Dental Health and Performance

When I run workshops for young athletes encouraging them to take care of their general health and wellbeing, I advise them to look after their teeth and to visit a dentist regularly. Right on que, a hand will go up (often one of a parent), and I can predict what the next question will be. “What have teeth to do with performance?”

Yes Eliz, what have teeth to do with performance?

Well let me start with an extreme case. Alan Campbell…. British rower….training for 2008 Beijing Olympics…abscessed lower-left wisdom tooth… disaster! The infection from the abscess spread to his shoulder, back and later his right knee. The knee required surgery two months before the games and required Campbell to miss six weeks on-water training, in the run-up to what was meant to be the biggest race of his life. 

Campbell finished fifth in the single-sculls final in what may, forever, have been a case of ‘what could have been’. Thankfully, this story has a happy ending. Campbell won bronze in London four years later. And learned an important life lesson in the process: our teeth can not only ruin our sleep, they can trample all over our dreams.

Campbell’s case is not an isolated one. Empirical (controlled scientific studies done by the scientists) and anecdotal evidence (observations of those in the know, this case people like dentists) suggests that athletes have poor dental health. Their finely honed bodies, often epitomising the very picture of health, often cover up a mouth full of bad teeth.

Causes

There are a number of proposed reasons why high-performance athletes have bad teeth, though little research has been done specifically on the causes of poor dental health in athletes.

Direct impact or trauma is a major cause of dental morbidity in sportspeople. Impact sports such as hockey, basketball and rugby have a high incidence of broken teeth, and worse. 

This is the obvious stuff. But there is substantial poor dental health even in those who participate in sports which involve no person-to-person impact.

The high volumes of carbohydrates required to meet energy demands can have a negative effect on teeth, particularly when a large portion of those carbohydrates come in the form of sugary, acidic sports drinks, gels and energy bars.

Physiological changes which occur during exercise may also play a role. These include decreased salivary flow and drying of the mouth (saliva is needed to regenerate tooth enamel) and exercise-induced immune suppression.

Grinding of teeth when lifting weights, or generally at night from stress, may also wear down teeth.

And then there’s the practical things like not making oral health a priority. Frequent travel may lead to busy high-performance athletes missing their regular check-ups, or pushing them down the to-do list. 

And then there’s the expense of keeping your teeth in check. Athletes struggling to make ends meet may simple not be able to afford regular check-ups or the cost of any follow-up maintenance work required.

The role of eating disorders, particularly bulimia, which is not uncommon in sport, cannot be overstated. Stomach acid, which will come in contact with teeth during vomiting, has a catastrophic effect on teeth, and can erode away dental enamel in a relatively short time period.

Something else to bear in mind is that individuals generally have the most trouble with their teeth, especially problem wisdom teeth, from the early twenties to their mid-thirties, the age bracket in which the vast majority of high performing athletes fall.

Effects

Dental health has a direct effect on general wellbeing and quality of life. The effect on sports performances can be both direct and indirect. 

Pain - from sensitivity, cavities and abscesses -  is the most obvious consequence of poor dental health. This can lead to sleepless nights, effecting performance and training, and indirectly leading to an increased risk of injury. Pain and dental discomfort can affect eating, and can have psychological impact on performance.

Tooth and gum infections can lead to systemic inflammatory response – a condition which is closely related to sepsis – and which isn’t good for either your general health or your sporting performance. 

A mouth full of bad teeth can also make an individual self-conscious which doesn’t do much for confidence.

Recommendations

• Brush and floss regularly

• Have regular dental check-ups. Use the off season to get any work required done.

• If you participate in an impact sport, always wear a custom made mouth guard in potential impact situations (games and contact training)

• If you find yourself grinding your teeth at night, seek help, both in reducing the stress that is causing the grinding, but also in protecting your teeth. You may need to wear a mouth guard at night.

And keep smiling!

Some further reading:

Oral health and elite sport performance A Consensus Statement, Needleman et al, 2015.

'Garbage mouth': Why many Olympic athletes have terrible dental problems Leicester, 2016. 

Milk.... The Perfect Recovery Drink?

Athletes of all abilities are looking for marginal gains, for the added extras that will improve their performance. When exploring marginal gains, diet is one of the first areas to look at. And athletes who are spending lots of time training, travelling and competing need to ensure they have a diet that is meeting their nutritional demands. They often turn to supplements as a quick fix to filling any nutritional gaps. Trying to fill these gaps with a natural source will not only be a cheaper approach, but may also be a healthier one, and some natural foods may also provide nutritional benefits beyond those intended.

Milk is one of these foods and may well be a suitable alternative to many sports drinks on the market. In terms of recovery products, there is none better than milk!

What is milk made up of?

Milk is a nutrient dense food containing lactose, proteins, fats, minerals, vitamins and water. Lactose, the major carbohydrate present, is essentially only found in milk. Milk contains a number of specific proteins, but the most common is casein, which compared to other proteins is very digestible in the intestine. Like eggs, milk also provides all nine essential amino acids. Calcium and phosphorous are the major minerals found in milk, and there are relatively small amounts of most other minerals required by the body, including zinc, magnesium, iron and copper. In addition, compared to other beverages, milk contains relatively large quantities of the electrolytes sodium, chloride and potassium. Milk contains varying quantities of many vitamins, including the fat soluble vitamins A, D, E, and K, found primarily in the milk fat.

Milk and performance

Due to issues relating to ease of consumption, the speed of release and the palatability of milk, it is less popular as a sports drink immediately before and during exercise and commercial sports drinks often become the preferred choice. But it's as a recovery drink that milk really comes into its own, and elite athletes often consume bottles of flavoured milk or milkshakes immediately after training or competition.

Post Recovery Nutrition

Many athletes will be familiar with the ‘golden window’, the period 30-60 mins immediately following exercise, during which nutrition can aid recovery. Refuelling correctly during this period is vital to those who may be training or competing more than once a day.

Recovery includes a number of processes, and milk can play a role in all of these:

1. Refuelling the muscle and liver glycogen stores (carbohydrate):

Athletes should aim for around 1g carbohydrate per kg of body weight to help refuel after exercise. Around 600ml of milk will provide 50g of carbohydrate, approximately the same amount as around 500-700ml of a sports drink (depending on the brand).

2. Replacing the fluids and electrolytes lost in sweat:
Athletes should aim to replace around 150% of their sweat lost during the 4-6 hours after training or competition. They should also replace the electrolytes lost in sweat, to ensure that fluids taken on board aren't just excreted in the urine. As well as being 87% water, milk is also a source of sodium, potassium and magnesium, all important electrolytes. Some but not all sports drinks contain electrolytes.

3. Manufacturing new muscle protein, red blood cells and other cellular components as part of the repair and adaptation process:
Early intake after exercise (within the first hour) of essential amino acids from good quality protein foods helps to promote protein rebuilding. Though research into the optimal type (e.g. casein versus whey), timing and amount of protein needed to maximise the desired adaptation from the training stimulus continues, most agree that both resistance and endurance athletes will benefit from consuming 15-25g of high quality protein in the first hour after exercise. Adding a source of carbohydrate to this post exercise snack will further enhance the training adaptation by reducing the degree of muscle protein breakdown. Around 300ml of milk contains 10g of naturally occurring protein and amino acids.

4. Allowing the immune system to handle the damage:
Ensuring adequate carbohydrate stores before exercise and consuming carbohydrate during and/or after a prolonged or high intensity workout has been shown to reduce the disturbance to immune system markers. The carbohydrate reduces the stress hormone to exercise, thus minimising its effect on the immune system, as well as also supplying glucose to fuel the activity of many of the immune system white cells. Milk provides a good source of protein and carbohydrates as well as a number of key vitamins and minerals to enhance the immune system and support overall health.

Milk can play a role in all the key recovery processes, is a naturally occurring product, supplies a number of key nutrients, and is cheaper than many sports drinks and recovery supplements. It could well be the best sports drink available!

Training during illness

Following the immunity theme, and while cold and flu viruses are doing the rounds, I thought it would be sensible to do a piece on how athletes can manage their training during this time. We all know that athletes are tough cookies, especially endurance athletes, and try to get out and train no matter what.  This, however, is a bad idea when you have a cold or virus! It is better to back off for a few days rather than end up with a much more serious condition.

One general rule is that light exercise is OK if all symptoms are above the neck, including a mild sore throat, stuffy nose and headaches. If any of the symptoms include a very sore throat, fever, fluid in your lungs, coughing, body chills and aches, exhaustion, diarrhea or vomiting, athletes should take a day off from training. If complete rest is more than you can handle, light general stretching may help.

If athletes are too ill to train, athletes should rest, drink plenty of hot fluids and still try to eat healthy, even if there is no appetite.

Once the below-the-neck symptoms have resolved, athletes should wait an additional day before resuming training.  The initial workout should be a light recovery-paced session, as should all exercise until all of the above neck symptoms disappear, and resting heart rate has returned to normal. Gradually build the intensity and duration of the sessions, paying attention to recovery, hydration and nutrition.

Hopefully the disruption to your training will be minimal and a regular routine will shortly follow. You won't loose a substantial amount of training in the 5 to 7 days that it normally takes to overcome a common cold.  In fact, with adequate rest and recovery, you may come back stronger than ever.

Related Posts:

Christmas and the Immune System
BCAA and Immunity
Immunity and the Athlete

Christmas and the Immune System

While we are on the theme of immunity and staying healthy over Christmas, here are a few pointers which may help with immunity during the busy festive time, when the normal training routine is often disrupted.

Christmas is the season to celebrate; there can be lots of late nights with visits and Christmas parties to be enjoyed. A lack of sleep, too much stress, eating poorly and being in contact with people who may be ill, all increase the risk of illness.

1. Stay hydrated

Make sure that you drink plenty of water as well as your other drinks so you stay hydrated and try to drink water as soon as you can when you wake up to rehydrate.

2. Plan when you train

With clubs and sports centres taking closed over Christmas, athletes often have greater flexibility with when they train.  Plan your training so that hard sessions don't follow late nights.  It's also a good idea to train in the morning before visitors and distractions makes you have to choose between doing your training and enjoying Christmas.

3. Moderate your diet

Some of the foods associated with Christmas do offer good nutritional content, its just about moderation and not over indulging in the bits - such as chocolates and sweets - which may have a lower nutritional content.

• Cranberries - High in Vitamin C, which is great for immity, and anti-inflammatories
• Turkey - Good source of protein and is often leaner than other sources of meat protein
• Parsnips - Excellent source of Potassium, which regulates hydration and is involved in muscle contractions
• Salmon - Sometimes an alternative choice at Christmas and a good source of omega 3 fats
• Carrots - Excellent source of antioxidants, beta-carotene, Vitamin A and Vitamin C
• Brussel Sprouts - Often a Christmas must - but are also a great source of Vitamin C
• Walnuts - Perhaps cracked open as a post-lunch snack - but a great source of Omega 3 fats

Fruit salad, dried fruit and salads are also good, nutrition-packed food options, which offer some protection against Christmas colds and viruses.

So enjoy your Christmas meal and the celebrations.

BCAA and Immunity

Two weeks ago I wrote a piece on how to improve immunity during the winter months, focusing on training load and recovery, environment, psychology, clinical conditions and diet and lifestyle. In the coming weeks, I will look in more detail at the nutrients that can improve immunity, and outline ways to ensure adequate intake and variety of these nutrients to maintain health and help training and recovery. I'll kick things off by referring to a blog post that I wrote earlier this year on Branch Chain Amino Acids, a vital group of nutrients for health and recovery.

Peanuts and almonds are both good sources of Leucine, one of the three Branched Chain Amino Acids.