Dr. Trent Stellingwerff is a leading academic in the field of endurance sports and energy availability—and in this episode of Fast Talk Femmes he talks in-depth about the importance of fueling your training as a foundation for success.
As Director of Performance Solutions at the Canadian Sports Institute and an experienced researcher who has published more than 120 peer reviewed papers, Stellingwerff has the perfect blend of academic knowledge and real-world insight. He is considered one of the top experts on RED-S (Relative Energy Deficiency in Sports).
In this episode he talks about some of his published work on topics such as overtraining syndrome and RED-S, periodized nutrition for athletes, patience during puberty, and nutrition interventions to optimize performance in middle distance runners.
Fast Talk Femmes podcast co-host Julie Young said: “My greatest takeaway from this show is that if you want to be in in for the long game and have a fruitful sporting career, don’t be afraid to fuel your training—and don’t be afraid to be patient with the training process.”
Dede Barry 00:05
Hi and welcome to Fast Talk Femmes with Dede Barry and Julie Young. Our guests on this episode is Dr. Trent Stellingwerff. We’re Trent serves as a research and development advisor at the Canadian sport Institute. In this role, he directs several different research projects across different sports performance discipline areas. He also provides physiology expertise to Canada’s national athletics, rowing, triathlon, and mountain bike teams. His primary sport and research focuses are in the field of physiology and nutrition interactions, as well as environmental altitude and heat expertise. He co-chairs OTPs relative energy deficiency and sport right as Working Group. Our discussion with Trent will focus on how to avoid the pitfalls of overtraining, RED-S, and on how periodized nutrition can be an effective strategy for female endurance athletes.
Rob Pickels 00:58
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Julie Young 01:29
We are thrilled to have Dr. Trent Sterlingwerff with us today. And I can just say through my education having read so much of Dr. Selling dwarfs work. It’s just such a thrill for me to meet him face to face at Slyke. Christmas has come early for me. He truly is a mega star in the world of physiology and nutrition. And for me what I respect is his depth and scope of research, but maybe even more so his success and translating and applying that science into effective practice. And I would imagine his position at the Canadian sport Institute is the perfect opportunity to marry that research and that practice. But Trent Welcome to Fast Talk Femmes. And can you tell us a little bit about yourself and what you’ve been up to lately?
Trent Stellingwerff 02:24
Yeah, great. That was a really nice introduction, Julie. And I’m humbled to be here with you all. And even just call me Trent as well. I worked hard for the doctorate. But I appreciate the casualty. And yeah, I work at the Canadian sport Institute Pacific. And we’re one of the Olympic Paralympic training centers up in Canada and in British Columbia. And I’m based in Victoria, though I’m in Flagstaff right now at a training camp. And I’m the Research and Development Lead for the institute. That’s my primary role. And it’s a great role as it spans across all sorts of research projects, with different universities up in Canada, as well as internationally. And then my personal area of research tends to be areas of sports nutrition, areas of environmental physiology, like altitude training, and then more specifically, over the last probably 10 years is female specific physiology, and a lot of work in relative energy deficiency in sport or reds, which I know that your podcast has covered before so and then I also coach a few endurance runners middle distance to long distance runners, as does my wife. She’s a multi time middle distance Olympian as well and the coach at our local university. And so both of us have a small elite group that we we coach, so I appreciate you messaging, the taking the research and putting it into practice. It’s nothing like putting it into practice when you have to make coaching decisions every day and every week
Julie Young 03:52
almost seems like I mean, in some ways, a harder part of the equation.
Trent Stellingwerff 03:56
Every researcher out there at the end of their talk, when they ask them a question they can’t answer. They’ll say, Well, we just need to do more research. But on Sunday, when I’m reading the training programs for the athletes, I can’t stop and say I need more research. So as a coach, you’re constantly making decisions without all the information and as a researcher, you’re trying to constantly make decisions with all the information so it’s like a it’s a real push pull. Well, let’s
Julie Young 04:22
start the conversation today and set the stage by providing an understanding of some key concepts. And as you mentioned, relative energy deficiency in sport otherwise known as reds, we have we have touched on this with Dr. Krauss in Episode 104. But you’ve been working on the New International Olympic Committee consensus statement on reds which will be published this summer. Can you bring us up to speed on this concept and the value and guidance that this new consensus paper provides to athletes and coaches?
Trent Stellingwerff 04:57
Yeah, so I was really honored and excited it’d be invited into the 2022 2023 International Olympic Committee consensus on reds, this will be the third one. The first one was in 2014. That’s where the Reds concept was first developed. That includes obviously all the great research that’s part of the female athlete triad. But at that point, they extended it to say, hey, there’s more body systems than just menstrual cycle or reproductive health and bone. And it can obviously we see rights in males, too. And for any of you interested in reds, yeah, Emily, Dr. Krauss is a close friend and colleague as well. And I’m sure she covered it really, really well. But there was an appreciation by the International Olympic Committee, the IOC that the last consensus was 2018. And since 2018, there’s been actually more than 200 papers published in the area, including reviews in the area of reds or low energy availability. And so there’s been a real explosion of work, some of it is good, some of it is not so good as with all research. And so the way that they do the consensus is just a little background is they’ll invite in usually 10 to 15 people from around the world to listen to the IOC headquarters. They’ll try to have a range of nationalities, a range of genders, a range of different disciplines, so some Sports Med physician, some physiologist, some registered dieticians, a psychologist, that an athlete and coach representative there. So it’s a really nice range of people. And we spent two and a half days deep diving into the evidence of what we can say and not yet say about Red’s. And that included ahead of time, for each of the nine papers that will be published or 10 papers later this summer, as you mentioned, voting statements that will be published. So every expert would say hey, like, is low bone mineral density assign a read, it’s like how much do you agree in a voting statement? So it was a really rigorous process. It was a neat process to be a part of. We’re now preparing all the papers for submission. Some of them are now in submission. And hopefully by the summer in the British Journal of Sports Medicine you’ll you’ll start to see all these papers come out. I was humbled to be there like some of the experts that were like Marva Mountjoy, and Louise Burke from Australia and Dr. Kate Ackerman is endocrinologist at of Harvard and Tony Hackney, who’s a physiologist endocrinologist at UNC. yorn son got Borgen son who’s done a ton of eating disorder research at in Norway. It was real honor for me to to be there. My personal contribution along with an amazing postdoc that I have Dr. EDA had Cora, who’s based in Canada is the new clinical assessment tool for reds. So it’s the new diagnostic tool physician led but that people will use to say, Yes, this person has reds or doesn’t have reds, and how severe are what is their risk and a traffic light approach. So it’ll it’ll be green, yellow, orange, and red, on increasing risk and severity. And we’ve really laid out and have a whole bunch of validated approach to that tool. It’s been a real labor of love. That was a monster paper. It’s been submitted now and in review, and hopefully you’ll see that this summer.
Dede Barry 08:10
That sounds amazing. Trent, can you help us understand the concept of overtraining and how red s and overtraining are somewhat intertwined?
Trent Stellingwerff 08:19
Yeah, so I think clinically, a lot of us that work at the coalface with athletes, with physicians with physiologist with coaches have seen very similar symptoms of overtraining and reds. When you dig into the research and into the literature. And you compare the symptoms of reds in overtraining, they’re almost identical. The only major difference is, a lot of the Reds research from the female athlete triad background, has really focused on bone stress injuries, and perhaps overtraining has not focused as much on bone stress injuries. And so they’re very intimately and closely they’re like brothers and sisters, but they are different. And as a COVID project, a bunch of us got together to write a position paper that’s been published now, that highlights the complexities of rents versus overtraining, I led the writing in that paper and then we pulled in a whole bunch of the overtraining experts. So the lead author of the last overtraining, consensus and diagnostic paper, Romain Newson is a co author on on that paper. And again, like the last overtraining research, consensus was 2014, before reds even existed as a concept. And so one thing that we have seen is that a lot of the previous overtraining studies, probably about 70 to 80% of them are confounded in that when in the studies when they all of a sudden increased training load by 50%. And they measure outcomes. They don’t actually account for the fact that they’re then in low energy availability. Because when you increase exercise expenditure by 50%, and you don’t increase energy intake by 50%, you’re in a deficit. And so a lot of the overtraining literature is confounded by the fact that is this actually an overtraining, or is this actually low energy availability and reds. And so we did an analysis to, to kind of showcase that. And that’s also why I think a lot of the symptoms are very, very similar. But the cause, or the medical term, the etiology of the disease, or the syndrome are different. If an athlete presents and you think it’s overtraining, and you do a full assessment, and you know, they’re in low energy availability, it’s reds, that is the cause of reds. Overtraining, is truly overtraining, you’re able to meet all your nutrition demands, you’ve excluded for any other diseases, or blood work issues, or inflammatory disease or autoimmune diseases. And all you’re left with is, gee, this athlete has buried themselves with 30 hour training weeks for the last three months, and they’ve maladapted and they’re fatigued. And that’s kind of like what you’re left with, with overtraining. Unfortunately, with both syndromes, they’re like multifactorial diseases, meaning we don’t have a pregnancy test for them. There’s not one indicator that says yes or no. Instead, it’s an accumulation of risk factors and signs and symptoms that makes the physician more confident of a diagnosis, and other multifactorial diseases, like obesity and diabetes can be like that as well. And so it is complex to diagnose these things accurately. But as you’ll see soon, hopefully, our new clinical assessment tool for for reds will will go a huge step forward in helping clinicians to more accurately identify this complex syndrome.
Julie Young 11:43
So Trent, a goal of our podcast is to provide listeners with actionable information. And so let’s let’s shift the conversation now and chat about tangible ways to avoid the pitfalls of reds and overtraining. And for me, as a coach I find many endurance athletes are susceptible to the more is better, if it’s not hurting me, it’s not helping mentality. And as a coach, I try to consistently educate my athletes on why they’re doing things and the principles behind the decision making. So they have that understanding and that intention when they’re doing things to kind of stay the course. But I find it it’s this tricky, like balance of achieving those training adaptations, while also keeping the athlete healthy. And I think, for example, like the autonomic nervous system, the endocrine system, the immune system. And it seems to me that female athletes may walk an even, like finer line and finding that balance. So how do you go about achieving this balance between adaptations and health?
Trent Stellingwerff 12:49
Yeah, I did a talk a few years ago at one of the sports medicine conferences about how a physician could best use their physiologist and I had a slide that I made with a big cliff. And part of the physiologists job is to try to set the fence as close to the cliff edge as possible. And normally, you set the fence a little further back. And then as you learn things, you can even get that fence a little bit closer to the cliff edge. I then had a pitcher come in have a have an ambulance cartoon at the bottom of the Clifford said unfortunately, this is when the physician sometimes comes in as a reactive model, right? And so how can we do a better job at this or, you know, as a joke, there’s a great Calvin and Hobbes cartoon, where Calvin asked his dad Oh, how do they know the load limit on the bridge, because we’re driving up to a bridge and it says 20 times and, and the dads like, well, they just drive heavier and heavier trucks across the bridge until it breaks. And then they wait the truck. And unfortunately, in many instances, coaches don’t even wait the truck, they just go right back into smashing their athletes. And so it’s a little bit of a preamble and what I tried to do, you know, we need a lot of humility and coaching and that it’s really complex. But there’s three things, there’s three really key things I think we can think about, to try to figure out where that fence is on the cliff. And one is, whatever sport you’re in, try to find an internal load metric that is easy to track. So that’s, that’s one of them. I’m going to I’m going to identify all three, then I’ll come back and explain what I mean by them. Second, is find an external load metric you can easily track. And then thirdly, have a system to just and this could be self report to assess athletes systemic fatigue, and it could be a palms questionnaire, daily athlete life demands questionnaire, it could be a scale of one to 10 and try to track those three things diligently. And I think with those three things, you’re in a really good spot to make much more informed decision making on how an athlete is tracking. And so with internal load metrics, that’s anything internal to the body in its response to exercise that can be rating of perceived exertion. I love RPE. It’s simple. It’s easy. I program a bunch of workouts and RPE oh, what’s the goal today is this split that split and whatnot RPE five. That’s the goal today. But it could be heart rate, it could be lactate. Those are other internal load response metrics. external load. If you’re in cycling, it’s wattage, if you’re in running, it’s running speed or swim speed. And if you can track those two things, you can see a lot of relationships, especially at steady state in the training. And then if you just have a fatigue score on one to 10, I think you’re in really good place. It sounds so easy to do, the hard thing to do is to have the diligence or the athlete to have the diligence to do it longitudinally over a long period of time. And so I used to use the word athlete compliance on monitoring, a very good mental performance experts said, obviously, Words matter. So I now use athlete cooperation on monitoring instead of compliance. It’s a more positive and proactive word. But then I also talk to the athlete and say, we’re going to periodized, this monitoring, I’m not going to descend you to do it year round, like on your break, take your break in the three weeks before altitude, I really want to focus on these metrics so that when we go to altitude, we have a good baseline, at certain times of the year, a transition phase will drop it all together, because there’s also monitoring fatigue with the athletes. And so those are the three things that I would I would really look at. The last two things I’ll just say really quickly is be proactive with your rest and recovery cycles. Don’t just wait until the athletes at the edge of the cliff are injured. And, you know, if you’re on weekly mezzo cycles, maybe as a runner, it’s it’s three weeks hard one week, easy. If you’re in an non neuromuscular, or a lower neuromuscular sport, like like rowing, maybe you could do a five or six week training block before recovery block, if you’re a high jumper or a triple jumper, it might be a 10 day block, and then trading or recovery block. And then finally, as you just said, you have to train hard, don’t I am not, you can look at some of my athletes, Travis, but you got to rest hard to and fitness doesn’t come without fatigue. But performance doesn’t come without fitness and shedding fatigue. And so those are the three variables every coach is always trying to manage it’s it’s the fatigue variables, the fitness variables and performance variables. And, and it is complex. So I’m humbled to that chaos of complexity. And I hope, hope that frames it, maybe in a way that people can take something tangible and use it.
Dede Barry 17:45
That’s really helpful. Trent, I’d be curious as to how you ensure that an athlete’s getting adequate recovery, like how reliant Are you on software systems such as like heart rate power meters, versus just the general feedback from the athlete? And how strictly Do you have an athlete adhere to like regular rest and recovery periods, like during a training week and during a mezzo cycle? From my experience working with athletes, it seems like it’s a constant adjustment based on like the day to day feedback or the week to week feedback, because some athletes have busy lives. And so, you know, you go into a cycle with a particular plan, but then things come up psychological stressors or whatever, not enough adequate sleep, and you have to make adjustments. So I’d be curious as to how how you manage all that to ensure they have adequate recovery?
Trent Stellingwerff 18:42
Yeah, that’s a great question. I’ll probably answer it in two different ways. As a physiologist that has worked across rowing across triathlon, a little bit in pro cycling, mainly track and field, I will work with the coach and use whatever metrics and software that they’re keen on while at the same time supporting and educating them in ways that I think we can enhance their decision making. So I’ve used a lot of different software approaches out there, you know, Lady elite, and one is training peaks. And I think generally for cycling, it’s a pretty good model. But again, every single software approach, every approach has its pros and its cons. And it’s just really good to have your eyes wide open on some of the pros and cons. So a training stress score in based on cycling data that I’ve seen in training peaks holds up pretty well for most people in sports like running with a way higher neuromuscular demand. I don’t think it holds up as well. The muscle fatigue scores are a lot different than just overall training stress score. So for me as a coach, I’ve created my own bespoke Excel software solution. It’s all RPE and minute based within periodic checks on heart rate and lactate sampling. Just as sense checkers. Every single athlete has a T In his channel, and then the staff where that athlete are invited in on the teams. And so it’s it’s a completely live document where the athlete puts in their RPE scores and their minutes, their comments on each day, I then also program in there so that I have a graph that looks on program versus actual. Because Never assume the athletes are doing what you think is written unless you can confirm that there can be a disconnect between program versus actual. And I use that approach. We will do session audits now. And again, for example, just to better dial in threshold pace, Upon arrival, the altitude, we’ll do some lactate sampling with some heart rates. But later in the camp, I want them to go and feel again. And so it’s not that complex. The beauty of it is that the athletes that I work with are really bought in, and they can really see over time how valuable it is to go back and like look at really good record keeping, I will then on key workouts as well use a critical velocity model have their speed and duration curve. Everyone knows critical power model model, I can do critical velocity. I’m a bit of a techie nerd, I have a template for each athlete, and I can see exactly where they’re tracking. And I’ve had pretty decent success at saying, Hey, you’re in this kind of shape, or this kind of space, or I want you to hit these splits today. And it should should be a lactate of 3.5. And, and it works out pretty well. So there’s no perfect solution. Long story short, I think you need to be open minded to what what software can add or not add. The biggest factor I think is the athlete’s cooperation with the software. And then the coaches ability to slowly take on the metrics. Maybe one last story I’ll say here is early in my career. Probably one of the bigger mistakes I’ve made as a physiologist is with a younger coach who is keen and happy. We just did absolutely everything. And it was like an Olympic program. I won’t, I won’t name names here. But at the end of the year, we would say I they had a b minus or a C plus report card. But because we did too much all at once, it was really hard to decipher what worked, what didn’t work, I could tell at the end that the coach was overwhelmed with way too many new metrics. I was overwhelmed with way too many metrics. So go slow, be purposeful about what you’re going to track. Maybe add one or two things a year. And slowly as a coach, you’ll build some tools that you know work for you and that you can really hang your hat on to make better informed decisions.
Julie Young 22:37
Trent do you use? I know this is kind of basic, but do you use like morning resting heart rate and or whoop or aura data for feedback on recovery?
Trent Stellingwerff 22:47
Great question at certain times of the year will enhance recovery monitoring. So for example, right up here in Flagstaff right now, there’s another physiologist here, Gareth Sanford is helping out and driving leading the physiology at this camp. He was a postdoc of mine a few years ago. And so here we’ll have morning heart rate, if athletes want to opt in a morning, bodyweight check, because we want to keep people in energy balance, a morning oxygen saturation check. For some athletes that use HRV. And more than an HRV check. It’s not not required. And then a morning hydration check because we’re at altitude, basically in the desert Flagstaff. And every morning, athletes can cooperate and opt into that I’m struggling, I don’t require my athletes, I educate them. And hopefully they opt in. So the athletes I’m here are opting in and we get a little report every morning. We see how they’re doing how they’re feeling. And yeah, it helps me make more informed decisions on how we’re tracking. I certainly write a program for a camp like this in pencil, like three or four weeks in advance. But the athletes I work with know from workout to workout, we’re going to take information from that workout and apply it in the very next workout like, Oh, we’re going to make these splits faster because you outperform that last workout. Or we’re going to pull back here because I over interpreted where you’re at. So yeah, there’s constant feedback loops. And I, I don’t like the current definition of periodization. I think the current definition of periodization should focus on communication feedback loops, rather than this grandiose, mythical plan that you could produce at the start of the year. I think that the definition for periodization should change.
Julie Young 24:34
I just like a few things you said kind of initially, you’re talking about the different feedback mechanisms that you use, you know, and you use all of them RPE heart rate or power all of those mechanisms. And I think we see this in cycling I don’t know if you see this as much and running but people have just become so obsessed with data and especially like their power numbers like they’ve thrown everything else out. And I think I know for me as a coach like I feel It’s so important that athletes are still in tune with how they’re feeling because they get in a race situation and in race situations, you know, if they’re on dirt power is not going to apply heart rates not going to apply. So you need to be understanding like that perceived exertion. So I really appreciate that. And I also thinking about like whooping ora feel like sometimes kind of what what you said more data is not better. And I think it’s sometimes it can really play on athletes heads in the wrong way.
Trent Stellingwerff 25:28
I agree. There can be absolutely paralysis by analysis, but also negative feedback loops. And there’s no publications on that where people get too obsessed on certain numbers. And especially obsessed with numbers that are aren’t necessarily validated. Like if you wake up in your Olympic morning, the chances are that you’ve had a crappy sleep. It’s the Olympic final. Well, no kidding. And then you look at your whoop, and it says that you’re under recovered, you don’t need that, get rid of it and realize it’s okay that you had a little bit of a crappy sleep. So did everyone else. Here’s some military data to show you’re going to perform Okay, off one night a crappy sleep. And get out there and go for it. So I’m totally with you on on the over doing it at times. And my analogy with the marathoners I work with is it’s a bit metric ik I could convert it to Imperial, for the first 20 Miles race with your brain for the last six miles race with your heart. And I think in a lot of instances is a place to use the metrics in racing. But if you don’t give your self a chance to do something special in the last 25% of a race, because you’re you kind of hold this wattage or this heart rate, you may never have the the epic special day where you can rise above and I coached Natasha woodtech. And all my data suggested she was going to run a her PV going into Berlin marathon last year was 226 50. I think you couldn’t run to 2430. She’s like, What am I Yeah. And so she went out into 2450. And she ran to 2310. And so my only comment on Twitter was Natasha, you Max messed up all my algorithm. She ran 90 seconds faster. She had a like a four minute PB, or three and a half minute. And she did that exact thing she ran to 2430 through 30k. Like her last day at 10k was just unbelievable. Like it was a 3310 10k at the end of a marathon. So yeah, I think there’s time for data. But then there’s also time for filling it out your emotions, reading the play of a race, when to go when not to go. And sometimes I love pro cycling. And it’s just almost gotten to mechanical at times. And so as someone of Dutch descent, I liked that Matthew Vanderpool is very unpredictable. So he makes it exciting.
Dede Barry 27:46
I would agree with you. I actually think Pro Cycling has gotten a lot more exciting in the last few years because a lot of the current pros are racing like juniors is going for it with our heart all the way.
Trent Stellingwerff 27:57
Yeah, I think that was Vanderpool is quote after Perry rupay. Last weekend. So yeah,
Dede Barry 28:02
I agree. Yeah. Now it’s really fun to watch. But yeah, one of the more kind of disturbing things that I’ve seen, just working with developmental cyclists is that there is so much public data out there now power numbers of pros that kids can compare their numbers. And, you know, I’ve seen some kids putting out pretty amazing numbers, right. But that gives them this level of confidence that they can skip developmental steps, they focus so much on the power that they forget about tactics, they forget about bike handling. And they’re trying to push their way into higher level races when they don’t quite have all the soft skills that you need to be a great bike racer, for example. And they’re almost setting themselves up for failure, even though they can maybe put out similar five minute power values. They’re just not quite there. And so that can be an issue too. Right?
Trent Stellingwerff 28:56
I totally agree. And coming back to, to the Reds piece, it’s really important for young athletes to understand that when they see their heroes on TV at the Olympics, and what they see visually in terms of body composition is not what they see for probably eight or 910 months of the year. They are in their absolute peak form physically and body comp and everything else and you can’t aspire to be like that year round. I mean the last a couple of years and that’s it. And you know strive is cool too like I have wide open if anyone wants to see any of our training you can follow Gabriella to boost Stafford you can follow Natasha would have every workouts there. The secret is why it’s there. That’s what happened at like go for it is probably going to mess up most athletes because like they don’t understand the context of where we built from where we’re going. And so Didi I totally agree with you and, and swift five minute power. I mean, can you write the punch and hold the wheel and with 80 people at 55k An hour and a crosswind and an Echelon and Belgium it’s it’s totally different situation. So I almost feel like a good coach can fix power better than bike handling at that age. Yeah.
Brittney Coffey 30:13
Hi, listeners, we’re so excited that you’re here to check out fast talk them 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 fast talk labs.com.
Dede Barry 30:37
So, with young female athletes specializing earlier, do you have any special guidance in terms of training plan development to keep them emotionally and physically healthy, because I personally see so many of them trying to jump ahead of themselves, and push them at the level that really they should be aspiring to maybe a little bit further in the future when they’re physically and emotionally ready. I’d be curious to know how you’re managing that.
Trent Stellingwerff 31:06
The word that comes to mind and that I’ll say over and over and over again is just patience, patience, patience. And I realized that, especially from the endurance sport lens, it selects for a type individuals, high performers, perfectionist attitudes, and those are those are good attributes to have. And when you’re a young girl or young boy and you can make a world cross country team or go to you 23 UCI worlds, you want to go all in on that opportunity. And I get it. Sometimes it might be your only shot or your only crack at it. But I would also just always say, educate yourself on how many people as juniors make it to seniors, it’s not many, there’s a few are that are outliers. Educate yourself on the fact that every single world record in endurance sport is held by a senior woman and not a junior woman, educate yourself that every single world record holder is a senior woman they’ve weighed more than a junior woman, they have more muscle mass, they have better health. And so I think some of these things just have to be permeated in and just to realize that, especially through puberty, you need a lot of patients, there’s some really important developmental windows, that if you don’t optimize them during puberty, like bone health, you’ll never get it back, you’ll be compromised for the rest of your career around bones, because there’s two two parts of your life where you really put down a lot of bone or curl. And one of them’s in their first three years of your life and the other ones during peak height velocity during puberty. And if if you miss that period, because you’re not having a menstrual cycle, or as a male, you’re low testosterone, you’re just going to be compromised your entire career and in some sports like running, that will just result in five, six stress fractures by the age of 21, and 22. And you’re done with a sport. In other sports, like cycling, or swimming, stress fractures don’t present as easily or they’re a little more hidden, or you can kind of cheat and get away with it a bit more, until you forget to clip out at a stoplight and you just tip over and you got a broken collarbone because you’re you got BMD like grandma. And so again, patients, patients, patients understanding that athlete development cycles take time. And there’s another thing that I’ll mention too, and it’s under research, but there’s a couple of papers that gynecological age is also an important factor. And so if we take a 30 year old woman or a 20 year old woman in a study, and say we just put them into negative 500 calories for a few weeks, or a couple of months, probably every 20 year old woman will lose their menstrual cycle, while only a handful of 30 year old women might, there seems to be a protective effect of aging on gynecological age, to be more robust to training loads, and to some periods of lower energy availability. If they were to happen, hopefully, inadvertently. So again, like we want to get athletes to their best years healthy years when they’re 25 to 35. Heck, we have 40 year olds kicking butt now. So you got to think long term and you gotta be you gotta be patient.
Julie Young 34:15
Trent, we’ve referenced your article, patients during puberty several times in this podcast, and I have passed that along to so many parents of kids, I coach and directors of teams. And I think the more we can help people be considerate and mindful of that, and just, you know, help those kids have in the people that surround those kids have that perspective of that patience and the long game.
Trent Stellingwerff 34:41
That’s awesome. I sort of mentioned that. Yeah. If you google search that I think you’ll you’ll find it online somewhere.
Julie Young 34:47
Yeah. And we’ve linked it and we will link it and I just really appreciate that that’s become a guiding principle for me and my practice. Really appreciate that paper. Let’s just kind of jump around a little bit and what kind of jumped back to a little bit where we started on this with energy availability. And that playing such a key role in reds and, and again, we did chat about this with Dr. Krauss in Episode 104. But you know, it seems with wearables overall energy expenditure is is easier to calculate more accurately calculate, however, like the calculating energy intake still seems tricky. And I would guess to like, you probably know this better than anyone working with athletes, you know, wanting them to maintain that healthy relationship with food when you ask them to start logging and weighing that, you know, there’s that that jeopardy of kind of throwing them into that unhealthy relationship with food. So how do you navigate this to accurately calculate energy intake in order to calculate energy availability?
Trent Stellingwerff 35:48
I don’t, okay. I will and research projects, we will try to get a handle on certain research projects of energy availability and, and just very briefly, energy availability is a simple equation, its energy intake, in calories minus exercise, energy expenditure and calories divided by fat free mass or muscle mass. And it’s therefore the energy available leftover after training to fuel your body. So you know, if you take in 3000 calories and food and you have a massive training day, and it’s 2000 calories, you only have 1000 calories left for basal metabolic rate and recovery and glycogen and bone health and menstrual cycle and reproductive health. Liver glucose production, the brain likes glucose, that’s where psychology comes in, and depression and everything like that the whole body needs energy, your brain needs energy. It’s a simple equation that is very fraught for over and under reporting of energy intake. And even with wearables, it’s still challenging to really drill into accurate exercise energy expenditures. In situations where you have a wearable that features heart rate and wattage and its steady state, it’s pretty good. But in interval sessions and short interval sessions and in the anaerobic sessions, our ability to measure energy expenditure in the anaerobic domain is frankly dreadful, even with metabolic carts and everything else. It’s the white elephant in the physiologist corner, we’re always estimating in the anaerobic domain. So the gold standard is double labeled water, which is a really expensive lab approach to measure total daily energy expenditure. But we’re still back calculating and predicting the exercise part. So in practice, as a coach, I don’t try to get a handle on that. Instead, we use markers, long term markers, and short term markers of low energy availability. So short term markers are poor recovery from session to session bombing workouts every two or three times because you just haven’t recovered well enough and probably haven’t eaten enough specifically carbohydrates to get your glycogen back up. mood shifts and changes, obviously, a change in menstrual cycle status for males a change in mourning erections, I know that’s kind of hard to talk about as a coach, but males should be aware of that that is a very good marker for a male sex drive or morning erections. Longer term, it’s bone health, it’s depression is sex hormones, depression of T three thyroid hormone, are also indicators. So you’re better off to look at the indicators rather than to try to measure low energy availability. Even our Olympic level trained registered dieticians rarely go down that path, they will do some food logs now and again, but more to see how an athlete structures are eating throughout the day to see for opportunities to have better caloric spread across the day, rather than to use it to try to estimate energy intake, because again, it’s really messy. So I’ve said this on other podcasts, I’ll just finish with it. At the very best even in laboratory measurements, we can get energy availability to within accuracy of maybe 300 calories a day. That’s pretty good. You’re like okay, but if you’re out 300 calories a day for a year, that’s 110,000 calories that you messed up on. That’s like taking the month of March off of eating. And this is the really tricky, insidious, insidious thing with reds and low energy availability is the mismatch for most athletes is usually only three 400 calories. It’s actually quite small. It’s like a really aggressive recovery beverage. And I know one day it doesn’t matter. It’s just when that happens for months on end or a year all of a sudden man i i should have been up at 100,000 calories and I just am not and then slowly these things are present in Yeah, last menstrual cycle, bone health, lack of recovery, increased illnesses, etc etc. So yeah, I will say is getting a handle on low energy availability is truly kind of for the reason Search great professionals because it’s really hard to do.
Dede Barry 40:03
Try it. This may be a stupid question. And I’m not an exercise physiologist, so excuse me if it is, but like, I know, continuous lactate monitors are in the works. And once you have that information, will that affect your ability to measure energy availability better for those high intensity workouts where you’re saying like, right now it’s a white elephant? Like you really can’t measure it at all? Will that be game changing? Do you think in that regard, or or not?
Trent Stellingwerff 40:32
Physiology is really complex. So there’s no such thing as a dumb question. Because I have about 10 dumb questions myself and tried to study it no, like, us humans are tricky. So it’s a great question to be 100%. Sure, you did mean continuous lactate monitors, not glucose?
Dede Barry 40:46
I mean, glucose, like we already have it? And it seems like it’s still not tricky. Oh, yeah. I mean, we could do a whole we want to do a podcast on that. But I was wondering more with those high intensity efforts. If lactate will help inform.
Trent Stellingwerff 41:01
It will a little bit, but I don’t think any better than what we have now. And the reason I say that is if you have an athlete who is has a very anaerobic dominant profile, and you have them do a full warm up, and they do at 90 seconds, all out, and you measure their lactate three minutes later, and if they’re anaerobically, dominant, it’s going to be between 15 to 20. If their aerobic ly dominant, it’s going to be maybe around eight to 12, they just can’t produce as much lactate because they don’t have the muscle mass. And they don’t have the fiber typing to do it. Now that anaerobic, faster Twitch muscley athlete, that peak lactate will still be high an hour later. So we just don’t have the resolution. So even if we had continuous lactate monitoring, it’s gonna go up on the first interval, we already know that and then it’s just going to kind of live there, even with the rest, so it won’t, it won’t come down very much. And so I’m not sure we will get the resolution, we would need to, to best do that. The way that it’s functionally done now is we look at old muscle biopsy studies where they took muscle biopsies like in a six second sprint, like a 10, second sprint, a 15, second sprint, and then we can make back calculations of how much glycogen was used and how much lactate was produced. And as well as the power output and then the blood lactate. And you can get a decent handle by going back to the biochemistry and looking at all the pathways and calculating ATP, like old school, high school, university biochemistry and our understanding and appreciation of the anaerobic domains and even how big or little it is, it’s just hard to do methodologically. And the reason I say that is very well trained athletes on a 32nd sprint will already have their aerobic metabolism turning on at a high degree over the last 10 seconds of that sprint. So in other words, you’re no longer measuring just anaerobic, you’re measuring anaerobic and aerobic. Well, how much of what is it? Like? How do you get your hands on that? Right? So yeah, like a good 32nd Or third sprint with a lactate will give you a great indicator whether how anaerobically dominant an athlete is or isn’t. And I think for 99% of coaches decisions, you’re that simple test will get you where you need to be
Julie Young 43:16
have a couple follow ups. Since we’re talking about lactate, you had said that in training you you will I believe you’ll use lactate measurement as a way to determine an interval I suppose like you’re hitting a three millimolar in an interval, I run a physiology lab, and I’m familiar with work using the lactate meter in the lab, but can you help us understand how you’d use that in the field?
Trent Stellingwerff 43:41
Yep. So one thing that I found very helpful in my practice as a physiologist is to work closely with coaches to periodically do what I’ll call it, or others call it tonight is me a session audit, like okay, you’re a track coach and you love six by a K on three minutes or two minutes. And you have that in there a few times a year. How do you know what the athlete what are the outcomes that you’re actually looking for out of that session. So we will do this on every session because this is way too time intensive. But uncertain sessions will then have it all set up so we can maybe especially at altitude, we’ll get the heart rate profiles, we’ll get the lactate profiles throughout, we’ll get the speed profiles or wattage profiles throughout will slip an O to SAP meter on between the intervals quickly to see how much they’re desaturated and then coming back. And then we’ll look at lactate clearance at the end. So maybe the last lactate is 30 minutes and 60 minutes post session or putting that all together into a report to the coach and the quality of conversation that comes out of a session on it like that is awesome. And it’s just oh wow, those lactates were lower than I thought or higher than I thought or look at the heart rate so or okay you know if we’re doing a video to Max, you know, we want to accumulate as many minutes as poss The ball over 90% of heart rate Max,
Trent Stellingwerff 45:02
did we do that? How good did we do? Do we have to shorten the rest of the length and the rest are the intervals too long for altitude, so the athletes wattage is or speed, so just just tanking, that’s no good, let’s split them up, we’ll do micro rest of 30 seconds in the workout or in the boat. And so especially for threshold and steady state type efforts, it’s quite effective. Because then in the field, you get a lactate measurement. With the coach there, you can be like, oh, there, you know, it’s a bit hot, or they’re going too fast, we got to dial it back. Let’s make this next kilometer rep 320 per kg rather than 315. And we’ll do another check. Okay, that’s the number. Okay, let’s just keep it there. And it just it creates some good conversations around pace discipline, athletes don’t necessarily have great pace discipline, it’s a learned thing, I believe. And when you can give some feedback beyond just the coach’s opinion, I think it helps helps accelerate the learning around pace discipline of of intervals. But with everything, you can do it way too much. And so we’ll just bring it in and out periodically, because as a good coach, lactate threshold is very linked to respiratory threshold. And if you’re riding a bike beside your athlete, and you’re listening to their breathing, you can get a lot of information just that way as well. So I’ll do a lot of breathing RPE checks on long runs or threshold runs as well. Do you find
Julie Young 46:30
that your athletes lactate numbers change significantly from sea level to altitude
Trent Stellingwerff 46:36
at a given speed? Absolutely. Yes. So I’ve very good 5000 meter runner I work with her 3.5 millimolar lactate threshold at sea level is about 315 per kilometer. I don’t really have to look that up in miles, I’m not sure. And here at altitude in the first week when we did threshold, it was 330 per kilometer. So it was a 15 second per kg shift. And that there’s papers on that. And that that’s usually typical, when in the first week, we have another threshold session coming up later, I’m going to ask her to do the first reps around 325 per kg rather than 330. And I because we’re here the extra week, she’s cumulated more red blood cells, I think we’ll be able to pinch it down. But we’ll do a little lactate check and and see where how we’re doing.
Julie Young 47:23
That’s so neat to be able to take I know you said and we talked about this more is not necessarily better. But for you to kind of be taking all this in and making these kind of adjustments real time with the coaches must be pretty fun.
Trent Stellingwerff 47:35
Yeah, it’s you have to have bought in athletes and coaches for sure. For it to work. You know, unless you’ve been under a rock, the encryption brothers out of Norway have done a ton of this. My wife and I lived in Switzerland for seven years. And our second home was safer it so 10 years ago already, we were chatting with the Norwegians and learning from the Swiss and I just I’m so lucky to have been in the right place at the right time of a few times. Because Maurice Belkin wrote kind of the article on his website on how the universe is trained. He was he was up in Switzerland training at that time and was able to have dinner with him a few times, and just better understand what his philosophies were around training. And I certainly don’t do all of it. But there’s there’s elements there that yeah, I’ve really held up. Okay, across the test of time.
Julie Young 48:21
One more follow up question to some things we’ve chatted about just to not not to beat a dead horse, but kind of back to energy availability. And so, you know, maybe most of our listeners may not have the access to like the nutritionist, the physiologist, the coaches. So, are there any like suggestion strategies you could suggest for those athletes in order to avoid kind of tempting that low energy availability? You know, as opposed to waiting for those signs and signals? Like, are there some things that you could suggest?
Trent Stellingwerff 48:53
Yeah, so I’m sure Dr. crusted and earlier in the podcast, I highlighted some of the signs and symptoms to watch for, but more proactively as you’ve just asked. I think it’s really important to recognize and understand that the harder you train, the more you train, the more you gotta feel. And it isn’t always a subconscious decision. Your hunger signals don’t always drive that you got to be conscious and aware. And so some people will say become a little more mechanical around feeling and eating. When there’s changes in training intensity training volumes going up or training locations such as altitude, because altitude increases basal metabolic rate by 10 to 12%. Just being here along with he makes all the training more carbohydrate dominant. And so just being really aware of those things, obviously, trying to titrate your food appropriately throughout the day. So good breakfast, good snacks, good lunch, but really emphasizing fueling and carbohydrate fueling, before, during and after training is a really good critical period to focus on Yeah, don’t be back in loading your day with like huge massive meals because your your body, especially with protein can only absorb so much. So you want to want to spread it out a little bit more. Maybe the last thing I would say is just, again, just be patient with your training program and your training loads, you want to explore the cliff’s edge, but you want to do it in a safe way. And you want to be able to explore it when you’re 28 and 30. And maybe at the peak of a career and not be broken and out sick of your sport by the age of 22.
Dede Barry 50:31
Trent, what about supplements? I mean, generally, from my experience, there’s a lot of them that over promise and under deliver. But there are some exceptions to that, obviously. And I’d like to know if you feel like there are any that are particularly beneficial for female endurance athletes to boost the effectiveness of training, recovery so that they can enter a greater training load. What are your thoughts on that?
Trent Stellingwerff 50:57
I’m gonna be provocative and first ask what your definition of a supplement is, because there’s about 40 of them out there. And even the world anti doping Association doesn’t have a clear definition of what a supplement is, or isn’t. Do you include sports foods and supplements? Or are those not supplements?
Dede Barry 51:14
That’s tricky, Julie. Yeah.
Julie Young 51:17
I mean, I guess like if we’re thinking about I think, you know, if we think about what general public thinks about, you know, I think they’re thinking of something that might I guess caffeine, like things that come in pill form? Okay, I guess it’s kind of, I guess what I would think about in terms of, because I know like carbohydrates. I mean, they’re not a supplement, but they’re performance enhancing. But I think more things that are not not necessarily dietary,
Dede Barry 51:40
and things that are legal.
Trent Stellingwerff 51:42
Yeah, I’m sorry, that was a real nasty question. Because at the last IOC consensus on supplements, it was debated about it for an hour, like what is and isn’t a supplement, and there is now a subcategory there’s food, sports foods, and supplements. There is a gray space at some of the sports foods of like, when does it become a supplement or not? You know, the really nasty example is, you know, an Omega three and a pill is is a supplement. What about Omega three enriched eggs at the grocery store? Is that, like, where?
Dede Barry 52:16
Do you draw the line? Oh, gosh,
Trent Stellingwerff 52:18
that’s a whole. That’s a whole other podcast. Anyways, I do think that there’s a time and place for certain. And then within supplements, there’s sub sub, there’s ergogenic, aid or sport performance supplements, and then health supplements, and those are separate as well. And by House supplements, I mean, a clinically physician diagnosed deficiency in something. So yes, of course, as a female athlete, you should be getting routine bloodwork. And do female athletes need to take an iron supplement more than male athletes? Yes, they do. That is a supplement that as a health supplement they definitely need to be aware of in the winter, could you benefit some from, say, 2000 international units a day of vitamin D? Yes, you’re probably could. If you’re lactose intolerant? Do you need to look at maybe a calcium supplement or calcium and rich foods? Yes, you should. Beyond that. There’s probably performance supplements out there that have enough evidence that if used in the right situation with the right athlete, making sure that they’re tested, it might consider but to me, those are all very elite athlete concepts. And it doesn’t make sense for a you know, teenage boy rugby player to be taking creatine but they’re going to McDonald’s three days a week. But that’s that’s work on wholesome nutrition first, and then when you’re 23 or 24, and we’ve almost maximized your you’re great in the kitchen, you maximize your recovery, you’re close to maximizing training. All right, then we can start talking a little more but um, you know, the big five that the IOC have identified are our creatine, beta alanine, sodium bicarbonate, high nitrates, so maybe beetroot juice, and they do that it count caffeine. So I don’t think we’re in a position yet, that there’s enough evidence to say this specific ergogenic aid supplement needs to be different for a male or female, maybe eventually we will get there. Now I’m on a paper that was just published that looked at every single supplement paper ever done, and looked at the male and female outcomes to them. And I can say 99.5% of every supplement paper ever published in a female has not used appropriate female methodology. So even though there’s females and supplement papers, we still can’t really draw a conclusion because they didn’t measure menstrual cycle properly. They didn’t do baselines properly. It’s a massive, we just don’t know yet. That said, you know, there’s going to be a bunch of stuff where the recommendations will be the same for men and women if we scale it to body mass or body weight, but there’s probably some things that will be a little bit different. I do think that sports foods especially for Very busy athletes or athletes that have a lot of transportation between sessions can be a very effective sport foods supplement to help achieve their daily energy availability. So gels and drinks on the bike or a protein shake right after practice, because, you know, you’re not going to be able to get to dinner in a couple of hours, because your student athlete, those things can be quite quite helpful to get the calories you need.
Julie Young 55:24
I agree with you, I think like, we’re so quick to kind of chase these silver bullets. And I know from my athletic career, like I felt supplements, were distracting from what really mattered in terms of improving my performance. And I think especially, you know, with the young kids, like just nail the fundamentals, like Good nutrition is hard, like to your point and McDonald’s and sleep and hydration. Like if you can nail those fundamentals, that’s going to take you much farther.
Trent Stellingwerff 55:52
I agree. 100%.
Julie Young 55:53
One other thing I’d love to chat with you about is this the idea of periodized nutrition, kind of we’ve touched on nutrition a little bit and I know you conducted I believe it was a nine year case study with your wife as you coached her as a middle distance Olympic runner. Can you tell our listeners a little bit more about the concept of periodized nutrition? And if you do feel like it is an effective strategy for female endurance athletes?
Trent Stellingwerff 56:18
Yeah, I mean, this is a really big topic that I’ll try to whittle down and a few salient comments probably starting 10 or 15 years ago, and it was at an IOC sport nutrition consensus that I was invited to I was a bunch of us got together and wrote one of the first papers on the concept of periodized nutrition. And the idea there was, especially in middle distance athletes is the types of volumes and intensities a 1500 meter runner will do in the fall is sometimes close close to a marathoner, but in the summer and peak season before the Olympics is almost like a sprinter. And so obviously, that athlete needs different nutrition recommendations in the fall, compared to the summer. And so we presented that concept that just like there’s large changes in training periodization that has registered dietitians, are those of us working in nutrition, we should be aware of the energetic, caloric and macronutrient demands like is this training more carbohydrate based? Is it more fat oxidation? Is it really explosive with long rests? What are the actual demands of the training, and therefore to then try the best as we can to create food options that will best meet the demands of those training part of periodized nutrition is also the potential the periodized body composition. So the paper that was published, and my wife and I talked very much together about health first and female health first and reds together as a coach and an athlete and as a practitioner, was looking at the changes in her body composition very purposely throughout her nine year career. And the fact that her race, body composition is absolutely not sustained year round, nor would you want to. And we’re able to show a long career a very successful career with just one, one injury. And that was after she had a baby. And we were trying to rush back, we weren’t patient enough, there’s that word again. She wanted to rush back to try to make a pan-am team and she had a stress fracture because we rushed it. But that’s a very elite concept of round periodized body composition. And I would say that nine athletes at a 10 just need to focus on excellent recovery and feeling year round and the body composition will take care of itself. And unless you’re in a situation where you have a really good team around you of experts that can help deliver a really peak body composition performance, it’s something I would not recommend people just try and do on their own. Because they’ll probably get into trouble more often than not. And so the paper has been received in in in kind of polarizing, some people say they really love it because it was a way to show really good health along a long career. And then some other people say, oh, people at home are going to try to do this and end up you know, and reds are an eating disorder. And I appreciate that as to as well. And that’s why I’ve been very upfront. And we’re very vocal as saying and when you read the full paper where there’s like disclaimers, like no, this is an elite concept. We had a team around her, we’re able to track everything and measure everything. And unless you can do it like that, I wouldn’t necessarily recommend periodized in body composition. purposefully.
Julie Young 59:36
I do like the idea. And to me it makes a ton of sense. And I guess it’s kind of thinking of it in really simple terms of just looking at the carbohydrate amounts and having that fluctuate based on the demands of the workout are the goals of the workout. To me, it can kind of be simple in that respect
Trent Stellingwerff 59:53
the macronutrient that needs the most attention to change his carbohydrate. Right now we’ve report carbaugh I’d read in the research letter is grams per kg per day. And others would love to get to a point where it can be grams per kg per hour of training per day, because a cyclists who’s in the middle of a 35 hour week, so we’re talking pros here, the amount of carbohydrates that they need, and the amount of sodium they would need, would make a obesity physician fall out of their chair. Like I used to run a lot more I am now on a much lower carbohydrate diet when I rant my running back up, that’s the macronutrient that mainly needs to change on my plate. And so the US Olympic Committee has these awesome plates. So if you just type in usopc, athlete plates, this is great visuals of just how to structure your plate and when you look at the visuals, the carbohydrate is what’s changing I’m big trading days versus taper versus small training days to again, try to fuel for what the workout requires and are required.
Julie Young 1:01:06
love that idea.
Ryan Kohler 1:01:08
Hey, listeners, this is Ryan Kohler, coach, physiologist and owner of Rocky Mountain Devo. Whether you’re a competitive athlete or a fitness focused individual, Rocky Mountain Devo has a place for you. We provide coaching, nutrition, lactate and metabolic testing and training plan guidance so that you can get to where you want to be. Check us out today at Rocky Mountain devo.com.
Dede Barry 1:01:33
Trent, I’d like to wrap up by just asking if you could give three actionable pieces of advice for female endurance athletes to avoid the pitfalls of rat acid overtraining?
Trent Stellingwerff 1:01:44
Yeah, I’m gonna just give a little bit of summary of the of the things that we’ve talked about today and three bullet points is don’t be afraid to fuel your training. Again, fuel allows for better training training will allow for better performance fuel is your friend. So it’s fine. To Be patient, especially through puberty. We’ve mentioned that a few times, you know, your body’s changing and evolving, it’s going to be growing to be stronger and more resilient. And you just need to be patient through that period. And then I think three is just gradually and intelligently increasing training loads. You know, there’s most sports, especially in endurance, or there’s no peak age, there’s a peak age range, and it keeps getting bigger and bigger. You know, we’re seeing well records from 25 year olds, Kip CIOB, runs the Boston Marathon on Monday, his last race was a world record. I know they list them at age 38. He’s in his early 40s. Yeah. So especially if you want to have a long fruitful career. Be patient and feel well, and you’ll maximize success.
Dede Barry 1:02:49
Trent Stellingwerff 1:02:50
You bet guys. It was really awesome to be here. Both. Thanks for inviting me on and you guys have a great, great podcast so it’s honored. I’m honored to be here,
Julie Young 1:02:59
Trent. Thanks so much. It’s been such a pleasure to finally meet you face to face. Enjoy your training down there and Sedona and Flagstaff.
Dede Barry 1:03:07
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 a review the thoughts and opinions expressed on fast talk fan or those of the individual. As always, we’d love your feedback, and any thoughts you have on topics or desks that may be of interest to you get in touch via social. You can find fast talk labs on Twitter and Instagram at fast talk labs, where you will also find all our episodes. You can also check them out on the web at fast talk labs.com for Dr. Trent Stelling worth, and Julie Young. I’m Didi Berry. Thank you for listening!