Download Athletes who eat well, play well

Athletes who eat well, play well
Nourish your sports medicine practice with supplements
By Mitchell Ghen, DO, PhD
No one questions that athletic performance is related to eating and good micronutrient consumption. A
quick review of the past 100 years nutritionally would support this statement. The seasoned athlete to
the weekend warrior should all be interested in any combination of nutraceutical, food and/or
hormones that will give them an edge in winning in their respective sports.
Certainly, there is also no question that sports and exercise nutrition represents a multibillion-dollar
industry. The only question is: Will you be part of its ever-increasing growth? Will the chiropractic
physician trained in vitamin, mineral and amino acid repletion be the primary leading group of
healthcare practitioners or will it be relegated to a new breed of alternative physicians, exercise
physiologists or nutritional experts?
If you choose to journey toward becoming a leading healthcare provider — especially in sports
medicine — take the first seven steps, outlined here:
Seven steps to success
1 Become fluent in the language of sports nutrition. Reading a single article or book or attending
one seminar just won’t do! Here are some ways to learn the language:
• Subscribe to journals, attend formal college classes, and/or hire a coach who is an expert in
developing your knowledge base in the nutritional art.
• Ask for help from vitamin and mineral manufacturers who often have scientific officers willing to
support and educate you.
• Develop a relationship with a neighborhood compounding pharmacist; they are an excellent resource
for you to understand much of the chemistry you will prescribe.
• Use the Internet often with “eyes wide open.” Many sites are not scientifically based and their only
interest is in selling you something.
• Recognize the importance of the expression, “one shoe does not fit all”. Your knowledge base must
allow you to develop a program for your patient that is as individualized as their thumbprint.
2 Assess the individual. Delivering an optimal plan for your patient requires understanding the
specific needs of that person. To make a good evaluation of the athlete’s micronutritional needs:
• Ask specialty questions about the individual’s digestion and absorption.
• Order simple functional testing. At minimum, get a comprehensive metabolic profile and CBC blood
testing, as well as a urinalysis. These tests give a clearer picture about kidney and liver function as
well as electrolyte and sugar balance.
• Consider a gastrogram evaluation. This evaluation provides information on the sterilization of food,
slowing the passage of food for absorption, B12 absorption and — very important — its role in protein
digestion.
Having the patient swallow a one-time-use capsule, which is actually a radio transmitter, does the
gastrogram. The transmitter sends a signal to a receiver that records pH (acid/base) in the esophagus
and stomach as well as giving information about gastric transit time.
• Consider a stool analysis to evaluate absorption, digestion, inflammation, beneficial bacteria and
pathologic organisms (bacteria/fungal).
3 Supplement. Exercise is good, but athletes often exercise to the extreme, and this has an effect on
their nutritional needs. An adequate discussion of sports-nutrition micronutrient supplementation
would require several articles. However, several cutting edge supplements are worth noting briefly:
• L-carnitine. This is an amino acid that improves fat utilization, triglyceride deposition and memory
augmentation. A dose of 3000mg a day is required to have a benefit.
• L-carnisine (not to be confused with L-carnitine). Carnosine is a combination of two amino acids,
alanine and histidine, found in all muscle cells. The aging process decreases the quantity of carnosine
within the muscles. Severe exercise affects the output of alanine. Supplementing with L-carnisine
enhances performance and endurance.
• DHEA (dehydroepiandrosterone). This is often known as the “Mother Hormone” and is also one of
the most abundant hormones in the body. It is a precursor to the sex hormones and is intimately
involved with maintaining a healthy immune state.
Lay journals often suggest using this hormone (along with others like androstenedione) in doses that
are extremely high. The use of DHEA should be done with caution, particularly in men with prostrate
enlargement or cancer and women with breast and other reproductive tumors and cancers.
It is best to check a thorough history and record salivary DHEA levels. Continue to monitor these
levels throughout the year and adjust your treatment accordingly.
• L-glutamine. This amino acid is found in abundance in bone, lung and gut and plays an important
role in immune support for the athlete. Exercise in moderation (different for each individual) may
improve the immune response by escalating the number and function of natural killer cells.
The converse is also true. Overdoing a workout may lead to low levels of L-glutamine and subsequent
increase in the opportunity for host infection. Consider 2000-5000 mg in divided doses before and
after your patient’s workout. This may help prevent exercise-induced immune dysfunction.
• Additional considerations. Controversial use of the amino acid creatinine may improve muscular
performance parameters. However, high doses may be kidney-toxic and studies do not support its
expense and use.
Supplementation of essential fatty acids, omega-3 and gamma linoleic acid will help control
inflammation and may improve muscle recovery.
B-Complex is a major component in carbohydrate metabolism and protein catabolism. Other watersoluble vitamins, like Vitamin C, also help to maintain adequate immune response.
Since exercise increases free radical propagation, your athletic patients should consider Vitamin E, full
spectrum and natural, selenium, and CoQ10 augmentation. I like the use of alpha-lipoic acid, which is
both water and lipid soluble to recharge Vitamins C & E and intracellular Glutathione.
Don’t neglect mineral levels: Be sure to replete zinc, potassium and magne-sium (the intracellular
minerals), along with copper, chromium, manganese, vanadium, rubidium and germanium.
4 Customize the diet. The key to prescribing the perfect diet is the understanding that there is no
perfect diet. High carbohydrate, low carbohydrate, high fat, low fat, high protein, low protein, blood
type, etc. all have their unique limitations.
Some studies suggest that high carbohydrate consumption allows for increased performance better
than high fat. High proteins in branched chain amino acids (leucine, isoleucine, valine) are useful in
exercise since they are oxidized in muscle and not in the liver.
Basically, well-balanced and individualized diet plans are indicated. Extreme intakes of any of the
macronutients (carbohydrates, proteins, fats) are not shown to have any obvious advantages.
5 Rehydrate. Pay careful attention to pure water consumption. And remember that all waters are not
created equal. Fluids saturated with simple sugars do not count for water rehydration.
Rehydration is a very important part of all good sports nutrition plans. Forty to 70 percent of the
human body is water and most water is utilized at the cellular level.
Exercise, hot conditions and temperature all require increased water consumption. To calculate the
amount of sedentary water intake, take one half of the patient’s weight in pounds and change that
number to ounces. For example a 150 lb person should drink 75 ounces of water a day to replace the
water compartment’s loss from urine, feces, skin and inspired air.
6 Use biofeedback. If you have not been trained in any mind-body discipline now may be a good
time to begin. Performance is significantly improved in individuals who can coordinate their mind and
body simultaneously.
Use of biofeedback, guided imagery, neurolinguistic programming and meditation can allow the person
to reestablish a physiology that will bring mind, body and actions into focus.
7 Get started! Your current patients, as well as your new patients, will appreciate your interest in
their optimal health through exercises/sports.
Introduce these services by placing brochures in the office waiting area and exam rooms. The
brochures should emphasize your desire to help patients reach their optimal spots and exercise levels.
Then, assign a CA or nurse to intro-duce your patients to your new services and initiate initial
evaluations, testing, treatment, supplements and follow-ups.
This part of your practice will most likely be on a “cash-basis” only. Patients will pay for your expertise
and will certainly appreciate the quick improve-ment that you will provide for them.
Dr. Mitchell Ghen pioneered the first-of-its kind alternative/ complementary wing within a medical
hospital at Miami Heart Institute. He is author of two textbooks for doctors, has written dozens of
articles, is a TV/radio personality and lectures nationally and internationally.