Overtraining Research: New Insights into Athlete Triad. Plus: Depression, Palpitations, Urination, Injuries and Weight & Performance Plateaus, the Many Faces of Overtraining

Chronic overtraining is one of the main contributers to the occurrence of often likewise chronic injuries, which persist even, when you finally realized that your own ambition is about to ruin your health.

It's the last day of the SuppVersity Exercise Science Week with a topic of which you actually have read as an aside, or "read up on" note in the previous installments, already: Overtraining and the infamous athlete's triad (read the whole SuppVersity Special here). Since I know that especially the male SuppVersity readers tend to believe they were bullet, or rather overtraining proof by nature, I decided to add a more general follow up to the results of a tightly controlled rodent experiment from the Graduate School of Sport Sciences at the Waseda University and the National Institute of Health and Nutrition University in Japan (Yanaka. 2012), which provide insights into the etiology of the (female) athlete triad phenomenon. A follow up with a potpourrie of studies pertaining to hard to diagnose pathology that goes by the name "overtraining" and is something I guess every training has experienced at least once in his or her career.

The female athlete triad - female only by definition

While Kaoru Yanaka, Mitsuru Higuchi and Yoshiko Ishimi follow the current scientific paradigm and discuss the problem in a female specific context, I want to remind everyone that the athlete triad, which is defined as the triad of eating disorders, amenorrhea, and osteoporosis is in fact female specific (at least I have not yet seen a guy with amenorrhea), but will - in a very different, much more subtle form featuring orthorexic eating patterns, loss of libido and general fatigue - also occur in men.

Figure 1: Time effect of restricted feeding on body weight, food intake and voluntary wheel running in sedentary + ad libitum diet (full filled rhombus; obviously not present in the running distance graph), vol. exercising + ad libitum diet (filled circles) and dietary restricet + ad libitum exercised rats (Yanaka. 2012)

As the data in figure 1 goes to show you, the ergolytic effect on endurance exercise performance was very short-lived and compensated for, when the body weight levels reached a new steady state (see figure 1, left). In other words, once you're caught in the spiral, you will probably not even notice this due to further weight loss and/or noticeable performance declines - specifically if you are not strength training or put an (over-)emphasis on volume training.

Weakening bones and infertility in the presence of (in parts) normal hormonal status

What's even nastier and actually different to human studies, where the "voluntary" exercise is actually compulsive and thus probably way more demanding, is the fact that even some of the hormonal you would expect to be good indicators of the athlete triad, namely estrogen (E2 and osteocalcin (OC), don't differ between the ad libitum and the restricted feeding group.

Figure 2: Levels of estrogen (E2), the bonebuilding protein osteocalcin (OC) and luteinizing hormone (LH) in the sendentary (SED) and voluntary wheel running ad-libitum (RC) and restrictedly fed (RR) rodents (Yanaka. 2012)

That being said, LH remains as the sole, reliable marker of the athlete's triad in response to insufficient food intakes. Whether it is similarly sensitive to overtraining and how the interaction between these two aspects of the athlete triad actually are (beyond increased energy needs in response to exercise) would yet have required a different study protocol, which the rodents being dumped into a container full of water to have them swim to exhaustion on a daily basis. What? That's animal abuse? True. It is however the perfect model for what I see people do at the gym day in and out - the same people who will then tell me that they cannot get rid of their belly fat, although they are "on a calorie deficit, avoid carbs like a plague, eat 100% clean and never miss a workout". My reply in these cases usually is: "You see, and that's why!"

A couple of additional findings on overtraining

Since I know that many of you will simply ignore the above post, because they feel that it does not affect them (don't tell me that's not you, guys ;-), I will summarize a handful of significant findings from general studies revolving around "overtraining" in general.

Table 1: Symptoms of overtraining (Fry. 1992)

• 10 days of 2x daily HIIT induce fatigue and compromise immune system for longer than 5 days (Fry. 1994) -- The five well-trained men (mean(s.d.) age 31.6(3.5) years; members of the Special Air Services Regiment of the Australian Army) who performed 15x 1 min HIIT protocols (2min rest between sprints) and 10 "sets " of the same protocol in the PM for ten days were unable to fully recover from this intermediate overexertion within the following 5 days of active recover.
  
  And while the overall mood disturbance index was remained only nonsignificantly 15% elevtet (p > 0.05), the soldiers felt still 7x more confused, 5x more depressed, 6x more angry.
  
  The exercise performance, on the other hand was restored to normal levels and that despite persistent immune system deficits. This is in line with the findings of the above rodent studies, where the volume of voluntary wheel running was not a reliable criterion to identify overtraining / undereating. So you better be careful about the "well, I did my 10 squats with 250lbs as usual"-mentality that lulls us into the believe that we are fully recovered and just did not sleep long enough and therefore feel fatigued.

• 

  It's not in table 1, but not just in the case report by Uusitalo et al. from 2004, frequent urination (especially nightly) is one of the classic features of severe overtraining.

  Overtraining induced depressive mood state is not related to depressed 5-HT reuptake, but tinnitus, palpitations & frequent urination are additional symptoms of OT (Uusital. 2004 & 2006) -- Contrary to what you could assume the OT induced depressive mood states are not mediated by decreased serotonin reuptake, which means that they will be resistant to the standard treatment with serotonin-reuptake inhibitors (SSRIs). With this study the scientists did by the way refute a hypothesis they themselves had proposed in a study 2 years earlies, where single-photon emission computed tomography (SPECT) of a single patient had suggested that it was a decreased 5-HT uptake that was behind the major depression he had in addition to continuous fatigue, tinnitus in his left ear, disturbing palpitation and pollacisuria (frequent urination) he had developed after upping his training volume by 100% (Uusitalo. 2004)

• High intensity + low rest times = increased risk of overtraining (Szivak. 2012) -- In Szivak et al.'s 2012 study, the 18 trained men (age: 23.5±3.5 years, height: 172.4±4.0cm, weight: 77.8±8.8kg) and women  (age: 22.9±2.0 years, height: 168.4±9.4cm, weight: 68.5±10.4kg) completed high intensity short rest protocol (HI/SR) participated consisting of a descending pyramid scheme (from 10 down to 1 rep) of back squats, bench presses, and deadlifts. The ensuing increases in lactate (IP men: 17.3 mmol·L, IP women: 13.8 mmol·L) and cortisol (+15 men: 1860.2 nmol·L; +15 women: 1831.7 nmol·L) were considerably greater than those produced in typical resistance exercise programs. The scientist interpret this absorvation as indicative of the fact that coaches should implement HI/SR protocols only sporadically, and prefer a gradual reduction in rest interval length with concurrent gradual increase in intensity to minimize potential negative effects such as non-functional overreaching.

• 

  The self-perpetuation viscous cycle of upping your efforts, decreasing your returns and reupping your efforts again is actually the real danger - and I don't care if you call it overtraining or athlete triad + suggest you don' either (learn more)

  Mental exhaustion and vigorous-intensity training are significant correlates of the occurrence of injuries (Vetter. 2010) -- While mental exhaustion during and outside of the competitive season is a risk for chronic injuries in women, in men, only intra-seasonal mental exhaustion correlates with acute injuries, the occurrence of which is likewise increased with the number of vigorous-intensity training days per week, which in turn is a reliable predictor of mental fatigue in the off and on-season. You see, we are going round in circles once more.

• Hitting it hard to frequently will downregulate the beta-2 adrenergic receptor (Fry. 2006) -- If you are fatiqued and stims have long seized working for you, you are likely to be chronically overtraining. That's the practical implication of a 2006 study by Fry et al. who found that subjects who performed 10 x 1 at 100% 1 RM daily for 2 weeks on a squat simulating machine, ended up suffering from a -8kg decrease in their 1-RM max, as well as a -36.3% decrease in mean power at 100% 1-RM loads. While this was to be expected and not actually new, the -37% reduced muscle beta(2)-adrenergic receptor density and 49% increases in nocturnal urinary epinephrine in the overtraining group suggest a
  

  "decreased beta(2)-AR sensitivity for the OT group (2.4-fold increase) [suggesting] that this may be an important contributor to performance decrements due to excessive use of maximal resistance exercise." (Fry. 2006)

  That this will likewise compromise your efforts to lose weight and blunt many of the beneficial fat loss effects you may have in mind, when thinking about brief, hard and frequent training, is not mentioned in the paper and should yet be as obvious as the cardio-protective effect of this adaptations. After all, the beta-adrenergic receptors, which are targeted by endogenous catecholamines and stimulated either directly or indirectly by many stims (most prominently clenbuterol and ephedrine) are responsible for the activation of the sympathetic nervous system, which mobilize the body's nervous system fight-or-flight response, increase the heart rate, widens the pupils, kicks the fat out of the adipocytes to have it available as additional fuel etc.

That's not the breakfast of a champion, that's the breakfast of a complete moron and if that's even remotely to what your breakfast looks like, it's high time to learn about the 3 Simple Rules of Sensible Supplementation

I guess you would like to have some supplement recommendations now, but I won't give you any - aside from the advise to abstain from cortisol blockers and the abuse of stimulants, which are only going to deepen the whole you have been digging (on a related note: I suggest you check out the recent facebook post on the -80% risk reduction for obesity in women with high morning cortisol; Manesh. 2012).

Adequate rest and nutrition cannot be compensated for by any supplements and if you allow yourself both, you won't be overtraining in the first place.

Once you have established that baseline, you are obviously free to use the Three Simple Rules of Sensible Supplementation to optimize your results.

References:

• Fry RW, Morton AR, Garcia-Webb P. Craford GPM, Keast D. Biological responses to overload training in endurance sports. Eur J Appi Physiol 1992; 64: 335-44.
• Fry RW, Grove JR, Morton AR, Zeroni PM, Gaudieri S, Keast D. Psychological and immunological correlates of acute overtraining. Br J Sports Med. 1994 Dec;28(4):241-6.
• Fry AC, Schilling BK, Weiss LW, Chiu LZ. beta2-Adrenergic receptor downregulation and performance decrements during high-intensity resistance exercise overtraining. J Appl Physiol. 2006 Dec;101(6):1664-72.
• Uusitalo AL, Valkonen-Korhonen M, Helenius P, Vanninen E, Bergström KA, Kuikka JT. Abnormal serotonin reuptake in an overtrained, insomnic and depressed team athlete. Int J Sports Med. 2004 Feb;25(2):150-3.
• Szivak TK, Hooper DR, Kupchak BK, Apicella JM, Saenz C, Maresh CM, Denegar CR, Kraemer WJ. Adrenal Cortical Responses to High Intensity, Short Rest, Resistance Exercise in Men and Women. J Strength Cond Res. 2012 May 3.
• Uusitalo AL, Vanninen E, Valkonen-Korhonen M, Kuikka JT. Brain serotonin reuptake did not change during one year in overtrained athletes. Int J Sports Med. 2006 Sep;27(9):702-8.
• Vetter RE, Symonds ML. Correlations between injury, training intensity, and physical and mental exhaustion among college athletes. J Strength Cond Res. 2010 Mar;24(3):587-96. 
• Sedaghat F, Rabiei S, Rastmanesh R. Bassak Nejad S, Poloi Shahpor Abadi F, Davoudi I. The Relationship between Serum Cortisol and Vitamin C Levels with Obesity. Jundishapur Sci Med J. 2012;11(4):341-353 
• Yanaka K, Higuchi M, Ishimi Y. Effect of long-term voluntary exercise and energy restriction on bone mineral density in mature female rats. J Phys Fitness Sports Med . 2012; 1(4): 695-702.