Fitness questions and answers for July 8, 2008

Got a question about fitness, training, recovery from injury or a related subject? Drop us a line at...

Form & Fitness Q & A

Got a question about fitness, training, recovery from injury or a related subject? Drop us a line at fitness@cyclingnews.com. Please include as much information about yourself as possible, including your age, sex, and type of racing or riding. Due to the volume of questions we receive, we regret that we are unable to answer them all.

Carrie Cheadle, MA (www.carriecheadle.com) is a Sports Psychology consultant who has dedicated her career to helping athletes of all ages and abilities perform to their potential. Carrie specialises in working with cyclists, in disciplines ranging from track racing to mountain biking. She holds a bachelors degree in Psychology from Sonoma State University as well as a masters degree in Sport Psychology from John F. Kennedy University.

Jon Heidemann (www.peaktopeaktraining.com) is a USAC Elite Certified cycling coach with a BA in Health Sciences from the University of Wyoming. The 2001 Masters National Road Champion has competed at the Elite level nationally and internationally for over 14 years. As co-owner of Peak to Peak Training Systems, Jon has helped athletes of all ages earn over 84 podium medals at National & World Championship events during the past 8 years.

Dave Palese (www.davepalese.com) is a USA Cycling licensed coach and masters' class road racer with 16 years' race experience. He coaches racers and riders of all abilities from his home in southern Maine, USA, where he lives with his wife Sheryl, daughter Molly, and two cats, Miranda and Mu-Mu.

Kelby Bethards, MD received a Bachelor of Science in Electrical Engineering from Iowa State University (1994) before obtaining an M.D. from the University of Iowa College of Medicine in 2000. Has been a racing cyclist 'on and off' for 20 years, and when time allows, he races Cat 3 and 35+. He is a team physician for two local Ft Collins, CO, teams, and currently works Family Practice in multiple settings: rural, urgent care, inpatient and the like.

Fiona Lockhart (www.trainright.com) is a USA Cycling Expert Coach, and holds certifications from USA Weightlifting (Sports Performance Coach), the National Strength and Conditioning Association (Certified Strength and Conditioning Coach), and the National Academy for Sports Nutrition (Primary Sports Nutritionist). She is the Sports Science Editor for Carmichael Training Systems, and has been working in the strength and conditioning and endurance sports fields for over 10 years; she's also a competitive mountain biker.

Eddie Monnier (www.velo-fit.com) is a USA Cycling certified Elite Coach and a Category II racer. He holds undergraduate degrees in anthropology (with departmental honors) and philosophy from Emory University and an MBA from The Wharton School of Business.

Eddie is a proponent of training with power. He coaches cyclists (track, road and mountain bike) of all abilities and with wide ranging goals (with and without power meters). He uses internet tools to coach riders from any geography.

David Fleckenstein, MPT (www.physiopt.com) is a physical therapist practicing in Boise, ID. His clients have included World and U.S. champions, Olympic athletes and numerous professional athletes. He received his B.S. in Biology/Genetics from Penn State and his Master's degree in Physical Therapy from Emory University. He specializes in manual medicine treatment and specific retraining of spine and joint stabilization musculature. He is a former Cat I road racer and Expert mountain biker.

Since 1986 Steve Hogg (www.cyclefitcentre.com) has owned and operated Pedal Pushers, a cycle shop specialising in rider positioning and custom bicycles. In that time he has positioned riders from all cycling disciplines and of all levels of ability with every concievable cycling problem. Clients range from recreational riders and riders with disabilities to World and National champions.

Current riders that Steve has positioned include Davitamon-Lotto's Nick Gates, Discovery's Hayden Roulston, National Road Series champion, Jessica Ridder and National and State Time Trial champion, Peter Milostic.

Pamela Hinton has a bachelor's degree in Molecular Biology and a doctoral degree in Nutritional Sciences, both from the University of Wisconsin-Madison. She did postdoctoral training at Cornell University and is now an assistant professor of Nutritional Sciences at the University of Missouri-Columbia where she studies the effects of iron deficiency on adaptations to endurance training and the consequences of exercise-associated changes in menstrual function on bone health.

Pam was an All-American in track while at the UW. She started cycling competitively in 2003 and is the defending Missouri State Road Champion. Pam writes a nutrition column for Giana Roberge's Team Speed Queen Newsletter.

Dario Fredrick (www.wholeathlete.com) is an exercise physiologist and head coach for Whole Athlete™. He is a former category 1 & semi-pro MTB racer. Dario holds a masters degree in exercise science and a bachelors in sport psychology.

Scott Saifer (www.wenzelcoaching.com) has a Masters Degree in exercise physiology and sports psychology and has personally coached over 300 athletes of all levels in his 10 years of coaching with Wenzel Coaching.

Kendra Wenzel (www.wenzelcoaching.com) is a head coach with Wenzel Coaching with 17 years of racing and coaching experience and is coauthor of the book Bike Racing 101.

Steve Owens (www.coloradopremiertraining.com) is a USA Cycling certified coach, exercise physiologist and owner of Colorado Premier Training. Steve has worked with both the United States Olympic Committee and Guatemalan Olympic Committee as an Exercise Physiologist. He holds a B.S. in Exercise & Sports Science and currently works with multiple national champions, professionals and World Cup level cyclists.

Through his highly customized online training format, Steve and his handpicked team of coaches at Colorado Premier Training work with cyclists and multisport athletes around the world.

Richard Stern (www.cyclecoach.com) is Head Coach of Richard Stern Training, a Level 3 Coach with the Association of British Cycling Coaches, a Sports Scientist, and a writer. He has been professionally coaching cyclists and triathletes since 1998 at all levels from professional to recreational. He is a leading expert in coaching with power output and all power meters. Richard has been a competitive cyclist for 20 years

Andy Bloomer (www.cyclecoach.com) is an Associate Coach and sport scientist with Richard Stern Training. He is a member of the Association of British Cycling Coaches (ABCC) and a member of the British Association of Sport and Exercise Sciences (BASES). In his role as Exercise Physiologist at Staffordshire University Sports Performance Centre, he has conducted physiological testing and offered training and coaching advice to athletes from all sports for the past 4 years. Andy has been a competitive cyclist for many years.

Michael Smartt (www.wholeathlete.com) is an Associate Coach with Whole Athlete™. He holds a Masters degree in exercise physiology, is a USA Cycling Level I (Elite) Coach and is certified by the NSCA (Certified Strength and Conditioning Specialist). Michael has more than 10 years competitive experience, primarily on the road, but also in cross and mountain biking. He is currently focused on coaching road cyclists from Jr. to elite levels, but also advises triathletes and Paralympians. Michael is a strong advocate of training with power and has over 5 years experience with the use and analysis of power meters. Michael also spent the 2007 season as the Team Coach for the Value Act Capital Women's Cycling Team.

Earl Zimmermann (www.wenzelcoaching.com) has over 12 years of racing experience and is a USA Cycling Level II Coach. He brings a wealth of personal competitive experience to his clients. He coaches athletes from beginner to elite in various disciplines including road and track cycling, running and triathlon.

Advice presented in Cyclingnews' fitness pages is provided for educational purposes only and is not intended to be specific advice for individual athletes. If you follow the educational information found on Cyclingnews, you do so at your own risk. You should consult with your physician before beginning any exercise program.

Blood in urine, gross hermaturia
Sugar and honey
Question on rhabdomyolysis
Appetite suppressant
Pain between the shoulder blades

Blood in urine, gross hermaturia

I'm a 42 year old male who is a weekend warrior type rider from the Seattle Tacoma area. I mostly ride for fun and exercise, when I'm not training for anything specific I usually ride 40 to 60 miles without much thought. Lately I have been training for a 150 mile 10,000 vertical ride around Mount Rainier some friends and I are planning. My training rides have been somewhat sporadic 40 to 60 miles here or there usually incorporating large hills, plus a couple 100 milers. For the most part the spring in the northwest has been cold 50-60F and wet. Last Saturday after 2 weeks of only minimal riding I did a 107 mile with two big climbs of about 3000 feet and 2000 feet, with a total of about 7000 vertical. The weather was much hotter than it had been 80F in town.

I felt pretty good on the first climb and climbed at my usual long climb output of about 180-184bpm, although staying hydrated was difficult. The second climb was more exposed to the sun, after about mile one out of six on the second climb I started to feel bad (a little worse than usual), so I dropped my speed substantially lower than previous times (15%) and tried to keep my heart rate below 180bpm. I ate a little while still on the bike and kept drinking as much as I could tolerate while resisting the temptation to get off the bike or turn around, I really craved shade.

I just ground it out and at the top I got off the bike and started sweating profusely. I felt pretty uncomfortable and my heart rate was a little rapid, which isn't uncommon for me in high heat and exertion situations, but it seemed a little worse than usual. My riding companions reported my face to be flush. I definitely felt on the edge of a heat related event. We took an hour break or so, during which I almost called for a pick-up; I wasn't able to eat much, just some chips and a little pasta. Lack of appetite is pretty normal for me, but I drank a soda and some water.

Since it was 40 miles mostly downhill to the car, and most of the general discomfort had gone away I decided to continue. I cut my pace to below 170bpm and slugged it out. My legs felt better than they had at that point on previous rides and even had a bit of a kick at the end. When I got home I had lost 4 pounds. I felt I ate as much as I normally do, drank as much as I could take in (maybe a little more earler in the ride), and went to the bathroom a little more frequently than usual, but felt I needed to do better with electrolytes. The next day I noticed some blood in my urine and my lower back had a dull ache.

I contacted a Dr who told me to drink a half a gallon of energy type drink and if it didn't go away, go to t he ER and get a CPK test to evaluate muscle break down. I drank as directed plus some more water and the pink colour went away within a couple hours. Tomorrow I am going to consult with my regular Dr. My questions for you are:

Based on research on the internet this seems common among long distance runners and strenuous exercise, but no mention of cycling, I think it was referred to as exercise hermaturia. Is this common in cyclists?

What can causes blood in the urine with these types of circumstances? Was it the kidney shutting down or not working properly due to dehydration or heat exhaustion?

How serious of trouble was I in?
What are the short and longer term ramifications?
Can I resume my training as long as the symptoms don't return?
Other than stopping when I feel bad what can I do to prevent this type of problem?

Scott Saifer replies:

You were right to contact the doctor with this issue. I've worked with more than 1,000 cyclists (road and MTB racers, ultra-endurance, century and even BMX) and not run into blood in urine before. That doesn't mean it doesn't happen in cyclists (I'm sure 20 or 30 are getting ready to write me as they read this), but it does mean it's very rare.
The rest of your questions about training and long-term implications should be directed to your doctor.

Sugar and honey

I limit my sugar intake but am perplexed as to why I keep being told I can eat honey. Does the source of the sugar affect its effect on the body?

Doesn't honey have tons of calories and almost the same glycemic index as white sugar? Why would it not act the same on the body? Would honey not count on that magic 'calories in vs calories out' balance?

In the same vein wouldn't the sugar in fruit also count as sugar?

As an aside I find that my mind crashes after eating white sugar. I have to have a very brief cat nap to restore function. Honey doesn't do that? Can you explain that phenomenon? That's how I can tell if I've had white sugar by accident. If it was in something but not listed or in someone's home made dish at the pot luck I can tell afterwards.

Is there some article that explains the effect of sugar at the cellular level and the differences in effect of the sources and types of sugar?

Michel

Pamela Hinton replies:

Not all sugars are created equal. The most basic sugars consumed by humans are glucose, fructose, and galactose. Glucose is actively absorbed in the intestine, so ingestion of glucose causes a rapid increase in blood glucose levels. In turn, an elevation in blood glucose stimulates insulin release to promote glucose uptake by liver and fat cells. Glucose is the standard by which the glycemic index of other foods is evaluated.

The glycemic index, which reflects the magnitude of the increase in blood glucose, is set at 100 for glucose. Fructose is absorbed by a different mechanism than glucose and the magnitude of its effects on blood glucose is much less. The glycemic index of fructose is 20. Similarly, fructose does not stimulate secretion of insulin from the pancreas. Unfortunately, large amounts of fructose entering the liver promotes fat synthesis and increased release of triglycerides from the liver.

Table sugar is sucrose - one molecule of glucose bound to one molecule of fructose. As a result, the digestion and absorption of sucrose and its effects on blood glucose are intermediate to those of glucose and fructose. The glycemic index of sucrose is 60. The sugar in honey is about half glucose, half fructose. As a result, honey as a lower glycemic index than table sugar (sucrose) at 50. It's important to remember that the glycemic index is for the food consumed alone. Consumption of a high-glycemic-index food with fat or protein lowers the glycemic index of the meal.

Although honey has a slightly greater caloric content than table sugar (22 vs. 16 kcal/teaspoon), honey also tastes sweeter than table sugar, so you may not need to consume as much of it to achieve the desired sweetness.

Question on rhabdomyolysis

I have a dear friend (and tremendous cycling buddy) who is now struggling with rhabdomyolysis, and has brought him to the point that he cannot ride or perform any physical exertions without hard cramping in his leg muscles. To be honest, we're kind of scared about this because of the perceived risk of irreversible kidney and heart damage.

His medical attention has been unsatisfactory thus far. He's on the standard military medical treatment system where generalists give uncaring general answers and send the soldier back to work. The doc's have given the standard responses for what caused this condition:

1. Dehydration, or
2. Getting crushed by a building. Neither of those happened.

This is a military guy who is in his early 40's, has competed in loads of triathlons and road races, and does the electrolyte & hydration balance equations in his head. This is the guy who looks at the snacks in my pockets and stuff in my water bottle and hands me extra goodies he brought along because he knew I wouldn't do the nutrition/electrolyte/hydration calculations. And he hasn't been crushed by any buildings.

On the first go-round his protein counts were 3000-7000, and the fine military healthcare system treated him with an IV to hydrate him and oxycontin for discomfort. That was over a year ago and it took months for his protein levels to drop and for him to be able to walk across the room without cramps. Quite a setback for a guy who could average 26 mph+ on the bike split in a triathlon.

Now it's back, and the doc's are claiming the same thing: dehydration or traumatic injury. Neither is even remotely possible. He gained over 10 lbs the first day it returned.

So, a couple of questions:
1) What kind of specialist would know most about this?
2) Where to get good information for support?
3) Are there known case histories of other endurance athletes where this has cropped up?

F. Martin
Maryland, USA

Kelby Bethards replies:

So, I agree with you. something is wrong. He needs further testing and this needs looked into.

Questions a doc should ask (at a minimum). Is he on medications (cholesterol meds in particular)? Does his urine change colour with this? Do all of his muscles hurt everyday?

Tests needed:
CPK (muscle breakdown indicator)
ESR (inflammatory marker)
CRP (inflammatory marker)
Creatinine and BUN levels (simple blood test for kidney function)
Urine tests (myoglobin, protein, etc)

This, to me, is a starting point. He probably needs to go see a Rheumatologist. They will order a whole other battery of test and so on.

In my humble opinion, your friend needs to pursue this further and find out what is wrong. I would be worried about an autoimmune inflammatory myopathy or something along those lines, but without seeing your friend its hard to pin down. IT definitely need looked into further.

Appetite suppressant

As a rule, I try to avoid taking new-age supplements and pills. That being said, I am very interested in appetite suppressants. I feel like I am doing everything on the bike I can to achieve race weight, but the pounds are still not coming off. I ride hours of tempo at 45-55% MHR. I take a spin in the morning to get my heart rate up before going to work. Sometimes I take a nap in the afternoon to get an extra burst of HGH.

I have even started taking green tea supplements, a general vitamin, and omega-3s. This is all on top of drinking water like it's my full-time job. I think I know my downfall: I love carbs, and lots of them. Would any of the over the counter appetite suppressants be a safe/effective addition to my daily routine?

Peter Simonsen

Richard Stern replies:

Are you sure that you mean 45 - 55% MHR? That would seem like a rather low intensity.

Lastly, carbohydrates would not be your downfall. They're pretty much essential for fuelling so that you can exercise. However, incorrect weight management would be down to an excess of energy rather than any particular macronutrient. That is, if you consume too much energy for the work that you do you'll ending up gaining weight (fat mass) (irrespective of what the fuel source was that you ate).

Pain between the shoulder blades

I'm a 36yo male, who is probably best described as a runner who loves cycling. At the moment I ride 5 8000km/yr and the only racing I've done is triathlon/multisport.

My issue is the gradual onset of a pain between my shoulder blades on longer rides. I have no hint of it for the first couple of hours, and then it gradually creeps up on me over the next hour or so. After 3hrs it's usually pretty bad, and by 4hrs its pretty much all I'm thinking about.

At first I suspected bike position, but over the past year or so I've being doing some riding on an mtb, and I've found the problem persists. While my seat height/angle measurements are identical on both bikes, the reach and drop to the handlebars is much reduced on the mtb, leading me to wonder whether bike position isn't the issue, or at least not the only issue. (BTW, I've used Steve's balance test to assess my road bike position and have no trouble taking my hands off the bars.)

I'm guessing a couple of things could be contributing: on the longer, cruisy rides I tend to relax down onto the bars a bit, which tends to hunch my shoulders. Also, I don't tend to vary my position much (sit up, stretch, etc) until I notice the pain. Could either or both of these be contributing? And are there any stretches, or exercises, or weights I should be doing that could help reduce the problem?

Vince
Melbourne, Australia

Scott Saifer replies:

When you say "between the shoulder blades", is that low or high? I've seen pain low between the shoulder blades when the bars are too wide, which might explain why you have it on both the road and MTB even though the positions are very different. On the road bike the center-to-center spacing of the drops should match your "acromion process spacing."

You'll need an assistant to measure this. Have them stand behind you and measure the distance between the outermost bony spots on the top of your shoulders (not the tops of your arm bones which are a bit lower).

Pain high between the shoulder blades often comes from craning the neck up to see down the road with bars too low. Most likely this is not your issue since you have the pain on the MTB, but you can test to be sure.

As you are riding along on the drops or on the MTB in normal position in some large, open safe place or on a trainer, look down at the ground, then slowly raise and lower your head to identify how high you can look with no tension in the back of your neck. Then roll your eyes up and down to find the highest you can look without straining your eyes. Now look down the road the highest you can with no neck or eye strain. If you are looking high enough to comfortably see where you are going, your bars are high enough. If not, low bars are probably the cause of at least some of your pain.

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