Illness can jeopardize important races or even entire seasons. In this episode, we address how to better understand illness, how to avoid it, and ways you can cope if you do get sick.
Illness can be a big setback for cyclists at all levels. What causes us to get sick, and how do we avoid it? If we train too hard, will it ruin our immune system, or can we power through it and ride with the sniffles?
We are joined by Dr. Jason Glowney of the University of Colorado Sports Medicine and Performance Center to answer these questions and better understand the science of illness and how it can make us healthier cyclists.
- Fehrenbach, E., & Schneider, M. E. (2006). Trauma-induced systemic inflammatory response versus exercise-induced immunomodulatory effects. Sports Med, 36(5), 373-384.
- Gleeson, M. (2006). Immune system adaptation in elite athletes. Curr Opin Clin Nutr Metab Care, 9(6), 659-665. doi: 10.1097/01.mco.0000247476.02650.18
- Gleeson, M., Bishop, N., Oliveira, M., & Tauler, P. (2013). Influence of training load on upper respiratory tract infection incidence and antigen-stimulated cytokine production. Scand J Med Sci Sports, 23(4), 451-457. doi: 10.1111/j.1600-0838.2011.01422.x
- Gleeson, M., & Williams, C. (2013). Intense exercise training and immune function. Nestle Nutr Inst Workshop Ser, 76, 39-50. doi: 10.1159/000350254
- Spence, L., Brown, W. J., Pyne, D. B., Nissen, M. D., Sloots, T. P., McCormack, J. G., et al. (2007). Incidence, etiology, and symptomatology of upper respiratory illness in elite athletes. Med Sci Sports Exerc, 39(4), 577-586. doi: 10.1249/mss.0b013e31802e851a
- Suzuki, K., Nakaji, S., Yamada, M., Totsuka, M., Sato, K., & Sugawara, K. (2002). Systemic inflammatory response to exhaustive exercise. Cytokine kinetics. Exerc Immunol Rev, 8, 6-48.
Caley Fretz 00:00
Welcome to Fast Talk the Velonews podcast. Everything you need to know to ride like a pro.
Caley Fretz 00:13
Welcome back, everybody to another episode of Fast Talk Velonews training podcast. I’m Caley Fretz senior editor here at Velonews across the table, actually, next to, as always, our good coach Trevor Connor. How are you feeling today? Trevor?
Trevor Connor 00:28
Caley I’m feeling pretty sick.
Caley Fretz 00:31
Well, that’s perfect, actually, because the topic of today’s podcast is actually illness. So I really appreciate that you went the extra mile Trevor to illness, illnessify yourself.
Trevor Connor 00:46
This is my commitment to you the listeners. We’re doing an episode on staying healthy. So I got myself sick.
Caley Fretz 00:53
I am sitting as far away from Trevor as I possibly can. Uh- across the table even farther away from Trevor is Dr. Jason Gladney, medical director at the CU Sports Medicine Performance Center. You cater to endurance athletes, right? And I hear that you recently were working to get Taylor Phinney back on his bike. Is that right?
Dr. Jason Gladney 01:12
Oh, that was a while back, myself and Andy Pruitt and he frequented the facilities for his PT. And he had kind of definitely took a team effort to get him back. But it was great to see him raise to the level he did this year in the tour. So it’s great guy and quite quirky. And he’s fun to watch. So, but I’d like to thank the whole center played a role in that.
Caley Fretz 01:31
Well, we’re we’re really excited to have you on here because the topic today, well, it’s not exactly the leg injury that Taylor had. But we’re talking about health, we’re talking about illness, the purpose of this podcast, hopefully at the end of today, you have some idea how to stay healthy, some idea what to do if you get sick. And then well-
Trevor Connor 01:50
-don’t time trial Flagstaff.
Caley Fretz 01:52
don’t time trial Flagstaff, like Trevor did well, uh-
Dr. Jason Gladney 01:55
I think he knew that too.
Kaylee Fred 01:58
And we’re actually going to start today with a bit of scientific background into the immune system. And the various ways that training really hard, as many of our listeners do, affects the immune system. So Trevor, we want to start with a bit of scientific background here, there’s a whole lot of things that happen in your body, when you’re training really hard. We were discussing this before we turn the recorder on, there’s a J-shaped curve, as you put it, in terms of how much someone is training or how much athletes are training, and the end the relationship to getting ill. So a little bit of training seems to sort of help the immune system right. But a lot of training, doesn’t. We see elite elite athletes getting sick more than the general population? Why is that?
Why the Immune System is Important for Athletes
Dr. Jason Gladney 02:44
First thing we can start with is just why is the immune system important kind of as athletes, cyclist and other endurance sport activities, you need the immune system for kind of repair processes in the muscles. So after workout, you know it’s the immune system plays a big role with getting muscles to recover, getting tendons, ligaments to heal up and things of that sort. In terms of exercise and the effects it has on immune system. You’re right when you say that light exercise seems to boost immunity, it seems like in studies there’s a decreased risk of cancer, especially colon cancer, breast cancer and athletes who exercise mild to moderately. They have done some studies looking at athletes who are doing excessive volume, say on the bike or excessive intensities. And they do notice a decreases in immune responses in some ways. That comes in the form and fashion of decrease lymphocytes decrease natural killer cells, but also in decreased secreted antibodies, especially in the upper respiratory tract and in particular IGA. So IGA is an Immunoglobulin that’s supposed to fight off viruses, bacteria coming in the respiratory tract. So they notice after intense exercise, some elite cyclists are more prone to upper respiratory tract infections. Thought being that it is the IGA and the decreased amount of that had to do with the the exercise itself. You look back at some of the science and as to why does this happen? Some theories are that um yeah, you exercise hard, you have damaged muscles, there needs to be replicated processes that go on in these. And so you might lose some of the cells that are lymphocytes that are important for the immune system, by just doing all these repairs. The thoughts are increased risk of you know, high levels of cortisol in response to exercise. So we do know that corticosteroids are a depressant to immune system function as well. So that might play a role also, with why this happens. To be good you got to do those hard efforts. And those long days though, so you got to strike that balance. That’s kind of what we say to our patients here. So it could be right in the Tour de France if you’re just taking these easy strolls on the bike path. So yeah, you got to kind of put in the time and the effort. And probably one of the more important things is recovery. So what are you doing off the bike and that plays the biggest role?
Caley Fretz 03:52
I want to step back a little bit to something that you said right at the beginning that we’re going to get into later. Some of the other reasons why well, for example, why we why we always see Grand Tour riders get sick. And last week, I think we just got a few hints in what you were just saying. But I want to step back to the immune system and its role in recovery. Because I think that most people, if you’re, if you don’t have a scientific background, like myself, I think of the immune system is something that just fights illness. I was not actually aware before about half an hour ago, that the immune system has a large role in recovery from athletic effort. Can-can you guys just talk about that a little bit and explain how exactly that works, what some of the processes are?
Trevor Connor 05:41
Right. So I mean, inflammation is can be a very good thing. And this is why there’s other research out there showing that when one of the worst things you can do after exercise is take all these anti inflammatories, because you’re essentially preventing the immune system from able to do the repair work to the muscles that you want. When you have inflammation just in the muscle. And we’re not talking about a one hour easy spin, we’re talking about a long, hard, you’re crawling through the door type ride. You’re gonna get a lot of inflammation in your muscles. And that’s a good thing. The issue, and so I before this read some really interesting studies on what’s called systemic inflammatory response syndrome, or SIRS, that can be caused by exercise. And it’s also a syndrome that’s caused by Sepsis.
Caley Fretz 06:32
Which is really bad
Trevor Connor 06:33
Which is a really bad thing.
Trevor Connor 06:35
You don’t want sepsis. So the issue is you want the local inflammation at the the muscle level, but you don’t want that inflammation to go throughout your body, which is that that systemic inflammatory response. So what you actually see happen is your body starts releasing what are called cytokines, but it releases anti-inflammatory cytokines, which I know I’m going down the rabbit hole, but we’re talking about your AL2, AL4, AL10, which basically tell your immune system to shut down. So it’s not that your immune system gets weak, because you’re exercising, it’s actually that your body’s saying, I don’t want this systemic response. I just want you to work locally. So I’m going to actually make your your immune system. So the word is suppressed, I’m going to suppress your immune system.
Dr. Jason Gladney 07:26
Yeah, so I think that, yeah, like Trevor was alluding to, some of the anti inflammatories can stop that process of of repair that you want to actually have happen. And in particular, looking at antioxidants to combat free radicals, taking too much of them can actually blunt your response to the training, meaning your recovery, and then hopefully your improvement and your fitness gain. So that’s something that we need to be careful about. Yeah, just for the immune system. And the repair process that happens happens in the muscles, neutrophils that are going in there, they’re cleaning up, things are laying down new tissues to to repair things. And you don’t want to short circuit that. Historically, and inflammation got this really bad reputation. And now we know quite a bit better. This a little bit of a segway. But we’re now using the immune system to heal tissues. So sometimes we might see cyclists who come in with patellofemoral pain or one of these knee pains, achilles pain, we’re actually using their own blood cells and harvesting platelets and growth factors and injecting them back in right into tissues to try to elicit that inflammation response.
Trevor Connor 08:33
So actually read this really interesting study. It was from 2007. It was published in Medicine and Science and Sports and Exercise. And as usual, we’ll put all the references up on the Velonews website. And this was a study of upper respiratory tract infections in elite athletes. And they were really taking athletes that were pushing overreach, even overtraining. And looking at the incidence of upper respiratory tract infections in them versus controls. And they certainly had much more frequent incidents of the infections. But what was really interesting about this study, is that for only about 30% of those infections, could they actually find a pathogen, one of their theories is going back to this systemic inflammation, that basically these athletes are pushing themselves so hard, and constantly causing the systemic inflammation from all their training that actually it’s it’s causing the symptoms of being sick without actually being sick. That they’ve so activated the immune system, they feel sick. And that’s potentially one of the reasons you’re seeing elite athletes, especially when they’re starting to overtrain get sick much more frequently.
Caley Fretz 09:54
Because they may not actually be sick
Trevor Connor 09:56
They may just be over activating the immune system.
Dr. Jason Gladney 09:59
Reasons unknown, like overtraining sometimes presents a sore throat and as to why it does, yeah, that’s kind of a little bit unclear. But yeah, they might not culture, any virus that really kind of explains it. I think the other thing too, is like real hard efforts. Yeah, you can see your, your, your respiratory lining, you get all these mast cells activated. And sometimes it’s hard to tell the difference between that and a true URI. So with a lot of the people when they look at that, I don’t think they culture for viruses. And many of the studies that they did before maybe that one did, though. So that’s kind of interesting. Yeah.
Trevor Connor 10:30
Yeah, another potential factor. So when we talked about sepsis, and one of the other studies that I read said that actually, endurance exercise, so systemic inflammation from endurance exercise should be classified, under the same category of sepsis, they went that far. Sepsis is caused by something called endotoxemia, which is, basically a lot of the bacteria and the bad things in your gut, actually get past the barrier of your digestive lining and get into your system and cause an immune response. You don’t want that, in particular, that up regulates something called lipopolysaccharides, which is LPS, which sparks an immune response. Endurance exercise, a lot of research a lot of studies on this showing that, when you do heavy endurance exercise, especially in the heat, you cause what’s basically called leaky gut, you open up the tight junctions in your gut, and that allows a lot of allows basically the same thing as endotoxemia. It allows this bacteria in the LPS to get into your system and, again, spark a an immune response.
Dr. Jason Gladney 11:25
You know, sometimes even when you defecate, you’re gonna have this transient bacteremia, where you stretch out the rectum and things kind of get into the bloodstream. You know, the listeners should note that the the gut is chalk full of bacteria, both good and bad. And there’s a protective barrier, which is the mucosal lining along the the GI tract that protects the blood, you know, from those things. And with hard efforts, yeah, the thought is there a transient low blood flow to the gut, where kind of blood is diverted to working muscles to to kind of feed them, in addition to potential plasma volume losses from dehydration and things of that sort. All leads to this transients schemee in the gut and causes increased permeability and kind of those bacteria getting into the bloodstream as well as the LPS and things of that sort that definitely will cause like, an immune response in a bad way. So you’re kind of this sepsis or this sepsis type phenomenon, blood pressure goes down, and you need to be able to maintain blood flow to different tissues, and can be a whole storm of things that you don’t want to have happen. Usually with exercise. Yeah, you recover from it to sepsis. When you have someone in the ICU who’s had an infection somewhere that’s gone systemic, it’s not a good thing. It is pretty interesting that there is this parallel between exercise and what can happen in a really sick patient.
What Athletes can do to not get Sick
Caley Fretz 13:05
So if I understand this correctly, and I think I do, that was a whole lot of science in the last 15 minutes. So the long story very short here is that training really hard is not necessarily good for immune system. So the next thing we want to talk about are some sort of some solid takeaways, what people can actually do about this, given the fact that if you were training hard, your immune system is probably not as as useful as strong as it should be. In terms of keeping you healthy. What can people do to not get sick.
Dr. Jason Gladney 13:40
So you know, one thought, it’s, it’s kind of, you know, common knowledge to wash your hands. Try not to be around people that are sick, especially if you have an important race or competition that’s coming up. That’s pretty simple stuff to do.
Caley Fretz 13:53
As we sit in a room with a sick guy,
Trevor Connor 13:56
Immunosuppression, try not coughing for-
Dr. Jason Gladney 14:00
-Two days later, I’m gonna call the show and be like, what’s going on? I think I have Trevor’s illness. It’s the stuff that you do off the bike, it’s really important. You know, Trevor, as a coach knows, as well, too. It’s what your coach lays out for you. So there shouldn’t be hard efforts, they should be hard enough to get the fitness that you need, but you need those easy days where you have time to recover. So that’s basically geared towards sleeping appropriately, getting enough sleep, hydrating, making sure that you have a sound diet, and that’s probably one of the more important things that you can that you can do. So kind of whole foods, we always kind of push those supplements. Some of them maybe have some potential, but a lot of the really big studies with that are high powered, you know, don’t really see much improvement after supplementation for immune system with the exception of potentially vitamin E, and maybe vitamin C and like I alluded to before and a point here that might help to stop some of the free radical damage that is inherent some of the cells in the immune system and that also plays a role in What’s your job like? Are you stressed? If you’re always under stress, you’re going to have these cortisol releases that will suppress your immune system as well. So sometimes, you know, you compare yourself to someone who doesn’t work, it seems like it’s pretty common here in Boulder, all they do is ride their bike. And maybe they have a trust fund. But meanwhile, you got to go to work and work 50 hours a week and try to train and beat this guy out on the roads. Yeah, you got the card stacked against you in that way. So you need to realize that, and it’s kind of how you react to stress too, if that’s at all possible, where you just kind of need to have a relaxed attitude about things and don’t let them affect you. But yeah, it’s kind of what you do off the bike that probably plays the biggest role was staying healthy.
Caley Fretz 15:39
You mentioned earlier that actually feeding and nutrition on the bike is relevant as well, because I’m assuming that that, you know, if you if you’re, if you’re paying attention, you need to your nutrition on the bike, you’re not digging as deep a hole, right? So
Dr. Jason Gladney 15:52
Caley Fretz 15:52
Is that is that I mean, can that literally eating well on the bike and that keep you healthy?
Dr. Jason Gladney 15:57
I think so if you think about if you’re in a starved response on the bike, that’s a stressor to the immune system and your hormonal balance that that actually occurs as a result of that. So it’s actually what are you doing on the bike and treating the bike as the rolling buffet where you got to take in calories. And we do know that calorie intake helps to maybe bond some of the corticosteroid response or cortisol response to exercise. And if you’re riding on fumes that’s probably definitely enhanced and can probably lead to more of this immune suppression that we might see. Yeah, if you’re feeding having enough carbohydrates, that’s probably what you can ingest most easily. Yeah, it makes sense to you to kind of do that on the bike just to blunt that cortisol response that can be detrimental to the immune system.
Trevor Connor 16:38
There has been some research has actually shown that if you maintain your plasma glucose levels, that attenuates the cortisol AL6, AL1, or AL10, it basically prevents a lot of this immunosuppression.
Caley Fretz 16:51
And maintaining your plasma glucose levels means eating food, right?
Trevor Connor 16:54
Caley Fretz 16:55
Okay. Continue eating food. Yes, that’s the thing that people with diabetes are paying to pay-paying attention to correct?
Dr. Jason Gladney 17:03
Yes. So yeah, cyclists by large endurance athletes, the risk of non purging bulimia, that means you eat a big meal, and you want to go ride five hours of burn it off and not eat anything that day. That’s not good for your immune system.
Trevor Connor 17:16
Ah the coffee ride, have a cup of coffee, go for a six hour ride?
Caley Fretz 17:22
I mean, the funny thing about a lot of these things to me is it is you know, it’s not rocket science, right? Like, some of the things you guys are discussing in terms of what’s happening inside your body might as well be rocket science to me, but the things that you can do, to stay healthy are not the things that that coaches have been saying to do forever. Basically, it’s just treat yourself well on and off the bike. You know, wash your hands, make sure that you’re not hanging out with sick people. Is there anything else in particular that people should be really paying attention to? I mean, if you’re in a stage race, for example, and granted, a lot of amateurs are not doing super long stage races. But if you’re doing Haute Route, you know, or if you’re doing the Green Mountain stage race, just just a couple days at the end of the season here. What can people do to make sure that they are not getting sick on days? Three and four of those?
Trevor Connor 18:08
A couple things I’ll add that will answer both that question in general, because I think you did a fantastic job. Thank you. That was all great advice. One, you know, one of my pet peeves. If you go and do a long, hard ride or an Haute Route, and you’re killing yourself each day, you’ve seen me cringe when right afterwards, everybody goes to the coffee shop. Because here you now have a compromised immune system, let’s go in a place where you’re probably gonna have a whole bunch of sick people. And I don’t mean to be gross, but sharing the germs all over the place. You want to get sick. That’s what you do. So I’m a big believer. And if you’ve done and I’m not talking again, about a one hour recovery ride, I’m talking about that fatiguing ride where you know there’s gonna be some immunosuppression. Be a bit of a monk. Keep away from people who are sick, don’t put your put yourself in places where you can be sick.
How Long After a Ride Until your Immunosuppression is Back to Normal?
Caley Fretz 18:58
How long is the immunosuppression window there. So you get your six hour ride, you’re wasted at the end, how long? I mean, how long until you’re sort of back up to normal, how long you have to be careful for?
Dr. Jason Gladney 19:12
again, the cycling, hopefully, it’s a non impact sport, you’re not crashing. But you usually kind of study shows probably three or four days with really hard efforts, that there is some immunosuppression, that’s the amount of time it takes to sometimes renormalized lymphocyte counts if they were to do a blood test to look for that. So it is a little bit of some time. And then what Trevor saying too, it’s just compounded and worsened by the fact that you’re doing that one day and then the next day you’re doing it again and again and again. And the listeners will look in the tour and then they’ll see you know, someone just flying up the mountain and then attacking and looking great. Then the next day they’re off the back. So get set up and spread but yeah, so that happens too. So you know, there’s a there’s only so much you can do. But when you’re going at it day after day in succession, that’s when you’re going to kind of open up that risk for that immune response, you know, but yeah, with with your typical run of the mill hard ride, yeah, it might be three or four days. And that could be like 100 mile or you’re doing a lot of burning a lot of matches out there doing a lot of threshold stuff on it might take a little while.
Trevor Connor 20:22
Another little one that will add, but this one, I’ve actually it saved me a few times. And I still remember Altoona, 2007, I was on a squad, we had this young kid who was doing his first big stage race. And about three, four days into the race. He was dying, and he was telling me his stomach was killing him. He was starting to feel a little sick. And he just didn’t think it could go on. And he still thinks I’m some sort of witch doctor because I went with just “hold on” and I went to the store, bought some old glutamine brought it back said wolf stuffs down, just take this down and and he took a couple doses through the day. And the next day, he walks up, woke up, he’s like, “I’m feeling good.” And it is a little cheesy, but it’s actually to me a an important one, or a good one. Sorry, you have to deal with my sick talk today. Where I lose my train of thought, but we have more L glutamine in our body than any other amino acid. L glutamine is the primary fuel and L think the only fuel of our immune system and the primary fuel of our digestive system. When you are going out doing a long, fatiguing ride and you start to deplete your blood glucose, you start depleting your glycogen, your body’s going to look for alternate fuel sources, and the first one that will go to is L glutamine. If you start depleting your L glutamine, all of a sudden your immune system, your gut doesn’t have the fuel that it needs. So if you take L glutamine every day, you’re wasting a lot of money. But if you’re at something like Haute Route, where you’re doing long, hard days every day, you’re probably going to be depleting that on top of your carbohydrate stores and a lot of your other nutrients and supplementation at that point can help you and help keep your immune system a little stronger.
Should Athletes be Taking Vitamin C and E Frequently?
Caley Fretz 22:14
I guess I have one more question for you. Which goes back to the vitamin C, vitamin E thing. I mean, that’s what we’ve always been told is that you just, you know, cover yourself and vitamin C, dive in a pool of vitamin C, is that Hocus Pocus? Or is there? Is there something maybe to that, and then also the vitamin E that you were talking about? I mean, are these things that athletes should just be taking all the time just in case or something you take if you get sick? Or what’s the story? behind those two,
Dr. Jason Gladney 22:43
There’s been a lot of debate about supplements and their effects and whether they’re beneficial or not. Some further research looking at free radicals which are created in the mitochondria during exercise. Those have, they’re quite destructive to cell membranes, and those can be released, they affect tissue locally, but they also affect immune cells as well. So, you know, they have done some studies with some athletes who are taking smaller doses of vitamin E and the range of about 800 international units, that shows that a lot of immune function can be restored in a small dose like that. It was popular back maybe 10 years ago, where some people were taking mega doses of vitamin C. And that caused some alarm after they studied it. And they showed that um yeah, some elite cyclists weren’t making fitness gains after taking those bigger doses, a couple of things that are at issue is the purity of the supplements that you’re supposed to be getting. And I think that’s something definitely cyclists have to be careful about, especially if they might be prone to being tested. If they’re racing or one of those, there is discrepancy between what’s on the label and what’s actually in there. So that’s one thing that you need to kind of keep in mind. In terms of antioxidants, you do need them. I’ve done some testing on many athletes and some comeback kind of low in vitamin C. Vitamin C in its own right is important for collagen synthesis and recovery in that manner. But just some of the studies looking at the immunology of exercise and the effects of vitamin E and vitamin C, maybe are two of the supplements that play a role with with some immune system recovery. So they noticed individuals that take that their lymphocyte levels rebound a little bit quicker. It’s pretty common practice when we do blood tests on athletes, especially in Boulder, everyone’s on this borderline kind of lymphopenia levels when we do complete blood count or CBC. So that’s kind of par for the course. And if you ask them when they come back like that, yeah, they’re training hard. They’re training all week-
Caley Fretz 24:33
Meaning they’re kind of on the edge of being in trouble?
Dr. Jason Gladney 24:36
It’s almost par for the course in that way. And so the thought is, well, they’re not really immune suppressed in that manner. It’s just that the immune cells are somewhere outside of the of the blood, or the circulating blood doing some work to recover and most most theories that have been proposed on that.
Trevor Connor 24:54
So when I was at CSU, we had a professor there who he was actually studying vitamin C, and his area of research was antioxidants, I believe was anti-. Well, he was, that was part of it because his research was really aging. But he showed me a whole bunch of stuff on vitamin C. And so this is this is a little bit of opinion here. But a lot of the research about the health benefits of vitamin C and how it fights off bugs comes from Linus Pauling. And basically, Linus Pauling studies, they’ve never been able to reproduce them. There is some implication there that that’s because his numbers were touched.
Dr. Jason Gladney 25:33
Thas quite common by the way-
Trevor Connor 25:39
so a lot of that just isn’t panning out. A bigger issue with vitamin C that is coming out in current research is vitamin C is a powerful antioxidant. But when you consume too much, it can actually become a very powerful oxidant. And there has been some research showing that it will actually hurt training.
Caley Fretz 26:00
Dr. Jason Gladney 26:02
Yeah, I think, just to add, yeah, the doses should be quite small 500 to 1000 milligrams, where some of the people like a decade ago, were taking 10,000 milligrams, especially in like bodybuilding circles, where they thought that was good for them. Kind of moderation is usually the way to go with almost anything that comes out in medicine or sport. And, yeah, people take it to the extreme, and sometimes they suffer.
Caley Fretz 26:23
But I think, you know, as long as you’re, as long as you’re in moderation, vitamin C is probably not gonna hurt you. Again, be be super careful if you’re in a in an anti doping testing pool, as you should be with absolutely any supplement, but probably not going to, you know, even though there’s some question as to whether it’s, as to its efficacy, probably not going to do too much damage.
Dr. Jason Gladney 26:45
And we probably always suggest, if you can get it in a food source is a better way to go about it.
Caley Fretz 26:49
Not going to get any weird substances, anti doping substances and orange juice, hopefully.
Are Vitamin D and Zinc Beneficial to Athletes?
Trevor Connor 26:56
I mean, the ones that I would recommend that I recommend my athletes, I’m very interested in hearing your opinion on this, but I’ve certainly read research saying they can help both prevent illness and shorten the length of illness is vitamin D, and zinc.
Dr. Jason Gladney 27:09
Sure, sure. Yeah. Those are two big ones. And there was a recent article, I think it was so online today that looked at supplements and what ones might have benefit and vitamin D and zinc are both on that. Vitamin D is important for several different enzymatic reactions in the body probably 1000s as cyclist and endurance athletes, and in particular, they’re involved in fast twitch muscle fiber health. So that’s definitely a plus for that knowing cyclists are maybe prone to loss of bone density, you know, just a vitamin D in its role. And bone health is important as well, but also for the immune system. And and its benefits they’re looking by and large deficiencies. In Americans, zinc is one of the top ones that we tend to be deficient in. Magnesium is up there too. And whether that’s from depleted soils that that we farm with maybe that plays a role with some of those. But yeah, zinc is definitely an important booster for the imm- the immune system. So I Trevor’s right when he says that those two are probably the more important ones that you can take that maybe have a purported benefit.
Caley Fretz 28:13
But again, probably better to get them from food, if you can?
Dr. Jason Gladney 28:15
If you can, yeah.
Trevor Connor 28:16
Yeah, vitamin D, really, one of the few food sources is mushrooms to get enough. So you actually have to supplement best getting from the sun. It’s actually a misnomer to call vitamin D a vitamin, it’s really a hormone. That we produce, but we only produce enough when you’re you get a lot of sun exposure.
Dr. Jason Gladney 28:33
So yeah, another thing with that, too, is just looking at overall health. Nowadays, everyone puts sunscreen on maybe up here in Boulder at altitude, the sun’s a little harsher. And it makes sense if you had a skin cancer, but the effects of sunshine include vitamin D synthesis. But also, probably there’s some effect on the circulatory system where it helps in vascular health meaning laser dilation, things of that nature. And some studies came out a couple years ago looking at smokers in Europe who sunbathe versus those who didn’t, the ones who were smokers and sunbathe live just as long as these really healthy people. So they attributed that to the effects of the sunshine and UVB radiation in particular that it had on just the body at large. So there’s vitamin D and that and that factor to that seems to play a role with with health overall.
Caley Fretz 29:21
Be careful skin cancer, but get a little bit sunshine.
Dr. Jason Gladney 29:24
Exactly. Don’t get burned, don’t fry yourself. Don’t pass out in the lawn chair, but
What Should an Athlete do Once They get Sick?
Caley Fretz 29:29
Everything in moderation, everything in moderation. Let’s let’s move on a little bit. So we talked about a whole bunch of different things that that athletes can do to avoid getting sick. What about when you get sick? Because this happens to everybody. I mean, this is if you look back even just over the last couple Tours de France, the overall the top five overall in the Tour de France every single year is affected by illness. Somebody got sick this year. Fabio Aru, Chris Froome has been sick before even when he won the race. Kitaen has gotten sick in the last week, this happens to even athletes at the very, very top of the sport who are being taken care of very, very carefully. What do you do once you get sick?
Trevor Connor 30:12
Mind you, what you’re seeing at the tour might go back to we were talking about before, which is just that systemic inflammation, they might not actually be sick as in, they’re fighting off a virus, it might just be by the end of the tour, they have such an activated immune system, they feel sick.
Caley Fretz 30:27
Regardless, they’re sick, or feel sick. Regardless, they’re slowing down. So let’s just assume that they that they have, that you have some sort of virus, what do you do when you get ill, to get better quickly?
Trevor Connor 30:41
So Dr. Gladney, will be able to answer this whole question much better than me. But there is one thing I want to quickly just throw in. That I’ve learned over the years, both with myself and my athletes. If you are ever going out for a ride and use a heart rate monitor, and you look down and you see this really high heart rate, and you say I’m just not going that hard, it shouldn’t be that high. And you can’t come up with other explanations. Like if it’s 110 degrees out and you’re dehydrated, yes, you’re gonna have a high heart rate. But there’s no other explanation. You see this weird my heart rate, it’s just way up there. That happens quite frequently, a couple days before you become symptomatic when you have a virus. So if you see that it’s an early warning sign, don’t ignore it, get some rest, maybe think about skipping the intervals the next day. And you might be able to prevent it sometimes.
Dr. Jason Gladney 31:35
Yeah, I think that’s good advice. In terms of say you’ve done everything right, and you still got sick? Yeah, I guess we kind of characterize it by what is the illness and the two things that I talked to patients about is are you febrile, meaning that you have a fever. So I think when you’re in that situation, it probably makes sense to rest and, you know, take time off until you’re A-febrile, and then we usually say 24 hours of being A-febrile, then you can kind of get back out on the bike and do some training. The other thing is, is it just kind of isolated to the upper respiratory tract, meaning sinesses, maybe a little sore throat those things, you know, it’s probably okay to ride usually say that, you want to ride easier, though. So, like we said, when we talked about before, mild to moderate exercise seems to be an immune system booster. So that’s what you want to ride. And that’s not the time to do intervals, like Trevor said, so if anything, you’re just gonna do shitty intervals, and then you’re gonna feel worse after. So, don’t do that. So, but if the infection seems to be in the lungs, that’s kind of a sign that, yeah, it’s probably time to maybe go see your doctor and make sure that you don’t have a pneumonia. That’s something that you don’t want to try to ride through. In addition to that, if it’s just a URI, what are the things that you can do to get better? Yes, just eat sleep, nutrition, that’s not the time to get worried about your weight and not eat anything, you definitely need this in your grandma, you need to feed a cold and that way, and it seems to make some sense in terms of, yeah, having a circulating glucose in your bloodstream, it’s definitely a benefit for you.
Trevor Connor 33:04
So remember, all those cytokines that we’re talking about, they’re just proteins. And your body’s trying to produce a lot of them. So when you are sick or getting sick, that’s when you need to make sure you’re getting a lot of good quality protein in your diet. So this would actually be a good time to hear from Brent Bookwalter, who talked a lot about what he does when he gets sick. And one of the things I really hope you get from this is, here’s a guy that has done Grand Tours, he is a tough rider. And when he gets sick, he doesn’t try to be tough, you will see he is all about, let’s get healthy, I’m off the bike until I feel good. And then I’m off the bike a little longer. And then I go out and train. So if you’re thinking I’m tough, I’m just going to push through being sick, listen to what he has to say.
Brent Bookwalter 33:51
Probably inevitable that you are going to get sick at some point, you got to be able to deal with it well and and have the confidence and patience and the the system in place that know that you can get through it. So things do happen you get get a cold or I struggle on the screen with allergies, and then bronchitis, then it’s just a matter of managing it and letting it run its course and giving your body everything it needs to, to fight off what it’s dealing with. And I’d say the biggest things are sleep, diet, and, and just low stress. And if possible, you know, a little bit of a little bit of gentle, gentle exercise. But I think it’s really important to do when you get sick to acknowledge it, accept it. And understand that the quicker you get healthy, you know, the better you’re going to be down the road. If you if you try to push through your training block or you push through another race or two, you’re just prolonging it. You’re either competing and training compromised, and then you’re just going to be compromised for a longer period of time. So I think recognizing it. And then, you know, setting a plan of action out as far as I’m going to try to get this much sleep and I’m going to force myself to stay on the couch as much. And I’m going to be the real meticulous with my diet, and eating good food, not too much sugar and staying hydrated and doing the simple fundamental things, which will give your body the best chance to bounce back.
When do you Know When to get Back on the Bike After Being Sick?
Trevor Connor 35:22
So how do you know when to be back on the bike?
Brent Bookwalter 35:24
I generally, well, I definitely, definitely rely heavily on my coach and my doctor, if and when I do get sick. Because I think as athletes, you know, we’re all we’re all pretty ambitious. And we’re probably ready to jump back into it probably a little before we should. So I think it’s important to have a support network, whether it’s your, your wife, or your husband, or your roommate, as well as a coach, and then obviously a doctor to kind of monitor-help you monitor your progress. And to be honest with the steps that you made, you can, you can pretend you’re getting better. But if you’re up all night coughing, no matter how good you feel in the morning, you’re clearly not healthy. So it’s that time to dive back into training quite yet. Generally, I think when, when I’m when I’m sleeping good, when my energy levels of return, when I feel generally healthy. I think the first day that happens that you’re not quite ready to jump back into it, I was in favor of taking one more day, have a full day where you feel good and feel healthy, ride a little, you come back feeling like you could definitely do more. That’s a good sign. So you get one or two of those days under your belt. And then, you know, a day or two later, I think then you’re ready to dive back in.
Trevor Connor 36:44
It’s a good conservative approach.
Brent Bookwalter 36:46
Yeah, it’s uh, being too aggressive with it has definitely blown up in my face. Time and again before so if experience has taught me one thing, it’s to be conservative and try to be patient, which is so much easier said than done. But in the long run, I think patience. And a little bit of a conservative- conservative approach there is always rewarded with with better performance and a quicker return to real quality training and racing. It’s so important to have a coach or a trainer, someone that can provide a perspective on that kind of thing. Because like I said, we’re all we’re all just chomping at the bit. And yeah, whether if you’ve been puking or for 24 hours or coughing for four days, you still have that, that drive and you get back out there and you feel like you’re if you’re not going forward, you’re going backwards. But the absolute worst thing you can do is come back, try to push it too soon. And then you lose another three days. You’re too much too soon.
Trevor Connor 37:46
So it sounds like you were talking a bit about I hear, athletes all the time, say above the above the neck or below the neck. So is that what you were getting out? And what does that mean?
Dr. Jason Gladney 37:57
Exactly? So above the neck means it’s an upper respiratory tract infection, meaning throat sinuses that’s above the neck, and then below the neck means it’s kind of situate itself in the lungs. So if you’re coughing up sputum that looks green, yellow, those things. You know, that’s kind of a more ominous sign about your illness, and that’s one that you want to probably pay more attention to. And he that one, so that’s the time to take rest.
Caley Fretz 38:25
I like how all the things, the names for phlegm are all really gross. Phlegm is gross sputum is gros- is really gross. It’s almost onomatopoetic or whatever that is for physicality. Anyway. My my own little word tangent there. Trevor, what else do we have to talk about today?
Trevor Connor 38:46
Did we cover fever?
Things Athletes Should Know About Fevers
Dr. Jason Gladney 38:48
Fever? So my thoughts on fever to a fever that’s too high, that can definitely be dangerous. So getting up to 104-105. Yeah, that’s not good. But a febrile response is actually the immune system, increasing temperature to actually fight infection. So usually, if your fevers 101-101.5, I usually say ride it out. And that’s typically what I’ll do to you might feel a little bit more uncomfortable, but I think it’s going to make the body more effective and the immune system more effective at fighting the infection. It’s always in this day and age with medicine, everyone wants some comfort. But there’s reasons why the body does certain things. And, you know, many times it’s for a reason so uh-
Caley Fretz 39:28
You mean allow, don’t allow essentially allow the fever to-
Dr. Jason Gladney 39:30
Ride it out. Unless you’re unless you’re really really sick. Yeah, that’s a different story. Those higher temperatures, bacteria, and, you know, some viruses have certain set points that they are more virulent with. And yeah, just the increase in temperature is a good thing. The other thing the body does too with infection, is it hampers the absorption of iron. So a lot of bacteria that are pathogenic use iron and the oxidative stresses that they can create to make themselves more dangerous and more potent. So not the time to be eating stakes and taking your iron supplements, some might say. So that’s another thing to consider.
How to Conquer Traveling and Trying to Stay Healthy
Trevor Connor 40:05
So Brett talked a bit in our interview about challenges of flying and trying to stay healthy. Granted, most of us aren’t flying to bike races, but we do travel, for work and for vacations. So this is a challenge for us, Brett had some interesting advice, it might be a little different from what you would think. So let’s hear what he had to say.
Brent Bookwalter 40:27
When I’m traveling, the biggest thing is just diligence. It’s a little bit like a, you know, a race or a training session, like when I when you go into a big travel, they’re a big travel period, kind of have to have your travel head screwed on, and be attentive and to be to be on the lookout for those people who are coughing all over the place. And to know you can’t accidentally be walking through an airport and then rubbing your eyes to know that you have to be washing your hands before you’re eating and have a hand sanitizer with you. And just really be be diligent and all the all those aspects in that not a slip up. Again, it’s a little bit of a balance, you can’t you can’t isolate yourself, it’s inevitable that you’re going to come in contact with other people and germs and at the end of the day, or we have to have a little bit of faith in our immune system to. And also not going into travel if you can prevent it to run down. Like one thing I always try to do before a big trip or an international flight is to kind of taper my training down. So my immune system isn’t compromised. And I’m not, I’m not totally blown out and physically at my wit’s end, going into the travel day, because although it might feel good, really good to do a couple big blowout rides before the long, long couple of travel days, your body is busy in devoting energy to rebuilding itself. And then you’re not going to have the same immune response if you do encounter something. I struggle with that because if I know I’m going to go to Europe, and I’m going to have a 12 hour travel day, and then I’m gonna have jetlag and I’m, you know, you’re basically gonna lose two or three days of training, what I really want to do is I want to go out the last three days on here and just smash it and get it out of my system. And I’m not so high strung and uptight, and the flight and the travel and dealing with the jetlag, I’ve kind of earned by my downtime, but uh, you know, travel stressful, travel days are usually not a rest day. There, there are a whole different kinds of stress. And it’s important to plan for those accordingly. And I think build them into your training.
What are Things you can do to Prevent Getting Sick While Traveling?
Trevor Connor 42:32
So my first question is, what are things that you can do to prevent getting sick when when you’re traveling?
Dr. Jason Gladney 42:38
Sure, what I’m aware of, yeah, it’s kind of hygiene. And if you are exposed to maybe some pathogenic bacteria or viruses, you don’t want to keep rubbing your eyes and rubbing your nose and rubbing, you know, spots that it can gain entry into your body. You know, in terms of like these supplements that are purported to help you not get sick, probably all bullshit. So the one thing that I know that might work while you’re on the plane, turn on your your blower and that’s going to blow all the viruses away from you give them to someone else. So that’s probably what you can do. Obviously, with travel on planes is a stressor. Sometimes you lose sleep. My advice is to kind of have a sleep routine. And you see a lot of the pro cyclists are they’re pretty good about it. Whether they take an Ambien or one of these things to get into the plane just to get some sleep when they arrive on the other side of the pond. You know, sometimes they do do that. But yeah, sleep hygiene, practicing it, seeing what works for you, knowing what you need to bring to make that happen. Do you need a neck pillow on the plane or one of these things, that’s the time to do it.
Caley Fretz 43:40
As someone who flies a lot, I just I carry one of those little bottles of disinfectant goo, and I use it religiously. And it’s not something that I ever, ever, ever use when I’m at home. But when I when I travel, when I fly, I am dousing my hands in that and washing my hands every single time I head to the bathroom usually two or three times and trying to clean myself as much as possible. For me, it’s always been hygiene. You know, I don’t fly, actually, I might fly more than some cyclists. I just don’t necessarily have to perform and the other end still suck sucks getting sick. And that’s that’s always been what worked for me is just doubting myself and antibacterial fluids or anti whatever that stuff’s called. Well, the yeah, disinfectant.
How can Cyclists with Kids Train and Avoid Catching Bugs From Their Kids?
Trevor Connor 44:29
So my next question for you, I think of my brother who is a cyclist and I coach him and he has five kids. And he had a while there where his kids were bringing so many bugs back from school. And I put together his yearly training plan where normally with most athletes, you build these blocks to a fatigue and then you rest I’m like, okay, so here’s our two weeks of training and then you’re probably gonna be sick this week. So whereas there and then here’s another couple weeks, then you’re gonna be sick that week. And he just he couldn’t go a month without getting sick. So what about people who have kids and are trying to train?
Dr. Jason Gladney 45:03
That’s that’s the toughest question you could probably ask me, you know, my thoughts are, there’s no way you’re going to totally avoid all those bacteria and pathogens that might that want to take hold in your bodies. The best thing you can do is have a good defense. And that means trying to get your rest. And now if you have a newborn, that’s a that’s easier said than done. And in some ways, if they’re keeping you up all night, yeah, once again, it’s the sleep. It’s the food that you eat, you know, proteins that you have, and the quality of all those things that you do. That’ll hopefully prevent things from taking hold. But yeah, that’s the time maybe if you do have a race come up, if it gets sick, yeah, maybe you have your significant other, take some responsibilities for the kids at that point, just to kind of keep yourself safe distance away. And also use just like hand hygiene and and things, things of that nature. And if you’re really type A maybe you need to get a hotel room somewhere else and a couple days before your your big event. Yeah, it’s always best to have a good defense where you can fight something off. Even if it takes a little hold, you can knock it out quickly. And I was kind of always under that impression with working in the ER as an ER resident and we’re gonna internal men with all these sick people. Yeah, I didn’t stress about it. I just touched him and did all these things. But I went home and yeah, I was I was pounding some food and seemed to do well for me. So I think the more anal and worried you get about it, the more likely you are to get sick, though.
Caley Fretz 46:22
My wife’s a teacher, so I’m just doomed. For exactly exactly the same reasons.
Trevor Connor 46:29
Well, there is an urban legend that when a team has a rider that has a good chance of winning the tour, they have to spend the two months before the tour away from their kids, if they have kids.
Dr. Jason Gladney 46:39
Caley Fretz 46:40
that doesn’t surprise me. And quarantining definitely happens in Pro Cycling. And there is something to be said for quarantine. I mean, you joked about getting a hotel room. But like, if the focus of your entire season is is a week away, and your kid comes home sick. Maybe that is what you have to do, right? I mean, in in the pro ranks, if a non vital staff member is sick, they literally they’re not even allowed anywhere near the team. If a rider gets sick, they put them in a room alone immediately. And and there’s you know, they dinner alone, they breakfast alone, they sleep alone, they are completely removed from the rest of the team immediately. And that is something that you can definitely you know, you’re not living like a pro cyclists have storefronts, but if one of your teammates is sick, give them the solo room things like that.
Trevor Connor 47:31
And likewise, if you’re sick, your teammates a favor? Yes.
Dr. Jason Gladney 47:35
I think that’s, that’s great to do that in some ways, but a lot of the viruses and pathogenesis relates to viral shedding. That’s what it’s called, it’s called when a human has something. They’re kind of infectious even before symptoms develop, and a lot of these things, so sometimes it’s too little too late. But I think you can still get sick from someone who’s showing obvious signs of illness. So but yeah, sometimes it’s tough to count for everything that you can possibly do to do it. Someone might be looking great. And then two days later, yeah, they’re sick. And then meanwhile, you got it when they were looking great. So.
Trevor Connor 48:11
So my final question, what the hell is wrong with me?
Dr. Jason Gladney 48:14
Haha. What’s wrong with you zero Flagstaff today and tried to put out 300 plus the whole way up.
Caley Fretz 48:22
Trevor Connor 48:25
So do that. But that is actually what you are talking about and needing the rest. A really good example because I got sick on Monday. So right now it’s Thursday. And I actually felt like I was fighting off really well. And yesterday and the day before, you know, I could tell I was sick, but I wasn’t doing too bad. And I was thinking about that J-shaped curve. And the last two days, I just went out and did super easy one hour ride just to get that immune system flowing, but to promote the immune system. Today, I went out did that climb up Flagstaff, and literally, if you look on Strava, you can see this I fell over at 20 minutes. And the rest of the day today I have felt awful.
Dr. Jason Gladney 49:07
Yeah, I’ve been there before too, or you kind of with a cytokine release. One of the first things you feel is just this whole body malaise and you feel achy, those are cytokines in action, and you might not have spiked a fever, you might not have a cough yet, you might not be having the runny nose and all those things. You know, sometimes if you catch it in time, you get a good 10 hour sleep. Boom, you wake up the next day gone. But, you know, many times that’s not the case. And sometimes, you know, some of these viral illnesses, you know, you have people coughing for six weeks later, where even though you’re over the infectious, kind of quality of the whole experience, you still have these symptoms that drag on. So in your case like the breathing going up, yeah, sometimes that’s still affected and the bronchial lining is hyper responsive to irritants like breathing air high volumes really fast or dry air cold air those things so even though you’re, you’re over the infection, sometimes it lingers, though.
Caley Fretz 50:05
Alright, so we’ve gone through the science of essentially the immune system and what training does to it, we’ve talked about the various ways not to get sick. And then we just talked about what to do if you get sick. You had one more for us.
Dr. Jason Gladney 50:21
Sure. Maybe some of the listeners will listen to this and think about well, what’s mild to moderate exercise basically a difference for for everyone and, you know, exercises that boosts the immune system. In cycling, we base those on threshold watts, sometimes heart rate, and I think it’s important if, if you have questions about your training, and are you training too hard, have you been sick too frequently? Having a coach behind you is definitely a nice way to to look at what your capabilities are, are you over those on more days than not, and then how to kind of create a schedule that keeps you progressing in terms of fitness, but maybe ward’s off the risk for these infections to kind of occur.
Trevor Connor 51:01
And the only thing I will add to that, as a coach who’s constantly talking with athletes that are getting sick and worried about it, don’t worry about the time off, don’t worry about the rest, your fitness won’t disappear, you will be back quickly and probably come back stronger. If you try to ride through it. You’re gonna be sick for a long time. And then your fitness is in trouble.
Caley Fretz 51:22
Yeah, and if you want a little bit more information on, well, how a little bit of a break could actually be beneficial. Go back and check out the past the Fast Talk episode that we did with Dr. Pruitt a couple weeks ago, about offseason and how the offseason is very, very important. A lot of those concepts apply very, very well to getting sick and middle of season and how you can sort of get through that and maybe even come out the other end better off. That was another episode of Fast Talk. As always, we love your feedback. Email us at firstname.lastname@example.org. You can subscribe to Fast Talk on iTunes, Stitcher, SoundCloud, and Google Play. Bee sure to leave us a rating and a comment. And while you’re there, check out our sister podcast, the Velonews podcast, which covers news about the week in cycling. Become a fan of Fast Talk on facebook at facebook.com/velonewsmagazine on email@example.com/velonews. Fast talk is a co production of Velonews and Conner Coaching. The thoughts and opinions expressed on Fast Talk are those of the individual for Dr. Gladney and Trevor Connor. I am Caley Fretz. Thank you for listening!