What happens in Kona IronMan….

What happens in Kona IronMan….

Changes people.


I keep meaning to get a blog up about my stay in Kailua-Kona, Hawaii, and my experience of watching the Ironman World Championships 2014…. and life is throwing so many fabulous experiences at me that I am failing to find the time. I am just back to Ireland now after spending three days in  Reno Nevada. It has been a fortnight of every emotion and now jet lag. (PS key to jet lag nutritionally is to stick with protein in the am and carbs in the pm).

It was super to get back to Reno; to reconnect to two precious people, to have some me time, and to indulge in some running time. Reno is at 4,400+ feet above sea level and so I was sucking oxygen on my runs and was grateful for the sun to offset the lungs 🙂

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Back to Kona

I had an amazing week in Kona watching my loved one, new friends, and all sorts of sizes, shapes, speeds, techniques and training gear flash by that was all the other competitors as they hit the roads in their final preparations. Just walking down the street or sitting in a café provided ample opportunity to watch the athletes train in the sweltering sun; while I knocked back another Kona coffee.

{Did you know they have a coffee here called peaberry coffee that due to its lower acidity is gentler on the stomach? If you cannot get to Kona this is available to buy online in addition to the real deal Kona coffee. I digress; back to the blog. Coffee has a way of diverting me in my writing as well as in person!}


Those lucky enough arrived to the island with several weeks to acclimate to the heat and humidity and others arrived in their masses as the days closed in on race start October 11th 2014. Given the higher than normal temperatures over the past weeks and on the actual race day, those fortunate to have extra time benefitted from their training time here. I don’t think that an athlete ever gets fully used to this heat; but they do get mentally stronger at dealing with it, more savvy at keeping cool, and their bodies improve at cooling via sweating.

In fact I overheard a lady living locally explaining that you don’t ever get used to the heat; only bringing changes of clothes around with you!  And that you get good at always having a swimsuit to hand for a sea dip when the urge grabs you to cool.

For the athletes in this heat however, acclimated or not, at the end of the day the most important determinant of pace during an endurance event is body temperature followed by fuelling and hydration and so this makes three things of prime importance on the day:

  1. Keeping cool
  2. Hydration and electrolytes
  3. Nutrition strategy – maintaining blood glucose levels in a steady stream to fuel muscle function, all performance related functions, and cognitive function .

To fail on any of the above spells disaster –  in addition to many other unforeseen factors such as injury, bike mechanics, vomiting and gastrointestinal distress, sunburn and so on.

This is the official IronMan advice on nutrition although I would consider this far too basic  for someone at  ironman level; it is however a start. I have written a more comprehensive e-book on endurance preparation for triathletes and endurance athletes. Follow the link if you would like to read more.

If your goal is to compete at a significantly competitive level in triathlon, endurance racing, ironman and more, then consider this a start and seek professional advice to further tailor and individualise your strategy from there. (This service is provided in the clinic along with comprehensive health, body fat, metabolic assessment,  recovery analysis and diet planning. I have numerous diagnostic tests available to me to monitor rest-recovery balance as well as assessment of diet quality and nutritional balance. we can also assess for food intolerance and specific nutrients such as red blood cell magnesium and zinc; or fatty acid profiles; or intracellular antioxidant function).


There were so many real moments to the race that I struggle to define in words; but I will try.

The buzz

The Village of Kailua was buzzing with people, normal people who had travelled great distances at significant costs  to be there supporting their loved ones. A colour fest of flags, differing cultural appearances and languages all joined together by the common cause of being the invisible supporting person on every mile of the athletes long journey with the island.

For every photo here of me supporting my boy and his happy face on seeing myself and his sister supporting him there are hundreds of tales of love, sacrifice, support, and an understanding between loved ones about just how much ironman means. However as I mentioned before; we can never fully appreciate the journey for the ironmen men and women themselves.

The athlete parade summarised the deep sense of pride in all the athletes for their countries and brought home the massive significance of their qualification for this event as many nations came together in one parade under many flags. I defected to South Africa for the parade and confused a few of the Irish team with my roars of support.


I got to see the pros in action here albeit it in fast passings; in fact I couldn’t believe my luck as I walked out of the apartment (after a break from viewing in person to catching the live coverage on the computer) to see Sebastian Kienle whizz by me in all his 8 minute lead at the beginning of the run stage. There wasn’t much happening after him for a while, put it that way!!

Sebastian Kienle
Sebastian Kienle

To see the female pros (especially Miranda Carfrae running by like something that isn’t human) and age groupers whizzing by at speeds and intensities that most male triathletes can only dream of was truly inspiring.

I did my best to get around the course, catching loved ones three times and also the loved ones of others once if not twice. To see the desire, passion and effort in everyone’s eyes was truly inspiring and humbling and to experience the love on the support line elevating. I was a part of IronMan support, like everyone else it fired a dream to return and more.

To see some fabulous photos of the final hour at the finish line see here: http://triathlon.competitor.com/2014/10/photos/photos-final-hour-kona_108192

2014 Ironman World Championship

What stood out to me most was the courage, strength, determination and performances of the ordinary people achieving the extraordinary…. and the crowd and atmosphere told a similar tale. It was a phenomenal experience.

Here are some race highlights which help to convey all that is World Championships at Kona Hawaii IronMan.

The food – always top of my list!

I was only here a week so it is tricky to conduct a review of the restaurants. I was staying in rented accommodation and as an athlete house we cooked at home for most meals. It is expensive to buy food and to eat out here in Hawaii as fresh produce that is not local requires importation; but when you are in countdown to IronMan it is a case of suck it up and flash the plastic in the local supermarkets to buy fresh healthy produce because food matters; more than anything.

We did enjoy meals at Bongo Bens, Huggos on the Rocks and the food on offer was clean and healthy and catered to the numerous training athletes. There were also gluten-free options and so I was happy. Kailua village almost becomes one big athlete training camp; and the local restaurants have risen to the healthy eating challenge.

As much as it is possible to stick to your nutrition plan when eating out. It is equally easy to make poor food choices; so choose wisely! If you do get tempted by the local ice-cream and other indulgences then try to savour a taste and leave the rest aside.

Kona coffee and peaberry coffee is a green light as are the local Macademia nuts, fresh coconut water, and peanut butter-coconut nut butter blends which are to die for!
If indulging in nuts and nut butters then just take the additional fats into your fat allowance for the day and you are good to go as both provide nutrition  and important fats to recover intramuscular triglyceride stores.

Coconut fats in particular are beneficial for the endurance athlete as they provide helpful MCT (medium chain triglyceride fats) and anti-viral substances. I write about this more in my Endurance Race and Triathlon Preparation E-Book available here:

I never made the swim out for my coffee as we simply ran out of time; it is on the to do return list!

Other foods that are helpful to recovery include turmeric and turmeric tea, ginger, beetroot, green leafy vegetables, non-gluten containing grains such as rice and buckwheat, omega 3 rich fish, CLA rich grassfed beef, green tea, the infamous Acai bowl as found here in Hawaii, and many more as detailed in the e-book. Diet is a key part of IronMan strategy; no excuses.

The temperatures:

It is hot and humid here; say no more! Not only do the athletes need to pay attention to smart strategies to prevent burning but so do the spectators!

As mentioned before, keeping abreast of your hydration and electrolyte needs is paramount and I have written about this in my E-Book should you require further guidance.

Body weight monitoring pre- and post-training is a good idea to get a gauge on your sweat loss and hence hydration needs; especially as your fluid requirements may change as you acclimate to the heat and humidity (your body learns to sweat less and to excrete less salt over time). Over-hydrating is NOT recommended in these conditions and especially the use of water alone. At this stage of the game I always recommend sticking to your tried and tested brands of gels, electrolyte tabs, sports drinks, or water. If you can filter your water then do; our apartment gained a jug filter :-).

Monitoring body pH can also he helpful and there are also more sophisticated ways than urine colour and body weight to monitor your hydration status such as an osmometer; e.g. osmocheck.

Coconut water is the buzz here and rightly so; I am a big fan of coconut water as a hydration aid for athletes. It is refreshing and rich source of the minerals potassium, sodium, manganese, and magnesium,  some vitamins such as  Vitamin C and Riboflavin,  and also contains some carbohydrate sugars. I suggest that it is used in the regular diet as a refreshing drink and as an hydration aid before/ during/ after lighter training sessions.

I do not recommend coconut water as a substitute to your carbohydrate and electrolyte strategy for IronMan competition day as the electrolyte and carbohydrate content of coconut water alone is unlikely to meet the extreme demands placed on your body by the event (or more intense training sessions).

coconut water
Read More http://nutritiondata.self.com/facts/nut-and-seed-products/3115/2#ixzz3H4dNgK00.

Here is a nice review on the use of coconut water versus sports drinks during training, as you can see it is a super healthy option, however not one to take without trialling it first should you decide to use it during sport.


Please bear in mind that coconut water alone may not suffice to meet your electrolyte and carbohydrate needs during IronMan but is a superb addition to the day-to-day diet and as part of your recovery strategy while preparing for IronMan.

I was not competing but I love coconut water and so to economise I found the perfect dink mix in 3/4 water, 1/4 coconut water and ice… YUM.

When purchasing coconut water aim for a fair trade brand when possible and pure coconut water with nothing added in and nothing taken from!

Nutiva also do a coconut powder which is handy for travel as it can be added straight to water. Electrolyte tabs may be added to meet your elevated electrolyte needs.

The nerves:

Me not the competitors!

There is a heady mix here running across the spectrum from the cool and focused to the heady high of nerves; competitors and spectators alike. The infamous underpants run did a great job to infuse giggles and silliness into all involved and although I am sure that not every coach was reeling in positivity at the thoughts of their athletes out in the hot sun at day -1 to the event, I am sure that the fun run did wonders to relax all in the final countdown to gun.

I am a firm believer that focus and visualisation are of paramount importance to performance success; time and time again I have seen the more successful athletes incorporate this into their training programme. I recommend that all my athletes start to visualise the event starting many weeks out from race week.

When it comes to visualisation it is the feeling that matters the most. And following your own gut on what this means for you. For example you may wish to focus on the following in your mind’s eye and thoughts:

  • Feeling energetic and focused.
  • Feeling calm and prepared.
  • Feeling strong, positive, and that the preparation is done.
  • Focusing forward to various points on the course where you will feel an energy boost and feel good (and not focusing on the negatives of where you are weak; flip them over into a positive).
  • Feeling in tune with your body and its intuitive calls for hydration and fuelling.
  • Having a strong digestive system; absorbing your fuel easily and efficiently.
  • Focusing forward on what it feels like to cross the finish line feeling good and with energy.
  • Etc.


Remember that your body does not know the difference between fantasy and reality so tell it that how you want it!

The sheer demands of this triple discipline endurance event:

For those of you not in the know:

An Ironman Triathlon is one of a series of long-distance triathlon races organized by the World Triathlon Corporation (WTC) consisting of a 2.4-mile (3.86 km) swim, a 112-mile (180.25 km) bicycle ride and a marathon 26.2-mile (42.2 km) run, raced in that order and without a break.


World championships is where the fittest compete with the professionals and the fittest of age groupers from across the globe. To get here alone involves sacrifice, training, training and more training. I discussed this in my previous blog.

IronMan places massive demands on the athletes body, this is a lovely article written by Matt Fitzgerald about the physiological impact of an ironman. And here is an article written by Pro triathlete and doctor Tamsin Lewis detailing how to race in Kona.

What struck me most was the sheer brutality of the swim where no one was immune from a punch, dig, being swam over, or black eye and also the anger of the islands winds; double head wind became words I am familiar with as the athletes discussed their bike training sessions along that ‘Queen K”.

The memories:

Whatever it is about Kona IronMan or maybe it was Kona this year 2014 but it changed people.

This Big Island and her IronMan gave them a trial by fire, she opened their hearts, she connected people, she brought loved ones even closer together; closer than before.
And she gave them all silently more in their hearts…..
that something that will be held a secret that not even I know of to weave a tale; because I am not an IronMan.

I saw new friends achieve far more than a time. I saw them face emotions that were more raw than ever and physical demands more painful than ever in weather conditions that dealt high temperatures, sun and a double headwind. I saw them connect to inner self, I saw them pull strength from the invisible realm, I saw them do away with old conditioning about what a successful performance really is and I saw them connect with loved ones in deeper ways.

Annchen all smiles
Annchen’s smile tells it all

I will not forget what I experienced here.

Nor will I forget, as an intuitive healer the energy of these lands. I felt Hawaii as an island of two extremes between the energy of love that is in the flowers and nature and the healing waterfalls and at the other end of the spectrum in the anger and release of the spewing active volcano. If there is healing in the lands, and for the people we felt it here as grateful respectful guests. Hawaii we honour you and wish your peoples a remembrance and return to source.

While in Kona I was also blessed to be drawn to a market stall selling bone carved necklaces and pendants and shared time chatting with the wonderful store owner; he was also with his son a gifted weaver. The pendants he crafts from heart, hold very special symbols for the people and I was delighted to learn more. His work is special and if you ever in Kona to seek him out or to visit his webpage.

Garron 5
There are many symbols carved into Garron’s pendant.

If you would like to know more about the wonderful work of this gifted artist please see his webpage: http://www.makaunui.com/

The rawness that was the race mixing with the people:

Waiting for loved ones
Waiting for loved ones

I was not prepared for just how close we as spectators and encouragers got to the athletes. We were not separated by fences and security; we got to be close to our dear ones and that was special.

Oh and as a spectator then I would highly recommend that you go all out on a colourful bike helmet for it makes all the difference; thanks G!

Garron 8
Wear a bright helmet!

The organisation:

Every athlete commented on the superb organisation of the event and it is only fair to add this here as a gesture of thanks from those I know that competed to those that helped in ways sometimes more than they realise mattered. I cannot recall the number of volunteers that worked for the event but I do know that it was significant. And also to mention the superb medical staff on site as the event surely tested many beyond their limits.

One of many aid stations providing crucial hydration and cooling aids
One of many aid stations providing crucial hydration, fuelling, and cooling aids

The finish line:

There is a saying here in Limerick that the crowd is Munster (rugby team)’s 16th man. I am not sure what the crowd here in Kona was; the second man? The thousandth man? The two thousandth and something’th man? A silent strength? I have never seen a crowd before rev more in intensity as the event proceeded.

The crowd was here for the ordinary man and woman doing the extraordinary.

The professionals were doing their job; the competitors were fulfilling dreams and the crowd fed on this.


It is hard to describe that feeling of pride that I felt for my loved one and friends experience, to be inspired by their growth and see their sheer grit, determination and heart. I cannot even imagine what it must feel like for them.

Here are a few interesting links and articles:

Immune system support

I just wanted to add a few words about the health of the athlete I connection to immune system support. To do an IronMan places a massive physiological stress on the athletes body and in particular the immune system. Most athletes attended the awards ceremony in the aftermath and then had long journeys ‘home’.

The post-event awards ceremony

The immune system is suppressed for quite some time after the event, leaving the athletes vulnerable to infections and in particular viruses. Large events, less than optimal treat recovery foods, and air conditioning and international travel will all test even the strongest of immune systems.

To keep my waffle short I am including some abstracts from a medical resource called PubMed further down below.

There are several strategies worth considering to maintain a strong immune system around competition time.

Diet and nutrition are key, good sleep and daily hygiene important, and your recovery strategy paramount.

In the clinic I also recommend a number of individualised strategies including diet macronutrient balance,  nutrient supplements, probiotics, and plant and herbal extracts to support the immune system of the athletes during travel and competition.

If you are interested to learn more please email me on andreacullenhealthsolutions@gmail.com

Please see below for some interesting reads on the immune system.

The touristy stuff:

Hawaii big island is beautiful and an island of two sides: The hot and humid Kona and the very wet and humid Hila. We were in line to do a heli trip from Hila over the volcano when the weather went from this:

Heli neliTo this in less than fifteen minutes


So instead we did a true athlete recovery doing this! Sadly I am not an athlete 🙁

Andrea, Garron, Claudia
Pizza Annchen
Hungry? IronMan can do that!

Please follow the link here to see the trip that we had planned on doing from Hila airport and sadly missed due to the storm.

Kilauea volcano is currently active
Kilauea volcano is currently active

The Manta rays:
We did however get to experience the amazing Manta rays by sunset; this is our own video taken with the GoPro

The Turtles:
I missed out on the opportunity to see the turtles. Turtles are very precious to the people of Hawaii.


annchen and turtles
Annchen and turtle 🙂

And the memories that invoked inspiration; Claudia Hazelwood your words and quote summed it up:


“A place like no other. Spent my last morning here reflecting. My heart is sad to leave Kona but in order to grow one must keep moving.”

‘Happiness cannot be travelled to, owned, earned, worn or consumed. Happiness is the spiritual experience of living every minute with love, grace, and gratitude.’ Denis Waitley



The Rainbow Falls



PS do NOT do as we did and forget to fuel if driving across the island….. it makes for the stuff of heart attacks and freak-outs when you see signs telling you that you are in an extreme danger zone and to “do not stop”; fuel stations are few and far between in the middle of the island and it is terribly eerie up there; and we were not the first to do this so I hear!

Gems and Jewellery

I am a big fan of crystals and gemstones for healing and I also wear them. I have a wonderful selection of stones and jewellery collected from as far as South Africa to Reno, California and now Hawaii. I will always return to Selenite, Rose Quartz and Amethyst but Hawaii has her own wonders in the land as a result of her volcanic activity

There are several stones found locally worth mentioning for their healing properties and these are Rhyolite, Obsidian, and Peridot.



I fell in love with a polished sphere of Rhyolite similar to this one and all my friends gravitated to it when we were doing energy healing work. I felt peace, calm and the ocean in this stone. There is jewellery available in this stone although I found her prettier as she is, polished and in simple sphere form. It is astonishing that this is lava given all the wonderful colours. I purchased mine in a stall in the covered markets in Kona To read more see here:


Obsidian is a wonderful stone of protection and grounding for the home and also in jewellery and what makes it even more awesome is that it looks great in men’s jewellery given its deep black colour. Large obsidian is a wonder in the home and garden and I really wish that luggage allowance allowed me to bring a big chunk of a rock home from Hawaii, where it is created in the lava fields (obsidian is a dense volcanic glass). To read more about obsidian see crystalsandjewelry.com



Peridot is a gem that is lime or citrus-green in colour. It forms deep within the earth due to extreme temperatures and pressure from volcanic activity in Hawaii. Native Hawaiians believe peridot to be the tears of the goddess Pele. It is also considered the birthstone for the month of August. The Island of Oahu has beaches whose sand is made up of small grains of peridot. Although large peridot gemstones can still be found in Hawaii today, many larger stones sold in Hawaii actually come from Arizona.
Read more here and here

The trees!

A picture says a thousand words:

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I hope that this blog has more than inspired you and also given you a taste of what Hawaii and IronMan World Championships, Kona 2014 meant to me and my loved ones.



Huggos on the rocks

PS: Further research abstracts on the immune system and endurance sport; follow the links to the abstract and for access to the full article when available.

PubMed  has a vast number of other papers available all you need to is get searching (keep it as specific as you can).

The physical training undertaken by athletes is one of a set of lifestyle or behavioural factors that can influence immune function, health and ultimately exercise performance.

Others factors including potential exposure to pathogens, health status, lifestyle behaviours, sleep and recovery, nutrition and psychosocial issues, need to be considered alongside the physical demands of an athlete’s training programme.

The general consensus on managing training to maintain immune health is to start with a programme of low to moderate volume and intensity; employ a gradual and periodised increase in training volumes and loads; add variety to limit training monotony and stress; avoid excessively heavy training loads that could lead to exhaustion, illness or injury; include non-specific cross-training to offset staleness; ensure sufficient rest and recovery; and instigate a testing programme for identifying signs of performance deterioration and manifestations of physical stress.

Inter-individual variability in immunocompetence, recovery, exercise capacity, non-training stress factors, and stress tolerance likely explains the different vulnerability of athletes to illness. Most athletes should be able to train with high loads provided their programme includes strategies devised to control the overall strain and stress.

Athletes, coaches and medical personnel should be alert to periods of increased risk of illness (e.g. intensive training weeks, the taper period prior to competition, and during competition) and pay particular attention to recovery and nutritional strategies.

Although exercising in environmental extremes (heat, cold, altitude) may increase the stress response to acute exercise and elevate the extent of leukocyte trafficking it does not appear to have marked effects on immune function other than a depression of cell-mediated immunity when training at altitude.

The available evidence does not support the contention that athletes training and competing in cold (or hot) conditions experience a greater reduction in immune function compared with thermoneutral conditions. Nevertheless, it remains unknown if athletes who regularly train and compete in cold conditions report more frequent, severe or longer-lasting infections.

Research should identify whether the airway inflammation associated with breathing large volumes of cold dry air or polluted air impairs airway defences and whether athletes (and their physicians) wrongly interpret the sore throat symptoms that accompany exercising in cold or polluted air as an infection.

Elite athletes can benefit from immunonutritional support to bolster immunity during periods of physiological stress. Ensuring adequate energy, carbohydrate and protein intake and avoiding deficiencies of micronutrients are key to maintaining immune health.

Evidence is accumulating that some nutritional supplements including flavonoids such as quercetin and Lactobacillus probiotics can augment some aspects of immune function and reduce illness rates in exercise-stressed athletes.

Limited data are non-supportive or mixed for use of N-3 polyunsaturated fatty acids, beta-glucans, bovine colostrums, ginseng, echinacea or megadoses of vitamin C by athletes.

Relatively short periods of total sleep deprivation in humans (up to 3 consecutive nights without sleep) do not influence the risk of infection, and the reported increase in natural killer cell activity with this duration of total sleep deprivation would seem to rule out the possibility of an “open-window” for respiratory infections.

Very little is known about the effects of more prolonged sleep disruption and repeated sleep disturbances on immune function and infection incidence, although recent studies have highlighted the importance of sleep quantity (total duration of sleep per night) and quality (number of awakenings per night) to protect against the common cold in healthy adults.

Short- or long-term exercise can activate different components of a physiological stress response. Prolonged intense exercise may induce negative health consequences, many of which may be mediated by physiological pathways activated by chronic stress.

Psychological stress is likely additive to the effects of physical stress and whereas short exposures to both physical or psychological stress can have a beneficial effect on immune function, chronic exposure to stress exerts detrimental effects on immune function and health. However, regular moderate exercise could be an important factor in ameliorating the negative health effects of chronic stress via the optimization and maintenance of the survival-promoting physiological changes induced by the short-term or acute stress response.

Further research on mechanisms mediating the salubrious effects of exercise, and on the relationship between exercise and the psychosocial stress-status of an individual, is likely to be helpful for more fully and widely harnessing the health benefits of exercise.

It is agreed by everyone that prevention of infection is always superior to treatment and this is particularly true in athletes residing in countries with limited medical facilities. Although there is no single method that completely eliminates the risk of contracting an infection, there are several effective ways of reducing the number of infectious episodes incurred over a given period. These means of reducing infection risk include appropriate management of training loads, use of appropriate recovery strategies, good personal hygiene, avoiding contact with large crowds, young children and sick people, good nutrition, getting adequate good quality sleep and limiting other life stresses to a minimum.

Part two of the position statement includes sections on: training considerations (David Pyne); nutritional countermeasures to exercise-induced immune perturbations (David Nieman); effects of stress on immune function (Firdaus Dhabhar); sleep disruption and immune function (Roy Shephard); environmental extremes and the immune response to exercise (Neil Walsh and Samuel Oliver) and finally, prevention and treatment of common infections (Stéphane Bermon and Alma Kajeniene).Arch Ital Biol. 2013 Sep;151(3):126-36. doi: 10.4449/aib.v151i3.1523.

Daily probiotic’s (Lactobacillus casei Shirota) reduction of infection incidence in athletes.

Influence of vitamin D status on respiratory infection incidence and immune function during 4 months of winter training in endurance sport athletes.

The purpose of this study was to examine the influence of vitamin D status on mucosal and systemic immunity and the incidence, severity and duration of upper respiratory tract illness (URTI) episodes in endurance athletes during a 16-week winter training period.

Blood was collected from 225 subjects at the start of the study and plasma was analysed for total 25-hydroxy vitamin D (25(OH)D) and cathelicidin concentration. Blood was also collected at the end of the study and analysed for 25(OH)D and antigen-stimulated cytokine production.

Unstimulated saliva samples were obtained at the start and at 4-week intervals during the study period. Saliva samples were analysed for salivary antimicrobial peptides and proteins (AMPs). Weekly training and daily illness logs were kept.

At the start and end of the study 38% and 55%, respectively, of the athlete cohort had inadequate (plasma 25(OH)D 30-50 nmol/L) or deficient (plasma 25(OH)D < 30 nmol/L) vitamin D status.

There was a significantly higher proportion of subjects who presented with symptoms of URTI in the vitamin D deficient status group (initial plasma 25(OH)D < 30 nmol/L) during the study period than in the optimal vitamin D group (> 120 nmol/L) and the total number of URTI symptom days and the median symptom-severity score in the vitamin D deficient group was signifi- cantly higher than in the other groups.

The plasma cathelicidin concentration positively correlated with the plasma 25(OH)D concentration and the saliva secretory immunoglobulin A (SIgA) secretion rate in the optimal vitamin D status group was significantly higher than in the other groups.

Low vitamin D status was associated with lower pro-inflammatory cytokine production by monocytes and lymphocytes. Low vitamin D status could be an important determinant of URTI risk in endurance athletes and mucosal as well as systemic immunity may be modified via vitamin D-dependent mechanisms.


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