Cupertino High School Track

Before you read on and decide that the following is either gospel or garbage, let me suggest that it's neither. I'm addressing a medical issue, but I'm just a high school track coach with degrees in English and Physical Education. I have no medical training, but I have watched enough athletes fade mysteriously from super-fitness to super-misery that I started researching the possible causes.

More than anything else my questions led to the same answer: Iron. Too often we've attributed declining performances among high school athletes (especially girls) to structural changes relating to puberty or injuries resulting from overtraining. It's my belief-and I'm not alone here-that a great many of those cases are caused directly from iron depletion and could be remedied with proper nutrition and supplementation.

But don't take my word for it. Do your own research; talk to you coach, parents and doctor and make an informed decision about what's right for you. For starters though, you can continue reading and find out what I've learned over the last few years.

Iron is a particularly important mineral for endurance athletes due to its role in binding oxygen, which is circulated through the lungs and to the working muscles. Unfortunately, our bodies absorb only about 15% of the iron we ingest, and distance runners do just about everything possible to deplete the iron that they do consume.

Iron is lost through sweat and gastrointestinal irritation. It is temporarily lost through "footstrike hemolysis" (bursting blood cells through foot impact with the ground). Iron absorption is inhibited by calcium, coffee, tea, carbonated beverages and non-steroidal anti-inflammatories (all that ibuprofen some of you swallow). Women lose a substantial amount of iron through menstruation, making them more susceptible to iron depletion, but it is a concern for all distance runners-male and female.

Anemia, clinical iron deficiency, is not rare among runners, but even more common than iron deficiency is "iron depletion" due to low ferritin stores. Ferritin is an iron-containing protein that is primarily responsible for iron storage in the bone marrow. It is common among distance runners to have acceptable hemoglobin and hematocrit counts even when ferritin levels are severely depleted. For less active people, low ferritin levels are much less significant and don't often draw the attention of medical professionals.

However, the results of low ferritin levels for distance runners are significant. While iron depletion rarely results in the general lethargy associated with true iron-deficiency anemia, distance runners with low ferritin will likely experience abnormal exhaustion, increased blood lactate, slow recovery, declining performances, heavy legs, muscular tightness, loss of motivation, and substantially increased risk of injury. Does any of this sound familiar?

And there's more. Overuse injuries (the type of injuries distance runners get) double with ferritin levels under 20 and triple with levels under 12. I think it's safe to suggest that iron depletion is rarely considered to be the root cause of these injuries. Instead we focus on mileage, running surfaces, shoes and the other usual suspects. If you were nodding your head thinking the previous symptoms sound like a checklist of your most recent season, go get your serum ferritin tested.

People within the medical and running communities have been aware of anemia for decades, but the prevalence and severe impact of iron depletion (low ferritin) is still far too much of a secret. The normal range for serum ferritin levels depends on whom you talk to. I have read everything from 50-150 nanograms per milliliter (ng/ml) to 10-300 ng/ml. However, we know that the lower the ferritin level, even within the "normal" range, the more likely a person is iron depleted. Virtually all female distance runners who have been training for a year or more are well below 50 ng/ml unless they take supplemental iron.

At South Eugene High School, we became aware of the consequences of low iron in the spring of 2001 when three of our female distance runners all came back from blood tests with ferritin levels below 10 ng/ml. All three had all run their best times two years before but had been plagued with injuries and frustration since. During those two years, they had multiple blood tests, but the doctors never checked their serum ferritin levels.

Within four weeks of beginning an aggressive supplementation program, all three felt substantially more energy while running; their enthusiasm and joy for running returned, and they began to run much faster. Within two months, their levels were between 35 and 55 ng/ml. All three went on to compete collegiately and ran times far superior to what they ran in high school.

Since that initial experience, we have suggested that all the girls on the team have complete iron tests. Only five out of the dozens who have been tested, have been within the acceptable range for serum ferritin, and those five were either big meat eaters or had been taking supplemental iron for years. Half of the girls tested have been below 12 ng/ml.

Most of those tests were conducted at the beginning of the year, giving the girls enough time to boost their levels by the end of the season. It makes better sense to have everyone tested (boys and girls and absolutely all vegetarians) long before the season begins, so that any deficiencies can be addressed before the more strenuous training begins. Obviously, the best attack against this problem is not allowing it to occur in the first place. Those taking supplemental iron and eating an iron rich diet will most likely never develop an iron deficiency.

When a blood test reveals that iron supplementation is called for, there are many options for correcting the deficiency. Begin by increasing the amount of iron-rich foods and foods high in Vitamin C in your diet, avoid caffeine with meals, use cast iron cookware, and consider taking supplemental iron.

With our athletes, we have noticed significantly faster and more dramatic results among those who are supplementing with ferrous sulfate or ferrous gluconate elixir and ascorbic acid than with those who have taken iron tablets. Obviously, this is something that should be undertaken only after consulting with a physician, but many doctors still appear to be unaware of the problem of iron depletion. You may need to educate your doctor before your doctor can help you.

As a competitive distance runner, you should know about the importance of iron, but it's not a cure-all, and it should be a blame-all either. I've had a few athletes develop instant cases of iron depletion the day after a hard workout or a late night of homework. It doesn't work that way. Iron consumption is only one piece of the big nutrition puzzle, and nutrition is only one piece of the enormous How-to-be-the-best-runner-I-can-be puzzle, but if you're truly devoted to completing the enormous one, you might help yourself get there by giving your doctor a vial of your well-pumped blood.

(Jeff Hess grew up in Eugene when it was the running mecca and states that he is looking forward to "being part of its renaissance". Jeff coached 25 state champions at Glendale High School (OR) between 1990 and 1999. He then came back to his alma mater, South Eugene High, in 1999 and served as an assistant track coach and co-head cross-country coach until taking both head positions in 2003. The SEHS girls team was the Oregon State XC champs in 2001, runners up in 2002 and 2005, and the boys were runners-up in 2004.

4-time Oregon high school state champion
Junior National Champion - Steeplechase 1979
High School National Record Holder - Steeplechase 8:50.1
US Olympic Trials finalist 1984 - Steeple PR of 8:25.41)

Feed your hungry jocks foods to fuel performance

A scary thing happens in the kitchen when a kid, who used to scarf down half the pantry and call it "just a snack," decides to take up an uber-taxing sport. And then decides he is going to eat like the pros.

We went with the latter when the lanky 6-foot-3 kid in our house decided to become a varsity rower and put us to the test.

We turned to the sports nutritionist Harper's Bazaar calls "one of the top 10 experts to help revamp your diet" -- and who counts among her clients elite athletes and pros, including the Stanley Cup-winning Chicago Blackhawks, the Miami Heat's Dexter Pittman and the Minnesota Twins' Jim Thome.

Julie Burns, founder of SportFuel Inc., and the mother of high-school-age triplets, has long been a walking encyclopedia of supernutrition.

Here's her Gospel for Hungry Jocks (and those who feed them): "What we tell athletes and kids: Eat foods that will rot and spoil, but eat them before they do."

She explains: "Say you have a box of (sugary cereal) that you leave over winter at some cabin in the woods. You come back the next summer, you can still eat it. But with foods that rot, the reason they become not edible is that they're alive and they have enzymes. What creates high performance is clean protein, healthy fats and minimally processed carbohydrates with all the nutrients and enzymes nature packaged with them."

Instead of grabbing a bagel, she says, scramble eggs and grab a bowl of raspberries. You need the antioxidants and the protein.

She knows too well what kids will eat if they're at an all-day swim meet, or a rowing regatta, and the booster club -- with best intentions -- hauls in a groaning board of granola bars, PB&J and juice bottles.

"You want to make every bite count," she says. "So think ahead, pack a cooler of real foods: hard-cooked eggs, plain yogurt, turkey jerky, pumpkin seeds, nuts, and dried and fresh fruits."

Give these tips from Burns to your teen athletes and tell them: No need to tackle all of 'em at once. Just take one at a time, and watch what happens to your sports performance.
Consider grass-fed beef. It contains higher amounts of omega-3 fatty acids, GLA (gamma-linolenic acid, an omega-6 fatty acid), vitamins A and E, and zinc, essentials all.
Add a green drink (a fresh or powdered blend of an alphabet of fruits and greens) to your daily regimen to boost your vegetable consumption.
Add lemon to water whenever possible; it helps to alkalize your body, which makes you feel good.
Drink at least one 8-ounce cup of green tea each day. Its wonders are too long to list.
Chow down on carbohydrates and some protein in liquid form -- whey with colorful fruit juice and even coconut water -- as soon as possible after your workout.
Brazil nuts will boost selenium intake and may have anti-cancer properties.

Colleges are beginning to put more emphasis on students' shut-eye

As college students return to campus, they're showered in the usual handouts of coupons, condoms and credit cards. But some schools are also giving students what a growing body of research reveals could make a huge difference in their college careers: ear plugs, sleep shades and napping lessons.

College health officials are finally realizing that healthy sleep habits are a potential miracle drug for much of what ails the famously frazzled modern American college student: anxiety, depression, physical health problems and – more than most students realize – academic troubles. Some studies have found students getting adequate sleep average a full letter grade higher than those who don't.

But adolescent biorhythms make it hard enough for college students to get the sleep they need, a recommended nine hours. On top of that, campus life turns out to resemble a giant laboratory experiment designed for maximum sleep deprivation: irregular schedules, newfound freedom, endless social interaction, loud and crowded housing, late-night exercise and food washed down by booze, coffee and energy drinks. Campuses pulsing with energy at midnight by mid- afternoon resemble Zombie U, with students dozing in library chairs, on yoga mats and even in coffee shops.

Technology isn't helping, with wireless Internet adding to the 24/7 distractions and students sleeping with their smartphones on. That likely helps explain data showing college students got about eight hours of sleep in the 1960s and '70s, seven by the '80s, and, according to more recent surveys, closer to six these days.

Campaigning recently, even President Barack Obama told some students at an Ohio State University diner that he assumed "you guys have arranged it so you don't have really early morning classes."

No such luck.

"Actually, I failed that," one student replied, telling the president he had one at 8 a.m. the next day.

Now, some counselors and health officials are trying to get the message out in creative ways. At tiny Hastings College in Nebraska, student peer educators plop down a bed in the middle of the student union, dress themselves in pajamas, and talk to passers-by about sleep. Macalester College in Minnesota publishes a "nap map" listing pros and cons of various campus snooze sites. And many schools offer seminars on napping (basic lesson: short naps work best).

The University of Louisville is even planning a campus-wide "flash nap" – think of a flash mob but with sleeping, not dancing – later in the school year. ("We have to arrange in it advance so our public safety folks know it's not an epidemic of something," said director of health promotion Karen Newton).

Still, given the scope of sleeping problems, what's surprising is that such efforts are exceptional. Major, campus-wide campaigns appear rare or nonexistent. Experts say professors (and doctors) aren't always good sleep role models. As for deans and administrators, many seem hesitant to tell parents who've just dropped $50,000 on tuition that the big push on campus this year will be for everyone to sleep more.

While awareness is growing, at most schools sleep efforts amount to a few posters on campus or perhaps a few lines in a quickly forgotten talk during orientation week. While about three-quarters of college students have indicated occasional sleep problems, the latest National College Health Assessment found about the same proportion reported receiving no information from their school about sleep (though it's possible, in their sleepiness, some forgot).

"The average student is functioning with a clinical sleep disorder," said Lee Ann Hamilton, assistant director of health promotion and preventive services at the University of Arizona, describing research conducted on students there. They average about 6 1/2 hours per night (though students tend to over-report in such surveys).

But sleep time and quality measurements declined over the course of the academic year, while anxiety, depression and conflict with family, friends and roommates all rose.

Hamilton's office has been sending students a "Snoozeletter" with sleep tips.

As described by junior Sara Campbell, residence hall life at UA makes it hard even for students trying to sleep – constant late-night chattering, visitors coming and going, early morning cleaning crews. She aims to be asleep by 12:30 a.m. or so, but was dumbfounded to find girls on her hall regularly pulling all-nighters for papers and exams – basically academic suicide, the research shows.

"Not to speak bad of them, but a lot of them are freshmen and just decided to wait 'till the last minute," she said. Her big challenge was managing with a roommate who tries to keep earlier hours; this year the pair are moving off-campus together where they'll have separate bedrooms.

Still, Campbell is applying what she's learned about sleep as a psychology major. This year, she's arranged her schedule to have classes and work start at 8 a.m. every day of the week. That will be tough, but commits her to avoiding the destructive pattern that traps many college students – getting up early one day, then sleeping late the next.

"Regularity is key," Campbell said. "You can pick a schedule here and have a different time to get up every day, but going to bed at a different time every night, it wears on your body."

College mental health professionals are increasingly asking students about sleep right away, finding it's often the low-lying fruit for helping students with a range of issues.

"When you find depression, even when you find anxiety, when you scratch the surface 80 to 90 percent of the time you find a sleep problem as well," said University of Delaware psychologist Brad Wolgast.

Many students who think they have attention deficit hyperactivity disorder are often just sleep-deprived. Some simple steps to improve "sleep hygiene" are usually far preferable to prescribing drugs. (Wolgast is also seeing more students who've been prescribed sleeping pills, which he says usually harm sleep patterns more than help).

"On a campus they're dealing with alcohol, cocaine, marijuana, Ritalin abuse, sexual assault," Wolgast said. In comparison, sleep "looks like a small problem. But the truth is if I could wave a magic wand and change everybody's sleep, there would be fewer problems with pretty much everything else."

But Wolgast and others don't have a magic wand, and have concluded that nagging students, or fighting the campus culture, is hopeless. Running napping classes – pitched as ways to help students maximize their sleep – has proved a more effective pitch.

Students also happily accept earplugs. Hastings, with just 1,200 students, orders them in bulk from a manufacturing supply company and hands out thousands, said Beth Littrell, director of campus health services.

The guru of the college sleep crusade is James Maas, who over 48 years taught more than 65,000 students in Cornell University's most popular class – a sleep-focused version of introductory psychology. Maas evangelized to his students and experimented on them as well, asking them to wear sleep-monitoring headbands and showing them magnetic-resonance images of the brains of sleep-deprived college students.

"You can see that nothing is going on in their brains," Maas said. "Literally nothing."

Confronting students with such photos, along with hard data on how sleep undermines academic performance, is the most effective way to change behavior, Maas said. Still, he'd like to see colleges do more: ending early classes, sound-proofing and air-conditioning dorms, putting sleep education into the curriculum.

The people most receptive to his message on campus are usually coaches. A few years back, he made his pitch to Cornell's basketball coach, who stopped morning practices. The next year the Big Red became the first Ivy League team since 1979 to advance to the Sweet 16 of the NCAA men's basketball tournament.

Sleep efforts have paid off at a number of boarding schools. After Maas spoke at the Deerfield Academy in Massachusetts in 2007, the school moved the start of classes from 7:55 to 8:30 a.m., cut sports practices and homework expectations 10 percent each, and got students back into dorms earlier at night.

The results? Twenty percent fewer student visits to the health center (in a bad flu year); 17 percent more students taking time for a hot breakfast, and a record increase in GPA. Also, several Deerfield sports teams enjoyed unexpectedly good years, thanks to late-season surges.

Of course, boarding schools have more control over students than colleges. But Deerfield Headmistress Margarita Curtis said that's no excuse for higher education. She said Deerfield's efforts worked because students bought into them.

"You need to appeal to their intellect," she said. "They responded because they saw that correlation. They saw if you get that extra hour of sleep, this is what happens in your brain, what happened to that athlete."

25 Horrible Things That Happen If You Don't Get Enough Sleep

Everyone knows that it's important to get enough sleep — but you may not realize just how many things can go wrong when you don't.

Here are 25 unfortunate risks of partial and total sleep deprivation, some more common than others.

"Complaints of irritability and [emotional] volatility following sleepless nights" are common, a team of Israeli researchers observed. They put those complaints to the test by following a group of underslept medical residents. The study found that the negative emotional effect of disruptive events — things like being interrupted while in the middle of doing something — were amplified by sleep loss.

Scientists don't yet know exactly why sleep deprivation leads to headaches — but it's a connection doctors have noticed for more than a century. Migraines can be triggered by sleepless nights, and 36 to 58% of people with sleep apnea wake up with "nondescript morning headaches."

Sleepiness has long been an issue among adolescents. One study of middle school students found that "delaying school start times by one hour, from roughly 7:30 to 8:30, increases standardized test scores by at least 2 percentile points in math and 1 percentile point in reading."

But it's not just kids. Short-term memory is a crucial component of learning, and sleep deprivation significantly impaired the ability of adult volunteers to remember words they'd been shown the day before. In another study, researchers found that while people tend to improve on a task when they do it more than once, this isn't true if they are kept awake after they try it the first time — even if they sleep again before doing it again.

People who are underslept seem to have hormone imbalances that are tied to increased appetite, more cravings for high-calorie foods, a greater response to indulgent treats, and a dampened ability to control their impulses — a very dangerous combination. It's true that you burn more calories when awake, but not nearly enough to cancel out the many excess calories you consume when exhausted.

Sleep deprivation is associated with tunnel vision, double vision, and dimness. The longer you are awake, the more visual errors you'll encounter, and the more likely you are to experience outright hallucinations.

When researchers kept people awake for 88 hours, their blood pressure went up — no big surprise there. But even subjects who were allowed to sleep for 4 hours a night had an elevated heart rate when compared to those getting 8 hours. Concentrations of C-reactive protein, a marker of heart disease risk, increased in those fully and partially deprived of sleep.

Your reaction time is severely impeded when you don't get enough sleep. When researchers gave West Point cadets two tests that require quick decision-making, some were allowed to sleep between the tests, while others were not. Those who had slept did better the second time — those who had not did worse, and their reactions slowed down. A study in college athletes found similar results.

You know that great thing your immune system does, where when you get an open wound of some kind it doesn't always get infected immediately? Prolonged sleep deprivation and even one night of sleeplessness can impede your body's natural defenses against microorganisms.

Planning to make some changes to your portfolio? You might want to make sure you're well-rested. "A single night of sleep deprivation evoked a strategy shift during risky decision making such that healthy human volunteers moved from defending against losses to seeking increased gains," researchers concluded.

When people sleep, the body slows down its normal urine production. This is why most people don't have to pee in the night as much as they do during the day. But when someone is sleep deprived, this normal slowdown doesn't happen, leading to what researchers call "excess nocturnal urine production." This condition may be linked to bed wetting in children and, in adults, it's tied to what's called nocturia — the need to use the bathroom many times during the night.

Having trouble paying attention to what you're reading or listening to? Struggling with anything that requires you to truly focus? "Attention tasks appear to be particularly sensitive to sleep loss," researchers have noted. If you want to stay alert and attentive, sleep is a requirement. Otherwise, you enter "an unstable state that fluctuates within seconds and that cannot be characterized as either fully awake or asleep," and your ability to pay attention is variable at best.

Vaccines work by spurring your body to create antibodies against a specific virus. But when you don't sleep, your immune system is compromised, and this doesn't work quite as well. In one small study, 19 people were vaccinated against Hepatitis A. Ten of them got 8 hours of sleep the following night, while the rest pulled an all-nighter. Four weeks later, those who had slept normally had levels of Hepatitis A antibodies almost twice as high as those who'd been kept awake.

Another study found that a sleepless night did not have a long-term effect on immunity after a flu vaccine, it concludes that the effect might be specific to certain diseases. "Sleep should be considered an essential factor contributing to the success of vaccination," the Hep A researchers wrote.

Severe sleep deprivation might make you sound like a bumbling idiot — much like having way too much to drink. "Volunteers kept awake for 36 hours showed a tendency to use word repetitions and clichés; they spoke monotonously, slowly, [and] indistinctly," one study noted. "They were not able to properly express and verbalize their thoughts."

If you're wondering why you're sick all the time and seem to pick up every bug that travels around the office, it's probably because you're not getting enough sleep. When a group of 153 people were exposed to a common cold, those who had gotten less than 7 hours of sleep in the two weeks prior were almost 3 times more likely to get sick than those who'd had 8 or more hours of sleep. How well you sleep is also a factor – those who had spent 92% of their time in bed actually asleep were 5.5 times more likely to catch a cold than those who had been peacefully slumbering 98-100% of the time they were in bed.

One in 250 Americans suffer from Inflammatory Bowel Disease (IBD), and sleep deficiencies make its symptoms much worse. Regular sleep loss also makes you more likely to develop both IBD and inflammatory bowel syndrome, which affects an estimated 10-15% of people in the U.S. And patients with Crohn's disease were twice as likely to experience a relapse when they weren't getting enough sleep.

Drowsy driving is often compared to drunk driving: You really shouldn't do either. "Motor vehicle accidents related to fatigue, drowsy driving, and falling asleep at the wheel are particularly common, but often underestimated," one review concluded. Pilots, truck drivers, medical residents, and others required to stay awake for long periods of time "show an increased risk of crashes or near misses due to sleep deprivation."

Testosterone is an important component of sexual drive and desire in both women and men. Sleeping increases testosterone levels, while being awake decreases them. Sleep deprivation and disturbed sleep, consequently, are associated with reduced libido and sexual dysfunction, and people suffering from sleep apnea are at particular risk.

People in pain — especially those suffering from chronic pain — tend not to get enough sleep. This makes sense: Pain can wake you up in the night and make it hard to fall asleep in the first place. But recently, researchers have begun to suspect that sleep deprivation may actually cause pain or at least increase people's sensitivity to pain. One study found that after research subjects were kept awake all night, their pain threshold — the amount of painful stimulus they were able to endure — was lower.

Being awake when your body wants you to be asleep messes with your metabolism, which in turn increases your risk for insulin resistance (often called "pre-diabetes") and type 2 diabetes. "Interventions to extend sleep duration may reduce diabetes risk," one study in adolescents concluded. And four large studies in adults found a strong association — though not a cause-effect relationship — between regular sleep loss and the risk of developing diabetes, even after controlling for other habits that might be relevant.

Most people notice that when they're sleepy, they're not at the top of their game. One study found that one sleepless night contributed to a 20-32% increase in the number of errors made by surgeons. People playing sports that require precision — shooting, sailing, cycling, etc. — also make more mistakes when they've been awake for extended periods of time.

Scientists are just beginning to investigate the relationship between sleep and cancer, and different kinds of cancer behave differently. But since disrupted circadian rhythm and reduced immunity are direct results of sleep deprivation, it's no surprise that preliminary research seems to indicate that people who don't get enough sleep are at increased risk for developing certain kinds of cancer, most notably colon and breast cancers.

Sleep disruptions in the elderly can lead to structural changes in the brain that are associated with impaired long-term memory — and sleep-related memory deficits have been observed in the general adult population as well. As early as 1924, researchers noticed that people who slept more forgot less. Poor sleep and not enough of it have also been linked to higher levels of β-Amyloid, a biomarker for Alzheimer's.

A 2013 study shed some light on why sleep is tied to so many different aspects of our health and wellness. Poor sleep actually disrupts normal genetic activity. After one week of sleeping less than 6 hours per night, researchers found that more than 700 genes were not behaving normally, including some that help govern immune and stress responses.

Some genes that typically cycle according to a daily (circadian) pattern stopped doing so, while others that don't normally follow a daily pattern began doing so. What does this mean? Just one week of less-than-ideal sleep is enough to make some of your genetic activity go haywire.

In a classic study led by Nobel Prize-winning psychologist Daniel Kahneman, a group of 909 working women kept detailed logs of their moods and day-to-day activities. While differences in income up to $60,000 had little effect on happiness, a poor night's sleep was one of two factors that could ruin the following day's mood. (The other was tight deadlines at work.)

Another study reported higher marital happiness among women with more peaceful sleep, although it's hard to say whether happy people sleep better, better sleep makes people happier, or — most likely — some combination of the two. Insomniacs are also twice as likely to develop depression, and preliminary research suggests that treating sleep problems may successfully treat depressive symptoms.

Many health problems are associated with sleep deprivation and poor sleep, but here's the big one: People who consistently do not get 7-8 hours of sleep are more likely to die during a given time period. Put more simply: We all die eventually, but sleeping too little — or even too much — is associated with a higher risk of dying sooner than you otherwise might.

Iron Depletion: What you and your doctor need to know

Feed your hungry jocks foods to fuel performance

Colleges are beginning to put more emphasis on students' shut-eye

25 Horrible Things That Happen If You Don't Get Enough Sleep