Juicer: The Athletes Friend

Endurance athletes demand a lot from their bodies. Hours of training depletes micronutrients (vitamins and minerals) and stresses cells. Although some supplements can help replete important micronutrients, research suggests repletion through whole foods is far superior. Whole, unadulterated foods contain thousands of enzymes. At the current time, the complete role of these enzymes in our bodies is not fully understood, however it appears that one role the enzymes play is to make micronutrients more bioavailable to the cells. As science moves forward, it is my guess that we will learn these enzymes are critical to our health.

An easy way of ensuring you are getting all of your micronutrients and the associated enzymes is through juicing. I MUCH prefer the blender type of juicers, where you get 100% of what you put into the blender out. I use a Vitamix blender.

In creating your juice, it is optimal to include both fruits and vegetables. As a general rule of thumb, the deeper the color, the better it is for you. Here are some of my favorite ingredients to use in juices:

  • Kale
  • Chard 
  • Beets
  • Blood Oranges
  • Apples
  • Carrots
  • Spinach
  • Yams 
  • Pears
A favorite recipe of mine that is power-packed with nutrients is the following:
Red Chard
1 Small Beet
1 Blood Orange
1 Pear
3 Large Carrots
1/2 Small Yam
1 Cup Orange-Pineapple Juice
3 Cups Water
Breakfast Smoothies:

Another great utilization for the blender is breakfast smoothies. During training, it is important that you are starting your day with a meal that provides sustained energy. I prefer to start my day with a protein smoothie. Protein is essential in your diet during training. It is crucial to muscle recovery. 
Here are a couple of my favorite breakfast smoothie recipes:
Shake #1:
1 Large Banana
1 Tbsp Peanut Butter
1 Scoop Vanilla Protein Powder
1 Tbsp Honey (optional) – adds calories, so if you aren’t burning them be careful
1 Cup Frozen Mixed Berries or Frozen Strawberries 
1 1/2 – 2 Cups Vanilla Almond or Coconut Milk
Shake #2:
1 Large Banana
1 Tbsp Almond Butter
1 Scoop Vanilla Protein Powder
1 Large Mango
1 Kiwi
3 Strawberries
1 1/2 – 2 Cups Vanilla Almond or Coconut Milk
Written on June 30, 2016
By Garret Rock

Cramps: What We Know About Prevention

Cramps are a very common occurance in endurance athletes. Despite plenty of research, the science of cramping is still a bit inconclusive. Despite our desire to pin cramping down to a single nutrient deficiency or event, it does not appear we will find this. So, what do we know? Here is the short version of a couple key concepts in preventing cramps?

The Science of Cramping

There are different types of cramping. Some are serious (and if you get them you will know they are serious), and some are benign. This blog is going to focus only on the benign cramps, the ones most of us have experienced.

The two primary culprits for cramps appear to be fitness and hydration status.

Fatigue Induced Cramps

Fatigue cramps are the most prevelant types of cramps. They are essentially the consequence of a muscle hitting a point of exhaustion and going into a hyper-excitability state due to aberrant brain-muscle communication.

Have you ever noticed that your muscles seem to cramp only at the worst times, such as during a race? This is most likely to be fatigue cramps, and an indicator that you are missing out on an important aspect of training. That aspect is typically race intensity training.

For those that follow my blog, you know I am a fan of base building using your heart rate for monitoring. This type of training helps prevent injury and results in improvements in “aerobic speed” (see post on heart rate monitoring), which is important to becoming faster over longer distances. I put myself through an experiment prior to last season where I didn’t do anything but heart rate training for several months leading up to the race season. The results? I was a much faster triathlete all season despite not ever doing speed work, but I did have cramping issues during races.

As race season approaches, it is important that you mix in race-effort intensity into your training. If you don’t, you are asking for a bonk, muscle fatigue, and fatigue cramps. A race is generally not the time to introduce your muscles to a new level of intensity. That doesn’t mean you should go out and cook yourself each workout. But, it does mean your body should at least be adapted to the intensity level. Typically, 1-2 days per week of intervaled race intensity work is enough. Anymore, and you risk over-training (see my blog on cumulative stress and over-training syndrome).

Try mixing in these workouts into your routine (for a 70.3 or Half-Ironman distance triathlon):

Key Interval Run Off Bike:

Spin easy on trainer or flat outdoor route for 60 minutes, then do a 1:15 – 1:30 run off the bike with the following sets (4 x 10 minutes at 10 seconds below goal race pace with 5 minute recovery run between sets. Follow this with 5 x 3 minutes at 20 seconds below goal race pace with 2 minute recovery run between).

Key Interval Bike With Short Run Off Bike

On your long ride day, mix in 5-8 sets of 10 minutes at your race pace with 2-3 minutes rest between sets. End the bike with a 20 minute time trial. Do a short, easy effort 20 minute run off the bike.

Drink a protein shake or recovery shake immediately after these workouts. Here is my favorite recovery shake:

1 Banana
1 TBSP Honey
2 Level Scoops Hammer Nutrition Recoverite (chocolate!)
2 Cups Vanilla Almond Milk (Coconut Milk or Regular Milk can be subsituted)
4 Ice Cubes

Make sure you follow this workout with a low intensity day the following day, such as a long easy/moderate swim. Putting your muscles and joints through that intensity requires recovery.

Hydration and Cramps

Both dehydration and over-hydration can cause cramps. Both result in a loss of electrolytes. There are several different opinions on proper hydration leading up to a race. Because of variable sweat and water loss rates among individuals, it is very difficult to give specific recommendations on how much fluid to take in leading up to a race.

I generally simply recommend monitoring your urine color. Prior to the start of the race, your urine should be relatively clear and colorless. During the race, I subscribe to the 1 bottle per hour during the bike with electrolytes every other bottle as a starting point. During the run, grab something every aid station for an Ironman and at least every other aid station during a 70.3 as a starting point. If conditions are hot and humid, or you are at higher altitudes, or you have a higher than normal sweat rate, you may want to increase your fluid intake during the race. But, don’t overdo it. If water is sloshing around your gut, slow the fluid intake down.

Proper hydration can be made more complex than the above if you so desire. I generally choose to keep it simple, as there isn’t a lot of research showing the more complex methods result in better outcomes. This is where experimenting during training can make all the difference. Train in all types of conditions and experiment with different intakes.

Happy Training!

Written on
By Garret Rock

Does Running Make You Fat? – Debunked

Warning…the first seven paragraphs are a preamble. If you just want the tips, feel free to skip to the “Meat and Potatoes” section.

Several months ago my wife told me I need to read a blog post one of her friends shared on Facebook. Her friend shared the post with an attached comment of “This really makes sense”. The post was an amateur post by a personal trainer who makes the claim that running makes you fat. An impressively long list of over 80 references followed the post, making this claim look legitimate on the surface.

I read the post. The author did a great job selling their theory. They did such a great job that I began to doubt my knowledge on this topic…and yes, I am very well trained, read, and researched on this stuff. According to the post, steady effort exercising, such as running and cycling elicit “self preservation”, a state where the body slows metabolism, thyroid function, and fat utilization in order to “save itself” from dwindling down to nothing. Now, I am trained in this stuff, and I knew this to be largely untrue except in specific circumstances, however this list of references was really impressive. In addition, the titles of most of the references supported this conclusion. Could I really have been led so far astray?

So, I pulled out the credit card and dropped a bunch of money on the full reports for many of the referenced studies. For the next week I spent my lunch breaks reading the complete studies. The good news following my review was that I no longer doubted my expertise. The bad news was that this post was irresponsibly written, poorly researched, inaccurate, and self-serving. The majority of the studies from the list of references, when read in their entirety, had much different findings than the titles would lead one to believe.

The post was spreading like wildfire, influencing hundreds of thousands of people into believing that running, triathlon, and cycling are not good for them. What reading the full studies led to is a conclusion I was already familiar with, which is that under certain circumstances the body will go into a “self preservation” mode. The author took this particular consequence due to certain circumstances, and generalized it to everyone. I’m giving the author the benefit of the doubt and chalking it up to inexperience.

Initially I blew it off. However, in the last several months I have been seeing more and more articles making the claim that running will “make you fat”. The posts seem to be getting more dogmatic as well…this is the way it is and we are right! I even read one rather strong article by an exercise physiologist turned testosterone supplemented beach body trainer ranting about Ironman athletes and marathoners idiotically setting themselves up for getting fat with their training. For those that have competed in, or at least watched, an Ironman, it has the appearance of a giant meeting of the fittest looking people on earth. As some of my friends say (male and female), watching an Ironman is eye candy. In a funny twist, this particular gentleman has a picture of himself on his website without a shirt on…and interestingly, he would be the “fat guy” toeing the line of an Ironman.

Well, after reading too many of these articles I can’t stand it anymore, I need to debunk the claim.

Meat and Potatoes…because that’s what us endurance athlete fatties love most, right? đź™‚

Does running make you fat? No. Can it? Given the right set of circumstances, it can lead to slowed metabolism, hypothyroidism, and fat preservation. Are these circumstances avoidable? Absolutely. Should you continue reading this so that you know how to avoid these circumstances? Yes. Can running lead to fat loss? MOST DEFINITELY! Are endurance sports a good way to “get skinny”? Yep.

The truth is that our body tolerates steady state exercise extremely well. In fact, many experts on exercise physiology believe that our physiology is made for steady state exercises. My opinion is that we are an incredibly adaptable species that can thrive doing both burst activities and steady state activities. Just look at the incredible adaptability in football players, who are able to explode out of a crouch and push with enormous forces, compared to Ironman athletes who are running sub-6 minute miles after swimming hard for nearly an hour and biking hard for almost 5 hours. Both are very different, yet we are achieving mind-blowing feats in both. I don’t think it is fair to say we are meant for one type of activity.

When the body is given the fuel it needs and limits are not exceeded too quickly, running is great for your health. It is also convenient. You don’t need a gym or fancy equipment. You just lace up a pair of shoes and go. Mentally, running has incredible benefits. Research links running to reduced rates of depression, mental illness, suicide, and greater happiness.

Physiologically, we also tolerate running very well. Adaptations in hormones, red blood cell turnover, metabolism, and fat burning are clear indicators that our bodies are meant to do endurance activities. If we weren’t, some of the adaptations, such as the transition between carbs and fats as fuels, just wouldn’t occur.

As I mentioned, circumstances do exist that may lead to a state of “self preservation”, which is characterized by slowed metabolism, fat preservation, decreased thyroid function, and more. The circumstances are largely related to dieting or nutrient deprivation, such as low fat diets while training. Here are some tips to ensure you avoid sending your body into “self preservation”:

1. Do not restrict calories when initiating your training. The start of endurance training is NOT the time to start a new diet. If weight loss is a goal, ramp up training for at least 4-6 weeks and then start cutting calories in small quantities, if you are not dropping weight already, until your calorie output slightly exceeds your calorie input. During training, do not restrict calories more than 200 less per day than what you are burning, and do not sustain this deficiency for more than a week or so at a time without 2-3 even calorie days (in equals out).

2. Eat fat! The 90’s brought about a fear of dietary fat. I remember a good friend of mine in high school once saying at the end of the day, “Yes! I only ate 2 grams of fat today!”. Fats are absolutely essential for hormone production, and the absorption of many essential nutrients, such as Vitamin D. If you are not eating fats during training, your body will do all it can preserve body and dietary fats. In addition, your training and racing will suffer because your body will not go into a fat burning state as quickly…if at all.

3. Make your calories count. Before you eat or drink anything, ask yourself “What is this doing for me?” If the answer is nothing, don’t eat it. Of course, there are definitely times for exceptions to this rule…I’m not a complete stick in the mud. But, in your daily diet, every bit of food and drink you eat should provide your body with something it needs. Eat your veges. Eat your fruits. Eat adequate amounts of fats and proteins.

4. Do NOT crash diet…ever.

Written on
By Garret Rock

Hey Endurance Athletes, Want Your Testosterone Back?

It’s no secret that endurance training can lead to reductions in testosterone. Theories behind the reduction of testosterone during endurance training previously revolved around the loss of body mass, increased cortisol levels, and changes in luteinizing hormone. However, there is some debate around this, and the mechanism is not 100% clear. Nonetheless, the reduction of testosterone can have a mildly negative impact on recovery from training and a big impact on your quality of life.

Drops in testosterone can result in decreased libido, mood changes, decreased energy, and prolonged recovery from workouts. There are several more symptoms, however these are the most relevant to endurance athletes.

Testosterone decreases appear to be correlated to the amount and intensity of training. The general rule of thumb is, the longer you train each week, the lower your testosterone level. Interestingly, resistance training, such as lifting weights, increases testosterone, while endurance training decreases testosterone. Research has yet to answer some questions regarding this difference. If I may throw in a completely subjective opinion, I will say that when something like this occurs naturally, there is typically a reason, and that reason is protective against a detrimental consequence. However, for now we must work with the body of evidence we have, and that appears to suggest that lower testosterone negatively affects performance.

Testosterone supplementation and hormone replacement is banned in sports. Yes, even for amateurs. Of course, some discretion should be used here. If you are a middle of the pack age grouper without a shot at placing within your age group, your relationship with your wife is hurting because of decreased libido and mood, and you are struggling to be as productive as you should be around the house because of your lower energy, well, the answer of what to do seems obvious. But, cases like this have not been addressed by USADA yet, and the substance is simply banned in sanctioned events. However, if you are a top age grouper, I would strongly advise you against even considering testosterone, unless you may qualify for a therapeutic use exemption (no, “my wife wants me to go on testosterone” does not qualify you for an exemption). Recent evidence has found a high incidence of “cheating” among master’s and age group athletes, and testing on this population is likely to become routine in the future for top age group finishers. In fact, it has already started. Pro’s don’t even stand a chance, they will be caught.

Fortunately, there are interventions that may increase testosterone naturally. Here are some of the most effective.

  • Strength Training – adding in a day or two a week of strength training is one of the most effective ways to boost testosterone. If you can keep the intensity high that can further enhance the effects. Do intense 1-2 minute bursts of weight lifting.
  • Zinc – zinc is one of those “tricky” micronutrients in endurance athletes. It is involved in several important pathways that tend to be “used in excess” during training. Therefore, it is often lower than normal in endurance athletes. Zinc is important in testosterone production. Studies show that zinc supplementation may increase testosterone levels. On a related note, if you supplement iron at any point in your training (and if you do make sure you read my blog post about this), this can cause a reduction in zinc absorption, and thus a decrease in testosterone production. Zinc should be supplemented during iron supplementation. Supplementing zinc at low levels is generally recommended for endurance athletes training more that 8 hours per week.
  • Reduce Sugar Intake – testosterone levels decrease after eating sugar. Diets high in sugar have been associated with reduced testosterone levels in some small studies.
  • More “relations” – having “relations” more frequently increases testosterone levels. Kind of a catch 22.
  • Eat Fats – fats are essential to testosterone production. This includes both healthy fats (avocados, fish oils) and saturated fats (yep, the ones we have been told are terrible for us all of these years). Studies show that increased fat intake may be correlated to increased testosterone. Now you have an excuse to eat bacon one day a week!
  • Eat eggs – egg intake is shown to increase DHEA-S, which in turn leads to more testosterone.
  • Get enough protein – endurance athletes should at least consider supplementing whey protein during peak training. This should be considered on an individual basis. However, most athletes could benefit from this, and it can help maintain higher testosterone levels.
Written on
By Garret Rock

Maximizing Your Potential: Hemoglobin and Oxygen Delivery

Marginal gains. The term “marginal gains” is being heard more and more in the world of sports. The concept of marginal gains is simple. What are the little (marginal) things you can improve that cumulatively result in overall performance improvements? As a performance adviser to many of the
world’s top endurance athletes, it is my job to identify where marginal gains can be made physiologically. One focus is oxygen availability, and a key player is hemoglobin, a protein in red blood cells. Hemoglobin is a micro-sized protein that has macro-sized effects on performance. And what you eat on a daily basis can affect hemoglobin levels.

Put simply, endurance exercise is largely characterized by a simple requirement; sustaining repeated muscle contraction. This criterion is
fulfilled via two basic functions, the ability to consume enough oxygen and adequate fueling. Regarding fueling, that is another topic, however summarized by simply providing the right fuels at the right time during activity. Regarding oxygen, the process is a bit more complex.
Muscles require oxygen to convert sugars into energy. In the absence of replenishing oxygen, muscles reach complete exhaustion in just a few
minutes. Therefore, endurance athletes require constant oxygen delivery to the muscles. It is hemoglobin that carries oxygen to the muscles.
Hemoglobin picks up oxygen in the lungs and delivers it to the tissues of the body, most notably your muscles. Hemoglobin levels have a direct
impact on endurance exercise performance. Lower levels of hemoglobin causes decreased efficiency of oxygen delivery to the muscles. The result is more rapid muscle fatigue, decreased VO2max, and higher heart rates. As a dramatic example, if you have ever exercised at high altitude, you know what it feels like to have less oxygen delivered to the muscles.

Certain micronutrients are essential in the formation of hemoglobin. Because of the high turnover rate of red blood cells and hemoglobin in endurance athletes, the dietary requirements of these micronutrients are higher than the average person. Failing to replenish them can result in a decrease in hemoglobin production, and thus performance.
Iron, folate, and vitamin B12 are directly involved in hemoglobin formation. Other micronutrients, such as vitamin B9, vitamin C, copper,
and vitamin A are indirectly involved in hemoglobin formation. Although the goal in replenishing micronutrients should be through dietary means, many athletes require supplementation at some point in the season.
To put this in an easily understood context, let me share a real-life case study.
A pro triathlete presents for routine monitoring. She has transitioned over the last nine months from the ITU circuit to the Ironman 70.3 and Ironman distances. She has been tolerating the training well and does not have complaints. Being new to the higher volume she does not know what to expect.

Blood work revealed low-normal hemoglobin (12.0), hematocrit (36.2), small platelets (MPV 6.5), and borderline large red blood cells (MCV 99.7). These findings are consistent with her prior test results during training. Micronutrients were tested as well and revealed a mild functional folate deficiency (within the low limits of the “normal range”, but given the high turnover rate of folate in a female endurance athlete her levels indicate a deficiency in these circumstances).

Intervention included significantly increasing dietary intake of folate and two weeks of supplementation. Follow up tests were performed each week for the following four weeks.

Follow-up #1: Folate
16.2, Hemoglobin 12.4, Hematocrit 37.7
Follow-up #2: Folate
18.8, Hemoglobin 12.7, Hematocrit 38.2
Follow-up #3: Folate
>20.0, Hemoglobin 13.1, Hematocrit 40.4
Follow-up #4: Folate
>20.0, Hemoglobin 14.2, Hematocrit 44.8 (following 5 days of taper)

There is little doubt that the 15% increase in hemoglobin achieved in the case study above will result in improved performance, and this
particular athlete’s performance last year confirms. In this example we must consider the effects of coming from sea level to 5,600 feet of elevation. However, these changes significantly exceed what would be expected for acclimation at this elevation, and the red blood cell indices were highly suggestive of a folate repletion effect being the primary driver behind the improvements. Thus, much of this change was the result of simply making an adequate amount of micronutrients available to keep up with the high turnover of red blood cells, and thus hemoglobin.
As an endurance athlete, your dietary requirements of
certain micronutrients are increased. Regarding oxygen delivery to the muscles,
iron, folate, vitamins B9 and B12, vitamin C, copper, and vitamin A are
critical to optimizing hemoglobin levels. Be sure you are eating ample amounts
of foods high in these micronutrients. Doing so will aid in optimal oxygen
delivery to the muscles, and thus help you perform at your highest potential.
The following table shows foods high in each of these
essential micronutrients.

(Vitamin B9)
Red Meat
Beans and Lentils
Egg Yolks
Dark, Leafy Greens
Red Meat
Dark, Leafy Greens
Asparagus and Broccoli
Dried Fruit
Romaine Lettuce
Beans and Lentils
Yogurt and Milk
Oranges and Tropical Fruits
Fortified Vegan Products
Sunflower and Sesame Seeds
Peppers (Chili and Bell)
Dark, Leafy Greens
Cocoa Powder
Broccoli and Cauliflower
Sundried Tomatoes
Sunflower and Sesame Seeds
Calamari and Lobster
Thyme and Parsley
Dried Herbs
Pine Teas
Written on February 11, 2016
By Jordan J

Why Eating Disorders In Endurance Athletes Are Especially Dangerous

It is time for those of us involved in endurance sports to bring attention to the problem of eating disorders in endurance athletes. I hope you will help address this problem by sharing this post with every runner, triathlete, and cyclist you know. Thank you.

The topic of eating disorders in endurance athletes is too often neglected. The numbers are staggering. Studies show that up to 25% of female and 10% of male endurance athletes have either a subclinical or clinical eating disorder. In a population dominated by highly motivated, highly disciplined, perfectionist personalities, we are all at risk of developing an eating disorder. Yet, it continues on without much attention, and in fact often unintentionally persuaded through publications talking about lighter being faster, ideal race weight, and on and on.

Even more staggering than the frequency are the long term implications of eating disorders in endurance athletes, especially when they occur during adolescence.

Eating disorders in endurance athletes tend to be different. Although plenty fall in line with the classic definitions of specific eating disorders, many do not. For example, excessive exercise is simply part of training, not a “sign” of an eating disorder. Endurance athletes must eat to train, and rarely is prolonged anorexia a problem. Athletes eat. Most often, an “eating disorder” in an endurance athlete is simply inadequate fueling during training. But, where is that line?

Eating disorders cause problems in endurance athletes. Stress fractures, hormone disorders, poor bone development, malabsorption, and micronutrient deficiencies are just some of them. They also can cause significant health problems later in life, such as osteoporosis and hip fractures, which substantially increase the risk of death and major morbidity. The biggest problem with eating disorders is that many of the consequences don’t present until long after the eating disorder is corrected. The treatment is prevention.

Some of the Long Term Consequences of Eating Disorders In Endurance Athletes

Bone Mass

The most critical period of bone mass development is adolescent years to late teens/early twenties. During this time, your body is rapidly increasing bone mass to keep up with growth. If bone mass development is compromised, such as in cases of malnutrition due to eating disorders, peak bone mass will be reduced. The consequences are significantly increased risk for stress fractures throughout the span of the athletic years, and risk for osteoporosis later in life. Osteoporosis greatly increases the risk of fractures, physical deformity, organ compression, chronic pain, and overall morbidity and mortality. Hip fractures, one of the most well-known consequences of osteoporosis, have a 15-37% 1 year mortality rate in people over age 65.

Hormone Disorders
Studies show that inadequate fueling amidst excessive exercise can reduce thyroid function. This may occur by way of impacting adrenal function, and thus cortisol levels, or it may be secondary to reduced dietary fat and/or reduced body fat. Science has posed and supported all of these pathways, however they all lead to one causative factor, inadequate fueling (eating disorder) during training. Hormones are critical to our well-being, and performance. The types of hormone disorders sparked by inadequate fueling during training can cause excessive fatigue, decreased muscle recovery (by way of the HPA axis and growth hormone), mood swings, sleep problems, compromised immunity, and more. 
Malnutrition has far reaching consequences. For the sake of keeping this article short, let’s just address one thing that matters much to athletes, performance. Nutrients are what keep our cells going. A deficiency in intake often leads to a deficiency in function. For example, for red blood cells to replicate, iron, B12, folate, and several other micronutrients are essential. Red blood cells are destroyed at high rates in training endurance athletes. In response, your body will produce new cells. If the necessary micronutrients are not readily available, the process of new red blood cell production will be limited, which can result in fatigue, decreased performance, and anemia. The citric acid cycle (or Kreb’s cycle) is driven by micronutrients. These are just two examples of many. There are countless pathways critical to performance that rely 100% on the availability of micronutrients. And for that matter…life relies 100% on it as well. 
Absorption Problems and Food Sensitivities?
I typically prefer to stick to writing scientific supported information. However, in my experience working with professional, elite, and recreational endurance athletes, I have noted an interesting correlation between past eating disorders and current micronutrient absorption problems and often food sensitivities. I have yet to find any research on this (if you have please share it!), yet the correlation is so strong that I feel confident in sharing it.
Eating disorders ruin careers. They have far-reaching effects that follow people long after recovery, especially athletes.The predisposition for eating disorders in endurance athletes is strong. There are many reasons endurance athletes might develop eating disorders, ranging from body image to performance. While the tendency is to attempt to address the “underlying problem” (via counseling), doing so is complicated, as it varies per individual. However, I believe that by making the long term consequences of eating disorders in endurance athletes known, we can reduce the incidence. It is working with smoking. We have reduced smoking from 42% of adults in 1965 to 19% of adults in 2011. Eating disorders in endurance athletes can have implications nearly as serious as smoking. 

An eating disorder in an endurance athlete is often unidentifiable. Athletes eat. By definition, an eating disorder in an athlete simply means inadequate fueling during training. There are very few circumstances when an athlete increasing training should be concurrently dieting. If this is a desired combination, it should be done under careful monitoring by a health care professional familiar with the dangers of dieting while training. 

Written on
By Jordan J