Gary Moller: [DipPhEd PGDipRehab PGDipSportMed(Otago)FCE Certified, Kordel's and Nutra-Life Certified Natural Health Consultant]. ICL Laboratories registered Hair Tissue Mineral Analysis and Medical Nutrition Consultant.

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Tuesday, January 04, 2011

Stressed to Breaking Point - Stress fractures in elite female runners

Carrying a little extra weight during
training.

Stress fractures are common in runners, predominantly in females.  Running causes micro fractures in the bones of the legs.  This is of no concern in the healthy runner who is following a training programme that has a balance between workouts and recovery periods.  In fact, the micro damage that happens in training is what stimulates the process of bone renewal, remodeling strengthening, so a healthy runner will be able to tolerate more and more pounding as the years go by.

Stress fractures occur more often in female runners because the sport is particularly attractive to individuals with eating disorders of which, by far the majority, are female.  Women are also vulnerable because hormonal changes that happen with calorie deprivation may hasten bone loss (More about this later).

Disordered eating and long distance running make for common bed mates.  They reward each other.  This is because being extremely light confers a performance advantage, while running seriously long distances makes for an effective way to lose that last pound.  
Racing the big ones thin; but
not for long!

Running far while running on empty

This is self-destructive behaviour that can not continue indefinitely without the runner's health and structural integrity being seriously compromised.  The body has to consume itself in order to meet its most immediate needs. The consequences of running on empty include constantly getting infections, poor healing, joint and muscle problems, including stress fracture and even infertility.  Taken to its extreme the result is death.

For more about this: Please read my E-Book "Too Thin to Win" which is dedicated to the memory of NZ International Representative runner, Helen Moros.

Training Overweight
Lorraine Moller is remembered for her astonishing longevity (28 years) on the international running scene.  Her longevity was no accident; but the result of lessons learned from mistakes made during her early years as a middle and long distance runner.  One, which she explained to me many years ago, was not to run on skinny empty during the long months of cranking out the kilometers.  Instead, she learned to carry extra weight (fat) during those long months of training and relatively unimportant races and then she would carefully strip off any excess fat over the last few months leading up to the Big One, such as the Olympics, pull out a big performance, rest up, put on some weight and then commence another long build up.  This process was repeated, with success, time and time again.

The Female Athlete who is running on empty may present with an athletic history that is extremely impressive.  However; analysis of her running history may show a pattern of big weekly kilometers  in training, some wonderful performances; but these are often punctuated with frustrating injuries that are associated with overuse, including stress fractures. Or, she may present with a history of repeated injury , including stress fractures, despite running unusually low kilometers per week.  On presentation for treatment, she may be unable to run at all due to stress fractures.  Such fractures are usually found in the the feet, ankles and even the tibial plateau.  Stress fractures may be present in the thighs and even the pelvis of runners.  It is not unusual for there to be a history of recurrent stress fractures over ten or more years.

She may present with a long history of anorexia or bulemia that most often develops during adolescence.  Often there is denial of the presence of disordered eating.  Even where the eating disorder is long gone, the consequences of disturbances to her metabolism, including nutrient imbalances, may persist.  This will show up on a Hair Tissue Mineral Analysis.

Completion of Dr Wilson's Adrenal Fatigue Questionnaire may indicate the presence of moderate to severe adrenal fatigue.

Exercise recall may indicate very high levels of activity even when injured, such as many hours spent swimming, aqua-jogging or in the gym.  Diet recall may indicate calorie intake being highly in deficit when compared alongside her exercise patterns.

Case Study
A 19 year old female middle distance runner. After at least 12 months since symptoms began, she was diagnosed in March 2010 with a navicular stress fracture to her right foot. She had two other stress fractures in both feet a few years back. 

Indications of low thyroid with parathyroid dominance, plus adrenal
fatigue.  High copper is indicative of estrogen dominance.  High
copper, relative to zinc, may cause collagen disorders affecting
the skin, bones, ligaments, joints, tendons and blood vessels.
She was non-weight bearing for six weeks then spent a further 10 weeks in an aircast boot. After this she spent 2 months rebuilding strength in the foot via rehabilitation. Scans three months after the fracture was diagnosed showed that there had been a fracture but it was healed. She has been progressing a return to running VERY slowly, but is plagued with yet another injury in her left foot which is still preventing her from training.


She has had problems with bone spurs, tendons and ligaments in her feet.

She has a history of anorexia which she reports is now well under control.

Body composition indicates 20% body fat which is unusual for an elite runner.  This rather high body fat has nothing to do with "over-eating" - It is indicative of low thyroid function which is seen on the HTMA chart above as elevated Ca and Cu.  She is about to undergo surgery to remove a bone spur from one of her navicular bones.

She has been on an estrogen patch to promote regular periods and the timing of this medication appears to be uncannily close to her most recent episodes of stress fractures, bone spur, ligament and tendon injuries and failure to heal. An estrogen dominant contraceptive may cause copper levels to soar and zinc levels to plummet (Refer HTMA above); whereas a progesterone dominant one may cause zinc levels to soar and copper to plummet - both scenarios causing most unwanted complications (More about this later).

Some comments about bone loss
Excess calcium, relative to elements such as magnesium and sodium, indicates the ongoing loss of calcium from the bones and the deposition of calcium into the soft tissue, including the hair cells.  This is the process of osteoporosis, loss of resilience of the skin, tendons, ligaments and cartilage and the hardening of the blood vessels.  For more about this most undesirable process of calcification, please read this article.

Elements such as sodium, potassium, manganese, boron and molybdenum are as important as calcium for strong bones.  There must be a balance between copper and zinc.  And there must be a balance between all of the above for there to be strong, healthy bones, tendons, ligaments, skin and even the lining of the digestive tract (Symptoms of a weak digestive tract includes IBS, Crohn's and stomach ulcers).

This young athlete's HTMA indicates that there may be a lack of a number of vitamins, such as pyridoxine which are needed for effective use of many minerals, including magnesium, copper and zinc.

Excess copper and relative zinc deficiency are quite spectacular for this female athlete.  This may be the legacy of a severe viral infection such as hepatitis or mononucleosis, or due to the severe shut down of the thyroid and adrenals, along with abnormal liver function, following a prolonged episode of disordered eating and accompanying stress.  Even after the original causation may be long gone, the elevated copper may persist, causing ongoing ill health, such as chronic fatigue following a severe viral infection.

Protein and fat are essential for strong bones, as well as for strong tendons, ligaments, skin, blood vessels and other connective tissues.  Both are vital for the production of hormones and are involved in just about every cellular process taking place every second, of which there are thousands.  Fats and proteins need to be from a wide variety of sources, including plant and animal.  Including saturated fats.

Protein is not stored like fat and sugar.  If there is insufficient circulating in the blood to meet immediate needs, such as for hormone production and tissue repair, the body will take protein from itself - all structures and organs, including the bones and muscles.

Lack of Vitamin D is widespread nowadays, even among distance runners.  Vitamin D is essential for numerous functions in the body, including producing strong bones.  Vitamin D is manufactured from cholesterol residing in the skin which converts to cholecalciferol (vitamin D) when exposed to ultraviolet light. Low levels of serum cholesterol, low dietary intake of vitamin D rich foods and lack of sunlight, including use of sunscreens may contribute to vitamin D deficiency.  However: megadoses of vitamin D may cause fatigue, muscle pain, bone spurs and even osteoporosis.  Read this article and related ones to learn more.

Chronic stress is a powerful factor in bone loss due to the effect on adrenal function.  The adrenals produce over 90 different steroidal hormones and an excess, or lack of may affect bone health.  Excess adrenal cortisol, for example, may cause calcium loss from the bones.  Our young athlete indicates poor adrenal function with an underactive thyroid with parathyroid gland dominance - which add up to fatigue, fat gain, poor muscularity and bone loss. As mentioned earlier, the stress may have abated, the eating improved; but the abnormal liver and glandular functions may continue.

More about the relationship between copper, zinc, joint and ligament damage
Estrogen dominance due to copper retention is evident.  Giving this young woman an estrogen patch contraceptive may have been the last straw, causing copper levels to soar off the chart.

A balance between copper and zinc regulates the cross-linking of collagen.  If there is an imbalance, then there may be a reduction in this cross-linking.  This leads to connective tissue that stretches and may not return to its original length.  It also leads to cartilage that is unable to resist impact and shearing forces.  This explains why scoliosis, a devastating deformity of the spine, is almost exclusive to young women and first shows when the female hormones soar during puberty.  The lax ligaments of the spine are unable to maintain the spine's integrity leading to spinal collapse.  This also explains why double-jointedness is most common in females than males.

This ligament laxity may be exacerbated by the addition of a contraceptive, by further exacerbating a copper/zinc imbalance.

If there is ligament laxity due to reduced cross-linking of collagen, joints are vulnerable to injury and this may explain why women are particularly vulnerable to knee and ankle injuries.

Ligament laxity in the feet will lead to their flattening, causing abnormal stresses on the bones and joints of the foot and ankle.

Low thyroid function results in calcium deposition into soft tissues including the joint margins, as well as softening of the bones.  These related processes (ligament laxity and calcium deposition) help explain the torrent of lower leg ligament, bone and bone spurs that this female athlete has suffered and which appears to have gained momentum following administration of an estrogen patch.

Recommended dietary actions to restore health
  • Restore a healthy balance between copper and zinc.  This is slowly by dietary supplementation of zinc, magnesium and various vitamins and avoidance of contraception that manipulates the female hormones.  Where there is a copper excess, not wearing copper jewelry..
  • Ensure a diet that is low in calcium and copper while ensuring the diet is high in just about every other nutrient.  Copper is found in shell fish, mushrooms and chocolate.
  • At the same time, take Reparen daily.  Reparen is a specialty bone, tissue, muscle repair and support complex. Reparen is a water soluble, rapidly absorbed and highly bioavailable source of ionic calcium phophate that can assist in the treatment and prevention of osteoporosis, tissue repair and sports injuries, maintains healthy heart function, nerve function and transmission, cellular energy, assist in hormone secretions and enzyme activity, supports better health and improved recovery.

    Reparen is made from a special high-grade preparation of monobasic calcium phosphate that improves vital calcium and phosphate balances in the body. This form of calcium is found at the sites of healing in all tissue, including bone and tendon.  It is not the form of dietary calcium that we want to reduce.
  • Increase dietary intake of sodium and potassium.  Avoid refined salt (pure sodium) and be liberal with the pink salt that contains over a hundred different mineral salts (principally sodium).  Himalayan Sea Salt is best.
  • Commence an adrenal fatigue recovery programme (Readers interested in this will need to contact me directly for a consultation).
  • Increase levels of vitamin D from judicious exposure to sunlight, vitamin D rich foods and supplementation (Vitamin D supplements here).
  • Ensure there is a small intake of protein about every 2-4 waking hours and fats daily (including saturated fats).  This may include a protein shake.  Douglas Ultra Protein is recommended for shakes because it is of the highest quality and packed with numerous nutritional cofactors.



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