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AMSSM and FIFA Hold 2nd Summit on ECG Interpretation in Athletes with top Worldwide Sports Cardiology Experts

27 Feb, 15 | by BJSM

Focus on scientifically driven ECG interpretation standards, developing clear guide to the proper evaluation of ECG abnormalities in athletes and updates to Free Online Training Program for Physicians.

vectorSEATTLE, Wash. – In a continued effort to help physicians more accurately interpret ECG results to improve cardiac safety in athletes and impact sudden cardiac death, the American Medical Society for Sports Medicine and the FIFA Medical Assessment and Research Center (FMARC) are bringing together top sports cardiology and sport medicine physicians from around the world for the 2nd Summit on ECG Interpretation in Athletes in Seattle Feb. 2627.

The Summit will focus on reaching agreement upon scientifically driven ECG interpretation standards, defining clear steps in the evaluation of ECG abnormalities and making updates to free online ECG learning modules that were designed as a result of the first ECG Summit. The 2012 Summit yielded four consensus papers and the launch of the educational modules available on the AMSSM and British Medical Journal learning site. To date, more than 13,000 modules have been completed by physicians from over 117 countries.

More than 30 of the world’s foremost authorities in sports cardiology and sports medicine will be part of the Summit, which is also being supported by the National Collegiate Athletic Association (NCAA) and includes representatives from the American College of Cardiology (ACC) Sports & Exercise Council, the European Society of Cardiology (ESC) Sports Cardiology Section and the Pediatric & Congenital Electrophysiology Society (PACES). The expert panel includes participants from 10 countries – Australia, Austria, Belgium, Brazil, Italy, Qatar, Sweden, Switzerland, the United Kingdom, and the United States.

“Whether an ECG is performed for screening or diagnostic purposes, physicians responsible for the cardiovascular care of athletes must be guided by ECG interpretation standards that distinguish normal ECG findings in athletes from ECG abnormalities requiring additional evaluation for conditions associated with sudden cardiac death,” said past AMSSM President Jonathan Drezner, MD, who is chair of the meeting. “Ideally, these standards, combined with greater physician education, will improve disease detection and limit false positive results.”

The 2012 meeting helped establish athlete specific ECG interpretation standards dubbed the “Seattle Criteria.” The 2015 Summit will update these standards based on new and emerging research to produce an international consensus to guide ECG interpretation in athletes. Dr. Drezner, who is also director of the UW Medicine Center for Sports Cardiology and a team physician for the University of Washington Huskies and Seattle Seahawks, added, “We all want athletes to be safe during sports participation. The summit represents a true scientific collaboration and commitment from the sports medicine and cardiology communities to protect the cardiovascular health and safety in athletes.”

The AMSSM is a multi disciplinary organization of sports medicine physicians whose members are dedicated to education, research, advocacy, and the care of athletes of all ages. Founded in 1991, the AMSSM is now comprised of more than 2,700 sports medicine physicians whose goal is to provide a link between the rapidly expanding core of knowledge related to sports medicine and its application to patients in a clinical setting.

One sports physiotherapist’s journey: From Beeston to Brazil

25 Feb, 15 | by BJSM

Association of Chartered Physiotherapists in Sport and Exercise Medicine blog series @PhysiosinSport

By Michael Whichello

Physio Michael Whichello and colleague

For any athlete, representing their country is often the pinnacle of their career. For all without exception comes pride, and an overwhelming sense of personal achievement. Early mornings, late nights, social sacrifice and often minimal funding – successful athletes are born out of a foundation of commitment, dedication and an intrinsic drive to achieve.

The kudos of representing Team Great Britain (GB) is by no means exclusive to athletes. Ask any Physio, doctor or coach with an interest in working in sport: covering a Team GB event is a dream. When the opportunity to travel with Team GB to Sao Paulo in Brazil came through, to say I was excited, proud and astonished is no exaggeration. Thankfully, it didn’t disappoint. However, exciting as the trip was, and at the risk of this sounding like a shamelessly narcissistic bio, it’s important to understand the processes involved in reaching the dizzy heights of national representation; this is rarely realised independently. In sport, coaches, managers, physiotherapists, often play a significant role in the making of both successful individuals and teams.

In amateur sport particularly, the level of synonymous and often selfless commitment to a common cause is imperative. My experience of working with National League Hockey club, Beeston is a prime example of this. This was my first, and to date, most important experience of working in an elite environment. No egos. No hidden financial motives. No yearning for recognition. Just an exceptional group of down to earth and talented athletes, working collaboratively with the support staff towards National Championship titles in 2 of my 3 seasons there.

Admittedly at times, it was tough. Two evenings a week after a full days’ work, and, not uncommonly, a whole weekend dedicated to travelling up and down the country with hockey, for what effectively amounted to ‘expenses’. Working alone, isolated, questioning my own knowledge and abilities, and at times getting things wrong. Occasionally the feeling of being undervalued, and even undermined would creep in. You begin to question your role – am I just a glorified first aid certificate holder? A tick in the ‘health and safety provision’ box? Friends, colleagues and often I myself in fact, questioned if this was really worth all the time and effort.

But then I left.

It’s only really at this point where you truly come to appreciate the significance of your role as a physiotherapist with a championship winning team. The kind messages of thanks from players, internationals, coaches and managers was testimony of their appreciation for my position as a physiotherapist, but moreover I think, for my commitment to the cause. An elite athlete craves a stable environment in which to train and prepare for competition; the stability of their pre-match routine, their choice of music, and the responsibility for bringing the speakers, having enough time to relax before competing, and time to mentally ’tune in’. Being safe in the knowledge that there is a physiotherapist there if needed shouldn’t be underestimated, and is all part of this stability. I often viewed my role at Beeston as another ‘job’. I had to be there, unless there was a very good reason, I felt obliged. So aside from the back end of my first season, where personal circumstances dictated that I couldn’t commit, more often than not, I was there, home or away, rain or shine.

People frequently ask me how best to get into sport, but by no means am I a very ‘experienced’ physiotherapist in the world of sport. To the contrary, I am in fact in the very early phase of my career, albeit a very exciting one. My ‘journey’ thus far carries an important message to anyone wanting to get into sports physiotherapy:

The market is saturated with keen and willing new graduates, chomping at the bit, and very forthcoming in offering their services. As a result of this, in the early stages, positions are often unfunded and lacking in ‘senior support’. You only need to look on the jobs listed on UK Sport to see how many of these are offering ‘expenses’ in the salary column. This begs the question, are physiotherapists underselling and undervaluing themselves? Should we be voluntarily tendering the skills we have worked very hard to learn and develop over the years? Am I justifying the fact that less experienced physiotherapists are doing all this extra work, for no real financial gain? Yes! I came to realise that the people questioning me when I was doing all this extra work just couldn’t comprehend that I was there because I enjoyed it, and I wanted to be there. If in any way I could contribute to the success of a team like Beeston, and learn and develop clinically in the process, then I was more than happy to commit my time.

It was for this reason that my role with the Talented Athlete Scholarship Scheme (TASS) was so exciting. Specifically, working as a Sports Physiotherapy intern with TASS athletes at the Sheffield Hallam hub (or TAC as they are known). The prospect of working alongside coaches and other support staff with a common agenda was too good to pass up. This was not without sacrifice: new house, new city, more hours, less pay, less time, less stability –a familiar story in the world of sport. But my role in the NHS treating patients with chronic lower back pain had lost its appeal. I wanted to work with talented, motivated athletes. Little did I know, however, that a massive bonus and justification would be almost immediate. An email from Craig Williams delivered the opportunity to provide physiotherapy cover for Team GB at the Brazilian Paralympic School Games, alongside Lawrence Mayhew of Leeds Beckett University, in November 2014.

Beeston to BrazilThe trip exemplified all of the fundamental components I’ve outlined. But disability sport also offered something a little bit different. It’s not a different level of commitment, sacrifice or support, nor is it a different level of funding or quality of facilities. It is, however, a very unique type of mentality. It would be easy to mistakenly assume that these athletes have ‘overcome their disability’ in order for them to compete at this level. Because for many of them, their disabilities will be ever present. But these are athletes who have accepted their disabilities. They don’t dwell on them, but instead they have discovered where their abilities lie, and push these to their limits! It made for a very humbling environment.

If truth be told, in my role as physiotherapist I had very little clinical work to do whilst we were out in Brazil. But as with my time at Beeston, it was the unseen background work and presence that were important. The preparation, attention to detail and communication in the months leading up to the trip were thorough, to say the least. Ultimately, I think this was the key to the success of the trip – the tireless efforts, and communication amongst support staff, coaches, NGB physiotherapists and parents, ensured we knew all we could about our athletes, and had catered for every eventuality. Even the inevitable glitches that come with travelling by bus in a major Brazilian city were taken in our stride – Rio-bound practitioners, beware.

Cliché as it may be, the ethos of “Together Everyone Achieves More” (TEAM) was fundamental to the success that the athletes achieved in Brazil, which included an impressive hoard of gold, silver and bronze medals. The ‘TEAM’: Coaches, team managers, support and welfare personnel, physiotherapists, a doctor, a liaison officer and a media officer, all created an elite environment from which we learned and developed. Brazil was ‘beyond expectations’ for many, as outlined by Dr Guy Evans in his recent BJSM blog.

There was never any doubt that our athletes would win medals, but that isn’t what this trip was about. The potential for these athletes to compete at Rio is very real, and they were far and away ahead of their field in Sao Paulo. So the emphasis of the trip wasn’t on winning, but on becoming familiar with the various personnel associated with these trips abroad, and what is expected of them as an elite athlete in an elite environment. For us as a medical team, the emphasis was on remaining vigilant, daily monitoring, educating the athletes, and in particular developing working relationships, and an outwardly approachable presence that was important. The athletes knew we were there, and over the course of the week, hopefully they came to understand why we were there. The hope is that they, along with the rest of us, gained valuable experiences in working and competing in a very different country, climate and culture.

This was an excellent showcase of what TASS represents, as it pushes forward in an exciting partnership with Sport England. There is no question, that its success will be measured on the achievements of its athletes. But these achievements will be built on a foundation of collaboration, and to a great extent the experiences of their support teams. I am extremely grateful to have had such an amazing opportunity, and look forward to carrying my experiences forward, as I continue to develop as a Sports Physiotherapist.


Michael Whichello is a Physiotherapist with TASS in Sheffield. Further pictures and comment on the GB team competing at the Paralimpiadas Escolares (Brazil Paralympic School Games) 2014, Sao Paulo, Brazil can be found @schoolgamesGB

Final round of the best covers of BJSM from 2014: Vote now and win prizes!

23 Feb, 15 | by BJSM

It’s finally here. The Oscar’s of BJSM. Vote now in the 2014 BJSM cover competition for your chance to win one these four fantastic books:

We have tallied the votes from the preliminary rounds, and the finalists are below. You have one week to vote.

To qualify for the prize draw:

1. Vote below on your favourite BJSM cover from 2014.

2. Include your email address for us to contact you if you win – we delete them all after the competition. Your email will not be used for list serve or promotional purposes.

3. Tweet this blog post: mention @BJSM_BMJ and hashtag #BJSMcovercomp


4. Like our Facebook page, like the link to this blog, share the link on your own Facebook wall, and hashtag #BJSMcovercomp

If you share this post on both Twitter and Facebook you double your chances of winning. But just one prize per person. Fast, fun, and the rewards are big!


Cover 22: December 2014

Cover 22: December 2014

Cover 18: September 2014 (ii)

Cover 18: September 2014 (ii)

May 2014, Volume 48, Issue 9

Cover 9: May 2014


Cover 6: March 2014 (ii)

Cover 6: March 2014 (ii)

Which BJSM cover is your favourite?

Have we found the key to open the door to optimal nutrition? Day 3 at #LCHF Summit, Cape Town

22 Feb, 15 | by BJSM

Dr Liam West (@Liam_West), Johann Windt (@JohannWindt), & Ania Tarazi

We’re back and nutrition is once again in the spotlight here at the #LCHF Summit in Cape Town. If you haven’t yet seen them yet, go back to read Day 1 & Day 2 Blogs. It is a very polarised topic, but what exactly is the best diet to follow to stay healthy and increase performance? Here’s the Day 2 and Day 3 Storify from the summit!

Dr Michael Eades – 40 years of flawed nutritional science. What will it take for change to be accepted?

Using anthropological data, Dr. Eades argued that when humans used to eat #LCHF diets they were in better health. Dr Eades discussed an Isotope Analysis used by Richards (2000) which showed Neanderthals had diets high in protein & when diet changed to include CHO and how pathological consequences ensued.

Dr Aseem Malhotra – How Dietary changes can rapidly and substantially reduce risk of cardiovascular death

In a bold address, Dr Aseem Malhotra (@DrAseemMalhotra) covered both the worries of the quality of current medical research and also how diet can impact heart disease. For more from Dr Malholtra, listen to this BJSM Podcast here.

Dr Malhotra identified “7 sins that contribute to lack of knowledge” [Extra reading]:

1) Biased funding of research,
2) biased reporting in medical journals,
3) biased patient pamphlets
4) biased reporting in the media,
5) Commercial conflicts of interest
6) Defensive medicine
7) Medical curricula that fail to teach doctors how to comprehend & communicate health statistics.

On one hand, Dr Malhotra challenged physicians. He highlighted the imperative of physicians to focus on a patient-centred approach through sharing the decision making process – For example, providing patients with informed consent prior to procedures shown in this PCI study as an example. Dr Malhotra also identified that many doctors do not understand health statistics and therefore cannot evaluate the evidence for or against a treatment.

On the other hand, Dr Malhotra criticized the uphill battle patients face in the area of diet due to industry funding biases, in the face of strong data for the efficacy of diet primary prevention of cardiovascular disease. He also stated that saturated fat is not the major issue, read more in this study: Cambridge MRC.

For people with low risk of CVD, “Statins are not the answer”, Dr Malhotra emphasized. It is more likely that are pushed by industry bias (BMJ). The primary prevention of CVD was achieved through the Mediterranean diet to date PREDIMED RCT.

Dr Malhotra then went onto discuss the #ObesogenicEnvironment we live in surrounded by processed, energy dense foods. He explained that we have toxic hospital food environments with fast food on-site and hospital snack trolleys.

Dr Jason Fung – Novel Management of diabetes & insulin resistance

In his second talk of the summit, Dr Jason Fung narrowed his focus to the treatment of diabetes and insulin resistance. Dr Fung predicated his discussion on the fact that increased insulin levels produces and exacerbates insulin resistance, the underlying problem in T2DM. In this model:

  • Under conditions of high persistent insulin: Liver becomes full of sugar and fat. The reduction in insulin levels (via decreased CHO intake, sugar intake, increased fiber intake, caloric restriction) can restore beta cell function – improve the diabetes.
  • Type 2 Diabetes Mellitus (T2DM) has 2 phases prior to diagnosis. Initial slow phase with building resistance and then late stage sharp increases in fasting glucose due to Beta Cell Dysfunction
  • Insulin resistance has shown to be reversible through surgery, fasting, and diet. For that reason, Dr. Fung argued that diabetes should not be considered a progressive, chronic disease. This contributes to a learned helplessness, the targeting of blood glucose control when it is just a symptom of diabetes. Should aim to lower insulin and to do this lower CHO intake.

In summary, Dr. Fung argued that insulin and subsequent insulin resistance causes T2DM, not blood glucose. Therefore, treatments should work to lower insulin, not simply manage the symptom of blood sugar.

 Dr. Gary Fettke – Nutrition and lifestyle related illnesses

“So you think you need sugar? Cancer needs it more!” Dr Fettke challenged delegates to consider whether we have the right focus for the treatment of cancer. Discussing the metabolic model of cancer, he highlighted the various types of cancer with the same metabolic pathway – glucose – and the possibility that it is the metabolically derived free radical production that changes chromosomal structure. He then connected this to ketogenic diets which could have an ability to slow tumour growth through lowering glucose availability

Prof Tim Noakes – Why did I support high CHO diets for athletes for so long? Review of scientific studies supporting either high or low CHO diets for athletes

Few people are more qualified to present on the topic of athletic performance as Professor Tim Noakes. In this particular address, Professor Noakes explained his own U-Turn from recommending carbohydrate loading and high carbohydrate diets for athletes to now promoting #LCHF diets. Attendees were taken through a review of the performance data from a carb-centred approach, then again from a fat-focused approach. Take home messages included:

  • For endurance athletes, the preservation of muscle glycogen is an important performance parameter, and historically attempts have focused on loading and maintaining glycogen/glucose supplies throughout activity. However, increased fat oxidation during exercise will similarly spare glycogen through supplying a greater proportion of exercise energy through fat metabolism.
  • In a brief address from Prof. Noakes’ colleage, Dr. James Smith showed that in athletes adapted to a low-carbohydrate diet, fat oxidation during exercise is significantly higher than those on a higher carbohydrate diet.
  • Though traditional diet-performance studies focus on the effects of diet and nutrients on single exercise bout performance, it is important to consider long term health effects as well as the effects of diet on recovery measures and total training volume.
  • Athletes who are insulin sensitive may continue to perform best on higher carbohydrate diets, whereas insulin resistant athletes will most benefit from the #LCHF approach.
  • Though endurance athletes may benefit from a #LCHF diet, there is more research needed to evaluate their efficacy in other sports such as strength/power sports, or intermittent sports such as cricket or golf.

Dr. Stephen Phinney – 30 years studying low CHO diets for athletes

Continuing the theme of #LCHF diets and athletic performance, Dr. Stephen Phinney discussed his many years of work with keto-adapted athletes. Similarly to Prof. Noakes, Dr. Phinney discussed data showing that endurance athletes, once adapted to a low-carbohydrate diet, can form at least as well as control diets. Most notably, he presented data that would require the reconsideration of classical exercise physiology textbook sections, demonstrating that the rates of fat oxidation at different exercise intensities are significantly different in athletes who are fat-adapted. Data that indicate anti-inflammatory effects of ketogenic diets provide preliminary insight into the potential effects of ketogenic diets in minimizing exercise-related muscle damage, increased training volume, and reducing overtraining. Additional potential benefits of nutritional ketosis in various sporting contexts remain an area in need of robust research.

So to return to the title of this blog, have we finally found the key to open the door to optimal nutrition after this #LCHF summit? No, not entirely. The door is definitely ajar and the data in the room is certainly promising. However, there is a need for further robust research before we can walk through the threshold into a new consensus of nutrition. At this point, low carbohydrate diets have documented effects on reducing weight, improving glycemic control, improving cardiovascular risk profiles (with variable LDL responses), and promising evidence in the area of endurance sports. For this reason, they should be considered a valuable and viable dietary option. Indeed, a universal one-size-fits-all approach to diet would certainly be premature and ill-advised at this point, but to dismiss and ignore the evidence on the efficacy of low-carbohydrate diets would be negligent.

Discussion continues for #clarityofmessage: Day 2, 2015 Low Carb High Fat Summit (#LCHF)

20 Feb, 15 | by BJSM

Johann Windt, Liam West (@Liam_West) and Ania Tarazi

The low carbohydrate diet discussion continues: does the LCHF diet fall better under well-researched intervention or ill-advised fad? Today the focus was on various health parameters, including metabolic syndrome, type 2 diabetes, and metabolic syndrome. Check out the Day 2 Storify here!

Dr Eric Westman – #LCHF treatment of obesity & metabolic syndrome

Launching the morning, Dr Westman described the clinical use of #LCHF diets for the treatment and prevention of obesity as well as metabolic syndrome. He presented a number of trials that demonstrated the improved efficacy of #LCHF diets in comparison to low GI diets, Mediterranean diets, and low fat diets. #KeyTheme – a conscious reduction in carbohydrate content would subsequently limit caloric intake (without deliberate restriction), and the various components of metabolic syndrome. Want some extra reading? Try these papers: 1, 2 & 3.

Dr Jay Wortman – The #LCHF diet for obesity, metabolic syndrome & T2DM

Dr Jay Wortman from Canada outlined the significant decline in the health of the aboringinal people following the introduction of western dietary foods, including processed and refined foods. Continuing the trend of many other speakers, Dr Wortman drew on the hormonal model of obesity, its associated metabolic dysregulation, and the role of insulin resistance in fat accumulation. #ModelSummary – Carbs à Insulin à Fat accumulation. His presentation concluded with data showing the most significant reductions in HbA1c levels in response to very low carbohydrate diets. (Westman et al. Nutr. Metab. 2008; Nuttall & Gannon JAN 2007).

Dr Jason Fung – Insulin toxicity & how to treat T2DM

The #LCHF theory still needs work. Dr Jason Fung addressed some “holes” in the hormonal model. Namely, he identified the repeated central cycle of insulin resistance and increased insulin levels – what comes first, the chicken or the egg ? Do high insulin levels cause insulin resistance, or is it that insulin resistance causes the increase in insulin levels. Within this model, he included 3 separate ways to impact the cycle to prevent subsequent weight gain:

  • Lower CHO intake – especially refined sources, which will lower blood insulin levels.
  • Eat #RealFood (with fiber intact) – thereby reducing insulin load of food and lowering blood insulin levels.
  • Restrict fructose intake, as it contributes more powerfully to insulin resistance than glucose.




Dr Gary Fettke – Disease-causing effects of high carbohydrate diets

Australian orthopaedic surgeon Dr. Gary Fettke expanded his focus from strictly carbohydrate intake, and presented the inflammatory response in the context of high polyunsaturated fat intake, refined carbohydrate, and fructose content. An orthopaedic surgeon with a passion for biochemistry #Solid

Dr Andreas Eenfeldt – Weight control: calories vs insulin theory

Swedish family physician Dr Andreas Eenfeldt addressed weight control in the context of the energy balance theory of obesity and the hormonal theory of obesity. He was pro-hormonal theory as per the theme of the summit but allowed the audience time to debate his opinions #OpenDebateNeeded

Dr Ann Childers – Stone-age, space-age diet: nutrition metabolism & mental health

Moving away from the waistline & heart, Dr Ann Childers presented data linking tooth decay and dental diseases to fermentable carbohydrate intake. In elite athletes, sports drinks heavily laden with sugar can lead to suprisingly rapid, advanced, caries. You can access an expert Consensus on Oral Health and Elite Sport free here.

Dr Robert Cywes – #LCHF, hunger management and limited bariatric surgery in children with morbid obesity

Shifting gears, bariatric surgeon Dr Robert Cywes brought an #addiction approach to the discussion. Take home points included not just the removal or restriction of unhealthy foods, but replacement of those foods with other foods or other rewarding activities. Physicians were encouraged to engage in lifestyle counselling with their patients and to remain sensitive to patients’ barriers. Just as smoking is not a pathology but a driver towards it, Dr. Cywes portrayed obesity in a similar light.

Dr. Jeffry Gerber – The lipid hypothesis, diet heart hypothesis & the 2013 cholesterol guidelines. Addressing treatment & management controversies based on current guidelines

Finally, Dr. Jeffry Gerber discussed the intricacies of cholesterol, HDL, LDL, particle size, and additional advanced testing methods, as well as how different diets impacted various markers. #HomeworkReading #1 & #2

Though bound together by a common thread of carbohydrate restriction there was variation among the speakers. This included their recommendations for specific daily carbohydrate values, fiber intake, and the proportion of the population who should follow a #LCHF diet – points picked up by salient questions from audience members.

The common threads woven throughout include eating #RealFood, #SayNo2RefinedCarbs, and #Don’tFeartheFat. As a number of the speakers remarked, #LCHF diets have proven effective in clinical trials, but there is a need for more research in the field of weight loss, cardiovascular risk, and dietary interventions.

Tweet your questions or comments to @BJSMPlus (BJSM’s in-depth conference Twitter handle) as we update you on the Summit.

An attempt to untie knots: day 1 at the low carbohydrate, high fat (#LCHF) summit

20 Feb, 15 | by BJSM

Last week we asked if the low carbohydrate, high fat (#LCHF) diet was a fad. This week, we’re at Cape Town to find out. Here are the highlights from the first day of the #LCHF conference. Also, check out our #LCHF Day 1 Storify.

Time for scientific humility

FullSizeRender-2The opening keynote, Gary Taubes (@garytaubes), author of ‘Why We Get Fat’ and ‘Good Calories, Bad Calories’ questioned the cause for people to overeat. Taubes uprooted the current energy balance hypothesis where, ‘too much eating and too little physical activity causes people to overeat’. He planted his alternate hypothesis: ‘obesity is a disorder driven fundamentally by insulin and dietary carbohydrates’. Taubes proposed his solution, ‘to restrict the causative agent i.e. refined grains and sugars’.

Obesity researcher, Zoe Harcombe (@zoeharcombe), studied the evidence behind the national dietary fat guidelines introduced over 30 years ago in the UK and US, and found that they were not supported by the RCTs. She proposed what we really should eat: real foods and mostly animals.

Harcombe called for:

  • public health authorities humility,
  • economic adaptations,
  • and the need to abolish conflicts of interest (showcasing conflicts of interest at the American Diabetic Association and British Nutrition Foundation).

Nutritionist, patient and doctor perspective

Christine Cronau (@ChristineCronau) talked about the fat revolution and the diet results. She explained that those who eat the most saturated fat have the healthiest bowels. Cronau questioned how food is processed (acid forming or alkalising) in the body.

Jimmy Moore (@livinlowcarbman) gave the patient perspective. He told his personal story from calorie restriction, to fat free diets and finally to the low carb, high fat diet. Moore emphasised the need to empower patients through education.

A long standing advocate in the #LCHF diet, Dr Michael Eades (@DrEades), thrashes the evidence for a low-fat diet up against the low-carb diet, and explained how he tweaked existing commercial diets to power a low carbohydrate diet for his patients. Are individualised diets the way forward?

An invitation to constructive debate 

The #LCHF convention is an opportunity for both nutrition and scientific experts to showcase their research and enrich the debate. We look forward to new research questions, and extending existing hypotheses.

Tomorrow, we look forward to hearing from the #LCHF experts on the treatment of obesity, metabolic syndrome, type 2 diabetes, mental health, bariatric surgery and the lipid hypothesis.

Reminder: Sunday 22nd February is open to the public – voice your opinion! Or, tweet @BJSMPlus and we’ll do it for you!

Stay tuned, #Don’tFearTheFat & #EatRealFood

– #TeamBJSM

The FSEM calls for a National Sporting Injury Register to encourage safe sporting and exercise practices for the general public

18 Feb, 15 | by BJSM

News Release – The Faculty of Sport and Exercise Medicine

fsem_v_Variation_1The Faculty of Sport and Exercise Medicine (FSEM) UK supports the need for a National Injury Register to cover all sports in order to identify and inform activities that may pose injury risk. Such a Register would provide key data for Governing Bodies in developing and assessing the effectiveness of injury prevention strategies including, when necessary, changes to the rules of a sport. The Faculty also acknowledges the need to apply accepted sporting risk management principles to age- group sport, including rugby union 1.

The lack of comprehensive injury statistics is a feature of almost all youth sports. Sport related hospital-treated injuries are more than five times more common than road traffic injuries for children aged 15 or younger 2. Road traffic injury prevention is a well-resourced public health issue in the UK, but sports injury identification and prevention is not. The FSEM welcomes opinion and debate on this, including the BMJ article, The unknown risks of youth rugby 3. However, it should also be noted that a growing number of individual sports governing bodies and sporting leagues are currently completing high-quality peer reviewed work in this field 4.

Dr Roderick Jaques, President of the Faculty of Sport and Exercise Medicine comments:

“There is a clear need in the UK to work towards the set-up of a National Injury Register for sport. This is essential not only for established sports, clubs and teams, but to also encourage and manage sporting and exercise practices for the general public within safe limits. The challenge is identifying how this can be done and how it can be delivered. “The barriers to developing a National Injury Register are principally outside the influence of national governing bodies for sport, therefore we need to look towards relevant organisations, regulatory bodies, colleges, faculties and public health authorities to collaborate and create a solution. Funding will also be an important part of this.”

The FSEM is already supporting and developing research strategies with key partners, such as the National Institute of Exercise and Health, to demonstrate the risks and benefits of sport and exercise to the health of the population.

Funding is now needed to support initiatives like this and the creation of a National Injury Register, in order for popular sport and exercise to be developed and encouraged within safe limits, including youth sport.


1 Fuller and Drawer Sports Med. 2004;34(6):349-56.

2 Finch CF, Wong Shee A, Clapperton A. Time to add a new priority target for child injury prevention? The case for an excess burden associated with sport and exercise injury: population-based study. BMJ Open 2014;4:e005043. doi:10.1136/bmjopen 2014-005043

3 The unknown risks of youth rugby, M Carter, Published 08 January 2015: BMJ 2015;350:h26

4 Palmer-Green DS et al Am J Sports Med. 2013 Apr;41(4):749-55. doi: 10.1177/0363546512473818. Epub 2013Feb 4


Follow FSEM on Twitter @FSEM_UK Linkedin and Facebook Web:

For further information contact Beth Cameron, PR & Communications for the Faculty of Sport and Exercise Medicine;

Email:, Tel: 0131 527 3498, Mobile: 07551903702

Low carbohydrate, high fat (#LCHF) nutrition: a neglected form of healthy eating, or a dangerous dietary fad?

15 Feb, 15 | by BJSM

By Johann Windt, Ania Tarazi & Liam West

Global experts in #LCHF nutrition are gathering in Cape Town, February 19th – 22nd, for the 2015 Old Mutual Health Convention. Hosted by Professor Tim Noakes, the summit looks at the effects of the #LCHF diet on key health issues including type 2 diabetes, obesity, and cardiovascular disease, as well as the role in athletic performance.

The lineup of 15 world-renowned speakers, both clinicians and researchers, includes Dr Aseem Malhotra, Dr Stephen Phinney, Dr Eric Westman, and Gary Taubes.

All about you

What do you think? As a BJSM Blog reader, you are undoubtedly aware that low carbohydrate diets is a polarizing topic, with vocal proponents on both sides. Do you believe that low carbohydrate diets are the best way to go? Or do they encourage dangerous levels of fat intake, with associated heart disease risks? Is carbohydrate loading necessary for optimal athletic performance?

Call to Action!

Members of the BJSM Editorial team (#TeamBJSM) will cover the convention, with live tweets, blog posts, and a series of podcasts. We also want to hear from you. What are your questions to the LCHF speakers?

Tweet your questions to @BJSMPlus, or email them to We will aim to have them answered during the four days at the convention and report back the responses via an in-depth blog analysis.

You can follow the conference via the twitter handle @BJSMPlus or the hastags #LCHF & #Don’tFearTheFat. Expect daily blogs and several podcasts with some of the keynote speakers for you to listen to after the event.

The 2015 Old Mutual Health Convention is being organized by Karen Thompson (@HELPdietSA), and you can visit the official website at


Is Cricket the Ultimate Endurance Sport?

13 Feb, 15 | by BJSM

CC Image courtesy of PJ R on Flickr

CC Image courtesy of PJ R on Flickr

Guest blog by sports physiotherapist @NicolvanDyk (Qatar)

Endurance sports require long periods of physical exertion. Defined as the “subset of sports in which the goal is prolonged athletic output, over an extended distance or for an extended period of time.” A cricket match can last for 5 days for 6-7 hours a day and if you’re a fast bowler, you may end up running 20km in a single day.
One of the most well-known endurance sports is triathlon; the IronMan® competition. If you are thinking Robert Downey Jr and the Avengers at this point, stop reading – you’ve missed the point. Ironman® triathletes are crazy, silly people who compete in an event that requires a 3.8km swim, 180km cycle and then finish it off with a “regular” 42km marathon. So, what has this got to do with cricket? Well, quite a bit perhaps…

Similarities: endurance sport and cricket

Let’s get the obvious (#tongueincheek) stuff out of the way. Both endurance sport and cricket have some pretty noticeable similarities:

  • It takes forever just to finish, the cut off time for an Ironman triathlon is around 20hrs, a regular cricket test match can include up to 30hrs of playing time.
  • A somewhat above normal interest in statistics and numbers. All physios who have assisted triathletes will know this, and all team physicians will probably know batting averages and number of balls faced/bowled by heart (because they players won’t let you forget!).
  • Training is always debated with how much fitness/strength work vs sports specific training is necessary, with the latter almost always winning (form follows function I guess – but I will steer clear of that debate). And let’s not forget
  • mental stamina and
  • overuse injuries.

Mental toughness

Mental strength is needed to endure a physical activity for hours and hours on end. Cricket is a team sport composed by individual performances, and unlike many other team sports, it can get pretty lonely out there. And rough. Just ask Jonathan Trott after his spectacular collapse in the most recent Ashes Test Series Down Under, or indeed, see if Darryll Cullinan would like to revisit some of the Shane Warne moments. You are alone, and when the going gets tough, it gets really tough. The pressure starts building, and everything seems to close in.

Similarly, in triathlon, or indeed any endurance effort, “hitting the wall” is not something any athlete ever wants to experience. Paula Newby Fraser (@paulanewbyfrase), the undisputed “queen of Kona”, an eight time world champion, had to suffer one of the most well documented moments where she completely collapsed in 1995 (she did go on to win it again a final time in 1996). A top athlete, a seven time winner already, how could it go so wrong? The answer, simply, is because at the elite level, you are constantly striving for the edge. It is about pushing the limits, about finding ways around the pain and getting over the finish line – whatever it takes.

The latest on the 2015 ICC Cricket World Cup

Back from a possible-career-ending Hamstring Strain Injury, Michael Clarke (@MClarke23) will make it to the 2015 ICC Cricket World Cup in a few days. Coach Lehmann confirmed he won’t start against England, but will play in the majority of the matches. Return to play after a hamstring injury is a tough call. Stuart Broad questions the strategy to get Clarkie back so soon. But, it seems that Dr. Peter Brukner (@PeterBrukner) and the Australian medical team got it right (#kudos) – Clarke is playing. Was it the addition of some eccentric work on the Nordic Hamstring Device? A decision like this would of course have many components, see Paul Dijkstra’s (@drpauldijkstra) excellent piece on the integrated management of the athlete. There are many overuse injuries in cricket, as is the case with endurance athletes.

I concede that cricket seems less likely to push physical limits the same way a triathlon does (let’s set aside the courageous players who faced fast bowlers with broken hands, broken ribs, or continued playing with injured muscles). There is something about the ability to concentrate for a prolonged period of time that seems to be the make of a great athlete (Hanif Mohammad holds the record individual innings in cricket with 970 minutes). In any book, that takes some sort of mental strength, endurance and ability.

So is cricket the ultimate endurance sport? Perhaps not, but it does get pretty close in terms of mental toughness. And I for one will be watching how Clarkie goes with great interest. If the ICC ® Cricket World Cup 2015 lives up to its expectations, it will be one to remember.

Nicol van Dyk is a sports physiotherapist with special training in manual therapy. He is writing this in his personal capacity as a physiotherapist. You can read his previous BJSM Blog here – advice for Tiger Woods

Genomics, Genetics, and Exercise Biology: A Celebratory Symposium – May 2015, Santorini, Greece

11 Feb, 15 | by BJSM

The International Federation of Sports Medicine (FIMS) Reference Collaborating Centre of Sports Medicine for Anti-Doping Research are planning a historic event aimed at the development of the new “omics” technologies (including genomics, transcriptomics, metabolomics and proteomics) with applications in sports medicine and sport science, including anti-doping. Despite numerous attempts to discover genetic variants associated with elite athletic performance, injury predisposition and elite/world-class athletic status, progress is limited. The reliance on candidate gene analyses, involving a small number of single nucleotide polymorphisms (SNPs) and structural variants (eg, the commonly studied insertion/deletion polymorphisms) necessitates coordinated research efforts. New approaches involving large, well-funded consortia and utilising well-phenotyped large cohorts and genome-wide technologies are necessary for meaningful progress.

santoriniTo develop this capacity, a first of a kind symposium will be held on the Greek Island of Santorini (14-17th May 2015). Here, attendees will review the most significant findings in sports “omics” and explore future trends and possibilities, including a Position Stand/Santorini Declaration. Potential participants have been identified in view of enhancing existing consortia (the Athlome Project, PowerGene, Genesis, GAMES and GeneSmart) and, as necessary, develop new consortia to move the field forward significantly. Representatives of all significant consortia and their respective funding agencies have been invited to participate in this symposium. Papers from the conference can be submitted for publication in a dedicated edition of the British Journal of Sports Medicine (BJSM) to be published in 2015.

 Organising bodies:

  • Centre for Sport and Exercise Science and Medicine (SESAME), International Federation of Sports Medicine (FIMS) Reference Collaborating Centre of Sports Medicine for Anti-Doping Research, University of Brighton, Brighton, United Kingdom
  • Pennington Biomedical Research Center, Baton Rouge, USA
  • Sports Medicine Association of Greece

Programme committee:

  • Prof Yannis Pitsiladis
  • Prof Claude Bouchard
  • Prof Vassilis Klissouras (local)
  • Prof Konstantinos Natsis (local)

Provisional Conference Programme:

14th May 2015 – Day 1: University of Athens – Keynotes/Life Time Awards

15th May 2015 – Day 2: Santorini – Lessons from the past

16th May 2015 – Day 3: Santorini – Current and future prospectives

17th May 2015 – Day 4: Santorini – Current and future prospectives

Register now:

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