trail and ultra runners what is going on what's happening? Welcome to another episode of the coop cast. As always, I'm your humble host coach Jason coop. And on the podcast today we have some big picture discussions lined up for you is all about the potential long term health problems and key word and that statement is potential of ultramarathon running and ultra marathon racing. On the podcast today, I have repeat offender again, Nick Taylor to talk about a recent review article that appeared in the journal sports medicine, the lead author of which is voeckler shear who is part of the ultra Sports Science Foundation. Nick was one of the co authors on this paper, and the title of it is potential long term health problems associated with ultra endurance running and narrative review, a link to that paper is going to be in the show notes. And this combined with two other factors. First off this narrative, that endurance exercise is either bad for your heart or bad for certain Oregon seems to come around every few years, we talked about the last time that this narrative came around, in kind of in the intro of this podcast. And the second thing and more tragically, recently, with a death that happened actually out on the marathon to sob course, we always need to keep these things in the back of our mind, because ultimately, we do ultramarathons for our own enjoyment, our own health and just simply as a recreational activity. Very few of the listeners out there are doing this professionally. And even amongst those professional athletes, they certainly do not want to do any of these activities at the potential keyword there, again, expense of their long term health. So I do think that it is important and also responsible for those people in the industry, including myself and including people like Nick, to present the entire picture as we know it today, based on what the science is actually saying, do these types of activities, whether they're training or racing, can they potentially have a negative impact on our long term health. So we explore all of that, during the course of this podcast, as always, is a really fun conversation with Nick, you guys go and check out the show notes to this podcast, there are going to be a lot of links out there to some of Nick's work, you guys should go and check it out. We start out the conversation with a little bit of banter about the book, which he was a scientific reviewer on, and some other things that were going on. But I promise we get right into this paper. Within a couple of minutes. You guys will all enjoy it. I guarantee you. Here we go. I'm going to step right out of the way. Here's my conversation with Nick Taylor. I found this hard copy of this book. Do you remember when this book came out the haywire heart?
Yeah, a few years ago, wasn't it?
I think it was 2016. And kind of there's two reasons that I want to use it as an as a little bit of an intro and why it's still kind of vivid in my memory. First off, just as a personal connection, we use the same publisher, so the first edition of my book, use the same publisher as this. And for whatever reason, these things kind of go it's just like everything else, they go in cycles, right? Doesn't matter whether we're talking about a ketogenic diet or you know, endurance is going to kill you. It seems like every four or five years, this narrative starts to starts to come back up in the combination of the fact that we have the same publisher. And in addition to that, just the title and I'll read the title for the people that are that are listening to the podcast version of this it's called the haywire heart which is by Chris case, John Van mandrel. In Leonard's in Leonard's in is a longtime cyclist has had a huge footprint in cycling for a long, long time. And the first part of the subtitle, which I don't think people got past, is how much to or how sorry, how too much exercise can kill you, comma, and then a line break and what you can do to protect your heart. And I think the way that, you know, it's obviously ordered provocatively, because you got to sell books, right? You're presenting the negative first in this really provocative manner, and then almost kind of surprised that the second part of that subtitle was it in smaller, smaller font just to like, hide it even more. But the the, the book kind of caught the endurance world by storm because it spoke to the entire endurance spectrum cyclists, runners triathletes, and it was right around the time where more Ultra marathoning was starting to take off once again 2016 Ironman was doing very well in cycling was was was still kind of doing very well at the time and even on the on the cover. They've got that You know, they've got this, they've got these images of all three of the different endurance disciplines across the front. So it kind of spoke to kind of spoke to everybody. And what ended up in the totality of the book is what is what I think is fairly balanced, meaning it does what the entirety of the subtitle actually says, it goes through how much too much exercise can be bad for your heart, maybe not how it can kill you, but how can be bad for your heart. And then also, it gives you a lot of preventative takes on even what to do when you go to the doctor's office, right, how to prepare yourself for a cardiologist visit and things like that. So now here you go four or five years later, right on cue with you and your colleague Buckler bringing the narrative up again. And so I want to know, like, has, like the lay media started to reach out to you to to get some takes on this, since it's kind of in the same, it's in the same vein?
Well, the difference here, of course, is that I don't have a book to sell. So you're absolutely right. The title, they have a create the problem with the title itself, they create the problem. And then they're like, well, here's this, here's the solution, you know, so they're catastrophizing, the whole thing, and then and then providing a solution to it, which I think is so irresponsible, but I understand why it's its business, and you've got to sell books course. And now generally, the I haven't had too much negative feedback from the paper, that when you do get negative feedback tends to come in the form of one of two logical fallacies. It's either a false dichotomy, or it's a slippery slope. So what people generally say to you is well, okay, so let's just stop exercising, and we'll just sit on the sofa, and we'll we'll get cardiovascular disease, will that make you happy? You know, which is obviously it's a slippery slope fallacy, but it's also presenting it as like, well, either there's either we go, we go into ultra endurance running, which is the most extreme form of exercise that you can do when you do nothing. And well, obviously, that's, that's a false equivalency, because there's a lot of space in the middle there, where you can do you know, recreational exercise, you can go out and run marathons. And it's still not going to be as extreme as going out and running for 2024 to 48 hours, two to three times a year. But, but you know, I'm used to getting it in the natural people, because I spend a lot of my time writing about, you know, tackling chiropractic and cupping, and people who are very zealot about these alternative therapies. So, yeah, that stuff doesn't bother me. But you know, what, what we wanted to do with this paper, and that's the different series that I'm not gonna get paid for writing these papers. So certainly not directly non any form that I recognize. But what we wanted to do was try to just get a very clear and lucid message across that very broadly, exercise is good for you, reduces the risk for all cause mortality reduces risk of cardiovascular disease, being active, being physically active, doing exercise is a good thing. But not all exercises completely benign. And actually, you know, I'm an ultra runner myself, and I've been running Ultras for for nearly two decades. And as an ultra runner, I want to get more people running, or to get more people participating in this sport, but I also want them to do it safely, I want to increase kind of the standard of medical support at the events, and I want to improve longevity in the sport. And to do that it's no good. Just burying our heads in the sand and pretending like these, these things don't exist, it's important, it's better to have just an open discussion about the risks and the benefits and make a sensible approach going forwards. And that's how you improve. That's how you increase longevity in the sport,
in that's really what I appreciated about this paper. First and foremost is that it was balanced, we can't stick our heads in the sand and say all everything is good. And it's all unicorns and rainbows. And there's no risks associated with anything, you have to be realistic about the risks. And then the potential trade offs that you get for training as hard as a lot of the athletes that are in this space have have to train. And I've always looked at things through a 10 year lens, if you can do things and 10 years down the line, they're not positive, you should go ahead and do them. They might be net negative for like a week or a month, or maybe even maybe even a year in some cases. But if you can do things, you put content out there in this case, right? Training interventions are whatever that are net positive over long periods of time. That's is what I think is true ambassadorship within the sport, which is what people like yourself who are in leadership positions should always aspire to do so. So let's dig into it. You guys took a cyst camp, what I would what I would describe as a system by system approach, very scientific, right? We're gonna take the whole body and we're gonna look at all of these individual components and say, okay, Here's how things are affected by ultra marathon training. Here's how this system is affected by ultra marathon training, here's how this system is affected by ultra marathon training. And then you took what I thought was a really unique approach where you looked at I hate to say the word special populations, but just like different populations that might be under studied, and pointed out some differences within those within within those populations group. But let's look at the system by systems approach first, right? When you were going to bring it all back together at the end, because I think there's a good synopsis that we need that we'd be remiss to mention that, that health is far beyond one system or another. And that's going back to the title, potential long term health problems, right? Which we need to be mindful of. So when you look at each one of those systems, would like in your reviewing the literature, which ones kind of stuck out to you that okay, these things are more affected by ultra marathon training than the other ones?
Yeah, and we took this approach in the paper, because I think it helps scientists to sometimes create those arbitrary abstractions, to think of it in different body systems. You're absolutely right, that actually, the body is an organism, and all of these different body systems work synergistically. And I think it's always better to look at how these different systems overlap and intersect. You know, we talked about cardiopulmonary function, for example, you know, how the, the, the heart and the circulatory system and the lungs kind of work together as the sort of single unit. But actually, the way that one system functions will have have implications for all of the others. But I think when you're looking at the research, it's certainly easier just to split it up and, and kind of create that arbitrary sort of boundary. And the other thing that you mentioned, which I just want to touch on very quickly, is we were very pointed about using the term potential in the title. And we went back and forth, whether it's a two word wherever, whatever, but actually including the word potential in there, and we use it, we litter it throughout the manuscript. Because these are potential, these are not guaranteed mal adaptations that all people are going to experience. These are potential long term implications for some people. So I think that was really important to just touch upon quickly. So in terms of which ones jump out, more prominently if certainly the cardiovascular system, respiratory to, to a lesser extent, and perhaps renal as well. But the one, the main one that people are concerned about, and this is probably why the book you mentioned was so popular is because cardiovascular system, the heart and the blood vessels are a really important role in the body, you know, the circulatory system literally keeps us alive, pumps, blood and oxygen to various tissues. And if that system failed, in fact, if any one of the system systems failed, you've got a problem, the cardiovascular system, and you know, that the heart and blood vessels, really to do kind of strike us is one of the more kind of prominent systems that is so crucial for life. So when we look at the long term implications, Mal adaptations in the cardiovascular system, particularly in the heart center, be more prominent in the literature. And then there's more literature in that area as well. So I think that's why it's possible to write a book on this subject,
in what always strikes me when I look at this is the proportion of, of endurance athletes will kind of scale it down from ultra marathon athletes, but endurance athletes that present some sort of abnormal heart structure, and it's on the order of 50%. And more. And I think that's why it gets so much attention is that when you line up a bunch of people, and you start doing, you know, measurements and scans and things like that, on their heart, very specifically, the endurance athletes as a consequence of their training, their hearts just look differently in the in the in that in those differences are what could potentially to use your word, and I just looked it up 22 times in the paper, by the way, so that's over, that's over one per page. So potentially, could cause problems. What people are going to want to know is, this is an impossible question to ask, but it's my job to ask it. What's the threshold? Where's the threshold where things might cause more harm than good? Specifically with a heart when we're looking at training and the potential for that training to manifest itself in some sort of cardiac problem?
Well, see, this is the million dollar question. And this is what I find so fascinating about this topic, and it's not been explored enough. We need to kind of really zone in on answering this question, because the key question that we have to answer here is, is it the high volume training that does the potential damage to the cardiovascular system primarily, or is it the physiologic called stress strain of periodic racing that does the damage. And that's a really important question that the moment we can't answer, there was a really fantastic study published by Ben Levine's group. In the last year or so have you have you spoken to Ben,
I had him on the podcast. Now I want to bring him back. I want to bring him back to talk about stuff like this, though. So the longtime listeners remember had been living on to talk about potential cardiac complications from contracting COVID based on a study that they did primarily in NCAA athletes. So that's the that's the reference point there that Nick was talking about.
He's a great guy and a world renowned cardiologist. And his group published this study looking at more than 2000 Extreme exercises. And they did this long term follow up and a really comprehensive cardiovascular assessment. They did echoes echocardiography, which is basically getting ultrasound images of the heart to look at the structure and function. And they look to coronary artery calcium, which is kind of calcified deposits in the in the blood vessels that actually supply the heart with blood that the heart itself. And as I said, they looked at over 2000 Extreme exercises. Now, these are not ultra endurance athletes, and they're not professional athletes, they just love exercise, and they do something up suddenly upwards of 30 hours a week, okay, which is, which is, which is a lot of exercise, I think, even for most ultra runners, you know, 30 hours a week would probably be enough to satisfy all of your training requirements. And so we do a lot of exercise. And what they found was actually that there was no greater risk of cardiovascular disease and no greater risk of mortality in this group in a fairly long term follow up. Now, this is great news, because it means that in theory, you can do a lot of exercise, you know, upwards of 30 hours a week. And it's not going to have negative implications on morbidity and mortality. But this is this is the problem, this is the problem that we have is the output with Ultra running. It's a different scenario, because you're not just doing a very high volume of training. You're also going out a couple of times a year, and you're running for a day or two days. I mean, how you know, from the euro athletes, how many times a year do they typically race?
three, maybe four?
Okay, so let's say somewhere between two and four times a year, they're going out, and they're racing, at least for 12 hours, maybe 24 hours could be 48 hours. And that's it, I think about like a typical 100 mile race, like UTMB, for example. So it's 10,000 meters in the sand, is a very, very hard race to good athletes will still take 30 hours to finish that race. You know, the elites do it in? I mean, what's the record now it's like 20 coverage 22, something 22. So the elites are taking basically a day to get around this course, for everyone else is it's closer to 30 or 40 hours, you do that two to three times a year, for a decade or two decades. Nobody really is, you know, in the right mind is going to think well, that that's going to be good for you. There's there's got this, this intuitive to think that going out and doing that that kind of really extreme physical activity is going to have some kind of Mal adaptation. And it appears that if you do this, you engage in these really extreme exercise behaviors. That might not necessarily be the problem. But what could be causing the long term cardiovascular implications. It could be the fact that we're going out two to three times a year, and you're exercising for a day or longer. I mean, I saw this girl on social media. I won't name her but she's got something like 10,000 followers on Instagram. And her thing is that she races really, really frequently. And I think the last time I checked, she's clocked up six or 700 miles this year alone. That's awful lot of racing. And particularly, you know, the 100 mile races are at the definitely at the extreme end of the spectrum. Most ultra runners probably won't brace 100 milers, and if they do, they won't do them very often. And so you have to think a lot of people think that what for whatever reason they're doing it for maybe they just like the intention. She's She she's not an elite athlete. So she's not getting sponsorship. Maybe at some point, she can monetize the 10,000 followers that she has. But the point is that is not somebody who is racing sensibly. And I'm concerned about her longevity in the sport, because if I think intuitively, that it's the periodic stress of racing that could be doing damage rather than the training itself.
Yeah, that's an interesting piece of deductive logic and it kind of comes out with let me just like synopsize that a little bit for the listeners, right. So based on the Levine study, they're taking all of these chronic extra sizes 30, exercisers 30 hours a week, which I agree that's a lot of training that's like Ironman professional Ironman level training. And they're not finding any issues with their cardiovascular system or with their cardiac system. However, so if so if it's not the high volume training that could potentially cause problems, it could be these repeated doses of overload in the form of races that could cause that. And there's another, there's kind of another thought, there's another line of thought around this as well, which kind of follows that similar deductive path, okay, if it's not chronic endurance training, even very high volumes of chronic endurance training, it's something that you're doing repeatedly, that's over. And the other thought process is high intensity training. So if you do high intensity training, once a week, twice a week, over the period of 20 years, that high intensity training over that period of time, because it's so far over has the potential to cause cardiac issues as well. But it's always interesting how these things kind of come back to okay, we're going to rule this out, we're going to rule this out, we're going to rule this out. And the thing that's left over is is the logical answer, right?
Yeah, sure. And it's for it's really difficult to do because ultra endurance for ultra running more specifically, it's only really been studied for the last 3040 years, which sounds like a long time, but that human physiology has been around for an awful lot longer. And we're really just starting to scratch the surface. And unfortunately, a lot of the research that we have in ultra endurance sport, isn't that good. It's not very mechanistic. It's kind of just publishing stuff for the sake of publishing. And it doesn't really advance the field forward. They're all we we have this wonderful string of studies back in sort of 2009 2010 and 11. From Andrea Gersh is group and I mean, I've got some of the papers up here, which was cited in our review. Yeah, the girl she's group and Jessica Scott, with Keith, George and Rob shaver, those guys. And they did this great string of studies looking at, you know, fairly small sample sizes, but looking at the cardiovascular implications of competing in either an ultra marathon, or ultra triathlon, which was Ironman. And, you know, fine, looking at it mechanistically. And looking at what are the structural and functional changes that occur pre to post race? And what are the follow up? You know, if you do a follow up a week later, do the, do these kind of acute perturbations come back to baseline? And generally they do. But we haven't done a lot of really good work on it since then. And there are a lot of unanswered questions. So, for example, this study, in particular, that was published back in 2008. And again, this is from Andrea Gorjuss group, and they took 26 athletes who had done an Ironman Triathlon, and they took some blood samples pre and post, and they looked at these biomarkers of cardiac damage, it's kind of debated whether the markers really reflect cardiac damage, but, but it's kind of like troponins, and BNP, and so forth. And they did some echocardiography as well. And what they found was that when he did a follow up, which was a week after the event, all variables have returned to baseline. So they had 26 athletes, and they looked at left ventricular and right ventricular function. And they looked at these biomarkers in the blood. And pretty much everything you've returned to based on a week after the event, which is just great news, except in one athlete, where right ventricle dysfunction had persisted even one week after the event. Now, lastly, there was only one line in the in the paper, you know, they're really exploring in any in any sufficient detail. And it's easy to just kind of gloss over that, but that one athlete, that that one individual is clearly more susceptible to these acute kind of cardiac dysfunction. And so if this athlete then goes away, and does another Ironman, you know, a couple of months later, or does the third Ironman in a given year? Are they more susceptible to these long term mal adaptations? Because clearly, in this one individual, everyone else has recovered back to baseline within a week of the race. But one week later, this one individual is still exhibiting some kind of dysfunction. So they're obviously not recovering as quickly. So with repeated stimuli, is this the individual that is, you know, wanting 25, who is going to potentially, you know, exhibit with these these cardiovascular abnormalities after a decade of training and racing, and that's we've got to do more work in that area as well to kind of pull out the ones who are potentially more susceptible.
It makes sense that you see those things show up in In races, as opposed to training, because if you think about a training bout, even the hardest training bout that you can design, it's not that much different from whatever your baseline physiological output is, right? If you think about homeostasis, right, you're not removing, you're not moving up and down the homeostasis ladder all that much in any one single training bout, but a race, particularly Ironman, particularly ultra marathon, you're moving way up the ladder from a homeostasis standpoint. So the potential for disruption in any one singular system is always greater or greatest when you're when you're doing that the most.
Oh, think about the race, the race duration, okay, typical marathon runner. And this is kind of if you're not looking at ultra endurance sport, but the kind of the next peg down if you like, is marathon running. You go out and train for marathons. Even if you're not elite, you might, you might still go and run 20 miles, 22 Miles case, you're running your first marathon, it's recommended while you're the coach, you tell me if you disagree, and it's recommended probably go and do at least 20 to 22 miles. So
that's the point. Yeah, that's the cliche formula.
That's the question. That's the one that I'm most familiar with, because I'm not a coach. But okay, but but still, you kind of try and you can get close to the distance. Okay. You could argue that that last 10k is what does the damage, but okay, even even worst case scenario, you go out, and you might do 18 miles, 2022 miles, even if you do the full distance, the fact that you can go out and practice the full distance is meant as a memory. When do you ever go out and practice running for 24 hours, you don't do it because the physiological strain is so great, it will have a knock on effect on on all of your training, it's impossible to really condition your body to go out and run for 24 hours. So go and run 400 miles. And that's the discrepancy that we're looking at.
Yeah, that's it. That's one of the things that makes ultra marathon so fascinating. So okay, we've got the we've got the cardiac system, right. And there's this, we're not going to come up with any like brilliant answers here. But I want to give people information to where they can actually kind of track things down. And I think looking at things post race might be a good way to start to do that. What are the other like heavy hitter physiological systems or organs that once you pour through the literature, just more susceptible to long term health implications from either repeated racing or, or repeated ultra marathon training.
So I think the respiratory system is another one that for which there is potential for long term adaptations, probably the, for the most part, as far as we know at the moment in terms of the respiratory system, the negative aspects of long term training of racing, probably not greater for ultra than you would expect for other types of endurance training. So that so when you when you compete in a in any given Ultra race, and you see similar kind of responses to a marathon, but it's, it's kind of exacerbated and Ultra, we see this, this acute drop in lung function. So when we say lung function, we're talking about lung capacity, the amount of air that an individual can move in and out of the lungs in a given breath. And also peak flows, how quickly the air can be expelled from the lungs. These are all kind of very basic, superficial measures of lung function. And and all of these things drop by somewhere between 15 and 25%. Immediately post race, you see similar responses if you were to do a triathlon, or marathon. And for the most, for the most part, these these changes are not clinically significant. In most people case, you'd get this significant reduction. But it's not in most people, it's not clinically meaningful. Now, there is a caveat to that, that if you have a pre existing respiratory disorder, if you have asthma, or if you have baseline function that is below average, then they could be clinical manifestations for somebody who then goes out and does an ultra endurance race
because they're starting lower, and then they get
from a lower body exactly the starting from a lower baseline. So if you have somebody with below average, below average baseline function, and then they drop by 20%, they're now getting into this kind of region where we might be a little bit concerned from a clinical perspective. But most marathon runners if they don't have a pre existing respiratory disorder like exercise induced asthma or kind of regular asthma, and you know, most of the time they don't have, you know, COPD, there are some COPD athletes, but for the most part, if you have chronic obstructive pulmonary disorder, you're not going to be you know, be running marathons and doing travels. Most people it's not clinically meaningful. But what I will say about that is it's always if you're unsure or if you're competing in your first Ultra it's always a good idea. it to maybe go and get screened go and get your respiratory function screen because it's an easy test to do. It's basic spirometry. And a lot of these ultra races, they don't they're extremely distance, they're extremely duration, a lot of the time you're competing in extreme environments. And you don't want to find out for the very first time that you have a pre existing respiratory disorder. When you're halfway up a mountain, or when you're, you know, traipsing through the desert, because you know, medical assistance, as good as it is, in most of these races. If you are halfway up a mountain, you don't want to start having some kind of, you know, distant distressing respiratory symptoms that could have been avoided. So if you are competing in your very first race, it's always a good idea to make sure that you don't have any pre existing conditions. But to kind of finally answer your question, with the respiratory system, the main thing that we're looking at is kind of long term damage to the airways. So this is the stress and strain that causes inflammation in the airways. And this can happen whether or not you have asthma. And this can occur just through high volume training, particularly in cold and dry conditions. When you dehydrate the airways, it causes an inflammatory response. And, and in the long term, studies show that this can cause kind of damage and remodeling of the airways.
But this is more volume dependent, I guess, is what you're kind of getting at right long term, repeated repeatedly breathing in dry air over long periods of time, that might cause some type of remodeling of the airways that could have a negative consequence
is particularly with endurance type exercise, because the hyperventilation rate, so whenever you're doing an exercise where the ventilation rates are kind of going to be relatively high and off for a prolonged period of time. And, as you've said, you quite rightly say it's the duration seems to be the issue. So this is what we refer to as exercise induced asthma or sometimes called exercise induced bronchoconstriction. The highest prevalence rates are in cross country skiers, because they have very high ventilation rates, long periods of time, but it's in very cold, dry conditions that dehydrated airways causes this inflammatory response, the very limited data that we have at the moment suggests that the prevalence rates of exercise induced asthma are probably not higher in ultra runners than they are and in the rest of the population, maybe very slightly higher, but certainly not as high anywhere near as high as what you see in Olympic athletes. So we're talking about an ultra runners prevalence with about 11% Olympic athletes, you're looking at 20%, something like this, we've got very limited data, the only data we have on this is was a survey done by Marty Hoffman. And they looked at over 1200 ultra marathon runners, and self reported prevalence of exercise induced asthma was about 10%. You have to take those data with a pinch of salt, because it's self report. And you could argue either way, you know, individuals who, who respond to these types of surveys, maybe they have, you know, maybe they're responding because they are less healthy. And they want people to know that they're less healthy. Or maybe they're happy to respond because they're more healthy. You know, so it can kind of swing both ways.
Yeah, that data, that data has been brought up when the TV chronic controversy with inhalers at the Olympic level, right, because the diff, the discrepancy between the number of Olympic level endurance athletes that have asthma, right and are applying for a therapeutic use exemption to us, usually it's a you know, usually it's some sort of inhaler, to treat that is so much higher than the general population or even when you subset the general population into like recreational endurance runners, people kind of look at that. And, you know, they get the skeptical snake guy and think that something's arrived. But interesting that that the highest prevalence see is in cross country skiers, which makes all the sense in the world, they're doing the highest volume in the driest conditions.
Yeah, and also, anytime you're doing this endurance type exercise in an environment that could irritate the airways, so if you exercise in an area with high pollution, you know, that can have a negative effect as well. You know, climate change is real folks, and it can have a, you know, downstream negative effects if you're doing very high volume training. You know, I've been in California for a little while heading back there soon, but during wildfire season, they're like, maybe don't exercise outside because it's it's not going to have a positive effect on In fact, there are a dozen studies recently on this. It's absolutely fascinating that the the long term effects of exercising in a highly public To area could could have more damage and actually may offset the beneficial effects of doing the exercise in the first place. And it's like, okay, finding a gym during COVID is going to be tough. You know that's that's why treadmill sales has gone
through the roof. Yeah, exactly all those indoors, elbows, indoor exercise equipment. Okay. Anything else on the respiratory equipment? I'm going to dodge the UTMB health policy question with you. By the way, we're going to handle that in the podcast later done. A lot of people are listening and wanting me to ask that question. We're not going to cover that here. But anything else on the respiratory system or if you just want to go off on the UTMB health policy, you're more than welcome to?
Well, all I will say about all I will say about it is that I absolutely support the fact that it banned the use events, I think we're talking about NSAIDs and analgesics or something slightly different. When it comes into play. When we're talking about renal issues. That's the other thing that we can touch on very briefly, is the potential for long term renal problems, because this is something more prevalent, potentially an ultra endurance sport because of the stress that you're putting the immune system under. And banning NSAIDs is a fantastic move, because there is more than enough data now to show that NSAIDs have this really negative consequence on the way that the renal system function basically blocks prostaglandins, which, which restrict blood flow to the renal system. And when you're doing an ultra with we've segwayed nuts, you know, smoothly seamlessly function. But you know, when when you do an ultra race, and particularly the really long Ultras, and this is why Ultra Sr, crazy sport because you say marathon to somebody and everybody knows, the marathon is 26 26.2 miles, 42.2 kilometers. And Ultra can be six hours, or it can be 46 hours, you know, and everything in between. But when you when you do an ultra, you're still really stressing the renal system. Because anytime you restrict blood flow to the renal system, you're potentially causing inflammation, and then downstream damage. So it's the prolonged nature of the event, which which causes redirection of blood flow to the exercising muscles. It's the fact that a lot of these races are done in the heat, sometimes at altitude. So that has implications as well, you become chronically dehydrated, and people don't take in enough fluid, there's the risk of potential risk of hyponatremia, you know, not taking in enough electrolytes. And that's a whole separate podcast, I'm sure you've talked about that before. And, you know, when you pile NSAIDs on top of that, that that increases the renal stress, then you have this kind of cocktail of ingredients, that that it's very easy to see why acute kidney dysfunction is kind of so common in ultra endurance for now, for the most part, it's benign, and it doesn't have clinical manifestations, mostly. And really catastrophic renal injury during Ultra races very rare. That's a really important to say, what we don't yet know is if you have repeated injury, with the renal system, even low grade injury, whether that could cause chronic renal scarring, chronic scarring of the kidneys, and how that kind of manifests in renal dysfunction in the long term. That's the thing that we don't yet know.
And I always like to point this out that these are things that are greater than the sum of their parts, right? So you do this ultra marathon. And yes, it's a really long duration event, your kidneys are under a lot of stress just from the stress of the event, and then you add on high temperature and then you add on dehydration, and then you add on the stress that the NSAIDs are present. And there it's an exponentially weighted equation at that point, right? It's not linear, it's not linear. It's not one plus one equals two, it's like two squared, or two to the fourth power or two to the sixth power, and so on and so forth of all these things. And, you know, there are a lot of medical directors out there. And we should spend some more some more time on this because this, I think, is a big, big problem. There are a lot of medical directors out there that that's what they're preparing for. They're preparing for acute kidney injuries and people with renal failure to come in and what are they going to do with them? Right? I mean, that's, that's their almost kind of like nightmare situation where they have to treat those people out in the field or try to transport them to a hospital as quickly as possible in not only the kind of the short term consequences of that, I think, are things that athletes need to be wary of. But the long term consequences of repeatedly doing that because it's an organ that doesn't repair itself very well is, I think, also underappreciated with endurance athletes, because we have in races in particular, every ultra marathoner that's listening to this has this mindset of, I want to do whatever it takes to get to the next aid station to fit has just raised to get a 24 hour belt buckle. And they're not thinking about things that they're doing and the consequences of those things two or three years down the line. And this is an instance where when you're taking NSAIDs, particularly during a race, or you're repeatedly damaging your kidneys, and some other form or fashion during the race, that might have long term consequences, specifically, because it's not like a musculoskeletal injury, where you take two months off, or you take, you know, four weeks off, and it repairs itself, this is something where the regeneration in the repair is low, if not non existent in a lot of cases.
And I think anytime you have the potential for a maladaptive response, then you have the potential for long term implications. So with the renal system, as you say, it's not an organ system that seems to regenerate as as perfectly as optimally as you would like, if there is some kind of, you know, acute renal injury, then the risk that you're not going to come completely back up, the baseline is always going to be down with the respiratory system. It's more than that the unknown is kind of pulmonary edema, which is something that we that we didn't mention, but very briefly, pulmonary edema, or extra vascular lung water is a common response to strenuous exercise. We see it very frequently, often marathan. And after culture, it seems to be relatively benign in most cases. But again, if you have this repeated stimuli, and you repeatedly experienced pulmonary edema, what are the long term implications of that? And with the cardiovascular system, it seems to be more right ventricle function, left ventricle seems to adapt pretty well. Yet, left ventricular hypertrophy, this is a normal response to endurance training, left heart gets bigger and stronger and pump more blood out with with each contraction, but the right ventricle seems to maybe not repair itself quite as effectively the the long term implication seems to be more pronounced in the right ventricle. So you're absolutely right renal system is one of those organ systems doesn't seem to bounce back quite as effectively after an acute injury.
So the take home for the for the listeners are stay hydrated. And don't take NSAIDs. Really? That's really That's simple.
Yeah, pretty much it don't obviously, don't over Drink, drink, tea, right amount of fluid. And if you're serious about your ultra running, you should know what that is. And don't take NSAIDs. There's a reason I fully support the fact that they're banned and says, I hope other organizations follow suits. I'm also so sure about the banning of analgesics altogether, I understand why they've done it. They don't want people masking symptoms. Masking pain is issues with that. But NSAIDs, there's no debate that
we should we should differentiate between the two colloquially. So NSAIDs would be something like Aleve or Advil, ibuprofen and naproxen and then an analgesic would be Tylenol and aspirin always kind of like floats in between the categories. I never even gotten that.
Yeah, as soon as I believe it's an NSAID. It's a plus a blood thinner as well. Avoid aspirins avoid any kind of unsteady, the colloquial names are different in in Europe and, and in the US. So I'll take your word for that in the Europe it's like Ibuprofen is the most common answer to all avoidance is analgesics like Tylenol and in Europe is paracetamol. It's the same stuff. And these are just analgesics these are just just pills usually built on capsules that mask the pain
the Yeah, so the difference and I think that we should point this out the differences the NSAIDs are affecting the renal system and the analgesics have the potential to mask pain which just makes you run through a musculoskeletal injury or some sort of other injury when you would not have otherwise.
Yeah, for sure. And I think if you have most runners again, if you if you've got enough experience, you'll know when there's when there's a new law because you've been running for quite hours and you're low hurts and when there's a pain in your leg because you've taught something you would hope that people would know the difference, but it's much harder to detect that very fine line. If you don't stop on, you know, Kokoda mall or you know, other other types of analgesics, you know, opioids and analgesics, whereas NSAIDs are, as we've said, non steroidal anti inflammatory drugs, they're all They're anti inflammatories, which is the key thing. And they work in in a very different way. So it's important to draw a line in the sand separating those two things.
I always my rule is I think I've mentioned this on this podcast before if I find ibuprofen or naproxen or leave or whatever, in an athlete's draw bag or something like that, and I'm caring for him. I just throw it in the trash. Yeah, don't know. I don't give him the option. Yeah. And I know themselves. Well. It's just like, well, I just need this just in case I'm like, No, you don't. Yeah, no, you don't. I don't want to take the risk. I don't want it over.
There's no excuse. I think there is more of a lucid argument for basic analgesics. But and since the question,
okay, we'll put that one to bed. Okay. Last topic is in the paper, you, you, you and your co authors. Good friend voeckler took some time to point out some what's different between different populations and specifically with female athletes and and masters athletes, that there might be certain considerations that those groups need to take into consideration when they are looking at their long term health. We'll talk with the Masters athletes first, because that's pretty much everybody and ultra running. I mean, come on, look at the demographics, everybody's over 45. I'm about to be over 45 in a couple of years. So I'm gonna get in that in that
peak as well. If you look at the data, you know, most of the European performance in races between 50 and 100 miles probably going to occur in your mid 40s. Yeah.
So you guys drew the line, you guys drew the line at 35. Right, which is, you know, people draw the line at 3540 45, or whatever. What what specifically, though, do masters athletes need to look at that could potentially cause issues for their long term health when they're training or racing ultra marathons?
Well, there's two, there's two basic scenarios that you that you can look at. The first one is a Masters athletes, so somebody over 35, but But typically, this could be somebody over for your own safety, who's having something of a midlife crisis, and then probably some of them have never exercised before they give up smoking, and they start doing Ultra running. And this is, this is a recipe for disaster, because there may be pre existing conditions that maybe haven't manifested, they're not conditioned, and that they basically jump in at the deep end. And it's kind of asking for trouble. And so that's kind of one scenario you're looking at. The other scenario is somebody who started running Ultra at a kind of a much younger age, maybe somewhere between 20 and 30. And they've been running for 20 to 30 years. And in those people, because they've been endurance training for such a long period of time. In everything that we've been discussing, for the last 45 minutes, there is the potential for chronic mal adaptations in a small subset of people. So you just need to take precautions to make sure that you don't fall into that subset. And if you do, you've you've scouted it out, and you're taking the relevant, you know, the appropriate steps to minimize your risk. So those are kind of the two types of masters athletes. And as you've said, kind of the the average age of an ultra runner is probably somewhere between 35 and 55. And there was a great paper published by the Nestle and Nicole nuclide is back in 2018. physiology and pathophysiology and ultra running. And one of the things they did right at the start, I produced a bunch of tables and looked at the average age of peak performance in the different race distances, what we basically find is that from the shorter races of 30k, the average age of peak performance is like 35 years old. And then as you as you go through the higher distances, you get up to 100 miles, the age of peak performance is like the mid 40s. So kids your age of peak performance increases concurrent with the race distance.
You know, it's interesting when you mentioned those two different types of masters athletes, because in my coaching practice, the first couple of years of coaching athletes in either one of those groups looks markedly different. I can have a 40 year old that comes into Ultra running from no exercise background, bull ride, I had this guy who was professional bull rider for many, many years. And then he came into running and was not he did not use endurance as part of his bull riding training, which partly probably part of his problem. That's another story. But his training looks markedly different than the 40 year old that has 20 years of endurance running experience, whether it's high level high level training or not. And kind of the fundamental, the fundamental way that a different is in the first category, the 40 year old that doesn't have that type of experience is you're just checking a lot of boxes at the beginning. Like are they good candidates for training, you don't know what their training strengths and weaknesses are. So all those things that you pick that you can pick up from previous training patterns, with the latter group that has all that training history, you don't have to You're guessing a lot more. So you've got to put these checks and balances in the beginning from the first place. They might do the same overall mileage but the architecture and the way that you're analyzing the training I've always found is a whole lot different. Whole a different Yeah,
and this is all going to be with regards to screening. And then Levine is kind of his his, you know, his he's really kind of prominent in those debates and I won't get myself in hot water by making a stance you know, on either side of the fence. But I think if there is a bit of basis very briefly is what we can't do is just have Getting widespread screening for everybody. Because we don't have the infrastructure we don't, you know, it's the economic burden of that is, is going to be unrealistic. And it may not be necessary could cause more harm than good in some respects. But I think if an argument can be made for screening, it's more more likely to be in masters athletes or people who other other high risk groups. So if you have somebody who is an older athlete, and we're, you know, we're not about, you know, masters, over 35, we're talking about somebody who's maybe in their 40s 50s, you know, maybe late 40s 50s, who's never done an ultra before, it might be sensible to have a full health screening before you got to do your first Ultra. And that the other end of the spectrum, you know, there's this really interesting, you could call it print preliminary data, because it's the small samples, but data in a really nice study published in 2011. But Greg White was involved with, and what they essentially found was they did some cardiac MRIs in 12, lifelong, ultra marathon and ultra marathon runners. So they've been doing this for a number of decades. And what they found was that, that the prevalence of myocardial scarring, so myocardial fibrosis was about 50%. So they found considerable amounts of my myocardial fibrosis in six out of the 12, that top athletes, when you compare that to age match, age matched controls who weren't lifelong doctors, prevalence was like, zero, maybe, you know, borderline one out of 12. So certainly, as far as subjects, but if you can make an argument for doing screening in in ultra runners, maybe it's in those people that have been doing it their whole lives, and maybe a higher risk of myocardial fibrosis?
Well, as we talked about earlier, that's more maybe more likely, what was the word that you use potentially, because by the racing over that long period of time, right, those extreme perturbations in our way from baseline that the racing actually causes that might actually it'd be interesting to compare those groups, right? The people who've just chronically trained it's almost been Levine's earlier study that you mentioned earlier, trained for 30 hours a week and didn't do any racing or training for 30 hours a week and didn't do the racing. What is the incident rate between those two groups? That'd be a qualifier anymore
really need is this a longitudinal or empty large epidemiological study that looks at 1000 veteran or Lifelog, drawn as just as a bunch of cardiac MRIs? And just looks at what's going on? Because at the moment, we've only got studies in the self reported data or small samples like this one, which is, which is interesting, doesn't really get to the root of the question.
Okay, last group, female athletes, ironically enough, before I actually reached out to you to set this podcast up, I wrote an article about this earlier. It's it, this arrow keeps get or all the indicators keep pointing to the same error over the last four years that any endurance athlete and in particular ultra marathon, in particular, ultra marathon, female athletes need to be extremely cognizant of their total energy availability. And one of the one of the great and for any female athletes out there, if you don't want to read this whole paper, go and read section 6.3 In this paper, because it will point this this aspect out very clearly, it'll take you two minutes to read. And I think it reinforces the concept very well that female athletes tend to have, they tend to be more susceptible and tend to have higher negative consequences or more severe negative consequences to low energy availability as opposed to men. I kind of summarize this section for you and I wanted you to do it. So now I don't know where to go. So Nick, like you take it over? Like like why, like why is this the case? And what do we actually see within the ultra the female ultra marathon population of why this becomes a big issue?
Well, we've this is an ongoing problem, not just in as you'd expect, it's not just in Ultra thought, but in any kind of endurance sport, you can look at you know, people are competing in 10k races, 1500 meter runners, female runners, they are at high risk of suffering the same problems, the reason why it is potentially more of an issue an Ultra is because of the extremely high mileage and a high exercise durations. So the the energy expenditure is much more likely to exceed the energy intake. So anytime that you have kind of even short periods of insufficient energy intake, it can affect the physiological functioning in males and females. So this idea of relative energy deficiency in in sport or bread's for its syndrome, it affects males and females because anytime that you have insufficient energy intake affects your ability to recover. The reason It has more prominent effects in females is because of the interaction of energy intake with bone health and menstrual cycle. Okay. And that's the kind of the key difference between males and females. So it does affect both groups. But because of the downstream effects that energy intake has on basically its sugar concentrations, and this kind of synergy between the two. Well, we need to look at this and consider this more carefully in in female athletes. So everyone knows about the female athlete triad, how always they should. And if you're a female athlete, you should definitely know about the female athlete triad. It's this kind of this idea that there is this interplay between three important components of a triangle. The first one is, as we've said, energy intake or, or calorie balance. And this idea that if you're burning a lot of calories, through your training and through your through your competing, you need to make sure that you're getting sufficient calories, too fuel basic metabolic function to fuel recovery. If you're not getting enough calories, you'll know that because you start losing weight, specifically, you'll start losing body fat. And sometimes, that is a deliberate decision that somebody is made to get leaner. And sometimes it's inadvertent, they're just not thinking carefully enough about their energy intake, and they end up losing weight. The other The second kind of component of that triangle is bone health. And, more specifically, bone mineral density. And bone mineral density is affected by the third prong in that triangle, which is estrogen concentration. So if you have an A memory Academy, that's going to have more profound effects on estrogen concentrations. And if you're if you have insufficient energy intake, that's going to affect your estrogen concentrations. And that puts the athlete at an increased risk of poor bone health. And in terms of stress fractures, and other, you know, muscular skeletal injuries.
Well, and then when you think about it from like, a really practical training standpoint, one of the one of the features of ultra marathon training are these big swings in volume, when you look at it on a day to day basis, or even a three day rolling basis, right, you might go out and run an hour for your easy run, and then three, four or five, six hours for a long run. And you don't see that in other endurance sports, maybe you could say you see that in like Ironman Triathlon, where they're doing those longer bricks that get into third, the three or four hour range, but ultramarathon is really unique in that that the energy expenditure that you're that is specifically from the activity can be 3x 4x 6x, sometimes even 10x, from your normal baseline and for athletes to get a fix on the energy intake that they need to consume, to cover for that maybe not within the day, maybe over two or three day rolling period is, is a hard thing to it becomes really problematic to get a fix on and the athletes that are really pushing that at the edge, then become susceptible susceptible to this week over week chronic energy deficit, that then kind of wrecks havoc on their entire system. And that's one of the reasons that from a practical standpoint, I leave a lot of these fasted and in carbohydrate ox or sorry, fat oxidation strategies just on the table. Because if you can't get energy balance, right, fundamentally, why would you try any of these advanced interventions to like further, you know, kind of that could potentially further perpetuate those problems?
What is the benefit to risk ratio? What is the benefit of, you know, nailing a Keto or low carb diet, or you know, any other fad diet or taking a particular supplement, when actually the potential risks of getting that wrong, particularly if you've got a very, very high mileage output is you've said, you need to first and foremost focus on the biggest challenge the biggest nutritional challenging challenge that ultra runners face is getting sufficient calories. And we you know, we had a three hour chat about this last last year sometime. But that's the thing to focus on first. And you know, when you look at the prevalence of stress, fracture injuries is higher in ultra runners because there's a high volume. And if you look at the average numbers, depending on the report, it's somewhere between five and 10%, on average, overall, but it's like 20% in females. And that's because they are at a higher or higher risk group. And as we wrote in the paper, very succinctly at the end of that section is failure to consider these differences in the design of female specific training programs may have a negative impact on athlete longevity. And that's what we've got to avoid, particularly in these high risk, potentially high risk groups.
very succinct right there. So above all else, make sure you have adequate energy intake to cover the output. We talked about this last time on the podcast, you're an advocate for using heart rate based training to get a fix on how many how much caloric expenditure, you're actually going through the intake side is always problematic, more problematic, though, in the registered dieticians, I'm going to speak for them, because I have a lot of those I have a lot of those colleagues, they pull their hair out because of the reporting becomes so problematic. But I just tell athletes, you got to try download an app, there's, you know, five or six of them out there, work with a registered registered dietician and just get a close fix on it, because the education is going to the education in and of itself is going to raise the level of your knowledge. And that you're just aren't, you're just putting up more armor at that point for your training, your training is going to be more effective. And you're less likely to experience any of these negative side effects just by going through that educational process.
Well, people think they just have to go out and train, get the miles in. And that's the most important thing. But that's like one piece of the puzzle. Because as you all know, training doesn't make you fitter, recovering from training makes you fitter. And people forget this time and time again. So you go and put the miles in. But then you've got to think you've got to put equal effort, equal time and effort into your nutrition, and getting that right, and equal time and effort again, into other aspects of your recovery, like your sleep. And you got to do that, again, thinking about your mental health, because you're so good having physical health if you don't have mental health, right? So you've got to try and balance all of these things. And it's, they're all equally important parts of very complex equation that you're trying to balance. And, yeah, it's not easy, but you've got to put in the time and think about all of these different balls that you're trying to juggle
100% It's not just about the running, right?
I wish it were but it's not that simple. You can't just put on a pair of runners and, and just go and run your body into the ground. Because you're you'll do it for six months, and then you'll have you know, a year off from injury.
Yeah, but usually it's it's the duration, right? So the duration that catches up with people, usually six months a year, maybe two years, you can kind of get away with those bad practices. But then eventually they kind of catch up with
there's a weakness if there's a weak link in somewhere along that process. It will be exploited, unexposed by ultra endurance training.
This was awesome. Nick, I'm going to obviously leave a link to the paper. In the show notes. You cleverly put up your author copy, I noticed what's the deal with that does it get like blocked the official copy gets blocked for a certain amount of time, but then you can upload a previous author copy or something. That's how I got
that was an adverse and maybe it's like, free for a month or something I don't know. Don't tell the people that spring up.
Anyway, so a link to it will be in the show notes as gray paper, thank you for doing it, I'd be remiss not to go back and forth with you just a little bit on some of the debunking that you have been doing. Since the Olympics ended on all of these different areas. So pick your favorite one, that you just want to go on a little bit of a tangent. I know I'm putting you on the spot right now. But you just came out with an article is it was it in triathlon magazine or Triathlete Magazine?
Yeah, that was an interview I did with Susan lac who's and it's just become editor of triathlon magazine. And Porter is a triathlete. And, and she's kind of done a great expose on some of the pseudoscience that so pervasive, and health and sport and I've done a whole bunch of stuff since the Olympics, I wrote an article in the conversation, which got lots of feedback, or all positive, negative from people who like cupping and chiropractic and other you know, bullshit, alternative remedies. But everyone else thought it was a great article. And then I did a talk for Skeptical Inquirer magazine, which you can find I tweeted it a couple of times, that it's on YouTube, if you look up Center for Inquiry. And it's I think the the talk is Pseudoscience in exercises for and it's like a 45 minute lecture with a q&a at the end. And I really go to town on kind of the, the, yeah, exact Pseudoscience in Exercise and Sport, because we're dealing with it all the time. It does one to answer your question, if there's one that I that I really frustrated me more than the others, it probably be something like chiropractic, or cupping, chiropractic, probably more so. Because chiropractic somehow is kind of smuggled its way snuck its way into mainstream practice. And a lot of people go and see chiropractors without realizing that it's a complementary and alternative medicine. You know, that they think it's mainstream part of mainstream practice, but it's actually it's a very, you know, it's a very niche alternative. And when you actually look at you know, I'm a scientist and I don't I never apologize for the truth. I always point my nose in the direction that the evidence suggests because that's the strength of Science, right? We don't, we don't look at anecdote, we're not really interested in the it worked for me argument, that kind of defense, what we look at is high quality controlled studies that are designed to minimize bias, and to try and get to the truth of the matter. And with chiropractic, when you look at the evidence, there's loads of research on it. The disparity between the claims that are made for chiropractic, and the evidence in support of those claims, is as big for chiropractic as it is for anything, chiropractic doesn't work at all, for almost anything. And it's so frickin popular. And people, if they have back problems and neck problems, and headaches, and you know, to suffering from stress and anxiety, they often go and see a chiropractor. And there are lots and lots of case reports, far too many to mention, unfortunately, of chiropractic related deaths, where people have been killed by a chiropractor, who's kind of, you know, manipulated somebody's neck and, and broken the neck, of course, a stroke or some other kind of catastrophic injury. And, you know, when when you talk about alternative therapies, you you've got to talk about the risks to benefit ratio, which which is, which is what you've got to do for all any kind of intervention risks to benefit. Now, with actual medical treatments that, you know, have proven efficacy, the physician, you know, the primary care provider will make a judgment on the relative risks and the red relative benefits. But with alternative medicine, the benefit hinges on placebo, the only potential benefit of chiropractic is a placebo effect. And the risk just can't be justified. So it's just to me it's, it's mind boggling to see how popular it is the end. Yeah, exactly. Sorry for starting me off.
That's why I Hey, man, I wanted to get you at least give one good rant, I know you're good for more than that. But one good one will say shape my, my, my needs for now, the discrepancy between the claims. And what the science says about the intervention or the treatment or whatever, that has always been one of my longtime frustrations with anything nutritional supplements is another big area that you can talk about where the discrepancy between what this nutritional company is going to claim that their product does versus what the research will say or doesn't actually say about, about what that will actually do that that difference how wide that chasm is, has always been one of my biggest frustrations as well. So I feel your I feel your pain of that area. I'm going to link up in the shownotes to all of those different interviews and things like that. So if people are curious, they want to hear any more of Nick's rants, they can go and check those links out. Thank you, my friend. I appreciate it. We'll have you back on and maybe we'll just do that for three hours
a month. So there's a lot of fun. Thank you.
Alright, folks, there you have it. There you go. That wraps up another episode of the coop cast. Once again, thanks to Nick for coming back on the podcast for your third time, you make my job really easy, because I can just throw all these questions and you run with him. And you know the science so well. And you it's just incredibly relatable to the audience. Hope everybody had fun listening to this episode of the podcast, we are closing in on almost 100 episodes of the coop cast, I can hardly believe it. Maybe I'll do something special for the 100th episode, you guys will just have to wait with bated breath. But that gives me a chance to say I appreciate everybody who has tuned in every single week to these podcasts. These podcasts have come to you advertisement and sponsorship for you. That was a commitment that I made to the audience and I made to myself from the onset of that podcast. I've honored that commitment for nearly two years to date right now. And the reason I do that is to make the information that is contained within all of these podcasts as unbiased and unadulterated as possible. So you can help the podcasts out by sharing it with your friends, family, your running partners, your colleagues, whoever you think would benefit from this information, just go ahead and pass the link along to them. You can also leave a rating or review on Apple podcasts I almost said iTunes, Apple podcasts. Those mean a lot to me as well and helps the podcast get exposure. But most importantly, I just apprec appreciate people tuning in. I love seeing you guys out on trail and hearing feedback when I get out into the community or online. So I do appreciate the heck out of each and every one of you and as always, we will see you out on the trails.
