by Dr. Oscar Coetzee – Associate Professor/Clinician/Researcher
What is Sports Nutrition?
Nutrition is one of the fastest growing professions in the world according to the U.S. Bureau of Labor statistics. It will grow as a profession between 15% – 22% in the next five years, and it is estimated due to the chronic illness in the USA, the demand will outweigh the supply. The integration of the Functional Medical Paradigm all over the world in education, is setting nutritional professionals apart from any other medical specialty, as the true success of functional medicine lies in the nutritional intervention and lifestyle modifications. Thus, many subspecialities are forming in nutrition, and the one still on the outside looking in, is sports nutrition.
The Importance of Sports Nutrition
Every aspect of sport performance enhancement today is at the highest level through the evolution of computer science and high-level biomedical research. Yet, in sports nutrition it is still about macros and calories, and pretty much a one size fits all approach. Some diets like Carbohydrate loading, Ketogenic or Paleolithic and certain nutraceuticals are highly touted for sports performance, but none of these have been truly investigated through proper research in the scientific literature. Bio-individuality seems to be left out when it comes to sports nutrition specifically. Various electrolytes, antioxidants, fatty acids and branched chain amino acids are frequently promoted as the all-encompassing nutrients for top athletes. But are they? Is it possible that for one athlete a specific amino acid or antioxidant can be a friend and for another a foe? As a part of my practice, I have worked with professional athletes for more than 15 years. I have sculpted my assessments and interventions through trial and error and created a new area of sports performance that I term Psychonutrigenomics. In collaboration with Diagnostic Lab Solutions, my team and I have been able to take sports performance, sports nutrition and sports immunity to a level of total athletic individuality. Through the implementation of this approach, we have had various international victories and successes, taking our athletes to the peak of individual achievement.
It is time that we march to a different drummer, time to truly evolve the field of sports nutrition and performance by integrating the individual assessments of metabolic, physical, genetic, biochemical and psychological markers. As an example, mental clarity and anxiety control can come from proper nutrient absorption through the conversion of amino acids like tryptophan and tyrosine. They convert into neurotransmitters (NT) serotonin and dopamine, which in turn convert into some catecholamines like epinephrine and norepinephrine. These NT and catecholamines have everything to do with focus, motivation, concentration and athletic performance and they require iron, vit. C and B6, and SAMe. These micronutrients can only be obtained through food and supplementation, of which most humans in the USA are deficient. In addition to this, some people have issues genetically in converting these, and others are just in a state of malabsorption due to overtraining or intestinal permeability, thus they cannot have these intermediates convert properly. The science of nutritional assessment has come very far, and today we can determine if you have a genetic shortcoming, if you are immunocompromised, if you are malnourished, if you have an energy conversion deficit or all the above.
In order to evolve athletes to optimal performance from a bio-individual perspective; the athlete needs to be assessed at 5 levels:
- Psychology of performance – assessing personality performance profiling.
- Proteomics – the large-scale study of proteins, and their involvement in human performance.
- Metabolomics – the scientific study of chemical processes involving metabolites, the small molecule substrates, intermediates and products of metabolism, as it relates to energy and athletic performance.
- Nutrigenomics – the scientific study of the interaction of nutrition and genes, especially with regard to the optimizing performance.
- Microbiomes – the study of the totality of microorganisms and their collective genetic material present in or on the human body and the effect on human performance, recovery and immunity.
In partnering with Diagnostic Solutions Lab, we incorporate various functional tests, to determine the origin and baseline of each athlete, in order to design the appropriate intervention strategy not only for performance but also recovery, something that is very often overlooked in professional athletes.
Various tests we use from DSL to assess the above criteria:
- The GI-MAP’s™ accuracy and reliability allows practitioners to create personalized treatment protocols to address gut dysfunction. Although qPCR is becoming more commonplace in in-vitro diagnostics (IVD), DSL is the only laboratory in the United States exclusively using qPCR technology for advanced comprehensive stool testing. This technology is used routinely in clinical and academic research because it provides highly-accurate quantification, as well as high levels of sensitivity and specificity. Standard PCR technology doesn’t offer the same level of sensitivity, or the ability to express precise numerical results.
- GenomicInsight™ provides a global view of the interconnectedness of SNPs and offers access to information that reveal lifestyle and therapeutic recommendations that may influence a gene’s expression and function. The role of genomics and epigenetics is recognized as an important tool in monitoring, preventing, and treating dysfunction. Furthermore, medical literature supports that epigenetics (the impact of the environment on gene expression) plays a critical role in human health. GenomicInsight™ with Opus23 Explorer™ identifies how the function or dysfunction of one gene impacts the expression and function of a separately-related gene or SNP.
- Labrix introduced neurotransmitter testing in 2012, meeting the need for non-invasive solutions for practitioners who wanted a more comprehensive view of the body’s functional neuroendocrine status. Doctor’s Data neurotransmitter testing utilizes HPLC Triple Quadrupole MS/MS technology which is proving to be the most sensitive and accurate methodology for measuring urinary neurotransmitters. This testing has higher sensitivity and has stronger results reproducibility than has been available through other methodologies; this gives you far greater confidence in the reported results.
- Functional Blood work overview. All our athletes are also screened through their CBC and CMP panels from a functional perspective to review any underlying, or early-stage chronic inflammation or metabolic issues that can inhibit performance. Looking at conventional blood markers and assessing them based on optimal levels. Too often people fall into “normal” ranges on their blood work performed by their doctors, and although they feel sick, they are told everything is normal. By taking a deeper look, and combining regular blood work with additional functional markers, a more comprehensive assessment can be made regarding one’s current performance and in the future. In a 2019 review article by Pedlar et al. they found that serial blood test data can be used to monitor athletes and make inferences about the efficacy of training interventions, nutritional strategies or indeed the capacity to tolerate training load. Via a profiling and monitoring approach, blood biomarker measurement combined with contextual data has the potential to help athletes avoid injury and illness via adjustments to diet, training load and recovery strategies. Since wide inter-individual variability exists in many biomarkers, clinical population-based reference data can be of limited value in athletes, and statistical methods for longitudinal data are required to identify meaningful changes within an athlete.
- Organic acids are chemical compounds excreted in the urine of mammals that are products of metabolism. Metabolism is the sum of chemical reactions in living beings by which the body builds new molecules and breaks down molecules to eliminate waste products and produce energy – understanding energy is vital in athletes. Organic acids are most commonly analyzed in urine because they are not extensively reabsorbed in the kidney tubules after glomerular filtration. Thus, organic acids in urine are often present at 100 times their concentration in the blood serum and thus are more readily detected in urine.
How to Use Sports Nutrition in Practice
Once we have reviewed all the above information, we can build a nutritional protocol for athletes, around their genetic makeup, assisting in the weaker areas of the genetics, through a strong nutritional prevention strategy. We can assess inflammation, metabolic energy status, and the levels of immune suppression by looking at the other markers, and design intervention strategies to address those issues.
This level of scientific precision and assessment on an individual nutritional level, is not going to be the exception but the rule for future professional athlete intervention. The change of a higher level in the standard of care has already begun for competitive athletes and weekend warriors. Using these tools at our disposal will help us in the future better understand the different needs of different kinds of athletes, and the level of stress and depletions these sports put on our bodies.
Maryland University of Integrative Health is one educational institution that is taking the lead in enhancing this new subspeciality.It’s Masters of Nutrition and Integrative Health also trains the future nutritionist at a level of superior functional assessment by investigating all the above biochemical assessments in some of their core courses. The best way to become a good sports nutritionist is to have a very good base education in the overall nutritional sciences.
In conclusion as biochemist Dr. Roger J. Williams states in his book “Biochemical Individuality”: There is no such thing as an average person, we are all genetically and biologically unique. But when sperm meets egg, our characteristics are not locked in stone, bad genes do not necessarily cause disease by themselves, and nutrition and environment can alter the outcome.
Pedlar, C.R., Newell, J. & Lewis, N.A. Blood Biomarker Profiling and Monitoring for High-Performance Physiology and Nutrition: Current Perspectives, Limitations and Recommendations. Sports Med 49, 185–198 (2019). https://doi.org/10.1007/s40279-019-01158-x