181. The Truth About Menstrual Cycle Training & Hormonal Impacts on Performance | Shawn Arent, PhD, CSCS

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Welcome to Medicine Redefined, a
podcast focusing on helping you

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reclaim ownership of your
health.

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I'm Doctor Darsha and I'm Doctor
Ultimash Raja.

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We're your hosts, here to
challenge conventional practices

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and uncover the stories behind
pioneers shaping the future of

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medicine.
Our conversations not only focus

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on the individual level to
dissect common practices for

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health optimization, but also
zoom out to enhance systemic

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change.
Join us as we look to break the

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status quo, move the needle
forward, and put the help back

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in healthcare.
Welcome back to Part 2 with

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Doctor Sean Art.
Here we pick up our deep dive

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into hormone Physiology for
performance enhancement.

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In Part 1, we covered cortisol,
insulin, growth hormone, and

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briefly test on the sex
hormones.

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Today we'll dive into the second
part of the gonadal or sex

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hormones from a female lens.
We'll also discuss female

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Physiology and the menstrual
cycle by programming around

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cycle phases isn't supported by
science and what actually

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matters for female athletes.
Thyroid hormone optimization and

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the critical role of reverse C3
that most panels miss and why

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thyroid effects everything from
recovery to cholesterol.

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We talked about catecholamines
and the autonomic balance,

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understanding sympathetic versus
parasympathetic dominance, and

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practical strategies for
optimization.

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And then a topic that I've been
very interested in and that's

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GLP 1 agonist and muscle
preservation.

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These drugs are revolutionary
when it comes to weight loss,

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but muscle wasting is something
that we need to be concerned

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about.
So thankfully there are lots of

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people out there working on
different pharmacological

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enhancements to help with muscle
regain and preserving as much

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muscle as possible.
Especially my stat inhibitors

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are something that I was very
interested in.

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So we talked about that as well
as the future performance

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enhancement, as some people like
to call them, non allergenic

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anabolic drugs.
And what's coming next?

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As a reminder, Doctor Sean Art
is the leader in the world of

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human performance and sports
science.

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He is a professor and the chair
of the Department of Exercise

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Science in the Arnold School of
Public Health at the University

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of South Carolina.
He also directs the USC Sports

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Science lab.
Let's jump right back in.

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All right, Sean, let's pick
right back up where we left off.

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So we had just talked a lot
about the male hormones,

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testosterone, emphasizing on
that.

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I'd like to shift gears to talk
a little bit about from the

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female Physiology.
Sure.

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I think it might be worthwhile
if you're interested in talking

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a little bit about the menstrual
cycle and what stage of that and

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whether in their follicular
phase or the luteal phase and

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how that might affect it.
I know there's been a lot of

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discussion on social media,
particularly in a couple of

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recent papers that have actually
come out which you might be

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familiar with respect to the
stages of menstruation and the

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menstrual phase and whether or
not that affects training,

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whether it should affect
training performance, etcetera.

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So what can you tell us about
that and take it whichever way

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you want?
Yeah, I think I could probably

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sum that up fairly quickly and
that the evidence doesn't

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support there's much of an
effect.

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It's very individual, right?
So within given phases of the

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cycle, whether you're talking
early follicular to late

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follicular, where you talk about
the changes in estrogen going

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from its lowest levels to its
higher levels and then peaking

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at ovulation.
I've been obviously maintaining

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high during mid luteal before
falling during late luteal as

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they move towards the actual
bleed phase as we're looking at

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that menstrual week.
The reality is it's Much Ado

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about nothing.
To be fair, there's a lot of

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social media hype around timing
this around phases of your

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menstrual cycle.
Training should change, diet

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should change.
The reality is the science

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doesn't support that.
What is supported is the same

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thing we support for males,
which is auto regulation when

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you're feeling a certain way.
And so not everybody's going to

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have the same signs and symptoms
during phases of the menstrual

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cycle.
So a lot of it is modifying your

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training, your diet based on how
you're feeling, not specifically

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because of a phase.
And I think the part that

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worries me a little bit is if
you look at a lot of the

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recommendations, especially I
work with athletes, right?

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And the reality is I look at
some of the things that are out

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there and all I can ever think
is when in the hell would you

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ever train hard?
There's over this four week

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phase, there's two weeks where
they don't have them doing a

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whole lot from the standpoint of
progression just because they

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think something's timed around
the cycle.

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So I think that's really
problematic and I think really

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what you're better off going off
of is how they feel.

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The other thing too is, again,
being in that athletic world,

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you don't get to pick the timing
of your competitions around your

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menstrual cycle, right?
So these women are under

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pressure to perform regardless
of what that phase is.

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And I think if nothing else
around sort of feelings during

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sort of premenstrual phase,
menstrual phase, it's more long

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lines of helping to manage those
symptoms and some of the things

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that might go along with that.
But overall, when we look at

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effects on reaction time,
adaptation capacity for

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hypertrophy, strength changes,
if any of that exists, honestly,

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it's so small.
And I think what gets lost in

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this is if you were to compare
the influence the phases have

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versus the influence of training
and competition, training and

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competition meant those are the
big rocks, those are the big

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movers.
That's going to dictate more of

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the physiological response than
just those menstrual cycle

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phases.
So is it something that needs

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more research?
Yes, and it's actually a lot

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that we have ongoing.
We just wrapped up a study with

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our beach volleyball team
looking at this in their

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offseason.
There was a minor effective

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cycle, but again, they weren't
in competition and the effect

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was so small from a strength
standpoint versus power that I

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would expect that probably gets
pretty washed out during the

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competitive phase we've had.
We've been part of an

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international consortium that's
been doing a study looking at

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this.
Hopefully those results will be

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coming out later this year as
they compile all the sites

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across all the countries.
But again, nothing of particular

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note.
And this isn't to say that

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hormonal fluctuations and female
hormones don't matter.

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That's not the point at all.
It's how much do their normal

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phase fluctuations really
influence performance and the

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reality is very little if any
for most individuals.

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So most people will learn 28
days is the average cycle.

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Sure -7 Right.
So that's your point.

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I think if you're, if you're
going anywhere from three to

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five weeks and you're only doing
consistent training, we know

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that consistency Trump's all.
But I think maybe for those just

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not familiar, if you're starting
with the menstrual phase or

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actually the bleeding phase like
you talked about, training after

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that is my God, this is gonna be
terrible.

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It's the follicular phase next.
Yeah.

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So you go from early to late
follicular and then into the

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ovulatory.
Phase and then so that'll be

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luteal and stuff.
And So what are the predominant

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hormones during the early and
late follicular phase?

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So in the early follicular phase
is when estrogen and

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progesterone are both at their
lowest.

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Late follicular estrogen rises,
progesterone still low.

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As you move into ovulation,
that's when you get peak

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estrogen and and progesterone
starts to climb.

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So it's rising at that point.
It's really during the mid

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luteal where they're both at
their highest.

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They're both high, right?
Because obviously you hit peak

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estrogen during ovulation, but
it's still remaining fairly high

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during mid luteal.
And then during late luteal,

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that's when you get both of them
starting to fall back again.

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And this is where you get that,
that menstrual precipitation in

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terms of what you get from
there.

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I know that at least when we're
a Rutgers, you've worked a ton

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with the, because the soccer
team was at a national elite

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level, right?
And so I know that at some point

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in the sports medicine realm, we
would talk about, OK, why are

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ACL injuries particularly higher
in the female athletes, right?

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So we talked about the hip to
pelvic ratio or excuse me,

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pelvic to new ratio, valgus
collapse, that kind of stuff.

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We also talked about, or at
least there, one of the theories

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is the hormones have a lot to do
with it, right?

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So we know that progesterone
estrogen can contribute to some

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ligamentous laxity.
I guess my question for you

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would be, you talked a little
bit about auto regulation.

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What does that exactly mean from
a training injury prevention

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standpoint?
What does that mean?

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So let's back up a little bit to
lead into that.

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That'll help us, OK.
So if we're looking at this from

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the hormonal influence
potentially on injury, I would

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actually say that the absence of
these hormones because of

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dietary insufficiency and
overtraining are going to be

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even worse than just the natural
fluctuations of these hormones

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when it comes to injury.
The other thing too is

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recognizing that even if, for
example, with estrogen and

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that's high at its peak, whether
it contributes to some degree of

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joint laxity.
The question then becomes how

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much of that can really be
mitigated though by good power

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and strength development?
Because we know that women, when

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you equate across as many things
as possible, the one area where

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women consistently show up lower
than men is in power, right?

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And a lot of that has to do with
Testosterone's effects on

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muscular contraction and the
receptors that contribute to

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this.
So there's a real opportunity

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there for female athletes from a
power development standpoint,

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and that also from the ability
to handle rapid movements and

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rapid readjustments.
That's the definition of power,

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right?
It's that ability to rapidly

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respond in that situation.
So I think, and I think maybe

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it's the simplest thing I could
do to paint a picture that you

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mentioned.
When we were at Rutgers, we

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worked so closely with women's
soccer and what an amazing group

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they are.
We are very fortunate to have a

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coaching staff that was bought
in that wanted the best for

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their players.
But the short part of the story

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is when we first started working
with them, they had five times

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the national average for ACL
injuries, right?

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Over the last six years that we
worked with that team, they had

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one season ending injury one.
And when you look at that, we

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didn't program anything around
the menstrual cycle of hormones.

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We measured it.
We measured hormones.

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We're looking at biomarkers.
We were looking at the system

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though.
So it was a real dedication to

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strength training on their end.
They were amazing about that.

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It was systematic periodization
throughout the training phases

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across the entire year.
It was nutritional intervention

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to manage all these things.
So we were using all these other

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factors to get at any influence
these hormones might have in the

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1st place.
But we were looking well beyond

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just estrogen and progesterone.
And we're looking at growth

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hormone, we're looking at
inflammation, we're looking at

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dietary status, we're looking at
recovery metrics.

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So I think at the end of the
day, it sounds really appealing

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from a programmatic standpoint
and from a sales standpoint to

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suggest that women need this
magic intervention around their

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cycle phases to be good
athletes.

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And the reality is, to put it
really simply, and I know

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Kirstie Elliott Sale over in the
UK has done a great work in this

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area.
But as she notes, records have

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been set in every phase of the
menstrual cycle.

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That's the reality is women
perform.

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And so I think in some ways we
do a bit of a disservice if we

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suggest that faith might be
influencing that.

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But I do think that what we can
get out, though, is some of the

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factors that can disrupt those
hormones and maybe make them

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more important.
If we attend to those things,

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for example, dietary intake,
training and recovery, right

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when we start addressing all
those things, those make for a

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much more resilient and
responsive typical cycle that

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allows them to function at an
optimal level.

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That would be your key to injury
prevention more than anything

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else, more so than just paying
attention to, hey, Oh my God,

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I'm, I'm ovulating this week.
I'm going to blow out my ACL.

231
00:11:24,120 --> 00:11:26,240
That's just, it's not the way it
works.

232
00:11:26,440 --> 00:11:29,120
Should we maybe pay particular
attention in certain phases?

233
00:11:29,120 --> 00:11:31,160
Sure.
But here's the problem.

234
00:11:31,840 --> 00:11:36,240
That's assuming that we can
measure accurately enough to

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00:11:36,240 --> 00:11:39,080
know exactly where they're at.
As an example, across most

236
00:11:39,080 --> 00:11:42,440
teams, the gold standard in this
case would be blood based

237
00:11:42,560 --> 00:11:45,040
markers, right?
We would track the entire face

238
00:11:45,040 --> 00:11:48,160
because as you noted, that
duration of face varies from

239
00:11:48,160 --> 00:11:50,400
person to person.
So we can't just assume, but we

240
00:11:50,400 --> 00:11:51,720
know it's roughly 28 days,
right?

241
00:11:51,720 --> 00:11:54,840
So it gives us a benchmark.
So there's been criticisms of

242
00:11:54,840 --> 00:11:58,000
some of the tracking apps, but
then who really has the

243
00:11:58,000 --> 00:12:03,560
resources and the dedication to
to monitor every few days, every

244
00:12:03,560 --> 00:12:06,560
week to know what phase are it
and would we get those results

245
00:12:06,560 --> 00:12:09,160
early enough to know what we
need to predict to do over the

246
00:12:09,160 --> 00:12:12,360
next few days?
I would argue the burden of that

247
00:12:12,360 --> 00:12:15,080
is more invasive than damn near
anything else we could do.

248
00:12:15,080 --> 00:12:18,880
That would just be common sense
from a training and competition

249
00:12:18,880 --> 00:12:22,000
and feeding standpoint.
So I think there's some lessons

250
00:12:22,000 --> 00:12:24,760
in there in terms of what we
should be doing.

251
00:12:24,760 --> 00:12:27,000
And I guess it's one of those
things that just because we can,

252
00:12:27,000 --> 00:12:30,240
doesn't mean we should.
And so it's can we assess all

253
00:12:30,240 --> 00:12:32,040
these things?
Can we plan for them?

254
00:12:32,320 --> 00:12:33,800
Yeah.
Should we?

255
00:12:33,880 --> 00:12:36,000
I don't know.
Some of it's pretty burdensome.

256
00:12:36,240 --> 00:12:38,840
And you might have the elite of
the elite teams having the

257
00:12:38,840 --> 00:12:40,560
capacity to do that.
Maybe it makes them feel like

258
00:12:40,560 --> 00:12:42,440
they're being proactive about
it, and that's great.

259
00:12:42,840 --> 00:12:45,720
I would also argue, though, too,
that there's some value in that

260
00:12:45,720 --> 00:12:50,360
proactive concept of just
monitoring because you're paying

261
00:12:50,360 --> 00:12:53,600
attention.
So are you really basing this

262
00:12:53,600 --> 00:12:57,400
around the face of the menstrual
cycle or you paying attention to

263
00:12:57,400 --> 00:13:01,440
monitoring in a way that clues
you into other things that may

264
00:13:01,440 --> 00:13:03,560
be going on?
So that's where your

265
00:13:03,560 --> 00:13:06,280
intervention comes in.
And so I think that, yeah, some

266
00:13:06,280 --> 00:13:07,440
of it's just common sense.
You're right.

267
00:13:07,440 --> 00:13:08,720
A lot of it sounds great,
though.

268
00:13:08,720 --> 00:13:11,920
It's super cool to think, yeah,
man, we could program around

269
00:13:11,920 --> 00:13:13,600
this.
But like I said, they don't get

270
00:13:13,600 --> 00:13:17,480
to choose when they compete.
So your best or your best, no

271
00:13:17,480 --> 00:13:18,760
matter where you put them.
And so that.

272
00:13:18,880 --> 00:13:21,160
So coming back to your question
about the auto regulation, what

273
00:13:21,160 --> 00:13:23,560
does that look like?
The reality is that it's

274
00:13:23,560 --> 00:13:25,560
throughout the menstrual cycle.
I think one of the things that

275
00:13:25,560 --> 00:13:30,080
can be very useful is to really
track how an athlete feels

276
00:13:30,280 --> 00:13:32,000
during those phases of the
menstrual cycle.

277
00:13:32,480 --> 00:13:35,360
And if you start to detect
patterns, and they typically

278
00:13:35,360 --> 00:13:37,600
have, like we've worked with a
few athletes that certainly

279
00:13:37,680 --> 00:13:39,600
during that sort of
menstruation, we during that

280
00:13:39,600 --> 00:13:43,080
bleed phase and maybe the days
leading up to it, whether it was

281
00:13:43,160 --> 00:13:46,280
severe cramping, whether it was
just discomfort, they didn't

282
00:13:46,280 --> 00:13:50,160
sleep as well, whatever.
Like those are symptoms that we

283
00:13:50,160 --> 00:13:52,840
can pay attention to and help
them through their training and

284
00:13:52,840 --> 00:13:55,960
recovery.
It's a side effect to the phase.

285
00:13:55,960 --> 00:13:57,920
It's not because of the phase.
Does that make sense?

286
00:13:59,640 --> 00:14:02,080
So that's the approach that
we've traditionally taken that I

287
00:14:02,080 --> 00:14:04,800
think works really well.
That being said, this is not to

288
00:14:04,800 --> 00:14:07,320
suggest that we don't need more
information in this area.

289
00:14:07,320 --> 00:14:09,360
And we're continuing to work in
this space.

290
00:14:09,360 --> 00:14:12,160
One of my great colleagues here,
Katie Hirsch, is doing some

291
00:14:12,280 --> 00:14:14,200
awesome work around female
athletes.

292
00:14:14,360 --> 00:14:16,840
And then again, the work that
Kirstie Elliott Sale and others

293
00:14:16,840 --> 00:14:20,600
around the world are doing, I
think we're adding information

294
00:14:20,600 --> 00:14:23,640
to this part of the puzzle.
But most of the information that

295
00:14:23,640 --> 00:14:27,600
we have right now would suggest
that modifying training itself

296
00:14:27,640 --> 00:14:32,120
just based on menstrual cycle
phase adaptation is not really

297
00:14:32,120 --> 00:14:34,920
warranted at this point.
Basing it around how they're

298
00:14:34,920 --> 00:14:37,400
feeling and symptoms that may go
with it, that's a different

299
00:14:37,400 --> 00:14:39,040
story, but it's not quite the
same thing.

300
00:14:40,040 --> 00:14:42,200
Yeah, I think it's a classic
majoring in the minors type

301
00:14:42,200 --> 00:14:44,560
situation.
And to your point, I don't think

302
00:14:45,000 --> 00:14:47,840
part of the check in process at
the Olympics is to register what

303
00:14:48,080 --> 00:14:51,000
phase you're in, right?
Let's talk about progesterone.

304
00:14:51,000 --> 00:14:54,280
So we talked about, so you said
progesterone, estrogen lower as

305
00:14:54,280 --> 00:14:57,160
we get up towards the luteal and
olitory phase, both of them are

306
00:14:57,160 --> 00:14:59,560
going to rise.
I should also mention you have

307
00:14:59,560 --> 00:15:02,680
that LH peak which causes the
ovulation that happened.

308
00:15:03,040 --> 00:15:07,280
Now we talked earlier about how
testosterone is still on an

309
00:15:07,280 --> 00:15:10,280
absolute level, still probably
the highest level or in terms of

310
00:15:10,320 --> 00:15:11,920
all hormones even in females,
right?

311
00:15:11,920 --> 00:15:14,080
Is that correct?
And the importance of that both

312
00:15:14,080 --> 00:15:17,720
in males and females.
However, progesterone is unique

313
00:15:17,840 --> 00:15:20,120
to females, OK.
So talk a little bit about the

314
00:15:20,120 --> 00:15:23,840
role of that and how that plays
into in terms of female

315
00:15:23,840 --> 00:15:27,400
Physiology and why it's not
necessarily necessary in male

316
00:15:27,400 --> 00:15:28,960
Physiology in there.
And some of the differences are

317
00:15:28,960 --> 00:15:30,760
there.
The reality is from progesterone

318
00:15:30,760 --> 00:15:33,640
standpoint I guess probably and
this is a way

319
00:15:33,640 --> 00:15:36,160
oversimplification, but for the
purposes of this it works.

320
00:15:36,160 --> 00:15:39,960
But compared to so estrogen can
be very supportive to athletic

321
00:15:39,960 --> 00:15:41,400
performance and health and
things like that.

322
00:15:41,840 --> 00:15:45,840
Progesterone on its primary rise
is far less favorable to

323
00:15:45,840 --> 00:15:47,240
performance, right?
So one of the things that

324
00:15:47,240 --> 00:15:49,920
happens with increasing
progesterone can be challenges

325
00:15:49,920 --> 00:15:53,960
to Thermo, to Thermo regulation
because it can help increase

326
00:15:53,960 --> 00:15:57,160
core temperature there.
There may in certain situations

327
00:15:57,160 --> 00:15:59,320
with the central nervous system.
There's some evidence for a

328
00:16:00,240 --> 00:16:02,560
little bit of overseer, but a
bit of a sedative effect, one of

329
00:16:02,560 --> 00:16:06,000
those that may dampen that CNS
response just a little bit,

330
00:16:06,000 --> 00:16:08,720
which is why there's been some
suggestions that maybe when

331
00:16:08,720 --> 00:16:12,040
progesterone's at its highest,
that maybe reaction times not as

332
00:16:12,040 --> 00:16:13,240
good.
Again, it depends on the

333
00:16:13,240 --> 00:16:15,080
athlete, depends on the
situation.

334
00:16:15,360 --> 00:16:18,120
It may play a role in some of
the psychological responses in

335
00:16:18,120 --> 00:16:20,960
terms of mood, feelings of
fatigue and things like that.

336
00:16:21,200 --> 00:16:24,160
And it looks like whereas
estrogen seems to be fairly

337
00:16:24,160 --> 00:16:28,000
supportive of anabolism or at
least protein synthesis to some

338
00:16:28,000 --> 00:16:31,040
degree, progesterone can play a
little bit more of a role in

339
00:16:31,040 --> 00:16:33,800
protein catabolism.
And this does not mean you want

340
00:16:33,800 --> 00:16:36,520
to block progesterone, right?
So in other words, like these

341
00:16:36,760 --> 00:16:42,080
play complementary roles under a
normal cycle phase and normal

342
00:16:42,080 --> 00:16:45,360
female Physiology.
So there's the nature of what

343
00:16:45,360 --> 00:16:48,080
they both lend to this.
But you also notice that over

344
00:16:48,080 --> 00:16:51,200
most of the menstrual cycle,
comparatively speaking,

345
00:16:51,560 --> 00:16:55,000
progesterone does not peak for
as long and is not as high

346
00:16:55,000 --> 00:16:57,200
nearly as long as what estrogen
is.

347
00:16:57,400 --> 00:16:59,880
And so that's where we pay
attention to what that impact

348
00:16:59,880 --> 00:17:01,760
might be.
But but yeah, it's just, it's

349
00:17:01,760 --> 00:17:05,040
all part of the normal
physiological functioning more

350
00:17:05,040 --> 00:17:08,560
than anything else.
Yeah, I, I think an important

351
00:17:08,560 --> 00:17:10,760
thing to to mention it from a
fertility standpoint and from a

352
00:17:10,760 --> 00:17:12,920
child bearing standpoint, that's
the most important thing, right.

353
00:17:12,960 --> 00:17:13,800
So that's.
Absolutely.

354
00:17:13,800 --> 00:17:15,200
I think that's what needs to
talk about.

355
00:17:15,599 --> 00:17:18,280
That being said, though, I've
this believe it or not, at least

356
00:17:18,280 --> 00:17:20,880
in the physique competitor and
you don't have to speak to this

357
00:17:20,880 --> 00:17:23,520
right, because if your wife if
somebody's necessarily not

358
00:17:23,520 --> 00:17:25,240
interested in that, they were
like, OK, what role does that

359
00:17:25,240 --> 00:17:27,400
serve?
Turns out actually to your

360
00:17:27,400 --> 00:17:31,080
point, serves a very important
role in mood regulation.

361
00:17:31,080 --> 00:17:33,160
We talked about the role of
estrogen in males in terms of

362
00:17:33,160 --> 00:17:34,960
mood regulation.
In fact, people will be, you

363
00:17:34,960 --> 00:17:40,160
know, the rapid drop in estrogen
is often times responsible for

364
00:17:40,160 --> 00:17:42,560
the PMS type of symptoms that
people have.

365
00:17:42,560 --> 00:17:45,120
And so one of the treatments
just micronized progesterone, it

366
00:17:45,120 --> 00:17:48,040
could be for that.
And so why that tends to happen

367
00:17:48,040 --> 00:17:50,360
in some individuals more so than
others.

368
00:17:50,480 --> 00:17:53,240
I don't think we know the answer
to that, but it is very

369
00:17:53,240 --> 00:17:55,240
important.
So I think, yeah, it's to your

370
00:17:55,240 --> 00:17:57,760
point like this context and
taking a big picture approach to

371
00:17:57,760 --> 00:18:00,960
looking at this.
And again, left the the audience

372
00:18:00,960 --> 00:18:04,200
last time with me looking at I
understand Diane and going up

373
00:18:04,200 --> 00:18:07,000
and taking egg yokes and it
isn't Physiology isn't quite as

374
00:18:07,000 --> 00:18:10,240
simple to your point, right.
I realized I took something for

375
00:18:10,240 --> 00:18:11,280
granted.
I'm taking the audience for

376
00:18:11,280 --> 00:18:13,320
granted in terms of we talked
been talking about these

377
00:18:13,320 --> 00:18:16,600
hormones at a primary level.
So I know we we've hinted at

378
00:18:16,600 --> 00:18:17,640
that.
You've hinted at that couple

379
00:18:17,640 --> 00:18:19,120
times.
So we've got the hypothalamus,

380
00:18:19,120 --> 00:18:21,480
pituitary adrenal axis,
hypothalamus, pituitary quinatal

381
00:18:21,480 --> 00:18:23,400
axis.
I'll just give a little primer

382
00:18:23,400 --> 00:18:26,200
for them because maybe we
haven't just been very clear

383
00:18:26,200 --> 00:18:27,040
this.
So we talked a lot about

384
00:18:27,040 --> 00:18:31,200
cortisol at the hypothalamus.
So we have cortical releasing

385
00:18:31,200 --> 00:18:34,440
hormone, CRH, correct the
pituitary ACTH, adrenocortic

386
00:18:34,440 --> 00:18:37,120
hormone and then down to the
adrenal cortex, cortisol for

387
00:18:37,120 --> 00:18:39,880
growth hormone, we have GHRH,
growth hormone releasing hormone

388
00:18:40,000 --> 00:18:42,320
or somatosatin, that's another
name.

389
00:18:42,320 --> 00:18:44,920
Yep.
And then we have what's the next

390
00:18:44,920 --> 00:18:46,440
one at the, we have growth
hormone at the.

391
00:18:46,520 --> 00:18:48,080
Growth hormone, yeah.
Down the road you're gonna have

392
00:18:48,080 --> 00:18:50,600
IGF, testosterone, we're going
to have gonadotropin releasing

393
00:18:50,600 --> 00:18:52,920
hormone, FSHLH, which we're
talking about.

394
00:18:52,920 --> 00:18:55,160
And then at the, we're going to
have that insulin is the

395
00:18:55,160 --> 00:18:56,320
exception.
We talked a little bit about

396
00:18:56,320 --> 00:18:58,280
insulin, yeah, that's not going
to be in that axis.

397
00:18:58,280 --> 00:18:59,840
That's going to be at the in the
pancreatic.

398
00:19:00,040 --> 00:19:01,680
Pancreatic level between that
and Glucagon.

399
00:19:01,720 --> 00:19:05,080
Yeah, that and beta cells.
OK, so with that clarified,

400
00:19:05,200 --> 00:19:07,120
let's let's continue.
So we talked a lot about that

401
00:19:07,120 --> 00:19:09,520
you last time we talked about
the importance of some of the

402
00:19:09,520 --> 00:19:12,600
other ones that are not often
talked about in social media as

403
00:19:12,600 --> 00:19:14,320
much.
Although the prevalence of

404
00:19:14,440 --> 00:19:17,800
thyroid hormone abnormalities is
extremely high, especially not

405
00:19:17,840 --> 00:19:20,880
hypothyroidism, far more common
than hyper.

406
00:19:21,200 --> 00:19:23,160
So let's talk about
hypothyroidism.

407
00:19:23,160 --> 00:19:26,160
You even talked about how often
times people when you're looking

408
00:19:26,160 --> 00:19:29,600
at your labs, well RT 3 you said
was really important.

409
00:19:29,600 --> 00:19:31,960
So give us a high level of
thyroid, right?

410
00:19:31,960 --> 00:19:35,320
I forget what the So again, TSH
at the pituitary, forget what's.

411
00:19:35,560 --> 00:19:38,520
Correct.
So you got, so you got thyroid

412
00:19:38,520 --> 00:19:41,400
stimulating hormone, correct.
And then when you move from

413
00:19:41,400 --> 00:19:44,640
thyroid stimulating hormone at
that level down to the thyroid

414
00:19:44,640 --> 00:19:47,080
itself, now we're looking at the
thyroid production.

415
00:19:47,080 --> 00:19:49,600
So we're looking at primarily T4
and T3, right.

416
00:19:49,600 --> 00:19:54,800
So T4 thyroxine is the
predominant form of thyroid

417
00:19:54,800 --> 00:19:57,880
hormone in the body.
About 90% of what we manufacture

418
00:19:57,880 --> 00:20:00,840
is primarily T4 and then other
tissues.

419
00:20:01,240 --> 00:20:05,760
Can convert T4 to its active
form, which is T3, which is

420
00:20:05,800 --> 00:20:09,680
triadathyrenine.
So thyroxine is comprised of

421
00:20:09,680 --> 00:20:12,840
four iodine molecules.
Triadathyrenine is 3.

422
00:20:12,960 --> 00:20:18,800
OK, now reverse T3 is basically
an inactive form of T3.

423
00:20:19,080 --> 00:20:23,240
So same 3 iodine molecules,
except they're configured

424
00:20:23,240 --> 00:20:26,120
differently.
And the problem is they actively

425
00:20:26,120 --> 00:20:30,360
compete for T3 receptors.
And So what reverse T3 will do,

426
00:20:30,360 --> 00:20:34,520
because it's not the active form
of that three iodine molecule is

427
00:20:34,520 --> 00:20:37,280
it can really blunt metabolic
response in that case.

428
00:20:37,320 --> 00:20:40,200
And So what we can get is in
some cases, let's say for

429
00:20:40,200 --> 00:20:43,600
example, if somebody's taking T4
primarily for the treatment of

430
00:20:43,600 --> 00:20:47,120
hypothyroidism, but if they get
to a point where they don't

431
00:20:47,120 --> 00:20:50,320
necessarily need that T4, or if
there if the T4 dose is

432
00:20:50,320 --> 00:20:54,120
potentially wrong, you can get
T4 conversion to reverse T3

433
00:20:54,120 --> 00:20:56,960
instead of active T3.
The other thing too is under

434
00:20:56,960 --> 00:21:00,120
situations of high metabolic
stress, for example,

435
00:21:00,120 --> 00:21:04,480
overtraining, high load,
insufficient caloric intake, the

436
00:21:04,480 --> 00:21:07,800
body's natural response is to
try to slow down the metabolism

437
00:21:07,800 --> 00:21:12,040
so that we retain muscle, fat,
things like that, and so we can

438
00:21:12,040 --> 00:21:14,520
get conversion to reverse T3 in
that case as well.

439
00:21:14,880 --> 00:21:16,360
I don't think it's looked at
often enough.

440
00:21:16,360 --> 00:21:19,520
It is not typically a part of
most thyroid panels.

441
00:21:19,520 --> 00:21:22,440
You have to ask for it, and I
think in some ways because of

442
00:21:22,440 --> 00:21:24,360
that, we often miss part of the
story.

443
00:21:24,560 --> 00:21:26,880
The other thing that's really
interesting too is so the way

444
00:21:26,880 --> 00:21:29,120
I've always looked at thyroid
hormone, is thyroid a permissive

445
00:21:29,120 --> 00:21:32,120
hormone?
It helps other hormones do their

446
00:21:32,120 --> 00:21:34,600
job better, right?
So because of what they do to

447
00:21:34,600 --> 00:21:38,400
cellular metabolism.
The interesting thing is in a

448
00:21:38,400 --> 00:21:42,200
lot of cases, and we've seen
this now in a few of our studies

449
00:21:42,200 --> 00:21:44,200
where we're at our highest
training loads.

450
00:21:44,600 --> 00:21:46,960
Or were you looking at
insufficient dietary intake?

451
00:21:46,960 --> 00:21:50,040
So for example, we've seen this
in ballet dancers, we've seen

452
00:21:50,040 --> 00:21:53,080
this in soccer players, field
hockey players during their

453
00:21:53,080 --> 00:21:57,160
highest training load phases.
In many cases, we'll see LDLS

454
00:21:57,160 --> 00:22:00,040
actually go up and we're looking
at why the low density

455
00:22:00,040 --> 00:22:02,400
lipoproteins, they're not eating
that much more fat like what's

456
00:22:02,400 --> 00:22:05,400
going on.
And usually it's because T3 is

457
00:22:05,400 --> 00:22:08,040
falling, right?
And so what's happening is T3

458
00:22:08,040 --> 00:22:11,160
can actually help with the
metabolism of lipids.

459
00:22:11,480 --> 00:22:14,760
And so in many cases, you'll see
cholesterol go up, you'll see

460
00:22:14,760 --> 00:22:19,240
LDL go up because thyroid
hormone is going down, right?

461
00:22:19,240 --> 00:22:21,640
And so it's, and again, we've
seen this across multiple

462
00:22:21,640 --> 00:22:24,120
states, as have others.
This isn't some, Oh my God, Sean

463
00:22:24,120 --> 00:22:27,160
found the coolest thing.
No fix is consistently seeing

464
00:22:27,160 --> 00:22:29,760
what some others have as well
from a metabolism standpoint.

465
00:22:29,760 --> 00:22:31,440
Does HDL go up too in that case
then?

466
00:22:31,440 --> 00:22:33,440
No, not really.
As matter of fact, in some cases

467
00:22:33,440 --> 00:22:35,960
you'll see it go down because of
preferential conversion to LDL

468
00:22:35,960 --> 00:22:37,240
in those cases.
And that's one of the

469
00:22:37,240 --> 00:22:39,000
challenges.
Interesting.

470
00:22:39,000 --> 00:22:40,360
Walk me through in terms of
labs.

471
00:22:40,360 --> 00:22:43,280
So let's just take that person
to the ballet dancer.

472
00:22:43,400 --> 00:22:46,000
Caloric deficit, high metabolic
stress, high demand.

473
00:22:46,320 --> 00:22:48,720
You're going to get that panel.
Are you going to see elevated

474
00:22:48,720 --> 00:22:51,920
RT-3?
Yeah, we typically do in the

475
00:22:51,920 --> 00:22:54,440
studies where we've examined it.
We haven't done it in all of our

476
00:22:54,440 --> 00:22:56,200
studies.
It depends on what we were doing

477
00:22:56,200 --> 00:22:59,000
and what we were asking.
And sometimes thyroid was not a

478
00:22:59,000 --> 00:23:00,800
primary outcome for us.
It was a secondary

479
00:23:00,800 --> 00:23:03,240
consideration.
But typically in the situations

480
00:23:03,240 --> 00:23:05,920
where we have seen that, we'll
also see elevated cortisol,

481
00:23:06,280 --> 00:23:09,320
typically elevated
catecholamines at rest as well.

482
00:23:09,320 --> 00:23:12,200
So it's really during those high
training load phases that we'll

483
00:23:12,200 --> 00:23:13,720
see it.
And again, I think one of the

484
00:23:13,720 --> 00:23:17,560
reasons why when it comes to
sort of biomarker tracking,

485
00:23:17,560 --> 00:23:21,240
modeling, it's why I like a bit
more of a comprehensive approach

486
00:23:21,240 --> 00:23:23,560
rather than just trying to
single out one or two things

487
00:23:23,960 --> 00:23:26,200
because there is individual
variability.

488
00:23:26,200 --> 00:23:28,520
And as you hit on before looking
at dealing with some of the

489
00:23:28,520 --> 00:23:30,760
basics of the primary hormones
and stuff and then getting at

490
00:23:30,760 --> 00:23:34,200
the axis, the reality is, I
think one of the things that

491
00:23:34,200 --> 00:23:37,160
attracted me to endocrinology
and the reason I studied it was

492
00:23:37,920 --> 00:23:41,680
both the complexity of it, but
also the incredible redundance

493
00:23:41,800 --> 00:23:44,400
of it, right?
We have built in stop gaps.

494
00:23:44,640 --> 00:23:47,440
For example, you look at
cortisol and obviously we know

495
00:23:47,440 --> 00:23:50,920
that CRH or corticotropic
releasing hormone, you also see

496
00:23:50,920 --> 00:23:52,760
this corticotropic releasing
factor.

497
00:23:52,760 --> 00:23:56,240
CRF is a primary stimulus for
it, but not necessarily during

498
00:23:56,240 --> 00:23:58,880
exercise.
During exercise, actually

499
00:23:58,880 --> 00:24:01,040
vasopressin, especially
arginine, vasopressin is a

500
00:24:01,040 --> 00:24:04,400
primary stimulus for ACTH and
cortisol secretion.

501
00:24:04,400 --> 00:24:08,560
There's multiple ways to get at
that same outcome in order to do

502
00:24:08,560 --> 00:24:10,200
this.
And because of the complexity

503
00:24:10,200 --> 00:24:14,840
and importance of feedback and
feed forward regulation, I think

504
00:24:14,840 --> 00:24:15,840
that's where you get some of
this.

505
00:24:15,840 --> 00:24:18,840
And I think that's where one of
the things that we'll often see.

506
00:24:18,840 --> 00:24:21,600
So if you're looking at that
thyroid panel, a very important

507
00:24:21,600 --> 00:24:25,040
part to look at is what the
changes are in TSH, right?

508
00:24:25,040 --> 00:24:27,920
Because what's going to happen
is if the thyroid hormones are

509
00:24:27,920 --> 00:24:30,800
not able to do their job, in
other words, there's so much

510
00:24:30,800 --> 00:24:34,800
stress on the system or there is
a problem with that T3

511
00:24:34,800 --> 00:24:36,760
conversion.
So metabolically, there's a

512
00:24:36,760 --> 00:24:39,760
challenge.
The feedback mechanism is going

513
00:24:39,760 --> 00:24:42,960
to tell TSH to increase because
TSH is basically going to look

514
00:24:42,960 --> 00:24:44,920
at this, right?
But thalamus goes, hey, crap,

515
00:24:44,920 --> 00:24:46,720
like we're not producing enough
of this.

516
00:24:46,720 --> 00:24:49,080
I got to get more.
We're not getting the desired

517
00:24:49,080 --> 00:24:50,720
effects.
So what happens is TSH goes up.

518
00:24:51,280 --> 00:24:54,600
And so under those situations of
metabolic stress and things like

519
00:24:54,600 --> 00:24:56,800
that's a certain, that's
certainly a situation where

520
00:24:57,120 --> 00:25:01,840
looking at these sort of
increasing responses to TSHT 3

521
00:25:01,840 --> 00:25:05,040
May not follow along with that
because it is not being

522
00:25:05,040 --> 00:25:08,160
converted at a fast enough rate
or it's not doing its job.

523
00:25:08,240 --> 00:25:11,080
And so that's where that that
feedback response becomes really

524
00:25:11,080 --> 00:25:17,400
important too.
Are there any instances where T4

525
00:25:17,400 --> 00:25:19,480
or any of the thyroid hormones
might be elevated?

526
00:25:19,480 --> 00:25:23,040
And I'm not talking about RT 3,
so T particularly with respect

527
00:25:23,040 --> 00:25:24,920
to training and performance and
that kind of.

528
00:25:25,520 --> 00:25:26,360
Stuff.
Yeah, it's actually cool.

529
00:25:26,440 --> 00:25:28,760
So training has a really
interesting effect on thyroid

530
00:25:28,760 --> 00:25:32,440
hormones.
So it does appear that chronic

531
00:25:32,440 --> 00:25:36,080
training can actually increase
resting levels of T4.

532
00:25:36,440 --> 00:25:41,240
We think it's mostly due to an
increase in thyroid turnover in

533
00:25:41,240 --> 00:25:43,880
terms of what we're getting.
But it's cool because it seems

534
00:25:43,880 --> 00:25:47,040
to be a unique effect to
exercise.

535
00:25:47,040 --> 00:25:48,840
We're under a non exercise
condition.

536
00:25:48,840 --> 00:25:52,280
If you saw that going on, then
there's a concern over

537
00:25:52,800 --> 00:25:55,720
clinically what that might mean
for thyroid function.

538
00:25:56,240 --> 00:25:57,920
Exercise seems to be unique in
this.

539
00:25:57,920 --> 00:26:01,560
So with that increased thyroid
turnover, it doesn't seem to be

540
00:26:01,560 --> 00:26:05,240
of clinical importance.
It is simply a natural response

541
00:26:05,760 --> 00:26:08,440
to the increased metabolic
demand of exercise.

542
00:26:08,440 --> 00:26:09,720
And so the thyroid responds
away.

543
00:26:09,720 --> 00:26:13,240
So yes, you can actually see in
some cases T4 go up a little

544
00:26:13,240 --> 00:26:15,080
bit.
We typically see more of a rise

545
00:26:15,080 --> 00:26:18,560
in that than T3, again, mainly
because it's the thyroid sink,

546
00:26:18,840 --> 00:26:20,320
right?
That's where we're storing most

547
00:26:20,320 --> 00:26:23,440
of this in terms of to then
convert it to the active T3.

548
00:26:23,560 --> 00:26:25,600
But yes, there are some
situations with training where

549
00:26:25,600 --> 00:26:28,480
you can see that rise.
We've seen that a few times.

550
00:26:28,480 --> 00:26:32,880
It doesn't tend to be a large
rise, maybe 5 or 10% at most if

551
00:26:32,880 --> 00:26:36,640
you're even seeing that, but
enough that it's notable.

552
00:26:36,640 --> 00:26:39,680
But again, it doesn't appear to
be of real clinical significance

553
00:26:39,680 --> 00:26:41,920
in that case.
That's around the workout

554
00:26:41,920 --> 00:26:43,400
though, right around the
training center, OK.

555
00:26:43,640 --> 00:26:47,080
So, yeah, primarily even during
rest, though even with a chronic

556
00:26:47,080 --> 00:26:49,440
training program, we can
actually see this increased

557
00:26:49,440 --> 00:26:52,240
thyroid turnover.
So you may, when testing have a

558
00:26:52,240 --> 00:26:55,320
slightly elevated T4, but The
thing is it appears to stay

559
00:26:55,320 --> 00:26:57,960
within clinical range.
So it's not an abnormal

560
00:26:57,960 --> 00:27:00,400
response, so we don't really
hang our hat on that.

561
00:27:00,400 --> 00:27:03,400
But that being said, when you
start looking at those changes

562
00:27:03,400 --> 00:27:06,480
over time, especially if you're
coupling that to changes in TSH

563
00:27:06,840 --> 00:27:09,880
and T3 or the reverse T3, it's
enough.

564
00:27:09,880 --> 00:27:13,440
Then it may spark some interest
on our end to consider what the

565
00:27:13,440 --> 00:27:17,000
context is driving that and
looking at dietary influences,

566
00:27:17,000 --> 00:27:20,320
sleep influences, training
influences, stress influences,

567
00:27:20,320 --> 00:27:22,560
things like that.
Yeah, I'm just thinking about,

568
00:27:23,400 --> 00:27:26,240
I'm trying to apply everything
this to this from a clinical

569
00:27:26,240 --> 00:27:27,480
performance.
Sure point, right.

570
00:27:27,480 --> 00:27:32,800
So yeah, we talked a little bit
about in overtraining states how

571
00:27:32,920 --> 00:27:35,840
heart rate can be elevated.
That's a very straightforward

572
00:27:35,840 --> 00:27:37,400
thing with respect to elevated
thyroid levels.

573
00:27:37,400 --> 00:27:38,520
Your heart rate is going to be
elevated.

574
00:27:38,520 --> 00:27:42,520
And how do you sure, I guess it
doesn't matter if you are going

575
00:27:42,520 --> 00:27:44,880
to take a big step back and look
at their diet, nutrition because

576
00:27:44,880 --> 00:27:46,680
you're going to affect, you're
not necessarily trying to

577
00:27:46,960 --> 00:27:49,280
manipulate individual hormones,
correct.

578
00:27:49,440 --> 00:27:53,840
But I suppose my question for
you is, are there instances

579
00:27:53,840 --> 00:27:57,960
where you've worked with
clinicians where it does warrant

580
00:27:57,960 --> 00:28:00,720
manipulating individual hormones
in those circumstances?

581
00:28:00,720 --> 00:28:04,440
Maybe because I don't know,
during a certain macro cycle for

582
00:28:04,440 --> 00:28:06,600
an athlete or like extended
thing or actually combat

583
00:28:06,600 --> 00:28:08,560
athletes, right?
And I'm not even thinking I'm

584
00:28:08,560 --> 00:28:12,120
military, right?
You don't, you don't get like a

585
00:28:12,120 --> 00:28:14,200
one event thing.
Maybe you're you're there for

586
00:28:14,200 --> 00:28:16,040
months or years.
How do you play with that?

587
00:28:16,760 --> 00:28:18,800
I think it depends on what the
hormone is that you're trying to

588
00:28:18,800 --> 00:28:22,920
modify and what, what the change
in that hormone represents to

589
00:28:22,920 --> 00:28:25,000
you.
So for example, at the simplest

590
00:28:25,000 --> 00:28:28,400
level, testosterone, right, if
we see testosterone fall,

591
00:28:28,400 --> 00:28:31,160
especially to hypogonadol
levels, intervention with

592
00:28:31,160 --> 00:28:34,600
testosterone can make tremendous
sense if you don't have the

593
00:28:34,600 --> 00:28:38,040
capability to back off on other
factors, right?

594
00:28:38,040 --> 00:28:40,600
So let's say for example, let's,
it's just like Ranger training,

595
00:28:40,800 --> 00:28:42,240
right?
Like Ranger School and they're

596
00:28:42,240 --> 00:28:44,560
getting beat up during that
period of time.

597
00:28:44,560 --> 00:28:46,560
They are in a massive caloric
deficit.

598
00:28:46,560 --> 00:28:48,600
They're in a massive sleep
deficit.

599
00:28:48,840 --> 00:28:51,680
Testosterone falls to damn near
0 in some cases, right?

600
00:28:51,680 --> 00:28:53,320
So you can't just sit in the
middle of that and be like, yo,

601
00:28:53,320 --> 00:28:55,240
time out, let's take a break for
a while.

602
00:28:55,240 --> 00:28:57,040
We'll come back to this.
Let's let test on me, do my

603
00:28:57,040 --> 00:28:57,840
breathing.
Yeah.

604
00:28:57,880 --> 00:28:59,520
So there's going to be a
situation there.

605
00:28:59,680 --> 00:29:02,240
You'll see it especially with
like female physique competitors

606
00:29:02,240 --> 00:29:04,720
when you're looking at that
massive restriction that they're

607
00:29:04,720 --> 00:29:07,520
into, especially closer to
competition as they're nearing

608
00:29:07,520 --> 00:29:09,640
these very low body fat levels
and stuff like that.

609
00:29:09,880 --> 00:29:14,640
The disruption of estrogen up
progesterone up LH of FSH, all

610
00:29:14,640 --> 00:29:16,080
those things become very
apparent.

611
00:29:16,600 --> 00:29:19,960
Thyroid hormone gets interesting
because just trying to say

612
00:29:19,960 --> 00:29:24,520
manipulate that in the short
term may not be warranted if

613
00:29:24,520 --> 00:29:26,800
really what's needed is a fix in
the training or the other

614
00:29:26,800 --> 00:29:28,720
demands.
On the other hand, if somebody

615
00:29:28,720 --> 00:29:33,120
is truly hypothyroid, in other
words there is a dysfunction of

616
00:29:33,120 --> 00:29:38,480
the thyroid gland, then
continued use of thyroid in

617
00:29:38,480 --> 00:29:41,600
whatever ratio of T4 to T3 is
probably necessary.

618
00:29:41,800 --> 00:29:44,120
It's going to be something that
might be depth, not might be.

619
00:29:44,200 --> 00:29:46,240
In that case, it would be
medically indicated in terms of

620
00:29:46,240 --> 00:29:48,600
what we're looking at.
But within just a training

621
00:29:48,600 --> 00:29:51,240
phase, some of those shifts tend
to be fairly acute.

622
00:29:51,240 --> 00:29:55,120
But I will say where we've
probably had the most impact

623
00:29:55,680 --> 00:29:58,280
using biomarkers during these
training phases during

624
00:29:58,280 --> 00:30:02,120
competition is assessing them in
a way where action can be taken

625
00:30:02,200 --> 00:30:05,040
in time to actually impact
outcomes.

626
00:30:05,480 --> 00:30:10,520
And in that case, it's not so
much what we do to say give a

627
00:30:10,520 --> 00:30:14,160
hormone, it's really looking at
why is that hormone potentially

628
00:30:14,160 --> 00:30:17,480
changing and the surrounding
biomarkers and what would that

629
00:30:17,480 --> 00:30:20,480
intervention look like to get it
back on track, right.

630
00:30:20,480 --> 00:30:23,960
Maybe there is more rest and
recovery needed mid season when

631
00:30:23,960 --> 00:30:26,200
we're seeing these things
carried over from pre season.

632
00:30:26,520 --> 00:30:29,560
Maybe this is where I love
having dietary markers as well.

633
00:30:29,560 --> 00:30:32,120
When we look at iron, when we
look at magnesium, when we look

634
00:30:32,120 --> 00:30:36,040
at omega-3, omega-3 and omega-3
6 and Omega index, you start to

635
00:30:36,040 --> 00:30:38,840
look at those things as OK, if
we're seeing deficiencies here,

636
00:30:38,840 --> 00:30:43,080
this gives us some objective
ways to consider how we might

637
00:30:43,080 --> 00:30:45,840
intervene to adapt to this.
And now when we start layering

638
00:30:45,840 --> 00:30:49,280
on things like HRV and we start
layering on things like sleep

639
00:30:49,440 --> 00:30:52,480
and sort of sleep assessment and
stuff like that, it gives you a

640
00:30:52,480 --> 00:30:55,000
much better picture of what's
happening to the whole system

641
00:30:55,600 --> 00:30:58,160
rather than just this one small
little park.

642
00:30:58,280 --> 00:31:01,880
That being said, certainly
hypogonadism may be needed to be

643
00:31:01,880 --> 00:31:04,200
treated with drugs.
If we look at menstrual

644
00:31:04,200 --> 00:31:06,560
dysfunction getting at the root
cause of that, there may be

645
00:31:06,560 --> 00:31:09,680
other issues besides just not
enough calories or too much

646
00:31:09,680 --> 00:31:10,800
training.
There could be medical

647
00:31:10,800 --> 00:31:13,680
considerations there.
Same thing with thyroid hormone

648
00:31:13,680 --> 00:31:15,680
for sure.
In that case, if we're seeing a

649
00:31:15,680 --> 00:31:18,960
situation where we have this
incredibly high hemoglobin or

650
00:31:18,960 --> 00:31:21,840
hematocrit, what are we looking
at there that the body may be

651
00:31:21,840 --> 00:31:23,280
doing?
Or if we're looking at

652
00:31:23,280 --> 00:31:26,360
incredibly low levels of
ferritin and iron, what's

653
00:31:26,360 --> 00:31:27,680
happening from a conversion
sample?

654
00:31:27,680 --> 00:31:30,480
Is there actually a disorder?
They're not just dietary

655
00:31:30,480 --> 00:31:32,400
related.
So I think that's where somebody

656
00:31:32,400 --> 00:31:35,960
on your end, from the clinician
standpoint, and this is where I

657
00:31:35,960 --> 00:31:40,240
think it's really valuable to me
as a sports scientist to work

658
00:31:40,240 --> 00:31:42,800
with physicians that actually
have an appreciation of

659
00:31:42,800 --> 00:31:46,800
performance and optimization,
not just sufficiency.

660
00:31:47,360 --> 00:31:49,520
Because in certain situations
you be like, oh, it's still

661
00:31:49,520 --> 00:31:51,480
within the normal range, but
you're like, yeah, that's a

662
00:31:51,480 --> 00:31:55,360
massive change.
Can we do something now before

663
00:31:55,360 --> 00:31:57,200
it takes a real turn for the
worse?

664
00:31:57,200 --> 00:31:59,840
And just because now it's below
the clinical norm, now we do

665
00:31:59,840 --> 00:32:03,680
something, but never mind the
50% drop we saw before.

666
00:32:03,680 --> 00:32:08,040
So I think that's where the
management aspect and really

667
00:32:08,040 --> 00:32:12,640
good communication between the
sports medicine and sports

668
00:32:12,640 --> 00:32:15,000
science, strength and
conditioning, nutrition and

669
00:32:15,000 --> 00:32:17,800
coaching Staffs when you're
working with athletes become so

670
00:32:17,800 --> 00:32:19,800
critical.
I also think it's one of the

671
00:32:19,800 --> 00:32:24,480
reasons why a lot of people in
the fitness industry, for

672
00:32:24,480 --> 00:32:28,360
example, need to be very aware
of what their lane is and what

673
00:32:28,360 --> 00:32:30,120
they can realistically
interpret.

674
00:32:30,480 --> 00:32:31,800
And I think I'm seeing a little
it.

675
00:32:31,800 --> 00:32:33,760
It bothers me, and I know you
and I have talked about this

676
00:32:33,760 --> 00:32:35,000
before.
I think we talked about it last

677
00:32:35,000 --> 00:32:38,200
time, actually.
It worries me how much people

678
00:32:38,200 --> 00:32:42,400
are trying to simplify this
conversation, right, in terms

679
00:32:42,400 --> 00:32:43,880
of, oh, you got your blood work
back.

680
00:32:43,880 --> 00:32:46,400
I know what that means.
And do you though, do you really

681
00:32:46,400 --> 00:32:48,560
understand how these things
interact and what they

682
00:32:48,560 --> 00:32:51,400
represent?
And this is also, even from a

683
00:32:51,400 --> 00:32:54,320
sports scientist standpoint,
it's very important for me to

684
00:32:54,320 --> 00:32:56,560
have context.
Just somebody sending me their

685
00:32:56,560 --> 00:32:57,920
blood work and goes, what do I
do?

686
00:32:58,200 --> 00:33:00,000
I don't know.
What are you currently doing?

687
00:33:00,200 --> 00:33:02,640
What has changed for you?
What hasn't changed?

688
00:33:02,640 --> 00:33:06,040
Like, where do you intervene if
you don't know what's going on

689
00:33:06,040 --> 00:33:08,560
in the first place?
Because then it's easy to just

690
00:33:08,880 --> 00:33:11,640
slap a fix on there and be like,
oh, your iron's low, let's give

691
00:33:11,640 --> 00:33:13,880
you an iron supplement.
Yeah, but why is your iron low?

692
00:33:14,240 --> 00:33:18,200
What's going on from the rest of
what you're doing to make that

693
00:33:18,200 --> 00:33:21,360
difference?
Why is HRV changing?

694
00:33:21,360 --> 00:33:22,880
Is it falling?
Why is sleep now?

695
00:33:22,880 --> 00:33:25,200
What's going on that's doing
this?

696
00:33:25,200 --> 00:33:27,880
We get at everything from
external stressors to some of

697
00:33:27,880 --> 00:33:31,040
the internal stressors from the
training itself, dietary

698
00:33:31,280 --> 00:33:34,480
impacts, sleep impacts.
And so I think when you see how

699
00:33:34,480 --> 00:33:38,680
all these hormones and really
biochemical influences when we

700
00:33:38,680 --> 00:33:41,720
look at say inflammation, right,
not necessarily a hormone when

701
00:33:41,720 --> 00:33:44,680
you look at cytokines, but they
are biochemical indicators of

702
00:33:44,680 --> 00:33:47,440
what's going on in the system.
I think that's when putting the

703
00:33:47,440 --> 00:33:51,320
pieces together become so
important and not so.

704
00:33:51,320 --> 00:33:54,560
Simple, love it.
Awesome.

705
00:33:55,360 --> 00:33:58,440
Let's shift to talking about EPI
norepi or adrenaline

706
00:33:58,440 --> 00:34:01,040
noradrenaline, right?
So this acute and chronic

707
00:34:01,160 --> 00:34:04,440
catecholamine response to
training, what is it at a high

708
00:34:04,440 --> 00:34:06,880
level that we need to understand
maybe what maybe define people

709
00:34:06,880 --> 00:34:09,840
for what catecholamines even are
those who are not familiar and

710
00:34:09,840 --> 00:34:13,080
then and how does training and
performing and affect that?

711
00:34:13,880 --> 00:34:17,360
So you really have three primary
catecholamines and two in

712
00:34:17,360 --> 00:34:20,560
particular that we often see in
greater abundance, right.

713
00:34:20,560 --> 00:34:23,600
So you've got epinephrine,
norepinephrine, which if you're

714
00:34:23,600 --> 00:34:26,320
from Europe is adrenaline,
noradrenaline, and then

715
00:34:26,320 --> 00:34:27,760
dopamine.
So those seem to be that.

716
00:34:27,760 --> 00:34:30,920
Those are the big three, if you
will, with EPI and norepi

717
00:34:31,199 --> 00:34:34,199
providing a lot of what we see
from a fuel mobilization

718
00:34:34,199 --> 00:34:37,239
standpoint.
So catecholamines by default are

719
00:34:37,239 --> 00:34:40,080
considered catabolic.
They breakdown, right?

720
00:34:40,080 --> 00:34:41,679
And but they do this amazingly
well.

721
00:34:41,679 --> 00:34:44,280
There's a purpose to that
because for those that don't

722
00:34:44,280 --> 00:34:47,080
fully appreciate the role, think
of them as a huge part of the

723
00:34:47,080 --> 00:34:50,400
fight or flight response, right?
Because this is where what

724
00:34:50,400 --> 00:34:53,199
catecholamines along with
cortisol, what their job is to

725
00:34:53,199 --> 00:34:57,760
do is to mobilize resources.
Whether you're staying to fight

726
00:34:57,840 --> 00:35:01,200
or you're running your ass off,
the bottom line is they're there

727
00:35:01,200 --> 00:35:03,760
for a reason to help your system
respond.

728
00:35:04,040 --> 00:35:06,800
So let's put it in an exercise
context.

729
00:35:07,560 --> 00:35:10,160
At lower to moderate
intensities, we don't tend to

730
00:35:10,160 --> 00:35:12,400
see a large shift in the
catecholamines.

731
00:35:12,400 --> 00:35:16,560
Some you'll see, some go up.
Catecholamines, especially

732
00:35:16,560 --> 00:35:20,480
epinephrine, are primarily
derived from the adrenal cortex.

733
00:35:20,600 --> 00:35:23,000
I'm sorry, adrenal medulla.
I was jumping at the cortisol.

734
00:35:23,520 --> 00:35:25,920
Pertisol is derived from the
adrenal cortex, all right.

735
00:35:26,040 --> 00:35:28,720
So both of these sets of
hormones, as part of the fight

736
00:35:28,720 --> 00:35:30,160
or flight response, come from
the adrenal gland.

737
00:35:30,680 --> 00:35:33,760
Now at the adrenal medullary
level in abundance, we'll also

738
00:35:33,760 --> 00:35:37,000
get norepinephrine too.
But norepinephrine is also

739
00:35:37,000 --> 00:35:38,880
produced by sympathetic nerve
endings, right?

740
00:35:38,880 --> 00:35:41,880
Because norepinephrine is a
pretty potent neurotransmitter

741
00:35:41,880 --> 00:35:44,080
as well.
So we can get norepinephrine

742
00:35:44,080 --> 00:35:46,360
from the sympathetic nervous
system in the sympathetic nerve

743
00:35:46,360 --> 00:35:48,840
fibers as well as from the
adrenal medulla.

744
00:35:49,440 --> 00:35:52,360
Norepinephrine can convert to
epinephrine, have a greater role

745
00:35:52,360 --> 00:35:55,000
in terms of its activity and
both of these together help

746
00:35:55,000 --> 00:35:57,760
regulate that response.
Now during exercise, especially

747
00:35:57,760 --> 00:36:02,000
high intensity exercise, that
catecholamine response is really

748
00:36:02,000 --> 00:36:04,520
important for mobilizing glucose
in particular.

749
00:36:04,680 --> 00:36:06,720
They also play a role in
lipogenesis too.

750
00:36:06,720 --> 00:36:11,240
So lipid mobilization from a fat
standpoint, cortisol complements

751
00:36:11,240 --> 00:36:13,400
this quite well.
Cortisol is a little more long

752
00:36:13,400 --> 00:36:17,120
acting as a steroid hormone
versus these peptide hormones as

753
00:36:17,120 --> 00:36:19,920
EPI and Norepi.
The other thing that we see

754
00:36:19,920 --> 00:36:23,640
though is, is really cool.
So with training, right?

755
00:36:23,640 --> 00:36:26,640
So we take somebody through a
one year training phase, what

756
00:36:26,640 --> 00:36:29,120
you'll see is that the same
absolute intensity.

757
00:36:29,120 --> 00:36:32,120
So let's say for example you
were running 6 miles an hour

758
00:36:32,120 --> 00:36:34,960
before we train you for a year.
Now you do 6 miles an hour

759
00:36:34,960 --> 00:36:37,440
still, right?
Your catecholamine response will

760
00:36:37,440 --> 00:36:38,480
be lower.
Why?

761
00:36:38,600 --> 00:36:41,160
Because on a relative basis,
it's easier.

762
00:36:41,680 --> 00:36:44,440
So what we typically see with
training is that catecholamines

763
00:36:44,440 --> 00:36:48,080
respond very similarly to
relative intensity, the

764
00:36:48,080 --> 00:36:51,840
percentage of your maximum, your
effort, but they dampen in

765
00:36:51,840 --> 00:36:55,000
response to absolute intensity,
just the total workload, right?

766
00:36:55,000 --> 00:36:57,440
Because you're more fit.
The stress isn't right.

767
00:36:57,520 --> 00:36:59,160
Growth hormone does the same
thing, by the way.

768
00:37:00,120 --> 00:37:02,800
But what's interesting is, and I
think this is the part that's so

769
00:37:02,800 --> 00:37:07,080
funny, so I'm about to hit on
what actually made me totally

770
00:37:07,080 --> 00:37:09,480
know that exercise endocrinology
was my jam.

771
00:37:09,480 --> 00:37:12,560
This is what I wanted to do.
I think what is really cool is

772
00:37:12,560 --> 00:37:16,440
that with high intensity
exercise in particular, even

773
00:37:16,440 --> 00:37:21,120
after training, we can often see
an elevated catecholamine

774
00:37:21,120 --> 00:37:24,440
response and cortisol response.
And this is often what we refer

775
00:37:24,440 --> 00:37:28,320
to as the sports adrenal and
what it is the system figuring

776
00:37:28,320 --> 00:37:33,480
out how to maximally mobilize
all resources to handle this big

777
00:37:33,480 --> 00:37:36,040
ass stimulus because you're
capable of doing it now.

778
00:37:36,360 --> 00:37:40,200
But what's super cool about it
is that with training and you

779
00:37:40,280 --> 00:37:43,280
clear that faster too.
So you can Jack up that

780
00:37:43,280 --> 00:37:46,680
response, but then it comes down
much quicker after.

781
00:37:46,800 --> 00:37:49,400
So you get the body back into
homeostasis a little bit

782
00:37:49,400 --> 00:37:50,800
quicker.
And that is a, that's a really

783
00:37:50,800 --> 00:37:53,960
cool hallmark of training,
especially for high intensity

784
00:37:53,960 --> 00:37:55,840
work.
And so when we look at how these

785
00:37:55,840 --> 00:37:59,280
hormones interact with each
other, that's really where these

786
00:37:59,280 --> 00:38:03,080
catecholamines fit in.
And what happens is much like

787
00:38:03,080 --> 00:38:05,400
cortisol, that acute response is
critical.

788
00:38:05,400 --> 00:38:08,920
If we can't mobilize those
hormones, performance is going

789
00:38:08,920 --> 00:38:11,360
to go down the toilet.
Like we don't have the ability

790
00:38:11,360 --> 00:38:13,160
then to mobilize the fuels that
we need.

791
00:38:13,640 --> 00:38:16,440
And they have an important role
in the autonomic nervous system,

792
00:38:16,440 --> 00:38:17,320
right?
Because they're playing that

793
00:38:17,320 --> 00:38:20,920
role on the sympathetic side to
drive the system up to respond

794
00:38:20,920 --> 00:38:25,040
from ACNS standpoint as well.
But one of the things we have to

795
00:38:25,040 --> 00:38:27,360
worry about though, if they say
chronically elevated, so for

796
00:38:27,360 --> 00:38:30,880
example, under situations of
continued stress, right?

797
00:38:30,880 --> 00:38:33,280
And that's The thing is that
we've mentioned this for the

798
00:38:33,280 --> 00:38:36,680
human body, we don't really care
whether it's physical or

799
00:38:36,680 --> 00:38:38,640
psychological stress.
Stress is stress.

800
00:38:38,960 --> 00:38:42,120
Right now we have a little bit
more abundant epinephrine

801
00:38:42,120 --> 00:38:45,040
response to physical stress than
psychological, but it doesn't

802
00:38:45,040 --> 00:38:47,520
mean it doesn't exist.
And So what happens is when you

803
00:38:47,520 --> 00:38:50,360
start to look at continued
elevations in cortisol,

804
00:38:50,600 --> 00:38:55,240
continued elevations in EPI and
nor EPI, a lot of these things

805
00:38:55,240 --> 00:38:58,360
can actually contribute to some
of the cardiovascular dynamics

806
00:38:58,360 --> 00:39:02,120
that are less desirable with
that chronic stress, contribute

807
00:39:02,120 --> 00:39:04,560
to inflammatory cascades and
what we're looking at.

808
00:39:04,560 --> 00:39:07,520
And then there's a feedback
between those two as well in

809
00:39:07,520 --> 00:39:10,920
order to continue that response.
And so I think overall, the

810
00:39:10,920 --> 00:39:12,480
complexity of it's really
important.

811
00:39:12,480 --> 00:39:15,400
But again, I see a lot of these
dampen epinephrine and

812
00:39:15,400 --> 00:39:17,880
norepinephrine like they're bad
and cortisol is bad.

813
00:39:17,880 --> 00:39:19,720
That's no man.
It depends on context.

814
00:39:20,040 --> 00:39:24,280
Acutely, they are so important.
Chronically, we want to bring

815
00:39:24,280 --> 00:39:27,040
them back under control and
that's where stress management,

816
00:39:27,040 --> 00:39:29,600
sleep recovery, all these things
start to play a pretty important

817
00:39:29,600 --> 00:39:33,760
role.
In chronic elevations cuz again

818
00:39:34,240 --> 00:39:36,640
they clear out so fast even they
do they.

819
00:39:36,840 --> 00:39:38,040
Should they?
Should.

820
00:39:38,040 --> 00:39:39,080
That's the problem.
But yeah.

821
00:39:39,800 --> 00:39:41,920
I'm sure you've come across and
said, do you check them?

822
00:39:41,920 --> 00:39:45,440
You'll check EPI, neuropathy and
just young blood markers is the

823
00:39:45,480 --> 00:39:46,680
best.
Way we'll do blood or urine.

824
00:39:46,680 --> 00:39:49,560
So actually morning urine, that
is a pretty good way to to track

825
00:39:49,560 --> 00:39:52,240
what resting catecholamine
levels are as well because of

826
00:39:52,680 --> 00:39:54,600
the consistency of what that
should look like.

827
00:39:54,600 --> 00:39:57,200
And so we will see some chronic
elevations.

828
00:39:57,440 --> 00:40:01,160
I would probably say over most
of the work we've done.

829
00:40:02,480 --> 00:40:04,920
Cortisol is a little bit more
telling in that part of the

830
00:40:04,920 --> 00:40:08,640
story from a stress response.
But catecholamines are no joke,

831
00:40:08,640 --> 00:40:10,680
especially when it comes to
blood pressure regulation,

832
00:40:10,760 --> 00:40:12,320
right?
Catecholamines are pretty

833
00:40:12,320 --> 00:40:15,360
important in that baroreceptor
response and how they help

834
00:40:15,360 --> 00:40:19,760
regulate overall hemodynamics,
and so they're worth paying

835
00:40:19,760 --> 00:40:21,160
attention to.
The other thing too is people

836
00:40:21,160 --> 00:40:24,120
should realize is caffeine
intake will increase

837
00:40:24,120 --> 00:40:26,680
catecholamines as well as
cortisol in most cases.

838
00:40:26,680 --> 00:40:29,040
It's just that it's a fairly
normal response.

839
00:40:29,480 --> 00:40:34,200
And with chronic intake, we
actually get pretty resilient to

840
00:40:34,200 --> 00:40:35,600
that.
It's not as noticeable, but

841
00:40:35,640 --> 00:40:38,360
there are some genetic
influences there in terms of

842
00:40:38,360 --> 00:40:40,360
what we'll see in terms of
response to caffeine.

843
00:40:40,520 --> 00:40:43,480
And This is why if somebody has
some level of depending on the

844
00:40:43,480 --> 00:40:46,200
type of cardiovascular
dysfunction, if it's a blood

845
00:40:46,200 --> 00:40:49,480
pressure issue, whatever,
caffeine intake may need to be

846
00:40:49,480 --> 00:40:53,200
very limited in order to not
precipitate that any more than

847
00:40:53,200 --> 00:40:54,440
it already is.
Yeah.

848
00:40:55,520 --> 00:40:58,000
So you touched on something in
terms of sympathetic dominance,

849
00:40:58,000 --> 00:41:00,640
and it brings me to this concept
of, I think profiles of

850
00:41:00,640 --> 00:41:03,560
individuals, right, sympathetic
versus a parasympathetic profile

851
00:41:03,880 --> 00:41:07,520
and autonomic dominance.
I would classify myself as a

852
00:41:07,520 --> 00:41:09,360
very sympathetically dominant
person.

853
00:41:09,360 --> 00:41:10,800
I suspect.
I don't know, actually.

854
00:41:10,840 --> 00:41:11,880
You seem like a pretty laid back
guy.

855
00:41:11,880 --> 00:41:13,560
I know you like to surf.
No, I'm pretty.

856
00:41:13,760 --> 00:41:15,960
Yeah, I'm way, way too much
sympathetic half the time.

857
00:41:16,920 --> 00:41:22,280
If you were to counsel somebody
or get your assessment and I

858
00:41:22,280 --> 00:41:24,040
guess what will your assessment
process be like when you're

859
00:41:24,040 --> 00:41:27,360
trying to tease that out and
what implications would that

860
00:41:27,360 --> 00:41:30,920
have with respect to training
and programming and just

861
00:41:31,160 --> 00:41:33,080
considering allostatic load in
general?

862
00:41:34,040 --> 00:41:37,520
So I think the important thing
to realize is that dominance can

863
00:41:37,520 --> 00:41:41,840
change, right?
So you may have just a trait in

864
00:41:41,840 --> 00:41:44,920
terms of how you tend to respond
to certain situations, right,

865
00:41:44,920 --> 00:41:48,800
with from an anger standpoint,
from an escalation standpoint

866
00:41:48,800 --> 00:41:50,640
versus de escalation, things
like that.

867
00:41:50,880 --> 00:41:52,800
And I will tell you from
experience, that has changed for

868
00:41:52,800 --> 00:41:55,040
me over the years, right?
And so it's one of those things,

869
00:41:55,040 --> 00:41:57,360
it's getting a handle on what
the psychological input is

870
00:41:57,360 --> 00:41:59,200
there.
So I think what's important to

871
00:41:59,200 --> 00:42:01,440
recognize is when we start to
talk about sort of these

872
00:42:01,440 --> 00:42:03,640
profiles, are you more
sympathetically dominant?

873
00:42:03,640 --> 00:42:05,720
Are you more parasympathetically
dominant?

874
00:42:06,680 --> 00:42:08,920
We've got to consider the cause
and effect side of that.

875
00:42:08,960 --> 00:42:11,960
And it is what's the chicken and
what's the egg, right, in terms

876
00:42:11,960 --> 00:42:14,840
of what order this goes in.
Because we know that with

877
00:42:14,920 --> 00:42:19,600
endurance training, with quality
sleep, with things that we can

878
00:42:19,600 --> 00:42:22,880
do to reduce inflammation, in
terms of recovery and how we

879
00:42:22,880 --> 00:42:25,920
treat our system, you can become
more parasympathetically

880
00:42:25,920 --> 00:42:28,000
dominant, right?
On the other hand, with

881
00:42:28,000 --> 00:42:31,360
sympathetic responses, there may
be periods of time where that

882
00:42:31,360 --> 00:42:34,440
sympathetic dominance may be
very appropriate under

883
00:42:34,440 --> 00:42:37,400
situations of high stress where
you need to mobilize resources.

884
00:42:37,720 --> 00:42:41,080
But over time, if it becomes
your main carry forward, this is

885
00:42:41,080 --> 00:42:44,680
typically where we're looking at
other strains on the system.

886
00:42:45,080 --> 00:42:48,440
And ultimately what we're trying
to do is build some balance

887
00:42:48,440 --> 00:42:50,720
between those things, right?
Because if you're an athlete, if

888
00:42:50,720 --> 00:42:53,560
you're an avid exerciser and
things like that, you need to be

889
00:42:53,560 --> 00:42:56,240
able to mobilize your
sympathetic response, but then

890
00:42:56,240 --> 00:42:58,960
you want your parasympathetic to
kick in when it's time to rest

891
00:42:58,960 --> 00:43:01,400
and recover, right?
And so I think we look at some

892
00:43:01,400 --> 00:43:05,760
of these things and it's really
interesting because it's not

893
00:43:05,760 --> 00:43:09,640
Even so cut and dry in terms of
what's better all the time.

894
00:43:09,640 --> 00:43:12,560
Because for example, we could
say, hey, with regular endurance

895
00:43:12,560 --> 00:43:15,840
training, we tend to see more
parasympathetic dominance here

896
00:43:15,840 --> 00:43:19,320
or at least more parasympathetic
contribution with a high quality

897
00:43:19,320 --> 00:43:22,960
diet, protein intake, sufficient
calories to support recovery,

898
00:43:22,960 --> 00:43:25,200
things like that.
Parasympathetic nervous system

899
00:43:25,200 --> 00:43:29,080
can do its job, but we also see
in situation certain situations

900
00:43:29,080 --> 00:43:31,640
of overtraining.
We can see parasympathetic

901
00:43:31,640 --> 00:43:34,200
overtraining.
What that leads to is feelings

902
00:43:34,200 --> 00:43:38,000
of fatigue, malaise, lack of an
ability to train, actually a

903
00:43:38,000 --> 00:43:40,120
dampened overall response.
That's not a good thing.

904
00:43:40,120 --> 00:43:43,880
So is parasympathetic dominance
always a good thing?

905
00:43:44,080 --> 00:43:47,680
The answer is no.
Again, it depends on what's

906
00:43:47,680 --> 00:43:50,480
driving that.
But from a rest and recovery

907
00:43:50,480 --> 00:43:55,240
standpoint, we would like the
flexibility to shift between the

908
00:43:55,240 --> 00:43:59,800
parasympathetic sympathetic
balance fairly readily in order

909
00:43:59,800 --> 00:44:02,280
to do this.
And so I think it really depends

910
00:44:02,280 --> 00:44:04,360
on what we're looking at there
in terms of what's going to be

911
00:44:04,360 --> 00:44:06,760
driving that.
But certainly if you have

912
00:44:06,760 --> 00:44:08,920
somebody, OK, let's say, for
example, if we work with an

913
00:44:08,920 --> 00:44:12,280
athlete that we know does not
have problems sympathetically

914
00:44:12,280 --> 00:44:16,560
mobilizing, right, like they're
ready to go, we may approach

915
00:44:16,560 --> 00:44:18,520
them a little bit differently
from caffeine intake.

916
00:44:18,560 --> 00:44:22,120
Maybe the dose is not as high,
right, because of what it might

917
00:44:22,120 --> 00:44:24,800
do to push that over the edge.
So we're aware of that.

918
00:44:24,800 --> 00:44:27,160
But that also applies to doing
your athletes and knowing how to

919
00:44:27,160 --> 00:44:30,440
respond prior to games, right?
Do they get just super amped up

920
00:44:30,440 --> 00:44:31,920
or are they able to keep it in
check?

921
00:44:31,920 --> 00:44:33,320
And that becomes important as
well.

922
00:44:33,640 --> 00:44:36,080
And so when we start to look at
some of those things, I think

923
00:44:36,080 --> 00:44:39,360
that's how we can look at it.
But certainly it's not unusual

924
00:44:39,360 --> 00:44:42,000
to see heightened, heightened
sympathetic activity during

925
00:44:42,000 --> 00:44:45,080
periods of your highest training
loads and intensities during

926
00:44:45,080 --> 00:44:48,440
peak competitions, chronic
stress and anxiety, things like

927
00:44:48,440 --> 00:44:50,360
that.
And certainly if you're not

928
00:44:50,880 --> 00:44:56,120
sufficiently replenishing when
it comes to nutrients, those are

929
00:44:56,120 --> 00:44:58,320
all going to be things are going
to tip it in that direction.

930
00:44:58,320 --> 00:45:02,320
So we might see elevated resting
heart rate, we might see fairly

931
00:45:02,320 --> 00:45:05,480
poor heart rate variability.
And again, on a day-to-day

932
00:45:05,480 --> 00:45:07,640
basis, and I know we've said
this before, but just to re

933
00:45:07,640 --> 00:45:10,320
emphasize here because I think
it's important for those that

934
00:45:10,320 --> 00:45:12,880
use wearables that are tracking
HRV and stuff like that,

935
00:45:12,920 --> 00:45:16,320
honestly don't get caught up in
the day-to-day stuff.

936
00:45:16,320 --> 00:45:19,800
Look at trends because
day-to-day, if you try to base

937
00:45:19,800 --> 00:45:21,960
your training around it and
things like that, you might have

938
00:45:21,960 --> 00:45:25,000
a day where your HRV looks
really low, you might feel

939
00:45:25,000 --> 00:45:27,640
great, don't look and go.
I shouldn't feel great though,

940
00:45:27,640 --> 00:45:30,040
because my HRV isn't the toilet.
It happens.

941
00:45:30,040 --> 00:45:33,720
Watch for trends over time and
that's where ultimately you can

942
00:45:33,720 --> 00:45:35,920
get your greatest interventions.
If nothing else, where the

943
00:45:35,920 --> 00:45:37,880
day-to-day fluctuations can be
useful.

944
00:45:38,080 --> 00:45:41,120
And this also plus the just
simply how you're feeling is pay

945
00:45:41,120 --> 00:45:45,080
attention to what your behaviors
and your activities were on

946
00:45:45,080 --> 00:45:47,480
those days.
What was really good or really

947
00:45:47,480 --> 00:45:50,680
bad, what set it into it into
that stratosphere.

948
00:45:50,960 --> 00:45:54,520
It's funny, a friend of mine who
works with a very high level

949
00:45:54,520 --> 00:45:57,840
rugby team, so alcohol is part
of the rugby culture for the

950
00:45:57,840 --> 00:45:59,440
most part.
But where they've had some real

951
00:45:59,440 --> 00:46:02,720
success in helping these guys
actually recover better is by

952
00:46:02,840 --> 00:46:06,080
using wearables and allowing
them to see what it did to sleep

953
00:46:06,080 --> 00:46:08,680
quality as well as HRV and some
other metrics.

954
00:46:09,040 --> 00:46:12,280
It gave them their own data and
the players on their own then

955
00:46:12,280 --> 00:46:15,320
started to realize that this was
negatively impacting the

956
00:46:15,320 --> 00:46:17,200
recovery, so they backed off on
it quite a bit.

957
00:46:17,200 --> 00:46:19,920
So it's not just telling them
why they should, but being able

958
00:46:19,920 --> 00:46:22,560
to show them why they should and
then they could look at trends

959
00:46:22,560 --> 00:46:24,640
over time with that.
So there again there's good

960
00:46:24,640 --> 00:46:28,640
application for that.
Yeah, I remember, I think I

961
00:46:28,640 --> 00:46:31,240
heard Andy Galvin talk about
this, that those athletes that

962
00:46:31,240 --> 00:46:33,840
have no problem that they're
just bouncing off the walls when

963
00:46:33,840 --> 00:46:35,880
they're going to the gym, he'll
often times say you're not even

964
00:46:35,880 --> 00:46:38,440
going to listen to music when
you're training because that's

965
00:46:38,440 --> 00:46:40,320
going to even turn it on a
little bit more.

966
00:46:40,320 --> 00:46:41,960
And then another thing that he
talks about that I've

967
00:46:41,960 --> 00:46:44,680
implemented my training, I try
to do for most part, although I

968
00:46:44,680 --> 00:46:47,760
skipped it today is just after
the workout ends, just spend 3

969
00:46:47,760 --> 00:46:50,120
to 5 minutes just down
regulating couple of deep

970
00:46:50,120 --> 00:46:53,200
breaths in and out and just to
turn that down as you spoke

971
00:46:53,200 --> 00:46:55,400
about.
I've heard that from him too.

972
00:46:55,400 --> 00:46:58,280
And I don't, I got to be honest,
I don't see a huge value in that

973
00:46:58,360 --> 00:47:01,760
because you're going to get a
natural recovery anyway and just

974
00:47:01,760 --> 00:47:04,280
what you do in those first 3 to
5 minutes versus what you do the

975
00:47:04,280 --> 00:47:05,880
rest of the day is a drop in the
bucket.

976
00:47:06,280 --> 00:47:10,120
I would actually say that time
down regulating is probably more

977
00:47:10,120 --> 00:47:12,600
important around other
activities and through other

978
00:47:12,600 --> 00:47:15,240
parts of the day rather than
just around your workout.

979
00:47:15,240 --> 00:47:17,600
I'll be honest, there's not a
single study that would support

980
00:47:17,600 --> 00:47:19,840
that at this point
recommendation wise, Hey, if

981
00:47:19,840 --> 00:47:21,680
nothing else to get you to pay
more attention to what you're

982
00:47:21,680 --> 00:47:24,160
doing.
But in terms of it magically

983
00:47:24,160 --> 00:47:26,400
leading to greater strength
gains or anything like that,

984
00:47:26,680 --> 00:47:28,760
there's a there's unfortunately
there's a lot of advice out

985
00:47:28,760 --> 00:47:30,920
there where you know, and this
is the same stuff with don't

986
00:47:30,920 --> 00:47:33,680
have caffeine first thing in the
morning because it's so bad for

987
00:47:33,680 --> 00:47:36,200
you and it'll increase cords And
we've debunked the crap out of

988
00:47:36,200 --> 00:47:37,880
that.
It's just a poor understanding

989
00:47:37,880 --> 00:47:40,640
of mechanisms at that point.
Think that it nothing else.

990
00:47:40,640 --> 00:47:42,600
It just get somebody to pay
attention to what they're doing.

991
00:47:42,600 --> 00:47:45,720
But I would argue that you're
equally as well served by what

992
00:47:45,720 --> 00:47:49,400
you eat in that first say 3 to 5
to 30 minutes after your workout

993
00:47:49,400 --> 00:47:51,120
and stuff like that.
So there are ways to do it, but

994
00:47:51,120 --> 00:47:54,400
I guarantee what it has done for
you on the days you do that is

995
00:47:54,400 --> 00:47:58,000
it simply helps you get control
back and then it's easier to

996
00:47:58,000 --> 00:48:01,080
apply that to other areas.
Because I would argue where it

997
00:48:01,080 --> 00:48:04,520
could be really useful is prior
to going to sleep in order to

998
00:48:04,520 --> 00:48:06,240
get you into that phase, a post
workout.

999
00:48:06,240 --> 00:48:09,040
You're getting natural recovery
from the catecholamines anyway.

1000
00:48:09,280 --> 00:48:11,360
I've heard that they'll use it
to try to clear lactate.

1001
00:48:11,360 --> 00:48:13,920
Dude, lactate clears so fast
when you're done working out.

1002
00:48:13,920 --> 00:48:16,720
Like if you're not continuing to
engage in high intensity, it's a

1003
00:48:17,800 --> 00:48:19,600
pretty low hanging fruit from
the standpoint of.

1004
00:48:19,600 --> 00:48:21,040
That's what I haven't heard, so
that's new to me.

1005
00:48:21,320 --> 00:48:23,520
Yeah, and so I've heard that,
but again, this is where people

1006
00:48:23,520 --> 00:48:26,440
take an idea and then they twist
crap out of it cuz they're like,

1007
00:48:26,640 --> 00:48:29,080
I wonder it helps with down
regulation and that would be

1008
00:48:29,080 --> 00:48:31,200
lactate clears faster.
That's probably already done.

1009
00:48:31,200 --> 00:48:32,160
Did.
The lactate thing.

1010
00:48:32,560 --> 00:48:34,040
So you're familiar with the Wim
Hof?

1011
00:48:34,480 --> 00:48:36,360
Yeah, yeah.
Is that, do you think that came

1012
00:48:36,360 --> 00:48:38,280
from that?
Cuz I he's, he's an interesting

1013
00:48:38,280 --> 00:48:40,360
guy.
And I know he's had studies

1014
00:48:40,360 --> 00:48:42,440
where he's literally injected
himself with, I think I don't

1015
00:48:42,440 --> 00:48:46,120
know what bacteria specifically
and has and so did any of that

1016
00:48:46,120 --> 00:48:48,040
come from there at all?
Who knows?

1017
00:48:48,040 --> 00:48:50,280
I don't know man, honestly
anymore on social media.

1018
00:48:50,280 --> 00:48:52,240
I don't know where half the shit
comes from.

1019
00:48:52,520 --> 00:48:55,000
Like what was the Genesis?
It's always there's.

1020
00:48:55,200 --> 00:48:58,520
It'll come from some grain of
truth or something that somebody

1021
00:48:58,520 --> 00:49:00,800
saw work one time and all of a
sudden becomes gospel.

1022
00:49:00,800 --> 00:49:04,560
And I don't know, it's funny for
me because look, don't get me

1023
00:49:04,560 --> 00:49:06,080
wrong.
The one thing I will readily

1024
00:49:06,080 --> 00:49:08,400
admit to having been in this
field long enough and having

1025
00:49:08,400 --> 00:49:10,880
been a strength coach myself and
some like that is there's

1026
00:49:10,880 --> 00:49:12,640
certain things that we'll that
we do.

1027
00:49:12,640 --> 00:49:15,080
We've done in the weight room
that we've done on the field

1028
00:49:15,440 --> 00:49:18,200
that sort of the coaches, the
strength coaches, people like

1029
00:49:18,200 --> 00:49:19,720
that.
They had it figured out before

1030
00:49:19,720 --> 00:49:21,600
the scientists did.
Then we'll do the science and

1031
00:49:21,600 --> 00:49:22,880
go, oh, hey, actually that
works.

1032
00:49:23,080 --> 00:49:24,920
But there's been other things
too that over the years we've

1033
00:49:24,920 --> 00:49:27,600
changed our minds on because no,
that actually doesn't work.

1034
00:49:27,760 --> 00:49:29,480
It may actually be
counterproductive.

1035
00:49:29,480 --> 00:49:31,800
And so sometimes the science is
head of the practice.

1036
00:49:31,800 --> 00:49:34,080
Sometimes the practice is head
of the science and was beautiful

1037
00:49:34,080 --> 00:49:36,640
is one of the two match up.
And I think that when I try to

1038
00:49:36,640 --> 00:49:38,840
keep that in mind, and that's
why I said we've been looking at

1039
00:49:38,840 --> 00:49:40,360
that down regulation post
workout.

1040
00:49:40,360 --> 00:49:44,280
There's really no science to
suggest that's that important

1041
00:49:44,280 --> 00:49:47,360
compared to other things you do.
But it sounds great and

1042
00:49:47,360 --> 00:49:48,680
appealing.
Like somehow it's like you got

1043
00:49:48,680 --> 00:49:51,520
to now bring the system down.
But to be honest, if you're

1044
00:49:51,520 --> 00:49:53,880
still bouncing off the walls at
the end of your workout, I'm not

1045
00:49:53,880 --> 00:49:55,200
sure we're doing.
I've even heard don't look at

1046
00:49:55,200 --> 00:49:57,040
your phone when you're done
because then that'll just amp

1047
00:49:57,040 --> 00:49:58,680
you back up.
It's like, yeah, but you might

1048
00:49:58,680 --> 00:50:00,800
be more anxious if you were
actually were expecting some

1049
00:50:00,800 --> 00:50:03,280
calls for you're on the clock
and you got to answer some

1050
00:50:03,280 --> 00:50:04,680
stuff.
It's get back to your life.

1051
00:50:04,680 --> 00:50:07,720
So I think there's an individual
factor there that becomes very

1052
00:50:07,720 --> 00:50:09,880
important.
I think what's useful about that

1053
00:50:09,880 --> 00:50:13,880
recommendation is it means you
are continuing to set aside and

1054
00:50:13,880 --> 00:50:18,120
take time for yourself.
So there's that level of sort of

1055
00:50:18,120 --> 00:50:20,760
commitment and engagement that I
think is really important.

1056
00:50:20,960 --> 00:50:23,040
And there's many ways to do that
though, right?

1057
00:50:23,040 --> 00:50:24,520
So there's not just this one
way.

1058
00:50:24,680 --> 00:50:27,680
And if that works for you and
you feel like that allows you to

1059
00:50:27,760 --> 00:50:30,680
finish off that workout and feel
good about now carrying on with

1060
00:50:30,680 --> 00:50:32,240
the rest of it, I think that can
be super useful.

1061
00:50:32,480 --> 00:50:34,760
May also depend on when you do
it, right?

1062
00:50:34,760 --> 00:50:37,040
If whether you're a morning
workout person, an afternoon or

1063
00:50:37,040 --> 00:50:38,840
evening workout person, things
like that.

1064
00:50:39,080 --> 00:50:41,800
Because like, I tend to work out
later in the evenings and at the

1065
00:50:41,800 --> 00:50:45,080
end of the day I can tell you
that 3 to 5 minutes post workout

1066
00:50:45,080 --> 00:50:49,200
isn't going to do nearly as much
for me as what I do from then on

1067
00:50:49,320 --> 00:50:51,920
to try to allow the system to
recover prior to going to bed.

1068
00:50:52,000 --> 00:50:53,760
Drop in the bucket.
Yeah, I think the context free

1069
00:50:53,760 --> 00:50:55,960
advice thing is really
interesting and a

1070
00:50:55,960 --> 00:50:59,200
contextualizing advice takes a
lot of time and people don't end

1071
00:50:59,200 --> 00:51:01,400
up doing that.
I no, I remember with the whole

1072
00:51:01,400 --> 00:51:04,440
morning routine, people think I
I'll share with you again very

1073
00:51:04,920 --> 00:51:09,160
soon, but I find when I get up,
like for me, those first two

1074
00:51:09,160 --> 00:51:14,000
hours, if I get up at 532 hours,
it's the most peaceful time for

1075
00:51:14,000 --> 00:51:15,880
me.
And sometimes I like to just sit

1076
00:51:15,880 --> 00:51:18,600
out there and drink my coffee
within 30 minutes getting up

1077
00:51:18,600 --> 00:51:20,120
because that's what I like.
There you go you're good.

1078
00:51:20,200 --> 00:51:22,200
And, and, but I recently heard
Tim Ferriss talk about this and

1079
00:51:22,200 --> 00:51:24,400
he was saying, oh, he doesn't
have a family.

1080
00:51:24,400 --> 00:51:26,360
He was saying something the same
to him that he likes to get up,

1081
00:51:26,360 --> 00:51:29,600
do some deep work, but he
doesn't know what it's like when

1082
00:51:29,600 --> 00:51:32,240
you have a kid jumping on your
social plexus at 5:30 in the

1083
00:51:32,240 --> 00:51:33,880
morning.
A little hard to do your morning

1084
00:51:33,880 --> 00:51:35,360
routine when your 3 year old's
doing that.

1085
00:51:35,360 --> 00:51:38,640
I love her best thing ever, but
I don't think she has an

1086
00:51:38,640 --> 00:51:41,120
appreciation that I need my to
do deep work at 5:30 or 6:00 in

1087
00:51:41,120 --> 00:51:41,960
the morning, you know what I
mean?

1088
00:51:41,960 --> 00:51:44,120
And so I think that's really
important for people to

1089
00:51:44,120 --> 00:51:47,520
understand that you're not
losing out on something if

1090
00:51:47,520 --> 00:51:51,520
you're not exactly doing it how
the 24 year old fitness coach is

1091
00:51:51,520 --> 00:51:53,080
telling you or performance coach
is telling you.

1092
00:51:53,240 --> 00:51:55,880
As intelligent as they might be,
and as good as the advice might

1093
00:51:55,880 --> 00:51:58,680
be, it just might be bad advice
for you specifically in your

1094
00:51:58,680 --> 00:52:01,360
context.
Yeah, I really like these 24 and

1095
00:52:01,360 --> 00:52:05,000
25 year old life fitness gurus
and life coaches.

1096
00:52:05,520 --> 00:52:08,600
To your point, just wait, like I
tell a lot of my students, I'm

1097
00:52:08,600 --> 00:52:10,560
like, you don't know what it's
like to be 50.

1098
00:52:10,560 --> 00:52:14,200
I know what it's like to be 25.
It's so it's like there's a

1099
00:52:14,200 --> 00:52:16,560
context to this that that you
could build on.

1100
00:52:16,680 --> 00:52:19,000
But you're right.
I think that I think sometimes,

1101
00:52:19,040 --> 00:52:22,000
and I'll freely admit this, even
from a from an academic

1102
00:52:22,000 --> 00:52:24,800
standpoint as well, and we try
to come up with these solutions,

1103
00:52:24,800 --> 00:52:27,400
we work with these athletes is I
think the thing that I have

1104
00:52:27,400 --> 00:52:31,160
really learned to appreciate
over the years, maybe more so

1105
00:52:31,160 --> 00:52:34,840
than when I was younger and
earlier in my career, is meeting

1106
00:52:34,840 --> 00:52:37,360
them where they're at.
So to your point, yeah, you can

1107
00:52:37,360 --> 00:52:38,520
come up with this.
Oh, I get up.

1108
00:52:38,560 --> 00:52:39,800
What should you do in the
morning?

1109
00:52:39,800 --> 00:52:44,400
Here's your two hour routine and
do yoga, do deep breathing, go

1110
00:52:44,400 --> 00:52:46,880
for a walk with no shorts on,
blah, blah, blah.

1111
00:52:46,880 --> 00:52:48,840
It's like all these things and
you're just like, you're like,

1112
00:52:48,960 --> 00:52:51,520
bro, it's not realistic.
What are you going to do?

1113
00:52:51,520 --> 00:52:53,840
And so it might work for some
people, but the reality is, like

1114
00:52:53,840 --> 00:52:57,880
you said, when you have kids or
you have other responsibilities,

1115
00:52:57,880 --> 00:53:02,360
things like that, I think what's
cool is then you figuring out in

1116
00:53:02,360 --> 00:53:05,680
that context, what then does
work for you.

1117
00:53:05,800 --> 00:53:09,600
So for example, I love to get up
in the morning and take our dog

1118
00:53:09,600 --> 00:53:11,960
for a walk.
That's my time with her.

1119
00:53:12,280 --> 00:53:15,120
It it's sun exposure.
So you're starting the day off

1120
00:53:15,120 --> 00:53:16,840
with this light exposure.
I love it.

1121
00:53:16,960 --> 00:53:18,960
I feel good.
We're just getting moving.

1122
00:53:18,960 --> 00:53:21,280
It's not exactly like it's a
high intensity type thing.

1123
00:53:21,520 --> 00:53:23,640
Sometimes it is depending on
what she sees and then she'll

1124
00:53:23,640 --> 00:53:24,760
start hauling ass.
So we're good.

1125
00:53:24,760 --> 00:53:27,600
But it's little stuff like that.
Again, you build into your

1126
00:53:27,600 --> 00:53:29,920
routine what gets you going in
that space.

1127
00:53:30,000 --> 00:53:33,360
And like you said with the kids,
yeah, there might be period of

1128
00:53:33,360 --> 00:53:35,600
time where I would love to be
able to do this, but here's what

1129
00:53:35,600 --> 00:53:37,880
I've really got to work with.
And so it's figuring out what

1130
00:53:37,880 --> 00:53:39,560
that looks like and paying
attention to how it makes you

1131
00:53:39,560 --> 00:53:41,640
feel.
And maybe some days are more

1132
00:53:41,640 --> 00:53:44,160
ideal than others, right, in
terms of how you can balance

1133
00:53:44,160 --> 00:53:46,240
that.
But to me, it's also about the

1134
00:53:46,240 --> 00:53:50,080
entirety of your day.
So it's not just that first hour

1135
00:53:50,080 --> 00:53:52,360
or two, it's not even just the
last hour or two.

1136
00:53:52,760 --> 00:53:55,600
It's how you manage things over
that period of time.

1137
00:53:55,600 --> 00:53:58,840
So when we talk about what can
influence the endocrine response

1138
00:53:58,840 --> 00:54:01,520
and what can the endocrine
response influence, right?

1139
00:54:01,520 --> 00:54:04,840
And we look at this as a dual
direction type of relationship.

1140
00:54:05,720 --> 00:54:10,280
How you do all of these things
has a fundamental impact on the

1141
00:54:10,280 --> 00:54:12,720
system, right?
And how that system balances,

1142
00:54:12,720 --> 00:54:16,120
how that system adapts,
recovers, over reaches.

1143
00:54:16,480 --> 00:54:18,600
And I think it's paying
attention to that completely.

1144
00:54:18,720 --> 00:54:21,320
Also paying attention to
preferences, paying attention.

1145
00:54:21,320 --> 00:54:24,600
But it's funny, you could put an
ideal diet together for an

1146
00:54:24,600 --> 00:54:27,560
athlete and everybody thinks, Oh
my God, working with high level

1147
00:54:27,560 --> 00:54:30,400
athletes must be so amazing.
They're so motivated and they'll

1148
00:54:30,400 --> 00:54:32,040
do whatever.
Oh my God, if you only knew.

1149
00:54:32,240 --> 00:54:35,240
No, honestly, some of them are
the worst because like they've

1150
00:54:35,240 --> 00:54:38,000
gotten by on talent to a great
degree and they're so damn

1151
00:54:38,000 --> 00:54:41,440
genetically gifted that they're
like, now what I'm doing works.

1152
00:54:41,440 --> 00:54:44,200
And so sometimes it's just
finding the little things to

1153
00:54:44,200 --> 00:54:47,280
adjust with them that make them
that few percentage points

1154
00:54:47,280 --> 00:54:49,280
better.
Then they start to buy into

1155
00:54:49,280 --> 00:54:50,920
other things when they see the
value of that.

1156
00:54:50,920 --> 00:54:53,840
So it's, and I think the other
thing that people make a huge

1157
00:54:53,840 --> 00:54:57,800
mistake doing is trying to fix
everything all at the same time,

1158
00:54:58,480 --> 00:55:01,000
right?
Find the low hanging fruit, find

1159
00:55:01,000 --> 00:55:03,600
the big rocks, right?
What are the things you can put

1160
00:55:03,600 --> 00:55:06,880
in there first that will make
the biggest difference?

1161
00:55:07,920 --> 00:55:09,400
Then you can work on the smaller
stuff.

1162
00:55:09,400 --> 00:55:11,920
But if you try to do it all at
one time, and we've done this, I

1163
00:55:11,920 --> 00:55:14,200
think one of the reasons we've
had pretty good success working

1164
00:55:14,200 --> 00:55:17,360
with the athletes and the teams
that we have over my career is

1165
00:55:17,360 --> 00:55:21,440
we don't go in and just
implement everything in Year 1.

1166
00:55:21,840 --> 00:55:24,840
We find the two or three biggest
things where we can make a

1167
00:55:24,840 --> 00:55:28,960
difference that makes sense for
what that program's goals are

1168
00:55:28,960 --> 00:55:32,800
for the athletes they have.
And then over a period of time,

1169
00:55:33,000 --> 00:55:36,280
once we get really good at those
things, think about do we need

1170
00:55:36,280 --> 00:55:37,760
anything else?
Maybe not.

1171
00:55:38,000 --> 00:55:40,120
And if we do, how do we layer it
in?

1172
00:55:40,400 --> 00:55:42,400
Because the one thing that will
often happen, and I would

1173
00:55:42,400 --> 00:55:45,120
imagine you've got to run into
this from a medical standpoint,

1174
00:55:45,120 --> 00:55:48,080
but if you give somebody too
many things to attend to, they

1175
00:55:48,080 --> 00:55:50,960
wind up doing none of them.
So it's not even OK, we still

1176
00:55:50,960 --> 00:55:52,440
did two or three out of the six.
So that's good.

1177
00:55:52,560 --> 00:55:54,880
No, sometimes you get that straw
that broke the camel's back.

1178
00:55:55,040 --> 00:55:56,160
We're like, OK, I'm good with
that.

1179
00:55:56,560 --> 00:55:58,560
I'm good with that, I'm good
with that.

1180
00:55:59,120 --> 00:56:00,680
That's one too many.
I'm not doing any of it now.

1181
00:56:00,840 --> 00:56:03,320
And we honestly, we run into
this with athletes all the time.

1182
00:56:03,320 --> 00:56:05,480
It's actually.
Once you understand that, it

1183
00:56:05,640 --> 00:56:09,200
gets a little bit easier to
gauge how you approach this.

1184
00:56:11,320 --> 00:56:14,240
Yeah, I forget it might have
been the power of now in that

1185
00:56:14,240 --> 00:56:16,680
book where they had talked
about, I think when somebody

1186
00:56:16,680 --> 00:56:19,680
tries to do 1 habit, the
likelihood that over 2 weeks it

1187
00:56:19,680 --> 00:56:23,160
might be very high, 80 to 9%
somewhere that you add on to two

1188
00:56:23,160 --> 00:56:24,760
all of a sudden drops down to
like in the 60s.

1189
00:56:24,760 --> 00:56:28,040
Whatever you add on three habits
or 4 habits, it's basically

1190
00:56:28,040 --> 00:56:30,000
gonna be in like the single
digits attempts or whether

1191
00:56:30,000 --> 00:56:31,120
they're gonna be able to execute
that.

1192
00:56:31,120 --> 00:56:33,440
And so, yeah, when you're
talking about behavior change,

1193
00:56:33,760 --> 00:56:35,760
very complex.
So yeah, I think giving people

1194
00:56:35,760 --> 00:56:39,200
actionable small things that
they can bite on and also it's

1195
00:56:39,200 --> 00:56:41,520
empowering when you get becomes
it is with something like, oh,

1196
00:56:41,520 --> 00:56:44,360
OK, I got this, you already
actually got this and and I

1197
00:56:44,440 --> 00:56:45,560
think that's a really good
strategy.

1198
00:56:46,280 --> 00:56:48,400
I made note of two things that I
really wanted to get a deeper

1199
00:56:48,400 --> 00:56:51,240
understanding on.
You earlier talked about with

1200
00:56:51,240 --> 00:56:53,320
respect to trying to promote
parasympathetic dominance.

1201
00:56:53,320 --> 00:56:55,440
You said indoor screening does
tend to help with that.

1202
00:56:55,840 --> 00:56:57,920
It does.
Are we talking more low

1203
00:56:57,920 --> 00:57:00,760
intensity steady state cardio or
are we talking about more like

1204
00:57:00,880 --> 00:57:03,560
long duration and it could be
high intensity or does it not

1205
00:57:03,560 --> 00:57:05,680
matter?
It doesn't matter a whole lot.

1206
00:57:05,680 --> 00:57:08,440
They both work.
I think that I think one of the

1207
00:57:08,440 --> 00:57:14,040
mistakes we've made in how we
promote this sometimes, and I

1208
00:57:14,040 --> 00:57:16,680
will say this, let's let's lump
resistance training in here too,

1209
00:57:16,840 --> 00:57:20,280
is I don't know why, but we
started to try to treat it as

1210
00:57:20,280 --> 00:57:23,680
what's best and treating it like
an either or.

1211
00:57:24,240 --> 00:57:26,560
And the reality is it's all
good, right?

1212
00:57:26,560 --> 00:57:28,560
So it's if you could only
resistance training or do

1213
00:57:28,560 --> 00:57:29,760
aerobic exercise, what should
you do?

1214
00:57:29,760 --> 00:57:32,520
If you're like, oh, and
resistance training, right,

1215
00:57:32,520 --> 00:57:35,240
because you build muscle, you
can still build some degree of

1216
00:57:35,240 --> 00:57:36,680
aerobic fitness with that.
It's so good for you.

1217
00:57:36,680 --> 00:57:38,880
And then other people like no
endurance training because of

1218
00:57:38,880 --> 00:57:41,640
the cardiovascular benefits and
I'm over you're going or both.

1219
00:57:42,160 --> 00:57:43,800
Like why does it have to be 1 of
the other?

1220
00:57:43,840 --> 00:57:46,880
So we play this really weird
semantic game that doesn't

1221
00:57:46,880 --> 00:57:48,440
really need to be played.
So I would even say from an

1222
00:57:48,440 --> 00:57:51,320
endurance standpoint, we know
there are tremendous benefits to

1223
00:57:51,320 --> 00:57:52,560
high intensity interval
training.

1224
00:57:52,840 --> 00:57:54,960
Guess what?
There's also some pretty damn

1225
00:57:54,960 --> 00:57:58,760
good benefits to long duration
moderate intensity training.

1226
00:57:58,760 --> 00:58:02,280
And if you try to do high
intensity every day, that's

1227
00:58:02,280 --> 00:58:04,360
going to be met.
That is really sympathetically

1228
00:58:04,360 --> 00:58:07,280
taxing as well.
So my answer to that is mix it

1229
00:58:07,280 --> 00:58:08,880
up.
And there was just a study that

1230
00:58:08,880 --> 00:58:11,920
came out where they were looking
at the training habits and

1231
00:58:11,920 --> 00:58:14,920
training approaches of most of
the elite coaches for endurance

1232
00:58:14,920 --> 00:58:17,280
athletes.
Most of those athletes spend

1233
00:58:17,280 --> 00:58:19,840
very little of their week at
their highest intensities.

1234
00:58:20,320 --> 00:58:24,240
There are a lot of what we call
Zone 2 and Zone 3 type of

1235
00:58:24,240 --> 00:58:26,760
training.
It's not always hard, right?

1236
00:58:26,760 --> 00:58:30,400
So I think there's a value in
that and mixing it up and part

1237
00:58:30,400 --> 00:58:31,440
of it also depends on how you
feel.

1238
00:58:31,440 --> 00:58:34,280
Because here's The thing is,
don't forget about the value of

1239
00:58:34,320 --> 00:58:36,000
psychological responses to this
too.

1240
00:58:36,160 --> 00:58:38,560
And we know that honestly, from
a depression and anxiety

1241
00:58:38,560 --> 00:58:41,640
standpoint, from an aerobic
standpoint, the strongest

1242
00:58:41,640 --> 00:58:43,880
effects still appear to be with
low to moderate intensity

1243
00:58:43,880 --> 00:58:45,800
exercise.
It doesn't mean high intensity

1244
00:58:45,800 --> 00:58:48,720
can't be useful for other
factors, but we don't just want

1245
00:58:48,720 --> 00:58:51,160
to stress that.
So again, I think getting away

1246
00:58:51,160 --> 00:58:54,280
from the either or better, worse
things like that is the reality

1247
00:58:54,280 --> 00:58:58,880
is they both work really well.
Yeah, I think and maybe I have

1248
00:58:58,880 --> 00:59:01,120
some sense of why I think we
really get excited and get

1249
00:59:01,120 --> 00:59:04,000
married to the idea about being
efficient efficiencies really.

1250
00:59:04,680 --> 00:59:06,800
Yeah, I'm honestly more
interested in effectiveness.

1251
00:59:06,800 --> 00:59:09,440
I think that's probably far more
important in terms of quality of

1252
00:59:09,440 --> 00:59:12,240
life and quality of the results
and I think that's what it is.

1253
00:59:12,240 --> 00:59:14,680
OK, if you have three hours, how
can I maximize that?

1254
00:59:14,680 --> 00:59:18,400
Again we talk about love him but
that the four hour work week I

1255
00:59:18,400 --> 00:59:20,520
think it was over the four hour
body in the four hour chef.

1256
00:59:20,520 --> 00:59:23,960
All those were such hits because
OK, how can I the most

1257
00:59:23,960 --> 00:59:25,960
productive in the least amount
of time?

1258
00:59:26,000 --> 00:59:27,800
How can I hack the system, so to
speak?

1259
00:59:27,800 --> 00:59:30,680
Or how can I hack my biology?
I think that's where that comes

1260
00:59:30,680 --> 00:59:32,440
from.
And I don't really know if we

1261
00:59:32,440 --> 00:59:35,280
can hack biologies.
And I think it depends, if we

1262
00:59:35,280 --> 00:59:38,520
look at it from ROI standpoint,
the question you have to ask,

1263
00:59:38,520 --> 00:59:40,640
and this is going to be a little
different for different people,

1264
00:59:40,640 --> 00:59:43,240
it is the investment timer is
the investment effort.

1265
00:59:43,840 --> 00:59:47,680
Because for some people, if
you're not a big exerciser, like

1266
00:59:47,680 --> 00:59:51,440
you don't love exercise, the
intensity part could be very

1267
00:59:51,440 --> 00:59:53,280
daunting.
Yeah, this sucks.

1268
00:59:53,280 --> 00:59:55,040
This is hard.
I don't want to do this.

1269
00:59:55,200 --> 00:59:57,280
I'd rather work out for a little
bit longer, but do it.

1270
00:59:57,480 --> 00:59:58,600
You know what?
That's cool because that still

1271
00:59:58,600 --> 01:00:00,080
works.
But if you look at it from a

1272
01:00:00,080 --> 01:00:01,440
time investment, it's actually
cool.

1273
01:00:01,680 --> 01:00:04,160
One of my doctoral students for
a part of her dissertation is

1274
01:00:04,160 --> 01:00:06,400
finishing up the study now, and
she actually just presented on

1275
01:00:06,400 --> 01:00:10,080
the preliminary results.
But we're comparing traditional

1276
01:00:10,080 --> 01:00:13,320
resistance training to
concurrent training and so same

1277
01:00:13,320 --> 01:00:16,160
lifting program plus doing high
intensity intervals at the end

1278
01:00:16,480 --> 01:00:18,600
and then compared to high
intensity functional training.

1279
01:00:18,600 --> 01:00:21,240
So more of you like your Medcon
CrossFit type of approach.

1280
01:00:21,840 --> 01:00:24,000
And it's interesting because
actually the concurrent training

1281
01:00:24,000 --> 01:00:26,440
group is coming out ahead on
most measures you when you talk

1282
01:00:26,440 --> 01:00:28,880
about efficacy, right, the
effectiveness.

1283
01:00:29,400 --> 01:00:33,000
But once you adjust for time,
they're actually remarkably

1284
01:00:33,000 --> 01:00:34,360
similar.
And that high intensity

1285
01:00:34,360 --> 01:00:37,240
functional starts to win out on
a lot of things, right, because

1286
01:00:37,240 --> 01:00:39,240
it's a shorter time.
So now we what we're doing is

1287
01:00:39,240 --> 01:00:42,160
we've come up with a calculation
where we're looking at it as

1288
01:00:42,320 --> 01:00:47,000
percent gain per amount of time.
So how much lean mass did you

1289
01:00:47,000 --> 01:00:49,880
gain per hour of training that
you did right.

1290
01:00:49,880 --> 01:00:53,160
So what's that return on
investment from that standpoint?

1291
01:00:53,400 --> 01:00:55,320
And I think that gets left out.
And I think that's even been the

1292
01:00:55,320 --> 01:00:57,800
case with a lot of the stuff on
resistance training and like

1293
01:00:57,800 --> 01:01:01,040
high load versus low load.
And they both work like both

1294
01:01:01,080 --> 01:01:04,160
whether you're doing 30 reps to
near failure or you're doing

1295
01:01:04,160 --> 01:01:06,880
like 10 reps whatever, it's like
they're they both create

1296
01:01:06,880 --> 01:01:08,840
hypertrophy.
Yeah, strength is a little

1297
01:01:08,840 --> 01:01:10,960
better with the 10 reps, but you
still get stronger with the 30

1298
01:01:10,960 --> 01:01:12,720
reps.
But my question is, OK, now

1299
01:01:12,720 --> 01:01:16,680
adjust for time on that because
to do 30 reps takes three times

1300
01:01:16,680 --> 01:01:19,680
as long as to do 10 reps.
So are you get?

1301
01:01:19,680 --> 01:01:24,840
So if it's just as good but it
takes you two to three times

1302
01:01:24,840 --> 01:01:27,560
longer to do, is it really as
good?

1303
01:01:28,600 --> 01:01:29,720
It depends on your preferences
there.

1304
01:01:30,200 --> 01:01:32,600
The one thing with if you're
doing, I guess if you're doing

1305
01:01:32,600 --> 01:01:34,840
near failure, you'd still be
waiting longer between sets.

1306
01:01:34,840 --> 01:01:37,960
But I think from a recovery
standpoint, even if you are

1307
01:01:37,960 --> 01:01:41,520
going near failure, I would
think that you might be ready to

1308
01:01:41,520 --> 01:01:43,840
go within 60 to 90 seconds
maybe.

1309
01:01:44,240 --> 01:01:49,600
Whereas opposed to A10 Rep or
8R8 Rep like at 80% with one RIR

1310
01:01:50,200 --> 01:01:52,440
you might need 3 minutes to
recover.

1311
01:01:52,880 --> 01:01:55,360
For optimal for if you're
looking at strength from set to

1312
01:01:55,360 --> 01:01:58,480
set, but we've done studies
where we do 60 to 92nd recovery.

1313
01:01:58,680 --> 01:02:00,880
And so those training sessions
can still be pretty short

1314
01:02:00,880 --> 01:02:03,280
depending on how you structure
it, let alone, hey, now let's

1315
01:02:03,280 --> 01:02:05,760
look at say super sets, what
happens when you're doing push

1316
01:02:05,760 --> 01:02:08,880
pull, things like that.
So my point in that is that

1317
01:02:09,120 --> 01:02:12,880
sometimes we hear it's as good
as this or it's better than

1318
01:02:12,880 --> 01:02:16,080
this, but you've got to put it
in the context of what the other

1319
01:02:16,160 --> 01:02:19,120
considerations are with that
from a time, from an effort,

1320
01:02:19,320 --> 01:02:22,000
things like that, from an
equipment standpoint, all these

1321
01:02:22,000 --> 01:02:24,520
things need to factor.
And so I think what's cool,

1322
01:02:24,520 --> 01:02:25,960
here's the here's where I take
away from it.

1323
01:02:26,640 --> 01:02:30,920
There is a menu of options to
improve your fitness and improve

1324
01:02:30,920 --> 01:02:33,480
your health.
It really depends on which one

1325
01:02:33,480 --> 01:02:35,480
will fit for you that you will
stick with.

1326
01:02:35,480 --> 01:02:37,640
Because as we already mentioned
much earlier in this whole

1327
01:02:37,640 --> 01:02:40,000
thing, consistency is key,
right?

1328
01:02:40,000 --> 01:02:43,000
Like that will win out over
almost everything else.

1329
01:02:43,240 --> 01:02:47,360
And so the consistency aspect is
so critical, but the reality is

1330
01:02:47,360 --> 01:02:50,760
you have a few different ways to
get there, all of which work.

1331
01:02:50,960 --> 01:02:53,000
Some may work a little better
than others.

1332
01:02:53,000 --> 01:02:55,080
Now, if I'm working with an
athlete and we're trying to set

1333
01:02:55,080 --> 01:02:57,320
a world record, we're trying to
win Olympic gold, we're trying

1334
01:02:57,320 --> 01:03:00,520
to do these things, we're going
to look for the best option,

1335
01:03:00,560 --> 01:03:03,680
even if that option is 1%
better.

1336
01:03:03,800 --> 01:03:06,960
That can be the different in
difference in placing for most

1337
01:03:06,960 --> 01:03:09,280
people looking to improve their
fitness or their health.

1338
01:03:09,960 --> 01:03:13,040
Man, you got a couple ways to
get there.

1339
01:03:13,400 --> 01:03:15,640
So there's no one right way.
And that's where even when we

1340
01:03:15,640 --> 01:03:18,640
talk about the hormones and the
endocrine aspects behind this is

1341
01:03:18,640 --> 01:03:21,760
where monitoring becomes very
useful because it allows you to

1342
01:03:21,760 --> 01:03:25,280
gauge how these things are
working for you in a much more

1343
01:03:25,280 --> 01:03:27,880
holistic sense.
So not just did my bench press

1344
01:03:27,880 --> 01:03:30,000
go up, not just did my blood
pressure down, but it's like,

1345
01:03:30,120 --> 01:03:34,880
how am I physiologically doing?
How are, how is my, how are my

1346
01:03:34,880 --> 01:03:37,880
blood lipids, how are my, how's
my nutrient status?

1347
01:03:37,920 --> 01:03:41,120
Am I taking in the right micro
micronutrients to further

1348
01:03:41,120 --> 01:03:43,360
support this?
So then you can fine tune it a

1349
01:03:43,360 --> 01:03:46,880
little bit and do it in a way
that fits what you have at your

1350
01:03:46,880 --> 01:03:49,880
disposal, what you can get at
your disposal and what you

1351
01:03:49,880 --> 01:03:52,160
prefer to.
I think that can go a long way

1352
01:03:52,160 --> 01:03:54,360
towards really improving health
globally.

1353
01:03:54,680 --> 01:03:56,440
Love that.
One more thing I want to put a

1354
01:03:56,440 --> 01:03:59,840
bow on Sean before I get your
vessel preservation and GLP is

1355
01:04:00,040 --> 01:04:01,680
IGF one.
We talked a little bit about

1356
01:04:01,680 --> 01:04:04,400
growth hormone downstream IGF
one and maybe even IGF two.

1357
01:04:05,040 --> 01:04:07,920
Help me think through this, how
I might use this in a clinical

1358
01:04:07,920 --> 01:04:10,400
practice.
So of course I and I'm really

1359
01:04:10,400 --> 01:04:15,120
interested in thinking about
injury and recovery and I'm

1360
01:04:15,120 --> 01:04:17,640
thinking, been thinking a lot
about is there a role of me

1361
01:04:17,640 --> 01:04:21,480
looking at this in people who
are just taking longer with

1362
01:04:21,480 --> 01:04:24,120
respect to their recovery after
an injury, right?

1363
01:04:24,160 --> 01:04:27,120
Whether it is a treatment
intervention that I've done or

1364
01:04:27,120 --> 01:04:29,960
not, is there a role in that and
how would you think about that?

1365
01:04:30,800 --> 01:04:33,360
So I think it's important to
realize, so IGF one really comes

1366
01:04:33,360 --> 01:04:36,640
from two sources, right.
So the primary growth hormone

1367
01:04:36,640 --> 01:04:40,280
driven IGF one, the one that's
the downstream from GH is going

1368
01:04:40,280 --> 01:04:44,120
to be liver derived IGF one.
However, muscle and other

1369
01:04:44,120 --> 01:04:46,960
tissues for prolifically muscle,
but certainly even adipose

1370
01:04:46,960 --> 01:04:50,440
tissue and bone can do this.
There's also localized IGF one

1371
01:04:50,440 --> 01:04:54,160
production and secretion as
almost a more of a pericrine or

1372
01:04:54,160 --> 01:04:56,360
autocrine gland versus an
endocrine gland.

1373
01:04:56,480 --> 01:04:58,280
All right, So muscle can
function in some capacity.

1374
01:04:58,280 --> 01:05:03,760
So when you measure that IGF one
is also going to be dictated or

1375
01:05:03,760 --> 01:05:07,120
be influenced by which of those
things you're looking at, right?

1376
01:05:07,120 --> 01:05:10,000
So the liver dried IGF one
typically has a fairly

1377
01:05:10,000 --> 01:05:13,840
significant lag from the GH
stimulation, right?

1378
01:05:13,840 --> 01:05:16,720
And can be anywhere from 12 to
36 hours in some cases.

1379
01:05:17,160 --> 01:05:19,840
Whereas if we see an immediate
rise in IGF one, that's

1380
01:05:19,840 --> 01:05:22,360
typically more on the paracrine
side where we're getting it from

1381
01:05:22,360 --> 01:05:25,200
the muscle itself because of
contraction and the production

1382
01:05:25,200 --> 01:05:27,920
of the more local level.
And that can be a very important

1383
01:05:27,920 --> 01:05:31,000
influencer on on muscle growth
and repair and things like that

1384
01:05:31,000 --> 01:05:33,120
as well.
So I would say if nothing else

1385
01:05:33,120 --> 01:05:36,640
with IGF one, we typically do
include this as a measurement in

1386
01:05:36,640 --> 01:05:39,160
most of the biomarker work that
we do if we're looking at growth

1387
01:05:39,160 --> 01:05:42,400
hormone as well.
I think what is useful to know

1388
01:05:42,400 --> 01:05:46,680
though too is if you see and
you're tracking IGF one

1389
01:05:46,680 --> 01:05:50,840
responses is also being aware of
what can influence IGF one,

1390
01:05:51,120 --> 01:05:54,320
because if you're also getting
markers of inflammation at the

1391
01:05:54,320 --> 01:05:58,680
same time, those so inflammation
can suppress IGF one secretion

1392
01:05:58,680 --> 01:06:01,400
as well.
So looking at these in concert

1393
01:06:01,400 --> 01:06:03,760
can be very useful to start to
figure out what the cause of

1394
01:06:03,760 --> 01:06:05,840
this might be and where you can
intervene a little bit more

1395
01:06:05,840 --> 01:06:08,360
effectively.
But we found IGF One to be a

1396
01:06:08,360 --> 01:06:10,960
fairly useful marker.
And what was interesting

1397
01:06:10,960 --> 01:06:12,880
process, we've got a couple
studies where we're actually

1398
01:06:12,880 --> 01:06:16,280
where we actually showed that
changes in IGF One over sports

1399
01:06:16,280 --> 01:06:18,720
season were actually tied to
performance, right?

1400
01:06:18,720 --> 01:06:22,040
So we do know that it does
appear to play a role here in

1401
01:06:22,040 --> 01:06:24,520
terms of adaptation to some of
the things we see.

1402
01:06:24,520 --> 01:06:28,040
So I think IGF 1 can be fairly
reflective of stress, overall

1403
01:06:28,040 --> 01:06:30,200
stress to the system, not just
distress, but the stress of

1404
01:06:30,200 --> 01:06:33,240
training, the stress of life.
And so I think that IGF 1 can be

1405
01:06:33,240 --> 01:06:35,240
important there.
But again, time course is going

1406
01:06:35,240 --> 01:06:39,320
to dictate a lot of stuff in
terms of how in what proximity

1407
01:06:39,320 --> 01:06:42,600
to training or competition were
the draws taken.

1408
01:06:42,880 --> 01:06:44,560
And that's going to tell you
whether it's private.

1409
01:06:44,560 --> 01:06:47,600
Because honestly on most of the
most of the panels you can get,

1410
01:06:47,920 --> 01:06:50,320
it's not going to be able to
distinguish between paracrine

1411
01:06:50,320 --> 01:06:52,280
derived or endocrine derived IGF
one.

1412
01:06:53,640 --> 01:06:58,000
In those studies over lower IGF
one as in worst performance is

1413
01:06:58,000 --> 01:06:58,960
what I'm guessing.
Yeah, OK.

1414
01:06:59,000 --> 01:06:59,760
Correct.
Got you.

1415
01:06:59,800 --> 01:07:01,360
Especially around strength and
power.

1416
01:07:01,760 --> 01:07:03,000
OK, cool.
All right.

1417
01:07:03,000 --> 01:07:05,080
Let's talk about GLP, one
agonist brief.

1418
01:07:05,080 --> 01:07:07,560
Sure.
With respect to muscle

1419
01:07:07,560 --> 01:07:09,440
preservation.
So I think I've been a record of

1420
01:07:09,440 --> 01:07:11,720
saying this.
I think and at least in my time

1421
01:07:11,800 --> 01:07:14,640
and practicing medicine over the
last 20 years, maybe I would say

1422
01:07:14,640 --> 01:07:17,960
these have been one of the most
revolutionary medications,

1423
01:07:17,960 --> 01:07:21,560
although we're now learning that
the effects are not as profound

1424
01:07:21,560 --> 01:07:24,200
as they are in the clinical
studies and real world results.

1425
01:07:24,800 --> 01:07:26,040
But I'll table that for a
different day.

1426
01:07:26,400 --> 01:07:28,600
But I think the effect that
they've had in terms of just the

1427
01:07:28,600 --> 01:07:30,440
obesity crisis have been very
good.

1428
01:07:31,080 --> 01:07:33,960
The huge downside that I've
recognized in my practice, I use

1429
01:07:33,960 --> 01:07:37,160
these, I've seen it a lot, I
think it's well recognizes their

1430
01:07:37,160 --> 01:07:40,080
effect, their negative effect on
lean body mass and fat free

1431
01:07:40,080 --> 01:07:41,880
mass.
And so I just want to get your

1432
01:07:41,880 --> 01:07:45,040
general thoughts about that and
then I'll get into what Doctor

1433
01:07:45,040 --> 01:07:48,960
Mike calls non Adergenic
performance enhancing drugs.

1434
01:07:49,920 --> 01:07:53,360
Yeah, I think that when we look
at it from that standpoint, I,

1435
01:07:53,480 --> 01:07:56,440
I, you look so with these anti
obesity medications, if we're

1436
01:07:56,440 --> 01:08:01,040
looking at the GLP ones and
variations on that as well, I

1437
01:08:01,040 --> 01:08:03,040
agree with you about the
revolutionary nature of them,

1438
01:08:03,080 --> 01:08:05,560
right and what they bring to the
table and how they've modified

1439
01:08:05,560 --> 01:08:08,640
this.
We do see pretty significant

1440
01:08:08,640 --> 01:08:10,960
lean mass loss.
But what's interesting is you

1441
01:08:10,960 --> 01:08:13,320
also sometimes see that with
just caloric restriction too,

1442
01:08:13,800 --> 01:08:16,439
right.
So it, it's not as unique to

1443
01:08:16,439 --> 01:08:19,760
them as one might think.
What was really cool if you

1444
01:08:19,760 --> 01:08:23,840
delve into the science behind
this though, where it appears

1445
01:08:23,840 --> 01:08:28,560
that these GLP ones do not
exacerbate lean mass loss is in

1446
01:08:28,560 --> 01:08:32,120
those with type 2 diabetes.
So there's been some really cool

1447
01:08:32,120 --> 01:08:35,160
studies, especially early ones.
And remember, these were these

1448
01:08:35,160 --> 01:08:38,920
drugs were designed for type 2
diabetes treatment.

1449
01:08:38,920 --> 01:08:42,439
So there's something that
appears to work within this

1450
01:08:42,439 --> 01:08:46,200
context where they don't get the
same degree of muscle loss.

1451
01:08:46,200 --> 01:08:49,680
And I have a feeling it has to
do with the insulin regulation

1452
01:08:49,800 --> 01:08:52,319
and what it's doing in that
population that may be more,

1453
01:08:52,399 --> 01:08:56,000
more needed than what you would
get in a just an otherwise

1454
01:08:56,040 --> 01:08:59,359
overweight or obese individual
with obesity compared to

1455
01:08:59,399 --> 01:09:01,640
somebody that's actually got
true metabolic disorder in this

1456
01:09:01,640 --> 01:09:03,279
case.
So I think that's pretty

1457
01:09:03,279 --> 01:09:05,680
interesting.
But the reality is I think

1458
01:09:05,680 --> 01:09:08,120
there's some ongoing trials
right now looking at what some

1459
01:09:08,120 --> 01:09:10,800
useful interventions might be.
We could take a very pragmatic

1460
01:09:10,800 --> 01:09:14,960
approach to this and simply say,
OK, what are two things we know

1461
01:09:14,960 --> 01:09:20,120
helps with lean mass protein and
resistance training, right?

1462
01:09:20,120 --> 01:09:22,600
So if we use these as a
foundation, I think one of the

1463
01:09:22,600 --> 01:09:25,439
things that I find interesting
that we had written, I'm

1464
01:09:25,439 --> 01:09:28,080
actually part of a review paper
on this where we looked at the

1465
01:09:28,080 --> 01:09:30,680
role that these could play that
we published last year.

1466
01:09:31,040 --> 01:09:34,920
It's funny because there's
people designing like GLP one

1467
01:09:34,920 --> 01:09:40,040
workouts, AOM, anti obesity
medication workouts and all they

1468
01:09:40,040 --> 01:09:42,600
are is especially resistance
training for beginners, just

1469
01:09:42,600 --> 01:09:45,439
with a new label, right?
So they're like take a little

1470
01:09:45,439 --> 01:09:48,160
longer rest because they may not
have as much nutrient

1471
01:09:48,160 --> 01:09:50,000
availability.
So it's gonna be a little harder

1472
01:09:50,200 --> 01:09:53,200
and we'll progress them through
the weight they use and you're

1473
01:09:53,200 --> 01:09:55,040
like, so yeah, beginning weight
training problem.

1474
01:09:55,040 --> 01:09:57,120
Got it.
So there's not much difference

1475
01:09:57,120 --> 01:09:58,440
there.
I think the thing to pay

1476
01:09:58,440 --> 01:10:01,720
attention to is if somebody's
losing that degree of weight,

1477
01:10:02,640 --> 01:10:06,680
paying attention to fatigue
factors and also being aware of

1478
01:10:06,680 --> 01:10:09,480
micronutrient deficiencies that
may be going on, because that

1479
01:10:09,480 --> 01:10:13,320
might help support some of what
we see as well in terms of

1480
01:10:13,320 --> 01:10:16,280
adaptation in a good way.
But I think the reality of the

1481
01:10:16,280 --> 01:10:19,240
situation is it, look, at the
end of the day, there's not much

1482
01:10:19,240 --> 01:10:21,200
of A downside to resistance
training, right?

1483
01:10:21,200 --> 01:10:23,720
So we know we that and I agree
with you.

1484
01:10:23,720 --> 01:10:26,000
I think one of the concerning
parts is that lean mass loss

1485
01:10:26,000 --> 01:10:28,560
because muscle is our bank,
right?

1486
01:10:28,560 --> 01:10:31,520
That's our health bank, that's
our health currency in order to

1487
01:10:31,520 --> 01:10:33,960
preserve function.
So we don't want to lose a lot.

1488
01:10:33,960 --> 01:10:37,040
But at the end of the day, man,
anytime you lose significant

1489
01:10:37,040 --> 01:10:40,560
amounts of weight, you're going
to lose lean mass along with it.

1490
01:10:40,800 --> 01:10:43,520
The question is how much.
And I think in some of the

1491
01:10:43,520 --> 01:10:47,400
studies, they've seen lean mass
losses anywhere between about 20

1492
01:10:47,400 --> 01:10:50,040
and 40% of the total weight
loss.

1493
01:10:50,040 --> 01:10:52,680
And I think with some of the
caloric restriction studies, it

1494
01:10:52,680 --> 01:10:55,560
might be more of a 16 to 20 or
25%.

1495
01:10:55,560 --> 01:10:59,680
So they overlap in that range.
It just seems to be a bit more

1496
01:10:59,680 --> 01:11:03,600
pronounced with the medications.
But I think what we have not

1497
01:11:03,600 --> 01:11:07,600
really gotten deep enough into
yet is the things that can be

1498
01:11:07,600 --> 01:11:09,240
done.
To your point, even though the

1499
01:11:09,240 --> 01:11:13,440
amount of weight loss doesn't
seem to look quite as promising,

1500
01:11:13,440 --> 01:11:16,640
it's still good, but it's not
quite as promising in real world

1501
01:11:16,720 --> 01:11:19,520
as what we're seeing in these
clinical trials When you're not

1502
01:11:19,520 --> 01:11:23,000
supervising everything that they
do like damn thing called choice

1503
01:11:23,240 --> 01:11:25,320
to get in the way and.
Cost, right?

1504
01:11:25,880 --> 01:11:28,320
Absolutely, Yeah.
It's that adherence factor that

1505
01:11:28,320 --> 01:11:30,360
goes a long way with it.
And that's where I think that

1506
01:11:30,680 --> 01:11:33,520
what I see is an opportunity
from a dietary standpoint with

1507
01:11:33,520 --> 01:11:35,400
sort of protein intake and
educating on that.

1508
01:11:35,760 --> 01:11:37,560
And then from a resistance
training standpoint.

1509
01:11:37,560 --> 01:11:41,760
And the value of that for lean
mass is the educational and

1510
01:11:41,760 --> 01:11:44,000
lifestyle change aspect that
goes with this.

1511
01:11:44,000 --> 01:11:48,800
So if somebody cannot or will
not continue on the AO Ms. how

1512
01:11:48,800 --> 01:11:51,280
were they managing themselves
when they come off of it?

1513
01:11:51,280 --> 01:11:54,160
And what do they do long term?
And do we have an opportunity

1514
01:11:54,160 --> 01:11:56,440
here to teach some more positive
behaviors?

1515
01:11:56,760 --> 01:11:58,440
Have you worked with athletes
who are on these?

1516
01:11:58,960 --> 01:12:01,680
No, no, yeah.
I'm wondering, would you counsel

1517
01:12:01,680 --> 01:12:05,920
somebody so that that, that for
1.6 to 2.2g per kilogram the

1518
01:12:06,160 --> 01:12:08,440
yeah, I said recommended.
Would you tell somebody to be on

1519
01:12:08,440 --> 01:12:10,480
the higher end of that to to two
point?

1520
01:12:10,480 --> 01:12:12,160
Yeah, at that point, yeah.
Yeah.

1521
01:12:12,160 --> 01:12:14,400
And I think if you look at some
of the work that Joey Antonio

1522
01:12:14,400 --> 01:12:17,680
and others have done in that
space, especially with caloric

1523
01:12:17,680 --> 01:12:19,560
restriction, which is going to
be a hallmark of these, right,

1524
01:12:19,560 --> 01:12:20,600
like, how does the weight loss
hurt?

1525
01:12:20,600 --> 01:12:21,680
They're not eating as much,
right?

1526
01:12:21,680 --> 01:12:23,760
So there's a huge aspect of that
in terms of what it does to

1527
01:12:23,760 --> 01:12:26,720
appetite and otherwise.
But I think that we've seen that

1528
01:12:27,040 --> 01:12:29,600
during situations of severe
caloric restriction in

1529
01:12:29,600 --> 01:12:34,520
particular, higher gram per
kilogram doses of protein does

1530
01:12:34,520 --> 01:12:37,760
seem to do a better job of
preserving lean mass and

1531
01:12:37,760 --> 01:12:39,840
facilitating some degree of
adipose loss, too.

1532
01:12:39,960 --> 01:12:41,960
Yeah.
The one caveat I think I'll give

1533
01:12:41,960 --> 01:12:44,560
to people is, again, because
this is my world, I think I can

1534
01:12:44,720 --> 01:12:49,000
be the person who is fighting
tooth and nail to guard and hold

1535
01:12:49,000 --> 01:12:50,680
on because that's the currency,
right?

1536
01:12:50,680 --> 01:12:53,760
The currency of longevity we
talk about is muscle being in

1537
01:12:53,760 --> 01:12:56,240
that catabolic state and neutral
deficiency that you talked

1538
01:12:56,240 --> 01:12:57,840
about.
Your injury risk goes up high.

1539
01:12:58,440 --> 01:13:00,920
So now if you all of a sudden
are really pushing and you're

1540
01:13:01,120 --> 01:13:03,560
really all the time and maybe
you're adding extra resistant

1541
01:13:03,560 --> 01:13:05,480
training sessions because you
want to hold on to that muscle,

1542
01:13:05,760 --> 01:13:07,840
you have to be really cautious.
So you have to be really

1543
01:13:07,840 --> 01:13:10,520
responsible with how you program
around that as well and

1544
01:13:10,520 --> 01:13:12,600
understand that.
Yeah, again, stress is stress.

1545
01:13:12,680 --> 01:13:16,280
And amazing point.
And I think that's where we have

1546
01:13:16,280 --> 01:13:18,680
to be smart, especially if you
have a lot of these people that

1547
01:13:18,680 --> 01:13:21,560
go on the drugs because other
weight loss efforts haven't

1548
01:13:21,560 --> 01:13:23,560
worked and things like that.
But part of what the challenge

1549
01:13:23,560 --> 01:13:27,800
has been for them is a lack of
ability to adhere to to exercise

1550
01:13:27,800 --> 01:13:29,520
programs.
And maybe they've never really

1551
01:13:29,520 --> 01:13:32,600
weight trained before then you
start them off as a beginner

1552
01:13:32,600 --> 01:13:34,760
anyway, right?
So be cautious in how we

1553
01:13:34,760 --> 01:13:37,600
progress, paying attention to
strength gains, paying attention

1554
01:13:37,600 --> 01:13:40,120
to your point about recovery and
injury risk and things like that

1555
01:13:40,120 --> 01:13:43,120
and being aware of that, but
also paying attention as they

1556
01:13:43,120 --> 01:13:46,080
lose more weight, how do some of
these things change for them and

1557
01:13:46,080 --> 01:13:47,800
how do they continue?
So I think there's some

1558
01:13:47,800 --> 01:13:50,280
adaptation that goes on there.
But you're exactly right now.

1559
01:13:50,440 --> 01:13:52,440
Love that you said that because
I think that's an important

1560
01:13:52,440 --> 01:13:55,480
consideration is we don't want
to just do more because to be

1561
01:13:55,480 --> 01:14:00,560
honest, in a state of reduced
nutrient intake, recovery is

1562
01:14:00,560 --> 01:14:03,320
going to be mitigated to some
degree anyway.

1563
01:14:03,680 --> 01:14:07,360
And so we don't want, I'm not
saying go lift weights six or

1564
01:14:07,360 --> 01:14:10,160
seven days a week, honestly, get
a good three days in, get your

1565
01:14:10,160 --> 01:14:12,680
recovery, do your aerobic
exercise because it's good for

1566
01:14:12,680 --> 01:14:14,680
you and it's going to help with
everything else too.

1567
01:14:14,920 --> 01:14:17,600
And it's really just a
fundamentally structured

1568
01:14:17,600 --> 01:14:20,280
exercise program that we are
going to try to base around

1569
01:14:20,280 --> 01:14:22,880
their feelings of fatigue or
whatever else is going on.

1570
01:14:22,880 --> 01:14:25,160
But I think that with some of
the patients that report

1571
01:14:25,160 --> 01:14:28,600
feelings of fatigue and stuff on
this, it's a catch 22, isn't it?

1572
01:14:28,600 --> 01:14:31,400
It's like they may not feel like
they have the energy to work out

1573
01:14:31,400 --> 01:14:33,120
because of it.
But yet The funny thing is we've

1574
01:14:33,120 --> 01:14:36,560
got plenty of studies that show
that working out will help with

1575
01:14:36,680 --> 01:14:40,320
overall sort of feelings of
energetic arousal and capability

1576
01:14:40,320 --> 01:14:42,040
so that they feel like they can
do more.

1577
01:14:42,040 --> 01:14:44,800
So some of it is just what do
you, what will you do?

1578
01:14:44,800 --> 01:14:47,080
What will get you going?
And then how do we help you get

1579
01:14:47,080 --> 01:14:47,960
there?
Love it.

1580
01:14:48,640 --> 01:14:51,480
So where there are problems or
opportunities and the right now

1581
01:14:51,480 --> 01:14:54,120
the race amongst the
Pharmaceutical industry is to

1582
01:14:54,120 --> 01:14:57,000
try to combat this big problem
that we've highlighted and

1583
01:14:57,000 --> 01:14:59,760
everybody's highlighted.
And so one of the common things

1584
01:14:59,760 --> 01:15:02,480
that they're doing is including
these mystatin inhibitors which

1585
01:15:02,480 --> 01:15:05,840
have been studied in other
pathologies, right?

1586
01:15:05,920 --> 01:15:09,120
So in such as spinal muscular
atrophy, those kinds of things.

1587
01:15:09,480 --> 01:15:13,120
What and maybe starting off with
telling people what myostatin is

1588
01:15:13,120 --> 01:15:15,520
and myostat inhibitors are
because a lot of these agents

1589
01:15:15,520 --> 01:15:18,920
are combining those with either
the semi glutide or is going to

1590
01:15:18,920 --> 01:15:21,440
be trespatide.
And yes, coming up, what can you

1591
01:15:21,440 --> 01:15:25,400
tell us about that?
So think of myostatin almost

1592
01:15:25,400 --> 01:15:27,640
working in opposition to growth
hormone is the way I try to

1593
01:15:27,640 --> 01:15:30,040
phrase it.
So myostatin is it's your

1594
01:15:30,040 --> 01:15:32,520
governor on muscle growth for
lack of a better way of putting

1595
01:15:32,520 --> 01:15:34,480
it right.
And so if you can inhibit

1596
01:15:34,480 --> 01:15:38,360
myostatin, you increase, you
take the brakes off muscle

1597
01:15:38,360 --> 01:15:41,200
growth to a great degree, right.
And so if you ever if anybody

1598
01:15:41,200 --> 01:15:43,200
ever wants to see the difference
in this actually look up

1599
01:15:43,360 --> 01:15:46,320
myostatic inhibitor cow and
there's a certain.

1600
01:15:46,320 --> 01:15:48,120
Logs and they got it all.
Yeah, there's certain.

1601
01:15:48,120 --> 01:15:50,640
Species of some of these animals
that are born without the

1602
01:15:50,640 --> 01:15:55,480
myostatin molecule and they're
huge, they're jacked traps to

1603
01:15:55,480 --> 01:15:57,120
their ears.
But anyway, what we're looking

1604
01:15:57,120 --> 01:15:59,160
at though is this is funny if
you think about it.

1605
01:15:59,160 --> 01:16:03,240
So they're like, hey, we've got
a drug that'll help you lose

1606
01:16:03,240 --> 01:16:06,200
weight 0 but you might lose
muscle because of it.

1607
01:16:06,200 --> 01:16:08,800
So not to worry though, we've
got another drug that you can

1608
01:16:08,800 --> 01:16:10,880
take with that to help you from
doing that.

1609
01:16:10,880 --> 01:16:13,200
And it was like, Oh, yeah.
You're selling the problem and

1610
01:16:13,200 --> 01:16:14,520
the solution at the.
Same time, yes, and it's

1611
01:16:14,600 --> 01:16:16,160
freaking brilliant.
And so you're like, all right,

1612
01:16:16,160 --> 01:16:17,960
here you go.
But I think there was a study

1613
01:16:17,960 --> 01:16:24,520
with magnetite and the Magramab.
It was an Actavin, a signal, the

1614
01:16:24,520 --> 01:16:26,080
inhibitor.
And run pharmaceuticals when

1615
01:16:26,080 --> 01:16:27,760
you're talking.
About the actor too and but it

1616
01:16:27,760 --> 01:16:29,280
was cool.
But most of those studies at

1617
01:16:29,280 --> 01:16:30,640
that point had been done in
mice.

1618
01:16:31,080 --> 01:16:33,440
But it was interesting because
combining those two in obese

1619
01:16:33,440 --> 01:16:37,640
mice actually had a 10% increase
in lean mass.

1620
01:16:37,640 --> 01:16:40,960
So this is interesting.
So I think the ongoing, I think

1621
01:16:41,040 --> 01:16:44,560
the last I heard, I believe
there's a couple trials in phase

1622
01:16:44,560 --> 01:16:46,920
two that are looking at this.
Now.

1623
01:16:46,920 --> 01:16:50,240
I'm really curious to see what
happens in phase three in terms

1624
01:16:50,240 --> 01:16:51,800
of the long term effects of
this.

1625
01:16:52,120 --> 01:16:55,080
But look, I got to be honest,
like the athletics world,

1626
01:16:55,280 --> 01:16:57,840
especially bodybuilding,
myostatin inhibitors have been

1627
01:16:57,840 --> 01:17:00,920
the Holy Grail, right?
It's like, when can we?

1628
01:17:00,960 --> 01:17:03,680
Because there's been plenty of
like supplements marketed as

1629
01:17:03,680 --> 01:17:06,720
myostatin, myostatin inhibitors,
none of which actually work, but

1630
01:17:06,720 --> 01:17:08,640
it's the Holy Grail from muscle
growth standpoint.

1631
01:17:08,920 --> 01:17:11,200
I wonder if we're talking about
the same one because the one

1632
01:17:11,200 --> 01:17:13,320
from Migraine Pharmaceuticals is
actually in.

1633
01:17:13,400 --> 01:17:16,640
I think that one was in Primates
in Monkeys, which is why I'll

1634
01:17:16,640 --> 01:17:18,720
link a video.
The one I'm aware of is in mice,

1635
01:17:18,720 --> 01:17:20,480
and I think that was published
in 2024.

1636
01:17:20,480 --> 01:17:22,040
OK.
OK, there's a really good video

1637
01:17:22,040 --> 01:17:24,000
from Mike Izer tell.
I love that guy, he's so funny.

1638
01:17:24,280 --> 01:17:27,040
And I'll link that and the show
notes for people goes through

1639
01:17:27,040 --> 01:17:28,640
the different forearms about
this.

1640
01:17:28,920 --> 01:17:32,680
But then recently Eli Lilly has
his belief trial where they also

1641
01:17:32,680 --> 01:17:35,240
showed very similar effects.
And of course, they combined it

1642
01:17:35,240 --> 01:17:36,640
with I think that was semi
glutite.

1643
01:17:36,640 --> 01:17:38,720
So there's gonna be with
tricipatite and they're gonna go

1644
01:17:38,720 --> 01:17:41,320
head to head.
So I'm really excited and

1645
01:17:41,320 --> 01:17:43,520
interested in looking at this.
But yeah, This is why that

1646
01:17:43,520 --> 01:17:45,520
doctor Mike, I think he's very
bullish on this.

1647
01:17:45,520 --> 01:17:49,880
He talks about he calls them non
androgenic anabolic drugs.

1648
01:17:50,400 --> 01:17:51,640
Right.
Yeah, absolutely.

1649
01:17:51,920 --> 01:17:53,480
I'm not gonna lie to you, but
actually looking, it's like, can

1650
01:17:53,480 --> 01:17:56,880
I invest in this because this is
where we're gonna go like you

1651
01:17:57,120 --> 01:18:00,840
pointed about in the Holy Grail.
And even if it's not FDA

1652
01:18:00,840 --> 01:18:02,920
approved for several years from
now, I could see it being on the

1653
01:18:02,920 --> 01:18:05,200
black market and Gray market
stuff.

1654
01:18:05,200 --> 01:18:07,160
Matter of time.
And it's funny because every

1655
01:18:07,160 --> 01:18:09,520
time I see something, you ask if
we, if we worked with any

1656
01:18:09,520 --> 01:18:12,640
athletes that are on like GLP
ones or anything like that, my

1657
01:18:12,640 --> 01:18:15,360
honest answer is no.
And I should have said no that

1658
01:18:15,360 --> 01:18:17,560
I'm aware of, right?
Because some of them, it depends

1659
01:18:17,560 --> 01:18:19,600
on what they're doing.
But we may see this in some of

1660
01:18:19,600 --> 01:18:22,760
the weight category sports.
But we also have seen that in

1661
01:18:22,760 --> 01:18:25,160
most of these, if you have an
athlete that's not significantly

1662
01:18:25,160 --> 01:18:27,360
overweight in the first or
anybody that's not overweight,

1663
01:18:27,560 --> 01:18:30,320
the effects of these GOP ones is
going to be fairly modest from

1664
01:18:30,320 --> 01:18:31,960
what you get.
And I hope I don't have any

1665
01:18:31,960 --> 01:18:34,800
athletes doing this because of
what my concern is over the loss

1666
01:18:34,800 --> 01:18:37,920
of muscle, which they really
need for performance.

1667
01:18:38,280 --> 01:18:39,880
I'm going to, I think where I
wouldn't be surprised if you

1668
01:18:39,880 --> 01:18:42,640
don't start to see this is like
retiring NFL players that were

1669
01:18:42,640 --> 01:18:45,120
lineman, right when they decide
it's time to go back to normal

1670
01:18:45,120 --> 01:18:46,960
size, like how do I more quickly
do this?

1671
01:18:46,960 --> 01:18:49,600
I think that's going to be a
whole nother argument there in

1672
01:18:49,600 --> 01:18:52,680
terms of what we might see.
That makes me wonder, as has

1673
01:18:52,680 --> 01:18:55,920
WADA or IOC have taken a stance
on this in terms of weight

1674
01:18:55,920 --> 01:18:58,200
cutting sports, Is there any?
Because this could be a really

1675
01:18:58,200 --> 01:19:00,560
slippery slope in terms of what
you can and cannot regulate if

1676
01:19:00,560 --> 01:19:03,360
it's a medical issue.
If it's but here's the thing, if

1677
01:19:03,360 --> 01:19:05,760
it's a medical issue, they can
get a therapeutic use exemption.

1678
01:19:05,840 --> 01:19:07,640
And that's true with
testosterone, with growth

1679
01:19:07,640 --> 01:19:09,040
hormone, with kids, all kinds of
stuff.

1680
01:19:09,040 --> 01:19:13,120
So depends on the TEU.
But in terms of I have not seen

1681
01:19:13,120 --> 01:19:15,800
it specifically now I haven't
looked recently, but I've not

1682
01:19:15,800 --> 01:19:17,720
seen it specifically on band
lists.

1683
01:19:18,280 --> 01:19:20,640
But my guess is it's probably a
matter of time before they at

1684
01:19:20,640 --> 01:19:23,880
least listed as a substance of
concern and start to consider

1685
01:19:24,280 --> 01:19:26,920
whether or not it should be
regulated at all.

1686
01:19:27,160 --> 01:19:32,360
More often than not, unless they
can tie it to performance

1687
01:19:32,360 --> 01:19:36,280
enhancement as a performance
enhancing drug, there may not be

1688
01:19:36,280 --> 01:19:38,960
a reason to because it's not a
stimulant.

1689
01:19:39,160 --> 01:19:40,840
There's no evidence that it
helps with performance.

1690
01:19:40,840 --> 01:19:43,640
But you're right in terms of
weight cutting sports, it would

1691
01:19:43,640 --> 01:19:47,000
not surprise me if we don't
start seeing that show up if we

1692
01:19:47,000 --> 01:19:49,680
haven't already and just
depending on the way it's been

1693
01:19:49,720 --> 01:19:52,920
handled from that standpoint.
But again, in in most of these

1694
01:19:52,920 --> 01:19:55,040
populations, even when I'm
thinking weight cutting sports,

1695
01:19:55,360 --> 01:19:57,640
other than say it'll be
interesting because it'd be so

1696
01:19:57,640 --> 01:20:01,000
ironic and bodybuilding, because
we don't know right now.

1697
01:20:01,200 --> 01:20:04,680
We can look, we can suppose we
can theorize the resistance

1698
01:20:04,680 --> 01:20:08,000
training in protein intake
should help mitigate lean mass

1699
01:20:08,000 --> 01:20:10,120
loss.
It doesn't mean it will reduce

1700
01:20:10,120 --> 01:20:11,960
it completely.
Like it'll eliminate it.

1701
01:20:11,960 --> 01:20:14,280
Like we don't know.
And so if you have a physique

1702
01:20:14,280 --> 01:20:18,400
competitor who really needs to
maintain muscle but yet wants to

1703
01:20:18,400 --> 01:20:21,760
cut weight TOP ones might be a
really dumb way to do this,

1704
01:20:21,760 --> 01:20:23,800
especially if it's going to cost
you all that muscle you've been

1705
01:20:23,800 --> 01:20:25,480
working for.
We also don't know how they

1706
01:20:25,480 --> 01:20:27,240
might interact with other drugs
they might be on.

1707
01:20:27,760 --> 01:20:29,600
If you're looking at it from an
athlete temple, let's say a

1708
01:20:29,600 --> 01:20:32,360
fighter, so you do an MMA,
you're talking boxing, things

1709
01:20:32,360 --> 01:20:35,120
like that, again, for them to
make weight, in most cases, it's

1710
01:20:35,120 --> 01:20:37,720
not so much the fat loss that
matters, it's your ability to

1711
01:20:37,720 --> 01:20:39,600
drop water.
And how do you become more

1712
01:20:39,600 --> 01:20:41,400
efficient of being able to drop
water, have more muscle?

1713
01:20:41,720 --> 01:20:43,360
Because all I need to do is
dehydrate that muscle.

1714
01:20:43,360 --> 01:20:44,880
I can make weight and put it all
back on.

1715
01:20:45,120 --> 01:20:47,160
We want to get rid of the fat
though, So if they're

1716
01:20:47,160 --> 01:20:49,000
eliminating these things, it
would actually potentially be

1717
01:20:49,000 --> 01:20:53,000
very counterproductive, which is
probably why I haven't seen much

1718
01:20:53,000 --> 01:20:55,120
of it in that space yet, at
least being talked about.

1719
01:20:55,120 --> 01:20:56,800
I have no doubt there's somebody
doing it.

1720
01:20:57,000 --> 01:20:58,680
Yeah, because that's what
athletes are going to do.

1721
01:20:58,680 --> 01:21:00,160
There might be a way they get an
advantage to it.

1722
01:21:00,160 --> 01:21:03,480
They'll give it a shot, but I
haven't seen it broadly at this

1723
01:21:03,480 --> 01:21:05,280
point.
It'll be interesting to see how

1724
01:21:05,280 --> 01:21:07,640
it plays out in terms of what we
see with that mid health

1725
01:21:07,720 --> 01:21:10,240
officially want to talk about
myostatin inhibitors, that's

1726
01:21:10,240 --> 01:21:13,160
going to be a different story.
That what I can see very quickly

1727
01:21:13,160 --> 01:21:15,680
winding up on a lot of list and
once they perfect this.

1728
01:21:17,000 --> 01:21:18,640
Exciting stuff.
I'm keeping a close eye on this

1729
01:21:18,640 --> 01:21:20,080
one.
And yeah, we definitely got to

1730
01:21:20,080 --> 01:21:21,840
get somebody here to dive a
little bit deeper into the

1731
01:21:21,840 --> 01:21:24,120
mechanisms and visit this
because I think this is very

1732
01:21:24,200 --> 01:21:26,480
exciting.
Sean, thank you so much, man,

1733
01:21:26,480 --> 01:21:28,480
for coming back.
It's been a, this has been a

1734
01:21:28,480 --> 01:21:32,280
whirlwind of two port series for
people in terms of performance

1735
01:21:32,360 --> 01:21:34,360
enhancing endocrinology, if we
can even call it that.

1736
01:21:34,680 --> 01:21:37,000
Any parting words for our
audience?

1737
01:21:37,000 --> 01:21:40,360
I think one thing I'll say is
even just in the last, I guess,

1738
01:21:40,360 --> 01:21:42,120
4 1/2, five years, the first
time you came on.

1739
01:21:42,120 --> 01:21:44,640
And now I am excited about the
fact that more people are paying

1740
01:21:44,640 --> 01:21:46,360
attention to performance.
Yeah.

1741
01:21:46,360 --> 01:21:48,520
As much as we've been bashing on
social media, I think the one

1742
01:21:48,520 --> 01:21:51,040
thing is done is people are
paying attention to the fact

1743
01:21:51,040 --> 01:21:53,240
that, hey, I'm not just
interested in not being sick,

1744
01:21:53,240 --> 01:21:56,920
I'm interested in being healthy.
And that's a motto of mine is

1745
01:21:56,920 --> 01:21:58,520
that health is not the absence
of a disease.

1746
01:21:58,520 --> 01:22:00,320
And I know you expected that
philosophy.

1747
01:22:00,960 --> 01:22:02,440
Anything you want to leave the
audience with that.

1748
01:22:03,520 --> 01:22:05,040
I think at the end of the day,
if you're approaching from the

1749
01:22:05,040 --> 01:22:06,520
stamp with the, we're all
athletes, right?

1750
01:22:06,520 --> 01:22:09,680
We were designed to move.
And so when we look at it from

1751
01:22:09,680 --> 01:22:12,080
that standpoint, you may not be
an elite athlete.

1752
01:22:12,280 --> 01:22:14,040
You may be happy to be able to
do certain things.

1753
01:22:14,040 --> 01:22:16,240
But I think the reality is, and
the older I've gotten, the more

1754
01:22:16,240 --> 01:22:20,000
I appreciate this is the ability
to maintain function for as long

1755
01:22:20,000 --> 01:22:21,360
as possible to do the things you
love.

1756
01:22:21,800 --> 01:22:25,480
And I think the reality is that
we've already talked about ROI.

1757
01:22:26,040 --> 01:22:28,760
I think we need to think about
that investment now for what the

1758
01:22:28,760 --> 01:22:32,480
return is later in terms of your
ability to carry this out, to be

1759
01:22:32,480 --> 01:22:34,880
able to continue to exist in a
state of health and

1760
01:22:34,880 --> 01:22:36,800
optimization.
Because I think it's a great

1761
01:22:36,800 --> 01:22:38,720
point.
Even what it's funny because I

1762
01:22:38,720 --> 01:22:41,760
think one of the things that
drove me in this space around

1763
01:22:41,760 --> 01:22:43,680
biomarkers and things like that,
if you actually look at the

1764
01:22:43,680 --> 01:22:48,400
classic definition of biomarker,
health and performance are not

1765
01:22:48,400 --> 01:22:50,560
really mentioned in that.
It's all about absence of

1766
01:22:50,560 --> 01:22:52,680
disease or seeing how drugs are
working.

1767
01:22:53,160 --> 01:22:56,040
And so to me, when we start
thinking about health,

1768
01:22:56,320 --> 01:22:59,800
performance optimization, health
optimization, psychological

1769
01:22:59,800 --> 01:23:02,600
effects, things like that and
mental health, I think all these

1770
01:23:02,600 --> 01:23:05,520
things start to go together.
And so I really would encourage

1771
01:23:05,520 --> 01:23:08,000
people, Google will give you
some information.

1772
01:23:08,000 --> 01:23:10,480
I actually like the format that
you do for this because I

1773
01:23:10,480 --> 01:23:13,160
appreciate that over the years.
And and I've said this before on

1774
01:23:13,160 --> 01:23:16,120
your podcast, but it's awesome
for me to see a former student

1775
01:23:16,120 --> 01:23:17,800
doing the things you're doing
like that.

1776
01:23:17,800 --> 01:23:20,880
To me, that's a win, right?
I'm so proud of you and what

1777
01:23:20,880 --> 01:23:22,760
you're doing to get this
information out there and what

1778
01:23:22,760 --> 01:23:24,720
you do when your day-to-day and
your practice and things like

1779
01:23:24,720 --> 01:23:26,720
that.
But I think for me, being able

1780
01:23:26,720 --> 01:23:30,560
to carry that message out and
trying to get people to simply

1781
01:23:30,560 --> 01:23:33,160
pay more attention to what
they're doing.

1782
01:23:33,160 --> 01:23:37,840
And I think that I, I think
probably one of the most, one of

1783
01:23:37,840 --> 01:23:40,600
the truest things that has held
over the last 20 something years

1784
01:23:40,600 --> 01:23:43,280
of my career is that if
something sounds too good to be

1785
01:23:43,280 --> 01:23:46,280
true, it probably is.
And so I, I, that's my caveat

1786
01:23:46,280 --> 01:23:48,600
with social medias.
It sucks because I got to be

1787
01:23:48,600 --> 01:23:52,200
honest, there's some really
useful information out there,

1788
01:23:52,560 --> 01:23:54,920
but unfortunately, sometimes it
either gets twisted and it goes

1789
01:23:54,920 --> 01:23:59,520
from science to sciency or it
gets bastardized or people just

1790
01:23:59,520 --> 01:24:01,840
go off on a rail.
And I think that there's this

1791
01:24:01,840 --> 01:24:04,080
human nature of we we kind of
look for the things that

1792
01:24:04,080 --> 01:24:05,800
reinforce our beliefs.
In many cases.

1793
01:24:05,800 --> 01:24:09,000
I knew that's what I needed to
do and I think to like looking

1794
01:24:09,000 --> 01:24:11,320
for the specific, but honestly,
at the end of the day,

1795
01:24:11,560 --> 01:24:15,360
consistency of training,
balancing your diet, you don't

1796
01:24:15,360 --> 01:24:18,880
have to be overly restrictive.
Just use some common sense

1797
01:24:18,880 --> 01:24:20,760
guidelines.
Start with protein filling

1798
01:24:20,760 --> 01:24:21,960
around it.
Don't forget about your

1799
01:24:21,960 --> 01:24:25,920
micronutrients and sleep, man,
if you start with those three

1800
01:24:25,920 --> 01:24:29,840
things, you're going to be so
much farther along than most

1801
01:24:29,840 --> 01:24:31,600
people.
And I think as we hit on today,

1802
01:24:31,880 --> 01:24:34,840
there is no one right workout
program.

1803
01:24:34,840 --> 01:24:36,440
There's multiple ways to get
there.

1804
01:24:37,600 --> 01:24:42,360
Do what will work for you.
But there's enough science

1805
01:24:42,560 --> 01:24:45,840
behind each of these approaches
to do it well.

1806
01:24:46,480 --> 01:24:48,720
But you've got alternatives.
There's some variety in this

1807
01:24:48,720 --> 01:24:52,400
that you can pick from, but the
basics still hold true.

1808
01:24:52,840 --> 01:24:57,320
Lift some heavy stuff, do some
aerobic work, lift some.

1809
01:24:57,320 --> 01:25:00,320
It's sleep, don't eat like an
idiot.

1810
01:25:00,680 --> 01:25:06,200
I know people don't like simple,
right?

1811
01:25:06,200 --> 01:25:08,640
They want complicated.
They're like, how can I make,

1812
01:25:09,120 --> 01:25:11,680
how does that make my daily
routine the most efficient?

1813
01:25:11,680 --> 01:25:13,600
And they do it in a way that is
the least efficient thing I've

1814
01:25:13,600 --> 01:25:16,640
ever done that I've ever seen.
So I think that just simply

1815
01:25:16,640 --> 01:25:19,600
paying attention to the
fundamentals, it's not sexy, I

1816
01:25:19,600 --> 01:25:23,840
get it, but it works.
And that folks is putting the

1817
01:25:23,840 --> 01:25:27,000
health back in healthcare.
So Sean, thank you so much.

1818
01:25:27,040 --> 01:25:28,960
Always you better off man.
Looking forward to the next.

1819
01:25:29,320 --> 01:25:30,400
One, absolutely.
Take care, brother.

1820
01:25:30,400 --> 01:25:32,760
Thanks for listening to another
episode of Medicine Redefined.

1821
01:25:33,280 --> 01:25:35,480
If you enjoyed this episode,
please be sure to check out some

1822
01:25:35,480 --> 01:25:37,200
of the additional resources in
the show notes.

1823
01:25:37,880 --> 01:25:40,840
Please also check out our social
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1824
01:25:40,840 --> 01:25:44,280
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1825
01:25:44,600 --> 01:25:47,000
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1826
01:25:47,720 --> 01:25:49,720
We also want to thank our team
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1827
01:25:49,720 --> 01:25:51,600
podcast.
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1828
01:25:51,920 --> 01:25:54,400
Zenab Lugmani on research, and
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1829
01:25:54,840 --> 01:25:57,600
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01:25:57,600 --> 01:26:00,440
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1832
01:26:03,720 --> 01:26:06,120
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1833
01:26:06,120 --> 01:26:07,680
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1834
01:26:08,640 --> 01:26:11,680
Now time for the ever so
important disclaimer.

1835
01:26:12,480 --> 01:26:15,280
This podcast is intended for
general public use and is for

1836
01:26:15,280 --> 01:26:18,040
educational purposes only.
It does not cost you the

1837
01:26:18,040 --> 01:26:20,160
practice of medicine nor should
it be construed as a medical

1838
01:26:20,160 --> 01:26:21,960
advice.
No physician patient

1839
01:26:21,960 --> 01:26:24,000
relationship is formed and
anything discussed in this

1840
01:26:24,000 --> 01:26:26,560
podcast does not represent the
views of our employers.

1841
01:26:27,040 --> 01:26:29,520
We recommend that you seek the
guidance of your personal

1842
01:26:29,520 --> 01:26:32,000
position regarding any specific
health related issues.