20 Years In Elite Sports - Blog 2

Functional Medicine Model Applied to Elite Sports

Pretty much everything you do as a practitioner involves a level of persuasion and behaviour change. Some athletes will follow the letter of the law, other need reasons and direction, some are suborn or just not into taking new ideas on board.

‘Selling’ the route to increased performance is important as understanding the mechanisms and rational behind the protocols both shows duty of care and builds belief in the system.

So, in each case, establishing a clear performance need for change is necessary. Show athletes where they might be deficient and why this might matter. Show them how they can either improve their health or their performance.

Gather relevant data and remember to talk to the players.

How many times does everything come up 100% on wellness, then when you sit and have a coffee you find sleep, stress and other items out of balance which you can offer fixing solutions to? Wellness data is gathered each morning with teams, and players are asked various questions, sleep, energy, motivation etc. Whilst this is important is can end up being a ‘tick box’ activity.

It’s best to change the questions or the way they are gathered every now and again to avoid staleness or the blanket ‘I’m fine’ responses. For me the old thumbs up is a pretty good indicator of readiness to train ;)

Here's a visual analogue scoring system. all you need to do is measure out a 10cm line and tick on the line between the lowest version of each interpretation on each question and the best outcome or present situation on each score.



Please take a moment to answer the following 5 questions: -

1. Are you sleeping well?

Slept terribly <---------------------------> Best night's sleep I can remember 

2. Do you wake feeling refreshed?

Wake up ready to go back to bed <---------------------------> Wake up totally refreshed

3. Do you look forward to your next training session?

Take it or leave it <---------------------------> Can’t wait for it

4. Indicate your energy level over the last week.

No energy at all <---------------------------> Full of energy

5. Are you constantly making progress?

No progress <---------------------------> Shattering PBs 

6. Indicate your general wellbeing over the last week.

Felt terrible <---------------------------> Felt on top of The world


Amino Man
Above is a functional medicine structure diagram. The key take home here is looking at the body systems and seeing how they join up.

Building on the basics means applying the functional medicine model into clinical practice. The functional medicine matrix is brilliant, but it’s worth unpacking it into a step wise approach.

When we simplify this it’s easy to step back and look at 5 stages of possible influence.

Food, elimination, inflammation, communication and the vessel we all live in. The vessel is constructed of bones, ligaments, tendons and muscles. Collagen is the glue which hold this framework together. That’s why I’ve bought out an Enhanced Amino Acid and Cofactor Collagen Matrix Formula.

5 Things Which Can Go Wrong:

Nutrition and digestion ‘WRONG STUFF IN’
Detoxification and Elimination ‘CAN’T GET IT OUT’
Immune function ‘defense & repair’= Inflammation
Endocrine Function ‘communication’
Structure ‘Form follows function’ (Perform and Function Ltd)! J


We can take these same systems and then spin them into performance areas of influence. Here’s the same 5 points if influence with a more performance focussed slant;
Energy ’In’ vs Energy ‘Out’ Lean Mass and Fat Mass
Absorption, GUT & Microbiome, Immune and inflammation
Sweating = exercise and micronutrients, Liver detox ‘OUT’ energy expenditure fat burning – metabolic flexibility

Antioxidants, omega 3, anti-inflammatory nutrition, vitamin D
Hormones, body and brain = over reaching and over training
Muscles, ligament, tendon and bones; lean body Mass & Injury Risk

Let’s deal with energy balance, energy balance is an unsurprisingly massive important area of influence. It’s a fundamental controlling mechanism. It’s about the fed or fasting states and their role on energy production and influencing body composition. I’ve written entire blogs on this alone, it’s worth digging them out if you are interested. Here’s a diagram which summarises the blogs in one picture;

The role of the gut in terms of the microbiome our health it’s influence on immune function and gut integrity. This is an area which we’ll see unpacked in the next 20 years. Right now it’s early days. Best thing you can do is eat a variety of plant based foods, with mixed fibres and use appropriate probiotic formulas if required. If you have gut issues then a stool test is normally needed to investigate things in more detail.


I’ll finish up today talking about metabolic flexibility. In short this is what most people are not. Often and in the majority of cases humans become sugar burners even at rest. As they consume too many calories, carbs and don’t’ move around enough.

If you move more, consume less you’ll both improve your burden on the planet and improve your body composition and metabolic flexibility. One key nutrient which helps with this is called L-carnitine. One of its roles is to help an enzyme which transports fat into the cell for burning. If that wasn’t cool enough carnitine also protects the brain and does a whole load of other things. If you take carnitine you can improve metabolic flexibility (as long as you train and eat properly)..Yes there’s a strong brain friendly version of L-carnitine (ALC) in the Focus Sustain Formula and also carnitine L tartrate in the Metabolic Amino Complex.

Chronic oral ingestion of L-carnitine and carbohydrate increases muscle carnitine content and alters muscle fuel metabolism during exercise in humans (February 15, 2011 The Journal of Physiology, 589, 963-973.)

The Carnitine group increased work output 11% from baseline in the performance trial, while Control showed no change. This is the first demonstration that human muscle TC can be increased by dietary means and results in muscle glycogen sparing during low intensity exercise (consistent with an increase in lipid utilisation) and a better matching of glycolytic, PDC and mitochondrial flux during high intensity exercise, thereby reducing muscle anaerobic ATP production. Furthermore, these changes were associated with an improvement in exercise performance.

This was an 11% improvement in exercise performance.

Acetyl-L-carnitine is a derivative of carnitine and is a precursor to the molecule acetyl coenzyme A, important in the citric acid cycle
N-acetyl-carnitine also assists in the transportation of long-chain fatty acids into the mitochondria for beta-oxidation
Beta-oxidation is the process in which fatty acids are broken down in mitochondria to generate Acetyl-CoA, the entry molecule for the citric acid cycle
The carnitines also have significant antioxidant activity, providing a protective effect against lipid peroxidation and oxidative stress.
Metabolic flexibility which means how well you can burn fat up to mediumly intensive levels of exercise. Which can be trained with the right use of substrates and cycling depleted state and well-fed state training. This means you spar carbohydrate for higher levels of intensity of exercise – especially important in the latter stages of matches.

More to follow later this week.