Can You Be an Athlete When You're Chronically Ill?
Today's post is near and dear to my heart, and will discuss two things that seem to oppose each other entirely: athletes and chronic illness. When you think of an athlete, what words or images come to mind? Strong, capable muscles? Hard training sessions? Early mornings? Picture an athlete. Now picture a person with a chronic illness. They're polar opposites, right? These two things can be merged, end of story...or is it the end of the story?
I have been an athlete all of my life. From the time I ran my first thrilling mile at age 8 for the presidential fitness test at my local co-op, to my first gold medal at a local figure skating competition, sports and fitness have been a HUGE part of my life. I LOVE to exercise--it has always been, for me, a way to de-stress, escape the reality of my less-than-well body and health status, and a way for me to feel closer to God (it's true that we are more productive when we are moving, and have clearer thoughts...and thus more focused prayers! This awesome lady talks about this fascinating fact a lot!)
Aside from the years of month-long hospital stays, back-to-back surgeries, and failing organs, I have remained active to the best of my abilities, even if, during some seasons of more severe sickness, that just meant 15 minute walks, or rebounding (which is amazing for your body, sick or not sick!). More recently, since my four reconstructive abdominal surgeries last year (and thanks to my permanent ileostomy), I have been able to return to participating in the sports and activities I have loved for 3/4 of my life: figure skating and long-distance running.
However, for the first twenty years of my life, in which I was undiagnosed, sports felt very difficult. I assumed that, since doctors ASSURED me that "everything was fine" and that "I just had asthma," sports and athletics were this tough for everyone.
When my chronic pancreatitis became severe at the end of 2017 (and my kidneys relapsed into barely functioning), I had to give up pretty much all forms of exercise, after already having to give up skating in 2015 (read more about my journey with skating HERE and HERE). But all glory to God, I have been able to be reunited with the thing that makes me the happiest: MOVING MY BODY, specifically through skating and running! It's been a miracle, truly, and not a day goes by (and DEFINITELY not a step on the track or a glide on the ice) that I don't thank God for what He has done and is doing still.
MENTAL AND SPIRITUAL FITNESS
Returning to sports has been an interesting experience, and at times, a confusing one. Now armed with the knowledge of my many maladies and cascade of conditions, it was very hard at first to get back in the proper headspace to be able to feel fully "free" both on the ice and while running--which is what made skating and running so enjoyable for me in the first place. At the same time, I found myself struggling with two significant sides of my identity: "sick person" and "athlete." In our culture today, we like things to be all or nothing. Either you're chronically ill and constantly hooked up to tubes or receiving round-the-clock care in the hospital, or you're healthy and normal and living life unhindered. The fact of the matter is, LIFE IS NOT BLACK AND WHITE, and it's not all or nothing. And when we start doubting our identity, and feeling frustrated at the daunting divide between the various aspects of our lives, we need a reality check: WE ARE PERFECTED IN CHRIST. Jesus defines us--not our health or lack of, not our athlete status or ostomy bag. Jesus, and only Jesus. In Him all things find their place and have their place.
So, can you be an athlete when you're chronically ill? Absolutely. With a few caveats: the main one being you MUST (I repeat MUST) be healthy enough PER YOUR DOCTOR AND/OR MEDICAL TEAM to engage in exercise, sports, and athletics. Once you have the OK from your doctor(s), you're good to go!
With this said, there are some important things to consider when juggling your life as a chronically ill athlete.
CONSIDERATIONS FOR THE CHRONICALLY ILL ATHLETE
*Before I jump in, please be aware that these are general recommendations and things to consider, but that you must find what works for YOUR body. If you have a chronic illness and are active in sports and/or fitness endeavors, it's important that you modify and adapt these tips and tricks to YOU and YOUR condition(s).*
Proper fueling is crucial for any and all athletes, but even MORE important for the chronically ill athlete. Exercise is very hard on the body: it's a form of stress. We build muscle through the process of tearing down (through exercise) and rebuilding (through rest). When we have a chronic illness, our bodies are under stress all the time as it is, because the has to work harder than it normally would to perform and carry out "normal" functions when it's in a compromised state. Ever wondered why you're always more tired than your non-chronically ill counterparts? Your body is working a LOT harder to keep you alive and functioning. It uses more ENERGY, and therefore, requires more energy.
Calories are units of energy in the food we eat. The word "calorie" has almost been deemed a bad word, and these units of energy have been villianized and tried to be removed from food entirely (think "diet" products, "lite" foods, "low-calorie" this and that, etc.) because we equate calories with weight gain. Viewing calories in this way is really doing ourselves a disservice, especially when we are chronically ill, athletic, active, or all of the above. Your body cannot survive without ENERGY, and that means calories. Calories are your body's fuel source: when you take in enough calories to fuel your body's needs, you experience homeostasis. When you take in more energy (calories) than your body has immediate/ready use for, it will store that energy for a later date, either in the form of muscle or liver glycogen or body fat. If you take in too little energy than what your body needs, you will either lose body mass, as your body starts breaking down it's tissues (either body fat OR muscle, sometimes both) for fuel, since there isn't enough fuel coming in from your diet, OR your body will down-regulate it's ability to BURN energy, resulting in a decreased metabolism, and oftentimes negative effects on the entire metabolic system (hormonal balance, thyroid dysfunction, digestive problems, etc.).
Ensuring we get enough calories as chronically ill athletes can be challenging, but not impossible. When it comes to fueling, keep in mind that your body's resting metabolic rate (the amount of energy your body needs to sustain itself) will ALREADY be higher than a normal person's, both due to your muscle mass (muscle uses more energy than fat) AND the fact that your body is working so much harder because of your chronic conditions and biological weaknesses.
Calorie-wise, this means you most likely need to eat much more than NON-chronically ill athletes. The Academy of Nutrition and Dietetics' most updated recommendations for cystic fibrosis patients states that CF patients (both children and adults) require 110%-200% more calories than healthy individuals (1). For reference, the American Dietetic Association's calorie recommendations for an average female equate to 2,000 kilocalories per day. For CF patients, this equates to between 2,200 and 4,000 calories per day. AND THIS IS FOR NON-ATHLETE CF PATIENTS! This can seem tough, but working with a dietitian, sports nutritionist, or medical nutrition therapist with experience working with athletes can be a huge help when it comes to ensuring you're getting enough calories.
You've probably heard how important post-workout recovery fuel is...and it IS important! Even more so when you're chronically ill. It is recommended to consume a combination of protein and carbohydrates within 15 minutes following a workout greater than 30 minutes, and a full meal containing a 3:1 ration of carbohydrates to protein within 2 hours after your training session.
Because you're likely to be dehydrated after your training session (especially if you're a "salty girl" like me! #cysticfibrosisathletes), so it's best to consume a liquid fuel source immediately following your workout that contains electrolytes, carbohydrates, and protein.
My favorite post-workout beverage is a combo of grass-fed whey protein powder and BOLT sports drink. The whey contains high-quality, leucine-rich, quick-digesting protein to boost muscle repair and recovery, and the sports beverage contains electrolytes and quick-digesting carbohydrates to replenish muscle glycogen and help with hydration (sugar is an electrolyte, too!).
(Note for my fellow CFRD/CF related diabetes/T1D athletes: please consult your endocrinologist or CF specialist prior to consuming high-sugar beverages when not in a hypoglycemic episode. From my own personal experience, I have found that I do okay with sugary liquids immediately following a workout or training session, most likely due to increased insulin sensitivity, which results in the glucose being sent straight to my muscles instead of lingering in my blood stream and spiking my BG like it would outside of the anabolic window/post-training window. This has been MY experience, but please consult your medical team prior to experimenting with this for yourself.)
Rest days, aside from proper fueling, are what make or break your performance...and oftentimes, health. Rest is when you actually BUILD MUSCLE--it's only when we are resting that our muscles can knit themselves back together, returning stronger and more capable than they were prior to our tearing them down.
As a chronically ill athlete, it's probable you will require at LEAST one more rest day per week than the average person. For me personally, I noticed a HUGE difference in my performance, training, and health once I added an additional rest day each week. Rest isn't always fun if you're like me and love to move, but it's essential, and a great opportunity to engage in other things that promote the health of your whole being, like time with friends, spending some extra time in God's Word, reading a good book, or heck...taking a nap!
LISTEN TO YOUR BODY
This last one is something that I have struggled with my whole life, and if you're a chronically ill athlete, you probably have, too, to some extent. It's hard to listen to your body when it's constantly screaming at you, constantly tired or hurting or messed up, constantly fighting you whatever you do. After living through everything I've lived through thus far, I've developed a ridiculously high pain tolerance...which is both a good thing and a bad thing. It's a good thing when surgeries need to be performed or IV's need to be repeatedly redone, but it's a NOT-so-good thing when needing to be super honed-in to my body's signals as an athlete with cystic fibrosis.
But something I have learned is that, while I will never feel good, I know what my baseline feeling is, and what is "safe" to push through, and what's not. This will differ for everyone, and I implore you to really sit down and think about what the hallmarks of your "baseline health" are: write them down so you won't forget them, and when you have a harder-than-usual workout, or just can't seem to bounce back after a hot and humid week, reference what you wrote down. Take a week off, call your doctor, focus on foam rolling and hydration, take it easy. All athletes push themselves to some extent, but as an athlete with chronic illness, it's even MORE important to know when your "pushing yourself" is really "pushing too far." Only you can know this!
This has been a LOT of information, and I'm going to wrap it up here so this post won't turn into a BOOK! But I hope this has been helpful. Like I said, from what I have been able to find, there is virtually NO information on how to manage your life as a chronically ill athlete. I truly hope this can serve as a reference for you, and helpful guide if you have struggled with this, too.
If you're desiring more one-on-one help, I'm available for that, too, and have a few more patient spots open for this coming month. Shoot me an email at firstname.lastname@example.org, and let me know what I can help you with.
Until next time...
Stay happy, healthy, and hopeful.
Dr. Anna Johnson, ND/CNS