Chris G. Koutures, MD, FAAP Pediatric and sports medicine specialist

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Orange County Physician Of Excellence, 2015 and 2016

 

Filtering by Tag: sleep

5 Sensible Tips Guiding Nutrition and Recovery After Exercise

For centuries, athletes have searched for any substance or technique that could enhance exercise and allow for more effective weight gain/loss or increases in strength and endurance. Many available performance enhancing products may report claims of potential amazing efficacy but use of them can be clouded by concerns over true scientific support, side effects, and financial cost.

Here are 5 sensible tips to guide you on nutrition and recovery with your exercise program:

1.       The Importance of Sleep

Can’t begin to tell you how sleep deprivation can derail even the best constructed exercise program, as skeletal muscle needs adequate recovery time to rebuild damaged fibers and to increase the working capabilities of contractile units. Multiple studies support the efficacy of a minimum of 8-9 hours of sleep a day to foster such recovery. Insufficient sleep can also reduce mental alertness on the job or at school and has also been associated with statistically higher risk of illness or injury.  Establish a regular bedtime and not allow deviation of more than ½ hour and also encourage daytime naps of under one hour per day which have been shown to be restorative, add to the cumulative daily sleep amount, and not adversely affect nighttime sleep patterns.

·         TIP TO ASSIST WITH SLEEP: Stop any type of screen device use no later than one hour before bedtime, and do not have screen devices in the sleep area, as use right before bedtime or alerts/temptation to check during sleep have been associated with reduced amount and quality of sleep.

2.       The Timing and Amount of Protein

Protein is the building block of skeletal muscle and is needed to assist in that reparative and rebuilding process after exercise. Good data suggests that the best time for workout-related protein intake is within 30 minutes after completing exercise. A post workout protein amount of 25-30 grams along with a total daily intake of 0.5-0.7 mg protein/pound of body weight are both solid recommendations. I have always favored dairy or meat/bean/egg sources of protein as readily available products that confer well-absorbed collateral benefits of calcium, Vitamin D, and iron. Amino Acids are the building blocks of proteins, and intake of specific individual amino acids has been touted for both weight loss and strength building. However, there is a lack of rigorous support for high amounts of individual amino acids, so stick with whole food protein sources.

·         TIP TO ASSIST WITH PROTEIN INTAKE: 8-12 ounces of chocolate milk within 30 minutes of exercise is a sensible recovery drink that has a ratio of carbohydrate to protein that allows enhanced transport of protein to recovering muscles. Other good post workout food-based protein sources include Greek yogurt and peanut butter.

3.       What About Creatine?

Creatine is a natural substance that assists with regeneration of short-acting energy sources that fuel contraction in working skeletal muscle. Increased amounts of creatine in working muscles can potentially contribute to more intense workouts and also assist in muscle recovery after workouts. Powdered and liquid creatine supplement products have been studied, with trials that include higher loading doses for the first few days, followed by lower daily maintenance doses and other regimens that include medium daily doses without any higher loading amount. Positive results have included increased speed and ability to complete multiple short-burst activities such as 80-100 yard sprints. Possible side-effects include water retention, bloating, muscle cramping, and potential kidney injury (currently only reported with individuals that had pre-existing kidney concerns).  Anecdotally, many athletes using creatine have reported enhanced recovery with increased ability to work harder in subsequent workouts, and documented strength increases support increased muscle size not being simply due to water retention, but to increased contractile abilities.  Take note that many United States-based sports medicine advisory organizations do not endorse creatine supplementation in children under 18 years of age.

·         TIPS ON CREATINE USE: Creatine monohydrate in either liquid or powder format has been the best studied form of creatine. If using any supplement, ensure that you are getting exactly what is on the container and not any additional substances (see below). Reductions in creatine dose have been shown to assist with bloating, cramping or extreme water retention. Good food sources of creatine include wild game meats or wild-caught fish which also have those collateral benefits of protein, calcium and iron. Domestic meats and fish (especially free-range meats) still have reasonable amounts of creatine.

4.       Are Pre-Workout Supplements Safe and Efficacious?

Advertised preworkout supplements or “energy drinks” report to enhance athletic performance and routinely contain multiple components such as caffeine and taurine. While a few small studies support the performance enhancement of stand-alone agents, published data on combination products is scant, inconclusive, or confusing.  Safety concerns exist with use of products that have cross reactivity of multiple agents or larger than studied amounts of a certain product.

·         TIPS ON PREWORKOUT SUPPLEMENTS: Read labels! If using any preworkout supplement in addition to usual daily caffeinated beverage of choice, you might be getting an enormous caffeine load with possible dangers that outweigh possible benefits to your workout.

5.       What’s the Lowdown on other Supplements?

Use of a vast array of pre and post-workout supplement products has been touted to enhance athletic performance and exercise capabilities. Many of these products will work- no doubt about it, - however the gross majority of products do not have any rigorous practical scientific result to support clams and there is a tangible risk of adverse consequences from both known and potentially unreported elements in supplement products.  What is on the label of many products is not the same as what is in the actual container. Personal experience along with results found by national sport organizations have found a significant number of supplements that have additional, unreported elements that are potentially dangerous and might be banned for sporting competition. While most of you are not subject to drug testing for performance-enhancing agents, suffering real and possibly long-term health consequences is not worth the short-term gains in strength and endurance.

Teenagers Not Designed as Early Birds: How to Combat Adolescent Sleep Deprivation

Are you a well-meaning coach trying to get the most out of your athletes during early morning training sessions? Somewhat frustrated that everyone seems a step slow or out of sorts during zero period? While "morning people" are a dime a dozen in the adult world, doesn't it seem that finding teenagers raring to go at 0600 is like the proverbial needle in a haystack?

According to a timely American Academy of Pediatrics (AAP) policy statement on School Start Times for Adolescents this type of behavior is not just an irritating by-product of teenage rebellion and striving for independence, but is a consequence of age-related delays in release of melatonin (hormone that influences sleep onset) and a slower drive to fall asleep compared with non-adolescents.

So yes, teenagers are biologically designed to have their own (circadian) rhythms and if they truly ran the world (instead of thinking that they do) they would select later school start times around the order of 8:30 if not later. This does often conflict with the usual norms of the adult-oriented world (such as parents having to be at work by 9 AM) and the realities of limited access to pools and court space along with trying to fit in another activity into already tight class schedules.

The ultimate goal according to the AAP and its review of the scientific literature would be to provide a consistent 8.5-9.5 hours of sleep per night and reduce the consequences of cumulative sleep deprivation:

How do we best respond to these sleep deprivation concerns?

First of all, don't think that teenagers shouldn't get off without taking some responsibility for their less than impressive sleep statistics, as they often do not do themselves any favors with poor sleep initiation behaviors such as late night caffeine use, using electronics and media right before bedtime, and having access to television in bedrooms. Modifying some of these habits definitely could should be a high priority for parents, coaches, and educators with emphasis on the importance of sleep in post-activity recovery, preparation for next day activity, and especially the impact of insufficient sleep in mood and academic focus:

While giving appropriate counsel to sleep hygiene behaviors, there are certain nutritional recommendations that may also increase the quality of sleep initiation and maintenance according to an article conveniently published just before the AAP article:

  • High Glycemic Index foods such as white rice, pasta, bread, and potatoes may promote sleep; however, they should be consumed more than 1 hour before bedtime.
  • Diets high in carbohydrate may result in shorter sleep latencies.
  • Diets high in protein may result in improved sleep quality.
  • Diets high in fat may negatively influence total sleep time.
  • When total caloric intake is decreased, sleep quality may be disturbed.
  • Small doses of tryptophan (1 gram) may improve both sleep latency and sleep quality. This can be achieved by consuming approximately 300 grams of turkey or approximately 200 grams of pumpkin seeds.
  • The hormone melatonin and foods that have a high melatonin concentration may decrease sleep onset time.

Promoting short naps (under a hour) during the day can contribute to the overall daily sleep total, and if done before an afternoon or evening exercise session may contribute to reduced sleepiness and and can be beneficial when learning new skills, strategies or techniques.

Finally, those of schedule-making adults might want to take a hard and scientific look at the utility of early-morning activities designed for adolescents. While the decision for later school starts may not be part of your pay grade, carefully weighing the risks and benefits of zero period weight training sessions or other before school activities in favor of more after school activities may actually increase athletic and academic performance in this age group. Delaying the start of afternoon training or competition sessions to allow for that brief nap (again, under an hour) may also enhance overall performance and mood of the team or group.

Do these sound like sensible and realistic recommendations to address sleep issues in adolescents?

 

 

Struggling to Sleep may lead to Struggles with Injury and Peformance

Not quite able to get that elusive eight hours of sleep?

Figure you'll catch up on the weekend, or once summer starts, or after the upcoming tournament ends?

Maybe you just don't think that sleep is that important in training and competition?

Well, if your goal is to optimize your athletic performance and limit your risk of injury, then wake up and take notice of the following studies on the importance of sleep:

  • Colleagues from Children's Hospital of Los Angeles found that adolescent athletes who slept more than 8 hours a night were 68% less apt to be injured than peers who did not get that much sleep per night. Athletes who reached higher grade levels in school actually had higher injury risks, so the additional sleep recommendations are even more important for older adolescents versus younger adolescents.
  • A wonderful infographic from fatiguescience.com compares a well rested athlete with a tired counterpart in a visual description of how poor sleep directly leads to poor performance. The graphic also illustrates the sleep habits of several well-known athletes and gives sensible tips on how to increase the quantity and quality of your sleep.
  • For those who must deal with frequent long-distance travel and the demise of regular sleep habits, there's an App for that. Researchers at the University of Michigan utilize smartphones to monitor circadian clocks and make recommendations on lighting and other tips to more rapidly adjust to new time zones with travel.

Now, even when young athletes try to get this adequate amount of sleep, It is very common to have struggles with falling asleep, especially in the junior high or early high school years. If this scenario sounds familiar, start with the following recommendations:

  • Use bedrooms only for sleeping and changing clothes
  • Eliminate or reduce electronic exposure (TV, DVD, smartphones, computers, etc) in the bedroom
  • Try to go to sleep within 1/2 hour of the same bedtime every night
  • Stop all electronic exposures at least one hour before bedtime
  • Limit caffeine use at or after dinner time
  • If having trouble falling asleep, turn your clock/timer around so you can't see the time

Many other athletes report awaking frequently during the night, or even more perplexing, getting the recommended 8+ hours a night, but still awakening tired or feeling fatigued during the day. In in these cases, highly recommend scheduling a medical evaluation to review sleep habits and hygiene, with focus on possible tonsil/adenoid enlargement, overtraining, uncontrolled asthma or allergies, and other illnesses that might contribute to interrupted sleep or poor sleep quality.