Ready, set, go! This is episode 408 with exercise scientist, award -winning author, ultra -marathoner, and contributor to Ultra Running Magazine, Dr. Nick Tiller.
Welcome to the Strength Running Podcast. We surround you with the same experts as pro runners.
So keep listening to hear running coaches, physical therapists, strength experts, dietitians, sports psychologists, and other thought leaders give you the best guidance possible to take your running to the next level.
I'm your host, Coach Jason Fitzgerald.
I'm a former cross country and track athlete for Connecticut College.
I've been coaching runners since 2010, and I used to write for Trail Runner Magazine and Runner's World.
Today, I'm the head coach of Strength Running, host of this podcast, and I work with a small handful of startups in the running space.
You can learn more about me and Strength Running at strengthrunning .com.
All right, we are now getting into some hot weather here in Denver, Colorado.
It's 80 degrees right now, and no doubt there are going to be some heat training content episodes coming up soon.
Now until then don't miss my prior episode with Brady Homer about Zone 3.
That episode was published last June.
I also did a really interesting episode about Zone 3 which is your aerobic threshold with John Davis from last August. If you haven't yet too make sure you either subscribe or follow the show so you don't miss any of the upcoming heat training material.
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My guest today is Dr. Nick Tiller.
He's a research associate at the Lundqvist Institute at Harbor UCLA Medical Center and acclaimed writer and author of The Skeptic's Guide to Sports Science, which was named one of book authority's best sports science books of all time.
His research centers on exercise physiology and respiratory medicine with a a specialism in extreme exercise, a fitting topic as Nick is an accomplished ultramarathon runner.
He is a regular contributor to Skeptical Inquirer and Ultra Running Magazine and serves as an associate editor for the International Journal of Sports Nutrition.
Today's episode focuses on health and wellness fads.
I love debunking bad science or trendy training fads that look good today, but will absolutely not be considered best practices tomorrow.
morrow. Today, Nick is helping us think through six different health and fitness ideas from detox diets to organic food, barefoot running, nasal strips, cupping, and respiratory muscle trainers.
It's a fascinating look into the actual supporting evidence of each one of these interventions.
Without further delay, please enjoy my conversation with Dr. Nick Tiller.
All right, Nick, welcome to the podcast. Great to be here.
Thanks for the invitation.
Well, I am excited for this conversation.
We are going to talk more about some big health and fitness myths or misconceptions and better ways of organizing our thoughts around these topics.
But Nick, before we get started, I learned after doing a little more research for this episode that you're also an ultra marathoner and I had no idea when I first reached out to you.
So that's awesome to hear.
Yeah. I've been running for well over two decades now.
I started doing marathon running when I was, as soon as I turned 18, because historically I was a very, very bad runner.
When I was at school, I would always finish close to the back of the pack whenever we did cross country and this kind of thing.
So I decided, you know, the best way to overcome that kind of limitation is to tackle it head on.
So as soon as I left school, I entered my first marathon and in the UK, you have to be at least 18 to run a marathon. So I did that.
And as the saying goes, you know, I got the bug and I never looked back.
And after a while, after doing, I would say 10, 15 marathons, I decided that I had a very finite upper limit to how fast I could run.
I was never going to do a 245 marathon. I think I could maybe have done a sub three if I'd have really trained, but I was genetically limited in that respect.
So I thought the best way to approach it is to go further rather than faster.
So that's how I got into ultra.
Yeah, it's been a very cool journey.
What kind of distances have you run in the ultra world?
Everything, really.
I started off with a couple of 50ks, then went up to 50 miles.
I've done a couple of hundred mile trail races as well.
I've done stage racing.
I did Marathon and Day Saab, which is the race through the Sahara desert.
I've done Ironman as well.
So ultra endurance more generally.
And I've sort of taped it off in the last couple of years because I just haven't quite had the hunger for it.
And it's not the kind of sport that you can do in a half -hearted kind of way.
You sort of have to do it all in.
And I just haven't had that fire the last couple of years.
So I've sort of just been focusing on other things, but I'm waiting for the right opportunity to make my comeback.
Well, that's a high level of self -awareness that I commend you for.
And, you know, I'm sure that your personal experience in what I might describe as some more extreme endurance sports has led to some additional insights when layered on top of your academic background.
And, you know, I'd love to get started with your thoughts on a few somewhat controversial topics in the health and fitness world.
And, you know, I'm hoping we We can spend maybe five to 10 minutes on each topic and just get your high level thoughts and whether or not these certain ideas are worthy of us trying to implement them in our training and really what you think of them from an evidence -based perspective.
So let's start with something that is a little broad, but you did cover it in your book, Detox Diets.
Is this something that you think is a good idea, not just for runners, but really for for anybody who might want to get healthier and maybe even quote unquote, detoxify themselves.
Yeah. Well, this is a good one to start on because the term toxins and detoxes are absolutely everywhere.
It's become a mainstay in modern wellness marketing.
And the idea is very attractive because it sort of, it, it, it conveys the sense that you can somehow atone for bad lifestyle choices.
You know, if you've been out the night before and you've, you've drunk too much, or if you've been binge eating all week, or if you have an exercise that you can somehow make up for this poor lifestyle with even more extreme dietary interventions.
Some people might go on a juice fast where they'll have nothing but fruit juice for a week or two.
Other people will fast altogether.
There are some diets that literally just involve you restricting everything you eat down to one specific food group.
And the short answer is no, these are definitely not recommended it apart from anything else the the whole idea of detoxifying the body is is not a it's not it's not a real intervention the the only the the the term of detoxing the body or detoxifying the body is really only relevant in extreme cases of of uh of of alcohol poisoning or drug addiction in which case most of the time this is taken taking place in a clinical environment and in which case the the liver and the kidneys might need an extra helping hand to remove alcohol from the blood in the case of blood poisoning.
But in pretty much every other scenario, your liver and your kidneys do a pretty good job of detoxifying the blood, and they don't need any help from, you know, a juice fast or an ear candle or a coffee enema.
I mean, hot coffee enemas is one of these detoxing practices that people actually do.
And there are case studies and scientific reports of exactly what you'd expect, side effects of squirting hot coffee up the rectum.
So you can imagine what kind of side effects and what kind of risks there might be.
But people have bought into the fact that the blood needs help detoxifying.
And in fact, like I say, the liver and the kidneys do a pretty good job of doing that already.
So no, I don't recommend detox diets.
I don't recommend any kind of practice for or a kind of detox.
And it's all building on this idea that there are quick fixes, that there are simple solutions to complex problems, and invariably, they don't exist. It's my understanding that no individual food or beverage is going to give you that detoxifying effect, because your body sort of treats everything, you know, somewhat the same, you know, just sort of breaks it down, goes through the normal digestion process.
process and whether or not you're having a juice fast or you're giving yourself a coffee enema.
I might have to put an explicit rating on this episode.
But it just doesn't really work like that, right?
Like the human body doesn't process food in a different way because it's clean, quote unquote, or something else, right?
Well, it's just intuitive to think that if you have some kind of medical ailment or if you're lacking energy or if you've got a headache or if you're you know, training as you'd expect, that there is some kind of tiny unmeasurable demon in the body that's making you sick.
It sort of harkens back to ancient Greece philosophies of the four humors, which, as we know, was incredibly wrong and it's now been replaced by much more modern, much more effective medical interventions.
But yeah, it's intuitive to think that we might be able to do, to eat one particular food or to engage in one practice that's going to help to filter out toxins from the blood, but invariably these toxins don't exist because in the very rare cases where your body does produce toxic compounds, they are processed and filtered out from the liver and kidneys because if they weren't, if they didn't do that very quickly, very efficiently, you'd get sick very quickly.
So yeah, millions of years of evolution have given us very sophisticated, very complex machinery for taking care of these processes and there's nothing that a juice fast or teabags in your socks or ear candles or vaginal jade eggs are gonna do to expedite the process.
Also a real product, by the way.
Yeah, and fortunately, I have actually heard about that one.
It also makes me kind of think that detox diets are also very similar in some ways to the extreme recovery protocols that some athletes go through without recognizing that recovery, or in the parallel example, detoxification, they happen without us really doing anything anyway.
It's a normal process that occurs within our body.
And so we can certainly help our recovery along.
We can certainly do things that hamper our recovery.
But I think remembering that it is a natural process that is happening by itself, without any of these interventions, is a really helpful one, because we don't have to obsess over it.
And I think the same can be said about detox diets.
Yeah, absolutely. And I think the most part of my job is getting people to understand that, as you rightly say, the body is going to take care of these processes by itself.
And the 98, 99 % of your recovery is going to come from a broad brushstrokes approach of getting rest. So as in not training hard when you need to recover, getting sleep and eating well, right.
And that, that's going to give you 98, 99 % of your recovery.
And then there might be a few percentage points to come from, you know, doing some active recovery or doing some stretching or doing some massage or, uh, you know, whatever, it happens to be.
But almost all of the most profound gains in your recovery are going to come from stuff that you're doing anyway, just resting, eating well, and sleeping well.
And if you're not doing those things, that's what you need to focus on.
The problem is, is that those things are quite difficult to monetize.
They're difficult to sell.
And so these are the things that your fitness influencers and your wellness gurus tend to focus on.
They want you to focus on the ice baths and the expensive supplements and the saunas and the massage guns and the compression boots and the compression socks and tights and these hundreds of other things that if they do work, might give you a couple of percentage points.
But really, those are the things that can be sold.
But what's going to make most of the difference are the things that you can't package and sell on a website.
Yeah, that's really well put.
Let's stay on the topic of diet, diet, nutrition and food.
Let's talk about organic food.
This, you know, I went through a phase where I pretty much only bought organic food.
Then I got a little disillusioned by it because I learned some things about sort of the label and what it means and also what it doesn't mean.
And so I'm curious, especially for the listeners of this podcast who really care about their running, they want to leave no stone unturned in their quest for, you know, the best running performances that they can muster.
Is it worth it to spend the extra money for organic food?
How do you think about this one?
Organic food has been pretty well studied, and there's no convincing evidence that it's more healthful for the body.
So if somebody is already eating organic because they prefer the flavor, or they're eating it for ethical reasons, for environmental reasons, then I would never tell anybody to stop eating organic.
But certainly from improving your health and performance or your recovery, there's no need to pay extra to go organic.
As I say, this has been extensively studied.
So even in cases where you get a slightly higher concentration of nutrients in some organic produce compared to non -organic produce, in the grand scheme of things, it's not going to make a huge difference to your health or to your performance.
And the whole idea that organic foods are free from pesticides is actually not true.
The regulatory bodies only test for synthetic synthetic pesticides, whereas organic produce still uses pesticides, but they use organic pesticides.
And in many cases, those organic pesticides are actually less effective so that you need more applications.
So they actually end up using more of the stuff than they would if they just used an artificial or a lab -based pesticide.
So these things are not necessarily more helpful.
Again, the research is really unclear on that.
They are definitely not free free from pesticides.
They're free from synthetic pesticides.
And in some cases, it depends on the particular product.
They may be more environmentally friendly.
They may have a lower carbon footprint, but it's not always the case.
So I guess the summary is, if you prefer the taste of organic food, which some people do, or if you want to use that kind of produce for environmental or ethical reasons, then go ahead.
But there's no reason to go organic or by extension, any kind of like non -GMO, which is another kind of worms, which we can talk about if you like, for your health or your performance.
There's no evidence that it contributes to either of those things.
You know, one aspect of this that I think a lot of people have heard about is, you know, the dirty dozen, which is a list of 12 fruits and vegetables that are said to have higher levels of those synthetic pesticides.
So if you are going to buy organic, it's best to, you know, focus on those 12 foods.
Is there any truth to the fact that, you know, some fruits and vegetables are exposed to dramatically higher levels of those synthetic pesticides?
And does that even matter?
uh probably there is i mean i couldn't tell you what they are certainly different different fruits and vegetables are going to have a higher tolerance they're going to need more applications maybe because they have more problems with pests and that kind of thing that's the whole point that's the whole reason we use pesticides right is to control pests and uh and and so yeah it's i think that's a reasonable um conclusion but the thing is you know i always wash all of my fruit and vegetables when i get it and that's because it's not because i care about the about eating the earth, the dirt, that doesn't
bother me. But it's, I don't want to consume any of the pesticides.
So as long as you're washing your fruit and vegetables before you consume them, then you're going to be rinsing away most of the pesticides on the surface of the thing anyway.
So, and as I say, the thing with organic produce is that they still use organic pesticides and you need more applications to get the same kind of effect.
And in some instances, you're going to be getting more exposure to the fruit and vegetables from organic pesticides, and it can be worse for the environment, for the soil as well, because you're having to apply so much more of it.
So I think it's certainly not something to lose a lot of sleep over.
If you prefer organic food, then by all means use it.
But it's again, just to reiterate, it's not something that you need to do for your health or your performance.
You know, so far, we've talked about organic fruits and vegetables.
What about organic other foods?
You know, we can buy you can go to the store and you You can buy organic chicken, organic beef.
You can even buy organic yogurt.
Is there anything very different about these foods compared to fruits and vegetables?
Well, let me give you an example.
I will only buy organic eggs because the only eggs that I can find in my local supermarket that are free run or sorry, free range eggs are organic.
If I buy any other kind of non -organic eggs, then they're either caged or they're free which is not quite the same thing.
They sound kind of the same, free run and free range, but they're not.
And just from an animal rights perspective, I don't want to consume eggs from caged hens.
So in that respect, yeah, there definitely is something to it.
Unfortunately, organic and non -GMO produce is much more of a marketing hook than it is anything that you can hang your hat on in terms of an evidence way to eat more healthily.
It's something that pervades all aspects of health and wellness.
It's called the appeal to nature.
It's this idea that something that is natural is inherently better, and something that's unnatural or synthetic is inherently worse.
And when I used to teach my students a few years ago, I always used to give them, I used to run a class on applied physiology and had elements of critical thinking in there.
And I would always run a thought experiment with them.
And I would say, imagine that you have a spoonful of sugar in one hand that is derived from nature.
You know, maybe it's extracted from a plant.
And in the other hand, you have a spoonful of sugar, the exact same volume, let's say it's five grams, that was made in a lab.
And if you were to look at both of these sugars under a very very high -powered microscope, they had the exact same chemical structure, C6H12O6.
So that's six carbons, 12 hydrogen, six oxygens.
And if you were to consume either one, they would have the exact same effect on the body.
Which one would you prefer to put in your coffee?
Would you prefer the natural sugar or the synthetic sugar?
And 95 % of the class always put their hand up for the natural sugar.
And the question is why?
If they had the exact same chemical formula, if they had the exact same effect on the body, why would you prefer to consume the natural one?
And that invariably they would say, well, I'd rather put a natural product in my body than an unnatural one.
But really when you start to peel away those layers and you dig to the deeper levels, there's no logical reason to favor the natural one over the synthetic one.
It's an inherent, it's an ingrained human bias that we just have this natural affiliation for, a pun not intended, intended, for natural produce.
And so when we advertise with organic, we advertise for non -GMO, it really comes back to exploiting this appeal to nature, this idea that something that is natural is somehow better.
And really, when you look at the evidence, there's no reason to assume that, but it's just marketing is designed to exploit one of our many biases.
Yeah, that's a really good point.
Let's move on to a training -related topic here.
This is is something that I've seen maybe because I live in Colorado and you know people people here you know I seem to get ads to try to help me acclimate to the higher altitude here and so this is a respiratory muscle trainer you know I've seen these where you kind of put a mask over your mouth and nose you sort of look like Bane from the Batman movies and it's supposed to make breathing a little bit more difficult.
And that trains your diaphragm, all those respiratory muscles.
And I'm not even entirely sure of the promises that they're making for something like this.
So maybe you can first talk a little bit about that and whether or not you think these have any merit.
Yeah, well, respiratory muscle training, and I should say, obviously, I'm English.
And so I always say respiratory.
And my American friends tell me that it's respiratory.
respiratory and uh and then i have to point out that there's an eye in there so how can it be respiratory as you know it's clearly not correct where this is aluminum all over again but uh so i'm going to probably i'm going to switch back and forth between respiratory and respiratory depending on how i feel but they mean the same thing we're talking about the respiratory system which is the airways and the lungs and you could probably include the respiratory muscles in there there as well and so these respiratory muscle trainers are targeting mainly the inspiratory muscles so the prime mover is the diaphragm
that broad dome shaped muscle that sits just below the lungs it's the prime mover when you breathe in so whenever you take a breath in the diaphragm pulls downwards distends into the thorax closer to the pelvis and it changes the pressure change and it allows the lungs to expand.
And one of the very extensively researched phenomenon in exercise, particularly high intensity exercise is respiratory muscle fatigue.
So it's usually, we're talking about the inspiratory muscles.
So when we're breathing in and these muscles, just like any other muscle of the body in the quads, in the calves, they can fatigue, they can get tired.
And when your breathing muscles start to fatigue, that can affect how hard you can breathe.
It might make you more breathless and it can certainly affect exercise performance.
So a bunch of different products have come out over the past couple of decades that claim to train the respiratory muscles to increase how much pressure they can generate.
And basically just like you would go to the gym and you would lift weights to make your muscles stronger, it's basically weight training for the inspiratory muscles.
It's the same kind premise.
Of course, you can't actually lift weights with the diaphragm because it's deep in the thorax.
So what we do is we use a mouthpiece, or in this case, it's a face mask, and you breathe in against a resistance.
So it's inspiratory resistance or resistive load.
And at the start of the training program, you might just do 30 breaths breathing in against a resistance.
resistance and then over time you can do more you can do more sets and reps or you can increase the resistance so you're essentially adding more plates to the barbell right so that's the basic premise respiratory muscle training does have a does have a benefit you can through various training interventions you can increase the strength of the respiratory muscles you can increase how much pressure they can generate, and that can make the muscles more fatigue resistant.
And that's been demonstrated extensively in the literature.
Now, it's probably one of the only respiratory -based products that actually delivers on its promises.
Now, what's important to partition out here is that there's only one type of respiratory muscle trainer.
This is the PowerBreathe device that's actually been researched extensively.
And in pretty much all of the studies on respiratory muscle training, they've used this PowerBreathe resistive and spiritually device.
And to my knowledge, very few of the other products have actually been evaluated in the same way.
So the face mask that you're talking about that goes over the nose and mouth that provides a resistance that I think it's been tested a little bit, but most of the research has not looked at that particular device.
I think when it was initially marketed, it was called like an altitude training mask and they had to change the name because it has nothing to do with altitude.
It doesn't replicate the reduced partial pressure that you get from altitude.
It just provides a resistance for you to breathe against. So yes, certainly for people who are doing endurance exercise, respiratory muscle training is worth looking into, especially if you have some kind of, if you experience excessive breathlessness during exercise, it's probably less important for people who are doing the really extreme long distances.
Uh, it's, it's mostly relevant for people who are going to be breathing quite hard and quite fast for, for their, uh, for their, for their competitions or in training.
But, but yeah, this is a, one of those devices that seems to have a pretty good research base behind it.
Nick, my intuition on this, and please correct me if, if that's a little bit off base here is that this might be a little bit more effective for the beginner runner who maybe doesn't have, you know, we talk about a base of endurance, like almost like a base of risk, respiratory muscle fitness.
Um, cause, cause I remember, and this is true in my coaching practice as well.
When you first start running, you're probably more likely to have a side stitch or a side cramp.
And I know this is a little bit of an issue where where we don't entirely know the causes of side stitches.
However, my hunch is that it's potentially a diaphragm cramping issue or something very similar to that.
Would you say that training your respiratory muscles might be more effective for the runner who is just getting started and doesn't have that kind of experience running the hard workouts, running the shorter or races, which have the obvious effect of getting you to breathe really heavy and training those respiratory muscles.
Well, sure. Let me put it like this.
If you were to get a group of untrained individuals and you put them through a 12 -week training program and you measured their respiratory muscle strength before and after the training intervention, their respiratory muscles are certainly going to get stronger because they're training more.
and just by going out and running regularly particularly if you're doing high intensity efforts you're training your respiratory muscles to contract more forcefully because they have to so certainly if you get somebody who's trained and somebody untrained the trained person is almost always going to have stronger respiratory muscles because they've been through that process but that said elite athletes can still experience respiratory muscle fatigue because by virtue of the fact that they can contract those muscles harder and more forcefully, they can ventilate harder.
They're actually, they could potentially be more predisposed to fatigue because they can work at a higher rate.
You know, it's kind of like if you have somebody who's literally never exercised before in their life and you ask them to go and do 400 meters around a track, they're going to do it so slowly that the type of fatigue that you're going going to see in those individuals will be very different to the kind of fatigue you'd have in a well -trained sprinter because they're actually able to stress mechanisms of the body that the untrained person can't even access, right?
So yeah, you're absolutely right.
A trained person will have better lung function scores than somebody who's untrained.
A lot of that will come from the fact that they have trained their respiratory muscles to be able to contract more more forcefully, but elite athletes still do get respiratory muscle fatigue.
So if you're interested in training, training the respiratory muscles, again, it's, it's not going to be, it's not going to change your world.
It's not going to turn you from an amateur athlete into an Olympic performer.
But if it is going to work for you, it will work for people across the spectrum.
So don't worry about, you know, if you're untrained or high level, it's something think that is it could be worthwhile if you're interested in endurance sports to begin with yeah and i think particularly those middle distances probably you know i would venture 10 000 meters and shorter where you're going to be accessing a little bit more of that vo2 max zone which does take your your your ventilatory threshold pretty high yeah and you're right and just to add on to that it's the the respiratory system is generally considered to be overbuilt for its demands so it's very rarely going to be a limiting
factor in exercise performance but if it is as you quite rightly say it's going to be during the high intensity efforts where you're where you have to exercise for you know at least 10 minutes so you're looking at you know i don't know from 3k upwards really 3k probably up to about half marathon and once you get up to marathon and ultramarathon, it's still good.
It still could be an issue, but there's going to be less of your, your ability to ventilate the lungs is going to be less of a limiting factor.
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Try it for yourself at prevonex .com and be sure to use code JASONGREENS to save 15 % off your first order and don't tell anybody but you're also going to get that discount on anything else that might be in your shopping cart just make sure that you put gut and greens in your cart and use code Jason greens and that discount will be yours for whatever you're buying all right Nick our next issue is one that I grew up with as as a young runner something that uh was promoted as uh something that could help us stay healthy improve our performances improve our running form it was very much popularized
by christopher mcdougall's book born to run that came out in i think 2009 that is the topic of barefoot running uh i have a lot of thoughts on barefoot running but i i'm gonna hold those close to my chest and let you take take this Okay, well, I don't have my own opinions.
All I do is just point my nose in the direction of the evidence.
So I just wanted to reiterate that.
If I say something that people don't agree with, that's absolutely fine, but don't shoot the messenger.
I'm just looking at the body of evidence as a scientist, and I just tell you what the evidence says.
If you don't like it, then, you know, go, go to another universe where the rules are more, more philosophically pleasing for you.
You know, I'm just telling you how the body works.
So barefoot running has actually been around since the 1960s, 1970s, but it wasn't really popularized quite rightly said until born to run was written.
And, uh, and then the sales of barefoot running and went through the roof.
And at the time, it was a very plausible mechanism.
The proposed mechanism of action was very feasible.
It was this idea that modern running shoes, so those kind of shoes with thick, bouncy heels and soles have allowed our feet to have sort of caused our feet and the muscles in our feet and low limbs to become deconditioned.
And they also allow us or kind of encourage us to land heel to toe.
And when you land heel to toe, you're getting a much higher impact forces going through the lower legs.
So it can potentially increase the risk of injury.
Now the premise was that if you change from a traditional running shoe to a barefoot shoe or a minimalist shoe, so something with a very, very thin sole or no sole at all, then you can no longer run on your heel because it's uncomfortable and the impact forces that would go through the lower our body would be too great.
There'd be too much shock there.
So actually running barefoot obligates people to shorten their stride length and land relatively flat footed.
And if you do a study and studies have been done, but if you were to get people into a lab and you were to look at the impact forces going through the lower limbs, when somebody is wearing a traditional running shoe versus, versus a barefoot shoe, the impact forces are much, much lower when somebody is in a barefoot shoe because like i say they shorten their running gait which also increases running economy it's a more efficient way to run and they're running relatively flat -footed which reduces the amount of force the reduces the shock absorption so there was a few really good studies at the time
by Lieberman and colleagues and uh and all of these wonderful ideas that this was was going to reduce the injury prevalence that was associated with long -distance running.
And a bunch of different companies came out with their own brand of minimalist shoe, and they all claimed that it would reduce injury risk and injury prevalence based on the biomechanics.
Fast forward to probably about a decade, actually, there have been dozens of studies looking at injury risk when people wear traditional shoes, barefoot shoes, and when they transition from traditional to barefoot shoes.
And it doesn't seem to have any effect on injury rates.
In fact, unless you're very, very careful when transitioning from a traditional shoe to running minimalist, you can actually increase your injury risk because you're not careful enough to make sure that your biomechanics have been corrected, that you've corrected any strength imbalances because most people have, maybe they have weaker hamstrings on their non -dominant side, for example.
And so you've got to put in a lot of time and a lot of effort to make sure that you're transitioning very carefully over from one type of running shoe to the other.
And there have been a bunch of different reviews and meta -analyses now, all of them saying that, look, the premise was sound.
It made sense that this idea that wearing minimalist shoes would reduce the amount of force going through your lower limbs doesn't seem to have any effect on injury rates so that's kind of where we are so when people ask me now do you think i should try barefoot running i'm like look i know some people that do prefer minimalist shoes because they like the kind of the tactile feel they like the the feeling of connection with the ground they have better proprioception and they're relatively injury free and if that's the case hey knock yourself out keep doing it but if you're not already running
barefoot. There's no evidence to suggest that transitioning to minimalist shoes will provide any kind of benefit.
So that's basically the upshot of it.
It was a great premise.
It was a great idea, but there have been a bunch of court cases with different running shoe manufacturers who have been producing minimalist shoes have been sued because they made these claims that it would reduce injury rates.
That's not what the evidence shows.
Yeah, there's actually been been some interesting evidence showing that, you know, running in a very minimalist shoe or even barefoot will dramatically reduce the forces that you might experience at your knee, but it just transfers it down to the ankle.
And so, you know, you're just sort of playing whack -a -mole with the forces of running, you know, you can't ever escape it entirely.
Instead, it's just going to be transferred to a different area.
So, you know, while Born to Run was a boon to Christopher McDougall, It was also a boon to podiatrists everywhere who are treating a lot of runners for stress fractures in the feet and plantar fasciitis and Achilles tendinopathy and all kinds of injuries that resulted from making that transition too quickly and before the body really has enough of a chance to adapt.
What I think is interesting is that, again, a lot of the premise for going minimalist list was that it shortens your running stride and forces you to run land relatively flat footed as opposed to heel to toe.
And you can, if you really want to, if you're really that desperate, you can change your running by mechanics without having to change your shoes.
You know, you can keep wearing the traditional shoes with the thick soles and the high stability and the arch support, whatever you like.
And if you really want for ultra endurance running, it's probably a good idea to shorten your stride a little bit.
Cause again, it will increase your running economy economy, because it is a little bit more efficient.
And if you want to run relatively flatfoot as opposed to heel to toe, which I think a lot of people are naturally doing now anyway, then those changes in technique are available to you, regardless of what shoes you wear.
There's no reason to run barefoot or run in a minimalist shoe to force you into changing your biomechanics.
If that's something you want to do, you can go ahead and do it.
So Nick, now let me tell you my philosophy around this topic.
And I'd love your thoughts on it.
So, you know, as a running coach, I look at barefoot running and minimalist shoes as tools that can accomplish a certain job, just like a long run or a deadlift. And so I don't think most runners should try to run in minimalist shoes, because it's not necessarily going to help you stay healthy.
It might actually predispose you to injuries.
However, if you do want to run a tiny percentage of your overall volume in a more minimalist shoe than what you might be used to, I think that variety is good for, you know, just helping you become a little bit more resilient.
And, you know, it's probably not a good idea to wear the same shoe all the time.
So let's not wear the same type of shoe all the time.
And I also think there's value in a very minuscule amount of barefoot running.
Like let's say you do a 10 mile run, 16 kilometers, and maybe the final two minutes are on grass or synthetic turf field, and you're just kind of reinforcing that slightly more efficient running form.
I like to see runners do some strides barefoot, you know, maybe two or four strides once a a week just to just to reinforce you know the mechanics of running barefoot and i do think it it'll have some carry over to foot and lower leg strength but it's it's it's the the sprinkles on top it is not becoming the next barefoot ken bob it's not transitioning to minimalist shoes it's using it strategically to just expose yourself to a little bit of a different stress Yeah, I really like that sort of mentality because as you say, using it as a tool and it's sort of analogous to something like low carbohydrate
diets in the sense that it doesn't have to be a false dichotomy.
It's not like you go high carb or low carb and there's no evidence that following a low carb diet is really going to be that beneficial for endurance type exercise.
exercise, but there might be times, there might be cycles during your training or even in the micro cycle, you know, in particular day of the week where you don't need as much carbohydrate as you do another day.
If you're going through a rest period or if you're recovering from injury, then you might want to moderate your carbohydrate a little bit more.
That's not eliminating it.
It just means maybe taking in slightly less carbohydrate.
If you have a particularly intense training period, you might want to take in more carbs.
So it's not an all or nothing approach. It's like using it as a tool to augment your training, to augment your adaptation in the exact same way as, you know, using the right, a different shoe in the right time in a particular session can help to potentiate the adaptation.
So I think, yeah, it makes perfect sense.
And it's just, it's using all of these things as tools to help you adapt and perform.
You know, and it's probably true for a lot of these different, you know, ideas and topics that we're discussing that that it's not a binary proposition.
It's not yes or no. It's a little more complicated than that.
There are some applications.
There are some people that are going to benefit a little bit more than others.
And so I do appreciate that nuanced look at some of these topics because I think it's really easy to sit here and say, barefoot running is awful.
You should never do it.
But truthfully, you go to any university, you might see college runners doing barefoot strides.
That's just a very common training staple among that subcategory of athlete.
And I think there is an application for a lot of these different things.
Yeah. And I think the other thing to add is that when you do see people who've run very successfully in minimalist shoes, or it could be with a low carb diet, the temptation as athletes, and especially, you know, if you're navigating the wild west of wellness, the temptation is to think, well, if it works for them, it must work for me.
And the truth is that different people will have different approaches that work.
Some approaches work for some people and don't work for others.
People are individual.
You can look at people on a population scale, but at the individual level, there's going to be quite big big differences in the way that people train and respond to training.
And in the case of if somebody's following a keto diet or wearing barefoot shoes, it could be that they're successful in spite of using that practice, not because of it.
And it doesn't mean that it's necessarily going to work for you.
So I think that individual approach is so important.
And that's why we need good running coaches who understand how to work with athletes on an individual level, while at the same time looking at the broad scientific consensus you can use that to help guide training and to help guide approaches and to be able to you know using science and evidence is how we go well this is unlikely to work this is more likely to work but but when you get more granular that's when you have to work with the individual to see what works for them specifically Nick, I'd love to ask you about something I know absolutely nothing about, nasal strips.
I have seen a lot of runners these days starting to adopt nasal strips.
There's a lot of anecdotal evidence that it just helps people breathe a little easier.
It feels like you can get more air into your lungs.
there's even these new nasal strips that I've seen advertised on Instagram like their marketing is so good, Nick I am this close to buying these things but it almost looks like they double the size of your nostril and they are just really opening up your nose so that you can get more air in there but I have no clue as to whether or not these are effective Yeah, so nasal strips are an interesting one Again, none of these things really work in isolation It's like talking about a body system system.
The thing never works in isolation.
If you talk about the respiratory system, you've got to talk about the cardiovascular system, which links to the renal system.
You know, everything works in symphony.
And if we're going to talk about nasal strips, we've kind of got to talk about nasal breathing.
And then we have to start talking about gas exchange in the lung.
So it gets a little bit complicated.
The very short version is that using nasal strips is mostly perceptual.
So when you get people in a controlled situation where you can look at how much airflow is going through the nostrils, and I'm speaking now as a respiratory physiologist, my PhD was all in breathing and breathing mechanics, the amount of air that you can take in through the nose and how quickly you can breathe in, it does increase when you use a nasal strip because it literally stents open the nasal passages or the nostrils in particular, and it helps you to get more air in.
That said, it doesn't improve exercise performance because at very low exercise intensities, people don't breathe through the nose much anyway.
They switch from nasal to oral nasal breathing at about 30 liters per minute, which is a very low exercise exercise intensity.
And most people could exercise at max or pretty much close to max breathing exclusively through the mouth.
You don't actually need to breathe in through the nose at all.
Now there might be benefits to breathing in through the nose.
It helps to humidify the air a little bit, but certainly if you were to put in like six months of training, using nasal strips and training yourself to breathe in exclusively through the nose, you might get to the point where where nasal breathing wouldn't inhibit your performance, but it wouldn't augment your performance at all.
So using nasal strips is beneficial purely from a perceptual perspective.
So athletes feel like they can get more air in, but it's been studied.
It doesn't improve your maximal exercise capacity.
It doesn't improve exercise efficiency at all.
It's really just about how you feel.
So if when you're running or doing any kind of endurance exercise, exercise, you like the feeling of having the nostrils slightly wider and you feel like you can get more air in, then there's nothing wrong with doing it, but it's mostly perceptual.
Doesn't your perception have an impact on your performance?
Isn't this a placebo that, you know, you go to CVS, Walgreens, any pharmacy or drugstore and pick up a box of nasal strips.
And to me, this seems like a fairly low -cost and non -invasive intervention that, if it makes you feel better, like, I'm all for it.
Like, I love sort of gaslighting yourself to a certain extent, you know, lying to yourself, going out on a windy, rainy, cold day and saying, oh, this weather is just beautiful, I can't wait to run in this.
You know, this seems like one of those situations where I'm okay with that.
Well, placebo has an extraordinarily powerful psychobiological effect.
Like if you believe that something's working, then it is.
And when scientists have done surveys with athletes, high performance athletes, the vast majority of them say in surveys that they don't mind being lied to by their coach into using a placebo as long as it works.
So if the coach gives them something, the coach knows that this thing doesn't actually work.
If the athlete believes that it work, that will provide a performance enhancing effect.
And this is how a lot of athletic teams justify using cupping and acupuncture and chiropractic that are not evidence -based.
But if the athlete feels better, that's a big part of the battle because, uh, that there's the psychology of sports performance.
I don't need to tell you or any of your, of your listeners, uh, is absolutely huge.
So yeah, this is a relatively low cost. It's a, it's a safe intervention using a nasal strip just to improve the perception.
You could say the same about using menthol or some kind of you know menthol on your chest or a chewing gum that contains menthol before a training session it's going to give you the perception of better airflow it's not actually going to improve airflow but it's going to give you the perception of improved airflow and the perception is everything now we get into a little bit of a can of worms when you start to think about interventions that are not necessarily as benign.
So if you use a nasal strip to improve your breathing, you might feel that it improves your breathing.
If it doesn't, then there's no big deal.
You haven't lost anything.
But some interventions that are based purely on placebo effects, they actually come with risks and they can potentially cause harm.
So acupuncture, I hate to say it, but there's no good evidence that it actually has a direct physical effect on the body.
There have been thousands of studies on acupuncture.
And if you separate them into low quality, average quality, and high quality, the high quality studies all show that acupuncture doesn't work.
The low quality studies show that it's beneficial and reduces pain perceptions and enhances recovery.
But if you look at the controlled studies where they've done sham acupuncture, so that is acupuncture but placing the needles in the wrong places, for example, example it shows that there's no difference between acupuncture and the placebo now the problem here is again you could use that same argument while it's you know so what if it doesn't work if somebody feels better having done it then what's the problem well the problem is that if you have acupuncture let's say on the midsection or muscles of the midsection or the back there's a very small risk of pneumothorax punctured lung and you can look
in the scientific literature and there are hundreds of cases of people suffering collapsed lungs because the needles were placed incorrectly.
I have a friend of mine who had acupuncture on his Achilles, a runner, uh, a couple of months ago, and he was getting dressed, putting on his socks, and he felt this stinging pain in his Achilles and the acupuncturist had forgotten to take out one of the needles.
So he had one of the needles still stuck in his Achilles and there was no long term damage.
But I'm thinking, what if that thing was, was in his neck or in his head or in his chest right so not the point I'm trying to make is not all placebo interventions are benign so we kind of get into this very tricky situation of like okay do we do we endorse and promote placebos or some placebos and not others do we just advocate that it's a free -for -all and that people should use things if they feel that they work or do we sort of speak out and criticize criticize and prohibit all kinds of placebos because there are lots of cases where people will use a placebo intervention, sometimes for a condition that needs
a real medical intervention and these things have tragic consequences.
So yeah, it's a bit of a slippery slope and it's not an easy one to answer.
And there's no way to restrict all of these things exclusively to sports performance where, you know, if the thing doesn't work, okay, so you don't break your PR and, you know, it's not, not the end of the world, but there's no way to, to restrict placebos exclusively to the domain of health and fitness sooner or later, it's going to have downstream effects in the clinical world.
So yeah, it's a little bit, it's a complicated one for sure.
Yeah. That, that sounds definitely very tricky.
And especially when you start getting into things like acupuncture, which are invasive, like almost by definition, you are getting stabbed by little metal needles.
I've had it done once.
Don't think I'll have it done again.
And you did mention something in the same category that I haven't had the nerve to bring myself to do because it just looks like some sort of medieval torture, which is cupping, where you sort of put a glass cup, cup for lack of a better word on top of someone's skin and then create a vacuum underneath and it kind of sucks up your skin a little bit and it creates this pressure system where it brings a lot of blood to the surface to me this seems kind of crazy but i'd love your thoughts on what if any evidence is behind this yeah kind of similar to acupuncture there's not quite as many studies
in cupping as there are acupuncture they're both ancient chinese therapists so they've They've been around for many, you know, thousands of years.
And people claim efficacy on that basis alone, right?
It's another one of these biases that I mentioned at the start.
It's called the appeal to tradition, this idea that something that's old, that's been around for a long time isn't necessarily a good thing.
And I sort of, I'd rather use something that works.
I don't want to use it just because it's old, because it's been around a long time.
And with cupping, there's no clear mechanism for how this thing should work.
again the the idea initially was as you as you rightly say you place these glass cups on the skin you create a suction inside the cup either using a vacuum pump or in what's known as wet cupping they'll actually use a heated mechanism so the the heat creates the vacuum they'll make this kind of big kind of blister on the skin and then they'll lance it to bleed out uh to bleed the skin and initially when cupping was first conceived it was based on unblocking energy meridians in the body so to to ensure the consistent flow of qi and and make sure that there was that that uh that this idea of this ethereal
life force called qi which is written qi is um it sort of it underpins all of our health and our longevity and if we have pain or if we we have some kind of ailment, it's because the energy meridian has been blocked.
And so people will use acupuncture or cupping to help maintain the flow of qi.
In the past sort of decade or so, this idea of energy flow has been replaced with more science -sounding terms like blood flow.
So the idea now is that we're not increasing energy flow, but we're improving blood flow.
and blood flow somehow means recovery and it means reduced inflammation and healing, right?
And it's all of these kind of health and wellness buzzwords that are very ill -defined, but you'll have acupuncturists and cupping therapists throwing around these terms like reduced inflammation, improved blood flow, enhanced recovery, which again, they're buzzwords that sound very convincing, but when you look at it under microscope, nothing's actually happening here.
There are a couple of studies showing that if somebody has cupping therapy, it will actually improve blood flow to the area that is undergoing the treatment, but you can get the same kind of effect by having a hot shower or by, you know, getting a hickey.
It's the same idea.
If you create a bruise on the surface of the skin, it's because you have leaking blood vessels, which by definition is an increase in blood flow to the very local area but then the blood clots and then you've got the opposite of improved blood flow so um so yeah cupping again it's a very potent placebo intervention a lot of athletes feel that it works it was made phenomenally popular by michael phelps the most successful olympian in history 20 was it 23 gold medals and he's been a longtime proponent of cupping therapy.
So he's sort of responsible for pioneering trends in athletes.
But if you want a real intervention that actually has a direct physical effect on the body, then cupping is not it.
And I'm sort of an advocate of, look, I understand how powerful the placebo effect is, but most athletes have limited resource.
Most athletes are not Michael Phelps.
Most athletes, especially if they're not professional, They have limited time, limited money, limited resources.
You might want to spend those resources on things that actually work, not things that you believe to work.
It's fine if you're Michael Phelps or, you know, some other kind of high -profile athlete.
But for everyone else, I think there are limited resources to go around, you know?
Yeah, I think just almost as an aside, when you see professional athletes throw in the kitchen sink at their fitness and recovery, that's usually just because they can.
And they are literally trying to try everything, even knowing some interventions are not going to work, some interventions are purely placebo.
SIBO, they just want to get every advantage, even if that advantage might be just in their head, or something doesn't have an advantage at all.
Yeah, absolutely. And also the the difference between success and failure at the elite level is like a hiccup.
You know, certainly in some events at the Olympics, you're talking about the fraction of a second can be the difference between gold and silver.
And in some countries, you get a lot of prize money for winning gold and nothing thing for getting for winning silver so you're talking about livelihoods here and so and you know i've worked in elite sport and the mentality is win all costs athletes and they're not interested in taking part by and large they're interested in winning if you're not there to compete to win then what is the point and so elite athletes and coaches are much more experimental like you say Hey, they'll try everything, whether it works, whether it doesn't, whether it's plausible or implausible, it all just goes in the melting
pot. And if something sticks, then great.
But for the rest of us who don't have unlimited resources and time, we need to be a little bit more selective.
Well, I was very heartened to hear that you can take a hot shower and get some of the benefits there.
I think I'd rather do that than cupping, which I admittedly have zero interest in ever Well, and this is the other thing is that people don't ask the important questions.
It's like acupuncture or, you know, they've sort of rebranded it to dry needling now and people who are people who practice dry needling say that it's not acupuncture.
Acupuncturists say that it is.
So they're kind of odds at each other and cupping and, you know, all sorts of other interventions.
They all claim to be able to improve blood flow, which number one is a claim that nobody can demonstrate.
number two so what why is blood flow why is increasing blood flow necessarily a good thing it's like reducing inflammation so many of these different wellness trends claim to be able to reduce inflammation why do we necessarily have to reduce inflammation some inflammation is important some inflammation triggers signaling pathways in the body to help actually with real recovery with authentic recovery if you have too much chronic inflammation that's a bad thing and you know a lot of the time you'll you'll have interventions that claim to be able to improve blood flow and if you ask well why is that good
well it increases oxygenation uh you know increases oxygen and nutrient delivery and it's like well if you know anything about how the body works a healthy person has pretty good oxygenation most of the time like if you were to put a pulse oximeter on somebody and look at how much oxygen is in their blood it's going to be at 97 98 99 percent Your blood is pretty much saturated with oxygen at any given point in time.
The only instances where that will be different is if you're at high altitude because the partial pressure of oxygen is reduced or if you have some kind of cardiorespiratory disease, right, in which case your oxygen saturation drops.
But otherwise, in all other healthy people, oxygen levels are gonna be high and there's no reason why improving blood flow and improving oxygenation is even necessary.
But these are terms that are thrown around by proponents of these various placebo interventions because they sound sciencey.
And to people who are not necessarily up on these particular areas, they go, well, that sounds plausible to me.
I'll invest. But actually, you've always got to ask the question, well, why is that beneficial to me?
Do you have any evidence to support what you're saying?
Because otherwise, I'm not going to believe you.
Nick, I've appreciated you peeling back the onion a little bit, sharing some hard truths about some of these somewhat controversial issues.
And I certainly recommend everyone check out your book, The Skeptic's Guide to Sport Science, Confronting Myths of the Health and Fitness Industry.
history. Really interesting look at not just some of the topics that we talked about, but the thinking that goes into how you evaluate some of these interventions and training strategies.
It's really more about how to become a better consumer of science information and, you know, health and fitness products that are out there on the market.
So I think it's a really valuable addition to our understanding of these things.
So thank you, Nick.
Is there anywhere else you'd like to point people if they want to follow your work on the internet somewhere?
Yeah, I think probably the best place is to check out my website, nbtiller .com.
And you can find all of my work on there, but it's pretty much all available for free.
I write a column in Skeptical Inquirer magazine, which you can link to from there.
I write a column for Ultra Running magazine as well.
And, uh, and you can find all my social media stuff on there as well.
So, you know, reach out on social media and keep up to date with my work.
And, uh, uh, and, and yeah, I write, um, about the, the, the intersection between health and fitness and critical thinking, because there's too much space between those two entities.
And I'd really, I'd love for us to bring them closer together and podcasts like this are really helpful in doing that.
Yeah. Well, if I can help facilitate, that goal, I certainly will.
So Nick, thank you so much for your time and your expertise today.
My pleasure. Thanks, Jason.
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