RED-s with Ida Heikura PhD | Koopcast Episode 121

trail and ultra runners what is going on what's happening welcome to another episode of the KoopCast as always i'm your humble host coach Jason Koop and this episode of the podcast is about a topic that is going to be familiar with most trail and ultra runners and runners at large and that is because it is one of the hottest nutrition topics in the world today and that is relative energy deficiency in sport otherwise known by its two acronyms reds or red s depending upon where and whom you hear that acronym enunciated this is a topic that is relatively new and as the discrepancy and the acronym might actually imply we're still trying to wrap our heads around the term as athletes and as coaches reds is an evolution of what was previously known as the female athlete triad and while the change in naming convention might seem trite to some make no mistake that the name change is important to better educate and understand things within this topic so to unpack this all and why reds is so problematic and in particularly problematic for ultra runners who have a high energy demand in the first place due to their training on the podcast today we have ida hekera who

originally hails from finland was schooled underneath the esteemed luis burke in australia and now finds herself working for the reds working group for canadian high performance sport where they have this extremely compelling project that is currently underway where they're trying to educate athletes coaches and support staff including parents on reds as well as gather information from the athletes themselves to determine best practices of particular note during this podcast one of the things i wanted to explore was this confluence between relative energy deficiency low energy availability which i've done a podcast on that previously and i'll link that up in the show notes and low carbohydrate availability and figure out which one of these could potentially be a trigger for any of the negative outcomes associated with relative energy deficiency so with that as a bit of a backdrop i'm going to get right out of the way here's my conversation all about reds with ida hekera i'm glad you could actually uh finally come on the podcast i remember when i originally reached out to you it was kind of underneath a different context and i think you're actually working with um uh with luis burke's group is that correct um i was i was with voice from 2016 or 2015 almost um until 2020 so i

i was there but then and i spent six months in philand after that before coming to canada but i've been in canada for 18 months now so uh yeah definitely a long time with luis i think it just goes to speak sometimes i reach out to these guests and it takes for forever to schedule everything so i'm glad we could i'm glad we could bring you back on i think to start out with um something for the listeners to kind of get to know you a little bit better is how you initially started out with uh the australian institute for sport and then relocated to canada and what's your what like what you're what you were involved with during that transition um yes i guess um i'm originally from philand and i did my master's in exercise physiology um in at the university of uvascular um in philand and then i went to australia to do a PhD with louise uh professor louise burke and also tion holly and dr trent stellingworth um who i work with now um he was assistant supervisor for the PhD uh but i went to australia in 2016 i stayed almost four years did my PhD there um it was an amazing experience um i got to do a be a part of a lot of um the research going on um at the australian institute of sport and it's um it's amazing opportunity really with the facilities you have um over there so all the supernova studies

are from from uh from the ais um and currently louise uh is with acus australian catholic university but they continue um similar research and i left the ais um or acus australia early 2020 um i plans to come to canada we had applications and everything underway with covid and all that stuff i spent six months in finland um working kind of as a combined research uh practice role um with three different institutions so there was university of yes vascular there's uh the helsing metropolitan sports academy and then the research institute for olympic sports so that was six months kind of transition period which was a cool change from the being a PhD student uh to doing something different and then 18 months ago i i arrived in canada and now i work as a postdoc fellow with dr trent stellingworth and his team that's a that's a really good pedigree and i think it's it kind of goes without saying but the listeners should kind of understand that that that is a lot of uh high level expertise that you have had the opportunity to uh to work with and that type of exit that type of expertise to continually be under like all of those different

mentors for the period of time that that you've been working with them it's kind of irreplaceable i mean you get so much experience working with those experienced people that it's uh it like i said it's just a really it's a really cool background one that i'm the that i'm sure you are very appreciative of but it actually shows up in your work a lot as well oh thank you i appreciate that it's definitely um i feel really lucky that i kind of not by accident but kind of just um i didn't want to go to australia and then things kind of just it was a much better experience than i hadn't even thought it could be so i'm really really lucky that i was able to to have that opportunity and then yeah to come here um it's been awesome so just um i can be happier with those choices really i wouldn't change anything going back so um definitely really really lucky yeah good for you i feel like 10 or 20 years from now like you're going to be the person that's at the you're going to be one of the people that are kind of at the top of the pile when we start to talk about things in sports science so one of the the topic du jour today is we're going to talk about reds and this has been oh this has been a really cool topic that's come up recently uh in sports science and in particular in in particular endurance sports um and uh i think that uh to kick things off to kick things off we've got to have a little bit of a history lesson and how this acronym kind of came about and why like why the

why why this current transition from what the what this like set of conditions was known as previously why is it why is the vocabulary important on this so since you've been at the forefront can you kind of take the listeners through this transition first and then we're going to get into some like practical aspects of it definitely um so yeah it's always good to go back um so i guess if you go we go way back um around 30 35 years ago um it was discovered that female athletes with um eating disorders or disordered eating behavior also showed symptoms of amenorrhea so lack of periods or regular periods and these um individuals also often showed poor bone mineral density so um and then research researchers kind of combined this um zentrum into female athlete triad so there's the bone there's the menstrual cycle and then the eating disorder um category and um they had the first consensus statement um in the 1990s it was further developed in 2007 um when the experts realized that it's actually a continuum from health to disease so the athlete can have extreme conditions of eating disorders amenorrhea and osteoporosis but they can also have some mild menstrual disturbances or some uh poor but

not clinically osteoporosis so poor bone mineral density uh they can also have um disordered eating behaviors so some kind of uh orthorexia or um some issues with dietary intake but not anorexia um to speak with they also realized that low energy availability is the underlying condition behind this syndrome and what low energy availability means is uh when we talk about energy availability it refers to the energy intake um minus exercise energy expenditure and its factor for battery mass so it's the energy available after exercise training for other body systems to to be used and the concept concept is based on professor and logs studies from 30 to 20 years ago and she had a lot of lab based um really uh clinical and well-designed studies in sedentary females usually four to five days of duration and they tested different levels of energy availability from 45 calories per kilo fat free mass down all the way to 10 calories per kilo fat free mass and how those different energy availability levels affect um several hormones or bone marker concentrations of females and they showed that when energy availability goes down those markers also

get impaired so markers of um hormones uh several reproductive or metabolic hormones go down course cell goes up markers of bone formation go down markers of bone resorption and go up um so several uh detrimental effects up here and they defined the threshold of one's availability in these sedentary females as 30 calories per kilo fat free mass but with some markers showing impairments at higher levels and with some markers showing impairments at lower levels they also did studies uh with um comparisons of diet versus exercise induced longevity but we can go to that later on but basically those studies from the foundation of longevity availability being the underlying um cause for the symptoms of the female athlete triad and then i guess um in 2014 when reds so relative energy deficiency in sport was um formed it was for several reasons one of the reasons was to include males in the in the concept as well because it was realized that male athletes do suffer from the effects of longevity uh maybe not to the same extent as female athletes females may definitely be more susceptible to the effects of um longevity but male athletes do definitely also

suffer from the consequences of longevity uh it was also to acknowledge the fact that there is other body systems involved or affected by longevity not just the bone and the reproductive um system um but the same thing as with the triad longevity was uh acknowledged as the underlying factor or the development development of reds and the reds if you look at them the wheels then it still includes the triad as as a component there but just wants to emphasize the fact that it's a much uh broader um syndrome than just the triad yeah and it what's interesting and pervasive throughout that entire history is that low energy availability seems to be kind of at the linchpin of everything it almost seems to be like the start point to which all of these different things emanate and i know that your group in canada actually has a actually has a working group that is starting to study relative energy deficiency in sport and try to understand it a little bit better can you explain to the listeners like what that working group is like and what things that you y'all are trying to uncover um yeah yes i was really fortunate to to join a group when i came to canada it was um started a year before i arrived here but

uh there's several goals or aims of the group one is definitely education and increasing the awareness of reds among athletes but also the support staff so coaches physios anyone really parents because we know that the some of the outcomes of reds or prolonged long-range availability such as um you know impaired bone density can be really difficult to reverse some of them might be even irreversible so prevention is definitely key and to prevent something we need to increase the awareness so one of the the goals of the group has been to develop an education module on reds and that should be almost ready um to be online in the next month or two i suppose but then alongside that we've got several research projects um going on around the topic of reds and one of the studies is um the postdoc study that i'm working on with um leading the study with dr turen stellingworth and um that's that's a pan canadian kind of a multi-center research study where the main goal is to to we screen athletes for different symptoms of um potential symptoms of reds so we've got a potential symptoms of red so we've got an online survey we do bone density scans we look at several blood markers of hormones and we do resting metabolic rate testing so all of the potential

um outcomes or symptoms of reds we try to screen athletes for those symptoms and hopefully towards the end of the end of the study we'll be able to have a better idea of what kinds of symptoms should we be looking for when we screen athletes for reds to be able to to kind of filter through the athletes with potential risk factors early on to then not let the longevity develop into a full-blown reds case i'm interested to know a little bit more about this since you're interfacing with such a broad array of people that are in the athletic space i mean you mentioned athletes coaches researchers parents that you guys are trying to try trying to educate and trying to trying to really get in front of the problem before it actually starts to manifest itself into something that's a big issue because as you mentioned the consequences can actually last years and can it can and in some cases can be irreversible so it's definitely a problem worth getting in front of versus trying to like course correct all the time but i'm curious to know when you when you as you are getting in front of these all these different groups of people that interface with athletes in different ways what are some of like the main themes that you are seeing when you're trying to educate these people and and how can like the listeners take that away into something like tangible like what are like the main pieces of education that you're trying to impart on

those groups uh well the education is um and the increasing of awareness is something we we are only starting to work on now so i i didn't have experience from working with this working group from like what it actually looks like but but some of the things that definitely are um not really an issue but just a thing that really arises often is several misconceptions among athletes and coaches and even physicians so some of the athletes and even physicians might still and coaches must still think that a female athlete who misses their period that that's a normal sign of heavy training and we know that's not true but that's something they might even think if i miss my period that's awesome now i know that i train hard enough and i can just keep going which is not true but most of the people still seem to think that way another misconception that's quite common is if i don't have an eating disorder then i don't i can't have longevity and that's also not true so you don't have to have eating disorder or disordered eating behavior to develop rats some of the rats cases might be elite male heavyweight rowers or soccer players who just expend so much that even though they really eat a lot they

just can't keep up with the expenditures and this is the issue in ultra marathon running right that i always come back to with registered dietitians and people in the space is it's such an energetically intensive sport that it's hard it's hard to keep up with the caloric demands kind of from two different angles right one is the sheer number of the just the sheer number of calories that you have to consume when you're when you're when you're training heavily but also problem but but also and i would say even more problematic than that for athletes to figure out and coaches like myself to figure out is kind of the daily discrepancy of caloric expenditure that athletes go through not that it's a bank balance that you have to you know pay back every hour or something like that but when you have like a 10 000 kilojoule day followed by a 2500 uh or 20 uh 2500 kilojoule day that that five fold or four fold discrepancy in caloric expenditure when you're kind of cycling in and cycling out of that is actually a kind of a problematic thing for a lot of athletes to to to kind of to to get a grip on and a lot of the times it ends up slowly manifesting itself and this low energy availability it's not one day but it's several days and several weeks that all of a sudden kind of like dog pile upon an athlete and before they know it they're in a they're in a they're in a real pickle and it takes a long time to recover from

that that's definitely that's a good point and i think like we still don't know enough of how much kind of the small like a short-term longevity will affect but we do think that if you across a week or two weeks average with optimal or okay levels of energy availability that will mitigate the effects of one or two days of deep when you have really low energy availability i guess the issue is with athletes like you just mentioned um if you have a really big training day you can't keep up with the levels of energy needs and then the next day if you're not hungry or you try to just match the the rest day or low activity delay day um energy requirements then you will develop them long-term launch availability yeah and that's the council that we've been trying to relay to athletes is that you have to think about things on like a and i don't know the answer to this either maybe you kind of you kind of illuminated the the this this we don't really know right what the short-term effects actually are from a pragmatic perspective i've always kind of used like a three or four day rolling average like if we look at that and we try to balance it on a three or four day rolling average then it then everything tends to work out but that's just me kind of guessing and all full admission like i don't think that that's the that's the perfect answer nor is science really uncovered it i think like i'll definitely go with something like that uh we had a field study with athletes which

uh always when you try to estimate or calculate energy volatility it's it's really tricky but what we did was with um elite cyclists over eight days where they had four days of racing we um recorded all the food intake and then got really accurate estimates of energy expenditure from power meters and those cyclists on the four racing days their energy volatility was almost zero or five like super low but then on resting days or training days in between and your quality was maybe 60 or 55 so they averaged over the whole eight day period around 36 calories per kilo of fat for a mass which is above the threshold and the threshold has been established for females so for males the threshold might actually be lower but what we found was over that eight day field study period the hormones and everything like the levels stayed fine so we think that if you average over a week or so period a longer term um and your ability that's normal or optimal then those one or two day really low levels should be manageable yeah i know the study that you're referencing and interestingly enough uh we we use that and then some some very similar research in uh some of the training protocols that we use particularly when we're designing like camps for athletes so for normal athletes right they can get away for like a three or four day camp

and they can increase their training volume by usually threefold right which is a typical cycling you know cycling stage race type of setup you race for three or four days in a row so they're all very very hard you can't keep up with energy demands but then you can kind of make it up make it up on the back end so it's interesting to see all these things kind of confluence right what we see in the field from a training perspective but also what gets illuminated from the races when we're looking at it in this cycling stage race stage racing concept it's so funny that you just mentioned that because i was going over that with one of my colleagues just the other day that's so cool that's that's awesome um i want to talk about another uh piece of uh uh uh research and and really some commentary that you guys have put out in the space and that's this that's this overlap that we've already really alluded to with overtraining syndrome and reds and low energy availability which always gets put into like this sports science goulash that we try to that we try to that we try to unwind and i'm going to leave a link in the show notes to the to the uh to the paper itself um i think it's really i think it's one of those papers that's really accessible for normal people to understand so if people want to go check it out and they can absolutely read it um but i want to know what your like what your takeaways from this paper well first we can kind of talk about the construction of it right and why this why this paper is important and why you decided to like tap tackle this this enormous

uh this this enormous topic and kind of basically unwind all of these different pathways that get entangled um yeah so the paper you're referring to is the um then i guess the discussion we had over uh overtraining syndrome and reds and if they are um originated in the same from the same um longevity ability and if sometimes they might be confused so or overtraining syndrome might be confused um as overtraining when it's actually under fueling um so the review we wrote is a narrative review so it's not that if you do a systematic meta-analysis it's it's a much more strict protocol you have to follow a narrative review it can be a bit more freely and creatively written i guess um but the main idea there was um we still don't know with overtraining syndrome how to diagnose it's it's a diagnosis of exclusion you exclude clinically every condition possible even um poor dietary intakes and then you come up with um this must be overtraining if the athlete is tired and poorly performing or performance is decreasing and uh although overtraining syndrome is a lot uh older concept than the breads currently uh reds is also a similar kind of diagnosis of exclusion almost um that exclude other uh clinical

conditions and then you come up with um potential reds but what's interesting with both of these so with overtraining we usually think that it's the increase in training load or energy expenditure that then the athlete can't really handle and it develops into um poor adaptation and increased fatigue and then with reds um it's more often the lack of or it is lack of energy available available but it can be as a result of uh increased training loads or increased exercise energy expenditure or decrease in energy intake or a combination of both such as the imbalance which leads to launch availability uh so that was the main i guess underlying um idea or hypothesis um behind um the review and how we kind of started working towards it was we went through all the studies that we could find uh you can't really find actual overtraining interventions it's ethically not okay to drive people into that state but you can find studies of um intensive training loads which then lead to some sort of um functional overreaching so which is less severe than overtraining syndrome so we went through all the literature and all the studies we could find that fit the training overload um topic uh mostly this is endurance based research or

industry endurance training and then with all the studies uh we only chose studies that also reported energy um or dietary intakes to calculate energy intake and possibly energy availability i think we had two studies who did the energy availability calculations in the paper but with the rest we tried to estimate um initial ability um that's really hard like i just want to point that out like you're like you're just going through this like oh we just tried to estimate it's like that's really freaking hard to do like i appreciate you guys going to the those lengths to try to figure that out it's it's definitely it was it was a ton of work but it was really cool as well to to go through and then especially when you started going through and then you actually start finding them the trends there being well actually most of these intervention groups it's this paper says that it's it's overreaching or for training adaptation because the overload they also seem to have poor energy availability or poor carbohydrate availability or both uh so it was really cool and that was that was something we had to do to to give some basis for the hypothesis we had um originally and when going through the studies we could show a link there um it was a ton of work but it was really cool cool to to find what we anticipated we might find um going through the papers um so i guess eventually we found 21 papers uh that had some sort of

a training overload intervention or observation and that also recorded reported um energy energy energy intakes for us to be able to calculate or estimate energy availability uh differences between groups or from pre to post and of the 21 papers and of the 21 papers we found 18 papers it show poor energy availability or poor carbohydrate availability in the either the intervention group or then from pre to post um so at the same time as they showed some sort of over training or overreaching there was a dietary component present which then gave us some further support for the hypothesis that maybe some of the at least some of the over training or over reaching cases might actually be rats or a result of low energy availability and maybe we focused on the fueling part of the equation during the heavy overload some of the cases might actually um be fine they wouldn't be showing the symptoms that they did in those studies well and here's i think here's the crux of of it and this the the the analysis that you did really uh illuminates this very well is that we use this term over training syndrome in an incorrect fashion because it's not actually training that is over

in almost all cases certainly you can have too much training but that's very very very rare normally what results in this bag of symptoms that you try to that that you try to identify with an athlete is that they're either as you started out by saying they're either under recovering or under fueling which is the root cause of things if it were truly over training you can simply remove the training and they would get better but we don't actually see that in almost all cases they actually need to increase their energy intake in order to course correct the symptoms which is exactly what you were describing definitely um that's that's totally true i think in finnish we had a term for over training it's something like being over or like beyond good shape which is totally inaccurate but yeah so i definitely agree with that uh the terminology can be misleading yeah i i i'll go back to i'm gonna link this up in the show notes too like one of my first one of my very first podcasts with uh my coaching colleague corinne malcolm we tried to unpack this vocabulary and i think it's it's when when the everyday athlete comes across that terminology in their mind what they're thinking is okay i have to avoid training too much but that's normally not the case they have to avoid under fueling or avoid low energy availability kind of first and foremost because that's the first step in the whole process i want to get to this i want to get to kind of

another topic that um that you guys were trying to unwind here and that's this confluence of low energy availability or low carbohydrate availability and this is a you know as you're very well aware of working uh with louisa's group especially around the time that you were working uh you're working with them um low carbohydrate and ketogenic diets come up in the sports science space all of the time i think this is like my fourth round you know now that i've been coaching for a long time now that low carbohydrate diets seem to like rise in popularity and those waves will kind of continue in the future and so it becomes a popular topic because a lot of athletes want to undertake that type of you know that type of dietary pattern for for whatever for whatever reason but i i'd like i'd like for you to to to try to describe a little bit more about what you're thinking or what some of the research actually says about which becomes more problematic is it actually the total energy availability or is it specifically the carbohydrate availability that can cause this cascade of issues it's a really good question i think my short answer is we don't know but to hypothesize and some of the findings um that we or some of the evidence we do have is carbohydrate definitely has enrolled it might be energy independent especially with some pathways we know with bone

bone or bone markers when you look at them um in relation to different dietary or exercise interventions sometimes the lack of carbohydrate is a specific cause of impairment in those markers we also know that some of the hormones uh lah so luteinizing hormone uh t3 which is a thyroid hormone and then leptin so those reproductive and metabolic hormones might be especially susceptible to lack of carbohydrate fuel but it doesn't mean that the energy availability is irrelevant it just means the carbohydrate is the the additional factor there that might um influence those um adaptations i guess um to different dietary conditions so i definitely i wouldn't say that the high carbohydrate very low energy availability diet would cause no issues but we know that carbohydrate is is important um not just for the obviously for training and racing quality as a as a fuel for the activity but also the the hormones and the health um components um in there yeah and the interesting part of that is it seemed it seems to be as you mentioned with some of with some of these markers and some of the research that you did is is very particular to to bone health that it seems to be low carbohydrate availability seems to be problematic to that independent of the total

energy availability meaning you have enough total energy to cover your energy expenditure but if there's a low low carbohydrate uh if there's if there's a low carbohydrate condition it still tends to be problematic yeah and it's definitely like the whole um is it the energy availability or is it the carbohydrate or a combination of both can you um kind of save some of the consequences of launch availability if you focus on higher carbohydrate that's definitely one of the key research areas for the future that we need to explore more but we know from studies of as i mentioned and laws she showed that um some of the impairments to hormones might be due to carbohydrate lack of carbohydrate as opposed to just lack of energy availability the most more recent studies and bone show the same trend um and it's kind of the last as you mentioned the ketogenic diets have well they come and go but for athletes to understand that carbohydrates have a role beyond the exercise performance um would be really really useful in in in the current world where carbohydrates seem to be demonized a lot more often than fat or proteins well and that we get caught up in the endurance space and particularly in the ultra marathon

space with pigeonholing carbohydrates to gels and you know chewables and sports nutrition products right but the fact that they serve a role outside of simply providing you energy while you're locomoting or cycling or running or whatever it is i think that's what the research is actually started starting to uncover that's more important is that they serve these these these biochemical roles in the uh along a lot of different pathways that are uh outside of quote-unquote energy production right which is what we typically think about when we think about consuming carbohydrates for no i definitely agree with that you so you just you just mentioned this uh a second ago in terms of what the future holds so you have this you have this complicated you know not only vocabulary but all these pathways dealing with energy deficiency low energy availability low carbohydrate availability where personally do you want to see the research go from here like what questions you want to kind of continually uncover that you think will be beneficial for athletes um so many different directions honestly i feel like there's 10 or 20 years worth of research to to be done um one of them which is um going back to them to the reds um component is getting a better idea of uh how to screen athletes for for reds to to to get a hold of the athletes early on and to prevent the

long-term negative consequences and to do that we need to know what seems to symptoms to look for that's something we hopefully will know in a couple years time when our study but also other other research around the world um has been finished uh but that's definitely one of the one of the big big uh goals uh for the next couple years but then when we go back to the longevity or low carbohydrate availability um we have these really um well done studies by analogs which are four to five days of duration but we still lack of the um knowledge of the time course of changes in several markers um as the result of launch availability so we know what happens in four to five days but we know less about what happens in the medium term so weeks to months and um in the long term so that would definitely be beneficial so that we can as you know athletes and especially endurance athletes do need to modify or periodize body composition so knowing a safe way to do this uh without causing long-term impairments uh would be beneficial another theme in terms of launch availability that we still don't know is the dose of launch availability uh that's been discussed in the last couple years a bit so by dose we referred to the combination of duration of exposure to

launch availability the frequency so if it's as we talked about um every day every single every other day two days a week uh the magnitude so then is it uh 30 calories per kilo of fat free mass per day or is it 15 and then that in combination with the duration and possible breaks from the launch availability and finding the i guess the best way to do this without causing the the impairments to to health would be really beneficial and yes we also touched the theme of macronutrients and especially the role of carbohydrate availability in relation to uh launch availability to maybe prevent those outcomes i'm sure i'm sure you realize this as you're thinking about it and discussing it but you're picking all the really complicated problems like not this not the simple ones you're picking the preventative problem which is like to get in front of these things is that's always it's the most impactful right because then you don't have to you don't have to unwind any you know any ill effects but it's also the most difficult problem to solve because it's got a predictive nature to it right you're trying to prevent something and you've got to figure out how you can kind of forecast physiology in a certain in a certain way you're also picking the long-term uh problem the the the long-term interventions the long-term trials to actually to actually study which is really problematic because

you know as you increase the duration that you're studying somebody you run into issues of you know non-compliance and it just gets really complicated there so i i appreciate the audacity of trying to figure out all those things because one it's important because we've seen a lot of athletes careers kind of get unwound uh unnecessarily by uh some by some of these issues but more importantly it impacts health for for not only elite athletes but everyday athletes yeah i definitely agree and with the health component sometimes when you talk to athletes athletes and especially younger athletes and and this maybe goes to the education and prevention but in the early days or previously um if you were a female athlete and you missed your period you might talk to the physician or someone and then be told that you need to get your period back because otherwise you will get osteoporosis when you're you know 60 years old and that's something the young female athlete doesn't really care about so definitely also talking about health you need to know how to what language to use and um what kinds of things to refer to to convince the athlete and the coach that it's important right now and not just you know 50 years down down the track yeah it's super important because the people surrounding those athletes and i've seen that in a high performance context i can't tell you how many times it's important to put that 20 year lens on and not just the proverbial

four-year olympic cycle or two-year olympic cycle or whatever two two-year world championship olympic cycle like we tend to like we tend to look look through things you really have to look out for the next 20 30 40 years of a person first because they're not incongruent in in almost all cases and then you can focus on the performance second health first performance second all like always and all all too often that gets kind of like lost in the shuffle when we talk about you know how to optimize our diets and optimize our performance and things like that we take a lot of uh we tend to take some some shortcuts that might have long-term ill effects yeah i definitely agree and i like the and i totally agree with the health first and performance second i think that's the motto of the norwegian sports um institute our olympia open but but i also think it's important to highlight to the athletes and coaches that it's not health and performance kind of separate but they are connected so they would understand that health does precede performance and then maybe that way and that's part of the education and prevention component to to increasing the awareness that they go hand in hand might you know motivate the athletes to focus on both yeah 100 we're in 100 alignment there well i i i'm very appreciative of your work i can't wait to see uh what comes out of the group there for the listeners out there that want to learn a little bit more about what you and the group up there in canada is doing where can you direct them to and i'll link all this stuff up in the show notes as

well um i think at this point uh twitter is always a good place to to follow um there's so many people involved in the study it's not just me and trent um but yeah i might send links to you to those um key websites or people to follow and then uh there might be a good place to start excellent i'll have all those in the show notes and for the people listening go check out the paper it's a super important one and uh follow this group out of canada you guys are doing great work out there i appreciate you coming out on the podcast and uh i hope to bring you back once you can once once you figure out all the complexities of these future studies that you want to tackle i hope we can bring you back on the podcast thank you so much it's my pleasure all right folks there you have it there you go much thanks to ida for coming on the podcast today really appreciate the effort that her and the entire team up in canada has been has been putting forth for this effort to educate the public on these issues with reds and inform athletes and coaches alike makes my job a whole heck of a lot easier when i have smart people like ida working on these types of issues also appreciate the heck out of all of the listeners out there as i have reiterated from the onset of this podcast this podcast has no sponsors no endorsements i do it simply as a community service

and you can help out by sharing this podcast giving it a rating or review on apple podcast and really if you like it just send me a direct message via social media and tell me what topics you would like to see coming up in the future that is it for today folks and as always we will see you out on the trails