The Hormonal Edge with Dr Nicky Keay

Foreign.

I'm charlie redding.

And I'm claire fudge and this is.

The tribe athlon podcast.

Your body composition doesn't improve, it gets worse. Right. So it's counterproductive. You'll be more likely to end up with more body fat and less muscle.

That was Dr. Nicky Kaye, and this episode is the Hormonal Edge. Hey, Clare, how are you doing?

Yes, I'm good, thank you. How about you?

I am good, thank you. I'm good now. Now, since the last episode, you've been racing somewhere exotic avenue. So tell us all about it. Tell us where you were and how.

Did you get on.

We've both been racing, so we have to share our stories. Yeah. So I was out having done South Africa. Well, would have been four weeks. I raced in Portugal in Lisbon last weekend. So. And it was. I mean, it was hotter than South Africa. It was 31 degrees. So that was really lovely and makes such a difference. But it does actually bring me back to the fact that we do need to acclimatize ourselves to heat. So although it's not some far flung country, it is really difficult for your body to suddenly go from, you know, the conditions we've got here in the UK and then going out into 31 degrees. But it was good. It was a race that I'm. I don't really like racing on the flat and it was pretty much flat race with a hill four times and a flat run and obviously flat sea. So, yeah, it was a good race. It was a good race all in all.

And I think it was a really good race, wasn't it? Because how did you. How did. Where did you come in your age category?

So I won my age category, which was amazing and really good result off the back of South Africa. I was very pleased that I could recover and repair and get ready for my next race. So, yeah, that. That was a kind of really smooth process from one race to the next. That was. That was brilliant. And I came back with a very small plastic trophy, a medal, a very, very, you know, very happy. And also brought Covid back with me. So that. That was my new prize from Portugal.

Well, we'll come back to Covid, but actually, so. So that means you qualified for Kona at Ironman, South Africa. And then what do you. So Lisbon's not an Ironman race, is it? So what have you qualified for?

Yeah, so Lisbon this year is challenge, although they have just sold the race, interestingly. But Lisbon is a challenge race and qualified for. What's it called? It's In Slovakia anyway. Yeah, so they, they've got their world championship in two weeks time, but I'm going to race next next year.

Okay.

So I'm not sure enough in two weeks time after Covid, but. And hey, you had, you had your race at the Outlaw this weekend as well, and it was going to be like amazingly hot. And I think you had weather from every condition, didn't you this weekend?

No, well, actually we got really lucky when we looked at the forecast. So yeah, it was Outlaw half this weekend and we were looking at the forecast on kind of Wednesday. It looked like it was going to rain most of Sunday morning. Then Saturday was proper Scorchio and. And then yeah, actually it was perfect conditions. So Saturday's heat warmed up the lake nicely for us and then we got a little bit of a shower first thing Sunday morning, but not much. And so yeah, the swim was. Swim temperature was fine. The bike was warm enough. There was no, at no point did I think I was getting, gonna get cold actually. The run was, was getting pretty. Scorchio probably wasn't quite as hot as Lisbon. So I'll give you, I'll give you that feather in your cap for the, for our race comparison, but no, it's really good. It's really good. And I, I didn't win my age category.

You knocked off a large chunk of time from last year though, Charlie. That was pretty good going.

I did. I knocked 15 minutes off last year's time. So I was really happy with that. And I was a bit faster on each of the elements, so. So yeah, yeah, I was, I was, I was pretty happy with that actually. I was. I felt like I was running well. I feel, I felt like it hit me hard because yesterday evening I was properly done for.

But how's your recovery been? What have you been doing nutritionally today? Do you want to share that?

What have I been doing nutritionally today? So I had some, some granola, my usual breakfast. So. Granola and, and a bit of granola. More muesli actually for breakfast. Plus I have Seedful, which is a type of. It's a gluten free bed made with lots of seeds and I had a couple of slices of that with peanut butter on this morning.

Nice. You had some nice omega 3s to dampen down that inflammation.

Absolutely. So that felt like a good breakfast. And then for. I had chicken salad. What did I have with that? A bit of potato, so a little bit of car, but mostly protein. Lots of good veg. I also had a smoothie this morning after A very gentle recovery swim to try and fresh out the legs. Partly because I couldn't be bothered to swim harder, partly because my swim spa had gone up to 34 degrees overnight and it was like a bath. It was. Yeah, I would think I would have. My head would have popped if I'd done a proper swim in that.

You sound like you had amazing racing and that is like, you know, really, really well done for that from 15 minutes off last year is pretty, it's pretty good going.

Yeah, I was, I was, I was happy with that and, you know, and well, congratulations to you because qualifying for both the challenge and the Ironman World Championships is amazing. You said about the importance of adapting to temperature, temperature changes because obviously we often go out to exotic places to race. What did you do to adapt to the, you know, the heat of Lisbon?

I didn't give myself enough time because I actually only had. I literally flew out a couple of days before and it was hot. But I think although South Africa hadn't been. Wasn't that hot, I was actually in South Africa for 12 days, I think, in the end or 10 days. So there had been a little bit of adaptation, if you want to call it that, compared to kind of coming out of winter in the uk. So I didn't actually find it. I. I'm pretty good in the heat, but the adaptation actually takes anywhere up to kind of 10, 12, 14 days properly, you know, if you want to adapt to altitude or heat properly. So, you know, I think I. I spent quite a bit of time in the heat anyway when I was there. So if there was any sort of adaptation in a couple of days, probably wasn't possible, but I was used to. I was used to heat. And the other thing that I did do is I made sure that I kept my body cool the whole time. So one of the, one of the important things is not to let your body as much as possible get too hot. And you might have remembered when we spoke to Morgan actually about things like the slushies when he was in Tokyo racing at the Olympics. You know, these were all part of the strategies of the Olympics of keeping everybody really cool. So as much as you can keep your body temperature down, your core temperature, that's really, really important. So what I did on the. I made sure I pre. Hydrated properly actually as well. So did a bit of like making sure I laid a little bit with sodium fluids, but I also made sure right at the beginning of the bike, even though it wasn't really hot, sort of at 10 o' clock in the morning is. I used to every aid station I used half a bottle of water over my head, then had the other half to put in my bike frame. So I actually kept myself pretty much cooled down the whole of the time. And actually that was really, really useful. But I mean, the run was good because it had showers and there was lots of water and comparison to South Africa, there were long periods in South Africa with aid stations with these plastic bags to throw over your head and no showers or anything. And that made a massive difference to me in terms of keeping core body temperature down.

And what about electrolyte? How did, did you, how did you refine your electrolyte strategy Given, given the heat?

Yeah, no, I did. Absolutely. So I did a bit, I did a bit of a different pre hydration to South Africa because I knew it was going to be hotter.

And.

I also increased my carbohydrates a little bit because I knew it was going to be hotter as well. So our bodies preferentially use more carbs in the heat. So. But I preloaded with a little bit more than I did in South Africa with sodium. So the day before and the morning before, I drank about the same on the bike as I would usually. I didn't feel like I needed to drink anymore. And then I actually just took one sodium tab on the run, but I didn't need any more than that. So. But I'm, I'm lucky also because my sodium needs relatively low. Saucy sweater. So it does make a difference. You know, I could probably get away more than somebody that sweats out huge amounts of sodium. So that's, that's where the real individual kind of element sort of plays in as well.

Yeah, I mean, I took, yeah, I had a couple of salt tabs on the, on my run, which I wasn't sure whether I was going to take. And then it was as hot as it ended up being because it wasn't forecast as hot as it was. I might as well just get these inside me because there's a good chance I will need them and. But yeah, I think that, that remembering to sort of have electrolytes the day before and in fact, actually I have forgotten to have electrolytes today. Actually, I should have done. I felt like I was good the day before, good on the day and then. But I've probably, I probably should have had a few more electrolytes today just to kind of try and you still.

Could do that today, though. That's still something that you could do. And also when you're eating just even just optimizing that rehydration when you're eating, if you're eating something a bit more salty, where you have a rehydration, you have some say a bit more sodium with a meal that will help you to be able to absorb that sodium a little bit better and hold on to the fluid as well. You still have time to optimize that.

Charlie, I can do that as soon as we get off this, off this call. So you mentioned that you brought back another trophy, which is a little white plastic one with a Covid red line across it. So that's a bit of a nightmare. I hear there was a bit of that knocking around at the Lisbon race because I've heard from somebody else that they knew people that caught it there. But that's just potluck, isn't it? What are you doing? Because you're supposed to be racing again this coming weekend, aren't you? What are you doing to make sure that you don't, you know, cause yourself issues with kind of training, racing with.

Recovering from COVID So I, I'm, I guess I'm lucky enough to have like worked with so many athletes this year that have had and also working with performance pathways in the UK so for things like British pentathlon and the likes of kind of those volleyball England and people like that. So we have return to play or return to competition guidelines in the UK and actually every sport body has one. So even speaking to some of my colleagues in Switzerland and Germany, they all have their return to play protocols which are very, very similar. So as Covid has developed over time, when we first had Covid, right in the very beginning, we didn't obviously we didn't know, did we? We didn't really know how we'd be affected as athletes coming back in. So they are slightly different now, but they're not too far removed actually from last year, having read the most up to date guidelines. But I'm absolutely following a protocol to get myself back kind of into to training again. Because of course the damage that you can do is permanent damage. You can have pericarditis or myocarditis and you know, in terms of like what are those translate in terms of inflammation, inflammation around your heart. So that's myocarditis. So the long term consequences of that. So to put this into perspective, you can, it's not common to get that, but it is totally possible to get that. And I, I was kind of recalling actually, you know, years ago, having worked on cardiac on heart units and on intensive care units. You absolutely did see that runner who trained when they had flu who then had to go on to have heart surgery or even a heart transplant. So some of those that really stand out in my mind of times when I was working clinically that actually we should not be training when we have a virus at all. And we know that Covid attacks our heart and lungs even more so than some of the other viruses. So it's really important that we are really, really sensible. And this is something that I'm really, you know, I, as I'm sure a lot of people, you know, some people have had Covid and felt horrendous and actually that's stopped them from training. So that's a good thing. But actually I feel like I have a cold and I probably could train, but yeah. So just getting back into things slowly, making sure you don't raise your heart rate too high. But I think the biggest thing is listening to your body. I've just felt when I've done 40 minutes of easy turbo absolutely wipes out. And that's got nothing to do with having raced last weekend. So I think you've just got to give yourself your body the time. Otherwise it would take twice as long to recover or you get some long term damage that you can't undo.

So. So in our. So, so then are you racing this coming weekend based on what you.

I am absolutely not.

Very sensible.

Yeah.

Knowing how competitive you are, that is. Yeah. If, if I think that's. People should take that as good advice. If being the competitive lady that you are, if you're going to not race based on that, I think other people would be wise.

I think. Do you know the way that I feel today? I think it's very, very easy for an athlete to go out and train because as endurance athletes and you'll know this for having us having done the race together, you get, you get it done. Like you finish, you will push your body to the nth degree. And there is absolutely no doubt that I could go and train today. Would I feel great afterwards? Absolutely not. I didn't even like I don't have a cough or anything. But I just know that it wiped me out a bit yesterday and that I don't feel 100% and I think the. Look, the long term consequences are actually the, the short term. Was it what's. I can't even think of the word about taking time now basically to have the long term gains, short term wins for long term gains. I can't remember what it is, something along those lines.

That'll do. We know what you know.

But you know, the more, the more quickly you trying to get back into training now, the longer it's going to take to recover. So it's just, yeah, I am as you, as you know, super competitive but I am not willing to put my health on the line and that's something that I'm going to sit with for another couple of weeks until, until I feel good. So good.

Well, and that is actually a lovely segue into what is a brilliant and fascinating interview with Dr. Nikki K. So let's go into that now. This podcast is sponsored by 33 fuel. Now 33 fuel produce award winning natural sports nutrition and everything they do is led by their fuel Osophy for performance health and a fitter future. 33 Fuels Mighty products have been fueling triathletes worldwide since 2012, as well as many of the world's best athletes, whether that be England football team, Tour de France winners and also triathlon world champions. In fact, four times Ironman world champ Chrissie Wellington has been using 33 fuel for years. 33 fuel also leads sports nutrition sustainability with plant based formulas for reduced environmental impact. Recyclable packaging and also carbon neutral delivery is a free option on all orders. Rated by Runner's World as one of the top 50 Ecohero companies worldwide, a portion of all of the 33 fuel sales also support reforestation initiatives. So if you want to find out more go to 33 fuel comm and if you use the discount code Tribeathlon, you will get a lovely discount at the checkout and also if there's a link in the show notes to take you through to that discount code as well. Enjoy. 33fuel.com. Doctor Nicky Kay is a leading expert in endocrinology, having gained extensive clinical and research experience in hormones and the impact on the human body. She's focused much of her research on both sport and dancers and in particular has done a lot of research on how what we eat affects our hormone balance, how that impacts both our performance in sport but also our long term health. So Clare and I got the chance to chat to Dr. Nicky about the impact of hormonal balance in our sport, how we can test and improve it to maximize our results, and also the hidden side effects of under fueling in our training. She's done a whole load of research, particularly in cyclists and there is just so much wisdom to glean from this talk and also the combination of interviewing Dr. Nikki K, but also Claire's Experience and wisdom and the nutrition space, because these. These two work together quite a lot. So I know you're going to have lots to take away from this interview with Dr. Nikki K. So, Nikki, welcome to the Tribe Athlon podcast. Really looking forward to chatting to you. And I'm delighted to say I've got Claire back with me to help me negotiate a territory that I feel like I am totally out of my depth on, because we're going to be talking lots about hormones and, yes, very much out of my depth, even though we have done one episode on hormones in the past. So I feel that I'm slightly less out of my depth than perhaps previously. But I always like to kick things off. Nikki, tell us a little bit about how you ended up where you are now, both from a sporting point of view. I know you come from a sporting background, but also from a medical point of view. So tell us a little bit about what you do now and kind of the story of how you got there.

Well, first of all, thanks for inviting me. So, as a youngster, I was always very interested in sport. I was in the tennis team, competitive swimmer, went to the nationals, gymnastics. But my main passion developed to be ballet dancing. And as a teenager, I have to admit, I was thinking maybe I wanted to be a professional dancer. But like, with professional athletes, it's, you know, it's. It's tough. And although I was good, I realized I wasn't amazing. So actually I realized that I could probably make more contribution to sport and exercise and dancers by being a doctor, because then I would get that understanding of how the human body works and, you know, things that can go wrong. And, um. And so that's what led me on to do medicine, always with the mind, that I wanted to come back and apply it to athletes, I guess. Um, and then I chose folk. I realized also quite early on that I didn't want to do. Do injuries, because for me, injuries is. I mean, accidents happen, we know, but injuries can often be something, you know, it's what caused the injury in the first place. I wanted to take it, to step backwards and see what are the contributing factors to prevent the person becoming injured, ill, whatever. Preventative medicine, in other words. And the key to that, in my opinion, and I think that's true now, I've become convinced of that. Are our internal chemical messengers hormones? Hormones are intriguing. You can't touch them, you can't see them, but they are the boss when it comes to sorting out and controlling and timing everything that happens inside your body. And So I love the challenge of being a detective and figuring out why is the person saying they're feeling really tired or whatever, getting recurrent injuries, what's causing that? And so I have to open up and look inside at the hormones and then figure out what's going on there. What could we improve on to make the person, well, be as healthy as possible and perform and compete to their personal potential, whatever that is.

Fantastic. And should we just kick things off for those people that are out of their depth when it comes to hormones like me? Can we kick things off and sort of just talk, explain a little bit about what hormones are and why they are important and why athletes need to really be aware what's going on with their hormones.

Well, hormones are these internal chemical messengers, but actually that's doing them a disservice because actually everyone knows about DNA. That's the blueprint inside all your cells. But what switches on? How does the body know which bit of DNA to activate and produce proteins when? The answer is your hormones, and your hormones go in and say, right, we need this, we need that. And if you're an athlete, you do training because. Why do you do training? Because you want to improve, obviously. Yeah. So you go and do your training session, you have your recovery nutrition, I hope, and you have your sleep, and then the next day you wake up and you hope and you expect, anticipate that you're going to be improved. Right. You're going to now be fitter, stronger, all those things. Right. But what has happened? What's this transformation that's happened? And that adaption process is driven by your hormones. You actually get fitter when you're asleep, when you're asleep. Growth hormone. It's not just about children growing, by the way, it's also for muscle strength, etc. Lots of hormones get busy when you're resting after your exercise. And so that when you go and try and the next day, and obviously with the training schedule cycle, you know, in gradually, gradually you'll have incremental improvement in your performance. So athletes need to pay attention, be kind to their hormones if you want to improve.

And so what you're saying is you could be. I think what you're saying is you could be doing absolutely the right training. But if the hormones don't do what they're supposed to do, you wouldn't see the benefits of, of the training that you've done. But also if you get your hormones kind of ideally imbalanced, you may see the most benefit possible from the training is that Right. Is that why we're trying to get this.

Yes, exactly. So, I mean, when I say a training schedule, I'm of course talking about the actual physical exercise. If you're a triathlete, you know, you're swimming, you're running and you're cycling, of course, but the actual training. But also, and Claire, I hope, will agree with this, part of that training schedule of the exercise is also the nutrition. Are you having the right nutrition at the right time, in the right amount, the right types of food, et cetera, and also recovery. Are you having a rest day? Because the rest is when the hormones do their magic. So it's a fallacy to think that you just train, train, train and train, because you will never be able to recoup the benefits of that training unless you give your body a time to settle and for the hormones to work their magic. So. Exactly. You don't want to. You're training. But training schedule includes the exercise itself, the nutrition and the sleep, the recovery. Get all of those three components at the right time in the right amount. Absolutely. Your hormones will be really, really brilliant for you and you'll get those positive adaptations. Of course, the warning is if you don't therefore get the right balance and timing of those three factors, then of course the hormones are going to struggle to do anything for you.

I think the warning bit is really interesting to me because I think people don't necessarily say males and females don't see that straight away. And I think that's why it's often very forgotten, because with training you might just think, oh, I'm tired because I'm doing lots of training, which might well be the case, but it's all those pieces of jigsaw, isn't it? And I think from a hormonal point of view, it's not unless you test it, that you actually, for males and females, that you actually kind of see what's going on. And having that evidence, isn't it? It's kind of. I think it's really powerful to be able to see what's going on. You know, these kind of looking at hormone profiles and actually seeing it on paper and being able to explain that, I think is really, really useful.

Well, you're right. Don't guess, test. And also the other thing is, because you can misinterpret what you're feeling, it might confirm what you're. It might confirm that you're right or not, but you don't know. So that's really, really important. And also, everyone is individual, you know, Just because you know your friend does X amount of training, eats this and sleeps this amount doesn't mean that's going to be the correct recipe for you. Right? But the only way you're going to know if that's right or not right for you is by seeing how your body is recognizing this, looking at this training metric. And also, I agree with you, I mean, athletes, triathletes, well, in fact, any athlete love data. Both my sons used to be triathletes to quite, especially the younger one to quite high level. And now my husband's a master cyclist and my son, elder sons now transition to competitive cycling. And so I know they love data. So you know what I mean? This should be music to your ears if you're an athlete. I've got some more data to give you. But this data is your personal data, right? Internal data. So this is a. Wow. It's a treasure trove, so why not tap into it?

But this data, as Claire will remind me repeatedly when I'm sort of talking about things like my aura ring and the new gadget, this, that and the other, the data is only good if you know what to do with it, isn't it?

Well, exactly, exactly. We don't want to get carried away because, you know, you can collect, there's, as you say, there are all sorts of tracking things and I don't know, power meters, aura rings. I can't really like, you know, anyway, the list goes on all these bits of information, so. Exactly. In medicine, it's like you only test things or look at things that you know are going to make a clinical difference. So that's like an athlete, what's going to actually, how are you going to interpret that and how are you going to react to that if it's not going to change anything or you don't know what the heck that means and actually probably not worth doing it. But hormones have been around. Well, I mean, obviously they've been around since, from the start of time, evolution, et cetera. But I mean, hormone testing and understanding what those hormones mean, you know, that that's been around for a long, long time. We know. So in that sense, you're on pretty firm ground that, you know, hormones, it's like reading a book, you know, I look at these hormones, these are results. And for me, that's like reading a book. Right? A detective book, more to the point. It's right. Oh, this, like this, you see. So absolutely, it's the interpretation of it that's the important crucial thing. And then what do you do about it, you know. So I only recommend testing things that, number one, we know exactly what that means and we know what to do about it, you know.

So in my research I was listening to on a couple of other podcasts and you talk about reds and in particular reference cycling and the problem that reds create in cyclists as an example. Can you explain? I suspect that that term is going to get, is going to come up between, you know, between you guys. So I thought let's, let's, let's pick that one off and explain a bit about that and the importance of it and why it affects cyclists as an example in your research.

So reds, that's not the American football team or is anyway, what it stands for is relative energy deficiency in sport. So if you just think about the words relative energy deficiency, so it's relative for the individual that you haven't got enough energy on board sport. It's basically exercise. What does this exactly mean? It means that we're talking about these three elements you have under your control of the training load, the nutrition and the recovery. So red is particularly reflective of if there's an imbalance in the nutrition, the energy and your expenditure from exercise. So if you were lying in bed all day not doing any exercise at all, that sounds awful, doesn't it?

But Claire's probably doing.

Yeah, no, well, listen. No, I listen, everyone should have a rest day. But even if you do that, Claire, even now in your rest, if you were lying in bed all day, that's going to take a lot of energy just to stay alive. A lot of energy. Okay, so I think that's what people sort of forget anyway. So let's take an athlete. An athlete eats a certain amount of food which provides the energy for the body. The priority is given to the energy demand from exercise training. That's from an evolution point of view when we used to have to run away from saber tooth tigers, et cetera. Not quite the same as running around a race course, but you get the idea. So the energy goes there. Now if you do your maths, what's left over? That's called energy availability. If that meets your sort of basic requirements, equivalent of lying in bed all day doing nothing, brilliant. We haven't got a problem. But if you haven't put enough energy in the first place, you haven't got enough energy in the system, or you've used it so much up in your training, then you're going to be in a deficit. It's like running on having an, you know, sort of a warning Light on your petrol tank, okay? When you're in the red, it's below that minimum amount just to stay healthy. But the body is not stupid. It adapts. So it looks for how is it going to save energy? Goes into eco mode. And one of the places it can save energy on is in female athletes. That would be switching off periods, menstrual cycles, because that saves energy doing all that business with the hormones. In men, a similar situation, testosterone will go low. It can also save energy by slowing down the bone, the bone turnover, our bones are continually turned over. It's not just a static skeleton, by the way, but that takes energy. It's like recycling your skeleton. So there are definitely some bad health effects if you've got reds, but also, crucially, performance effects. Because I've just already told you, and we already discussed that hormones are essential for driving those adaptive responses to exercise. So if your hormones are low or not working very well, then you won't improve. So there are two important points, health problems and also actually performance detriment. Why cyclists? I mean, that was just an example. I mean, any athlete could be at risk of getting reds if they haven't got. If they've got this mismatch between energy in input and output, in very simple terms. But the sports where it's going to be particularly, we know it's more prevalent than others, is something where it's against gravity. So, I mean, that's a lot. That's most sports, right? So, you know, cycling, you'll have to go up a hill. So that's sort of physics, isn't it, that you're going to have to overcome gravity to go up the hill. Triathlon, of course, you've got cycling. You've also got running, which is against, you know, against gravity. Got to move yourself. So theoretically, any sport is particularly at risk. But the reason I focused on cyclists, and they were male cyclists, by the way, is because I thought, well, we need to look more at the male athlete, but also cyclists, not only do they think that being low body weight confers a performance advantage, Also cycling, you're sitting on the saddle, so you're not loading your skeleton at all. So they're at a double whammy for having poor bone health issues. So I think that's. Claire, is there anything you want to add on that? So that's reds, it's low energy availability. It could be a mistake. It could be simply the person didn't realize I had a few of those cyclists, they didn't realize that they needed to eat More or they weren't fueling consistently on the bike or whatever. It could just be a sort of a, and a fuelling error, if you will, that they just didn't realise. Or it could be intentional.

Right, absolutely. And I think that's the interesting part is sort of sometimes for me, from a nutrition perspective, sort of picking that apart a little bit. But yeah, we often see people, don't we, that, that don't do it intentionally, but just because training. College, it's all of those pieces, is all of those pieces of the jigsaw, isn't it? Of making sure that you're getting the right nutrition at the, at the right time. But I think, you know, the different sports like, like psychic cycling or weight sensitive sports or aesthetic sports are definitely more, more prevalent, isn't it?

Yeah. More to the intentional ones, as it were, because. But that's just the way of it. So I do want to say that we're not saying that doing sport or exercise is a bad thing for your health. Obviously it's not. It's just when you get into these realms of not having those behaviors balanced, that's when you can run into problems. And you know, we want to make sure highlights of athletes warn them of the pitfalls so they avoid these things. So, you know, we're not saying, oh, you've got to stop training. We're just going to say you just got to be really, really mindful on these things.

And you mentioned, you mentioned bone health and I think I'm right in saying that that means that you end up with weaker bones. If I think, I think I heard you say that. Chris Broadman. Chris Broadman retired early because of osteoporosis, I think when he switched from track to the road. But it's not. And that's partly to do with the fact that it's not, you know, you're running and therefore the bones aren't load bearing, isn't it? But it's also linked to what you were saying about the hormone deficiency or kind of not producing the hormones. But of course that has a bigger impact for cyclists if they fall off, doesn't it? If you've got weaker bones, you're more likely to be injured for a long period of time.

Yeah, exactly. So there's this paradoxical effect of exercise, as I say. So we all know that loading your skeleton is a good thing for bone health. It stimulates the skeleton to recycle and become strong. That's why astronauts in space, when they come back, yes, their muscles are weak, but Also their bones, they're prone to osteoporosis, by the way. So we know that loading the skeleton is a good thing. But again, it's this imbalance. If you're loading it, but you haven't got enough nutrition on board, the hormones will be low, so they won't be able to help the bones in benefiting from the exercise. You see, this is where hormones are the key link between you do the exercise and you get stronger bones, you get fitter, etc. If you missing that link, the hormones, then that's however much you jump up and down on the spot, it's not going to help your bone health. And then you're at risk. If you're a runner or any of those sports where you are loading your skeleton, you're more at risk of stress fractures. There's a lovely study to show that massive increase in stress fracture incidence in women, in female athletes whose periods are stopped and in male athletes who's got low testosterone. But you're really absolutely right to point out in cyclists, they won't necessarily realize because I can absolutely for sure say this with a family, with two male cyclists in my family, they're either on the bike, in the car or on the sofa. They don't really like running or anyway, so. So the cyclist might not realize until, I mean, we see horrendous crashes. I know on these tours and of course anyone falling off at speed, you know, you might break something. But if, even if a low energy trauma, I think it was Nibali a few years ago that just sort of toppled off, it looked very benign. Toppled off his bike and then he had a fracture on the side of one of his vertebrae. So that was like, oh, so you're absolutely right. Yes, bad crashes happen. But of course you're more likely to get a fracture from even an innocuous bike fall if your bones are weak.

And you've mentioned a couple of times.

That.

The first thing that a lady would probably see if they're hormone deficient is that their period would stop. But, and you know, and a guy would have lower testosterone. But of course there's no, there's no warning sign that that's the case, is there? Because, you know, so without testing, it's not. So are there other things that, is it fatigue or are there other things that people can be looking out for to kind of prompt them to get a test? Or should every athlete be testing?

Well, just to go back on your testosterone question. I mean, listen, just in the, in the, for fairness, women we talk about our periods. Guys, I'm afraid we have to talk about warning erections and libido and there's just a study out now for male athletes questionnaire and it said, yeah, one of the warning signs of low, low testosterone is reduced libido and reduced number of morning erections. So guys, I'm sorry but because women, we have to talk about periods, right. Which can be messy. So we have to talk about that. So that's one sign. But you're right on. But I think going back to Claire's point, she actually said if you're an athlete, especially if you've done an ironman, for goodness sake, you're going to feel tired. So how are you going to distinguish fatigue, expected fatigue from your training or competition? And how are you going to know if that's what you expect or how are you going to know if it's something else, if it is reds? And so that I think is where we can talk about subjective things and libido and I suppose periods are pretty subjective and objective but ultimately doing the blood tests, you know, being certain about it. So you, because you can easily get in this cycle of sort of self guessing and thinking, well maybe, maybe it's because I had a slightly late night or this, that or the other. But actually just confirming on the blood test, you know, what's going on. I think that's, I agree with you. I think that's probably the best way. Do you agree Claire, just get that objective data?

Absolutely. And then also the regularity of testing because it's like a snapshot in time, isn't it? If we do a nutritional like diary with somebody, I always say like this is a snapshot in time, so what do we do about it? And then come back to it and look at it again, what have we changed? What do we need to do again? And I think, you know, with, with looking at blood is, you know, our training will have different sports obviously have different cycles and period training and it's really important to kind of look at where you are at different parts of the, of the season as well and see if you've kind of been able to make those, you know, make these changes. But I think it is really interesting how people feel. I think people, athletes often get used to feeling tired as well. So until they feel better they don't realize how terrible they were feeling.

I think that's a very good point. Well, first of all, your first point about, you know, one test is it's helpful but obviously that's the whole Thing of, you know, monitoring. And after all, you monitor lots of other things, don't you? So why wouldn't you include monitoring your hormones? And as you say, according to what sport you're in in your season, you might want to target that at, you know, say three or four times a year at the key points, you know, after a winter training block, you know, before race season, at the end of the season, at the beginning of the season, you know, whatever it is. But I agree, get it. The more data you accumulate, the more personalized you get it, because then you have your, you know, what your pattern should look like or typically looks like over a year. And if it was, you know, something when something went wrong, then you can highlight, oh, I can look out for that warning sign of whatever it is, the cortisol going up, testosterone going down or, you know, whatever it is. So I think that regularity of testing is very important. And also, you're right about the, you know, you don't realize I have lots of athletes come to me who have got reds for sure, and they look at me and say, listen, I think I'm fine, I'm doing fine, you see, but it's only until, you know, I sort of coax them out of that to have some rest and just eat a little bit more carbohydrate and all that sort of thing, coax them out of it. And then the next time I see them. And that was a chap in the cycling study. The first time I saw him, he was. Looked so miserable. And, you know, he definitely had reds. Really not in a good situation. And then the next time he came back for his repeat DEXA scan to look at his bone health, he walked through the door and he had a smile on his face. And I said to him, I almost don't need to look at your bloods and your bone scan because I know that you're feeling better. And he said, exactly. And you don't realize that until you get there. So, absolutely, I think that's really, really.

Interesting, important point that kind of brings us on to all the kind of different elements to this, doesn't it? So in relative energy deficiency, there are so many different systems and physiological systems, metabolic systems, that it affects. And I think, you know, you talked about kind of the happiness part of it, you know, the effects neurologically on how we feel and our mood and low mood, which often links with over training as well, doesn't it? So, you know, I think it's all these little points that maybe people can pick up on yeah. What just thinking about from a male perspective, in your experience, do you. Male athletes, I don't know if there is any data on this, actually tend to test less or be less likely to seek help with regards to kind of testing. Because I think, well, this is my. I would think that females probably are more likely to. But maybe that isn't the case. I'm not sure if there is any data.

I think it's more on the individual, you know, rather than making generalization about male, female. I mean, they always say that men are less likely to go and see a doctor and whatever. I don't know, but. And you could argue that maybe there's a sort of a macho thing, with all due respect, that, you know, I'm going to push through this and whatever, but also that women are pretty tough like that as well. So I think actually rather than saying there's a male, female difference, I would think it's on the individual, you know, the individual person. But also it's just being kind of honest with yourself almost, you know, you know, what, what you feel like and what you're concerned about. And so if you feel it's just a little bit different for you, but you can't put your finger on it, then why not just sort of try. Try and find out a bit more. I think also, traditionally, men have been more reticent about considering reds because as one athlete put it in the cycling study, he said, well, how would you like to be told that you've got female athlete triad? See, so originally, reds, it sort of started in women. It was called the female athlete triad because women have this more obvious clinical sign of periods. I think that's why it started there. But then, you know, we mentioned Chris Boardman. People began to realize that this isn't exclusive to females. It can happen in males as well. So maybe traditionally, men have kind of been less out of the picture. And also, there's an interesting point you mentioned. Over training, maybe men are more accepting, shall we say, of the word over training than reds. Maybe. But again, then we're just, you know, I had to review a paper which was saying, is there really a difference between overtraining and reds? Because I've just told you that reds is a result of too high a training load relative to energy input. But guess what? High training load, that sounds like overtraining, doesn't it? So I don't think. You know what I mean. I don't think we can say there are these two totally separate entities. And this paper is very good. It says actually there is an overlap somewhere or other. And maybe we're more talking about unintentional reds when we're talking about over training and we're talking more about intentional reds. Like it's more about the food, whereas the other one is more about the training. But listen, it comes out in the wash. The bottom line is, if there's a mismatch then, and you're in low energy availability, you will have experience adverse effects on your hormones, health and potentially your performance.

One of the other things that strikes me as different between male and female around hormones is the fact that hormone replacement therapy is much more widely accepted amongst females. I know there's still some hype around that and links to cancer and maybe you can talk a little bit about that. But I've also heard mixed things about male hormone replacement therapy in the sense that I've heard, again, health concerns around doing it. Equally, as I mentioned to you before we started reading, started recording, I just read a book by a guy called Dave Asprey called Superhuman. And he talks a lot about, you know, if you want to be he. His primary goal is to live to 180. So he's trying to look at every way possible to put himself in the best shape possible. And he says if you want to be a young, if you want to, you know, have the body of a young person, you've got to have the hormones of a young person. So he's quite pro testing hormones and then getting up to the level of hormones. That's right. For a young person, not necessarily somebody of his age. So. So he's quite keen on it.

But.

So I'd be interested to hear a bit more about hormone replacement therapy for both males and females on those points.

Well, the thing about testosterone is that it's on the WADA band list. So that's the main point. If you're a male athlete, it's a no, no Lance Armstrong, need I say more? Even if you say, oh, I'm taking it because I want to live to 180 or whatever, even if you say, oh, it's not for performance that is not going to wash, you will get banned, full stop. So that's number one reason. The other reason is, with all due respect to men, women are estrogen levels maximum is about 1000 picomoles per liter during a menstrual cycle. After the menopause, they plummet to below 100 picomoles per liter. All right, that's a big drop. Agreed. Testosterone, male ranges, okay, so they are about in under, under 50s, the range is from 9 to 31, something like that. Nanomoles per liter. After 50, they drop. Not. So the range just slips a little bit to like 6, 8, something like this, to about 28. So if we. So that is the reason women's hormones drop off a cliff, literally because the ovaries stop working entirely. The ovaries is where you produce estrogen and progesterone, by the way. Right. So that's, there's a. It stops working in men. Testes keep producing testosterone, slightly less, admittedly, but we know that men can hand father children, you know, when they're 70, 80, for example, so they're still producing some testosterone. So from a physiological point of view, there's not really a justification for replacement unless the testes do totally fail. Like in a woman's ovaries. Right. If they totally fail or if you've had testicular cancer and had the misfortune to have both testes removed, then obviously equivalent of a woman having oophorectomy, the ovaries out. So I'm not saying never for testosterone replacement, but I'm just saying just. I think there's been a lot of hype about it. And it's a different thing for women. And anyway, for men it's just a no, no. And same for women. By the way, the British Menopause Society, which I remember, says that for post menopausal women it is, it is a possibility to give them some testosterone, replace them, to bring them up to the levels that they were before they reached menopause. That's okay from a medical point of view for their health. But WADA still say it's banned. I've had a problem with that with some female masters athletes. HRT is okay, but the testosterone, even though it's medically advised, is not. You'll get banned. So that's another thing specifically about HRT for women. You're right, there was a scare, and it's true, to use the word scare about causing breast cancer from a study back in 2000 from America. And what happened was that the media got hold of the results of the study before it had been properly reviewed, medically reviewed and published. But of course, journalist, media, they like headlines. What more headline to say that HRT causes breast cancer. But unfortunately it proved. Well, fortunately, in that sense it proved to be false because there were many flaws with that study, you see, maybe won't bother to go into all the detail of that, but suffice to say hrt, it's true. It does slightly increase the risk of breast cancer by four cases per 1,000. But that's compared to women who take two and a half hours of moderately intense exercise or more per week. It decreases the cases of breast cancer by 7. So if you do your maths right, compared to a woman who doesn't take hrt, doesn't exercise, she smokes and she drinks. Whopping increase in breast cancer cases of 24. So again, do your math. By the way, what the figures I've just said, you can go and look at them. On the British Menopause Society, which I remember, there's a nice infographic which illustrates quite nicely those things. So HRT for women, it is truly a replacement. It's bringing you up to the levels that you would expect to have been before. But for men, please, just to emphasize, all right, nothing against you guys, you.

Know what I mean?

I'm just trying to be objective about it from a medical point of view. It only slips down a little bit. So it's not quite the same. And by the way, this guy who wants to live to 180, on the one hand, I applaud and I totally agree with him that hormones are important for health and longevity. I totally agree with him. But even I have to admit it's more than hormones make you live longer, by the way, it's the cell programming itself. So good luck to him. But yeah, I don't think even taking all the testosterone in the world is going to get him there. But I wish him luck.

One question that actually kind of springs out from that is something that Dave Asprey refers to again in this book. So you've just let's take testosterone in postmenopausal women. There is actually a significant health benefit for them taking testosterone in certain situations, isn't there? Get it back up to premenopausal levels. And yet it's banned on WADA's list. And I think there's probably several examples of things on their list that are actually as much as anything would be there to offset. If we take an Ironman professional athlete, they're doing maybe up to 35 hours of training a week, multiple Ironmans a year. And so actually there's an argument to say there's certain things that they could be doing that would just basically offset the negative impact of that level of training. So tell me, maybe you can give me your thoughts on the banned list and whether it should be as onerous as it is.

Well, just to quickly pick up on that. Testosterone in menopausal Women, the British Menopause Society. It's only for. Specifically for libido issues. Right. It's not for any other reason. Right. So that's number one thing. Okay.

But that on that point, there's quite a lot of research coming out that says that is actually helping women in the menopause, from what I understand.

Oh, yeah, it helps them, but particularly. But I'm talking from the prescriber's point of view.

Right.

We. Yeah, you. There might be other things, but the kind of recommendations and the prescriptions that I. That as doctors were allowed to do have to be based absolutely on hard facts. And so, yes, there might be new research, but as it currently stands, that's the reason for it. And also, I kind of slightly agree with you that I think it's a little bit on fire on wada, that it's not to give them a performance advantage. But still, I'm not going to. On the other hand, I do see their point that, you know, it's the thin end of the wedge and all this sort of thing and blah, blah. There's been a lot of talk about testosterone levels. And so I kind of. I kind of get it why they're saying that even however much frustrating, you know, you might think it's not right. But also going back to your point that if you're an athlete, for example, if you're an athlete and you have got reds because you got in relative energy deficiency and your hormones will be low, you cannot get a TUE because that's a functional thing. Because basically it's a training error or nutritional error. All right? It's a functional thing. The body is fine, the ovaries can work, but it's just they've decided to shut down because of the situation. So that's why you can't get a TUE therapeutic use exemption, which I agree with. I absolutely agree with Wadhra on that. There are some things, actually, I would argue that should be on there that aren't. Rather than taking them off, I'll put them on. Right. I mean, Salazar, you know, he was doling out thyroxine, speeds up metabolic rate to help with the weight control of, you know, of athletes. Keep them, you know. Right. When it wasn't medically indicated yet, it's not on. He wasn't banned, by the way, because of thyroxine. Right. So in my opinion, I mean, this is just my opinion, by the way, in case WADA come and anyway, so, you know, I think the thing is it's very Difficult. I think WADA have got to be. It's tricky. They want to put on things there that, you know, are definite, no nos. And also, you know, then it opens up to gray area as well. If you're menopausal and now you've got to prove your level what it was before the menopause, you've got to prove what it was after, and you've got to prove that. It's like, I can kind of see that could be a headache, you know, sort of thing. But so. But maybe there are some things that, if anything, could be added on there, but I'm definitely not going to take that on.

And that actually lead. That sort of. What you just said there leads me onto a topic that seems to be very. A very hot topic at the moment, and that is transgender in sport. So I seem to remember reading about. I can't remember which athlete it was, but they were saying, well, the argument is that a female that was formerly a male now has the same testosterone levels that a female would have. However, did they get an advantage from having higher testosterone levels for vast majority of their life? So have you got any. I'd be interested to hear your insights and thoughts on transgender in sport.

This is my opinion because, as you say, it is, but I just agree with what you said that, okay, today, when you test it, or within the six months I think it is leading up to a competition, your testosterone level is below the five nanomole mark.

Right.

And so now you're allowed to compete in a woman's event. But we can't turn back the clock during puberty to change the bone structure, to change the musculature, to change the red blood cell. But that is definitely a difficult area. But I think we're talking about two different things, because people, you know, say that express that opinion. By the way, women are entitled to an opinion. Right? That's an opinion. But that's. That is an opinion in. Was competing in sport. If. If you, you know, transgender, that's fine. That's not a problem. Do you know what I mean? Fine. But then it becomes tricky with competition.

Yeah.

So that's. So. But I think that, you know, the trans. Some. Some transgender athletes get very upset because if one makes, as a woman, one makes a comment like that, suddenly we're accused of discriminating and it's like, no, not at all. But we're just talking about a specific situation because we know that, you know, with 10 times level higher levels of testosterone. 10 times higher. Right. Men and women in their 20s, 10 times difference. That's why men normally are faster than women, full stop. So, you know, on the one hand, we have all that research and everyone talking about that, and then the next breath was saying, oh, we'll actually build. So it is a little bit. It's. Listen, it's, as you say, a very complicated area. It takes other people with far more expertise and diplomacy. But it's badly to. To, you know, to argue this.

I thought it was very diplomatic. I thought it was very, very good diplomacy. But. No, but. But it is interesting asking somebody that really understands hormones and hormones in athletes, that even though if that somebody has the same hormone level, two people have the same hormone level now, it. They've had a benefit from having 10.

Exactly. A retrospect. Previously, I mean, you know, when I, as a researcher, I was part of an international team, it's really exciting time for developing a doping test for growth hormone. Okay. So, you know, again, yes, it's the here and now. What's your growth hormone level or what indicators have we that you have recently doped with growth hormone? But, you know, we can't say what that effect had beforehand. You see what I mean? So it's the same thing. It's. It's a really, really tricky area. So, anyway, yeah, there you go. We'll leave it to other people to discuss that in that area, I think.

Yeah.

But also, it was slightly ironic that there wasn't meant to be a. There's a. There was meant to be a talk about transgender athletes, and the panel were all men. And so actually, that, in my mind, is a discrimination against women. So that panel, I'm pleased to say they have realized that, and it's going to be redressed. So, you know, anyway.

Well, you're absolutely right. It should be an open conversation.

But.

Also a diverse conversation.

Yeah, exactly, exactly. So I don't know what the answer is, but we'll leave it to other people with. Yeah, more expertise and diplomacy and whatever. Deal with it.

So a question I want to ask both of you, really, and this maybe you can both answer, this is from a dietary point of view. So let's say somebody is suffering from reds. They're, you know, they're doing too much faster training. And so from a dietary point of view, is it. Is it. What should people be doing to boost their hormone deficiency? Is there types of food or is it quantity or, you know, how should people be doing dealing with that?

Well, I'm going to say a few things, but then I'm going to pass it to the expert because I'm not a dietitian but in general terms, because what I, what happens normally is I will give them what I'm about to say now and then I'll pass them to someone like Claire to give them the nitty gritty. So the general principle is if your hormones are down regulated it's because you haven't got enough energy in the system. But it's not just about eating a lot in the evening, for example, it's about the timing. We know there are good studies to show that if you space out the nutrition during the day, you mentioned faster training for example, which hormones don't like by the way. Then actually your hormones, if you have big gaps, it increases cortisol, decreases the sex steroids, estrogen and testosterone. So absolutely, of course it's the amount but it's also the timing. And, and from my point of view there's lots of evidence to show that for females especially it's the complex carbohydrates that female hormones love. So I'm going to pass over to Claire because I think she's got more expertise in that. But that's my general gist of what I say to people and then I pass them to you Claire. Right. For the detail.

And that's absolutely where I start with and really just I think getting people on board to understand this is not about making somebody gain huge amounts of weight because I think that's the first thing that somebody really worries about often in my experience is that well, if I'm going to be doing all this eating it's going to negatively impact my training. So absolutely, I think with the regularity of eating is really, really important because a lot of people tend to for whatever reason and there are many reasons why people might save up energy in the evening and it might just be where you've had a really high intensity training in the morning and you actually don't have the appetite, feel the appetite at that time. And so absolutely talking about fueling around each training session. So I always talk about like kind of micro, these micro cycles and actually thinking about fueling for each of those microcycles in a day rather than thinking I need X amount of calories, it doesn't matter how I get them and they're helping them to understand, you know, the different energy needs for different days as well that you know, we can't make it all up on our day off to be eating everything then either. So but, and it's interesting with carbohydrates, you know, in terms of people's perceptions of how much they should be having. And you know, I find it very interesting and I was just talking before we started about being away with a whole group of, of male athletes and you know, the amount of conversation around that perception of trying to change body composition is not eating. I just find it fascinating because I just, I'm often around big groups of women and actually being around big groups of men was really fascinating. Oh, I just don't eat until 12 o'. Clock. Why do you not eat until 12 o', clock? You know, or whatever it might be. So I think, you know, that that idea around fueling for the work that you're doing is really important. And also educating about, you know, carbohydrates are not bad at all. Fats are not bad either. We need fats. And you know, you can pick up on that point. But you know, fats from a hormonal perspective is really important. So yeah, the education around what the different nutrients do and when you need them, I think that that for me is a big, a big kind of.

Aspect, but also myth busting. We do that right here and now. Right. If you do, if you do what you just described, you do fasted training in the morning and you don't eat till midday, I can guarantee you your cortisol will be high, your testosterone will be low. Cortisol favors deposition of fat. And this was also shown in the study. If you do that day on day, on day, like we just described, the big energy deficit, cortisol's up after your body composition doesn't improve, it gets worse. Right. So it's counterproductive. You'll be more likely to end up with more body fat and less muscle. So it's, it's. And also it's slightly weird because I have to explain that in order to stabilize your metabolic rate and your energy balance, whatever words we want to use, you actually have to eat more. Now that sounds really weird. So I'll explain. So when you're not eating enough, we talked about the hormones adapting and saving energy. And that includes down regulating your metabolic rate, the rate at which you burn through energy. Your thyroid tests, I can see, if you test them, I'll tell you they're all low. So everything's going slowly. Okay. So you need to get that boost that it's like igniting the pilot light. So in order to do that, you have to introduce some energy in the system to get the thing working. And then once everything equilibriates, the hormones get happy again. Then now we're in normal physiological, good working conditions. Now we can start to work on your body composition and all these other things by doing strength training, by the way, properly fueled, because then your hormones will respond and you will adapt. So, yeah, that was very interesting, the body composition. So just to, just to get rid of that myth. Now, that doesn't help.

Absolutely. And I think that's why people often say, well, I'm, I've just cut back, back and back and I'm not eating. And actually I'm not, I'm not losing weight, I'm not changing body composition. And, you know, that's also an important part of education, isn't it?

Well, the body's the. Listen, the body is not stupid. It's had millions of years of evolution, by the way. So it knows if you're effectively kind of getting into sort of starvation or restriction, it's not going to let you lose weight, is it? It's going to try and maintain you. So that's why it doesn't work. Guys or girls, everybody.

And so we talked a little bit about diet, but what about supplements? Are there any supplements that people can take if they are deficient in as well as, you know, fueling for the right for the work done? Are there any supplements that help that speed up that process perhaps?

By the way, just going back to that expression fueling for the work required. It's. That was actually quote from Sam Impey's paper, who's worked with James Morton. Anyway, fueling for the work required. I love it because it's like you're thinking forward, what's right now you should be thinking, what training am I going to be doing tomorrow? What do I need to eat the stage evening so you're prepared. You see what I mean? Anyway, that was just slight side, which.

Is actually an interesting point because you like quite often on your recovery day, or you might be thinking, well, I'll, I might eat less because I'm not doing so much. But that, that would go against what you just said.

Exactly, exactly. So people, what I mean fundamental to this working is if you've refueled correctly, so you've done so today, you've done your training and you've taken within 20 minutes of stopping your carbohydrate and protein recovery. And then you've had. And then. But then your evening meal. The evening meal is not for recovery. You should have already done that. Your evening meal today is looking forward, but actually on the rest day, you're on the rest day. And now what's going to happen the next day. All right, so I agree there might. Listen, there's some, I mean Claire will be more. Knows more detail, can explain better than me but. And of course there'll be slight fluctuations of variations but generally I think this thing about proactive and looking forward is really helpful. Do you agree with that, Claire?

No, absolutely. And also we talked right at the very beginning about all these different metrics and data and actually thinking about what works for that individual. So if I did this around a training session, what happened, what happened to my appetite? How did I respond? Because again there are many athletes that try to manipulate body composition and leave themselves being really hungry once that high intensity or endurance work is done and then end up overeating or eating.

Yeah, yeah.

At the end of the day. So I think that feedback about how did that fueling go for you? What did it work? How did you feel, how did you sleep? Like all of these other kind of metrics in there as well I think are really important.

I'm going get to that new, that supplement question I'm going to pass to Claire but because she's definitely the expert in this. But from my point of view, I'll say if Claire agrees with this, my, from my point of view, if you're having a diet with a variety of things, the only supplement we all need if you live in the UK is vitamin D because that's from the sun. The action of sunlight on the skin makes vitamin D. And so personally, for example, I take a thousand international units every day, even through the summer. Well that if for example, we are going away for a week to Italy for windsurfing and I hopefully will be seeing a lot of sun so probably I won't bother to take them for that week in the sun. Right. But otherwise, you know, let's be honest, somewhere in England, I mean and also if you're a triathlete out training, okay, oh, I'm outside but you're on your bike, you've got a helmet on, you're leaning forward, you're actually not much. So much of your skin is going to be seeing the sun. Really? You sort of mean so, so vitamin D is in my books the crucial one, the non sort of fixed one and then of course for different diets, the vegetarians, B12. But I'm going to pass over to Claire on that. What do you think about supplements?

I think, I think I absolutely agree with you with regards to vitamin D and unless there's any medical reason why you need to supplement your diet Then always start with like get the diet right first. Because people are very good at kind of looking at something else to take to help with my metabolism or help getting cramps or whatever it might be. And actually sometimes we don't look at the diet itself. So get the diet right around your training sessions and for your recovery and for your sleep and then to optimize things or if your training is really, really heavy or. I work with quite a few track athletes that may not get home until like 9 o' clock in the evening or whatever, may not want to eat. And actually that's going to affect their, affect their sleep. Then what could we do to optimize that recovery? And that is might be where you take a recovery milkshake or whatever it might be that's been, that's been batch tested. So I think there is a place in the space for the use of batch tested supplements. But appropriately, and that's the word supplement itself is to supplement what we are eating. It's not. Instead of. And I think that's a really important thing to remember.

Does vitamin D have a specific impact on the hormones or is it just, you know, is it something we just need generally or is it specifically for hormones that we need? Vitamin D?

Well, guess what? Vitamin D is a hormone. That's why I'm chatting it.

You see.

I know, well, you see, this is. But you listen, you're right, because it's a, it's a, it's a little bit unusual. Number one, all vitamins, like Claire said, we get from the diet, apart from vitamin D, which from the sun. So already it's a little bit of an outlier. And secondly, it's actually misnamed, I'm claiming it better for hormones. And also it works in tandem with other hormones, particularly with estrogen and testosterone. And that means it's very good for bone health. So I think most people know it's good for bone health. So that's number one. Yeah. But number two, also very interesting research in dancers actually showing that it helps muscle strength and muscle recovery. The dancers that were given vitamin D, they jumped higher. It's like, wow, there's a performance benefit right there. Taking a vitamin D, it's like easy. And also immunity, of course, very important for athletes who, you know, a good study showing that athletes that took vitamin D, especially over the winter months, they were less likely to have colds and stuff like this and Covid, etc. You know, so vitamin D hormone. Vitamin D. I need to rename it, don't I? Anyway, that's, yeah, it's super great. And also it's, we know that if it's low people often come and they do the blood test and they do the blood test, they say I'm just feeling, just not feeling great, just feeling fatigue and then I see that vitamin D is in their boots and it's like here, this is an easy fix. You just take some supplements and then literally it's a, it's a quick, it's an easy win, put it that way. Brilliant.

Yeah, no, that's fantastic advice. Thank you. Now I can't let you go without asking you for a book recommendation. We always ask everybody for a recommendation of a good book. So if people want to sort of learn more about their hormones and the importance of them, are there any good books you can recommend?

Well, as I warned you before we started recording a shameless plug, I've just finished the first draft of my book which is Hormones, Health and Human Potential. So first draft. So there was lots of, as you can imagine, work still to do but hopefully it will be out in print later this year in time for Christmas. So that will, and it will include some of the things we've discussed by the way. So in the meantime, I mean I've got a recommendation for a textbook but that's probably not quite what you're looking for and I'm not sure you're going to probably hold up that Chaps book about living to 180 but that's not proven. So I'm not sure you want to recommend that. But I mean other good, good authors, not particularly in hormones. Tim Spector who writes a lot about the microbiome. So. Yeah, well you'll just all have to buy my book, won't you?

It's really exciting. Nikiyabi. I have that on my Christmas list.

Right, thank you.

So it's another that you can add to the pile of books you haven't read, Claire.

Yeah, I haven't actually read one since I've been away. I read a whole two books, Nikki, on the last time I was away.

Wow, that's very impressive.

Non textbook because I only read textbooks.

Yeah, well that's, that's my sort of thing as well. So my book is, I mean it's going to have some facts and references, it's going to be, you know, solid information but it's not, definitely not a textbook. Right.

Well the big question I have to ask you is are you going to make it into an audiobook? Because I'm much better with audiobooks than I am with physical books.

Oh, gosh, I don't know. I haven't even thought ahead to that. No, but listen, I. Listen, yeah, sure. Get someone to, you know, listen. Thank you for that tip.

I agree.

Because when, if you're out for a run, you've got a podcast or something like that. Yeah, yeah, sure. Well, listen, I'll see. I'll have words with my editor.

I have turned one of my books into an audiobook. So if you want, in terms of the process of doing that, then I can help you a little bit. But no, I definitely, for athletes, it makes it much more accessible, but also for people that are dyslexic, which.

Yeah, that's true. Yeah, yeah.

My son is much easier to listen to a book than.

Yeah, yeah, good point. Thank you.

Fantastic. Well, that'll definitely be on my Christmas list too. And last question, and I don't know, this might be a bit of a curveball, but is there. I like to ask people what they're looking forward to, but what's exciting them at the moment? Is there a particular area of the work that you do that you think is really exciting in terms of the research or anything that's coming out or anything new that you think is really exciting?

Well, the work I've been doing, I'm chief medical officer of Fourth, which is a blood testing company, including for athletes, of course, and actually better improve ways of looking at these results. So we're using artificial intelligence to map female hormones. So to personalize the information and explanation we can give to people with regard to their results. So that's really, really exciting because it's all very well, getting some results and even me giving some explanation, but actually giving a more in depth interpretation of a set of results and also providing advice and smart goals. That's really super motivating. So that's what I'm working on at the minute.

Amazing. And so for people that want to get tested and benefit from the hormone mapping that you just described, how do they go about that?

So if you go to the Fourth website is spelled F O R T H Fourth. There's Fourth Edge, which is specifically for athletes, but also Fourth with Life is for testing for many things. But on both sites there's a thing called female hormone mapping, which has just been renamed MyForm. And that's specifically for female athletes who are having periods and want to know about the fluctuation of their hormones. And especially for female athletes, perimenopausal, who are wondering, is this red or is this perimenopause because it's very, actually pretty tricky. I can tell you, even as a doctor, difficult to distinguish just from symptoms which of those it is. For a woman of an athlete in her 40s, it's difficult to pick apart which of those it is. But if you do the MY form, the female hormone mapping, that helps. So if you go onto the website, you can have a look and see what the tests are there. But also, I mean, Claire and I, we both use fourth testing. So, you know, if people are interested either of course in the nutrition side, Claire, or more the medical hormone side, then they can get in touch with me. I offer virtual appointments and I will do the testing through 4th with a discount.

And so, so, so if people go to 4th then get the test, then you guys can help them interpret it. Which, which by the way, I'm actually supposed to, as I said before we started, I am, I wanted to have my results that we could discuss today, but I, yeah, I didn't get on so well with the, the finger prick test so I need to put booking somebody to come and actually extract the blood so I can pass out while lying down.

Better. Well, that's fine. We can discuss the results when they come through then. Sure, we can set up. But yeah, we can go through them.

Excellent. Fantastic. Nikki, it's been an absolute pleasure chatting to you. There is so much wisdom in that conversation, so much that we can take away and yeah, it's been an absolute pleasure. So good luck with the book. I look forward to seeing it come out.

Okay, thank you.

If you want to find out more about Nikki, then the best place to go to is nikkikfitness.com and that's K E A Y. If you want to get your hormones tested and then get Nikki's commentary on them, then go to fourthedge.co.uk.com and I'll put all of her social media links in the show notes. But generally speaking, she's Nikki K or Nikki K Fitness and fairly easy to find. So Claire, what did you make of the interview with Dr. Nikki K. Fascinating.

I mean, as you know, I, I work with Nikki a little bit outside of this as well and her insight and knowledge is just amazing. And what I love about, about the way that she speaks is it is we can all relate to what she's saying. She makes it so easy to understand and I need, I know that was kind of a bit, quite a new area for you to kind of talk about and listen to as well. So what did, what, what were your thoughts? What were Your thoughts?

I thought it was really, really interesting and I think it really opened my eyes as to how like if we don't fuel correctly when we're in, you know, in reds as it was termed so relative energy deficiency when we, when we're in reds that, that impacts our hormones and then that though that imbalance of hormones impacts so many other things whether it's osteoporosis or whether it's muscle development, all of that sort of stuff. In fact I was, when I was racing Outlaw half at the weekend, I was chatting to a friend of mine, um, who was also racing, we were staying in hotel and he has had so many stomach issues over the years. So his, his default now is to basically in rate on race day just underneath under fuel because he's much less likely to then end up vomiting on the side of the road than he is by putting lots of fuel in. But he then has a habit of training in that way as well. And I was like, well look, you know your kind of late 50s Chris Boardman, you know, retired early because of osteoporosis, because of relative energy deficiency. So that whole piece I just thought was really, really interesting and how it's so important that we, that we balance out these hormones. One other thing that got me, got kind of, I was thinking about afterwards was you know, I haven't had my test yet as you know, but if it came back that I'd got a testosterone deficiency, let's say then I know that long term health is going to be impacted by that. Like for example Alzheimer's becomes a much higher risk I believe if you, if you're low on testosterone. So, but equally testosterone is on the water band list. So then you have that dilemma of well okay, how you know, how do you deal with that? So I'd be interested to hear your thoughts on that whole piece.

I mean I find it fascinating and this is why I always will test with my athletes like at least every quarter or when they're not feeling particularly well. And even myself like I will make sure that I'm in the best health possible. And one thing I would say is a lot of these things, unless you're testing on a regular basis, you probably wouldn't realize they're happening. So this is the great thing that Nikki was talking about about like the internal information that you get from these results which are really good. So some of the long term consequences obviously of having low testosterone are going to be the impact on your bone health as well. So that, you know, let's Think about the here and now that you wanting to do sport maybe and be active for the rest of your life, that is, that is going to have an impact and on muscle development, body composition and all of those things. And all of these things are so closely tight knit. And that's what Nicky was talking about, the fact they all interplay with each other. So looking at it on face value and saying, unless you've got somebody to help you interpret those results, we talked about this as well, you know, having those results and then knowing what to do with them. So if you had that result, what would you do with it? Well, some people might think, well, you know, what I need to do is supplement it because that's the problem. And it's actually looking outside of that and saying, well, what caused it? What's causing the low testosterone for example, and what else is also low or what is high? So what are the interplays that are going on? So it wouldn't, it would be very unlikely that you'd have to look at it and say, I need testosterone. It's probably, probably if there's no other medical cause or you've excluded those causes to low testosterone, it's then worth looking at what am I doing nutritionally, what's my training like? Because those things will have an impact on your testosterone levels and it's likely that you'd see something else alongside your testosterone being high or low as well, that would give you more of those indicators of the story.

Can you give me an example of what you might see if testosterone was low, what else might you see? That would be an example, would be one of those indicators.

So depending on what you've measured in there as well, you can see some of what you would think of, and Nikki talked about this, of more of the framework, female hormones in there as well. So you may see those out of balance with the testosterone. You may also see your thyroid hormone, which we talked about, that might be a bit out of balance as well. So you can see those indicators. The other thing might be that if there is a bit of under fueling going on, you may see an impact on things like your iron levels, your ferritin levels and your hemoglobin levels. So it really tells like this internal story of what's going on and being able to look at that and being able to look at it over a period of time is really useful to see what changes you need to make. But also the warning signals about this has happened before. This is what was going on before. This is what I need to do about it. So, you know, it'll be really interesting to see when you do get your results back and hopefully they'll all be in really good. A really good place as well.

Well, yes, absolutely. Well, I'm having a bit of a nightmare trying to organize the appointment because I'm traveling quite a lot with work. So actually I think I might end up just going into a super drug or somewhere and say just do it for me, because it's proving to be a bit of a nightmare. But as soon as I've got those results, I'll share them with you and you can happily kind of dissect them on the podcast and kind of we can talk about. Hopefully it's. I'm a, I'm a picture of health, but.

Well, I certainly do. I can. And anything that I don't know the answer to, we can, we can ask Nikki as well because she is, she is far more knowledgeable than I am on all, all things hormone. But we can certainly have a look for those markers of like under fueling for sure.

Brilliant. And the last question before we let everyone go is Nikki, right at the end, mentioned about the female hormone mapping. What do you think the impact of that will be?

I think it's really, I think it's really, really interesting. And I think again, this is, this is being able to, I think, grab hold of recognizing where you are right now and actually how we can help to see what, see what things are going to be like in the future as well. So really kind of knowing why your body's doing, what it's doing at the time and how that might interplay on your training, how it might interplay on changing your diet. So I think it's really, really important, actually. And I think it gives a really good insight as to what your hormones are doing at this point in time because it is something you would need to kind of keep, keep on tracking. But I think we're going to see more and more of this kind of like modeling over time of us learning more and more about our bodies. So, yeah, I know I've had a number of athletes that have already been working with it and found it really useful.

Fantastic. Well, I think, I think it's a conversation we need to continue to explore over the, over the podcast because there's clearly a huge amount of detail to dig into here. But. So let's wind up for today. I hope you kind of get through Covid as quickly as possible. Start feeling back to yourself again. Get. Now that you've dropped this weekend's racing. When's the next race after that?

A couple of weeks time. So I've got a couple of weeks grace and then on to the next one.

Absolutely.

I am absolutely going to be sensible. Like I am not. I am just looking after my health. So I, I want to race the whole this season.

So that's exactly it. It's more important that you're racing well by the time you get to Kona and like than it is about your.

Race might be your next race might be before mine. So when's yours?

Oh no, my next race isn't until about July or August I think because my diary is so ridiculous. I've got the cowman to look forward to a slightly ominous named triathlon. But yeah, no, that's a long so just some interesting things going on between them. But well, I hope you're feeling better soon. Good luck with the training and for everybody else, keep on training. And remember this podcast was sponsored by 33 fuel so rethink your sports nutrition with 33 fuel award winning natural sports nutrition for your performance, health and a Fitter Future. It's the 33 Fuel Fuel Osophy. Get yours@33fuel.com and if you use the discount code Tribeathlon or the link in the show notes, you'll get a discount at the checkout. If you enjoyed this podcast, please do review it and share it because it helps other people find what we think is really valuable learning lessons from amazing athletes. So please do that. You can also find the whole back catalog@tribathlon.com and you can also find out about the Tribe Athlon app which helps people find events find people to train with and enjoy their events through their tribe. So check out tribathlon.com.