Herbs for Sport performance

The aim of this clinic report is to show the effectiveness and potential of herbal treatment in relation to Sport performance and fitness goals. Factors effecting performance from a pathophysiological viewpoint will be assessed and whether Herbal treatment can potentially help with a few of the factors that may effect sporting performance in its differing degrees.

Case study

33-year-old Jiu Jitsu fighter has been training 3 times a week for the past 6 years and runs in a 6-mile twice a week. He has come for herbal treatment to aid in his sport performance. He has noted that he is finding that his muscle recovery time is taking a lot longer than 3 years ago. He feels that he tires more quickly and it’s becoming harder to focus his mind during fights and in his daily life.
 He would like herbal treatment to support his training program, to see noticeable changes in the distance and time during runs and an increase in his energy levels toward the end of fights where he says he tires and his muscles become heavy and he is holding on to survive in bouts as his legs feel like ‘jelly’ and he feels ‘extremely heavy’.
 After sessions he says it takes him 2 days to recover from muscle soreness where as in the past, he could go a few days without feeling like needing rest.
 He would like to see if herbal treatment can help with stamina, muscle recovery, focus and being able to last a whole fight at a good pace.
 In his personal life he is working 4 days a week as carpenter and says he ‘loves’ what he does. He works 10-hour days 7-5 so sometimes if he needs to work out after work this can be quite demanding, but he pushes himself to do so, however he appreciates the 3 days off where he gets time to rest and train. He says he feels ‘tense’ at times as he has a competitive nature and strives to improve his sport performance. He has concerns about making money and this can cause ‘stress’ he finds it hard to unwind sometimes and he sleeps around 7 hours a night, but this is broken and not ‘rejuvenative’. He can often be constipated one day and have diarrhoea the next. His energy levels are a 7-10 but can slump to a 5-10 especially when he has days off.

 He feels ‘good’ in himself and maintains that he has a strict mind and feels in control of himself due to his training and he meditates from time to time also which he feels help him control a ‘busy mind’. He has a partner of 3 years and he says that they have a good relationship and a good understanding.

Diet

 His diet is mainly consisting of porridge with fruit in the morning, with a fried English breakfast on weekends. Salads and sweet potatoes or rice and beans or a chicken sandwich once a week for lunch and usually vegetarian dinner which will be lentils or beans and curry or stew or vegetable soup. Sometimes a cheese lasagne and meat once a week. He is considering a vegan plant-based diet as he has been recently watching documentaries on the benefits of a plant-based diet for sport performance. He is slowly cutting down his meat and dairy intake. He drinks 2 litres of water a day and 2 coffees a day, sometimes more if he needs to ‘push through’ a session or a hard day at work.

He feels like he can’t unwind when he has time to relax in the evening and always feels a degree of tension and heat in his body.
He finds he is getting ‘snappier’ at things lately and he feels like he is more impatient than he used to be.

BP 130/70

Pulse 72

Considerations of presentation

The patient may be experiencing Liver heat as he says he is becoming irritable and has restlessness and a bit of insomnia.

His tongue appears slightly red. This may also indicate a sympathetic excess as his Systolic is high at 130 showing that the heart is pumping harder than needed for a diastolic of 70 and that he may be finding it hard to switch off the fight or flight when not training/ working and this is impairing his rest and digest functions. His impatience that he reports may also indicate sympathetic excess and he may be responding to external work demands and pressure.

His sympathetic system may be overactive due to not having enough energy reserves and may be on fight or flight alert as it feels unable to deal with threats.

Potential mechanisms of interest

Oxidative stress in exercise

As part of the metabolic process the body’s cells produce free radicals and when oxygen in the body splits into single atoms the unpaired electron has no pair. Electrons like to be in pairs so the atom containing the electron (Free radicals) begin scavenging and searching the body for another electron. This causes damage to DNA, proteins and other cells. Ageing has been defined as a gradual accumulation of free radical damage (Watkins, 2001). Free radicals can be found in fried food, tobacco, air pollution, water and pesticides.

Free radicals are essential to life. The body's ability to turn air and food into chemical energy depends on a chain reaction of free radicals. They also attack foreign invaders and aid the immune system.

When a free radical takes an electron from another molecule it is then destabilized and becomes a free radical. This molecule then has to take from another causing a domino effect. This can damage whole cell membranes and effect what is entering the cell, for example a lipid may be altered structurally may get trapped within an artery, these damaged molecules can mutate and cause other problems altering DNA code (HSPH, 2019). After a large degree of cellular damage it is classed as oxidative stress and proteins, nucleic acids, lipids and DNA coding become disrupted leading to our cells growing incorrectly and accentuating the ageing process. Studies suggest oxidative stress contributes to arthritis, lupus, cancer, emphysema, Alzheimer’s and Parkinson’s (Lobo et al, 2010). Cardiovascular disease and mitochondria damage are said to be linked and studies have looked at antioxidants as a way of limiting mitochondria damage (Dai et al, 2012).

All forms of exercise cause oxidative stress (Fisher-Wellman, 2009). When training levels increase, considered ‘excessive’ to the individual it generates large quantities of free-radicals that likely outstrip the buffering capacity of the system, leaving individuals susceptible to oxidative stress (Patil et al, 2012). During intense exercise your body in theory will run out of anti-oxidants and free radicals will begin to take over cells.

A TED talk by Jame O’Keefe suggested that after hard exercise, example a 60 minute run at a ‘considered’ hard pace, “free radicals will blossom and start burning the heart, leading to inflaming inside the arteries”
(TED talk, O’Keefe, 2012).

This is the short term effect of training and explains the effect on the system when we train harder than normal, which is important for someone trying to improve their sporting performance. Long term training once the body has adapted can produce the opposite effect. Dr Karl Heinz Wagner in 2011 theorized that free radical activity in exercise can cause adaptive mechanisms in the body over time which leads to decreased oxidative stress, more antioxidant activity and less cell death (Wagner, 2011). Prolonged exercise can help reduce oxidative stress and increase anti-oxidant levels and less lipid peroxidation (Miyazaki et al, 2001). This adaptive process can be sped up and an increase in anti-oxidant rich herbs and herbs that reduce oxidative stress can help reduce the oxidative damage done by exercise and aid in the recovery and exercise adaption mechanism

Anti-oxidants can give a molecule to a free radicle without becoming destabilized. Well known anti-oxidants are vitamin c, e, lycopene and phytonutrients. They are plentiful in berries, fruits, vegetables and numerous herbal medicines. Plants are able to provide essential metabolites such as carbohydrates, lipids, and nucleic acids and secondary metabolites such as terpenoids, alkaloids, and phenolic compounds (Ksouri et al, 2007). Studies have highlighted the importance of reducing oxidative stress to enhance muscle recovery and maintain energy. Biological properties of plants having anti-allergic, anti-atherogenic, anti-inflammatory, hepato-protective, antimicrobial, antiviral, antibacterial, anticarcinogenic, antithrombotic, cardioprotective, and vasodilatory effects, are theorized to be mediated by anti-oxidant properties (Ksouri et al, 2007).

Testosterone

A debated topic is the use of anabolic steroids in sport. This is due to the anabolic actions of testosterone (Jones and Lopez, 2006). Testosterone whether created by one’s body or added is said to offer an advantage in sport performance (ACSM, 2006). Testosterone and androgens increase strength and increases muscle mass (Storer et al, 2003) and are responsible for greater aggression and motivation during sport by acting on substrates in the brain (Gleason et al, 2009), (Hermans et al, 2008). Studies suggest that testosterone increases the will to train and compete. Over a course of 5 training sessions, athletes were monitored, and the results showed that testosterone levels directly affected the choice of weight and performance levels when lifting the weights (Cook et al, 2013).

Nitric Oxide

Nitric oxide aids vasodilation which in turn aids in delivery of nutrients and oxygen to muscles during exercise. Amino acids L-arginine and L-Citrulline are said to increase nitric oxide. Nitric oxide is essential for increased blood flow and improved exercise performance and stamina (Tschakovsky et al, 2008). It is secreted by the endothelium of the blood vessels, converted by bacteria in the mouth by eating nitrate containing foods and created by bacteria on the skin exposed to adequate sunlight. Nitric oxide aids muscles’ ability to contract and transport metabolic by-products such as lactic acid increasing stamina. The delivery of oxygen rich blood by nitric oxide is important for every tissue, cell and organ in the body. This aids in glucose uptake, muscle recovery, power output and muscle growth (Bloomer, 2010) (Txchakovsky et al, 2008).

Studies suggest that by age 40 half the nitric oxide will be produced by the body than when in your twenties and that at age 70 only 25 percent the amount which greatly effects your ability to exercise, recover and maintain endurance levels and grow and maintain muscle mass. (Taddei et al, 2001).

Cortisol and stress effects on exercise

Studies show that cortisol is released during exercise, as exercise is seen as stress for the body and is released as part of the flight or fight response. The effects are effective when short lived as to ward off any potential immediate threat. This response is relevant for those in fighting sports and sports of short intensive bursts. Plasma glucose levels are raised at the time of stress and provides energy to recover from injury, illness or inflammation (Hall, p931, 2010).

However too much cortisol resulting from too much stress can have negative effects on the system and in turn sport performance. Tissues can breakdown, protein synthesis is reduced and conversion of protein to glucose causes increased abdominal fat and reduced muscle bulk and tone. Also, growth hormone and sex hormones decrease and levels of testosterone, all these things are unwanted in sports performance and general wellbeing (Talbot, p46, 2007). Studies have shown that time and intensity of exercise effects cortisol levels for example a study concluded that moderate to high intensity exercise provokes increases in circulating cortisol levels. These increases seem due to a combination of haemoconcentration and HPA axis stimulus (ACTH). In contrast, low intensity exercise (40%) does not result in significant increases in cortisol levels, but, once corrections for plasma volume reduction occurred and circadian factors were examined, low intensity exercise resulted in a reduction in circulating cortisol levels (Hill et al, 2008). Training for 60 minutes will burn up glycogen stores in the body and stimulate cortisol release and that exposure is higher in endurance athletes (Skoluda, 2012) If rest isn’t sufficient or intensity too high then cortisol surges and constant overwork and lack of rest causes a lot of problems and complications to health and significantly reduces exercise performance.

Adaptogens and sport performance

Phytochemistry and stress response

Chemically adaptogen herbs contain phenolic or tetracyclic triterpenoids and saponins. These are structurally similar to catecholamines which are the mediators of sympathoadrenal system which is a physiological connection between the sympathetic nervous system and the adrenal medulla, it is essential in how we response to outside stimuli and the early stress response. Phenolic compounds such as these are found in Rhodiola rosea (Kurkin et al, 1986). (Salidroside) and in lignan form in Eletherococcus (Eleutheroside E) (Norr, 1993). And Schisandra (Schisandrin) (Kim et al, 2004).

Tetracyclic triterpenoids include ginsenosides found in (Panax Ginseng) and eleutheroside A (Eleutherocuccus senticosus) (Hiai et al,1979) and they structurally resemble corticosteroids that structurally resemble the corticosteroids and stress hormones that act as stress hormones involved in protective inactivation of the stress system (Panossian and Wikman, 2010).

Herbal Mix Recommendation

Panax Ginseng

13 Ginesonosides of these have been found in Panax Ginseng roots and are said to be the main active ingredients (Bahrke and Morgan, 1994). Panax has a stimulating effect on the central nervous system, increases corticotropin and cortisol and has anabolic actions (Bahrke and Morgan, 1994). Panax has antioxidant activity and scavenges hydroxyl radical and inhibits lipid peroxidation (Zhong and Jiang, 1997).
Panax may improve alertness, combat tiredness and feelings of being stressed and with long term use may improve cardiorespiratory function, lowering lactate concentration in the blood resulting in longer exercise periods before exhaustion (Kim et al, 2005). Panax has been reviewed to monitor the stress adapting qualities in athletes when undertaking physical activity showing that for long term stress and acute stress Panax is effective. This is said to be mediated by the regulation of pituitary adrenocorticotropic hormone secretion to combat stress (Rai et al, 2003). This effect could also lead to longer periods of exercise time, stamina and endurance.

350mg of Panax per day for 30 days showed that endurance increased by a mean of 7 minutes, lowered blood pressure and improved VO2 max also for cyclists (Liang et al, 2005). Another study also showed that Panax significantly increases maximal oxygen consumption (VO2 max) and also had great benefits to muscle strength of the pectorals and biceps. This was based on 1 g a day for 6 weeks (Mc Naughton et al, 1989). As well as these potential benefits Panax at just 200mg can modulate circulating blood glucose levels, have benefits for cognitive function and reduce feelings of mental fatigue (Reay et al, 2006).

As the patient may need regulation of sympathetic and parasympathetic function, coupled with the mental and physical proposed benefits of Panax this could be a great herb to add to the mix.

Schizandra sinensis

Schizandra can have a regulating effect on stress levels during exercise. It was shown in a study that when monitoring human saliva and treatment with schizandra, nitric oxide and cortisol levels increased during physical exercise with less of a spike after heavy physical exercise regulating levels efficiently compared to placebo. This could be good in giving the patient a boost when needed to exercise and adapting in the moment and then allowing levels to balance out after exercise. Schizandra may also have an effect of lowering blood glucose and corticosterone levels after chronic stress and exercise (Panossian, 2009) (Sun et al, 2009). lowering stress levels in general after exercise or stressful events could lead to an increase and better maintenance of testosterone, better sleep and less tension leading to better sport performance. Another effect is Schizandra’s ability to control the changes is adrenaline and serotonin caused by stress and can combat adrenal fatigue, this may help with general feelings of wellbeing and anxiety regulating stress levels both in training for relaxation and recovery. Schizandra also increases blood flow and nitric oxide availability. (Panossian, 2008).

Other herbs to consider for exercise performance

Zinigiber officinalis

Ginger can aid in reducing post workout oxidative stress and is a herb high in anti-oxidants (Aruoma et al, 1997). Studies have been carried out to see its effects in progressive resistant training and the anti-oxidants may be responsible for Gingers effect in reducing low grade chronic inflammation and inflammation from training (Atashak, 2011) The same author also proposed that Ginger reduces plasma free radical damage through increasing anti-oxidant capacity and this was shown in a marked decrease in plasma oxidative stress markers (MDA, Malondialdehyde) and increased total antioxidant capacity in obese men (Atashak, 2014) Another study suggested that some factors such as reduction of lipids in the liver and plasma by ginger powder may play a role in decreasing MDA (Afshari et al, 2007).

Curcuma Longa

Turmeric can be beneficial after exercise and reduce serum inflammation biomarkers

(Nakhostin-Roohi et al, 2016) This can be with just 150mg of supplementation directly after exercise.

Trigonella foenum-graecum

Used traditionally in Ayurvedic medicine to increase libido in men Fenugreek has a use in sport performance. It is the highest containing ‘cooking spice’ source of arginine (Nutrition data, 2020). It can increase testosterone levels by acting on aromatase enzyme inhibiting its ability to metabolize testosterone to estradiol (Rao et al, 2016). With 600mg of supplementation a study showed significant increase in bench press repetitions (Wankhede et al, 2016) and another with 500mg showed after 8 weeks of Fenugreek extract supplementation, lower body fat and higher upper and lower body strength (Wilburn et al, 2010).

Allium sativum

Garlic activates nitric oxide synthase which converts nitric oxide from L-arginine (Das et al, 1995) and can increase Nitric oxide levels up to 40 percent within an hour of consumption (Morihara et al, 2002) and maximize the nitric oxide that can be absorbed (Weiss, 2011). It can also improve exercise tolerance, increase cardiac efficiency and lower blood pressure (Verma et al, 2005), (Al-Qattan et al, 2006).

Herbal Dietary considerations

When looking at herbal treatment for sport performance high it is important to investigate a few dietary factors. Herbs can be tinctures, teas, powders or eaten in their whole form. Many vital nutrients can contribute to performance, stamina, strength, growth and recovery.

Cannabis sativa seed

Zinc deficiency has been linked to a decline in testosterone levels (Prasad et al, 1996). Seeds can be an effective source of Zinc as well as having a range of other benefits for exercise performance.

Hemp seeds provide an easily digestible and readily available source of zinc, especially if ground into a powder or unshelled. Just 30 grams (3 tablespoons) can provide 2.97g of Zinc (US DOA, 2019) which is more than a quarter required for a male age 14-70 (Ncbi, 2019)

Contrary to belief that only animal sources contain all amino acids Hemp and numerous other plant foods contain all amino acids and Hemp contains them in abundance and in a balanced way. Studies suggest it is better than most other sources of protein (House et al, 2010).

Another benefit of Hemp is the ratio of Omega 6 (linoleic acid) to Omega 3 (alpha-linoleic acid) which in Hemp seeds is 2-3/1 which is considered the perfect balance for supressing inflammation. The western diet is said to contain a ratio of 15-17/1 (Simopoulos, 2010).

Hemp also contains a high amount of Arginine which can enhance protein synthesis and also aid in tissue repair. It is a precursor to nitric oxide which increases muscular power, endurance and improves blood flow. Nitric oxide is a signalling messenger in the cardiovascular system and has benefits in the arterial wall in maintaining homeostasis of platelets, leukocyte interactions, vascular tone and maintaining homeostasis of blood pressure and reducing proliferation of smooth muscle cells (Napoli and Ignarro, 2009).

Also, the protein in Hemp seeds is of better quality than meat when compared in the ‘protein quality score’ which considers content of amino acids and digestibility which may make hemp seed a great choice in herbal treatment for sport and exercise performance (House et al, 2010).

As well as a high level of antioxidant (Chen et al, 2012) Hemp seeds can ward off atherosclerosis and have a similar effect to statins by blocking enzymes that are vital in LDL cholesterol production and prevent LDL oxidation which is a major cause of atherosclerosis (Zanoni et al, 2017).

Based on these factors and the balance of nutrients, herbal supplementation with Hemp seed may directly benefit sport performance.

Beetroot juice

Beetroot juice, rich in nitrates which the body converts to increase levels of nitric oxide 21 percent after just 45 minutes this is shown with just 100ml of juice (Biaia, 2016), (Kroll et al, 2016).

Also it can improve VO2 Max and endurance levels in cyclists at altitude after just a single dose (Muggeridge et al,2014).

Proposed mix

15 ml twice daily b.i.d (last dose before 5 pm)

Panax Ginseng 20ml

Allium sativum 10ml
Zinigiber officinalis 10ml

Trigonella foenum graecum 15ml

Schizandra chinensis 25ml

Curcuma longa 25ml

After workout

15g Cannabis sativa powder (in a smoothie)

125mg curcuma longa powder

(Mix with beet juice if possible)

Plus 15 g two times daily with food (eg porridge) or in a smoothie/shake

Therapeutic approach

The approach was to aid the patient in sport performance. The patient didn’t want any additional emotional support and was very clear that he wanted an effective treatment for energy levels and to aid in endurance and help with his focus and strength. The mix included Panax which is an adaptogen to aid with the imbalance in any stress hormones. As the patient seems to have a sympathetic excess, Panax may regulate this and this may aid in helping sleep and also relieve a bit of tension when the patient is resting and relaxing at home. The effect of nitric oxide has been discussed in this report and Garlic was added to help this process and aid in efficiency of performance. Zinigiber for oxidative stress and as an anti-inflammatory which may help with muscle recovery and also act as an adjuvant for the medicine. Fenugreek for aiding in testosterone levels and for its reputed benefits on strength and Shizandra and turmeric to aid in liver health and efficiency of assimilation of nutrients. Turmeric also as an anti-inflammatory and Shizandra to disperse the heat effectively and as a tonic to the liver and an adaptogen. As there are a few ‘hot’ herbs in the mix Schizandra should act as a balancing herb. The patient also was prescribed Hemp for a protein boost and an additional boost of zinc after workouts and also through the day. As it has good balance of nutrients and amino acids it was added to the treatment to also aid in nitric oxide efficiency and to help with recovery after sessions. The aim was to provide a feeling of power and focus during training and the practitioner feels these herbs should have a focusing, energizing effect for the patient in training and also in day to day living with focus on ‘regulating’ hormones long term as well as improving performance short term.