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It’s worth finding a doctor who understands the intricacies of cholesterol, thyroid hormones and iron.
“It was like going from being blind to getting my vision back.”
This is how Paul Thomas, an elite runner, duathlete, triathlete and cyclist for most of his life, described finding a health practitioner who knew how to evaluate the lab results of an athlete, whose body has different requirements than those of normal folks.
Thomas went looking for this professional because of the “deep hole” he had dug for himself “by training for and racing an Ironman in just four months.” During the Ironman, Thomas was unable to get his heart rate above 122 on the bike, no matter how hard he tried. Afterward, he was constantly tired. Knowing something was wrong, he visited his general practitioner, who ordered lab tests including a comprehensive metabolic panel (total cholesterol, protein and electrolytes), glucose and CBC panel (complete blood count). But Thomas’ creatinine, sodium, phosphorous, thyroid-stimulating hormone, iron, pH, aspartate aminotransferase (an enzyme) and other markers all came back within normal ranges. Nothing was too high or low.
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But Thomas knew something definitely wasn’t “normal,” so he began searching for someone who could help. Finally, he connected with Jerry Moylan, a chiropractor in San Diego who not only has more than 20 years of experience working with athletes, including Canadian triathlete and Olympian Carol Montgomery, but is an avid athlete himself and three-time Ironman finisher. Moylan explained to Thomas that the “normal” reference ranges that most health practitioners use to evaluate lab results are intended to assist in identifying and diagnosing disease states and do little to help one reach an “optimal” state of health.
To help Thomas get back on track, Moylan used narrower, or “functional,” reference ranges supported by the American Association for Clinical Chemistry. Taking this approach, Moylan found more than a dozen results “within the limits” of normal reference ranges but that fell outside of functional ranges, or the ranges an athlete’s results should be within to remain healthy and able to consistently respond to training stimuli.
Thomas’ sodium level of 143, for example, was within the normal reference range of 135 to 145 mmol/L but outside the narrower functional range of 135 to 140. This high sodium level naturally upset his electrolyte balance, something critical to performance for any endurance athlete, yet his initial practitioner overlooked it.
Moylan compares the “normal ranges” that are tested for in traditional lab tests to the FDA’s recommended daily allowances for vitamins. These recommendations are structured to provide the minimum nutrients necessary to stave off disease.
Similarly, lab values falling within a normal range simply mean that there’s likely an absence of disease, not necessarily normal health.
Using these functional ranges for guidance, Moylan helped Thomas tweak his diet and suggested nutritional supplements and a detoxification regimen. After Thomas spent a year rebuilding his health, he was able to respond to training stimuli again and continues to train at an elite level to this day—almost seven years after his Ironman incident. Indeed, Thomas won the individual general category of the pro/Cat. 1 division of the 2011 Valley of the Sun Stage Race in Arizona in February despite being twice as old—42—as the youngest rider.
Thomas’ example demonstrates just how important it is for athletes to find a conscientious doctor who is experienced with athletes and willing to take a long, hard look at current and past lab results. This doctor must also be adept at evaluating not only disease states, but also whether or not an athlete’s body is functioning as optimally as possible.
Besides finding a conscientious doctor who is used to working with athletes, runners and triathletes should be concerned with finding a health practitioner who understands the intricacies of cholesterol, thyroid hormones and iron. Endurance athletes are especially at risk for poor health if they don’t have enough HDL cholesterol and iron in their bodies, and if their thyroid isn’t functioning properly, according to Victoria Vodon, a chiropractor from Newport Beach, Calif., who has worked with many elite endurance athletes, including those under renowned athletics coach Bobby Kersee. HDL cholesterol is particularly important, as it is “used by the endocrine system to create hormones via the adrenal gland,” Vodon said. But many endurance athletes do not have enough of it. And thyroid problems often go undetected, as many patients with thyroid problems have normal lab tests, according to a study in the British Medical Journal.
Finding the right doctor can be a challenge, however. Former Ironman 70.3 world champion Samantha McGlone dealt with a doctor who misread lab results, and this experience pushed her to do the research required to assemble a team of practitioners she trusts, largely by using input from other athletes. McGlone recommends that triathletes find a doctor who will read results with an eye on how they trend over time—that is, how current lab results compare to lab results taken months or even years in the past, paying special attention to any big swings.
Athletes can also use the American Medical Society of Sports Medicine as a guide.
Failure to properly interpret lab results is a top reason for medical malpractice lawsuits, according to a study published by the University of Wisconsin Medical School, so choosing the right practitioner is key. Before you settle on one, seek a second opinion. And when you do find a prospective practitioner, Moylan and Vodon recommend that you give the practitioner your previous lab results and boldly go where few patients have gone before—ask why you should put your health and fitness in his or her hands. If the practitioner doesn’t take the time to provide a thoughtful answer, how can you be sure he will take the time to carefully consider your lab results?
Lab tests are of immense value, but only when interpreted by the right practitioner. It pays to treat your hunt for that practitioner as the most important shopping venture of your life, because it may well be.
This article originally appeared in the 2011 July/August issue of Inside Triathlon.
About The Author:
Bob Augello is a retired coach who has worked with Lance Armstrong, guided NCAA national champions in cross-country and track and sent five cyclists to the Olympics.