I have been practicing preventive, integrative and naturopathic medicine for over 20 years. I currently specialize in men’s health and preventive cardiology including all aspects of blood pressure control, cholesterol management as well as aggressive early detection and treatment of cardiovascular disease. I also work with athletes, both old and young, and as a competitive endurance athlete myself, I have a lot of personal experience.
How do Nutrients Affect Exercise Performance?
For optimal performance, we need our system to be firing on all 8 cylinders. To do this we need adequate vitamins, minerals and amino acids for biochemical reactions to take place. For example, macro and micro nutrients such as fat, amino acids, carbohydrates, CoQ10, lipoic acid, selenium, glutathione and carnitine are needed for the Krebs cycle. The Krebs cycle makes ATP, which is critical for muscle contraction and cellular function, within the mitochondria. Think of mitochondria as the powerhouse of the cell and ATP as the energy currency. A nutrient deficiency may affect ATP production or cause a decoupling reaction.
The Importance of Nutritional Testing
Do you follow a vegetarian or plant-based diet? Is your conventional diet well balanced? Are you getting all the blood work needed for optimum athletic performance including essential screening and prevention? A mantra in my practice is “why guess when you can know.” This statement resonates for me because I like objective data and believe there is too much assumption and guessing going on, especially with athletes. It seems simple, but adequate testing allows key nutrients to be measured.
All diets, from vegetarian to plant-based to conventional, can be deficient in vitamins, minerals, phytonutrients, fiber and healthy fats which is why it is important to be certain that you are hitting all your nutrients. For example, a pure plant-based diet may be deficient in carnitine and the sulfur containing amino acids needed to make glutathione such methionine and cysteine. A conventional diet, even a fairly healthy one, can be deficient in magnesium, fiber, antioxidants, essential fatty acids, B vitamins, iron, vitamin D, and folic acid. So, there could, in theory, be an effect on ATP production. However, any deficiency is easily screened for and completely fixable. I typically look at B12, iron, vitamin D, essential fatty acids, and zinc. If done correctly, I believe a whole food, plant-based diet will provide a performance benefit to most endurance athletes. One big benefit of this diet is the increase in nitric oxide which affects oxygen delivery and vasodilation. Another benefit is better recovery and less inflammation.
Health Markers of a Successful Athlete
- Appropriate signaling for muscle contraction including all 4 electrolytes calcium, sodium, potassium and chloride. E.g. the voltage-gated calcium and sodium channels which mediate the action potential of muscle contraction.
- Optimal oxygen delivery and oxygen exchange in the lungs (adequate iron, hemoglobin and red blood cell size as well as number).
- A balanced sympathetic and parasympathetic nervous system. Neurotransmitters such as serotonin, dopamine, GABA, epinephrine, norepinephrine, cortisol and even melatonin can be measured. Imbalances in these neurotransmitters and neurohormones can be the result of too much stress or the cause of an imbalance in the nervous system and insomnia.
- Adequate sleep. Elevated stress hormones from overtraining may interfere with sleep and affect recovery by interfering with growth hormone and sex hormone production. Inadequate sleep also increases inflammatory molecules.
- Normal cardiac muscle and valve function. The heart is not just a pump; it is also a muscle. As we age, the valves can become leaky and the heart muscle may enlarge or develop fibrosis in response to chronic long-term endurance training. Arrhythmias are often a symptom of this because electrical impulses become disorganized due to wall thickening and/or atrial/ventricular enlargement.
- Balanced sex hormones (DHEA, testosterone, estrogen) as well as neurohormones such as adrenal hormones and brain neurotransmitters.
- Adequate nutrients needed to make ATP. CoQ10 and glutathione can be measured in blood. A urine test also exists that will analyze metabolism including energy production.
- Ability to recover. When Frank Overton coached me, he taught me about the importance of recovery including how to actually do it, not just talk about it. It is important to make sure you are not overtraining, although most coaches can easily determine this without any testing. Some studies suggest you can empirically test for overtraining by measuring hormones. Typically, overtraining produces increased stress hormones and decreased sex hormones. This can lead to a catabolic environment making it difficult to put on muscle and even leading to muscle loss and decreased performance. Overt overtraining is easy to spot, but high-level athletes may want to know if they’re at the tipping point.
The Conventional Medical Model
People ask me all the time why the testing I advocate is not covered by their provider at their annual physical. Here is the answer – the insurance-based model for an annual physical by a conventional doctor is limited to what is allowed by the insurance company. The insurance companies dictate what is covered during this physical, not the doctor.
According to World Population Review, the United States ranks 35th on the list of the healthiest countries. We have an obesity rate of over 50% and diabetes is rising all the time. We also have an aging population. Our medical system is overburdened with the unhealthy and primary care doctors are overworked and underpaid. Fit people over 40 with no complaints get the bare minimum of testing; they are just too healthy.
Also, the conventional medical system is not preventive in nature. Not really. Take, for example, atherosclerosis, the cause of most heart attacks and strokes. It typically progresses for many years with no symptoms until a section of the artery wall ruptures causing a blocked artery and subsequent heart attack. In many of these situations, the patient has no symptoms prior to the heart attack and may even pass a treadmill test only a week before. In our conventional system, doctors wait until the patient has symptoms before they do tests or make a diagnosis. It is just the system we have. Doctors want to help but you, as the patient, need to be in charge of your health and be proactive! Here is a list of tests that can be of real benefit. Some are done as a standard of practice and some you can probably get your doctor to perform.
Tests Typically Included
- Typical annual blood work includes CBC, CMP, TSH, and lipids. This screens you for anemia, liver and kidney disorders, blood cancers, infections, some forms of immunodeficiency, electrolyte imbalance, cholesterol, to some degree protein status, and thyroid disorders. By the way, the red blood cell count and hemoglobin numbers are not adjusted for altitude so borderline low in Colorado is too low. If you ask, you can usually get vitamin D, iron and B12/folate done if vegetarian. Some insurance companies require you to already have a diagnosis of low vitamin D in order for it to be covered ….funny thing is how do you know if you don’t check? If your blood sugar runs high, 98 or above, you can ask for an A1c to see your 90 day average blood sugar. That’s about it unless you already have a disease that requires other tests.
- If you are over 40 you can ask for an electrocardiogram. If you have no symptoms, it will typically be normal but it can reveal important information.
- If you have a family history of aneurysms you can ask for an abdominal aortic aneurysm screening.
- If you are over 50, you should get a colonoscopy and women should follow the advice of their doctor regarding breast and cervical cancer screening.
- I do not see anything wrong with vaccinations for flu shots. There is a new shingles vaccine that holds promise. I just got one. Athletes over 60 are more susceptible to shingles…especially when they push their bodies.
- I think unless determined otherwise you should follow all the advice from your doctor, but just know that they do not specialize in all the crazy athlete stuff I talk about in this post. Doctors are trained in hospitals and the encounter with an athlete is a rare occurrence (unless it’s orthopedics!)
Tests Typically not Included
- Screening for nutrient deficiencies – Minerals such as zinc, magnesium, iron, selenium and iodine can be done with regular blood tests. I like to back this up with a test called the spectracell intracellular micronutrient profile which checks all vitamins, antioxidants and most minerals. It even performs an immune system evaluation. Why guess when you can know?
- Iron is of critical importance for the formation of hemoglobin and subsequent oxygen delivery. There is an optimal ferritin level which is around 180 for men and at least 80 for women. Both ferritin and iron should be done together. Insurance will not typically cover (and doctors not check) ferritin unless you have iron deficiency anemia. It is much more important for females to get their iron tested. Why guess when you can know?
- Vitamin D Testing – Vitamin D is involved in immune function, mood, and bone health. It also helps reduce inflammatory molecules after prolonged endurance exercise which impacts inflammation, exercise recovery and exercise performance. Vitamin D is involved in cardiac structure and function, skeletal muscle function, muscle repair and remodeling. Higher vitamin D levels have been linked in multiple studies to higher VO2 max . Optimal blood levels are 50-80. Do not take vitamin D unless you know your appropriate dose. Why guess when you can know?
- CIMT Testing – For anyone over 40 with a history of high cholesterol, a family history of heart attack or stroke, and/or hypertension, I perform a special type of carotid ultrasound called a Carotid Intima Media Thickness (CIMT) test. This test measures arterial age and even small deposits of plaque. Being fit does NOT preclude you from atherosclerosis and heart disease. Coronary calcium scoring is also helpful. It looks for calcified atherosclerotic plaque in the coronary arteries. But the most dangerous plaque is non-calcified, so the scoring may miss the mark there. The two test in conjunction have considerable value in the diagnosis and treatment of atherosclerosis and preventive cardiology. Why guess when you can know?
- Comprehensive inflammatory molecule testing – Inflammation is the buzzword but when was the last time anyone talked about actually measuring their inflammation? If you were to ask your doctor to test this, what would you ask for? I really like the PULS test which measures vascular cytokines in addition to CPK, hsCRP, PLA2 and Sed Rate. A whole food, plant-based diet is promoted as anti-inflammatory and it is. I have tested athletes before and after. But, does that mean that a “normal” diet is causing excess inflammation? Do you need to go plant-based or simply take antioxidants? Is the plant-based diet enough? Why test when you can know?
- Echocardiogram – An echocardiogram can look for pathologic remodeling or early valve problems. Athletic heart syndrome, as it’s called, is a healthy heart that has a low resting heart rate and has enlarged in response to training. It has adapted and remodeled accordingly. But there is also a type of athletic heart that is mal-adapting, remodeling in an unhealthy way, causing fibrosis, enlargement and/or excessive wall thickening. Recent books such as Haywire Heart describe this in detail. If more middle-aged athletes were tested early, many of these electrical disturbances could be prevented. I will also sometimes order a stress echocardiogram which can be even more helpful in athletes. This is an ultrasound of your heart, including valves, while exercising. It can help rule out exercise induced pulmonary hypertension. The early stages of this condition may not cause symptoms and hard exercise can cause more harm than good. Why wait until there are symptoms when you can get screened and cleared for high intensity exercise and know you are not damaging your heart. Why…..I think you know what I am going to say.
I hope this post was helpful. I can be reached for appointments by calling my staff at 303.884.7557. Also follow me on instagram healthy_dad_nd