athletesanctuary, Author at Athletes Sanctuary

Relative Energy Deficiency in Sport – or RED-S as it is known – is caused when there’s a negative balance between dietary energy intake and the energy output needed to promote optimal health, performance, growth and daily life.

Up until 2014 RED-S was referred to as the female athlete triad – disordered eating, menstrual disturbances and low bone density. At this time the International Olympic Committee updated their position statement with the new term (RED-S) to be far more reflective of the wider-spread effects in both female and male athletes – on performance and throughout the body.

In 2018 the IOC published the RED-S Consensus Statement Update.

More than 10% of athletes experience RED-S throughout their career, yet despite its potential to have such adverse effects, RED-S is still only just becoming widely recognised and discussed within a majority of sports.

Symptoms of RED-S

There are many physical symptoms of RED-S, including:

Fatigue
Recurring illness
Difficulties staying warm in the winter and cool in summer months
Poor sleep quality
Stress fractures and low bone mineral density, and impaired accumulation of peak bone mass (PBM)
Weight loss, or below healthy weight
Growth restriction in junior and teenage athletes
Disordered eating or eating disorders such as bulimia or anorexia, orthorexia, restrictive disorders or recurrent dieting/fasting
Digestion issues
Vitamin and mineral deficiencies
Metabolic disturbance
Menstrual disfunction

But REDS can also have far-reaching behavioural and psychological effects as well, including:

Pre-occupation and constant discussion around food
Poor sleep patterns
Restricting or strict control over food intake
Overtraining or struggling to take rest days
Impaired judgement, coordination and concentration
Recurrent soft tissue injury
Irrational behaviour
Fear of food and weight gain
Severe anxiety
Withdrawing or becoming reclusive
Reduction in motivation
Depression

REDS can have an incredibly adverse long-term effect on athletic performance, including an increased risk of injury and decreased training and performance responses. These effects can include:

Decreased muscle strength
Decreased endurance performance
Impaired judgement
Decrease in coordination
Decrease in concentration
Decrease in glycogen stores
Negative impacts on muscle recovery
Poor muscle growth
Increased risk of injury

WHAT ARE THE LONG-TERM EFFECTS OF REDS?

The majority of our bone density is formed during our teenage years. If our bone density formation is impacted during our adolescence or early in our adult years, it can lead to issues with bone weakness and osteoporosis later on in life.

Longer-term, REDS can also have a negative impact on fertility, thyroid function, cardiovascular function, and mental health.

The good news is that most of the negative consequences of RED-S can be reversed if picked up early.

WHAT ARE THE COMMON MYTHS SURROUNDING REDS?

The common perception that athletes with RED-S have an eating disorder is false. Although eating disorders are associated with RED-S not all athletes with eating disorders have RED-S and not all athletes with RED-S have an eating disorder.

It’s true to say that athletes with RED-S can present as underweight- but this is not true in all situations. RED-S can exist without the athlete appearing to be underweight.

RED-S is also not something that just female athletes suffer from. All athletes competing in sports with higher training volumes or weight category restrictions are at a higher risk of developing RED-S. This can include athletes competing in sports that can be judged by aesthetics including figure skating, gymnastics and synchronised swimming, and body weight-dependent sports including long-distance running, mountain biking, and cycling, and weight classed sports such as lightweight rowing and marshall arts.

In one study 44% of ultra-endurance runners were identified as being at risk of developing RED-S while 39% of elite female sprinters should signs of RED-S.

“RED-S can occur in athletes of any competitive status. Among world-class endurance athletes, 37% of females presented with amenorrhea and 40% of males with testosterone in the lowest quartile range indicative of RED-S, which is similar to the reported 40% of Australian female athletes competing at the 2016 Rio Olympic games who were identified as at risk of RED-S. Similarly, among recreational female exercisers, 45% had risk factors associated with RED-S.” (Sports Information Resource Centre).

WHAT SHOULD I LOOK OUT FOR?

The most important piece of advice when it comes to RED-S is – listen to your body. Don’t ignore niggles and definitely don’t skimp on sleep and recovery. You should also:

Monitor menstrual cycles
Think about your relationship with food and/or exercise
Be mindful of your eating patterns: disordered eating to eating disorder.
Notice your exercise dependence
Monitor your behaviour, mood and sleep patterns
Notice change in clothing fit
Be aware of growth and development
Note injuries, illness and gastrointestinal issues
Athletic performance (stagnation-deterioration)
Try to be flexible in your approach

WHERE TO GET HELP

We appreciate that talking about many of the symptoms associated with RED-S can be difficult. Our Sports Naturopath and Holistic Coach Kate Smyth has extensive lived experience with REDS in elite sport and provides a discreet and confidential platform to share your concerns.

About the Author: Kate Smyth is a Sports naturopath, nutritionist and female centric running coach. She is the founder of the Athlete Sanctuary- a holistic healthcare clinic for athletes of all levels and sporting codes. Kate has a thirst for knowledge with two bachelor’s and a master’s degree under her belt. She has been involved in sports for many decades and competed for Australia in the Commonwealth Games and Olympic Games marathons with a personal best time of 2 hours 28 minutes. For more information visit www.https://https://athletesanctuary.com.au/wp-content/uploads/2023/03/normatec-3-lower-body-system-thumb_720x-1.webp.com.au/wp-content/uploads/2020/05/Seed-Cycle-Blends-scaled-1.jpg.com.au

Resources

The Sport Information Resource Centre: SIRC,

Berg, S. E. (2021). The Relationship between Eating Disorders, Weight Control Methods, and Body Satisfaction in Elite Female Runners Competing at the 2020 US Olympic Marathon Trials.

Sygo, J., Coates, A. M., Sesbreno, E., Mountjoy, M. L., & Burr, J. F. (2018). Prevalence of indicators of low energy availability in elite female sprinters. International Journal of Sport nutrition and exercise metabolism, 28(5), 490-496.

The high demands of sports make athletes more vulnerable to illness, with 65% of athletes experiencing regular colds and infections. Zinc is a key nutrient required for immunity and keeping an eye out for low zinc symptoms, may just make the difference between being sick or great performances.

It can be so frustrating to put in many months of hard training only to be sidelined during a taper or on race day by heaving lungs, debilitating fatigue, and a pounding headache. Sports performance is materialised through consistency, akin to writing a book, one page at a time. Forced breaks from training due to illness detract from progress and drains confidence. Not all athletes rest when unwell and opt to “push through” the illness only to experience prolonged symptoms and more disruption to competition.

Building a robust immunity is all part of a holistic approach to coaching and training. So how do you minimise your risk of getting sick?

There are many nutrients that contribute to a healthy immune system as discussed previously.

Athletes may be more susceptible to being deficient in zinc because exercise, particularly strenuous and endurance exercise, increases zinc requirements, encourages zinc loss through sweating, and changes zinc transportation and metabolism.

In our opinion, zinc plays the most critical role in supporting athletes and immunity.

Zinc’s role in hormone control and immunity

Zinc regulates several crucial processes in both your innate and adaptive immune system. Being deficient in zinc can lead to athletes becoming more susceptible to respiratory illness, particularly in the colder months.

Apart from zinc’s well-established role in immunity, this mineral, contributes to protein structure, regulates gene expression, metabolism and is the second most abundant trace element in the body after iron. Zinc deficiency can impact an athlete through hormone dysregulation (testosterone, thyroid, and growth hormones to name a few) and may affect erectile function and fertility.

Zinc is essential to maintaining optimum performance due to its function in metabolism and healthy cell division – essential in repairing damaged tissues after you exercise.

Studies show being deficient in zinc can lead to a reduction in the number of fast-twitch muscle fibres and muscle mass and performance decline. For Masters Athletes this is of particular relevance as aging is also associated with sarcopenia, the age-related loss of muscle mass, muscle strength, and physical performance.

Zinc also helps maintain blood sugar control and assists with muscle contraction during exercise, glucose metabolism, and glycogen storage.

Zinc also plays an essential role in antioxidant production by increasing antioxidant activity and inhibiting free radical production that may damage tissues, impact liver function, and prevent muscle exhaustion.

Low zinc symptoms

Apart from recurrent colds and other infections, there are many low zinc symptoms.

*Anxiety and depression

*Hormone imbalances

*Poor concentration

*Stomach pain and gas

*Slow healing

*White spots on nails

*Skin issues and acne

*Loss of appetite

*Loss or change of smell

*Changes in taste

Zinc rich foods

The most concentrated sources of zinc are contained in animal products, particularly meat, seafood and dairy. Vegan and plant-based athletes may be more susceptible to zinc deficiency due to reduced dietary intake, lowered gastric acid (which is zinc-dependent) and higher phytate consumption. Phytates found in plant-based zinc-rich foods such as legumes can inhibit zinc absorption.

Soaking nuts and seeds and legumes prior to cooking is a great way to minimise this issue and allow for greater micronutrient absorption.

Iron absorption

The gastrointestinal tract plays an important role in maintaining total body zinc homeostasis by regulating zinc absorption and excretion. In order to boost your absorption, the addition of a probiotic may be beneficial.

In certain situations, zinc supplementation may be recommended. The amount ingested, supplement form, and the timing of zinc matters. Speak to a naturopath or nutritionist with an interest in sport before self-prescribing. You’ll definitely want to avoid zinc toxicity. High zinc levels can have a detrimental impact on your performance through anaemia, copper and iron deficiency and unpleasant gastrointestinal side effects.

Zinc testing

Serum blood testing is used by some conventional practitioners to determine zinc levels in the body. Keep in mind 60% of zinc is stored in muscle and 30% in bone therefore serum may not be the best measure of zinc homeostasis. A mineral test can be another alternative method of assessing zinc levels and is available through our clinic as explained here.

If you need help building a robust immune system, book an appointment with our naturopath.

About the Author: Kate Smyth is a Sports naturopath, nutritionist and female-centric running coach. She is the founder of the Athlete Sanctuary- a holistic healthcare clinic for athletes of all levels and sporting codes. Kate has a thirst for knowledge with two bachelor’s and a master’s degree under her belt. She has been involved in sports for many decades and competed for Australia in the Commonwealth Games and Olympic Games marathons with a personal best time of 2 hours 28 minutes. For more information visit www.https://https://athletesanctuary.com.au/wp-content/uploads/2023/03/normatec-3-lower-body-system-thumb_720x-1.webp.com.au/wp-content/uploads/2020/05/Seed-Cycle-Blends-scaled-1.jpg.com.au

References

N. Walsh. Nutrition and Athlete Immune Health: New Perspectives on an Old Paradigm.
2019 Nov 6. doi: 10.1007/s40279-019-01160-3.
A. Venderley, W.Campbell. Vegetarian diets : nutritional considerations for athletes.
2006;36(4):293-305. doi: 10.2165/00007256-200636040-00002.
J.Hernández-Camacho, C. Vicente-García, D. Parsons, I. Navas-Enamorado. Zinc at the crossroads of exercise and proteostasis.
2020, 101529, ISSN 2213-2317. doi.org/10.1016/j.redox.2020.101529.
P. Trumbo, A. Yates, S. Schlicker, M. Poos. Dietary reference intakes: vitamin A, vitamin K, arsenic, boron, chromium, copper, iodine, iron, manganese, molybdenum, nickel, silicon, vanadium, and zinc.
2010 March.101(3):294-301. doi: 10.1016/S0002-8223(01)00078-5.
A. Baltaci, R. Mogulkoc, S. Baltaci. Review: The role of zinc in the endocrine system.
2019 Jan;32(1):231-239. PMID: 30772815.
P.Ranasinghe, S. Pigera, P. Galappatthy, G. Katulanda, & R. Constantine. Zinc and diabetes mellitus: understanding molecular mechanisms and clinical implications.
23(1), 44. doi.org/10.1186/s40199-015-0127-4
M. Hambidge, N. Krebs. Zinc metabolism and requirements.
2001;22(2):126-132 doi: 10.1177/156482650102200202

The immune system is a busy network throughout our entire body including cells, vessels, lymphoid tissue, nodes, nodules, bone marrow, and organs.

Our thymus gland helps regulate the immune system, and is the storage tank for immune cells responsible for eradicating viruses.

The spleen recycles iron, captures and destroys pathogens and initiates the maturation and release of immune cells when the body is required to fight infections.

The lymphatic system is a filtering system removing waste and obsolete immune cells from our entire body through a system of lymph nodes and vessels. Mucous membranes in our respiratory system and gastrointestinal tract, tonsils, and adenoids also contain lymphatic tissue.

Our immune system would not be complete without the gut-associated lymphoid tissue (GALT) – and Peyer’s patches in the small intestine. Nearly 80% of our immunity is actually based in the digestive tract.

A robust immunity has many lines of defence

Our immune system is equipped with a multi-tiered response to battle with foreign invaders 24/7.

The innate immune system includes a first line of defence which prevents pathogens (germs) from gaining entry into the body. The skin, mucous membranes, gastrointestinal tract and secretions (mucous, vaginal secretions, bile, gastric acid, saliva, tears, and sweat) all play an important role.

The next line of defence houses our infection-fighting cells such as natural killer cells and phagocytes which act like Pac-men against microbial invaders. The immune system also releases antimicrobial proteins such as complement and interferon which interfere with virus replication and cell-to-cell communication.

Our adaptive immune system also keeps a record of every germ it has ever defeated so it can recognise and destroy the microbe quickly if it enters the body again.

A balanced whole-foods diet containing real foods rich in antioxidants, vitamins, and minerals can help build robust immunity.

Key vitamins and minerals to boost immunity
Vitamin C

Vitamin C builds resistance to infection and stimulates immune cells and proteins which help eradicate viruses.

Vitamin C-rich foods include veggies such as red capsicum, broccoli, cabbage, cauliflower, spinach, parsley, and sweet potato. Fruits such as kiwi, berries, pawpaw, pineapple, citrus, guava, broccoli, mango, currants are great sources of vitamin C. Rosehip, camu camu, and Kakadu plum provide concentrated powdered forms of vitamin C widely available through health food shops. One we recommend is Wild C.

In some circumstances, vitamin C supplementation may be beneficial. Having small amounts of vitamin C throughout the day may reduce the likelihood of any gastrointestinal side effects.

Quercetin

Quercetin is a flavonoid reported to have antiviral properties in numerous studies. Vitamin C and quercetin taken together, has a synergistic antiviral action.

Quercetin is contained in apples, honey, raspberries, strawberries, blackberries, onions, red grapes, cherries, citrus fruits, and green leafy vegetables.

Zinc

Zinc plays a crucial role in supporting immune cell production and modulation of immunity.3, 4 Common zinc deficiency signs include frequent and prolonged colds, and poor wound healing, acne, dermatitis, low stomach acid, poor smell or taste. White spots on nails may also be a sign of zinc deficiency.

There are many factors that may contribute to zinc deficiency. Inadequate dietary intake, poor absorption, loss through perspiration, and high iron and copper levels can have a detrimental impact on zinc homeostasis.

Foods rich in zinc include oysters, seafood, tahini, peanuts, liver, eggs, nuts, seeds, and legumes. Soaking and sprouting legumes, nuts and seeds helps to break down the phytates that may bind to zinc and reduce zinc’s bio-availability.

Keep in mind there are many other nutrients that support the immune system, however, zinc, vitamin c, and quercetin are key when it comes to fighting viruses.

Gut health

Gut health plays an important role in immunity.

Including prebiotic (skins on vegetables and fruit, psyllium husks, slippery elm, etc.) and probiotic-rich foods (kimchi, sauerkraut, kefir, tempeh, kombucha, miso, and quality yogurt) can improve your immunity. Probiotics can also improve sports performance as discussed on our blog here.

Don’t self-sabotage your immunity

Avoid substances that reduce immune system function.

Diets high in saturated fats, sugars, and refined carbohydrates have been shown to contribute to the prevalence of obesity and type 2 diabetes, and increase the risk for severe COVID-19 pathology and mortality. 5 Studies suggest sugar reduces the capacity of white blood cells for up to 5 hours within 1 hour of consumption. Sugar can also feed fungi such as candida which deplete the immune system and increase fatigue.

Caffeine or other stimulants can stress your nervous system, reduce sleep and deplete stores of zinc, and magnesium. Switching your second coffee for a green tea has been shown to improve innate immunity.

Enjoy alcohol in moderation. Excessive alcohol may also suppress the immune system and increased susceptibility to respiratory pathogens and lung injury.

Sleep has an influence on immunity maintenance and immunological response and can increase your risk of picking up infections. Obtain at least 8 hours of sleep every night, ideally hitting the pillow before 10 pm.

Chronic stress depletes the immune system. Focus on what you can control and avoid getting caught up in daily news. Your mindset matters in times of stress and unpredictability. Consider ways of dispelling stress such as meditation, mindfulness, reading, or creative activities. Don’t forget laughter has been shown to improve immunity and mental health.

Keep your exercise balanced and consistent. Regular exercise improves immunity however excessive exercise of long duration and intensity can make athletes more susceptible to respiratory infections.

If you feel you need to boost your immunity, feel free to contact us and let’s discuss how we can help.

References

1. Carr AC, Maggini S. Vitamin C and Immune Function. (2017) Nutrients. 3;9(11):1211.https://pubmed.ncbi.nlm.nih.gov/29099763/

2. Askari et al., Quercetin- an overview. (2017). Nutrient Delivery https://www.sciencedirect.com/topics/agricultural-and-biological-sciences/quercetin

3. Maywald M, Wessels I, Rink L. Zinc Signals and Immunity. Int J Mol Sci. 2017 Oct 24;18(10):2222. doi: 10.3390/ijms18102222.

4. Skalny AV, Rink L, Ajsuvakova OP, Aschner M, Gritsenko VA, Alekseenko SI, Svistunov AA, Petrakis D, Spandidos DA, Aaseth J, Tsatsakis A, Tinkov AA. Zinc and respiratory tract infections: Perspectives for COVID‑19 (Review). Int J Mol Med. 2020 Jul;46(1):17-26. doi: 10.3892/ijmm.2020.4575.

5. Butler MJ, Barrientos RM. The impact of nutrition on COVID-19 susceptibility and long-term consequences. (2020) Brain Behav Immun. Jul;87:53-54. doi: 10.1016/j.bbi.2020.04.040.

6. Does Sugar Weakn the Immune System? Biotics Research. 2020. www.blog.bioticsresearch.com

7. Chowdhury P, Barooah AK. Tea Bioactive Modulate Innate Immunity: In Perception to COVID-19 Pandemic. Front Immunol. 2020 Oct 28;11:590716. doi: 10.3389/fimmu.2020.590716.

8. Yeligar SM, Chen MM, Kovacs EJ, Sisson JH, Burnham EL, Brown LA. Alcohol and lung injury and immunity. Alcohol. 2016 Sep;55:51-59. doi: 10.1016/j.alcohol.2016.08.005

9. Silva ESME, Ono BHVS, Souza JC. Sleep and immunity in times of COVID-19. Rev Assoc Med Bras (1992). 2020 Sep 21;66Suppl 2(Suppl 2):143-147. doi: 10.1590/1806-9282.66.S2.143.

10. Dhabhar FS. Effects of stress on immune function: the good, the bad, and the beautiful. Immunol Res. 2014 May;58(2-3):193-210. doi: 10.1007/s12026-014-8517-0.

11. Yim J. Therapeutic Benefits of Laughter in Mental Health: A Theoretical Review. Tohoku J Exp Med. 2016 Jul;239(3):243-9. doi: 10.1620/tjem.239.243

12. Cerqueira É, Marinho DA, Neiva HP, Lourenço O. Inflammatory Effects of High and Moderate Intensity Exercise-A Systematic Review. Front Physiol. 2020 Jan 9;10:1550. doi: 10.3389/fphys.2019.01550

If you’re training hard, but don’t feel like you’re improving your athletic performance, then enriching your gut health through choosing the best probiotics to complement your gut microbiome could be the missing ingredient.

What are probiotics?
Probiotics are live microorganisms, mainly bacteria, and yeasts, that naturally reside in your gut (microbiome) and convey a health benefit. Your microbiome typically contains over 1000 different organisms, both beneficial and pathogenic.

Because a healthy gut microbiome strengthens your immune system and enhances your recovery from fatigue and overtraining, taking care of your gastrointestinal system is vital. This will enhance your general health and help to improve your athletic performance.

We consume probiotics via gut-friendly fermented foods such as yogurt, kefir, kimchi, kombucha, and sauerkraut, and commercially produced supplements.

Probiotics shouldn’t be confused with prebiotics. Prebiotics are carbohydrates and fibres such as inulin and other fructo-oligosaccharides found in foods like artichoke, bananas, and asparagus. The microorganisms in your gastrointestinal tract use prebiotics as fuel.

Supplements called ‘synbiotics’ contain both prebiotic molecules and probiotic organisms.² Synbiotics offer a dual-action strategy for even greater health benefits. A diet rich in pre and probiotic foods support your gut to develop a robust immunity.

Understanding probiotics for runners

As the popularity of ‘gut health’ supplements for athletes increases, a basic knowledge of the assortment of beneficial probiotics in your supplement is helpful.

Probiotics are classified by their unique microorganism strain, which includes the genus, species, subspecies (if applicable), and an alphanumeric strain designation.

The seven core probiotic genera are Lactobacillus, Bifidobacterium, Saccharomyces, Streptococcus, Bacillus, Enterococcus, and Escherichia.

Lactobaccillus rhamnosus, Lactobaccillus acidophilus, and Saccharomyces boulardii are common commercially produced probiotic and yeast species. This ‘probiotic tree’ diagram highlights several commercially available probiotic strains.

Research on specific probiotic strains has expanded our knowledge of the health benefits and targeted treatments of probiotics for athletes. However, probiotic supplementation may not be appropriate or necessary for all athletes.

Probiotics for Runners

Certain probiotic species impart significant anti-inflammatory effects within your gut. In particular, Lactobacillus strains produce lactate, which is then converted into short-chain fatty acids by your gut bacteria. Butyrate is a pivotal short-chain fatty acid for intestinal homeostasis due to its anti-inflammatory properties and beneficial effects on intestinal cells, gut barrier function, and permeability.

Over thirty years of research supports the widespread use of Lactobacillus rhamnosus GG (LGG) for common gut-related issues such as diarrhoea, antibiotic use, infections, e.g., Clostridium, irritable bowel syndrome, inflammatory bowel disease, respiratory tract infections, and allergies in athletes.

Studies also show certain probiotics can improve vitamin D levels in athletes.

LGG along with L. acidophilus, and B. bifidum improve exercise-induced gastrointestinal symptoms. In fact, almost 60%of runners and endurance athletes who train intensely experience gut microbiome upsets and unwanted symptoms. Probiotics offer relief by supporting immune function and intestinal cell proliferation and function, as well as shortening the duration of gastrointestinal symptoms.⁵

Probiotic strains interact favourably with other probiotic species in the microbiome to improve the overall balance and composition of beneficial bacteria in your gut. For example, Lactobacillus fermentum (PCC) can increase the Lactobacillus genus seven-fold after 11 weeks of supplementation.

Probiotic supplements can help regulate blood sugar levels and maintain energy for training and performance. Also, yeast probiotics such as Saccharomyces cerevisiae are widely used to suppress the overgrowth of Candida or thrush fungal infections.

Lastly, new research demonstrates that probiotics can enhance sports performance. Runners taking Bifidobacterium longum (OLP-01) for five weeks significantly increased their running distance in a timed test. Bifidobacterium longum (OLP-01) also provided other health benefits such as increasing the abundance of gut microbiota in the runners.

There are a few final points to keep in mind before you add probiotics to your diet.

First, the quality of your probiotic supplement may vary significantly. Be careful about your choices as the label “probiotic” doesn’t necessarily mean this option will be suitable for your microbiome.

Second, a probiotic combination or an inappropriate supplementation duration may exacerbate unwanted symptoms in some situations. Therefore, it’s vital to consume high-quality, well-characterised live probiotics that deliver a therapeutic dose over an effective length of time.

Finally, the best probiotics for endurance athletes are selected case by case to improve your performance, recovery, immune and gut health. Be sure to seek professional advice for the most suitable probiotic therapy for your training and health circumstances.

Unsure if a probiotic supplement could help you?
Speak with Athlete Sanctuary’s sports naturopath and nutritionist about your health and sports performance goals today.

About the Author: Kate Smyth is a Sports naturopath, nutritionist and female-centric running coach. She is the founder of the Athlete Sanctuary- a holistic healthcare clinic for athletes of all levels and sporting codes. Kate has a thirst for knowledge with two bachelor’s and a master’s degree under her belt. She has been involved in sports for many decades and competed for Australia in the Commonwealth Games and Olympic Games marathons with a personal best time of 2 hours 28 minutes. For more information visit www.https://https://athletesanctuary.com.au/wp-content/uploads/2023/03/normatec-3-lower-body-system-thumb_720x-1.webp.com.au/wp-content/uploads/2020/05/Seed-Cycle-Blends-scaled-1.jpg.com.au

References

Hill C, Guarner F, Reid G, Gibson GR, Merenstein DJ, Pot B, et al. The International Scientific Association for Probiotics and Prebiotics consensus statement on the scope and appropriate use of the term probiotic. Nat Rev Gastroenterol Hepatol 2014;11:506-14.
World Gastroenterology Organisation. Probiotics and prebiotics. 2017.
Capurso, L. (2019). Thirty years of Lactobacillus rhamnosus GG: a review. Journal of Clinical Gastroenterology, 53, S1-S41. doi: 10.1097/MCG.0000000000001170
Leite, G. S., Student, A. S. R. M., West, N. P., & Lancha Jr, A. H. (2019). Probiotics and sports: A new magic bullet? Nutrition, 60, 152-160. https://doi.org/10.1016/j.nut.2018.09.023
Salarkia, N., Ghadamli, L., Zaeri, F., & Rad, L. S. (2013). Effects of probiotic yogurt on performance, respiratory and digestive systems of young adult female endurance swimmers: a randomized controlled trial. Medical Journal of the Islamic Republic of Iran, 27(3), 141. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3917487/
West, N. P., Pyne, D. B., Cripps, A. W., Hopkins, W. G., Eskesen, D. C., Jairath, A., … & Fricker, P. A. (2011). Lactobacillus fermentum (PCC®) supplementation and gastrointestinal and respiratory-tract illness symptoms: a randomised control trial in athletes. Nutrition Journal, 10(1), 1-11. https://nutritionj.biomedcentral.com/articles/10.1186/1475-2891-10-30
Gaziano, R., Sabbatini, S., Roselletti, E., Perito, S., & Monari, C. (2020). Saccharomyces cerevisiae-based probiotics as novel antimicrobial agents to prevent and treat vaginal infections. Frontiers in Microbiology, 11, 718. https://doi.org/10.3389/fmicb.2020.00718
Lin, C. L., Hsu, Y. J., Ho, H. H., Chang, Y. C., Kuo, Y. W., Yeh, Y. T., … & Lee, M. C. (2020). Bifidobacterium longum subsp. longum OLP-01 Supplementation during Endurance Running Training Improves Exercise Performance in Middle-and Long-Distance Runners: A Double-Blind Controlled Trial. Nutrients, 12(7), 1972. doi:10.3390/nu12071972
Probiotic professionals

Normatec recovery therapy is suitable for athletes of all levels.

Sporting clubs, associations, and teams such as Australia Triathlon, AFL teams, USA Triathlon, Ironman US, USA Track and Field, British Gymnastics, Belgian Cycling, American Cycling, USA Hockey, Ireland Hockey, and the Boston Ballet are just some of the crew ahead of the curve using Normatec recovery.

We have been so impressed with Normatec recovery we’ve made it accessible to athletes of all levels through our exclusive hire service. We also sell the Normatec recovery systems to those who like to take their training and recovery a bit more seriously.

WHAT IS NORMATEC?

Normatec is an evidence-based recovery system with proven results and research supporting its claimed benefits.

Normatec is a form of active compression therapy (peristaltic pulse dynamic compression) with a sophisticated massage pattern that studies show results in reduced muscle soreness and fatigue, enhanced blood flow to the treated areas, decreased inflammation, improved clearance of waste products, and increased range of motion. Studies also show the peristaltic compression process may deliver positive adaptive responses to exercise and improve artery endothelial function systemically making it also useful for individuals who have circulation and lymphatic drainage issues.

Key benefits of Normatec recovery

1. REDUCES PAIN: Journal of Strength and Conditioning 2015 – dynamic compression may accelerate and enhance recovery by reducing muscle tenderness from pressure stimuli.

2. INCREASES RANGE OF MOTION: Journal of Strength and Conditioning 2014 -Peristaltic pulse dynamic compression rapidly enhances acute range-of-motion with less discomfort and time and has been shown to be more

3. REDUCES DOMS (DELAYED ONSET MUSCLE SORENESS), PAIN, and SWELLING: Journal of Athletic Training 2016 – a 30-minute treatment of pulse compression increases blood flow in the lower extremity, making Pulse compression a viable option in the management of exercise-induced muscle damage (DOMS). In general, DOMS-related swelling, range of movement limitations, and pain ratings were lower and returned to baseline faster while using NormaTec when compared to continuously-worn compression sleeve options International Journal of Exercise Science 2018.

4.DECREASES MUSCLE FATIGUE AFTER ACUTE EXERCISE: PLOS One Medical Journal 2017. External pneumatic compression increases flexibility and reduces select skeletal muscle oxidative stress and proteolysis markers during recovery from heavy resistance exercise.

5. PASSIVELY CLEARS WASTE AND METABOLITES FROM BODY: Journal of Athletic Enhancement 2013 This form of compression significantly lowers blood lactate concentrations when compared to a passive recovery group.

6. IMPROVES ENDOTHELIAL FUNCTION: European Journal of Applied Physiology 2015. A single bout of peristaltic pulse compression improves artery endothelial function systemically and improves blood flow in the compressed limbs.

7. IMPROVES EXERCISE ADAPTATION AND GENE EXPRESSION: Journal of Experimental Physiology 2015. A 60-minute bout of whole-leg, peristaltic pulse compression transiently upregulates PGC-1α mRNA, while also upregulating eNOS protein and NOx concentrations in biopsy samples.

Clinical Physiology & Functional Imaging 2016. Peristaltic pulse compression may upregulate rps6 and downregulate Stat1, which may facilitate positive adaptive responses to exercise.

8. ENHANCE LYMPHATIC SYSTEM FUNCTION: Journal of Strength and Conditioning Research Muscle stiffness, tenderness, strength loss, and edema have been linked to exercise-induced muscle microtrauma. Enhancement of lymphatic flow and clearance of waste may accelerate recovery.

“A goal of dynamic compression is to reduce lymphatic obstruction and thereby enhance the removal of the protein- and debris-rich fluid that accumulates in the interstitial spaces after exercise-induced inflammation”. Maintaining an anti-inflammatory diet can also speed up your recovery time. Ginger is one natural remedy that may help reduce inflammation. Read our blog on how easy it is to use ginger here

Normatec features

Individualised programs for rehab, recovery, and injury treatment to suit your needs.
Normatec can be set to focus on key problem areas of the body such as the quads or calves through a “zone boost” allowing extra attention where needed. There is also an option to deactivate zones of the body.
Setting can be set to varied pressures to suit you and your comfort
Portable in a durable case, battery powdered for remote use, and lightweight
Versatile- single control unit is compatible with leg, arm, and hip attachments. The calibration phase ensures a personalised fit for all body types.
Super easy to use- set up takes less than a minute, giving you more time to relax
Made from highly durable material
The Normatec app allows you to integrate Normatec use seamlessly with your training plan

HOW TO USE NORMATEC

Typically 20-30 minutes once a day is sufficient for most athletes. Athletes in heavy training may consider use after each training session.

Normatec boots and hip attachments are popular with athletes preparing for and recovering post events. Committed athletes are using the system as an ongoing recovery tool on a daily basis.

Normatec Hire- TRY BEFORE YOU BUY

Normatec Pulse 2.0 (covers feet and legs) are now available for hire through the Athlete Sanctuary.

AVAILABLE FOR PURCHASE:

*Normatec pants 3.0 includes compression for the legs, ankles, and feet

*Normatec lower leg (includes attachments for the feet, ankles, legs, and hips)

*Normatec Full Body Recovery System – includes attachments for the legs, ankles, arms, and hips for the ultimate recovery experience

*Normatec Arms – great for swimmers, rowers, adventure racers and canoeists

*Normatec Hips- a great addition to the lower leg attachment

We recommend purchasing a Normatec carry case or backpack to keep your Normatec protected, and secure during transport and at home.

Visit our shop to view the Normatec recovery systems we stock.

Iron deficiency is one of the most common issues athletes face. Iron and thyroid health go hand in hand and the effects of exercise on the thyroid gland and hormones are not well understood.

Iron and thyroid function
Undiagnosed iron deficiency presents an increased risk of impaired thyroid function. Active women have high-energy lives, managing work, family and training, and many will accept low energy and brain fog as simply a result of being overworked or as an inevitable part of hormonal changes.

However, low thyroid function, iron deficiency, overtraining and hormonal changes also present with many of the same symptoms.

Signs that your thyroid function may be underactive (hypothyroid) include fatigue, unexplained weight gain, headaches, low blood pressure, dry skin, constipation and cold intolerance. These early signs of cellular hypothyroidism can appear when blood pathology remains within standard ranges.

As with most chronic issues, there are multiple factors that may contribute to dysfunction.

The Link between Exercise and Thyroid Function

In athletes, endurance and high-volume training promotes thyroid function. During exercise, your hypothalamus stimulates the pituitary gland to secrete thyroid-stimulating hormone (TSH), which in turn signals your thyroid to synthesise and release the thyroid storage hormone T4 and active thyroid hormone T3.

These hormones influence your body’s metabolism and allow it to increase exercise intensity. Over time, this repeated, high demand of your thyroid during prolonged intense exercise may impact your thyroid function, causing it to slow down and consequently lose the ability to produce sufficient hormones.

Iron and Thyroid Function

Normal thyroid function is dependent on several nutrients to regulate the synthesis of thyroid hormones. Iodine, iron, tyrosine, selenium, and zinc are needed to facilitate the conversion of T4 to T3 . A deficiency of any one of these nutrients would result in reduced T3 production, causing you to experience hypothyroid symptoms. Vitamins A and D also play important roles in cell receptor behaviour to regulate thyroid hormone metabolism.

While iodine is the key mineral for healthy thyroid function (read more…here) it is not uncommon to find iron deficiency in hypothyroidism. Although widely recognised for its influence on red blood cell production, iron is also an important component of thyroid peroxidase, an enzyme essential for thyroid hormone biosynthesis.

Iron deficiency interferes with the normal functioning of the thyroid, contributing significantly to fatigue, exercise intolerance and lightheadedness.

Increased menstrual bleeding can lead to iron deficiency. Many of us dismiss low energy as a symptom of a busy, active lifestyle and so iron deficiency frequently goes undiagnosed in perimenopausal women. For athletes, iron plays a critical role in exercise performance as outlined in our blog “Increase your iron absorption and rebound from anaemia” here

The most common causes of iron deficiency include inadequate dietary iron intake, inflammation, poor iron absorption in the gut, parasites, iron loss through sweat, urination and faeces, blood loss through menstruation. Pregnancy, breastfeeding or high-volume exercise will also significantly increase iron demands. Take our free anaemia quiz to see if you may be iron deficient here

Thyroid Function and Sex Hormones in Women

Your thyroid function is sensitive to fluctuations in sex hormone levels, particularly oestrogen. Oestrogen stimulates the production of the thyroid hormone precursor, thyroglobulin, and increases the protein that carries thyroid hormones in your blood.

As oestrogen changes (such as during peri-menopause) so too does thyroid hormones, which play an important role in metabolism, muscle strength, energy production and expenditure, heart function, and temperature regulation.

As oestrogen levels rise and fall later in life, menstruation may become irregular and heavier. Peri-menopausal women may experience symptoms for over ten years as described in our blog on “Natural solutions for menopause” here .

During peri-menopause declining oestrogen may impact thyroid function and can lead to inadequate production and circulation of thyroid hormones.

Exercise During Hormonal Changes

Despite common misconceptions, women can train and perform well throughout peri-menopause, and beyond, if they listen to their bodies and be mindful of maintaining adequate dietary intake of key nutrients. It is important to recognise that both iron deficiency, thyroid function and hormonal changes can impact your ability to exercise.

Years of consistent exercise accumulate like pages in a book. As a mature you know your body very well. The pathway to success utilises your book of wisdom and skills. Mature athletes can benefit from greater recovery, individualized strength and conditioning and modified programs. Focussing on the balance between training intensity and volume will help you to achieve your desired goals.

If you suspect your symptoms are impacting on your quality of life and sport, it’s time to seek support to help you navigate the journey.

Blood serum pathology and functional tissue mineral testing can be a good starting point due to the critical role nutrients play in hormonal and thyroid function.

With the right self-care and a holistic approach to health, you can continue to achieve your life goals and physical challenges irrespective of hormonal changes.

References

Kawicka, A., & Regulska-Ilow, B. (2015). Metabolic disorders and nutritional status in autoimmune thyroid diseases. Postepy Higieny i Medycyny Doswiadczalnej, 69, 80–90.
Luksch, J. R., & Collins, P. B. (2018). Thyroid Disorders in Athletes. Current Sports Medicine Reports, 17(2), 59–64.
Santin, A. P., & Furlanetto, T. W. (2011). Role of estrogen in thyroid function and growth regulation. Journal of Thyroid Research, 2011.
Soliman, A. T., De Sanctis, V., Yassin, M., Wagdy, M., & Soliman, N. (2017). Chronic anemia and thyroid function. Acta Biomedica, 88(1), 119–127.
Wouthuyzen-Bakker, M., & Van Assen, S. (2015). Exercise-induced anaemia: A forgotten cause of iron deficiency anaemia in young adults. British Journal of General Practice, 65(634), 268–269.

As interest in herbal medicines is increasing among athletes, we thought we’d share some insights from recently published medical journals on energy boosting herbs.

The area of sports performance and sports products can be confusing but by sharing evidence-based information, we hope to create greater awareness and empower you to make informed decisions. Please keep in mind, this information is general in nature and does not qualify as specific advice for your individual sport or health status.

Many sports products are underpinned by large marketing budgets, whereas many natural products demonstrate clinical results but unfortunately allocated limited research budgets in regard to their effects on sports performance.

Plants provide nutritious macro-nutrients such as carbohydrates and lipids. Herbal medicines also contain active compounds that reduce infections and inflammation. Their applications are very broad from improving cardiovascular health to balancing hormones. The most popular herbs contain antioxidant properties that play a role in reducing oxidative stress, enhancing muscle recovery and energy with intensive exercise. Let’s investigate four of the herbs used by athletes namely Green Tea, Ginseng, Turmeric, and Tribulus.

Green tea extract

Green tea extract (Camilla Sinensis) is often found in weight management and stimulating supplements. Green tea extract (GTE) contains polyphenols, and antioxidants reported to increase fat utilisation. The phytonutrients in green tea have also been shown to inhibit pro-inflammatory substances and improve tendon, cartilage and collagen in athletes. Unfortunately, the majority of poor quality (yet widely available) GTE products do not declare their level of active ingredients and therefore provide very mixed results for athletes.

Dietary inclusion of GTE antioxidants is well supported. A 2017 clinical trial involving 54 soccer players taking GTE demonstrated significant improvements in oxidative status over a six week period (Hadi,2017). A subsequent study involving cyclists, demonstrated positive effects on neuromuscular function, reduced oxidative stress and muscle damage with cumulative exercise. Other studies suggest it may improve body mass and composition in athletes.

I encourage athletes to use GTE as a substitute for coffee with limited withdrawal side effects. Although the average cup of pure green tea usually contains around 25 milligrams of caffeine, this is considered to be low when compared to around 100-180 milligrams in a typical coffee.

Synopsis: Green tea extract is a great source of antioxidants. Clinical trials focused on weight loss do not include well-trained athletes and therefore the relevance of results remain questionable. Whilst green tea is well researched by credible sources such as the Cochrane Review (Jurgens, 2012), in my opinion GTE supplements do not deliver significant weight loss benefits over and above a sound nutritional and exercise plan to warrant the marketing hype. Green tea is however a great alternative to coffee and absolutely delicious as a matcha latte or in bliss balls.

Ginseng

When considering herbs for sports performance, the ginseng family is widely studied and praised for its support of physical endurance. There are many different forms of ginseng. The root of Korean ginseng (Panex Ginseng) is widely recognised for its anti-inflammatory, antioxidant, immune enhancing and endurance performance benefits. It also contains vitamins A, B, C and E along with iron, magnesium, potassium, phosphorous and ginsenoside active compounds.

A 2018 study demonstrated ginseng’s anti-fatigue effects related to its reduction in creatine kinase and blood urea nitrogen. Other studies suggest that use over a nine week period may improve aerobic capacity, (Vo2max), physical performance, lactate production and heart rate in athletes.

Its medicinal use extends to erectile dysfunction, libido, weakness, poor memory, cardiovascular issues, fatigue in menopausal women, and cognitive function.

Synopsis: Ginseng’s inclusion in nearly 8000 research papers in PubMed suggests this herb deserves consideration, especially in athletes with fatigue.

Turmeric

Turmeric Curcuma Longa is the most well-researched root in the world and is renowned for its antioxidant, anti-inflammatory and hepatoprotective coumarin agents. In clinical practice it is widely prescribed for inflammatory conditions such as arthritic joint conditions, liver and digestive issues, cancer, neurodegenerative disease and autoimmune conditions.

Turmeric has benefits for marathoners, downhill runners, and weight trainers by attenuating muscle inflammation caused by training and competition by reducing inflammatory cytokines. Some researchers suggest curcumin may serve as a more effective anti-inflammatory agent than ibuprofen during and following heavy exertion..

A study involving male master cyclists showed a significant reduction in advanced glycation end-products (AGEs) which are associated with stiffening of skeletal muscle, tendons, joints, bone, heart, arteries and lung with turmeric use. A recent 2020 systemic review concluded turmeric before, during and up until 72 hours post-exercise, improved performance by modulating the inflammation caused by physical activity.

Synopsis: Turmeric’s appearance in over 15,000 published research papers provides credibility behind its anti-inflammatory capabilities for recovery and injuries. Turmeric is generally well tolerated in therapeutic doses without significant side-effects. Sufficient levels of active curcumin are difficult to obtain through dietary intake alone and therefore supplementation may be beneficial for some athletes. Professional guidance around its bioavailability and quality is however imperative in order to obtain its reported benefits.

Tribulus

Tribulus Tribulus Terrestris gained popularity amongst eastern European male athletes for its reported ability to improve testosterone, muscle growth and libido in power and weight-lifting athletes. Tribulus is used medicinally for hormonal support in both men and women. Tribulus contains steroidal saponins, such as diosgenin and phytosterols with beneficial effects on reproductive, urinary and cardiovascular systems.

Many of the recent studies investigating the anabolic and androgenic action of Tribulus are poorly designed and provide conflicting results. A 2008 study was unable to reveal a significant variation or increased above the WADA cut-off limits testosterone. Another study on Australian rugby union players failed to use adequate therapeutic levels of Tribulus.

Synopsis: Although considered a relatively safe herb by clinicians, this plant has been targeted for contamination with illegal substances in supplements. Some supplements containing Tribulus have led to positive doping control tests. Therefore this herb should be cautioned for elite athletes. In our opinion further research is warranted before safe and effective recommendations of this herb for sports performance can be provided. As with all-natural medicines, just because they are “natural” does not necessarily imply they are safe or without side effects or interactions with other medications. Therefore, athletes should consult with a qualified herbal practitioner who is across drug controls before self-prescribing.

References

Fernández-Lázaro, D., Mielgo-Ayuso, J., Seco Calvo, J., Córdova Martínez, A., Caballero García, A., & Fernandez-Lazaro, C. I. (2020). Modulation of exercise-induced muscle damage, inflammation, and oxidative markers by curcumin supplementation in a physically active population: a systematic review. Nutrients, 12(2), 501. https://www.mdpi.com/2072-6643/12/2/501

Suhett, L. G., de Miranda Monteiro Santos, R., Silveira, B. K. S., Leal, A. C. G., de Brito, A. D. M., de Novaes, J. F., & Lucia, C. M. D. (2021). Effects of curcumin supplementation on sport and physical exercise: a systematic review. Critical reviews in food science and nutrition, 61(6), 946-958. https://www.tandfonline.com/doi/abs/10.1080/10408398.2020.1749025

Sellami, M., Slimeni, O., Pokrywka, A. et al. Herbal medicine for sports: a review. J Int Soc Sports Nutr 15, 14 (2018). https://doi.org/10.1186/s12970-018-0218-y

Machado, Á. S., Da Silva, W., Souza, M. A., & Carpes, F. P. (2018). Green tea extract preserves neuromuscular activation and muscle damage markers in athletes under cumulative fatigue. Frontiers in physiology, 9, 1137. https://www.frontiersin.org/articles/10.3389/fphys.2018.01137/full

For further information on the suitability of these options for your particular situation, book in for an individual assessment with our Sports Naturopath Kate Smyth here

Is cramping cramping your style? In this article, we explain how cramping and hydration go hand in hand and what you can do to avoid issues.

Several factors contribute to cramping. Many athletes have increased their training intensity and volumes but possibly overlooked their nutritional needs to meet their supplementary training requirements.

Go back to the root cause

Dehydration may contribute to cramping in athletes along with imbalances in electrolytes and muscle fatigue.

There are a number of reasons why we may get more dehydrated. In the heat, we lose more sweat and are more prone to dehydration through both sodium and water loss. We also get dehydrated in winter. We often reduce our consumption of salads packed with magnesium-rich leafy vegetables over the cooler months and our natural inclination to drink fluids may also be reduced and our thirst mechanism sluggish over winter.

Coffee, alcohol, and some drugs (such as oral contraceptives) may also accelerate the excretion or reduce the absorption of water and electrolytes such as magnesium and calcium. Not all athletes realize they require 20% more magnesium than a sedentary person.

The adrenal gland churns through sodium, vitamin C, and magnesium when we are stressed. It is pretty rare to find a person who can honestly say they are stress-free, especially in the current environment.

How to stop cramping- a reminder of the basics

Increasing magnesium-rich foods such as spinach, broccoli, squash, peanuts, cashews, almonds, oats, brown rice and cocoa (quality chocolate can be beneficial!) pumpkin seeds, chia seeds, and yogurt may help reduce cramping in athletes. These foods may also ward off more advanced issues linked to magnesium deficiency such as fatigue, immune, bone, or cardiovascular issues.

Most athletes grossly underestimate their daily fluid needs when taking into account fluid losses from training. Endurance athletes are notorious for skipping hydration opportunities during a session (especially long-distance runners) despite large sweat losses. Many athletes are shocked at how many liters of fluid they lose in a single session and ignore the increased risk of nausea, vomiting, diarrhea, and other gastrointestinal problems due to dehydration. However, excessive fluid intake also causes issues such as hyponatremia (low sodium concentration in the blood). Therefore, knowing your sweat rate is the best way to determine how much you should be drinking during and post-exercise.

Calculating your sweat rate can be completed at home by following these simple steps:

1. Weigh yourself just before an intense one-hour session

2. Complete your session and record any fluids you had during the session

3. After your workout towel dry yourself

4. Weigh yourself again in the same clothing you had on for the session

5. The difference between the two weight measurements equates to the fluid lost per hour i.e. 1 liter = 1 kg of fluid lost. If you had fluids during your session deduct this amount i.e. 1kg of minus 200ml of fluid ingested during the run = 800ml of fluid lost.

Companies such as The Sweat Lab provide home-based sweat tests you can order online here

Post exercise rehydration

During recovery, you will continue to lose fluids through sweating and urination. Plan to replace 125-150% of this fluid deficit over the next 2-6 hours. Sip a small amount of fluids constantly over a few hours rather than sculling large amounts at once.

Make sure your daily total fluid intake includes both your exercise-associated requirements and physiological needs. Although we are led to believe 8 glasses is sufficient as a basic requirement, national health associations are now suggesting that 15.5 cups (3.7 liters) for men and 11.5 cups (2.7 liters) of fluids a day for women is more appropriate for adults living in temperate climates. Typically 20-30% of your hydration needs are obtained through water-containing foods and the remainder through liquids.

Athletes with a limited intake of dietary sodium (strictly whole foods diet) may benefit from adding a small pinch of sea salt to evening meals or drink bottles (except athletes with elevated blood pressure).

In some cases where magnesium depletion is significant, a magnesium supplement and adequate electrolytes may be beneficial. As with all supplements, it is best to speak with a health professional to avoid the pitfalls of self-prescribing such as gastrointestinal issues and interactions. Athletes with a history of iron or zinc deficiency should be mindful of magnesium forms. Magnesium citrate is often found in supplements as it is well absorbed and specific to muscles however long-term use may interfere with the carrier protein (ceruloplasmin) and contribute to future mineral insufficiency.

Five quick tips for boosting your overall fluid intake:

1. Keep a pot of warm herbal tea or lemon and ginger in your workspace and sip continuously

2. Enjoy a cup of bone broth, miso or soup as a snack or with dinner.

3. Increase your fluid through foods. Enjoy more “wet” dishes such as soups, casseroles or Vietnamese style Pho bowls and enjoy snacks with high water content such as cucumbers, watermelon, oranges and apples.

4. Add warming herbs and spices such as cinnamon and turmeric to your favourite smoothies or juices (made with room temperature water or warm milk and fresh fruits instead of frozen).

5. Stick to a hydration plan during training sessions and keep a record of total intake daily in your training app or journal.

About the Author Kate Smyth is a Sports naturopath, nutritionist and female-centric running coach. She is the founder of the Athlete Sanctuary- a holistic healthcare clinic for athletes of all levels and sporting codes. Kate has a thirst for knowledge with two bachelor’s and a master’s degree under her belt. She has been involved in sports for many decades and competed for Australia in the Commonwealth Games and Olympic Games marathons with a personal best time of 2 hours 28 minutes. For more information visit www.https://https://athletesanctuary.com.au/wp-content/uploads/2023/03/normatec-3-lower-body-system-thumb_720x-1.webp.com.au/wp-content/uploads/2020/05/Seed-Cycle-Blends-scaled-1.jpg.com.au

Tart cherries have been used for decades to treat gout and osteoarthritis, but they also contain phytochemicals which stimulate melatonin, enhance sleep, recovery and sports performance and reduce inflammation.

Tart cherries contain the phytochemicals anthocyanins, flavonoids, flavanols and phenolic acids. Tart Cherries have a higher content of anthocyanins than sweet cherries and contain potassium, calcium, iron, magnesium, vitamins A, C, B6, E, and folic acid. Some sources suggest cherries have 19 times as much vitamin A & beta carotene as strawberries and blueberries!!

Evidence supports tart cherries

A 2016 study involving soccer players found tart cherry juice is efficacious in accelerating recovery following prolonged, repeat sprint activity, movement patterns often seen in soccer, AFL and rugby. The study also supports evidence that polyphenol-rich foods such as tart cherry juice are effective in accelerating recovery following various types of strenuous exercise.

A 2010 study involving recreational male and female runners competing in the London marathon, who supplemented tart cherry juice twice daily for 5 days prior and 2 days after the marathon showed improvements in muscle strength recovery, reduction of inflammatory markers and uric acid. The athlete’s total antioxidant status was 10% greater, while oxidative stress was lower in comparison to placebo.

Studies involving trained cyclists have also shown significant benefits when using Montmorency tart cherry concentrate on reduced oxidative stress, inflammation and muscle damage across 3 days of 109 minutes of road cycling racing when used twice daily for seven consecutive days. They concluded tart cherry juice has direct application for athletes competing in scenario’s where back-to-back performances are required.

How tart cherries help

Tart cherry juice may reduce pain and accelerate recovery after exercise and decreases blood markers of inflammation/oxidative stress in both strength and endurance exercise.

1. Reduces creatine kinase (CK) a pathology marker for muscle damage and breakdown

2. Reduces inflammation -shown in studies by reductions in interleukin-6 (IL-6), tumour necrosis factor-alpha (TNF-α), interleukin-8 (IL-8), interleukin-1-beta (IL-1-β) and C-reactive protein (CRP),

3. Reduces oxidative stress- it’s ORAC rating of 12,800 is one of the highest in the world.

4. Increases tryptophan, melatonin levels and improves sleep quality.

How to use Tart Cherry Juice for recovery and sleep

Tart cherry juice is unlikely to have beneficial effects during the adaptation/build stage of training, but when there is competition or intense training or multiday tournaments it may improve recovery. Examples of such competitions include: a rugby or AFL tournament, a marathon, a multiday cycling event, triathlon or an ultramarathon.

It is unlikely to be beneficial for consistent use where adaptation to the training stimulus is the athletes’ priority.

General recommendations found in the literature suggest having 30ml of tart cherry juice concentrate in 100ml of water twice daily. This equates to 60-90 cherries per serving.

Tart Cherry juice represents a more convenient way to ingest a large quantity of these polyphenolic compounds without associated side effects such as stomach pain or diarrhoea.

Take the 30ml in water first thing in the morning and in the evening. The evening dose is typically suggested one hour before bed to help facilitate quality sleep, which is of course an athlete’s primary innate recovery tool.

This protocol is suggested for 2-3 days post an event or strenuous training session.

We still need further research and larger studies involving athletes to substantiate claims that a preloading phase of 4-5 days prior to competition is required. It is unlikely that the compounds responsible for its benefits stay in your body long enough to accumulate over many days. Therefore, it remains questionable as to whether the loading phase is really necessary.

What to look out for and where to purchase?

There are many brands of tart cherry juice available online, in health food shops and in supermarkets.

Montmorency and Balaton TC varieties have both been studied; however, most researchers have used Montmorency brands (more predominant and widely available commercially to athletes).

Check the label on the bottle states the juice specifically contains either of these varieties.

The beneficial compounds (anthocyanins) in tart cherries are reduced with heat. Therefore it is important to source tart cherry products that are cold pressed if you wish to maximise the anthocyanin levels and possible benefits. There are a few companies who do this, so check before you purchase.

As a general rule most juices contain around 25 grams of sugar per 250mls but just remember you should only be having 30mls at a time. Low sugar options are available that contain stevia or vanilla extract but generally speaking the sugar content (3 grams per serve) is not an issue for most athletes.

You can expect to pay around $26-28 Aus for organic start cherry juice (450-950ml). The cheaper juices found in chemists or supermarkets are less likely to be cold-pressed.

We hope this information may inspire you to try something new that you may not have otherwise considered. As with all things, moderation and targeted use is more likely to yield desired benefits than overconsumption.

References:

Bell, P.G.; Walshe, I.H.; Davison, G.W.; Stevenson, E.; Howatson, G. (2014).Montmorency Cherries Reduce the Oxidative Stress and Inflammatory Responses to Repeated Days High-Intensity Stochastic Cycling. Nutrients, 6, 829-843.

Bell, P. G., Stevenson, E., Davison, G. W., & Howatson, G. (2016). The effects of montmorency tart cherry concentrate supplementation on recovery following prolonged, intermittent exercise. Nutrients, 8(7), 441.

Howatson G, McHugh MP, Hill JA, et al. (2010). Influence of tart cherry juice on indices of recovery following marathon running. Scand. J. Med. Sci. Sports 20:843–52.

McCormick, R., Peeling, P., Binnie, M., Dawson, B., & Sim, M. (2016). Effect of tart cherry juice on recovery and next day performance in well-trained Water Polo players. Journal of the International Society of Sports Nutrition, 13(1), 41.

Szalóki-Dorkó, L., Végvári, G., Ladányi, M., Ficzek, G., & Stéger-Máté, M. (2015). Degradation of anthocyanin content in sour cherry juice during heat treatment. Food technology and biotechnology, 53(3), 354-360.

Vitale, K. C., Hueglin, S., & Broad, E. (2017). Tart cherry juice in athletes: a literature review and commentary. Current Sports Medicine Reports, 16(4), 230-239.

Supplementation by athletes can be a minefield to navigate for the unwary. Whilst there may be significant value in taking additional nutrients, most of us share the view that it should always be a ‘food first’ policy. Maintaining a balanced nutrient–dense diet, is the key foundation for sports performance regardless of the level of competition.

Foods ingested in their natural format contain a package of bioavailable nutrients that help the body absorb key nutrients in ratios that are more easily assimilated than many supplements, and no volume of supplements can make-up for a poor diet. Athletes undertaking regular hard training sessions, may however benefit from taking supplements to maintain nutrient sufficiency and to maintain optimal health.

Supplementation by athletes should ideally focus on only high-quality supplements that are more likely to contain nutrients in beneficial ratios and bioavailable forms. Unfortunately, supplements may not contain all the active ingredients and compounds found in nature. Poor quality (and often cheaper) supplements may contain artificial forms of nutrients that are more difficult for the body to absorb. Retail products may also be formulated in doses below the therapeutic range required for health benefits. The storage and manufacturing processes of some supplements may also be questionable. Investigations of cheaper supplements such as fish oil may be rancid! Supplementation by athletes does have its place. It just isn’t practical to expect anyone to eat 2 buckets of spinach a day! Some nutrients are difficult to obtain purely from food sources when an athlete has high demands, digestion issues, illness, dietary restrictions or nutrient depletion. Iron, iodine, vitamin C and vitamin B12 are just some of the nutrients that fall into this category.

A 2015 study showed up to 70% of athletes use some form of supplement. This study by Outram and Stewart (2015) also revealed between 10-15% of supplements contained banned substances and over 80% did not contain what the label said. Competing athletes are typically aware of known banned substances but some are unaware of the considerable risk of accidental or inadvertent doping through using supplements.

If you are taking supplements and likely to be drug tested either in or out of competition in the future, the general guidelines below may be helpful. Some athletes are currently not in competition but still need to be aware there is no guarantee that taking “at risk” supplements will be out of your system when testing and competition resume.

Avoid imports
Imported supplements purchased online may sometimes appear to be cheaper but come at a huge cost to your sporting career. There are a number of issues to consider. Product quality can be difficult to ascertain due to being produced under different standards and labelling laws from those imposed on us from the Therapeutic Goods Association (TGA) in Australia. All ingredients may not be listed on the label of an imported product and this may put athletes at significant risk of testing positive to a banned substance. In the USA, dietary supplements are classified as a subcategory of food, exempting manufacturers from providing pre-market evidence of product safety and efficacy. The U.S. Food and Drug Administration (FDA) cannot inspect supplements until after the products have entered the marketplace and some disreputable manufacturers have spiked products with drugs such as anabolic steroids and amphetamines.

Know your banned substances
Always check labels and know the banned substance list for your specific sport both in and out of competition. The list of banned drugs and substances can be found on the ASADA website and substances can be checked here. If you are likely to be competing internationally, it would be wise to also look at the WADA guidelines here. Just because the substance does not appear on the prohibited list, does not mean it is 100% ok to ingest. The rules change frequently and supplements and other over the counter drugs may have different names from what appears on the list. Substances such as Bupropion, caffeine, nicotine and phenylephrine are included in the WADA 2020 Monitoring Program and their status may change at any time. If in doubt, avoid the substance.

Health foods and natural products
Some health food products and herbal medicines should still be avoided even if they are not on the banned list if you are unable to be assured of their purity and quality. For example, maca powder taken to support hormone function, energy and sports performance is one natural food product that is at risk of contamination. Tribulus is another product to be weary of. The Australian Institute of Sport (AIS) states “these products do not appear on the WADA list and are thus not specifically banned. However, they are often found in multi-ingredient products that contain banned ingredients or are at high risk of being contaminated. Therefore, they are not recommended for use.” See the AIS Supplement Group D list here .

Supplementation by athletes -Consider certified
Common sports supplements such as magnesium, probiotics, vitamin C, protein powders, creatinine etc. are now being batch tested and certified. Human and Supplement Testing Australia (HASTA) is an Australian commercial product testing organisation for WADA and has a certification scheme. Certifying a product involves not just multiple batch testing, but verification of the manufacturing quality controls that are in place and site inspections. If a product has been “HASTA Certified” it means that every batch has been tested for over 200 WADA prohibited substances.

Informed Sport also conduct supplementation testing on international sports nutrition brands. You can read more about the Informed Sport certification process here and HASTA process here

The same supplements should not be more expensive than usual just because they are batch tested.

Are there any guarantees?
No. Supplements screened by Hasta and Informed Sport cannot offer a 100% guarantee that an athlete will not test positive, but they are significantly less risky than other supplements. As batch testing is very expensive, limited supplements are available despite some manufacturers having large product ranges. If you have purchased a Hasta certified product, always check your supplement bottle has been batch tested. If your supplement does not come with a Hasta certificate, you are unable to safely assume it has been batch tested.

Are certified products better quality?
Unfortunately no. Companies that can afford to undertake the rigorous and expensive certification process may have some products included. Smaller companies that produce high quality products, may not be on the list. Just because a product is certified, does not mean they are suitable for you. Athletes still need to choose supplements with bioavailable forms of nutrients and take sufficient amounts to reach therapeutic levels and health benefits. There are Hasta certified products from reputable companies that I recommend frequently but it may be difficult for an athlete to choose suitable options if they just scroll through the list of supplement options.

Therefore, if you are a competing athlete, we suggest always checking with a qualified practitioner before self-prescribing any supplement, even if it appears to be batch tested or packaged as ‘food grade’ at the health food shop. Batch tested supplements are available through the Athlete Sanctuary.

We hope you found this information useful. If you would like further guidance with your supplementation protocol or health concerns, please get in touch.

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