This is Part Two of my article series -Diet Patterns of an Injured Athlete. What a can of worms I have opened for as you will soon find out, there will be a Part Three!
In Part One, I wrote about my battles with inflammation and Achilles Tendonitis, describing how I had tried just about every form of treatment for my stubborn injury. After 9 months I began to query my overall health, eventually reaching a point where I realized there must be more at play than just my running, training and biomechanics. What I now believe was occurring in my body was an accumulation of stressors that were inhibiting my body’s ability to recover from my chronic injuries and training loads.
The Stress Response
A stressor is anything that places a load on the body and generates a flight or fight response. During such a response, the stress hormone Cortisol is pumped into the body generating physical changes that help us to remove the stressful situation. The interesting thing about the human stress response is that it is a ‘one-size-fits-all’ mechanism. That is, the body cannot distinguish between different stressors, whether they derive from your workplace, family life, pain, other discomforts, environmental inputs or even your diet. And it is the accumulation of these individual stressors that can lead to a chronic stress response in which the body remains in a heightened state of stress-induced arousal.
Last year, this was me in a nutshell. I was accumulating stressors from training, Find Your Feet, emotional ‘female’ occasions, my general environment. Further to this, without realizing it, my diet had evolved to be rich in inflammatory foods, particularly sweet substances such as sugar, fructose and natural sweeteners. As I began to awake to these circumstances, I began delving into the literature. Everything I read alerted me to the fact that my body was struggling to stay in homeostasis (a balanced physical state). I was constantly pumping out cortisol to the detriment of my hormonal, physical & psychological health. It was this disruption to my hormones that was likely leading to my injury woes.
Hormones and Stress: A tight link
The body derives almost all of its hormones from one master hormone, Pregnalone. It is produced in the adrenal glands and is the precursor to many hormones including cortisol, DHEA, aldosterone, testosterone, estrogens and progesterone.
When we are in balance, there should be ample Pregnalone for the body to make adequate amounts of our sex hormones and cortisol. However, if we enter a chronic state of stress (such as through poor diet, inadequate exercise, insufficient sleep, lack of relaxation, and internalizing our emotional stress) we can fatigue our adrenal glands. This begins an occurrence of ‘Pregalone Steal’. That is, we override our need to produce the sex hormones for the sake of creating more Cortisol.
For optimal health we need our sex hormones. They help to keep us: in balance; feeling masculine or feminine; generating empathy towards others; rested at night; alert during the day; balanced in our emotions; healthy in our musculoskeletal system; and most importantly for the athlete, physically recovered. One of the two most important hormones here are Testosterone and Growth Hormone, both of which are produced by males and females (although to a much lessor extent in females). Without testosterone, the body’s ability to repair musculoskeletal tissue is hindered. I believe now that this was one of my main issues throughout 2014 – increased Cortisol levels and inadequate sex hormone levels.
Making Changes: A big mountain to climb
I believe that one of the biggest challenges to any athlete is identifying and acknowledging one’s chronic state of stress and with it, an unbalanced hormonal state. What many of us struggle to appreciate, myself included, is that stress doesn’t mean stressed. After all, in 2014 I was Happy Hanny. I didn’t snap at everyone and I wasn’t hiding in a hole feeling depressed or stressed. However, I was often on overdrive and if I add into this my poor diet, huge amounts of travel, elite level racing and fluctuating sleep patterns, my body had quietly accumulated stressors. This had crept up on me over a longer period of time and my hormonal health was now compromised.
Challenging myself to trawl through the research on overcoming Pregnalone steal and naturally boosting my hormones, I came across one very common suggestion: fix what you can fix. That is, whilst we can often point the finger to a large area of our life that feels stressful, it might not be the easiest one to initially change. For me it was Find Your Feet and my training. I couldn’t easily stop working otherwise this would add financial strains into the mix. I couldn’t reduce my travel as this was what I did for work. I couldn’t alter my training any more as I was already doing far less due to my injury. But two changes that I could make easily were to my diet and sleep routines. Thus I embarked on the journey of fixing what I could fix.
Change: Fixing what I could fix
Injury frustrations and research triggered me into radical change. Increasing my sleep was easy but in November I embarked on the overwhelming process of removing all forms of sugar for a two-month period. I chose this as my starting point because it seemed to be the most well documented and successful area of research into hormonal health. I knew I had a serious sweet tooth and that I found it hard to avoid the overwhelming need for more, especially mid-afternoon and after dinner. Therefore, the changes that I made included:
Be it chicken or eggs, my Achilles improved 100%.
Sugar: The bad and the ugly
There are many problems with sugar. In order to understand them one needs to understand what sugar is actually composed of and its impact on the body.
Sugar (the white stuff) is just pure energy and contains no nutrient value at all. It is composed of 50% glucose and 50% fructose. The glucose component of the sugar is readily acted upon by body cells in the presence of insulin, a hormone produced by the pancreas. The fructose component must be processed into glycogen by the liver.
If our diet is too high in sugar and its various forms, many problems can occur. Some of these problems include:
In other words, consuming high amounts of sugar doesn’t really do anything for you. Simply put, sugar is empty calories.
Removing the White Stuff: The results
You might be asking why I decided to cut out all sugar for eight weeks, including fruit and natural sugars? My reasoning comes back to my addiction to sweet things. As I inferred in Part One of this article series, I was loading up on sugar and refined foods to the detriment of good nutrients, fatty acids and protein intake. Without these vital nutritional components, my body was pushed into a greater state of stress and inflammation whilst being denied the very things that would help it to recover. I needed to go cold turkey and break my sweet tooth!
The first two weeks was a nightmare. I was terribly lethargic and fighting constant headaches and moodiness. My partner, Graham, had also jumped on the challenge of two months without sugar. On one occasion we were out on a gentle ride and literally both bonked about 55 minutes into our gentle ride, crawling and pushing our bicycles home again. What likely had happened was that our bodies were so used to burning glucose that once our glycogen stores dried up we were left incapable of efficiently resorting to fatty acid metabolism for energy production. This is not the state that an endurance athlete should find himself or herself as fatty acid metabolism is what drives energy production during long events.
The biggest change that occurred in my diet wasn’t just the removal of sweet foods, but also the fact that I had to replace this energy with something else… fats and proteins. Till then, I had been educated from all fronts that fats were bad! Sports scientists, nutritionists, the AIS, coaches… everyone pointed the finger at fats being bad for you. To turn this around and be snacking on avocados, nuts, full-fat butter and cheese… it was hard but rewarding. During this period Graham and I saw no increases in weight and if anything, we leaned & toned up. Further to this, over the two months our energy levels began to sore. The cravings subsided and my own general emotional wellbeing strengthened. I began to feel like I was in a constant state of calmness, no longer seeking sugar inputs for the mid-morning and mid-afternoon cravings. Better still, I began to see signs that my hormones were balancing, my endurance was enhancing, recovery from strength training had quickened, and my Achilles was getting better! At last I was winning.
Since this experience I have not been a princess when it comes to sugar intake and there have been setbacks. The festive season threw me off course a little, as did an increase in travel and competitions, which lead to a loss of routines. But I have realized that reducing stressors and remaining in nutritional health is all about balance and being aware of what certain tasks, thoughts and food groups do to your own body. For me, I have realized that as soon as I overindulge in sugary foods, I become more susceptible to inflammation. This is also true if I work too much without enough rest. For example, despite no dramatic changes to my training, in the post-festive season I saw a slight return of my Achilles as well as a grizzly knee. This less balanced diet and lifestyle also saw more of my raw emotions and my ability to cope with stressors diminish. As I became aware of the fact that I felt I was travelling backwards, I cleaned up my diet and work schedule again, noticing rapid improvements in the inflammatory responses in my body. In short, I started winning again!
Way Forward: More research!
Since experiencing such dramatic changes for myself I am beginning to cautiously suggest similar changes to clients who are experiencing chronic injury issues. Without fail, I am seeing similar results. I have seen a client who had not menstruated for two years return to healthy cycles. I have had another who felt she was unable to cope with workplace stressors thrive again. Similarly, I have had two clients overcome tendinopathies and another a chronic knee inflammatory issue. Things certainly look positive from a coaching perspective.
But the story doesn’t just stop at sugar and stress. What I have now become aware of through my continued research into the modern literature is that there is a plethora of studies currently being conducted on holistic health, diet and lifestyle, with plausible links to chronic inflammation. Evidence suggests that chronic inflammation could be strongly linked to lifestyle diseases, such as cardiovascular disease, arthritis, diabetes and even neurological diseases. Whilst such studies appear to be embraced by the medical and alternative health world, it fascinates me that it doesn’t appear to be filtering into the sports industry. I see a strong need to find current, accurate research on diet, stress and chronic inflammation’s link to the world of sports injuries and recovery.
Therefore, in later blog posts, I hope to be able to share my studies on other aspects of nutrition and lifestyle, and how this may begin to point the finger towards causation for poor recovery from training and injury. Areas of interest to me are now:
Until then, I urge you to reflect on your own holistic health and to take note of how small decisions in diet, sleep, exercise and work manifest in your body’s ability to recover. Should you feel the need to experiment with your holistic health, I believe that the perseverance and hard work will likely pay off in your health, recovery and performance. Play hard!
Since the start of 2014 I have been battling return from an Achilles injury. I do not use the word battling loosely as this is what it has been. A battle. I have tried just about every quick remedy I can. In this order I have tried and mostly failed:
However, not completely naïve I did start to think about nutrition and recovery earlier this year when I sat with AIS dieticians, a leading sport nutritionist. I had reservations of my ability to recover from hard sessions, and constant tendency to iron deficiency and hormonal imbalance. I had noticed that my resilience from stressor loads was not where I wanted nor expected it to be, and that it was something I needed to address. In other words, I needed to stop patching and start fixing underlying causes. I made some changes to nutrition then:
The results? A slight improvement but I was still noticing the niggles and my Achilles still showed inflammation. So I faced the reality and plucked up the courage to fight the biggest battle of all – removing all sugar from my diet. As the ultimate fruit bat, this is like putting a possum on a fruit-free diet. Yikes!?
Nutrition guru, Darryl Griffiths of the Australian company Shotz Sports Nutrition in Melbourne, first highlighted the evils of sugar to me. Built sturdier and more mean than an Audi sports car, Darryl was horrified at my tendency… no dependency… on sugar. At the time I shrugged it off as bulls$@t – ‘Yeah, yeah, but endurance athletes need the carbs!’ I was merely frightened. If I wrote my current dietary pattern for a day down it looked something like this:
So there you had it, a day of highs, lows and one huge amount of sugar… mostly in the form of fructose. My moods swung, energy pitched and plummeted and stress levels were hard to control. I struggled to sit down, felt restless at my desk, and thoughts could even feel cloudy. If something got difficult I found myself reaching for the dried fruit jar. It sometimes helped a bit. However, underneath this is no way to live life. It was time to make a change.
There is so much information out there on how to come back from injury. We have all heard it. Build 5% each week, start with slower training and gradually introduce the faster stuff. However, there are so many other times of transition in our lives and as summer approaches, I believe this is a time for caution. For haven’t we all at some stage said to ourselves, ‘Summer is here! It is time to finish up work for a while, whip out the toys and get fit!’
I know that I used to have it in my head that as soon as university exams were done and dusted I would be able to throw myself head first into heavy training to 'get back to where I want or need to be'. This thought process spells danger and I fell into the trap many times.
The first problem is that many of us lead a more sedentary lifestyle and our body may have become used to sitting down a lot. Suddenly bouncing up and spending time on your feet, added to a training load can come at the price of injury or illness.
Secondly, you need to think about how much you have been doing and slowly ease yourself into heavier training. Perhaps give yourself 1-2 weeks of slowly building up the training. If you are unsure how to do this, maybe the first week should just be about slow volume. Go for runs, some long and some short, some with friends and some on your own. Add in some strength and easy cross training, all at a talking pace. Then, in the second week, I would start to add in some gentle intensity in your training. Opt for longer, slightly slower repetitions over shorter & faster ones. Some example sessions that can get you started are:
These sessions are still aerobic sessions and will prep the body. Don't forget to keep up the strength training and focus lots on activating the core and glute (bottom) muscles to support your hips & running form.
For those who feel prone to niggles or injury, one of the best things that I have been recently introduced to by my NZ coach, James Kuegler of Cadence Coaching, is water running, preferably in the ocean or sea water. Here is what I do (at least 3 times per week at the moment as I return from injury):
In summary, avoid the pitfalls of being too excited about summer. Remember, it is a wonderful season but should not always be viewed as a boot camp. My challenge to you is this: Get yourself fit without taking risks. Learn to train smart and in a way that you can sustain most of the year despite how busy your life can become. If you do, the results will take care of themselves.
These articles are a collection of my writing. If you have feedback or questions, would love to hear from you!