42. Shawn Arent, PhD, CSCS*D: Nutrient Timing, Ergogenic Aids & Individualization (Ep 4 Rebroadcast)

Hello everyone, I'm Dr. Darsha, and I'm Dr. Altamash Raja, and welcome to Medicine Redefined. A podcast where we will explore the often overlooked but necessary components of health, what we consider to be the fundamentals. We will investigate topics and practices that can give you and your patients the best chance to optimize a healthy lifestyle. It's time to move the needle forward and put the health back in healthcare. Hello ladies and gentlemen, welcome to Medicine Redefined. First off, I want to wish everyone a very, very happy and joyous holiday season, and hopefully we are all in the spirit of giving and laughs and good drinks and good food, and we have new years coming up, so there's a lot to look forward to. Now Altamash and I have decided to re-broadcast our most played episodes in the last year. So last week, we had Dr. Will Bolsa, which is talk on gut health, what it means to be fiber-fueled, and why the gut microbiome is so important. This week, we are going to re-broadcast episode four from Dr. Sean Arnt. So we're going to talk about things like nutrient timing, right? We've all heard the so-called myth of we need to get the protein in our bodies right after workout as fast as we can. Well, is that really true, or do we actually have more time? Next, we'll delve into herbogenic aids. Are there any other supplements out there that could potentially help increase our performance? And then lastly, we talk about individualization. Now, this is a topic that I really love, because I think as a field in medicine, we're starting to realize how important it is that we understand people's bio-individuality, right? We all have different gut microbiomes. We have different circadian rhythms, different personalities. The way we interact with the environment is different. And we have different DNA and genes. So there's no way that averages can tell us how to live. And I think this is a huge jump in medicine that we're starting to see. Now I know this is about an hour and forty minutes, but we think you guys can all handle it and is pure information and bite-sized information. So you guys will definitely, definitely learn a lot from Dr. Sean Arnt. If you didn't hear him in episode four, enjoy. Alright guys, today we have Dr. Sean Arnt. Dr. Arnt, thank you so much for joining us and before we jumped on here, we were talking a little bit about what we've been up to, what you've been up to. As I mentioned earlier, when we wanted to get you on this show, there are so many ways we can go down, because you have expertise in different realms of sport science and performance exercise physiology, but we'll talk a little bit about, I think, touch on all of the things. Before we get there, why don't you tell our audience a little bit about what got you to where you are today and what interested you to get in this field? Yeah, and first of all, guys, thanks for having me on. And for the listeners, understand that all was one of my interns at Rutgers back in the day. So it is particularly awesome for me to see one of my former students go on and be doing big things, and it really is my honor to be on here and get to talk to you at this professional level to see the things that you guys have accomplished. So I couldn't ask for anything more as a professor, to see what you guys have accomplished and what you're continuing to do and educate. It warms my heart, but it's just cool to see. And I'm glad that you didn't hate me enough, that you didn't even want me on your show. So who knows, I'll get ambushed here at some point. So what got me here? So I was, I guess, sort of the way I look at it, I was a jock that happened to be good at science. Right? So that was really, sport for me was my world. From playing in college, for me, soccer has been very, very good to me. I want to be with the national staff for US soccer for the better part of 17 years. You know, working with the national teams, coaching development, the coaching schools and education process. So I did my master's, I undergraduate at University of Virginia, and then I did my master's in PhD at Arizona State in exercise science. And actually, when I finished up at Arizona State, the position I got was an assistant professor at Rutgers University. And so I was at Rutgers for 17 years, had the pleasure of going through the tenure process, promotion to full professor. And it was, you know, it was really a learning process and a great growth opportunity. And about six years ago now, six, yeah, I guess it was about six or seven years ago now, the opportunity to create the Center for Health and Human Performance there. And so that was a big turning point for us. You know, we partnered very closely with Quest Diagnostics to really start ratcheting up what we were doing in biochemistry and inter chronology and the biomarker work that we were able to take off with. But, you know, we had the pleasure working very closely with a couple of the athletic teams. They're most notably men's and women's soccer. And really those last five, six years there, the run we had with women's soccer was remarkable. And they were just such a great program to work with. And it was a real opportunity to take what we do as scientists and put it into a real world setting, right? Because a lot of the research that happens in optimizing athletic performance or overtraining and overreaching and something that is often done in a very contrived fashion in the lab, right? We bring somebody in for a few weeks, jack up their volume. Oh, does it suck? Like, how much do you break down? There is nothing like a high level athlete because you realize, you know, this was a top 10 team. And actually one of the years we worked with them was the first year they went to the final four. You know, so you're talking about an elite team. And we had them over entire seasons. So we had four or five months worth of data looking at training load, recovery, biomarkers, especially in female athletes. Do you know how rare that is? And so to understand that and the female physiology they went with it, but also see them succeed as our research progressed, and to be able to put it into practice for the following year or even in that year, I think was really one of the highlights of my career. So then in 2019, I was very, very fortunate to be offered the department chair position at the University of South Carolina. We are the top ranked program in the country. We have the top doctoral program. We are one of the top 13 sports science programs in the entire world. And we are the top sports science university in the United States. So for me, it was just an opportunity that I couldn't say no to, and it is such an incredible environment here. Once I got here, we created the U of SC Sports Science Lab, which we now have up and running. We're doing a lot of work with athletics here already. They are just an amazing group to work with. Talk about not territorial. They want to win. You got SEC athletes, you know, like, it's awesome. So we've got that going. My lab staff is absolutely first rate between my doctoral students, master students and my postdoc. But, you know, that kind of gets me to this point. And, you know, now we've got a grant with the Marine Corps. We're doing stuff with the Army. So now we're taking a lot of the human performance work that we've been doing on the athlete side and turning it to the tactical athlete. And looking at sort of national defense and readiness issues and stuff like that. So it's a nice transition, but it sort of fits right in with what we do. My background is under chronology. You know, so that's been the basis of much of what we do. And a lot of what my research revolves around is stress. So it's looking at the stress response. It's looking at buffering stress, optimizing stress without stress. We don't grow. Right. So it's how do we find that that that fine line between, you know, optimal training and overtraining in terms of pushing the boundaries. And I'm one of those people that, you know, we hear a lot about like minimal effective dose. But I've never really bought into that concept. Unless you also know maximal tolerable dose. Because if you're working in athletic population, you got to know where the breakout point is too and the breakdown point. Because if you just work with minimal effective dose, you're also going to get minimal effective metals. So you've got to know what boundaries you can push to optimize that performance world as we get through. But we've also worked with like adolescent cancer survivors. We've done some obesity work and performance to me transcends all of that. What's performance to an Olympic marathoner might not be the same thing that's performance to an elderly individual that needs to be able to function daily, but it's still performance to them. You know, and so those are the things that we really try to gravitate towards and keep in mind. Wow. You know, that is that is phenomenal. There's just so much you're doing your man of many hats. It seems like you're you're very passionate about what you're doing. I do have what I do. Go. You're wrong. I absolutely. I am blessed to do what I do. I really, you know, my preference would have been to be a pro athlete. There weren't as many opportunities. And I'm short. So, you know, pro level, you know, power wise and stuff, I was good. But, you know, for me to be able to still stay around this world and now to really be able to contribute on the military research side of group in the Marine Corps household. So to me, it's a it's an easy natural fit and something that I feel very good about. And honestly, that my lab is just super excited about like these kids are geeked to be able to get into this world. And as well as with some of the teams who are working with the South Carolina, it's remarkable. Hold on, Dr. I think you're selling yourself a little bit short because I'm pretty sure you were division one college football player. Am I am I right? Talker. Yeah. So. Talker. She's okay. They're national titles at Virginia while I was there. So that's right. That's right. Okay. It's funny. You know, there is. So sometimes with some of the themes I've worked with, I've got a PhD. I was 2017 sports scientist of the year. I'm a department. They are typically far more impressed by national titles and playing at a top school than they are with any of that. So I just roll. Okay. There you go. And it's all good. So yeah, it's pretty funny. You know, and that's what's interesting, right? You kind of touched on this this idea of minimal effective dose and maximum tolerable dose, right? I think that, you know, probably a few years back, maybe not even a few years back. Over the last couple of decades, there's this idea that if some is good, more is better, right? So. And then, and then now, as of late, people are understanding, okay, that's not what it's about. Maybe it's more about minimal effective dose. And then there's this pendulum. And Darshan, I always talk about this pendulum that swings back and forth. And what you're trying to see is you've got to know what the extremes are. And then we try to find in sweet spot for every single person. We try to individualize it. And yeah, this is this was a struggle that we had. And you know, because we could go so many ways, but one thing I don't know if you mentioned, and now you were also the president of the International Sports Society of Nutrition. Yeah, right? So yeah, obviously you were extremely well versed in that. And you know, again, this is something a new project that we've started when we look at medicine, one of the foundational components is nutrition. So I think that probably that's where we want to start today. And when I look at nutrition, when I'm giving counseling, and you know, in my fitness background, people come to me about what's important. There's three components we look into it, right? We look at quality, quality, and timing. I think that everybody can agree that quality is definitely the most important one. And then the latter two or something that, you know, maybe the 20% of effort should be going in there. Yet the question that I most often get from my family equals friends is about nutrient timing. Sure. I know you've been on a couple of position papers by the ISSN about this. So you've written well about this. So I think that that's probably where that we should start with. What do you think? Yeah. Yeah. Let's let's go. Let's delve into that because I'll tell you, even from personal experience, you know, I got into lifting probably around like 18 years old, right? So about about 10 years of experience now that I have. And I would go through, okay, it's pre-worked out. I got to get a meal post-worked out that antibiotic window that we always hear about 30 minutes. I got to get home and get that protein shake in. But then some research came out and I said, okay, maybe I should work out fasted. And then should I wait to eat a maybe an hour or two like growth hormone or, you know, some other biomarkers kind of creep up so that I can optimize. So what is the current research telling us? What have you found? So great questions. And there's a lot we can talk about here. One thing, let me start off with this though, all to come back to something you said that that quality pretty much supersedes everything. I will say this though, with enough quantity of even subpar nutrients, you can still meet your needs, right? So there's quality and quantity going ahead. Because like for example, I could eat all way protein, right? Ice away, right? But if I only like 40 grams of it today, I'm not getting anywhere. So the quality and quantity go hand in hand. And what I would argue and to kind of set the stage, I usually kind of end with this when we talk about this stuff. But I think it's appropriate to address it up front. Think about like baking a cake, okay? If the quantity and the quality are the foundation of the cake, the timing becomes the icing, all right? So you don't start with the icing, even if it's the tasty part, you know, especially on carrot cake. But you know, when you start to put these things together, you've got to bake the cake first, then you put the icing on. So I can time that crap out of whatever I want to. But if I don't eat enough of it, it's not going to do me any good, right? So I think that that timing aspect becomes important when you take care of the other stuff. And so to me, I think that this has unfortunately, especially like the fitness and bodybuilding world, almost been treated as like an either or, you know, is quantity important or is timing important. And I look at it as quantity is important and timing is important, you know? So it doesn't have to be mutually exclusive, but you do have to take care of the big movers first, you know? And I think that, you know, whether I'm working with an athlete, whether working with tactical operators, whether we're working with general population, pick the low hanging fruit, right? Go after the big movers first, the things that will make the biggest bang for the buck, the biggest dent in whatever you're trying to do, then you can fill in around it. But here's the thing, like if you take, if you take somebody like Darce, you said, you know, you start working out at like 18, right? So if I take somebody who's never really lifted before, man, I could time the crap out of their protein intake post workout, the big needle mover there is the workout. That's the stimulus. You know, you could do damn near anything to them and make some progress because it's a novel stimulus. So the timing aspect starts to become a bit more critical or maybe impactful when you start to get a little farther down the road, right? And you're looking for that one, two, three percent difference. But that being said, there's even some data on on on protein pacing in terms of how you feed throughout the day that becomes important. So I think that one of the most important aspects of nutrient timing is understanding what it encompasses. And I think that when the whole field started, it was a bit of that that anabolic window idea, right? And so it's this notion that and it was, it was honestly, it was very good work by John Ivy, you know, back in the 80s and 90s where they were looking at this effect. And so we all said, oh my god, we got to eat right after we work out. That's the key. And they're not wrong. It's just that what we've come to understand is that window is more like a garage door, right? It's a lot bigger than we thought. So it's not like after a half hour, oh crap, they're going all my games, right? Like that's not the way it works. But unfortunately, some have treated it like, well, then I don't need to eat right after because I've got all this time. I looked at it very different way from a pragmatic standpoint. And especially if I'm working with an athlete, I'm going to use that garage door to fit as many meals in there as I can. In other words, instead of waiting, why not take advantage of the fact that you have anabolic up regulation for an extended period to metabolize more of those foods that you're trying to take into the body, right? So in other words, your repair window just got that much better. So rather than they going, I don't need eat, it's like, hey, why not, though? And especially, you know, if you're working with somebody who trains multiple times a day, where we saw this in particular, here's a really good example. If you work with anybody that does MMA, right? If you're working with any kind of fighter because they don't typically just have one training session a day because they train in multiple disciplines and multiple skill sessions throughout the day. If I don't eat right after one of those, I'm going to suffer later. You know, and I think that's where the timing aspect becomes important. And the other thing too is there's some really cool research that's come out within the last year that's actually shown that skipping breakfast impacts performance later in the day. So you're talking like afternoon evening, you even after they fed the same number of calories. So if you still eat the same amount as if you would have had breakfast, but you account for it throughout the rest of the day, skipping breakfast has a negative impact on performance later because of the way our bodies adjust to this and because of circadian rhythms and the overall impacts. And so, you know, when we start to look at it, you know, it really becomes a much more holistic thing. So what I've come to appreciate more than anything else is timing is not just post workout. Timing is also pre workout and timing is also during the workout and timing is also before sleep and timing is also when you wake up. So in other words, timing extends itself throughout the day. What we can probably do is just maybe identify where those few real sweet spots are to make the biggest impact with it, but really it's a daily process to be able to do this. So once you account for total protein intake, for example, how it's used throughout the rest day and how you feed that throughout the day becomes a little bit more important. And I think the other thing that we do have to understand here is there's been quite a bit of work that's really protein timing that's been confused with nutrient timing. Melrose protein is a nutrient, but it's not all of them. So when we look at carbohydrate and fat and health, even some supplements, when you look at timing of creatin and things like that, caffeine, right? Those are timing issues as well. So nutrients extend beyond just one particular macro nutrient. Yeah, Dr. Art, I love that. So I mean, to me, obviously what you're saying is context matters, right? Are you talking about a teenager who's never actually exercised before versus an elite athlete at the Olympic level, maybe at the national, you know, just some of the suckers or cyclists that you've worked with, you know, you're going to try to go for those big movers again, but I definitely want to talk a little bit later about the circadian rhythms and skipping breakfast and performance later on, but you mentioned the anabolic window post training, right? We know that obviously cortisol is going to be mobilized, so you can mobilize energy cortisol is going to spike through the workout, but at the same time, you want that to be suppressed as soon as possible afterwards, so you can get into that anabolic window. I'm sure the work, the type of training you do matters, right? Whether you're going 405 for 10 versus just an endurance exercise, how long do you think that anabolic window is technically the or the garage door, we should say? And then is it because of up regulation of growth hormone insulin? What is it? So insulin is going to play a role in terms of the impact of carbohydrate, didn't take at that point, right? Because what's going to happen? And I would probably argue it may be a little less about insulin and more about glute four, right? So a glute four translocation occurs with physical activity, so what's happening is in some ways you've primed your body for glucose uptake to convert to glycogen recynthesis when you're done because of glute four, but at the same time, you get a nice double whammy here because if you eat carbohydrate after, you also increase insulin, which further increases glute four. So now you've shortened that time frame for the need to replenish glycogen. Now I will say this for most people, like so if we take a weight training workout, it's not glycogen depleting, maybe 50% depletion. On the other hand, if I take a soccer match, there was work done by Benxal team back in the 70s where they showed as much as 95 to 98% glycogen depletion in a soccer match, okay? Now the reason that becomes important is for somebody with weight training, I'm not going to sit here and say, if you don't eat carbohydrate right after, you are completely screwing yourself. Now honestly, if you eat enough carbohydrate throughout the rest of the day, within 24 hours, you'll be replenished, all right? It's not particularly hard, but does that mean that it doesn't make sense to eat it right after? No, in that case, why not? Like, you know, if you're here's here's something that we can kind of consider going through if it helps or doesn't hurt, do it. You know, so it's like, I've never understood the resistance to some of this, but in terms of, you know, Dars, you had mentioned and then you just brought it back up the growth hormone idea, right? So, hey, so don't eat right away, you know, with growth hormone increase, we'll food suppress it. Guys, here's the deal, that acute growth hormone response is fairly useless. In other words, it's going to be the pulsatile nature of growth hormone and the signaling that occurs. Otherwise, your primary impetus for hypertrophy and muscle remodeling is really going to be m-tore activation, right? So, you're getting that through the loading. Growth hormone can play a role in this, but growth hormone kind of throughout the day is going to be more important. And here's the thing, if you're in a depleted state, you can't be anabolic. I don't care what the growth hormone level is, you've not created an environment to repair and recent the size muscle, right? So, if that's your ultimate goal, that's important. And the other thing too is, you know, we also probably have to understand the difference between adaptation and optimization. So, if I'm competing in a match, we want optimization, right? We want me to be at my best, optimally fueled, ready to go. Adaptation can be uncomfortable at times, right? So, there may be a time where I train in a carb depleted state. Your system gets used to that. We get mitochondrial biogenesis. That can potentially help as well, right? Doesn't mean I want to do it every day. It doesn't want to mean I want to train in an impaired state on a regular basis, but at the same time, discomfort, again, kind of back to that whole stress idea, right? Like, how do I manage it? That can be useful in the training process. Ice baths are a perfect example of this, okay? So, from an acute standpoint, if I'm in a tournament or I'm in a hot, hot climate, we know that ice baths can reduce feelings of soreness. They can help with readiness to return to play. However, there's research that shows that ice baths will also decrease adaptation and will actually impair muscle hypertrophy. So, it depends on whether you're playing the short game or the long game. Are you just trying to get ready for the next practice or are you trying to get ready for the season, right? And that's ultimately where your decisions about what you do after and the recovery modalities that you typically use start to become really important in how we consider this. But at the end of the day, that replenishment post exercise, there's really no advantage to delaying it. The only advantage to delaying it is with some of the work that James E. Morton and his group have done looking at carbostricted training, they've done it mostly in cyclists. And what they found is that so what they would do is they would do like two sessions in one day and then after the evening session, especially a high intensity session, they wouldn't replenish carbohydrate, then they would have them do like a steady state training session the next morning. But here's where people confuse that with fasted cardio is with the studies where they actually showed a performance improvement doing that. They still fed them protein in the morning, right? Because now you're preventing that muscle breakdown to provide the raw materials in order for these other fueling sources to be able to be available. And then what they would do after that morning session is then they would refeed carbohydrate, right? And what they found is an up regulation in mitochondria, some modest performance improvements. So there's a time place, but even that wasn't done every day. That was like two or three days a week. And so that somehow much like the whole, you don't have to protein right after a workout turned into doni protein right after a workout. Same thing with carbohydrate-stricted training turned into fasted cardio. And there's no evidence for that. So the timing aspect in that window I think are something that we can look at. But you know, how long is that window? I'd probably say a few hours. We could probably argue up to eight hours easily that you could see an up regulation in anabolic capacity because of that resistance training worked out. That doesn't mean you want to wait eight hours to eat. It just means that now within that eight hours you've got some opportunities to refeed, promote recynthesis and actually get the most adaptation possible in that case. Yeah, no, thank you for that. That was a great explanation. It's been 20 minutes and I'm already I'm I'm learning my head off here. Can you can you really quickly just for like the lay people out there who might be listening to this or even some medical students? Can you just quickly explain like basic biochemistry of insulin, glute four, how it just kind of works? All right, so so glute four or group, glute four, transporters in particular are an insulin dependent transporter with one exception. They also translocate to the cell surface with physical activity, right? So with muscle mobilization. What glute four is responsible for is basically for lack of a better way of putting it, pulling glucose into the muscle. Okay, we also have glute two, three and five that operate throughout different organs as well as the brain. The nice thing with the brain one, it's a non insulin dependent transporter. You definitely don't want that to be reliant on insulin, but at the muscular level, it's insulin dependent with the exception of physical activity. So what happens is we have our circulating blood glucose, right? Your blood sugar. And ideally, we're going to be able to use that as a fuel. We can transport that into the muscle cell, otherwise it can go through actually triglyceride recynthesis fairly easily as well if you're not using it for that. So what's going to happen is when activity starts, the higher the intensity of the activity, the more we rely on endogenous carbohydrate sources, in other words, glycogen, what's stored in the muscle because of blood flow changes, because of changes in transport capabilities, and because of changes in bioenergetics, using glucose for fuel becomes a lot harder to do. So we're really relying on glycogen. So moral of the story is make sure you're topped off before you start. If you start in a glycogen, depleted state, you're already pretty screwed. So what happens then is throughout this and through low to moderate intensity exercise, we can bring this glucose into the muscle cell, show it through glycolysis, and then on through oxidative phosphorylation if we're doing a aerobic exercise. So it depends on what we need it for and what fuel source is going to be our primary, the higher the intensity, the more carbohydrate we need for fuel, and the more that's going to be glycogen rather than just glucose. What happens is once activity is done, and the muscle is going feed me, right? Like I used up my carbohydrate source, I used up my glycogen feed me. So what happens is that glute four can basically help bring that glucose into the cell and store it as glycogen because now we're not in breakdown mode, we're in repair mode. Now glycogen synthase is more active so we can keep that in place. Now we can keep the glycogen where it needs to be. We'll bring water in with that as well. It's also one of the reasons why creatin, ingestion, post workout may be a little bit better than pre workout because you're actually taking advantage of it coming in with the carbohydrate as well. It's kind of pulling everything in in order to feed the muscle. The other thing we have going on at this time though is and throughout the training period is lactate is also being converted as a fuel source. Lactate is an excellent fuel source. It's so often gets confused as a way product. And by the way, people please stop talking about lactic acid. It's gone. It turns over really, really quickly. That's not why you get a burn during your workout. Unless they have significant kidney abnormalities or some type of muscle disease. But that's a different story. So what we're talking about is another wise healthy individual. And so once you start changing kidney dynamics, you've changed all kinds of parameters in the first place, right? And so what we're looking at is clearance capabilities and stuff like that. But I will say it's interesting you bring up the kidney point. It's kind of well, I don't want to say it's kind of cool because like in stage renal disease sucks. That's not what I mean by this. But even now with what we know about protein, we're realizing that even some of the myths and misconceptions about high protein as hard on the kidneys really is not bearing out. Like if you look at a preponderance of the research, it does not support that. But in a kidney patient, if you do have kidney disease, you do need to pay attention to what your protein intake is. But even then, it doesn't look like it needs to be as low as it was originally thought. Because realize too that if you're not feeding the muscle, you're also now further losing function when you're talking about physiological adaptation. So that's a concern that we have to be aware of as well. And especially if we want somebody and we do to maintain an active lifestyle through this process. But anyway, so when we're looking at this overall in terms of the bioenergetic pathways and how we're going to use that carbohydrate, that probably darts that in a nutshell is kind of my overly simplified version of glute 4 processing, the role that insulin plays. By the way, it was a super anabolic hormone and it's a whole job of storage. You could probably argue it's our most anabolic hormone. IGF1's right up there too. But it's good at storage. I mean, it really is. That's a whole job. And the way I teach exercise into chronology, we can probably wrap it up with the following. When you exercise, all your hormones go up, except for insulin, which goes down done, right? So the very dumbed down version of endocrinology. There's a cliff notes right there. Yeah, exactly. For all those things, we're pretty good. And the higher the intensity, the more the others go up and the more insulin comes down. So that's kind of the overall process that we'd be looking at there. Okay, so I want to ask about glycogen because you mentioned being preloaded before going to a workout. I've heard people say, oh, I want to work out fasted because once my glycogen's depleted, I tap into my fat reserves and now I can lose weight or I lose fat. How does that play a role until this? So I think the first most important thing is just because you're using fat for fuel doesn't mean you're losing fat, right? So at the end of the day, it comes into caloric deficit. And actually, real quick segue because I think this is important too. Calories in calories out is a real thing, right? Thermodynamics. However, where I think we've missed the boat and where people have a misconception of this, it's not necessarily calories in in terms of what you eat, calories out in terms of expenditure. It's calories in in terms of what you absorb and then calories out, right? Because there's a whole part of the digestive process. There's two studies that I think are really cool. The peanut butter sandwich study and the cheese sandwich study. So the peanut butter sandwich study, what they did is they fed whole peanuts, peanut powder or peanut butter. And what they found is that the metabolizable energy was less with the whole peanuts. In other words, it cost you some energy to metabolize that. So the more you process and pound down and change a food source, the more you absorb it, right? So now there's more calories absorbed, less fat and digestion. The other one was the cheese sandwich studies, right? So the cheese sandwich study, what they did is they either used all like whole unprocessed cheese and unprocessed bread. And by the way, these are all calorie matched or highly processed white bread with like American cheese, right? Highly processed cheese. And the processed sandwich did not cost you as many calories to to absorb, right? So in other words, you kept more the calories from the processed sandwich than you did the whole food sandwich. So again, same calories and it's not people will use this to say, oh, see, it's not calories in calories out. That doesn't make sense. And it's like, no, it does. We're just looking at the wrong intake. We need to look at what happens at the level of the gut, not just at the level of the mouth, because it's that metabolizable energy that starts to make the difference in terms of how we account for this. So actually, in many ways, all that's back to your point about quality being so important. There you go. That's part of the reason why, right? Because even fiber is going to change metabolizable energy when you take it as a whole food source, along with other things. So back to the glycogen question in terms of the load in fast. So here's the thing, just because you are in fat burning mode, really doesn't mean you're going to lose any more weight. As a matter of fact, none of the research supports that. Just it's not the way it works. You know, with high intensity work, where it's mostly carbohydrates being used, guess what? Still lose weight. And so the question comes from where the stores come from, the catch is if you think about fueling for the work necessary, the higher the intensity, the more it relies on carbohydrates. So here's the deal for you to exist in a fat burning state, right? Where you're mostly using fat for fuels, I percentage, your intensity has to be much lower by default. You can't use glycolysis for that. That's not how fat goes into that. It's not converted readily for that purpose. You've got to be relying on oxidative phosphorylation. And oh, by the way, to some degree, when you look at the overall, especially with the TCA cycle, realize that oxaloacetate is a carbohydrate derived intermediate. So for that all to actually work to burn more fat if that's your intake source or your input source, you actually still can utilize carbohydrate to help that process. So it's definitely one of those things that I think we've gotten too caught up in what's the fuel you're burning and that equals what you're losing. It still comes down to energy balance to a great degree. And so yeah, I get the whole, I'm not going to eat before because then I tap into more fat burning. But yeah, but your workout can't be as high intensity. And honestly, there's not a big advantage. If that's your preference, in other words, if you just don't feel good on a fuller stomach or if you eat something before, okay, I can kind of understand that but don't for a minute think that it's helping your necessarily weight loss goals. That's not really what it's doing. It's more of a preference at that point. But, you know, by and large, hey, at the very least, if somebody's going to do that, at the very least, eat protein beforehand because at least it helps spare muscle. And it's not going to impair your fat burning capability, if that's really what you're gearing towards. But those would be the things that I would probably focus on at that point. Yeah, I love that, Dr. Aaron. And I think that, you know, obviously, when you talk about nutrition science, it tends to be a very polarizing topic, right? And part of it, I mean, more so than almost anything else. And part of it is all these fat diets and whatnot. I remember us, maybe what a decade ago when we were in exercise physiology class talking about how Atkins diet, maybe 20, 25 hours of super popular. And now then it became keto. And I've been listened to more and more about, you know, athletes, elite athletes talking about being fat adapted after being in keto for a while. You know, most recently, I was listening to the ReadyState, and I think Mark Sisson was on there from Mark Staley Apple. You probably know him. He was talking about metabolic switching and stuff. And as of late, you know, at least in the fitness industry, maybe I want to say eight to 10 years ago, intermittent fasting and time restricted eating were a big thing. And finally, I think that whether fortunately, unfortunately, the medical literature is kind of catching up to it, although it's still pretty young in terms of, you know, its effects on weight loss and cardio, cardiovascular disease and those types of things. And then obviously lean body mass stuff. But I wanted to kind of get your thoughts on this idea of fat adaptation and then metabolic switching. So you're going to burn primarily what you eat. Okay. So if you eat a high fat diet, your primary output source for fuel is going to be fat. Here's the catch though. Is that a good thing or a bad thing, right? So if you're fat adapted, so what it comes down to is the kind of work you want to try to do. There is, let me put it this way, there is not a single study. That has shown a ketogenic diet to be better for performance than even a moderate carbohydrate. And so let me back up for one second just because your anti keto for athletes does not mean your pro high carb. All right. I am a big fan of carbohydrate periodization. It depends on what you're fueling for. It doesn't mean you just sit around and eat twinkies all day. That's not the point, right? It's not the pop part diet versus the avocado diet. That's not the way it works. And so the fat adaptation, here's the thing, you know, maybe this is a really good example for where quote unquote fat adaptation is not always ideal. So the concept of the ketogenic diet in the military has been popular lately in terms of how they can use it because they see weight loss and even even in the military obesity is a big problem. So they've been talking about this and the fact that they've seen that divers can stay down longer on a ketogenic diet because of what happens with ketones for brain fuel and yada yada yada. So they've talked about, hey, maybe with special forces, if we've got them out in the field and we fuel them ketogenically, like we put them on a ketogenic diet, their fuel, like what they have to carry with them isn't as heavy, right? That's lighter when you consider like per gram, when you're thinking about energy. Here's the problem. All right, I was on a panel a few years ago with with so calm and one of the master chiefs from the seals had made the comment when the dietitians were saying, what can we do to help you? Like what do you need? And he goes, picture the most austere environment possible where what we need help with is learning how to properly butcher and cook a goat that we have to buy from a local village because we're out on mission and we will make mission and then always stuck with me because here's a thing ketogenic diet only works for that fat adaptation as long as you stay ketogenic. So what do you do when you're in the field and you need to eat whatever you need your hands on? Right now you're kicked out of ketosis. Oh crap. The other thing too is I always find it funny from a ketogenic proponents standpoint that no study is long enough. That's the problem, right? Oh keto adaptation takes four months and you only did three months and three weeks. So then somebody does four months. No, it's more like four months and one week. So I'm kind of convinced that if you're pro keto, the study needs to be n plus one of whatever the longest ketogenic study has been. Luis Burke over in Australia has done an amazing work with the supernova studies. They used Olympic racewalkers, aerobic sport, truly high level. These are Olympic caliber people and performance was decreased on a ketogenic diet. It's that simple. All right. And I guess the way I look at it too is if keto adaptation takes, you know, let's say four months. Let's be nice. We'll go for months. Even though even in Luisa's stuff, they've shown it takes about a week to two weeks. All right. But let's let them get benefit. That's four months. If I'm working with a protein and let's use hockey as an example from when I worked with the devils. All right. Let's say they make the Stanley Cup. They're playing into June. They're reporting back in late August early September for camp July, August, September, maybe not even three months. So what I'm going to do is I'm going to shift somebody's diet that's going to cost me performance during those three months of offseason in order to put them on something that's never been found to be better than the diet they were on. That just doesn't make sense. The other thing too is if you want anything metabolic flexibility, the ability to utilize whatever fuels are really. You know how you do that? You eat a multiple nutrient diet, right? Your body gets used to using these things because you perform under these different environments and demands. And it's funny because even some diets are promoted for the metabolic flexibility. What are hey, I hate to like burst everybody's bubble. But everybody must have missed one really basic physiological fact. The human body was designed to be metabolically flexible, right? We can use proteins and fats and carbohydrates. So unless there's a like a fourth macronutrient that I'm unaware of, I might argue for bourbon or maybe coffee. We might be able to throw five in there, actually, right? Bourbon and coffee. I want to argue for coffee, definitely. Yeah. I got you in the bourbon. Yeah. Okay. Okay. So we've got five macronutrients. We should probably put water in their thumb. We're just, you know, yes, yes. Overall, when we look at it from that standpoint, the flexibility pattern is, you know, here's the problem is, so we've got, I've actually done a talk on the paleo keto vegan macro fasting diet, right? So it's like you take all of the fat diets you put in. So do they work? So that's one big question, right? So one of the things we have to sort of decipher when we start talking about this kind of stuff is the difference between can we and should we? Can we lose weight on these diets? The answer is yes. And it is almost always for the exact same reason because you reduce energy intake. That is plain and simple. Intermittent fasting turns out you never fully compensate when you have that non-eating window, even if you're at liberty to eat those other eight hours, you never fully make it up. And then intermittent fasting gets fun because there's all kinds of versions of it, right? There's the five, two, there's the 16, eight, like, blah, blah, like, take your pick, right? So it's like, which one are you talking about? So that becomes part of the problem. Ketogenic diet, usually because of satiety, you wind up not eating as much. There's nothing magic about it. It's not like there's like calorie fairies that suddenly don't count because it's it's fat. It doesn't work that way. You know, when you look at the paleo diet, it's funny. It's based on this assumption that that our ancestors didn't have modern diseases. They were hunter gathers, hey, guess what? They didn't live long enough to have heart disease and cancer. They were dead by 30 because that ate my saber tooth tiger, right? So, and the thing is, guess what? They hunted for all their own food. They gathered it. So as you drove down to the supermarket to go get your ground beef, your grass fed ground beef, and everything else like you didn't go hunter gather. You went and bought, right? So there's all these other factors that we miss. And oh, by the way, when we talk about what our ancestors ate, hey, hate to break it to you. It depended on what part of the world they were in. We're now finding that actually in the Middle East, they ate grains. And do you think for a minute, if you would have offered Captain caveman a loaf of bread, he would have turned his nose up at it because he was like, no, that's going to kill me. No, it'd be like, I don't have to go find food today. This is amazing, right? So we adapt to what's available. And so even from a vegan and vegetarian standpoint, there are some advantages with BMI and certain blood markers. But more than anything, the strongest argument for those diets is really more ethical. If somebody has a problem with eating animal protein, that's fine. Just be up front about it. But in terms of demonizing it or, you know, we know that the plant-based proteins overall are not as good, right? They're not complete. But can you make a diet out of it? Absolutely, but you better know what you're doing. And you typically need to eat a little more protein, probably about 20% more to account for the differences in absorption, too, because the amount of fiber in the diet and the amount of carbohydrate. So for some people, they actually may have a little bit of difficulty losing weight on those diets because of potentially the extra calories they eat to get enough protein in because of what they're eating for carbohydrate. Again, not to demonize any of them, but I think your point all in terms of how polarizing it is, I look at it this way. To me, there are three things that are some of the most polarizing factors in human society. Religion, politics, nutrition. Can you think of people identified themselves as Democrat, Republican, independent? Then we got on the, you know, the religion side, you've got Catholic, Jewish, Baptist, you know, Buddhist, whatever you want to do. And then we have, what else can you think of where people literally identify themselves by saying, I'm keto. I'm paleo. I'm vegan. Like, they literally, their self identity is tied into the diet. So here's what I did. My wife and I actually came up with a diet since people like names, right? And instead of if it fits your macros, paleo, keto, any of those, it's helpful. Let's try this one, right? Because people really like names. If it fits your lifestyle. In other words, eat mostly whole foods. Enjoy your life. Don't diet away your time with people. Eat things in moderation. Start with protein. Fill in around it depending on your energetic demands. Train hard and enjoy it, right? If it fits your lifestyle, it depends on what you're trying to accomplish and you're fueling for the work necessary. You know, but if you start with some basic principles, I know it's not sexy. And people are like, oh, that can't work because that's just too, you know, common sense. That's exactly what it is. And unfortunately, we over complicated it for the sake of sales and fads and something being catchy and all this stuff. And at the end of the day, it really comes down to the same basic principles. Eat high quality foods. You can, by the way, the other thing that I hate is when people talk about, oh, you know, you cheat day and that's not, no, it makes it something you're doing something wrong. If there's something you want to eat and you enjoy it in moderation, freaking eat it. You're not cheating on your diet. And also, you don't have to eat clean. Like, what does that mean? You wash your hands before a meal, which by the way, you're in trouble, if you're a good idea. But, you know, by and large, it's like eat mostly whole foods. Supplements have a place because honestly, if you're looking for more rapid, um, mTOR activation post workout, protein powders are going to be better than eating a steak. It just gets into the system faster. That's the reality. So, you know, again, it's, it's time and place. And I think you use the word that I think is the single most important one when we talk about all the stuff, which is context. Right? And I, I don't want to use it as a cop out where with everything we say it goes, well, it depends. But it kind of does. But at the same time, we can also come up with some sort of broad sweeping positive statements that can apply across a huge range. But again, context dependent. What are you trying to accomplish? What do you have access to? What are you reasonably willing to do? And what are your priorities? Right? So, if we identify those things, then we can start to make some reasonable recommendations that fit, and again, if it fits your lifestyle. Right? If you tell me it's like somebody coming in and saying, Hey, man, I, you know, I want to work out, give me a program. I want to work out five days a week. You go, Okay, well, how many days are you working out? Now, none. Like, I really want to do this though. Okay. How many days do you really want to work out? What do you mean five? No, no, no, like really? Well, I know I can do three. Okay. So my three day a week program is going to look different than my five day a week program. So let's start with what you're actually going to do. Then we can progress from there. So I think having some realistic expectations is also important in this as well. Yeah, that's some some really amazing stuff. And, you know, I for, for everybody listening to this, I really want you to stop rewind for the last 10, 15 minutes and kind of listen to that again, because I think that that's some of the most sound advice that people often don't get or they don't understand. I mean, but just to summarize, and I think it bears repeating is, you know, all of these approaches tend to work. And what we look for is common themes between different different diets and different philosophies and camps and whatnot. And we try to say, okay, what are the foundations between them? And this is why I really love the folks that precision nutrition with John Barardi. I respect him so much because they've really got this figured out. Darshan, I was talking to you. He uses this example. He's like, you know, when somebody is going left for and it's working for them to get there, then they want everybody to go left with them and they forget what it's like to go right, right? And so that's so important. And then to your point about the research, again, there's tons of confounding variables when you're looking at these different diets and, you know, and a lot of times they don't go for long enough. And so many different things with nutrition, when we're looking at long term health, when we're looking at longevity, some of these things, the nutritional interventions you're making today, you might see dividends of that 30 years down the road. And studies don't usually go for that long. And this is why I wanted to do this. It's hard. Yeah. You know, a 16 week study is hard, right? Because of that. And actually, that brings us to probably one of the most important parts when it comes to diet. Here's a secret for all your listeners. I'm going to tell you what the best diet is. The best diet is the one you'll do. Yep. And that's the reality. Same thing with the workout. What's the best workout? The one you'll do. And when we, when we start thinking about some of these fat diets, to me, one of the biggest problems with them is sustainability. Can you stick with, so for example, if you're on a paleolithic diet, and by the way, the foundational concept of a paleolithic diet, let's throw the name out because really most of what they emphasize are whole foods, right? You're like, hey, you've eliminated half the crap in your diet. No wonder you lost weight, right? And no wonder you feel better. Like, it's a no brainer. So we don't have to have a name for that. It still fits into if it fits your lifestyle, right? So when we look at that and we think about how that all ties together, if you, if you're only used to eating grass-fed venison and organic this and organic that, and then you want to go out to eat with some friends, there's a lot of restaurants where you're not finding that on the menu. Now what do you do? You just not eat, right? And so it's one of those things where again, common sense goes a long way. You want to talk about metabolic flexibility. How about some attitude flexibility as well in terms of being able to do things, you know? And so that's where I think that you can still find quality food, even if it's not what was, and this is also one of the reasons why I honestly hate meal plans, right? So many people write meal plans. You don't teach anybody how to eat that way. And I've actually had athletes that have told me that they were working with a dietitian who gave them a meal plan. And then they go, but then I got to the dining hall and like, I couldn't find this food. So I didn't know what to do. No, I'm not a fan of meal planning, but I am a fan of planning meals, right? In other words, learning what to look for to fill your plate. And so now you got plenty of options. And most people would be amazed. We think, you know, athletes, they're super motivated and all this stuff. Having worked with college athletes for as long as I have, most people would probably be amazed at how many of them, even as seniors, don't know the difference between a carbifat and a protein. They don't. And it's not their fault, you know, you know, whatever was or wasn't taught in high school or the other classes they've taken. So a lot of our, you know, sport nutrition that we deal with upfront is just nutrition, right? You can't get to the sport part before they even know what and the hell you're talking about in terms of what you're trying to have them eat and why. So but a lot of it's just education upfront. And this applies to general population. Do I, you know, I hate the fact that there is so much conflicting information out there. And on, you know, social media and the internet are both a blessing and a curse, right? Because information is readily available, but unfortunately, a lot of very unqualified people have plenty of access to putting that information up. And if it sounds good enough and it's specific enough, my wife always says, the more specific it is, the more likely somebody is to think it's going to work. So if you say, if you only eat purple foods on the third Tuesday of every month, you're going to lose weight. People are going to go, damn, that sounds like you can work. I believe it. That is specific. Like that must work. And so, you know, that, I think that's the challenge. And when you have like Super Bowl winning quarterbacks that put diet books out because they want to Super Bowl, you know, these are the five different things that we deal with. By the way, now that you're in Baltimore, are you a Ravens fan yet? No. Oh, come on. I mean, to be fair, I don't have allegiance to any specific team, I'm one of those. I'm kind of rude for players. To your point, I mean, simple is not sexy. That's what it is. That's it. So nobody wants that. But again, I love having this conversation with you because again, when people are talking about research and me being an academic and same thing with Darshan, we're looking at the science. Again, you can find research to support whatever your hypothesis is probably in one way or another because again, this goes back to the idea that, hey, all of them work, you know, again, in the right context. And you're producing most of that research. But I want to shift gears. And I definitely do want to talk about a little bit about intermittent fasting, super popular. I've been getting so many questions from family members. And I think it's making a lot of buzz, particularly with our generation on millennials. Hey, skipping breakfast is super easy. I'm sure athletes are doing this. You're seeing this. And then we're talking about that metabolic flexibility component of it as well. So I'd like to hear your thoughts on in terms of one for performance and your high performance individual. But then also, you know, what we're interested in is we're looking at this longevity. So, you know, we're talking it's effects on hypertension, you know, cardiovascular benefits, lipids, and you know, there's stuff on that as well. So where are you on this? And are you doing any research in this regard? No, but you know who is actually Grant Tinsley. He's done a lot of good work in this area as well. There's some stuff going on in Europe with some Spanish researchers that I think is very good. But Grant's done some cool stuff in theory. The problem is a bulk of it is not very long, like you had said, in terms of the dietary duration, you know. And so the end of the day, most of it appears to be simply because people have cut calories. You're not eating as much. You never make up for that difference. Where intermittent fasting is useful is for people that don't want to have to think about how to restrict. But what was interesting is there's also been studies that have shown that metabolic down regulation in terms of metabolism as well as weight maintenance is actually worse on intermittent fasting than it is on sort of continuous chloric restriction, where you just sort of make a deficit every day versus just doing it over certain times. The other thing I would say about intermittent fasting is most people do it as backwards. And I cannot figure out why this has been the case and why it's breakfast that has to be skipped. And I blamed Dr. Oz to a great degree where he's demonized breakfast, which is the dumbest demonized common breakfast foods. Sure. Breakfast though? No. Why does breakfast have to be French toast and pancakes and just super high carb stuff? You know, breakfast could also be a chicken breast and vegetables and whatever. So here's the deal. When you look at it though, with most of the work that's been done, you're actually better off if you're going to do time restricted feeding, have early time restricted feeding. In other words, eat breakfast, eat earlier, cut off the meals earlier in the day. Everybody does it backwards where they just skip breakfast. They'll drink some coffee or whatever. And then they go on, we know from a performance aspect, that's not ideal. All right. There's been plenty to show that now. And one of the more recent studies is really well done in that respect. And so it that, you know, and one of the most common protocols is the 8-16, right? So as you eat for hours, you fast for 16. Mine's more like a 16-8. Like I do intermittent fasting. I don't eat well on the sleep. So yeah. Oh, you know, I'm kind of in that ballpoint. But to your point about, you know, why people are doing it, I mean, I think it's just in terms of feasibility and you know, clinically applying it to daily lifestyle. Yeah, people mostly, if you're going to stop eating at 8 p.m. at night and you're waking up at 7 in the morning, you've already fasted for 11 hours, extended for another five, right? So it's a simple, so it's funny, right? Because it's actually, I think the reason it's been popular is because it's not cognitively difficult to do, right? It's math. It's like starting here. I could eat, starting here. I can't. Okay. Cool. Like don't have to think a lot of between. And then in between, I can eat whatever I want. I'd probably argue that quality still matters in that period of time. But at the end of the day, they just never fully make up that deficit. So yeah, you're going to lose weight potentially and whatnot. But here's the thing. The reason most people really have bought into it though is because as the promises, it doesn't deliver on. It uses a lot of buzzwords and it uses a lot of babies in terms of all this stuff that it can magically do. So intermittent fasting is a perfect example of something in terms of the way it's marketed, not to say in terms of the way it works. That's not fair. The way it's marketed is it's sciencey rather than science, right? So science is based in data. Science is based in in a structure of proving and disproving hypotheses, right? In terms of the way we do this. Sciencey is like science with fairy dust sprinkled on it, where it sounds really good, but it's missing something, right? In other words, it doesn't translate and there's like a magical quality to it. Somehow, some way this just works. And that's unfortunately what a lot of people are faced with with some of the nutritional guidance out there is that it's more sciencey than it is science. And if you really look at the science, you have actually a lot of options in terms of how you want to, you know, do your diet and what you want to do for it. They all kind of work. The question becomes, what's sustainable for you? And there is nothing particularly magic about it. Hell, you talk about, you know, it's funny with intermittent fasting. You know, we talk about the effects on triglycerides, on blood glucose and all these other factors, human globin A1c, like we've seen some positives there, but we've also seen that with we've seen that with the vegetarian diet, we've seen that with the paleolithic diet. Hell, there's one study that actually showed the paleolithic diet is better than the Mediterranean diet for that. We've seen it with ketogenic diets, only to find out that like eight weeks later, it's a wash and when you track somebody for a year, it all equals out. So, you know, again, it's the kind of, well, because here's the thing. If you really think about it, if somebody's overweight or obese, and you guys on the physician side, you can answer me this, riddle me this fat man, if somebody loses body fat and loses weight, what tends to happen to those markers? Is it the diet or is it the effect of the diet that's doing that? You know, and again, some of these things have been marketed so incredibly well and it sounds, again, it's got a name, intermittent fasting. And then you ask somebody, which one? You do the five two, the alternate day fasting, the partial fasting, you know, like what do you consider fasting? You know, and so, you know, it's really funny. I think most of the really solid data we originally had on this was stuff that was done during Ramadan. That probably gave us our best insight into the time restricted feeding. We've extended that now, but that being said, still, you know, I think if nothing else, it's a, again, it's a perfect example of can we should be? You know, can you do it and have it work? Yes. Should you? It depends on how you do it and what you're trying to get out of it from a performance standpoint, not something I would argue for, especially depending on when your games are, what your matches are, what your practice schedule is, like just because you have a window cut off, does that mean you stop eating, but your game's not for another four hours? That's a bad idea. You know, so how I would apply this in an athlete model versus other would be very, very different in that case. Yeah, I mean, I couldn't agree more. I think when you're talking high-level athletes, again, I think that there's nuances to this stuff, and then you have to, it's like almost like micro-dosing, right? Again, it's the last five, 10% that you really have to. I'll give you a personal anecdote. I think that, you know, again, back, I worked at Precy Speed School. I don't know if you know that, but I also work. Yeah, so I also work for like Jay Furuja, and at that time, you know, I, one of my colleagues was a professional bodybuilder, and so with him, I was again, trying to get lean, it's possible. And so I went from, with intermittent fasting, this is probably 2011. I went from 11% body fat down to 6%, but then my goal was to get to around four and a half five, but I couldn't. And then, so at some point, again, the negative effects of it on my performance, the stress, because it is stressful to try to skip a meal and then try to consume all your calories within an eight or six hour window. And then not only that, if you're eating late at night, there's going to be implications on your sleep quality being disrupted. And then that's going to stress you out. It's going to be this positive, terrible feedback loop. But, you know, so again, yeah, to your point about, again, we're going back to context. First of all, what are you doing it for? Are we are we doing it for heart health? Are we doing it for blood pressure management? That's important. And then if it fits your lifestyle, if you are a high stress individual who doesn't have time in the morning because you have to get your kids ready and then you got to run out to work, maybe skipping breakfast is okay for you. Maybe then you can do it. Or you find an alternate. So in other words, what else could you have for breakfast that would be quick but nutritious from like protein shake standpoint, something to go with you, a Greek yogurt, you know, something like that. Yeah. And you bring up an interesting thing right like that stress of like, and then if you eat late at night, what about your sleep? One of the challenges, you know, and I'm I think probably here would be a cool study or something to kind of look into would be time restricted feeding, but that restriction is really more around the carbohydrate intake than it is around food intake. And the reason I say that is Mike Ormsby and some others have done some really cool work on nighttime feeding. And so eating right before bed and feeding a protein bolus before bed has some really positive benefits to it in terms of muscle repair, recovery, well being some of the blood markers. So I guess the question becomes if you're, let's say a body builder, right? And you're trying to get down like six, seven, you know, five percent. Is it to your advantage to not eat at night when you're now going to go this extended period of time where there is a catabolic environment, especially just the nature of dieting, you're creating catabolism. So how much muscle do you want to lose in this process versus starting to restrict when carbohydrates are taken in based on circadian responses and what you're trying to do in terms of glycogen replenishment to fuel for the next day in terms of, you know, entertaining that high intensity workout. So again, it's so context dependent, but at the same time, you know, I'm really curious to see the research that really should be done, looking at what happens if you're looking at, I almost look at time-restricted feeding sort of like within day nutrient periodization. It's kind of the idea right in terms of like an off-season on-season, you know, in season I think. But, you know, is there a time and a place for other nutritional implementations then where you're looking at, hey, during this frame of time where you would mostly be under that fasting rule, would that be a more optimal time to just have protein, right? And then the other times a day in terms of your carbohydrate intake, and I could argue for a plan where most of your carbohydrate, especially your your high energy carbs, your more nutrient dense carbohydrate, or I guess nutrient shallow, but calorie dense carbohydrate might be more around your workouts with your lower energy carbohydrates at all other times where it's mostly vegetables and things like that that are slower processing. So, you know, have more fiber content. So even within that day, if you periodize your nutrition based on what you're trying to accomplish in that time frame, you know, and again, I don't mean to make that sound overly complicated. It's not. It's basically like, around your workouts, eat stuff that'll fuel you quickly and replenish every other time of the day, eat all of your nutritious vegetables and all that other stuff, right? It's like, yeah, it's not that hard. Yeah, no, I mean, again, I love that. And I think that's kind of probably where some of the idea of taking casing before bedtime probably developed as well. But I guess from our perspective, you know, one of the things that I've really found interesting about this whole intermittent fasting TRE approaches, the whole metabolic flexibility being one, right? Being able to utilize fatty acids and glycerol for energy and using ketones, which we know can be beneficial for brain health if your brain can start utilizing that as well. There's some literature trying to support that in terms of the cognitive benefits and Alzheimer's prevention, because I think that's an area of interest as well, obviously with great implications. And then the other big one is being stress resilience. I think we're very, very prone to stress. Obviously, the state of the world is making it that much more so. And then this idea at the molecular biological level of increased expression of, you know, antioxidant defenses and DNA repair and autophagy and, you know, how that can help with the longevity aspect of it. But again, it's the literature and that is definitely in its infancy. What I do want to hear about those, you mentioned two things, one about skipping breakfast, tend to affect performance and athletes later in the day. So what's like the mechanistic thing behind it? Because I think the only thing that I'm familiar with is kind of like such in Pandas work in the circadian code, which is a rape book talking about the bodies. Each organ has its own circadian rhythm and showing that we are much more insulin sensitive during the morning than we are in the evening. So again, that goes back to your point about don't skip breakfast, rather skip dinner, might be better. So so could you talk about that? Yeah, so I mean, from a performance sampling, there are multiple things that work here, one of which is obviously in the morning is when cortisol is going to be the highest, right? That's where it's peaking as you wake up. So by taking it a meal and starting to switch to a more sort of anabolic response, you're potentially getting that in check. If you allow that to go unchecked, certainly the body is going to have to find, it's kind of like Jurassic Park. Nature finds a way, right? And so, you know, we kind of look at that and you realize that there's going to be adjustments that have to occur at the systemic level in order to account for that. So even if you fully account for calories, the question is how important was that morning portion for for glycogen storage for priming the body for the rest of the day and not throwing you out of your normal rhythm that you would rely on? Because we know that that peak performance tends to occur a little bit later in the day, like late to mid afternoon, mid to late afternoon to early evening. So now does that mean that like that's when you should work out? Again, when's the best time to work out when you'll do it? And your body can adapt to it, but if you're an athlete and you're looking to be at peak performance and, you know, ideally, when would you train? It might be that situation because it's also more meals you can fit in. So some of it may simply have to do with a fueling standpoint in terms of when your body was more primed to to metabolize it, to use it for later in the day. Some of it might be, as you mentioned, with the circadian rhythms in terms of what it throws off or not, in terms of sort of optimized, non-optimized, in terms of what we would get. So I think all of those things are things that are worth looking at. And I would even bring up, you know, you mentioned with intermittent fasting and some of the things that it can do. I would say that the autophagy has not been supported. That's actually been one of those buzzwords that gets thrown out there a lot, that really when you compare it to almost anything else, it is so overhyped and at the same time for most people you go, what does it really mean? Because then like to your point with like Alzheimer's and with ketones, then I would argue, okay, so with what we see with cognitive impairment, like ketogenic diet, really cool history of that, right? Because this would back in really the 1800s, early 1900s, where Johns Hopkins University really pioneered this in terms of using it for kids that had seizure disorders, right? And epilepsy in particular. And it started that they realized that starvation created this ketone bodies. And so that created this less seizure response. They go, well, the problem with that is that you got to starve. So what do we have in between this? And that's where the high fat diet came in. That became repopular in early 2000s when there was a special on BBC about a guy that had epilepsy that they rediscovered. And it's funny because the ketogenic diet for epilepsy purposes and for certain brain disorders has actually there's good medical basis for this. Actually, but then drugs came along. And so then it fell out of the textbooks. It wasn't as popular. Oh, let's just use a pharmaceutical. And now it's kind of become popular. But what's interesting is somehow that translated from the medical utility and the ketones and what it does to as a brain brain fuel source versus glucose in somebody with seizure disorder. And then it became sort of a fitness trend, a weight loss trend and stuff like that. And it doesn't have the same benefit there. So I would argue even on the intermittent fasting side, if you've got somebody where you're looking at trying to to maximize the ketogenic response at the level of the brain for ketone use, you're probably better off using ketogenic diet, you know, because that intermittent fasting, unless you continue with that throughout the day in terms of, you know, I mean, could you do ketogenic intermittent fasting? Absolutely. You know, you can throw a bunch of these together if you want to help. You could do ketogenic intermittent vegan fasting if you want to. It doesn't sound fun though. With paleo avocados, like you'll be fine, right? Sounds good. Yeah, right. So I think it really just comes down to how you use it. But again, I would just say that like anything else, if you compare it to a control and especially a standardized Western diet, it works. But if you compare it to damn near any other diet that has the same principle behind it, energy restriction, there's really not that much special about it. There's nothing that unique. And, you know, and to our point, I guess what I would rather is, okay, look, if somebody is 100% sold and I got to try this intermittent fasting thing, right? I want to do time restricted feeding. Do me a favor, try it with including breakfast and cutting your calorie intake a little, you know, the later in the day stuff. And then maybe even consider eating up a bolus of just casing protein before bed so that you still are technically in a carb fasting state, but you kind of still have the the the anabolic response going for you. There's a couple ways you can do this where you don't have to, you know, it's not that difficult. Now, I love that I'm going to I'm going to have to try that cutting out like the dinner because when I was doing IF before, I was skipping the breakfast, but then I realized like, I was doing for a year or two. I became so bloated. I guess I was putting too much calories at like one point. And then what I switched to was, okay, I would just eat every day and then every month, I would do like a 48 hour fast. And it wasn't really so much from a health perspective, it would be a lot more just to like get back to our like animalistic self, that hunger drive, that discipline. I found like my meditation would be a lot more heightened. And again, to to both of your points, it comes down to what is it for, right? I think I think that's the biggest thing I want to take or have the listeners take away from this. As well as, you know, there's so many biohackers, right? I put quotes on that like coming out so many people on Instagram saying, oh, you got to do this and you got to this. And to your point, all we're doing is repurposing an idea and making it sexy or making it fancy, right? And people just need to go back and look at the history of, you know, keto. And why was it there in the first place? Right. But yeah, we'd want a little bit of the historical context for some of these things and the scientific context for them. And, you know, unfortunately, that's where that scienceiness has come in, right? Where it's like they, your point about repurposing ideas, what they'll do is, it's the same shit that we've been doing, but there's a new spin on the advertising of it, but there's nothing uniquely special about it. They just make it sound really good. You know, and people like that, because people are looking for quick fixes. You know, I think Instagram is a perfect example of that. I mean, it's funny, you know, you know, all having been around the bodybuilding world, right? And having worked the bodybuilder used to be, so my wife was a former pro, I have BB pro. And it used to be a point at which you had to win contests and be in magazines to actually be considered a pro and whatever. And now you've got these like Instagram models that have never won a contest and never won a pro-cargaret thing, but they're a fitness expert because they take some pictures, right? And, you know, by the way, you're not a fitness model if you're always paying somebody else to take your photos, all right? Like, you know, it's one of those things where it's hard. And I think that that's been lost a little bit too. You know, and I think, again, back to our point to start this whole conversation, you know, a little over an hour ago, is I'm so glad you guys are doing something like this because I think we desperately need the actual science to be put in a way and to the people that need you to hear it. Like, for example, when I worked with coaching education with US soccer, right? I love working with athletes, but if you think about it as a multiplying factor, being able to get to the people on the front lines that then can work with 10 or 20 other people, that's really the key to getting good information out there because the only way to combat bad information is with good information and helping people realize that remove the myth, remove the stigma, the over-promise stuff, the hype, and just boil down to like physiologically and psychologically. Does this make sense? Because some people have to realize too that trying to adhere to these really strict diets and these specific things you can and can't eat. Like, I hate that. Like, bad foods, good foods. There's no bad food. It's quantity dictates that, right? It's the dose that determines the poison. And so when you start to look at it, it's one of those things where let's take the stigmas off it. Let's make people not feel bad about wanting to have a cookie. Just don't have 20 of them because that's often what happens, right? You restrict, you restrict, you restrict, and then it's like, no, I blew that. And then your whole day is gone. And you're like, oh, well, you know, I'll start tomorrow again. No, it's like, no, start the next meal. Like, it is what it is. Like, why do you have to wait like three days to get back into this? So I think that really nutritionally, you can send good messages and at least provide people. You can't make them do it, but you can at least try to provide the appropriate information so they can make a better decision. The problem is, as I've generally found, I don't know if you guys run into this, is because people tend to be come so tied to these ideological ideas around nutrition and diets and so like that is they don't listen, right? And you know, like, you gave a good example of like, you did intermittent fasting to get down to weight, right? And it's like, oh, I got down to like 6% body fat. Well, I can tell you a lot of people have got down to 6% not doing intermittent fasting, right? So in other words, it's like, and this is often what we deal with with ketogenic athletes, like, oh, and ultra endurance. So this person won a race and they were ketogenic athletes. I'm great. Here's 300 that weren't, right? In other words, they won the race on carbohydrates. And so there's always going to be that example. And that's where I think it becomes problematic. It's like, well, it worked for me. So it must be a real thing. And it's like, it probably worked for you because you were able to stick with it. I'm not saying any one of these things is is right or wrong. Some are certainly nutritionally better than others. There's no question about that, but it really comes down to will you stick with it? You know, how does it work? But just because it worked for you and it just because you changed how you ate health, somebody else could do a completely different diet and works for them because it changed how they ate. They started to pay attention to what they were doing. I'll just supply five. They don't listen unless you tell them what they want to hear. Yes. No, you're 100% wrong. And I think that's the real trick is it's starting to you got to recognize, look, I understand why, like I understand your why in this in terms of why you think this way and whatever. Run with me on this, though, let's actually start to kind of let's start to tear this down and really look at it in parts to put it all back together as a package. Does this really hold up to what you think or are there better ways to do this? And so yeah, it started like optimizing nothing, right? There's a lot of right ways to do stuff. There's very few like optimal ways, though. And so if we can identify those, you get the most out of it. But in most cases, just getting somebody to pay attention to what they're eating is the first step. It's like you can attach whatever name or whatever you want to it. But it's like great, at least you're not just shoveling whatever in your mouth. You're thinking about what you're eating. So there's a mindfulness factor there. Absolutely. Dr. you nailed our mission, right? Like our tagline is putting the health back in health care. And it's I feel like it's our job to educate other doctors, you know, through people like you, it's to educate the general population, just to become healthier, just to open up their minds, look at things, not look at one person, say, oh, if they did it, that means I can do it, you know, with that exact same diet, with that exact same protocol, everyone's different, everyone's individualized. I want to stay on the same topic of nutrition timing, but I want to talk about different population. Talking about those who are injured, either athletes or, you know, offline, you kind of talked about your mom, just suffer to stroke. And then defining performance, right? Because I think a lot of us have this idea of performance of going into the gym, pushing a sled, benching. But what is performance to you and how can that population that post injury population get better in terms of, you know, what they put in their bodies? Performance is function, right? So the ability to move soundly, to do the activities of daily living, and to optimize what's important to you, right? I mean, it's one of those things like, can I move as much weight as I used to? No, but I'd still like to think I'm doing pretty well. Hell, I had neck surgery 10 weeks ago now. I had too disreplaced, and it's a process. I used blood flow restriction training quite a bit coming out of that, really nailed down the nutrition, and so like that was a big deal to me going into surgery, coming out of surgery. You know, and finally, everything I studied was useful. So I was like, this is great. But like the other day, you know, I was finally able to get, you know, 225 across my back with a safety squat bar, and you know, bang out 7-8 reps with that, you know, back to 245 for deadlifts. I'm not where I was, but I'm better than I was yesterday, right? But to be able to do that 10 weeks out from disreplacement, I think that's performance. It's being a little bit better or trying to identify what your goals are that you want to be able to do. Have you guys seen the online ad? I think it's a German ad, and it's a Christmas ad, and it's this older guy training with a kettlebell, and all his neighbors are looking at him like, you need to watch it, because really what it boils down to is it turns out that he finds this old rusty kettlebell in his garage, and so he starts training with it. He's constantly lifting it up and moving it out. And the final scene is him at his granddaughter's house lifting her up like the kettlebell to put the star on the tree. And at the end of the day, what's your purpose? Find your purpose, right? That's your performance. That's your function. And so it's that ability to have that health aspect within your life, however you wanted to find that. And it's more than just blood markers, but it's also in terms of how you can move and how you can function within your capacity. And I think that becomes really, really important. And so the nutritional aspect to that is so highly supportive to help with recovery. We know with older adults, right? They need more protein, not less. Like they have antibiotic resistance that we don't see in younger adults. So it takes a little more loosing to hit their threshold to really stimulate the overall antibiotic effect. So it's all those little things that we have to think about that can go into that. And so yeah, for me, you know, when you start to look at these these these unique populations and unique demands, it's really identifying your purpose, your why, and gearing your training towards that. You know, and even for me, God, I've been training. I started lifting when I was what 11? And so between playing sports, lifting my whole life, there's a point at which like just the lifting for lifting purpose, it's a little bit boring. And so there's other stuff I like to do, mountain bike, surf, ski, skateboard, play soccer. So when I started to realize this, I started to periodize my training around what season was coming up because it helped me train like an athlete again, right? Where I'm getting ready for ski season or I'm getting ready for surfing and you know all that stuff. So it really kind of changed how I approached it. Now coming out of next surgery, it's more just function to get me back, you know, because what I did is right before surgery, I did strength testing all week. I wanted to know where I was at. So that was my minimum that I wanted to get back to coming back from surgery, right? So once I hit that, that's my why, right? And now I've got that sort of a benchmark to aim for to get me back there. But the good thing is I'm operating functionally, I'm much better than I was before the surgery. So now it's just an issue of being able to get back there. But like I said, I used BFR for like the whole time and recovery. And I was able to keep my body weight within one pound of where I was at pre-surgery to maintain as much muscle mass as possible. You know, you do, I probably got a little fluffy because you know, it's like one of those things where, you know, I think one of the biggest mistakes people make when they're injured is yeah, in some cases you may be fewer calories, but here's the catch. Depends on what your activity level was, but also realize you need more energy to heal. Right? So being able to be in that anabolic positive nitrogen balance state is critical. I definitely up my protein intake. And it was already pretty high, but I was like, all right, like whatever it takes to make sure that the repair takes takes hold. You know, I've continued with creatin with fish oils. You know, all those things became really useful to me in terms of the things that help maximize function. Wow. I mean, that's, I think that's really impactful stuff. I mean, you touched a little bit about supplementation. And I think no, no conversation of nutrition is complete without talking about organic aids, which is just, you know, supplementation. So I definitely, at the risk of opening up this can of worms, I want to talk about that, but I want to pause before we get there. And I want to talk to you about a little bit about this concept of nutrient genomics, right? I think that, you know, with basically 23 and me and ancestry DNA and ATHLEG and Prometheus, all these folks haven't, people get a genetic code. And we're starting to identify these SNPs. And I think that for the folks who don't know what they are, they're essentially these single nucleotide polymorphism. And in a nutshell, it's the most common way we are genetically different from each other, right? But we know that there are SNPs out there that show that some, you know, athletes that are more susceptible or more likely to be power athletes versus endurance athletes might have slightly different SNPs. Same thing when it comes to, you know, a previous position to type due diabetes and you're being more insulin resistance Alzheimer's, APOE is one that's implicated in that as well as cardiovascular disease. I think that a lot of that also, we can, we might be able to take that data. I don't think we're there yet, but we might be able to take that data and actually start looking at what type of nutritional protocol might be optimal for somebody's performance. What, I mean, like, is that stuff that that you were going to be like, what do you know about that? I mean, have you looked at that in the lab or what are your thoughts? Yeah, so I think you said that there's a key phrase, we might be able to that that that that that we're not there yet. We're not. And I think, I think the problem with Neutrogenomics right now is that I think that the science is very interesting, right? I love the science aspect of it. That's that's like the geek outside of me. I do think we're overstating the findings in some cases in terms of the conclusions that can be reached because there's some work that's been done on the power gene, you know, with the act 3N and it doesn't always play out the way you would think, you know, there's mixed evidence on the effects for caffeine metabolism, right? And so in a general population in terms of fast versus slow metabolizers, there's some evidence for blood pressure responses and stuff, but mostly I know Nancy guest had done a study where they found that that the the the the alleles actually did kind of predict or determine what the effect was on a time trial performance, but realize these were not cyclists, right? So even your trial performance can be affected because then there's been a few other studies that have come out by Joe Joe Erzick and a few others that have shown it may not matter, right? In other words, caffeine helped everybody sometimes need a little more or a little less whatever it is, but I think that it would be cool if we get to a point where we can identify more of these factors that might help us dial into the diet a little bit more, but by and large, most of the conclusions that have come out of it are not that different than what we would just normally recommend for performance effects. And so do I think there is the possibility that down the road, this could influence how we optimize performance and health? Yes, I absolutely do. Do I think we're there yet? No, you know, and I think that it's definitely a next frontier. I think that understanding some of that, what I'm afraid of though, is that does it serve as a cop out? Does it serve to artificially screen some people, especially on the performance side? If we start to use these genetic markers as evidence, whether you will or will not be an elite athlete, and there's so many other factors that go into that, but certainly the genetic code. I mean, it's one of those things, right? You want to be, you want to be an elite athlete? Choose your parents well. All right. The genetics find that definitely make a difference, but you know, do I think we're there yet? With something sure, I think some of the cardiovascular markers, I think we have a little better evidence for, I think in terms of the some of the risk factors on the brain side, I think are emerging and something that we need to pay attention to, but on the athlete side, man, I just, I think it's really interesting stuff, but I really think we have to be very careful not to overstate the findings and modifying how we're training somebody or how we're feeding somebody based on some very preliminary type of data. You know, I just think that's where it's at, not to say that it's not promising. I just don't think we have what we think we have sometimes. How far do you think we are away from that, though? Because I mean, when I look at these statistics and the expectation is that at 20, 30 greater than 50% of the US population is going to be obese. That's terrifying. It's absolutely terrifying when we're talking about that. And so when, okay, so let's talk maybe high performance athletes. Let's talk about, you know, type two diabetes and obesity and the codes for that. I mean, you think 10 years, you think less. I mean, so let me ask you this. This is a round about way of answering that. I think 10 years, sure, reasonable, whatever. But here's my problem. There's a lot we know about health now that we have to be genetic side for. And so we're going to tell me that, you know, 50% of the population has the genetic code to be obese. I mean, it's like, it's one of those things. If you look at SNPs and what it's doing, I think the problem is, even if we have the information and terms of, hey, here's what you should particularly be doing. You still got to get them to do it. You know, so I really think that it's, you know, because then you run the risk of somebody being like, oh, well, the reason I'm obese is, look, genetic code, right? There you go. And so do they take ownership of other behaviors that can still help them that maybe you're never like super lean, but can you be more healthy because of these other factors? So the other thing I will say too, and the reason that maybe I'm not as high on this as somebody, some people would be, but again, not that I don't think it has promise. The human body is complex. So which of those SNPs do we identify becomes the most important thing to target? Because by the way, they don't work in isolation. So how many of these factors, you know, because now what do you do with an athlete who has the power profile for act 3N, but then at the same time for SIP 1A, they're, you know, when you're looking at the effects on caffeine metabolism, they're a slow metabolizer. Like, how do you start to put those things together? Like, what's your advice for somebody in that situation, you know? And so that's where I think as we start to underify the one of the my favorite parts about the human body is how freaking complex it is. But the thing I love about endocrinology is how remarkably redundant it is too. We have a lot of systems that overlap that have the capacity to make up for each other of something malfunctions, right? And so there's a redundancy in that. And I think that identifying the fact that we've got these genetic influences great, but the question becomes how do you parse those out and can you really look at them in a vacuum when you have all these other input variables that are feeding into the system to create this, right? And so that's where I guess I think the most consideration will ultimately need to be paid beyond just the ethical side of it too in terms of what do we do? But I think certainly the complexity factor and how these systems feed into each other and how they sort of redundantly influence these outcomes, I think it's something that we can't ignore. Yeah, I love that you said that. I mean, I think that ultimately that's what it comes down to. I mean, sure, you could have some snips that make you more predisposed to obesity and all that stuff, but that's not that big mover. That's not the low hanging fruit. That's not the reason why I've created 40% of the US population is obese right now. But I think it's definitely an interesting discussion and certainly we should be excited about from that science, the geeks in us point, and I want to give the folks over a wild help shout out because that's this is exactly what they're doing, but they always caution that you need a guide when this stuff comes up because it's so complex and my fear is that with 23 and me and ancestry nothing wrong with them. I have a 23 million, but people can get this information and then they see that and they're like, oh, I have the act in 3G and I'm a power athlete and therefore I'm going to completely overhaul my protocol even though I enjoy running and that's the only exercise that I get. I'm going to stop doing that. I'm going to try to resist and train, but now I'm not training anymore because I hate it. And so I think that we have to be really cautious and I hope people can take that away from it that we cannot allow this dictate our practices. Let's just go back to the truth and try things that we know work. In the end of the day, I think that ideally we get to a point where it can inform our practices. It's sort of like for me, it's like sport science where we've got all these technological tools and stuff like that. At the end of the day, those should not dictate how you train an athlete, they inform how you train them because you also have to take the individual into account. You know, you have to environment into account the needs of the team, the coaching, about all these things play in. And so you have to make some judgment calls at that point, but you at least have objective data to utilize to base your decisions on, right? And then it's all in the implementation and the context. Yeah, absolutely. All right, touch on. I don't know how much more time do you have left? But I do want to talk to you. I'm going to get bored by this point. They're like, this is what they've been waiting for. They've been waiting for supplementation. I know that probably five times a week, more than that, somebody's texting you at some point asking you what supplement they take anytime. And that's the first question that we get unfortunately. Again, family, this is what they're asking. What supplement should I be taking for XYZ, whatever, fill in the blank? I mean, obviously, you touched on something. You mentioned creatine, omega-3 fatty acids, fish oils. You talked about some branching amino acids as well in there. Now, there's a few that have robust amounts of data behind them, caffeine being one of them. When it comes to high performance athlete, what are your base that, again, supplements are supplemental. We want to put that out there, right? But when we're talking high level performance, if you want to take it to the next level, one might be some that have the best research behind them. And then maybe even for some of the lay population or the general population who aren't at that elite level, what would you say? Yeah, so great question. And so let me start by saying one thing that is a common misconception to hear this from physicians all the time. I even hear it from dietitians. Supplements are FDA regulated. They are, they are regulated under a different code, though. So they're under the disay act, but people are like, they're not FDA regulated. No, technically go to the FDA site. Supplements are under there. Okay. Now, in terms of quality control and the proof of concept, that's different than pharmaceuticals, all right? But understand that. And so there's also things that are not FDA approved to be considered supplements. CBD is a big one right now, right? Everybody's like pro CBD, but funny thing is it's not actually a supplement that's approved for marketing as a supplement. And a lot of people mistake that. So could you elaborate on that in terms? Because actually, I'm probably guilty of this. So it may be a little bit more of what FDA regulation means and under which type of code than how that impacts. So under the, in the 1990s, they came out with the disay act, right? Dietary supplement act. And so supplement has to be taken orally, all right? So that was part of one of the classifications. But the FDA has the ability to request more information. The question is how much they enforce that? What's interesting is more companies get nailed by the FTC than by the FDA for supplement claims in terms of how they do this. So you can't have a specific health claim attached to it and things like that. But it does fall under FDA guidance. It's a subsection of FDA guidance under the disay act that doesn't put it in the same category as pharmaceuticals, but it does still fall under FDA purview. And as a matter of fact, there's a couple of clauses in there where they can, they can require proof of efficacy and proof of safety in order to move something to market. So it has to have studies behind it in terms of clinical controls and stuff like that. So when people say supplements aren't regulated, that's not entirely accurate. It's a question of how are they policed from the standpoint of quality control? In terms of supplements that may or may not have banned substances in them and things like that. And again, it's not to say that they're held in the same standard as a pharmaceutical. That's not what I'm saying. But they are under FDA purview. And I hear all the time. They're not FDA regulated. No, they actually are. They are. And so I think that's something that's often missed. And I'm not sure how and why that started as sort of the understanding. And I think it's just because supplements in some subsections get very demonized. Here's a thing. It's hard to outrun a bad diet, right? In other words, like if you have a pretty crappy diet, now, that being said, there's still health benefits. So it's hard to not that it's impossible to ever. It's something like you can't outrun a bad diet. Kind of can, but it takes some work, right? And there's other massive health benefits to exercise regardless. Technically, you can out supplement a bad diet, right? Because if you have a fairly crappy diet and you take enough of the other supplements, you can make up some of those deficiencies. All right. Now, it's not the approach I would recommend, but you can do it. But supplements have a time and a place. And like you said, they are a supplement to the diet. So when I hear people say, oh, no, I'm whole food. No supplements. Whole foods. I'm like, you can be in favor of whole foods and still recognize the value of supplement. Right. Again, it's sort of like either or question, right? It's not dichotomy. It's like it's both. So for me, creatin for sure has so much data behind it, tremendous safety profiling. We're seeing effects for brain health. We certainly see the effects on power. We're seeing stuff for repair and regeneration, following surgery, following injury. There's a tremendous amount of interest in this. And it's funny because the one thing I always hear is like, but don't like kids take it, right? Because it's bad. I'm like, they read meat. There's creatin in that. You know, but the other thing too is one of the largest trials on brain health and creatin is actually done in kids. It was a study in New Zealand. And they actually used it when kids were admitted to the emergency room with traumatic brain injury. And they found that creatin supplementation in high doses actually improved their recovery, their linguistic recovery, their time spent, in intensive care and all that stuff. So, you know, really cool stuff. So actually there's safety profile even in kids. But I think creatin's been one caffeine for sure. Huge fan. I'm trying to forget how to get my lab sponsored by Starbucks. In all fairness. So I will say it for full disclosure. So I actually have a patent on a black T extract that's been shown to improve recovery. And there's a company workout coffee that put it in their coffee. So it's like best both worlds. It's like my patent plus caffeine. This is freaking awesome. Oh, it's like about that. So that's kind of fun. They're really cool guys too. But caffeine is a big one protein, right? In terms of, you know, in terms of protein supplementation is an easy one, especially around training. I would encourage people to eat primarily whole food proteins because of the protein matrix that you get with that. But at the same time, there's a real value in protein supplementation, especially for athletes when you're looking at around training, right, to get to restart that recovery process as quickly as possible. Beta-aligning is sort of a next level one for me where I don't necessarily think I would recommend it for a lot of people. But there are some cognitive benefits potentially. But certainly if you engage in a lot of high intensity work, there's some benefit there from the standpoint of buffering acidity with the karnasine and stuff like that. So within the muscle cell, but I don't know that I'm as high on beta-aligning as I used to be. But at the same time, I do think that there is a time and a place where there's a lot of data on it. I mean, the data on it are fairly robust. It's just not a huge effect, you know, when you look at that. I'm a fan of Omega-3s. There's some cool work in older adults, especially where they're looking at the impacts on inflammation and recovery. The cardiovascular benefit, I feel like depending on which study you look at, there's been like five that have shown there's a benefit, five that's shown there's not. It depends on how it's screened, the doses being used. In some cases, I think that people may need to take more in terms of like two to three grams a day instead of the maybe one gram that a lot of people might take. But I think if you're looking at it from a brain standpoint, the fish oils higher in DHA are going to be ideal if you're looking at it from an inflammatory standpoint and a recovery standpoint EPA should be the highest component by far. And they do have very different effects in that case. So I think those would be some of the big starting points for me, you know, creatin, caffeine, bedalanine, protein, and then fish oils would kind of be my easy five. That is five, right? And so that's kind of where my starting point would be. There's a lot of untested stuff out there that sounds good in theory, but there's really no research behind it. It's one of the reasons I'm kind of proud of the Black TX track is we have clinical trial and data and as well as some animal model work. But but again, you know, in terms of what people are looking for, it doesn't have to be super expensive, you know, creatins actually cheap. The other one, you know, it's funny. So the other one that I find very useful that I actually did take in in quantities post surgery is glutamine. And I didn't do it from muscle repair as from a from a muscle growth standpoint glutamine, probably too much, where I find the most interesting data with glutamine to be is for immune function because glutamine availability directly affects lymphocyte function. And so I think that the glutamine affects on the immune system. There's some cool work that's been done in marathoners, especially high predisposure to upper respiratory tract infection. And the role that high goes glutamine played post marathon in delay and in preventing of symptoms, which I thought was actually pretty cool. So again, maybe not for everybody, but from an immune standpoint, I thought that was pretty cool. I used to be big into like antioxidant stuff because that's a lot of the work I did early on with antioxidants and anti-inflammatories. I'm a little less geeked about that at this point because I realized that antioxidant wise, that is absolutely something I'd rather get from food because I think high dose antioxidants actually create a potential or galitic effect because it turns out we need oxidative stress and we need inflammation in order to adapt. And so if we completely want that process, we run into some problems. But with proper training and with dietary intake of antioxidants, we actually see an up-regulation of endogenous antioxidants, which is a good thing, right? Because then from our own system, we handle that better. So I think there's some interesting work that can be done there in terms of endogenous up-regulation. And that was interesting, that was kind of one of the things we saw with that black tea that I thought was really unique because in the animal model, we weren't sure about the antioxidant effects, but it looked like it affected endogenous glutathione production. So kind of had it instead of it being the antioxidant, it really kind of facilitated the system's response. But we didn't continue to do that pathway, as Mourncht and the performance and recovery effects with it weren't anything else. What's your black tea called or the coffee that they're using? So it's workout coffee, and the black tea, they branded it as theafit because it's high in theaflavin content, and that's where it comes out. Speaking of which, I will say one other supplement that I think is really kind of cool in the caffeine vein is tecreen and dinamine. We've actually done a couple studies on this, and we got one we're just wrapping up in tactical operators looking at this. But so tecreen, it's like a caffeine derivative, but it's got a longer half life, but a lower peak. In other words, it's a more sustained function, but they've actually found in other research that you don't get habituation to it, like you do with caffeine. That's unique. Dinamine is faster-aphing. So we're actually the study we're just wrapping up, and we haven't looked at the data X was double blind, but we're looking at whether a dinamine tecreen and caffeine combination is better than caffeine by itself because, and we're using a lower dose of caffeine in the mixture, right? So we're equating for total intake when we do that. But I'll be interested to see how that plays out, because the work we had done in soccer players actually did point to an improvement in some cognitive function issues, but also time to exhaustion following a simulated soccer match, which I thought was actually pretty cool. But we'll see where some of that goes. Again, on the horizon, potentially has some utility, because it also doesn't look like it has the same hemodynamic response that caffeine does. What about, what about, sorry, I was going to ask, what about something like L-theanine, right? I think that has that lower peak, but goes longer. Same idea, the question becomes in what dose and stuff like that, and really, tecreen is tied to the the theanine molecule. So would you expect that we actually work in concert or similarly in that case, from a mechanistic standpoint? Yeah, no, that's cool. I'd be definitely be excited to see what the data shows ultimately when you sift through that. I think I just want to jump back to your point and emphasize when you talked about omega-3 fatty acids, and getting the dose earlier, you talked about how the dose makes the poison, and by that same token, the dose makes the medicine as well. And so, you know, I can't tell you how many times I'll have people send me a picture of supplement they take, and then I'll say, okay, send me the back, I want to look at the ingredients. And it'll have some good ingredients, like it'll have maybe curcumin, and we know curcumin is pretty well studied when we were talking about OA and pain and inflammation in that regard. But then the dose is going to be like 50 micrograms. And I'm like, the date is going to be 500. Because curcumin's bioavailability is crap. I bioavailable curcumin in a sufficient dose. Absolutely. Warption is so low on that. But that's the problem is you'll just read the names, and the names, it's good. These are all great. But if the ingredients or, you know, the amount is tiny, then that's not what's been studied. It's not really doing anything. So I think that's really worth emphasizing for people. What you're getting at is what we refer to as efficacious dosing. And so it's one of those things that are you following what the research says or you just dumping the kitchen sink in there. The thing that continues to boggle my mind that I immediately will never use a supplement or have any of my athletes work with it at all is if they use a proprietary blend. Because what I laugh at is when you have a proprietary blend that's like say six grams. And they've got creatin and beta alanine and they've got caffeine and they've got blah, blah, blah. And you go, okay, so let's see. Directed dose of creatin is five grams. Effective dose of beta alanine is 3.2 to 6.4 grams per day. All right, right away, you're already it should be close to 11 grams. And you've got six total, which tells me you don't have enough of any of those things in there for it to be even used. You're just labeling because it's been supported by research. I think we need more finished product testing. I will say as a scientist, one thing that drives me nuts when we, you know, have done some of the finished product testing and then reviewers come back and like, well, you don't know what's actually influencing this. And so, you know, you need to study these things in isolation. It's like, but that's the point of finished product testing is how do they work in concert, right? How do they work when you put them together? Does this product work? It's not so much about identifying which substance is driving the the bus in this case. It's how do they work together? Because you could even have some that potentially interfere with each other. Oh, I mean, hell, St. John's word. Here's a fun one. Most people don't realize that St. John's work can interfere with other medications most notably oral contraceptives. So, you know, things that are often left out in the in the description of that. So, you have to be aware. And the other thing too is just being aware of other substances that can increase or decrease bioavailability of certain drugs as well, especially if somebody's on like an SSRI or anything like that for depression. There are some things that can affect the metabolic response there, not the least of which is St. John's word. So, you do have to be a little bit aware of some of the medical supplement interactions, which we don't know all of, you know, but certainly anything that potentially influences liver function, especially with anything that's the tip 1a activator in terms of some of that or, you know, even with some of these things you take with like grapefruit juice or, you know, anything like that, like all of those things can impact how we metabolize them too. Yeah, I'm a huge proponent of figuring out what the finished product is. I don't know if you remember, but I was actually that's where we met. I was part of a study. I don't know if it was double blind or not. Was it the one where we were training them in the gym or was it the one where they were just supplementing and doing their own training? Supplementing and doing their own training. I think that was like stemming line? Yeah, I'm pretty sure it was, yeah. Yeah, that was like all the rave. I've never, it was like a year that it lasted all over the place and I was like, this looks like it. But that was a miserable experience in terms of checking our vio2 max and doing the wing a test, which I would not recommend on anybody. It's a it's a hard experience. I remember my roommate would be throwing up every single time. It's not fun. The roommates are rough, man. That's yeah. So were you in the lab when Alan Walker started with me as a master student? I don't think so. Now Alan came in. So Alan is a faculty member at Lebanon Valley College now and just killing it. He's great. So he graduated with his PhD for me at Rutgers before I left. And I remember it was hilarious. We got a new velotron in one day. I get a text from him and he's like, I learned two things. The velotron works. Number two, it's a bad idea to eat chipotle before doing windgates. I was like, you're a grad student, what are you thinking? I'm like, that was that was the highlight of my now. You got to be kidding me. Patrick, Patrick, David and Devon were there during my senior, at least when I was in turns. And so they did. I think I think Devon's out somewhere in the West Coast now. Oh, he's back east, but she actually started her own business. She got out of academia. And so has her own consulting business. She's actually helped a lot of programs start nutrition programs. Love it. She's worked with some school in Philly. And then Pat is actually on faculty at at the University of the Sciences in Philadelphia now. So he was up at Mercy College in New York, Connecticut area. And then now he's down in Philly there. And apparently he's back working with Rutgers football now that Shiong was back because Pat was working as their team nutritionist. So I think they brought him back for the season. I don't know what he's going to do after this. Once they actually have to be back in person, it is actually a university. But anyway, so my understanding is, you know, that's what both of them are doing. So actually, that's good. I'm glad they're here there on these coasts again. I want to ask you a quick follow up on Cretan. I mean, Cretan Monohadrate, you're talked about as cheap and we know it works. I think that for again, the power output, muscle hypertrophy, those are the main things that's been studied. What about athletes? Because I know you work with athletes like fighting athletes, where what cutting weight is a is a big thing. And you know, a lot of times these athletes are dehydrated. That compounded with the risk for kidney injury. I mean, is that something? I mean, how do you, is as one type of athlete that you don't recommend Cretan in or? Oh, actually, we do. What we do is in their weight cutting week or just leading up to it, we'll back off on the dose of Cretan. It's not going to fully wash out of the system. And so we won't get quite the same degree of water retention. But if you're smart about high, so and this is, this is my thing too, is you also have to be smart about how you're getting to weight during the camp, right? Because ultimately, we don't want a huge weight rebound after weighing to a point where they're now heavier than they've been training at. So how we manipulate that becomes important. But like with one of the fighters we worked with it wound up winning a title, he actually, when we were going to water load him and then cut the week waiting up to the fight, we cut the Cretan back, but then we reloaded right after he weighed in. So we did 20 grams over the next few hours to resaturate from that standpoint, because he hadn't lost it completely. And he wound up doing great in the fight. Obviously won the title. But, you know, so, so it's not a group that I don't recommend creating for, especially because the cognitive effects of and potential protection from brain injury, TBI in particular, is becoming pretty notable in terms of as a possibility. I think there's still some research done in that for sure. But if promising, and I'll tell you what, if you're getting bounced in the head, you know, over and over again, I would rather air on the side of having Cretan than not, because we know that from from the TBI and concussion mechanism, it's not so much about cellular damage as it is energy disruption. And so because Cretan can cross the blood brain barrier, it actually provides the energy intermediate when that gets disrupted with a head blow. And so I think that's where some of the really cool work at originating some of the work at Michigan State and an animal model, you know, we're now looking at maybe potentially doing this in in military personnel as a potential prophylactic, especially for those that are prone to blast concussion when they're charging through doors and stuff like that. So those are some of the areas I think that are that are on the horizon. And I think there's been some work in Huntington's in Huntington's and in Alzheimer's and Parkinson's for the role that it may play as well. Just to clarify, though, we're talking Cretan on a hydra because I know there's other formulations like ethyl ester and people in market and all that. I mean, garbage. We're all on hydrate, man. It's I still haven't seen anybody roll through on it. Some of the other stuff that doesn't work, but it's cheap. It works. It's the most research. And not to say that maybe somebody won't come out with something that absorbs even better, but honestly, the absorption rate of Cretan on hydrate is really good. You don't need the load you can. So if you're not taking Cretan, you know, taking 20 to 25 grams, I would split that up in multiple doses. Otherwise, you get stomach upset. But you only need that for four or five days, and then you can just go to five grams per day. We're really looking at like three to eight grams per day, five is kind of an easy one for everybody to do. It's usually like a tablespoon. So pretty easy, and there's multiple benefits to it in terms of cognition. And I would definitely say if you're vegan or vegetarian, take Cretan because they're the group that tends to be most efficient, where the cognitive benefits have been most pronounced with supplementation. Absolutely. Now this has been fantastic. And speaking about the future of research, I mean, I've learned so much already just under two hours here. Is there anything that you're really looking forward to in the next year or five years, 10 years, something that you might be working on, or something that you're just excited that the field is now going to pop out some studies? Is there anything that you're really looking forward to? Honestly, I love the work that the field is doing in general. I'll always be excited about the role that monitoring can play in terms of helping to establish. And we talked about, you know, the Neutrogenomics and some of the measurables there, but at the same time, some of the information we already have from an athlete and person monitoring standpoint to help achieve more optimized health and fitness and function, I think is really key. That includes biomarkers, that includes wearables. You know, I think there's some really cool stuff. It's really one of those assesses. Don't guess kind of ideas, right? And the other thing, too, is our lab has been very interested for a while on the female side of things. And I think it's an area that really needs more exploration. And I think people like Kirstie Elliott sale over in the UK are just killing it in this area. Kate Ackerman here in the Boston area, like, you know, there's some great work that's being done. And that's something that we want to continue to contribute to. And we're interested in now moving that to female military because of the challenges they're having passing the new army on the new army combat fitness tests. And so we're looking at ways to optimize their training, their preparation, and stuff like that. And really some alternative training models for how we're doing this. We're, you know, doing a study with the Marine Corps now looking at their gender integration model for boot camp, where we've got physiological and sociological measures included in there. We've got this work that starting with an army grant, where we're going to be doing blood flow restriction training and minimal equipment training to look at what can be done in a field and very portable in order to facilitate recovery aspects. But also when they don't have access to a lot of heavier equipment, you know, sandbags, weighted vests, stuff like that, TRX. So those are some of the things that we're looking forward to. You know, some of the work that's even being done in our department, everything from youth physical activity, you know, BCD to community health to cardiovascular health to we're getting ready to start a study in looking at sickle cell trait and care discrepancies between HPCUs and other NCAA colleges in terms of care for the black athlete that might be, you know, that has the predisposure for this. So I just, you know, and cancer, exercising cancer is definitely a hot topic, right? We faculty member here, Kieran Farman, who we just hired, who does great work in that area. So I'm excited, you know, I'm definitely partial to the work done at University of South Carolina. I just think there's great stuff going. I know Sarah Campbell and others in the field doing work in the in the microbiome and its impacts on, you know, gut health and both obesity performance and all these things. And we have a position stand on with ISSN on both the microbiome but then also probiotics. You know, I think those are some areas of interest going forward in terms of where we might see some of this. So, you know, there's a lot to be excited about. Yeah, it is. And, you know, for us, it will always be founded in stress and optimization and and looking at ways to facilitate that. You know, we're continuing to work with the athletes at South Carolina and getting things even related to heart rate variability across the season and some the loading changes and even some strength discrepancies, interim discrepancies that occur with fatigue that might explain some of the injury mechanisms. So, you know, those are fun areas for us, right? We'll always do, hopefully we'll always have something in the works with supplements, you know, and stuff like that because I do find that to be, you know, an area that needs more research because it's always funny, right? I will say, and this is where we need the physicians help in terms of messaging. Here's a quick message from our sponsor, ComPELP. There are a lot of podcasts out there, murder mysteries, breaking news, there's even a podcast about garden notes. But instead, you're here learning how to be the best version of yourself, smart move. Do you know what else is a smart move? Working a locomotinent assignment with ComPELP. Now, I know what you're thinking. If you are a physician, you already have a job. That's the best part. You can work flexible locom assignments on the side for extra income, or you can work locomotives full time too. And to top it all off, locomotives almost always pays more on average. Just head to financialresidency.com for slash ComPELP and see what locomotives can do for you financially. And now back to the show. As there's no research behind that, then when there's research behind it, they criticize it because the company sponsored it. And it's like, guys, a lot of this stuff is not what NIH is paying for, right? So they're not sponsoring a bunch of stuff, especially in high-performance stuff. So I think that one of the messages going out there is judge it less on who funded it and more on the design, because at the end of the day, and we have a lot of disclosures that we sign, but we reserve the right to publish. It might be that we have to take a trade name out of it or something like that. But the data are the data. And I think that having research in this area is critical. And I think that if people are going to be like, hey, we need more research in this area, don't just immediately criticize the research that's been done because somebody's willing to pay for it. So I think that's a challenge we often face. Dr. Arnt, I think that despite the fact that we have been talking just under two hours, this, I mean, I think we've just scratched the surface on the things that we can dive into nutrition. And we didn't even, like you said, we didn't even get into really what your area of expertise is, which is many of exercise, endocrinology, and those types of things. And I told Darsis offline when you weren't here is, you know, you made me actually fall in love with endocrinology. And for a long time, I was going through medical school and I thought that I was going to be an endocrinologist. But then one of my buddies, close friends, like if you do endocrinologists, you're probably going to be taking care of a lot of diabetes and you're not going to be dealing with growth hormone disorders and those kinds of things. So I decided I can go down the sports medicine aspect and do endocrinology that way instead. We want to thank you so much. You've been a mentor for me for such a long time. And this just means that we got to get you back on here again and have a happy time. Honestly, man, coming from me, that means a lot. I'm really excited to see the stuff you guys are doing and all I'm really, honestly, I mean this from my heart, I'm really proud of you. So it's really been my pleasure to be on. I'm happy to have more ongoing dialogues or point more people in your direction for you to interview people that, you know, that I really respect that I think make for good interviews. It has some really cool data and stuff like that because I think what your mission is and what you're trying to accomplish, I think is a good one. And I know as a field, we are more than happy to contribute to that because we need those voices to help bridge that gap that often exists. And I think that's where, you know, that becomes a real consideration. So yeah, you guys, you guys have been fantastic. And I appreciate it. And yeah, definitely looking forward to more of these if we haven't. Awesome. Thank you. Well, thanks so much for sticking around and listening to that episode. Like I said, there is so much information that Sean Arden packs into that. So my call to action for all of you is to be curious. If there's any questions that popped up in your head while listening to this episode, go down the rabbit hole in Google, go read a book on the topic or go reach out to the experts on social media who can cover these topics. It's the only way to really empower your own health and your own brain. And we have so much information at our fingertips. It would be a waste for us to not at least be curious. And of course, if you have loved these episodes on the last year, it would mean a great deal to all to much an eye. If you could take five seconds out of your day and leave a review or subscribe or share this episode with anyone else, we're really excited for 2022. We have an awesome list of guests planned out in January. And we just cannot wait to get those guests their topics over to you. So we're really pumped for 2022. All right, disclaimer, everything in this podcast is for educational purposes only. It does not constitute the prize of medicine and we are not providing medical advice. No physician patient should relationship is formed. And anything discussed in this podcast is not represent the views of our employers. We recommend that you seek the guidance of your personal physician regarding any specific health related issues. And with that, have a happy, happy new year and we'll see you in 2022.