judges, when it comes down to trying for performance improvement through diet change without supporting analytical data. Eating lots of broccoli can only take one so far. Many athletes depend on nutritional supplements to assist with their overall and performance nutrition. So how does one go about gaining quantitative insight into the nutritional state of the body? Blood and urine testing can provide extensive information, far beyond the more usual "cholesterol, sodium and protein" content of plasma.

Personally, my diet over the past decade has consisted of copious colourful veggies, monounsaturated fats (in moderation) and chocolate, along with some fish, chicken and without beef or pork. I also consumed a multivitamin, vitamin D and calcium on occasion. And with that, I assumed as an athlete I was set to race, perform at a high level, and establish good health and nutrition for life.

What I didn't know was that despite the veggies, nuts and chocolate, there lurked significant gaps in my diet highlighting the need for some vital dietary changes and/or the addition of some supplements. While basic blood testing can provide quantitative results of plasma cholesterol, minerals and overall protein content, and as such provide a general indicator of health, these basic tests can be significantly lacking in breadth and depth. As well, testing only plasma (whole blood) means that the snapshot of data can be significantly affected by recent meals, stress and training, compared with erythrocytes (red blood cells) that carry with them nutritional information from a 3-month window.

Enter the latest high-tech and exhaustive performance nutrition testing. Broken down into about 10 categories, advanced testing can pinpoint individual deficiencies, immunogenecity to dozens of substances, toxic loading, individual amino acid content, bacterial profile, etc., through the combined use of blood (plasma), red blood cells (erythrocytes) and urine.

I recently had the opportunity to undertake this advanced testing, and I need to confess I entered into this testing as a skeptic and left as a believer. As a chemist by training, I recognize the value of analytical results, and given an appropriate interpretation, conclusions of great value can be obtained from proper testing. However, I was skeptical that the profile of my blood could provide specific insight into so many aspects of my being. How wrong I was.

The testing itself constitutes a fasting blood draw of 6 vials, and a first-of-the-day urine sample. The test material was sent by mail to a main depot where the vials were then sent to specialized laboratories that undertake specialized testing on instruments and methods such as ELISA, GCMS, HPLC, LC-MS, ICP-MS, immunoassay and colouromatric analysis. The 23-page report that was generated was interpreted for me by consulting physician and nutritionist Christopher Talley to help make sense of the results. As with any testing, if possible, it is worth retaking the test after 6 months or a year of diet and supplementation modification to gauge the level of success and the need for further change.

One thing to keep in mind: For each analyte, there is a window that is considered to be the “normal” range for a given substance. This window represents the concentration that is generally accepted to be associated with good health. There is also a broader 95% range that indicates the range in which 95% of the population falls. However, this healthy window does not provide an indication of the much narrower range or level that may be conducive to performance, longevity or superior health. Sometimes that level may be at the low end of the normal window, for example as with omega-9 fatty acids, or at the higher end, for example with magnesium levels. As athletes, we should strive towards the “performance goal” if possible, and at the very least, to fall within the normal window.
Presented below is a snapshot of selected results from my testing. This information is provided to you, the reader, as a case study of a fellow athlete who discovered there were measurable deficiencies in key nutritional parameters that over the long term could have severe consequences to overall health as well as performance in sport. It goes without saying that only individualized testing to provide your individual results will be able to provide a basis for custom supplementation or diet change, however, from speaking with the nutritionist, the areas in which I fell short are not uncommon among athletes, and so some general advice is offered here as well. Please note it is always advised to consult your physician before making changes to your diet or exercise program. The results shown below are partial excerpts from my extensive report.

The Results: ION (Individualized Optimized Nutrition)

IgG4 Food Antibodies (90 antigens)
Plasma was analyzed for the presence of antibodies to 90 common antigens. This test is very different than the typical allergy test that is dependant on the IgE response of the immune system, characteristic of a fast-onset allergic reaction. By contrast, IgG4 reactions take several days to develop and appear typically as mild symptoms such as malaise, runny nose and congestion. Interestingly while I have never experienced any reaction to milk or milk products, testing indicated that from 90 antigens, I was moderately sensitive to both milk and casein (milk protein). The nutritionist suggest that I exclude all milk products from my diet for about 2 weeks prior to an important race, to allow any activation of the immune system by the presence of those antigens to return to normal. All other antigens returned negative findings. Not even shrimp, that causes a mild allergic reaction and congestion through the IgE pathway showed a blip on this IgG4 binding test. So if you feel like you’re only running on 3 cylinders in your next race, this type of testing could help determine which food or foods may be the culprit.

Fatty Acid (Erythrocytes)
Testing a bulk sample of red blood cells allows for an averaging of cell health over about a 3-month window, as the sample contains cells of the full age range, from newly formed to those at the end of their useful life. As such, there are important advantages of this type of testing over the much more common plasma (blood fluid) testing. The quantitation of the fatty acid composition of cells, primarily in cells walls, is therefore possible.

Much has been written about the importance and need for Omega-3 fatty acids in diet, and flax oil capsules are among the most popular of supplements currently. And for good reason. Alpha Linolenic acid (ALA) is a primary constituent of cell walls, and as a starting material for bio-compounds such as testosterone and other hormones. Good sources of ALA are foods such as pumpkin seeds, walnuts, and in particular, flax seeds (ground or milled, not the indigestible whole seeds) or supplements usually containing flax seed oil (also known as linseed oil).

Eicosapentaenoic acid (EPA) is a very important building block for nerve coverings, hormone production, vitamin absorption and other bio functions. Common sources are from cold-water oily fish like salmon, also available easily in fish oil capsules.

Docosapentaenoic acid (DPA) and Docoshexaenoic acid (DHA) are both critically involved in brain function, memory and reaction time. These are also available from cold-water oily fish like salmon, also available easily in fish oil capsules.

In my case, erythrocytes showed very low levels of all omega-3 fatty acids. I was even clinically low in ALA, falling slightly in the red zone. Performance goals for these components fall at the higher end of the normal window, and so the nutritionist was quick to recommend a quality flax and fish oil supplement, with enough active to provide at least a combined 1000mg of ALA, EPA and DHA per day, in addition to trying to adhere to a diet richer in fish. The current popularity of omega-3 supplements is testament to the fact that many people appear to have low levels of this important class of compounds, even those with an overall “healthy” diet. This is one area where some supplementation as an easy prophylactic is almost certain to be successful and useful.

Omega-6 and omega-9 fatty acids: These substances are also important to have available for various biochemical processes, but the performance goal is at the lower end of the normal window. The nutritionist suggested finding an omega-3 supplement that does not add any additional omega 6 or 9 compounds. Only individualized testing can appraise you of your nutritient levels, but on a whole, it appears that in particular, the omega-3 fatty acids are an important supplement for most people, or to eat a whole lot of fish and ground flax seeds!

Other Fatty Acids
Results included fatty acid levels of 33 analytes, including nervonic acid. This is an indicator that some level of degradation or aging of nerve covering (myelin sheath) is occurring, and is most commonly due to low levels of DHA (an omega-3 fatty acid). Raising levels of DHA in my diet should cause nervonic acid levels to drop over time. The performance level is at the low end of the normal range.

Trans fat: Much has been written about this “evil” fat in popular media and a somewhat recent FDA ruling requires the amount of this fat to be specifically listed on food labels. Its effect on cardiovascular health has been well documented and there is no real safe upper limit. As a non-natural side product of artificial hydrogenation of liquid fats to inexpensive solid fats (for example, most margarines contain some trans fat), these trans-fats are not readily metabolized by our bodies and appear to contribute significantly to heart disease. Therefore measuring this analyte in blood is a historical biomarker of diet over the past 3 months. My exceptionally low value supports that a non-fast food and healthful diet, while apparently deficient in some things like omega-3’s, is thankfully also very low in trans-fats.

There are certain key indicators of health and performance goal targets linked to ratios of some of the measured fats. For example, the ratio of arachidonic acid (AA) to omega-3’s EPA is related to degree of inflammation in the body. A performance goal is a ratio of 4. A result of 26 indicates it would be highly beneficial to increase my level of EPA, which we already know from the low absolute level of EPA. This would likely reduced inflammation and aid in recovery from training and racing.

Another useful parameter is the ratio of stearic acid to oleic acid. Studies have demonstrated a significantly greater risk of various cancers when a calculated ratio of 1.1 or lower is observed. While the actual link with cancer has not been confirmed, empirical evidence suggests that a result of 1.5 is approaching a danger level, and it would behoove me to eat more chocolate (raise stearic acid levels) or reduce olive oil intake (oleic acid). However, since I know my diet does not include excessive olive oil intake, perhaps there is not much I can do to modify this ratio through diet alone.

Chronic Inflammatory Markers:
There are some important bio markers that circulate in our blood that can provide a snapshot of the current level of stress and inflammation. These include ferritin, fibrogen and C-reactive protein (CRP). The performance goal of all three markers is at the low-to-mid end of the normal window. The nutritionist indicated that in his experience most athletes show some level of inflammation during the training and racing season, and this level is often raised further by psychological stress due to work, family, and other commitments. In the case of ferritin, it may help to boost levels slightly with the addition of more dark green leafy vegetables such as spinach. CRP levels are often high due to physical and emotional stress, and reducing whatever stress is possible within the framework of one’s life would be suggested. This could include relaxation techniques such as yoga.

Nutrient Elements:
Levels of nutrient elements including potassium, magnesium, zinc, copper, selenium and calcium were determined from erythrocytes and whole blood. Performance goals are at the top end of the normal except for calcium, where the results show free calcium and where a high level would indicate poor nutritional calcium intake and greater bone resorption (a bad thing). In my case, the results indicate that additional calcium (or other mineral) supplements would be unnecessary if I were to continue my current diet. A daily multi-vitamin could be helpful in general but not necessary based on the current results.

Toxic elements:
Heavy metals accumulate in the food chain and tend to be retained in fatty tissue for long periods of time. These heavy metals are present naturally in the environment in low concentrations, and in larger amounts in industrial chemicals, paints, and some consumer articles. Higher concentrations of heavy metals in our bodies can have a profound biological effect. Looking at my possible exposure to sources of cadmium, there was no clear origin of the higher levels observed. The nutritionist suggested I consider eating more Jello, the large amount of glycine in the gelatin can help chelate (bind) heavy metals and help remove them. This isn’t hocus pocus science- EDTA and glycine are effective binders of metals and are used at an industrial scale as well.

Energy Production
The Krebs energy cycle diagram (see below) is commonly found in biology textbooks and visually describes the primary source of energy within our body, from protein, fats and carbohydrates and eventually into ATP and energy.

Along this complex path are many “exit ramps” that represent the formation of byproducts that are created only when the pathway breaks down due to illness, disease or lack of starting materials or cooperating vitamins or cofactors. The nutritional analysis includes determination of levels of a multitude of these byproduct or toxic indicators, numbers 30-35 are shown below. Understanding of the presence of these substances can provide insight into the lack of important nutritional intake limitations. For example, the high level of orotate observed in my sample indicates a likely deficiency in the amino acid arginine. A different section of the report shows my plasma level of arginine to be mid-range, but from a performance standpoint, it is low. A supplement of 3g powdered arginine per day was recommended.

Among the other indicators within the Krebs cycle, there was a clear indication of a lack of the B-complex biotin observed as elevated levels of xanthurenate. A B50 or B100 complex that contains a broad spectrum of B-vitamins was suggested. Also likely are low levels of L-carnitine. This makes sense because my diet excludes red meat that is a primary source of this important amino acid that assists with energy production from fat. A simple L-carnitine supplement of about 1000mg/day was suggested, along with CoQ10.

Overall Report Suggestions and Health Profile
The ION report includes a visual perspective of an individual’s risk across an array of illness and disease indicators. By combining current understanding of the relationship between the various chemical indicators as discussed above, results were grouped into common systematic traits (such as cardiovascular risk, motor function, memory, metabolic disease, etc.) This approach can be helpful to identify otherwise disparate results into trends and possible areas of concern for overall health. With few out-of-normal results, no particular trend was established for my results, however this can be a very valuable tool for individuals with greater nutritional or disease irregularity.

The nutritionist left me with some guidelines for supplementation. As my diet overall was deemed to be healthy and varied, he suggested that an effective change would be best accomplished by supplements rather than making drastic changes to an already healthy diet, with the exception of the general addition of more fish and spinach. The supplements he suggested include:

Before training or with meals:
L-Carnitine 1000 mg/day
Arginine: 3g/day

With meals:
Omega-3: 500-1000 mg/day
CoQ10: 100 mg/day
B-complex with biotin: 100 mg/day
Jello (glycine)

Optional:
Vitamin D
Multivitamin

I provide this list only because the nutritionist identified my deficiencies as common among athletes and semi-vegetarians, and it may be useful to you as a starting point or guide to design your own supplementation regimen in the absence of complete individualized testing as presented here. You may also find it useful to speak with your primary physician as some of the testing may fall under standardized blood testing available as part of your standard health coverage. If you are a pro reading this, or otherwise count on your performance to pay the bills, this testing may well be worth more than all your aero equipment combined at a fraction of the cost.

Further Resources:
A complete set of sample reports are available here.

The testing was conducted by Metametrix laboratories. Many tests are offered: complete descriptions are available here. The Cardio-ION, IgG4 and Fatty Acid testing costs about $1000, the optional but highly recommended nutrition consult is about $300, plus you are responsible for coordinating the initial blood draw and sample preparation at a doctor’s office or blood testing center.

Nutritionist Chris Talley from Precision Foodworks can be reached at chris@precisionfoodworks.com or by phone at 310-322-8624.

Jonathan Toker is the Slowtwitch.com science editor and an elite-level trail runner-triathlete who hails from Canada and lives in Southern California. He received a Ph.D. in organic chemistry from The Scripps Research Institute in 2001. Jonathan invented the SaltStick products in 2002, and has been found to have high levels of electrolytes in his blood. www.SaltStick.com.