1 00:00:00,440 --> 00:00:03,000 This episode of The Doctors are Running podcast is sponsored by 2 00:00:03,000 --> 00:00:04,200 our friends at Running Warehouse. 3 00:00:04,640 --> 00:00:07,000 With the introduction of super Foams and carbon plates, it's 4 00:00:07,000 --> 00:00:08,720 never been more fun to tackle the trails. 5 00:00:09,200 --> 00:00:11,640 The Nike Ultrafly hit shelves recently, giving runners a 6 00:00:11,640 --> 00:00:14,160 chance to take the tried and true Zoom X Mid Cell Foam off 7 00:00:14,160 --> 00:00:16,280 the road and onto the trails for long distances. 8 00:00:17,030 --> 00:00:18,870 And our chief editor Matt Klein's review of the shoe. 9 00:00:18,870 --> 00:00:21,310 He says those wanting Zumex Foam with a plate that feels 10 00:00:21,310 --> 00:00:23,870 comfortable at both easy and up to PO paces will enjoy the 11 00:00:23,870 --> 00:00:26,030 Ultrafly. The ultra marathon community 12 00:00:26,030 --> 00:00:28,350 should be excited that they have a super shoe designed for them. 13 00:00:28,950 --> 00:00:32,189 Not to be outdone, Hocus Tectonics 2 New Balances Super 14 00:00:32,189 --> 00:00:34,950 Comp Trail at Sakenes Endorphin Rift offer excellent 15 00:00:34,950 --> 00:00:36,710 alternatives that each have their own strengths. 16 00:00:37,350 --> 00:00:39,630 Find reviews on all four Super Trail shoes at Doctors Are 17 00:00:39,630 --> 00:00:42,110 Running and have a runningwarehouse.com to shop 18 00:00:42,110 --> 00:00:52,530 today. Hello and welcome to the Doctors 19 00:00:52,530 --> 00:00:55,890 of Running podcast, where we, a group of doctors of physical 20 00:00:55,890 --> 00:00:58,970 therapy, discuss the art and the science of the stuff we're 21 00:00:58,970 --> 00:01:02,330 putting on our feet. I'm Andrea Myers, and today we 22 00:01:02,330 --> 00:01:06,490 have two very special guests with us, Doctor Liz Herman and 23 00:01:06,490 --> 00:01:10,240 Doctor Jared Pastoya. Doctor Herman and Doctor Pastoya 24 00:01:10,240 --> 00:01:13,360 are naturopathic physicians here in Bethel, CT. 25 00:01:13,720 --> 00:01:15,960 I've known Doctor Herman for several years. 26 00:01:15,960 --> 00:01:20,320 We had the great opportunity to work together for a while, and 27 00:01:20,320 --> 00:01:25,520 Doctor Pastoya is a new addition to the clinic and it's been 28 00:01:25,520 --> 00:01:28,320 exciting getting to know him over the past few weeks. 29 00:01:29,240 --> 00:01:32,240 So we have Doctor Herman and Doctor Pastoya here to talk 30 00:01:32,240 --> 00:01:36,620 about blood work. We hear so much on social media 31 00:01:36,620 --> 00:01:40,660 and in articles about getting regular blood work for us as 32 00:01:40,660 --> 00:01:45,260 endurance athletes, and I think there's so much confusion about 33 00:01:45,260 --> 00:01:48,780 what blood values mean and why do I need to get all of this 34 00:01:48,780 --> 00:01:52,420 extra testing? Why can't my primary care doctor 35 00:01:52,420 --> 00:01:54,300 just do my normal blood work? Why? 36 00:01:54,300 --> 00:01:57,710 Do I need something extra? So I asked Doctor Herman and 37 00:01:57,710 --> 00:02:02,470 Doctor Pastoya to come on to kind of help us understand a 38 00:02:02,470 --> 00:02:06,870 little bit better what blood values are, what they mean, and 39 00:02:06,870 --> 00:02:08,870 what's important for us as runners. 40 00:02:09,590 --> 00:02:13,230 So just to introduce Doctor Herman and Doctor Pastoya. 41 00:02:13,350 --> 00:02:17,550 Dr. Herman is the owner and director of Bethel Naturopathic 42 00:02:17,550 --> 00:02:20,910 Medical. She's owned it since 2006, which 43 00:02:20,910 --> 00:02:24,010 is awesome. She is the former president of 44 00:02:24,010 --> 00:02:27,890 the Connecticut Naturopathic Association, and she's also 45 00:02:27,890 --> 00:02:31,170 served as a supervising physician for students at the 46 00:02:31,170 --> 00:02:35,050 University of Bridgeport School of Naturopathic Medicine here in 47 00:02:35,050 --> 00:02:38,330 Connecticut. Dr. Pistoya is an attending 48 00:02:38,330 --> 00:02:42,410 physician at Bethel Naturopathic Medical, and he has a background 49 00:02:42,410 --> 00:02:45,450 in nutrition, fitness training and health coaching. 50 00:02:45,930 --> 00:02:48,570 He's also an author. He wrote a book called In 51 00:02:48,570 --> 00:02:51,920 Pursuit of Health. And he also is an author for 52 00:02:51,920 --> 00:02:54,000 Health Line and other publications. 53 00:02:54,520 --> 00:02:57,000 So welcome Dr. Herman and Dr. Pistoya. 54 00:02:57,000 --> 00:02:58,920 Thank you so much for joining us. 55 00:02:59,160 --> 00:03:02,800 It's great to have you on. Thank you and glad to be here. 56 00:03:02,920 --> 00:03:06,760 Yes, thank you guys. And I just wanted to give your 57 00:03:06,760 --> 00:03:10,240 guys a few minutes to tell our listeners a little bit about 58 00:03:10,240 --> 00:03:14,480 each of you, your backgrounds, what you like to do for 59 00:03:14,480 --> 00:03:17,600 exercise. So let's start with Dr. Herman. 60 00:03:18,120 --> 00:03:20,390 Hi. Thank you. 61 00:03:21,390 --> 00:03:28,310 Really just I graduated Naturopathic school in 1999 and 62 00:03:28,310 --> 00:03:31,110 immediately started my own practice. 63 00:03:32,390 --> 00:03:36,950 My bachelor's degree is actually in exercise science and I always 64 00:03:36,990 --> 00:03:38,950 thought I was going to be an athletic trainer. 65 00:03:40,030 --> 00:03:44,670 And oddly enough, I went in a direction where afterwards I 66 00:03:44,670 --> 00:03:46,590 thought I was going to be a physical therapist. 67 00:03:47,740 --> 00:03:51,500 But then life changed, and I wound up being a naturopathic 68 00:03:51,500 --> 00:03:53,700 physician. But I was always interested in 69 00:03:53,700 --> 00:03:58,220 combining science and exercise. That was always two of my 70 00:03:58,220 --> 00:04:03,380 favorite loves, and being able to be an atropathic physician 71 00:04:03,380 --> 00:04:06,780 allowed me to do that. I love exercise. 72 00:04:06,780 --> 00:04:10,180 I love everything about it. I love the way it makes you 73 00:04:10,180 --> 00:04:12,740 feel. I love. 74 00:04:13,420 --> 00:04:17,220 All different types of exercise, whether it's walking well, for 75 00:04:17,220 --> 00:04:20,380 me it'd be jogging, slow jogging that's still running but not. 76 00:04:21,019 --> 00:04:23,340 Running. You're a runner, yes. 77 00:04:25,340 --> 00:04:31,500 Swimming, yoga, you know, Pilates, weightlifting, anything 78 00:04:31,500 --> 00:04:34,970 I could do, it would, you know. I just loved it. 79 00:04:35,330 --> 00:04:39,290 So for me to be able to get to do a podcast where I bring two 80 00:04:39,290 --> 00:04:41,050 of my loves together is wonderful. 81 00:04:41,050 --> 00:04:42,450 So thank you. I appreciate it. 82 00:04:42,490 --> 00:04:44,250 Well, thank you so much for coming on. 83 00:04:45,530 --> 00:04:48,090 And Dr. Pastoya, could you tell us a little bit about your 84 00:04:48,090 --> 00:04:50,130 background? Sure, yeah. 85 00:04:50,130 --> 00:04:54,610 For the first half of my life, it was involved with just 86 00:04:54,610 --> 00:04:56,690 getting acquainted with health in general. 87 00:04:57,520 --> 00:04:59,680 I'm just learning various principles of health and 88 00:04:59,680 --> 00:05:03,440 lifestyle medicine and strategies that I can use just 89 00:05:03,440 --> 00:05:07,240 to keep myself healthy. And so naturally I just kind of 90 00:05:07,240 --> 00:05:10,760 found my way into fitness training as well after kind of 91 00:05:10,760 --> 00:05:12,080 getting acquainted with nutrition. 92 00:05:12,720 --> 00:05:16,160 And I became a East of certified fitness trainer for about 5 93 00:05:16,160 --> 00:05:18,120 years. And I was doing all kinds of 94 00:05:18,120 --> 00:05:21,920 exercise and activity at that time and was taking clients and 95 00:05:21,920 --> 00:05:26,000 just kind of working on my own. And then really started to study 96 00:05:26,500 --> 00:05:29,860 some of the specifics of exercise science with some 97 00:05:29,860 --> 00:05:32,700 dabbling in strength and conditioning and that sort of 98 00:05:32,700 --> 00:05:37,060 information. And then medical school happened 99 00:05:37,260 --> 00:05:41,460 and because of the workload, you kind of have to put your 100 00:05:41,460 --> 00:05:45,300 exercise pursuits on the side. And so me, I've always been 101 00:05:45,300 --> 00:05:49,460 trying to gain more muscle and lift stronger and heavier and 102 00:05:49,460 --> 00:05:51,550 whatnot. And so when you're in school, 103 00:05:51,550 --> 00:05:53,150 you just don't have any endurance. 104 00:05:53,310 --> 00:05:56,230 This kind of ties in a little bit with today, no endurance, no 105 00:05:56,230 --> 00:05:58,790 ability to really push yourself at all. 106 00:05:59,270 --> 00:06:00,790 And so you're just like the heck with it. 107 00:06:00,790 --> 00:06:07,030 I'm just gonna succumb to being sedentary and recently have just 108 00:06:07,390 --> 00:06:11,190 been getting reacquainted with exercise again and on the 109 00:06:11,190 --> 00:06:15,590 strength and conditioning side, but previously some experience 110 00:06:15,590 --> 00:06:17,230 with endurance and running as well. 111 00:06:17,840 --> 00:06:21,480 So exercise is definitely a major interest and I've had some 112 00:06:22,240 --> 00:06:25,960 patience if we get time to discuss some young athletes who 113 00:06:25,960 --> 00:06:28,160 are endurance runners that I've been able to help out and listen 114 00:06:28,160 --> 00:06:31,960 to their stories and whatnot, so the timing is very relevant. 115 00:06:31,960 --> 00:06:33,320 That's great. And you're right. 116 00:06:33,320 --> 00:06:38,120 It's never too late to go from a sedentary period to getting back 117 00:06:38,120 --> 00:06:40,920 to being more active, so I'm glad that you're finding more 118 00:06:40,920 --> 00:06:43,360 time to get back to what you love. 119 00:06:43,640 --> 00:06:46,120 The gods have blessed me to give another opportunity. 120 00:06:47,380 --> 00:06:52,900 That's wonderful. So let's move on to our 121 00:06:52,900 --> 00:06:55,220 subjective. So this is for our listeners. 122 00:06:55,580 --> 00:06:59,740 So what changes have you made, if any, to your diet that has 123 00:06:59,740 --> 00:07:03,220 improved your running? You can leave us a comment on 124 00:07:03,220 --> 00:07:05,380 YouTube. You can send us an e-mail at 125 00:07:05,380 --> 00:07:10,030 doctorsofrunning@gmail.com. Leave us a comment or send us a 126 00:07:10,030 --> 00:07:12,910 message on social media. Facebook, Instagram. 127 00:07:13,470 --> 00:07:17,430 We want to hear how diet has changed your running 128 00:07:17,430 --> 00:07:20,910 performance. If it has, so we're going to 129 00:07:20,910 --> 00:07:24,390 move on to the main segment. So like I said, the whole 130 00:07:24,550 --> 00:07:30,070 purpose of this podcast is for us to learn more about why we 131 00:07:30,070 --> 00:07:32,990 should get regular blood work, what we should be looking for, 132 00:07:32,990 --> 00:07:36,230 what those values mean. So first of all. 133 00:07:36,890 --> 00:07:40,130 Why do doctors order annual blood work as part of the early 134 00:07:40,130 --> 00:07:41,890 physical? What's the point of it? 135 00:07:42,250 --> 00:07:47,890 Well, really it's for to check different blood biomarkers and 136 00:07:47,890 --> 00:07:52,610 gain an insight into an athlete's nutritional and 137 00:07:52,610 --> 00:07:57,340 physiological status. That could really help in 138 00:07:57,420 --> 00:08:01,180 preventing over training, illness and injury. 139 00:08:01,180 --> 00:08:04,980 And are there different blood markers that runners or 140 00:08:04,980 --> 00:08:07,900 endurance athletes should have looked at compared to the 141 00:08:07,900 --> 00:08:09,940 general population? Because, you know, when I go to 142 00:08:09,940 --> 00:08:14,260 my primary care doctor, they don't order the same blood work 143 00:08:14,260 --> 00:08:17,380 that like you've ordered for me, Dr. Herman. 144 00:08:17,620 --> 00:08:19,740 It's much less extensive, so. Right. 145 00:08:19,820 --> 00:08:23,260 What are some additional tests or markers? 146 00:08:23,770 --> 00:08:27,450 That you might look for if your patient is an endurance athlete 147 00:08:27,490 --> 00:08:30,810 as compared to just an everyday person. 148 00:08:31,370 --> 00:08:37,010 I mean, definitely, just in addition to your comprehensive 149 00:08:37,010 --> 00:08:40,330 metabolic and your CBC which looks at red blood cells and 150 00:08:40,330 --> 00:08:43,450 hemoglobin and hematocrit levels, we would want to 151 00:08:43,450 --> 00:08:47,210 definitely check iron levels, calcium levels, vitamin D 152 00:08:47,210 --> 00:08:51,270 levels. Even vitamin B12 and folic acid 153 00:08:51,270 --> 00:08:56,790 levels, iodine levels, Sometimes we even go into looking at 154 00:08:56,790 --> 00:09:01,430 insulin levels, hemoglobin, A1C's just to even see how 155 00:09:01,430 --> 00:09:06,990 somebody might be utilizing glucose if they have a problem 156 00:09:06,990 --> 00:09:11,950 with that because even athletes can have other health 157 00:09:11,950 --> 00:09:15,360 conditions. That might increase their need 158 00:09:15,360 --> 00:09:18,520 for different types of nutrients. 159 00:09:19,320 --> 00:09:24,240 And you know, even we can even take a look at creatinine kinase 160 00:09:24,240 --> 00:09:28,160 for example, which you know. Especially in endurance athletes 161 00:09:28,680 --> 00:09:33,280 and training, you might want to look at muscle breakdown and 162 00:09:33,280 --> 00:09:38,080 that might affect a runner and how much they can run, or if 163 00:09:38,080 --> 00:09:42,600 they need to recover, have a greater deal of recovery time. 164 00:09:43,070 --> 00:09:45,990 So we can look at these biomarkers and see if there's 165 00:09:45,990 --> 00:09:50,350 anything that nutritionally we might need to do either through 166 00:09:50,350 --> 00:09:54,710 like plant based medicines, supplementation or with food. 167 00:09:55,310 --> 00:10:00,670 Okay and Dr. Pastoya, what are some common issues that you see 168 00:10:00,670 --> 00:10:03,750 in your endurance athlete patients like Dr. Herman 169 00:10:03,870 --> 00:10:06,110 mentioned abnormal glucose levels? 170 00:10:06,690 --> 00:10:10,810 If somebody's glucose levels were off, what symptoms might 171 00:10:10,810 --> 00:10:13,450 they come in complaining to you about? 172 00:10:13,810 --> 00:10:15,370 I'd say that they'd probably be tired. 173 00:10:15,890 --> 00:10:19,290 And when they're trying to perform or going to run, they 174 00:10:19,290 --> 00:10:22,610 may fatigue easily. And it's not that complicated, 175 00:10:22,610 --> 00:10:24,050 right? You just, you don't have enough 176 00:10:24,050 --> 00:10:27,450 blood sugar, so there's not enough fuel for your cells. 177 00:10:27,890 --> 00:10:30,570 And so when there's not enough fuel, it's just these sort of 178 00:10:30,570 --> 00:10:33,630 systemic symptoms that you'll get, I think just being 179 00:10:33,630 --> 00:10:36,150 fatigued, maybe even some dizziness you might see as well, 180 00:10:36,150 --> 00:10:39,030 especially during when you're trying to exert yourself on 181 00:10:39,030 --> 00:10:41,030 those runs. I like that you brought up 182 00:10:41,030 --> 00:10:45,670 fatigue because it reminds me of one of my friends who is a 183 00:10:45,830 --> 00:10:50,470 decades long endurance athlete and he went to his doctor and he 184 00:10:50,470 --> 00:10:53,940 said you know. I just don't feel the same as I 185 00:10:53,940 --> 00:10:57,700 used to. I I'm not as fast on, you know, 186 00:10:57,700 --> 00:11:00,620 these rides that I do. I think something's wrong. 187 00:11:00,620 --> 00:11:04,220 And this is a person who, you know at age 50 or 60 was still 188 00:11:04,220 --> 00:11:08,740 regularly doing 100 mile bike rides and his doctor told him, 189 00:11:09,100 --> 00:11:11,700 well, nothing's wrong with you. Look at what you're still able 190 00:11:11,700 --> 00:11:14,740 to do. But for him, he knew that his 191 00:11:14,740 --> 00:11:18,270 performance wasn't normal. And I think it can be hard 192 00:11:18,270 --> 00:11:21,990 sometimes to for athletes to have those discussions with 193 00:11:21,990 --> 00:11:25,110 their doctors, especially if their doctors don't really 194 00:11:25,110 --> 00:11:28,870 understand the type of training they're doing as exactly. 195 00:11:28,870 --> 00:11:32,990 And as an athlete, we're really in tune with our bodies and we 196 00:11:32,990 --> 00:11:37,390 can tell when something's off. So one if you know something's 197 00:11:37,390 --> 00:11:39,400 off. They should go to their doctor, 198 00:11:39,400 --> 00:11:41,600 right? But what should they do if their 199 00:11:41,600 --> 00:11:44,640 doctor kind of blows them off? Like you're fine? 200 00:11:44,640 --> 00:11:47,600 You can still ride 100 miles. Most people can't do that. 201 00:11:47,960 --> 00:11:51,000 How would you suggest somebody handle that? 202 00:11:51,760 --> 00:11:58,600 So one find yourself a naturopathic physician and or 203 00:11:58,600 --> 00:12:03,800 you could always find a MD who specializes in sports medicine. 204 00:12:04,950 --> 00:12:08,110 Who would understand the specific nutritional 205 00:12:08,110 --> 00:12:11,550 requirements and supplementation for the sport that you're 206 00:12:12,190 --> 00:12:15,750 involved in? Yeah, I think that's a very good 207 00:12:15,750 --> 00:12:19,710 suggestion. So you had mentioned Dr. Herman, 208 00:12:19,710 --> 00:12:23,910 creatine kinase and how that can indicate levels of muscle 209 00:12:23,910 --> 00:12:27,270 damage. And it is normal after like a 210 00:12:27,270 --> 00:12:31,110 hard workout or let's say a marathon for creatine kinase 211 00:12:31,110 --> 00:12:33,630 levels to be elevated, right? So. 212 00:12:34,400 --> 00:12:38,800 If somebody is getting their regular, you know, yearly or you 213 00:12:38,800 --> 00:12:42,560 know every six months blood work, should they do that blood 214 00:12:42,560 --> 00:12:45,920 work two days after a big race or should they wait a little 215 00:12:45,920 --> 00:12:49,800 bit? I would say to do it also 216 00:12:49,920 --> 00:12:55,240 somebody who is already training and the gentleman that you were 217 00:12:55,520 --> 00:13:02,240 describing who is doing what 50-60 hundred miles a week. 218 00:13:02,860 --> 00:13:04,460 You know that's intense training. 219 00:13:05,540 --> 00:13:10,580 I would actually do that on a person initially to see what 220 00:13:10,580 --> 00:13:16,500 they're they're walking in with basically that kind of baseline 221 00:13:16,860 --> 00:13:22,060 CK level and see if they are already experiencing muscle 222 00:13:22,060 --> 00:13:26,300 breakdown because then you can incorporate into whether it's 223 00:13:26,300 --> 00:13:28,420 their food or through supplementation. 224 00:13:29,010 --> 00:13:34,130 To actually improve that and somebody who is an older 225 00:13:34,130 --> 00:13:39,370 individual unfortunately does need more time to recover. 226 00:13:39,690 --> 00:13:44,850 So it might be a combination of longer recovery time plus 227 00:13:45,690 --> 00:13:52,570 different types of nutrients, protein, calcium, B12, you know, 228 00:13:52,570 --> 00:13:57,580 iron levels even for men. And and then doing that again 229 00:13:57,580 --> 00:14:03,180 after a competition and do a comparison study. 230 00:14:04,380 --> 00:14:08,420 And can you just briefly, Dr. Pistoya, explain what creatine 231 00:14:08,420 --> 00:14:13,660 kinase is and why it might be elevated if somebody's 232 00:14:13,860 --> 00:14:17,020 experiencing muscle breakdown? So we throw around these terms 233 00:14:17,020 --> 00:14:20,020 and you know, the everyday person has no idea what they 234 00:14:20,020 --> 00:14:21,860 mean. So I'm hoping to kind of. 235 00:14:22,220 --> 00:14:25,940 Help people understand what all of those terms on their blood 236 00:14:25,940 --> 00:14:28,580 work results mean. Sure, Yeah. 237 00:14:28,580 --> 00:14:32,420 So creatine kinase basically helps your muscles produce 238 00:14:32,420 --> 00:14:34,500 energy. So that's just kind of the 239 00:14:34,500 --> 00:14:36,340 simplest way that I can define it. 240 00:14:36,940 --> 00:14:40,340 And so if you're an endurance athlete, or really any athlete, 241 00:14:41,140 --> 00:14:45,340 your muscles need more energy constantly, so they're going to 242 00:14:45,340 --> 00:14:49,340 be using more creatine and are requiring more creatine as well. 243 00:14:50,090 --> 00:14:52,730 That's why for a lot of athletes, it's who are 244 00:14:52,730 --> 00:14:55,050 vegetarians. It can be sometimes difficult to 245 00:14:55,050 --> 00:14:57,370 meet energy demands. It's not just because of 246 00:14:57,370 --> 00:15:01,690 nutrients lacking, but also compounds like creatine, which 247 00:15:01,690 --> 00:15:04,530 are naturally more in abundant in the muscle tissues of 248 00:15:04,530 --> 00:15:06,690 animals, right? That's because that's where a 249 00:15:06,730 --> 00:15:08,290 lot of times they're being utilized. 250 00:15:08,810 --> 00:15:13,790 So creatine kinase is basically just an enzyme that will allow 251 00:15:13,790 --> 00:15:16,550 the will extract the energy from the creatine itself. 252 00:15:16,630 --> 00:15:18,390 Great. Thank you so much for explaining 253 00:15:18,390 --> 00:15:22,030 that. So in your practices, what are 254 00:15:22,030 --> 00:15:26,190 the most common abnormal blood work findings in runners or 255 00:15:26,190 --> 00:15:30,710 endurance athletes? What I have found is usually 256 00:15:30,710 --> 00:15:32,870 they're iron, they're ferritin, they're B12. 257 00:15:34,150 --> 00:15:39,390 A lot of times we'll wind up being low or if they've having a 258 00:15:39,390 --> 00:15:43,790 lot of inflammation, I could see ferritin being actually 259 00:15:43,830 --> 00:15:47,230 elevated. So that's something that I see. 260 00:15:47,230 --> 00:15:53,350 Sometimes I'll see hypoglycemia where initially we do a glucose 261 00:15:53,350 --> 00:15:59,590 test and I see that they have two low glucose and they're not 262 00:15:59,590 --> 00:16:04,330 replenishing it quick enough. Sometimes their calcium levels 263 00:16:04,330 --> 00:16:09,210 might be low as well as their vitamin D so those are for me 264 00:16:09,210 --> 00:16:13,130 the majority of the time that I'll test an athlete and I'll 265 00:16:13,130 --> 00:16:15,050 find those levels. Yeah. 266 00:16:15,410 --> 00:16:18,370 And we're going to get into more details about some of those 267 00:16:18,370 --> 00:16:20,170 specific blood markers in a minute. 268 00:16:21,530 --> 00:16:25,090 Dr. Pistoya, do males and females require different types 269 00:16:25,130 --> 00:16:28,090 of tests? And if so, what are those tests 270 00:16:28,090 --> 00:16:32,590 and why are they different? Not necessarily. 271 00:16:32,670 --> 00:16:37,990 I mean it really depends on how old you are, especially for, 272 00:16:38,310 --> 00:16:39,870 well, I guess it's really doesn't make a difference 273 00:16:39,870 --> 00:16:43,270 between men and women. But obviously you know, around 274 00:16:43,750 --> 00:16:47,470 when menopause is kind of starting, if you're still very 275 00:16:47,470 --> 00:16:50,470 active at that time, you're having changes in hormones, 276 00:16:50,510 --> 00:16:52,230 right. So your estrogen is withdrawing 277 00:16:52,230 --> 00:16:53,990 a little bit. You're not producing as much. 278 00:16:54,590 --> 00:16:57,430 And that can result in symptoms like fatigue. 279 00:16:58,110 --> 00:17:01,220 So it becomes a game at that point of okay. 280 00:17:01,220 --> 00:17:04,300 Well, you know your levels. You're not anemic. 281 00:17:04,500 --> 00:17:06,060 You know, you're eating enough calories. 282 00:17:06,060 --> 00:17:08,060 You have enough high enough blood sugar. 283 00:17:08,579 --> 00:17:12,140 So why could it be that you're tired And so and then we might 284 00:17:12,140 --> 00:17:15,220 look at hormones. And so you know, your basic 285 00:17:15,220 --> 00:17:18,020 estrogen and progesterone labs for women. 286 00:17:18,660 --> 00:17:22,970 And then for men who also experience a kind of an 287 00:17:22,970 --> 00:17:25,890 unofficial term called andropause, which is just the 288 00:17:25,970 --> 00:17:30,050 reverse of the slow decline in testosterone as men get older. 289 00:17:30,690 --> 00:17:35,130 In that case, it may be worthwhile to check testosterone 290 00:17:35,130 --> 00:17:39,010 levels. So I would say the biggest thing 291 00:17:39,010 --> 00:17:42,490 that would indicate the need for hormone testing would probably 292 00:17:42,490 --> 00:17:45,980 be energy levels. That's a common reason that a 293 00:17:45,980 --> 00:17:48,980 lot of people, middle-aged people will come in and say, I 294 00:17:48,980 --> 00:17:51,580 just don't have the energy and nothing really changed 295 00:17:51,580 --> 00:17:54,500 specifically in my life. And in that case, okay. 296 00:17:54,500 --> 00:17:56,340 Well, let's look at some of the sex hormones. 297 00:17:57,340 --> 00:18:00,020 Yeah, that makes sense and we'll get into that a little bit 298 00:18:00,020 --> 00:18:03,780 later, cuz I wanna talk about what can be done if hormone 299 00:18:03,780 --> 00:18:06,780 levels are abnormal and depending on the level of 300 00:18:06,780 --> 00:18:10,120 athlete you're talking about. You can't always supplement with 301 00:18:10,120 --> 00:18:14,400 testosterone, because that's against Federation rules, and 302 00:18:14,400 --> 00:18:17,960 you can get in big trouble for taking exogenous testosterone 303 00:18:18,240 --> 00:18:22,240 whether you're male or female. So what are some other options 304 00:18:22,240 --> 00:18:28,280 for people who have to follow Federation rules for addressing 305 00:18:28,280 --> 00:18:31,920 hormone imbalances? But we'll save that for later in 306 00:18:31,920 --> 00:18:36,050 the episode. Just in general, if someone's 307 00:18:36,050 --> 00:18:40,210 blood work is abnormal, what are like the categories of what can 308 00:18:40,210 --> 00:18:42,370 be done about it? You're you're both already 309 00:18:42,370 --> 00:18:46,250 touched on it a little bit, but let's say I get blood work done 310 00:18:46,250 --> 00:18:51,090 and my ferritin's low, my iron's low, vitamin D is low. 311 00:18:52,410 --> 00:18:55,930 What is there to do? So most often. 312 00:18:57,400 --> 00:19:01,600 You know, usually like a general multivitamin is suggested, but 313 00:19:01,600 --> 00:19:05,720 The thing is, is that with athletes having such a higher 314 00:19:05,720 --> 00:19:12,110 demand for nutrients. To repair and recover to support 315 00:19:12,110 --> 00:19:17,350 healthy immune function, especially after training really 316 00:19:17,350 --> 00:19:22,150 hard or having multiple competitions, is that you're 317 00:19:22,150 --> 00:19:26,310 going to want to provide more than what you would see in a 318 00:19:26,310 --> 00:19:29,910 multiple vitamin and so that might be where you need to 319 00:19:29,910 --> 00:19:33,150 provide. An additional iron, let's say, 320 00:19:33,430 --> 00:19:38,990 and an iron with B12 and fluic acid in it, you know, you might 321 00:19:38,990 --> 00:19:43,990 need to look at. Well, that's a tangent, but I 322 00:19:43,990 --> 00:19:46,990 was going to go off on like digestive enzymes and all this. 323 00:19:47,070 --> 00:19:48,350 Oh, we. Love tangents? 324 00:19:49,030 --> 00:19:51,710 Please please out. Of you know all these, you know 325 00:19:51,710 --> 00:19:56,030 from your hydrochloric acid in your stomach anyway, so but no 326 00:19:56,030 --> 00:19:58,190 please. Go down that tangent actually, 327 00:19:58,190 --> 00:20:01,130 because I. I think a lot of people think 328 00:20:01,130 --> 00:20:02,730 that things like this are straightforward. 329 00:20:02,730 --> 00:20:05,370 You're deficient in this, you take this and then it's taken 330 00:20:05,370 --> 00:20:06,410 care of. But it's not. 331 00:20:06,410 --> 00:20:09,210 It depends on absorption, right? So could you talk a little bit 332 00:20:09,210 --> 00:20:13,450 about digestive enzymes and cofactors and how our bodies 333 00:20:13,450 --> 00:20:16,050 actually absorb and utilize these nutrients? 334 00:20:16,050 --> 00:20:20,570 Yes, yes. So depending upon you know, the 335 00:20:20,570 --> 00:20:24,570 person's health, age, medications that they might 336 00:20:24,570 --> 00:20:29,830 already be taking could affect. Absorption of nutrients in the 337 00:20:29,830 --> 00:20:35,030 small intestinal tract and so, well, usually digest digestion 338 00:20:35,030 --> 00:20:37,790 happens in the mouth 1st and then in the stomach. 339 00:20:39,390 --> 00:20:42,910 And when it gets to the stomach, whether you know you're taking 340 00:20:43,590 --> 00:20:46,590 really, if you're eating your foods and you're chewing well, 341 00:20:47,430 --> 00:20:51,630 what your body will do is that with the hydrochloric acid 342 00:20:51,630 --> 00:20:55,390 that's in the stomach, it kind of pulls apart. 343 00:20:55,870 --> 00:20:59,070 The components, the nutrient components from your food, your 344 00:20:59,070 --> 00:21:02,670 B12, your calcium, your folic acid, whatever it is, your iron. 345 00:21:03,270 --> 00:21:07,750 And then with these little finger like projections that are 346 00:21:07,750 --> 00:21:12,550 lining your intestinal tract, it kind of grabs on to these pieces 347 00:21:12,550 --> 00:21:14,830 and pulls it into your bloodstream and then takes it 348 00:21:14,830 --> 00:21:18,270 down to where it needs to go to whatever tissue or organ it's 349 00:21:18,270 --> 00:21:24,310 trying to either support, nourish or repair. 350 00:21:24,970 --> 00:21:31,370 And so if for whatever reason the amount of acid in your 351 00:21:31,370 --> 00:21:36,770 stomach is low, you have a low volume or if it's diluted for 352 00:21:36,770 --> 00:21:40,610 any reason, if it's neutralized for any region reason. 353 00:21:40,610 --> 00:21:46,090 Which is why a lot of times when people are on, and I believe 354 00:21:46,090 --> 00:21:51,090 people are more familiar with this example if they're on anti. 355 00:21:51,590 --> 00:21:56,790 Acids You know your your Nexium, your Prevacid, your Prilosec, 356 00:21:56,790 --> 00:22:03,790 your Prantoprazole Omeprazole, or even your Tums which is just 357 00:22:03,790 --> 00:22:07,670 simply calcium. It actually neutralizes or shuts 358 00:22:07,670 --> 00:22:10,990 down the pumps that put out the acid necessary to break down 359 00:22:10,990 --> 00:22:14,870 your foods to get all these components that you can pull out 360 00:22:15,230 --> 00:22:20,430 that you can utilize so often times. 361 00:22:20,920 --> 00:22:25,280 We need to naturopathic physicians are are very big 362 00:22:25,280 --> 00:22:29,920 about digestive enzymes and being able to break down your 363 00:22:29,920 --> 00:22:33,480 foods appropriately in order to grab onto those nutrients. 364 00:22:33,480 --> 00:22:35,880 That's great. Thank you so much for mentioning 365 00:22:35,880 --> 00:22:38,960 that. So let's move on to probably the 366 00:22:38,960 --> 00:22:42,080 most common. In my mind, it might not be the 367 00:22:42,080 --> 00:22:48,800 most common that you see blood marker deficiency that runners 368 00:22:48,800 --> 00:22:52,280 may experience, which is anemia. So first of all, Dr. Pistoya, 369 00:22:52,280 --> 00:22:55,560 can you just tell us what it means to be anemic? 370 00:22:55,600 --> 00:22:58,760 And are there different things that can cause anemia? 371 00:22:59,320 --> 00:23:03,080 Sure. So anemia basically means that 372 00:23:03,440 --> 00:23:07,280 you either don't have enough red blood cells or enough 373 00:23:07,280 --> 00:23:10,360 hemoglobin. And hemoglobin essentially just 374 00:23:10,360 --> 00:23:12,960 carries oxygen in the red blood cell. 375 00:23:13,750 --> 00:23:17,790 So the red blood cell needs hemoglobin to actually grab that 376 00:23:17,790 --> 00:23:20,670 oxygen from the lungs. So you're breathing in air, the 377 00:23:20,670 --> 00:23:24,710 blood's going to your lungs and then kind of interfacing with 378 00:23:24,710 --> 00:23:28,510 your red blood cells. And so that's basically it. 379 00:23:28,670 --> 00:23:31,510 It's not enough red blood cells or not enough hemoglobin. 380 00:23:32,190 --> 00:23:34,870 And so if that's the case, then you don't have enough oxygen, 381 00:23:34,870 --> 00:23:36,190 right? So your cells are kind of a 382 00:23:36,190 --> 00:23:40,470 little bit starved of oxygen. And so yes, there can be 383 00:23:40,470 --> 00:23:44,440 different causes. It depends on what's going on 384 00:23:44,440 --> 00:23:47,280 with the person, but most commonly this is probably, you 385 00:23:47,280 --> 00:23:50,120 know, next question. But iron deficiency anemia is 386 00:23:50,120 --> 00:23:52,240 the most common reason why people become anemic. 387 00:23:52,240 --> 00:23:53,960 Just having an iron deficiency, OK? 388 00:23:54,240 --> 00:23:58,440 And then if someone has an iron deficiency, what would you see 389 00:23:58,440 --> 00:24:00,840 in their blood work to suggest that? 390 00:24:00,840 --> 00:24:04,400 And what markers would you specifically look at for that? 391 00:24:04,960 --> 00:24:09,200 So you would at first. Start with just a regular blood 392 00:24:09,200 --> 00:24:14,480 count ACBC and on the CBC you would likely see low hemoglobin 393 00:24:14,920 --> 00:24:18,720 or even low hematocrit. And the hematocrit is 394 00:24:18,720 --> 00:24:22,800 essentially the proportion of your blood that's made-up of red 395 00:24:22,800 --> 00:24:25,760 blood cells. So your blood consists of red 396 00:24:25,760 --> 00:24:28,440 blood cells, right? White blood cells, which is your 397 00:24:28,440 --> 00:24:32,040 immune system and also just a liquid substance called plasma. 398 00:24:32,920 --> 00:24:37,000 And so the hematocrit is just a measurement of how much red 399 00:24:37,000 --> 00:24:40,320 blood cells percentage wise are in that entire blood sample. 400 00:24:41,040 --> 00:24:43,680 So which makes sense, right, because if you have anemia and 401 00:24:43,680 --> 00:24:46,280 you look at hematocrit, well, OK, the hematocrit's probably 402 00:24:46,280 --> 00:24:50,120 low because this is not enough red blood cells or the 403 00:24:50,160 --> 00:24:53,080 hemoglobin's too low. So that's the first thing that 404 00:24:53,080 --> 00:24:56,280 you would see. And then what you might do from 405 00:24:56,280 --> 00:24:58,400 there is just follow up with an iron panel. 406 00:24:58,970 --> 00:25:02,930 And so we we can actually check okay how much iron is actively 407 00:25:02,930 --> 00:25:06,930 in your blood right now and also how much iron is does your body 408 00:25:06,930 --> 00:25:10,650 have in storage. And so we can directly measure 409 00:25:10,650 --> 00:25:12,050 those levels. So if someone has iron 410 00:25:12,050 --> 00:25:15,330 deficiency anemia, it's very obvious your iron just comes up 411 00:25:15,330 --> 00:25:18,090 as low. And so sometimes it can be that 412 00:25:18,090 --> 00:25:24,250 your blood iron itself is too low or you have just low storage 413 00:25:24,250 --> 00:25:26,290 or both. So it can be all those things 414 00:25:26,290 --> 00:25:28,940 depending on. How deficient you are? 415 00:25:29,540 --> 00:25:35,500 OK And Dr. Herman, would you consider the specific numbers 416 00:25:35,500 --> 00:25:39,340 for hemoglobin and hematocrit to be different for, say, 417 00:25:39,340 --> 00:25:43,460 somebody's who's running a marathon compared to just a 418 00:25:43,460 --> 00:25:47,060 sedentary person? Do would you want to see 419 00:25:47,060 --> 00:25:51,260 hemoglobin and hematocrit numbers a little bit higher than 420 00:25:51,260 --> 00:25:55,180 what, say, Quest considers to be the cutoff for a low? 421 00:25:55,540 --> 00:26:00,290 Or do you use the same zones? Yes. 422 00:26:00,290 --> 00:26:03,890 I mean, there's the difference between what's normal, meaning 423 00:26:03,890 --> 00:26:07,850 that it's within the range of that specific lab that you're 424 00:26:07,850 --> 00:26:10,490 going through. And then there's optimal ranges, 425 00:26:10,490 --> 00:26:14,930 which are more narrow within that normal range. 426 00:26:15,250 --> 00:26:18,690 And so when somebody is an athlete and we know that they're 427 00:26:18,690 --> 00:26:22,130 needing more nutrients and supplementation. 428 00:26:22,840 --> 00:26:27,080 I like to see them up a little higher towards that higher 429 00:26:27,240 --> 00:26:32,480 portion of that range because then they have the necessary 430 00:26:32,480 --> 00:26:36,360 nutrients in order to perform their sport. 431 00:26:36,880 --> 00:26:42,080 And so when it comes to, you know, red blood cell count, you 432 00:26:42,080 --> 00:26:46,200 may want to see it closer to, you know, over a four, you know, 433 00:26:46,200 --> 00:26:51,630 with the hematocrit. And hemoglobin, you know you're 434 00:26:51,630 --> 00:26:53,550 going to want to see it on the top end. 435 00:26:53,950 --> 00:26:59,150 Same thing with iron, even though you know you want it to 436 00:26:59,150 --> 00:27:02,470 be in range because there's obviously issues if something is 437 00:27:02,510 --> 00:27:05,510 either too low or too high. But you know, getting more 438 00:27:05,510 --> 00:27:08,550 towards the top end of those normal ranges can be very 439 00:27:08,550 --> 00:27:10,390 helpful. And the same thing with 440 00:27:10,390 --> 00:27:13,830 ferritin, so that you know that the, that the athlete does have 441 00:27:13,830 --> 00:27:17,630 something in reserve for especially during competition, 442 00:27:18,070 --> 00:27:20,030 right. And OK, I'm glad you brought up 443 00:27:20,030 --> 00:27:23,150 Ferriton because we we all talk about it in the running 444 00:27:23,150 --> 00:27:26,030 community and I think people kind of understand what it is. 445 00:27:26,030 --> 00:27:29,910 But what is it specifically? Why does it matter when it comes 446 00:27:29,910 --> 00:27:34,590 to anemia, and what is its relationship to hemoglobin and 447 00:27:34,590 --> 00:27:37,150 hematocrit? Oh, did you want to take this, 448 00:27:37,190 --> 00:27:37,790 Doctor? Sure. 449 00:27:37,910 --> 00:27:42,300 Yeah, definitely. So ferritin is basically a 450 00:27:42,300 --> 00:27:46,420 protein that stores iron. So you think of it as just a 451 00:27:46,420 --> 00:27:50,380 container for iron basically. So when you eat food and get 452 00:27:50,380 --> 00:27:53,420 iron from your food, your body will use whatever it needs to in 453 00:27:53,420 --> 00:27:56,260 your cell and then the ferritin will come and just say, hey, let 454 00:27:56,260 --> 00:27:57,900 me grab this and store that for later. 455 00:27:58,500 --> 00:28:01,380 And it kind of just lives inside of your cells for the most part. 456 00:28:02,140 --> 00:28:05,700 And when your iron is low, just like if your checking account is 457 00:28:05,700 --> 00:28:08,620 low, you'll draw on your savings, which is your ferritin. 458 00:28:09,040 --> 00:28:11,480 And so it's just think of it as like an iron savings account 459 00:28:11,480 --> 00:28:15,760 basically and when you need more iron and say OK, let me have 460 00:28:15,760 --> 00:28:19,840 some of that stored iron and I think that it's usually stored 461 00:28:20,160 --> 00:28:25,200 in skeletal muscle and deliver stores iron I believe and some 462 00:28:25,200 --> 00:28:28,480 other areas too like the spleen, but it's mostly inside your 463 00:28:28,480 --> 00:28:30,800 cells just kind of ready to be released as needed. 464 00:28:30,960 --> 00:28:32,720 OK. I love that analogy. 465 00:28:32,720 --> 00:28:34,640 Your iron savings account and I'll. 466 00:28:34,760 --> 00:28:38,850 Remember that one. So if somebody has normal 467 00:28:38,850 --> 00:28:42,370 hemoglobin and hematocrit, but they're ferritins low, what does 468 00:28:42,370 --> 00:28:44,810 that mean? And are there different levels 469 00:28:44,810 --> 00:28:47,330 of low ferritin? Like would you want to see 470 00:28:47,810 --> 00:28:51,490 ferritin levels that are higher than like the normal zone? 471 00:28:51,490 --> 00:28:54,970 Just like what Dr. Herman said, what's optimal ferritin versus 472 00:28:54,970 --> 00:28:57,170 what's normal ferritin? Yeah. 473 00:28:57,170 --> 00:29:00,450 So you can have normal hemoglobin, hematocrit, but your 474 00:29:00,450 --> 00:29:02,690 ferritin is low, right? That's fairly common. 475 00:29:04,090 --> 00:29:08,060 It just means that you're. Your blood, your red blood cell 476 00:29:08,060 --> 00:29:10,740 count is fine, but your iron savings are low, right? 477 00:29:10,740 --> 00:29:14,100 So your savings account is low, and so you're probably eating 478 00:29:14,100 --> 00:29:18,220 enough iron on a regular basis to cover your your immediate 479 00:29:18,220 --> 00:29:20,140 needs. But you're not eating an excess 480 00:29:20,140 --> 00:29:21,860 to where you can replenish that storage. 481 00:29:22,500 --> 00:29:25,900 So over time, it could lead to anemia, especially if you're 482 00:29:25,900 --> 00:29:29,540 doing more than usual or you're eating less than usual, and so 483 00:29:29,540 --> 00:29:31,900 whatever source of iron you're getting is not replenishing your 484 00:29:31,900 --> 00:29:34,690 stores. So I think the value is 485 00:29:34,690 --> 00:29:38,530 somewhere like below 20 nanograms per milliliter is the 486 00:29:38,530 --> 00:29:42,050 unit. But you know, for if you're 487 00:29:42,050 --> 00:29:45,450 lower than that then you then for the average person you know 488 00:29:45,450 --> 00:29:48,050 that would be considered low. But for an athlete, especially 489 00:29:48,050 --> 00:29:50,650 an endurance athlete, you probably want to be somewhere 490 00:29:50,650 --> 00:29:54,370 between 40 and 50 pretty regularly nanograms per 491 00:29:54,370 --> 00:29:57,850 milliliter, just in case you're not really getting enough iron 492 00:29:57,850 --> 00:29:59,410 from your diet. You always want to have some 493 00:29:59,410 --> 00:30:01,890 storage there for you just because it's so important. 494 00:30:02,430 --> 00:30:04,990 That's great. And again, iron savings account 495 00:30:04,990 --> 00:30:07,510 makes perfect sense. Did you have something to add? 496 00:30:07,910 --> 00:30:13,310 I did because oftentimes we'll also see low like normal red 497 00:30:13,310 --> 00:30:16,430 blood cells, normal hemoglobin, hematocrit, and we'll even see 498 00:30:16,430 --> 00:30:19,550 their red blood cell diameter with normal. 499 00:30:19,750 --> 00:30:22,830 We'll still see ferritin low. Usually I see that with women 500 00:30:22,830 --> 00:30:26,550 who are still having periods, regular periods. 501 00:30:27,160 --> 00:30:32,280 And so for athletes who are having periods and should there 502 00:30:32,280 --> 00:30:34,680 be a significant flow, we could see that. 503 00:30:35,000 --> 00:30:40,760 And so during those times, to fortify that athlete even more 504 00:30:40,760 --> 00:30:45,360 so with nutrients, foods, dark green leafy vegetables, 505 00:30:46,160 --> 00:30:51,720 molasses, raisins, anything that's going to replenish that 506 00:30:51,720 --> 00:30:56,100 basically blood loss. So when would a woman who's 507 00:30:56,100 --> 00:30:58,940 menstruating want to increase their iron? 508 00:30:58,940 --> 00:31:00,540 Like at what point in their cycle? 509 00:31:00,700 --> 00:31:02,660 Right. So usually right before their 510 00:31:02,660 --> 00:31:07,980 period is a really good time and then during their period and 511 00:31:07,980 --> 00:31:10,860 just that week after. So usually you get about two 512 00:31:10,860 --> 00:31:15,180 weeks where you're really trying to build up a little reserve, 513 00:31:15,580 --> 00:31:19,940 then you have your period and then you build back up again. 514 00:31:20,380 --> 00:31:22,380 OK, great. That's a that's a great 515 00:31:22,380 --> 00:31:25,340 suggestion. So you mentioned a fear foods 516 00:31:25,340 --> 00:31:28,500 that are iron rich, could you just go over those again? 517 00:31:28,500 --> 00:31:33,900 So if somebody has low ferritin or low blood iron, what foods 518 00:31:33,900 --> 00:31:37,700 should they focus on eating to try to get those levels up? 519 00:31:37,860 --> 00:31:41,860 And like you had mentioned earlier about absorption, there 520 00:31:41,860 --> 00:31:45,260 are certain foods or vitamins that help with iron absorption, 521 00:31:45,260 --> 00:31:48,620 right. So what would those foods or 522 00:31:48,620 --> 00:31:52,080 compounds be? So one thing that really helps 523 00:31:52,080 --> 00:31:58,440 to absorb iron is vitamin C So pairing foods that are iron rich 524 00:31:58,680 --> 00:32:03,480 with foods that have high vitamin C levels are perfect. 525 00:32:03,760 --> 00:32:09,160 So if you're having, let's say a steak, you can have a salad with 526 00:32:09,160 --> 00:32:12,400 like a lemon vinaigrette, you know, so you're getting the 527 00:32:12,400 --> 00:32:16,360 vitamin C, you're getting the iron and that food combining is 528 00:32:16,360 --> 00:32:18,480 going to help increase the absorption. 529 00:32:19,600 --> 00:32:22,800 Any of your dark green leafy vegetables are going to be a 530 00:32:22,800 --> 00:32:27,680 combination of iron and vitamin C And so that's going to be good 531 00:32:28,480 --> 00:32:34,280 if you're doing things where even and not everybody likes 532 00:32:34,280 --> 00:32:37,520 molasses, but it's a great source of iron actually. 533 00:32:38,080 --> 00:32:44,240 And so using that in shakes or smoothies, adding that in and 534 00:32:44,240 --> 00:32:46,760 also you know if you're going to have. 535 00:32:47,490 --> 00:32:52,050 Any kind of, you know, meal, you could always, you know, like 536 00:32:52,050 --> 00:32:57,130 oatmeal, throw some raisins on it, then you'll get your iron 537 00:32:57,330 --> 00:33:00,570 up. And now there are two different 538 00:33:00,570 --> 00:33:04,410 types of food sources of iron, right Heme and non heme. 539 00:33:05,050 --> 00:33:07,570 And one has better absorption than others. 540 00:33:07,570 --> 00:33:10,850 So, Dr. Pastoya, could you tell us the difference between the 541 00:33:10,850 --> 00:33:14,170 two and which one absorbs a little bit better? 542 00:33:15,700 --> 00:33:17,700 Yeah. So heme iron typically comes 543 00:33:17,700 --> 00:33:23,660 from animal products and the non heme iron usually is from the 544 00:33:23,660 --> 00:33:27,020 plant based sources. So plants are a little bit 545 00:33:27,020 --> 00:33:29,420 different, right, Then well, they're a lot different than us. 546 00:33:29,420 --> 00:33:32,500 They can't move, they can't detach themselves, they don't 547 00:33:32,500 --> 00:33:35,860 have flesh, they don't have organs in the way that we have 548 00:33:35,860 --> 00:33:38,460 organs. So what's interesting about 549 00:33:38,460 --> 00:33:42,020 plants is that they do have kind of their own blood. 550 00:33:42,580 --> 00:33:44,020 You can think of it as a plant blood. 551 00:33:44,970 --> 00:33:49,650 At the center of the what would be their hemoglobin instead of 552 00:33:49,730 --> 00:33:53,810 iron is actually magnesium. So they're kind of oriented a 553 00:33:53,810 --> 00:33:57,010 little bit differently but they do use iron as well. 554 00:33:57,010 --> 00:34:01,930 So not to get too off topic, but non heme iron is from usually 555 00:34:01,930 --> 00:34:05,290 plant sources and it's less absorbable than heme iron. 556 00:34:05,890 --> 00:34:08,969 And the reason is because the way that it's presented to the 557 00:34:08,969 --> 00:34:14,290 body is kind of not in an optimal, easy to access form so. 558 00:34:14,750 --> 00:34:19,590 The reason why you know eating meats is a little bit easier to 559 00:34:19,590 --> 00:34:23,630 obtain iron is because it's already packaged in the way 560 00:34:23,630 --> 00:34:27,590 that's deliverable to your body. It's already where it needs to 561 00:34:27,590 --> 00:34:29,989 be essentially. So it's just a lot easier for 562 00:34:29,989 --> 00:34:34,310 your body to grab that heme from the the meat versus the plants. 563 00:34:34,310 --> 00:34:36,590 It's not to say that you're not going to absorb any from plant 564 00:34:36,590 --> 00:34:39,389 based diets. So it's just a difference 565 00:34:39,389 --> 00:34:42,670 between the source essentially that creates absorption 566 00:34:42,670 --> 00:34:44,730 differences. OK, thank you. 567 00:34:44,889 --> 00:34:48,690 That makes perfect sense. And then finally on the topic of 568 00:34:48,690 --> 00:34:52,850 anemia and iron, if somebody just can't get enough iron from 569 00:34:52,850 --> 00:34:55,610 their diet and their doctor determines that they need a 570 00:34:55,610 --> 00:34:58,650 supplement, what options are out there? 571 00:34:59,810 --> 00:35:03,410 Dr. Herman had mentioned earlier that it's important to have an 572 00:35:03,450 --> 00:35:06,050 iron supplement that contains a couple of B vitamins. 573 00:35:06,050 --> 00:35:09,770 So what should people look for? Is there a particular supplement 574 00:35:09,770 --> 00:35:12,250 that you both recommend to your patients? 575 00:35:13,030 --> 00:35:16,070 Doctor Herman, can you go first? Absolutely. 576 00:35:16,070 --> 00:35:19,910 So the form of iron that I really like is iron 577 00:35:19,910 --> 00:35:23,230 bisglycinate. I find that it's the most gentle 578 00:35:23,510 --> 00:35:28,030 on your stomach and the least likely to cause any type of 579 00:35:28,030 --> 00:35:33,470 Constipation. So any form of iron 580 00:35:33,470 --> 00:35:37,590 bisglycinate, any anything that's clean doesn't have any 581 00:35:38,510 --> 00:35:41,990 heavy metals toxins usually on the bottle. 582 00:35:42,340 --> 00:35:46,300 You'll see that they will state that that there's no Pcb's, 583 00:35:46,300 --> 00:35:49,340 there's no plastics, there's no nothing that's like a 584 00:35:49,340 --> 00:35:53,540 contaminant, There's no additives, preservatives, you 585 00:35:53,540 --> 00:35:55,820 know, there's several companies that are out there that are 586 00:35:55,820 --> 00:35:58,580 really great. I do like to pair it with 587 00:35:58,580 --> 00:36:03,700 vitamin CI, like vitamin C from tapioca sources. 588 00:36:03,700 --> 00:36:09,980 That tends to be the least allergic reaction, one that 589 00:36:09,980 --> 00:36:14,410 people can utilize. I like to do the iron with 590 00:36:15,130 --> 00:36:19,650 vitamin B12, like a methylated form of B12 and methylated form 591 00:36:19,690 --> 00:36:26,490 of folic acid to also help with increasing red blood cells and 592 00:36:26,490 --> 00:36:31,410 overcoming anemia. And yeah, that would be probably 593 00:36:31,410 --> 00:36:35,610 what I would start with. Great Doctor Pastoya, do you 594 00:36:35,610 --> 00:36:39,370 have anything to add on your preferred iron supplements? 595 00:36:39,800 --> 00:36:41,520 I actually don't prescribe them very often. 596 00:36:41,720 --> 00:36:46,760 Usually what I'll tell people is really look for the foods that 597 00:36:46,760 --> 00:36:49,680 have iron that are iron rich and include those in your diet. 598 00:36:49,760 --> 00:36:52,240 And not only is that going to provide you more iron, but it's 599 00:36:52,240 --> 00:36:54,440 also going to provide you additional nutrients as well. 600 00:36:55,160 --> 00:37:00,000 So that's my preferred method for supplementing iron, so to 601 00:37:00,000 --> 00:37:03,010 speak. And I'll even tell people if if 602 00:37:03,010 --> 00:37:06,370 they're not strict vegetarians, but they do better. 603 00:37:06,370 --> 00:37:09,530 As an athlete on a plant based diet, I usually say, well 604 00:37:09,690 --> 00:37:13,450 consider having some source of iron once a week and consider 605 00:37:13,450 --> 00:37:16,690 that to be your supplement. So if it's a piece of red meat 606 00:37:16,690 --> 00:37:20,770 or it's some oysters or something, I prefer to prescribe 607 00:37:20,770 --> 00:37:22,570 foods. In that sense, I think that it 608 00:37:22,570 --> 00:37:25,170 just works better and and people are like, I don't want to take 609 00:37:25,170 --> 00:37:27,250 any capsules, I'm already taking too many capsules. 610 00:37:28,030 --> 00:37:29,310 So that's what I usually default to. 611 00:37:29,430 --> 00:37:30,950 That's great. That makes a lot of sense. 612 00:37:31,470 --> 00:37:34,030 One more question about iron. Sorry, I said that was the last 613 00:37:34,030 --> 00:37:36,790 one. But another way that people 614 00:37:36,790 --> 00:37:41,350 sometimes try to get iron in their diets is by cooking with a 615 00:37:41,950 --> 00:37:45,390 particular pan that has iron in it. 616 00:37:45,710 --> 00:37:48,910 Is that a good way to increase your iron intake? 617 00:37:49,950 --> 00:37:53,350 If people are gonna do that, do you have any tips for them? 618 00:37:54,070 --> 00:37:55,910 I think it's a good way to get more iron. 619 00:37:57,700 --> 00:38:00,380 It is an interesting way to get iron, that's for sure, but it 620 00:38:00,380 --> 00:38:02,380 has been shown to increase your iron levels. 621 00:38:02,540 --> 00:38:05,780 So if you're using cast iron cookware for a long time. 622 00:38:05,780 --> 00:38:10,260 So cast iron cookware, right? It's literally just like 100% 623 00:38:10,260 --> 00:38:11,900 iron. A lot of in a lot of cases it's 624 00:38:11,900 --> 00:38:14,900 super heavy and like annoying to cook with sometimes. 625 00:38:14,900 --> 00:38:19,140 But if you like cast iron cookware, if you use it for a 626 00:38:19,140 --> 00:38:22,980 long time, you can get some some side effects of just having too 627 00:38:22,980 --> 00:38:26,500 much iron. So it definitely does increase 628 00:38:26,500 --> 00:38:29,830 your iron levels. I'm not sure if there's any kind 629 00:38:29,830 --> 00:38:32,630 of research out there on. There's probably at least a few 630 00:38:32,630 --> 00:38:38,190 articles about people's iron levels and associations with how 631 00:38:38,190 --> 00:38:40,910 often they're using iron cookware, so I think it's 632 00:38:40,910 --> 00:38:42,590 probably something that can help you a little bit. 633 00:38:42,950 --> 00:38:45,070 I just wanted to add something to that. 634 00:38:45,390 --> 00:38:52,830 So oftentimes I would say that if you're going to be cooking 635 00:38:52,830 --> 00:38:58,040 with cast iron or even taking. I would say mostly with cast 636 00:38:58,040 --> 00:39:04,800 iron is that if it's a woman who is no longer menstruating and 637 00:39:05,360 --> 00:39:09,760 not all men, but a good portion of men don't need that extra 638 00:39:09,760 --> 00:39:13,680 iron. And So what can happen though is 639 00:39:13,680 --> 00:39:19,280 that they can build up excessive iron and we could see that in 640 00:39:19,280 --> 00:39:22,680 blood work. And so I think it's a fine line. 641 00:39:23,210 --> 00:39:29,770 That you walk between foods that are iron rich, your ability to 642 00:39:29,770 --> 00:39:34,010 absorb the iron and nutrients from those foods and then going 643 00:39:34,010 --> 00:39:38,050 ahead and supplementing. So I think that definitely 644 00:39:38,050 --> 00:39:45,250 working with a Doctor Who is very savvy with blood tests in 645 00:39:45,250 --> 00:39:49,650 relation to an athlete and their specific needs and being able to 646 00:39:49,650 --> 00:39:52,640 interpret those. Test results is going to be 647 00:39:52,640 --> 00:39:54,760 important because you really wouldn't want it. 648 00:39:54,760 --> 00:39:58,960 Like Dr. Pistoya said, you don't want to accumulate too much iron 649 00:39:58,960 --> 00:40:02,880 because then you wind up having other issues that you don't want 650 00:40:03,120 --> 00:40:04,480 as an athlete. Right. 651 00:40:04,640 --> 00:40:08,960 Yeah, Hemochromatosis, right. Yeah, The technical term, yeah. 652 00:40:08,960 --> 00:40:13,360 And that can cause problems with your liver, kidneys, defects, 653 00:40:13,360 --> 00:40:16,920 muscle function. So just like everything else, 654 00:40:16,920 --> 00:40:21,260 there's always a medium. You don't want too little and 655 00:40:21,260 --> 00:40:24,500 you don't want too much. And iron is definitely one of 656 00:40:24,500 --> 00:40:26,060 those things. Yes. 657 00:40:27,340 --> 00:40:29,060 All right. So we're going to move on to the 658 00:40:29,060 --> 00:40:33,500 next blood marker that I think is commonly affected in 659 00:40:33,500 --> 00:40:35,940 endurance athletes, and that is calcium. 660 00:40:36,500 --> 00:40:40,340 So we all know that calcium is important for our bones, but I 661 00:40:40,340 --> 00:40:42,860 don't think everyone really understands why. 662 00:40:43,260 --> 00:40:46,740 So, Dr. Herman, can you tell us why calcium is important for 663 00:40:46,740 --> 00:40:49,060 bone health? Absolutely. 664 00:40:50,020 --> 00:40:55,820 Calcium actually helps your body create bone cells that will 665 00:40:55,820 --> 00:41:01,180 eventually lay down within the matrix of your bones themselves. 666 00:41:01,940 --> 00:41:07,740 And so you know, it also helps with muscle contraction. 667 00:41:08,620 --> 00:41:13,740 It actually can help break down fats and use them for energy. 668 00:41:15,220 --> 00:41:19,490 It can help with. You know, creating and well 669 00:41:19,490 --> 00:41:23,330 controlling the creation of adenosine triphosphate. 670 00:41:23,330 --> 00:41:27,010 So there's a lot of physiological pathways that 671 00:41:27,010 --> 00:41:30,210 calcium is involved with and bone. 672 00:41:30,210 --> 00:41:33,610 I think a lot of people think that bone is just this static 673 00:41:33,610 --> 00:41:37,330 structure, but it's not. It's constantly being built up 674 00:41:37,330 --> 00:41:42,130 and broken down, and ultimately calcium levels are important for 675 00:41:42,450 --> 00:41:47,230 maintaining that balance of you don't want more bone breakdown 676 00:41:47,230 --> 00:41:51,150 than build up. Absolutely, absolutely. 677 00:41:51,470 --> 00:41:55,550 And so you want to make sure that somebody is testing for 678 00:41:55,550 --> 00:42:00,790 calcium and usually through a general blood test they're 679 00:42:00,790 --> 00:42:06,310 testing either serum or plasma calcium, which is a nice marker, 680 00:42:07,350 --> 00:42:14,040 but there is also calcium in. Your T cells that actually could 681 00:42:14,440 --> 00:42:19,400 potentially find out if you're needing more than what is 682 00:42:19,400 --> 00:42:22,680 showing up in a regular blood test through like Quest or 683 00:42:22,680 --> 00:42:28,360 LabCorp. So, but dietary wise, usually 684 00:42:28,360 --> 00:42:32,720 you want your calcium to keep like strong bones and to prevent 685 00:42:32,720 --> 00:42:36,040 like stress fractures from happening, helping with 686 00:42:36,040 --> 00:42:40,330 repairing bone. Often times you need about 1500 687 00:42:40,330 --> 00:42:44,890 milligrams a day, and that's for both men and women. 688 00:42:45,530 --> 00:42:49,810 Usually our need for calcium goes up as we get older. 689 00:42:49,810 --> 00:42:54,170 So older athletes need to really make sure that they're getting 690 00:42:54,170 --> 00:42:59,930 enough calcium and that they're absorbing it, and that when you 691 00:42:59,930 --> 00:43:03,090 do take calcium that you're only taking calcium. 692 00:43:03,630 --> 00:43:07,430 In small amounts, because the body can only absorb maybe about 693 00:43:07,430 --> 00:43:10,630 four, 500 milligrams of calcium at a time. 694 00:43:10,990 --> 00:43:14,590 So if you're taking all of that calcium at one time, you're 695 00:43:14,590 --> 00:43:18,110 going to, your body is getting rid of it because it just can't 696 00:43:18,310 --> 00:43:22,630 uptake it all at once. And to take it with food so that 697 00:43:22,750 --> 00:43:26,750 the digestion of the food helps with breaking down the calcium 698 00:43:26,750 --> 00:43:30,350 that you just took in, and usually with different calcium 699 00:43:30,350 --> 00:43:34,030 forms. You know the suggestion is to do 700 00:43:34,030 --> 00:43:37,150 more of like a calcium carbonate, but that's a really 701 00:43:37,150 --> 00:43:42,390 hard form to digest sometimes, and so calcium citrate or 702 00:43:42,390 --> 00:43:47,870 calcium oritate or lactate can be an easier form for the body 703 00:43:47,870 --> 00:43:51,350 to digest and breakdown. And why is why are calcium 704 00:43:51,350 --> 00:43:53,790 supplements always paired with vitamin D? 705 00:43:54,110 --> 00:43:56,590 Does it play a role in calcium absorption? 706 00:43:56,990 --> 00:44:00,150 Yes, it does actually. So vitamin D is a vitamin D is a 707 00:44:00,150 --> 00:44:02,270 hormone, right. So it's kind of a misnomer that 708 00:44:02,270 --> 00:44:08,110 we call it a vitamin, A vitamin. When we refer to a vitamin, we 709 00:44:08,110 --> 00:44:12,150 we really think more of a compound that's needed to make 710 00:44:12,150 --> 00:44:14,070 some chemical reaction in the body. 711 00:44:14,550 --> 00:44:17,990 So if we're trying to extract nutrients from food, we need to 712 00:44:17,990 --> 00:44:20,790 B vitamins to do that for us. So we need those physical 713 00:44:20,790 --> 00:44:23,310 compounds to come in and catalyze those reactions. 714 00:44:24,210 --> 00:44:27,810 Hormones are actually more to do with information, and they're 715 00:44:27,810 --> 00:44:29,450 kind of like messenger molecules. 716 00:44:29,570 --> 00:44:32,890 So when a hormone's released, it tells the body to do something. 717 00:44:33,530 --> 00:44:37,130 And so vitamin D, for example, is kind of like what 718 00:44:37,130 --> 00:44:40,810 orchestrates the calcium in the body. 719 00:44:40,810 --> 00:44:45,610 So the way that calcium is moved and stored and utilized in the 720 00:44:45,610 --> 00:44:47,610 body is orchestrated by vitamin D. 721 00:44:47,970 --> 00:44:50,130 So it's kind of like the conductor right in an orchestra 722 00:44:50,650 --> 00:44:52,930 and it's telling it you have to do this specific thing, go to 723 00:44:52,930 --> 00:44:57,130 this specific place. And so it's it's not so easy. 724 00:44:57,130 --> 00:44:59,490 It's just like oh, the calcium comes in and it knows where to 725 00:44:59,490 --> 00:45:00,970 go, the body knows how to use it. 726 00:45:01,650 --> 00:45:03,650 It's it's a lot more complicated than that. 727 00:45:04,290 --> 00:45:08,690 So taking it together with Vitamin DI, guess it would be 728 00:45:08,690 --> 00:45:12,410 kind of theoretically that the vitamin D would ensure that the 729 00:45:12,410 --> 00:45:15,250 calcium is is going to the right place which is inside your 730 00:45:15,250 --> 00:45:17,440 bones. Because it can just be stored in 731 00:45:17,440 --> 00:45:19,920 your arteries as well. And that's something that's 732 00:45:19,920 --> 00:45:23,520 fairly common is we'll see calcification, it's called in 733 00:45:23,520 --> 00:45:26,480 the arteries. And so there are some thoughts 734 00:45:26,480 --> 00:45:28,480 of that. Well, maybe it's from calcium 735 00:45:28,480 --> 00:45:30,880 supplements, just taking straight up high doses of 736 00:45:30,880 --> 00:45:33,560 calcium. And I think that there's some 737 00:45:33,560 --> 00:45:37,280 sense of that because if if it's the body doesn't do anything 738 00:45:37,280 --> 00:45:40,320 with it, then instead of, you know, if you're going to go to 739 00:45:40,320 --> 00:45:43,640 the bathroom, pee it out or poop it out, your body may just hold 740 00:45:43,640 --> 00:45:45,580 on to it. Whatever is a convenient place 741 00:45:45,580 --> 00:45:48,420 to store it and so that can lead to issues down the road. 742 00:45:48,420 --> 00:45:51,100 So the bottom line is that taking it with vitamin D is 743 00:45:51,140 --> 00:45:54,580 thought to have a better effect in terms of how the calcium is 744 00:45:54,580 --> 00:45:58,580 being utilized. Regarding vitamin D, of course 745 00:45:58,660 --> 00:46:02,500 our bodies make vitamin D when our skin is exposed to the sun. 746 00:46:02,500 --> 00:46:07,020 But you know, for those of us living in Connecticut, we don't 747 00:46:07,020 --> 00:46:10,180 always get all that sun exposure year round. 748 00:46:10,180 --> 00:46:14,510 So because basically everybody need to supplement with vitamin 749 00:46:14,510 --> 00:46:19,190 D, are people able to get enough vitamin D through food alone? 750 00:46:19,590 --> 00:46:23,310 Should people change their vitamin D supplementation based 751 00:46:23,310 --> 00:46:26,710 on the season? What are your thoughts and 752 00:46:26,710 --> 00:46:31,030 recommendations regarding that? Yes, usually what I do with 753 00:46:31,070 --> 00:46:33,310 athletes is they test them twice a year. 754 00:46:33,660 --> 00:46:37,340 I test them in the winter time and I test them in the summer 755 00:46:37,340 --> 00:46:40,940 time and I adjust. So usually, especially up here 756 00:46:40,940 --> 00:46:44,580 in the Northeast where we do find more deficiencies of 757 00:46:44,580 --> 00:46:51,980 Vitamin DI would more often than not the levels would be such 758 00:46:51,980 --> 00:46:57,500 that 5000 international units per day would be appropriate. 759 00:46:57,930 --> 00:47:02,090 And then dropping them down in the summertime to about 1002 760 00:47:02,090 --> 00:47:05,250 thousand international units, because now they're spending 761 00:47:05,250 --> 00:47:10,130 more time outside with more skin exposure and they're making and 762 00:47:10,130 --> 00:47:12,450 converting more vitamin D in the skin. 763 00:47:12,650 --> 00:47:15,490 So they're less likely to need that, but definitely in the 764 00:47:15,490 --> 00:47:19,610 winter time, bumping it up. And is there an issue with 765 00:47:19,610 --> 00:47:23,050 taking too much vitamin D or too much calcium? 766 00:47:24,090 --> 00:47:26,250 Yeah, there's definitely issues with both. 767 00:47:26,900 --> 00:47:31,740 So especially with vitamin D and really any fat soluble vitamin, 768 00:47:32,260 --> 00:47:36,660 so fat soluble vitamins just means that it basically is 769 00:47:36,700 --> 00:47:39,340 dissolved in fat. So a lot of times you'll see 770 00:47:39,340 --> 00:47:41,980 vitamin D comes in those capsules, those gel capsules 771 00:47:41,980 --> 00:47:43,860 with like some kind of oil to carry it. 772 00:47:44,620 --> 00:47:48,700 And the reason that there's an issue with fat soluble vitamins 773 00:47:48,700 --> 00:47:51,780 is because our body will will store the excess in our fat. 774 00:47:52,560 --> 00:47:56,080 And so if we have too much vitamin D, it's basically toxic 775 00:47:56,080 --> 00:47:58,640 to the body. And so I don't know specific 776 00:47:58,640 --> 00:48:01,520 symptoms of it, but there's probably various systemic 777 00:48:01,520 --> 00:48:04,320 symptoms. Now remember this, do you 778 00:48:04,320 --> 00:48:08,560 remember the specific name, Dr. Herman of too much vitamin C? 779 00:48:08,560 --> 00:48:11,480 It's something toxicosis or one of those. 780 00:48:12,200 --> 00:48:14,960 Vitamin toxicosis. Yeah, Vitamin D toxicosis or 781 00:48:14,960 --> 00:48:19,040 something like that, yeah. Yes, So that basically it's 782 00:48:19,040 --> 00:48:22,580 just. You know, winding up now that 783 00:48:22,580 --> 00:48:26,660 it's being stored in organs and your body's not able to filter 784 00:48:26,660 --> 00:48:33,020 it out quick enough and so it could actually damage liver, 785 00:48:33,020 --> 00:48:37,620 kidneys, and obviously you don't want that. 786 00:48:37,820 --> 00:48:42,020 Yeah. And with calcium, I mean I don't 787 00:48:42,020 --> 00:48:46,340 know if if the the studies show this specifically but my hunch 788 00:48:46,340 --> 00:48:49,260 is that with high dose calcium you're you can create. 789 00:48:49,600 --> 00:48:53,000 Arterial calcifications and so that can lead to hardening of 790 00:48:53,000 --> 00:48:55,920 the arteries and worsen, the kind of natural stiffening that 791 00:48:55,920 --> 00:48:59,200 we see with aging. But you can also kind of alter 792 00:48:59,200 --> 00:49:01,800 the micro environment of your stomach too. 793 00:49:02,040 --> 00:49:04,800 That's really more so with the Tums and the calcium that's 794 00:49:04,800 --> 00:49:09,160 designed to act in the stomach. And so initially it may help 795 00:49:09,160 --> 00:49:12,080 you, but then down the road you may have issues with the acid 796 00:49:12,080 --> 00:49:14,320 and base balance in your stomach just from taking too much 797 00:49:14,320 --> 00:49:17,040 calcium a long term. Absolutely. 798 00:49:17,430 --> 00:49:20,270 If you're working with a runner, let's say someone who's training 799 00:49:20,270 --> 00:49:23,950 for a marathon, what are you looking for in terms of their 800 00:49:23,950 --> 00:49:26,630 blood calcium levels? What would be an optimum level 801 00:49:26,630 --> 00:49:30,670 for that athlete? I like for athletes to have a 802 00:49:30,670 --> 00:49:36,270 calcium level of about, I'd say 99.2. 803 00:49:37,870 --> 00:49:42,550 And I find that when, you know, I have an athlete that has that 804 00:49:42,550 --> 00:49:47,430 level, we could see that their bones are being supported, the 805 00:49:47,430 --> 00:49:52,870 hearts being supported. It's actually helping use up 806 00:49:52,910 --> 00:49:55,470 different sources of energy in the body. 807 00:49:55,790 --> 00:50:00,150 That's going to make them a better endurance athlete. 808 00:50:00,150 --> 00:50:04,590 So if you have somebody whose values are low, what foods do 809 00:50:04,590 --> 00:50:07,510 you recommend for people to get their calcium levels up? 810 00:50:09,130 --> 00:50:14,890 So I actually like people to, you know, definitely take in 811 00:50:14,890 --> 00:50:17,330 their proteins because there's calcium in that. 812 00:50:17,970 --> 00:50:20,330 Your dark green leafy vegetables, again, will have 813 00:50:20,330 --> 00:50:26,450 calcium even like black sesame seeds. 814 00:50:26,850 --> 00:50:30,530 Sprinkling that over your foods is a great source of calcium 815 00:50:31,850 --> 00:50:35,750 even. For women, red Raspberry leaf 816 00:50:35,750 --> 00:50:38,870 tea is a great source of calcium and oats straw. 817 00:50:38,870 --> 00:50:40,750 What is oats straw? I don't think I've. 818 00:50:40,750 --> 00:50:43,870 Ever had that? It's a, it's a it's it's a plant 819 00:50:43,910 --> 00:50:47,150 and you know, it's a great source of calcium. 820 00:50:47,590 --> 00:50:51,670 It's very nourishing for the body over kind of an overall 821 00:50:51,670 --> 00:50:54,910 tonic, OK? Is that? 822 00:50:55,030 --> 00:50:56,950 How would you prepare it or eat it? 823 00:50:57,070 --> 00:50:58,950 Oh, go ahead, Dr. Pistoya, what were you gonna say? 824 00:50:58,950 --> 00:51:02,490 It's also called Avena sativa. In the herbal medicine world, 825 00:51:02,770 --> 00:51:04,650 OK. It's it's been used for a long 826 00:51:04,650 --> 00:51:05,930 time. I've actually heard of that. 827 00:51:07,130 --> 00:51:09,010 Wow, you know the Latin name and not the regular name. 828 00:51:09,010 --> 00:51:14,210 I'm surprised I do. Usually it's all the way around 829 00:51:17,250 --> 00:51:20,530 if somebody needs. So if foods aren't enough to get 830 00:51:20,530 --> 00:51:24,370 someone's blood calcium levels up, what kind of calcium 831 00:51:24,370 --> 00:51:26,890 supplement would you recommend? I know Dr. Herman mentioned that 832 00:51:26,890 --> 00:51:30,960 there are a few kinds and one is a little bit easier to absorb, 833 00:51:31,320 --> 00:51:33,800 but others are a little bit gentler on the stomach. 834 00:51:33,800 --> 00:51:37,320 So what's your like? What's the most common one that 835 00:51:37,320 --> 00:51:38,920 you're recommending to your patients? 836 00:51:39,840 --> 00:51:46,000 I'd say it's probably a combination of hydroxy apatite, 837 00:51:46,000 --> 00:51:53,400 calcium and probably a calcium glycinate or a tape combination. 838 00:51:53,440 --> 00:51:55,360 OK. And then with the D? 839 00:51:55,880 --> 00:51:58,640 With vitamin D and I give vitamin K too. 840 00:51:59,060 --> 00:52:01,220 OK. And what does the K do in 841 00:52:01,220 --> 00:52:08,100 relation to those other two? So basically vitamin D helps the 842 00:52:08,100 --> 00:52:11,740 absorption of calcium and the best way I could describe 843 00:52:11,740 --> 00:52:15,140 vitamin K is vitamin K kind of tells it where to go once it's 844 00:52:15,140 --> 00:52:17,100 in the body. OK, awesome. 845 00:52:17,820 --> 00:52:21,660 So it's the additional conductor in that orchestra until you're. 846 00:52:21,860 --> 00:52:26,590 In the store, Yeah, Doctor Pistoya, do you have a 847 00:52:26,590 --> 00:52:29,070 particular supplement that you prefer? 848 00:52:30,990 --> 00:52:34,030 It's the same thing with iron. You know, I tend to shy away 849 00:52:34,030 --> 00:52:37,390 from giving the supplements, and a lot of times people come in, 850 00:52:37,430 --> 00:52:39,830 they're already taking a supplement and they're like, 851 00:52:39,830 --> 00:52:42,390 it's, you know, I'm not really noticing any differences and so 852 00:52:42,390 --> 00:52:44,950 I usually go okay. Well, you know, what kind of 853 00:52:44,950 --> 00:52:47,310 exercises are you doing? Are you giving your bones any 854 00:52:47,310 --> 00:52:49,830 reason to hold on to more calcium? 855 00:52:50,510 --> 00:52:51,990 That's usually where I go with people. 856 00:52:53,800 --> 00:52:56,040 But, you know, it depends on everyone's individual needs. 857 00:52:56,040 --> 00:52:59,680 So I think what Dr. Herman says, probably she probably has the 858 00:52:59,680 --> 00:53:02,440 best advice on which form to use when it comes to 859 00:53:02,440 --> 00:53:04,720 supplementation. All right, so we're going to 860 00:53:04,720 --> 00:53:09,960 move on to vitamin B12. So can you tell me, Dr. Pastoya, 861 00:53:09,960 --> 00:53:13,160 what functions B12 performs in the body? 862 00:53:13,800 --> 00:53:17,480 Yeah, so B12 is another. I mean, every vitamin is a 863 00:53:17,480 --> 00:53:21,000 critical vitamin, right? So B12. 864 00:53:22,190 --> 00:53:25,070 Has a lot to do with red blood cell formation. 865 00:53:25,350 --> 00:53:28,430 So the way that red blood cells are formed in addition to iron 866 00:53:28,430 --> 00:53:30,830 also requires vitamin B12 as well. 867 00:53:32,270 --> 00:53:37,230 Beyond that, it's also necessary for actually creating DNA. 868 00:53:37,630 --> 00:53:40,070 So it's like a really super critical function. 869 00:53:41,030 --> 00:53:44,230 So the way that cells are kind of dividing and the information 870 00:53:44,230 --> 00:53:47,190 for the division of those cells requires DNA, which is just 871 00:53:47,190 --> 00:53:49,230 fundamental pieces of information in the body. 872 00:53:50,070 --> 00:53:52,390 And then also neurological functions. 873 00:53:52,390 --> 00:53:55,470 So people may be familiar with, you know, just having 874 00:53:55,590 --> 00:53:59,510 neurological issues from like vitamin B12 or you know, vitamin 875 00:53:59,510 --> 00:54:01,710 B6 imbalances or something like that. 876 00:54:02,470 --> 00:54:05,630 And then like the other B vitamins, it also helps with 877 00:54:06,230 --> 00:54:10,630 metabolism, so specifically with amino acids and fatty acids, 878 00:54:10,630 --> 00:54:13,510 just sort of breaking them down and extracting the active. 879 00:54:14,000 --> 00:54:17,960 Components from them. So if a runner was low in B12, 880 00:54:17,960 --> 00:54:21,800 what symptoms might they be having, or how might it be 881 00:54:22,120 --> 00:54:27,680 affecting their performance? So definitely reduced endurance 882 00:54:27,680 --> 00:54:30,840 capabilities overall, and that's probably because if you're in a 883 00:54:30,840 --> 00:54:34,680 true deficiency, you might have a what's called a megaloblastic 884 00:54:34,680 --> 00:54:37,870 anemia. And so Megalo just meaning big. 885 00:54:37,870 --> 00:54:41,430 So they're just instead of we're in the case with iron, they 886 00:54:41,430 --> 00:54:44,190 usually the cells a little bit smaller I believe without iron, 887 00:54:44,950 --> 00:54:49,390 with B12 it's actually bigger. So and you can see that on a on 888 00:54:49,390 --> 00:54:51,270 a lab it just looks like a giant cell. 889 00:54:51,990 --> 00:54:56,790 And so that sort of anemia would also come with its fatigue. 890 00:54:57,510 --> 00:55:01,550 You may also have muscle weakness or more neurological 891 00:55:01,550 --> 00:55:04,070 problems versus iron, where iron is more of your. 892 00:55:04,700 --> 00:55:07,740 Higher you may have heart palpitations, you may be dizzy. 893 00:55:07,780 --> 00:55:11,100 This is more of a neurological type of thing, so like shakiness 894 00:55:11,100 --> 00:55:13,900 or dizziness or. Probably like a numbness or a 895 00:55:13,900 --> 00:55:18,180 tingling would be the big thing and and just feeling sort of a 896 00:55:18,180 --> 00:55:21,300 weakness too I would say would be the other thing and are 897 00:55:21,420 --> 00:55:25,140 vegetarians or vegans at greater risk of a B12 deficiency? 898 00:55:25,820 --> 00:55:30,780 I would say so and I would say about 50%. 899 00:55:31,250 --> 00:55:34,690 Vegetarians and vegans probably aren't getting adequate 900 00:55:34,690 --> 00:55:39,450 nutrition, and that's because it's harder to get as much as a 901 00:55:39,530 --> 00:55:44,250 vegetarian or vegan. And and that's not because 902 00:55:44,290 --> 00:55:47,690 vegetables or and fruits are inherently less nutrient dense 903 00:55:47,690 --> 00:55:51,170 than meats. It's just because it, at least 904 00:55:51,170 --> 00:55:53,690 in my experience, they tend to be eating more processed foods. 905 00:55:54,410 --> 00:55:57,490 So it's like they're avoiding meats because of various 906 00:55:57,490 --> 00:56:00,120 reasons, and that's fine. And there's advantages to that, 907 00:56:00,360 --> 00:56:01,960 but then they're kind of replacing some of it with the 908 00:56:01,960 --> 00:56:05,240 process stuff. So yes. 909 00:56:05,240 --> 00:56:09,000 And then the concentrated sources of B12 are things like 910 00:56:09,000 --> 00:56:12,720 egg yolks and just muscle tissue itself from animals. 911 00:56:13,240 --> 00:56:17,320 So unless the foods are actually fortified with added B12, then 912 00:56:17,320 --> 00:56:20,400 it becomes harder to gain just organically naturally occurring 913 00:56:20,400 --> 00:56:22,880 sources of the B12 which you'll get in the animal products. 914 00:56:22,920 --> 00:56:26,200 Are there any plant sources of B12 or just animal? 915 00:56:27,050 --> 00:56:31,050 I think I could be wrong about this, but I think that natto 916 00:56:31,050 --> 00:56:34,050 might be a source or that might be confusing with vitamin K2. 917 00:56:35,530 --> 00:56:37,610 I'm actually not too sure and I have to look at. 918 00:56:37,890 --> 00:56:41,810 Usually in fermented like kombucha, you can find B 919 00:56:41,810 --> 00:56:46,730 vitamins in, but it might not be in a level that an athlete can. 920 00:56:47,130 --> 00:56:51,730 It'll be good, and you could add too, but they still might need 921 00:56:51,730 --> 00:56:55,450 supplementation for it. So in your fermented foods. 922 00:56:55,790 --> 00:57:01,630 All right, so good food sources of B12 would be meats, eggs, 923 00:57:01,870 --> 00:57:03,990 fermented foods. Yeah, the egg yolk. 924 00:57:04,950 --> 00:57:08,190 Yeah, well, that's the most delicious part of it, so. 925 00:57:09,630 --> 00:57:14,590 What is an egg without the yolk for an endurance athlete, what 926 00:57:14,590 --> 00:57:18,270 would what B12 levels would you look for in their blood work? 927 00:57:19,510 --> 00:57:25,530 So usually on lab work. Say through Quest, I believe 928 00:57:25,530 --> 00:57:33,970 their range is about 400 to 1100 picagrams per milliliter, which 929 00:57:33,970 --> 00:57:36,610 is normal. But I really like to see 930 00:57:36,730 --> 00:57:40,650 actually everybody but definitely athletes well above a 931 00:57:40,650 --> 00:57:45,170 400. I like to see them around A700I 932 00:57:45,170 --> 00:57:49,210 find that and research has shown that when you have levels that 933 00:57:49,210 --> 00:57:53,560 are about 400. And lower, actually I think that 934 00:57:53,560 --> 00:57:56,640 quest is even lower. I think it's like 2 or 300 to 935 00:57:56,640 --> 00:58:00,680 about 1100. And so research has shown that 936 00:58:00,920 --> 00:58:04,720 when you have levels around a 400 or less, you can have 937 00:58:04,720 --> 00:58:08,040 neurological psychological and hematological issues. 938 00:58:08,360 --> 00:58:12,200 And so, especially for the athlete who's using up their 939 00:58:12,200 --> 00:58:15,720 nutrients at such a tremendous rate, I like to keep them up at 940 00:58:15,720 --> 00:58:19,700 around a 700. And there I know there are 941 00:58:19,700 --> 00:58:22,380 different means of B12 supplementation. 942 00:58:22,380 --> 00:58:25,660 Some people get an injection, some people take pills. 943 00:58:26,300 --> 00:58:28,500 Is one way better than the other? 944 00:58:28,500 --> 00:58:32,580 If your B12 is really low, is it better to get an injection from 945 00:58:32,580 --> 00:58:35,260 your doctor or? Absolutely. 946 00:58:35,700 --> 00:58:40,380 OK, so why is that? Because what can happen is that 947 00:58:40,380 --> 00:58:44,540 again, it goes back to somebody's ability to absorb 948 00:58:44,540 --> 00:58:46,780 B12. But the other thing with B12. 949 00:58:47,340 --> 00:58:50,340 Is In order for it to be absorbed properly, it first has 950 00:58:50,340 --> 00:58:55,580 to be methylated and then it needs to pair up with something 951 00:58:55,580 --> 00:59:01,380 called intrinsic factor in the in your body in order to absorb 952 00:59:01,380 --> 00:59:02,940 properly. So it needs these other 953 00:59:02,940 --> 00:59:07,260 chaperones in order to be taken up into your system. 954 00:59:07,260 --> 00:59:10,340 Otherwise it's not getting there and then getting an injection or 955 00:59:10,340 --> 00:59:13,660 an infusion would bypass the need for that and it goes right 956 00:59:13,660 --> 00:59:17,670 into your system. And some people have a genetic 957 00:59:17,710 --> 00:59:20,150 issue where they don't methylate properly. 958 00:59:20,150 --> 00:59:22,230 Is that correct? That is correct. 959 00:59:22,230 --> 00:59:28,950 So if you have a mthfr mutation, you're you're going to not be 960 00:59:28,950 --> 00:59:33,750 able or capable, or you might be impaired in some way of 961 00:59:33,750 --> 00:59:37,990 methylating that cyanocobalamin in order to be able to be taken 962 00:59:37,990 --> 00:59:41,510 up into your system. And so definitely just. 963 00:59:42,110 --> 00:59:46,110 You're basically jumping over that step and going right to a 964 00:59:46,110 --> 00:59:50,750 methylated form and not even bothering with just a plain 965 00:59:50,750 --> 00:59:53,270 cyanocobalamine. And how? 966 00:59:53,310 --> 00:59:56,550 How would someone know that they have that genetic mutation? 967 00:59:56,950 --> 01:00:00,230 They would have to test for it, but that's a really expensive 968 01:00:00,230 --> 01:00:01,750 test. It's a genetic test. 969 01:00:01,750 --> 01:00:04,870 Mostly it's used for women who are trying to conceive. 970 01:00:05,350 --> 01:00:10,790 Otherwise. I think that the last time I. 971 01:00:11,840 --> 01:00:13,560 Somebody had to payout of pocket for it. 972 01:00:13,560 --> 01:00:16,240 I think it was about $1500 out of pocket for it. 973 01:00:16,760 --> 01:00:21,240 But you might be able to go through some of these genetic 974 01:00:21,240 --> 01:00:25,240 tests like 23 Andme or I'm not plugging anything, but you know 975 01:00:25,240 --> 01:00:29,760 some of these other genetic profiles from a lot of different 976 01:00:29,760 --> 01:00:34,200 companies and they might have that included in on what they 977 01:00:34,200 --> 01:00:36,400 test for it. Probably costs less than if you 978 01:00:36,480 --> 01:00:40,560 go through, yes, exactly. Exactly which is. 979 01:00:41,360 --> 01:00:44,200 Good in one way, but unfortunate in many others. 980 01:00:44,600 --> 01:00:47,240 Correct. So sometimes just giving a 981 01:00:47,240 --> 01:00:50,400 methylated form is the easiest thing to do. 982 01:00:51,040 --> 01:00:54,520 And is there anything wrong with someone who doesn't have that 983 01:00:54,520 --> 01:00:56,560 mutation taking a methylated form? 984 01:00:57,160 --> 01:01:01,200 No, not at all. So if someone, just anyone, 985 01:01:01,200 --> 01:01:04,600 could take that and that would be a good supplement for them, 986 01:01:04,960 --> 01:01:07,040 yes. And unless, of course, there's 987 01:01:07,040 --> 01:01:10,170 some kind of underlying medical issue or there's a 988 01:01:10,170 --> 01:01:12,810 contraindication with some kind of medication that they're 989 01:01:12,810 --> 01:01:13,770 taking. Yeah. 990 01:01:14,130 --> 01:01:17,090 OK, great. All right, so let's move on to 991 01:01:17,090 --> 01:01:19,850 our last topic today. There's when I was writing the 992 01:01:19,850 --> 01:01:23,370 outline for this episode, I came up with so many things I wanted 993 01:01:23,370 --> 01:01:25,290 to talk about. And then it's like, no, this is 994 01:01:25,290 --> 01:01:27,170 going to be a three hour episode. 995 01:01:27,570 --> 01:01:31,050 I better pare it down. But I did want to talk to you 996 01:01:31,050 --> 01:01:33,010 both about men's and Women's Health. 997 01:01:34,180 --> 01:01:37,740 And you mentioned this at the beginning of the podcast Testing 998 01:01:37,740 --> 01:01:40,540 for Hormones. So just. 999 01:01:40,540 --> 01:01:46,180 Again, could you say, let's say you have a perimenopausal female 1000 01:01:46,180 --> 01:01:49,460 runner. Are there hormone tests that you 1001 01:01:49,460 --> 01:01:53,900 would run for her that you wouldn't run for someone who 1002 01:01:53,900 --> 01:01:57,920 was, you know, 25 years old? Yes, absolutely. 1003 01:01:57,920 --> 01:02:02,080 I would see how far along into perimenopause they were. 1004 01:02:02,080 --> 01:02:06,360 So you're talking your FSH, your LH, estrogen, progesterone. 1005 01:02:06,360 --> 01:02:08,560 I would even throw in testosterone. 1006 01:02:09,400 --> 01:02:13,640 You could potentially do pregnanolone, which is kind of 1007 01:02:13,640 --> 01:02:17,600 like the grandmother hormone of all of them, to see if there's 1008 01:02:17,600 --> 01:02:21,720 anything that might be either. The ratio of hormones to one 1009 01:02:21,720 --> 01:02:28,060 another is not imbalanced. So definitely when it comes to 1010 01:02:28,900 --> 01:02:33,380 estrogen, it's going to naturally over time decrease. 1011 01:02:33,380 --> 01:02:38,860 So things like flaxseed oil, if you want to put that in shakes 1012 01:02:38,860 --> 01:02:41,740 and smoothies, that's actually very helpful. 1013 01:02:41,740 --> 01:02:45,020 It's we're not going to see it on a blood test elevate 1014 01:02:45,020 --> 01:02:50,220 estrogen, but it's going to have estrogen like effects even 1015 01:02:50,420 --> 01:02:52,940 something like tofu soy products. 1016 01:02:53,410 --> 01:02:57,130 Are going to have an estrogen like effect, but we will not see 1017 01:02:57,170 --> 01:03:02,570 estrogen rise or at least I've never seen it rise on a patient 1018 01:03:02,570 --> 01:03:04,450 on a blood test. OK. 1019 01:03:04,770 --> 01:03:09,130 And what symptoms might somebody have if their estrogen levels 1020 01:03:09,170 --> 01:03:11,330 are low? It's basically like the common 1021 01:03:11,450 --> 01:03:14,050 menopausal symptoms, right? Right. 1022 01:03:14,050 --> 01:03:17,090 You can have hot flashes, you could have mood swings. 1023 01:03:17,090 --> 01:03:19,810 You can have problems sleeping like insomnia. 1024 01:03:20,780 --> 01:03:25,020 Sometimes you could have brain fog, cognitive function, but in 1025 01:03:25,020 --> 01:03:30,340 the athlete what we see is that it's harder to put on muscle you 1026 01:03:30,340 --> 01:03:35,180 have you have a greater amount of fat, your body composition 1027 01:03:35,180 --> 01:03:38,860 starts to change. So what we see is that weight 1028 01:03:38,860 --> 01:03:41,580 starts to accumulate around the waist. 1029 01:03:41,940 --> 01:03:47,660 You see, definitely a decrease in muscle mass. 1030 01:03:48,180 --> 01:03:53,380 And so that definitely can, you know, winds up for the athlete 1031 01:03:53,780 --> 01:03:58,140 like poor performance. OK, and along those lines, 1032 01:03:58,180 --> 01:04:02,300 because as women go through the menopause transition, they tend 1033 01:04:02,300 --> 01:04:06,780 to lose muscle mass and gain fat mass, what other dietary things 1034 01:04:06,780 --> 01:04:11,220 might someone who's perimenopausal change to help 1035 01:04:11,220 --> 01:04:16,750 preserve lean muscle mass? So you may want to go ahead and 1036 01:04:16,990 --> 01:04:21,510 not eliminate but reduce amount of carbohydrates. 1037 01:04:21,510 --> 01:04:23,630 Even though you have to be careful with that because you do 1038 01:04:23,630 --> 01:04:26,710 need certain amount of carbohydrates to perform. 1039 01:04:27,870 --> 01:04:32,310 So more complex carbohydrates you can eat more protein. 1040 01:04:32,310 --> 01:04:35,550 Protein is going to be really important as. 1041 01:04:36,700 --> 01:04:42,460 All athletes age they need more protein, probably about 30 grams 1042 01:04:42,460 --> 01:04:46,820 on average per meal I would suggest and then at least 20 to 1043 01:04:46,820 --> 01:04:49,580 30 grams of protein with each snack. 1044 01:04:50,060 --> 01:04:54,740 And so doing things like that, doing more high intensity 1045 01:04:54,740 --> 01:04:57,420 interval training can be really helpful and that can also help 1046 01:04:57,420 --> 01:05:01,220 your hormones too. And so that kind of combination 1047 01:05:01,260 --> 01:05:05,380 allowing your body more time to recover and repair and rest. 1048 01:05:06,220 --> 01:05:11,060 All of that getting to sleep on time, having a very good sleep 1049 01:05:11,060 --> 01:05:15,660 hygiene will also help with hormones and help with body 1050 01:05:15,660 --> 01:05:19,980 composition along with better eating habits and and higher 1051 01:05:19,980 --> 01:05:22,940 protein. Great, those are all great tips. 1052 01:05:22,940 --> 01:05:26,100 Thank you. And Doctor Pistoya, do male 1053 01:05:26,100 --> 01:05:29,740 runners, dietary needs changes, they age and obviously men don't 1054 01:05:29,740 --> 01:05:32,540 go through menopause. But you mentioned kind of the 1055 01:05:32,540 --> 01:05:34,900 pseudo term that people use, andropause. 1056 01:05:35,670 --> 01:05:41,390 So what does that mean? And do you recommend that male 1057 01:05:41,390 --> 01:05:45,550 athletes, as they enter their 50s and 60s or above, change 1058 01:05:45,550 --> 01:05:50,870 their diet at all? Usually when you get older, 1059 01:05:51,150 --> 01:05:54,350 regardless of if you're male or female, what I've noticed in 1060 01:05:54,350 --> 01:05:59,510 terms of trends for athletes and also for just a layperson is. 1061 01:06:00,300 --> 01:06:02,260 You're not working as much, right? 1062 01:06:02,380 --> 01:06:05,140 So you may have some more boredom in your life. 1063 01:06:05,140 --> 01:06:06,380 Like, what am I going to do every day? 1064 01:06:06,980 --> 01:06:09,700 And so if, you know, running is one of those things that keeps 1065 01:06:09,700 --> 01:06:13,020 you, you know, just entertained, and it's something that you feel 1066 01:06:13,020 --> 01:06:16,300 good. So essentially what winds up 1067 01:06:16,300 --> 01:06:19,060 happening is your diet becomes worse, right, Because you're 1068 01:06:19,300 --> 01:06:21,580 more bored. So I'll just have some chips or 1069 01:06:21,580 --> 01:06:22,980 whatever it is. I'll just have you know, this 1070 01:06:22,980 --> 01:06:25,300 snack or whatever, whatever it Maybe we'll go out to eat more 1071 01:06:25,300 --> 01:06:28,860 often so you become less cognizant of what you're eating. 1072 01:06:29,620 --> 01:06:32,300 And a lot of times, you may not even realize that. 1073 01:06:32,660 --> 01:06:35,540 So as you get older, it's important just to periodically 1074 01:06:35,780 --> 01:06:39,340 take stock on what your diet is. So I wouldn't say that there's 1075 01:06:39,340 --> 01:06:42,020 any specific changes like, oh, you should definitely be eating 1076 01:06:42,020 --> 01:06:46,020 more of this, you know, maybe fiber, trying to just keep up 1077 01:06:46,020 --> 01:06:48,300 with your fiber intake so you're not reaching for as many 1078 01:06:48,300 --> 01:06:52,140 processed foods and you're actually getting just to support 1079 01:06:52,140 --> 01:06:54,780 your overall health essentially. So I wouldn't say there's 1080 01:06:54,780 --> 01:06:57,180 anything specifically that people should focus on. 1081 01:06:59,160 --> 01:07:03,840 So andropause refers to a natural decrease in testosterone 1082 01:07:03,840 --> 01:07:07,200 as a man ages, and so that contrasts with something called 1083 01:07:07,200 --> 01:07:10,600 hypogonadism, which is where the testes are and actually aren't 1084 01:07:10,600 --> 01:07:13,200 producing enough testosterone, to the point where there's an 1085 01:07:13,200 --> 01:07:17,920 actual pathology there. So with Andropause, the testes 1086 01:07:17,920 --> 01:07:22,080 seem to be working fine, but the testosterone is still low. 1087 01:07:22,800 --> 01:07:27,160 And what that'll lead to is typically men will come in and 1088 01:07:27,160 --> 01:07:29,680 the reason is because they can't get an erection or they can't 1089 01:07:29,680 --> 01:07:31,960 maintain an erection and that's what brings them in. 1090 01:07:32,600 --> 01:07:38,480 But behind that, there's also depression, brain fog symptoms 1091 01:07:38,480 --> 01:07:40,240 that are actually similar to menopause. 1092 01:07:40,440 --> 01:07:44,200 Decreases in bone density, increases in body fat and then 1093 01:07:44,200 --> 01:07:48,680 also feeling weaker. Just decreases in muscle size 1094 01:07:48,680 --> 01:07:51,840 and strength as well. So those would be your main 1095 01:07:51,840 --> 01:07:54,080 symptoms of Andrew Paws. OK. 1096 01:07:54,320 --> 01:07:56,240 Yeah. Thank you for differentiating 1097 01:07:56,240 --> 01:08:00,440 between the two. So thank you so much for joining 1098 01:08:00,440 --> 01:08:02,080 us. Do you have any closing thoughts 1099 01:08:02,080 --> 01:08:05,080 for our listeners about blood testing? 1100 01:08:05,080 --> 01:08:09,080 How maybe how frequently you would recommend it for distance 1101 01:08:09,080 --> 01:08:12,230 runners and? Anything else you would 1102 01:08:12,230 --> 01:08:15,430 recommend just in general regarding sports nutrition? 1103 01:08:15,630 --> 01:08:19,950 Yeah, I would say that one thing to keep in mind is not to over 1104 01:08:19,950 --> 01:08:23,630 complicate things. So what you gotta remember when 1105 01:08:23,630 --> 01:08:27,310 you're an athlete and you're running a lot, you're using up a 1106 01:08:27,310 --> 01:08:29,870 lot of nutrients, right? That's as simple as it can be. 1107 01:08:29,990 --> 01:08:34,149 So you have to remind yourself that I'm constantly using up 1108 01:08:34,149 --> 01:08:35,870 nutrients, so I need more nutrients. 1109 01:08:36,520 --> 01:08:39,359 And so nutrition is super important, just keeping that at 1110 01:08:39,359 --> 01:08:42,040 the forefront of your brain and that it's not some mysterious 1111 01:08:42,040 --> 01:08:43,439 reason why you're feeling fatigued. 1112 01:08:43,439 --> 01:08:45,439 Just like, hey, you're not eating enough or you're not 1113 01:08:45,439 --> 01:08:46,760 eating enough of the right foods. 1114 01:08:47,399 --> 01:08:49,760 And so it depends on how much you're running. 1115 01:08:49,760 --> 01:08:53,479 But I would say, you know, every three months, if you have some 1116 01:08:53,680 --> 01:08:56,760 competition coming up or a marathon coming up, you want to 1117 01:08:56,760 --> 01:08:59,399 make sure that your levels are adequately loaded up to that 1118 01:08:59,399 --> 01:09:01,399 event. So if it's your ferritin and it 1119 01:09:01,399 --> 01:09:04,560 says your ferritin's low okay, well that'd be something that by 1120 01:09:04,560 --> 01:09:06,080 the time you get to that marathon. 1121 01:09:06,550 --> 01:09:08,950 That you want to have that resolved so that you have enough 1122 01:09:08,950 --> 01:09:12,229 iron. But if you're not really doing 1123 01:09:12,229 --> 01:09:14,550 anything competitively, you don't have many marathons 1124 01:09:14,550 --> 01:09:17,590 planned, then maybe every six months to kind of check in on 1125 01:09:17,590 --> 01:09:20,710 your basic markers would be a good cadence to be in. 1126 01:09:21,149 --> 01:09:22,390 Great. Thank you so much. 1127 01:09:22,390 --> 01:09:25,149 And I I love that it really is just keep it simple. 1128 01:09:25,470 --> 01:09:29,950 Sports nutrition can seem really complicated and I think some. 1129 01:09:31,649 --> 01:09:34,609 People on social media or some providers want it to seem 1130 01:09:34,609 --> 01:09:38,410 complicated so that you rely on them, but it's really not that 1131 01:09:38,410 --> 01:09:41,130 complicated. Make sure you're fueling enough. 1132 01:09:41,130 --> 01:09:43,090 Make sure you're eating the right foods. 1133 01:09:43,970 --> 01:09:47,850 Get tested often enough to make sure to head off any potential 1134 01:09:47,850 --> 01:09:51,410 problems and, you know, keep running. 1135 01:09:53,930 --> 01:09:57,010 Unfortunately, we lost Doctor Herman so. 1136 01:09:57,520 --> 01:10:00,560 Thank you, Doctor Pastoya, and thanks to Doctor Herman for 1137 01:10:00,560 --> 01:10:03,600 joining us. If you want to find Doctor 1138 01:10:03,600 --> 01:10:08,600 Pastoya and Dr. Herman online, their clinic is called Bethel 1139 01:10:08,600 --> 01:10:11,880 Naturopathic Medical. We'll put the link to their 1140 01:10:12,240 --> 01:10:14,880 website and social media in the show notes. 1141 01:10:15,880 --> 01:10:18,800 Thanks everybody for listening and we'll see you next time.