Blood Biomarkers with Charlie Pedlar, PhD | KoopCast Episode #186

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 podcast is coming to you being recorded from my adventure van smack dab after the conclusion of the western states 100 on my way back to colorado what a fantastic weekend for our cts athletes congratulations to winners courtney de walter and tom evans as well as all of the finishers of the western states 100 hopefully we'll get to do a quick recap of that race but for now this episode of the podcast is all about blood testing and using blood testing to inform your training i don't need to tell you that with the proliferation of testing services like inside tracker as well as some of the more advanced services that combine both blood and genetic profiling athletes are having a harder and harder time discerning and navigating this ever-changing and complicated landscape so enter into the fold a professional like charlie pedlar charlie started out as a research assistant for the british olympic association and since then has held a number of high performance positions in both team and endurance sports he also works in the commercial space as the chief science officer for orico which provides blood

testing services for athletes namely in team sports like basketball football and soccer and so i wanted to leverage the constellation of charlie's different expertises in all of these areas being involved in the commercial space as well as a researcher as well as working with athletes in order to demystify blood testing for athletes out there now in a perfect world we would all have somebody like charlie to help look at our blood results and determine what is actually going on and in fact when i have athletes that i am working with i use people in my extended network like charlie in order to determine what is going on with athletes blood work however i realize that that's not practical for many of you out there you're going to go to your primary care provider or you're going to use a service like inside tracker and you're going to rely simply on the results and or your own interpretation of those results in order to make sense out of what is going on so this podcast is an attempt to help you diy your blood testing if you choose to undertake it as well as what to look for if you want to bring a professional into the equation so with that as a backdrop i'm getting right out of the way here's my conversation all about blood testing with charlie pedlar welcome to the podcast i appreciate you coming on all the way from the uk thank you very much it's

good to be here good to have an invitation excellent um so we're going to talk a lot about blood bowel markers and probably deviate as we were talking about uh offline about how it's difficult to talk about them in isolation we have to take in the whole context of things but before we get into the whole context of the athlete let's talk about the whole context of you so our listeners can get to know you a little bit more tell the listeners a little bit more about uh what you do professionally in some of your areas of research sure yeah no i i um consider myself to have one of the most interesting jobs uh out there uh uh you know studying and um working with athletes uh all around human performance um so i have one foot in academia as a research professor at st mary's university in twickenham and then uh and that's in that's in london and then uh i also you know work with athletes primarily through a company called orico which is kind of disclosure to get out there from the start and orico provides um blood biomarker testing for pro athletes and elite athletes um and so um that gives me a good kind of broad kind of uh perspective on uh the science underpinning what we do and then the sort of reality of what's useful and relevant on the ground when it comes to training and trying to stay healthy while training sometimes to excess well so you you already touched on this and to set the table a

little bit further you know i've been involved in sport in using blood biomarkers mainly in sport for a couple of decades now and i will say that the landscape on this has shifted quite dramatically because it used to be where we had to kind of force our athletes to go to their primary care provider they would we would dick the coaches would insist on a certain type of blood panel and there was always this communication gap between the coach and the primary care provider as to why they needed certain markers that they did we would then take all of those and kind of track them ourselves and to be honest with you it was a lot of like stabbing in the dark because it wasn't until maybe the the you know the mid 90s or early 2000s to where a lot of the research underpinning what we're now seeing today in terms of how to use these markers to inform sport performance started to start and started to actually emerge and now it's almost shifted to the kind of the other side of the spectrum to where the instant you get one blood test you're then kind of assaulted with a myriad of different markers and pieces of information and what to do and i need more salmon and more iron and kind of all this other stuff just based on one kind of kind of based on one draw and to see the arc of that to to that the arc of that use right or the arc of the info and the arc of the information has actually been quite

quite astounding to me but let's back up a little bit and let's talk about like kind of this value proposition of monitoring athletes blood work and any athlete elite athlete or a regular athlete if an athlete is considering this like what what fundamentally should they be thinking about in terms of what can they actually get out of it in order to inform their performance yeah well i mean there's a there's a lot of things a lot of points you touched on there in your in your intro around the sort of history of of biomarker monitoring and and why we would do what we would get from it and and how it's how it's evolved but i think that fundamentally the um the word that comes to mind is objectivity in that you know you you can perceive how well your training is going you can perceive how healthy you are you can perceive how well your diet is but you can't necessarily know with some certainty and um rightly or wrongly athletes will get that from a blood test sometimes so um now they can still get erroneous data and they can still misinterpret that data and all those things but um it's a it's a number on a piece of paper that's related to a reference range that brings objectivity to uh to what they're doing so sometimes it confirms that things are going well they're healthy everything is where they would um want it to be um sometimes it throws up surprises and things that they can do differently and sometimes it can help to provide

answers when things have gone wrong or when an athlete is in a state of um should we call it unexplained under performance um so i think there's the there's those probably those three three reasons why um it might add something useful to the to the process of of training and performing and it's become so accessible now and i guess more commonly known because a lot of the podcasts and the in the lay articles have kind of proliferated the the the the use of it and it's just and like i said it's been more accessible but it's tend it started to creep into not just looking at are you not in a disease state or are you in a healthy state to this optimization uh concept and you know whether this is the you know bro science biohacking you know kind of movement that's that's been you know propagated over the past several years or what but can we really use blood blood biomarkers to say that you are in an optimized state and the reason that i mentioned that is because kind of the entire dialogue that you discuss with an athlete in terms of why they should get blood testing it really emanates from this fundamental piece of what are you trying to do with it are you trying to figure out just hey are you healthy to train

or can we explain this underperformance syndrome via blood biomarkers or are we trying to take a normal normally healthy individual and somehow supercharge the adaptations that they're getting from training yeah well i think the answer is no to much of that in that this concept of optimization um is a is a difficult one and if we just take a step back and think about training and recovery we're trying to repeatedly stress our physiology uh and balance that with recovery so that we then super compensate and improve our performance and that might be through changes in strength um it might be changes in some other structural structural systems like you know bone health and so on um it might be aerobic capacity and our ability to kind of sustain high workloads um and the whole time with training when training is very successful we're moving closer to our genetic potential um now with with with everyone that's going to be different with all individuals so um optimizing to you know there's no there's no magic number that we need to hit for each of these biomarkers and actually when it comes to blood testing um it can be quite a blunt tool because the if you think about why like we're really drawing on years and years of research in medicine and health for these blood tests and the reference ranges are all created

so that you know the data that we compare ourselves to when we when we uh when we have a test result those reference ranges are based on uh a healthy population in inverted commas so not necessarily an athletic population so we have to think about how we interpret the results of any tests with that in mind that and you know we do work in football and one of the things one of the phrases that we use when we're looking at reference ranges is that you're comparing yourself to to the players on the pitch but you're also comparing yourself to the fans and you think about the breadth of people that are healthy in that fact it's not the same as your elite athletes so you have to imagine that quite often there's a a different reference range for each of these biomarkers that applies to elite athletes than there is for the general population that's not always available so um we might it might be that we're regularly flagged as athletes outside of a clinical or normal reference range because we're experiencing a lot of muscle damage for example or uh or we have a um you know as we train our cardiovascular system we tend to get something called plasma volume expansion so that can dilute our uh our the the red cell portion of the blood and so it can look like we're anemic when we're actually not it's a pseudo anemia so there's sometimes we're out of range uh from the from the general population as well so um either way it's the the point is that we're individuals here and we're looking for that we're looking for clues as to what might be a real deficiency or a real biomarker

of concern um but it's not going to be the definitive answer until we have um lots and lots more data you know and and ideally you know you want more than well you want a few blood tests on yourself in order to build up your own reference ranges so i'm sure we'll get onto that in the in the conversation yeah but i think what i want to try to bring out is this is what i call train trap avoidance right and and a lot of training to be frank to be frank with you if i just put my coaching hat on for a little bit a lot of training is just not screwing up you know you just got to keep the athlete healthy and you prevent the zeros on the calendar and you prevent them from getting injured and you just let let time take care of the adaptive process with reasonable training and i keep coming back to this and i wanted to quote unquote optimize performance with part in part with the use of blood biomarkers for years and what i've begun to appreciate i think is encapsulated in in just kind of that recent dialogue that you went through that it's a very blunt tool and if you're looking for something if you're looking for to drill down on a very very surgically on a number and i'll give a classic example in the endurance world which would be hematocrit and or hemoglobin and for years we would try to drill down on that and try to optimize that i mean i'm emphasizing that word intentionally we would try to optimize either one

or a combination of those numbers in order to kind of like drive performance but what we found was is there was a lot of noise within that signal and you mentioned some within the plasma volume and you can actually have some within the you know just the whole the whole the whole milieu of of what's going on within the testing environment and so i've begun to what i've begun to appreciate is to back up a little bit and say let's just make sure things aren't let's just make sure things aren't completely screwed up and avoid this very narrow definition of optimization where we're looking at fractions of improvement within whatever kind of number and take the take the bigger win of the athlete is healthy let's just go ahead and apply training yes yeah no i i uh i hear you that makes that makes sense i think um we mustn't go too far down that route i think because you know there are some things that will be fundamental to performance particularly endurance performance that will stand out very clearly in a uh so uh in a blood test so um one of those you know is um if somebody is genuinely anemic yeah and we have a detailed enough iron panel then you know that will that that clearly leads to endurance uh under performance because we're not able to produce the red blood cells that we need to carry the oxygen um and we see a you know decrease in that hemoglobin value um i mentioned there's that pseudo anemia but

um we're still talking kind of within physiological levels it can dip way further uh something like hemoglobin can dip further into an anemic state which can then have profound effects on on performance so you've got to catch those uh those things um you know with a blood test it'll tell you very clearly if you if you're if you if you're uh iron deficient and uh and uh in an anemic state uh optimization though is something different because you know the we need we we know we can often do better and adapt our physiology further than we have already take for example taking an athlete going up to high altitude um where there's a where there's a stimulation of uh red blood cell production through erythropoesis um and then we have a direct effect on our iron stores to produce more red blood cells and then when we come down from altitude the theory goes that we can then um perform better if we if we optimize that that process in some way and and that's a that's a time where um you know we we know we can retune our physiology to a new environment that that causes a change in our uh in our iron requirements in that in that particular example um and the biomarkers can be really useful in preempting that pro that that problem or you know measuring the change in some way so um this is the old ferritin threshold that a lot of coaches will be familiar with that have used altitude protocols and once again we've been using altitude

protocols for a long time and you're absolutely right and i feel like we kind of threw a dart at a dart board with the blindfold with some of the earlier altitude interventions where we would do an altitude panel and we would say okay as long as your ferritin's above 26 you know we'll be just pick a number between 20 and 30 or you've kept we you and i have both kind of heard all of them as long as your ferritin's above this magical level of 26 you're a candidate for this altitude this altitude intervention that's kind of what you're getting out there and and we've started to get better at that i would say in the future but but with the original with the original altitude and interventions we knew that we needed something to base it off of and we like i said we just literally kind of guessed at what that something was and since then we've kind of we've kind of narrowed it down a little bit yeah so while we're on the subject of altitude and and iron i mean there's a you know there's this there's now more and more really big studies where they've been able to track um changes in um say hemoglobin mass uh with um iron status markers and there seems to be this threshold when you when you when you think about many many data points on the graph uh and you draw a line through the data there seems to be a threshold around 50 for ferritin which um seems to be a bit of a inflection point where if you're below 50 you're more likely to be um your body's trying to absorb

more iron whereas if you're you know above 50 those systems are down regulated but then if you look at the individual data spots it's a huge cloud of data so for some people that 50 might be absolutely no evidence that they're looking for more iron others it might be you know it could be that they they can go even down to 20 or or lower and still be um you know if there's a there's a there's a broad range in both directions and um so i think you know those thresholds are trying they're trying to be a standard threshold for the whole population just doesn't work so um you you know and this is why often you know you can do it can develop a theory with sort of data around what's happening but it might not necessarily you might not respond in exactly the same way as another person will respond to the same treatment so okay let's let's back up a little bit before we start to talk about uh optimization ranges and individual bayesian statistics and things like that let's get into where people can start because there are going to be a number of people that are curious okay i want to start tracking these things and there's a whole host of companies that are out there but then each company kind of offers their own like little suite of things and they've tried to categorize them to you know this is the health suite and this is the endurance suite and this is the the platinum suite of biomarkers that you can that you can actually look at but let's take it from an endurance athletic population right you have an athlete comes to you charlie and says hey listen i i you know i think something's going on

i want to start you know tracking my blood work in order to get a fix on that what's the standard set of set of steps standard set of tests that they can start to look at and track over periods of time yeah well i think it boils down to um probably only three or four things that you would say is like a really fundamental test i think most athlete groups that i work with now uh you know would recognize that so you want to get what's called what we call a fbc but in the north america would be a cbc so um checking all your populations of of uh red and white cells are kind of within um healthy or expected ranges and then underpinning that with your iron status normally a ferritin value or or a more detailed iron panel ideally um and then vitamin d is the other one that's got a pretty good body of evidence behind it and really you're not you're the the best bang for your buck with that is if you're actually deficient as opposed to trying to optimize to some super normal threshold um everything there's many other things that you can measure um folate b12 would be important ones as well for the red cell production um there's a host of nutrition related markers um magnesium biomarkers associated with quality of your diet fruits vegetable intake these kinds of things but i think

i think the critical ones that i would point people towards would be that um full blood count um with ferritin and uh vitamin d yeah i mean in the in the us that that's a standard suite of tests you can go to your doctor and yes it's a complete blood count with an iron profile is typically how it's how it's served up the the one that a lot of athletes will either choose to do either in combination of that or as some sort of permutation of a of a commercial service is a complete metabolic panel and i've always kind of viewed that as a nicety not a necessity and i wanted to kind of get your opinion on that because that's another host of of things that you can actually look at as well yeah many many of the markers in there are around kind of homeostasis you know so things like electrolytes that actually um you know they're almost always going to be in the normal range in a healthy individual so they're not going to tell you too much extra um other things like liver function tests uh that come as pretty standard with a with a you know with a hospital blood test again uh are most likely to be pretty normal in the absence of any kind of symptoms so um yeah i'm not i don't see a huge value in in those um uh yeah things like uh lipids um cholesterol and so on um are

useful but we're you know we're assuming here we've got a pretty healthy well-trained uh population um i mean we can there's so many different biomarkers when you think when you start going through the list that you know you could you could start adding in um and it's sort of it's a bit of a sliding scale so one of the ones that comes up uh increasingly is that what endocrine markers for for example um trying to understand your energy status are you fueling enough um is there so things like a fire in thyroid tests for example um there's reasonably well established uh thresholds there for um free t3 for example as a marker of energy status that would be um helpful in avoiding low energy availability for you know for long periods of time um in males testosterone is a you know really useful interesting marker to to to to understand if you're you know as an anabolic marker but as a general marker of recovery even better if it's combined with cortisol so you know they they kind of they accumulate that like like that and and um you can get insights from all of these things um but yeah if you measure enough things you'll find things that are out of range but it's the trick is in the you know how you sort of put it all together and interpret that um inflammation you know is a is a great um you know it is very informative to sort of try and understand how inflamed you are but only if you've collected

enough data to understand like more what the chronic picture is so as athletes we might be inflamed transiently for periods of time particularly if we've done a um say we've done a lot of uh eccentric loading on hill running or we've done an accustomed you know strength training session uh lots of muscle damage secondary to that would be an inflammatory process so you might have raised information by the way that's not the ideal time to be having a blood test um because it's going to be everything's going to be out of whack so um yeah there's there's more and more things to add to the list but i think it's still comes back to those fundamental few things i think probably the most bang for your buck when it comes to the biomarker testing so let's kind of continue the best practices theme right you started out with complete blood count with an iron panel let's go into what just what you mentioned timing of that and we can bring in some of the nuances of working with female athletes around their menstrual cycle timing of those draws either relative to their relative to their training and or menstrual cycle and then the frequency of those if we're trying to track it over time monthly weekly quarterly and things like that i wonder uh uh can you expand on that a little bit as well yeah so um i think the uh firstly like doing the testing well so if you're going to invest in a blood test um don't just rock up to a clinic have a have a test drawn after a run or like you know while you're still in your kit

well yeah you know try and standardize it as best you can and we you know the way that we've historically done that with athletes is to get fasted rested samples in the morning so that just means do it before breakfast and it means do it before you do any training and then to extend that a little bit further try and avoid having uh having done excessive or unaccustomed exercise the day before if it's just a half an hour recovery run or something that's not going to have an impact in a trained individual but um if you've gone out and done it you know a 20 milo or you've done a race or something then that could have a significant impact so um so just stand like think about standardizing those conditions so that the next time you test you repeat the same thing you can then see if there's actually any physiological differences not just differences in the time of day or the fact that you've um you know you're in a different state of recovery than you were for the first test um so that i mean we've run there's a whole section in a paper we've written in sports medicine in in 2019 which i can give you the link the link to it's an open access paper and it and it gives you a whole host of things like so actually there's 10 points of you know guidelines for how to get good quality blood test data so otherwise you're just adding a lot more noise to those already noisy um and i'll mention while you're thinking about that i'll mention that's hard enough that and this is what i always come back to with the proposition of of monitoring biomarkers with

athletes simply standardizing the testing environment just amongst the training going into it fasted with a rest day in advance or an off day in advance that can be tricky enough that that in in and of itself is it it presents a point of friction for the athlete to actually go in and go in and especially for a normal athlete who has a job and kids and they're running around being the soccer coach and things like that so we start to get into these like practical elements of actually using blood biomarkers in a realistic situation and for athletes that that are out there that are thinking about this this is a very realistic one it takes time you have to standardize it you can't just go on a whim you're not going to be able to put a patch on and do it like there's a there's some realistic practical considerations in order to create as standardized of a testing environment as possible so you're not getting as much noise coming through whatever the lab values are actually telling you yeah um and i think that can put people off too yeah um we're not talking about standardizing every little tiny detail it's just that simple if you can a simple thing of um doing it at the same time of the day doing it before breakfast that's hard enough man i know it's hard and it depends what resources you have available so like some providers will be able to send out a phlebotomist to your house have a test done at the time when you want it to be done and

take the samples off to the lab and you don't have to think too much about that process whereas for others if they're trying to get an appointment in a clinic after the referral from a physician or however they might be doing it then that can be significantly more challenging to standardize those things and the phlebotomists often are not thinking that way either you're in and out as part of a you know a whole a roster of of of tests that are being done that day and so you know because we would have a time we would um advocate um being rested for you know up to half an hour before a test if you can 10 minutes from a minimum of sitting down but that's not always possible yeah in a clinic yeah okay so we've got standardized test environment yeah what about frequency so frequency well some things are going to change quicker than others um and you know certain things you might you know depending on how detailed the blood panel is that you that you have access to there's no point in measuring constantly measuring things that are normal every time you test them um so um yeah we we typically would do three to four venous blood tests per year with a um with a elite athlete um so quarterly basically is what is quarterly yeah i mean you know we have them more frequently than that um maximum monthly um that's in a very well resourced thing with a with a targeted you know we want to monitor this specific thing

um and do it regularly enough to understand what the what the picture is um a whole different sort of conversation is around point of care testing for recovery that like from capillary blood samples and you might do those much more frequently so you know measuring things like uh oxidative stress inflammation um sometimes testosterone cortisol uh urea these things if you have some some some pros teams now uh are doing this frequently they're doing it you know after um you know in micro cycles of training um but that's not i don't think that's quite what we're talking about here we're talking about more yeah uh yeah the the you know something that's successful to more a larger wedge of the population yeah not everybody's going to have one of the istat models where they can just kind of like take those on demand almost they're they're looking at going into a lab they're getting a venous puncture they're getting you know three tubes of blood drawn or something two two or two to four uh tubes of blood drawn and and that's kind of the the extent of it yeah but it's it's an interesting it's an interesting point of advocacy right quarterly right so the the time investment that i mentioned earlier that might be clumsy right or or or it might have some friction associated with it um you're looking at only being able to have or only having to do that once every three months a lot of people will look at that as a reasonable proposition okay i can identify a period of training in time you can set aside my set aside my schedule to get something done quarterly however here's the like

hitch in the giddy up right if you're if you're looking at monitoring things once and then every three months there's a three month period of time in between those two to which you kind of don't know if the intervention is actually working yes so we so this is where you you know of course it is just purely based on a 12 month calendar but actually what what is what is the athlete doing in that year when is it good when is it when that's when are good timely opportunities for testing so for example if there's a build-up gonna happen to a key event there's no point in waiting until the week before the event to do the bud test bring it back to earlier in that build-up so that you can make sure that as you're needing these nutrients as you're needing this iron as you're kind of drawing on this physiology that it's all there and it's you know when it's working well so um so put it timing them around those kind of events makes well it makes makes sense it's also not really worth testing if you're about to go on a break you know so you know so scheduling around like key events and early on in the build-up so those events would make sense and that might that those cycles are going to vary between individuals depending if you're somebody who races uh numerous times through the year or if you do you know one or two marathons in a year like you know it's it kind of it's going to vary a lot by individual but giving that some thought obviously will optimize it further and that concept of quarterly it kind of goes

out the window then but i think you know four times per year um in general it seems to be a sensible thing if you're going to altitude then you know before heading off to altitude you know with enough time to maybe try and improve your iron status or something like that before you go would make sense um but yeah so that i think that optimizes or improves that quarterly i think here's so you're you're using you're using the blood test is almost as a little bit of a uh like a hurdle to clear in advance of intensified training and here's how we've used it in and i'm sure you're aware of this here's how we've actually used it in a high performance context in in the coaching world is we actually back it up one quarter so we lay out the whole 12 months or 18 months we identify the periods of time that are intensified training periods leading into the olympics or whatever big competition that somebody actually has and we don't want to test right before that because there's not like the information that is you got to train like sorry like the olympics are you know six months from now you got to train like right there so the the information is not all that valuable at that one moment in time it's valuable in advance of that with enough time that's whatever intervention you want to do whether you're doing some sort of iron supplementation or whatever it is where that intervention can where you know you need to throw that intervention at the uh at the athlete at that

point so typically what we'll do is we'll back it up one quarter or even six months to start the profiling process so that the table is set during that intensified training period that the athlete has the best opportunity possible yes yeah no that exactly describes describes it well um and you know i think you you kind of you you're going to organize your life around those things too so just like well for people like me who's not you know not an elite athlete i'm going to be thinking right i've got this pair of shoes that i'm going to be training in and these are the ones i'm going to be saving for the event you know it's kind of it's you know it's but you also like i'm not going to start training intensely for a so the total athlete in terms of the the the load that you know the life stresses and so on if you're you know i remember when i was doing my PhD uh i was i wasn't able to do the kind of physical training that i wanted to do or if you know so there's other life events that people have that are going to result in this sort of total stress on them and they factor in the type of races they're doing um maybe you know some some things less flexible like the olympics like you mentioned but um you have to take that all into account in your planning and i think the biomarket testing slots into your calendar at sensible times um which you know you would work on with your coach or you know when you're sitting down and making a plan you would work out when is the most sensible time here to to have a blood test to get the most benefit you know in the months that follow yeah and i mean kind

of like looking at once again i'm i'm looking at it through the terrain trap avoidance lens right yes i i have run into this with athletes where and this is a coaching error where we've introduced biomarker testing just in advance of a really important training phase maybe not an intensified training phase but a really important training phase and something is just kind of awry it's not necessarily concern it's not necessarily concerning but it gets in the athlete's head in terms of oh my god i'm not optimized to absorb all of this training or to adapt from all this training and so i kind of go back the reason that's a coaching error is because i kind of go back to well what you should have done is done that three or six months ago so you have enough time for some sort of course correction whether it's a supplement or even just a normal nutrition you know intervention or kind of whatever it is because it's just like changing your shoes on race day or something like right before race day right where you're introducing that wrinkle where you kind of like where you kind of shouldn't have i think the athletes that are looking at taking this on like give yourself some runway because the the the the course corrections that you apply do not happen instantaneously in most cases most of the time it's a a month or three months before you're actually going to see some sort of realistic improvement yeah and i and i think you touched on a really important point there which is the psychology around this and giving people a piece of information about themselves that they didn't know before and some athletes are going to overthink that dramatically and so i would always try and encourage

not to over interpret a biomarker profile it's an it's one piece of data that you know you have to put into a uh you know whole um you know reservoir of other information that you're that you're looking at and much of that doesn't need data it's just you know it's it's your observations it's you know it's it's it's changes in mood it's all these other these other pieces and and sometimes a blood test can have the opposite effect that you want it to have if it's taken too seriously by the athlete so well we're gonna we're gonna talk about that over psychologizing when we get into the exotic biomarkers and i've reserved a specific spot for that we're both going to have to kind of rack our brains a little bit on it because uh i think i do think exotic is the right word but before we leave this um uh this dialogue of best practices i'd be remiss if we didn't come back to one piece and that is is how should women set this up women who have a regular menstrual cycle we talked about standardizing it based off of the training easy day beforehand or off day beforehand morning and fasting how should women approach biomarker testing in terms of trying to trying to standardize that component of it yeah um and that's a something that hasn't been well defined anywhere i haven't seen anything that really explains well how you should um take into account the menstrual cycle um uh or uh hormonal contraceptive

cycle um for a for a female athlete and and so the the the the thing the thing is that yeah you you've got a menstrual cycle length that might vary slightly between individuals and the phases will vary slightly between individuals and again it's that same sort of idea that we're trying to look for a change in the background physiology here so taking into account the phase of the cycle would make most sense and we know that um things like iron metabolism will vary across across the menstrual cycle so you do need to test at the same time in fact we have a review in european journal of sports science that that covers some of that um that um the um the hormone hepcidin that controls iron absorption will be slightly different through the cycle and so uh you might have lower ferritin values for example uh from memory towards the end of the cycle um so you need to um yeah again it comes down to taking that into account and and say you had a menstrual um bleed that occurred so the uh what's known as the period um testing at that time is probably not ideal i would say testing a week into the follicular phase of the menstrual cycle probably makes more sense when things are somewhat stable and then trying to factor that into future blood tests as well um so yeah it just adds another layer of complexity to the standardization but i mean your your point is that you're going to be a

the point that it's hard we can't draw on research to say okay this is the best time you're once again trying to train trap avoid using that analogy again and you're saying some based somewhere around the follicular phase to make sure that there's more of a homeostatic environment yes um yeah uh so the you know during that phase you're in this kind of rebuilding phase in terms of the endometrial lining we have um we have estrogen dominant phase um this tend to have fewer symptoms fewer um uh off days in terms of uh in terms of training during that phase um and so i would say that's probably the best time to test but there's no like i say there's no kind of rules around that um and uh it's yet to be decided i mean ideally you would test kind of every phase kind of every phase and then be able to factor that in so you know on this phase uh this biomarker is x and then you have a reference range that's you know that builds up for that particular reference but you know you just can't you can't test that often and get that much information so um picking your day so you're not testing right in the middle of your period for example would be uh would be sensible okay so now that we've got these best practices right we're standardizing when we're standardizing when we're taking them based on training and on the menstrual cycle let's kind of go down to the interpretation and there's kind of two there's basically well there's three flavors of this right so the first flavor is is through

an athlete's primary care provider they're going to go into their doctor and they're going to request a blood test and then they're going to get the the results back and it's going to compare their whatever shows up in their blood to a reference range which is you you use the analogy earlier if it's everybody in the stands right it's based on everybody it's not based on them that that's one flavor of the analysis they're just going to look at that and say am i in these normal ranges second flavor of it is if they get it done through a commercial uh some sort of commercial setting inside tracker the company or the company that you work for what how do you pronounce it again you're gonna have to remind me oracle oracle oracle okay oracle and it's going to take those and if they especially if they have a series of them it's going to tailor the reference range in some fashion i'm going to leave it as generic as that and you can expand upon that if you want to but it's taking this reference range and individualizing it in some kind of in some fashion and the third flavor is and this is what i try to do very poorly this is why i have you on the podcast and what you do professionally is they bring in the they bring in the the big hammers they bring in the professionals to look at it and say okay this is what this is what's really going on and i wonder if you had any commentary on that those different types of how we actually interpret these things because it it's always been difficult for me as a coach because there's a lot of noise and once again i'm just trying i'm just trying not to screw it up

from a from a blood profiling standpoint i'm just trying to make sure that the athlete is healthy that they're going to be able to adapt to the training and that there's not a you know some sort of i'm gonna use the word disease state but uh under under training under performance syndrome or some sort of unideal state that's the that's what that's the word i was looking for some sort of unideal underlying biochemistry going on when i'm when i'm applying heavy training so do you have any thoughts on these different levels of interpretations because we're going to have athletes across that entire spectrum they try to diy it with their doctor they go to a commercial setting and or they're going to bring on a practitioner and what are some like guidelines that they can use to kind of like weed through wherever they are in that across that spectrum yeah um so if you are working with a company that has a lot of data to hand then it does make that kind of more advanced analysis a little bit easier if you don't then you kind of you know you you have your blood test data and i've seen you know it was it's maybe it was amazing that you still find people trying to find their previous blood tests in an email chain somewhere oh my god oh my god it's attached yeah and then you're kind of opening that screen and then you're flipping up another screen and it's like oh hang on a minute now i'm looking at the wrong one and it's the worst it's the worst it's the worst on and then you're going through and it's oh i'm sure i had ferritin tested that time and then you're scribbling them down on a piece of paper or putting them into an excel sheet

yeah and it's pretty messy and pretty clunky now the technology has been around for a long time to do much better than that in that you know you can nice interface where you can see your historic data you can see the reference range from the lab you can maybe even see an athlete athlete range that just takes into account or makes a guess what would be not a guess but some informed uh you know reason why there would be a an athletic range within that um and then also plots an individual adaptive range around the data and and and so that and there's many different ways to do that and we've you know we have a partner we've done research with um professional uh professor john newell over in ireland and his team that will look at this kind of like modeling the data here so that you can really individualize um and and individualize it with context around the data as well so you know you can get really advanced with the way that you kind of um you know you interpret the data but what those adaptive ranges give you is a bit of a guide as to is this normal for you and so i don't know if you'd like even we're seeing them all over the place now like even in strava they tell you what what your training volume is this week is that kind of it broadly in line with where you normally sit is it higher or lower than where you sit and you can see that kind of cloud behind your data that shows you something about uh it was interprets it something a bit more individualized to you um so but when

unless you're unless you're collecting data quite frequently and you have so you have enough data to start to build up this own your own range and you have some skills around calculating that um it's probably just as effective to kind of look at the data judge you know what kind of you know direction is that higher or lower than previous tests you've had done um if you want to go more advanced than that then calculating something like a standard deviation from from a mean value or or a percentile if you're if you've got outliers then using a median value and looking for percentiles um above and below that can give you a nice simple way of saying is this normal for me or how far away from my normal is that but really you want to have five six seven tests in the bank in order to get an accurate enough average or you know median median so okay i'm going to unpack a few things and i'm going to give you the earmarks so that we don't forget them the first is is individualization versus optimization i'm going to pick on the commercial companies yeah you might be modeling data that's chronically abnormal and actually one time when you're when you have a normal like a high result is actually normal you know what is it is more optimal than the others so okay we're gonna we're gonna do that right now because i gotta i gotta get this i gotta i gotta get this beef off my chest before i forget about it okay so when somebody goes to a commercial uh uh when somebody goes to a direct to consumer

commercial type of company they get these things back and these company the companies are trying they're trying to create a value proposition to the athlete kind of starting back to our original uh original discussion point one of those value propositions is they try to present what they are what they are determining is an optimized range and i'm i'm i'm intentionally emphasizing the word optimized because i think that that's important when in many cases if not all cases what is actually pre being presented is the individualized range or something that is normal for the individual that that can be the optimal range but it's not necessarily the optimized range because as you just mentioned that athlete could be chronically under or over depending upon the marker that you're looking under or over what should be op what should be optimal for them and it has seeing that vocabulary has just this is just a personal gripe that i'm going to take out on you seeing that vocabulary has just always been irritating to me because like i and i have had this yeah with uh with a commercial company i had an athlete who i knew was anemic we started doing blood profiling and it kept telling me and her that this that they were in their optimized range for a few of these markers when i knew that it was an unoptive certainly an unoptimal state but all it was

doing was looking at their regular thing and saying okay this is like within your regular norm and i'm just like no so i wanted since you work on the commercial side i wanted you to kind of like peel that curtain back a little bit for the listeners out there and kind of describe the difference between an individualized range and an optimized range and how we shouldn't really kind of conflate those two yes yeah so you know optimized suggests that that at that point in time uh the athlete is going to perform at their best um they have let's say they're not deficient in anything all systems are operating as best they can operate you know this is kind of this is optimization right and so we don't necessarily unless there's research out there to show if your biomarker x is in this range oh you know we tested this many athletes and all the ones that were performing at their best had this level of something to help us prove or get as close to the truth as we can which is what we try to do in science and statistics um that uh that might be an optimum range um a lot of times these companies are saying you're here against a whole load of other athletes who are in your similar um similar maybe maybe they're in similar uh sex or gender um similar age bracket similar sport um this is where you sit now that might be a

population that's not healthy um that you're compared that you're competing so it's a reference it's reference data but it's not necessarily optimized or normative data there's still different terms here that means suddenly different things so um most of the reference ranges that you get from a from a blood test uh from a clinical lab will be quite a wide range because it catches like we were saying the fans and the athletes and it's kind of it's a it's a you know health to us on minimum standards as a you know with athletes we're looking for this optimization so um that's why i think you know you have to to be cautious around that um just because it's individuality doesn't mean it's necessarily optimal one one thing to look out for is whether or not your individualized range is sitting within the reference range yeah and that's one check like if it's modeling you and saying you're normal and you're outside of the reference range then it's you know that would suggest that it's not quite quite right and so companies really shouldn't give you an individualized range unless it's well within uh you know and it's actually narrowing in on what's already deemed to be a wide population normal range so um yeah does that ask you well but here's what i always come back to and i've told this to a number of athletes they don't know if you're performing well it's not like you're inputting the training data or inputting the performance data and then correlating that with the blood biomarkers

it's taking the blood biomarkers in isolation which you can do in certain circumstances you can say okay you know this is an optimized range for whatever to produce the adaptation but it's not like that necessarily that that is automatically going to be correlated or creates a performance but the fact that there is like you don't even have anywhere to input that at least amongst the commercial um the commercial outfits that i'm aware of it's not like they're taking your training data and saying oh my gosh you're training really well or you're performing really well here here's your underlying blood biochemistry leading up into that we're going to individualize your range based off of that it's a very isolated point of view that they're that they that is being presented i think this is the value though of retrospective analysis of data yes for endurance for endurance athlete you know you can if you and this doesn't happen enough but if you were to put the data together and sit down with an athlete and review like when they felt they were going well when they were performing well what was their biomarker profile like then and that enables you to kind of throw uh a lot of the sort of you know red flags you know out the window and say well actually let's look look at you as an individual what was happening at this time can we explain did you do anything to address any issues that actually then led to a period of better performance or reduce negative

symptoms that you might have been having or off days like actually enabled you to keep training as you say health and performance just go hand in hand so if we can actually avoid stopping training then if we can complete a planned training program then we're more likely to perform to our best well it's analogous to what i teach our coaches to do with an athlete intake is look at when they were training really well and what preceded that or when they were performing really well and what preceded that from a training perspective they're evaluating training log they get a new athlete they want to kind of like dig into what they were doing previously when were they doing really well and what was preceding that and when did they suck like take those almost polar opposite ends of the spectrum and figure out what the themes were going into those in what you're suggesting is coupling that if the if you have the resources retrospectively with the blood biomarkers and adding that into this storyline of how you would arrange nutrition interventions and training and things like that i would absolutely be a huge advocate of that yeah we did this a while back and actually published a case study where we just mapped training sessions and adaptation uh on that we're doing monitored treadmill runs looking at blood lactate responses um over several training cycles through uh cross country season in the winter through to track season through to olympics um and you know when you mapped

iron state our iron markers uh alongside that you can see clearly that the correspondence between drops in ferritin drops in uh biomarker panels and heavy training phases and you could you could really like by doing that retrospectively you could really identify times when you would want to have blood tests done but then also look to intervene and manage training load carefully uh more recent examples and this isn't in distance runners but with um menstrual cycle length and menstrual cycle features of female female athletes are a great um you know have this wonderful signal in their menstrual cycle that can kind of tell them a lot about how stressed and overloaded they are um in their menstrual cycle will extend um at times when there's excessive life stresses also a menstrual cycle related symptoms even injury flare-ups and things will occur by phase in the menstrual cycle um and so when you map on all the life events alongside those uh simple kind of menstrual cycle um biomarkers you get a really clear pattern that you know these things are all integrated together they're all linked together um and so yeah putting the biomarkers in common like that was a lesson i learned very early on was that like you know when like the time point that we test in terms of you know heavy training versus lighter training weeks altitude versus non-altitude corresponding with big world championships or olympics you know these these tight these these will have big uh disturbances on

our systems if we uh if we depending on when we measure so um then you have to take them into account in the in the process i'll leave a link uh to that case study that you just mentioned that was an older one man you pulled it out of the memory banks that was published 10 years ago i looked it up when i was doing some research for this i'll link to that i'll link to that in the show notes it's uh because i think it's a good one um but i want to i want to move the dialogue a little bit to something that i mentioned earlier and these are the more exotic markers that we start to see and i've seen these start to start to become um the interest of them has certainly perked up so we started with this very basic proposition of hey listen just go get a complete blood count with an iron profile and for the users that are not familiar with that those are very basic markers red blood cell count hemoglobin hematocrit it is not it is not very it's not it's not very sexy right it's very very simple and i think i'm completely i'm completely with you charlie i think that that's enough to cover about 90 of the bases and i don't get into this hyper optimization of all of these other things but what i've started to what i started to notice uh more recently is this proliferation of what i'm calling these exotic markers and they're exotic because they're taking ratios of certain biomarkers and while once again i'm a i'm a very naive knucklehead

within this i don't work in within the research world while i understand a lot of the the while i understand a lot of the bio plausible mechanisms of why these ratios might actually be beneficial i have a very difficult time actually finding much if any and most of the research is not very good it's usually really old for whatever reason to to support some of these ratios and i know that there there's a whole host of them now and it's kind of an unfair question to cast a broad blanket on them but i'm i'm wondering if you just had any how do you had any had any opinion on some of those and if certain ones actually have a better basis of support to actually to actually use um yeah i i um i'm quite a fan of actually the testosterone cortisol ratio and similar to that is the dhea to to cortisol ratio that you mentioned and but you do need to test frequently and you do need to more than ever take into account that control that we mentioned around uh time of day and that kind of thing because these are when you look at hormonal markers they have fluctuations uh across the day and the night um and so you can be on a you know hour by hour in the early part of the day you can have

quite big differences in the data so um so that's very important but over time if you have enough data points and when training is going very well you will see uh consistent or increasing uh testosterone for example in a program that is uh you know where the athlete is getting stronger and they're mentally healthy uh positive in a positive state um then testosterone will go up in in parallel with um with cortisol uh staying stable or going down so that ratio is quite an important marker for recovery and uh and performance um and conversely we see the opposite when the you know when there's a negative state uh you know negative spiral excessive fatigue um energy depletion and so on so um because of that variability though they're not always going to do exactly what you expect them to do sometimes you'll get erroneous markers so you need to test often enough to plot a you know what i call peppering a line and so it becomes very expensive um or you need to like you know if you look at the research studies they tend to be big cohort studies where that where when you look at the the mean and the standard deviation it's moved in one direction but you look at any one individual and it might not have done so you lose the individual within those cohort studies um that's the can i interrupt you for a second

so within that ratio because once again just looking at one of those it's hard to find the signal through the noise with any one individual person and then you combine the two and like you said they should be going in opposite directions if the if the if the training is going very well but what i what i found when when trying to use that from uh just from a very pragmatic you like utility point of view it's very it's just very difficult because there's just so much other context that you need to take into what is going on and you can't just say oh you need to rest more or or okay the training is really good right now because yeah and a lot of in a lot of cases you get these opposing signals where the biomarker is telling you one thing and the training and the performance is telling you another thing and then it's like the athlete kind of gets confused as to okay which one should i trust should i trust the biomarker should i trust the performance or whatever yeah and it's confusing because sometimes they go in they don't necessarily get the direction that you expect exactly yeah or there's a phasic process that they go through where initially you might present as fatigued and exhausted whereas it was actually this is just part of that damage recovery um sequence that then so the timing is very very important you know sometimes it's sometimes you you know you might do a hard training session you don't sleep well the following night uh and so measuring the next day you're a mess whereas actually you know

two nights later after some good sleep you've got a really positive compensatory response so uh you've got you know the without like really understanding the physiology around training and that each of these biomarkers like you say it becomes it becomes very noisy but there's definitely powerful signals within there if you do understand it so there's a researcher uh early on this is you know 20 or more years ago but a guy called professor christian cook is a new zealand uh researcher um has very compelling data and some nice publications around testosterone cortisol ratio responding according to whether or not you slept well um whether or not you're cycling you've had if you know he's done experiments where uh giving a team uh positive feedback positive team talks and that actually changing the anabolic environment within the within the you know physiology um versus negative ones you know reducing the response so it's very much like context specific there's a there's a brain a large brain element here to that to those hormonal responses because it's controlled by the hypothalamus and the hypothalamic pituitary adrenal axis is you know fundamental to all of these responses and the sympathetic nervous system as well so um it's you know really really interesting but yeah it's very hard for the lay athlete to go out and measure those kinds of things and get meaningful insights from the data i completely agree with you there um so so okay here's i'll completely buy this testosterone or

cortisol ratio being a thing that you could kind of add into the hero metrics like if we could wave a magic wand and say this is the profile cbc with an iron profile and that i i would i would take that if i could track that every two to three months with an athlete i i could i could do something with that here's here's the final thing for you to ponder and i didn't put this in the outline and i thought i put it i and i thought i was or i i wanted to i had it initially let me back up i had it initially in that line i was like no i'm just gonna spring this on charlie at the end to get your kind of like authentic response to it so sorry not sorry um we're we're getting to the point to where a lot of the friction associated with obtaining these biomarkers is going to be reduced significantly and we can use the analogy of just taking heart rate variability there used to be a lot of friction associated with that and now it's actually relatively you know kind of relatively easy i saw a patent the other day uh with a for a contact lens that can measure cortisol speaking of our cortisol ratio here and my point with that is is instead of going into the doctor's office and getting a venipuncture and you know having the all this kind of like rigmarole we're gonna within the next few years this is me extrapolating within the next few or several years we're going to get to the point to where a lot of these are just more accessible it's either on demand it's either on a patch or we use a smaller you know maybe even a dry blood spot type of testing which

is more readily accessible or it's in real time some combination of some combination of all of that i wanted to get your opinion on is that going to be better or worse or how can we actually use that in the future because we've mentioned several times that a lot of the a lot of the consternation with doing this testing is doing it on a frequent enough now uh on a frequent enough basis getting enough samples tailoring them to the individual and in theory this accessibility the accessibility being improved is a way through a lot of that friction to where we can actually get some really good stuff and we can you know to kind of tailor training and i wanted to get your thoughts on that because that is that is starting to that is absolutely starting to emerge and something that athletes will have to take into consideration in the very near future absolutely and i think it's it's already happening and i think it's really exciting um we've still got lots to learn around many of these things but if you take for like two other examples that come to mind blood pressure monitoring used to be go to a doctor yeah have your blood pressure but now you're sent away with it with an automatic um monitor and it takes samples throughout the day and you want to the doctor can understand um your blood pressure in a much more normal environment and the same with um glucose monitoring for diabetes you know we've got real time uh blood glucose monitoring continuous blood glucose monitoring so we can understand what that pattern is like across the day um there's more

and more examples that you know um that are gonna come out all the time hrv um that we can measure continuously um there's um things like uh well it would be lovely if we can measure things like uh hepcidin continuously so hepcidin is the iron uh controller so it will tell us when is hepcidin low and therefore we should take our iron to optimize the absorption um so you know inflammation margin we've seen in some of the uh athletes that we work with you know uh actually nfl players some of them are chronically inflamed because of the head impacts and the you know the size they have to be the training they have to do and it's a small part portion of them that seem to be chronically inflamed and we know that because we're testing them uh several times in a week and several times through the season as opposed to just a single health check at the beginning of the season and one at the end so and then you get an idea about the total exposure of that individual to inflammation so i think there's there's a huge amount of development to go you know um and you know other we have to be cautious around other tissue like you mentioned or other fluids you mentioned um uh teardrop there's also saliva um there's interstitial fluid all of these are going to be further away from the kind of the site of most which is the muscle or it's the organs or it's the brain and so we're already removed from that with the blood test so we're even further removed with uh saliva and other markers so we have to really understand does it reflect

what's happening more systemically so there's lots of things like that to sort out but um yeah it's it's hugely exciting to be able to to measure i mean even gps like we didn't use to be able to running speed and distance with the accuracy that we can now with such ease across all of our training and so it's going to be the same with biomarkers somehow i think that you're going to have to come back on the podcast in like two years and explain how we're going to use our continuous cortisol monitor in an effective manner because you're absolutely right not only do we have all of the things that we just talked about that kind of complicate it you're now you're also talking about the fact that it's further removed from whatever the original impact is that further clouds the if just further clouds the assessment that you're trying to to apply to the biomarker yeah yeah so we end up with a a sort of a tsunami or a you know of data that we have to make sense of yeah we want to put all of this together um but this is but there's there's opportunity there too because i think when when you have multiple biomarkers all flagging up as red concern out of range you know the athletes get more and more comfortable they need to back off the training recover um versus you know focusing entirely and obsessing over just sleep or just you know one particular biomarker you know that's not going to tell you the whole picture so i think it's it is it is exciting to see how those new tools of the future

are going to put everything together and then work out the thresholds like and conversations about those individualized ranges become very simple when you're talking about one biomarker at a time or when you're talking about 15 different biomarkers all or 100 different biomarkers all with their own adaptive ranges and then trying to work out which ones are the most important it can become complicated quite quickly so to to kind of put a bow on all of this i'm trying to pull out some major themes that we had talked about maybe you can kind of help me along the way so the listeners can kind of encapsulate the entirety of of the discussion the first one that we talked about is to understand that if you start using biomarkers taking a less granular approach to the movement of those biomarkers is probably a good idea you want to take a wide approach first and make sure that there's nothing kind of egregious going on and then if you want to tailor those markers into your particular range it is a very long proposition perhaps maybe even two years right i mean of getting enough of getting enough data in order to into into in order to make sense out of it i want kind of further that that proposition a little bit like fundamentally what we just talked about are there any other kind of hero points that you want to kind of re-emphasize to the listeners out there i know i think i i think those points are are good ones definitely obsessing over a single data point is something that's really ill-advised

you know i think um trying to bring my cortisol down that's the one that i always hear my cortisol has to be as low as possible yeah yeah cortisol is really important to manage inflammation and so with athletes you're going to have you know you're going to have cortisol we think of it as a stress one but it's actually helping us to manage that stress as opposed to being the stressor itself right so that's an important nuance as well but um and there's there's many other biomarkers that we haven't already talked about and the dietary one is an interesting uh interesting one i know this isn't a summary point because it's kind of a new theme but i i think um you know we've we've we saw some really interesting patterns with a cohort of um fatigued athletes and this is this unexplained under performance syndrome or overtraining syndrome group which is a poorly defined um but what we what we observed in that group is that biomarkers of um oxidative stress all seem to be consistently uh different in the fatigue group compared to the healthy group and that can many of those were related to dietary fruit and veg until you think about um dietary fruit and vegetables as being our kind of five a day as a standard recommendation for athletes it's probably more like you know eight to ten per day um and so and we were seeing in particularly young athletes um very low levels compared to compared to healthy controls so um another one is um fatty acids and fish oils you talked about salmon at the

beginning of the of the of the um of the of the tour but you know there's a there's there's good evidence that there's multiple systems that might be affected by um these these healthy fats also we need so and that's very easy to measure too so um going off on a bit of a tangent but i think there's that nutritional piece you can get quickly to uh insights about your diet quality with by measuring some of those biomarkers that would take you weeks and weeks to do via dietary analysis for example so um yeah i would kind of recommend you know looking at those two but the interventions always this is just me being cynical the interventions always come down to train correctly eat more and sleep more i mean kind of eat more probably has some nuance to it as you were just kind of mentioning yeah but but whenever whenever we look at the practical like course corrections it's like well you should be doing that anyway yes yeah you're right uh i think everyone has their own kind of personal set points on what they think is the right diet or the right exactly the right amount of sleep and the right you know and and you know most of us are not getting enough sleep and so um you know even if you think you are getting enough sleep there's probably ways that you know you can you can you can potentially kind of optimize that so um yeah you're right the the the fundamentals are always going to be the same uh but uh the big one i think that's often overlooked

within that is is the the multitude of stressors so it's not just you've got the training load and you can compensate for that with good sleep and good nutrition but there are other things that you're carrying with you there's a term i like to use called allostasis allostatic load which is probably a whole different podcast but this is um you know somewhere it takes into account all of those stresses and how we remain stable through that and it's uh and what the long-term impact can be of those stresses but that total load not just the training stress load is is is important as well 100 and so i already booked you now for two podcasts we're going to talk about allostatic load and then two years from now we're going to come back and talk about uh continuous cortisol monitoring charlie i appreciate you coming on the podcast and entertaining some of my uh uh some of my personal coaching questions but also this is enlightening for the audience uh before we let you go tell the listeners where they can find more about you and your research and then where they can find more about orico sure um yeah so uh orico.com that's o-r-r-e-c-o.com is uh is um you know the uh consult with them pretty uh pretty consistently on uh particularly on the biomarker front um and then my research yeah if you look up st mary's university twickenham or look me up on google scholar um yeah

you'll find my my research papers on there i will uh have links to all those in the show notes and thank you for being very practical and honest about this a lot of times when we bring on researchers that have this intertwining within the commercial space and i tend to be a cynic of the commercial space more more often more often than not uh sometimes they're a little bit guarded but i appreciate your really practical approach to it and it's uh it's really refreshing to hear great that's nice to hear thank you all right folks there you have it there you go much thanks to charlie for coming on the podcast today and helping us to demystify this ever complicated landscape of blood testing blood profiling and how we can actually use it to inform training this is one of those areas that i gotta be honest i'm always quite reluctant to do with athletes because it's complicated and yet we have to simplify it kind of all at the same time the blood testing can be quite nuanced and we try to look at very small deviations in some of these blood profiles and in many cases what we really need to be doing is broadening the lens out and looking at broad patterns and just as i mentioned several times during the course of the podcast trying to use a little bit of terrain trap avoidance particularly when we're using intensified training periods and or altitude interventions but at the same time

it's nuanced enough that we need to also provide a very critical lens to it and i firmly believe that the best solution to this is to get with a practitioner that knows this area very well that you can rely on in in order to weed through the results in a very per in a very personalized manner so if you do decide to undertake blood uh blood profiling try to keep that in mind as you're going through it is that you are going to get a lot of noise and perhaps very little signal associated with your particular blood profiling test i hope this podcast provided a little bit of guidance into any of those endeavors i appreciate the heck out of all you listeners out there if you liked the content contained within this podcast please share this podcast with your friends and your training partners that is the way that we get the word out i do not monetize this podcast in any way shape or form in fact it is a loss leader for me cost me money every single month to produce this and i'm happy to do it as long as you guys find the information valuable and i appreciate you guys sharing the information with your friends and your training partners that is it for today folks and as always we will see you out on the trails