November 7, 2015
[3:36] Introduction/Kimera Koffee
[3:22] About Chris Kelly and Tommy Wood
[7:24] The Background Behind Chris’ Interest in Blood Chemistry
[9:17] Why Measuring Total Hemoglobin Mass is Important
[10:54] The Importance of Owning One’s Health and Data
[12:22] How Conventional Treatment with Intravenous Iron Didn’t Help Chris
[14:29] The Biochemistry Behind Hemoglobin and Tommy’s Experience.
[17:40] EPO and The Evaluation of Kidney Function
[22:35] Chris’ Personal Experience with Testing for Nutrient Deficiencies, Reference Ranges, and Other Tests
[28:10] Causes of Chris’ Nutritional Deficiencies
[33:01] Reasons for Red Blood Cell Destruction
[35:16] How to Determine if Inflammation or Oxidize Stress is Occurring Excessively
[38:57] Possible Causes of Actual Loss of Blood Cells
[44:42] How to Protect Yourself From Damage to the Gut
[46:06] How to Know Where to Start and Prioritize Tests
[47:58] The Process for Testing and Test Interpretation
[49:31] Benefits of Clinical Coaching
[51:45] Other Resources, Discount Codes, Service Options, etc.
[55:42.1] End of Podcast
Ben: This podcast is brought to you by Kimera Koffee and I know I told you in the last podcast episode that I'm going coffee-free and alcohol-free, little bit of an experiment. But I can tell you that I super-duper miss my morning boost of Kimera Koffee. It kind of sucks. Yeah, maybe my gut is feeling fantastic but my brain is missing Kimera Koffee and I didn't stop drinking coffee because coffee is bad for you, I just stopped because I am giving my gut a little bit of a detox from pretty much everything. Sourdough bread, coffee, alcohol, anything like hard like seeds and nuts. I'm just giving myself a little bit of a break, but ultimately that doesn't mean that you can't drink your cup of Kimera Koffee. That doesn't mean I'm not going to jump back into my habit of Kimera Koffee as soon as I end this freaking experiment.
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In this episode of the Ben Greenfield Fitness Show:
“When our chain of fatty acids are oxidized or used as fuel in the citric acid cycle, so this is inside of the mitochondria inside of a cell, then these carbons get chopped up, two by two.” “Something we’re seeing more and more of is hemochromatosis or iron overload so the problem is almost in the other direction where high levels of iron are then causing inflammation and could then also be preventing proper red blood cell production.” “If you’re deficient in B12 then you’re not going to produce red blood cells as well as you should and then you’ll end up with less oxygen deliverability, less power threshold.”
He’s an expert in human performance and nutrition, voted America’s top personal trainer and one of the globe’s most influential people in health and fitness. His show provides you with everything you need to optimize physical and mental performance. He is Ben Greenfield. “Power, speed, mobility, balance – whatever it is for you that’s the natural movement, get out there! When you look at all the studies done… studies that have shown the greatest efficacy…” All the information you need in one place, right here, right now, on the Ben Greenfield Fitness Podcast.
Ben: Hey, folks. It’s Ben Greenfield here and you might remember a guy named Christopher Kelly from the podcast episode that I did a while ago called “The Little Known Test That Tells You Everything You Need To Know About Your Metabolism”, and in that particular episode we talked about this test called Organic Acids Test. Really interesting podcast and I’ll link to that in the show notes for this episode and you can access the show notes for this episode over at bengreenfieldfitness.com/epo. That's bengreenfieldfitness.com/epo.
But today Chris is back along with a special guest named Doctor Tommy Wood and the reason I'm inviting Chris back onto the show is because he recently wrote to me about some new methods that he's been using to identify how to increase EPO legally, how to increase oxygen consumption, how to beat things like anemia, how to boost red blood cells, and how to get some pretty big increases especially if you’re an athlete in power and in endurance. And I'm always looking for insider tips on how to maximize my own athletic performance and help my clients out. So I figured it would be a good idea to have Chris back on the show to talk about these new relatively less well known testing and treatment methods for things like oxygen utilization.
So who is Chris? Well, Chris, if you didn't get a chance to meet him in the last podcast episode we had with him, is a computer scientist. So he’s a nerd. He’s a pro mountain biker also, however. He's a certified functional diagnostic nutrition practitioner and he's a graduate of the Kailash Institute. I’ve talked about Doctor Daniel Kailash before on the show and some of his really cool books and also his certification programs and Chris has been through those. Chris is, as you'll I realize momentarily, British but he actually lives in California now and he runs the functional medicine practice there called Nourish, Balance, Thrive. And he also does quite a bit in the realm of adrenal fatigue as well and as a matter of fact, I have had him on to talk about that too, about salivary hormone testing for adrenal fatigue. So Chris, I was thinking that twice that you've been on the show but I guess this will be the third time.
Chris: It is. Yes. Thank you.
Ben: You fall into the three-guest honorarium. But we've also got Doctor Tommy Wood on the show. Doctor Tommy is a medical doctor, graduated from Oxford University. So a couple of brits on the show and he has a previous bachelor's degree in natural sciences in biochemistry from Cambridge and after he worked as a doctor in the UK for a couple of years, he's now working towards a PhD in neonatal brain metabolism at the University of Oslo in Norway. So a couple of smart dudes here with me today. So guys, how you doing?
Chris: Thank you.
Tommy: Yeah, absolutely. Thanks for having us.
Ben: Now, just so we can know the difference between the two British accents gracing the podcast, Chris, can you go ahead and say hello to the listeners so that folks can recognize your voice.
Ben: (laughs) I'm gonna keep my fingers crossed here that Tommy doesn’t sound identical, but Tommy, can you also say hello or anything you'd like?
Ben: Okay. Alright. Cool.
Chris: Tommy’s posher than me. He’s been to Oxford and Cambridge. He’s definitely posher.
Tommy: I don’t think that’s fair.
Ben: Wait, what did you call him? Posher?
Ben: I don’t even know what that means.
Chris: Upper class.
Ben: You’re already throwing away or throwing around your British terms. Okay, posher. I’ll add that to my vernacular. I feel like I should be drinking tea and eating crumpets during the show. And now I'm gonna get angry emails from listeners about offending other people's nationalities. Be careful about that. I get called out for that a lot of the time. I'm just celebrating diversity though. So I'd like to start here with this whole idea behind blood chemistry which, Chris, it seems like you're pretty keen on. That was almost a British phrase there.
Chris: Yes absolutely.
Ben: (chuckles) So you guys are already wearing off on me. So we talked about salivary testing for adrenal fatigue the first time I had you on, Chris. And then we talked about urinary organic testing. So I guess we’ve covered saliva and urine, but when did you become interested in blood chemistry?
Chris: Yes, going back a few years now, and you know, I haven’t talked about blood chemistry before but I think it's maybe almost the most important part. It’s really quite crucial and the reason I got interested in it was, I've always been looking for ways in which to bridge the gap between me and the elite riders. I’ve not always been a pro mountain biker. Before I turned pro, I was just in an age group there and trying to look for whatever advantage I could find in order to upgrade to the elite guys, but I really struggled with that. And I think it was, I mean everyone's done a race altitude, right? I hope you’ve done a race altitude because if you’ve done a race altitude, you understand what it's like to be slightly hypoxic, right? So, you know that you're giving it your all and you’re not really feeling it in your legs, not really feeling any better, and you know you’re not going that hard and yet still you‘re not going very fast. And if you’ve got a power meter on your bike, if you're a cyclist, then you look down, you see the number and you’re like, “Whoa. This sucks.” And if you've ever experienced that then you know exactly what it's like to be slightly anemic or not delivering oxygen quite as well as you should.
You know, Ben, I know you talked about hypoxia which is low oxygen availability and hyperoxia which is high oxygen availability as a therapeutic means of increasing exercise performance, and yeah, I think really how I realize this was so important was looking at the work of Doctor Puchowicz, Doctor Michael Puchowicz, and he has a blog called Velo Clinic. He’s a really interesting guy.
Ben: Velo? Is that V. E. L. O. Clinic?
Chris: Yeah, V. E. L. O. Clinic.
Ben: Okay. Got it.
Chris: He’s a super interesting guy and the reason I find him so interesting is he’s a certified sports medicine physician, and he's been trying to develop mathematical models to try and detect doping in cycling. And it was by looking at some of his models I realized that there’s such an important relationship between total hemoglobin mass and VO2 max. So basically the more hemoglobin you have, and for those that don’t know, hemoglobin is a protein inside of red blood cells that transports oxygen. So the more hemoglobin you have, the greater your VO2 max. Now, the more oxygen you will conceive. And then if you’re a cyclists like me, the more hemoglobin you have, the greater your watts per kilo. So this is super-duper important. And I realize when I went back to my test results, the first time I saw some of his models, I realized I wasn’t even on the chart. I was not even close to where these dopers were in terms of the amount of total hemoglobin I had. And at the same time, I wasn't really feeling good. So I was doing pretty good on the bike you know, I’d win a few races in the amateur age groups. And I had kind of a lot brain fog, a lot of fatigue, I wasn't sleeping very well, pretty low sex drive, a lot of bloating, a lot of digestive complaints.
And so I went to the doctor and I said, “Hey, what's up with this low hemoglobin thing? Should I be doing something about this?” And he says, “I don’t know. It looks, I mean it’s low, but I'm not really that concerned about it so we should just keep an eye on it.” And that was the moment I had. I think this is a really important thing for everyone to understand that your primary care physician does not care about your race results, right? They’re not gonna, there’s no diagnosis codes. Whenever there’s a problem, you go to the doctor and you present with symptoms or a disease then there’s a code to diagnose that condition and there's no code that is, wants to upgrade to pro mountain biker or wants to qualify for the Boston Marathon. And I think understanding that is really important and what it means is it's up to you to take the initiative to get some blood chemistry done, maybe some organic acids and to understand the results so that you can optimize what you find for your exercise performance which is important in the weekends when you race. So, yes and for me, I kind of, I pushed on with my doctor and I got him to run some more tests and the hemoglobin kept coming back lower and lower and eventually I ended up in a hospital having some iron actually infused intravenously.
Chris: Which was super expensive and I was kind of annoyed that it had to come to that because maybe I could have solved that problem earlier with a sort of not less invasive therapy. But the thing that was really curious to me was my hemoglobin didn't really improve that much after I took the iron. You know, I thought that was going to be the magic pill. All I needed was iron and we would transport more oxygen and would go that much faster on the bike, but that's not what happened. And you know, there was a lot of learning and studying and trying to figure out the different moving parts that were going on, and then eventually I saw a 32-watt improvement in my power threshold. So I’ve seen almost a whole milligram per deciliter improvement in my hemoglobin on a blood test and that led to this 9% improvement in my power threshold and that was easy enough to make a difference to where I could upgrade to pro.
Ben: So 9% improvement in your power at threshold from the test that you did and then the treatments that you did afterwards when you realized extra intravenous iron therapy wasn’t working.
Chris: Yeah, exactly. So there was much more to it than just the iron and Tommy’s my biochemistry fairy godmother and he's going to get into some of the really technical details. Tommy’s someone I work with on a daily basis and he is the coolest performance coach you’ll ever find because he understands the biochemistry. It’s like, it’s more than just a training plan. I mean like how many hours would you have to train in order to get a 9% improvement in your power threshold and the answer is maybe never, right? You know like understanding the biochemistry.
Ben: Yeah. 9% is, I mean to a lot of people, 9% doesn’t sound big, but I mean 2% is huge.
Ben: And 9% is unheard of and I don’t want to sound like we’re blowing this out of proportion or something like that but this is really interesting stuff. And I’d like to hear a little bit from Tommy perhaps about kind of where we start into this in terms of, you know, for people who have perhaps already run a blood test or people who already have a little bit of a knowledge of their blood, how we then dive into the type of protocols that Chris did to actually see these improvement. So, Tommy, can you dive into kind of the basics behind what's going on here from a blood biochemistry level?
Tommy: Yeah, of course. So, I think what's been really great over the last few years is the fact that people are starting to be able to get access to their basic biochemistry data. You can go out and get a blood test or your organic acid test or a saliva test, and actually start to look at what's going on underneath the hood rather than just, people will spend years taking supplements trying to increase performance or improve the way they feel but you never really know what you're dealing with unless you’re actually looking at what's going on in the cell itself. On the other hand, it’s very easy to get caught up, you might do some tests and you notice one number that's really low, say your hemoglobin’s low and you can kind of keep chasing that without necessarily knowing what's going on and you can get kind of worked up about one particular number. But what we’re trying to see is that if you’re sort of look at general patterns, you can start to see where people can make some improvements. And you know for something like hemoglobin, we can try and improve red blood cell health, improve hemoglobin production just by tweaking maybe just some basic lifestyle stuff or some basic supplementation maybe, then I think people can see so many big benefits like Chris did.
The way that we start to look at this is you maybe think about how or the life of a red blood cell and that involves three main processes which is the production, the destruction, and then the loss or any loss of the red blood cell. And if anybody has low hemoglobin or some kind of anemic tendencies then they might be something going wrong in one of those three. So if you think about the specific areas then you can start to narrow it down. So if you start by thinking about production, well we generally term hematopoiesis is just a fancy word for making blood, cells, and then erythropoiesis is making red blood cells. And that requires kind of two main parts. So you have to make the red blood itself and then you also have to make hemoglobin which is part heme which is a proferrin molecule is certain type of organic molecule which has an iron bounds to it and then a globin protein and the two go together to make hemoglobin.
And what’s interesting is these are very nutrient dependent steps. So particularly things like vitamin B6, Zinc, and Iron are important for making heme and B12 and folate are very important for making a normal healthy red blood cell. And then this whole thing is regulated by EPO, which we mentioned briefly at the beginning, but there are some other things that can maybe play into that. So like general metabolic health. So if you have consistently elevated blood glucose then that can inhibit some of the steps of making heme, making hemoglobin. And then also if you have something like low testosterone or low sex hormones then that can cause an anemia as well. So it's kind of if you look at lifestyle as well as nutrition, any deficiencies, then you can start to tease apart where some of the problems might be happening.
Ben: Gotcha. And I want to talk to you in a second about how we can actually find out if were deficient in some of those nutrients, Tommy, that you mentioned for producing red blood cells but before that, I wanna ask a little bit more about EPO. To my understanding, erythropoietin or EPO is mostly produced by the kidneys, and so I would imagine that kidney function kind of plays into this as well. So is there a way that you can actually test whether you can know if your kidneys are working properly to actually produced EPO because it seems like no matter how many of the proper nutrients that you dump into your body that your body needs to make you EPO if your kidneys can't produce then that’d be kind of an issue.
Tommy: Yeah, absolutely. So that's kind of, that's the starting point, really. And EPO is basically acts as a survival factor. So you’re actually making precursors to red blood cells the whole time in your bone marrow, but they actually need EPO to come along and tell them that they should survive and continue to mature and then turn into red blood cells. And EPO is made by the kidneys and the kidneys do that basically by detecting lower oxygen levels. So if your oxygen level drop, for whatever reason, and that's because you're not getting enough delivery from the red blood cells then the kidneys will start to make EPO.
So obviously, if the kidneys aren’t working then EPO production drops off and you see that in people with chronic kidney disease. You have to give them EPO because they’re not making enough. So, generally if have the average athlete’s, who’s just trying to get healthier, kidney function probably isn't gonna be the rate limiting step, but a lot of people have some inherited kidney disease or maybe you’ve had a lot of rhabdo and abused your nonsteroidal anti-inflammatory drugs and that scores some kidney damage. And then some really basic blood tests like creatinine or BUN, the blood urea nitrogen, they can be elevated if people have problems in their kidneys. And if anybody's had a basic blood test with their doctor, they’d probably have seen those numbers. One caveat is that if you're taking creatinine as a supplement or if you have a lot of muscle mass then that’ll, those will both increase your Creatinine. But if it is something that, you know, you’ve had a few drug tests and see if your creatinine is very high and you don't have a reason to explain it and maybe you're anemic as well, then that's something you should really go and see a doctor about because it could be that you have some chronic kidney problem.
Ben: Okay. So let's say that our kidneys are working properly like we’ve tested our blood, urea nitrogen is good to go, creatinine is good to go, I know glomerular filtration rate or the, I think it’s the EGFR is another common one you tend to see on kidney panels and that's something that a lot of basic blood tests will look at. Let’s say you find that your kidneys are good to go. So how would you then know if you’re deficient in one of these other nutrients that's necessary to produce red blood cells?
Tommy: So that's when we start by just looking at basic complete blood count or a CBC and that’s where you begin to see whether maybe you even have a tendency towards anemia in the first place. So, the things that we’ll talk about, would look at, which people have probably heard of, most of these will be hemoglobin. So we talked about that earlier. You have a total red blood cell count, you have something called the MCV or mean corpuscular volume which is basically the average size of your red blood cells, you have the hematocrit which is the percentage volume of your blood that's taken up by red blood cells, and then you have the mean corpuscular hemoglobin and mean corpuscular hemoglobin concentration which basically just tell you how much hemoglobin is in your red blood cells and then finally, you have something called the red cell distribution width or RDW which basically tells you how variable in size your red blood cells are.
So if you’ve had some problems with some certain nutrients and you have very different size of red blood cells then that’s not a good thing if you want them all to be roughly the same size. And then you can look at those things and you'll see certain patterns. So, if you, say you just have like a basic iron deficiency which Chris thought he had previously, pretty much all of those numbers will be low and maybe your RDW will be a little bit higher. So if you have an iron deficiency, then your red blood cells are smaller than normal. But if you have, say maybe a B12 or a folate deficiency, then they stop the red blood cells maturing properly and if you have a deficiency in those, you stop your red blood cells maturing properly so they’re bigger than expected so then you might see an elevated MCV and an elevated RDW. And then finally, you could have something like your red blood cells are a normal size but you don't have very much hemoglobin. So then maybe B6 and Zinc which are very important for synthesizing heme, there might be an issue there. So if you look at the general pattern of those markers, you can get an idea of where the deficiency might be occuring.
Ben: Okay. Got it. That make sense. It sounds to me like gold standard though would be, you look at both the red blood cells then also at some of these nutrients are able to kind of see both what's going on in terms of like the size and the red blood cell count, but then also say what's going on with like B12, folate, et cetera.
Chris, I wanna ask you in terms of test results, like I know you went through this whole testing process, you obviously saw a big boost later on but I'm curious for you specifically, did you find any of these nutrient deficiencies that Tommy is talking about?
Chris: Yes, absolutely. And the blood testing to find an initial problem was very very useful and I think it's important to keep in mind when you look at your lab results, the reference ranges that you see on those results, those are just averages, right. So maybe LabCorp or Quest, they take 7,000 of these results and then they just draw a [23:13] ______ around it and they save maybe two standard deviations either side of the mean and that’s what determines the reference range. And the reason this can be a problem is because, I mean, you only have to look around you on the street and know that most people are not listeners to the Ben Greenfield Podcast, right? People are in pretty bad shape in general and then the people that go to the doctor are probably in even worse shape, and those are the people who are doing this blood test. They’re not doing this test to try and improve their performance. They’re doing it because they’re sick.
And so, those averages that you see on the blood test result are not always as good or as helpful as they can be and so having someone like Tommy or me and some special software that we have is really really useful to just find some optimal or tighter reference ranges and I think that’s super helpful for debugging this problem. But yeah, beyond the blood testing, now I already talked about neuro organic acids on the last podcast and that was super helpful for me for trying to figure out. So I've been seeing, I fixed the iron problem, that's now solved and I'm still seeing like very high MCV. So very big red blood cells. For some reason these red blood cells are not maturing properly. It's kind of, it's almost paradoxical but red blood cells, they become smaller as they reach the final stages of maturity and so yeah, high MCV. And then when I did the urinary organic acids test I saw an elevation of an organic acid which is called formino glutamate and that’s just a compound that's made from amino acid histidine.
Ben: What’d you call it? Formino…?
Chris: Yeah, sorry. It's kind of, they’ve all got this, these organic acids have all got really difficult to pronounce and unmemorable names. So this is formino glutamate and it’s sometimes referred to as Figlu. So if you wanna do some research on this, if you are a nerdy kind of person like me, the magic key word in pop major looking to unlock all this stuff is called figlu. F-I-G-L-U.
Chris: So figlu starts to build up. You see an elevation of figlu on your organic acids test when there’s insufficient folate and that might be because you're not eating enough leafy vegetables or maybe there’s not enough of other sources in your diet. But I think one of the main reasons why people might be deficient in folate is because they have some sort of genetic mutation which means they're not very good at converting it into the most bioavailable form. And we talked about that in the last podcast and you've mentioned it several times. So if you think that might be you, you’ve done some genetic testing and you’ve seen some mutations in the MCHFR gene then I think it's a really good idea to take the methylated form of folate or five metal tetrahydrofolate which is the type that’s in the Thorne EXOS multi and all the Thorne products actually. I didn’t just see that actually. I saw an elevation of methylmalonate which is a by-product of odd chain fatty acid metabolism. It’s super interesting all this biochemistry. Like I absolutely love learning about all this stuff.
So when odd chain fatty acids are oxidized or used as fuel in the citric acid cycle, so this is inside the mitochondria, inside of the cells then eventually you get leftover with the bit. Like you know these odd-chains, these carbons get chopped off two by two. And so in an odd-chain fatty acid, you get left over with a bit and eventually that does get converted and goes into the citric acid cycle, but that’s a B12 dependent step. So if you are deficient in B12 then you end up with an elevation of a methylmalonic acid and you can measure on the organic acids test. So this is the kind of really cool surrogate marker that you can use to show whether you are deficient in B12 and if you are deficient in B12 then you’re not gonna produce red blood cells as well as you should, and then you’ll end up with less oxygen deliverability, less power threshold.
Ben: Interesting. Okay. So we've got this figlu which is the one that can be elevated and that's one that we would be concerned about because that would indicate you didn't have enough folate and then methylmalonate is another one and that's when that can accumulate when you don't have enough B12 and both low folate and low B12 in addition to low iron can all affect your oxygen delivery capabilities.
Chris: Yeah, absolutely.
Chris: Absolutely, and you have to remember that these nutrients, they're really important for a number of things, a number of processes that go on within your body and I think that's the beauty of tackling this problem from the biochemistry level is that unexpectedly good things might happen. So methylation, so folate is the most important methyl donor or one of the most important methyl donors. And methylation also influences histamine break down in the gut and it may just be a coincidence, I never know this for sure but when I started taking the methylated folate, I found that my allergies just went away and it was kind of a strange coincidence but you know a really nice side effect.
Ben: Interesting. So, Tommy, in the case of Chris, what is it that would have caused these type of nutrient deficiencies or the kind of things that were showing up on his urinary organic acids test?
Tommy: Yeah. So, I think when Chris sort of started out on his journey, he was in pretty bad shape actually. I think there was a lot of stuff that was going wrong and hopefully most of your listeners don’t have all of these sort of interacting things happening at the same time but sort of individually each one could be fairly common and there are things that you could start to sort of tease out and might be having an effect on performance. So the first one is he had just talked about, brain fog and bloating and certain problems with his gut and he definitely had all that hallmarks of gut inflammation and you get a certain number of pathogens that ended up treating as well. And one of the really common ones is he had to back to pylori. So people have probably heard of H. pylori as a fairly common gut infection that ulcers and stomach cancer and a lot of people end up with heart burn or GERD because of low stomach acid caused by H. pylori. And where you know you’ve got an infection, you’ve also got inflammation, but relevant to this topic, if you got low stomach acid then that prevents or reduces the absorption of things like iron, zinc, and B12 and they can all directly affect red blood cell production.
And then if you're talking about the information side of that, information can affect both production of red blood cells and then destruction as well. So, if we're talking about production, one particular thing that happens is when you’ve got some information going on, your liver upregulates the production of something called ferritin which people might have heard of which is a protein which binds to iron. And so it’s basically a reactive mechanism. So if you’ve got some kind of stressor or inflammation, the body just tried and stores some iron for later, essentially. But if you've got chronic inflammation then a lot of the iron you have can’t be used up, so you cause like a relative iron deficiency. So even though you got plenty of iron, your body’s not getting access to it.
And then in addition to that, Chris was quite a high functioning endurance athlete and endurance athletes, we've seen in a number of studies, have an increased risk of certain deficiencies of micronutrients and two of the same again, iron and zinc, and these can be lost particularly in the sweat. So if you sweat a lot, we see that the people particularly in endurance runners or endurance athletes, zinc and iron can drop quite significantly, so that can be a big problem for that kind of athlete. And then Chris kind of alluded to certain genetic problems. So he's a poor methylator and he needs to take methyl folate and this is the interesting thing because you talked, you sort of alluded to earlier, Ben, that we would want to test for the nutrients themselves to see if there’s a deficiency. But actually if you do a direct test of some of this stuff, it's not really that useful.
So, if you just test serum zinc from your blood, it doesn't really give you a full idea of what the zinc’s doing or if you measure just B12 in the blood, it doesn't tell you that the B12 is at the right place doing what you want it to do and that's why you can look at instead, products that increase if the B12 is not working properly or is not doing its job properly like methylmalonate. So that's why you can kind of actually look, you're looking at what the nutrients are supposed to be doing rather than just looking at the basic levels. And then another thing, if we’re going back to genetics, a common thing and I think that something we’re seeing more and more of is hemochromatosis or iron overload. So the problem is almost in the other direction where high levels of iron are then causing inflammation and could then also be preventing proper red blood cell production.
Ben: And you could have high levels of iron but still have like low hematocrit, low hemoglobin, low oxygen delivery capabilities because of deficiencies in some of these other nutrients like folate and B12, right?
Tommy: Yeah, absolutely and you can almost, the problem is you can also precipitate deficiencies. So if you’ve got a very high iron level then you’re almost driving the blood or driving the body to produce more red blood cells but then you don't have enough of the other nutrients to sort of catch up and keep up so you can almost, by having a very high level of one but not enough of another and that particularly happens with B12 and folate as well and you can almost precipitate the deficiency in the other.
Ben: Okay. Got it. So Chris’ gut was messed up and so he wasn’t absorbing iron, zinc, and B12 and then he also had, in addition, a gut inflammation, just general chronic inflammation which was causing red blood cell destruction and basically sequestering his iron.
Tommy: Yeah, absolutely.
Ben: Okay. So that was affecting production but what about destruction. Can you actually destroy red blood cells as well via some type of mechanism that's going on in your body?
Tommy: Yes, so destruction is kind of, but we use it for the normal break down of red blood cells and all red blood cells eventually need to be broken down and recycled because they can’t repair themselves because they don’t, if you think about a normal cell, has a nucleus, can make proteins and can actually do some repair, red blood cell doesn't have most of that machinery. So eventually, after about, you say about 120 days after it’s made, it needs to be broken down. So what happens is over its lifespan it accumulates damagery, it ages. So maybe the membrane becomes slightly less pliable so it can’t fit through the capillaries, it can’t deliver oxygen as well and then as that happens then it gets stuck in places like the spleen and something like a macrophage, one of the white blood cells will essentially gobble it up and start to recycle it. And so particularly relevant to athletes or anybody who has any kind of chronic inflammation, so high volume of exercise can increase inflammation and oxidative stress and these can damage red blood cells when you get something very similar if you have, say a chronic gut infection.
Then in a healthy athlete, you might have a higher red blood cell turnover so you basically, your red blood cells don’t live quite as long because you’re exposing them to a higher level of oxidative stress but that’s not necessarily a bad thing because we know that if you stress the body, it adapts and that’s one of the ways that we get better, get faster is because we stress the body and then it gets better, it comes back stronger. But if you are somebody who for some reason has some kind of deficiency or some kind of underlying problem that means you can’t keep up with the demand for new red blood cells because of all the exercise you’re doing then the problems kind of stack up.
Ben: Okay. Got it. So it sounds to me like from both levels, inflammation and oxidative stress are going to be an issue whether it comes to hampering production or causing excessive destruction. And so, but part of this is nutrients, but part of it is like avoiding overtraining and having a properly structured training protocol.
Tommy: Absolutely, yeah.
Ben: Okay. So what do you specifically, Tommy, look for to show whether inflammation and oxidative stress is occurring excessively?
Tommy: Yeah, so one thing that people will have heard a few times, I know you’ve talked about it a few times, is high sensitive to CRP or C reactive protein which is basically produced by the liver in response to certain inflammatory stimuli and a lot of people will look at that in terms of something like cardiac risk or problems, say risk of heart attacks in the long term. So if you have inflammation then your CRP will go up. But then you can also look at some other things and again it's all about looking at patterns and maybe if your ferritin’s increased, that could be due to inflammation like we talked about earlier or it could be say, due to iron overload. So you could look at both their homocysteine, you could look at in the blood and that, again, might indicate if you have problems with methylation or folate or B12 problems.
And then uric acid is something that we’d also look at and that’s an indicator of certain types of oxidative stress. And then, so that’s on a blood test if you're then gonna do a little bit further and look at the urine and the urinal organic acids then we might look at something like P-hydroxyphenylacetate which is the marker of cell turnovers. So if you’re damaging cells due to whatever inflammatory process that's going on then you'll see more of this turn up in the urine and similarly something like 8-Hydroxy-2-Deoxyguanosine which is a really sensitive marker of DNA damage and oxidative stress and that’s something that you could look at in the urine and it's very nicely tied to increase risk of things like cancer. Particularly due to the DNA damage.
Ben: Gotcha. Chris, did you have any of those?
Chris: Yeah, absolutely. So the high sensitive C-reactive protein is a tricky one. You have to watch that if you're an athlete. If you go to an Ironman and then measure your C- reactive protein the next day or even the day after, you might well see it’s elevated, but I went to the doctor and had some blood drawn during a rest period and I was still seeing really high C-reactive protein. And for me, I'm pretty sure that the chronic inflammation was coming from my gut and when I switched over to the autoimmune paleo protocol which I'm sure you know is a subset of the paleo diet like a restrictive version of the paleo diet then my C-reactive protein, it came back into the normal range.
And since then, I've switched to a ketogenic diet, a very high fat diet and my CRP has fallen even lower. It’s down to point 26 now even though I’m still doing quite a lot of training and then I've also seen improvement in the markers that Tommy mentioned, the P-hydroxyphenylacetate and the 8-Hydroxy-2-Deoxyguanosine. and I think you know when there’s less inflammation. You can feel it. Like if you’ve ever done a really hard session and then you get back and you just feel like you’ve been hit by a bus, right? Like you’re just completely nonfunctional for the rest of the day. I mean that for me is what inflammation feels like after a race. And so, now I really noticed that I'm pretty functional like even after training and that's really important to me because I'm 40 years old now and I have a daughter who’s two and she’s becoming extremely demanding and it’s just not acceptable to spend the rest of the day on the couch after you do a bike race even so…
Chris: Super important to me to get these levels of inflammation down on this kind of the chronic level.
Ben: Interesting. Okay, so you've obviously tested for these type of things. We've tested for the production of specific nutrients that are going to assist with production of things like red blood cells. You also, Tommy, talked about destruction and the inflammation and chronic oxidative stress that can cause that but what about actual loss of blood cells? Like you hear about how for example like men are at higher risk of hemochromatosis or iron overload compared to women because men don't bleed every month from menstruation, et cetera. Are there other things to take into consideration when it comes to just straight up red blood cell loss?
Tommy: Yeah, I mean that's a great point. Those women are kind of protected at least for that period of their life from something like iron overload because they sort of lose some of the extra as it were. But if it looks like they’re losing blood, this can be a bit of a problem to sort out because it's probably going to be from the gut because any other bleed is usually quite obvious and that can be something like an ulcer in the stomach or a polyp or a small growth or potentially even colon cancer. Particularly as people get older the risk usually increases. And you can’t really rule out a bleed but you can confirm a bleed by doing something like an alcohol blood stool test. And the more people hear me talk they’re probably gonna think that I'm really hating on endurance athletes because this is another problem in endurance athletes and that's not the case at all but Chris and I have done a huge amount of various endurance racing and that’s sort of been our passion throughout a large amount of our lives which is kind of why we’re doing this. But a lot of athletes, particularly endurance athletes, have some kind of GI complaint during, particularly during races, and that might just be nausea but it might also be diarrhea or something like that. And that particularly increases with distance and especially in runners. And then when you go to something like ultra-distance running then probably most people end up with some kind of gut symptom. And what that really highlights is the gut it's kind of at risk when you're doing prolonged endurance exercise and what that seems to do is that it increases the risk of actually losing iron or losing blood from the gut.
And there’s this thing called athletes anemia where you're hemoglobin sort of spontaneously drops in endurance athletes and what people originally thought was that’s mainly or it’s largely due to an increase in the plasma volumes. So basically the volume of the blood increases as a response to training and then that sort of dilutes the hemoglobin a little bit. But they've done some more detailed studies with a given basically labeled iron and it’s incorporated into the red blood cells and then you can see after a long training session it can be lost through the gut. So people are bleeding in the gut. And then that goes on to kind of be reflected in something like some very very long distance ultra-marathons where they then test the people when they found that they have blood in their stool afterwards in a very high proportion participants, sort of 80-90% of people. So you know that kind of distance with that kind of stress then people really have the potential to lose some blood through the gut. And part of that’s because as you stress your body or you’re trying to push yourself, your body redirects blood away from the gut, say to the muscles that are exercising through hormones like norepinephrine or epinephrine. And then when you stop, all that blood can kind of come rushing back to the gut and cause a reperfusion injury.
Ben: What's a reperfusion injury?
Tommy: So basically everybody knows that if you cut the blood supply off to a certain area of the body for long period of time, that’s probably not very good for it. So in brain it can cause a stroke, in the heart equals a heart attack. And actually a lot of the damage occurs when the blood comes back. And so while the blood’s been cut off there’s this increase in all this sort of like metabolites and waste products and stuff as that area of the body has undergone anaerobic metabolism without oxygen, without any blood supply. And then when the blood supply returns then you get this huge increase in blood supply to try and sort of wash all that away, but that can actually end up causing damage in itself. So if people who have done a very long session say, and then they put a large amount of demand on the gut immediately afterwards then you can potentially precipitate some of these problems.
Ben: Interesting. I wasn’t really familiar with this issue with the reperfusion injury. It makes sense that if you're obviously training way too much that that might cut off some kind of blood supply to an area for a long period time or if you’re overstressed, too much norepinephrine, et cetera. Chris, did you find out that you had this issue as well?
Chris: Yeah, I did test positive on one occult blood stool test. So you can get these things, maybe we could link to one in the show notes, but you can buy these things online and do them at home. They’re not expensive.
Ben: It’s called an occult blood stool test?
Chris: Yeah, occult blood stool test. They’re not that hard to find. They’re really cheap. And I did test positive on one of them but switching to the autoimmune protocol actually fixed that very very quickly. The bleeding stopped. Tommy mentioned, I found some gut infections and worm and some weird amoeba thing, a yeast overgrowth and I found that since I’ve healed my gut and got rid of those things that I don't need to be quite as strict as autoimmune paleo anymore. But yeah, I think it's still fair to say that I'm not one of those guys that you see at the end of the race with a beer in one hand and a burrito in the other, and I think based on what Tommy’s just said it's important to consider what’s happened to your gut. So we already know, you talked about it a lot, Ben, on this podcast that certain foods might be pro-inflammatory and not such a good idea to eat in general. Well that becomes especially true when you just finished hard workout or a bike race or a running race, whatever it might be because your blood, your gut has just had its blood supply removed. Is that really a good time to like dump a load of really kind of difficult to digest foods? So I think that’s an important consideration.
Ben: In terms of gut damage, you know obviously just based on the title of this show about increasing EPO, we're gonna have a lot like cyclists, and runners, and triathletes, and obstacle racers listening in. Are there other ways that they could protect themselves from damage like this to their gut?
Chris: Yeah, absolutely. So I think you know switching to a high fat diet that makes a lot of sense to me. If you’ve become a fat-adapted athlete and I’ve been racing in ketosis for a couple of years now and still getting really really good results, that's protected against these types of problems because you already have the few on board. You don't need to be stuffing your face. Back in the day before I knew any of this, the first glance at this is the Ben Greenfield Podcast, I was consuming 6% carbohydrate solution and a massive camel back on my back and I was choking down a sugary sports jelly every 40 minutes even when I was out on training. And that’s kind of a lot for your gut to deal with and then if you're taking eating other food on longer events, you're asking a lot of your gut to process all that stuff and if you're in a high-fat or ketogenic or fat-adapted state and your primary source of energy is fat then that fat is already on board and you don't need to eat anything.
Ben: Okay. Got it. Got it. So we've talked a little bit about blood testing for nutrients and blood testing for specific biomarkers related to iron and to anemia and we've talked about urine and like these urinary organic acids test. We've talked about stool testing and the fecal occult blood tests. How do we know? Because this is obviously a lot of stuff. Where to start? Like which test you should or prioritize or do first?
Chris: Well, I think a basic blood chemistry is something that everybody should be doing. It’s so cheap now. It's like everybody should be doing those and I think that most people listening to this podcast probably will have some data and my question to you is: What’s that data doing for you? Do you really understand it? Do you understand how it could be better and how that might affect your performance? So, I think a basic blood chemistry is essential and then if you can afford to get a better one that has markers like a full iron panel obviously homocysteine, B12, folate, parsing insulin, hemoglobin A1c then that's even better, And then if you wanted to dig deeper and really understand some of the reasons why you might find problems on your blood chemistry then I think the organic acids, those two tests, they go together like twins, like they’re really really helpful to have them side by side. And then that’s a super cool test that’s also gonna look at not just the nutrient deficiencies but also bacterial overgrowth which obviously is a problem for the gut and then other problems related to mitochondrial energy production and neurotransmitter turnover as well.
Ben: Yeah, and that was the one that we also did a whole podcasts on, and I’ll link to that in the show notes. By the way again for those of you listening in, the show notes are at bengreenfieldfitness.com/epo that's bengreenfieldfitness.com/epo if you want to really dig deep on to the organic acids test which is the urinary organic acids test that Chris and I talked about in our last podcast. So in terms of these tests, Chris, test interpretation, like getting all these tests is one thing. Being able to understand what's going on is another. Can you tell me a little bit about how exactly one would go about interpreting the results?
Chris: Sure. Yeah. So you don't have any recent results then I can certainly order those for you and you don't need to go and see a doctor to get this test done. I can send you a PDF requisition form and then you can print that out and you can take that directly to LabCorp especially if you go on the weekdays, it’s super-fast. Like you’re in and out of there in 10 minutes and then you get results sent to you electronically. And then at that point, I can run the software, run the results through my software which defines these tighter limits and then provide you with a written report and then Tommy and I can then sit down and review your results ahead of a 30 minute one on one consultation that you could arrange online using my scheduling software. But having said that, so what I’m saying here is that you can get a world class biochemist to look at your results but I think it’s important to mention that even though Tommy is a medical doctor he can’t takeover as your primary care physician.
Tommy: Yeah, so that's I guess that’s important to point out and I kind of hopefully people can see that if you optimize certain biochemical parameters, you sort of have a little bit of a dig then you can essentially get a performance boost for free which is what Chris ended up doing, but if you have any evidence of bleeding or kidney problems or anything like that that's not something that we are really gonna be much help for and that’s sort of something you need to see your, and that’s exactly what your primary care physician is there for. That’s what their expertise is in.
Ben: Okay. Yeah. That makes sense.
Chris: Yeah, I mean I think it's really important to understand what this is. So this performance coaching, this is clinical coaching. This maybe a good way to describe it. It’s not disease management. We’re not gonna cure you of any disease but what we might be able to do is give you that extra 3, 4, 5% and just go back and look at your race results and see what difference that would make to you. Like I’ve just been literally doing this high-race cycle cross at this time of the year and I raced in the elite race and I am not a cycle-cross guy. I do it because I love it, because I find so much fun. I’m like super slow to which I'm not nearly strong enough to be able to sprint out of the corners and I place mid-pack in the elite men’s race here on the west coast of California which is pretty competitive. And still when I look at the results, so yesterday I was exactly three minutes back from the winner of the elite race. He’s like the under 23 national champion. So that’s only 5%. 5%. Like if you can find something on your blood chemistry that gives you a 5% improvement, that’s the difference between a 40 year old dude like me that's just having fun and the under 23 national champion. So this is like, it’s huge.
Ben: Yeah, it is big and you know some of this stuff, I’ll be honest like I've done one off tests of you know like my iron, my red blood cells. I've had a urinary organic acids test done but not to actually look at specific parameters that could affect things like erythropoietin production just because I was more looking at it for absence of disease than for performance. But now that I've kind of got all this together in my head, it makes sense. And then fixing it with some of these things you've talked about like B12 and folate and you know, addressing specific parameters especially in that organic acids test that are like a little laser pointers going out for some of these smaller things that could go wrong. I could see how putting it all together would make a big difference. I'm taking a lot of notes. This is giving me a lot to work with when it comes to creatively figure out ways I can legally boost EPO. So this is pretty cool stuff. I know that you guys have your Nourish, Balance, Thrive website, and I’ll put a link to that in the show notes where people can go to your oxygen boosting protocol and basically do the testing and the consults and everything like that, and you guys have a discount code for us, right?
Chris: Yeah, that’s right. So act on it now. Stop the car and place an order because there’s only so much of Tommy’s time I can sell. We're not selling just a supplement here and there’s limitless amounts of it like there’s only so much. Tommy’s doing his PhD and he only has so much time. So if you would like for him to look at your test results then go ahead and place an order. You can use the code ‘Ben10’ to get 10% off and I should probably point out. Actually there’s a couple of options here. If you’re in the US and you want to get a blood test done, that’s super easy. I can just send you to LabCorp. It’s really easy and even if you don't live near a LabCorp, I can just send you a collection kit and you can take that collection kit to anyplace where they draw blood so like a local doctor's office or somewhere and you can do it that way.
And then if you're in the UK, the 21st century has arrived there, you can do this with a finger stick like they can send you a kit and you can stick your finger with a lance and then drop some blood into a little vial and send that to the lab using FedEx and they use exactly the same machine, it’s exactly the same test. The only difference is they don't need so much blood. I don't, there’s some companies like Theranos in the U. S. which are emerging but for some reasons it’s very slow to happen and it's not really happening in the US, but if you’re in the UK then this is really cool. You don't even need to go to the lab. You can collect the blood at home so it’s typical. And then the third final option is if you already have some test results and you would like us to look at those then that’s no problem then. It's obviously much cheaper to do that. You can just place an order online and then you’ll still get that same one on one consult and Tommy will look at your results and you still get the written report as well.
Ben: Got it. Cool. Good stuff, guys. I’m gonna link to all this stuff in the show notes including Nourish, Balance, Thrive. The discount code is ‘Ben10’ for that. Go to bengreenfieldfitness.com/epo to check this stuff out. I know this was kind of a heady technical show so if you have questions for Chris or for Tommy or for me, leave them in the comments over on the show notes for this episode at bengreenfieldfitness.com/epo, and one of us will reply, and I’ll also link to things like the fecal occult blood test, the paleo autoimmune protocol, Doctor Michael Puchowiz website and some of the other things that we mentioned during the show as well. So Chris and Tommy, I want to thank you guys first for spending the time on the show and telling us how to legally boost and upgrade some of our oxygen levels, our EPO, et cetera. This was pretty cool stuff.
Tommy: Thanks very much.
Chris: Thank you.
Ben: Alright, folks. Well, this is Ben Greenfield, Chris Kelley and Doctor Tommy Wood, signing out from bengreenfieldfitness.com/ Have a healthy week.
You may remember Christopher Kelly from the podcast episode “The Little Known Test That Tells You Everything You Need To Know About Your Metabolism” and “7 Signs Your Cortisol & Adrenals Are Broken“.
In today's episode, Chris is back, along with special guest Dr. Tommy Wood.
The reason I've invited Chris back on the podcast is because he recently wrote me about new methods he's been using to identify how to increase EPO, increase oxygen consumption, beat anemia, boost red blood cells, and get double-digit percentage increases in power and endurance.
I'm always looking for insider tips on how to maximize my own athletic performance, so figured it would be a good idea to have Chris on to talk about these new, little-known testing and treatment methods.
Christopher Kelly is a computer scientist, pro mountain biker, certified Functional Diagnostic Nutrition Practitioner and graduate of the Kalish Institute. Chris is British but lives in California where he runs the functional medicine practice Nourish Balance Thrive. Chris has been on the podcast twice before, once to talk about salivary hormone testing for adrenal fatigue, and once to talk about organic acid testing.
My other guest, Dr. Tommy Wood is a qualified medical doctor, graduating from Oxford University in 2011. He has a previous Bachelor's degree in Natural Sciences and Biochemistry from Cambridge University. After working as a junior doctor in the UK for two years, Dr Wood is now working towards a Ph.D. in neonatal brain metabolism at the University of Oslo, Norway.
During our discussion, you'll discover:
-Why oxygen deliverability is so extremely crucial if you plan to compete at elevation or altitude, or you want to maximize your physical performance…
-The exact blood-building protocol Chris used to get a a 32-watt (9%) improvement in his cycling power at threshold…
-Specific conditions you probably get exposed to that directly shut down your ability to produce red blood cells and EPO and what you can do about it…
-How to know if you're deficient in any of the nutrients required to produce red blood cells…
-The common nutrient deficiencies (which Chris had) that severely hamper your oxygen delivery capabilities, and how to fix them…
-The best way to track and monitor whether excessive red blood cell destruction is occurring…
-Little known ways that you can actually lose red blood cells, and how to test to see if that is happening…
-And much more!
[7:24] The background behind Chris’ interest in blood chemistry.
[9:17] Why measuring total hemoglobin mass is important to athletic performance, i.e. its relation to VO2 max.
[10:54] The importance of owning one’s health and data instead of relying on one’s primary care physician, especially when targeting athletic goals.
[12:22] How conventional treatment with intravenous iron didn’t help Chris, and how doing his own research into other treatments led to improvements in his hemoglobin and, eventually, a 9% increase in his threshold wattage.
[14:29] The biochemistry behind hemoglobin and Chris’ experience.
[17:40] EPO and the evaluation of kidney function (which produces EPO).
[20:16] Tests that can be used to identify issues with producing red blood cells, including both examining red blood cell size and count and nutrient tests.
[22:35] Chris’ personal experience with testing for nutrient deficiencies, reference ranges, and other tests that helped him such as testing for formiminoglutamic acid (FIGLU).
[25:20] Common reasons for folate deficiency.
[25:55] Interpreting elevated levels of methylmalonate.
[28:10] Causes of Chris’ nutritional deficiencies including gut inflammation, pathogens, sweat loss, genetics, etc.
[33:01] Reasons for red blood cell destruction such as the normal breakdown cycle, exercise, and chronic inflammation.
[35:16] How to determine if inflammation or oxidize stress is occurring excessively.
[38:57] Possible causes of actual loss of blood cells, including athlete’s anemia and reperfusion injuries.
[44:42] How to protect yourself from damage to the gut.
[46:06] How to know where to start and prioritize tests.
[47:58] The process for testing and test interpretation.
[49:31] Benefits of this clinical coaching.
[51:45] Other resources, discount codes, service options, etc.
Resources from this episode:
–NourishBalanceThrive.com (where you can use code BEN10 for a 10% discount on the testing and consulting services we discuss in this episode)