The Performance Doc - AMA about sports performance, sports physiology/medicine, life in professional sports, becoming a better athlete

Gerrit Keferstein, MD
May 13, 2018

I am a Performance Coach and Medical Doctor working with professional athletes. I am also specialized in Functional Medicine, which is a branch of medicine that is focussed on optimizing the function of the digestive system and hormonal system to optimizie health (and sports performance).

For over 10 years I have been working with pro athletes from basketball, ice hockey, soccer, and other team sports. I worked with the german national team in ice hockey, womens basketball, several pro teams and individual athletes.

At the top, everybody trains hard. The athletes who recover better and adapt more optimally to training, will come out on top. Gerrit Keferstein

AMA about

  • daily training routines
  • inside tipps
  • sports science
  • training management
  • injury prevention
  • rehabilitation
  • nutrition
  • regeneration
  • treatment, etc...

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How did you initially become involved in mental training?
May 18, 6:51AM EDT0
What similarities are there between training elite athletes and business leaders?
May 17, 7:56PM EDT0
Who had the greatest influence in your life and why was it such an impact?
May 17, 6:10PM EDT0
What, in your opinion, are some of the worst and most common time-wasting habits most of us are guilty of – and how easy is it to eliminate these from our daily routine?
May 17, 1:23PM EDT0

my husband (65) has been taken blood pressure medication for a year (Candecor comp 8mg). Is there any way to lower blood pressure without aleopathic medicine? Can he get off the pills? And if so, how does a healthy transition look like?



May 17, 7:00AM EDT0

Definitely there is. And it is part of allopathic medicine.

The official guidelines of allopathic medicine advise to always adress lifestyle changes, BEFORE resorting to treatment with drugs. And that is even recommended in Grade 3, and even with many other risk factors.

So lifestyle changes are ALWAYS part of the blood pressure treatment.

A lifestyle change is an individual process. A help of a lifestyle/nutrition coach/doctor is advised! There are some general things that carry a high rate of success. And these stem from the DASH diet. It is a diet that has been evaluated scientifically very well. DASH stands for Dietary Approaches to Stop Hypertension.

This diet alone showed to lower blood pressure by 5 points, and even 13 points ON AVERAGE, when combined with regular exercise.

In my experience though, there is one form of diet, which is even more effective, and that is eating only vegetables and fish/meat. Little fruit. No sugars (soft drinks, marmalade etc) and no starchy carbs from Noodles or bread.

Again, I advise working with a professional health coach, because change is not about "knowing", but about "doing", and that is often not easy. Integrating change with mindset, movement, food, and other lifestyle factors (family, friends, work, spirituality) requires individual attention.

A great place to start a journey by yourself would be to read Dr. Mark Hymans Blood Pressure Solution PDF.

Last edited @ May 17, 8:15AM EDT.
May 17, 8:10AM EDT1

Are so called superfoods (chia, goji, ashwaganda ...) an overrated hype or would you recommend any?

May 16, 11:01AM EDT1

As with the building blocks in tetris, a biochemical compount is SUPER, when it is YOUR missing piece. It'd stupid to say the long block of tetris is SUPER, while the square is BAD. They are both equally SUPER and BAD, depending on the game situation.

In a similar way our bodies biochemistry is like a game of tetris. When we have the right building blocks at the right time, our biochemistry will be "in flow" and we feel great and are healthy.

The majority of people have oxidative stress. Anti-oxidants are the missing piece in that case. And that is where Goji for example comes in. 

Many people have a damaged lining of their gut. That is where chia comes in.

Many people have chronic stress and that is where ashwagandha comes in. 

All of the ones you mentioned are VERY VALUABLE in the right dose, for the right person, at the right time.

Are they overrated? In a sense, YES! Ashwagandha does not solve all inefficiencies in the body, just as the square tetris block does not solve all tetris issues ;)

May 17, 7:32AM EDT1

Was hilft bei Fersensporn?

May 15, 9:46AM EDT1

Question : What helps against heel spurs (calcaneal spur)?

In my experience the issue originates in limited mobility of the forefoot and the lower leg.

You can rotate you forearm,because it has two bones. The lower leg has two bones as well, and should be able to rotate as well. Not as much, but there should be mobility. When that complex gets stiff, the blood supply and lymph drainage of the foot is decreased. This is often an issue in achilles tendonitis, but can also play a role in spurs. Soft Tissue massage and therapy of the calf muscles goes a long way. 

Mobilizing the fore foot is important as well. When that mobility fades, the backfoot gets put in awkward positions putting more stress on the plantar fascia, which gets inflamed and calcifies, leading to the bone spur.

To support healing from the inside Curcumin is good to take the inflammatory edge of. For example Meriva from Thorne.

May 17, 7:39AM EDT0

Welchen Sinn macht es , seinen Trianingsplan, bezüglich Laufen, mit festgelegter Herzfrequenz zu gestalten?

May 15, 9:45AM EDT1

Whats the use in running with a predetermined pulse rate?

For most regular people, there is very limited physiological reasoning behind it. The theoretical reasoning is that the pulse rate is a representation of what happens inside the cell in terms of fat and sugar metabolism. But that is why more inaccurate and fuzzy than marketing of heart rate monitors seems to suggest.

Many elite athletes train without pulse monitors, because they trust their instincts more, and use speeds and distances to manage daily training. Heart Rate and other physiological measures are only used as diagnostics.

But some people are motivated by the numbers. When the use of a heart rate monitor increases satisfaction with training and leads to them moving more often, then go for it!

In general it is NICE to have but not necessary to get big results.

There is one application though, where heart rate is more valuable. And that is when training specifically to increase the volume of the heart.  FOr that type of training the goal is to maximized the heart filling with each heart beat. When the heart rate is to low, the heart does not fill enough to train the heart, and when it is too fast, then the heart does not have enough time to get completely filled before the next heartbeat. For that type of training a heart rate of 125-160 seems to be optimal for most individuals.

May 17, 7:49AM EDT0

When would you recommend to operate a torn disc?

May 15, 7:47AM EDT0

I assume you mean a herniated disc in the back? Tough question. 

There are hard criteria:

- uncontrolled bowel movements

- muscle paralysis

When these occur surgery has to be considered.

Pain is a soft criterion. With only pain and some numbness surgery is always optional.

I am currently working on a large article on herniated discs. One preview is that even severely damaged discs can completely and almost 100% recover, meaning they "dry up" or dissolve and not only the pain is gone, but the hernitian is also not visible on the MRI anymore. I do not know for sure if -and there is no evidence about it-all disc herniations have this recovery potential, even though I personally believe this to be the case.

To operate or not is an extremely individual decision which should obviously be carefully considered. 

One key piece of knowledge is the symptom fluctuation. If there is daily fluctuation in symptoms it is a good sign. Some days are bad, some are good is a good sign that there is a good chance of conservative full recovery. I don't know of data about this, but it is my experience. When the pain is the same every day and there hasn't been a single pain free day in a long time, then surgery can be put forth as an option. But if there have been fluctuations I would try to stay away from surgery. 

May 15, 9:37AM EDT1

Is magnesium supplement = magnesium supplement? Do you recommend certain ways of intake ?

May 15, 7:40AM EDT1

No. They differ in the way our body can absorb them and which body tissues best absorb them.

The absorption is determined by which compound Magnesium is bound to.

magnesium-Sulfate. Does not get absorbed well in the gut. That is why it is used to induce diarrhea.

Magnesium-Oxide should be avoided.

Magnesium-Citrate is a decent general magnesium. Not optimal, not shitty, decent pricing. 

Magnesium-Glycinate is in my opinion the best Magnesium for muscle tissue and connective tissue. It's okay for nervous system but not perfect.

Magnesium-Threonate is great for the nervous system. In my experience very effective in sleep disorders.

Magnesium gets absorbed through the skin as well. You can use Magnesium gels to soothe muscles or help with skin conditions. They can be quite itchy sometimes.

A bath in Magnesium is also another way of absorbing Magnesium. These are called Epsom salt baths. 

May 15, 9:25AM EDT1

Would you recommend Testosteron hormone therapy for boosting physical performance?

May 15, 5:31AM EDT0

Definitely not for sanctioned athletes. 

For someone who is not competing and experiences symptoms of testosterone decline in their 50's or 60's it can be game changer. But it's important to remember that sleep is the best testosterone injection we can give ourselves. 

1 week of only sleeping 5 hours a night reduces our testosterone levels as if we have aged 10 years!

May 15, 6:01AM EDT1

Which kinds of supplements do you recommend ? 

May 15, 5:24AM EDT0

I use supplements only for specific situations. But there are three from which most people benefit :

1. Vitamin D 

2. Magnesium

3. Omega-3-Fish Oils

May 15, 5:27AM EDT1
How is Functional Medicine different from Conventional Medicine?
May 14, 1:53PM EDT1

Functional Medicine is part of Conventional Medicine. It is a board-recognized specialty branch focussing on evidence-based strategies to prevent, diagnose, and treat the root causes of disease. 

It does that by focussing on FUNCTIONS of organ systems. It looks at the function of the digestive system, the hormonal system, the immune system, and the nervous system and seeks to optimize these functions as a priority. The underlying principle is that symptoms will reside when function is restored.

For example a headache can be resolved by treating the symptom (Tylenol will take away the pain), or it can be resolved be finding the underlying disfunction that LEADS to the headache. Both approaches are warranted and are better suited for certain patients. For the people I mostly work with, the functional approach is the better option.

May 15, 4:51AM EDT0
Where do you see sports medicine in five to ten years?
May 14, 5:29AM EDT1

The healing and preventative potential of right movement and right nutrition becomes more and more evident. Clinics are overwhelmed by the huge rise in chronic disease, mental disease and cancer. There will be a huge need for people specialized in movement and nutritional medicine to prevent and heal these ailments.

It remains to be seen if sports medicine will take on that responsibility, and a new branch of medicine will take care of elite athletes, or if sports medicine will take care of elite athletes, and a new branch of medicine will focus on movement and nutrition for managing chronic disease.

May 15, 4:38AM EDT0
Which is better for replacing fluids - water or sports drinks?
May 14, 1:36AM EDT1

In general Water.

But Plain Water has a little less minerals than our blood. Drinking only plain water can therefore reduce the mineral content of our body. 

This can be big problem for performance and health. A lot of people have died in marathons for example because they drank a lot water, but it was plain water without minerals. They died of demineralisation. 

All they had to do was to add some salt to their water. This will bring the water and the blood to a similar level of minerals (isotonic) and is the best way to re-hydrate.

Most sports drinks are not solely about re-hydration, but also about re-filling sugar stores. This is obviously necessary in some sports. But it is definitely not AS necessary as often advertised :)

So in most situations drink water with a pinch of salt. When you do intense exercise you can add sugars. Either add some juice, or some dextrose, or use a sports drink. Most are too dense. It is better to dilute them 50:50 in water.

Last edited @ May 15, 4:32AM EDT.
May 15, 4:32AM EDT1
How does the nutritional needs of athletes differ from non athletes?
May 13, 8:25PM EDT1

A lot less than one would think, but with athletes the feedback is much more direct if something is not optimal in the diet.

When something in your car is broken it is much more obvious when you drive 150mph than having the car sit in your garage.

A non-athletic person might not notice a vitamin deficiency for years. And I see that in hospitals. People come in with severe dysfunctions or malnourishments and some have not even noticed.

But an athlete will notice when his performance is 2% less.

The main difference is obviously the amount of calories needed that increases with activity. The more you move the more protein you need, and depending on the sport you might need more carbohydrates. The level of fats should not differ much between athletes and non-athletes.

May 13, 11:58PM EDT0
How much do you get involved with the mental health of the people you coach? Is that a concern and how do you address it?
May 13, 7:13PM EDT1

It concerns me A LOT. I do it the same way I would with my best friend. Nothing different. I listen, I ask questions, and often people will find their answers, but if they do not I might suggest working with a professional. But sport itself is a process of creative self-discovery and can solve many "problems".

May 13, 11:48PM EDT0
Do you have any favourite inspirational stories, tips or quotes that have guided you on your professional path?
May 13, 5:40PM EDT1

Many! I will share two.

The first one relates to managing what happens around us and I learned that from my first football coach. This has shaped me immensely since. He said : "Gerrit, there are things within your circle of influence, and things outside your circle of influence. If something bothers you, and it is inside your circle of influence, then stop whining. Change it. If it is outside your circle of influence, then stop whining. You cannot change it anyway."

Since I learned this concept my life changed. Either I change it,or I do not. No use in whining about it. Somebody pisses me off? I go have a talk with him. No use in complaining to other people about that person. That does not change things.

I do not like my current life situation? I change it. No use in whining about it. Change it or leave it. 

Another eye-opener for me was so super small, but it kickstarted a thought that since grew on me more and more. It was around 5 years ago, when Fergus Connolly, a friend of mine who was working for Liverpool FC at the time, was visiting me in Germany. We were supposed to meet at 9am at the hotel. I was there 8.45. I am german. Of course I was there early. Then 9am rolls around I get nervous already. My german instincts made me feel uncomfortable that we are late. 9.05am I go into the hotel and there Fergus is sitting and having coffee. I sat down and he clearly noticed I was agitated that we are late. 

I told him : "Hey Fergus, I think punctuality is important if we want to be successful" or something along that line. All he said was : "You'd be a terrible coach for Usain Bolt."

That was such an eye-opener and it really helped me become a lot better at working with people who grew up completely different than me. People with different values, different definitions of "succcess", different ideas of life, and a different path before our mutual paths crossed. The way I see the world is just the way that I MYSELF, see the world.  

That really helped me have a much more joyful and successful relationship with athletes and people in general.

Last edited @ May 13, 11:45PM EDT.
May 13, 11:43PM EDT0
How has your love of sport influenced your career?
May 13, 4:46PM EDT1

Actually there were many times in my life when I tried to get away from sport. I wanted to get away from it like it was a bad drug. I felt I was addicted. And it is a struggle for many of my collegues who work in sport as well. We see all those things happening in the world, and all WE think about is making 24 people win a game on friday night? That is kind of fucked up in the big scheme of things, isnt it?

But as I stated earlier I came to understand that sport is a creative process of self-discovery and that is one of the most beautiful and important things in this world even on the largest scale of looking at humanity. 

In my opinion there is nothing more important than finding a way to express our inner true self, creating a voice for ourselves, discovering the strengths within ourselves and learning to use these strengths not for evil, but for the greater good. All arts are a process of creative self-discovery of that kind. And sports, especially team sports are very special form of this art, where you come to understand to transcend your own self for the success of the community, or your tribe. And I cannot imagine a better place for me in this world than being a part of that.

May 13, 11:30PM EDT0
What would be your advice in terms of planning pre-competition routines?
May 13, 3:51PM EDT1

Haha thats actually been one of my personal biggest questions in the last months. As with most things I do not have a final answer there.

For me, there is a fine line between routine and ritual. 

And I think the goal is to have enough of a routine to catapult you from all states of mind into the "gameready" state of mind, but at the same time not letting it become so much of a ritual that players start to project success of the ritual to potential success during the game. An extreme example I had was a hockey player who would always put on his right sock first, then his left (many hockey players do that). But he did it in such a manner, that when something disrupted him from doing that RITUAL just perfectly, then he was completely off for the rest of the day.

And that is bad, because that shows his inability to handle the presence independently from the past, which is HUUUUGELY important to be a successful and CONSISTENT athlete. 

Last edited @ May 13, 11:22PM EDT.
May 13, 11:21PM EDT0
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