The following is an article we had published in the Space Coast Runner’s monthly newsletter stressing the importance of going beyond the musculoskeletal system in an athlete’s approach to training and life.  Invaluable information geared for the runners in this particular article, but applicable to all.

BEYOND THE MUSCULOSKELETAL SYSTEM

How to Intelligently Improve Performance

 

In life, and especially running, we oft get caught up in haphazardly making narrow minded assumptions based upon the obvious, somewhat tangible, direct correlations.  These beliefs then dictate our actions which can eventually end up harming us if a full on, knowledgeable approach is not properly implemented.  To truly blend optimization with longevity, we must look beyond the heavy pavement pounding sprinkled with mindless stretching and old school carb loading.

 

Much of what was accepted as truth 20, 10, even 5 years ago, no longer holds weight.  This doesn’t mean we were necessarily wrong.  Based upon the information we had at the time, theories were devised and implemented accordingly.  However, when more scientific knowledge naturally becomes elucidated as we perpetually grow via learning, we would be best served to swallow our pride, move our egos aside, and utilize this information to modify our approach in our quest to perform and live better.

 

Like it or not, running, especially distance, although viewed as a healthy thing, can wreak havocs on our bodies, including beyond the obvious musculoskeletal system.  Now don’t get me wrong.  I too run and therefore am a runner.  I don’t plan on stopping anytime soon.  I get it.  However, if we are going to take part in activities that we love, regardless of the potential deleterious effects, it would be to our utmost advantage to not turn a blind eye to physiology.  To not take into consideration the entire body (which, last time I checked, all of which is involved in running), will lead to subpar performance, higher chance of injury, longer required recovery (which we are all so good at), and breakdowns beyond the musculoskeletal system.  Ignorance is bliss, until you’re injured, always in pain, sick, and in search of the port-a-poddy.  

 

When it comes to supporting an active running lifestyle, the importance of adrenal health cannot be overstated.  I’ve spoken, written, consulted about, and revived these stress workhouses in the past.  They serve as an undeniable focal point in any one’s life, but especially the constantly physically stressed, faithful runner.  

 

We won’t be directly addressing the adrenals today per-say (although it’s all connected), but will be focusing our attention on a system that is just as effected by running, and has an even more comprehensive reach on our performance and the rest of our health; including many seemingly unrelated, not so obvious issues we referenced in the opening.  Sit tight while we simplify a complicated system in order to connect the dots between running and gut health and why if you want to sustain an optimal running career and healthy life, you would be best served to pay it the attention it requires to thrive.

 

The first thing we need to acknowledge is the fact that when we run or perform any moderate to intense exercise, we are activating the sympathetic nervous system.  This is known as the “fight or flight” nervous system and is also activated due to emotional and chemical stressors.  When this occurs, we are inhibiting the parasympathetic nervous system, also known as the “rest and digest” system.  When the sympathetic response is activated, oxygen rich blood is shunted from the parasympathetic innervated digestive tract (along with many other organs) to our skeletal muscles in order to carry out the task at hand, whether it be escaping a predator of cranking out causeway repeats.  

 

The issue arises when the stressor persists.  This can be in the form of constant emotional stress from the job, bank account balance or relationships, or from the constant bombardment of chemical stressors from an undiagnosed food sensitivity or heavy metal exposure.  

 

In our case we are referring to the constant physical stressor of training; some may call it overtraining.  You couple this high volume training with inappropriately inadequate bouts of recovery and we have the recipe for a nervous system that loses its preferred autonomic balance between sympathetic and parasympathetic.  We are left with a nervous system that not only shunts blood from the GI tract (gastrointestinal aka gut) during training, but now has a carry-over effect into non-training times as we have up-regulated and enhanced the stress response.  (If you add in the other previously mentioned likely sources of chemical and emotional stressors, one can comprehend how this can get out of hand rather quickly.)

 

Why does this matter? Well, the digestive tract has one of the fastest turnover rates in the body.  It also serves as a major barrier system from our external environment, as such it is exposed to and damaged by many harmful, unwanted guests throughout the course of any day.  As such, it requires a strong supply of oxygen and nutrients in order to fuel this constant and necessary turnover.  This is supplied by way of blood, which as we previously noted can be inhibited by overtraining (constant sympathetic nervous system), and inadequate recovery (lack of parasympathetic nervous system).

 

Let’s dig deeper and make the empowering and hopefully motivating connection.  With less blood flow providing the gut the fuel it needs to keep up with the constant cellular turnover, the structural integrity of the gut wall begins to become compromised; commonly referred to as intestinal permeability or leaky gut.  Other than the obvious digestive issues (bloating, constipation, diarrhea; particularly on race day due to that increase in sympathetic fight or flight and consequential less blood flow to the gut) that can occur, we will begin to see issues outside of the GI tract that can start to hamper other areas of your life.

 

Let’s go to the science for a more detailed view of these far reaching potential detriments.   First off, what’s become the gold standard for determining the presence of a leaky gut is a biomarker called zonulin. When zonulin is high, it is telling the tight junctions of the intestinal wall to open, increasing permeability, and changing the slew of the immune system.  When the digestive tract becomes compromised, and this can be due to many reasons, but especially the decrease in blood flow that comes with overtraining, this zonulin begins to show up in our blood and throughout or body.  

One study out of Scientific American involving endurance cyclists illustrated that the high volume training appeared to lend itself to increased levels of zonulin that was linked to subpar performance, increased inflammation and thus larger levels of discomfort and longer recovery.  When the athletes were then supplemented with probiotics as a means of re-establishing their gut integrity, zonulin was decreased, along with the associated major markers of inflammation and oxidation, and training times improved.

 

(Link to study:  Probiotic supplementation affects markers of intestinal barrier, oxidation and inflammation in trained men; a randomized, double blinded, placebo-controlled trial; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3465223/ )

 

 

One of the reasons an overtraining induced leaky gut can be such a detriment for the professional athlete to the weekend warrior is due to the malnutrition and increased systemic inflammation that occurs concurrently.  If intestinal permeability exists, function suffers, and when it comes to the gut, we’re talking about nutrient absorption and proper fuel utilization for the rest of our body; from muscle to brain.

 

The body must also now exhaust its depleting fuel in order to attack and dispose of what has gained access through the compromised integrity of the gut wall.  This causes inflammation throughout the body, in addition to that sustained courtesy of your workout.  We are now looking at an inflamed body.  And what is the major underlying factor behind the vast majority of pathology and dysfunction? You know where I’m going here.  Inflammation. 

 

Two other key markers that begin to show up in the blood due to this up regulated, constant shunting of the blood away from the GI tract, are LPS and Diamine Oxidase.  

 

When LPS (lipopolysaccharides) escape the gut due to permeability, they trigger the release of more inflammation, including specific mediators called cytokines that can cross our blood brain barrier and start to negatively affect our neurotransmitters, like dopamine, acetylcholine, serotonin, and gaba.  When these are off we begin to see depression, anxiety, sleep disturbances, brain fog and fatigue, problems with memory and focus, etc.  There is also a notable correlation with LPS and America’s number one killer, cardiovascular disease.

 

DAO (diamine oxidase) is molecule known as an enzyme that can be notably decreased due to lack of blood flow, and subsequent damage to the gut.  This enzyme is directly responsible for the degradation of histamine.  This means if you are lacking in DAO due to a damaged intestinal barrier, you will become hypersensitive or over-reactive to histamine driven reactions in the body.   Now we are looking at allergies (new or worsening), increased sensitivity and allergenicity to histaminergic foods (many fish, cheeses, sausage, salami, sauerkraut, spinach, eggplant, tomato ketchup, red and white wine, top and bottom fermented beer, and champagne), and other issues associated with histamine intolerance like Crohn disease, Ulcerative Colitis, colorectal neoplasms, vertigo, hyper and hypotension, headaches (especially concurrent with the monthly cycle), and disruption of circadian rhythm.

 

If I haven’t lost you yet, I tip my hat to you.  This is crucial, beyond musculoskeletal information that can prove empowering for everyone, but especially in a population of people who voluntarily shunt blood away from the foundation of optimal health and function, the digestive system.  

 

The question is, what can you do about it?  Because I know and you know, we’re damn sure not going to stop running.

 

The first thing you can do is test for intestinal permeability.  In our office we run a blood test that measures the three markers mentioned above (zonulin, LPS, DO).  This can provide insight into if a leaky gut truly exists, and may provide some comfort as far as an explanation for various, frustrating and unexplainable symptoms.

 

 

The second thing to do is to start being proactive based upon the aforementioned understanding of physiology and how it can be negatively affected by the activities we choose.  It’s the same as a marathoner taking an adrenal support supplement in order to continue to do what they love to do, but understanding and accepting the fact that certain support is needed due to the increase demand imposed upon the body.  

 

We know this heavy training coupled with inadequate recovery is destructive to the gut, which we have also shown, leads to ramifications well beyond the typical GI issues.  A quality probiotic, L-glutamine, digestive enzymes, curcumin, a high quality omega3 oil,  identification and elimination of any fungal, bacterial or parasitic overgrowth that may flourish in the presence of a damaged gut, are all proactive ways to not only enhance your running and recovery, but the rest of your life.

 

We all want to keep doing what we love to do.  That’s what life is all about.  Don’t leave it to chance when the knowledge exists to tilt the scales in your favor.  

Investigate.  Understand.  Implement.  Enjoy.  We only get One Body.  Treat it right.

As always, it’s been a pleasure.  If you have any questions, comments or concerns, I encourage you to reach out (321-848-0987; Dr.RClarke@gmail.com).  Step your approach up beyond the musculoskeletal system, and begin to truly thrive.

 

 

 

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