June 22, 2019

https://bengreenfieldfitness.com/podcast/fitness-podcasts/best-supplements-for-recovery/

[00:00:00] Introduction

[00:01:15] Podcast Sponsors

[00:04:35] About this Podcast and Guest

[00:08:21] How Marc Gathers, Curates and Assimilates New Information for His Practice

[00:14:54] Current Research on Caffeine as An Ergogenic Aid

[00:20:51] How Endurance and Strength Athletes Differ Regarding Sleep Needs

[00:24:33] Podcast Sponsors

[00:27:49] continuation on Sleep of Endurance and Strength Athletes

[00:30:41] The Relationship Between Finger Temperature and Circadian Rhythm

[00:35:21] How Aerobic Training Can Help the Immune System of Endurance Athletes

[00:42:00] Probiotics as An Ergogenic and Performance-Enhancing Tool

[00:50:42] Up and coming supplement research and diet strategies Marc is following

[00:56:05] Why athletes on a subpar diet show the same blood biomarkers as those with pre-diabetes

[00:59:01] Case Study in Japan On Two Ultra-Marathoners

[01:03:59] Fructosamine Measurements for Blood Glucose Levels

[01:07:43] The Best Time to Consume Carbs Before Training

[01:14:44] Optimal Overall Carb Intake for Strength Vs. Endurance Athletes

[01:22:41] Comparing the Effectiveness of Cold-Water Immersion (CWI) To Cryotherapy

[01:30:57] Closing the Podcast

[01:31:49] End of Podcast

Marc:  Hitting some of these walls where guys and gals are going to struggle, and then maybe catching a bad cold or flu at the wrong time of year, obviously when you're peaking for competition is what everyone's trying to avoid, right? The findings are that you can reduce muscle soreness up to about four days with techniques like this, but it doesn't work the way you think it does. You would think that Olympic athletes are better. If you compare them to age and sex match controls, you actually get poor sleep quality and more fragmented sleep, so athlete health and also strictly for performance.

Ben:  I have a master's degree in physiology, biomechanics, and human nutrition. I've spent the past two decades competing in some of the most masochistic events on the planet from SEALFit Kokoro, Spartan Agoge, and the world's toughest mudder, the 13 Ironman triathlons, brutal bow hunts, adventure races, spearfishing, plant foraging, free diving, bodybuilding and beyond. I combine this intense time in the trenches with a blend of ancestral wisdom and modern science, search the globe for the world's top experts in performance, fat loss, recovery, hormones, brain, beauty, and brawn to deliver you this podcast. Everything you need to know to live an adventurous, joyful, and fulfilling life. My name is Ben Greenfield. Enjoy the ride.

Alright, strap on your thinking caps because we're going to geek out on exercise and sports science, taking a deep dive with my brilliant guest today, who wrote a fantastic book, Dr. Marc Bubbs.

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Welcome to the show. This is one of my favorite times on the Ben Greenfield Fitness Podcast in which I simply get to get an author of a book that I really enjoyed on the show and talk to them about all of the little areas in the book that I think you guys would find enchanting or very interesting. As a matter of fact, I pinch myself with my job sometimes that I just get to read the work of brilliant minds, like today's guest on my show, and then be able to somehow get a chance to talk to folks on the phone who probably wouldn't otherwise normally give me the time of day, but who I can get a chance to chat with about these amazing concepts, in this case, performance and recovery, and record it for you.

For me, that's just–I pinch myself sometimes when I'm reading a book and I'm like, “Hey, I get to talk to this person, this author,” and just dig into more of these concepts and pick their brain is the slightly annoying phrase that goes. So, my guest on today's show wrote this book called “Peak: The New Science of Athletic Performance That's Revolutionizing Sports.” I get a lot of sports books, training books, recovery books, et cetera, sent to me, and most of them are the same old same old, but this one is not. It goes into everything from genetic anomalies that affect everything from response to caffeine, which we'll talk about today, to response to different training methods, to some more advanced concepts in heart rate variability that we'll also discuss today, particularly in response to macronutrient ratios, a ton in there on sleep, on immune system, great end section on sports psychology.

The areas I tended to kind of–it seems fold. The most pages over are more regarding some of the very interesting information on nutrition, supplementation, and nutrients. And so, you'll probably get about 80% of that today in our discussion with some stuff on sleep, some stuff on genetics, and some stuff on cold. And the author of this book is Dr. Marc Bubbs, B-U-B-B-S. As a matter fact, everything you hear on the show today you can go access, including a link to his book if you go to BenGreenfieldFitness.com/bubbs, BenGreenfieldFitness.com/B-U-B-B-S. Marc, I don't want to know what kind of nicknames that you had in grade school with the last name like Bubbs.

Marc: Yeah. Everyone thought Bubbs was my nickname, so that was definitely written on the baseball glove, but there were a few alternatives, but I'll keep those to myself for now.

Ben:  Yeah. Be on Bobby, Bob Man and the Bubbs. Anyways though, Dr. Bubbs is a CSCS, a certified strength conditioning coach, and a CISSN, certified by the ISSN as a sports nutritionist, same as me. However, he's also, and this is probably why the book has such a scientific bent in addition to those certifications, he's a licensed naturopathic doctor. So, he's got an MD certification. And he is the performance nutrition consultant for Canada basketball team. He's a speaker. He's a former strength coach. He also has a podcast, great podcast called Dr. Bubbs' Performance Podcast, and he works with folks in the NBA, in the NHL, and the MLB, private professional athletes. And he practices himself out of Toronto, Canada, which is if you hear a weird accent or overly polite vernacular, that's why, and London, England as well. He practices in London as well.

Marc, welcome to the show, man.

Marc:  Ben, appreciate it, man. Thanks for carrying out sometime.

Ben:  Yeah, yeah, for sure. And from what I understand, a lot of what you go into in this book is not something the average MD will learn in naturopathic medical school. And for me, having gone through a CSCS and also a CISSN, a lot of this stuff is not taught at least in the depth that you go into in the book in those courses as well. So, I'm curious just for you, kind of big picture as an MD and a CSCS, how you go about discovering new information on exercise science or nutrition science, like, how do you effectively assimilate and gather or curate or digest information on performance and recovery yourself?

Marc:  For sure, yeah. I mean, it probably starts back from when I played sport growing up, loads of team sports in high school. And then towards the end of high school, trying to add some muscle mass, trying to gain some size. All of a sudden, I just couldn't escape these colds and flus, these little niggles, these things that were coming up. And so, it was a question of, “Why was I getting so rundown?” I did all the typical tests that you do in a doctor's office and nothing seemed to really help. I'd never heard of a naturopath before, but somebody pointed me in that direction, and with a few nutritional changes, all of a sudden, recovery was on point. The immune system wasn't a problem anymore, wasn't getting cold and rundown.

I think that started on this idea of having a holistic approach to solving problems because I was interested in potentially going into the traditional medicine, helping clients with weight gain, obesity, diabetes, all these things. And I was doing my undergrad at UBC actually out in Vancouver, and this is like 2000s. And I went around asking the different docs around how much nutrition or movement or exercise are we using with patients. The unfortunate reality at that time was that there's not a lot of time in visits, and so these things just weren't really being used much at all. They weren't really on the radar.

And so, for me, that's what led me more holistic or going down the naturopathic medicine route, especially being in an environment in Toronto where there's a [00:10:23] ______, et cetera. And then from there, having the background in sport and conditioning, that's where–reading the research, attending different conferences, talking to experts, experts across a lot of different fields. How does a naturopath view this problem? How would a medical doc–even between dietitians and a performance nutritionist, you might get different slants, not to mention, strength coaches.

So, that sort of philosophy of trying to view the same problem from these different angles is what led to the book. And really, it's what we do at Canada basketball, as the performance nutritionally, working with guys like Charlie Weingroff, our strength coach, and Sam Gibbs, the performance director. That emphasis on wearing multiple hats and being able to see the problems from different perspectives is really big. Yeah, that's kind of how it all came about.

Ben:  And these days, do you subscribe to certain journals, or are you–when I interviewed Naveen Jain, who runs a company called Viome–he's kind of a super billionaire. He's delved into a ton of different sectors. Whenever he's wanting to learn a specific topic, he'll subscribe to all the different Twitter feeds on that topic, from folks who are putting out research in that specific area, or who are forward-thinkers in that specific area. Other people subscribe to journals. I tend to subscribe to journals, and also digest, like Alan Aragon's Research Review, or the Examine Research Digest, for example, or a couple of my sources of information. But do you have any digests or journals or folks you follow to keep yourself up to date on information?

Marc:  Yeah. I mean, definitely across multiple disciplines there, whether it's ResearchGate following various practitioners, a lot of it. I find the best way even just talking to various experts, so having some friends in different fields, and then asking them what they're reading and what papers are coming down the pipeline, and they'll flip them over to me, and even better if they're the experts, the researchers on the frontlines doing the work because there's so much nuance in the studies that doesn't even get into the paper. So, I always find that a bit fascinating of what their take is across–more so than even what's the next, or a conclusion, or the summary of the paper.

So, yeah, those are sort of the different ways of getting the information. And then from there, it's great nowadays as you mentioned. I mean, the things like Twitter and the different subscriptions you can get. You can really go down different rabbit holes, but it is a matter going to so many hours in the day. So, you definitely have to figure out which areas you want to focus on.

Ben:  Yeah. And it's definitely not a case of simply reading the gawker or the–gawker is one culprit there. There's a lot of different websites, medium, et cetera. But case in point just this morning, someone shot me over a “study” on an Instagram message, and I said that coffee could inhibit blood flow to the brain. Therefore, you should be careful drinking coffee before cognitively demanding activities, which is quite paradoxical of course and flies in the face of what we'd expect. And of course once you open the article and read it, it was one case study, an MRI in which a woman was given an acute dose of 400 milligrams of caffeine, and then they measured blood flow to her brain and found that some amount of vasoconstriction, which is not surprising, seem to occur in response to caffeine that slightly, ever so slightly reduced blood flow to the brain.

And A, there was no human clinical research being done. There was no control group. There was no actual executive function or cognitive performance test. It was simply a blood flow MRI on one person who had a very high acute dose of coffee. It's so difficult these days when something like that is read by one reporter and then they turn around and write a headline that says, “Essentially, coffee makes you stupid.”

Marc:  Yeah. It's amazing how it contributes to this sort of fatigue that the general public gets around. Like, one minute, something's good for you. The next minute is not good for you. And then, unfortunately, the messages just get lost and all the mess because people just throw their hands up in the air because–is coffee good for me or bad for me, right? Thankfully, I'm a coffee lover, so I just roll with it.

Ben:  Yeah, yeah. Me, too. I mean, of course, there are some genes–we can get into genes, too. There's that CYP1A2 gene you talked about in the book with regard to athletes. Actually, why don't we just talk about that right now since we're on the topic? Caffeine, for example. It's a known ergogenic aid, and you discussed it pretty heavily in the book, but it appears that it can actually, speaking of deleterious effects of caffeine intake, affect certain athletes, especially pre-competition or pre-workout in a negative manner. Can you go into that, and how one might find out if they are good responder or poor responder to caffeine, and what the deal is right now in terms of the research on caffeine as an ergogenic aid?

Marc:  For sure, yeah. I mean, this is the work of Dr. Nanci Guest from University of Toronto in nutrigenomics. A few years back, she was investigating how your genes, specifically when you mentioned the CYP1A2 gene that you possess, how that controls, how quickly, or not so quickly for others, that you metabolize caffeine. She recruited, I believe it's over 100 male athletes, so pretty well-powered study, and they did a cycling time trial under three conditions. There was zero caffeine, two milligrams of caffeine or four milligrams per kilogram per day of caffeine.

And so, what she found–depending on the variant that you had. So, if you had the AC gene variant, which is typically considered a slow metabolizer, which, unfortunately, I am, you didn't get any benefit in performance. Whereas the AA gene variants, these are the fast metabolizers, they both got benefit at the 2 milligrams and 4 milligrams per kg per day dose. But one of the really cool things about her work was that there was this CC genotype, which she refers to as the ultra-slow metabolizers, which is basically nobody wants to be this type if you enjoy coffee because it means you're going to be really sensitive to caffeine. And they actually got a worse performance outcome at four milligrams per kilogram per day. It's early days and a lot of the work around nutrigenomics, but there are some gene variants that are very actionable, and this is definitely one —

Ben:  They were at four milligrams per kilogram. Let's say, someone who weighs 80 kilograms, we're talking about 300 to 400 milligrams of caf. So, the equivalent of basically like three to four cups of coffee in slow metabolizer would be about what we're looking at here with this particular study or this research.

Marc:  Yeah. And it's sort of three to four cups, when we look at the research, how they define a cup, I think the tricky part in the general public is that if you go to Starbucks and get a venti, you're already there, right?

Ben:  Oh, yeah.

Marc:  You're at the 450, 500 kilograms.

Ben:  I think it's actually, it's eight ounces I think is what's considered to be 100. And I don't know about you, but my coffee cup here at home is–my mug is effing enormous, like it's probably a 20-ounce mug. So, I actually, in a single cup of coffee, am probably getting closer like 250 or so.

Marc:  Yeah, for sure. I think most people are the same. It's a little bit different when you come over to London or in the Europe, they get the smaller European-sized cups, but otherwise, yeah. In Canada or the U.S., we're typically getting a bigger dose every day.

Ben:  And so, when it comes to actual exercise performance, the general advice is you deload with caffeine for 10 to 14 days, try not to drink too much coffee, and then on race day or competition day, you then consume a relatively high amount. From what I recall, just based on memory, it is in that kind of 400-milligram-plus range, and that results in, in many cases, increased time to exhaustion or faster time trial performances, et cetera. But what you're saying is if someone were to test themselves and they have the CC genotype of this CYP1A2 gene, and there are slow caffeine metabolizer, or I guess you said an ultra-slow caffeine metabolizer, is there actual research that shows that that hampers exercise performance?

Marc:  I believe Nanci was the first to show that. From a practical standpoint, most people are going to naturally feel if they take caffeine before an event, they feel pretty good, they perform well. You're likely doing all right. Now, there's going to be folks in the middle there that take caffeine and aren't really sure if they're doing that well or a bit confused as to how it's impacting them. And I think those are the people–especially as it relates to endurance, because this study was done with endurance athletes, that can be worthwhile. They dig a little bit deeper and find out what your genes are telling you.

Even then, the first protocol would be 3 to 6 milligrams per kilogram per day is sort of that sweet spot. And some would argue that 3 to 4 milligrams is really the sweet spot. As you get towards 6, you might start to get some symptoms of like the anxiety and whatnot. And you actually see Joseph Gerges (ph) did a recent great review around strength training. Actually, for 1RM, you had some benefit up at 8 or 9 milligrams per kg, but you wouldn't want to be doing that for too many days in a row, or else you might not be sleeping too much.

So, you definitely want to be specific when you're taking it and timing it, or if it's training, you might have a different dose as you build up. If it's a competition day and you can tolerate it, then you might be going for some higher dose, as you mentioned, to help with things like–or capacity, perceived exertion, things like that.

Ben:  Yeah. Well, fortunately, this is one of those deals where you don't have to go and get a fancy genetic test. I believe 23andMe, for example, they test from that SNP. And so, it's very easy for you to just go to your 23andMe results, pull up the CYP1A2 gene, and I'll name that in the shownotes as well. For those of you who just want to go to the shownotes at BenGreenfieldFitness.com/bubbs, you can check it out. And you just look at that and you see whether you have the CC genotype. And if you do, maybe, and especially if you're an endurance athlete, avoid caffeine prior to competition.

Marc:  Yeah. It can be bad news for some folks, unfortunately, but yeah, that can be the reality.

Ben:  Yeah. And I guess we could pivot straight from coffee to sleep because you have a couple of fantastic chapters on sleep. And one of the things that I highlighted, and I folded over a page about this, would you briefly allude to the fact that–I think what you say is that endurance athletes seem to need more sleep than strength athletes, although both suffer when sleep is anything less than six hours, there's like a dramatic drop-off in performance. But what's the deal in terms of sleep and the difference between endurance versus strength athletes?

Marc:  Yeah. I mean, that's an interesting question, and one that came up with pretty much all the sleep experts that I talked to and working from it, and then building out of the books of Dr. Amy Bender, the Canadian Sport Institute in Calgary, Dr. Cheri Mah in the U.S., Dr. Ian Dunican out in Australia, and Shona Halson as well, Dr. Shona Halson. Dr. Bender was actually one of the ones who really brought this to my attention of endurance athletes typically faring better with aiming for the upper end of the sleep requirements or suggestions.

National Sleep Foundation recommends seven to nine hours. Typically, athletes were trying to get them to get at least eight. And in some research and Dr. Mah's research, there are upwards of trying to get to even 10 hours a night with adding some naps and whatnot. But the reason why, and they're hypothesizing here, is obviously with endurance athletes, you have inherently a greater volume of training. You also have typically more early morning sessions, right? And so, all these things are going to be cutting sleep short a little bit, increasing the sensation of fatigue. And in an endurance sport, you tend to be treading that line a little bit more as well, razor's edge between that adaptation and pushing a little bit too far.

So, sleep is definitely a really important one, and to a person, and particularly, Dr. Halson there with recreational athletes, I mean sleep is the number one recovery tool that she's emphasizing with clients. And today, it's nice because clients know more about sleep, but again all of them would agree that it's the actual application, right? You get a lot of head nodding from your client or athlete saying, “Yeah, yeah. I know sleep is important.” But actually, doing it, actually adding in an extra half hour a week and building that up over time is something that they still struggle with.

Ben:  So, it's the endurance athletes who seemed to suffer most from sleep loss versus the strength athletes?

Marc:  Yeah. I mean, it was interesting in terms of some of the studies, whether this is because they're collegiates, but collegiate weightlifters on zero sleep performing 1RMs the next day had no decreases. So, that could be particular to having those real intense exertions, but it does seem that the endurance athletes can be a little bit more prone to this. And we even see this in some of the research on one night of bad sleep. So, some research in cyclists doing a time trial the following morning, they would see reductions in their time trial performance.

That's where most of the experts are going to be suggesting to folks aiming for that upper end of eight to nine hours of sleep. Even when we look actually across elite athletes, like if you look at some of the studies done in South Africa, 800 national level athletes and 75% are getting less than eight hours at night. You would think that Olympic athletes are better. Olympic athletes, if you compare them to age and sex match controls, you actually get poorer sleep quality and more fragmented sleep. So, it's something that performance, not only performance nutritionists obviously but sports scientists are always trying to support in terms of athlete health, and also strictly for performance.

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Yeah. At first, it seemed counterintuitive to me because I would have imagined that the more well-tuned the nervous system needs to be, for example, when it comes to motor neuron recruitment, or when it comes to precision of motor patterning, that the strength athlete or the person engaged in heavier lifting or a more precise movement pattern such as, say, a clean and jerk would be the population that needs more sleep. But then when I guess you think about or even look at the literature around this, things like growth hormone or your non-REM sleep phases have been shown in many studies to affect substrate metabolism. And especially decreased growth hormone can limit substrate utilization when it comes to like altering carbohydrate metabolism.

And so, I suspect just because endurance sports tend to also be the more metabolically demanding of the sports, if you're looking at an athlete, especially any athlete who's above their lactate threshold, or even to a certain amount above their aerobic threshold, you see increased reliance on all substrates, but particularly carbohydrate metabolism. And so, I would imagine that comes into play versus the strength athlete who may–depending on what kind of strength or power athlete they are, they might have access to like creatine phosphate pools, and ATP pools, and other forms of energy that don't require the same substrate metabolism that would be altered by a drop in growth hormone from sleep deprivation in someone who needed more carbohydrate availability or metabolic throughput during exercise.

Marc:  Oh, for sure. And I mean, it's not just even that strength athletes don't need sleep because we know from the research that that's obviously the case and they perform better overall, making sure they get enough. As you mentioned, I mean yeah, longer sessions for endurance athletes, more sessions in the week, it's a grind. The interesting things here, actually Olympic athletes, it's different than even professional athletes because they obviously typically have a job or two to support themselves. There's not as much funding as you think there might be. So, their days are–the life load is actually a big part of the recovery piece. And for them, they're balancing a lot of different things in the day as well, right?

Ben:  Yeah, yeah. And when it comes to this too, it makes me wonder if there's a way to, if you were a sleep-deprived endurance athlete, to get more substrates on board that could allow you to stave off some of those issues like the use of, say, like ketone esters and maybe creatine phosphate, or something like–even ATP, for example, to allow you to have more access to bioavailable substrates even in a sleep-deprived state. It would be interesting to see a study on something like that.

Marc:  Oh, 100% for sure.

Ben:  Yeah. Now, another area that you delve into with sleep is regarding these so-called zeitgebers, which I've talked about before on the show, but things that can normalize circadian rhythm or jumpstart the circadian clock at the beginning of the day. For example, exposure to light, some type of movement, some type of meal to stabilize circadian rhythm. But one thing that you get into that I hadn't seen before was temperature. And the fact that it turns out that one of the first zeitgebers were exposed to when they wake up in the morning is a change in hand or a change in finger temperature that seems to actually drive an overall core temperature change that can influence sleep drive. Can you go into that a little bit, what the relationship between finger temperature and circadian rhythm is?

Marc:  Yeah. I mean, that's a fascinating tidbit. That was actually something I first heard from Dr. Dan Pardi when he was on my podcast.

Ben:  Oh, yeah. Dan is great.

Marc:  It really stuck out for me because it's not something that you naturally think of. His work and the work in his lab that they're doing more investigations on is suggesting that our sleep environment, obviously through evolution being outside, that the fingertips were the first area of the body that's sensing these changes in temperature, and then it's being relayed to the brain and throughout the body. And so, it is a pretty interesting phenomenon. I think it's early days now in terms of the work that Dan's doing on that. It seems to suggest that obviously, sleep environment is really that important. Your sleep environment at home or when you're traveling, making sure you've got the right setup, is probably going to be pretty crucial.

Ben:  What about the idea of–because I was thinking about this when I was reading this section, like if your body, if your circadian rhythm in the same way that looking at natural light or large amounts of blue light in the morning, eating a well-timed morning meal, moving in the morning, et cetera, all these things can jumpstart the circadian rhythm. What about some kind of, and this is where my mind went, a device that one could use that if you're trying to alter your circadian rhythm, let's say you want to send your body a message that it's 7:00 a.m. and you've traveled from the west coast to the east coast, so it's like 4:00 a.m. for you when you're waking up on the west coast at 7:00 a.m., that you might be able to jumpstart things by changing the temperature of–like, literally putting your hands or your fingers in warm water or even some kind of like a–like if someone were to develop some kind of a device on the bed stand, you could just place your hands on it, it warms the hands very quickly. I wonder if that would actually affect circadian rhythm significantly.

Marc:  I mean, those types of zeitgebers or jet lag strategies are definitely something that's used and needed and lead sport. I know Dr. Ian Dunican, who's out in Adelaide–excuse me, Perth in Australia, he worked with the Western Force out there, and they actually, a few years ago, traveled the most kilometers of any professional sports team in the world. I mean, going from Australia to South Africa and back up to Japan. So, he works a lot with different jet lag strategies and circadian strategies. I mean, in terms of technology, I think that would be definitely something to look into to be able to facilitate that action there and trigger the whole response, right?

Ben:  Well, seriously, it's like that Stanford cooling glove. Someone developed the opposite of that for the morning. You put on this glove in the morning and warms your hands, although I suppose you could just like put on a pair of ski gloves and drop a hand warmer in there and kind of make your own MacGyver version.

Marc:  Get your blue light glasses on and your gloves and you're good to go.

Ben:  Yeah, exactly. Or no. In that case, you'd want no blue light blocking glasses. You'd want blue light producing glasses, and then some hand warming device. It's interesting though, I sleep on one of these chiliPADs that circulates water at about 55 degrees under my body while I'm asleep. And I did notice there's a function on there where if you pair it to your phone app, you can actually have it during a certain phase of your sleep cycle. I think it's your lightest sleep cycle. At some point during the morning as you're waking up, it'll switch from cold water to warm water. Maybe I could actually experiment with something like that and see if that causes especially a faster change in circadian rhythm after I've been traveling. I haven't really messed around with that feature on the chiliPAD before, but it's an interesting thought pattern.

And another thing that you get into is the immune system. You talk again about like strength versus endurance athletes in the immune system, but one thing that you recommend is aerobic training for strength athletes, particularly with regards to immunity. What exactly are you getting at there?

Marc:  Yeah. In terms of the book, we have a whole section on recovery, and one of those chapters is all about immunity. One of the themes of the book is trying to connect people to all the different experts across the world who are doing all this research on the frontlines. A couple of years ago, I had the chance of going to the International Society of Exercise in immunology. They hold a conference every couple of years and this one is out in Portugal. So, pretty nice place to go and take in some talks.

Ensuring athletes have a decent aerobic base when we look at the research, regardless of the sport, is a pretty effective tool, not only for recovery but on the immunity front. When we look at the immune system, you have experts now like Dr. Michael Gleason from Washburn University, who talks about how elite performance is incompatible with frequent illness. So, if you rundown all the time, if you're tired all the time, you just can't get the training days in to keep pace with the people who are really elite.

And so, depending on your sport, if you're more strength-based in America, you think of sort of offensive lineman, d lineman, sports like that where they're more strength power based. Maintaining an aerobic base is going to help to support innate immunity, right? So, your body is the foot soldier, so to speak, of the immune system like your macrophages and neutrophils. And these guys are [00:37:00] ______ line of defense, protecting you against foreign intruders.

That was an interesting one because we know, in terms of concurrent training, adding a little bit of aerobic training even if you're a powerlifter isn't going to have any detrimental effects on performance, so long as it's drip-fed in in a strategic way. And I think that's definitely one that the guys or gals are struggling with immunity. It's one that tends to be forgotten if you're more on that power end of this spectrum in terms of your sport.

Ben:  So, basically, what you're saying is that if you're a strength athlete, that including some element of aerobic training in your protocol would actually result in an improvement in immune system strength?

Marc:  Yeah. And of course, you're always trying to pick out players who are struggling with this type of thing. So, if you have an athlete who's not getting sick, not missing practices or days of training because they're rundown or tired or have symptoms of an upper respiratory tract infection, then that might not be a priority. But if you're starting to see athletes that are struggling that you're red flagging because they're always rundown and missing sessions, et cetera, then that can be something that you might want to look at to be able to support innate immunity, right, to be able to fight off some of those bugs before they cause an infection.

Ben:  Yeah. That's interesting. I think that some coaches might myopically look at a strength athlete and say, “Well, we don't want any, say, fast-twitch, slow-twitch, muscle fiber conversion, or we don't want to do the type of concurrent endurance strength training that could potentially limit power strength adaptations. But if you're looking at it from purely a performance standpoint, and not perhaps stepping back holistically and saying, “Well, maybe we'll see a slight downregulation in strength and power,” that might not even be from a performance standpoint significant or meaningful, but this athlete would see a robust improvement in immune system strength. Therefore, fewer sick days, more training days with the inclusion of aerobic training. You would include that in that athlete's strength conditioning protocol anyways.

Marc:  Yeah. I mean, it's a form of active recovery as well, right, when you're doing at these low intensities. And so, it can be a great way to support recovery on the back-end of that. One of the stats that really jumped out at me to researching the book was the fact that national level athletes get sick about 30% to 40% more than international level athletes. Again, just keeping yourself well enough to show up the train is a huge piece of the puzzle that we tend to forget because it's tough to have that real 30,000 macro view of looking at your whole year versus it's easy for us to get stuck into what's happening day to day, or even week to week.

So, that's definitely one that–and when you look at the research, guys like Dr. Neil Walsh as well, University in Wales, talks about how even symptoms, even just upper respiratory symptoms, and not even the actual infection. So, just the scratchy throat and dark circles under the eyes, kind of these types of things also reflect–are associated with poor performance. So, if you're a coach, practitioner, these are some of the things that you want to be paying attention to so that–it's great that your athletes may be pushing through a little bit on some of these things, but you do want to note them and see where things are trending in terms of how they're progressing with their training, what their daily wellness or subjective feeling might be, trying to triangulate some of those metrics so that you can avoid hitting some of these walls where guys and gals are going to struggle. And then maybe catching a bad cold or flu at the wrong time of year, obviously when you're peaking for a competition, is what everyone is trying to avoid, right?

Ben:  Yeah. That's interesting. It probably returns to the sage wisdom of some trainers. I remember, for example, there was one guy who coached Ironman triathletes back in the day. Blake [00:40:47] ______, he coached a bunch of teams over in Thailand, and he would–actually, rather than using something like heart rate variability as a recovery or readiness quantification, he would simply look the athlete in the eye and tell them what their training was going to be for the day. Maybe just paying attention to those black circles or something like it.

Marc:  That's it. I mean, yes, objective wellness is a pretty darn good indicator. The other crazy thing on the immunity front, Ben, to go a little bit further here are things that are–these fundamentals that just aren't as sexy as some other things, like washing your hands. In terms of immunity, just simply handwashing can reduce these rates of infections 30%, 40% as well. And so, that sort of blew me away, and even have PhDs who've done work around what parts of your hand are we typically missing.

So, if people really want to geek out on the handwashing, the fingertips, the webs of the fingers and the back of the thumb or the spots, you really got to get after. Feel like you're going into the OR or something when you wash your hands. But in the wintertime, if you could do that frequently, you'd be amazed at how that can support better immunity, especially if you've got little kids at home and you're busy, stuff like that. That's when the colds and flus just really work their way around the house, right?

Ben:  Yeah, yeah. One thing that's often recommended for the immune system is the use of probiotics, just because of the link between of course the gut and immunity. You actually though, in a discussion of a few different ergogenic age, actually discuss probiotics as a sports performance enhancement tool. What's the actual research behind that? And how would a protocol actually work to use probiotics to enhance performance?

Marc:  Well, this dovetails on that whole idea of immunity and keeping athletes healthy, and the research by guys like Dr. Nic West from Griffith University in Australia, as well as his colleague, Dr. David Pyne from the Australian Sports Institute. This goes back a few years, but in the early stages, I actually think it was in preparation for the Beijing Olympics in 2008. Again, they were looking at all the research with respect to upper respiratory tract infections, how can we make sure our athletes aren't succumbing to these things at the wrong time of year.

And so, they pulled together all studies around probiotics and upper respiratory tract infections. And what they found was about two-thirds of the study were showing benefit in two key areas. One of them was actually preventing the upper respiratory tract infection. And the second one was reversing it, right? So, really shortening the severity or the duration, which again is massive. I mean, we're in the midst, at the moments of the NBA Finals. Again, you got some guys who've gotten some colds and flus.

So, being able to limit some of the duration and severity is huge when it comes to whether or not an athlete can feel their best and perform their best at the subsequent game. That was a pretty fascinating one. They go into some strategies again around–again, if you have an athlete struggling with poor immunity, how do you layer this stuff on? Well, you definitely want to trial out the probiotics before your competition. They suggest starting two weeks out, right, because some athletes can actually get some adverse acute effects. So, you can throw off your bowels a little bit for a few days. So, this is just warning athletes, giving them a little bit of a heads up.

And we have different strains in the research, lots of different strains being examined, lactobacilli fermentum, rhamnosus, caseis in there. We see a lot of work around bifidobacterium. And so, you see a recommendation around 10 billion cells per capsule, but of course, you'll get a lot of researchers in the probiotic world. It will tell you it's more about the strains and it is about the dose. But again, all this seems to come back to this idea of supporting recovery, supporting immunity, and just making sure those athletes can be in the gym, hit those training sessions and then be available on match day or competition.

Ben:  When you look at something like caffeine, which we discussed earlier, or beet juice would be another thing that the body responds quite well too in terms of like a loading protocol, leading in a competition, like loading with beet juice for two weeks or abstaining from caffeine for two weeks then partaking in caffeine on the morning of exercise with something like probiotics, would there be–another one that comes to mind, by the way, is colostrum. There are other studies that show that especially for athletes competing in the heat, loading with colostrum prior could reduce gut permeability, and also assist with performance, particularly in the heat. When it comes to probiotics, do you know if there's like a loading protocol or a certain period of time one is supposed to be on a probiotic leading up to an important event, like let's say somebody has signed up for an Ironman triathlon or something like that in order to get some of these effects?

Marc:  In the review that they did, in the research review based on the available research, it suggests that there's about a two-week lag between when these effects are taking root in terms of the beneficial effects from the bacteria. Now again, you'll talk to some researchers who'll tell you if you get the right straining combination, that within a few days, you might get this effect. We've always got to go with the evidence base first. So, if you're working in team sport, whatever else, then you might want to make sure you're starting two weeks out to cross all your t's and dot all your i's. But if you're working with an individual athlete for a competition or whatnot, then layering these things in a few days' time could have an effect. You just want to make sure you're not throwing off anything if they haven't trialed it before, right?

Ben:  Yeah, yeah. It is interesting though. I think a lot of people think of that again as just immune system aid, but I think it's worth a shot. Maybe if you are an athlete that deals with gut issues, actually try something like a probiotic or a probiotic colostrum stack leading up to a big race, especially one in which you're concerned about your gut health interfering with performance. It is interesting. That's not something I've seen before much talked about in the research on probiotics was there their effect on sports performance and in a positive manner.

Marc:  It makes doing some work around investigating how certain microbiome signatures will actually elicit greater caloric outtake. You'll get more calories from the food that you eat. Now typically, these folks are folks that are pre-diabetic and hyperinsulinemic, et cetera. But the idea here is a bit like what you're suggesting is if you could get that sort of signature or even a probiotic that contain that into someone who's fit and elite, and they can get more calories from the food that they're eating, that's a potential performance aid.

And they did actually, in terms of performance, as you mentioned this idea of establishing a signature, a microbiome signature for elite athletes, recreational and sedentary, and they did find some of those trends around different strains. So, your bifidobacterium, your akkermansia, et cetera, that were typically found in elite athletes, in the elite endurance athletes, as well as things like rugby. So, yeah, it is really interesting.

The question there becomes is it the chicken or the egg? Are they fit? And then the microbiome signature takes root, or the other way around. From what I gathered from interviewing and chatting with them was at least we can use this microbiome signature. It has a real marker for athlete health. So, if we're seeing really low diversity, again it doesn't necessarily mean we do a reductionist approach and just try to increase diversity, but it does mean we have to have a conversation around, “Okay, what's going on in the nutrition exercise, lifestyle side of things?” And typically, if we fix those then the diversity will start to come back up for sure.

Ben:  I can just imagine all the probiotic supplement companies that will pop up that will have something like probiotics isolated from Steph Curry's fecal matter that you can take to become a better basketball player.

Marc:  Shoot 50% from 3s.

Ben:  Yeah. I mean, all joking aside, I do know that when you talk about what came first, the chicken or the egg, when it comes to the microbiome, sure, there's evidence that certain bacterial species are responsible for certain elements of immunity or capability to digest or not be able to digest certain foods or blood sugar response to certain foods. But there's actually not a whole lot of evidence that says, “Okay. Well, based on this bacteria strain, X, Y or Z causing X, Y or Z effect, if you were to take this strain, it would cause you to get that same effect.” All they've really shown in most research so far is here's what the biome looks like, but there's not a whole lot of research showing, “Well, you take this probiotic to get your biome to look like this one and you'll see the same results.” So, I suspect it's the–I guess that would be the egg came first, not the chicken.

Marc:  And that's what they're all mentioning. I mean, the gut is really like a black box. And so, we need to be cautious with these interpretations. One of the big things as well as around the use of antibiotics and things like amoxicillin, a standard antibiotic that's used, wiping out about 95% of diversity in the gut. This is Dr. Lauren Peterson's work. If you didn't have a decent diet or take some kind of probiotic, prebiotic, then a year later, those folks still have the same eradication. They have the same level of diversity. So, that really hammers home how that flu first approach is pretty key.

Ben:  Yeah, yeah. And there are other supplements of course that you mentioned in the book. I've tweeted out research on a lot of these before that are probably the most well-proven supplements when it comes to exercise science. Caffeine, we already talked about. That's got a great deal of research behind it, as does creatine. I know that beet and any of these nitrate precursors like alanine, for example, may also have some kind of an effect. Whey protein, you talked about that, even using baking soda or sodium bicarbonate. If you can get past the gut distress and do kind of microdoses and a couple of hours leading up to a hard workout or race seems to have an effect. But do you think there's anything else, aside from the probiotics that we already talked about, any kind of up and comers in terms of supplement research or things that you're interested in when it comes to specific dietary strategies that you think are gradually building a strong track history for themselves?

Marc:  Yeah. It was interesting looking into the supplement side of things. I mean, as a lot of practitioners, I have a food first approach to fueling athletes, for clients as well. But supplements can definitely provide a boost. Oftentimes in sport, those small margins are pretty important. And so, one of the themes across the book was showing some of the supplements that have this–they continue to pop up in different chapters, whether you're talking, fueling, or recovery, or immunity. You tend to see a lot of the same names popping up around creatine, or whey protein, and we talk caffeine. And so, that was the real emphasis of the book, to whittle it down to some of the major players.

You mentioned already, but nitrate precursors I think for things like beetroot and rocket, arugula, for a lot of the recreational athletes, guys and gals who are maybe in their 40s to 60s, gained a little extra weight, blood sugar is a little high, maybe hypertensive, that's a pretty nice way to get a bit of a performance boost and supports overall health as well, right, because we know it works better in recreational athletes than elite athletes, which is somewhat normal obviously. The elites, there's very little margin for gains there.

But that's one that can be a pretty nice strategy to get this upregulate a nitric oxide, then more of a vasodilator effect and support overall health, as well as performance, because I think sometimes, particularly endurance sports, when we talk recreational, you get guys and gals who are training for whether it's a marathon or some cycling event. And after three months of dramatically increasing their training volume, they've struggled to lose much weight. And so, that's typically a really good sign that you've got the wrong nutrition approach, right? There's got to be some tweaks there to be able to help support some weight loss along the way.

Ben:  Yeah, yeah. Well, some of these things I know get talked about a lot such as peptides and SARMs, and different kind of lesser-known molecules, I guess things like HMB or ATP or anything like that. Have you looked into much of that or did you come across research on any of these type of things during the time you're writing the book or at other times?

Marc:  I mean, a little bit. There are the ones that came across the research and it's more around–from a practical sense, there's only so many things we can do with athletes in terms of layering in some of these strategies. So, you're always trying to find the ones that are going to give you the biggest bang for their buck across multiple areas. But even in terms of endurance sport, things like nicotinamide riboside is sort of an early days that might be providing some support.

On the concussion front, you mentioned ketones before with various forms of ketones that can be providing an alternate fuel source for concussion recovery. I think those are pretty interesting because when it comes to concussion, we always think of elite sport, whether it's football or ice hockey, guys getting hit, but we tend to forget that. Adolescence teens have a really high rate of head trauma, and that girls get affected more than boys. I mean, I don't think most people would guess that women's ice hockey is the number one risk for head trauma, right? So, I think some of those strategies are pretty interesting. It's issues that are pretty current, and then it's early days in the research, but hopefully, there would be some effects there.

Ben:  Yeah. Obviously, a lot of the stuff that you'll see in like anti-aging or longevity medicine is looked at with a wary eye by USADA and WADA. And I think the majority of the peptides aside from, I believe, BPC 157 are frowned upon or named in the WADA schedule. And I think the same thing with most of the selective androgen receptor modulators out there like SARMs, et cetera.

But then there are others that I think seem to be amassing a little bit of a growing body of research behind them that I think could be effective, things like I mentioned, like colostrum or like HMB for strength and power athletes. Yeah, nothing touches the robust research behind creatine, caffeine, nitrate, whey protein, beta alanine, and sodium bicarb, but it'd be cool to see more research done on some of these other tactics. I mean, heck if they're safe. For example, I consider peptides to be very safe, at least most of them. It'd be interesting to see more athletes becoming aware of stuff like this as well.

Marc:  Yeah. I mean, once the athlete has their fundamentals in place, once they're able to hit their macros or calories, their protein, their carbohydrates, whatever they need in terms of that sense. I'm all for guys and gals trying stuff that's going to help to give them that edge. And typically, it'll be driven a lot by the athlete. If they think it's going to be something that's going to help them, and the risk profile is really good and their benefit is potentially there, then I think there's always an opportunity.

Ben:  Yeah, yeah. So, shifting in a different direction. One of the things that really struck a chord for me I guess about six years ago when I began to delve into more self-quantification and blood and biomarker testing. At the time, I was racing triathlon and thought myself to be metabolically healthy with a huge aerobic engine. However, I tested some things like cortisol and thyroid and the endocrine system and did find testosterone dysregulation. I found rampant inflammation. I found a very high TSH with low bioavailable T3. And I also noted some pretty concerningly high levels of insulin, and also glucose, ironically, with as much as I was exercising.

And you mentioned in the book how elite athletes have been shown to have the same blood biomarkers as those with pre-diabetes. Now, why is that? Was there a reason that seemed to exist? Was it just like an anomaly or what's the deal with the pre-diabetics in folks who are heavily exercising?

Marc:  Yeah. So, this is definitely an interesting area. It sounds like I had a similar episode to yourself, or a few years ago. I was traveling a lot. I was on planes and I had a scheduled blood draw after taking a red-eye from one side of the country to the other. And all of a sudden, I get my labs back and fasting glucose is really high, and some of these metrics around inflammation are really impacted. And so, in researching the book, things like continuous glucose monitors now are becoming more and more prevalent in the research.

And when we looked at–the studies I looked at around sub-elite endurance athletes. And so, they used a CGM on about 10 athletes. They're just observing what's going on for a week. They're fueling strategies, and of course, classically, an endurance set sport, as you would know, Ben. We're more concerned about hypoglycemia than hyper, right, because there's all the exercise. We just assume this is all going to be used up pretty nicely. And in the study, four out of ten participants spend 70% of their time with their blood glucose in this pre-diabetic range.

Now, this doesn't mean they're pre-diabetic, but it shows that exercise is a stressor, and that's going to contribute to raising blood glucose as well. Even the authors in the study were pretty quick to note that again, traditionally, we've been worrying about hypoglycemia, but this notion around hyperglycemia and really overfueling may be more of a problem than we think. And that circles back to our conversation around the recreational athlete who is not losing weight but training for a marathon or a cycling event. And this is troubling because when we talk about people just want to be fit and healthy as they get older, and all of a sudden, you're engaging in a sport that you're feeling so much that actually, you might be contributing to worsening your health rather than improving it.

That was really interesting. And there's also a case study that was done in Japan. This only had two participants. They were ultra-marathoners. One was elite and one was sub-elite. And so, things like fasting morning glucose again is a way of generally assessing training stress, life stress. And so, as you get up above 100, that's typically going to let you know that whether it's a fueling issue or maybe–it's fine if it's there if you're training hard, but it's purposeful. And when you have a chance to rest or deload, it should come down.

But in this study in Japan, the elite runner is waking up with a fasting glucose around 90. The sub-elite is waking up with a fasting glucose around 110. And as you watch the glucose throughout this 100-mile race, now you can actually see this sub-elites' glucose rising and rising and rising throughout the first 60, 70, 80 miles. And then all of a sudden, just bonk and velocity goes right down and the racer just really struggles in those last 20 miles. Whereas, the elite runner has got their nutrition dialed in. The velocity stays pretty consistent and they come through across the board with a good time.

So, it seems to be this might be more of an issue around not the elite athletes, but those ones that are even–when we call it sub-elite, I mean it's tough to quantify, but I think one of the–Andy Jones is a researcher in the UK who worked with the Nike Breaking 2. He worked with Eliud Kipchoge. And he had a great story about how to frame the difference between a recreational elite and an elite. And he talked about a friend of his who was a really great runner for an amateur, and they're doing an exercise test, and he gets up to about 16 or 17 kilometers an hour, and he is just tapped out. That's it.

And of course, he's the last one. All the elites come over thereabout to get tested. They start the testing at 17 kilometers an hour and build up from there. So, it's pretty amazing at how they really are just a different animal, so to speak, in terms of that elite's level. But yeah, you're right in the sense. Fueling is one that's pretty important. And when we look at just around general health too, I mean that's one that fasting glucose–when you look at even healthy populations, if you're in the upper quartile, so the top 25% in the normal population, a 20-year observational study showed that you had a 40% increased risk of cardiovascular mortality. And they extended that out to a 33-year observational study called the Whitehall Study, and that showed a dose-dependent response as well. So, the worse your fasting glucose, then the greater risk you had. It's definitely one that I know all the docs are keeping an eye on, but I think it's one that we don't normally associate training stress from that, or even having a poor fueling strategy for a more advanced athlete.

Ben:  Yeah. And it is interesting because I've noted in myself, for example, that my–I wear a continuous blood glucose monitor these days, and I have noted that when I am exercising more, especially while following a lower carbohydrate protocol, my average fasting blood glucose is actually higher than it is. If I'm eating more carbohydrates or exercising less, it ranges from about upper 80s to upper 90s when I'm eating low carb, when I'm exercising. Whereas, it's typically like mid-80s or lower if I'm not.

From what I understand, part of that is the slight downregulation in GLUT4 transporters and insulin sensitivity that can occur in response to a lower carbohydrate diet because some of those mechanisms simply are not as necessary. And so, I do know that there are some scenarios in which blood glucose can be elevated, but it's not necessarily a bad thing, and that glucose has a relatively transient time or low amount of actual time spent in the blood due to the fact that it's being utilized for fuel, and there's not that much of it.

But in many cases, especially for athletes on a poor diet, or athletes with rampant inflammation, or athletes following the traditional, I guess 55 to 65-ish percentage of the diet from a macronutrient ratio coming from carbohydrates, there can be high blood glucose and high insulin values and relatively low amounts of insulin sensitivity that might not be a good thing. You talked about how to test that in the book, and I believe it was either–I think it was actually Chris Kresser who was talking to me about this hemoglobin A1c. And the fact that hemoglobin A1c, the standard measurement for blood glucose in normal non-athlete populations is something that can show the approximate average blood glucose over the past three months.

However, in people with high red blood cell turnover and the difference in red blood cell survival rate, because that test is measuring A1c on red blood cells, you may actually see it to be artificially high in athletes. And you actually talked about potentially an alternative to A1c called a fructosamine measurement. What's a fructosamine measurement? Would you consider that to be more of a gold standard measurement for an athlete who might want to measure their average blood sugar concentrations?

Marc:  Yeah. I mean, definitely, the HA1c is still a good measurement. It definitely skews to your more recent fueling. So, if you're an endurance athlete, whatnot, if in the last month or so you've been fueling in a certain way, then that's definitely going to impact in terms of the readings. If you want to expand on that, depending on getting a better sense of how you're fueling or the impact of the training stress, whatnot, then fructose aiming can be another one that you can measure. And this is effectively a two to three-week window versus the three-month.

And so, what you're doing is rather than measuring–you're measuring effectively glycated albumin versus that glycated hemoglobin from the HA1c. It's typically a more expensive test. You don't see it running in GP's offices because they can get enough of a sense of what's going on with HA1c. But for some athletes, oftentimes endurance athletes getting a little bit more of an acute picture of that two to three-week timeframe can be pretty beneficial to see if you've got the right fueling strategy for the training block or for where you're at with your training.

Ben:  Yeah. And this fructosamine measurement, for people who haven't done it, I think your doc can order that. I think some places you can just order it online, like I believe you can get it from something like DirectLabs. But it's measuring I believe the reaction between fructose and ammonia to average blood glucose. And I think that one thing I should name though, and this is something I find to be the most valuable, is that probably one of the better determinants of metabolic flexibility is simply how long your blood glucose stays elevated after a meal.

And I find that any time I'm metabolically healthy, my diet is solid, my exercise routine is consistent, I tend to see a return to normal blood glucose values, whatever that normal is, whether it's 90 or 95 or 85 within two hours after a meal, two hours after a major meal that might contain an appreciable amount of carbohydrates like 80 to 100 grams plus of carbohydrates. And I think that's really one of the easier methods, especially for athletes or for nutritionists or coaches working with athletes because you can get a cheap-ass blood glucose monitor from Walgreens or CVS or whatever, and just do a few blood measurements on an athlete after they've eaten their normal training meals, and just see if it stays elevated postprandially for a couple hours.

Marc:  Yeah, for sure. I mean, those are nice strategies, especially when they're cost-effective because athletes and practitioners oftentimes don't have a lot of disposable money for some of these things. A good last note here as well, Ben, is around doing some of this testing when again it's a deloading week or a period where the athlete is resting because it's not always–you're going to see some abnormal responses during an intense training block, and sometimes people might overrespond to that. And so, I think it's also important to make sure they're testing during a deload or an off-week because then it should start to return to normal. And if you're seeing abnormal readings after someone's had multiple days off, that's when the red flag should really go up.

Ben:  Yeah. And with regard to carbohydrates, you also talked about pre-workout or pre-competition carbohydrate intake. And particularly, you discussed timing of carbohydrate intake prior to the event. What are some of the best practices regarding timing of carbohydrate if one was toeing the line of, whatever, whether it's a CrossFit workout or a Spartan Race or a football game or whatever, when it comes to pre-performance carbohydrates in terms of timing or composition, whether it's a high glycemic or a low glycemic index carbohydrate? What are kind of the best practices regarding carbohydrate prior to competition or exercise?

Marc:  Yeah. This is pretty fascinating work and it's work that's come out in the last–very recently around halftime nutrition. I don't know if you remember. A few years ago, obviously, the Super Bowl halftimes are longer than normal Super Bowls. And a few years ago, the Patriots were playing the Falcons. The Falcons have the big lead at halftime. I think even the owner came down from the owner's box, which is typically something you only do at the end of a game. And then all of a sudden, Patriots come back a huge second half and win the game.

This idea of fueling, especially in team sport, how it impacts not only your first half but the second half, you see it in sports like soccer, obviously, they call it football over in Europe. The last 10 or 15 minutes is when the vast majority, the goals are scored. Even in sports like basketball, the fourth quarter is such an important time. This first came up on my radar with the work of Dr. Mark Russell who's from Northumbria University, and his research on halftime nutrition. Ironically, he was actually studying the effects of these different glucose drinks on skilled performance in elite youth soccer players. But what he actually found was after halftime, they had this big drop in their blood sugar levels. So, he noticed this rebound hypoglycemia. It was actually most pronounced in those who were having their drinks 75 minutes before the game, right? So, this is oftentimes, whether you're on the team–

Ben:  Seventy-five minutes before was resulting in hypoglycemia during competition, 75 minutes before taking carbohydrates in.

Marc:  So, 75 minutes before the game, then the first half is played, then there's this halftime break. So, this period where now they're sitting down, they're resting, going over, reviewing tactics, et cetera, right? So, compared to 45 minutes and 50 minutes before the match, they're having this significant drop. So, this is where this question around timing came in of, “Well, if we can fuel things a little bit closer to the actual competition.” And for the rest of us who are playing recreational sport, this still has a lot of applicability in terms of how you might want to layer in your pre-game or pre-workout fueling.

So, the question was around, “Okay. Well, what else can we use?” And so, there was some follow-up work by a lady named Emma Stevenson, Dr. Emma Stevenson from Newcastle University. And so, she did a study comparing maltodextrin versus honey. And again, before the games, assessing glucose levels at halftime and just having a look to see how blood glucose was faring between the two, how much of a drop were they seeing? And of course, the one group that had the maltodextrin, which is a common simple sugar that you'd find in the most common sports, drinks or bars, whatnot, you've got this blood sugar drop of about 19%. And the other group that she used was a group that were given honey, and they only saw a 4% drop in blood glucose. And so, when you look at the different sugars and honey, isomaltulose is a natural sugar. It has sort of a “slower burn” if you will. And so, some of these strategies can be pretty nice when you're trying to layer, and maybe the best approach, whether it's team sport or whether it's endurance sport, to be able to support, prevent some of this rebound hypoglycemia that even at the highest level can happen.

Ben:  So, basically, you would want to time your carbohydrate so that the blood glucose spike occurring from those carbohydrates would take place when you're already started into your event. So, like 20 to 30 minutes prior. If you're going to do like a sports gel or a sports drink or any form of carbohydrate, you would want to avoid that hypoglycemic drop by timing it pretty close to the actual event itself.

Marc:  Yeah. You're trying to get it as close as you can. And so, oftentimes that'll mean it's actually going to happen like during some type of warmup, or when you're in the locker room versus a lot of athletes, whether they're pro even or recreational, they tend to have it when they're in the car or on the bus an hour and a half before the game. And so, that's definitely a strategy that people can throw in there that's going to have a big difference in terms of–especially in the second half and towards the end of these competitions.

Ben:  Yeah, yeah. What I kind of like stumbled across as the sweet spot in terms of pre-workout fueling was twofold. For an anaerobically demanding event, let's just say like a sprint triathlon versus an Ironman triathlon for the former, I would have a carbohydrate-rich meal, but time it pretty far from the event so that any type of hypoglycemic rebound was already gone by the time the event came around. Meaning, having my pre-race meal, which would typically be like sweet potato with some honey and some sea salt, like two to two and a half hours prior to the event.

And then right before the event, like 10 to 15 minutes prior or whatever, right before I go down and warm up for the swim and a triathlon, for example, that's when I would slam the gel, like that follow-up carbohydrate. And then for the longer events, I wouldn't even mess around with carbohydrates for that pre-race meal and would instead kind of try to keep my RER low, my respiratory exchange ratio low, my rate of beta-oxidation and fat utilization high by doing more of like a fatty coffee, for example.

That was actually what I did for many of my races. I would have a coffee and blend that with some coconut oil or butter or other kind of slow-release fuel, again a couple hours prior. And the same thing, once I got 10 to 20 minutes prior, that's when I would start to consume some type of sweeter carbohydrate source, like a gel or something like that. So, I'd start that slow bleed of carbohydrate for the actual event. But ultimately, I think the big takeaway is if you're going to use a sports drink or a gel or an energy bar or something like that, don't do it like in that 60 to 75 minutes prior. If you're going to do something like that, do it far, far prior, like two plus hours prior or right before, but don't hit that mid-range leading into the event.

Marc:  Yeah. I mean, as you mentioned correctly, they're obviously endurance sport for sure. The longer the events than these things, avoiding them full stop is pretty important. But yeah, you got to hit that sweet spot and you can definitely feel it in terms of performance.

Ben:  Now if I recall, you actually discussed overall carbohydrate intake just in terms of overall macronutrient ratios with regards to strength versus endurance athletes. Can you get into that a little bit with what the overall macronutrient ratios look like?

Marc:  Yeah. So, in terms of targets, suggested intakes these days, if you're looking at team and strength sport athletes, you're looking at between four and seven milligrams–excuse me, four to seven grams per kilogram per day, endurance athletes are looking at higher windows, so six to ten grams per kilogram per day. And this is interesting because when you look at —

Ben:  Again, for that 80-kilogram athlete, I mean that's like 800 grams plus of carbohydrate per day?

Marc:  Yeah. So, we're talking. And this is when you're really getting into —

Ben:  There's a lot of pasta.

Marc:  The elite of the elites, right, in terms of–and unfortunately, I think a lot of these recommendations have been drip-fed down to the recreational public because even in some of these position stands recently of the American College of Sports Medicine, Dietitians of Canada, 30% to 50% of training, even for elite athletes, should be done with this low carb availability, right? So, less fuel onboard and you actually need to elicit —

Ben:  Train low, yeah.

Marc:  Yeah, train low strategies to elicit some of these differences. That's something that you obviously see a lot of in endurance sport, but I was interested in researching the book. It's fascinating to see that even in team sports, this is happening to certain degree as well, so in football, premiership football. When they looked at a week of fueling for the professional soccer players, they actually found that during the week, they were consuming about 4.2 grams per kilogram per day. And then on the weekends, when games were played, they were actually bumping that intake up to 6.4 grams per kilo.

Now, whether that was a purposeful and strategic strategy, whether that was just inherent from the athletes in terms of behavior, still remains to be a bit flushed out. But from some of the performance teams I talked to, this idea of even training low in team sports is starting to gain a bit more of a foothold as well.

Ben:  Okay. So, one of the interesting things about this, and it does make sense that–again, to summarize, you're saying the overall carbohydrate recommendations for endurance athletes for macronutrient ratios is significantly higher than that that's recommended for strength athletes, right?

Marc:  For sure, yeah.

Ben:  Okay. It's kind of similar to sleep. Those darn strength athletes, they can [01:17:13] ______ so much.

Marc:  For sure.

Ben:  The thing that I think is the glaring issue in this type of sports nutrition research is influenced when I look at the work of folks like Jeff Volek or Steve Phinney. And I was part of the FASTER study that they did at University of Connecticut, for example, where they had a group of athletes, fat adapt, eat a carbohydrate limited diet, even trained low as a lot of these studies have done. And also, in this case, compete low. And for 12 months, follow a diet like this. We're not talking about a short four-day to two-week adaptation period, which is what many of these studies will use.

And they actually did find that there were multiple mechanisms involved that allowed for a saving of glycogen levels or glycogen sparing effect, meaning that these athletes who follow the fat adapted diet were utilizing glycogen a little bit more slowly, or saving it a little bit better due to their upregulated ketone and fatty acid utilization. But they also saw no performance decrements in following a diet like this, even endurance athletes. Granted, I still think that a strict ketogenic diet is a myopic approach because even if it perhaps does not hinder performance, I think there's some endocrine and some thyroid bounce back, and it can just be a difficult diet socially, especially for a traveling athlete to follow.

But I think that sometimes, some of the research on carbohydrates, specifically with regards to how much carbohydrates, in the case of something like 800 grams of carbohydrates per day, a good 3200 calories of carbohydrates per day, I think that's an overestimation of what might actually be necessary should an athlete be following a diet that I guess is more metabolically appropriate for overall health, right? Because then we get this paradoxical situation where, yeah, athletes, based on fructosamine or HbA1c measurements, have pre-diabetic symptoms. And at the same time, you're turning around and saying–or not you, for example, but the Gatorade Sports Science Institute is saying eat X number of carbohydrates per day, but it's really not doing the athlete any favors when it comes to the diabetic issues, or the fact that as you allude to in the book, and this was an interesting part of the book, how high sugar intake can also lower heart rate variability, and perhaps impact recovery time.

So, I think the big takeaway is, yeah, endurance athletes might need more carbohydrates, but in those who are following a diet in which they're paying attention to glycemic variability and fluctuations in blood glucose and some of these pre-diabetic symptoms, maybe they should, although they're going to eat more carbs than the average strength athlete, not go all the way up to what the common recommendations are. And many of the folks I coach, for example, they're eating one quarter to one-half of those recommendations and still performing quite well, although there's kind of an adaptation period that takes a little time to actually get used to when it comes to low carbohydrate availability.

Marc:  Yeah. I mean, this was the most fascinating chapter to write. Chapter 5 was all about endurance nutrition. You sort of juxtapose these general recommendations and you compare them to things like Dr. James Morton, Head of Nutrition for Team Sky, and they have loads of days where their athletes are well below the six grams per kg per day. And so, they are training with low carb availability for a lot of sessions. And then we even get into Prof Larson's work around blood glucose levels of three, being able to sustain 300 watts in terms of his outputs on the bike.

And so, challenging a lot of these things. And so, we try to juxtapose these different strategies because it really does show you that there's a lot of nuance, and that's just as you would know obviously being in the endurance side. But that in the training block, even at the elite level, a lot of these teams are far below some of these recommendations. But as you alluded to before, when it comes to race day and nutrition, that's when they get back to being a little bit more on point with what's actually suggested.

Ben:  Yeah, yeah. That train low thing, just for people who might be confusing that with altitude, train low rate [01:21:36] _____, this is just based on the research that shows that training in a state of low carbohydrate availability, and sometimes training in a state of low carbohydrate availability, not replenishing carbohydrates, then also sleeping in a state of low carbohydrate availability and doing the following morning's workout in a continued state of low carbohydrate availability upon reintroduction of carbohydrates prior to the actual event such as on race morning or in a couple of days prior, it appears to induce a pretty significant decrease in time or increase in time to exhaustion and better time trial performance compared to, say, both training and racing in a state of high carbohydrate availability or training and racing/competing in a state of low carbohydrate availability.

So, it's kind of like the train low, compete high type of approach, which I actually think is–it's a pretty good idea. It's kind of similar to the old-school bodybuilding approach of carb depletion followed by carb loading.

Marc:  There you go. All the nuances in between, right?

Ben:  Yeah, yeah. I would be remiss not to ask you a question that you–or a topic that you addressed in the book, when it comes to cold water immersion and cryotherapy. This is one that pops up over and over again. What's better? Should I be doing either, really, when it comes to cold thermogenesis or hot-cold contrasts or anything like that? But then specifically, what's better, water or these new sexy chambers that they find in a lot of places now that a lot of athletes are using?

Marc:  They are sexy.

Ben:  Yeah.

Marc:  Yeah. I mean, this was another–this idea of recovery, obviously, a whole section devoted to it, and first off, these sort of pillars of recovery. So, when you talk to guys like Lachlan Penfold, who used to work as the performance director for the Golden State Warriors, and now he's in Melbourne working for the rugby league team there that's a perennial favorite to win at all. I mean, these folks are always prioritizing nutrition, sleep, mental, emotional stress as sort of a foundation of the recovery. On top of that, you get things like training plan. Lachlan is quick to say you can have all the ice baths in the world if you want, but if you fuck up the training plan, then you've got no chance.

And so, those are the really big rocks. And as you work your way up, this sort of recovery pyramid, you get to these different modalities. As you mentioned, cold water immersion being one. Cryotherapy, obviously more popular these days. Now, I remember as a kid watching in the '80s, watching William, The Refrigerator, Perry, The Training Camp for the Bears, dunking his 300-pound body in a tub of ice and he's just looked brutal. But it's something that's in all sports, right, and in terms of using ice baths and you think, “Okay. Well, this must reduce inflammation.”

But actually, when I was looking into this, you have experts from Australia, guys like Dr. Jonathan Peake, the findings are that you can reduce muscle soreness up to about four days with techniques like this, but it doesn't work the way you think it does. So, his team and the reviews that he'd done was that it didn't actually lower inflammation compared to active recovery. And so, that was the use of ice baths, cold water immersion.

How does it work? Well, even the best experts in the world aren't really sure. Does it redistribute things like blood flow? Is there a localized cooling effect? Is there an analgesic effect? But overall when we look at how long you should do this for, typically, it's going to be 11 to 15 minutes done at a temperature of about 11 to 15 degrees Celsius. So, that's about 60- or 59-degrees Fahrenheit. But the question that you're posing here, which is a great question, is how does this compare to cryotherapy? And of course, there are some recent studies that were done comparing the two. And on first glance, I mean you think, “Geez, cryotherapy, you're using temperatures.” And again, I'll stick to Fahrenheit, minus 176 to minus 374, which is a little bit ridiculous. Obviously, it's air flowing over you for only a couple of minutes, but it's got to feel like a long time. Even two to four minutes, it's going to feel pretty long at that temperature.

But the really interesting thing is that if you do an ice bath at 46 degrees Fahrenheit, or a cryo session at minus 166, your core temperature is being reduced by the same amount, right, because air has obviously got poor thermal conductivity. And so, you don't get the same amount of subcutaneous cooling as you would do, right?

Ben:  As you would with cold water immersion.

Marc:  As you would with cold water immersion, exactly. And with cryotherapy, I mean the skin is going to come back in the baseline in about 60 minutes. So, the benefit of cryotherapy is obviously how–the duration is very short in terms of how long it takes. And so, even some elite sport teams are using things like cryotherapy. Well, there's been some studies, one of them was done in marathoners. So, in the build-up to the London Marathon.

You had a comparison of ice baths to cryo to placebo on muscle function, perception of muscle soreness, and training stress. And so, this was done immediately after they finished the race. It was then repeated 24 hours and 48 hours afterwards. And this is Laura Wilson's work out of Middlesex University. The results actually showed a negative effect for cryotherapy, and all three of the parameters. So, muscle function, muscle soreness, and training stress.

When you compare the two, it looks like things like ice baths come out a little more favorable, especially in terms of the potential effect on maintaining things like muscular power you do see with cold water immersions, improvements in muscular power, but not so much in terms of strength. But the bottom line in terms of context is if your athlete is not going to go on the water in a cold tub for 11 to 15 minutes, then what strategy are you going to use? And so, I think this is where you see some teams leaning on cryotherapy. It's shorter duration. It's sort of new and sexy. And even young athletes might be drawn to using that.

But even then, I was talking to Shaun Holthouse and Lachlan Penfold. At the end of the day, they didn't even have–their priority was to just say, whatever the athlete even wants to do, whatever the athlete feels best doing, if they have access to a hot tub, a cold tub, a cryo and they could choose the one they want to do, the real big rocks here was the fact that the athlete was going to do one every single time. Scan, post, train. That became the bigger rock, but it is pretty fascinating to see that comparison between, yeah, cold water immersions and cryotherapy.

Ben:  Yeah. I still think cold water immersion beats cryotherapy, in particular, because you get a little bit more of the hydrostatic pressure of the water against the skin. You can see a slightly lower decrease in skin and core temperature. I think anybody who's just intuitively done, whatever, three minutes of cryotherapy versus three minutes in an ice bath, knows that it's far more intense. And in addition, many of these studies are looking at recovery parameters such as inflammatory cytokines, or delayed onset muscle soreness, or inflammation, et cetera.

It would be interesting to also just investigate the overall well-being of the athlete, or potentially the stress resilience of the athlete, or even–one thing that I think is glaringly neglected is autonomic nervous system, particularly the heart rate variability measurements, or sinus arrhythmia measurements, or LF/HF ratios, or something that would indicate long-term effects on nervous system strength because again, I feel that just based on the vagal nerve effect of cold water head immersion, that cold water immersion, just from a long-term HRV effect on an athlete, likely has a pretty good effect even though most the research just looks at inflammatory parameters and some other things that don't necessarily reflect autonomic nervous system response. So, it'd be interesting to see a more robust study still done on cold water immersion versus whole body cryotherapy.

Marc:  Yeah. I think even some of what you're saying is you do see a little bit around like higher perceptions of recovery with cold water immersion, less exercise-induced drops and muscular power, less muscle soreness. So, I think you're very right in the sense that the cold water is having all these other effects that are going to be pretty profound. It's great when you have athletes that love it and that are going to do it. And then I think the trick is the ones that don't gravitate towards it, what kind of carrot can you dangle to get them to do it is the next step, right?

Ben:  Yeah, exactly. And I think that when it comes to the cold water immersion, also for folks who might be a triathlete or an obstacle course racer, something like that, you actually have a lot of cold water in your competition. So, there might be a little bit of a crossover effect in terms of just like mental adaptations to cold water exposure too that could be beneficial.

Marc:  A hundred percent.

Ben:  Again, it hasn't been studied. But now, there's a ton that you get into in the book that we didn't have a chance to dive into on today's show. But I will link, for those of you listening in, to everything we mentioned in addition to Marc's book if you go to BenGreenfieldFitness.com/bubbs, BenGreenfieldFitness.com/B-U-B-B-S. The book is called “Peak: The New Science of Athletic Performance That is Revolutionizing Sports.” And again, I'll post some of my biggest takeaways and also link to Marc and his website. That's all going to be over at BenGreenfieldFitness.com/bubbs. And Marc, in the meantime, dude, thanks so much for writing this book and also for giving your time on the show to share some of these insights with us.

Marc:  I appreciate it, Ben. Thanks for having me on.

Ben:  Yeah. Alright, folks. So, I'm Ben Greenfield along with Dr. Marc Bubbs signing out from BenGreenfieldFitness.com. Have an amazing week.

Well, thanks for listening to today's show. You can grab all the shownotes, the resources, pretty much everything that I mentioned over at BenGreenfieldFitness.com, along with plenty of other goodies from me, including the highly helpful “Ben Recommends” page, which is a list of pretty much everything that I've ever recommended for hormone, sleep, digestion, fat loss, performance, and plenty more. Please, also, know that all the links, all the promo codes, that I mentioned during this and every episode, helped to make this podcast happen and to generate income that enables me to keep bringing you this content every single week. When you listen in, be sure to use the links in the shownotes, use the promo codes that I generate, because that helps to float this thing and keep it coming to you each and every week.

 

 

Peak: The New Science of Athletic Performance That is Revolutionizing Sports is a new book by my fellow C-ISSN and CSCS, Dr. Marc Bubbs. It was one of my best reads of the year for all things sports science. A few of my big takeaways include:

• Endurance athletes seem to need more sleep than strength athletes, and both seriously suffer when sleep is anything less than 6 hours.
• A temperature change in your fingertips is likely the first circadian cue you get at the beginning of the day (I could totally see a potential jet lag device that warms the fingers – I’ll take the royalty for that, please. ;) ).
• Aerobic training for strength athletes could assist with their immune system strength.
• Loading with probiotics for 2 weeks leading up to competition could give you an ergogenic edge.
• Elite athletes on a subpar diet show the same blood biomarkers as those with pre-diabetes and a fructosamine blood test can be one of the best ways to measure this.
• Top supplements proven to work in exercise science, with the strongest track history, are creatine, caffeine, nitrate precursors (e.g. beet), whey protein, beta-alanine, and sodium bicarbonate.
• Athletes with the CC genotype of the CYP1A2 gene are actually hampered in performance in response to caffeine intake.
• Eating carbs too far from a performance event (e.g. 60-75 minutes) results in hypoglycemia before the event vs. consuming them closer to the event (e.g. 20-45 minutes)
• Fish oilcan stimulate muscle building by stimulating mTOR pathways. Vitamin D and creatine are also very good for recovery, not just performance. Creatine can even be helpful for TBI/concussions.
• High sugar intake is associated with lower heart rate variability (HRV).
• Cold water immersion (CWI) beats cryotherapy for recovery, hands down.

You can get this brand new book here.

But I also decided to get author Dr. Marc Bubbs on this podcast to take a deeper dive into the concepts above, including the best supplements for recovery, performance, as well as many other topics. He is a licensed naturopathic doctor, performance nutrition lead for the Canadian Men's National Basketball Team, speaker, and former strength coach. Marc also hosts the Dr. Bubbs Performance Podcast, connecting listeners with world-leading experts in human performance and health. Dr. Bubbs regularly presents at health, fitness and medical conferences across North America, UK, and Europe and consults with professional teams in the NBA, NHL, and MLB. He practices in both Toronto, Canada and London, England.

During our discussion, you'll discover:

– How Marc gathers, curates and assimilates new information for his practice…8:45

• Struggled as a young athlete with disease, etc. and discovered naturopathic medicine
• He realized that there wasn't much of a market for it (circa 2000) but he embraced it and became the best at it
• The more personal contact with the source of info, the better (there's nuance in conversation that doesn't make it into an academic paper)
• Vast resources available on the Internet (and they're all true, of course)

– Current research on caffeine as an ergogenic aid…15:00

• Study conducted by Nanci Guest, University of Toronto:
  • Cycling time trial under 3 different conditions:
    • 0 caffeine
    • 2 mg caffeine
    • 4 mg per kg of caffeine
  • AC gene variants had no benefit
  • AA gene variants had a benefit at both 2 mg and 4 mg levels
  • Athletes with the CC genotype of the CYP1A2 gene are actually hampered in performance in response to caffeine intake
• The sweet spot: 3-6 mg of caffeine per kg per day
• 23 and Metest will identify CYP1A2 gene

– How endurance and strength athletes differ regarding sleep needs…21:18

• Endurance athletes fare better on the upper end of the sleep suggested amounts (8-10 hrs)
  • They also suffer more on lack of sleep
  • Greater volume of training
  • More early morning sessions
• Sleep is #1 recovery tool some docs recommend
• It's one thing to acknowledge the need, quite another to actually get more sleep

– The relationship between finger temperature and circadian rhythm…31:25

• Fingertips are the first to sense changes in environment
• Possibility of warming hands to help the body adjust its circadian rhythm while traveling
• ChiliPad I sleep on

– How aerobic training can help the immune system of endurance athletes…35:30

• “Elite performance is incompatible with frequent illness.” –Dr. Michael Gleason
• Maintaining an aerobic base supports innate immunity
• Aerobic training in the protocol of a strength athlete will improve immune system
• Consider incorporating aerobics if red flags of sickness or fatigue occur
• Could be a means of recovery
• Simply being well enough to train is a big part of the picture
• Don't forget fundamentals like washing hands
  • Fingertips, webs, and backs of hands are often missed

– Probiotics as an ergogenic and performance-enhancing tool…42:10

• Studyon Olympic athletes in 2008:
  • 2/3 of those studied showed benefit in 2 key areas:
    • Preventing upper respiratory tract infection
    • Reversing upper respiratory tract infection
  • Start 2 weeks before event
  • Colostrumcan be efficacious while performing in the heat
  • Gut is a “black box” of the body; a key indicator in assessing overall health

– Up and coming supplement research and diet strategies Marc is following…50:45

• “Food first” approach
• Creatine, whey protein, caffeineare major players
• Nitrate precursors: beetroot, arugula
• Endurance sports, struggle to lose weight: have the wrong approach
• Nicotinamide riboside
• Ketones for concussion recovery
  • High rate of head trauma among teens
  • Women's ice hockey is the highest risk
• Peptides

– Why athletes on a subpar diet show the same blood biomarkers as those with pre-diabetes…56:10

• Endurance athletes are more concerned with hypoglycemia, not hyperglycemia
• Study: 4 of 10 participants spend 70% of the time with blood glucose in prediabetic range
• Exercise is a stressor; contributes to raising blood glucose
• Over fueling more of a problem than we think
• Case study in Japan on two ultra-marathoners: one elite, the other sub-elite on a 100-mile race
  • At wake-up: elite has glucose level of 90; sub-elite is 110
  • Sub-elite glucose level rises, then crashes around mile 70
  • Elite runner came through just fine
• Fructosamine measurements for blood glucose levels
  • HA1c skews to more recent fueling in its readings
  • 2-3 week window vs. 3 months on HA1c
  • Measuring glycated albumin rather than glycated hemoglobin
  • More expensive; used for a more acute picture

– The best time to consume carbs before training…1:07:45

• Mark Russell: Half-Time Strategies to Enhance Second-Half Performance in Team-Sports Players
  • Biggest drops in glucose came from those who had drinks 75 minutes before the game
• Emma Stevenson of Newcastle Universitydid a study on maltodextrin vs. honey
  • Maltodextrin had blood sugar drop of 19%
  • Honey had blood sugar drop of 4%
• Time carb intake so that blood glucose spike takes place duringthe event
• Optimal overall carb intake for strength vs. endurance athletes:
  • Strength: 4-7 g per kg per day
  • Endurance: 6-10 g per kg
  • “Training low” in team sports: low carb availability

– Comparing the effectiveness of cold water immersion (CWI) to cryotherapy…1:22:40

– And much more…

Resources from this episode:

– Peak: The New Science of Athletic Performance That is Revolutionizing Sports

– Examine Research Digest

– Alan Aragon's Research Review

– Chilipad

– The combo of ATP and HMB Ben mentions

– Dr. Mark Russell: Half-Time Strategies to Enhance Second-Half Performance in Team-Sports Players

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