Rhabdomyolisis, is not a Crossfit issue, it is a Metabolic issue!

What man does not understand, he fears; and what he fears,

he tends to destroy (unknown).

The condition of Rhabdomyolysis (Rhabdo) is not isolated to the practice of Crossfit. Has Crossfit created more awareness around the condition of Rhabdo? Absolutely, however I think understanding why this might be true is very important. As a former Exercise Rehabilitation Coach, I will admit my own skepticism around Crossfit. Now, as a current “Crossfitter” I would have to agree there are individuals who may not be as prepared to meet the physical demands present in the typical Crossfit WOD (workout of the day). This does not mean I think they can’t and/or shouldn’t, however it can be a dangerous game for many when not properly supported. The goal of this article is to provide awareness and insight into how you can enjoy and benefit from the workout of your choice no matter what the intensity.

EastWest Healing and Performance educates people across the world in how to support the healing and restoration of metabolic function using nutrition. The breakdown in metabolic function is the common denominator in all degenerative diseases as well as the cause and influence over the condition of Rhabdomyolysis.

Normal Muscle Breakdown

Muscles go through a constant process of breakdown (catabolism) and rebuilding (anabolism). Under the influence of intense exercise muscle fibers undergo trauma in which there is a disruption to muscle cell organelles. This disruption activates skeletal muscle satellite cells or mononucleated myogenic cells. These cells act as a reserve population of cells able to proliferate in response to injury and give rise to regenerated muscle. The muscle cells myofibrils increase in thickness and number serving as a source of new nuclei to supplement the growing muscle fiber.

Hormone like compounds, known as growth factors, are key regulators of satellite cells. While each play a role in the stimulation and migration of these nuclei others support the formation of new blood capillaries during muscle regeneration. Insulin -like growth factor-I and –II (IGF’s) have been a primary focus of research in the area of muscle regeneration. IGF’s play a primary role in regulating muscle regeneration promoting changes occurring in the DNA for protein synthesis and promoting muscle cell repair. Insulin itself stimulates regeneration by enhancing protein synthesis and facilitating the entry of glucose into the cells. Satellite cells use glucose as a fuel thus enabling their cell growth activities. Glucose is also used for intramuscular energy needs.

What is Rhabdomyolysis?

Rhabdomyolysis (Rhabdo) is the identified as a rapid breakdown of skeletal muscle tissue resulting in the leakage of myoglobin into the urine (myoglobinuria) and elevated levels of creatine kinase (CK). The severity of symptoms can range from asymptomatic elevations in serum muscle enzymes to life-threatening disease associated with extreme enzyme elevations, electrolyte imbalances and acute kidney injury.

Symptoms are not limited to muscle swelling, pain and weakness and can also include:

· Nausea

· Vomiting

· Confusion

· Coma

· Abnormal heart rate

· Dark “tea colored” urine (presence of myoglobin)

What causes Rhabdomyolysis?

Any form of muscle damage of sufficient severity can cause Rhabdo, such as extreme exercise exertion (crossfit, triathletes, etc), metabolic syndromes (hypoglycemic state, hyperosmolar state, hyponatremia (loss of sodium and water retention) and hypokalemia (loss of potassium), low body temperature, and drugs such as statins (cholesterol lowering drugs) and SSRI’s for depression.

The link between Rhabdo and Hypothyroidism

Rhabdo is a result of muscle cell death, which can be triggered by a number of initiating events. As described by Mark Miller, MD, the final common pathway for injury is an increase in intracellular mitochondrial calcium. This may be caused by depletion of ATP, the cellular source of energy, and/or by direct injury and rupture of the plasma membrane. The latter pathway of injury also results in ATP depletion.

The increased intracellular calcium leads to activation of proteases, increased skeletal muscle cell contractility, mitochondrial dysfunction, and the production of reactive oxygen species, resulting in skeletal muscle cell death. ATP depletion leads to myocyte injury and the release of intracellular muscle constituents, including creatine kinase and other muscle enzymes, myoglobin, and various electrolytes.

Under normal conditions our cells use sugar to produce energy: ATP, CO2 and water. Under excitation our cells begin to take up water, estrogen and calcium, which alkalizes the cell, increasing the cells affinity for water, thus increasing glycolytic conversion to lactic acid. This slows metabolic rate, decreases body temperature, leading to a hypometabolic state, hypoglycemic state and calcification of the mitochondria. Entering into any exercise program without the proper nutritional and lifestyle support for your metabolic needs will stimulate the process of Rhabdo.

“When hypothyroidism is severe, it can cause myopathy, in which the pain swollen condition involves leakage of muscle proteins (especially myoglobin) into the blood stream. The combination of hypothyroidism with fatigue and stress can lead to the breakdown and death of cells, rhabdomyolysis.” – Ray Peat PhD

Carbon dioxide (CO2) is the driving force behind energy production and sodium in the body. The constant formation of CO2 drives salt excretion, inhibiting the formation of CO2 prevents the excretion of sodium. Since cellular respiration is driven by thyroid hormone and CO2’s main source of production is thyroid hormone, we can conclude that any thyroid deficiency will impair our ability to regulate water and sodium.

According to Ray Peat PhD, hypothyroid is associated with increased prolactin, which perpetuates sodium retention and leads to hyponatremia, low levels of sodium in the blood. Hypothyroid people also fatigue easily taking up more water than normal during exertion. According to western medicine, a symptom of Rhabdo is swelling of damage muscle tissue and hyponatremia.

Additionally, Broda Barnes, MD identified high cholesterol as a marker for hypothyroidism. Our cells use cholesterol to make all our steroidal hormones to fight inflammation, regulate blood pressure and blood sugar. Cholesterol is one of the largest anti-oxidants in the body and will increase under any form of stress. This happens so our cells can use cholesterol for the purpose of adaptation to what we are doing. If the body’s cells are not equipped with the proper levels of thyroid hormone for CO2 production and we are under constant stress, cholesterol will continued to be produced but prevented from being converted. It is common-place these days for MD’s to prescribe statins to lower cholesterol. “Blood lipid lowering drugs impair mitochondrial respiration and increase the incidence of rhabdomyolysis (Barker et all 2003)”

If you are looking to begin any exercise program here are some great ways to properly support your metabolism for the added demand exercise places on the body.

1. Don’t eat Paleo! I know, I know…this can be a bit threatening to many Paleo fanatics out there. But please know this is not only about Paleo. EastWest Healing and Performance does not promote any one diet but believes the proper diet for anyone person is based solely off the metabolic state. Sorry guys, but this is one reason why so many crossfitters get Rhabdo. Remember our cells need sugar to not only produce energy but to produce thyroid hormone. You can’t regulate blood sugar with 60g of carbs per day. Doing this forces the body into adapted alternative energy production, which over time weighs heavily on metabolic health. Lack of glycogen intake and storage forces the body into survival mode and leads to the release of excess amounts of adrenaline, cortisol and…the breakdown of muscle tissue.

2. Avoid polyunsaturated fats (PUFA) at all cost. This includes all nut, seed and vegetables oils as well as all the fish oils! PUFA’s have a high affinity for water. When cells are in an excited state, they take up water. This hyperosmolar condition will increase the cells uptake of unsaturated fats due to their high affinity for water. This will increase calcium uptake (calcification of mitochondria), alter energy production and increase lactic acid production.

3. Hypoglycemia is a metabolic condition that can lead to Rhabdo. Regulating blood sugar with the right foods, right frequencies and ratios can assist in regulating blood sugar. According to Tom Brewer MD, malnourishment is a stress and will increase cortisol production, estrogen production and decreased its detoxification, decrease albumin levels, thus leading to hyponatremic conditions.

Starvation, which for some bodies can equate to allowing to poor meal frequency, causes glycogen stores to decrease while adrenaline secretion is increased to liberate more glucose (as long as glycogen is available) and free fatty acids (FA). When our nutrition contains more PUFA, our fat stores will contain more PUFA. Fat cells prefer to oxidize saturated fats for their own energy but the greater water solubility of PUFA cause them to be preferentially released into the blood during stress. This causes the stimulation of stress hormones, which increases lipolysis (FA oxidation and decreased glucose oxidation) producing more FFA decreasing oxidative energy production, thyroid production and body temperature. FFA slow the heart rate, increase heat loss, decrease heat production and shift your cells energy production away from glucose and towards fat use during stress.



4. Vitamin K and Cascara Segrada (active ingredient is emodin) will assist in regulating blood flow and hyperosmolarity of the blood.

5. Be smart! Scale down and take rest when needed. Do what you feel is right for you. Crossfit is about challenging yourself! Don’t worry what everyone else is doing, be safe and have fun! One of the best things about Crossfit is the community and support you receive no matter what level you are at. KNOW YOUR LIMITS!

Jeanne Rubin

References:

Brewer, Tom MD. What Every Pregnant Women Should Know. Penguin Books. 1985

Ivy, John, PhD & Portman, Robert, PhD. Nutrient Timing. Basic Health Publications. 2004

Peat, Ray PhD. Heat and Hormones. Ray Peat Newsletter. May 2013

Peat, Ray PhD. Cascara, Energy, Cancer and the FDAs Laxitive Abuse. 2012

Peat, Ray PhD. Salt, Energy, Metabolic Rate and Longevity. 2007

Peat, Ray PhD. Water: Swelling, tension, pain, fatiuge, aging. 2009

Young sub Kwon, M.S., Len Kravitz, Ph.D. How do muscles grow? Retrieved from http://www.unm.edu/~lkravitz/Article%20folder/musclesgrowLK.html

Research:

Thyroid hormone replacement therapy improves thyroid and renal functions and reverses rhabdomyolysis.

This observation suggests that rhabdomyolysis in hypothyroidism may be due to a reversible defect in glycogenolysis and that hypothyroidism should be excluded in patients with rhabdomyolysis and/or myoglobinuria.

The present case represents rhabdomyolysis secondary to undiagnosed hypothyroidism in a developed stage which manifests itself with rhabdomyolysis.

Hypothyroidism may cause rhabdomyolysis.

After thyroxine replacement, musculoskeletal symptoms disappeared and creatine kinase concentrations decreased.

Conclusion: Hypothyroidism, although rare, should be considered as a potential cause in patients presenting with elevated muscle enzymes and acute renal failure.

The exact cause of rhabdomyolysis in hypothyroidism is unclear, but both impaired glycogenolysis and impaired mitochondrial oxidative metabolism may be responsible. Hypothyroidism should be consideredas one of the causes of rhabdomyolysis.Rhabdomyolysis manifests with muscular symptoms and severely elevated serum levels of muscle enzymes.Thyroid hormone replacement therapyimproves thyroid and renal functions and reverses rhabdomyolysis.

Other YouTubes:

Are you healthy!

Cellular respiration: part 1, part 2 and part 3



Sucrose, fructose and glucose: part 1 and part 2

Visit HERE to download your FREE e-book: The Stress Reduction Manifesto!

Jeanne Rubin, CN, CST