Athlete’s Guide to Reducing Inflammation

October 5, 2022September 6, 2022 by amystephens

Athlete’s Guide to Reducing Inflammation

What is inflammation?

In the world of sports and athletics, all athletes experience inflammation. Inflammation is a natural and healthy process by which the body protects itself from harm. Intense exercise causes metabolic waste as toxins are released, causing the body to respond. Inflammation is the process whereby the body heals itself from toxins.

Athletes perform at extraordinarily high levels, whether it’s running a marathon or playing a three hour tennis match in 100 degree weather, which can greatly affect the body. The need to take care of one’s body after these extreme efforts is essential to the process of reducing inflammation. The main jobs of an athlete are to workout, get stronger, and recover.

C-reactive protein (CRP) is an inflammatory protein that can be measured to determine the level of inflammation in the body. Higher levels of CRP are found in your blood after a workout and can persist for a few days. Your body can naturally lower CRP levels but this process can take a few days. During this time, muscle growth and repair are inhibited.

There are many different tools to reduce inflammation, but healthy eating is the single most important factor in reducing inflammation. Foods improve recovery and one’s own ability to perform. Many athletes will undergo procedures to lower inflammation but nothing is more potent than eating anti-inflammatory foods because healing nutrients are delivered directly into the body. These anti-inflammatory properties begin when certain foods are passed through the gut. There, certain nutrients such as omega-3’s, antioxidants (Vitamin C, E and A), and probiotics are absorbed into cells. Other foods like saturated fats and processed sugars have been shown to increase inflammation throughout the body.

Here is a list of foods that will reduce inflammation:

Tart cherry juice is a convenient source of Vitamin C and potassium which are used to restore electrolytes and promote recovery.

Vegetables such as peppers, broccoli, kale, beets (beet juice), and spinach are high in Vitamin C and antioxidants.

Berries and citrus fruits are also rich in antioxidants, Vitamin C, and anthocyanins. Best sources include: strawberries, blueberries, blackberries, raspberries, oranges, and grapes.

Green tea contains catechins which suppress the inflammatory protein response. (Ohishi)

Turmeric contains an ingredient called circumin which has been shown to reduce inflammation. Turmeric is most commonly used as a seasoning. To make tea, use 1 tsp ground turmeric and mix with warm milk (also a great source of iron).

Nuts and seeds such as chia seeds, almonds, walnuts contain monounsaturated fats and alpha linoleic acid (ALA) which has been shown to reduce levels of CRP. They are also rich in fiber which slows the release of glucose into the cells, also referred to as low glycemic foods. Peanuts are a great, less expensive option.

Avocado and Olive oil are great sources of monounsaturated fatty acids. These fats help raise good cholesterol and maintain the body’s cells. These foods are also rich in Vitamin E which is an antioxidant that helps fight inflammation.

Fatty fish such as salmon, sardines, anchovies, and mackerel are rich in omega-3 fatty acids, eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). Omega 3’s have properties that interrupt the inflammatory process, similar to aspirin (Calder).

Probiotic yogurt has been shown to lower levels of CRP and inflammation in the gut. The bacteria from yogurt protects the gut from invading viruses and bacteria and offsets proteins released during prolonged exercise (Forseth and Bienstock). Kefir and plain low-fat Greek yogurt are great because they have many strands of live cultures. (Salehzaden).

In addition to food, sleep and stress reduction will reduce inflammation by allowing hormone levels to reset so it can repair damaged tissue.

Sleeping 8-10 hours per night will help restore stress hormone levels and reduce inflammation (Mullington).
Reducing stress by practicing breathing exercises, yoga, taking a walk, or sitting quietly.

These foods cause inflammation

When you consume these foods in your diet, studies have shown elevated CRP levels.

Alcohol

Refined carbohydrates made with white flour do not contain many nutrients or fiber. They have a higher glycemic response which has shown to increase inflammation. These foods include: sweets, cookies, ice cream, pastries, cakes, processed foods.
Saturated fats found in shortening, lard, red meat, smoked meats, hot dogs, hamburger, sausage, fast food and fried foods. These foods have been shown to raise bad cholesterol levels and contribute to inflammation.

Sample meal plan

Breakfast

Bowl of plain low-fat yogurt with almonds and berries and top with chia seeds

Post-workout snack

Toast with almond butter, berries, glass of tart cherry juice

Lunch

Spinach salad with avocado, chickpeas, and pumpkin seeds, olive oil and vinegar dressing

Quinoa or brown rice bowl with broccoli and peppers and grilled salmon

Blueberry smoothie made with plain yogurt

Snack

Grapes and almonds or walnuts

Chia pudding made with milk or almond milk

Green tea

Dinner

Chicken fajitas, sliced avocado, tomates, peppers and onions, tomato salsa

Easy chia pudding recipe

In small jar or covered container, mix together:

2 Tbsp chia seeds

½ cup milk

1 tsp honey

Shake well and refrigerate for at least 2 hours. Top with strawberries and cinnamon.

References

Calder PC. (2010). Omega-3 fatty acids and inflammatory processes. Nutrients, 2(3):355-374.

Forsythe P & Bienenstock J (2010). Immunomodulation by commensal and probiotic bacteria. Immu invest, 39(4-5): 429-48.

Kuczmarski MF, Mason MA, Allegro D, Zonderman AB, Evans MK. (2013). Diet quality is inversely associated with C-reactive protein levels in urban, low-income African-American and white adults. J Acad Nutr Diet, 113(12):1620-31.

Lankinen M, Uusitupa M, Schwab U. (2019). Nordic Diet and Inflammation-A Review of Observational and Intervention Studies. Nutrients,18;11(6):1369.

Mullington JM, Simpson NS, Meier-Ewert HK, Haack M. (2010). Sleep loss and inflammation. Best Pract Res Clin Endocrinol Metab, 24(5):775-84.

Ohishi T, Goto S, Monira P, Isemura M, Nakamura Y. (2016). Anti-inflammatory Action of Green Tea. Anti Inflam Anti Allergy Agents Med Chem, 15(2):74-90.

Salehzadeh, Karim. (2015). The Effects of Probiotic Yogurt Drink on Lipid Profile, CRP, and Record Changes in Aerobic Athletes. Int’l J Life Sciences, 9;(4)32-37.

How to change body composition in a healthy way

January 28, 2022September 12, 2021 by amystephens

change body composition in a healthy way

Why important

It has been proven that athletes with more muscle mass and less fat are able to run faster due to the power-to-weight ratio. Oftentimes, athletes will try to lose weight in an unhealthy way which can negatively affect performance and cause injury. This post reviews safe and effective strategies to lower body fat without compromising performance and mental health.

Factors influencing body composition

Genetic predisposition, age, sex, activity level, and dieting history are a few factors that affect body composition. As we age, our bodies have a greater percentage of fat tissue although studies have recently shown that can be mitigated with healthy eating and exercise. Gender is also a factor, as male athletes tend to have lower body fat composition while female-identifying athletes tend to have higher body fat.

Off season

In the off season, many athletes find themselves increasing weight. Rather than crash dieting to get back into shape, I created a guide to help decrease body fat without losing muscle or compromising performance and may cause injuries to ensue.

Performance

Running performance is based on a power to weight ratio. Increasing the amount of muscle and decreasing body fat enable an athlete to move faster through strides with less effort.

Oftentimes, athletes will cut calories and “diet” or utilize intermittent fasting in an effort to lower body fat and improve performance. However, these types of diets lead to depletion of glycogen and muscle mass. They are overly restrictive and the athlete often ends up regaining the weight, mostly as fat tissue which decreases performance.

The human body needs a combination of carbohydrates, fats and protein to perform at its best. I’ve compiled a list of tips below to help athletes lose fat in a healthy way without feeling deprived, compromise performance or lead to weight regain.

Carbohydrates

During a run, our bodies are using glycogen, a stored form of glucose, as the primary source of fuel. Easy and tempo runs (VO2max 50-80%) utilize a combination of fat and glucose for fuel. Harder track workouts (VO2max >80%) will use mostly glucose. Since our bodies are mostly using glucose for energy, replenishment after a run with carbohydrate-rich food is essential to improve training and overall fitness. Studies have shown that carbohydrates are the fastest source of energy to power a workout or run. Carbs convert into glucose at a faster rate than protein or fats and enable the athlete to run and continue running at a faster speed. Target about 5-8 grams of carbohydrates per kilogram of body weight per day (Burke).

Protein

Protein-rich foods are essential to help replenish amino acids used by muscles and repair muscle damage that occurs during eccentric exercises such as down hill running. If the diet is lacking in protein, muscle repair and growth will be negatively affected. Target 1.5-2.3 grams of protein per kilogram of body weight per day (Mettler).

Fat

Fat provides calories to support hormone production, which helps regulate many important functions in the body such as; menstruation, bone formation, or iron regulation. It’s important to get in enough healthy fat calories to keep you full and provide fat soluble vitamins. Aim for 20% of calories from fat per day.

To convert pounds to kilograms, divide by 2.2.

All of these nutrients are critical to achieving optimal performance so careful attention needs to be made especially during weight loss efforts. Several studies have shown that crash diets don’t work and can lead to muscle loss, slow metabolism, poor mood, and decreased performance. To decrease body fat in a healthy way, follow these tips:

Tips

Focus on timing of meals. Eat more food immediately before or after a run/workout and then prioritize eating a sensible meal when hungry with lots of fiber (brown rice, veggies, grilled chicken, turkey burger and salad).
Increase protein to stay full. Aim for 20-30 grams of protein per meal. Grilled chicken, sliced turkey, hard-boiled egg or edamame.
Cut back on added sugars from sweets or processed foods. Too much sugar can cause a sugar crash and leave you feeling lethargic and increase hunger.
Avoid getting too hungry, as this can lead to overeating.
Keep the refrigerator stocked with fruits, veggies, lean proteins like chicken, sliced turkey, low-fat cottage cheese, hummus, low-fat plain yogurt.
Snack on fruits, vegetables and small portions of nuts. Snack foods tend to be less nutritious and the calories can often add up to another meal. Add more food at meals to cut back on snacking. Use snacking as an opportunity to eat fruits + veggies. Veggies in dip such as hummus, peanut butter or tzatziki. Rice cake with peanut butter or yogurt with fruit.
Avoid weighing yourself daily. Your weight fluctuates daily from fluid shifts and seeing the scale increase and decrease can be discouraging.
Aim for at least 8 hours of sleep each night because sleep allows your stress and hunger hormones to reset. Hormones like ghrelin, insulin and cortisol increase during stress which affect metabolism. These hormones are responsible for increasing your appetite and storing fat and adequate rest will maintain an optimal balance.
Allow 10% of calories to be “fun foods” or less nutritious foods (approx 200-300 calories). If you include these foods in your diet, you are less likely to crave them.
You don’t need to clean your plate every time you eat. Restaurant portions are typically too large. Stop eating when you are full and save leftovers for later in the day or another meal.

Learn more about intuitive eating. This is a concept that focuses on hunger and satiety cues. Reconnect with how your body feels when you are hungry. Learning to slow down when eating by chewing slowly and taking breaks will help you recognize when you are full. These simple strategies will prevent overeating.

Sample meal plan

Breakfast

Pre workout

Oatmeal w/ banana + nuts or nut butter

Post workout

Chocolate milk, granola bar or green smoothie

Lunch

Rice bowl with grilled chicken and vegetables

Bowl of strawberries

PB&J with green smoothie – banana, ice, milk, peanut butter, and spinach

Snack

Plain low-fat yogurt with fruit

Dinner

Grilled chicken, salmon or turkey burger, baked potato, salad or steamed vegetables with olive oil and lemon

Dessert – blueberries or dark chocolate

Snack (optional)

Graham crackers and low-fat milk

References

Burke L. and Deakin V. (2015). Clinical Sports Nutrition (5th edition). North Ryde, N.S.W McGraw-Hill Education.

Close GL, Sale C, Baar K, Bermon S. Nutrition for the Prevention and Treatment of Injuries in Track and Field Athletes. Int J Sport Nutr Exerc Metab. 2019 Mar 1;29(2):189-197.

Jeukendrup AE. Periodized Nutrition for Athletes. Sports Med. 2017 Mar;47(Suppl 1):51-63.

Mettler S, Mitchell N, Tipton KD. Increased protein intake reduces lean body mass loss during weight loss in athletes. Med Sci Sports Exerc. 2010 Feb;42(2):326-37.

Stellingwerff T, Maughan RJ, Burke LM. Nutrition for power sports: middle-distance running, track cycling, rowing, canoeing/kayaking, and swimming. J Sports Sci. 2011;29 Suppl 1:S79-89.

Thomas D, et al. Position of the Academy of Nutrition and Dietetics, Dietitians of Canada, and the American College of Sports Medicine: Nutrition and Athletic Performance. J Acad Nutr Diet. 2016 Mar;116(3):501-528.

Iron for endurance athletes

May 30, 2023September 10, 2021 by amystephens

Iron levels for athletes

Why iron deficiency is important

Iron is an important nutrient to endurance athletes because it carries oxygen and produces energy. Low levels of iron mean that fewer red blood cells are available to carry oxygen. Oxygen is essential to power muscles and the removal of metabolic waste so the body can function at peak performance. Many studies have reported the prevalence of iron deficiency in endurance athletes to be as high as 50% in females and 30% in males (Koehler 2012, Tan 2012). Although more common in female athletes, male athletes are also at risk for low iron. Often, athletes will report low energy levels or difficulty completing a workout, and later will find it’s iron deficiency. This post will review how iron impacts performance, symptoms of low iron, and how to prevent iron from impacting performance.

Stages of deficiency

Dr. Peeling defined stages of deficiency and depletion (2007). What’s interesting about these stages is that iron stores can be depleted while hemoglobin levels remain within normal range. It’s not until stages 2 or 3 of deficiency that an athlete begins to see a performance impact. Before a substantial training block begins, assessing individuals’ risk factors and low iron risk factors is helpful. If an athlete has a drop in iron during a racing season, treatment can take a few weeks, which can have a detrimental impact on the racing schedule. A basic iron assessment contains the following labs: ferritin, hemoglobin, and transferrin saturation. Your physician can order these tests and a sports dietitian can help interpret them and review best treatment options.

> Stage 1—Iron deficiency (ID): iron stores in the bone marrow, liver and spleen are depleted (ferritin < 35 μg/L, Hb > 115 g/L, transferrin saturation > 16%). Treat with food first approach by including many iron-rich foods along with Vitamin C.

> Stage 2—Iron-deficient non-anemia (IDNA): erythro- poiesis diminishes as the iron supply to the erythroid marrow is reduced (ferritin < 20 μg/L, Hb > 115 g/L, transferrin saturation < 16%). Initiate iron supplements 65mg elemental iron. Can take 4-12 weeks to show results.

> Stage 3—Iron-deficient anemia (IDA): Hb production falls, resulting in anemia (ferritin < 12 μg/L, Hb < 115 g/L, transferrin saturation < 16%). When levels are this low, consult with your physician about the cause and best treatment options.

NOTE: 325 mg ferrous sulfate is equivalent to 65 mg elemental iron.

Risk factors for low iron

There are a variety of factors that contribute to low iron levels. Any one of these risk factors can cause iron levels to drop, and multiple risk factors will carry an even greater risk for low iron. Endurance athletes are at the greatest risk due to the hemolysis from the footstrike and blood loss in the gut while running and sweat. During a training block, iron can drop 25-40% (McKay).

Menstruation for females
Underfueling/Low calorie intake (RED-S)
Endurance athletes
Altitude training
Vegan or vegetarian diets
Have a history of low iron stores

Symptoms

Initially, symptoms are not overt, however, you may feel tired overtime or less of a desire to complete a workout. Most common symptoms include: feeling lethargic, dizzy, negative mood, or poor performance (Sim).

Hepcidin

Hepcidin is a hormone released during exercise that inhibits iron absorption for 3-6 hours after a workout (Sim). This hormone regulates the amount of iron absorbed by the gut. Hepcidin levels are known to elevate 3-6 hours after a workout, thus reducing the amount of iron absorbed from food and supplements.

Iron- rich foods

There are two types of iron-rich foods – heme and non heme sources. Heme sources are more bioavailable compared to plant-based iron sources. Up to 35% of heme versus 20% iron from plants are absorbed (Beard). An athlete can add a Vitamin C food to further enhance absorption. If iron stores are very low or you are at a higher risk for iron deficiency, you may require iron supplements in addition to dietary intervention. Currently, the RDI for iron men is 8mg and 18 mg for women.

Heme iron

Beef
chicken
fish
turkey

Non-heme

Lentils, beans
Chickpeas, hummus (especially if made with tahini)
Spinach
Apricots, prunes
Baked potato with skin
Enriched breakfast cereals (Cheerios)
Enriched pasta

Click here for a full list of iron-rich foods from the USDA database.

Sample meal ideas

Grilled chicken over rice with roasted red peppers.

Turkey sandwich on whole wheat bread with an orange.

Spinach salad with chickpeas, dried apricots, and lemon vinaigrette dressing.

Key points

Iron is an important nutrient involved with energy production and promoting oxygen uptake. Iron deficiency can negatively impact performance in athletes by reducing oxygen transferred to the cells and making the body work harder to produce energy.

Females, vegetarians, calorie-restricted diets (RED-S), endurance athletes and training at altitude increase the risk for low iron.

Symptoms of iron deficiency include fatigue, negative mood and poor performance.

Hepcidin is a hormone that reduces iron absorption for 3-6 hours following a workout. The best time to take an iron supplement or eat an iron rich meal is outside this window.

Best food sources of iron include meat, fish, poultry, dark green leafy vegetables. Combine iron rich foods with Vitamin C to enhance absorption.

Certain foods will compete with iron absorption, such as calcium and phytates.

Speak with your physician or sports dietitian to help assess and treat iron deficiency.

References

Beard J, Tobin B. 2000. Iron status and exercise. Am J Clin Nutr. 72 (2):594S-597S.

Coates A, Mountjoy M, Burr J. Incidence of iron deficiency and iron deficient anemia in elite runners and triathletes. Clin J Sport Med. 2016.

Koehler K, Braun H, Achtzehn S, Hildebrand U, Predel H-G, Mester J, Schänzer W (2012) Iron status in elite young athletes: gender- dependent influences of diet and exercise. Eur J Appl Physiol 112(2):513–523

McKay, AKA, Peeling P, et al. (2019a) Chronic adherence to a ketogenic diet modifies iron metabolism in elite athletes. Med Science Sports Exercise. 51(3):548-555.

McKay et al. Iron metabolism: interactions with energy and carbohydrate availability. Nutrients. 2020 Nov 30.12(12); 3692

Ostojic SM & Ahmetovic Z. Weekly training volume and hematological status in female top-level athletes. Ahmetovic Journal of Sports Medicine and Physical Fitness; Sep 2008; 48, 3; ProQuest Nursing & Allied Health Source pg. 398

Peeling P, Blee T, Goodman C, Dawson B, Claydon G, Beilby J, Prins A (2007) Effect of iron injections on aerobic-exercise perfor- mance of iron-depleted female athletes. Int J Sport Nutr Exerc Metab 17(3):221–231

Sim et al. Iron considerations for the athlete: a narrative review. Eur J Appl Physiol. 2019 July; 119(7):1463-78

Tan D, Dawson B, Peeling P (2012) Hemolytic effects of a football-specific training session in elite female players. Int J Sports Physiol Perform 7(3):271–276

USDA database for iron rich foods

Hydrating in heat and humidity

June 23, 2023August 19, 2021 by amystephens

Hydrating in heat and humidity

Water is the forgotten nutrient

Exercise produces heat and leaves the body as sweat to stay cool. Studies have repeatedly shown that losing more than 2% body weight impacts performance (James). More sweat is produced when the temperatures are higher or when humidity is high. Dehydration results in an increase in one’s core temperature, reduced cardiovascular function and imparied exercise performance.

Essentially, dehydration increases an athlete’s perceived effort and reduces the ability to continue exercising at a high level (Nybo). If you’re overheating, the body will prioritize cooling itself versus rapid energy production (James).

Role of sweat

During exercise, the body produces heat and energy. Sweat is the body’s built-in cooling system that enables the body to make more energy. In warmer temperatures, exercise raises core temperatures at a faster rate which require more water expelled through the skin to keep the body cool. As temperatures increase, our bodies respond by sweating more. However, humidity compounds this problem by preventing evaporation. In situations where humidity levels are high, as we experience on the east coast all summer long, there is more moisture in the air and the sweat does not evaporate. As a result, the body’s core temperature increases, making exercise seem harder.

Dehydration affects performance

Many studies have shown that a 2% loss in body weight will impair performance (Lewis). The body has to work harder to keep the heart pumping to produce energy and muscles firing. Not only does it feel harder when you are dehydrated, but your body is also producing energy at a slower rate.

As core temperatures increase, energy metabolism shifts from aerobic production to anaerobic and this causes a buildup of anaerobic by-products that stimulate fatigue. This process occurs at a faster rate in hot and humid conditions. Fuel source shifts from fatty acids to glucose and amino acids and creates more hydrogen and lactic acid (Burke 2015). The heart receives less blood and therefore, less oxygen is delivered to working muscles. This makes exercising even more difficult in warmer conditions. Muscles have a harder time contracting when they’re overheated and premature fatigue can set in (Nybo).

Cramping

If you lose too much water, the risk of cramping is increased. Humidity increases risk of dehydration which causes an imbalance of electrolytes, especially potassium, magnesium and sodium. These electrolytes are lost at high levels through the skin and have a significant impact on cramping (Jung).

Symptoms of dehydration

feeling thirsty
lightheaded
fatigue
dry mouth
urinating less often
infrequent, dark colored urine

Dietary recommendations in the heat

Fluid requirements are individualized. Establish your sweat rate by using a sweat test to better estimate the amount of sweat you lose in one hour of exercise. Once you know how much fluid your body loses, you can more precisely match your fluid requirements. Estimate fluid losses by using a sweat rate calculator to input your weight and fluids. Calories do not need to be increased when exercising in heat (Burke).

Start drinking fluids when you wake up. Have a glass of water before you drink coffee!
Before exercising, urine should be a pale yellow color.
Exercise in the beginning or end of the day when it’s cooler
Don’t chug water without electrolytes, this can lead to hyponatremia.
You will rehydrate faster when fluids contain electrolytes and carbohydrates. This helps stimulate thirst and retain fluids consumed (Baker & Jeukendrup 2014).

Hyponatremia is caused by drinking too much water and not enough electrolytes. Make sure to have salt or nuun tablets handy. Water follows electrolytes and when you sweat, you lose both!

The color of your urine is the best indicator of hydration. Aim for pale yellow, shade 1 or 2 on the chart is ideal. Clear urine can indicate fluid overload and hyponatremia. If your urine is dark yellow before a run, delay the start until you can drink more fluids.

References

Baker & Jeukendrup. Optimal composition of fluid replacement beverages. Comp Physiol. 2014;4:575-620.

Burke L. Nutritional needs for exercise in the heat. Comp Biochem Physiol Mol Integr Physiol. 2001; 128: 735-48.

Burke L. Clinical Sports Nutrition, 5th edition. 2015.

Cory M, et al. Resistance training in the heat improves strength in professional rugby athletes. Sci Med in Football. 2019;3:198–204.

James LJ, et al. Does Hypohydration Really Impair Endurance Performance? Methodological Considerations for Interpreting Hydration Research. Sports Med. 2019 Dec;49(Suppl 2):103-114.

Jung A, et al. Influence of Hydration and Electrolyte Supplementation on Incidence and Time to Onset of Exercise-Associated Muscle Cramps. J Athl Train. 2005; 40: 71–75.

Lewis J, et al. Does Hypohydration Really Impair Endurance Performance? Methodological Considerations for Interpreting Hydration Research. Sports Med. 2019;49:103-114.

Nybo & Sawka. Performance in the heat physiological factors of importance for hyperthermia-induced fatigue. Compr Physiol 2014;4:657-89.

Lau W, et al. Effect of oral rehydration solution versus spring water intake during exercise in the heat on muscle cramp susceptibility of young men. J of the Intl Soc of Sp Nutr. 2021; 18 (1).

Amy Stephens