Burnout and Prolonged Fatigue —

This is not nutrition but is of interest, at least to me.

Burnout and prolonged fatigue are both characterised by the symptom of fatigue. Both come from different backgrounds. Prolonged fatigue has medical cause. Burnout has a psychological origin eg work conditions.

There is considerable overlap between the two conditions. However burnout is seen as not merely fatigue bu rather a specific work related syndrome.

Leone et al 2007 Similarities , overlap and differences between burnout and prolonged fatigue in the working population QJM vol 100 , 617-627

Drugs In Sport —

The use of pharmacologically active drugs to enhance sporting prowess is widespread. The usage has increased over the last 40 years

The usage of such drugs is not only cheating but also threatens the long term health of the person so indulging.

Sjoqvist and Rane have reviewed the area in Lancet 2008 vol 371 May 31st.

The drugs currently banned are

Anabolic agents

Anabolic steroids

Exogenous anabolic steroids eg danazol, nandrolone

Endogenous anabolic steroids eg testosterone

Other anabolic steroids eg desbuterol, androgen receptor modulators.

Hormones ands related substance.


Growth hormone, insulin like growth factor, mechano growth factors

Gonadotrophins LH, human chorionic gonatrophins




All of them

Hormone antagonists and modulators

Aromatise inhibitors eg anastrozole , letrozole

Selective oestrogen receptor modulators eg tamoxifen

Other anti-oestrogenic substances.

Agents modifying myostatin functions

Diuretic and other masking agents




Α-reductase inhibitors

A formidable list to be detected. Factors such as gender and ethnicity may result in minor but significant physiology.

Sjoqvist and Rane 2008, Use of doping agents, particularly anabolic steroids, in sports society. Lancet vol 371 pp 1872-82.

Exercise —

Exercise is good and can be a problem to do. The Royal Canadian Air force exercise regime is a superb way to exercise in a small space and 11 minutes a day can only be good.

There is a good article on this in FT com /weekend magazine July 18/19 pp 38-39 by Angus Watson

Exercise I

Stand with feet apart, arms up. Bend forward to touch the floor then stretch up

End bend backward. Do not strain to keep knees straight.


lie on your back with feet 6in apart. arms at sides. Sit up just far enough to see your heels. Keep your arms straight. Your head and shoulders must clear the floor.

Exercise 3

Lie on our front, palms placed under your thighs. Raise your head and one leg , repeating using alternative legs. Keep leg straight at the knee. Thighs must clear palms.

Exercise 4

Lie on your front , arms under shoulders , palms flat on floor. Straighten arms and lift upper body , keeping knees on floor. Keep body straight from knees, arms fully extended . Chest must touch floor to complete one movement.

Exercise 5 Stationary run. Lift feet approximately 4 inches off the floor. Every 75 steps do 10 “scissors jumps ” : stand with right leg and left arm extended backward. Jump up and change position of arms and legs before landing. Arms reach shoulder height.

Further details are available on the internet – Click here

Exercise and Sudden Death —

Nutritionists interested in promoting good life styles always mention sporting activities. However from time to time this worthy advice is marred by the death of a fit young person.

Cardiac death in young athletes is caused by a wide range of structural diseases of the heart eg cardiomyopathies and electrical channel defects.

A questionnaire before embarking on heavy sport can help identify those at risk e.g. family history of sudden death in young parents, exertional chest pain, undue breathlessness fainting attacks .

However more than two thirds of sudden deaths occur in previously fit young athletes.

Clearance by a standardised questionnaire, physical examination and an electrocardiogram reduced sudden death to one tenth of the previous experience

A large study by Sofi and colleagues in the BMJ showed that resting and exercise electrocardiography was a good way to identify those at risk.

Editorial 2008 Sudden cardiac death in young athletes BMJ vol 337 pp 61-62

Sofi et al 208, Cardiovascular evaluation ,including resting and exercise electrocardiography before participating in competitive sport: cross sectional study. BMJ vol 337 88-92

Exercise —

Physical exercise is good for us, and is said to decrease the risk of coronary heart disease, type 2 diabetes and cancer of the colon. It is curious that in any list of reduced risk whatever the pre disposing element is , cancer of the colon is on the list.

Walking even at 3 miles / hour increases respiratory and cardiac measures and blood glucose concentrations. Most of all there is an enhanced feeling of well being.

Everyone who has had 3-4 year old children knows that it is essential to give them a run about to burn off some of the exuberance of being 3-4.

There is no reason to believe that this requirement becomes unnecessary as one grows older.

30 minutes of moderate exercise on most days of the week cannot be other than good.

Walking is such an exercise, gardening and cycling are also good as is swimming

Ogilvie D et al 2007, Interventions to promote walking : systemic review BMJ , 334, 1204-7

Andersen LB 2007 Physical activity and health BMJ 334, 1173.

Marathons And Death —

The first person to run the Marathon was said to be Pheidippides, a Greek messenger sent from the town of Marathon to Athens to announce that the Persians had been defeated in the Battle of Marathon in August or September, 490 BC. It is said that he ran the entire distance without stopping. In additon to running the first recorded Marathon he was the first to die running a Marathon, he finished his run and and burst into the Athenian assembly, calling “?e?????aµe? ( We have won.’) before collapsing and dying.

Every year some runners attempting to run the Marathon or a half Marathon die. Over heating or failure to drink sufficient are the cause. Sometimes previously unknown cardiac anomalies are the cause of death. Often there is no apparent cause.

As reported by Tara Parker-Pope in the New York Times Sport section Thursday October 2nd 2009 a study reported at the American Collee of Cardiology meeting in April gave the risk of death in a marathon at 0.8 per 100, 000 runners. For the triathalon the risk is 1.5 per 100,000 , young non athletes 0.9 per 100,000, young athletes 2.3 per 100,000, childbirth 13 per 100,000, diabetes cause of death 23 per 100,000. The risk of dying in a car crash is 1 per 6,700

Marathon Running And Death —

Exercise is an integral element in the advise for a healthy and long life. There are those , including myself who love running and run or ran marathons.

The distance is considerable and the training demanding. People die on such runs.

It is therefore interesting to read a paper which studies marathon running and the chances of sudden death.

Redelmeir and Greenwald looked at the risk of sudden cardiac death associated with running in an organised marathon compared with the risk of dying from a motor vehicle crash that might otherwise have taken place if the roads had not been closed.

They looked at Marathons with at least 1000 participants that had two decades of history and took place on public roads in the United States, 1975-2004.

The marathons provided results for 3,292,268 runners on 750 separate days about 14 million hours of exercise.

There were 26 sudden cardiac deaths observed, equivalent lo a rate of 0.8 per 100000 participants. Because of road closure, an estimated 46 motor vehicle fatalities were prevented, equivalent to a relative risk reduction of 35%. The net reduction in sudden death during marathons amounted to a ratio of about 1.8 crash deaths saved for each case of sudden cardiac death observed (95% confidence interval: 0.7 to 3.8). The net reduction in total deaths could not be explained by re-routing traffic to other regions or days and was consistent across different parts of the country, decades of the century, seasons of the year, days of the week, degree of competition, and course difficulty. So organised marathons are not associated with an increase in sudden deaths from a societal perspective, contrary to anecdotal impressions fostered by news media.

Redelmeier and Grenwald 2007 Competing risks of mortality with marathons: retrospective analyis BMJ . vol 335, 1275-7


Nutrition and Stamina in Juvenile Football Teams —

I have a grandson who plays in an under 10 year old football team. The boys include several who are included in a Scottish Premier Division Football Academy.

They play with all the commitment and activity of little boys but they always flagged in the second 25 minute half. This left them vulnerable to loosing goals. The team includes several boys from underprivileged homes and whose nutrition is far from good. These boys are often given money to buy a bag of chips as their evening meal. These boys are resistant to any offer of food acceptable to a nutritionist.

So what does one give them to enhance stamina?

One Scottish Premier Division Club gives the players wine gums before the game, presumably as slow release sugar

We gave our young boys a small Mars bar before the game and a similar one at half time and afterwards

The change in stamina was striking in the most demanding game of the season. Hopefully we can persuade them to eat pasta the night before.

Nutritionsport —

FOOD & Drink for Footballers

WATER is important to keep you hydrated.

Drink water before the game and at half time. Energy drinks are ok but water is vital

PROTEIN is important, if possible, every day.

Meat, chicken, eggs, bread, beans.

This helps build muscles.


Fruit, vegetables & fresh fruit juices, the famous five (a day) are still as good as ever.


You need energy stored in the body to last the full game.

Energy comes from sugar. You can get different sugars from different foods

Quick acting energy comes from ordinary sugar

Found in sugary drinks, sweets and chocolate bars.

These are good to eat at half time, but can damage your teeth if too much is eaten.

Slow acting energy comes from starchy foods (stores energy for long term fitness)

Found in bread, pasta, potatoes, rice, breakfast cereals, beans and bananas.

It is good to eat some slow acting energy food twice on the day of the game

In the morning before the game

And later on in the day

Try to eat 2 of these foods every day

These foods and drinks could make you a better player who is energetic all through the game, and help you be a winner!!!

Along with exercise, food and drink are vital for young football winners!

Olympic Athletes —

The wonders of the Beijing Olympics are now behind us

The implications for nutrition of the activities of these extraordinary people are immense.

Two asides

The great swimmer Phelps eats 12000 calories a day. This energy intake is presumably monitored by a nutrition team. What happens when he rests from swimming or retires? I hope that he is guided through this change of energy intake and utilisation whilst returning to normal activity.

Or Chris Hoy the Scottish cyclist who has a thigh measurement of 26 inches, greater than Mrs Beckham’s waist. What happens when he retires?

Physical Activity and Childhood Obesity —

This is a somewhat older review but still very relevant published by Reilly and McDowell in the Proceedings of the Nutrition Society in 2003.

The emergence of the childhood obesity epidemic, was not apparent in the UK until 1999.

Interventions for prevention and treatment of childhood obesity typically target increases in physical activity and. more recently, reductions in physical inactivity (sedentary behaviour such as television viewing). However, the evidence base for such strategies is extremely limited. Randomised controlled trials that targeted activity or inactivity, that followed up children or adolescents for at least 1 year and that included an objective weight-related outcome measure were included.

The evidence base has increased markedly since the completion of earlier reviews, although high-quality evidence is still lacking. This position reflects a combination of factors; limitations in trial design before the advent of the Cochrane and CONSORT processes; the major difficulties (methodological, financial, practical, ethical) presented by carrying out long-term research in this area.

The evidence on childhood obesity prevention is not encouraging, although promising targets for prevention are now clear, notably reduction in sedentary behaviour.

There is stronger evidence that targeting activity and/or inactivity might be effective in paediatric obesity treatment, but doubts as to interventions, and the clinical relevance of the interventions is unclear..

A number of previous studies have noted the possibility that the large-scale changes in society that have driven the obesity epidemic may be beyond the reach of interventions aimed only at the family or school environment

Large-scale policy or strategic initiatives, employing macroenvironmental or “ecological’ approaches, may be essential if the public health impact of the childhood obesity epidemic is to be addressed However, any such initiatives should also be evidence based and should be evaluated rigorously

Reilly and McDowell 2003 Physical activity interventions in the prevention and treatment of paediatric obesity: systematic review and critical appraisal Proceedings of the Nutrition Society vol 62 pp 611-619

Triathlon Thoughts —

Many people progress from marathon running to triathlon events which is a very taxing riding , swimming and running trial.

Maybe Swim 2.4 miles! Bike 112 miles run 26.2 miles

A real challenge.

This is an interesting summary of needs in the Financial Times Weekend Magazine

Triathlon kit Seasoned triathletes are well known for forking out a lot of money on gear, but you don’t need to spend a fortune when you’re starting out.

~ Goggles are a must. Those for “open water” swimming often use a mask style, which offers greater peripheral vision..

~ A wet suit is compulsory for most UK open water triathlons. But if your triathlon might be a one-hit wonder, hire a wet suit for the season instead of shelling out.

~ Many triathletes wear a “tri-suit”, beneath their wet suit, in which they can perform the cycle and run. But swim wear or close-fitting sportswear is fine.

~ You don’t need a super-light road bike (let alone a tri-specific bike), although it will be faster than a mountain bike or other upright. Use an aluminium-framed road bike with carbon forks.

~ Clipless pedals and cycle shoes fitted with cleats enable you to apply more power to the pedals, but they aren’t essential. Ensure you get a good-fitting, well-vented helmet that meets British safety standards and fits snugly, even without the strap fastened.

Any old running shoes will do –But good shoes with the all-important elastic laces for quick access and a chafe-free interior for wearing sock-free.

~ Finally, a race belt with race number belt, to which you attach your race number, dispenses with the need for safety pins. Simply twist it to the back for the cycle and the front for the run.

Nutrition tips

1. Three to four days before the race, increase your carbohydrate intake to maximise stores of glycogen in the muscles (the fuel your body breaks down for energy). Aim for 7g per kg of body weight per day.

2. Start the race well fuelled and hydrated. Many triathlons begin at dawn, which means getting up even earlier to eat a light breakfast of cereal or toast. If you can’t face food, at least have a smoothie or sports drink.

3. Consider drinking a cup of coffee 01′ taking a caffeine gel an hour before the race starts. Caffeine has been shown to boost endurance performance.

4. Find out what – if any – sports drink is provided during the race so that you can try it out in training. Research has shown that isotonic sports drinks containing carbohydrate and electrolyte salts are more effective than plain water. Sip frequently, don’t guzzle ..

5. As the bike leg is the longest part of a triathlon (and given that you can’t drink during the swim), this is when to fuel up. Take an energy gel as soon as I get on the saddle, and another shortly before I get off, as well as drinking 500ml-750ml of sports drink. Jelly Babies are a good energy gel alternative.

6. Refuel afterwards to replenish energy, fluid and electrolytes, A milky drink, salty snack and fruit are ideal.

My only concern with this very good advice is the use of caffeine supplements, which are also cardio toxic at the wrong time. I would avoid them.

Source Sam Murphy FT weekend June 6/7 p 41

Sam Murphy “Triathlon start to finish “ Kyle Cathie p £14 .99.

Weight History and Physical Performance —

Are overweight individuals overweight all their lives? We have all seen pictures of lean and hungry looking youngsters and this contrasts with the overweight middle age person. I have always related this to less exercise and an ample diet and alcohol intake in the more sedentary older person.

Houston et al (2007 ) The association between weight history and physical performance in the Health , ageing and body composition study : International Journal of Obesity vol 31, just that.

Maintaining a healthy body weight throughout adult life may play a role in preventing or delaying the onset of less physical activity

A thought on this is in my experience (small though this is) that long distance athletes (slow muscle predominantly) tend to keep exercising throughout life whereas the sprinters (Fast muscle predominantly) retire form exercise early on and become overweight. An interesting field for study.

Weight and Performance —

Are overweight individuals overweight all their lives? We have all seen pictures of lean and hungry looking youngsters and this contrasts with the overweight middle age person. I have always related this to less exercise and an ample diet and alcohol intake in the more sedentary older person.

Houston et al (2007 ) The association between weight history and physical performance in the Health , ageing and body composition study : International Journal of Obesity vol 31, just that.

Maintaining a healthy body weight throughout adult life may play a role in preventing or delaying the onset of less physical activity

A thought on this is in my experience (small though this is ) that long distance athletes ( slow muscle predominantly ) tend to keep exercising throughout life whereas the sprinters (Fast muscle predominantly ) retire form exercise early on and become overweight. An interesting field for study.


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