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Vegetarian top athlete gets rhabdomyolysis

An Italian swimmer, who had his sights set on the national championships, was forced to pull out because the breakdown of his muscles was so serious that doctors feared it would lead to kidney failure. The cause was the swimmer's ultra low-protein diet. The case study was written up by health scientists at the University of Rome, and has been published in the American Journal of Physical Medicine & Rehabilitation.

The swimmer in the case study was a young man of 16. He trained four hours a week at school, and on top of that did swimming training five days a week, 2-3 hours a day. During swimming sessions the guy worked on his technique, training on his short acceleration, work at high intensity and lactic acid tolerance.

In the run up to the championships the guy went to his doctor, complaining of feeling weak, muscle pain in his legs, which came on suddenly and then disappeared again. He felt unwell, and had heart palpitations on and off as well as nausea.

After examining the swimmer, the doctors discovered that he was suffering from muscle breakdown, known in the trade as rhabdomyolysis. Pockets of fluid had built up in his legs, and the creatine kinase concentration in his blood was indicating that the muscle cells were getting crushed under the burden. The results of the blood analysis are shown below.

Vegetarian top athlete gets rhabdomyolysis

His iron reflected in the ferritin - a storage protein concentration and B12 levels were low. The cause of this, and the cause of the rhabdomyolysis, was the guy's vegetarian diet. A vegetarian diet can be very healthy, as long as you make sure you get enough proteins, vitamin B12, vitamin D, iron, zinc and calcium. But the
Vegetarian top athlete gets rhabdomyolysis
swimmer didn't really pay attention to this. His diet consisted of pasta, bread, tomatoes, lettuce, carrots, fruit and potatoes. He drank a small glass of milk every day and ate a small portion of soya a couple of times a week. Meat, fish, eggs, dairy and even beans were conspicuous by their absence.

To start with the doctors were not in favour of the young man taking part in the swimming championships. They thinned his blood with saline solution to relieve the burden on the ripped muscle cells and gave the guy vitamin B12 supplements. And last but certainly not least, they made the guy increase his protein intake. He started eating meat four times a week and dairy every day.

After three months the boy's problems had disappeared, and he was able to continue with his swimming career.

"A vegetarian diet per se is not associated with detrimental effects on athletes", the doctors conclude. "But vegetarian athletes must achieve optimal protein intake and a balanced amino acid intake through careful planning with an emphasis on protein-rich plant foods."

Am J Phys Med Rehabil. 2009 Aug 5. [Epub ahead of print].

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