Sleep & Circadian Rhythms – 6-Tips from World-Experts

Sleep is fundamental to human health and performance.

Over the last decade, the research on sleep and athletic performance has exploded, highlighting the dramatic impact of sufficient rest on an athlete’s ability to train, recover and perform. 

Talk to any strength and conditioning coach and they’ll likely say, ‘for sure, I focus on sleep’. Talk to any nutritionist or practitioner and you’ll probably hear ‘yep, I emphasize sleep with my athletes’. Talk to any athlete and they’ll say ‘yep, I know sleep is important’.

Today, everyone ‘knows’ sleep is good for athletic performance but here is the uncomfortable truth; athletes still aren’t getting enough sleep!

Are Athletes Getting Enough Sleep?

Despite all the science, social media coverage and focus in high performance and clinical circles, athletes are still struggling to achieve sleep recommendations. 

In fact, the research shows athletes are remarkably poor at rating their own sleep quantity and quality. 

In elite national-level athletes, recent study of over 800 participants found 75% were not getting 8 hours of sleep per night, and more alarmingly, 11% were not even getting 6 hours of sleep nightly.(1)

What about Olympic-level athletes? Surely, they optimize sleep to support optimal recovery and performance? Not quite. Olympic athletes consistently show poorer sleep quality and more fragmented sleep than age and sex-matched controls.(2)

Why do athletes still struggle with sleep? Athletes are people too. Balancing training, work commitments, family and personal life takes up a lot of time in the day. Unfortunately, sleep gets the short end of the stick. 

It’s not just athletes. The general population averages 6.5 hours of sleep per night, below the National Sleep Foundations recommendation of 7-9 hours nightly.(3) Even more troubling, 30% of the population gets less than 6 hours of sleep per night. 

The trickle-down effect on health and performance are profound. If you don’t get enough sleep, your physical output is impaired (e.g. sprint speed, reaction time, etc.), sport-specific skill (e.g. three-point shooting, first-serve accuracy), immunity (e.g. more colds and flu), cognition (e.g. memory, executive function, etc.) not to mention how it impacts your overall health (e.g. increased risk of virtually all chronic disease conditions.)

It’s no longer about raising awareness of inadequate sleep time and quality, but rather, actually getting athletes to implement the strategies!

(It would be great if we, as humans, made decision based purely on logic, but as expert sport psychologist Dr. Peter Jensen PhD points out, it’s not usually the case).

Sleep & Circadian Rhythms - 6 Tips from World-Experts

I’ve had the privilege of interviewing some of the top sleep experts in the world. Here is a quick glimpse into some of their strategies for supporting sleep and circadian rhythms in athletes. 

1)    Set Your Schedule – Sleep Timing

In training, consistency is crucial for achieving success. The same is true for sleep. Dr. Amy Bender, PhD of the Canadian Sport Institute – Calgary emphasizes the importance setting your morning wake time and evening bedtime.  

For athletes, this can be very difficult. Early morning exercise, two-a-day training, and late-night sessions or competitions (not to mention media, work, or school commitments) make it difficult for a lot of athletes to get into a consistent sleep schedule for an extended period of time. Inevitably, this leads to inadequate total sleep time and compromises sleep quality.

Get back to the fundamentals; be consistent with your sleep and wake times. The more you stick to a routine, the more impact you’ll see in the gym and on the field.  

2)    Circadian Rhythms & Weight Gain

When you eat has a big impact on your circadian rhythms and therefore sleep. In my recent interview with Dr. Dan Pardi, PhD he highlighted some important recent research in this area, comparing how night time eating impacted weight gain in mice. In the study, one group of mice were fed their normal meals during the day, while the other group received all of their meals at night (when they would normally sleep). Total caloric intake and physical activity were controlled and exactly the same in both groups.

What happened?  The mice who were fed all of their daily calories during the night - when they would typically be asleep - gained significantly more weight compared to the control group eating during the day. What’s the lesson? Food intake has a significant impact on your circadian rhythms, therefore avoid eating too late at night if you’re looking to keep body composition (and health) on point.

3)    Don’t Be Stupid – Caffeine & Athletes

Physically demanding sports require a special amount of effort and intensity. Not surprisingly, American football, hockey, and rugby players often turn to caffeine and pre-workouts for an added boost. 

Dr. Ian Dunican PhD, recently completed a study in Super Rugby players in Australia and found many athletes were unaware of the amount of caffeine contained in their pre-workout supplement. (In fact, some didn’t even realize it contained caffeine!) 

Too much total caffeine and too much caffeine late in the day can both compromise your sleep total and quality. 

If you’re pushing the caffeine limits hard on game day, make sure to balance your short-term goals (i.e. game day) with your long-term goals of  recovery and health throughout the season. A good heuristic – or simple rule – is for athletes not to exceed 6mg/kg/day of total caffeine and to limit intake in the afternoon.

4)    Morning Larks & Night Owls - Athlete Chronotypes

During pre-season training camp or when you travel on a road trip with your team an important consideration that often gets overlooked by coaches and performance staff is athlete chronotype. In the research, morning larks are defined as early-risers while night owls naturally prefer to stay up later.  

Dr. Michele Lastella, PhD has examined the effects of athlete chronotype on performance and found some emerging evidence on performance and recovery. A recent study found baseball players who were morning larks had significantly higher batting averages in day games.

In practice, an important take home message for coaches is to carefully consider whom they pair together as roommates; combining morning larks with night owls could lead to more disturbed sleep for both and compromise recovery (and ultimately performance).

5)    Can You Make Up A Sleep Debt? Memory, Executive Function & Sleep

It’s not just physical performance that is impaired from lack of sleep, mental performance also takes a big hit. Dr. Norah Simpson, PhD from Stanford Medical School recently found in her study on sleep and performance that 17-19 hours of wakefulness significantly compromised your cognitive performance (and the equivalent to having a blood alcohol level past the legal limit!

Does this mean you can simply catch up on sleep on the weekend after not sleeping enough through the week? Unfortunately, Dr. Simpson’s work says no. 

You need to be consistent on a night to night basis to reap the full benefits of total sleep. If you don’t get enough sleep at night, it will compromise memory, attention and executive function. In short, your brain game will suffer (important on the playing field or the boardroom). 

6)    The Nappucino – Pros & Cons

If you’re seriously running low on sleep, but still need to be sharp and perform, the coffee nap or ‘nappucino’ has become a popular new strategy to support cognitive performance after an afternoon nap. 

Why has this become so popular? A recent study found having a small coffee before your nap (e.g. coffee + nap) outperformed having a coffee or having a nap, respectively.(4)

How does it work? Dr. Cheri Mah, MD, sleep expert and consultant to professional sports teams, explains it takes approximately 15-minutes for caffeine to begin to exert its effects in the body. As such, after you wake up from your 20-minute nap your mental acuity gets a small boost from the power nap (increasing alpha-brain wave activity) as well as an additional boost from the pre-nap caffeine hit. 

Of course, Dr. Mah warns you need to be sleep-deprived for this to be truly effective. What qualifies as sleep-deprived? You must feel so fatigue you could fall asleep within five minutes. If that sounds like you, Dr. Mah finds it’s a great tool to keep cognitive performance running on all cylinders.

The Bottom Line

Sleep is a key pillar for recovery. Get back to the fundamentals and figure out how to best apply them in your setting, with your athletes, for long-term success.

Strength coaches aren’t looking for ‘new’ exercises to train and develop athletes; they have the tools already, it’s simply a matter of fine-tuning them. 

The same mentality should be applied to supporting improve sleep time and quality. You don’t need any ‘new’ strategies (or tech), you just need to figure out what evidence-based strategies your athlete will actually implement. It takes time, it takes experimentation, and it takes willingness on the part of both athlete and practitioner. 

Implement some of the fundamentals from the 6 world-experts in sleep science discussed in this article, or listen to more in-depth discussion in Season 3, Episode #9 of the Dr. Bubbs Performance Podcast).

Knowing you need more sleep is the first step, but in and of itself, rarely leads to behavior change.  Take the time to uncover what will inspire and motivate your client or athlete to take action and keep your focus on sleep fundamentals for long-term success.

 

Dr. Marc Bubbs, ND, MS(c), CISSN, CSCS

 

Want to learn more? Take a deep-dive into sleep and circadian science in Chapter 1 of my new book PEAK – The New Science of Athletic Performance That Is Revolutionizing Sport.

Pre-order on amazon and get free bonus material… as well as a chance to win prize packs, 1-1 visits with dr. bubbs or a talk for your gym or facility1

Pre-order on amazon and get free bonus material… as well as a chance to win prize packs, 1-1 visits with dr. bubbs or a talk for your gym or facility1

Question about sleep and circadian rhythms? Leave it in the comments section below…

Coenzyme Q10: Implications for Health & Human Performance (And 20 Top Food Sources)

Coenzyme Q10 is a member of the ubiquinone family of compounds, named for the ubiquitous nature of these compounds in humans and all living organisms.  

Coenzyme Q10 is made naturally in the human body, therefore it’s not considered a vitamin, however it has many fundamental roles in human physiology and health.(1) 

In this article, I’ll review the roles of CoQ10 in the body, highlight its potential role in athletic performance, review CoQ10 rich food sources, and discuss considerations for special populations and supplementation. 

What Is It?

Coenzyme Q10 is a fat-soluble compound made in your body and acquired from your diet. The highest levels are found in the heart, liver, kidneys, and pancreas.

At the cellular level, the greatest concentration of CoQ10 is found in the mitochondria – the tiny powerhouses of your cells – and thus it plays a fundamental role in aerobic energy production.

To convert the carbohydrates and fats you eat into adenosine triphosphate (ATP), the primary energy currency used by your cells, it’s necessary to have CoQ10 present in the inner mitochondrial membrane.

Coenzyme Q10 also plays a key role as a fat-soluble antioxidant in your cellular membranes and lipoproteins, the latter responsible for ferrying lipids around the body. For example, oxidized low-density lipoprotein (LDL) is a biomarker associated with increased risk of heart disease, and when LDL is oxidized, the CoQ10 antioxidant is the first called into action.(2)

Coenzyme Q10 also plays an important role in recycling other antioxidants in the body, in particular, alpha-tocopherols (vitamin E) and ascorbate (vitamins C).(3)

High concentrations of CoQ10 are also found in lysosomes, the garbage collectors of your cells which clean up all the cellular debris. 

CoQ10 & Athletic Performance

If you’re an athlete, can CoQ10 help your athletic performance?

Only a few small studies have looked into whether supplementation with 100-150mg/day of CoQ10 could impact physical performance in recreational and trained athletes. To date, CoQ10 supplementation has failed to produce benefits for maximal oxygen consumption (VO2 max), time to exhaustion, aerobic power or anaerobic markers.(4,5,6,7,8)

There may be some potential benefit for muscular recovery from intense exercise, specifically with respect to oxidative stress and low-grade inflammation, however the research is limited.(9,10,11) 

CoQ10 & Human Health 

Coenzyme Q10 plays a key role in supporting cardiovascular health.

Atherosclerosis is a condition where arterial walls become inflamed and accumulate fatty substances called plaques, narrowing and stiffening arteries and increasing your risk of heart attack and stroke. 

An early sign of the development of atherosclerosis is the oxidation of in your arterial walls. A reduced form of coenzyme Q10 - the first antioxidant called into action - works together with vitamin E to quench the pro-inflammatory oxidative fires in the artery wall.  

Supplementation has been shown in multiple studies to increase the concentration of CoQ10 in LDL in humans.(12, 13) Ensuring sufficient levels of coenzyme Q10 may be a promising strategy to reduce LDL oxidation and therefore the early progression of atherosclerosis.

Some studies have shown mild benefit for blood pressure, endothelial function, and blood flow however the effect size does not appear to be large.

Fibromyalgia is another condition where coenzyme Q10 may play a supportive role in symptom management. Several small, double-blinded studies found a dose of 300mg per day reduced fatigue and tiredness, as well as pain and soreness in fibromyalgia sufferers.(13,14)

COQ10 Food Sources

What foods are richest in coenzyme Q10? 

Currently, the US National Academy of Medicine does not have a specific dietary intake recommendation for CoQ10.(15)  The estimated daily intake of CoQ10 in the general population is approximately 3-6mg per day.(16)

The dietary sources with the highest concentration of CoQ10 are animal-based foods, such as organ meats, venison, beef, chicken and fish.(16) The next best sources include nuts and oils. (See 20 Top Food Sources infographic below)

Want to learn more?    Listen to expert Dr. Cate Shanahan    talk Deep Nutrition: Why Your Genes Need Traditional Foods on the Dr. Bubbs Performance Podcast, Season 1 Episode 28.

Want to learn more? Listen to expert Dr. Cate Shanahan talk Deep Nutrition: Why Your Genes Need Traditional Foods on the Dr. Bubbs Performance Podcast, Season 1 Episode 28.

Symptoms of CoQ10 Deficiency 

Lower plasma levels of CoQ10 are found in people with diabetes (type-1 and type-2), regularly taking cholesterol lowering medications called statins, congestive heart failure (CHF), and cancer.

Insufficient coenzyme Q10 status may also occur as you get older, research showing  plasma concentrations declining with age.(17) Therefore, some experts believe it may play a role in supporting longevity. However, it’s not clear whether this reduction over a lifespan is indeed a sign of deficiency or a natural phenomenon.

If your intake of coenzyme Q10 is deficient or insufficient, you may experience some of the following symptoms; physical fatigue, poor memory and difficulty concentrating, poor immunity, muscle pain, and increased risk of heart disease.

It is possible to perform a blood test to assess CoQ10 status, the general population reference range is 0.36-1.59 ug/mL.

Drugs Interactions & Supplementation

If you’re taking CoQ10 supplements, be sure to check with your doctor for potential interactions with medications. 

For example, if you’re taking a blood-thinning medication like warfarin (coumadin), as well as a CoQ10 supplement, you may experience a potentially dangerous reduced anti-coagulant effect of your medication.(18)

A common side-effect of statin medications is lowered plasma levels of CoQ10.

If you’re taking a statin medication – drugs classified as HMG-CoA reductase inhibitors – you will experience a drop in your CoQ10 levels because the enzyme HMG-CoA reductaseis responsible for both cholesterol and coenzyme Q10 production. 

It’s been well-established that lipid-lowering statins like Crestor, Lipitor, etc. consistently reduce CoQ10 levels in patients.(19,20,21,22) That said, experts believe CoQ10 levels are reduced when patients take statins because overall circulating lipid levels are reduced on statins, rather than a direct inhibition of CoQ10 synthesis.  

(Talk to your doctor about supplementation if you’re currently taking a stating drug).

The best evidence for the benefit of supplementation of CoQ10 is with respect to genetic mitochondrial disorders caused by mutations in CoQ10 genes (at very high doses). CoQ10 may be somewhat effective as an adjunct therapy for congestive heart failure and coronary artery bypass surgery. And currently, there is no evidence it improves diabetes, neurodegenerative conditions or breast cancer. 

If you’re supplementing with CoQ10, be sure to consume with meals that contains some dietary fat to improve absorption. Supplement doses can range from 30-100mg per capsule.

This well above the estimated average daily intake, therefore it’s probably best to consume smaller doses more frequently throughout the day. Finally, CoQ10 production may be impacted by inadequate intake of pantothenic acid (vitamin B6).

The Bottom Line

Coenzyme Q10 is made naturally in the body and an important compound for human health, playing key roles in aerobic energy metabolism and as a fat-soluble antioxidant. 

While it has not shown the ability to directly improve athletic performance, it may be able to support recovery from intense exercise via its role in buffering oxidative stress and low-grade inflammation. 

A “Food First” approach is ideal for athletes and upgrading health, with organ meats and animal proteins the richest natural sources of CoQ10. Incorporate more foods high in coenzyme Q10 to support your best mental and physical performance.

Dr. Marc Bubbs ND, CISSN, CSCS

 

References

1)   Acosta MJ, Vazquez Fonseca L, Desbats MA, et al. Coenzyme Q biosynthesis in health and disease. Biochim Biophys Acta. 2016;1857(8):1079-1085. 

2)   Ernster L, Dallner G. Biochemical, physiological and medical aspects of ubiquinone function. Biochim Biophys Acta. 1995;1271(1):195-204.

3)   Navas P, Villalba JM, de Cabo R. The importance of plasma membrane coenzyme Q in aging and stress responses. Mitochondrion. 2007;7 Suppl:S34-40. 

4)   Laaksonen R, Fogelholm M, Himberg JJ, Laakso J, Salorinne Y. Ubiquinone supplementation and exercise capacity in trained young and older men. Eur J Appl Physiol Occup Physiol. 1995;72(1-2):95-100.  

5)   Malm C, Svensson M, Ekblom B, Sjodin B. Effects of ubiquinone-10 supplementation and high intensity training on physical performance in humans. Acta Physiol Scand. 1997;161(3):379-384.  

6)   Weston SB, Zhou S, Weatherby RP, Robson SJ. Does exogenous coenzyme Q10 affect aerobic capacity in endurance athletes? Int J Sport Nutr. 1997;7(3):197-206.  

7)   Porter DA, Costill DL, Zachwieja JJ, et al. The effect of oral coenzyme Q10 on the exercise tolerance of middle-aged, untrained men. Int J Sports Med. 1995;16(7):421-427.  

8)   Braun B, Clarkson PM, Freedson PS, Kohl RL. Effects of coenzyme Q10 supplementation on exercise performance, VO2max, and lipid peroxidation in trained cyclists. Int J Sport Nutr. 1991;1(4):353-365. 

9)   Abdizadeh L, Jafari A, Armanfar  M. Effects of short-term coenzyme Q10 supplementation on markers of oxidative stress and inflammation after downhill running in male mountaineers. Science & Sports. 2015;30(6):328-334. 

10)Díaz-Castro J, Guisado R, Kajarabille N, et al. Coenzyme Q(10) supplementation ameliorates inflammatory signaling and oxidative stress associated with strenuous exercise. Eur J Nutr. 2012;51(7):791-799.  

11)Leelarungrayub D, Rawattikanon A, Klaphajone J, Pothong-sunan P, Bloomer RJ. Coenzyme Q10 supplementation decreases oxidative stress and improves physical performance in young swimmers Open Sports Med J 2010

12)Mohr D, Bowry VW, Stocker R. Dietary supplementation with coenzyme Q10 results in increased levels of ubiquinol-10 within circulating lipoproteins and increased resistance of human low-density lipoprotein to the initiation of lipid peroxidation. Biochim Biophys Acta. 1992;1126(3):247-254.

13)Cordero, M et al. Oxidative stress correlates with headache symptoms in fibromyalgia: coenzyme Q₁₀effect on clinical improvement. PLoS One. 2012;7(4):e35677.

14)Cordero, M et al. Can coenzyme q10 improve clinical and molecular parameters in fibromyalgia? Antioxid Redox Signal. 2013 Oct 20;19(12):1356-61.

15)Weber C. Dietary intake and absorption of coenzyme Q. In: Kagan VE, Quinn PJ, eds. Coenzyme Q: Molecular Mechanisms in Health and Disease. Boca Raton: CRC Press; 2001:209-215. 

16)Pravst I, Zmitek K, Zmitek J. Coenzyme Q10 contents in foods and fortification strategies. Crit Rev Food Sci Nutr. 2010;50(4):269-280. 

17)Hernandez-Camacho JD, Bernier M, Lopez-Lluch G, Navas P. Coenzyme Q10 Supplementation in Aging and Disease. Front Physiol. 2018;9:44. 

18)Natural Medicines. Coenzyme Q10. Professional handout/Drug Interactions. Available at: https://naturalmedicines-therapeuticresearch-com. Accessed 1/21/19.

19)Folkers K, Langsjoen P, Willis R, et al. Lovastatin decreases coenzyme Q levels in humans. Proc Natl Acad Sci U S A. 1990;87(22):8931-8934.  

20)Colquhoun DM, Jackson R, Walters M, et al. Effects of simvastatin on blood lipids, vitamin E, coenzyme Q10 levels and left ventricular function in humans. Eur J Clin Invest. 2005;35(4):251-258.  

21)Mabuchi H, Higashikata T, Kawashiri M, et al. Reduction of serum ubiquinol-10 and ubiquinone-10 levels by atorvastatin in hypercholesterolemic patients. J Atheroscler Thromb. 2005;12(2):111-119.  

22)Bargossi AM, Battino M, Gaddi A, et al. Exogenous CoQ10 preserves plasma ubiquinone levels in patients treated with 3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors. Int J Clin Lab Res. 1994;24(3):171-176.  

 

 

  

 

Exercise-Induced Muscle Damage: Why Does It Happen? (And 5 Nutrition Solutions To Support Recovery)

Athletes train hard. They train almost every day, often twice a day, in order to be elite..

Does this mean athletes are constantly in a state of delayed-onset muscle soreness (DOMS) or fighting off excessive inflammation to effectively adapt to training to achieve their goals? Maybe. What about an athlete’s training phase, does that play a role? For example, if an athlete is optimizing for competition versus adapting to get bigger, stronger, or faster? 

What about recreational clients?

For many people, the sensation of mild to moderated delayed DOMS that creeps into your muscles 24-48 hours post-training is a sign of a good workout. You feel like you’ve trained and are making progress toward your goal. However, if it persists for more than 48 hours, if it limits your range of motion (ROM) or muscle function is it still helpful?

 Exercise-induced muscle damage (EIMD) is a complex and nuanced topic. 

A better question is when does exercise-induce muscle damage become so pronounced it requires specific nutrition strategies to mitigate the effects? I interviewed expert Dr. Daniel Owens PhD from Liverpool John Moore’s university to talk about his research in this area and what nutrition solutions you can turn to for evidence-based recovery support. 

First, let’s define exercise-induced muscle damage.

Listen to Daniel Owens PhD talk exercise-induced muscle damage on the Dr. Bubbs Performance Podcast!

Listen to Daniel Owens PhD talk exercise-induced muscle damage on the Dr. Bubbs Performance Podcast!

What Is Exercise-Induced Muscle Damage?

Exercise-induced muscle damage (EIMD) is characterized by symptoms that come on directly after training and persist for 1-5 days afterwards (although potentially all the way up to 14 days post-training). That’s a pretty wide margin, what happens if you get your training plan or recovery process wrong? 

For the athlete, the consequences of EIMD include is a direct effect on functional capacity (e.g. strength, range of motion, etc.), muscle soreness, muscle capacity and sense of force production and limb position.(1,2,3,4) How long and how intense these symptoms are for you depends on the intensity and duration of exercise and how your own individual susceptibility to the damaging stimulus of training.

For the athlete, loss of muscle function and increased muscle soreness likely have the greatest potential to negatively impact performance. 

Can targeted nutrition strategies help to offset these effects? Could this allow you to train more frequently or more intensely, thereby increasing the likelihood of achieving your goals? Or could it actually interfere with the recovery process? 

It’s a matter of balance; adequate training stress combined with sufficient recovery. Let’s take a deeper-dive into what causes exercise-induced muscle damage.

What Causes EMID?

Training of any type can cause exercise-induced muscle damage (EIMD), however there are a few types of training that may trigger greater muscle damage, such as; resistance training, prolonged or downhill running, and high-intensity interval training.(5,6,7,8)

Muscle damage is amplified during eccentric actions, particularly at longer muscle lengths, with greater forces, and faster angular velocities.(9,10,11) Interestingly, if you perform a training session with more eccentric loading, it may actually reduce the EMID in the subsequent sessions, a phenomenon known as the “rebound effect”. 

What are the underlying mechanisms that cause EMID? Let’s review.

#1 Primary Muscle Damage

Experts aren’t exactly sure the principle reason why eccentric training is more damaging to the muscle, however the consensus seems to be the mechanical loading during exercise.(12) Eccentric contractions have a lower motor unit activation compared to isometric and concentric contractions (when force is equal), putting an increased mechanical stress on a smaller number of muscle fibers during eccentric movements, and thus more muscle damage.(13)

#2 Secondary Muscle Damage

After the initial primary damage of training, a secondary effect occurs when calcium moves into cells, as the mitochondria attempt to maintain homeostasis.(14) The resultant inflammatory response is a crucial and natural process that clears away damage tissue, triggers tissue repair, and ultimately adaptation.

#3 Satellite Cell Activation

Muscle fiber recovery and regeneration requires the activation of muscle stem cells called satellite cells. Satellite cells are activated post-training, specifically in response to eccentric compared to concentric contractions.(15) The research highlights that sustained activation of satellite cells provides the muscle with the capacity to adapt more effectively from training.

To sum up, impaired muscle function, increased muscle soreness, elevated inflammatory levels and activation of satellite cells all play a role in exercise-induced muscle damage. 

What does all this mean for you the athlete?

 Nutritional strategies to target these areas - when used in the right context – may improve recovery from exercise-induced muscle damage. Let’s review five evidence-based nutrition strategies. 

Dietary Solutions for EIMD

Now you’ve understood the mechanisms underlying exercise-induced muscle damage (EIMD), you can better appreciate what nutritional interventions influence those mechanisms in order to exert a desired effect. 

There is a lot of nuance when it comes to application.

You don’t want to limit or buffer the exercise-induced stress and subsequent beneficial adaptations to training. The nutritional strategies we’ll discuss impact inflammation and oxidative stress – known to be important stimuli for adaptation - so it’s important to consider why you’re using them (i.e.  to cope with increased training volume and/or intensity) and when you’re using them (i.e. adaptation versus optimization phase).

The following are five potential evidence-based nutritional strategies.

#1 Protein

Protein is crucial to muscle protein synthesis and adaptation to resistance and endurance exercise.(16) Experts can’t say for sure whether protein around intense or damaging exercise can limit EIMD, but recent evidence suggests it can improve markers of muscle damage and accelerate recovery of force.(17,18) Aim for a protein intake of 0.2-0.5g/kg/meal around exercise, with bigger athletes trending toward the upper end of the range.

#2 Tart Cherry Juice

Dietary polyphenols are most commonly found in the diet via fruit, vegetable, tea and coffee consumption. Polyphenols have shown to exert significant antioxidant and anti-inflammatory effects, possessing the ability to attenuate cyclo-oxygenase (COX) 1 and 2 output to a similar degree compared to common, over-the-counter non-steroidal anti-inflammatory drugs (NSAIDs).(19,20) 

In particular, tart cherry juice stands out from the pack when it comes to recovery.

Research in resistance training using heavy eccentric bicep curls combined with two servings of tart cherry juice per day found an accelerated rate of recovery and reduced muscles soreness.(21) 

A key benefit to using a “food first” approach to performance nutrition is that it’s unlikely to interfere with the primary muscle damage response from exercise and thus not limit positive adaptation to training (compared to supra-physiological doses in supplements). Where functional foods like cherry juice can exert its effect is during the secondary phase, when inflammation and oxidative stress ramp up post-training.

#3 Omega-3

Omega-3 polyunsaturated fats, specifically eicosapentaenoic acid (EPA) and docosahexanoic acid (DHA), are important nutrients that exert anti-inflammatory effects. Omega-3 fats like EPA and DHA are found in highest abundance in cold, deep-water fatty fish (e.g. salmon, mackerel, anchovies, sardines, herring, etc.), seafood (e.g. oysters, mussels, etc.), grass-fed beef and nuts like macadamia and walnuts

Numerous studies have shown beneficial effects of omega-3 on inflammation, oxidative stress, and muscle function after intense exercise.(22,23,24,25)

Interestingly, there appears to be a “loading phase” of approximately two weeks to see changes in muscle omega-3 composition. A recent study found a highly effective loading protocol to be 5g/day dose of fish oil capsules (providing 3,500mg EPA and 900mg DHA), however this is much higher than the current recommendations.(26) Typically, a dose of 1,000-1,500mg (combined EPA/DHA) is suggested in athletes, however more research is needed in this area to confirm an ideal dose.

#4 Vitamin D

Vitamin D isn’t really a vitamin. In truth, it’s a seco-steroid hormone acquired by the body through exposure to the sun (e.g. ultraviolet B radiation or UVB). Sedentary lifestyles in the general population and athletes training indoors (or even outdoors in sun-shy athletes wearing skin covering apparel) has led to a large of number of athletes and active people being diagnose with deficient (< 30 nmol/L 25[OH]D) or insufficient levels of vitamin D. 

In the last decade, new technology has allowed for discoveries of the important effects of vitamin D on muscle function and performance.

Vitamin D is a potent regulator of the immune system and has shown to exert potentially important effects on athletic recovery; anti-inflammatory response post-exercise was found to correlate with the individual’s vitamin D levels, runners with low vitamin D exhibited increase inflammatory responses post-exercise, and athletes performing eccentric-concentric jumps on a plyo-press displayed faster recovery at higher vitamin D status.(27,28)

#5 Creatine

Creatine is keystone supplement in many athlete’s nutritional arsenal. However, many are unaware of the impacts of creatine on recovery. Creatine has shown beneficial effects on satellite cell number and muscle function post-training.(29)

DOWNLOAD THIS INFOGRAPHIC of EVIDENCE-BASED RECOVERY SOLUTIONS to inform your practice below…

DOWNLOAD THIS INFOGRAPHIC of EVIDENCE-BASED RECOVERY SOLUTIONS to inform your practice below…

The Bottom Line

Exercise-induced muscle damage is an important and natural phenomenon that triggers the positive and beneficial adaptations to exercise. In the general population, training stimulus and volume is unlikely to require additional recovery support beyond the nutrition fundamentals of adequate protein, omega-3 and vitamin D intake are likely all you need to support your training goals. 

In athletes, the stakes are much higher. Greater training volume and intensity, as well as two-a-day (sometimes three-a-day training in MMA athletes!) increases the need for the application of functional food strategies to support quicker recovery. 

As always, think about the typetiming, and total amount of the supplement, functional food, or nutritional strategy you’re implementing with clients and athletes.  

(Now get back to your training!)

Dr. Marc Bubbs ND, CISSN, CSCS

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References

1)    Byrne, C., Eston, R. G., & Edwards, R. H. T. (2001). Characteristics of isometric and dynamic strength loss following eccentric exercise-induced muscle damage. Scandinavian Journal of Medicine & Science in Sports, 11(3), 134–140.

2)    Marcora, S. M., & Bosio, A. (2007). Effect of exercise-induced muscle damage on endurance running performance in humans. Scandinavian Journal of Medicine & Science in Sports, 17(6), 662–671. 

3)    Twist, C., & Eston, R. G. (2009). The effect of exercise-induced muscle damage on perceived exertion and cycling endurance performance. European Journal of Applied Physiology, 105(4), 559–567. 

4)    Paschalis, V., Nikolaidis, M. G., Theodorou, A. A., Giakas, G., Jamurtas, A. Z., & Koutedakis, Y. (2010). Eccentric exercise affects the upper limbs more than the lower limbs in position sense and reaction angle. Journal of Sports Sciences,28(1), 33–43. 

5)    Burt, D. G., Lamb, K., Nicholas, C., & Twist, C. (2014). Effects of exercise-induced muscle damage on resting metabolic rate, sub- maximal running and post-exercise oxygen consumption. European Journal of Sport Science,14(4), 337–344. 

6)    Millet, G. Y., Tomazin, K., Verges, S., Vincent, C., Bonnefoy, R., Boisson, R. -C.,...Tarnopolsky, M. (2011). Neuromuscular consequences of an extreme mountain ultra-marathon. PLoS One, 6(2), e17059.

7)    Chen, T. C., Nosaka, K., Lin, M. -J., Chen, H. -L., & Wu, C. -J. (2009). Changes in running economy at different intensities fol- lowing downhill running. Journal of Sports Sciences, 27(11), 1137–1144. 

8)    Leeder, J. D., van Someren, K. A., Gaze, D., Jewell, A., Deshmukh, N. I.K., Shah, I., ... Howatson, G. (2014). Recovery and adaptation from repeated intermittent-sprint exercise. International Journal of Sports Physiology and Performance,9(3), 489–496. 

9)    Child, R. B., Saxton, J. M., & Donnelly, A. E. (1998). Comparison of eccentric knee extensor muscle actions at two muscle lengths on indices of damage and angle-specific force production in humans. Journal of Sports Sciences,16(4), 301–308. 

10)  Nosaka, K., & Sakamoto, K. E. I. (2001). Effect of elbow joint angle on the magnitude of muscle damage to the elbow flexors. Medicine and Science in Sports and Exercise, 33(1), 22–29. 

11)  Chapman, D., Newton, M., Sacco, P., & Nosaka, K. (2006). Greater muscle damage induced by fast versus slow velocity eccentric exercise. International Journal of Sports Medicine,27 (8), 591–598. 

12)  Proske, U., & Morgan, D. L. (2001). Muscle damage from eccentric exercise: Mechanism, mechanical signs, adaptation and clinical applications. The Journal of Physiology,537(Pt 2), 333–345. 

13)  Enoka, R. M. (1996). Eccentric contractions require unique activation strategies by the nervous system. Journal of Applied Physiology (1985), 81(6), 2339–2346.

14)  Ebbeling, C. B., & Clarkson, P. M. (1989). Exercise-induced muscle damage and adaptation. Sports Medicine, 7(4), 207–234. 

15)  Hyldahl, R. D., Olson, T., Welling, T., Groscost, L., & Parcell, A. C. (2014). Satellite cell activity is differentially affected by con- traction mode in human muscle following a work-matched bout of exercise. Frontiers in Physiology,5, 485. 

16)  Phillips, S. M., & Van Loon, L. J. C. (2011). Dietary protein for athletes: From requirements to optimum adaptation. Journal of Sports Sciences,29(Suppl 1), S29–S38. 

17)  Buckley, J. D., Thomson, R. L., Coates, A. M., Howe, P. R. C., DeNichilo, M. O., & Rowney, M. K. (2010). Supplementation with a whey protein hydrolysate enhances recovery of muscle force-generating capacity following eccentric exercise. Journal of Science and Medicine in Sport, 13(1), 178–181. 

18)  Nosaka, K., Sacco, P., & Mawatari, K. (2006). Effects of amino acid supplementation on muscle soreness and damage. International Journal of Sport Nutrition and Exercise Metabolism, 16(6), 620–635. 

19)  Seeram, N. P., Aviram, M., Zhang, Y., Henning, S. M., Feng, L., Dreher, M., & Heber, D. (2008). Comparison of antioxidant potency of commonly consumed polyphenol-rich beverages in the United States. Journal of Agricultural and Food Chemistry, 56(4), 1415–1422. 

20)  Wang, H., Nair, M. G., Strasburg, G. M., Chang, Y. -C., Booren, A. M., Gray, J. I., & DeWitt, D. L. (1999). Antioxidant and anti- inflammatory activities of anthocyanins and their aglycon, cyani- din, from tart cherries. Journal of Natural Products,62(5), 802. 

21)  Connolly, D. A., McHugh, M. P., Padilla-Zakour, O. I., Carlson, L., & Sayers, S. P. (2006). Efficacy of a tart cherry juice blend in preventing the symptoms of muscle damage. British Journal of Sports Medicine, 40(8), 679–683. discussion 683. 

22)  DiLorenzo, F. M., Drager, C. J., & Rankin, J. W. (2014). Docosahexaenoic acid affects markers of inflammation and muscle damage after eccentric exercise. Journal of Strength and Conditioning Research, 28(10), 2768–2774. 

23)  Gray, P., Chappell, A., Jenkinson, A. M., Thies, F., & Gray, S. R. (2014). Fish oil supplementation reduces markers of oxidative stress but not muscle soreness after eccentric exercise. International Journal of Sport Nutrition and Exercise Metabolism, 24(2), 206–214. 

24)  Jouris, K. B., McDaniel, J. L., & Weiss, E. P. (2011). The effect of omega-3 fatty acid supplementation on the inflammatory response to eccentric strength exercise. Journal of Sports Science & Medicine, 10(3), 432–438. 

25)  Phillips, T., Childs, A. C., Dreon, D. M., Phinney, S., & Leeuwenburgh, C. (2003). A dietary supplement attenuates IL-6 and CRP after eccentric exercise in untrained males. Medicine & Science in Sports & Exercise,35(12), 2032–2037. 

26)  McGlory, C., Galloway, S. D. R., Hamilton, D. L., McClintock, C., Breen, L., Dick, J. R., ...Tipton, K. D. (2014). Temporal changes in human skeletal muscle and blood lipid composition with fish oil supplementation. Prostaglandins, Leukotrienes and Essential Fatty Acids (PLEFA), 90(6), 199–206. 

27)  Barker, T., Martins, T. B., Hill, H. R., Kjeldsberg, C. R., Dixon, B. M., Schneider, & E. D. (2014). Vitamin D sufficiency associates with an increase in anti-inflammatory cytokines after intense exercise in humans. Cytokine, 65(2), 134–137. 

28)  Willis, K. S., Smith, D. T., Broughton, K. S., & Larson-Meyer, E. D. (2012). Vitamin D status and biomarkers of in ammation in runners. Open Access Journal of Sports Medicine, 3, 35–42. 

29)  Olsen, S. (2006). Creatine supplementation augments the increase in satellite cell and myonuclei number in human skeletal muscle induced by strength training. Journal of Physiology, 573(Pt 2), 525–534. 

 

 

The Power of Mushrooms - 8 Benefits for Health & Performance

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Nutrition is a powerful way to improve your health and athletic performance. What you eat impacts your inflammatory response, immunity, gut microbiota, stress hormone output (or lackthereof), your capacity to train hard and recovery, as well as how sharp your mind feels. We're always told to eat a "plant-based" diet to promote overall health, and of course protein and healthy fats are essential, but there is one category that doesn't get mentioned much... Fungi. Mushrooms aren't fruit or vegetable, but rather their own distinct category and their evolution is actually tightly tied to ours as humans.

If we go back over a billion years ago, before there were plants and animals, fungi were here first. In fact, research shows the animal and fungi kingdoms actually come from the same evolutionary branch, perhaps revealing why mushrooms inhale oxygen and exhale carbon dioxide, just like humans. It’s thought that 40% of the diet of ancient primates was derived from fungi, and strong evolutionary connection may be a reason why mushrooms provide so many potential health benefits. Today more and more research is uncovering the many health benefits of this superfood (sorry, I know that term gets thrown around a lot, but mushrooms may actually fit the bill!).

Let's take a closer look at how mushrooms can impact health and performance

Benefits of Mushrooms

Mushrooms are incredibly nutrient-dense, chock-full of protein, iron, B-vitamins and key nutrients like glycoproteins (i.e., ergosterols) and polysaccharides (i.e., beta-glucans). They also provide an array of health benefits:

  • antioxidant
  • anti-inflammatory
  • antiviral
  • boost metabolism
  • improve lipid levels
  • anti-cancer

Different types of mushrooms can provide different types of benefits. The following is a list of eight mushrooms you can think about adding to your nutritional arsenal to support better health, recovery, immunity or potentially performance.

Eight Mushrooms for Health & Performance 

Reishi

Athletes need to train hard and train often. This takes its toll on your nervous and immune systems. If you're constantly busy and on the run, this is also a tremendous stressor on these systems. Reishi mushrooms (Ganoderma lucidum) are known as the “king of the mushrooms” and have been used in traditional medicine for centuries to boost resiliency and immunity. They're also adaptogens - a substance that supports the body during times of stress - making them a great fit for athletes or anyone who is pushing themselves hard at work or play.

Shiitake

If you live in a city with a true winter climate, your vitamin D falls dramatically throughout the coldest months of the year. Unfortunately, very few foods contain much vitamin D (making supplementation a good option for most people). All mushrooms contain ergosterol, a plant sterol compound that makes up a fundamental part of the cell membrane. Sun exposure converts ergosterol into vitamin D, and a 100g serving of fresh mushrooms will provide 2,000 IU. (1) I like my clients to add shiitake mushrooms to their nutritional arsenal because they're not only a natural source of vitamin D but also chocked-full of B-vitamins (riboflavin, niacin, pantothenic acid, etc.), selenium, zinc, and copper. (They also taste great in omelettes and on steaks!) Here's a quick tip; slicing your mushroom will yield even higher vitamin D levels as it exposes more of the surface area to light. Shiitake mushrooms have also been shown to be beneficial for weight loss, heart health, immunity, and fighting off cancer cells.

Maitake

Maitake mushrooms are another fungi from Asia that provides a wealth of health benefits. They are particularly high in beta-glucans, polysaccharides that have been shown to boost immunity via increased T cells, B cells, macrophages, and natural killer (NK) cells. (2) That means they’re a great tool for increasing your innate “first-line of defense” immune system, as well as supporting your adaptive “seek and destroy” immune system. As I mentioned above, training hard and working hard can compromise your immunity (known as the "open-window" theory in exercise immunology) and leave you more likely to catch a cold or flu. Adding more mushrooms to your nutritional arsenal athletes can help keep you going when you're really pushing the pedal to the metal.

Agaricus

Beta-glucans aren't just good for your immune system, they're also highly beneficial for lowering elevated blood glucose levels. The Agaricus blazei mushroom contains significant amounts of beta-glucan polysaccharides and recent studies show the addition of Agaricus blazei to conventional diabetes medication in type 2 diabetics dramatically improves insulin levels compared to controls. (3) The researchers also noted the mushrooms increased adiponectin levels, a key hormone released by fat cells that helps to regulate blood sugar levels.

Lion’s Mane

Lion’s mane (Hericium erinaceus) mushrooms are an impressive species, as they grow in a waterfall-like cascade from trees and logs. Compelling new research shows Lion’s mane exhibits tremendous potential as an agent to support healthy brain cell (neuron) function. Lion’s mane contains neuroactive compounds that promote nerve growth factor, making it a potent brain and nerve support. (4) To achieve this therapeutic dose, concentrated supplemental forms would need to be consumed (rather than just from eating the fungi).

Cordyceps

Cordycep sinensis mushrooms are native to high altitudes and have been used in Asia for thousands of years to support physical performance. Studies have shown they have the capacity to improve oxygen uptake, and could therefore be highly beneficial for endurance athletes, although not all studies show benefit.(5) Interestingly, they’ve also been used traditionally to combat fatigue and as a tonic for enhancing libido and sex drive.

King Trumpet

The King trumpet (Pleurotus eryngii) mushroom goes by many different names – French horn, king oyster or king trumpet – and it’s been used throughout Europe, the Middle East, Africa and Asia for centuries. This edible mushroom has a thick, meaty stem (and small cap), which contains a particular amino acid called ergothioneine that acts as a powerful antioxidant. (6) Antioxidants are crucial for fighting off oxidative damage caused by free radicals, typically due to poor diet, training (or mental) stress and environmental toxin exposures. King trumpet mushrooms make a great addition to omelets, soups and stir-fries.

Turkey Tail

Turkey tail (Trametes versicolor) has been brewed as a traditional tea for centuries in China, and it’s become one of the most well researched mushrooms in the world. It’s shown so much promise as an adjunctive support for protecting cancer patients from the immuno-suppressing effects chemotherapy that the National Institute of Health has launched a new major trial to further investigate these benefits. (7) The mycelium found in turkey tail is also a prebiotic food source for the gut microbiome, and has been shown to be beneficial as an antiviral against the human papilloma virus (HPV). (8)

Mushrooms are an absolute nutritional powerhouse and support health via immune, inflammatory and antioxidant support. If you've been avoiding them because you don't like the taste, or aren't familiar with preparing them, then it's time to upgrade your nutrition game. Sauteed mushrooms with onions are a tasty additions to eggs, steaks and burger, as well as stir-fries. Mushrooms provide a wealth of health and performance boosting benefits, support your health, training and recovery by adding more mushrooms to your diet.

Dr. Marc Bubbs ND, MS(c), CISSN, CSCS

Want to learn more about Vitamin D and Immunity? Listen to Precison Nutrition DIrector of Performance Nutrition Brian St-Pierre in Season 2 of the Dr. Bubbs Performance Podcast...

11 Factors Increasing an Athlete’s Risk of Cold & Flu

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To achieve your athletic potential, you need to train hard and train often. This means walking the fine line between the appropriate amount of training (and life) stress and the positive adaptations it provides and pushing yourself over the edge. The sport science term pushing athletes just past their capacity to improve performance is called functional over-reaching (FOR), it’s what every good strength coach and sport scientist are striving to achieve. Unfortunately, the quest for constant gains means the possibility of stumbling over the line into too much stress (i.e.  non-functional over-reaching), or the abyss of overtraining syndrome, when athletes are tired, rundown and progress stalls for months.(1) Incredibly, 70% of high level athletes have experienced or will experience over-training syndrome (OTS) at some point.(2)

Adding to all this complexity is the reality that increasing training volume is strongly associated with increased risk of upper respiratory tract infections (i.e. cold or flu) and upper respiratory symptoms.(3) Interestingly, even if you're athlete experiences pronounced symptoms of an infection - congestion, scratchy throat, fatigue, etc. - they're at similarly increased risk of diminished performance.(4)

Simply keeping your athlete healthy enough to train is a crucial piece of the high-performance puzzle. If you're healthy, you can train. And if you can train more than the competition, you'll have the best chance of winning (all other things being equal).

To fall victim to an infection, two things must happen; your immune system gets compromised and you're exposed to an infection. Let's take a closer looker at 11 factors that can increase your risk of catching a nasty bug.

1.    Exercise - As I mentioned above, when your training load increases so too does your risk of URTI.(5) This is unavoidable for high-level athletes as they must follow their periodized training plan to achieve their goals and prep for competition. If you're about to enter an intense training period and you feel a scratchy throat, congestion or fatigue setting in, then shifting your focus to your sleep and nutrition strategies is key to supporting immunity.

2.    Mental & Emotional Stress - If you're a person who get stressed out more easily, it actually makes you more susceptible to catching a cold or flu.(6) If you're a type-A personality, experience anxiety-like symptoms or are a general "worrier" than you’re at greater risk of infection as well. Key things to watch out for include fatigue, tension, anger and depression.

3.    Sleep - Lack of sleep is major roadblock to a healthy immune system. If you get less than 7 hours of sleep per night your risk of cold and flu increases 3-fold.(7) Prioritize sleep if you're feeling like you're coming down with something (especially if you're hitting the gym hard).

4.    Personal Hygiene – It’s not very sexy advice, but it plays a massive role in keeping you cold and flu free. Washing your hands regularly – before every meal and after contact with sick people -  and keeping your hands away from your mouth and nose should be your top priority to reduce your risk of infection plummets.(8)

5.    Poor Nutrition - If your diet doesn't have enough calories (i.e. energy) to meet the demands of your training, if you're training at high-intensity with low-carbohydrate availability, if your diet is restricted and low in vitamin D, zinc or iron (just to name a few) then you're likely compromising your immune system.(9) Nutrition is a key player for maintaining a robust immune system and reducing frequency and severity of colds and flu.

6.    Dental Hygiene - You might not think brushing your teeth is a powerful immune booster, but in fact, it's a reliable method for reducing your risk of infection.(10) If you don't keep your teeth clean, bacteria accumulate in your oral mucosa, especially if you’re eating multiple meals and shakes throughout the day. Brush 2-3x a day to reduce your risk.

7.    Sharing Water Bottles - A great motto for life is “Sharing is caring”, just not when comes to athletes and their immunity. Sharing water bottles increases your risk of mononucleosis infection 8-fold!(11) Stick to your own water bottle.. no sharing!

8.    Travel – Plane travel can feel like an immunity Armageddon; waiting to succumb to the onslaught of microbes with nowhere to hide. There is always a handful of passengers  - sneezing, coughing and touching everything in sight – increasing your risk of exposure to infection.(12) Unfortunately, they're putting you at risk and there isn't much you can do about it. Hand sanitizer, a face mask, and if the person next to you is ill, asking to changes seats are probably your best strategies.

9.    Extreme Environments - If you're training at altitude, or in extremely hot and humid environments, your immune system can be impacted. Altitude has been shown to reduce sIgA levels, potentially increasing risk of infection, while hot climates can lead to dehydration and reduced plasma volume, also potentially compromising immunity.(13,14)

10.   Drugs - If your athlete or client is taking medications like corticosteroids for arthritis, asthma or allergies, or if they’re taking immune-suppressive medications for an auto-immune condition they may also be more susceptible to colds and flu.

11.    Vaccination History - If you're team is traveling abroad and you haven't had all the appropriate vaccinations (i.e. hep C, hep B, flu vaccine) then you're increasing your risk of infection.(15) This is not only a performance problem, but a potentially serious health problem.

These 11 factors are some of the most common reasons why your immune system is compromised, and risk of infection increased. Reducing this risk factors, as best as you can, will go a long way to keeping you cold and flu free this winter (or anytime of the year for that matter!) so you can keep training and keep improving.

What about factors that can positively impact your immunity? Here's a short-list of high-impact factors;

1.    Sleep (Listen to Dr. Amy Bender PhD talk sleep strategies in athletes)

2.    Nutrition (Check out 21 Foods To Boost Your Immunity)

3.    Relaxation (Learn how deep-breathing impacts performance)

4.    Periodized Exercise

5.    Holidays  (When was the last time you actually went on holiday? If you can't remember... you need a holiday!) 

Maximize your performance high this winter by minimizing your exposure to colds and flu. Next, add a few fundamental strategies that increase pillars of recovery; sleep, nutrition and mental stress.

Dr. Marc Bubbs ND, MSc(c), CISSN, CSCS

 

Want to learn 10 evidence-based strategies to reduce illness in athletes? Download my FREE infrographic here! (Coming soon...)

Keto Diet & Running Economy – The Forgotten Factor

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Ketogenic diets hit the mainstream in a big way last year after more than a decade of build-up in athletes in the CrossFit and ultra-endurance scene, and more than 30 years after initial research into the diet. The very low-carb, high-fat keto diet has shown some impressive results in people who are overweight, obese, struggling with type-2 diabetes or metabolic syndrome.(1,2,3) The reduction in carbohydrates in these groups - typically from elimination of processed foods, sugars, desserts and alcohol – results in a significant caloric reduction which is the key underlying principle of all successful weight loss regimes. Keto diets also increase your ability to burn body-fat as a fuel source, and perhaps the most important factor, helps your feel full and satiated for much longer periods throughout the day, new research highlighting this may be due to a reduction in triglycerides crossing the blood brain barrier.(4)

Okay, so keto diet can be a very useful tool for weight loss and improving metabolic health, but what about performance? The internet is loaded with anecdotes about transforming yourself into a ‘fat burning machine’ by shifting to a keto diet, as well as emphasizing to recreational athletes that ‘carbs are for suckers’, implying endurance performance is superior when you follow a keto diet compared to the traditional high carb diet. Are all of these anecdotes correct? Are sport scientists missing out on something? And is there any research to back up these claims? Let’s dig a little deeper and find out.

There is actually very little research on ketogenic diets and endurance performance. The original study on keto diets and performance was done by Stephen Phinney in the early 1980s on five cyclists. Among this group, two cyclists improved their endurance, one saw no change and two cyclists got worse.(5) Not exactly a home run in terms of evidence, however this study was ground-breaking because it showed fat-adapted athletes could burn far more fat (1.5g/min) compared to what had previously thought to be the maximum rate (1.0g/min). It’s an impressive finding. Advocates of a keto strategy for endurance performance highlight the fact that body-fat stores provide a massive fuel source, because even an athlete at 10% body-fat has approximately 30,000 calories of excess energy. Unfortunately, a major shortcoming of Phinney’s study, if you’re trying to win a race, is that cyclists trained at 62-64% of their Vo2max, not exactly a speed that will win a race.

Fast-forward to 2016 and Phinney and colleague Jeff Volek published the FASTER (Fat-Adapted Substrate use in Trained Elite Runners) study in elite ultra-endurance triathletes and runners. The long-term keto adapted athletes (almost 2 years adhering to the diet) were found to burn fat at a high rate (1.2g/min) during a 3-hour submaximal aerobic test at 64% VO2max.(6) Another study in 2016 by Tim Noakes group comparing keto-adapted endurance athletes – following a diet of less than 50g of carbs and 70% fat for over year – were pitted against a group of higher carb athletes in a 2-hour ride at 70% VO2max. Researchers found the keto group did indeed burn more fat (1.2g/min) compared to the high carb group (0.5g/min).(7)

All of this information is really interesting, but it still doesn’t answer the most important question; what happens on race day? When you’re trying to beat the competition, does keto help or hinder an endurance athlete.

Dr. Louise Burke PhD, Head of Sports Nutrition at the Australian Institute of Sport, put this question to the test last year. Her research group took a collection of elite and Olympic race-walkers, adapted them to a ketogenic diet, and simulated a race to examine the impacts on performance.  To date, this is the best study on the impacts of keto diet on endurance performance. Let’s see what they found.

Twenty-one male racewalkers participated in the study at the Australian Institute of Sport (AIS), living in residences where all their meals and training was under strict supervision from the research team. These were not your run of the mill recreational race walkers. They were selected based on their performances and rankings by the IAAF (International Association of Athletics Federation) and made up of 7-time Olympic and World championship medalists to world-ranked juniors.

The study involved three different training groups; a high carb group, a periodized carb group and a keto group. All the participants underwent three weeks of intense training - race walking, lifting, and cross-training (running, cycling, or swimming) – and were tested pre- and post- competition to assess the impact of the three diets on performance.

What did Dr. Burke and her team uncover?

After the three weeks of training, all three groups of racewalkers improved their aerobic fitness regardless of which diet they were on.(8) (Not really surprising, considering they were all in a training camp setting. If they didn’t get fitter, something would really be off piste).

Next, the keto group of racewalkers did exhibit significantly higher rates of fat oxidation during the race walk competition over a wide range of intensities, averaging about 1.5/min.(8) (This is on par with Phinney’s earlier study in the 1980s).

Sounds great, but how did they the keto group perform in the 10km race and 25 km long walk event? In the 10km trial, both the high-carb and periodized-carb group improved their race time, by 6.6 and 5.3% respectively (over their pre-camp testing), following the three-week training camp.(8) Unfortunately for the keto group, their performance was marginally worse during the 10km race (see figure below).

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In the 25km long walk, the keto group showed an increase in heart rate compared the both carb groups who experienced reductions after the long walk. The perceived exertion was also greater in the keto group compared to carbs race walkers.(8)

Why did the low-carb group struggle to perform as well as the carbohydrate fueled racers? Ketogenic diets have a negative impact your running economy.(8) Running economy is how much oxygen you used up at a given running pace. A runner with a superior running economy uses less oxygen at a given speed, which is a reliable metric for who will win a race. In Burke’s study, the fat-adapted elite keto racewalker did burn more fat, but at the expense of a reduce running economy (which means higher oxygen demand) at real-life race intensities. This wasn’t the case for either the high or periodized carb groups. (And don’t forget, the more fat-adapted you are, it comes at the expense of your ability to burn carbs effectively for fuel - pyruvate dehydrogenase enzyme levels fall – which is another performance roadblock).(9)

What does all this mean for you?

If you’re an elite athlete or performance-driven, you need carbs to win on race day. Keto diets reduce running economy (increasing your oxygen demand) as well as increasing heart rate and perceived exertion. At the moment, there just is not enough evidence to support going 100% keto, nobody has beat the competition using this strict dietary strategy. (Even renowned ultra-marathoners in the blogosphere who are “keto” athletes rely primarily on simple carbs when it comes to race day).

Of course, this isn’t a black or white situation. There are definite advantages to training in low-carb states (called low carb availability in the research) during your training blocks to trigger beneficial adaptations in the lead up to competition. Dr. Burke and her team acknowledge this in their research, stating … “a periodized programme that includes some training sessions deliberately undertaken with low… carbohydrate availability (‘train low’) or a delay in replacing muscle glycogen after a session (‘sleep low’) may promote greater cellular adaptations to training and enhance performance to a greater magnitude than undertaking all sessions with high carb availability.” This is a powerful statement.

If you’re a low-carb or keto athlete, it’s effectively saying you can absolutely get benefits by using these approaches during your training block. It can be a great training-nutrition strategy. Just don’t confuse that with your “race-day” nutrition strategy, where carbs are still king.

This doesn’t mean you commit to 100% keto or 100% high carb all of the time. As Dr. Burke highlight in her study… “the quantity and timing of carbohydrate intake should be personalized to the athlete and periodized within the various micro- and macro-cycles of training and competition.”

Just like you wouldn’t train the same way every day of the week, so why do you eat the same way? Regardless if it’s keto or high-carb. (There is a lot of nuance in different fueling strategies, and I’ll get into these in more detail in future blog posts).

Individualizing your carb intake to match your goals is a crucial piece of the puzzle.

Also, take into account your current fitness level and body composition.

If you’re a recreational exerciser training up for a half-marathon or marathon with the aim to lose weight and improve health, yet you’re guzzling back sports drinks every session and seeing not shift in body composition, then your fueling strategy is flawed. Re-assess and adjust accordingly.

Bottom Line: At the end of the day, what are you trying to accomplish? If it’s to win the race or perform your personal best then the research shows race-day nutrition should definitely have carbs (as well as in the 24-hours leading up to the race). If it’s to lose weight and improve metabolic health, and not about your personal best, then you’re fine to err more on the side of low-carb to reap more benefits on the weight loss and health front. But, don’t be afraid to add more carbs on days when training intensity is higher to maximize your adaptations to training.

There is a lot nuance and no single correct answer when it comes to fueling for sport. Just remember to always consider the context of your specific athlete, and their individual goals, when designing the right nutrition strategy for them.

Dr. Marc Bubbs ND, MSc, CISSN, CSCS

Ps. Wonder how exogenous ketone supplements would impact endurance performance? Stay tuned for an upcoming podcast episode on this topic… (Subscribe here!)

 

4 Root Causes of Low Mood & Depression

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Low mood and depression are increasingly at an alarming rate in today's modern society. The Center for Disease Control shows 10% of people suffer from depression, but in clinical practice people struggle with low mood at much higher rates in today's constantly connected world seemingly fuelled by processed foods. The World Health Organization has estimated that by the year 2050, one-third of the global population will suffer from either anxiety or depression. This is a moind-boggling statistic. How is this possible? Why are we more prone to depression today than in generations past? As with any complex condition, multiple underlying factors conspire to create an environment where low mood and depression can thrive. Let’s look at a few common root causes to better understand how things go wrong at a cellular and hormonal level. 

#1 BLOOD SUGAR AND INSULIN DYSFUNCTION

Today, 75% of the North American population are classified as overweight or obese. While the annual consumption of processed and simple sugars has dropped a little over the past few years, it's still incredibly high at 100-140 lb. of sugar per person. Combined with the over-consumption of processed carbs and alcohol and you've got five of the top six foods in the American diet; desserts (grain-based), breads, processed chicken, soda pop and energy drink, alcohol and pizza. This leads to an excessive caloric intake, which is further exacerbated by these hyper-palatable foods, meaning the cycle continues over and over again. When your cells are constantly flooded with excess energy, they eventually say "enough is enough" and refuse to take in more energy. This is the state of insulin resistance and further down the road diabetes (type-2). 

How does this relate to mood? Research from Scandinavia has uncovered a clear association between elevated HbA1c - a three-month average of you blood sugar levels - and insulin levels with increased risk of depression. They found that young men with insulin resistance were three times more likely to suffer from severe depression.(1) Another study in Diabetes Care of over 4,000 people showed depressive symptoms were highly associated with higher fasting and 30-minute insulin levels.(2) The authors specifically noted that antidepressant medications did not alter this association because the medications target neurotransmitters (e.g. serotonin, dopamine) and do not address blood sugar and insulin dysfunction. Improving blood sugars and insulin control is an important first step for reducing your risk for low mood and depression.

#2 CHRONIC & SYSTEMIC INFLAMMATION

Inflammation is another potential root cause of low mood. Low-grade systemic inflammation leads to the over-production of pro-inflammatory cytokines that are also associated with depression.(3) The prestigious New England Journal of Medicine recently published a review of the growing connection between chronic inflammation and the development of today’s most common chronic diseases, including depression.(4) The current medical literature tells us that if you are overweight or obese, you likely have low-grade systemic inflammation.(5) This shouldn't be a surprise, as inflammation is "upstream" of blood sugar and insulin dysfunction. A diet rooted in traditional foods - rich in animal protein, healthy fats and antioxidants - will help to cool inflammation and reduce the damaging effects of reactive oxygen species (ROS) produced during the inflammatory response. Polyphenols found in coffee, dark chocolate (even red wine!), as well as vegetables are great sources of anti-inflammatory polyphenols. Extra-long chain omega-3 fats DHA and EPA also exert powerful anti-inflammatory effects and a poor omega-3 to omega-6 fats ratio is also associated with a chronic stress state and increased risk of depression.(6)

#3 GUT DYSFUNCTION & DYSBIOSIS

The gut microbiota - commonly referred to as your microbiome - plays a key role in your mental health through its constant communication with the brain via the vagus nerve. Key neurotransmitters targeted by medications for improving symptoms of depression – serotonin and dopamine – are actually produced in the greatest concentrations in the gut (not the brain). This gut:axis is highlighted by research showing that if you are overweight, you're at much greater risk of poor zonulin function, a key molecule that regulates gut permeability.(7) Poor zonulin function leads to symptoms of a leaky gut, leading to a pro-inflammatory environment that creates the cytokine storm that contributes to low mood and depression. You don’t need to be overweight to suffer from leaky gut. If you travel across multiple time zones, consume alcohol excessively, or chronically rely on NSAIDs – non-steroidal anti-inflammatory drugs – like ibuprofen and naproxen you'll be much more prone to leaky gut and chronic worsen inflammation.(8,9) A dietary approach rooted in traditional foods - animal protein, healthy fats, vegetables and unprocessed carbohydrates - will help to keep blood sugar levels balanced and support a healthy gut microbiota, thus keeping systemic inflammation and low mood at bay.  

#4 A SEDENTARY LIFESTYLE

Movement is a critical component of mental health and wellbeing. Long, busy workdays make it difficult to find time to exercise, however it should be a foundation of every mental health plan. A recent meta-analysis of 92 studies on more than 4,310 people showed that light to moderate exercise significantly reduced the incidence of depression.(10) Try adding 15-20 minute walks at lunch or the end of your day to increase your activity level.

Strength training can also play a key role in mental health. Basic movements like squatting, lunging, bending, pushing, and pulling are deeply engrained in our DNA and exert tremendous positive benefit on multiple systems of the body: improving blood sugars and insulin, reducing inflammation, boosting testosterone (low levels have been associated with depression), and supporting healthy gut flora. If you’re not active, start slowly with 10-20 minutes of strength training 2-3 times weekly and focus on bodyweight type movements.

There is no “magic bullet” to fix depression. It’s a complex multi-factorial condition that is impacted by numerous systems of the body. From a biochemistry and physiology standpoint,  addressing root causes like blood sugar and insulin dysfunction, chronic inflammation, dysbiosis and leaky gut and maintaining an active lifestyle are great places to start so you can raise the playing field. (It's also important to consult a qualified mental health professional to address the underlying emotional root-causes). Take control of your mental health by making the small changes to your nutrition, movement and lifestyle so you can get back to feeling your best. Many people and athletes alike experience low mood and depression, you're not alone.

Dr. Marc Bubbs ND, CISSN, CSCS

Want to learn more? High blood sugar and insulin levels are strongly associated with depression. Listen to diabetes expert Dr. Jason Fung MD in Episode #15.

 

 

REFERENCES

1. Timonen. M et al. Insulin resistance and depressive symptoms in young adult males: Findings from Finnish military conscripts. Psychosom Med 69(8):723-28.

2. Pyykkonen AJ et al. Depressive symptoms, antidepressant medication use, and insulin resistance: the PPP-Botnia Study. Diabetes Care. 2011 Dec;34(12):2545-7.

3. Felger J, Lotrich FE. Inflammatory cytokines in depression: neurobiological mechanisms and therapeutic implications. Neuroscience. 2013 Aug 29;246:199-229.

4. Emerging Risk Factors Collaboration. Diabetes mellitus, fasting glucose, and risk of cause-specific death. New England Journal Medicine, Mar 2011;364;9:328-341.

5. G. S. Hotamisligil, N. S. Shargill, and B. M. Spiegelman, “Adipose expression of tumor necrosis factor-α: direct role in obesity-linked insulin resistance,” Science, vol. 259, no. 5091, pp. 87–91, 1993.

6. Larrieu T, et al. Nutritional omega-3 modulates neuronal morphology in the prefrontal cortex along with depression-related behaviour through corticosterone secretion. Transl Psychiatry. 2014 Sep 9;4:e437.

7. Moreno-Navarrete JM et al. Circulating zonulin, a marker of intestinal permeability, is increased in association with obesity-associated insulin resistance.. PLos One 2012;7(5):e37160.

8. VanWijck K et al. Aggravation of exercise-induced intestinal injury by Ibroprofen in athletes. Med Sci Sports Exerc. 2012 Dec;44(12):2257-62.

9. Matsui H et al. The pathophysiology of non-steroidal anti-inflammatory drug (NSAID)-induced mucosal injuries in stomach and small intestine. J Clin Biochem Nutr. 2011 Mar;48(2):107-11.

10. Rebar A, et al. A Meta-Meta-Analysis of the effect of physical activity on depression and anxiety in non-clinical adult populations. Health Psychol Rev. 2015 Mar 5:1-78.

3 New Years Resolutions for Weight Loss (That Actually Work)

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It’s the New Year and the number one resolution on most people’s list is to trim their waistline and lose a few pounds.  After a festive holiday break, it’s easy to consume a few too many tasty treats or festive drinks. Unfortunately, the calories and the pounds start to add up. The natural tendency is to want to completely overhaul your eating habits and exercise routine to kick-start your weight loss. Unfortunately, most people fall short of their new goals before the end of the month and research shows only 5-10% lose weight and hold it off by the end of the year. 

The key to long-term successful weight loss is to focus on weight loss principles and not get too lost in the latest fads (although, if a fad motivates you to get started, by all means!). Let's review two key underling principles of weight loss; caloric restriction and compliance. The common theme amongst all types of diet, regardless if its LCHF, Keto, Paleo, Vegan, IIFYM, the Cabbage Soup diet (yes, a real thing) is a caloric deficit. Ironically, if you chase artificial sweeteners and zero-fat foods you likely won't see the progress you're after. Far easier to adopt a method that gets you naturally into a caloric deficit and focuses on real food. Next, on the compliance side of things, once again it doesn't matter what type of diet you start, if you can't stick to it you're going to fail. Compliance is fundamental to success. 

In this article, I've review three methods my overweight and obese clients have adopted with a high degree of success to support acute and long-term weight loss; low-carb breakfast, no snacking and HIIT training. You can jump in with both feet and adopt all three, or drip-feed them in to suit your schedule. (There is a lot more nuance than these three steps, but it's a great place to start if you're looking simple, effective methods for success). Let's take a closer look.

#1 Adopt A Low-Carb Breakfast

If you’re overweight, out of shape, or in poor health you're more than likely in a caloric excess.  Your body will be stuck in "storage" mode due to the excess of calories, converting them efficiently body-fat and unfortunately blocking your ability to tap into your own fat stores for fuel ( a big problem if you're trying to lose weight). The research shows 5 out of top 6 calorically dense foods in the North American diet come in the form of mainly processed carbohydrates; grain-based desserts, breads and cereals, soda pop, pizza and alcohol. If you start your day with the conventional high-carb breakfast, the hormonal signals telling your body to "store" your energy as fat will ramp up (i.e. insulin), putting the brakes on your ability to burn your own body-fat for fuel. Research shows that chronically high blood sugar levels and poor insulin sensitivity contribute to increased risk of weight gain diabetes, cardiovascular disease, cancer, depression, dementia and alzheimer’s.(1,2,3

A simple and effective strategy to reduce your caloric intake and improve your blood sugar control is to ditch your high-carb breakfast in favor of a higher protein and fat alternative. For example, poached eggs with avocado and cherry tomatoes or plain yogurt with berries and walnuts are great breakfast options, even if you’re busy and on the go. If you prefer breakfast smoothies, add 30-40g of protein along with a source of dietary fat (e.g. avocado or coconut oil), keep fruit to a minimum (i.e. ½ cup) and remember to use water as the base rather than juice to keep the carb and calorie count to a minimum.

The added protein you naturally achieve in a low-carb breakfast is one of the major reasons why this strategy is often so effective; helping to keep you full and satiated, as well as boosting metabolism due to its higher thermic effect of food (a fancy way of saying it "costs more" for your body to metabolize and process the protein you eat).  It also provides a more nutrient-dense food option, supplying you with key vitamins and minerals to support overall health. 

#2 Ditch The Snacks

You've probably heard the common refrain that eating lots of small meals throughout the day supports weight loss via increasing your metabolism. Context is crucial when considering this generic piece of advice. Like most things in life, the answer isn’t black and white. A recent meta-analysis review over the last 50 years in overweight people (i.e. general population) found eating multiple meals throughout the day (i.e. snacking) did NOT increase their metabolism and did NOT improve their weight loss.(4) In fact, they often gain weight! Lean protein snacks can be beneficial, but in an office setting you probably don’t have chicken breasts, steaks and salmon fillets tucked away in your desk drawers to snack on. Processed carbs and sugary treats tend to dominate the snack options, and these types of foods are hyper-palatable, leading to over-consumption. In fact, research shows overweight individuals can often trigger greater weight loss with fewer meals, rather than constantly grazing throughout the day.(5) (Remember, you still need three meals a day, as dropping to only two will slow metabolism and hinder weight loss.(6)

This New Year, a simple strategy to support effective, long-term weight loss is to ditch the snacks at your desk and re-focus your energy on eating three “high-quality” square meals throughout the day (just like your grandparents used to!). At first, you may struggle with some cravings, so feel free to add coffee (only in AM) or tea as caffeine helps to curb cravings, or a glass of water between meals (mineral water works great) to help prevent the negative impacts of "distracted eating" in this article.

(Note - If you're an athlete or bodybuilder and training frequently, eating multiple meals throughout the day - with protein at each meal - can definitely help optimize training adaptations and body composition. More on this in a future post.)

#3 Add More High-Intensity Interval Training (HIIT)

In January, gyms across the country are full of people doing steady-state cardio in an attempt to lose weight. While a properly periodized plan from a coach can definitely help you get fitter and leaner, most people tend to do the same routine every time they train and this type of “chronic cardio” strategy is a major roadblock to weight loss success. Over time, you burn fewer and ferwe calories to perform the same exercise bout. You're not getting fitter and you're not getting leaner. The solution is more efficiency (not more miles on the treadmill). The research shows that short, intense bursts of HIIT exercise can produce powerful changes in body composition and is far more time-efficient than steady-state cardio. That’s right, HIIT helps build a greater VO2 max (a reliable marker for aerobic fitness), can burn more calories than traditional cardio and is just as good as for your heart as steady-state aerobic training. It's a time-efficient way to get your movement i

The Bottomline: You don't have to completely overhaul your life to achieve your goals. Embrace your New Year's resolutions this year and get back to the fundamentals to achieve success;  adopt a low-carb breakfast and ditch the snacks to achieve a caloric deficit and better sustained energy (and satiety), and add HIIT training to improve your cardiovascular fitness and capacity to burn fat. 

What will your legacy be this New Year? The answer is much simpler than you think. It’s not about finding the best new exercise regime or trendiest diet, but rather transforming your old habits that hold you back and transform them into new “good” habits that promote weight loss. Make small changes that you can sustain over the long run.  Building new habits will enable you to achieve your weight loss and health goals this year and before you know it, you will be set up for long-term success and a better body this year!

Dr. Marc Bubbs ND, MS(c), CISSN, CSCS

Want to learn more about weight loss principles? Listen to Danny Lennon MS talk weight loss in Season 2, Episode 1 of the Dr. Bubbs Performance Podcast.

Ready for more in-depth support? Check out my Weight Loss Masterclass program for 8-weeks of 1-1 support to learn to upgrade your diet, exercise and lifestyle to finally achieve your goals!

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Do you struggle with persistent fatigue or unexplained low energy? Are you having trouble maintaining your strength at the gym? Are you constantly getting mouth ulcers or dealing with low mood? While there are many potential causes of these symptoms, vitamin B12 deficiency could be part of the problem holding you back from feeling and performing your best.,

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As summer comes to an end and we move into fall, cold and flu season beings. Chronic congestion, runny noses, fatigue and germs start to spread easily through training facilities, locker rooms, offices, and daycares as we move indoors during the colder, darker and shorter days of winter.

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Are achy joints simply the inevitable consequence of getting older? How about fatigue or poor sleep? Should you just “learn to live” with a chronic condition or is there something you can do to reverse it? You may have been told by your health practitioner that these symptoms are due to the natural aging process, but there isn't quite true. The different between "life span" versus "health span" is the final decade is typically in pain and discomfort in the former, while the latter is health and vitality right up until the end.  Which option do you prefer?

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Do you like to exercise hard? Are long and grueling training sessions a regular part of your routine? If so, the research shows you’re more likely to get sick or experience adverse symptoms similar to a cold or flu.(1,2) Contrary to popular belief, it’s not simply a high total training load that depletes immunity, but rather how abruptly your training ramps up that leaves your immune system compromised and susceptible to attack.(3) In fact, experts have uncovered dramatic increases in training volume are perhaps a better predictor of upper-respiratory tract infection (URTI) than just your training load alone.(4) However, as an athlete you often have no choice, you have to push the accelerator to the floor and train hard to compete with the competition.  

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With all the conflicting information, it’s no wonder one of the most common questions I get asked by patients and athletes...

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For years the recommendation from run coaches has been to drink beforeyou are thirsty, to prevent dehydration and subsequent decrements in performance. But if you aren’t racing at the front of the pack, do you need this much water?

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Circadian rhythms are triggered by the bright light stimulus in the morning and darkness in the evening. The hypothalamus area of the brain – specifically the suprachiasmatic nucleus (SCN) – is the master regulator, synchronising the body’s circadian clock based on information it receives from photoreceptors in the eyes in response to light [2]. The impacts of circadian rhythm are wide-reaching:

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The question for athletes is… “can your gut microbiota impact your athletic performance?” New research suggests it can. Let’s take a quick look at seven potential areas of interest:

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