Episode #201: What To Do About Knee Pain That Won’t Go Away

In today's episode, what to do about knee pain that won't go away. Also, can heat acclimating improve fitness? Is infinite nutrition good? How to treat runner's knee How BMR works curing hip and glute pain should yogurt be part of your diet? Should you worry about creatinine levels, overtraining and thyroid stimulating hormone? And what to eat after lap band or gastric bypass surgery?

Welcome to the BenGreenfieldFitness.com podcast. We provide you with free exercise, nutrition, weight loss, triathlon and wellness advice from the top fitness experts in the nation. So whether you're an Ironman triathlete or you're just trying to shed a few pounds, get ready for non run of the mill cutting edge content from BenGreenfieldFitness.com. Hey.

Hey everybody. Welcome to another episode of the Ben Greenfield Fitness Podcast. I'm Brock and I'm here on the on episode 201. It was really exciting last week to hit 200, wasn't it Ben?

Yeah, it was incredibly exciting. The rest of my day I was just on, on pins and needles. And yeah, it's this week has been kind of a downward spiral in terms of excitement since that one. My kids are at camp all day, like all day, like nine to five. And dude, what do people without kids do? I mean my kids, we enjoy our lives. Seriously. My wife and I have like been riding our bikes around and going out to lunch and sitting around during the day like watching Hulu and it's like time all of a sudden expands like four or five fold as soon as your kids are gone all day. So it's amazing. We were both talking the other day thinking we'd probably be like over trained and probably poor from eating out too much if we didn't have kids.

Yeah, I'm often if I didn't work as hard as I do, like if I didn't work freelance and a full time job, I would have that same problem. But then I look at my day and think, well, I work full time job and freelance and train and race. How could I ever have time for kids? So yeah, it's the same on both sides.

Yeah. What's amazing is when you have kids and you learn how to be extremely efficient with your time once you have kids and then once the kids are gone, it's just freaking amazing.

Just imagine in 18 years. News flashes. All right, twitter.com BenGreenfield is the place to go for all the interesting news flashes. And you can also go to Google and look for Ben Greenfield Fitness there as well. And this is the time when we highlight some exciting things that have been tweeted or plussed. Is that what you'd call it? I don't know about. Over the last week.

Oh, holy man boobs Batman was the beginning of a tweet I put out a couple days ago linking to a study on soy, specifically consumption of, like, a lot of these supplements that have soy in them. And in this case it was a study done in men that found elevated estrogen levels of up to 17 times higher than normal in men who were consuming plant derived nutritional products. Specifically plant derived nutritional products that were derived from soybeans, where we're talking about soy protein products primarily. We've talked about estrogen dominance on this show before. How in guys we can get stuff like man boobs, how in ladies we can get things like propensity to gain weight as you get older. And this I think is a little bit of a blow against specifically like soy protein. Unfermented, powdered, high concentration forms of soy are something to stay away from. And this study kind of backs that up.

So, yeah, we've talked about that before.

Careful. If your protein powder has soy in it, I'd be real cautious there. Another thing that I tweeted and links to was a nice little chart that has FODMAPS on it. And if you don't know what a FODMAP is, basically FODMAP is an acronym and it stands for fermentable oligode and monosaccharides and polyols. What that is an acronym derived by a true geek nutritionist or scientist or somebody or some group of researchers. But basically the theory is that foods that contain those type of carbohydrates, those type of highly fermentable carbohydrates, can exacerbate some of the symptoms of digestive disorders like irritable bowel syndrome or inflammatory bowel disease or just plain gas. You know, if you've got a lot of issues with like bloating and flatulence and gas and you always feel like you're farting more than the average individual, what you may want to do is just check out this chart and I'll put a link to it in the show notes. Of course, this is episode number 201 and it just shows the most villainous FODMAPS. Nice little picture single page PDF. You can print it, you can put it on your fridge and it shows the fruits that have the most fructose in them. It shows kind of the most lactose containing foods, foods that contain high amounts of fructans, which are a little bit different than fructose, but you're going to find those in different forms of vegetables and cereals and fruit, galactans, which you're going to find in some forms of legumes. Baked beans is probably the basic example. And then polyols, which are another form of fermentable carbohydrate that you're going to find in sugar, alcohols like sorbitol, some vegetable like cauliflower for example, and stuff like that. So basically, if you're trying to get rid of gas, get a little bit of irritable bowel syndrome, that type of thing, print this out, toss it on your fridge and just try eliminating those foods for a week and see what happens. But fodmaps is what they're called.

So you're talking about not fermented foods in the way that, like yogurt or.

Kimchi or sauerkraut, not fermented foods, but fermentable foods.

So fermenting in your gut, not in.

A, in a bowl, in a canning jar, in your, you know, in, in your pantry, but literally foods that, that are much, much prone to ferment in your gut based on bacterial fermentation. If you've got irritable bowel syndrome, gas, stuff like that, you cut those out and you can, can see a pretty stark difference. So check that out. Useful chart for those of you who are struggling with that. And then the last thing is an interesting article I noted on sugar and what happens specifically when you add phosphate to sugar. So of course a characteristic of coke or any other soft drink is that they contain lots of sugar, but they also contain lots of phosphate. And over in Japan they did a study that showed that when you consume sugar, of course your blood glucose will go up. But when you consume sugar with a high phosphate containing meal or beverage, the rise in blood glucose is significantly higher. And so I know that a lot of folks who listen to this show are already healthy and probably already avoiding soft drinks. But it is yet another blow against any food that combines sugar and phosphate. And that would include things like Red Bull, Monster Energy drink and rock star as well. So be careful with these type of foods because when we're talking about a steep rise in blood glucose that can be created with that combination of sugar and phosphate, we're talking about increased risk of diabetes, insulin insensitivity, obesity and weight gain and things of that nature.

You'll just Stay away from it.

That's right. So toss that Coke can in the trash rock and let's move on to the special announcements.

Except that I found out this week that Canadian Coke is actually the same as Mexican Coke.

Really?

So that sought after desire for Mexican Coke can be handled in Canada.

The taste of a Coke that is made with glucose is just far superior to fructose, regardless of what it does to your blood sugar levels. Like I mentioned, I am a Coke drinker about two or three times a year and it's usually when I'm on a nice long hot bike ride. But if I can get one of those old school glass bottles of real glucose containing nice fizzy cool Coke, it's way better than the washed up fructose containing American version.

I'll mail you some from Canada.

Thanks. Be sure to refrigerate it Special Announcements.

Okay, cool stuff going on@BenGreenfieldFitness.com as usual, a couple of really great articles, especially one around circling around Ramadan.

Ramadan starts tomorrow, actually. It's the Muslim fast for about 30 days where you basically from dawn until sunset, you don't eat, you don't drink or anything. And I coach some folks who are observing it and who still want to continue their pattern of lean muscle gain and fat loss during Ramadan, still want to exercise during Ramadan. So what I posted on Ben Greenfield Fitness this week was how to lose fat and gain muscle during this entire month of fasting. So whether you're observing Ramadan or whether you're just interested in kind of how to fast and still put on muscle, check that out. Check out the article. It would be super helpful for you. The other thing, thing that you may have heard if you subscribe to the podcast is that I interviewed ultra endurance vegan athlete Rich Roll about crazy, crazy superfoods that you've never heard of. So if you didn't get a chance to listen to that interview, you can head over to the podcast show notes over@BenGreenfieldFitness.com you can download it and check it out because there's some interesting superfoods on there.

He's a very cool guy too.

Just cool. Yeah, he's a cool dude. The other things that I wanted to mention was that if anybody happens to be because I know we have a lot of triathletes that listen in. Anybody happens to be going over to Spain to compete in the ITU Long Distance World Championships next week, I will be there. I am the reigning world champion for the 3034 year old age group or whatever the age group is. And I'll be going over there to defend my gold medal. So if you're going to be in Victoria Spain next week, drop me a line. I'd love to meet you. Holy. Yeah, I'm brushing up on my Spanish and the other thing is that the future of health now that we've talked about a few times on this podcast, those free videos are going to go away this Sunday. So if you have not yet claimed your free 10 day pass to be able to access that online health event jam packed with some very cool videos, head over to the show notes for this podcast and we'll link over to them in the show notes. So that is all over@BenGreenfoldFitness.com episode number 201.

Hey Ben, this is Eric calling from Atlanta, Georgia. I just want to let you know, man, that I got you a tri rate program to get ready for a Half Ironman that I did back in May. And man, the program is awesome. I did very good. The program is very nice. Especially for a person like me. That time is a big deal. I'm working full time and also going to school so it's kind of hard to feed a workout. But the workouts were perfect, you know, the right time, length wise, perfect. And I really enjoy actually the strength workout. They're pretty good. But anyway, the program took me to the Half Ironman. I won my age group and I'm very excited, man. I'm using the program again in preparation for Augusta that is coming up. Anyway, just want to let you know, thank you so much, man. And I really enjoyed your podcast and I have learned a lot. So again, thanks. Take care, man. Bye.

Listener.

Q and A. All right. We had a bit of a backlog of audio questions from last week's show when we asked everybody to call in and win a free book if your question was chosen. So we've actually got a whole bunch of audio questions to kick off this week, starting with this question from Gordon.

We don't break bank though. If your question was featured in episode number 200, you get me mailing you a book. But that is not the practice going forward or else I'd be spending a lot of time at the post office.

Yeah, yeah, sorry, I thought I made that clear. But yeah, definitely that was a celebration.

All right. But if you do want to ask a question, you can always call in and we'll still answer it.

Yeah, just no free books or chocolate. Okay? Go Gordon.

Hi Ben, this is Gordon from Alabama. I have A kind of a topsy turvy question. I know it's fairly well documented that training at altitude and then racing at sea level is a benefit for the body. You come across stronger because of the oxygen deprivation at altitude. Is it possible to argue the other direction? And let's say I live in Alabama and I train through the summer heat and humidity and what that does to the body in terms of the inability to cool and get oxygen into the bloodstream with moisture laden air. Can one. Is it possible, can you even theorize that it's possible that one could train in a high humidity, high heat summer of the south and then race in the fall at altitude or race at altitudes? So can you go the opposite direction if you're coming from an area where you've had to struggle through heat and humidity all summer long? I hope that makes sense. It's something I've been kind of thinking about recently and I found last year I trained for the San Francisco Marathon in the heat and humidity of Alabama and then got over to the relative cooler temps of San Francisco and had a much stronger rate than I expected. So anyway, just thought I'd throw that out there and see what you think. Thanks a lot. Love the show. Bye.

All right.

Well, this is interesting. I guess he's. The way I boil this question down is is there a real fitness benefit from training in high heat or high humidity or, well, those sorts of situations in the same way that there is like training at high elevation.

Well, there's certainly a physiological adaptation that takes place when you're putting heat stress on your body. So. So you can compare exercising at cool conditions to exercising at hot conditions to kind of see what those adaptations would be. And it's one of those deals. Anytime you're exercising, period, you're gonna see a little bit of an increase in your blood volume and a decrease in your resting heart rate and an improvement in oxygen consumption and things of that nature. But when you compare exercising in the heat to exercising in cool conditions, assuming that you're already exercising, the main differences that occur are when you're exercising in the heat, you basically have an onset of sweat formation at a lower core temperature. So your body starts sweating a little bit earlier into exercise. That's one of the things that'll happen. It's basically an enhanced cooling mechanism.

That's me. I start sweating the minute I think about working out.

And if your heat adapted, that's going to occur faster than if you're just in good shape but you haven't been exercising in the heat, you're going to notice an increase in sweat either way, but you'll notice it more if you're heat adapted increase in blood volume. So what happens is basically your heart is able to have a higher stroke volume, it's able to decrease the heart rate for any given work output, and that allows you to stay a little bit cooler, shuttle blood around your body a little bit easier, which is one of the main ways that you cool yourself is carrying blood to the skin surface. And that is going to occur in a greater amount in hot conditions as well. So your plasma volume or your blood volume is going to go up once you start exercising period, but it's going to go up higher if you're exercising in the heat or if you're including like heat acclimation type of sessions in your training. Decreased core body temperature for any given level of exercise. That's going to happen more so of course in the heat than in cool conditions. Although interestingly, skin temperature doesn't really change that much. So it's mostly your core temperature that's affected, not your skin temperature, which is kind of a cool regulation of your body. Now, when it comes to like using heat to prepare yourself to perform at altitude, this is probably the biggest effect that you should note is that when you exercise in the heat compared to when you exercise in cool conditions, you get improved exercise economy. And so what that means is in scientific terms, your oxygen uptake for any given level of exercise is lower, meaning that you've improved your ability to produce movements while utilizing less oxygen. And as you can logically figure out, that adaptation would come in pretty handy when there's less oxygen available. And so if you were going to go compete at altitude or you're going to go live at elevation for training, yes, exercising in the heat could technically help you out quite a bit when it comes to improving your economy or your efficiency. You know, the interesting thing is that there was a study done a few years ago that looked at the effect of exercise in like neutral conditions at sea level at hot conditions at sea level, neutral conditions up at elevation and hot conditions up at elevation. And as you would have expected, the hot conditions at sea level and the neutral conditions at elevation were higher or were lower. Your time to exhaustion was reduced when you were exercising in very hot temperatures at sea level or in just normal temperatures at elevation compared to neutral sea level conditions. But the interesting thing is that the, the amount to which you get exhausted exercising in the heat at sea level or exercising in the not in heat but at elevation are similar, meaning that you can draw a little bit of similarity in terms of like the the physiological stresses that take place in temperature, high temperature at sea level or regular temperature at altitude. Now, of course, it's important to realize that the stresses on the body are from two entirely different mechanisms. You know when it's when you're exercising in the heat at sea level, the stress is heat. When you're exercising at altitude, the stress is lack of oxygen to your body and what's called respiratory alkalosis or the kind of the rapid hyperventilation, breathing off of CO2 while you don't have much oxygen available and kind of a change in the PH of your blood. But either way, you're looking at similar stresses and the change in economy or efficiency when you're exercising in the heat could certainly help you. However, there are a ton of other things that you can do to acclimate yourself or get yourself ready for altitude. This would be a good opportunity for me to throw in a shameless plug for a new book that came out over@EndurancePlanet.com I didn't write it, but we get a ton of questions about altitude training from endurance athletes over@EndurancePlanet.com so Jeff, who also listens in this show, he lives in the Colorado mountains. He trains in the Colorado mountains. He's done it for years. He's an expert on elevation. He wrote an entire guide to elevation. It's called Practical Tips for Living, Eating and Training at Altitude. I will put a link to that in the show notes. It's seven bucks and it's like 80 pages jam packed that you can download right to your computer. You can also get the hard copy for 12, $13. And you know, whether you're training for like, you know, Ironman Lake Tahoe or you're just getting ready for something at altitude, it would certainly be a good read.

And only seven bucks. Sweet.

Yeah.

All right, well, let's move on to this next audio question and I'm going to call this fellow BMR man because he didn't give us his name.

Hello Ben, Love your show and your newsletter. I have a quick question on bmr. I've done the calculation with a bunch of different ones and I'm a 6:2 male. I currently weigh 229 and I go to the gym for the last six months. I've been going to the gym for four to six times per week. The BMR calculator is basically telling me somewhere between 2,800 and 3,000 calories a day. Now, if I do that, I don't gain any weight, but I really don't lose it or I lose it really, really slowly. Like, you know, less than a pound a week. But I do get bigger, bigger, more muscular. However, I found if I go down to like 1800-2000 calories, then I'm losing over £2 a week. So I'm just wondering what the best solution is. Am I doing it right or wrong by trying to stick to 2000? Should I just take the slow weight loss and eat the 3,000 calories? Or is 2,000 best? Thanks, bye.

Okay, so first, BMR, basal metabolic rate.

Am I right, Beamer man? Yeah, basal metabolic rate. So that's just like how many calories that you burn doing nothing, sitting in a chair or lying on a mat all day. Gotcha. Yeah. As many calories as are necessary laying on a mat, Kidneys to filter blood and your lung muscles to automatically function and that type of thing. So all of those involuntary contractions and reactions that take place. So his BMR, he says, is about 2,800 to 3,000 calories a day. You can measure that or you can use a calculator to calculate it, like an online calculator. Now, the thing about the BMR is you can find out how many calories that your body needs to sustain life, right? And if you undercut that for too long, you can get what's called, like this metabolic reset. And frankly, too many personal trainers and too many nutritionists worry about this too much. They say that, oh, if you fast for a day or if you don't eat as many calories as your body needs, it's going to down regulate your metabolic rate. It takes about four weeks for that to actually happen. Four consistent weeks, almost basically 30 days of not eating as many calories as you, your body needs to sustain life in order for your body to begin to very gradually down regulate your metabolism so that your basal metabolic rate falls. And this is why you can eat fewer calories than your body actually needs. You can lose weight consistently, and you can do that without risking down regulating your metabolic rate or resetting your metabolism to be lower as long as you don't go for 30 consecutive days doing that. That's why I like the concept of calorie cycling. You know, doing like five to six low calorie days, one to two higher calorie days, or even calorie cycling week to week, like doing three weeks lower calorie, one week, you know, higher calorie. It's the same reason why, you know, somebody, we talked about Ramadan. If you're going through the month of fasting for Ramadan, you know, I would definitely be throwing in, you know, a good five to seven day period after that where you're eating as much, if not slightly more than your body needs so that you're not risking that down regulation of your metabolic rate that can come with long term consistent undercutting of calories. Now, that being said, it's no surprise here that even when BMR man eats fewer calories than are in his metabolic rate that he gains muscle. And this is a very, very strange adaptation that's been observed in science that kind of flies in the face of thermodynamics, that you can actually gain muscle when you're not eating enough calories. They have observed people to gain muscle on as low as 800 calories a day while lifting weights. So it's very, very interesting. You can lose fat and gain muscle while on a very, very low calorie diet. Again, you're going to risk metabolic damage if you go about trying to do that for too long a period of time. But, but it's no surprise there. And there's not a very good scientific explanation for it. However, my general recommendations to folks when it comes to if you know your basal metabolic rate and you want to figure out how many calories you should eat is, I don't recommend that you eat anything fewer than 1,000 calories underneath your metabolic rate for more than a consecutive week or seven consecutive days. Okay, so what I mean by that is, for example, I've had my metabolic rate tested in a physiology lab. I burn about 3,200 calories a day sitting around doing nothing at all. So I will never let myself go longer than a week eating fewer than 2,200 calories a day. If I go longer than that, then I find I get very sluggish, I start to get really grumpy. You're going to find that in literature if you do that for 30 consecutive days. Yeah, you're going to down regulate your metabolic rate. But I've noted that in myself and in my clients, even going longer than a week without some kind of a refeed day or some kind of a day, that in my case gets me up to at least that 3200 calorie range is necessary. So that's basically how you go about doing that. I just find that going with that calorie cycling 5 to 6 days eating, if you're trying to lose weight 5 to 6 days. Eating at least no less than 1000 calories underneath your basal metabolic rate and then having 1 to 2 days during the week where you're eating at least as many calories as are in your basal metabolic rate works really well. Hopefully that wasn't too confusing. But did that make sense, Brock?

Totally. Yeah. I'm still sort of baffled about the whole being able to gain muscle while losing weight. If you're cutting back, that's a very cool adaptation. It's not one of those. It's one of those surprising things that the body just does.

Yeah, yeah. There's likely something going on there in terms of remobilization of storage fat and some type of physiological adaptation that's allowing you to somehow build muscle in the presence of inadequate amino acids. They're coming from somewhere. Probably you're eating in your left lung or something. I don't know.

Our bodies were made somehow to survive. Okay, I feel terrible. This, this next question, I listened again and again and again, and I could not figure out what the name of this person is. I think it's Ty or Taig. Did you get it, Ben?

Let's go with Tig.

Yeah, I like it. I think Tig is an awesome name.

Cool.

Good morning, Ben and Brock. My name is Tig, calling from Calama, Washington. I'm looking for some information on Infinite Nutrition. They run a program you may or may not be familiar with. You can make your own mixtures with protein without protein for a bike mix and a run mix. Looking for fueling for half iron and full iron distance races and kind of in the concept of keeping it simple. Seems like a good way to go and a way to custom build a mix that will work for your nutritional needs and tastes, desires, all that stuff. Anyway, if you could provide some feedback on Infinite Nutrition and how that would work for feeding on an iron distance race, I'd appreciate it. Thank you very much. Enjoy the podcast.

All right, Infinite Nutrition, are you familiar with this product?

Oh, yeah, I've used it before. Really? I've used just about every nutritional product. I got a question on the Inner Circle recently on the forum. You know, someone was asking me, it wasn't about Infinite, it was about something else. You know, kind of like, how do I, you know, why don't I use this particular product? And for me, it's one of those deals where I've used everything and everything works for me. And, you know, for me, if it ain't broke, I don't fix it. And, you know, for me, for Something like competition gels work really well. I know that every race is going to have them. I can find them anywhere on the planet. And I don't have to carry a bunch of Ziploc bags and bags full of special powders and mixes with me. So that's what I use, and it works for me. And, you know, in many cases, there's more than one way to skin a cat when it comes to, you know, what you're eating to support something like a marathon or a triathlon or something like that. But Infinite is pretty cool because you go to their website and you've got these sliders. So there are. I'm pulling it up right now, actually, so I can do this live. Live radio. We've got 1, 2, 3, 4, 5, 6, 7 sliders at our website. And when I say slider, what I mean is there's this, this slider underneath each category that allows you to choose low or high. And the categories are flavor, carbohydrate blend, calories electrolyte blend, protein, amino acid blend, and caffeine. So you can combine all that to figure out exactly how many calories you want in your. In your custom formulation, how much sodium you want, how much protein you want, what carbohydrate blends you want, and just a few little things to think about. First of all, for flavoring, I'm just going to go from the top down. For flavor. All that means is basically what it tastes like, the sweetness. And Infinite in particular uses sucrose as its flavoring, which is a very small sugar. We talked about it in the interview with Stacy Sims here on the podcast Quickly Absorbed. I generally, when I can choose the flavor of something that I will be eating during exercise, I go with as low a flavor profile as possible, because flavors are always just something extra that typically introduce either extra sugars or some type of extra sweetener into a compound. And I generally just don't even like to mess with that. So I go with as low a flavor as possible. So if I were going to make like a custom blend for my exercise sessions, I would have the flavor blend, like, on the very, very low end. Now, for carbohydrates, Infinite uses two different forms of carbohydrates. You get to choose between dextrose, which is a really, really simple sugar, or maltodextrin, which is kind of like a long chain bunch of glucose molecules stuck together. So dextrose is just like two glucose molecules, and maltodextrin is like 10 plus. So one's a big Chain one's a small chain. The advantage to the small chain is it burns quickly, quick energy source, and it doesn't produce a lot of heat on its oxidation and it's maximally absorbed. The advantage of the bigger chain, carbohydrate is that you can mix in a higher concentration. You can sometimes consume more calories from it per hour. But if you're trying to exercise really fast, like whatever, a 10k or a sprint triathlon or something like that, you could limit yourself because it's got a higher heat of oxidation and it attracts or can attract a little bit more water and stuff like that into the gut, specifically, like into the colon after hours and hours of exercise. So, you know, it's one of those things where you want to be careful with. When I can choose, I like to go a little bit more towards the simple sugar side. So for me, if I were going to choose like a carbohydrate blend for most of my activities, I would choose, you know, since anytime I'm fueling, I'm out there for longer than two hours, typically I would choose something that's kind of like 25% dextrose, 75% maltodextrin. Ish. They've got an electrolyte blend on there. You know, we've interviewed Tim Nokes on the podcast before. We've come to the conclusion that electrolytes really aren't necessary unless you're out there hammering for three or four days. So electrolyte blend, it's kind of like, you know, the electrolyte blends that they've chosen, you know, they've got like, magnesium gluconate and calcium gluconate and sodium chloride and potassium chloride. None of these are going to hurt you. It's just a matter of whether or not they're actually necessary. I would tend to move those more towards kind of the lower end of the profile, just because the more electrolytes you consume during exercise, the more you're going to lose because consumption drives loss. Were you going to say something? Yeah.

Stacy Sims mentioned something about taking, like, if your stomach is starting to turn or if you feel like you. You might have a problem with your stomach to take. Take Tums, like peppermint Tums. Now, the calcium blend, would that help at all with that sort of situation.

Like calcium carbonate kind of coating the stomach in the same way that Tums would? Yeah, yeah. Technically, that's not the reason that they have it in there. And I'm not sure how the amount. If you were to put that electrolyte blend slider all the way to the right, it's going to be super salty. You may get some extra calcium kind of coating your stomach if you tend to get GI distress. But why not keep it low and just grab some peppermint tums and have those available in case your stomach flips. Good point. You got to remember too that a lot of electrolytes can have a constipative effect. So be careful with that too. That's why a lot of times the day after an ironman, you can't poo protein. They've got two different options. They've got a whey protein that you can use and then they've also got an amino acid blend of branched chain amino acids. Now because whey protein has to be broken down and digested, I would have the protein slider for actual whey protein all the way down like far to the left. But for the amino acid blend, which means that the protein's kind of already been pre digested and it's very, very available for metabolism. I would actually be dragging that farther to the right. So I would have like a lower whey protein content but a higher amino acid blend content. And then the last option is caffeine. You know, that kind of depends if you're going to be out there a long time. I would have caffeine lower because the cumulative effect of caffeine for anybody who's used like a caffeine containing supplement and been out there competing for 4, 6, 8, 10 hours, you start to get a little batty when you've been taking in caffeine for that long. If you're doing more than right around 50 milligrams per hour or about what you'd find in like one gel. So kind of depends if it's going to be something super short that you're making this custom blend for. I'd drag that caffeine slider all the way up if it's anything two hours or less. Otherwise I'd keep it fairly conservative and moderate. So. So yeah, I mean, kind of, kind of fun. I've, you know, I've coached people who've used Infinite. I've used it before. I've got no issues with it. I'm not sponsored by them or anything like that. The sliders are kind of cool if you want to mess around with it and make your own custom formulation. But, well, we'll link to it in the show notes, you can check it out.

Sounds really cool. I might have to give that a try. Although I'M like you. I just sort of stick with the gels and water and occasionally some of the gummies. Just because it's easy. It's easy to carry. You can take it on the plane.

Yep, simple and easy.

Okay, our next question comes from Joe.

Hey, Ben, Rob. This is Joe again. Just giving you guys a call back. Now, I recently just participated in the Philadelphia tri, but about a month and a half ago, I was diagnosed with patellar tendonitis in both knees. My doctor put me on a regimen of just doing a lot of high cadence work with running and biking, so being in a very, very low gear whenever I can. And then also I'm wearing nitroglycerin strips on my knees, typically for heart patients that are cut in half. And I'm putting them both right on the talat tendonitis spot. Other than that, I've been doing some random little stretching here and there, but I wasn't sure if there was anything else that I could be doing to help get this moving along. I still have three more races left in the season, and I would like to be able to bend down and pick things up without being in pain. Thank you and hope you guys have a good one.

Bye.

Okay, Joe again, like, I had problems with Tige's first name. I also, I listened to the itis that's happening in your knee a bazillion times and wasn't able to sort it out. So it's inflammation in the knees.

Patellar tendonitis.

Is that what it was?

Pretty sure that's what he said.

Yeah, probably.

Yeah.

So that's runner's knee.

Yeah, basically. And, you know, I had horrible patellar tendonitis. I couldn't run for, like, nine months. Really, like, could not jog, not spread. This was before I was doing triathlon, too, so I didn't care that much. You know, the longest I'd ever run at a time was like a mile. But it was back when I was playing, playing a lot of volleyball and water polo. Volleyball really was my big thing. Like, my sophomore and junior year at University of Idaho, I played middle for our men's volleyball team. I taught the sand volleyball class. I would literally, like, just be out either out at Lake Coeur d' Alene on the beach out there, or like out at the sand volleyball courts, you know, down in Moscow, Idaho. I'd be out there for two or three hours a day just playing volleyball, and as you can imagine, got pretty dang strong hamstrings and glutes from all that. That Jumping. And, you know, at the same time, I was doing some bodybuilding, so I was doing a lot of. A lot of squats, a lot of deadlifts, stuff like that. And you were totally the guy who.

Kicked sand in my face at the beach, weren't you?

Yeah, wearing my Speedo. Totally. But, you know, what happened was I got this hamstring quad ratio that was just out of sight. Super tight, strong hamstrings and quads that were. That were not quite up to par compared to the hamstrings. And what happened was I got basically maltracking of my patella, my kneecap, because you get to the point where the hamstring muscles are pulling back on that thing really hard. And your quad muscles, specifically one part of your quad muscle called your VMO or your vastus medialis, is not stabilizing that patella properly. And so what happens is your kneecap slides all over the place in the femoral groove. It causes a bunch of pain, and at the same time that it's sliding all over the place, it's also pulled slightly posterior, almost like into the joint. So you get kind of like this pain in the back of the joint in the back of the patella as well. It's called chondromalacia patella or kind of this wearing in the kneecap. And for me, I was just super confused. I'm like, I'm this big, strong boy. You know, I got these strapping legs. I, you know, I'm healthy. Why. Why do I have knee pain? And it got to the point where it was. It was like debilitating. You know, it got. I. All of a sudden I couldn't squat, I couldn't jump. I had to quit playing volleyball. I couldn't run around. And I was really, really stressed out about it. And I went in and I saw an orthopedic surgeon, and I kind of thought I was going to have to get my knees cut on or something. And I got an X ray. And finally he takes me into his office and he just does some simple functional tests with me on the table. And he's like, dude, your quads are extremely weak and your hamstrings are extremely tight, strong and inflexible. And so from the time I walked out of his office, my goal in life was to get my quads strong and my hamstrings more flexible. I'm one of those all or nothing type of guys. So what I did was I started doing a bunch of primarily PNF stretching for my hamstrings where I would lie on the ground and I would pull one leg up and stretch it, and then I would contract down against my hand really hard for like six seconds and then stretch that hamstring again. And that form of stretching takes advantage of the fact that after you contract a muscle in that window of time, that short window of time after a contraction, the muscle relaxes more than it normally would and you can pull it even deeper into a stretch. You can do that yourself or you can do it with a partner, but it's called proprioceptive neuromuscular facilitation, or PNF stretching. Did a ton of PNF stretching for the hammy, as well as a lot of foam rolling on the back of the leg and in the hamstring. Then simultaneously, I did a ton of quad strengthening. I started off by simply doing seated straight leg raises, where I would just sit down on the ground with my legs outstretched in front of me, turn my toes slightly out so that I would use more of that inner quad muscle, which happens when you turn your toe slightly out. And I would just raise one leg like a hundred times, then raise the other leg 100 times and just do this until my quads were just burning, but keeping them straight. After that, I progressed to doing that same type of motion, but at the gym with first an elastic band attached to my ankle and then a cable attached to my ankle. So I was just gradually getting my. My quad stronger and stronger. I progressed from there to leg extensions, which I didn't do early on because that bending and extending of the leg actually hurt. But once my quads started to get stronger, I started doing the seated leg extensions again, kind of slow and controlled with the toe Turned out it's a seated leg extension machine along with uphill walking on a treadmill, where I would focus on kind of having my toes turned slightly out and really, really think about my quads contracting as I would walk up that hill on the treadmill and literally just walking until the quads were fatigued up the treadmill for 15, 20 minutes on a pretty steep incline. It took me about from the time that I couldn't run and couldn't do anything. It was about a good three to four months of really focused hamstring stretching and quad strengthening to get myself to the point where I was pain free. But since that time, I've never, ever struggled with anything related to pain on the front of the knee. Patellar tendonitis, chondromalacia patella, any of that stuff. And it was all Just straight up quad strengthening and hamstring stretching. So, you know, more so than wearing like these nitroglycerin strips on your knees or doing like high cadence, low resistance workouts. I would be strengthening the quads and stretching the hamstrings. And I mean, you can find out if that VMO muscle on your quads is weak. Like, you could sit with your legs stretched out in front of you. And if you want to put like a little rolled towel up underneath your legs so that your knees are slightly bent, put your finger the area of your quadriceps where your VMO would be, little teardrop muscle that's kind of supposed to be above your knee. But in a lot of people with this type of pain, it's just not there. And then what you do is you push your knee down into the towel. Okay. So you're basically like straightening your leg to almost like contract it. And when you do that, you should feel, feel a pretty strong contraction of this muscle. You should feel like that muscle kind of bulges underneath your fingers. If it doesn't, then you've got some issues and you need to strengthen your vmo. And I can almost guarantee, you know, if you've got patellar tendonitis, you've probably got VMO issues. So, you know, that's my story. That's what I did. It worked really well and that's where I'd start.

Sounds good. It also sounds remarkably similar to everything that we did in ballet school.

Yes, I would have made a good ballerina.

You would have. Okay, our next question comes from Steve.

Hi, Ben and Brock, this is Steve and I want to say great show. Thanks for all the hard work you guys are doing. Congrats on episode 200. Here's my question. I'm an active 40 year old triathlete. I enjoy about the half iron distance as my limit and I've been dealing with hip and deep glute pain for about a year. It hurts in general, does not hurt me more to swim, cycle or run, although it tends to flare up during after running and also first thing in the morning and after long periods of sitting. The pain moves around the region, varies in intensity and also varies in what it feels like. Some days it's just tight, other days it's still pain and other days it's very short, sharp pains. I've had an X ray, did not show any impingements or anything out of place. Had an MRI which did not reveal anything except that my injured left side, the piriformis muscle, is much larger. Than on my uninjured side. Had physical assessments, and they show nothing to pinpoint the pain, except that I have a very weak glute med on the injured side. So on the injured side, I have a large piriformis and a weak glute mead. I've had cortisone injections, which provided me no relief, and I'm just at a loss for what to do next. Alternative therapies, Prolozone, acupuncture, strengthening the weakness or get my results. MRIs, X rays in front of more sets of eyes. Any advice you have would be great so I can get rid of this liberal pain in the ass. Thanks, guys. Keep it up. Bye.

We've got a lot of injured collars.

Yes, I can totally. Steve, I feel your pain. This is something that I struggle with and, well, I shouldn't say struggle with. If I let my guard down, then I struggle with it. Otherwise, it's pretty easy to keep under control.

Yeah. And the way that Steve describes this frustrating issue is like class pure syndrome and piriformis syndrome. Sometimes it's sharp, sometimes it's dull. You feel it after you've been sitting for a long period of time with your hips flexed. You feel it when you've been running or biking with your hips flexed. It comes, it goes away. Classic piriformis syndrome. I'm not a doctor. This podcast is not for medical advice. But, I mean, this sounds very, very similar to piriformis, and that's. That's where I'd be coming at. And, yeah, cortisone injections are not going to fix this. Those are just a band aid. And the big piriformis that was noted, what would be called hypertrophy in your piriformis. Weak glute Mead on the injured side. All of that really points pretty clearly to piriformis pathology. So the idea here is that what piriformis syndrome is, is that happens when this nerve, called your sciatic nerve nerve, is compressed by the actual piriformis muscle, which you've noted has gotten bigger. And when that happens, you get pain, you get tingling, you get numbness in your butt, down your lower thigh, along your leg. And it's frustrating, especially if you're active, and even more so if you do chronic repetitive motion activities like running and cycling. So the sciatic nerve gets compressed by this piriformis that has somehow gotten too large. But, of course, what you have to look at is how the piriformis got hypertrophied in the first place. Anytime a muscle gets bigger, or hypertrophies, specifically a muscle that puts compression on a nerve like that, it means that muscle's not. It's not supposed to be overworking. It's not supposed to be performing this extra role that it wasn't designed to do. But the piriformis will have to do that if for some reason your glutes are not performing the action that they are supposed to do. Okay, so what happens is when your glutes get inactivated, your glutes get weak, your glutes aren't working properly. A lot of the, what are called the synergists to the glutes, the muscles that help the glutes out, this would specifically be your adductor muscles on the inside of your thigh, and then also your piriformis. Those all have to do extra work. Now, why would your glutes be weak? Why would your glutes be inactive? Well, what typically causes weak glutes or inactive glutes is what's called reciprocal inhibition. Okay. Reciprocal inhibition occurs when your hip flexors are too tight. When your hip flexors are overactive, that turns off your glutes. And then you get this vicious cycle where you've got inactive glutes from basically tight and overactive hip flexors. And when those inactive glutes are not working properly, the piriformis and the adductors have to overwork. Okay. That's how piriformis syndrome actually occurs. So how can you fix it? Basically, you start off by going after the root of the issue, which is not weak glutes. That's not the root of the issue. The root of the issue is that the glutes aren't turning on in the first place because the hip flexors are tight. So you need to start off by doing a lot of hip flexor stretching. You can do lunging hip flexor stretch. We talked about hip flexor stretches on the podcast. Was it number 200, Brock?

Yeah, that was last week.

Last week, listening to episode number 200 and follow my rule, I never sit for longer than an hour without standing up and doing some type of a lunging hip flexor exercise. So especially if you work at a computer, that's very, very important. It's also very important if you are running, cycling, engaging in any type of forward moving activity that doesn't involve a lot of lateral stretching or lateral movement that you be stretching specifically, like lunging, type of heat hip opener stretches specifically after you've finished that activity. So you're essentially you know, hip flexion is that decrease in angle between your thigh and your abdomen. You know, that would occur for example, when you're sitting. Just never let yourself be in that angle for extended periods of time. And if you ever are really, really need to stretch before or you do anything like running or cycling or anything that's going to require those glutes to be working. Because if those hip flexors are tight and the glutes aren't working, the piriformis and the adductors have to overwork. So step one is you stretch out the hip flexors to dig yourself out of this hole. Yes, you absolutely have to get your glutes stronger. That's going to involve a lot of lateral rotation exercises. And I will put a link in the show notes for you. It's going to be the same link that I put out last week when we talked about a little bit about like external rotator exercises and it band. I'm going to put a link to a PDF in the show notes for you for this episode, episode number 201. And I'd start doing those glute and external rotator type of exercises literally like every 48, 72 hours. Finally, your adductors and your piriformis are going to be be in this state of spasm. They're going to be, you know, in your piriformis specifically you got a little bit of hypertrophy going on. You need to stretch those babies. I will put a link to one of my favorite piriformis stretches. It's called a seated hip internal rotator stretch. Basically you just, you're basically sitting in a cross legged position as you're pushing one knee down. It's a good stretch for the piriformis. There are other stretches you can do for your adductors, for the inside your legs, for your piriformis. But that seated hip internal rotator stretch really hits the piriformis pretty nicely. And I like that one. So start into all that stuff and that's what I would do. The last thing you may want to consider is that if you're a runner, when your foot strikes the ground, if you're over pronating, if you're turning your shoe too much towards the toe side as your foot lands, that can cause your knee to turn medially or to turn to the inside and that can also over activate your piriformis muscle. So another thing you may want to look into is foot strengthening and possibly like an overpronation type of orthotic like A super feet or a custom orthotic or some. It used to be that I would always tell people, get the super feet, get the overpronation orthotic, get a more built up shoe. Now I'm more cautious to make sure that I mention that, you know, you want to go after the root of the problem of overpronation, which is more often than not just like weak foot muscles, weak ankle stabilizers. And so whereas you do want to be careful with overpronation, I would be doing a little bit of barefoot work. You know, even if it starts off with just like, you know, if you work at a computer trying to get a standing workstation like Brock is using now and you know, standing up in your bare feet or in some Vibrams. But I'm kind of leaning now more towards because I am myself an overpronator and I only wear minimalist shoes or bare feet now. And I'm leaning more towards the idea of using minimalist shoes and strengthening the feet versus kind of covering up the problem with band aids and using like a custom orthotic or an overpronation orthotic for something like that. But that can also be an issue with piriformis syndrome for sure.

Yeah, I'm with you on the foot strengthening. It took me probably two, maybe three years to go from somebody who had to shop very specifically for a very specific shoe in order to, to run without any pain. And I just slowly started working on the strength of my foot, started wearing Vibram, started wearing like sandals more often. Like today I'm, I'm wearing my Birkenstocks and I, I think I've been wearing my Birkenstocks straight for like two months now. And even when I'm at the office I'll kick my shoes off and just walk around barefoot. And now I can actually, I feel like I could run in like a cardboard box on each foot and not have any problems.

Yeah. And you know you've got the Vibram shoes that look like frickin monkey shoes. Nike Freeze are okay. But I want to give a big shout out right now to us to Skora running down in Portland. I've been wearing those shoes and they are, they're just sick. They're awesome looking shoes. They look like Italian designer shoes. They, they look great. I'll be racing with them in Spain. I'm sure the Europeans will love them. But it's a company called Skora out of, out of Portland. I think it's S K O R a sweet shoe and it's It's a minimalist shoe, and I'm, I'm digging it. So that's a good one.

Is that from Portland, Oregon or Maine?

Oregon. Yeah. Cool.

I want to check those out. All right, that is it for the audio questions. So now we move on to having to hear my, my dulcet tones. This question comes from Lisa, and Lisa said she just wanted some clarification on the yogurt versus ice cream question from episode 200. In response to this question, Ben suggested that yogurt and dairy in general was something to avoid given its insulinogenic effects. She goes on to talk about how she took dairy out of her diet for a little while, but then after seeing it in your. Your superhuman food pyramid, she introduced it back in. And now she's just confused because when she heard this recommendation for yogurt rescinded on the podcast last week, it was a little bit confusing. She wants to know, should it not be part of the base of the superhuman food pyramid, or am I missing something?

Think of it this way. And my response to this question won't be super long because we did talk about yogurt quite a bit last week. Yogurt, milk, ice cream, any type of dairy food is pro growth. So use it in a pro growth state. Use it post workout, use it early morning, and those would really be the two times of day that you would use something like yogurt. I love it for its good bacteria, like a raw, unpasteurized yogurt. I even like that for its gut healing effects. I like yogurt as a rebuilding food for muscle repair and recovery. But if yogurt is your snack food while you're sitting around watching TV or you're sitting at your office digging into some Dannon, that's a pretty good way to introduce a lot of insulin like growth factor and this strong insulinogenic effect into your body. And that can do things like cause weight gain. So just remember that dairy is one of those things that mentally you want to kind of categorize as like your recovery food or your pro growth food. In the two times a day that that something like that would be most appropriate would be post workout or in the morning when you first woken up, you know, it's breakfast, you're getting your body ready for the day and you're putting some nutrients into it, that would be the time to use yogurt. So, you know, anytime you've got foods that I recommend, for example on the superhuman food pyramid, there are definitely considerations when it comes into when and why to eat the foods that I recommend. I'm currently writing a system series of articles that go into why I put the foods that I put on the superhuman food pyramid, where I put them in the eat category, the moderate category, or the avoid category. And I'll certainly be sending out some links to those articles when they're ready. In the meantime, if you're listening in and you want to get the superhuman food pyramid, if you're in the U.S. just text the word fitness. Text the word Fitness to 411, 247. Or you could go to BenGreenfieldFitness.com and there's a link there on the right side of the page.

Cool. I guess I should stop eating so much yogurt right before bed.

Yeah, I mean, you know, if you got choose between that or ice cream, you know, go for the yogurt. But I, you know, it kind of depends too. Like, you know, for me, I do a lot of early evening, sometimes even later evening workouts and in case, like me too for bed. And that's great. It's going to help you with repair and recovery. So it all depends.

Makes sense. All right, let's move on to Jacob's question. Jacob says, I'd like to ask you about a diet as a way to lower creatinine levels in my blood. I have since 11 years of age had a kidney inflammation called. I'm not even going to try that. Igonephrite, perhaps Iga nephrite. I have been a swimmer since I was six years old. And now at 44 years of age, I'm into triathlon. Since I train about 12 to 15 hours a week and follow a paleo diet for athletes from Joe Friel to about the 80:20 rule, the relative amount of protein in my diet has increased. So my question is really, what can I do naturally to lower my creatinine in order to help my kidneys?

Well, let me start by saying that I very, very, very rarely see an active individual get their blood levels of creatinine tested and have those levels be low. Creatinine is a byproduct of creatine breakdown. And it doesn't matter whether or not you're supplementing with creatine. You'll certainly have a higher amount of creatinine in your bloodstream if you are supplementing with creatine. But whether or not you're supplementing with creatine, you're going to see a fairly high concentration of creatinine plasma and in the urine of active Individuals. Normally, that elevated creatinine can indicate that what's called your glomerular filtration rate in your kidneys is low. And when kidney filtration rate is low, it can be a hint that there are issues going on with the kidneys. But in active individuals, more often than not, the elevated creatinine is simply due to breakdown of muscle or the type of damage that occurs when you exercise. So that's something to bear in mind. A better number to look at, really want to know whether or not the kidneys are doing an adequate job, is to look at a measurement called the bun, which stands for blood urea nitrogen and blood urea nitrogen. You're still going to see that elevated a little bit, especially in athletes, and even more so in athletes who are eating a higher protein diet. But that elevated, along with creatinine being elevated can be an issue. There's one measurement that you're going to see on some tests that's basically a creatinine to blood urea nitrogen ratio. And if that ratio is really, really low and blood urea nitrogen is high, especially compared to creatinine, that's typically more of a red flag than like really high creatinine levels. Because I've had a lot of athletes who've gotten their blood tested and who have asked me about their, you know, why their creatinine levels are so high in their blood. And a lot of times it's just that's. It goes kind of like elevated liver enzymes that you see. Same thing. You'll see elevated liver enzymes a lot of times in athletes and active individuals who are tested. And it just kind of goes with the territory of muscle and body breakdown. And in a sedentary population, it's a red flag. In an active population, a lot of times it's not. So blood urea nitrogen is one thing that can be tested. Creatinine is another thing that can be tested. I did mention there was something else, and that would be albumin. And if you get a blood test of albumin and you see that elevated in the urine along with elevated blood urea nitrogen and elevated creatinine, that can indicate that there's a lot of proteins getting pushed into a glomerular filtration and pushed into the urine, and kind of the threefold high albumin, high blood urea nitrogen, high creatinine altogether can be an issue. But high creatinine in and of itself I wouldn't be too worried about. And it's it's one of those things where if you're an active individual, you're probably going to have that going on anyways. If you have existing kidney problems, the deal with protein is basically that if you've got nice healthy kidneys, protein intake and a high protein intake is not going to be deleterious for the kidneys. If you've got kidneys that are having issues with filtration, and I'm not familiar with this kidney kidney issue that Jacob brought up, but regardless, in a problematic kidney, protein can aggravate the issues. Because a lot of times when the kidneys are not working properly, they're not excreting urea or nitrogenous waste products. And when those aren't getting excreted, we can get basically this neurotoxicity going on. And that can be an issue. So if you've got kidney issues, sometimes lowering protein can help. And that's where you can just substitute protein with higher amounts of fat, which is fine to do. I mean, you can get away with about 0.5 grams of protein per pound of body weight and still have enough protein on board to be in nitrogen balance. But in healthy individuals, it's not an issue. If you've got kidney issues, sometimes that excess protein can be an issue. What I want to point out here though is that for your kidneys, there are things that go way above and beyond protein in terms of their ability to be problematic for kidney function and their ability to damage a lot of the structures in your kidney. And a few of the things to be aware of when it comes to that. One would be advanced glycation end products. That happens when a sugar binds to a protein or a sugar binds to a fat. These are a lot of times the type of things you're going to find in foods that have been heated with a combination of sugar and fats. Baked goods, a lot of casseroles, a lot of like meats that have sweet barbecue sauces on them. Anytime you combine sugar, protein and heat, or sugar, fat and heat, that can have a real, real big propensity to produce these advanced glycation end products. And that would be one thing that you would want to avoid. So be careful with advanced glycation end products. Another thing to be really, really careful with would be inflammation. And specifically, one of the things that have been shown to be problematic for kidneys is fructose based inflammation. Have a piece of fruit here and there is not an issue. But if you've got a lot of fructose in your diet, what can Happen is there can be increased production of what's called MCP1, which is monocyte chemoattractic protein. And that can cause an elevated immune response that can result in inflammation that can damage some of the components of the kidneys. So I would be careful with, with high fructose. I would be careful with high consumption of heavily heated foods, especially if sugars are present. And then the last thing I would be careful with is gluten, which can also have an inflammatory effect. And there is some evidence that when it comes to glomerular filtration in the kidneys, that gluten and transglutaminase, as you would find in bread and pasta and starches and things of that nature, specifically in like modern wheat based bread products or processed wheat products that big as well. So I just as careful with that stuff as I would be with the protein. So those are some of the considerations when it comes to the kidneys. I realize I didn't address Jacob's specific kidney issue, this kidney inflammation issue that he talked about specifically. That's because I'm not a kidney diagnostic. But ultimately there are things that go above and beyond protein in the diet and creatinine in the urine that I'd worry about. And those are some of the things to take into consideration.

Awesome. There you go, Jacob. Okay, our next question comes from Gary. And Gary says my question relates to thyroid stimulating hormone. I had a blood test five months ago that came out high, 5.03 units per milliliter. I've seen it can be related to a lack of iodine in the diet. Unfortunately, I live in mainland Europe, southern Germany, where there is little iodine in the soil and hence locally grown fruit and especially root vegetables have very little iodine content. I repeated the blood test last week and I still have an elevated TSH. It's 4.37. Now my doctor suggested hormone treatment, but I would like to hear if there may be other options. Also, since elevated TSH can be related to lacking energy and reduced metabolism functions, do you consider it could be related to a series of issues I've recently been suffering such as over training symptoms?

Yes. Okay. So basically the, the question is, which comes first, the chicken or the egg when it comes to overTraining and high TSH? Because one of the things that TSH does is, or not that TSH does, but that the thyroid does is it helps to protect from gut inflammation. And so low activity of thyroid hormones can lead to increased gut inflammation, which can affect kind of plasma inflammation, which can increase propensity of tendons and ligaments to be weak and you get injured more and you have that overtraining effect. So that's one possible issue. But typically you see it going in the other direction when it comes to overtraining, hormonal depletion, and subsequent depletion of thyroid hormones. Basically, the idea here when it comes to, to TSH and the way that TSH actually works is just to understand basic thyroid physiology. You've got this little pea sized gland in your brain that's called your hypothalamus and that monitors how much thyroid hormone that you have circulating around in your body. Now, if thyroid hormone is low, as could happen if you were training a bunch, if you were just depleting your hormones, the hypothalamus is going to produce something called thyrotropin releasing hormone, or trh. Now what this TRH does is it acts on a part of your brain that's below your hypothalamus called your anterior pituitary. And that causes the pituitary to produce thyroid stimulating hormone, or tsh. And when we see high levels of tsh, sometimes it can mean that the pituitary gland is trying to send this message to your body to get more thyroid circulating, more thyroid hormone circulating. Because what TSH does is it acts on your thyroid gland. So your thyroid gland produces T4 and it produces T3, and those are your primary circulating thyroid hormones. So you've got TRH from the hypothalamus, which acts on the pituitary gland, which produces TSH, which acts on the thyroid glands to produce more T4 and more T3. Now, the thyroid gland is always going to produce a lot more T4 than it does T3. But what happens is that all of this T4 that's circulating in the bloodstream, it can get converted into the more biologically active form of thyroid hormone, T3 when it reaches different tissues and organs. Specifically, the place where T4 gets converted into T3 in the greatest amounts would be your liver and then to a limited extent also your gut and your muscles, your skeletal muscle. So those are all the places where the hormone conversion actually takes place. Now, as you can imagine, there are various areas where this whole cycle could get broken. There's an entire book that I'll link to in the show notes for you. It's called why aren't. What's it called? Why do I still have thyroid symptoms when my lab tests are normal? But in that book, there are multiple reasons that are gone into which is why? Maybe TSH would be high or T4 and T3 would be low. One would be your pituitary gland isn't functioning at all. And remember, your pituitary gland is kind of where the whole cascade starts in most people. That's not an issue. I mean, it can be an issue, but that's usually not as big of an issue in the general population. Instead, sometimes some of the other reasons that you can have increased TSH or low levels of circulating thyroid hormones, one would be that cortisol inhibits the conversion of T4 into T3. And this is why I said yes when he asked about whether overtraining could cause that high TSH and the low thyroid hormone. It's that inability to convert T4 to T3 that's caused by excess cortisol. Another thing that can happen is if you've got just basically like liver that isn't working really well, if you've used a lot of alcohol, a lot of pharmaceuticals, if you've never done something like a liver cleanse, again, that's the place where a lot of the T4 to T3 conversion takes place. And you can use things like milk thistle extract and calcium deglucarate and some of the same things that I've recommended to women to help their livers to metabolize estrogen more quickly. You could also use some of that same stuff to kind of support your liver a little bit when it comes to T4 to T3 conversion. Although I suspect that cortisol is probably a bigger issue than a weak liver when it comes to some of the other issues with low thyroid. A lot of times autoimmunity is a big, big issue. And your body actually attacking the thyroid gland or attacking the thyroid tissue, and that's typically due to inflammatory foods. You're living in Germany if you're doing a lot of bread and beer. Those are two things I'd consider cutting out and seeing how your TSH levels respond for sure. Just because anything that would increase autoimmune attack on the thyroid, specifically, like gluten containing foods, can be a big issue. And I know I've mentioned gluten twice on this podcast.

Now time to have a drink.

Getting a hint now. Finally, as far as the iodine part of this question goes, iodine deficiency certainly can be a fairly common cause of hypothyroidism. If you are taking an iodine supplement or you're getting iodine in salt and things of that nature, and you're eating stuff, seafood, a lot of times it's not an issue. And as a matter of fact, if you have hypothyroidism and you're taking in high, high amounts of iodine, that can actually increase the propensity for there to be an autoimmune reaction against thyroid tissue. And specifically because iodine reduces the activity of an enzyme called thyroid peroxidase and that's required for proper thyroid hormone production, if you take in too much iodine, you can increase the autoimmune attack on the thyroid. So be careful with iodine. One of the things that can protect you against iodine toxicity is selenium. And that would be something that you would find, for example, in fish, nuts and seeds have pretty decent content as well. I wouldn't be going out of your way to take an iodine supplement. I would be going out of your way to, to basically just eat decent amounts of fish and salt your food, limit cortisol production by engaging in a smart and healthy training program. And then be careful with gluten. And a lot of times in the average person who doesn't have a full blown hypothyroidism, Hashimoto's type of thing, those are some of the things that just basically support a healthy thyroid. So if you have been a heavy drinker, if you have had a lot of that German beer, you may want to consider a liver cleanse as well.

Sounds good. There you go, Gary. Hopefully that works for you. Okay, actually, it's our final question and actually not a moment too soon. The greenfields chocolate pudding that I had for breakfast is pretty much worn off at this point.

Nice. Well, I didn't have anything for breakfast, so it's a good time for me too.

All right, well, let's get this last question done then. It's from Anonymous.

I said I'll answer in my hypoglycemic funk from.

All right, the question is I have a friend who recently had lap band gastric bypass surgery, which I thought were two different procedures, but.

Okay.

Do you have any recommendations for what she should take in while on liquid, on the liquid only phase and then going forward?

Yeah. And let me start by saying that I'm not a huge, huge fan of lap band surgery, as you may have guessed. Although you are correct, Brock, it is a little bit different than gastric bypass surgery. Lap band surgery literally makes your stomach smaller. You essentially get this band wrapped around your stomach so you get decreased size of your stomach. The reason I'm not a big fan of it is there are a lot of complications. One would be that that band that they put on your stomach can slip and that can cause a blockage of your stomach outlet. It's called a stoma. And that can be fairly life threatening. Erosion can take place over time. And what that means is basically you get a lot of inflammation and irritation around the site where that band was placed, where the ports to your stomach is. And that can be just tough on the body from an overall inflammation perspective, which, you know, if you've listened to this podcast for any period of time, can have a pretty stark effect on full body systemic hormone function when you've got high levels of inflammation from something like an infection and irritated skin around your stomach. And then you can also get some issues with esophageal function, some gastroesophageal reflux, heartburn, a lot of issues in terms of difficulty swallowing and chest pain and even interference with your esophageal, your esophagus ability to deliver food and fluid to your stomach. So the interesting thing is that in obese people, most of them are highly recommended to lose up to 10% of their excess body weight before they're allowed to go in for this type of surgery. And so my whole head scratcher here is why, if you're able to lose 10% of body weight, why are you going in for a lap band surgery in the first place? Anyways, though, whole different discussion. To answer the actual question that Lisa asked. When you first get a lap band surgery, you gotta be really careful because certain foods are easily lodged in the stomach and can cause a lot of swelling and a lot of discomfort. That would include any fibrous foods. If you do have fiber containing foods, you got to very thoroughly chew them. And typically if you have vegetables, you have to cook them very well. You got to be careful with high fat foods, specifically sticky, high fat foods like peanut butter and any other nut butters like almond butter, any type of doughy type of thing like sticky rice or dumplings or anything of that nature, even dried fruit. Pretty much anything sticky can literally like lodge in that area and plug up the outlet to your stomach. You gotta be really careful with anything that's, that's tough or that's stringy, like beef jerky, or like, you know, if you're eating chicken, like the skin from the chicken or anything of that nature, that can be a big issue. And then the last thing you gotta be careful with is like bubbly beverages, like, you know, carbonated beverages and soda water and stuff like that. Those can also cause a lot of discomfort and the swelling from that gas in your tiny, tiny new stom stomach can be quite uncomfortable. So as far as ultimate, like eating for life, once you've had lap band surgery, once you've taken into consideration some of those recommendations that I just made, I mean, really, most of what I've seen is that the whole low carbohydrate approach that we've talked about on the show before and being really careful with starches and high amounts of fruit and fruit juices and processed sugars and things of that nature, and trying to limit carb intake to anywhere from 50, up to around 100 grams per day or like 200 to 400 calories per day. Eating some of the easily digested fats like coconut milk and avocado and stuff like that, combined with very moderate amounts of protein is a pretty decent way to see better results from lap band surgery compared to eating higher amounts of carbs and some of the more traditional, easily digested foods like juice and stuff like that. If you have a lot of trouble post lap band surgery, one thing that I've recommended quite a bit that works really, really well, that's like a complete meal replacement, I take it, when I'm traveling digest super easily would be any of the Living Fuel meal replacement stuff like Living Fuel, super greens, Living Fuel, super berry, Living protein. I love, love, love any of that stuff in terms of it being super easy to digest, super easy to transport, and full of everything you need. Digestive enzymes, probiotics, vitamins, minerals, nutrients, you name it. So that stuff's super cool. I've interviewed the guy that kind of formulated it on the show before any of the interviews with Casey Kreischy. It's called Living Fuel. But that stuff would come in pretty dang handy in terms of digestibility when it comes to something like lap band.

Fantastic. And that wraps up episode 201.

Wow. Cool. Well, of course, as usual, links to everything over in the show notes over@BenGreenfieldFitness.com if you're going to Spain, give me a shout out if you get a chance to see those Future of Health now videos. Check them out and then, yeah, I've.

Been downloading them each day when I get all the links, just putting them right onto my computer and keep them for watching later.

Yeah, so we'll put a link to that over@BenGreenfieldFitness.com in the show notes and then you've got a little adventure this weekend. Brock, you've got like half marathon to a sprint. Yeah.

In Rochester, New York. The yellow jacket running grouper or our fitness group is putting on. Well, first of all, my girlfriend just wanted to do the half marathon and I thought I'd go down and do the sprint triathlon. And then they had a special price if you signed up for both, so I decided to do both.

Nice. Nice. Brock's always throwing coaching challenges my way, so half marathon and a sprint triathlon sounds like a fun weekend. And I'm actually going to do a triathlon this weekend myself. So cool. Where at least tune up race. It's up in Colville, Washington. So it's called the Tiger Triathlon, a really tough, hot Olympic distance triathlon. So do that. And then this Saturday we'll release an interview with Doug McGuff on Super Slow training and a book called Body by Science. Pretty cool stuff. And we geek out on how strength training can give you a really good cardiovascular and aerobic effect. And then next week, because I will be in Spain, you can look forward to a special episode and it will either be a podcast from Spain, more special interview at least. We'll just have to surprise you with that. So yeah, I'll be surprised too. Brock will be surprised too, because we've been talking. So thanks for listening, folks. And again, check out everything over@BenGreenfieldFitness.com did you know you can get personalized nutrition and fitness consulting from Ben Greenfield? No matter who you are, if you want to run a triathlon, lose a few pounds, reinvent your diet, or have Ben create a training program or nutrition plan that's customized to you, here's what you need to do. Visit tinyurl.com helpfromben that's tinyurl.com help from Ben. Ben will personally contact you within 48 hours. What do you want waiting for? Visit tinyurl.com helpfromBen today and get the body and results you've always wanted.