May I introduce the first guest to our recovery month! Dr. Izzy Smith is a specialist in hormone health and today we focus on all things hormones, stress & recovery. Firstly, Izzy talks about the concept of 'over-training vs under-recovering' and why a recreational runner needs to be mindful of this. We then move onto the role of certain hormones that hinder and enhance our ability to recover. Particularly nor-adrenaline & cortisol, these are typically classed as 'stress hormones' and the body will not enter the rest & recovery phase if circulating high amounts of these. We all know the body will struggle to recover if subject to large amounts of physical stress, but Dr. Izzy Smith highlights the role of emotional & psychological stress as equally important states. We simple cannot recover to the same ability if subject to these psychological stressors. We finish off today's episode with some listener Q&As around magnesium supplements, Vitamin D supplements and anti-inflammatory medications for recovery. You can find Izzy's Podcast Behind the uniform here Also click the link for Izzy's instagram If you would like to support the podcast, participate in Q&As & access bonus material sign up for $5 per month at our patreon page For Brodie's running blogs, podcast episodes and online courses visit our Run Smarter Website To follow the podcast joint the facebook group Becoming a smarter runner To find Brodie's running information on instagram @runsmarterseries
Expand your running knowledge, identify running misconceptions and become a faster, healthier, SMARTER runner. Let Brodie Sharpe become your new running guide as he teaches you powerful injury insights from his many years as a physiotherapist while also interviewing the best running gurus in the world. This is ideal for injured runners & runners looking for injury prevention and elevated performance. So, take full advantage by starting at season 1 where Brodie teaches you THE TOP PRINCIPLES TO OVERCOME ANY RUNNING INJURY and let’s begin your run smarter journey.
:
On today's episode, do runners over train or under recover with Dr Izzy Smith. Welcome to the Run Smarter podcast, the podcast helping you overcome your current and future running injuries by educating and transforming you into a healthier, stronger, smarter runner. If you're like me, running is life, but more often than not, injuries disrupt this lifestyle. And once you are injured, you're looking for answers and met with bad advice and conflicting messages circulating the running community. The world shouldn't be like this. You deserve to run injury free and have access to the right information. That's why I've made it my mission to bring clarity and control to every runner. My name is Brodie Sharp. I am a physiotherapist, a former chronic injury sufferer, and your podcast host. I am excited that you have found this podcast and by default become the Run Smarter Scholar. So let's work together to overcome your injury, restore your confidence and start spreading the right information back into your running community. So let's begin today's lesson. First guest for recovery month, we have Dr. Izzy Smith. We've been following each other for a while on social media. We do talk about that in the interview, but Dr. Izzy Smith is a endocrinologist. She studies hormone health and also women's health. She is a podcast host. It's slightly different. It's called Behind the Uniform. It's talking around mental health. Dr Izzy Smith is her Instagram account is Dr Izzy K Smith. I'll include the links in the show notes and I just love the work that she does and similar to what this podcast is revolved around. She helps people understand their health, helps them understand mental health and does a lot of posts and tries to get a lot of awareness out there and recent evidence. And it's kind of like that. direct to the public type of content. So really love her work. We talk today around over training or under recovering. And I did hear Izzy Smith on another podcast, which again, I talk about in the interview. I won't delve too much into it, but she talks about this concept of either over training or under recovering. Back to our last episode with our house analogy. Is it the- weather that we subject our house to, or is it our lack of being able to recover from the weathered storm that is decreasing our performance or increasing our risk of injury or just that inability to thrive as a runner? And so we talk about this concept in a bit more detail, particularly around the hormones and stress and these hormones and chemicals that circulate throughout our body that hinder our ability to recover or enhance our ability to recover. It's really interesting stuff. If we need to understand recovery, we need to understand what's going on in our body. And Dr. Izzy Smith does a perfect job of explaining that without getting too technical. And yeah, we talk, we dive into stress and how stress hinders recovery. We talk about the, whether there's any difference when it comes to psychological stress compared to physical strength, like going out for a run or doing a workout. And yeah, then we do some listener Q and A's and tie it all up in a nice little message. So I hope you enjoy without further ado, let's bring on Dr. Izzy Smith. Thank you for coming on and thank you for coming on to our recovery month. I'm excited to talk about this theme and talk about your expertise. So let's start. Thanks for coming on. No worries Brody, I've been a fan of your podcast and your Instagram so I'm excited to now be a part of it. Brilliant, likewise the feeling is mutual. So let's start off by talking about your field of expertise and how you got into the interest that you're in right now. So I'm a medical doctor, I have been a doctor for seven years now. I had a bit of a funny path of deciding what I wanted to do career-wise. I'm now a endocrinology doctor which is hormone health. I initially wanted to be working cancer, which I decided was the most depressing, sad thing and definitely not right for me. I toyed around with sports medicine as a specialty for a little while. However, I realized my passion wasn't treating injuries and I also think some parts of sports medicine can be a little bit non-evidence based, which doesn't completely sit with me. And that's where I fell in love with the concept of sports endocrinology, which is hormone health. which dictates so much to do with our recovery, our performance. And I think it's an area of sports that hasn't really been, you know, I think it's the next frontier of athletic performance. I think we now know how to train people really well. And the next way to, you know, improve athletic success will be more focusing on how do we get people to recover better. And our hormones are such a big part of that, you know, the, you know, training stimulus adaption. So that's my... I guess what I'm doing career wise is focusing on sports and chronology. And that's on the background of me, myself being a very passionate athlete. I'm probably not very good, but I make up for that enthusiasm and passion. So I'm now, you know, love running and dabbling in triathlon. Yeah. Talk about your, your endurance experience at the moment. So you said you've done a bit of running, a bit of triathlons. Um, what's been on the list, what's on your bucket list and what have you completed? So I was training for UTA 50 this year, which as everyone has experienced, most events have been canceled from COVID. But my running background is I grew up in Tasmania and I started running as a medical student, mainly to manage stress. I then did the first big event was the pointer pinnacle, which is a half marathon from the base of Hobart up the top of Mount Wellington, which is 1300 meters of elevation. That's where I fell in love with running. Um, and since then I've done quite a lot of trail runs. I like the longest stuff around the marathon distance. Next big thing for my list is a half Ironman in a quarry in May. And I know, you know, once you get the buzz, I thought I was just going to do a sprint distance track on, and then that moved to an Olympics and then I'm doing a half Ironman, I know down the track, I need to do a full Ironman or Ironwoman as I like to call it. Yeah. Very good. Um, the concept, well, just talking about your background and what your interest is. I am pumped that I've got you want us to share around recovery for athletes. And I was, I know we've been following each other's content for a long time. Now it wasn't until I think last month, I heard you talk on, um, trying you and podcast, the athletes garage. And you're talking a little bit about recovery sickness, that kind of stuff. And you did mention that athletes tend to, when they injured, they tend to or it's due to either over training or under recovering. And I'm like, that's such a perfect concept. It's such a perfect idea, which I hadn't heard of before. Now I hear it all the time, but you were the first one to actually get into my ears and get that concept in there. And I'm like, I've actually stolen it several times being on other podcasts as well, so thanks for that. But I think I stole it from someone else. Yeah. Like I said, it's so simple. It must be around for so long, but it's such a good idea that yes, you can over train, which The concept is introduced several times on my podcast. So people know that they can do too much too soon, which leads to injury, or they could do exactly the same as what they're currently doing, but still get an overuse injury from under recovering. So can you maybe just explain this concept of under recovering and what a recreational runner would need to know about that? I guess when we think about our training and our athletic goals, we just think about the hard work. When in reality, and we think it's the hard work that gets us fitter, stronger, faster. However, in reality, it's the rest after the hard work where we do the adaptions from the stress of training where we, that's when we're getting the benefit. So I like to say, you know, we don't get fitter, faster, stronger from training. We get fitter, faster, stronger from the rest we do after training. So that recovery is when we get our adaptions, when we get our gains. And there's so many factors that impact that post training recovery and our potential to get the full maximum benefit from our training, as well as recovering for the next session. So from a recreational runner perspective, really important things to think about what are you doing beyond your running? So for people who are example who may, you're a physiotherapist, you might be on your feet for 10 hours a day. If you're doing a training session in the morning, really hard, and then on your feet all day, your body doesn't have time to recover properly and get its adaptions. Or if you're having a rest day, which we know is really important for training, is to have one rest day at least once a week. I think you might've shared something a while ago that was for athletes that were having less than two rest days or one rest day a week. and a much increased chance of getting an injury. But to, you know, so looking at your rest days, are you properly resting on your rest days? If you've got a lot of psychological stress, you're on your feet, you're doing more than 10,000 steps, that's not a rest day. So my thing is, you know, when we talk about under recovering, it's, you know, are you getting the maximum benefit from your training? Great. And I think it's my very, very first episode of the podcast was adaptation education. And making sure people understand the importance of the body adapting to the loads you want to put it through or how strong you want to get. And it's, it's awesome that you illustrate that point that it's not during the actual exercise where your body adapts, your body actually adapts when you're not exercising and you are trying to utilize that recovery session as much as you can, and that might necessarily might not necessarily be not running. It's actually like complete load off and you know, maybe walking around and going to work, your body's still maybe not be, you might not feel like you're exercising, but you're definitely not recovering, is that right? Yeah, and the other really important factor to talk about is psychological stress. We think about stress when we train, it's a very physical stress on our body, and we're flooding our system with stress hormones, such as neuroadrenaline and cortisol. However, when we are psychologically stressed, we are releasing the same hormones. we're releasing the neurogenome, releasing the cortisol that prevent the rest and the adaptions. So if we are getting pumped at work, if you're a uni student and you're studying for exams, your body's actually stressed all the time and you're not giving it that time to recover. And your individual cells, when we are psychologically stressed, our muscle cells can't really tell the difference between physical training stress or psychological stress because it's the same hormones that are acting on every single cell in our bodies. So I think that's something really important for people to look into is psychological stress and the impact that has on training load. And we know with athletes, there's a lot of studies that show, you know, looking at university and college students, just before exams, their training performance usually drops. And it shows, you know, your total load is impacted by that stress. And you might not be able to push as hard just because you're under recovered from when you started. Keeping in mind that the listeners don't have much of a scientific background, we can try and keep this as simplistic as we can. Can you in your, um, best way explain why we can't recover when these hormones are circulating around the body? So firstly I'll explain what a hormone is. So hormones are our body's messenger systems. Often people think of hormones as just being sex hormones like testosterone or However, in reality, we have nine, 10 different hormone systems from melatonin that tells us to sleep to our adrenal glands that produce cortisol that's important with blood pressure management, blood sugar management. Your thyroid produces hormones that manages metabolism. And so hormones work by traveling to different parts of your body. That's what makes it a hormone. It travels through the blood and then acts on a different organ. When I talked about the stress hormones. We evolve from our hunter-gatherers and our behavior has changed very rapidly in the last thousand years, but our bodies haven't evolved very much. So often we hear about the flight or fight response. And that's when we're stressed, we get that big flood of noradrenaline and cortisol because that primal brain thinks there's a threat. There's a, I don't know, some kind of wooly mammoth that we need to run away from because it's gonna eat us. So when we're psychologically stressed, we get big floods of stressful moments and they prepare our body for a fight. That's to run really fast, our blood vessels dilate, our blood sugar levels go up to prepare our body. In that primal brain, when you're stressed, you don't, it doesn't worry about recovery. It's not caring about healing your body from the day. It has more important things to do. It's trying to keep you safe. The issue is now in our, switched on 24 seven stressful jobs, you're never having any time to unwind. We're often stressed all the time. So we have those high levels of neuroadrenaline and cortisol, then you know, big two stress hormones. If they're always gonna be high, our body's never gonna be able to go back into that repair system to recover the muscles, you know, and let those adaptions happen because it's always thinking, okay, I need to keep you safe from this threat. So that's why, you know. things like meditation and mindfulness and winding down, not just important for our minds, but also really important for our bodies. Okay, so from a hormone perspective, it's sort of treated the same, whether you are under psychological stress, like exams or work or kids and family, all that kind of thing, compared to actual physical stress, which would be doing a hard, intense workout, that kind of thing. Absolutely 100% correct. Wow, okay. And then... goes without saying with what we said before, if you have that noradrenaline cortisol circulating around in the body, the body then won't have the opportunity to recover because it's the, it's the preparing for a final flight. Yeah, it's not preparing to rest, digest, recover, heal your body from the days, you know, physical training. Right. I wanted to cover stress as the general topic of today. But before we dive into maybe specifics, are there any other common areas around this whole like preventative of adaptation that people underutilize or some recreational runners might undervalue that you see that's like inhibiting their recovery? Yes, the most obvious simple one would be sleep and I think that goes for health and well-being a lot. Often we you know want to cherry pick the things at the top, you know we think eating goji berries or you know super foods or whatever rubbish is important for our health. where it's really the basics of eating enough fruits and veggies, getting enough sleep, doing a bit of exercise. And recovery is the same. The most sleep and managing mental well-being will be the most important things for recovery. We are humans and we are complex biology and our bodies are designed to have eight hours sleep. We try and shortcut this. We're trying to, you know, we've got artificial lights now, keeping us awake for longer, but really our bodies are designed to sleep when it goes dark. And if you think about melatonin and the VATS release when it goes dark, it makes sense. You know, biologically we're supposed to sleep when it's dark, which is eight hours. People try and shortcut this and think they can, you know, cope with sleeping only six hours a night. But like I said, we're biology, we're not robots. So I think prioritizing sleep is so important. Also looking after mental wellbeing. And I'm not a dietician, but the other one is making sure nutritionally you're meeting your needs. And something I think a lot of runners falling to the mistake of is thinking protein is for your gym junkies who are trying to get big muscles. And like I say, running is thousands of single leg squats over and over again. We actually have a really high rate of muscle breakdown. So making sure you're getting enough protein as well as your other macros are definitely the basis of good recovery. Cool. I did want to get another guest on later in the month to talk around sleep. So I think it's important that people realize the importance of hormones when it comes to sleep, when it comes to stress. So very good that we illustrate that. But we might, uh, hone in on the stress component for today's episode. I will say just one thing about the sleep and hormones is after Katie and rhythm and our hormones are on a 24 hour clock. So, you know, our cortisol, our testosterone, our growth hormone, all fluctuate during the day, and that's dependent on sleep. So that is why, as well as sleeping eight hours, also when we sleep, our body clock is quite important as well. Cool. If we are just adding in a little bit more value, any tips for people to help improve their sleep? Everyone is different, but some really simple stuff. Cutting out caffeine after midday, getting off our phones at night, the blue light comes in through, looks at our retina, through our supranucleus, oh, supranucleus goes through our brain, suppresses melatonin release. So cutting out blue light is really important, having some time to wind down, getting up at the same time every day, and also trying to avoid napping too late in the day. Fantastic. I could talk about sleep for an hour, but these are really basic needs. Personally, I love the Calm app, which is like sleep music and sleep stories. As someone who's been a shift worker, I know that's been a complete game changer for my sleep. Yeah, I've used the Calm app as well. And yeah, also a big fan. Regarding stress, if stress hinders recovery, what are the recommendations that you might suggest if... let's just say someone's training for a marathon and they've got a job promotion and that is like some unavoidable high levels of stress for a certain period of time, but they still want to continue building their marathon training plan. If they've recognized that they're under high levels of stress, what would be some recommendations to reduce their risk of injury and help aid recovery? I feel like you'd be able to answer these questions well, Brody, but. Something I would talk about is accepting that you might not be able to train at as high intensities during high levels of psychological stress. As I said, your body already has a certain amount of load, so it just might not be able to tolerate that higher load of a very high intensity session. So that is something I would recommend of maybe decreasing the load but maintaining the volume. Obviously with the job stress, you know, that is unavoidable. still trying to find some time to actively decrease those stress hormones through, you know, whether it's mindfulness, listening to a guided meditation. There's actually not quite a lot of evidence that he's developing for things, you know, activities like mindfulness and meditation. And this is someone as I hate trying to meditate, I'm terrible at it, I'm trying to get better. And it's something I think people need to accept takes time, you know, learning to meditate and become mindful is... It's like getting fit. We're not going to be really good at it straight away. And it can take a bit of time, but the evidence shows it's really great. Also the other thing, you know, when you do have that stressful job, trying to still get enough sleep, avoiding alcohol as well, because that's going to muck up your sleep, that's going to increase your stress and seeing what other stressors in your life you can take out. I'm all about outsourcing. So if you've got a really busy stressful job and it's important to you, what other stresses can you get in your life? You know, I get food prep. And I'm very fortunate I get my house clean because, you know, removing those other stressful activities, you know, helps me focus my energy on the things I'm really passionate about. Yeah, cool. And I know that is an incredibly privileged answer. So I'm sorry. I know not everyone has the financial capacity to get a house clean up, but it's, you know, removing the stressors that, you know, aren't a high priority. And it's just goes to show that you can be creative at identifying other stresses that might be around and being creative. in removing those or allocating those to other people so that your total psychological stress is decreased and that would ultimately mean that you can start recovering or at least tolerating a little bit more load if you decrease your levels of stress, which is really cool. I talk about the stress cup and we all have a stress cup that at one point it's going to fill up and whether that's psychological stress and physical stress, you know, and We are only human, we are biology, there's only so much we can handle. So seeing what you can do to try and take out that stress cut before it overflows. And physical stress and psychological stress, I say quite common because we can only handle so much psychologically until we'll break. In the same way, our bodies can only handle so much physically until it will break. So seeing what we can do to take away some of that load. And as you said, in the stressful job, if someone's on their feet all the time, can they have some time off their feet? Ways you can... decrease both your physical and your psychological stress. Yeah, I might get a bit of backlash for this, but I'm also a fan of knowing that psychological stress in a lot of situations is kind of like internally driven. Like it's the person themselves that makes it stressful rather than like someone could have a stressful job, but it just doesn't affect them the same way it might affect someone else. Like someone might affect psychologically their- constantly wired up with high levels of stress because they're taking on like say personal responsibilities or they just don't respond too well to either being yelled at or having, uh, like deadlines or pressure, that kind of thing. And that's of course that's, you know, that's makes sense. And we are all a different, and that would be, you know, working and being self-aware and working on your, you know, your own mental fitness. I think often when we talk about mental health, we talk about it as if it's mental illness. and then people being really mentally well. In reality, there's a very big spectrum between the two. And most people sit somewhere in the middle and at different periods, you might be a little bit more mentally unwell. You might not have a mental illness, but you'll be under more psychological stress. And the reality is alive. Hard things are gonna happen. COVID has told us that hardships will happen and it's about developing skills and support network. So when those hard things happen, it doesn't have... such an impact and load on you. So you're right, you know, everyone will adapt to different experiences and experience stress in different ways. And psychological stress itself isn't necessarily bad. That's how we become more resilient. It's about being aware, like with our physical training, you know, that's short stress on the body, being aware and, you know, getting some practices in place. So you decrease that mental stress and you slide back towards the mentally well. Great. And yeah, having that support network like you suggested, perhaps using like the Calm app and practicing like some self-awareness or meditation or breathing exercises. They're all really good strategies as well. Back to the scenario of someone who might be training for a marathon and experiencing levels, high levels of stress. I think there's also just knowing that you can, if you're following a running program, you can swap out some days here and there. You can adjust your week. Let's just say on a Sunday, Monday, you've... recognized you are particularly stressed and you haven't been sleeping too well, just take out your hard session and replace it with an easy session. Do your hard session later in the week when you have started sleeping better or you have felt a little bit more recovered. That might be a really nice strategy as well. And the good thing to point out is if you are really under recovered, your body's not going to be able to tolerate the load and get the benefits on that high intensity session anyway. So apart from the fact it's going to, you know, just make you feel probably worse. You're not going to get the benefit. that really hard session anyway. And it can be really hard, especially for Taipei personalities when they have a running plan that says, you know, I do this and this and it's really nice to tick those things off the box, you know, tick them off as we go. And I think that's as we become more experienced as a runner, we get better learning and recognizing our own body and when we do need to have those days off. And, you know, I think that's where you'll see those really, you know, high elite athletes, they know when they need to have a session on. It's not, they're not monitoring their heart rate. They're not doing anything tech savvy to know they're under recovered. Most of the time they just know their body's well enough and know they need to, you know, decrease the intensity or take a rest day. Yeah. I did have the question written down around, should we base our decisions off feel, or is there a way that we can measure our stress and kind of say, all right, I'm not doing well in this area. Let me make this decision. Or is it like what you said, just what athletes are doing, they just know. you know, it's the year 2020 and we have so many different wearables and weight and monitor track, absolutely everything. It's important to recognize a lot of the things we do use for tracking such as our sleep monitoring, our heart rate monitoring, a lot of them haven't been calibrated to see if they're evidence-based. So, you know, I don't know if my garment, when it tells me I've had two or three hours of deep sleep, we don't know if that's actually true. So that's something that's important to recognize. Two, there's most of the evidence shows that we have all the data in the world, but that never is, hasn't been shown to be more effective of being able to recognize, you know, the feeling of if you're under or over, you know, if you're not recovered already for the next session. The third thing is sometimes those tracking, you know, all the different data we can collect become it can become a bit of a stressor on itself. you know, if you do have an important game or training session and you feel good, but then your watch told you, Hey, you are, you know, under recovered or you haven't got enough sleep, but you feel great. That's probably going to stress you out more and impact your performance. So I think, you know, this definitely benefits all different technology and data, but it's important to recognize one, we don't know how evidence based it is. And two, the best evidence we've got doesn't really show it's more effective than knowing how we feel. I definitely recognize that when, cause I wear an aura ring when I go to sleep and I definitely recognize I shouldn't be paying attention to the sleep stages that it gives me. I, I think in the past listening to sleep scientists and that you really need to go into a sleep lab and have like those electrodes on the head to really measure what phase of the sleeping cycle you're in. And like I said, yeah, you need the polysynography where we measure all the electrodes on your brain, which you know, obviously the watch doesn't do. Yeah. Absolutely. Um, if we're looking at someone who is particularly stressed and hasn't done any meditation or the calm app or practicing mindfulness or breathing or anything, what would be your recommendations for like somewhere to start? Well, they, they don't have a high education on like, you know, strategies to do what would be your first starting point. learning how to be present and not distracted by technology. I really encourage people to go for walks without their phone. You know, so often we are connected to devices 24-7 and we're never actually just present in ourselves. And I think we need to learn how to be present in ourselves because that's how we start to recognize how we're feeling. Are we exhausted? Are we stressed? And how can we become self-aware if we're constantly distracted by... devices, laptops, movies. And you know, I'm no better than anyone else. Sometimes I'm sitting at home watching a movie with my laptop on my lap doing work and I've got my phone. I'm like, this is just absolutely ridiculous. So yes, learning to just be present in yourself. So you know, whether it's a walk without your phone, you know, sitting down by the beach for 10 minutes and just sitting there. So yeah, I really recommend trying to take time off technology. or even reading a book, you know, reading a book, you need to be present. You can't be, if you're watching a movie, you can do what I do. How would my laptop and my phone reading a book, you have to be present. And I think it can be quite confronting when you realize how hard it is to read a book these days, because we're just so used to our attention constantly being grabbed. See, that would be my advice. Just some really simple measures. Cool. One of your topics when you're talking to Trang that I really love that haven't talks much about on the podcast was sickness and you're, um, boosting or inhibiting your immunity. Can, if we're under high levels of stress and we are under recovering, are we at more or higher risk of developing some level of sickness? Short answer. Yes. Um, so our immune function is definitely, uh, most active when we are sleeping. And when that parasympathetic nervous system, the relaxed nervous system is predominantly on. Because if you think back to what I said about, that primal person who's running away from the wooly mammoth that wants to eat them, at that time, their body's priority is not their immune system or fighting an infection. The cortisol actually has a suppressive effect on our immune system. So, high levels of stress do increase the risk of getting coughs and colds. The other thing is sleep deprivation. There was a study a while ago, it's a great study, they showed people who were sleeping six hours or less a night, they injected rhinovirus, which is the most common virus that causes coughs and colds. They injected rhinovirus into people's nasal flares, and people that slept less than six hours were 4.5 times more likely to get a cough or cold than the people that were sleeping seven hours or more. And if you think about it, Like that's amazing. And I know for me, whenever I have a late night, if I go out, I always get a cold or a cough afterwards. And the other thing, apart from getting sick, you're also gonna probably miss a few training sessions. And we know consistency is one of the most important predictors of athletic success. And so yes, one, sleep deprivation has a big impact on our immune function. Most antibodies are made when we're sleeping. Immune function is predominantly working at night. And that makes sense. You know, when you're sick. You just bloody want to sleep. You know, sometimes you'll go home and sleep five hours in the middle of the day and night, what is going on? And that's your immune system, you know, being active in your body telling you, you need to rest because your immune system needs to, you know, be working hard right now and yes, the psychological stress, cortisol has a suppressive effect on our immune system. Okay. And I think if someone to say is trying to become a better runner, trying to increase their running performance, trying to prepare for a race, they may have experienced how. one or two weeks of a sickness can knock them out and set them back in their training plans as well. So I think not only are we trying to boost recovery to reduce our risk of injury, but also reduce the risk of sickness can be really beneficial for performance. Yeah, and something I would say, well, you know, someone who's sick for a couple of weeks, I really recommend if you do have a cough or cold, just completely resting for two days. Our bodies... Because of all of those factors, cortisol and sleep things are important. If we're trying to push on with a low grade cold, we might be able to do our training sessions. They're not going to be very good. But that's when you see a cold linger for two weeks. Stay at home, have two proper days of rest where you're not trying to get work done. You can actually cycle psychological and physical rest. And that will get you so much better. I mean, get you better so much quicker and be able to get you back to training at full capacity much quicker. Yeah. And that kind of ties in with what we're talking about at the start. If you, if you're sick and your body's trying to fight a sickness and you're say, Oh, let's just do a light session or let me just like stay on my feet or day, I won't do a hard session, but let me just go for a run and I'll just take it super easy. You're still like giving yourself some physical stress that like we said before, we need to flip the equation and really get into that rest recovery mode rather than that. Um, exercise mode. A hundred percent. You want to keep, you know, your heart rate low. And I, cause I do say to athletes, I always get asked, should I train when I'm sick? And I say, you know, really trying to keep your heart rate. If you are going to train zone one, you know, I don't want it going above one 21, 30, which for most people means, you know, a walk or a very slow job. Because we know once you start to get your heart rate up, that's when your, you know, sympathetic nervous system kicks in and you do have those suppressive immune effects. Great. We're, we're getting better at more value than I have written down on my page here. So this is great. We're delving into a lot more. Is there, if a runner is loving this and like learning a whole bunch while we're on this, the topic of like hormones, are there any other hormones or any other topics around hormones that a runner might need to know when it comes to recovery? I could get a little bit complex and we could talk about, you know, growth hormones and what type of training we do for new growth hormone peaks. But I think it's probably getting a little bit scientific and a bit theoretical. Um, the other thing that I guess, which is very, very relevant is the importance of our sex hormones or athletic performance. So that's, you know, testosterone and estrogen, um, so for men and women and, you know, testosterone is also important for women as well. And that's important for your muscle growth. something. So relative energy deficiency syndrome is getting a lot of press at the moment, which is excellent. And that stands for relative energy. Oh, I already said it red, sorry, red S relative energy deficiency syndrome in sport. You may have heard it being called female athlete triad and that's standard for disordered eating, losing periods and you know, bone health problems. You know, repetitive stress fractures is what people say. Have they realized it occurs in men as well? So, you know, men can get low testosterone and that's where you start seeing decreased performance, increased costs and colds. And obviously they don't have, you know, periods as a warning sign, but you know, loss of warning erection is what we say is the kind of the equivalent of amenorrhea in women and amenorrhea standing for loss of periods. And so that is, you know, something that we see in very lean athletes or athletes that are dropping a lot of weight quickly. However, it's also important to recognise that it's not just in lean people. If someone, you know, increases their training load really quickly without increasing their nutrition, their body's going to say, I don't have enough energy. Um, and it will shut down different organ systems. So not shut down, but it'll give less energy. So what we see is, you know, people getting crops and coals, they lose their periods, their bone health goes off. And that's, you know, relevant, very relevant to recreational and professional athletes. I think it's worth. when we're talking about this, because now we're delving into nutrition, which is great. Um, it's something a bit out of my lane. I'm sorry. It's, I love it. It's important to recognize that recovery, like your body needs energy to recover. Like it needs nutrients and needs while you're resting, it's utilizing the energy stores to recover. It goes to the muscles, bones, tendons, everything like that. It's redirecting and reprioritizing where it sends that energy. And so what you're saying is someone's. like dramatically, like if they're not getting the amount of nutrients required for recovery, then the body's going to use all of that energy stores when you're physically working out, but then it just won't have anything left when it comes to the recovery component side of things. And so that's why nutrition is really important. Make sure that's on our priority list. And that's, unfortunately, we see athletes who think on their rest days, they don't need to eat as much when really, you know, adaptions and, you know, physical improvements, it's a metabolic process. We need those extra calories. So, you know, rest days, nutrition is super important as well. And like you said, it's, you know, our body will be giving energy to, you know, just be able to do the training, but it won't get the performance improvements and other things will start going wrong. You know, bone health, you know, short-term infertility, immune problems, and you know, mental health as well. You know, not having enough, you know, your nutrients, calories, just for your brain to function properly. Yeah. Let's dive into some listener Q and A's and this is a really nice segue to what Carl asks. He, well, a man a few words, he just put supplements dash magnesium question mark. And I assume he's asking, is there any supplements that we can take to help recovery? And what are your thoughts on magnesium for recovery? So first we'll go back to saying, remember the most important thing we can do is adequate sleep, managing our mental health. then getting enough calories and a varied diet. Then once we get more towards the top, we're looking at things like massage, ice baths. And that's when I think supplements would probably go a bit around those top areas. Magnesium is very popular with athletes. And there's a little bit of evidence that it can actually help with sleep and relaxation, not strong evidence. But... it's important to recognise that it's hard to get good evidence in athletic performance and some musculoskeletal things. It is a bit easier because magnesium is a tablet, so you can have a placebo. But there's just not the drug companies doing these big power trials because magnesium is cheap as chips, so why would they? But yes, one, there is evidence that magnesium can help a little bit with sleep and relaxation. We know sleep is very important for recovery. Two, if people are magnesium deficient, And this is a really important concept to talk about in supplements. You know, saying supplements don't benefit people is provided their levels are replete, you know. Um, if you're deficient in vitamin B or vitamin D or magnesium, you know, supplementing them reports will make you feel better and help you perform better. So magnesium deficiency is not uncommon. So for people that are depleted, they would definitely get benefits. The third thing I would say is placebo effect is real. and there's nothing wrong with placebo effect. And people do feel like taking magnesium, whether it is helping their stiff muscles or not. If they think it helps, there's nothing wrong with that. Magnesium, it's a pretty hard supplement to overdose on. As a doctor, I've never seen any complications from hypermagnesemia. So I think if people feel like it's working, no, why not? The other thing is, we are now seeing popularity of magnesium sprays and creams. there isn't really the evidence to show that magnesium could be systemically absorbed. You know, our skin's a pretty great barrier. You know, it's there to keep nasty things out of our body. So do we know that magnesium is absorbed through the skin into the muscles? We don't. So I would probably recommend, you know, more oral magnesium than the creams. Maybe the creams have a bit better placebo effect. Also recognizing that magnesium can cause diarrhea and, you know. running guts plus lots of magnesium supplements could be problematic. But yeah, I think anecdotally we see a lot of athletes saying it helps with cramps and stiff muscles. Okay, so if anything for the recovery component, there is low level of evidence so they can get, it can aid with sleep, but it's kind of like something you might try as at the top of the pyramid, whereas we wanna make sure that you are getting good sleep, nutrition, or like dealing with the... the stresses in your life as the base. And then you might wanna try, once you've covered all of those, you might wanna try some magnesium. Maybe, do you get blood tests to see if you're low in magnesium? You can, but the reality of doing blood tests are the levels fluctuate so much for a day-to-day basis. And the other thing with blood tests for things like magnesium, vitamin D, they're done on a general population. We don't have trials showing what's the peak magnesium levels for athletes that are training one, two times a day. So you can get blood tests to see if you were deficient. However, I don't really think there'd be that much utility in them, in honesty, because one, levels of blood charade on a day-to-day basis. Two, the cutoffs of what we decided normal are based on a general population of a confidence interval where most people fit. Yeah. Any other supplements that you think might help someone who's doing everything correctly, but wants to, um, get that extra 1% for recovery. Anything you might suggest. I won't go into sports supplements because that's a bit out of my lane, you know, right? Beta-alanine and those types of things. Have a vitamin D is something that is, you know, in the literature quite a lot at the moment. And I think it was BMJ did a good study showing that athletes supplemented with vitamin D. It can help. performance and athletes may be increased risk of vitamin D deficiency and a higher requirement than the general population. And I, not that anecdotes are evidence, but I know I supplement with vitamin D. I'm really worried about, you know, I'm very cautious about skin cancer and sun damage. So I think, you know, vitamin D is one that lots of athletes could benefit from. Vitamin D, magnesium, I think they would be the main ones. diet is definitely going to be the most important one. The other thing is, you know, we're seeing a massive increase in plant-based athletes. You know, I am one of them. But, you know, having enough adequate protein approach training, we are seeing evidence, especially if people are training twice a day for improved recovery with protein supplementation. Okay. So if you find that you're lacking in protein, if you find you're lacking in vitamin D, make sure that they're supplemented or make sure that you're getting to help performance and aid recovery. Spot on. Okay, great. Our next Q&A question comes from Amanda and she asks around anti-inflammation. She's heard a couple of things, whether a couple of different opinions to have anti-inflammation before a run or during a run or after a run, or not taking them at all. And so she's heard all these different opinions and wondering if we could. help with clarifying a lot of this. She also mentioned that it's mainly for her arthritic knees. So it's mainly around that condition. So can we clear this up at all? Without, you know, seeing someone's knee MRIs and knowing, you know, they're great of osteoarthritis and their medical chromobities, they definitely can't. And that's why, you know, especially asking advice from, you know, your running friends or your coach or no offense, your physio, who probably doesn't have that. in prescribing medications and some of the side effects and complications. There's really no one size fits all for people and it's about individual basis. So first just talking about what an anti-inflammatory medication is. They work on the COPs 1 and 2 enzyme pathways and they decrease prostaglandins that can cause inflammation and pain. So that's why they're called an anti-inflammatory. A few things, you know, one in mild osteoarthritis, it's important to talk about pain and what slightly sore knees means, meaning the significance of pain. We know in arthritis, you know, exercise is actually, and physical activity is quite good for arthritis, and it can, you know, actually prevent worsening. So thinking about what the pain is, what are the concerns, are you worried that... is exacerbating arthritis and what are your goals for taking the anti-inflammatories? It's because you can't get through the run without them or are you concerned that the pain in itself is a warning sign and bad? The other thing would be, I would be concerned if people were relying on anti-inflammatories to run, if they couldn't get through a run without those anti-inflammatories. These medications do have side effects, looking at GI alteration, increased risk of bleeding. And I'll talk a little bit about kidney injury for endurance and anti-inflammatories. So yes, I wouldn't want someone to have to rely on anti-inflammatories all the time. Occasionally, if we're a little bit sore, if you're doing a lot of kilometers training for an ultra marathon, you're gonna have aches and pains. That's the reality of it. And an occasional anti-inflammatory is fine. And then thirdly, if we're looking at people with quite severe arthritis, do take anti-inflammatory all the time, but that would really be that severe osteoarthritis where I don't think people would be able to run. So that's a bit of an all over place answer, but one, I would say anti-inflammatory, they're not gonna worsen their arthritis or the knee pain. Two, I wouldn't want someone though needing them every single run, that would be a bit of a red flag for me and I think you probably need to see a specialist. Three, how bad is the pain? It doesn't necessarily mean there's damage and is it actually arthritis? Could it be patellofemoral syndrome? Is there something else going on? And I think the complex issues like this, this is when a sports medicine physician can be really great. Because if you see a orthopedic surgeon, sometimes they might just say, oh, just stop running. To runners, that's like, you know, world-shattering. Sports medicine physicians really wanna keep people training and keep people running, but they've got that medical background of knowing when it's appropriate to prescribe medications and some non-operative measures for. things like arthritis. Very well said on such a complex topic. The other thing I'm just going to say that sorry, anti-inflammatories is, you know, a lot of endurance events now are banning them because they do increase the risk of kidney injury, which can, you know, result in rectal myelitis. I'm going to say that muscle breakdown. So they can decrease the blood flow to kidneys, you know, a 45 minute run, you know, half marathon, probably fine, you know, running 10, 12 hours. I definitely wouldn't want people to be taking anticholomataries. Okay. A few things I will add the, when it comes to the arthritic condition, if we're talking about cortisol and these hormones that circulate around the body, if someone is getting decreased levels of sleep and is under particular high levels of stress and it circulates a lot of cortisol in the body, that can actually be a direct correlation to. arthritic like sensitivity, like the structures around, let's say it's an arthritic knee and that kind of thing. And that making sure that all of those concepts and all of those recovery strategies are in place and not just like having really poor sleep and then just taking anti-influenza because their knees sore. If you want to really make sure you decrease the sensitivity of those tissues, we want to talk about all of that, all those recovery strategies we've already mentioned in this episode. We know psychological stress is associated with increased pain. And that's probably, I'm sure there's some survival instinct reasons for that. And you're 100% right that as well the inflammation from stress, because we know inflammation and stress and mental health related, is also going to worsen the knee pain as well. Which exercise is amazing because it has a short-term inflammatory effect, but its overall impact is anti-inflammatory. And that's why exercise is actually really good for. Yeah. And you might be able to help me out with this one as well in the acronym, the injury acronym of peace and love with, um, when it comes to acute injuries and overuse injuries, the, the a in peace and love stands for avoid inflammation. Uh, I think that would be for overuse injuries, like a tendinopathy and those kinds of soft tissue injuries. Um, can you shine any light on that? So what they're talking about is an anti-inflammatory, as it says, it's decreasing inflammation. And it's actually inflammation that is involved in the healing process. As an example, you cut your skin and as it's healing, it gets a bit red and itchy. And that's actually inflammation that's causing that red and itchiness, but it's also helping the tissue repair. We have a sprained muscle, that's the same thing. The inflammation is actually involved in the healing process. A sprained ankle. often it feels quite warm, that's inflammation, it's part of the healing. So there is thoughts now that anti-inflammatories would actually inhibit part of that healing process. A soft tissue injury is very different to maybe some sore, feeling a little bit aches and pains and sore muscles after a heavy training session. And I think that's all right every now and then to take an anti-inflammatory. There is theoretical Theoretical risks and concerns of taking anti-inflammatories could decrease adaptions to training. So let's say you've done a really hard session, your muscles are sore, taking the anti-inflammatory could decrease those adaptions. It's important to think about, yes, this is on a scientific perspective, it's right. The anti-inflammatories will decrease some of those inflammatory cytokines, but they're definitely not gonna decrease all of them. And it's important to look at outcomes, not just methodology. Because often we can look at amazing scientific studies and things make lots of sense from a cellular level, but do we actually see the outcomes in people? So what was I saying? I guess what I was saying is anti-inflammatories do have that anti-... They can decrease some of those maybe adaptions, but you need the anti-inflammatories to fit in your next training session the next day. Maybe it is beneficial from a whole perspective. Get that extra training in, potentially lose a little bit of... the adaptions from the anti-inflammatories, but they're not gonna all be gone. It's not like they can just magically decrease all inflammatory, all inflammation from that high session. Yeah, so some good takeaways around the use of anti-inflammations as well. That's really nice. It's nuanced and complex and there's no strict guidelines, but we are saying now for acute injury, try and avoid anti-inflammatories for three days. You're sprained ankles, torn muscle. After that, if it's still hurting a little bit, you're probably fine to take them because most of that healing should start especially with like an ankle sprain. Yeah, well at least I think as long as the listener can go away with knowing that it's not just the answer like if you have an injury it's not just taking anti-inflammations and that's the direct like response you should do for an injury like that. We have covered so much on today's episode, um, more than I thought we would, but I guess with your level of expertise and the amount of knowledge you have, we take on these tangents that are full of value. So, um, hopefully waffle too much. It was good. People waffle, but people w like this type of waffling is just more and more value, which is what I love. So, um, I really love your ability to like seek out the most recent evidence. And you seem extremely passionate around like the people that you serve and your level of like the field that you've chosen. You've just constantly like looking at the research and following you through social media and that I can tell that you have a passion for constantly wanting to learn and constantly wanting to educate people. So we tend to share the same ambitions with that, just trying to relay and get people the right information. So if someone wants to learn more about your, your content and love hearing. about what the expertise that you have, where can people find more about you? Firstly, I'll say thank you. That's really nice of you to say that Brody. And I think, as you said, passionate about being up to date with evidence, things are changing so drastically. You look at how people used to train for endurance events 50 years ago, and it was hard training sessions. Now we're seeing that what's most important is consistency and what maintains a long, athletic career is more low volume training and then, you know, a little bit of really hard speed work. So that's why it's so important to stay up to date with knowledge rather than saying, you know, this is how we've always done things because knowledge is changing and research and especially in the sports world. So, and you know, the peace and love and the avoiding of anti-plant trees is a great example of that. Everyone needs to recommend to us injuries straight afterwards. So, um, and I think that's where it's so good for practitioners to keep their egos in check, you know. it's nothing wrong with you if you used to do something that we've now realized might not be the right method. It's just that science is evolving and you want to be part of that journey and do the best thing for your athletes. So anyway, so thank you. And if people here want to follow or see any of the content, actually, I mainly do stuff on Instagram, which is I've got a blog called Dr. Izzy K. Smith. I also, if you're interested in mental health, have a mental health podcast called Behind the Uniform. She was partnered with Fox Sports or a lot of athletes, quite some heavy mental health stuff, but I think really valuable as well. And I think that's the main platforms. Fantastic. I'll link those into the show notes, including the podcast and including the Instagram links. So if people want to go there, they can just click on the show notes, click on the link and it'll take you straight there. Izzy, once again, thanks for coming on. Thanks so much, Brody. Thanks for listening to another episode of the Run Smarter Podcast. I hope you can see the impact this content has on your future running. If you appreciate the mission this podcast is creating, it would mean a lot to me if you submit a rating and review. If you want to continue expanding your knowledge, please subscribe to the podcast and get instant notifications when a new episode comes out. If you want to learn quicker, then join our Facebook group by searching the podcast title. If you want to take your learning to the next step, including injury prevention principles, injury specific insights and modules to boost your running performance, then head to our website by searching runsmarter.online and jump into our Run Smarter Online course. Once again, thank you for listening and becoming a Run Smarter Scholar. And remember, knowledge is power.