Salt, Soil and Fatigue

Q&A for Session #5
Sports Nutrition Symposium 4.0
Wednesday January 19th, 2022 @ 12 pm CST

D. Enette Larson-Meyer, PhD, RD, CSSD, FACSM

As our understanding of the wide role the gastrointestinal tract plays in our overall health, research into probiotic bacteria has boomed. This talk will discuss basic principles of probiotics, where there is some evidence for their use, and what athletes and practitioners should look out for.

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  •  I’ve read that cooking the goitrogen vegetables reduces the available goitrogens. Is this true?
    • Overall yes it does.

  • What do you mean by thermal injury?
    • Being out in the heat too long as an athlete. Typical signs of passing out, excess dehydration, that sort of thing.

  • How much rest time are you referring too after a HITT type workouts for thyroid to come back down to normal? And this for anyone or those with the disease .? Many people do HITT workouts 4-6x/week which is probably considered overtraining.
    • Data from just one study found it was 12 hours, but they didn't follow up to see what happened at 24 hours and they did not do repeated HIIT to see what happened. So right now, it's really just a consideration that thyroid could be used and there needs to be more studies to see if thyriod is still worth monitoring for overtraining. There are many individual variabilities which is why is is difficult to study. There will hopefully be more reasearch in the future.

  • Are the changes in the eyes permanent with Graves or reversible (partially or fully)?
    • They are not completely reversible due to hypertrophy and incorporation of fat that occurs. That person may have elevated/bulging eyeballs for Graves. Probably not, maybe a little bit.

  • To avoid excess iodine associated risk of autoimmune disease what would you suggest?
    • Most of the time in the diet, at least in the U.S., individuals are exposed to excess iodine. In Japan and other countries where it is common to consume seaweed, you can get huge amounts of iodine intake in the diet. If you do like seaweed, just don't over due it on a regular basis. This question is really an argument that we've had of whether or not we should add iodine to something else in the food supply. If we did do that then there would be an even greater risk of over exposure. Safest way to get iodine is from foods or a multivitamin- don't add excess amounts of salt.

  • If the hypo or hyperthyroid may be nutrient related, can repletion of the nutrient (eg. iron, iodine, or Vit D3 etc) be used first before medical interventions?
    • That is one of the things that needs more research. For hypothyroidism you can measure antibodies in addition to TSH. Determine what nutrient is it through tests. Push for antibodies to be measured and if that isnt positive, you can measure for specific nutrient and attempt to corret that.

  • How much of an influence would hypo- or hyper- thyroidism effect weight gain or loss when an athlete is adhering to a nutrient dense calorie oriented diet in order to gain or lose weight (Increase lean muscle mass and reduce body fat)?
    • Just the fact that the thyroid is so important for basal metabolism, it really can contribute to weight concerns, high or low which makes it difficult. Is it stimmulating appetite, is it increasing metabolism, is it excess sweating? Needs to be assessed on one on one basis.

  • How much would be considered an excess of cruciferous veggies?
    • I don't know that we really know that- a lot of the goitergen research is done in rats. Probably something that's above 5-9 fruits and vegetables or the concetrated form and consuming that. It is not going to be something that you would get from a typical "healthy diet". It is seen typically when you have iodine deficieny at the same time. i.e. eating cauliflower as your only vegetable source. Hard question to answer concretely.

  • Do you reccomend non flouridated water?
    • Concerned on excess flouride in certain areas because of the impact on the thyroid from enviornmental exposures - moving forward it's a consideration. A bit of loaded questions, but there are potential exposures that could damage the thyroid in suspectible individudals.

  • Coffee and grapefruit interact with thyroid medication which is why it is reccoended to take this medication on an empty stomach. For athletes who are doing early morning workouts and can only remember to take thier medication in the morning- could they handle certain pre-workout foods like applesauce/ dates/ oatmeal etc to be able to fuel high intensity exercise?
    • Should be taken on an empty stomach, ADA research article. Rx interacts prevents synthroid absoprtion. typically wait 1-2 hours (fact check this). What about pre-game fuel (applesauce/dates) - Known that fiber has a major impact - just playing around with what foods on rx bottle that are listed to decrease absorption.

  • How does iodine from surgical interventions play a role in excess iodine? I.e. the dyes used for imaging--these stay in the body and aren't excreted.
    • This is something to consider since that iodine is being absorbed.

  • Is there an impact of iodine based sanitizers used in food service and iodine intake in athletes who eat a lot of food prepared away from home?
    • Yes. One of the reasons dairy products are decent source is because iodine is used to keep udders clean on cows and sometimes they are fed iodine supplemented food. So that would also be a condideration, definetly.

  • I’ve recently seen at home thyroid testing kits. What are you thoughts on this kind of approach for assessment in the private practice setting?
    • TSH is an easy and inexpensive test to measure, at least in the university setting. Is the first step to take as a screener. To save costs recomend to start with TSH screen to help you figure out what is going on.

  • Where or how do we order a thyroid panel when in private practice? any suggestions?
    • In "my world" TSH is a pretty easy and inexpesnive test to measure, depending on the lab, its a first step as a screener. if the value comes back norma you can use at the context of other fractures. if its WNL and is still experiencing side effects, if its on the higher side there may be reason to contiue to investigate. Unless you suspected euthyroid-6 - in which the thryoid is functioning normally, it is the peripheral conversion that is the issue.

  • What are the considerations for iodine in sports drinks? Many of them are marketed for replenishing electryolytes for athletes that have extensive training time, should iodine be included here? Especially for runners as mentioned in that study you shared..
    • I love that question. There are a couple of papers that have suggested that idoine is lost in sweat. So maybe there is a need for idodine to be in sports drinks. Though, excess iodine is also not good. So i would probably say that is shouldn't be included but that athlete needs to find a source of iodine to include in the diet- coming from multivitamins or regular consumption of dairy products, eggs, or iodized salt. Also, iodine is not so acute that if it drops it won't impact performance. No, not yet. We do not have enough evidence to add iodine.

  • Hyperthyroidism signs and symptoms sound similar to s/s of menopause for female masters athletes. If they are similar, how can you distiguish?
    • These signs and symptoms can decribe many athletes (fatigue, forgetfulness). I would go back to having your TSH measured. CBC and TSH are pretty inexpensive. Make an appoitment with your doctor.

  • Going gluten free suggested with hypothyroid?
    • Reference Crouse- a few studies suggest that this is intresting, some individualsthat might have an autoimmune response could hypothetically have an autoimmune response to something else. Dr. Enette does NOT recommend by any means, but it wouldnt hurt to try.

  • What is your opinion if the athlete has hypothyrodism do you recommend reduce soy or just not to eat when you take the medication ?
    • Should be taken on an empty stomach, ADA research article. Even something like coffee can make the medication ineffective. Rx interacts prevents synthroid absoprtion. typically wait 1-2 hours (fact check this). What about pre-game fuel (applesauce/dates) - Known that fiber has a major impact - just playing around with what foods on rx bottle that are listed to decrease absorption.

  • Do you find thyroid dx are more common in older populations vs. teens/20s? Thinking about the impact mammogram radiation can have on women 40 and up. Oftentimes they don’t use a guard when administering those exams.
    • Yeah, its definteily very real and age is a factor that influences the thyroid. However, young indviduals can have problems too. But watch that radiation from the dentist!

  • Can you explain hyperlipidemia in hypothyroidism?
    • Elevated cholestrol that is commonly seen. I cannot explain off the top of my head.