The Female Athlete Triad

For many athletes, participation in exercise is a healthy pursuit.  Unfortunately, for a significant proportion, exercise can lead to, or exacerbate one or all of the trio of conditions which constitute what is termed the Female Athlete Triad.  This blog looks at the triad, highlights why it should be of concern to female athletes and their coaches, and suggests some interventions to prevent or treat the conditions of the triad.

The condition comprises the following:

1. Disordered eating or an eating disorder 
2. Low bone mineral density, usually in the form of osteopenia (less severe) or osteoporosis (more severe) 
3. Absent or irregular menstrual cycles (olgiomenorrhoea or amenorrhoea)

According to the American College of Sports Medicine (ACSM), the triad is interrelated in aetiology (causes), pathogenesis (symptoms), and consequences.  The triad can result in long-term medical and psychological illness, as well as in short-term declines in physical performance.

Stress fractures, related to declined oestrogen levels, an insufficient diet and subsequently reduced bone mineral density are a major concern for athletes, and anything that increases osteoporosis, a highly debilitating disease which increases with age, is of major concern to society. 

 

Body composition, eating disorders and disordered eating

Body mass and body composition can be a major obsession of athletes in certain sports, particularly those related to those which are subjectively scored (figure skating, diving, synchronised swimming, body building and gymnastics), those where a lean body mass and low can help performance (high jump), endurance sports associated with low body mass (distance running, cross country skiing), weight-restricted sports (lightweight rowing, boxing and some martial arts, horse racing), and sports which require reviling clothing during performance (cheerleading, diving, swimming, beach volleyball and gymnastics).  Athletes in these sports are particularly susceptible to disordered eating and eating disorders.

A low percent body fat can directly lead to menstrual dysfunction, and low bone mineral density.  Practices, such as restricted or unhealthy eating practices, insufficient calorie intake, insufficient mineral intake, obsessive exercising and eating disorders, which lead to low body mass, can have additional indirect effects on menstrual health, and bone mineral density.

Eating disorders in themselves can lead to severe morbidity, and even death.  Anorexia nervosa and bulimia nervosa are severe psychological illnesses, and require early diagnosis and treatment to limit the long-term effects of the sufferer.  Individuals who develop an eating disorder enter a downward spiral of self-destruction and denial and obsessive behaviour, and the longer it goes untreated, the more difficult it is to break out of the situation.

Anorexia nervosa can be caused by a number of reasons, and suffers will require professional treatment relevant to the source of their illness.  Though clinical eating disorders may not be much more prevalent in sport than in the general population, a range of sub-clinical form of eating issues, known collectively as disordered eating, or anorexia athletic, are extremely prevalent in sports people.  Suffers often intentionally attempt to reduce their weight because they perceive it to be important in their sport, and engage in unhealthy practices to do so.   Disordered eating can lead to menstrual dysfunction, low bone mineral density, impaired performance and a range of other illnesses, and injury risks.

Some warning signs include:

• Excessive concern about body size or shape
• Noticeable fluctuations in weight
• Changes in ‘normal’ eating behaviours
• Obsession with food
• Eating alone
• Excessive exercising
• Depressed mood, low self-esteem
• Use of diet pills, laxatives
• Going to the bathroom frequently after meals
• Fear about gaining weight or becoming fat
• Bloodshot eyes, smell of vomit

Amenorrhoea and menstrual dysfunction

Amenorrhoea, i.e. prolonged absence of menstrual bleeding, is probably the most recognisable and easily assessed of the three component parts of the triad.  Sports participation, with or without the co-existence of disordered eating, is shown to be higher in female athletes than their sedentary counterparts.  Low body mass, inadequate energy intake and physical and psychological stress and training history are just some of the proposed contributing factors.  Prolonged menstrual dysfunction, and the associated reduction in oestrogen levels, can have prolonged detrimental affects on bone mineral density.

Bone mineral density, osteopenia and osteoporosis

Bone mineral density, which generally increases in response to impact exercise, can actually be compromised in response to sudden, sever increases in training volume, low oestrogen levels, insufficient nutrient intake and low body mass.  Low bone mineral density is significant, not only because of the long-term risk of osteoporosis, but also because of the short-term injury risk for the athlete.  Stress fractures have been shown to be higher in athletes with low bone mineral density, and take longer to heal in those with contributing risk factors.

Treatment

Treatment is often difficult, as athletes will likely resist increasing body weight and decreasing training loads.  Athletes also find it difficult to admit to menstrual problems and eating problems, particularly if they have spiraled deep into the circle if self-destruction and denial.  Early diagnosis is important.  Treatment of eating disorders, which should be undertaken by qualified staff, is paramount.

Menstrual disturbance should be medically assessed to ensure that it’s not pathological.  The return of menses, which should occur after a reduction in training volume and a return to a healthy body weight is ideal.  A reduction in training volume of around 10% is recommended, though this does vary from one individual to the next.  Energy intake should be increased gradually.

The contraceptive pill and other hormonal medications are prescribed in many cases, but don’t cure the underlying causes.  Bone mineral density has been shown to increase after the resumption of menses, but bone mineral density may never return to normal levels, even after years of regular menses and hormonal use.

Further information

• There is lots of useful information relating to the Triad on the Female Athlete Triad Colation website.
• Some useful information relating to eating disorders can be found on the B-eat website (uk) and on Bodywhys (Ireland).
• The Eating Disorders in Sport research group at Loughborough University also have good information on their website, and look for research participants from time to time.
• UK Sport produced a good downloadable booklet entitled Eating Disorders in Sport which is specifically designed for practitioners and coaches working with high performance athletes.

A number of good books are available for those suffering from eating disorders as well as those supporting those suffering from anorexia and bulima.  These are just some of the options available:

Eating disorders are not exclusive to women, and there is an increasing rate of disordered eating, body
dismorphic disorder and biogrexia among male exercisers. This book highlights some of the issues:

 

Here are some good general books looking at issues faced by female athletes:

 

Striking a balance

Last week I delivered a workshop to a group of sports scholarship students at the University of East London.  The session specifically looked how a student-athlete can set about creating a balance in their lives, an environment which will both help them in their sport and facilitate their development as a human being.  Some interesting discussion followed.  Here is a summary of the key points:

No man is an island

Athletes, like everyone else, live in an ever changing environment, and have to interact with many different people, and balance many different aspects in their lives.  These are just some of the many things that athletes (and particularly student-athletes), need to be good at:

• Managing budgets
• Selling themselves (to funders and potential sponsors)
• Dealing with the media
• Managing their time
• Organising and planning
• Coping with setbacks (bouncebackability)
• Managing relationships (with coaches, teammates, fans, sponsors)
• Coping with pressure (from the press, fans, teammates, self, parents)
• Decision making
• Accepting the uncontrollable
• Negociating
• Striking a balance
• Setting goals

All these skills are required in addition to the physical and mental attributes required for their sport, and more than a good measure of hardwork.  The above factors are just some of the elements which make up the ‘athlete lifestyle’

Getting a balance

The best story that I heard of to demonstrate balance, is the one where the university professor gets two pint glasses, and demonstrates to a group of university students how they can go about getting a balance in their lives.  He takes the first glass and fills it to the brim with water (signifying alcohol or a social life).  Filled to the top, there is no room left in the glass to for anything else; place a stone or pebble in it, and some of the water will flow over the edge.  He takes the second glass, and fills it to the top with stones.  The glass takes 5 or 6 medium sized stones and can take no more.  The glass, it could be said, is full of stones.  With the stones, however, there is still some room of other things.  The professor takes some small stones, and puts as many of them as he can in the glass.  He fits a large handful in.  A handful of pebbles follow, and then a small handful of sand.  Just as the audience think that the glass can hold no more, the professor takes a beaker of water, and manages to fit some into the glass.

The glass can be taken as a metaphor for the student-athlete’s life.  Think of the larger stones as the training sessions, the smaller ones as the lectures and coursework, the pebbles as all the little chores of life like shopping, cooking, and eating, the sand as sleep, and the water as relaxing and social time.  This way around, there is plenty of time to fit everything in.

A good route to striking a balance, can be broken into 5 processes:

1. Set goals

Deciding what you want to achieve, and what you want to get from life will help focus your balance.  Some of the questions that you might want to ask yourself include: what do you want to achieve?  What do you need to do to achieve those goals?  Are  the goals realistic?  Do you have goals in multiple areas of your life (sport, academic, career, other hobbies, life)?  What can be done to ensure that those goals fit together?  Are you following your goals for the right reasons (i.e. are they your goals, or are the goals you think others expect you to achieve).

2. Make a plan

Plans can be set on a daily, weekly, termly, seasonal, or yearly basis.  Some specific forms of planning are included in the timemanagement blog below.  Use the tools and planning process that work best for you.  Constantly consider your goals when planning.  Do your plans work towards your goals?  Review your plans to ensure that you are realistic in what you can achieve on a daily basis.  Identify where you are losing time, or being inefficient (are you spending two hours travelling each day, when the journey would be quicker to cycle? Did you spend time travelling because you failed to pack everything you needed for the day before you left the house in the morning?).

3. Make any important decisions

Student athletes constantly need to make decisions as they attempt to strike a balance in their lives, and often make decisions on a daily basis which they don’t even realise that they are making.  At certain times, however, important decisions which affect one’s goals and plans, need to be made.  Procrastination over making decisions can be an additional source of stress for an athlete, and delaying making the decision can result in missed opportunities.  Athletes should develop sound decision-making skills.  The following task, helps to highlight some of the processes involved in making decisions:

• Pick an important decision that you need to make now, or in the near future
• Consider what happens if you don’t make a decision, or delay making the decision
• List all your available options (include at least one ‘dream’ option i.e. in an ideal world what would you do?)
• List where you can find further information to help you make your decision
• List all the people that you can seek advice from (don’t just include people who will tell you what you want to hear)
• List any factors that you will use to help you make your decision (e.g. your goals, values, abilities, time, financial or family situation, location, things that you will/won’t compromise on)
• Consider what sort of things stop you from making decisions
• After seeking further information and advice, and considering any factors that your decision will be influenced by, choose 2 or 3 viable options from your initial list
• List the positive and negatives for each option
• It will be a lot easier to make a decision once you know what exactly your options are.  Imagine yourself in different situations.

In many cases, there are no right or wrong decisions, just decisions that cause stress because they haven’t been make.

4. Build in relaxation or recover time

Planned recovery time can be far more rewarding and beneficial than ad hoc down time.  Consider how you are going to relax and recover each day, week or season and use recover to refresh and revitalise the mind as well as the body.  Use down-time at the end of the season to cross things off your bucket list that you don’t get to do during the season.

5. See everything as a choice, not a sacrifice

Sport for most is a hobby, and the choices you make to achieve your goals should never be seen as sacrifices.  Choose to be successful.

Hay Fever and Sport

With hay fever season well and truly here, I thought it appropriate to share some advice on the illness.  I, like many others it seems this year, am relatively new to the illness, and am beginning to realise that summer time is not all sunshine so to speak!

Firstly, all high performance athletes who suffer from hay fever, should check that any medication that they take complies with anti-doping regulations.  While there are many over-the-counter and prescription treatments which are permitted, some are not, especially intra-muscular injections with are sometimes prescribed to treat the condition, and products containing pseudoephedrine which is prohibited in competition (e.g. Zirtex Plus Decongestant Prolonged Release Tablets).  Athletes should check the status of any medication (intra-muscular, oral, nasal or otherwise) that they take on their national drug database - www.globaldro.com for medications purchased in UK, including Northern Ireland, USA and Canada and www.eirpharm.com for products purchased in the Republic of Ireland.

Any athlete who is prescribed a prohibited cortiosteriod intra-muscular injection will need to take additional measures, including obtaining documentation to show that such a treatment was necessary, over and above the permitted medications available.  Athletes who are part of their national testing pool (i.e. subject to out-of-competition testing) will need to obtain a Therapeutic Use Exemption (TUE) prior to use, and other high performance athletes will need to obtain and provide TUE permission after testing.

Further information can be obtained here (for athletes in the UK) and here  (for athletes in Ireland).

As well as the potential of failing a drug test, taking hay fever medication can result in drowsiness; not ideal when you're trying to compete at the top of your game!  Any steps that you can take to avoid the symptoms may be better than taking medication.  Simple things like wearing wrap-around sunglasses can help prevent pollen getting the eyes, and can therefor reduce at least one of the symptoms of hay fever.

This article provides useful basic information on hay fever.  Remember though you should always seek medical advice for any condition that you suffer from, and check all medications, even if they have been prescribed by a doctor.

Depression and Sport

I’ve never been so glad to finish a book as when I finally reached the end of A Life Too Short: The Tragedy of Robert Enke.  While on the one hand I couldn’t put the book down, reading it was, at the best of times, an upsetting and difficult process.

The book details the life and death of Robert Enke, a German national goalkeeper who suffered from depression, and who, in 2009, took his own life.

Robert is just one of a number of high performance athletes who have been affect by depression.  Multiple Olympic swimming champion Ian Thorpe, Celtic FC Manager Neil Lennon, and double Olympic Champion Dame Kelly Holmes are just some of the high profile athletes who have made their depression public.  Andrew Flintoff, Marcus Trescothick, Paul Gascoigne and Frank Bruno are just a few other who have been afflicted by the illness.

When exercise is a common treatment for depression, why do so many of the world’s most talented sportspeople suffer depression at some stage in their lives?  It may not be surprising that most athletes suffer some form of 'down' after a major Championship into which they have put their heart and soul, or after retirement, when the world they have been such an integral part of ceases to exist, but this is not normally the type of mood which would cause an individual to take their own lives.

While depression, described as feeling blue, sad, or miserable, may affect most individuals for short periods at some stage in their life, true clinical depression (or major depression) is a mood disorder resulting in feelings of sadness, anger, emptiness, frustration or loss which has a major impact on everyday life for weeks, months or years.

The causes of depression are not fully know or understood.  There is a common misconception that tragic event must occur for an individual to experience depression.  While trauma is one cause of depression, it can also be the result of genetic factors and underlying medical conditions.  Many researchers and medical professionals believe that chemical changes in the brain, caused by defective genes or triggered by stressful events, lead to depression.  While there are strong family links, individuals with no history of depression can suffer from the illness.  The onset of depression most often occurs between the ages of 20 and 30 years, with a second peak between 30 and 40 years of age, though it can affect individuals of any age, even young children.
 
Some of the factors which may be result in a depressed mood, but not always a psychiatric condition include:

• Medical conditions including long-term pain, underactive thyroid, multiple sclerosis or cancer
• Drug or alcohol abuse
• Use of certain medications (e.g. steroids)
• Stressful life events including divorce, bereavement, retirement, menopause, job loss, isolation, child abuse or failing an exam.

Depression alters or distorts the way in which the sufferer sees themselves, their life and their surroundings.  They usually have a negative outlook on situations, and find it difficult to see a positive solution for situations or problems.

Symptoms of depression include:

• Difficulty concentrating
• Becoming isolated or withdrawn
• Irritability, agitation an restlessness
• Fatigue and lack of energy
• Difficulty sleeping
• Dramatic appetite and weight changes
• Feelings of guilt, self-hate or worthlessness
• Feelings of helplessness or hopelessness
• Difficulty sleeping or oversleeping
• No longer finding pleasure in activities that once enjoyed
• Thoughts of suicide or death
• Delusions and hallucinations in extreme cases
• Poor memory and concentration
• Reduced sex drive
• Physical symptoms such as fatigue, digestive problems and headaches
• In the US about half of those with clinical depression also suffer lifetime anxiety

After testing for other underlying physical or medical conditions which may result in similar symptoms to depression, patients are treated with medication and /or councelling or psychotherapy.  Depression may appear no more than once in and individual’s lifetime, and last no more than a few weeks, or could last a lifetime with a number of major depressive episodes.

Tips for those working with athletes:

• The thought of retirement from sport may be a major cause for anxiety among athletes.  Encourage athletes to lead a balanced lifestyle and to prepare early for retirement.
• Ensure that athletes receive psychological support following major championships, during and after retirement, and while recovering from major injuries.
• Avoid placing unnecessary pressure on athletes.  Athletes are often highly self-motivated, and any pressure should come from them, and be manageable.
• Encourage athletes to deal well with problems.
• Create an environment in which athletes always have someone to talk to in confidence (even if that is not you), and provide support where necessary.
• If an athlete is suffering from depression, encourage athletes to seek professional medical help.
• Understand that performance may decrease in athletes who are adjusting to anti-depressant medication.  Create a supportive environment in which they can continue to compete (if they wish), but with manageable pressure.
• Try to understand the illness.

A Life Too Short is a well researched and beautiful account of Robert Enke’s life and death, documented by his friend Ronald Reng, with whom Robert had discussed writing his memoirs.  It details the difficult phases that Robert went through in his life, the changes of environment, the death of his daughter, the late development of his talent, and most importantly how Robert reacted to important transitions in his life.  The real tragedy is that, while Robert received successful treatment for this depression during the first dark phase of his life, it was the fear of his illness becoming public and the potential of loosing his place in the national team that stopped him receiving professional help and treatment at his darkest hour.  With the World Cup in South Africa just months away, Robert couldn’t cope with the thought of his depression becoming public.  In the end, he never made it to South Africa; he was already dead.

The real beauty of the book is that the author puts forward all the facts and details Robert's reactions to certain events, and his perceptions of those around him, but doesn’t try to give all the answers or lead the reader in any way.  In places, the book could not have been more autobiographical if Robert had written it himself, but Reng doesn’t try to fill the gaps that will always exist.  Nobody knows why depression affected Robert at the stages it did, and the author accepts his inability to answer this question. 

I would strongly recommend the book to anyone who thinks that depression only affects the weak or those who are unsuccessful; who thinks that depression doesn’t happen to people like them; who supports high performance athletes; or who would like to understand the disease a little bit more.

Just make sure that you have a box of tissues close to hand.



Some useful resources and reading material:

Louiseellis.com - Loss, retirement and depression in sport
Cycling Weekly - Depression in Sport
Samaritans

Drug use versus training methods: EPO as an example

For some athletes, there is a fine line between modern training methods and the use of banned substances.  For me the difference is clear as day.  Below is my slightly tongue-in-cheek take on the differences between EPO use and altitude training which I wrote earlier this week for another blog.  I use it as an example of how training methods and drug use differ, and hope that it will have athletes confused by the differences between the two.   

In the interest of keeping things simple, when I refer to a drug’s secretion naturally in the body I give it it’s full name (e.g. erythropoietin), and when I’m referring to the drug in it’s synthetic, exogenous or administered form, I refer to it in abbreviations (e.g. EPO).

‘Legalise EPO’ they say, ‘because you can’t ban altitude training, and they’re essentially the same thing’.  ‘The only difference between EPO use and altitude training is that one is banned in sport and that the other isn’t’, I’ve recently heard people argue.  ‘They both increase red blood cells, so they must be the same thing’; a simplistic, and ignorant, statement which not only misinterprets how EPO and altitude training work, but completely ignores the ethos behind drug-free sport.

People’s arguments suggest that if there were different legislators in sport, altitude training might find itself on WADA’s prohibited list, or that one day we might see EPO legalised in sport.  As somebody who has strong anti-doping convictions, but has benefited from altitude training, for me, EPO use, and altitude training are worlds apart. 

To argue that EPO use and altitude training are the same thing because they have similar effects would be the same as saying that steroid use and weight training are similar (they both increase muscle size), and that taking an afternoon nap following training would be just as unethical as injecting HGH, as to do so would cause an increase in human growth hormone secretion and expose the body to it’s benefits.  In fact, hill training, endurance training, recovery runs, fartlek training, plyometrics, good nutrition, heat acclimatisation… and pretty much every other form of training, increases the body’s ability to perform through increased hormone secretion, increased tissue growth and/or increased neural adaptation, and it would be ridiculous to suggest that any of these are on the same moral footing as using banned performance-enhancing drugs.  Training is very much allowed!

The drug EPO is not only banned in sport, but it is a prescription-only drug, designed to help keep individuals with an inability to produce it naturally healthy.  It is not (or at least should not be) available for healthy individuals to purchase and use without medical reason.  Conversely, individuals around the world have the right to be born or live at any altitude at which human life is possible.

The use of EPO is extremely dangerous.  Prolonged or excessive use can have at least two fatal consequences in humans.  EPO increases red blood cell production, and the more red blood cells you have, the thicker your blood becomes.  Blood can in fact become so thick that your heart is no longer able to pump blood around the body.  If that happens, you die.  Additionally, EPO use can affect your body’s natural ability to produce erythropoietin.  Without erythropoietin you can’t produce red blood cells, and without red blood cells you can’t transport oxygen around the body.  Oxygen, I hear, is fundamental for human life (and not just in life involving sport), so that’s pretty crap.  Of course you don’t have to die, but you do become dependant on EPO.  Altitude exposure at or below 3,000m, even over a prolonged period of time, though not without it’s side effects (crazy dreams for example), is unlikely to kill you!

And now to the scientific bit, and the crux of my argument. Just because two things have the same end product, doesn’t mean that they are the same thing, physically, morally or legally.  We’ve already agreed (unless you’re the real argumentative type), that training in sport is allowed, and indeed encouraged if you want to be any good at sport, and call me an idealist, but I feel that injecting ourselves with any substance (when not medically required) to take a short-cut to enhanced performance is not in line with drug-free sport, irrespective of whether that substance is banned or not.

Now, I will agree that a large portion of the response to EPO use, and to altitude training, is the same, but there are some fundamental differences.  As we mentioned before, EPO use increases red blood cell production; increased red blood cells carry more oxygen around the body; and a greater oxygen carrying capacity increases endurance performance.  The main way in which altitude training is proposed to work is that the reduced atmospheric oxygen stimulates the body to increase erythropoietin synthesis, which in turn increases red blood cell production, increased red blood cells carry more oxygen around the body; and a greater oxygen carrying capacity increases endurance performance.  Taking EPO makes training easier.  It allows the body to recover quicker (because the body is not the one synthesising the EPO, which believe you me is stressful business for the body), and allows you to train hard day after day.  Altitude training on the other hand is a nightmare!  It’s impossible to breathe, you sleep 14 hours a day, simple tasks like walking to the shops can tire you out, you can’t run as hard or as long as you can at sea level, and think again if you think you’re going to do session after session after session.  Like lots of other beneficial training methods (e.g. weight training, hill reps), you need to recover.  Increased EPO increases red blood cell production.  More EPO creates more red blood cell production.  Altitude exposure increases erythropoietin, and subsequently red blood cell production, to respond to the reduced oxygen in the air, but once it’s adapted, it doesn’t keep on producing erythropoietin.  More altitude exposure doesn’t mean more erythropoietin.  And the real catch is that some people’s bodies are so against the whole erythropoietin synthesis lark that they don’t bother.  Yes, not everyone responds to altitude.  The good news though is that these people are usually the freaks that find altitude training easy.

For me altitude training and EPO use are as different from each other as helping old ladies cross the road and sticking needles in little babies’ eyes.  Other methods of increasing endurance such as altitude tents, altitude masks, iron injections, blood transfusions and blood doping may fall various degrees closer to the proverbial fine line, but training your ass off in difficult environments is not the same as injecting yourself with a drug, which you’ve acquired illegally, to make the route to the top easier for yourself.

Now, I don’t’ know if all of you, or in fact any of you, have managed to read through my waffle, but I have sure as hell enjoyed putting up my side of the argument.  If you’d like to agree or disagree, then please leave your comments below.

 

I've been Elizabeth Egan, and I'm for Drug-free sport (and for afternoon naps!).  Thanks for reading.

Travel advice for athletes

The high performance athlete spends a considerable amount of time on the road.  With regular short trips to training, journey to compete at home and abroad, and flights away for warm-weather and altitude training trips, the miles, and time spent travelling, quickly add up.  For many people travel can be a stressful experience; something that is seen as a negative consequence of getting from one place to the next. Travel doesn’t have to be an additional stress in an athlete’s life, and when properly planned, it can be productive, motivational and even enjoyable!

The risks of long-haul flights: jet-lag, fatigue, stress and infection

There are a number of risks to health and performance associated with travel.  Trying to do a hard session straight after getting off a long-haul flight isn’t the brightest idea in the world; breathing recirculated cabin air when flying can increase the risk of infection; and rushing around and getting stressed can wear you down.  Here is some practical advice to help you get through long journeys:

• Be organised, and pack well in advance of your trip
• Get a good night’s sleep before you travel
• Complete the Travel Preparation Worksheet to ensure that you have everything covered
• Don’t do a heavy session immediately before or immediately after a long flight, as this will increase your injury and infection risks
• Pack plenty of food and snacks, and eat fresh healthy food where possible
• Check out the jet-lag factsheet for advice on coping with jetlag
• Add in additional time for things to go wrong when travelling to the airport
• Drink plenty of liquids, but avoid alcohol, on the plane
• Delays are a common part of travel.  Don’t let delays stress you out.  Use the time to stretch, walk out tired legs, read, and stock up on liquids and snacks.

Other essential travel advice

• Email a copy of all important travel documents (passport, visa, driving licence, travel vaccine records, itinerary, travel insurance and important telephone numbers) to yourself so that you can still access this information if all your belongings are stolen.
• Be aware of hand luggage allowances. Liquids greater than 100ml are not allowed in hand luggage and many budget airlines have a strict hand luggage allowance.
• Inform your bank of your planned trips to avoid your credit/debit card being blocked while you’re abroad.
• Pack important training or competition kit in your hand luggage so that you can still compete/train if your checked baggage doesn’t arrive.
• If you travel frequently duplicating toiletry items such as hairbrush, razor, toothbrush, shampoo can make packing and unpacking easier.
• Roll rather than fold cloths to prevent wrinkles and create more space.
• Label luggage clearly on both inside and outside to avoid confusion if outer label gets ripped off.
• When buying bus/train tickets in a country where you can’t speak the language use a phrasebook to write down the destination, ticket type and travel date in the native language before approaching ticket counters.
• If travelling with a group, don’t always depend on others.  Know the address of your accommodation or where you’re supposed to be in case you get detached from the group, or lost.  Take responsibility.
• Give yourself some peace of mind.  Travel insurance costs less than you think.  If you travel a lot consider annual multi-trip insurance.  It works out cheaper, and saves you having to worry about insurance every time you travel.
• Always pack toiletries in a plastic bag to prevent spillages in your luggage.
• If you find travel a useless waste of time, try to be productive. Listen to a language CD when driving; do some study on the plane; take up a needle craft, write your Christmas cards on the train, use the time to catch up on sleep.
• Enjoy!!!!!!!!

Essential preparation – things to do and plan well before your trip:

• Passport - does it have at least 6 months validity?
• Visa - do you need to apply in advance?
• What vaccine requirements are there?
• Arrange money/currency and alternative forms of money should anything go wrong
• Transport to/from airport
• Accommodation
• Check expected weather
• Inform bank of travels

Packing checklist

Before you embark on a trip, it’s a good idea to put together a list of everything that you need to pack.  Not only will this help prevent you forget important items, it will also make you more efficient and ensure that the correct items are in hand/hold luggage.  The beauty of making a list, is that next time you travel you only have to adjust the list rather than start from scratch.  Do this for short domestic trips as well as longer international trips.

Useful resources

www.fco.gov.uk

www.dh.gov.uk

www.wunderground.com

Jet-lag and travel fatigue, and travel nutrition factsheets, and travel preparation worksheet from AltitudeTrainingCamps.com

Guest Blog - Nutrition Improves Quality of Life for Cancer Patients

The latest blog post is a guest blog from Jillian Mckee.  Jillian has written about the benefits of a healthy lifestyle and good nutrition in coping with cancer.  We thank Jillian for taking the time to send us this piece, and hope that it can help educate those suffering from cancer as well as those caring for individuals with the disease.  Would would welcome your thoughts on this as well as your personal experiences.  Please feel free to use the comment tool below.

Cancer is a major cause of death in the US and worldwide.  it will affect one-third of the population at some stage of their lives, and over 70 percent of cancer cases occur in people over 65 years old.

Cancer is caused by genetic mutations in cells, which cause an overabundance of abnormal cells.  Only about 6 percent of cancers are belived to be caused by inherated mutations, while 95 percent are considered ''sporadic'' meaning they are the unpredicatable result of a combination of genetics, chance, and environment.

Cancer patients typically develop a wide range of physical symptoms, including weight loss, anorezia, fever or fatigue, and malaise.  Also, different forms of cancer cause different symptoms.  Teh actual treatments for cancer, like chemotherapy, radiation, surgery, and immunotherapy can produce a number of serious side effects.  This is because they cannot usually target the cancer cells only, but instead cause 'collateral damage' to healthy cells as well.

Most cancer patients have already had significant weight loss before they are diagnosed.  malnutrition is very common among cancer patients, with an incidence of anywhere from 30-90 percent, depending upon factors such as gender, age, type, location, and the stage of the cancer.  Patients who have gastric or pancreatic cancer seem to experience the highest rate of weight loss.  Also, patients with cancers of the nexk and head, lungs, and oesophagus are often victims of malnutrition.

The nutritional needs of cancer patients often vary widely from that of healthy people.  They may need more nutrition because of impaired organ function, hypermetabolism, the need for weight gain, or greater nutritnt losses.

Folate
It is believed that people with low folate levels are more likely to experience DNA mutations that can cause cancer.  Folate is a B-complex vitamin that can be gotten thorough foods or supplements.

Vitamin D
Current research suggests that vitamin D slows the growth of cancer cells.  Recently, the American Association for Cancer Research demonstrated a connection between higher vitamin D consumption and a lowered risk of developing breast cancer.  Vitamin D was found to lower the risk by up to 50 percent.

Vitamin D may also be good nutrition for mesothelioma patients.  A Harvard study found that lung cancer patients who had surgery for their cancer in the summer, when vitamin D is most prevalent from sun exposure, had 33 percent higher survival rate than those with winter surgeries and lower vitamin D intake.

Cruciferous vegetables
These members of the cabbage family can help prevent some cancers.  This includes turnip greens, kale, broccoli, cauliflower, and cabbage.  REsearch on cruciferous vegetables showed great promise in fighting colon and prostate cancers.  These veggies are great in soups, salands, or lightly steamed.

Tips from the Top- Chrisse Wellington Nutrition

Want some ideas on how to fuel long endurance sessions?
See article below from the Chrissie Wellington Blog!
http://www.chrissiewellington.org/blog/my-favourite-session-food-and-fuel/

Five Food’s that’s…… reduce bruising (www.220triathlon.com)

Rocket- This leafy green is rich in Vitamin K, a fat soluble vitamin essential for blood clotting and preventing excessive bleeding. It also strengthens blood vessels, thereby minimising the easy breakage or rupture of blood vessels that can result in bruising.

Green Cabbage- Cabbage is a good source of both Vitamin C and K; the deficiency of both results in easy bruising and bleeding. So increasing the intake of these vitamins helps to strengthen blood capillaries and prevent bruising.

Satsuma’s- Vitamin C deficiency can result in excessive bleeding, bleeding gums and decreased rate of wound healing. One of the easiest ways to boost your vitamin C intake- snack on Satsuma’s.

Olives- These are rich in Vitamin E essential for the formation of red blood cells. It is also needed for the proper utilisation of vitamin K. Vitamin E also helps prevent the blood vessels fragility that can lead to easy bruising.

Raspberries- These popular delicious red berries are super rich in Vitamin C and bioflavonoids which help strengthen collagen- the primary connective tissue- minimising the risk of being bruised when injured.

Tips from the Top

Please click on the link below for some real life nutrition examples from the Nations top Sports Stars

http://www.guardian.co.uk/lifeandstyle/series/eating-for-gold-britains-s-2012-olympic-stars-diet-secrets

Monitoring your own Hydration

Want a simple way to monitor your own hydration and sweat rate......without lots of reading.

From the Gatorade Sports Science Institute the following video helps to explain all
http://www.youtube.com/watch?v=_gPd4NH3Tgc&feature=related

Travel Nutrition - The Basics

High performance athletes are constantly on the go, not only travelling around the country for competition and training, but often across the globe.  Managing your diet can be one of the most difficult things to do while you’re away, and your nutrition may need considerable planning and preparation before you travel.  This article aims to point out some of the common problems, and give advice on how to overcome them.

There are 3 main areas to consider:

Ensuring that you have adequate micro-nutrients to prevent illness (colds, virus, infections)

Ensuring that you have enough of the right calories to fuel performance and aid recover

Prevent traveler’s diarrhea, and other illnesses from unhygienic food preparation conditions and unfamiliar food.

Packing for your Trip

·   Pack as much food as reasonably possible for your outward journey.   Food should be a fresh as possible, bearing in mind that if you don’t like the food out there you may have to survive the remainder of the trip on processed foods such as cereal bars.

·    When packing foods keep airport restrictions on hand luggage allowance (flying from UK airports, you are only allowed 1 item of hand luggage), fluid restrictions (no liquids in hand luggage through security), and restrictions on exporting/importing meat products to/from other countries in mind.

·        Remember that if your flight is delayed you may not have time to eat in the airport before you catch your connecting flight.

·     Food available for sale at airports tends to be expensive and it can be difficult to find nutritious options.  It is always useful to have some supplies in case of unexpected delays.

·    If you have to buy food in the airport, buy the most nutritious available (e.g. fresh made sandwiches or rolls; fresh meat with salad) even if this is not the cheapest option.

·    Once you have cleared security, make sure that you buy adequate fluid supplies for your flight.

Good Foods to Pack

Dried fruit

Nuts and seeds

Tinned Fruit

Dutch breakfast cake (only 3% fat)

Cereal bars

Breakfast cereal

Crackers

Fig rolls, Jaffa cakes & other low fat biscuits

Rice cakes

Liga, Rusks and other dry baby food

Jam, honey, peanut butter

Instant noodles

Baked beans, tinned spaghetti

Powdered milk

Powdered sports drinks

Jellies and sweets                              

Concentrated fruit juice and fruit squash

Peanut butter

Plane Food

·        It is best to take your own supply of suitable snack foods to supplement the meals supplied on board.

·      The vegetarian meal choice on most airlines is usually rice or pasta based so is a good alternative if you are expected to train shortly after you arrive.

·       Long hours of travelling can upset your digestive system.  To minimise constipation, drink lots of fluids and eat fibre-rich foods such as fresh fruit, wholemeal bread, breakfast cereals and vegetables.  When flying, a vegetarian or low fat meal usually provides more fibre than the regular meals.

·       Fluids are very important.  The humidity in an aircraft is around 10-15%, which means that the moisture is literally drained from your body.  Drink water or fruit juice.  Travelling with your own drink bottle on long flights is a great idea.  Don’t be afraid to ask for extra water or other beverages

·        Don’t drink alcohol on the flight.

·        Avoid drinking too much tea, coffee and cola; all of these may increase dehydration

·        Avoid overeating to relieve boredom.  Drink fluid instead!

The Dining Hall

·       If you are going to be eating in a dining hall, try to get a copy of menu in advance.  Using sound nutrition principles elect what you want to eat and stick to it.  Avoid trying everything on the menu. 

·        In most instances your meal should mainly be carbohydrate based (noodles, potatoes, cereal, bread), with some protein (eggs, meat, fish, cheese), and ample fresh vegetables.

·        Avoid eating food that you are not used to.

·        Practice eating what you will eat on competition day as soon as you arrive.

·        Eat plenty of fresh fruit when available.

·        Don’t be afraid to ask for alternatives if your nutritional requirements are not being met.

Food Safety

·      Be particularly careful in African, Asian and South American countries where food hygiene may not meet ‘Western’ standards

·       The general rule in countries which has a reputation for food poisoning the general rule is: ‘Peel it, cook it, shell it, or forget it’

·        Do not eat from stalls.  Eat only in places well-known or recommended by a reliable person

·        Where possible, eat food that has been well cooked.  It should be hot too.

·        If the local water is unsafe to drink:

§  Drink only bottled water or drinks from sealed containers

§  Avoid ice in drinks

§  Clean teeth with bottled water

§  Avoid salad vegetables unless washed in bottled or boiled water

§  Only eat fruit if it can be peeled

·       If vomiting or diarrhea does occur, it is important to replace lost fluids and electrolytes.  Oral rehydration solutions and a safe water supply should be used.  A bland diet consisting of dry toast, crackers, biscuits and rice may help.  Avoid alcohol, fatty foods and dairy products until the diarrhea has ceased.  If you are using oral contraceptives, beware that absorption may not have occurred due to diarrhea.

Fluids

•      The importance of fluid, especially in the hot and humid weather, cannot be overemphasized — always have an adequate fluid supply with you.
•          Always make sure that bottles are sealed before you buy/use them.
•          Ensure that you are always drinking from your own bottle

Eating for Recovery

Plan a recovery strategy, do not leave it to chance.

·        The best time to start refuelling is as soon as possible after exercise, as glycogen storage is faster during this post-exercise ‘window’ than at any other stage.  Carbohydrate store replenishment during the first two hours post exercise is 1 and a half times faster than normal.  It continues to be faster than normal during the subsequent 4 hours.  Therefore, eating carbohydrate during this time speeds glycogen recover. 

·        Most researchers recommend consuming 1g carbohydrate per kg body weight during the 2-hour post-exercise period.  So, for example, if you weight 75 kg you need to consume 75g carbohydrate within 2 hours of exercise.   For efficient glycogen refuelling, you should continue to eat at least 50 g carbohydrate every 2 hours until your next  main meal.  If you leave long gaps without eating, glycogen storage and recovery will be slower.

·        Immediately post exercise, choose foods with a high or moderate glycaemic Index (GI) in either liquid or solid form (or a mixture of both).

·        Suitable foods include cereal bars, rice, sports drinks, breads

·        If exercise suppresses your appetite, try apples, grapes or other fruit.

·        Nutrient–rich carbohydrate foods and meals after exercise, not only help refuel, but also help boost the immune system which is suppressed immediately post exercise.

Another area to consider?

Meat production in some Asian, African and South American countries is not subjected to the same rigorous controls as in Europe.  Use of illegal hormones to aid lean meat production has been blamed for inadvertent doping offensives, particularly in the case of Clenbuterol.  Clenbuterol is a banned substance in sport, and levels can be raised by eating contaminated meat.  Mexico and China have both been associated with illegal Clenbuterol use.  Care should be taken when travelling to these countries.