LogSeq/pages/Dr. David Saenger - Cardiovascular Health & Endurance Training - Episode 370.md

Tags:: cholestrol health

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  • {{youtube-timestamp 2}} thanks for tuning in this episode of the human performance outliers podcast with Zack bitter all right everyone welcome back to another episode of the human performance outliers podcast I am your host Zach bidder and today I have a guest interview for you today's guest is Dr David Sanger Dr Sanger is a cardiologist ultramarathon Runner and someone who practices intermittent fasting and a low carbohydrate approach with his nutrition he joined the show to discuss cardiovascular health and complications related to endurance training so one thing that has become more of a story over the last few years is cardiovascular health when it comes to endurance activity so I think most people's intuition leads them towards endurance training or exercise in general is heart healthy and they would be correct but there are some interesting details that are worth noting and considering as you kind of structure your training and racing habits
  • {{youtube-timestamp 65}} potentially so I wanted to talk to Dr David Sanger about those specific things and find out exactly what maybe that means and see if maybe there's some difference that we need to be aware of as endurance athletes in terms of kind of what shows up on maybe some sort of cardiovascular screening and we got it all sorts of stuff along those lines as well as other things just related to cardiovascular health so this is a fun one to do before I get rolling with Dr sang just a quick reminder that I do host a raffle with the human performance outliers podcast that is for a free consultation with me a 30-minute consultation so the way that one works is if you want to enter the raffle all you have to do is share a show that you enjoyed on social media and tag me just make sure you tag me or send me an email at hpop podcast gmail.com showing that you shared a post so that I know to enter you in the raffle you can do that on any of the social media platforms
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  • {{youtube-timestamp 323}} a couple of weeks is I've been doing a series of podcasts that just go through all sorts of different strategies when it comes to programming your training and racing and that series of episodes is getting quite long so I'm just going to remind you what those episodes are here and I'll have those Linked In the show notes as well for those of you who are either embarking on your endurance Journey or would like to maybe just dial things in a bit the episodes include episode 337 the long run considering the variables episode 344 and durage training simplified episode 346 short interval simplified episode 348 long interval simplified episode 352 proper aid station navigation episode 356 easy run simplified episode 363 mental training for endurance episode 366 race course specific training and the most recent one episode 369 speedwork distribution and double threshold sessions all right that's all for me let's welcome Dr David Sanger onto the
  • {{youtube-timestamp 382}} show all right David thanks for joining the show hi thank you we we were just chatting a bit off the air about Ultra marathons and I know from experience that you like your 50k events and uh and what do you got coming up I got the uh three sisters Skyline um in a couple weeks up at sisters in uh Central Oregon I live here in Eugene Oregon so it's a great access to a lot of really good uh trails and uh lot of races around here so it's great yeah no doubt Eugene is a Mecca of running so to speak so yeah that's right you get it all did did you make it to the to the the the Championships last year when it was in Eugene uh no I didn't it was too you mean that like the TRU and Champion yeah sorry I should have specified yeah that's right no I it was too hard to get tickets it was so hard I watched it on TV I was it was impossible to get tickets yeah it was one of those things where like Nicole and I were talking about maybe we should make a trip up
  • {{youtube-timestamp 443}} there and see if we can get some but sounds like we made have struggle and we decided to do that yeah exactly yeah yeah I just crossed my mind after it being uh championships this year in in Budapest and we're watching that quite a bit and there a it's just been so interesting to see the just kind of the growth of running in general but then also with some of the different events where like specifically like the 1500 meter I thought was just it's just getting insane how fast you have to be in that event to even have a shot at a metal where I was looking at some of the data and it was suggesting that because you got to do three rounds of it essentially just to make just to to have a shot at a metal and then in order to be in that position you basically have to be able to run like about like a 335 then a 332 and then if you want a shot at a metal you probably need at least 330 if not dipping under so it's just like so fast and uh a
  • {{youtube-timestamp 501}} different different world than what we're doing in Ultram Marathon for sure yeah that's that's right it's totally different yeah well perhaps that the topic today though maybe is as as equally of a concern for our track and field friends as it is for the ultramarathon folks out there I think so yeah it could be yeah there's been a you know this topic isn't new necessarily I think it's been something that's been sort of like in the conversation or floating around the world of running for quite some time now after we've had some situations where people have literally had uh heart attacks on course during marathons and things like that and uh right I me there's a lot of speculation early on I think as to like what would cause that and and this that and the other thing but generally speaking I think as the as the conversation kind of goes it's kind of like is doing endurance sport at least to the capacity when you get to marathons and perhaps
  • {{youtube-timestamp 552}} Beyond or in a level of training that would maybe be more suggestive to it crossing over from Hobby to Passion maybe I'll say right is it like where where's that margin of diminishing returns or is there a margin of diminishing returns when it comes to right yeah cardio so that's that's really important and I get a lot of um I mean that's something I deal with and think about quite a bit so I'm a I should say I'm a cardiologist I don't know if I I I should mention that I do do uh I'm board certified um uh invasive cardiologist and uh I have special training in cardiac C so I've done I I can read those studies and uh I I practice General Cardiology here in Eugene and uh I'm very busy I've been and I've been practicing Cardiology for just 20 years now so um or actually 19 and a half years so yeah so I'm I'm pretty busy and have a lot of experience with this issue um so yeah I guess the qu interesting question is like first of all it's important to clarify the
  • {{youtube-timestamp 617}} difference between cardiac arrest and heart attack like and then that's often used interchangeably and it's different so if you see somebody collapse on the field uh with a during a race or something and they're uh uh have no circulation they need to get CPR and so forth that's a cardiac arrest right and that might or might not be due to a heart attack and a lot of times when runners or athletes um collapse and have Cardiac Arrest they have totally normal arteries it's not due to a artery disease problem it's due to something else and there are other other things that come into play that aren't even that rare there's uh something called hypertrophic cardiomyopathy which is a genetic disease uh of the heart muscle that is a lot of those people are very good athletes but they can have electrical instability with their heart and they can um Keel over and die during exercise it's not that's actually the most common reason why somebody would
  • {{youtube-timestamp 674}} just drop dead at a uh a track meat or something like that um and that's uh so that's a whole different de uh but I guess what we're talking about is uh calcium scores and coronary disease um which is a a different topic so um should I should I go ahead and just like explain that or uh do you want to talk about calcium scores I can I can explain what they are yeah what don't we do let's just continue on with kind of an overview of the difference because you I mean you kind of got it started with cardiac arrest and let's get into some of the other on so people have a bit of a lay of the land of what sure what the heart health uh overview I guess maybe sure sure yeah so uh so uh I guess the um for athletes I mean you and for endurance athletes in particular you you know there are other rare diseases but the most common disease to worry about if it's not coronary artery disease is um uh hypertrophic cardiopathy which is I mentioned earlier and then then if
  • {{youtube-timestamp 738}} you're thinking about coronary disease which is probably the next most common reason why an athlete would uh have a heart attack or Cardiac Arrest or uh uh die during exercise would be doing um due to coronary disease coronary artery disease is what we refer to plaque buildup or blockages in the uh coronary arteries um uh these are the arteries that Supply blood to the heart muscle remember that heart muscle is a muscle like any other muscle that needs oxygen and um if what supplies oxygen to the heart is these blood vessels called the coronary arteries and they can get um uh plaque buil up in the arteries which is uh complicated what caused this plaque it's probably a mixture of um there is something with h cholesterol of course but then it's not just cholesterol also blood pressure affects it and um uh and then what happens is you have an injury to the vessel wall and that uh causes uh calcium to respond to the injury uh
  • {{youtube-timestamp 803}} basically you have uh the body tries to heal the injury and um when you have that injury or turbulence or disturbance of the inner lining of the blood vessel which is called the endothelium when you when you disturb that you uh heal it by laying down calcium and um the calcium is kind of the body's way of uh of healing a wound um so uh we look for calcium to see if there's been uh blood vessel injury or or damage I guess that's the best way to say it so and calcium is really easy to see just by convenience um the uh calcium is dense and it's a lot denser than tissue than than normal uh vascular tissue or muscle tissue which tends to be more like um uh very soft and uh because it's mostly water so calcium is much harder and picks up on the scan so that's why we have this thing called a coronary calcium scan what that is is basically a fancy x-ray that um it's uses a a a CAT scan but it doesn't actually use the full um uh uh
  • {{youtube-timestamp 874}} amount of radiation uh and we don't need to use a contrast eye injection um it's just uses the scanner to take um kind of a quick uh uh view to pick up calcium uh and you can pick it up anywhere in the body so obviously bones are going to pick up a ton but uh if you see calcium in an artery that means that probably that's plaque or or or um uh injury to the in inside of the artery and you can pick that up anywhere you can see calcium in the aorta you can see calcium in in the in the arteries going to the brain you can see it everywhere and so if you look at the heart you can get something called a coronary calcium score that's the CAC that we hear talked about a lot these days so calcium score is a basically the um what you do is you just count the pixels it's super easy you're just counting the number of pixels on the um on the image that are uh uh lighting up bright like because that means they must be calcium the only
  • {{youtube-timestamp 934}} thing that lights up bright like that is calcium inside the body so um you you count the number of bright pickles pixels and that gives you a CAC or calcium score so a normal calcium score would be zero you shouldn't have any calcium it's not supposed to be there so if you get uh higher and higher levels that gives more and more concern that there's been vascular injury uh that the blood vessel has been damaged and that it's healing and that there might be narrowing of the blood vessel so that would be you know that's what we call plaque um buildup in the blood vessel does that make sense so far I'm sorry to go on so long yeah no this is great I I have a couple questions just go ahead maybe points of clarification if anything so yeah yeah sure please when the the way I'm understanding is optimal is no calcium at all so correct let's say you go and you get a ca g and there is calcium there is there a different is is there like a range of problematic
  • {{youtube-timestamp 996}} within a certain score meaning like can you have a calcium that is more problematic like it's looser or more firm or how does that right yeah yeah that's a great point so then then once you look at the so there's different kinds of okay so that's a first thing is that yeah there is a gradiation so that you get a score anywhere from zero to I you know you can go well over a thousand 2,000 so um and then you'll get a percentile ranking if you get your calcium scroll they'll give you a percentile which is based on um the general population with your uh uh ethnic group and your age and gender how how much calcium is this relative to other people so you'll get a percent if you go and get a calcium scor by the way I think there's no reason everyone shouldn't get one uh one of the problems is that it's often not covered by Insurance because the is considered a screening test so insurance doesn't like to pay for screening tests because
  • {{youtube-timestamp 1053}} you're not technically ill yet so they uh you'll have to pay out of pocket but it's really inexpensive like in my community you can get a calcium score for about 200 bucks so it's really not a lot of money to get because it doesn't entail much technology and much uh radiologist reading time so yeah so that's the that's what you get if you want to go get one you can it's easy enough to find some somebody who do a calcium score for you and give you a number um so and I guess what you're getting at is a higher score is worse right so um scores of over a thousand are probably really significant and indicate a very heavy what we call very heavy burden of plaque um there's uh maybe even over 500 is is a lot and over a thousand is is a lot a lot um it does tend to correlate with age it should be saying also I need to mention that you definitely will get a higher calcium score as you get older it's kind of part of the wear and tear of Being Human
  • {{youtube-timestamp 1113}} right I mean as we get older there's more wear and tear on our blood vessels the the blood vessel Linings are exposed to uh cholesterol exposed to blood pressure exposed to stress and sheer stress and um particularly with exercise more stress so that will cause the calcium score to gradually increase with age um I guess the other thing you're mentioning is the whole concept of different kinds of plaque right so I get I I'll go ahead and talk about that so there's soft plaque and calcified plaque so you can have plaque and and to look at that you need more than a calcium score so if you want to know if you have soft plaque which means uh so plaque means the buildup of cholesterol and calcium on the inside of the arteries so once once it starts you get a little bit of calcium and then if you get progression you get more calcium and then if you get um uh it's more inflammation uh involved in the plaque that's building up in the artery the um the
  • {{youtube-timestamp 1172}} plaque can become more complicated we say complicated meaning that it's not just calcium there's also cholesterol there's also um white blood cells um uh uh inflammation inflammatory tissue fibrotic tissue there's other stuff in there than calcium and that's what we call a mixed plaque or a complex plaque or and then if it gets less calcium and more uh immune cells and more um uh uh uh cholesterol we call that a soft plaque that's the you'll hear that talked about to diagnose that you really need more imaging than just a calcium score because calcium score remember is just kind of a very simple thing it's just counting the calcium pixels so if you want to know more characteristics of the plaque then you need to get a uh a real what's called a CT angiogram so coronary CT angiogram is a little bit more uses the same scanner but what with that tails is injecting dye so you're going to be injecting contrast into the vein and then you're going to give quite
  • {{youtube-timestamp 1234}} a lot more radiation because you have to get high uh uh Fidelity really clear pictures of the artery so you can actually see down to the very submillimeter scale of the blood vessel inside the blood vessel and you can look at the plaque and you can tell is this just purely calcium or is this a mixture of calcium and cholesterol or mixture of calcium cholesterol and uh inflammatory tissue or or what so that's when you talk about something called a vulnerable plaque if you heard I don't know if you've heard that or a high-risk people talk about a high-risk plaque or a soft plaque that that would be something to be a lot more worried about right so a soft plaque or a plaque that is more um uh uh full of other stuff than just calcium tends to be higher risk tend to be something to be more uh uh likely to to burst open so what a heart attack is I should probably go back and explain what usually what a heart attack really is is uh caused by
  • {{youtube-timestamp 1295}} one of these soft plaques one of these um uh mixed plaques that's not purely calcium that suddenly bursts open so what happens is the the plaque the the lining on the plaque ruptures or opens and forms a blood clot and then you get a blood clot in the artery and that obstructs blood flow to the in the artery and that causes uh uh that's that's what you really want want to avoid that's what a heart attack is and that's what kills people that's what uh you I mean usually that's what you're going to die from when doing exercises rupture of a soft plaque and I guess to get back to endurance athletes this would be something that is less likely if you have a calcified plaque so calcified plaque is more stable so that's a actually paradoxically it's kind of a good thing you want calcified plaque you want to have plaque that's if you had to choose between plaque I mean you don't want any plaque it's better have zero but um if you're going to have
  • {{youtube-timestamp 1351}} plaque you want calcified plaque not soft plaque or non-calcified pla or mixed plaque uh mixed plaque is a lot more likely to uh to kill you or to cause heart attack or Etc does that make sense is that explaining it pretty clearly yeah yeah no that does I think it's it's just interesting because I think sometimes you'll hear people talking about how they got a C score and it's zero awesome it's zero which is good I mean obviously you'd rather have zero than a thousand like you were saying but if you have a zero but also have a lot of sof soft you could be in worse shape than someone with a score higher right right that's that's a controversial can so that's really important you tested on an interesting topic there this is an area of controversy so the studies seem to show that the likelihood of that is pretty low that you're not that calcium does if you have a lot of calcified plaque you're going to have some non-calcified
  • {{youtube-timestamp 1409}} or more high-risk plaque and they kind of correlate it's very unlikely although it is possible and people talk about this it is possible that you could have a CA score of zero and you could have soft plaque and could be at risk because of that yes it is possible and there are a few cases of that but it's pretty unusual it's in the less than 10% probably less than 5% range I mean that would be pretty darn unlikely you shouldn't bet on it you shouldn't you shouldn't worry about it I mean it's more like B yeah I mean that's not a re then people say well gez should everybody just get a full CT angiogram don't even do a c a CA score just get a CT inogram because that'll that'll detect soft plaque right so maybe you should do that for everybody but the thing is that a CT anagram is a lot more expensive it's more like $1,500 and um it entails die injection right so you're injecting somebody with contrast eye which can hurt you can have
  • {{youtube-timestamp 1465}} complications of that um all kinds of complic from injecting somebody with contrast plus there's quite a bit more radiation uh which is a whole another thing radiation exposure so you know I I I don't know I mean there are definitely cardiologists out there who say everyone should get a um a CT angiogram I think that's a little aggressive um but I mean that's yeah that's kind of what you're what you're talking about I think the interesting thing for for us for endurance athletes is you know do we need to really worry about the elevated C scores in endurance athletes I think you know that's what you and I would be worried about and I can talk about that if you or do you have any more questions about the CX scores in general or coronary artery calcifications no I think well maybe one more actually so is there any variance in let's say we both get CA scores and we both score 100 so we've got some there is there any reason to believe
  • {{youtube-timestamp 1524}} that one person's 100 can be more problematic than another person since 100 if the assuming soft plack is also equal or is it just 100 is 100 uh according to the big studies it's just the number so just basically like the higher the number the worse the more likely that you're going to have events in the long term but it's over the really long term that's the thing I mean these studies show like it's years and years it's not months or weeks um and that um more more calcium is worse but you know calcium square of 100 is pretty modest right I mean a calcium score of a thousand is a lot more important there are recommendations that if you have a calcium score of over a thousand you probably should get a full cogram or you should get a stress test or or something I mean there are even some people who say to do an invasive coronary angiogram and somebody who calcium score of a so I wouldn't do that I don't do angiograms on people like that I just don't I would
  • {{youtube-timestamp 1581}} base it more on symptoms uh because I mean it needs to be said also that all of the studies in Cardiology show that just putting a stent in and opening up a blood vessel doesn't necessarily solve a problem if you're not having a heart attack so you know that's really important stenting doesn't prevent heart attacks and I need to get that clarified you you have a a blockage it's calcified okay you know you you can deal with that but putting in a stent doesn't fix the problem it doesn't prevent a heart attack it doesn't do anything like that so um in fact it might cause more problems so so uh yeah I just want to just make sure that's that's clear more Cal more calcium more plaque is is not a good thing but it's something that you want to treat with uh with lifestyle not with going in and doing angiograms and procedures on uh people just because of their calcium scores does that make sense yeah so I I think the the issue that
  • {{youtube-timestamp 1640}} comes up for for us for ultr runners is um is there a a risk of having I mean it does Orly right so that's the problem is that running in particular puts sheer stresses you know blood pressure goes up right when you're running I mean there's you put a blood pressure cuff on somebody on a treadmill their blood pressure is high I mean they're you know it's not like they have high blood pressure it's they get high blood pressure during exercise you'll see blood pressures that normally go up to 180 190 when they're on a treadmill and then you take them off the Tre I do this every day and you take them off the treadmill it goes back down to normal that that's that's going to be some strain some turbulence um on the uh that stresses the inner lining of the arteries I me there's no way around that that's what's happening the question is is that a bad thing right uh so probably it isn't although it does correlate with I mean because there's so many good
  • {{youtube-timestamp 1695}} things that you get from exercise right there's so many so many we all know about all the tremendous benefits that you get from having a um uh endurance exercise and from that whole the experience of Doing exercise on a regular basis but then I guess the question is you know like what what's happening to your arteries and the studies show that over time people who do vigorous exercise at high volume do get higher calcium scores um it does correlate and it doesn't correlate perfectly that's the problem it's not like you know um there's an exact onetoone correlation um but it does tend to roughly correlate that you get get a higher calcium score with uh with uh high volume long duration endurance exercise um what the interesting I guess the interesting study that came out recently uh earlier this year was the uh Mark 2 study in um in the Netherlands can I talk about that or or do you have any more questions okay so that was a
  • {{youtube-timestamp 1758}} big study that came out that people are would generated a lot of press was uh they took a a group of about 300 um athletes in middle-aged white men needs to be said these are not women these are all men and they were all white and they were all in the Netherlands and they were all like started at age 50 and ended at age 60 approximately um and uh they followed them to look at their C scores so they took C scores in one Baseline and then again in um I think it was like five years later and saw the progression which is about right about five years is where you'd see any difference um and they found that uh endurance exercise uh volume did not I mean everybody progressed right you'd expect that there was definitely a slight increase in calcium score over five years which is exactly what you'd expect in any study of the general population um but with these uh athletes who were doing endurance exercise the total amount of exercise didn't really
  • {{youtube-timestamp 1819}} correlate with progression um but what did correlate was what they call very vigorous exercise so very vigorous exercise and they defined that as being it was a little bit confusing how they defined that but basically they they defined that as pretty high workload for a uh re significant amount of time so probably something like uh run and they said greater than nine Mets so to put that into real like uh understandable terms a met is a metabolic equivalent that's how we measure exercise in the physiology lab right so you know what a met is so more than nine Mets counts as very vigorous exercise in their study so that's running like Beyond a an easy Pace I guess that would be running at like you know a uh maybe intensity level of seven out of 10 something like that or six something like that would be I think would be nine Mets um so that's up there but it's not like super intense so that did correlate significantly with plaque progression so if you take that
  • {{youtube-timestamp 1886}} that study as something to you know take action from you it would say you know if you do high very what they call very vigorous whatever very vigorous means uh very vigorous exercise at a high volume uh then you're going to have plaque progression probably does that make sense yeah I have one question along those lines and this may be an unanswerable question just based on like not being able to tease this out but I'd be curious with something like that where is it like a continuous exposure to N9 mats Plus or would something where so like is there a difference say than if I did like a let's say I did like a lactate threshold field test which is going to be like or no just like a 60-minute race that's going to probably be around that intensity is that going to be worse due to the continuation for those 60 Minutes versus if I did say six by 10 minutes with a small break and gave myself a relief from that intensity right yeah so that's a really that's
  • {{youtube-timestamp 1941}} exactly what I was wondering when I'm reading the study because I'm like I'm doing the Zack bidder 50k training plan and it it entails quite a bit of you know these these the long intervals yeah right the long intervals exactly that's exactly what I'm thinking so they didn't study that kind of thing they don't I mean there's just not enough data um if you want my opinion I would say that longer more exposure to high blood pressures and sheer stress is probably worse um probably will incre but I mean again then it comes back to the question of how bad is the calcium score right I mean is it really all that bad or not I mean the the the thing that needs to be mentioned is that statins increase your calcium score right we all know that that if you put somebody on a stat and the calcium score goes up and as a cardiologist we say that's good that's not bad because what you're doing is you're healing the plaques and the statins are inducing healing they're
  • {{youtube-timestamp 1997}} inducing um fibrosis or stabilization they make plaques more stable they stabilize plaque so um is stabilizing plaque maybe a good thing right I mean um and then the other question is who are these people anyway right are you running because you already have some plaque and you're stabilizing your plaque that you already have right so I mean we don't have the counterfactual we can't take somebody who you know and and go back and look like well what would have happened to your plaque if you hadn't ex I just I don't know um I think there's just not enough data I would say that in general my I guess my take-home is that um you know longer duration at high intent intensity is probably putting more stress on your heart um and maybe that's not a great thing over a long period of time am I G to change my behavior based on that I don't know I mean I'm I'm still persuaded that uh exercise is so beneficial for mental health and for metabolic health and for you know so
  • {{youtube-timestamp 2059}} many other things right so it's really hard to say if it if if that ought to change your behavior or not I think you should be aware of it um get a calcium score um you know check your apob level um or your lipid profile or whatever get get in um get some you know Labs talk to you know get get checked I guess um that would be my uh my rough recommendation that's kind of what I would do does that make sense yeah yeah it's interesting because I think like I'm just thinking people listening think like well maybe I'll do one less like 10K to Half Marathon perer right yeah I just don't know I mean I I I mean I do feel better that like long duration exercise is totally not associated with you know if you're doing uh like a whatever zone two or zone three um even zone three is probably fine so and they said vigorous exercis is not correlated but it's only very vigorous so uh and total volume was not correlated so and this is the only study
  • {{youtube-timestamp 2125}} that we have that was long itudinal that looked at a group of people at Baseline and those are the same people again five years later so that's a really valuable data we don't have a there's only one study that shows that so um yeah I mean I don't know I would do you know more longer duration more uh more Ultras at a at a kind of easy pace and maybe less super intense like 10ks I guess that's kind of the my take-home but again I wouldn't worry that much overall like the events in these the number of cardiac events in this population was pretty low right these people are not dropping dead everybody we have this emotional response that we we see an athlete die and we get it's very emotional it's very scary and it it really uh makes everybody get excited but the fact is that the reason why we get excited is because it's so unusual right yeah I mean we see somebody who's who's not an athlete uh or is especially if they're if they have a lot of risk
  • {{youtube-timestamp 2186}} factors for heart disease and they have a heart attack we say yeah well that's what you expect right you know so nobody blinks an eye but you see these cases where somebody who's athletic and has a heart attack that really sticks in your mind and it can cause a I think perhaps a disproportionate response uh to uh to an incident like that yeah you know it always when when this sort of topic comes up to I always think about there's a study I'll have to dig up the link and put in the show notes and then share it with you if you haven't seen it where they actually looked at just like basically like life progression in a group of Olympic track and field athletes so we're talking or I should say Athletics for our European listeners but they looked at that and the cool thing about that study was they looked at a whole the whole the whole Athletics competition participants so it was like you had your shop Putters your discus your jav in your long jump high jump
  • {{youtube-timestamp 2249}} sprinters middle distance long so you got basically what I would consider like super athletes and people that are just like you know Peak Physical specimens that we have to offer and then across the spectrum of discipline when you have Athletics because that's what that does it's basically testing every type of human physical type of you know so people who are obviously all these individuals at that level are somewhat genetically selected because like you're not going to throw the shop put if you're my size no matter how hard you work at it and you're not going to run the marathon if you're you know if you're someone who's six foot six 300 pounds you're gonna be throwing the shop in that exactly so but the cool thing about that is they looked at all these people uh and you know likely quite a bit healthier than the average person and looked at just life expectancy different things that like would potentially happen to them along the way
  • {{youtube-timestamp 2302}} before they died and the longest living ones out of that group were the longdistance runners so um I there might have been I have to double look there might have been another group in there that was equally as high like the decathletes or something like that but you know that's kind of just a moras sport of everything at that point so I would imagine they're probably in a pretty good spot but but it just goes to show you like if you're running for let's say you're doing the 1500 through the 10,000 somewhere in there you're going to be doing long intervals and you're going to be doing short intervals for quite quite a amount of that from probably early life to whenever you retire and then maybe to some degree after you retire so we're probably talking about an exposure to a type of intensity that is both very difficult to actually do because as you know like on my training plans there's only so much volume I can prescribe of
  • {{youtube-timestamp 2353}} long intervals and then way less even yet on short intervals because there's a limiter your body puts on you for that it gets to a point where if I kept giving you that workout eventually you just wouldn't be able to do it and it wouldn't take that long right so right yeah exactly exactly yeah so yeah I mean I I there was another study uh that similar like they looked at Swedish uh uh cross country skiers uh who were over AG 70 and they scanned them there was like a hundred of them and they scanned them all and they all had very high calcium scores they had calcium scores of like over a thousand a lot of them uh very high prevalence because they're 70 years old but they were also endurance athletes um and they were healthy right and they're living they're they have very few illnesses not a whole lot of other medical problems and sure maybe it's irrelevant right I mean if you look at people like that that are doing high volume exercise for endurance exercise
  • {{youtube-timestamp 2409}} for long periods of time maybe it doesn't matter that they have a high calcium score um I'm not sure I I think I would say I give one more thought is that U uh if you have a high calcium score I mean probably if you're going to do an endurance event you might take a baby aspirin beforehand I mean that does provide some benefit uh uh aspirin is not necessarily for everybody certainly not if you're low risk because aspirin can cause bleeding um and have side effects for some people so I'm not telling everybody to take aspirin but I'm saying that I mean that's what I do I mean I you know I I if I'm running a a 50k or or 100K race um I know that I'm going to be putting whatever calcium I've got under some stress and probably won't nothing's going to happen but if I repture one of those plaques that's what that's what you want to be avoid right and the one thing that does keep a blood vessel open if it ruptures is aspirin that's one thing that and it's
  • {{youtube-timestamp 2469}} relatively benign so there's definitely this is in my idea there's definitely cardiologists out there who say well if you're going to race if you're going to do something really intense uh maybe take a baby Aspirin because that does mitigate what what exactly happens when you take an aspirin that would make that beneficial so just two things uh number one is it's anti-inflammatory uh and a lot of these plaques I mean it's important to say that corner AR disease is to a large extent an inflammatory process um it's not just laying down cholesterol and a blocking the arteries there's inflammation involved uh which is one of the reasons why exercise is so good right because exercise is kind of anti-inflammatory over the long term and that's why something like smoking is so bad right because smoking is super pro-inflammatory um and that's why a lot of other if you kind of look at it through that lens then a lot of coronary disease Mak sense right anything that is
  • {{youtube-timestamp 2524}} inflammatory is probably bad for you so that's why not getting sleep is is bad for you because it's it's pro-inflammatory that's why um you know mental stress is pro-inflammatory that's why you know that can go on and on like people show people there's studies that show that like just the you can look at inflammation that's the whole thing about CRP right remember there was all that studies that came out like a few years ago showing that CRP might be more interesting than cholesterol more meaningful than cholesterol in predicting coronary disease rate right so what's CRP CRP is a measure of inflammation that's all it is so um inflammation is maybe that's more important than cholesterol um a lot of people think that so um aspirin is is a good anti-inflammatory and taking just a baby dose is probably all you need and then the other thing that aspirin does is it probably and definitely inhibits platelets from sticking together which
  • {{youtube-timestamp 2580}} makes your blood clot a little bit more slowly which will if you're going to have a heart attack it's not it it's not going to form that clot that obstructs the blood flow in the coronary artery does that makes sense yeah yeah and just for clarification for like a baby aspirin we're we're that's different than other like anti-inflammatories like ibuprofen totally different right yeah totally different yeah ibuprofen does not have that benefit and ibuprofen they've studied that it doesn't really prevent coronary disease it is anti-inflammatory but it probably has other bad things that counteract that um it can cause blood pressure to go up it has other effects we don't even understand completely so nonsteroidals in general probably not so great um uh and a lowd dose aspirin is probably preventative but again just to clarify it's not for everybody and it does have some risk M yeah what are some of the risks that would be that would entail in
  • {{youtube-timestamp 2638}} that obviously it's like anything you're going to be looking at this through a lens of I want to lower my overall risk factor so obviously when you're making that consideration someone who decides that they're going to do it or the doctor tells them to do it it's because the benefits of that what you just described outweigh whatever those side effects would May so what are some of the side effects though of aspirin aspirin will can cause intestinal bleeding irritate your stomach it can cause um uh in general it makes you more prone to bleeding it can there's a small very small risk of uh cerebral hemorrhage which is terrifying but that's pretty small but it could happen um yeah I think those are the main things that you you know so I stop aspirin all the time and low-risk people like if you're you know young and you don't have any uh any plaque in your arteries and you're you're totally healthy then taking the aspirin doesn't
  • {{youtube-timestamp 2694}} make a whole lot of sense but if you're if you're older especially men I mean the studies again over keep showing that women get less benefit from aspirin might not even get any benefit from aspirin which is weird it's interesting maybe has to do with the fact that women have lower risk in general uh but men have get more benefit from aspirin and um older people get more benefit from aspirin and if you have plaque in your arteries you get more benefit from aspirin so I guess that does that sort of answer your question yeah no that's great thank you um okay cool I mean needs to yeah I would just mention I mean it's interesting a lot of the studies I mean we should mentioned that I was talking about men versus women the studies are all mostly in men uh and mostly in white men so I just need to mention that again we really don't know a lot about other uh about women and the benefits and risks and longdistance exercise for I
  • {{youtube-timestamp 2752}} mean we just don't know as much there's just not as much data um so I mean we have a lot of data on uh European men uh it's it is it's good and bad it's good that we have the data I mean that that's where they do the studies um but it's bad that it doesn't we're still kind of out you know we don't know a lot about uh women athletes we don't know a lot about uh other ethnicities um so I mean if you're in doubt then see a cardiologist get get some more testing and try to sort it out mhm yeah I guess at the end of the day a lot of this is sort of like an overview of what could potentially be problematic but really any data that would be suggestive of it being unique to European men versus women versus other ethnicities can be cleared out with individuals by looking in and you know taking a look at where everything's at so it probably correlates but you have to be careful not to generalize not to overgeneralize and be too confident
  • {{youtube-timestamp 2819}} based on you know information that we have which just isn't that good um I guess that's the bottom line I mean I I I I take from this again that um exercise does more good than harm but we should recognize that it probably does a little bit of harm I mean you can't I wouldn't deny that so uh am I going to stop running Ultras because of this no of course not but uh it's just good to be aware of it I guess that's my point yeah do you know is there like a general timeline I mean there I'm sure there is and if you don't have it on the top of your head that's fine but I'm just curious like I'm guessing they kind of stratify this by age groups where it's like if you're in your 20s you should almost certainly have a CA score of zero so if a 20-year-old goes in and has a CA score of zero it's like okay you're just doing what you should be doing versus someone who's like say 5560 they're going to go in right is the I'm guessing the expect there is probably not a c
  • {{youtube-timestamp 2877}} score zero but that's likely fine because they're not expected to live as long at that from that point onward as someone who's in their 20s right right I mean I wouldn't use age as a rigid cut off right because I see this all the time I see 60-year-olds who look like they're 40 and I see 40-year-olds who look like they're 80 so uh it's I really do so I I just don't know um I think family history also comes into play a lot um if you if if you're 20-year-old but your dad had a heart attack at age 30 that's a lot more concerning you know so uh I think family history is important I think exposure to other risks right so I saw the other day I saw a patient who was 40 but who had smoked throughout his 20s and then quit so that's that that person would be significantly higher risk um even though they you you know what I mean they're relatively young so that would be somebody that I would want to do a c C score maybe even get a CT nagram if the
  • {{youtube-timestamp 2937}} C score is abnormal and someone like that um so it's you got to kind of take the Nuance of the uh of the patient and the individual uh risk factors um into play that's why I think U getting more lab testing is good uh getting a uh there's something called LP little a I know Peter AA talks about it a lot on his podcast and it's super important LP littlea is a uh genetically determined uh risk factor it's a type of uh it's a it's a protein that gets attached to LDL cholesterol and um markedly increases the risk from it um it makes it a lot worse of a um uh of a bad actor uh if you have elevated LP littlea um and uh I've been testing it a lot in patients and it's been really really interesting when you get uh elevated LP little a uh that's super important I mean I have patients when I see somebody in their 20s who comes in with a heart attack it's almost always because they have a high LP little a and I've seen that like a whole bunch of times and um so that's
  • {{youtube-timestamp 3006}} important I think everybody every the recommendations are that everybody should get their LP little a tested um just once in their life we don't yet have a therapy for that um although it's coming maybe in a year or two but as of now there's no treatment for elevated LP little a but to know about it makes a big difference in terms of knowing your risk um I think of it as like being um it's about as bad as smoking I mean it's that bad um and um it's kind of like smoking that you can't quit yeah yeah so if if if you were a smoker and couldn't quit and had that exposure I think you ought to know about that um that's something that's worth worth finding out so I think everybody every everyone should get their LP little a tested yeah and I think just like you mentioned this is some this is a situation where these are risk factors they don't make they're not guarantees right so it's one of those things if you have a high L LP little a then that may just be an
  • {{youtube-timestamp 3065}} indication at this point in time you should probably have all your ducks in a row on the other ways to lower your risk exactly versus exactly someone who's lower they maybe don't have as much I mean they probably should still be mindful of the other risk factors but maybe they don't have as much of an incentive exactly right so that's you yeah you if you're if you have a LP little a that's elevated I had this happened actually just recently I had a patient who um I tested her LP little a and it was like super high and I'm like you really really got to quit smoking yeah oh my goodness you know yeah you really don't want to combine you know there there's a Synergy of risk right if you combine high blood pressure and smoking and elevated little LP little a you're really guaranteed to have a problem so um absolutely yeah you know you mentioned uh Dr Peter AA and one thing that he said that I thought really kind of summed up the cardiovascular
  • {{youtube-timestamp 3119}} risk uh factors and how to think about them was he described as everybody is just imagine yourself being a car and this car has a minimum like let's say you're neutral so you're just coasting that's the slowest you can possibly go and the end like all these cars are going to The Cliff the cliff is when you die obviously so you can do things along the way that either hits the accelerator or hits the break on that that progression towards that Cliff so like let's say if someone has High AP Little a they just have a little bit more of a static foot on the gas pedal that they're not going to be able to manipulate so then if they start smoking pushing that gas pedal down further and then eating a diet that's higher risk and all these other things then they may be just pushing further and further down and getting closer sooner and that's the way to maybe think about it whether your delt a poor hand or not exactly yeah I think so yeah um and
  • {{youtube-timestamp 3178}} and then there are tools that we have to to mitigate risk right I mean um you know Statin a lot of people uh they do great with them not everyone of course there are people that are St and tolerate but if you can tolerate satins then they they're they're great there are other options now there are a whole bunch of other drugs that have come out in the last 10 years that are really uh effective in lowering uh the um uh apob which is the best way of looking at cholesterol just a B level so there's that there's and then if we're talking about if we're talking about higher risk usually athletes don't have high blood pressure but if you're having High I mean there was some in that study by the way that the the the the study out of the Netherlands had like I think 20% of them had high or 15% had high blood pressure so there are athletes with high blood pressure out there so if you've got that then treat that should be treated that will lower your risk um
  • {{youtube-timestamp 3231}} right there's a lot of things you can do to reduce your get better sleep I mean it's s sleep is I keep thinking about how sleep is super important so there's a lot of things that we can do to uh to take our foot off that gas pedal so to speak absolutely I have a couple questions for you sure just to kind of get a l like I find like a lot of these topics are really interesting because it's one of those things where if you go a layer deep in a certain Community you find things to be very problematic or be like like the the savior us all sort of type of mentality uh and then when you go a few layers deep you kind of find the Nuance within it and where the middle ground I guess is where it usually ends up falling so if we look at statins in general I mean I've seen everything from like if your doctor recommends a Statin you go find a different doctor like full stop like no more consideration to to like we should put statins in the drinking water like
  • {{youtube-timestamp 3287}} what's the deal with statins in general like I I assume it's like anything and there's a risk factor there for certain populations maybe or things that are going to maybe be suboptimal with them but if it's something that's going to prevent you from dying earlier you might want to take that is there can you just give us an overview of that yes be happy to yeah so Statin will lower your apob level and if the stud's over it's very clear that APO B is atherogenic so it c meaning causes plaque to build up so statins will lower that and they also there's studies numerous studies that show that they induce plaque regression or stabilization so that it takes that that high-risk plaque that we talked about um and it converts it into a calcified plaque that's more stable less likely to cause a heart attack and then there's epidemiologic studies like meaning like looking at large groups of people over time that show that the ones on the statins have a significantly
  • {{youtube-timestamp 3345}} lower risk of death heart attack stroke Etc so there's the data showing benefits of studens is is just overwhelming that being said you know are other I mean not everybody can tolerate Statin I'm one I can't so far I mean I tried and I uh I had I I had full rabdo my alysis on a run uh from oh really so I quit the Staten yeah yeah I was doing one of your one of your runs it wasn't my fault was it yeah it was no it was the st's fault it wasn't my fault yeah right so yeah I had been taking the St for a couple of months and no problem and then I did like a uh low medium intensity 90minut run and was going downhill at a Brisk pace and all of a sudden I had to stop and I was like oh my this is unbelievable uh and I went in and got my blood levels checked and my CPK level was like several thousand like I can't remember it was really high and uh so yeah okay I stopped the Staten waited like a few days and I was fine I went back to
  • {{youtube-timestamp 3410}} running no big deal I mean it's not like any major damage was caused so I think people get a little too emotional um do I I mean people yes there's about recognized incidence of about uh 5% of patients re maybe 10% uh cannot tolerate Statin because of the muscle uh pain issue does statins cause dementia no that's not true that's um dist STS cause other no they in fact they probably do good they do raise blood glucose a tiny bit so there is that that whole thing but is it enough to cause diabetes probably not it raises your blood glucose by about 1% or something like that according to most studies so it's really probably not significant so um you know it's a tool I was think statins are a tool to use to reduce your risk but it's not the only tool there was a big study that came out recently that showed that bempedoic acid which you might have heard of it's called nexletol um came out that's a drug that came out just about three four years ago and it
  • {{youtube-timestamp 3469}} actually did just as well as statens in terms of reducing uh outcomes and acts on a different pathway Works higher up on the cholesterol synthesis pathway in the liver so it blocks the liver from making cholesterol in a different totally different way it does not cause any muscle problems at all so you can take bidic acid if you don't want to take a Statin uh probably does the same benefit there's Zia which works under totally and that's cheap that came out like a while ago it's generic now that works not as well but it does something does it it's probably beneficial for reducing risk um then there's other options there's this drug the pcsk5 Inhibitors which are injectable which is a little bit of a hurdle for some people but once every two weeks you inject yourself with this drug that block it's a long story of how it works but basically it lowers cholesterol more than stattin very expensive but it does work and it's got no side effects pretty
  • {{youtube-timestamp 3526}} much so there are other options out there um so I always try to work with when I have a patient who says that they don't want to take a stat and I say like you know let's talk about different options also there's different Statin right I mean you can do a lot of people do they get away with doing a um a lower dose of a more quote milder stattin there are milder ones that are water soluble that leave your body quicker um and you can do that you can do it twice a week or three times a week I have a lot of patients who take statins three times a week and have no problem um so there's a lot of different uh ways to skin that cat of getting your apob B level as low as possible ible um it's not like I mean I also use lower doses I mean a lot of doctors I see give way too much high doses of statens which are a lot higher risk of causing side effects I some somebody comes into my office on like 80 milligrams of lipor I'm like Jesus why there's no IM it's not
  • {{youtube-timestamp 3583}} necessary just you can give a low dose and they'll be fine and the risk is a lot lower so is there uh it sounds like this is probably would just be a temporary solution because it sounds like we're we're we're continually developing this sort of a therapy to a point where eventually we'll have something that has all I shouldn't say all but like it has like so many benefits and the trade-offs are so slow it' be silly not to do it type of a scenario but if someone were to say have a situation like you did where they were having muscle issues with the Statin but it was by and large very proactive for their cardiovascular health would you be able to do like a could you dose it on like an offseason like you're taking a break from running or maybe you're reducing training and then get some benefit and then phase out of it during your Peak training when it would maybe be problematic that's a clever idea I've never thought of that uh sure I mean you
  • {{youtube-timestamp 3637}} can try it I mean there's no you can definitely do that you can Cycle Therapy or you can switch around yeah you could do that I don't know I mean my experience is that if you're going to have if you have full-blown I me there's a difference between muscle pain like just a nak in pain and full-blown like lab uh Labs that show Muscle injury rabo RIS that's that's a little bit more concerning because if you have rabdo then you can injure your kidneys you can have other issues that happen from that so I don't know if I would screw around with it too much if you had rabdo but if you just had muscle pain then um that's a lot milder then sure you can and there are ways to mitigate that too uh studies show that if you have uh muscle pain from statens check thyroid because that's associated with a higher risk of problems and check your vitamin D level because you have low vitamin D then that makes it higher risk so yeah I mean there's definitely ways to kind of
  • {{youtube-timestamp 3695}} negotiate around that for sure I did want to touch on one of the thing you mentioned and that's apob as that has been something that's come up a lot more as sort of maybe a little bit I I've seen a bunch of different things I've seen like okay this is the number you really want to test it's not on a typical lipid profile so you sort of have to request it and I've seen other lipidologists suggest yeah it's a great test to get but it also correlates so nicely with some of the other stuff that really you can kind of pretty much predict your apob with some other stuff anyway you want to just talk about like you can yeah sure yeah so so apob is the that's what the atherogenic particle all the atherogenic I would say arenic again I should be careful atherogenic means something that causes plaque to build up so we say the word atherogenic so all of the atherogenic or bad uh uh uh lipid particles have apob attached to them so HDL is not atherogenic does not have
  • {{youtube-timestamp 3755}} apob attached but vldl IDL uh triglycerides LD they all have um apob so if you just look at the apob number that's a lot simpler and easier then what you're what you're referring to is can you just like just look at the total cholesterol and people do What's called the non-hdl cholesterol so you take the total cholesterol and subtract HDL and then you're left with all the bad particles the reason why that's not as good as apob is it doesn't account for particle density so the fact is that you can have a lot of little dense particles and that's way worse than having um uh uh what's called light fluffy LDL particles that's not as bad so getting the apob number tells you the number of particles which tells you particle density which tells you more about risk so so when I look at a patient I really just want to know their apob level yeah I'll look at their triglycerides sure but it's not I mean that tells me something a little bit about their
  • {{youtube-timestamp 3813}} metabolic Health but it's not that interesting it's not that important in terms of predicting their cardiac risk um if I I I really want to know how dense those lipid particles are because it's the dense lipid particles that do the damage right it's the little they're like little um baseballs somebody once wrote that they're like little baseballs being thrown at a window right if you throw a lot of baseballs at the window you're going to break the glass um and the more part the more of the baseballs you throw the more likely you're going to break the glass if you have light fluffy particles they're not like baseballs they're more like uh uh fluffy Beach volleyballs yeah they're beach balls they're much less likely to break the glass if you're um if you're smoking you're you're throwing stones now uh they're even denser and they're even worse right um so does that that that's kind of how I think about it so I just want to know the number of of baseball
  • {{youtube-timestamp 3865}} sub of being thrown at my window yeah know that makes sense I just want to know I I just want to know my ail B level and um I want to get it as low as possible and however I get it down Statin are the most convenient and for goodness sake they've been well studied right I mean Statin have been out for like you know what what 40 years now 30 years so we know everything The Good the Bad and the Ugly about Statin and um and they're relatively cheap they're generic so you know that's that's your go-to now but if you can't take it no big deal yeah there's some other paths to explore for sure um for sure yeah so with apob B just maybe one step further with that if someone were to get their apob tested is there like a magic number that you would suggest it should be under this and does that number is there like the lower the better or is there a point where you said yeah going lower than this really doesn't matter anymore yeah so that's great so so this
  • {{youtube-timestamp 3923}} seems to show that I mean for example like human babies have apob B level that is like crazy low it's like 20 or something and they're fine they they don't they're they're very healthy uh they develop normally their brains grow they they do fine so low apob is not bad right there's no such thing as too low nobody you you get your apob level down to 20 congratulations you're the same as a a human uh uh baby and you're fine so it's not like I wouldn't worry about it the problem is that you get into the point of diminishing returns right you get um you start pushing it lower and lower and lower you start getting side effects of drugs you start spending money that's not necessary you get drug interactions right maybe you're taking some other drug and then it interacts with whatever drug you're taking for your cholesterol and that can be a mess so um you know and then what I I try to individualize it like I like if you have a 90-year-old do you really care that
  • {{youtube-timestamp 3981}} they're a be is super low probably not it's not going to make a whole lot of difference but if you have an a 20 or 30y old with a family history or calcium score that's positive and they have an APLE B level that's even a little bit elevated then you really want to jump on that you want to make it as low as possible because the idea is you want to lower the air as Peter AA talked about at once that you really want to lower the area under the curve right you don't want to have high exposure to apob over a long period of time so for younger people I'm a lot more aggressive so I want and if they're lower like they you know somebody like you like if you came in and and you're you're a young guy and you're exercising a lot you really don't want to be exposed to a high level of ail B for if you're we're assuming you're going to be alive to age 90 or 100 we don't want to have you exposed to that for a long period of time so I would want like you to have an AAL B
  • {{youtube-timestamp 4033}} level of less than 50 okay for sure but if you're but if you're a uh if you're a 70-year-old and and you're otherwise pretty healthy then yeah I mean I would if you look at the textbooks they say the normal apal B is less than 90 and I would tolerate that if somebody's like you know lower risk and they're not going to they're already elderly then fine I'd settle for an AAL B level of of 80 or 90 it's no big deal that being said I I would say this that I don't abandon the elderly at all nobody should do that I mean uh if I have a older patient that's healthy and highly functional uh I'm still going to get their uh able will be level as low as possible because I don't want them to have a stroke right I mean I'm talking about you know I'm not I'm not saying I want them to be an athlete I don't I just want them to be healthy I want to keep them out of the hospital and um um so sure I would still treat them I just might not treat them quite as
  • {{youtube-timestamp 4088}} aggressively interesting you know that all makes sense David this has been awesome I have learned I've learned a learned a bunch and I've had some questions kind of along these these topics of like I kind of had an idea of where I thought it was going but it's always nice to have have someone come in and kind of point to show exactly where that is and yeah I'm sure the listeners are going to love to hear some of this information and start exploring perhaps but uh other than that I mean we'll have to have you come back on down the road when you get pulled out of the lottery for western states and and go and experience that epic event yeah that's right yeah that's great yeah I don't think there are a lot of cardiologists qualifying for Western States so I'm kind of an odd odd breed there yeah yeah no you'll you'll be I'm sure one of few if any so that'll be that'll be fun uh awesome David do you want to share with the listeners where they can find you
  • {{youtube-timestamp 4143}} are you on the internet anywhere social media I'm on the I'm on the yeah I do uh social media I'm on um Twitter and uh uh threads and uh uh Facebook and um uh I see patients and uh I'm uh love to see endurance athletes uh or Ultra Runners I have a few of them that have come in and that that's really fun so um yeah I mean I'm happy to see people who aren't even sick I mean I'm happy to talk about like Risk reduction instead of just illness that's always a fun change for me yeah and you're up in Eugene in Eugene Oregon yeah cool and is your does your business do only inperson stuff or do you have any sort of online type of stuff that people can access oh wow uh at present no I'm it's not my business I'm employed by a big hospital okay gotta Health it's a big it's a big um uh Health System here in uh the Pacific Northwest so I I work for them but I see patience and I you can find me online and uh go through that way but um
  • {{youtube-timestamp 4203}} no I don't do remote stuff now that coid has kind of died down I don't do that right at presently but I could think about it in the future it's a good idea I'm just imagining all these Ultra Runners looking for your consultation oh jeez man no uh no David it's been great to have you on thanks a bunch for uh giving me some of your time today and have a great rest of the day well thank you very much excellent thanks all right everyone if you're still here you're sticking around to hear about how I use the show sponsor element electrolytes and Delta G ketones for element they make an electrolyte supplement so what I know about me is that I lose 614 milligram of electrolytes per liter of fluid loss so what that means is if I go out for a run and I lose 2 L of sweat then I'm also going to lose roughly 1,28 mg of electrolytes with it which ironically happens to be about one packet of element so what I likely will do is if I'm going out for a longer
  • {{youtube-timestamp 4269}} training session or I'm going to be out in the Heat and sweating a lot I'm going to supplement the fluid intake I have with electrolyte to make sure I have that stuff in Balance the way this usually looks for me is I'll wake up in the morning and I'll have a cup of coffee and I'll put half one of those packets in with my coffee it will be one of their chocolate flavors though because it's coffee after all I'm not going to stick one of the fruity flavors in there so that gets me kicked off then what happens is I go out for the workout and then I am drinking basically to thirst but I am also targeting some numbers at times when it's hot enough and I know what my sweat loss is but generally speaking for every liter of fluid I'm taking in I'm matching that with 614 Mig of electrolytes to make sure I'm staying on top of that and remaining hydrated throughout that training session if you're interested in a deep dive and figuring out more about
  • {{youtube-timestamp 4320}} your fluid loss and electrolyte needs I actually have a couple podcast episodes that might be interesting to you one is episode 358 with Andy blow where I go over all things hydration and he talks about how I came up with that 614 milligram loss number and how you can maybe find out about yours as well as how much fluid you are losing with some simple atome tests also I did an episode a while back episode 300 which is just titled personalizing workout hydration so check out both of those if you're interested in doing a deep dive into your hydration and electrolyte needs something new I added to my training and racing this year are exogenous ketones the research for exogenous ketones is still in its early stages but there is a lot coming out and it is getting more convincing in my opinion to the degree where I wanted to try it out I actually stress tested it during a 15-hour 100 mile run at the Rocky Raccoon 100 earli this year as a
  • {{youtube-timestamp 4378}} way to confirm whether it was something I was going to include in my racing protocol one thing I was a little nervous about with exogenous ketones like I am with anything I'm ingesting during an ultramarathon is what is it going to do to digestion I was interested in the recovery research for some time now with exogenous ketones and there are some newer research studies now that suggest it could also have some performance applications as well if you're able to tolerate it and get it in the right dose so when I decided to try out I went with Delta G ketones because they are the Ketone eser that basically all the research that has promising effects is tied to and it's their formula that's being used in those research studies so a lot of times you'll just go and look for an exogenous Ketone and there's all sorts of potential issues with that whether it's a dosage or just an incorrect type and it's not actually going to do what the
  • {{youtube-timestamp 4427}} research suggests it would do so to me it was looking at if I want to potentially get get the benefits that these could be bringing I need to be using the one that they're actually showing the research with so that was Delta G ketones they actually received the DARPA funding and Grant to actually put together that formul so like I said in the the intro message they have 50 plus published studies and are part of 20 plus ongoing studies my protocol with this right now and this is something where I am evolving as I kind of do more with it but at the moment I'll do a bottle of their Ketone performance Delta G Performance and that is their little blue bottle so I'll take one of those about 20 minutes before a big key training session and that's it if it's a race day though I'll do that same protocol but I will take another bottle about every 3 hours after that so if I'm doing something that's longer duration like that 15h hour Rocky Raccoon effort
  • {{youtube-timestamp 4484}} I just described I would be doing that again at 3 69 and 12 during that particular performance so like I said in the intro if you want to chat with one of their experts you can actually go to deltag gon.com and they have a consultation service there right now where they will help you understand the research and whether your lifestyle is even something that they would would be worth considering it for so if you want to get a little more information on that that option is available to you links to both Delta G ketones and element electrolytes can be found in the show notes as well as at Zack bit.com hpos sponsors thanks for tuning into this episode of the human performance outliers podcast with Zack bitter