Rhabdomyolysis in a Young Vegetarian Athlete
Well, I’ve had pretty good news for awhile, so now it’s time for some that is not so great — but important to be aware of.
A case report of a lacto-vegetarian boy from Italy with rhabdomyolysis was published in the American Journal of Physical Medicine & Rehabilitation (1).
Rhabdomyolysis is a potentially life-threatening disease of severe muscle damage.
Let me quote the authors:
“The patient is a 16-yr-old boy who was a nationally ranked swimmer at that time. In the 2 wks preceding this episode, he was undergoing training 5 days per week, 2–3 hrs per day, in addition to the 4 hrs per week of school-based physical activity.”
“During the week before the visit [to the doctor's], the boy experienced progressive weakness and intermittent muscle ache particularly in the legs and reported those symptoms to his coach. At the time of the medical encounter, he also reported malaise, episodic tachycardia, and nausea.”
“A dietary history revealed that, since the age of 14 yrs, his diet had contained adequate energy but very little protein. In particular, he reported to have avoided eating meat, fish, eggs, cheese and dairy products, and legumes. The only source of protein was 100 ml of milk in the morning and soy-derived products once or twice a week. For unexplained reasons, his diet mainly and monotonously comprised pasta, bread, tomatoes, salad, carrots, fruits, white pizza, and potatoes.”
Laboratory results of interest were:
|Vitamin B12||120 pg/ml||190 – 1200|
|Ferritin||12.5 ng/ml||20 – 300|
|CK||9952 units/L||39 – 308|
CK is creatine kinase, which is a marker for muscular breakdown.
The authors believed that a low protein intake was the main problem with this boy. Upon adding meat four times a week as well as dairy to his diet, and a B12 supplement, he made a complete recovery.
I am not convinced that it was only, or even mainly, a low protein intake that caused this boy’s problems. It could have been another nutrient deficiency or a combination of deficiencies, including some that were not tested for (such as calcium and magnesium).
Of course, he could have gotten all the necessary nutrients and stayed with his vegetarian diet. Although the authors note that vegetarian diets can be healthy for athletes, they apparently did not find out why the boy was vegetarian or instruct him on how he could maintain a healthy vegetarian diet.
1. Borrione P, Spaccamiglio A, Salvo RA, Mastrone A, Fagnani F, Pigozzi F. Rhabdomyolysis in a Young Vegetarian Athlete. Am J Phys Med Rehabil. 2009 Aug 5. [Epub ahead of print] PubMed PMID: 19661778.