Vit i D iVitamin D in Performance SportPerformance Sport

S tti h P bli H lth C fScottish Public Health Conference2nd November 2017

Dr Niall Elliott, Head of Sports Medicine

C hCoachParentSport

Sports MedicinePhysiotherapyPerformance NutritionSports PsychologyPhysical PreparationPerformance Lifestyle

Sports Governing BodiesUK Sport

20 years old in 2018Government & Lottery funded700+ Scotland’s top athletes700+ Scotland s top athletes

Sunshine the risksSunshine – the risks

• Skin related– Sun burn

Premature aging– Premature aging– Skin cancer risk

Occ lar related• Occular related– Photo Keratosis and

Conjunctivitis– Eyelid cancer– Cataracts

Sunshine the benefitsSunshine – the benefits

• Increase or maintenance of Vitamin D

• Improved mood

• Improved sleep quality

Imm nological rob stness• Immunological robustness

• Increase in Melanocyte Stimulating Hormone– UV protection, melanin increase, improved appetite

Sunlight Exposure ScotlandSunlight Exposure - Scotland

• UVB needed for production of Vitamin D

• UVB absorbed by dehydrocholesterol and

ti ll id iessentially aids in creation of Vitamin D which is furtherwhich is further metabolised in the kidneys and liver

Sunlight Exposure AthensSunlight Exposure - Athens

Sunlight Exposure GlasgowSunlight Exposure - Glasgow

Scotland's Monthly Sunshine A 1929 201

180550Average 1929-2017

160500

urs

urs

120

140

400

450

shin

e ho

ylig

ht h

ou

100

120

350

400

Sun

s

Day

80300MAR APR MAY JUN JUL AUG SEP

Daylight

Dundee to Edinburgh c 36 miles (air)Edinburgh to Glasgow c 43 miles (air)Glasgow to Dundee c 63 miles (air)

Lat LongDundee 56 46 2 97Dundee 56.46 ‐2.97Edinburgh 55.95 ‐3.18Glasgow 55.86 ‐4.25

100%

75%

50%

25%

0%0 6 12 18 24 30 36 42Athens Paris Reykjavic Dundee Ratho Glasgow

Sunlight Exposure ScotlandSunlight Exposure - Scotland

Vit D Window of Opportunity

No Vit D Window of Opportunity

Vitamin DVitamin D

Bone healthImmune system functionImmune system functionSoft tissue recovery and repair

Scottish Population avg 37.5

SIS Athlete avg 78 nmol/lSIS Athlete avg 78 nmol/l

Vitamin D Winter levelsVitamin D Winter levels

L l Cli i l D i ti P fLevel Clinical Description Performance Description

< 25 nmol/l Severely deficient Severely deficient

25 – 50 nmol/l Deficient / inadequate Performance risk

51 75 nmol/l Adequate Performance risk51 – 75 nmol/l Adequate Performance risk

76 – 125 nmol/l Adequate Borderline performance riskrisk

> 125 nmol/l Adequate No performance risk

Vitamin D Winter levelsVitamin D Winter levels

• The difference in ranges and description reflects research• The difference in ranges and description reflects research where there is risk to bone health, hormonal function (eg: testosterone), cardiovascular health

• There is research pointing to optimised range for peak physiological performance but ensuring key functions are maintainedmaintained

• Barker et al. (2013). Higher serum 25(OH)D concentrations associate with faster recovery of skeletal muscle strength after

muscular strength. Nutrients, 5, 1253-1275.• He et al. (2013). Influence of vitamin D status on respiratory infection incidence and immune function during 4 months of

winter training in endurance sport athletes. Exercise Immunol Review, 19, 86-111.

• He et al (2015) The effect of 14 weeks of vitamin D supplementation on antimicrobial peptides and proteins in athletes J• He et al. (2015). The effect of 14 weeks of vitamin D supplementation on antimicrobial peptides and proteins in athletes. J Sports Sci, in press.

Testing questions- what are the Vit D levels in Scottish athletes over a year?

what supplemental regime to use?- what supplemental regime to use?- what was the result of that supplementation regime?- was there a dip in Vit D levels and to what level?

Vitamin D Loss from Sep to Dec

70%

(2012-2015) n=56

50%

60%

%)

34%40%

50%

t D L

oss

(%

34%

20%

30%

Blo

od V

i

10%

0%

Winter Vitamin D regimeWinter Vitamin D regime

High Street Vit D supplement ranges from 10ug to 25ug

SIS regime

- 20000iu once off 10ug to 25ug weekly dose ( 500 ug) over winter months for those with l l b l 75 l/lScientific Advisory

Committee on Nutrition ( )

levels below 75 nmol/l

- 20000iu every 2 fadvise 10ug (400iu) daily weeks for those with levels

75 – 125 nmol/l

1 ug = 40iu

How much sunshine?

• Sun elevation ≥ 30° allows for access to UVB

ght

H)

• Higher elevation = higher risk for damage to skin

Hei

g (H

tan(x)=H/L

X°

damage to skin

• Brief exposure, daily, is adequate

Length (L)

tan(x)=H/L

Height (H) Length (L) tan(x) arctan(x) Degrees (°)

1.89 3.55 0.53 28.03 28.03

These times only apply for sun exposure in Scotlandexposure in Scotland

Sunshine and SupplementSunshine and Supplement

Advice on sunshine exposureAdvice on sunshine exposure

- annual plan Winterannual plan

- daily plan

Winter Supplementation

- skin colour - 20000iu weekly October to April

- skin exposureOctober to April

- time exposure

AcknowledgmentsAcknowledgments

Nik J k bi kNikos Jakubiak Performance Nutrition

Irene Riach Performance Nutrition

Dr Carrie McCrea Sports Medicine

Dr Niall Elliott niall.elliott@sisport.com@dundeesportsmed