Sponsor:
Be sure to open Amazon via enduranceplanet.com—it’s just one extra click to link to Amazon through the sidebar banner or click the Amazon links in the show notes. Thanks for supporting the show.
Sponsor:
This holiday season give the gift of health, wellness and elevated performance–whether to yourself or to a loved one. Just head to enduranceplanet.com/shop for a bunch of cool products and services we’ve come to love, use and endorse. Everything we offer is centered around helping you achieve the ultimate in health and performance. Also when you shop through endurance planet you directly help support the podcast so we can continue to provide you with great content always for free… The new year and new season is coming, why not give the gift of health and performance optimization!
Dr. Tommy Wood is back on the show for another edition of Ask the Doctor, Tommy’s sixth time as our resident doc. You can find Tommy over at NourishBalanceThrive, and be sure to check out their Elite Performance Analysis quiz. On this show, we catch up with Tommy and he tackles the following listener questions:
Tommy’s published Letter to the Editor in the Strength & Conditioning Journal, written in response to a point-counterpoint article:
A Case for and Against a Ketogenic Diets in Athletes Point: Matthew Kavalek and Ryan GannonCounterpoint: Mike T. NelsonBoth sides made great points, but Tommy had some extra thoughts!Point:“the beneficial effects of a KD on aerobic performance are fairly well established”Wish that were true, but isn’t yetProbably due to the nature of the studiesLouise BurkeRace walkersKetone ester in cyclistsRecent Caryn Zinn study5 cyclists on keto for 10 weeksAll of them lost weightPeak power decreasedAll of them saw worse time to exhaustionBut one had an increase in VO2MaxCounterpoint:Metabolic flexibility is importantRisk of “losing metabolic machinery”This is only really true if you look at PDHThe rest of glycolysis is working just fine (FASTER study)Extra pyruvate either via PC to OAOr converted to lactate (Cori cycle)If wanting to boost PDH and maintain metabolic flexibility on keto, do HIITRemember:For performance, some carbs are likely to always be importantKeto for the sake of keto doesn’t make much sense from a performance standpointKeto athletes still eat carbs!Ironman athlete, 50-year-old female, with familial hypercholesterolemia (FH) – LDL’s been high since 20s, on medications (Lipitor, Crestor), being advised a low-fat diet, training for Kona, having adverse effects from meds – what to do!??
Everything MUST be discussed with a doctor/cardiologistFH is a result of mutations that reduce the expression or function of LDL-RReduces uptake of LDL into the liverIncreased LDL levelsWhen it comes to heart disease risk, LDL-P matters much more than LDLHigh LDL-P isn’t enoughNeed some damage to the artery for cholesterol to accumulateMost people have heterozygous FHOnly one receptor mutationIncrease in death from heart diseaseHighest risk is in the 20s-40sOnce you reach your 60s, risk is the sameLower cancer riskOverall mortality rate is normalYou have to die of something!Family tree mortality study in HollandMortality risk and cause of death varied widelyLower in 19th CenturyHigher in 1950sDetermined that environment was much more important than the mutation itself.Smoking, diet, exercise etcIn those with hFH that have had a heart attack, their LDL is not higher than those who have not had a heart attackHave higher insulin and measures of insulin resistance.HbA1c is one of the strongest predictors of atherosclerotic risk in FHGlucose control, insulin, and insulin resistance appear to be better predictors of CVD risk in FHMuch like in people without FHAngie has:“High HDL”Can be dysfunctional in the setting of high oxidative stressNormal triglyceridesLikely has a Trig/HDL ratio <1, which means she has little evidence of IRStatinsNo clinical trials have shown efficacy of statins specifically in FHStatins have a poor ability to reduce CVD risk as primary prevention in womenSome evidence that statins can impair adaptations to exerciseMay have a greater negative effect in males than in femalesMost interesting:Increase the risk of type 2 diabetes, especially in womenMost studies show about a 50% risk increaseStrategiesMaximise expression of LDL-REnsure proper thyroid functionAdequate caloriesSays she’s hungry all the timeAdequate insulin (carb cycling?)Manipulate PCSK9Insulin sensitivity and *some* insulinMinimise inflammationChris Masterjohn would suggest a Kitavan-style diet20% fat, 10% protein, 60-65% carbsHigh-quality carbs (whole foods)Refined carbs can increase LDL-P numberProbably need more protein for an athleteOthers would say eat a low carb dietMinimises glucose influx and insulin levelsI’m agnosticEat whatever maximises performance while:Minimising inflammationKeeping HbA1c and markers of insulin/IR lowIn summaryWhat causes heart disease in FH is what causes heart disease in everybody elseLDL levels don’t matter on their ownIn the HUNT-2 study, overall mortality decreased with increasing total cholesterol in womenTake this stuff to doctor to review and make decision!Ask for evidence that statins will reduce her risk of CVD as primary prevention in FHDiscuss the linked papersTrack advanced particles (LDL-P, Lp(a) etc)Carnitine can reduce Lp(a)Can also increase endurance performanceTake Q10 if continuing on the statinDoses up to 600-1,000mg until muscle pain stopsAlso fat soluble vitaminsAlternativesEzetimibe and low-dose statinPCSK9 inhibitor?Identify and minimise sources of inflammationEnsure proper training and recoveryHusband needs advice for wife: References and guidance on how a natural eating lifestyle can help cure low serotonin and depression, and pros and cons of SSRIs like Prozac.
Let’s initially say that the assumption that depression is due to a deficiency in serotonin is correct.SSRIs as the main treatmentRevisit previous Ask the Doc (talked about serotonin and PMS)Paper by Rhonda Patrick and Bruce AmesTryptophan shunted away from serotonin production in the setting of stress and inflammationMinimise thoseExercise and insulin (carbs) both increase the uptake of large neutral amino acids (like the BCAAs) into the muscles, which reduces competition for tryptophan to enter the brainVitamin D is required for the production of the TPH2 enzyme, which converts tryptophan to 5-HTPSUNLIGHT!Omega-3 fatty acids are needed at synapses in the brain to make sure serotonin signalling work properlySerotonin is important for moodHowever, the suggestion that depression is due to a serotonin deficiency is not that well provenIn general, the benefit from SSRIs in depression is minimalOld studies comparing antidepressants to active placebos (usually atropine) showed very similar effects from bothWhen compared to inert placebos~40% reduction in symptoms from anti-depressants~30% reduction in symptoms from placeboThough they haven’t been compared directly, the effect size of SSRIs smaller than or at best equal to that seen from:MeditationExercise (aerobic, yoga etc)DietSMILES trial12-week trial in moderate and severe depressionWhole food-based Mediterranean-style dietRemove sugar, fried foods, and processed grainsDepression probably isn’t directly due to a serotonin deficiencyBUT is tightly correlated to inflammationGenetic susceptibilityOptimise vitamin D and some Omega-3sReduce stress and inflammationHigh-quality diet has an effect size at least as large as taking SSRIsTo get off SSRIsStrategies from Dr. Josh TurknettCHECK with psychiatristCAN go cold-turkey (with permission)Need to believe that the other strategies are at least as good (if not better) than the pillA good trick is to try paired conditioningTaper down the drug (i.e. 50%)Take it with something elseAn action – meditation or exerciseVitamins (Vitamin D)Sugar pill (real placebo)Imagine getting that same mood boosting effect as you would from the full SSRI doseTaper again (25% or 0%)Placebo still works even if you know it is a placebo!Cure – Jo MarchantAthletes in 50s experiencing twitchy legs in bed (restless leg syndrome). Struggling to relax muscles and can twitch violently every couple of minutes for what seems like forever. What’s the research say on drinking pickle juice before bed? The Swiss brand, Sponsor, is now selling shots of vinegar, pickle juice, magnesium & quinine to relax muscles – is there any science behind this tonic?
Start by talking about exercise-associated muscle crampsThis is what the Sponser supplement is designed to improveA large amount of the research has been done by Kevin Miller, Central Michigan UniversityInitially thought that cramps were due to:DehydrationElectrolyte depletionSome combination of the twoMainly based on anecdotal studies and case reportsControlled trials have shown these are likely not the causePickle juice does reduce crampingDoes so faster than it would take to replenish electrolytes or fluidsMany doses (1-2ml/kg) of pickle juice have been shown to have negligible effects on sodium and potassium levels during exercise.Unlikely to be due to dehydration or electrolytesAnother product – HotshotsRoderick Mackinnon and Bruce BeanRoderick won a Nobel prize for describing the structure of ion channels that contribute to nerve impulsesContains acid, ginger, cinnamon, and capsaicinThe Sponser and Hotshot product both aim to do the same thing – desensitise certain pain receptors (Transient Receptor Potential or TRP channels)TRPV1 and TRPA1Now thought that cramps are due to hyper-excitability of α-motor neuronsBrainstem and spinal cordBasically get permanent contraction of the muscleOr a reflex movement without a significant stimulusExciting the TRP channels (skin, tongue, oesophagus, stomach) dampens down the overall excitability of other nervesUse of capsaicin creams to reduce painMay be best to use a combination of TRPA1 and TRPV1 agonists?TRPV1 activatorsGarlicCapsaicinCloveCinnamonAcetic acidPiperine (black pepper)TRPA1GingerMustard and wasabiAcetic acidGreen tea catechinsLong term quinine for muscle cramps may increase death risk.Used for restless leg syndrome (I used to prescribe it!)Reduces leg cramps by about 25%BUT long term use (usually in the elderly) is associated with increased risk of death!For myoclonic jerks, as you get during early sleep, the evidence isn’t as goodBut the hyperexcitability of spinal nerves (or decreased inhibition from the brain) is thought to be part of itSimilar mechanism of action to cramping5-HTP may also helpMy tip: Brew a chai (green) tea with some chili and add apple cider vinegar!Or eat curriesA 37-year-old female runner with Ulcerative Colitis in need of advice. Took prednisone (steroid) for last flare, never lost the weight gained, a lot of bloating issues and cortisol belly, considering digestive enzymes, fermented foods. Not following a specific diet, still eating gluten and dairy.
Will certainly have digestive issues and a different gut microbiota in UCAutoimmuneSome evidence for elimination dietsSpecific Carbohydrate DietMay be better for Crohn’s, but some evidence in UC tooLow FODMAP dietAIPI would trial one of these in that order, and re-introduce slowly over time. Dairy and gluten are two common culpritsBut good evidence for probioticsVSL #3 and E. coli Nissle 1917 (Mutaflor)Bio-Three (Streptococcus faecalis, Clostridium butyricum, and Bacillus mesentericus). This is a product that contains it.Probiotic-3 from Advanced Orthomolecular ResearchMixed Bifidobacteria and Lactobacillus strains. (i.e. D-Lactate free Bifido and Lactobacillus probiotic from Custom Probiotics)Bifidobacterium longumUC is associated with increased intestinal permeability and visceral fatMay contribute to her bloated feelingShould improve as inflammation improvesElimination dietProbioticsOther anti-inflammatory approachesSoothing gut tonics – popular in our athletesCurcumin, Boswellia, Quercetin, MarshmallowGI-revive (DfH)Enteromend (Thorne)CBDGreat data in animal models of IBDSome promising data in humans, including people we know and have worked withDifficult to get high-quality CBD due to extraction issuesElixinol is popular15mg 1-4 times per dayIf you think you have gut issues – try NBT’s automated “Elite Performance Analysis” at NBT.AIMore references (mentioned on show):
https://enduranceplanet.com/ask-the-doc-how-fasting-affects-females-differently-causes-and-treatments-for-pms-why-hba1c-is-an-unreliable-marker-and-more/https://enduranceplanet.com/dr-richard-maurer-decode-your-blood-tests-for-optimal-results-managing-insulin-cholesterol-thyroid-weight-fitness-and-more/https://enduranceplanet.com/nikki-kimball-on-depression-a-fat-adapted-diet-and-ultrarunning/The post Ask The Doc: Dr. Tommy Wood on Familial Hypercholesterolemia in Athletes, Restless Leg Syndrome, His ‘Elite Performance Analysis’ Test and Much More first appeared on Endurance Planet.