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Talking Health, Performance, and Longevity, with Jesse Charles, M.D.
2k Plays4 years ago
Scott Johnston is joined by Doctor Jesse Charles, M.D. Jesse is a rural medical doctor and longtime adherent to the Uphill Athlete training methods. As a general practitioner in a rural setting, Jesse sees a wide variety of patients, from those at peak health, to the infirm. In this episode, Scott and Jesse discuss changes that take place as the result of regular exercise; exercise as a ‘phase change’ in the functioning of the body; how exercise facilitates learning; responses of the heart to exercise; nervous system changes and loss of motor units through time; the importance of balance practices in aging populations; the evolution of mitochondria; gut bacteria as a health indicator throughout life; dietary considerations for gut health; training progressions and adaptations for increasing vitality; and thoughts on arthritis prevention.
References:
Exercise promotes the expression of brain derived neurotrophic factor (BDNF) through the action of the ketone body β-hydroxybutyrate
https://elifesciences.org/articles/15092
Molecular Choreography of Acute Exercise
https://pubmed.ncbi.nlm.nih.gov/32470399/
Hyperglycaemia is associated with impaired muscle signalling and aerobic adaptation to exercise
https://www.nature.com/articles/s42255-020-0240-7
Physical activity offsets genetic risk for incident depression assessed via electronic health records in a biobank cohort study
https://onlinelibrary.wiley.com/doi/abs/10.1002/da.22967
MAP training: combining meditation and aerobic exercise reduces depression and rumination while enhancing synchronized brain activity
https://www.nature.com/articles/tp2015225
Exercise Alters Gut Microbiota Composition and Function in Lean and Obese Humans
https://pubmed.ncbi.nlm.nih.gov/29166320/
Meta-omics analysis of elite athletes identifies a performance-enhancing microbe that functions via lactate metabolism
https://www.nature.com/articles/s41591-019-0485-4
Blood factors transfer beneficial effects of exercise on neurogenesis and cognition to the aged brain
https://science.sciencemag.org/content/369/6500/167
Studies of a targeted risk reduction intervention through defined exercise (STRRIDE)
https://pubmed.ncbi.nlm.nih.gov/11581566/
BDNF polymorphism predicts the rate of decline in skilled task performance and hippocampal volume in healthy individuals
https://www.nature.com/articles/tp201147
Is Your Blood Sugar Undermining Your Workouts?
https://www.nytimes.com/2020/07/29/well/move/blood-sugar-diet-foods-workouts-exercise-muscles.html
Fiber-Mediated Nourishment of Gut Microbiota Protects against Diet-Induced Obesity by Restoring IL-22-Mediated Colonic Health
https://www.cell.com/cell-host-microbe/fulltext/S1931-3128(17)30497-3
Association Between Dietary Fiber and Lower Risk of All-Cause Mortality: A Meta-Analysis of Cohort Studies.
https://academic.oup.com/aje/article/181/2/83/2739206
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Transcript
Introduction & Free Training Resources
00:00:01
Speaker
Welcome to the Uphill Athlete Podcast. These programs are just one of several free services we provide to disseminate information about training for mountain sports.
00:00:10
Speaker
If you like what you hear and want more, please check out our website, uphillathlete.com, where you'll find many articles and our extensive video library on all aspects of training for and accomplishing a variety of mountain goals. You'll also find our forum where you can ask questions of our experts and the community at large. Our email is coach at uphillathlete.com, and we'd love to hear from you.
Meet Dr. Jesse Charles
00:00:36
Speaker
Greetings and welcome to another episode of the Uphill Athlete Podcast. I'm your host, Scott Johnston, co-founder of Uphill Athlete. Today I'm delighted to have with me Dr. Jesse Charles, MD. Jesse is not only a strong mountain athlete with whom I occasionally get out in the mountains with, he's also a very curious guy when it comes to health and fitness related topics.
00:00:58
Speaker
This has led to quite a few long conversations on some of our big days out. I finally realized that other people might enjoy and benefit from Jesse's musings, convinced him to come on and have a conversation with me. In the show notes below are links to a few of the articles and studies Jesse references.
Integrating Uphill Athlete Methods in Healthcare
00:01:16
Speaker
So Jesse's been a long time proponent and user of the uphill athlete methods. And as I recall, Jesse, you can correct me if I'm wrong about this, but some of these ideas you've even told your patients about, right? Yeah. Yeah. I'm, give you a little background.
00:01:39
Speaker
rural family medicine doc here in the Valley. And it's a really unique position. I take care of people from babies to people who are soon to die. And I take care of people, particularly in this Valley, some people who have a significant disease burden and other people who are extremely healthy and wanting to get healthier. And so I see this really broad range of
00:02:03
Speaker
helping people use exercise to improve their health. And then people who are already extremely healthy, seeing people, helping people use exercise or lifestyle to improve their performance. And yeah, for my patients, I've worked with them for helping them find ways to incorporate exercise into their life. And so life,
Exercise and Health Signaling Pathways
00:02:30
Speaker
One of the things I know you are eager to talk about, and so am I, is some of the changes that take place in the body with exercise. And I also think we'll want to talk some strategy for folks to how they can implement some of these ideas so they're not just a vague
00:02:50
Speaker
a concept or a theory or just talking about some study that was done, I think we want to try to give them a little, a handrail that would guide them into a better place. But I want to start off the conversation with folks that are familiar with our books, training for the new alpinism and especially in training for the uphill athlete.
00:03:10
Speaker
I've written about what we call signaling pathways that occur as a response to exercise. And I hope I did a decent enough job for people that have read that, that they grasped some of it. But basically the idea is that when you introduce some sort of stimulus, and it doesn't even have to be exercise, but the ones we're interested in here are exercise,
00:03:36
Speaker
When you introduce the stimulus, maybe it's more strength-oriented, maybe it's more endurance-oriented, that causes a chain reaction of effects that result in, hopefully in the long run, you becoming fitter, better at what you're trying to do. And that's the body's response to this stress that you've imposed. But what I think is fascinating about what we're going to talk about today, Jesse, is to get down into the weeds a little bit about some of those pathways.
00:04:05
Speaker
like how they affect different systems in our body. Some of which are, you know, I think pretty well understood. And as you just pointed out to me in our previous conversation, some of them we haven't got a clue. Yeah. It's, I think we both like to geek out on this kind of fascinating. And we've spoken about this one, one recent study found that after a single session of exercise, 9,815 different molecules changed in the body.
00:04:33
Speaker
And that might not be the exact number, but it just shows you the scale of the change. And the way I sort of like to think about it is almost as though it's a phase change in the body. Say water goes from ice to fluid water. That's like a change in its physical state and its fundamental characteristics change its density, buoyancy.
00:05:00
Speaker
exercise is like a phase change for the body. We go from being sedentary to active. And we almost, we should almost call this a different thing in the sense of like, we say exercise is good for health.
Exercise Boosts Brain Health
00:05:17
Speaker
And I would almost flip it on its head and say, not exercising is bad for your health. In the same way that they say going into nature lowers your blood pressure.
00:05:26
Speaker
I would say being out of nature raises your blood pressure. In that our default origin, our origin story is movement and it is being in the natural environment. And so movement is our natural state. It's what we're evolved for. And it's the not moving that's bad for you. And so we say, oh, exercising is good for you. Do it. But exercising should be our default.
00:05:50
Speaker
That totally makes sense. And that's something I've alluded to in the books, how evolutionarily we are predisposed to endurance, because that was what gave us the advantage over other animals that we could hunt. And we had a high-protein diet that allowed us to grow bigger and stronger. And I think I've been made the little quip in training for the New Alpinism that the fact that you're reading these words
00:06:17
Speaker
is proof that this evolutionary predisposition worked because now we're at this highly evolved state. But as you just pointed out, the downside of that is we're so clever, we figured out all kinds of ways to not have to exercise now and lately people are beginning to realize, oh, we kind of screwed ourselves over with the luxuries that we currently have. And you can't know
00:06:48
Speaker
the consequences of what's missing. Until it's missing. Until it's missing. And even then it's hard to know. Like we know enough about the body now to know that we know almost nothing at all. And so we have to sort of interpret everything with a grain of salt. But one of the things I think about is if we evolve to exercise and all of these potentially 10,000 metabolites change,
00:07:12
Speaker
there are probably systems that piggybacked onto that to use those as the signal to do X. So maybe the first one for us to talk about is maybe the brain. So when you exercise, we've known forever, exercise is good for your brain and good for your overall health, but they recently discovered that when you exercise, particularly aerobic exercise,
00:07:40
Speaker
you have an increase in this hormone or compound called brain derived neurotropic factor or brain derived neurogenic factor. And basically what it does is it's like a growth hormone or a growth stimulus for neurons, particularly in the hippocampus. Tell me what the hippocampus does. I've heard it and I've been told it, but then I forget. Yeah. So the hippocampus is really, it's one of those gatekeepers centers that's really essential for learning in memory.
00:08:06
Speaker
And so, for example, if you're studying for an exam, you should also be exercising because the data is clear that the more you exercise, the more brain-derived neurogenic growth factor you get, the more new neurons you have growing in the hippocampus waiting for something to learn. And so we can take this even down on a further level. They subsequently think that they've figured out how exercise does that.
00:08:36
Speaker
So maybe before I get into this, maybe you could very briefly talk about where ketones come from exercise wise. Well, and I'm no biochemist. So my understanding of, you know, metabolism is at the one on one level. So people, you know, I'm sure that I'm going to save the wrong things here about some stuff, but I think I've got the general ideas and that.
00:09:00
Speaker
What we as athletes tend to experience and have ketone bodies floating around inside of us is when we've kind of gotten low on glycogen storage. So we don't have much sugar left and we end up starting to use fat and fat
00:09:23
Speaker
can be turned into these ketones, which are, again, my very crude, simplistic understanding is that they kind of mimic sugar. They kind of mimic glucose.
00:09:35
Speaker
And so the body can use them much like it would use glucose. And you can induce this elevated levels of ketone through fasting or a special diet. And I'm sure everybody's familiar now with the ketogenic diet fad that's out there.
00:09:55
Speaker
Nothing wrong with it. I mean, it actually, it does work. I've known lots of people that have used it. But the kind of the upshot of all this is that we tend to think of our metabolic system
00:10:11
Speaker
of needing energy coming from fat or carbohydrates. Fat being stored in the
Exercise vs. Depression & Brain Health
00:10:19
Speaker
form of long chain fatty acids that are broken down. And the carbohydrates are stored as glycogen, which is then broken down. Glycogen just being two glucose molecules tucked together. And those are broken down through a pretty simple process that allows rapid energy production. It does not produce.
00:10:40
Speaker
and does not produce ketones. Gluconeogenesis does. Yeah. Your liver has the capability through a process called gluconeogenesis of actually producing more glucose. It can do that, I believe, through from ketones, which can come from the fat. Yeah. To bring this all together.
00:11:05
Speaker
aerobic exercise either as a primary product or byproduct creates ketones, which are interestingly can be used as a direct fuel source for the brain. But what they have found, and this is in mice models, is that those ketones when they get into the brain,
00:11:23
Speaker
potentially into other cells, when they get into the brain, they change the epigenetic regulation of the cell. So epigenetics is basically how genes get turned on and off and whether or not they're expressed and what proteins are made at a given time.
00:11:39
Speaker
And so the ketones go into the cell and change the methylation, the methyl group on the DNA and basically turns the brain derived neurogenic growth factor gene on. And so the ketones, if they go up, you end up making more of this hormone. And then you have more of it floating around in your blood saying, grow more, grow more new neurons.
00:12:03
Speaker
And especially in the hippocampus. It seems to be the case, which is really interesting. So then you see this downstream effect, say for depression. Depression is a state, there's, we think many different types of depression, depression and many different causes. But one thing they frequently see is that the hippocampus is smaller. There's less
00:12:22
Speaker
learning going on and more reprocessing of old memories. And so the hippocampus seems to be smaller. And I think that partially, it may be a small factor, accounts for why exercise is so good for depression. And we've talked about this
00:12:43
Speaker
For those who carry a genetic risk for depression, getting sufficient exercise each week brings them to an average level of depression risk. It basically neutralizes their risk factor, which is profound. Yeah, and a lot easier and probably with much better side effects than taking some drug. If you can get yourself two exercises, and unfortunately, motivation can be very limited when you are depressed.
00:13:11
Speaker
And what would be sufficient to cause this stimulus, do you think? Is that something people have to experiment with individually? Yeah, so I think it's, as we know, it's very different for everyone in terms of what gets them to the point where ketones are being produced. For some of your more elite athletes, it takes a lot to produce ketones. But for the average person, who's mostly sedentary, it doesn't take very much at all. You can even stop eating sugar and you'll start making ketones because you're not good enough at burning fat.
00:13:42
Speaker
And that's something we see sometimes when we look at people's urine, they'll have ketones in it, and it's only been 10 or 12 hours since they've eaten. But anyway, I think it's different for everyone. One study that I reference a lot is this study where they took two groups of people, and one group they had meditate for 30 minutes, or meditate for 20 minutes, focusing on their breath, and then do walking mindfulness for 10 minutes.
00:14:11
Speaker
do a 30 minute aerobic exercise. And they did that. So it was about an hour long, twice a week for eight weeks.
Exercise for Heart Health
00:14:19
Speaker
So two hours of effort a week for eight weeks, 16 hours of effort. And depression was based on the back depression scale, which is a really respected measure was cut in half. And the perseveration is the tendency to obsessively think.
00:14:37
Speaker
Perseveration was cut in half. And what they also noticed, they think that they also checked like the hippocampus and the hippocampus, like the shrinkage of the hippocampus was reversed. And so they think two things were happening. One, people were learning to identify the fact that they were thinking and experience rather than think, which seems to be a key treatment for depression.
00:15:00
Speaker
But then additionally, the act of learning that, the act of learning how to be aware of what you're thinking is a skill and exercise increases brain derived neurogenic growth factor. You have all these new neurons waiting in your hippocampus to learn something and you're learning this trial and error practice of how to become aware of the fact that you're thinking. And so it's this sort of symbiosis that showed that it was
00:15:23
Speaker
one of the most effective, currently available treatments that we have. Wow. And so this video, I get what you're saying, this sort of synergism between the mental and the physical there. The physical stimulus, allowing the brain to be more receptive to these learning new things. And to change. And so
00:15:49
Speaker
I think that's maybe a good point to sort of say, you know, throughout your life, things happen emotionally, physically, and adaptability requires sort of this like baseline potential. And if we evolved in a default state of exercising, then there are all these systems that function best if we're exercising.
00:16:18
Speaker
And if we want to have this like pluripotent capacity to adapt emotionally or physically to our lives, being in that sort of best default human state of exercise, I think gives us that potential say, as we age, maintaining our proprioception, which is our ability to sense our joint position, which is a neurologic process. Presumably those nerves are healthier if we're exercising. And maybe this is a good time to transition to the heart.
00:16:48
Speaker
So we've known for quite a long time that exercise is one of the single best things for our heart and muscles. And we're starting to understand a bit more about that. So we were just talking about how basically we know roughly how much exercise improves people's heart health.
00:17:14
Speaker
But of that amount, only half of it is accounted for by
00:17:21
Speaker
improvement in blood pressure, improvement in heart rate, and improvement in people's cholesterol panel, which is the main thing people check. If we're trying to assess someone's heart health. Do we know what the other half is coming from? We're starting to get an idea. So when we, I mean, one of the, again, I'm not an expert in this, but I read a lot about it and I've been tested a whole bunch of times myself. And what I've been told by physiologists is that
00:17:48
Speaker
So an active heart, somebody who's exercising a lot, um, that the ejection fraction of the heart is larger than somebody who's sedentary. In other words, the heart contracts with more strength and you have a higher cardiac output on each stroke. And, um, and that that seems like, you know, that's going to be a performance and help your performance, whether how that helps health. I don't know. Um, but I've been told a number of times when I've gone in to see doctors,
00:18:17
Speaker
that, oh, your heart is extra big. But I've been doing exercise in sports since I was just a little kid. And they said, oh, yeah, this is what we call an athlete's heart. We see this a lot. And if we saw it in a sedentary person, we'd be worried. What is it? Cardio? Cardio. What's that? Cardio megalit. Megalit. Your heart's big. Yeah. But anyway, so I've had that concept over many years.
00:18:45
Speaker
But I hadn't thought of how, other than that, obviously when the heart's not healthy, nothing else is going to work very well. But I haven't really thought about how the heart itself would be affected by exercise other than, you know, getting bigger and stronger and that sort of thing that we, I think, intuitively realize. And maybe we should just take it to its base level real quick, which is just to talk about
00:19:09
Speaker
You know, and this sounds absurd, but what is the heart and what does it do? And I have this conversation with my patients a lot, especially to demonstrate why high blood pressure is so dangerous. The heart is a fluid pump. It moves fluid through a fluid system. Your blood pressure determines the pressure and it is the pressure in the system. The higher your blood pressure, the more back pressure there is for each beat.
00:19:38
Speaker
Your heart is like a, if any of you ever used a boat motor, when you like squeeze the little bulb to get the gas in, priming it and you squeeze it and it squeeze the blood forward and then you release it and it has to fill back up with blood and then you squeeze it again. And there's a delay there each time. So the heart stretches to absorb, to fill up with fluid and then it squeezes down and shoots it forward. The higher your blood pressure is, the more each beat requires more work.
00:20:06
Speaker
So the heart's working a little harder to overcome the pressure in the arteries. Every beat of your life. But then in addition, we have what's called reserve capacity. So the stroke volume is how much fluid you're moving with each beat. And all of us have a range because the heart can stretch and squeeze. And so we can go from being a 200 cc engine to a 500 cc engine.
00:20:28
Speaker
when we really are pushing it hard. What happens over a lifetime is if your blood pressure is higher, your heart has to work harder. And the way the heart responds to that type of stress is that it gets stronger. And the only way for it to get stronger in that context is for it to get thicker. And the thicker it gets, the less stretchier.
00:20:49
Speaker
And so if you imagine a really stiff boat motor bulb, it doesn't fill up very fast. And so you go from having a 500 cc reserve to 450 to 400 to 300. And eventually you can get so that your 200 cc engine at baseline gets cut in half and you can't even move the blood around your body because your heart becomes so stiff because the wall is so thick.
00:21:14
Speaker
And also, it's harder for the blood to get into the heart itself because there's a high resistance and it's so thick. And so that's how blood pressure can lead to heart failure, for example.
00:21:27
Speaker
or even without high blood pressure, just a lack of use of the muscle makes it stiff and makes it less healthy and less functional. And so one of the ways that we're starting to discover is that basically exercise makes your heart younger. It can make your heart younger and it can keep your heart down. Can it reduce blood pressure for people? Yes, it absolutely reduces blood pressure. So both those things seem like really good. And the truth is,
00:21:56
Speaker
I would rather someone lower their blood pressure through exercise than through medicine. If I lower it through medicine, that lowers their blood pressure, but that's all it does. So it's a kind of uni-dimensional, one-dimensional improvement.
00:22:12
Speaker
We know there's all these other multitude, multifaceted benefits from exercise, but much rather someone lower their blood pressure through lifestyle because then they're getting the endorphin benefits, the brain benefits, the mood benefits, all these other things. So one thing we found is if someone exercises regularly throughout their life,
00:22:35
Speaker
their heart does not age at the same rate. And particularly if people get at least four days of exercise at 30 minutes, people's hearts are decades younger. And when they're younger, when you're examining somebody, I don't know how you do this, what do you see and what's the difference between a young heart and an old heart? So that's interesting. So like I can't obviously directly see someone's heart, but more capacity to get up and go off of
00:23:04
Speaker
the couch, more capacity to do exercise, and then just obviously a lower risk for heart attack and stroke.
Aging Healthily with Exercise
00:23:13
Speaker
But I'll sort of answer it a different way. When I look in people's eyes, I can see their blood vessels. And so it's actually, I think down the road, going to be a way to scream for heart disease. And blood vessel disease is actually to see people's blood vessels in their eyes. And when I look in kids' eyes, they're glossy, they're wet, they look really kind of
00:23:33
Speaker
super healthy. And as people age, you can see those changes. It just looks slightly drier and you can see little blockages and you can, you can sort of track, like everyone's eyes, like few adults eyes look like kids eyes, but you can tell that difference in people's health based on their eyes. Interesting. So one of the things they found in the heart, so they like first figure out like,
00:23:58
Speaker
Oh, can I? This is an interesting side note before I forget it. I'm thinking about the eyes that once I was reading a Russian ski coaching study, not a study, but an article written by these Russians cross-country ski coaches.
00:24:16
Speaker
And they used this method. I've never heard anybody else use it. They could tell whether the way they checked to whether the athlete was recovered enough to perform the workout of the day was they peeled back their eyelids and looked at the backside of their eyelids and saw how red they were.
00:24:35
Speaker
And if they were very red and vascularized, then they knew they were recovered. And if they were kind of pale pink or whitish, they would say, no, you need another rest day. And I remember reading that and thinking, first of all, I can't imagine any of the skiers I've coached wanting to let me peel their high lid back to look underneath. But I mean, it kind of jives what you're saying. The eyes do tell a lot. We know that.
00:24:59
Speaker
Um, but it's, it's something I've never heard of before, but I was fascinated. I mean, I mean, it's obviously, I remembered it from what, 20 or 30 years ago. Yeah. In our instance, we're looking through the iris, through the pupil to the back of the eyeball. Yeah. Um, yeah, it's a little different, a little different coach feeling back there. Still also not comfortable that upright light shining your eyes.
00:25:28
Speaker
Yeah, so what they think they figured out or at least started to figure out is this. So in your DNA, at the end, you have these things called telomeres. And they're basically like a buffer at the end of your DNA that protects it from damage. And the important thing about DNA is that
00:25:50
Speaker
you needed to be accurate in order to produce the correct proteins and to not develop genetic mutations that lead to cancer or other dysfunction. We start with a certain telomere length in cells and they tend to get shorter and shorter over time through replication and through time.
00:26:10
Speaker
What they have found is that regular exercise, at least in cardiac cells, and I imagine in other cells, but at least in cardiac cells, is that it keeps the telomeres long. And so from a cellular level, it keeps the cell young. Because once the telomeres get short, eventually those cells stop replicating and or just dying. Or they replicate poorly. Yeah, replicate poorly and say maybe in certain parts of the body, develop genetic changes that can lead
00:26:40
Speaker
cancer or in the heart they just die. It's not good to have the heart muscle cells dying and getting weaker. And so one thing they found is that, going back to that other study,
00:26:58
Speaker
After, basically, you can make your heart younger. So if you enroll, if you engage in a series of regular exercise over the course of a year or two, your heart parameters, how flexible it is, how stiff your arteries are, all of those sort of measures can start to roll back in time. Interesting. So not only can you remain younger, but you can actually turn the clock backwards a bit. Absolutely.
00:27:28
Speaker
You know, I've seen that here in the Valley, right? So we're this wonderful outdoor destination that a lot of people hope to retire to. And I've seen a lot of patients who are in their sixties or seventies who moved here after like a long life, really hard work.
00:27:43
Speaker
And because we already have this really great outdoor community here, they make friends, they start skate skiing or classic skiing or mountain biking or whatever, and they're more active than they've been since they were kids. And they say, I feel better than I have in decades. Yeah, I've heard people say that. Better than I have in decades. And probably all of us have heard things like that from folks. And so we see it to be true, right?
00:28:06
Speaker
And it's really wonderful. And fortunately here we have this social community that can really get people out because that's the key thing is you have to do the exercise to get the benefit. Maybe someday they'll figure out one time and there's talk about this. There's like certain proteins that maybe can replicate some aspects of exercise, but I don't think anything will ever replace the exercise itself.
00:28:29
Speaker
Because these signaling pathways, which essentially we're talking about right now, there's probably thousands of them that occur. When I go out for an hour run ... 10,000, maybe. Exactly. It's just all these things that are happening, it'd be pretty hard to design a drug that had the same effect. Maybe you could turn on a few of these proteins.
00:28:51
Speaker
with a drug, but you're probably not going to get all of it. Maybe there would be negative benefits in doing it in the wrong way. It's not going to be the same as the phase change that we talked about, going from ice to water. Let's talk about muscles. Unfortunately, starting at age 30, you start losing motor units.
00:29:16
Speaker
So motor units are basically the individual little micro branch of a nerve and the muscle bundle or fiber that it connects to, correct me if you're wrong. That's right. That's what I know about. I mean, again, I'm no physiologist. There's a time when I do this much better, right? What do you know what you're saying, guys, is what I know. So say in your bicep you have thousands of motor units.
00:29:39
Speaker
And so you have the nerve that goes off of a larger nerve, a little small branch, and the little local bundle collection of fibers that it connects to. And you have thousands of those in your bicep. In order for the muscle to function and exist, you need the nerve to be healthy and you need the muscle to be healthy. And if you cut the nerve, those bundles will die, right? So if I cut a certain nerve and it just stays gone, that muscle will atrophy and go away.
00:30:09
Speaker
Starting at age 30, we start losing motor units, unless we use those muscles. We use it or lose it. Exactly. So we found that over time, as long as you use that muscle regularly enough, and I don't recall exactly what the number was that they had in the study, you don't lose the motor units, which means that you retain the capacity to build or lose strength.
00:30:35
Speaker
but the motor unit's still there, the nerve is still alive, the muscle's still alive, but once it's gone, it's gone. And so there's a really strong argument, you know, obviously for many different reasons to be exercising your entire life, but in particular from 50s on, because that's where we really see us, it's like, sure, it starts in the 30s, but it really accelerates 40 to 50, but then especially 50 to 60, 60 to 70, and we start to see that loss accelerate.
00:31:04
Speaker
And I've talked a little bit about that in the Aging Athlete podcast, this concept of muscle loss as we age. And being 67 years old now, I've noticed a drop in strength despite the fact that I'm working pretty hard to try to slow the decline. But it's interesting to me having been a lifelong athlete,
00:31:30
Speaker
to watch this decline or to see how much harder it is for me to gain strength now than it was 25, 30 years ago. And it's because I'm like a longitudinal study of one person in a way. And I think that this, you know, it's something we've talked about, as I said before, and we've talked about muscle fiber types and the recruitment of those different fiber types and something I've just to kind of
00:31:57
Speaker
drive home this point that you're bringing up about the lose it or use it or use it or lose it concept is that the slow twitch fibers have a pretty low threshold, what they call action potential, how much energy it takes to activate to send the signal to the muscle.
00:32:20
Speaker
And so it doesn't take very much to keep those muscles active, a walk or an easy jog or a ski or riding a bike, something like that, at a very low intensity, these kind of long duration aerobic activities that we talk so much about.
00:32:37
Speaker
But as you move up the force generating scale of the muscle fiber types from these low activation energy, slow twitch fibers, all the way up to your strongest, most powerful fast twitch fibers, it takes a lot more effort to engage those. And so if you don't do something that's very effortful, they don't get engaged and then they begin to
00:33:05
Speaker
atrophy or you know, you start to lose them and I think that what
00:33:11
Speaker
So what I've noticed is, and the climbers call it try hard, and is that it's harder for me to generate try hard now than it was 30 years ago. Because I'm not sure where the connection is. I'm not sure whether, I think it's mostly neurologic. Climbers work a lot. Rock climbers who are trying to climb hard work very hard on being able to generate that try hard.
00:33:40
Speaker
and it's something it's a skill that you have to practice.
00:33:43
Speaker
And I didn't really, I took that off for granted when I was 30 years old. Yeah, exactly. I can just pull on this thing. And now I'm coming to realize, Oh, I have to really practice the try hard a lot in order to try to maintain it, even just maintain it, let alone try to get better at it. Yeah. And so when that try hard is you've just tripped and are you going to fall and break your hip or not with you, but like, say one of my older patients and you haven't tried hard and
00:34:13
Speaker
years, that's one of those moments where you can fundamentally sort of alter someone's health, right? So interestingly, what you're describing has been documented in a really great study that looked at the different exercise stimuli in the aging population in terms of muscle groups and what was required to get a stimulus for change. And so light exercise
00:34:41
Speaker
was great for certain things, but not great to get a muscle response for building or maintaining muscle. You need a bigger stimulus. It's almost as though there's like less transmission from stimulus to like we were talking about the signaling pathway. The system's less responsive to the signal. So the signal needs to be louder in order to create a response. And so it's harder to build muscle as we age.
00:35:08
Speaker
And that, you know, so this is again, something we've talked a little bit about on the aging athlete podcast with Steve is this, the need, not just the desire to, but the need for aging athletes to do more strength training than you ever thought you needed to do when you were 25 or 30 years old, because then you had this.
00:35:28
Speaker
what I call natural vigor. You were strong out of the box and you didn't really have to do much to become strong when you were 25. But at 65, you have to do a lot to be strong. And I think it's a very important thing, even though uphill athletes' emphasis tends to be on these long duration, low intensity type of activities.
00:35:52
Speaker
you need to have a certain level of strength to perform those well. And as we age, then I think it just has to take a higher priority in our training than it did when we were younger.
00:36:04
Speaker
And just for, you know, I'll go out for a trail run and I'll trip and fall. I mean, almost everybody falls down when they're running, you know, around here, rough trails and roots and rocks and that sort of thing. And I'm still pretty good at, like, catching myself or rolling and, you know, I mean, I might bang myself up. Like that day you and I were out on that ridge one day, I mean, and that was kind of gnarly. I mean, that could have been dangerous. We were a long way when I fell.
00:36:31
Speaker
But it's still the ability to, as you just said, the thing we hear about is the old people who fall in their house and can't get up. And they certainly can't catch themselves as they fall. But I think this is a way that we, as we age, and one of the things we learned from the survey that we
Exercise and Bone Health
00:36:53
Speaker
did
00:36:53
Speaker
for uphill athlete a month or so ago is that we have a whole lot of aging athletes listening to what we say. And so I want to make sure we get these points across to them. So then I have my like, I'm going to take out my soap box. The single most important thing that affects people's quality of life as they age, particularly the healthier population who are going to live a long time is their balance.
00:37:24
Speaker
As your balance goes, your world closes in on you and your quality of life decreases. The trail, your favorite trails may be like too much for you now, so you can't go there anymore. And as you stop going there, you lose the capacity to do it. And it almost always sneaks up on people.
00:37:44
Speaker
And as we just talked about, it's harder to build muscle as you get older. It's a much better idea to maintain it. And it's almost like you were talking about how it takes more effort to get strong now. And aging is almost like raging against the dying of the light. Yes, exactly. So I think the best way to approach it is like shoot for the highest peak altitude.
00:38:12
Speaker
so that when you coast, you got a long way. Right, exactly. And don't wait because it's going to be harder to gain that strength, it's immoral. Yeah. And the next day and the next week than it is today. So like start today. Right. And so like, I don't need to focus on balance, but I do mostly right now for injury prevention. But down the road, it's for quality of life. Like single leg exercises, closed eye exercises, so I can practice proprioception. But balance, the loss of balance,
00:38:42
Speaker
starts 50 to 60 for a lot of people who really accelerate 60 to 70, 70 to 80. And we know after a certain age, if someone breaks their hip, you're extremely high likelihood of dying in the next five years. And it makes sense from an evolutionary perspective. Like that is a really hard thing to survive if you are a hunter and gatherer.
00:39:07
Speaker
And so preventing hip fractures is of immense value for longevity. And we tend to focus a lot on bone density, which is really important, but the single strongest predictor, whether or not someone falls and breaks their hip is not.
00:39:22
Speaker
bone density is whether or not they fall. The bone density will help them not break their heels, but it's like hit the ground. If I could take all the money that's spent on bone density scans and all the drugs that we use for it and put it towards fall prevention, because someone's quality of life, unless they avoid a fracture, having stronger bones doesn't actually improve your quality of life.
00:39:49
Speaker
unless it prevents a fracture. But having better balance improves everyone's lives. Moving around is easier. You can go all these places you want to go. You can continue to live this meaningful, fulfilling life. You could not be afraid in winter. All of these things.
00:40:03
Speaker
And so that's the thing where, again, it becomes harder to maintain those motor units and it becomes harder to build strength. And so starting with a strength and core or balance routine earlier is a really wonderful idea. Let's see other things about muscles.
00:40:29
Speaker
I think we covered most of the muscle stuff unless you have something you want to riff on. One thing that I found fascinating in some of the readings that I've done about aging, and we've talked a lot in the books and on the website about mitochondria. And as people hopefully know, that mitochondria is essentially the engine of a cell. It's what produces the energy that a cell lives from. And every cell in our body besides the red blood cells has mitochondria in it.
00:40:56
Speaker
But what's fascinating to me is that mitochondria has its own DNA. It doesn't share with the rest of the body, which some evolutionary biologists think means that it was probably some sort of invasive thing that came into, you know, not human. Of course, we thought that temperature is way, way back because it's a different DNA. And it turns out we inherit that DNA from our mothers.
00:41:22
Speaker
which is one of the reasons, one of the ways they can trace heritage now. But one of the things that I've been fascinated by in the aging realm was the fact that so mitochondria doesn't live very long. A couple of weeks maybe is a long life for a mitochondria. So you've had tens of thousands of generations of mitochondria
00:41:44
Speaker
And each time there's a new generation, that means that the chromosomes have had to split and the genes are replicating, just this whole thing with the telomeres and all that. So there's more opportunity for mistakes to go along. And this article I was reading saying that one of the reasons we age and we get wrinklier skin or our eyes don't work as well or we're not as strong or don't have the aerobic capacity we once had is that these
00:42:14
Speaker
mutations in the DNA, excuse me, in the mitochondrial DNA begin to accumulate. So the mitochondria doesn't function nearly as well. So that's going to affect your performance because it's not going to probably have the aerobic capacity it once had, but it's also going to affect things like your hair color or your skin texture, because those are all affected by that. And I just found that really fascinating to learn a fact like that. And I think it just shows
00:42:44
Speaker
You know, one of the things we've talked about in the fact that aging is, it's a multifaceted thing. It's not just one part that's, although I do have a good friend who he calls aging. He says every day it's like he calls it the daily insult. He wakes up and he goes, okay, so what's not working the way it's supposed to today?
00:43:11
Speaker
And there's often, and anybody who's getting over the age of 60s probably experiences, yeah, there's almost always something that's not quite right. You're like co-stigma playing. You think, okay, I got it. I got it all. Everything's good now. And then, oh, shit, this isn't right now. Something else is not working away, shit. Aging is the best mindfulness teacher. My, oh, my foot hurts. Why does my foot hurt? What did I do to my foot?
00:43:33
Speaker
When you were talking about the mitochondria thing, one thing it made me think of is in addition to just replicating the DNA, you also produce the protein. And sometimes proteins are just chains of amino acids that are folded in specific shapes. Sometimes proteins are misfolded and that causes damage. And so there are these things called chaperone proteins that make sure that proteins are folded correctly.
00:44:00
Speaker
Then there are these things called heat shock proteins that I think may actually function as chaperones, but I'll have to remind myself of that. Putting yourself in certain stress states increases heat shock proteins, which ensures that the proteins are folded correctly. So say going in a sauna, raising your core body temperature increases heat shock proteins. It's a stress state that your body responds to, and in that stress state,
00:44:26
Speaker
It's a signal that something might go wrong and you, at least I think, and then the proteins get folded more consistently, I believe. Right. And I've heard a bit about heat shock proteins and people using saunas in particular for them. But aren't there things like cold shock proteins too that have a similar effect? That's one of the reasons people do ice baths and that sort of thing. But what I'm sort of getting at is
00:44:56
Speaker
I imagine there's a equivalent of a heat shock protein from exercise, right? It's a stress state and that regular stress helps the proteins fold correctly, helps the DNA be replicated correctly, helps the telomeres stay longer. It just helps the system continue to function at peak potential and not degrade as quickly.
Gut Health: Exercise and Diet
00:45:18
Speaker
On a side note, so the reason the mitochondria are inherited from your mother is that the sperm just has DNA. The egg has all the other cellular mechanisms. And so the mitochondria come from the egg. And so the mitochondria are always passed in from the mother. And I almost wonder if there, because there are certain mitochondrial disorders that are only inherited in the matrilineal line.
00:45:44
Speaker
I wonder if there are also certain performance losses or performance benefits that are inherited from the maternal line. Well, there is that saying in sport that you should choose your parents wisely because a lot of what your ultimate genetic ability is going to be is going to come from them.
00:46:07
Speaker
is maybe a good sequitur to the gut, I think. You should choose your gut bacteria wisely, if you can choose them at all. That's something I think I really want to hear what you have to say about this because I think it's something that most of us
00:46:25
Speaker
don't think about, honestly, and for good reason. I mean, we don't know anything about it. It's bearing a way in the middle of us. Maybe we have indigestion or problems with our stomach, but how much of that relates to our biome of our gut? I don't know. Well, for a long time, I often think about
00:46:45
Speaker
you can only try to answer the questions you can even think to ask, right? So I'm talking some questions you were completely oblivious to even asking, right? And there are certain questions that we haven't even thought of asking because we don't even have the technology, right? So before we knew that bacteria existed, we couldn't even ask what bacteria did in our bodies. We're just like, I am a human unit. I'm just me, the human.
00:47:10
Speaker
That's me. But now we know that we're not an organism, we're an ecosystem. I have somewhere around five pounds of bacteria in my gut and probably fungi and viruses and also sometimes protozoa and parasites and other stuff. That's because you drink out of mud puddles. That's right. If I'm thirsty.
00:47:34
Speaker
I'm thinking of running with Sam Naney and getting super, super dehydrated and being ready to drink out of a bottle straight out of Ross Lake. Yeah. So if you think about it from this perspective, so we were talking before about how exercise is our default state, right?
00:47:52
Speaker
We co-evolved around other organisms from before we were humans, from before we were animals. We were in an environment with bacteria and fungi and parasites everywhere. And as we turned into multicellular organisms, and then as we turned into actual animals that had a GI tract, as we developed certain functions, they played a role in that. And so for example,
00:48:22
Speaker
Gut bacteria seem to be crucial in training our immune system what to attack and what not to attack. And there's this theory that's, it's basically been called the teachers of tolerance hypothesis, that the bacteria in our gut teach our immune system what to react to and what not to react to. And it also includes fungi and parasites and all this other stuff. When those bacteria aren't there, things go wrong.
00:48:51
Speaker
And in our modern society, we're not exposed to feces. We have sanitation. We're not spending as much time in wild environments being exposed to lots of different bacteria. The food we eat does not have soil on it. It has preservatives in it. Some of the food we eat is unrecognizable from 300 years ago. What, you mean Cheetos? Yeah. What's wrong with Cheetos? Yeah, or margarine, or these high-process oils, and all these other things, right?
00:49:20
Speaker
Conceptually, the things that make up our body in our ecosystem are not the things that made up our body before. Makes sense. I don't know if this study is still validated, but at one point they were saying that 98% of the atoms in your body are replaced every two years. Literally, it's like a new unit. Yeah, we're like sand. That's just, we're like a sand dune that's there, but it's like flowing, right? So the bacteria in your gut are one of the pillars of health.
00:49:50
Speaker
They determine how much inflammation is in your bloodstream, which is crucial. They also determine how vigorous you are. And we all know the feeling of like having our gut be off and we feel just weak. We just feel extremely weak. And have you even found this in kids, if their gut bacteria is off, they think that that's what accounts for, say you get malnourished as a kid, of which a really unacceptable number of kids around the world are malnourished.
00:50:20
Speaker
That can change your gut bacteria in a way that is difficult to recover from. And they find that that change in bacteria, even once they get enough calories, it makes it hard for kids to grow at the same rate. And so I think that there are other changes that we're either creating or making worse that are similar to that. So we give people, kids, a lot of antibiotics. Antibiotics change the gut bacteria anyways. Because most of the time we take them orally. Yeah.
00:50:51
Speaker
We eat highly processed foods and preservatives are a form of antimicrobial. They stop bacteria from growing in our food. And they probably do that in the gut too. Say you're born by a C-section. The way your gut bacteria are seeded is through the mother's vaginal flora.
00:51:15
Speaker
If you're born by a C-section and you're not inoculated with vaginal flora, your skin bacteria match your parents' skin and the environment externally and not the vaginal flora, which to me is a fundamental change. And unfortunately that also means that if you're a woman, you then can't pass those changes on to your daughter or son, I think. So it's an inherited.
00:51:39
Speaker
Um, so all these things are fundamental changes in our environment, not to mention the fact that the food we eat is maybe the single biggest determinant of what's in our gut. So like people are super into taking probiotics and, uh, there's probably an appropriate application of that, but probiotics are just seeds. If I take a palm tree seed and throw it in the Arctic, it's not going to grow. And if I, and if I take like a Doug for a red Cedar and I throw it in the desert,
00:52:09
Speaker
is not going to grow, right? It's not the appropriate environment. And so the food you eat is the soil that determines what bacteria grow in your gut. And so it's almost this concept of a prebiotic, the food you eat being crucial for the health of your gut and what grows there. And I'll try to wrap this up because I'm going on a rabbit hole. It's not directly exercise-related. No, but it's fascinating. And I think it's certainly health-related, but perhaps we won't touch on that.
00:52:40
Speaker
There's this really interesting study that they, and a lot of what I'm talking about is a mix of like observational studies in humans and mice, but I think this one really gets to the heart of the story. We've known forever that interest intuitively and from observational data that vegetables are like the single best thing you could eat for your health, right? And we've also known intuitively
00:53:00
Speaker
that sugar is bad for you. Sugar runs your teeth in sugar. We've known this, right? And yet for a long time, we've been off on this like, wow, goose chase that saturated fat is what causes heart disease. They did this study where they took two groups of mice. One, they put on a very low vegetable fiber, high fat, high sugar diet. And the other group, they put on a very high fiber diet that was like moderate in carbs and fat.
00:53:29
Speaker
And then they looked at the gut bacteria in the ecosystem. And in the low fiber, let's call it the McDonald's diet, the low fiber, high sugar, high fat, you have this ecosystem of bacteria in your gut that's really diverse. In those mice, it was not very diverse and the bacteria were stressed and starving.
00:53:53
Speaker
You have a biofilm between, or you have this mucus layer between the bacteria and between the lining of your gut, because they're not supposed to touch. You have this mucus layer. The stressed bacteria were eating that mucus layer and making it thinner. And then all of their signaling molecules, potentially were leaking through into the bloodstream. In particular, all the inflammation. And so what we find is sugar is a super simple molecule, right? Yeah.
00:54:19
Speaker
Because it's so simple, the one bacteria that's really good at eating it takes over the gut and over dominates. And that bacteria creates inflammation into the bloodstream. We have more inflammation floating around causing achy joints and excess degeneration and quickening our age.
00:54:40
Speaker
Whereas in the bacteria that were eating a lot of vegetable fiber, sorry, in the mice. Thank you. The fiber is a really complex molecule. Um, and so one bacteria breaks down this part and a fungi breaks down that part. And then those byproducts are broken down by this other thing. And so it creates a really diverse ecosystem. And we know like in, in.
00:55:03
Speaker
Life and environments diversity is good. Diversity is good for health. It's good for resilience. It's good for communities. You get a more diverse gut ecosystem. The bacteria were healthy and happy. They might have been happy when they were healthy. They can't drop amorphizes. The mucus layer was really thick. And then you develop certain bacteria that secrete anti-inflammatory compounds in the bloodstream.
00:55:30
Speaker
And so to me, that's the single best thing that points to how fiber, how the food you eat changes your heart health and your overall health. So to cut you off and ask a question here. So what could I do to, I mean, I can't probably without doing some kind of special testing to find out what my gut environment is like. What could a typical person do to
00:55:59
Speaker
set themselves up better and perhaps ensure that they have the healthiest gut bacteria. What decides eating vegetables and whatnot? Is that pretty much it or is there some other stuff that a person can do? Yeah. I think there's two parts to this question.
00:56:18
Speaker
The question is up in the air in terms of how much you can like permanently change your gut bacteria or if it's like this thing you have to constantly do, right? I think the gut microbiome does change in fundamental ways that become irreversible for some people, but a lot of these things are like consistent effort you have to make. And so let's start younger. So if you have young children, you should avoid preservatives, avoid processed foods as much as you can.
00:56:46
Speaker
maximize vegetable fiber intake and keep sugar limited. Not no sugar ever, but it's all about balance. It's all about the ecosystem that you're creating. If there's occasionally sugar coming in, but lots of vegetable fiber, you're still going to have lots of those healthy gut bacteria. And then avoid antibiotics if you can. And most often when antibiotics are prescribed for kids, they're not necessary.
00:57:13
Speaker
Those are the key things. And then get kids out into the natural environment. Get them out in the woods. Let them get dirt on their hands. Let them get dirt in their mouth. Don't wash it off. Let them be around livestock, around animals, and stuff like that. For adults, the single best thing you can do is... Let me ask a quick question about that. So when you were... I mean, I grew up rolling around in the dirt.
00:57:37
Speaker
playing outside as a child a lot. And I grew up around livestock and a lot of animals. And so does that sort of set up this gut biome that then you have that for the rest of your life? Yeah, they think so. Obviously, the single first and most important thing is the inoculation when you're born.
00:57:58
Speaker
being seated with the vaginal gut bacteria or vaginal bacteria. But then the first probably five years of your life are probably the key moment when your gut bacteria are set. And that's like your gravity. Well, I'm good. I ate a lot of dirt. Yeah, right. And so there's actually, it's my alma mater is University of Wisconsin. And they're doing a study where they're comparing children who grew up out of the country. I know, rural versus urban. What we actually see is that
00:58:25
Speaker
In rural areas, houses tend to have more bacteria in them, and in urban areas, they tend to have more fungi. And that's like a fundamental change. That's pretty big, yeah. You know, in the air and on the surfaces.
00:58:37
Speaker
So as an adult, um, the single best thing you can do is again, avoid processed foods, avoid sugar, um, and eat lots and lots of vegetable fiber. And when, when, let's specify, when we say sugar, we're talking sucrose, the molecules, sucrose and just straight glucose. Right. Well, what do we eat? That's just true. Most of the most things are probably straight. They're going to have sucrose or fructose now, which everybody knows the dangers. Yeah. Basically the way I sort of.
00:59:07
Speaker
recommended is don't eat a carb that's pre-processed. Let your gut do the processing because it gets broken down too fast and then the bacteria can just multiply, multiply, multiply. Plus there's the whole insulin response to sucrose. So eat intact carbohydrates and eat lots of
00:59:27
Speaker
vegetable fiber. And what I mean by vegetable fiber is not necessarily like romaine lettuce. What I mean is like garlic and onions and Brussels sprouts and cruciferous vegetables like broccoli and Brussels sprouts and stuff like that and beans and things that have fiber in them. And there's lots of nuts and seeds. There's lots of different things and potentially supplement with powdered vegetable fiber. And that's the only supplement I recommend
00:59:54
Speaker
And you've actually done it, didn't I? Fair warning. It creates a lot of activity in your gut. You've got to start slow because it can create gas and cramping because you're fundamentally changing your gut. It's definitely not an effect. But you know, I'm just on that subject.
01:00:14
Speaker
People often ask, you know, email to us or ask questions about dietary supplementation. And I've talked a little bit about this with Rebecca, our nutritionist, but I have this, I mean, I've played around with dietary supplementation a lot in my life, you know, or let's call it nutritional supplementation. And I have my customary response now to people who say, well, should I be taking this or should I try that?
01:00:42
Speaker
Try it. Try it for a few weeks. And if you can't tell the difference, then it's probably not doing anything. But you can run this experiment on yourself. And if you're careful in monitoring what you expect to happen. In general, I think most of the ones that I've ever tried in my life had
01:01:01
Speaker
immeasurable results. I couldn't feel a difference. And so I still play around with them from time to time when I think, Oh, that sounds kind of interesting. I'll try some of this and I go through a bottle of it and I'm not going to reorder that stuff because it didn't seem to do anything. And I think, I think certain things are, are well validated. Like say for, I agree with Rebecca for performance, like creatine makes sense, you know, for strength training and for, and for exercise for as a, as a pure health supplement.
01:01:30
Speaker
To me, supplementing with vegetable fiber is just an additional way to push your bacteria in a specific way. In particular, most hunter-gatherer societies were eating somewhere between 80 and 100 grams of vegetable fiber a day, and it would be extremely hard to get that amount. The average American gets 10 grams. The recommended amount is 40 to 50, and it's hard to even get that. You've got to be having veggies at every
01:02:00
Speaker
So like, let's just say like a carrot or a red bell pepper, but those things have, seems like they ought to have a lot of fiber in them. I don't know the exact amount. So say, I think, uh, I think a quarter and someone you guys should Google will answer this way faster than me, but I think a quarter cup of like beans has
01:02:21
Speaker
10 grams of fiber, a quarter cup of pre-cooked beans, or not cooked beans. That's not very much then, okay. It takes a while. And our ancestors might have been eating 80. Right, a lot of root vegetables. So to answer your question and to bring it back around,
01:02:41
Speaker
Let me specifically say, inulin, so types of vegetable fiber. Inulin seems to be really beneficial. That's what I tried. Yeah. With questionable results. Galacto oligosaccharide, which is also GOS. Apple pectin is another one. You can find these just as pre-made powders.
01:03:00
Speaker
start slow because they change your gut bacteria and that can be very uncomfortable and you can slowly increase. But yeah, so to bring it back around, another thing you can do as an adult to change your gut bacteria, it turns out, is exercise.
01:03:13
Speaker
That sounds simple. It's easier on me than the inulin. Yeah. So it's another, again, phase change signal that your body adapts to. And so they found all sorts of interesting changes that happen in the gut.
01:03:32
Speaker
it was outside magazine recently, a couple of years ago, I had a thing about the gut microbiome that looked at like Alex Honnold's gut and all these different types of athletes and what their specific gut profile was. And we haven't done a big enough study to say like this type of exercise is this and this type of exercise is that, but I imagine it does to a certain extent.
01:03:53
Speaker
But one of the things they found was that it changes, just like it does in us, it changes the genetic regulation of the bacteria in your gut. It has them adapt to that phase change state of exercise in ways that lower inflammation
01:04:10
Speaker
Um, in the gut, probably also in the bloodstream since it's absorbed. Um, and then interestingly, those changes are heritable. So they are not heritable. Basically they, they took these different groups of natural health. I remember this correctly. They took these different groups of mice. They had one group exercise, one group, not exercise. They had this third group. That, uh, had they sterilized their gut bacteria. They like killed everything.
01:04:40
Speaker
They then took the gut bacteria from the exercising and non-exercising mice and put it in the sterilized mice. And just to see like, to get rid of the actual exercise direct effect, just the exercise effect on the gut bacteria. And I forget what the outcome was, but I think it was something that like aging, physical fitness, and
01:05:06
Speaker
certain other molecules in the gut and it was transmitted by the gut bacteria. And this is something we found, right? So if you take obese mice, you take their gut bacteria and swap it with skinny mice, they'll switch to a certain extent. And the same is true for depressed mice and happy mice and all these different models. The gut bacteria are like their own form of genetics that change our state.
01:05:30
Speaker
One of the things they found that exercise does is it makes your gut bacteria produce these things called short chain fatty acids which decrease inflammation in the gut stream or in the gut. Interestingly, when you eat vegetables, the vegetable fiber is fermented by bacteria in your gut and you make these things called medium chain fatty acids, which are the number, they're the primary energy source for your colon cells.
01:05:59
Speaker
Like we don't directly feed our colon cells primarily. It's the bacteria in the gut that do in our small intestine and our colon. And so I see lots of young people who are unfortunately whooping blood and have like irritable bowels and almost invariably their story is that they eat almost universally processed foods. And if we can get them to switch
01:06:27
Speaker
at least for every patient I've worked with, it goes away unless they have some specific condition. The same is true for exercise. So like I would say, if you want a healthy gut, you need to exercise. It's another way to naturally produce anti-inflammatory compounds in your bloodstream and change your gut bacteria in a healthy way, which is essential because our gut is the core of our being.
Preventing Running Injuries
01:06:48
Speaker
And when we're off or off,
01:06:51
Speaker
And that affects our emotional state. There's a very strong link between depression, anxiety, and mental illness in the health of our gut. Wow. Okay. Interesting. I have to pay more attention to this. Yeah. Um, but I do exercise a lot, so maybe I've got to help you God. I don't know. I don't know.
01:07:12
Speaker
Well, what else have we not covered? Oh yeah. The conversation we're having about obesity. So in a lot of these studies, there's this really interesting pattern that I've noticed that seem to be, well, these are the changes created by exercise. And a lot of them, I hear the same line where they say the changes were not as pronounced in people with obesity, despite the same exercise stimulus.
01:07:41
Speaker
which to me makes me even more compassionate to people who suffer with obesity, not that everyone who is obese suffers, but in that it's almost never a choice or a behavior, right? It's like gravity. Something in the risk factors for obesity makes people less responsive to exercise and less responsive to the changes that most doctors recommend for weight loss.
01:08:08
Speaker
And I suspect it's a multitude of things, but one of them is probably gut bacteria, is that fundamental change in gut bacteria makes you sort of what we would call obesogenic or proobesity, like easier to gain weight. We see that sometimes after people have significant gut illnesses or are on antibiotics for a really long time, they either like lose a bunch of weight and that's their new set point, or they gain a bunch of weight and that's their new set point. Because of the antibiotic's effect on the gut.
01:08:38
Speaker
Yeah, or whatever the stimulus was. You traveled internationally and got a gut bug and then you took ciprofloxacin and your gut was never the same. And I think down the road, we might be doing gut bacteria transplants for lots of different conditions. Not that you shouldn't do that at home.
01:08:58
Speaker
Probably not. That's the other exercise things. Bone density, which obviously we touched on a bit, which was really crucial. Weight-bearing exercise, and in particular, strength.
01:09:13
Speaker
Think of bones like trees. They grow in response to stress. So if a tree is always in the wind, it develops the resistance to that wind. Bones respond in the stress, in the way that they're stressed, which is why if you start a new activity, you can get a stress fracture if you just go right at it. Because you haven't been stressed in a bone that way. So it's good to stress your bones.
01:09:38
Speaker
so that they grow strong and stay strong. And again, like the analogy we made about fly the plane as high as you can so you can coast, develop as much bone density as you can.
01:09:49
Speaker
Well, I think I was interested when they started noticing or doing these bone density checks on astronauts who are sometimes only out of the Earth's gravity for a week or two. They come back and they would see huge changes in huge reductions in their bone density just because there was no stress from gravity. And if humans lived in space and forgot that we ever lived on Earth, we would be
01:10:20
Speaker
So fragile. We would be so fragile, but what we would be saying is humans went to earth and their bone density got better. Going to earth is good for your bone density. But in reality, going to space is bad for your bone density. That's the way we think about it. And so impactful sports, like walking, running, that sort of thing would be better than, let's say, swimming or cycling, which don't happen. So we already know.
01:10:49
Speaker
High aerobic output, low impact exercise is bad for bone density. So cyclists, swimming, you need the impact to maintain the bone density. And I think the joint lining, the synovium, all the different components, the proprioception, the ability to sense joint position, all these things are really crucial for joint function.
01:11:12
Speaker
And I should say the whole idea that running is bad for your knees has been completely debunked. That is definitely not the case. You need to make sure you have good balance and good core strength and good mechanics, but running is protective for knees. Yeah. I mean, I've often felt that and said that to people without any real background in it other than we were made to run.
01:11:37
Speaker
I mean, that's why we stand erect. That's why we have long legs. I mean, compared to other animals that stand erect, our legs make up a greater percentage of our body size. And so we're genetically built for running. Unless you have some kind of congenital problem, malforming
01:11:59
Speaker
joints or whatever, or an injury, of course, and cartilage damage from a ski accident or whatever, that you probably can run. And we've had amazingly good luck getting people who are in their 50s or 60s
01:12:14
Speaker
who come to us and say, well, I haven't run in 30 years. And we'd say, okay, well, we can probably get you, you know, do you have, do you have any of these preexisting conditions that why we shouldn't be running? Like, you know, knee damage or something. And the problem I think with most people with running is they ramp up
01:12:34
Speaker
too fast. And so this, and this segues into something that I've learned that Tony Yoneiro, a climbing buddy of mine, who's quite a famous climber, once told me, and he was a doctor as well, and he told me that
01:12:51
Speaker
the connective tissue like the fascia and the tendons are vascularized at something like one seventh the amount that muscle tissue has. And so they respond to stress much, much slower, like at one seventh the rate.
01:13:08
Speaker
And he said that the way climbers are notorious for injuring their fingers, the connective tissue in their finger joints, because they load it up. And the reason for that is when you start training your forearm strength, the muscles get strong seven times faster than the little tiny tendons and ligaments and pulley tendons and all that that are in the fingers.
01:13:30
Speaker
And so as your muscles feel stronger, you start pulling harder on smaller holds. And if you do that too soon, you're going to get an injury in your fingers. And the same thing is true with running that your cardiovascular system, your heart, and your blood vessels, and your muscles are going to respond way faster than all of that connective tissue, especially in the lower legs.
01:14:00
Speaker
that result often in running injuries. And I developed over the many years, a little formula and I say, you need to have a hundred miles in your legs before you can actually think of training as a runner. And it might take you, you know, for somebody who's well conditioned as a runner, they might run a hundred miles for two weeks, but for other people, it might take four or five months to get to
01:14:23
Speaker
And I think it's because it's the impact, the pounding of running that causes the stress in all this soft tissue in your legs to get stronger and you've got to give it a long time.
01:14:39
Speaker
years or decades. Do you recommend some sort of run walk? Absolutely. That's our program is we use a run walk progression. Because the most common problem for people, especially if they have fitness coming from another sport, is they think, well, an hour bike ride is nothing. I'm going to go for an hour run.
01:14:57
Speaker
It's a completely different animal. Strong quads. Yeah, and those people, maybe because they're genetically gifted or they're just lucky, they might last a couple of weeks. But if they start running an hour, three or four times a week, I can almost guarantee they're going to be injured
01:15:15
Speaker
short period of time and so what we do is have people they might run for a minute walk for a minute for 15 minutes something that and it has to be very depends on their you know their history and we don't progress that very fast so it's you can imagine with that slow progression and that very limited amount of running it's going to take a long time to get to that hundred mile mark
01:15:38
Speaker
and before you're actually really ready to go out and run with some abandon and not have to worry. And we've had great luck in getting people back to running that way and people who haven't, you know, they thought they could never run again. Yeah. Which is really sad. It is. It's a sad thing because running is fun. I mean, it's a beautiful way to move. And I think that, you know, I first ran into this when I was working with skiers who would come out of the ski season really fit in the spring.
01:16:06
Speaker
And then cross-country skiers, pretty much all of them train by running, at least to some extent it's running in the summers. And it's so customary for them to go into these started running program, and they're so fit and so strong. And two weeks later, they've got Achilles tendonitis, plantar fasciitis, shin splints, you name it, the whole repertoire of lower leg injuries.
01:16:32
Speaker
And I began to just say, you can't do that to your body. And so I think it holds true for everyone when you've not been active in running, even a healthy person who has a running history, but spends a whole winter ski touring. When they get back to running in the spring, they have to be pretty careful to add that in. And on the other end of the spectrum, for my patients who are in quite poor health,
01:17:01
Speaker
You know, we're not even getting close to running. It's like, I just tell them to walk up hill, you know, and I define exercises like at a rate that your breathing is increased and your heart's, your heart rate's increased, right?
01:17:16
Speaker
And my colleague, Dr. Tabia has worked with his patients a lot on this as well. And that's where I learned about like the run-walk thing that like, it can really help people get back into that state of being able to run. And running is a funny state that everyone like, there's almost, it's like broccoli. People are like, oh, it's this thing that's so uncomfortable. And my friend, Chris Blora on the radio, when he was first starting getting into running, he was talking about how itchy he would get when he ran.
01:17:43
Speaker
how uncomfortable he felt, but he got through that stage and then learned to love running and it felt good, right? And it's almost like I take my snowmobile out at the end of the summer and I get it ready to go. And then it's like, it just doesn't run well at first. There's like, get the connected design. It's just like not good. You need to burn through that. I think metabolically, physically, it's just a thing that you have to
Insights on Joint Replacement
01:18:10
Speaker
sort of slowly navigate through. And one of the things I was thinking about when you're talking about weakness and tenons and ligaments is the importance of correct mechanics and function for prevention of injuries, right? Because getting injured prevents further exercise. I think the primary way that arthritis develops is in laxity and looseness in ligaments. So that then the joint doesn't move correctly and you get
01:18:41
Speaker
Misalignment. Misalignment, inappropriate rubbing, inappropriate mechanics. And so it's always a good idea to check in and like with PT or with someone to make sure your mechanics are correct and make sure you're doing those core strength exercises that'll facilitate correct motions. So like glute medius, hamstring exercises, transverse abdominis.
01:19:06
Speaker
Yeah, pretty basic stuff, but stuff that gets ignored. And I honestly, I'm kind of, I'm a poster child for this because, you know, I had, as some people might know, and I've written an article about my knee replacement, um, seven years ago and kind of what led up to it, you know, I had a very bad climbing accident in 1978 and that
01:19:26
Speaker
had what was probably at the time state-of-the-art surgery to repair my knee, but it was still pretty bad. I had laxity in the joint. I had insufficient ligaments. I was actually missing one of the ligaments. Over the course of 35 years, I developed a lot of arthritis because I was running and skiing and climbing and doing all these things with it.
01:19:53
Speaker
But I'm sure, as you point out, that misalignment and all the thousands of steps I took in those 35 years, every single one of them was grinding a little bit on the cartilage in a way that it wasn't designed to do, eventually resulting in that knee being bone on bone and had no choice but to replace it.
01:20:14
Speaker
And, and initially when I thought about starting to run again after that knee replacement, I did run walk progression and I started, and this is something I think that is, if you're tentative about running, you should start by running uphill because the impact is so much less than running down or running on the flats. Excuse me. I didn't mean running, running downhill has very high impact. But so I would say on a gradual uphill,
01:20:40
Speaker
you run for a minute. And I did this when I was deciding whether I thought I could run again after the research rate was I would go hiking. And if I found a gradual grade, I might run for a minute or two. And then I'd hike for a while. It was not anything structured or planned. But then I would see how I felt the next day.
01:21:02
Speaker
I just, my knees flaring up and I kept, I found out that, oh, actually it feels pretty good. And so gradually over the course of several months, over one summer, I got to where I could run for 20 or 30 minutes at a time. And then by the next summer, I was running, by the end of the next summer, I was running 30, 40 miles a week.
01:21:20
Speaker
And I think it was the reason I had to be gradual was not probably so much because the joint itself wasn't going to get injured. It was the muscles around it and also just my, and I think a lot of people face this when they have joint replacement is, you don't want to screw this up. And so I wanted to kind of tip my tip toe into it and find out
01:21:44
Speaker
What would happen if I ran for 20, 15 or 20 minutes today? How am I going to feel tomorrow? And now, as you know, eight weeks ago, I had my other name replaced and I've already begun to experiment a little bit. We're snowed in here, so there's no running, but I've got a treadmill and I put the treadmill up at 10 or 12%.
01:22:05
Speaker
and I will get on there and hike and warm up and then I'll run for a couple of minutes and then I'll hike some more and I'll run. And then it's not a big, it's not like what I would call a workout, but it's sort of beginning to test the waters and see how it's doing. And the first time I did it, I probably overdid. I probably ran for three or four minutes and the next day my knee was all swollen and not happy. And I went, okay, well, I kind of screwed that up.
01:22:31
Speaker
So, you know, I've begun to back off from that and said maybe a minute is enough. But I think that it's the uphill grade that's helpful. That's a really good idea. It's almost like when you're skate skiing, the best way to learn is go slightly downhill. Yeah. A little extra golf. Yeah, keep the skis moving. One of the things I was thinking about when you're saying that is the importance of proprioception. So proprioception is the ability to sense your joint position. Right.
01:22:57
Speaker
without even looking at it. With my eyes closed, I can touch my finger to my nose, and it's not because there's a magnet or a sensor in my finger and my nose. It's because I know the exact feeling subconsciously in every one of my muscles of my arm and finger to make that connection. It's because you're so good at picking your nose. That's right, because I can pick up my nose.
01:23:21
Speaker
So, and the way that actually works is there are these specialized nerves in the muscles near the joint that sense pressure and tension. And they basically learned that at this tension of pressure, that's what the joint positions at. When you cut the joint out and replace it, that's all gone. Yeah, it's all gone. You have to relearn. And so when you first start running, it's like all the signals are funky.
01:23:46
Speaker
Yeah, I mean, it's definitely, plus I had something, you know, I've talked to you professionally about is, I mean, there's been, there was nerve damage. You can hardly avoid it. They go in and they start ripping and tearing and nerves are these are pretty delicate little things. And even if they're very careful, they're going to, they're going to damage them. And, you know, they're, you know, it's like the outside of my lower leg is numb. I can't, I can't feel the light touch. I can feel pressure if you push on it, but I can't feel a light touch.
01:24:15
Speaker
I think, and I think I lost a little motor control in those, like the anterior tibialis and some of those muscles on the outside, the lateral side of the lower leg. And when I started running, that was the first thing that would start to hurt. It was like, oh, there's something going on. And I was thinking, wait, they replaced my knee. How can this thing in my lower leg or my arch of my foot be hurting when all they did was replace my knee? More like a subtle change in the mechanics of her knee.
01:24:43
Speaker
just reverberating throughout. I think that's exactly what it is. Whether it's the collateral damage of the surgery, then bumping into things, or just the fact that I'm having to relearn.
01:24:55
Speaker
I'm definitely further ahead in terms of introducing running back into my program now than I was seven years ago. I was a little more tentative then, but I had such good luck with it. I thought, what the heck? Why not try after eight weeks? It's not like I'm running a marathon or anything. My total mileage so far after eight weeks might be a half a mile, so not exactly. A big load.
01:25:21
Speaker
And again, there's a lot of folks when they read that article that I wrote about knee replacement, I got so many emails from people who said, hey, I'm considering a knee replacement because they've been a lifelong athlete and they've worn their knees out or done some damage to them at an injury of some sort. And so my recommendation to folks in that is do it sooner rather than later.
01:25:46
Speaker
Yeah, we were talking about that the other night. When you're younger. I think I'm guilty of giving that reverse advice, which is like write it as long as you can. But now that you mentioned it's like, if it's lessening your quality of life and you might recover faster when you're younger, maybe that's an argument to replace it sooner.
01:26:08
Speaker
Well, and I would definitely be, I'm totally on the same page because like keep your own body parts as long as you can because I'm again, a poster child with the fact that yet it's remarkable that they can put these joints into us and restore a big chunk of our quality of life, but it's still ain't as good as the real thing. It's a long way off from the real thing. So the real thing better be pretty bad before you're signing up for this kind of thing because there's a lot of
Exercise as a Transformative Signal
01:26:39
Speaker
It's not an easy surgery to recover from, let's put it that way. No, no. Let's see. So let me think if I have other things. I think almost to sort of summarize it, I would say exercise is a stimulus. It's a signal.
01:26:57
Speaker
And it's a phase change that creates all sorts of changes in your body. And I think 9,800 and something, the exact number who knows. But I think the idea is we know without a doubt that it increases the length of your life, the physical quality of your life, the experience of being able to breathe.
01:27:21
Speaker
being able to get the places you want to go and feel secure about it. And it improves the emotional quality of your life. We know without a doubt that exercise improves our emotional health, makes us more resilient against the bad stuff that happens to all of us. And we're learning more about how those things actually are created, but yeah, exercise is our fundamental state.
01:27:50
Speaker
It is. I can vouch for that after many years of doing it. I can't live without it. The day that I can't do this, it's going to be a black day for me. I've been in situations with injuries like my knee, where it was a huge hit to my psyche and my quality of life when I couldn't ski, run, climb, and do all those things.
01:28:15
Speaker
I know there will be a day when that comes again, but I'm fighting against
Encouragement & Closing Remarks
01:28:21
Speaker
it. I'm out there every day doing something. I encourage our listeners to do the same. If you've got questions for me or Jesse, you can just address them to Scott, an uphill athlete, and I'll pass them on to Jesse if he's interested. I know he would be interested in trying to help you.
01:28:40
Speaker
Well, thanks a lot, Jesse. It's been a great chat. It was just a lot of fun. Yeah, good. Well, thanks, everyone. We'll catch you the next time. Thanks for joining us today. For more information about what we do, please go to our website, uphillathlete.com.