Mental Health and the Strength Athlete: Why Powerlifters Get Ulcers

TAGS: high intensity strength training, reduce stress hormone, life events, fight or flight, managing mental illness, mental illness, stress response, stress management, mental health, depression, Dr. Eric Serrano, cortisol, strength athlete, autonomic nervous system, Joe Schillero

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We live in a world where people love to talk in absolutes. No matter what the topic is, it’s very easy for us to see an individual situation and then broad brush it as true for everything and everyone. Two topics where this happens a lot are exercise and mental health, particularly in the relationship between the two. For years we’ve heard things like “exercise is good for depression”, but not much clarification beyond that. The goal of this article is to bring more clarity to the relationship between training and mental health, and how each one affects the other.

In the first article of this series, I discussed the high prevalence of mental illness in strength athletes and those who take training seriously. As strength athletes and coaches we spend a lot of time analyzing variables that affect our training (whether it’s a type of program, nutrition, training equipment, etc), but often time’ mental health seems to mysteriously slip through the cracks when we’re putting together the game plan for our training. Going back to the idea of “absolutes”, it’s very common for many to think of mental health/illness as purely psychological (all in our head), and training as purely physiological (it’s all about muscles moving weights). But what if a more comprehensive approach to training allowed not only athletes with mental illness to train and live more optimally, but all strength athletes to perform better as a whole? What if your mental state has direct physiological effects on your body that can change the way you program your training, and how your train can have a profound effect on your mental health even outside of the gym?

Redefining Stress

To begin examining this relationship between mental health and training we need to look what stress is and how the body responds to it. When we hear the term stress in everyday conversation, we usually think of it solely in the context of worry or busyness, such as, “I had a busy day at work, I was stressed.” Or something along those lines. But the phenomenon of stress goes beyond just little daily worries, and has a direct effect on a multitude of physiological operations in the body, including several important hormones that are also involved when we’re training hard in the gym.


RECENT: Mental Health and the Strength Athlete: Strength Beyond the Barbell


To help frame this conversation, let’s take a look at a different definition of stress. Hans Sayle used the term “stress” to represent the effects of anything that seriously threatens homeostasis.1 If it’s been a while since your last biology class, remember homeostasis is any self-regulating process by which biological systems tend to maintain stability while adjusting to conditions that are optimal for survival.”2 Basically, if homeostasis is in best case scenario, everything in your body is running perfectly. If homeostasis is in worst case scenario, you die. This is why our bodies are constantly fighting to maintain homeostasis, to keep us alive and kicking. If you’re a visual person like I am, you can think of homeostasis as a see-saw that’s perfectly parallel to the ground with people of equal weights on each side. Stress is anything that can possibly add weight to one side of the see-saw and start to throw things out of whack.

But it isn’t just having a “stressful” day that can throw the see-saw out of whack. Genetics, life events, and—yep, you guessed it—training is a big player in this game too. And like most things, training doesn’t just affect the see-saw in one way. Depending on how you train, it can throw it out of whack, or balance it back out. Buddy Morris, Head Strength Coach of the Arizona Cardinals, has said often of training his elite athletes, that, “We're really not [just] coaches of preparation. We're stress managers. How do you manage the stressors that are imposed upon your athletes? This is our job. We are stress managers; we are innate problem solvers.”14

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Why Powerlifters Get Ulcers 

There’s a book written by Robert Sapolsky called Why Zebras Don’t Get Ulcers (thus where I created the name for this article), which does a really good job describing the effects that different stress has on the body systems and how chronic stress in various forms can cause different types of illness (ulcers being one of them). The reason for the title is the premise that in the wild, many animals, in this case the Zebra, are either in a “rest-and-digest” (eating grass or laying around), or in “fight-or-flight” mode (running from a lion trying not to die). The Zebra isn’t spending hours of their day chronically stressed because they’re worrying about their mortgage, relationships, whether or not their co-workers hate them, etc. (human problems).

The key is that we have all have a complex system in our body which is dramatically affected by both training and mental illness, and also happens to control pretty much every function of your body. Your autonomic nervous system connects your brain to all of your internal organs, and is separated into two systems that allow us to fight (or in our case, hit a PR squat), or allow us to rest.4 When you’re in “fight-or-flight” mode, you’re utilizing the sympathetic nervous system; which releases the hormone epinephrine (also known as adrenaline), and then later releases hormones such as CRH, ACTH (I’ll save you the long names for now), and cortisol (also known as glucocorticoid).5 All of these hormones kick start your body in preparation to respond to an extremely stressful event. Think of it like your brain telling your body to “floor the gas pedal” in reaction to an extremely stressful moment (again, in our case, think last play of the game, biggest deadlift PR of your life type moment). The hormones listed above do a great job at allowing your body to respond to that situation, and aren’t necessarily harmful as long as your parasympathetic nervous system kicks in and tells your body to ease off the gas pedal. Your parasympathetic nervous system counterbalances the sympathetic, and allows your body to return to rest (and stop releasing those ammonia-snorting, “let’s do this” hormones we listed above).5

A problem that many of us face is that consistent stress can cause you to constantly be pushing down on the gas pedal without letting off. As you could imagine, this isn’t good. Chronic low-level stress can keep the components of the sympathetic nervous system activated, similar to a car motor that’s idling high for too long. This causes persistent epinephrine surges and consistently elevated cortisol levels. Consistently elevated stress hormones can cause a variety of health issues; ranging from diabetes and heart disease, to increases in body fat and lowered testosterone levels4[5] (pretty concerning to us as athletes). But even more important to this discussion, having elevated stress hormone levels can increase the risk for mental illness such as depression3[11], and even affect how our body reacts to additional stress in the future (including training).

So now that we’ve briefly discussed what constitutes “stress”, how it affects the nervous system, and in turn what hormones are released (and some of their potential effects), we can focus on the major variables that affect us as strength athletes. It’s important to mention that you could write 1000+ pages on all the different things that cause stress and the reactions to it, and this article certainly is not a comprehensive look at stress responses in the human body (I’m not nearly smart enough to pull that off). But that’s okay, because you didn’t open this article to take a biology course, you started reading so you could find out how to better manage mental illness in respect to your training as a strength athlete. For those purposes, I’m going to focus on in on three variables that all affect stress response in the athlete:

  • Life Events (environmental circumstances)
  • Mental Illness
  • Training

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Life’s Effect on Stress Response

So life events is a pretty broad term, but for our purposes let’s just think of it as daily events that “stress us out.” Work, relationships, pets, traffic, bills — you name it. These can be small things that are within our control (for instance, waiting until the last minute to turn in a school paper or assignment at work), or things outside of our control (family illness, or getting laid off). The key thing I want you to remember here is that life events are both a mix of controllable, and non-controllable variables. Also remember that some events can cause a sudden, short, and intense acute stress response (think jumping out of the way of a car right before it hits you, but then calming down once you realize you’re okay), and some events can cause a longer, low-intensity chronic stress response (think going through a drawn-out divorce). Like we mentioned earlier in our discussion of the sympathetic nervous system, for those that experience chronic stress response, their ability to handle the acute stress situations in life is negatively affected. The stress response to these situations is also affected by our psychological state, as research has shown that parts of the brain affected by our perception and emotional state affect the stress response of our sympathetic nervous system (and the release of stress hormones).3 So situations in our daily life, and how we perceive and process them (think psychology), both affect our body’s stress responses (and our homeostasis).


RELATED: Is Stress Killing Your Progress?


Mental Illness’ Effect on Stress Response

Like I mentioned earlier, chronic stress response in the body can cause a pre-disposition to mental illness such as depression (think along the lines of your body’s engine getting beat up from the gas pedal being pushed to the floor too long). But not only that, there is some evidence to show that a gene found in those with depression affects their ability to respond to additional stress (think about that engine having some faulty parts from when it was built). One example of this is a gene that produces 5-HTT and affects re-uptake of serotonin3 (one of several neurotransmitters suspected of contributing to anxiety and depression3[6]).

It is important to note when discussing body chemistry and mental illness that although much research has been done on the brain chemistry involved with various conditions, it isn’t clear that one specific biological dysfunction is the same cause of all mental health conditions. Like most health conditions, mental illness differs with each individual, and both the causes and the treatments will differ as well.7 This is why (going back to absolutes), it’s rare for a doctor to say to you that “this specific medication works perfect for everyone”, and on the flip side, it’s foolish for someone to say that a certain treatment or medication doesn’t work at all. I will go more into this in my next article, but remember that a comprehensive approach to mental illness (utilizing all available support systems such as family, church, physicians, counselors, and other resources) is important. If you limit yourself to one form of care, you’re also limiting your chances of finding a solution.

Regardless of the cause, mental illness has a profound effect on the body’s release of stress hormones. A meta-analysis looking at over 350 research studies concluded that over 73% of clinically depressed individuals have elevated cortisol levels compared to those without depression.8 So the main take-away here is that while the exact chemistry behind mental illness varies, we know:

  1. Release of stress hormones contributes to mental illness
  2. Mental illness affects the release of stress hormones

Hopefully you’re starting to see how close this relationship is between stress response and mental illness, and how it works in both directions. Dr. Eric Serrano works with a multitude of the top strength athletes in the world, and says that for many of his patients dealing with depression, their depressive symptoms are made worse because of all life’s stressors adding up, and then being compounded by high intensity training16 (which brings us to our next topic).

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Training’s Effect on Stress Response

So here we are at the double-edged sword of training. I mentioned in the beginning of this article that it’s pretty common to hear “exercise is good for depression” and things of that sort, but that’s not giving us a whole lot of clarification. There is a large body of research that shows exercise in general can relieve conditions such as depression through improved mood, self-image, and cognitive function.9 However, when it comes to specific stress response, exercise can both reduce it (think of letting the foot off the gas pedal), and increase it (flooring the gas again). This usually relates to the type of exercise (think cardio versus resistance training) and especially the intensity (think percentage of max heart rate or 1RM).

When we look at research that supports reduction in stress hormones, we typically see this in what we would consider low to sometimes moderate intensity training. One study that looked at adolescents with depression showed that consistent (five days per week for eight weeks) cardiovascular exercise kept at less than 50% of max heart rate (so low-intensity), not only improved depressive symptoms, but showed a decrease in blood cortisol and epinephrine levels.10 From the research I’ve seen, the majority of research done on exercise and mental illness utilizes this type of training. On the positive side, we get a good body of evidence of how consistently improving general fitness can reduce stress hormone levels and improve mental health (I will elaborate on this in my next article as well). On the flipside, the majority of strength athletes would consider the above exercise “general physical preparedness”, or “recovery work”, and not necessarily the intense training that makes up the majority of strength athlete’s routines. For anyone that works in a University or research setting, we know that realistic strength training studies (at least as they apply to strength athletes) are hard to find. There are, however, a few studies that give us an idea of the stress response caused by high intensity strength training. One study looked at the role of glucocorticoids (cortisol) in adaptation to exercise and recognized that many acute exercise studies show increased amounts of cortisol in heavier exercise but not in lighter to moderate exercise (as noted in the previous study above).12 Other studies have shown that exercise to the point of exhibiting overtraining syndrome can cause adrenal insufficiency13, which in turn affects the release of stress hormones.

So what we can start to see from what research is out there, is that training can have a very positive effect on stress hormone levels, but there is a point of diminishing returns that is dependent on exercise intensity13.

To summarize, remember that training is stress just like any other that affects the body. Certain types of training can alleviate stress hormones, while others can spike them dramatically. Coach Morris sums it up well when he says that the stress from training can be more harmful to the body than a broken bone. A bone is localized to one area of the body, whereas intense training causes the entire body's organism to be affected by stress.15

Recap

So now, we’ve looked at a few important concepts that play a huge role in the life of a strength athlete who deals with a mental illness. We examined:

  • What is stress?

(remember, think “anything that throws the see-saw out of whack”)

  • What are the sympathetic and parasympathetic nervous systems and why do we care?

(sympathetic = flooring the gas pedal, parasympathetic = pulling your foot off the pedal) 

  • What do the stress hormones released by the sympathetic nervous system do?

(tells the body “it’s GO TIME” / remember, too much is not a good thing) 

  • How do stressful life events effect stress hormone release?

(constantly pushing your foot on the gas pedal)

  • How does mental illness effect stress hormone release?

(affects everyone differently, but overall takeaway = makes it harder to deal with stress from other sources)

  • How does training affect stress hormone release?

(both positively and negatively, and there is a point of diminishing returns)

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The Perfect Storm: A Powerlifting Case Study

Now that we’ve accounted for all the players in this game of stress management, I think the best way to drive home the importance of this is to use a fictitious, but practical example.

For our example we’ll use John Doe, who is a powerlifter and competes several times a year. He is 30 years old and has been competing for about five years now. It’s been a particularly stressful year for John. He’s at risk for losing his job due to layoffs at work, and financial stress has been putting a lot of extra strain on his marriage. John is preparing for a big national-level meet, and while he is concerned financially and is feeling overwhelmed, he figures he only has a few weeks to go and can stick it out. John trains using a fairly high intensity training program, and his peaking phase (which brings his percentages pretty close to 100%) is approaching. He is also torn about the fact that he has been struggling with anxiety and mood swings, and knows he has a family history of mental illness, but isn’t quite sure the details. His wife has encouraged him to see a doctor and therapist, but with training already going poorly his pride has taken a hit and he doesn’t want to seem even weaker by “having to see a shrink”. Training-wise, not only have his numbers been dropping, but he has been leaving sessions early and skipping assistance work and conditioning because he’s so burnt out from stress. As his peaking phase continues, his performance drops even more, his anxiety gets worse, and now he’s not sleeping either. Emotionally the stress and lack of sleep is doing a number on him, and he’s been unusually rude and disrespectful to his wife and in turn now she’s been staying at her family’s house.

It’s the week of the meet and now John is trying to stay positive about the competition, but he’s burnt out, stressed, lacking his support system, and weaker than ever….

After reading that fictional account of someone leading into a meet, how familiar did that story sound to your own? Or maybe someone you know? There are a mix of variables in that story that are both in and out of John’s control, but when you look at in the context of stress that we’ve been discussing, you see how John basically had all three of those variables (life, mental health, and training), all contribute to a downward spiral that just made all three worse. His life is stressful to begin with (risk of losing his job) which was no fault of his own. That chronic stress is made worse by his pre-disposition to anxiety and possibly depression, and the emotional effects and lack of sleep are making his life circumstances (relationship with his wife) even worse. Now throw high intensity training on top of that, and John is running himself even further into the ground. You can start to see how this downward spiral of stress mismanagement can start to get worse and worse. While some of those variables are outside of John’s control (company layoffs, family mental health history), some are within his control (ability to see a doctor and therapist, and how he approaches training). By managing some of those controllable variables differently, life certainly won’t be perfect, but he can dramatically reduce his stress levels which will improve both his life and training performance.

That is just one example to try and bring all of these concepts together in a way that makes sense and seems applicable. All the biology, psychology, and training talk in the world doesn’t mean a thing if you can’t apply it to your own life in a way that makes sense.

Now that we’ve introduced this concepts and talked about their importance, my next article will go into how you can better manage your controllable variables in training to not only improve your mental health, but increase your performance and get the most out of your strength sport. Remember, like I said in the first article of this series, this is an imperfect journey, but there is hope. Keep fighting and as always don’t hesitate to reach out to me with any questions regarding these topics, and I’ll try my best to point you in the right direction.

Helpful Resources

  • National Alliance on Mental Illness: https://www.nami.org/#
  • Project 375: Mental Health Advocacy (co-founded by NFL Wide Receiver Brandon Marshall): http://project375.org/
  • Strength Over Suicide (S.O.S) Facebook Page:https://www.facebook.com/Strength-Over-Suicide-SoS-1037148352973435/?fref=ts
  • National Suicide Lifeline: http://www.suicidepreventionlifeline.org/

References

1. Schneiderman, N., Ironson, G., & Siegel, S. D. (2005). Stress and Health: Psychological, Behavioral, and Biological Determinants. Annual Review of Clinical Psychology Annu. Rev. Clin. Psychol., 1(1), 607-628. doi:10.1146/annurev.clinpsy.1.102803.144141

2. The Editors of Encyclopædia Britannica. (n.d.). Homeostasis. Retrieved June 30, 2016, from https://www.britannica.com/science/homeostasis

3. Sapolsky, R. M. (1994). Why zebras don't get ulcers: A guide to stress, stress related diseases, and coping. New York: W.H. Freeman.

4. NDRF. (n.d.). Retrieved June 30, 2016, from http://www.ndrf.org/ans.html

5. Understanding the stress response - Harvard Health. (n.d.). Retrieved June 30, 2016, from http://www.health.harvard.edu/staying-healthy/understanding-the-stress-response

6. University of Maryland School of Medicine finds depression stems from miscommunication between brain cells. (n.d.). Retrieved June 30, 2016, from http://www.eurekalert.org/pub_releases/2013-03/uomm-uom031813.php

7. What causes depression? - Harvard Health. (n.d.). Retrieved June 30, 2016, from http://www.health.harvard.edu/mind-and-mood/what-causes-depression

8. Stetler, C., & Miller, G. E. (2011). Depression and Hypothalamic-Pituitary-Adrenal Activation: A Quantitative Summary of Four Decades of Research.Psychosomatic Medicine, 73(2), 114-126. doi:10.1097/psy.0b013e31820ad12b

9. Kern, M. (2016). Exercise, Physical Activity, and Mental Health. Encyclopedia of Mental Health, 175-180. doi:10.1016/b978-0-12-397045-9.00064-1

10. Nabkasorn, C. (2005). Effects of physical exercise on depression, neuroendocrine stress hormones and physiological fitness in adolescent females with depressive symptoms. The European Journal of Public Health, 16(2), 179-184. doi:10.1093/eurpub/cki159

11. Ogłodek, E., Szota, A., Just, M., Moś, D., & Araszkiewicz, A. (2014). The role of the neuroendocrine and immune systems in the pathogenesis of depression.Pharmacological Reports, 66(5), 776-781. doi:10.1016/j.pharep.2014.04.009

12. Tharp, G. D. (1975). The role of glucocorticoids in exercise. Medicine & Science in Sports & Exercise, 7(1). doi:10.1249/00005768-197500710-00003

13. Ka, B. (2013). Overtraining, Exercise, and Adrenal Insufficiency. Journal of Novel Physiotherapies J Nov Physiother, 03(01). doi:10.4172/2165-7025.1000125

14. All Movement Begins in the Brain. (n.d.). Retrieved June 30, 2016, from https://www.elitefts.com/education/coaching-education/all-movement-begins-in-the-brain/

15. Adaptation and Stress. (2010). Retrieved June 30, 2016, from https://zachdechant.wordpress.com/2010/08/26/adaptation-and-stress/

16. Mental Health & Strength Training Interview with Dr. Eric Serrano [Telephone interview]. (2016, June 01).

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