COACHES! Are you doing enough to manage your athletes welfare?
Laboratory Testing for Athlete Health
Many university athletic programs, professional teams and sports federations have protocols for monitoring their athletes’ health using various laboratory tests…
This generally consists of quarterly or semiannual blood work. (Some also engage in regular cardiac screening, but that is a separate topic than what will be discussed here.) The labs which are regularly performed on these athletes are often not actually very sensitive markers of health nor metrics by which overtraining is likely to be detected early enough to intervene preemptively. However, with advances in scientific and medical knowledge, there has been an increase in the implementation of more relevant lab studies. In this article, I’ll take a look at some tests that can be quite useful to coaches and team medical staff when monitoring athlete health throughout the course of training and competing.
In the US, it is now possible to order most blood testing without the assistance of a physician, as there are websites and shops which enable this practice. I would not recommend such avenues though, as it is the interpretation of the results which is of greatest utility. For that, a well-trained sports medicine doctor is best consulted.
When I consider such testing for my patients, I categorize the tests with regard to their ultimate purpose. Some look at measures of accumulated stress, while others may look at nutritional deficiency. In describing these tests here, I’ll categorize them similarly. Please note that there is certainly some crossover between categories, and the discussion here will be far from exhaustive.
The purpose is to illustrate some ways that coaches and medical staff can effectively monitor their athletes and ensure that they are in a state of health that will allow them to benefit from the training prescribed for them.
Some tests are basic and serve as a foundation for medical screening. A blood count will give some idea of the athlete’s oxygen carrying capacity when looking at hemoglobin and hematocrit. This is very rudimentary, but any panel of tests should start here. Likewise, a blood chemistry should be used to evaluate kidney function, liver function, and basic electrolyte levels. Neither a blood count nor a chemistry are often terribly useful in this setting, but they can serve to establish simple and inexpensive parameters by which certain symptoms may be evaluated.
Quantification of an athlete’s iron stores can provide very useful data for many types of athletes. An iron panel, including ferritin levels, should be monitored in endurance athletes and females, if not all athletes. Ferritin is an iron storage protein, and its decrease can be one of the first signs that an athlete is venturing into the early stages of Overtraining Syndrome or struggling with iron deficiency anemia. Again, this is one of the more common tests run, and it’s not terribly specific. But it is something that should be checked.
Delving into some more novel and, perhaps more useful tests, we’ll look at those which evaluate nutritional issues. Magnesium is an extremely important mineral for athlete performance and recovery. The serum magnesium level acquired in a standard blood chemistry is, however, a poor measure of available magnesium stores. A better option is to look at RBC Magnesium. This offers a much more accurate determination of available magnesium stores. Vitamins B12 and D are also easily measured. The B vitamins are essential to energy production, and Vitamin D works as a hormone in the body, affecting skeletal muscle function, testosterone production, and a host of other important processes. Also included in the nutrition category would be a lipid panel. With athletes, I’m concerned by cholesterol that is too low or triglycerides that are elevated. Cholesterol is vital to hormone production, cell membrane formation, and a properly functioning neurologic system. All are incredibly important for athletes. Elevated triglycerides are caused by a combination of systemic inflammation and intake of simple carbohydrates, neither of which are good for health or performance.
I also like to look at a resting insulin level and Hemoglobin A1c in athletes to evaluate for poor fueling strategies and developing insulin insensitivity. Rapid fluctuations in insulin levels, often due to a diet high in sugar, can be something that is quite detrimental to overall performance. These swings cause irregular availability of glycogen (a major fuel source for muscles), lead to insulin resistance, and can increase an athlete’s systemic inflammation.
Speaking of inflammation, there are a number of tests which can help to determine if an athlete is suffering from too much stress and too little recovery. Cortisol and hsCRP (“high sensitivity C-reactive protein”) can be used for this.
A morning blood cortisol is a decent marker, but there are other ways to check hormone levels which may be better. I use salivary testing because it is easy to get four or five samples throughout the day, establishing a better picture of this dynamic process. A single blood test gives only a snapshot, which is not ideal.
In the United States, I use a lab which is able to perform sophisticated nutritional testing on urine samples. This offers a great picture of each athlete’s individual nutritional requirements, from vitamins and minerals to amino acids and probiotic support. I find it to be indispensable in helping athletes know what they need to be eating and supplementing. It is much better to tailor such advice to the individual, rather than simply make blanket recommendations.
So to wrap up, here’s what I recommend as a comprehensive quarterly or bi-annual test panel to track athlete health and aid in optimization of performance.
- Blood count
- Blood chemistry
- Iron panel with Ferritin
- Lipid panel (with evaluation of lipid particle sizes)
- Fasting insulin and Hemoglobin A1c
- RBC Magnesium, Vitamin D, and Vitamin B12 levels
- Thyroid panel (TSH, free T3, free T4)
- 24hr salivary hormones (testosterone, estrogens, cortisol, melatonin)
- Nutrition panel via urine sample
The cost of such testing is a consideration, of course. While not terribly expensive, it’s not cheap. Depending on the level of the team (pro, amateur, etc), the budget is going to allow for different levels of expenditure. Work with your team doctor to determine which tests may be most useful and fall into your team’s budget. Some may be best reserved for annual testing, with others making up a simpler, quarterly panel.
In the end, the important thing is to be proactive. Athletes invest large amounts of time training to reach an elite or professional level. They expect coaches and medical staff to provide the resources to help them achieve their goals. Likewise, teams have much invested in their athletes. Aside from the obvious and necessary moral obligation to care for their wellbeing at all times, teams have a very real interest in ensuring that their athletes are healthy and able to perform optimally. Talk with your team’s doctor to determine a screening and monitoring plan that will best serve your team and your athletes.