Being an athlete has its own obstacles, but being an athlete and training with an autoimmune disease can really complicate things. Let’s talk about what an autoimmune disease is and what you can do as an athlete to best manage it.
What is an autoimmune disorder or disease?
Under normal conditions, your body lives in harmony. It recognizes your bones, tissues, and organs as ‘self.’ If bacteria or a virus enters your body, your immune system recognizes them as ‘foriegn’ and will attack. Your immune system is there to maintain the peace in your body. But when you have an autoimmune disorder or disease, your immune system has a glitch, and starts to recognize parts of your body as foriegn and attacks your own cells.
When your immune system attacks your body, it releases immune cells into that area of your body to kill off those tissues, cells, or organs. This self-attack can lead to tissue damage, declines in health, and other illnesses.
However, not all autoimmune disorders are the same. Some disorders or diseases will only affect a single organ. Whereas others may only impact certain types of tissues (such as your joint), while others might impact your entire body.
Some of the most common autoimmune disorders include:
- Celiac Disease: affects the villi of the small intestine.
- Irritable bowel syndrome: affects the large intestine.
- Lupus: affects the kidneys, liver, skin, blood, heart, and lungs.
- Rheumatoid arthritis: Primarily affects joints.
- Type I diabetes: Affects beta cells in the pancreas.
Autoimmune Disease and the Athlete
Living with an autoimmune disease is a serious task in itself, but what about if you are an athlete with an trying to train with an autoimmune disease?
Typically, training results in inflammation and reduced immune function in the average athlete. If the average athlete without an autoimmune disorder does not prioritize nutrition and recovery, they are in for a world of hurt…literally. But if you are an athlete and are living with an autoimmune disease, your ability to train and recover is even more at risk.
An autoimmune disease can impair your ability to train, recover, and perform. Your symptoms may come and go depending on the type of autoimmune disorder and the severity, but it will likely at some point affect your training. Flare ups are driven by an increase in inflammation, which is in abundance if you are an athlete, especially a strength athlete.
This doesn’t mean you cannot train without risking your health, it just means you have to take extra precautions to take care of your body.
Training with an autoimmune disease
When training with an autoimmune disease, the biggest battle you are going to face is controlling inflammation. The stress caused by training may be enough to induce a flare up, if the bout of training is extremely intense. In order to make training work, you may need to adapt your training in accordance with how you feel.
If your training has been going well, your symptoms are minimal, and your recovery has been on point, then you are going to be in the prime position for a heavier training block. However, if you are tired, run down, and dealing with some emotional stress, then a couple of light recovery days are likely what you need. Work with your coach! If they know what you are dealing with, they will be in a better position to adjust according to how you are feeling/recovering.
In one study, Cullen et al. had participants cycle in intervals at 80% VO2 MAX for 4 minute intervals interspersed with 3 minute intervals at 50% VO2 MAX. The results showed a staggering 3 fold increase in inflammatory markers demonstrating that high impact (or intense exercise) significantly increased incidence of inflammation. Other activities, such as running or Olympic weightlifting, where there is high impact on the body, also likely significantly increases inflammatory markers.
However, research has also shown that lifelong training improves the anti-inflammatory environment in the body and helps maintain the number of regulatory immune cells that help keep the body in a state of homeostasis, or harmony. Additionally, lifelong training has been shown to actually prevent autoimmune disorders. Crazy!
Anti-inflammatory Diet to help regulate inflammation in athletes
Individuals diagnosed with an autoimmune disorder would likely benefit from following an anti-inflammatory diet. This consists of the following:
- Eat plenty of fruits and vegetables
- Eat good sources of omega-3 (n-3) fatty acids, such as fish, fish oil, or walnuts.
- Eat plenty of whole grains, such as brown rice and bulgur wheat
- Eat lean protein sources, such as chicken, and cut back on red meat and full-fat dairy foods.
- Cut back on animal sources of fat that aren’t grass-fed or pasture-raised animals
- Minimize consumption of saturated and trans fat
- Avoid refined food and processed foods
- Consume alcohol in moderation (see more on alcohol and training HERE)
- Add a variety of spices, especially ginger and curry to your diet
- Additional information can be found here: https://jandonline.org/article/S0002-8223(10)01555-5/fulltext
Following an anti-inflammatory diet is NOT the same as taking an anti-inflammatory agent! Ibuprofen and aspirin will not produce the same effect, or even a similar effect, as an anti-inflammatory diet.
Finally, avoid foods you have known allergies or intolerances to, which is very common among individuals with autoimmune disorders.
Put it all together
To reduce inflammation and keep your body recovered, here is what we recommend when training with an autoimmune disease:
- Your recovery must be on point! This means sleep, nutrition, and other recovery methods are being implemented daily.
- Manage your stress! Stress can adversely affect recovery and can suppress the immune system.
- Adjust training when you know you will be under-recovered or are feeling under-recovered.
- Work with your doctor on following an anti-inflammatory diet to minimize non-training inflammation in the body.
Want more? Check out Episode 115 of Empowered by Iron where we discuss this topic in detail!
The Rise of Autoimmune Disease: https://www.glutenfreesociety.org/the-rise-of-autoimmune-disease/
Autoimmune disease is controlled by genetic and environmental factors. Both of these affect susceptibility to autoimmunity at three levels: the overall reactivity of the immune system, the specific antigen and its presentation, and the target issue: https://www.nature.com/articles/nm0801_899
Gleeson, M., Bishop, N. C., Stensel, D. J., Lindley, M. R., Mastana, S. S., & Nimmo, M. A. (2011). The anti-inflammatory effects of exercise: mechanisms and implications for the prevention and treatment of disease. Nature Reviews Immunology, 11(9), 607–615. doi:10.1038/nri3041
Lifelong training improves anti-inflammatory environment and maintains the number of regulatory T cells in masters athletes: https://link.springer.com/article/10.1007/s00421-017-3600-6
Cullen, Tom, et al. “Interleukin-6 and associated cytokine responses to an acute bout of high-intensity interval exercise: the effect of exercise intensity and volume.” Applied physiology, nutrition, and metabolism 41.8 (2016): 803-808: https://www.ncbi.nlm.nih.gov/pubmed/27377137
Tibana, Ramires A., et al. “Corrigendum: Two Consecutive Days of Extreme Conditioning Program Training Affects Pro and Anti-inflammatory Cytokines and Osteoprotegerin without Impairments in Muscle Power.” Frontiers in physiology 9 (2018): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4924482/
A diet low in arachidonic acid ameliorates clinical signs of inflammation in patients with RA and augments the beneficial effect of fish oil supplementation. https://link.springer.com/article/10.1007/s00296-002-0234-7