Episode 434: Fit But Unhealthy?

For this episode, I share some thoughts on the topic of "fit but unhealthy." Recently, pro triathlete Lionel Sanders shared some details about his health concerns. This came as a surprise to some as he is visually very healthy and performed at a very high level. Some have hypothesized it is due to his hyper carb fueling strategy. Others have suggested endurance training to the degree taken by professional athletes is unhealthy.

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Timestamps/Topics:

00:00:00 Welcome to the Human Performance Outliers Podcast

00:01:52 Hyper Carbohydrate Fueling in Endurance Sports

00:03:41 Pre-Diabetic Concerns in Athletes: A Case Study

00:05:26 Importance of Nutrition in High-Performance Training

00:07:38 The Importance of Nutrition in Training Performance

00:08:48 Balancing Nutrition for Peak Performance

00:10:23 Balancing Endurance Training with Health and Longevity

00:12:06 Balancing Risk and Passion in Life Choices

00:13:52 Achieving Top Performance in Elite Sports

00:15:47 Optimizing Training Programs for Cross-Country Teams

00:17:39 Enhancing Athletic Performance: Training and Age Considerations

00:19:13 Optimizing Diet for Training Performance

00:20:45 Optimizing Carbohydrate Intake for Training Sessions

00:22:20 Optimizing Carbohydrate Intake for Training

00:22:20 Show Sponsor Details

Episode Transcript:

Alright folks, for this episode, I have a topic for you and the topic today is going to be fit but unhealthy. So I wanted to cover this one because it's been around for a long time. This isn't anything new, but recently a story popped up on the internet that looked at a highly competitive, popular triathlete, Lionel Sanders, who dropped a YouTube video and basically said, hey, you know, I've been following this hyper carbohydrate fueling strategy that we've gotten that's gotten more popular over the last few years where we're seeing some of these professional endurance athletes sort of challenge the evidence in terms of how much carbohydrate can yield better performance. And now we're seeing targets of 150, sometimes even 180g per hour, both in training and racing efforts. And when you see that sort of stuff, there's always often. All right, everyone, welcome back to another episode today. I've got a topic based one for you, and this one is going to be on a topic that has sort of been back in the news. It's not something that's necessarily new to performance, health and nutrition. But a recent story kind of popped it back up, which is this idea of fit but unhealthy. So, you know, we've got like these pro athletes out there who on the surface look great, they look healthy, they look like there's nothing they could do differently that would improve their health and longevity. But when we go on the inside and test, we find out, okay, maybe there's some problems here that, if not corrected, are going to result in some downstream issues for them later on in life. So I sort of just wanted to unpack that idea and share with you my thoughts on just like where the risks and where the decision making within that actually are worth exploring versus doing what oftentimes happens online, which is taking an anecdote and projecting it on an entire group of people, because we've got this new flashy story to kind of base it off of. So for a little bit of background, the Lionel Sanders story was he's a very competitive, popular triathlete, and he's been doing this hyper carbohydrate strategy for his training and competitions. And he went in to check some health markers. I think he got a blood draw on your continuous glucose monitor and found out that his markers were decent or good. But his blood, his fasting blood glucose was not. So I think both his CGM and the fasting blood glucose suggested that he is in the pre-diabetic range of blood glucose levels, and for him that was concerning. He saw that and said, hey. I don't like where this is heading. If this continues, it's possible that I would develop type two diabetes and then give myself a whole lot of complications later in life that I don't want to deal with and I don't want my family to have to deal with. And he made some nutritional adjustments that I believe have helped kind of correct that scenario for him. And with that came all the expected sort of online rhetoric around. All right. Is this a dangerous application that we should be discouraging against for professional athletes like Lionel Sanders? And, you know, certainly your average endurance athlete out there who's sort of blending that lifestyle in with whatever else they have going on between careers and family and things like that, and then also people who are more optimistic, maybe about this type of a fueling strategy, saying, hey, but look at this. Like he was doing this wrong. This is an application issue, not a feature of this input. And, you know, you just get a lot of back and forth with that sort of stuff. So I wanted to sort of cover the fit but unhealthy topic and maybe use that as a little bit of an example of how to kind of go around with this stuff, sort of stuff. So for the first thing with, fit but unhealthy that I like to think about is. When we look at athletes like Lionel Sanders or even myself to a degree where, you know, we're training 20, sometimes 30 hours per week preparing for these events that we're trying to optimize for performance and the demands of a lifestyle like that. Personally, I think you need to pay closer attention to your nutrition, not less attention. So by less attention, I mean sometimes the assumption is, oh, well, when I'm training 20-30 hours per week or Lionel Sanders is out there, you know, taking in 1000 g of carbohydrate per day, it's really a non-issue as to what it is. It's just to get the fuel in, make sure you're not under-eating so you can support training, more training and faster recovery and things like that. And to some degree, that's true. You do want to make sure you're getting enough energy in to support training and allow yourself to recover and get more of it in and over time, stack more bricks and be ready for race day and perform at the highest level. But to think of it as it, oh, it's as simple as just eat a bunch and you can get away with more because you've got this huge metabolic demand is missing the point, because I think when we're asking our body to perform at that level, and we're asking ourselves to put in that work and recover from a quicker, we almost have to pay closer attention to nutrition because. If you don't. The margin of performance dip is just going to be a little more noticeable. So like if I was just sedentary and I wasn't paying closely close attention to my nutrition or making a bunch of mistakes in nutrition, I mean, I'd probably pay a price for that, but it wouldn't necessarily be something that would limit my performance to any large degree to be able to get through a sedentary lifestyle, at least in the short term. Whereas with something like performance at a professional level, it could. So like you could go out and say, I'm going to do this with this workout and you doing it 98% as well as you could versus 100% could be something that's just maybe a little more obvious. And you start seeing those things pop up. And I think paying attention to nutrition is a big component of making sure you're closer to 100% more often than not. So that's the way that I like to look at it. I think it's something where when you start adding more training to your lifestyle, more exercise to your lifestyle, you should pay even closer attention versus less attention, because you can, quote unquote, get away with more, more input in that scenario. I also think it's worth mentioning that it's probably going to be more difficult the further you get to the extremes. So if we take Lionel Sanders as an example, an extreme on the high carbohydrate side, or if we wanted to use the exact opposite of that of a very low kind of ketogenic diet, I think when you start getting to those far ends of the extreme, you're also adding a layer of complexity in terms of how close you have to pay attention, because you could potentially be crowding out things that would be coming from the part that you're lowering to make room for the thing you're raising. So on the hyper high carb side of things, what are you missing out on by adding that much carbohydrate from both a micronutrient and a metabolic standpoint, by the reduction of fat that's required to kind of fit and make room for that much carbohydrate. Same thing on the low carb ketogenic side of things. Like what micronutrients are metabolic things are you missing out on with a complete or nearly complete removal of carbohydrate to make room for that level of fat intake and things like that? So generally speaking, the further you get to the extremes, I think the even more. Close, close. You need to pay attention to these things. So whether that's relevant to you or not, it's worth noting that I think that's just my general thought of the matter. I think when you increase training, when you put a higher premium on performance, you need to pay closer attention to nutrition. And then when you get further to the extremes of what you're doing for nutrition, you have to add a whole nother layer of thought and consideration with that sort of thing. And the risk and the potential error by not going up when you're kind of doing those sorts of things. So the next part of this that I want to kind of talk about is like we look at someone like Sanders or any professional athlete you can find that kind of had a rough end to their life because presumably, their lifestyle to chase peak performance when they were younger had a cost at the back end of it. And it can be easy to sort of demonize professionalism, in this case professional endurance athletes and say, hey, by being a professional endurance athlete or living a lifestyle that's similar to that, you are setting yourself up for problems down the road. I like to say, okay, let's forget about that anecdote and actually just look at what the evidence suggests and really unpack what are the risks for that strategy and what are the benefits. So if we actually just take a look at the research that looks at professional endurance athletes, Olympic professional athletes, we can start to kind of tease this out to some degree. And what we find when we look at that is if we compare those individuals to just the average person, they actually have quite a bit better life outcomes. So that could lead someone to think, okay, well, you know, training like a professional endurance athlete is going to be a much better long term outcome for me than doing whatever the average person is doing. And they would likely be right. But I think that's almost maybe a little too much surface level exam examination, because the counter to that is always going to be, well, the average person isn't all that healthy. So that's a pretty low bar if a professional endurance athlete's lifestyle can clear that. So then we look at maybe what are the middle grounds here. So let's say we took a person who's not focusing on peak performance, at least not exclusively. And they're willing to make some trade-offs that aren't going to get them potentially as good at a very specific discipline in order to have a more well-rounded lifestyle and potentially focus a little bit more primarily on health and longevity. In which case, I think you probably can make an argument that if you took a professional endurance athlete and compared them to someone who took the components of endurance training that have good evidence to longevity and health long term, and applied those, but removed a lot of the risks, like peaking for a race, maybe pushing through an injury to get to a start line and really kind of working everything around, trying to perform at the highest level on a very specific day. Yeah, that person likely could have a better long term outlook or potential for that anyway. Then say that. So it really just depends on who we're going to compare these groups to. And I like to look at these things through like, well, what level of risk is involved in this versus that. And what are your goals and objectives like? At the end of the day, I tend to look at life as something where I want to enjoy it along the way and I want to chase my passions. So there's a certain amount of risk I'm willing to take to be able to put myself in a position to feel like I can run my fastest hundred miles, even if that means that by doing something different, I could potentially be serving myself better down the road from just an overall health and longevity standpoint. Because otherwise you can you can quickly find yourself arguing your way into just living, living a life where you're avoiding every potential like fun, exciting thing in this effort to just live a couple of years longer, which, you know, for some people that might be exciting and motivating, in which case, cool, go for it. But you know, for me and a lot of other people, I think it's more about, all right, what activities are going to bring more value and more excitement to the time we are here. And then at the end of the day, try to minimize long term issues that could come up from that by paying attention. And like I was saying earlier, just like looking at these demanding lifestyles as something that actually probably means you have to pay closer attention versus less attention. So the other thing to think about here when we get into this topic, is when we look at things like the hyper high carb fueling side of things, we have a scenario here where it's possible that that sort of strategy is a feature that is going to be very selective. So what I mean by that is when we get to the level of someone like Lionel Sanders or an Olympic athlete, tour de France cyclist or something like that, there's going to be a lot of things that are going to select for the person who can tolerate the demands that are going to, on paper, yield the best performance. So let's say, for example, we determine that the best way to win the Tour de France is to be able to tolerate 150 to 180g per hour. And we say, okay, well, our goal is to produce a winner of the tour de France. So I want to work with a certain number of athletes to try to do that. If I know that the path to winning the Tour de France is 150-180g of carbohydrate per hour. And I also know that let's say 1 in 30 people are going to be able to tolerate that properly and find performance from it or versus have like a negative consequence from that. It may be worth it in my mind to run that on all 30 of them, just to produce that one. Who is going to be able to outcompete everybody else? Because now I found the person who responds to that specific input and has the potential to tolerate it better than the rest. So we oftentimes will look at pro athletes and things like that as these examples of what to do when in reality, it could just be a selection process where they can tolerate certain things much better than the average person. And if the average person applies that they may have a negative consequence and not only have worse health outcomes down the road, but also maybe lose out on their specific potential in whatever pursuit they're doing from a sports standpoint as well. So, I mean, we see this selection type of thing all across the board with professional sports and things like that. It's not just nutrition I think of. Here's another example. Like we took like a cross-country team and we determined, okay, here is a training program that is going to on average yield the fastest runner. And I have to say 40 runners tryout for this cross-country team. If I know that this program is going to yield the fastest runner, if done right, then if I apply it to all 40 of them, and let's say that like I identify 5 to 7 out of that 40 who just respond really, really well to it. I'm probably going to run a faster team cross-country race with those 5 to 7 who responded well to the program that on average is going to outperform other programs, even if a bunch of those other 40 end up not responding well to it. So you see that sort of kind of like selection to what could potentially yield the best oftentimes in sport. And that's where I think you get a big disconnect between maybe the average person and what we likely see on the podiums and things like the Olympics or professional sports and things like that too. So, another thing to consider here is age. So when we look at things like extreme carbohydrate usage or any, any input training to, you know, a young athlete in their 20s, they may respond to dietary inputs like carbohydrates differently than, say, someone at the end of their career in their mid 30s, late 30s, early 40s or something like that. So what maybe they were able to get away with and work with in their 20s with success is no longer the same type of input that is going to work for them later in their career. And some of this may even just be like where they're at and what stages in terms of what their needs are from a training standpoint, because you take a young professional who's just getting into the sport professionally, they likely still have a fairly extensive background of training just to get to that point. But they also have more potential growth inputs from different types of training stimulus versus, say, they're now 15 years later in that they've got 15 additional years of training that may change the inputs to some degree of what's going to yield the best result for them at that point in their career, because at that point they've likely already peaked, and now it's about maintaining it and potentially like strategizing in a way where they're going to outperform their competition through the tactics and things like that, verses for them doing training inputs that are going to get them to the next stage in their career, so to speak. So there's also an age related kind of question with that sort of thing too. So when we come back to the nutrition side of this topic, I think there are some basic kinds of considerations that I find useful. And the way I like to kind of start this is first of all. If you're just getting into this, if you haven't said, like, all right, I've been doing this hyper high carbohydrate strategy and it's working great for me. I'm getting my blood tests. They're coming back. Great. All health markers are wonderful. You know, more power to you. You can ignore anything I'm going to say going forward. Same thing if you're on the other side of that. If you're following a strict ketogenic diet and you're like, hey, this has been just a game changer for me. My health markers are great. My performance is great. you know, what's the argument for me to change? Maybe there isn't one. If you're not one of those two extremes and you're just kind of curious and thinking about it, well, I want to learn. I want to try to figure out what I should be doing here. This is just what I would maybe say is worth considering here. Look at it through the lens of thinking more about the right fuel for the task you're going to be doing next. So if we kind of go back to the beginning where I talk about that variability in training for someone, focusing on performance and how one day to the next might be different enough where you have to consider your dietary inputs. This is kind of what I'm getting at here, where if you take out your training calendar and say, like, okay, what's coming up next? I think that can help guide you in terms of what type of fuel input is going to be useful for that, and put you in a position where you make the least amount of trade offs in order to kind of reach your potential on that sort of training session. So if you're going in and you're looking at the calendar, you say, okay, I've got this hard workout on the schedule tomorrow, regardless if you skew lower carb or higher carb. I think in that situation, you're going to want your meals to include a little more carbohydrate than you normally would have. So if you're like me and your lower, lower carb, that doesn't mean you employ Lionel. Lionel Sanders strategy of a thousand plus grams of carbohydrate per day that day before it means I'm coming off of the baseline of what I would normally do. And, you know, maybe instead of 100g of carbohydrate, I'm gonna have 200g of carbohydrate or something like that that day. and just kind of increase the carbohydrate to prepare myself for that harder training session the next day. And kind of the same thing, if someone's on a moderate carbohydrate diet, high carbohydrate diet, they might just want to look at that through the lens of all right let's look at this through a multi-day view. And I've got a hard training session coming up. So I might skew a little more carbohydrate than I normally would for my meals leading into that next training session. Now, if we're looking at that training calendar and the next thing in line is, say, a long run or a high end zone two training session, I think we want to look at this as well. Where are you in training? So if you're at a part in training where you're doing, say, that long run or that high end zone to workout, but you also have some speed work involved in that training week or that training block in that scenario. I think you want to follow a similar strategy to what you did when you had that hard workout there. You might want to think about it, all right, I don't. I can't just be thinking about my fuel demands for this particular workout, but I also need to be planning for what's coming up now. Next and maybe include a little more carbohydrates above baseline with that type of a training session versus a scenario where, let's say you're in base training. You're doing very little speed work, maybe just some strides or hill bones or something like that. In that scenario, I think that's an opportunity to keep your carbohydrates a little bit lower, regardless of whether your baseline is low carbohydrate or high carbohydrate, so that you're just leveraging the fact that, okay, I'm not going to be asking myself to do a ton of glycolytic work later in this week. I'm more or less rinsing, repeating a lower intensity volume here than I think. You can probably do yourself a metabolic favor by being a little more strategic about how much of that higher octane carbohydrate fuel you end up using for a task that's going to require much less of it. And when you start kind of looking at the training program through that way, where it's like, okay, I found the dietary strategy that I generally like, and now it's just kind of manipulating the ebb and flow of like the carbohydrate side of that thing. Throughout the training plan, I think when you're looking at it through that lens of all right. What is the fuel that is going to be more dominant in this task? How much of it am I doing? And, and and what's coming up next are generally going to be the better focus points than saying like, okay, I just need to throw carbohydrates in a super refined form at everything or on the other side of things. I need to avoid every carbohydrate altogether. because, you know, I want to be a high fat burner or something like that. So those are my thoughts on that specific topic and things like that. If you're if you're interested. I actually did do a Substack post recently where I looked at the question of, is endurance athletes unhealthy or is that an unhealthy lifestyle? Should we be avoiding that sort of a training input? So if you want to kind of get another glance at that and, and that study I referenced with the Olympic athletes, head over to my Substack, which is just Substack. But also if you have other topics or things you'd like me to hit on on some of these solo episodes, feel free to shoot me a note either on socials, my website, or hpopodcast@gmail.com.