About Me

My Photo
I am an Internal Medicine physician and a mom of two kids. I have long had an interest in public health education. All too often I see medical misinformation in the media. I want to get relevant, useful, non-judgmental, unbiased and accurate medical information out to teens, and to encourage teens to be part of the discussion! Nothing replaces a conversation with your doctor, your parent, or another supportive adult in your life, but Real Talk with Dr. Offutt can be a place to get involved in your own health!

Saturday, April 12, 2014

Coach says do it, I gotta do it.

Today’s topic is a big one, but I’ll try to keep it under control.  This is about those situations for those of you on sports teams where you are PASSIONATE and you LOVE your sport and you want to be an AWESOME teammate and you want to please your coach.  You’re tough.  You know that training can be hard, but you can do it.  You care.  You want to perform at your peak.  And you are hoping that might lead to that college scholarship at your most wished-for college.  Or to being recruited for college teams, (pro teams one day even?).  So back to pleasing your coach.  There are all sorts of things that your coach demands of you to get the best out of you.  Sometimes (and you need to keep your eyes open to this) those demands are really dangerous to you.   It can kind of sneak up on you and before you know it, you are doing things that your gut tells you is wrong or dangerous. 

Now, don’t get me wrong.  99.9% of coaches are in it for the passion – for the athletes and kids - for the team – for the sport.  And they really want what’s best for you and for the team.  Where this goes a bit off track is when their passion for a “now” result (winning that race, wrestling match, regatta, gymnastics meet, etc) sometimes takes over what is best for you over the long term (for the rest of your life).   Usually this passion is enthusiasm, but sometimes it is actually bullying.  Yes, a coach can be a bully. 

Not sure if your coach might be a bully or of he or she is just a tough demanding coach?  Here is a definition from StopBullying.gov, and I have added little examples for you that a coach could do if he/she were bullying: 

 In order to be considered bullying, the behavior must be aggressive and include:

  • An Imbalance of Power: (OK, this is obvious – the coach has more power than you do)
  • Repetition: Bullying behaviors happen more than once or have the potential to happen more than once. (That means a single bad day does not = bullying (coaches are human too!))
There are three types of bullying: 

Verbal bullying is saying mean things and includes: Teasing, Name-calling, Inappropriate sexual comments, Taunting, Threatening to cause harm.
  • Hey fatso – you’re never gonna win lumbering around like an elephant.
  • Hey, don’t cry like a girl.
  • You think it hurts now?!  I’ll show you what REALLY hurts.
  • You’re obese – you better make weight!!!  Or you'll be sorry!
Social bullying involves hurting someone’s reputation or relationships and includes: Leaving someone out on purpose, embarrassing someone in public.
  • Hey everyone, look at Jimmy,  he's gonna bring the team down.  
  • That was the worst match I’ve ever seen.  Don’t you all agree?   You should have lost those 16 pounds so you could have competed at the lighter level.  How can you let down your teammates?
  • Concussion?  Whatever.  You look fine.  Look at your teammates getting clobbered and you won’t even go out there and give them a break?!  Who cares what your doctor says – I’ve seen this a MILLION times.  You’re fine.
Physical bullying includes: Hitting/kicking/pinching, Spitting, Tripping/pushing, Taking or breaking someone’s things, Making mean or rude hand gestures
  • This one is pretty obvious….
OK, time for your input – how many of you think you have a bullying coach?  What do they do?  There is plenty of room for your comments at the end of this post.  Sharing experiences can help other teens realize they aren’t alone with this type of problem.

OK, back to the matter at hand.  What I wanted to talk in more depth is about “Making Weight”, and more generally about making sure that you athletes are getting enough nutrition to fuel your brains for school, your bodies for puberty, and your muscles for competition.  Some sports require weigh-ins to compete at certain weight levels or classes.  Others don’t have official weight classes, but there is a general belief that athletic performance is better at a very thin, low fat body make up.  You can probably tell me all about these sports, but some are wrestling, gymnastics, cheer, crew, endurance running, figure skating, etc.  There is actually a minimum percentage of body fat that a teen has to have to support your growth and health, and to make sure all your hormones are working properly to do their jobs.  For females, this is about 15% or more; and for males about 9% or more.

So, what’s the problem?  Well, often there is a demand by a coach or an inner drive from yourself, the athlete, to cut weight rapidly before competitions.  Crazy things are done to try to make weight or enhance performance.  Fasting, running in rubber suits, sitting in a sauna in a garbage bag, drinking no liquids, using laxatives and diuretics to pee and poop extra weight out, vomiting, even spitting to get spit weight out of you.   This is what I want to spend some time on.

OK, you’re young.  You’re healthy.  You’re an elite athlete for goodness sake.  Therefore, you are invincible and your body can withstand demands that would take the average teen down.  So you’re done reading this.  OK, wait a minute – read about these guys who thought they were invincible too.  This was big news in the late 90’s (yes, you were babies then, if you existed at all!) about 3 college athletes that died while doing their ritual of rapid weight loss and dehydration to make weight:

·         Billy Saylor was a 19 year old wrestler who died after using dehydrating practices trying to lose weight in order to qualify for his first college-wrestling match.   He riding a stationary bike in a predawn workout when he suffered a heart attack.

·         Jeff Reese was 21 and was trying to lose 17 pounds so that he could wrestle in the 150-pound weight class. He died after a 2 hour workout in a rubber suit in a 92-degree room.  He had rhabdomyolysis (massive muscle breakdown) and dehydration that caused kidney failure and heart malfunction.

·         Joseph LaRosa was 22 was riding a stationary bike and wearing a rubber suit when he collapsed and died.

You think this doesn’t happen anymore?  Here’s totally insane stuff I have heard from a bunch of people that still goes on in high schools. 
·         Run in a rubber suit (where do you get these things anyway?!) or a trash bag
·         Eat nothing.
·         Drink lemon juice and cayenne pepper (what?!)
·         Eat only 1 or 2 types of food – fruit / vegetable.  No protein.
·         Take protein supplements.
·         No eating before competition.
·         No drinking liquids before competition.

You get the idea.  What’s the craziest thing you guys have heard?  Have done?  Have seen done by a teammate?  Comments welcome below……

So back to what is the problem?

ONE: Dehydration is a huge problem.    Dehydration is defined as more than a 2% decrease in body weight with fluid loss alone.  So say you are 160 pounds and you take diuretics or water pills and skip drinking water for 24 hours and then run 4 miles in a Glad Bag.  You get down to 155 the next day.  That is a 3% fluid body weight loss – totally from dehydrating yourself.  So what?
·         If you don’t have enough liquid in your body, your kidneys and liver can be damaged and your electrolytes (sodium, potassium ,etc)  can get all messed up (that will then mess up your heart rhythm, or make it stop – hard to compete when your heart is not beating). 
·         Also without enough liquids in your system, you don’t have enough blood volume going through your heart – so then your heart cannot pump out blood effectively to your muscles and brain and all the parts of your body that need blood. 
·         Your body won’t be able to get rid of extra body heat and then you can get really sick from heat exhaustion or hyperthermia – and your muscles can start to break down and that protein from your muscles damages your kidneys to the point that you can need dialysis or die.
·         Abusing laxatives to poop out everything in your intestines or water pills to squeeze all the fluid out of you like a wrung sponge, or making yourself vomit to get rid of fluid are incredibly dangerous as well, and make all of these situations even worse.

TWO:  You need nutrition to grow.  The teen years are a time when you are building your body.  The body that has to last you for another 60, 70, 80 years.  You need even more nutrition to fuel the athletic demands.  There are a bunch of myths out there that lower body weight = better performance.  There is NO evidence that performing in a lower weight class as the biggest person improves chance of victory.  So let’s get rid of that myth right there.   So?
·         You will actually grow less without enough nutrition – you know, the Food Pyramid, or the My Plate – carbohydrates, proteins, fats, minerals….  Athletes should be having the higher end of the serving numbers on those plans.    3-5 servings it says?  You need 5.
·         Your bones will not be built properly and will be more likely to break.  How about female endurance runners at very low body weight (so low they stopped having their periods – more on that later) that got stress fractures in their legs?  They kept right on running, right on competing.  Then the top part of their femurs slipped over the lower part as that fracture gave way while they were running.  No joking.
·         Poor nutrition will mess up those hormones that are taking you through puberty.  The stuff that changes you from a boy to a man; from a girl to a woman.  Guys will have less testosterone.  For real.  Girls will have less estrogen – and that makes the bones even less strongly built.
·         During puberty into your 20’s you are building your bone up to the point that it will be its strongest.  Then through the rest of your life, especially for females, your bone gets thinner and you are more likely to break a hip or a leg or a wrist.  The more you have to start with, the better you are for the rest of your life.  Build now or never! So bones are an issue now, and an issue later.
·         Even if you correct all this stuff later, there seems to be a point that your body cannot catch up anymore to the growth it would have had if you had been feeding it what it needs all along.  And scarfing a pizza and 6 milkshakes after 2 days of fasting plus competition is not going to help.  Not to mention, that is not exactly fine nutrition either!

THREE:  You need good nutrition and fluids to concentrate in school.  Probably I don’t have to tell you that, since if you are honest with yourself, you know that skipping a bunch of meals and getting yourself dehydrated as a weigh in day approaches really messes up your test-taking success.  Seriously, most athletes tend to perform better in academics during their on-season; except for those in sports like wrestling where making weight is a key part of the training – these athletes are more likely to have mood swings, extreme fatigue, difficulty concentrating and lower grades.

Finally, there is another life-long effect of the cycle of making weight.  You know the pattern: 1) starve, fast, pee, poop, sweat, spit, cry – whatever it takes to get the weight down.  2) Compete.  (Underperform actually since many sports medicine studies have shown that endurance, muscle strength and competitive advantage are all LOWERED with these behaviors).  3) Go to Five Guys or Dominoes or whatever you have a hankering for and eat eat eat.  4) Repeat.

·         OK, the problem here is that this called “disordered eating”.  It can actually turn into an eating disorder. 
·         For more on those: <about bulimia>  <about anorexia>
·         You are learning your eating patterns now, so repeating an unhealthy cycle of binge / purge can stay with you forever.
·         And that cycling actually may affect how your blood vessels function later in life; may cause higher levels of bad cholesterol and total cholesterol too.  Both of which can add up to heart attacks and strokes later in life (more studies needed here, but a worrisome pattern).

 One last thing....:  Athlete’s Triad.  Short and sweet.  Female athletes that really take some of these behaviors to the extreme can have a trio of unhealthy problems.  1) disordered eating – or a full-blown eating disorder 2) osteoporosis (thin, weak bones) and  3)amenorrhea (no periods).  OK, so I know you’re thinking now “Yay!  No more periods!  Who needs the Curse anyway?!?!  But there is a problem actually.  Did you know that your periods and your bone strength are related?  That’s right.  Losing your periods due to extreme thinness or low body fat is a sign that your estrogen levels have dropped.  And you need estrogen to build up those bones.  So, low estrogen = weak bones (made worse by low calcium that is probably also going on in girls that avoid dairy like the plague to cut calories).  So the message is – if you stop having your periods, or your periods get really irregular after they already settled into a pattern for you, you need to see your doctor, since that is not normal.  And guys, you can have similar affects too (minus the whole periods thing, obviously) But definite effects on messing up bone building.

So, now you know what is important to avoid with the Making Weight problem.  Now, what can you do if your coach is instructing you and your teammates to engage in dangerous behaviors?  First of all, remember, in the end, you are responsible for staying safe and protecting your body.  So even thought it will be difficult, you can respectfully disagree or quietly ignore the unsafe recommendations.  Then go to a trusted adult, someone who has your back.  Such as your parent, a teacher, a school nurse, the principal.  And tell them what your concerns are.  Show them information – you can even print this out and show them this post!  Anything to get a discussion going.  If you aren’t sure what your coach in recommending is safe for you, ask your regular doctor.  They are the best person to help, since they know your body type, your stage of development puberty-wise, and what is a healthy fat percentage for you.  They can even provide medically rational and safe recommendations to meet your nutritional requirements for school, growth and athletics.  Now when you talk to your parents, you can even show them this link – it is information for parents to help them support kids who are being bullied by coaches – since it is hard for adults to know what to do sometimes too!  Adolescents and Bullying Coaches from Psychology Today
Whew!  That’s a lot of information – I hope you made it to the end.   I think we’ll stop here for today.  Next we can talk about something a bit more positive – what is good nutrition for teen athletes.  Some athletes take stimulants to reduce their appetite while keeping their energy up and hoping that helps weight loss.  Other athletes take protein supplements or creatine to improve performance at low weights.  We’ll touch a bit on the different supplements and why they are just expensive, no better than nutrients from food, and even often bad for you.  .  I know that more teens use ‘em than we adults think!   Let me know if there is anything else you want to talk about….  Comments encouraged!  You can even disagree!  I don’t mind.  That is how we all join the discussion.