A case study of an adrenally fatigued,
nutrient-depleted professional athlete
Ian Craig
Ross – 28 year old Welterweight
Boxer
GOALS:
•Win a World Title Fight in
8 weeks
•Make weight (10 ½ stone)
easier
•Stop getting ill
Functional Analysis
INPUT• stress/anxiety
• snacky diet
• ibuprofen/antibiotic
DEFENCE
• recurrent infections
• pneumonia at 11
• diarrhoea
COMMUNICATION
• stressed
• tired
• low blood sugar
STRUCTURE• fractured rib
• inflamed knuckle
• diarrhoea
OUTPUT
• headaches
• diarrhoea
• fluctuating mood
Input
• Stress/anxiety (worry about weight; driving 2-
3hrs/day; training; selling tickets; hypercritical;
overcommitted)
• Obsessive personality – father alcoholic
• Ibuprofen for headaches and injuries
• Antibiotics in past for infections
• Food – snacky (eats in the car); moderate sugar and
caffeine content; drinks tap water
• Nutrients – Vit C, Iron, CLA, Vitabalance, Omega 3,
Glucosamine/Chondrotin, Whey, Fruit + Veg Blend
• Training – 3 hrs per day
Output
• Headaches related to stress and 2 migraines in his
life
• Diarrhoea – digestion is first to go when getting ill
• Fluctuating mood; feeling of hangover
• Grandfather had pancreatic cancer
• Mother had constipation
Defence
• Recurrent throat and chest infections – always
known it that way - much worse when training hard
• Pneumonia at age 11
• Digestive upsets
Communication
• Stressed
• Needs >9hrs sleep, tired in morning and afternoon
• Iron blood test low 2 yrs ago
• Low blood sugar; needs to eat frequently
• Dizzy when standing too quickly
Structure/Repair
• Fractured rib in last fight (a month ago)
• Right knuckle inflamed – recent steroid injection
• Twice daily training (muscle breakdown)
• Leaky gut?? Digestive upsets; fluctuating mood;
feeling of hangover
• Low pain threshold!
Training
• Gym – 5 days a week – 2 hours boxing
specific training
• Run – 6 days a week – 1 hour steady
• Weights – 2 days a week – strength,
plyometrics and some Olympic lifts
• Yoga – 1 day a week – just started
DIET
9am Apple juice; porridge, skimmed milk, honey & blueberries; green tea
10am Drive to training (1 hour)
11am Apple and pint water
11-1 Gym (+ 1l water + 1 ‘Go Bar’)
1.30 Black tea; brown bread (2 slice), butter and gammon; 8 strawberries
3.30 Nectarine
5pm ½ pint water + J2O drink
5-6 1 hour run
7pmWheat wrap with smoked mackerel, tomato, carrot and spinach; stick celery; green
tea with honey; biscuit
9pm10 king prawns; 2 handfuls spinach; fat-free fruit yoghurt; 5 strawberries; ½ pear; ¼
tin fruit cocktail
11.30 Sleep
Body Fat
10%
Height
170cm
Weight
73kg
Ragland
113/65 (42)
142/68 (49)
Zinc Taste
2 to 3
Barnes
Basal
temperature
Ave 35.9
Values
• I asked him to pull out the top Values in his life
from the areas of; Career, Spirituality, Family,
Personal growth, Health & fitness &
Relationships
• The top five were:
1. Love
2. Vitality
3. Success
4. Longevity
5. Self Worth
Steven’s Lean Body Mass
• Body Fat ~ 10% (estimated by Durnin and
Womersley)
• Weight = 73kg
• Fat Mass = 10% of 73kg = 7.3kg
• Lean Body Mass = 73 - 7.3 = 65.7kg
Steven’s Calorie
Expenditure
• Resting Metabolic Rate = 500 + (22 x 65.7) ~ 1945 Cals
• Daily Activity Levels = 40% of 1945 ~ 778 Cals
• Training in a week = ‣ 10 hrs at gym 5000 Cals
‣ 4-6 hrs jog 4000 Cals
‣ 2 hrs weights 900 Cals
‣ Total in week - about 10000 Cals
• Training per Day ~ 1400 Cals
Total Energy Expend = RER + Daily Activity + Training
= 1945 + 778 + 1400 = 4123 Cals
Cunningham (1980)
Steven’s Calorie Intake
• Based on 3 days of dietary analysis:
– Calories 2415 Cals (10,143 kJ)
– Carbs 264g (44%)
– Protein 127g (21%)
– Fat 94g (35%)
Adrenal Stress Index
“Exhaustion Stage:
This is generally a state of insufficient production
of adrenal hormones after multiple years of
persistent stressors with insufficient coping
mechanisms. Patients usually present with
fatigue, poor energy and immune system
hypofunction. They may exhibit chronic anxiety. In
some patients this represents impaired response
to shorter-term stressors.”
Secretary IgA
“Several studies link stress and emotionality with
levels of SIgA. Production is adversely affected by
stress, which is mediated by cortisol levels. This
could result in inadequate production of SIgA in
response to a mucosal infection.”
Nature of Stress
Let’s emphasise two points about the stress
response
1. It takes priority over all other metabolic
functions
2. It wasn’t designed to last very long
Infection
• Athletes who are overtrained may be more
susceptible to infections. Their immunoglobulin
levels may be decreased, especially IgA
• Cortisol has been shown to inhibit the activity of
NK cells and has anti-inflammation properties
including the suppression of histamine
• Proneness of infection has also been attributed to
a decrease in glutamine due to heavy training
Gilmore (2004); Kuipers (2000); O’Brien (1988)
Diet – Balancing Act
Challenge:
• supply macronutrient needs
for training, immune
and endocrine systems
• strip body fat to make weight
NEW DIET
On Rise 1 pint water with squeezed lemon
8.30B-fast - 3 eggs scrambled + 100ml SS milk + ½ avocado + 2 thin slices rye bread + a
tomato and a carrot
10.30 Pre-exercise – small handful mixed nuts plus a banana
11-1 Gym (+ 1l Sport drink – 60g glucose plus 20g whey)
1pm Post-exercise – 1l sports drink (30g glucose plus 20g soya/whey mix)
2pmLunch – 125g chicken + 30g brown rice + lettuce, tomato, cucumber, olives, onion,
20g cheese, ½ avocado
4.30Snack – Smoothie (125g natural yoghurt, 50g mixed berries, 1 tbsp 3-6-9 oil, 10g
whey plus a touch of water)
5-6 1 hour run
6.30Dinner – 125g salmon, 100g broccoli, 30g spinach, 60g carrots, 50g cauliflower, 50g
quinoa, 2 tbsp pumpkin seeds
9.30 Supper – 125g natural yoghurt, 50g blueberries, 1 tsp honey
10-10.30 Sleep
Steven’s New Calorie
Intake
Based on computer analysis of diet:
– Calories 3323 Cals (13,957 kJ)
– Carbs 300g (36%)
– Protein 197g (24%)
– Fat 146g (40%)
Lifestyle Recommendations
• Delegate – it seems to me that you like to take charge of things. I suggest that you let others help you out.
• Don’t drive any more than you have to – it is a stress load on the body.
• Routine routine – it seems to make you thrive, so stick with it at least for this period. Have a planned, monotonous day for a while.
• Yoga – do 1 session per week and focus on letting your tension go to get into the stretches. Also, use the yoga breathing for at least 15-20min per day to create a state of calm.
Supplements
• Multivit, high in chromium, B-vits, antioxidants
• Vitamin C – 1g bid
• Hemp oil – 2 tbsp on food• Oil – EPA/DHA/GLA blend – 1 tsp bid
• Probiotic (24 billion microrganisms per cap) – 1 bid
• L-glutamine powder – 5g per day• Phophatidylserine – 200mg post-exercise
• L-tyrosine – 500mg before exercise and mid-afternoon
• Whey – post-exercise nutrition and in afternoon smoothie
• Fruit and Veg Concentrate – in smoothie
• Epson salt baths – 2-3 cups Epson salts in a bath 3-4 times a week before bed
Glucose-
Alanine Cycle
Wagenmakers (2000)
Phosphatidylserine
• Phosphatidylserine (PS) is a phosholipid found in all cells, making up about 70% of nervous tissue
• It aids in the activity of NT’s and their receptors and is involved in cell-to-cell communication
• It stimulates the release of dopamine, increases production of acetylcholine, enhances brain glucose metabolism and boosts the activity of nerve growth factor
• PS has been shown to significantly blunt the responses of stress hormones (including ACTH and cortisol) to physical exercise, without affecting the rise in GH and prolactin
LE Magazine (2002)
External oblique enthesopathy - fluid / tissue stress in the space at the attachment
of the muscle to the rib
Additional supplement advice
for injury
• Anti-inflammatory product - curcumin, boswellia, green tea, ginger, rosemary, celery, alpha-lipoid acid, resveratrol – 4 caps 3 X day with food
• Digestive enzyme product - when taken on an empty stomach, the enzymes are able to digest inflammatory debris from an injury site and speed up recovery – 6 caps 2 X day on empty stomach
Visit 2 (3 months later)
Changes
• Eating pretty much the way I had recommended
and maintaining weight despite the lack of
training
• Taking supplements as suggested
• Energy is fine for training
• Moved to London during the week to avoid daily
commutes to gym
• Agreed to run more elaborate tests to work
towards more optimal health
• Hoping for world title fight in 2-3 months time
Testing
Organic acids
and
Amino acids
Organic acids interpretations
• One yeast/fungal dysbiosis marker
borderline high
• Low adrenal catecholamine
neurotransmitter levels, supporting the
independent measure of adrenal
exhaustion
• Fumarate in the Krebs cycle low
Amino acids interpretations
• Histidine and essential amino acids are
deficient – consider gastric hypochlorhydria
• Tyrosine is deficient - consider thyroid
insufficiency, adrenal medullary dysfunction
or subnormal levels of adrenal
catecholamines with possible dopaminergic
dysfunction
Adjustments in recommendations
• To keep working on the diet as he had been
• To keep working on stress management
strategies, potentially working with somebody
like a Neuro Linguistic Programming (NLP) or
Cognitive Behavioural Therapy (CBT)
practitioner
Revised supplements
• Multivit, high in chromium, B-vits, antioxidants
• Vitamin C (supportive to adrenals and immune system)
• P5P (active form of B6) for neurotransmitter conversion
• Digestive enzyme (to increase amino acid absorption)
• Amino acid broad spectrum product (to increase aminos in
body)
• Saccharomyces boulardii (anti-fungal)
• Phophatidylserine (to calm the mind)
• Oil – EPA/DHA/GLA blend
• Probiotic (24 billion microrganisms per cap)
• L-glutamine powder
• Nighttime sleep snack for GH production
• Epson Salt Baths
The taper
• He had already lost 1-2 kg with the revised diet, so had
about 5kg to drop for weigh-in
• Two weeks before the fight, we restricted his dietary
carb intake, but kept his drinks and snacks around
training
• One week before the fight, with the taper in training, we
also dropped the drinks and snacks
• Two days before weigh-in, he weighed 3kg above
weigh-in weight
• The night before, he restricted water intake and ran in
his sweat suit and took a sweat bath and comfortably
dropped the 3kg
The re-load
• He had 32 hours between the Friday noon weigh-in and
the Saturday 8pm fight
• We had 2 lunch, 2 dinner, 1 breakfast and 3 snack
opportunities to load him with 5870 Cals of food and
about 6 litres of fluid (with electrolytes)
• He entered the ring weighing 75kg (8kg more than the
day before)
TIPS FOR THE TAPER
Work down to a lean body composition during the months before the fight
Strengthen adrenal and immune strength in the months before to cope with the harsh
regime
Within two weeks of the fight, tighten in on the carb consumption to the point that you start
losing body fat, or whatever other technique works genetically for you
2 days before the fight, if you still need to lose weight, start water fasting but only under
experienced supervision
After weigh-in, have a carb- and water-load strategy ready to rebuild as quickly as
possible. Take plenty of rest at this time.
References
• Cunningham (1980). A reanalysis of the factors influencing basal
metabolic rate in normal adults. Am J Clin Nutr. 33:2372-2374.
• Gilmore (2004). Overtraining – its effect on the endocrine system.
Lecture Notes – University of Glasgow.
• Kuipers (2000). Overtraining: Nutritional Intervention. Chapter 37.
Nutrition in Sport. The Encyclopaedia of Sports Medicine (IOC
Publication). Blackwell Science
• LE Magaxine (2002). Phosphatidylserine (PS) the essential brain
nutrient. LE Magazine
http://www.lef.org/magazine/mag2002/sep2002_report_ps_01.html
(accessed March 2007)
• O’Brien (1988). Overtraining and sports psychology. The Olympic
Book of Sports Medicine – An International Olympic Committee
Publication. Blackwell Scientific Publications.
• Wagenmakers (2000). Amino acid metabolism in exercise. Chapter
9 – Nutrition in Sport. Edited by Maughan. Blackwell Science Ltd.
Queensbury Boxing
• Ross Minter is now a boxing promoter and a
personal boxing coach
• View www.queensburyboxing.co.uk for
upcoming shows