adamrice 

Not sure if this belongs in 50+. Let's find out.

I'm a long-time cyclist, but have been training more intensively and more methodically since the pandemic hit. If you had asked me a few months ago, I would have told you I was in excellent shape. Then I had my annual physical and found out all the things that are wrong with me.

Then about a month ago, I was riding an interval session on my stationary trainer. 4 × 10 min @ 105% FTP. This is one of the harder interval workouts I do, but I've done it before and know I should be able do it. I barely got through the first interval. I lowered the resistance for the subsequent intervals to 90%. Got through the second and third; got halfway through the fourth and had to abandon even that. I knew something was wrong. Another high-intensity session a few days later was even worse.

Went to see my doctor. Labwork showed that my folate is at the bottom end of "normal" and that I was anemic (folate deficiency can cause a type of anemia). That would explain the unexpected fatigue levels. This had not shown up on labwork just a couple of months before--granted, they don't normally test for folate, but I know my hematocrit had been fine. Apparently folate deficiency is rare, usually only seen in alcoholics (I'm not). It's usually related to diet, but my diet hasn't changed.

I'm curious if anyone else has seen the sudden appearance of anemia or folate deficiency, and what you did about it. I'm taking folic acid daily now. Not sure how long it will be before it makes a noticeable difference. Less intense workouts feel about the same as before, and my average heartrate during them is about the same, but I'm keeping resistance at 90% FTP or lower for now.

Also, FWIW, this is an unexpected (to me) benefit of having a smart trainer and a regular workout routine: it would be too easy to chalk that up to an "off day" and let it go if I weren't measuring power output and didn't already have a baseline established.

pdlamb

At the risk of sounding like Cassandra, are you sure you've got cause and effect straight? Could you have something causing anemia which is draining the folate from your system?

adamrice 

I don't know enough about it to say—that's the explanation I was given by my doctor's office. My own reading on Wikipedia didn't mention anything about anemia being the cause of reduced folate levels.

Schwinneffect

I only learned recently that freezing reduces the folate content of veggies. By the 6 month mark in the freezer, much of the folate is gone. I eat a lot of vegetables, but frozen more so than fresh due to convenience. I think liver is a good source of folate and freezes well.

ScottRiqui

I was surprised by low hemoglobin levels about a month ago when for the first time in my life, I was turned away from donating blood (my level was 11.5, and "normal" is 13.5-17.5. No changes in my diet other than quantity, although since the beginning of the year I've lost about fifty pounds and taken up cycling. My doctor confirmed the hemoglobin level and told me that losing weight and greatly increasing exercise can deplete the iron reserves and hemoglobin levels in your body. He put me on an iron supplement, and when I donated blood last week my hemoglobin level was back up to 15.0.

marquhar

This problem is complicated, but well known,
Since 1998 all refined grains & flour have added folic acid (FA), by law. It has to do with neural tube defects. However, FA is not folate and is not L-5-methyl-folate which is what your body actually uses. FA is a synthetic and needs an extra handful of enzymatic steps to even begin to be used - more steps than folate needs.

As you consume pizza and refined breads/cereals the FA accumulates in your body and actually clogs the enzymatic pipeline to convert folate to L-5-methyl-folate. So, taking FA is counter-productive and can cause additional problems as mentioned.

You are better off consuming anything from the cabbage family, plus kale, and spinach. I like cole slaw.
Another approach is to supplement with methyl-folate and methyl-B12 together. This will help you get useful folate quicker and get around the clogged pipeline caused by FA. I like the Jarrow products, especially the 1000 mcg B12 with 400 mcg of Methyl Folate.

Its also possible that you have a common SNP on the MTHFR gene (C677t) which lowers your FA conversion efficiency by 75%.
Doctors rarely test for this mutation, but it will show up in a 23andme genomic medical profile.

Can you confirm that the anemia you have is macrocytic anemia, where the RBC size is too large and mis-shaped?

cheers,

canklecat

Those kinds of deficiencies -- assuming a healthy diet -- are often associated with more complex problems. Trying to fix a deficiency in (x) can end up with years of tail chasing. Been there, mostly due to a hodge podge of doctors varying in competence and diligence.

If possible try to get a complete physical including questions and tests to check for endocrine system disorders, an auto immune disorder, including exposures to viruses and other pathogens that can have delayed long term side effects. We're just beginning to realize that so-called "respiratory" viruses have serious long term consequences that may have delayed onset, affecting the cardiovascular system, arthritis, inflammatory diseases, etc.

And even common rhinoviruses can have long lasting effects on our energy, sense of smell, taste, etc. Another is mononucleosis or Epstein-Barr, a viral disease that can cause long lasting debility in some people (it effectively ended the career of cyclist Mark Cavendish).

In my case early onset osteopenia, deficiencies in vitamin D, calcium, anemia, etc., were related to Hashimoto's, an auto immune disorder I've had for years that suddenly worsened a few years ago. I neglected my health and ended up with thyroid cancer in one lobe. Fortunately that was removed with surgery two years ago today. I get a couple of times a year to check the remaining lobe for cancer. So far, so good.

Working back through my complete medical history, it appears my Hashimoto's resulted from an exposure to hepatitis (I was a hemodialysis nurse and many of our patients had hepatitis), and gamma globulin shot (now called immune globulin) to treat the hepatitis. That was in 1981. I had an immediate bad reaction to the gamma globulin and had to drop out of college for the rest of that semester. Before then I'd been very active, competitive in amateur boxing, cycling and racquetball. After that it was years before I was physically active again, and my family said I was never the same again. It's hard to see from my limited perspective because it seemed like I was doing better. But I tended to overlook or forget a series of seemingly unrelated health problems that accumulated over the decades.

I didn't make the connection until about 15 years ago when a doctor did a complete medical history and suggested a thyroid supplement (synthroid or levothyroxine). It was a low dose, 25 mcg, but seemed to help. However I moved to another county, ran out and didn't bother to renew the prescription. The condition worsened so gradually I didn't notice how bad it had gotten until 2018.

But the various deficiencies persist, despite taking a fistful of supplements twice a day. I have some good days, but am often inexplicably exhausted other days.

I've seen a bunch of doctors, including immunologists, ENT, ortho, etc. They're all fine for essential health care needs. But I'm pretty much on my own for trying to maintain the level of fitness I know I'm capable of. I suspect it's because my docs are accustomed to patients my age who are obese, sedentary, smoking and drinking too much, and not really trying to improve (disappointingly common among fellow veterans I see at VA clinics). So in comparison I suppose I seem like I'm doing fine. But that's compared with a very low bar.

The past couple of years I've added some supplements: vitamin D (and I get outdoors in sunlight more often, sans sunscreen or long sleeves); calcium; iron; B complex; bromelain and bee propolis for chronic rhinitis; beta ecdysterone, an analbolic agent derived from some plants, shellfish and bug exoskeletons. The most common source for ecdysterone comes from Asian plants that aren't considered "food", although some greens like spinach contain small amounts. I've found a couple of brands that seem to work. I took ecdysterone supplements for several months, then quit using it for a couple of months to see if I noticed any difference. I gradually felt exhausted again and resumed taking it a week ago and already feel more energetic. I even began jogging again this week, first time in 30+ years. I've mostly bicycled and walked, but decided to try jogging a little at a time this week. So far, so good.

I'm wary of making exaggerated claims for this stuff. I don't know whether there's any way to test or prove it works. But it's worth a try if the conventional stuff doesn't seem to help.

Iride01 

Have they also checked your serum B12 levels?

If those are also low, then the two things might be working or actually not working to keep your folate levels at a proper level. I think.... seems the two things have a relationship that I've not delved into very deep into.

But green leafy vegetables of any sort will generally have folates. Asparagus being a favorite. If you are vegan or vegetarian you do have to be careful you get B12 from somewhere. A lack of B12 that might impact your folate levels..... again, I think.

B12 and folates are something that I don't think the average family doctor understand well. Usually I find better information about such from Neurologist's and Hematologist's.

I've got pernicious anemia and have to give myself B12 injections because I can't absorb enough from foods. Unless it's something like liver which has a mega dose of B12 in a serving.