141: The Complexities of RED-S in Athletes | Dr. Kyle Gillett | The Nick Bare Podcast

All right, ladies and gentlemen, welcome back to another episode of the podcast.

For a third time, returning Dr. Kyle Gillette.

Welcome.

Thank you, Nick.

Always a pleasure.

I love having you on.

There's a lot of topics that I'm very interested in, but I don't necessarily have the credentials or all the research or credibility to speak into them.

And one of the reasons I love bringing you on the show is you have the research, you have the credibility, you have the credentials to add some validity to the topics that I'm interested in, that I'm genuinely curious and interested in.

So I appreciate all your insight and knowledge and wisdom into all things health performance, human optimization.

Certainly.

Thank you for letting me spam your inbox with various studies and findings.

So I know we have a few topics that we want to discuss today.

What are you genuinely really interested and curious about right now, as you pursue your own personal and professional curiosities around health, performance optimization, all the things.

Yeah, there's a variety of things, but I'm always very interested in any cutting edge therapy, including peptides.

And I'm also very interested in different health issues that are specific to runners or hybrid athletes.

As you know, I've been running a lot more personally recently.

I've done high rocks.

I'm going to do some more of them.

And I've also recently done things like gotten my first colon cancer screening and And I see things like reds relative energy deficiency in athletes pop up.

I see things like runners are at increased risk of colon cancer.

I see this all over social media as well.

I also see people talking about how they took a peptide and it magically helped them heal and they're healthier.

There's no downside.

So I just like to talk about all the upsides and downsides of these various issues in an evidence-based way.

What's your view on the way social media approaches and shares information?

Do you think that we're in an age right now, where there's a lot of fear mongering amongst a lot of topics that are being shared?

The extremes get all of the headlines.

Yeah. you're just bought off by big pharma.

And then when I do the opposite, the people comment the opposite.

So sometimes I feel like if you're more balanced or in between, you actually get pushed out of both groups.

So it's better to choose a side if you want to have fast growth.

But the way that I see myself and I think that you're very similar to this as well, and many of our colleagues in the health podcasting space, if you will the people who do particularly well often don't choose a side.

They're independent and they have a higher what I'd call social credit not official social credit in the dystopian way, but people will listen and understand this person is truly unbiased.

Maybe they change their mind when new evidence appears or they're open to.

For example, I live reacted yesterday to the press conference about Tylenol and pregnancy and autism and ADHD and I gave my non-political open thoughts and I pointed out some good things, pointed out some bad things and just posted this too.

So I'm sure there's going to be a lot of unfortunately, negative comments or unfollows, but the people who do know me, I think that will provide some trust and right now trust in health professionals, especially doctors, is at all-time low.

Yeah, something I recently talked about on a podcast that was all around leadership was that I think it's a really important trait and characteristic as a leader to have a strong set of core values but a loose position on where they stand on certain things.

Because new information comes out and having a bias towards certain things or positions doesn't allow you to adapt or flex properly.

We see so many people in the health and athletic performance space, who they make their identity, a certain position or bias, or way of eating or way of training.

Yes.

And when you make that your identity, you put yourself in a spot where you can't flex or change your mind, because you then lose all of your credibility for the identity that you put upon yourself.

So I agree with what you're saying.

I like putting myself in a an unbiased, independent position in terms of all things health performance, athletic training.

And then, as I'm presented with new information or ideas or methods and concepts, I had to try it out myself.

Uh, read the research, test it, try it, and see what it's really like.

But I'm never really drawn to the extremes.

I'm always cautious of the extremes, because I typically know that those extremes are generated to create some sort of movement or position.

Yeah, and you do have a very unique perspective.

Credential is great, but people want experience.

And there's not many people that have, for example, with REDS, the relative energy deficiency and training in a state where you're in a caloric deficit.

You've done it from the perspective of a bodybuilding, resistance training athlete, of an endurance athlete.

Not many people have experienced seeing both of those ends of the spectrum at a very high level.

Yeah.

No, I appreciate that.

I am very interested in reds.

So reds being relative energy deficiency in sport.

I'm, I'm actually, I haven't been that familiar on reds.

And when I first came across, it was actually a few months ago.

Um, there was a video and I've heard about it in the past, but I started looking more into it when I first started my training for this Ironman.

Actually because Lionel Sanders, who's a professional triathlete, posted a video about his experience with Reds.

And I started looking into it and found it extremely interesting because I have, for sure, at many parts of my life, experienced Reds myself, maybe even to an extent right now.

And I realize there's probably a lot of athletes who don't even realize it that they are also experiencing REDS.

So I really want to dive into what REDS is, but I think kicking it off, explaining what is REDS.

Yeah.

And sometimes graphics are fairly helpful, but REDS is a spectrum condition.

So it's not a condition where you can do a single lab test.

And no, it's not just for females.

Last podcast, we talked about the female athlete triad, iron deficiency, many of those things.

And that is actually just one of the spokes or components of REDS.

But in general the difference between a REDS and an overtraining syndrome or I think it's called OS is is that in REDS there is an energy deficiency.

So it's not that much of a difference.

But generally, you have... Again, this is the importance of holistic health, body, mind, and soul.

You have psychosocial problem, mental health issues even.

You have gut and gut-brain access issues.

You have increased injury risk.

You have decreased athletic performance.

And similar to PCOS...

Or other kind of diagnosis of exclusion conditions.

You can kind of be on this side of reds or on this side of reds, if that makes sense.

So a bodybuilder that gets reds is probably more likely just to be in the energy deficiency side of reds, whereas a lot of people who are training endurance events, which is kind of the classic REDS patient.

Usually they're very underweight, low BMI classically.

You've lost a decent amount of weight since our last podcast.

I've actually lost a decent amount too.

And I started getting injured because I was trying to cut down and be lighter to be a faster runner.

So it's a spectrum.

Like you said, you're kind of having some REDS, maybe mild or even moderate now.

I was having some mild REDS and then I put my caloric deficit on stop.

So I think a lot of athletes do this without thinking about it.

There's also people who don't like it if you talk about REDS, because they say it's not a real condition.

You can't do a test or an imaging study and diagnose it.

And they say the more you think about REDS, the more likely you are to think you're going to get it.

And it's a self-fulfilling prophecy.

I don't know if you've seen that's true since learning about it recently.

But the way I look at it is, If you learn about it and you give a name to it, it helps, because then you can seek help or even find information yourself in order to minimize the chance of the outcome happening.

Yeah, I think it's important to be informed about it.

And I don't think that it... makes the issue worse for the individual.

But, in my opinion, being aware that you might be creating this unknown and unnecessary deficit, that doesn't just lead to and this is what I really want to focus on Red's relative energy deficiency in sport.

It doesn't just lead to decreased athletic performance.

It doesn't mean that you just can't, you don't have the energy to recover and run as fast and hit certain workouts.

It started affecting all different parts of the body, from the immune system to the endocrine system, your hormones, your ability to sleep well, your mental state, your mood.

You might become irritable.

Hangry.

Hangry, like all of these things.

This thing that people say, especially in the endurance training space, that there's no such thing as overtraining.

Just under-recovering.

There is under-recovering.

And I think under-recovering can also be viewed as under-fueling.

In this Ironman prep, for example, there are days where I'm burning 6,000 calories.

And that's from actually burning calories through exercise, but then also just burning calories from what my body needs to maintain homeostasis and function.

I think a lot of people will hear that and think, oh, I can easily eat six, seven, 8,000 calories.

But when you have three training sessions a day and you're trying to fit meals around training and digestion and It becomes challenging to get all those calories in.

And I think what happens with a lot of people in these big training blocks and I've experienced it on certain days you're burning five six, 7000 calories.

And it's really hard to find the time and select foods that you want to consume to make sure you aren't in a caloric deficit.

And maybe one day isn't going to hurt you.

Maybe two days isn't going to hurt you.

Maybe one week's not going to hurt you.

But when you're in this deficit, even a slight deficit for days and weeks and months around a prep or a build or just your lifestyle, that's when it starts exposing all these bigger issues that have downstream effects other than just I'm tired today.

I can't hit this training session.

How big of an issue is, Do you see, especially in endurance sports, under-fueling?

At the higher the level, the bigger an issue it is.

So for the average Joe, especially someone who is new to an endurance sport, they can track their weight and they're unlikely to be trained at a level to where they can be essentially a metabolic furnace enough to need a lot of fuel at a high level, or if you've been doing it for a long time.

It's a huge issue and i think that people should take into account.

Um, you know, some people who are new might want to lose some body fat as they train into the sport, and that can be reasonably done so, but you probably don't want to be in your biggest caloric deficit during your hardest period of the training phase.

So it is a big issue.

This is why I make fun of CrossFitters because they're the little saying that they do.

And I like doing this type of workout too.

So I'm not just hating on them, I'm just hating on the saying.

It says low carb, no sugar, I think, or low carb, little sugar.

And every high level elite CrossFitter is going to be consuming huge amounts of caloric beverages and carbohydrates in order to replete glycogen stores and stay fueled.

You need it.

Yeah.

So now I could say that for someone who is 60 and who has never exercised and who is trying to lose a lot of body fat, then they do need a low calorie diet.

But that would be the emphasis.

The emphasis would not be the performance outcome.

The emphasis would be the caloric deficit and the metabolic health.

So once your emphasis is performance outcome, fueling is always a major issue.

I was just listening to a podcast this morning.

And it was from a professional runner talking about their experience with Reds as I was preparing for this conversation.

And I think that a lot of people believe that Reds affects people who are less educated around training and nutrition.

But I would counter to that.

I think that REDS and I would love to hear your opinion I think REDS actually affects more of the intermediate or advanced athletes, because those, the individuals, especially professional athletes, who are trying to balance this, especially when it comes to endurance sports, lighter is faster.

So it's getting to a optimal race weight that allows you to move with the most efficiency.

Mm-hmm.

The lightest weight, but also being fueled enough to perform at the highest level.

Mm-hmm.

And that's a really thin line to ride on.

I think most athletes would be safer consuming a surplus, a slight surplus, to avoid some of these Reds issues, as opposed to being in a chronic deficit and then going into Reds.

I agree.

Reds does affect intermediate and advanced and elite athletes much more.

And especially for intermediate athletes, if they try to consume a caloric surplus, they might be surprised they might not gain any weight or any body fat.

I know there's been a lot of people i think jeremy miller is one of them that has mentioned that as his weight got heavier, his running performance paradoxically got slightly better.

And this obviously doesn't work for everyone, and the lighter your starting weight, the better your running performance can increase as your, as you think you're in a slight surplus.

But the other factor is actually genetic.

For example, I have two sons and now I have a daughter as well.

And she is very unlikely to get REDS because I know she's going to have a very sensitive androgen receptor, because I gave her my X chromosome.

And I also know that, which makes her more likely to have PCOS, which is actually great.

And because you're less likely to get REDS, you're more likely to have the cycle irregularity, but your testosterone is going to be a bit higher.

You're going to be more sensitive to testosterone.

And then I also gave her a gene that makes her more likely to hold on to iron called an HFE gene.

So she's less likely to get iron deficiency as well.

How do you test for that?

Genetic tests.

Okay, interesting.

Yeah.

So I have two copies.

So I know I gave her one of those too.

Yeah.

Kind of regardless which allele, which is like paternal versus maternal gene she got.

And then...

Past that, I have a huge hunger drive and so does my wife.

So she's probably going to just naturally eat a lot more.

A lot of that is genetic.

So she would probably be a great.

Well, her body size might not make her a great runner, but she'd probably be a great endurance athlete.

And there's other genetic factors that go into reds as well.

The hormonal ones are of particular interest to me.

And the hormonal ones are like there's something called hypothalamic amenorrhea that a lot of females get.

But these hormonal abnormalities happen just as often in men.

It's just that we don't notice them because we don't kind of have that cycle or metronome where we don't have the same biofeedback.

But there's a lot of things that you can do, even with less than optimal genetics as a male, to make sure that you're hormonally in a better state as you train more and more.

There's lots of kind of the two big studies on runners recently.

We mentioned the one about colon cancer risk.

The other one is about if it affects your testosterone, making it go up or down.

But this has been well-known for years in the bodybuilding industry.

Yeah.

For anyone who's not familiar with REDS, can we kind of paint a picture of what this looks like?

Like walking through an example of an athlete from like how it looks from the start to then what the symptoms look like.

So let's take this athlete who is training for some sort of endurance event.

And they don't know it, but they're actually in a caloric deficit.

They think they're eating enough.

They actually aren't based off of their energy demands and their energy expenditure.

And they're doing this for weeks and months.

What happens?

What are they going to start experiencing?

Some of those first symptoms.

And then how do those symptoms kind of progress and get worse and worse, to the point where it's affecting many different systems in the body.

Yeah, I'll kind of use myself as an example, if that's okay.

Yeah, for sure.

In the past, as I've started to run more, I almost always drop weight.

And even not counting calories whatsoever, my weight just slowly decreases.

And as that happens, my sleep is somewhat disrupted.

I have less energy to do rough play and wrestle with my boys, to throw the football with them, to play soccer with them, especially in the evening.

I noticed that in the evening, my energy is lower.

In the morning, it's much higher.

I also like to track my labs, of course.

So the recommendation would be to go to sagebio.com.

And if you've never had labs before, you can get the athlete panel.

But I will have panels that you can get and even individual labs eventually.

But you can get a blood test every three months and what you would see is that your cortisol is going to have less of a normal pattern.

So often it goes up initially and then it goes down after it's gone up.

So with like later stage reds, you'd actually have low cortisol.

And then your testosterone and estradiol as a male, both of those decrease.

They might be less than half of what they previously were, even if you can't notice.

So regardless of my testosterone level is low or medium or high, I can't really notice a difference.

But I do notice that my energy is different.

But I don't have changes in libido or how good lifting weights seems, if that makes sense.

So what I'd recommend is people just go get their labs tested.

And even if you want to test them at your normal doctor, you can still go to sagebiocom and see my recommended panels and specific things that athletes need as well.

Can we talk about cortisol for a second?

Yeah.

When you say it starts higher and then it becomes lower, is that over a long period of time or is that throughout a day?

That trend.

Great question.

So that's over a longer period of time.

However, there's a huge amount of variation from day to day.

For example, if you have a very poor night of sleep, then your cortisol is going to change significantly from day to day.

Our friend, Dr Andrew Huberman did a podcast about two months ago on cortisol, which was excellent.

That shows that cortisol is actually like a steroid hormone, similar to testosterone, estrogen etc.

But it's not just released based off of signals from ACTH is what it's called, but it's also released from a different area of the brain, purely based on rhythmic timing.

So this is where...

You see a bigger effect in athletes that might be traveling from a different continent or a huge time zone, and how it affects their performance if they're going to the east or going to the west, or even what time the race is.

For example, I'm usually very early to bed.

I didn't cross any time zones to do my high rocks in Dallas.

But I think my race was at 9 p.m.

And I usually wake up before 5 and go to bed at 8.30.

The High Rocks race schedule was just absolutely wild.

It was terrible.

I felt like I was in Malaysia or something.

I know.

And you probably consumed caffeine before the race.

Yeah.

And caffeine does help.

Caffeine actually helps potentiate the release of cortisol.

But if you had checked my cortisol at 9 pm even without the time zone change, I'm sure that it was particularly bad.

I actually posted my HRV because this is soon after I had my third child.

And after I had her, my HRV went from 70 down to the mid-20s.

Oh, wow.

Before my... race.

So I posted on Instagram, which is kind of wild.

But yeah, between that and the late start, I think that that was a significant effect on your cortisol, because cortisol gives you energy.

It's what helps get you out of bed in the morning.

If you're sitting in bed and you just don't feel like getting up, then cortisol can help with that.

And there's a lot of ways to support it.

For example, pregnenolones, an over-the-counter supplement.

It's not WADA approved for those WADA athletes and whatnot, but there's a lot of other ways to help.

How do we want to see cortisol being released and controlled within the body?

What is an optimal trend?

Yeah, a nice high curve in the morning and then around midday it's going down and then it's kind of steady, but not too low, not completely crashed, but not high in the evening.

And what does an unhealthy cortisol level look like?

There's a couple types.

So there's like the wired and tired type of cortisol, where it's just flat across the whole time.

It could be high flat or low flat.

There's the late peaker.

So that could be someone who's like relatively low in the morning.

And then all of a sudden it increases a little bit in the afternoon.

Maybe that's someone who's like switched time zones recently or just never kind of got on that circadian rhythm.

And then there's also the like bimodal or multimodal peak.

So people who consume caffeine too late in the day, this could be part of it.

Cortisol also, not to complicate things, but there's a lot of other factors.

One example is cortisol shares a binding globulin, which is a protein with progesterone.

So as progesterone spikes and crashes, that also changes the regulation of cortisol.

So unfortunately, there's a whole bunch of different inputs.

And how do you measure? uh, cortisol throughout the day.

How do you, how do you get this trend in this graph?

Yeah.

So what I, most people don't need to get the entire graph.

You can get it via saliva or urine or blood tests, but that's a lot of blood tests.

Um, so often I, uh, order what's called like a four-point salivary cortisol test.

But for most people, I just start with a morning cortisol and then I see what symptoms they have.

If someone thinks their cortisol might be off and they don't necessarily want to do a four-point cortisol.

You can also get an AM within four or five hours of waking and then a PM and then compare the two.

I would love to actually do the four-point with you.

For sure.

I'd be very curious.

Okay.

So going back to your example with reds, you're starting to run more.

You're losing weight.

You're experiencing lower energy levels.

I can definitely relate to the lower energy levels, especially in the evening.

Getting home from work after a long day of working and training.

Meetings where I don't talk are the worst.

Yes.

Oh, yeah.

I'm traveling.

I'm engaging with people.

I'm outside.

Days where I'm stuck inside all day behind a computer, I am tanked at the end of the day.

But especially in this Ironman prep right now in the evenings I really have to turn it on to be ready to go with the family until we put the kids down for bed and it's me and Steph's chill time.

In your example...

How does it keep progressing from just normal levels of fatigue and tiredness?

And you brought up what's happening in the back end with cortisol and your hormones.

But how does it get worse?

Where does it go from there?

The next hormonal input so we've kind of mentioned the sterol hormones would be what I consider their growth agonist hormones.

Growth hormone IGF-1, which is insulin-like growth factor one, even insulin, because insulin is a particularly anabolic hormone as well.

And it's very common that you see all three of these drop as you're more into the red spectrum, especially with more energy deficiency and not to scare anybody, including yourself.

But the next thing that tends to happen is what I consider tweaks or injuries.

So I usually consider an injury something that happens.

It's been going on for more than seven days and it's bad enough to where you are thinking about seeking out someone to care for it.

So it's a little bit of a spectrum.

But in my case it was my calf cramps, my hamstring strains and my shoulder pain, which is unfortunately still ongoing despite kind of ending my caloric deficit phase.

And this, of course, doesn't happen for everyone, but it just goes to show that you're better pre-planning for these things that might happen rather than being reactive.

So, in terms of muscle strains, ligament strains, Is that primarily because your body doesn't have the energy, the caloric energy, to recover optimally?

Partly.

So it obviously has something to do with glycogen stores.

That's one reason why there's not really an anabolic window for protein.

We don't need to have like a protein shake within 30 minutes of training anymore, but there kind of is for carbs.

And that's one thing that your company does really well is emphasizes the importance of intra and post-workout carbohydrate.

Because the sooner you get carbohydrates on board, the faster you're going to have intramuscular glycogen repletion.

So you're restoring the glycogen, basically carbohydrate in the muscle.

It happens in the liver as well.

But you want to restore it both in the muscle and the liver.

And a lot of times it takes 24 hours.

So if people are doing two a days, there is zero chance that you're going to have significant glycogen repletion within a 12-hour time period.

So you're smart with your training.

So a lot of people will do things like split their resistance training with their cardio and they'll watch the intensity and pick specific times to be intense.

This is where a coach is particularly helpful to have a program that's going to put you with the best chance to succeed before you start.

That being said, there's also things other than just nutrient repletion, like localized IGF-1.

So, without getting too technical, basically there's different hormones that are like systemically helpful for growth, like growth hormone and like IGF-1.

And then there's localized IGF-1 too.

So if people have heard of a study, you know doing five back squats, five sets of them, with this weight percentage of your max, is going to improve your growth hormone.

It's going to double your growth hormone or increase your testosterone by 50%.

It's a localized effect that only lasts a couple hours.

Oh, interesting.

Okay.

Yeah.

So it doesn't actually improve your systemic levels.

That's good to know.

So this is also why if you're like training complementary muscle groups, you can do two a days.

For example, you could do a morning run or bike and then you can do upper body training the same day, and you can go pretty hard on both of them.

But the hormonal abnormalities with what I consider the growth agonist hormones or growth hormones.

That includes endogenous peptides as well.

For example, when people are younger, they make more of this peptide called GHK copper peptide.

And the levels decline pretty sharply as time progresses.

And things like that also help heal.

You know, people love talking about BPC-157.

In the body we make it, it's called gastric protective compound 157, GPC-157.

And as your gut is less healthy and as you're like deeper into reds, you will make less of this as well.

So you're losing all of these naturally made or endogenous peptides that are going to prevent injuries even before they happen.

Something you said that I just wanted to touch on in terms of glycogen replenishment.

I think something that a lot of people don't realize is it takes 24 hours from about 24 hours from the consumption of that carbohydrate to be stored as glycogen, because it has to be consumed digested, then assimilated into glycogen.

So when people are carving up for an event um, you know the traditional model of the night before the race.

Go eat this large bowl of pasta.

I mean that available glucose will help, but it's not going to be stored as glycogen in the muscle in the liver.

And I think back to that one uh, a classic office episode where Michael Scott is consuming the bowl of fettuccine Alfredo at the start line.

It's like there's only downside.

There's no benefit to that.

So just for people to keep in mind, if you're trying to top off on muscle glycogen stored carbohydrates, it's going to take about 24 hours from consumption to stored in the muscle in the liver for use.

Yes, definitely.

I remember running track and field in college and high school and whatnot.

And it used to be.

We did the classic pasta the night before and then it kind of fell out of favor and said well, carb loading is not important.

And now it?

We found out that yes, it's important you just do it over a longer period of time and not so aggressively to cause gut disruption and whatnot.

And some of it depends on the person as well.

So if you're running the 400 and the 800, then it's probably not as important to...

As an ultra endurance athlete, certainly, or even a 5K runner.

But if you're a, The hormonal component is probably more of a factor in someone who is a middle distance athlete, where it's kind of between aerobic and anaerobic.

Yeah.

Talking about injuries, and maybe you're going to get here.

You touched on and we just got done touching on injuries in terms of muscles and potentially, ligaments.

But what about bones?

When someone is in this caloric deficit for long periods of time, You'll see athletes who have reds, who end up getting fractures, broken bones.

What is happening to the bones during this time?

This is extremely hotly debated among runners.

My friend Nick Norwitz, who is also a physician I think newly graduated said But a very interesting page.

He also kind of does the benevolent clickbait that I sometimes do.

But he's a runner that I think, ran marathons and he had an osteoporosis diagnosis, if I remember right.

And there is some genetic factors that lead to having thinner or more dense bones.

But I know he was at a very light body weight when he did that.

So perhaps it's not, I don't think it's as much of a genetic factor.

I think that has partly to do with it.

But I actually also have the genetics to where I tend to pee out two amino acids called glycine and proline, which can also lead to a higher risk of osteoporosis.

But I went and I checked my bone density and it was extremely high.

It was a T-score of four for those that know what T-scores and standard deviations were, which is odd because I didn't really lift heavy weights until I was in my mid-20s.

And I did almost exclusively running, but just at a much higher body weight.

And strength training does help with... bone density.

It definitely does, but we used to tell people your bone density is set after you're 20.

Your adolescence is done, you're not going to gain bone density.

I wish I had done DEXA scans when I was younger, but I didn't.

I think that my bone density is definitely better because of the resistance training I started to do, but I think the running also helped too.

Because, in general, you think the main number one thing that helps with bone density, even more so than vitamin D optimization, et cetera, is actually axial loading, weight bearing exercise.

And that just means the weight goes from top down through your feet.

So walking with a weighted vest is axial loading.

Jumping is axial loading.

Squats and deadlifts obviously, but running is also technically axial loading, but just at much sub-maximal force.

So the higher the force or the higher the weight, the better it is for your bone density.

So where do you personally stand in terms of Red's effect on bone density?

I think that it's related to both absolute body weight and the relative change in your body weight over time.

So the hormonal components also matter.

It does appear that if you replace estrogen testosterone, growth hormone and IGF-1 and vitamin D, which is also a steroid hormone, vitamin D has the same exact cholesterol backbone as other steroid hormones.

Replacing those five which are all commonly deficient in reds, plus limiting the amount of caloric deficit, I think will attenuate or stop almost all of the bone density loss.

So with a lot of these athletes, I think I heard that more commonly there's women who experience fractures and there's this specific bone that gets injured.

I can't remember exactly which one it is.

I think it's like the sit bone that fractures most commonly in women, especially female runners.

Do you think this has something to do with?

Not just reds, but also menstrual cycles, lower iron and then just the impact on bones over a long period of time.

Yeah, if you're a female with REDS and what's called hypothalamic amenorrhea, which is where the brain is not producing enough hormones to send signals to the ovaries to produce hormones, that puts you at extremely high risks of these pathologic fractures, or even fractures that can happen without a huge amount of trauma happening.

I'm not sponsored by any like DexaScan place, but people can go to DexaFitcom DexaScancom, slash locations, Fitness City spelled with one S, And there's a couple other places of, like you know, national chains of places where you can go get your DexaScan for body composition.

That'll also tell you kind of a total body size.

And then if your total body T-score is not in the positives, you should go get a specific DEXA scan for bone density that looks at, like you mentioned, the pelvis, the neck of the femur, which is kind of the thigh bone.

And then a lot of them also look at the radius, which is a bone in your forearm.

And then a lot of them also look at the, or almost all of them should look at the vertebrae and the spine.

Okay, that's good to know.

So say an athlete is experiencing reds.

They're in this caloric deficit for extended periods of time.

How bad can it get and what does that look like?

What are the symptoms?

Yeah, people can kind of jump between the different stages, but perhaps a stage that I never got to is the significant psychiatric complications.

People can have insomnia so bad that they kind of enter a... bipolar-like state.

Depression is very common as well.

And a lot of times this affects people's relationships.

I think it's interesting that if you look at professional athletes that are married, have a spouse, then often within a few years of stopping the cycle of their pro athletics, they split up.

Because you'd think that, at least for certain professions, it would put a lot of strain on your relationship to be going through this cycle of in-season out-of-season in-season, out-of-season.

For a lot of sports, there's also other factors.

For example, if there's boxers, then there's head trauma and concussions, things like that, but that would be kind of a late stage manifestation of reds.

Hopefully it wouldn't get to that, because i do think that even if you're training hard, as long as your caloric deficit is not too significant, there are natural ways to address the different abnormalities that lead to this happening.

To where it can be better and even if it's not 100 better.

I know a lot of athletes just like to grit through something and they just finish it and then be done.

And that does lead to a little bit more of that dopamine surge during and after.

But you can at least make it a lot more tolerable and healthy for your body.

So I'm assuming one of the solutions to REDS if you're in say, a big training block or a big cycle and you're experiencing symptoms of REDS, where low energy beyond what is expected with increased training load.

Mm-hmm.

Mood dysfunction irritability, disrupted sleeping, maybe some loss of performance, not as much strength power endurance stamina, immune system suppression all these things just start happening.

Once that training block is done, you finish the race or the competition.

You're back to normal life training volume, intensity.

Decreases again.

You're now in a caloric surplus.

Those symptoms should go away pretty quickly.

They should.

A lot of times they don't.

And unfortunately I see people for this very often that are six months, even 12 months old after the reds phase, if you will.

So there seems to be a lag and part of this is probably because all the different axes haven't been addressed.

So i actually have a couple different protocols for reds and i'll tell people kind of like the bare bones of it.

I won't gatekeep and make you sign up for gillette health or whatnot.

I'll give people actionable items yeah um, where possible, But a lot of times you see a lag in how your body recovers after any illness.

So after viral illnesses, there's things called post-viral syndromes.

Even after medications, after someone comes off of an SSRI or hair meds like finasteride, there's these post-this syndromes.

Even after supplements like ashwagandha or lion's mane.

And they don't happen most of the time, because most of the time people go back to their normal life and their diet is more consistent.

They're not overfeeding their gut, their gut health gets better, the gut-brain axis gets better, their relationship gets better, et cetera.

And things improve secondary to those lifestyle things improving.

But often supplements and medications can be used for help.

The three big things that you can't miss, and this could be during or after REDS sorry, during or after the caloric deficit phase and the training phase.

If you're having these symptoms, always consider these three things your sleep, your diet, especially fat, and things that can improve IGF-1.

You mentioned dairy last time.

I think that for people who can tolerate it and kind of learn to tolerate it, perhaps before they even start their training phase, finding out what very high calorie, often high fat foods can help.

High fat leads to better production of things like testosterone, if it's not already making up 30 of your calories.

And then it often leads to better growth hormone and IGF-1 as well.

Things like cheese and milk do.

And they're also particularly tasty, in my opinion, if you learn to like them.

The sleep can be addressed via supplements.

It can be addressed via medications.

Often I address it via medications just to jumpstart someone's sleep cycle and get that fine-tuned again.

And then the last component is the mind and soul component.

Where are you at spiritually?

Where are you at with your relationships, with your family, with your close friends?

How has it affected them?

Maybe how... maybe you're affecting them in some way that you're not even realizing.

And that's kind of a subconscious thing to consider, so that there's a lot of interplay in that as well.

So those are the three things, sleep, diet, and then the social emotional.

That's a good call out.

In terms of you know reds, it's not just affecting you, it's affecting the people in your life too.

And you probably don't even realize it if you're in that state.

I know I've been there before.

You don't realize the effect and the impact on your relationships, your family, the people around you while you're in this decline state of just mental emotional physical, wellness.

A question I have is, What do you think the difference is between reds and disordered eating?

Are they similar?

Or is it that REDS typically occurs when you don't know you are under-consuming, under-fueling?

Great question.

I hadn't thought of that because REDS is often compared to overtraining syndrome.

So this would kind of be on the other side of REDS.

And certainly someone with a history of disordered eating is probably more likely to get it, because they're more likely to want to over-restrain.

Their calories?

It's body dysmorphia involved.

People may have heard of exercise anorexia, where you're still consuming a lot of calories, but you feel like you need to exercise in order to get this disordered body image.

So yeah, the number of calories involved can be part of it.

I think there's some overlap, but I'm not sure how exactly you would compare the two other than just looking for the history.

Mm-hmm.

Do you think there's a downside?

Maybe not a downside.

Let me reposition this question.

If someone's tracking their caloric expenditure through a wearable device like my Garmin watch, for example, it tells me, at the end of the day, how many calories I will have expected to burn, just based off of me living breathing, doing everything.

And in addition to that, my training.

So say my watch is going to burn 6,000 calories in a day.

That would tell me I need to eat 6,000 calories to be at maintenance.

Do you think there's validity in that approach?

Or how would you approach ensuring that you are at maintenance or in a caloric surplus to avoid reds, do you rely on a wearable or do you not?

I do use a Garmin watch, but only when I train and not for all training.

I think there is validity in that approach and some people can succeed with it.

I just don't personally do it.

But I do think that looking at things like your HRV and your resting heart rate, that's great data.

And I do that.

Don't put any, don't put too much stock in any one single weight.

So one weighing on a scale should never like concern anyone.

And obviously there's a But for advanced and elite athletes.

I think that's one way that they can get around not having to track every single calorie.

That being said, in the past, there is this term called intuitive eating.

And basically, it meant that people should be able to know what they need to eat intuitively.

But it has more to do with food intelligence.

And the more experience you have with foods and you kind of roughly know the macronutrients and the calories in the food, you intuitively know what to eat.

For most beginners, they're not going to know what to eat.

And people who are at risk of REDS have the opposite problem of almost the entire rest of the population, in that they're not intuitively eating things that are high enough caloric density.

So most of the population eats too many milkshakes and hamburgers, but people that are having reds, they want to eat healthy.

So they have too many broccoli, Brussels sprouts and chicken breast, whereas they actually need to be having foods of very high caloric density, because it's hard to keep up.

Yeah.

I'm curious for all the years you've been training, practicing medicine, prioritizing your nutrition, when have you felt your best?

What did your training look like?

What was your weight?

What was your diet?

If you could look back and be like, I want to, I want to feel this again.

What did your lifestyle look like?

Yeah, that's a great question.

Um, I felt I could pick three different times.

When I started to really care about nutrition a lot was when I was a senior in college.

That's when I kind of dabbled into cross-training.

I was homeschooled.

My brothers and I were.

And then I ran track in college, but I didn't really care about nutrients or fueling.

I just ate.

And I did feel significantly better, caring slightly more about nutrition then, and also cross-training and uh, sleeping relatively well.

Um, I was definitely less stressed.

My final year of residency um, I had my first child.

My final year of residency.

But before my first child arrived I felt pretty good and I was making some great gains and successes with training.

And my sleep was much better because I was a senior resident.

I wasn't doing 24-hour shifts and whatnot.

It wasn't nearly as hard-worked.

And my diet was pretty good because I cared about my diet more so.

I still ate a lot, but I also trained a ton.

I did mostly basketball, soccer, volleyball.

Lately, I would say I know way more.

But the thing that really holds me back is sleep.

Just because I have three kids, five and under.

If not for that, I think that my training would be significantly better.

I will say that I'm definitely not as fast as I have been in the past.

And I'm probably not as good at basketball or soccer or volleyball.

But I'm definitely stronger.

So, I see the glass half full.

Yeah.

I mean, there's definitely trade-offs.

Yeah.

When would you say that is for you?

Because it's probably different for, it's got to be different for strength training versus cardio.

Oh yeah, completely.

I mean, my training has changed so much over the years.

And I think what has allowed me to continue improving and also stay healthy is that, From the outside, looking in, I think a lot of people think that I wake up, and I've been running 10 miles a day, every day for 10 years.

And that's not the case.

That is definitely in certain seasons within certain preps.

But after I go into a big endurance prep, I go into an off season where I gain weight, my endurance training decreases, my strength training increases and I feel better.

Mm-hmm.

So I look at it two different ways.

There's performance goals and then there's the health goals.

There is definitely a way to manage and balance both depending on what your goals are.

But right now, for example, being an Ironman prep performance-wise, this is in the best shape I've ever been in.

I'm getting leaner.

I'm getting faster.

I feel strong.

I'm staying healthy.

My sleep is definitely not there.

I have two young kids as well.

It's not where I want it to be.

I know I'd feel a whole lot better if I had more sleep, but I don't feel my healthiest right now in terms of mental energy, mental clarity.

But I know it's a season that I'm in.

This comes with the territory of training for an Ironman triathlon.

I experienced the same thing in a marathon prep and an ultra prep.

I love preparing for these things, but I also know it comes with a cost and a sacrifice.

So I'd say when I feel my best, my weight is roughly 205, 210 pounds.

I'm running maybe 30 pounds, Maybe 40 miles a week, 30 to 35 miles a week, strength training three to four days a week and really just enjoying life.

Spending a lot of time with my family, not obsessing over the foods that I'm consuming, not trying to restrain calories or certain foods based off of what workouts I have come up next.

I think a lot of people would think that in an Ironman prep I'm burning 6000 calories a day sometimes.

You can just eat whatever you want.

But the truth is that When you're eating this much, your gut becomes more sensitive.

Yeah.

So you have to be more selective with what you're actually consuming.

Easily digestible.

It's like being in a bulk kind of for bodybuilding.

Yeah.

A good example, I know tonight if I eat sweet potatoes-

That will slow down my digestion.

That's how aware I am of my food consumption right now.

Awesome.

As opposed to white rice.

If I eat white rice with dinner tonight, I'll be hungry a few hours later to have another big meal before I go to sleep.

If I eat sweet potatoes, I'll actually not be as hungry because of the lower glycemic carbs and the fiber added to it.

So I have to be more selective with the foods that I'm consuming that make me feel good.

What about a regular potato?

Because I actually like regular potatoes, but I've never really loved sweet potatoes.

And there's obviously a difference between a massive Yukon Gold potato that's almost pure starch and the little potatoes that have a lot more fiber ratio.

I can do red skin potatoes and Yukon Gold potatoes pretty well.

But my favorite way to consume them is...

I'll boil them or I'll air fry them and then I'll let them cool.

And I actually like to eat them cooled like an apple.

They're high in resistant starch.

I just find that they digest very easily for me.

I'll dip them in some salt and ketchup, just eat it like that.

But I take that when I feel my best, it's not an extreme thing.

And I'm still enjoying life.

I'm not as stressed and controlled over the training and the diet, all of these things.

But then there's certain times where I want to hit a PR.

I want to accomplish a goal.

And that's when I go into a season of more extremes that come with a cost or a sacrifice.

And most of that being there's a time sacrifices, you know obviously, but more so mental energy sacrifice that comes with it.

So it doesn't have to do with necessarily resistance training or aerobic work, because there's some things like CrossFit and I guess High Rocks is still mostly running, but there's some sports that are certainly more balanced than Ironman prep or bodybuilding show prep.

I think for me, it's a split between strength and endurance.

And it's not...

It's not like, hey, I'm running 70 miles a week and then lifting a few times a week.

It's bringing that running mileage down to say 30, 35 miles a week and more strength training.

And I think even what I'll do post Ironman is keep running, obviously, but add in more cycling.

Because what I'm finding is with cycling, it doesn't have that impact on the body that running does, especially in my central nervous system.

And I can get a really good strength workout out of it as well.

You know, like one of the things I found in my when I was prepping for that bodybuilding show is the last couple of weeks I could not drop any weight.

It just like calories were going down lower and lower and lower and weight would not fall off.

And then I finally pulled running out.

And when I pulled running out, my weight over a week dropped five pounds.

Yeah.

Because of the inflammation that I was just holding on to from running.

Less venous stasis.

Yeah.

So I find I feel my best when I'm truly balancing my training and just listening to my body.

I don't think the way that I'm training right now for an Ironman is any way sustainable for long periods of time.

And you know I watch athletes and I'm sure you do as well.

They're the race junkies online who go from race to race, to race to race.

And in any given year, they might have 10 to 15 races on the schedule.

For me, I put one race on the schedule a year.

But I think when you go from race to race to race to race and you don't let your body recover, that's really like when you put yourself at risk of things like reds or potentially even worse.

You know, chronic.

Yeah, I agree.

And you know I do various events that I trained through, like I did the Patriots run, which is a rock that you do for nine hours, 11 minutes for nine, 11 and you have a team of five.

Um Maddie, my wife did it with me.

And I did get up to a new max heart rate of 199 during that ruck.

But I didn't train for that.

I just kind of went and did it and did fine.

I've done it a couple of years now.

And I did the same thing for some small local CrossFit competitions.

I did one at One of the gyms I go to Saturday but, like you said, I'm not training hard for this and I'm not straining my body.

It's more like a Saturday. that you just go and have fun.

But that is very different.

I think that a lot of people, you know, just like you can ego lift, you can ego run.

And some people are more of like weakened warriors and they don't put in the adequate training.

And then they don't know how to like modulate their system.

Like any event that I do, I'm going to try as hard as I possibly can, but I'm going to be smart about it and pace yourself in a way, I guess.

Yeah.

What's your opinion on social media's impact on training for the fitness population?

And there's obviously a positive element to it.

I will never argue that there's not.

There's a positive element for sure.

You mean like Strava and posting things on Instagram?

Yep.

Yeah.

People were inspired to start working out and to push themselves.

But I think there's also can be a downside to social media pressures in comparison with physical training in races and performance.

And it puts people into this mindset of having to strive and crush themselves daily.

And they're going to become harder and tougher by crushing themselves and not fueling and not sleeping regularly.

And then these are the type of people who are experiencing overtraining and under-recovering and REDS.

What have you seen, maybe even on social, but in your practice with individuals that fall into that pattern?

Yeah.

The more pressure that someone puts on themselves because, regardless if you're posting everything on Instagram or Strava or whatnot, the more pressure you put on yourself to get to a certain thing, you're going to have more mental health and psychosocial issues.

You know outcomes.

So you're more at risk of that part of reds if that makes sense which might not even have that much to do with the physical part.

Has some to do with it.

And I think it's just.

You know, some people are trying to be, they're trying to do it just because they think that's the right thing to do.

So I think I actually don't don't post enough of the different competitions and events I do.

I hardly post any on Instagram.

I don't do the things on Strava.

When I do, there's a lot of interest and people ask me about it because they want someone with empathy.

They want someone that's in the trenches.

For the same reason why people occasionally will say well have, what do you do personally in.

Or they say, Dr Gillette, what do you do for this?

Or, you know, when you've had a, have you had a calf strain before?

What do you do?

Et cetera.

They like it when I can answer from my perspective and then they kind of develop their perspective from there.

So I do think there's a lot of benefit to it.

And I am going to try to post more on social media about the different things that I'm doing.

But it's just so hard.

I don't need that to toughen me up.

I have my spiritual life and trying to strive to be a better Christian and love Jesus and love others.

It's just super hard to do, especially as a public figure, at least in my opinion.

And having kids is hard too.

So that's where I toughen myself up is tough. getting hard for those things.

And then the physical things, it's kind of like a break.

I'm happy when I do them.

Yeah.

A lot of that comes from just maturing and growing up and getting your priorities in order and wisdom as a whole.

I certainly don't care about as much about like body composition or big muscles or like whatever, how much I bench as I did, even five, 10 years ago.

Yeah.

I completely agree with that.

It all used to be.

Fitness was vanity metrics and, And now it's more so, performance metrics, which I feel now is even shifting and evolving towards health and wellness metrics.

That's one thing that CrossFit does really well.

They have this big continuum where you have pathology on this side and then lack of pathology or health.

Then fitness is over here.

But it's just one smooth spectrum.

I like that.

So for a hard pivot another thing that I know we were talking about previously, that we want to talk about on this episode during this conversation what I'm actually really interested in is light therapy.

So a few years ago, I bought a red light panel, got really into it, fell off, just stopped using it.

Didn't think much of it.

About two weeks ago, started doing research on red light therapy again.

I bought a panel.

We have one of the full body panels in our closet.

I am hooked.

I don't know what the difference is now compared to back then.

You know, when I had my previous panel, it was before having kids.

Steph and I were getting a whole lot more sleep.

Life just looked a little bit differently.

But now I do red light therapy for 15 minutes every single morning when I wake up.

I can feel myself literally waking up within those 15 minutes.

Throughout the day, my mood, my energy is much better.

I'm not drifting towards that caffeine as frequently as I was.

I don't have the slumps and dips.

Maybe there's a correlation, maybe not.

Maybe it's just coincidence.

And in the evening, I do the red light therapy for 10 minutes before going to sleep.

And I fall asleep faster than ever before.

So red light therapy, light therapy, is it legitimate or is it overhyped?

Yeah.

So the short version, it's legit, but more study is needed.

I'm also experimenting with red light therapy for a couple of years.

I've had a panel.

It's not a full body panel, but it's a big panel and it has a wide array of spectrums.

So there's red light and there's infrared or quote unquote near infrared spectrum, which is usually a higher number.

For example, I think in the 800 nanometer range is often infrared.

Yeah, this panel that I have has both.

670, I believe, is like deep red.

So a lot of them will have a red, a deep red, and then a couple different near infrared or IR wavelengths.

And those actually have better evidence for things like neuropathy.

But I know I sent you an article that was a meta-analysis of six of the best randomized placebo-controlled trials.

Which is generally what you want in medicine is you want repeatability, because you can find an RCT for almost everything now, which is crazy.

It's great that there's that many studies being posted.

But these large sample numbers kind of help parse out the bias.

So the sample size is over 200 people and it did appear to decrease pain and help people feel better and perhaps help them move better biomechanically earlier on in injury and for recovery, especially with muscle strains.

It appears to be particularly good.

And I think that it's also going to help bring in some of the fluid into the area to actually help it recover.

The limitation is it didn't look particularly good for getting people back to full activity faster, which for quality of life doesn't really matter.

But it might be slightly overrated from a pro athlete perspective if someone's saying I need to go back to playing full all-out basketball or volleyball.

If I was a volleyball player and I wanted to get my shoulder back to 100.

I've been doing red light therapy actually a couple different types of red light therapy devices that I've purchased, and also hydrogen water, which is a different topic.

And I don't think it has helped my shoulder at all.

So when I go back, I'm going to do some PRP and peptides.

And then I'm going to see if that helps.

More than the red light therapy and hydrogen water I've been trying.

I have done PRP before for a quad strain.

And I will say that made a huge difference.

Yeah.

A huge difference.

Quick side note, hydrogen water.

Yes or no?

You know, that's why I'm trying it is I'm open-minded.

You know, I tried that, the Echoflask hydrogen water.

I know there's differences and they all say that they're better than the other one, of course.

I also tried the hydrogen prebiotic and I just didn't feel fantastic on it.

And I did a gut health test and it said I had like hydrogen dominant SIBO as well.

So I don't know if that's from the hydrogen prebiotic.

Were you experiencing symptoms of SIBO?

No, I wasn't.

But I've been kind of underwhelmed.

There's a lot of confounding variables in my life right now, but I'm still going to continue to try hydrogen water.

I don't think it's harmful and it's kind of cool, although it does make Maddie, my wife, cringe a lot.

I would rate it maybe like a one or two on a scale of 10, whereas I'd rate photobiomodulation.

I think it's called PBM.

It's just light therapy.

I would rate light therapy maybe a six or a seven, with the potential to get up to an eight or a nine with more study.

On that scale, do you rate that effectiveness for recovery or for what kind of outcomes?

For recovery.

Presumably, hydrogen water might have some of the same effects as bicarb in terms of performance enhancement because of its pH buffering and effect affecting the bicarbonate system, which is basically not to go into too much science, but there's like three different forms of bicarbonate and hydrogen ions have to do with one of them.

But I...

Theoretically, I understand it.

And there's actually some small studies that show a little bit of benefit compared to regular water.

But I don't think that it's significantly performance enhancing enough to where it's probably not worth it to do for the average person.

Do you like using red light therapy, both the red and the infrared, near infrared, for anything outside of recovery?

I personally am using it, in my opinion, for regulating circadian rhythm, my awake and sleep cycle.

I feel like I'm getting a lot out of it for those outcomes.

Yeah.

Yeah, actually I did some Monday.

I did something called photodynamic therapy, which is a combination of red and blue wavelengths.

Blue because it helps target bacteria in the skin.

Just because my skin has been very oily recently.

I came off of like a hair med called Dutasteride and my skin is always more oily when I do that.

And for this podcast and this Vibrant Longevity Conference, I didn't want my face to be too oily or have breakouts, and blue light and red light therapy have some evidence to help with that.

That's why a lot of times after you go to your med spa like gillette aesthetics spa to get your salt facial, which is what we do i just got salt exfoliation and then that red and blue light therapy and it might have some collagen restoration benefits as well.

In the past I've had what's called a laser therapy done where they take off the outer layer of skin to help with like fine lines wrinkles, acne scars.

And then after that, I have patients including myself also do that light therapy.

So for aesthetics I would rate it as a nine, maybe even a 10, because there's almost no downside to it.

Yeah.

And the downside to the panel that we use is it's one that actually works well.

So it's super strong.

So even if I close my eyes tight all the way and put the complete blackout goggles and even an extra thing over it, I still feel like it's pretty bright on my eyes.

Is that the red or blue?

The combination of red and blue light?

But there's a setting for red light only.

There's a setting for red and amber.

There's a whole bunch of different settings, but this panel is just so strong it's almost always too bright for my eyes, even with um, like multiple layers of blackout goggles, which generally is the case for really strong light therapies.

When would you recommend, like say, someone wanted to start experimenting with light therapy?

What protocol would you give someone to use a red light panel?

But then also when to limit blue light exposure and when to incorporate blue light exposure.

So blue light coming from our devices, our phones, our TVs, our screens, stuff like that.

Yeah.

So blue light is fine in the morning.

The last hour or two of the evening I would eliminate all blue, including kind of full spectrum white light that contains blue.

People can go to their iPhone and click the night mode, and that eliminates most of the blue spectrum light.

And there's a similar setting for most tablets and maybe even TVs.

I'm not sure.

So that's the first thing to do is eliminate blue light later on.

There is benefit to infrared light.

And most of the lights that are here, like these indoor lights.

Some people say there's a deficiency of infrared light because we used to get it, because we're outside all the time.

So I think infrared light is fine in the morning and the evening.

It's particularly important for those with neuropathy.

Because again, I think most of the studies on neuropathy did include those wavelengths of light near infrared light.

Whereas if there's somebody that doesn't have neuropathy, just a wide spectrum, multiple bands, we don't exactly know which ones are best.

I've talked to the owners of many of the companies.

I don't have a horse in the race.

I've been offered these huge affiliate codes because you know people have to make money and right i'm uh, i've done enough health and fitness podcasts that people say yeah, we'll offer you this percentage.

It looks really good for selling all these, but at the end of the day, i just don't know if that's true and i've went through.

I don't.

I don't use like directly grok or chat gpt, but i use consensus or hippocratic um And there's open evidence and there's a bunch of these different kind of like thinking or reasoning model AIs that help you find the latest studies.

And people can still go through Google Scholar too, but that's going to save them a lot of time if they use something like ConsenSys.

Is ConsenSys an app?

Yeah, it's an app.

So it's just consensus.app.

And you can plug it into your chat GPT as well.

So some people do that.

Yeah, it's super cool.

But anyways, you can find, you can look for all the studies.

You can talk to all the experts.

I've spoken with many of them.

And right now I would just say I don't know, but I'm very interested to see kind of what ends up looking like the best in the future.

Yeah.

Where do you think light therapy is going?

Do you think it's just going to stay where it's at or is it going to become more popular?

I think it's going to become extremely popular.

Especially with, like, it makes sense to me.

You know, we're in this, that's why, you know, the sunlight is a pillar of health.

Because the indoor lights and environments that we're in is not natural.

That's why we have saunas and cold plunges is because we're in temperature control environments all the time.

And I think that light therapy will kind of be the equivalent of what's happened with contrast therapy.

Yeah, sometimes in the morning, when I'm standing butt naked in front of my full red light panel, I'm almost like disgusted with myself because I'm thinking we have gotten to a point where we have to stand in front of a light that mimics the effects of the sun because we can't find enough time to be out in the sun.

Yeah.

This is pathetic.

It is sad.

But here we are.

Yeah.

And you know, depending on where you live, you can go get that low solar angle light and But yeah, it is kind of sad.

You know, when I was in residency, I used to longboard, which is like a type of skateboard to the hospital.

Like you know, it'd either be in the evening if I was doing the night shift, or super early in the morning.

And I would go outside and I always joke that people would just tell me to go touch some grass, but I'm always pretty chill.

But you know, I would literally go touch the grass and the birds would be chirping and the wind would be like I'd feel the wind and it was usually very cold not, you know, freezing.

And I got such a great rush from that.

People would always think I'm on Adderall or Xanax or both, which I was not.

Where were you living at this point?

This was in Springfield, Missouri.

Okay.

But yeah, whenever I could, as long as it was not actually snowing or pouring rain, I would ride my board to the hospital.

I mean, there's nothing like a... a cold, I should say cool, crispy fall, spring morning.

Yeah.

Growing up in Pennsylvania and when we lived in Nashville, the fall, the spring, just like crispy.

And you go outside, the sun is rising.

There's some like dew on the grass.

You can smell like the season.

Nature just really can like, energize you yeah that's one great thing about having a dog more excuses to go outside early in the morning late at night yeah that's true that's true okay well I'm so far sold on light therapy red light therapy specifically and one of the things I've been doing in the evening because I'm really trying to build my my sleep hygiene sleep routine to optimize and improve my sleep at night one of my goals post Ironman that I tried to incorporate during the prep and I've realized it's just unrealistic.

Uh, I'm going to get eight hours of sleep a night.

Wow.

That is the goal.

Post Ironman, eight hours of sleep a night.

I'm going to prioritize it.

I'm going to sleep in till 6 a.m. if our children allow us to.

Like right now, I'm still waking up 4, 4.15 a.m. to knock out my run before the kids wake up.

But in the evening, I do my red light panel.

I stay off my phone.

I put my blue light blocking glasses on.

I lay in the bed, I put my compression boots on, Normatec Hyperice compression boots.

I just try to bring myself to a parasympathetic state.

And I read and I just pull my Bible out and I read for 30 minutes.

And a lot of times I don't even make it to 30 minutes.

I fall asleep with the compression boots on, Bible in hand, Steph has to wake me up.

But like that routine has really improved my life, just like fall asleep cycle in the evening, as opposed to what it used to be of being on my phone until literally, I put it down, turned over and now wear a sleep mask over my eyes.

That helps too.

I like that.

So there's a lot of things I'm building into my nighttime routine to try to improve my sleep.

Yeah, that's great.

Nighttime routines are tough, especially.

You know we have church small group Wednesday night.

That usually goes pretty late.

And then my run club, which is like the track workout that I do is 30 minutes away at five, 30 in the morning.

So that's a quick turnover.

And then everything just kind of gets thrown off a little bit there.

How many hours do you think you're getting at night?

It depends anywhere from five and a half to seven and a half.

But most good nights, I really do try to emphasize seven and a half.

Yeah, what I found is because I've been in this sleep routine for so many years of waking up at 4 415 am.

Even when I try to sleep until 6, my body's up and ready to go.

So I know it's going to take a long time to break that cycle.

Yeah, and it becomes harder as you get older too.

We're the same age, so it's only going to get more difficult.

So that's one reason why I like being the early bedtime.

Oh, I love early bedtimes.

That's great.

Sorry, my bedtime is early.

I got to go.

No, I love it.

Last time I was in bed, the kids fell asleep early.

I was in bed by 8.30, fell asleep early.

In the bed with my compression boots on, Bible on chest, blue light glasses on by like 8.50.

Yeah.

And Steph woke me up like 30 minutes later saying, hey, go to sleep.

Okay.

Next thing I wanted to talk about, I know you said it was going to be brief, but-

You brought up this new study linking high mileage running in colon cancer.

And from what I understand online, it's gaining some traction right now.

But I believe you might have some different opinions on what is being shared online.

Correct me if I'm wrong.

Yeah.

So the study itself is a good study.

So they took runners that had done at least two ultra marathons or, I believe, at least five or six marathons.

So people who had put in some serious mileage and then they screened them for colon cancer, and a surprisingly high percentage I think somewhere between 10 and 20 did have colon cancer and they were between 30 and 50.

Now the recommendation for first colon cancer screening did just go from 50 to 45.

So all those people between 45 and 50 probably should have been screened in some way.

There's many ways that you can screen it.

But the theory is that you have less of that parasympathetic rest and digest input to your gut and that.

And then also you know all the junk that you're taking when you run, which you know a lot of runners consume a lot of energy drinks, etc.

Maybe all these different things will lead to an increased risk of colon cancer.

But I think it's more likely a correlation because, for whatever reason, a lot of runners have significant history of gut issues, like inflammatory bowel diseases, or they've had a SIBO diagnosis, etc.

From running specifically, you think?

I don't think it's from running.

I think that people who tend to seek out running also tend to have those things in common.

For example, the other thing that a lot of runners share in common, and swimmers as well, is actually alcoholism.

So they're significantly more likely to like binge drink and have that dopaminergic response from alcohol which there is some causatory links there.

But I think that it's.

I could see the parasympathetic thing being a little bit of a link, but I think it's mostly correlation.

And if people improve their diets and consume less processed foods and address their gut health early on, try to avoid antibiotics, etc.

You know, ultra marathon runners and people who are in a lot of marathons are a certain mental type.

In fact usually, even if they didn't have a different body, habitus or whatnot, you can kind of recognize them.

And those same people will seek out, you know, going on a trek in Nepal or And getting terrible dysentery in the Amazon or something like that.

So I think a lot of the other factors that they tend to have lead to the increased risk of colon cancer.

My takeaway is the same as the takeaway in the study is if you have blood on the stool or any GI symptom, If you're 30 plus, 35 plus, don't wait to 45 to get screened for colon cancer.

Do it earlier.

I've recently had my first screening, which fortunately was clear.

But I also know people who have been screened before the age of 45 and found very early stage precancers and colon cancers.

With colon cancer, is that easily treatable?

It depends on the stage.

So early stages, often so, but it can come back and it can also metastasize.

So it can be difficult.

So you think these studies were more so correlation as opposed to causation?

I think there's a lot of things that the people in the selected group did.

So the exclusion criteria was Lynch syndrome and hereditary polyposis, which is like different hereditary colon cancer syndrome.

So I think that there's probably some variables, like the type of things that those runners tend to seek out also lead to increased risk.

But I do think that uh runners should be because of the study i think it's reasonable to be more cognizant if you've had gut symptoms and i think if you have any gut symptom especially blood on the stool then um my reflexive thing would be screened for colon cancer yeah there's there's no reason not to it seems like a Is there a reason behind that?

Is it the inflammation that the exercise is causing itself, or is it the amount of just food that endurance athletes have to consume to keep up with energy demands outside of training and during training?

What are your thoughts around that?

Yeah, both those contribute.

And, like I mentioned, the longer you are training.

So if someone's an endurance triathlete for their entire career, that is a lot of training hours.

During those training hours, your sympathetic fight or flight system is active and your parasympathetic rest and digest system is less active.

So I think that does lead... to more gut pathologies.

And then those individuals.

Maybe they're having to do more courses of antibiotics because of environmental exposures or whatnot.

And that also is going to lead to more gut issues.

And then those individuals are also like I mentioned with alcohol.

Maybe there's other things that they're uh taking.

Um, you know, i know a lot of endurance athletes in the past used to smoke cigarettes or use tobacco products, and that's certainly going to affect your risk as well.

They don't do that much as much anymore, but if you take a study of runners in their 40s, 50s and 60s, you're going to see a pretty high like lifetime um use of those products.

Yeah, i just feel like there's a lot of endurance athletes who experience stomach issues.

And I've always been curious why or what was causing some of that.

Yeah, I think all those things are significant inputs.

I think that once you do have your first gut episode, whatever it is, whether it's IBS, diarrhea symptoms, whether it's constipation you think about it a lot more, which actually improves your biofeedback, which I think is a good thing.

Some people don't have a great biofeedback with their gut and they just kind of ignore it.

But when there's no bathroom close, you can't ignore your biofeedback.

Oh yeah.

I have gone to the bathroom on runs in many different places in my life.

Some I am proud of, many I am not.

Yeah.

Which is wild because I haven't had those issues in probably the last two years.

Yeah.

But there was a phase and it wasn't when I first started running, but it was when I first started training seriously for endurance that I'd be on the middle of a run and I'd have to go to the bathroom out of nowhere.

And now I haven't had those issues for probably two years.

Yeah.

And you know, there's a couple of ways that you can look at this.

One issue you mentioned is that they have to consume more calories.

So you literally just need more digestive enzymes and you need to be better at digesting the bulk of fat and carbohydrate and protein that's in your gut.

And your gut is often full and is trying to work as you're running.

So that can be difficult and lead to a lot of symptoms as well.

And then, secondary to that, there's a lot of microbiome changes that you see, that is not necessarily unique to runners, but is unique to athletes.

There's certain bacteria like acromantia that tend to be very high if you exercise a lot.

Whenever I test mine in a stool, it's always sky high.

And it's almost always low in people who are metabolically unhealthy.

So having that as a protective mechanism, it can take time to develop that ecological niche.

Just like if you have a fish tank, it can take a while to make the environment of the fish tank perfect for that species of fish.

It makes sense.

For someone who... Earlier you mentioned... you have just naturally a large appetite.

For some of these people, athletes especially, who naturally don't have just a crazy appetite or they're training a lot and they have trouble keeping up with the amount of calories they have to consume.

Is there anything that people can take, such as digestive enzymes, to stimulate hunger and to ensure that they can consume as many calories, as much food, as they need to to fuel the energy demands?

Yeah, there's a lot of things, even without taking digestive enzymes that help.

Digestive enzymes can be reasonable and there's specific types of digestive enzymes that can help.

But one of my favorite tips is from Diana, and she's one of our sports and performance dieticians at Gillette Health.

And one to 10 minutes before your meal you can take something called bitters, like apple cider vinegar, lemon water, even ginger anything that's bitter on your tongue and you leave it there, just enough to get that bitter sensation.

And that will stimulate the natural flow of digestive enzymes from your own body even before you start to eat.

Also, if you smell or taste something you particularly like, that will also help start the flow of digestive enzymes.

And then if you take literally longer to eat something, then that will also help.

Sometimes if you're inhaling a bar as you go, then it can't take as long.

I'm a fast eater.

Yeah, I'm a super slow eater.

I think we talked about this before, but being a fast eater, it can be more difficult to acclimate to that.

To make sure you digest it.

And a lot of fast eaters do use digestive enzymes or the bitters before the meals, things like that, to help.

Would you consider like pickled ginger a bitter?

Like the ginger you get with sushi.

As long as it gives you that, it's just enough.

It's not super bitter, but it should be bitter enough to give you that sensation where it makes you want to make a face.

Yeah.

That ginger, like sushi restaurants does that to me.

And I can go crush, you know, nigiri.

Yeah.

Crushed nigiri.

But I'm the person who's eating the ginger, multiple plates of it throughout the entire meal.

I love that ginger.

When I get back from crushing sushi and nigiri, And I keep it very like, you know, clean.

Like it's not like these hand rolls with all the spicy mayo on it.

But two hours after a massive meal, that type of meal, I'll come home and I'm starving again.

And I'm wondering if that ginger is helping aid in digestion during that meal.

It could be.

Yeah.

Could also be the glucose and insulin shift, which often leads to that too.

And then it could also be MSG, depending on what's in it.

Bodybuilders used to use MSG for bulking.

For what reason?

To upregulate appetite.

And then sodium in general is going to slow gut transit.

So MSG will upregulate appetite, but sodium will slow down the digestion.

Yeah.

And then an hour after, I actually posted this on my Instagram.

I did a donut eating competition with a continuous glucose monitor on.

I got up to 213 and then I crashed to 50.

Oh, wow.

And I did it one hour after eating, I think like eight or nine donuts.

I did a high rocks workout and-

I felt great.

I took a video of myself.

I was literally sugar high when my sugar was up.

And then an hour and a half later, I kind of felt hungry, sweaty.

I felt like I had to lay down.

I was cramping up.

I felt terrible because my insulin spiked so fast.

My glucose crashed, despite having however many thousand calories of donuts.

But that insulin spike will aid short-term and athletic performance?

Yeah.

So, you know, donuts are high in fat, so not the exact same as sodium slowing.

And you don't want your insulin spiking as you exercise.

Exercise is an insulin mimetic.

They both actually push carbohydrate into your cells similarly.

But I think donuts could be a reasonable thing to eat the night before doing a workout.

I felt terrible that I could barely finish the workout.

I was cramping so badly.

But I did it, for I guess I did it for the social media and I did it for my own interest, because I've also heard people influencer doctors say your glucose should never go above 180 or your glucose should never go above 200, or it means you're really unhealthy.

Yeah.

But I think that that one time that my glucose went to 213, it was not terrible for my health.

And my next two days, the glucose was perfectly normal.

I felt great.

I was completely back to normal.

So from time to time something like that, or even a couple times a year, drinking some alcohol.

I mean, it's very trendy to avoid it completely.

100 now.

I think things like that can be worked into a healthy diet.

On the topic of alcohol, what is happening?

Do you consume alcohol occasionally?

Yeah, I do.

In the last year probably only three or four times, partly because I have a young child and I'm not going to drink by myself.

And if I do, I want to do it at 10 a.m., as ridiculous as that sounds.

I don't want to consume alcohol late in the day because it's just going to destroy my sleep.

So it is very rare.

But I think that it's safe to say there's no physical benefit, but there is a significant social benefit, whether people like it or not.

I think it's kind of falling out of favor, which is great.

But I think that people can consume small amounts of alcohol infrequently and still have optimal health.

So I do.

And I enjoy it when I do.

I don't feel guilty.

If you feel guilty when you drink, even if it's just a tiny bit once a year, then don't do it.

Yeah, we rarely drink at this point.

Yeah. in our lives anymore.

And if we do, it's, it's one drink, it's like one glass of wine.

It's a crazy night if it's two glasses of wine, you know, or it's like it's like a four hour dinner out with friends, like all right, we'll get the second glass of wine.

But it's just, it's so rare now at this point that for me, it's, If there's no net positive, I'm like, why even do it?

But I do love the social aspect of it.

Like if we're having a group of friends over for dinner and we're cooking some good food and we're just relaxing.

You know, crack open a good bottle of wine and have a good one.

Mm-hmm.

What is happening in the body when you consume alcohol?

What creates those downstream negative effects that we're trying to avoid?

So alcohol is ethanol, of course.

And ethanol converts to acetaldehyde via alcohol dehydrogenase.

And then acetaldehyde is metabolized via acetaldehyde dehydrogenase.

So people who get flushed from alcohol usually is from that acetaldehyde metabolite.

And there's a lot of different things in your microbiome, or even probiotics, that can help metabolize it.

I'll actually send you my alcohol attenuation stack that I take, even though I probably don't need to because I hardly ever drink.

But even with one drink, you take this?

With one, I don't.

But I also rarely drink one drink.

If I'm going to drink, I'm probably going to have two or three or four.

And I'll probably start in the morning, maybe trying to smoke something on the Traeger or whatnot.

And it's a social benefit, like you mentioned.

But there's things that you can take before and after.

DHM is another one that helps with metabolism.

I also take NAC, which is an amino acid that helps replete glutathione.

And often glutathione itself helps.

A lot of times I prescribe subcutaneous glutathione injections or even NAD plus injections to take the next morning for a nice energy boost, if people kind of feel under the weather.

And some people just come in and get IV of glutathione or NAD plus.

But those are prescriptions.

Glutathione is a tripeptide.

But I'll kind of post the full stack.

Sometimes I also take something called LDN, which is low dose naltrexone that I've talked about a lot.

That does the opposite thing of dairy protein and gluten.

It kind of helps push the gut forward and helps give it more normal motility, because alcohol is going to slow the gut motility.

A lot of it's actually absorbed pretty quickly but it's going to slow the rest of the motility of the gut.

And then some people get that dopaminergic spike from alcohol and then they kind of get the crash after.

Almost like a mild version of what happens when someone takes an ADHD medicine a little bit of extra energy and adrenaline and then almost kind of a pseudo-depression phase after.

You can also get with alcohol.

And then because it's also GABAergic you think about Xanax Ambien Gabapentin, alcohol these things increase GABA signaling.

Then you kind of have that GABA withdrawal.

So alcoholics in the hospital, put them on protocols called AWAS or CWA, but basically it's just measuring how much like desensitivity they've had from the GABA standpoint.

And we give them things like Xanax or Valium to help bind that GABA receptor.

So there's a lot of things that you can do, but L-theanine is a good thing to kind of balance that out.

LDN also helps that side of things.

But yeah, I'll post the full protocol.

So consuming alcohol has a lot of downstream negative effects almost immediately on the body.

That's why I say there's zero physical benefit.

It used to be.

Like the Heart Association said, some alcohol can be heart healthy, maybe for males, but doesn't really appear to be the case.

Yeah, I've even found, especially when I'm in a big training block, you know, one drink with dinner will affect my sleep and performance.

And right now I feel so good in this training block because my diet, my sleep, my recovery protocols are so dialed in.

You know, when you feel that good, you don't want to do anything that's going to take away from that.

Yeah.

People are scared of antibiotics and they should be.

They should just be used for things that are not going to get better otherwise.

But alcohol is kind of a mild antibiotic in your gut as well.

It's going to lead to a lot of gut microbiome shifts that are going to lead to downsides even multiple days after.

You see a lot of males of college age developing things like Crohn's disease or inflammatory bowel disease.

And often you see antibiotic use, alcohol use, and poor sleep as a lot of the kind of sparks.

Of course, there's a lot of genetic causes.

And with any autoimmune disease, there's the fuel to the fire.

And then there's the tender, which is the kind of genetics that is the preexisting environment.

And there's a spark that actually starts it all up.

Yeah, Steph and I were actually talking about this this past week.

She grew up in Michigan.

I grew up in Pennsylvania.

And just the environment that we grew up in.

Going to college was just this natural progression from high school to the next chapter of life, before you get a full-time job.

And college wasn't taken seriously. in all honesty, very serious.

In the environment I grew up in, it was considered like here's four years of just truly having fun and partying and all these things.

And one of the things we've talked about a lot recently is, as we're raising our children Charlie's three, Nico's one, so we have some time before they go to school is just instilling in them core values and our faith and following Jesus and living in a way that he would, in hopes that in our goal, our mission is that by the time they get to college age, whether they decided to go to college and university or not that we don't have to tell them Hey, when you go to school next year, this is what you should and should not do.

But they go, if they go to university and college and, They're going for an education.

They're going to learn.

They're going to get better.

They're not going to make these poor decisions.

And just like the way that we are trying to lead and raise our children, is that they can make those decisions on their own, based on the core values that are true to them and their life.

And I just look back to how I was born, prepared to go to that next chapter of life with not those tools or mindset.

I think it's a huge opportunity as parents, you know, leading and raising children.

The complete side tangent based off of where we started with the alcohol conversation, but it just had me thinking.

You know it's a drink.

It's consuming this beverage but has such negative, not only short-term but potentially life-altering consequences.

Yeah, very true.

As I mentioned, my brothers and I were homeschooled all the way through.

So I actually almost went to a six-year med school program and I would have been done when I was 21 because I finished the high school classes early with my older brother that we did all the school together.

But I wasn't culturally mature enough So yeah, I definitely wasn't into that type of things.

In hindsight, I was probably a very uncool homeschooler.

And I remember I ended up joining a fraternity.

One of my fraternity brothers told me when I was in one of my last couple of years of college, before I went to KU Med.

He said something like well, you've changed.

I feel like you're just being a fake person because you're trying to be cooler than you are, or something like that.

And he knew me pretty well, so I didn't take it negatively.

But I thought to myself I think I've literally just changed and been okay with growing as a person through college.

I think it helps me do podcasts and relate to people who are homeschooled from Kansas or whatnot.

Yeah.

But that's the other thing that Maddie and I have talked about with Ozzy and Archer and Goldie Grace is that we want them to be able to be lifelong learners and be able to change as a person and not be stuck into whatever personhood that society or the average person thinks that they might be stuck in.

So when you got to college-

So you didn't drink when you got to college?

No.

Did you make that decision based off of the values that your parents taught you or based off of just lack of exposure prior to that life transition?

That's a good question.

I would say, you know, everybody's kind of in a micro environment of culture and the one that my family was in was not really.

It was kind of in the category of nobody drank.

So I just figured I wouldn't.

I would almost say it's like more part of my faith than anything back then, but now not so much.

I don't think it really has much to do with being a Christian than you know, some Christians are okay microdosing nicotine or taking CBD, or there's all these different things that some Christians are okay with.

And I think that comes down to your personal relationship with Jesus and what your convictions are.

And I'm just worried about mine.

I'm not worried about other people's, but at least at that point in time I think I just kind of considered it.

That's part of my like walk of faith.

That's what we're trying to really instill in our children is not necessarily trying to teach our children what is right or what is wrong, but truly knowing the Lord and having a relationship with Christ.

And we believe that if we can teach our kids to have a relationship with Christ, they will make the right decisions on their own, based off what they know is right or wrong, not what we are telling them.

I love that.

Again, Charlie's only three, Nico's only one, but really just starting to plant the seeds in preparation for raising them prior to sending them off, because I recognize how fast that goes.

Most brain development occurs before age seven anyway.

So it's kind of crazy to think with Ozzy who's five, almost a third of the time that I've had with him before he goes off is gone.

That's pretty crazy.

At my church, they have a... sign and they fill up beads of how much time is left with your child.

And they show newborn, kindergarten, sixth grade.

That's sad.

Freshman and then done.

Yeah, it's crazy.

Yeah, I've recently had that realization of just how fast it goes.

And everyone tells you it goes fast, but it actually scared me.

You know, realizing...

I'm having full conversations with my daughter about real stuff now.

And before I know it, she's going to be running off, playing with friends and moving away.

I don't want to wish these years away.

I actually want to slow these times down and be very present, which is one of the reasons.

My whole view and perspective, perspective around training and sport and, you know, striving in it and running myself into the ground physically for a race to rob me mentally from time with my kids.

I'm like, this doesn't make any sense.

So it's been a, it's challenged me.

It's made me grow and realize, okay, I'm seeing what's important now and what's really not.

Mm-hmm.

Yeah, there's definitely a level of growing as a person and being an example.

And you're talking about being an example to your kids for their walk of faith.

But exercise is obviously the same thing.

And that's different for everyone.

So if some people say... my parents were a good example or not a good example.

My parents at least knew that exercise was important.

Maybe it wasn't extremely consistent, but it's that way in all areas of life.

Yeah, I agree.

Well, Dr. Gillette, This was another good one.

As always, I appreciate you everything you're doing for the community and the health and wellness and performance and optimization space.

My family obviously works very closely with you and we appreciate you.

So thanks for coming on the show again.

Thank you.

[Navigating the Spectrum of Health, Performance, and Holistic Optimization]-[141: The Complexities of RED-S in Athletes | Dr. Kyle Gillett]

📋 Summary

Navigating the Spectrum of Health, Performance, and Holistic Optimization

Understanding REDS: The Relative Energy Deficiency in Sport

The Role of Technology and Light Therapy

The Intersection of Gut Health and Performance

Leadership, Parenting, and Core Values

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📝Key Phrases

📖 Transcript

[Navigating the Spectrum of Health, Performance, and Holistic Optimization]-[141: The Complexities of RED-S in Athletes | Dr. Kyle Gillett]

📋 Summary

Navigating the Spectrum of Health, Performance, and Holistic Optimization

Understanding REDS: The Relative Energy Deficiency in Sport

The Role of Technology and Light Therapy

The Intersection of Gut Health and Performance

Leadership, Parenting, and Core Values

Deep Learning with ListenLeap

🎯Key Sentences

📝Key Phrases

📖 Transcript

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