Athletic Performance Enhancement

Paul L. Reller L.Ac. / Last Updated: April 13, 2016

Athletes are always looking for ways to enhance performance and speed healing from nagging injuries, as well as prevent injuries in training and competition. The physiotherapies of Traditional Chinese Medicine (CIM/TCM) offer unique tools to integrate into the athletic training and health maintenance routine. Utilizing herbal and nutrient science to improve health and performance has also long been a key focus for athletes, but with the large number of banned substances this is getting to be a confusing challenge. Complementary and Integrative Medicine (CIM) offers a professional array of treatments and products to achieve these goals, and attention to the official doping lists allows the Licensed Acupuncturist and herbalist to utilize products without worry, combining them with soft tissue therapies, acupuncture, and instruction in targeted stretch and exercise that the standard trainer may be overlooking.

Even without utilizing herbal and nutrient medicine, a TCM physician with training in soft tissue therapies (Tui Na), myofascial release, ART, neuromuscular retraining, and a knowledge of sports medicine, could provide a valuable resource to integrate into your athletic regime. All athletes, professional and amateur, or even weekend warriors, can reap benefits from Traditional Chinese Medicine (CIM/TCM) if the specific physician has the right background. Acupuncture could be utilized in the regimen or avoided, according to the needs and desires of the athlete, but acupuncture also provides a unique method of enhancing natural physiological efficiency through stimulation that is proven to effect both the local tissue physiology as well as the organ systems and central nervous system. Research cited below in Additional Information has discovered the unique ways that acupuncture increases athletic endurance in training. Of course, many professional athletes are utilizing acupuncture to relieve pain and speed tissue healing, and have touted these benefits in the press. One of my teachers in medical school was employed by the San Francisco 49ers as a staff acupuncturist, and a student in a class that I taught at the American College of Traditional Chinese Medicine was a member of the Oakland Raiders' athletic training staff sent to this college to complete a medical degree in TCM and acquire acupuncture training. These are just examples of the increasing respect for acupuncture by professional athletes. Today, athletes are turning to the use of pharmaceuticals such as NSADS to reduce injury, even before strong exercise or competition, but this is doing more harm than good. Non-steroidal ant-inflammatories work by inhibiting prostaglandins via inhibition of cyclooxygenase enzymes (COX), and these enzymes are also involved in adaptive responses to stress and the production of new collagen in tissue repair. To see an assessment of this practice from experts at Indiana University, go to the link below in Additional Information. A more holistic approach to stress adaptation and healthy functional potential of muscles, tendons and joint tissues will insure better performance, quicker healing and recovery, better tissue architecture, and a healthy treatment of pain. Pain is a signal that we need to respond to properly, and inflammation is a tool of the immune system that is useful and necessary in the natural process of tissue repair.

USADA, or the U.S. anti-doping agency publishes a yearly full report of banned substances, with explanation. The international standard is the WADA list. Standard herbal and nutrient medicine does not violate this list. To access this list, click on the links below. Even the banned herbs and supplements on the list, for example, ephedra, is prohibited only when the dosage produces a high concentration in the urine. The 2010 list shows that many of the benign herbal and nutrient supplements listed in the past are no longer on the banned list. In addition to herbal chemicals proven to aid muscle metabolism and adaptation to stress, ongoing research is finding specific herbal and nutrient chemicals that aid muscle metabolism in remarkable ways. Since there is virtually no regulation of herbal and nutrient medicines in the United States, the only assurance of content and quality is that provided by professional companies. Products bought off the shelf often contain unlisted chemicals, and there is virtually no legal penalty for this in the United States. Treatment provided by a professional herbalist and Licensed Acupuncturist may insure that the products used are obtained from the most assured source.

Athletes such as Dara Torres in the 2008 Olympics spoke highly of nutritional medicine. This 40 year old Olympic swimmer continued to earn gold medals and attributed her success to such aids as amino acids, which helped her to speed tissue healing after workouts, and decrease muscle fatigue during repeated heavy workouts. An increasing number of professional athletes are now touting the benefits of acupuncture stimulation to achieve decreased muscle fatigue and faster recovery with heavy athletic training, and a number of scientific studies have shown that acupuncture stimulation can reduce lactic acid accumulation, increase oxygen utilization, enhance antioxidant effects of super oxide dismutase (SOD), and clear malondialdehyde toxicity induced by heavy exercise.

The utilization of soft tissue mobilization, termed Tui Na in Traditional Chinese Medicine (TCM), can also be a valuable adjunct therapy in sport maintenance. For instance, the amazing athlete Steph Curry, of the NBA Golden State Warriors, works out harder than anyone, and has been able to develop from a player deemed too small to be an NBA star, to its MVP. During his years of development, Steph developed severe ankle problems, and had to resort to surgery to correct these ankles prone to frequent severe sprains. An article in the February 10, 2016 ESPN The Magazine, by Pablo S. Torre, outlines how as Curry was taken in by his orthopedic surgery for a second reconstructive surgery, that a test with stress X-rays and a small HD camera inserted into the ankle tissues was performed while he was sedated under anesthesia, revealing to the surgeons that the problem was not structural, but involved excess bands of scar tissue, inflammation, and loose bodies of very small bone and cartilage. These issues are very common, and can be avoided and resolved with professional passive soft tissue mobilization. Steph Curry was afraid that repeated surgeries and insertion of tendon and ligament material from a cadaver would eventually destroy his career, and was relieved to learn that he just needed to take a more conservative holistic approach to his health. By working on improved body mechanics, and receiving the correct physiotherapy, he ended up with ankles that were stronger and better overall athletic function, becoming a durable and fearless athlete that many consider one of the best in NBA history. This story also details how Steph went on to double his free-lift weight routine and become one of the strongest athletes on the team without bulking up his body with huge muscles. His muscles achieved their amazing strength by working on the balance between strength and length, the metabolism of the muscle, and functional aspects, not just the size. In doing so, his athletic performance continued to improve in all aspects, especially flexibility and reaction, as well as burst. This is a valuable lesson for all athletes, and their physicians.

The history of anabolic steroids and why this is the wrong approach to improving athletic performance

While there is much talk of the Era of PED and Steroids in sports, a careful analysis of the history of performance enhancing drugs and steroids in sports shows that this era began around 1915, not with the rise of Barry Bonds as the best baseball player of all time. An anabolic steroid is an anabolic-androgenic steroid, or a drug that has similar effects to testosterone in the body. Anabolic refers to anabolism, or the metabolic pathway that constructs molecules from small chemicals. For as long as we can fathom, athletes and warriors that strove to be stronger and faster sought out foods and medicines that could help create bigger and stronger muscles. The term steroid indicates a type of organic compound with four fused rings of 20 carbon atoms, and the most well-known steroids are the hormone cascade that is built on cholesterol, and includes pregnenolone, progesterone, the estrogens and androgens. Anabolic steroids are a class of steroids that interact with androgen receptors. Testosterone is the most well-known androgen in this category.

Natural testosterone extract was achieved in 1889 by the Harvard professor Charles Edward Brown-Sequard, who injected this anabolic steroid into his body subcutaneously and reported remarkable increase in vigor. The testosterone was derived from dog and guinea pig testicles. Bovine testicle extract was discovered to be a more bioidentical and potent anabolic steroid in 1927, by a professor from the University of Chicago, Fred C. Koch, who touted this medication as a remarkable sports enhancement tool. This development was followed closely by sports trainers and athletes, and articles in sports publications touted its effects. The problem was one of supply, because it took 40 pounds of bovine (pig) testicles to obtain 20 mg of androstenone. Only those athletes with considerable money and motivation could afford this on a regular basis. Coincidentally, Babe Ruth, a previously skinny baseball pitcher, suddenly hit 60 home runs in 1927 and developed a large and strong body where previously he had a relatively thin frame. In 1918, Babe Ruth led the league with only 11 home runs. By 1920, he held the home run record for a season of 27 home runs, and was bought by the Yankees, a very business oriented baseball organization. Ruth was highly pressured to reward the purchase of his contract for $100,000, unprecedented at the time. He demanded $20,000 per year, a relative fortune at that time, especially for a sportsman, and needed to live up to expectations. As he gained power and size he transformed baseball, and the fans demanded more and more home runs.

As Babe Ruth developed athletic power, and Professor Fred C. Koch wrote articles touting the performance enhancing androstenone, the Babe put on a lot of midsection weight along with the muscle, became famously surly, infamous for his sexual exploits, short-tempered, full of vigor, and developed a lot of health problems, such as gastrointestinal complaints, exacerbated by a penchant for eating a lot of meat and drinking heavily. His large frame and relatively skinny legs indicated a hormonal imbalance. By age 40, his health had declined considerably, and he died 13 years later of cancer. Of course, it is a sacrilege to suggest that he took advantage of a legal performance enhancing natural anabolic steroid touted as a drug that all serious athletes should take by a prestigious University of Chicago professor of physiologic chemistry.

In the 1930s, the first synthesized anabolic steroids were invented, derived from cholesterol. Already, medical use of Testiclep, a natural anabolic steroid, had been in use since the late 19th century, and purified androstenone had been used medically since 1931, and later synthesized by Ruzicka in 1934. In 1938, the sports magazine Strength and Health, touted this new synthesized anabolic steroid as a sports enhancement drug that was now accessible to all athletes. Of course, it is a sacrilege to suggest that any of our baseball heroes would decide to take a legal anabolic steroid that would allow them to hit more home runs or increase the velocity of their fastball, as well as recover from injury and more intense bodybuilding, and make more money, and get more famous. Pure sacrilege! Oh my gosh!

An interview in the August 22, 2010 New York Times, with famed Olympic gold medal champ Harold Connelly, perhaps the most impressive U.S. olympic athlete ever, since he was born with a right arm much shorter than his left, and became a multisports superstar, winning many gold medals, is very telling. When asked by the reporter at the end of his life whether he could of achieved even more in the Steroid Era, he replied "You kidding?", and noted that 'everyone was taking steroids by 1960'. He still didn't think that there was anything wrong with taking steroids to enhance the sports performance, despite noting that his wife, also a famed athlete, was a staunch critic of steroid performance enhancing drugs, even back in the late 1950s. He thought that these drugs, significantly improved at the height of his career, in the late 1950s, were just another tool for the athlete to compete, and since everyone did them, there was no cheating. His wife thought that they were a harm to health.

Now, in 1961, a young skinny baseball player from the Midwest came to the Yankees and hit 61 home runs. Previously, for Kansas City, he hit his first major league home run in 1957, missed 45 games in 1958 after a burst appendix, and had never been a significant power hitter until he was traded to the Yankees in 1959, mentored by another Midwest ball player, Mickey Mantle. Maris was not a true hitter, like Ruth, hitting for only .269 in 1961, but he did develop power quite suddenly. He was frequently injured, and had only 8 full seasons in the majors, hitting 33 home runs in 1962, and only 275 homers for his career, in 13 seasons, an average of about 20 home runs per season. But for a short time, when the pressure to perform was high in New York, and fans who liked their East Coast baseball stars, not these Midwest guys, Maris suddenly developed a lot of power. He was also famous for his surly mood, erratic behavior, hair loss, and other signs of anabolic steroid use. A documentary movie entitled 61 addresses these issues, and the fact that after this one great year, he only hit 30 home runs in a year 2 more times. His mentor, Mickey Mantle, another Midwest guy that the New York fans hated, and had similar sudden power and health problems and signs of anabolic steroid use during the late 1950s, when the famed Harold Connelly stated that practically everyone in sports was using anabolic steroids, now designed for better results and less side effects, was one of the only people in this film that spoke positively about Maris. The Maris family was strongly linked to the guy that hounded Barry Bonds as he approached the Maris record of single season home runs.

Despite the fact that it is a sacrilege to talk about the obvious use of anabolic steroids in sports in the past, they were heavily used. The now infamous documentary on bodybuilding and Arnold Schwarzenegger, who won the title of Junior Mr. Europe in 1965, at age 19, developing from a skinny kid to a monstrous physical specimen in a short time, entitled Pumping Iron was a college favorite in 1977, not because kids were interested in bodybuilding at all, but because this weird guy openly discussed the massive amounts of anabolic steroids he took, and everyone took, and now mixed these with recreational drugs and lots of sex. Of course, this guy later became a Hollywood icon and governor of California, continuing to support anabolic steroid use and bodybuilding even after he was governor. He even continued to have a vigorous libido, admitting to having sex with his immigrant housekeeper and fathering a son while he was governor, which broke up his marriage. The "Steroid Era" began well before Barry Bonds.

Are these sports enhancing anabolic steroids the best athletes can do, though, to achieve maximum performance in the healthiest way possible? What has been missing from the debate on performance enhancing drugs is the fact that most of these drugs are very injurious to the health, and actually required quite a lot of attention on the part of the athletes that use them to take other supplements to counter the adverse health effects. Not only anabolic steroids, but hormonal growth enhancing chemicals are now routinely used in sports, even despite the bans and bad publicity, yet no one seems to be talking about the health risks. The way the media has handled this issue has only promoted these hormonal drugs, and many young athletes are being injured because of this, unaware that the health risks in the teenage years are much more pronounced than for athletes starting the drugs later in life. Anabolic steroids cause many adverse health effects. Damage to the immune system, hormonal balance, neurohormonal health, the cardiovascular system, metabolic system, the skin, and of course, to the reproductive and sexual system, is well known. What we see in the media is only the huge muscles, the athletic power, the fame, and the money generated from use of the drugs, though, until the athlete is "caught", although considering the openness of the Biogenesis case in 2013, we don't appear to be very interested in actually "catching" these athletic stars. While this story of a steroid era in professional sports garners a lot of attention, we almost completely ignore the damaging future health consequences of steroid use in youthful athletes.

A host of common health problems are associated with anabolic steroid use, including mood disorders, hypertension, metabolic syndrome, high blood sugar, cardiovascular disease, heart arrhythmias, acne, baldness, liver damage, gynecomastia, reduced sexual function, infertility, testicular atrophy, anovulation, polycystic ovarian syndrome, premenstrual syndrome, severe menstrual cramps, increased growth of body hair, and problems with fetal development. Long-term negative effects on the central nervous system have been documented as well, not just temporary mood disorders and mania, but chronic changes leading to addictive syndromes, psychoses, and depressive mood disorders. If the athlete has engaged in the use of anabolic steroids or other performance enhancing hormonal drugs, such as human growth hormone and EPO, some attention to recovery of health holistically, and preventing future disease may be in order.

Complementary Medicine is the ideal place to obtain this medical help. If the athlete is convinced that such harmful performance enhancement should be avoided or curtailed, there is still much that they can do legally and naturally to help with athletic performance. This is not cheating, although the WADA rules initially were designed to imply that the athletes should be wary of any nutrient medicine or herbal supplement. Professional herbal and nutrient medicines utilize low dosage and safe medicines that comply with WADA rules, and almost no cases of professional prescription of herbal and nutrient medicines by professionals, namely Licensed Acupuncturists and herbalists, and Naturopathic physicians, can be found involved with anti-doping violations. In the case of the now infamous Biogenesis and the Bay Area Laboratory Co-operative (BALCO) scandals, we see companies that purported to utilize Complementary Medicine, herbs and nutrients, yet when looking closely, just used this as a front, providing little more than illegal pharmaceutical hormones to the athletes.

Performance enhancement in athletics involves more than just bigger muscles and faster recovery from injury. It involves more efficient muscles, more flexible joints, and the prevention of injury. By focusing too much on bodybuilding and not enough on physiological efficiency, the athlete is ignoring valuable resources to enhance their ability to perform at their peak, as well as to keep as healthy as possible. Huge muscles that get injured due to poor basic physiological parameters result in long periods of recovery, which involves no sports performance. By keeping healthy and learning how to make your body more efficient, the ultimate achievements may be astounding.

The science of muscle fatique, how to get less fatique and more performance

Understanding muscle fatique will enhance your ability to train harder without injury. Research has uncovered that the physiological cause of muscle fatique is the leaking of calcium ions due to overuse tissue injury. Calcium ions carry much of the energy that your muscles utilize to exert strong contraction, and when the tissues of muscle innervation are torn during normal workout, calcium ions leak into surrounding tissue, eventually causing muscle fatique. When calcium ions accumulate, the firing of the muscle is weakened, local circulation is reduced, and surrounding tissue irritation causes excess inflammatory reponse. These factors work together to inhibit continued strong firing of the muscle. If the local tissue is not cleared of irritating chemicals, a myofascial trigger point syndrome may develop which chronically hinders muscle firing, and also causes chronic pain. While it is true that larger muscles will provide more strength when this natural tearing of tissues and leakage of calcium ions occurs with heavy activity, these larger muscles are not performing at their peak activity when this occurs, and our scientific study has found that there are a number of ways to prevent and decrease muscle fatigue, aid faster recovery from heavy workouts, and achieve greater muscle efficiency, without anabolic steroids or banned chemicals.

The tissues of innervation in the muscle are called the sarcoplastic reticulum. Like all muscle tissues, when there is strong overexertion, tissues experience microtears and physiological damage that needs to be repaired. Muscle soreness is one symptoms of normal damage to tissues from exertion. A holistic protocol allows the athlete to pay attention to all of the needs of the body to repair tissues, clear accumulations, and restore a healthy supply of nutrients for the next workout. Maintenance of optimum circulation to the area and promotion of optimum stimulation of tissue regrowth are key to performance enhancement and quick healing. Anabolic steroids helped the athlete to stimulate faster tissue repair, but with the banning of performance enhancing chemicals, the athlete must again turn to enhancement of their own natural hormonal health, and a complete array of factors that combine to provide optimum tissue healing and performance.

Calcium channels in the endoplastic reticulum are voltage dependant. Treatment with acupuncture and electrical stimulation has been researched and found effective to relax muscles and enhance this metabolism. Repair and maintenance of these calcium ion channels, as well as natural calcium channel blockers, may be utilized to increase endurance by inhibiting excess leakage of calcium ions. Reactive oxygen species (ROS) are oxygen free radicals that exert extracellular stress on these calcium channels, causing increased calcium leakage during heavy workout. The right antioxidant chemicals will help the body clear these ROS to decrease damaging stress on calcium ion channels. There is no one simple protocol to achieve these goals of greater muscle function and quick healthy repair after strong exertion. A thorough holistic protocol is needed.

Fatique is also induced as a response in the brain to heavy exercise. Excess production of serotonin precursor 5-hydroxytryptophan and the catalyzing enzyme tryptophan hydroxylase produces a sense of fatique in the brain that is very powerful. Scientific study (cited below) confirms that one of the herbs that is sold as Siberian ginseng, Acanthopanax senticosus, is able to reduce these neurotransmitter excesses and thus reduce fatique sense as well as caffeine. Propolis, Siberian ginseng, Astragalus and Ligustrum fruit are all studied herbs to help achieve less sense of fatique to increase athletic stamina. Rhodiola rosea is a Chinese herb long used to treat fatigue and adapt to both physical and mental stress. In 2012, a meta-review of published scientific studies in this regard by the University of Alberta School of Public Health, in Edmonton, Canada, found 206 scientific papers studying Rhodiola rosea and treatment of fatigue. These researchers noted that only 11 of these studies met the most rigorous criteria at peer-reviewed randomized and controlled human clinical trials, though, but noted that 5 of these 11 human clinical trials proved effectiveness in treating physical or mental fatigue. Of course, in Complementary Medicine, an herbal extract of Rhodiola rosea is just one small part of the protocol to treat fatigue, enhance adaptation to stress, and achieve better sports performance. Acupuncture stimulation was also proven to decrease these fatique causing physiological excesses in the brain, and a study cited below shows this proof as well. In addition, acupuncture has been documented to achieve more efficient peripheral clearing of oxidant chemicals such as malondialdehyde, as well as lactic acid in circulation, that contribute to poor muscle function and fatigue. The effects of acupuncture stimulation are broad, improving every aspect of the physiology. Short courses of frequent acupuncture are more dramatic in studied effects, and these effects are proven to last, because acupuncture stimulation works by stimulating your own physiological processes, not replacing or overriding them. By combining short courses of acupuncture with a holistic herbal and nutrient protocol, as well as deep tissue physiotherapy, every athlete could achieve improved athletic function and recovery.

Muscles during fasting do not use glucose as their main source of fuel. During these times between meals the muscles mainly use free fatty acids (FFAs). These are a class of lipid macronutrients that are essential to formation of adenosine triphosphate (ATP), and yield much more ATP per gram than carbohydrates or proteins by utilizing the beta-oxidation pathway. Fatty acids are also useful in energy storage and signaling pathways. Fatty acids store in our tissues mainly as triglycerides, but with an increase in adrenalin, during athletic stress, these stored triglycerides break into free fatty acids and glycerol. Free fatty acids provide energy both directly to the muscle cells as well as the small intercellular energy factories called mitochondria. The amino acid carnitine is essential in this process, as is beta-oxidation, and a healthy hormonal metabolism with insulin and adrenaline (epinephrine) is important as well. The metabolism of free fatty acids for muscle energy may leave behind ATP fragments and oxidants that inhibit future muscle performance, though, and these need to be efficiently cleared. In addition, the consumption of healthy fatty acids before athletic muscle stress will supply direct free fatty acids for this fuel, as long as the digestive function is healthy, and sufficient carnitine is available. As these free fatty acids in the system are depleted, stored glycogen is used for this fatty acid fuel, and then fatty acids stored in adipose tissue. At this stage, both adrenalin and glucagon regulates the release of fatty acids for muscle fuel. A protein in the blood called albumin transports these now free fatty acids to the muscle cells for use. Albumin is created in the liver, and related in structure to alpha-ferroprotein and Vitamin D-binding protein, and acts as an important antioxidant as well as a transport protein. The amino acid cysteine is important in the production of albumin, as is a healthy liver function, and the amino acids arginine and lysine, as well as aspartic acid and glutamic acid are important in the albumin structure. Since albumin is created as needed in the liver, maintaining a healthy liver function is essential to sports performance and muscle energy metabolism. By understanding the basic metabolism of muscle energy use during exertion, a holistic protocol may be devised to provide optimum performance.

Underlying health problems that affect athletic performance

Along with soft tissue maintenance, myofascial release, professional guidance with herbs and nutrient supplements, and unique instruction in targeted stretch and exercise, the Licensed Acupuncturist is also able to analyze and treat health problems that get in the way of optimum performance, such as asthma, allergies, hormonal imbalances, menstrual irregularities, digestive problems, anxiety, depression, etc. Treatment of various nagging underlying health conditions with natural holistic medicine may greatly aid the athletic performance.

Herbal and nutrient products that can be utilized safely to aid the optimum natural performance, enhance tissue repair, insure the optimum circulation and utilization of blood nutrients

Some of the Chinese herbs that have been used for centuries to enhance athletic performance are heavily researched, and work by stimulating the natural systems in the body, not be replacing these systems with drugs. Some examples include Herba epimedii (Yin yang huo), which was cited in a 4th century BC herbal classic as a bodybuilding agent, and contains chemicals that have been shown to exert calcium channel blocking which vasodilates arteries, enhances immune activity to modulate inflammation, and has potential to enhance hormone metabolism. Cistanche deserticola (Rou cong rong) is also listed as a bodybuilding agent in the Chinese classic, the Shen Nong Ben Cao Jing, and scientific study has found that animals show prolonged endurance and increased ability to perform in oxygen deprived conditions with sufficient dosage of this herb. The herb is also able to stimulate the hypothalamus pituitary axis to increase natural anabolic steroid metabolism, and has been shown to aid tissue repair and immune response. Adaptogenic herbs aid the body's natural ability to handle physical stress, and herbs such as Rhodiola rosea and Eleutherococcus (Siberian ginseng) are well studied and proven to enhance both endurance and performance. Rubus coreanus Miguel (Fu pen zi, or Cha tian pao), a genus of black raspberry, was proven to significantly reduce exercise fatique in animal studies, and proven to be a potent antioxidant as well, boosting antioxidant effects by 150-300% in studies. Schisandra chinensis (Wu wei zi) is another much studied medicinal berry that if found to have both adaptogenic and antioxidant effects, increases endurance, increases physical working capacity, and benefits swimming under load in an atmosphere with decreased air pressure (see study cited below). Reishi mushroom is a well known immune enhancer, but is also shown to increase ATP production in studies. Cordyceps is another immune enhancing herb that has been shown to increase ATP production. Propolis is derived from bees, and various types of propolis have been proven to act as metabolic stimulants, antioxidants, and exert liver protective effects. A high content of usable amino acids are found in propolis, including leucine, isoleucine, and valine, precursors of human growth hormone, as well as glycine, proline and threonine, which aid cartilage repair.

These and other beneficial herbs are available in professional formulas that are safe and effective. And ginseng, of course, has been touted as a significant metabolic aid and performance enhancer with low dosage for centuries. In 2010, the anti-fatigue biochemical activity of ginseng (Ren shen) was finally tested, at Northeast Normal University, Changchun, China, and it was found that polysaccharides in ginseng significantly inhibited reduction in glucose utilization, depletion of glutathione peroxidase, excess creation of creatine phosphokinase, lactic dehydrogenase, and malondialdehyde (cellular toxin), all indicators of fatigue, with heavy exercise. Moreover, this study identified that the acidic portion of the ginseng polysaccharides achieved greater effects with lower dosage. Acidic polysaccharides in herbs are enhanced by sulfation, and some of the well-known sulfated acidic polysaccharides are heparin, hyaluronic acid (HLA), and chondroitin sulfate. Ginseng is prepared with sulfated ash in China in certain forms of the herb, but pills and extracts of ginseng may not be sulfated. The type and quality of the ginseng are thus important, and professional Chinese herbalists are able to distinguish and provide the best type of ginseng and the proper dose to each individual.

Endurance and recovery may also be improved with heavy exercise if the ill effects of oxidative stress may be prevented or ameliorated. More and more study in China and other countries is showing that a number of Chinese herbs and nutrient supplements may offer this benefit. Studies in the United States have shown that strenuous physical activity can increase oxygen consumption by 10-15 times and result in significant oxidative stress. Some studies have also noted that professional athletes adapt to this oxidative stress and that common antioxidants do not enhance performance significantly, but for those who are not in training but exert themselves more rarely, this adaptive mechanism would not be developed. For the person who performs strenuous athletic workout inconsistently, the use of antioxidant herbs and supplements may help with endurance and performance, as well as protect against the adverse health effects of oxidative stress. Choosing the right herbs and supplements and using them correctly may be the key to success, and a number of studies cited below show the potential of Chinese herbs, and certain nutritional medicines. Since herbal medicines provide an array of chemicals and benefits, the use of such herbs as Rhodiola, Cordyceps, Lycium, Gymnostemna, Siberian ginseng, and other adaptogens may provide significant benefit. These herbs are not listed on the banned substances list of WADA, and may benefit both amateur and professional athletes.

The supplements mentioned above can be prescribed in the correct manner, given with beneficial herbal formulas, and myofascial release and deep tissue massage to enhance your athletic training. This would be a complete regimen tailored to individual needs by this physician. Below is a list of various key nutrients, herbs and formulas that may be utilized to create the optimum protocol for each individualized strategy.

  • Creatine: Creatine depletion in muscles during heavy workouts has long been documented. While supplements are popular, there is a healthier way to insure adequate creatine availability. 50% of creatine is made from other amino acids in the liver, kidney and pancreas. Use of a quality whey protein supplement provides a large boost of creatine without negative effects. Ingested creatine itself is highest in wild game meats and fish. Wild ocean fish (not farmed) will supply much creatine along with healthy fatty acids. Vegetarian foods high in certain amino acids (arginine, methionine & glycine) will provide the building blocks for creatine production in the body as well. Glycine is abundant in a healthy diet, but these other amino acids may be supplemented. Supplementing with L-arginine and SamE is recommended. L-arginine is the enzyme most crucial to efficient creatine biosynthesis. Herbs with arginine include shudi/rehmannia, coriander and white mustard seed/baijiezi, as well as yiyiren/white pearl barley. Foods with arginine, methionine & glycine include lentil, mungbean, chickpea/garbanzo, fava bean, kale, spinach, asparagus, pistachio, sunflower seed, sesame seed & pumpkin seed, as well as soy. Barleygrass is also rich in methionine and many important nutrients. Dried barleygrass sprout is a valuable supplement, both for nutrition and as an inflammatory regulator. Herbal formulas to aid kidney and liver function and health along with the synergistic acupuncture treatments will greatly benefit efficiency in creating creatine for athletic training. Creatine phosphate has been found to be depleted by some muscle fibers at the point of muscle exhaustion, although this is not associated directly with muscle fatique during single high-intensity exercise bouts, but may be associated with fatique during workouts with repeated high-intensity exercise routines. Also, heavy long workouts create a higher need for key enzymes in anaerobic muscle use, and various amino acids could help the body decrease fatique in these circumstances.
  • Myelin: myelin forms the sheaths of the nerves and is the tissue that carries the nerve conduction; essential fatty acids, EPAQ/krill oil, L-arginine, & 5HTP, along with intake of healthy oils, nuts and seeds, will all be helpful to increase efficiency of myelin biosynthesis to aid training. Pumpkin seed oil, for example, will help build myelin and creatine as well as providing rich essential fatty acids for inflammatory regulation.
  • Antioxidants & Collagen: whole grape extract, a potent antioxidant for the tissues that contains resveratrol (increasing endurance), as well as whole pomegranate extract, are shown to be contain some of the best types of antioxidants to clear muscle and joint tissues of excess oxidant radicals. Combining these with natural collagen type 2 in the supplement Collagenex, is proven to deliver the needed collagen to effect faster tissue remodeling in joints and muscles after damaging heavy workout. This most important joint and tissue nutrient was heavily researched at Harvard Medical College to find a bioidentical supplement that was proven to actually contribute to increased collagen type 2 needs in joint tissue remodeling. Other antioxidants of merit include Vitamin C (Astr C) and coenzyme Q10-H2. An article explaining the various types of antioxidants can be found elsewhere on this website.
  • Collagen type 2 & topical glucosamine and MSM supplement: Studies at Harvard have confirmed that the most usable collagen II is obtained from a purified extract of collagen from analogous chicken tendon tissues. Whenever there is strong workout, tissues are torn and need to repair quickly. This increases the need for collagen type 2, and your cells may not be able to produce enough to achieve as fast as tissue repair as you would like. Health Concerns uses the latest study information to formulize Collagenex 2, with eggshell membrane chemicals to improve absorption and utilization. Typically, athletes have taken glucosamine and chondroitin to achieve these results, but studies show that these ingredient taken orally do not reach the tissues before they are broken down, and that most companies do not put the advertised amounts of chondroitin in the product due to expense. Utilizing Collagenex 2, and even Resinal E (herbs and enzymes) will help speed tissue recovery after heavy workouts. To deliver glucosamine and MSM directly to the affected tissues, a topical cream is recommended, and bioidentical pregnenelone cream with a variety of tissue nutrients, including glucosamine, and anti-inflammatory herbal extracts, is ideal in this regard. Pregnenelone, as a bioidentical plant extract, is also effective for providing greater bioavailability of precursors for your body to produce DHEAS, or androgen precursor hormone. This strategy increases the anabolic potential without direct supplementation that is considered illegal in modern sprorts competition, and is very safe and effective.
  • Flavonoids: bioflavonoids are a large class of chemicals common to plants and animals that exert potent antioxidant clearing, modulate inflammatory reactions, improve circulation, and enhance tissue repair; a balanced blend of gentle herbs that contain a variety of flavonoids is found in Flavonex. This will enhance capillary or microcirculation health in the muscle tissues, especially benefiting fast twitch muscle, or heavy, exercise.
  • Calcium and magnesium aspartate: this is the calcium used in the muscle to power the nerve signaling contraction and relaxation as well as to buffer the excess acids produced by heavy anaerobic activity. They are combined with a few herbs in SPZM. Since aspartic acid is utilized in muscle firing, a molecule combining calcium with aspartate insures that more of the calcium will carry to the muscle. All calcium supplements are not the same.
  • PKA: pyroxidine alpha ketoglutinate, a metabolic cofactor in utilization of fats and carbs by the tissues as well as steroid hormone production in the adrenal and other cells is found in Adrenosen, which combines adrenal cortex extract with gentle herbs to enhance athletic performance. Adrenal cortex extract is another means of providing the body with enhanced bioavailability of precursors to natural adrenal anabolic hormones. The added benefits of this approach is that your body maintains the protective regulatory hormonal balances that promote optimum health in all regards. Natural promotion of anabolic hormonal health provides benefits without the side effects and long-term consequences seen with synthetic anabolic steroids.
  • L-carnitine and alpha lipoic acid: together are shown to increase mitochondrial health to produce ATP, the fuel of your muscles. L-Carnitine L-Tartrate: found in studies to decrease exercise-induced muscle tissue damage, and increase insulin-like growth factor binding protein-3. Other anabolic hormonal effects were not observed in studies. Other beneficial cofactors for improved ATP production include certain metabolites of Vitamins B2 and B3, which are the precursors to FADH2 and NADH, which are required in the body to produce ATP. Increased ATP production is important in athletic activity to provide muscle energy, improve firing, and delay fatique. A sustained release formula of B2 Riboflavin and B3 Inositol hexacotinate is available in the formula ATP Cofactors.
  • D-ribose: ATP is the fuel inside of cells, just as calcium ions are the source of energy outside of the muscle cells. D-ribose is required for cellular production of ATP, and when muscles are exerted fully, increased ATP production is required. D-ribose supplement, taken before heavy workouts, may help supply the raw ingredients for this increased production of ATP. D-ribose is a 5 carbon carbohydrate that is easily metabolized. D-ribose is also an essential building block for guanosine triphosphate and neurotransmitter production and bioavailability. Balance of serotonin, dopamine, adrenaline, melatonin and nitric oxide is key to healthy central nervous system regulation of fatique and performance. While ATP is not a direct limiting factor in studies of muscle fatique, adequate supply could enhance overall performance, and D-ribose could have indirect effects decreasing fatique in heavy workouts.
  • L-arginine: an essential component of creatine, myelin, and collagen; this amino acid also aids tendon repair, as well as other tissues, benefits liver function, and aids antioxidant activity. Arginine is proven to aid immune function, help detox tissues, facilitate in the increases of muscle mass and reduction of body fat, and assists in the release of growth hormones crucial for optimum muscle growth and tissue repair. Decreasing meat consumption may significantly impact arginine availability in the body, and while arginine is generated in the protein digestion and breakdown (the urea cycle), a concurrent increase in arginase enzyme limits the availability in circulation. Arginine in the form of arginine free base is a more effective product, as it is free to be utilized in circulation. Freebase refers to the pure basic form of an amino acid, as opposed to its salt form, which the body uses to store arginine. Scientific studies have suggested that L-arginine and other amino acids were found to speed healing of microfractures in bone, increase local blood supply, supplement growth factors, and improve collagen synthesis. A 2009 study on laboratory animals (Sinha S, Goel SC: Indian Journal of Orthopedics 2009 Oct;43(4):328-34) found that the combination of arginine and lysine exerted significant benefits on fracture healing, assesed with both radiological and histomorphological anaylysis. L-lysine is an essential amino acid found in the food sources, eggs, cheese, lima beans, nutritional yeast, soy, potatoes, fish, and red meat. Arginine, on the other hand is not as readily available in the diet, and is also produced in the body when dietary needs do not sufficiently supply it.
  • SamE and zinc monomethionine: methionine: an essential component of creatine which also aids membrane fluidity for more efficient nerve firing and cellular metabolism, and has been shown to aid tendon repair and antioxidant activity. Zinc monomethionine is widely touted to improve athletic performance and tissue repair, and may be combined with calcium and magnesium aspartate (plus Chinese herbs for muscle health in SPZM, from Health Concerns).
  • Proteolytic enzymes: serratiopeptidase is a powerful enzyme clinically proven to aid tissue repair and inflammatory disorders, and is available in SerraMend. Other more common enzymes are available in Resinal E, a tissue repair anti-inflammatory herbal formula with enzymes, and in Chzyme, an herbal formula to aid digestive function. Nattokinase is also an effective potent proteolytic enzyme useful in clearing of accumulations of protein fragments and fibrins from tissues, as well as clearing clotting in cardiovascular disease. The accumulation of protein fragments in tissues can both decrease function and firing, and cause increased discomfort and pain. Hardening of tissues in dysfunctional states is usually attributed to both calcium ion accumulation and accumulation of protein fragments. Tissue membranes are composed of protein and fat combinations (lipoproteins), and tearing of tissue membranes produces protein fragements that need to be cleared in circulation.
  • Barley grass powder: more digestible than wheat grass but similar in makeup, containing 3 types of anti-inflammatory biologics, enzymes, SOD antioxidant, and other nutrients.
  • Niacin: aids vasodilation and muscle nourishment. Niacin is a form of Vitamin B3, and a number of niacin-like chemicals can be utilized for enhanced circulation and neural firing, and benefit the heart muscle and liver metabolism. Niacinamide and Inositol hexacotinate are 2 forms of B3 that may exert specific effects that you want.
  • Amino acid combinations: various amino acid combinations supply the protein building blocks that the muscles need to repair quickly and maximize lean muscle tissue. While a healthy amino acid profile from food is most desirable, a supplement provides the nutrients when the athlete is not able to consume an optimal diet. Various formulas are available, most of them are very similar, with key ingredients being L-isoleucine, Leucine, and Lysine, essential for tissue repair. Amino Edge by Vitamin Research combines these and other amino acids with iron, potassium, selenium and glutamic acid, which research shows are also helpful to optimum muscle performance. Protein supplements are also widely used in sports performance enhancement, and the choice of a protein source is very important. Soy protein products may create an accumulation of chemicals that are difficult to digest and create some potential health problems. Smart protein products utilize undenatured whey protein and low temperature processing to protect naturally occurring bioactive proteins, and are higher in content of leucine, methionine, glutamic acid, and lysine. Whey protein versus soy protein studies showed that whey has a better biological value (digestability and assimilation of amino acids), better net protein utilization (percent of amino acids converted to usable protein), better protein efficiency ratio (measure of gain in body weight per weight of supplement), better amino acid score, and equal protein digestibility corrected to amino acid score. Soy protein has a better concentration of arginine and glutamine, but these amino acids are more regulated in the body, and protine supplements do not necessarily provide increased availability in circulation. Combining smart protein whey supplement with freebase arginine is clearly the best choice and avoids the potential negative effects of soy that is not properly processed with a fermentation process. If increased glutamine itself is desired, a separate pure glutamine powder is recommended, although glutamine is the most abundant amino acid in the body and stored in tissues with a highly regulated release physiology. For a healthy athlete, glutamine supplementation probably does not help bioavailability, whereas glutamic acid supplementation in whey powder smart protein may aid this regulatory process and provide more optimum use of glutamine as needed in the body .

Maintenance and repair of the body are both aided by a therapeutic regime of acupuncture and soft tissue mobilization, or TuiNa. Acupuncture is able to stimulate any physiological mechanism to help cure illness or improve health. The effectiveness depends on the skill of the practitioner. Acupuncture is also symbiotic with herbal therapies and tonics to achieve maximum effect, and when combined with manual physiotherapies, creates a very effective course of therapy. Repair of tissue injury can be accelerated, pain relieved, and overall health and function of the liver, kidney and hormonal system can be enhanced. Steroid hormones can be at their peak naturally without cheating. Many acupuncturists are now knowledgeable in modern sports medicine and work to complement the care of the trainer and M.D. Peak athletic performance requires a well tuned body and the Licensed Acupuncturist can provide that extra addition to the athletic regime that prevents injury and allows the best performance.

Additional Information: Information Resources and Links to Scientific Studies

  1. More and more professional athletes are utilizing acupuncture in their program, both for maintenance, prevention of injury, and quicker recovery. Here, a Los Angeles based Licensed Acupuncturist describes some of his famous patients and there responses to the treatment: http://www.pacificcollege.edu/acupuncture-massage-news/articles/593-.html
  2. An expert at Indiana University, Stuart Warden, explains why the practice of using NSAIDS before exercise and competition involves more risk than benefit, and actually decreases the ability of the body to repair tendons and joint tissues properly, with COX enzyme inhibition also diminishing the ability to produce healthy collagen: http://newsinfo.iu.edu/news/page/normal/12805.html
  3. A 2010 meta-review of all published studies of acupuncture in sports performance by experts at the Near East University, in Nicosia, Turkey, bound that evidence shows that it is useful to enhance muscle strength and endurance, and that further scientific studies are needed: http://www.ncbi.nlm.nih.gov/pubmed/20386479
  4. A 2016 assessment of acupuncture in the acute treatment of sports injuries, by experts at the Tripler Army Medical Center, in Honolulu, Hawaii, U.S.A., shows that acupuncture stimulation has been proven effective for injury and faster healing in the field, and emerging evidence shows that integration of acupuncture into the treatment and prevention of sports injury is sensible. Overuse of pain medication with tissue injuries overlooks many risks and adverse effects over time, and more conservative therapies provide benefits without these adverse effects: http://www.ncbi.nlm.nih.gov/pubmed/26963020
  5. A 2011 article in Men's Journal describes the utilization of acupuncture by some of the biggest names in the NFL, especially since the U.S. Army has extensively studied the positive effects and adopted acupuncture both in the clinic and in the field to treat and maintain soldiers: http://www.mensjournal.com/magazine/big-men-little-needles-acupuncture-in-the-nfl-20130130
  6. The U.S. Army maintains an official homepage, and in 2010, reported that that the U.S. Army Surgeon General, Lt. Gen. Eric B. Schoomaker, has found that acupuncture meets the highest standard of national standards of scientific efficacy and has been incorporated into the standard medical care for chronic pain: http://www.army.mil/article/41446/
  7. A 2014 randomized controlled study at the University of Agricultural Sciences and Veterinary Medicine, in Cluj-Napoca, Romania, observed the effects of electroacupuncture stimulation on acute tendon injury with biopsy of animal tissues, and found that electroacupuncture resulted in decreased inflammatory responses needed initially, and improved activity of fibrous tissue remodeling after this phase, concluding that electroacupuncture has a proven positive effect on tissue healing: http://www.ncbi.nlm.nih.gov/pubmed/25441949
  8. A 2014 study of deep tissue massage (Tui na) for the treatment of the problematic hamstring strains in sports, showed that deep tissue stripping technique did increase hamstring length and did not affect strength negatively, and that adding eccentric resistance (patient actively extends the muscle against mild resistance applied by the physician) produced even more hamstring flexibility, thus potentially preventing hamstring injuries, and treating hamstring strain effectively: http://www.ncbi.nlm.nih.gov/pubmed/24411162
  9. The U.S. anti-doping agency provides an updated website with links to WADA and other athletic banned substances websites, and a search engine for your sport where any substance can be researched before you take it: http://www.globaldro.com/us-en/
  10. The updated 2010 WADA prohibited list can be downloaded from their website by clicking on Prohibited List: http://www.wada-ama.org/en/World-Anti-Doping-Program/Sports-and-Anti-Doping-Organizations/International-Standards/Prohibited-List/
  11. Serratiopeptidase is clearly explained at http://www.purebodysolutions.com/Merchant2/graphics/00000001/PDF/serratiopeptidase.pdf
  12. L-Carnitine L-Tartrate was studied in 2003 at the University of Connecticut Human Performance Lab and found to benefit tissue recovery and reduce the amount of excercise-induced muscle tissue damage with heavy exercise, as well as stimulate higher insulin-like growth factor protein receptor: http://www.ncbi.nlm.nih.gov/pubmed/12930169
  13. Scientific study explains how a type of Siberian ginseng aids decreases fatique as well as caffeine with enhancement of normal health biological processes: http://www.sciencedirect.com
  14. A 2008 scientific review in Sweden of over 40 years of extensive Russian research on the chemicals in Schisandra chinensis (Wu wei zi) found that it has strong adaptogenic and antioxdant activities, and benefitted both athletic endurance and function, exerting metabolic adaptations such as increased oxgyen utilization, nitric oxide and cortisol benefits, and increasing accuracy of movement and mental performance: http://www.ncbi.nlm.nih.gov/pubmed/18515024
  15. A 2005 scientific review in Sweden of adaptogenic Chinese herbs, such as Rhodiola rosea, Siberian ginseng (Eleutherococcus), and Schisandra chinensis, found that these herbs exerted a significant benefit with a single dose, providing within 30 minutes of oral administration a 4-6 hour stimulating effect that increased physical endurance and mental performance. Of these three top adaptogenic herbs, Rhodiola rosea performed the best: http://www.ncbi.nlm.nih.gov/pubmed/16261511
  16. A 2009 scientific review in Sweden of adaptogenic Chinese herbs study revealed the amazing physiological mechanisms of adaptation to stress and fatique that occurred at the molecular level when chemicals from Rhodiola, Eleutherococcus and Schisandra were taken. The herbs affected both the hypothalamic-adrenal axis and the genetic expression of key regulatory proteins that prevented stress-induced increases in nitric oxide and the associated depletion of ATP, the fuel for muscles in athletic exertion, increasing both performance and endurance: http://www.ncbi.nlm.nih.gov/pubmed/19500070
  17. A 2009 study at the University of Siena in Italy found that a combination of Omega-3 fatty acids and policosanol effectively improved reaction time in athletic performance in a placebo-controlled study. These supplements are available as EPAq and Polilipid: http://www.ncbi.nlm.nih.gov/pubmed/20234035
  18. A 2009 study at East China Jiaotong University, Nanchang City, China, found that a chemical in herbal licorice root (Gan cao) called glabridin significantly inhibited fatigue, extended the exhaustive exercise time, effectively delayed the elevation of lactic acid, and increased muscle glycogen stores in animal studies. Glabridin is now enhanced and standardized as a weight loss aid proven to enhance cellular metabolism, called VFM-100: http://www.ncbi.nlm.nih.gov/pubmed/21304608
  19. A 2013 study at the University of International Business and Economics, Beijing, China, Department of Physical Education, showed that polysaccharides from the herbal extract of Cordyceps sinensis (Dong chong xia cao) cleared exercise-induced oxidative stress in a number of ways: http://www.ncbi.nlm.nih.gov/pubmed/24047103
  20. A 2010 study at Northeast Normal University, in Changchun, China, showed for the first time in scientific study, that low dosage of ginseng polysaccharides exerts significant reduction of exercise induced fatigue, as well as providing improvement in glucose utilization, glutathione metabolism, decreased creatine phosphokinase, lactic dehydrogenase, and malondialdehyde, all standard markers of exercise-induced muscle fatigue. Moreover, the ginseng polysaccharides that were acidic were more efficient, requiring even lower dosage to achieve significant effects: http://www.ncbi.nlm.nih.gov/pubmed/20580802
  21. A 2011 study at Zhejiang University of Technology, Huangzhou, China found that chemicals in the Chinese herb Lycium barbatum (Di gu pi) significantly reduced exercise-induced oxidative stress: http://www.ncbi.nlm.nih.gov/pubmed/21541044
  22. A 2012 study at Tianjin University, Tianjin, China found that the herbal chemical salidroside, a glucoside of tyrosol found in the Chinese herb Rhodiola rosea, significantly clears exercise-induced oxidants and aldehydes: http://www.ncbi.nlm.nih.gov/pubmed/22948446
  23. A 2019 study at Sun Yat-sen University, Guangzhou, China, found that polysaccharides in the Chinese herb Morinda officianalis (Ba ji tian), extracted in alcohol extract, exerted significant anti-fatigue activity with heavy exercise: http://www.ncbi.nlm.nih.gov/pubmed/19150459
  24. A 2005 study at Fu-Jen Catholic University, Taipei, Taiwan, found that taking L-Arginine amino acid before heavy exercise protected against oxidative stress: http://www.ncbi.nlm.nih.gov/pubmed/16038634
  25. A 2013 study at McMaster University, Ontario, Canada, noted that current scientific study is inadequate to prove that nutritional supplements could augment muscle function in high-intensity workouts, but that theoretically, several nutritional strategies could enhance performance, by improving energy metabolism, promoting adaptive responses, and even lead to enhanced physiological adaptations over time: http://www.ncbi.nlm.nih.gov/pubmed/23765349
  26. Scientific study has also measured the effects of acupuncture stimulation on the brain and increased athletic endurance, as this study in 2002 from the Research Institute of Sports Science in Seoul, South Korea demonstrates: http://www.sciencedirect.com/8
  27. A 2013 study at Chongqing Three Gorges College, Chongqing, China, found that electroacupuncture stimulation at SP10, SP6, ST36 and LV3 daily for 15 days decreased serum malondialdehyde (MDA) and increased super oxide dismutase (SOD) significantly in athletes undergoing intensive athletic training, contributing to relief of athletic fatigue and enhanced sports recovery and performance. Malondialdehyde and SOD are the primary markers of oxidative stress: http://www.ncbi.nlm.nih.gov/pubmed/23650800
  28. A 2009 study at MingDao University, Taiwan, found in a randomized controlled clinical trial that acupuncture at just 2 points, ST36 and P6, enhanced oxygen utilization (VO 2max), decreased lactic acid accumulation, and aided cardio function in professional athletes: http://www.ncbi.nlm.nih.gov/pubmed/19606508