Running: Overtraining- Prevention 2

Eat good food, sleep well and hydrate well. These are no-brainers when it comes to prevention of overtraining syndrome. A good multivitamin & fish oil are also good additions (this is true even for non-runners). But one important nutritional supplement seems to be especially significant; phosphatidylserine.

Let's look at some of the evidence supporting the use of phosphatidylserine.
" The findings suggest that phosphatidylserine (PS) is an effective supplement for combating exercise-induced stress and preventing the physiological deterioration that can accompany too much exercise. PS supplementation promotes a desired hormonal status for athletes by blunting increases in cortisol levels." Journal of the International Society of Sports Nutrition 2008 Jul 28;5:11.

"This is the first study to report improved exercise capacity following phosphatidylserine supplementation. These findings suggest that phosphatidylserine might possess potential ergogenic properties." Medicine and Science in Sports and Exercise 2006 Jan;38(1):64-71

"...chronic oral administration of phosphatidylserine may counteract stress-induced activation of the hypothalamo-pituitary-adrenal axis in man." European Journal of Clinical Pharmacology 1992 April; 42 (4):385-388
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In the world of sports nutrition, there are many supplements and research studies that show benefits of various agents in improving sugar metabolism, energy production, fat breakdown, other variables that can aid performance (creatine, carnitine, ribose to name a few). Phosphatidylserine is worth consideration because of its ability to regulate hormones shifts by stabilizing the HPA axis.

Running: Overtraining- Prevention 1

If you are overtrained, it can be difficult to recover. As with most conditions, prevention is the best step. The single best training step you can take to prevent overtraining is the use of a heart rate monitor.

There are a few different ways that athletes utilize heart rate monitors. A doctor by the name of Phil Maffetone devised a method of finding your maximum heart rate. This is calculated by subtracting your age from 180. So if you are 40 years old... (180 - 40= 140) your maximum heart rate should be 140.

Those of you familiar with heart rate monitors may realize that at first glance, this seems a bit low. The traditional method has been to subtract your age from 220; use that as the maximum heart rate and then to train between 65-85% of that maximum. For the 40 year old person (220-40= 180) 65-85% of 180 is 117-153. The traditional recommendation is to train closer to the 85% point for increases in overall performance and aerobic capacity.

For our 40 year individual, the question arises; should I train at 140 or 153 bpm? The answer is 140. This is a good opportunity to make this point: There is a big difference between "training for performance" versus "training for performance AND good health."

Training for performance is a relentless, "all-in, do what it takes" attitude that demands the most of your body. For example, you can drive your car fast all the time (performance) but you must realize that the life of the engine, tires and brakes will suffer as a result of that. On the other hand, if you take good care of your car and drive responsibly, it will certainly give you excellent performance when you need it.

Training at 140 (for this imaginary 40 year old runner) may seem slow and awkward at first. You may feel like you're doing a gentle jog rather than a training run and you may experience some frustration. But over time, you will be able to run faster while maintaining that slower rate. This has the important effect of minimizing chemical and hormone stress while programming the aerobic engine of your metabolism. For more on this, read Maffetone's book, "In Fitness and In Health."

To be clear, healthy individuals may perform just fine while training at the higher heart rate derived from the traditional calculation. But the hidden cost of that is potential hormone and metabolic shifts that have long term implications. If you are already overtrained or getting to that point, it is essential that you follow the 180-age formula for heart rate.

Running: Overtraining & Immunity

You should be convinced by now that overtraining has significant health consequences as a result of hormone shifts. Another question that arises is the effects on immunity.

Overtraining is associated with compromised mucosal immunity. This means that you are more prone to infection. It is clear that overtrained athletes have a decrease in salivary IgA. This is an immunoglobulin that serves to protect mucous linings. That means that when viruses or bacteria get into your nasal cavity or gut, you are more likely to suffer an infection because you have fewer antibodies in the area to defend you. Exercise Immunology Review 2004;10:107-28.

The immune system falls out of balance. Many of us have a general idea that people can have weak or strong immune systems. This black or white approach toward physiology is not accurate. Although I mentioned in the previous paragraph that mucosal immunity is compromised, we should understand this to mean that one component of immunity is compromised. It's not fair to say you have a globally weak immune system. One paper that speak to this point states:

" It is concluded that an increased incidence of illness associated with overtraining syndrome and in response to excessive exercise is not due to immunosuppression per se, but rather to an altered focus of immune function, with an up-regulation of humoral immunity and suppression of cell mediated immunity." Sports Medicine 2003;33(5):347-64.

This is the equivalent of our armed forces failing to cooperate during a time of war. While each branch may be powerful alone, there must be central coordination for success.

Another group of researchers echo this sentiment and states:
" Whereas athletes are not clinically immune deficient, it is possible that the combined effects of small changes in several immune parameters may compromise resistance to minor illnesses such as upper respiratory tract infection." Medicine and Science in Sports and Exercise 2000 Jul;32(7 Suppl):S369-76.

You can see that overtraining has major negative impact on the immune system.

Running: Overtraining & Hormones

Let's dig a little deeper into the effects of overtraining.

Testosterone levels will decline. A team of researchers grouped 286 subjects into moderate or heavy exercise groups. They ran for 2 hours, 5 days per week for about 1 year. After that, they spent 9 months with a low intensity running schedule. They found that the pituitary hormones LH and FSH (luteinizing hormone, follicle stimulating hormone) decreased, testosterone levels decreased, and sex hormone binding globulin levels increased. Levels improved back to normal during the low intensity recovery period. They concluded,

"Long-term strenuous treadmill exercises (overtraining syndrome) have a deleterious effect on reproduction." Journal of Endocrinology 2009 Mar;200(3):259-71. Epub 2008 Dec 9

Females can also experience reproductive dysfunction. While the mechanisms are still to be determined, the probable suspect is decreased estrogen production as a result of overtraining. This does more than set women up for poor athletic performance. It sets you up for osteoporosis, infertility, decreased muscle mass & behavioral problems. Journal of Endocrinological Investigation 2001 Nov;24(10):823-32.

The hormone cost of overtraining is considerable. The consequences of these shifts are significant.

Running: Overtraining

Overtraining may involve more than just a drop in your athletic performance. Common symptoms include: headaches, insomina, pain, loss of enthusiasm for running, increased number of injuries, slower healing time, slower recovery time, frequent infections, loss of appetite and more.

Classically, the treatment for overtraining syndrome is rest. Depending on the extent of compromise to your body, this may require complete rest or a substantial reduction in your training time. Let me explain a little of the hormone physiology behind the syndrome.

1. Cortisol production is a priority in your body.
Just as we can say your heart is more important than your feet and your brain is more important than your spleen, we can say that cortisol is simply "a little more important" than many other hormones.

2. Cortisol, testosterone and estrogen have a common mother.
The precursor to all these hormones is pregnenolone. Generally, there's enough pregnenolone to go around so we make adequate amounts of all hormones, but when physical (or emotional) demands are extraordinarily revved up, cortisol production takes priority.

Do you remember the old Star Trek episodes where the Captain would say, "more power to the shields!" during times of attack? Presumably, sending the available power to shields took priority over the lights in the kitchen, powering the microwave oven or whatever else required power. The limited amount of available resource needed to be carefully distributed to get through the day.

Similarly, our pregnenolone needs to be transformed into what matters most at the time.

3. Over time, you won't even make enough cortisol.... or testosterone... or estrogen... to get through the day.
In Star Trek; eventually, the shields went down.
In California; eventually, you'll run out of water.
In overtraining; eventually, you'll run out of cortisol.

When your cortisol production "dries up", other hormone production will also suffer.
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Let me ask women a question? What happens when estrogen levels decline?
The answer is; the classic symptoms of menopause. Muscle mass declines, bone density decreases, fatigue, discomfort, insomnia etc. Sounds familiar?

Now to the men. What happens when testosterone levels decline?
The answer is: muscle mass declines, bone density decreases, fatigue, discomfort, insomnia etc.

Now a question to all runners. What happens when you are overtrained?
The answer is: muscles don't recover as well, bone loss, fatigue, discomfort, insomnia etc.

Running: Protect Your Adrenal Function

As the last entry discussed, the adrenal glands are subject to stress during training. This is perfectly acceptable if you have healthy adrenal status. But if you have some level of adrenal fatigue, you must be prepared to train wisely. If the idea of "adrenal fatigue" sounds a little strange to you, we should describe it more accurately as "hypothalamic-pituitary-adrenal axis dysfunction." This is the biological system that regulates adrenal activity and is commonly referred to as the HPA axis.

HPA dysfunction is common and is related to multiple symptoms.

1. Chronic fatigue. Psychosomatics 2008 Sep-Oct;49(5):450.
2. Irritable Bowel Syndrome. Neurogastroenterology & Motility 2009 Feb;21(2):149-59. Epub 2008 Aug 5.
3. Altered immune function. Journal of Neuroimmunology 2002 Dec;133(1-2):1-19.
4. Depression Psychological Medicine 2009 Apr 1:1-4.

If you already have some level of HPA dysfunction, then aggressive training may actually harm your health. This doesn't mean that you shouldn't run at all. Interestingly, low intensity exercise reduces burden on the adrenal glands. Journal of Endocrinological Investigations 2008 Jul;31(7):587-91.

Because HPA dysfunction is not a "disease" per se, there are no accurate numbers for how many Americans are affected but adrenal health is relatively simple to assess. It involves a simple saliva test that many functional laboratories (i.g. Diagnos-techs, Metametrix, Genova Diagnostics) perform.

If you have experienced a drop in performance, slower race times, slower recovery, gastrointestinal discomfort or fatigue, you may be overtrained. More on overtraining next time.

Running: A Fresh Look

I like to run. I am not a fast runner; quite average in fact. But it gives me a chance to renew my body and my mind. Running outside helps me think more clearly, meditate and recharge while I give my muscles, bones and heart a great workout. I'm sure there are many of you who are passionate about running and can relate to the mental and physical boost it provides. For you running nuts, I wanted to do a short series that gives a fresh look to an old movement.

First off, I won't talk about the cardiovascular and general health benefits that running provides. You all know about that and it's been well researched and written about by hundreds of authorities. Instead, let's start by looking at the hormonal milieu that your body goes through.

A 2008 paper in the European Journal of Internal Medicine found that cortisol levels are increased after running a marathon. This comes as no surprise as cortisol is famous for being a "stress hormone." A 26.2 mile race is quite a physical stressor.

Cortisol itself is a great hormone but in today's hectic world, the "emotional marathon" of daily life takes its toll. Coupled with other physical demands such as irregular meal times & sleep deficit, we continue to tax the adrenal glands (the body part that produces cortisol) until there is either overburden or outright fatigue of these glands.

In other words, training with "burned out" adrenal glands can be hazardous. We'll make a case in future blog entries.

Your Insurance and Tobacco

The story making headlines this morning is the report in the New England Journal of Medicine that several life & disability insurance companies invest billions of dollars into tobacco company stock. This seems to cross obvious moral and ethical lines, suggesting an attitude of "dollars over principles", but I'll leave further commentary to others.

The take home message here: You are in charge of your health.

The last thing I want is for readers to become absorbed in a "the evil world is out to get you" kind of attitude. I just want us all to realize that no one else; no 3rd party, insurer, friend or professional will care about your health as much as you will.

Be empowered. Take ownership. Take control of your health. No one else will do it for you.

Is Health Care in Trouble?

President Obama has consistently called for dramatic health care reform. Most economists agree that if the health care system isn't fixed, it has the potential to drag down the entire economy. Check out this June 2009 report from the White House Council of Economic Advisors. It states,

"Health care expenditures in the United States are currently about 18 percent of gross domestic product, and this share is projected to rise sharply. ... is projected to reach 34 percent by 2040"

There is no arguing the need for reform. The debate seems to be what that reform will look like and how it will be paid for.

I recently read an article and one line burned into my brain. The author wrote, "America doesn't have a health care problem. It has a health problem." (I've searched high and low but cannot remember or find the source).

This may be a bit of an overstatement but the point it makes is clear.
1. Nearly 50% of Americans have at least 1 chronic disease.
2. Risk factors for chronic disease are largely preventable.
3. Chronic disease accounts for 75% of health care spending.

If you put 2 and 2 together, this translates as "75% of our health care dollars, or $1.5 trillion, can be saved by living well."

I appreciate the efforts to streamline medical care, insure the uninsured and promote electronic medical records to improve efficiency and save dollars. But that savings will not equal the $1.5 trillion that we have the power to save by making wise decisions.