Sports anemia is not a true anemia. It is an anemia-like condition that is normal in endurance and ultra-endurance athletes, which is widely considered to be a normal adaptive response to endurance exercise, which manifests as endurance athletes having lower hemoglobin levels (Hb) than nonathletes. These athletes will often look slightly anemic compared to others and this decrease in plama Hb levels can range from 5% in recreational runners to 20% in elite marathoners. There are two mechanisms for this pseudoanemia and the latter described is the best explanation for a chronic low hemoglobin level.

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One way that aerobic athletes experience temporary low hemoglobin may be due to the destruction of older red blood cells through a sudden increase in aerobic exercise. This would lower the blood cell count and cause the body to have to clean up the dead cells, which would lower the blood's iron level temporarily.

Also, regular aerobic exercise expands the plasma volume, thus diluting the RBC and Hb levels of the blood. This is termed dilutional pseudoanemia. This probably occurs as an adaptive response to the acute loss of plasma volume that occurs early in each workout. The reduction in plasma volume, or hemoconcentration, is due to three factors:

1) The mean arterial blood pressure and the muscular compression of venules is increased, which both increase capillary hydrostatic pressure.

2) Tissue osmotic pressure is increased because of the generation of lactic acid and other muscle metabolites, increasing osmotic pressure.

3) Sweat is produced, resulting in fluid loss.

It is thought that the body responds to this repeated hemoconcentration by releasing renin, aldosterone, and vasopressin so as to conserve water and salt. Abumin is also added to the blood to help pull in more water, expanding the plasma volume.

As early as one day after a strenuous aerobic exercise bout, plasma volume can expand by up to 10%. The amount of the rise, and thus the reduction of Hb levels, correlates with the intensity and frequency of exercise, so the more the hardest training athletes will tend to have the lowest hemoglobin levels, likely making it appear as if they are training too hard. Any increases in plasma volume, however, will disappear as fast as they came, once exercised is ceased.

Since hemoglobin is responsible for delivering oxygen to the muscles and any anemic condition would seem to reduce aerobic endurance, dilutional pseudoanemia being an adaptive response may seem to present a paradox. However, as the plasma volume rises so to does the cardiac stroke volume, which more than makes up for any loss in Hb per unit of blood, so that more, not less, oxygen is delivered to the muscles.1

After a few months of consistent exercise during which large shifts in volume or intensity are not made, blood concentrations tend to return to normal. However, long-term sports anemia is present in some elite endurance athletes.2

Diagnosis and Problems with Sports Anemia

The major problem with the sports anemia is that it is a misnomer. For one, as described above, it is not a true anemia. Also, the term would make it seem as if there is one anemia unique to sports, when, of course, athletes can experience anemia due to all the normal causes. It is also problematic because certain athletes do seem to be at increased risk for iron deficiency anemia, namely female athletes, long distance runners, and vegetarian athletes.2 It is more important that practitioners be aware of this increased risk than to be aware of a pseudo-anemic phenomenon called sports anemia.

Diagnosis of sports anemia can only be made after all other likely causes have been eliminated, together with the knowledge that the patient is an endurance athlete or engages in regular aerobic exercise. Although hemoglobin levels may be low, other blood parameters will test normal.

Once diagnosed, the condition should does not need to be treated or prevented, as it is a beneficial and normal response to exercise.1

by EricT

Turning over a new leaf, just for this post, at least, I decided to actually write about fat loss. People who read my articles regularly know that I do not hand out weight loss advice. But a fun subject, and one a knowledgeable feller like myself can tackle, is the "negative calorie" claim that has surfaced through the years. The thing about this claim is that it can seem logical at first glance, to someone with no in-depth knowledge of nutrition, and at the heart of it, there is a kernel of truth. For those without knowledge and those who wish to cash in on that market, a kernel of truth is all that is needed.

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Negative Calories and TEF

Negative Calories has to top the list of magical weight loss myths, because it would be the most amazing if it were true. This myth says that there are some foods that by virtue of their composition require more energy to chew and digest than they actually impart to the body, thus giving "negative calories" and helping to lose fat. Basically, you are burning calories by eating the food, so if you eat a lot of it, you'll lose weight!

It is actually pretty hard to believe, at present, that people swallowed this one, but they did. Oh, they really did! Celery was the king of negative calories. Other contenders are cabbage, lettuce, cucumbers, and Snicker bars.

But I did say there was a kernel of truth, didn't I? Well the idea is based on what is called the thermic effect of food (TEF). Of course, when someone comes up with a term like that, someone else always has to one-up them so there are other names for it like diet-induced thermogenesis (DIT), specific dynamic effect (SDE) of food, and specific dynamic activity (SDA) of food. You'll understand if I stick to thermic effect or "TEF" for short.

TEF is one of the three categories that total energy expenditure (TEE) is broken down into. The other two are your resting energy expenditure(REE) and your voluntary physical activity. You may also have heard the terms "basal energy expenditure" (BEE) or "basal metabolism rate" (BMR). See the section I added below for further explanation. For now, know that resting energy expenditure typically accounts for about 70 percent of TEE. Physical activity accounts for about 20 percent. That leaves just around 10 percent for the TEF. 1,2 In clinical settings, TEF is not measured, but rather estimated based on the equation:

TEE = (REE + EEPA) x 1.10

Again, TEE is total energy expenditure, REE is resting energy expenditure and EEPA is energy expended in physical activity. And the factor of 1.10 accounts for the TEF.2

The TEF is the energy required to process the food you eat. It takes some energy to chew it, digest it, transport it, absorb it, metabolize its nutrients, and to store some nutrients. You chew food. That takes a bit of energy. The muscles in your GI tract speed up their contractions, so that takes some energy. Digestive juices and enzymes are secreted, and that takes some energy as well.3 All this produces heat, thus a "thermic effect". To produce heat is to expend calories.

The thermic effect of food actually has another component. The energy required to process the food, as I've described above, is called the obligatory thermogenesis. The other component is facultative thermogenesis. This is the excess energy expended above the obligatory thermogenesis due to metabolic inefficiency. 2

This COSMED device is an indirect calorimetry device.
Indirect calorimetry is a way of estimating energy expenditure in
steady state conditions from the rate of oxygen consumption (Vo₂),
and the rate of carbon dioxide production (Vco₂).
Image courtesy of COSMED

So how much energy are we talking about, for the thermic effect? Well it's easily overestimated. Or even underestimated. That's the problem. See, we can only estimate it in the first place and the errors involved in that estimate are likely so large that they offset any small contribution to calories burned. As you can see, it is simply assumed to be 10% and only the resting and physical energy requirements are measured actively. The composition of the diet greatly affects the TEF. The TEF is greater with carbohydrate and protein ingestion than for fat, protein being the greatest. It should be noted that this energy cost is probably more related to the cost of storage than to the cost of processing and absorption, although there are probably other components as well.

Also, other dietary factors such as spicy foods, caffeine, and nicotine can increase it. So based on our ten percent, let's say that a person who takes in 2000 calories a day burns around 200 calories to process the food….plus or minus how much?2,3

Looking at celery, you can see, as with many myths, there is an element of truth at base. Celery is 95% water and the rest mostly cellulose, which is difficult for our body to break down. One stalk contains only six to ten calories. The chewing part, well, that couldn't possibly burn enough calories as you'd have to chew for an hour to burn 5 to 10 calories, at an estimate. Which means an hour worth of celery. The math is a bit staggering to me so I'll leave that alone. The actual digestion? Sure, by the time the body deals with celery it is probably fair to say that there is no appreciable net gain in calorie energy. If you did nothing but chew on celery all day..you may even end up with a calorie deficit. But of course, you would never do that and there is no way you could ever eat enough celery to make a difference in your caloric intake. Celery is not only hard to digest, it is a nutritional pauper. A celery diet would be a diet with an absolute lack of proper nutrition.

The whole concept of a "negative calorie" is absurd in the first place. A calorie, by which we usually mean a kilocalorie, is a distinct positive value: the quantity of heat needed to raise the temperature of 1 kg of water from 0 to 1°C. There can never be a negative calorie.

Although most of the negative calorie hoopla is limited to advertisements or articles in questionable publications like the Weekly World News, it finds it's way into mainstream books, magazines, and websites all the time. Negative calorie foods are often billed as foods that help you or even cause you to lose weight. Some M.D. named Neal D. Barnard actually wrote a book called Foods that Cause You To Lose Weight: The Negative Calorie Effect. 4

There is something called a Negative Calorie Diet but I am not sure if that is one fad diet, several, or just a general term for any diet claiming to utilize this effect. I really do not think that investigating that nonsense further is worth a few more hours of my life. Also, there is the Cabbage Soup Diet, which is based on the supposed negative calorie value of cabbage and other vegetables put in a soup. Or something like that.

Clever Rules for Negative Calorie Counting

Anahad O'Connor, author of the "Really" column in the New York Times, in his book Never Shower in a Thunderstorm: Surprising Facts and Misleading Myths About Our Health and The World we Live In 5, relates some funny stories of readers who wrote into the Times with some clever rules for "negative calorie counting." Most of these are obviously jokes, but the author does not really say so. Thing is, I've heard people say things like this so at least some of them may not have been joking. Here are the highlights:

• With foods like steamed crabs, it takes more energy to get at the crab meat than the crab actually contains. Therefore, you have to factor in the calories used in getting to the food in the first place. Marylanders rejoice!

• The cold beer rule: Cold beer has negative calories since it takes more energy to bring the beer down to body temperature than there is calories in the beer. Given the typical calorie count of beer, you'd have to say this one with a grin on your face and your finger crossed behind your back.

• The body can't count, so count your food, not your calories. This one says that your body cannot count very high so eat in multiples and make sure to eat so many of each thing that your body reaches it's counting limit. Anything over this limit has no calories. Apparently, anything over six silver-dollar pancakes, your body cannot recognize. If the person who wrote in this one wasn't joking, they have serious mental deficiencies.

• Anything you resist eating…you get to subtract from your calories for the day. That's right..the temptations you don't give in to are negative calories. If you turn down a big chunk of chocolate cake, that's 400 calories less at the end of the day. Just today, I refused to eat cake, M&M's, and Doritos. I also avoided two Dr. Peppers which were taunting me. That puts me at, I don't know, 1500 calories down?5

Ice Water and Negative Calories

Ice water gets a lot of credit for its negative calorie effects. You saw the cold beer thing above right? Well, beer contains calories. How much better to drink ice water, with no calories. Why, it takes so much energy to warm that cold water up to body temperature, you could cancel out a whole meal by drinking ice water! Really? Of course not. But you could cancel out some of it though, right?

Let's see. For each gram of ice water the body will have to use about 37 calories to raise the temperature to body temp. Hey, this is looking good! I think we're on to something. Now, if I eat 3000 calories, I just need to figure out how much ice water I need to drink. It shouldn't matter when I drink it; I can drink it throughout the day or all at once, whatever. So, a gram of water is equivalent to a cubic centimeter of water:

(37 cal/cc)(#cc) = (3000 x 10³ cal)

Okay, so I divide 37 into 3000, and I get 81 and then, that leaves me with #cc = 81 x 10""3"" cc. So…the answer is 81 liters, or 20 gallons. It will take 20 GALLONS of ICE water to burn those calories. Oops.

Well, I only need to burn off that extra 500 calories.

(37 cal/cc)(#cc) = 500 x 10³ cal).

That is so much better. You can do that with only 13.5 liters of ice water. That is about 3.5 gallons. You try it and let me know how it works out for you. By the way, chewing the ice cubes works even better. That takes 80 calories for each gram of ice. Nice! And cold.

I know you are impressed with my math. Sucker! I can't even help my son with his fourth grade math, half the time. I got help from Back-of-The-Envelope Physics by Clifford E. Swartz, which is the only kind of physics book I can understand, except the kind of physics in most science fiction books.6.

Chewing Your Way Thin

I mentioned calories burned by chewing above. A lot has been made, in books and articles, about a study published in the New England Journal of Medicine back in 2007 7, usually given as "a doctor from the Mayo Clinic," which found that chewing gum burns 11 calories per hour. Eh, so that's a lot of chewing, and I have TMJ problems, so I had to give up gum. But, it's not like there is nothing to this. You see, there are more things to consider besides just the calories burned by the chewing. Maybe you avoid a high calorie snack. Or maybe there is an appetite suppression, or it contributes to resting energy expenditure in some way. Tom Venuto blogged about this, and brought up another study that dove further, so you can find out more in Does Chewing Gum Help You Lose Weight?

Here's the thing: I don't know about you but I find people who constantly chew gum to be a bit repulsive. Sorry to any dedicated gum chewers reading this but, it's a little off-putting to have someone chewing their cud while talking to you. So, consider that if you try the chewing gum diet, you may not be able to sit with me at the cool kid's table.

Negative Calories and the Dieter's Paradox

The belief in negative calories is part of the kind of thinking involved in what Alexander Chernev calls "The Dieter's Paradox." The kinds of foods promoted to be negative calorie foods fall into the category of healthy foods, for the most part. People are being encouraged to eat more healthy foods. In fact, it is outright shouted by every health organization in the world. Eat more health foods! Eat more fruits and vegetables; everybody needs to! This has been going on for a while. Yet, there seems to have been no impact on the obesity epidemic. According to Chernov, "An important factor contributing to this obesity trend is the misguided belief about the relationship between a meal's healthiness and its impact on weight gain, whereby people erroneously believe that eating healthy foods in addition to unhealthy ones can decrease a meal's calorie count."

Chernov asserts that although lack of willpower to control consumptive behaviors is often given as the chief cause of the still rising proportion of overweight people, this is not the only factor. He argues that over-consumption "might also stem from people's misguided belief about the relationship between a meal's healthiness and its impact on weight gain."

And there may be something to that. He gives the example of adding a side salad to an unhealthy meal and believing that the healthy option added to the unhealthy meal decreases the calorie count of the meal. This "halo affect" of healthy foods is believed to extend not only to the nutrient quality of the meal but also to its effect on weight gain. A side salad 'cancels out' other calories because of the negative calorie bias.8

Have you seen this behavior? Have you exhibited it? I've seen it. Two big macs and a side salad, anyone? This belief in protective effects is just one part of the dieter's paradox. The paradox, in general, is that the most weight-conscious people, especially dieters, are more prone to making irrational decisions about food, and therefore more prone to weight gain!

In chapter 4 of the book, Leveraging Consumer Psychology for Effective Health Communications, Chernov and co-author Pierre Chandon name this negative calorie bias is one of several biases that cause people to make errors in their estimation of caloric intake. The negative calorie balance falls under a larger bias, called the halo bias. Another main category of underestimation bias is the averaging bias.

Chernov says the halo bias "refers to the tendency of a particular feature of the food, such as nutrition labels or marketing claims that it is healthy, to influence the overall estimation of the calorie content of the food item or of an entire meal." And "the averaging bias refers to people’s tendency to average the calorie content of combinations of healthy and unhealthy items."

The problem with the idea of the halo bias is that the higher the actual calorie count of a food is, the more people tend to underestimate it. In a quick evaluation of a clients problem with his middle-age paunch, for instance, I asked him to list out his meals for a few days. He, of course, didn't think he was eating much and had no idea where all the calories were coming from. Typically, you will find that your clients have been severely underestimating (informally) the calories actually contained in the highest calorie items they tend to eat. For this client, the big problem was the habit of getting take-out lunches from convenience stores and consuming some "large-ticket" items without a clue as to the huge amount of calories he was taking in. Accordingly, he was eating a "healthy" turkey sandwich, for instance, but was chasing it with a large (jumbo) sweetened bottled iced tea that topped 500 calories, a large snack pack of potato chips or other chips that easily did the same. He simply severely underestimated just how many calories were coming from the most calorie laden things in his lunches. Comparably, his typical breakfast and dinner was healthy and moderate. It was easy for him to drop up to 1000 calories a day by just changing a few lunch habits! Hardly a life-changing feat. But this was not the "halo-bias" it was just a basic problem: the more calories a food actually contains, the more our estimates will fall short.

So, Wansink and Chandon controlled for this in a study where they asked consumers to estimate the number of calories in two ten-ounce cups. One contained M&M's and the other contained granola. Guess what, you may not have guessed this but both of these have pretty much the same number of calories. The M&M's contain 1,380 calories and the granola contained 1,330 calories. What do you think happened? Of course, the participants underestimated the calories in the granola, by 28% while overestimating the calories in the M&M's by 9 percent. This is consistent with the perception that granola is a "healthy snack" and that M&M's are not.

The halo bias is also caused by food label claims and other marketing descriptions. So claims of "low fat" or "healthy" will cause people to underestimate the true calorie count. These general effects are not isolated to the over-weight and calorie conscious but are also present in normal-weight people. So there is a lot more to it, of course, than one bias.

Even though a persons chief goal is to control caloric intake, the way they categorize different types of food as "healthy" or "unhealthy" will cause them to underestimate the calories in a meal, based on this perception. In reality, the number of calories in a meal is nothing more than the calories contained in each food item added together. But people often do not rely on reality to help them choose a meal, instead they rely on impressions. Consider the example given by Chernov and Chandon. You are limiting calorie intake and you have a choice between a hamburger or a hamburger and a side salad. You choose the hamburger and side salad. This is inconsistent with your goals, logically, because the two-item meal contains more calories. But you chose the higher calorie option.

What is going on here? For one, you may have perceived the salad as imparting some "benefits" to your health, such as vitamins, fiber, etc. The addition of a beneficial and healthful food, then, caused you to categorize the meal with the hamburger AND salad as more healthful than just the hamburger. The idea that something is more helpful can cause you to underestimate its calories..even with the 'math' in plain site. Biases, remember, are largely unconscious. You "averaged out" the low calorie and healthy salad with the high calorie hamburger causing you to derive a lower calorie estimate, this is the averaging bias. These biases are interrelated, as you can see.

Now, you might be thinking, the salad thing is just the negative calorie bias! That would make sense, at first glance. A person might believe that the greens in the salad consumed more energy to process than they gave, so that they actually ended up subtracting a bunch of calories from the meal. Well, some people might believe this but the negative calorie thing is more a fad belief than a consistent bias. In fact, when asked to consider such foods alone, consumers will not tend to assume they have zero calories or negative calories, but will give an actual calorie estimate.

To test this, Chernev and Gal asked participants to estimate the calorie content of a cheeseburger alone, a broccoli salad alone, or a meal containing both. The average calories given for the cheeseburger was 761 calories. The average calories given for the broccoli salad was 67 calories. Okay, so you can see that the participants did not perceive the broccoli salad as having negative calories, when viewed alone, despite broccoli frequently being viewed as negative calorie food. They gave a positive estimate. when we look at the combined meal group, the one who evaluated the cheeseburger and broccoli salad together, we should expect to get a number that is a combination of both the cheeseburger and broccoli salad number, approximately 830 calories, right? Wrong. This is not what happened. Instead, the combined meal group estimated that the cheeseburger-broccoli combo had 583 calories. That's 178 calorie LESS than the cheeseburger alone group. What seems to have happened is the averaging bias and the halo bias. The broccoli's perceived health benefits contrived to produce a lower estimate for the combined meal.

Just to be sure, they asked another group to compare a cheeseburger and a cookie in the same way. The cookie had the effect we would expect, causing the combined meal to be perceived as the highest calorie option.9 To read more about these studies and biases, see the references below.

Basal Energy Expenditure, BMR, and Resting Energy Expenditure: What's the Difference?

As I explained above, one of the three main components, and really the main component, of your daily energy expenditure is your resting energy expenditure. Yet, you may not have come across this term before, and instead have been exposed to the terms basal energy expenditure and/or basal metabolic rate. Many times these terms are used interchangeably. Most fat loss experts on the internet tend to prefer the term basal metabolic rate, or BMR, for short.

You may have seen formulas, such as the Harris-Benedict Formula (Equation) that are used to determine your BMR. Well, unless you fast a lot and never get out of bed, this is a bit incorrect, in more ways than one. The terms "resting" and "basal" do not quite mean the same thing, when used in these terms.

Both resting and basal energy expenditure are estimates of the energy needed in a 24 hour period.
Basal refers to the minimal level of metabolism needed to keep your alive. Resting refers to Basal energy expenditure and is usually measured in a clinical setting, while lying at rest after a good sleep, after at least a 12 hour fast. Also, the environment is thermo-neutral so that the subject does not produce heat by shivering. The basal metabolic rate is measured and this is extrapolated to a 24 hour period. RMR is a a bit different and researchers usually measure this about 3 or 4 hours after a person eats or does significant physical activity. The RMR is measured and this is extrapolated to a 24 hour period. So, the RMR, and thus the REE, is slightly higher than the BMR and BEE. But, it's really not that significant.

As you probably guessed, the whole basal thing is a bit impractical, having to meet ideal conditions and all of that. It is okay to use these terms interchangeably but what we really want, technically speaking, are estimates of our resting energy expenditure, combined with our TEF and the energy used in physical activity.

Comments

by EricT

Ergolytic is the opposite of ergogenic. It is derived from the Greek word, ergon, meaning "work" and -lytic, which is the adjective form of the Greek word lysos, meaning "loosing, dissolving, or dissolution." The term ergolytic is used to refer to an agent, device, or factor that impairs athletic performance rather than enhances it. This impairment can be the result of physiological or psychological factors. Some common ergolytic agents are alcohol, tobacco (including smokeless), and marijuana.

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Some supplements or other products that are thought to be ergogenic for one aspect of performance may be ergolytic for other aspects of performance. For instance, although creatine is thought, with good evidence, to enhance short-term anaerobic metabolism, it has been suggested that this increase could produce more lactate and subject an athlete to more lactic acidosis.

Diet can be potentially ergolytic. A caloric excess resulting in weight gain, for instance, could impair performance for endurance athletes and relative strength athletes. A diet without adequate carbohydrate could impair performance for an endurance athlete, as well. The following sections discuss other potentially ergolytic products.

Beta Blockers

Beta blockers are used as an ergogenic aid in archery and shooting, but will likely impair performance, perhaps greatly, in endurance and strength athletes. These drugs, such as Inderal (propranalol) and Tenormin (atenalo), are used to treat high blood pressure. These drugs attenuate the heart rate and blood pressure response to exercise and also decrease tidal volume, increasing respiratory rate. They can speed time to exhaustion and impair the body's ability to regulate temperature. It is possible that some eye drops used to treat glaucoma, such as timilol, another beta blocker, may be absorbed into the body and worsen performance.

For more on beta blockers see Peformance Enhancing Drugs Other Than Anabolic Steroids Used in Sports. Most of the substance used as ergogenic aids discussed there are also potentially ergolytic, because of their often serious side-effects.

Calcium Channel Blockers

Calcium channel blockers are blood pressure and angina medications such as Diltiazem and Verapamil. They decrease heart rate response to exercise and may decrease myocardial contractility.

Alpha blockers are other blood pressure medications that are potentially ergolytic.

Antihistamines

Anthihistamines are commonly used over-the-counter remedies for cold and allergy symptoms such as diphenhydramine, chlorpheniramine, and loratadine. They can cause drowsiness, which would certainly impair performance. They can also decrease psychomotor performance.

Antacids

Other common over-the-counter medicines may also be ergolytic. Among them are antacids such as Tagamet (cimitidene), which has been found to be anti-androgenic to a small number of men, causing breast enlargement and inhibited sexual function. Interference with testosterone could reduce muscle mass and interfere with performance.

Caffeine

Caffeine is one of the most widely consumed drugs in the world, readily available in coffee, tea, and soft drinks, is also one of the most wildly popular ergogenic aids, with proven benefits to performance. However, it can also become an ergolytic for several reasons.

People who are not used to caffeine or consume it in very large doses may experience nervousness, tremors, restlessness, insomnia, headache, and gastrointestinal problems. Disrupted sleep patterns can obviously impair performance. Since it acts as a diuretic, it may put athletes at risk for dehydration in hot environments. Also, caffeine is physically addictive, and abrupt cessation of use can cause severe headache (caffeine headache), fatigue, irritability and gastrointestinal distress.

Inosine

Inosine is a purine based nucleotide which is a structural component of ATP. It is obtained in the diet or produced endogenously in the body. It has been marketed as a dietary supplement and claimed by manufacturers to increase ATP stores, and so increase muscle strength and training performance. It has also been said to increase oxygen delivery to the cells to improve endurance. This is based on the role that inosine plays in the formation of 2-3-diphosphoglycerate, a substance in erythrocytes that facilitates the release of oxygen to the tissues. Other benefits have also been postulated. No studies have provided support for these claims or theories and one study found an ergolytic effect, where time to fatigue was decreased. Perhaps more importantly, it increases uric acid levels to amounts associated with gouty arthritis, which cause joint pain, particularly in the knee and foot.

References

Kenney, W. Larry., Jack H. Wilmore, David L. Costill, and Jack H. Wilmore. Physiology of Sport and Exercise. Champaign, IL: Human Kinetics, 2012.

Baker, Arnie. Bicycling Medicine: Cycling Nutrition, Physiology, and Injury Prevention and Treatment for Riders of All Levels. New York: Simon & Schuster, 1998.

Miller, Mark D., Jennifer A. Hart, and John M. MacKnight. Essential Orthopaedics. Philadelphia, PA: Saunders/Elsevier, 2010.

by EricT

During high intensity anaerobic events, the muscles fatigue and energy supply is compromised because of the buildup of lactic acid from glycolysis. Athletes in high intensity events that last 2 to 10 minutes, such as a 400 to 800 or 1500 meter running races or middle distance swimming races sometimes use soda loading in an attempt to neutralize the lactic acid that accumulates in the blood. Depending on interpretation of the research, some experts suggest that the benefit is limited to events of 1 to 7 minute duration. Soda loading is also called buffer boosting or bicarbonate loading. It is also called, more rarely, soda doping or simply acid buffering.

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The theory is that since sodium bicarbonate (NaHCO₃) is an alkaline salt that appears naturally in the blood and has the role (among others) of buffering lactic acid, loading the system by ingesting large amounts of baking soda (sodium bicarbonate) in advance of the event should increase the amount of sodium bicarb in the blood, making it more alkaline and therefore increasing anaerobic endurance by limiting lactic acid buildup and/or hydrogen ions (H+). The accumulation of both of these is believed to inhibit muscle contraction and metabolic processes, resulting in fatigue and the inability to continue working at the same intensity.

The practice of soda loading is not new; it has been used for at least 70 years. Sodium citrate or sodium lactate loading is also used and widely advocated. There is no reason, whatsoever, that soda loading will help a maximum strength athlete performance of a 1RM as lactic acid buildup is not a factor in the time frame involved. However, the practice has found it's way into bodybuilding in an attempt to increase the volume of resistance training performed.

Doses of 0.3 grams of sodium bicarbonate, 0.3 to 0.5g sodium citrate, or 0.4g of sodium lactate per kilogram of body weight is ingested 1 to 2 hours before the event. These doses should elevate blood pH for up to 3 hours after ingestion, peaking at 1 to 2 hours.

Research into the question of whether the blood acid buildup (decreased pH) of the blood during high intensity anaerobic exercise could be attenuated have been going on for many years and studies regarding the administration of alkaline salts started at least 70 years ago. There is some evidence that this practice provides small results, as may be useful for an elite athlete, where the gain of 1 second can be significant. Around half of studies performed showed a beneficial effect, ranging from 2 to 62%. The very good results tend to occur only in the earlier studies, most likely because these studies were not well designed. Not all research studies have found a benefit, however, and the existence of any actual ergogenic effect is controversial. The benefit varies depending on the actual intensity of the exercise. It seems likely that any actual benefit is individual, causing some to speculate that certain people may be "non-responders". The idea of the non-responder is often used to explain inconsistent results with ergogenic aids, however, and should be met with skepticism. Although the amount of research is vast, the answer as to whether it works is still "maybe."

Doping Status

Soda loading is not banned at this time by any athletic organizations but it is likely to be banned in the near future as it clearly goes against most doping regulations. It is certainly in violation of the USOC/IOC doping law which prohibits the "administration or use by a competing athlete of any foreign substance to the body or of any physiological substance taken in abnormal quantity or taken by an abnormal route of entry into the body with the sole intention of increasing in an artificial and unfair manner his/her performance in competition." Here, sodium bicarbonate loading would be the use of a "physiological substance" in "abnormal amounts" and this clearly qualifies it as a banned practice. According to the law, although it isn't explicitly banned by the Olympic committees, it is illegal, it is just not tested for.

However, the use of sodium bicarbonate for the treatment of an upset stomach or to treat metabolic acidosis is perfectly reasonable. Small doses would be used for these treatments and very large doses are used for bicarbonate loading. Should it be banned, excess bicarbonate can be easily detected in the urine.

The practice is banned in dog and horse races.2,1

Side Effects

The side effects of soda loading may well offset any small benefit you get. As early as one hour and as late as 3 hours after ingestion, urgent diarrhea will occur in about half of users. Bloating and gastrointestinal cramping is also likely, as well as nausea and dizziness. There is also a significant gas development. The gastrointestinal symptoms are most likely due to a large amount of water being drawn into the intestines to counter the sodium load imposed on the gut.3,2 Consuming large volumes of water, as desired, may help to minimize these symptoms. It is also suggested that the dosage of 300mg/kg of body mass be divided into five equal parts over a one to two hour period.4

Metabolic alkalosis can occur when the blood reaches a very high pH (decreased H+ concentration) and a high plasma bicarbonate concentration. A loss of H+ or a gain of bicarbonate both can cause this condition, and the intent of soda loading is both. Excessive alkali ingestion from antacids containing bicarbonate or from using sodium bicarbonate during cardiopulmonary resuscitation have been known to cause metabolic alkalosis. Very large doses, especially ongoing ones, could be dangerous in this regard, although any harmful effect should be ameliorated by ceasing the loading of bicarbonate. Muscle weakness and spasms, vomiting, irritability, and even convulsions could occur, although unlikely.

There is no knowledge of the long-terms effect of this practice.3,2

General Statements about Bicarbonate Loading

• Optimal dosage seems to be around 300mg/kg body weight.

• Higher doses, although they may be more effective in some cases, usually result in gastrointestinal symptoms

• Bicarbonate loading does not enhance single bout performances of high intensity exercise of less that 50 second duration (a maximal lift, for instance)

• Bicarbonate loading does not seem to help with single bouts of submaximal intensity

• Bicarbonate loading may enhance performance during short-duration high-intensity exercise, if the exercise is sufficient to challenge the bicarbonate buffering system.3

by EricT

The Double Progressive System is a resistance training method that attempts to vary the stimulus by changing the number of repetitions and the resistance used. At first the resistance is kept the same and the number of repetitions is increased with each consecutive workout, until a certain per-arranged number of reps is reached. At this point, various scenarios are given as to how to continue, but all of them involve decreasing the reps and increasing the resistance. A common scenario would have the lifter simply increase the load by 5% and reduce the number of reps back down to the initial low starting point, and then repeating the process.

Other times, the resistance is increased and the repetitions are reduced gradually while continuing to increase the load. Supposedly, the method used would depend on the population being trained.
An example of this method is given in the chart below. The idea is that the load should not be increased until a certain number of repetitions (usually 12) can be performed with that load, and then the load can be increased, but with lower reps. This is a single-set system of training, primarily, although sometimes multiple set scenarios are described.

Although this "system" is frequently given as a set in stone method, essentially there are only a few things that are constant:

1. Two variables are manipulated, reps and weight (resistance).
2. The reps are increased with constant load until a certain number of reps can be performed.
3. The load is increased by a certain percent (most often 5%), which has the effect of decreasing the number of reps that can be performed.
4. The reps are built back up.
5. Sometimes, the load continues to increase while the reps are decreased, in a kind of "peaking" arrangement.

Essentially, you first add repetitions and then you add resistance. The concept is completely sound. However, the methods used are often short-sighted and result in frequent stalls. The term, and this type of training, has been described since the early 70's. A typical example is given below.

It is unlikely that most trainees will be able to constantly increase repetitions in this way. Most often, the trainee will get "stuck" at a certain number of repetitions. Therefore, one problem is that the number of target repetitions is set in stone.

Another variation uses one-set-to-failure. One set of exercise is done to the point that another repetition cannot be performed with proper technique. The weight is set so that this failure point is reach from between 8 and 12 repetitions. When 12 reps is reached, the weight is increased.

A more "scientific" method is to calculate the ideal rep range, advocated by Arthur Jone and Ellington Darden, early on. In this method you take 80% of your one rep max, which corresponds roughly to a hypothetical 8RM based on the widely accepted formula of 102.78 - 2.78 x repetitions. and do as many reps as you can. Then you take the number of reps and multiply it by .15, giving you your "ideal rep range."

A double progressive system such as this is often touted as being a superior way of training for strength as it allows constant uninterrupted progress and is "virtually" injury proof. Neither statement is true and there is no evidence that this method of strength training is effective for the long term. For free-weight training, there are a number of drawbacks even for the beginner. The total stimulus is actually quite low. The "slow" progress gives a false sense of security when the load is increased and the constant rep counting, without concurrent buildup of endurance, can result in low quality movement. This method of strength training, used alone, is not recommended.

The DeLorme System - Double Progressive Overload

It should also not be confused with the concept of "double progressive overload" which is sometimes used to describe an idea that was advanced as early as the 1940's by Dr. Thomas Delmore, who claimed that the most effective method for gaining muscular strength was to use 3 sets of 10 repetitions, increasing the load used by 25%. This so-called DeLorme System is actually a percentage based system, which starts at 50% of 10RM, increases the load to 75% for the second set, and up to 100% for the third set.

SDT Training

Do not confuse this "double progressive system" with the double progression that may occur in "SDT Training" (Single, Double, and Triple Progression).

Comments

by EricT

The term anorexia nervosa comes from the Greek word for "lack of appetite" and a Latin word implying a nervous origin. It is a major emotional eating disorder and is characterized by three main criteria:

• Significant self-induced starvation, or near-starvation
• An extreme desire for thinness or being extremely afraid of becoming fat
• The presence of medical signs and symptoms resulting from starvation

The short-hand anorexia is often used for this condition but this term only denotes loss of appetite as a symptom, and can occur as a result of many medical conditions. It is important, then, to recognize that anorexia nervosa describes an emotional disturbance resulting in anorexia, and not just any extreme lack of appetite. The term anorexia may also be misleading in the early stages of the disorder, since lack of appetite rarely occurs early on.

Those with anorexia nervosa sometimes eat only minimal amounts of food, causing body weight to drop dangerously. They may perceive themselves to be fat, or be extremely afraid of becoming fat, even though they may look perfectly normal to everyone else or even be very thin or emaciated. This perception and fear is accompanied by depression. Signs of anorexia include obsessive exercise and calorie or fat-gram counting. Like bulimia nervosa, self-induced vomiting may occur. In fact, only half of those with the disorder will lose weight by drastically reducing calories alone. The other half will use extreme dieting along with binge eating and purging behaviors. Some will purge even after eating only small amounts of food. It is also possible for bulimia nervosa to occur as a separate, but concurrent, disorder. Signs of depression, anxiety, and irritability usually occur.

Many sufferers may use alcohol and other drugs to help cope with the psychological distress, anxiety, guilt, depression and shame. Also, appetite suppressant drugs such as diet pills, methamphetamines, cocaine, nicotine may be used. Diuretics may be abused to control "water weight" and laxative abuse is common as well.

Usually beginning in adolescence, anorexia nervosa is much more prevalent in females than males, by 10 to 20 times. It has been reported to occur in up to 4 percent of adolescent and young adult students and has been reported more frequently in recent years, with prepubertal onset becoming more common, although the most common age of onset is midteens (14 to 18 years) with about 5 percent occurring in the early 20's. It is estimated to occur in 0.5 to 1% of adolescent girls.

Other Signs and Symptoms

• Rapid weight loss occurring over several weeks or months
• Continual dieting even though the person is very thin or when weight is very low
• Intense fear of or preoccupation with gaining weight
• Often eating in secret or having other strange eating habits or rituals
• A seeming obsession with food, calories, or nutrition
• Very interested in cooking and the desire to cook large gourmet meals for other which they rarely consume themselves
• May often express that they "feel fat", regardless of actual weight
• Unable to objectively assess their own weight
• Overly self-critical, self-loathing, or perfectionist attitude
• self esteem tied into body shape or weight
• Frequent illness due to malnourishment
• Loose baggy clothing to hide the weight loss
• Social withdrawal
• In females, infrequent or irregular menstrual periods (it is important to note that endurance training in female athletes can also cause this "amenorrhea " and therefore this symptom alone should not be taken as a sign of anorexia nervosa)
• Sleep disturbances including insomnia, early morning waking, or oversleeping

Physical signs other than low body weight

• Raynaud's syndrome: tips of fingers and toes cold and red, or white and blue in color, due to poor circulation
• Irregular heartbeat
• Low blood pressure
• Low body temperature
• Lanuga hair: a fine layer of hair covering the body, grown to help create body heat in the absence of body fat and muscle
• Dry skin
• Brittle nails
• Thinning hair on scalp
• Caluses forming on hands
• Constipation or diarrhea
• Yellowing skin

Associated Disorders

• Bulimia nervosa
• Body dysmorphic syndrome
• Depression
• Social phobia
• Obsessive compulsive disorder

Mortality

Anorexia nervosa has the highest death rate of any eating disorder. Among those followed for a sufficient length of time, up to 20% die as a result of the disorder, whih around 55 dying within 10 years of onset. Up to 30% of these deaths or suicides, and anorexics are 50 times more likely to commit suicide than the general population.

Treatment

Many people with anorexia nervosa will actively refuse treatment. As an ethical dilemna is inherit in treating a disorder that is an irrational drive to lose weight or remain thin when that person does not wish to be treated, initial assessment and treatment are often delayed for months or years. when treatment is undertaken, it is often due to the demands of loved-ones and the patients often drop out of treatment. When treatment is accepted, any components that involve increasing food intake, gaining weight or reducing physical activity may be resisted, even though psychotherapy and family therapy may be accepted. It is also not uncommon for treatment to be accepted, even in a inpatient setting, but the treatment protocols to be subverted in secret. Patients might throw out food, secretly use laxatives, or refuse certain treatments. When treatment is forced, an anorexic might use legal means to protect themselves from being treated.

Although the full legal and ethical considerations of treatment are beyond the scope of this explanation. One of the main ethical issues in the refusal of treatment is the issue of competence and the concept of autonomy. Even though family and friends find it difficult to watch their loved one engaged in behavior seen as foolish, destructive, and even deadly, it is generally agreed that patients who possess the competence to make treatment choices should be allowed to do so. So the question is whether someone suffering from anorexia nervosa has the capcitiy to understand and make rational treatment decisions. Determination of the right to refuse treatment is associated with foru main elements:

• the potential risk of the condition
• the likely benefit of treatment
• likely harm of treatment
• competence of the individual to make a reasonable medical decision

Although many anorexics might accept treatment during an emergency crisis precipitated by their condition, there is a difference between recognizing an emergency and identifying an impending emergency. Therefore, the potential risk component of competence is not as clear-cut and "obvious" as one might think. In fact, some deaths from anorexia nervosa occur after very little clinical warning, such as a sudden cardiac event. The following signs and symptoms could be used to determine the need for immediate medical attention:

• Rapid weight loss of greater than 15lbs in four weeks
• Seizures
• Fainting episodes
• Organic brain syndrome
• Slow heart rate of less than 40 beats per minute (bradycardia)
• Frequent chest pain from exercise
• Heart dysrhythmia
• Kidney dysfunction or low urine output of less than 400cc per day
• Excess loss of body fluid and a rise in blood sodium levels (i.e. volume depletion)
• muscle spasms caused by low blood calcium (tetany)
• rapid diminishing of exercise tolerance

Prognosis

Many anorexia nervosa patients recover, and sometimes recovery occurs spontaneously. Those who receive treatment in specialized anorexia nervosa programs seem more likely to recover than those treated in generalized programs. The results of treatment, however, cannot be reliable predicted at this time. It is clear that the results of short-term intervention such as refeeding and psychiatric treatment does improve quality of life for the short-term, but long-term prognosis is generally considered to be guarded. The earlier treatment is undertaken, the better the chances for recovery.

Athletes and Anorexia Nervosa

Female athletes, especially, can suffer from anorexia nervosa, especially in those sport which emphasize and require low-body weight, thinness, or a certain body image, such as ballet, gymnastics, figure skating, long distance running, and other endurance sports. However, disordered eating often occurs in serious athletes which is not necessarily anorexia nervosa or another eating disorder, but a unique but associated manifestation of ahtletics. This has been given its own term: anorexia athletica. For more information see Female Ahthletes - Eating Disorders.

Further Resources

National Alliance on Mental Illness. http:///www.nami.org
National Association of Anorexia Nervosa and Associated Disorders. http://www.anad.org
National Eating Disorders Association. Anorexia Nervosa. http://www.nationaleatingdisorders.org

by EricT