Transcription provided by automated transcription services, errors may occur. Please contact Mikki for clarification

00:03
Welcome. Hi, I'm Mikki and this is Mikkipedia, where I sit down and chat to doctors, professors, athletes, practitioners and experts in their fields related to health, nutrition, fitness and wellbeing. And I'm delighted that you're here.

00:25
Hey everyone, it's Mikki here, you're listening to Mikkipedia and this week on the podcast I speak to Dr Alana Mekai, a postdoctoral fellow and researcher at Australian Catholic University in the field of iron metabolism, immune system health and diet manipulation. We discuss the impact of carb availability on iron metabolism, chronically low carb intakes and immune function.

00:54
the differing impact of low energy, so low calories, and low carbohydrate and how these are often conflated on both immune and iron markers, and also Alana's most recent research published that looked at the acute effect of calorie restriction on performance markers and the pros and cons of this approach to be race weight for athletes. So Alana is…

01:21
as I said post-doctoral fellow at Australian Catholic University and is part of a really robust team of researchers exploring the impact of diet and exercise on a range of health outcomes in athletes with a specific interest in iron metabolism. So she completed a Bachelor of Science in Exercise, Health and Sport Science at the University of Western Australia in 2014.

01:48
and completed a postgraduate position within physiology department at the Australian Institute of Sport, where she was involved in the preparation of many Australian athletes prior to the 2016 Rio Olympic and Paralympic Games. Since then, Alana has submitted her PhD, titled The Effect of Dietary Manipulation on Iron Metabolism and the Immune System in Elite Athletes, which was undertaken in partnership with the Australian Institute of Sport,

02:17
Western Australian Institute of Sport and the University of Western Australia. And now, as I said, she's at ACU and she is a post-doctoral fellow working on a range of different and exciting research questions. So I have put a link to Alana's work in the show notes and also where you can find her on Twitter, which is the best place to keep up to date with the work of Alana and her colleagues.

02:47
Now, just a reminder though, before we kick on into the podcast, the best way to support this podcast is to hit the subscribe button on your favourite podcast listening platform. That increases the visibility of the podcast out there in amongst the literally thousands of other podcasts, so more people get the opportunity to learn from guests such as Alana that I have on the show. Alright team, enjoy this interview with Alana McKay. Alana

03:16
Thanks so much for taking time to speak to me this afternoon. And I'm super excited to talk to you because you have such an interesting portfolio of sort of research projects. And as I was looking through like your publications, in fact, a lot of them I had seen and not forgotten about, but your name was really familiar. And it was only when I was revisiting your sort of publication, I'm like, that's where I've seen Alana's name before.

03:44
Um, so I'm really excited to talk about your contribution to, you know, iron metabolism and immune function and diet manipulation. Um, can we start though with a bit of your own sort of personal and, and professional background as to, you know, how you got this interest in sports nutrition and how you've sort of built up this to where you are now? Hmm. So my, um, from a personal side of things, I actually was a classical ballet dancer.

04:13
throughout my adolescence. And that was what I did full time for a long time. And it was, you know, high discipline, very different environment to maybe elite sport. But I was always fascinated in the way the human body moves and went to university, did a general sports science degree, and then actually took a postgraduate position at the Australian Institute of Sport, where I worked with elite athletes and some really fantastic scientists for a one year position.

04:40
And during that time, I sort of started to scope out different areas of sport science and sports nutrition was one of those areas that I had only a small amount of exposure to, but met some very, very good people and went on and started doing a PhD looking really around diet and how diet affects different aspects of athlete health, being both the immune system and iron regulation. And then since then, I've still working with somewhat the same team, but really focusing in on

05:09
for my own personal research interests, I am metabolism. That's definitely, I always wonder and curious how or why athletes are always so deficient comparative to other populations. So that's definitely my primary research interest, but I'm pretty lucky to work with an amazing group of researchers here at the Australian Catholic University. So I really extended that out into looking at female athletes more generally. We do a lot around carbohydrate and energy manipulations.

05:39
at all sorts of other topics. Yeah, so interesting. And so did your own personal nutrition, I suppose interest, obviously it sort of grew from your experience. And just curious, did you fall into some of the traps that young athletes can fall into as part of your dancing and stuff and your career there?

06:06
Yeah, a little bit. I think it's only when you can objectively look back at what you've done, especially as an adolescent. I was dancing full time, so 25 hours a week from the age of 13 to 18. And there is no way that what I ate was sufficient to fuel what I was doing. And iron was a part of that as well. So you can look back and think about all the things I would have done differently and how I probably could have been a much more healthy and probably energetic person. But yeah, it does make you think back. Yeah.

06:36
Yeah, no, for sure. And, and, you know, I've spoken to Dr. Nikki Kay on the podcast a couple of times, and she, I imagine you're familiar with her work. And, you know, she, her experience with dance and thinking about dance as a sport, basically, because it is, I mean, the hours and the energy demands of it is just, you know, absolutely up there with some of the most demanding sports. And of course, in your work,

07:04
sort of as a professional, as I understand it, you've done a lot of your work with endurance athletes, with triathletes and racewalkers and things like that, which I'm sure that we'll, well, which obviously we want to sort of delve into. Alana, can we sort of begin with your PhD? So looking at dietary manipulation on iron metabolism and the immune system. So what were the overarching questions that you were hoping to answer from your topic?

07:34
Yeah, I think I was in a really lucky position when I started my PhD in that there are a lot of different nutritional strategies that were of interest at the AIS and with the sports nutrition group there. So things like ketogenic low carbohydrate high fat diets was a big topic and formed a big part of my thesis, but also sort of periodised training models where carbohydrates strategically manipulated sleep low, train low, and also scenarios of

08:02
sort of very high carbohydrate intake for endurance athletes around training the gut. And so all these strategies are really focused around optimizing performance. But what's sometimes lost when you're trying to optimize performance is that your health and different parts of your body systems that's related to health being, in my instance, iron regulation and immune function, it's really important that they're not compromised because of what you're doing to achieve performance.

08:27
Because if your iron deficiency is always going to have a larger impact on performance and maybe some very small shifts in when and where you're eating your carbohydrates. So we really wanted to look at these common strategies that have been implemented in the daily training environment of athletes and look at the effect that had on different health systems. Yeah. And Alani, did you sort of go in with any preconceived notions and were surprised by any of the findings? Like I've got a couple of the papers, which I want to just ask specifically about. But

08:56
In general, like with the thoughts and feelings around some of these strategies, did you sort of already know what you were going to find or were you surprised by your findings? I think I was surprised by some aspects of the findings. I think when you're undertaking research, I think the ketogenic diet was a really big study that we did where three weeks of adherence to this diet, we saw athletes feeling pretty terrible, particularly in the first week we put them on these diets and we asked them to train so much.

09:24
So when they then reported in some of the data that they felt terrible, I'm not shocked by watching the way they trained. But some of the more biochemistry markers that we looked at, some of that results were somewhat interesting and probably sparked more questions and ideas out of, questions and answers than what came out of my thesis alone. Yeah, for sure. And can we touch on iron metabolism particularly and diet manipulation? Like what is the link between

09:54
iron metabolism and how we might utilize or absorb and say a ketogenic diet. Like, are there known links now between what happens there? Yeah, I think when we talk about athletes specifically and iron, we're really interested in the function of the iron regulatory hormone, hapsodum. So this hapsodum has only been discovered probably two decades ago, and its function and role in athletes is still being really looked at.

10:24
And essentially what we know when we do an exercise bout is that we have an inflammatory response and that inflammatory response is actually what triggers the release of hepsodone about three hours post exercise and increases in hepsodone actually block iron absorption. Now what we do know is that when we're doing very long training bouts, that inflammatory response is going to be greater and therefore the hepsodone response and the time in which iron absorption might be impaired is going to be greater.

10:53
training in a low carbohydrate state. The muscle actually signals the liver via IL-6 to release more glucose because the muscle starts to realize that it's running low on fuel. It releases IL-6 from the muscle itself, which is an inflammatory cytokine, and that signals the liver to start increasing more glucose for the body to work. But at the same time that muscle is releasing IL-6 for the body to work, it's also releasing IL-6 to trigger a HEPsidone three hours later.

11:22
So when we're training in these low carbohydrate states, the hypothesis was that we were going to see these increases in Hexadine greater than what you normally would. And the ketogenic diet is really a repetitive model of training in low carbohydrate states, particularly when we look at, particularly in the study you're about to mention, elite race walkers, these guys were training upwards of 100 kilometres a week. And that's a very much a repetitive inflammatory stimulus, which we thought may have implications on...

11:51
both iron status and iron regulation. And what did you find? We saw that within this study and follow up studies that it was that the low carbohydrate diet or the ketogenic diets were causing greater Hepsodium responses to exercise. And over time, particularly longer than what we're able to study in our investigations here, but we do think that's going to have an impact on iron status. So we do

12:17
Suggest that if athletes are wanting to adopt ketogenic diets, that they are very mindful of how much iron they're eating. We did see when we analysed the diets that the ketogenic diet is lower in dietary iron because a lot of carbohydrate rich foods like breads and cereals can be fortified in iron and as soon as you remove that, you are seeing a lower dietary iron in the diet. So we do suggest athletes on ketogenic diets be particularly aware of how much iron they're eating.

12:43
potentially when they're eating it. So you don't want to be eating it while you're in an extended period of hapsodin elevation because you're not going to absorb as much. And if you're a ketogenic athlete, you may think about timing your iron to try and avoid those larger peaks in hapsodin. Yeah. Alana, the iron that's used to fortify those products, and I've never really known, like I've tried to find the information for this, but is it an iron that we can absorb anyway? Or is it...

13:10
like plant iron. So yeah, is it heme or non-heme that's fortified? Typically non-heme. But I think we sometimes I think we focus too much on whether something's heme or non-heme. Iron is going to be iron when you look at it holistically. Yes, you're going to get better absorption from heme iron and they're definitely the sources we would promote you look at especially if you're struggling with iron deficiency. But if you're removing a big element of your iron from your diet without looking at how you can

13:38
replace that and alter it, and particularly the ketogenic diet, because you can't up your protein too high, otherwise when you ingest the protein, it will turn into carbohydrate during metabolism. So protein's kind of fixed, and it's the fat that's very high. So if the protein's fixed, there's not really extra room for you to take in more heme iron through the diet. And non-heme iron is your source of iron that you're probably going to need. And if you're not getting enough of it through some of these fortified sources,

14:04
or even just carbohydrate rich sources, you really need to figure out how else you can achieve that in your diet. And it's not impossible, but it just requires much greater consideration. Yeah, no, that's a great point. And I guess it's, and so we've got, I guess diet is on a spectrum, right? So we've got high carb, high carb low fat. I mean, that's a conventional way to think about it, but you know, like high carb athletes, and then you've got ketogenic athletes. And then of course you've got that sort of middle ground and you've got.

14:32
athlete two might be more sort of lower carb or periodized carbohydrate. And do we know much about how iron, um, what the iron status is like of, of groups in that sort of periodized carbohydrate group where they might put in carbohydrate in and around training, but else, um, else wise be a little bit lower. Yeah. We looked at a part of my PhD thesis. We had a, um, a study looking at a sleep low periodization model. So this means

15:01
the athletes would do really high training sessions, sorry, very high intensity training sessions in the evening that then restrict their carbohydrate and have no carbs while they went to bed and went to sleep and woke up the next morning and trained in a fasted state. And we did this twice with the athletes, once when they did a cycling bout in the morning and once when they did a running bout in the morning and then repeated it with high carbohydrate as a comparison.

15:27
And we actually saw that when the exercise session was low enough intensity, so one hour or no more than one hour, quite low intensity, we didn't see any large disruptions to iron regulation. But if the exercise session was a little bit too intense or if the inflammatory stimulus was a little bit too high, there were some small adjustments to iron metabolism that would be deemed unfavorable.

15:51
But in a separate study, we actually looked at the repetitive cycling of these periods of low carbohydrate availability over a three week period. And we saw that no differences between those that periodised across a three week period and those that had consistent high carbohydrate availability had any differences in their iron status at the end or their regulation. So I think whilst we could be aware of some of the small adjustments that are occurring when you do maybe train fasted or train after sleeping low.

16:18
in the holistic long-term sense, as long as you're eating enough carbohydrate per day, you're probably not going to have a large impact on iron regulation. Yeah, no, that's great. And of course, you know, this sort of periodized carbohydrate models used to for athletes to potentially gain more adaptations that are favorable for endurance. Like, is this still the case, Alana? Has anything shifted in that?

16:44
periodised carbohydrates space that listeners might not be aware of or any updates compared to say what I don't know we may have known five years ago? Yeah, there are studies that are still coming out and looking at this. I think the general place we've landed is that it's likely the molecular aspects are changing in a way that's positive if you are training low. We are seeing some molecular adaptations, but when we look at it in a practical sense in real world athletes doing real world races or training activities,

17:12
we get to really see that difference manifest in terms of performance or training ability. So we always like to see nice things happening in the muscle, but how well it transfers into real life race performance. And if it's the difference between athlete medals at the Olympics, I'm not quite convinced yet, but either way it does provide a really interesting stimulus in terms of different training models. It probably also, it's probably more hard to train faster.

17:39
compared to feds. So it's not always a bad thing to do these things anyway. Maybe getting a bit more, you know, pushing through adversity for the same training session, I guess, or a harder stimulus. That's not a bad way to look at it. But I wouldn't hang my hat on that being the difference between gold and silver at the Olympics yet. Yeah. Oh, that's such a great way to put it. Now, Alana, some people, like when you look at the studies and they're like three weeks, that's not long enough.

18:03
Describe to us why actually this is quite a good model to look at, say chronic versus acute. Like is three weeks long enough? Is it that that was just what you had funding for? Like it's really good to understand it more. Yeah, and it's probably the biggest critique of our work as a group is that we've only gone for three, I think three and a half weeks is the longest study we've done. But it's just so physically taxing to implement these studies. I can tell you, we had, one of our camps we had

18:33
about 30 athletes and we would have had close to 15 support staff there every day working. When you're cooking and feeding athletes every single day and weighing the food that they're eating, it's physically exhausting. And the diet is also very hard for the athletes and pushing them to three weeks really was quite difficult, particularly the first half of the camps or the first week and a half is the most difficult and it gets a little bit better.

18:59
to ask an athlete to go much further than that, knowing that it's a decrement to their performance, it's really quite difficult ethically. So, if you could tell me that I had a group of elite athletes that wanted to go for six months and I had all the resources in the world to fund it, I absolutely would. And there was some great cross-sectional studies that have looked at six months periods of keto adapted versus non-keto adapted athletes. But what we implemented was an intervention and that's much different.

19:29
different and more difficult than a crossover study in terms of trying to control for that length of time. And we've also done now shorter studies, we did a five or six day intervention, and we didn't see any real differences between our results at five days and our results at three weeks. So we think the adaptations are quite rapid. But there are long term effects that we are probably missing. And I would take my hat off to anybody that can actually control dietary intake for that period of time, because it's a really big task to do.

19:58
Yeah. And you know, like I have mates and they've been like keto low carb for, for years and you've undoubtedly heard of these people as well, you know, like just the type of people that are. And I imagine that, um, that to be as to sort of gather those people up at all, to actually intervene in someone who isn't like that and then to spend years doing that, then it's, it all clearly is next to impossible, but it would be, you know, it is sort of interesting to think about, um, the,

20:28
I suppose a lived experience versus what you can do in a lab. Having said that, I saw a tweet of yours, I think it was last night, and you had pictures up of all of the stuff ready to measure biomarkers. You had all the food weighed on scales and these lines of meals, and you were like, this is supernova seven, we're kicking off, and just the amount of organization and precision required.

20:57
in funding to do the type of research you do is pretty phenomenal really. Yeah. And I think that's a really key point. It's not cheap and we don't want to, you know, if we're going to invest in research, we want to be able to have a meaningful impact for athletes. We don't, you know, if we're seeing no differences between five days of keto diet and three weeks of keto diet in these athletes, at the moment, why would we try and do six months of controlled dietary intake?

21:25
if we can pivot our research question and try and apply something that's more applied towards the athlete right now. And it is, it's a huge financial investment. It's also, you know, when we do these camps, as a research member, Supernova 7, you've just touched on and we went and lived at altitude on a mountain for three and a half weeks. So all the researchers are away from their families, away from their friends, living with these athletes and doing everything we can to support them. But it's a really big commitment. And you can't just

21:55
sort of think that can go on for six months without a rotating task of team. So yeah, you're right. It's a big financial commitment as well. Yeah, for sure. Um, Alana, can, so you touched on, um, being mindful of, I suppose, either giving in dietary iron or finding supplement solutions for athletes and the role of Hepsodin, can you just remind us like, what are the

22:20
practical recommendations for athletes in and around iron and when to take it? Yeah. So whether it's dietary iron or oral iron supplements, there are some sort of key rules, I guess you could say, around how to maximize your absorption from that supplement. The first thing is supplementing in the morning. So there is a diurnal variation to hepsidum. It is lowest in the morning, which means if you're consuming your iron or supplement at this time.

22:46
you are going to get the most out of it. So the morning supplementation is a big one. We also know that this can be difficult because there are things that can inhibit iron absorption. So if you're co-ingesting your iron with calcium or polyphenols, which are found in caffeine sources, usually like coffee and tea, that can actually inhibit iron absorption. So we like to say you can stay clear of those factors, but.

23:11
If you're taking a fortified iron cereal in the morning with some milk and some coffee, it's kind of hard to get around that. So you can work with what you've got, but that would be the best recommendation. And the best recommendation is actually to take your iron fasted. So that would be an oral iron supplement only, but if you actually take it fasted, you can have, we think it's about 50% better absorption compared to when you take it with food. And that's a typical iron salt compared to other newer formulations.

23:40
And some of the other things when we think about iron around exercise, we actually suggest that you take your iron either before, sorry, morning exercise, so if you're somebody that trains in the morning, we suggest you take your iron supplement before training, so immediately before training, or up to 30 minutes post-training. But as soon as you start to go further out from post-training than that, even one hour, you're going to see decrements in the amount of iron that can be absorbed. So you really want to get that iron in as close to exercise as possible.

24:09
if you're training in the morning, and if you're not training in the morning, still take it in the morning. So that's kind of the general thought around iron at the moment. There's still a lot of work to be done in optimizing the timing and the way that we take iron supplements, but that's sort of one of the rules around timing. Yeah. Oh, no, that's great. Do you know, I saw a study that looked at fluoridex. Do you have fluoridex over in Australia? I don't think so.

24:34
It's this plant-based iron supplement that is a liquid and it's quite sweet and we have it in our supermarkets and our health store and it's almost the go-to for iron supplementation. And

24:46
It's actually like, it also says on the label, it's full of polyphenols to really help your iron absorption. And the study was done, it was like, actually, you know what? Floridics is pretty rubbish for iron absorption because of all of those polyphenols. So the fact, you know, you mentioned that that's the sort of key consideration when taking it with caffeine and tea. I think it's something that, you know, there are other things which people just wouldn't be aware of, I guess. Yeah. And it's really a bit of a contradiction because we say, take your iron in the morning, but

25:14
In the morning, you're gonna have your breakfast cereal, which is probably fortified with iron, which is great, but it's also served with milk, which has calcium and you're probably gonna have a coffee at the same time. And all those things actually work against iron absorption. Um, so it's a bit contradictory and you have to just find a way to make it work and work within the recommendations to suit your lifestyle. You know, I'm never going to say to somebody don't take, don't drink your coffee in the morning. So your iron supplements better absorb because they'll be cranky and probably won't train well. So.

25:39
You've got to find a way to balance it out within each athlete's lifestyle about how you can optimize the ingestion of why you take iron. Totally. I have a friend who, whose cat wakes her up at about four o'clock every morning. And what she's done is she's actually started taking your iron supplements. It's a great time to take them. And when she gets up at about 5.30, then she can have a coffee and she's like, oh, I'm good. Yeah, that's a really good time to take it. Yeah. If you're up at that time in the morning. Yeah, that's the thing. That's the thing.

26:09
So Alana, can we just have a think about the immune function? So I studied nutrition back in the 90s, and I remember there was lots of, a guy who did a whole heap of work on carbohydrate in the immune system, and I just cannot remember what, I wanna say his name is Mark Someone, I can't remember. He's like a, he's an old school nutrition guru, actually I think from Australia. And...

26:35
And at that time, when I was studying my postgraduate sort of sports nutrition paper, there appeared to be a strong association between the immune system and carbohydrate intake and our ability to help dampen or resolve inflammation and also have a healthy immune system. So when you were looking at the immune system, what were your sort of questions going in and what did you find?

27:03
Yeah, so the immune system, I had two fantastic PhD supervisors, Pete Peeling was around the iron and then I had Professor David Pine who was really interested in the immune system. And we found this joining link with IL-6. So that cytokine I talked about before that upregulates hepsidine. It also starts the inflammatory cascade that occurs after exercise. And so we thought if we are seeing that increase in IL-6 due to the signaling of the muscle to the

27:31
We thought we might see an increase in some of the immune markets we're looking at as well. And so when we're thinking, so I came across one of your studies looking at that sort of low period, sorry, periodized and high carb diet and what impact it did have on immune function. What was the major finding? Yeah, we actually saw it didn't have as much as an effect as we thought it might. Yeah. We saw that...

27:56
the perception of health, particularly in the keto groups, when we looked at some of these immune markers, they actually felt like their health was deteriorating, but we didn't actually see it in the biomarkers we're collecting. And same with the periodised group, we didn't actually see any changes. There are some issues around what biomarkers we took, and I'll be the first person to say that they were very easily accessible biomarkers that we could actually implement with athletes. And they didn't seem to change, but if we were to do some of the more invasive procedures that some other

28:24
people have done, we may have seen some more changes, but how functional those changes are in the course of an athlete's daily training environment is still to be looked at. Yeah, interesting. So because did you use salivary markers? Yeah, we looked at salivary IgA as the primary marker, and then looked at some of the white blood cell functioning as well as sort of secondary supportive markers. Generally, we see the blood cells change. But there's more a response to exercise and maybe the dietary interventions.

28:52
Exercise has a big effect on the immune function. Again, it's, it's probably just a necessary effect. And I don't think it means that you're more susceptible to illness, but we do see a big effect on immune functioning from exercise and whether the small changes that diet are having on top of that are actually meaningful for an athlete. I'm still unconvinced. Yeah, yeah, cool. And if you were to use more invasive measures, what measures would they have been?

29:17
Yeah, you can do some really cool stuff where you can inject different viruses. That sounds terrible the way I say it like that. Particularly now. Yeah, and vaccine models where you can sort of, what's the right word? You have a very clear, you're provoking a response in a controlled way. And you can really see how that response is changing or the immune system is changing in response to that exact stimuli.

29:45
Whereas what we've done is we really just measured the immune function at rest and in response to exercise. But exercise, it's a great model because it provokes big inflammatory responses, especially in some of the exercise bouts we're doing. But how meaningful what we were looking at really was, I'm not quite convinced. Yeah, yeah, that's such a good point, isn't it? Because there's a lot of focus on certain things you can do to manipulate diet or...

30:12
Uh, I don't know. I'm just going to say other lifestyle things or a supplement, but actually the biggest overwrought over sort of umbrella, um, consequence, or I suppose the biggest thing maybe is just the exercise itself. Like, so you mean sort of anything else on top of it might not be meaningful. And we see these two spikes with exercise and changes in some of these markers, but we don't see athletes getting sick every day and that's cause they're pretty robust and so you're looking at big.

30:39
Big changes in biomarkers that don't mean much. What's the small addition on top of that gonna do? Potentially if they're exposed to a virus at the time, maybe, but that's pretty unlikely. And that's not what we're looking at when we're looking at the general health of athletes over time. Yeah, you know, that's great. I remember seeing something where someone said, you know, if you just looked at...

31:01
the outcome of exercise with regards to its impact on inflammatory markers and the immune system. You would think someone was having some like massive sort of health crisis. Yeah. And that's why we, yeah, we use a lot of these models. I think HEPsidin, we looked at that, or first looked at that in a liver failure or something like chronic disease. Oh, interesting. And then we went, oh, those inflammatory responses that are triggering HEPsidin in that model also would work in exercise.

31:31
So it is interesting, exercise and some of these really severe health implications can promote the same same markers to be elevated. Yeah, but in essence, with exercise, like you mentioned IL-6, like that, is it am I right in thinking that this is now, you know, that we look at IL-6 in exercise as us adapt as part of the adaptation process, like we don't necessarily, you don't want a low IL-6 response because potentially you're not going to get adaptation from the training? Am I right in that?

31:59
Yeah, sort of. So I think IL-6 is, it's an inflammatory cytokine and it's important because it has a trigger of, well it triggers a lot of other events which is trying to bring the body back into homeostasis after exercise. If it didn't do that, we wouldn't, you know, the immune system might just keep going on forever. And if we train more, the same exercise bout will start to produce a lower IL-6 response. And that's a good thing in essence because you're starting to...

32:28
Use your muscles more efficiently and it could be seen as a training adaptation. But you know, I would never suggest as part of the monitoring of athletes that we start to look at differences in IL-6 between people as a marker of anything. It's more just that it stimulates other responses. Okay. No, that, that makes perfect sense. Um, so another part of your research looked at both, obviously we're talking about carb availability.

32:56
low, periodized or high, but also energy availability. And often what you see is that people conflate the two. Like I often see it argued that some of the criticism against low carb, people are like, well, it's not even that it's not the low carbohydrate per se, it was the fact that they had low energy availability because their calories were lower. I understand that you have actually teased out a bit of this difference in some of your research, Alana. So

33:26
you know, were there any big takeaways from looking at both low carb availability and energy availability? Yeah, I think I'd say we did a study where we had three groups of elite athletes, one that we maintain high energy, high carb, one that we had a keto diet, so high energy, low carb, and then another group where we implemented a low energy availability style diet.

33:50
And so as a result of shrinking energy, you're shrinking carbohydrate as well, but it sort of was the mid range between the other two diets. And what we saw was that whilst energy can be really low, if there's enough carbohydrate in the system still, it can actually save some of the responses that we were seeing. So the ketogenic diet was really associated with poor bone health or bone turnover markers and also with elevated HEPs and concentrations, which has implications for iron absorption.

34:20
So we did see that carbohydrates probably the more dominant factor. And even in these energy availability models, if there is sufficient carbs, they should, at least in the short term, we've only looked at the short term. And that's really important point to make, but in the short term, you should be able to undergo periods of low energy availability without significant changes to some of those key health systems. Again, as long as carbohydrate is put into the diet. Yeah. Oh, they're super interesting because of course, part of performance is

34:48
You know, for a lot of sports, we're interested in body composition and being as lean as possible, I suppose, without compromising those health markets, right? Yeah. And I think that's a nice way. I think we can look at it in a way that we can periodize body composition. And I would say if anybody wants to do some reading, Trent Stellingworth has a great paper around periodized body composition of his wife over a long period of time.

35:17
What you can do is you can sort of put me's at like little micro cycles of low energy availability into your annual training plan to achieve peak body composition during or just prior to a performance outcome that you may be interested in. And this is again really sophisticated sports nutrition. So you're doing this at the top level, but if you're doing a short sharp period, like I said, it's not going to have a huge impact on some of those health markets. What is going to have an impact though, if you're in a very chronic, moderate state of low energy availability?

35:46
where yes, you might be achieving your body composition goals to an extent, and that will plateau over time, but to an extent. But it's going to come at the risk of things like increased risk of stress fractures, iron deficiency, and a whole bunch of other complications. So really short periods of time where you can implement low energy availability can be beneficial to manipulate body composition. Yeah. And when you're thinking low energy availability, so in the literature, it's often

36:16
as I understand defined as lower than 30 calories per kg of lean body mass. And so is that the, is that what you're referring to? Or is it lower than that? Like what, what sort of cutoffs were you looking at? Yeah, I think there is actually about to be an update from the IOC around reds and low energy availability. I'm not sure the cutoffs are the best way to look at it. The research that's done that's looked at the cutoffs. Firstly,

36:40
in females and we know males can suffer from reds and low energy availability too and we actually think their cutoffs are a lot lower than females. We also think that the research that's been done really looked at pulsility of hormones and bone health for those cutoffs. So I think they're very applicable to when we're looking at bone health but there is a bunch of other consequences of low energy availability that are not captured within those cutoffs at the moment and we don't know that's why. It's not that...

37:07
doing a bad job at research or misinformed, we just don't have the information yet and we're only going to see this area grow. So at the moment, I think it's important to measure these markers and do the calculations for these energy availability thresholds, but understanding maybe a dip in low energy availability is more important than, you know, you can be 30.1 or 29.9 and is one worse than the other? Probably not. You know, I don't think that's actually meaningful, but

37:34
Looking at changes over time, particularly athletes that might be coming out of adolescence or starting to really try and do different things with their body composition, I think that's the better approach to defining low energy availability. In the studies we've done with males, we put energy availability at 15 kilograms per kg fat-free mass, and that's a very severe energy deficit and can't be sustained from...

37:58
more than probably what we've done realistically. It's probably the lower end of what you could achieve through a dietary intervention. Yeah, yeah, I've got a friend who's in the sort of physique space and he's done his PhD and he's a very smart guy and I've like, when he was competing in bodybuilding, he's relatively, you know, like if you think about like, he's a guy, he's quite big, he's quite muscular. And I think, I'm trying to, I think he got down to

38:27
10 cal per kg body mass and again sustained for a very short period of time like this guy, big guy on like 1400 calories a day which is, which is, which you know is part of, was part of his particular sport so you know but yeah. Yeah short and severe we think. Yes. Is definitely less detrimental than the the moderate prolonged over time and low energy

38:58
great evidence to suggest that at the moment or direct comparisons, but everything we can piece together of the literature probably paints that picture. Yeah, I know that makes sense. And of course, the most recent paper in and around energy availability, you looked at performance, didn't you? And what potential outcomes to performance might arise from these sort of short dips? Are you able to just to go into detail into sort of what performance outcomes you looked at, but also what you did and of course what you found?

39:27
Yeah, so this study was the first authors, Louise Burke and Jamie Whithill here at ACU with me and we had a group of elite race walkers and we put them on, it was a nine-day low energy availability intervention. So we had half the walkers just stayed on high energy and then half the walkers went on to this low energy availability intervention. And we did a 10k time trial or a 10,000 meter time trial on the track before and after the intervention. And

39:54
24 hours prior to the intervention when we weighed them in, sorry, 24 hours prior to the race when we weighed them in, we did see a significant shift in body composition and body weight in the low energy availability group. So our intervention was really effective at reducing body mass.

40:11
But once we refed them with adequate carbohydrate availability, because we didn't want to race them when they were depleted in carbohydrate, we'd be looking at the effects of carbohydrate and glycogen. So we gave them 24 hours of a high carbohydrate diet, just like the high energy group to get those glycogen stores back. And then we raced them on the track. And what we found was that there was no differences in race performance between the two groups. And what it shows is that race performance is so much more complex and just lighter is faster. So whilst there's this notion that

40:39
get as light as you can and you'll be as fast. There are other things that could have happened during that training period, that nine day training period that are gonna affect performance. And one of the things we measured as part of this study was sort of their perceived feelings of how they were doing and both rest and recovery or recovery scales, we saw that the low energy availability groups were feeling more stressed and they're feeling less recovered over that time. And that impacts training quality and all sorts of other things. So...

41:08
As much as low energy and body weight can be shifted, whether that translates to performance or not, I think is not as simple as maybe it's been made out to be. And I think we need to consider training quality, the athletes' general happiness. Like during these low energy availability periods, I'd have some of the boys walk up and be like, can I just have a little bit more food? And the answer is no, because you've got to keep them in low energy availability. But it can be a bit soul crushing sometimes for them because they're just hungry. And that starts to...

41:36
play with their mind and their psychological state and doesn't allow them to train as well. So performance, I think is much more complex than just lighter is faster. Yeah, no, that's such a great point. And so with these guys, when you looked at body mass, was it just weight that you looked at or did you have the ability to, I don't know, dex them or anything? Yeah, we did dex them and it was primarily fat mass they lost. So they were pretty good at sustaining their muscle mass. And we did the supernova seven that we've just done. We actually...

42:04
learnt from our first findings and up the protein just a little bit more. Because if they've got enough protein intake, they can sustain that muscle mass, at least in the short term periods that we were implementing what was going on. So what they had lost in the study that I just talked about was primarily fat. Yeah, no, that's great. And if I relate this back to what we were talking about with these sort of short term dips in energy to help improve body composition, but do it in a way which doesn't impact negatively on health.

42:32
The nine day period that you used in this trial, is that the type of period with which a short term change in energy availability might be all right, or is it two weeks, or what is it that you've still like, do you, can you give an answer to that? I don't know if I can. I think what we're about to talk about in the, well, what the people that have written the new IOC consensus statement are talking about is this thing around severity of low energy availability and the dose.

43:02
longer period of time with a less severe dose of low energy availability or less severe threshold, or it could just be a couple of days with a very, very severe energy deficit. And how that sort of equals out as a dose and what maybe is the optimal formula, I don't think we have the answer to that yet. Yeah, no, and actually that sort of follows suit to a lot of these, if you think about weight loss strategies that people use, like it's that continuous versus intermittent.

43:29
sort of diet restriction approach, right? And I guess it's, that's a super interesting space, which will be good to see more research sort of emerging from that, eh? Yeah, and I think we'll see a lot more research going into this going forward, yeah. Yeah, awesome. Hey, Lana, I wanna shift gears and talk about ketone esters, cause these are...

43:48
Interesting. And I actually did speak to Professor Brendan Egan a few months ago, who was a delight to listen to with his accent. I love an Aussie accent too though, so I'm loving this right now. Like, can you just sort of brief us on some of the things you're interested in looking at with ketone esters? Yeah, I think, yeah, Brendan's done a lot more work in this space than I have. So he's definitely the guru to talk to. But we have started to look at ketone esters a little bit more closely.

44:18
We had a study published maybe last year or the year before, and we actually tried to combine the low-carb, high-fat diet with a ketone ester. So what we've seen with the low-carb, high-fat diet is that there was a decreased performance up to three weeks of adhering to the diet. And we think it's simply due to the carbohydrate restriction aspect, glycogen is low, and there's pathways involved with energy metabolism that have been impaired. But ketosis and ketones have been...

44:47
proposed as this additional fuel source that could be used to sustain performance. So we've tried to combine the two approaches as like a top up to the keto diet being the keto nester, but we didn't see any beneficial effects from this combined approach. So that wasn't something that we were able to, or not something that we could implement going forward. It didn't do anything above what we expected from the keto diet alone.

45:11
But we are, Jamie Whitfield and I are running a study currently looking at the ketone ester. He's primarily interested in its use in recovery. So looking at muscle protein synthesis as a result of ketone ester intake after exercise. And I'm more interested in, you know, the ketone esters provide a really cool mechanistic model whereby you're getting ketosis, but you still have adequate carbohydrate availability.

45:36
So I really want to look at some of the follow-up to the PhD work around keto diets and iron regulation and look at is it the ketones or is it the carbohydrate? And I assume it's the carbohydrate that's causing the changes in iron metabolism and bone metabolism, but this is a nice model where I can look at that and tease out the carbohydrate and the ketone influences. So that's something we're currently looking at. Yeah, oh, that sounds super interesting. And finally, it's so funny, I'm like,

46:05
What are all these things I want to ask Alana about this? You've just got to laugh, but I am really, like I did also see just a couple of different papers that you're an author on as well that look at, that do a basic overall audit of sort of the space of the female athlete with regards to, you know, carbohydrate recommendations, micronutrient supplementation and overall sort of health. Like that's quite vague, but on that,

46:34
Can you give me sort of an overview of, you know, where do we stand in terms of the research focus on females? I know this is changing as we sort of moving forward, but as it stands, what can we sort of derive from our current knowledge base? Yeah, so I think the area of female athletes is super interesting. This is where I've been spending a lot of my time of late too. And we've had.

47:02
been really lucky, we have two exceptional PhD students here at ACU, Megan Kirkman and Ella Smith, who have really driven these audits. And when we went started to dive into this female athlete space, we didn't even know where to start, you know, there is so many areas where females are underrepresented. And we looked at some of the areas where we're really interested in. So carbohydrates, the big one. And so Megan took some of the she audited the carbohydrate research. And she showed that there was so little females represented in the

47:30
the female carbohydrate research. And I know I haven't got the number here. I think it's about nine to 16%. I think when we looked at across both acute and she's actually just had another paper accepted looking at chronic fueling strategies. So things like the keto diet and other strategies like that. And it's not only that there's not much research, but the quality of that research is really cool. There's no control of menstrual cycle. And we.

47:58
there's good evidence that says that things like fat oxidation does change across the menstrual cycle. And a lot of these papers didn't even classify their athletes as naturally menstruating or human-oreic or on contraception. And when they did, there's often really confusing crossover terminology. So she's really put some thoughts down around how we may need to target our research into looking at recommendations that are specific to female athletes. The

48:27
carbohydrate targets to body size to account for smaller females, but that's not exactly counting for females in the research. So that's some of Megan's work. And then Ella's work has looked at both performance supplements and health supplements. And Ella's work around performance supplements showed a really similar thing, that females were underrepresented. But when she looked at the health supplements, so we're talking iron, vitamin D and calcium, she actually showed that females were really well represented in the literature, about 70%.

48:56
And that's because females are probably the ones that suffer from these micronutrient deficiencies the most. But there are still big issues around menstrual cycle control or even just reporting. And also a lot of these females weren't athletes. So we still have a niche space in the athlete area that's still not addressed. But at least females are being represented. And actually in those studies, the majority of females, or maybe not the majority, but a good substantial part were pregnant.

49:24
And because pregnancy is obviously an area where we see micronutrient deficiencies, there is a lot more attention on females in pregnancy than there is on athletes. But at least it was a step in terms of including females in the right direction. So Megan and Ella are doing really good work in this space and I think they will continue to as well. That's awesome, Alana. And I do find it is interesting, isn't it? Like in sort of public health research or health research, like if I think just weight loss, which is an area which I've been sort of primarily interested in over my career, like

49:54
it's 90% woman, but when it comes to the exercise science and exercise performance and things like that, that absolutely like it's the lion's share of data. It certainly comes from that sort of male. Yeah, and a lot of, it's often cited, and I heard it as an undergrad a lot, and I even probably was a bit guilty of it during my PhD.

50:19
Females are hard to research and there's no getting around that. If you want to do good scientific control, you have to control for the menstrual cycle, um, to some degree. And it's difficult. We've just implemented a study with elite rugby league players and there were 25 in a team with us at one time. And how do you account for each individual's menstrual cycle and get a meaningful outcome of performance? It's really, really difficult, but we all need to do a better job at trying to do that still. Yeah. Yeah. And I mean, Hey, you mentioned it earlier on with regards to faster training,

50:49
mental tenacity and you know like a challenge so no I completely agree. Alana thank you so much for your time can we just finish off by you sort of telling us you know what should we be looking out for with regards to other published stuff in the literature this year what what are you hoping to sort of get out there? Yeah that's a big question we've got so much on the go I think I've focused on my iron work because that's the thing I'm most passionate

51:18
which will be an abstract at ACSM this year and the paper shouldn't follow too far behind it. So that's going to review looking at iron supplementation timing. So as I talked about before, we've tried to refine the timing guidelines a little bit further and we use some novel isotope measurements both at sea level and at altitude and we looked at how that affects iron absorption. And the trial we have on the go, which is the really exciting one for me, it's called the

51:47
And we've actually labelled a large bunch of runners, about 50 to 60 runners, both male and female, with a isotope. And we're actually tracking that isotope over a 12-month training period. And at the end of the study, we'll be able to distinguish iron loss from iron absorption. And we'll hopefully be able to put some really targeted strategies in place to try and help treat iron deficiency in athletes. And we'll also be able to hopefully, the goal is, if it works,

52:14
is to calculate some new dietary recommendations for athletes because we don't have any for ironing. We rely on the general population guidelines, but that's not sufficient for athletes. So hopefully if our study works, we should be able to put some really specific, both male and female iron recommendations out into the literature. So that will be one for 2024 probably. Alana, that is fantastic. Like as I sort of said when we kicked off, like your contribution in this space seems almost...

52:40
not overwhelming, but you've just done so much. And if what you're talking about, like when that comes to fruition, that's just like further, um, sort of proving, well, not proving my point, but, uh, further showing just how, um, the work that you guys are doing is just pretty outstanding really. Yeah. I'm, I have to say, I'm very lucky. I work here under Louise Burke and she's as good as it gets when it comes to sports nutrition, so I couldn't have a better mentor in Louise and, um,

53:09
the team here at ACU is so supportive and it's just a great place to be. That's awesome, Alana. So now I have found, I found you looking at your profile on ACU and on Twitter. Is there a better place? Or is that where people should look? I think Twitter's probably the best place at the moment. I try to put at least a little bit of an update on some of our lab trials and things that are happening on Twitter and all our recent publications will definitely be there too. That is awesome. Well, we will put...

53:36
links to both your publications and your Twitter handle in the show notes. And thanks so much for your time, Alana. No, thank you for having me. It's been great.

53:58
Alrighty then, and for such a young researcher, she has a wealth of different publications and research interests, and it is really exciting to see this sort of new generation of researchers come through and expand our understanding in different areas. So I hope you really enjoyed that interview. Next week on the show, I talk to naturopath and

54:26
sports nutritionist Kera Sutherland all about diet for teenage athletes and do not forget that I have my Anatomy of Fat Loss live virtual event that is taking place this Sunday, well it's virtual so it's wherever you are and it runs over three days so we will put a link in the show notes to that so you can jump on sign up and we can kick off.

54:54
and this is all to give you the tools and tactics that you need to help you be successful in your fat loss journey. Love that word journey, not at all overused right? However, if you've got any questions on this or anything, don't hesitate to touch base. You'll find me on Twitter at Micky Willardin and Instagram at Micky Willardin or over on Facebook at Micky Willardin Nutrition. You can always also send an inquiry.

55:23
through my website mickeywelledon.com. Have a great rest of your week.