Sports Medicine:

Being active and athletic is one of the most rewarding experiences in our lives. Exercise not only conditions our muscles or maintains a healthy body weight, but it stimulates our minds and our immune systems. Exercise is the most basic of life changes that we can make to ensure a healthier body for the future and prevent disease.

The three fundamental aspects to increase fitness are endurance, strength and flexibility. Strength training is usually done by resistance exercises using weights. It involves the increase in muscle cell size (hypertrophy) instead of an increase in the number of muscle cells (hyperplasia). Think of a muscle cell as an electrical wire that is covered in plastic. Muscles get bigger because more wires are added inside the plastic coating, making the cell larger. Endurance or aerobic exercise is the continuous motion of muscles for an extended period of time. Flexibility is the increase in range of motion across a joint. All three aspects are important for a healthy fitness routine and the prevention of injury.

Exercise is the starting point on the road to great health. You must also eat properly and take the correct supplements to keep your body energized. No matter what type of athlete you are, you can enhance your performance by making correct nutritional choices with food and supplements. Your body will require more nutrition proportionate to the increase in exercise or the greater the intensity. As we age our bodies have a tendency to become more injury prone and take longer to recover. Supplements can make a huge difference in all of the components of exercise. There are so many supplements and claims in the market of nutritional medicine, and Dr. Metcalfe wants to make it easier for you to understand and be the best that you can be.

Endurance:

Endurance training is otherwise known as aerobic exercise. Its most profound effect on the body is with the cardiovascular system (heart, arteries, and veins). Your heart rate or pulse measures the intensity with which you exercise. The heart rate is directly related to the intensity of the exercise. As the intensity increases and you work harder, the heart rate increases. The maximum heart rate remains a constant in all individuals, and exercise will not change this figure. Maximum heart rate is measured by subtracting your age from 220. Aerobic exercise increases so much blood flow through the heart that it decreases the heart’s demand for oxygen even while at rest. The heart increases its muscular walls and the ventricular chambers increase in thickness. It also lowers the resting heart rate (bradycardia), so that the heart doesn’t have to work as hard to pump blood to the rest of the body. This is why exercise is so important for people with heart disease, because it makes the heart stronger and more efficient.

Ergogenic aids are those that claim to enhance energy utilization during exercise. It’s quite simple, you must provide your body with energy or else it won’t do the work. Your body utilizes its energy in various ways depending on the intensity with which you exercise. Intensity is usually measured by your heart rate (pulse). ATP, adenosine triphosphate is an energy rich complex consisting of adenine (amino acid), ribose (sugar), and a tri-phosphate bound to either magnesium of manganese. Your body breaks ATP down with the help of calcium to provide a powerful source of energy. The problem with ATP is that the body utilizes its entire stores within the first 2-3 seconds of exercise. The body then turns to a second high-energy source of phosphocreatine, which it utilizes within the next 10 seconds. In sprinters it is utilized even more rapidly. It is then, that the body must begin using other forms of energy either from fat stores or glycogen. If you workout at a low intensity (low heart rate), your body will utilize energy initially from ATP in the muscles, then utilize energy from fat stores of the body. In a typical 70 Kg male, the energy stored in fat is about 135,000 Kcal, so there is plenty of stored energy. However, as exercise intensity increases, the body immediately utilizes ATP, then begins consuming glycogen, which is stored in the muscle. As long as the body is exercising at an aerobic level, the body will utilize glycogen. However, glycogen stores last on average about forty minutes at a high intensity. As glycogen stores decrease, the body then starts utilizing fat stores. You can see the importance of refueling your body with food as you continue to exercise past forty minutes. It’s like fueling a fire, it won’t continue to burn without wood! It is essential that you consume carbohydrates during longer training and racing events because your body will start breaking down muscle protein for energy. This is totally counterproductive for an athlete trying to strengthen his body.

There are also 2 types of skeletal muscle fibers in our body and the proportion of both is genetically predetermined. Fast twitch muscle (white fibers) is unable to utilize oxygen effectively and produce relatively small amounts of ATP, but they can contract very quickly. Sprinters are typically dominant in fast twitch fibers. Slow twitch muscle (red fibers) are much better utilizers of oxygen and produce high amounts of ATP for longer periods of time. Marathoners or distance cyclists have a predominantly higher proportion of slow twitch fibers. Exercise cannot change the types of muscle fibers in your body, but it does make them more efficient.

Ergogenic aids are definitely required for anyone doing moderate to high intensity exercise, have blood sugar imbalances, or for low intensity exercisers that are active for longer than a couple of hours. It is important for an Ergogenic aid to contain more than just sugar. Dr. Metcalfe believes the best product on the market for endurance are those that contain minerals and other cofactors essential in muscle metabolism.

The nutritional needs of an endurance athlete must include the following:

Calcium:

Males and Females 1000 mg daily. This is an essential nutrient for muscle contraction. Dr. Metcalfe recommends supplementing calcium, as it is so essential to muscle function. If you get more from your diet on a certain day then you can take a little less calcium, but extra never hurts. Foods that contain calcium are dairy products, leafy greens, broccoli, almonds, salmon, and tofu. She recommends taking calcium with your pre-workout meal, some more right after you exercise, and again before bed for relaxation.
Cal-Plex: An excellent calcium supplement, which contains L-Arginine a precursor for growth hormone, which helps drive calcium into bones. Take 2 capsules with breakfast, 2 post-exercise and 2 before bed.

Magnesium:

Males and Females 600 mg daily. Some magnesium supplements will cause diarrhea, so Dr. Metcalfe recommends Mag Glycinate, which doesn’t cause diarrhea. Magnesium is essential for ATP utilization for energy. Magnesium is readily lost during sweating and through the urine from sugar ingestion. Red blood cells also require magnesium to function and healthy red blood cells means more oxygen to the body. Early onset of fatigue while exercising may be due to low magnesium, along with cramping and nausea. Foods that contain magnesium are vegetables, fish, nuts, and seeds.
Mag Glycinate: 2 tablets three times daily. 2 with breakfast, 2 post-exercise and 2 before bed.

Glutathione:

Glutathione is essential for repairing cellular damage caused by oxidative damage from prolonged exercise. It is essential for DNA synthesis and repair, liver detoxification, immune system enhancer and a potent anti-oxidant. Even though you’re exercising, your increased oxygen consumption is harmful to cells. Glutathione is essential in all athletes, especially those that live in larger metropolitan areas and are exposed to smog.
Recancostat 100mg: this product contains 100 mg of glutathione along with antioxidants. Dr. Metcalfe recommends 1 capsule twice daily.

Potassium:

Males and Females should make sure that they drink a potassium rich drink as they exercise. You should also reload after exercise with 100mg of potassium for every hour you have exercised! Food sources of potassium include bananas, avocados, and dried figs. Potassium is readily lost through sweat and urine. Potassium is essential in maintaining the energy of each cell in the body. When you exercise, cells release potassium into the blood stream and this may contribute to fatigue.
Endura Lemon Lime: carbohydrate replacement drink contains 180 mg of potassium per serving.
Endura Orange: carbohydrate replacement drink contains 180 mg of potassium per serving.
Mag-K Chela Max: 1 capsule upon completion of exercise for every hour of exercise. If more than 3 hours, divide capsules into 2 every two hours.

Vitamin C:

Males and Females 1000 mg every morning and evening with a full glass of water. Food sources include fruits and vegetables. Vitamin C is essential in the formation of collagen and connective tissue such as cartilage, and it has potent anti-oxidant benefits. It potentiates your immune system, particularly your white blood cells to fight off illness.
Ultra Potent C 1000: 1 capsule twice daily with a full glass of water.

Glutamine:

Males and Females 2gm daily. Glutamine is an amino acid, which is made by the liver. It is fast becoming one of the most studied nutrients for endurance. Food sources of glutamine include raw spinach. Glutamine is required for muscle anabolism (growth) and a precursor for human growth hormone. It is also a good buffer for preventing lactic acid accumulation in muscle tissue during anaerobic metabolism. This decreases the onset of muscle soreness and fatigue. Glutamine is also being studied further for its effect on fat loss. It may do this because of its ability to lower high blood insulin levels. Glutamine is also used by the central nervous system in the production of neurotransmitters. During endurance events, our brains can use a little extra help!!! Glutamine is also essential for maintaining a healthy intestinal mucosa level. This mucosal level may get depleted due to the stress of competition and may minimize pre-competition diarrhea.
Permeability Factors: 6 capsules contain 1.5 mg of glutamine along with gamma oryzanol and other essential nutrients to enhance nerve cell function and endurance. Take 3 capsules twice daily.

Vitamin E:

Males and Females 800 iu a day. Vitamin E is an anti-oxidant, which protects cells from the oxidative effects of exercise. It may also be important in increasing anaerobic threshold and decreasing lactic acid production. Foods that contain Vitamin E include corn, wheat germ, nuts and seeds. It is important to make sure you take a "natural" vitamin E as opposed to a synthetic form.
Vitamin E: Take 2 capsules daily with food.

Protein:

Males and Females should eat 1 gm of protein for each pound of their body weight daily. Protein is essential for providing the amino acids, which are the building blocks of muscle tissue and neurotransmitters of the nervous system. Endurance athletes require extra protein because of the catabolic effect, which occurs on long training days. Amino acids will help prevent depression and fatigue. Food sources of protein should primarily come from fish, lean meats, low fat dairy products, and protein drinks.
Progain: An excellent pre and post exercise drink when it’s too hard to eat. This contains carbohydrates as well as protein.
Ultrabalance Protein: A protein only drink mix. Excellent for adding extra protein in the diet.

The endurance athlete’s cupboard should contain: