Mental Health and the Athlete

Mental health has become a major talking point during the COVID pandemic with feelings of despair, lethargy, hopelessness, low drive which is compounded by the prevalence of mental health disorders already present in the community with one in five people suffering from a depressive or anxiety disorder. Athletes are not immune from mental health disorders including depression, anxiety and eating disorders which can be associated with sporting performance, injuries, multiple surgeries, maladaptive perfectionism, retirement with rates of depression and anxiety as high as 45% in elite athletes.

Athlete Burnout

Athletes and individuals who train hard will routinely experience symptoms of tiredness, exhaustion, fatigue, reduced motivation, decreased performance which may or may not be associated with increased injuries and often describe feeling “burned out”. However, overtraining and burnout are two different states where burnout can occur in the absence of excessive training stress. Burnout is conceptualised as a psycho-social syndrome comprised of emotional and physical exhaustion, a reduced sense of accomplishment and sport devaluation.

It is the consequence of chronic stress which can result from high training loads, perfectionism, uncertainty around team selection, perceived performance pressure. It is not a transient condition and shares overlapping symptoms with depression such as concentration difficulties, anhedonia (inability to feel pleasure), sleep disturbance, self-criticism, psycho-motor changes, fatigue/exhaustion however burnout and depression are two independent states.

Burnout is characterised by psychophysiological and behavioural changes such as;

  • Struggling to meet personal and professional demands
  • Physically tired and not able to participate in activities
  • Difficulty communicating
  • A feeling of not being supported by the team (coach/support staff)
  • Ongoing disappointment
  • Mentally exhausted
  • Physically exhausted
  • Feel your own contribution to the team is small and isn’t valued by others in the team
  • Feeling like you have no social support

Personality factors have also been associated with burnout in particular perfectionism either striving for perfectionism or concerns about making mistakes.

Consequences of Burnout

Burnout has been shown to lead to a range of negative consequences like depressive mood, decreased commitment to sport, decreased performance, antisocial behaviour including social distancing and termination from sport. Every individual will experience burnout differently as such treatment of burnout needs to be tailored to the individual. Mindfulness based interventions and cognitive behavioural therapy including stress management techniques like breathing, and exercise and cognitive restructuring to help keep an individual’s mind in the present moment while also addressing any issues around perfectionism may be of benefit. Professional interventions such as involving the athlete with any decision-making processes, rotating the athlete to allow for time off from training and/or competition should also be considerations.

It is important that we are acutely aware at understanding and identifying the mental health issues present in the general and athletic population. Burnout although overlapping in symptoms with depression and often associated with overtraining is its own standalone state which can have consequences on the mental health and performance in athletes and professionals.

For one-on-one information, contact Melbourne Chiropractor, Dr. Nick Shannon.

Why is protein important for athletic performance?

In sports where power and strength are important, athletes/individuals need lean muscle mass which occurs through a process called muscle protein synthesis. In short muscle protein synthesis is the remodelling process of skeletal muscle in response to resistance training leading to muscle growth (hypertrophy).

Protein is therefore an important building block for muscle growth and also for nonmuscular structures like tendons and bone. It is thought that adaptations in muscle occur due to a rise in leucine (an amino acid in protein) which triggers off muscle protein synthesis. Resistance training is the main stimulant for muscle protein synthesis, where one bout of resistance training leads to muscle protein synthesis for up to 24 hours.

Types of Protein

There are different types of protein, which commonly come in the form of supplement bars and powders. Many of these products are successful more so through slick marketing than the ingredients involved, with supplement companies usually promoting the more amino acids and secondary compounds the better the product, which is seldomly the case.

The 3 most common types of protein are whey, casein and soy. When these three are compared against each other it is whey protein that is absorbed the fastest and contains the highest leucine content, the most important amino acid for augmenting muscle protein synthesis.

Timing of Protein Ingestion

TThe timing of protein ingestion is extremely important, because if protein ingestion occurs too close together it creates a blunting effect of muscle protein synthesis. As such, protein ingestion needs to occur equally over a 4-5 meals throughout the day with one pre bedtime meal/shake. The pre bedtime intake is important as muscle protein synthesis diminishes throughout the night and a pre bedtime meal can aid to reduce the drop off. As a guide ingesting protein within 2 hours post exercise and every 3-5 hours is a solid approach.

Protein Dosage

Dairy sources of protein appear to be superior to other sources of protein due to the higher leucine content. However, there are reports of increased muscle protein synthesis with lean meat, casein, soy and egg.

For athletic performance, the optimal dosage is .25-.3g per kg. Pre bedtime meals should contain .6g per kg. While the optimal dose for older adults is around 40g per serve. Dosages greater than 40g have not been shown to augment muscle protein synthesis any further, with any excess protein being oxidized (removed).

Ketogenic diets or low carbohydrate diets routinely appear in the media with stories ranging from the negative health implications they can have including reduced bone health to the benefits they have on weight loss, diabetes and performance in elite athletes. With such conflicting information out there, let’s turn to the literature to see what the truth is about ketogenic diets and performance.

What Is Keto?

For a diet to be considered ketogenic it needs to contain less than 50g of carbohydrates (CHO) per day, be high in fats 70-80%, with the remaining 15-25% coming from protein. For athletes, especially endurance athletes CHO’s are the preferred fuel source for enhancing performance therefore by restricting CHO intake it forces the body into ketosis. In a ketosis state, ketone bodies (fat molecules) are released from the liver, producing an alternative fuel source to CHO’s.

Why Athletes Choose a Keto Diet

The utlization of fats as fuel becomes one of the primary reasons endurance athletes are attracted to ketogenic diets. This attraction occurs because fats provide a better source of energy than carbohydrates and there is an abundance of fat stores compared to the limited glycogen (CHO) stores in the muscles. Other reasons athletes are attracted to ketogenic diets include, the feeling of enhanced recovery, improvements in body composition and reduced post exercise inflammation.

It is well documented that ketogenic and low CHO diets are beneficial for body composition changes, namely weight reduction through decreases in adipose (fat) tissue. This isn’t surprising considering fat oxidation (fats being burned for fuel) becomes the primary energy source in a ketogenic diet.

Keto Diets and Athletic Performance

In terms of athletic performance the evidence is less clear. Majority of the current studies looking at athletic performance and ketogenic diets routinely involve small sample sizes of elite athletes and over a short time frame (3-10 weeks). As a result, any findings from these studies need to be interpreted and considered with other available literature. With such a specific cohort (study population) transferability of the results to other non-elite athletes becomes difficult.

Exercise Capacity

In terms of endurance performance, there appears to be a reduction in performance during high intensity bouts above 70% of VO2Max when on a short term (3-10 week) ketogenic diet. The postulated causes include; fats require greater oxygen uptake and energy to be broken down compared to CHO, possible impaired glycogen metabolism at higher intensities. However, one study which looked at endurance athletes who were on ketogenic diets for longer than 6 month showed no changes in muscle glycogen stores.

Resistance Training

For resistance training and lean muscle mass it appears that ketogenic diets result in reduced body mass, with conflicting evidence on whether it impacts on lean muscle mass. Regardless, it doesn’t appear to negatively impact strength.

Bone Health

Bone health is an interesting area. An Australian study published early this year revealed that bone resorption (break down of bone) increased and bone formation (new bone formation) decreased in elite athletes (race walkers) while on a short term (3 – 3.5 week) ketogenic diet. This study received a lot of press because the implications are potentially serious; ketogenic diets leading to reduced bone mineral density and bone injuries in elite athletes. However, this study needs to be put into context. It looked at elite race walkers, predominantly males who were on short term ketogenic diets. This is a very specific subgroup of people. As the study rightly points out, further research is needed to understand these findings further before any definitive answer is known about ketogenic diets (short and long term) and bone health in elite athletes and in the general population.

The Wash Up

When it comes to athletic performance ketogenic diets improve fat oxidation and reduce body mass, which is important in endurance sports and weight-class based sports such as boxing, weight lifting, martial arts etc. They don’t negatively affect exercise capacity at submaximal workloads below 70% VO2Max but they do appear to reduce exercise capacity at high intensities. They may also reduce endurance capacity but this appears to be individual, with some athletes being affected and others not. At present, finding the right balance of lower CHO levels which are higher enough not to impact performance at higher intensities is the best approach to maximize athletic performance through a ketogenic diet. One final note, even though CHO intake levels are low, this does not mean an athlete will be running a negative energy balance; energy expenditure should always match energy intake.

[Click Through To Read About Plant-Based Diets]

When people talk about the keys to living a healthy life and performing at your best, exercise and diet are always front and centre. Rightly so, as exercising at least 150 mins per week at moderate to vigorous intensity and eating a well-balanced diet rich in green leafy vegetables, fruits, grains and seafood and low in red meats and saturated fats are essential for longevity and a healthy life. But there is a third pillar that is regularly overlooked that is just as important as diet and exercise and that is sleep.

Sleep Deprivation

Sleep deprivation can be due to sleep disorders like insomnia and sleep apnoea. These disorders are often associated with symptoms such as difficulty falling asleep or maintaining sleep and require further clinical investigation. However, most sleep deprivation occurs due to poor sleep quality and duration. The average adult requires 7-9h of sleep per night yet those with sleep deprivation will get less than 5-6h of sleep per night. Some people pride themselves on their ability to work with very little sleep yet sleep deprivation has been shown to affect human (and athletic) performance in a myriad of ways including:

  • Impaired cognition effecting decision-making, judgment, mood, and reaction times
  • Metabolic disruption including diabetes and obesity
  • Weight gain to due craving more unhealthy and high carbohydrate foods and in larger portions
  • Immunological resulting in increased proinflammatory cytokines which impair immune function and impede muscle recovery and repair from damage
  • Cardiovascular dysfunction
  • An increased risk of injury

There is also a dose-dependent relationship between sleep and performance; the greater the sleep loss the greater the performance loss, with performance loss occurring with as little as 2-4h of sleep loss. And for those who believe they are able to recoup the sleep they lose during the week on the weekends, the evidence says the contrary.

Improving Sleep Quality and Duration

The two sleep interventions that have received most research are sleep extension and sleep hygiene. Sleep extension and napping involves extra sleeping time to make sure the 7-9h daily limit is being met; this is especially useful when one knows they have a day of potential sleep deficit ahead. Sleep extension might involve going to sleep earlier or utilization day time naps that are more than 20 mins but less than 60 minutes and occur before 3pm. Sleep hygiene helps to improve sleep quality and duration and essentially involves a healthy sleep routine such as:

  • Don’t go to bed if you aren’t sleepy
  • Rise at the same time every morning, including on the weekends
  • The bed is for sleeping only, don’t watch TV or use electronic devices in bed
  • Avoid caffeine after lunch
  • Avoid alcohol, especially before bed
  • Avoid high intensity interval training before bed
  • Try to create a dark, quiet and cool space to sleep (ambient temperature is 19+/-2 degrees)

Improvements in sleep extension can lead to improved skill specific execution in sports, improved cognition including reaction times. mood, alertness and vigor. While improved sleep hygiene results in less fatigue and sleepiness.

Whether the goal is optimizing performance at work, in sport or about doing all you can to live a healthy life, sleep needs to be given as much attention as diet and exercise. By improving the quality and duration of sleep through better sleep hygiene and sleep extension one will yield benefits such as, reducing the risks of preventable disease like diabetes, obesity, cardiovascular disease, improved judgment and decision-making and optimized athletic performance and recovery.