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. 

 

 

6 Longevity Tips - Increase Your Health Span

6 Longevity Tips - Increase Your Health Span

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?

Read More

Reduce Omega-6s (and Increase Omega-3s) for Better Health & Performance

If there’s one area where the nutrition media seems to sing a different and more confusing tune every week, it’s with their messages about fats.

Low fat was good for us, now it’s not. Saturated fats may not be the heart-clogging poison we thought. And what exactly are trans fats? It’s enough to make us throw our hands in the air and reach for the nearest burger.

Fortunately, one message has been consistent: omega-3 essential fatty acids (EFAs) are extremely beneficial for your overall health.  

The problem is, not all sources of omega-3 fatty acids are created equal.

In fact, the most common plant source of Omega-3s, called DHA, is converted to the form that we use, called EPA. It’s EPA which exerts the majority of the potent benefits of omega-3 fats.

But that’s only half of the story. While omega-3’s benefit our health, too much consumption of its counterpart, omega-6 EFAs, increases circulating levels of inflammatory arachidonic acid (AA) which can promote heart disease, cancer and most chronic diseases. 1

Unfortunately, our bodies can more readily convert omega-6 fatty acids to AA. Especially among some multi-generational vegetarians. That’s why, for optimal health, it’s not enough to just increase your variety of DHA and EPA-rich foods. You need to reduce your intake of pro-inflammatory omega-6 fats as well.  

Decrease Your Omega-6 Intake

The balance of omega-6 to omega-3 is critically important and unfortunately today’s modern diet is loaded with omega-6 fats. The omega-6 to omega-3 ratio of ancestral hunter-gatherer diets was approximately 2:1-3:1, whereas today’s ratio is around 10:1 to 20:1 (and higher among vegetarians). 2

Many people aren’t even aware they consume as much Omega-6 fatty acid as they do. It’s hidden in processed and convenience foods, used in most restaurants (even the expensive ones!) and in your favorite midday treat.

Vegetable and cooking oils are the most common sources. The following is a list of common omega-6 rich oils:

Oil - Omega-6 (%):Omega-3 (%)

Safflower- 75:0%

Sunflower- 65:0%

Corn - 54:0%

Cottonseed50%0%

Sesame - 42:0%

Peanut - 32:0%

Soybean - 51:7%

Canola - 20-9%

Fish Oil - 0:100%


Most of us will benefit from cutting out these pro-inflammatory oils in favor of animal fats like beef tallow and duck fat (best for high-heat cooking) as well as coconut, avocado, walnut, macadamia or extra-virgin olive oil (best for moderate-heat cooking).

Increase Omega-3 Intake (EPA/DHA)

Now that you’ve cleared your kitchen of pro-inflammatory omega-6 fats, it’s time to ramp up your dietary intake of the extra-long chain omega-3 fats; DHA and EPA.

A daily intake of just 1g of combined EPA and DHA can have many positive effects. If you’re overweight or struggling with poor health, increasing your intake of omega-3 fats can improve blood sugar and insulin control, help fight off low mood and depression, and protect you from coronary heart disease. 3,4,5

If you’re exercising regularly (or just getting active), the University of Florida found consuming DHA post-training was able to significantly reduce exercise induced pro-inflammatory markers IL-6 and CRP over a two-week period. 6 In the UK, researchers at Cardiff University found that EPA and DHA were able to reduce key proteins that trigger the disease progression in osteoarthritis. 7

Fish: A Great Source of EPA

Terrific sources of extra-long chain omega-3 fats include Atlantic mackerel (2.6g per 3.5 oz. serving), herring (1.8g), tuna (1.6g), and salmon (1.5g per 3.5 oz.). If you like shell fish, blue mussels (0.5g per 3.5oz serving), oysters (0.6g), and squid (0.4g) are nice options as well.

Lean Meats: A Less Known Sources of Omega-3s

While most people naturally associate feedlot beef with saturated fats, and look to fish and seafood to get their omega-3s, grass-fed beef is actually a good source of EPA and DHA (0.3g per 3.5oz. serving).  Ancestral staples like wild game meats – elk, bison, venison, etc. – are also good options as they’re naturally low in pro-inflammatory omega-6 with some omega-3s.

Omega-3 Eggs

Pasture-raised eggs are far more nutrient dense than conventional eggs and provide 0.3g of omega-3s per two large eggs.8

If there’s a lesson to be learned, it’s that the balance of omega-3 to omega-6 is what’s crucial for optimal health, as well as mental and physical performance.9,10,11 Focus on both reducing your intake of pro-inflammatory omega-6 fats and increase your intake of extra-long chain omega-3 fats to reverse chronic degenerative conditions and restore health and vitality.

Dr. Marc Bubbs ND, CISSN, CSCS

 

References

[1]  ResearchGate. (March 29, 2016). Human genome shaped by vegetarian diet increases risk of cancer and heart disease. Retrieved from https://www.researchgate.net/blog/post/human-genome-shaped-by-vegetarian-diet-increases-risk-of-cancer-and-heart-disease

[2]  Cordain L, Eaton SB, Sebastian A, et al. Origins and evolution of the Western diet: health implications for the 21st century. Am J Clin Nutr. 2005;81(2):341-54.

[3] Delarue J et al.Interaction of fish oil and a glucocorticoid on metabolic responses to an oral glucose load in healthy human subjects.Br J Nutr.2006 Feb;95(2):267-72.

[4] Su K, et al.Omega-3 fatty acids in major depressive disorder. A preliminary double-blind, placebo-controlled trial.Eur Neuropsychopharmacol 2003;13(4):267-271

[5] Okuyama H et al. ω3 Fatty Acids Effectively Prevent Coronary Heart Disease and Other Late-Onset Diseases – The Excessive Linoleic Acid Syndrome. World Review of Nutrition and Dietetics (Karger) 2007, 96 (Prevention of Coronary Heart Disease):83-103. Retrieved From – https://www.researchgate.net/publication/232471505_o3_Fatty_Acids_Effectively_Prevent_Coronary_Heart_Disease_and_Other_Late-Onset_Diseases_-_The_Excessive_Linoleic_Acid_Syndrome

[6] Phillips T et al.A dietary supplement attenuates IL-6 and CRP after eccentric exercise in untrained males.Med Sci Sports Exerc 2003;35(12):2032-2037.

[7] Zainal, Z et al. Relative efficacies of omega-3 polyunsaturated fatty acids in reducing expression of key proteins in a model system for studying osteoarthritis. Osteoarthritis Cartilage. 2009 Jul;17(7):896-905.

[8] Karsten H et al. Vitamins A, E and fatty acid composition of the eggs of caged hens and pastured hens. Renewable Agriculture and Food Systems. Volume 25/ Special Issue 01 / March 2010, pp45-54. Retrieved From – http://journals.cambridge.org/action/displayAbstract?fromPage=online&aid=7219036

[9] Sheppard, K.W. and C.L. Cheatham, Omega-6 to omega-3 fatty acid ratio and higher-order cognitive functions in 7- to 9-y-olds: a cross-sectional study. Am J Clin Nutr, 2013. 98(3): p. 659-67.

[10] Simopoulos, A.P., An Increase in the Omega-6/Omega-3 Fatty Acid Ratio Increases the Risk for Obesity. Nutrients, 2016. 8(3): p. 128.

[11] Simopoulos, A.P., The importance of the ratio of omega-6/omega-3 essential fatty acids. Biomed Pharmacother, 2002. 56(8): p. 365-79.

 

Vitamin D and Omega-3 Supplements on The Paleo Diet

Choosing a Paleo diet and eating more in tune with how we’ve evolved provides the body with a robust amount of essential protein, healthy fats, gluten-free carbohydrates and nutrient dense veggies. An ancestral approach to eating also provides your body with key nutrients, vitamins and minerals the way nature intended. Does this mean that supplementation is unnecessary if you’re following a Paleo lifestyle? It’s a complicated question.

Most articles and blogs about supplements inevitably discuss the benefits or drawbacks of multi-vitamins. Research shows that if you eat a diet centered around the most nutrient dense foods – quality meats, veggies and fats – you’ll likely already be achieving a therapeutic dose for most vitamins and minerals. When intake is at a supra-physiological dose (that can never be found in nature), too many vitamins can actually put you at risk of chronic disease. Does this mean if you’re following a Paleo diet you don’t need any supplements?

Let’s look at the two most common instances where supplementation might still be a good idea, vitamin D and omega-3 fats. In both of these cases, although a Paleo diet is a great place to start, for many people this may not be enough.

SHOULD YOU SUPPLEMENT WITH VITAMIN D?

Vitamin D is classically known as an essential nutrient for bone health and immunity, however new research shows this fat-soluble vitamin has much more profound impacts on your health and well-being.

How important is vitamin D? Dr. Michael Holick, physician and vitamin D expert sums it up. “Imagine what would happen if a drug company came out with single pill that reduces the risk of cancer, heart attack, stroke, osteoporosis, PMS, depression and various autoimmune conditions? There would be a media frenzy the likes of which has never been seen before! Such a drug exists… it’s the sun.”1, 2, 3

Vitamin D is different than other vitamins because it’s created under your skin when ultraviolet light from the sun interacts with a specific enzyme to form cholecalciferol or vitamin D3. However, exposure to daily sunlight is no longer the norm as we are cooped up in cubicles all day and the deeply ingrained ancestral benefits of light exposure are overlooked.

It’s estimated that up to 70% of the American population is deficient in vitamin D (defined as blood levels below 20ng/mL or 50 nmol/L), or suffering from vitamin D insufficiency, a level above a diagnosed deficiency but still not sufficient for good health (measured as 20-32 ng/mL or 50-80nmol/L). 4

If you live in a northern climate with a true winter season, or north of the 49th parallel, it’s very difficult to achieve the required blood levels of vitamin D from food alone. While cold-water fatty fish, eggs and mushrooms are good foods sources of vitamin D, in the dead of winter they’re likely not enough. Adding a supplement can be highly beneficial.

The standard medical recommendation for vitamin D drops is 1,000-2,000 IU per day, however in the darkest winter months you may need a higher dose. Remember, always get your blood levels tested and work with a doctor if you’re thinking of supplementing with more than the recommended dose. The normal range is typically between 32-50ng/mL (80-125nmol/L) and for athletes new research suggests achieving levels greater than 40ng/mL (100nmol/L) to support superior performance and recovery.5 Be sure to take your vitamin D supplement with a meal that includes fat for optimal absorption.

SHOULD YOU SUPPLEMENT WITH FISH OILS?

Extra long-chain fats eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) are the omega-3 ‘all-stars’ when it comes to supporting overall health and combating chronic disease. While most people know the benefits of omega-3 fats for cardiovascular health, many don’t realize they also help reduce the risk of diabetes and depression, protect against mental stress, and even support athletic performance by improving muscle protein synthesis and controlling excessive inflammation.

How important are omega-3 fats? In 2013, the Cardiovascular Healthy Study found that people with the highest omega-3 (e.g. EPA and DHA) levels in their blood had the lowest overall mortality rates.6 In short, the more omega-3 fats you consume, the less chance you have of dying from absolutely any cause. The good news is they are found in abundance in a Paleo diet (e.g. grass-fed meats, wild ocean fish, farm fresh eggs). However, modern day living and long, busy days might mean you’ll benefit from extra support.

If you’re prone to low mood or depression, or cope with regularly high stress levels fish oils could well be an important key to improving your brain health. A study in the Journal of Clinical Psychiatry found people experiencing depression had consistently lower levels of essential fatty acids in their blood. When subjects supplemented with fish oils they had significant improvements in their Hamilton Rating Scale, a recognized evaluation system for depression.7 The British Journal of Nutrition also discovered that supplementing with fish oils helps reduce the adrenal over-activation associated with high levels of mental stress.8

Rates of diabetes and pre-diabetes have never been higher, and constantly being on the go is just one factor that can lead to snacking on convenience foods that are high in processed carbs and sugars. A recent study of fish oil supplementation effects on blood sugar and insulin levels over a 3-week period found significant improvements in insulin function in those with elevated levels.9

Of course, it’s not enough just to increase your omega-3 intake. It’s far too easy to obtain excessive amounts of omega-6 type fats in today’s world, whether from processed foods, restaurant eating, or convenience snacks. The beauty of adopting a Paleo diet is that it often naturally restores this common imbalance. However, the impacts of modern living may still leave you short.

Unless you’re eating 1-2 pieces of cold, deep-water fatty fish daily, it’s best to add an omega-3 supplement rich in EPA/DHA. Fish oil is the richest in EPA and DHA, however krill oil, sea oil, and sea algae are all viable options as well. Aim to supplement with 1,000-1,500mg of combined EPA and DHA daily.

If you’re an athlete and training intensely fish oil supplementation can be a game changer. Supplementation can lead to an amazing 50% increase in the up-regulation of mTOR, the genetic signaling pathway that stimulates lean muscle growth, leading to significant increases in muscle protein synthesis and muscular hypertrophy.10If you’re serious about your training, adding extra omega-3 fats to your sports nutrition arsenal is important.

A Paleo diet is a great way to cover all your bases on the nutrition front. However, depending on your genetics, where you live, how busy you are, and your lifestyle, diet may not be enough to correct low or insufficient levels of vitamin D and omega-3 fats. Adding these two supplements into your regime, particularly throughout the winter months, may be the fix you need to improve your health, productivity at work and performance in the gym.

(This article originally appeared @ThePaleoDiet.com)

Dr. Marc Bubbs ND, CISSN, CSCS

Want to learn more? Listen to Paleo founder Dr. Loren Cordain PhD in episode #10 of the Dr. Bubbs Performance Podcast.

 

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REFERENCES

  1. Holick M.Vitamin D Deficiency:What A Pain It Is. Mayo Clin Proc 2003 78(12):1457-59Holick, M. Article Review: Vitamin D Deficiency. NEJM Medical Progress. 2007, 357:266-81.
  2. Holick, M. Shinning A Light On Vitamin D-Cancer Connection IARC Report. Dermato-Endocrinology, 2009 1(1):4-6
  3. Hanley D, Davison, K. Symposium: Vitamin D Insufficiency: A significant risk Factor in Chronic Disease and Potential Disease-Specific Biomarkers of Vitamin D Insufficiency: Vitamin D Insufficiency in North America. J Nutr 2005, 135:332-37
  4. Koundourakis, N et al. Vitamin D and Exercise Performance in Professional Soccer Players. Plos One. 2014 Jul 3;9(7):e101659.
  5. Mozaffarian D, Lemaitre RN, King IB, et al. Plasma phospholipid long-chain omega-3 fatty acids and total and cause-specific mortality in older adults. A cohort study. Ann Intern Med 2013; 158:515-525.
  6. Su K, Huang S, Chiu C, Shen W. Omega-3 fatty acids in major depressive disorder. A preliminary double-blind, placebo-controlled trial. Eur Neuropsychopharmacol 2003;13(4):267-271
  7. Delarue J et al. Fish oil attenuates adrenergic overactivity without altering glucose metabolism during an oral glucose load in haemodialysis patients. Br J Nutr. 2008 May;99(5):1041-7.
  8. Delarue J et al. Interaction of fish oil and a glucocorticoid on metabolic responses to an oral glucose load in healthy human subjects. Br J Nutr. 2006 Feb;95(2):267-72.
  9. Smith GI et al. Omega-3 polyunsaturated fatty acids augment the muscle protein anabolic response to hyperinsulinaemia-hyperaminoacidaemia in healthy young and middle-aged men and women. Clin Sci (Lond). 2011 Sep;121(6):267-78.