This is the start of the Talk Nerdy To Me series. These talks will be about 20 minutes in duration. The goal is to simplify complex and/or tabooed subjects. We will release one a month by myself or one of our many esteemed colleagues throughout the country.
Without further adieu…
And below are the individual images and a video with the animations of the slides for this presentation.
As I was walking out of the first day of the Optimizing Athleticism Seminar, Dr. Culleton asked me, “That was phenomenal, what do you think the audience took from that?” I had been contemplating the same thought as the day progressed. The audience was primarily strength coaches and physical therapists and Dr. Rakowski who headlined the first day was not playing coy with big words and systems biology. I responded to Dr. Culleton,”Probably not that much right now, but they now know what they don’t know, and this group of people will run with that somewhere special.”
This conversation has floated in and out of my mind over the past week and it becomes a question of scope of practice and ultimately responsibility to the client to do the right thing. Davis and I have posted on this topic many times. We both believe that a Strength Coach’s knowledge base must be vast, but not necessarily overly specific until they find their passion/niche. They have to be able move seamlessly and talk intelligently with many other professions. I will give two examples of how I feel the strength coach or personal trainer is either the gateway to health or the hammer of dysfunction.
Many of us have seen and/or signed the waiver forms that say: You must see a health care professional before starting this or that exercise program.
And how many clients actually do that?
But this is because the average Joe primary care physician isn’t going to tell anyone anything unless they have some set of obvious symptoms that fit into the bundle of this or that disease that can then be medicated “appropriately”. At which point you might be thinking why the hell did I go or send someone I care about there!
“Disastrously, primary care is a dying field, yet at the same time primary care diseases are increasing at dramatic rates.”
Mark Hyman MD
The average primary care physician can tell you nothing about function or underlying causes of dysfunction, let alone address how these dysfunctions could or are leading to decrements in performance. They can only tell you if you have a disease state. This is not very helpful to the strength coach, personal trainer, or client. However, a strength coach that has been introduced to functional medicine will know that there are those professionals out there that can tell them something of value and help further individualize and care for their clients throughout the life course.
Does the strength coach or personal trainer need to be an expert in Functional Medicine? Absolutely not, that cannot be expected, but they do need to understand the recommendations and the potential pitfalls of their approaches in the weight room and work with a health care professional to form a plan that will include more data points and quality input over time. Some strength coaches or nutritionists may catch the bug and want to go back to school for a decade or so to thrive in such a profession and that is also powerful but we cannot try to fix problems beyond our current abilities, because in that scenario everyone loses.
If you weren’t at the seminar you may be asking – Dude! What is Functional Medicine?
“Functional medicine is a dynamic approach to assessing, preventing, and treating complex chronic disease. Functional medicine helps clinicians identify and ameliorate dysfunctions in the physiology and biochemistry of the human body as a primary method of improving patient health. Functional medicine clinicians focus on restoring balance to the dysfunctional systems by strengthening the fundamental physiological processes that underlie them, and by adjusting the environmental inputs that nurture or impair them. This approach leads to therapies that focus on restoring health and function, rather than simply controlling signs and symptoms.”
Jeffrey Bland PhD
The second example moves to the realm of physical therapy. Many strength coaches, including myself have taken a plethora of physical therapy or massage therapy based certifications or apprenticeships. I am confident with my hands and can fix a lot of problems that come up in the gym, but I am not naïve enough to think that I can fix all the problems. For example, a strength coach doesn’t need to know everything a DPT does, but they should know what they don’t know and refer out when they can’t fix a problem or need a second opinion. And then if a strength coach is lit with a passion for physical therapy they should follow that path and enroll in physical therapy or massage therapy school and/or shadow the best of the best.
This may strike some as unfair, why does the strength coach have to be a generalist and be able to communicate effectively with so many other “specialties” to be able to provide a true health building performance experience for their client. Yet, the same can be said for the functional medicine practitioners and physical therapists. They need to lift and have an understanding of foundational strength and conditioning concepts, programming, and exercise selection so that they can in turn communicate effectively with the strength coach or personal trainer.
The ultimate goal is for this network of professionals to be able to have a thoughtful conversation, understand and formulate a plan for the client, and then test that this plan is working and redirect if needed.
That one sentence…will likely take you years to find the right people and learn enough to make this happen. Take that as a challenge, I hope it doesn’t stop you.
Canada Basketball deserves some props here as they have built an interdisciplinary model and have hired a staff of stellar physical therapists, strength coaches, and functional medicine practitioners to drive performance as far as possible while monitoring and building health from underneath. All of us are building and tuning up this machine while it’s being driven and there will likely be many models and systems that come out of this work, but Canada Basketball seems to be integrating and applying faster than most. Here is a great Podcast with Dr. Marc Bubbs, Canada Basketball’s Functional Medicine Doc.
On the private side, many may have noticed that Davis and I bridge the gap between S&C and Nutrition/Functional Medicine (and we are not alone). Davis is in my mind one of the best S&C minds in the country and will stop at nothing to understand how the body adapts to different exercise and lifestyle stimuluses and then how best to apply this knowledge. I still maintain a personal training client load and likely always will, but have slowly transitioned more towards the functional medicine side of the spectrum with the help from many unbelievable mentors and colleagues. Yet, given all this, if there is a physical therapy problem or pathology that we can’t figure out we have physical therapists, osteopaths, MDs, and DCs, that we can refer out to without hesitation.
No one has all the answers, but ignorance is dangerous. Hunt down what you don’t know. Then establish what and how much you need to know so that you can further understand and help your clients. Strip the shackles of what other people think you should do because of some title and create a community to get the job done.
Supplements, groceries, gym memberships, programming, blue blocking sun glasses, comprehensive lab work, unfortunately it all costs money. This post is about breaking down the cost of attempting to be awesome. Health in our current climate takes effort and is expensive, but the alternative is likely much more expensive. I mean how much does a heart attack cost?
ummm 10 grand at a minimum, throw in some kind of higher end surgery and it’s pushing 50k. Lifetime cost of a stroke $100,000 dollars and perhaps not being able to move one side of your face.
Cancer somewhere in the neighborhood of 60 to 120k, depending on the type and where you live.
Diabetes a cool $13,700 per year.
Now you might say well I don’t have to pay all of those medical costs, to which I would answer, someone does. Like it or not the US of A is one big Team. If all the tubbie Marthas decide to go and get diabetes, have a heart attack, survive, and then get put on dialysis it will be a huge financial burden on the rest of us. So tubbie Marthas get your shit together and start front loading your costs so we can all relax.
Now you might not care at all about Martha and only care about lifting weights more better and running more faster, this is fine, whatever drives you to do the right thing for the rest of us. I’d be lying if I didn’t admit that this and how I feel/look is what ultimately drives me more than anything. Figuring out your why is important, and for some people it’s all about the money.
Thus, let’s break this down and start with the biggest chunk of cash – Food.
I eat a lot and my grocery bill with all organic produce and meat is $150-200 a week at a minimum. My wife who doesn’t eat nearly as much me spends $100-$150 a week, but she likes fancy stuff. We also live in Texas, so if you live in a more urban area like Chicago or LA this figure will likely be more.
If you are an athlete let’s call it $600-800 a month.
If you just want to be healthy, more along the lines of $400-600 depending on how many coupons you can dig up.
or better yet Medical Foods which have guaranteed Potency and Purity, but can only be sold by health care professionals.
If you think you can get all your nutrients from food alone, it’s just not possible anymore (without an awkward amount of chewing), only 7% of our farm land is rated prime and since the 1970s the nutrient content of our produce has dropped anywhere from 15-30%.
These are the Bare Minimum supplements I believe most people would benefit from and can take with very minimal risks. I will not give dosages as these would depend on the person. These prices are also reflective of very high quality products with third party testing.
High Quality Fish Oil and make sure it has been tested by a third party for purity.
Greens Powder jam packed with organic phytonutrients
Liquid Vitamin D
An athlete will also need:
Some sort of protein powder
Gen Pop – $70-150 per month
Athlete – $140 – 265 per month
*Some people may spend a lot more in this category in the beginning when they are healing their gut, mitigating the stress response with adaptogens, or balancing the immune response – I could go on for a while, but I’ll stop there. Also, people should have exit plans on supplements and if someone needs to be on a supplement forever they should be told this. The above supplements should be in the mix all the time, and some in and out with proper cycling.
Comprehensive lab work should cost you about $250 to 300 a pop and then depending on who your practitioner is anywhere from $250-1,500 to get a good and proper interpretation/feedback. You can do this biannually or annually. If any serious underlying conditions pop up you may need to run more testing and test more often, but it is obviously better to catch these type of things early.
$500 – 1,800 per year or…
$42 – $150 per month
I believe these cost anywhere from $100-300 and it may be a good investment to work in a one-on-one or small group setting with a well-regarded coach/trainer who can not only get you moving appropriately but teach you how to fish for yourself. One could also front load their costs and build their own home gym for about $2000-3000 or $150-250 a month if you spread that investment out over the year.
Grand Total for The Economics of Doing Stuff Good
Athlete – $882 – $1515
Gen Pop – $612 – $1100
Now with going out to eat and buying expensive processed nonsense the average American spends $151 a week or $600 a month on food. Wait what? Yo bro that’s not even that much more deffferent.
This means that caring about yourself, your loved ones, and this planet costs an extra $7-500 bucks a month and that very roughly means 5 years of doing stuff good equals just one year with diabetes. This post is purely about money and doesn’t even take into account how one will feel or increased production at life and work. It’s all about finances because a lot of people have this cemented idea that being all granola, annoying, and organic is just too expensive, however the truth is that it costs everyone much more beyond dollars and cents not to care.
By: Ben House PhD Candidate, FDN, fNMT
* All of these numbers are from national polls and/or my estimations. I know it’s crazy but these numbers could be slightly off, yet if someone from the national math nerdery wants to run this analysis that could make for an interesting read, just sayin.
I have read a lot of posts lately that give broad recommendations based on circadian rhythms or the idea that certain hormones or biological systems are high or low at different times of the day. Don’t drink coffee at this time, but drink coffee at this time, work out at this time, eat carbs at this time, and on down the line. This may be a great way to get clicks, but these generalizations are likely ineffective for any one individual, and perhaps even dangerous. Many people know about cortisol which peaks in the morning to wake us and then dwindles as the day progresses. Melatonin on the other hand wanes in the morning and creeps back up to its peak in the evening allowing us to go to sleep. Both ideally and theoretically. Melatonin and cortisol are not the only peaks and valleys in the system but without getting them back in step you won’t be able to correct other hormonal imbalances. Every hormone in the body is pulsatile and the brain is constantly collecting data and adapting to whatever situation we give it.
Dr. Gottfried puts cortisol dysregulation at 92% of the population. We don’t live in a primal world. Some people never see the sun, let alone feel it on their skin. We can do anything we want whenever we want. We aren’t active throughout the day, but instead exercise in spurts. 90 cents of every dollar we spend on food is thrown away on processed garbage which dismantles our internal clocks through blood sugar spikes, insulin surges, and food sensitives/allergies. Most of our lives are not ideal, and thus theoretically most Americans do not have intact circadian rhythms.
I haven’t tested a single person with a normal cortisol rhythm on an Adrenal Stress Index (and I service a high end demographic in one of the healthiest cities in the United States). In fact, I rarely ever run them because we can save money and work on lifestyle changes to actually fix the underlying problem instead. If they need buy in, I’ll order the panel and explain to them that their HPA axis is struggling and/or dysregulated. Sometimes people need to see numbers, sometimes they don’t. You have to decide how long of a lever you need to move the client to the correct actions for them.
Hans Seyle founded various stages of “Adrenal Fatigue”, however, I don’t believe in the linearity of those stages and for most people adrenal burnout or fatigue is likely brain based (only a very small portion of the population has actual Addison’s disease or the destruction of adrenal tissue). As Nora Gedgaudas puts it the adrenal glands are just hormone factories doing what they are told to do. To fix the problem you have to change the message to and from the brain, and this is why adrenal fatigue supplement protocols are a waste of money without appropriate lifestyle change.
You can’t out supplement lifestyle, no matter how much vitamin C and adrenal glandulars you are inhaling. Sometimes you may need supplements to correct certain issues you can’t fix with lifestyle alone, but ultimately you have to change the message to the brain by breaking the stress response and telling the body there is not a charging bison and a five alarm fire around every street corner. This again is highly individual and you have to figure out what their stressors are: environmental, over-exercising, under-exercising, emotional stories they replay again and again in their heads, underlying infections, blood sugar swings, food intolerances, and/or a combination of the above.
Let’s look at the most common example I see.
Now say you have a client who comes to you and claims to be an Owl. They are most productive in the evening and wouldn’t dream of going to bed before midnight. They “feel” fine, but crave sugar, and get irritable between meals. They also wouldn’t dream of eating a big breakfast.
The first and most common form of cortisol dysregulation is an inverted rhythm. Meaning cortisol is higher at night than in the morning. Due to this rhythm, this person feels dog tired in the morning and progressively gets more energy as the day goes on. They may still get really tired in the afternoon if this has been going on for a long time, but then they catch a second wind and perk back up in the evening. Due to cortisol being high in the evening they aren’t going to be able to get a good night’s rest and the horrific cycle continues.
Now say a trainer has read some chronobiology texts and believes in the Owl vs. Lark philosophy. Great, no problem, but you better damn well know that your client is in an ideal state before you go justifying having them work out at 6pm, which will likely push their circadian rhythm back even farther and feed the underlying problem.
This is because if they are in the above pattern of cortisol dysregulation what they need to do is exactly the opposite of what they will want to do. They first need to reestablish their cortisol awakening response which can be done with a very short bout of exercise upon waking (talking 5-10 min), they have to eat something for breakfast that has protein and fat, and they have to control their blood sugar throughout the day. They then need to do cover all the other aspects involved in building health: investigate underlying and unseen causes of stress, limit work and emotional stress whenever possible, move every day, get sunlight especially in the morning, and unplug at night, but none of those other strategies will work if you just let them do what they want.
They may hate you for a time, but in two months when they feel better than they ever have and are sleeping like a baby from 10pm to 6am, you will be the hero. And if they are in fact an Owl and have given it their best shot, done some serious healing, and you retest their rhythm and it is normal then you can play with pushing some things back.
We are animals and we live with the sun, the moon, and also with the seasons. We have daily, monthly, and seasonal rhythms. Our culture has thrown away these ebbs and flows and replaced them with 24 hour grocery stores with every color food you could dream of. This is only bad if you let it be, but making the assumption that we can construct and popularize rash generalizations on what rhythm every person should have is asinine and dangerous. Biological rhythms live with the individual and should be treated as such. We must look objectively at the situation and collect data whether it is in the form of an ASI, blood work, and/or questionnaires. Then we must further individualize the recommendations to maximize adherence because that ultimately is all that matters.
Are you an insightful enough professional to ask the hard questions and to figure out how to get the results very few can?
Are you a coach who is athlete centered and not tied to what you think should happen or what worked for you?
Are you a client who is receptive and confident enough to live outside the norms of a society that is smothering the essence of what it means to be human with concrete, anti-depressants, and flashing lights?
I don’t like the brain. It’s egotistical and bumpy and effing complicated with words like gyrus, mesensephalon, and pontomedullary reticular formation that make you want to curl up in the fetal position with a Snuggy. I have tried as hard as I can to stay away from this amazing structure even though my lab group performs functional brain scans on a weekly basis. Also, my colleague Grace Shearrer is an absolute brain genius and can rattle off neuroanatomy and how these different areas of the brain influence physiology and vice versa. It’s awesome and I love listening to her lectures, but a good portion of my time at UT with her being so amazing allowed me to say, “Grace will handle it.” Yet, over the last year I have had to come to terms with the fact that ultimately the brain controls everything and although we cannot fix the brain without fixing physiology, many times we cannot fix physiology without respecting and understanding brain chemistry, anatomy, and physiology.
“You are your brain – the health of the brain dictates everything about you. The brain is one of the most susceptible and fragile organs to the imbalances caused by poor diets and chronic stress. ”
And we are not doing well at respecting or supporting our brain health
One in eight senior citizens develop Alzheimer’s. One in three seniors die with Alzheimer’s Disease or some other type of dementia.
One in eight children are diagnosed with brain development disorders (autism, ADD, ADHD)
The brain needs oxygen, glucose, and stimulation to survive. Period. The brain weighs about 3 pounds, yet utilizes up to a third of our glucose supply. Evolutionarily, we literally grew bigger, more expensive brains at the cost of our digestive system (for more on this read the book Catching Fire by Harvard primatologist Dr. Richard Wrangham.) This means that suppling our brain with the proper amount of energy, oxygen, and stimulation is absolutely critical to our health and further evolution.
Let’s look at the energy and oxygen side of this equation first. Proper neuronal signaling is maintained by a concentration gradient across neuronal membranes. There is more Potassium (+) inside the cell and higher Sodium (2+) concentrations outside the cell, thus the inside of the cell has a net negative charge. When a neuron is stimulated Sodium enters the cell which causes an action potential or the neuron to fire.
This membrane potential is maintained by ATP (energy) created by the electron transport chain (housed in the mitochondria) which needs energy substrates and oxygen (among other things) to run effectively. So if we don’t fuel and provide oxygen to our brains resting potential cannot be maintained adequately. Our brains can become overstimulated and fatigue more easily, and eventually this over excitation can even cause neuronal death. Enter chronic fatigue, lack of brain endurance, and neurodegeneration. NO Bueno.
Well that was a mouthful.
Let me go get a snack.
That mouthful is called the Energy Linked Excitotoxic Model of Neurodegeneration. I don’t think there is a real need for the vast majority of people to memorize any of this, but health professionals need to be able explain and perhaps draw this concept if necessary and more than anything be able to think through the repercussions.
For example, when most of our young athletes come to us in a very hyperventilated state (not getting adequate oxygen) and eating highly processed and sugar laden diets (massive swings in blood sugar). We also see either severely overstimulated Central Nervous Systems (CNS) or CNS patterns that are completely bottomed out – dunzo – fatigued – finish him!
Thus, we have to know that without adequately addressing proper nutrition and breathing mechanics with these youngsters they are never going to be able to pay attention to the words. that. are. coming. out. of. our. mouths. and we will be limited in what we can teach them in the weight room, how much, and what if anything sticks.
I have walked out to one of our client’s cars to see all of the kids death gripping volcano red big gulp slurpies. The sedan looked like Gremlins. Guess what, on any given day this little guy can take about 25-30 minutes of speed and power work before his CNS taps out. Coincidence. I think not. How do you change an entire family’s relationship with food? I haven’t figured that out yet, it will likely take a village and at the end of the day they have to buy in, some wont. Wash your hands.
We can then extend this out further to gain a respect for how environmental toxicity, cardiovascular disease, adrenal dysregulation, thyroid problems, and blood sugar issues can all lead to decreased energy and oxygen availability which causes inadequate mitochondrial function in the brain and eventually if left unchecked – neurodegeneration.
What? How in god’s name did you make that jump. Well…
Toxins kill mitochondria. End of story. No mitochondria, no electrochemical gradient and neurons become overstimulated and die. Sad day, take care of your mitochondria. For more on this read Dr. Terry Wahl’s book – The Wahl’s Protocol.
Cardiovascular disease, such as arteriosclerosis and issues like anemia are going to severely limit the amount of oxygen that gets to the brain which is very distal, as well as the most vertically placed structure on the human body. So if your hands and feet get cold or you can’t get a hard on, you can bet your brain ain’t getting what it needs either.
Blood sugar swings are extremely stressful to the brain. The brain needs a steady supply of glucose. In fact, blood sugar instability disrupts all aspects of physiology necessary for healthy brain function. Also, one of the adrenals main jobs is to regulate blood sugar via cortisol, so if the HPA axis is all jacked up blood sugar control will be even more critical due to the fact that their body and brain are not going to be able to take long periods of time without food. To take it a bit deeper, this aspect is so important the Brain has evolved multiple mechanisms to make sure that blood glucose levels doesn’t get too low, these include the hypothalamus signaling increases in hunger, ramping up cortisol via the HPA axis, and even the secretion of sympathetic hormones like adrenaline. Let’s now think through one of the most common reasons people wake up in the middle of the night – blood glucose drops too low while sleeping, sleep walk eating might help, but better yet would be a slow rise in cortisol, however the adrenals might be too kicked to make this happen so then the last resort is to pump out adrenaline to raise blood glucose in a matter of minutes via glycogenolysis and you jump out of bed screaming with little chance of getting back to sleep.
So the next time your client comes in and can’t pay attention ask them what they had for breakfast, ask them if they eat any high quality sources of fish, ask them about their sleep, and creepily watch their breathing mechanics. Over time with the right interpretation, advice, and buy-in your client will be able to get more productive work done in each session. They may even see a massive difference in their everyday life, and who knows over time you may even be able to stop someone from getting Alzheimer’s or type 3 diabetes. Don’t think that’s a big deal – volunteer to get dementia or forget your kid’s names. If that doesn’t scare you into action maybe this will by 2025 Alzheimer’s related costs will exceed the entire fiscal budget of the United States.
Once or twice a week a client will text me some link to some bullshit site about some supplement or high level tweak that they want to add. It also comes from here-say recommendations. My buddy has been drinking yack urine and is f$cking jacked, can I do that?
These types of texts make me noticeably angry, not because I am mad at the people (ok a little) but because the black hole of the internet and personal recommendations from unqualified friends are the lowest forms of information.
A lot of people say I shouldn’t give clients my phone number, but I like to be accessible and at night I have the ability to flick the iPhone off. Let’s face it if someone is blowing me up with power clean questions at Midnight, we have much bigger problems and there is no way I am answering. The other virtue I have to instill in my clients is where they get their information, how to sift through the nonsense, and better yet how to just flat out avoid it. In our culture, information is stressful and unrelenting. I have to give them the security so their beliefs are unwavering. They have to know they are doing the right thing and therefore they aren’t flipping around in the wind, swayed by every Tom, Dick, and Marge that comes by the house and talks about their new Splenda and Collard Green diet or the most bestest fluorescent bottle of RED 40 on the shelves of GNC.
These texts usually come from new clients who haven’t mastered the fundamentals. This is because when you master the fundamentals everything else is just a drop in the bucket and your bucket is already full of swoll, slender, feel-goodness.
If one of those wheels is off you can’t put on a bigger wheel of nutrition or add in some extra massage sessions with Betty Lou – it ain’t going to matter. You have to have those four wheels on the car before you can go play around with lifting up your truck, putting on a fancy new exhaust of creatine and BCAAs, because if you don’t, you will just have a really expensive useless frame of bells and whistles that can’t pull out of the driveway.
Let’s take this thread from a guy who drinks like it’s going out of style, is prediabetic, doesn’t sleep, and handles work stress like a sugar deranged toddler.
Here is the text (read italicized texts with an Aziz Ansari accent)
Weightlifting raises testosterone – can I train 5 to 6 days a week?
The increase in testosterone is generally transient and overtraining it probably more a risk than undertraining for the majority of our population. When testosterone is low it is in an indicator that you are over driven – so likely you have to park the vehicle and put the wheels back on. If this guy lifted weights 5 to 6 days a week I can guarantee it wouldn’t help and he would get injured in under three weeks due to the aforementioned shit show.
“Low testosterone in the absence of primary hypogonadism is a barometer of ill health, rather than a primary marker. “
– Corey Schuler, MS, DC, LN, CNS, CNP, FAAIM
Next text, 2 seconds later.
What about BCAAs and intermittent fasting? Those raise testosterone.
Here was my response.
Get off the internet.
Next texts a few minutes later feeling remorseful.
BCAAs are fine. BCAA away.
Intermittent fasting, maybe but it will depending on blood glucose homeostasis and adrenal function.
Next text knowing that this conversation is far from over.
All of these things you are texting about are tiny drops in the bucket of your problem. Your body needs rest, quality nutrition, quality movement, and stress management consistently over time. Sorry it’s not sexy, but you don’t pay me to lie to you.
I can say all this because I am not afraid of losing business. If he doesn’t like what I have to say, by all means find some 22 year old that will combine all the things you want – intermittent fasting, BCAAs, and weightlifting 5 to 6 days a week on a Vietnam shoulder, a shattered ankle, and low testosterone levels. Good luck. He will be back or he won’t, but I can guarantee is problems will be worse and the results he wants won’t be had because he took a giant poop on the fundamentals. Guys unfollow people who suck. If you are going to read things on the internet have a plan and only intake information from people who have credentials and the respect of the industry, and for god’s sake when in doubt – master the fundamentals – there is nothing more powerful.