Episode 499: REDs & Body Composition | Dr. Trent Stellingwerff
Dr. Trent Stellingwerff joined the show to discuss the topic of relative energy deficiency syndrome (REDs) in endurance athletes, and body competition management. Trent includes working with the Women’s Health, Sport & Performance Institute (WHSP) in Boston Trent is the Chief Performance Officer (CPO) at the Canadian Sports Institute. Trent has developed many national and international collaborations in various applied research projects in the fields of nutrition and physiology, and been a part of 8 IOC position statements. Trent joined the show to discuss the topic of relative energy deficiency syndrome in endurance athletes, and body competition management in athletics.
Trent: whspinstitute.org & csipacific.ca/team-members/trent-stellingwerff | X: @TStellingwerff
Episode Sponsors:
LMNT: drinkLMNT.com/HPO (free sample pack with purchase)
deltaG: deltagketones.com Code: BITTER20 (20% Off)
Support The Show:
HPO Sponsors: zachbitter.com/hposponsors
Support HPO: zachbitter.com/hpo
Zach’s Coaching: zachbitter.com/coaching
Relative Energy Deficiency in Sport, body composition, and performance with Dr. Trent Stellingwerff
This episode is an interview with Dr. Trent Stellingwerff, Chief Performance Officer at the Canadian Sport Institute and a major voice in sports nutrition and physiology. Zach Bitter and Trent focus on relative energy deficiency in sport, how it affects performance and health, and why body composition is a far more nuanced topic than simply “getting lighter.”They also cover body composition periodization, the difference between low energy availability and REDs, and why the best interventions depend on the athlete, the sport, and the support around them.
Key topics
In this episode, Zach introduces Dr. Trent Stellingwerff’s background, including his work in nutrition, physiology, and IOC consensus statements, to frame why he is such a strong guest on performance fueling and REDs.
Trent explains why he prefers the term body composition over body weight, and why optimal performance usually sits inside a range, not a single number.
We discuss how elite sport often filters ideas brutally fast. If something works in cycling, marathoning, or Olympic track, it tends to survive. If it does not, it usually disappears.
Trent defines REDs as a syndrome caused by prolonged problematic low energy availability, with effects on metabolism, reproduction, bone health, immunity, cardiovascular health, well-being, injury risk, and performance.
We discuss why someone can have REDs even if their scale weight is stable. Resting metabolic rate can downregulate before body weight changes.
Trent breaks down key warning signs, including menstrual disruption, stress fractures, low libido in men, fatigue, poor recovery, illness, low blood pressure, and major changes in diet or body composition.
He explains the difference between conscious and unconscious low energy availability, from deliberate underfueling to simply not realizing training load has doubled while food intake has not.
Trent outlines how REDs is assessed using the IOC Clinical Assessment Tool, which scores athletes by risk level using a traffic light system.
We discuss recovery timelines, which can be a couple of months for early cases but much longer when severe REDs or an eating disorder is involved.
Trent emphasizes that carbohydrate is the key macronutrient for improving REDs related problems, especially when placed before, during, and after training.
He makes the case for body composition periodization across a season, arguing that intentional off-season weight regain or body comp rebound can support long-term health and performance in well-supported athletes.
The conversation closes with Trent stressing that athlete availability, consistency, and long-term durability matter more than chasing aggressive short-term leanness.
Timestamps
0:00:00 - Why Trent Stellingwerff is a major authority on sports performance and nutrition
0:01:26 - Why race weight and body composition are such a sensitive topic
0:03:15 - Trent’s curiosity-driven approach to research and elite sport
0:09:00 - Introducing the episode focus: relative energy deficiency in sport
0:10:51 - Why REDs is more than just a nutrition problem
0:12:18 - Why comparing your body to another athlete is usually a mistake
0:13:30 - Performance happens inside a range, not a single ideal number
0:15:48 - Why body composition matters more than body weight alone
0:18:33 - The modern definition of REDs and how the consensus evolved
0:21:32 - How REDs can exist even when scale weight does not change
0:24:53 - Low energy availability as an exposure, not an automatic diagnosis
0:28:24 - The main biomarkers and warning signs to watch for
0:32:00 - Conscious versus unconscious paths into low energy availability
0:35:27 - How long recovery can take once REDs is identified
0:37:37 - Why knowledge alone does not change behavior
0:40:40 - What actually motivates athletes to change
0:46:12 - Why stress fractures are often a delayed warning sign
0:49:03 - Carbohydrate as the key macronutrient for REDs support
0:50:17 - Fueling around training instead of staying in a constant deficit
0:55:13 - Why body composition periodization can support long careers
01:01:58 - Why strong support teams matter for any body comp intervention
01:04:47 - Why context determines how low energy availability should be handled
01:07:32 - Why younger athletes should be patient through puberty
01:10:06 - Where to find Trent and his current work
Transcript
(00:02)
Thanks for tuning into this episode of the Human Performance Outliers Podcast with Zach Bitter. Today I have a very exciting guest coming on the show, Dr. Trent Stellingwerff. He is the Chief Performance Officer at the Canadian Sports Institute. Trent has developed many national and international collaborations in various applied research projects in the fields of nutrition and physiology. He also holds adjunct faculty.
(00:30)
positions at the University of Victoria and University of British Columbia and a faculty member for the International Olympic Committee. Diploma in sports nutrition and strength and conditioning programs. Trent has been the lead or co-author on eight different international sports consensus statements and has been author or co-author on a hundred and fifty plus peer-reviewed scientific publications, totaling more than twelve thousand plus citations. So Trent has a huge
(01:00)
body of work behind him. He's been involved in a lot of the information around sports performance, especially around the nutrition side of things. And I wanted to have him on to talk about one topic in particular, but we could go a few different directions, I think, just based on the amount of information he can provide us. But basically my last episode I had Matt Fox on and we talked about a bunch of things with Matt, but one topic that Matt was sharing with us was
(01:26)
This approach that he is using currently to try to optimize his race weight or really leverage the power weight ratio in the quest of seeking the fastest possible marathon he could run. So that topic can be touchy for a variety of reasons because it can oftentimes be misused, it can be dangerous if applied incorrectly and things like that. And Trent is maybe one of the best guys in the world with respect to understanding things like relative energy deficiency syndrome.
(01:56)
and how a professional athlete or someone seeking peak performance would go about managing something like weight in the quest for performance, but also remaining healthy and sustainable throughout their career. In fact, I think this was on Dr. Mark Bub's podcast nearly seven years ago. Dr. Stellingwerff was there and they were discussing this topic about how he works with professional athletes to make sure that they're showing up at the start line of their key events that might be just a couple of times per year.
(02:26)
in the best possible position to perform, but also staying healthy and not having that go backwards on them when it comes to weight management and things like that. So I think Trent's probably one of the best people we could possibly talk about. So I'm excited to bring him on and share some of that stuff. Also, one other contact point I have with Trent actually dates way back to 2013 when I broke the hundred mile American record and the 12 hour world record at the Desert Selsus track invitational.
(02:53)
One of the reasons why that race stood out to me is because it was a race that sort of put my name on the media a little bit more than it had been prior to that. And with that, people wanted to know everything I was doing between training, nutrition, everything that went into that performance. And at the time I had been following a low carbohydrate diet for just over two years. So
(03:15)
Trent got wind of that and being the professional is the ultimate curiosity, wanting to know all these things. He actually reached out to me and wanted to know everything about it, what I was doing, why I was doing it. He offered me some feedback and some things to look out for with respect to what I was doing because it did not match what was normally being advocated in the endurance world at the time, or currently for that matter. And I think when I think of people that are in the world of sports performance and how curious and
(03:44)
open-minded they actually are to try to figure out exactly what's going to work best, knowing limitations, applying them appropriately to different contexts and things like that. Trent's gonna be a tough guy to beat with there. So he'll be a great guest and I'm really excited to share his wisdom with all of the listeners. Quickly before we bring Trent in here, just so everyone knows, if you want to access any of my coaching services or just reach out with questions, head over to my website at zacbitter.com. I have all my coaching services, pre-made plans and
(04:14)
And my new app up there, which is designed more for new runners or runners who are trying to get into the sport a little bit. But I do also have some strength and mobility stuff on there as well as an updated every four-week training plan that works with beginners all the way to advanced if you're just looking to improve your running efficiency. I'm also raffling off a 30-minute consultation every month for listeners who share an episode on social media or leave a review. So if you do do that, make sure you tag me or send it to me.
(04:42)
via my website or social channels so that I can enter you in that raffle. The most recent winner is Valentina Geromelo. Valentina left a review on one of the episodes. So I appreciate that, Valentina. I will reach out to you and make sure you have all the information to set up your thirty minute consultation. All right. Trent, welcome to the show.
(05:02)
Thanks for having me on, Zach. I feel like it's been too long, but we'll make it a good one.
(05:07)
No doubt about it. Yeah. I I actually pre recorded the intro before coming on and I was just sharing with the listeners that you're a person that I use as an example often when it comes to just the level of curiosity around top performance and the the levels that like elite, highly competitive pressured sports will go to to find where the benefits are, where the margins are going to let give someone a
(05:34)
a fraction of a percent because it's just so refined up there. You know, if you can manage to find something that works slightly better, you're gonna potentially move up in the podiums and things like that. And I think you're one of the better examples from my experience as someone who's been very interested in seeking some of that stuff over the years. And I shared the story of you reaching out to me back in 2013 after I had one of my better races earlier in my running career, just out of curiosity around what I was doing with my own nutrition approach and things like that.
(06:04)
Yeah, I I I'm one of those rare people that spend try to spend as much time as I can with one foot firmly placed in research and academia where we try to control every little variable and you know use double blind crossover designs and then I got another foot firmly planted in and the real world of elite sport where it's chaotic, it's hard to measure, you can't control everything. but
(06:32)
it's such a crucible for pushing new ideas and new performances and trend analysis and and you you can't ignore that and you can't ignore the competitive pressures of what what athletes will do and and I find that I get as many research ideas from pe reaching out to people like you in twenty thirteen or to coaches
(06:55)
take back to the lab as we do from the lab across to lead athletes. So it can go both directions and I purposely try not to stay too biased either way and appreciate both sides of the table.
(07:13)
Yeah. Yeah, it's interesting stuff. And I always love some of the sports like cycling and road marathoning and basically any Olympic athletics event at this point where if something's gonna work, it's gonna stick in those environments. And if it doesn't, then it's sort of like the ultimate filter 'cause you do include everything that goes into the preparation and then the ultimate performance. It's like it controls all that stuff. So even if there's things we don't know
(07:42)
if you plug something into it it's gonna address all of it because it has to. It's the full system.
(07:48)
Yeah, and I agree. And and and there can be some ebbs and flows with what sticks and doesn't stick and what I I do think cultural trends and or elite athlete endorsements sometimes unduly accelerate certain interventions or maybe overemphasize certain inv interventions, but then they don't stick or they don't last, you know? And when I say stick or last, I'm talking, hey, you know, two or three years later we're still implementing the same same
(08:18)
ideas and inputs because yeah, there's a long list of things that have been kind of tossed to the side or or said, you know what, it is just in everything else that I'm doing, it's a distraction or noisy or I just don't feel the benefit. So yeah, I like that philosophy. I agree. And when when the well controlled lab data marries up to what's sticking in the real world, then then you know
(08:46)
you really know you have a high yield intervention. Unfortunately when that happens, it's usually twenty years after the first paper's published and it's a consensus statement. So we have to be curious and explore new ideas too.
(09:00)
Yeah, absolutely. So exciting stuff. One of the topics that I wanted to focus on with you today, because I think you're maybe one of the top people in the world on this topic, if I'm not mistaken. I know you've done a lot of work with it, which is just the topic of relative energy deficiency and how that kind of applies to athletes as they're trying to seek optimal performance. Because when we get into peak performance, there's so many variables that need to be accounted for.
(09:29)
to get yourself to that spot and you know, one of them in the endurance world that has just always kind of been there and it's sort of always been a bit of a touchy topic is just like race weight. And I had a guest on the podcast last episode, Matt Fox. I'm not sure if you're ever aware of Max, he does the sweat elite content creation stuff. Yep.
(09:48)
aware I don't know, I'm I I'm aware of the content though.
(09:52)
Yeah. So his background is like he was a middle distance guy, kind of like a national class and middle distance guy in Australia and he's since decided to try to see how fast he can run a marathon. And he's down to two eighteen. I think he thinks he can get maybe to like two fourteen or so. So he's sort of in that quest, but he's a little bit of a bigger guy. And then he didn't like training competitively for years. So one of his levers he was pulling was just getting his weight down to a spot where he felt he could run his fastest marathon. So he's been kind of like open about that and
(10:21)
I think anytime you're talking about that topic, it gets to be a little touchy sometimes because of just the the risk factors involved with it being abused, that information being abused, or just not understood and then misapplied, and then you get eating disorders thrown into the whole mix and people respond differently to to whether they can they have those or not and things like that. So it just ends up being a pretty tough topic, I think, to not unpack thoroughly. So I thought you would be a good guy to have a talk about it.
(10:51)
Yeah, no, thank you. There's so much nuance and context. This topic spans from the physics of sport to the emotions of how you are as a person and what you believe in your body and how you look and eating disorders and the s you know, psychological constructs and and everything in between. And I'm always gonna never be able to do a
(11:21)
fully articulated answer because the individual context and way they present and their background and their sport and their history and whether or not body composition is as involved as they think in their sport, their health profile, there's their like all these contextual moderating factors really change how you answer each of these questions or how you would do it, you know, in the real world. And so I'll try my best today to answer things
(11:51)
fairly and science driven, but at the same time just really valuing and appreciating that for some athletes, not measuring anything in this space is their very best approach to performance. And I can tell you all you know many of the Africans that are winning medals aren't measuring body weight and body calculations. They have no, they have no idea. So it's not the end and be all of everything either.
(12:18)
Mm-hmm. You know, the the first time I saw this topic get talked about, I I had a I I had a question pop up into my head I was just kind of curious about, which was just if we look at like Olympic endurance athletes from say like the 5K, 10K in marathon, like what would be like the range in that group versus like some individual? Because there is that where I think where people oftentimes go wrong is they look at somebody and they're like,
(12:46)
That's what I need to look like in order to perform my best. And it's just kind of a self false comparator at that point. So I was just curious, even amongst a group of people that are quite similar in appearance when you get to Olympic level athletes within their disciplines, you do still see a range there. And I think the distance range on the male side was something like five to ten percent body fat. So even there, you have a fairly wide range of what would be optimal in most cases from one individual to the next. And to me, that was like
(13:16)
That said, like, okay, mistake number one would be me look at my looking at my buddy and asking him what his body fat percentage is and think, okay, I need to look like you or I need to do what you're doing to find my best performance because there's gonna be some variability from one person to the next.
(13:30)
There's a lot more variability than I think people realize. So first of all, you use the word range, which is really important to appreciate. There's a range, there's an envelope or there's a window. So there's a range of where optimal performance can occur across many physiological variables, including body composition. I don't like to use the word body weight, we can talk about that later. Body composition.
(13:58)
And so there's a performance window or an envelope there or range. It's never a single number. And once you're within that range, that range may shift for an individual athlete from year to year, too. So you've got to be open minded to just being, okay, I'm in this performance range. And that can include, you know, certain splits on the track or metabolic outcomes like VO2 Max, like there's gonna be a range that just gets you into the party.
(14:27)
of performance or get you into the Olympics, so to speak. If we were to measure body composition, every physiological variable we could think of of the Olympic 1500 final, men or women, and and this is slight this has happened before, there would be no relationships. There would be no correlations, there would be no statistical differences in anyone that we measure in that Olympic final. It's just too homogeneous.
(14:56)
I truly believe that difference makers tend to be neck up in terms of how you're handling the pressure, where your confidence levels are, where you're ready to go. And you know, the classic paper is Andy Jones a few years ago published a paper on all the athletes that they tested prior to the Breaking Two project, so the sub-two-hour marathon. And they had about 15 or 20 world-class guys. One of those dots is Iliad Kipchoge. We don't know which dot it is. And
(15:24)
They correlated VO2 max and running economy and lactate threshold to all their marathon performances and nothing stuck because everyone was just so good. There was no difference maker in that paper. Now, if they included recreational athletes and collegiate athletes, of course there'd be a nice correlation because there's a big spread of data. So, you know, going back to your question on body composition.
(15:48)
and I like body composition because that includes the importance of muscle mass, not just body weight, muscle mass and the composition of the performance envelope or window or range that that athletes do need to be in, probably to optimize elite performance. That range or envelope is probably a little bit wider than most realize.
(16:12)
You know, and and I know there's lots of examples of body comp outliers that perform exceptionally well within that range. You know, an early one in an old slide that I have is every single human that is broken twenty seven minutes in the ten thousand, and when Chris Selinski first did it, he was a massive body composition outlier. He he he he's a he's a tall and larger dude. And my wife went to Wisconsin. We know Chris well.
(16:42)
And you know, he still performed exceptionally well because of his mass and his weight and his heart and you know, his body composition, he could run world class, right? So yeah, like I think what you said there is important regarding the variability and the range in that envelope.
(17:02)
Mm-hmm. Yeah, Chr Chris was an interesting one. I grew up in Wisconsin and I think Chris was maybe a year older than me. So everyone, every cross country track and field runner in Wisconsin, you know, was our guy here. Yeah.
(17:19)
My wife is a badger and she's a multi time all American Peter Teagan coaster and she yeah, she was in Madison from two thousand to two thousand and four. So I made many, many trips across. I was in grad school then and I just remember if you know what, Jerry Schumacher was so gracious. He'd meet with me many many times. I'd have my little textbook, I'd be asking them questions because their team was just so dominant. Obviously Jerry went on to
(17:46)
really big, big, big things. But my wife was just down and was hanging out with Jerry and the University of Oregon two weeks ago. So yeah, small world and yeah, Chris Chris is now the new head coach again at the University of Wisconsin. So he's come full circle. Yeah.
(18:04)
That's very cool. Awesome. Well, maybe let's back up a bit towards the topic here and start maybe from when things go wrong. So if you 're in the world of relative energy deficiency, that means you've made some mistakes intentionally or unintentionally to the degree where now whatever you're trying to do is working backwards on you and you're likely seeing symptoms and issues arising in your performance and health and things like that. So maybe we just start with
(18:33)
Like what is the kind of the current working definition of relative energy deficiency syndrome?
(18:38)
Yeah, so we call it Reds Now, and it was first coined in twenty fourteen. There was an International Olympic Committee consensus where we were a whole bunch of us. and of course, the prevailing thought then was what syndrome then was called the female athlete triad. And it was readily agreed upon at that consensus statement that
(19:03)
Well, this can work in males as well. And it's not just three criteria. There's lots of body and organ systems that are affected. And so there's been an excuse, a few iterations. I'm one of the authors on the most recent consensus, IOC consensus, 2023. And the current definition is, and I did put it up here because it is longer. So it's a syndrome, it's not a disease of impaired physiological and psychological experience.
(19:31)
functioning experienced by both females and males due to exposure to problematic low energy availability. And so it's that exposure to problematic low energy availability that eventually results in detrimental outcomes that can include but not limited to a decrease in energy metabolism, so resting metabolic rate, reproductive function, musculoskeletal health, like stress fractures.
(19:58)
Immunity, hematological and cardiovascular outcomes that result in aspects of impaired well-being, increased injury, and decreased performance. And so it is a multifactorial complex syndrome. and when we look at defining it but then measuring it, it can be quite complex because it is multifactorial.
(20:23)
It shouldn't be surprising. Like if we think how, you know, we've evolved and if we're in energy deficits and there's just not enough calories to go around, it is gonna impact the whole body and many different organs at different rates and different ways. So that's the current definition according to science. And usually the way these things work is every, you know, every five to ten years, there might be an update in the consensus statement, an update in how you assess it and how you address it.
(20:53)
but we're pretty fresh. It's just twenty twenty three, since the last update.
(20:59)
Yeah, there's what there's one thing I was going to ask you with that too that I found interesting and I'm I guess I'm not a hundred percent sure of the accuracy of it, so maybe you know, is I think when people think of this, they think of like you get an athlete who's maybe experiencing this and they notice, well, I'm not even losing weight or I've gained weight. Is it possible to have this syndrome while maintaining weight because of just
(21:27)
the way you're partitioning your energy around your training and things like that.
(21:32)
Absolutely yes. And that's why body weight or body composition metrics are currently not used to diagnose reds. When you're in a longer term or more severe energy deficit or low energy availability, one of the first adaptations your body does is to just dial down resting metabolic rate or basal metabolic rate as a way to conserve energy.
(22:01)
That can come at the cost of bone health, reproductive health, less recovery, poorer sleep, but you're just dialing down your recovery processes. And so by doing that, you can get energy conservation and body weight, you know, may not actually change very much. It's not always the most accurate indicator. Even something as simple as body mass index.
(22:31)
Yes, extremely low BMI body mass indexes the relationship of weight and height that your doctor's office does. So an extremely low body mass index is an indicator for an eating disorder, but it's not the sole indicator. And I can tell you, having worked around the world, some of the healthiest athletes I've seen, not always, but I've seen over the years are some of the very petite and small African runners.
(23:00)
And their body mass indexes are impressively low. mainly because part of it is just a mathematical phenomenon. If you have a small petite athlete, it overexpresses a low BMI because of the way the ratio works and you square the height and divide by the weight. So like I I I I've seen athletes in with BMIs and high sixteens and low seventeens who who need to go into an eating disorder clinic, and I've seen athletes in
(23:29)
High 16s and low 17s, BMI who never had a stress fracture, have had a 20-year running career and have won an Olympic medal. I've also seen athletes severely in the red and eating disorders with a BMI over 22 because they're world-class rugby players with a lot of muscle on them. So body compositions alone, like a really big change for you in a body composite, body weight or body composition.
(23:58)
along with, you know, fatigue or lack of a menstrual cycle or, you know, some of these other symptoms, absolutely, that's an important thing to look at, but body comp alone can't and won't necessarily predict your energetic state.
(24:15)
Mm. Yeah. No, that's great information. And one thing I wanted to ask or just make sure that we share too is when we have we kind of have two things going on here. We have low energy availability, which is not inherently bad. It's just a reality of less going in that's going out essentially. And that can ebb and flow over time.
(24:42)
But if you have low energy availability sustained for long periods of time, that's usually where you end up having it turn into something like a relative energy deficiency or reds.
(24:53)
Yeah, so one of the new aspects to the IOC twenty twenty-three consensus was an appreciation or a better appreciation that low energy availability could both be adaptable or problematic. And there's probably a continuum there. low energy availability on its own, and you gotta think of low energy availability, excuse me, as an exposure variable. So the longer you're exposed to it and the more severe it is.
(25:23)
the more likelihood and probability that you will develop reds. So, you know, the analogy to that is if you expose yourself to smoking or secondhand smoking, that's the exposure variable. You're more likely then to end up with lung cancer, but you won't necessarily always end up with lung cancer. And so adaptable LEAs, low energy availability is a really good treatment tool for obesity to improve health.
(25:53)
Adaptable LEA is, you know, all of us wake up after eight to nine or ten hours in bed or sleeping or resting and we haven't eaten. Well, we were acutely in a low energetic state, but that's as long as you have breakfast and carry on with your day, that's that's no problem. And so it is the problematic, which is prolonged and severe and sustained energy low energy availability that results in the deleterious
(26:19)
biomarkers and some of the markers that we use to assess reds. So again with the smoking analogy, which is an extreme analogy, but it makes sense. Like we don't, we don't diagnose lung cancer by adding up the number of cigarettes or exposure to the cigarettes. We we, you know, you you diagnose by looking at the the problematic and deleterious outcomes and markers of of cancer, usually through a biopsy, but
(26:47)
Obviously in this situation we have certain biomarkers that we look for to create a risk risk profile for reds.
(26:59)
I've been sharing for quite some time about how I use Delta G ketones for my longer, lower intensity training sessions after my harder, short interval sessions, and even during my ultra marathon races. I also like to let people know that most of the exogenous ketone research is done on ketone esters and that's exactly what Delta G will provide. Delta G likes to go the extra mile by helping you get it right the first time.
(27:26)
They invest in the education and research on exogenous ketones. So if you'd like to learn more, head over to DeltaGKetones.com forward slash Bitter20 or enter promo code BIDER2Zero at checkout for 20% off your next order. Details and links can also be found in the show notes.
(27:48)
Do you mind if we get into some of those biomarkers, what we're what you're looking for if you have an athlete that you suspect is maybe struggling with threads?
(27:56)
Yeah, you bet. So I was the lead author on the new CAT to clinical assessment tool, version tool, too. so you can look that up and it's open access. So you can download that and you can have it, and it's like a full explanation of every biomarker, which are different for men and women. and then there's even an online scoring tool because once you put those numbers in, it results in a traffic light of risk. Green means you have.
(28:24)
No or very low level or risk of reds, and then yellow, mild, mild risk or severity, orange is more moderate to to high, and then red is severe, probably removal from exercise training and sport required. and so I won't go through every single aspect of the clinical assessment tool. People could look that up and see it.
(28:49)
Instead, I'll highlight some of those biomarkers and some of the other symptoms that I think are more relevant for your listeners and for parents and for athletes themselves. So if you're a female and you're not on hormone contraceptive or birth control, a shift or change in your menstrual cycle status is a really big and important flag. So if you're amenorrheic, so you have less than nine menstrual cycles per 12-year period, that is a very severe risk factor and symptom.
(29:18)
Of low energy availability. It can be caused by other things, but it is one. Or if you have secondary or oligomenorrhea, so your menstrual cycle is on and off every month, or it's incredibly variable, or you have like spotting one month and then you know eight days off of heavy flow the next month. These things need to be brought up to your physician and looked at. And again, they're not.
(29:44)
Absolutely always exclusively due to low energy availability. So for women, that's a big one. Two or more career stress fractures is also a sign and symptom. Again, that's something every athlete can address on their own. A very low heart rate and blood pressure is another one. bordering on symptomatic orthostatic intolerance. So what that is is when you stand up real quick, you feel like you're gonna pass out, or you have episodes of passing out.
(30:14)
very inconsistent training up and down and just chronic levels of fatigue are another symptom. Especially in men, poor or decreasing sex drive or libido and/or number of morning erections, if that is going and changing, that that is a that is a there's lots of data to support that.
(30:36)
Other aspects parents and and you can look up for are major dietary changes or major body composition changes. I know before we said subtle changes don't always show, but so the more that you kind of add up there, the more likely reds would exist. Now, the blood work we also do is we look very carefully at thyroid hormones, cholesterol, and eating disorder assessment, either with a questionnaire or with a professional as well.
(31:05)
as well as a stress anxiety assessment and all of those go into a package that are then scored for the REDS clinical assessment tool. So there's a lot there. I really focused on the ones that your listeners can kind of look out for in terms of the symptoms.
(31:22)
Hm.
(31:22)
Yeah. It it I'm curious about if we have any information with respect to the likelihood of this being intentional versus unintentional with respect to like the athlete has an eating disorder and therefore their behavior is going to likely increase a bunch of risk factors that leads to it versus someone's training very aggressively for something and they're just maybe not paying very close attention to their nutrition and they find themselves kind of backed into a corner and then before they know it they're
(31:51)
I'm kind of struggling with this. Is that something we have any sort of data on or is it just pretty one of those things where it could be either one, but we don't really know very much about that.
(32:00)
Yeah, so there's a few things there that I'll comment on. So first of all, not all diagnoses of REDS automatically means an eating disorder diagnosis, or vice versa. For example, within the eating disorder field, it is a DSM five psychologically based disorder. in most instances with REDS, once there's an education piece, most athletes are cognitively
(32:29)
engage with you to make changes. If they're cog cognitively restrained and they're really disciplined and constrained on body dysmorphia and energy intake and eating, it's probably landing more in the eating disorder realm of things. And just telling someone to eat more is just not going to work. They they they need some some major and hard working psychological and emotional
(32:58)
therapy and support there. So that's one point that I'll make. For sure, there's both conscious and unconscious examples of low energy availability leading to reds. Some of the more conscious examples can include aspects of exercise addiction, because again, energy availability is energy intake minus exercise energy expenditure.
(33:25)
Conscious decisions about underfueling, purposely trying to lose weight at certain times of the year. Of course, eating disorders. There's awareness there. There's a conscious awareness. Unconscious, this can also occur unconsciously. And many times you see that with developing athletes who, you know, from 11th to 12th grade or from 10th to 12th grade have doubled their training load, and their parents and themselves don't realize, gee, I need to double what's
(33:55)
on my plate, like to keep up with his training. And it's just that they're just unaware. So they may slip into an early phase. Hopefully it's caught early of low energy availability in reds and you can reverse track quite quickly. Other aspects of being unconscious can just be about food availability. So planning throughout the day, you know, you've gone off to university for the first time and man, I forgot lunch. I had class. I didn't bring a snack and
(34:22)
You know, I and it's just you, you're not on top of things. Food security at times, like just having being able to pay for enough food, can both be conscious and unconscious. So I think we need to appreciate that. There's not enough research on this. There are some papers and literature on the causes of LEA from a kind of a psych social, emotional cognitive perspective of why people choose to eat or not eat or fuel or not fuel.
(34:52)
But that's kind of the working model that a lot of us work under in thinking about both conscious and unconscious factors of LEA.
(35:01)
Interesting. So if it's on the side where it's either unconscious or it's conscious, but the person is in a place where they're going to switch directions as soon as they know it's impacting their health and performance. Is there a timeline that you usually look at with respect to all right, once we kind of get things heading in the right direction here, you should start to see the symptoms result resolve?
(35:27)
Yes. So if you can catch people early and they're, you know, inadvertent or/or unconscious, you can usually get people back on track within a couple of months. It's just literally like, hey, you have these few early biomarkers, you have one stress fracture, your fatigue's up and down, you know, maybe your thyroid was a little T three was a little bit low. And and usually in those instances when you catch someone early and you provide education.
(35:55)
the light bulb goes off and they're able to course correct really quickly. The more severe cases and when you get into severe cases that also have an eating disorder diagnosis involved with it.
(36:09)
That can take years, if not individuals battling aspects of that in and out, dipping in and out of problems for the rest of their life. Not always, but it is a much longer and further workup to to correct things. So again, there's not a lot of research on the timelines of recovery. There's only a handful of papers that have looked at this. And I think a lot of experts might say something like,
(36:39)
You know, for the amount of time that you were in the red, that may be the amount of time it takes to get out of it. So, you know, if you've dipped into it for three or four months, you can work your way out of it in three or four months. But if you've been in it for a long, long time, it's gonna it it's it's gonna be a longer runway out. Another point that I'll make is that we also published. I think it was nearly 200, 220 or 230 athletes that went through this.
(37:07)
New clinical assessment tool here in Canada across all the Olympic training centers. So we have some athletes that are green, yellow, orange, or red. And we also did a REDS education screen as part of the questionnaire. The athletes with the least RES knowledge with the least REDS knowledge were the ones in green. The athletes with the most REDs knowledge were the highest risk athletes in red, statistically significant. And so
(37:37)
So they're the ones with the most severe REDs diagnosis, and have the most knowledge about what REDS is. And so I and I think many professionals would look at education really helps with aware awareness and upfront prevalence. So decreasing the prevalence of Reds or people getting REDs in the first place. But increasing knowledge isn't necessarily always and rarely a good treatment intervention. You you need knowledge with
(38:06)
behavior change. And there's so many examples in the literature of people who are very knowledgeable but just won't do the behavior changes. And yeah, when you have someone that's an orange or red traffic light, a more severe case of reds or eating disorder, knowledge is usually not the problem. They have tons of knowledge. They know the disease inside out, upside down and backwards. It's really working on some of the behavior c change constructs and slowly working on on on changing those behaviors to to
(38:36)
To refuel themselves and to get into a better place of health.
(38:40)
At that point is it almost always an eating disorder if they have that much knowledge about it and they're actively sort of working against their own progress?
(38:50)
Yes, probably.
(38:52)
It's just hard to have a case where it wouldn't be at that point. You'd have to have a very unique set of situations probably lining up.
(39:00)
But not all athletes will want to go there and be open and admit to that. And that's okay. If we can, we can call this thing anything if you're willing to journey into recovery. If you want to call it reds, fine. Let's work on those behavior changes to improve your red traffic light score then. It's also important to note like within the eating disorder diagnoses framework, you know,
(39:29)
Anorexia will flag a lot of the similar low energy availability biomarkers I've just said. And and and most anorexic athletes will end up with an orange or red traffic light assessment, but not necessarily bulimic athletes, which is also a very serious medical condition. They they won't always flag up those same biomarkers, because there's not a
(39:56)
always a sustained low energy availability state with bulimia and it's just very quick ups and downs. So yeah, they're separate but interrelated syndromes and diseases. Yeah.
(40:11)
Has there been anything that has stood out with respect to incentives that typically or more frequently pull people out of this? I mean I am the one that stands out in my mind just intuitively like performance. If you're working with athletes and you're able to convince them that they're actively deterring their ability to perform, I think that would draw at least some of them towards okay, I need to make some changes because that's my actual goal here. but I'm sure obviously that's not always gonna work. But does anything stand out like that?
(40:40)
This is, you know, what you're getting at here is really the art and science or or more the art of really good practitioners and getting to know the patient or athlete in front of them and what motivates and makes them tick. And so the answer is absolutely yes. The way that you present information, but I would say that this is yes for any intervention you want to do in sport.
(41:09)
Some people love to be driven by data and they want to see the science and the research and they want to see their own data. Other people are driven by success stories of other athletes that you're able to share that maybe they've shared their journey online because you gotta be confident about those things. Other people are more driven by trust with the practitioner. Hey, I've worked with you for two years. I know you got my back. I believe what you say. Other people are driven by
(41:37)
a more combative relationship and fear mongering. Like like getting you know, being a little more aggressive and
(41:45)
Yeah.
(41:45)
That style will backfire for someone else. And they, you know, you maybe you know, it's the whip and the carrot kind of approach in terms of incentivization versus consequence, right? Like so there's no one size fits all. And that really is where
(42:06)
Really good practitioners know how to turn the dials in a way that's going to optimize health and performance for their client and their athlete in front of them. I would say generally, as a gross generalization for most really elite performance-minded athletes, when you bring the conversation back to performance and training, you get more buy-in. And so I tend to go there and say, and I like evidence, I'll just say, hey.
(42:33)
Look at Ray Smith et al. this paper from 10 years ago that tracked track and field athletes in Australia for a 10-year period. And they wanted to look at the impact of injuries and their performance goals. And look at this. Those athletes that did that couldn't do more than 80% of their planned training. So they had 20% more injury rate, their performance goals decreased eight times. They were eight times lower.
(42:59)
So athlete availability of at least 80% is a really important benchmark. You had three stress fractures the last four years. You know, which bucket are you in here? Like I, you know, I try to make these relationships and really talk about the performance impact of some of these things. there's a great swimming paper, Van Heast et al. where they had 12 weeks of swimmers and athletes and
(43:25)
Negative energy balance versus energy balance and like every single female swimmer in negative energy balance didn't have a menstrual cycle and all of them got slower. As teenagers, over twelve weeks of training. Teenagers, like man, that's usually like when tr you perform
(43:43)
Skyrockets, yeah.
(43:44)
Yeah. Just keep your kids half ha happy and healthy and you're gonna get most of your kids will get better because it's puberty. You know, you're putting muscle mass on and to have twelve weeks of hard training to have all your athletes go slower. Like I just show them that they're just not recovering. They're just not absorbing the training to be able to then express it in performance. So yeah, even till I get passionate about that and f figuring out that secret sauce and how to talk to the athletes, is something that
(44:14)
I think all really good practitioners take a lot of pride and joy in but also work really hard on that part of their skill set.
(44:23)
Yeah, it sounds like maybe the hard part about it is there it doesn't really matter if something stands out as more likely to draw someone out of it because at you're gonna always have to start with the individual and what makes them tick and what they're what what kind of got them there in the first place and that's what's gonna give you the tools and the information to help them out versus leaning on something maybe working more often than the other at a population level.
(44:45)
You nailed it. And that that is really the art of working in this space. And I think the art of working with all athletes in terms of like even how you design an a taper and talk to the athlete during the taper or altitude or no altitude, you know, all of these things, really coming to the individual level and creating that really strong trusting relationship is where to me that's where all the secret sauce happens.
(45:14)
Sweat loss rates in electrolytes can be challenging, especially when the miles pile up and the temps climb. To help solve this problem, I got a sweat test done that suggested that I lose approximately 614 milligrams per liter of sweat when I'm out there working out. To keep up with this, I turn to Element Electrolytes, convenient single surf packs, and Element Sparkle, which is their latest offering that combines carbonated water and their top-notch electrolyte flavors. Check out their variety of flavors at
(45:43)
drinklmnt.com forward slash hpo. If you use that URL, you can get a free sample pack with your first purchase. If it turns out they don't meet your needs, rest assured they have a 30-day money-back risk-free guarantee. Details and links can be found in the show notes. Yeah, one thing you've mentioned a couple times with respect to just the things that show up when this is present is like stress fractures and bone injuries and things like that.
(46:12)
Which is an interesting one to me because bone injuries and stress fractures tend to be things that need some time to get to that point. So you won't know it's there until it's there. And once it's there, it's like boom. So with that one, is that something where you almost have to look at other symptoms that could maybe predict that's the next step because that one isn't necessarily gonna be usable in the short term the way other things would be?
(46:43)
Yeah, so there was a subsection of the twenty twenty three IOC consensus on on the on the master paper by our fearless leader, like Marvo Mountjoy, was the physician that helped drive this all, where we had Red's time course and we had short, medium, and long term biomarkers kind of listed out. We decided to pull that out because it
(47:11)
Strictly speaking, from an academic evidence base, some of them are still emerging. But there are, as you've noted, some of the outcomes and biomarkers are much quicker to appear. Some take longer to transpire or or to output. So yeah, you don't know you're gonna miss your menstrual cycle until at least one, you know, regularly one one approximately once a month. So that you know, that's a medium time marker.
(47:39)
A bone stress injury might take months to present. So that's a long term. And then some of the short-term stuff, it tends to come more down to the symptoms that the athlete and coach are seeing. irregular training, not recovering from training, lots of bouts of illnesses. Yes, acutely, if you were to measure it, perhaps there's some drop in sex hormones, but not everyone can measure those. Like me, no one in the real world measures those all the time. So you don't, you don't see that.
(48:07)
that drop off of testosterone, estrogen, and progesterone. But that does happen acutely. And there's studies out there on boxers and MMA fighters making weight. And you can see thyroid and testosterone just drop right off a cliff quite quickly. Once they refeed it it bounces back about a week later as well. Like it usually they bounce back. So some of those biomarkers can adapt quick, but you
(48:35)
You can't measure them. So you're looking at more of these fatigue markers that you see in training that maybe weren't there before. You're blowing up more often, you're not handling the training, you're sore more often. So those are some of the earlier markers. You're grumpy more often, your sleep's disrupted. And so though those are markers that you gotta look at and think about and and think about, has my training increased, have I, you know, do I need to eat more carbohydrates?
(49:03)
And usually as a macronutrient, if there's anything as a take-home here, the macronutrient carbohydrate is absolutely the key macronutrient in addressing reds. There's more and more data to show that carbohydrates are really key for bone and bone turnover. Obviously it results in glucose, which is one of the only fuels your brain uses. and carbohydrate availability is your acute glycogen.
(49:30)
storage fuel for recovery day in and day out. So if you're if you're gonna increase calories or you've s you you're listening to this and you're like, hey, some of those signs and symptoms resonate with me, focus on increasing carbohydrate first and foremost.
(49:46)
This maybe gets a little bit back to what we were talking about before with respect to the symptoms showing up in different contexts, one being weight stability yet still getting symptoms. Is that the reintroduction of more carbohydrates? Is there a protocol that is advised with that? Is it something where the starting point is putting them as close to the activity levels as you can to try to make sure that you're really leveraging the point at which they'd be utilized the most effective or the most
(50:15)
Directly.
(50:17)
Yeah, I agree with you, Zach. So first and foremost, look at optimizing carbohydrate around your training boats before, during, and after. That's a really good spot to look at. And sometimes what's tricky with Reds is if you're out or in a decrement of just three or four hundred calories a day for a year, that's a hundred thousand calories that you're missing.
(50:45)
It's like taking a month off of eating. And I said this on other podcasts. But you can never measure 300 calories a day. It's too hard to measure energy intake. That's it. and so many times I'm like, hey, let's just try increasing three or four hundred calories of carbohydrate. Let's focus on it around your training, a bit before. Let's feel better during the training and immediately after, and it's quite quick to get to three three or four hundred calories.
(51:13)
And let's try that for two or three weeks and then report back on your major sessions and how you're doing. And in many instances early on, that might be that's all that's required. Or hey, let's let's move, you know, you're in an Ironman triathlon. So three or four hundred calories is enough. You know, let's try to get six or eight hundred or maybe a thousand calories extra around your major you know, long session break days where you're gonna
(51:39)
a four hour ride and a ninety minute run off the bike. Like, all right, let's put a lot of fueling around that. In many instances early on, that can be it. And it just really helps get an athlete back on track. The next place that I would look to as well as a major intervention is just asking the athlete to take and appreciate what their plates look like.
(52:04)
on hard training days versus easy training days versus moderate days, because the plates should look different. You know, the amount of carbohydrate on your plate is the major thing that's gonna move across those training days. And if again, if you have a monster day, that night and the next day should feature at least half your plate being carbohydrate. so it's it's just appreciating the differences that need to occur with harder training days and lighter days and
(52:33)
And in many instances, those two interventions, eighty or ninety percent of the time get someone where they need to be. It's just being consistent with that. Mm-hmm.
(52:47)
One more question with Reds that I'm just curious what your thoughts are since you've been so involved with this. Is there any question at the moment that you're thinking like, man, if we could just get the answer to that or some clarity there that would really help out that we just haven't gotten to yet?
(53:05)
Yeah, great, great question. I will say so we talked about body composition and we did talk about how in many instances body weight may not always change. Sometimes it goes down for sure, but in other instances it doesn't always change. I'm really interested in the ebbs and flows of fat-free mass or fat mass throughout.
(53:33)
And most specifically as a confounder or moderating factor for protection against reds. If you talk to evolutionary biologists, they absolutely show changes in fat mass and pregnancy and fertility rates in Africa in feasts and famines. We just have not done enough in really accurately measuring the shifts and changes in fat mass.
(54:00)
in athletes and because it is an energetic reservoir. And I think I don't care less, way less at all, about body weight, but I am interested in that component of fat as an energetic reservoir. And fat as well as an endocrine organ. it it impacts leptin signaling, which we know impacts energy availability and some of the other downstream outcomes of
(54:25)
of fat. So that is one area in combination with reds and energy availability and energy balance that I think will be interesting in the future and more interesting coming out. And there are definitely a bunch of us thinking and talking and working on that.
(54:46)
Yeah. That is really interesting. And it it almost kinda leads me into the the next topic I wanted to ask you about, which is like if we remove ourselves from individuals who are having these symptoms or at risk of these symptoms and move to a a population of healthy athletes training for their events and they are in a position where maybe they're coming off off season or something like that, or they are able to lose weight healthfully to improve their performance.
(55:13)
We want to see them do it the right way because otherwise they eventually may end up in this world. I was just curious with respect to what you see with professional athletes. They're generally not well, they're never perfectly fit all year long because it's unsustainable. So they're going through these cycles of peaking and then off season and then building back up. And then ideally you have a long career where you sort of have a higher floor from one year to the next and then therefore a little bit of a higher peak.
(55:43)
I'm just curious about just like the value of say you get done with a training cycle, your goal race, taking an off season and intentionally gaining weight in order to sort of reset the system to some degree so that you're creating a bit of a buffer as you kind of get back into those early stages and fire things back up. Is there any value in those body composition shifts through the seasons as you're kind of going through the different phases of training?
(56:13)
I am an absolute massive fan of doing that and working with athletes to believe in doing that year in and year out. I think it is one of the largest contributors to a long and healthy career in endurance sport that is not as appreciated and valued as it should be. And when you sit down and you ask an athlete, Hey, is your hero in peak personal best shape year round? They're like, No.
(56:43)
W why do you think their body comp is then as well as well? Like it's just not sustainable. and so the concept of body composition periodization is something that has certainly gained a lot of momentum and a lot of focus and a lot of more awareness. It is a sensitive topic for some individuals, as it should be. It really depends.
(57:10)
where the athlete is in their career and their support level. Like would I sit down and talk about body composition optimization and periodization with, you know, an up-and-coming adolescent athlete? Absolutely not. Would I talk to a 25-year-old professor with a history of an eating disorder? Probably not either, right? do some athletes naturally without much effort, body comp periodiz up periodized without worrying about it? They actually do. And so sometimes it's just
(57:39)
Maybe we take a few measurements and their health checks and their training's great. Well, sometimes having the confidence as a sports scientist to not do something or to intervene is also really important. So a bunch of years ago, I did, I think it was 2018, I did publish obviously granted approval for that body comp and performance periodization of my wife's 14-year career and showing how her body composition.
(58:08)
very purposely bad and flowed every single year and and those correlates then to her 1500 meter race performance. And that paper got a lot of attention. Most of it was supportive and positive. I had some people online saying you know that this would cause eating disorders. I don't think they read the full paper and the disclaimers and the caution that was written into that paper. Most athletes that I work with
(58:39)
believe in interventions like that because of that paper and they see it as a really positive thing. Okay, yes, I'm not gonna be so scared to gain some four, five, six percent body fat in the off season because I successfully transcended over 14 years with someone else. He, you know, we can do this. I I'm gonna I'm gonna trust in this journey and and do and and try it out and and and you know a lot of times in an athlete's career when
(59:10)
They do acutely lose weight. There is a performance boost from that. But if you're chronically at that weight and there's no reset button, you can't use that trick or that tool again. It's done. You're pinned there. Or you lose more weight and then you're pinned there and then you're l less and less healthy. And I'm like, how about we just do that every single year for your career? Cause we reset it every time. So you
(59:37)
Eight, nine, ten months a year, you're training your body to carry extra muscle or extra weight, extra muscle mass. You're creating a stimulus and training that's really healthy. You're recovering more, you're gonna be sick less, you're gonna have less risk for stress fractures. And then there's a time of the year and and and again, in many instances, the intensity of training and peaking and stress around peak championship season, a lot of athletes do their body composition period on its own. And
(01:00:06)
They're in their body comp envelope and they have outstanding performances. So everything I just said is for the elite well-supported athlete at that, you know, at the the peak of the pyramid, where they also have the cooking skills and the emotional skills to to hand handle these conversations. And again, we're lucky that we have support staff around them like an Olympic training center to do it really, really well. It's not sending an athlete out on their own to try and
(01:00:34)
Nilly will do it themselves.
(01:00:38)
Yeah, it is interesting. You hit on a good point too. It's like these are interventions that are gonna always get better when you have a support team with you that are helping you go through the amount of variables included there and just making sure that things are caught before they become problems. And it was an interesting I think I think one of the reasons this topic maybe burst up a little bit recently was with j the Josh Kerr Mileworld record because people who followed his career noticed pretty pretty easily that he had gotten leaner over
(01:01:08)
stages of that. And he was also very open about everything he was doing. And there was no confusion around the amount of support that he had put in place for that effort. So at first I saw that and I was just like, I could see this going really badly with respect to just people misusing that information, that visible information. But then I thought about it too, I was like, well, I mean, what is he going to do differently in that scenario? And I'm really like sharing that he had that
(01:01:37)
enormous support crew in place and that enable them to be able to do that, you would hope is enough to showcase to people that hey, if you if you're gonna try to do the Josh Kerr thing, be prepared to be armed with a team of people to help you with it or at least very much do your homework ahead of time and don't assume it's just as simple as I'm gonna eat less and train really hard for an extended period of time.
(01:01:58)
Yeah, I and I agree. And I think having those and again in that case study that I wrote up on my wife Hillary, there's a whole section on some of the markers and biomarkers we used to to know that she was on the right, the correct side of the cliff. We weren't dipping too far into things and and one of them for her was menstrual cycle status, and making sure that if if she did lose her menstrual cycle, it was only
(01:02:27)
a couple of times in the summer and then it came back in the fall and it did every single year, you know, so I knew we were on a good track there. Obviously the Josh curl current mile, it's right right down the street here in Seattle. I'm in Victoria. We see that when my wife is coaching, we're down in Seattle. Like yeah, Brooks put a big team around him, a really big team.
(01:02:54)
And I know Danny , his coach and him looked at every single facet that they could look at in terms of doing this. And I don't know, Josh, but kudos to him for calling the shot and saying this is the year and I'm gonna go for it and this is how I'm gonna do it and he's always seemed to be a guy that was really transparent. I like that. Maybe it rubs some people the wrong way, but I like it that he's he's he's just put it out there and then he went and did it. Like
(01:03:25)
Like pretty awesome. So I'm sure aspects of body composition were absolutely addressed in what he was doing. Yeah.
(01:03:36)
Yeah. Like one other topic that I think is maybe worth hitting on too is like sometimes when I see people get interested in it, their mind goes to, well, deficit is necessary to do this. And to some degree it is, but there's a hundred different ways to get there, right? And you could do that by just always having a deficit in place, or you could do that in a way where
(01:04:00)
you're picking and choosing your battles. And this is maybe moving a little bit more into the acute versus the macro of like off season, on season, peaking and all that stuff, to like a week where you're probably going to have two or three quality sessions. And then if you're an endurance athlete, that's going to be padded with a lot of low intensity work, recovery and things like that. So my thought is like if you're going to do something like that, there's probably a better way. And my my guess would be the better way would be not having deficits around those
(01:04:29)
quality workout days and maybe have those deficits be in days where you're doing a lot less up on the aerobic intensity spectrum and you can maybe tolerate a little bit less on those and find that picking and choosing your battles wisely within that small time window as well.
(01:04:47)
Yeah, so this speaks exactly to the disclaimer I had up front about how it's going to be really difficult to answer every question because the context matters. So how you would deliver a low energy availability intervention, like I can think about 15 different things you would need to think through in terms of risk and reward and
(01:05:13)
or and how and where you might do it. I also highlight that we have very little published data in the literature on how to best safely do this. You know, is three months out of a 300 calorie deficit better than doing something like two days out of a 1200 calorie deficit? Like a shock and awe short term it fueled and shock and awe and short I I we don't know. We don't know.
(01:05:42)
I'm a really big fan of fueling for workouts and for performance. And so I agree with you on face value generally for the high quality intensity workouts. If you want to feel those. Yeah. both physiological adaptation but also psychological and you're just not hitting splits and you feel miserable. It's just never a good spot to be in.
(01:06:10)
But yeah, like the best way to deliver that is more art than science right now. And I think it depends on a whole bunch of contextual and moderating factors and and yeah, and and and also where you are in the risk and reward continuum of your career, your entry history and you know, and and and everything else. It's not simple and straightforward for sure.
(01:06:36)
Yeah, and then definitely start with those resources that you all put together on the IOC website so that you don't start out in a risk category and then progress it further.
(01:06:46)
And also start with and I think Josh has said something to this is the number one predictor of long term performance is training availability and consistency. One of the number one predictors of poor training availability and consistency are stress fractures. So depending where you are in your career and how much you're gonna dip in and out of energy availability and and whether you're gonna use that as a tool or not, like
(01:07:16)
Ninety nine times out of a hundred, you're always going to choose something that's probably increases the probability of better training consistency and athlete availability day in and day out. absolutely for sure.
(01:07:32)
Yeah, just another example amongst many is why like younger athletes should definitely not be thinking about a protocol like that when they're in their high school, collegiate, maybe even early professional years, because they've just so much potential to grab at before they even need to be really trying to look for the fruit on the very top of the tree, perhaps.
(01:07:51)
Actually, yes. And so I'd encourage young listeners or parents or anyone interested in this. I've written a piece, it might be through the Stanford website, a faster website called Patience Through Puberty. If you just put my name and that in, and you'll and it is a running lens, but it just highlights how fundamentally important that puberty phase is. It's a critical life phase. 40 to 60 percent of your bone mineral density is laid down in that phase.
(01:08:21)
If you mess up that phase, you know, you're going to be predisposed to stress fractures for the rest of your career. And it's like the kiss of death. Like our best juniors around the world are never our best seniors. And like that the stats bear it just bears out. Like, yes, there's outliers to that, but there is not a single world junior track and field record that has the same person as a senior, not even your same bowl.
(01:08:51)
And yeah, like it it it can be the kiss of death to to to to be really fast young, especially when it's coming at the cost of some of these health markers like amenorrhea or low testosterone or psychological burnout, or you're already training like you know, a high school kid at eighty miles a week, like where where are you gonna go from that? Like hey Yeah, hey Yeah, like where are you gonna build from there? So
(01:09:18)
So yeah, patience through puberty and there's an article out there, I think it's four or five pages long, but it's written for the general public and mainly aimed at parents and coaches of adolescents.
(01:09:30)
Awesome. Well, thanks a bunch, Trent. This has been great. Did we miss anything that you think we should probably touch on?
(01:09:37)
No, I think thanks Zach for doing your homework. You were well prepared and it always makes a podcast much better when the host has done their homework and is prepared. And I think we covered hopefully all the aspects that your listeners will be interested in.
(01:09:55)
Awesome. Well I really appreciate it. Before I let you go, is there any spot you want me to let the listeners know where they can find you, like websites or resources that I can link to the show notes?
(01:10:06)
Yeah, so I have a split role now. So I'm the research and development director at the Women's Health and Sport Performance Institute, WISP, in Boston, Massachusetts. And so if you look up WISP Institute, there you'll see all sorts of resources, especially for female athletes on things like iron, reds, injuries, ACL. and so yeah, about three quarters of my job is there at WISP.
(01:10:34)
The other 25% I'm still here at our Olympic Training Center, Canadian Sport Institute Pacific. I'm not that prolific on social media. I was before kids, and then when kids and writing papers came along, it fell off. I was decently prolific on Twitter and I do have an Instagram account, although I don't follow very many people. So yeah, you can sometimes look for com content on X.
(01:11:04)
but otherwise, yeah, publications or speaking or podcasts are where you can hear me.
(01:11:12)
Very cool. Well I really appreciate it, Trent.
(01:11:15)
Thanks for having me on, Zach.
(01:11:18)
Delta G ketones and Element Electrolytes have been longtime supporters of this podcast. I use Delta G ketones in an evidence-based way during my longer, low-intensity training sessions like long runs and during my 100 mile ultra marathon races. I'll also use them after some harder training sessions like interval work. Element electrolytes is how I meet my additional electrolyte needs in and around training. I'll use their individual packs during, before,
(01:11:46)
longer training sessions out in the hot summer weather and then oftentimes when the temps are high like they are now in between sessions then I'll usually turn to their Element Sparkle which is their carbonated version of their product. So I've got some options for listeners to get some discounts if you want them. First of all, don't let the promo code fool you with my Delta G ketones options. It is bitter to zero. That will actually get you twenty five percent off and if you subscribe
(01:12:16)
Additional 10% So that'd be a total 35% off their normal prices if you use promo code BITTERT20. And you can do that by heading to DeltaGKetones.com forward slash bitter to zero. Also, Elements gives you a free sample pack with purchase if you go to drinklmnt.com forward slash hpo.
(01:12:42)
Thanks for tuning in to this episode of the Human Performance Outliers Podcast with Zach Bitter.