Inflammation Demystified: Where Endurance Training and Autoimmunity Meet

posted about 1 year ago in Training

Those of us with an autoimmune disorder, like Crohn’s disease, are in a constant state of managing inflammation and dealing with the systemic disruption and damage that can happen when inflammation gets out of control. Long cycles of endurance training can exacerbate inflammation, with symptoms and impact similar to what we see with autoimmunity, making continual training more difficult and increasing the likelihood of injury.

Creating inflammation is one of my superpowers—when diagnosed with Crohn’s disease in 2012 the screen for inflammatory bowel disease (IBD) came back showing inflammation levels 100x over normal. It wasn’t until I combined a ketogenic diet with endurance training that my tests (hsCRP, ESD, and homocysteine levels) started coming back normal. Balancing inflammation while growing my strength and endurance with the chronic wildfire that went along with my Crohn’s became one of the primary ways I manage my overall health.

How I Learned to Stop Fearing Inflammation and Love Training Adaptations

My first attempt at training was with a goal to ride 50 miles in just six weeks after being too sick to even ride a bike for several years. Through that process I inadvertently rebooted my body and eventually put my Crohn’s into deep remission by giving my body something to apply all of that heightened response to. I learned inflammation wasn’t out to get me, but is a complex physiological process, a flood of chemicals, histamines, and cytokines triggered by the immune system to promote healing. My body had been fighting a war against an invasion that didn’t really exist—by consistently and repeatedly putting in effort that pushed my body to new capabilities, I started forcing adaptations that were health-promoting, instead of damaging.

Inflammation in athletic recovery is what sets of healing the microtrauma done to the muscles by the physical activity, leading to changes in the body we associate with strength, resilience, and performance. But we need just the right amount. Recovery strategies—sleep, proper nutrition,hydration, and supplementation—can help optimize inflammation making recovery faster and more efficient.

This is what is known as acute inflammation, a short-term response (similarly in fighting infections or healing wounds) that resolves itself in a few days. With chronic inflammation, like what I've experienced with Crohn's, the immune system remains in an activated state unable to eliminate the perceived threat, leading to ongoing tissue damage and impairing the body's ability to heal. My first training ride was just 2.5 miles and my wife had to come pick me up, thoroughly exhausted at the end. But, I just kept waking up, following my training plan and experimenting with different ways to fuel and recover and my capacity steadily grew.

Endurance training cycles often include 6 to 7 days of activity (sometimes multiple workouts per day), making recovery even more important. The constant stimulation of inflammation may simulate a chronic inflammation response in athletes, or cause a flare for people with an autoimmune disorder. Using strategies to manage and reduce inflammation is key to optimizing training, recovery, and long-term success as well as keeping autoimmune symptoms in check.

Optimizing Inflammation Where the Rubber Meets the Road

Having a well-formulated training plan is ground-zero to minimizing the negative impacts of inflammation and keep away from pitfalls like overtraining. I started with a century ride training plan I downloaded and adjusted for my 50-mile timeframe, but quickly graduated to reading books, and buying plans from places like TrainingPeaks when I started tackling bigger goals, like my first triathlon two years later. When I hit a wall in training to run a half-marathon during the pandemic, I got into a semi-personalized bodyweight strength plan with a coach. If you can’t afford to hire a coach to put together a training plan for you, here are some things to look for:

Start with a reputable source. Look into the coach who designed the plan, do some research, look for testimonials that sound like people at the same training level. There are some great plans on TraningPeaks, including year-round plans from my coach, Menachem Brodie.
Gradual progression in training volume and intensity. Many plans start out with 10% distance gains week-over-week, which seems small but can significantly reduce injury risk and prevent overtraining.
Periodization and strategic rest days. Both of these strategies are key for adequate recovery, pushing the body to the max all the time and not taking rest days are surefire ways to set off a more intense inflammation response.
Incorporating strength training. Resistance training strengthens bone and connective tissue, but it also adequately prepares our energy systems for long training cycles. Early on in my training, I was just dealing with varying workouts, or just increasing my time in the saddle or distances I was running. Strength training not only made me stronger, but more resilient as my disease has ebbed and flowed through surgeries and training cycles.
Lower-impact cross-training like swimming or cycling helps build and maintain fitness while being gentler on the body. After my colectomy and abdominal surgery in 2022, I rented a Peloton (yes, you can rent!) and it has transformed my whole house.
A well formulated plan should allow for a generous range of variability and safety margin. How much rest and how well you are recovered greatly impacts what your body is ready for. Listen to your body and adjust workouts accordingly.

In addition to what is in the training plan, incorporating active recovery activities like foam rolling, light stretching, yoga, and mobility work can enhance training by promoting blood flow, reducing muscle tension, and improving mobility. Having a plan to properly fuel in and out of training provides the inputs needed to balance the output of all of the work done out on the trails, road, and fields. Fueling in-workout on longer efforts with gels, chews, ketones, and electrolytes is vital to keeping the body hydrated and from running out of glycogen stores, otherwise known as the dreaded bonk. Outside of the workout, getting a well-balanced diet and avoiding processed food is the starting point.

Does My Dinner Make Me Look Inflamed?

Everyone has heard of a well-balanced diet, but there are no set definitions for “eating healthy”. When dealing with Crohn’s or Coliti, the individual variability and sensitivity to food makes this a hot-button topic (I should know, I’ve written a cookbook for the AIP diet!) In general, a balanced diet should be filled with nutrient-dense, whole foods and avoiding processed foods filled with preservatives and unhealthy oxidized fats. We often think of fueling or eating in terms of total calories (too much and you get fat, too little and you are tired and weak), but when we are training how-much-of-what really matters. One way to think about macronutrients (protein, carbohydrates, and fat) is how your body uses them. In the simplest terms, fat is fuel, protein contains the building blocks for every cell in the body, and carbohydrates (fiber, sugar, and starches) pave the way for a healthy gut and keep glycogen stores topped off in our muscles and brain. We need each of these micronutrients, but some more than others in different scenarios. Inflammation can double protein demands as the body goes to work to repair all of the microtrauma and and if you find yourself tired and unusually hungry in your training cycle, it is quite possible you aren't getting enough. Proteins are made up of amino acids, which the body uses for nearly every process and is critical for cell production. Runaway inflammation dramatically increasing the demands for amino acids, while things like leaky gut make it difficult to absorb nutrients is why it is so difficult to stop an autoimmunity flare or build muscle with Crohn's. Throughout my training, my weight remained quite low and it wasn’t until I put my Crohn’s into deep remission that I started to build muscle. After one surgery, I created what I called Miraculous Healing Mode, a protocol that went for optimizing protein synthesis using amino acid supplements and mineral co-factors, and resulted in a massive turnaround in my healing.

If you think about the demands endurance training, getting adequate amounts of protein to keep up with the increased need to rebuild and repair is the highest priority. Experts in protein synthesis are now saying that people who are active could need twice as much protein as the RDA of 0.8 grams per kilogram of bodyweight to 1.6 grams per kilogram of bodyweight, or about 0.7 grams per pound (learn a lot more here & here). Getting adequate protein is key to athletic recovery and preventing damaging levels of inflammation and timing for athletes matters as well. The best time to get some protein is after 20-30 minutes post-workout to about 2 hours after, when your body can utilize it most effectively. This is why recovery drink mixes and bars are protein-centric. Based on the research, it seems more optimal for the rest of the day to get around 3-4 ounces of protein several times per day rather than having large protein-heavy meals, where your body can’t utilize the protein for muscle repair. We also need micronutrients for protein synthesis, which can be found in what we season, spice, and pair our protein up with.

Healthy fats from things like olive oil and avocados, as well as Omega-3 fatty acids found in fatty fish, flaxseeds, and chia seeds are one of the most powerful sources for combatting inflammation. as are many herbs and spices, like turmeric,ginger, and Ceylon (Sri Lankan) cinnamon. Eating a variety of colors, like dark leafy greens, broccoli, Brussels sprouts, blueberries, blackberries, citrus fruits, and sweet potatoes is a powerful food-centric approach for healthy inflammation. One of my favorite inflammation hacks is to cook cored apples with their peels for about 30 minutes and blend them with some Ceylon cinnamon. Eating a 1/2 cup of the applesauce with peels daily has been shown to rival some steroid treatments for inflammation, and the pectin from the peels are a powerful protectant for the health of your gut lining.

The longer we train—and the more strain we put on our body—the higher the demands for micronutrients to keep everything functioning optimally. The most common example are electrolytes (magnesium, potassium, calcium, and salt) which we’ve been conditioned as athletes to add to our water, but just as these become depleted with exercise, so do a variety of vitamins and minerals. While it is best to try and get as much of your nutrients from whole foods, a solid supplement regimen can keep our energy up and protect against the damaging aspects of inflammation. Here are some of my top supplements to keep things balanced:

Omega-3s (triglyceride form). Most of us are not getting enough fatty fish like salmon and sardines in our diet. There is a wide range of quality and freshness in supplements, but there are some good lists for triglyceride form Omegas on the internet. I use a Pure Catch Wild Alaskan Salmon Oil from Costco. The benefits of Omega-3 are sort of incredible, here is a very detailed read, and podcast on the importance of these fatty acids to overall health.
Vitamins like a B-complex with methylfolate, C, D & K. It is worth finding out your vitamin D levels, as many people are deficient without even knowing it, even if you spend a lot of time outside.
I take essential amino acids (and grass-fed collagen) as a way to provide my body with aminos in a form that doesn’t need digested and experts have found that leucine is the primary driver for muscle growth, so this helps ensure I’m getting what I need. MAP Amino Acids and a powdered red algae called, Aquamin are the key components to my Miraculous Healing Mode.
Glutamine is an amino acid that can be a powerful addition for protecting and healing the gut lining as well as combatting the bloating and issues associated with eating wheat.
CoQ10 is a powerful antioxidant found in things like fatty fish, eggs, and nuts. Supplementing along with PQQ can help your body maintain healthy levels of inflammation as well as positively impact mitochondrial health (better recovery and energy levels!)

There are few recovery drinks that I like (many have ingredients I don’t really eat, or have protein sources that don’t work well for me), but the Swiss RX Recovery drink is fantastic. If you are doing intense endurance training, it can be hard to get enough food to fill your needs, and while the Swiss RX products are kind of expensive, they have very high quality ingredients, and is pretty much the only recovery product that has actually made me feel the difference.

Having spent thousands of hours with doctors does not make me a doctor. As with all supplemental recommendations, make sure you check with yours before diving into new regimens.

Inflammation as Stress Manifested in the Body

What we put into our body with food is not the only way we can give back to ourselves for the energy we are putting out in training, there are a number of practices that range from essential to powerful additions to your recovery.

Sleep is the most underrated activity we engage in, rebuilding and repairing our body and minds. Getting enough restorative rest and sleep is a game changer. I discovered that sleep dysregulation was a common issue for people with an ileostomy and I needed to up my game in order to get the kind of rest my body requires to stay active. Most days, I sleep with an eye mask and earplugs, which shows up as 15%-20% bump on my deep sleep according to my watch. There are so many great resources emerging on the power of sleep and how to create good sleep hygiene, like the book, How to Sleep.

Sleep is also critical to maintaining healthy levels of stress and inflammation. Stress is the x-factor for many diseases, including IBD. My daily meditation practice (going on 7 years) is one of the most powerful tools I have in keeping a tendency toward anxiety at bay. Studies have shown that just 15-minutes a day for 3-months shows measurable differences in how our brains operate and perceive stress. Pro-inflammatory hormones like cortisol and adrenaline are directly related to stress levels, and impact everything from digestion, insulin levels, and inflammation. Regular practices like meditation, journaling, and walking in nature, have been shown to dramatically impact our body’s ability to respond to stress in a balanced way.

Additional practices that can have a profound effect on recovery are foam rolling, massage therapy, sauna, cold-water immersion, and, of course, adequate hydration. Having an ileostomy makes staying properly hydrated with endurance training challenging because water reserves are largely stored in the large intestine. I’ve learned that smaller drinks of water more frequently (every 20-30 minutes) along with electrolyte supplementation (taken in smaller amounts of water so as not to dilute them too much) are necessary for me to keep at optimal hydration.

With a long career in technology, I do love a good gadget and there is a growing industry of recovery-focused tools ready to take every dollar. Many of these things can provide a benefit, but at what cost, and could an equivalent or similar benefit be had with things that I already have? One toy I have a percussive therapy device, similar to a Theragun, purchased from Amazon for about a third of the cost. Oura rings have become very popular, but I rely on my Coros watch for measuring sleep quality and my heart rate (heart rate variability in training is a pretty fascinating and effective approach.) The watch isn’t specialized for these things, but works well for me with all of the data I track. They are not as fun as magic rings and vibrating foam rollers, but I wear knee high compression socks for long runs, which help with blood flow and many people (myself included) report less fatigue and muscle soreness from wearing them.

Inflammation is the crossover point between those of us living with a chronic disease and people pushing their body with intense cycles of endurance training. Giving your body the tools to keep inflammation levels healthy is key for managing long-term success in reaching your goals as well as overall health. Taking just a few of these strategies and incorporating them into your daily routine and training cycles can have a profound effect. Just like with training, start slow and add things as you start to see improvements. Experiment, read, experiment more. Scheduling practices just like rest days, like long walks in a park, reading, or meditation into your day can be a simple way to get your mind to prioritize them just as you would workouts. And as training cycles wind down, you may find that you have created new habits that make you feel more energetic, less stressed, and healthier when training season is over.