Kate Smyth Archives - Athletes Sanctuary

Endometriosis is a painful condition impacting over 830,000 Australian women and girls and over 176 million women worldwide. With endometriosis, inflammation and estrogen dominance impacts tissue similar to the uterine lining and encourage growth in other areas of the body outside the womb such as in the pelvic cavity, the ovaries, fallopian tubes, intestines, or bowel.

Treatment commonly consists of medical and surgical therapies to remove the endometrial-like tissue. Painkillers and hormonal treatments are frequently offered to sufferers, but unfortunately, up to 50% of women will experience a recurrence of symptoms within 5 years ⁽²⁾. Many find the years before diagnosis extremely frustrating as they seek validation for their symptoms.

The exact causes of endometriosis remain unknown, however, family history, retrograde menstruation, metaplasia (conversion of normal pelvic tissue into endometriosis), alcohol intake, and early onset of periods (prior to 11 years of age) may play a role.

A third of women will be diagnosed after being unable to fall pregnant or inadvertently during an operation.

10 symptoms of endometriosis:

Abdominal, lower back, or pelvic pain during periods
Pain during or after sex
Pain on going to the toilet
Ovulation pain, including pain in the thigh or leg
Heavy bleeding or bleeding longer than usual
Bleeding from the bladder or bowel
Increased abdominal bloating, constipation, and other digestion issues such as small intestine bacteria overgrowth
Tiredness or lack of energy
Anxiety
Depression

Athletes and endometriosis

Endometriosis impacts athletes at all levels. Olympian Elinor Baker along with many women in sport are working to improve the awareness of endometriosis in sports. If you suffer from this condition it’s likely you may be able to relate to Elinor’s painful symptoms “as though someone was ringing out my organs as if they were a tea towel”. The fatigue, pain and heavy bleeding can severely impact athletes and their ability to compete and train. It is not uncommon for athletes to miss competitions due to surgeries, muscle cramps, and debilitating pain.

Natural treatment options

Our understanding of endometriosis is deepening, and holistic treatment approaches are showing promising results. Symptom reduction and improvements in quality of life have been demonstrated through food first and a targeted treatment approach including herbal and nutritional medicines.

By reducing underlying inflammation, improving the immune response, and clearing excess estrogen, women can reduce the severity of symptoms, scarring, and formation of endometrium growths.

Dietary interventions alone have reported reductions in painful symptoms and bowel complaints in up to 75% of women. Increased consumption of essential fatty acids, antioxidants, and a combination of vitamins and minerals have also been shown to have positive effects on endometriosis-associated symptoms. Other nutraceuticals such as resveratrol may improve endothelial wound healing while phytochemicals such as Diindolylmethane (DIM) or calcium-D-glucarate may help support clearance of excess estrogen and relieve pain associated with periods in sufferers of endometriosis.

Our seed cycling blog describes the benefits of using seeds to maintain healthy hormones. purchase your seeds for your cycle here

It can be reassuring to know that with the right self-care and a holistic approach to health, you can continue to achieve life goals and sporting success. An early diagnosis and understanding of your condition may result in better management of your symptoms.

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

Endometriosis in Australia: prevalence and hospitalizations. VIEW

Hickey M, Ballard K, Farquhar C. Endometriosis BMJ 2014; 348:g1752 doi:10.1136/BMJ.g1752

Hui, E., & Nap, A. (2020). The effects of nutrients on symptoms in women with endometriosis: a systematic review. Reproductive BioMedicine Online, 41(2), 317-328. https://www.sciencedirect.com/science/article/abs/pii/S147264832030225X

Marziali M, Venza M, Lazzaro S, et al. Gluten-free diet: a new strategy for management of painful endometriosis related symptoms? Minerva Chirurgica. 2012 Dec;67(6):499-504. http://europepmc.org/article/med/23334113

Moore, J. S., Gibson, P. R., Perry, R. E., & Burgell, R. E. (2017). Endometriosis in patients with irritable bowel syndrome: the specific symptomatic and demographic profile, and response to the low FODMAP diet. Australian and New Zealand Journal of Obstetrics and Gynaecology, 57(2), 201-205. https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/ajo.12594

Jean Hailes www.jeanhailes.org.au

Oregon State University (2022).Resveratrol www.https://lpi.oregonstate.edu

Endometriosis Australia www.endometriosisaustralia.org

BBC Sport www.bbc.com/sport/56276626

As we start to experience our hottest months in Australia, some individuals are starting to feel the effects of heat and humidity. This article provides a summation of the latest evidence-based options for heat training and preparation for racing in the warmer months.

Most athletes can train in the heat over a normal summer but then find they come unstuck when it comes to competing in hot conditions, especially when there are seasonal differences between where they train and then compete.

As a classic example of an athlete who did not perform well in unexpected hot conditions, I learnt some brutal lessons from heat stroke in the 2006 Commonwealth Games and the not so delightful conditions of the Beijing 2008 Olympics. Most of us have seen the horrific images televised during hot championships… the examples of athletes collapsing are endless, and the ill effects of heat are not limited to the marathon but extend to most endurance sports such as cycling, race walking, triathlon and ironman triathlons. Unfortunately, most major championships are held in warm conditions which are ideal for boosting attendance numbers, and sprint and power-based sports performances, but not so good for the endurance athlete.

Research to clearly define the “best way” to undertake heat preparation is lacking. Most recommendations are based on the lessons learned from athletes attending previous games (Olympics, Commonwealth, and IAAF World Championship Games) rather than large-scale studies. We should see further progress in recommendations for sports performance in extreme conditions in the coming years, however, good suggestions are available to trial now. These suggestions will need to be adjusted to suit individual needs.

Although you may not be aiming to compete at a championship level, you can still draw on the techniques used by elite athletes to improve performance. If you plan to compete in hot conditions, give yourself every opportunity to perform at your best and enjoy your race by following some of these simple guidelines.

TOP 10 TIPS FOR OPTIMISING SPORTS PERFORMANCE IN THE HEAT

1. Know your predicted event conditions. Researching the average event conditions over the previous years can help you better understand what you are likely to face. Remember there are multiple factors to consider that influence body temperature and how well you will cope with the heat. Some of these factors include humidity, solar radiation from direct sunlight, clothing, diffused radiation off clouds and road surfaces, wind speed and expected outside temperatures. Outside temperatures are usually taken in the shade so the actual perception of how hot it is, can change significantly.

2. Know your sweat rate. Get your sweat and sodium rate loss checked properly. You can do this at a sweat lab for approximately $200 or with a home-based test kit costing around $99. It is recommended athletes test fluid and sodium levels before and after heat acclimatization. Another simple option that gives you a basic measure is completing a basic fluid loss count yourself. Weigh yourself before and after you do an exercise session of at least 60 minutes in warm conditions. Subtract the amount of any fluids taken during this session. This gives you an estimate of how much fluid you lose per hour.

3. Keep your fluids up. If you are competing in the heat you will lose more fluid than in cooler months. Fluid losses of over 2% of your body weight reduce sports performance. When athletes reach this 2% threshold, increased fatigue, reduced endurance, reduced motor skills and mental function, and declining motivation can be observed. Studies also show heart rate increases by 3-5% for every 1% dehydration. Drinks including electrolytes such as sodium and magnesium are important and beneficial over water, especially in events with 90 minutes duration or more. Drinking to thirst is advised for shorter events under 90 minutes duration and events with low intensity in cooler climates. A general rule of thumb is to aim to sip 250ml of fluids every 20-30mins of an event of high intensity over 90 minutes.

Enter a race well hydrated and then remain as well hydrated as possible during a race.

4. Replenish fluids. Drinking 150% of the fluid lost during an event within 2 hours is also key to a speedy recovery. This does not mean you should skull huge quantities of fluid. Imagine yourself as a plant. If you tip large amounts of water on a plant, the water just runs through but if you water the plant gradually, the roots have time to absorb the fluid and nourish the plant. Humans are the same, so ideally sip fluids slowly and continuously in combination with consuming high-water content foods such as watermelon in the 2 hours immediately after your event

5. Heat adaptation. Studies reveal it is not uncommon for core body temperatures of elite athletes to reach 41c during races. This naturally coincides with a drop in pace. In many situations, high core temperatures are unavoidable however the time at which athletes reach this level of temperature can be delayed, therefore minimising the time at which their pace will drop in a race and reduce the risk of unfavourable side effects such as heat stroke. Some of the most widely used protocols to help athletes prepare for performance in heat climates include heat acclimatisation and heat acclimation. Both of these techniques improve the athletes’ physical responses and overall ability to cope with heat exposure. Heat acclimatisation involves adaptations in response to heat stress in a controlled environment such as a heat chamber (typically under supervision) over the course of 7 to 14 days.

Heat acclimation is a similar process but in a natural environment such as training in a warm climate such as Cairns. Some of the positive adaptations that occur to heat adaptation/ acclimation include reductions in heart rate, body and skin temperature, and perceived level of exertion/ effort. An increased sweat rate and sweat onset also help you to cool down more efficiently. Reduced sodium loss and blood pressure are also observed. These changes equate to an athlete’s increased ability to perform in the heat.

Undertaking 70-80 minute sessions in heat chambers a few times per week as part of a well-structured training plan can aid in heat adaptation. This is great for those with access to heat chambers but what about everyone else?

Homebased options do exist like hot rooms, hot baths, and saunas. Athletes can also create a DIY heat chamber in a bathroom or laundry by switching on the heater and using a treadmill or stationary bike.

Using a humidifier in this room will also create humidity. Heat acclimatisation protocols are individualised and vary greatly. Some studies suggest completing 12 x 30 minute sessions in a hot sauna over a 3 week period while others with 10 continuous days of 1 x 90 minute heat session/ day showed increased VO₂ max and endurance performance. Having a base level of fitness prior to starting heat exposure will help the process along as you will already have an increased sweat rate.

Following the heat acclimatisation phase, spending 10-14 days just prior to your event in a similar environment to the one you are competing in will facilitate heat acclimation. This will also help you adjust to a different time zone if applicable. Ensuring you have enough time to climatically adjust and have adequate support during this tapering phase, is really important.

6. Avoid altitude and heat in combination. If you are planning on doing altitude training, don’t forget to leave plenty of time between leaving altitude and commencing heat preparation to allow your body to recover. Ideally this window will be 21 days. Avoid combing altitude and heat training. Studies suggest mixing heat and hypoxia at the same time, does not provide beneficial outcomes.

7. Pre-cooling. Although your core temperature will rise during the course of the event, there are various methods that can be used to keep your core temperature lower for longer. Ice vests are used by elite athletes but you could make your own version using ice packs in towels or a Camelbak during the warm up. Fans, cold towels and cold baths in a bucket are makeshift options. One of the methods used in Beijing involving sipping an ice slurpy before the race as we warmed up. This is suggested to reduce the body’s core temperature by up to 5%. Mixed methods of a few of these options seem to be most effective. Trial what can be tolerated and what works for you prior to your event.

8. Keeping cool during the event. Some of the more widely used tricks to stay cool during the event include using facial spray, overhead mist sprays, and cold-water sponges to cover as much skin surface with cooling water. Cool packs tied around the neck or in socks can also be helpful. Sunglasses and wearing a visor rather than a hat can also help keep the glare down but allow the sweat on your head to evaporate and feel the cooling effects of cool water when tipped over the head. If you have the luxury of putting out your own drinks, keeping them in some form of cooler or stubby holder can also keep them cooler for longer. Freezing the drinks that will be out in the sun for over an hour can also be helpful.

9. Adjust your race to the conditions. Planning for the heat in terms of running within your limits in the early stages, will certainly help you to remain strong throughout the later stages of the race. Heat is accumulative and can impact your pacing so always be conservative and factor in that your overall time may be slower no matter how fit you are.

10. Get help. To avoid “cooking yourself”, training during your heat adaptation needs to be carefully planned and moderated so the overall load on the body is well managed. A plan is best done under the supervision of a coach, sports-focused nutrition practitioner, and other specialists who have an understanding and access to the research behind heat protocols.

IN SUMMARY

Athletes can undertake a variety of measures to influence their performance but changing weather conditions is beyond even the most talented athlete. If you’re competing in an event during hot weather undertaking some of the simple strategies listed above could assist your preparation and performance in the event.

Remember that we’re all individuals, so what may work for your training partner may not work for you. Develop a plan with your coach and incorporate some of the measures listed above into your training regime well before your event. In the final weeks before your event employ the strategies that worked best for you and adjust your race plan according to the conditions.

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. She has a thirst for knowledge with two bachelor’s and a master’s degree under her belt. Kate has been involved in sports for many decades and competed in the Olympic and Commonwealth Games women’s marathon with a personal best time of 2 hours and 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

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.

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

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

Some women experience absolutely no symptoms during their transition through menopause but if you are like 80% of women who do, it’s reassuring to know there are treatment options available. Help for menopause is here.

Perimenopause is the stage where most of the symptoms begin and these can persist for over a decade. Menopause officially commences 12 months after your last period. Women can go through menopause anywhere between the ages of 40 and 58 years but the average age is 52 years. Symptoms can occur due to the falling levels of estrogen and progesterone, which has a multifaceted impact on organs and tissues throughout the body.

Most women identify menopause with hot flushes, night sweats, vaginal dryness, mood swings, poor libido and fatigue. Symptoms usually occur in the perimenopausal phase due to declining progesterone. Oestrogen actually increases to levels 30% higher than before but can go through periods of variations similar to a roller coaster leading to insomnia, depression, poor concentration, irritability, anxiety and poor stress tolerance and lethargy. In the later stages of perimenopause, oestrogen declines which may contribute to other symptoms such as heart palpitations, joint pain, osteoporosis and mental health issues.

One of the associated effects of estrogen decline is an increased risk of osteoporosis. This is due primarily to the 1-2% loss of bone density per year of menopause, as well as 10 years post-menopause. Estrogen decline is also associated with elevated cholesterol, cardiovascular disease, hypothyroidism, urinary tract infections and thrush.

Some women have concerns about the use of hormone replacement therapy (HRT) or are unable to use this option due to breast or ovarian cancer risk. Fortunately, there is now a large body of evidence that supports the use of herbal and nutritional medicines during the menopausal transition.

DIETARY INTERVENTIONS

Phytoestrogens are naturally occurring estrogen-like compounds found in plants, fruits, or vegetables and are commonly divided into three main classes: isoflavones, lignans, and coumestans.

Isoflavones are found in the legume family, with high amounts in soybeans and soy products.

Lignans are found in high-fibre foods such as unrefined grains, cereal brans, and beans, with flaxseed being a particularly good dietary source of lignans. A recent systematic review found that women who consumed protein bars containing flaxseed (410 mg of lignan) for 6 weeks reported a 50% decrease in hot flushes. Seed cycling can be helpful for women who want to boost their intake of fatty acids and lignans.

Coumestan-rich foods include alfalfa and clover sprouts, peas, pinto beans, and lima beans.

Herbs

Hops (Humulus lupulus) dampens tension and anxiety. The active ingredient in hops, 8-prenylnaringenin, is a potent phytoestrogen and has been demonstrated to reduce vasomotor symptoms by improving the ability of the blood vessels to expand and contract. Numerous clinical trials have also documented significant reductions in the frequency of hot flushes, sweating, insomnia, heart palpitations and irritability in women who used a hops extract for 6 weeks.

In clinical practice, a combination of herbs is often used to support women during the transition through menopause. Korean ginseng (Panax ginseng), which is considered to be a “buried treasure medicine”, is another popular herb for active women suffering from fatigue. Ginseng’s active constituents include saponins, amino acids, vitamins (particularly folic acid and niacin), alkaloids, phenolic compounds, and flavonoids. Ginseng has been widely used in traditional medicine to assist with building resilience to stress and used as an energizer, to increase libido, and testosterone and alleviate menopausal symptoms. Clinical trials have shown ginseng significantly reduced depression and improve perceived well-being, exercise performance and energy in perimenopause.

Another popular herb is chasteberry, or vitex. This herb has shown positive results in reducing PMS, anxiety, hot flushes and breast tenderness in perimenopausal women. Vitex is used to support the transition from perimenopause to menopause due to its ability to increase progesterone levels and help maintain a healthy balance between progesterone and estrogen.

For women experiencing persistent hot flushes or night sweats as a result of menopause, Red Clover (Trifolium Pratense) may often be prescribed. This herb contains high levels of phytoestrogens for improving hormonal balance, as well as helping improve bone density in those at risk of osteoporosis. Several clinical trials demon straight the isoflavones present in red clover inhibit bone resorption and therefore reduce bone turnover associated with osteoporosis.

Ginkgo Biloba is similar to red clover because of the phytoestrogens it contains and its ability to naturally elevate estrogen levels. Studies show that Ginkgo Biloba can reduce mood fluctuations associated with both PMS and menopause, as well as improving libido in 84% of trial participants after 4 weeks.

Sage, most commonly prescribed as a tea, has long been used in the management of fevers. However, there is also evidence to support the use of sage for menopausal hot flushes and night sweats. A study that assessed the use of fresh sage leaves in food or as tea demonstrated that the intensity and frequency of hot flushes were significantly reduced over a period of 8 weeks with consistent use.

Hormones play an integral role in your health, and changes in hormone balances can be challenging. There are many different ways that nutrition can be used to navigate menopause, without having to experience the numerous, negative side effects of HRT.

As with any element of health, there is never a one-size-fits-all approach and therefore we recommend individualised treatments for menopausal symptoms.

Green tea is just one of several teas beneficial for athletes. Packed in antioxidants, green tea is considered to have the highest polyphenol and therapeutic effects because it remains unoxidised during processing, where-as the other tea leaves are oxidised. Green, black and oolong tea is produced from the same plant Cameliia sinensis but their taste, constituents and colour vary depending on how the leaves are processed.

Green tea is packed with antibacterial agents and the phytonutrients also help counteract inflammation. Regular intake improves tendon, cartilage and collagen health in athletes.

Types of green tea

There are lots of different kinds of green tea depending on growing and harvesting methods. Our favourite is a Japanese tea called Genmaicha “brown rice tea” which is blended with roasted popped brown rice. The sugar and starch from the rice cause the tea to have a warm, full, nutty flavour without bitterness. It is considered easy to drink and can soothe an upset stomach.

Other popular options include the Japanese varieties of Sencha and Jasmine (which is often mixed with white and black tea).

Better than coffee

Green tea is an excellent substitute for coffee drinkers. Although the average cup of pure green tea usually contains around 25 milligrams of caffeine, this is considered to be a low amount of caffeine when compared to around 100-180 milligrams in a typical coffee.

So often athletes get a false sense of energy when they are pumped full of caffeine. Over the long term, this can set them up for adrenal fatigue, over-training issues, nutrient depletion, dehydration and chronic injuries. Green tea provides a great “pick me up” without flogging the adrenal glands. To further reduce your daily caffeine load, and avoid sleepless nights, you may like to consider these tips:

Get the most out of green tea

Avoid consuming green tea or other caffeine-containing foods or beverages after lunchtime
Opt for low-caffeine teas or other herbal teas like Rooibos tea.
Drink blends. A blended tea such as a 50-50 blend of lemongrass or mint and green tea usually contains about half the caffeine of its unblended counterpart.
Brew tea correctly. Many people use boiling water to brew tea for more than three minutes. This increases the level of caffeine in your cup. Instead, brew with simmering water for one-and-a-half minutes to three minutes.
Reuse the original tea leaves for additional cups of tea that will taste the same but contain less caffeine.
Drink whole-leaf tea instead of tea bags. Teabags have more caffeine than loose-leaf tea (usually).
Avoid powdered teas high in caffeine. Matcha is one tea to avoid if you are trying to reduce caffeine as it usually comes in a concentrated form and is made from powdered green leaves instead of an infusion of the leaf. Therefore, Matcha has much higher levels of caffeine than other green teas.

Caffeine is now the world’s most popular stimulant ingested by over 90% of people including athletes because it can make them feel “damn good”.

But is it really that good for you? This article explores a balanced perspective on caffeine use for sports performance.

Caffeine has been used for decades as a way of buffering fatigue, prolonging endurance and enhancing concentration in many team and individual sports. Sure, it gives you a “pick me up” but at what expense?

While some athletes will get the beneficial effects of enhanced focussed and reduced fatigue, others can get so fired up, they get the shakes, diarrhoea and their “rev” is excessive so they make poor tactical decisions during events. Caffeine is an adenosine antagonist affecting dopamine transmission and altering neurotransmitter function.

With long-term and high-volume caffeine intake, an increased risk of overstimulating the nervous system occurs. For some individuals, this looks and feels like anxiety, headaches, migraines, poor sleep, depression, angina, nutrient depletion, elevated blood pressure, addictive habits towards caffeine and severe fatigue.

Caffeine also contains a diterpene known as cafestol which has been shown to increase serum LDL cholesterol, increase aortic stiffness, blood pressure, endothelial dysfunction and homocysteine all of which contribute to heart disease- Yikes!

The other “doozy” with caffeine is that even if you are currently enjoying just one cuppa a day you most likely already have caffeine tolerance. As time goes on you’ll need to have more and more caffeine to feel any benefits.

So at this point, if you are sitting back saying “ I am good I don’t drink coffee” just take a breath. Just because you don’t drink coffee, doesn’t mean you aren’t consuming an excessive load of caffeine. Caffeine is found in many commonly consumed drinks and foods. Let’s take a look at the most common ones:

Food/ Beverage	Size	Caffeine in milligrams
Short black/ expresso coffee	(1 cup)	100-200mg
Instant coffee	(1 cup)	60-170mg
Decaffeinated coffee	(1 cup)	2-4mg
Green tea	(1 cup)	20mg
Tea (black)	(1 cup)	30-100mg
NO Doz	(1 tablet)	100mg
Revvies	(1 strip)	40g
Sports gels	(1 gel)	25mg-100mg
Coke and V energy drink	(1 can)	50mg
Hot cocoa	( 1 mug)	60-120mg
Chocolate	(60g)	10-50mg

So what to do?

The good news is that recent studies suggest the performance benefits of caffeine can be felt at low doses (1-3mg/kg) which are less likely to impact your health in other ways. So theoretically speaking effects may be felt by athletes using the following amounts:

50kg athlete 50-150mg; ( 1 coffee)
60kg athletes 60-180mg;
70kg athlete 210mg;
80kg athlete 80-240mg
90kg athlete 90-270mg ( 2 coffees)

Top tips for caffeine use for sports performance:

If you are using caffeine for the first time try small amounts initially and infrequently so you don’t develop resistance. Attempt any trialling caffeine as part of your race day nutrition and hydration plan during training several times prior to race day, in similar conditions first to avoid unsavoury surprises.
Caffeine may make you temporarily feel good it can also cause adverse performance effects. Caffeine displaces vitamins and minerals essential for athletic performance such as magnesium, zinc and B vitamins. Caffeine can irritate the kidneys and is a diuretic increasing the risk of dehydration in hot weather so you may need to increase your fluid intake. The most common issue with caffeine is diarrhoea. Taking caffeinated foods or drinks with food may help mitigate this problem.
Avoid caffeine after lunchtime to avoid sleeping difficulties.
High caffeine intake is inflammatory and prolonged use can contribute to systemic inflammation which underpins nearly all chronic conditions. Our suggestion is to enjoy caffeine in moderation and use a targeted approach in regard to sports performance.
Smart considered and moderate use of caffeine may provide a performance edge but it will not suddenly turn you into some kind of superhero breaking world records. You still have to invest in sound balanced nutrition and hydration strategies, train smart, rest well and allow the natural adaptation of the human body to occur!
As with all products, always remember to check each ingredient on the packaging of any sports product because some substances that may appear relatively benign may be banned under the Australian (ASADA) and World Drug Agency Association (WADA) guidelines. Rule of thumb- always do your own thorough research before using any supplement despite its popularity!
If you are currently a heavy coffee drinker, wean yourself off coffee gently so you don’t go into an unprovoked tirade at your family or work colleagues as you deal with the headaches associated with detoxification. By reducing your intake gradually by ½ a cup a day, you are also more likely to allow your tolerance to reduce so when you settle for smart and more moderate use, you can obtain benefits at a lower dose. In some individuals’ withdrawal may be more comfortably achieved with the use of herbal adaptogens, liver support, activated vitamins and dietary intake of brassica family vegetables (broccoli, cabbage, kale, cauliflower) to ease the transition.
If you are looking for coffee substitutes or reduced caffeine products you may like to try roasted dandelion tea, ginseng, high-quality green leaf tea, chai tea or Rooibos tea.
Try different forms of caffeine in sports products rather than just coffee. Caffeinated sports products come in powders, gels, strips and tablets and all will be digested/ metabolised slightly differently in the body. Some athletes experience digestive issues with coffee but not strips, while others have issues with caffeinated gels but not powdered versions.
Limit decaffeinated coffee. It may have reduced caffeine but many of the extraction methods still use chemical solvents that may be toxic.

Kate Smyth

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