Episode #201 – Full Transcript

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Podcast # 201 from https://bengreenfieldfitness.com/2012/07/episode-201-what-to-do-about-knee-pain-that-wont-go-away/

Introduction:  In today’s episode, what to do about knee pain that won’t go away?  Also, can heat acclimating improve fitness, is infinite nutrition good, how to treat runners’ knee, how BMR works, curing piriformis syndrome, should yogurt be a part of your diet, are creatinine levels important, over-training and thyroid stimulating hormone or TSH, and what to eat after lap band or gastric bypass surgery?

Brock: Hey everybody, welcome to another episode of the BenGreenfieldFitness Podcast.  I’m Brock.  And I’m here on Episode 201.  It was really exciting last week to hit 200 isn’t it Ben?

Ben:  Yes.  It was incredibly exciting.  For the rest of my day, I was just on pins and needles.  And this week has been downward spiral in terms of excitement since now.  My kids are at camp all day like nine to five.  And what do people without kids do?  I mean my kids are always here.

Brock:  We enjoy our lives.

Ben:  Seriously, my wife and I have been riding our bikes around.  We’ve been going out to lunch, sitting around during the day watching Hulu.  And it’s like time all of a sudden expands four or five folds as soon as your kids are gone all day.  So, it’s amazing.

Brock:  Yes.

Ben:  We were both talking about our day when we’d probably be over-trained and probably poor from eating out too much if we didn’t have kids.

Brock:  If I didn’t work as hard as I do or if I didn’t work freelance and a full time job, I would have that same problem.  But then I look at my day and think that I work a full-time job and freelance and train and race.  How could I ever have time for kids?  So, it’s the same on both sides.

Ben:  Yes.  What’s amazing is when you have kids and you learn how to be extremely efficient with your time once you have kids.  And then once the kids are gone, it’s just freaking amazing.

Brock:  Just imagine in 18 years.

News Flashes:

Brock:  Alright, Twitter.com/BenGreenfield is the place to go for all the interesting news flashes.  And you can also go to Google+ and look for BenGreenfieldFitness there as well.  And this is the time when we highlight some exciting things that have been tweeted or plus-ed.  Is that what you’d call that or not?  It’s about over the last week.

Ben:  Holy man-boobs batman.  It was the beginning of a tweet I put out a couple of days ago.  We came to a study on soy specifically consumption of a lot of these supplements that have soy in them.  And in this case, it was a study done in men that found elevated estrogen levels of up to 17 times higher than normal.

Brock:  No.

Ben:  It was in men who were consuming plant derived nutritional products specifically plant derived nutritional products that were derived from soy.  We’re talking about soy protein products primarily.  We’ve talked about estrogen dominance on this show before how in guys, we can get stuff like man-boobs, how in ladies, we can get things like propensity to gain weight as you get older.  And this I think is a little bit of a blow against specifically soy protein, unfermented powdered high concentration forms of soy are something to stay away from in this study.  And it backs that up.

Brock:  Yes.  We’ve talked about that before.

Ben:  Be careful if you’re protein powder has soy in it.  You got to be real cautious there.  Another thing that I tweeted and linked to was a nice little chart that has FODMAPS on it.  And if you don’t know what a FODMAP is, it’s an acronym.  And it stands for Fermentable Oligo Dye Di Mono-saccharides and polyols.

Brock:  What?

Ben:  That is a acronym derived by a true geek nutritionist or scientist or somebody or some group of researchers.  But basically, the theory is that foods that contain those types of carbohydrates, those type of highly fermentable carbohydrates.  It can exasperate some of the symptoms of digestive disorders like irritable bowel syndrome or inflammatory bowel disease or just plain gas.  If you’ve got a lot of issues with bloating and flatulence and gas and you’ll always feel like you’re farting more than the average individual.  What you may want to do is just check out this chart.  And I’ll put a link to it in the show notes of course.  This is episode number 201.  And it just shows the most villainous FODMAPS.  It’s a nice little picture, a single pdf.  You can print it.  You can put it on your fridge.  And it shows the fruits that have the most fructose in them.  It shows the most lactose containing foods.  Foods that contain high amounts of fructans which are a little bit different from fructose but you’re going to find those in different forms of vegetables, cereals, and fruit.  The lactans which you’re going to find in some forms of legumes, baked beans are part of the basic example.  And then polyols which are another form of fermentable carbohydrate that you’re going to find in sugar alcohols like sorbitol.  Some vegetables like cauliflower for example and stuff like that.  So basically, if you try to get rid of gas and get rid of irritable bowel syndrome and that type of thing, print this out.  Toss is on your fridge.  And just try limiting those foods for a week and see what happens.  But FODMAPS is what they’re called.

Brock:  So, you’re talking about not fermented foods in the way that yogurt or kimchi.

Ben:  They’re not fermented foods but fermentable foods.

Brock:  So, fermenting in your gut and not in a bowl?

Ben:  Exactly.  It’s not fermenting in the canning jar in your pantry but literally foods that are much prone to ferment in your gut based on bacteria fermentation.  If you’ve got irritable bowel syndrome, gas and stuff like that, you cut those out.  And you can see a pretty stark difference.  So, check that out.  It’s a useful chart for those of you who are struggling with that.  And then the last thing is an interesting article I noted on sugar and what happens specifically when you add phosphate to sugar.  So of course, the characteristic of coke or any other softdrink is that they contain lots of sugar but they also contain lots of phosphate.  And over inJapan, they did a study that showed that when you consume sugar of course your blood glucose will go up.  But when you consume sugar with a high phosphate containing meal or beverage, the rise in blood glucose is significantly higher.  And so, I know that a lot of the folks who listen to this show are already healthy and probably already avoiding softdrinks.  But it is yet another blow against any food that combines sugar and phosphate.  And that would include things like Redbull, Monster Energy Drink, and Rockstar as well.  Be careful with these types of foods because when we’re talking about a steep rise in blood glucose that can be created with that combination of sugar and phosphate.  We’re talking about increased risk of diabetes, insulin insensitivity, obesity, and weight gain and things of that nature.

Brock:  We’ll just stay away from it.

Ben:  That’s right.  So, toss that coke can in the trash Brock and let’s move on to the special announcements.

Brock:  Except that I found this week that Canadian coke is actually the same as Mexican coke.

Ben:  Really?

Brock:  So, that sought after desire for Mexican coke can be handled inCanada.

Ben:  The taste of a coke that is made with glucose is just far superior to fructose regardless to what it does to your blood sugar levels.  And like I mentioned, I am a coke drinker about two or three times a year.  And it’s usually when I’m on a nice long hot bike ride.  But if I can get one of those old school glass bottles of real glucose containing nice fizzy cool coke.  It’s way better than the washed up fructose containing American version.

Brock:  I’ll mail you some fromCanada.

Ben:  Thanks.  Be sure to refrigerate it.

Special Announcements:

Brock:  Okay.  There is cool stuff going on at BenGreenfieldFitness.com as usual.  There are a couple of really great articles especially one circling around Ramadan.

Ben:  Ramadan starts tomorrow actually.  It’s the Muslim fast for about 30 days where from dawn to sunset, you don’t eat.  You don’t drink or anything.  And I coach some folks who are observing it and who still want to continue their pattern of lean muscle gain and fat loss during Ramadan.  They still want to exercise during Ramadan.  So, what I posted on BenGreenfieldFitness this week was how to lose fat and gain muscle during this entire month of fasting.  So, whether you’re observing Ramadan or whether you’re just interested in how to fast and still put on muscle, check that out.  Check out the article.  It would be super helpful for you.  The other thing that you may have heard if you’ve been subscribing to the podcast is that I interviewed ultra-endurance vegan athlete Rich Roll.

Brock:  Yes.

Ben:  And the crazy super foods that you’ve never heard of.   So, if you didn’t get a chance to listen to that interview, you can head over to the podcast show notes over at BenGreenfieldFitness.com.  You can download it.  And you can check that out because there are some interesting super foods on there.

Brock:  He’s a very cool guy too.

Ben:  Yes.  He’s a cool dude.  The other things that I wanted to mention was that if anybody happens to be because I know we have a lot of triathletes that listen in.  If anybody happens to be going over toSpainto compete in the ITU Long Distance World Championships next week, I will be there.  I am the reigning World Champion for the 34-year old age group or whatever the age group is.  And I’ll be going over to defend my gold medal.  So, if you’re going to be inVitoria,Spainnext week, drop me a line.  I’d love to meet you.

Brock:  Olay.

Ben:  Yes.  I’m brushing up on my Spanish.  And the other thing is that the Future of Health Now that we’ve talked about a few times in this podcast.  Those free videos are going to go away this Sunday.  So, if you have not yet claimed your free ten day pass to be able to access that online health event jam-packed with some very cool videos.  Head over to the show notes for this podcast and we’ll link over to them in the show notes.  So, that is all over at BenGreenfieldFitness.com episode number 201.

Eric says:   Hey Ben, this is Eric calling fromAtlanta,Georgia.  I just wanted to let you know that I got your Tri-Ripped program getting ready for a half Ironman that I did back in May.  And the race was awesome.  I did very well for my age group.  It’s very nice especially for a person like me that time can be a big deal.  I’m working full-time.  And I’m also going to school.  So, it’s hard to do a workout.  But the workouts were perfect.  They’re the right kind.  Rest-wise, they’re perfect.  And I really enjoy the strength workout.  They’re pretty good.  Anyway, the full runs with me to the half Ironman.  I won my age group.  And I’m very excited.  I’m using the program again in preparation for another race coming up.  And anyway, I just wanted to let you know.  Thank you so much Ben.  And I really enjoy your podcast.  And I have learned a lot.  So again, thanks.  Take care and goodbye.

Listener Q and A:

Brock:  Alright.  We had a bit of a backlog of audio questions from last week’s show.  And we asked everybody to call in and win a free book if your question was chosen.  So, we’ve actually got a whole bunch of audio questions to kick off this week.  And it’s starting with this question from Gordon.

Ben:  I hope we don’t break bank though.  If your question was featured in episode number 200, I’m e-mailing you a book.  But that is not the practice going forward or else I’d be spending a lot of time at the post office.

Brock:  Yes.  I’m sorry.  I thought I made that clear.  But yes definitely.  That was a celebration.

Ben:  Alright.  But if you do want to ask a question, you can always call in.  We’ll still answer it.

Brock:  Yes, just no free books or chocolate.  Okay, go Gordon.

Gordon:   Hi Ben.  This is Gordon fromAlabama.  I have a topsy-turvy question.  I know pretty well that they documented training in altitude and then racing at sea level is a benefit for the body to become stronger because of the oxygen deprivation at that altitude.  Is it possible to argue the other direction?  And let’s say I live inAlabama.  I train through the summer heat and humidity.  And what that does to the body in terms of the inability to cool and get oxygen to the blood stream with moisture lighten air and all.  Is it possible?  Can you even theorize that it’s possible that one could train at a high humidity and high heat summer of the South and then race in the fall at that altitude?   So, can you go the opposite direction if you’re coming from an area where you’ve had to struggle from heat and humidity all summer long?  I hope that makes sense.  It’s something else and I’ve been thinking about it recently.  And I found last year when I trained for the San Francisco Marathon in the heat and humidity ofAlabama.  And then I got over to the relative cooler temperatures ofSan Franciscoand I had a much stronger race than I expected.  So anyway, I just thought I’d throw that out there and see what you think.  Thanks a lot and I love the show.

Brock:  Alright.  Well, this is interesting.  I guess he, the way I boil this question down, is asking if there’s a real fitness benefit from training in high heat or high humidity.  But those are the situations in the same way that there is training at high elevation.

Ben:  Well, there’s certainly a physiological adaptation that takes place when you’re putting heat stress on your body.  So, you can compare exercising at cool conditions to exercising at hot conditions to see what those adaptations would be.  And it’s one of those deals where any time you’re exercising, you’re going to see a little bit of an increase in your blood volume and a decrease in your resting heart rate.  And there’s an improvement in your oxygen consumption and things of that nature.  But when you compare exercising in the heat to exercising in cool conditions and assuming you’re already exercising.  The main differences that occur are when you’re exercising in the heat.  You basically have an onset of sweat formation at a lower core temperature.  So, your body starts sweating a little bit earlier into exercise.  That’s one of the things that’ll happen.  It’s basically an enhanced cooling mechanism.

Brock:  That’s me.  I start sweating the minute I think about working out.

Ben:  And if you’re heat adapted, that’s going to occur faster than if you’re just in good shape but you haven’t been exercising in the heat.  You’re going to notice an increase in sweat either way.  But you’ll notice it more if you’re heat adapted.  There’s an increase in blood volume.  So, what happens is basically your heart is able to have a higher stroke volume.  It is able to decrease the heart rate for any given work output.  And that allows you to stay a little bit cooler.  You shuttle blood around your body a little bit easier which is one of the main ways that you cool yourself.  It’s carrying blood to the skin’s surface.  And that is going to occur in a greater amount and hot conditions as well.  So, your plasma volume or your blood volume is going to go up once you start exercising.  But it’s going to go up higher if you’re exercising in the heat or if you’re including heat acclamation type of sessions in your training.  There’s decreased core body temperature for any given level of exercise.  That’s going to happen more so of course in heat than in cool conditions although interestingly, skin temperature doesn’t really change that much.  So, it’s mostly your core temperature that’s affected and not your skin temperature and the cool regulation of your body.  Now, when it comes to using heat to prepare yourself to perform at altitude, this is probably the biggest effect that you should know.  It’s that when you exercise in the heat compared to when you exercise in cool conditions, you get improved exercise economy.  And so, what that means is in scientific terms, your oxygen uptake for any given level of exercise is lower.  It means that you’ve improved your ability to produce movements and utilizing less oxygen.  And as you can logically figure out, that adaptation would come in pretty handy when there’s less oxygen available.  And so, if you were going to go compete at altitude or you’re going to go live at elevation for training, yes.  Exercising in the heat could technically help you out quite a bit when it comes to improving your economy or efficiency.  The interesting thing is that there was a study done a few years ago that looked that the effect of exercise in neutral conditions at sea level, at hot conditions at sea level.  It also looked at neutral conditions up at elevation and hot conditions up at elevation.  And as you would’ve expected, the hot conditions at sea level and the neutral conditions at elevation were lower.  Your time to exhaustion was reduced when you were exercising in very hot temperatures at sea level or in just normal temperatures at elevation.  That compared to neutral sea level conditions.  But the interesting thing is, is that the amount to which you get exhausted exercising in the heat at sea level or exercising at elevation are similar.  It means that you can draw a little bit of similarity in terms of the physiological stresses that take place in high temperature at sea level or regular temperature at altitude.  Now of course, it’s important to realize that the stresses form the body are from two entirely different mechanisms.  When you’re exercising in the heat at sea level, the stress is heat.  When you’re exercising at altitude, the stress is lack of oxygen to your body and what’s called respiratory alkalosis.  It’s the rapid hyperventilation breathing off of CO2 while you don’t have much oxygen available and change in the ph of your blood.  But either way, looking at similar stresses and the change in economy or efficiency when you’re exercising in the heat can certainly help you.  However, there are a ton of other things that you can do to acclimate yourself or get yourself ready for altitude.  This would be a good opportunity for me to throw in a shameless plug for a new book that came out over at EndurancePlanet.com.  I didn’t write it.  But we get a ton of questions about altitude training from endurance athletes over at EndurancePlanet.com.  So, Jeff who also listens in to the show lives at the Colorado Mountains.  He trains in the Colorado Mountains.  He’s done it for years.  He’s an expert on elevation.  He wrote an entire guide to elevation.  It’s called Practical Tips for Living, Eating, and Training at Altitude.  I’ll put a link to that in the show notes.  Its seven bucks and its 80 pages jam-packed that you can download right your computer.  You can also get that hard copy for 12 to 13 dollars.  And whether you’re training for Ironman Lake Tahoe or you’re just getting ready for something at altitude, it would certainly be a good read.

Brock:  And only seven bucks, sweet.

Ben:  Yes.

Brock:  Alright.  Let’s move on to this next audio question.  And I’m going to call this fellow BMR man because he didn’t give us his name.

BMR says:     Hello Ben, I love your show and your newsletter.  I have a quick question on BMR.  I’ve done the calculations with a bunch of different ones.  And I’m a 6’2’’ male.  I currently weigh 229 pounds and I go to the gym for the last six months.  I’ve been working out at the gym for four to six times a week.  The BMR calculators basically telling me it’s only somewhere between 2800 and 3000 calories a day.  Now, if I do that, I don’t gain weight but I don’t really lose it or I lose it really slowly like less than a pound a week.  But I do get bigger.  And bigger I mean more muscular.  However, I found if I go down to 1800 to 2000 calories, then I’m losing over 2 pounds a week.  So, I’m just wondering what the best solution is.  Am I doing it right or wrong?  But I try to stick to 2000.  I just take the slow weight loss and eat the 3000 calories or whether it’s 2000 left.  Thank you and goodbye.

Brock:  Okay.  So, first BMR means Basal Metabolic Rate.  Am I right?

Ben:  BMR-man, yes.  It’s Basal Metabolic Rate.  So, that’s how many calories that you burn doing nothing like sitting on a chair or laying on a mat all day as many calories as necessary.

Brock:  I’m lying on a mat.

Ben:  It needs kidneys to filter blood and your lung muscles to automatically function like that type of thing.  So, it’s all those involuntary contractions and reactions that take place.  So, in his BMR, he says that it’s about 2800 to 3000 calories a day.  And you can measure that or you can use a calculator to calculate it like an online calculator.  Now, the thing about the BMR is you can find out how many calories that your body needs to sustain life.  And if you undercut that for too long, you can get what’s called this metabolic reset.  And frankly too many personal trainers and too many nutritionists worry about this too much.  They say that if y9u fast for a day or if you don’t eat as many calories as your body needs, it’s going to down-regulate your metabolic rate. It takes about four weeks for that to actually happen.  And that’s four consistent weeks.  That’s almost 30 days of not eating as many calories as your body needs to sustain life in order for your body to begin to very gradually down-regulate your metabolism.  So, your Basal Metabolic Rate falls.  And this is why you can eat fewer calories than your body actually needs.  You can lose weight consistently.  And you can do that without risking down-regulating your metabolic rate or resetting your metabolism to be lower.  As long as you don’t go for 30 consecutive days doing that, that’s where I like the concept of calorie recycling.  That’s doing five to sixlow calorie days.  Or you do one to two higher calorie days.  Or you do calorie recycling week to week.  You do three weeks lower calorie, one week higher calorie.  It’s the same reason why somebody and we talked about Ramadan.  If you’re going through a month of fasting for Ramadan, I would definitely be throwing in a good five to seven day period after that where you’re eating as much.  If not, slightly more than your body needs so that you’re not risking that down-regulation of your metabolic rate.  And that can come with long term consistent undercutting of calories.  Now, that being said, it’s no surprise here that even when BMR man eats fewer calories that are in his metabolic rate and he gains muscle.  And this is a very strange adaptation that’s been observed in science that flies in the face of thermodynamics.  It’s that you can actually gain muscle when you’re not eating enough calories.  They have observed people to gain muscle on as low as 800 calories a day while lifting weights.  So, it’s very interesting.  You can lose fat and gain muscle while on a very low calorie diet.  Again, you’re going to risk metabolic damage if you go about trying to do that for too long for a period of time.  But there’s no surprise there.  And there’s not a very good scientific explanation for it.  However, my general recommendations to folks when it comes to if you know your Basal Metabolic Rate.  You want to know how many calories you should eat.  It’s that I don’t recommend that you eat anything fewer than 1000 calories underneath your metabolic rate for more than a consecutive week or seven consecutive days.  So, what I mean by that is for example, I’ve had my metabolic rate tested in a physiology lab.  I burn about 3200 calories a day sitting around doing nothing at all.  So, I would never let myself go longer than a week eating fewer than 2200 calories a day.  If I go longer than that, then I find that I get very sluggish.  I start to get really grumpy.  You’re going to find that in literature if you do that for 30 consecutive days, you’re going to down-regulate your metabolic rate.  But I’ve noted it in myself and in my clients that even going longer than a week without a re-feed day.  Or a day that in my case gets me up to at least 3200 calorie range, it’s necessary.  So, that’s basically how you go about doing that.  I just find that going with that calorie cycling five to six days eating.  And if you’re trying to lose weight, you have five to six days eating at least no less than 1000 calories underneath your Basal Metabolic Rate.  And then you have one to two days during the week where you’re eating as many calories as there are in your Basal Metabolic Rate.  It works really well.  So, hopefully that wasn’t too confusing.  But did that make sense Brock?

Brock:  Totally, yes.  I’m still baffled about the whole being able to gain muscle while losing weight if you’re cutting back.  That’s a very cool adaptation.  It’s one of those surprising things that the body just does.

Ben:  Yes.  There’s likely something going on there in terms of remobilization of storage fat.  And there’s some type of physiological adaptation that’s allowing you to build muscle in the presence of inadequate amino acids.  They’re coming from somewhere.  Probably, you’re eating in your left longer or something.

Brock:  Our bodies were made somehow to survive.

Ben:  Yes.

Brock:  Okay.  I feel terrible.  This next question I listened again and again.  And I couldn’t figure out what the name of this person is.  I think its Ty or Tige.  Did you get it Ben?

Ben:  Let’s go with Tige.

Brock:  Yes.  I like it.  I think Tige is an awesome name.

Ben:  Cool.

Tige says:   Good morning Ben and Brock.  My name is Tige calling fromKalama,Washington.  I’m looking for some information on Infinite Nutrition.  They run a program.  You may or may not be familiar with where you can make your own mixtures with protein and without protein for a bike mix and a run mix.  I’m looking for fueling for a half Ironman and the Full Iron distance races.  And in the concept of keeping it simple seems like a good way to go and in a way to custom build a mix that’ll work for your nutritional needs and tastes desires and all that stuff.  Anyway, if you can pry some seat back on infinite nutrition and how that works for feeding on an Iron distance race.  I’d appreciate it.  Thank you very much and enjoy the podcast.

Brock:  Alright, Infinite Nutrition.  Are you familiar with this product?

Ben:  Oh, yes.  I’ve used it before.  I’ve used just about every nutritional product that’s been out there before.  I got a question on the Inner Circle recently on the forum.  Someone was asking me and it wasn’t about Infinite, it was about something else.  And the question was why I don’t use this particular product.  And for me, it was one of those deals where I’ve used everything.  And everything works for me.  And for me, if it isn’t broken, I don’t fix it.  And for me for something like competition, gels work really well.  I know that every race is going to have them.  I can find them anywhere on the planet.  And I don’t have to carry a bunch of zip-lock bags and bags that are full of special powders and mixes with me.  So, that’s what I use.  And it works for me.  And in many cases, there’s more than one way to skin a cat when it comes to what you’re eating to support a marathon or triathlon or something like that.  But Infinite is pretty cool because you go to their website and you’ve got these sliders.  So, there are and I’m pulling it up right now actually so I can do this live.  We’ve got seven sliders on their website.   And when I say slider, what I mean is there’s this slider underneath each category that allows you to choose low or high.  And the categories are flavor, carbohydrate blend, calories, electrolyte blend, protein, amino acid blend, and caffeine.  So, you can combine all that to figure out exactly how many calories you’d want in your custom formulation.  How much sodium you want, you can figure out how much protein you’d want, what carbohydrate plunge you’d want.  And there are a few little things to think about.  First of all, for flavoring and I’m just going to go from the top-down.  For the flavor, all that means is basically what it tastes like or the sweetness.  And Infinite in particularly uses a sucrose as its flavor which is a very small sugar we’ve talked about in the interview with Stacy Simms here on the podcast.  It’s quickly absorbed.  I generally when I can choose the flavor of something that I will be eating during exercise, I go with as low a flavor profile as possible.  It’s because flavors are always just something extra that typically introduce other extra sugars or some type of extra sweetener into a compound.  And I generally just don’t like to mess with that.  So, I go with as low of flavor as possible.  So, if I were going to make a custom blend for my exercise sessions, I would have the flavor blend on the very low end.  Now, for carbohydrates, Infinite uses two different forms of carbohydrates.  You get to choose between dextrose which is a really simple sugar or maltodextrin which is a long chain glucose molecule stuck together.  So, dextrose is just two glucose molecules and maltodextrin is ten plus.  So, one’s a big chain and one’s a small chain.  The advantage of the small chain is it burns quickly.  It’s a quick energy source.  And it doesn’t produce a lot of heat on its oxidation.  And it’s maximally absorbed.  The advantage of the bigger chain carbohydrate is that you can mix it in a higher concentration.  You can sometimes consume more calories from it per hour.  But if you’re trying to exercise really fast for a 10k or a sprint triathlon or something like that, you could limit yourself because it’s got a higher heat of oxidation.  And it can attract a little bit more water and stuff like that into the gut specifically into the colon after hours and hours of exercise.  So, it’s one of those things where you want to be careful with. When I can choose, a like to go a little bit more towards the simple sugar side.  So, for me if I were going to choose a carbohydrate blend for most of my activities, I would choose since anytime I’m fueling, I’m out there for longer than two hours typically.  I would choose something that’s 25 percent dextrose and 75 percent maltodextrin.  They’ve got electrolyte blend on there.  We’ve interviewed Tim Noakes on the podcast before.  We’ve come to the conclusion that electrolytes really aren’t necessary unless you’re out there hammering for three to four days.  So, the electrolyte blends that they’ve chosen, they’ve got magnesium gluconate and calcium gluconate and sodium chloride and potassium chloride.  None of these are going to hurt you.  It’s just a matter of whether or not they’re actually necessary.  I would tend to move those more towards the lower end of the profile just because the more electrolytes you consume during exercise, the more you’re going to lose.  It’s because consumption drives loss.  Were you going to say something?

Brock:  Yes.  Stacy Simms mentioned something about taking if you’re stomach is starting to churn or you feel like you might have a problem with your stomach.  You take Tums, Peppermint Tums.  The calcium blend with that, will it help at all with that situation?

Ben:  Like calcium carbonate coding the stomach the same way that the Tums would?

Brock:  Yes.

Ben:  Yes.  Technically, that’s not the reason that they have it in there.  And I’m not sure how of the amount but if you were to put that electrolyte blend slider all the way to the right.  It’s going to be super salty.  You may get some extra calcium coding your stomach if you tend to get G.I distress.  But why not keep it low and just grab some Peppermint Tums and have those in case your stomach flips.

Brock:  That’s a good point.

Ben:  You got to remember that a lot of electrolytes can have a constipating effect. So, be careful with that too.  That’s why a lot of times the day after an Ironman, you can’t poop.  For protein, they’ve got two different options.  They’ve got a whey protein that you can use.  And then they’ve also got an amino acid blend of branched chain amino acids.  Now, because whey protein has to be broken down and digested, I would have the protein slider for actual protein to go all the way down far to the left before amino acid blend.  It means that the protein has already been predigested and it’s very available for metabolism.  I would actually be dragging that farther to the right.  So, I’d have lower whey protein content but higher amino acid blend content.  And then the last option is caffeine.  That depends.  If you’re going to be out there a long time, I would have caffeine lower because the cumulative effect of caffeine for anybody who’s used a caffeine containing supplement and have been out there competing for four, six, eight, and ten hours.  You start to get a little baddy when you’ve been taking in caffeine for that long if you’re doing more rather than 15 milligrams per hour or about which you’d find in one gel.  So, it depends.  If it’s going to be something super short that you’re making this custom blend for, I’d drag that caffeine slider all the way up if it’s anything two hours or less.  Otherwise, I’d keep it fairly conservative and moderate.  So, it’s fun.  I’ve coached people who’ve used infinite.  I’ve used it before.  I’ve got no issues with it.  I’m not sponsored by them or anything like that.  The sliders are cool if you want to mess around with it and make your own custom formulation.  But we’ll link to it in the show notes.  And you can check it out.

Brock:  That sounds really cool.  I’m might have to give that a try.  Although, I’m like you, I just stick with the gels and water and occasionally some of the gummies.  And it’s just because it’s easy to carry.  You can take it on the plane.

Ben:  Yes.  It’s simple and easy.

Brock:  Okay.  Our next question comes from Joe.

Joe says:   Hey Ben and Brock.  It’s the show again.  I’ve recently just did the Philadelphia Tri and a month after I was diagnosed with patellar tendonitis on both knees.  My doctor put me on a regimen of staying on a high cadence workout and a lot of running and biking.   So, I’ve been on a low gear running back then.  And also, I’m wearing Nitroglycerin Strips on my knees and I’m putting them on the right spot.  Other than that I’ve been doing some random stretching here and there.  I wonder if there’s anything else that I could be doing to get this moving along.  I’ve got three more weeks left in the season.  And I would like to be able to bend down and pick things up.  Thank you and goodbye.

Brock:  Okay.  I had the same problems with Tige’s first name.  I also thought I listened to the –itis happening in your knee a lot of times.  And I wasn’t able to sort it out.  So, it’s inflammation in the knees.

Ben:  Patellar tendonitis.

Brock:  Is that what it was?

Ben:  I’m pretty sure that’s what he said.

Brock:  That’s runner’s knee.

Ben:  Yes, basically.  And I had a horrible patellar tendonitis.  I couldn’t run for nine months.  I couldn’t jog.  I couldn’t sprint.  This was before I was doing triathlon too.  So, I didn’t care that much.  The longest I’ve ever run at that time was one mile.  But it was back when I was playing a lot of volleyball and water polo.  Volleyball was really my big thing.  In my sophomore and junior year at theUniversityofIdaho, I played middle for our men’s volleyball team.  I taught the sand volleyball class.  I would literally be out either out onCoeur d’Aleneon the beach out there.  Or I’d be out at the sand volleyball courts down inMoscow,Idaho.  I’d be out there for two to three hours a day just playing volleyball.  And as you can imagine, you’ve got pretty strong hamstrings and glutes from all that jumping.  And at the same time, I was doing some body building.  So, I was doing a lot of squats, a lot of dead lifts, and stuff like that.

Brock:  You were the guy who kicked sand at my face at the beach weren’t you?

Ben:  Yes and I was wearing my Speedo.

Brock:  Totally.

Ben:  But what happened was I got this hamstring-quad issue that was just out of sight.  I got super tight hamstrings and quads that were not quite up to par compared to my hamstrings.  And what happened was I got a maltracking of my patella or my knee cap.  It’s because you get to the point where the hamstring muscles are pulling back on that thing really hard.  And your quad muscles specifically one part of your quad muscles called VMO or your Vastus Medialis Oblique is not stabilizing that patella properly.  And so, what happens is your knee caps slides all over the place in the femoral groove.  It causes a bunch of pain.  And at the same time that it’s sliding all over the place, it’s also pulled slightly posterior almost into the joint.  So, you get this pain in the back of the joint and in the back of the patella as well.  It’s called chondromalacia patellae or this wearing in the knee cap.  And for me, I was just super confused.  I’m this big strong boy.  I’ve got these strapping legs.  I’m healthy.  And I thought why I have knee pain.  And it got to a point where it was debilitating.  All of a sudden, I couldn’t squat.  I couldn’t jump.  I couldn’t play volleyball.  I couldn’t run around.  And I was really stressed out about it.  And I went in and I saw an orthopedic surgeon.  And I was asking about my knees cut on or something.  And I got an x-ray.  And finally, he takes me his office and he just does some simple functional tests with me on the table.  And he told me that my quads are extremely weak and my hamstrings are really tight, strong, and inflexible.  And so, from the time I walked out of his office, my goal in life was to get my quads strong and my hamstrings more flexible.  I’m one of those all or nothing type of guy.  So, what I did was I started doing a bunch of primarily PNF stretching for my hamstrings.  It’s where I would lie on the ground and I would pull one leg up and stretch it.  And then I would contract it down against my hand really hard for six seconds.  And then I stretch that hamstring again.  And that form of stretching takes advantage of the fact that after you contract the muscle.  In that short window of time after contraction, the muscle relaxes more than it normally would.  And you can pull it even deeper into a stretch.  You can do that yourself.  Or you can do it with a partner.  But it’s called a poprioceptive neuromuscular facilitation or pnf stretching.  I did a ton of pnf stretching for the hamstrings as well as a lot of foam rolling on the back of the leg and in the hamstring.  And simultaneously, I did a ton of quad strengthening.  I started off by simply doing a seated straight leg raise.  It’s where I would sit down on the ground with my legs outstretched in front of me.  I turn my toes slightly out so that I would use more of that inner quad muscle which happens when you turn your toes slightly out.  And I would just raise one leg one hundred times and then I raise the other leg one hundred times.  I just do this until my quads were just burning by keeping them straight.  After that, I progressed to doing that same type of motion.  But at the gym, we had first an elastic band attached to my ankle.  And then I had a cable attached to my ankle.  So, I was just gradually getting my quads stronger and stronger.  I progressed from there to leg extensions which I didn’t do early on because that bending and extending of the leg actually hurt.  But once my quads started to get stronger, I started doing the seated leg extensions.  And it was slow and controlled with the toe turned out.  It’s a seated leg extension machine along with uphill walking on a treadmill.  And it’s where I would focus on having my toes turning slightly out and really think about my quads contracting as I would walk up that hull on the treadmill.  And I just walk until the quads were fatigued up the treadmill for 15 to 20 minutes on a pretty steep incline.  It took me about from the time that I couldn’t run and couldn’t do anything.  It was about a good three to four months of really focused hamstring stretching and quad strengthening.  It was to get myself to the point where I was pain-free.  But since that time, I’ve never ever struggled with anything related to pain on the front of the knee, patellar tendonitis, chondromalacia patellae, any of that stuff.  And it was all just straight up quad strengthening and hamstring strengthening.  So, it was more so than wearing these nitroglycerin strips on your knees or doing high cadence low resistance workouts.  I would be strengthening the quads and stretching the hamstrings.  You can find out if VMO muscle in your quads is weak.  You could sit with your legs stretched out in front of you.  And if you want to put a little roll of towel underneath your legs so that your knees are slightly bent, put your finger in the area of your quadriceps.  It’s where your VMO would be a little tear-drop that’s supposed to be above the knee.  And in a lot of people with this type of pain, it’s just not there.  And what you do is you push your knee down into that towel.  So, you’re basically straightening your leg to almost contract it.  And when you do that, you should feel a pretty strong contraction of this muscle.  You should feel that muscle bulges underneath your fingers.  If it doesn’t, then you’ve got some issues.  And you need to strengthen your VMO.  And I can almost guarantee you if you’ve got patellar tendonitis, you probably got VMO issues.  So, that’s my story.  That’s what I did.  It worked really well.  And that’s where I’d start.

Brock:  It sounds good.  It also sounds remarkably similar to everything that we did in ballet school.

Ben:  Yes.  I would’ve been a good ballerina.

Brock:  You would’ve.  Okay.  Our next question comes from Steve.

Steve says:     Hi Ben and Brock, this is Steve.  And I want to say that you have a great show.  Thanks for all the hard work that you guys are doing.  Congratulations on episode 200.  Here’s my question.  I’m an active 40-year old triathlete.  And I enjoy the half Iron distance as my limit.  And I’ve been dealing with hip and deep glute pain for about a year.  It hurts in general.  It doesn’t hurt me more to swim, cycle, and run.  It tends to flare up after running and also first thing in the morning and after long periods of sitting.  The pain moves around the region.  It varies in intensity.  And it also varies in what it feels like.  Some days it’s just tight, other days still painful and other days it’s a very short sharp pain.  I had an x-ray.  And it did not show any impediments or anything out of place.  I had an MRI and it did not reveal anything except that my injured left side, the piriformis muscle.  And it was much larger than my uninjured side.  I had physical assessments.  And they show nothing to pinpoint the pain except that I have a very weak glute mead need on the injured side.  So, on the injured side, I have a large piriformis and weak glute mead.  I’ve had cortisone injections which provided me no relief.  And I’m just at a loss for what to do next.  Alternative therapies, prolozone, acupuncture, strengthening the weakness, or getting my results, MRI’s, x-rays.  Any advice you would have would be great so I can get rid of this lower pain and the ass.  Thanks guys.  Keep it up. Goodbye.

Ben:  We’ve got a lot of injured callers.

Brock:  Yes.  Steve, I feel your pain.  This is something that I struggle with.  If I let my guard down, I struggle with it.  Otherwise, it’s pretty easy to keep it under control.

Ben:  Yes.  And the way that Steve describes this frustrating issue is just classic piriformis syndrome.  And piriformis syndrome, sometimes it’s sharp, sometimes it’s dull.  You feel it after you’ve been sitting for a long period of time with your hips flexed.  You feel it when you’ve been running or biking with your hips flexed.  It comes and it goes away.  It’s just classic piriformis syndrome.  I’m not a doctor.  This podcast is not for medical advice.  But this sounds very similar to piriformis.  And that’s where I’d be coming at.  And cortisone injections are not going to fix this.  Those are just a band aid.  And the big piriformis that was noted or what would be called hypertrophy in your piriformis, weak glute mead on the injured side.  All of that really points pretty clearly to piriformis pathology.  So, the idea here is that what piriformis syndrome is it’s that it happens when this nerve called your sciatic nerve.  It’s compressed by the actual piriformis muscle in which you’ve noted has gotten bigger.  And when that happens, you get pain.  You get tingly.  You get numbness in your butt down to your lower thigh along your leg.  And it’s frustrating especially if you’re active and even more so if you’re doing chronic repetitive motion activities like running and cycling.  So, the sciatic nerve gets compressed by this piriformis that has somehow gotten too large.  But of course, what you have to look at is how the piriformis got hypertrophy in the first place.  Any time a muscle gets bigger or hypertrophies, specifically a muscle that puts compression on a nerve like that.  It means that muscle is not supposed to be over working.  It’s not supposed to be performing this extra role that it wasn’t designed to do.  But the piriformis will have to do that if for some reason your glutes are not performing the action that they are supposed to do.  So, what happens is when your glutes get inactivated your glutes get weak.  Your glutes aren’t working properly.  A lot of the synergist to the glutes, the muscles that help the glutes out, and this would specifically be your adductor muscles.  It’s the inside of your thigh and then also your piriformis.  And those all have to do extra work.  Now, why would your glutes be weak?  Why would your glutes be inactive?  What typically causes weak glutes or inactive glutes is what’s called reciprocal inhibition.  Reciprocal inhibition occurs when your hip flexors are too tight and your hip flexors are over active.  That turns off your glutes.  And then you get this vicious cycle where you’ve got inactive glutes from tight and overactive hip flexors.  And when those inactive glutes are not working properly, the piriformis and the adductors have to overwork.  That’s how piriformis syndrome actually occurs.  So, how can you fix it?  Basically, you start off by going after the root of the issue which is not weak glutes. That’s not the root of the issue.  The root of the issue is that the glutes aren’t turning down in the first place because the hip flexors are tight.  So, you need to start off by doing a lot of hip flexor stretching.  You can do lunging hip flexor stretch.  We’ve talked about hip flexor stretches on the podcast.  Was it number 200 Brock?

Brock:  Yes.  That was last week.

Ben:  You listen in to episode number 200.  And follow my rule.  I never sit for longer than an hour without standing up and doing some type of lunging hip flexor exercise especially if you work at a computer.  That’s very important.  It’s also very important if you are running, cycling, engaging in any type of forward moving activity that doesn’t involve a lot of lateral stretching and lateral movement.  And you’d be stretching specifically lunging type of hip opener stretches specifically after you’ve finished that activity.  So essentially, hip flexion is that decrease in angle between your thigh and your abdomen.  And that would occur when you’re sitting.  You just never let yourself be in that angle for extended periods of time.  And if you ever are, you really need to stretch before you do anything like running, cycling, or anything that’s going to require those glutes to be working.  It’s because if those hip flexors are tight, the glutes aren’t working, the piriformis and the adductors have to overwork.  So, step one is you stretch out the hip flexors.  To dig yourself out of this hole, yes you absolutely have to get your glutes stronger.  That’s going to involve a lot of lateral rotation exercises.  And I’ll put a link in the show notes for you.  It’s going to be the same link that I put out last week when we talked about extra rotator exercises and IT band.  I’m going to put a link to a pdf in the show notes for you for this episode.  This is episode number 201.  And I’d start doing those glute and external rotator type of exercises every 48 to 72 hours.  Finally, your adductors and your piriformis are going to be in this state of spasm.  They’re going to be on your piriformis specifically you got a little bit of hypertrophy going on.  You need to stretch those babies.  I will put a link to one of my favorite piriformis stretches.  It’s called a seated hip internal rotator stretch.  Basically, you’re just sitting in a cross-legged position as you’re pushing one knee down.  It’s a good stretch for the piriformis.  There are other stretches you can do for your adductors, for the inside of your legs, for your piriformis.  But that seated hip internal rotator stretch really hits the piriformis pretty nicely.  And I like that one.  So, start in to all that stuff.  And that’s what I would do.  The last thing you may want to consider is that if you’re a runner, when your foot strikes the ground and if you’re overpronating.  If you’re turning your shoe too much towards the toe side as your foot lands, that can cause your knee to turn immediately or to turn to the inside.  And that can also overactivate your piriformis muscle.  So, another thing you may want to look into is foot strengthening and possibly an overpronation type of orthodic or like a super feet or custom orthodic.  It used to be that I would tell people to get super feet, get the overpronation orthodic, and get a more built up shoe.  Now, I’m more cautious to mention that you want to go after the root of the problem of overpronation which more often than not just weak foot muscles, weak ankle stabilizers.  And so, whereas you do want to be careful with overpronation, I will be doing a little bit of barefoot work.  Even if it starts off at just like if you work in a computer, try to get a standing workstation like what Brock is using now.  You’re standing up on your bare feet or on some vibrams.  But I’m leaning now more towards because I am myself an overpronator.  And I only wear minimalist shoes or bare feet now.  And I’m leaning more towards the idea of using minimalist shoes and striking the feet vs. covering up the problem with band aids and using a custom orthodic or an overpronation orthodic for something like that.  But that can also be an issue with piriformis syndrome for sure.

Brock:  Yes.  I’m with you on the foot strengthening.  It took me probably two or three years to go from somebody who had to shop who had to shop very specifically for a very specific shoe in order to run without any pain.  And I just slowly started working on the strength. My foot started wearing vibrams.  I started wearing sandals more often.  Like today, I’m wearing my Birkenstocks.  And I think I’ve been wearing my Birkenstocks straight for two months now.  And even when I’m at the office, I’ll kick my shoes off and just walk around bare foot.  And now I feel like I can run in a cardboard box on each foot and not have any problems.

Ben:  Yes.  And you’ve got the vibram shoes that look like monkey shoes.  Nike Frees is okay.  But I want to give a big shout out to Skora Runnnig down inPortland.  I’ve been wearing those shoes.  And they’re just sick.  They’re awesome looking shoes.  They look like Italian designer shoes.  They look great.  I’ll be racing with them inSpain.  I’m sure the Europeans will love them.  It’s a company called Skora out ofPortland.  They’re sweet shoes.  And it’s a minimalist shoe.  And I’m digging it.  So, that’s a good one.

Brock:  Is that Portland, Oregon or Maine?

Ben:  Oregon.

Brock:  Alright, cool.  I’m going to check those out.  Alright, that is it for the audio questions.  So, now we move on to having to hear my dulcet tones.  This question comes from Lisa.

Lisa says:   I just wanted some clarification on the yogurt vs. ice cream question in episode number 200.  In response to this question, Ben suggested that yogurt and dairy in general was something to avoid given its insulinogenic effects.  I took dairy out of my diet for 30 days on the Paleo diet, then cycled some cheese and butter back in since I seem to tolerate dairy fine.  I then added in full-fat yogurt after seeing it on your food pyramid.  I love yogurt with some berries and cinnamon for breakfast or a snack, although I haven’t been eating it long enough to track whether or not it’s affecting my weight loss goals.  But I was confused when I heard this recommendation for yogurt rescinded on the podcast.  Should it not be part of the base of the superhuman food pyramid or am I missing something?

Ben:  Think of it this way and my response to this question will be super long because we did talk about yogurt quite a bit last week.  Yogurt, milk, ice cream, any type of dairy food is pro-growth.  So, use it in a pro-growth state.  Use it post workout.  Use it early morning.  And those would really be the two times a day that you would use something like yogurt.  I love it for its good bacteria.  A raw and pasteurized yogurt, I even like that for its gut-healing effects.  I like yogurt as a rebuilding food for muscle repair and recovery.  But, if yogurt is your snack food while you’re sitting around watching TV or you’re sitting at your office digging into some Dannon.  That’s a pretty good way to introduce a lot of insulin-like growth factor and this strong insulinogenic effect in your body and that can do things like cause weight gain.  So, just remember that dairy is one of those things that eventually you want to categorize as your recovery food or your pro-growth food.  In the two times a day that something like that would most appropriate would be post-workout or in the morning when you’ve first woken up.  It’s breakfast.  You get your body ready for the day.  And you’re putting some nutrients into it.  That would be the time to use yogurt.  And anytime you’ve got foods that I recommend for example in the superhuman food pyramid.  There are definitely considerations when it comes into when and why eat the foods that I recommend.  I’m currently writing a series of articles that go into why I put the foods that I put on the superhuman pyramid where I put them.  There’s an eat category, the moderate category, and the avoid category.  And I’ll certainly be sending out some links to those articles when they’re ready.  In the mean time, if you’re listening in and you want to get the superhuman food pyramid and if you’re in the U.S., just text the word fitness to 411247 or you could go to BenGreenfieldFitness.com.  And there’s a link there on the right side of the page.

Brock:  Cool.  I guess I should stop eating much yogurt before bed.

Ben:  Yes.  If you got to choose between that and ice cream, I’d go for the yogurt.  But it depends too.  For me, I do a lot of early evening workouts.

Brock:  Me, too.

Ben:  That’s great.  It’s going to help you with recovery.  So, it depends.

Brock:  That makes sense.  Okay.  Let’s move on to Jacob’s question.

Jacob says:    I would like to ask you about diet as a way to lower creatinine levels in my blood.  I have, since 11 years of age, had a kidney inflammation called IgA Nephrite.  I have been a swimmer since I was six years old and now, at 44 years of age I’m into triathlon.  Since I train about 12 to 15 hours a week and follow a Paleo diet for athletes to about 80 to 20 rule, the relative amount of protein in my diet has increased.  So, my question is really, what can I do to naturally lower my creatinine in order to help my kidneys?

Ben:  Let me start by saying that I very rarely see an active individual get their creatinine levels tested and have those levels be low.  Creatinine is a by-product of creatine breakdown.  And it doesn’t matter whether or not you’re supplementing with creatine.  Assuming you have a higher amount of creatinine in your blood stream and if you are supplementing with creatine.  But whether or not you’re supplementing with creatine, you’re going to see a fairly high concentration of creatinine plasma and in the urine of active individuals.  Normally, that elevated creatinine can indicate that what’s called your glomerular filtration rate in your kidneys is low.  And when kidney filtration rate is low, it can be a hint that there are issues going on with the kidneys.  But active individuals more often than not, the elevated creatinine is simply due to breakdown of muscle or the type of damage that occurs when you exercise.  So, that’s something to bear in mind.  A better number to look at is you really want to know whether or not the kidneys are doing an adequate job.  It’s to look at a measurement called the BUN which stands for Blood Urea Nitrogen.  And in blood urea nitrogen, you’re still going to see that elevated a little bit especially in athletes and even more so in athletes who are eating a high protein diet.  But that elevated along with creatinine being elevated can be an issue.  There’s one measurement that you’re going to see in some tests that it’s basically a creatinine to Blood Urea Nitrogen ratio.  And if that ratio is really low and Blood Urea Nitrogen is really high especially compared to creatinine, that’s typically more of a red flag than high creatinine levels.  It’s because I’ve had a lot of athletes who have been blood tested and has asked me about why their creatinine levels are so high in their blood.  And a lot of times it’s just goes like elevated liver enzymes that you see.  It’s the same thing.  It’s the elevated liver enzymes a lot of times in athletes and active individuals who are tested.  And it just goes with the territory of muscle and body breakdown.  And in a sedentary population, it’s a red flag.  And in an active population a lot of times, it’s not.  So, blood urea nitrogen is one thing that can be tested.  Creatinine is another thing that could be tested.  I did mention that there was something else.  And that would be albumin.  And if you get a blood test of albumin and you see that elevated in the urine along with elevated blood urea nitrogen and elevated creatinine.  That can indicate that there’s a lot of protein pushed into a glomerular filtration and pushed into the urine.  And the three fold high albumin, high blood urea nitrogen, high creatinine all together can be an issue.  But high creatinine in it itself wouldn’t be too worried about. And it’s one of those things where if you’re an active individual you’re probably going to have that going on anyways.  If you have existing kidney problems, the deal with protein is basically that if you’ve got nice healthy kidneys, protein intake, and a high protein intake is not going to be deleterious for the kidneys.  If you’ve got kidneys that are having issues with filtration and I’m not familiar with this kidney issue that Jacob brought up.  But regardless, in a problematic kidney, protein can aggravate the issues.  It’s because a lot of times when the kidneys are not working properly, they’re not excreting urea or nitrogenous waste products.  And when those aren’t getting excreted, we can get basically this neurotoxicity going on.  And that can be an issue.  So, if you’ve got kidney issues, sometimes lowering protein can help.  And that’s where you substitute protein with higher amounts of fat which is fine to do.  You can get away with about 0.5 grams of protein per pound of body weight and still have enough protein on board to be in a nitrogen balance.  But in healthy individuals, it’s not an issue.  If you’ve got kidney issues, sometimes that excess protein can be an issue.  What I want to point out here though is that for your kidneys, there are things that go way above and beyond protein in terms of their ability to be problematic for kidney function.  And also their ability to damage structures in your kidney.  And there are a few of the things to be aware of when it comes to that.  One would be advanced glycation end products.  That happens when a sugar binds to a protein or a sugar binds to a fat.  These are a lot of the times the type of things you’re going to find in foods that have been heated with a combination of sugar and fats.  Baked goods, a lot of casseroles, a lot of meats that have sweet barbeque sauces on them, any time you can combine sugar, protein, and heat or sugar fat and heat.  That can have a really big propensity to produce glycation end-products.  And that would be one thing that you’d want to avoid.  So, be careful of advanced glycation end-products.  Another thing to be really careful with would be inflammation.  And specifically, one of the things that have been shown to be problematic for kidneys is fructose-based inflammation.  Having a piece of fruit here and there is not an issue.  But if you’ve got a lot of fructose in your diet, what can happen is there can be increase production of MCP-1 which is Monocyte Chemotactic Protein.  And that can cause an elevated immune response that can result in inflammation that can damage some of the components of the kidneys.  So, I would be careful with high fructose.  I would be careful with high consumption of heavily heated foods especially if sugars are present.  And then the last thing I would be careful with is gluten which can also have an inflammatory effect.  And there are some evidence that when it comes to glomerular infiltration in the kidneys.  It’s that gluten and transglutaminase as you’d find in bread and pasta and starches and things of that nature specifically in modern wheat bread products or processed wheat products.  That can be an issue as well.   So, I’d just be careful with that stuff as I would be with the protein.  So, those are some of the considerations when it comes to the kidneys.  I realized that I didn’t address Jacob’s specific kidney issue.  This kidney inflammation issue they talked about specifically.  It’s because I’m not a kidney doctor.  But ultimately, there are things that go above and beyond protein in the diet and creatinine in the urine that I’d worry about.  And those are some of the things to take into consideration.

Brock:  Awesome.  There you go Jacob.  Okay.  Our next question comes fromGary.

Gary says:    My question relates to thyroid stimulating hormone.  I had a blood test five months ago that came out high.  It was 5.03 U per ml.  I have seen it can be  related to a lack of iodine in the diet.  Unfortunately, I live in mainlandEuropethat’s southernGermanywhere there is little iodine in the soil and hence locally grown fruit and especially root vegetables have very little iodine content.  I repeated the blood test last week and I still have an elevated TSH of about 4.37 U per ml.  My doctor has suggested hormone treatment, but I would like to hear if there may be other options.  Also, since elevated TSH can be related to lacking energy and reduced metabolism functions, do you consider it could be related to a series of issues I have recently been suffering such as overtraining symptoms.

Ben:  Yes.  Okay.  So, basically the question is which comes first, the chicken or the egg, when it comes to overtraining and high TSH.  It’s because one of the things that the thyroid does is it helps to protect from gut inflammation.  And so, low activity of thyroid hormones can to increase in gut inflammation which can affect plasma inflammation which can increase propensity of tendons and ligaments to be weak and be injured more in that overtraining effect.  That’s one possible issue.  But typically you see it going in the other direction when it comes to overtraining, hormonal depletion, and sub sequential depletion of thyroid hormones.  Basically, the idea here when it comes to TSH and the way that TSH actually works is just to understand basic thyroid physiology, you’ve  got this little pea sized gland in your brain.  It’s called your hypothalamus.  And that monitors how much thyroid hormone that you have circulating around in your body.  Now, if thyroid hormone is low, that could happen if you’re training a bunch or if you’re just depleting your hormones.  The hypothalamus is going to produce something called thyrotropin-releasing hormone or TRH.  Now, what this TRH does is it acts on a part of your brain that’s below your hypothalamus called your anterior pituitary.  And that causes the pituitary to produce thyroid stimulating hormone or TSH.  And when we see high levels of TSH, sometimes it can mean that the pituitary gland is trying to send this message to your body to get more thyroid hormone circulating.  It’s because what TSH does is it acts on your thyroid gland.  So, your thyroid gland produces T-4 and it produces T-3.  And those are your primary circulating thyroid hormone.  So, you’ve got TRH from the hypothalamus which acts on the pituitary gland which produces TSH which acts on the thyroid gland to produce more T-4 and more T-3.  Now, the thyroid gland is always going to produce a lot more T-4 than it does T-3.  But what happens is that all of this T-4 that’s circulating in the blood stream, it can get converted into the more biologically active form of thyroid hormone which is T-3 when it reaches different tissues and organs.  Specifically, the place where T-4 gets converted into T-3 in the greatest amounts would be your liver and to a limited extent, in also your gut and your skeletal muscle.  So, those are all the places where the hormone conversion actually takes place.  Now, as you can imagine, there are various areas where this whole cycle could get broken.  There’s an entire book that I’ll link to in the show notes for you.  It’s called Why Do I Still Have Thyroid Symptoms When My Lab Tests Are Normal.  But in that book, there are multiple reasons that have gone into which is why TSH maybe high or T-4 and T-3 would be low.  One would be your pituitary gland isn’t functioning at all.  And remember that your pituitary gland is where the whole cascade starts.  In most people, that’s not an issue.  It can be an issue.  But that’s usually not as big of an issue in the general population.  Instead, sometimes some of the other reasons that you can have increased TSH or low levels of circulating thyroid hormones, one would be that cortisol inhibits the conversion of T-4 into T-3.  And this is why I said yes when you asked if overtraining can cause that high TSH.  And a big factor is that inability to convert T-4 to T-3 that’s caused by excess cortisol.  Another thing that can happen is if you’ve got basically a liver that isn’t working really well, if you’ve used a lot of alcohol, a lot of pharmaceuticals.  If you’ve never done something like a liver cleanse, that’s the place where a lot of the T-4 to T-3 conversion takes place.  And you can use things like milk thistle extract and calcium gluconate and some of the same things that I’ve recommended to women.  It’s to help their livers metabolize estrogen more quickly.  You could also use some of that same stuff to support your liver a little bit when it comes to T-4 to T-3 conversion.  Although I suspect that cortisol is probably a bigger issue than a weak liver.  When it comes to some of the other issues with thyroid, a lot of times auto-immunity is a big issue.  And your body actually attacking the thyroid gland or attacking thyroid tissue.  And that’s typically due to inflammatory foods.  If you’re living inGermany and if you’re doing a lot of bread and beer, those are the two things I’d consider cutting out.  And I’d try seeing how your TSH levels respond for sure.  It’s because anything that would increase auto-immune attack on the thyroid specifically gluten containing foods can be a big issue.  And I know I mentioned gluten twice on this podcast.

Brock:  It’s time to have a drink.

Ben:  You’re getting a hint.  Now finally, as far as the iodine part of this question goes, iodine deficiencies certainly can be a fairly common cause of hypothyroidism.  If you are taking an iodine supplement or you’re getting iodine in salt and things of that nature and you’re eating seafood.  A lot of times it’s not an issue.  And as a matter of fact, if you have hypothyroidism and you’re taking in high amounts of iodine.  That can actually increase the propensity for there to be an auto-immune reaction against thyroid tissue.  And it’s specifically because iodine reduces the activity of an enzyme called thyroid peroxidase.  And that’s required for proper thyroid hormone production.  If you take in too much iodine, you can increase the auto-immune attack on the thyroid.  So, be careful with iodine.  One of the things that can protect you against iodine toxicity is selenium.  And that would be something that you’d find for example in fish.  Nuts and seeds have pretty decent content as well.  I wouldn’t be going out of your way to take an iodine supplement.  I would be going out of your way to just eat decent amount of fish and salt your food.  You limit cortisol production by engaging in smart and healthy training program.  And then be careful with gluten.  And a lot of times, in the average person who doesn’t have a full blown hypothyroidism, Hashimoto’s type of thing.  Those are some of the things that basically support a healthy thyroid.  So, if you have been a heavy drinker, if you have had a lot of that German beer, you may want to consider a liver cleanse as well.

Brock:  Sounds good.  There you goGary.  Hopefully that works for you. Okay, actually it’s our final question and not a moment too soon theGreenfield’s chocolate pudding that I had for breakfast is pretty much worn off at this point.

Ben:  Nice.  I didn’t have anything for breakfast.  So, it’s a good time for me too.

Brock:  Alright.  Well, let’s get this last question done then.  It’s from anonymous.

Ben:  I’ll answer in my hypoglycemic funk.

Brock:  Alright.

Anonymous: I have a friend who recently had the lap band gastric bypass surgery.  Do you have any recommendations for what she should take in while on the liquids only phase and then going forward?

Brock:  I thought these were two different things.

Ben:  Yes.  And let me start by saying I’m not a huge fan of lap band surgery as you may have guessed.  Although, you are correct Brock.  It is a little bit different than gastric bypass surgery.  Lap band surgery literally makes your stomach smaller.  You essentially get this band wrapped around your stomach.  So, you get a decreased size of your stomach.  And the reason that I’m not a big fan of it is there are a lot of complications.  One would be that that band that they put on your stomach can slip.  And that can cause a blockage of your stomach outlet called the stoma.  And that can be fairly life-threatening.  Erosion can take place over time.  And what that means is basically you get a lot of inflammation and irritation around the site where that band was placed where the porch to your stomach is.  And that can be tough on the body from an overall inflammation perspective which you know, if you’ve listened to this podcast for over a period of time, can have a pretty stark effect on full body systemic hormone function.  It’s when you’ve got high levels of inflammation from an infection, an irritated skin around your stomach.  And then you could also get some issues with esophageal function.  That’s gastro esophageal reflux, heart burn.  You’ve got a lot of issues in terms of difficulty swallowing and chest pain and even interference with your esophagus’ ability to deliver food and fluid to your stomach.  The interesting thing is that these people, most of them are highly recommended to lose up to ten percent of their excess body weight before they’re allowed to go in for this type of surgery.  And so, my whole head-scratcher here is that if you’re able to lose ten percent of body weight, why have a lap band surgery in the first place.  Anyways, that’s a whole different discussion.  To answer the actual question that Lisa asks, when you first get a lap band surgery, you’ve got to be really careful.  It’s because certain foods are easily lodged in the stomach and can cause a lot of swelling and a lot of discomfort.  That would include any fibrous foods.  So, if you do have fiber-containing foods, you got to very thoroughly chew them.  And typically, if you have vegetables, you have to cook them very well.  You’ve got to be careful with high fat foods specifically sticky high fat foods like peanut butter and any other nut butters like almond butter.  And also any type of dough type of thing like sticky rice or dumplings or anything of that nature even dried fruit.  Pretty much anything sticky can literally lodge in that area and plug up the outlet to your stomach.  You’ve got to be really careful with anything that’s tough or that’s stringy like beef jerky.  Or if you’re eating chicken, it’s the skin of the chicken or anything of that nature.  That can be a big issue.  And then the last thing you’ve got to be careful with is bubbly beverages like carbonated beverages, soda water, and stuff like that.  Those can also cause a lot of discomfort and swelling from that gas in your tiny new stomach can be quite uncomfortable.  So, as far as ultimate eating for life once you’ve had lap band surgery, once you’ve taken into consideration some of those recommendations that I’ve just made.   Most of what I’ve seen is that the whole low carbohydrate approach that we’ve talked about on the show before.  And also be really careful with starches and high amounts of fruit and fruit juices and processed sugars and things of that nature.  And trying to limit anywhere from 50 up to 100 grams per day or 200 hundred to 400 calories per day.  Eat some of the easily digested fats like coconut milk and avocado and stuff like that combined with very moderate amounts of protein.  It’s a pretty decent way to see better results from lap band surgery compared to eating higher amounts of carbohydrates and some of the more traditional easily digested foods like juice and stuff like that.  If you have a lot of trouble post lap band surgery, one thing that I’ve recommended quite a bit that works really well that’s a complete meal replacement.  I take it when I’m traveling.  It digests super easily.  That would be any of the Living Fuel replacement stuff like Living Fuel Super greens, Living Fuel super berry, and Living protein.  I love any of that stuff in terms of it being super easy to digest.  It’s super easy to transport.   And it’s full of everything you need like digestive enzymes, probiotics, vitamins, minerals, nutrients, you name it.  So, that stuff is super cool.  I’ve interviewed the guy who formulated it on the show before, any of the interviews KC Craichy, it’s called Living Fuel.  But that stuff would come in pretty handy in terms of digestibility when it comes to lap band.

Brock:  Fantastic.  And that wraps up episode 201.

Ben:  Wow, cool.  Well, of course as usual, there will be links to everything over in the show notes over at BenGreenfieldFitness.com.  If you’re going toSpain, give me a shout out.  If you get a chance to see those Future of Health Now videos, check them out.

Brock:  Yes.  I’ve been downloading them each day when I get all the links and just putting them right onto my computer and keep them for watching later.

Ben:  Yes.  So, we’ll put a link to that over at BenGreenfieldFitness.com in the show notes.  And you’ve got a little adventure this weekend Brock.  You’ve got half marathon to a sprint triathlon.

Brock:  Yes.  It’s in Rochester,New York.  The yellow jacket running group or fitness group is putting on.  Well first of all, my girlfriend just wanted to do the half marathon.  And I thought I’d go down and do the sprint triathlon.  And then they had a special price if you signed up for both.  So, I decided to do both.

Ben:  Nice.  Brock’s always throwing coaching challenges by the way.  So, it’s a half marathon and a sprint triathlon.  It sounds like a fun weekend.

Brock:  Yes.

Ben:  And I’m actually going to do triathlon this weekend myself.

Brock:  Cool.  Where at?

Ben:  It’s a little tune up race.  It’s up inColville,Washington.  So, it’s called the tiger triathlon.  It’s a really tough, hot, Olympic distance triathlon.  So, I do that.  And this Saturday we’ll release an interview with Doug McGuff on super slow training and a book called Body by Science.  It’s pretty cool stuff.  And we geek out on how strength training can give you a really good cardiovascular aerobic effect.  And then, next week because I will be inSpain, you can look forward to a special episode.  And it will either be a podcast fromSpainor special interview release.  We’ll just have to surprise you with that.

Brock:  I’ll be surprised too.

Ben:  Brock will be surprised too.  So, thanks for listening folks.  And again, check out everything over at BenGreenfieldFitness.com.

For personal nutrition, fitness or triathlon consulting, supplements, books or DVD’s from Ben Greenfield, please visit Pacific Elite Fitness at http://www.pacificfit.net



July 18, 2012 – free podcast: What To Do About Knee Pain That Won't Go Away. Also: can heat acclimating improve fitness, is “Infinite Nutrition” good, how BMR works, curing piriformis syndrome, should yogurt be a part of your diet, are creatinine levels important, over-training and thyroid stimulating hormone (TSH), and what to eat after lap band or gastric bypass surgery?

Have a podcast question for Ben? click Ask a Podcast Question at the bottom of this page, Skype to “pacificfit” or scroll down on this post to access the free “Ask Ben” form.

If you have trouble listening, downloading, or transferring to your mp3 player just e-mail [email protected]. Also, please don't forget to leave the podcast a ranking in iTunes – it only takes a minute of your time and it helps grow our healthy community!


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Special Announcements:

The Future Of Health Now – Videos are Live, Free and Available!

Ben is going to Spain – drop him a note if you happen to going to The 2012 ITU Long Distance Triathlon World Championships in Vitoria-Gasteiz, Spain on July 29.

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Listener Q&A:

As compiled and read by Brock, the Ben Greenfield Fitness Podcast “sidekick”.

Audio Question from Gordon:
Is it possible to get a benefit from training in high heat and high humidity to then race in a cooler and possibly (but not necessarily) higher elevation?

~ In my response, I mention Endurance Planet's Guide To Elevation.

Audio Question from BMR Man:
He is 6'2″, weighs 229lbs. BMR calculation says 2800 – 3000 calories a day. If he does that he doesn't gain weight but he loses weight slowly while also gaining muscle. Is he doing that right or should he be cutting back to 2000 calories?

Audio Question from Tige:
Looking for information on the product Infinite Nutrition. Fueling for 70.3 and Full Iron distance.

Audio Question from Joe:
Joe just did the Philly Tri. Has now been diagnosed with… some sort of “itis”… in both knees. Doing high cadence low resistance workouts and wearing Nitro Glycerine strips on his knees. Is there anything else he should be doing to help get this moving along.

Audio Question from Steve:
40-year-old triathlete. Like 70.3 distance. Has hip, glute pain that flairs up after running, first thing in the morning and after sitting for a long time. Had Xray and MRI with did not reveal anything except that he has a larger peraformis and a weak glute med on the injured side. Cortisone injection provided no relief. What should he try next?

~ In my response to Steve, I mention these exercises and this stretch.

Lisa asks:
I just wanted some clarification on the yogurt vs. ice cream question in episode #200. In response to this question, Ben suggested that yogurt and dairy in general was something to avoid given its insulinogenic effects. I took dairy out of my diet for 30 days on the Paleo diet, then cycled some cheese and butter back in since I seem to tolerate dairy fine. I then added in full-fat yogurt after seeing it on your food pyramid. I LOVE yogurt with some berries and cinnamon for breakfast or a snack, although I haven't been eating it long enough to track whether or not it's affecting my weight loss goals. But I was confused when I heard this recommendation for yogurt rescinded on the podcast. Should it not be part of the base of the superhuman food pyramid or am I missing something?

Jakob asks:
I would like to ask you about diet as a way to lower creatinine levels in my blood. I have, since 11yrs of age, had a kidney inflammation called IgA Nefrite. I have been a swimmer since I was 6yrs old and now, at 44yrs of age I'm into Triathlon. Since I train about 12-15 hours a week and follow a Paleo diet for Athletes (Joe Friel et al. ) to about 80-20 rule, the relative amount of protein in my diet has increased. So my question is really, what can I do to naturally lower my creatinine in order to help my kidneys ?

Gary asks:
My question relates to thyroid stimulating hormone. I had a blood test 5 months ago that came out high (5.03 uU/ml). I have seen it can be related to a lack of Iodine in the diet. Unfortunately, I live in mainland Europe (southern Germany) where there is little iodine in the soil and hence locally grown fruit and especially root vegetables have very little iodine content. I repeated the blood test last week and I still have an elevated TSH (4.37uU/ml). My doctor has suggested hormone treatment, but I would like to hear if there may be other options. Also, since elevated TSH can be related to lacking energy and reduced metabolism functions, do you consider it could be related to a series of issues I have recently been suffering such as overtraining symptoms.

~ In my response, I recommend the book “Why Do I Still Have Thyroid Symptoms When My Lab Tests Are Normal?

Anonymous asks:
I have a friend who recently had the lap band gastric bypass surgery. Do you have any recommendations for what she should take in while on the liquids only phase and then going forward.

~ In my response, I mention the LivingFuel supplements at www.pacificfit.net



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