Is your frame stronger than your bones?

Image Source:  Cycling Weekly

Image Source: Cycling Weekly

One of the greatest cyclists to ever race in the professional peloton crashed out of the Tour de France yesterday. Fabian Cancellara was wearing the yellow jersey when he was involved in a high speed crash that took out several riders. Unfortunately, Cancellara did not ride away unscathed. He suffered fractures of his lumbar spine, effectively ending his Tour and the rest of his season.

Broken clavicles are a frequent occurrence among competitive cyclists. But broken bones of the spine? That usually happens in little old ladies, right?! Granted, Cancellara was likely racing at over 30mph and landed directly on cement, the accident got me thinking, are cyclists at risk for poor bone health?

I already had a good idea of the answer, but I wanted to dig into the research a bit more. Although, cycling has been shown to confer several health benefits, improving bone health is unfortunately not one of them. News Flash: cycling is a non-weight bearing activity and as a result it is associated with lower bone mass. In fact, two-thirds of the professional and master adult road cyclists could be classified as osteopenic, or having a bone density lower than normal. Many times it is the lumbar spine, or lower back, that is found to be osteopenic. This is the part of the spine that was fractured in Fabian Cancellara’s case.

Interestingly, calcium intake and hormonal influences on bone health, were found to be within normal ranges in the cyclists studied, suggesting that it is the lack of impact on the bones that leads to the low density. 

Speaking from experience, when you are really training and racing hard the last thing you want to do is exert more energy off the bike, so what do you do? You put your feet up and lie on the couch all day further reducing the needed stress on your bones to maintain their density.

Although, we don’t know if Fabian Cancellara has osteopenia, I’d be willing to bet that many cyclists in the elite and professional pelotons do. With a high incidence of crashes in road cycling, bone health is not a topic that receives it’s needed attention. And the research is pretty darn clear: those of us who compete in road cycling are more likely to develop osteopenia and osteoporosis.

So do we add in weight training to prevent bone density loss? For many cyclists this is an absolute no-no. If that’s the case for you, other forms of resistance training can be added instead, including pilates and plyometrics. Interestingly, it does appear that mountain biking, with its more impactful riding, is not associated with as much bone density loss.

It’s also important to think about getting screened for osteopenia if you consider yourself a competitive road cyclist. Screening would include a few lab test including hormone levels, calcium, and Vitamin D, as well as a bone density scan, or DXA (fyi: when you tell your doctor that you want to be screened for low bone density he or she will laugh at you, assuming you don’t have the normal risk factors for osteopenia, and rattle off what the USPSTF recommends and try to send you on your merry way. At that time please take out your phone and show him or her the link to this study and then politely ask again for a DXA).

It was a sad day, losing Fabian Cancellara to a crash just as he had donned the leader’s yellow jersey. He will be back, better than ever I’m sure. To make sure you’re able to bounce back from injury too, and perhaps prevent it from occurring in the first place, consider checking on the status of your bone health...or just go get yourself a mountain bike!


The Top 7 Probiotic Myths

All probiotic supplements are basically the same...

Probiotic supplements can differ in a variety of ways including: the amount of probiotics, the types of strains, the need for refrigeration, as well as the addition of other ingredients like prebiotics. While there isn't a maximum dose that is recommended, most studies are done with at least 1 billion CFU. The majority of studies done on athletes used amounts between 10 and 25 billion CFU. An appropriate amount ensures efficacy of the product. 

It doesn't matter which probiotic strains I take...

It most definitely does matter! There are many different strains of probiotics, and research has shown that they don't all have the same effects. Depending upon why you are taking the probiotics any old product may not be helpful for you. Probiotic studies have focused on athletes, depression, obesity, and multiple other medical conditions and populations, but the probiotic strains that were studied were certainly not all the same. Make sure you are taking one that is right for your needs. If you're an athlete, well, you've found the right place!

I should take as many probiotics as possible...

Consuming a high amount of probiotics doesn't necessarily improve efficacy. While research has yet to determine the ideal amount for any given condition or population, we do know an effective range. When choosing a probiotic it would be our recommendation to find one that has at least 10 billion CFU. 

It's enough to eat fermented food or yogurt...

While we fully support eating a variety of fermented foods (homemade kimchi anyone!?), food may not be the best source of probiotics for someone looking to take advantage of their specific effects. Few foods quantify the amount of probiotics in them, so you don't know how many and what types of probiotics you are consuming. As you learned above, knowing this information is really important if you are using a probiotic supplement for a specific reason. For example, you cannot expect the same benefit from a cup of yogurt as you would from a probiotic supplement designed for athletes.

FOS (fructo-oligosaccharide) is an ideal prebiotic to add to a probiotic supplement...

FOS is a prebiotic commonly used in supplements. However, higher amounts are needed, 4-8 grams per day, for any benefit. That's pretty hard to fit in a capsule! Arguably, the most important reason not to use FOS is that it can cause a lot of flatulence.

Probiotic supplements require refrigeration...

Probiotics are living organisms and die off in time. Recent advances in their production have led to the ability for them to survive longer without refrigeration. However, this isn't a practice for every manufacturer. If not needing refrigeration is important for you, make sure the supplement states that it is not required. The bottom line is this: refrigerating the bottle, although not necessary, will make them last longer, but if it isn't needed you should feel confident your little bugs will be safe outside a cold environment. Also, look for a probiotic supplement with an expiration date rather than "CFU counts are guaranteed at time of manufacture." 

Probiotics should have an enteric coating...

Enteric coatings like those used for aspirin and other drugs do not work with probiotics. For one thing the common polyacrylamide “super glue” coatings, besides having potential carcinogenic activity, actually destabilize the shelf life of probiotics because they cause moisture retention within the product.

There are now new generation delivery systems that employ polymeric carbohydrates such as alginates or pectin. But these are not enteric coatings, they are complex formulations that actually “turn on” once they contact stomach acid. This makes a big difference in the effectiveness of the probiotic supplement.