Tiredness in Thal minor, aerobic activity supplements and Overtraining

Hi there , i am thal minor (I'm not totally sure o that), I'm 38 and i'm male.
I practice aerobic exercise: Running and also gymnastic .
Now I'm in a forced state of total rest, probabily for overtraining. I was doing 35km (12 for 3 days/week) plus 1 hour/day for other 3 days of only exercice (abs and light lifting).
I know... for a minor is too much. Is too much for only a week...and I followed this routine for the last 4 months !!!
Now I'm paying the bill...
I have been feeling exhausted

These are my recent results which were done 02 of December 2017

CBC:

WBC    5.58
neut#    3.41
Neut%   61.10
lymph#    1.64
lymph%   29.50
Mono#    0.42
Mono%   7.53
Eos#    0.06
Eos%   1.14
BASO#    0.05
Baso%   0.83
RBC       5.34
HGB      11.50 < (normally in the past was around 12.15 )
HCT      36.50 <
MCV      68.40 <
MCH      21.50 <
MCHC   31.50
RDW      17.30 >
PLT      201.00
MPV      14.10

Ferritin               190
Serum B12         852.00
Folates               9.9
Total Transferrin   216
Blood Glucose      84
Creatinine           0.92
Serum Uric Acid      5.3   >>>>>> I'm taking 150 mg of ALLOPURINOL, and in the past, without Allop. was between 8.5 ~ 9.5 !!!
                        and this probably was the cause of many joints pain        
Lipase         39
Amylase         85
GOT            24
GPT            14
Gamma Gt         15

Sodium         136 (limit ?)
Potassium         4
Chloride         106   
Magniesium      2.1   
Serum Iron      107


in the Urine test only Ph is barely normal, it's at 5.5

Blood pressure is 105/60 +-5 (90/50 last week!!) and the minimum pulse I took at rest was 33 (and actually 36) !!!
Normally at rest I had 43 ppm
I Know this values are tipical of parasympathetic overtraining, are them ?

I was (and at 50% after a week I'm) very very weak. I was very tired. Last week I couldn't walk up the stair, and until now it's difficult to move. It was very difficult also to get out the car. I stayed about a minute or two inside after a drive.
I don't like sunbath and I didn't go to the beach for last 2 summer (D vitamin deficiencies?)

In the last 4 months I've lost fat and my weight has dropped of 4/5 kg (I'm at 57kg now, and I'm 1.70 cm tall) because I was eating low quantity
of food (less than 1950 Cal) and exercising. Quality was very good.
I eat eggs, greek yogurth, 2 time/week turkey fillet and 2/week cod or other fishes.
Many vegetables of all kind included legumes. No saturated fats, No cheese, only olive oil and almonds/nuts.

I have been taking for last 10 days (daily) half a compress of supplement of "B" complex called BVITAL http://www.saninforma.it/prodotti-dietetici-e-integratori/b-vital-totale + a great amount of vitamin "C" (approx 500 mg and higher in two times) and 100 IU of "E" that was inside the "Animal Flex" complex (a supplements for Joints)

I'm HLAb-27 positive.
B12 is high/normal, isn't it ?
Even they appear normal, should folates needs to be supplemented ?
Should I do new tests ?
Take more or/and new supplement?
Could supplements help to me to continue my training or is impossible to mantain that pace ?
Sorry Too many questions. (But I have many doubts and I feel non only weak but also sad)

Thanks to all who want to reply

Regards

BitterBlood

My opinion is that a few vitamin pills are not going to help much with something like thalassemia. I can only share my personal experience, but when I had a strenuous training session, my body would often signal me that no diet in the world would be able to help it with a fatigue as strong as the one I was experiencing.

Every body is different, of course, and in cases of Thalassemia Minor the disease itself might not even be the biggest problem people have with their body. It can also be a problem consisting of multiple health issues.

Unfortunately, as Thalassemia Minor is often seen as 'causing no problems', it seems to me that we are lacking actual 'markers' that could help to explain why many people seem to have such a big problem with fatigue.

Often, as it is in my case, doctors are probably going to blame the fatigue on depression or other mental issues and while I'm not at all depression-free, I can say that after a training session my mental health seems to always improve dramatically, but at the same time my central nervous system seems to take a huge hit, so that people from outside see me very tired and think it's depression while I'm actually feeling a lot better than normal and just very tired.

To find out more, I think we'd have to test someone with Thalassemia Minor extensively, especially under stress, doing sports. I feel like we'd have to include a lot more values and tests in order to find something. I once had the idea that the fatigue we experience wasn't any low hemoglobin like in Thalassemia Major, but rather the compensation mechanism of the body that at least partially normalized those values in Thalassemia Minor.

If your immune system is taking care of an infection, it's also not 'for free'. People are usually feeling tired, have their nose running, have elevated body temperature and everything. How can medicine then simply assume that the compensation mechanism in Thalassemia Minor is 'for free', as if the body didn't have to use resources for it that would otherwise be used elsewhere in healthy people.

Thanks
I agree with you about compensation.
What was your experience about it ? (blood values , preassure pulse ect.)

I'm trying reducing fatigue with less training and beginning supplements

I've orederd this 2:
Folates (as calcium salt)
and Vitamin E (natural with mixed tocopherols)


https://www.lifeextensioneurope.it/optimized-folate-l-methylfolate-1000-mcg-100-vegetarian-tablets

https://www.amazon.it/gp/product/B00EY6K0DI/ref=ox_sc_act_title_3?smid=A2AUL9BJVZK6XN&psc=1

Searching for a time released vitamin C supplement i Found "LongLife C complex 500 t/r"

For Vitamin D I'll wait tests results because in Italy if you have deficiency of Vitamin D or if you have a connected desease you can have it for free by national health system.

https://en.wikipedia.org/wiki/Calcitriol

Any experiences ?

I do think you are probably trying to overdo it. Thal minors have limits and need to recognize them. Tennis legend, Pete Sampras talked about his thal minor in an interview after he retired, and said he kept it a secret so opponents wouldn't try to take advantage by trying to draw out matches. He recognized his limits and tried to dispatch every opponent as quickly as possible, so that fatigue would not be an issue.

But you are also being affected by something reported here quite a bit, high uric acid levels. Because your body produces defective red blood cells, RBC's in addition to good ones, these defective RBC's are filtered out mostly by the spleen in the process of hemolysis, which can lead to higher uric acid levels that do not drop with dietary adjustments. The good thing is you're using a med without sulfur in it, as some of the uric acid meds are sulfur based, and sulfur can add to hemolysis. Some thal minors are also affected by favism, in which hemolysis is caused by fava beans and a wide range of chemical fumes, and possibly other foods. Even synthetic scents used in perfume and cologne and soaps and detergents affect some minors. Exposure can cause temporary drops in the Hb level.

It has been discovered that thal minors do better when their B12 is near the high end of normal. This may also have some positive effect on the adrenal fatigue many minors report. Your level is good. I would suggest taking the 1000 mcg of folate with 1000 mcg sublingual B12 for maximum effect. As far as other nutrients, magnesium can have a positive effect on the health of RBC's (ignore test levels. Most of the magnesium in the body is not in the blood, leaving the test of little value), and L-carnitine has been shown to extend the life of RBC's and will also help to provide nitric oxide, NO which keeps the blood vessels flexible, allowing for better circulation. If you're not getting sun, your vitamin D level is going to be low. I'm Italian but live in a cold climate and I have to take vitamin D year round. After years of trying to reach an acceptable level that prevents seasonal affective disorder, I finally switched to 50,000 IU caps once weekly. It seems to work better than daily doses, which was also the experience of a top thalassemia doctor, who told me the high once weekly doses were the only way they were having good success raising the D levels to acceptable levels in thal majors. My experience has been the same. It's best if you can get the level in the 50-80 range.

Then I want to leave you with something new that contradicts everything I have ever read about thal minor and autoimmune disorders, which was there is no connection. I just found this tonight and I haven't had time to digest it all, but not only is there a connection, but a theory of how and why is presented. I don't know if this can be seen without registering, but this is the link.
https://www.researchgate.net/publication/51525463_b-Thalassemia_trait_association_with_autoimmune_diseases_b-globin_locus_proximity_to_the_immunity_genes_or_role_of_hemorphins

Conclusions
Near   the β-globin   locus   at   11p15.5,   there   are   specific  immunity  genes,  which  not  only  match  with  the autoimmunity   susceptibility   of   thalassemia   trait   but also   with   their   renal   disease   susceptibility   (e.g.,   the tetraspanin   CD151).   All   these   strongly   suggest   close gene  linkages  at  the  same  band  changing  the  disease susceptibilities    of    thalassemia    carriers.    Moreover, thalassemia-heterozygote   mutations   may   change   the expression   and/or   synthesis   ratios   of   hemorphins, which are derived via proteolytical cleavage of hemoglobin,  mainly  the β-chain.  Since  hemorphins  are  closely linked  to suppression  of  inflammation  and  neutrophil migration,  their  diminished    synthesis    could    make thalassemia    heterozygotes    prone    to    autoimmunity. Whatever  the relevant mechanism,  closer  investigation of autoimmunity-suffering   thalassemia   heterozygotes may provide very interesting mechanistic insights about the pathobiology of  autoimmune disease.

This may very well change much of the thinking about thalassemia minor.

Well.
Thank you for your helpful suggestion and for your time.
Very interesting the research about Thal minor and autoimmune disorders (unfortunatelly I didn't understand all...).
I'm very happy there is an hope with carnitine to do something useful for my fatigue and normalizing Uric acid level.
Yesterday I got Optimized folate 1000 from lifeextension with a freebie... Magnesium citrate 160mg. The best for sport.
I'll take both of them, but with Folate Il take it for a week and then I'll stop for some other days to see if there are side effect.
nice and slow at first.
First because I'm still afraid of this high dosage and some relating side effect
Second I also want to check if this form of methylfolte (calcium salt) will be well accepted by my body.

My doctor would like I consult an Hematologist.
I'll keep you posted after that. I hope with less doubts...
Until then I only have only few doubts:

About L-Carnitine:

    I've checked the forum, and I found that the dosage to take is 50mg/kg or about 500-->2000, not higher. Is this correct ?

    I didn't find anithing about the best chemical form (maybe proprionyl ?): Acetyl or L-cartinitine-tartarate (or other and not acetyl) ecc. I read that one is more effective for nervouse sistem health (Acetyl) and
    the other is first choice for fat mobilization.
 
    I also didn't find anything about Pharmaceutical Form: Liquid/tablets/losenge or capsule and which one has the best bioavailability.
 
Ehi  Andy, I'm Italian too!

Thanks again !

I have seen some research that suggests even higher doses (as high as 100 mg/kg) of L-carnitine can be beneficial in thal major. You can go higher than 2000 mg daily if you're seeing a benefit. It can help to build muscle, so a higher dose may be helpful to someone who has been quite active, like yourself. For its use in thalassemia, Acetyl L-Carnitine is preferred.

Thank you for your suggestion Andy.

A little update.
I've started E-400 and stopped 5-MTHT. next week I'll try them together.
No side effects since last friday, but fatigue is still here. I know folates couldn't change this situation even in a month and probably more, neither other vitamins.
Next week I will also receive results of 25(OH)D with calcium, T3/T4/Tsh.
Last news: The Haematologist told me it's important to make a genectic study.
I don't know what type of thalassaemia I have (alfa beta or other rare variations), She's  only sure I'm thal.

I'll keep you up-to-date

Bye.

The genetic study is a good idea if you can have it done.

HI
Here new test result:

25OHD : 7 < (Have we found the reason of fatigue/tiredeness ?)
FT3  : 1.37 (1.71-4.20) <
FT4  : 0.88 (0.70 - 1.85) =ok
TSH  :1.61 (0.35 - 4.94) =ok
Calcium 9.3 (8.4 - 10.0) =ok

Next week I will ask doctor for Vitamin D treatment with "DIbase 50.000 shots"
http://www.my-personaltrainer.it/Foglietti-illustrativi/Dibase.html

For genetic study, there is a waiting list. Probabily next month the Emathologist will call me for that, I hope...

Bye
Oh... And happy New Year to all!

Yeah, your D level is extremely low.

Hi Andy
After 3 months of supplementation here are the changes:

Increased Calories intake (200 Cal) surprisingly without any increase of fat mass
Vitamin D was at only 7, and, after 120 softgels of 5000 ui day (first 2 weeks I took two softgel) it is at 50.
I use Nowfoods brand. Very good.

Unfortunatly until now there is no possibilities to make Genetic tests, so my doctor send me to check my HbA2 and Hbf:

HbA2 = 6.1% Beta trait
Hbf=     2.9 %

Do you think I'm Beta Thal Minor ?

Since January I took Vit. E-400, methylfolate 1000 and Vitamin C 250x2
Now I added Acetyl-L-Carnitine, Ashwagandha and Magnesium Citrate powder (300~400 mg)

Here here new CBC result, but it is even worst than last time:

CBC:

   Last TESTS      TODAY TESTS
WBC        5.58         4.64
neut#      3.41         3.1         
Neut%   61.10         66.6
lymph#    1.64         1.1
lymph% 29.50         24.3
Mono#    0.42         0.3
Mono%   7.53         5.4
Eos#       0.06         0.1
Eos%      1.14         1.2
BASO#    0.05         0.0
Baso%    0.83         0.7

RBC        5.34         5.18
HGB      11.50 <      11.2 <
HCT      36.50 <      35.0 <
MCV      68.40 <      67.6 <
MCH      21.50 <      21.7 <
MCHC    31.50         32.1 <
RDW      17.30 >      16.3 >
PLT      201.00         141 (lower)
MPV       14.10         6.7 <

I checked also my Cholesterol value
It's common with thals have low Hdl value ?

Glucose   85
Total C.   138
LDL      66
HDL   49 <
Try.      69

Serum Uric Acid  last time was    5.3, now it's at 6.2


I Think Folate doesn't work well with me. Need B12 even it was High in the test?
Still Avoid Iron ?

I reduce exercise with no more than 40 minutes of intense cardio training (plus 30 minutes of only walking) and no more than 30 minutes of light lifting (not at the same work out).
There is a light decreased of fatigue , but not significantly, and I suppose it's only for less exercise and higher calories intake.

@bitterblood79,

How often do you do "high intensity" exercises?  Excessively strenuous endurance work every day for 40 minutes even for non-thals can cause symptoms of overtraining.


you should mostly focus on steady-state training, sustained at <140bpm for 30+ minutes

I usually do cardio (running) in the Morning : 17 min walk for warm up + 40 min running + 13 walking for slow down. This only for 4 days a week
Every evening I do light weight training or Abs (I alternate) for not more than 15/30 minutes

BitterBlood

Yes, definitely beta minor. The high HbA2 is conclusive.

While LDL is often low in thal minors, HDL is usually within range. While yours is low, it is not in the at risk category. If you've used any steroid drug or testosterone booster, it could lower the HDL.

Your B-12 level is solid. If it got there by taking B-12, continue. If it's that high without supplements, don't bother. If you show no Hb improvement with folate and B-12, you probably won't benefit from supplements.

Don't take iron unless you have a full iron panel that conclusively shows iron deficiency.

That was a great turn around on your D level. It took me years to get there.