Overtraining Syndrome (OTS) describes a combination of physical and mental abnormalities that result from cumulative high-level physical activity that is not accompanied by adequate recovery.  OTS is generally used to refer to an abnormal and persistent state characterized by physical, mental, hormonal and immunological dysfunction.  Older terms include “burnout” (more commonly used now for non-athletic stress), staleness, adaption failure, training stress syndrome and unexplained underperformance syndrome.

Overtraining Syndrome (OTS) is becoming increasingly common in athletes at all levels.  Part of this increase relates to improved awareness and diagnosis, but a significant factor is the cumulative and synergistic impact of athletic stress and lifestyle stress.  The incidence of OTS in elite runners approaches 60% and even in non-elite competitive runners nearly a third will develop OTS at some point.  Preventative management and early recognition are essential to ensure the condition does not progress to a potentially dangerous and sport-ending stage.

Diagnosis:

One of the most important challenges in OTS is recognizing it early.  Once established, treatment becomes much harder and more prolonged.  If you suspect OTS then early assessment by a sports medicine physician or knowledgeable sports therapist or trainer is essential. Diagnosis relies on several areas of evaluation:

Rule out organic disease

A number of organic diseases can present in a similar way to OTS and are often overlooked as the population tends to be younger and disease uncommon.

• Undiagnosed lung disease (asthma)
• Hormonal Disease (Thyroid, Diabetes)
• Anaemia
• Infection (hepatitis, HIV, myocarditis, Lyme, EBV)
• Malnutrition/Eating Disorder (RED-S)

(RED-S or Relative Energy Deficiency Sport is a low-energy state resulting from inadequate nutrition relative to the degree of training.  Originally known as the Female Athlete Triad (anorexia, amenorrhoea, osteoporosis) it is now known to affect both men and women equally.  Although similar in presentation, it can be distinguished from OTS.  RED-S is predominantly a low-energy rather than low-performance state; there are stronger food anxiety and body image issues; amenorrhea is more common as is low libido and erectile dysfunction; bone injury (stress fractures) occur rather than muscle injury; RED-S is easily reversed with appropriate nutrition.)

OTS Symptoms

• Decreased performance
• Excessive fatigue
• Muscle pain
• Mental/Emotional disturbance (agitation, depression, poor concentration, poor motivation)
• Insomnia
• Appetite disruption/Thirst
• Weight loss/gain
• GI upset
• Recurring or non-healing injuries
• Recurrent colds/infections

Performance Testing

Physical and Mental testing appears to be the most reliable and useful method of assessing impending or established OTS.  Such tests include time-to fatigue tests, sport specific maximum aerobic function tests and strength or power tests in appropriate sports.  The Profile of Mood State questionnaire (or POMS) is a simple test with good reliability in diagnosing OTS.  By assigning values to self-perceived issues including fatigue, vigour, tension, anger, confusion and depression an overall emotional state score can be recorded and monitored.

Treatment:

Once an athlete shows signs of OTS then treatment needs to be instituted quickly and thoroughly in order to be effective.  Ignoring signs or taking half-measures will result in further deterioration and an even longer recovery.

Rest, rest and more rest is the key.  This is often incredibly difficult for an athlete to accept so involving a sports psychologist can be helpful.  Allowing cross training can overcome some of the inevitable despondency resulting from a halted season.  Restore sleep, one of the most essential factors in healing and improve nutrition ad hydration.  Consider the following supplements;

• Glutamine – 5 grams per day
• Liposomal Glutathione – 250mg twice a day
• Resveratrol – 100mg twice a day
• Sereniten Plus – 2 capsules twice a day (to address stress pathway imbalance)

Reduction in activity and training needs to be quite profound and surprises most athletes.  However, failure to adhere to an appropriate rest and recovery protocol will result in a high likelihood of relapse.

Genetics and OTS:

All athletes are not created equal!  Certain individuals may be faster, stronger, show greater endurance or have better agility and coordination.  Part of this relates to training, diet and other external factors that might be termed “nurture”.   50-60%, however, is due to “nature”, essentially our genetic makeup.  There is increasing evidence that our coding for certain genes has a profound influence on everything from muscle fibre mass and composition to oxygen utilization and recovery from injury.  Knowledge of an athlete’s genetic profile can be tremendously important in terms of training and nutrition.  Tuning diet and fitness protocols to make them more suited to an individual’s “nature” will not only improve performance, but also reduce risk of injury and OTS.

Genes affecting risk of OTS:

• ACTN-3 affects sprint vs. endurance muscle fibres
• ACE affects muscle blood flow and nutrition
• IL-6 affects inflammation, damage, repair and recovery
• TNF-alpha affects inflammation and injury

In addition, the following genes affect nutrition and tendon function:

• FTO determines protein requirement
• TCF7L2 controls carbohydrate handling
• APOA2 determines response to dietary fats
• MMP3 and COL1A1 affect sensitivity of tendons and ligaments to injury

Are seasonal allergy symptoms slowing your patients down? As healthcare practitioners, we know that Fall has truly arrived when we see an increase in patients with red, itchy eyes, congested sinuses and fits of sneezing. Far from being limited to respiratory symptoms, this allergenic patient picture can also include hives, rashes, shortness of breath, swelling and GI bloating.

Your patients likely know that they have seasonal allergies, and may be looking to you for symptomatic relief. But are you prepared to answer these patient questions?

• I tried antihistamines – why didn’t they work?
• I’ve never had allergies before – why am I getting them now?
• I got a cold months ago – why do I still have symptoms?

Patients may consider allergy symptoms annoying, but not serious. But you and I know what allergy symptoms are cries for help from a dysfunctional immune system. I’m sure you have many tools in your practitioner toolkit to support immune health. But have you considered where genetics fits in? Let’s take a closer look at which genetic factors influence the immune response, and how using integrated genetics can help you get to the root of your patients’ allergies this Fall.

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How Integrated Genetics Can Help You Design Personalized Exercise Protocols

Why Single SNP Analysis Doesn’t Work in Exercise Protocols

Are your patients out of shape? Five months into the sedentary pandemic lifestyle, your patients may be asking you how to drop those extra pounds. This is a golden opportunity to help your patients find new and exciting exercise options. But which style is best – HIIT or endurance?

As with any personalized recommendation, the answer depends on the patient. And their genetics. But did you know that viewing genes in isolation doesn’t give you the full patient picture? In fact, prescribing an exercise protocol without integrating your gene analysis could do your patients more harm than good.

Let’s take a look at why single gene analysis can be dangerous, and how you can use integrated gene analysis to design safe, effective, super-personalized exercise protocols for your patients.

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We used to think there was little we could do about the genes we’d been given. They were carved in stone and we were at the mercy of their bidding. It was a fatalistic attitude often used as an excuse to avoid making changes to our lives. What was the point if our genes were immutable?

Well it turns out that we were wrong! Although it is true that we cannot change our genetic code, we can greatly influence the expression of many genes and control the effects they have on our body. By making small changes to our lifestyle, our diet, our supplements, we can not only optimize the genetic blueprint we have been given but we can actually alter the way genes work. We can turn them on or off, up or down to maximize their beneficial side, while minimizing their adverse effects. We can steer them in a specific direction that enhances our health today and we can modify them to prevent problems in the future. Genes, it would appear, are malleable and with the right tools we can shape them to create better health and longevity.

Starting around 2011, I noticed an increasing number of articles referencing individual areas of genetic variation called SNPs, pronounced “snips” and short for Single Nucleotide Polymorphisms. Individual differences in these SNPs are called “alleles” and these alleles provide the basis of your personal genetic coding results from DNA testing. Articles discussed the association of SNP alleles with metabolic function, weight management and the risk of disease, particularly diabetes. So, although SNPs had been recognized for many years as components of our genetic makeup, the emergence of numerous studies examining the correlation of SNP variants with disease risk made them relevant to my practice. The potential to improve diagnostic accuracy, more clearly define risk and hone my therapeutic regimens according to individual genetics was exciting and, in terms of naturopathic medicine, somewhat of a Holy Grail for personalized health.

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Dispelling the myths behind frequent meals and why eating three meals a day with no snacks is the healthiest option.

Wherever you turn there is someone extolling the virtues of eating five to six small meals per day. From doctors to dieticians, from Cosmopolitan to Women’s health, there has been an explosion of acceptance that frequent small meals are the key to everything from weight loss to lower cholesterol and longevity. Almost all diet books either base their recommendations on this principal or incorporate aggressive snacking as part of their program. Yet remarkably, despite its presentation as dietary dogma, there is almost no science to support such information. In fact it flies in the face of everything we know about metabolism and the hormonal regulation of our energy supplies. Continue reading →