Cancer and the Athlete

Measuring health by how far you can run is a bad metric. So is using the bench press as a measure of anything other than a bench press.A run is just a run and a bench press is just a bench press. Health and performance are something altogether different and far too complex for any single measure says Dr.Art Devany

More of us should take note of Dr. Devany’s observation. Endurance athletes often mistake fitness for health and well being; be warned they are not interchangeable.

Over the years we have written about the dangers posed to athlete health by overdoing it training and racing. We are prompted to do so again because of the emergence of an alarmingly consistent body of evidence that shows endurance athletes can face major illness threats from mismanagement of their immune systems over time.

 While the popular online press is awash with some fairly tabloid depictions of cancer-riddled ultra endurance types succumbing in their thousands,

 it’s vital to take a step back and examine the mechanisms of immunity, the adaptive processes, and sensible management strategies – before jumping to sensational conclusions.

Oxidative stress

One of the prime movers in deprecating athlete immunity is oxidative stress. Although life-giving volumes of oxygen are taken in and processed with breath-taking efficiency by a fit athlete, excess oxygen does have a nasty flip-side. You see, oxygen can spawn unstable molecules known commonly as free radicals. Free radicals or ‘oxidants’ are atoms or groups of atoms missing an electron – thereby making them highly unstable.

Within a regime of modest exercise effort, the body adapts well; under repeated heavy training loads however the body’s ability to cope with the oxidative stress levels is diminished – all other things being equal.

Understanding the deleterious effects of prolonged exposure to extreme oxidation is one thing, convincing the near obsessive-compulsive endurance athlete to do something about modifying their behaviour is another thing altogether. So much of an athlete’s identity is bound up in their controlled world of exercise. In looking to adjust training (and behaviour) patterns hard-wired to an individual’s self-esteem it is worth considering the service of a sports psychologist in conjunction with your sports medicine practitioner. This is preferable to repeated bouts of illness and poor health.

When the body is exposed to oxidative stress, widespread damage may result. At high concentrations free radicals can damage fats, proteins, and nucleic acids. They can also cause cell death, gene mutations, and cancer ( Moslen MT 1994). Several diseases may be the result of cellular and genetic damage caused by free radicals, including several immune disorders ( Moslen MT 1994).

Antioxidants are valuable because they pair with unstable free radicals, eliminating the damage free radicals can inflict on other cells. Because of their ability to scavenge free radicals, antioxidants are important immune-system boosters.

Antioxidants

Natural antioxidants like vitamins A (sunlight, cod liver oil) C and E (which are prevalent in fruits and vegetables) provide robust defense against oxidative damage. As always, a diet rich in fruit and vegetables and bereft of processed and refined junk is the first factor to get right in the anti-oxidation battle.

Vitamin E is a powerful fat-soluble antioxidant. It protects cellular membranes of the immune system and other cells by trapping free radicals and enhances the effectiveness of lymphocytes (Kaminogawa S et al 2004).

Vitamin C is integral to an efficacious immune system and bulwarking antioxidant defense (Kagan VE et al 1991; Kagan VE et al 1992; Peters E et al 1993). It prevents the creation of free radicals and minimises DNA damage in immune cells.

Lipoic acid is a powerful antioxidant with antiviral, free-radical-diminishing, and immune system enhancing attributes. Diabetics should consult their physician before using Lipoic Acid as it is a compound which lowers blood glucose levels.

Both COQ10 and whey protein provide powerful antioxidant and immune boosting support.

A naturally-occurring antioxidant currying favour in some immunological quarters is grapeseed extract. The antioxidants in grape seed extract are twice as potent as vitamin E and four times as potent as vitamin C (Bagchi D et al 1997; Bagchi D et al 1998).

Chemicals in grape seeds known as proanthocyanidins have potent antioxidant and immune-boosting properties (Ashraf-Khorassani M et al 2004; Bagchi D et al 1997; Bagchi D et al 1998).

Researchers are not suggesting that people begin consuming grape seed extract madly because no one is certain about the potential side effects of taking the extract, but they have found that grape seed extract has the ability to slow the growth of colorectal tumors in both cell cultures and in mice by 44 percent.

In the study, the University of Colorado Health Sciences Center in Denver researchers were also able to determine the molecular mechanism by which grape seed extract works to inhibit cancer growth.

In 1999, the same researchers discovered that grape seed extract was effective in skin cancer. Later pre-clinical work demonstrated that the extract slowed the growth of prostate cancer cells. It’s potency as an anti-oxidant and immune booster shows promise.

Skin cancer and athlete immunity levels

In their 2000 research into then effects of exercise on lymphocytes and cytokines Pedersen & Toft of the University of Copenhagen discovered that during an acute bout of exercise, immunocompetent cells are mobilised to the circulation. After strenuous exercise, the lymphocyte count declines below baseline, whereas the concentration of neutrophils continues to increase. . In response to exercise, a pronounced increase in both proinflammatory and anti-inflammatory cytokines is found. All these factors indicate a strong inflammatory response during strenuous exercise. This means exercise produces concomitant inflammation and immune impairment.

The clinical consequences of repeated hard exercise are subclinical and clinical infections. The explanation may be that virus and bacteria gain a foothold after exercise by the time of the “open window” with altered immunity. The underlying mechanisms are multifactorial and include both neuroendocrinological and metabolic factors.

Even high levels of anxiety are associated with decreased immune function (Ironson G et al 1990; Koh KB et al 1998; Boscarino JA et al 1999; Kiecolt-Glaser J et al 2000).

Another recent research finding which raised eyebrows was that of Ambros-Rudolph CM et al. “Malignant Melanoma in Marathon Runners”, Arch Dermatol 2006, 142(11):1471-74. Prague meeting reported in The Guardian (UK), November 10, 2006: “Researchers use body’s immune system to fight skin cancer”, by Alok Jha.

In the study, scientists at the Medical University of Graz, Austria, evaluated 210 marathon runners — 166 men and 44 women age 19 to 71. One of their findings was that the marathoners had more atypical moles and “liver spots” than non-runners; higher numbers indicate a greater risk for malignant melanoma.

On face value you would immediately blame increased UV exposure by way of skimpy shorts and mid riff tops for this result. Certainly, inadequate external protection is a contributing factor. Only 56 percent of runners in the study reported wearing sunscreen. Most were unaware of the increased risk to their skin. The researchers emphasised the need to remind athletes to wear the right gear and regularly use sunscreen.

Many runners race with a lot of skin exposed. And sometimes training clothing covers different areas than racing clothing. Shoulders that are covered during training may be exposed during the long hours of a marathon.

The Austrian researchers actually state that it’s the sun-exposure factors “in addition to possible weakening of the immune system caused by extreme training” that may increase athletes’ skin cancer risk. Not sun exposure alone. Digging deeper beneath the apparel and sunscreen layer its the suppression of the immune system caused by excess oxidative-driven tissue damage that is dropping the guard of the endurance-addicted.

So what do we draw from this body of knowledge?

Endurance athletes like those who immerse themselves in excess work and emotional stress place their immune systems under threat by excessive exercise, particularly if recovery and nutrition are sub optimal.

In terms of training and racing you need to have a long hard look at yourself; your outlook, expectation and behaviour as an athlete. Are you addicted? If you require counsel, seek it, as any addiction can tip the scales to abuse and ill-health readily enough. If you are going to be overzealous try being staunch about your recovery and diet.

Nutritional supplementation may in principle protect against the increased risk of infection in the recovery period after strenuous exercise. Start paying serious attention to your diet; nutritional quality and relevance. Consider supplementation in consultation with a nutritionist (fitnet) and investigate the supplements touched on in this article.

Wear sunscreen and UV reducing clothing – let’s face it the ozone layer is not getting any thicker.