Latest / Find Your Edge: Training, Nutrition + Longevity for Endurance Athletes / Lab Values That Matter For Athletes (and why doctors shouldn't do nutrition) Ep 148

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Lab Values That Matter For Athletes (and why doctors shouldn't do nutrition) Ep 148 · Find Your Edge: Training, Nutrition + Longevity for Endurance Athletes

• 0:37
  Coach Carlie: All right, welcome back to the Find Your Edge podcast.
• 0:39
  Coach Carlie: I am your host, Coach Chris Newport.
• 0:41
  Coach Carlie: And today's topic is a fun, nerdy one, special lab values of interest, in particular for athletes and endurance athletes, of course, because you know you're our people.
• 0:54
  Coach Carlie: And I want to back up a little bit because when I first started practicing and I would have folks come in for nutrition consults, I would be giving them a list, like writing them out a little, like here are the things that I want you to go to your doctor and ask them, pretty please, to order because dietitians are in a little bit of a special bucket.
• 1:15
  Coach Carlie: We cannot order labs.
• 1:18
  Coach Carlie: We have found a little bit of a loophole to that.
• 1:21
  Coach Carlie: So now we're able to get them without necessarily having to go through your doctor because sometimes, in defense of doctors, sometimes they can't order something specific because they don't have an appropriate diagnosis code.
• 1:38
  Coach Carlie: And they can't just be like, well, yes, wouldn't it be sure, wouldn't it be nice to know some of these things, but we can't get it through your insurance company.
• 1:47
  Coach Carlie: They're probably not going to pay for it.
• 1:48
  Coach Carlie: And why are we doing this anyway without a more specific diagnosis code?
• 1:52
  Coach Carlie: Right.
• 1:52
  Coach Carlie: So there's that whole thing.
• 1:54
  Coach Carlie: And then now we're getting into this age of direct-to-consumer labs where you go through a particular company.
• 2:01
  Coach Carlie: I won't necessarily name any of them, but there's several of them on the market where you're just like, okay, you know, let's get all these biometrics, but you don't necessarily know, nor should you know what they mean.
• 2:14
  Coach Carlie: And then if there's anything that's out of the ordinary, people generally freak out and they're like, this one number is off.
• 2:24
  Coach Carlie: And then what does this mean?
• 2:26
  Coach Carlie: Oh my gosh.
• 2:27
  Coach Carlie: And then they're not able to, because why should they?
• 2:30
  Coach Carlie: They're not a healthcare provider.
• 2:31
  Coach Carlie: They're not able to zoom out and take into account a more holistic view rather than just picking and parting one number that might be out of normal limits.
• 2:41
  Coach Carlie: When in my mind, I'm trying to work in more functional limits because you guys are high performers.
• 2:48
  Coach Carlie: Generally, most of you are healthy.
• 2:50
  Coach Carlie: There are other things that are obviously going on.
• 2:53
  Coach Carlie: Some we we work with a lot of celiac disease.
• 2:56
  Coach Carlie: We work with a lot of Hashimoto's and graves and hypothyroidism and high cholesterol, whether it be genetic or not, or whatever.
• 3:06
  Coach Carlie: Every once in a while we've got some hypertension, uh, we've got fertility, we've got perimenopause, menopause, like all of those things depend on where you are in your life stage.
• 3:15
  Coach Carlie: What are your goals for your sport?
• 3:19
  Coach Carlie: And then what are the things that we want to hone in on that are also related to your genetics?
• 3:26
  Coach Carlie: So we've got all these different pieces.
• 3:28
  Coach Carlie: So I think of labs as what are the metrics that we should be tracking on a regular basis?
• 3:36
  Coach Carlie: And then what are maybe some of the metrics that are more specific to you and what you're trying to achieve.
• 3:41
  Coach Carlie: So, all of that to say is that these special labs are special.
• 3:48
  Coach Carlie: You're special.
• 3:49
  Coach Carlie: So having said that, Emily Q is here.
• 3:53
  Coach Carlie: She is my dietary intern, and she uh did some really great homework because, of course, she's been hearing it from me and been hearing it in our longevity lab program that we have of all the different labs that we have access to that we can get for people and start to look at trends and then have someone with you have a healthcare provider who is with you interpreting these and then helping you either get follow-up care or adjust accordingly from a diet, lifestyle, or supplement perspective.
• 4:28
  Coach Carlie: So, anyway, Emily, thanks for coming.
• 4:31
  Coach Carlie: Of course, I'm happy to be here.
• 4:34
  Coach Carlie: I think I've had too much coffee.
• 4:37
  Coach Carlie: So, for those of you guys who are listening right now, we're doing a couple of back-to-back episodes.
• 4:42
  Coach Carlie: And I I was on a bit of a rant in the last episode.
• 4:46
  Coach Carlie: So here we are.
• 4:47
  Coach Carlie: Welcome all the rants.
• 4:49
  SPEAKER_01: I I I love the high-energy stuff.
• 4:51
  Coach Carlie: Okay, cool.
• 4:52
  Coach Carlie: All right, so let's get into it.
• 4:53
  Coach Carlie: What are the these are like some standard labs that you would see just and these are like, you guys, these are like dirt cheap.
• 5:01
  Coach Carlie: And when I say dirt cheap, I mean like really dirt cheap.
• 5:05
  Coach Carlie: Anyway, talk us through these, Emily.
• 5:08
  Coach Carlie: I will, I promise I wouldn't grab.
• 5:12
  SPEAKER_01: No, say something if you got something to say.
• 5:15
  SPEAKER_01: But first of all, just wanted to go through the like kind of more standard lab panels.
• 5:20
  SPEAKER_01: You probably, if you go to your PCP like every year or something like that, they'll probably run these just to make they're just like really basic labs for screening for really common conditions like you know, cardiovascular disease, diabetes, anemia.
• 5:34
  SPEAKER_01: So they just want to make sure everything's good on all those ends.
• 5:38
  SPEAKER_01: They're probably gonna have um a complete blood count or a CBC.
• 5:42
  SPEAKER_01: This is measuring um your red blood cells, white blood cells, hemoglobin, hematocrit, and platelets.
• 5:49
  SPEAKER_01: This is like a screening for anemia mainly.
• 5:51
  SPEAKER_01: You also you're also gonna have some sort of metabolic panel, either a basic, a BMP, or a comprehensive, a CMP.
• 5:59
  SPEAKER_01: That will probably get you your fasting glucose, serum calcium, electrolytes, like sodium and potassium and all that stuff, BUN and creatinine, which are measures of kidney function.
• 6:11
  SPEAKER_01: You're and then the CMP will add on liver enzymes, bilirubin for just overall liver function, and then also total protein and albumin.
• 6:21
  Coach Carlie: Yes.
• 6:21
  Coach Carlie: Love that.
• 6:22
  Coach Carlie: So cool.
• 6:23
  Coach Carlie: And then what else, generally speaking, are you gonna do at like a physical?
• 6:27
  Coach Carlie: You get CBC, you get a CMP or a BMP, and then what else?
• 6:31
  SPEAKER_01: You'll probably see the lipid panel.
• 6:33
  SPEAKER_01: This will tell you your uh total triglycerides in your blood, your total cholesterol, as well as the subcategories of cholesterol.
• 6:41
  SPEAKER_01: You've probably heard of the LDL, which is the quote unquote bad cholesterol, and then the HDL, which is the, I guess they call it the good cholesterol.
• 6:49
  SPEAKER_01: So you'll see all those.
• 6:51
  SPEAKER_01: Something that's getting more common now is hemoglobin A1C.
• 6:56
  SPEAKER_01: That's going to measure your overall uh blood glucose for the last like two to three-ish months.
• 7:02
  SPEAKER_01: It's a good indicator of prediabetes or diabetes if it's in certain ranges.
• 7:07
  SPEAKER_01: And then sometimes an iron panel, if they're if you like ask for one, if they're concerned about anemia.
• 7:14
  SPEAKER_01: For athletes, I feel like the iron panel is important, but they don't always do it.
• 7:18
  Coach Carlie: Yeah.
• 7:19
  Coach Carlie: Because usually it's you're not gonna get triggered with an iron panel unless you complain about some sort of excess fatigue.
• 7:25
  Coach Carlie: Sorry, you guys, you're athletes.
• 7:27
  Coach Carlie: At some point you're gonna get tired.
• 7:28
  Coach Carlie: Like it's like it's just part of the equation, but oftentimes that's not gonna be triggered unless your hemoglobin or hermatocrit are low.
• 7:38
  Coach Carlie: And that's not an automatic thing that means your ferritin is low or your iron panel is off.
• 7:45
  Coach Carlie: So I always encourage folks to try to get that one tested.
• 7:48
  Coach Carlie: Um, and we have seen a couple of people who have done our genetic testing do have the hemochromatosis gene and did not know it.
• 7:58
  Coach Carlie: So if they had had their iron panel run, they probably would have been triggered to be like, huh, something is awry.
• 8:07
  Coach Carlie: Yeah.
• 8:08
  Coach Carlie: So, okay.
• 8:09
  Coach Carlie: So that's just kind of like the standard deal.
• 8:13
  Coach Carlie: Generally speaking, you do usually have to ask for an A1C, you do usually have to ask for an iron panel, and then I all I like to add in ferritin to go along with the iron panel.
• 8:23
  Coach Carlie: Um for sure.
• 8:24
  Coach Carlie: Yeah.
• 8:25
  Coach Carlie: So, but CBCs and CMPs are like does get run all the time.
• 8:31
  Coach Carlie: And they're again, like I said, dirt cheap.
• 8:34
  Coach Carlie: Okay.
• 8:34
  Coach Carlie: Ooh, this is a good one.
• 8:36
  Coach Carlie: So yay! We've got some relational workers of heart health.
• 8:41
  Coach Carlie: So tell us apolipoprotein B.
• 8:44
  SPEAKER_01: Yeah.
• 8:44
  SPEAKER_01: So now we're gonna try to get into some of the ones that are like less known or understood, or just kind of if a lot of your your normal labs are fine, but you still have concerns, these are some that you can measure to just check on things.
• 8:59
  SPEAKER_01: So apolipoprotein B, or apoplee for short, this is a protein that's found on the surface of LDL and VLDL cholesterol, which as we uh said earlier is kind of like the quote unquote bad cholesterol that we we want to reduce.
• 9:15
  Coach Carlie: Yes.
• 9:15
  Coach Carlie: And more specifically, because everybody thinks of all LDLs being bad, they're not all bad.
• 9:20
  Coach Carlie: They're not all bad.
• 9:21
  Coach Carlie: Right.
• 9:22
  Coach Carlie: But the VLDLs are bad.
• 9:25
  Coach Carlie: Some LDLs are like, I like to describe them as like big dopey cotton balls that just like, you know, float around in your blood and they're just kind of, you know, whatever.
• 9:34
  Coach Carlie: They're not necessarily hurting anything.
• 9:36
  Coach Carlie: But the VLDLs are like really very low density blood proteins.
• 9:39
  Coach Carlie: So they're very, they're like BB guns.
• 9:42
  Coach Carlie: And those are the ones that go through your system and pick off those plaques that are no bueno.
• 9:49
  Coach Carlie: So go ahead.
• 9:51
  SPEAKER_01: So you might be wondering, like, okay, why is this different than like the standard lipid panel and what they measure there?
• 9:58
  SPEAKER_01: So the standard lipid panel, when they measure your LDL, they're measuring like the weight, or I guess you could say the concentration of LDL in the blood in total.
• 10:09
  SPEAKER_01: While the APOB test is really going to measure how many particles you have, how many LEL particles you have, which can be it can be different because you could have an like an average or normal concentration of LDL in the blood, but somebody who has a lot more of like the cotton ball-y type LDL.
• 10:31
  SPEAKER_01: Big dopey was saying, yes, the big dopey ones, it's gonna be a very different cardiovascular risk than somebody who has a lot of smaller, denser particles.
• 10:42
  SPEAKER_01: And like they're gonna, and the APOB test will show the difference between those.
• 10:47
  SPEAKER_01: They could the because each molecule only has one APOB.
• 10:51
  SPEAKER_01: So the APOB will give you an accurate count of how many particles you have, as opposed to just how much space it takes up in your blood.
• 10:59
  SPEAKER_01: Yeah.
• 11:00
  Coach Carlie: Cool.
• 11:00
  Coach Carlie: And then yeah, I like how you really emphasized here the higher sensitivity and the specificity.
• 11:07
  Coach Carlie: APOB proving to have higher sensitivity and specificity than LDL cholesterol alone, right?
• 11:13
  Coach Carlie: Because so many people are like, oh, your LDL is high.
• 11:16
  Coach Carlie: Let's put you on a stat.
• 11:17
  Coach Carlie: And it's like, no, no, no, let's get more information.
• 11:19
  Coach Carlie: So better marker of predicting cardiovascular risk, right?
• 11:23
  Coach Carlie: Exactly.
• 11:23
  SPEAKER_01: Yeah.
• 11:24
  SPEAKER_01: It's usually more recommended to get an APOB test if you have either high triglycerides, if you have metabolic syndrome, type 2 diabetes, or a family history of cardiovascular disease.
• 11:39
  SPEAKER_01: Because you could be showing higher LDL because of like a genetic thing, but maybe like you're not actually like super at risk for cardiovascular events based on your APOB test.
• 11:51
  SPEAKER_01: You never know.
• 11:52
  Coach Carlie: And of course, you know, we're all nerds here, and uh, we test this because we can in our longevity lab, because we just want a bigger picture uh because that's why people come to us, right?
• 12:03
  Coach Carlie: They oftentimes your standard healthcare provider is like, they don't get the fact that I'm doing Iron Man or I'm riding my bike for multiple hours a day, or you know, even if you're not, even if you're doing sprint triathlons, they're like, wait, what?
• 12:16
  Coach Carlie: You know, well, let's just put you on a stat and you're like, but I you know, and then they're like, be sure to exercise.
• 12:22
  Coach Carlie: And you're like, oh my God, do you know what I like?
• 12:25
  Coach Carlie: Do you know how much I exercise?
• 12:27
  Coach Carlie: Like, this is it's like, no, I've got that covered.
• 12:30
  Coach Carlie: Yeah, I've got that heart covered.
• 12:31
  Coach Carlie: Can you not send me this like really lame note in the portal that's like, be sure to exercise and eat your vegetables?
• 12:38
  Coach Carlie: You're like, you got, I mean, come on, you guys.
• 12:40
  Coach Carlie: So uh, and that sounded really rude to all physicians out there.
• 12:43
  Coach Carlie: I'm so so I'm not it's our medical system is created more for is more of a sick model.
• 12:53
  Coach Carlie: It's more for treating disease.
• 12:56
  Coach Carlie: So why can't we know what this number is on a more regular basis?
• 13:01
  Coach Carlie: So in our longevity lab, we test this annually because we can.
• 13:06
  Coach Carlie: Like, why not have the markers to be proactive about our health rather than, oh, now I see your LDL is high.
• 13:13
  Coach Carlie: Let's go ahead and do all the other numbers when I could have been done doing something about this two years ago, three years ago, 10 years ago, before I even had to know any of this stuff.
• 13:23
  SPEAKER_01: Like preventative rather than reactive.
• 13:25
  SPEAKER_01: Yes, 100%.
• 13:26
  Coach Carlie: Yes.
• 13:27
  Coach Carlie: Okay, what else do we want to know about?
• 13:28
  Coach Carlie: Let's get into this guy.
• 13:30
  SPEAKER_01: Okay, another really good one is magnesium, which I feel like has been getting more hype recently.
• 13:35
  SPEAKER_01: It's so important.
• 13:37
  SPEAKER_01: Magnesium is required by every organ in the body.
• 13:40
  SPEAKER_01: It's in over 300 biochemical reactions.
• 13:44
  SPEAKER_01: That's bananas, if you think about it.
• 13:46
  SPEAKER_01: Isn't it?
• 13:47
  Coach Carlie: Yeah.
• 13:48
  SPEAKER_01: Yeah.
• 13:49
  SPEAKER_01: Keep going.
• 13:50
  Coach Carlie: I love this in the body.
• 13:52
  Coach Carlie: It's so awesome.
• 13:53
  SPEAKER_01: It's involved in so many different processes, like the just to name a few protein synthesis, muscle and nerve function, blood glucose control, energy production, all such important like big things.
• 14:07
  SPEAKER_01: And we know that magnesium deficiency is super common.
• 14:11
  SPEAKER_01: And a lot of people suffer maybe some symptoms that they don't know that it's because of their magnesium.
• 14:17
  SPEAKER_01: It's also kind of uh fickle to measure.
• 14:21
  SPEAKER_01: So a lot of the times, if you want your magnesium measured, they'll uh the lab that will be done is a serum magnesium test uh that'll measure the level of magnesium in your blood, but uh it's not always like super accurate because most of your magnesium is actually in your cells.
• 14:40
  SPEAKER_01: So um you would really rather get a test that measures the magnesium content in your red blood cells, but that can be more expensive sometimes.
• 14:50
  Coach Carlie: Yes.
• 14:50
  Coach Carlie: Yeah, that's uh for anybody in our longevity lab, that's what we test.
• 14:55
  Coach Carlie: Because again, we want a better reflection of what's actually going on.
• 15:00
  Coach Carlie: And of course, working with athletes, um, I'm sorry, has anybody not cramped before?
• 15:06
  Coach Carlie: Or had some sort of muscle issue or fatigue or things like that, you know, and we're losing it in sweat.
• 15:13
  Coach Carlie: We're losing magnesium in sweat, and it's not something that's necessarily well stored.
• 15:18
  Coach Carlie: We have to get it from food, which I love that you have foods high in magnesium.
• 15:22
  Coach Carlie: So for those people who are listening and not watching, you gotta name them off, Emily, because yeah, this is so I will for sure.
• 15:30
  SPEAKER_01: You've got uh pumpkin seeds, black beans, quinoa, flax seeds, Brazil nuts, edamame, cheese seeds, you're probably seeing a pattern here.
• 15:41
  SPEAKER_01: It's a lot of nuts and beans and seeds.
• 15:44
  SPEAKER_01: I do want to mention on that list is also dark chocolate.
• 15:47
  Coach Carlie: So for those out there who like dark chocolate, like not first.
• 15:53
  SPEAKER_01: Yeah.
• 15:54
  SPEAKER_01: But it for a lot of people, it is hard to get a lot of these foods in like super regularly.
• 15:59
  Coach Carlie: So you know, leafy greens.
• 16:01
  Coach Carlie: I know they're not specifically on that list, but yeah.
• 16:04
  Coach Carlie: But yeah, leafy greens for sure.
• 16:05
  Coach Carlie: Yeah, it can be a harder sell.
• 16:07
  Coach Carlie: I get it.
• 16:07
  Coach Carlie: And some people just, you know, listen, if you have preferences, you have preferences.
• 16:11
  Coach Carlie: Like, no, it's okay.
• 16:14
  Coach Carlie: I I remember just being like it's so annoyed when I first started practicing, like, eat your leafy greens, you guys.
• 16:19
  Coach Carlie: And then I'm like, you know what?
• 16:20
  Coach Carlie: Whatever.
• 16:21
  Coach Carlie: We all have different palettes, let's work around it.
• 16:23
  Coach Carlie: Like, it's like if you're being a brat about it, it's one thing.
• 16:27
  Coach Carlie: But if you just can't have it, it's another thing.
• 16:32
  Coach Carlie: So anyway, I think you have one more point on magnesium and then yeah.
• 16:40
  SPEAKER_01: Just because magnesium is so crucial in all these important processes, if you chronically have low magnesium, it can just put you at risk for abnormal heart rhythms and increase your long-term risk of type 2 diabetes and osteoporosis, which no one wants.
• 16:55
  SPEAKER_01: So if you notice that like you don't really eat much of these foods, you might want to get your magnesium checked out and just just be sure you're on the right track.
• 17:04
  Coach Carlie: We've had folks who are are in this situation and they go through full cardiac workups, which is not bad, not a bad thing.
• 17:11
  Coach Carlie: Listen, I'm I'm so here for it.
• 17:13
  Coach Carlie: But then they're finding, like, oh, I just needed some magnesium.
• 17:18
  Coach Carlie: And then I'm I'm good.
• 17:19
  Coach Carlie: But again, I'll I'm all for the workout for sure.
• 17:22
  Coach Carlie: Okay, what's our what's our next uh lab marker?
• 17:25
  SPEAKER_01: All right, vitamin B12, also a very important nutrient that's involved in a ton of processes.
• 17:32
  SPEAKER_01: Making your red blood cells, which take your oxygen around your body, making nerves, making DNA and energy, even more than that.
• 17:41
  SPEAKER_01: We know that B12 deficiency is common in older adults and vegetarians and vegans because uh B12 is only found naturally in animal sources of foods.
• 17:54
  SPEAKER_01: Anyone who's not looking at the slide right now, I've got some pictures of like chicken and cheese and meat and eggs and dairy and all that stuff.
• 18:04
  Coach Carlie: Yep, for sure.
• 18:05
  Coach Carlie: And this is dependent on, I know that you mentioned here like an underlying GI issue.
• 18:12
  Coach Carlie: We talked about this in the bone health podcast too, that in order to adequately absorb B12, you need something called intrinsic factor, which is starts at the initial part of digestion in the stomach.
• 18:25
  Coach Carlie: And if you're on proton pump inhibitors, if you're taking lots of antacids, you could have a B12 deficiency, which of course is really important when you are trying to push your body to the limits and doing all these athletic endeavors.
• 18:40
  Coach Carlie: So, you know, we want to make sure that we're doing good things here.
• 18:44
  Coach Carlie: Also, there are genetic links to vitamin B12 and making sure that you know those, first of all, so that you can optimize and track more effectively.
• 18:56
  Coach Carlie: MMA, did you talk about MMA and not the sport?
• 18:58
  SPEAKER_01: Not yet.
• 18:59
  SPEAKER_01: Yeah, let's let's talk about it.
• 19:02
  SPEAKER_01: So uh kind of like with the whole like magnesium thing, sometimes just measuring like your serum B12 is not going to be the most accurate picture of your B12 status.
• 19:13
  SPEAKER_01: There's a compound called methylmalonic acid or MMA, uh, because that's kind of a mouthful.
• 19:21
  SPEAKER_01: It's um a metab a metabolite that requires B12 to convert back into usable energy for the body.
• 19:30
  SPEAKER_01: And so if you uh it can better measure your B12 status because it accumulates faster than um the deficiency in B12 like shows up.
• 19:42
  SPEAKER_01: So basically, if you measure your MMA through your it's uh either the blood or urine test, and you see that it's elevated, even though your B12 levels are normal, that can be an indicator that there's not as much B12 as you need to convert all that MMA back to energy if you see it accumulating.
• 20:02
  SPEAKER_01: Yeah, interesting, cool.
• 20:04
  Coach Carlie: And again, no shocker, folks, this is in our longevity lab.
• 20:07
  Coach Carlie: And again, we're here to help you translate all this to what does that mean to the food that you need to be eating, supplement strategy in the exercise plan.
• 20:15
  SPEAKER_01: Right.
• 20:15
  SPEAKER_01: Especially if you fall into one of the camps of being like an old older adults or vegetarians and vegans, you might want to consider supplementing.
• 20:24
  Coach Carlie: Yes, and again, nothing wrong with you or if you're if you're a vegetarian or vegan, like it's fine, it's all good.
• 20:31
  Coach Carlie: We can work around that.
• 20:32
  Coach Carlie: But you know, know your genetics and know your numbers.
• 20:35
  Coach Carlie: There you go.
• 20:36
  Coach Carlie: Okay, cool.
• 20:37
  Coach Carlie: Ooh, and on the line of um B12, homocysteine.
• 20:43
  SPEAKER_01: Homocysteine.
• 20:44
  Coach Carlie: Yes.
• 20:45
  SPEAKER_01: Yes, it's very closely related to B12.
• 20:48
  SPEAKER_01: So um we we know that homocysteine is a natural byproduct of metabolizing methionine.
• 20:56
  SPEAKER_01: You might have heard of methionine before.
• 20:58
  SPEAKER_01: It's an essential amino acid that or EAAs is we all like to, you know, uh abbreviate everything.
• 21:05
  Coach Carlie: I get I get my EAAs.
• 21:07
  Coach Carlie: I'm like, okay, good.
• 21:08
  Coach Carlie: All right, cool.
• 21:10
  SPEAKER_01: Yeah.
• 21:10
  Coach Carlie: Methionine is a little bit.
• 21:12
  SPEAKER_01: Yeah, you'll just get that in like regular protein and your body will like break it down.
• 21:17
  SPEAKER_01: So when your body processes methionine, homocysteine is just kind of it's a product of that process.
• 21:24
  SPEAKER_01: And we know that B12 plays a huge role in converting homocysteine back into methionine, and B6 kind of helps convert it to a different amino acid called cysteine.
• 21:38
  SPEAKER_01: So a lot of B vitamins are working to convert homocysteine into other things.
• 21:43
  SPEAKER_01: So if you're deficient in any in the specific B vitamins that play a role, B6, folate, or B12, if you're deficient in any of those, that process is a lot less efficient.
• 21:55
  SPEAKER_01: And so you'll see an elevated level of homocysteine in your blood.
• 22:00
  Coach Carlie: All right.
• 22:01
  Coach Carlie: So, did we go over all of those things?
• 22:03
  Coach Carlie: Some cardiovascular outcomes.
• 22:04
  Coach Carlie: Also, I love this picture that you have if you guys are watching on YouTube.
• 22:08
  Coach Carlie: It's bringing me back to my biochem days.
• 22:11
  Coach Carlie: Biochem, yep.
• 22:12
  Coach Carlie: All the diagrams, all the processes.
• 22:15
  Coach Carlie: All the processes, yep.
• 22:16
  Coach Carlie: So I do like, I do want to point out in that process off to the left, because so many of us are getting things that are fortified.
• 22:24
  Coach Carlie: Anything that's fortified, which again, not necessarily anything wrong with it, but when you see folic acid needs to be converted to five methyl tetrahydrofoliate and goes through that whole process.
• 22:38
  Coach Carlie: Of supporting B12 and all this entire breakdown, some of us just don't convert very well the synthetic version of folic acid to the methylated version of folate.
• 22:53
  Coach Carlie: So, anyway, side note on that.
• 22:56
  Coach Carlie: And same thing with methylated B12 versus the synthetic version, which is often cyanocobalamin.
• 23:04
  Coach Carlie: So if you are taking a multivitamin, look at the label.
• 23:07
  Coach Carlie: If you bought it off of the grocery store shelves and it says cyanocobalamin, that is attached to a molecule of cyanide.
• 23:14
  Coach Carlie: Nobody needs that.
• 23:16
  Coach Carlie: So get on a better quality vitamin, talk to your local dietitian, reach out to us.
• 23:21
  Coach Carlie: We're happy to help you with that whole process.
• 23:23
  Coach Carlie: But you know, I'm on a mission to get people on better quality vitamins and whole foods so that they can do this little diagram all by their lonesome selves.
• 23:36
  Coach Carlie: Yeah, like do it efficiently.
• 23:37
  Coach Carlie: Do it if I'm all I'm all for efficiency.
• 23:39
  Coach Carlie: Anyway, what else do you want to say about homocysteine?
• 23:43
  SPEAKER_01: Yeah.
• 23:43
  SPEAKER_01: So in addition to all those like vitamin deficiencies that elevated homocysteine can catch, we also don't want to see elevated homocysteine because if those levels remain high in your blood, it can contribute to the development of blood clots, artery lining damage.
• 24:00
  SPEAKER_01: And if you like already have developing atherosclerosis, it can make that worse and eventually lead to negative cardiovascular outcomes.
• 24:09
  SPEAKER_01: High homocysteine levels have also in the literature that it's been associated with other chronic diseases and conditions like I don't know, like a lot of neurological ones, like Parkinson's, Alzheimer's, other types of dementia, that kind of thing.
• 24:24
  SPEAKER_01: So if if you have concerns, family histories of any of that, you might want to get your homelysteine checked out.
• 24:31
  Coach Carlie: Yeah.
• 24:31
  Coach Carlie: Again, shameless plug.
• 24:33
  Coach Carlie: Emily did this without I mean, she knows about the longevity label.
• 24:38
  Coach Carlie: But um, this is why we test this in our longevity lab, is for that exact reason.
• 24:44
  Coach Carlie: And I didn't know that about Parkinson's Alzheimer's and dementia.
• 24:48
  Coach Carlie: But when you s when you think through the biochemical process, yeah, why wouldn't that have something to do with not only cardiovascular risk, but also brain health?
• 24:58
  Coach Carlie: Or neurological, neurological health.
• 25:00
  Coach Carlie: Yeah.
• 25:01
  Coach Carlie: Right.
• 25:01
  Coach Carlie: Yeah, oh fascinating.
• 25:04
  Coach Carlie: So good.
• 25:05
  Coach Carlie: Okay.
• 25:05
  Coach Carlie: More nutrients.
• 25:06
  Coach Carlie: More nutrients.
• 25:07
  Coach Carlie: More nutrients.
• 25:08
  Coach Carlie: Okay.
• 25:09
  Coach Carlie: Yes.
• 25:09
  Coach Carlie: I would say definitely check out, yes.
• 25:12
  SPEAKER_01: Check out our last podcast episode on bone health because we we talk a lot about vitamin D there and calcium.
• 25:20
  SPEAKER_01: But just looking at vitamin D right now, we know that it's extremely common to be deficient in vitamin D, about a third of US adults, maybe even a little more.
• 25:31
  SPEAKER_01: Uh most commonly, if you go get a vitamin D test, they're going to measure the 25 hydroxyvitamin D form, which is the primary form that circulates in your blood.
• 25:43
  SPEAKER_01: And they will measure that as opposed to like the active vitamin D in your body because it just has a longer half-life.
• 25:51
  SPEAKER_01: So a little bit of nerding out right there.
• 25:54
  SPEAKER_01: Yeah.
• 25:55
  SPEAKER_01: Love it.
• 25:55
  SPEAKER_01: Yeah.
• 25:56
  SPEAKER_01: There's uh, as we we talked about this a little more in the last episode, but there aren't too many foods that naturally contain vitamin D.
• 26:04
  SPEAKER_01: Um, it includes like fatty fish, beef liver, egg yolks, maybe a little bit in mushrooms.
• 26:12
  SPEAKER_01: But if you struggle to get any of those foods in or don't live in an area where there's a ton of direct sunlight, or just don't go outside much to get that like natural vitamin D, you might want to look towards uh fortified foods and supplementation.
• 26:27
  SPEAKER_01: And a lot of you might have seen a lot of milk and milk alternatives are fortified with vitamin D.
• 26:33
  SPEAKER_01: There's also yogurt and breakfast cereal and orange juice for some reason.
• 26:38
  SPEAKER_01: Those are all fortified with vitamin D as well.
• 26:40
  Coach Carlie: Yeah, for sure.
• 26:41
  Coach Carlie: Usually most people, when they come to me, they're like, yeah, I take vitamin D.
• 26:44
  Coach Carlie: And I'm like, okay, well, what's the brand and how much?
• 26:46
  Coach Carlie: And then they're like, I don't know.
• 26:47
  Coach Carlie: Like, you know, this is it's I would relate it to being like, I have a pair of running shoes, and then I'm like, well, what brand are they and what size are they?
• 26:56
  Coach Carlie: And you're like, I don't know.
• 26:58
  Coach Carlie: I just bought, you know, like I just I was I just bought it off the shelf.
• 27:02
  Coach Carlie: Like, does it matter?
• 27:03
  Coach Carlie: Yes, it matters.
• 27:04
  Coach Carlie: Yes, it does matter very much so.
• 27:06
  Coach Carlie: So I think we're, I don't know.
• 27:09
  Coach Carlie: I just there's so many general recommendations, and I'm just not into general recommendations anymore.
• 27:15
  Coach Carlie: But you know, if you're at least getting like 400 IU, I think that they just boosted it to maybe 800 IU a day as like the general recommendations, but I just get so much more into precision nutrition than general recommendations.
• 27:29
  SPEAKER_01: Right.
• 27:30
  SPEAKER_01: Because like you mentioned earlier, like some people don't convert no vitamin D from the sun into the active form as well.
• 27:38
  Coach Carlie: 800 800 IU is gonna do them a hot bit of nothing.
• 27:42
  Coach Carlie: Yeah, I mean, seriously, like their vitamin D is just gonna be in the tank, and then we're gonna be like, I'm scratching our head, like, why didn't 800 IU work?
• 27:50
  Coach Carlie: And most folks are like, oh, your vitamin D needs a little boost.
• 27:53
  Coach Carlie: Go take a thousand IU a day or two thousand IU a day.
• 27:56
  Coach Carlie: And sometimes you need more than that.
• 27:58
  Coach Carlie: And sometimes you also need like a quick boost, and then we can go to a maintenance dose.
• 28:04
  Coach Carlie: Uh so again, know your metrics and know your brands, know your amounts.
• 28:08
  Coach Carlie: But if you don't care to know your brands and amounts, that's what we help with.
• 28:12
  Coach Carlie: We just tell you what to do, tell you what to take, and then it's up to you to and then try to work with you from a perspective of uh executing it.
• 28:21
  Coach Carlie: You know, because some people are like, I just I don't take pills very well.
• 28:24
  Coach Carlie: There are drops.
• 28:25
  Coach Carlie: There are like, listen, we have ways around these things.
• 28:29
  Coach Carlie: Right.
• 28:29
  Coach Carlie: We will make it as easy as possible so that you can be compliant.
• 28:33
  Coach Carlie: Because if you are not compliant, what's the point?
• 28:36
  Coach Carlie: Anyway, that was the end of my rant.
• 28:38
  Coach Carlie: Let's do that.
• 28:39
  Coach Carlie: Now we have calcium.
• 28:41
  SPEAKER_01: Yes.
• 28:42
  SPEAKER_01: Anyways, we we need the vitamin D and the calcium to ensure our bone health, among other things.
• 28:48
  SPEAKER_01: So I think I mentioned earlier that in the C the the BMP or the CMP like basic labs, they usually measure the serum calcium.
• 28:56
  SPEAKER_01: Yes.
• 28:57
  SPEAKER_01: But usually if you're deficient, if you're not eating enough calcium, if that doesn't really show up in your blood level, because your your body really tightly regulates your blood level of calcium.
• 29:09
  SPEAKER_01: And the bad part is that if that ever drops and you're not eating enough calcium, your body's gonna take calcium from your bones, it's gonna break down some bone and release the calcium from there in order to maintain the blood levels.
• 29:25
  SPEAKER_01: So your bone if you're not eating enough calcium, your bones might be slightly degrading and you don't even know.
• 29:31
  Coach Carlie: Yeah.
• 29:32
  SPEAKER_01: That's the danger.
• 29:34
  SPEAKER_01: So if you want to have a better grasp of what your calcium status actually is, you're gonna want to go get a DEXA scan.
• 29:44
  Coach Carlie: Yep.
• 29:44
  Coach Carlie: Emily, I was like holding my tongue.
• 29:46
  Coach Carlie: I was like, she's gonna say it in my favorite thing.
• 29:49
  SPEAKER_01: And I did a DEXA scan.
• 29:52
  SPEAKER_01: It's it's really, really good.
• 29:53
  SPEAKER_01: It it really tells you um a lot of things, really.
• 29:57
  SPEAKER_01: Your bone mineral density to see if you're eating enough calcium, but then also body composition things, uh, your fat and muscle mass, it will tell you that too.
• 30:07
  Coach Carlie: Yeah.
• 30:08
  Coach Carlie: I have seen, I've seen both.
• 30:09
  Coach Carlie: I've seen the one that uh you can pay out of pocket for.
• 30:12
  Coach Carlie: Of course, it is a medical expense and you can use an HSA FSA card and you can, you know, submit it on your taxes, et cetera, et cetera.
• 30:18
  Coach Carlie: But there are also, if there is any concern of that and your doctor orders it, you can still get a DEXA scan, but you don't get the, you know, cool pictures of broken down, you just get your actual like bone density.
• 30:30
  Coach Carlie: You don't get the pictures of your, here's how much lean body mass you have, here's how much body fat you have, you don't get the literal pictures of your body and seeing what that all looks like, but it still will evaluate your bone health, which is good.
• 30:46
  Coach Carlie: I find it fascinating.
• 30:48
  Coach Carlie: This is such an interesting marker because depending on your calciums, that doesn't necessarily dictate whether you should be cons like having an additional supplement again, like zooming out and seeing what are you more regularly getting in terms of food sources in order to get that.
• 31:03
  Coach Carlie: It does, if you are not eating dairy, um, you have to be a little bit more intentional.
• 31:08
  Coach Carlie: If you're having non-dairy milks, that makes it a little bit easier.
• 31:13
  Coach Carlie: But if a glass of milk or plant milk is somewhere around 400 milligrams, I mean you're still needing to do that's several glass, that's several glasses a day outside of you know, smaller sources of you know, and we got some broccoli and maybe greens.
• 31:28
  Coach Carlie: But anyway, I just find that whole calcium process to be so fascinating.
• 31:35
  Coach Carlie: And your body's acidity is tied into that, and how much protein you're getting, and um, you know, protein and albumin, which are part of your uh CMP2, those are necessary to see what what does that whole process look like rather than oh my calcium is low, therefore I need to supplement.
• 31:54
  Coach Carlie: That is that is not the way you want to go about that particular lab.
• 31:57
  Coach Carlie: There's right.
• 31:58
  SPEAKER_01: There's there's a lot a lot that goes into it.
• 32:02
  Coach Carlie: Yes, for sure.
• 32:03
  Coach Carlie: So that's why I always recommend if you are gonna do direct-to-consumer labs, you need to have somebody supporting you interpreting this.
• 32:11
  Coach Carlie: This is literally why one of our main reasons why we created the longevity lab, which again, shameless plug, theendurance edge.com forward slash longevity.
• 32:19
  Coach Carlie: We go into genetics, we go into specific biomarkers, and then you get the support with interpretation trends so that you can understand your health and your needs, and then work alongside your additional healthcare team for making sure that you're staying on point.
• 32:38
  Coach Carlie: Cause again, so many different healthcare providers don't understand the demands and necessities of an athlete.
• 32:46
  Coach Carlie: And they're just like, Well, you're getting your exercise and you're healthy, so have a nice day.
• 32:52
  Coach Carlie: You're like, but something just seems off, and you know, uh, so you have to advocate for yourself a little bit more.
• 32:58
  Coach Carlie: Anyway, being able to have this process alongside your sport and your coach and being able to interpret all this so that you can make agile changes in your protocols that you are already implementing and making sure that they are fully directed at you.
• 33:17
  Coach Carlie: So uh we don't have a slide about longevity, but it doesn't matter.
• 33:20
  Coach Carlie: So um, you know, endurance edge.com forward slash longevity to learn more about that.
• 33:25
  Coach Carlie: Any Emily, anything else you want to say about labs?
• 33:28
  SPEAKER_01: Um, I guess I have a little personal story.
• 33:31
  SPEAKER_01: Oh, yes, please.
• 33:32
  SPEAKER_01: Yeah, about the the calcium.
• 33:34
  SPEAKER_01: So I was really, I was really lucky when I was growing up.
• 33:37
  SPEAKER_01: I was maybe like 13 or 14.
• 33:39
  SPEAKER_01: I was just getting like my annual physical for like my school sports or whatever.
• 33:42
  SPEAKER_01: I was a I was a track and cross country girl.
• 33:45
  SPEAKER_01: So my pediatrician was going over, she looked at my labs and they were she was like, okay, they're all normal.
• 33:50
  SPEAKER_01: But then I like that she she asked me questions about like my diet too.
• 33:54
  SPEAKER_01: Oh yeah.
• 33:55
  SPEAKER_01: Just to like get a good picture of what was going on.
• 33:58
  SPEAKER_01: And she kind she asked me, like, do you like, do you, do you eat usually eat any dairy?
• 34:03
  SPEAKER_01: And I was like, no, because as a self-proclaimed picky eater, ever since I was a little kid, I've never liked milk, I've never liked cheese, I've never really liked yogurt very much.
• 34:15
  SPEAKER_01: And she was like, but that and and even though my blood calcium was fine, she looked at me and was just like, you need to be eating more calcium.
• 34:24
  SPEAKER_01: Or or like and and she would she like prescribed me a supplement like right there on the spot.
• 34:29
  SPEAKER_01: Like I don't DEXA wasn't like a huge thing back then, but also she knew I was growing.
• 34:35
  SPEAKER_01: I was I was 13 or 14.
• 34:37
  SPEAKER_01: I was still like in puberty and trying to build like my I was growing like taller, my bones.
• 34:44
  SPEAKER_01: She I think she knew that that just wasn't great for my bone health.
• 34:47
  SPEAKER_01: So she she told me to get a cow to get on a calcium supplement, and I did for a while there.
• 34:53
  Coach Carlie: So just just love it when we were talking about it last week, and you're like, huh, I probably should be thinking about that again.
• 34:59
  SPEAKER_01: Yeah, I should probably get maybe get maybe I should get back on it because now I do eat more dairy.
• 35:05
  Coach Carlie: It's so cheap.
• 35:07
  Coach Carlie: I love it.
• 35:08
  Coach Carlie: Uh wow.
• 35:09
  SPEAKER_01: This is a like bonus internship, you know?
• 35:11
  Coach Carlie: Yeah, it's bonus internship, right?
• 35:12
  Coach Carlie: Yeah.
• 35:13
  Coach Carlie: You get workouts, you get you get something like that.
• 35:18
  Coach Carlie: Yeah, totally.
• 35:18
  Coach Carlie: No.
• 35:19
  Coach Carlie: I I wish if I had my way, I wish more pediatricians, more orthopedists, more physical therapists, more folks were referring to dietitians when there is any sort of potential abnormality in that respect.
• 35:37
  Coach Carlie: Like, you know, you're an athlete and you're growing.
• 35:40
  Coach Carlie: Like, go see a sports dietitian.
• 35:42
  SPEAKER_01: Yeah.
• 35:43
  SPEAKER_01: That's what I should have done, honestly, after that visit.
• 35:45
  Coach Carlie: Like, you have anemia, go see a sports dietitian.
• 35:48
  Coach Carlie: Like, physicians see, generally speaking, this has been been my experience, they see 28 patients a day.
• 35:55
  Coach Carlie: I see on a large load, I see seven at the most.
• 36:00
  Coach Carlie: And that's like a day when I I want to like cross my eyes and fall apart because we spend an hour, 30 minutes to an hour with folks, and they don't.
• 36:09
  Coach Carlie: They don't have the luxury of that.
• 36:11
  Coach Carlie: But that's okay, because then we can get into the nitty-gritty details of this is the supplement you should be on.
• 36:19
  Coach Carlie: This is these are the foods that you need to be eating.
• 36:23
  Coach Carlie: And if you don't eat those foods for, you know, because you are gluten-free or because you're lactose intolerant, or because you don't tolerate this protein or have this sensitivity or this allergy or whatever, that's the all the stuff that we do as dietitians.
• 36:36
  Coach Carlie: So, shameless plug for dietitians.
• 36:38
  Coach Carlie: I think we're the heroes of the healthcare industry that can spend deeper time working into these details of your health and wellness such that you can generally go to the doctor less.
• 36:52
  Coach Carlie: Right.
• 36:53
  Coach Carlie: I mean, that's kind of the and I'm all for physicals.
• 36:57
  Coach Carlie: I'm all for that and like regular checkups and all that kind of stuff.
• 37:01
  Coach Carlie: But doctors should not be doing nutrition, period.
• 37:03
  Coach Carlie: End of story.
• 37:04
  Coach Carlie: Yeah.
• 37:04
  Coach Carlie: Like so many people are oh, doctors need to know know more about nutrition.
• 37:09
  Coach Carlie: Absolutely not.
• 37:10
  Coach Carlie: I think that that is a horrible idea because we have spent the time going through that process to work as a collaborative team rather than continuing to send them to more education when they need to be practicing medicine and we can practice dietetics and we can do it better together.
• 37:28
  Coach Carlie: Yes.
• 37:29
  SPEAKER_01: Anyway, I need a like I don't think you don't see people telling doctors to go study physical therapy.
• 37:35
  Coach Carlie: Like that's because that's not their job.
• 37:37
  Coach Carlie: No, it's like it's not their job at all.
• 37:39
  Coach Carlie: And nutrition is not their job.
• 37:41
  Coach Carlie: It's just not.
• 37:42
  Coach Carlie: And yeah, it just it pains me a little bit when so many people are like, oh, this this doctor wrote this nutrition book.
• 37:48
  SPEAKER_01: I'm like, where are the dietitians writing the nutrition books?
• 37:52
  SPEAKER_01: So many doctors also will like prescribe you a supplement or something, and then you just don't get any type of follow-up or like continuity of care until like your next yearly physical.
• 38:04
  SPEAKER_01: Yes.
• 38:05
  SPEAKER_01: It's just with the dietitian, you get so much more regular, like, how's that been going?
• 38:10
  SPEAKER_01: Yes.
• 38:10
  Coach Carlie: Is there any like it is more accountability, more ongoing care, more opportunities to see what motivation is, you know, just working through the ups and downs of what happens, like, okay, so you're an athlete and you're injured.
• 38:22
  Coach Carlie: Does that mean your nutrition needs to change?
• 38:24
  Coach Carlie: Yes.
• 38:25
  Coach Carlie: It does.
• 38:26
  Coach Carlie: Absolutely.
• 38:27
  Coach Carlie: Does that need to be mean that we need to stay on top of your labs?
• 38:30
  Coach Carlie: Yes, absolutely.
• 38:31
  Coach Carlie: And staying on top of your labs as it relates to this podcast is the same great thing to monitor overreaching and monitor overtraining because overreaching happens before overtraining.
• 38:43
  Coach Carlie: Those are things that you can see from the inside out.
• 38:45
  Coach Carlie: Those are things that we can see from your dietary patterns.
• 38:49
  Coach Carlie: I mean, all of this is so important and cheaper.
• 38:56
  Coach Carlie: Like it's cheaper than going to the it's cheaper than going to the doctor.
• 39:00
  Coach Carlie: It is.
• 39:01
  Coach Carlie: Anyway, that is all that is all of my rant.
• 39:03
  Coach Carlie: And this is great, Emily.
• 39:05
  Coach Carlie: Nice work on putting this together.
• 39:07
  SPEAKER_01: Thanks.
• 39:08
  SPEAKER_01: It was a lot of fun and really jogged jogged my jogged my brain there.
• 39:12
  Coach Carlie: That's right.
• 39:12
  Coach Carlie: I know you're gonna be so ready for this test.
• 39:14
  Coach Carlie: I'm excited for you.
• 39:15
  Coach Carlie: Thank you.
• 39:16
  Coach Carlie: All right, well, y'all, thanks for listening to our rants and thanks for listening to the Find Your Edge podcast.
• 39:21
  Coach Carlie: And if there are things that you want us to get deeper into, or whether it be a soapbox or some particular topic, uh let us know.
• 39:29
  Coach Carlie: Reach out, send us a DM on Instagram at the EnduranceEdge, or uh send us a contact us form on our webpage, theenduranceedge.com.
• 39:37
  Coach Carlie: Learn more about our longevity program, theenduranceedge.com forward slash longevity.
• 39:41
  Coach Carlie: And thanks for listening, and we will catch you next time.