CARDIOLOGY, PRIMARY CARE AND NUTRITION

Blogpost: Athletics and Nutrition-the Next Level

This is an exciting time of the year for cycling fans. The Tour de France is one of the most grueling endurance events with 21 stages covering 3,360 miles at an average speed of 40.206 mph. The route varies each year but always has mountainous climbs through the Pyrenees and the Alps. Crashes are not uncommon and many riders fail to finish because of injuries sustained in those crashes. They burn 4000-7000 calories a day depending on the climbs and the mileage of the day.

One complication of such high endurance athletes that you would not expect is vascular disease. It occurs in 10-20% of elite endurance athletes and is most common in males less than 40 years of age. The most common location is the external iliac artery but can involve the profunda, or femoral arteries as well. It is usually only on one side and occurs most commonly in cyclists riding 14,500 to 20,000 kilometer per year. It is not the typical atherosclerotic narrowing we see in older individuals with vascular disease, but the symptoms are somewhat similar. The pain is typically at maximal exercise and resolves in less than 5 minutes upon stopping. It can be in the lower leg, thigh, or buttocks and can cause a feeling of swelling or even transient numbness. The pathology occurs under the endothelial layer in what is called the intima. There are fibrotic changes with the accumulation of densely packed collagen, elastin, and smooth muscle cells instead of the typical atheroma with lipids and inflammatory cells. It is postulated that the damage occurs mainly from mechanical factors. Cyclists and speed skaters spend a lot of time bent over. This can be secondary to impingement of the artery from the enlarged psoas muscle extending from the lower back to the upper leg.

This endofibrosis or kinking of the artery can be difficult to diagnose. There are no symptoms at rest and because the endurance athlete is in such great condition, it often requires a maximal effort to bring on the discomfort. Typical ultrasounds and CT scans often miss the lesion. The best test is simple. A blood pressure measurement of the arm compared to the leg at rest and after maximal exertion. The measurement is called an ankle brachial index. The normal blood pressure is higher in the leg than the arm resulting in a number slightly greater than one. In this condition there can be a 23mmHg differece between each leg. There can also be a femoral bruit if the hip is extended. These are not findings expected in young adults and are often shrugged off as overuse injuries or nerve impingement. The treatment is often surgical repair and grafting of the vessel. Stenting of the vessel has not been shown to result in a lasting improvement. The condition can still recur or be a nagging injury to the athlete and even end their careers.

This year’s current third place rider in the Tour de France, Steven Kruijswijk of Team Jumbo Visma has had this condition requiring previous surgeries. I am sending him good vibes for a great finish after coming back from this potentially career ending condition.

So what does this have to do with plant based wellness? Not everything is caused by poor nutrition or can be healed by stellar nutrition. But nutrition does play a huge roll in these riders present and future performance and health. Even thought the endothelial cell lining is not damaged in this condition, it is important to maximize vascular health by taking in as many nitric oxide producing vegetables as possible. This will allow the tiny vessels to be at their maximum diameter providing support for the compromised vessel. Just because this particular injury can occur in no way excludes endothelial vascular disease occurring later in life at the site of the repaired vessel. It is assumed that this lesion is mechanical. We assumed osteoarthritis was mechanical and it is largely an inflammatory reaction associated with deteriorioration of muscle and bones. These riders bodies are under tremendous stress and it is well documented that their immune systems are compromised. Maximizing nutrition with antioxidants and phytonutrients from fruits and vegetables can only help the prognosis and perhaps even limit the damage.

If you are not maximizing your plant based nutrition, you are missing out on the potential to perform and live at your maximal potential. If you need assistance in fine tuning your health and nutrition. We are available to take you to the next level. See http://doctordulaney.com for more information.

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