Rick Cohen, M.D.: Optimizing Health And Performance

About this episode:
In this week’s episode, coach Adam has a wide-ranging conversation about understanding your particular needs as an athlete and taking steps to optimize your health and performance with Dr. Rick Cohen, M.D.

Guest Bio – Rick Cohen, M.D.:

Dr. Rick Cohen, M.D. is a leading authority in the fields of nutrition, sports performance and longevity medicine. He received his undergraduate degree in Biomedical Engineering with honors of distinction from Duke University in Durham, North Carolina and his medical degree from Hahnemann Medical University in Philadelphia, Pennsylvania.

Over the past 20 years, Rick has used his knowledge to create innovative health and performance protocols and specially-formulated nutritional products to bring thousands of sport enthusiasts and elite athletes to higher levels of performance. Rick’s passion for athletics extends beyond his work; in fact, it is a major part of his personal life satisfaction and well-being. He played ice hockey in college and competed on the world stage in the sport of luge, his wife is a nationally-ranked triathlete and his kids both were college athletes. So he personally understands how frustrating it can be to balance family, career, and an athletic passion. That experience is exactly what led him to create PureClean Performance.

About PureClean Performance:

PureClean Performance’s beet-infused, whole-food-based sports performance and recovery products are innovatively designed to not only improve performance but also to protect health and maximize overall well-being. Additionally, PureClean Performance’s new membership program makes staying healthy and fit more convenient and affordable by combining educational support with discount pricing on performance and nutritional supplements, lab assessments, natural groceries, coaching, gear, devices and more! Learn more about PureClean Performance at  http://www.purecleanperformance.com/.

Read More About Rick Cohen:

https://www.facebook.com/PureCleanPerformance/

https://purecleanperformance.com/pages/about-us

https://www.instagram.com/purecleanperformance/

Episode Highlights:

• Optimizing and personalizing health and performance
• Developing self-awareness to identify what specifically works for you
• How beets can help enhance performance
• Bolstering your immune system

Listen to the episode on Apple Podcasts, Spotify, Stitcher, Google Podcasts, or on your favorite podcast platform

 

*PureClean Performance is a partner of CTS

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Episode Transcription:

Adam Pulford:

Can we start by assuming the goal of every athlete should be to have good sleep habits, solid nutrition and hydration patterns before we start implementing some of this high level things that we’re going to talk about today, Rick?

Rick Cohen, MD:

Well, certainly, Adam. But the question I throw to you and to listeners is, what does that mean? We make broad based statements of, eat well. What does that mean for you? Sleep well. What does that mean for you? Hopefully we’ll be able to dive into understanding what’s most important for you and me and Adam.

Adam Pulford:

All right. Well, touché to that. I will give you that. But I guess before we get into the real nitty-gritty and juicy tidbits, can you tell our audience a bit more about yourself?

Rick Cohen, MD:

Sure. I am a physician and currently an educator. I also have a brand of products called PureClean Performance, which I am the formulator on. My background comes from engineering. I was a biomedical engineer. I was also a [inaudible 00:01:39] … I was a athlete in a variety of different ways. Currently, just more functionally staying fit and healthy. I actually competed in the sport of luge in the world cup when I was younger. My family’s been really always very athletic. My son was a college baseball player and my daughter was a runner, my wife is national ranked masters triathlete. Health and performance has always been part of our lives as I’m sure it is for-

Adam Pulford:

Yeah, it sounds like it.

Rick Cohen, MD:

… everyone else is. My goal, I’ve always had a passion for health. When I had a full-time practice up until I developed a nutritional product that sold quite well, I could switch my gears into being more of a broad based educator. It’s that passion for health and it still stays with me. I think from a background that is … I try and provide practical, useful information for people. I seem to have a knack for sort of gathering information and providing it in a way that hopefully is something you can do today and we all can study really deeply into the science of things. Which is awesome. But a lot of times, that’s just hard science and what are you going to do with it? Someone needs to do that and then someone needs to take that information and make it practical for each person. That’s sort of where I see myself now. Yeah.

Adam Pulford:

Got you. Yeah. No, that’s a great little description. But I’d say nutrition, hydration, it’s a huge topic and I think we can all agree about that. It can be a Pandora’s box too, but luckily we do have a medical doctor here to talk about some of these things in deep detail. I first like to always start with performance, performance applications and knowing how and why some of these things work. Let’s dive right into that first of all. I’d say, from the supplementary standpoint of the things out there that actually work to improve performance, Rick, what are those things? What’s the number one thing that you’d start with?

Rick Cohen, MD:

Well, I’ll be biased and we can go right into beets because it’s … Well, while everyone’s needs are different … I mean, I’m assuming we’re not dealing with more 20 year olds, we’re dealing with 40 and plus and one of the things that [crosstalk 00:04:24]-

Adam Pulford:

We’ve got everybody.

Rick Cohen, MD:

Yeah, okay. Well, it’s for everyone, but a product that sort of I got involved in is sort of part of a broader based nutritional company that I had founded was this organic beet juice powder. It was just part of what we were offering. It was a comprehensive whole food supplement. It was a whole food based powder, it was amino acids, vitamin D and K. A lot of what we were doing was assessing athletes, actually using physiological assessments. While they physically felt well, these physiological assessments actually showed that there were lots of holes in their key foundational nutritional needs. By sort of creating a comprehensive plan for them, we were able to see dramatic results. It took some effort for people to do that, they had to take six or seven different things, they needed to retest. But when they did that, they did really, really well. One of the products we had was this organic beet juice powder.

Rick Cohen, MD:

Just to sort of tell the backstory is, I had an opportunity to really dive deep into beet juice and nitric oxide at the time because the company that made this really unique beet juice powder decided to go out of business. I loved this product. I loved the way they sourced it. I loved that they tested each batch and they wouldn’t release a batch of product that wasn’t tested for the actual nitrate content of the beets. The third thing which was really cool, was they used this light refractory drying technique, which there’s only five in the country. Which actually uses super low temperatures. When they dried the beet juice, this frozen concentrate … It was called bricks and it was sort of the particular concentrated amount. It was a crystalline powder as opposed to, if you look at powders that you get are a lot of times freeze dried or even less expensively spray dried. They are really light and fluffy and that’s more damaging to the product. This is the organic deep, rich beet juice powder was just quite cool and it had a natural sweetness. That’s when I went-

Adam Pulford:

What do you mean damaging to the product? Why does that even matter?

Rick Cohen, MD:

Well, it’s the heat. They’re actually … We’ll use, when things get heated at times you can change some of the structure and nutritional content. There’s some data on that as well. The nitrates don’t change, which are sort of the active nutrient or molecule that we need to create nitric oxide. But some of the other nutritional components of beet juice powder, whether they’re betalains as an antioxidants or betaines become diminished. Particularly the betalains, which are sort of anti-inflammatory in nature and these betalains are responsible for that deep red color. Anyone who had beets initially and they’d go, “Whoa.” It doesn’t happen all the time, but you’ll definitely see your poop get red, or sometimes even your pee gets a little red. That’s a genetic … The poop issue is pretty much everyone, but that’s the betalains coming through. It’s that dark red color. In nature, anything with a deep color is those polyphenols phytochemicals that have a protective nature to the plant.

Rick Cohen, MD:

That’s why the plants develop these antioxidant chemicals to protect them from being eaten as opposed to fruits, which are sweet, which are wanting to be eaten. We could go down a rabbit hole of this [crosstalk 00:08:30]-

Adam Pulford:

Yeah, and we’re starting a rabbit hole there but-

Rick Cohen, MD:

Yeah, but the phytochemicals, the important thing there is they have a double edged sword with regard to that. That’s where we got into beets and really understanding some of the science behind beet nutrition and the science of nitric oxide and-

Adam Pulford:

How does that deliver performance though? What is kind of the mechanistic process of dietary nitrate to nitric oxide in the body?

Rick Cohen, MD:

Got it. Okay. This is really important. It’s sort of this key feature of nitrates are fixated by plants from nitrogen in the air. Then we eat these plants and certain plants are higher or have more bioavailability of these nitrates in their substrate. Beets are one of the highest ones. We eat the nitrates, they’re actually taken into our mouth and they’re either digested and we absorb them through our GI track into our bloodstream. Where they’re converted in the GI from nitrates to nitrite. The nitrates are best converted though in the mouth. The oral bacteria, actually healthy oral bacteria, start that process of converting nitrates to nitrites. Then nitrites then get converted in the body to nitric oxide. It happens in a variety of different tissues. The predominant tissue is the interior lining of the arteries, it’s called the endothelium. There’s an enzyme called eNOS, endothelium nitric oxide synthetase. That creates this. For a number of … Not too long ago, I don’t know exactly, when we understood that there was other pathways, was we thought that was the predominant way to produce nitric oxide.

Rick Cohen, MD:

Getting back to your question, nitric oxide then increases blood flow and blood flow increases tissue oxygenation. Nitric oxide is a gas that is only around for a few seconds. It’s a really potent cell communication device, signaler, a better word for it. Now, from relating it to what we know, you don’t see it very much, but certainly 30 years ago people with cardiovascular disease, what did they walk around with in their pockets? We all probably had a grandparent, or maybe a father if we’re a little bit older, who might’ve had cardiovascular disease and had-

Adam Pulford:

Nitro.

Rick Cohen, MD:

Nitro tablets, right?

Adam Pulford:

Mm-hmm (affirmative).

Rick Cohen, MD:

Yeah. I don’t see that and maybe our medicines are better and per se. But Nitro, well, nitroglycerin, literally nitroglycerin stimulates super rapidly the formation of nitric oxide. What does that do? Open up the blood vessels of the heart, open up the blood vessels of the lung, open up the blood vessels in the penis. Guess what? More blood flow, no chest pain. That’s how that works, pretty simply.

Adam Pulford:

More blood flow equals more oxygen to the working muscles? Therefore, go faster, do more, go harder kind of thing?

Rick Cohen, MD:

Correct. More blood flow to the muscles, more blood flow to the mitochondria, more oxygenation to the mitochondria where energy is produced. More ATP, go faster, go longer. You got it. Now, the part … Two things. As we get older, the lining of the vessels becomes less efficient. Now, it becomes less efficient due to time or we’ll call it age. That age could be a whole many different factors. Actually the process of aging or the process of how you’re living your life. That it isn’t as efficient and it could be 50% reduced, and/or disease. If that progresses and someone has some disease in that lining, they can’t produce as much nitric oxide. With regard to the penis, that’s where Viagra accidentally was discovered. Where Viagra blocks the enzyme that breaks down nitric oxide, so it hangs around longer. That’s the key. The benefit of Viagra is, it hangs around longer. They were actually trying to create a cardiovascular drug and they couldn’t get it to work in the heart, but it worked elsewhere.

Rick Cohen, MD:

Lo and behold of a multibillion dollar industry was created. Viagra it’s 15, I don’t know, 18 years old. It was the early 2000s that it really started to come in and we paid attention to testosterone. Now, here [crosstalk 00:13:22]-

Adam Pulford:

Yeah, that’s crazy. I didn’t think that we’re going to be talking about penises and poop on the podcast today, but it’s actually good background information.

Rick Cohen, MD:

Okay. Here’s where-

Adam Pulford:

To performance, here we go.

Rick Cohen, MD:

… the [inaudible 00:13:34]. Yeah, for performance. You know as a coach and anyone who’s gotten older knows, they just can’t do what they did when they were younger, even from an oxygenation. A lot of people can continue, but there’s definitely a decline over time. Certainly a bunch of factors play a role with that, age, disease, nutrition, testosterone, and so forth. But a huge factor is, we don’t produce as much nitric oxide. If you can’t produce enough nitric oxide in the vessels, you’re just not going to deliver oxygen in the same way that you do when you were younger. Another way to think about nitric oxide is, people who live at high elevation or train at high elevation one of the benefits is, you start producing more nitric oxide because you need to be able to utilize less oxygen. The more efficient you’re using oxygen, the better you’re going to perform. Now, we didn’t have a good way of increasing nitric oxide in the interior endothelium of the lining.

Rick Cohen, MD:

People were using arginine and citrulline. They helped, but the problem is, they could go down a whole variety of different pathways. You take arginine, and citrulline is better, it could be utilized any number of different ways. It’s like taking a funnel or having some type of funnel where it’s not just a single funnel. It would be 10 different things and you have to pour water in it and it’s not just going down the one you want. It’s going in all different directions. Some of those other pathways may not go to places you want them to go, so it’s not like you could just take more. Here’s the cool thing, the understanding that these dietary nitrates are a work around. If you up your dietary nitrates, you can start producing more nitric oxide to make up for what you’re lacking in your interior linings as you get older. Even if you’re younger and fit, by taking more, you can … This is sort of a more recent study with beet nitrates is, they took high level trained athletes and they had them take 50 to 75% more nitrates and they showed improvement in performance.

Rick Cohen, MD:

Where initially the thought was, nitrates are going to only work for people who are less fit or less trained. That’s true. Like anything we do, you start up, you’re going to see huge benefits. If you’re really deficient, you’re going to see huge benefits. Then that last extra push is always quite harder. Now, the problem with dietary nitrates is, it’s hard to get. Yeah, you can … Well, let me rephrase that. You can get dietary nitrates in beets and arugula and you can get some of the other polyphenols that work with it, dark cocoa and pomegranate that help the body utilize it. But to get enough to overcome that deficit in foods is really, really hard. To get 500 milligrams of dietary nitrates, you’re eating four beets a day. You’re eating, if that, depending on the actual nitrate in the beet.

Rick Cohen, MD:

That’s where the advent of using these selected variety of beets that are processed and tested for nitrate content and then concentrate it out so you’re getting a large dose of these nitrates in a small quick subtract makes a big difference. That’s how you overcome this dietary roadblock and the age challenge that we have to deal with.

Adam Pulford:

I want to get into that because I think that it’s important for the listeners to hear how things are concentrated in a way to get enough dosage. But before we do that, would you say all ages and all athletes would benefit from a dietary nitrate supplement or food product?

Rick Cohen, MD:

Yes. Yeah, all athletes. Certainly the older athlete and the ones that are sort of moderately trained are going to see the bigger benefits as opposed to the younger, higher level athlete. But not to say that that younger, higher level athlete won’t, they just are going to need to take more to sort of push themselves up to another level. Because they’re already at a high level already and the engine is working pretty well. We have more room for error when we’re younger.

Adam Pulford:

Yes, we do. But with that being said, I mean, with many of my athletes, once we get a lot of these things right in place with training, body composition and all this kind of stuff, I’m a big proponent. I’m a big fan of a beetroot product and I’ve always been a fan of your product specifically because it actually works. You can see elevated power with same or mildly suppressed heart rate. Not suppressed in a bad way, but lower heart rate, higher power. Let’s talk about that right now, because the way you concentrate the products or where you’re getting this nitrate from it’s actually pretty important. How do you do it?

Rick Cohen, MD:

Yeah. That is the most important thing when you’re looking for, we’re talking beets right now, a beetroot juice. That’s the first thing you need to look forward. It needs to be a beetroot juice because if you just take beetroots and pulverize them up and put them into a capsule or a powder, you’re getting all the fiber and other components too. Which isn’t bad, it’s just a general nutritional supplement. But you’re not concentrating for the nitrates, and that’s an important thing. The way you need to do that, is you need to take the beetroot, you need to juice it. First, you need to actually test the variety. There’re particular varieties of beetroots that have higher nitrates than others. This really, maybe only until three, four years ago was random because they weren’t growing it until the beetroot market sort of started to expand. You would just randomly test for what the farmers brought in. If you found a good one, you’d grab it really quickly. The range can be two and a half times. Most commercial beets are 1% nitrates and it’s about 100 milligrams per 10 grams of product.

Rick Cohen, MD:

The good, when you can get them now, they’re up to two and a half to 3%. But it’s still hard to get because not everyone’s growing it. You need to test the beets, you need to juice them and then you need to dehydrate them. That is a more laborious process as opposed to, a, where you don’t test them and where you just use the beetroot itself. I think the market is better, where most products now are beetroot juice. But most companies are not testing the actual beetroot juice concentrate for nitrates and [crosstalk 00:20:58]-

Adam Pulford:

But you are? That [crosstalk 00:20:59]-

Rick Cohen, MD:

We are, yeah. Yeah, correct. Even a lot of the manufacturers don’t, which I think it’s one of those, “We don’t want to know. If you’re not going to ask, we’re not going to tell.” Not that you’re getting a harmful or … But it’s just not a product that’s going to give you the same bang for, I guess, your buck or time. That’s important. The other thing, there’s a process of fermenting. They have a fermentation process where you can actually take the fermentation of these beets. It’s a multistep process and they actually readd beet extract back into it and there’s a way to get the beet nitrate content up to over 5%. The problem with that is … The good thing is, you’re getting a super concentrated nitrate. The negative is, it doesn’t mix well as itself as a powder. It’s not that deep red, dark crystalline organic beet juice, but you are getting more nitrates. The other benefit to that of the powder, is it’s really mild in flavor.

Rick Cohen, MD:

For us, we have the 100% beet juice which has all the betalains and the dark reds and it’s about two and a half to 3% nitrates. I think the last batch was a little over 3%. Where the BEET’UMS and UNBEETABREW we use more of the fermented beet juice powder, which we don’t need to put as much and it just blends right into the ingredients really nicely. You’re getting more of the nitrate kick with that, but you’re losing out on some of the betalains. But [crosstalk 00:22:43]-

Adam Pulford:

Those products you just mentioned, those are some of the products at PureClean Performance, BEET’UMS, UNBEETABREW. We’ll talk about that here in just a second. But you design everything specifically with the right amount of dietary nitrate per serving in your products already. You’re like whether it’s a scoop or a bite or whatever?

Rick Cohen, MD:

Correct.

Adam Pulford:

So we don’t have to, our audience members who are worried about getting in the milligrams specificity, where basically you take a dose of what you’re serving and they got it.

Rick Cohen, MD:

Yeah. Well, yes and no. I think in a perfect world, what I did and I certainly don’t mean to promote our products, but it’s just sort of share [crosstalk 00:23:25]-

Adam Pulford:

Sure. Yeah, I appreciate that.

Rick Cohen, MD:

Yeah, is just to share where we were thinking and sort of the logic to give you a better understanding of sort of the big picture. You have the beet juice, which is great, and it’s the more nutritionally rounded one. Then you have the BEET’UMS which are activated. The cool thing about BEET’UMS, is they taste good and you can carry them with you and they’re activated in the mouth. They sit there in your mouth and you’ll have more time for the oral bacteria to activate them. They’re a little bit lower nitrates per serving, and it’s all individual in everyone’s individual needs, but effectively they’re a little bit stronger. The other two products, the UNBEETABREW is a blend. That actually has higher nitrates per serving than the PURECLEAN POWDER. In a perfect world, I think people would do one of each or do half of a scoop of the PURECLEAN POWDER and some BEET’UMS or … BEET’UMS are thrown at anytime, but they’re … If that makes sense. Yeah, there’s sort of a serving … If someone’s really trying to push, I would say, choose two a day of something.

Rick Cohen, MD:

Even in a perfect world, one of something, twice … Man, let me take that back. Two different products taken once a day because you’re going to get different actions based on how they were formulated.

Adam Pulford:

Yep. Got it. We’ll talk … Excuse me. We’ll talk about a few of those products here in just a second, but let me get one drink of water here as I … I had a hard ride today using my BEET’UMS and whatnot.

Rick Cohen, MD:

Yeah.

Adam Pulford:

Excuse me, but-

Rick Cohen, MD:

One other thing [crosstalk 00:25:17]-

Adam Pulford:

… let’s [crosstalk 00:25:18]-

Rick Cohen, MD:

… [inaudible 00:25:18]. Yeah, go ahead. Yeah.

Adam Pulford:

I wanted to … Yeah, actually, one thing think about dietary nitrate. You mentioned the bacteria in the mouth. If you kill that bacteria, are you killing the dietary nitrate and what are some applications there, practical applications?

Rick Cohen, MD:

I mean, you’re definitely lessening the activity of the nitrates. There’s been studies with regard to using antibacterial mouthwashes, which is Listerine that actually show increase in blood pressure. I was like, “What?” Well, the antibacterial, whatever dietary nitrates you’re using or eating are not going to be as effective, and we actually see subtle changes in blood pressure. You also see that with antacids. Antacids, since you need a particular amount of acid to actually convert those nitrates to nitrite, if you’re blocking those acids, then again, you have an issue with blood pressure. Those are in the scientific literature. Not huge differences-

Adam Pulford:

If you’re [inaudible 00:26:27]-

Rick Cohen, MD:

… but there’s definitely a significant difference.

Adam Pulford:

If you’re brushing your teeth using mouthwash or antacids after you take dietary nitrates supplements, that’s not a good thing? That’s what you’re saying?

Rick Cohen, MD:

Yeah, that wouldn’t be a good thing. If you want the effects of dietary nitrates for performance, you definitely want to stop the antibacterial mouthwashes because they’re just going to keep that natural bacteria … There’s a trade off. We need healthy bacteria in our mouth. Just find another way to have a fresher breath.

Adam Pulford:

Well, yeah, and hopefully we don’t need fresh breath necessarily to ride bikes. I guess for all the listeners out there, I brush my teeth in the morning, take some beetroot powder in a smoothie in the morning, train, come back, brush my teeth then if I want to brush my teeth later on the day. No need to worry about that. But I did want to mention that because a lot of athletes who are taking dietary nitrate they don’t understand that and the antacids, for example. I wanted to mention that. Speaking of things that increase blood flow, you also mentioned the UNBEETABREW. It’s a caffeine, cordyceps, dietary nitrate thing, but let’s talk about caffeine. Why does that work and how do you include it into your products?

Rick Cohen, MD:

Okay, yeah. Obviously caffeine people have used it. They notice the effect. We notice and we know, especially for people who aren’t sensitive, that it increases mental focus, it increases reaction time. That’s really important for any athletic performance. The other thing that caffeine does is stimulate energy utilization, oxidations of fat. That’s the other benefit of caffeine. Now, Chris Kresser wrote an article, I can send that to you, it’s like … Yeah, let me find … It’s like … Here it is. It’s great. Coffee Is Good for You—Unless It’s Not! Everyone is different and I’ll preface, caffeine is good for you, unless it’s not. We hear studies [crosstalk 00:28:47]-

Adam Pulford:

Okay, fair enough.

Rick Cohen, MD:

… we drink lots of coffee, it’s good for health. People who drink more coffee have better heart disease risks, and blah, blah, blah. These are epidemiological studies which are useful but flawed, because they’re not looking at you, they’re looking at large groups of population. Maybe for half of that group, it’s awesome, for a quarter it’s [inaudible 00:29:12], and for a quarter it’s bad. Well, where do you lie within that realm? Well, the same thing for caffeine, it depends so much on what your genetics are. Are you a fast oxidizer? That means you could drink caffeine at 11:00 at night and you can go right to bed. Where someone else they’re going to be up for three days. It depends on their particular genetics and you could test for that. It also depends on their lifestyle. If you’re a smoker, here’s why does cigarettes and smoking go together and you can keep drinking a ton of coffee? Well, it turns out cigarette smoking slows down the ability to detoxify things. That’s another [crosstalk 00:29:58]-

Adam Pulford:

Shocker. Real shocker.

Rick Cohen, MD:

Shocker. You could drink more coffee because it’s affecting … I think I said that backwards. It actually enhances it, but it’s sort of more complicated than that, but it’s breaking down the caffeine more rapidly. And [crosstalk 00:30:13]-

Adam Pulford:

How do you know if you’re a fast metabolizer of caffeine or not? How do you figure that one out?

Rick Cohen, MD:

Right. How do you figure that out? You could do genetic testing. I mean, that’s to truly know. You could figure that out just by what your response is. If you’re someone who has coffee and it causes you to have … You know what, that’s not necessarily even the anxiety. Because you could metabolize it reasonably well, but some people also have another genetic, we call them snip, they’re called. That blocks this adenosine receptor in the brain. When that happens, you’re more stimulated by the coffee and you get more anxious. There’s variables and I’ll throw in the other variable. If you drink citrus juice, that actually blocks the liver and you have more exposure. You have this combination of genetics, a combination of lifestyle, when you’re having it, what foods you’re having it and so forth. It can become quite complicated. But my recommendations for … Let’s simplify this out for you and certainly you can test for it and you can determine if you are a fast or slow oxidizer.

Rick Cohen, MD:

I’ll give you a perfect story for me. I’m not really a coffee drinker, I’m not someone who needs caffeine to wake up and get going. It’s just something I’ve never done. But when we developed UNBEETABREW, I really liked it. I don’t love coffee, but a latte or this UNBEETABREW with some oatmeal or some coconut milk was pretty good. I started drinking every day and I liked my performance. Then about two, three weeks later, I started noticing like I got a little sweaty afterwards and I was just racing a little bit. Happenstancely, I’d just done a genetic test and it came back I was a slow metabolizer. It took me, someone who detoxifies pretty well in general, but it took me a couple of weeks of regular use to go, “Okay, everyday caffeinated coffee is just not something I need or should do.” But in my case, I just use it periodically. We actually have a decaffeinated version. But the caffeinated version I’ll use it when I need it or when I want that extra boost and I feel a bigger bump.

Rick Cohen, MD:

That’s for someone else, it’s like, the more you drink coffee, the more you have caffeine on a regular basis, the more your body utilizes it and breaks it down so you get less of an effect. From an athlete’s point of view is sort of figuring out what your needs are. Maybe one cup a day is just fine and you metabolize it quickly and you have it in the morning or you have it just before training and you’re great and you’re good to go. But someone else, one or two cups every day is way too much. They may be just fine using it before a hard workout or before a race as long as it doesn’t overstimulate them.

Adam Pulford:

Yeah. My go-to has always been try it in training first and then if it works positively, we will use it in the race. But if it increases anxiety, if it increases heart rate exponentially, meaning, the ventilation is just out of control and you feel like your chest is about to explode, either lower the dosage or just don’t do it at all. I think the take away here is, caffeine it’s well-proven to increase athletic performance. But if it is bringing adverse effects, don’t use it and find …

Rick Cohen, MD:

Yeah. I even go even further than that. It’s like, don’t wait until it causes a clear, apparent negative effect. You can get a clue like you’re using … I have an Oura Ring. Sort of, I know we’re going to chat maybe a little bit about COVID and immunity. They’re using Oura Rings now to sort of pick up people with increase in body temperature, or increase in heart rate, increase in respiratory rate, heart rate variability. Whether it’s just checking your blood pressure or heart rate variability, sort of get a sense of what that caffeine does to you. It may be really subtle. It may be … For me, my blood pressure just went up five to 10 points and I would have never noticed that. But after two to three weeks of it, your body picks up on it. Some of these subtle cues that we may not physically notice are definitely having a physiological effect. Some type of tracking, we can probably talk more about that if we have time, is really critical.

Adam Pulford:

Yeah. Well, and that is good. We’re spending a lot of time on performance and we only have a short amount of time, but that’s actually a pretty decent segue to start talking about general health and wellness. I guess I want to ask you, what is your approach to general health and wellness? What’s your philosophy?

Rick Cohen, MD:

I think, I should have shared before, is know yourself. Sort of dig in and understand that there’s not one method, one diet, one way that is going to be best for everyone. We’re all different. You have to know your body and you have to listen to your body. We’re so out of touch a lot of times. Athletes are better, that’s why I like working with athletes. I used to tell a story of a diabetic who came into my office and he was in a wheelchair. He just had his toe cut off and he was on five different medications. I said, “How are you doing?” He says, “I’m doing awesome.” I’m shaking my head, “But what do you mean? Don’t it …” “Well, doc added a new blood pressure medicine onto my protocol and he says it’s good now. I’m great.” I was like, “Oh my gosh.” Then literally the next person who came in was a high level athlete and they just had this one issue with … I forget. It was their knee, it always bothered them when they went up high levels in intensity and it was just driving them crazy.

Rick Cohen, MD:

Everyone’s perception of what’s important, obviously the athlete was much more in tune. Sometimes we can get overly in tune with our body, so know your body. The second thing to know is, humans are super, super adaptable. One of our blessings and curses is, you can eat a carnivore diet or you could be vegan. I know people have gone both ways, “Oh, I did great on a vegan diet.” Until they didn’t. Or, “I did really good in that carnivore diet.” Until they didn’t. Sometimes nutrition becomes a religion, and not to say I can weigh in on what would might be better for the majority of people, but everyone’s unique. Listening and having some way to track and understand what’s best for you, that’s important. I’d say the third thing is, I’ll say it in a … Don’t put crap into your body. With whatever we do it’s, get toxins out of your body. That could be toxic foods, toxic emotions, toxic environment, toxic personal care products because that’s a given. We do urinary toxin tests on people to look at metals and chemicals.

Rick Cohen, MD:

More and more these days, I didn’t see it as frequently, but in the past few years, it’s, the people who have levels of certain chemicals in their system that are way over 99 percentile are very, very frequent. It freaks me out actually how much of a problem … We don’t look at it. From that level, it’s really important because everything you do is going to be affected if your body’s clogged in some way.

Adam Pulford:

Yeah. No, I love those three points by the way. I couldn’t agree more. I think that that’s what muddies the water a little bit. Is that we as human beings are very adaptable and that’s a good thing. But that means that we’ll try to adapt around a bad stress if there’s a bad stressor there. But kind of a simplistic way is, put good in, get good out, put bad in, get bad out. When I was searching for some questions as I was kind of drafting up some questions for this podcast and oftentimes health and wellness were somewhat defined medically as absence of disease. If you’re absent of disease, then you must be healthy. I’m not a believer in that. Baseline is not the goal, it has to go above and beyond. That’s kind of what you’re talking about there. You need a holistic wellness, mind, body, and kind of that output of what you want your body to do and perform.

Rick Cohen, MD:

Correct, absolutely. Just because you’ve gone to your doctor and he says, “Everything’s great.” I was like, “Well, what does that mean?” “Well, it means as much as I’m looking, you don’t have an outright disease that’s going to need a new medication today, come back when you’re sick.” Basically. I apologize I’m being too … But it sort of is because the traditional world only has a certain amount of time to dig deep into each person. It is complicated. It does take time and effort and a lot of people just aren’t interested in digging that deep to try and understand what they can do to optimize their health and performance. I take personally a longer approach and I’m saying, “Okay, what are we trying to treat? Well, we’re trying to treat death. Yes, are we going to win? I don’t …” Okay. We’re trying to treat aging. Aging is the disease and that’s going on every moment. Every second, every minute our body’s getting older and it affects us.

Rick Cohen, MD:

The old paradigm is, we can’t do anything about that. Well, the new paradigm, which there’s many millions and millions of dollars being invested in, is, yes, we can. In fact, the disease of aging is what causes immune senescence, AKA, more susceptibility to viruses and what causes cancer and what causes heart disease. What’s going on genetically and what can we do with our lifestyle and nutrient protocols and whatever it might be that’s coming up next to sort of address that as a primary issue. Because the more you’re sort of chipping away or I envision holding back that process, the stronger your body is going to be in the meantime. I’m trying to take a offensive approach. We tend to be really defensive in Western medicine. We’re going to take an offensive approach and attack what we know the big issue is. Are you going to win that battle? Not today. Can we win it in 30 years? Who knows? Or could we hold that off for 20, 30, 40 years in 20 years? Very possibly.

Rick Cohen, MD:

How do we do that? That’s the question I ask myself all the time. For people who are interested, it’s like, how do we do that and what do we know today so that we can make changes? So everyday at least we’re trying to do something a little bit better for ourselves.

Adam Pulford:

Yeah. No, that’s really good. A point blank question for you is, for our listeners, what would you recommend for them to increase their awareness? How can they increase their awareness of putting vitality into their lives?

Rick Cohen, MD:

You want [crosstalk 00:42:51]-

Adam Pulford:

I mean, sure you can do a genetic tests, you can get some data points and all this kind of stuff. But just kind of a straight up, and I know I’m going off script here, but it’s just kind of, shine it to me is, how can we bring that awareness to athletes? I do it through data in training, there’s a training stimulus and all this kind of stuff. But as a kind of a medical doctor and from the kind of supplementary standpoint, how would you recommend getting awareness to the athletes?

Rick Cohen, MD:

Obviously the first and most important thing is, how do I feel today? It-

Adam Pulford:

Yeah. No, for sure.

Rick Cohen, MD:

But let’s … Sometime we’re like, “Oh, I have to do this. I have to train this way. I have to …” It like, “No.” Listen to your body. Yes, I’m sure, you’d say as a coach, there’s places for overreaching and pushing a little bit past fatigue so you can recover. But from the broader standpoint is, how am I feeling today? Should I push hard or should I just chill out and take a long walk? Or should I get in a sauna or maybe I need to go to bed a little earlier. Because something’s just not right. I will just give you a simple example for me. Two days ago, I did a strength workout. I do these slow two minute 20 seconds up and down of particular weights. The whole workout was really good. I got to the last one, which was curls, which are really painful to go two minutes really slow. Everything was good, on that last set of that last one, I couldn’t do the third rep. I’m like, “What the heck?” Because I had been …

Rick Cohen, MD:

It’s a sticking point that third one, but the last few times I broke through and I go, “That’s weird.” I sort of put it off to my shirt. Then I went, I do a sauna afterwards and I’ll do a quick cold shower. It was really cold and I’m like, “Okay, something’s off.” It was like, it didn’t feel right. I noticed yesterday and today a little bit allergies have kicked in, I’m a little bit scratching my throat. I was like, “Oh, okay. I get it.” Just that really … I’ll take a metric. Even the night before, my sleep metric, my deep sleep was down. There, I sort of combined paying attention to why didn’t I finish that little rep where I’ve been doing it and the water was a little colder and I really want to do the cold hormesis and my sleep was off. Something is brewing. Then yesterday [inaudible 00:45:29] I’m scratchy and this morning I sneezed a bunch. There it was. I don’t think I have corona, but something was funny I [crosstalk 00:45:37]-

Adam Pulford:

There’s still time.

Rick Cohen, MD:

How do you do that is, pay attention to your body and use some type of metrics. There’s a variety of different metrics that I love, whether it’s an Oura Ring or some sleep metrics. We do some longevity protocols and there’s some powerful ones like heart rate, temperature. Reaction time is actually really key. Heart rate variability, I like, because it gives us some long range data. There’s people who will say, “Oh, it’s great. People don’t like it. They don’t like to use it.” It’s very useful. It just doesn’t tell us everything. It’s sort of putting these different metrics together. But there’s a particular device called Brain Gauge. What it does, is it measures cognitive ability, reaction time and fatigue, cognitive fatigue. That’s something we can relate to. You wake up that next morning and you’re a little bit off and you take, your reaction time is down 10% and your decision making time is not quite as quick. Well guess what, something’s off.

Rick Cohen, MD:

It’s a quick little test and it’s meaningful because if your reaction time is off, maybe not as important for an endurance rider unless a car is going to come at them, but there’s a sign of fatigue in your body and pay attention to that. [crosstalk 00:46:57]-

Adam Pulford:

Is this pre or post coffee in the morning that you’re-

Rick Cohen, MD:

I would take-

Adam Pulford:

… using Brain Gauge?

Rick Cohen, MD:

… the baseline. Yeah, for sure. It’s sort of looking at heart rate variability or some at Brain Gauge in the morning. These are going to be important metrics to sort of say, listening, how am I feeling and putting this together with your goals, so you can then determine what to do. From a bigger picture, labs are great, but you certainly can’t use labs on a regular daily basis. From a testing perspective, there’s two, I mean there’s a lot, but there’s two that I really like. It is sort of a comprehensive serum chemistry, or a full comprehensive, not just, “We’re going to check your lipids.” But looking at certain metabolic markers, hormonal markers, glucose, metabolism. Then running those through, there’s some computer algorithms now where actually we’ll look at all this data and say, “Aha, this is the patterns that we’re seeing that my human eyes would not pick up.”

Rick Cohen, MD:

It might say, “A, we’re seeing a deficiency in magnesium or this is linked to this pituitary axis imbalance.” That’s really helpful to sort of, it’s not the … I like to use the ship analogy. Okay. You’re going to sail from New York to London. You know where you’re sailing, where you want to get, but that’s your long range plan where you’re going to do bigger direction changes. But it’s that day to day, obviously, what’s the wind doing today? What are the waves? They have to deal with the storm, they have to go around. That’s the metrics and how I feel. The other test I really like is, everyone at some point … Certainly genetics, but even looking at chemical and metal burden. Because I just see that as, you just don’t want to miss it. It’s like, if it’s something in your system, you could get it out. Why live with high levels of thallium because they’re using fracking water to spray kale in California on organic vegetables without telling you?

Rick Cohen, MD:

Or you’re a swimmer and the way they’re ozonating the water is, you’re exposed to perchlorates, which will affect your thyroid or … I could go on with stuff that [crosstalk 00:49:28]-

Adam Pulford:

Right. Yeah, that’s some scary stuff. I would say, I mean, if people are recognizing some adverse things within their training or themselves or their awareness, I mean, you go to a medical expert, whether it’s yourself or local doctor. But I think to kind of bring the message back home is, bringing that awareness requires a stimulus. You’re training or you’re testing, or you’re doing something, and then you evaluate on that and you record it. Whether it’s pen and paper or an online database of some kind, but a perceived effort of qualitative, quantitative. Using training peaks, for example, there’s plenty of metrics in there. Using wearables in the kind of sleep monitors as well to start monitoring a lot of these aspects that can make you feel certain ways. I always say, take that number and make a feel to it. Bridge it to the feeling. I think that’s a good thing.

Rick Cohen, MD:

Yeah. You said it earlier with regard to … Let’s go back to … My wife will not get on her bike without a power meter. It’s just, to her to ride without a power meter is like a [crosstalk 00:50:38]-

Adam Pulford:

Yeah, she’s seen the light, man. She has seen the light. It’s fine.

Rick Cohen, MD:

Right. Is a wasted ride. Beet nitrates, I didn’t have a chance to follow up, it’s totally … You’ll see power maintain the same for lesser heart rate. The other thing that’s sort of cool, is you’ll see quicker recovery. When you’re doing intense verticals or intense intervals, to me, I don’t know from a coaching perspective, is like, I like to see how quick people recover. To me, that’s a sign of a strong cardiovascular system. It’s not how hard you can push your heart rate up. If you’re doing in one minute really hard, how soon can you get back to 80% of that max heart rate? That’s when you know your cardiovascular system is really good.

Adam Pulford:

Yeah. I mean, it’s not who does the most training, it’s who can recover the fastest because then they do the most training. That’s kind of the way I think about it.

Rick Cohen, MD:

Exactly. Yep, for sure.

Adam Pulford:

Okay. Well, I want to touch on a few other things. We might have to kind of push through this. But I’ll point out the elephant in the room. We’re living in a pandemic right now, which is kind of crazy. But to just stay healthy, is there anything that we can do to boost up our immune system right now and maybe prevent some virus overtaking our bodies? What would you say to that, Rick?

Rick Cohen, MD:

I think everything that we’ve spoken to with regard to performance, anything that we’ve paid attention to with regard to solid sleep, I think we haven’t mentioned some of the other lifestyle components. You asked what’s important to me. It’s not finding a vaccine or not taking this herbal immune blend. Not to say that … They may or may not be helpful, but we’re relying on something else to support us to give us the strong foundation of health. We can take this opportunity now to change our habits to become a healthier, stronger person. You know what, I’m approaching 59. I’m approaching the, “Oh, you’re over 60.” Well, no. My immune system is not anywhere what the average epidemiological 60 would be. I’m not concerned at all. In fact, I think I probably had it coming back from Mexico. That’s not pleasant for five days, but at four or five days, but it went away. Getting sun in the morning. Waking up, getting some sun in your eyes. Going barefoot on the ground to get grounded to the earth. There’s a thing about grounding to getting out of EMF fields. Shutting off some …

Rick Cohen, MD:

The things that we hear all the time. Don’t be staring at computers before you go to bed. Eat three hours before bedtime. Staying away from lots of sugars and alcohols. All these things that are just, I guess to me-

Adam Pulford:

The basics.

Rick Cohen, MD:

Right. Or just go to the basics. Is taking a walk and be mindless, or if you like meditation or deep breathing. All this stuff, which we know is super good, is now even more important than ever. That’s sort of the critical factor here. Unfortunately, you don’t hear any of that from the powers that be, because we don’t want … Either it’s just the model or we don’t want, we’ll go down the rabbit hole. We want to give people a fix. We want to say a vaccine is going to fix it. Well, maybe not. Maybe we need to fix ourselves and the people, not solely, but the people who are more at risk are the people who are ill and inflamed and have issues. I’ll sort of throw the two components that you don’t hear and it was actually sort of cool. I saw 123 MEs doing some data searching with regard to people who are genetically susceptible to this cytokine inflammatory storm that seems to happen and causes lung issues.

Rick Cohen, MD:

We started looking at who’s more genetically susceptible. Well, that would be really helpful to know. Then we make this blanket assessment of, “Well, you’re over 60, you’re at risk.” Well, yeah, because you’re older or if you’re diseased. But the real risks are, what’s your immunity? I don’t understand why we’re not … I understand, it’s expensive and it’s not part of the marker. But we talked about the aging before. There are two key components of the aging immune system. Especially with viruses, it’s your T cell count. There are subsets of T cells which are sort of the immune component from our thymus gland that deal with invaders. We have these naïve T cells which are sort of what we have when we’re younger. We have a ton of them. They haven’t sort of been decided what they’re going to become. They’re there waiting to-

Adam Pulford:

Hanging out.

Rick Cohen, MD:

… become whatever they need to become. Then we have these senescent cells. It’s like, they’re done, they’re cooked, they’re damaged. Sometimes they’re even called zombie cells because they’re going out and making the other cells in your body sick or causing harm to them. They’re just bad guys. When we get older, we have less naïve cells. We can’t mount a new attack and we have all these senescent cells, just sick people in wheelchairs hanging around getting in the way and you can’t [crosstalk 00:56:25]-

Adam Pulford:

Zombies.

Rick Cohen, MD:

Right, basically. We-

Adam Pulford:

Getting in the way.

Rick Cohen, MD:

You can assess those. I mean, you can actually look at whatever your age is and see what your naïve senescent cells are. That’s going to give you a strong indication of what your core immunity is. Now that would be really good to know if … I’ve seen people who are younger who have really poor naïve senescent cell ratios. Not like a seven year old, but they’re 35 and it’s like, they’re 20 years behind. They’re immune aging. It’s that immune aging which kills people. Not from the virus, yeah, but from pneumonia. I mean, if heart disease and cancer, doesn’t get you, our number one cause of death is infection. That infection occurs as we’re older because of just what I shared you with. Knowing that is really, really critical. We should be …

Rick Cohen, MD:

If I were in charge, if I could scale that up, because I would say, “All right, if your immune system’s strong, get out in the world, get infected, develop immunity. If your immune system is weak, do what you need to do to get healthy. Here’s what we need to do. We need to do this and change your life and we need to give you thymus peptides.” There are certain little protein peptides, one is called thymosin alpha-1, Ta1, which is a really potent thymus stimulate. That can sort of retrigger some of that immune support. There are lots of pharmaceutical companies now looking into removing senescent cells, certain taking medication cocktails to remove this burden of senescent cells. There’s a number of other things one could do that don’t … That would be a huge benefit to the population. We wouldn’t have to shut down our whole world. We could just be supporting the people who are at greatest risk. [crosstalk 00:58:23]-

Adam Pulford:

Rick Cohen, 2024, is that what I’m-

Rick Cohen, MD:

Yeah, right. There I go.

Adam Pulford:

Well, to that point of exploring how to do that more, I mean, you’re actually creating something that allows our listeners to do that. Before we get into that, I’ve always been a big fan, for my athletes, creating a performance team around the athlete. That includes coach, doctor, sport psychologist, team manager or you name it. I mean just a lot of people, resources, things to help enhance and develop performance. One thing that you started doing that I realized, is you’ve created this members’ club. This is not a … Maybe a soft sell for it or whatever, but I think it’s actually unique and interesting and it’s a vehicle to help our listeners explore more about what all you’ve talked about today. From the immunity aspect, to the performance aspect, to the health and wellness. Could you tell us a little bit more about just the kind of two minute elevator pitch of members’ club?

Rick Cohen, MD:

Sure. Well here’s my … Actually I asked my wife earlier. It’s like, “Okay, why do you need the members’ club?” Is to make your life easier? Your health and performance stronger, all are saving you hundreds of dollars. That’s my elevator pitch.

Adam Pulford:

[inaudible 00:59:50].

Rick Cohen, MD:

There you go, done.

Adam Pulford:

Some details, yeah.

Rick Cohen, MD:

Right. [crosstalk 00:59:55]-

Adam Pulford:

Some details.

Rick Cohen, MD:

Yeah. Okay. As you can hear, as I sort of shared and it’s my passion, is just a whole variety of different topics and I really enjoy educating and working with people that want to learn. One of my greatest frustration when I was a practicing physician it was like, I always felt as sort of a functional alternative or non-Western of the Western train. But I was the doc of last resort. Now, that’s changed over the past 10 to 15 years, for sure. But people just sometimes don’t want to change. For me, that was really frustrating. Where I’ve been working with is sort of PureClean Performance and beetroot juice. Just on the side, there’re studies on … I forgot to add that on beetroot juice and nitric oxide and immunity. There’s this study currently going on in China with Viagra and its effect on COVID. There’s studies on nitric oxide gas actually inhaling and supporting the lungs. They had great results with SARS 10 years ago. That was sort of … Beetroot juice does fit into your immunity protocol in a deeper way than performance.

Rick Cohen, MD:

Yeah, just sharing beetroots. I really want to be able to share in a much bigger way for people to cut through so much clutter. Whether it’s a marketing hype of a product that is just so wonderfully marketed and you do, I’ll call it a supplement sleuth of the label, and this $59 product for 14 servings cost them $5 to make. It looks great, but you look at the label and it’s like, [inaudible 01:01:44]. Or it’s this new podcast and this new diet and this new information. Trying to simplify that for people like what we did today, what’s going to be most practical for you? What one step can you make? That’s a huge part of it. We’ll grow and expand that as we go. But the most practical thing initially is using sort of the power of a club and my access as a physician to discounts in products and lab testing. Negotiating pricing with Mindvalley for online training or certain companies that are really liked that are offering cool products, such as the Brain Gauge or a Mark [crosstalk 01:02:31]-

Adam Pulford:

Right.

Rick Cohen, MD:

… recovery device. I can go to them and say, “Hey, look, we’re going to have this membership. I’d really like to offer the members whatever discount you can give them. We’ll send you people.” Unlike a podcast or per se who might have an affiliate link who’s splitting and getting profit from that, certainly it’s a commercial and they need to sponsor their program, I don’t want to do that. The membership costs are where we make your money. Our goal is just to provide as much benefit to you like a Thrive Market online membership per year and you would be part of it. That’s the idea and the philosophy.

Adam Pulford:

Got it. I like that. Yeah. If our audience members are curious about this, I mean, how would they find out more?

Rick Cohen, MD:

Yeah. Right now, just email me rick@purecleanperformance. Today, we’re recording this on April 9th and we will be doing a launch, sort of a founders launch, next week for about 10 days. If you’re listening to this during that time, great. I can send you all the information, but if you’re listening to this in May or June and you’re just getting around to it, just email me anyway and we’ll be much more functional by then. But I’ll still be happy to sort of honor some of the founders members special coffers. Yeah.

Adam Pulford:

Cool. Just it’s rick@purecleanperformance.com?

Rick Cohen, MD:

Rick@purecleanperformance.com, correct.

Adam Pulford:

Got it. Okay. Well good. No, that’s great. For anybody who, this podcast their trigger has been tripped by a lot of this stuff, send Rick an email. He loves to geek out about a lot of this stuff and the members’ club might be of interest to you. Rick, this is awesome. We’re kind of going a little bit over the time, but I’ve got three questions that I want to ask you. Some takeaways for our listeners to apply to their training and nutrition and to health and wellness program. Let’s knock those out and then we’ll cap this thing off. All right. First question, if you a performance driven athlete and you had a budget for only one supplement, what would you go with? In other words, is there a Holy Grail of sorts? Can you just give me one?

Rick Cohen, MD:

Yeah. No. I would say, it depends. There is no magic solution and it depends on what’s your age, what’s your state of health, is it an amino acid for recovery is going to be more important? Is it a beet nitrate that’s going to be more important for you? Or is it foundational nutrition that’s going to be more important for you? Yeah, I guess my message would be, don’t fall for there’s one magic fix for you because you really need to figure out what your needs are and then just prioritize what’s most important. I would say most important is, a lot of the things we talked about today. Is taking care of your health in a more comprehensive way and tracking, however you might do, before resorting to buying something.

Adam Pulford:

Yeah, man, I was just going to say, I didn’t plan this. I knew that that was kind of the direction you’d go. I didn’t plan this, but the Holy Grail might be awareness. It’s just figuring out who you are, what works, what doesn’t.

Rick Cohen, MD:

Yeah. Get-

Adam Pulford:

That’s probably the Holy Grail.

Rick Cohen, MD:

Have support, someone like Adam, someone like that. People who are just a group of people that you can work with that can give you feedback on, “Hey, this is something that worked for me.” Then try it. That’s okay too.

Adam Pulford:

Yeah, exactly. Okay. Question two, when looking at a quality control for ingredients, what should our listeners be looking for in a product? Is there a stamp, is there a brand, is there a thing to look for in the supplement industry right now or what’s going on?

Rick Cohen, MD:

Yeah. It’s interesting, having spent a bunch of years in there. Just lifting up the skirt, you look at products on Amazon and honestly anyone can go to any contract manufacturer who does have criteria in cleanliness and lots of paperwork, et cetera. But you could put together anything you want of any quality, put a label on it and get on Amazon. There’s no one saying that that’s a good product or a bad product. I think, be aware of that. I would also say, look at what’s actually on the label. It takes some experience, but certainly there are ingredients that are very inexpensive versus ingredients that are perhaps maybe trademarks. Typically, if a company has a trademark ingredient, there’s some clinical research at least behind that particular ingredient. That’s useful. I would say looking at a label, if a company cares enough to put non-GMO or organic or Whole30 or putting some markers while it may be a marketing ploy, at least they’re conscious enough and care enough to put organic.

Rick Cohen, MD:

We can debate whether organic and then some things are better or not. But you know what, if they’re putting organic and they’re searching for it, at least it’s a step up than someone who doesn’t care at all. It’s like, “We use in our amino acid, a natural sweetener or organic berry flavor as opposed to cheap aspartame sucralose sweetened formula that you might get in a bodybuilding type amino acid formula. They’ve gone for the low end as opposed to … Unfortunately, you’re going to pay a little more for that, but like anything, if you like a fine wine, do you like a cheap rip-off? I think the third thing would be, typically you’re safer on professional brands. One of the things in the club is, well, you’ll have access to this well of a platform of professional brands that are actually vetted by this professional dispensary. They go through all the criteria and they won’t sell anything … They’re not perfect. I found a couple issues, but they’re really good for the most part, but they won’t sell anything of lesser quality.

Rick Cohen, MD:

Typically, the brands that are selling to health practitioners are obviously been around longer. They’re not just slapping labels on something to take advantage of a marketing sale or to put it on Amazon. They’re more established companies. For the most part, you’re going to do better with those.

Adam Pulford:

Got you. So do your homework, go with some legitimacy, people who have been around with for a while and some intentionality too if they’re sourcing their products in a specific way? I like that.

Rick Cohen, MD:

Yeah. I’d say, one more thing just on beet juice, if you don’t want to order ours, I challenge you and just order a product and try and contact the company and get a COA, Certificate of Analysis and see if they even know what their nitrate levels are. 95% won’t and/or you see if you can even get one. That’s a really important thing [inaudible 01:10:04]-

Adam Pulford:

Well, yeah. We keep on coming back to beetroot because it’s … I mean, I love the product. But one thing I didn’t tell you, Rick, I’ve been using or I have athletes that have been using your products since I think 2014. Because I was working full-time at CTS. Who knows? It might’ve been before that. Anyway, my project was to research kind of the best dietary nitrate out there. The best beetroot product out there that had quantifiable dietary nitrate that is sourced. You were the only one that I could find at the time. We started using it on professional athletes and away we go. Then kind of circled back around a couple of years ago when I moved here to Washington and we had the first conversation. For what it’s worth, there’s not too many people doing what you do out there. I just want to mention that.

Rick Cohen, MD:

Yeah, thanks. I appreciate it. It’s just challenging. It’s sort of, you either have to care enough and then the double edged sword is, if you get too big and there’s some big companies out there, it’s hard to source. This is a natural product that has some variability and difficulty. The large company out there does a decent job at it, but they just may sell too much to be able to, and they require a marketing budget and margins just to offer the same product. It just can’t be done at that level.

Adam Pulford:

Got you. Okay. Last question. If we can be judgy for just one minute, what is the number one thing that you see most athletes doing wrong in their nutrition game and how can they correct it?

Rick Cohen, MD:

Sort of a repeat, just not knowing who they are, not knowing what their particular-

Adam Pulford:

Awareness.

Rick Cohen, MD:

… needs are and just falling, “Okay, I’m going to do ketones.” Think about it, now we’re doing ketones and five years ago we were doing carbohydrates. It’s just this pack of people going from one thing to another. Everything has a place in nutrition and as we discussed before, the number one thing is get rid of the crap. That would be … Because you can’t go wrong there. Then figuring out what your particular needs are and how those can change. Maybe during high training season or racing season, you might need more carbohydrates. But winter or when you’re trying to build up, you need more protein and you can get by with less carbohydrates. Or if you’re doing longer slow, then that’s okay. But if you’re doing fast, you require that additional fuel. While you can get by and not be hungry on fats, the carbs are the twigs in the fireplace and they’ll create a higher energy. You just can’t miss that and you’re leaving something out. It’s understanding where you are and what your needs are.

Adam Pulford:

I like that. Well, let’s wrap it right there because I think that’s a perfect place to end. Rick Cohen, thank you so much for joining us on The TrainRight Podcast today. It’s been awesome.

Rick Cohen, MD:

Cool. Well, I appreciate and thanks for everyone for your time and I’m happy to share.

Adam Pulford:

All right, thanks.