The Life Of Physician & Pro Triathlete Tamsin Lewis

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Hey folks, it's Ben Greenfield. And I gotta admit, it's actually not very often that I get professional triathletes onto the Ben Greenfield Fitness Podcast. There's not really a specific reason for that. It's just that we have so many medical experts and nutritionists and fitness gurus coming on that there's only so much time left. But it just, just so happens that I was able to stumble across somebody that's kind of all those things wrapped into one. A physician, a professional triathlete, somebody who's a real expert in the realm of fitness and diet and just a wealth of knowledge. And we get the privilege of having her on today's podcast. Her name is Tamsen Lewis. And Tamsen, thanks for coming on the call today.

Happy to be here. Great to talk to you all. Hope I can impart some knowledge along the way.

Now you're right now getting ready to race like you're in France, right?

I'm actually post race. I raced in Alpe d' Hus triathlon yesterday.

How'd that go?

It went really well actually. It was sort of like a world class field. Rocked up with Caroline Steffen and Emma Jackson, ITU athletes and some other ITU athletes. So I actually ended up second after a strong bike ride. So I was pretty happy.

Wow, that's not bad at all.

That's not bad at all.

So folks, she backs it up. She's actually fast as well as knowledgeable. Who won that race?

Yeah, Emma Jackson, the Australian ITU athlete. I was a couple of minutes behind after not so wonderful swim in the freezing cold water here.

Still though, you look at like Carolyn Steffen, she was leading the race for most of Ironman World Championships last year, right? You beat her?

Yes. I mean, it's not really her type of race. It's literally up the mountain, so. Yeah, but you know, it's still nice to pass her on the bike.

Yeah, she is a big girl. What do they call her? Xena.

Yeah, Warrior prince.

So what's your story? How did you get involved in the sport of triathlon and then throw becoming a doctor and a professional triathlete into the mix?

It's Kind of like, I would say I stumbled upon it, but that wouldn't be quite true. I was a very sporty child. My dad was a professional cyclist, having competed in the Tour de France twice and national road race champion for Great Britain a few times. So I kind of grew up around that kind of sporting atmosphere. But my mum was very academic and sort of pushed me along the academic path. So I competed as a swimmer as a child up until the age of about 13 and then I did some running but nothing really to high level. And then I got into academia and kept fit, but nothing really extraordinary. And it wasn't until I was at medical school. I ran for the university a bit and I was pretty good but never really committed to any training. I was too busy studying or drinking, unfortunately. So it was after my first year as a houseman, I think you call it your resident year in the States. I was just fed up of feeling kind of unfit. I was working all hours God sends and then drinking at the weekend and my whole weekend was just spent in a blur. So a friend of mine who actually quite, you know, quite liked, you know, at the time, sort of like a boyfriend to be, as it were, got me into a triathlon. He was a keen triathlete and he said, come on time, you've got it, you've got to just do one. And after putting it off for two years, I just finally got on the start line, did a few hours training all week and did very well. I mean it's classic sort of story, you know, you rock up on a, on a half beaten up bike and you know, I did really well in my age group for somehow I don't know how. I think, I think what carried me through is the fact that I have that ability to push, you know, to push past limits and just kill myself in a race. So that's, that's how I got into it, the bug bit, as it were. And you know, as with triathlon, you can always improve on something. So that's what happened.

Has it helped you to be a doctor? Like have you relied on some of that knowledge that you picked up studying medicine to kind of like, you know, biohack your way into being a better triathlete or something like that?

I'd like to say yes, but it actually hindered me during my time with Team TBB and Brett Sutton, which I know we're going to talk about in a bit more detail, but because he's very sort of anti doctors and anti white coats and anti science, published science anyway, so we came to loggerheads and argued quite a lot about things. And he also says that some of the great athletes do, you know, switch their head off and just race. And I used to struggle to do that. Now I can do it a bit better. But I think in terms of now learning more about my nutrition, keeping on top of things, strength and conditioning, etc. Definitely my physiology knowledge and my nutrition knowledge has helped me, especially this season as I'm having a pretty good season, my best yet.

Yeah, I definitely want to dig into kind of like, you know, what you eat when you're out there racing and if you follow some kind of a special diet or anything like that. But first let's talk about Brett Sutton, because for people listening who don't know what he is, he's kind of a legendary coach in triathlon who's known for being extremely kind of like, kind of like hard to race for. Like, he throws out some pretty tough training programs, doesn't he?

Yes, and it was a baptism of fire for me because I literally won the world age group championships as an age grouper in Olympic distance and a mutual friend of Brett and mine put us in touch and he basically got me out to Thailand where they had a training base and gave me a two week trial and said, right, I'll take you on. Thinking, you know, probably slightly naively that I was going to be the next Chrissie because Chrissie Wellington, that is four time Ironman world champion because he thought we had similar physiology. It wasn't quite the case, but so I got on board with him then. But I couldn't agree with a lot of the physiology of his training. Half of it I thought was amazing, excellent, but the other half I couldn't see the point. But it's only in hindsight that I realized that a lot of it was just about mental toughness, just training for the sake of mental toughness. You know, just some crazy seven hour sessions that, you know, people used to do. And you've probably heard the story about running a marathon on a treadmill in a room no bigger than a bedroom, you know, a tiny box that's nuts.

And so what happened to your body when you trained in that environment? I mean, did you thrive or what exactly kind of fleshed out from that.

Some people do thrive in that environment and typically some people do thrive for a short period of time. I think why it didn't work for me, two reasons is that I came from a background of two years of Olympic distance racing. I hadn't done any form of strength and conditioning. And Brett classically does these long track sets of like 20 times 800 meters. Sort of like an extension of Yaso's 8 hundreds, but you know, 20 to 30 of them. And I got injured. I got a hamstring tendinopathy quite quickly because, you know, my glutes, my glute maximus and minimus wasn't working activating. I got the same injury as Chrissie Wellington got when she started training with him, which is classically because you weren't preconditioned for the, for the intensity and duration of the training. So that was one thing. And because he doesn't like typical physiology physiotherapists and scans. So he wouldn't let me get it scanned for a long time. And so it kind of progressed and became chronic and we kind of fell out a bit about that. So that was one reason. But you know, a lot of his sessions stick with me. Now I know I have to swim a lot. He taught me that as a non swimmer. A lot of his training is based on swimming. I mean they swim six days a week. A lot of volume and a lot of paddles pull buoy, a lot of strength work. And that definitely stayed with me. But he wanted me to race Ironman in the first six months of being with him and I'd only done one or two half Ironmans in that time and I wasn't ready mentally. And so we parted ways on good terms. And I should say that I met up with him here because he comes to Alpe d' Huez every year with the team TBB and we get on very well and have lots of exchanges. So it's always interesting to hear what he has to say because he has an amazing insight into the ironman world and WTC organization, etc.

Yeah. And you went from coach Brett Sutton over to a different kind of famous coach, Cliff English. A lot different in terms of the coaching experience and the kind of workouts that you did.

It was completely different. I should mention that my first coach in triathlon was Michelle Dillon. Have you heard of Michelle Dillon? She's an ex Olympian and she coached me as an age grouper and then I went to Breton. She recommended Cliff English to me actually because she didn't have the experience with longer distance racing. So Cliff is an incredible coach. He is very positive, incredible amount of energy and very different from Brett. And Brett tends to thrive on a lot of negative feedback and punishment almost, you know, and you find yourself. I felt like when I was with Brett that I was Almost going back to school that, you know, there's a very domineering relationship and a very submissive relationship. Whereas Cliff English is very much more open for discussion, for debate. You know, there's a lot of feedback going on. Whereas Brett, he famously said to me, if I want you to push a peanut with your nose on the running track, then you're going to effing do it. And I was like, okay. So that was his way of dealing with things. He'd. I found him impossible to work with because he'd say one thing and then do another. And there wasn't a lot of consistency in what he would say. But he dealt with athletes differently and that was my experience. I know it's not everyone's experience, but of every athlete you hear that does well with Brett, we don't hear about the ones that, you know, the eggs that get smashed along the side. And I think that's important to keep into perspective that he can overdo it sometimes. Cliff English is very much more quality based. What I found difficult with Cliff is that he was based remotely. I'd come from a situation with Brett where I was in a very close knit team environment, which was incredible in hindsight and as an experience I got to train along the likes of Stefan and Jody Swallow, James Kahnama, Dave Dello, etc. And built some very strong friendships. And then Cliff English works remotely. You know, most of my coaching was online. I only met him on a couple of occasions and that's why our relationship ended, because I needed something more hands on.

And now you're working with it with like a local hands on coach.

Yes, I was in Hawaii last year, not competing, but I was working in the medical tent in Kona, which is a fascinating experience. And I got to spend a week under the guidance of Darren Smith. I don't know if you've heard of him. D squad Darren.

Yeah, I think he and I are actually co presenting, I think at the Global Business Triathlon Conference in London.

Yes, he is a fascinating, fascinating person. And he coached Lisa Norton to the Olympic silver. And he coaches Jody Stimson Anhaug, the current Olympic distance ITU world champion. And he completely revamped my swim in Hawaii within a week. Changed me from a six beat kicker to a two beat kicker. Taught me how to use my forearms instead of just feeling the water with my hands. And he recommended my current coach who's called Tom Bennett, who lives local to me actually, because Tom had spent three weeks working with Darren and he thought we'd be a Good fit. And I was a bit hesitant because, you know, coming from Cliff and Brett and thinking, you know, I'm going to be working with an up and coming coach, but one with not much experience, but it hasn't proven out like that, you know, I mean, he's been. We have a great relationship.

Got it, Got it. All right, well, cool. Let's dig into the stuff that you're really an expert in, Tamsen. And I would say that, you know, as a doctor, you probably have a unique perspect on kind of like the rigors of training for triathlon, especially at the professional level. For you, what kind of health issues have you personally had to deal with or maybe have you witnessed going on around you in the community of athletes who are just like exercising and exercising a lot, and what have you learned in the process? And I realize it's a loaded question and there's probably a lot of little things, but what are some of the major things that you think we should hit on?

I think I'll try and keep it quite succinct, but the two main things splitting into men and women, because I get asked a lot of questions from a variety of athletes online. In terms of female athletes, I think it's very important to keep on top of nutrition. People get obsessed with weight and being as lean as they can because they think it's going to help their run. But actually strength, endurance wins out every time in a race. It's a strong athlete that gets to the finish line. So the one key thing, and I know you talk a lot about it then, is keeping on top of your iron stores. Many, many, many athletes, including myself, run low iron Ferritin stores the whole time. And I know for me, I was running along at about 10 last year and when I met you in Thailand, when I came back, I was down at like. And my GP's. Like, we really need to get this sorted and you feel like you're kind of running through mud. You just can't explain it. You just feel this general fatigue. Your recovery is impacted hugely. For me, it affects me mostly on the bike. I seem to lose strength. So from that I've learned that I need to stay on top of replacing my iron. And I didn't cope very well with the stronger iron supplements like ferrous sulfate. They upset my stomach. So I actually use what you recommend a lot, and that's Floradix. I take three times a day and that keeps me topped up and feeling good. And I think many women need to be tapping into their blood tests and keeping an eye on their ferritin levels and also their full blood count as well, because I do see anemias popping up with female athletes too. So that's the one thing that. The main thing that I've come across in terms of nutrition. I also think people, when they're getting too lean and undernourished, lose their periods, and again, that affects their. Can affect their bone density, etc. And I've come across some people with that problem.

Have you used medications or herbals or different foods to kind of try and mitigate some of those hormonal issues?

Well, for me, because I had a stress fracture last year, I got my bone density checked and thankfully that was all normal. But I started to take another thing that you like, which is colostrum. I use a supplement called neovite, which we have over here in the uk, which is bovine colostrum. And I think that contains what you say, lactoferrin. So there's some evidence that can help, you know, with the bones. So that's one thing. I also was on the pill for a long time, but probably for about 10 years. But one of the biggest changes, I think, in my performance and my recovery and strength has actually been to come off it, which happened in March this year. And I seem to have become a lot stronger and a lot more consistent in my performance since then. And I have read up and I've read what you've said about it and listen to your podcast on it. And I do think it's to do with B vitamin metabolism as well and the blocking of testosterone. So that has really benefited me. I didn't want to think it would, but it definitely has. So I would say to a lot of people, you know, if you are concerned about that, there are a ton of methods of contraception out there which don't all have to involve hormones. So do you know, question and ask your physician.

Gotcha. Gotcha now.

Sorry. While I was still on that with guys, one thing I have come across many through Brex athletes is, you know, a lot of guys become low on testosterone. So I think that's something that they, you know, need to keep an eye on, that do big hours. And also for guys, ferritin as well. I mean, it's an issue for men too. So I think that's two things that guys need to be aware of too.

Do you follow a specific diet yourself?

Do you know what? People ask me that because I do tend to lean this. I think that's because I'm blessed With good genetics for my dad. I'm very this year in particular and probably starting last year, I've become very much on top of my diet taking the colostrum. I also take magnesium citrate, which I know that you advise. I take spirulina. I choose greens all the time. I particularly have eaten more fat this year and probably much less. I've never been a big carb person anyway. Probably stems back to my When I experience an eating disorder in my teens, I've always tended towards lean proteins. But I used to be quite fat avoidant and that's something that I've changed up and I really think it boosts my immune system to eat more healthy fats. Nuts, seeds, avocados, hemp oils. I also use a supplement called Nordic oil, which is a high quality fish oil. So I'm very on top of it. You know, people would say it's obsessive but you know, I do a lot. I like chocolate. I love red wine and I know that's beneficial as well but you know, I, you know, I'm not a Nazi with it. You know, I will allow myself treat.

Yeah Unless you pay attention to the recent study on resveratrol and then you're going to die from red wine or at least not get any benefits from your exercise sessions. Right.

I haven't actually read that one. Maybe you should. I don't want to hear was a.

Study they did on I actually talked about it in a recent podcast on synthetic resveratrol supplementation. They gave These exercising men 250mg a day of resveratrol, which is a lot more than what you get in wine, but actually is what a lot of people are taking. And it blunted the response to exercise or simply resulted in a similar slightly lower response to exercise. And there were a bunch of kind of problems with the studies in addition to it being a synthetic nasty resveratrol pill. But yeah. Anyways, so there you go. Your red line might be holding you back.

I don't think so. I do swear by it for a number of reasons. But I think the whole thing about antioxidants and blunting the response to exercise I've been big on that. You know, I don't take a thousand milligrams of vitamin C anymore after reading some of the studies and you know, high dose anything to me apart from talking about fish oils and things like that. But selenium, any of the antioxidants I slightly wary of because, you know we need some inflammation in our muscles in order to adapt and strengthen and improve. And I don't know what your view is on that.

Yeah, my view is that most of the studies are done in people who do not need antioxidants to the level that the hard charging athlete actually needs them. So we really can't draw many correlations between like some, you know, 70 year old obese, sedentary individual and you know, an ironman triathlete. So I know I feel better when I take them and I get sick less so I take them and that's kind of where I stand on it right now. But speaking of beating your body up, you also, I assume do some strength training or have you been able to kind. You know, I know that especially for, you know, we just talked about like climbing hills and the Up d' huez triathlon and you know, body size and stuff like that. Do you kind of find that there's a balancing act between lifting weights and strength training and kind of not putting on too much muscle, especially for an endurance athlete?

Yes, I do. But a lot of athletes come into this sport with added bulk anyway. Perhaps not females, but guys definitely have it. You know, you yourself, you were an ex bodybuilder, strength weightlifter. So you know, it's hard for people to actually, you know, drop that muscle too into the more, you know, lean shape for triathlon. But on the other hand that gives you a good strength base in order to build on for the endurance sport. I didn't have a strength base so I suffered the consequences and got injured early on. And as a result of that, now do some strength training. I don't, I mean perhaps mostly every winter I'll do a lot of squats, I do a lot of bodywork stuff. I do a lot of one legged work, you know, working on proprioception, glute activation, etc. But I don't lift weights per se. I do a lot of specific work. Like I do a lot of hill climbing, big gear work on the bike, I do a lot of paddle work in the pool and running hill work similarly and working on my technique and efficiency.

Got it.

Yes.

So we haven't really touched on this too much. About your website, you have a website@sportydoc.com and we'll put a link to it in the show notes. But you have a blog there and you recently wrote a bit about heart damage and cardiovascular issues in triathletes and I know that you kind of have a stance on that. What are your feelings when it comes to how Our hearts specifically as endurance athletes are holding up under what we're doing.

Well, the studies that I highlighted in that blog, they were concerning and they were alarmist, you know, I mean they were basically showing that Ironman and repeated marathons were causing damage to the heart even though we all think it's very healthy thing to do. The repeated stress on the heart in some individuals was causing, you know, scarring of the heart tissue and a predisposition towards rhythmic changes in the heart which you know, can be quite dangerous. I think, I think the main take home point, and I've done a lot of reading and spoken to quite a few cardiologists about this, is that for the extremists, the people that end up in the medical tent every time they do an Ironman or a half ironman or a marathon, potentially causing themselves long term damage to their heart which we won't know about until they're sort of 50, 60 years of age. And that damage is irreparable at that stage. It's basically like having mini heart attacks in the heart. So I do think it's something we should be aware of, allowing adequate recovery and indeed preconditioning for an event, you know, turning up to eventually under trained, grossly under trained and getting yourself into a real state is obviously not going to be good for your heart because it is a muscle like any other muscle.

Are you concerned about yourself? Like do you ever wonder when you're out training or whatever, lying awake in bed at night or just kind of like living life, do you ever wonder about your own heart?

I'm very aware of it now, much more so than since I've been reading these studies. I monitor it with a similar system that you use and I do my morning heart rate, et cetera. And I have an appointment with a cardiologist later in this year to go through a whole battery of tests.

What tests are you going to do?

Well, I'm going to do a 48 hour ECG which is like a tracing of the hearts. I'll wear a monitor for 48 hours and go about my normal daily life and training to see if they pick up any arrhythmogenic changes, any beat differences in the heart. I'll also potentially for research purposes do a nuclear medicine scan which is where they inject a dye into the veins and they watch the heart beating. They give something a stress to increase the heart rate to see if there's any changes in the heart muscle. So I'll also do that some instances a cardiac MRI scan can pick up small calcium deposits in the heart. But these tests can show up false positives in some people, so they might be concerning us unnecessarily. I think the main thing is if you have a family history of heart disease, I think you should see your physician and go through a battery of tests, if there's any history of sudden death in the family, etc.

So do you think kind of like the gold standard is that nuclear scan?

I think my impression is, but I think you need to have different things. I think you need to get the hormones, the cardiac enzymes measured and they've done this in athletes, I don't know if, you know, after triathlons and they've found that they have very high levels of troponin, which is a cardiac hormone caused by damage to the heart muscle. So I think measuring the cardiac coal mains, doing a nuclear medicine stress test and the ECG monitoring of the heart would pick up most cardiac problems.

Interesting. It's something that you could probably. Can you get that covered by insurance over in the uk?

Possibly. I'm sure it would be difficult but if things, you know, if you had a. Yeah, it would, there would be difficulties, but it would be possible.

Interesting. Yeah, I know over here in the States that it'd be, it'd be tough. I think it's. It probably costs about a grand or so out of pocket to get one of those, one of those scans done. But yeah, it's something that I certainly think about quite a bit in terms of just wondering, you know, what, not only what my heart looks like, but the guys who are like 20 years older than me, you know, that I coach or, you know, who are out there competing alongside me in triathlons. I always just kind of wonder. It'd be nice if we just had some kind of like Star Trek Y handheld scanner that we could just, that we could just check with. Right.

It would like, you know, a portable echocardiogram, you know, like an ultrasound machine. But they're only as accurate as the people and the skill of the person that's using it. So perhaps in 10 years time we'll have something that's much more, you know, user friendly and we can biohack to the max.

Yeah, there we go. That's what I'm looking forward to. But you track your heart rate variability though, is that what you were saying?

I do. My coach keeps an eye on it as well. I'm very heart aware and sometimes I do get sort of a double beat, etc. And you know, I'm just aware of it. And I think that more and more people should be more aware of their heart. Not just, you know, just because they're in training zones, but when they're resting and. And what kind of things irritate the heart?

We talked about biohacking. The words come up a couple of times. I've recently been experimenting with tapping, which is kind of the process of tapping different meridians that are tied to Chinese medicine at various locations in your body. And I've been doing that while testing heart rate variability, and I've actually found that I can almost instantly increased my score by about five points just by tapping at specific spots using this Chinese technique of tapping at your meridian points. It's super interesting, but, yeah, I think we're just scratching the surface in terms of the different things that we can do to help our nervous system and our heart along.

Yeah, I think so. I mean, I know you use Sweet. Is that the system that you use?

Yeah, it's typically Sweet Beat. You know, I've experimented with some other stuff, like the Tinky and like the. Actually, I've used the Omegawave Bioforce. There's a bunch of them out there. Zumio has one as well. But I like Sweet Beat just because it gives you some interesting data on feedback from the different components of your nervous system, you know, so you can. You can dig in a little bit more.

Yeah. Talking about the parasympathetic and the sympathetic. I think just for a lot of people, just measuring their morning heart rate using that Azumio, it's a free instant heart rate app. I think that's a starting point for some people, isn't it?

Yeah, exactly. Their whole suite of apps is really good. I actually do some testing for their stuff, and they have a new one called an Argus that just came out. It's that fine line between always being tied down to technology and constantly tracking your body and just. Just unplugging and enjoying the fresh air and the wind through your hair. So it's, you know, it's one of those things where I'm iffy about constantly monitoring everything.

Yeah, I think that's very important to mention because I do think that triathletes in general are very highly strung, very dedicated individuals, and we do get too caught up in a lot of the data. And that's something that Brett Sutton picks me up on. You know, he says, throw your garment out of the window sometimes. Don't look at power. Just. Just feel and enjoy. Because if we're constantly stressing ourselves by having to stick to a training plan and to numbers, then, you know, it's stress.

It's stress and it's also decision fatigue. Like for me, if I look at a workout and It's a complex 60 minute bike workout versus just, you know, go out, ride some rolling hills and attack a few of them, that latter workout for me at the end of a workday is the one that I'll, that I'll end up doing versus decision fatigue and skipping the other workout because it's just too complex to think about when you're done with the day of work.

Yeah. Great. And I think that more and more people should think like that because instead of feeling like a failure if they don't do their prescribed FTP threshold sessions, just getting out there and doing some consistent work and enjoying it is much more beneficial.

Yeah, exactly. So you just got done with Alpe d', Huez, obviously. You did awesome there. What's next for you?

I'm going to be training out in France actually for a while and then I'm going to do the European Ironman 70.3 championships which is in Germany, beginning of August. So 10 days time.

Now, you and I met in Thailand and you're obviously a fan of that race, the whole Laguna Phuket's Triathlon festival. And I should mention to listeners you are going to be making kind of a special guest appearance at our Tanyapura camp, right?

Yeah, absolutely. I mean I went to Tanyapura when it was first opening a couple of years ago and I fell in love with the place. It is absolutely beautiful. The swimming facilities are incredible, the people are incredible, the food's incredible. So I love coming back to there. I mean there's something about Thailand and the race is fantastic. The organization's top notch. So yeah, I'm looking forward to coming back this year and doing both the races and talking to some of your athletes and campers.

Yeah. So if you want to do some medical Q and A with Tamzin, then you can get details on our Tanyapura camp over@pacificfit.net Thailand but check it out, she'll be there and we've got some other folks that we're lining up as well. So it's going to be a good time and Thailand is always a highlight of the year. Tamsen, I'm going to put a link to your website@sportydoc.com and also link to some of the resources that we talked about. But is there anything else you want to bring up or mention to the listeners? While I've got you on.

Well, I'm looking at setting up with a friend of mine who's a physician in the UK who also has a master's in sports medicine. We're looking at setting up a sporty doc consulting business where we're going to be doing some blood testing specifically for athletes, touching on the things that you already mentioned, ferritin and hormone profiles, etc. Because I get asked a lot of questions through social media related to that. And so that's something that should be quite exciting. But that's probably more for our UK athletes. But we'll also be going to doing some sports psychology alongside that, which a lot of it will be through Skype and online. So sporty doc consult and you can find out more about that on Twitter sportydoc.

Very cool. Well, I like your holistic approach and kind of balanced approach to this sport. And it's pretty rare to find a professional triathlete who's got a good head on their shoulders from the point of making sure that it's not just about beating up the body. So I appreciate what you're doing and the stuff that you write on your website and would encourage folks to go check it out over@sports sportydoc.com and we'll also link to that in the show notes. So, Tamsen, thanks for coming on the call today.

It's been great. Thanks a lot, Ben, for having me.

All right, folks, until next time, this is Ben Greenfield and Tamsen Lewis signing out from BenGreenfieldFitness.com visit BenGreenfieldFitness.com for even.

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