reNotes example:

Protein is an essential macronutrient that plays a role in everything from muscle building to hormone production. While most people can get the protein they need from a healthy diet, some people may benefit from supplementing with protein powder or other protein-rich foods.

There are a few different scoring systems for protein quality, but the two most common are the protein digestibility corrected amino acid score (PDCAAS) and the faecal digestible indispensable amino acid score (FIDIAAS). Both scoring systems take into account the digestibility of the protein and the essential amino acid content. However, the PDCAAS score also measures the amino acid content of the protein as it comes out of the ileum, while the FIDIAAS score measures the fecal content of amino acids.

There is some evidence that consuming protein with carbohydrates may improve protein utilization. This makes sense, as carbohydrates stimulate the release of insulin, which in turn can help to shuttle amino acids into muscle cells. Additionally, the combination of fructose and glucose in sucrose is transported into the gut quicker than just glucose alone, which may help to replenish glycogen stores more quickly.

Creatine is an amino acid that is found in our muscles and helps to produce energy. Our bodies make a small amount of creatine, but we can also get it through our diet or by supplementing. Some people respond better to creatine supplementation than others, and vegetarians tend to have lower creatine stores.

Creatine is a supplement that can be taken to increase phosphocreatine levels in the body. It does not need to be cycled, and the monohydrate form is the most effective.

The evidence for using supplements is mostly anecdotal, and Professor Stuart Phillips does not recommend them for young athletes. He suggests that kids focus on getting enough sleep and eating a nutritious diet before trying supplements.

Older adults may benefit from omega-3 supplementation, as it has been shown to help preserve muscle mass and strength. The mechanism by which omega-3s may influence muscle mass and strength is not fully understood, but is thought to involve effects on nerve function or muscle tissue.

Stuart Gray is a Scottish researcher who has done extensive work on the benefits of omega-3 supplements. He recommends taking a supplement, as it is difficult to get the necessary amount of omega-3s through diet alone.

Testosterone replacement therapy is one potential solution for people with anabolic resistance, but it is not clear if it is effective. More research is needed to determine the risks and benefits of this therapy.

In conclusion, protein is an essential macronutrient for muscle building, hormone production, and many other bodily functions. While most people can get the protein they need from a healthy diet, some people may benefit from supplementing with protein powder or other protein-rich foods.

Do you want to learn about protein and how it can help you build muscle? In today's podcast, Simon Hill and Dr. Stuart Phillips discuss the different scoring systems for protein quality and the importance of amino acids. They also chat about supplements, aging, and muscle mass. Check it out now!

Professor Stuart Phillips
From that standpoint, you can categorize proteins with respect to their digestibility and their amino acid score in general, animal proteins a little bit higher than plant proteins. So, you know, what do you ever get says, Oh, if you're on plant protein, you're getting inferior quality proteins. The simple answer is you just have to eat a little bit more plant policy.

Simon Hill
Welcome to the proof podcast, a space for science based conversation exploring the health and longevity benefits that come with mastering nutrition, physical exercise, mindfulness, recovery, sleep and alignment facts, nuanced and trustworthy recommendations, minus the hyperbole. Hi, friends. Great to be here with you. I'm your host Simon Hill. I'm a qualified physiotherapist and nutritionist with an undergraduate science degree and a master's in the science of human nutrition. Today I sit down for the second time with Dr. Stuart Phillips. Stewart is a professor in kinesiology and graduate faculty in the School of Medicine at McMaster University. He's widely recognized as one of the leading researchers in the world interested in skeletal muscle health, and healthy aging. In our last episode, which was episode 190, for those who missed it, Stuart and I spoke about the importance of fitness and resistance training for healthy aging, what protein is and why it's important for building muscle. How amino acids work, what an optimal protein intake looks like, the importance of protein source, animal versus plant, and a bunch of other things. In today's exchange, we tie off on a few extra things I wanted to ask about Protein Protein distribution over a day and if this is worth considering whether protein consumption around a workout is important. More on the protein quality discussion, and specifically the DS and PDKs scoring systems that you'll see people referring to online. The scoring system suitable for people with varied diet supplying sufficient calories and total protein. We then dive into a consensus statement on supplements from the International Olympic Committee, a committee that Stuart is a part of here we cover nitrates, creatine, sodium bicarbonate, and omega threes. Then in the last little bit of this conversation, we chat about hormones and protein synthesis, aging and muscle mass. And Stuart provides a few insights into exciting new studies on the horizon. Safe to say it's jam packed with information. Grab your pen and paper. And please do enjoy. This is me and Dr. Stuart Phillips. Hey, Stuart, welcome back. I trust that you've been well since our last episode, which was certainly very popular.

Professor Stuart Phillips
Yeah. Oh, good. Thanks, Simon. Thanks for having me back

Simon Hill
on. In that conversation, we spoke about the importance of resistance training, and staying strong for healthy aging. And also, we spoke about the importance of protein consumption and recovery. Today, I thought that we could kind of build on a few of the things that we spoke about go a little bit deeper, and then also introduce a few new things as well. I thought it would be good to start with protein here. Last episode, you spoke about the importance of total protein, when it comes to promoting our muscles to grow and increasing strength. And I think we, we spoke about that 1.6 gram per kilogram mark for healthy adults who are trying to optimize lean muscle and strength being a sort of threshold to try and get over. And then we also spoke about the importance of increasing protein intake as people get over the age of 65 or so to about 1.2 grams per kilogram, which is a little bit higher than the kind of point eight gram per kilogram rdi. I'd like to get your thoughts on protein distribution. That's one thing that we didn't cover. And whether it matters if you're having a lot of your protein, say in one or two meals, or if you're you are evenly distributing that out throughout the day.

Professor Stuart Phillips
Yeah, that's a good question. It's a tough one to answer based on the research we have. So I'll just sort of give you you know, my take on this is that protein stimulates muscle protein synthesis and synthesis of other proteins in a dose responsive manner. So it sort of goes up and then plateaus. So after a certain point, you can eat and digest a lot of protein. And I think a lot of people are confused when, you know, we published a study where we showed that the response of muscle protein synthesis plateaued at about 20 grams of protein rich, it's not a lot. And everybody said, Oh, well, that's all you can digest. And that's not true. The truth is you can digest a lot of protein but Remember the unlike carbohydrates and fats, protein, it's not a storage form of fuel, it's not burned, it's used as a substrate to build proteins. So you're going to have to stock some of it away to make new proteins. And then above and beyond the level of sort of making these proteins up to the maximum capacity that you have you, you need to do something to get rid of the nitrogen that's on the amino acid. And so, you know, I've always said that every organism has a mechanism. But if you're a fish, you excrete ammonia out of your gills, if you're a bird, you produce uric acid, if you're a mammal, you you make urea. And then the carbon skeleton that's leftover after you've taken the nitrogen off is really you either burn it, or you can use it as fuel, or you turn it into glucose through gluconeogenesis, or, through some convoluted pathways. Some of it, some of the carbon does end up in lipid, although it's not a direct pathway. But let's just say after that, that you have to do something with the carbon skeleton, this leftover, but you can digest lots of protein is whether you can actually use it to make new proteins. So from that perspective, you know, if you think about it, then maybe 20 to 30 grams per meal, quote, unquote, is the best way to go. Now, you know, putting a little bit more nuance in that we have done dose per kilogram conversions in older people and younger people. And we definitely see that older people require more per kilogram on a per meal basis to maximally stimulate muscle protein synthesis. So in the young, it's about a quarter gram of protein per kilo. And in the elderly, it's about point four grams of protein per kilo, so it's about 70%, greater and older, at least older men, we have reason to think it's the same sort of situation and younger versus older women. And so, you know, it's not a lot that you would think you would need to stimulate maximally stimulate muscle protein synthesis in a given meal. I guess the rub comes is, you know, whether you need to do that at every meal. And I guess the quick answer is, in theory, that that will be the best approach. And you know, whether doing it four times a day versus say two times a day is is better, I think then it gets pretty granular. I certainly think that say one protein containing meal per day of like, all of your protein is going to be pretty inefficient compared to save three. But the experimental evidence to say that that's the case, I don't have it's, it's more of a theoretical sort of guess, if you like.

Simon Hill
So there haven't been any studies where they've compared participants with a kind of single protein dose versus a more evenly distributed protein distribution at looking at lean muscle and looking at strength.

Professor Stuart Phillips
No, well, again, there have been some attempts, the study designs are pretty different. So you can't really sort of bring them all together. Although, when people have attempted to do that, and I know Wayne Campbell's group at Purdue has done a little bit of work in this area. And at least the results of the lean mass changes don't seem to favor you know, balanced distribution. So I couldn't say at this point that it's better on paper. And in theory, it's better. But maybe in reality, there's not that much different about it. But I'm just thinking about, you know, if you sat down and ate all of your daily protein requirements at one meal, I'm not sure that you're going to get the stimulation for as long and it may be to the same degree as you would with three evenly distributed meals. But again, that's that's speculation on my part, I'll be honest,

Simon Hill
okay, I want to come back to this idea that as you age, you may require more protein in a given meal to produce a certain amount of muscle protein synthesis. And, and we'll build on that, before we get there. I'm interested, aside from protein distribution, is it is it important to to consume protein with any other nutrients? For example, with carbohydrates, does that affect protein utilization? Often we hear about, you know, people after their workout wanting to have a lot of carbohydrates in their meal as well as protein? Is there any evidence to suggest that you can increase protein utilization? By consuming it with carbohydrates?

Professor Stuart Phillips
Yeah, I think the practice of CO consumption of carbohydrate and protein I mean, it makes sense. It's one of the when I talk to athletes about why it's important to recover after exercise. I talk about three hours. It's To rehydration, clearly the, you know, the top one, refuel, and that's the carbohydrates and repair, which is the protein angle. So it you know, if you're going to talk about what you should do you guys some fluid back and you need to get some carbs back in the protein that's more about the carbohydrates, at least are more of a restoration of muscle glycogen than they are of, you know, interfering or doing something to protein. There's been a lot of speculation around the rise in insulin, and that that is somehow stimulatory for protein synthesis? And the answer is, it is but you only require a small amount of insulin for that effect. And in fact, you know, consuming protein just by itself, which is, which is insulin, oh, genic, it actually results in a small stimulation of insulin release, is going to probably put in slim and to the levels where, you know, adding carbohydrate on top isn't further or stimulatory. The one thing that insulin does do, and the process that's, you know, really exquisitely sensitive to insulin is protein breakdown. So as soon as insulin goes up, proteolysis, or protein breakdown is pretty much shut off for at least for a short period of time. And then the provision of medium amino acids is what stimulates protein synthesis. So I stopped short of saying you need to have carbohydrate there, it may be better, but I'm not sure it has anything to do with muscle protein synthesis or synthesis of any other protein to be honest with you.

Simon Hill
Is that why sometimes you hear bodybuilders using exogenous insulin, injecting insulin?

Professor Stuart Phillips
Yeah, yeah, it's, it's, it's ironic, you know, the idea is to then it's sort of like, you know, if the pots boiling is that you're, you're, you're keeping a lid on the pot, and you're preventing, you know, from boiling over excessive proteolysis. The ironic part about taking insulin is its, its role in adults, once you're done growing is it's, it's a very, very potent, anti lipolytic and fat promoting in terms of storage hormone, so I'm not sure you're doing it for muscle. But if you're a bodybuilder, you're trying to shed body fat that it's the most beneficial practice.

Simon Hill
I wanted to also touch on protein quality. Again, and I know this came up in conversation on Twitter this week, there are these two scoring systems. And and I thought, you know, all people can can help us make sense of these and what their utility is, what, what their utility is, perhaps not the DS and the PD casts or however you prefer to say them. These are typically the scoring systems, as you know, that are used to determine protein quality in a particular food, be it meat, or milk, or tofu or protein powder, etc. I'm interested in hearing from you, what are the differences between these two scoring systems? How are they designed in terms of what they can tell us? And and how are the scores? Determined?

Professor Stuart Phillips
Yeah, so, I mean, I think the simplest thing is to distill them down to two key principles, the first of which rates, the digestibility of the protein itself. And so, you know, the fundamental truism biology, just you know, this is the way it evolved, is that animal source proteins are more adjustable than plant source proteins predominantly because plant source proteins are fibrous in nature, they have dietary fiber, it's anti nutritional, and so it tends to block digestive enzymes, it tends to inhibit absorption in the same, I mean, all the things that make dietary fiber good or, you know, that's the reason why in terms of you know, trapping fat or preventing glucose spikes, and that sort of thing or anti nutritional for protein digestion, but that's, you know, we'll gloss over that for now. And then the second portion of the score comes down to the essential amino acid content of the protein itself and so you know, that's just while the protein up hydrolyze it measure the amino acids and again, animal proteins tend to come out on top, not always but a number of them do. So, the difference between the two systems so PD CAs are the protein digestibility corrected amino acid score, you understand when we say PT casts, or the adjustable indispensable amino acid score, diass or DSO RBC are essentially very similar with the small wrinkle that PT casts measures what we call FICO, fecal nitrogen digestion, so it measures the fecal content of amino acids. What was realized oh, While ago was that our, our gut microbiome, and lots of other sort of metabolic processes are going on in our large coal and in our large intestine, excuse me in our colon, that are changing the nitrogenous contents of the foods that are going through there. So, you know, it could be that our gut microbiome even contribute some essential amino acids. But it definitely metabolizes nitrogen. And so if you measure it as fecal content, you're not really getting the full picture, because we don't tend to absorb amino acids from our large intestine. So the diass score actually measures the content of amino acids as it comes out of your ileum, which is the first proximal or the proximal portion of your intestine, as opposed to the last portion of your intestine. I know, like people are probably like, wow, you know, but let's just say is that the scores are out there. And I think it's important to remember who sets these values and where they come from. It is the United Nations University, the FAO, etc, The Who, and they are interested in international level nutrition. And so it's not just, you know, Western, I'm sure societal nutrition, you know, where we've got pretty plentiful food supplies, people have means and we can make choices, but you're getting into food, insecure regions, and, and lots of other things in the primary places where the scores are, I think, take on some importance are with kids, because of the stuff that you're feeding kids. And so infant formulas are very, very conscientious around getting good PD cast scores, good diet scores, and that sort of thing. Or people in food insecure regions who don't have access to, you know, all of the types of foods that people in westernized societies would, you know, so from that standpoint, you can categorize proteins with respect to their digestibility and their amino acid score, in general, animal proteins a little bit higher than plant proteins. So, you know, what do you pay for this is all, if you're on plant proteins, you're getting inferior quality proteins, the simple answer is you just have to eat a little bit more plant protein.

Or you move to isolated sources of plant protein or animal protein, where you've taken out the digestibility is an issue because now you've isolated the protein. And now it's really just a comparison of amino acids in the differences then become much smaller, because digestibility is not an issue anymore. And you can just ingest a little bit more of one particular protein or another. And it's a little bit of a fight over scorched earth, in, in the forest, that I see it, you know, where the fight, you know, it really takes place, is in young, healthy people who are physically active, you're actually very efficient at getting, you know, the protein that you need, digested and absorbed. And then the utility of it, because you're exercising is actually even more efficient. So, you know, these differences that we're everybody's squabbling about become, really, they're in the margins, like, they're not that big of a deal, unless you are food insecure, and relying on one or two foodstuffs for your, you know, your subsistence on a regular basis, or your growing kid where maybe it's a, you know, a bigger difference. But, you know, I think in westernized societies where you can make choices about the protein that you eat, it's less of an issue. But it exists, because we have situations where it is important. And, you know, we need to make considerations around what would be the protein source that we would give to these people in a food insecure region, who are subsisting on a diet have predominantly saved, you know, tuberous root vegetables where they do get some protein, but not a lot. And for, you know, as an example, everybody said, Well, who exists on that? And I said, well go back to the potato famine, and ask the Irish what a big deal it made. I mean, that was the, that was the tuba that most of them ate. And yes, it didn't contain a lot of protein, but ate a lot of potatoes. And then when the crops failed, that that was the cause of, you know, a tremendous famine and a lot of deaths. So it gives you an idea that, you know, even in a fairly quote unquote, developed country, you can you can run into problems.

Simon Hill
I think that's a great summary. Just just quickly here with regards to the the DS score. I'm interested in in kind of how that score is formulated. And I know you mentioned that digestibility and you and you spoke about the application of this within areas of the world where food security can be a problem and it's so under those places, people are getting all of their calories from a single food or maybe two foods. And, and as I understand the, the DRS score looks at what's called a limiting amino acid and uses that to help come to a total kind of protein score. So if we can kind of step through these two things first digestibility. I'm interested because I've heard very conflicting things. And I thought you you've probably looked at this when when looking at digestibility of particularly plant proteins, because as you rightly said, there are these various compounds, which can inhibit absorption in plants. But we do know that when you properly prepare various plant foods, soaking legumes, for example, and cooking them, that certain nutrients become more available. Do I have the studies that have looked at digestibility? And I think most of these peak studies? Are they using raw plant foods? Or are they using plant foods as you and I would consume them?

Professor Stuart Phillips
Yeah, yeah, like great questions, I think there's a few things to sort of unpack here. So first of all, I think we can probably all agree that the, the model that we would like to do all of this in is in human beings. But what you need to do if you're going to sample the ileal compartment is somebody with an ileostomy. So they have a tube that's draining their their ilium. And, you know, there's not, there are some people out there with that, but not too many. And we can't rely on that population. So the next closest animal that has a digestive system that resembles humans is pigs. So to your point, people are working on artificial digestion systems, these sort of, you know, it's like a metal stomach that gets all of the same gastric juices and then mimics stomach emptying and that sort of thing. But so let's just say that, we're going to have to glaze over and say, you know, pigs are the best we can do probably pretty close, close to humans, I think the main point to make as you say, is that if you cook, or you have sprouted or, you know, legumes, or you prepare them as you would in a in a food, then the digestibility issue gets closer. In other words, it's not as big as it would be for the raw food. And it does get closer. And there are some studies showing that that's the case. And I think, you know, when we're going to talk about human nutrition, we need to look at the method of preparation and the studies that have been done, there's not a lot of them, I'll admit that have been done with local preparation methods. So if you look in these food, insecure regions, but they do have access to say, you know, lentils, or beans, or peas or something like that as a legume, and they generally have figured out, which I always think is fascinating. How did everybody figure it out grains and legumes paired together, that they eat it with some type of grain, and things tend to go better. The difference is smaller, it's still there, but it's it's smaller, versus the raw form. So I agree that on paper, a lot of the scores that you get out there that you can see, are based on raw foods that are put through individually. And so they don't have as great a bearing on human nutrition as you would when you say, you know, you prepare these things, as people usually do or would and, you know, that sounds local cultural phenomenon, some, some people sort of glaze over that and say, Oh, it's not important. But you know, in certain regions of the world, you just don't prepare legumes in this way. You always cook them, you always, you know, so that will be more relevant in terms of the study. And the differences do get smaller, for sure.

Simon Hill
Be interesting to save we, we get some more data from that model that you just spoke about. That sounds pretty fascinating.

Professor Stuart Phillips
Yeah, this artificial stomach, it's called a Tim. And without going into it is there's probably, you know, there's not too many of them around, or not too many of them that are used on a regular basis. The people who do use them are busy sort of trying to churn through as many, you know, pardon the pun, mixed diet sort of combinations as possible. But the way the system is set up, is that even with diass, which is ostensibly the best system, it's not even universally adopted. In fact, there's nobody out there that uses it to grade food in Canada, we don't even use the PD cast, we still we go back to sort of a crude nitrogen utilization index and so and countries are all kind of over the place. So again, its relevance is interesting. If nothing further than having an academic discussion about proteins, or in children or infant nutrition, where I do think it is important, or in food insecure regions in Western societies, it's you know, people compensate for poor or if that's is the right way to say it quality proteins by just eating more protein. It's, it's almost a non issue. So, you know, I chuckle inside when I see some of these debates on on.

Simon Hill
Can we just a tie off on this? Can we briefly talk about the the sort of impact of what's described as eliminating amino acid in in the in the DSM? Because I think that's also interesting.

Professor Stuart Phillips
Yeah, I mean, I think the concepts really, it's pretty easy to understand, if you think there's 20 amino acids, all 20 of them are bricks that need to get put in a wall, nine of them, we have to get in by, you know, our diet, the other 11, we can make ourselves and one of them in a food in a particular food. So let's say you're, you're stuck on a desert island, and you're, you're stuck eating this one food. And the rate limiting amino acid is is you know, the the amino acid that's provided in the lowest amount below what we think is, you know, optimal for a person to make the wall as fast as they could, and when they could, and everything. And so, you know, the two that are sort of globally, limiting the one is in grains is lysine. And, you know, on a on a global basis, that is the limiting amino acid for for growth in particular. And the other amino acids are sulfur containing amino acids, methionine and cysteine. And, you know, that's the complementation, that occurs when you get legumes and grains together is that one has low lysine, the other has little bit finding, you eat them together and becomes a non issue. So it's really the, the brick that you know, so if there's people pass and bricks up, and then somebody says, Where's this brick, and you go, like, Sorry, man, I'm gonna have that stuff. And then all of a sudden, everything slows down, because you gotta wait for that brick. And so if you don't supply the brick, then the rest of the law can't be made, because the wall doesn't, you don't never have a hole in the wall, so to speak. So it's, it's the limp amino acid.

Simon Hill
So to summarize that, essentially, within the DNS kind of framework, a, a protein would get a lower score, if there was a certain amino acid that it contained at such a quantity, where if you were to consume just that food for all of your total protein and calories, you would have insufficient amounts of that particular essential amino acid based on what your body requires. Which is exactly to overcome through eating a diet, whether it is or can be overcome through eating a diet where there is modest diversity.

Professor Stuart Phillips
Yeah, and I think that that's, you know, speaks to the point of, you know, protein complementation is such a global practice that, you know, people who subsisted were animals were either they weren't killed for religious reasons, or they weren't killed because you didn't have many of them in why would you kill a cow? Because it gives you milk. And that was a good source of protein, and you only had one cow, you know, or you didn't kill the animal because it needed you needed to pull a plow, for example, and, you know, the meat was, yeah, that'd be a great idea. But then we can't we can't farm. So when you look at, like, all over the world, how is it that everybody in those cultures has figured out that, you know, grains and legumes paired together are good, and it can only be through natural selection and sort of survival that you know, grainy years, you know, didn't like they're gonna look humans, they died in Orland kilometers, the same thing. So, it's, it shows you Yeah, and when you talk about diversity, I mean, all you need is the grain legume, right? It's so it's probably the issue of diversity and westernized or, you know, whatever you want to call it society's is. It's a non issue like these, these concepts that you hear on social media about, you know, vegans and protein, like, it's it's pretty hard for me to understand I mean, don't get me wrong, there are people who makes some poor choices. dietarily, who are vegans, but the same is true of other omnivores show other people.

Simon Hill
So there's plenty of vegan junk food out there, that's for sure. No, I think I think that's, that's super clarifying. You know, I often see the DS being used online. And there's usually a kind of a list from highest to lowest, and I'm not sure people fully appreciate that limiting amino acid piece in there that goes into that score, which is overcome through a diet with diversity. So I think you've given some some great context there. Let's perhaps change gears a little bit. I know that you were part of a International Olympic Committee, consensus statement. I think it was 29 To 2018, published in the British Journal of Sports Medicine, can you share a little bit about how this paper came about on supplements and what the process looked like to determine what supplements would be recommended within the statement?

Professor Stuart Phillips
Yeah, well, the first thing to appreciate is that the IOC is located in Lausanne in Switzerland. So I get to spend five days in Lausanne. And if you've ever been there, it's not a bad place to spend five days, and with good good friends, good company, and good chat around science and supplements, I mean, so So the process was literally that prior to that, because the issuance of that position stand, the IOC would counsel athletes to avoid supplements at all costs, like, they don't work, there's no evidence, and yeah, you should avoid them. The problems began when force athletes are taking them, and with the belief that they're giving them a strategic advantage, or edge or that sort of thing. And frequently, as a result, they would fail a doping test. And that's problematic for the athlete, it's, you know, it's so, but the offense, you know, that everybody goes, What's not the athletes fault, the offense is having the substance that's banned in your body, it's doesn't matter how it got there. That's, you know, basically the rule. And it was a lot of pushback against the IOC to say, you know, we need to have a position on this, or you need to have a position on this, because athletes are taking these things. But it needs to be an evidence based position. In other words, you know, out of the multitude of supplements that are out there, let's get some experts together, let's sit down, let's talk and give these things a grade and say, what works? What doesn't? And is there a decision tree that you could flow through to decide, you know, this supplement, I might try this, because, or I might not try this, because et cetera, et cetera. So, you know, you get together in Roseanne, there's people from all kinds of different, you know, sporting environments, and scientists and Latos, they're watching as well, which is eerie, because they're very anti supplement bait. I mean, they're just all about doping. And so they're, you know, they're a watchful group. And now IOC officials in lots of so it was, you know, the conference room where there was about 40 plus people in there when we were going through that process. Really interesting. really satisfying in terms of being there. And, and humbling as well, I mean, it was great. There were a lot of fantastic people there. And it was was awesome to be part of it. That was the start of what then was about a year and a half to two year process to come up with that paper. And there were eight or nine of us that were part of the writing group that took that on. And all I'll say is, it was super difficult. And it was 39 different sort of drafts from from start to finish. And the only reason I know that is that I was curating that I saw the figures in there, I'll put my hand up, say I drew those figures, I revise them. I don't know how many times there was a guy. He's actually was a Canadian guy. I won't call him out by name, but he was a water representative. And he and I went back and forth, so many times over the decision trees that are in there, but you boil all of that down and everything that's out there, and you say what gives you an A plus grade. And so we were down to Yeah, sodium bicarbonate works. Caffeine works. Creatine works. Sports drinks, small edge, but they work protein, small edge, but it does something. And then the B list, we're sort of things like Beta Alanine was was on there, nitrates from various sources. And then after that things drop off fairly quickly. And you have to grade things, you know, according to an evidence based framework. And so we couldn't make statements around lots of different things. I mean, pretty much everything else

Simon Hill
you do you have a sense just to kind of contextualize this before we dig into a few of those examples there. How important supplements are if you have everything else addressed diet, training, sleep and recovery, which we spoke about last episode, and the importance of that, how, how much better can someone's performance get through supplementation? And I realized that might be a difficult question, but where is it in the priority list?

Professor Stuart Phillips
Yeah, I think the important point to make is there's a big difference between you know, we do a lot of studies in I'll call them recreationally active or even, you know, fairly decent, quote unquote athletes at the university varsity level. And we think that those are applicable to high level elite sport athletes. And so elite sport athletes are rarely and I mean, really rarely if ever studied. So it's hard for me to answer the question based on the science that we generate, we like to think that we answer that question, but only when the elites get a hold of them and do sort of a series of n of one experiments, do you get any sense for how they work with those athletes. So I'll just say this is that you know, lots of analogies, I've used many of them. A lot of people claim that they got them first or whatever. But if you're making a sundae, and this is everybody's favorite, and you scooping the ice cream, and you put the bananas on, and you put the whipped cream on, then supplements are either the cherry, or the sprinkles, I don't know, like, it's so in other words, you know, the, the bulk of the Sundays already there. That's your training, that's your recovery, that's, you know, you picked your mom and dad wisely. So you got some pretty good genes for you name it sprinting, or running or something like that. And you got your sleep, right, and you got everything, you know, all cued up to, you know, in your, you know, you came to the Olympic village with your pillow. And that was important, because you slept better with your pillow, as opposed to the village coat, you know, all, you know, how many different types of things can you add, and everything came together on the day, and you win the medal or, you know, something like that? Or at least maybe you get our personal best? Then, you know, how do you parse out what the supplement is worth. And we look for changes that we see in scientific studies that are always, in my opinion, massively magnified, compared to what they would be in elite athletes. So let's just say that I think the biggest thing that they give to a lot of elite athletes is probably a psychological edge feeling that I'm doing something that is the same as my opponent, or maybe he or she is not. And so I got a little bit of an advantage. And you know, but outside of that, yeah, there's probably your it's kind of that analogy, I like to say is like squeezing the water out of the cloth. Right. So, you know, the first you're training and the water's coming out, you're like, Yeah, this is awesome. And then the last little part, you're trying to squeeze that last drop. That's maybe where the supplements are to get that last little twist out. And, but I'm not sure whether that doesn't overlap as much with, you know, what? I feel I feel good, man, I'll come on there. And even so you're in the zone, everything happens. Great on the day. And, and, you know,

Simon Hill
I guess that's gold medal, blah, blah. I guess that's where we need some placebo controlled trials and elite athletes, but as you say, it's really

Professor Stuart Phillips
tough to do. Yeah, so SIBO, no secret, like, it's it's extraordinarily difficult. And this is a you know, it's sort of plagues the, the supplement forms literature as well, as, you know, there's been this big trend towards categorizing people as responders versus non responders. And, you know, a lot of people are asking is saying, is that real? Because the responder, to me means like, every time I give you caffeine, you respond the same. And I don't know if even, I don't know that we know even that, right. So, but but athletes, when I've talked to them, and I've had the pleasure of hanging around with a few. Everything is a case study there, you know, some of them, they do certain things, and then they change it and you know, so it's you tried, but you always try it and training and it's like, yeah, that didn't work, or it worked. Or, you know, okay, so let's try it again. And if it's a repeat, Hey, I like that I feel something, I feel better, then then you put it into competition?

Simon Hill
And I'm sure, or at least from my experience, there, there seems to be some sort of potentially genetic or microbiome differences that may affect how how well someone responds to something like caffeine. And And also, what are you consuming it with? Are you having it on an empty stomach? Or are you having it with carbohydrates?

Professor Stuart Phillips
Yeah, yeah, probably, you know, I don't know how many confounding variables that you'd have to control. Yet genetic susceptibility. We know it exists with drugs, you know, you give 100 People who have high blood pressure and antihypertensive drug 60 people lower their blood pressure, 30 people, it doesn't change and unfortunate 10 people, it goes in the opposite direction. And you know, if that's the case with with a drug, why are we surprised when a compound that is working in similar ways, has the same sort of distribution, so, you know, yeah, and then your microbiome and then that changes when you do a competition, that difference, you know, all kinds of things. So yeah, it's, it's hard to work. We're complex man. We got a lot of things going on. And so yeah, it works in training, and then you take an income Competition instead of it being ergogenic you you have a shitty day and it and it feels like hell and you guys stomach upset and GI issues and then it's not a great experience.

Simon Hill
What did you find for for caffeine in terms of what would the when it does seem to work? What are the kinds of proposed mechanisms that maybe underpin that? And when when we're talking about performance, what type of performance? Would caffeine be good for?

Professor Stuart Phillips
Yeah, I mean, caffeine is sort of the the go to I have a friend, John Hawley, who's a really, really well established researcher in Australia. And he would say that, you know, whatever we have that, that enhances performance. First, I gotta put it up against caffeine, because caffeine always, always works in quotation marks, I think, you know, Nancy guest who you would know would argue that genetic predisposition to either metabolize caffeine rapidly or not, might affect the performance outcome. There's a bunch of different theories, the predominant one now is that there's some sort of centrally acting mechanism through an adenosine receptors so that you feel what we all crave with caffeine is you're more alert, you're ready to go in hopefully, that gets you to sort of that peak on the what we call the inverted U, you know, you're, you're maximally aroused and stimulated ready to go, but not so far over the top that, you know, lose the lose the edge, so to speak. And I do think that it's probably, it'd be hard for me to disagree that it enhances, you know, sprint performance or repeat sprint performance in particular. It even enhances long term endurance performance. And there are various other theories beyond essentially acting for that. You should ingest it before as a general rule, but lots of people and prolonged races, marathons, etc. Also favorite during as well. So, and I think most of the work has been done, and I you know, hat tip to Louise Burke and John, and, you know, people in, in Australia, in particular, for their great work on this, and it's almost without fail, although not everybody's the same. It's going to do something for just about everybody, if I recall

Simon Hill
correctly with regards to insurance and consumption during was that were within the consensus statement. You, you mentioned, perhaps the benefit of CO consuming it with carbohydrates.

Professor Stuart Phillips
Yeah, yeah. It's odd that the sort of discovery quote unquote, of that is that you go back about 20 plus years, even longer, maybe 30 plus years, to when athletes would say that at a certain point in marathoner, they were drinking defeatist, or, or flat Coke, Coca Cola. And, you know, and it's like, they thought it was a carbohydrate phenomenon. And they were getting this boost in performance. But there's, you know, a little amount of caffeine and Coca Cola as well, which is probably right around the threshold to give you like a little bit of a, you know, a Brain Boost, quote, unquote, you know, people have got pretty sophisticated now with caffeine containing gels and that sort of thing. But yeah, it's definitely carbs. I mean, are in there. And caffeine. Fierce to give you the kick today? Yeah.

Simon Hill
I'm chuckling because the Australian Open, which, of course, you'll be familiar with the Tennis Grand Slam. And there's an Australian Australian player, Nick Kiryas, who is quite renowned for

Professor Stuart Phillips
a while yeah, I don't know, Nick, but I his reputation precedes unless just

Simon Hill
is a character and gets the crowd up and about, and he's been known for kind of in the long games that he's involved in. And I shouldn't really laugh, but he pulls out a can of Pepsi, and drinks that on the sidelines.

Professor Stuart Phillips
You Yeah, there you go. Yeah. And I mean, it's, it's got a sugar, sugar content. And again, people sort of say, Oh, sugar, you know, and I'm like, but that's still that's the fuel that drives the performance these guys have right? And even the fructose and glucose combination of sucrose we now understand is transported into your gut quicker than just you know, glucose alone. So you know, oddly speaking, it's you know, athletes through trial and error figure this out. The only thing that I find odd is that if you drink the Pepsi and it's is you know, gas, so it's fizzy, is you tend to get you know, you're either belching or something else after that. And so these guys would shake a bottle of Coke, take all the fears out of it and then drink that. And it's it's a slightly higher suit. First concentration than you would normally recommend. But some people can tolerate it very well. And it does have a little bit of caffeine in it too. So

Simon Hill
Well, there you go. That's the first recommendation on this show for sugar sweetened beverage. Maybe one out of

Professor Stuart Phillips
x Pacific. Yeah, absolutely.

Simon Hill
You mentioned sodium bicarbonate. And that's an interest. Yeah. I think folks probably thinking Hang on. Did did. Dr. Phillips just mentioned baking soda. And I know that there is good evidence to support this. I know that it's been studied for a long time. I personally when I have it. Fortunately, I get a little bit of Gi kind of distress. It doesn't work that well with me. Yeah. But perhaps you could kind of describe what the evidence is the evidence that we have that supports the use of sodium, sodium bicarbonate or baking soda, and what the mechanism is that sort of underpins that.

Professor Stuart Phillips
Yeah, I mean, yeah, it is baking soda, sodium bicarb. So you can you can get it in, obviously, a tablet form, because you probably well, not about you, but your parents probably took them as antacids. When they were popular in that form, or, you know, you I mean, the newer or similar acting version now is beta alanine, it all works by modifying intramuscular pH. And so trying to prevent the decline in pH and keep you a little bit more closer to neutral where things you know, function a little bit better. Obviously, you got to take it before the event, as you pointed out that the big downside is people respond really variably to it. Some people, it's no issues, no problem at all, it's general doses. And I think I have this right, it's about 300 milligrams per kilo. So if you're, you know, an 80 kilo guy, it's about 24 grams of sodium bicarb. About two hours before the event. Some people no issues at all, they take that they just get a you know, get a bit of a reflux, but then it's gone. By the time the event happens, other people like yourself, tremendous GI issues and all kinds of problems. So it's always a try before you do it in competition. Type supplement works by just keeping your pH up just a little bit that then buffers the acidity that happens with exercise particularly good in sort of repeated sprints, etc. Probably, middle distance events. So I want to say anything, probably over about 3000 to 5000 meters, you're not going to notice it as much. But I'm sure there are athletes doing say during the 10,000 meters, for example, that might be trying it or whatever. But yeah, it's kind of old school now not quite as cool. So beta alanine is the new way of getting, you know, sort of a buffering capacity in your muscle. I think by now, we could probably move that supplement up to sort of eighth grade evidence. Beta Alanine that is and you know, it's it's more of a chronic digestion, you it goes into your muscle forms a compound called carnosine. That is also buffering and pretty good body of literature suggesting that it's ergogenic, for performance, for sure.

Simon Hill
To kind of thing, is that, sort of, does that act as an antioxidant? Is that kind of mopping up free radicals? Or what's the sort of mechanism there?

Professor Stuart Phillips
Yeah, actually, it's it has a number of residues of a number of different amino acids that are actually buffering in nature. And, you know, without going into the science too much is that it acts as acts as a buffer. It's an intracellular buffer. So it's not as much anti oxidative, although a lot of these things sort of may act in that manner as well, when you have some of them in the muscle, that they they kind of soak up the hydrogen ions prevent the decline in pH. And it may be just enough to enhance your performance, most of the trials where they've seen performance enhancing effects in that with that soft limit, or the sort of mental distance. So you know, I'd say somewhere from sort of, you know, two to maybe eight to 10 minutes tops in terms of duration, so pretty high intensity type events where small differences in pH might make a bigger difference in

Simon Hill
performance. Hi, friends. I hope you're enjoying this episode. So far. A quick message from one of our sponsors, who makes this show possible, and then we'll jump straight back into things. If you're familiar with my nutrition philosophy, you will know that I'm a huge believer in plant rich diets being better for people and our planet. You'll also know that I frequently draw attention to what I describe as nutrients of focus. These are nutrients that science shows plant based eaters, with a plant predominant or exclusive can fall short in which can leave you feeling rundown lacking energy experiencing brain fog, and generally just not as vital as you'd like to be. For that reason, together with a meal, a plant based health and wellness company, I formulated essential eight. Essential eight is your one stop multi nutrient formula with DHA, EPA omega threes from algae oil, vitamin B, 12, ideen, vitamin d3, iron, zinc, selenium, and calcium to perfectly complement your plant rich diet. I personally take essential aid every morning with breakfast just to capsules, much easier than supplementing with these eight key nutrients individually. What's even more convenient, is I have monthly subscription, so it turns up automatically on my doorstep, and I never miss a beat to get yours heads of the proof.com forward slash friends. That's the proof.com forward slash friends, where you'll find a link to purchase essential aid that will get you an extra 5% off your first order. On top of the significant subscription discount. There will also be a link to this in the show notes. Okay, back to the show. And I know for me, and I think you might have written this in the paper, or you've you've said it somewhere. But this is the supplement that can give you some of the tingling. And I find that if you separate your your dose, if you kind of split that dose, as opposed to having it all in one, it can reduce those symptoms for people that respond in that way.

Professor Stuart Phillips
Yeah. Yeah, yeah. Yeah, it does is sort of there's various forms of it. There's a form that I want to say I'm not sure if the supplement company that makes it but I think Nestle owns the rights to it. But it's a slow acting beta alanine, you don't get that sort of pins and needles type feeling. Oh, a lot of people think that's cool. Like, I don't know about you, I, I don't like it. I don't think I find it particularly pleasant. But I have an older son who think he for him that's like part of the stick. He goes, I can feel it working. And I'm like, Okay, fair enough. And then when people can perceive things like that, but yeah, it's like caffeine, soon as you take it, you sort of get that, you know, Wow, I feel that. And people respond to that it does it almost doesn't matter what it does. But you get a psychological. Yeah, there's something to this. And so but as you said, you divide up the doses, or you get a slow form. And you don't get that sort of pins and needles type. Fact, yeah,

Simon Hill
yeah, that would be a fun trial to set up to try and find a placebo that also gives the tingling, but doesn't ask the active combats.

Professor Stuart Phillips
Yeah.

Simon Hill
And and you mentioned before dosage. And I'll just remind everyone, I'll put the link to this paper into the show notes. It's got beautiful tables in there that has a summary of all the dosages that you can kind of work through

Professor Stuart Phillips
this got two beautiful flow diagrams if then and you asked if those are the ones to look for? Because I drew you eight different drafts.

Simon Hill
No, you guys, you did a great job. Nitrites kind of, I guess in some ways the new kid on the blog, they're very popular. You can you can find beetroot powders and all sorts of stuff out there. Tell me Tell me about the research that has been conducted on nitrates and the type of benefit that perhaps someone could experience if they supplemented with them?

Professor Stuart Phillips
Yeah, it's interesting nitrates are you call it the new kid on the block. And I think now we're beginning to realize that some of the antihypertensive effects of dietary approaches like very plant, vegetable and fruit based approaches, like dash for example, probably, you know, the most widely regarded and healthiest diet, etc, etc. Or Mediterranean style diets. Some of the blood pressure lowering effects that that are mediated in those diets actually may be through nitrates. So we're beginning to appreciate there's a there's a chronic connection. So the long and short is, you know, vegetables that are grown in in nitrate rich soil. So if you grow beet roots on nitrate, poor soil, the beet juice that you get from them actually doesn't work that well. So go figure. So it's, it's more of a quality of the soil. you ingest these things, and there's bacteria that are in your mouth that actually convert this to nitrite. And then it gets converted in your in your stomach in the stomach acid to nitric oxide, and that's the act of molecule that results in vasodilation and can then enhance performance and there's some evidence to suggest that it improves mitochondrial bioenergetics and the mechanism of that I'm not exact actually sure on budgeting, it could increase blood flow. And, you know, the beat shots are one way of doing it used to be used to have to drink a lot of beet juice. And that created some GI issues. But now they've got it down to a small shot. Here's my here's my tidbit of I think it's a missed marketing opportunity. And I don't know I think in Australia, you call I would call it here, we would call it arugula. That you guys would call it

Unknown Speaker
rocket, right? That's right.

Professor Stuart Phillips
Yes. Right. So in the UK, it's called rocket and the highest nitrate content per 100 grams isn't isn't rocket. But a ruble has got this sort of spicy edge to it. But I was thinking, I was saying this to Andy Jones, who is the he's like, Mr. Beetroot so to speak. I said, mate, yes, it you missed an opportunity. You could have branded this this supplement that had this spicy taste to it. And it gave you this edge. And it was rocket and like, you know, and he goes, Yeah, but it's a ruble in North America. I said, that's just rockets. The trade name, you know, anyway, so yeah, it does a little bit better than beet root. rocket fuel. Yeah. Or golden beet roots as the other one. I said, you know, it should be like beat gold, you know, and everything. But it just never He never ran with it. I don't know what happened to it. But I have these great marketing ideas that nobody ever.

Simon Hill
Well, I'm sure there is some entrepreneurs out there listening and hopefully the

Professor Stuart Phillips
Oh, yeah. Yeah, well, I mean, the bottom line is, is that you know, any sort of mashed up and concentrated vegetable juice that had that's that's grown in vegetables in nitrate rich soil, would have this effect. The only the interesting part is, is if you and I know this is sort of a dentition thing, if you use mouthwash, and the mouthwash kills the bacteria that you need for brushing your teeth is fine. I'm not saying don't brush your teeth. But the mouthwash kills all of the bacteria that you need for that transition. So brushing, good mouthwash over obsession with oral hygiene probably not necessary and gets rid of the performance enhancing effects. So eat nitrates are eat vegetables in nitrate rich, they're grown in nitrate, rich soil, rock is a good choice. Don't use it for some, you get a performance enhancing

Simon Hill
look after that oral microbiome.

Professor Stuart Phillips
Like everything else, right, all the other micro biomes that we all these biomes that, you know, years past, we were like, look what the hell you know. So but now we're learning it's a you know, it's a part of us, that probably gives us an imbues upon us all kinds of different, you know, benefits that we never knew were were because of something else that lived inside us. Very, pretty interesting.

Simon Hill
Perhaps one of the most studied that you mentioned is creatine. And I think a lot of people have heard this, many may have used it themselves. My understanding is that our our body makes creatine into the liver and kidneys from glycine, arginine, I think thymine, some combination. How much does our body make? And in your view, does our body make an optimal amount if we're talking about performance, or is creatine via our diet or through supplementation? A better way to achieve optimal levels?

Professor Stuart Phillips
Yeah, so you got your you got the three amino acids bang on your your spot on there a plus, we make about a grand or gram and a half a day, depending on how big you are, it's stored almost exclusively inside our muscle. It's stored as pre created, or as it's phosphorylated form phospho creatine, which we all know is a high intensity fuels are a buffer if you like, not much of it there. But it's the sprinters fuel, so to speak, when you supplement with this stuff, and so you take creatine, use lots of different protocols. But let's just say if you take, you know, five grams a day for a week, where you take 10 grams a day for about three or four days, then you begin to super saturate your muscles. So your muscle creatine content goes up, and so does your muscle phospho creating content. Again, we know that there's a phenomenon of response non response. So some people are great at storing credit and other people. The traditional Hallmark because it's what we call an Osmo light as well. So when you put more of this stuff inside your inside your muscle, it draws some water in with it so your muscles tend to swell. All the methods we have to look at muscle size would call that an increase in muscle mass because they're not sensitive enough to understand muscle water. that's in there. So people get bigger, they put on, you know, anywhere from the could be a half kilo, so about a pound to anywhere up to say two kilos. And that's a pretty substantial water weight gain, which some athletes don't like. Some athletes have no issue with, if you're somebody going to the gym and your muscles swell a little bit, and you've look and feel bigger. That's probably great. So, I think a lot of people probably get close to what your body says, you know, this is all I need to produce. The supplement just gives you a little bit of an edge on that vegetarians as a group, and vegans in particular, are tend to have lower creatine stores. And I don't know whether that's an amino acid supply issue, more than anything else. And so a lot of vegetarians or vegans can can really amp up their creatine stores by killing themselves.

Simon Hill
Do you think that could also be because there is some creatine in animal foods?

Professor Stuart Phillips
Yeah, no, that's true to it. I mean, probably the group of people in the world that have the highest daily creative mentaiko, the Scandinavians who eat a lot of fish, and in particular herring, which is just rife with, with creating. So yeah, they're getting a lot of dietary creatine as well, and probably stocking some of that way. It's hard to get up in terms of say, supplement levels, to say, you know, five grams worth of creatine through dietary intakes, although there are some, some people out there that are on carnivore diets that are probably pretty close.

Simon Hill
Yeah. At what cost?

Professor Stuart Phillips
You know, just, I just lay it out there. Yeah, it's not the way I choose. However, however, you know,

Simon Hill
I'm just having fun. Is this a supplement that, that you need to cycle? Or can you just take this five grams a day ongoing?

Professor Stuart Phillips
Yeah, so I don't think you need to cycle it. I mean, I'll be I'll tell you my personal regime, I do take it on and off. But there are times when I stopped taking it. Like more than anything, I just, I worry far less about supplements now because I'm not really competing with that twice. But, you know, the bottom line is, I think you could probably safely maintain your, you know, your enhanced phospho creatine levels by dropping down to as low as three grams a day. Everything we're, we've given people created and seem to spill over in their urine, which is where it goes, if you can too much. suggest that, you know, when you're at three grams, which is twice what even the biggest person would normally make, you can take that type of dose and keeps levels up in a higher range.

Simon Hill
And the common creatine that I think most people will be familiar with is creatine monohydrate. But sometimes you do see a fancy new type of creatine and have some claims about absorption. Is there evidence to suggest that you should buy anything other than creatine? monohydrate?

Professor Stuart Phillips
No, no, there's nothing out there like creatine nitrate or kryton. You know, you you've had another, you know, hyphenated form on the end, and there have been plenty of them. Yeah, like monohydrate is the, it's been out there for, you know, close to sort of 30 plus years now, well studied, works very well. You can get a generic no name, current monohydrate at Costco, or, you know, some other great big grocery stores. And it's just as good as as the stuff the fancy dance stuff. So I don't see any need to go to anything other than monohydrate, to be honest with you. Now, something

Simon Hill
that I haven't asked you that I have been specifically asked about creatine is all the supplements we're talking about. The the evidence is mostly an adult What about if we're talking about a an athlete who is say, 1314 15? They're under the age of 16? Is there any evidence to support their use of that age?

Professor Stuart Phillips
So I have three sons all through went through, you know, they played various sports and every now and again, when they thought I was cool enough, they would say, Hey, Dad, you know, and creating was usually the first one we asked about, because it works and, you know, it gains a reputation. I always encourage them to there were lots of other things that they could do before they sort of decided the supplements were the answer to you know, I need to get to the next level. You know, I'm, I do work with some younger athletes. So now we always do a training compliance grid. If we didn't sleep grid would be another matter altogether. But when people say I'm not getting back what I think I'm putting in, I say, Okay, show me your training compliance grid. And if it's anything below 75%, I'm like, you just got to come to training more often you got to, you know, you gotta be in the gym, you got to be, you know, you got to work with your coach. And that's the commitment that will give you the the extra edge as opposed to, I'm going to get a supplement that's going to push me up to, you know, the 95% sort of zone. Kids don't sleep. A lot of actually, that's not true, they sleep a lot, but in the wrong times of the day, and they watch screens, like all the time now, which we now know, does a big, you know, number on your sleep quality and everything else that I think those are some things that, you know, look, young athletes could dial in a little bit better before, I would say, okay, you know, gives creating a try. You're right, I'm not comfortable, you know, saying to kids, where people are still growing, where, you know, this is the thing that you need. I know a lot of people would would poopoo my attitude, but I'll be honest, is that I think that, you know, kids need to learn what it means to dial and trade once you get training really dialed in and sleep. And then you say nutrition. And then at some level, it's sort of like, you know, I mean, let's be honest, there are 1314 1516 year olds, who are world class competitors, and a number of sports in for those kids, maybe it is a supplement that you would try but for generic day to day kids that I've run into, I try and turn them away from that for as long as possible until they're an adult, quote, unquote, at least in age. And then say, okay, you know, do your here's, here are the facts and try it and see what you think. Most of them don't have a lot of money in their pocket, which is where I think a lot of these supplements really hurt you. So I always say, How much money do you have in your pocket and try and get play the economic game? Before I do anything? Very good.

Simon Hill
I understand that. There's some interesting research looking at omega threes DHA, EPA, supplementation, muscle mass and strength. How would you summarize the body of research looking at that to date? And what's the proposed mechanism here by which omega threes can influence muscle mass and strength?

Professor Stuart Phillips
Yeah, so I had a postdoc in my lab for four years guy named Chris McLaury. He's now gone on, he's an assistant professor at Queen's University, came from the UK. And then we corrupted him, and he took out his permanent residency here in Canada. So here for the long haul. And Chris was the guy that he kind of got me into this, it was his thing that he brought into the lab, I sort of thought, you know, what, I've seen some effects with these heart health and a few other things in cognitive function, etc, etc. The long and short is that we I saw some things that impressed me, as a scientist, it's odd to be surprised by in science, like you kind of have an idea what's going on, we gave these to some young women, before they put a knee brace on their leg for two weeks. Usually, in two weeks, you'd lose about five to 6% of your muscle mass in terms of cross sectional area, and went the women who took the high dose omega threes leading into that lost about, you know, two thirds, about a third of that. So it was really protective against muscle loss, which surprised me. But we saw this a similar type of effect and some other studies as well. I don't know how it works. I think that the you know, and Chris would be more up on this. I think the effects of the muscle are due today, EPA, the Eicosapentaenoic acid, and there are effects on the nerve or the neural end of things with the DHA, which is maybe where some of the central neuro protective effects of these fatty acids lives. I think from an anabolic perspective, it's easier or it has been easier to show this in older people. So people who are compromised to start out with and so maybe have a little bit more to gain. And there I'd say it's about a sort of a b b plus type signal for enhancing muscle gains. In younger people, it's a much smaller signal, because I think they've got a lot of other things that they can tap up before the Omega threes begin to exert their effect going in the opposite direction as an anti catabolic or an anti atrophy agent. It looks pretty promising and some more work to be done there. Stuart Gray, who is a Scottish researcher as well has done some great work in this area and a number of other groups. I don't have an issue with with recommending Omega three supplements Did you kind of do have to do the supplements though, because the doses of these long chains that we gave people were were pretty high. And so I know I like fish. I love fish and a lot of fish. But frankly, I can't eat that much fish. So you do have to take it as a supplement.

Simon Hill
So the dose you used was at around two to three grams.

Professor Stuart Phillips
Yeah, it was about a gram and a half each at the EPA and DHA. So it's about three grams a lot,

Simon Hill
because I think I think I calculated that two pieces of fatty fish like salmon a week is equivalent to having one gram a day of combined EPA and DHA. Yeah, so yeah,

Professor Stuart Phillips
yeah. And I mean, like you said, I like fishes as much or maybe more than the next guy. But so you kind of have to go to these these, you know, the natural experiment was always to say, why is it that Inuit who live in the north in Canada, and survive exclusively on marine five, have rates of heart disease that are, you know, X number of percent, two fold lower. And all they're eating all day, long as marine animal fat that is rich in these. So they're an extreme example, unfortunately, they also have a rate of stroke, that is, you know, two to three times higher that so there's, there's, there's the the teeter totter and the seesaw game to be played around what is good and what is bad. But I take an Omega three supplement, I just, I'm pretty diligent opposed, I pay more for a supplement that guarantees that it's not oxidized, and will and will present a certificate of analysis on. So a lot of people are, what's that, and it's just, you know, if you get some of these things in a pill, they go in an oxidized form, and that may actually not be good for you may actually be bad for you, as well. So a lot of commercially available pills, you just have to check to see whether it says it's a non oxidized

Simon Hill
subclass, and make sure you store them correctly as well. Let's change gears a little here. You mentioned older people then and I want to kind of bring this back towards anabolic resistance. But before we get right into that, what are the major hormones that affect synthesis of new muscle? And and affect our ability to promote or increase strength?

Professor Stuart Phillips
Yeah, I mean, you know, everybody says testosterone, right. And I don't think, you know, I wouldn't disagree, based on below clinical evidence, as well as anecdotal evidence and, you know, athlete performance evidence of athletes that have taken testosterone, both men and women, obviously, with women has a very, very potent, effective, because they're, you know, about tenfold lower than, than men. But you know, from a relative percentage of what muscle, women can gain, they can gain relatively speaking the same as men compared to, you know, what the muscle they had to start with is, but the big divergence occurs at puberty. And, you know, girls who turned into women and boys who become men that they get a surge because of the testosterone, but then after that, when men and women, relatively speaking, parallel each other, so it's the main driver. But clearly, there are other things that are maintaining muscle mass in women, estrogen is one of them, which I think will probably surprise a number of people to say that, you know, after menopause, women not only lose bone mass, but they actually lose muscle mass at a slightly faster rate as well.

Simon Hill
So so how would the how's How's testosterone? actually affect? Does it directly affect muscle protein synthesis? Or what's the kind of mechanism here?

Professor Stuart Phillips
Yeah, so, you know, it's a class of steroid hormones. They they move across membranes fairly easily, because they're fat soluble. And they bind to a receptor and they change the expression of a number of genes. And then they have they exert their effect that way. So yeah, probably does enhance muscle protein synthesis to some degree, enhances what we call satellite cell function. These are the cells within muscle that still retain the ability to divide. And so they can renew and replenish damaged muscle cells. Probably lots of other processes related to growth and basically, differentiation of cells that the hormone itself is enhancing to allow you to put on a little bit more muscle mass, and there's probably effects beyond that, that have to do other command. There's lots of research now to show that it could affect your mental state and our arousal and our aggression, quote, unquote, that You would find as an athlete in certain sports a desirable trait, for example.

Simon Hill
So when we age and we spoke about anabolic resistance, and my understanding is we get a sort of attenuated muscle protein synthesis after protein ingestion or after resistance exercise. So we get, essentially less bang for our buck, as we're getting a bit older. Is this is that explained by changes in hormones? You kind of alluded to it there, or is it nutrient utilization? Is it a combination? What is What do you think is underpinning that anabolic resistance?

Professor Stuart Phillips
Yeah, good question. It's probably a combination of a lot of things hormones may be in there. But the you know, the change with hormones is a chronic process, it's not really an acute thing. So it could be part of what's happening. I do think that it's probably related to blood flow to some degree. And so that's, you know, that has parallels and in terms of insulin resistance, because that's a consequence of insulin resistance is poor blood flow as well. But everything as it ages does loss doesn't matter whether you're an earthworm or a human being. So inactivity becomes part of the, you know, constellation of things that we could probably put in there. To say that that's part of anabolic resistance. We have had occasions in the lab where we studied, you know, protein, and novelists, and some older people, and you get these, they're almost like unicorns, they show up in their mid 70s. They're not taking any medication, which is really rare for 70 year olds, at least in North America. And they're taking, you know, 17,000 steps a day, because they either they run or they got a dog or two dogs or five dogs or something. And metabolically, they, they look like people in their 30s 40s. You know, I mean, it's, so chronological age is not particularly relevant. The more common or average older person, so probably on, you know, a statin or an antihypertensive, or, you know, you name it, they're usually Polly, Polly pharmaceutically, medicated people. It gets hard to disentangle all of this sort of, I wouldn't call them overt clinical symptoms, like they're not diabetic, but maybe they're sort of edging towards that state. And so, you know, that's just part of aging, per se. But it's, it's, it's hard to pull out the disease process that might be there just lurking under the surface. And those are the more typical older people that we find in these studies, as much as we tried to cut down on the meds, like if we said, no status, or we generally rule out but if we said no to antihypertensives, we probably get for every 10 people we screen, we can too. So you have to be tolerant of the existence of some comorbidities, which could be playing an influence of it could be playing a part and what we're seeing is

Simon Hill
main tip, try and stay metabolically healthy, for as long as you can.

Professor Stuart Phillips
What definitely. And I think, you know, my interpretation of that is be physically active. And you know, I know that that's just off the cuff corollary, but the people who come in learn on meds are generally if we give them a, you know, headcorn per dollar or something. They're upwards of sort of 14 to 16,000 steps a day. So they're pretty active people. And I'm not saying that it's a one to one relationship, but it's commonly that's what we

Simon Hill
find. What do you think about this idea, I sometimes come across this online where folks that are aged, maybe 50, or 60, or a little bit older, are using testosterone replacement therapy as a kind of strategy to try and hold on to muscle and offset a decline in testosterone as as they age. I see this particularly in males. Is that something that has been studied or you have a view on?

Professor Stuart Phillips
Yeah, I was just part of a consensus group for the American College of Sports Medicine, which updated the position stand on anabolic steroid use. So we had to add sort of a new wrinkle to that because in the last version of that stand, which was it was pretty old. I can't recall the year it was published, but it was at least 20 years old. Now, we have a lot of evidence from clinical trials of hypogonadal men that are put on testosterone. So by hypogonadal, it means they had low testosterone to start with. And they were brought into the normal range by, you know, testosterone replacement. In those situations, I think that it's as long as your testosterone levels are monitored, it's it's probably a net benefit. It might be smaller, in my view, at least then a lot of other people would would believe. If your normal testosterone anemic. In other words, you have normal testosterone levels, putting yourself on testosterone. And this is the big debate, because the range of what's considered normal is fairly raw is fairly wide. I think if you're up to the high end of that, you're probably you don't need to have testosterone replacement therapy. I don't think it's the be all and end all there's no, you know, and sort of small doses, lots of little things can add up to say, maybe you're in a better off position. There's, there's some psychological data where the, you know, people believe it's can alleviate depression. I'm not convinced by that data, to be honest with you. My only concern is that the one of the biggest sort of drivers of reproductive tissue cancer and for for men over the age of 40, that's prostate cancer. Is is testosterone. And so, you know, do you put yourself at increased risk of prostate cancer or other reproductive tissue cancers when you take this stuff? So I think the risks are, you know, when they've been examined are considered to be minimal. But I'm not sure I'm overly sold on the concept of a widespread use of it as an anti aging therapy.

Simon Hill
Do you have that range off the top of your head, if someone was to check their testosterone levels?

Professor Stuart Phillips
You know, I wish I did. No, I couldn't, I couldn't pull it off right now. Or I could probably I can guess. But if I got it wrong, I get in trouble. So let's just say it's wide. And there are some people who like I don't disagree that, you know, if you're feeling they call it feeling flat, like and you have no libido and you're just, you know, down is that you can get a tremendous boost from bringing that from, you know, hypogonadism or low levels into normal. And, you know, there's lots of people you go into online, they say, I had it, and it was a game changer. And I don't disagree with that. It's people who were like, you know, it's feeling like I didn't mind in mind, muscles weren't the same, and I wasn't as strong. And I noticed I was getting kind of flabby around the middle. So I started taking TRT, and I'm like, you know, that's, that, to me is, I don't see the rationale for that

Simon Hill
paper that you sent me on on anabolic resistance, that you sort of review that you published, I think in 2019, I quickly flicked through it, you only sent it to me a day ago, that was my fault. But there was an interesting fact in there, you you pointed out that relative to 2019. When we get to 2050, there will be almost double the amount of of people who are aged over 65. And so this, it really does help contextualize how important understanding sarcopenia is and coming up with various early ways to intervene to help people maintain their muscle.

Professor Stuart Phillips
Yeah, no, absolutely. I mean, the demographic shift is sitting here writing something today, like I'm right, the lion, about 20 times a year when I'm either writing a paper or a grant to justify either, you know, this is why we're writing this paper, or this is why we need this money to do this research. And it's it's always demographically driven. And even if so, you know, Canada only because I have statistics right off the top of my head. I mean, there's almost 18% of the Canadian population is over 65, compared to about 13 and a half percent that are under the age of 15. And that's, you know, that flipped about I remember, we reported that in the press probably about eight years ago, or something. For the first time in the history of this country, we have more people over 65 and under 15. Now, it's just you know, it's skewed even more, the fastest growing segment of our population is those over the age of 85. And so there's 12,000 centenarians in Canada, which is, you know, you're like, gosh, you know, when you go to the car shore, and you can see, like, happy birthday on turning 100 And there's not just one card, there's a selection of three or four, you're like, Okay, this is a market now, you know, so it's, it's highlighted in, you know, physical disabilities. It's a big deal. Old people go downhill really quickly when they when they lose it. So sarcopenia is a major predictive risk factor for that. So start early and prevent the decline as opposed to say, you know, in your 70s going, crap I should be

Simon Hill
doing by starting early. Just to kind of recap the, the major things that you'd be recommending are regular La resistance training some form of that, and having that protein intake at around 1.2 grams per kilogram of body weight.

Professor Stuart Phillips
Absolutely, absolutely. And when people say when does sarcopenia start? And I'm like, I'm not really sure. But, you know, for a lot of people, it probably starts when they really start doing and a lot less. And that could be somewhere in your 30s When your kids arrive and your jobs ramping up and everything else like that, that year, find yourself sitting, sitting down most of your day. And you're thinking like, what am I getting that stimulus for allow my muscle to recondition and grow and, you know, stay healthy and metabolically healthy as you point out. And so it probably starts in earnest for some people much sooner than we think.

Simon Hill
Well, do it. Pleasure having you back on today. This has been very, very insightful. Again, before we wrap up, one final question. I'm, I'm interested in in what you're currently researching or working on, I know that your your lab has fired, fired back up, I understand. Do you have any exciting studies in the works that people can can kind of look forward to?

Professor Stuart Phillips
Yeah, we have a few. I have two students that are working on we've done a bunch of resistance training studies, and we've not done enough work and full culpability in this one. In women. You can compare the number of resistance training studies in the number that are done with you know, men and women or women alone. It's a small fraction. And the the real question is, you know, do women respond as well as men? And if a relative percentage gain muscle and strength and everything they do, they just start out or lower level? So what we'd like to understand that if that's the case, why is it the testosterone such a big driver? What is it that women have that allows them to do that? So we've got a lot going on in that area, we do have some work going in the protein quality area, that we'll look directly at the effects of, you know, predominantly or heavily based plant based diets versus omnivorous diets, and that sort of thing. And older people, you probably know this, you know, and interacting with some of the people that you do, but in Canada, we've had a major shift in our food guidance in our food guide now is very plant based. And people are, you know, worrying to say no, is this something that older people can still live on and be okay. And so we're looking at that directly. We have some other work going on, looking at young men, and how resistance versus endurance exercise. And so lots of things. It's it's actually the first time since I've been doing this. So in 20 plus years, we're instead of having one trial is sort of finished another one started, we've we've got six studies lined up on top of each other ready to go. And that's thanks to COVID that so we're say we're busy is an understatement. But you know how many back in about a year and a half or two years and be happy to bring you up to speed with what we have?

Simon Hill
We will have a lot to talk about some interesting stuff there. I think so that I'm asked all the time, by usually by females, did that study include females and unfortunately,

Professor Stuart Phillips
it's an embarrassing truth. And you know, I'm, I live in a house where my wife is also a scientist. She's a major advocate for equity in science from all kinds of standpoints, but she's a cardiovascular physiologist, and one of her students just completed a review looking at the studies that are done in women, and it's a paucity of evidence and it's just, it's a bit of an embarrassment for for people in science. So it's something we're looking to rectify,

Simon Hill
fix. Yep, to fill. All right, Stuart, thank you so much. I appreciate your time. And I'll pop a link to your profile on the McMaster University website and of course, your Twitter link for those who want to keep up to date with all of your research. Absolutely. Thank you for joining me for this episode and your interest in science based conversation. I hope you enjoyed it and found the information covered interesting and instructive. If you did, and you'd like to show your support for the show, please subscribe to our YouTube channel where you can stay up to date with new episodes and watch them in video format. Yes, the full length videos. Please also consider subscribing to the show on the Spotify and or Apple podcast app