Ketogenic Diets: Fat-Filled Lies Won’t Make You Slim (or a Better Athlete)

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How do you turn your body into a fat burning machine, run faster than Usain Bolt, recover from exercise immediately and wake up each day bursting with energy? According to some people, the ketogenic diet is your answer (learn the basics of this diet here). This high-fat, moderate protein diet that is practically void of carbohydrates forces your body to use fat for energy. LeBron James supposedly tried it and offensive lineman decided to give it a shot after an ex-NFL center and O-line coach LeCharles Bentley recommended it. However, the offensive lineman and LeBron weren’t actually following a ketogenic diet. Though these athletes didn’t really know what they were following (no worries LeCharles, I’m sure your nutrition advice is on par with me coaching the O-line), people who actually follow it swear by it. Could this be an unconventional path to weight loss and better health? Unfortunately, the ketogenic diet craze has been fattened with misinformation.

Here is what I am covering in this post:

  • Eat Fat, Lose Fat? Does the ketogenic diet make you lose weight?
  • How does this diet impact muscle?
  • The ketogenic diet and athletic performance.
  • The issue with ketogenic research studies.

I am not covering “training low” or low carbohydrate  / non-ketogenic diets in this article.

Eat Fat, Lose Fat?

During the first several days on a ketogenic diet your weight will take a nosedive. Carbohydrate is stored in the form of glycogen in liver and muscle. Each gram of carbohydrate is stored with 3 – 4 grams of water. Decrease your carbohydrate intake, use glycogen and you’ll lose water weight very quickly. Weight loss, even if from water, can motivate people driven by the number on the scale. Given that adherence is the number one predictor of weight loss when on a diet, we can’t discount psychological effect of the number on the scale going down.

What happens if you stay on the diet? A group of NIH researchers admitted seventeen overweight or obese men to a metabolic ward and placed them on a high carbohydrate baseline diet for four weeks followed by four weeks on an isocaloric ketogenic diet (this diet contained the same amount of calories as the high carbohydrate baseline diet). The men lost weight and body fat on both diets. The ketogenic diet did not lead to greater fat loss as compared to the high carbohydrate diet and in fact body fat loss slowed during the ketogenic diet and subjects lost muscle (1). Time to chuck the “carbohydrates make you fat” books in the recycling bin.

What about other studies showing ketogenic diets help athletes lose body fat and maintain performance? These studies were not actually using a ketogenic diet protocol but instead were high fat, high protein, low carbohydrate diets. Also, none of the studies measured if the study subjects were actually in nutritional ketosis (2, 3, 4).  See the section on The Issue with Ketogenic Research Studies for more information on this topic.

Ketogenic diet and weight

Regardless of the studies indicating the ketogenic diet will not lead to greater weight loss as compared to a diet composed of the same amount of calories, some may lose weight because they will end up cutting down on their favorite foods. Fewer food choices often means fewer calories consumed.

Muscle Up with the Ketogenic Diet?

The ketogenic diet isn’t high enough in protein for maximal muscle gains. Using the lower end of fat intake on a classic ketogenic diet (80% of calories), one could consume 15% of calories from protein (112 grams) on a 3,000-calorie diet. Protein requirements are at least 1.2 – 1.8 grams of protein per kilogram bodyweight (or 0.55 – 0.82 grams per lb. bodyweight) per day if training and eating a diet with enough calories to maintain weight. Protein needs go up if you are cutting calories to spare the breakdown of muscle tissue when dieting. On this diet, 112 grams of protein equals just under 1.3 grams of protein per kg bodyweight for a 200 lb. person and even less for anyone who weighs more.

In addition to inadequate protein intake, “the ketogenic diet reduces many of the signaling molecules involved in muscle hypertrophy (growth),” states Dr. Antonio Paoli, M.D., B.Sc., Associate Professor and Vice Dean of the School of Human Movement Sciences, University of Padova. Without getting too technical, even with sufficient calorie intake, the ketogenic diet suppresses the IGF-1 / AKT / mTOR pathway (5). Using ketones for energy slows muscle breakdown. However it doesn’t stop this process (5).

The Ketogenic Diet and Athletic Performance

Once fully adapted to a ketogenic diet, athletes can supposedly rely on a seemingly endless supply of body fat for energy. No need for carbohydrate gels, beans, gummies and sports drinks every 15-30 minutes during long runs, rides or triathlons to sustain energy levels. Fewer calories consumed may make it easier for some people to stay within their total daily calorie needs (though if you are training that much staying within your calorie requirements shouldn’t be difficult).

Trading carbs for fat seems like a huge benefit for athletes, particularly endurance athletes who train and compete for several hours at a time (6). In addition to utilizing body fat, fat actually produces more energy (ATP) (5). However, fat is a slow source of fuel (see graphic below), the human body cannot access it quickly enough to sustain high-intensity exercise and therefore, this diet is really only (potentially) applicable to ultra-runners and triathletes competing at a relatively moderate to slow pace.

In a ketogenic diet study examining athletic endurance, researchers had subjects cycle at a snails pace (equivalent to a heart rate of about 120 beats per minute for anyone 20-30 years old or 115 for a 40 year old) until they became exhausted before and after 4-weeks on a ketogenic diet. There were no differences in the amount of time they were able to cycle before getting tired prior to or after the four-week ketogenic diet (7). In studies examining high fat diets (not ketogenic and ketones weren’t measured) and endurance performance, study subjects relied on more fat as opposed to carbohydrate during low intensity exercise, yet there was no clear performance advantage on the higher fat diet (8). A recently published study examined 20 elite ultra-marathoners and Ironman distance triathletes. Some were habitually consuming a traditional high carbohydrate diet while the other group was following a ketogenic diet (slightly adjusted macronutrient ratios yet they were in ketosis as measured by blood ketone levels). As expected, those following a higher fat diet used a greater percentage of fat for energy while the higher carbohydrate diet group used more carbohydrate for energy during a 180 minute submaximal running test (I’d call that leisure running intensity). There was no difference in calories burned over the course of the run. Both groups had the same level of perceived exertion and there was no test to determine performance differences between groups (9).

If there’s no performance benefit and we know carbohydrates work, why follow this diet? If your primary goal is weight loss, it doesn’t matter if you use more fat than carbohydrate while exercising (SN: can we please stop talking about the fat burning zone) as long as you’re burning more total calories over the course of the day. Plus, in the interest of (if you are not an ultra endurance athlete) jack up the intensity and burn as many calories in a short period of time as possible. Unfortunately, a ketogenic diet won’t help you do that – when relying on fat for fuel, the intensity of your exercise will drop – the body simply can’t access fat (a slow source of energy) quickly enough to sustain high-intensity exercise. Instead, carbohydrates are necessary for high intensity activity.
ketogenic diet and sports

The Issue with Ketogenic Research Studies

Here’s the issue with many ketogenic research studies and media reports based on them: in most cases, the study subjects were not actually following a ketogenic diet – they were following a higher fat, high-protein low carbohydrate diet (10, 11, 12). Each person’s carbohydrate and protein limits needed to stay in ketosis vary and therefore, measuring ketones through blood or urine is the only definitive way to determine if you are in ketosis. Complicating matters more, low carbohydrate diets (including ketogenic diets) lead to a substantial drop in carbohydrate content, and associated water stored with it, in muscle. This change overestimates the drop in lean body mass as measured by DEXA.

ketogenic and low carbohydrate diets

There are no modifications, higher protein intakes or “on again, off again” (where you go on it one day and off it the next) to this diet. You must be in a state of nutritional ketosis or you will need to decrease carbohydrate and protein intake even further to get into nutritional ketosis and rely on ketones for energy.

Is There Any Benefit?

Ketogenic diets help decrease incidence and severity of seizures in epileptic patients (this is what the diet is intended for). Also, ketogenic diets may be beneficial when implemented soon after a traumatic brain injury (including concussion) (13). In addition, scientists are examining if this diet is beneficial for diseases that affect the brain such as Alzheimer’s.

If you want to lose weight, the ketogenic diet is not superior to a reduced calorie diet. Also, unless you are an ultra endurance athlete who just loves dietary fat, hates eating at social occasions and can put up with the potential side effects from this diet it isn’t for you.
Now where is the O-line? I’ve got some coaching to do…

References

1 Hall KD, Chen KY, Guo J, Lam YY, Leibel RL, Mayer LE, Reitman ML, Rosenbaum M, Smith SR, Walsh BT, Ravussin E. Energy expenditure and body composition changes after an isocaloric ketogenic diet in overweight and obese men. Am J Clin Nutr. 2016 Jul 6. [Epub ahead of print]

2 Zajac A, Poprzecki S, Maszczyk A, Czuba M, Michalczyk M, Zydek G. The effects of a ketogenic diet on exercise metabolism and physical performance in off-road cyclists. Nutrients 2014;6(7):2493-508.

3 Rhyu HS, Cho SY. The effect of weight loss by ketogenic diet on the body composition, performance-related physical fitness factors and cytokines of Taekwondo athletes. J Exerc Rehabil 2014;10(5):326-31.

4 Paoli A, Grimaldi K, D’Agostino D et al. Ketogenic diet does not affect strength performance in elite artistic gymnasts. JISSN 2012;9:34.

5 Paoli A, Bianco A, Grimaldi KA. The ketogenic diet and sport: a possible marriage? Ex Sports Sci Reviews 2015.

6 Volek J, Noakes T, Phinney SD. Rethinking fat as a fuel for endurance exercise. Eur J Sport Sci 2014;2:1-8.

7 Phinney SD, Bistrian BR, Evans WJ, Gervino E, Blackburn GL. The human metabolic response to chronic ketosis without caloric restriction: preservation of submaximal exercise capability with reduced carbohydrate oxidation. Metabolism 1983;32(8):769-76.

8 Burke LM, Kiens B. “Fat adaptation” for athletic performance: the nail in the coffin? J Appl Physiol 2006;100(1):7-8.

9 Volek J, Freidenreich DJ, Saenz C, Kunces LJ, Creighton BC, Bartley JM, Davitt pm, Munoz CX, Anderson JM, Maresh CM, Lee EC, Schuenke MD, Aerni G, Kraemer WJ, Phinney SD. Metabolic characteristics of keto-adapted ultra-endurance runners. Metab Clin Exp 2016;65(3):100-110.

10 Tinsley GM, Willoughby DS. Fat-Free mass changes during ketogenic diets and the potential role of resistance training. Int J Sport Nutr Exerc Metab. 2015 Aug 12. [Epub ahead of print]2 Rouillier MA, Riel D, Brazeau AS, St. Pierre DH, Karelis AD. Effect of an Acute High Carbohydrate Diet on Body Composition Using DXA in Young Men. Ann Nutr Metab 2015;66:233-236

11  Paoli A. The ketogenic diet and sport: a possible marriage? Ex Sci Sports Sciences Rev 2015;43(3):153-62.

12  Johnstone AM, Horgan GW, Murison SD, Bremner DM, Lobley GE. Effects of a high-protein ketogenic diet on hunger, appetite, and weight loss in obese men feeding ad libitum. Am Society Clin Nutr 2008;87(1):44-55.

13 Nutrition and Traumatic Brain Injury: Improving Acute and Subacute Health Outcomes in Military Personnel (2011). The National Academies Press, Institute of Medicine. Washington DC. 2011 http://www.nap.edu/read/13121/chapter/15

 

Full Fat or Low Fat Dairy?

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If you are totally against low-fat dairy, it’s time to take a closer look at the research. After listening to this dairy debate and watching the finger pointing, I started searching through the literature for an answer to this question “does dairy fat increase LDL cholesterol and risk for cardiovascular disease?” Then I came to my senses. No one eats dairy fat. Unless you’re a food scientist, you aren’t separating the fat from milk or full-fat yogurt and eating it or adding it as an ingredient to your recipes. However, we do eat cheese and yogurt and drink milk. The array of compounds in each of these foods influences how they affect your cholesterol and risk for heart disease. So, I revised the question to: “how does full fat cheese, yogurt and milk impact cholesterol and risk for heart disease?”

Here’s what I’ll cover in this article:

  • Why people are up in arms about saturated fat – saying it is either good or bad;
  • How does full fat cheese, yogurt and milk impact cholesterol;
  • What should you do with this information?

Dairy Fat isn’t the Only Factor

The research on dairy generally follows the research on saturated fat: the replacement strategy matters. For instance, it isn’t a good idea to take cheese out of your diet and replace it with a highly refined carbohydrate (not a good move for blood fats). Butter isn’t better than liquid oil. Butter raises LDL cholesterol. Some research suggests dairy fat might raise the large, less artery clogging LDL cholesterol compared to small dense LDL. However, “less artery clogging” does not mean “not artery clogging” and this area of the science needs more work before we can draw firm conclusions. Also, there are a few differences based on the type of food (milk, cheese, yogurt, butter); aged cheese reigns.

dairy and cheddar cheese

-> Aged cheese does not raise LDL as much as butter (accounting for total fat in each). In fact, several studies show aged cheese appears to have a “relatively minor” impact on LDL cholesterol or no impact at all. This could be due to the calcium content, which leads to the excretion of some fat or, fermentation may have an effect. Aged cheese stands out in the research.

-> Yogurt appears to have less of a cholesterol raising effect than expected. However this research is inconsistent possibly due to differences in the type of bacteria in the yogurt (aka probiotics). I recommend choosing yogurt with “live and active cultures.”

– > Milk – when consuming the same amount of fat from whole milk or butter, both raise LDL to the same extent. Milk contributes substantially less total fat per amount consumed compared to full fat yogurt and butter. Cross-sectional studies suggest milk consumption doesn’t raise coronary artery disease risk, however, this may reflect lower total fat intake from milk compared to butter.

-> Cottage cheese –  this incredible food is oftentimes forgotten yet an excellent addition to your diet. I couldn’t find any studies on cottage cheese, however, the highest fat cottage cheese I could find  (4% milk fat) contained 5 g total fat per serving so we can expect the impact cottage cheese may have a lower impact compared to whole milk.

What Should You Do with this Information?

If your LDL is high, choose skim, 1% or low fat milk. Opt for a good quality yogurt with naturally occurring probiotics. As far as cheese goes – I’d take out all of the other offending foods and work on other aspects of heart health before ditching the cheese (unless your LDL is very high) and cottage cheese. However, always follow the dietary advice of your registered dietitian since there are many variables that should be taken into consideration.

What about the trans fats in dairy? They are good for you right? No. In large amounts, the trans fats in dairy have the same impact as those found in partially hydrogenated oil (not good for cholesterol, cardiovascular disease risk etc.). However, we don’t eat dairy trans fats in significant quantities (they make up very tiny amounts of dairy fat and beef fat).

Take Home Points

In general, dairy foods help lower blood pressure plus there is emerging evidence about the positive role dairy foods may play in metabolic syndrome. What about dairy fat? Consider the whole food and your diet overall so you can make the right choices based on your personal risk factors for cardiovascular disease. Also, keep in mind there are many factors that influence cardiovascular disease pathology, some of which are unrelated to cholesterol.

References

Tholstrup T, Hoy CE, Andersen LN, Christensen RD, Sandstrom B. Does fat in milk, butter and cheese affect blood lipids and cholesterol differently? J Am Coll Nutr 2004;23:169–76.

Hjerpsted J, Leedo E, Tholstrup T. Cheese intake in large amounts lowers LDL-cholesterol concentrations compared with butter intake of equal fat content. Am J Clin Nutr 2011;94:1479–84.

Biong AS, Muller H, Seljeflot I, Veierod MB, Pedersen JI. A comparison of the effects of cheese and butter on serum lipids, haemostatic variables and homocysteine. Br J Nutr 2004;92:791–7.

Nestel P. Effects of Dairy Fats within Different Foods on Plasma Lipids. J Am Coll Clin Nutr 2008, 27(6): 735S–740S.

Thorning TK et al. Diets with high-fat cheese, high-fat meat, or carbohydrate on cardiovascular risk markers in overweight postmenopausal women: a randomized crossover trial. Am J Clin Nutr 2015.

Labonté MÈ et al. Dairy product consumption has no impact on biomarkers of inflammation among men and women with low-grade systemic inflammation. J Nutr 2014;144(11):1760-7.

Sjogren P et al. Milk-derived fatty acids are associated with a more favorable LDL particle size distribution in healthy men. J Nutr 2004;134(7):1729-35.

Hodson L, Skeaff CM, Chisholm WA. The effect of replacing dietary saturated fat with polyunsaturated or monounsaturated fat on plasma lipids in free-living young adults. Eur J Clin Nutr 2001; 55(10):908-15

Soerensen KV et al. Effect of dairy calcium from cheese and milk on fecal fat excretion, blood lipids, and appetite in young men. Am J Clin Nutr 2014;99(5):984-91.

Grebe A, Latz E. Cholesterol crystals and inflammation. Curr Rheumatol Rep 2013;15(3):313.

 

 

Is Saturated Fat Good for You?

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Though largely driven by misinterpretation of the science and cherry-picked population studies, the “Butter is Back” movement comes with very persuasive sound bites followed by arrogant punctuation marks. No wonder so many people hopped on board the bandwagon while looking back, pointing fingers and shouting “health professionals have been misleading us for decades!” Yet the flawed reasoning behind the pro-saturated fat movement comes with a hefty price tag – you could be making food choices that, over time, will increase your risk for cardiovascular disease and type 2 diabetes.

Here’s what I’ll cover in this article:

  • Why is there so much confusion about saturated fat?;
  • The science behind saturated fats, cardiovascular disease (diseases of the heart & blood vessels) and type 2 diabetes;
  • Best food choices for heart health.

Why is there so Much Confusion about Saturated Fat?

There are a few reasons for the confusion about saturated fat (fat that is solid at room temperature such as butter, shortening, coconut oil and the fat on meat) and misinterpretation of the science. First off, some people group all saturated fatty acids (saturated fatty acids make up saturated fat) together as a team. However, there are several types of saturated fatty acids. Some raise LDL cholesterol (the kind that contributes to clogged arteries and is a risk factor for cardiovascular disease) as well as HDL cholesterol (“good” cholesterol, the kind that removes bad cholesterol; SN: drugs that increase HDL do not lower risk of heart disease so there is some considerable debate regarding the role of HDL), others don’t raise LDL cholesterol and some we aren’t quite sure about. Secondly, using population-based studies alone to draw conclusions about saturated fat intake and heart disease is misguided.  These studies are not designed to determine cause and effect (that’s the job of well-designed clinical trials) plus, there are inherent issues with the methods used in many of these studies.  Nutrition research is not easy, especially in humans living their life (those not in a metabolic ward where all factors are controlled and measured including diet and physical activity).

Lastly, some research studies (and the media) take the results way out of context. So, here’s the lowdown based on sound science:

The Science Behind Saturated Fat, Cardiovascular Disease and Type 2 Diabetes

  • There is no dietary requirement for saturated fat. Your body can make all of the saturated fatty acids it needs.
  • Foods high in saturated fat typically increase total, HDL and LDL cholesterol. However, the impact dietary saturated fat has on increasing LDL-cholesterol (the kind that contributes to clogged arteries and an inflammatory cascade in arteries) may depend on the amount of polyunsaturated fat (PUFAs) in your diet (as well as the type of saturated fatty acids consumed).
  • In general, replacing saturated fat with polyunsaturated fat (and monounsaturated fat though there is less evidence for monounsaturated fat) reduces LDL and total cholesterol, both risk factors for cardiovascular disease.
  • saturated fat and cholesterolOverweight, obesity and insulin resistance may reduce the beneficial effects (lowered LDL cholesterol) generally noticed from a reduction in saturated fat intake. *If obese or overweight, losing excess body fat (regardless of the type of diet used to lose the weight) has powerful effects on lowering risk for cardiovascular disease, some cancers, and type II diabetes.
  • Food contains a complex mixture of compounds that may affect cholesterol and cardiovascular disease risk (it is not just the fat). The food “matrix” matters.
  • Many factors impact how a food affects cholesterol and blood lipids (fats) including fats eaten at the same time, overall diet, and carbohydrate intake (and type of carbohydrates consumed – high fiber vs. foods high in added sugar with few other nutrients).
  • There are individual, genetic differences in response to saturated fat intake – your cholesterol might shoot up after eating a diet containing a diet high in the type of saturated fatty acids that raise LDL cholesterol and I might be able to get away with this diet without a problem (blame your genetics or consider it an opportunity to open your taste buds to foods containing less saturated fat; particularly the kind that is artery clogging).
  • Certain saturated fatty acids, or a diet high in saturated fat, may increase risk for type 2 diabetes.

Best Choices for Heart Health

If you are overweight, focus on losing excess body fat. Even small amounts of fat loss will improve health and risk factors for cardiovascular disease. If you have high total and LDL cholesterol, swap foods high in saturated fat for foods high in polyunsaturated fat (liquid oils, nuts, seeds, olives, avocados). Minimize your intake of foods high in added sugars and refined, white flour, carbohydrates. Instead, choose higher fiber carbohydrates as often as possible.

Don’t get sucked into the media headlines written by journalists who could sell ice to an eskimo. Butter isn’t back (for good health anyway). The bulk of your fat intake should still come from foods that are higher in polyunsaturated and monounsaturated fats. However, food is a complex matrix of compounds and therefore, some foods higher in saturated fat may have little to no impact on cholesterol and therefore fit into your diet while contributing to your vitamin and mineral needs and providing plant-based compounds important for good health.

References

Tholstrup T, Hoy CE, Andersen LN, Christensen RD, Sandstrom B. Does fat in milk, butter and cheese affect blood lipids and cholesterol differently? J Am Coll Nutr 2004;23:169–76.

Nestel P. Effects of Dairy Fats within Different Foods on Plasma Lipids. J Am Coll Clin Nutr 2008, 27(6): 735S–740S.

Hodson L, Skeaff CM, Chisholm WA. The effect of replacing dietary saturated fat with polyunsaturated or monounsaturated fat on plasma lipids in free-living young adults. Eur J Clin Nutr 2001; 55(10):908-15

Soerensen KV et al. Effect of dairy calcium from cheese and milk on fecal fat excretion, blood lipids, and appetite in young men. Am J Clin Nutr 2014;99(5):984-91.

 

The Truth about Detox Diets

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Detox Diets and Cleanses

Detox diets promise to clean up the mess left behind from daily life so you feel better, more energetic and lose excess body fat. Consider them the Merry Maids for your body. They come with an army of equipment and compounds to attack years of buildup from environmental toxins, pesticides, allergens, waste, and inflammatory substances. This “sewage sludge” is stuck to your gut, interfering with digestion, leaving you bloated, tired, fat and with joints and muscles that feel like they are on fire.

In theory this sounds great. But there’s one glaring issue. The human body doesn’t need to “detox” because it comes equipped with organs designed to remove waste products. Plus, many detox diets are simply very low calorie plans with added laxatives and diuretics (because instant, yet temporary, weight loss might fool you into believing the outrageous claims on detox and cleansing products). Instead of wasting your money, take the top 3 good points about many of these diets and incorporate them into your overall nutrition plan:

Drink More Water

There are a few studies showing that individuals who are obese can lose weight by drinking 2 glasses of water before each meal. Plus, many people don’t get enough water or total fluids each day anyway and dehydration can make you feel sluggish and grouchy. So, grab it from the tap or if it’s more convenient, fill up your stainless steal water bottles and carry them with you at all times.

Eat More Fruits and Vegetables

The average American is falling short on fruit and vegetable intake. According to the National Cancer Institute, people with diets rich in plant foods, such as fruits and vegetables, have a lower risk of getting some types of cancer as well as diabetes, heart disease and high blood pressure. Produce generally has fewer calories than many other foods making it a great addition to a weight loss diet.

Get Friendly with Bacteria

Many detox plans include unfiltered apple cider vinegar – the kind that has a cloudy appearance – is full of probiotics. Probiotics are friendly (beneficial) bacteria – the kind that live in your gut and have a number of important functions in your body. Improving your gut bacteria may support immune functioning, improve the health of your intestinal tract, increase your body’s absorption of certain nutrients and alleviate constipation. Apple cider vinegar is acidic so I don’t recommend drinking it straight. Instead, dilute it in a big glass of water or another beverage. Other great sources of probiotics include kefir, yogurt (check the container for “live and active cultures”), miso soup, tempeh, sauerkraut, kimchi.

Add 2 glasses of water before each meal, load up on vegetables and fruits and make an effort to consume probiotic-rich food daily and you will reap the rewards of better nutrition without wasting money on detox diets and cleanses.

References:
Parvez J et al. J Appl Microbio 2006;100(6):1171-1185.
Parretti HM et al. Obesity 2015, 23(8):1785-1791.
Dennis EA et al. Obesity 2010;18(2):300-307.

 

Tackling Concussions Head-On: How Nutrition Can Improve Outcomes

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football

I sat on the floor hunched over and crying. My elbows were raised – close to my eyes as my arms hugged my head, hands clenched at the base of my neck. My brain felt like a percussion instrument shaking inside my skull. As the pounding grew more intense the pain became unbearable. I had a concussion, my second in two years, which earned me a night in the ER.

Concussions are common in sports and recreation. Though considered a mild type of traumatic brain injury because they are usually not life-threatening, all concussions should be taken seriously. A single blow to the head can result in short-term loss of brain functioning or long-term changes in thinking, language, emotions and sensations including taste, touch and smell (1). Repeated concussions can be very dangerous and may lead to permanent changes in brain functioning or in extreme cases, death (2). Though widely recognized in football players, concussions happen in all sports – even in everyday activities – and they are occurring at younger ages. Athletes who have had one concussion have a greater risk (2 – 5.8 times higher) of experiencing another concussion (3). Multiple blows to the head could lead to chronic traumatic encephalopathy (CTE), a progressive neurodegenerative disease associated with poor memory, changes in personality, behavior, speech and gait (4). Posthumous examination of some former NFL players in addition to a few college football players who committed suicide revealed CTE. In March 2016, the NFL acknowledged the link between traumatic brain injury and CTE. The movie ‘Concussion,’ set for release in late December, 2015 highlights concussions in former NFL players though the league has gone to great lengths to make today’s game safer.

Decreasing the Damaging Effects from Concussions

Anyone who experiences a blow to their head or body (a forceful blow to the body can cause the brain to shake inside the skull) should be immediately examined by a physician with experience in the evaluation and management of concussions. Though the person may say they feel fine and can continue with regular activities, symptoms of concussion do not always appear immediately and may instead be delayed for several hours. Continuing to play or perform mental tasks like studying can increase severity or symptoms and cause complications including the possibility of developing permanent brain damage.

Symptoms of Concussion may include:

  • Confusion
  • Headache
  • Vision changes
  • Memory loss
  • Difficulty with coordination, clumsiness or stumbling
  • Dizziness
  • Irritability
  • Personality changes
  • Slurred speech
  • Delayed response to questions
  • Nausea or vomiting
  • Sensitivity to light and noise
  • Problems sleeping
  • Seizures
  • Loss of consciousness

In addition to the symptoms that occur soon after a concussion, some people experience Post-Concussion Syndrome (PCS) days or weeks later. PCS can cause many of the same symptoms experienced after a concussion as well as trouble concentrating, apathy, depression and anxiety. Symptoms may last a few weeks. If you suspect PCS, have the patient evaluated by a psychiatrist (5).

Nutrition Management

In addition to rest, following a graduated return-to-play and school protocol, and other steps you should take to treat concussions, emerging research suggests nutrition may play an important role. Certain nutrients seem to help reduce some of the damaging effects from concussions:

Protein: 1 – 1.5 grams of protein per kg body weight per day is recommended along with sufficient calories to reduce the inflammatory response (6).

EPA and DHA Omega-3 Fatty Acids: EPA and DHA, omega-3 fatty acids found in fish and algae, increase fluidity of cell membranes, reduce inflammation and enhance cerebral blood flow (which is reduced for up to a month or longer in athletes that recover slowly) (7). Cell membranes are like gateways allowing substances to enter cells or blocking their entry. When cell membranes are more fluid (and therefore less rigid), they perform better, opening the gate for nutrients to come in. DHA, in particular, makes up 97% of the omega-3 fatty acids in the brain and is essential for normal brain functioning (8). Several animal studies show EPA and DHA supplementation before or after a traumatic brain injury helps limit structural damage and decline in brain functioning (9, 10, 11, 12, 13, 14, 15).

There is no clear consensus regarding optimal intake of EPA and DHA prior to or after a concussion. Given that many Americans do not eat enough fish and an estimated 75% of American diets are too low in EPA and DHA, it makes sense to start by meeting the general guidelines for recommended intake of EPA and DHA by:

  • Consuming fatty fish varieties that contain high levels of omega-3s, including salmon, tuna, mackerel and herring at least twice per week;
  • Take an omega-3 supplement providing EPA+DHA daily (be sure to look for high-quality fish oil, algal oil or krill oil supplements in your local grocery or health store);
  • Eat and drink DHA omega-3-fortified foods and beverages, including milk, 100% juice, and yogurt.

Research has yet to identify exactly how much EPA + DHA may be helpful after a concussion. However, according to the Food & Drug Administration (FDA), doses of EPA + DHA up to 3 grams per day are considered safe.

Zinc is necessary for optimal brain functioning while a deficiency of this mineral may compound oxidative damage from concussions. Though zinc supplementation may be an effective treatment modality, additional research needs to determine if zinc supplementation is safe after concussions. The Upper Limit for zinc is 40 mg per day.

Animal and human studies suggest creatine helps prevent secondary brain injury after traumatic brain injury. However, animal studies show long-term creatine intake may decrease its beneficial effects on the brain after injury. Future research needs to better elucidate the relationship between creatine pre-TBI and creatine post-TBI and outcomes.

Other potential approaches to addressing concussions through nutrition include ketogenic diets which are very high-fat, minimal-carbohydrate diets that are effectively used to decrease both the incidence and severity of seizures in children with epilepsy. Ketogenic diets provide an alternate energy source for brain functioning – ketones derived from the breakdown of fat. This may be important since available glucose, the primary energy source for brain functioning, may be decreased after a concussion.

Current research supports the integration of a dietitian into the team of health professionals treating concussions. Though nutrition interventions are considered preliminary at this time, consideration should be given to nutrition strategies that may reduce long-term effects while causing no further harm.

Disclosure: I am a GOED/Omega-3 Science Advisory Council Member supporting the research behind omega-3 EPA and DHA for a healthy brain, heart and eyes.

References

1 What are the Potential Effects of TBI? Injury Prevention & Control: Traumatic Brain Injury. CDC. http://www.cdc.gov/TraumaticBrainInjury/outcomes.html

Concussion (Traumatic Brain Injury). Pubmed Health.

3  Harmon KG, et al. American Medical Society for Sports Medicine position statement: concussion in sport. Br J Sports Med 2013;47:15-26. http://www.amssm.org/Content/pdf%20files/2012_ConcussionPositionStmt.pdf

4  McKee AC, Cantu RC, Nowinski CJ, Hedley-Whyte T, Gavett BE, Budson AE, Santini VE, Lee H, Kubilus CA, Stern RA. Chronic Traumatic Encephalopathy in Athletes: Progressive Tauopathy following Repetitive Head Injury. J Neuropathol Exp Neurol 2009; 68(7): 709–735.

Post-Concussion Syndrome. PubMed Health 

6 Nutrition and Traumatic Brain Injury: Improving Acute and Subacute Health Outcomes in Military Personnel. The National Academies Press. 2011. http://www.nap.edu/catalog/13121/nutrition-and-traumatic-brain-injury-improving-acute-and-subacute-health

7  Meier TB, Bellgowan PS, Singh R, Kuplicki R, Polanski DW, Mayer AR. Recovery of cerebral blood flow following sports-related concussion. JAMA Neurol 2015;72(5):530-8.

8 Salem N Jr, Litman B, Kim HY, Gawrisch K. Mechanisms of action of docosahexaenoic acid in the nervous system. Lipids 2001; 36(9):945-59.

9 Mills JD, Hadley K, Bailes J. Dietary supplementation with the omega-3 fatty acid docosahexaenoic acid in traumatic brain injury? Neurosurgery 2011;68:474–81

10 Wu A, Ying Z, Gomez-Pinilla F. Omega-3 fatty acid supplementation restores mechanisms that maintain brain homeostasis in traumatic brain injury. J Neurotrauma 2007;24:1587–95

11 Wu A, Ying Z, Gomez-Pinilla F. Dietary omega-3 fatty acids normalize BDNF levels, reduce oxidative damage, and counteract learning disability after traumatic brain injury in rats. J Neurotrauma 2004;21:1457–67

12 Wang T, Van K, Gavitt B, Grayson J, Lu T, Lyeth B, Pichakron K. Effect of fish oil supplementation in a rat model of multiple mild traumatic brain injuries. Restor Neurol Neurosci 2013;31:647–59

13 Mills JD, Bailes J, Sedney C, Hutchins H, Sears B. Omega-3 fatty acid supplementation and reduction of traumatic axonal injury in a rodent head injury model. J Neurosurg 2011;114:77–84

14 Wu A, Ying Z, Gomez-Pinilla F. The salutary effects of DHA dietary supplementation on cognition, neuroplasticity, and membrane homeostasis after brain trauma. J Neurotrauma 2011;28:2113–22

15  Wu A, Ying Z, Gomez-Pinilla F. Exercise facilitates the action of dietary DHA on functional recovery after brain trauma. Neuroscience 2013;248:655–63

Should Endurance Athletes Switch to a Low Carbohydrate Diet?

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High carbohydrate pasta with tomatoes
Pasta – a typical meal for endurance athletes.

Should endurance athletes trade in their high carbohydrate gels, gummies, and pasta for fatty steak and butter?  A recent study found elite ultra-marathoners and iron distance triathletes on a low carbohydrate diet  burned significantly more fat while running than  their counterparts on a typical higher carbohydrate diet. There was no difference in the level of glycogen depletion between groups after a 3-hour run.

Why Carbohydrates Matter

For several decades endurance athletes have relied on a carbohydrate rich diet to fuel their training and performance. Carbohydrates are the primary source of energy used during activity. They’re also a fast fuel – your body can use gels, gummies and sports drinks very quickly while also accessing the carbohydrates stored in your muscle when your energy needs outpace how quickly you can squirt more gel in your mouth. Regular intake of carbohydrates during  prolonged activity provides an important source of energy for working muscles and helps spare dipping into your reserves in muscle tissue (in the form of glycogen). Once glycogen levels start getting too low, your performance will subsequently decline.

If carbohydrates are important for performance why would anyone go on a low carbohydrate diet?

The longer you run, bike, swim or exercise in general, the more carbohydrates you need to keep up with energy demands. There are three main reasons athletes (particularly ultra endurance athletes) want an approach that doesn’t require carbohydrate during long bouts of exercise are:

  1. Your taste buds get tired –  Eat any food over and over again and you will get sick of it eventually. Now imagine running 30, 50 or 100 miles and eating a gel every 30 minutes. The consistency, sweetness and flavors will make your taste buds revolt.
  2. Your stomach might get upset. Exercise + eating (even seemingly easy to digest carbohydrate products) can cause stomach upset in some people.
  3. You are trying to lose body fat. If you are exercising for long periods of time it may sound counterintuitive to consume 30-60 grams of carbohydrate (or 90+ depending on the type of carbohydrate, your stomach’s tolerance and the type of exercise you’re doing) each hour while training.

If any of these apply to you, a diet that doesn’t force your body to rely on carbohydrates for energy may sound very appealing.

The Study & the Low Carb Diets for Endurance Athletes

The body has amazing ability to adapt to changes in the macronutrient composition of your diet.  In other words, if you eat more fat you’ll burn more fat. If you are adapted to a low carbohydrate diet, you will rely on your body fat for fuel and will not need to consume gels, gummies or any other carbohydrates while running, biking or swimming. However, there is an adaptation period.  It takes time for your body to switch over from relying on carbohydrate to fuel activity to using primarily fat. The study subjects included elite male ultra-endurance athletes who habitually consumed a high carbohydrate diet (> 55% of calories from carbohydrate) and a separate group of those habitually consuming  a low carbohydrate diet (< 20% of calories from carbohydrate and > 60% from fat though the average was 70% from fat) for at least 9 months. Both groups slept, reported to the lab fasted and then drank a 343 calorie shake (the shake contained 4.3 grams of carbohydrate for the low carbohydrate group and  42.7 g of carbohydrate for the high carbohydrate group). Ninety minutes later they ran on a treadmill.

Results

As expected, the low carbohydrate high-fat diet group used a lot more fat when jogging then the high carbohydrate group (88% of calories from fat vs. 56% in the high carbohydrate group). They also used more fat at a higher intensity than the high carbohydrate diet group. They were able to use fat at a good rate – fat is typically a slow source of energy but the rate of fat use in this fat-adapted group was pretty compatible to the typical rate (but not the maximum) at which an athlete can use carbohydrates. Glycogen levels at rest, glycogen breakdown during exercise and re-synthesis after exercise was the same in both groups. * There was no difference in the amount of calories burned between the two groups.

Is This Diet Right for You?

Ultra endurance athletes can adapt to and train on a higher fat diet.  They can also do this without glycogen depletion – glycogen depletion can come with other negative consequences including potential suppression of immune system functioning.  At this time, we do not know if regularly following a lower carbohydrate diet = better endurance performance.

What you need to consider:

  • According to this study you will not burn more calories during exercise when on a low carbohydrate, high fat diet. ** See note below.
  • Your body needs at least 1 month to adjust. The first week will probably suck (you’ll feel terrible and have low energy).
  • You might not improve performance (we don’t know).
  • Can you stay on a low carbohydrate, high fat diet? Do milkshakes made of  heavy cream, olive oil, walnut oil and whey protein sound yummy? Is this diet practical for your lifestyle? If you answer yes to those 2 questions,  then it might be worth a shot. Work with a nutrition expert to ensure you are getting all of the fiber, vitamins, and minerals you need for performance and health.

* Keep in mind the results from this study are specific to endurance athletes.

** If weight loss is your goal, it makes no difference if you burn more fat during exercise if you aren’t burning more total calories in that exercise session. The only caveat here is if a low carb diet means you consume few to no calories during exercise. In this scenario, a low-carb diet may help you consume fewer total daily calories.

Which Fat is Best for Heart Health?

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Butter

If you are more confused than ever about dietary fats, you’re not alone. Can a high fat diet help you lose body fat? Which fat is best for heart health – butter, coconut oil or vegetable oil?

What is Cholesterol & Why is it Essential?
Cholesterol is an essential component of all cell membranes and a precursor to hormones, vitamin D and bile acids (needed for the digestion of fat). It is so important that your body regulates cholesterol balance to ensure your cells receive a continuous supply of cholesterol.

How does High LDL Contribute to Cardiovascular Disease?

Though cholesterol is critical for life, low density lipoprotein cholesterol, LDL cholesterol, is considered a risk factor for heart disease because excess LDL can lead to an increase in plaque buildup in your arteries. Think of this process like a garden hose with gunk stuck in it. The gunk interferes with water flowing through the hose. If too much debris gets in there, no water will flow through.  Likewise, plaque in your arteries will decrease the amount of blood that moves through your arteries at one time and a complete blockage could lead to a heart attack or stroke.  Now, this is a simplistic view, especially considering LDL isn’t just one particle but instead, several that contain different amounts of cholesterol. Some research suggests that smaller, more dense LDL particles are more artery clogging. However, in addition to particle size, total number of LDL particles and oxidation of LDL contribute to the disease process.

As LDL particles travel through the bloodstream, excess LDL particles can stick to artery walls (particularly walls that are damaged due to smoking, high blood pressure and other insults). Trapped LDL becomes oxidized and sets off an inflammatory cascade resulting in the development of plaque (gunk) stuck to arteries – atherosclerosis.

Coronary Artery Disease

How Can I Lower my LDL Cholesterol?

Cholesterol in food has little effect on your blood cholesterol.

Years ago we were told to stay away from shrimp, eggs and other high cholesterol foods. Yet this advice wasn’t based on sound science – cholesterol in food has little effect on your blood cholesterol levels. So there is no need to take these nutrient-rich foods out of your diet. Shrimp is loaded with protein, and is a good source of iron plus it contains just 80 calories per serving. Eggs are also packed with nutrition – the whites are an excellent source of protein and the yellow color you see in the yolk is from antioxidants – plant compounds that protect plants from disease and protect your body from the damaging effects of free radicals, compounds that are essential but can cause damage as well.

Coconut Oil, Butter and Other Solid Fats are Not the Best Options

Man-made trans fats (partially hydrogenated oils) are the worst kind of fat you can eat. However, they should, finally, be making their way out of our food supply over the next few years. High levels of *saturated fat, the kind that is solid at room temperature like butter, increases HDL (the “good” cholesterol but not a target of therapy – doctors don’t focus on HDL levels because increasing HDL does not lower heart disease risk) and LDL cholesterol in the blood. In controlled diet experiments where saturated fat is replaced with polyunsaturated fat rich vegetable oils, risk of heart disease is reduced. Replacing saturated fat with monounsaturated fat, the kind found in olive oil, also lowers LDL but not to the extent that polyunsaturated fat does.

Coconut oil is popular and calorie for calorie it might be better for weight management than other fats. However, coconut oil raises our total, good and bad cholesterol levels. And therefore, it is not the best option for heart health.

Excess Carbohydrate Intake can Increase LDL

Overconsumption of carbohydrate-rich foods can also increase VLDL cholesterol (very low density lipoprotein). Foods with added sugars, in particular, are potent stimulators of VLDL production when the energy (calories) aren’t needed right away for energy or increasing glycogen stores (stored carbohydrate in your liver and muscle).

Best Fats for Your Heart

Nuts, seeds, avocados, olives and liquid oils are your bets for heart health. Oils with more polyunsaturated fat have a greater impact on LDL cholesterol than those rich in monounsaturated fat. Make sure you are choosing the right oil for the right cooking application. Many oils can’t stand high heat and they break down, damaging the structure (and function) of the oil.

Fatty Acids in Oils

Conclusion

Many factors contribute to high blood cholesterol levels, including genetics, overweight/obesity, inactivity, smoking, diabetes and age, making cholesterol management a multifactorial issue. Saturated fat increases LDL cholesterol but, as I’ll say over and over, we are all different and, people vary in their response to dietary saturated fat due to intrinsic differences in fat metabolism as well as other factors including obesity, insulin resistance and high triglycerides.

Replace fats that raise cholesterol with liquid oils, nuts, seeds, avocados, and olives. Consider your overall diet as well. Eat a plant-based diet including vegetables (non-starchy veggies as well as beans, lentils and peas), fruits, nuts, seeds and whole grains (oats, barley etc.). Consume fatty fish ( salmon, mackerel, herring, halibut, sardines etc.) at least two times per week. Limit your intake of foods with added sugars and refined starches as well as your alcohol consumption. 

* There are differences in specific saturated fatty acids and their effects on blood cholesterol. Therefore, some foods high in saturated fat do not raise LDL cholesterol. Also, oils have a different array of vitamins (primarily vitamin E) and plant-based compounds that may be beneficial for heart health.

Fatty acids composition of oils taken from the USDA Nutrient Database.

Get off the Dieting Cycle and Lose Weight for Good

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Are you a yo-yo dieter, stuck in a seemingly endless cycle of losing weight and gaining it back again?  If so, you aren’t alone. I’ve met many people who say they are experts at losing weight but they just can’t seem to keep it off. So I’m going to share my top tips for taking the weight off and keeping it off for good – the very same steps I shared with Fox 5 viewers this week. But first, let’s talk about dieting….

All diets have one thing in common – they help you cut calories so you lose weight. And when you lose weight you’ll lose both fat and muscle. However, when you go on a juice fast or low calorie diet that doesn’t contain enough protein (and most don’t), you will lose a considerable amount of muscle tissue. And that’s a huge problem because muscle burns more calories at rest than fat (just a few but it adds up over time) so when you lose muscle you’ll need fewer calories each day just to maintain your weight. Over time, repeated bouts of protein poor diets could decrease your calorie needs even further, making it increasingly difficult to keep the weight off without dieting. And therefore, if you want to go on a diet there are two things you need to do:

  • Feed the Muscle to Keep the Muscle. You’ll need even more protein when you cut your calories to help ensure you are preserving muscle while losing fat. A good rule of thumb, start by consuming at least 25 – 30 grams of protein per meal. At breakfast consider mixing a packet of protein powder in 6 oz. of milk or higher protein soy milk, eggs (2 large egg whites + 2 large eggs = about 28 grams of protein and just 200 calories), plain Greek yogurt + 2 Tbsp. of peanut butter or eat foods that aren’t traditionally associated with breakfast (last night’s leftovers). At lunch and dinner, you’ll need about the serving size of a female’s palm worth of chicken, turkey or fish or mix and match proteins by adding tofu, tempeh, beans, bean pastas, nuts and seeds.
  • Have an exit strategy – a plan for transitioning off your diet. Don’t stay on a very low calorie diet for an extended period of time. You will decrease your metabolism – the amount of calories you need each day. If you are cutting calories for more than just a few months, take a day or two each week and don’t drop your calories – eat what you need to if you wanted to maintain your weight (bump up your calorie intake).

Now let’s focus on fitness. There are two mistakes I see people making over and over – spending hours on cardio machines and sitting around the rest of the day. If you spend some quality time burning calories on the treadmill, bike or other cardio machine, its time to trade in some of your aerobic sessions for resistance training – lifting weights, power yoga, or anything that requires you to exercise a muscle or muscle group against external resistance. As we age we lose muscle. Losing muscle means your body will require fewer calories each day (again, this means you’ll need to eat less over time just to stay at the same body weight). Maintaining muscle will be easier to maintain your weight. If you already lift weights, change your routine to continue to make gains. Incorporate different exercises, lift until failure – until you can’t squeeze out any more reps (you do not necessarily have to use a heavy weight but instead can lift lighter weights using more reps till failure) or try doing compound sets – two or more exercises in a row targeting the same muscle group without rest.

Last but certainly not least, get moving and stay moving. Simply going to the gym isn’t enough to help you maintain your weight or counteract the health hazards of sitting most of the day. Sitting for long periods of time slows blood circulation, increases your risk of developing blood clots, leads to tight muscles and, sedentary behavior is tied to an increased risk of heart disease. So get moving and stay moving all day long. Ignore modern conveniences including escalators, elevators, the drive-through, pay at the gas pump and more. All of these rob you of the chance to move your body, burn calories and improve your health. If you need a little motivation, buy a fitness tracker. I prefer the ones that show you how many steps you’ve walked on the device versus those that require you to log on to your computer or smart phone just to see how active you are.

Pre-Workout and Post-Workout Meal Ideas

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You’ve seen them. The people who faithfully go to the gym day after day and spend quality time on the cardio equipment and in the weight room. Yet their bodies never seem to make any visible changes. They are training. But they aren’t training smart with a plan that is specifically designed to meet their goals, lifestyle and current state of conditioning. A plan that helps them progress and not just maintain. But, even with the best training program, a person’s progress will be limited if they don’t eat a diet that provides the energy they need while also facilitating training adaptations and helping improve recovery. And though eating well means choosing nutrient-dense foods 90 – 95% of the time, the most important meals for an athlete are pre- and post-workout:

Pre-workout:

In order to sustain your energy levels through your workouts, your body needs food. If you have just 2 hours before you hit the gym, track or field, opt for a lighter snack. Four hours beforehand, opt for meal that is higher in carbohydrate, contains some protein for staying power and is low in fiber and fat (both slow digestion and who wants their stomach busy digesting food when they are about to run sprints?). Lastly, don’t try something new before workouts that may make you a little queasy. For example, spicy food can give you heartburn and greasy food may make you sick to your stomach. Think familiar and easy-to-digest.

Half a cantaloupe with cottage cheese

Snack examples:

  • Cottage cheese and fruit
  • Banana spread lightly with almond butter or peanut butter
  • Yogurt
  • Granola bar
  • Pancakes or waffles

Post-workout:

The main purpose of eating after you workout is to turn a catabolic environment into an anabolic one. In other words – your post-workout meal will facilitate the processes underlying muscle growth, re-hydrate, help curb excess inflammation and restore muscle glycogen. In addition to improving recovery, your post workout meal will help you make training gains.

Post-workout meal ideas:

  • Protein pancakes (Simply pancake mix with added protein powder.)
  • Protein shake
  • Low fat chocolate milk (you’ll need more protein than this if you are lifting weights)
  • Bagel, bread or pita with melted cheese
  • Tunafish or turkey sandwich

Eat so you can train well, don’t hit the gym or run a few extra miles as an excuse to eat more food that doesn’t fit in your training program.

Written by: Rachel Rosenthal & Marie Spano

Sleep – a Critical Component to Sports Performance

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Years ago hitting the gym and throwing around some steel was considered the most critical aspect of sports performance training. However, in more recent years a more comprehensive model of performance has developed based on decades of research on nutrition, sleep, psychology and several other critical components of an athlete’s training regimen. As a sports dietitian with an Exercise Science degree and CSCS, I focus mainly on food & supplements though I sometimes discuss training. But lately I’ve found that I’m also talking about the importance of sleep with my athletes. This topic comes up once I realize they are too tired to plan and prepare their food. Days of sleep deprivation also leads to poor food choices. If an athlete is tired and hungry, caring about good nutrition will be thrown on the back burner while finding food fast becomes the main priority. Quick and cheap turns into a double cheeseburger with fries. And, aside from failing to implement all aspects of their nutrition plan, skimping on sleep also interferes with an athlete’s training and performance. Studies show chronic sleep deprivation leads to:

  • decreased sub max and maximal lifts in the weight room
  • delayed visual and auditory reaction time
  • slowed decision making
  • impaired motor functioning
  • reduced endurance
  • increased fatigue, decreased energy
  • exercise feels harder than it normally is (increased rating of perceived exertion)
  • less efficient glucose metabolism
  • reduced leptin and increased ghrelin
  • decreased growth hormone secretion
  • increased risk of injury
  • elevated cortisol levels which may interfere with tissue repair and growth
  • impaired insulin sensitivity in fat cells = more fat in your bloodstream (over time this may contribute to obesity, Type 2 diabetes and cardiovascular disease).
  • decreased production of leptin, a protein produced in fat cells that tells your brain you have enough energy (fat) stored away so there’s no need to gorge yourself on food. Low leptin = you get hungry and eat.

According to research presented by Cheri Mah,a Stanford University sleep expert:

  • one night without sleep is the equivalent of being legally intoxicated
  • 4-5 hours of sleep for 4 days = 24 hours awake = legally intoxicated
  • 4-5 hours for 10 days = 48 hours awake

Mah’s 8 Strategies to Improve Sleep and Recovery:

  1. Adults should aim for 7-9 hours of sleep. Athletes need 8-10 hours of sleep (and getting in bed at 10 and waking up at 6 doesn’t mean you are getting a full 8 hours since it takes a while to actually fall asleep).
  2. Establish a consistent sleep schedule.
  3. Sleep like a caveman. It should be dark, quiet and cool. All electronics should be off and silent (or program in numbers for emergency calls only and set your phone for these emergency calls). All small lights on electronics should be covered up as these can interfere with sound sleep.
  4. Adults should only sleep when tired. If unable to sleep after 45 minutes, it is wise to get up and do a non-stimulating activity for 15 minutes (reading) then return to bed.
  5. Establish a 20-30 min routine before bed that includes non-stimulating activity. No computers, TVs or video games.
  6. Refrain from alcohol which impairs your sleep quality and fragments sleep preventing the deep sleep that is so critical for recovery (this is why people complain of being exhausted the day after they drink).
  7. Avoid heavy food, any foods that could cause heartburn, spicy foods etc.
  8. Take 20-30 minute power naps and pre-game naps (unless these interfere with the ability to sleep at night). Mah has found this improved alertness by 54%, improved performance by 34%

Matthew Edlund, M.D. takes it even further with the notion of morning people performing better during the day, night owls performing better at night, and both having to combat jet lag (each 1 hour time zone change takes a person 1 day to adjust; this is why West Coast teams beat East Coast NFL teams on Monday Nights). Check out Edlund’s article here. Sleep affects several aspects of training and performance (as well as body weight). Any athlete who wants to feel their best and reach peak performance should take a comprehensive approach to training which includes sound sleep habits.