Fast Talk Femmes Podcast: Fueling for Performance—with Dr. Dana Lis

We chat with high-performance sports dietitian and researcher Dr. Dana Lis about how female athletes can get the most from their nutrition.

As someone who has worked with world-class athletes across a variety of sports, Dr. Dana Lis knows a thing or two about how to help elite athletes get the most from their fuel—and in this episode of Fast Talk Femmes, she shares her experience and expertise about effective nutrition strategies for female endurance athletes.  

Whether it’s in her work with the NBA’s Golden State Warriors, the Canadian national swim team, or Rally Cycling, Dr. Lis is well accustomed to the rigors of fueling for high performance. We chat with her about how she helps athletes determine the best nutrition for their workouts, performance, and recovery—and what this looks like specifically for female athletes. With so many supplements now available in the sports nutrition world, we also drill down on some of these, and Dr. Lis gives her insights on those she believes to be most effective for performance and recovery. There’s also an interesting discussion of RED-S (relative energy deficiency in sport) that will help athletes and coaches alike.  

Did you miss our first episode of Fast Talk Femmes? You can find it here.  

Our next episode will drop on February 7 when we’ll be chatting with Julia Violich, founder and director of the Bear National Team, a top mountain bike development program.  

Subscribe for episodes on Apple PodcastsGoogle PodcastsOvercastSoundcloudSpotifyStitcher, or wherever you listen to your podcasts! 

Episode Transcript

Julie Young  00:04

Hi, and welcome to Fast Talk Femmes, hosted by Julie Young and DeDe Barry. Our guests for today’s episode is Dr. Dana Lis. Dana Lis is a researcher and practitioner. As a researcher Dr. Lis has been at the forefront of gluten free diets, gastrointestinal well-being in athletes, as well as FODMAPs and collagen supplementation science as a practitioner.

Julie Young  00:29

She is currently the performance nutritionist for the NBA Golden State Warriors and the World Tour teams Israel Premier Tat and EF Tipco as well as the director and us head of performance for science and sport. As a high performance sport dietitian and researcher and gifted endurance athlete Dr. Lis understands nutrition from every perspective, which provides value and effectiveness to our practice. Dr. Lis uses this depth and scope of her knowledge and experience to determine the most effective strategy for each individual athlete.

Julie Young  01:04

On today’s episode, we chat about performance nutrition strategies, most effective for female endurance athletes. For example, does it make sense for females to implement the fuelling for the work required strategy? We drill down on supplements and discuss those proven over time to be most effective for performance and recovery. We discussed from a nutritional perspective, ways to avoid the pitfalls of relative energy deficiency and sport known as reds.

Julie Young  01:36

Hi, listeners, we’re so excited that you’re here to check out Fast Talk Femme a new podcast series, it’s all about the female endurance athlete. Here at Fast Talk Labs, we pride ourselves on being the pioneers of information and education in the endurance sports world for both athletes and coaches. If you like what you hear today, check out more at

Julie Young  02:00

Hi, Dana, welcome to the podcast. And thanks for taking time out of your busy schedule to join us today. Will you fill us in on your background? And what you’ve been up to recently?

Dr. Dana Lis  02:09

Yeah, no problem. First of all, you know, thank you so much for having me on this podcast, it’s always great to chat with like minded individuals. Yeah, more recently, I’ve actually moved into working with the women’s professional cycling team. So working with that EF Tibco SPD. And that’s been, you know, a sort of a passion of mine to work in, in women’s little tour cycling. And I also sort of have a little bit of involvement in research, still involved with a little bit of college and research at UC Davis. And still working also with the Warriors. So kind of a very different sport from cycling more of an inner minute sort of explosive sport of basketball. So I worked with the Golden State Warriors who just won the championships last season. So we’re pretty proud of that. And then I also work in industry. So I work with science and sport as well trying to sort of develop the US and North American influence with the over the UK based company,

Julie Young  03:03

You have quite a background, which I am really impressed with working with both males and females, we’re going to focus a little bit more on your work with females today. And I want to start out by just asking you like generally from a nutritional standpoint, do you feel like women should be advised differently than men, when it comes to performance, nutrition,

Dr. Dana Lis  03:22

that’s definitely a great way to kick off, you can get pretty confused reading information online, I get confused a lot of the time and I’m you know, working more in women’s sport now to I’m able to sort of understand the perspective that female endurance athletes are coming from in terms of what they’re reading, how they’re interpreting that information. And there’s also some strong opinions on on, you know, on on social media and online with regards to how women should fuel for endurance sport knights, you know, at this time, I think it’s still a bit premature to recommend that female athletes require, you know, sec specific guidelines in relation to carbohydrate or protein requirements, provided their you know, their energy needs are met. You know, I think there’ll be further research coming along using sports specific and training related exercise protocols. But at this current time, I think I don’t think we have enough information to make those sort of hard, fast conclusions.

Julie Young  04:16

And are there physiological reasons to provide different guidelines in certain situations around macronutrient intake, for example, or micronutrients?

Dr. Dana Lis  04:26

Yeah, definitely. The whole menstrual cycle piece is one of the major differences. You sort of have two camps. I guess you have a camp that definitely advocates for training and nutrition to be tailored to a specific phase in the menstrual cycle. And then you have, I would say, probably a larger camp of researchers that are still very curious to learn more about how the menstrual cycle affects all of these aspects of fueling, and, and training adaptations. So well, I’d like to Thank you no. Yeah, of course we want to we want to tailor to females, as much as we can I still think we’re kind of in the infancy in this area of research. I don’t think we know enough to develop recommendations. And more often than not, we end up sort of using more of a personalized approach with athletes rather than using more generalized guidelines for no overarching guidelines for which phase of your menstrual cycle you’re ending. Some of the considerations are, yes, we know that certain hormones increase decrease during different phases of the menstrual cycle. And these changes in hormones may influence carbohydrate oxidation protein metabolism. But we haven’t really looked enough at athletes. And there’s, there’s a lot of extremes with hormonal concentrations in athletes as well. And I think anyone who’s researched athletes or worked with athletes would probably agree that, you know, some athletes don’t fit into, you know, the population, we may see in a research group and a study some of the athletes I’ve worked with, they’re just on such an extreme end of some of the physiological parameters that we would expect that, you know, the regular guidelines that are developed for athletes are hard to adapt for some athletes. So I think right now, for female athletes, I think it’s prudent to kind of use best practice guidelines right now, which are generalized for athletic populations, and then develop, you know, an adopt an individualized approach that takes into account, you know, athletes specific training competition goals, where they are at, with their career, the development in their athletic career, and then personalized symptoms associated with their menstrual cycle. I think, you know, one of the sort of, I guess, reality checks that I have gotten as a practitioners working earlier on with the pro Conti cycling team, and, you know, I’ve had a couple athletes that are really, really involved in their menstrual cycle and really interested in it, which I think is great, but, you know, using apps to a point where it was doing them a disservice. So they, you know, they became so wrapped up in how they should feel during a certain phase in their cycle that they got so wrapped up in, I should be fatigued at this point. Or I should probably eat more carbs during this point, or eat more protein at this point that they kind of forgot to race their bikes, or also had a good reason or went into a race going, Okay, I’m at this phase of my cycle, I know, I’m going to be more fatigued, therefore, you know, it’s in the back of their head, and they end up that ends up kind of overriding their race brain in a way. So I’ve had, you know, experiences with athletes where they get so wrapped up in how they should feel during a certain phase in their cycle that you know, they forget to race their bikes, or it does them a disservice. So I think it’s important to be very individualized and try to and try to understand how the individual athlete or athletes that you’re working with respond to different phases of their cycle. And also, you know, a lot of athletes have abnormalities with their cycle too. And I’m not saying that’s a great thing or a thing to expect. But it’s also just a piece that we need to we need to be aware of.

Julie Young  08:02

Yeah, I could definitely see how it could become a distraction for certain athletes. That’s interesting. And so when you’re working one on one with an athlete, can you just walk us through a little bit about how you unpack their individual needs? Or is that just too complex?

Dr. Dana Lis  08:16

Yeah, first is a bit starting with kind of their where they are at in their career. And I sort of, you know, just from working with athletes for 15 years, you kind of have an idea of in terms of where they’re at in their career, what their priorities are. So for example, if you have somebody who’s you know, a first year, World Tour rider, and they’ve come from North America, they’re honestly still learning how to just navigate nutrition when you’re traveling all over Europe and navigate smaller roads and navigate new foods. And dealing with new DS is the whole logistics around European cycling that yeah, of course, you know, the nuances of how your menstrual cycle or hormone levels may affect fueling are important. There’s some bigger picture pieces that I think are still going to influence your your performance and your overall health to a greater degree. So I sort of look at maybe a pyramid approach of looking at, you know, the basic fueling strategies is this athletes in energy balance most of the time are, do they know how to fuel differently for different training sessions? Do they have like travel nutrition strategies and sleep strategies dialed? Did they know how to fuel during a race? Do they know how to recover well, and then starting to build up into sort of the more of the top of the pyramid of we might look at specific strategies to optimize specific training or racing situations, and then possibly looking at supplements, strategies, and then manipulating body composition. So I think sometimes athletes flip that sort of pyramid upside down where the foundational pieces of fueling enough during a race are not covered, but then they you know, they start jumping on the bodyweight piece and that might not be their biggest performance gain. And oftentimes it’s not if they don’t have sort of the lower part of that pyramid, dialed tested retested, you know, and second nature, essentially,

Julie Young  10:12

yeah, that completely makes sense. And I think it’s really dangerous for a lot of athletes right now with power to weight being such a focus on a sport, like cycling, for example, you know, everything is based on your power to weight. And it’s easy to become overly obsessed with that and forget that you need fuel to go.

Dr. Dana Lis  10:30

Absolutely. And I think a lot of that information, I’m very interested in sort of empowering coaches, because I think, you know, a lot of athletes and Julie, you know, can speak to this, a lot of athletes have a very good relationship with their coach their coaches kind of dictates a lot of how they train, how they think about training, how they look at their data. And I think empowering coaches to understand when and where that power to weight piece is important to highlight, or important to focus on and when we might want to take focus away from that.

Julie Young  10:59

Day, and I really appreciate what you said about the data. You know, I just, I have such a love hate with data. And I feel like it’s, it’s similar to like sleep trackers, you know, and I think people get so in their head about the feedback. And, to me, it’s just keeping that perspective as we need to use this data to inform not dictate our decision making. So I really appreciated what you had to say there.

Dr. Dana Lis  11:24

Absolutely. And I tried to like just, there’s so many tools available now. And as I know, as a nutritionist, one of the I think one of the challenges with being a nutritionist is you actually have to be quite educated in a ton of different areas, you have to really have decent education and coaching strategy, and coaching science, in psychology, in physiology in sleep science, and the logistics of a race or training, etc, that you kind of have to be really a jack of all trades, but then be able to really, really use all that information and kind of weed through it when it’s important when it’s not important to us. And, you know, with the amount of data that athletes have access to, I really try to when an athlete, you know, may come to me or message me and be like, hey, I want to use this tool or this tool, whether it’s a continuous glucose monitor or another different sleep tracker. And I really try to push them towards, okay, how are you going to use this data, what’s going to be actionable at this point in your season, or at this point in your career, that’s going to be really actionable that is, you know, falls in line with the priorities that yourself and your coach or yourself if you’re not coached to have agreed on, and you know, some of the what I’ve found with some of the data, like, for example, the continuous glucose monitor piece that can be really, you know, helpful for some people. But there’s still a lot to learn. And I’m still, you know, pretty reluctant to use that tool and a lot of athletes because I find the stress associated with it with the lack of education that some athletes have with using that tool. And the lack of really knowledge we have it’s been shown not to be reliable during exercise, is that it can go the wrong way. So I think I’m not against using CGM at all or you know, sleep trackers, but I really think that that data needs to be actionable before we add that other layer of sort of external stress onto an athlete’s plate.

Julie Young  13:10

When I remember you saying to that, with the glucose monitor, I mean, you have a PhD, and it’s hard for you to analyze the data. I mean, sometimes it can be like, you think it’s this, but it’s means the exact opposite.

Dr. Dana Lis  13:23

Things are so like, you have to really, there’s so many things that affect blood sugar, that it’s really hard to control, and then use that information to make really conclusive, I guess, solutions for an athlete or suggestions. And, you know, there’s, I’m sure there are some practitioners that are, you know, using it and having, you know, great, great experiences, but so far, you know, if I have an athlete who’s, you know, a little bit more stressed about a travel day or sleep or something, they’ve ate something different in their breakfast, all of that plays into what the, you know, continuous glucose monitor readings are that I, it’s really hard in practice for a practitioner to be able to just focus on that data and pull out something actionable. There are a few instances where it’s been really useful for sure. But team wide, I think that a lot of the athletes I’ve worked with have bigger, essentially bigger fish to fry, where they are in their career, right,

Julie Young  14:14

the low lying fruit.

Julie Young  14:17

One thing I have thought about a lot, and I don’t have personal experience with using the continuous glucose monitor. But I do remember during my career, that the social component of eating together as a team was really important for the team ambiance and I think it’s really easy to lose sight of that when you’re on our really stringent diet or you’re overly focused on your glucose intake. And so, I would like you to just speak to a little bit how you help your athletes balanced that too, because I do think that the social component of eating is extremely important and it’s important within the team and just experientially and For us to all have fun doing the sport.

Dr. Dana Lis  15:03

Absolutely. And I’m glad you asked that question because I think that sometimes we forget about, you know, the cultural and social piece of eating. And that’s, you know, a huge part of nutrition and eating and, you know, cycling, exactly what you described is Team meals,

Julie Young  15:17

and it’s a part of performance to it lately, and

Dr. Dana Lis  15:22

if that environment is stressful, or negative, or you’re kind of withdrawn, because you’re overly conscientious about a certain part, or you’re sitting there with your phone, analyzing what your glucose is doing, I think that can take away from the benefits of having that tight, positive, you know, relationship with your teammates. And one part I usually try to work with on a team is, is one is being open with communication, talking about food, talking about body composition, body image, or, you know, relative energy deficiency. I think sometimes we were scared to talk about, you know, the elephant in the room, and you know, the power to weight right thing and the weight loss thing is, it’s all it’s part of endurance part, it’s part of cycling, it can be done in a very productive and positive and performance benefiting way. But I think, you know, creating those environments around a table with a team, where it’s a really positive experience, can be super, super crucial for team building and team function. And I would try to work with the team to kind of be able to talk about, you know, the stresses around food, but then also kind of develop a bit of a team agreement or team contract of how are we going to approach nutrition and food and discussion around the table. And I think sometimes athletes can get, you know, a bit stressed if someone comments on you know, how much carb they ate, or they’re not eating enough carb or blah, blah, blah. There’s a lot of little sort of niggling comments that can get to some athletes, especially if they’re really sensitive to those types of comments, that just trying to create a team culture around around food and around nutrition can really make those experiences of having team dinners and team meals really positive and in a way performance enhancing you’re developing trust and relationships with your teammates.

Julie Young  17:08

Yeah, I know when Didi when we were racing, there was like eating is cheating kind of culture. Yeah, it’s just was not super healthy. But and to I think What’s hard is like as clean athletes, you know, you’re you’re going to look for those ways to find that edge. So it’s a tricky, tricky to navigate. So Dana, in in endurance sports, such as cycling, that requires a range of intensities is fueling for the work required a good tool for women.

Dr. Dana Lis  17:37

Honestly, I, I think it is, and I use it in practice. I mean, it depends on the athlete I’m working with and the level they’re at where we sort of the level of detail, we get to, you know, their macronutrients and carbohydrate periodization. But I don’t see any sort of indication of where, you know, periodized and carbohydrate are fueling for the work required would be negative. If anything, I think when you use that tool properly, it really encourages athletes to and female athletes, obviously, to fuel appropriately for bigger longer workouts. And obviously races and what I’ve sort of experienced a bit in cycling and women’s cycling is fueling for races is okay, in terms of like as a generalization. I feel like riders are more more likely to fuel well in races. But even when you’re you know, having big training camp loads and intensities, the fueling there I find in a lot of circumstances is is is not enough. So I think that you know, the fuelling for the work required piece is a really good tool for helping to educate riders how and when to fuel and sort of helping them understand why for certain workloads, their body requires more fuel. I think the one piece to be a little, I guess, careful about is the fasted training piece. Females tend to be less resilient to energy deficits in terms of how rapidly hormones change and not not a great way. So I work in both in men’s and women’s cycling, and also just trying to follow the research and both of those areas. Males are definitely more more resistant to those sort of negative physiological consequences to add low energy availability than females. So I think that’s something that I tried to be a little bit careful about with some of the train low strategies and I don’t know if that necessarily falls into the fueling for the work require there’s sort of fueling for the work required and that sort of overlapping with that strategy are the train low strategies which are you know, different strategies for trying to upregulate fat oxidation or up regulates mitochondrial adaptations. I tried to you know, focus first with athletes on when we need to fuel Well, why do we need to make sure that we have more carbohydrate onboard we can fuel workout so that our you know, adaptations to certain training sessions are optimized. And athletes always have to ask about you know, Faster training sessions, when can I do faster training sessions? And I usually before advising on that and saying yes or no try to understand, you know, where they’re at with their development and also talk to their coaches to about, you know, what are their gaps and priorities for adaptation? What do they need to do to improve performance in some, some circumstances, you know, a faster training rides and stuff may not be what they need were at this point in the season.

Julie Young  20:25

To me the the idea of fueling for the work required makes so much sense. And, again, I’ll go back to when Didi and I were racing, and we’re racing for Saturn. I don’t know if you remember this, but we had a nutritionist, and she really like turned me off, because it was like the prescription was the same. And it was pretty much the same for us as it was the guys in terms of macronutrients, but then it didn’t change based on what we were doing in that day. And I think, to me, that’s why feeling for the work required makes so much sense is like, consider what you’re doing on that particular day in terms of training, and then tailor the nutrition to that salutely. And I

Dr. Dana Lis  21:03

found, as you know, riders will often you know, do a really hard or long ride, like six hour ride or longer, and then they’ll you know, sort of backfill of like, it’s a really long ride, and I’m come home and you know, make a big, big meal. And the next day is a rest day or the next day is a really light day. And you know, what the fuel for the work required sort of framework has helped athletes understand is how to kind of flip that of looking at what your training session is for that day looking what your training session is for the next couple days, and how your fueling is going to influence those sessions. And I think what I’ve also learned with, you know, we’re using that that framework is it, it is a framework, it’s not, you know, a black and white guideline of you need a moderate fuel is two grams per kg body weight of carbohydrate, but it is a framework. And some riders that I’ve worked with that are, you know, I’ve been racing at the world to a level for 10 years, have a very kind of different physiology and trying to learn about what they’ve found also works for them. And that’s speaking more to working with male athletes, but some of the, you know, sort of physiologies of some of the athletes I’ve worked with are, they’re unique, they’re very unique. And so taking that framework, and also then adapting it to the athlete you’re working with and trying to understand, you know, how they experience different types of fueling for different training sessions. And I think one piece that’s sometimes female athletes I come up against, as you know, you’re recommending, okay, we want you to try to get 90 grams, or even up to maybe 120 grams of carbohydrate per hour of multiple transporter carbs. And there’s a whole new area of research in that area as well is, you know, you’ll come up against I get massive, massive gastrointestinal issues or bloating, or I just don’t feel good on the bike like that. And then being able to then pull back and sort of work with that athlete to build up to those sort of optimal carbohydrate intakes during longer high intensity exercise.

Julie Young  22:53

It does seem like in a perfect world, you need to experiment as an athlete and see how your body responds. And obviously, for younger athletes, they’re at the beginning of that curve. But I can see how after 10 years of racing, I mean, certainly for me, I think in my 16 year career, I went I started out eating, you know, very balanced diet, not really thinking too much about how I fueled. And then as I started working with nutritionists, and being around teammates who did particular diets, I started experimenting, and I spent the middle part of my career experimenting with all kinds of wacky diets, diets that made sense. And then it was sort of like the last, I’d say, four or five years, I kind of came into my own and I didn’t need to think about it, but I knew what I needed to do. And I think that is sort of like the curve that most athletes that have longer careers tend to, to follow if if they have the opportunity to learn an experiment. So

Dr. Dana Lis  23:49

absolutely. And I think that is what you just sort of said about eventually learning enough that you know, what works for you is so key. And I find sometimes, you know, athletes want a prescription of this is exactly what’s going to work under percent your first year racing. And nutrition is such a gray area. So you know, I always try to encourage athletes to take ownership, yes, collect the tools, collect the knowledge, but then take ownership of using that knowledge and trying to do your own sort of exploration throughout, you know, a season throughout your career. And you know, after a few years, you’re you end up getting pretty dialed in, it does become intuitive, about a few of our different races, different race times different countries, different climates, it does start to get intuitive. And then there’s opportunity to sort of, you know, see what’s new and up and coming and what might give you that extra little extra little boost because it is a field that is continually emerging. And it’s hard to keep up with it’s hard to keep up with the research. I’m constantly reading, scrolling, and you just always feel like you can’t keep up. It’s just such a wide field for sure. Yeah, it’s

Dede Barry  24:56

fascinating and there’s a lot of crazy ideas thrown out there but then There’s a lot of really interesting ideas that can be implemented positively. On that note, I think regardless of gender, we’re all sort of looking for the next aisle. Most athletes anyways are looking for the next magic bullet. And I think supplements, in my opinion have kind of typically over promised and under delivered. Although that’s not true in every case, you know, some of them are Amani SOC, and they distract from what really counts the fundamentals of just good training, good hydration sleep. And it’s easy as an athlete to just keep chasing that silver bullet. And it’s a promise a performance enhancement, but I’d like you to just kind of touch on how we can advise more more well researched supplements and how they fit into the female athlete performance and nutritional strategy.

Dr. Dana Lis  25:45

Great question. You mean, ketones haven’t changed the game of fueling? Yeah, ketones have come in and out of cycling in the last little bit numb? You know, it’s still experimenting with them a bit. But yeah, we haven’t really had any terms of actual practical experiences breakthrough revelations. But, you know, I think fortunately, unfortunately, some of the supplements that have been around for a while are the best tested supplements, you know, caffeine, creatine, beta alanine, nitrates, those are probably your bigger, I guess, benefits in terms of aspects of enhancing performance. You know, caffeine and creatine are probably two of the most well researched supplements. And what I’ve sort of noticed in female cycling is actually there’s very supplement use. So some athletes using no supplements at all to some athletes periodically, you know, maybe dosing Beta Alanine here or there to, you know, some athletes kind of really, really dialed with this is how I use caffeine for a tea tea. This is how I use nitrates. So I’m the best resource is the Australian Institute of Sport, has done an excellent job of classifying supplements according to level of research and level of efficacy, that website is really well classified in terms of like coding for ABCD. And then having a really good summary of how to use best protocol, best practice. And then a lot of references for studies supporting the information that is on the website for that specific supplement. So that’s like, that’s definitely my go to, if I’m just looking for a quick summary to send an athlete of like, this is the summary of research. This is the best protocol. And now let’s see how we would adapt that for your your circumstances situation, I think that’s nitrates are definitely one that’s kind of come in and out a little bit of nitrates were sort of the new, next best magic bullet. And then when a little more research came out, and cross country skiers not seeing as much of a performance enhancement in these really, really elite well trained athletes, that some people kind of pulled back, my nitrates don’t work. And I think it’s important with any supplement first to make sure that you you know you’ve had the bottom of your pyramid dialed the supplements should really be sort of the sprinkles on the icing on the cake, as Louise Burke likes to say, then look at okay, what what are my goals rather than just performance enhancement, trying to understand what the physiological role of that specific supplement is? And is that something that my training is focusing on right now? Or my racing? And is it something that would benefit me? So caffeine, for example, it’s probably you know, I think every single paper and caffeine starts off saying it’s the most world’s most widely used drug or supplement. And caffeine is really, really well tested. But I find a lot of athletes don’t necessarily use it properly. And I think it’s important that we know sort of, do we know that we understand the pharmacokinetics of caffeine generally. And then, instead of just taking Okay, exactly 60 minutes before the start of a race? Let’s look at instead where you look at the parcours look at the profile the race, where do you sort of need to peak for your job in that stage or that race? Where do you need to peak? Okay, how are we going to dose that caffeine then and what makes logistical sense? So I think that was supplements, it’s not always just cut and dry with like, okay, 60 minutes before ticket, they’re really trying to think about the whole picture. And that’s something that you know, as you’re later on in your career, that you might have the capacity and bandwidth to integrate into your whole race strategy. Whereas if you’re younger in your career, man, you’re just trying to try to get to the start line on time with all your stuff, and making sure you know how to bring and take fuels Well, while not crashing your bike. So there are there are a handful that are well tested, and I regularly use with athletes. And then in some circumstances, we’re you know, we have a lot more capacity. We might experiment with some supplements as long as we have a way to measure the outcomes and that’s what I sort of is always a struggle isn’t reality. We don’t have a lot of capacity to do feel based measurements like we can’t always Look at blood lactates in a race ever. So I think that you know, using just your, you know, your best judgment for risk versus benefit for supplements strategies that are sort of may help may not in college and as an example of a sort of borderline, I guess, class, I think according EIS is Class B, collagen or glutamine are supplements that yeah, may help, but I think no may not. And you just need to sort of assess where you are at with your career and whether it’s not, it’s worth the investment. But if there’s no risk and you have lots of money, then it might be something that’s an easy decision.

Julie Young  30:33

The Australian Institute paper sounds amazing. And well, we’ll link to that. In our show notes. One thing I found interesting and just kind of reading about supplements is just understanding the dosing, and just particularly like what event does it target? What effort level? I think that’s super important to understand. Because I think, you know, a lot of times we’ll just try to implement in absolutes, and just like, okay, nitrates, awesome, I’m just gonna take a bunch of nitrates or beta alanine, and just really understanding the nuances of dosing.

Dr. Dana Lis  31:05

Absolutely. And I think that beta alanine is again, a great example on definitely athletes, like I take a Beta Alanine before race, and then not understanding that beta alanine, something you actually need to load for a while. And there’s different dosing strategies and loading strategies. And we sort of look at, you know, your whole entire yearly training plan and race schedule and race priorities, to then decide how we start loading because I’m also a proponent of, you know, trying to optimize natural adaptations, whether it’s buffering adaptations, or, you know, muscle protein synthesis, and really trying to sort of optimize what your body can do naturally, and then layering in, you know, Beta Alanine or, you know, buffering agent, for example, because I yeah, I just, I just that’s the strategy sort of, I try to approach but again, like the cycling season is long, you know, you might need to you might need to be performing really well early in the season for classics, and then performing well later in the season for the wellness or something like Beta Alanine might be something you just take for most of the season. I think that’s fine. I think it’s just understanding the doses and how to best best use that supplement. And same with nitrates. We don’t have a lot of evidence on nitrate dose per body weight. But if I look at let’s say, an NBA player, compared to a female cyclist who specializes in climbing, I can’t rationalize how that 400 millimole dose would have the same effect on those two very different athletes. So I think it’s also just looking at your specific athletes and if there’s not enough of a body of research to inform, you know, dosing based on kilogram body weight, use some of the knowledge that you have to make make those you know, better informed decisions.

Julie Young  32:46

I’ve heard it said you can but should you Yeah, that’s a great yeah, you can but should you absolutely. That’s a good one. Thank you. Lauren Banach?

Julie Young  32:55

Yeah, so good.

Chris Case  32:59

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Julie Young  33:57

So Dana, moving on, we will take a deep dive into relative energy deficiency in sport, otherwise known as reds with Dr. Krauss, a sports medicine physician at Stanford and a future episode. But in the meantime, for the purposes of our conversation today, would you provide a brief explanation of reds and help us better understand a couple of other concepts, low energy availability and the female athlete triad as they seem somewhat intertwined?

Dr. Dana Lis  34:24

Yeah, absolutely. And that’s definitely a topic that’s become pretty prevailing in the last maybe five, eight years across endurance sport. And you know, when I started my career, we only use the female athlete triad that was that the tool we had to look at an athlete with an eating disorder or restrictive eating behaviors, and you know, the physiological consequences that are associated with that. relative energy deficiency or reds is a newer concept and there’s definitely still a little bit of, you know, sort of two camps of thought in the research world of which one is more correct, but relative energy deficiency in sport is a condition of low energy availability affecting both males and females at all levels and ages. And it has wide ranging adverse effects in all bodily systems, and it can, you know, it can seriously compromise long term health and performance. You know, we sort of look at reds in sport, and I don’t always assume that an athlete who may I may end up working with that, you know, displays some of the some of the signs and symptoms of reds is intentionally under fuel, like, there are situations where athletes are just inadvertently under fueling, they are traveling and, or they travel a lot and haven’t really developed the strategies to make sure they are in energy balance and have food availability and training, where they don’t understand, you know, the the energy demands of their of their sport, some of it comes down to just knowledge and, and education and capacity. Whereas in other you know, sort of in other aspects of reds, you know, you have an athlete that’s trying to, you know, lose weight or, you know, improve, improve body weight ratio improve, you know, the performance, possible performance enhancing factors of having optimal, lean body to non lean mass, and maybe not doing that in the best sort of best way possible, where they’re just in chronic low energy availability. So they don’t have enough energy in their body to support their training, but also support sort of the normal normal bodily, bodily functions resting metabolic rate plus, that energy, your body needs to turn over protein and make hormones etc. And then what happens is, you know, after a period of low energy availability, which is you know, different between individuals, but it’s also different between females and males. And that’s what I would sort of say is, I don’t know if we’ve really quantified it very well, in research yet, but from a practitioner perspective, and I think I mentioned this earlier, too, is males are, from my experience are more resilient to low energy availability than females, I think, you know, the changes we see with hormones happen quite a bit sooner. So we know that there is a certain amount of energy, female athletes need day to day to maintain normal normal body function, normal hormone function. And so you know, if you have an athlete that ends up, you know, under fueling day after day, or maybe they have a quite a few days, during a week, couple of days, they’re an energy balance. But what ends up happening with this sort of long term, low energy availability is, you know, some just changes changes in physiological functions. And it’s everything from immunological function to metabolic endocrine, bone health, gastrointestinal function, psychological growth and development, cardiovascular menstrual function, I said mental function already, but that’s an obvious one. So, you know, all of those different physiological systems become affected with not fueling your body enough. And when I look at, you know, what does it take to really support an athlete to reach their full potential, if any of those physiological systems are not optimized that can really compromise an athlete reaching their full potential. So, you know, there are periods where an athlete may be in low energy availability. And there are strategic periods where we may, you know, develop a strategy for an athlete to be in low energy availability, but we need to do that very strategically. And in a sort of team based approach, where we understand what the coach is designing, we understand the race schedule, we understand psychology of an athlete. And so I think all of those pieces need to come into play to really design a good strategy that, you know, helps an athlete achieve sort of optimal body composition, without having all of those physiological effects associated with low energy availability, or minimizing those effects

Julie Young  38:46

seems challenging to accurately measure energy availability.

Dr. Dana Lis  38:51

Yeah, you know, when a lab we can do it, and, you know, we can do resting metabolic rates, etc. But there’s still variability with regards to that strategy and or that, that science and the methods around measuring resting metabolic rate, and I definitely, you know, more and more athletes, I think, are curious, and they’re trying to learn about their body and they’re trying to learn about, okay, what does my body need, and will go in and get, you know, RMR tests done in different labs, and, you know, different labs have different protocols, which can affect, you know, the K cows burned up to, you know, three 400 calories, which I’m not a huge calorie counter, but it is something that sometimes we use. So I think that first Yeah, it is like everything from understanding your individual energy needs. We can use calculations to give us a baseline of what your resting metabolic is, probably is. If you have an athlete who has been in low energy availability for a long time, and is having some of these, you know, physiological changes, oftentimes, their resting metabolic rate will decrease. So then they’re having, you know, an even harder time losing weight because they need to go even lower to lose weight, and then all of those sort of physiological consequences. Is are exacerbated, and then looking at sort of, yeah, just the whole measurement of nutrition intake. And calorimetry is, it’s a science that is not exact, you know, even things like almonds, for example, you know, with the almonds with the skin, the amount of energy that is absorbed from almonds is different with the with and without the skins. There’s like little nuances. Or if we look at an athlete’s gut, and I did a lot of work during my PhD with gastrointestinal physiology during endurance exercise, and we know that the ability to absorb nutrients is compromised with intense and long exercise. So that even compromises or changes how your body absorbs food, etc. So there’s a ton of complexity. And, you know, I think that it is, some athletes get really, really wrapped up in trying to nail down to the calorie or to the gram, exactly what their body needs. And there’s some cases where we try to get to the gram, with regards to fuelling properly for training. But I think that we need to understand that, you know, it’s, it’s a bit of a gray area with nutrient analysis and energy expenditure. And to use that tool, you know, appropriately with athletes that can get it can be a tool that’s really, really useful, or a tool that’s quite detrimental.

Julie Young  41:14

I have a couple of follow up questions when you spoke about strategically implementing periods of low energy availability, like what’s acceptable in terms of that low energy availability, calories per kilogram? And then also, how long would you use that strategy?

Dr. Dana Lis  41:29

Yeah, depends on the athlete, for sure. Um, if it’s an athlete that has had a history of restrictive eating behaviors, or they lose their, their menstrual cycle really fast, we’re a little more careful about how we use those strategies. So the first thing is putting an athlete in low energy availability and working to change their body composition is something that’s going to have a beneficial impact on performance. Now, and I’ll be straight up I work in high performance, it’s not something we beat around the bush with in terms of like, trying to not pretend it exists, it very much exists. And we’re very much like, this is a scale weight. This is the body composition measurements. So I think that the one piece that I’m first prioritize is the dialogue around that. So if you tell an athlete, hey, you need to lose weight, so you can climb better, I’m not sure that’s going to be super well received, you might have an athlete who just freaks out and starts cutting energy and take a ton of eating vegetables and protein only, where you might have an you know, an athlete that has been around for a longer time. And they understand what that means in terms of, okay, this is how I’m going to plug in different periods of, of energy deficit or create energy deficit, so that I can get to this certain body composition at a certain race or a certain period in the year. So I think first is just understand the psychology of the athlete and trying to create an environment from coaching to Team Manager to the DS is have a dialogue that’s going to support that specific athlete, the same dialogue and same strategy is not going to work for different athletes. And that’s not always realistic. I mean, I’m just sort of describing a best scenario. Most teams I work with, it’s a consulting position, I’m not there most, a lot of the time. So, you know, it’s this sort of best case scenario. But hopefully, most teams have, you know, weekly meeting where you can actually sort of create at least some of that cohesion with how we’re going to approach different scenarios. And then It partly depends on how, where we need to get an athlete. And when we need to get them there, how much of a deficit we would create, but I usually will usually use a fuel for the work required strategy where we’ll, you know, look at the week month training plan and figure out, okay, where are good places where we can create a deficit without compromising training capacity with trying to minimize lean mass loss. So I might look at, let’s say, let’s look at, you know, Monday to Friday for as a quick example, if they have, you know, a rest day Monday, and Tuesday is a short interval day, Wednesday is a longer maybe threshold ride, you know, you kind of use those three days to figure out okay, what kind of fuel do they need for those workouts? When is a good block during the day where we could create a deficit and it might be something like, okay, Wednesday, after they’re sort of done that threshold work, we can make sure that the recovery meal is an energy balance. And then in the latter part of the day, let’s say from 1pm, to when they go to bed, we still make sure protein intake is really high, so we’re minimizing loss of lean mass, but then we’re creating an energy deficit by reducing carbohydrate and fat intake and you know, might be 300 calories, you know, you try to make it as minimal as possible. Again, with calculating how much exactly of a deficit you’re creating. It’s it’s still still ballpark as accurate as we try to get it’s still ballpark. So it depends athlete’s athlete and I’m a little bit hesitant to give numbers. Most people might freak out or what we do in cycling. I might get some hate mail. But it’s also athletes athletes. So there are some you know, scenarios where we do experiment with more Stream deficits, but they’re definitely very, very short term. And then the one thing I’ve sort of realized as a practitioner, is a lot of times we’re very cautious about about what we do. And I’m cautious too. But I also am in some scenarios willing to experiment, if it’s if there’s the sort of bandwidth and the ability there to monitor an athlete well, but a lot of times, athletes are using strategies and doing things ahead of the research. So even period strategies where when you create energy deficits and how you create energy deficits, without compromising performance, or training adaptations, and sort of minimizing, you know, some of the physiological detriments that happen. Sometimes athletes have, especially in cycling, have tested and tried things and know they’re not measuring hormones and stuff after they come home from their ride. But they’ve kind of started to learn what works for their body. And I’ve learned a couple of good techniques from from other riders have like all kind of this kind of ride at this point in the year. And sometimes, you know, I will ride for this period of time really well fueled. And then if I have an extra two hours, I might pull back on carbon, that’s how I create my energy deficit that day, and the rest of the day, I’m not worried about it. So there’s, yeah, it’s definitely rider to rider day to day on how we create those deficits, I try to do three days max, and then try to have a day where an athlete’s and energy balance. And that, again, depends on how long we have to lose weight, essentially, and what that athletes schedule is, etc. If there’s holidays around, there’s all these sort of pieces with a you know, real life scenario that affect decisions that we make, ideally, you know, having a really well laid out yearly training plan where we can lay out and I’ll sometimes do that with coaches where we have, you know, the yearly training plan and an Excel sheet. And then, you know, all those, all the pieces were different training camps and periods of different training adaptations are in there, etc. And then we layer in the nutrition and layer in, you know what period, we want to focus on this back aspect of nutrition. Or if there’s a, you know, a period where an athlete is looking at developing explosiveness and working on their explosiveness or their sprint, nutrition is sort of pieced in below there. And sort of that made a really sort of linear way where we know that that is the period, we’re focusing on that. And, you know, if there’s a weight loss period, or a body comp period, that is very clearly outlaid, way ahead of time. And I think the biggest mistake that a lot of endurance athletes make is trying to lose weight all year long, and not being strategic with it. So I think, you know, in a best case scenario, we have a very well laid out plan, and we’re able to really clarify, this is a period we’re doing using this strategy,

Julie Young  47:36

you know, you spoke about want to just back up a little bit about just that situation where the athletes spiraling a little bit like they’re trying to lose more weight, but the metabolic rate has dropped. How do you reverse that?

Dr. Dana Lis  47:50

Oh, yeah, definitely not easy. You have to basically convince an athlete to one eat more, you know, they’ve been using these strategies. And all, you know, I’ll use an example that I think is, you know, is typical enough in cycling, where you might have an athlete that, you know, try is comfortable in a way getting a lot of their carbohydrate from fruits, vegetables, and dairy, or yogurt or Greek yogurt, and they’re not comfortable with eating, you know, rice and pasta and breads. And so they try to convince themselves that they can get enough fuel from those other carbohydrate sources, you have to eat a lot of Brussels sprouts to get enough carbohydrate, you will 160 stage 160 kilometers stage race loading that’s associated with it. That’s another story. But I think first you have to convince an athlete that this is the sort of long term game they need to play. Any athlete that’s been focused on losing weight and focused on restrictive eating behaviors, to lose weight is not going to be like, yeah, sure, I’ll, I’ll eat a pot Rex, no problem. There’s a lot of psychology that I think we need to understand first, as it as nutritionists, as coaches, to, you know, first, you know, what are the food rules that that athlete has? What are the thought processes that go on when an athlete sits down to a buffet or a teen meal and really trying to understand that athlete first. Generally, when you’re trying to do that, there’s a lot of tears. So, you know, bring a tissue box with you. But I think it’s also just building that trust with an athlete of like, you know, they’re struggling, you know, there’s a lot of, you know, stress around food and eating and fueling. And I think trying to help them understand that, you know, the stress and the energy they put into how much they think about everything they put in their mouth. That is a huge external stress that could be compromising performance. So trying to get them on board have a gap. I spent a lot of energy stressing about food. And there’s a certain amount of thought that needs to go into feet as an athlete, for sure. But the amount of sort of stress that some athletes battle and deal with every day is a huge energy drain. So trying to get them you know, realize that hey, this is you don’t have to live this way. You don’t have to operate this way. Just because you’re in endurance sport or in cycling. There is a hell If you’re way to approach it, and you know in cases like this, often you’ll have an athlete’s like a can’t lose any more weight. You know, d s, for some reason is telling you this is the way cycling is my DS is telling me I need to lose weight. Coach hasn’t said anything because they’re male, and they don’t want to say anything wrong. And I keep trying to lose weight. And I can’t, and you know, get to know the athlete, you know, they’ve been using these certain strategies for, let’s say, five years, 10 years. And you don’t always have access to, you know, all of the laboratory equipment that you’d like to have, you know, aren’t always able to do RMR. Ideally, if you can get an athlete in to do an RMR that will give you a more data driven, driven approach to then developing a plan that is suited for that athletes. But in reality, that’s not always going to happen. I think some athletes that are sort of in those scenarios that are just described, they are data driven, you know, they look at their training peaks a lot, analyze it a lot, you know, look at, you know, a bunch of other riders and figure out, you know, they’d like look online and social media and are analyzing all the different riders. And so sometimes that data driven driven approach does work for athletes in a you know, in a, in a place where they have some restrictive eating behaviors or eating disorders, it definitely depends on the athlete. And if I do have an athlete that is in a in a scenario that I’m not equipped to work with, I definitely will pass them on to a dietician or nutritionist who specializes in eating disorders. But I think that the sort of sport aspect of it is important for an athlete to understand and trust. But then I think, once you have an athlete’s trust and their sort of investment and trust in the process, that sort of next process of getting them to build up to being an energy balance, and then energy excess a little bit, it’s easier to get your period back, if you get a little bit of weight, sometimes athletes have aren’t so lean, that they’re just, they’re just not going to get their period back, they actually need to gain more body fat to then start to regulate hormones in a way that’s going to favor getting getting a regular menstrual cycle or getting a menstrual cycle. Again, we’re getting your period. So I think it is, it is a long process. And I think that picking a time during the season to approach that is important. I wouldn’t just you know, toss that in and start doing it at any time. Because sometimes you end up for one reason or another. But I think trying to do a lot of that work in the offseason is ideal. As you know, best scenario doesn’t always happen. But then making sure that you’ve kind of created that runway for the athlete, because in reality, if an athlete is not racing well, and they’re not climbing well, and they’re not performing for the team, they’re not going to get a contract next year. So I think you have to understand that is nutrition is to have like, yeah, you want this athlete to gain gained some weight to be to sort of recover from reds, well, then they’re not going to race and climb very well. And they’re not gonna get a contract. So I think that’s something that’s important is and I think that’s becoming more more, I guess, of the culture in some women’s cycling teams to is understanding, we need healthy athletes. And if it takes a year for an athlete to get healthy, where they may not be racing their best, giving them that time and space to get their body healthy. And I think that’s becoming Yeah, just more sort of normalized. But I think it’s important to understand and get the other team members and you know, people will pay the bills on board with what the priorities are for this athlete. And I think genuinely, you know, most team owners and managers and do care about the athlete as a person that’s more important than the performance of the team. So that’s been my experience. I don’t I definitely aware that’s not experienced across all teams. So I think just first is having that runway, and then laying out a plan that your athlete however, they understand, you know, food plans or nutrition plans, or whoever sort of tips and tricks are going to get them to be in energy balance, and then in a little bit of excess. And then I usually get blood work done is often as it makes sense on that’s a little bit different, you know, and in the US when healthcare system is different than Canada or Europe when it’s a little more public socialized healthcare system. So I even take that into consideration when when I’m working with different athletes because they can cost them a ton of money to get bloodwork done. So if you tell an athlete, this is really important, then you go, Oh, actually, your health care doesn’t cover that. Sorry about that. They’re gonna be like, Oh, I’m missing a part. This isn’t being done, right. So all of those little nuances are pulled into developing a strategy for an athlete, but I think the biggest piece is trust, having a long runway and communication with sort of everyone that’s involved in influencing that athletes journey or career.

Julie Young  54:37

And that makes sense. I think, to your point, like just really gaining that athletes trust and that the athlete understands that your decision making is in their best interest. But I also think it’s interesting and really good to hear that you feel like some of these teams have evolved to that point where they really are thinking about the health of the athlete and not just like bottom line and results.

Julie Young  55:00

That’s a big change from our generation. I very much think that the D S. ‘s were, you are as good as your last result. Yeah. And I think, you know, if you weren’t producing, they were always short contracts one year, maybe maximum two years. And if you weren’t performing, you know, you weren’t, you weren’t gonna get a contract, or you weren’t gonna make as much money and, and it’s good. I mean, you see, now there’s, there’s a lot of young riders being particularly in the men’s peloton, you’re starting to see, you know, first year, like, right out of the junior ranks, right, or signing long term contracts, and, and the teams are finally starting to invest long term. And I hope part of that means that, you know, they’re providing the supports, like the nutritionists and the physiologists and to help them and give them a long runway to develop and learn.

Dr. Dana Lis  55:50

And I’m definitely seeing that that change. And I think it’s something that, you know, gets me very excited. And it’s a very encouraging in cycling. And I think just a more and more teams are sort of putting energy towards developmental piece of developing riders having that long term vision rather than, you know, short, we want to win so many stages in the tour or whatever. And I think that’s, that’s, I think that’s definitely a more sustainable, healthier approach. And I think one thing that I’m also seeing sort of change in cycling, too, is the diversity of staff. I mean, spend a lot of time with staff staff really influence how things roll, swung interns are super, super integral VS is play a huge role. And I think educating those staff in regards to, you know, what we’ve learned about nutrition and fueling and strategies, educating those, those staff is really crucial to helping sort of develop this, this culture shift. But then also learning from those staff. I have learned so much from Swamis and DS is that I, I never raced at that level, there’s so many nuances to what’s put on the table and what’s available on the bus that I’ve learned more about the design of a of a bus than I ever thought I would know. So I think it’s important to exchange information but also like what I’d love to see happen and I’m so is on my like, bucket list of things to do. But it’s like an education series for cycling staff for Swan ease, and for for DSS and mechanics, and whoever else is interested, managers, team managers have just like sort of an education series of, you know, nutrition priorities, here are some strategies here are priorities for cooling athletes, I think it would be really cool to sort of just update some of those, you know, sternal nutrition staff, because a lot of those staff play a huge role, again, in nutrition. And I think, you know, again, I learned a lot from those staff. And I think that’s something that, you know, you guys, you’re having raced and still avid racers and in extremely good shape. dually duty, I’m sure you’re in amazing shape, too. But Julie is on machine is, you know, understanding like having been involved in sort of those boards that you wear tight spandex, like I grew up figure skating, I raced bikes for a while. So you kind of know, from a athlete perspective, the psychology around body image and you know, wearing tight stuff that, that just getting tighter and thinner in the summer of like, what sort of thoughts may go in an athlete’s head, especially if an athlete is, you know, prone to having sort of body image issues and restrictive eating behaviors of sort of understanding that and I think that’s a big piece of building trust is just being able to kind of understand and speak the same language and really help that athlete to understand that you actually do know, what they’re experiencing and and what they’re thinking. And it’s good, that I think helps allow you to create dialogue that is going to be helpful.

Dede Barry  58:43

Yeah, I think I think it’s really important within the teams to have everyone on board open minded about and using innovative concepts and, and kind of supporting the athletes in achieving marginal gains throughout their career and always moving forward. But that’s not the case on every team. Still, I think I do think there’s still some old school directors that you know, want to run things like they did in the 80s. And, you know, they want Perrier Bay and the 80s feeling this way. And they think that might still work today. And it might, you know, with a little bit of luck, it might but but we do know more now and and I think to build a really great team, you need you need everyone on board from this one yours to the directors to the writers need everyone building trust together and being willing to educate themselves and move the needle forward.

Dr. Dana Lis  59:38

Absolutely. There is a phrase though, everything was better in the 80s. I think just the clothes and the music, the hair. And I think some of the proteins now are taking more of the Olympic model in terms of that whole sort of integrated sports science team that sort of what was more typically in a Olympic The Performance Team model is now getting pulled more into cycling, which has a little bit more of a, like sort of old school, you know, cultural influence in the way things were. So I mean, it’s all, you know, sort of part of the evolution and I’m, it’s, you know, really encouraging to see to see that happen, it’s definitely got a long way to go. And a lot of teams, it comes down to, you know, comes down to money, like a lot of things. Some teams don’t have the budget to have every staff member at every race. But there are strategies where you can just sort of, you know, kind of improve communications and improve communication and education. Both ways. Yeah, I

Julie Young  1:00:32

think that consistency of messaging is so valuable. Yeah, just have everybody on the same page.

Dr. Dana Lis  1:00:39

Absolutely. And I think for us older, older, post 40 people is understanding, you know, the younger athlete, technology, and the way an athlete learns and communicates, has changed a lot in the last 20 years on. So you know, the one page exclamatory exclamatory, handouts, I used to send athletes via email, that is not going to work anymore. So I think now just like really trying to stay on top of what’s the best way that your athlete learns, is important for, for everyone to just be impactful?

Julie Young  1:01:11

Dana, as a nutritionist in elite sport, you’re front and center and helping athletes manage energy balance, reds has become a topic ubiquitous in endurance sport, suggested to be more predominant in female athletes. From a nutritionist perspective, what are the main things athletes, coaches, managers, etc, can do to reduce the risk of reds?

Dr. Dana Lis  1:01:33

That’s a fantastic question. And I think also in that, in that list, I’d include you know, parents, because with younger athletes, parents are often the people who have their eyes on on the athlete the most. And I think first is just kind of trying to understand I understand your athletes personality, there are some personality characteristics that are associated with, you know, a greater likelihood of developing reds, and those are sort of perfectionist tendencies, kind of that type A personality, then I think early education is the next piece. So sometimes, you know, we wait until an athlete displays signs and symptoms of low energy availability to engage in education. But I think the education piece should come early on of helping an athlete understand what their energy needs are, what the energy demands of their sport are, and doing that in a way where they’re not necessarily counting calories. But giving them tools and education understand how frequently they should fuel, how they should eat, pre training or pre exercise and during and after, and how you want to optimize recovery by having some, you know, protein and fuel before bed. So I think building strategies and understanding best practice strategies, rather than, you know, always being like, Oh, this is how many calories you need on different training days, I think that sometimes gets a little overwhelming for athletes, but just helping to educate and build in strategies early on for understanding what an athlete needs to do to optimize their development, optimize their recovery, reduce risk of injury, I think those are the biggest pieces early on is, again, is education, and that some from the athlete piece, and that’s all the way from, you know, like you tend just understanding like what your fueling needs are, but then adapting how you deliver that education, obviously, to the the age of the athletes, and then figuring out who else is important for that education earlier on, it would be the parents, educating parents. And then in some pieces, it might be, you know, the coach, or sometimes strength and conditioning coach has the most contact and influence with an athlete. So ensuring that sort of the education and reducing risk around reds is also at the forefront of all the people involved in this athletes, you know, training and racing. And I think also just food availability of understanding, you know, giving athletes tools of, you know, here’s what you take to school, here’s what parents should have in the car, hey, got one of those coolers that you plug into the cigarette lighter and has a little cooling thing so that you can have that fuel in the car for your athlete, when you pick them up. It’s all little sort of little pieces that add together and they seem really simple. But it’s all of those pieces that add together where then you finally have an athlete that is, you know, well into their sort of brocante level and they’re, they’re fueling Well, you know, ready to ready to go. And I think one of the other pieces where you sort of sometimes I’ve noticed this younger and younger with athletes, and you know, part of this has to do with social media of, you know, seeing so and so has egg whites and salsa for breakfast. And, you know, these just sort of a lot of times if misinterpreted nutrition strategies on social media and so, you know, a younger 14 year old athlete, they’ve been like, Oh, this is what this is what this rider does. So this is what I need to do for this race. And that’s sort of where their influence and education is coming from. So I think trying to get In front of that, and ensure that they kind of have that, I guess it’s more of a critical thinking brain. And some of that comes from school, just more of a critical thinking, way to look at their sport and the aspects of their sport to weed out what may and may not work for them, and then also getting them to take ownership. And it could be like, you know, little tools like, hey, as a coach, hey, I want you to make sure you have three carbohydrate things at this training session. So little pieces of ownership as an athlete develops as well. And I think the last part, and it’s a little message that I find sometimes gets a lot of buy in from athletes is when I was working with the Canadian sport Institute, and this, so that’s like, sort of, I guess the equivalent of the USOC Canada is always smaller. So we have a few different sport Institute spread across the country. But um, you know, working with Olympic athletes, when you’re, you know, going through a quad prepping an athlete for the games, very rarely, in my experience, would we have athletes with reds going to the games, and I think are even getting to that level where they’re in selection. And I’m, I’m making a statement based on my experience, but you know, what that could be due to as a lot of athletes who, you know, aren’t fuelling well, and are having sort of those physiological changes associated with not not fueling enough don’t reach their full potential and don’t get good enough to make an Olympic selection. So I think that’s important to consider through an athlete’s career too, is hey, if I kind of, you know, not eating, not fueling Well, and, you know, not really trying to, you know, try too early to get to lean too much, I might just not reach my full potential and, you know, might not make a team or not make the game. So I think it’s important to sort of sort of think about that, too. And some math when I tell some athletes that who are like, kind of on the edge of like, Yeah, I hear you, I know, I’m supposed to fuel but I really want to be super, super skinny, because that’s what I see on social media, with these riders that are flying up hills. So I just want to do that, whatever I hear you, but I’m not listening to you. Sometimes I’ll just tell a little story of like, hey, you know, this is what I’ve sort of observed is, you know, at that level, sometimes athletes don’t reach their full potential. So, you know, I think it’s sometimes pulls on the heartstrings, when you look at it from that perspective to

Julie Young  1:07:12

Yep, as a coach, I can really relate to the idea of educating the athlete and just empowering them with that understanding, because I feel like that’s, you know, when they can really connect those dots, it gives them that intention, that purpose, to follow through. Yeah, just

Dr. Dana Lis  1:07:29

it’s also just like, finding ways to educate. There’s so many tools out there, there’s like, an enormous amount of coaching education and nutrition tools online. And I think sometimes, athletes and coaches get overwhelmed too. So, you know, it depends on the scenario, what the best strategies are. But you know, for me, personally, I’d love to start at the school level. And that sort of just, I guess, coming full circle of, you know, I’d love to start the community and full circle of educating athletes and just having sort of a widespread impact, because some of those earlier education pieces are not that individualized, they’re more more generic in general,

Julie Young  1:08:04

plant the seeds. Yeah.

Julie Young  1:08:07

Dana, I want to shift the conversation over to micronutrients and how that might affect energy availability. I know, a lot of endurance. female athletes really suffer from iron deficiency, for example, how are you working with your athletes to regulate and help them avoid the pitfall of iron deficiency or calcium deficiency?

Dr. Dana Lis  1:08:29

Yeah, so the first piece is probably one of the biggest priorities is iron levels, and low iron levels, low iron stores, anemia, there’s different levels of anemia. The first piece that I think is really important is, is trying to get regular blood work. Some of the signs and symptoms of low iron stores or anemia, can crossover with other illnesses, issues, deficiencies. So like, you know, fatigue, or inability to recover well, or irritability. You’ve a teenage cyclist, they’re going to be probably irritable, regardless of their iron levels. I have. So I think that yeah, you can wait till you look for, you know, you see signs and symptoms of low iron stores. But, you know, I think with the knowledge we have and the research we have around iron in athletes and female athletes, I think it’s important if you know, when you are an athlete, especially an endurance athlete, but honestly, all female athletes, try to get you know, bloodwork done, especially even just one iron marker, which is serum ferritin, along with your complete blood count, which will give you information about your red blood cells, just get even serum ferritin done, you know, once a year at a minimum, just to see what your levels are at. There are some nuances with when you want to actually get that blood drive done, you know, just get the most accurate readings, but I won’t get into that, but I think it’s good to just, you know, once you have an athlete starting to menstruate of, you know, monitoring and see if there is a you know, a flag for low iron. And, you know, if you have an athlete who does have, you know, low iron stores from starting to educate around, you know, Iron foods and then supplementation for athletes who are little, sort of more advanced in their in their career, I’d usually say twice a year, get iron bloodwork done, and then individualize iron dosing protocol. Yes, of course food first. But I would say in reality, it’s really hard to get an athlete’s iron levels up with just just food. Very rarely will you get an endurance athlete who’s racing a lot to eat red meat, you know, frequently during a week. So I would say yes, of course, I, you know, we educate around dietary iron intake, but even something like, you know, a steak, you’re only absorbing about 20% of the iron that is in that steak. And then for more, you know, vegetarian or vegan, or plant based athletes, which, you know, it’s an increasing trend in some areas of the iron absorption from high iron plant based foods is about two to 5%. So even though we can get a lot of iron in our diet, when we look at the milligrams, the amount of absorption is, is actually quite low. So you know, in in reality, we end up supplementing a lot. So the first piece is, you know, recognizing Yes, we you know, iron stores may decrease with bleeding from menstruation. If you have an athlete’s with certain flags that may be associated with increased iron losses. That’s also something just to pay a little bit of attention to something could be a really heavy, heavy, long menstrual cycle. And generally, you know, we try to get bloodwork done. And then we look at as a sort of baseline serum ferritin levels, and then dose iron accordingly, depending on what there’s what an athlete’s serum ferritin level is. And you know, if you have an athlete who’s very anemic, and their hemoglobin levels are compromised because of low iron stores, then that’s in some cases, when, obviously, a doctor physician is involved, a hematologist is involved, and you would get a infusion, but um, it’s really Yeah, it’s not something that’s common practice. I’m not against it at all. I’ve had a few infusions, just from personal experiences with low iron. So yeah, the first piece of monitoring and I think like for most female athletes, probably all female athletes, I would monitor your iron levels once a year, if not twice a year. And if you’re more prone to big shifts, are you notice you really once you start picking up training, volume and training load, you’ve noticed, you know, over a couple of years, you’re you have a big shift in serum ferritin, you go from like 60 to 20, in three months, then I might get it a little more frequently, and then be a little more a little more proactive with food strategies and, and iron supplementation. And then the last piece we look at is for athletes using altitude, as a part of their sort of yearly training plan. We know that altitude obviously is put into a training plan to improve read hemoglobin mass, which then you know, theoretically would improve performance. In order to do that and have those sort of optimal increases in hemoglobin mass, you need to have really good iron stores. And there’s a really good study, it was a retrospective study done by the Australian Institute of Sport again. And it was a yeah, really large data set. It was a really cool study. But they looked at athletes that supplemented a higher dose versus lower dose of iron at altitude camps and then measured changes in hemoglobin mass. And they found that the athletes who supplemented the higher dose I believe it was 150 to 200 milligrams per day had a three to 4% increase in hemoglobin mass from baseline or the sort of total delta change. And the athletes is supplemented lower, which I can’t remember the number of I think it was around 100. Don’t quote me on any of those numbers. They only have like a one to 1.5% I think increase in hemoglobin mass. So I usually advise athletes if they do have an altitude camp, scheduled into their yearly training plan to make sure they get bloodwork done about six weeks, six, eight weeks out, so that we have time to optimize iron stores so that when they do go to camp, they can then you know, get as much gain as possible from that camp

Julie Young  1:13:51

to wrap up today’s episode. Dana, would you provide some key takeaways from the discussion?

Dr. Dana Lis  1:13:58

Yeah, I’d love to I think it’s hard to narrow down to say a few takeaways, I think part of it is like, yeah, I just I’m really passionate about trying to help athletes, you know, reach their full potential, but do that in a really sort of healthy, balanced way. But I think the first thing I would highlight as a takeaway is create sort of your strategy and a pyramid. So think about, you know, the nutrition strategies and physiological strategies you’re using and sort of a pyramid of, you know, where are your biggest gains going to be and your biggest gains are probably going to be from learning how to fuel and recover and sleep well. And then moving your way up the pyramid to when changes in body composition and optimizing power to weight may impact performance and not jumping right away to hey, I need to just optimize power to weight right away. And that’s going to be the biggest gain in in my performance. So I think that would be the first takeaway is just really being methodical about your strategies, not doing too much at once, but really figuring out what’s going to impact your performance more and starting there. And I think think the second piece would be not to be afraid of carbohydrate as an endurance athlete, carbohydrate is, you know, the most efficient fuel for high intensity endurance exercise. So it is your friend.

Dede Barry  1:15:13

Thanks, Dana, one more question for you, before we completely wrap up, if there was one piece of advice, you’re to give an aspiring female endurance athlete, what would it be, it would be to fuel

Dr. Dana Lis  1:15:25

and recover well, so fueling by, you know, making sure you’re eating enough I’m in terms of energy, and eating enough in terms of carbohydrate to fuel your workload and really fuel your body to adapt to all the cool training stimulus that it’s getting at a young age. And then the recovery piece is just understanding how to best sleep and take in you know, protein and other nutrients that are important for your body really recovering and adapting to the training stimulus. I think, you know, as you guys, as coaches, you know, definitely sort of see this a younger athlete with training, they kind of make leaps and bounds sometimes with, you know, their power output or repeated high intensity, power output for different blocks. And I think that I’m just helping an athlete to understand how fueling is really going to help them make those huge jumps early on, is probably the biggest piece of advice.

Julie Young  1:16:24

Thank you,

Julie Young  1:16:25

Dana. If listeners want to connect with you, what is the best way for them to find you?

Dr. Dana Lis  1:16:29

Yeah, definitely. Um, I have a website. I’m, I’m gonna say I definitely don’t maintain it all the time. But it’s there. It’s summit sports And then also social media. I do have social media accounts, connect with me on Twitter, and the handle is at de lis forest with two R’s. And, you know, I definitely encourage people to reach out. And I definitely, you know, try to I try to foster positive dialogue. I know there’s a lot of controversy around around nutrition, and that makes it fun. But it also, you know, I just tried to keep it positive dialogue, so I encourage people to stay on that track.

Julie Young  1:17:04

Awesome. Thanks so much for taking time to join us today.

Julie Young  1:17:07

Thank you, Dana.

Dr. Dana Lis  1:17:08

Thank you so much for having me.

Dede Barry  1:17:11

That was another episode of fast talk fan. Subscribe to fast talk fam. Wherever you prefer to find your favorite podcasts. Be sure to leave us a rating and review. The thoughts and opinions expressed on fast talk fam are those of the individual. As always, we’d love your feedback. Get in touch via social. You can find fast talk labs on Twitter and Instagram at fast talk labs, where you’ll also find all of our episodes. You can also check them out on the web at fast talk for Dana Elise and Julie Young. I’m Dede Barry. Thanks for listening!