Iron Man training, pt wants to go ” all in”

[Caroline Snelwar]

Hi

I have a 47 year old male who is competing in Spartan Race in November and then planning on Iron Man

He optimizes his health, diet wise and is a health coach.

Pt wishes to prevent further injuries and repair muscle and tendon injuries.
He has back and ankle osteoarthritis and is interested in growth hormone peptide and repair options.

Andropause: pt is taking Testosterone 150mg IM weekly from another provider.

I started him on Pentosan for injury repair twice a week.

I also wanted to prescribe CJC/ Ipa but as this was no longer available started him on Sermorelin 20 u am and pm SQ per protocol ( he is frustrated that we could not get CJC/Ipa), is this the case still?

He is having vivid dreams and he wakes up groggy which could be due to deep sleep.

Making some gains but I am wanting to switch him to Tesamorelin for fat loss and muscle gain.

It was suggested to use Thymulin to reduce inflammation as he trains, or instead SS31 and Methylene Blue for mitochondrial support.

Finally pt was looking into IGF LR3 and MGF which I have been told only comes in nasal spray form?

This guy wants to go ” all in”.

I am thinking that Tesamorelin, Pentosan and possibly SS31 would be more than enough.

I look forward to feedback to help move this patient towards his goals.

Thank you

Caroline Snelwar

 

 

 

 

 

 

[Anthony Castore]

This seems like a pretty well thought out plan. It is important to remember in addition to all of the optimization strategies being put in place, a solid foundation will set the stage for success:

Hydration I would start with iCell water 1 pack per day in addition to 3g taurine and 10g trelahose. Trelahose is not only a neutral osmolyte but, it also protects against cell stress and dehydration. Taurine, another neutral osmolyte, prevents oxidation of EFA, regulates electrolyte balance and is the only amino acid that can be metabolized in the heart. Sip this throughout the day to maintain cell volume and improve hydration

Ketone Esters 10ml 4x day (2 of the doses should be 30min pre workout and post workout on training days) Develops metabolic flexibility and spares glucose while improving the efficiency of the cell

AKG 1.5g pre and post workout kreb cycle support

Alka Seltzer gold 30min pre workout

Mitochondrial optimization:

Compounds

1. Methylene Blue (MB):

   – Mechanism: Acts as an electron carrier in the mitochondrial electron transport chain (ETC). It can accept and donate electrons, thereby bypassing damaged parts of the ETC and enhancing ATP production.

   – Benefits: Improves mitochondrial efficiency, reduces oxidative stress, and has neuroprotective effects.

2. MOTS-c:

   – Mechanism: A mitochondrial-derived peptide that regulates metabolic homeostasis and enhances mitochondrial function by activating the AMPK pathway.

   – Benefits: Promotes glucose utilization, enhances insulin sensitivity, and protects against metabolic stress.

3. SS-31 (Elamipretide):

   – Mechanism: Binds to cardiolipin, a lipid found in the inner mitochondrial membrane, stabilizing the ETC and reducing reactive oxygen species (ROS) production.

   – Benefits: Enhances mitochondrial efficiency, reduces oxidative damage, and improves mitochondrial bioenergetics.

4. 1-MNA (1-Methylnicotinamide):

   – Mechanism: A metabolite of nicotinamide that influences NAD+ metabolism and has anti-inflammatory properties. It supports endothelial function and may enhance mitochondrial function indirectly.

   – Benefits: Anti-inflammatory effects, supports endothelial health, and potentially improves mitochondrial function.

5. Nicotinamide Riboside (NR):

   – Mechanism: A precursor to NAD+, a critical coenzyme in cellular metabolism and mitochondrial function. Boosts NAD+ levels, enhancing sirtuin activity and promoting mitochondrial biogenesis.

   – Benefits: Increases NAD+ levels, promotes mitochondrial biogenesis, enhances cellular energy production, and supports longevity.

6. Trigonelline:

   – Mechanism: A plant alkaloid that influences glucose metabolism and has been shown to support mitochondrial function through its antioxidant properties.

   – Benefits: Enhances glucose metabolism, supports mitochondrial function, and provides antioxidant protection.

Synergy for Mitochondrial Performance and Biogenesis

Mitochondrial Efficiency and ATP Production

– Methylene Blue and SS-31 work synergistically to enhance mitochondrial efficiency. Methylene Blue acts as an electron carrier, optimizing the ETC function, while SS-31 stabilizes the inner mitochondrial membrane and reduces ROS production. Together, they improve ATP production and reduce oxidative stress, enhancing overall mitochondrial performance.

Activation of Metabolic Pathways

– MOTS-c activates the AMPK pathway, which is crucial for metabolic regulation and mitochondrial biogenesis.

Nicotinamide Riboside boosts NAD+ levels, further activating sirtuins and promoting mitochondrial biogenesis. This combination ensures robust activation of pathways that enhance mitochondrial function and increase the number of mitochondria.

Antioxidant Protection and Inflammation Reduction

– SS-31 and Trigonelline provide strong antioxidant protection, reducing oxidative damage to mitochondria.

-1-MNA adds anti-inflammatory benefits, supporting overall mitochondrial health and function. This combination helps protect mitochondria from damage, ensuring their optimal performance.

Enhanced Glucose Metabolism and Insulin Sensitivity

– MOTS-c improves glucose utilization and insulin sensitivity, while

Trigonelline supports glucose metabolism and provides additional antioxidant benefits. This synergy ensures efficient energy production and reduces metabolic stress on mitochondria.

NAD+ Metabolism and Sirtuin Activation

– Nicotinamide Riboside significantly boosts NAD+ levels, which is essential for sirtuin activation. Sirtuins play a critical role in mitochondrial biogenesis and function.

-1-MNA supports NAD+ metabolism indirectly, enhancing the effects of NR and promoting overall mitochondrial health.

Finally,

There is a new organism discovered that could be a beneficial addition:

Veillonella atypica is a gram-negative, anaerobic bacterium that has recently gained attention for its role in improving lactate metabolism, particularly in the context of athletic performance. This microorganism is part of the Veillonella genus, which is commonly found in the human oral and gut microbiomes.

Key Characteristics

Anaerobic Nature

   -Oxygen Sensitivity Veillonella atypica thrives in environments devoid of oxygen, such as the human gut.

   – Metabolism It primarily relies on fermentation processes to generate energy.

Gram-Negative Bacterium

   – Cell Wall Structure As a gram-negative bacterium, Veillonella atypica has a thin peptidoglycan layer and an outer membrane containing lipopolysaccharides, which can influence its interactions with the host immune system.

Lactate Metabolism

   – Lactate Utilization One of the defining features of Veillonella atypica is its ability to metabolize lactate. This is significant because lactate is a byproduct of anaerobic glycolysis in muscles during intense exercise.

   – Propionate Production: The bacterium converts lactate into propionate, a short-chain fatty acid that can be absorbed by the host and used as an additional energy source.

Discovery and Research

The potential role of Veillonella atypica in athletic performance was highlighted by a study published in Nature Medicine in 2019. Here’s a summary of the key findings:

Study Design

   – Researchers analyzed the gut microbiomes of elite athletes and non-athletes.

   – They found that Veillonella species, including Veillonella atypica, were more prevalent in the athletes’ microbiomes.

Experimental Evidence

   – Mice Experiments Mice supplemented with Veillonella atypica showed improved treadmill performance compared to control mice. This suggested that the bacteria could enhance endurance by metabolizing lactate.

   – Human Correlation Higher levels of Veillonella in elite athletes correlated with better performance and increased lactate metabolism.

Mechanism

   – The conversion of lactate to propionate by Veillonella atypica provides an energy boost during prolonged physical activity.

   – Propionate enters the Krebs cycle, contributing to the production of ATP, which is essential for muscle function and endurance.

There are other additions that could be used but, this is pretty robust. Making sure that the recovery is keeping up (in fact staying ahead) of the training is paramount, solid nutrition must be in place, optimize hydration before anything else, dehydration of 2.5% can adversely impact performance by 30%!!!!!

 

I hope this helps!! Keep us posted?

 

[Kristelle Reyes]

Thank you for this great input, @acastoregmail-com!

Hello, @byurthgmail-com, @drhusaininterlinkedmd-com, @dr-siobhannewmangmail-com, and @cpaigepaigemd-com, we would love to have your insights here as well. Thank you!

[Elizabeth Yurth]

Wow @acastore@gmail.com killed it here.

I would focus on using tesamorelin over sermorelin.

 

Agree with Anthony that iCell water and ketones are huge here!

 

Use pps , bpc with kpv (guttides from nubioage)  for recovery.

Also love myosMD which contains fortitropin to block myostatin and help muscle recovery.

But honestly ketones, iCell and 1MNA (3-4Caps ) gonna go a long way.

Anthony’s protocol great!!!

Dr Yurth

 

 

[Anthony Castore]

Thank you for your kind words, I learned from the best ? You ans the faculty of SSRP have taken my knowledge and results to the next level and I am grateful for this platform and the opportunity to learn. I will have to read up on ayosMD!

[Stephen Matta, DO, MBA, CAQSM]

I’m curious about the Methylene Blue.  I’ve prescribing Methylene Blue for a few years now and taking it myself.  I’ve been doing some research on it lately and I have some thoughts on MB and exercise.  While it does improve mitochondrial efficiency by acting as both an elector donator and acceptor, it also works by inhibiting NO synthase.  Seeing that in sports it’s often beneficial to boost NO via supplementation such as Beet root powder, I wonder if maybe using MB with exercise may counter some of that natural NO production with exercise.

Everything else sounds great.  I personally love the ketones as well.

[Anthony Castore]

This is a very good consideration!

I (personally) take mine in the morning (I am usually up at 4) and then train at 1pm.

Before the workout I supplement a high dose of citrulline as part of my personal protocol.

I have an NNoXX device that will measure local O2/ NO in muscle. When I get it set up I will test this out. I may reconsider only using it on my off days. What you say does make sense and I am curious as well.

[Elizabeth Yurth]

Hey guys!

This is actually a misconception of methylene blue I believe!

Methylene blue does not interfere with nitric oxide synthesis. It is a potent inhibitor of guanylyl cyclase, so MB blocks the release of cyclic guanosine monophosphate (cGMP), thereby preventing vascular smooth muscle relaxation without directly affecting NO synthesis. However, it does deplete glutathione, so be sure to take NAC!

https://meridian.allenpress.com/thij/article/43/1/103/85233/Methylene-Blue-Is-a-Guanylate-Cyclase-Inhibitor

EY

 

[Anthony Castore]

Thank you for this ?This is great information and clears it up!! Do you have any experience or data with the NNoXX yet Dr Yurth?

[Elizabeth Yurth]

I don’t, Anthony. You’ll have to educate me!!

[Anthony Castore]

The NNOXX device measures nitric oxide (NO) and oxygen levels in real-time. It continuously monitors nitric oxide and oxygen levels in the body during physical activity. It utilizes non-invasive sensors that can be placed on the It then collects data on NO and oxygen, which can be analyzed to understand the body’s response to different training stimuli.

Increased NO levels are associated with a greater “muscle pump”, which can enhance muscle activation and growth. By monitoring NO levels I am hoping to tailor training to optimize adaptations over time. The oxygen levels it monitors indicate how well the muscles are utilizing oxygen, reflecting aerobic capacity and endurance. My thinking is adequate oxygen supply is crucial for ATP production during aerobic metabolism, directly impacting performance.  By understanding oxygen levels I can help in optimizing recovery strategies, ensuring that muscles are adequately oxygenated post-exercise.

   I plan on collecting data along with subjective feedback and by monitoring NO and oxygen levels, i should be able to adjust training variables such as intensity, volume, and rest periods to maximize performance and muscle growth.

   For instance, higher NO levels may suggest that the muscles are primed for high-intensity work, while lower levels may indicate the need for more recovery or lower intensity.

   Real-time data can help in designing workouts that enhance blood flow and oxygen delivery to muscles, crucial for hypertrophy. Maybe techniques like blood flow restriction training (BFR) can be fine-tuned using NO and oxygen data to maximize their effectiveness.

   By understanding how NO and oxygen levels fluctuate during and after workouts, I can  implement targeted recovery strategies such as specific nutritional interventions, breathing exercises, or even hyperbaric oxygen therapy.

Tracking NO and oxygen levels over time can help in assessing the effectiveness of training programs and making necessary adjustments.

It will provide an objective measure of physiological adaptation, allowing for more precise and effective training cycles. I will have a lot of data. To collect and analyze but, along with the a velocity based trading device, PNOE and Indody I should be able precisely calibrate training for individual goals and specific outcomes.

[Caroline Snelwar]

I feel so honored to receive such great feedback and appreciate your help!

Thank you so much and I hope I can help this guy to get the gains he wishes to reach 🙂

 

Kind Regards

Caroline Snelwar

[Anthony Castore]

He will do great!! Please keep us posted and thank you for giving us the opportunity to contribute some thoughts on the case!!

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