The Underground Test That Shows You How To Legally Upgrade Your EPO, Increase Your Oxygen Levels, Boost Your Red Blood Cells & Build Double-Digit Percentages In Power And Endurance.

In this episode of the Ben Greenfield.

Fitness show, when odd chain fatty acids are oxidised or used as fuel in the citric acid cycle. So this is inside of the mitochondria, inside of the cells, then these carbons get chopped off two by two.

Something we're seeing more and more of is hemochromatosis or iron overload. So the problem is almost in the other direction, where high levels of iron are then causing inflammation and could then also be preventing proper red blood cell production.

If you're deficient in B12, then you're not going to produce red blood cells as well as you should, and then you'll end up with less oxyge, less power threshold.

He's an expert in human performance and nutrition, voted America's top personal trainer and one of the globe's most influential people in health and fitness. His show provides you with everything you need to optimize physical and mental performance. He is Ben Greenfield.

Power, speed, mobility, balance, whatever it is for you, that's the natural movement. Get out there. When you look at all the studies done, studies that have shown the greatest efficacy.

All the information you need in one place right here, right now on the Ben Greenfield Fitness Podcast.

Hey, folks, it's Ben Greenfield here. And you might remember a guy named Christopher Kelly from the podcast episode that I did a while ago called the little known test that tells you everything you need to know about your metabolism. And in that particular episode we talked about this test called an organic acids test. Really interesting podcast. And I'll link to that in the show notes for this episode. And you can access the show notes for this episode over@BenGreenfieldFitness.com EPO that's BenGreenfieldFitness.com Epo but today, Chris is back along with a special guest named Dr. Tommy Wood. And the reason I've invited Chris back onto the show is because he recently wrote to me about some new methods that he's been using to identify how to increase epoxy legally, how to increase oxygen consumption, how to beat things like anemia, how to boost red blood cells, and how to get some pretty big increases, especially if you're an athlete in power and in endurance. And I'm always looking for insider tips on how to maximize my own athletic performance and help my clients out. So I figured it would be a good idea to have Chris back on the show to talk about these new, relatively less well known testing and treatment methods for things like oxygen utilization. So who is Chris? Well, Chris, if you didn't get A chance to meet him in the last podcast episode we had with him is a computer scientist. So he's a nerd. He's a pro mountain biker also. However, he's a certified functional diagnostic nutrition practitioner, and he's a graduate of the Kalisch Institute. I've talked about Dr. Johnson, Daniel Kalish before on this show and some of his really cool books and also his certification programs, and Chris has been through those. Chris is, as you will realize momentarily, British, but he actually lives in California now, and he runs the functional medicine practice there called Nourish, Balance, Thrive. And he also does quite a bit in the realm of adrenal fatigue as well. And as a matter of fact, I've had him on to talk about that too, about salivary hormone testing for adrenal fatigue. So, Chris, I was thinking it's twice that you've been on the show, but I guess this will be the third time. Third time you've been.

It is, yes. Thank you.

You fall into the three guests honorarium, but we've also got Dr. Tommy Wood on the show. Dr. Tommy is a medical doctor, graduated from Oxford University, so a couple of Brits on the show, and he has a previous bachelor's degree in natural sciences and biochemistry from Cambridge.

And.

And after he worked as a doctor in the UK for a couple of years, he's now working towards a PhD in neonatal brain metabolism at the University of Oslo in Norway. So a couple of smart dudes here with me today. So, guys, how you doing?

Great, thank you.

Yeah, absolutely. Thanks for having me.

Now, just so we know the difference between the two British accents gracing the podcast, Chris, can you go ahead and say hello to the listeners so that folks can recognize your voice?

Hello.

I'm gonna keep my fingers crossed here that Tommy doesn't sound identical, but Tommy, Tommy, can you also say hello or anything you'd like?

Hello.

Okay. All right, cool.

Tommy's posher than me. He's been to Oxford and Cambridge. He's definitely posher.

I don't think that's fair. Wait, what?

What did you call him? Posher.

Yeah.

I don't even know what that means. That's serious. You're already thrown away or throwing around your British terms. Posher. I'll add that to my vernacular. I feel like I should be drinking tea and eating crumpets during the show. And now I'm going to get angry emails from listeners about offending other people's nationalities. I'll have to be careful about that. I get called out for that a lot of the time. I'm just celebrating diversity, though. So I'd like to start here with this whole idea behind blood chemistry, which, Chris, it seems like you're. You're pretty keen on. That was almost a British phrase there, by the way.

Yes, absolutely.

See, you guys are already wearing off with me. So we talked about salivary testing for adrenal fatigue the first time I had you on, Chris, and then we talked about urinary organic testing. So I guess we've covered saliva and urine. But when did you become interested in blood chemistry?

Yeah, it's going back a few years now. And, you know, I haven't talked about the blood chemistry before, but I think it's. It's maybe the. Almost the most important part. It's really quite crucial. And the reason I got interested in it was, you know, I've always been looking for ways in which to bridge the gap between me and the elite riders. You know, I've not always been a pro mountain biker. You know, before I turned pro, I was just, you know, an age grouper and trying to look for whatever advantage I could find in order to upgrade to the. To the elite guys. But, you know, I really struggled with that, and I think it was. I mean, everyone's done a race altitude, right? I hope you've done a race altitude, because if you've done a race altitude, you understand what it's like to be slightly hypoxic, right? So you know that you're giving it your all and you're not really feeling it in your legs. You're not really feeling any burning. You know, you're not going that hard, and yet still you're not going very fast. And if you've got a power meter on your bike, if you're a cyclist, then you look down, you see the number, and you're like, whoa, this sucks. And, you know, if you've ever experienced that, then you know exactly what it's like to be slightly anemic or not delivering oxygen quite as well as you should. You know, Ben, I know you've talked about hypoxia, which is low oxygen availability, and hyperoxygen, which is high oxygen availability as a therapeutic means of increasing exercise performance. And, yeah, I think really how I realized this was so important was looking at the work of doctor. Dr. Michael Puchowicz. And he has a blog called Veloclinic. He's a really interesting guy.

Veloc, is that VLO clinic?

Yeah, Vlo clinic.

Okay, got it.

Yeah, he's a super interesting guy. And the Reason I find him so interesting is he's. He's a certified sports medicine physician, and he's been trying to develop mathematical models to try and detect doping in cycling. And it was by looking at some of his models, I realized that there's such an important relationship between total hemoglobin mass and VO2 max. So, basically, the more hemoglobin you have, and for those that don't know, hemoglobin is a protein inside of red blood cells that transports oxygen. So the more hemoglobin you have, the greater your VO2 max. So the more oxygen you will consume. And then if you're a cyclist like me, the more hemoglobin you have, the greater your watts per kilo. So this is super duper important. And, you know, I realized when I went back to my test results, the first time I saw some of his models, I realized I didn't. I wasn't even on the chart. Like, I was not even close to where these dopers were in terms of the amount of total hemoglobin they had. And at the same time, I wasn't really feeling good. So I was doing pretty good on the bike. You know, I was winning a few races in the amateur age groups, and I had a lot of brain fog, a lot of fatigue. I wasn't sleeping very well, pretty low sex drive, a lot of bloating, a lot of digestive complaints. And so I went to the doctor and I said, hey, what's up with this low hemoglobin thing? Should I be doing something about this? And he said, I don't know. It looks. I mean, it's low, but I'm not really that concerned about it, so we should just keep an eye on it. And that was the moment I had. I think this is a really important thing for everyone to understand that your primary care physician does not care about your ACE results. Right. There's no diagnosis code. So whenever there's a problem, you go to the doctor and you present with symptoms or a disease, then there's a code to diagnose that condition. And there's no code that wants to upgrade to pro mountain biker or wants to qualify for the Boston Marathon. And I think understanding that is really important. And what it means is it's up to you to take the initiative to get some blood chemistry done, maybe some organic acids, and to understand the results so that you can optimize what you find for your exercise performance, which is important at the weekends when you race. So, yeah, so for me, I kind of. I Pushed on with my doctor and I got him to run some more tests. And the hemoglobin kept coming back lower and lower. And eventually I ended up in hospital having some iron actually infused intravenously, which was super expensive. And I was kind of annoyed that it had to come to that because maybe I could have solved that problem earlier with a less invasive therapy. But the thing that was really curious to me was my hemoglobin didn't really improve that much after I took the iron. You know, I thought that was going to be the magic pill. All I needed was iron. I'm going to transport more oxygen and I go that much faster on the bike. But that, that's not what happened. And, you know, there was a lot of learning and studying and trying to figure out the different moving parts that were going on. And then eventually I saw a 32 watt improvement in my power threshold. So I've seen almost a whole milligram per deciliter improvement in my hemoglobin on a red blood, on a. On a blood test. And that's led to this 9% improvement in my power threshold. And that was easy enough to make the difference to where I could upgrade to pro.

So 9% improvement in your power at threshold from the test that you did and then the treatments that you did afterwards when you realized extravenous or intravenous iron therapy wasn't working.

Yeah, exactly. So there was much more to it than just the iron. And Tommy's. Tommy's here. Tommy's my biochemistry fairy godmother, and he's going to get into some of the really technical details. Tommy's someone I work with on a daily basis, and he is the coolest performance coach you'll ever find because he understands the biochemistry. You know, it's like it's more than just a training plan. I mean, like, how. How many hours would you have to train in order to get a 9% improvement in your parent threshold? And the answer is maybe never.

Right?

You know, like, understanding biochemistry.

Nine percent is, I mean, a lot. To a lot of people, 9% doesn't sound big, but I mean, 2% is huge. 9% is unheard of. And I don't want to sound like we're blowing this out of proportion or something like that, but this is really interesting stuff, and I'd like to hear a little bit from Tommy perhaps about where we start into this in terms of. For people who have perhaps already run a blood test or people who already have a little bit of a knowledge of their blood, how we then dive into the type of protocols that Chris did to actually see these improvements. So, Tommy, can you dive into kind of the basics behind what's going on here from a blood biochemistry level?

Yeah, of course. So I think what's been really great over the last few years is the fact that people are starting to be able to get access to their basic biochemistry data. You know, you can go out and get a blood test or your urine organic acid test, or a saliva test and actually start to look at what's going on underneath the hood, rather than just people will spend years taking supplements, trying to increase performance or improve the way they feel. But you never really know what you're dealing with unless you're actually looking at what's going on in the cell itself. On the other hand, it's very easy to get caught up. You might do some tests and you notice one number that's really low. So say your hemoglobin is low, and you can kind of keep chasing that without necessarily knowing what's going on. And you can get kind of, kind of worked up about one particular number. But what we're starting to see is that if you sort of look at general patterns, you can start to see where people can make. Can make some. Some improvements. And, you know, for something like hemoglobin, if we can try and improve red blood cell health, improve hemoglobin production just by tweaking, maybe just some basic lifestyle stuff or some basic supplementation maybe, then I think people can see some benefits like Chris did. The way that we start to look at this is you maybe think about how. Or the life of a red blood cell. And that involves three main processes, which is the production, the destruction and then the loss or any loss of the red blood cell. And if anybody has low haemoglobin or some kind of anemic tendency, then there might be something going wrong in one of those three. So if you think about the specific areas, then you can start to narrow it down. So if you start by thinking about production, what we generally term hematopoiesis is just a fancy word for making blood cells. And then erythroparesis is making red blood cells. And that requires kind of two main parts. So you have to make the red blood cell itself, and then you also have to make hemoglobin, which is part heme, which is a porphyrin molecule. It's a certain type of organic molecule which has an iron bound to it, and then a globin protein. And the two go together to make Hemoglobin. And what's interesting is these are very nutrient dependent steps. So particularly things like vitamin B6, zinc and iron are important for making heme. And B12 and folate are very important for making a normal healthy red blood cell. And then this whole thing is regulated by epo, which we mentioned briefly at the beginning. But there are some other things that can maybe play into that, so like general metabolic health. So if you have persistently elevated blood glucose, then that can inhibit some of the steps of making heme, making hemoglobin. And then also if you have something like low testosterone or low sex hormones, then that can cause an anemia as well. So it's kind of, if you look at lifestyle as well as nutrition, any deficiencies, then you can start to tease apart where some of the problems might be happening.

Gotcha. And I want to talk to you in a second about how we can actually find out if we're deficient in some of those nutrients, Tommy, that you mentioned, for producing red blood cells. But before that, I want to ask a little bit more about epo. To my understanding, erythropoietin, or EPO is mostly produced by the kidneys. And so I would imagine that kidney function kind of plays into this as well. So is there a way that you can actually test or that you can know if your kidneys are working properly to actually produce epo? Because it seems like no matter how many of the proper nutrients that you dump into your body, that your body needs to make epo, if your kidneys can't produce it, that'd be kind of an issue.

Yeah, absolutely. So that's kind of. That's the starting point, really. And EPO is basically, it acts as a survival factor. So you're actually making precursors to red blood cells the whole time in your bone marrow, but they actually need EPO to come along and tell them that they should survive and continue to mature and then turn into red blood cells. And EPO is made by the kidneys, and the kidneys do that basically by detecting lower oxygen levels. So if your oxygen levels drop for whatever reason, and that's because you're not getting enough delivery from the red blood cells, then the kidneys will start to make epo. So obviously, if the kidneys aren't working, then EPO production drops off. And you see that in people with chronic kidney disease, you often have to give them EPO because they're not making enough. So generally, if you have the average athlete who's just trying to get healthier Kidney function probably isn't going to be the rate limiting step. But a lot of people have some inherited kidney disease or maybe you've had a lot of rhabdo and abused your non steroidal anti inflammatory drugs and that's caused some kidney damage. And then some really basic blood tests like creatinine or bun, the blood urea nitrogen, they can be elevated if people have, people have problems with their kidneys and if anybody's had a basic blood test with their doctor, they'll probably have seen those numbers. One caveat is that if you're taking creatine as a supplement or if you have a lot of muscle mass, then those will both increase your creatinine. But if it's something that you've had a few blood tests and you see that your creatinine is very high and you don't have a reason to explain it, and maybe you're anemic as well, then that's something you should really go and see your doctor about because it could be that you have some kind of kidney problem.

Okay, so let's say that, let's say our kidneys are working properly, like we've tested our blood. Urea nitrogen is good to go. Creatinine is good to go. I know glomerular filtration rate or the, I think it's the E. GFR is another common one that you tend to see on kidney panels. And that's something that a lot of basic blood tests will look at. Let's say you find out your kidneys are good to go. So how would you then know if you're deficient in one of these other nutrients that's necessary to produce red blood cells?

So that's when we'd start by just looking at a basic complete blood count or a CBC and that's where you'd begin to see whether maybe you even have a tendency towards anemia in the first place. So the things that we'll talk like, we'll look at which people have probably heard of, most of these will be hemoglobin. So we talked about that earlier. You have a total red blood cell count. You have something called the MTV or mean corpuscular volume, which is basically the average size of your red blood cells. You have the hematocrit, which is the percentage volume of your blood that's taken up by red blood cells. And then you have the mean corpuscular hemoglobin and mean corpuscular hemoglobin concentration, which basically just tell you how much hemoglobin is in your red blood cells. And then final called the red cell distribution width, or rdw, which basically tells you how variable in size your red blood cells are. So if you've had some problems with some certain nutrients and you have very different sized red blood cells, then that's not a good thing either. We want them all to be roughly the same size, and then you can look at those things and you'll see certain patterns. So if you say you just have a basic iron deficiency, which Chris thought he had previously, pretty much all of those numbers will be low and maybe your RDW will be a little bit higher. So if you have an iron deficiency, then your red blood cells are smaller than normal. But if you have, say, maybe a B12 or a folate deficiency, then they stop the red blood cells maturing properly. And if you have a deficiency in those, you stop your red blood cells maturing properly. So they're bigger than expected. So then you might see an elevated MCV and an elevated rdw. And then finally, you could have something like your red blood cells are a normal size, but you don't have very much hemoglobin. So then maybe B6 and zinc, which are very important for synthesizing heme, there might be an issue there. So if you look at the general pattern of those markers, you can get an idea of where a deficiency might be occurring.

Okay, got it. That makes sense. It sounds to me like gold standard, though, would be you look at both the red blood cells, but then also at some of these nutrients. So you're able to kind of see both what's going on in terms of, like, the size and the red blood cell count, but then also say, what's going on with like, B12, folate, et cetera. Chris, I want to ask you in terms of test results, I know you went through this whole testing process. You obviously saw a big boost later on. But I'm curious for you specifically, did you find any of these nutrient deficiencies that Tommy's talking about?

Yes, absolutely. And the blood testing to find an initial problem was very, very useful. And I think it's important to keep in mind when you look at your lab results, the reference ranges that you see on those results, those are just averages. Maybe LabCorp or Quest, they take 7,000 of these results and then they just draw a bell curve around it and they say maybe two standard deviations either side of the mean, and that's what determines the reference range. And the reason this can be a problem is because you only have to look around you on the street and know that most people are not listeners to the Ben Greenfield podcast. People are in pretty bad shape. Shape in general. And then the people that go to the doctor are probably in even worse shape. And those are the people who are doing this blood test. They're not doing this test to try and improve their performance. They're doing it because they're sick. And so those averages that you see on the blood test result are not always as good or as helpful as they can be. And so having someone like Tommy or me and some special software that we have is really, really useful to define some. Some optimal or tighter reference ranges. And I think that's super helpful for debugging this problem. But, yeah, beyond. Beyond the blood testing, you know, I already talked about the urinary organic acids on the last podcast, and that was super helpful for me for trying to figure out. So I've been seeing, you know, I fixed the iron problem that's now solved, and I'm still seeing, like, very high mcv, so very big red blood cells. For some reason, these red blood cells are not maturing properly. It's kind of. It's almost paradoxical. But red blood cells, they become smaller as they reach the final stages of maturity. And so, yeah, high mcv. And then when I did the urinary organic acids test, I saw an elevation of an organic acid, which is called forminoglutamate. And that's just a compound that's made from the amino acid histidine.

What'd you call it? Formino.

Yeah, sorry. It's kind of. They've all got. These organic acids have all got really difficult to pronounce and unmemorable names. So this is forminoglutamate, and it's sometimes referred to as figlus. If you want to do some research on this, if you're a nerdy kind of person like me, the magic keyword in PubMed you're looking to unlock all this stuff is called Figlu. F I, G, L, U. And so Figlu starts to build up. You see an elevation of Figlu on the organic acids test when there's insufficient folate. And that might be because you're not eating enough leafy vegetables, or maybe there's not enough of other sources in your diet. But I think one of the main reasons why people might be deficient in folate is because they have some sort of genetic mutation, which means they're not very good at converting it into the most bioavailable form. And, you know, we talked about that in the last podcast and you've mentioned it several times, so, you know, if you think that might be you, if you've done some genetic testing and you've seen some mutations in the MTHFR gene, then I think it's a really good idea to take the methylated form of folate or 5 methyltetrahydrofolate, which is the type that's in the Thorne Exos multi and all the thorn products, actually. But I didn't just see that, actually, I saw an elevation of methylmate, which is a byproduct of odd chain fatty acid metabolism. It's super interesting, all this biochemistry. Like, I absolutely love learning about all this stuff. So when odd chain fatty acids are oxidized or used as fuel in the citric acid cycle, so this is inside of the mitochondria, inside of the cells, then eventually you get left over with a bit like, you know, these, these odd chain, these carbons get chopped off two by two. And so in an odd chains fatty acid you get left over with a bit and eventually that does get converted and goes into the citric acid cycle. But that's a B12 dependent step. So if you are deficient in B12, then you end up with an elevation of methylmalonic acid and you can measure that on the organic acids test. So this is the kind of a really cool surrogate marker that you can use to show whether you're deficient in B12. And if you're deficient in B12 then you're not going to produce red blood cells as well as you should, and then you'll end up with less oxygen deliverability, less power threshold.

Interesting. Okay, so we've got this fig lu, which is the one that can be elevated and that's one that we would be concerned about because that would indicate you didn't have enough folate. And then methylmalonate is another one and that's one that can accumulate when you, you don't have enough B12. And both low folate and low B12 in addition to low iron, can all affect your oxygen delivery capabilities.

Yeah, absolutely. Okay, absolutely. And you have to remember that these nutrients, they're really important for a number of things, a number of processes that go on within your body. And I think that's the beauty of tackling this problem from the biochemistry level is that unexpectedly good things might happen. So, you know, methylation, so folate is the most important methyl donor or one of the most important methyl donors. And methylation also influences histamine breakdown in the gut. And it may just be a coincidence. You know, I never know this for sure, but when I started taking the methylated folate, I found that my allergies just went away. And it was kind of a strange coincidence, but, you know, a really nice side effect.

Interesting. So, Tommy, in, in the case of Chris, what is it that would have caused these type of nutrient deficiencies or the kind of things that were showing up on his urinary organic acids test?

Yeah, so I think when Chris sort of started out on his journey, he was, he was in pretty bad shape, actually. There was, I think there was a lot of stuff that was, that was going wrong. And hopefully most of your listeners don't have all of these sort of interacting things happening at the same time, but, but sort of individually, each one could be fairly common. And there are things that you could start to sort of tease out and might be having an effect on performance. So the first one is that he had, he's talked about brain fog and bloating and certain problems with his gut. And he definitely had all the hallmarks of gut inflammation. And he had a certain number of pathogens that he ended up treating as well. And one of the really common ones is Helicobacter pylori. So people have probably heard of H. Pylori. There's a fairly common gut infection that ulcers and stomach cancer. And a lot of people end up with heartburn or GERD because of low stomach acid caused by H. Pylori. And where you've got an infection, you've also got inflammation. But relevant to this topic, if you've got low stomach acid, then that prevents or reduces the absorption of things like iron, zinc and B12, and they can all directly affect red blood cell production. And then if you're talking about the inflammation side of that, inflammation can affect both production of red blood cells and then destruction as well. So if we're talking about production, one particular thing that happens is when you've got some inflammation going on, your liver upregulates the production of something called ferritin, which people might have heard of, which is a protein which binds to iron. And so basically it's basically a reactive mechanism. So if you've got some kind of stressor or inflammation, the body just tries and stores some iron for later, essentially. But if you've got chronic inflammation, then a lot of the iron you have can't be used up. So you cause like a relative iron deficiency. So even though you've got plenty of iron, your body's not getting access to It. And then in addition to that, Chris was quite a high functioning endurance athlete. And endurance athletes we've seen in a number of studies have an increased risk of certain deficiencies of micronutrients. And two of the same again are iron and zinc. And these can be lost, particularly in the sweat. So if you sweat a lot, we see that people, particularly in endurance runners or endurance athletes, zinc and iron can drop quite significantly. So that can be a big problem for that kind of athlete. And then Chris kind of alluded to certain genetic problems. So he's a poor methylator and he needs to take methylfolate. And this is the interesting thing because you sort of alluded to earlier, Ben, that we would want to test for the nutrients themselves to see if there's a deficiency. But actually if you do a direct test of some of this stuff, it's not really that useful. So if you just test serum zinc from your blood, it doesn't really give you a full idea of what the zinc is doing. Or if you measure just B12 in the blood, it doesn't tell you that the B12 is in the right place doing what you want it to do. And that's why you can look at instead products that increase if the B12 is not working properly or it's not doing its job properly, like methylmate. So that's where you can kind of actually look at, you're looking at what the nutrients are supposed to be doing rather than just looking at the basic levels. And then another thing, if we're going back to genetics, a common thing, and I think that something we're seeing more and more of is hemochromatosis or iron overload. So the problem is almost in the other direction, where high levels of iron are then causing inflammation and could then also be be preventing proper red blood cell production.

And you could have high levels of iron, but still have like low hematocrit, low hemoglobin, low oxygen delivery capabilities because of deficiencies in some of these other nutrients like folate and B12, right?

Yeah, absolutely. And you can almost. The problem is you can also precipitate deficiencies. So if you've got a very high iron level, then you're almost driving the blood or driving the body to produce more red blood cells, but then you don't have enough of the other nutrients to sort of catch up and keep up. So you can almost by having a very high level of one, but not enough of another. And that particularly happens with B12 and folate as well. You can almost precipitate a deficiency in the other.

Okay, got it. So Chris's gut was messed up. And so he wasn't absorbing iron, zinc and B12. And then he also had, in addition to gut inflammation, just general chronic inflammation, which was causing red blood cell destruction and basically sequestering of iron.

Yeah, absolutely.

Okay, so that was affecting production, but what about destruction? Can you actually destroy red blood cells as well via some type of mechanism that's going on in your body?

Yeah, so destruction is kind of a. We use it for the normal breakdown of red blood cells. And all red blood cells eventually need to be broken down and recycled because they can't, they can't repair themselves because they don't. If you, if you think about a normal cell has a nucleus, can make proteins, and can actually do some, some repair. A red blood cell doesn't have most of that machinery. So eventually after about, we say about 120 days after it's, after it's made, it needs to be broken down. And so what happens is over its lifespan, it accumulates damage or it, it ages. So maybe the membrane becomes slightly less pliable, so it can't fit through the capillaries, it can't deliver oxygen as well. And then as that happens, then it gets stuck in places like the spleen and something like a macrophage, one of the white blood cells will essentially gobble it up and start to start to recycle it. And so particularly relevant to athletes or anybody who has any kind of chronic inflammation to a high volume of exercise can increase inflammation and oxidative stress, and these can damage red blood cells. But you get something very similar. If you have, say, a chronic gut infection, then in a healthy athlete, you might have a higher red blood cell turnover. So basically your red blood cells don't live quite as long because you're exposing them to a higher level of oxidative stress. But that's not necessarily a bad thing because we know that if you stress the body, it adapts. And that's one of the ways that we get better, get faster is because we stress the body, and then it gets better, it comes back stronger. But if you are somebo who for some reason has some kind of deficiency or some kind of underlying problem, that means you can't keep up with the demand for new red blood cells because of all the exercise you're doing, say, then the problems kind of stack up.

Okay, got it. So it sounds to me like from both levels, inflammation and oxidative stress are going to be an issue. Whether it comes to hampering production or causing excessive destruction. And so part of this is nutrients, but part of it is like avoiding overtraining and having a properly structured training protocol.

Absolutely. Yeah.

Okay, so what do you specifically, Tommy, look for to show whether inflammation and oxidative stress is occurring excessively?

Yes. So one thing that people will have heard a few times, I know you've talked about it a few times, is high sensitivity CRP or C reactive protein, which is basically produced by the liver in response to certain inflammatory stimuli. And a lot of people will look at that in terms of something like cardiac risk or problems, you know, say, risk of heart attacks in the long term. So if you have inflammation, then your, your CRP will go up, but then you can also look at some other things. And again, it's all about looking at patterns. And maybe if your ferritin's increased, that could be due to inflammation like we talked about earlier, or it could be, say, due to iron overload. So you could look at both. There homocysteine you could look at in the blood, and that again might indicate you have some problems with methylation or folate or B12 problems. And then uric acid is something that we'd also look at. And that's an indicator of certain types of oxidative stress. And then, so that's on a blood test, if you're then going to dig a little bit further and look at the urine in the urine, organic acids, then we might look at something like P hydroxyphenol lactate, which is a marker of cell turnover. So if you're damaging cells due to whatever inflammatory process that's going on, then you'll see more of this turn up in the urine. And similarly, something like 8 hydroxy 2 deoxyguanosine, which is a really sensitive marker of DNA damage and oxidative stress. And that's something that you can look at in the urine, and it's very nicely tied to increased risk of things like cancer, particularly due to the DNA damage.

Gotcha. Chris, did you have any of those?

Yeah, absolutely. So, you know, the high sensitivity C reactive protein is a tricky one. You have to watch that if you're an athlete. You know, if you go do an ironman and then measure your C reactive protein the next day, or even the day after, you might well see it elevated. But, you know, I went to the doctor and had some blood drawn during a rest period and I was still seeing really high C reactive protein. And for me, I'm pretty sure that the, the chronic inflammation was coming from my gut. And when I switched over to the autoimmune Paleo protocol, which I'm sure you know is a subset of the paleo diet, like a stricter version of the paleo diet, then my C reactive protein, it came back into the normal range. And since then I've switched to a ketogenic diet, a very high fat diet, and my CRP has fallen even lower. It's down at 0.26 now, even though I'm still doing quite a lot of training. And then I've also seen improvement in the markers that Tommy mentioned, the P hydroxyphenol lactate and the 8 hydroxy 2D iguanosine. And I think, you know, when there's less inflammation, you can feel it. You know, like if you've ever done a really hard session and then you get back and you just feel like you've been hit by a bus. Right. You're just completely non functional for the rest of the day. I mean, that for me is what inflammation feels like after a race. And so now I really noticed I'm pretty functional even after training. And that's really important to me because I'm 40 years old now and I have a daughter who's two and she's becoming extremely demanding. And then it's just not acceptable to spend the rest of the day on the couch after you do a bike race even. So, yes, super important to me to get these levels of inflammation down on kind of the chronic level.

Interesting. Okay, so you've obviously tested for these type of things. We've tested for the production of specific nutrients that are going to assist with production of things like red blood cells. You also, Tommy talked about destruction and the inflammation and chronic oxidative stress that can cause that. But what about actual loss of blood cells? You know, like, you hear about how, for example, like, men are at higher risk of hemochromatosis or iron overload compared to women because men don't bleed every month through menstruation, et cetera. Are there other things to take into consideration when it comes to just straight up red blood cell loss?

Yeah, so that, I mean, that's a great point. Those. So those are. Women are kind of protected, at least for that period of their life from something like iron overload, because they sort of will lose some of the extra, as it were. But if it looks like they're losing blood, this can be a bit of a problem to sort out because it's probably going to be from the gut, because any other bleed is usually quite obvious. And that could be something like an ulcer in the stomach or a polyp or a small growth, or potentially even colon cancer. Particularly as people get older, the risk usually increases. And you can't really rule out a bleed, but you can confirm a bleed by doing something like an occult blood stool test. And the more people will hear me talk, they're probably going to think that I'm really hating on endurance athletes, because this is another problem in endurance athletes. And that's not the case at all. Both Chris and I have done a huge amount of various endurance racing, and that's sort of been our passion through a large amount of our lives, which is kind of why we're doing this. But a lot of athletes, particularly endurance athletes, have some kind of GI complaint during, particularly during races. And that might just be nausea, but it might also be diarrhea or something like that. And that particularly increases with distance and especially in runners. And then when you go to something like ultra distance running, then, you know, probably most people end up with some kind of gut symptom. And what that really highlights is that the gut is kind of at risk when you're doing prolonged endurance exercise. And what that seems to do is that it increases the risk of actually losing iron or losing blood from the gut. And there's this thing called athlete's anemia where the hemoglobin sort of spontaneously drops in endurance athletes. And what people originally thought was that's mainly or it's largely due to an increase in the plasma volume. So basically the volume of the blood increases as a response to training. And then that sort of dilutes the hemoglobin a little bit. But they've done some more, more detailed studies where they've given basically labeled iron and it's incorporated into the red blood cells. And then you can see after a long training session, it can be lost through the gut. So people are bleeding in the gut, and then that goes on to kind of be reflected in something like some very, very long distance ultramarathons where they've then tested people and they found that they have blood in their stool afterwards in a very high proportion of participants, sort of 80 to 90% of people. So that kind of distance, with that kind of stress, then people are really have the potential to lose some blood through the gut. And part of that's because as you stress your body or you try and push yourself, your body redirects blood away from the gut, say to the muscles that are exercising through hormones like norepinephrine. Or epinephrine. And then when you stop, all that blood can kind of come rushing back to the gut and cause a reperfusion injury.

What's a reperfusion injury?

So basically, everybody knows that if you cut the blood supply off to a certain area of the body for a long period of time, that's probably not very good for it. So in the brain, you can cause a stroke. In the heart, you cause a heart attack. And actually, a lot of the damage occurs when the blood comes back. And so while the blood's been cut off, there's this increase in all the sort of, like, the metabolites and waste products and stuff, as that area of the body has undergone anaerobic metabolism, you know, without oxygen, without any blood supply. And then when the blood supply returns, then you get this huge increase in blood supply as it tries to sort of wash all that away. But that can actually end up causing damage in itself. So if people who have done a very long session, say, and then they put a large amount of demand on the gut immediately afterwards, then you can potentially precipitate some of these problems.

Interesting. I wasn't really familiar with this issue with the reperfusion injury. It makes sense that if you're, you know, obviously training way too much, that that might cut off some kind of blood supply to an area for a long period of time, or if you're. If you're overstressed too much norepinephrine, et cetera. Chris, did you. Did you find out that you had this issue as well?

Yeah, I did test positive on one occult blood stool test. So you can get these things. Maybe we could link to one of the show notes. But you can buy these things online and do them at home. They're not expensive.

It's called an occult blood stool test.

Yeah, occult blood stool tests, they're not that hard to find. They're really cheap. And, yeah, I did test positive on one of them, but switching to the autoimmune protocol actually fixed that very, very quickly. The bleeding stopped. You know, Tommy mentioned I found some gut infections, a pinworm and some weird amoeba thing and a yeast overgrowth. And I found that since I've healed my gut and got rid of those things, that I don't need to be quite so strict as autoimmune paleo anymore. But, yeah, I think it's still fair to say that I'm not one of those guys that you see at the end of the race with a beer in one hand and a burrito in the other. And I think based on what Tommy's just said, it's important to consider what's happened to your gut. Right. So we already know you've talked about it a lot, Ben, on this podcast, that certain foods might be pro inflammatory and not such a good idea to eat in general. Well, that becomes especially true when you just finished a hard workout or a bike race or running race, whatever it might be, because your blood, your gut has just had its blood supply removed. Right. Is that really a good time to dump a load of really kind of difficult to digest foods? So I think that's an important consideration.

In terms of gut damage. Obviously, just based on the title of this show about increasing epo, we're going to have a lot of cyclists and runners and triathletes and obstacle racers listening in. Are there other ways that they could protect themselves from damage like this to their gut?

Yeah, absolutely. So I think switching to a high fat diet makes a lot of sense to me. If you've become a fat adapted athlete. I've been racing in ketosis for a couple of years now and still getting really, really good results. That's protective against these types of problems because you already have the fuel on board. Right. You don't need to be stuffing your face. Back in the day, before I knew any of this, before I started listening to, to the Ben Greenfield podcast, I was consuming 6% carbohydrate solution in a massive camelback on my back and I was choking down a sugary sports gel every 40 minutes even when I was out on training. That's kind of a lot for your gut to deal with, you know, and then if you're taking, eating other food on longer events, it's, you know, you're asking a lot of your gut to, to process all that stuff. And if, if you're in a high fat or ketogenic or fat adapted state and your primary source of energy is fat, then that fat is already on board and you don't need to eat anything.

Okay, got it, got it. So we've talked a little bit about blood testing for nutrients and blood testing for specific biomarkers related to iron and to anemia. And we've talked about urine and these urinary organic acids tests. We've talked about stool testing and the fecalt blood or the fecal occult blood test. How do we know? Because this is obviously a lot of stuff. Where to start, like which tests you should or prioritize or do first.

Well, I think a basic blood chemistry is something that everybody should be doing right. It's so cheap now. It's like everybody should be doing those. And I think that most people listening to this podcast probably will have some data. And my question to you is, what's that data doing for you? Do you really understand it? Do you understand how it could be better and how that might affect your performance? So, you know, I think a basic blood chemistry is essential. And then if you can afford to get a better one that has markers like, well, a full iron panel, obviously, homocysteine, B12 folate, fasting insulin, hemoglobin A1C, then that's even better. And then if you wanted to dig deeper and really understand some of the reasons why you might find problems on your blood chemistry, then I think the organic acids, you know, those two tests, they go together like twins. Like, they're really, really helpful to have them side by side. And then that's a, you know, a super cool test that's also going to look at not just the nutrient deficiencies, but also bacterial overgrowth, you know, which obviously is a problem for the gut, and then other problems related to mitochondrial energy production and neurotransmitter turnover as well.

Yeah, and that was the one that. That we also did a whole podcast on. And I'll link to that in the show notes, by the way, again, for those of you listening in, the shownotes are at BenGreenfieldFitness.com EPO that's BenGreenfieldFitness.com Epo if you want to really dig deep onto the organic acids test, which is the urinary organic acids test that Chris and I talked about in our last podcast. So in terms of these tests, Chris, test interpretation, like getting all these tests is one thing. Being able to understand what's going on is another. Can you tell me a little bit about how exactly one would go about interpreting the results?

Sure. Yeah. So say you don't have any recent results, then I can certainly order those for you. And you don't need to go and see a doctor to get this test done. I can send you a PDF requisition form, and then you can print that out and you can take that directly to LabCorp. And especially if you go on a weekday, it's super fast. Like, you're in and out of there in 10 minutes, and then you get the results sent to you electronically. And then at that point, I can run the software, run the results through my software, which defines these tighter limits, and then provide you with a written report. And then Tommy and I can then sit down and review your results ahead of a 30 minute, one on one consultation that you can arrange online using my Scheduler software. But having said that, so what I'm saying here is that you can get a world class biochemist to look at, at your results. But I think it's important to mention that even though Tommy is a medical doctor, he can't take over as your primary care physician.

Yeah, so that's, that's, I guess that's important to point out and I kind of, hopefully people can see that if you, if you optimize certain biochemical parameters, you sort of have a bit of a dig, then you can essentially get a performance boost for free, which is what Chris ended up doing. But you know, if you have any evidence of bleeding or kidney problems or anything like that, that's not something that we're really going to be much help for. And that's sort of something you need to see Your, and that's exactly what your, your primary care physician is there for. That's what, what their expertise is in.

Okay, yeah, that makes sense.

Yeah. I mean I think it's really important to understand what this is. Right, so this is performance coaching. This is, this is clinical coaching.

Right.

Is maybe a good way to describe it. It's not, it's not disease management. We're not going to cure you of any disease. But what we might be able to do is, you know, give you that extra 3, 4, 5% and you know, just go back and look at your test, your test results, your race results and you know, see what difference that would make to you. Like I've just literally been doing this, I race cycle cross at this time of year and I race in the elite race and I am not a cyclocross guy. I do it because I love it because I find it so much fun. I'm like super slow twitch. I'm not nearly strong enough to be able to sprint out of all of the corners. And I place mid pack in, in the elite men's race here on the west coast of California which is pretty competitive and still when I look at the results. So yesterday I was exactly three minutes back from the, from the winner of the elite race. He's like the, the under 23 national champion. And so that's only 5%. 5%. Like if you can find, you know, something on your blood chemistry that gives you a 5% improvement. That's the difference between a 40 year old dude like me that's just having fun and the under 23 national champion. So this is like. This is huge.

Yeah, it is big. It is big. And, you know, some of this stuff, I'll be honest, like, I've. I've done one off tests of, you know, like, my iron, my red blood cells. I've had a urinary organic acids test done. But not to actually look at specific parameters that could affect things like erythropoietin production. Just because I was more looking at it for absence of disease than for performance. But now that I've kind of got all this together in my head, it makes sense. And then fixing it with some of these things you've talked about, like B12 and folate and addressing specific parameters, especially in that organic acids test that are like little laser pointers going after some of these smaller things that could go wrong. I could see how putting it all together would make a big difference.

This.

I'm taking a lot of notes. This is giving me a lot to work with when it comes to creatively figuring out ways I can legally boost epo. So this is pretty cool stuff. I know that you guys have your Nourish Balance Thrive website and I'll put a link to that in the show Notes where people can go to your oxygen boosting protocol and basically do the testing and the consults and everything like that. And you guys have a discount code for us, right?

Yeah, that's right. So act on this now, like, stop the car and place an order. Because there's only so much of Tommy's time I can sell. Right? We're not selling just a supplement here. And there's limitless amounts of it. Like there's only. So Tommy's doing his PhD and he only has so much time. So if you would like for him to look at your test results, then go ahead and place an order. You can use the code BEN10 to get 10% off. And I should probably point out, actually, there's a couple of options here. If you're in the US and you want to get a blood test done, that's super easy. I can just send you to LabCorp. It's really easy. And even if you don't live near a LabCorp, I can just send you a collection kit and you can take that collection kit to any place where they draw blood. So like a local doctor's office or somewhere and you can do it that way. And then if you're in the UK, the 21st century has arrived there. You can do this with a finger stick. Like they can send you a kit and you can stick your finger with a lancet and then drop some blood into a little vial and send that to the lab using FedEx. And they use exactly the same machine. It's exactly the same test. The only difference is they don't need so much blood. I don't. You know, there's some companies like Theranos in the US which are emerging, but for some reason it's very slow to happen and it's not really happening in the us but if you're in the uk, then this is really cool. You don't even need to go to the lab. Like you can collect the blood at home. So super cool. And then the third final option is if you already have some test results and you would like us to look at those, then that's no problem. Then it's obviously much cheaper to do that. You can just place an order online and then you'll still get that same one on one console and Tommy will look at your results and you still get the written report as well.

Got it. Cool. Good stuff, guys. I'm going to link to all this stuff in the show notes including Nourish, Balance, Thrive. The discount code is BEN10. For that, go to BenGreenfieldFitness.com EPO to check this stuff out. I know this was kind of a heady, technical show, so if you have questions for Chris or for Tommy or for me, leave them in the comments over on the show notes for this episode@BenGreenfieldFitness.com EPO and one of us will reply. And I'll also link to things like the fecal occult blood test, the PALEO autoimmune protocol, Dr. Michael Pukowitz's website, and some of the other things that we mentioned during this show as well. So, Chris and Tommy, I want to thank you guys for spending the time on the show and telling us how to legally boost and upgrade some of our oxygen levels, our epo, et cetera. This was pretty cool stuff.

Thanks very much.

Thank you.

All right, folks. Well, this is Ben Greenfield, Chris Kelly and Dr. Tommy Wood signing out from BenGreenfieldFitness.com have a healthy week.

You've been listening to the Ben Greenfield Fitness podcast. Go to BenGreenfieldFitness.com for even more cutting edge fitness and performance advice.

Sam.