Category Archives: Athletes

“We Think What We Eat?” How the Health of the Gut Impacts the Health of the Mind

We have all heard of the “mind-body connection.” This is the theory that the way we think (positive, negative, anxious, relaxed etc) influences the health of the rest of the body. Our thought patterns initiate a cascade of neural and hormonal signals that have the potential to impact how all the systems of the body function; anyone who has ever gotten a stomachache from worrying about something has first hand experience of this.

However, what about the opposite? We are finding that more than we ever realized, the health of the digestive tract can profoundly impact our mental health.

Going back to the stomachache example, there is a fascinating interplay between our digestion and mood, referred to as the “gut-brain axis”. Stress hormones and neurotransmitters produced during times of anxiety and stress can alter the integrity of the digestive system, which can lead to chronic GI problems such as IBS or other inflammatory diseases. Going the other way, the function of the gut generally, and the makeup of the microbiome specifically (the bacteria that normally live in the digestive tract) can have a profound impact on symptoms of depression and anxiety.

Studies are suggesting that major stressors early in life can predispose a person to inflammatory bowel disease (IBD). The two types of IBD can also be called Ulcerative colitis or Crohn’s disease; these are long-lasting, possibly lifelong conditions that break down the walls of the gut and can profoundly impact a person’s digestive capacity. Those damaged intestinal walls release a variety of chemicals that trigger similar inflammatory responses in the nervous system, causing anxious and depressive symptoms. Similarly, in Irritable bowel syndrome (IBS) cells from the walls of the intestines have been found to produce lower amounts of serotonin, one of the primary neurotransmitters that helps us feel happy and balanced. This leads to increased sensations of discomfort in the gut, but also communicates with the brain to decrease the mood.

Even beyond the signals sent by an inflamed gut that can irritate the brain, the makeup of bacteria living in the digestive tract (what we call the “microbiome”) also significantly impact mood. The bacteria in the microbiome produce many of our neurotransmitters, such as GABA, serotonin and dopamine. These chemical signals impact mood by traveling from the gut up the vagus nerve to the brain. Particularly in IBS, many studies have found that reestablishing a healthy microbiome will improve digestive as well as emotional symptoms. A new class of drug has even been introduced, called a “Psychobiotic”. The idea behind these is that the patient ingests probiotic bacteria designed to produce mood enhancing neurotransmitters in the gut, thereby improving mental health.

Athletes in particular have been found recently to have increased rates of digestive concerns along with increased anxiety and depression. It is theorized that intense training for elite athletes causes stressors that deplete the lining of the digestive tract along with changing the makeup of the microbiome. Additionally, many elite athletes are counseled to eat diets that are very low in starch, which is the primary food source for most of the “good” bacteria that lives in the gut. This further attenuates the microbiome, which causes more digestive disturbance and lower production of neurotransmitters and can result in IBS, anxiety, and depression.

So what can we do every day to improve the health of our digestion and our mental health?

  • Stress management: stress (fight or flight) hormones suppress our rest and digest hormones. This means your digestive tract does not rejuvenate itself when we are stressed out which can make it sick.
  • Eat a healthy variety of plant based foods to replenish healthy bacteria to the gut. This includes organically grown produce, healthy complex carbohydrates such as whole grains, root vegetables, and winter squash, and naturally fermented foods such as sauerkraut and pickles.
  • Eat in a relaxed manner to engage your rest and digest hormones.  No standing at the sink or eating on the run!
  • If you are having trouble digesting your food, Warming foods such as soup and steamed veggies are easier to digest than cold foods like salads and veggie sticks.
  • Adequate sleep also gives the digestive tract time to rejuvenate itself.  If your brain needs more sleep so does your gut!
  • If you are training for an athletic event, make sure to include rest days and rejuvenating activities such as restorative yoga, stretching, breathing exercises, or tai chi to help the digestive tract restore itself.

Good luck and happy eating!

Holistic Approaches to Inflammation and Chronic Disease

An Introduction to Chronic Inflammation

In many chronic disease states, inflammation is a common underlying factor.  If you are suffering from something that ends with “itis” (arthritis, tendinitis, pancreatitis, diverticulitis, etc), this is a medical term for “that part of your body has inflammation”. So what is inflammation?  On the large scale, we look for heat, redness, pain, and swelling; these are all key factors that tell us inflammation is taking place. Microscopically, we see that blood vessels become more permeable and extra fluid and immune cells come to the area to protect and heal the body and remove waste from the area.

What is the purpose of inflammation?  It is your body’s natural defense system: this is how your body protects and heals itself in cases of infection, allergy, and injury. When a foreign organism such as a bacteria, virus or fungus enters the body, your immune system launches a highly sophisticated attack to kill the invader and then clean up the remains of the battle afterwards.

While inflammation is a very important and appropriate action for the body to take, when it pops up in inappropriate places or continues on beyond the normal course of infection or injury it causes chronic pain and damage to that part of the body.

Chronic inflammation is the underlying cause of many very common chronic diseases.  Cardiovascular disease, arthritis, asthma, autoimmune thyroid disease, IBS and other digestive disorders, and eczema are all cases of chronic inflammation. When inflammation becomes chronic the area will be in a state of simultaneous destruction and healing, which over time can lead to scarring and loss of function.

Conventional treatment for inappropriate inflammation primarily relies on four types of drugs, all of which act by suppressing a key component of the body’s inflammatory response: Steroids such as prednisone mimic your body’s stress hormones’ ability to suppress inflammation.  Nonsteroidal antiinflammatories such as ibuprofen and acetomenophen suppress an enzyme called cyclooxygenase that creates the mediators that cause inflammation in the body.  Biologic drugs such as embrel and humira block the action of another inflammation-causing protein called Tissue Necrosis Factor. For more allergic sypmtoms, antihistamines such as Allegra suppress the release of histamine from allergic cells.  Although the effects of all of these drugs have different effects and can be quite useful to control symptoms in the short term, what they all have in common is that they suppress our body’s natural reaction to an underlying issue and can have significant unwanted side effects.  

There are a few primary concerns regarding the use of conventional medications for reducing inflammation. In the case of steroids and biologic drugs, they can suppress your immunity, leading to unwanted infection that can be difficult to treat.  NSAIDs can damage the liver, gut and kidney.  Antihistamines impact the nervous system and can cause drowsiness, hyperactivity, a decrease in secretions to the eyes, nose and mouth, and difficulty in urination. Rather than suppressing natural function, the goal with natural treatments is to divert the body’s innate function towards anti-inflammatory pathways.

Natural options for minimizing inflammation

There are three key elements to minimize inflammation holistically:  Exercise, Diet, and Supplements.  If you feel good now and want to minimize inflammation in the long-term, diet and exercise are a great place to start.  If you are already in a position where inflammation is a concern for you, botanicals and supplements may be necessary to get things under control.

Exercise:  While in the short-term exercise can trigger an acute inflammatory reaction, research has shown a long-term moderate training regimen decreases the body’s production of inflammatory cytokines.  The inflammation that is caused by working out is important for remodeling and building muscle mass.  In fact, post-workout treatments such as ibuprofen and icing the area have been shown to decrease the body’s ability to build muscle mass.  As the initial inflammation post-workout decreases, though,  It is important to keep in mind, however, that repetitive exercise that pushes the muscles past their capacity, such as long-distance running and body building, cause short-term inflammation (aka, delayed soreness after working out) that over time causes scarring damage to the muscle fibers.

Diet:  There are three basic components to reducing inflammation in the diet:  Eat more antiinflammatory foods, eat fewer pro-inflammatory foods, and avoid allergens or sensitivities.

Antiinflammatory Foods are those that support healthy digestion and improved liver function help the body rid itself of wastes that can trigger inflammation.  These include high fiber foods such as leafy greens, broccoli, and carrots, foods high in soluble fiber such as apples, flax, pears, and chia, foods high in omega-3 fats such as fish and flax, liver support foods such as beets, cucumbers, and greens, and probiotic foods such as kefir, yogurt, natural sauerkraut and pickles, miso, and kombucha.

Pro-Inflammatory Foods encourage the formation of pro-inflammatory cytokines.  While meats can be beneficial for other reasons, they are good to consume in moderation because their fat content can create more inflammation.  Refined carbohydrates in white flours and sugar can cause inflammation in the digestion; they also spike the blood sugar, which in turn can cause the formation of excess triglycerides which then causes inflammation in the blood vessels and can lead to cardiovascular disease and diabetes.  Alcohol depresses the ability of the liver to move toxins from the body which can create more inflammation and also spikes the blood sugar.

Finally, food allergens or sensitivities can compromise the integrity of the lining of the digestive tract, which allows larger particles of foods to enter the bloodstream, which in turn can cause the body to have an immune reaction to those particles.  One particularly good example of this is the association between celiac disease and autoimmune thyroid disease.  The most common food sensitivites tend to be dairy, gluten, egg, and soy, but the body can react to any food; testing or elimination diets can be useful to help sort this out.

Omega-3 fatty acids:  These fats have gotten a lot of press in the past 15 years because of their remarkable ability to decrease inflammation and improve the texture and quality of the skin and mucus membranes.  Omega-3 fats divert the biochemical pathway that normally creates inflammatory cytokines to a pathway that creates anti-inflammatory mediators.  There are several good sources of Omega-3 fats on the market today: generally, our bodies are able to use animal derived sources (such as those found in fish)  more readily than vegetarian sources (such as flax or borage seed).  While krill oil has recently become quite popular as a supplement, I do not recommend it because I have been hearing reports that krill populations are becoming threatened due to overharvesting: I prefer to leave them for the whales.

Botanicals and Supplements:  There are a number of plant medicines available that are quite useful for decreasing inflammation.  These include curcumin, derived from the turmeric plant, quercetin, derived from onions, and boswellia, or frankincense.  Supplements such as deglycyrrhizinated licorice (DGL) and L-glutamine can help restore the integrity of the digestive tract.  There are also a number of proteolytic enzyme products on the market that can be useful for decreasing scar tissue that can form during times of chronic inflammation, which will decrease pain and increase the ability of the area to heal.

 

Muscle and Bone Health–What Calcium Should I Take?

The answer, of course, is that every person has different needs, so it is important to find a calcium supplement that is right for you. For anyone taking Calcium, I recommend balancing it with Magnesium, Boron, and Vitamin D, as all of these are critical for healthy bones. Many people also find Calcium to be constipating; Magnesium tends to help things move along so a supplement containing both can be beneficial to the digestion.

Although there are many Calcium supplements out there, I carry three basic types of Calcium ath the Golden Naturopathic Clinic. Liquid Calcium Magnesium is what I use most often because it is easy to take and easy for the body to absorb. In addition to bone health benefits, this formula can help with constipation, muscle cramping and can improve the quality of sleep. For this reason I usually recommend taking this at night before bed. For people with greater severity of these symptoms, I will often use a formula with equal parts Magnesium and Calcium; otherwise there is a formula with equal parts of these minerals.

Cal-Mag Chela Max is a chelated formula that is very easy to break down and absorb. It is formulated specifically for people who have difficulty taking other calcium supplements because they irritate their digestive tract.

For people with osteopenia or osteoporosis, I use a formula called Osteoprime. This formula contains Strontium, the only mineral found to help replace bone rather than just prevent further bone loss. Osteoprime also has a full complement of Vitamins and Minerals so it can substitute for your regular multi.

If you are wondering how much Calcium you need, this will vary somewhat based on your individual needs. Pregnant, lactating, and postmenopausal women, for example will have greater Calcium needs than other adults. That said, shooting for somewhere between 1000 and 1200mg/day is a good rule of thumb.

It is important to remember that Calcium ideally should come from food sources. The amount you take as a supplement is just that: supplementary. To get a feel for calcium amounts in food, assume that an 8 oz glass of milk (including non-dairy milks as long as they are fortified) contains 300mg of calcium. Beyond milk, 1 oz of hard cheese, 1 cup of broccoli, collard greens or spinach, ½ cup of almonds, ½ cup of tofu (made with calcium), 4 canned sardines, or 8 dried figs all contain about 200mg of calcium. For a longer list, a good source is this document from Harvard: click here to view

Fluid and Electrolyte Balance for Athletes

 


I learned my lesson this year when it comes to hydration.  As I wrote about last month, we did our first long bike tour this summer: The Courage Classic.  The first day of the classic this year we started in Leadville, looped around Turquoise lake then rode up to Fremont pass before descending to Copper Mountain resort. The first 15 miles or so around the lake were beautiful and exciting with steep, winding ascents and descents.  The next 18 miles up to the pass was a steady climb with a steep finish.  I knew as I started the final climb up to the pass that I was feeling slower and slower, and when I finally reached the pass I was ready for a snack.  Over the past 3 ½ hours I had drained my large bike water bottle, perhaps 25 oz or so, plus 4 or 5 oz at one of the aid stations.

At the aid station atop Fremont pass, I got off my bike and found a snack–a crustless pre-manufactured white bread pb&j in a plastic wrapper. Under the circumstances, absolutely delicious!  I took a couple sips of water then went to chat for a moment with someone from my team.  We gave high fives, said good job, I smiled and turned away.  As I turned, I noticed that all the muscles in my face had frozen into place.  It occurred to me at that moment that perhaps I had not properly prepared with water and electrolytes for the race.  I forced my cheeks out of their joker-mask configuration and got back on the bike.

The rest of the day was good, I had a fun screaming fast ride down into Copper Mountain and all was well; but I paid for it with a doozy of a headache for the rest of the day. I also know my performance and fatigue was seriously affected by my dehydration.  The next day I doubled the water consumption, rode faster, and wasn’t tired at the end of a similar ride.

So how much water do we need when we exercise?  A good rule of thumb is that if we are sweating at a maximal rate, we lose about 1 oz/minute.  This means that if you are going full-tilt, you will lose almost 1 liter for every ½ hour of exercise.  Most endurance sports will cause a 1.5 liter/hour fluid loss, and in high heat you can lose up to 2.5 L/hour.  Water weighs about 2 pounds per liter, so we can assume a loss of 3-5 pounds per hour for endurance sports such as biking, running, soccer, etc.

Research has shown that “sweating beyond 2% of body weight can cause significant impairment of endurance through deficiencies in thermoregulatory and circulatory function.”  This means two things: First, when we lose too much water through sweat, the body stops sweating and our body temperature rises too high and can make us more prone to fatigue and cramping and can even become dangerous to health.  Secondly, when we lose blood volume, the heart is not able to circulate blood as efficiently so we get less ideal oxygen supply to the muscles and brain which also impairs performance. This means, that for a 150 pound person, 1 hour of exercise without replacing the water lost will result in worse performance. If you are going to be out for several hours, working towards 1 liter/hour would help to keep up with fluid loss enough to meet the body’s needs for an extended event.

So what about performance and electrolyte drinks?  In most electrolyte drinks, there are three primary components:  water, carbohydrate, and electrolytes.  Research has shown that for the first hour of exercise, energy primarily comes from glycogen which is stored in the muscles.  After this, as the glycogen is used up, the body will rely more and more upon glucose in the blood.  For extended exercise, it is recommended to ingest 1 gram/minute, or 240 calories/hour.  Generally, it is better to start this before fatigue sets in so the body has time to absorb the calories.

The primary electrolytes that are lost during exercise are sodium and chloride, so again, for prolonged exercise it is worthwhile to supplement with salt; this can minimize muscle cramping and fatigue.  While these are the primary electrolytes in the fluid surrounding the body’s cells, the most common electrolyte found in the cells is potassium.  Potassium containing foods such as avocados, bananas, and potatoes can be a good follow up to exercise, and coconut water has a very high amount of potassium and is excellent for hydration.

Sports drinks can be useful before, during, and after a workout to keep blood sugar, water, and electrolytes, but you don’t necessarily have to get too fancy.  One study compared plain water, sports drink, coconut water, and a sodium enriched coconut water for rehydration after exercise.  The sports drink and sodium enriched coconut water were the most successful at rehydrating people, but the coconut water variety was the best tolerated in terms of volume.  Another thing to consider for kids following a big event is good old potato chips and a glass of water–they will get carbohydrates, potassium, and salt from the chips which will help with rehydration and prevent muscle cramping.

Sources:
Ismail I, Singh R, Sirisinghe RG. Rehydration with sodium-enriched coconut water after exercise-induced dehydration. Southeast Asian J Trop Med Public Health. 2007 Jul;38(4):769-85.

Coggan AR, Coyle EF.Carbohydrate ingestion during prolonged exercise: effects on metabolism and performance.Exerc Sport Sci Rev. 1991;19:1-40

Groff, Gropper.  Advanced Nutrition and Human Metabolism. 3rd ed. 2000.