Test. Don't Guess. A Guide to Physiological Testing

My mantra (well one of them), "Test. Don't guess". Powerful if you ask me. However, I have been accumulating feedback the past few years from individuals regarding various types of testing only to have concluded that we are living in the dark ages when it comes to testing. I believe that we are still following the Western Medicine guidelines of having blood work done only when necessary, for life insurance purposes, or once a year as an annual check up. I compare this model to the amount of nutrition education physicians receive in medical school: lacking.

I used subscribe to this same thought process too...albeit, when I was younger (read: bullet proof and NOT the coffee), and only new what university taught me. These days though, the older (read: wiser) me has learned quite a bit about the process of testing, applicability, and more importantly, the "why" behind some of the testing.

So, I thought I would share my thoughts on the way testing should be done, at least through my eyes. Keep in mind that there are SO many different types of tests out there (I am certainly still learning) so I am going to simply review the ones that are in my wheel house since I can speak intelligently about them. I'm going to limit this post to only 5 specific tests so I don't get too far on a rant and end up writing a novel.

Let's get started. First off, remember, there should be a fundamental reason for testing AND a method for using the information you receive. This is a pretty important point to keep in mind. Okay, here we go!

1. Metabolic Efficiency (ME)

Ah, the physiological test I created in the early 2000's. There is quite a bit of confusion not only on the proper protocol for this test but also the purpose of it. Let me make it crystal clear that the ME test is a nutritional assessment test. I guess you can even think of it as a nutritional performance test. However, what it is not is a physical performance test. You can read more about what you receive from the test HERE but this test will provide a "systems check" to see if your current daily nutrition (aka-diet) is meeting your health and performance needs. Quite simply, it looks under the hood to see if your macronutrients that you consume are out of whack or not. The test should progress in 4-5 minute stages, be done in a fasted state, and should last between 15-45 minutes. You should not do this test if you are merely looking to get heart rate, power, or pace training zones. That is physical performance data and there are better tests that will provide this.

The ME test is a sub-maximal. Yes, SUB-maximal, which means you should start at a super easy effort and progress slowly, possibly reaching close to threshold (but often times that is not even necessary)

Listen up because this really happens. An individual says, "I had a metabolic efficiency test last year, I'm fine". Well, um, no you are not. You see, what many do not understand is that your metabolic efficiency is more regulated by your daily nutrition than it is by exercise (more about that HERE). I have personally tested individuals (and myself) showing extremely profound changes in metabolic efficiency in one week. Yes, ONE WEEK! So folks, if you truly want a snapshot of your current nutrition situation, go have a Metabolic Efficiency Test done today. You cannot assume data from a year ago (or even a few months ago) is still valid.

2. Lactate Threshold (what I call, Lactate Clearing Efficiency)

This is the physical performance test that you want to set training zones. It doesn't require fasting and you should be prepared to go HARD on this test. Not like a VO2 but pretty darn close! I won't get into this test too much since I just blogged about it (click HERE to read that post).

In reality, only endurance athletes really need to bother with this type of testing and probably only 2-3 times per year based on their training periodization.

3. Sweat Sodium Concentration (and Rate)

Not many people understand the difference between concentration and rate. Sweat sodium concentration measures the, you guessed it, concentration of your sodium in your body. This is largely influenced by genetics and this testing only needs to be done once (what I term "one and done"). Once you know your sodium concentration, you can then move onto the rate part and get an accurate picture of your fluid and sodium needs during exercise. One thing to note: this type of testing can be done exercising (via patch, sweat bag) but the one we like to use at eNRG Performance is a non-exercise option that induces sweat from your forearm. Super easy and time efficient. In fact, it usually only takes about 30-45 minutes.

Sweat rate is what you need to really keep an eye on throughout the year based on the environmental stress and sport(s) you do. This can change quite a bit and will alter your fluid and electrolyte plan so it is best to do this when the seasons change or per sport (i.e.-if you are a triathlete, you should measure this for swim, bike, and run training). The rate testing is super easy and all that is required is an accurate scale. Simply weigh yourself (preferably nude) pre- and post-workout and record the information. HERE is a sheet detailing this information and how to use it.

4. Blood work

Seriously, this is probably the most important testing EVER, especially as you age or if you have family history of disease states. There are so many options it really isn't funny but suffice to say, I usually recommend a very comprehensive foundational blood work test at the onset of your testing, then follow-up panels based on any deficiencies you have or based on nutritional changes you are making. For example, perhaps you find that your lipids are a bit off (HDL, LDL, particle size, triglycerides) and you work with a Registered Dietitian to make nutritional changes. Your next blood work test can then focus on these specific markers instead of the "whole enchilada" again. Vitamin D or iron low? Work on it. Change your daily nutrition. Supplement if you need to but just be sure to have frequent blood work testing check-ups to ensure what you are doing is actually working. HERE is more information about various tests we do at eNRG Performance.

5. Genomics

This is relatively new and I will point you to the information I wrote for the eNRG Performance website as that is a great summary of what it is and why it is important. Suffice to say, yes it is important and no, it is not ancestry testing. The field is called Nutrigenomics and I remember about 10 years ago when I was reading a nutrition journal introducing this concept/field. I thought it was quite interesting and predicted that it would take off and become wildly popular. Here we are 10 years later and well, it is. This is very much a "one and done" test and is great because you find out which genes (related to nutrition) may have "spelling errors" on them and may not function they way they are supposed to. Perhaps you find out that genes for Vitamin D metabolism are not functioning well. Meet with a Registered Dietitian after the test, and he/she can help you identify work around strategies to help "fix" this problem so you do not risk Vitamin D deficiency. Be careful when you search for genomic testing though. There are quite a few choices, some cheap with not a lot of information and some expensive with too much information. Much like Goldilocks and the Three Bears, you want the one in the middle!

There you have it! Reach out if you have any questions.

 

Bob

Lactate "Threshold" Testing

I get quite a few questions from athletes regarding lactate threshold testing and if they should pay for this service at a lab or just do a field test outside. Let me address some of the confusion out there (as there is a lot of it!).

1. Lactate threshold as the name implies, is not really a "threshold" per se. The word threshold suggests that there is nothing above it. Rather, I have coined the term "lactate clearing efficiency", or LCE, to describe this term better. Why? Simply put, a lactate "threshold" test measures how efficient your body is at clearing lactate. You see, we are always producing lactate (it is a product of a metabolic cycle called glycolysis). Lactate isn't bad as it can be used for energy. However, above a certain intensity, and the build up of hydrogen ions actually begins to impair our performance.

Exercise is still possible above the lactate "threshold". Measuring the LCE provides us the point in time (as defined by heart rate, power, and/or pace) when our body begins to accumulate more than it can clear.

2. Once the LCE point is found, it's pretty easy to determine training zones. This is arguably the most accurate way to determine zone training. Sure, you can do some field testing but it is more difficult to control environmental conditions.

3. Here's where the real difference lies in lab (where blood is sampled every stage) vs. field testing, and one that many do not know. In a lab based test, yes, you are provided training zones but in my opinion, that is not the "a-ha" moment that you really need. More importantly, you can get a clear sense of the energy system that is weak or strong. For example, say a triathlete comes to visit me for a test and we learn that his aerobic energy system is a bit weak (as evident by the millimoles of lactate in his blood) but his anaerobic energy system is in full swing and ready to engage.

Summary

With this data, I can provide this information to the athlete and his coach, if he has one, to provide a better picture of where his training focus should be depending on the distances and his preparation timeline. Perhaps he is training for Sprint and Olympic distance triathlons and the season is 8-12 weeks away. This is a great place for him to be since his anaerobic energy system is so well prepped. However, if he was gearing up for an Ironman distance and only had 8-12 weeks left to train, it would be obvious that the energy system in most need would be aerobic.

In summary, it doesn't matter what name we give this testing. The important take away is that you can get much more data than just training zones from a properly executed lactate threshold/clearing efficiency test.

If I left you a bit more confused, feel free to reach out via email. I'd love to hear from you!

Bob

A Story

Sports nutrition is a passion of mine. My curiosity of how the body worked and why it did certain things led me to my university degrees in exercise science and nutrition. But it was growing up playing competitive soccer and basketball that really began this journey. I didn't grow up eating well or knowing how to take care of my body. I don't think any young athlete did at that time. And I certainly had no idea of what it meant to factor in proper recovery, sleep and stress management techniques.

I merely followed my coaches orders and back then, it was a whole bunch of hard training, punishment in the form of sprints, wall sits, or the like, and showing up on game day hoping for the best.

Maybe part of my fascination with the human body was due to wanting to understand why my coaches did what they did. Maybe it was just pure luck but I don't bet on that too much. Perhaps it was during in my first semester of college, studying architecture of all things, sitting at a desk, hunched over drawing sketches of buildings, that really made me step back and ask the question, "why am I doing this"? I loved to draw but sitting at a desk all day long wasn't for me. I remember during this semester, I took an athletic training course as an elective. I don't know why but looking back on it, I feel that I was drawn to it because I was an athlete. It was my inner self wanting to understand more about the body and how it worked.

That one class began my journey to carving my career, my passion, my story. You see, everyone has a story and I was thinking about this in context of companies that make sports nutrition products. Relatively speaking, most of these companies use similar ingredients, share the same types of products and shelf space in retail but what makes you and I gravitate to one versus another? Their story. It's pretty simple really. Think of these sports nutrition companies that you engage with and truly support. Not just because their products are on sale but because you connect with their mission and their philosophy.

What is important to you as a consumer of their products? I remember reading "Raising the Bar" years ago and was filled with emotions from confusion to joy. This book told the story of a company with different values from most. I also remember a phone call I received more than 10 years ago from a representative of a new company that was trying to enter into the sports nutrition market. They didn't open by asking my opinion of their product and idea but rather told me the story of a young boy who could not control his blood sugar due to genetic disorder and had to be constantly fed every couple of hours through the day and night. His parents were doing everything they could to help their son. His father eventually created a product that helped his son's condition and now this boy is a thriving teenager who has better control of his life.

The story. It's quite powerful if you think about it and it has allowed me to take a step back and truly evaluate the "why" behind my support of certain companies. At the end of the day, we must all be responsible for our actions and decisions. My story has shaped my passion, my career, and my support of others.

What is your story?

 

Quick and Easy

Times have changed. You know it, I know it. We have less time for many things due to the pressures we all face day in and day out. We live at a faster pace, skipping meals or eating them on the go oftentimes. The true mark of a good entrepreneur is to create solutions to problems or challenges and I believe Ample has done just that! While there have been other "meal in a bottle" concepts that have hit the market, I do not believe any of them have embraced the true nature of blending quality ingredients while optimizing the control of blood sugar with a decent taste.

In my opinion, Ample has done just that. Read on for my review of their product.

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Upon my initial exposure to Ample, I was quite shocked really. I thought, “why didn’t I think of that?”. Mostly because I am a smoothie-a-holic and this is a creation that would easily come out of my kitchen!

When I first got my hands on the Ample meal shake, I immediately turned to the label to see what ingredients were waiting for me. Grass-fed, a mixture of protein sources, fiber, resistant starch, omega-3’s, and probiotics topped off the list and are all ingredients that I myself would include if I had come up with this idea. It doesn’t appear that this company has skimped on any of the inclusions and that is something that I, as a Sport Dietitian, athlete, and parent, appreciate.

After the list of ingredients passed with flying colors, it was time to review the nutrition facts because sometimes no matter how great the ingredients are, some companies just don’t know how to put them together to stimulate positive physiological responses in the body. Ample gets it. Now, before I continue let me make it clear that this is a meal shake, not a snack. It provides a whopping 400 calories (they have 600 calorie options also) and I personally used this to replace my lunch one day. Many people will shy away from the 400 calorie sticker shock but remember, it’s a meal and you must approach it with this mindset. Calories aren’t really my biggest focal point so I moved onto the macronutrients. I am always concerned with the blood sugar controlling response of products and always look at protein first. At 27 grams, this falls right into correct amount needed for most individuals for a meal. I then moved to the carbohydrate content to make sure it is a 1:1 or 2:1 ratio of carbohydrate to protein as these ratios best control blood sugar (good for health and performance reasons). At only 21 grams of carbohydrate per bottle, this definitely achieves that goal! If you are an athlete, this may be too low of a ratio and a bit more carbohydrates may be necessary, depending on your training load. In this case, grab a handful of blueberries and/or mix Ample with milk of your choice for some extra carbohydrates to fuel exercise that is longer duration or higher intensity. The fat content comes in at 24 grams with zero trans fats.

Overall, the ingredients and nutrition facts of Ample support blood sugar control extremely well and will improve the body’s fat burning ability. But of course, who cares if it doesn’t taste good? After reading the ingredients, I was a bit weary and thought this would be the equivalent of picking up a handful of dirt and eating it. Not so! While Ample does have an “earthy” taste, I was pleasantly surprised how they made all of the super nutritious ingredients blend for a great taste that is smooth, creamy, and one that does not leave an ill aftertaste.

As I mentioned, I substituted Ample for a lunch and after mixing it with water, took about 10 minutes to drink it. What I noticed almost immediately afterwards was a comfortable sense of fullness. I was curious how long this would last and wasn’t too optimistic as I have tried other similar products and haven’t gone more than 90 minutes without eating something else afterwards. Ample provided a super high satiety (feeling of fullness) rating and I didn’t end up eating for 4 hours (yes, 4 hours) after drinking it.

Of course, there is an initial sticker shock that any consumer will have at first. Depending on the quantity purchased and the type (they have regular, Vegan, and Ketogenic), the price per bottle will range from $5.52 - $8.00. That may seem like a big chunk of change but remember, as I stated previously, this is a meal shake. It will replace a meal. Think of how much it costs to eat out then compare the nutrients in Ample versus a fast food meal. Ample doesn’t seem like much more than some powder in a bottle but dollar to dollar, I believe it will be a much more nutritious option that will help you optimize your blood sugar control, assisting in any health and athletic performance related goals.

As an aside, I had my teenage son, a highly competitive triathlete who trains upwards of 14 hours per week, try an Ample in between a swim and bike session. Two hours separated the sessions and he consumed an Ample immediately after his 4000 yard swim. He told me that he felt full, but not overly full, and his energy level was high all the way through his 1 hour and 15 minute interval bike session. Even after the bike, he said he wasn’t as hungry as usual. Success!

All in all, I will say that I will continue to use Ample and will always have a few bottles in my pantry for those times where I fall victim to the regular busy schedule of being a business owner, sport dietitian, father, husband, and coach. I would definitely recommend trying it as I believe you will be pleasantly surprised, not only by the super nutritious list of ingredients and pleasant taste, but also the ability it has on your body to stabilize your blood sugar and improve your energy level.

Want to try Ample for yourself? I would definitely recommend it to see how it works for you within you busy lifestyle. Click HERE or use the code ENRG15 to get 15% off your first order at the Ample website.

To carb or not to carb...that is the question

As I was enjoying one of my breakfast "rotations" of 2 fried eggs (cooked in butter) and a healthy topping of avocado (mashed with pepper, and garlic salt), it made me reflect a bit about why I chose this specific combination of food to start off my day. Of course, this led into analyzing a few of the current nutrition problems that athletes are faced with each day.

#1: First and foremost, I ate this breakfast because I really, really enjoy the taste of all of the food. Seriously, besides putting peanut butter on fried eggs (a blog post for the future), my taste buds are extremely tantalized when eating fried eggs with mashed avocado on top.

#2: This is a very low carbohydrate breakfast chock full of protein and fat. I am an athlete and train almost daily so what gives? Why am I not eating more carbohydrates? Well, put very simply, I didn't need many carbohydrates that day because my training load was due to be on the low side. In 2004, I published the first ever book on Nutrition Periodization (look it up, it's a good one). The concept describes the need to account for your training load when devising your daily eating program. In short, my mantra has always been, "eat to train, don't train to eat". I was eating to train for the day and since I didn't have much training on the plan, I didn't have the need for many carbohydrates. Plain and simple.

#3: There's a huge argument that many individuals (athletes and health professionals) are having these days and each seem to be taking a side on the low carb/high fat or high carb/low fat "diets". Listen up people, it's not about taking sides or choosing a diet. The body will require different amounts of macronutrients (carbohydrates, protein, and fat) each day according to your exercise/training plan (remember Nutrition Periodization?). You don't have to choose. Rather, you have to periodize.

#4: This breakfast was very metabolically efficient but not many people realize that 1) there are at least 5 different dietary methods that I have identified that improves metabolic efficiency and thus a "diet" does not have to be followed, and 2) there is not one single way to improve the body's ability to burn fat or carbohydrate. Unless specific disease states are present, it is quite easy to teach the body to use carbs or fat more efficiently. More about this in the white paper I am currently writing that will help to end the confusion on this topic.

At the end of the day (or the beginning in this breakfast example), here was my train of thought for making this breakfast:

  • Am I hungry?
  • What type and duration of training do I have today?
  • Are my taste buds geared more toward sweet or savory?
  • What do I have in my fridge?

There you have it. Don't think you need a PhD to make your daily nutrition choices.

Until next time...and probably a smoothie with more carbohydrates tomorrow morning since I am doing a double training session.

 

Bob

 

 

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Knee Pain

Throughout my athletic career, I have certainly had my share of aches and pains. The newest member of this "family" is chondromalacia (sometimes referred to as runner's knee). This wonderful (yes, that is sarcasm) condition is basically due to the protective cartilage covering the kneecap (patella) wearing down a bit, likely due to overuse and/or repetitive stress. So, my kneecap isn't getting its groove on any longer. No, seriously, my patella is not sitting properly in its groove right now!

For those who have experienced this before, it's not fun. If you catch it early and actually do something about it, consider yourself lucky. Mine got pretty bad. It hurt going up and down stairs, I couldn't squat, do lunges, steps-ups, or really any lower body exercise. Ugh. The pain during running fluctuated depending on the terrain (worse on hills and trails) and cycling was out of the question initially because I could hardly put any force to the pedals without that stabbing feeling in my knee.

So I read a bit more about this condition and didn't listen to much of the recommendations I came across because many of them are what I consider "old school". That is, until I came about something that peaked my interest as an endurance/strength coach: functional imbalances. I'm pretty big on finding and fixing these imbalances in the athletes I work with so I am no stranger to the process. However, it is a bit difficult to assess yourself so I asked my wife to snap a few videos of me running and still photos of my legs relaxed and contracted. I don't know if I was ready to see what I did but it sure did allow me to approach my treatment in a more methodical manner. And let's remember that this is a n of 1 case. I am not a physical therapist but I am a Certified Strength and Conditioning Specialist with training in functional imbalance assessment and exercise treatment.

Let's revisit chondromalacia. Back in the days, I remember people saying that once you got it, you couldn't get rid of it and that was the end of your running career. Well, it just so happens that chondromalacia can be due to a very simple (in my mind) muscular imbalance where the hamstrings are too tight and the quadriceps are too weak.

Taking a closer look at the videos and photos, I realized that I, in fact, do have weak quads on my right leg (probably due to having broken my foot a couple of times in the past 10 years and walking around with a boot). Once I looked at the videos and photos, it was very apparent that my right patella was not tracking properly. Yes, it was that obvious and I did not require any further testing.

So, onto fixing it right? Well, kind of. You see, I couldn't do many of the exercises that are prescribed to strengthen the quads because it involved knee extension, which hurt my knee. Hmmm...isometric contractions? Sure, but not too effective in my mind. Or perhaps I didn't choose this route due to my lack of patience. Nevertheless, I turned to a piece of technology that has been around for quite a long time: electrical stimulation. I researched "e-stim" years ago and have always kept up with the players in the market and the research but it wasn't until now that I became much more interested.

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I turned to arguably the most reputable electrical stimulation device company on the market: Compex. Armed with their Wireless 2.0, I wondered if I could make a more significant impact on improving my quad strength and thus ridding myself of this nagging "visitor". Honestly, I wasn't expecting much because I know it can take months or even years to address functional imbalances. Surprisingly though, I saw benefits within the first 9 days of using Compex. Pretty spectacular if you ask me.

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Prior to using Compex, I would struggle to run 3 miles without hobbling. My pain was usually a 8/9 on a scale of 1-10 (10 being pretty bad). Today, as I write this, I have done 6 mile runs pain free and even more importantly, I can squat, do step-ups, and walk up and down stairs with hardly any pain. Every so often, I do feel a bit of a chondromalacia reminder but the pain is mostly a 1-2 on the 10 point scale. This usually happens more in the morning before I begin my Compex routine.

Of course, you will want to know what I actually did with the Compex. It was a bit of self experimentation (remember n=1) but for the first 6 days, I was religious in using the resistance, strength, and active recovery programs for at least 90 minutes. Pretty easy, especially with the wireless unit, as I would just let it run while I was doing computer work. I then took a day off, then repeated this process for another 2 days. Today marks my 10th day of using it and I will continue to cycle through this methodology.

One thing to note is that I have been using the Compex mostly without training, meaning, I just sit there and let it do its job. Since my knee is feeling 100% better, I will begin using it during exercise this week to maximize the benefits of targeting the specific muscle fibers to seek even more improvement. One of the best ways to use this technology is during training (warm-ups, on the bike, pre-exercise potentiation, and during certain strength exercises). I think far too many people pick up a great device like Compex but do not utilize it to its full potential. If you are just using for active recovery, so be it, but you are really not experiencing the true firepower of this device.

To say I am elated would be an understatement. I firmly believe all athletes should be using this technology under the proper supervision of a professional in order to guide them through the different programs and periodize these programs into their overall training plan development.

I will post more updates as I utilize the Compex more during exercise throughout this month. Until then, Happy Holidays!

Bob