The Outside Blog

Dispatches : Nutrition

What Athletes Need to Know About Prescription Painkillers

Last fall, the FDA approved a powerful new painkiller that states across the country argue could increase heroin and prescription drug abuse. Now, officials in Vermont, Massachusetts, and elsewhere are working to limit or even ban Zohydro, which has approximately five times the amount of hydrocodone contained in other pills on the market. The drug was approved despite the recommendations of a panel of experts put together by the FDA.

Over the last 20 years, prescription drug overdoses have increased threefold—today, more people die of opioid overdoses than from car crashes— and officials argue that the introduction of a time-release painkiller that could easily be abused could have serious consequences.

While the states duke it out over regulations, it’s important that athletes—who are often prescribed necessary painkillers to deal with injury or recover from procedures—take care to make sure they are using their prescriptions correctly, and limiting their own addiction risk.

The good news: “Most doctors undertreat pain, rather than over treat pain,” says Dr. Linn Goldberg, a professor and head of the Division of Health Promotion & Sports Medicine at Oregon Health & Science University. According to Goldberg, doctors trained in pain management will often prescribe enough medicine to treat the pain, but also give patients a little wiggle room to increase their dosage if necessary, with directions like, take 1-2 pills every 4-6 hours.

But sticking to that range is “critically important,” Goldberg says. “Overdosing or taking other medications that increase the narcotic effect kills. It can depress the respiratory center of our brain, located in the brain stem.”

Unlike antibiotics, there’s no reason to stick to prescription medicine once pain has abated. Though doctors do prescribe prescription painkillers for long-term pain management, that doesn’t usually apply to sports injuries. “Typically an injury or surgery has a finite course and medications should not be prescribed beyond the typical recovery period,” Goldberg says. “That is why we place refills on medications or have the patient discuss the need for more pain medications.”

It’s also okay to talk to your doctor about which drugs are best for you—and to request less medication for pain. Certain drugs are more addictive than others—opioids and narcotics specifically—and the FDA classifies drugs into “schedules” based on their addictive qualities. Schedule II narcotics, for example, have a higher likelihood of addiction, and include morphine and codeine. Last year, the FDA also recommended that hydrocodone products—which include vicodin—be reclassified as schedule II drugs, increasing control over them.

No matter your prescription, it’s important to look out for signs that you’ve been taking too much, like impaired judgment, sleepiness or confusion. “What is critical is that when taking opioids, not to drink alcohol and not to take other medications that will depress the respiratory center or ones that are additive to the harmful effects, such as sedatives,” he says.

But when in doubt about side affects, dosage amounts, or even if you should be prescribed a certain drug, always consult your doctor.

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High-Performance Pizza

Ordinarily, pizza makes us think of a half-assed meal or an indulgent snack (either, according to how much you've had to drink, or how much you'd rather it be one over the other), but what if it were an ideal fuel for runners? Runner and writer Matt Fitzgerald has made it so. Granted, without grease on your fingertips and yeast in your stomach, you might not want to call it "pizza." But we see no great loss here.

Enter: the greaseless, yeastless Greek Tortilla Pizza—the runner's option, with a Greek tortilla in place of dough, whole grains in place of white flour, one day's serving of veggies piled on top for nutritional value, and the whole thing ready for consumption in one sitting so you don't have to think about portion control. Best of all, says nutrition expert Georgie Fear: the Greek Tortilla Pizza can still be a last-minute decision (so long as you have the ingredients). Preparing it takes only 15 minutes, about the same time it takes to deliver.

Ingredients

  • 1 whole-grain or sprouted-grain tortilla or wrap*
  • 1/2 cup prepared pizza sauce
  • 1/4 cup mushrooms, sliced
  • 1/4 cup red bell pepper, sliced
  • 1/4 cup onion, sliced
  • 2 tablespoons kalamata olives, sliced
  • 2 tablespoons (1 oz.) feta cheese, crumbled
  • 1/4 teaspoon dried oregano (optional)

*What kind of tortilla should I get? Choose a tortilla with whole-wheat flour or sprouted whole wheat as one of the first ingredients (not wheat flour or enriched wheat flour). Scan the rest of the ingredients and make sure they don’t include partially hydrogenated oil of any kind. Some of our favorite products are Ezekiel 4:9 Sprouted Whole Grain Tortillas, Flatout whole-grain flatbreads, and Alvarado St. Bakery sprouted-wheat tortillas. La Tortilla Factory white whole-wheat SoftWraps are also a good choice. Sprouted-grain tortillas may be found in the freezer section; the others are usually shelved in a tortilla section or Latin foods aisle.

Directions

  1. Preheat oven to 400 degrees Fahrenheit. Line a baking sheet with foil or parchment paper.
  2. Place tortilla on baking sheet and evenly spread with pizza sauce. Top with mushrooms, peppers, onion, olives, and feta. Bake for 10 minutes.
  3. Sprinkle with oregano, if desired, before serving. Cut into slices.

Nutritional Info: Per serving (which, again, is a whole pizza): 277 calories; 15 grams fat; 29 grams total carbohydrates; 11 grams dietary fiber; 15 grams protein

Republished with permission of VeloPress from Racing Weight Cookbook. Try more recipes at www.racingweightcookbook.com

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When An Explorer's Body Begins to Eat Itself

When an explorer is dying of starvation in the wild, his voice takes on a peculiar deep tone.

“We were all shocked at beholding the emaciated countenances of the Doctor and Hepburn,” wrote 19th century Arctic explorer John Franklin. “The alteration in our appearance was equally distressing to them... we were little more than skin and bone. The Doctor particularly remarked the sepulchral tone of our voices, which he requested us to make more cheerful if possible, unconscious that his own partook of the same key.”

Other strange physiological phenomena occur when the body is totally deprived of food, some that might be considered desirable, others not. The eyesight of one subject in a 1915 study improved dramatically on day 14 during a carefully monitored 31-day fast and was twice as acute at fast’s end as at the beginning. Others reported a peculiar lightness in their bearing. Heart rates can drop to 35 beats per minute. And there’s the nasty breath—breath that smells like a solvent such as acetone. 

These observations came from controlled studies of fasting. But the members of the expedition that I’m writing about, the Overland Party of John Jacob Astor attempt to found the first American colony on the West Coast, a kind of Pacific version of Jamestown, were not fasting. Rather, they were starving—they simply couldn’t find food—while traveling hard in winter’s cold, like Franklin’s party quoted above. Their caloric needs were enormous—as I wrote in my last blog posting, the energy demands of traveling hard on foot in winter can amount to an extraordinary 6,000 calories—or nine square meals—per day.

After abandoning their canoes, which had smashed among the waterfalls and rapids of a canyon, the 50-person Overland Party, led by Wilson Price Hunt, a young New Jersey businessman with no experience in the wilderness, split into two main groups in November, 1811. Trekking on foot, they followed the unknown river downstream toward what they hoped was the Pacific. Barren lava plains spread on both sides of the river gorge. With no game, and no fish appearing in their nets, they managed to trade with scattered bands of Shoshone Indians for a few dogs and horses. Consuming these—a group of 50 people trekking in winter could demolish the caloric equivalent of a large animal every few days, thus they traveled in two smaller groups—they chewed on bits of beaverskin and spare moccasins. Hunt stayed with the slower group, which included the family of the Indian interpreter, his pregnant wife, and their two toddler boys. 

For a month, Hunt’s group struggled onward along the river. Then the river poured into a massive canyon—now known as Hell’s Canyon of the Snake River, the deepest canyon in North America. One snowy December day, as Hunt’s slow party struggled downstream over rocky outcrops, they spotted the other main party staggering back upstream on the opposite bank! This was the worst kind of news. Led by Scottish fur trader Ramsay Crooks, it had been stopped by the extreme depth and ruggedness of the canyon and the onset of winter’s deepening snows. Still worse, Crooks and his party verged on collapse from starvation and exhaustion due to the tremendous exertion and caloric needs.

Hunt had a small boat crafted from a horsehide and brought Crooks and a voyageur, Le Clerc, across the river from the starving party on the opposite bank. Crooks told him there was no way forward down the canyon on foot or boat. Hunt knew he now had to retreat upstream in hopes of finding Shoshone villages and food. They were at least ten days or two weeks away. Even after Hunt fed Crooks and Le Clerc the last of his horsemeat, however, they were still too weak to walk and became feebler with every moment. Hunt, loyal to a fault, trying to lead by consensus, wanted to stay with the dying men. Crooks was his friend and partner. But the 20 other members of his party, the voyageurs especially, harangued him to abandon Crooks and Le Clerc and retreat as hastily as possibly to the Shoshone villages and the hope of distant food.

“They said that we would all die from starvation,” wrote Hunt in his journal, “and urged me by all means to go on.”

The process had now begun for everyone. 

The human body has a special mechanism to deal with starvation in these dangerous circumstances. A fascinating account on the physiology of human fasting can be found on the website derangedphysiology.com. Drawing on the classic 1970 study “Starvation in Man” by George F. Cahill, the website tells us that the human body, even when starving, wants to continue to feed nutrients to the brain, despite all else. The starving human body also tries to hold onto a certain reserve of ready energy for “fight or flight” or other emergencies.

Normally, the fuel driving our bodies is glucose (a simple sugar) and glycogen (glucose transformed and stored in the muscles). We constantly drain this fuel supply to power our muscle movements and metabolism. We refill this fuel supply through eating.

But under fasting conditions—starvation—the body makes a peculiar switch. The muscles and heart stop using up all the ready fuel—glucose and glycogen—saving some of it for emergencies, and start to draw on fuel made from the breakdown of the body’s fat reserves and what’s called “ketone metabolism.”

“The glycogen reserves in humans never get completely depleted,” according to the website. “There is at all times a hepatic [liver] reserve, waiting to mobilize and rescue the organism from some sort of horrible situation.”

But the brain has to function, too, in order to save the starving human from “some horrible situation.” The human body is remarkable among animals in that the human brain can function with alternative energy supplies to glucose. Some of the body’s fats are converted to what’s known as “ketone bodies,” which, only in humans, have the ability to enter the brain and power it. (The human brain of a 150-pound male requires about 325 calories a day, or the equivalent of about one-and-a-half energy bars, to keep the lights on.) Thus by switching over to alternative energy supplies like ketone bodies, the brain, too, helps save the body’s glucose reserves (as well as the body’s muscle mass) for emergency “fight or flight” situations like a kind of human rocket fuel.

The “acetone breath” of starvation or fasting comes from the metabolism of these ketone bodies into byproducts like acetone, which is then dissipated through urine and through exhalation from the lungs.

Eventually, however, as the fats are used up, the body will begin to break down its own proteins—its muscles and tissues—and convert them to fuel. (None of the physiology of starvation or fasting that I’ve read explains the deep voices such as Franklin’s, but I wonder if it has something to do with the proteins of the vocal cords breaking down. Maybe a reader will know the answer.)

“An organism which is consuming its own protein is truly struggling,” according to derangedphysiology.com. “That said, if your [human] organism is struggling it has some 6kg or so of protein to get through before it dies.”

Ramsay Crooks and the voyageur Le Clerc had clearly entered this protein-consuming phase of starvation, and had finally used up whatever rocket-fuel reserves they had possessed.

Hunt, deeply conflicted, profoundly troubled—were his loyalties to his good but dying men, or to his leadership of the group as a whole?—finally abandoned the starving pair in the canyon depths. But he didn’t forsake them entirely. He left them two beaverskins to chew on, and promised that as soon as he found food, he would send it back to feed them.

Peter Stark is a full-time freelance writer of non-fiction books and articles specializing in adventure and exploration history. His most recent book, Astoria: John Jacob Astor and Thomas Jefferson’s Lost Pacific Empire; a Story of Wealth, Ambition and Survival, tells the harrowing tale of the quest to settle a Jamestown-like colony on the Pacific Coast and will be published in March 2014 by Ecco/HarperCollins.

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No, Eating Fruits and Vegetables Isn't Bad for You

Does any one diet regimen stand out above all others? Is there any consensus at all? Well, yes. And yes. But you wouldn’t know that if you just read the headlines.

Recently, vegetarian diets were found to be associated with “poorer health (higher incidences of cancer, allergies, and mental health disorders), a higher need for health care, and poorer quality of life.” But only a few weeks later, research found that “Eating seven or more portions of fruit and vegetables a day reduces your risk of death at any point in time by 42 percent.

Whom to believe?

Dr. David Katz, director of Yale University’s Yale-Griffin Prevention Research Center, sought to find out after the Annual Reviews asked him to compare the evidence for every mainstream diet.

In the recently published study, he and Stephanie Meller assessed the efficacy of seven different diets, from low carb and low fat to Mediterranean and vegan, and found that—surprise!—no specific diet is much better than the next. The evidence, instead, supports several common themes: Eating lots of vegetables is good for you. Probably the best. And stay away from processed foods. Do this and you’ll perform better physically, mentally, and more than likely lengthen your lifespan.

“Our paper basically revealed the truth and what we’ve been telling people forever,” declares Dr. Katz, who claims to have no “dog in the fight,” for one diet over any other. “Eating more fruits and vegetables is good for you.”

As for the reliability of the Austrian anti-vegetarian paper, “Your eyebrows go up,” says Dr. Katz. “The methodology doesn’t pass the sniff test.” For one, dietetically, very few Austrians eat fruits and vegetables. “So among the ones who say they do, who are they and why?”

In his experience, there are two groups who are vegans and vegetarians. “People who’ve eaten according to this diet their whole lives. And those who have cancer. So it’s their doctors who’ve advised them to go on this vegan or vegetarian diet.” But it wasn’t reported that way in this Austrian study. “So it’s just a very deeply flawed study.”

Besides, not all vegetarians are created equal. It’s easy to eat a vegetarian diet rich in fats and simple carbohydrates, which are terrible for you, says Dr. Aaron Baggish, associate director for the Cardiovascular Performance Program at Boston’s Massachusetts General Hospital. “And for athletes in particular, if they’re on a vegetarian diet, they tend to eat a lot of simple carbs.”

If, however, you’re consuming minimally processed foods and plenty of fruits and vegetables—whether you’re Paleo or vegan—you’re eating pretty healthily. “Eating wholesome foods is the cornerstone,” says Dr. Katz. “Especially for athletes.” (Complex carbs take longer to break down, and so continue to provide you with more energy.)

What most distresses Dr. Katz is the overattention placed on this or that diet, and not enough on applying what we do know. Constantly adjusting or changing one’s diet according to the latest breakthrough regimen (Lose weight! Run faster! Eat whatever you want!) is just missing the old-growth forest for the faddish trees.

“All we really need to do is commit to the fundamentals of what we know,” says Dr. Katz.  “The theme of healthy eating is well-established, and the evidence is incredibly consistent—across years, across cultures, across everything.”

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