To Multivitamin or Not to Multivitamin?

Introduction

About 30% of adults in the western world take a multivitamin. Multis alone make up about 40% of all vitamin and mineral supplement sales. However, research evidence supporting the use of multis is mixed at best with recent large population studies reporting no association between use of multis and better cardiovascular or brain health, and only modest cancer protection. In contrast, one 2011 study, the Iowa Women’s Health Study, showed an increased risk of death in women who took multis.

I’m aware of these ‘fors’ and ‘againsts’ and have for year taken a daily multivitamin (and Flaxseed oil – source of Omega 3, 6 and 9). I eat very healthily with plenty of natural cereals, 5 servings of vegetables a day and at least 3-4 serves of fruit a day. However, I’m also very active exercising 1-2 hours a day. My belief is that despite eating a nutritious and well-balanced diet, my multi a day might cover my butt with any dietary deficiencies I may have in vitamins and minerals.

Recently I found a great discussion paper in a journal where four experts from Tufts University in the USA discussed their thoughts on use of multivitamins. One was a professor and director of an antioxidant research laboratory, one a professor of nutrition and contractor to the Office of Dietary Supplements in the USA, one a professor of nutrition science and director of a cardiovascular nutrition laboratory, and the other a professor and director of a vitamin and cancer lab. Collectively, world leaders in the field I feel!

What were the main points raised?

  1. Multis are not harmful and help fill the inadequacies in the average requirements for vitamins D, E and K and minerals magnesium and potassium that about 60% of Americans fail to meet. Moreover, about 40% of them fall short on vitamins A and C. Why are this happening? Because sadly people aren’t eating fruit, vegetables and whole grains where collectively all these great vitamins and minerals are found. In general masters athletes like us tend to be well-educated and eat well. So maybe we don’t need multis if we are eating natural foods and not hammering the junk food and take-aways!
  2.  Not every person needs a multi.Some examples where they might be needed include:
    • the very old and / or frail who don’t eat a lot
    • people with disease or illness who may not eat well
    • athletes who train hard and / or long and are not getting enough energy intake in a day so are losing weight
  3. People who might need supplements such as iron or calcium supplements should be taking these supplements and not a multi. The belief that a multi contains enough of a particular vitamin is wrong. In general, the amount of any one vitamin and/or mineral in a multi is not enough to make up for a problem a particular individual may have. This is where a dietician or doctors input is critical.
  4. If you are shown to have an inadequacy in a vitamin or mineral look for a natural food solution rather than a pill. For example, the intake of the mineral calcium and vitamin D is often found to be inadequate in older people, especially in post-menopausal women who don’t get much sun, including older female athletes. So is low-fat greek yoghurt or increasing your dairy intake a better option? These experts think so!
  5. What about the 2011 study that said women who take multis are at higher risk of death than those that don’t? This study has not been supported by other studies since. Moreover, it did not tightly control for other factors that may have contributed to deaths such as smoking, obesity and pre-existing illness. The consensus at present is that taking multis does not increase how long we live but equally it does no harm either. A recent study called The Physician’s Health Study II tested a complete multivitamin in 15,000 men and actually found a reduction in cancer incidence in those men who took multis. They also controlled for confounding variables like smoking.
  6. Taking too much of a vitamin does not appear to be an issue. Except taking too much vitamin A which has been linked to bone loss.
  7. Bottom line is to personalise your intake of vitamins and minerals based on your nutritional intakes, health status and exercise habits. While a multi may not do any harm, they have small amounts of everything and may miss something you as an individual may need. Chat with your doctor or dietician is my suggestion.

Source:  Should you take a multivitamin? Four Tufts experts tackle the multi-billion-dollar question, Tufts University Health & Nutrition Letter Sept. 2015.

 

Veteran team sport players have great heart health

Introduction

We all know that physical activity is beneficial for several risk factors of cardiovascular disease and all-cause mortality. We also know that if we improve our aerobic fitness we increase our chances of living longer. However, despite this knowledge, the number of people meeting the recommendations for physical activity is lowest in older people. Why? Because with normal ageing, body fat increases and muscle mass decreases and these changes are more evident in the physically inactive than active people. Obesity is related to several metabolic and cardiovascular diseases and obese men have been shown to have 2.6 times higher mortality from cardiovascular disease than normal weight men.

Research has shown a strong relationship between low cardiorespiratory fitness and mortality in normal-weight, overweight, and obese men. Research has also shown that lean unfit men had higher risk ratios for cardiovascular and all-cause mortality than obese but fit men. These findings highlight the importance of endurance fitness in older people to prevent heart disease and live longer. Moreover, no differences in risk ratios were found between lean and obese but fit men.

Research has also shown that higher levels of endurance fitness are related to more vigorous training rather then low to moderate intensity endurance training.  In team sports, a recent study has shown that the exercise intensity is high during recreational soccer independent of age, gender, the level of training and social background and that recreational soccer is an effective health-promoting activity for untrained men and women aged 20–45 years.

But is recreational soccer a health-promoting activity for the very old? This study aimed to investigate whether lifelong participation in recreational soccer results in superior exercise capacity and cardiovascular health status for elderly (65-85 years old) in comparison to age-matched active men with no regular exercise training as well as strength-trained and endurance-trained elderly men.

Methods

A number of performance measures and indicators of cardiovascular health were measured in elderly soccer players (n = 11) compared to endurance-trained (n = 8), strength-trained (n = 7) and untrained (n = 7) age-matched men. The 33 men aged 65–85 years underwent a testing protocol including measurements of cycling performance, maximal oxygen uptake (VO2max) and body composition, with muscle fibre type and capillarisation determined from a muscle biopsy from the thigh.

Results

In the veteran soccer players, peak aerobic power on the bike was significantly greater (203 ± 20 watts) than in the untrained older men (150 ± 16 watts) and strength-trained men (156 ± 22 watts), but similar to the performance of the endurance-trained older men (201 ± 38 watts). Fat percentage was significantly lower in the veteran soccer players (21.8 ± 4.9%) than the untrained men (28.3 ± 2.1%) but not the endurance-trained (20.7 ± 4.4%) or strength-trained older men (21.7 ± 6.4%). VO2max was not significantly different in the soccer players (30.2 ± 4.9 ml O2 · min−1 · kg−1) compared to untrained (only 14% higher) and ST (only 9% higher), but 22% lower than the endurance-trained older men. The number of capillaries per fibre (a measuer of blood carrying capacity in muscles) was significantly higher  (almost double) in the soccer players compared to both the untrained and strength-trained men but similar to that of the endurance-trained men.

So what?

The scandinavian and UK researchers concluded that both the exercise performance and cardiovascular health profile of lifelong veteran soccer players are markedly better than for age-matched untrained males. Moreover, the exercise capacity and muscle aerobic capacity of veteran soccer players are also superior to lifelong strength-trained athletes and comparable to veteran endurance athletes. Given how important endurance capacity is for reducing cardiovascular disease and all-cause mortality, the study strongly supports older individuals engaging in team sports to enhance the quality and quantity of life into older age.

Source: Randers and others (2014). . Journal of Sports Sciences, 32(13): 1300-1308.

 

Masters endurance athletes more at risk of heart arrythmias

Introduction

Over the last 5-10 years I have become aware of a number of former elite endurance athletes having heart issues. This is counter intuitive given endurance athletes are considered to have strong hearts. However, over the last 10 years research is increasingly showing that the incidence of arrhythmias is higher in athletes, especially in elderly athletes with a lifelong training history in marathons, ultra-marathons, ironman distance triathlons and long distance bicycle races. An arrhythmia is any change from the normal sequence of electrical impulses in the heart. The electrical impulses may happen too fast, too slowly (bradycardia), or erratically so that the heart can’t pump blood effectively.

Bradycardia, defined by a resting heart rate <60 beats min−1, is the most frequent rhythm disturbance in response to endurance training where the resting heart rate can be ~30 beats min−1 and even lower at night. Cyclists Sir Chris Hoy and Tour de France winner Miguel Indurain reportedly had resting heart rates of 30 and 28 beats per minute. Although the bradycardia is usually a harmless adaptation to endurance training, it can become a pathological condition. It was previously thought to affect the electrical activity of the heart that starts in what is called the sinus node (see photo) which is an area of specialized cells in the upper right chamber of the heart that controls the rhythm of your heart.

The most compelling evidence of a link between endurance training and sick sinus syndrome comes from a study of former professional cyclists. Their average heart rate was lower, sick sinus syndrome was more frequent, and pacemaker implantation for bradyarrythmias was more frequent relative to a control group with matched cardiac risk factors. Similarly, a high incidence of pacemaker implantation has been reported in elderly marathon runners.

Historically, this slowing of the heart rate was thought to be the result of a change in the nervous system stimulation of the heart muscle through the sinus node, the pacemaker structure in the heart muscle itself. However, a recent animal study is the first to show that the heart rate adaption to exercise training is not the result of changes in this nervous system control of the heart, and instead is primarily the result of a training-induced remodelling of the sinus node within the heart itself.

Methods

Rats were trained for 12 weeks (1 hour per day, 5 days per week) by aerobic interval training (uphill running) alternating between 4 min at 85–90% of the maximum oxygen uptake and 2 min active recovery at 50% of maximum oxygen uptake. Experiments were also carried out in mice that were trained for 4 weeks (1 hour per day, twice a day, 7 days per week) by swimming. Resting heart rates, electrical activity of the heart, as well as actual tissue samples from the sinus node of sedentary and trained animals were analyzed.

Results

The resting heart rate of the trained rats and mice was ~26% and ~20%, respectively, lower than the heart rate of untrained animals. The resting heart rate of exercise-trained human subjects in various studies varies between ~17–26% lower than the heart rate of inactive people, a reduction similar to that observed in the animal models in the present study. This decrease is less than in elite human athletes. However, severe bradycardia or heart rate slowing in human athletes is uncommon. A protein found in the sinus node (the heart’s pacemaker) changed in response to training with a decrease in an important pacemaker protein, known as HCN4, a protein that is responsible for the low heart rate seen in fit animals.

So What?

With lifelong endurance training, research has consistently shown that veteran endurance athletes have a higher incidence of sinus node disease and artificial pacemaker implantation than normal individuals. Historically, we always believed this was due to changes in the nervous system stimulation of the heart. The present study, although done on rats and mice, suggests the slowing of the heart rate may be due to actual remodeling of the sinus node in the heart wall that actually stimulates the heart muscle to beat. The researchers believe that this finding may also help explain syncope (fainting) in the young athlete as well as other heart rhythm disturbances in older athletes including atrial fibrillation, heart block, bundle branch blockand even sudden cardiac death.. They suggest that it is likely that these disturbances may be the consequence of an actual remodeling of other parts of the heart that are responsible for electrical activity in the heart and perhaps in combination with a pre-existing heart condition in the case of sudden cardiac death.

Critically, the researchers suggest endurance exercise is undoubtedly beneficial for the cardiovascular system, but at the same time intense endurance training over many year can have harmful effects, especially in elderly athletes with a lifelong history of training and competing in endurance events like marathons, triathlons and ironman. They conclude that although endurance exercise training can have harmful effects on the heart, it is more than outweighed by the beneficial effects. Importantly, the researchers also know that this animal study’s findings need to be reproduced in humans and that more research is needed before we could draw conclude that too much endurance training is bad for the heart health of veteran athletes who have undertaken years of endurance training.

Source: D’Souza, A. and others (2014). Exercise training reduces resting heart rate via downregulation of the funny channel HCN4. Nature Communications, 5, Article 3775.

Supplementing with Probiotics Reduces Risk of Sore Throats in Physically Active Adults

Introduction

How often do we hear stories of people getting sore throats or ‘the cold’ leading into or following a major sporting goal or event. Research has shown that most adults get 2-3 of these a year and the older we get, the more of them we get. There is no doubt that the physical and emotional stress lowers the functioning of the immune system leading into the event. It also doesn’t help to be exposed to 100’s or 1000’s of people during and after racing – another time our immune system is compromised! Here is some new Aussie research suggesting that taking probiotics can help reduce upper respiratory tract infection (URTI) in physically active adults.

The Research

The World Health Organisation (WHO) defines probiotics as live micro-organisms which, when administered in adequate amounts, confer a health benefit on the host. Probiotic foods include dairy foods including yoghurt, cheese, and acidophilus milk (eg Yakult) as well as non-dairy foods such as olives, gherkins, sauerkraut and probiotic drinks and supplements that are increasing in popularity. The researchers from a number of research institutions including Griffith University in Queensland and the Australian Institute of Sport conducted a randomised double-blind placebo-controlled trial (this means well-controlled study!). 465 male and female adults aged between 18 and 60 years who exercise a minimum of three times a week for 30 minutes for 3 months took part. They were assigned to one of three groups:

  1. Bifidobacterium animalis subsp. lactis group
  2. Lactobacillus acidophilus NCFM and Bifidobacterium animalis subsp. lactis group
  3. Placebo group

Patterns of illness were determined via a web-based questionnaire. Signs and symptoms of URTI included a scratchy or sore throat, sneezing, and a stuffy or runny nose. URTI was diagnosed when two or more of these symptoms were recorded for three or more consecutive days.  The researchers also monitored gut upsets such as diarrhoea, constipation, tummy rumbles, nausea and abdominal pain but did not get enough people experiencing these to do an analysis on gut upsets.

The Results

The risk of an URTI episode was significantly reduced by 27% in the Bifidobacterium animalis subsp. lactis group. While it wasn’t statistically significant, the combined probiotic of Lactobacillus acidophilus NCFM and Bifidobacterium animalis subsp. lactis did reduce the risk of URTI too. Importantly in this study, those taking both probiotics also delayed getting URTIs compared to the placebo group by about 3 weeks.

The So What?

While I don’t advocate or push products through my website, I do like to ‘bridge the gap’ between science and masters sport. In Australia the two probiotics listed above are available as a product called Inner Health Plus. The study reported here showed that risk of an URTI episode was significantly reduced by about 25% by taking probiotics.  Interestingly, taking vitamin C, something most of us are aware of to fight colds, only reduces the risk of getting a common cold by about 3%. Those taking the probiotics in this study also delayed getting URTIs compared to the placebo group. Be aware that probiotics take about 10-14 days to colonise the gut so if you plan to use them leading into an event, travel, or the winter months, plan ahead. For plenty of great ideas on how to stay healthy and well as an athlete over 30 years of age, chapter 14 (Staying healthy and illness-free) of my book The Masters Athlete has heaps of great scientifically-proven tips to stay healthy while training hard and often.

Source: West, N. and others (2013) Probiotic supplementation for respiratory and gastrointestinal illness symptoms in healthy physically active individuals.  Clinical Nutrition (published ahead of print).

Heart damage from too much training??

Introduction

There’s been some recent media speculation that older endurance athletes are more prone to heart problems than healthy age-matched people. Just after one of our readers advised me of this negative press, a mate in his mid-60’s and pioneer of Ironman triathlon in Australia and now a lecturer in sport coaching at an Ozzie university told me he has had a pacemaker inserted. This goes against the common belief that aerobic exercise is good for you in that it keeps many of the heart disease risk factors in check. So what does the research really say when it comes to this supposed increased risk of heart problems in older endurance athletes?

The Facts

Exercise is increasingly been seen as medicine. In fact, internationally, there has been a movement started called Exercise is Medicine. The movement is being driven by the enormous amount of scientific evidence supporting the value of doctors prescribing exercise as medicine rather than pills!! Consistently and unequivocally recent research has found that regular exercise prevents and treats many of our common and deadly chronic diseases including:

  • coronary artery disease
  • diabetes
  • obesity
  • high blood pressure
  • heart failure
  • depression

Moreover, people who do regular physical activity have lowere rates of disability and an average life expectancy about 7 years longer than non-exercisers.

However, as with any drug there appears to be a safe upper range dose of activity above which there may be adverse effects that may outweigh the benefits above. For example, a long-term study published in 2011 in the highly prestigous medical journal the Lancet tracked 416,000 Taiwanese people over about 8 years and found that there was a protective health effect up to about 60 minutes of daily vigorous (huff and puff!) exercise. Another recent longitudinal study 0f 52,000 adults found that running distances of up to 19.9 miles/week, speeds of 6-7 miles/hour, or frequencies of 2-5 days/week were associated with a lower risk of all-cause mortality, whereas higher mileage, faster paces, and more frequent running were not associated with better survival.

Very recently, there has been some suggestion that long-term endurance vigorous training such as that greater then the doses above may increases the risk of atrial fibrillation (irregular heart beat). This review article presented many studies conducted over the last 15 years that have suggested training too hard for too long can increase the risk of atrial fibrillation in healthy middle-age men. They suggested that although such training may prevent coronary artery disease, it might also cause of atrial fibrillation.

An increasing amount of research evidence also suggests that training and competing long term in ‘extreme’ endurance events such as marathons, ultramarathons, ironman triathlons and very long cycling or swimming events can cause transient problems and damage to the heart walls and chambers as evidenced through blood markers. However, these problems return to normal within 7-10 days after stopping training.

In veteran extreme endurance athletes such as my mate, this consistent heart muscle damage and repair process may lead to heart fibrosis (thickening and stiffening of the heart valves and muscle). Over years, this may lead to heart arrythmias (irregular heart beats).

However, recently another group of cardiology researchers critically analysed these studies that suggested increased risk of heart issues in older endurance athletes (like me and my mates) who train long and hard and often. These researchers concluded that the

  1. the incidence of atrial fibrillation in middle-aged endurance athletes is rare
  2. if a risk exists, it is limited to vigorous endurance exercise only and in those middle-aged men with other risk factors such as smoking or high blood pressure
  3. there is no increased risk in healthy middle-aged men with a normal heart who have no blood pressure issues and no other risk factors
  4. Critically, the researchers concluded that the beneficial effects of exercise will offset this low risk which, even if increased, remains very low.

The So What?

As with any issue in science, research typically is inconclusive. There are always studies and papers that contradict each other. While a number of studies over the years have shown a potential increased risk of heart issues in older athletes who train long and hard and often, other studies suggest the risk is very low in these athletes if they are healthy and have no other risk factors. Moreover, the current concensus appears to be that while the the risk is very low, the benefits of such training outweigh the low risk of heart issues. For me, I intend to keep training regularly unless my body tells me otherwise!

Chapter 4 (Principles of Training the Masters Athlete), Chapter 6 (Endurance Development in the Masters Athlete), Chapter 10 (Periodisation and Peaking for the Masters Athlete), Chapter 13 (Preventing Overtraining in the Masters Athlete) and Chapter 14 (Staying Healthy and Illness-Free) are excellent guides and how-to chapters when it comes to optimising your training and preventing health issues as an older athlete. Each chapter is now available online as a pdf. Check it out by clicking here.

Sources:

  1. Delise, P. and others (2012) Does long-lasting sports practice increase the risk of atrial fibrillation in healthy middle-aged men? Weak suggestions, no objective evidence. Journal of Cardiovascular Medicine, 13: 381-385.
  2. Patil, H and others (2012) Cardiovascular damage resulting from chronic excessive endurance exercise. Missouri Medicine, 109(4): 312-321.