Iron Deficiency in Endurance Athletes: Signs, Testing & Treatment Ep 150

Welcome to the Find Your Edge podcast. I'm your host, Chris Newport, founder, head coach, sports nutritionist, and exercise physiologist at The Endurance Edge. Our mission is to empower people to reach and sustain peak performance and health. So get ready to dive into all things training, nutrition, recovery, and more. We hope to give you detailed information and inspiring stories to help you be your best. Let's do it. All right. Welcome back to the Find Your Edge podcast. I'm your host, Coach Chris Newport. And actually today I'm not your host. I am handing the reins over to Emily Q because she has done an interesting project for school and came across a researcher. So I'm gonna let you take it from here, Emily, and, and go for it.

Thanks, Chris. I'm excited to act as your pseudo host today. Yeah, so for my master's capstone project at UNC in the Nutrition and Dietetics program, we were tasked with picking a public health problem and making an intervention for it. So the one that I picked was iron deficiency anemia in adolescent female athletes. And in my research for that project, I came across some of Dr. Corey Dugan's research and found it super helpful for my project. So I decided to reach out to see if he'd want to pop in as a guest speaker, and here he is. So I'm really excited about this collaboration. So Corey, please just tell us a little bit about yourself and how you came to do this research.

Thanks so much for having me. I came to do this research. I, I'm from Western Australia and I did my undergraduate degree in sport and exercise science at the University of Western Australia. And I was very passionate about exercise. That kind of led me down the, the research path. And, uh, my PhD supervisor was an endurance athlete researcher, and iron deficiency being as prevalent as it is in that population became essentially the, the topic of my PhD project, which was looking at iron deficiency in a variety of different contexts. Mostly a female athlete setting, right?

That's— well, I'm not going to say it's wonderful, but it's wonderful for our purposes today because that's exactly what we're all about.

So yeah, it's always, it's always tough, it's always tough to have— yeah, to, to give the intro and then say, you know, that it's fantastic to research this area. However, you know, if we had a perfect world, no one would be iron deficient.

Yeah, but unfortunately here we are. So start off, start us off with some of the basics here, Corey. So why Why are endurance athletes at such high risk for iron deficiency? There's a lot of reasons, I'm sure.

There, there are several. Exercise, specifically endurance exercise, like running as a, as an example, is a mode that causes iron loss. So you lose iron during exercise through a variety of different mechanisms. Gastrointestinal bleeding, when you sweat. Foot strike hemolysis. So if you're running and when your foot hits the ground each step, you can, you do destroy red blood cells with that strike. Some of that iron does get recycled though. However, these are all factors that go into play when it comes to looking at iron status in endurance athletes.

Can you tell us a little about hepcidin and how that affects all this too?

Yeah, definitely. So I only touched on iron loss during exercise, but it's a fantastic point that another avenue for susceptibility to iron deficiency from exercise is the absorption block, which is hepcidin. Hepsidin as the master regulator of iron status in the body. So if your hepcidin levels are high, then you have a low iron absorption capacity. And in exercise or endurance exercise, you have a really big inflammation response and hepcidin spikes. We see very high, uh, levels of hepcidin during high levels of inflammation. So after exercise and specifically endurance exercise, we see that rise in hepcidin and then, uh, accordingly you see that decrease in iron absorption.

Right. So a lot of factors stacked against us endurance athletes here.

Yes. And that's, that's not even considering the, uh, if, if we were to look at female athletes particularly, which was, uh, the topic of my PhD, there's just a whole nother dimension of factors to consider in, in this context. Yeah.

Can you tell us a little bit more about some of these additional factors?

Well, we already have the increase in iron loss from exercise. However, in a woman's health perspective, we also have iron loss from menstruation. If the athlete we're concerned with is regularly menstruating, we also have increased iron demand for that reason. And additionally, if it's a younger female athlete, we have increased iron demand during adolescence. And all of these things, again, they all just keep on adding to, I suppose, the list of things that can make you susceptible to iron deficiency. And if you are, you know, if you're someone that has a lot of these things ticked off, you, it's just very likely that you're not only at risk, but since it's very normalized, you can definitely experience it without noticing it.

Wow. Absolutely. So with all that considered, if you're out there and you're a female endurance athlete listening to this, you might be thinking, how do I know if I'm deficient in iron? Do you have a short list of the signs and symptoms that you should be looking for?

Yeah, this is where it gets— this is where it's difficult as well. So a lot of stuff I'll, I'll talk about is, um, I suppose another dimension adding to why this issue was so prevalent and so underrecognized. That a lot of the symptoms associated with iron deficiency, namely the common, most common ones are fatigue, brain fog, or difficulty concentrating, restless legs, difficulty falling asleep, or decreased recovery. All of these things, right? They're not necessarily like, if you were to experience any one of those things, you're not immediately going to attribute it to iron deficiency. It could be several other things at play there. So they're not normalized, they're not specific to iron deficiency, these symptoms, which, which I think makes it go, uh, underrecognized.

Right. And then a lot of people will attribute that to like normal training load. And when you're in a, you know, intense training cycle, you're bound to feel fatigued, you're bound to feel, you know, drained. So by the time you're feel like it's— the symptoms have gotten bad enough to go check it out, it's probably— you've probably got like really depleted in iron.

Yeah, and it's just a repetitive cycle and it just keeps on almost feeding itself. And then you can see, uh, contextually, if it's not caught, then, you know, the perspective that coaches might have are athletes not trying hard enough or athletes not putting enough effort into recovery. And then You know, there's even other things to consider there.

I've even heard of, to add on to the list of potential symptoms, like heart palpitations, almost like, is there something wrong with my heart? How is that part of some of the symptoms that you've seen?

Yes, yes, definitely. There was a list of 20 or 30 symptoms I could have listed there. I just did the, um, the, the most common. But yes, heart palpitations, um, hair loss. Brittle nails, cold intolerance. A really interesting one, uh, it's called pica, which is the craving of non-nutritious substances. The most common ones I've seen in the US and Australia is ice, so craving ice or paper. I've spoken to professors all over the world. I've been very fortunate, and the one that I heard recently at a conference was in South Africa, there is pica in the desire to consume clay. And then additionally, there's the smell of burnt rubber or petroleum. So these are all things that I'm learning as well as I, you know, develop my research and get to go to conferences and stuff. And I find it, I find it so interesting.

That is, yeah, I've never heard of, well, I've heard of pica. I've never heard of the smell of burnt rubber or anything like that. So super good to know. I guess if you, if you're not experiencing, or maybe if you're experiencing some of the more like general symptoms that you can't really attribute to iron right away, if you go into like the doctor to get labs done and see and try to like assess your iron status, what are the things that you should— you want to be looking for?

Yeah, great question. Straight off the bat, it's important to screen athletes, as, as you know, any coach would know. And female athletes specifically, there's a lot of research out there to endorse the idea that they should be getting their iron checked relatively consistently. Now, the issue when you go to just a general doctor's appointment and you get bloods done is that you're not actually having your iron assessed per se. A full blood count doesn't include any iron-specific panels. The one that you can look at in a full blood count is your hemoglobin level. However, looking at that and interpreting iron status from that is like reading the last page of a book and trying to understand the entire book in its context. It's the, it's the final, it's the final variable to, to fall through that iron deficiency cycle. So if I was a coach and I'm wanting to screen a female athlete, I would definitely have them ask for iron studies when they're going to have a blood test. And then that gives you a range of specific biomarkers that you can look for, and some of the most common ones are ferritin transferrin saturation, iron binding capacity. And these are all, all things that you can consider in, in the context of iron deficiency for a, for a female athlete.

Okay. So what you're saying is that like hemoglobin, it can be indicative of iron deficiency, but more likely than not, like if you're iron deficient, you still might have a normal hemoglobin.

Yes. I had a col— I actually looked over a colleague's blood tests this morning. She's a, she does a lot of cycling, and her hemoglobin was 13.5, so 13.5 or 135 grams per liter, which is in, in the healthy range. And her ferritin was 7.5. So what, what that tells me is that she's on the way to anemia. So you can think of it as almost like a stepping ladder. So at the start you have optimal iron stores and normal hemoglobin. And then as you lose iron stores, you still have that leftover reserve to be able to make red blood cells and hemoglobin. But it gets to a point where if the ferritin drops so much that you're not able to make red blood cells and hemoglobin, then the hemoglobin will drop. And that is, that, that is the end stage of iron deficiency, which is iron deficiency anemia.

All right, so we want to catch this before it gets to that point. So my next question is, what are the optimal levels of ferritin that endurance athletes should be aiming for? Because I, um, in college actually, I was a rower for a while and I remember going through a period, like maybe like a, a few weeks or maybe like a month, a month and a half of feeling particularly fatigued. So I went in to go get my iron tested and when I got my results back, I don't think my ferritin was that, was that bad. Like it was showing up fine, like within normal limits or whatever. But the doctor there told me that ideally they should be higher for an endurance athlete. So can you elaborate a little bit on like how much higher?

Yeah, it's, um, if you were to, uh, if you were to ask any researcher that, I, I feel like that'll give you a different answer. Mm-hmm. And The optimal ferritin level is something that's, uh, debated. It's been debated for decades. I try to stay away from that debate specifically, and I always come back to the sports science principle of individualization. So if you're a coach and you're screening female athletes, it's really important to think about it contextually. So a single ferritin measurement doesn't really tell you much. It is the best indicator we have of iron stores. However, not always. So as I said, high inflammation, um, changes Hepcidin. It also changes ferritin. So that's an important consideration. The other consideration, as I was saying, is the single measurement. So what's really important is to measure it over time, to look at the delta or the change in ferritin over time. So if you are in an optimal iron status state, then it's important to measure it over the course of the season or the periodization plan. And you can track changes in iron status with, you know, changes in exercise performance, competition, all of those things.

Although, is there at least a number that we all can all agree on that's in the toilet?

The world—

less than 20, less than 15, less than 10? Like, what? Or, or would you just say it's context of the athlete, kind of like what you were indicating?

I— the World Health Organization defines it as less than 15. I've seen people pass out from iron deficiency with a ferritin higher than that. The Australian Medical Association has a ferritin less than 30. Here in the US, I've seen a variety of different levels. I think it's pathology, uh, specific. So I've seen levels from 7.5 all the way up to 35. I think that, as I said, I try and stay away from the optimal ferritin debate, but there is new research out in the last few years that I've found really interesting because it doesn't just— these, these thresholds come from or have come from taking a population sample and saying, okay, we have this sample, this is the average ferritin. So someone is iron deficient if they're 2 standard deviations away from the optimal, optimal average. Now what this new research is looking at is, okay, we're looking at it physiologically. We're not just taking a sample a population sample where looking at the cellular level, when does the body call for more iron? When is it that some of these biomarkers change as we are losing our ferritin? And some of those have come back with, um, a ferritin of less than 25. And there was another research article looking at the changes in Hepcidin, and that was a, a ferritin of less than 50.

Wow. That's higher than I would've thought.

Yeah, it was a really good research paper. I, I just can't remember the, the author's name, but yeah, it was, it's definitely worth a read. It, it suggests that hepcidin begins to decrease before, you know, anyone would catch it in a standard blood test. And that's, you know, it, it, the, the standard blood test for female athletes, it's, it's not set up to catch it. So it's really important to understand that and then, you know, know what it is you should be looking for in terms of screening.

Okay. Very interesting. So you've gone to the, you've gone to the doctor, you've gotten your labs, you've, and it turns out, looks like you're deficient in iron. So what are the steps you should be taking after that to get in some more iron? Cuz Chris was telling me yesterday about somebody that was super low in iron and was like, okay, so do I need more spinach? And it's like, man, if you're at the point of like anemia or borderline anemia, like more spinach isn't going to save you. So what, what, what would you suggest as ways to get that iron up?

No, you're right. You're definitely, definitely correct there. The, the standard pathway to increasing your iron status depends on firstly, you know, what your current levels are. If you're at a suboptimal level, let's say, then you potentially have the ability to correct it with dietary intervention only. And that's always— that would be always my first point of call if I was, if I was the coach. However, if your iron status is in one of those deficiency categories, then changing it with the diet, it's going to be very difficult and it will take a, a long time. So that's where Individuals might consider an iron supplement. So the, the first line of call there would be an oral iron tablet. And if you are in that iron deficiency anemia category, then oral iron tablets probably aren't gonna bring ferritin up very much. And I would say within the first 6 months, and if that. So that's where, um, intravenous iron infusions are typically used. But I've also seen that intravenous iron used in, in stage 2 as well.

In that just deficiency category before progressing to anemia, you mean?

Yes. Iron deficiency, non-anemia.

Okay. Got it. Typically if you are in that second camp, I guess the deficiency but not anemia, if you start taking oral iron supplements, how long do you usually see that it takes before you start to see improvements in your ferritin?

It would change depending on the individual, the type of iron that you're consuming, and then specifically the, the way you're consuming it, and with some other characteristics or factors. But I would say that it would be months, in, in the months, not, not days and not weeks.

All right, months, I see. Can you tell us more about the different types of iron supplements out there? There's, there's a lot of names and a lot of forms, so just want to clear the air.

As someone that doesn't have a, an MD, I can't necessarily come out and say this one's better than this one, so nothing here is medical advice, just a disclaimer. Um, but yeah, the, the standard iron tablets that you see or are prescribed are Elemental iron, it's non-heme, so it's, it's tough to absorb. So you really try it, you really need to try and have strategies in place that would improve your absorption rate. Now we know from previous research that things like vitamin C are very beneficial to iron absorption. So some strategies an athlete can, can do is having it in the morning with a glass of orange juice. We also know that things like coffee and tea and some, um, oxidants are really big inhibitors of iron absorption. So avoid— yes, calcium, that was— yeah. So those things are important to avoid before taking the iron supplement. And we said before about exercise having that increased hepcidin response, so that kind of shuts the door on it as well. So you should try and avoid taking it in and around exercise, especially post-exercise.

All right, good to know. So the, the, the timing is really crucial. And Chris Newport and I just did a podcast on bone health ear— uh, earlier this week. And if you're somebody who's trying to make sure you're getting in enough calcium and vitamin D for your bone health, but then also trying to get in enough get in your iron supplements and all of that. You really have to like start to strategize and plan out when you're taking what.

Yes. And, and that I think is— it's something that if you were to go to a, a general practitioner, then you know that they would, they would prescribe calcium and iron. But in terms of exercise performance, you would need to consider so many other things in terms of your strategies around timing and consumption because it's going to have a big impact, and it's not something necessarily that a medical doctor would, would think of. So it comes back, and I think it's a, a very big responsibility of the coach to have this knowledge and understand how to apply it practically. And then, you know, I think that the athlete also has, um, somewhat of a responsibility as well to ensure that that they're using those strategies to get the best possible output, to get the best possible performance.

And, and Corey, I will interject that that's also where the sports dietitian comes in on the teams.

Yeah, totally.

We help with the, the bridge between the physician and the coach and making sure that people are optimizing their, what supplements to take and when, optimizing their performance, what in between food. And so anyway, shameless plug, Corey, go on.

Oh yeah.

No, I, I, uh, I couldn't agree more.

Yeah, yeah, always got to put the dietitian plug in there in every episode. I love it.

Yeah.

So speaking of all this, uh, this, uh, timing and strategizing, I have heard and experienced, um, that sometimes the oral iron supplements can cause some like GI side effects. So how do you suppose if you're having to take it in the morning, like say before practice or before your workout or training session. Do you have any strategies or tips on how to mitigate those GI effects?

Yeah, it's very common. Uh, any— I think I've seen research that shows anywhere between 40 to up to 60% of individuals have adverse, uh, effects from oral iron supplements. And there's a few strategies that, you can employ to, to potentially help with that issue. The— I think the biggest one is to take iron. So I would actually advise this as well, even if you didn't have GI upset, is to take the iron supplement, uh, once every second day and not once a day.

Okay, interesting.

So the body is horrible at absorbing iron, and when it does absorb iron, it is very quick to shut the door. So when you take an iron dose, it paradoxically increases hepcidin as a response and decreases iron absorption. Now, if we were to take another dose the next day, and research has demonstrated this, that you actually have less absorption due to the hepcidin response from the first dose. So some research has even demonstrated that over a 4-week period, let's say, that you have a greater iron absorption from taking the dose once every second day.

Wow. Like in total for the 4 weeks?

Yeah, correct. So it, yeah, almost is paradoxical because you're taking half the amount of iron, but you're con— uh, absorbing more.

Yeah, that's really good to know.

And I assume Corey, this is ferrous sulfate more likely than like a, like a bisglycinate or something like that. Cuz it seems like ferrous sulfate is probably the most researched, I would guess.

Yes. Ferrous sulfate is the most researched and it was, I think it was the initial one as well. So iron supplementing started, actually started in the 1600s. And that was, that was introduced with iron filings in cold red wine, which sounds not like a great concoction. No, no. Um, but hey, treatment had to start somewhere. Someone had to, had to try it. So that's where, that's where it started. And it, yeah, slowly moved to, to, I think ferrous sulfate was the first oral pill. That was developed in the, the 1800s. Don't quote me there, but yes, ferrous sulfate would be the most common and you would get roughly 20% of that absorbed. Similarly, ferrous, uh, bisglycinate is roughly, depending on the research, you can see similar absorption rates. Now, if you are someone that has significant GI upset from the oral tablet, then a lot of people, um, suggest taking ferrous bisglycinate over the ferrous sulfate, or at least trying it. So if it's something that, you know, you, you're not tolerating well, then it would be worth trying to change something up to see if that is any better.

You mentioned that the oral supplements are all non-heme iron. Is that correct?

Yes, that's correct.

Is there any way to isolate heme iron? Just wondering.

I had—

I did see something on the market. I think this was last year at some point. I, I wouldn't be able to tell you what specifically it is, but yeah, I think there are a few. I'm not sure about the research behind them, but the main way to get heme iron is to be consuming your animal products in the diet. Now that's not to say I would never say to— if I was a coach, uh, if an individual, a female athlete, is vegetarian for whatever reason they choose to be, which is completely fine, I would never say, okay, the strategy to improve your iron status is to start eating meat. I think that comes back to the individualization of the, uh, the coach in terms of their screening. I've had, I've seen people go to doctors and doctors have said, okay, you need to, you know, change this practice. And I, I don't think that's, that's very effective coaching.

Yeah. Not necessarily the answer. And if they're not going to do it, then it's not a good recommendation for them either.

Yeah, exactly.

So maybe you're somebody who struggles to, who, or chooses not to eat red meat for, for whatever reason. In addition to supplementation, I've also heard of some other ways to get in iron in your diet, like either— like cooking with cast iron is supposedly supposed to, like, you know, your food's supposed to absorb some of that iron from the pan or something. How, how true is this, and how much does it contribute?

This was, this was actually a journal club for my lab a couple of months ago. It was very interesting. The, the idea behind it, it's very plausible, right? You know, uh, to try and increase the iron that's coming into a food source. And research shows that you can increase the iron in a source, for example, um, tomato sauce, which is very acidic. You can increase it by 800% roughly. Now in saying that, you're actually not consuming almost any of it. So it comes back, it's a non-heme form of iron, it's poorly absorbed, and research has demonstrated— well, one of the biggest randomized controlled trials on the, the Lucky Iron Fish, as it's called, is, um, it suggests that it doesn't improve ferritin or hemoglobin.

Man, okay, because I saw— I didn't actually find out about the Lucky Iron Fish until a few days ago. I saw an ad for it and was really like excited about it. I was like, this could be great, because it's— it's— for those of you that might not know about it, it's literally just— it's an iron fish. Like, it looks like a paperweight kind of, and you're supposed to put it into— if you're boiling water, if you're making soup, if you're making curry, just anything like liquid if you put it into like a pan and boil and like when you're cooking and then take it out afterwards, it's supposed to have like released some iron into the food or the, or the water. But man, I'm sad that that's not actually the quick answer to this.

Well, there, there is research. I would, would be, you know, not giving the whole picture if I was to say that that was just the only study. There are studies, smaller studies that have demonstrated a weak improvement in hemoglobin and ferritin. However, these were much smaller studies, non-randomized. So as a, as a researcher, I always go looking for the, the big randomized double-blind controlled trial. And the one about the Lucky Iron Fish was in 2017. And yeah, that suggested no, no gain, unfortunately.

Ah, too bad. So I guess we gotta go back to the basics. Stick to the, the dietary sources and then supplementation if needed, or infusions if needed.

Yeah, definitely. I think it does always come back to, to screening the athlete because it gives you the information you need to have strategies in place to ensure optimal performance. And this is, you know, in the context of exercise performance, this is, this is important. However, you can even take a step back and see that it impacts quality of life of the individuals affected. And, you know, it's not necessarily just something in the exercise world.

Definitely right about that. Do you have in mind like how often you should be getting screened for iron status if you're somebody who's competing and training a lot?

Yeah, there's a lot of really cool research out there that's coming out suggesting different kinds of screening practices. I recall it, it's a paper by Mark Sims in 2019. I think he suggested to screen at least twice a year for iron, and that could be changed depending on how susceptible you are to iron deficiency and whether you've had it or not previously.

Hmm.

So building a screening tool is very much the research I'm involved with at the moment, and we're trying very hard to figure out a way to predict iron deficiency without necessarily having to take blood out of the individual. Because if you take blood out of the individual, you take out iron and therefore more susceptible to iron deficiency.

So it's counterproductive there.

Yes. You wanna test for it, you need to lose some. So we're, um, yeah, we're trying very hard to develop screening tools that, that don't necessarily need to involve a blood test.

Well, Cory, when you come up with your screening tool, you're going to have to send it. You're going to have to let me know, and I want to see it because one of the things for my project, the school project I was working on, was they wanted us to, um, kind of, we, we didn't need to find like a screening tool out there that already fit every single thing, but we needed to find something similar and adapt it. And it was really, really difficult to find an iron screening tool for that, that like adolescent age, like, age would understand and like it wouldn't be too long to fill out or whatever. So I'm really interested in that too.

Yeah, it's, um, like you said, the, the difficulty comes from so many different angles. The non-specific symptoms, the lack of recognition, the underdiagnosed, undertreated, all of these things play important roles for any screening tool, and iron deficiency unfortunately has all of them together.

And I know we've been focusing more on females, but it happens in men too. And I've also seen it in perimenopausal women as well. So it's sort of this carryover from perhaps a history of anemia. Now, you know, no more menstruation, but their iron is still tanking. So it's, it's, uh, an important tool to have some sort of screening for people who wanna be lifelong athletes.

Like definitely, I think, I think it should be for, for anyone and everyone. As most recent prevalence rates have, one, one third of the human population is iron deficient.

Wow. That's a big chunk.

That's, that's massive.

Yeah. Yeah.

Gracious. And then, you know, to, to your point of how potentially detrimental all this pounding and running is for iron. And then oftentimes, like we had a gentleman in the lab today and he's training 6 days a week and, you know, or running 6 days a week more specifically. So I'm not telling people to not run, but sounds like keep track of your metrics in conjunction with what your training looks like so that you can stay on top of adequate iron stores.

Yeah, that's exactly right. And I think it comes similar to so many other things, you know, like if you have an injury, then it's, you know, really important that you get all the information available around that injury and then come up with a plan moving forward as to rehab and then getting back on the track or whatever it is that you are training for, I think nutrition is, is not very much different to that. And I think it's important to, to screen.

Or is there anything else you wanted to touch on, Corey, before we wrap up?

I did write one thing down about intravenous iron infusions. I did a bit of research just trying to make sure that I could cover all the points, and I saw something interesting that I didn't know was a rule, but the, the WADA iron infusion ruling is an elite athlete that's bound by wider law, any infusion greater than 100 milliliters across 12 hours is— it's actually banned at all times without exemption. So I think it's important. Yeah, yeah, it's banned. I think it's really important that if you are in that elite athlete context to understand the, the wider regulations around this. Now you can get exemptions. If you are anemic or you definitely need it, you know, as a, as a solution. However, if you engage with it and then don't, you know, go through those right channels, then yeah, there are potentially consequences.

Wow. Okay. Yeah. So be careful out there if you're getting some iron IV infusions, but yeah, very interesting.

This was awesome. Corey, you are so knowledgeable. I'm so thankful that Emily found you and we were able to interview. This was so awesome.

No, thank you so much for, for having me on. And as I said, I'm very passionate about this, this field of work, so any opportunity I can get to, to raise awareness, I'm, I'm always going to take it.

Awesome. Well, when we get this all published and good to go, we'll send it your way, and, um, and we're gonna, you know, send it to as many endurance athletes as we can, and. And, uh, whomever is listening. So this was great. And it's so, it's so awesome to hear it from the horse's mouth. You know what I mean? So especially in the age of TikTok and Instagram where, oh yeah. Yeah. Right.

Yeah. But this is like your whole career, so we want to hear it from you. Yes. Yeah.

We've actually published, we've published a paper or we took a bit of research to a conference. That was looking actually at the information on TikTok regarding iron deficiency and iron status. And it's, yeah, it's quite alarming the amount of, well, I, I suppose it's not surprising, but it's, it's alarming the amount of misinformation out there around this topic. And yeah, I think that's also an important thing to, to have as a consideration. Wow.

That, yeah, don't get your health advice from social media. I think is the, the short answer to that perhaps.

Online. Uh-huh. Yeah.

Yeah.

Yeah.

Definitely.

Yeah.

And, and just to confirm, this was not specific medical advice. Make sure you speak to your healthcare providers when it comes to medical interventions. We are— this is here for educational and perhaps even entertainment purposes. So, but this was awesome. Thank you so much, Cori and Emily. Great job.

Thank you.

Yay. It's so good.

Awesome. Thanks again, guys.

All right.

Yeah.

Thank you. Thanks for listening to the Find Your Edge podcast. If you like what you heard, don't forget to subscribe on your favorite podcast platform so you never miss an episode. And if you're interested in learning more about our endurance coaching, sports and wellness nutrition, metabolic and sweat testing, triathlon training team, or our triathlon training library, Be sure to check us out at theenduranceedge.com and don't forget to follow us on social media at The Endurance Edge. Thanks again. And we'll catch you next time.