Wed 17 Jul 2013
Posted by Doug McGuff under Uncategorized
I did the following WOW this past Friday.
MedX Overhead Press
Thick Bar Biceps Curl
Nautilus Plate Load Triceps with SS retrofits
Thick Bar Reverse Curl
MedX Leg Press
This was a great workout. Recovery was awesome and I was in a great mood in the days that followed.
Speaking of mood, as I was going through the comments on the admin page, I found a comment from a new poster named “Alex” that did not make it through. I thought his problem was an important one to address. Here is his question:
I am new to this blog but have started a SS-style workout at a facility in San Francisco and have had about 11 sessions over the past few months with a trainer. I’m not super familiar with the lingo but we use the “RenEx” or “MedEx” style machines i’m pretty sure.
I am enjoying it and have seen very significant gains, but have a few issues/questions which are threatening my continuation with this training style. I’ve done a lot of searching and have read a few things in both the book, the Q&A book, and this website, but figured I’d ask this community directly.
1. I am, consistently, experiencing severe depression that begins anywhere from 24-36 hours post workout, lasting anywhere from 1-2 days. The day of the workout (usually in the morning) I still feel ok. I have preexisting bipolar disorder (primarily depression) and though fairly well managed, it is still distressing and I fear the risk of further mood destabilization triggered by the workout.
I read various thoughts about why this might occur, but this occurs every single time, and i’m not sure how i can counteract it, if at all. Doesn’t happen with any other form of working out i’ve done in the past (lifting, swimming, hiking, at various intensity levels).
2. I was a pretty solid guy to begin with 5′11 225lbs, lots of muscle but also plenty of fat, not cut (34″ waist), swam and lifted before starting SS, but have been impressed with my gains in strength and size given the low number of workouts i’ve done. (+70lbs on leg press in 3 months), so I’d really like to be able to continue this protocol.
My Answer to Alex was triggered by something I have seen in the ER and have been studying since. It is particularly germane to Alex given his history of bipolar disorder. This is especially true if his disease is managed with the medication Depakote (Valproic Acid). Depakote is chemically a fatty acid and is used for treating certain varieties of seizure disorder, and as a mood stabilizer in bipolar disorder. Recently I have seen a few cases of, and read several case reports of, patients who are on Depakote for seizures or bipolar disorder showing up in the ER with depression, or altered mental status. In each case, the patients had been on this medication for months or years without any problem, thus ruling out an allergic reaction or paradoxical response to the medicine. After a diligent search for an underlying cause, I (and others) came up empty handed. Fortunately, this has become a hot topic in the toxicology literature and was the featured topic on one of my continuing education services.
Toxicologists solved this dilemma by going back to their basic biochemistry. Depakote is a fatty acid and is metabolized in the mitochondria by the process of Beta Oxidation. If you go back to your BBS books and look at some of our biochemistry discussion, you will recall that fatty acids are mobilized by an amplification cascade when epinephrine (adrenaline) interacts with hormone sensitive lipase to release fatty acids. These fatty acids are transported into the mitochondria by the Carnitine shuttle where they undergo a series of chemical processes called Beta Oxidation which yields 96 ATP per cycle. Depakote is metabolized by this process of Beta Oxidation and is moved into the mitochondria by Carnitine.
Over time, the increased presence of fatty acid to metabolize (the Depakote) can exhaust Carnitine stores. When Carnitine is depleted, fatty acids (including Depakote) cannot be transported into the mitochondria. Instead fatty acids remain in the cytosol (the liquid portion of the cell) and undergo Omega Oxidation, which occurs largely in an organelle called the endoplasmic reticulum. Fatty acids that are metabolized in this way produce ammonia and several inflammatory cytokines that can produce a state of depression or even delirium.
If Alex is on Depakote his Carnitine stores may be depleted and this depletion is tipped over the edge when a high intensity workout causes a surge in fatty acids needing processing by Carnitine. Not only is Carnitine depleted during high intensity exercise, Beta Oxidation of fatty acids is inhibited by lactic acidosis (which is a transient effect of a HIT workout). These two facts can drive fatty acid production preferentially toward the Omega Oxidation pathway.
Based on my reading of the literature, this process could occur with high intensity strength exercise even in the absence of Depakote, and may explain why at times I have experienced depression for 2-3 days after a particularly severe training session. Cytokines that are generated during omega oxidation are a major component of the overtraining syndrome and ROBAT (run over by a truck). Carnitine seems to be easier to deplete than I had previously thought. The word Carnitine derives from the Latin root Carne or meat, which is the major source of Carnitine. Avacadoes are also rich in Carnitine. Most who are interested in strength exercise eat a good bit of meat, but I wonder to what extent cooking may denature or damage Carnitine. There are several steps in Carnitine’s action, and there is a genetic component to these steps with varying degrees of expression, including inborn errors of metabolism. It is possible, some may be more sensitive to Carnitine depletion.
Since I have been studying this topic, I have been supplementing with 500mg-1000mg of Carnitine daily and have not had any recurrence of ROBAT or depression. Alex may want to discuss Carnitine supplementation with his doctor and give it a try. Anyone else who has experienced problems with exercise tolerance or mood problems after really hard workouts may also want to give it a try. It definitely works for Depakote overdose or paradoxical depression.
Post your WOW’s and your thoughts.
P.S. Respectful discussions, polite debate and disagreement, no profanity.