”It sure is nice to talk with someone that understands health from an athlete's perspective!”

We received the above comment from an emailer athlete who had sent in a question to us. After a back and forth discussion, he was so happy to have figured out a new direction to work on his medical issues. His primary care doctor really had no idea what to do with him. Here is an example of why you need a doctor who understands the rigors that endurance athletes put their bodies under.

Hi Marion;
Hopefully, I can ask you an additional question. I know that everything is connected. However, does creatinine clearance play a role in this possibly? Last year my DO became very concerned that my creatinine clearance numbers were high. She ordered an MRI and for a few days everyone in my family was concerned that I was in kidney failure. The MRI tech and radiologist told me that I was fine and nothing to worry about.

Being me, I went out and did my homework. I found out that endurance athletes and in more general terms people that train and workout more than the normal person and take in more protein can elevated these levels. I reviewed all of this with her and I think she was taken back a bit because I think I knew more about it than her....I kept track of the amount of protein I take and I try not to over do it.

Regards
M

Protein Breakdown During Endurance Athletic Performance

Endurance athletes will commonly exhibit elevated Blood urea nitrogen (BUN), Creatinine, and/or Creatinine Clearance levels. For those of you who are not familiar with these terms, these are blood tests that provide information about kidney and hydration status. Blood urea nitrogen (BUN) measures the amount of urea nitrogen, a waste product of protein metabolism, in the blood. Urea is formed by the liver and carried by the blood to the kidneys for excretion. Because urea is cleared from the bloodstream by the kidneys, a test measuring how much urea nitrogen remains in the blood can be used as a test of kidney function. However, there are many factors besides kidney disease that can cause BUN alterations, including protein breakdown, hydration status, and liver failure. Creatinine is a protein produced by muscle and released into the blood. The amount produced is relatively stable in a given person. The creatinine level in the serum is therefore determined by the rate it is being removed, which is roughly a measure of kidney function. Creatinine clearance is technically the amount of blood that is "cleared" of creatinine per time period. It is usually expressed in milliters per minute. Normal is 120 ml/min for an adult. It is roughly, inversely related to serum creatinine: If the clearance drops to one half of the old level, the serum creatinine doubles. So for an adult, serum creatinine of 2 is roughly a creatinine clearance of 60 ml/min.

At Caring Medical, we may see endurance athletes show elevated levels of BUN, Creatinine, or Creatinine Clearance. In fact, it has even happened to us when we have done routine lab work. As our emailer reports, other physicians may automatically jump to the conclusion that you have kidney problems. However, many do not realize the extent of the trauma that endurance athletes undergo. If the doctor questions the patient as to their recent athletic activity, he/she will find that the athlete may have recently completed some serious amount of training, as was the case with this writer. He writes, “Yeah, the blood test was taken the day after my Olympic distance winter triathlon, so that does make perfect sense!”

Excessive Protein Breakdown

This writer said that his doctor went to the trouble of ordering an MRI ($800-1200) when a repeat blood test on a non-training day would have most likely done the trick! Athletes break down huge amounts of protein during exercise. Contrary to what other practitioners will say, these elevated levels are not due to excessive dietary protein consumption. It would be very difficult to take in too much protein given the amount of exercise that endurance athletes are performing at one time. We are talking about 2-4 hour bike rides followed by 2 hours of running. This is just one day of training. Or the athlete may swim for 2 hours straight and then do a 10-mile run. The average person cannot even comprehend this. Your body is working hard to repair itself during these times of breakdown. That is why it is imperative that we plan rest into our schedules. Our coach is constantly telling us to listen to our bodies. If you are starting to get sore or tired, we most likely need to slow down a little.

An athlete’s blood kidney function levels will be constantly going up and down depending on his/her activities. If you do get some blood work done, be sure to let your doctor know what type of exercise you are doing, but more importantly, seek a natural medicine practice such as Caring Medical where the staff are very attuned to athletes and their needs. Our medical director is an Ironman!

How Much Protein?
An endurance athlete in regular training for at least two hours per day needs at least 1.5 grams of protein per kilogram of bodyweight to remain in positive nitrogen balance. If this means nothing to you, let me give you an example. The average non-endurance athlete requires 0.8 grams of protein per kilogram of body weight. Here’s an example of what this means:

Example:

Case #1: 150 pound non-exercising man

Step 1: Convert weight in pounds to kilograms by dividing weight in pounds by 2.2. OR 150/2.2 = 68.2 kilograms.

Step 2: Multiply (0.8 grams of protein/kg body weight) by (68.2 kilograms of body weight) = 55 grams of protein

Case #2: 150 pound male endurance athlete

Step 1: Convert weight in pounds to kilograms by dividing weight in pounds by 2.2. OR 150/2.2 = 68.2 kilograms.

Step 2: Multiply (1.5 grams of protein/kg body weight) by (68.2 kilograms of body weight) = 102 grams of protein

Endurance exercise, and for that matter, all exercise, causes the body to use protein at a much faster rate. As you can see in the above example, the endurance athlete requires nearly twice as much protein as the average person. A positive nitrogen balance means that the body is obtaining sufficient protein from the diet. A negative nitrogen balance means that the body has insufficient input of protein, and is therefore breaking down muscle and other protein structures to provide its daily needs. We have to match our intake of protein to our training program as well as our body make-up.

Athletes definitely need more protein than sedentary people, because most of it is used to offset the losses in protein caused by training and protein used for energy. Our experience personally, as well as in our athlete patients, shows that an endurance athlete who wants to increase lean mass (muscle) and is training accordingly (strength workout) may even need to increase protein intake up to 1.8 to 2.0 grams of protein per kilogram of bodyweight. Training hard to improve muscle strength demands an increased intake of protein.

How much Protein is Contained in Food?

This chart can give you an idea of how much protein you should be eating per day and where you can get it in your diet.

4 ounces of chicken, fish, or meat (size of a deck of cards): 28 grams
1 large egg: 7 grams
1 slice bread: 3 grams
½ cup vegetables: 3 grams
1 ounce nuts: 4-8 grams
8 ounces milk: 8 grams
8 ounces fortified soy milk: 11 grams
8 ounces natural organic yogurt: 8 grams
1 cup legumes: 12 grams
¼ cup Protein powder: 12-14 grams
2 tablespoons natural peanut butter: 9 grams
¼ cup soy: 7 grams
½ cup tuna: 12 grams
1 ounce cheese: 7 grams

Notice, fruits, fast foods, and other junk foods are not on this list. They do not contain any protein.

If you would like assistance with your sports nutrition plan, please feel free to make an appointment with us today. We’d love to help you maximize your performance!

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Caring Medical and Rehabilitation Services - Oak Park, Illinois Call 708-848-7789
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