The Evolution of the Perception of Supplements, with Dr. Louise Burke

We're joined by one of the world’s preeminent nutrition researchers to dive into the history, changing perception, and efficacy of supplements.

nutritional supplement pills

While we’ve talked about supplements on Fast Talk before, we’ve never sat down with one of the world’s preeminent nutrition researchers to dive into the history and overall value of supplements.

But that’s just what we do today. Dr. Louise Burke is a sports dietitian with 40 years of experience in the education and counseling of elite athletes. She worked at the Australian Institute of Sport for 30 years, first as Head of Sports Nutrition and then as Chief of Nutrition Strategy. She was the team dietitian for the Australian Olympic Teams for the 1996 through 2012 Summer Olympic Games.

Her publications include over 350 papers in peer-reviewed journals and book chapters, and the authorship or editorship of several textbooks on sports nutrition. And her list of accomplishments and accolades goes on. She is now a Professorial Fellow at Australian Catholic University.

With the limited time we had with Dr. Burke, we discuss the rise and fall of many supplement fads, the evolving classification of supplements, and the role she played in the creation of an evidence-based categorization system. Then we take a closer look at some of the most popular and effective supplements, discussing the history, development, and efficacy of each.

Today we also hear from a host of other athletes and coaches to get their opinions on supplements. These include Amos Brumble, Houshang Amiri, Dr. Andy Pruitt, Colby Pearce, and Rebecca Rusch.

Cover photo: Ruslan Bogdanov on Unsplash

Episode Transcript

Chris Case 00:00
Hey everyone, welcome to another episode of Fast Talk your source for the science of endurance performance. I’m Chris Case, while we’ve talked about supplements on Fast Talk before, we’ve never sat down with one of the world’s preeminent nutrition researchers to dive into the history and overall value of supplements That’s just what we’re going to do today. Dr. Louise Burke is a sports dietitian with 40 years of experience in the education and counseling of elite athletes. She worked at the Australian Institute of Sport for 30 years, first as head of sports nutrition, and then as chief of nutrition strategy, and she was also the team dietitian for the Australian Olympic teams for the 1996 through 2012 Summer Olympic Games. Her publications include over 350 papers in peer-reviewed journals and book chapters, and the authorship or editorship of several textbooks on sports nutrition, and her list of accomplishments and accolades goes on. She is now a professorial fellow at Australian Catholic University. With the limited time we had with Dr. Burke, we discuss the rise and fall of many supplement fads, the evolving classification of supplements, and the role she played in the creation of an evidence-based categorization system. Then we take a closer look at some of the most popular and effective supplements discussing the history, development, and efficacy of each. Today we also hear from a host of other athletes and coaches to get their opinions on supplements. These guests include Amos Brumble, Houshang Amiri, Dr. Andy Pruitt, Colby Pearce, and Rebecca Rusch. Time to talk the science of supplements. Let’s make you fast.

Chris Case 01:55
It’s a pleasure, Dr. Burke to have you on Fast Talk. We’ve been waiting for this episode for quite a while now, welcome.

Dr. Louise Burke 02:02
Thanks for your patience.

Trevor Connor 02:03
oh no, thank you. We really appreciate having you on the show. You are one of the big names in sports nutrition research. So we’ve been really excited to get you on the show.

Dr. Louise Burke 02:13
Oh, thank you very much.

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Trevor’s Coaching Experience With Supplements

Chris Case 03:07
Trevor, I know that we’ve spoken about supplements of one kind or another in the past on the show today is not a rehashing of those ideas, we’re not going to go product by-product, if you will, and talk about what’s good and what’s bad. This is more of a global view of supplements, and some bigger themes there. And you had a little thought and a story to share about supplements to start us with.

Trevor Connor 03:29
Yeah, exactly that we’re not gonna just sit here and talk- we will talk about some of the supplements,- but this isn’t going to be a deep dive into any of them. This is more talking about the industry and the perspectives on them. And yeah, this is one of my early experiences when I was very new to coaching. Where I had an athlete who asked me for advice, he wanted to talk with me and I was over at his place helping him out a bit. And his counter was probably filled with about 20-25 bottles of different types of supplements. And he had this whole supplement routine that he was doing. He had supplements he took in the morning, supplements he took a lunch, supplements he took at dinner. And I think he thought this was going to be his secret, this was his weapon. This was going to what was going to turn him into a top pro cyclist. Being new to coaching I was probably a little insensitive and just kind of went you got to get rid of those, that’s not helping you, you shouldn’t be doing that, that’s too much. And like I said we could have a different conversation about the fact that I was probably a bit of a jerk.

Chris Case 04:37
Your delivery was off, maybe?

Trevor Connor 04:39
One of my things about coaching was learning how to deliver better. But I as I was telling him all this I looked at him and he was crying. I had absolutely devastated him because like I said this was his secret weapon. This is a bit of an extreme but- and Dr. Burke, this is where we’ll throw it to you.- It does seem a lot have athletes put a huge focus on supplements and really feel, without them they can’t perform, they can’t be at the top level, this is something they must have.

Dr. Louise Burke 05:10
Yeah, I agree with you that they can be very powerful in terms of the marketing and in terms of the belief that people attribute to them. And it’s hard to know why. Maybe it’s because people kind of just have this lucky charm idea that there’s going to be something that you can get that’s easy. And there’s going to be magic answers that come from something. And it’s tangible when you take a supplement, you can sort of see yourself doing it, whereas maybe some of the other things that you’re doing like sleep or bars on the bike, etc, they’re harder to record, or maybe they were in the old days. So it’s a much more visible sign that you’re investing in yourself when you’re taking supplements. And we’re all just suckers, I guess, in some ways, just thinking that this gotta be some magic out there. We can go back to Jack and the Beanstalk and all this idea that somehow there’s going to be this magic bottle of something that provides us with the quick fix to where we want to go.

Trevor Connor 06:16
Yeah, I guess that’s something we all kind of hope or wish for. But I guess part of what we’re going to answer today is how much is there to that belief? And how do you get through the marketing hype? But that’s going to be for later. So before we dive into what supplements are, let’s hear from pro-athlete Rebecca Rusch and how she handles supplements to support her training.

Rebecca Rusch 06:40
Let’s see I take a probiotic, I take magnesium, I take branched-chain amino acids, fish oil, and vitamin D, and some beet juice stuff. All of those are, you know, magnesium is for sleeping, fish oil brain and heart health, vitamin D, especially in the winter. Really it’s come from research of people that I respect, including my coach, including, other athlete friends of mine, I’ve never been one to want to take a lot of supplements. So really, I have tried to hone down a sort of small list, I used to take a multivitamin, but I don’t know, because I actually really put a lot into trying to eat whole foods. And you know, a lot of the micronutrients that are found in multivitamins, hopefully, I’m getting in food. So I am a big proponent of trying to get your vitamins in food. But you can’t do that 100% of the time, or I haven’t been able to and the branched-chain amino acids, those are really for recovery tool and the beet juice just because I actually kind of like it. And it tastes really good. And everyone says it’s good for you.

Chris Case 07:54
Wow. You are one of those weird people that like the taste of beets. You truly are from Idaho.

Rebecca Rusch 07:59
I do you like beets. Yeah, I grow them in the summer. And like I said, if I can eat them in real food, that’s great.

What Are Supplements?

Trevor Connor 08:07
So why don’t we start very, basically, and just ask you to define what is a sports or performance supplement?

Dr. Louise Burke 08:17
That’s a really good question. And there’s no one single answer that everybody in the world is going to agree with. Because many countries have different ways of regulating supplements. And they have different ways in which they put things in and out of the basket. What we’ve tried to do with some of the work at the Australian Institute of Sport, or with the IOC, that I’ve been involved with around supplements, is to try and come up with a definition that just makes sense in terms of the way athletes use them. So sometimes when we talk about supplements, and sports foods, as a broad category, we’re dealing with things that don’t quite fit some of the ways that countries regulate these things. But we are looking at products that are made to provide a practical or nonfood source of nutrients are other ingredients. And I’m putting sports foods in there because I’m saying that they’re an alternative to everyday food. So it’s a manufactured form of providing nutrients or ingredients in a way that they could be consumed by an athlete to do something around the sports performance. So we really focus on ones that are targeting athletes and performance. And that’s not to say that athletes don’t take other supplements. I mean, most adults take a supplement of some sort. And they may have sort of a health or another reason for doing it. But we really tried to just focus on the ones that have some kind of a claim that might help sports performance. And furthermore, we’ve broken them down into three more categories if you like, because we try and target what the athletes looking for. And sometimes the athletes look for sports food, which is, as I said before, a more practical form of just normal nutrition. So we’re not dealing with things that couldn’t be found in everyday foods, the same kind of nutrients, but they’re just presented in a way that makes them easy to consume in an athlete’s lifestyle. And that’s sometimes to do with having them around exercise. But we’re dealing with practical forms of normal nutrients. Then we have another group, which we call medical supplements, which contain nutrients that we know about. These are now mostly concentrated so that an athlete’s uses them to treat or prevent a known nutritional deficiency. And again, that’s around making sure they’ve got the health and the nutritional support to be able to train effectively and compete. And then the third kind of category, we have the performance supplements. And these are products that are not necessarily nutrients, but they’re ingredients that are often found in food, and they’re offering the athletes improvements in performance. And it could be directly like the take the supplement and you go faster. Or it can be sort of an indirect performance improvement, where if the athlete is able to train harder, or it helps them to change their body composition to what’s good in their sport, or helps them to feel less sore the day after competing or training, all those things can help the athlete eventually improve their performance on a competition day, but it just takes a while to build it up. So that’s the way we sort of see three different categories of things. And if you understand those different reasons for using them, it helps because then you can say, well, do I really need this based on the way that these products should be used and am I using it in the correct way so that it makes the target use?

Trevor Connor 12:03
Yeah, no, I remember reading about your categories, you actually just recently did a review in 2019, that really broke that down. But another way to look at this that I found really interesting, and you are a big part of this is some of the evolution of the ways that these supplements have been categorized. And really in the early days, they were pretty much just categorized by chemical property, then you start to see them being categorized more by the function of the particular supplement. And then what I found really interesting is something I’ve kept close to hand for a long time since you wrote this is you and the Australian Sports Institute came up with that A B C D categorization based on the efficacy of the supplements, whether there’s a large body of evidence showing that this is efficacious, down to there’s no evidence or potential evidence that this is damaging.

How Are Supplements Catagorized?

Dr. Louise Burke 13:04
Yes, and again, this is a manmade construct. And it comes back to the reason why we came up with the supplement program in the first place. So back in 2000, when I was at the Australian Institute of Sport as the head of nutrition, we suddenly found ourselves at a crossroads, because up until then, we’ve been sort of saying to athletes, the usual thing that you expect to hear from dieticians, you know, you don’t need to take supplements, all it does is produce expensive urine, etc. And that’s the way that most experts and most industry recommendations were posed to athletes. And yet, we saw that it just wasn’t true. And it wasn’t very helpful to the athletes, because athletes knew that some things actually were useful, whether it’s because they actually do have a direct performance-enhancing effect, or because they do make use of the sports foods or the medical supplements in a way that helps their performance. So we started to recognize that by saying to athletes, you don’t need to take supplements, you were alienating the athlete from good advice, because they’d look at you and think, Well, if you’re not listening to me, if you’re not helping me do something that I actually know is useful. Well, then, what good, are you?

Dr. Louise Burke 14:22
We started to say, well, why don’t you look at it from the point of view of the athlete and change their minds about where the supplements work or not. And it’s not black and white In many cases, you can say, well, there’s pretty good evidence that something could be useful if you use it in the right way. And there’s pretty good evidence that some things don’t live up to the hype. You know, there’s been studies that really just failed to show any benefits from them. So we’ve got these sort of ends of the spectrum, but somewhere in the middle we’ve got things that are too new to really trust the evidence yet but certainly got a good background story, and there’s some preliminary evidence that it might be useful. Rather than making it black and white, could we start sort of having these different levels of proof? And as we were thinking about the proof, we also thought, well, maybe there’s some things that could work. But they’re risky for an athlete to use either because of the fact that they might be dangerous in terms of health, but remembering that athletes compete under an anti-doping code, so maybe there’s some products that are also problematic because they’re either banned outright, or they’re at higher risk of being terminated. So why don’t we come up with a categorization that builds in the level of evidence as well as the risk of anti-doping. And then if we keep those categories, the same, like we believe this is what that categories trying to communicate to an athlete. So that categories always stay the same, but depending on the evidence, we could have products and ingredients moving in and out of those categories as we learn more about them. So we had this sort of idea that it would be an evolving system, there’d be sort of a spectrum of efficacy or evidence around the efficacy. And that would change as we learn more about things. And when we did this we were trying to always think of it from the athletes and coaches point of view, they’re interested to look for things that enhance performance, and you need to work with them to help them to make those decisions. And when we first came up with supplement program, it was kind of a shock to the whole industry, we had so many people say to us, this is just terrible. You’ve gone to the dark side, you’re telling athletes that supplements don’t work. And now you’re creating all this confusion, you’re saying that athletes could use supplements. And we’re saying yes, be careful about what we’re saying. We’re not saying that athletes have to take supplements, we’re just saying that there may be some supplements in sports foods that could be useful to an athlete. But by creating that communication to the athlete, you’re now creating open dialogue, and that athlete will come and talk to you. And what we found over the next years was that rather than increasing supplement use by athletes by having our new standards, we actually decreased supplement use, because what athletes did was come and talk to us about what they were doing. They knew that we were interested in what they had to say. And we’ll try and look at it from their perspective. And as the trust built, they began to suddenly say, well yes, there are some supplements that might be useful, but there’s a whole backup load, that really don’t make sense. So I’m going to just concentrate on working with you around that small group that could be useful. And so the net effect is that they’re using fewer supplements. And that’s a really nice outcome I guess 20-22 years later, a lot of people now like this idea and can see what why we did it and it all just seems natural now, but I can tell you back in 2000, it was controversial. And we had to really take a lot of heat for making this decision to change the general statement that we made to athletes. And I’m glad we did it because a lot of other people now go along with the same idea. And they’ve found how useful it is when we’re all willing to have dialogue with athletes. But I have to say that we were on our own for a while.

Trevor Connor 18:27
So I read about that in your paper and found that really fascinating because I wouldn’t have expected that you would get that sort of negative response. I think back to that time, and you had so many coaches and athletes that were really pushing supplements, they really felt they needed to take them. I’d never really thought of it as a huge pushback against supplements.

Trevor Connor 18:50
Amos Brumble is an experienced coach and shop owner in New England. He’s addressed the supplement question many times and has some skepticism.

Amos Brumble 18:57
I go and put supplements under marginal gains, mostly because the way I look at it is if any of those things really worked, that would be doping. For me, that’s where you meet the definition. I mean, in terms of like, what I would take personally, I used to tell people I take a fish oil pill, and I’m trying to think that’s it. That’s it. I don’t take anything, mostly because I think the cost-benefit doesn’t weigh out. You know, most people would be like, you know, instead of spending x amount of dollars, why don’t you work less? Train one more day or I think there’s a lot better ways for people to spend money so I’m not always one person to advocate for supplements. Now I will tell people food that you have in the ride, whether it be some kind of powdered drink mix or some commercially available product to give you enough energy to ride that I usually highly recommend.

Chris Case 19:55
I also think, correct me if I’m wrong, Amos you strike me as the type of right that likes, in some ways to let their legs do the talking. Do you have this philosophical distaste, I guess for supplements? Is that part of it?

Amos Brumble 20:11
Ah, no, I kind of come from a background of looking at what is most likely to get me to where I want to be and then what does it take to get there. And I kind of looked at supplements as being a very high cost relative to the benefit, and very difficult to get a measurable gain out of it. And I forgot to mention, there is one supplement that I take only when I compete and it’s sport likes,

Chris Case 20:38
And what’s that?

Amos Brumble 20:40
It’s like, I want to say it’s an electrolyte supplement. And it’s probably one of the few things I’ve ever taken where I’m like, yeah, it seems like it makes a difference in terms of how much pain I feel while competing. And I do sell that, you know, in the shop to my customers, because I’ve found it effective, and to speak to one of the earlier questions. A lot of times I tell people, what makes you stop? is that how many watts you’re putting out? Well, maybe technically but most people quit because mentally there’s too much pain. They can’t tolerate the amount of pain that’s required to actually continue at whatever the pace is. So, if I have found a way to maybe limit it slightly, then I found that to be effective. And I do recommend it.

Trevor Connor 21:26
So you and Dr. Holly both brought this up that sometimes there’s a disconnect between the researchers and the athlete’s needs. And perhaps this is one of those cases.

Communicating The Correct Information About Supplements

Dr. Louise Burke 21:36
Yeah, it’s a case of that. But it’s also a case of communication. And that often we look for such a black and white view of things. And if you look at the whole of the supplement industry, and all the products that are out there, yes, the majority of them really don’t have evidence to support their use. And so if you think of yourself as the glass half full or the glass half empty person, so in the old days, we would have gone with the glass half empty and said all because so many of them don’t work, we just tell athletes not to use supplements full stop. Whereas now we say, well, there are a small number that are useful. So let’s be glass half full and say yes, there’s some benefits to thinking about supplements within your sports nutrition plan. Let’s work on it together to make the best choices.

Trevor Connor 22:20
Yeah, I mean to me this was- I remember reading this 10 years ago and thinking this was great.- It was a change of perspective of saying, there’s all these supplements out there that make all these wild claims. But who is actually saying, what is the legitimacy to this? What is the true efficacy and to rank them on efficacy to me made a ton of sense. We have this store over here called GNC. I don’t know if you have it in Australia?

Dr. Louise Burke 22:49
Yes, we do.

Trevor Connor 22:50
There’s several 1,000 different products on the shelf. And how does anybody walk in there and know what to take, they all have claims, they all make these miraculous claims of what they’re going to do. And I can say, I’m looking at your group A and group B products here and if that’s all GNC carried, it would be a pretty small store.

Dr. Louise Burke 23:10
Yes, that’s true. But a couple of things to think about too, is that when we started this project, it was about managing supplements in our space. So the Australian Institute of Sport was the government’s funded agency for helping athletes and one part of it was to do with elite athletes, that was the part I was working. And we had scholarships for a group of athletes and so we have a defined population. And because we had scholarships, we had the ability to put the requirements of what a scholarship means, and what’s expected of you as an athlete who’s going to accept a scholarship. So we were trying to make sense of it for a defined group of athletes. And we had an ability to be able to sort of control our environment to some extent, we decided to make this a publicly available program, because one of the things we were looking at was why is the supplement industry so successful? Why does it market so successfully in terms of selling things when the evidence of this stuff isn’t that great? And we decided that one of the things that the supplement industry was doing really well was it was out there telling people how wonderful it was. And it was communicating through not just scientific articles, and not just even the advertising, but there were so many different ways the word of mouth, as we were moving into the internet age then there was all this chat groups and sites where you can get information etc. And we thought, if we want to have athletes, this is what we’ve got to say, our athletes are gonna think we are good and back in 2000 when we looked at the way that we were working with our athlete group. The athletes say look, you are nice people, and we come to you for cooking classes and to learn something about eating food. But if we want to know anything about supplements, we get online, or we go down to the supplement shop, because you don’t know anything about us. So we thought, well, the best way to have someone think that you’re good is to tell other people about it. And then some of those people that you’ve told how good you are, start talking about you and your athletes hear about it. So we thought we would kind of bluff our athletes into thinking that we had some knowledge about sports nutrition and supplements that they might like to hear about, by having everybody talking about us. And I remember having discussions with my managers at that time, and saying, Why do you want to put your stuff on the web, the athletes from the English Institute of Sport and the United States Olympic Committee are going to be able to read the same thing, you’re going to give all these secrets away, you’re going to be telling athletes how to improve their performance. And our athletes are going to then go and compete against these people who’ve got the same information. Yeah, that just doesn’t make sense. You’re giving this stuff away for free. We said no, think about it. Our competition is not the English Institute of Sport and the United States Olympic Committee, our competition in this space is the supplement industry. And it would be so much better if all the athletes thought the same things about supplements, and we’re talking about the same way, they would help educate our athletes to have the same concept and principles about supplements that yes, some of them work, but there’s only a small amount of them. And you need to know how to use them properly. If that athlete talk was enhanced by us having this information freely available, and all the athletes in the world, were talking about it the same way, it’d be much easier for us to then work with our athletes, because they come to us with this belief that we knew what we’re talking about, we were going to help them to make the best use of supplements. And the expectation was that only a few supplements worked. But let’s get cracking on finding which ones and how to use them. So we would be more effective in the way we worked if we could get athletes starting from there. And that’s exactly basically what happened. You know, we went from being ignored by our athletes, as a source of information on supplements to making the supplement program sort of world-leading. And it happened because a lot of other countries and a lot of other athlete groups wanted the same sort of thing. Let’s make sense of this. And so by putting it on the web and making it freely available, we had a lot of other agencies look at that and say, Oh, that’s so good. We don’t have to repeat this, we don’t have to reinvent the wheel. Why don’t we all go and use this, and then we can take this as the background and then we can color it in with the different things that different countries want to do. And it was so effective, because it was just there at the right time, but suddenly it came became sort of famous if you like. It’s funny now and I back then think about the small team of people that were working on this and that’s the good thing about the internet is it makes something look really professional and look like there’s like a whole army of people behind it, when it’s just a few dedicated people trying to concentrate their efforts. And so we’re able to amplify resources that we could put into supplements, and make it very effective by using this kind of principle. Again, it was a lot of being in there at the right place at the right time there wasn’t a lot of other information there. So we were able to move into a vacuum and have it really well-read and you know, people took it up because of its novelty. But it was a really good thing to do looking in hindsight because it was so effective in just getting a message out and changing the culture of our athletes.

Trevor Connor 28:53
And so that really leads to the question I want to ask you is what changes did you see it make? And do you feel it helped? Let’s face it, there were athletes that were taking- and probably still are- taking some dangerous supplements. Do you think it got them away from that? Do you think it made other changes?

Was This Helpful To Atheletes?

Dr. Louise Burke 29:09
Well, let’s remember the group of athletes that I am working with- or was working with at the time- and that’s Olympic athletes who are within a system. And we don’t really think that we can change the minds or the practices have a lot of say bodybuilders who compete in a different kind of sport with a different kind of culture. And many of them don’t have anti-doping concerns, or they don’t worry about that sort of thing. So we didn’t ever go and say we need to change everybody’s mind. We just said we have a very specific environment in which we work. We’re interested in high-performance athletes who are within a system who have anti-doping rules that they’re very clear and concerned about. And we’ll start with the pathway of those athletes. So the younger athletes, one of the things we did sort of do with our philosophy was to say that there’s a pathway that athletes deserve to be on in terms of maturing in their sport. And supplements need to be put into that pathway. So when you’re a very young athlete, even though you could be quite good, we’d say, well, you don’t get the $10,000 bike or the trip around the world to compete. When you’re at the beginning of your career, you need to be home working on maturing in your sport, maturing with new growth and biological development. And let’s get that right. And then as you get better and get more mature in your sport, then we can start thinking about the special things that go on top of it. So even though we had a suppliment program that said group A things work, we didn’t always say that was appropriate for that athlete at that point in their career. So we had a philosophical viewpoint that had a lot of nuance in it. It wasn’t just welcome to the IRS, there’s the creatine powder help yourself- because creatine was a group supplement with some evidence base- it was very carefully structured around what was the right time for the athlete to be starting to think about supplement use, and also, how should it be implemented. So we’d be able to differentiate between something like a sports drink, where we might say well that’s going to have some benefits for use during longer training sessions, in these sort of sports. So we will make them available in a jug or somewhere that the athlete can fill up their bottle from in that sort of sport. We didn’t put taps with sports drinks for everybody to be used at all time. But rather, we said, that’s when it’s used. And we also let the athletes take it for themselves if you like, and we didn’t need to police that. But there was a lot of education around appropriate uses. And that’s different from the way we treated something like creatine where that was treated almost like a prescription supplement that an athlete would only get to take creatine when they’d sat down the coach, the sports scientist, the doctor, the dietician and said, yes this is a case where an athlete could benefit from creatine supplementation in this sport, and that we’ve gone through this with the athletes. We’ve talked about the pros and the cons, we’ve sourced a product that has been batch tested so that we are happy with the risk of it contributing to an anti-doping outcome being very low. And we’ll have the athletes make the decision That it is what they’d like to do. And then we’ll monitor what’s happening. So even though everything might fit into the group A and you might think they’re all the same. No, there’s different ways in which the way that they’re implemented in the athletes sports nutrition plan would be adjusted, depending on those kinds of factors.

Trevor Connor 32:47
Top Canadian coach Houshang Amiri works with athletes at the highest levels. And like Dr. Burke, he feels that at that level supplements may be needed. But like her as well, he feels it should be handled carefully and more like a prescription.

Trevor Connor 33:01
Are there any recovery foods or drinks that you recommend athletes use?

Houshang Amiri 33:06
Absolutely. I think depending on volume and intensity of the training and recovery, it will be needed but different type of recovery tricks. Our athletes at the center, they’re using infinite. Yes, definitely recovery is one of the key areas because if they don’t recover, they not train real next day.

Trevor Connor 33:27
So you generally recommend doing some sort of recovery drink after every hard training ride?

Houshang Amiri 33:34
Yes, pretty much if it comes to the volumes on training, we don’t need that much recovery. But when they go hard and intensity is high definitely they need recovery after strength training sessions or hard climbing sessions recovery becomes very key.

Trevor Connor 33:51
Are there any supplements that you recommend for athletes? Are you big on supplements or do you feel athletes should for the most part avoid that?

Houshang Amiri 33:58
I feel supplements is very important because the athletes who trains over 20,000 Kilometer a year or 1000 Kilometer a week, they cannot just get it from straight foods. The supplements can be all nutritional supplements usually we run a blood test through their doctor and based on the blood tests create a supplementation plan based on what they may need and what they may not. Generally speaking, I believe in supplements and I believe athletes really not taking supplements take are not getting enough nutrients.

Trevor Connor 34:40
Are there any particular supplements that you pretty much make sure your athletes take?

Houshang Amiri 34:45
Therapy usually comes with multivitamin vitamin D. As I said depending on their diet, sometimes omega threes and from there all depending on their blood tests.

Dr. Stephen Seiler 35:08
Hi, I’m Dr. Stephen Seiler. I gotta tell you, it’s a thrill for me to have the opportunity to go in and see a whole collection of my lectures and webinars all in one place, free of charge, for the members of Fast Talk and the broader sports science world. And not only me, but other sports scientists have collected their work in Fast Talk Laboratories is presenting it for all of you to use and learn from every day.

How To See Through The Smoke And Mirrors Of Certain Supplements?

Trevor Connor 35:37
So I want to throw a thought at you and hear what your response is to this. But I’ve been in the industry long enough to see that there seems to be this kind of ebb and flow where you have a supplement or a particular vitamin, mineral, whatever you want to call it, that appears gets really popular, whether it’s due to marketing, or whatever, and suddenly, everybody’s on it. And it’s going to be the miracle cure to everything. And then there seems to be kind of a backlash to it and it kind of loses its popularity. And I’m not just saying that from a marketing perspective, I’ve seen that in the research world, too. For example, when I was in school, vitamin D was the hot thing. And we used to joke that if you are struggling to get funding for your research, figure out how to get vitamin D in the title and you get tons of money. So even in the research community, there’s the hot thing, vitamin D, Omega three, you can list a whole bunch. Have you seen this? And how as an athlete can you figure out what’s hype versus something that’s quite legitimate? Especially considering there’s so many supplements out there so many products, it really is hard for the science to stay on top of them.

Dr. Louise Burke 36:55
That is a great question and theory and I see a lot of that. And I think as humans, we love to be part of the new brigade, you know, when there’s something new out, we all like to convince ourselves that we’re the cool kids, because we are an early adopter or an early discover. And then after a period of time, when everybody’s doing the same thing, it’s like, well I need something new, I don’t want to be just part of a group, I’m an edgy person. And so there’s a bit of that sort of just cycling of chains and fashions. And that happens in every part of our life. You know, you think about the haircuts and the clothes and different things that you wore, and why did suddenly flares go out, and something happened, changed what they look like, it’s just we moved on. So there’s a bit of that. And that sometimes tells you a bit about the evidence that supports the product, because in the beginning, you might have a lot of belief affects a bit of a placebo effect that goes into things. And then after a period of time, people realize, well,that doesn’t seem to be doing that much. So they’re moving on. And when you talk to me about athletes being so confident about products, I think that’s a good thing that you do get a benefit from taking something that you believe in through the placebo effect. But I think the best kind of arrangement with supplements or anything is that you add a placebo effect on top of a true physiological effect. So everything’s aligned, you’re kind of getting double the benefit, because you’re confident in something that’s actually having a physiological effect as well. And sometimes, you know, when you see athletes that are just taking butt loads of stuff, and they just keep adding more to the group, or they don’t seem to have a really good differentiation between what they’re taking, it’s all thought to be fantastic. You think that’s a waste of a placebo effect because it’s not being targeted at getting the best belief out of the products for us.

Trevor Connor 38:56
Interesting.

Dr. Louise Burke 38:57
So I do agree with you that a lot of cases, you see this cycling of things because it doesn’t work as well as claims and people eventually see through it, but also because they’re not plying the placebo effect as targeted way then they are probably just churning through things and not being systematic about how they get the best out of products. But another thing that is interesting, though, is there are a couple of cases where I see products that are reasonably evidence-based, there’s some good hypothetical backgrounds, the idea of why it might work. And there’s some evidence that it does appear to work under control conditions, but something doesn’t really catch on, it moves on if you like, because sometimes that product may be a chronically applied product. So if something takes 12 or 16 weeks to get the effective dose. Sometimes it’s really difficult for the athlete who’s investing in that to sort of see the benefit. And I’m thinking of an example of something like beta-alanine. So I’m always intrigued why if something in A group, something like caffeine is so popular. And it’s just at the top of that A group the whole time in terms of both the science and the use of it. Then why do scientists keep doing studies on it? Why do athletes keep buying it? Well, it works. And so it’s really easy to invest in for something like beta-alanine, as a researcher, you think do I really want to do a study, or I’m going to have to control everything for 12 weeks, before I can go back and measure stuff. And then I can’t do a crossover, because it’s going to take that long to get the product out of the system. So we have the athletes do the other half of the experiment. So as a researcher, it’s kind of too much trouble. And as an athlete, it’s like I have to pay to take the 12 weeks before you’re telling me I’m going to optimize my muscle levels. And so it’s an example of something that probably has some pretty good evidence, but doesn’t get the same investment, just because it’s harder to take and see the benefit, the bigger investment as a researcher. And so it just suddenly doesn’t have the same kind of popularity some of the other ones.

Trevor Connor 41:18
Well that’s interesting. And you need that research, not just to prove efficacy, but there’s all sorts of questions. You saw this with caffeine, where they used to recommend a pretty high dosage and through the research discovered, no actually, you don’t need that much. I mean, with all these, we need to figure out, what is the right dosage? When is the right dosage? Should you be taking this before your event? Should you be taking this hours before? Is this something you take every day? Is it something you take multiple times per day? That’s only something that the research can answer.

Dr. Louise Burke 41:48
That’s right. But you know, you’ve got to have something that’s researchable, or to be able to keep engaging with it. And that’s why you sort of get these products that just keep gaining and gaining and gaining momentum, because they’re just so easy to study and think about caffeine that’s also helpful is that it seems to work for so many different kinds of sports. So that is always another angle of what you might be interested to study. Whereas some of the products that are very targeted to a really specific physiological phenomenon, like the Beta-Alanine being about addressing an overuse of glycolytic pathways producing the hydrogen ions and lactate results. So it’s a very specific type of sport that’s involved with possible use of beta-alanine. And that means that this market is going to be smaller, because the number of situations in which it’s focused is smaller. And so it’s less likely to have as many research angles or interests and then it just sort of pales in comparison to all the wonderful different ideas that you can explore with caffeine. So they start to divide in terms of what’s popular as a research interest and what’s popular as an athlete’s usage pattern. And so even though you can say well they’re both in Group A, because there’s evidence that they work. But once the star and one’s kind of like the shy retiring person at the back of the room, deserves to be in the room, but doesn’t get all the attention.

What Supplements Should We Use?

Trevor Connor 43:25
Well, I know your time is short. So with the time we have left, maybe we can dive a little into some of these products. And there’s big lists so I will really let you pick and bear in mind, we have an endurance sports audience here. What are some of the products that you feel there is some efficacy? and what is on the products that you feel endurance sports athletes are using that they really shouldn’t be?

Dr. Louise Burke 43:48
Oh, that’s good question. So I mean, caffeine is top of the list it is just so interesting. And you pointed out already that, it’s been around for a long time and if you asked me in the 90s, about caffeine, I’d say oh, we know so much about that. And it’s dedicated for endurance athletes, and we can explain how it works. And you take it an hour before and this dose and yes, it’s really well known. And yet almost everything that I would have told an athlete in 1990 about caffeine, I would completely change my current advice, because, as you said, we now know that it works at much lower levels and it works in lots of different types of sport other than endurance, and includes the training for an endurance sport, where it may be even its best self where it helps you to train harder and better quality. But there’s still so much that’s evolving about caffeine now in terms of are there different responders based on your genetic background? Are there things that we might need to do to maximize our response to caffeine in terms of having some downtime way from caffeine to sharpen up our response to it. So there’s still a never-ending list of things about caffeine that we can answer. But what’s really good about it now is that in the old days, it was almost like we drank caffeine or consume caffeine as everyday people for one effect. And then we thought that you take it completely differently, the sports performance, and it’s acting in a different way, you know, so people who were quite happy to have a couple of cups of coffee of the day strategically placed within thinking that caffeine needed to be taken in this massive dose an hour before exercise, and that was the end of it. And it was sort of almost like, but it’s the same product. And you know, in your everyday life, you don’t get up and have six cups of coffee in the morning and then say take notes for caffeine for the day, you know that the way that it works is that when you’re doing those reports, or you’re in the meeting, and you start getting a little bit fatigued, you have a break, and almost the smell of it makes you feel better. But certainly after the first couple of mouthfuls, you’re feeling better, and then you’re able to not turn into this superhuman, Incredible Hulk. That’s not how caffeine works, caffeine allows you to do what you were previously able to do, but just keep going for longer before you fatigue. So it’s great now that we’ve understood that caffeine is working in the same way, whether it’s helping you with your everyday activities, or your sporting activities. And so we’re now learning a little bit about our own personal use of caffeine as a consumer, using that information to drive it around our sports performance. So I think we’ve made some really good improvements with caffeine. But if you think about something that athletes are using, at the moment in endurance, I think probably the ketone esters would be a good one to talk about, because there’s a lot of interest in them. But the science is moving so quickly in all different sort of directions, because it’s really failing to nail whether they are useful and how to use them. And if you are listening to what athletes are doing in their different groups, or lets think of the group that’s often the most associated with ketone esters, and that might be the cyclists. And then you look at what the research is saying. From what I’m hearing cyclists are now using ketone supplements as a recovery aid and as an appetite downer to try and help with their body composition goals. And then sort of moving away from the use of it as a performance aid during riding a lot of it because it’s very difficult to isolate the kind of scenario in which it might have a benefit to performance. There’s still only two studies that have shown that the ketone esters actually enhance performance. And they were done under some sort of fairly specific conditions, the majority of studies, including the ones that we’ve done, haven’t shown a transformative to improve performance. And in fact, some of them have shown a disadvantage to performance for different reasons.

Trevor Connor 48:05
Certainly, if you’re going with endogenous ketones because you blunt the carbohydrates.

Dr. Louise Burke 48:10
But the use of the exogenous version offered you advantage, where you might be able to get the benefit of the ketone body, without having to do a carbohydrate restriction. So the ketone esters was sort of another idea that was more flexible to induce, to get endogenous ketone production, you sort of have to be on a low carbohydrate, or a low energy diet for a long period of time, before you start producing them yourself. Whereas using the ketone esters supplements meant within 20 seconds, you could make the decision you wanted to be shown. And so, they did have an intriguing proposition, but the information is just swirling around how they might be used. And I don’t think it’s really settled into something that we can say, is really evidence-based. And you could really put your house on taking it and knowing you’re going to get a benefit. So we have them in the B group of the supplement program at the moment saying that there’s a lot of interest and there’s a lot of theories. But just still haven’t been able to nail the kind of the magic recipe of yes, this is how you use them in these scenarios, and it can be pretty sure that you’re going to get a benefit. So this is an area where there’s still good research coming out. There’s some good people doing research. So I’m interested in it and I keep my ear hearing about what athletes are doing. Sometimes athletes are ahead of the curve and they’ve worked it out for themselves. Sometimes it’s the opposite. They’re doing all the wrong things and just spreading rumors about stuff and everybody’s sucked in. But at the moment, I don’t think either the researchers or the athletes can be really confident they’ve got a good recipe for how to use the ketone esters supplements.

Trevor Connor 49:55
Yeah, well, that’s what I was gonna say me. From the health side I have read a ton of research on ketone esters and some of the benefits they can have. But I’ve seen virtually nothing on the performance. So, yeah, it doesn’t surprise me that you’re saying there’s really only been two studies.

Dr. Louise Burke 50:11
So I guess that somewhere between those two examples, there’s other products that have either got a fairly good history of use, and people can be convinced if they want to invest in it, that they’ll be able to find a protocol that some evidence-based and helped. And then there’s the ones that are just really hard to work with, some of the things like creations and the beta-alanine and bicarb to a certain extent, I mean, they may have some application to endurance sports if they are used to try and support training scenarios. Or if you’re wanting to focus on a really specific element of an endurance race. We did a study a decade ago now, looking to see where the creatine supplementation might have a benefit for endurance sports, and we had two thoughts about it. One was that there was some evidence that a creatine-loaded muscle was better able to store glycogen. And so we wondered whether that would help with the Super compensation of glycogen pre-race. But we also wondered what happened to those endurance events where it’s not a steady even pace that wins the race. But rather, there’s a stochastic pattern of work. So in lots of cycling races it’s not a time trial from beginning to the end. There are lots of passages where the sudden breakaways and there are sprints and there are all sorts of different changes in workloads. And they often get into the kind of energy territory where creatine supplementation could be useful, and enabling you to do these repeated sprints with short recovery intervals. And you might even think about beta-alanine, and you’re getting into the territory where you’re working at very high intensities, and doing a lot of reliance on the glycolytic system. So there may be some benefit in having better intracellular buffering. So even though that might be a very small part of the race, you know, it might be only 5%, or 1% of the race it might be the bit that gets you to the finish line first, or the breakaway or the chase, or whatever the part of the race is that’s sort of the critical race move. So I think there’s a lot of opportunity to do more exploration around those products. But because it is such a tricky thing to say, well we were trying to just focus on this 1% of the race, and see what this might do to benefit. Sometimes you’re not sure whether that 1% of the race is always going to be available to or whether there’s something else that’s happening in the 99% of the race that your product might interfere with. And so with creatine, we’re worrying about whether the weight gain that would go with creatine, if it’s helping you to store more glycogen and more water in the muscle as well as the creatine. Now if you’re half a kilo to a kilo heavier as a result of that supplementation protocol, you might be able to do your repeated sprints better, but just the fact that you carrying an extra kilo, sort of balance that out well enough. And so these are the kinds of studies that are really hard to do, because it’s hard to mimic a stage of the Tour De France in the lab, especially the unexpected portion of it. And it’s also then difficult to sort of tease out whether some of those negative effects are going to have an appearance, not just in that race, but in other things that the athlete needs to do. So these are the big questions that keep you awake at night that are just sometimes really hard to study to get the right answer to see whether you could say yes, that’s a good evidence base in which I’m going to trust. And these are sort of sometimes things that you have to then experiment with the athlete and get the feedback through that sort of case history approach.

Trevor Connor 53:58
Right. So now, are there any products that you feel a lot of endurance athletes use that they really should be reconsidering?

Dr. Louise Burke 54:07
That’s a good question. I’m trying think of something that I’m interested to think about why athletes take things and maybe I’m not knowing everything that an athlete takes is. There’s a lot of products that people take around the sort of recovery, soreness, bounce back on your ability to keep training hard. And I put some of the like the berries and cherries and the fruit polyphenols into that. And then antioxidants, there’s a lot of interest in this kind of approach to helping an athlete either train harder or recover better a competition scenario and I not saying that these don’t work, but I’m just saying it’s very difficult to get enough information to know how well and when to use them. Particularly when there’s perhaps the concept that they may assist in recovery, but they may also choose the degree of adaptation that the athlete is wanting to get, because some of these products may work through a technique that reduces some of the signaling pathways. And so there’s always a difference between when you do an exercise session wanting to recover as quickly as possible versus wanting to get all the adaptation that was providing. And so you need to be really clear about what the goal of the exercise session is that you’re doing. And whether it is a matter of trying to get that session finished and stop the adaptation and get into recovery mode really quickly, or whether you’re trying to maximize that period after exercise where there’s still more adaptation occurring. And we have some evidence, in some cases that a product say like an antioxidant, I’m thinking of vitamin C and vitamin E, they may help with reducing the oxidative damage during exercise, which may be involved in helping the athlete to recover better for the next day. But they may also by reducing that oxidative damage, stop some of the pathways of adaptation that signal their activity via the oxidative damage. And so we do have this sort of quandary of am I wanting to recover? Or am I dampening adaptation if I’m using this product? And getting it right is the big question. And so there may be things that you think will be more suited to a competition phase versus a training phase, for example. I’m not saying that people using things wrongly, but I’m just saying that there’s still a lot of lack of clarity about how best to use these things. And you know whether or not there’s actually a disadvantage in the way that people are using them.

Trevor Connor 56:50
That’s a great point.

Do Not Supplement Without A Cause

Trevor Connor 56:52
During our conversation with Dr. Andy Pruitt, Colby Pearce, and Todd Carver, we asked these three experts their take on supplements, they brought up one other medical supplement, but echoed the concerns of treating this carefully and like medication.

Todd Carver 57:06
Start with iron. That is a popular supplement and there’s some data that says if you are female, and you’re not taking iron supplements, you should. Right? So I do think that’s one and I mean I’m not a doctor or nutritionist, but seems like that’s one that should still be.

Dr. Andy Pruitt 57:27
But you’re talking about menstruating.

Todd Carver 57:30
Yeah, that’s right a female

Colby Pearce 57:33
Who hasn’t gone through menopause and has a normal cycle

Todd Carver 57:36
right.

Colby Pearce 57:37
Men don’t lose blood regularly. So how I’ve learned about it- I’m also not a nutritionist or doctor don’t play one on the internet Full disclaimer,- but iron is a growth factor. So if you’re a male and you’re not bleeding regularly, you will bioaccumulate iron just in our diets and whether your using a cast iron skillet and what you eat, and whether you’re a vegetarian or bla bla bla, but pretty much all men accumulate iron over time. And I don’t know about you guys, but I’m well done growing. So if things are growing in my body, that tends to not be good. Right? So I think there are a lot of doctors that I know that I’ve worked with, including my general health practitioner, Dr. Scott Story who I had on of my podcast, he talked about, basically middle-aged men and past should have their own iron levels checked. And if they’re high one of the only way to get rid of it is to get blood. Yeah, it’s common for endurance athletes to be like, oh I’m not going good, quick, get my blood checked, is my iron low? Because that’s sort of a easy lever to theoretically push.

Dr. Andy Pruitt 58:37
You should get it checked.

Colby Pearce 58:38
You should definitely get it check, and obviously, if you’re from sea level, and you go to a training, camp at altitude, or whatever, and you can expect that your blood chemistry might take a hit because you’re increasing your demands of your oxygen delivery system, etc.

Dr. Andy Pruitt 58:53
Right, which I think brings us to blood testing, right? I mean, so if you’re a serious endurance athlete, I think you ought to have your simple CBC or even a full blood panel, once or twice a year is probably as important if more not more important than your bike fit. And don’t supplement without cause.

Colby Pearce 59:12
That’s a great point.

Dr. Andy Pruitt 59:14
Yeah, period don’t supplement without cause.

60 Second Take-Homes

Trevor Connor 59:19
Now, I hate to say it, but I know you have a meeting in four minutes. So Chris, I think I could keep talking about this another hour, but I think we need to our one minutes.

Chris Case 59:29
Yeah. Sorry, I haven’t spoken much at all today. This may be the least I’ve ever spoken on an episode but you guys were having great conversation. We like to close every episode, we give each guest one minute to give us their most important take-home message, if you will. Today, Dr. Burke, what would you say that message is about supplements from our discussion.

Dr. Louise Burke 59:47
Look, it’s a fascinating topic in sports nutrition. And I think there’s so much opportunity to do more research and refined practices. But at the end of the day, we like to think of it as sprinkle on the icing on the cake, and that if your made your cake and you’ve iced it well, and you go into the Olympics, those sprinkles might make it to the gold medal, but just buying a packet of sprinkles by themselves isn’t really substantial. So understand the interest in them, they are shiny and bright. But recognize that the substance of sports nutrition comes from everyday use of food, so get both going.

Chris Case 1:00:26
Trevor what would you add?

Trevor Connor 1:00:28
Well I mean, the thing I have always found interesting and really enjoy as I was getting ready for this episode is just that whole concept of shifting towards evaluating these products and efficacy. Which you think, would have been something they did from the start but that wasn’t really the case. And certainly you walk into any sports supplement store, they’re going to tell you that everything is amazingly effective, which is also not the case. So I like that you pointed out yes, there are some supplements that can be effective, the list is small. My take-home is do that research and make sure if you’re taking supplements, you’re focusing on the ones that there’s a pretty high degree of certainty, there is some benefit there, because you never know when you’re going to be taking something that can have negative impacts that you just don’t expect.

Chris Case 1:01:17
Well, I don’t know how much I would add to that, honestly. My philosophy is that supplements are for the most part things that majority of listeners don’t really need to focus on to get better or healthier. That said, having a grading system, if you will, that gives some of these a much better grade than others is clearly a benefit to people out there. So have people turn to that do their own research, but I’d also say yeah, these things are sprinkles. You can’t just buy a packet of sprinkles, like you said Dr. Burke, and expect that product to taste good. You got to have the cake underneath it and the frosting on top of it before you even think about adding the sprinkles. So we will leave it there.

Trevor Connor 1:02:01
Dr. Burke, thank you very much. And we’ll make this a short goodbye. But it was a real pleasure getting you on the show.

Dr. Louise Burke 1:02:07
Thanks for the great questions.

Chris Case 1:02:09
Absolutely. Thank you.

Chris Case 1:02:12
That was another episode of Fast Talk. Subscribe to Fast Talk wherever you prefer to find your favorite podcasts and be sure to leave us a rating and review. The thoughts and opinions expressed on Fast Talk are those of the individual. As always we love your feedback. Join the conversation at forums.fasttalklabs.com to discuss each and every episode and become a member of fast talk laboratories at fasttalklabs.com/join and become a part of our education and coaching community. For Dr. Louise Burke, Amos Brumble, Houshang Amiri, Dr. Andy Pruitt, Colby Pearce, Rebecca Rusch, and Trevor Connor, I’m Chris Case. Thanks for listening

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