Personalized care is critical for the health and well-being of all your patients, but I have found my patients who are athletes tend to have certain requirements in common.
When treating athletes, I utilize four batches of tests to help design a supplement protocol specific to them that addresses the demands of sports on their bodies.
Test Group #1: Baseline
With athletes, I do four baseline tests. One is my full blood chemistry panel: a complete blood count (CBC), comprehensive metabolic panel (CMP), lipid panel and full thyroid, which includes TSH, T3 total, free T4 total, free T3 uptake, reverse T3, TPO antibody and thyroglobulin antibody. I also include creatinine kinase (which can indicate muscle trauma from overtraining), hemoglobin A1C (HgA1C, which measures average blood glucose), vitamin D, B12, folate, RBC magnesium, LDH (a marker of organ or tissue damage), vitamin K (to check for deficiency, which causes easy bruising and bleeding), lipase and amylase (markers of pancreatic function), C-reactive protein and erythrocyte sedimentation rate (which indicate inflammation) and homocysteine (an indicator of B vitamin deficiency).
With these tests, we first pay attention to the clinical range: Are they within the normal or reference range? But each also has a subclinical range that may or may not indicate some specific needs. For example, a blood glucose level between 85 and 99 mg/dL is ideal. A lab will not identify hypoglycemia, low blood sugar, until it is under 65. An athlete with glucose level of 70 may be experiencing significant hypoglycemia symptoms, such as excess sweating, hunger, syncope, nausea, heart palpitations, unsteadiness and fatigue, which all affect performance.
Test Group #2: Individual Factors
I also typically test quite a few nutrient levels in athletes, including:
Iron, which is low in a lot of athletes. Young athletes who are still growing especially need iron, as do people who train in high altitudes. There’s also runner’s anemia, where the pounding of the feet on pavement destroys red blood cells, further lowering iron levels. An elevated total iron-binding capacity (TIBC) test means iron isn’t getting into the red blood cells. That process is facilitated by vitamin C, so I then suggest C supplementation. (Speaking of vitamin C, take this supplement starting with 500-1,000 milligrams a day and increasing every two or three days, backing off if diarrhea develops.) I also test ferritin, transferrin and iron saturation, markers of iron storage.
Calcium, but do not get your dosage from dairy products, because most dairy contains calcium carbonate, the least absorbable form, plus dairy creates an alkaline environment in the body while calcium is best absorbed in an acidic one, in the presence of cofactors vitamin D, manganese, zinc, magnesium, molybdenum, boron and vitamin K, which help calcium get into bones. (Don’t forget bone density testing for older athletes.)
RBC zinc, kept at midline levels; too-high levels affect the zinc-copper ratio, which can affect immunity. Zinc has great wound healing, tissue repair and illness-repelling characteristics. The toll training takes on athletes’ bodies may depress the immune system, making them more susceptible to infections. Take zinc with food to avoid stomach upset.
Magnesium, which helps with muscle soreness, low energy, oxidative stress and other issues. Magnesium glycinate is best for muscle recovery, magnesium threonate for brain injury and recovery. Threonate crosses the blood-brain barrier, whereas the other forms do not.
B vitamins, which are easily depleted by stress as well as medications, especially riboflavin, B12, folate and B6. Test levels and suggest B supplementation if patients take prescription medications including antacids, birth control pills, antidepressants and proton pump inhibitor medicines for acid reflux.
I always test levels of vitamin D, manganese and copper (important for bone health), antioxidants CoQ10, cysteine, glutathione and selenium, choline and inositol (which support nervous system function), methylmalonic acid (an indicator of B12 deficiency), carnitine (which converts fat into energy), the electrolytes sodium and potassium, and various omega-3 (DPA, DHA and EPA) and omega-6 (AA, LA) fatty acids. Supplementation of those needed is essential on a cellular level.
Test Group #3: Metabolic Performance Profile
Depending on their sport and skill level, athletes may have increased supplementation needs based on energy expenditure. Plus, they have to recover from injury, so they may have a higher requirement for some nutrients. But every athlete has different needs and deficiencies.
The third test I order, a metabolic performance profile, goes deeper than standard lab tests, looking at biomarkers related to genetics, diet, lifestyle, environment, metabolism and detoxification. These give an idea of supplements or foods to recommend to decrease oxidative stress, lower inflammation, improve cognitive and cardiovascular health and balance the gut.
Test Group #4: Genetic Testing
The fourth part of my athlete approach is genetic testing, because they may have predispositions we need to help or inhibit to maximize their performance. For example, if an endurance athlete wants to do a lot of carbohydrate loading, but genetically doesn’t break down carbohydrates well, we can consider an intervention such as a digestive enzyme supplement. Genetics can explain why a certain diet or form of exercise isn’t working as well as other roadblocks in supporting systems.
Now make a game plan
Ask your athlete patients plenty of questions during their appointment, too. How old are they? Are they in training or actually competing? How often? Are they in a low- or high-elevation location? What are their specific goals? Supplement needs may also differ by gender or lifestyle factors.
Once you’ve run all these tests, considered the patient’s unique needs and made supplement choices, plan to re-test the patient in three to six months to make sure you’re getting the supplementation correct. (And if not ― adjust!)
More supplements for athletes to try
Some more choices to consider as you build each athlete’s personalized plan:
Creatine promotes lean muscle mass gain, but use caution, as it can affect liver and kidney function or cause uncomfortable tingling.
White willow bark, a natural alternative to NSAIDS, can be used to deal with muscle soreness and other sports-related pain. Curcumin is also anti-inflammatory, especially when combined with ginger and boswellia.
Nitric oxide products, such as beet root powder, arginine and citrulline, help produce nitric oxide, which increases ATP production in the mitrochondria, facilitating cellular respiration and blood flow to the muscles.
Other supplements to investigate include glutamine and beta glucans for immunity, beta alanine for sustained high-intensity exercise and protection against muscle soreness, omega-3s for cognitive processing, hydroxy beta methylbutylrate (HMB) to aid protein synthesis, probiotics for gut health and collagen to build cartilage and decrease joint pain.
Look before you recommend
Before you suggest a supplement for an athlete, always double-check the banned substances list maintained by the World Anti-Doping Code (wada-ama.org).
Final thoughts
By running these four batches of tests and using the results to design a targeted supplement plan specific to each athlete’s needs, you help improve their health and wellness and give them tools to excel at the sport they love, even further enhancing their quality of life.
CINDY M. HOWARD, DC, DABCI, DACBN, FIAMA, FICC, is a board-certified chiropractic internist and nutritionist in private practice and the owner of Innovative Health and Wellness Center in Orland Park, Ill., where she focuses on individualized care. She is the author of Positively Altered: Finding Happiness at the Bottom of a Chemo Bag and writes for Stopain Clinical. Learn more and contact her at DrCindySpeaks.com.
