Rational Wellness Podcast 033: Nutrition to Improve Athletic Performance with Dr. Tommy Wood

Dr. Tommy Wood discusses with Dr. Ben Weitz how to improve athletic performance through the proper use of nutrition. I asked when you see a professional cyclist or runner, what is the first thing that you will do. Tommy explained that the first thing they will do is have the patient take their subjective questionaire and this can get an idea if the athlete has any particular issues with their health, such as with their gut.  Then they will do a thorough consultation with the client and then they will have the client get some blood, urine, and stool testing, since many of the clients that come to see them have digestive issues. This may be because high intensity and endurance exercise may be very taxing on the gut. Or you may have been overtraining, under sleeping, under eating, etc. and may have made yourself susceptible to whatever came along to populate your gut. Then he and the other coaches at Nourish, Balance, Thrive will intervene with dietary recommendations, supplements, and other lifestyle recommendations.

4:54 I then asked if he typically sees mostly endurance athletes?  Dr. Wood explained that that’s where the company started, since it was started by Chris Kelly and another doctor who are both pro mountain bike racers. But they have expanded out to all sorts of people after that.

5:55 I asked if he has an athlete who has gut issues, and he is complaining of symptoms of gas or bloating or abdominal discomfort or diarrhea or constipation, what are some of the things that you are looking for and how do you approach it?  Tommy explained that the testing is important. How do you know what’s in there unless you look?  He does a combination of urinary organic acid testing (through Great Plains) and he does both culture (through Doctor’s Data) and pcr stool testing (GI Map through Diagnostic Solutions).  I also asked what are some of the most common gut problems and how does he approach the treatment and does he handle the gut problems first and then go to the athletic performance program or incorporate it into it? Tommy explained that he likes to address the whole person and he will look at sleep, stress, diet quality, the person’s purpose in life, etc. Their performance may be the hook why they came to get help, such as “I want to qualify for the Boston Marathon” or they may be an Olympic athlete who wants to perform as well as they can at the next Olympics. Dr. Moore explained the types of gut problems they tend to see: H. pylori, yeast overgrowth, Claustridium difficile, parasites. They tend to treat using herbal protocols.

10:44 I mentioned that C diff is often a very difficult condition to treat and asked how he treats it? Dr. Wood answered that C diff can be very dangerous and cause toxic megacolon and sometimes you need to go straight to antibiotics. Other times he will use a ketogenic diet, black cumin seed oil, lauricidin, and saccharomyces boulardii.

12:25  I asked about how he manages the  carbohydrate intake in athletes and does he take care to restore depleted glycogen, does he use glycogen loading, the window for replenishing glycogen immediately after exercise? Tommy said that he often tells his clients that they should eat more carbs because his clients tend to be on a low carb/paleo approach already and carbohydrates have become something that we are not supposed to eat any more. And now we are even told that we are not supposed to eat protein because it will activate mTor and IgF1. Some of his clients are not eating enough of anything because they are intermittent fasting, they don’t want to eat too much fat, they are low protein, they don’t want to eat carbs and they are training 20 hours per week. They may be doing low FODMAP, low histamine foods, with autoimmune paleo and intermittent fasting and this just doesn’t work if you are trying to fuel for training. Then their thyroid function goes through the floor and sex hormones go down and they can’t sleep and are anxious all the time.  On the other hand, Dr. Wood does not believe in eating the type and volume of carbohydrate intake that has traditionally been recommended for endurance athletes, such as 2-4 grams of carbohydrates per pound of bodyweight or more of highly refined flours and sugars. He does believe in the targeted application of carbohydrates, such as after an intense training session. He likes to use carbohydrate cycling–something called “sleep low”. You do a high intensity workout in the evening and then you have a low carb/high protein/high fat dinner and the next morning you do a fasted workout of 1-2 hours of lower intensity and then after that you eat a high carbohydrate meal. You have depleted glycogen, you do an aerobic exercise session that activates those pathways like AMPk, mitochondrial genesis, etc. and then you load back up with carbohydrates and you get some of those anabolic pathways and glycogen restoration. This allows you to get those benefits without just overloading on carbs or completely restricting carbs.

16:33 I asked how much carbohydrates he is recommending for say a 170 lbs athlete and what form does he like?  Dr. Wood said he likes to start with a gram per pound of bodyweight or carbohydrates and it can go up 2,3,4 times that if you are doing high volumes of high intensity exercise. He focuses on real foods like sweet potatoes, bananas, rice, other potatoes. I then asked if uses high or low glycemic carbs? Tommy said that it depends. In some clients he will recommend a protein shake with maltodextrins, a high glycemic carb.

18:35 I asked what about using the ketogenic diet with athletes who are essentially fueling with fat. What are some of the advantages and disadvantages of that? Tommy talked about Stephen Phinney and Jeff Volek who wrote The Art and Science of Low Carbohydrate Performance http://www.artandscienceoflowcarb.com/the-art-and-science-of-low-carbohydrate-performance/  and they have done research on this topic. They did a study that looked at how keto adapted athletes use fuel compared to high carb athletesknown as the FASTER study (Fat Adapted Substrate use in Trained Elite Runners). http://www.sciencedirect.com/science/article/pii/S0026049515003340   We know that fuel selection and usage changes on a ketogenic diet but we are not at a point where we can say that that improves performance.  Professor Louise Burke in Australia is running very short term and poorly controlled studies of a ketogenic diet and she shows that it makes the athletes worse. But this is just muddying the waters because such short term studies do not give the athletes time to adapt.  The most recent study that came out of New Zealand that was conducted for ten weeks by Caryn Zinn found that some athletes did well and some did not with a ketogenic diet. Overall performance was neither increased or decreased.   https://jissn.biomedcentral.com/articles/10.1186/s12970-017-0180-0   If you look at some of the famous keto athletes, like Zach Bitter and Sammy Inkinen, when they are doing a long, hard exercise session, they will eat some carbs.  Sammy Inkinen published on his blog that he was doing a very tough mountain bike stage race and when he had a long, hard day on the bike he ate 200-400 grams of carbs afterwards.  The next morning he was still in ketosis, so a ketogenic athletes can still eat some carbs. There are certain things that go on in the gut where a keto diet seems to be beneficial, but other things, such as proteobacteria that secretes endotoxins and the fat seems to increase the translocation of the endotoxin across the gut wall into the circulation. If they have a Bulletproof coffee they will feel really foggy after.  But there are some potential benefits.  When you exercise, you divert blood away from the gut and it is not a great time to ask your gut to digest or absorb some food.  If you are doing very long exercise sessions, someone who is fat adapted, will better utilize stored fat for energy and will not need to fuel as often during exercise. This is easier on the gut. Right after the ride, the blood comes rushing back to the gut and this is also not a great time to shove some food into your system, as some riders will do who may grab some tacos and a beer.

24:33 I said that I spoke to one nutritionist who said that he likes to use a lipid profile to determine how well their body processes different types of fats to see if this is something is working for them.  Dr. Wood said that it depends upon what type of lipid profile you look at.  If you look at an advanced lipid profile, like the True Health Diagnostic lipid profile, and you look at cholesterol absorption and particle size, this might tell you that saturated fats are not good for you because you have an increase in LDL particle number that occurred when you went on a ketogenic diet. On the other hand, some individuals might find that when they go on a ketogenic diet, their LDL goes up, but they tend to get a shift in energy distribution and then the more fat they eat, their LDL goes down because you are transporting fat in chylomicrons rather than in LDL.  If we look at a standard lipid profile, your LDL can go up because you have a chronic infection or because you are hypothyroid.

26:53 I asked what he thinks about supporting the mitochondria for sports performance? I explained that I heard a discussion that Lebron James in the off-season two years ago went paleo/low carb and was training very hard and he got extremely lean and it was thought that this would create increased mitochondrial density. Then when he kicked carbs back in before the start of the season, he could benefit from both increased mitochondrial density and from carb loading. Tommy said he thought this made sense and that you do stimulate your body to produce more mitochondria with ketogenic diet or training fasted and you might reduce inflammation and set yourself up to use carbs better at a later date.  He said that there are some potential discussion points and some people would say that there are certain enzymes that are down-regulated when you are on a low carbohydrate diet which then may prevent your from being able to use carbohydrates later on, such as pyruvate dehydrogenase, which can be measured. Pyruvate dehydrogenase turns pyruvate from glycolysis into acetyl CoA to be used in the Kreb’s cycle in the mitochondria. Some of the discussion of whether ketogenic diets are good or bad for performance is centered on that enzyme. If you spend a long time doing low carbs and not doing any high intensity exercise, you may reduce pyruvate dehydrogenase and then if you eat some carbs, you won’t be able to process them. But if he did some high intensity exercise during that time period [which I’m sure Lebron did], then you may maintain your levels of this enzyme. Tommy said that he recalled seeing Lebron James doing this several years ago and by going low carb and losing excess bodyfat and gaining metabolic adaptations and then going back to eating and training in a more traditional way for basketball, that could be beneficial.

31:20 I asked if there is good data showing that training on low carbs will result in increased mitochondrial density? Tommy said that that had not been established in humans. I next asked if Dr. Wood uses nutritional supplements to support mitochondrial function? He answered that if someone is on a ketogenic diet, they will usually benefit from carnitine, CoQ10, D-ribose, riboflavin (to make FAD) and you can get them as a combined mitochondrial health supplement.

33:22 I asked Tommy about a blog post he wrote where he talked about how people with more muscle live longer and you quoted Mark Rippetoe, who said that more muscular people are harder to kill and more useful in general. I asked Dr. Wood to explain the importance of lifting weights for longevity. Tommy responded that there is a load of data looking at strength such as grip strength, and longevity and those with more strength live longer. And muscle mass also has some benefits as does strength. If you have a large set of quads from doing squats, that is a way to absorb glucose from your blood stream.  If you are stronger it means that you can walk up and down stairs, you can get up and down from the toilet, you can do everything you want to do in life much longer. Art Devaney and Doug Mcguff  talk about physiological headroom, which means that there is a difference between what you are capable of doing and what you do every day in your normal life. Tommyu explained

 

Dr. Tommy Wood is the Chief Medical Director at Nourish, Balance, Thrive and can be reached through their website for consultations: http://www.nourishbalancethrive.com/

 

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