View all show notes and timestamps on the KoopCast website.
Episode overview:
Floris Wardenaar is an assistant professor at the College of Health Solutions since September 2017 with expertise in Performance Nutrition.
Floris's education:
Episode highlights:
(35:15) Sodium bicarbonate example: best for sprinting 30-90 seconds, lack of relevance to ultramarathon running, know what problem you are trying to solve
(51:18) Single substances: caffeine example, controlling dosage, timing, and substance, coffee example
(1:01:00) Personalized nutrition: potentially the future, testing for deficiencies, magnesium supplement example
Additional resources:
How Sports Health Professionals Perceive and Prescribe Nutritional Supplements to Olympic and Non-Olympic Athletes
AIS supplement framework
Blood Biomarkers with Charlie Pedlar, PhD | KoopCast Episode #186
SUBSCRIBE to Research Essentials for Ultrarunning
Buy Training Essentials for Ultrarunning on Amazon or Audible
Information on coaching-
www.trainright.com
Koop’s Social Media
Twitter/Instagram- @jasonkoop
View all show notes and timestamps on the KoopCast website.
Episode overview:
Floris Wardenaar is an assistant professor at the College of Health Solutions since September 2017 with expertise in Performance Nutrition.
Floris's education:
Episode highlights:
(35:15) Sodium bicarbonate example: best for sprinting 30-90 seconds, lack of relevance to ultramarathon running, know what problem you are trying to solve
(51:18) Single substances: caffeine example, controlling dosage, timing, and substance, coffee example
(1:01:00) Personalized nutrition: potentially the future, testing for deficiencies, magnesium supplement example
Additional resources:
How Sports Health Professionals Perceive and Prescribe Nutritional Supplements to Olympic and Non-Olympic Athletes
AIS supplement framework
Blood Biomarkers with Charlie Pedlar, PhD | KoopCast Episode #186
SUBSCRIBE to Research Essentials for Ultrarunning
Buy Training Essentials for Ultrarunning on Amazon or Audible
Information on coaching-
www.trainright.com
Koop’s Social Media
Twitter/Instagram- @jasonkoop
Trail and Ultra Runners. What is going on? Welcome to another episode of the Coupecast. As always, I am your humble host, coach Jason Koop, and this episode of the podcast is going to focus on sports supplementation and we are going to try to unentangle this minefield of how to approach supplementations and if you should actually approach them in the first place. You longtime listeners of the podcast will realize that I have spent a lot of episodes on this particular topic and that is because I get a lot of questions from you out in the audience about what works, what doesn't work, should I take this and should I take that? So, in order to provide a little bit of the landscape for how we should actually approach this particular topic, I invited on the podcast today Flores Wardenar from Florida State University.
Speaker 1:Flores is a applied scientist as well as a performance nutritionist. He works across all different athletic populations, including tactical athletes, endurance athletes. He also works with registered dietitians. The thing that drew me to Flores to try to work on this particular aspect was a paper that he wrote recently titled how Sports Health Professionals Perceive and Prescribe Nutritional Supplements to Olympic and Non-Olympic Athletes. I am going to leave a link in the show notes to this particular paper. I encourage all of you guys to go and check it out. But what he describes in this paper is how all of the different stakeholders that can surround an athlete can be perceived by that athlete and work together in order to provide the correct recommendations for the athlete itself. So with that as a little bit of a backdrop, I am getting right out of the way.
Speaker 1:Here's my conversation with Flores Wardenar, all about sports supplementation and how you should approach this tricky landscape. First off, thanks to you for hosting me. I'm always appreciative when I can do these in person. I'm coming off Black Canyons this weekend, as we were talking about when I rolled in and very serendipitously you came up on the docket to record with, and so I figured, hey, might as well record in person. So we're here in an office that probably won't be here in a couple of weeks.
Speaker 2:It will be a couple of months. Yeah, yeah, they will tear it down and they will put a new library over here.
Speaker 1:Yeah, Okay, so it will be a McCain Memorial Library, right?
Speaker 2:Yeah, so it will be a national library, interesting to see how it will look like and what they will do with it. But yeah, I need to look for a new space.
Speaker 1:And you've got to pack up all your equipment, all the things from the lab that you have and stuff like that, and move it from one. Well, you got to find a location and then move all that stuff from one location to another.
Speaker 2:Yeah, but I have done that before because when COVID hit before that I actually was having my lab in the old American football locker room in Sun Devil Stadium.
Speaker 1:Oh yeah.
Speaker 2:You know, we're here at Arizona State University and I had to pack up my things because they needed the space to be able to test their athletes and then I ended up here, which is actually a nice location because it's relatively quiet and you can go outside and do all kind of fun stuff here close to Papago Park. Yeah, it allows me to do, you know, some testing outside and look into thermal regulation and so on. So we have been doing stuff here on the parking lot and that makes things really easy. Just to you know, organize stuff.
Speaker 1:Okay, so you mentioned we're here at Arizona State University, but you're not from here. No, explain, so the listeners can get to know you a little bit better. How did you get here? Because you have a really cool background that I think the listeners are going to appreciate, especially given the context of the discussion we're going to have today.
Speaker 2:Yeah, so you know, obviously it goes a while back. Do you want to do the full thing?
Speaker 1:Let's see if we can get it to three or four minutes Full history.
Speaker 2:Yeah, so I am from the Netherlands, which is a small country in Western Europe, and we have 17 million people over there and it's probably one-fifth the size of Arizona, so it's sort of crowded but it's a good country to live in and live at. And when I was young, I was interested in nutrition and I was an avid cyclist. I was cycling and track cycling and I was relatively small. So, you know, everyone is looking for competitive advantage and I thought maybe nutrition is something that I can look into, and that's how it started, for me at least, a personal interest. And then, obviously, after that, you know, I ended up doing dietetics, sports dietetics, going into a master's education, looking into nutritional physiology and lending after that my first job, the Han University of Applied Sciences, and they were having a group that was focusing on sports nutrition, sports dietetics, and, yeah, that was my field and it was actually my dream to work with elite athletes, olympic athletes, become the best in what you can do in that field. And so I ended up relatively soon starting to work with elite athletes world champions, speed skaters, rowers, cyclists, all kind of athletes and at the top of what I was having as my dietetic career, I was overseeing 200 athletes from different teams and at the same time, you know, I was always interested in the science behind things and at some point I figured out that a lot of the things that I was doing, I was always referring to the science, and if we didn't know about something then we invited scientists to tell us about you know what they, what was their best guess? And after, I think, six, seven or eight years working with the elite athletes, I sort of tried to cross over and said okay, I start my PhD. You know, try to figure out some things myself, do some science myself and, you know, become potentially the person that people want to talk with if they are not sure. So that was basically how it went.
Speaker 2:So in 2012, I did my PhD at Wageningen University. It's an agricultural university in the Netherlands and they have the full chain from, you know, the soil until the production of nutrition and food, and nutrition and healthy behavior is part of that. I investigated dietary intake of, let's say, the Dutch athlete. Since then, I think it had been 25 years. No, in those 25 years, no real evaluation had been taking place. So I thought let's start there, take a picture of how the current status is.
Speaker 2:And that was actually what was bringing me here indirectly is, you know, doing the research. I figured, okay, but now what's next? I really had a nice job with a nice team. I was team lead sports and exercise nutrition at my university. Then we had a team of 12, 14 people and we were working in the room of obviously educating our students, but also advising our sports associations and doing research. So a nice triangle of things that were coming together. But, you know, I had the feeling I need to do something that is even, you know, that is more out of my comfort zone. When I had been in the US, I interned at UT Texas in Austin, the Kinesiology Department, in 2005 or so. I knew a little bit about how it was to be at a large university and I talked with my wife and said, you know, potentially we, you know, is this something that you want to do too? And then she said, yeah, go for it. So I applied, had a good interview here at Arizona State University and seven years later I'm still here.
Speaker 1:Well, and what I can appreciate about that is is, first off, you started in elite sport very quickly as you, as you were going over, and you got to work with some of the best athletes in the world very early in your career. And then you went from a practitioner's lens to a research lens, and one of the things I've always enjoyed about this podcast the most is finding people like you that have both those vantage points.
Speaker 2:And often it is the other way around right, exactly.
Speaker 2:People become a scientist that is highly cited and then people feel, okay, I need to get this person in my team and in my area Somehow. You know I love watching sports, I love participating in sports, I love the whole dynamics, but in the end, I think my work mainly focuses on how to provide additional tools and ways of working for those people that are actually around the athlete. So things that we talk about today likely are interesting for the athletes as well, but a lot of my work in developing tools is something that I developed for the people that were doing the work that I was doing, like being a dietitian or a sports nutritionist trying to help them. To then let the athlete yeah, 100%.
Speaker 1:So your Dutch upbringing is actually quite interesting. First off, you could probably tell the last name, koop, right? That's where my family is from, although I can't claim to have much connection much connection right now but it's interesting within the context of what we're going to talk about today, which is sports, which is supplements and the listeners will appreciate this conversation because I've talked about it a number of times on this podcast and, as you now are aware of having lived in the States for a number of years, it's messy. The supplement ecosystem is really messy here in the United States. It's very poorly regulated. People don't understand it.
Speaker 1:There are all kinds of things that are in supplements that shouldn't be, and it's lent its way to these third-party testing systems that elite athletes have to use to make sure that there is no contamination in their supplements mainly NSF for sport and form choice for sport. But that is not the system where you come from and I did not know this prior to reading a couple of your papers that the Netherlands actually has its own. Is it a government run or government subsidized third-party testing system Like? Explain to the listeners how that works, because I think that's an interesting compare and contrast to what we are used to here in the United States.
Speaker 2:Yeah, so there is a Dutch safety system for supplements in sports. It's called NZVT it's Dutch abbreviation and it started, I think, around 2000, when we saw that a lot of Dutch athletes were testing positive band substances. People found out that a lot of the supplements that we purchase, that we use, are actually containing substances that are not listed on the label, and sometimes that happens on purpose. That's what we call spiking, but often it's just a contamination, impurification, but it is not necessarily unharmful, right so, and in some cases this can lead to positive doping tests, and at that time there was not really a good system available to go to. Although third-party testing organizations may have been existing, there was a lot of different ways how to measure substances. So at that time, multiple partners in the Netherlands said okay, this is something that we need to be aware of, village enough, organize something ourselves. So then, with support of the Dutch government and, for example, the Dutch doping authority and Dutch Olympic Committee and some other partners, this system was developed, and yet it is still existent.
Speaker 1:And does it work similarly to NSF, where an athlete can look up a particular supplement that they find in a Dutch GNC I don't know what the equivalent is over in the Netherlands or does it act as a clearinghouse in advance of those supplements actually getting on the shelves?
Speaker 2:Yeah, so the different third-party testing organizations all tend to work a little bit in a different way.
Speaker 2:Obviously, what you like, if a company says, do you want to test my product, Then you want to have all batches tested. But that's not always the case and it's not always suitable or feasible for companies, especially the smaller companies, because there's a lot of money affiliated with having that testing done. So what NSFVT does is that they allow batch testing. So it could be that one batch is tested by NSFVT and therefore it is cleared and there is a lot number on the bottle so that you can identify it. If companies decide that they want to test all their batches, then they're allowed to put an icon or a label on the bottle that identifies NSFVT testing and, I think, many other third-party testing organizations because you have them in the Netherlands, you have them in the US, you have them in Australia as well they work in a sort of similar way it's going to become a topic in the ultramarathon world that people need to become more and more apprised of, and the reason I'm kind of like bringing this up is a little bit of context.
Speaker 1:There just happened to be a recent paper that crossed my desk just the other day by Paul Robach, who was part of the medical team for UTMB, and they used this really interesting double-blinded method to both survey ultramarathon athletes as well as collect their urine samples, and it's kind of a novel way to actually collect the urine samples, where the athletes were blinded as to if their urine was actually being collected, and then that was also blinded to the researchers as well, so they could never match up. I guess my point is they couldn't match up the survey data with the urine samples. That's what they were trying to do, and I'll link this paper up in the show notes, and there are a number of interesting findings on it, the most stark of which, though, is that there were no prohibited substances declared by any of the participants that they were surveying, and yet there were an appreciable amount of drugs I think it was 16, actually found in the urine. So you have this interesting dichotomy already start to exist, where the athletes are saying we're not taking prohibited substances, yet it's showing up in their urine in some way shape or form, either through contamination, or they really are using performance enhancing drugs.
Speaker 1:That would all be wild speculation. But mark my word out of competition testing and I'm saying this to the audience, not to you. For us, out of competition testing is coming to trail and ultramarathon and there are a new and novel audience to this, and whenever that is the case, whenever you bring in any type of doping control and, more importantly, out of competition testing, there is a whole ball of wax that needs to get unwound with any number of different elements and it tends to cause a little bit of headache in the first few years when those programs get rolled out, before people get their bearings and stuff like that. So that's neither here nor there is just something more that I was curious about.
Speaker 2:Yeah, can I reflect on this? Because I think it is a real interesting study that they did and that they show that you can do something in real life like that. That's great. I think also that it has to do likely with the unfamiliarity with the rules. If you look into the type of substances that come up that they found many of those are more in the area of using certain medicines, certain drugs that are not necessarily associated with performance enhancement. And then the substances that come up that are potentially affiliated or associated with dietary supplement behavior were, in my opinion, very minor.
Speaker 2:So that means there are some things like they measured metabolic modulators or anti-androgen substances and the cream disruptors. These are substances that actually can be part of dietary supplements, and the issue is with it is that you potentially can test positive for them and at the same time, you're not sure what they're actually doing, because some people may feel like, oh, but if it is stimulating my testosterone, maybe it's a positive thing. The only thing is, if you test positive on it, it's not a positive thing. So you don't want to have substances in your supplement that you don't know, that you don't know what they do. Another positive thing is that they didn't find an EPO or anabolic steroids in the urine.
Speaker 2:They were mentioning, as a limitation, that they expected that there were roughly 300 elite runners being part of the races that they were tracking, but they also said it's very unlikely that they delivered a urine sample in the stalls that they set up, and so I was a percentage of the total sample, so I would be very interested to see if that specific group, if you would establish the stalls that are at the first part of the race, if you have stalls there to see, if you see different things, because what I sort of expect is because they are way more aware of what they can and cannot do, especially on the medication side of things, I would expect better results there.
Speaker 1:We have a blueprint for this.
Speaker 1:In the United States which you've been here long enough to have probably witnessed this with USA Cycling so many years ago, they started rolling out mainly in competition drug testing to their basically citizen riders.
Speaker 1:So you're normal people like you and me, we're in our 40s and we're cat three riders and we're not trying to do anything. They'll roll out drug testing to that and a lot of those people fail those drug tests because of some random medication that their doctor has put them on that they don't realize is banned. And I think that storyline in the learning lessons from that are that when you roll these things out to a naive audience, there needs to be a lot of education that goes on alongside of that rollout. Otherwise people get tripped up in the system that are not trying to cheat but then they get labeled as cheaters many times not all the time, but many times erroneously and very unfortunately. So both the people who are deliberately trying to cheat and the people getting caught up in the system use the exact same excuses when they went, when they're kind of encountered with this which is I didn't know or so and so was contaminated, and it's impossible to discern the truth because of all of this that's going on.
Speaker 2:And the difference here is that sport is having strict liability, meaning enforcing strict liability means you are responsible for what you do, and it's sort of different with if you are going to the court of law and then they need to prove that you did something wrong. But in sport it's the other way around. You need to prove that you're clean, which makes it very difficult in some situations. So the fact that this study showed some substances that I think could potentially be associated with supplement use contaminated supplement use that sort of carefully confirms for me that we need to keep an eye on safe supplement use and therefore that's my interest in looking into how compliant are people to use third party test supplements, because that's basically the only thing that you can do, and if you want to use a supplement in a safe way because there's no other way, the other option is not taking any supplements, and a lot of people don't opt for that option.
Speaker 1:Yeah, Okay, so let's get into the meat of the conversation, because it is true, what I really want to hone in on is how can athletes and coaches and practitioners filter the landscape down to make the correct decisions, and this is something that you've done an incredible amount of work on. I think it's first important to describe the landscape of stakeholders that exist in this realm, and what I mean by that are athletes have any number of people advising them, from people like me they hire me as a coach to their friends and family, and Instagram influencers and things like that, and you've done a lot of research in this area. So how would you first describe how people are getting initially influenced or they receive counsel from to start out this entire journey?
Speaker 2:Yeah, so, unfortunately, a lot of people take advice from their family and friends, and in some cases, from teammates as well, and which is usually well intended right?
Speaker 1:No, true, yes.
Speaker 2:Well intended, but it is also confounded by personal experience, and personal experience does not say a lot when you want to make a science, scientific based decision. Obviously, personal experience is important, but in you know, so I think it the lens. So that's where it starts. A lot of people are informed by their direct peers or family friends. The same thing is if you ask professionals, health professionals, if they know something about this topic. There's, in each group there are specialists, seeing that they are you know, believing that they are the expert. If you ask them as a group, there is general consensus that the sports are D sports. Registered dietitian is main expert. But even within that group you see lower scores when it becomes more complex. So if you ask them about you know, do you feel well equipped?
Speaker 2:On the topic of general sports nutrition, then sports dietitians are almost 100% in agreement, but it goes down. If we talk about sports specific recommendation, it's already getting a little bit less. And then, specifically talking about supplements, efficacy of supplements, safe supplements they are a little bit less confident that they have all the knowledge that they need to have and what you see with the other professions. And talk about coaches, strength and conditioning coaches, athletic trainers and all kind of other health professionals. They show a similar trend and they start as a group a little bit lower. So the percentage of people feel that they are well equipped to provide advice. The number on itself is lower, but there is enough within you know, of people within those groups that feel that they are well equipped to provide that advice.
Speaker 2:Now the question is if they can right it's not part of their education normally, but self study and self education can do a lot. I don't say that coaches cannot give nutrition advice. I don't say that strength conditioning coaches cannot give advice. But to do before and after training, to optimize, you know, the training or the recovery. But you are really dependent on what they have been learning, what they, how they educated themselves and where they get their information off. And I think as a lay person, it's sometimes difficult to assess if that information is the information that you really need, that you really should seek, because there is a lot of alternative thinking in different areas as well. So the safe bet is, would you know, would be to go to the real expert, that's the sports RD.
Speaker 1:Well, and it even goes beyond that. We're starting to see this like hyper specialization within the sports RDs, where they are focusing on maybe a narrow silo of sports maybe it's the endurance sports, maybe it's just running, or they are in the combat sports right. There's specific registered dieticians and professionals that work with that cohort of athletes as well. I'm always reminded that I describe coaching very often as being a profession where we are jacks and jills of all trades and really masters of none and I think that this conversation with nutrition really illustrates that very well where we are equipped to give what I would call very basic advice, but once you scratch, you know, one or two layers down, it's always better to turn those things over to a professional.
Speaker 2:Yeah. So I think an important role for the coach that is working with the athlete is to be there and to work, you know, in some extent as a mirror, helping to identify if there is any specific issues based on experience. Obviously you learn. So if it is about you know eating during, during a race, obviously coaches will see what their athletes do and they will get you know an idea about what tends to work and what not. But there is so much more that you normally can do if you are looking at it from a more specialized perspective.
Speaker 2:And you know, one of the things that I think in ultra marathon running is that often people have a plan that the question is do you also have a plan B for what is going on in the race? And I think in some cases people you know need additional specialism to get to a plan B or even a plan C, and I have actually been doing it myself, even in a race where we were doing measurements and the runner was saying, you know, I cannot do this anymore what I was planning to do, and then I had to go and look into the buckets, what they had and decide okay, let's try this or that, just because you try to optimize the performance of the athlete at that time.
Speaker 1:Yeah, and I'm always reminded that we're kind of slaves to our own experiences.
Speaker 1:So athletes want to know hey, did XYZ work for you, this flavor energy gel work for you, this supplement, kind of like, work for you?
Speaker 1:And we want to give that advice as coaches. But we're so very limited in our number of repetitions that we have and the experience that we have actually doing that. So the analogy I always give is people will ask me oh, when you, when you talking to me personally, when you trained for the Leadville Trail 100 in 2009 or whatever year, what did you do? And I tell them that's irrelevant because I have a hundred times more experience coaching people for the Leadville Trail 100 as compared to me actually personally running it. So here is the lens that I can offer you through all of that experience with sports dietitians and nutrition professionals. It's the exact same way If they're in front of athletes day in and day out. They have so many repetitions that they have gone through on advising what is what's going to work across a wide range of athletes. They just have more experience to give off that counsel than anybody else in the room and that's a very powerful thing.
Speaker 2:Yeah, and at the same time, I think we are colored too and we have also our preferences and think about some things that work or, you know, work less. I remember when gels came, you know, came into play, it was the first you know one or two years that the companies were, you know, organizing providing these gels to athletes.
Speaker 2:Yeah, goo is the original gels. I was really not in favor of it because I thought you know, this is probably too concentrated. The issue is that people probably will not drink enough and I was really fond of the idea of having fluid as my energy carrier and it was sort of my vehicle to get in enough fluid. But at the same time, over the years I learned that you know when it is really hot and you want to drink, but probably you don't want to drink a warm sports drink and then at that time, for example, cold water in combination with the gels maybe a very nice combination or even warm water with the gels, better than just having the sticky sports drink. So there's different ways that you can look at it and you need to know in the end. I think that's the fun thing of it is, if you work with a lot of athletes, you figure out as well what they like to do and you can see how you can also and create something that you know, a sort of toolkit that you can use in the future.
Speaker 1:And that's what I kind of. That's one of the things that I want to get down to as well. You just mentioned all these different stakeholders. Right, there's an athlete, there's a coach, there might be a strength and conditioning specialist, there might be a nutrition specialist, but they all distill answers down differently and, fundamentally, what they're trying to figure out is does XYZ work? If we're talking about supplements, right, I'm going to. I've got this red pill on the table. If athlete X uses it, is it actually going to work? Now, I'm going to figure out the solution to that problem, or the answer to that question, much differently than an athlete would, and that athlete is going to figure out the answer to that question, or try to solve that question, much differently than a nutrition professional. I'm wondering if you can, let's hone it down to what's the most ideal case to answer that question, like how you would look at it as a professional, and then use that as a little bit of a blueprint when athletes are trying to like navigate this entire landscape.
Speaker 2:Yeah. So I think an important part is always is what do you want to get out of it? What is your goal? Often, obviously, the performance goal is to run a good race, finish within a certain amount of time, so that is asking a lot from your body. So you can sort of start looking from a physiological point of view, what is going to help you to do it in a better way than you have done before, and is there a specific supplement that potentially can fit?
Speaker 2:I think the issue is that a lot of people are always looking for the additional advantage and the advantage patch and therefore they come home with all type of new supplements. The issue is they are new, so there's not a lot of evidence that backs up their efficacy Doesn't say that they don't work, we just don't have the evidence. So is it worth to you to then be your NS1 testing person to see if you feel that it works for you in a not really controlled setting? Because there's so much going on. You make so many changes, so many adjustments to your training schedule. Anyways, almost nobody is running a marathon based on the schedule that they decided to run 12 weeks before the marathon. So there's so many adjustments that you make.
Speaker 2:So I think that obviously, if someone wants to bring a new supplement and that's what everyone think, that's the best bet then you're going to think about okay, do we really feel that it could work, and then how could it work? And then can we use it in a safe way? So is it available, for example, as a third party tested supplement? If not, then probably not going to use it, because there's always the risk of being helping test it. But in most of the cases, what I would do is look to the body of literature and the evidence that is available and then it comes down probably to maybe four or six different supplements that we have enough evidence for that they potentially can do something, and then you need to decide are they a fit for me in this specific situation?
Speaker 2:And that really depends on your goal and who you are as a person and your previous experiences potentially with those supplements yes or no. For example, sodium bicarbonate is a great supplement for people that want to sprint 30 to 90 seconds Awesome, and it seems to work very well for people that do that. Okay. So how often are you, as an ultramarathon runner, going to do that? There are companies now that suggest that endurance athletes can benefit from it as well. I've been talking with nutritionists that work with athletes that use it as part of their ultra or as part of their endurance exercise and they're pretty positive about it. But again, it is in a specific setting. I would be sort of hesitant. I think if you want to improve your ultra endurance performance, then it's more likely that you should seek in a different direction, a different type of supplement.
Speaker 1:I'm so glad that you brought that up and it fits the narrative that you started out, with which, if we're trying to figure out or trying to get a handle on what supplements might be effective, the original question should be what problem are you trying to solve and how does this actually solve, or potentially solve this from a physiological perspective? So if you walk that logic through the sodium bicarbonate thing, you're absolutely right that it makes sense in certain high intensity contexts, but it doesn't make sense in lower intensity ultramarathon contexts. The thing that people wrestle with so much that I'd like to get your perspective on is the stories from the athlete, because that's part of the information distill that people are going through. They will recognize, especially if you're taking it from a professional practitioner's perspective. Okay, this is the problem we're trying to solve. We're trying to improve performance.
Speaker 1:Will sodium bicarbonate work? Yes, it can, probably in these high intensity environments. It probably shouldn't apply in a low intensity environment. Yet we see all these athletes that have a positive impression of it. And so, as a practitioner, from your point of view, how do you reconcile that? Or it doesn't make sense on the physiology, but yet the athletes are telling you a different story.
Speaker 2:Yeah. So I think it is difficult. And again, I think it's contextual, because if you are in a pro elite team and you get the product sponsored, or maybe you're actually involved in the development of the product as a team, then the narrative is quite different. It sort of relates to something that you wrote to me while prepping for this. I think you said can you elaborate a little bit on the statement? It can't hurt.
Speaker 1:It can't hurt yeah.
Speaker 2:And if, for example, sodium bicarbonate can be taken in such a way that it doesn't upset your gut, that's one of the reasons that people don't want to use it, right? So if that is sort of a passage that you have gone through and it doesn't upset your gut, then maybe you can say, okay, but it can't hurt If it doesn't work. If it has an impact, then I at least have the benefit, and yeah, to some extent. But at the same time, I also believe that if people want to focus on certain things, you can only do so much. So I always tried and it's just by, do you say by rule of thumb, yeah, yeah, so I always try not to work with more than three different supplements.
Speaker 1:That's interesting.
Speaker 2:Because if you want people, for example, to do their creatine right and you want to do their sports drink right and you want to do make sure that they take their multivitamin, if you are going to count how many actions that involves during the day and during the different training sessions and before and after, for example that is a lot.
Speaker 2:So if you want to make sure that people really do and are consistent in what they need to do, then I think you need to reduce the noise. And the more professional your organization is and the more people you have around the athlete, the more you can bring in because you can take care of them. But I think one of the things that ultramarathon runners do is that they're often alone and maybe they have a team that is helping them. But you know you need to have really good friends that help you. You know, in preparation and every day and I know there's a lot of ultramarathon runners that have those friends that will help them they will come to the race and they will help to prep the food and everything that people need and they know what they like. But in the end, often you are making decisions alone, so you really need to think about. Okay, what is making the difference for me? I don't say, do this, do that, but I think you need to make choices in what you're going to focus on.
Speaker 1:I think that's actually kind of a remarkable statement that you, as a professional who has worked with the best of the best athletes and you now have both a practitioner hat and a research hat you're only working with typically three supplements at a time in any sort of advisement capacity, and I just think that says a lot about the whole system in general but how it doesn't need to be complicated, right, and you're kind of coming at this.
Speaker 1:What I find remarkable about that statement is you're kind of coming at this from a compliance perspective, meaning the athlete only has so many brain cycles or resources right to figure things out and if they're not compliant on something it's probably not going to be effective anyway. You've kind of distilled it down to maybe just three and I absolutely have the experience of taking on elite athletes and working with them and a registered dietitian and in more than half of the cases we're doing exactly what you just mentioned. We're taking a supplement list of 12 and we're whittling it down to two, and the reason that we're whittling it down to two is to make sure that we can do those one or two or whatever it is those handful Really well versus doing 12 half-assed.
Speaker 2:Yeah, and obviously we can have discussion about what do you see as a supplement and, to be honest, I like to use the term nutritional supplements, which is sort of overarching for the dietary supplements that we know, like the vitamins and the minerals and maybe essential fatty acids, and then there's the sport food, that is, more the products that we use around or during our exercise, and then there's the air organic supplements as well. So that doesn't necessarily mean that they are performance enhancing, but at least they're classified as having a claim listing that they will enhance performance. And there's so many supplements. So, going back to how do you determine which supplement works is? There are some frameworks available, and I think one of the best frameworks that is available is that of the Australian Institute of Sports, the AIS, and they have been working on this for years, and I think it started sort of around the time that they were landing the Sydney Olympics. They invested a lot in specific areas.
Speaker 2:Australian government did, and they have been building this system for years, and the interesting part of that is that they also, you know, they have an A category list and that doesn't mean that all the supplement on that list are performance enhancing, but there's also supplements that they, for example, classify as medical supplements. So that means that those vitamins and minerals and potentially I think they have probiotics as well on that list there they, you know. They say if there is a medical condition that is asking for supplementation, then this is providing a reason to supplement. So there are actually organizations worldwide that say you know, supplements is you know, it's such a mess. We don't recommend the use of any supplements. But the issue is, if that's the case and someone develops an iron deficiency, which is very common in running, then you cannot help that person. That's obviously not what we want to do when we want to optimize performance, because if you want to optimize performance, then you need to make sure that the health is in order as well. So it is always the combination of optimizing health and performance.
Speaker 1:The position stand that you mentioned, just for the listeners, is freely available and I'll link it up in the.
Speaker 1:I'll link it up in the show notes, and it uses this ABCD type of classification system and they use this. This is a theme that we kind of keep coming back to, but I want to simplify and contextualize it for the audience. The AIS is using a very, some simple guideposts to come up with this, and is it, and they are, are, is it safe, is it permitted in sport, and is there evidence that any of this stuff works? And then they use those three guideposts to filter all of the supplements down into these various categories. So I would encourage the listeners to go and give it a read. It'll take you 10 or 15 minutes to work through the paper, but it's a really great resource to help you make decisions, not to say this is going to be what I need for or I'm going to start taking this tomorrow, right? And then we now have the framework in order to evaluate things when they do come up, because one thing's history has taught us anything, there's always something new around the corner that we're going to have to evaluate.
Speaker 2:Yeah, yeah, and I think what Australians do a very good job in is that they list per topic, per product or substance. They list most of the time a PDF for the athlete, so that is very simple, and then there is an additional PDF that is going and it's providing more information for the health professionals. So if you are in the nitty gritty, then that gives a deeper layer about why did they make decisions on this and how is that organized. Another thing that we need to appreciate there is that a lot of the things that are listed on the A list are, for example, protein, carbohydrate sources like a sports drink, gels, confectionary the things that you potentially can use as normal foods as well, and I think ultra runners they have a big scope of normal products that they tend to use as well, because, looking from the side, I think, okay, maybe this is not that smart and maybe there's a lot of fiber in these products and maybe you know that's not beneficial. On the other hand, you know if your stomach is handling it and you're getting the performance out of it that you are seeking without too much issues, maybe then there's nothing wrong with that.
Speaker 2:So I always try to learn. So, for example, we just developed an education program for high school athletes here in the US on safe supplement use and one of the things, one of the elements of the course, is that you can always look into okay, if I have those macronutrient based sports foods, how can I sort of cross over and what kind of normal foods can I use and then have potentially the same impact or same effect? So one of the easiest ways if you want to have a protein shake with a certain amount of protein and maybe you want to replenish your glycogen as well so you need to have carbohydrates potentially chocolate milk will do just as good and it is way cheaper. So we try to educate people that normal foods often can do exactly the same as what sports foods are doing. So in sports foods they can be used when you don't have access to those normal foods or when those normal foods don't allow you to get amount of carbohydrates in that you're seeking.
Speaker 1:The phrase real food first, but not always real food kind of comes to mind. I know that some variation of that has been thrown around in the research setting, but when you describe that kind of like triage which you can actually take, I'm reminded of that wording.
Speaker 2:Yeah, I really like the article. It was written by Graham Close. He is a professor in England and they wrote an article about what is food first, but not food on. And there's nothing wrong with trying to have a good basic diet with good basic nutrition, but in some cases supplements are convenient and they will help you to better provide you with the nutrients that you need at a certain time.
Speaker 1:This allows me a good opportunity to go a little bit off topic or maybe off the outline.
Speaker 1:I apologize because nobody can see this, but Floris has a really detailed workflow based on the outline that I sent him, so some of that's going to go to waste.
Speaker 1:But there's been this kind of like polarizing aspect of sports supplements that I think is actually quite fascinating over the years, to where one side of that polarization is hyper focused on something very specific, something like magnesium or even ketone bodies, something really kind of specific, and they're using, like maybe a novel technology or novel food production to enhance whatever element or supplement that that would be kind of classically delivered through food.
Speaker 1:On the other side of the equation, you have supplements that have started to emerge that are meant to be and I'm going to use this terminology very specifically because it's what the companies are using they're trying to develop supplements that try to cover all of your foundational nutrition. So you take one thing and it's supposed to cover all of your bases, and I'm wondering if you had just any opinions on that interesting dichotomy where this one side is starting to get like hyper focused on the novel delivery mechanisms or enhancing very specific things, and on the other side, the bullets seem to be shot out of a shotgun, so to speak, where you're trying to cover everything all at once.
Speaker 2:Yeah. So, oh, it's a good question and I think it is indeed happening and again, it's really contextual where you potentially see the benefit of these type of different products. So normally when we talk about performance enhancing supplements, I personally like to have single substances. So if I want to supplement with caffeine, normally I would like to have a caffeine supplement. Maybe in some cases you can go with. If you don't have that available, you can go with an energy drink, for example, because then at least you know the amount of caffeine in that specific drink and I sort of assume that there is not much beneficial effect of the additional substances that are in the energy drink, Despite what companies are trying to let us believe, and is that because you're trying to control, like dosage and, yes, timing and the what's the word?
Speaker 1:I'm trying to come up with the actual molecule itself right, versus being in a food product where you're consuming it and as a bolus of other stuff, you want to take it just singly by itself.
Speaker 2:If we take the example of caffeine we know that it is in coffee and but it really depends on the type of coffee, the grind, the size, how much you get in. So if you, if you're prepping, and you want to have a specific amount of caffeine because, based on the literature, you believe that will give you a certain advantage, then you need to make sure that you get that in. So that's something that we can organize and therefore you need to be sure that the amount is really in the product. So that's a good reason why you go with a certain supplement or a specific product. At the same time, I think what we now see, what is industry is doing?
Speaker 2:For example, I've been looking into the I complains of ultra runners. I've been looking into giant complaints recently, more in a team sport setting what people report, and the issue is that those complaints can be multifactorial. So people report different type of complaints and a wide range of scales and the question is likely they're not all having the same cause. So what you see more and more is that companies try to put multiple ingredients in there, for example, that potentially can suit for this or that. If you can show that it works that way, obviously that's nice, but that's it's a real new deal, and so you need to be a little bit careful with believing everything that is set on the market. And if it is about, you know, the GI complains situation, then to be honest I think a lot of people sort of omit products. They try it by trial and error that you figure out what works for you.
Speaker 2:That's the way we office or normally already do it. So if there's a supplement that says you know I'm reducing, or this is reducing GI complains, then obviously it's great if it seems to work that way. And for full disclosure, I'm currently working on a funded study for a project of a company that suggests that it may reduce GI complaint. So I see that is happening. But obviously it's important to have good research that backs that up, and if it's not there, then it's not there as well.
Speaker 1:And so let's take the other side of it, right. I mean, you talked about how, if you were choosing to deploy a supplement first off, there's just a few and you want to do it as a single thing, using the example of caffeine. But what about the kind of the other side of supplementation that I was trying to get to earlier, where people are taking what would amount to be an exotic multivitamin. Is there any use for that to cover your bases or anything like that within a sporting context?
Speaker 2:Yeah, so the multivitamin, obviously you know, maybe you can elaborate on what you feel that is exotic.
Speaker 1:Oh, any of the greens powders or the things that are tailored to your genome or to some sort of blood profiling that you might do, not the centrums that you're going to get at Walgreens or your favorite, you know, like, like Raseer or whatever. I'm talking about the mainly subscription based multivitamin surrogates that are out there.
Speaker 2:Yeah, so that's a market on its own? Yeah, exactly. And then we're not even talking about the potential of IV that people can now.
Speaker 1:Oh.
Speaker 2:God, now we're going to get into the weeds.
Speaker 1:So I it's more the principle that you can take one thing and cover all of your bases.
Speaker 2:Yeah right, yeah, so I'm going to talk about it all if you give me the time. Yeah, do it so, but let's talk about the IV first. Is that is certainly not something that is allowed in competitive sport, correct? So, even if it is for health purposes, you know, I don't think that any athlete self respecting athletes should go to a store and get him or herself hooked up, so that's something that you shouldn't do you see a lot of the professional like stick and ball sport athletes do that.
Speaker 1:It's very pervasive.
Speaker 2:I'm so surprised by that and maybe it has to do with that. In the US there's all kind of different circuits that have different rules, but if you adhere to water, the World Anti-Doping Agency and their legislation, there is a no needle policy.
Speaker 2:So that doesn't fit for that purpose and you know, from a perspective of hydration, for example, you know, there is really old, good research that showed that the consumption of fluid just orally, just through the mouth, just drinking stuff, old school that the retention of fluid is way better than with an IV. And if you are in in an accident and there and you lose a lot of blood, obviously the IV is, for medical purposes, the way to go, but that's a different situation.
Speaker 1:Ok, so no to IV bars.
Speaker 2:There's a stairway to nose, yeah, and don't go there. So then let's go back to the multifitamin. So I'm not against a low dose to multifitamin because even if people try, there is variation in what you eat and the vitamins and minerals that you get in. So I'm OK with that. And there's something that is interesting to me is if you stratify nutrition intake data and you stratify a group or the ones that report the use of supplements versus the one that don't. Somehow that's what I've seen in my own data is that the group using supplements often tends to report a slightly higher dietary quality In comparison to the ones that don't. So I don't say that there is really a causal relation. I think it's more an association that people that are interested in supplements probably are interested a little bit more in their body and health and performance and therefore likely they eat better.
Speaker 1:They're not the best candidates for it. Anyway, it's kind of what you're getting at. Yeah, so the ones that you, they have a good diet to start out with.
Speaker 2:At the same time we did 24 hour recalls and we did multiple 24 hour recalls because only one recall is saying something about one day and we know that people don't eat the same every day Most people don't, by the way. So if you do multiple recalls and you also ask them about what supplements they use, you see a huge inconsistency in the type of supplements that are reported and also in the amount of multifitamins that are reported. So multifitamin users tend not always to use the supplement every day, and if that is being lazy, forgetful or that it is not that important, I don't know, but we see that happen. That also means that even using the supplement is probably something that gums and goes. It flows like a wave, going up, going down, it's back to your adherence point that you were making earlier Again.
Speaker 2:Yeah. So I think if you do something, try to be compliant if you feel that it really makes a difference. Now, with the multifitamin it's not really going to make a difference. That's the reason why people can get away with it. Obviously, if you have poor diet and therefore you get low nutrition intake and therefore you become deficient, then it helps to supplement. So it is a sort of insurance that people are taking, and probably this is you know it can be an expensive insurance, but you can. You know you can take a cheaper. The question is how effective it is. But I don't say that you don't need to take multifitamins, but if you take them, be aware you know why are you taking them. So then the personalized nutrition part.
Speaker 1:Obviously, I gave you a really loaded question and you're going through it all.
Speaker 2:I appreciate that, obviously, you know Probably that's the future, but I don't think we're there yet. Nutrition advice based on blood levels, on genomics or nutrigenomics I don't think that there is a lot that we can do based on the interpretation side. Already that really makes a difference in the type of supplement that people then need. You know, the existing things that we really well can measure are the deficiencies, and that's the thing that normally spikes up when you do a blood panel with your doctor. So, and then you will see that there is an iron deficiency. If we talk, for example, about magnesium, popular supplement and I don't know exactly why, because it is abundant in our diet normally you know.
Speaker 2:You can find it in whole grain products. You can find it in seeds, in nuts, in leafy green vegetables, peanut butter all kind of products that the healthy ultramarathon runner probably is already using. There is no clear evidence that it, for example, helps with cramping. On the other hand, there are probably four or five other physiological mechanisms that can influence potential cramping that are more likely. You know that you need to solve one of those before magnesium comes into play and at the same time, our magnesium recommendations are set in such a way that normally 98% of the population should have enough of it.
Speaker 2:So if you belong to that 2% of people that need more, to be honest, likely if you're an ultramarathon runner, you eat so much that you will compensate for that. If you're not sure you know, then you obviously you can do blood tests. The issue with magnesium is that it is expensive to do actually magnesium in red blood cells. That's the only real good test. The issue is that most of those panels that test you for magnesium deficient don't use that type of test. So what are you basing your assessment and your diagnosis on if you don't test it in red blood cells?
Speaker 1:Well, and people are not only bombarded with a lot of the nutrition supplements out there, but they're also bombarded with a lot of the blood testing and other types of physiological testing that they can do. When do you, as a practitioner, when do you choose to deploy specifically something like blood testing to get a better fix on if supplementation is necessary?
Speaker 2:Yeah, so I come from background where we always worked with a doctor on the team, so then it was relatively easy. You see sort of symptoms, or you see a dietary intake that really has hold, and then you start to wonder, and often they go together. But you're starting with the dietary intake first obviously as a dietitian, that was the first thing that I saw.
Speaker 2:At the same time, in some teams they were taking a blood panel and doctors were sometimes asking about what do we need to measure? But the limitation there is that there is not so much that we really can measure. Well and because, for example, if people have no calcium is an interesting one, you can measure calcium but doesn't say much, because 98% of the calcium that we have in our body is in the bones. So if there is not enough in the diet, then the bones will supplement it. So you often need to do additional assessments and, for example, need to do a bone density scan to get a better understanding if there's really an issue. So a lot of these things are really complex and I don't say that you don't have to look into it, but it's not a one way. Stop to do a blood test in most cases.
Speaker 1:That's a really great way to put it. I think often we think that doing blood work is going to provide some sort of magical solution to what you are deficient in, and then the answer is right in front of you and you don't have this, and then, therefore, you should take more of it, and many times in reality especially with people who really know what they're doing a very murky picture starts to emerge where you don't have a lot of clear answers. I'll link up in the show notes the previous podcast that I did with Charlie Pedlar over at Oraco, where we went through how they specifically use blood biomarkers to try to inform a whole host of different things, not just supplementation. So I think, as the listeners are starting to think about this, what I'm kind of getting from you is, yes, using blood biomarkers can be beneficial, but they're not a silver bullet or a magic solution or a clear solution to what you might need to do next. You might have to layer on other things with it.
Speaker 2:Yeah, true, and I think there's a job for the industry and for science as well, to develop tests that we can use. In the end, I'm not against having good blood tests. The only thing is that there is just not that many tests that are valid.
Speaker 1:It's hard I mean it's hard to do it because you have to do it so frequently, and then the resource that takes to talk about what we're speaking to earlier on the compliance side of it the amount of time and effort and things like that that it takes to get that versus the value can be fully disproportionate. Okay, I'm glad we went in a full circle and we came back to blood testing. I really appreciate your time and thanks for hosting me here in your conference room. That's not going to last more than a couple more months. You mentioned a number of different projects that you are either working on or about to work on, but where can people find more about you in your lab and some of the work that you do?
Speaker 2:Yeah, so we actually have an Instagram page that is called athlete field lap or the athlete field lap, and then athlete is written as athlete, but then we're then EA in it, so from eating maybe slightly difficult, but then it'll be in the show notes and people want to try to find it.
Speaker 2:Yeah, you can see it here on the back right and then I have an Instagram no LinkedIn page that I use to post a lot of you know the things that we have going on, so people can always check that out and I think that's sort of it. But, to be honest, we have been talking with, you know, the students that are part of my lab about how we can make sure that we are more accessible and trying to work on that in the coming months to allow people to find what we actually are developing, because you know, we developed a lot of tools over the years and you know it should be good that it's not only research based but that people can actually I really appreciate it when researchers actually take the time to take their papers and put them into more friendly formats whether that's an infographic or an Instagram post or a Twitter thread or whatever because it just gets more people talking about it and then, if they want the really detailed view, they can go and check out the paper.
Speaker 1:I'm actually going to link up another one that you are the lead author on, which is how sports professionals perceive and prescribe nutritional supplements to Olympic and non-Olympic athletes, which is probably the main piece of work that I know you from A lot of our dialogue around who these stakeholders are really comes to light through that. I really come to light through that paper, so I'm going to link that up in the show notes as well for everybody. Once again, Flores, thank you for your time and the work that you've done has been quite insightful.
Speaker 2:You're welcome, all right, folks.
Speaker 1:There you have it. There you go. Much thanks to Flores for coming on the podcast today, and this is one of those podcasts that I'm going to continue to refer back to in order to help me with some organizational framework about how I approach sports supplementation, and there are a few highlights that I think that we can all take from this. First off, single supplementations are more likely going to provide more bang for your buck and also be more precise in what you want to achieve, as opposed to a lot of the blended or combined supplements that you actually see out there. The second thing and I hope that all of the listeners can really appreciate this aspect is that is when you're choosing a supplement, you have to determine what problem you're actually trying to solve.
Speaker 1:Many times, we're looking at these things and we'd like to say, well, it just works, but that is not good enough. If we are professionals trying to prescribe these things for athletes, what we need to be thinking about is what problem does it actually solve? Does it have a reasonable mechanism of action? What does the science actually say, and can the athlete actually be compliant in taking the supplement at the correct dose and timing that would be required to be efficacious. I think if we look at supplementations through that lens, as opposed to the very simple well, it works or doesn't work, I think we will be well on our way to providing better answers to athletes.
Speaker 1:All right, folks, as always, if you want to support this podcast, just share it with your friends. That's all you have to do is you can just hit the share button in your podcast player of choice, send a text message or any sort of message that you want to send that helps the podcast out a lot. As always, no Patreon sponsorships. There's no sponsorships of any kind associated with this podcast, and that is because I want to talk about things like supplements in an open and honest way, and it's extremely difficult for me to do that if I'm entangled within various sponsorships. All right, folks, that is it for today and, as always, we will see you out on the trails.