Spinal Fitness Crossfit Chiropractic Team: CrossFit is a fitness regimen developed by Greg Glassman several years ago. Composed of Increased work capacity across broad time and modal domains. He then created a program specifically designed to improve fitness and health. It is promoted as both a physical exercise philosophy and also as a competitive fitness sport, CrossFit workouts incorporate elements from high-intensity interval training, Olympic weight lifting, plyometrics, powerlifting, gymnastics, girevoy sport, calisthenics, strongman, and other exercises.
It is practiced by members of over 13,000 affiliated gyms, roughly half of which are located in the United States, and by individuals who complete daily workouts known as “WODs” or “workouts of the day.” It is constantly being varied with functional movements performed at a high intensity. All workouts are based on functional movements. These movements reflect gymnastics, weightlifting, running, rowing, etc.
Moving larges loads over long distances, which makes this type of workout ideal for maximizing the amount of work done in the shortest time. Intensity is an essential component for results. This is measurable as work divided by time and or power. The more work you do in less time, or the higher the power output, the more intense the effort. Trainers constantly vary the approaches when training which leads to dramatic gains in fitness.
Nutrition�Abstract: A number of factors contribute to success in sport, and diet is a key component. An athlete�s dietary requirements depend on several aspects, including the sport, the athlete�s goals, the environment, and practical issues. The importance of individualized dietary advice has been increasingly recognized, including day-to-day dietary advice and specific advice before, during, and after training and/or competition. Athletes use a range of dietary strategies to improve performance, with maximizing glycogen stores a key strategy for many. Carbohydrate intake during exercise maintains high levels of carbohydrate oxidation, prevents hypoglycemia, and has a positive effect on the central nervous system. Recent research has focused on athletes training with low carbohydrate availability to enhance metabolic adaptations, but whether this leads to an improvement in performance is unclear. The benefits of protein intake throughout the day following exercise are now well recognized. Athletes should aim to maintain adequate levels of hydration, and they should minimize fluid losses during exercise to no more than 2% of their body weight. Supplement use is widespread in athletes, with recent interest in the beneficial effects of nitrate, beta-alanine, and vitamin D on performance. However, an unregulated supplement industry and inadvertent contamination of supplements with banned substances increases the risk of a positive doping result. Although the availability of nutrition information for athletes varies, athletes will bene t from the advice of a registered dietician or nutritionist.
Introduction To The Importance & Influence Of Nutrition On Exercise
Nutrition is increasingly recognized as a key component of optimal sporting performance, with both the science and practice of sports nutrition developing rapidly.1 Recent studies have found that a planned scientific nutritional strategy (consisting of fluid, carbohydrate, sodium, and caffeine) compared with a self-chosen nutritional strategy helped non-elite runners complete a marathon run faster2 and trained cyclists complete a time trial faster.3 Whereas training has the greatest potential to increase performance, it has been estimated that consumption of a carbohydrate�electrolyte drink or relatively low doses of caffeine may improve a 40 km cycling time trial performance by 32�42 and 55�84 seconds, respectively.4
Evidence supports a range of dietary strategies in enhancing sports performance. It is likely that combining several strategies will be of greater bene t than one strategy in isolation.5 Dietary strategies to enhance performance include optimizing intakes of macronutrients, micronutrients, and fluids, including their composition and spacing throughout the day. The importance of individualized or personalized dietary advice�is becoming increasingly recognized,6 with dietary strategies varying according to the individual athlete�s sport, personal goals, and practicalities (eg, food preferences). �Athlete� includes individuals competing in a range of sport types, such as strength and power (eg, weight-lifting), team (eg, football), and endurance (eg, marathon running). The use of dietary supplements can enhance performance, provided these are used appropriately. This manuscript provides an overview of dietary strategies used by athletes, the efficacy of these strategies, availability of nutrition information to athletes, and risks associated with dietary supplement intake.
Review Of Diet Strategies Employed By Athletes
Maximizing Muscle Glycogen Stores Prior To Exercise
Carbohydrate loading aims to maximize an athlete�s muscle glycogen stores prior to endurance exercise lasting longer than 90 minutes. Benefits include delayed onset of fatigue (approximately 20%) and improvement in performance of 2%�3%.7 Initial protocols involved a depletion phase (3 days of intense training and low carbohydrate intake) followed by a loading phase (3 days of reduced training and high carbo- hydrate intake).8,9 Further research showed muscle glycogen concentrations could be enhanced to a similar level without the glycogen-depletion phase,10 and more recently, that 24 hours may be sufficient to maximize glycogen stores.11,12 Current recommendations suggest that for sustained or intermittent exercise longer than 90 minutes, athletes should consume 10�12 g of carbohydrate per kg of body mass (BM) per day in the 36�48 hours prior to exercise.13
There appears to be no advantage to increasing pre- exercise muscle glycogen content for moderate-intensity cycling or running of 60�90 minutes, as signi cant levels of glycogen remain in the muscle following exercise.7 For exercise shorter than 90 minutes, 7�12 g of carbohydrate/kg of BM should be consumed during the 24 hours preceding.13 Some14,15 but not all16 studies have shown enhanced performance of intermittent high-intensity exercise of 60�90 minutes with carbohydrate loading.
Carbohydrate eaten in the hours prior to exercise (com- pared with an overnight fast) has been shown to increase muscle glycogen stores and carbohydrate oxidation,17 extend cycle time to exhaustion,5 and improve exercise performance.5,18 Specific recommendations for exercise of longer than 60 minutes include 1�4 g of carbohydrate/kg of BM in the 1�4 hours prior.13 Most studies have not found improvements in performance from consuming low glycemic�index (GI) foods prior to exercise.19 Any metabolic or performance effects from low GI foods appear to be attenuated when carbohydrate is consumed during exercise.20,21
Carbohydrate Intake During The Event
Carbohydrate ingestion has been shown to improve performance in events lasting approximately 1 hour.6 A growing body of evidence also demonstrates beneficial effects of a carbohydrate mouth rinse on performance.22 It is thought that receptors in the oral cavity signal to the central nervous system to positively modify motor output.23
In longer events, carbohydrate improves performance primarily by preventing hypoglycemia and maintaining high levels of carbohydrate oxidation.6 The rate of exogenous carbohydrate oxidation is limited by the small intestine�s ability to absorb carbohydrate.6 Glucose is absorbed by the sodium- dependent transporter (SGLT1), which becomes saturated with an intake of approximately 1 g/minute. The simultaneous ingestion of fructose (absorbed via glucose transporter 5�[GLUT5]), enables oxidation rates of approximately 1.3 g/minute,24 with performance benefits apparent in the third hour of exercise.6 Recommendations reflect this, with 90 g of carbohydrate from multiple sources recommended for events longer than 2.5 hours, and 60 g of carbohydrate from either single or multiple sources recommended for exercise of 2�3 hours� duration (Table 1). For slower athletes exercising at a lower intensity,�carbohydrate requirements will be less due to lower carbohydrate oxidation.6 Daily training with high carbohydrate availability has been shown to increase exogenous carbohydrate oxidation rates.25
The �Train-Low, Compete-High� Approach
The �train-low, compete-high� concept is training with low carbohydrate availability to promote adaptations such as�enhanced activation of cell-signaling pathways, increased mitochondrial enzyme content and activity, enhanced lipid oxidation rates, and hence improved exercise capacity.26 However, there is no clear evidence that performance is improved with this approach.27 For example, when highly trained cyclists were separated into once-daily (train-high) or twice-daily (train-low) training sessions, increases in resting muscle glycogen content were seen in the low-carbohydrate- availability group, along with other selected training adaptations.28 However, performance in a 1-hour time trial after 3 weeks of training was no different between groups. Other research has produced similar results.29 Different strategies have been suggested (eg, training after an overnight fast, training twice per day, restricting carbohydrate during recovery),26 but further research is needed to establish optimal dietary periodization plans.27
Fat As A Fuel During Endurance Exercise
There has been a recent resurgence of interest in fat as a fuel, particularly for ultra endurance exercise. A high-carbohydrate strategy inhibits fat utilization during exercise,30 which may not be beneficial due to the abundance of energy stored in the body as fat. Creating an environment that optimizes fat oxidation potentially occurs when dietary carbohydrate is reduced to a level that promotes ketosis.31 However, this strategy may impair performance of high-intensity activity, by contributing to a reduction in pyruvate dehydrogenase activity and glycogenolysis. 32 The lack of performance benefits seen in studies investigating �high-fat� diets may be attributed to inadequate carbohydrate restriction and time for adaptation.31 Research into the performance effects of high fat diets continues.
Nutrition: Protein
While protein consumption prior to and during endurance and resistance exercise has been shown to enhance rates of muscle protein synthesis (MPS), a recent review found protein ingestion alongside carbohydrate during exercise does not improve time�trial performance when compared with the ingestion of adequate amounts of carbohydrate alone.33
Fluid And Electrolytes
The purpose of fluid consumption during exercise is primarily to maintain hydration and thermoregulation, thereby benefiting performance. Evidence is emerging on increased risk of oxidative stress with dehydration.34 Fluid consumption prior to exercise is recommended to ensure that the athlete is well-hydrated prior to commencing exercise.35 In addition,�carefully planned hyperhydration ( fluid overloading) prior to an event may reset fluid balance and increase fluid retention, and consequently improve heat tolerance.36 However, fluid overloading may increase the risk of hyponatremia 37 and impact negatively on performance due to feelings of fullness and the need to urinate.
Hydration requirements are closely linked to sweat loss, which is highly variable (0.5�2.0 L/hour) and dependent on type and duration of exercise, ambient temperature, and athletes� individual characteristics.35 Sodium losses linked to high temperature can be substantial, and in events of long duration or in hot temperatures, sodium must be replaced along with fluid to reduce risk of hyponatremia. 35
It has long been suggested that fluid losses greater than 2% of BM can impair performance,35 but there is controversy over the recommendation that athletes maintain BM by fluid ingestion throughout an event.37 Well-trained athletes who �drink to thirst� have been found to lose as much as 3.1% of BM with no impairment of performance in ultra-endurance events.38 Ambient temperature is important, and a review illustrated that exercise performance was preserved if loss was restricted to 1.8% and 3.2% of BM in hot and temperate conditions, respectively.39
Dietary Supplementation: Nitrates, Beta-Alanine & Vitamin D
Performance supplements shown to enhance performance include caffeine, beetroot juice, beta-alanine (BA), creatine, and bicarbonate.40 Comprehensive reviews on other supplements including caffeine, creatine, and bicarbonate can be found elsewhere.41 In recent years, research has focused on the role of nitrate, BA, and vitamin D and performance. Nitrate is most commonly provided as sodium nitrate or beetroot juice.42 Dietary nitrates are reduced (in mouth and stomach) to nitrites, and then to nitric oxide. During exercise, nitric oxide potentially influences skeletal muscle function through regulation of blood ow and glucose homeostasis, as well as mitochondrial respiration.43 During endurance exercise, nitrate supplementation has been shown to increase exercise efficiency (4%�5% reduction in VO at a steady attenuate oxidative stress.42 Similarly, a 4.2% improvement in performance was shown in a test designed to simulate a football game.44
BA is a precursor of carnosine, which is thought to have a number of performance-enhancing functions including the reduction of acidosis, regulation of calcium, and antioxidant properties.45 Supplementation with BA has been shown to�2�state; 0.9% improvement in time trials), reduce fatigue, and�augment intracellular carnosine concentration.45 A systematic review concluded that BA may increase power output and working capacity and decrease feelings of fatigue, but that there are still questions about safety. The authors suggest caution in the use of BA as an ergogenic aid.46
Vitamin D is essential for the maintenance of bone health and control of calcium homeostasis, but is also important for muscle strength,47,48 regulation of the immune system,49 and cardiovascular health.50 Thus inadequate vitamin D status has potential implications for the overall health of athletes and performance. A recent review found that the vitamin D status of most athletes reflects that of the population in their locality, with lower levels in winter, and athletes who train predominantly indoors are at greater risk of deficiency.51 There are no dietary vitamin D recommendations for athletes; however, for muscle function, bone health, and avoidance of respiratory infections, current evidence supports maintenance of serum 25-hydroxy vitamin D (circulating form) concentrations of 80�100 nmol/L.51
Diets Specific For Post Exercise
Recovery from a bout of exercise is integral to the athlete�s training regimen. Without adequate recovery of carbohydrate, protein, fluids, and electrolytes, beneficial adaptations and performance may be hampered.
Muscle Glycogen Synthesis
Consuming carbohydrates immediately post exercise to coincide with the initial rapid phase of glycogen synthesis has been used as a strategy to maximize rates of muscle glycogen synthesis. An early study found delaying feeding by 2 hours after glycogen-depleting cycling exercise reduced glycogen synthesis rates.52 However the importance of this early enhanced rate of glycogen synthesis has been questioned in the context of extended recovery periods with sufficient carbohydrate consumption. Enhancing the rate of glycogen synthesis with immediate carbohydrate consumption after exercise appears most relevant when the next exercise session is within 8 hours of the first.53,54 Feeding frequency is also irrelevant with extended recovery; by 24 hours post exercise, consumption of carbohydrate as four large meals or 16 small snacks had comparable effects on muscle glycogen storage.55
With less than 8 hours between exercise sessions, it is recommended that for maximal glycogen synthesis, 1.0�1.2 g/kg/hour is consumed for the first 4 hours, followed by resumption of daily carbohydrate requirements.13 Additional protein has been shown to enhance glycogen�synthesis rates when carbohydrate intake is suboptimal.56 The consumption of moderate to high GI foods post exercise is recommended;13 however, when either a high-GI or low-GI meal was consumed after glycogen-depleting exercise, no performance differences were seen in a 5 km cycling time trial 3 hours later.57
Muscle Protein Synthesis
An acute bout of intense endurance or resistance exercise can induce a transient increase in protein turnover, and, until feeding, protein balance remains negative. Protein consumption after exercise enhances MPS and net protein balance,58 predominantly by increasing mitochondrial protein fraction with endurance training, and myofibrillar protein fraction with resistance training.59
Only a few studies have investigated the effect of timing of protein intake post exercise. No significant difference in MPS was observed over 4 hours post exercise when a mixture of essential amino acids and sucrose was fed 1 hour versus 3 hours after resistance exercise.60 Conversely, when a protein and carbohydrate supplement was provided immediately versus 3 hours after cycling exercise, leg protein synthesis increased threefold over 3 hours.61 A meta-analysis found timed post exercise protein intake becomes less important with longer recovery periods and adequate protein intake,62 at least for resistance training.
Dose�response studies suggest approximately 20 g of high-quality protein is sufficient to maximize MPS at rest,63 following resistance,63,64 and after high-intensity aerobic exercise.65 Rate of MPS has been found to approximately triple 45�90 minutes after protein consumption at rest, and then return to baseline levels, even with continued availability of circulating essential amino acids (termed the �muscle full� effect).66 Since exercise-induced protein synthesis is elevated for 24�48 hours following resistance exercise67and 24�28 hours following high-intensity aerobic exercise,68 and feeding protein post exercise has an additive effect,58,64 then multiple feedings over the day post exercise might maximize muscle growth. In fact, feeding 20 g of whey protein every 3 hours was subsequently found to maximally stimulate muscle myofibrillar protein synthesis following resistance exercise.69,70
In resistance training, where post exercise intake of protein was balanced by protein intake later in the day, increased adaptation of muscle hypertrophy resulted in equivocal strength performance effects.71,72 Most studies have not found a subsequent bene t to aerobic performance with post exercise protein consumption.73,74 However, in two�well controlled studies in which post exercise protein intake was balanced by protein intake later in the day, improvements were seen in cycling time to exhaustion75 and in cycling sprint performance.76
Fluids And Electrolyte Balance
Fluid and electrolyte replacement after exercise can be achieved through resuming normal hydration practices. However, when euhydration is needed within 24 hours or substantial body weight has been lost (.5% of BM), a more structured response may be warranted to replace fluids and electrolytes.77
Availability Of Nutritional Information To Athletes At Varying Levels
The availability of nutrition information for athletes varies. Younger or recreational athletes are more likely to receive generalized nutritional information of poorer quality from individuals such as coaches.78 Elite athletes are more likely to have access to specialized sports-nutrition input from qualified professionals. A range of sports science and medicine support systems are in place in different countries to assist elite athletes,1 and nutrition is a key component of these services. Some countries have nutrition programs embedded within sports institutes (eg, Australia) or alternatively have National Olympic Committees that support nutrition programs (eg, United States of America).1 However, not all athletes at the elite level have access to sports-nutrition services. This may be due to financial constraints of the sport, geographical issues, and a lack of recognition of the value of a sports-nutrition service.78
Athletes eat several times per day, with snacks contributing to energy requirements.79 Dietary intake differs across sports, with endurance athletes more likely to achieve energy and carbohydrate requirements compared to athletes in weight-conscious sports.79 A review found daily intakes of carbohydrate were 7.6 g/kg and 5.7 g/kg of BM for male and female endurance athletes, respectively.80 Ten elite Kenyan runners met macronutrient recommendations but not guide- lines for fluid intake.81 A review of fluid strategies showed a wide variability of intake across sports, with several factors influencing intake, many outside the athlete�s control.82
Nutrition information may be delivered to athletes by a range of people (dietitians, nutritionists, medical practitioners, sports scientists, coaches, trainers) and from a variety of sources (nutrition education programs, sporting magazines, the media and Internet).83 Of concern is the provision of�nutrition advice from outside various professional�s scope of practice. For example, in Australia 88% of registered exercise professionals provided nutrition advice, despite many not having adequate nutrition training.84 A study of Canadian high-performance athletes from 34 sports found physicians ranked eighth and dietitians, 16th as choice of source of dietary supplement information.85
Risks Of Contravening The Doping Regulations
Supplement use is widespread in athletes.86,87 For example, 87.5% of elite athletes in Australia used dietary supplements88 and 87% of Canadian high-performance athletes took dietary supplements within the past 6 months85 (Table 2). It is difficult to compare studies due to differences in the criteria used to define dietary supplements, variations in assessing supplement intake, and disparities in the populations studied.85
Athletes take supplements for many reasons, including for proposed performance benefits, for prevention or treatment of a nutrient deficiency, for convenience, or due to fear of �missing out� by not taking a particular supplement.41
The potential benefits (eg, improved performance) of taking a dietary supplement must outweigh the risks.86,87 There are few permitted dietary supplements available that have an ergogenic effect.87,89 Dietary supplementation cannot compensate for poor food choices.87 Other concerns include lack of efficacy, safety issues (toxicity, medical concerns), negative nutrient interactions, unpleasant side effects, ethical issues, financial expense, and lack of quality control.41,86,87 Of major concern, is the consumption of prohibited substances by the World Anti-Doping Agency (WADA).
Inadequate regulation in the supplement industry (com- pounded by widespread Internet sales) makes it difficult for athletes to choose supplements wisely.41,86,87 In 2000�2001, a study of 634 different supplements from 13 countries found that 94 (14.8%) contained undeclared steroids, banned by WADA.90 Many contaminated supplements were routinely used by athletes (eg, vitamin and mineral supplements).86 Several studies have confirmed these findings. 41,86,89
A positive drug test in an athlete can occur with even a minute quantity of a banned substance.41,87 WADA maintains a �strict liability� policy, whereby every athlete is responsible for any substance found in their body regardless of how it got there.41,86,87,89 The World Anti-Doping Code (January 1, 2015) does recognize the issue of contaminated supplements.91 Whereas the code upholds the principle of strict liability, athletes may receive a lesser ban if they can��show �no significant fault� to demonstrate they did not intend to cheat. The updated code imposes longer bans on those who cheat intentionally, includes athlete support personnel (eg, coaches, medical staff), and has an increased focus on anti-doping education.91,99
In an effort to educate athletes about sports-supplement use, the Australian Institute of Sport�s sports-supplement program categorizes supplements according to evidence�of efficacy in performance and risk of doping outcome.40 Category A supplements have sound evidence for use and include sports foods, medical supplements, and performance supplements. Category D supplements should not be used by athletes, as they are banned or are at high risk for contamination. These include stimulants, pro-hormones and hormone boosters, growth hormone releasers, peptides, glycerol, and colostrum.40
Conclusion
Athletes are always looking for an edge to improve their performance, and there are a range of dietary strategies available. Nonetheless, dietary recommendations should be individualized for each athlete and their sport and provided by an appropriately qualified professional to ensure optimal performance. Dietary supplements should be used with caution and as part of an overall nutrition and performance plan.
Disclosure
The authors report no conflicts of interest in this work.
Kathryn L Beck1 Jasmine S Thomson2 Richard J Swift1 Pamela R von Hurst1
1School of Food and Nutrition, Massey institute of Food Science and Technology, College of Health, Massey University Albany, Auckland, 2School of Food and Nutrition, Massey institute of Food Science and Technology, College of Health, Massey University Manawatu, Palmerston North, New Zealand
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Allostasis: The process of achieving stability, or homeostasis, through physiological or behavioral change. This can be carried out by means of alteration in HPATG axis hormones, the autonomic nervous system, cytokines, or a number of other systems, and is generally adaptive in the short term. It is essential in order to maintain internal viability amid changing conditions.
Antecedents: Factors that predispose to acute or chronic illness. For a person who is ill, antecedents form the illness diathesis. From the perspective of prevention, they are risk factors. Examples of genetic antecedents include the breast cancer risk genes BRCA1 and BRCA2.
Apoptosis: Programmed cell death. As a normal part of growth and development, cells that are superfluous or that become damaged activate a cascade of intracellular processes leading to their own demise. In cancer cells, DNA damage may inactivate the apoptosis cascade, allowing mutated cells to survive and proliferate.
Biochemical individuality: Each individual has a unique physiological and biochemical composition, based upon the interactions of his or her individual genetic make-up with lifestyle and environment�i.e., the continuous exposure to inputs (diet, experiences, nutrients, beliefs, activity, toxins, medications, etc.) that influence our genes. It is this combination of factors that accounts for the endless variety of phenotypic responses seen every day by clinicians. The unique makeup of each individual requires personalized levels of nutrition and a lifestyle adapted to that individual�s needs in order to achieve optimal health. The consequences of not meeting the specific needs of the individual are expressed, over time, as degenerative disease.�
Bioidentical Hormone Therapy: Giving exogenous hormones that are identical in structure to the endogenous hormones.�
Biomarker: A substance used as an indicator of a biological state. Such characteristics are objectively measured and evaluated as indicators of normal biological processes, pathogenic processes, or pharmacologic responses to a therapeutic intervention. Cancer biomarkers include prostate specific antigen (PSA) and carcinoembryonic antigen (CEA).
Biotransformation: The chemical modification(s) of a compound made by an organism. Compounds modified in the body include, but are not limited to, nutrients, amino acids, toxins, heavy metals, and drugs. Biotransformation also renders nonpolar compounds polar so that they are excreted, not reabsorbed in renal tubules.
Cancer: A group of diseases characterized by uncontrolled growth and spread of abnormal cells, which, if not controlled, can result in death. Cancer is caused by both external factors (tobacco, infectious organisms, chemicals, and radiation) and internal factors (inherited mutations, hormones, immune conditions, and mutations that occur from metabolism), two or more of which may act together or in sequence to initiate or promote carcinogenesis. Ten or more years often pass between exposure to external factors and detectable cancer.
Chronic Care Model: Developed by Wagner and colleagues, the primary focus of this model is to include the essential elements of a healthcare system that encourage high-quality chronic disease care. Such elements include the community, the health system, self-management support, delivery system design, decision support and clinical information systems. It is a response to powerful evidence that patients with chronic conditions often do not obtain the care they need, and that the healthcare system is not currently structured to facilitate such care.�
Complementary and Alternative Medicine (CAM): A group of diverse medical and healthcare systems, practices, and products that are not presently considered to be part of conventional, mainstream medicine. The list of what is considered to be CAM changes frequently, as therapies demonstrated to be safe and effective are adopted by conventional practitioners, and as new approaches to health care emerge. Complementary medicine is used with conventional medicine, not as a substitute for it. Alternative medicine is used in place of conventional medicine. Functional medicine is neither complementary nor alternative medicine; it is an approach to medicine that focuses on identifying and ameliorating the underlying causes of disease; it can be used by all practitioners with a Western medical science background and is compatible with both conventional and CAM methods.�
Cytochromes P450 (CYP 450): A large and diverse group of enzymes, most of which function to catalyze the oxidation of organic substances. They are located either in the inner membrane of mitochondria or in the endoplasmic reticulum of cells ans play a critical role in the detoxification of endogenous and exogenous toxins. The substrates of CYP enzymes include metabolic intermediates such as lipids, steroidal hormones, and xenobiotic substances such as drugs.
DIGIN: A heuristic mnemonic for assessment of gastrointestinal dysfunction. Thorough assessment of the GI tract should include investigation of the following:
Digestion/Absorption � Problems with the digestive process including ingestion, chemical digestion, mechanical digestion, absorption, and/or assimilation
Intestinal Permeability � Permeability of the intestinal barrier: is the epithelium allowing in larger particles in a paracellular manner, making the gut barrier �leaky�?
Gut Microbiota/Dysbiosis � Changes in composition of the gut flora including balance and interaction of commensal species (See: Dysbiosis)
Inflammation/Immune � Inflammation and immune activity in the GI tract
Nervous System � Enteric nervous system function, which controls motility, blood flow, uptake of nutrients, secretion, and immunological and inflammatory processes in the gut.
Dysbiosis: A condition that occurs when the normal symbiosis between gut flora and the host is disturbed and organisms of low intrinsic virulence, which normally coexist peacefully with the host, may promote illness. It is distinct from gastrointestinal infection, in which a highly virulent organism gains access to the gastrointestinal tract and infects the host.�
Functional Medicine: A systems-based, science-driven approach to individualized medicine that addresses the underlying causes of disease, using a systems-oriented approach and engaging both patient and practitioner in a therapeutic partnership. It reflects a personalized lifestyle medicine approach and utilizes the Functional Medicine Matrix to organize the patient�s story and determine appropriate interventions for the prevention and treatment of chronic diseases.
Functional Medicine Matrix: The graphic representation of the functional medicine approach, displaying the seven organizing physiological systems, the patient�s known antecedents, triggers, and mediators, and the personalized lifestyle factors that promote health. Practitioners can use the matrix to help organize their thoughts and observations about the patient�s health and decide how to focus therapeutic and preventive strategies.
Cytokines: Immunoregulatory proteins (such as interleukin, tumor necrosis factor, and interferon). They may act locally or systemically and tend to have both immunomodulatory and other effects on cellular processes in the body. Cytokines have been used in the treatment of certain cancers.�
Genomics: The study of the whole genome of organisms, including interactions between loci and alleles within the genome. Research on single genes does not fall into the definition of genomics unless the aim of this functional information analysis is to elucidate the gene�s effect on the entire genome network. Genomics may also be defined as the study of all the genes of a cell, or tissue, at the DNA (genotype), mRNA (transcriptome), or protein (proteome) levels.�
GO-TO-IT: A heuristic mnemonic for the processes involved in the clinical practice of functional medicine:
Gather oneself and be mindful in preparing to see each patient; gather information through intake forms, questionnaires, the initial consultation, physical exam, and objective data. A detailed functional medicine history that is appropriate to age, gender, and nature of presenting problems is taken.
Organize the subjective and objective details from the patient�s story within the functional medicine paradigm. Position the patient�s presenting signs and symptoms, along with the details of the case history, on the timeline and Functional Medicine Matrix.
Tell the story back to the patient in your own words to ensure accuracy and understanding. The re-telling of the patient�s story is a dialogue about the case highlights�including the antecedents, triggers, and mediators identified in the history and correlating them to the timeline and matrix. The patient is asked to correct and amplify the story, engendering a context of true partnership.
Order and then prioritize the patient�s information:
Acknowledge patient�s goals
Address modifiable lifestyle factors
Sidney Baker�s too much/not enough model: what are the insufficiencies/excesses?
Identify clinical imbalances or disruptions in the organizing physiological systems of the matrix
Initiate further functional assessment and intervention based upon the above work:
Perform further assessment
Referral to adjunctive care:
Nutritional professionals
Lifestyle educators
Other healthcare providers
Specialists
Initiate therapy
Track assessments, note the effectiveness of the therapeutic approach, and identify clinical outcomes at each visit�in partnership with the patient.
Heuristic: A strategy used for problem solving, learning, and discovery that is experience-based, not algorithmic. When an exhaustive search is impractical, heuristic methods may be used to speed up the process of finding a satisfactory solution. A heuristic is sometimes referred to as a rule of thumb.
Homeostasis and Homeodynamics: The former term describes the tendency of living things to maintain physiological parameters within a narrow range usually considered normal in order to maintain optimal function. Under this definition, disease can be defined as a departure from the homeostatic state. The latter term describes the tendency of homeostatic set points to change throughout an organism�s lifespan, and thus describes how departures from a homeostatic norm can be adaptive (e.g., fever) or pathological, depending on the context.
Integrative Medicine: Medicine that combines treatments from conventional medicine and those from Complementary and Alternative Medicine (CAM) for which there is some high-quality evidence of safety and effectiveness. In a broader sense, it is healing-oriented medicine that takes into account the whole person (body, mind, and spirit), including all aspects of lifestyle, and makes use of all appropriate therapies, both conventional and alternative. The field is more than 10 years old and it is the only one of the emerging models to explicitly encompass the integration of therapeutics that, until recently, were the sole purview of complementary and alternative medicine. Note: functional medicine is different from integrative medicine because functional medicine emphasizes the evaluation of underlying causes of health and dysfunction and organizes assessment and treatment using the Functional Medicine Matrix, the timeline, and GOTOIT.
Lifestyle Medicine: The use of lifestyle interventions such as nutrition, physical activity, stress reduction, and rest to lower the risk for the approximately 70% of modern health problems that are lifestyle-related chronic diseases (such as obesity and type 2 diabetes), or for the treatment and management of disease if such conditions are already present. It is an essential component of the treatment of most chronic diseases and has been incorporated in many national disease management guidelines.
Long Latency Disease: Disease that becomes manifest at a time remote from the initial exposure to disease triggers, or that requires continued exposure to triggers and mediators over an extended period of time to manifest frank pathology. Examples include heart disease, cancer, and osteoporosis.�
Mediators: Intermediaries that contribute to the continued manifestations of disease. Mediators do not cause disease; instead, they underlie the host response to triggers. Examples include biochemical factors (e.g., cytokines and leukotrienes) as well as psychosocial ones (e.g., reinforcement for staying ill).�
Metabolomics (or metabonomics): �The study of metabolic responses to drugs, environmental changes and diseases. Metabonomics is an extension of genomics (concerned with DNA) and proteomics (concerned with proteins). Following on the heels of genomics and proteomics, metabonomics may lead to more efficient drug discovery and individualized patient treatment with drugs, among other things.� (From MedicineNet.com)�
Nutrigenomics (or nutritional genomics): The study of how different foods may interact with specific genes to increase the risk of common chronic diseases such as type 2 diabetes, obesity, heart disease, stroke, and certain cancers. It can also be described as the study of the influence of genetic variation on nutrition by correlating gene expression or single-nucleotide polymorphisms with a nutrient’s absorption, metabolism, elimination, or biological effects. Nutrigenomics also seeks to provide a molecular understanding of how common chemicals in the diet affect health by altering the expression of genes and the structure of an individual’s genome. The ultimate aim of nutrigenomics is to develop rational means to optimize nutrition for the patient�s genotype.�
Organ Reserve: The difference between the maximal function of a vital organ and the level of function required to maintain an individual�s daily life. In other words, it is the �reserve power� of a particular organ, above and beyond what is required in a healthy individual. It can also be thought of as the degrees of freedom available in the body organs to perform their functions and maintain health. Decline in the organ reserve occurs under stress, during sickness, and as we age.�
Organ System Diagnosis: In the allopathic medical model, it is common to give a collection of symptoms a name based on dysfunction in an organ system, then to cite the named disease as the cause of the symptoms the patient is experiencing. This bit of circular logic avoids any discussion of the systemic or underlying causes of dysfunction and also treats all people with �disease X� the same, despite the fact that two people with the same collection of symptoms may have completely different underlying physiological causes for the symptoms they display.�
Organizing Physiological Systems: To assist clinicians in understanding and applying the complexity of functional medicine, IFM has organized and adapted a set of seven interrelated biological systems that underlie all physiology. Imbalances in these systems or core clinical imbalances are the underlying cause of disease and dysfunction.
Defense and Repair (e.g., Immune, Inflammation, Infection/Microbiota)
Energy (e.g., Energy Regulation, Mitochondrial Function)
Biotransformation and Elimination (e.g., Toxicity, Detoxification)
Transport (e.g., Circulation, Lymphatic Flow)
Communication (e.g., Endocrine, Neurotransmitters, Immune messengers)
Structural Integrity (e.g., from Subcellular Membranes to Musculoskeletal Structure)�
Using this construct, it becomes much clearer that one disease/condition may have multiple causes (i.e., multiple clinical imbalances), just as one fundamental imbalance may be at the root of many seemingly disparate conditions.�
Oxidation-Reduction (also called Redox): Paired chemical reactions that occur in balance with each other within the body of a healthy individual. These reactions involve the transfer of electrons (or the distribution of electron sharing) and thus require both a donor and acceptor. When this physiological parameter is out of balance, a net accumulation of donors or acceptors can lead to deleterious cellular oxidation phenomena (lipid peroxidation, free radical formation).�
Oxidative Stress: Oxidative stress occurs when there is an imbalance between the production of damaging reactive oxygen species and an individual�s antioxidant capacity to detoxify the reactive intermediates or to repair the resulting damage. Disturbances in the normal redox state of tissues can cause toxic effects through the production of peroxides and free radicals that damage all components of the cell, including proteins, lipids, and DNA. Oxidative stress is implicated in the etiology of several chronic diseases including atherosclerosis, Parkinson’s disease, Alzheimer’s disease, and chronic fatigue syndrome.�
Personalized Lifestyle Factors: The modifiable lifestyle factors that appear along the bottom of the Functional Medicine Matrix. Clinicians and their patients can partner to develop an individualized plan for addressing these issues. Health-promoting lifestyle factors include:
Sleep and Relaxation � Getting adequate sleep and meaningful relaxation time in one�s life
Exercise and Movement � Participating in physical activity that is appropriate for age and health
Nutrition and Hydration � Eating a diet that is appropriate for age, genetic background, and environment, as well as maintaining adequate hydration
Stress and Resilience � Reducing stress levels and managing existing stress
Relationships and Networks � Developing and maintaining healthy relationships and social networks while reducing the impact of noxious relationships
Personalized (Individualized) Medicine: Personalized medicine can be described as the effort to define and strengthen the art of individualizing health care by integrating the interpretation of patient data (medical history, family history, signs, and symptoms) with emerging ��omic� technologies�nutritional genomics, pharmacogenomics, proteomics, and metabolomics. It is also defined as medicine that treats each patient as a unique individual and takes into account the totality of personal history, family history, environment and lifestyle, physical presentation, genetic background, and mind/body/spirit. Interventions are tailored to each patient and adjusted based on the patient�s individualized response.�
Precipitating Event: Similar to a trigger�a trigger, however, only provokes illness as long as the person is exposed to it (or for a short while afterward), while a precipitating event initiates a change in health status that persists long after the exposure ends
Prospective Medicine (aka: 4-P Medicine): A relatively new concept introduced in 2003, prospective medicine is a descriptive rather than a prescriptive term, encompassing �personalized, predictive, preventive, and participatory medicine.� Snyderman argues persuasively that a comprehensive system of care would address not only new technologies (e.g., identification of biomarkers, use of electronic and personalized health records), but also delivery systems, reimbursement mechanisms, and the needs of a variety of stakeholders (government, consumers, employers, insurers, and academic medicine). Prospective medicine does not claim to stake out new scientific or clinical territory; instead, it focuses on creating an innovative synthesis of technologies and models�particularly personalized medicine (the �-omics�) and systems biology�in order to �determine the risk for individuals to develop specific diseases, detect the disease�s earliest onset, and prevent or intervene early enough to provide maximum benefit.�
Proteomics: The large-scale study of proteins, particularly their structures and functions, how they’re modified, when and where they’re expressed, how they’re involved in metabolic pathways, and how they interact with one another. The proteome is the entire complement of proteins, including the modifications made to a particular set of proteins, produced by an organism or system. This will vary with time and distinct requirements, or stresses, that a cell or organism undergoes. As a result, proteomics is much more complicated than genomics: an organism’s genome is more or less constant, while the proteome differs from cell to cell and from time to time.�
PURE: A heuristic mnemonic for assessment and treatment of toxicity-related disorders. Steps to consider when assessing and treating patients with toxic exposures include:
Pattern Recognition � Recognize common patterns of toxicity signs and symptoms, including those associated with neurodevelopmental toxicity, immunotoxicity, mitochondrial toxicity, and endocrine toxicity
Undersupported/Overexposed � Examine the patient�s environment and lifestyle to determine what might be lacking and what there might be too much of
Reduce Toxin Exposure � Design a strategy for the patient to avoid continued toxin exposure
Ensure a Safe Detox � Support the patient during detoxification by ensuring adequate nutrients to aid in the detoxification and biotransformation process and by recommending lifestyle changes that increase the safety and efficacy of detox programs.�
PTSD: A heuristic for general treatment of hormone-related disorders. Factors to be considered include:
Production � Production/synthesis and secretion of the hormone
What are the building blocks of thyroid hormone and cortisol?
Transport � Transport/conversion/distribution/ interaction with other hormones
Do the levels of insulin impact the levels of E or T?
Does a hormone�s transport from its gland of origin to the target gland impact its effectiveness or toxicity?
Can we influence the level of free hormone?
Is the hormone transformed (T4 to T3 or RT3) and can we modulate that?
Sensitivity � Cellular sensitivity to the hormone signal
Are there nutritional or dietary factors that influence the cellular response to insulin, thyroid hormones, estrogens, etc.?
Detoxification � Detoxification/excretion of the hormone. For example:
How is estradiol metabolized in the process of biotransformation?
Can we alter it?
What can we do to affect the binding to and excretion of estrogens?
Single Nucleotide Polymorphism or SNP (pronounced �snip�) is a DNA sequence variation occurring when a single nucleotide�A, T, C, or G�in the genome differs between members of a species or between paired chromosomes in an individual. Almost all common SNPs have only two alleles. These genetic variations underlie differences in our susceptibility to, or protection from, several diseases. Variations in the DNA sequences of humans can affect how humans develop diseases. For example, a single base difference in the genes coding for apolipoprotein E is associated with a higher risk for Alzheimer’s disease. SNPs are also manifestations of genetic variations in the severity of illness, the way our body responds to treatments, and the individual response to pathogens, chemicals, drugs, vaccines, and other agents. They are thought to be key factors in applying the concept of personalized medicine.
Relative Risk: A measure of the strength of the relationship between risk factors and a condition. For example, one could compare the risk of developing cancer in persons with a certain exposure or trait to the risk in persons who do not have this characteristic. Male smokers are about 23 times more likely to develop lung cancer than nonsmokers, so their relative risk is 23. Most relative risks are not this large. For example, women who have a first-degree relative (mother, sister, or daughter) with a history of breast cancer have about twice the risk of developing breast cancer compared to women who do not have this family history.�
Systems Biology: Although there is not yet a universally recognized definition of systems biology, the National Institute of General Medical Services (NIGMS) at NIH provides the following explanation: �A field that seeks to study the relationships and interactions between various parts of a biological system (metabolic pathways, organelles, cells, and organisms) and to integrate this information to understand how biological systems function.�
The 5Rs: A heuristic mnemonic for the five-step process used to normalize gastrointestinal function that is a core element of functional medicine:
Remove � Removing the source of the imbalance (e.g., pathogens, allergic foods) is the critical first step.
Replace � Next replace any factors that are missing (e.g., HCL, digestive enzymes)
Reinoculate � Repopulate the gut with symbiotic bacteria (e.g., lactobacilli, bifidobacteria)
Repair � Heal damaged gut membranes using, for example, glutamine, fiber, and butyrate
Rebalance � Modify attitude, diet, and lifestyle of the patient to promote a healthier way of living
Three Legs of the Stool: A framework for practicing functional medicine that includes three parts:
Retelling the patient�s story with ATMs (antecedents, triggers, and mediators): The clinician collects information from the patient through extensive interaction, then reflects the problem back to the patient in terms of antecedents, triggers, and mediators
Organizing the clinical imbalances: The clinician organizes the clinical imbalances in the organizing physiological systems and lists them on the Functional Medicine Matrix.
Personalized lifestyle factors: The clinician assesses each patient�s environment and lifestyle, and partners with patients to help them develop, adopt, and maintain appropriate personalized health-promoting behaviors.�
Timeline: A tool that allows clinicians to visualize a patient�s story chronologically by organizing important life events and health issues from pre-conception to the present.
Triage Theory: Linus Pauling Award winner Bruce Ames� theory that DNA damage and late onset disease are consequences of a �triage allocation mechanism� developed during evolution to cope with periods of micronutrient shortage. When micronutrients (vitamins and minerals) are scarce, they are consumed for short-term survival at the expense of long-term survival. In 2009, Children�s Hospital and Research Center Oakland concluded that triage theory explains how diseases associated with aging like cancer, heart disease, and dementia (and the pace of aging itself) may be unintended consequences of mechanisms developed during evolution to protect against episodic vitamin/mineral shortages.
Triggers: Triggers are discrete entities or events that provoke disease or its symptoms (e.g., microbes). Triggers are usually insufficient in and of themselves for disease formation, however, because the health of the host and the vigor of its response to a trigger are essential elements.
Xenobiotics: Chemicals found in an organism that are not normally produced by or expected to be present in that organism. This may also include substances present in much higher concentrations than usual. The term xenobiotics is often applied to pollutants such as dioxins and polychlorinated biphenyls, because xenobiotics are understood as substances foreign to an entire biological system, i.e. artificial substances that did not exist in nature before their synthesis by humans. Exposure to several types of xenobiotics has been implicated in cancer risk.
El Paso, TX. Chiropractor, Dr. Alex Jimenez welcomes all to the new clinic location grand opening!
Grand Opening: Injury Medical Chiropractic Clinic
El Paso, TX, INJURY MEDICAL & CHIROPRACTIC CLINIC announces its newest east side location at 11860 Vista Del Sol, Suite 128 will officially open. The clinic is located in TheMission Business Center near Walgreens.
Injury Medical & Chiropractic Clinic offers an innovative, patient-friendly experience that allows patients access to affordable, quality chiropractic care. Appointments are not necessary, however in order to avoid waiting time appointments are recommended.
Based in El Paso, TX Injury Medical & Chiropractic Clinic is reinventing chiropractic by making quality care convenient and affordable for patients seeking pain relief and ongoing wellness. Extended hours and three convenient locations make care more accessible. Injury Medical & Chiropractic Clinic is an emerging company and key leader in the chiropractic profession. For more information, visit www.dralexjimenez.com, follow us on�Twitter @dralexjimenez�and find us on�Facebook, and�LinkedIn.
I thank you and have a special and respectful message� God loves motion.�God has created a fantastic design in all of us. His love of joints and articulations is obvious. Simply put, as an observer, our creator would have not given us so many joints with so many functions. So again, I repeat, God loves motion. Therefore, it is not just a choice to take care of them,�it is our obligation. I will help everybody I meet and treat to move better while�freeing themselves of any joint limitation preventing the full expression of life.
With a bit of work, we can achieve optimal health together. I look forward in doing my absolute best and helping those in need. It is what my mentors taught me, it is what I teach and it is what I will do passionately until�my last breath.
The term �ergogenic� stems from the Greek roots � �Ergon� and �genes,� meaning �work� and �born,� respectively. Any means of enhancing energy production or utilization may be described as an ergogenic aid.1 Ergogenic aids have classically been classified into five categories: mechanical, psychological, physiologic, pharmacologic, and nutritional.2 The present use of the term �ergogenic aid� usually revolves around the physiologic, pharmacologic, and nutritional categories.
While ergogenic aids have been linked to athletic �doping,� the terms are not synonymous. Doping is a term used by the International Olympic Committee (IOC) to describe the administration or use of a substance by a competing athlete with the sole intention of increasing in an artificial and unfair manner his or her performance in competition.3 Not all ergogenic aids are banned by the IOC. A partial listing of substances banned by the United States Olympic Committee is found in Table 1.2,3 Table 2 provides a list of commonly used athletic ergogenic aids.
Ergogenic Aids:
Anabolic-Androgenic Steroids
Anabolic-androgenic steroids (AAS) are testosterone derivatives that exert anabolic (tissue building) and androgenic (masculinizing) influences on the body.3 Since the discovery of the chemical structure of testosterone in 1935, attempts to separate the anabolic and androgenic effects of AAS�have been unsuccessful.3 Athletes have been using AAS since the 1940s in efforts to improve their performance.2 Concerned with widespread abuse of AAS among athletes, the IOC banned AAS use in the early 1960s.2 The Anabolic Steroids Control Act was legalized in 1990, making it a felony to possess or distribute AAS for non-medical purposes in the United States.3,4 Oral, parenteral, transdermal, and intra-nasal forms of AAS are available. The vast majority of AAS used by athletes is thought to be obtained on the �black market,� as only an estimated 10% to 15% of AAS used by athletes for performance enhancement are obtained by prescription.3
AAS are believed to exert their main effect by increasing anabolic processes and inhibiting catabolic processes via specific receptor mediated responses within the target cells.5 Effects of AAS include: the anabolic build-up of muscle mass, the androgenic development of secondary male sexual characteristics, an anti-catabolic reversal of cortisol�s action, and a direct psychological effect thought to allow a more intense and sustained workout.2,5-8 Early studies of AAS and athletes produced mixed results.5,6 More recent reviews support the notions that AAS can provide significant increases in muscle mass and strength in athletes.2,5,6 In order to maximize the effects of AAS on strength and power athletes, an adequate diet and exercise regimen is needed.5 There seems to be little advantage gained while using AAS in the untrained individual.5,9 Benefits obtained from AAS are more established in strength-dependent sports. Data supporting increased aerobic capacity and improved endurance with AAS use is limited and inconclusive.4 AAS effect on endurance sports is currently an area of great interest given the large number of endurance athletes who still use AAS.4,10
An intricate terminology describing the dosing practices of athletes has evolved. Athletes will commonly use AAS over 6 to 12 week �cycles.�4 �Pyramiding� describes a�gradual escalation in the dose of AAS taken over a cycle.2,11 �Stacking� involves the use of more than one AAS, usually with staggered cycles of the individual drugs.2-4 An �array� describes the practice of using other drugs to counteract side effects or enhance the effects of AAS.3 The practices of cycling, pyramiding, and stacking are used by athletes in an attempt to minimize the negative effects of AAS while maximizing the desired enhancements.2,4 At the current time, no solid scientific support exists for these practices.2,4,5
The adverse effects attributed to AAS abuse have been historically overstated.4,12 The majority of AAS side effects are considered minor and reversible following the cessation of use.4 While the incidence of serious side effects from AAS use has been low, devastating consequences have been reported.13 Documented fatalities from myocardial infarc- tion, stroke, and hepatocarcinoma have been attributed to AAS use.2,3 The long-term effects of AAS use are generally unknown.3,11
Dehydroepiandrosterone (DHEA)
Dehydroepiandrosterone (DHEA) is a precursor to testos- terone produced primarily in the adrenal glands.4,14 Natural sources of DHEA include wild yams. The FDA banned sale of DHEA in 1996 due to insuf cient evidence of safety and value; however, DHEA remains a legal and popular item sold as a nutritional supplement.14,15
The mechanism of action of DHEA is poorly understood but most likely revolves around the conversion of DHEA to testosterone in peripheral tissues.4,14 Preliminary studies suggest that DHEA may have a broad range of clinical uses including anti-Alzheimer and anti-Parkinson capabilities, however randomized, double-blinded clinical studies are�lacking.5
DHEA is a pre-cursor to testosterone and theoretically may enhance athletic performance in a manner similar to AAS. Investigations of DHEA use and athletic performance are scarce.14 Existing studies do not support a significant increase in lean body mass, strength, or testosterone levels with the use of DHEA in athletes.14,16-18
Long-term side effects of DHEA use are currently un- known but are probably similar to those associated with AAS use.6,14
Androstenedione
Androstenedione is a testosterone pre-cursor produced in the adrenal glands and gonads. Several professional athletes have used this substance, bringing it to national attention.2 Androstenedione is found naturally in the pollen of Scottish pine trees.19
Similar to DHEA, the mechanism of action and side ef- fects attributed to androstenedione are poorly understood and thought to be related to the conversion of androstenedione to testosterone in the peripheral tissues.5
Despite manufacturers� claims to the contrary, there is little scientific evidence of the purported ergogenic aid effects of androstenedione.2,5,16,20 Recently concerns have grown over the unfavorable alterations in blood lipid and coronary heart disease profiles seen in men using androstenedione as an ergogenic aid.2,20,21
Dietary Supplements
The increased visibility of ergogenic aids in the last de- cade has occurred primarily because of the passage of the United States Dietary Supplement Health and Education Act (DSHEA) of 1994.22 Certain vitamins, minerals, amino acids, herbs, and other botanical preparations can be classified as a �dietary supplement� under the DSHEA guidelines. Dietary supplements, as a result of DSHEA, are no longer under the direct regulatory control of the FDA. In fact, substances sold as a dietary supplement do not require FDA evaluation for safety or efficacy, and do not have to meet quality control standards expected of approved drugs.5 The content and purity of dietary supplements are not regulated and can vary widely.5,23 Since androstenedione and DHEA have been found to occur naturally in plant sources, these testosterone precursors can be labeled as �dietary supplements� and sold legally over-the-counter.
Ephedra
Dietary supplements containing Chinese ephedra, also known as Mahaung, are marketed as performance enhancers and weight-loss aids.24 Ephedra species of herb have been used for over 5,000 years for respiratory ailments.25 Currently, ephedrine alkaloids are found in hundreds of prescriptions and over-the-counter products, such as antihistamines, decongestants, and appetite suppressants.24-26 Ephedra and related ephedrine alkaloids are sympathomimetic agents that�mimic epinephrine effects.
Multiple studies of isolated ephedrine alkaloids have shown no significant enhancement of power or endurance at dosages considered to be safe.24,27-31 In contrast, the combination of caffeine with ephedrine has been associated with improvements in performance and may promote metabolic effects that are conducive to body fat loss.26,32
The actual content of ephedra alkaloids in 20 ephedra- containing dietary supplements was studied using high- performance liquid chromatography.33 Ten of the twenty supplements exhibited marked discrepancies between the label claim for ephedra content and the actual alkaloid content. Between 1995 and 1997, 926 cases of possible Mahuang toxicity were reported to the Food and Drug Ad- ministration.34 A temporal relationship between Mahuang use and severe complications including stroke, myocardial infarction, and sudden death was established in 37 of the 926 cases. In 36 of these 37 cases, the Mahuang use was reported to be within the manufacturers� dosing guidelines.
Ephedra and related ephedrine alkaloids are currently banned by the U.S.O.C. and cannot be recommended for general use given their association with potentially life- threatening side effects.2,34
Creatine
Creatine use in athletes has grown as a result of a 1992 study that showed that creatine supplementation produced a 20% increase in skeletal muscle creatine concentration.2,35 In the phosphorylated form, creatine serves as an energy substrate that contributes to adenosine triphosphate (ATP) re-synthesis during high-intensity exercise.36 Creatine re- mains popular with power and resistance athletes as it is thought to produce increases in strength, muscle mass, and to delay fatigue.2,14,36
Creatine is synthesized from amino acids primarily in the liver, pancreas, and kidney and is excreted by the kidneys. Creatine is found in skeletal muscle, cardiac muscle, brain, retinal, and testicular tissues.2,37 The interest in creatine as an ergogenic aid revolves around its ability to participate as an energy substrate for muscle contraction.14 Creatine, which easily binds phosphorus, can act as a substrate to donate phosphorus for the formation of ATP. Furthermore, creatine-phosphate (PCr) can help buffer lactic acid because hydrogen ions are used when ATP is regenerated.14,36,38 This role of creatine in exercise is governed by the following reaction:
Normally PCr stores deplete within 10 seconds of short, high-intensity exercise.14,39 Increasing the level of PCr in skeletal muscle, in theory, should result in the ability to sustain high-power output longer and lead to a greater re-synthesis of PCr after exercise.14 The beneficial effects of creatine in response to resistance training are most likely mediated by the following sequence: increased muscle creatine concentration, increased training intensity, which lead to an enhanced physiologic adaptation to training with increased muscle mass and strength.36
Studies evaluating the effectiveness of creatine as an er- gogenic aid are mixed.2,36,40 Multiple reports do conclude that short-term creatine supplementation signi cantly enhances the ability to maintain muscular force and power output dur- ing high-intensity exercise.2,36,41,42 Data on results of creatine supplementation with highly trained athletes is inconclusive. While some papers report improvements with creatine use in highly trained individuals with regards to high-intensity exercise, many show no improvements.2,36,43
Most investigators agree that creatine supplementation does not seem to enhance aerobic-oriented activities.2,36,44
Human muscle is thought to have a maximum concen- tration of creatine that it can hold.14,45 There appears to be no additional bene ts of increasing creatine supplementa- tion above this storage capacity of muscle as the excess is simply excreted by the kidneys.2,46 Humans have differing baseline levels of muscle creatine.14 Accordingly, athletes with lower baseline levels of creatine may be more sensi- tive to creatine supplementation than those with a relatively higher baseline creatine level.14,36 The terms �responder� and �nonresponder� have been used to describe two groups of athletes: those with relatively low baseline creatine levels that may show signi cant performance enhancement with creatine supplementation, and those with high baseline creatine levels that do not show marked improvements with creatine supplementation.14,36,47 These differences in creatine concentrations are thought to play a signi cant role in the varied results on performance found in the literature examin- ing creatine supplementation.14
Reported side effects from creatine use have been scarce.2,14 The major reported side effect associated with creatine use is weight gain, which is thought to be primarily a result of water retention.2,14,48 Some reported longer-term side effects include dehydration, muscle cramping, nausea, and seizures.2,49 Given the relative lack of studies, caution still remains about the long-term effects of creatine usage.14 As creatine use among younger athletes continues to increase, concern is growing over the lack of studies that examine the possible side effects speci c to this age group.14,38
Human Growth Hormone
Human growth hormone (hGH) is a polypeptide produced in the anterior pituitary gland. After its release from the pituitary, hGH can exert its effect in all cells of the body via tissue specific receptors. Human growth hormone is shown to promote protein anabolism, carbohydrate tolerance, lipolysis, natriuresis, and bone and connective tissue turnover.4,50
Potential benefits of hGH abuse in athletes revolve around�its anabolic effect on the body.4 Human growth hormone is thought to increase muscle mass, and spare muscle glycogen by stimulating lipolysis during exercise.2,3 The popularity of hGH among athletes is furthered by the fact that hGH re- mains extremely difficult to detect by current drug screening processes.3,51 Human growth hormone may be particularly attractive to female athletes as the virilization side effects associated with AAS use are not thought to occur with hGH.4
There are no studies that demonstrate signi cant increases in athletic performance with the use of hGH.3,52,53 Neither human or animal studies show any signi cant strength gains with supplemental hGH use in non-de cient individuals.4 The abuse of hGH is thought to be increasing despite the lack of scienti c evidence linking hGH to improved athlete performance.3,52 A survey of high school males revealed that as many as 5% reported past or present use of hGH.54 The purity of hGH abused by athletes may be poor as Drug Enforcement Agency estimates project that up to 30% to 50% of the hGH products sold are phony.4,55
Adverse effects of exogenous hGH use are extrapolated from the ndings seen in patients with endogenous over- secretion of hGH.2 Adults with high levels of hGH are at risk for the clinical syndrome of acromegaly. Medical complications associated with acromegaly include: diabetes, hypertension, coronary heart disease, cardiomyopathy, men- strual irregularities, and osteoporosis.2,4 High levels of hGH in individuals with open physis may lead to gigantism.2
Erythropoietin (EPO)
Recombinant EPO (r-EPO) was approved by the FDA for manufacture in 1989 after the EPO gene was cloned in 1985.14 Since its approval, r-EPO has been abused for athletic personal gain as an alternative to blood doping.3,14 Recombinant EPO has largely replaced the practice of blood doping, as r-EPO produces a dose-dependent increase in hematocrit.2 In theory, r-EPO should provide all of the benefits of blood doping without the risks involved in blood transfusion.3
There are few studies evaluating the use of r-EPO in healthy athletes; however, numerous studies have shown a signi cant increase in work capacity due to r-EPO use in patients with renal disease.14 Berglund and Ekblom reported an increased maximal oxygen consumption and increased time to exhaustion in male athletes after a 6 week trial of r-EPO.56
The risks associated with r-EPO abuse involve the potential for dangerously high hematocrit levels.14 A resulting hyperviscosity syndrome may lead to a decreased cardiac output, hypertension, and potential heart failure.3 Further- more, thrombosis could be manifest as myocardial infarction, pulmonary embolism, or cerebrovascular accidents.2,3 Although the use of r-EPO has been banned by the IOC since 1990, its use is extremely difficult to detect with current drug screening measures.2,14
Antioxidants
The antioxidant capabilities of certain vitamins are believed by many to counter-act the production of free-radials that occurs during exercise.14 Most of the research to date involves vitamin E, vitamin C, and beta carotene.2 The existing literature does not support the notion that antioxidants have significant ergogenic capabilities.2,14,57 There are currently no recommendations for antioxidant use in athletes that exceeds the normal adult recommended daily allowance (RDA).
Beta-Hydroxy-Beta-Methylbutyrate
Beta-hydroxy-beta-methylbutyrate (HMB) is a metabolite of the branched-chain amino acid leucine. HMB is theorized to inhibit muscle breakdown during strenuous exercise but its exact mechanism of action remains unknown.14,58 Studies show that HMB supplementation may significantly lower serum lactate dehydrogenase (LDH), lower serum creatine phosphokinase (CPK) levels and delay blood lactate accumulation after endurance training compared to placebo.59,60 Furthermore, short-term HMB use has been shown to significantly increase strength gains with resistance-exercised training over placebo in one double-blinded study.61
HMB is a relatively new ergogenic aid and published results are considered preliminary.14,58 Although there is evidence for a potential ergogenic aid advantage with HMB use in resistance and endurance training, its use can not be recommended until more studies are performed and potential side effects are elicited.
Caffeine
Caffeine is a methylxanthine occurring naturally in many species of plants. Caffeine is thought to work through a variety of mechanisms. The central nervous system effect of caffeine is probably the result of adrenergic receptor antagonism.3 Its use by athletes stems from the theory that caffeine may delay fatigue by enhancing skeletal muscle contractility and spare muscle glycogen levels by enhancing fat metabolism.6 Multiple studies have reported an improved endurance time with caffeine use.6,62,63 There is evidence that caffeine use may enhance performance with more intense short-duration exercise as well.2 The caffeine dosages most associated with an ergogenic effect range in the literature from 3 to 9 mg per kilogram of body weight.2,6
Side effects associated with caffeine use include anxiety, diuresis, insomnia, irritability and gastrointestinal discom- fort.2,6 Higher doses of caffeine ingestion can lead to more serious consequences such as cardiac arrhythmia, hallucina- tions, and even death.2,3
The legal urine level of caffeine for athletes is 12 ?g/ml (IOC standards) and 15 ?g/ml (National Collegiate Athletics Association standards).6 An athlete would need to drink six to eight cups of coffee in one sitting and be tested within 2 to 3 hours to reach urine levels over the IOC legal limit.3 The amount of caffeine needed to produce ergogenic benefits is potentially far less than that required to exceed the athletic�legal limit.3
Ergogenic Aids: Summary
Claims championing exotic substances that produce healing or ergogenic powers have been around for centuries. The�competitive, peer-pressured environment enveloping today�s athletes and adolescences makes these groups particularly susceptible to the uproar surrounding the current ergogenic aid market. Presently, it seems that rumor and anecdotal information overwhelms the available scientific data. While there is evidence that some touted ergogenic aids do indeed enhance performance, there are many unanswered questions about product safety, efficacy, and long-term consequences. A working knowledge of specific ergogenic aids is essential for the treating physician in order to best advise patients and athletes as to the possible benefits and risks of any substance they may be using.
By Adam Bernstein, M.D., Jordan Safirstein, M.D., and Jeffrey E. Rosen, M.D.
Americans’ Perception Of Chiropractic
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El Paso, TX. Chiropractor, Dr. Jimenez takes a look at top running shoes that are great for knee pain and Iliotibial (IT) Band Syndrome.
Running Shoes: Knee pain is one of the common problems with most active people. It could get worse for those who love running, especially the athletes. A majority of them suffer from knee pains each year. This pain hinders you from enjoying your daily sports activities and might even become worse with time if not treated correctly. There are causes and cures for such pains that this article is going to look at, but the main focus is on the best shoes for knee pain, also referred to as Iliotibial (IT) Band Syndrome.
This can happen due to various causes like overtraining, running many hills, and wrong running form, among others. These injuries are very frustrating as they can take up to months to go away. This is the reason different companies have designed shoes that will offer you support for any knee problem.
What Goes Wrong
The iliotibial band (ITB) is usually a structure whose job is to provide leg stability whenever you take a step. It works with the hip muscles in a thigh’s outward movement and also helps counter the movements within the knee joint. This band starts in the hip and ends just under the knee joint.
Repeated use of the ITB leads to stress, causing knee pain. You will also notice clicking sensations from the joint as ITB snaps across it. This pain is always experienced when the heel comes into contact with the ground; running slowly or downhill tends to make the symptoms worse.
ITBS will usually start as tightness while running but continues to a point where the pain is severe and unbearable. Although ITB continues to tighten when overstressed or injured from training, this is not the main problem. What causes the injury is how the ITB functions and the weakness around it.
The ITB is generally a weak structure and any weakness around it will lead to injury. Most runners have weak core muscles due to the fact that they don’t do strength training or have never been in any sports with side-to-side movement.
Signs Of IT Band Syndrome
If you are a runner, you will be able to distinguish ITBS by:
A swelling
A cracking feeling when stretching the knee
A feeling of burning, stinging and aching on the outer side of the knee that might migrate to the thigh. You will notice these discomforts especially, on your second half of the run.
Bending the knee at 45 degrees causes severe external knee pain
Criteria You Should Follow When Selecting The Best Running Shoes for ITBS
?There are various things that you should always consider when buying running shoes. Since most runners experience knee pain, it is wise to look for shoes that will help alleviate this pain without slowing them down. Below are some of the features to look out for in running shoes:
Stability/ Support
Since it is common to have knee pains due to lack of motion control and lack of stability, it is good to choose shoes that will offer you the support you need while running. If your running shoes don’t have any stability, you will end up stressing out your knee, which will result in pain and discomfort while running.
Fit
If you want to do away with pain, you might consider looking for a fit pair of shoes as they will reduce any pain, causing issues in the long run. Pay attention to small specifics like shoes that offer enough heel space, sufficient toe box room, and enough space for wide feet. Your toes should be able to move freely without being constricted.
If your foot cannot move freely and the toes are restricted from spreading, it could lead to painful issues in your feet, legs, and knees.
Motion control footwear is not the whole solution; you need to ensure your feet can still function naturally as they are supposed to.
Comfort
No one wants to wear uncomfortable shoes! Each of these selected best shoes come with upper and underfoot comforts to ensure you get to enjoy your run.
Most of these shoes are made with DNA technology, Gel cushioning, and REVlite midsole for ultimate comfort.
Durability
Your running shoes should run their course without falling apart as this will cause you pain in the long-run. If they promise to offer you support, they should do just that and not start peeling off and tearing when you are on the run.
The ??below 5 shoes have passed the durability test to ensure they give you maximum performance.
Breathability
Although this has nothing to do with knees, it is paramount that your running shoes have enough breathing space to avoid accumulating excess moisture, which might bring discomfort and other feet related problems.
There is no magical cure for knee pain and you should always know the root cause. This way, you will be able to come up with the best solution of minimizing or even eliminating the pain entirely. Although there are various causes of knee pain, this article is focusing on ITB syndrome which happens to be one of the causes.
Reviews Of The Top 5 Shoes
These shoes have been selected with the runner’s welfare in mind. They will help deal with the ITBS, which is a problem for most of them. Since one way of dealing with this condition is getting good running shoes, here is a review of such products.
Asics Gel Kayano 23
This upgraded version is lightweight to help with any knee problems. It offers you comfort through cushioning that help absorb shock as you run as well as other features like grip, fit, and durability. The shoe has an added outer sole to ensure it lasts you as long as possible.
PROS
?Gel cushioning will act as a shock absorber for more comfort
?Has superb breathability feature
?Is ideal for overpronation and knee pain
?The outsole’s traction will offer the intended support on various surfaces
CONS
?It is a bit pricey
New Balance 890v5
It tops the list of 5 best running shoes. Also, it has remained the first choice for most runners with knee pain issues. This pair offers all the above functionalities too, making it your best choice.
PROS
?It comes with one of a kind breathability and fit due to its great FantomFit design
?Its smooth upper construction will ensure no irritation occurs
?The REVlite midsole will give you much needed cushioning
CONS
?It has a narrow toe box and might not fit a person with a wide foot
?Puma Faas 600 V3
Puma models have never disappointed, and this one is no exception. Puma Faas 600 is the solution to your knee pain. It is also an affordable option for the short-handed.
PROS
?Great breathability
?Comes at a reasonable price
?It’s lacing system and fit offers you a secure and comfortable run
?It is designed to fit perfectly
CONS
?There have been reported concerns about the outsole’s durability
New Balance 1080v7
This is another great choice on the list. It is one of the New Balance Fresh Foam Series. Its midsole offers you the required support coupled with comfort to eliminate knee pains.
PROS
?Very durable
?Enough breathability for long runs
?Good amount of cushioning and support from the Fresh Foam midsole
?It fits like a sock giving you a confident use
CONS
?The upper design is not seamless
?Can be stiff
Saucony Hurricane 16
This is the 16th edition of the Saucony Hurricane, which offers a combination of steadiness and protection. Those with knee pain have agreed with the stability offered by this shoe. It is also cushioned to help you go for long runs without any pain or injury. It is perfect for heavy runners and those who are out of shape due to inactivity.
PROS
?Superb stability
?Lightweight rubber offers protection and cushioning
?Great ground contact
?Reflective parts allow you to have a safe run
?Comes with Sauc-Fit Technology that enhances its comfortability
CONS
?It is a bit narrow
?Limited colors to choose from
?Might be heavy for fast runners
If you are a long-distance runner, it is good to know that your shoes cushioning will wear out quite easily and you might be tempted to continue using them since they look good on the outside. This is a big mistake. The following will help you prevent any more ITBS recurrences:
Replace running shoes frequently to avoid wearing those with worn out inner cushioning
Always give your shoes time to rest so that the cushioning can get restored; it would be wise to have two pairs of running shoes.
Although shoes can offer you relief from ITBS, it is better to look out for other ways of helping you cope with or eliminate the pain entirely. Also, know what triggers the problem and avoid it at all costs.
These shoes have been tried and tested and found to offer support and help in managing the iliotibial band syndrome. Asics takes the lead on these best shoes. It comes with gel cushioning that will offer you the best shock absorption and maximum comfort as seen above. Its sole is also made to help you tackle any terrain and you can be assured that your knees will thank you later. The only drawback is the price, which is on the upper-side. However, always remember that cheap is expensive.
If you are an active person or an athlete suffering from ITBS, go ahead and get yourself a pair of these shoes as per your preference and choice.
Hey there, I’m Zoey, founder and the main editor of The Babble Out. I know nobody’s life is smooth as they wish, and it�s the same with mine. I had some terrible news a few years ago and running was the way I got through these issues. This has given me enough motivation to create this blog, so that I can give you a helping hand for as many daily problems as I can. If you are curious why “babble out” is the? name of the blog, then check the “About” page and find out more about me.
Yoga is a great way to improve flexibility and strength in your body. In this article we will go over some standing poses to use in your practice.
YOGA: MOUNTAIN POSE (TADASANA)
The mountain pose is the foundation of all standing poses. It might not look like much but the mountain pose is an important starting position, resting pose and tool to improve posture which leads to many other standing poses in yoga.
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STANDING FORWARD BEND (UTTANASANA)
Standing forward bend is a smooth transition from mountain pose and you will find a deep stretch in the entire back body.
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WARRIOR I POSE (VIRABHADRASANA I)
There are three variations of the warrior pose of which this is number I.
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WARRIOR II (VIRABHADRASANA II)
Warrior II stretches and strengthens the body in the one movement, allowing you to feel like a strong warrior. This pose will build strength your ankles, legs, glutes, core, back and shoulders.
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REVERSE WARRIOR (VIPARITA VIRABHADRASANA)
Reverse Warrior is a variation of the warrior II pose that provide a great stretch in the side body.
Occlusion training involves restricting the flow of blood to a muscle group while training. That is why it is also commonly called �blood flow restriction training.�
Basically you take a wrap or band and apply it to the top of your limb.
The aim of this�isn�t�to completely cut off circulation to the area as that is dangerous and painful.
This means that you aren�t restricting arterial flow to the area, but you are restricting the venous return from the muscles.
Arteries are what takes the blood from your heart to your muscles and it is then returned to your heart through a system of veins.
Restricting the blood flow back to your heart causes a pooling of the blood in the area that you are working.
This is what occlusion training uses to create an�anabolic effect�on your muscles.�
HOW DOES OCCLUSION TRAINING WORK?
The bloodstream is the network that connects the muscles in your body, providing oxygen and nutrients and carrying away waste products
Muscles require a steady flow of blood to operate.
That is why we aren�t cutting off the flow to the muscle, we are only slowing the rate at which the blood releases from it.
When performing any kind of resistance training your body directs more blood to your muscles performing the exercise.
The reason you get a �pump� when working out is that the speed at which your body is pumping blood into your muscles is faster than the amount of blood going out of them.
Your pump reduces when you rest between your sets as more blood is released from your muscle groups.
Blood flow restriction training prolongs and intensifies your pump.
This is done by placing wraps in one of two places during your working sets.
You wrap above your bicep for movements that involve your bicep�s, triceps, forearms, and even chest and back can benefit from this.
While wrapping in this position it makes sense that it would benefit your arms but how does it help your chest and back?
There is no possible way that you can restrict blood flow to your chest and back because of the positions they are located in.
However wrapping your arm allows you to pre-fatigue your arms and as a result chest and back exercises that you perform are going to require more involvement from those muscles rather than your biceps or triceps.
Wrap your upper thigh for movements that involve your quads, hamstrings, glutes and calves.
Building Muscle With Occlusion Training
During training you have two�types of muscle�that are responsible for all muscle growth in the gym.
Fast twitch fibers and slow twitch fibers.
Slow twitch muscle fibers are smaller muscle fibers and generate less power and strength than fast twitch fibers. However slow twitch fibers fatigue slower and can sustain activity for longer.
Fast twitch fibers are larger muscle fibers, generate more power and strength and have the most potential for growth.
Fast twitch fibers are recruited last during contractions and mostly don�t use oxygen. Slow twitch fibers on the other hand use oxygen and are recruited first in the movement.
This means that by restricting the blood flow to a muscle group you are pre-fatiguing the slow twitch fibers and forcing the fast twitch fibers to take control even when you�re using low weights.
Occlusion training seems to�trick your body�into thinking you are lifting heavy weights. This means you can get very�similar benefits�of heavy training by using 20-30% of your 1 rep max.
There are two main factors that lead to muscle growth during training. These are:
Metabolic Stress
Cellular Swelling
Metabolic Stress
When you�re working out your body is burning energy. As your body chews through its fuel stores, metabolic by-product accumulates in your muscles.
Metabolic by-products act as an anabolic signal, telling your body to increase size and strength.
Under normal training most of these by-products would be washed out by blood flow.
Occlusion training keeps them near the muscle helping to increase the anabolic effect that the by-products have on the muscles.�
Cellular Swelling
During resistance training your cells expand and fill with fluid and nutrients. This is known as cellular swelling and has also been shown to be an anabolic�signal for muscle growth.
Occlusion training isn�t a better option than heavy training, but that said it is a nice supplement.
Regularly pushing your muscles to the point of failure or at least close to it (1-2 reps) is an important factor of increasing your strength and muscle mass.
Occlusion training allows you to replicate this without putting anywhere near as much strain on your joints, ligaments and tendons as you would to get the same result from lifting heavy.
This means that you can do more volume without the risk of�overtraining.
Here are a couple of scenarios where this could be really beneficial for you:
If you suffer from joint issues
If you�re travelling and only have access to hotel weights
If you�re injured or have nagging aches and pains.
In short your body might not always feel up to another heavy training day. Occlusion training can be a great way to get a good workout in and help you maintain muscle mass.�
How To Do Blood Flow Restriction Training
As I mentioned earlier you only ever wrap yourself at the top of your biceps and the top of your thighs.
Elastic knee wraps, medical tourniquets and exercise band �are good options to use for your wraps.
Here�s two videos explaining how to wrap your arms and legs
Blood flow restriction training works best when with isolation exercises. If you are going to do compound movements do them at the start of your workout and save the blood flow restricted exercises for the end.
Layne Norton recommends performing lifts at 20%-30% of your 1rm for 20-30 reps of the first set and then the next three sets at 10-15 reps. Have a 30 second rest between sets before going again.
You want to keep the cuffs on your limbs for the entire 4 sets and then release them at the end.
If you�re in pain before the exercise starts that�s a good sign that your wraps are too tight.
Also if you can�t complete the prescribed sets either the wraps are too tight or the weight is too heavy.�
Conclusion
Blood flow restriction training has been getting a lot of hype lately.
While it isn�t better than regular strength training, it is a good supplement for it and can be beneficial when used in conjunction with your regular training.
This is more of an advanced training technique so if you are just starting out lifting it probably won�t give you any more benefits than your normal heavy training.
If you�re an advanced lifter, are injured, or don�t have access to heavier weights than this training technique could benefit you.
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Nutrition is increasingly recognized as a key component of optimal sporting performance, with both the science and practice of sports nutrition developing rapidly.1 Recent studies have found that a planned scientific nutritional strategy (consisting of fluid, carbohydrate, sodium, and caffeine) compared with a self-chosen nutritional strategy helped non-elite runners complete a marathon run faster2 and trained cyclists complete a time trial faster.3 Whereas training has the greatest potential to increase performance, it has been estimated that consumption of a carbohydrate�electrolyte drink or relatively low doses of caffeine may improve a 40 km cycling time trial performance by 32�42 and 55�84 seconds, respectively.4
Carbohydrate ingestion has been shown to improve performance in events lasting approximately 1 hour.6 A growing body of evidence also demonstrates beneficial effects of a carbohydrate mouth rinse on performance.22 It is thought that receptors in the oral cavity signal to the central nervous system to positively modify motor output.23
The �train-low, compete-high� concept is training with low carbohydrate availability to promote adaptations such as�enhanced activation of cell-signaling pathways, increased mitochondrial enzyme content and activity, enhanced lipid oxidation rates, and hence improved exercise capacity.26 However, there is no clear evidence that performance is improved with this approach.27 For example, when highly trained cyclists were separated into once-daily (train-high) or twice-daily (train-low) training sessions, increases in resting muscle glycogen content were seen in the low-carbohydrate- availability group, along with other selected training adaptations.28 However, performance in a 1-hour time trial after 3 weeks of training was no different between groups. Other research has produced similar results.29 Different strategies have been suggested (eg, training after an overnight fast, training twice per day, restricting carbohydrate during recovery),26 but further research is needed to establish optimal dietary periodization plans.27
There has been a recent resurgence of interest in fat as a fuel, particularly for ultra endurance exercise. A high-carbohydrate strategy inhibits fat utilization during exercise,30 which may not be beneficial due to the abundance of energy stored in the body as fat. Creating an environment that optimizes fat oxidation potentially occurs when dietary carbohydrate is reduced to a level that promotes ketosis.31 However, this strategy may impair performance of high-intensity activity, by contributing to a reduction in pyruvate dehydrogenase activity and glycogenolysis. 32 The lack of performance benefits seen in studies investigating �high-fat� diets may be attributed to inadequate carbohydrate restriction and time for adaptation.31 Research into the performance effects of high fat diets continues.
While protein consumption prior to and during endurance and resistance exercise has been shown to enhance rates of muscle protein synthesis (MPS), a recent review found protein ingestion alongside carbohydrate during exercise does not improve time�trial performance when compared with the ingestion of adequate amounts of carbohydrate alone.33
The purpose of fluid consumption during exercise is primarily to maintain hydration and thermoregulation, thereby benefiting performance. Evidence is emerging on increased risk of oxidative stress with dehydration.34 Fluid consumption prior to exercise is recommended to ensure that the athlete is well-hydrated prior to commencing exercise.35 In addition,�carefully planned hyperhydration ( fluid overloading) prior to an event may reset fluid balance and increase fluid retention, and consequently improve heat tolerance.36 However, fluid overloading may increase the risk of hyponatremia 37 and impact negatively on performance due to feelings of fullness and the need to urinate.
Performance supplements shown to enhance performance include caffeine, beetroot juice, beta-alanine (BA), creatine, and bicarbonate.40 Comprehensive reviews on other supplements including caffeine, creatine, and bicarbonate can be found elsewhere.41 In recent years, research has focused on the role of nitrate, BA, and vitamin D and performance. Nitrate is most commonly provided as sodium nitrate or beetroot juice.42 Dietary nitrates are reduced (in mouth and stomach) to nitrites, and then to nitric oxide. During exercise, nitric oxide potentially influences skeletal muscle function through regulation of blood ow and glucose homeostasis, as well as mitochondrial respiration.43 During endurance exercise, nitrate supplementation has been shown to increase exercise efficiency (4%�5% reduction in VO at a steady attenuate oxidative stress.42 Similarly, a 4.2% improvement in performance was shown in a test designed to simulate a football game.44
Consuming carbohydrates immediately post exercise to coincide with the initial rapid phase of glycogen synthesis has been used as a strategy to maximize rates of muscle glycogen synthesis. An early study found delaying feeding by 2 hours after glycogen-depleting cycling exercise reduced glycogen synthesis rates.52 However the importance of this early enhanced rate of glycogen synthesis has been questioned in the context of extended recovery periods with sufficient carbohydrate consumption. Enhancing the rate of glycogen synthesis with immediate carbohydrate consumption after exercise appears most relevant when the next exercise session is within 8 hours of the first.53,54 Feeding frequency is also irrelevant with extended recovery; by 24 hours post exercise, consumption of carbohydrate as four large meals or 16 small snacks had comparable effects on muscle glycogen storage.55
An acute bout of intense endurance or resistance exercise can induce a transient increase in protein turnover, and, until feeding, protein balance remains negative. Protein consumption after exercise enhances MPS and net protein balance,58 predominantly by increasing mitochondrial protein fraction with endurance training, and myofibrillar protein fraction with resistance training.59
Fluid and electrolyte replacement after exercise can be achieved through resuming normal hydration practices. However, when euhydration is needed within 24 hours or substantial body weight has been lost (.5% of BM), a more structured response may be warranted to replace fluids and electrolytes.77
The availability of nutrition information for athletes varies. Younger or recreational athletes are more likely to receive generalized nutritional information of poorer quality from individuals such as coaches.78 Elite athletes are more likely to have access to specialized sports-nutrition input from qualified professionals. A range of sports science and medicine support systems are in place in different countries to assist elite athletes,1 and nutrition is a key component of these services. Some countries have nutrition programs embedded within sports institutes (eg, Australia) or alternatively have National Olympic Committees that support nutrition programs (eg, United States of America).1 However, not all athletes at the elite level have access to sports-nutrition services. This may be due to financial constraints of the sport, geographical issues, and a lack of recognition of the value of a sports-nutrition service.78
Supplement use is widespread in athletes.86,87 For example, 87.5% of elite athletes in Australia used dietary supplements88 and 87% of Canadian high-performance athletes took dietary supplements within the past 6 months85 (Table 2). It is difficult to compare studies due to differences in the criteria used to define dietary supplements, variations in assessing supplement intake, and disparities in the populations studied.85
A positive drug test in an athlete can occur with even a minute quantity of a banned substance.41,87 WADA maintains a �strict liability� policy, whereby every athlete is responsible for any substance found in their body regardless of how it got there.41,86,87,89 The World Anti-Doping Code (January 1, 2015) does recognize the issue of contaminated supplements.91 Whereas the code upholds the principle of strict liability, athletes may receive a lesser ban if they can��show �no significant fault� to demonstrate they did not intend to cheat. The updated code imposes longer bans on those who cheat intentionally, includes athlete support personnel (eg, coaches, medical staff), and has an increased focus on anti-doping education.91,99
Allostasis: The process of achieving stability, or homeostasis, through physiological or behavioral change. This can be carried out by means of alteration in HPATG axis hormones, the autonomic nervous system, cytokines, or a number of other systems, and is generally adaptive in the short term. It is essential in order to maintain internal viability amid changing conditions.
Chronic Care Model: Developed by Wagner and colleagues, the primary focus of this model is to include the essential elements of a healthcare system that encourage high-quality chronic disease care. Such elements include the community, the health system, self-management support, delivery system design, decision support and clinical information systems. It is a response to powerful evidence that patients with chronic conditions often do not obtain the care they need, and that the healthcare system is not currently structured to facilitate such care.�
Complementary and Alternative Medicine (CAM): A group of diverse medical and healthcare systems, practices, and products that are not presently considered to be part of conventional, mainstream medicine. The list of what is considered to be CAM changes frequently, as therapies demonstrated to be safe and effective are adopted by conventional practitioners, and as new approaches to health care emerge. Complementary medicine is used with conventional medicine, not as a substitute for it. Alternative medicine is used in place of conventional medicine. 
Cytochromes P450 (CYP 450): A large and diverse group of enzymes, most of which function to catalyze the oxidation of organic substances. They are located either in the inner membrane of mitochondria or in the endoplasmic reticulum of cells ans play a critical role in the detoxification of endogenous and exogenous toxins. The substrates of CYP enzymes include metabolic intermediates such as lipids, steroidal hormones, and xenobiotic substances such as drugs.
Dysbiosis: A condition that occurs when the normal symbiosis between gut flora and the host is disturbed and organisms of low intrinsic virulence, which normally coexist peacefully with the host, may promote illness. It is distinct from gastrointestinal infection, in which a highly virulent organism gains access to the gastrointestinal tract and infects the host.�
Functional Medicine Matrix: The graphic representation of the functional medicine approach, displaying the seven organizing physiological systems, the patient�s known antecedents, triggers, and mediators, and the personalized lifestyle factors that promote health. Practitioners can use the matrix to help organize their thoughts and observations about the patient�s health and decide how to focus therapeutic and preventive strategies.
Lifestyle Medicine: The use of lifestyle interventions such as nutrition, physical activity, stress reduction, and rest to lower the risk for the approximately 70% of modern health problems that are lifestyle-related chronic diseases (such as obesity and type 2 diabetes), or for the treatment and management of disease if such conditions are already present. It is an essential component of the treatment of most chronic diseases and has been incorporated in many national disease management guidelines.
Single Nucleotide Polymorphism or SNP (pronounced �snip�) is a DNA sequence variation occurring when a single nucleotide�A, T, C, or G�in the genome differs between members of a species or between paired chromosomes in an individual. Almost all common SNPs have only two alleles. These genetic variations underlie differences in our susceptibility to, or protection from, several diseases. Variations in the DNA sequences of humans can affect how humans develop diseases. For example, a single base difference in the genes coding for apolipoprotein E is associated with a higher risk for Alzheimer’s disease. SNPs are also manifestations of genetic variations in the severity of illness, the way our body responds to treatments, and the individual response to pathogens, chemicals, drugs, vaccines, and other agents. They are thought to be key factors in applying the concept of personalized medicine.
Triage Theory: Linus Pauling Award winner Bruce Ames� theory that DNA damage and late onset disease are consequences of a �triage allocation mechanism� developed during evolution to cope with periods of micronutrient shortage. When micronutrients (vitamins and minerals) are scarce, they are consumed for short-term survival at the expense of long-term survival. In 2009, Children�s Hospital and Research Center Oakland concluded that triage theory explains how diseases associated with aging like cancer, heart disease, and dementia (and the pace of aging itself) may be unintended consequences of mechanisms developed during evolution to protect against episodic vitamin/mineral shortages.
Xenobiotics: Chemicals found in an organism that are not normally produced by or expected to be present in that organism. This may also include substances present in much higher concentrations than usual. The term xenobiotics is often applied to pollutants such as dioxins and polychlorinated biphenyls, because xenobiotics are understood as substances foreign to an entire biological system, i.e. artificial substances that did not exist in nature before their synthesis by humans. Exposure to several types of xenobiotics has been implicated in cancer risk.
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Anabolic-Androgenic Steroids
Anabolic-androgenic steroids (AAS) are testosterone derivatives that exert anabolic (tissue building) and androgenic (masculinizing) influences on the body.3 Since the discovery of the chemical structure of testosterone in 1935, attempts to separate the anabolic and androgenic effects of AAS�have been unsuccessful.3 
Dehydroepiandrosterone (DHEA) is a precursor to testos- terone produced primarily in the adrenal glands.4,14 Natural sources of DHEA include wild yams. The FDA banned sale of DHEA in 1996 due to insuf cient evidence of safety and value; however, DHEA remains a legal and popular item sold as a nutritional supplement.14,15
Androstenedione is a testosterone pre-cursor produced in the adrenal glands and gonads. Several professional athletes have used this substance, bringing it to national attention.2 Androstenedione is found naturally in the pollen of Scottish pine trees.19
The increased visibility of ergogenic aids in the last de- cade has occurred primarily because of the passage of the United States Dietary Supplement Health and Education Act (DSHEA) of 1994.22 Certain vitamins, minerals, amino acids, herbs, and other botanical preparations can be classified as a �dietary supplement� under the DSHEA guidelines. Dietary supplements, as a result of DSHEA, are no longer under the direct regulatory control of the FDA. In fact, substances sold as a dietary supplement do not require FDA evaluation for safety or efficacy, and do not have to meet quality control standards expected of approved drugs.5 The content and purity of dietary supplements are not regulated and can vary widely.5,23 Since androstenedione and DHEA have been found to occur naturally in plant sources, these testosterone precursors can be labeled as �dietary supplements� and sold legally over-the-counter.
Dietary supplements containing Chinese ephedra, also known as Mahaung, are marketed as performance enhancers and weight-loss aids.24 Ephedra species of herb have been used for over 5,000 years for respiratory ailments.25 Currently, ephedrine alkaloids are found in hundreds of prescriptions and over-the-counter products, such as antihistamines, decongestants, and appetite suppressants.24-26 Ephedra and related ephedrine alkaloids are sympathomimetic agents that�mimic epinephrine effects.
Creatine use in athletes has grown as a result of a 1992 study that showed that creatine supplementation produced a 20% increase in skeletal muscle creatine concentration.2,35 In the phosphorylated form, creatine serves as an energy substrate that contributes to adenosine triphosphate (ATP) re-synthesis during high-intensity exercise.36 Creatine re- mains popular with power and resistance athletes as it is thought to produce increases in strength, muscle mass, and to delay fatigue.2,14,36
Human growth hormone (hGH) is a polypeptide produced in the anterior pituitary gland. After its release from the pituitary, hGH can exert its effect in all cells of the body via tissue specific receptors. Human growth hormone is shown to promote protein anabolism, carbohydrate tolerance, lipolysis, natriuresis, and bone and connective tissue turnover.4,50
Recombinant EPO (r-EPO) was approved by the FDA for manufacture in 1989 after the EPO gene was cloned in 1985.14 Since its approval, r-EPO has been abused for athletic personal gain as an alternative to blood doping.3,14 Recombinant EPO has largely replaced the practice of blood doping, as r-EPO produces a dose-dependent increase in hematocrit.2 In theory, r-EPO should provide all of the benefits of blood doping without the risks involved in blood transfusion.3
The antioxidant capabilities of certain vitamins are believed by many to counter-act the production of free-radials that occurs during exercise.14 Most of the research to date involves vitamin E, vitamin C, and beta carotene.2 The existing literature does not support the notion that antioxidants have significant ergogenic capabilities.2,14,57 There are currently no recommendations for antioxidant use in athletes that exceeds the normal adult recommended daily allowance (RDA).
Beta-hydroxy-beta-methylbutyrate (HMB) is a metabolite of the branched-chain amino acid leucine. HMB is theorized to inhibit muscle breakdown during strenuous exercise but its exact mechanism of action remains unknown.14,58 Studies show that HMB supplementation may significantly lower serum lactate dehydrogenase (LDH), lower serum creatine phosphokinase (CPK) levels and delay blood lactate accumulation after endurance training compared to placebo.59,60 Furthermore, short-term HMB use has been shown to significantly increase strength gains with resistance-exercised training over placebo in one double-blinded study.61
Caffeine is a methylxanthine occurring naturally in many species of plants. Caffeine is thought to work through a variety of mechanisms. The central nervous system effect of caffeine is probably the result of adrenergic receptor antagonism.3 Its use by athletes stems from the theory that caffeine may delay fatigue by enhancing skeletal muscle contractility and spare muscle glycogen levels by enhancing fat metabolism.6 Multiple studies have reported an improved endurance time with caffeine use.6,62,63 There is evidence that caffeine use may enhance performance with more intense short-duration exercise as well.2 The caffeine dosages most associated with an ergogenic effect range in the literature from 3 to 9 mg per kilogram of body weight.2,6
Signs Of IT Band Syndrome
If you are a runner, you will be able to distinguish ITBS by:
If you want to do away with pain, you might consider looking for a fit pair of shoes as they will reduce any pain, causing issues in the long run. Pay attention to small specifics like shoes that offer enough heel space, sufficient toe box room, and enough space for wide feet. Your toes should be able to move freely without being constricted.
This upgraded version is lightweight to help with any knee problems. It offers you comfort through cushioning that help absorb shock as you run as well as other features like grip, fit, and durability. The shoe has an added outer sole to ensure it lasts you as long as possible.
It tops the list of 5 best running shoes. Also, it has remained the first choice for most runners with knee pain issues. This pair offers all the above functionalities too, making it your best choice.
Puma models have never disappointed, and this one is no exception. Puma Faas 600 is the solution to your knee pain. It is also an affordable option for the short-handed.
This is another great choice on the list. It is one of the New Balance Fresh Foam Series. Its midsole offers you the required support coupled with comfort to eliminate knee pains.
This is the 16th edition of the Saucony Hurricane, which offers a combination of steadiness and protection. Those with knee pain have agreed with the stability offered by this shoe. It is also cushioned to help you go for long runs without any pain or injury. It is perfect for heavy runners and those who are out of shape due to inactivity.
