Topics Covered In This Episode:
- How gastric distress happens
- Gut bacteria and your health
- The link between your gut biome and ultramarathon performance
- Tips and strategies to promote a healthy gut microbiome
- The protective effects of probiotics for athletes
In this episode, Corrine Malcolm is joined by Dr. Greg Grosicki and Dr Jamie Pugh, two eminent researchers in the field of gastrointestinal distress and the microbiome. They dive into the common culprits behind GI distress, how to troubleshoot those less than ideal moments, and what we currently know about the microbiomes influence on GI distress..
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Please note that this is an automated transcription and may contain errors. Please refer to the episode audio for clarification.
Corrine Malcolm (00:00):
On the podcast today, I sat down with two experts, Dr. Greg gross sicky and Dr. Jamie P, who are experts in the field of gastrointestinal distress. And the microbiome. Greg is professor of kinesiology in the department of health, sciences, and kinesiology, and is the director of the exercise physiology laboratory in biodynamics and human performance center at Georgia south university Armstrong campus. Jamie’s a post-doctoral researcher and lecturer at Liverpool, John Moores university separately. They have written seminal papers on the microbiome and probiotics and relationship to sport and exercise. And together are part of a research team, conducting studies at huge events like the Western states endurance run and the Ironman world championships in Kona. If you’re going there, if you’re gonna be in Kona, hit these guys up, they’re looking for subjects for an upcoming study today. We’re gonna dive in though, to talk about the common culprits behind GI distress, how to troubleshoot those less than ideal moments and what we currently know about the microbiome’s influence on GI distress and endurance events with that I’ll get right out of the way, and we can dive into our conversation. Jamie and Greg, welcome to the podcast. I would love to have you both introduce yourselves to our audience, just so that people can start to pick out voices here as we dive into our conversation today.
Jamie Pugh (01:14):
Awesome. Yeah. So maybe I’ll kick off. Uh, so my name’s Jamie P uh, first, thank you so much for, for the invite for coming on today. It’s, uh, it’s awesome to, to come and, and chat with you. Um, I’m a researcher and a lecturer in Liverpool, John Moores university in the, the UK and for the past seven ish years, I’ve been researching probiotics, the microbiome and all of the factors, uh, behind why endurance athletes in particular suffer from, from gut distress, essentially.
Greg Grosicki (01:49):
Yeah. Karen, thanks again. Uh, just echo Jamie’s comments for having us on I’m Greg. GKI an associate professor and scientist at Georgia Southern university. The also director of the exercise physiology lab. I’ve been an endurance athlete since high school, really when I started running cross country and really the research on the gastrointestinal distress and probiotics and the microbiome is just the total, um, kind of a mix of both my academic interests and my personal interests. So something that I’m very passionate about and love the love talking about.
Corrine Malcolm (02:20):
Yeah. And for those of you who don’t know, cuz no one knows this it’s all behind the scenes. Um, I think we, we all canceled on each other at least once. And so this has been a long time coming, but that’s gonna benefit everyone because I actually got to meet both Jamie and Greg at Western states, not that long ago because they were conducting research there that we’ll talk about a little bit today. Um, but kick things off. I like to joke that when it comes to GI distress and endurance athletics and particularly running for whatever reason, running running definitely has a specific, um, I guess affinity for GI distress that there’s two camps, the people who have experienced GI distress and people who have not yet experienced GI distress, that it’s almost a given. And I would love to hear from both of you, like why, why, why is this what you study? Why GI distress, why the microbiome, what kind of kicked off those interests? Was it a personal experience that made you, made you dive into this? Um, or kind of, how did you end up in this, in this niche, in this niche field?
Greg Grosicki (03:18):
Yeah. Well, like you hit on, I’ve had a number of personal experiences as an endurance athlete where I find myself over there on the side of the road or in the woods. Uh, I think we all have, I actually got into studying the gastrointestinal tract by my post where I looked at the relation between the bacteria and the microbes that live in our GI tract, which we refer to as the microbiota and in the podcast. And if you look into the literature, you’ll hear that referred to somewhat interchangeably as the microbiome, which really refers to their genetic material. But if you hear one or the other, we’re talking about the same thing. Um, but anyway, we were looking at how those bacteria may contribute to the age related loss of muscle mass. So totally different than what we just did at Western states and what I’m doing now.
Greg Grosicki (04:02):
Um, but when I’m thinking about older adults and how they’re losing muscle mass and how changes in the gut bacteria may relate to that, uh, kind of the first thing that comes to my mind as an athlete is, well, what effect does exercise have on those gut bacteria? And that’s really how, where I’m at now. We know that as you get older, uh, a lot of physiological systems go downhill. And so we know exercise improves things, although it may not feel like it necessarily when we’re out there mile 20 of a marathon. Um, so I just wanted to know what is it that exercise does to the gut bacteria and how does it influence gastrointestinal distress,
Corrine Malcolm (04:37):
Jamie, anything similar for you there? Why, why did you end up in this, in this field was study, was putting us weird athletes.
Jamie Pugh (04:43):
Yeah. And especially with the gut stuff and going around trying to collect, uh, fecal samples from, from individuals, mine mine’s a little bit different. Um, so like growing up, I I’ve pretty much played football or soccer, uh, to the American listeners. So I came to, to athletics and run a little bit late. Um, and then it was a bit of a mix between yeah, but personal experiences as well in that you, you sort of get these symptoms that you’ve never really had doing other sports, but at the same time, uh, my dad was actually diagnosed with an inflammatory bowel disease. So I was doing all of this side reading and research in the, the gut trying to find out a few different things, but I’m, I’m no MD <laugh>. I was always sports science. So eventually the opportunity came up to do this in, in an excess physiology related capacity. And I just jumped in, um, managed to secure a PhD at the, the university that I still work at. And I’ve just been studying this, this side of things ever since. It’s just, um, it’s been fascinating. And the more you look into it, the more you see that it seems to have a role in so many aspects of, of health and performance. So it’s just been almost like a nonstop, uh, journey. It just seems in the, the places it could go and, and could lead to.
Corrine Malcolm (06:04):
Yeah, there’s definitely, I think, well, when, as we touch on the microbiome more, you know, there’s, it’s interconnected into so much of us as humans, um, which is pretty FA I teach anatomy and physiology as a long term sub a bunch. And we get to dive into these topics and watching high schoolers light up like finding these connections is, I don’t know, maybe the best thing ever. Um, but as you mentioned, you know, both of your ex personal experiences kind of came predominantly when it, when it turned towards athletics or running versus other sports. And we do, we do pull in a bunch of cycling listeners, um, cuz my co-host Adam Pulford is a cyclist, um, by trade and for coaching. And so why might, you know, while GI distress does happen in some of these other endurance activities, why is running in particular, such a, such a hot spot for these issues to, to crop up in a, in a long event that where people might not, not have ever experienced it before?
Jamie Pugh (06:55):
So part my PhD was putting together some of the numbers behind this and we did some, some studies at some, some marathon races. And it’s crazy how disproportionate symptoms are in ultra marathon runners in particular compared to of a sports. Um, the marathon is probably still only as comparable to like iron man triathlon. So even if you look at some of the worst case scenarios, about a quarter of marathon runners and a quarter of iron man, TRIA athletes seem to suffer from symptoms, you go up to ultramarathon, all of a sudden, now you’re talking about 70, 80, 90% of, of participants. Don’t just say they suffer from symptoms, but say that it almost directly impacts their performance negatively. So it’s not just a mild bit of gas or something like that. They’re pulling out of races, it’s slowing them down and just like ruining them the experience essentially.
Jamie Pugh (07:49):
So I think there’s probably a lot of reasons why, um, the, the duration of the event, the fact that you have this jostling movement, as you run compared to cycling where you, you, your body position is pretty, uh, pretty stationary. Some of these ultramarathon races or run a like really cool, really challenging environment. So they could be in the heat. They can be an altitude like Western states is a great example. Isn’t it? You start at 2000 meters and at some point in the day you could be running at like 35 degrees Celsius, which is a huge challenge. There aren’t many other sports that you, you get that add in the fact then that you are chucking down, maybe 2, 3, 400 calories an hour for that entire length of time. Um, and then the fact that it’s like, it’s a long time to go. So if you just think anyway, and I think some athletes struggle with this concept. If you are running in an event for 20 hours, you probably would’ve gone to the toilet in a normal 20 hour period. Anyway. So sometimes that side of things isn’t unnatural, it’s just that it’s gonna happen during a race. So you might need to prepare for it.
Corrine Malcolm (08:56):
Yeah. I was leading a nutrition panel recently and one of the audience questions was simply what happens when you have to, when you have to use the restroom <laugh> and the panel went dead silent, and I had to kind of pick on someone to be like, okay, Patty, like take the question. And he’s like, man, I don’t know. Like you just, you gotta do it. Yeah.
Greg Grosicki (09:13):
Corrine Malcolm (09:13):
Yeah. So is there, it’s a perfect storm, is what it sounds like.
Greg Grosicki (09:16):
Yeah. As Jamie touched on, there’s a lot of different factors happening within your body when you’re doing exercise that are kind of creating this environment for gastrointestinal distress to get a little bit more, but not too deep into the nitty gritty. One of the things that happens when you exercise is at rest, you have a lot of blood going to your stomach and as a kid, right, you grow up and you always learn, I don’t know why it’s the pool, but everyone’s always worried about it. Like it’s like don’t eat a couple hours before going to the pool, cuz you’ll get a stomach cramp. Maybe cuz if you cramp, when you’re swimming in the pool, bad things happen. Right. Um, but then when we start exercising, this phenomenon happens in our body where all that blood that’s going to our stomach and two digestion goes to our muscles.
Greg Grosicki (09:55):
And, and so that, that creates this environment in the stomach where there’s, there’s no blood flow and that, that, you know, that’s pretty bad as is. And then as Jamie said, you add in the heat and that takes even more blood from our stomach to go elsewhere in our body. And so you have this crazy redistribution of blood that really creates this again, perfect storm. And then the jostling of the cycling and um, some of the numbers that we just saw at Western states, as you just touched on, we were there, we surveyed 43 athletes. We got a bunch of data, wonderful athletes, by the way, thank you so much from them pre and post race of the 43 athletes, 23 of them said that they had gastrointestinal distress severe enough to impact their race. And so some of those said that it was, you know, kind of moderate enough, but it did definitely slow them down five to 10%.
Greg Grosicki (10:40):
12 of them said it was very severe or extremely severe and of the five or six in our study that we had drop out, I think four or five of them. So all but one of them dropped out of the study due to gastrointestinal distress. Another unique question that we added on. And I think it was actually, one of the participants was talking to us before the race. And they were like, are you guys gonna ask about how many times people vomit? And I was like, I didn’t even think about that. We had people throwing up and pooping 10 times or more during the race. Some people vomiting 20 or 30 times reported during these ultra-marathons. So yeah, one or two times over the 20, 20 hours is normal. But when you have people, you know, pooping eight or 10 times over the course, that’s, that’s a serious concern. And even talking to them after some of them would send us emails and like it’s been three days and my stomach is still totally not. Right. It can barely take any food down. So it’s certainly a really severe problem. Um, and the Jos and we need it needs to be studied more for sure.
Corrine Malcolm (11:40):
Yeah. I think that’s really interesting to point out is that it’s, it’s almost a norm and I keep joking on this podcast that I’m really selling the sport of ultra running. Someone’s gonna accidentally find this podcast for a different reason and, and be like, why would anyone sign up and work to get into a race like Western states where I’m gonna vomit 20 times? Um, it’s definitely not, not a good sales pitch, but what you guys highlighted there was that there’s all these things that are almost that are, that are related to the environment, to the conditions, to the nature of running for that long. Those are all things that, you know, we don’t have a ton of control over, right? Like we don’t, we can’t control the weather despite our desires to, we can’t control the fact that we’re running a hundred miles because we signed up for it. Um, so what, those are things that we can’t control, but what are the mistakes that athletes make in this environment that might lead them towards GI distress outside of those environmental conditions? Like what, what, like, what are those hangups that athletes have?
Greg Grosicki (12:35):
Jamie, do you wanna tell the story that Robbie talked about and the, from the supermarket the night before
Jamie Pugh (12:40):
<laugh> yeah. That say athlete, the, the number one thing is, is obvious. It’s the nutrition and you think how many athletes are meticulous in their train and they know how many miles they’re gonna go up each week, how many miles, the long run’s gonna be, what pace is to hit. And the nutrition is seem, it seems some for a lot of athletes still is like this after for, and we are speaking to, to Robbie Britain. Uh, and he was in one of the supermarkets, literally the, the Friday night before Western states. And he said there were two of the, the runners from the event in one of the aisles and they were deciding there and then what to have for dinner and maybe what were some of the things they should buy to eat during the race. And it’s, that’s highlights one of the, maybe more extreme ends of, of why people suffer.
Jamie Pugh (13:24):
Um, like what goes in is going to have a huge impact on, on how it’s digested, how it’s tolerated, what symptoms you get. So the biggest thing that people can do is, is think about their nutrition, maybe work with a registered dietician or sports nutrition, and hit some of the basics and then practice it as well. Um, it’s you, it’s not, uh, so many runners that I speak to, they think they’ve practiced their nutrition because they maybe go out for a free or four hour run and they have a couple of gels and then they get to the race and all of a sudden it’s no, I need, I’m slamming down leases of fluid. Every couple of hours I’m taking gel after gel or I’m grabbing foods from the, the cruise stations that I’ve never eaten before. Um, like you can’t obviously practice 16 hours worth of nutrition, but you can certainly plan for it and have your, a plan, your B plan, your C plan of foods that you might, um, filter down through.
Jamie Pugh (14:23):
Maybe when you’re feeling a bit nauseous, you’re sick of sweet sensations or you’re sick of salty sensations. But having a plan for nutrition is, is the biggest thing equally with the hydration strategy, as much as hyper nutrient is probably something that’s on a lot of people’s minds. So the over consumption of fluids, it is a balance act where you can’t just ignore it because dehydration also has a huge role to play in nausea and vomiting, especially if you are severely dehydrated, that is gonna have a huge, uh, huge influence on, on development of those symptoms.
Corrine Malcolm (14:59):
Greg, anything to add to that as far as like common mistakes you see out there with athletes.
Greg Grosicki (15:03):
Yeah. I think Jamie hit the nail on the head that it’s practicing and, and not only to see what works for you because it’s not gonna work be the same for every person. Right. Um, I just, anecdotally in my personal experience, uh, during half Ironmans, I could be totally fine on just, uh, like sports drink and, and gels energy gel GOs. I’d be totally fine. And I’d get into an iron man and it’d be about six hours onto the run. And it didn’t matter how many calories I had had if I hadn’t chewed something even so simple as a sports block, I would just come totally UNW and, and some people can do all of Western states just on, just on sports drink. And so I think practicing to see what works for you, but also something that we’ve learned over the past couple of years, just from a scientific perspective is that the gut is also extremely trainable.
Greg Grosicki (15:50):
And I don’t think people think about the gastrointestinal tracts like that when they think about it that much like skeletal muscle, the gut can be taught to take in more calories during racing. And so as an endurance coach, when I’m working with my athletes, I have ’em many months before we even do whatever Ironman we’re doing. It’s like, listen, now the research is showing that you might be able to take in a hundred grams an hour on the bike. And so we’re gonna go for that and you’re gonna do that in your training session. And if it works for you, then you’re gonna do it during the race because we wanna get as many calories in you as we can. And as an endurance coach, I’m, I’m not a nutritionist, I’m not an RD. I’m not. So I don’t try to confuse myself with that, but, but I think people need to learn that it, if at first it may not be super comfortable, but the gut is trainable. And so learning that it’s adaptable and, and, and that, you know, you wanna practice like you play is, is really the simple matter of it.
Corrine Malcolm (16:42):
Yeah, you’re right. We, we find athletes just kind of throw it away right on race day when it comes to nutrition that they’ve invested a lot of time and money into this activity, into this race, and then to, to kinda waste it because you didn’t want to eat on your long run or you didn’t want to, you know, practice the fact that you thought you were gonna take potato chips and Coke at the aid station. And you’ve never done that before. Or the fact that pretzels are really dry at miles, 60 of Leadville, and maybe you don’t want pretzels. Um, so I think it’s important to you’re right. That practice does seem to be the biggest thing there. I’m curious, you know, if athletes are getting into a race like any, I mean, any endurance, any endurance activity, and they’ve, they’ve made a mistake, something’s going sideways, right. They are vomiting or they’ve got diarrhea or something is not, not good. They’re hiding in the bushes, let’s say on Cal street somewhere, what can they do to correct that? Is there a correction or they just gonna kind of have to like, you know, walk it in type of thing as far as like getting back on track when you’ve, when you’ve pushed your body to that extreme,
Greg Grosicki (17:42):
That’s a tough one. I think, finding ways to cool themselves down. So I certainly don’t think trying to push through it is gonna be of any help. We talked about one of the, you know, physiological factors at play here being heat. And so in the heat, this is very commonly experienced. And so if you’re trying to exercise at a high intensity or you’re, or you’re exercising when it’s extremely hot, trying to cool oneself down, and then you get some of that blood flow back to, to back to the GI tract, um, certainly might be helpful, certainly pushing through, uh, probably is good. I mean, it depends where you are, right. You’re very close to the finish maybe, but, but if there’s a long road ahead, um, I think it can maybe even do more harm than good. Any ideas, Jamie?
Jamie Pugh (18:23):
Yeah. I was gonna say it’s one that I’m gonna assume that people have got a good plan and a good strategy in place already. And if that’s the case, then could try your best to continue with that. Ideally you need a contingency plan as well. So your, your taste preference to change some like that. But the worst thing you can do is stop in stop drinking, switch to water only because you can’t target anything else anymore. Um, stick to the plan as much as you can, or I said fall back to the contingency and don’t go to extreme. So don’t now cut everything out. And at the same time, don’t try and compensate for maybe some of the things that you’ve lost, cuz that can make symptoms worse or give you other symptoms if you think, oh no, I’ve just lost 400 calories in vomit or I’ve just spewed up, uh, half a lit of fluid.
Jamie Pugh (19:14):
The worst thing you can do then is think I need to replace all of that and get it down as quickly as I can. Cuz you’re just gonna flood the system again. You’re gonna fill the stomach completely. You’re gonna saturate all of the transporters in the, in the small intestine and you’re just gonna create new problems for yourself or make the problems that you’ve got already that little bit worse. So assuming that you have a good plan already, um, cuz maybe it might be the plan that you, you went into the race and we’ve just got you there in that first place. But if your plan is smart and it’s just one of those things that’s crept up, the conditions have got to you, you’ve ran a little bit too hard. Um, the effort’s been a little bit too high for what you could do that day. Um, just, just fall back to the plan reassess and uh, and just try and, and stay as sensible as possible.
Corrine Malcolm (19:59):
Yeah. That troubleshooting can become really important. And those contingency plans, I think are maybe what’s gonna save someone’s day if they’ve gotten themselves into a bit of trouble, um, at any race, be it Western states or something different. So I think what I would love to talk about now is so why like how’d you guys end up at Western states? Why like why of all of all the people you could be studying, why did you choose a bunch of ultra hunters in California, um, in a super hot race and then maybe, you know, kind of talk about, um, not only the methodology, but kind of like the, like the question you’re trying to get at with this research. And then we can kind of go go from there
Greg Grosicki (20:34):
That all started back in, uh, 2018, probably fall of 2018 Patrick Reagan and I were sitting in my front yard drinking, uh, a bunch of beers and, and shouting about his race plan for the, I, I probably shouldn’t have said his name. That’s all right. Um, he won’t mind and talking about his race calendar for the 2019 year and I had just met, I had just moved to Savannah. We became friends and he is like, yeah, you know, got this Western states race. And as, as a triathlete, I was familiar with the ultra running community, but I, um, I didn’t know it super well, but I had certainly heard of Western states and I was like, oh, that sounds pretty rad. And I was looking at it more and I, and I was doing some research on exercise and the gut microbiome and I was chatting with pat and it kind of just came.
Greg Grosicki (21:19):
I’m like, Hey man, I got these extra collection kits. I was like, what do you say we have, we have a go at this. And so we started studying him actually in February. And this was a collaboration with, um, his coach that year, which is the Magdalene B at go energy and, and Roxanne vocal their sports nutritionist. And they kind of pushed pat. Um, he was, he was going to do the race and, and you know, they were, he was kind of iffy about getting into the physiology lab and they’re like, listen, you need to go get tested in, in, uh, in Greg’s lab. So he came in and then he was all on board to, we were really excited about it. He has an undergrad in, uh, health and exercise science. So once we started getting in and I was showing him his VO two max data and all this other stuff, he got really excited about it.
Greg Grosicki (21:59):
And so over the course, basically from February until two weeks after Western states, we studied him. We did a whole bunch of VO, two max and running economy and lactate threshold and DXA scans for body comp, basically just, you know, what is, what is he like as a, as a physical specimen? Um, and, uh, we also studied his, his, the bacteria in his gut, the gut microbiome at four time points. So we wanted to see how are those bacteria changing if at all, as he gets ready for the race in February, he was kind of training running like 30 or 40 miles a week, but certainly not like peak training. Um, so we studied him in February. We studied him before the race, um, kind of like we did at Western states this year. And then, um, one of the, you know, interesting things about microbiome research is it’s not like drawing blood or collecting saliva or even urine where you can kind of collect it whenever you want.
Greg Grosicki (22:51):
It’s, uh, the sample comes when it comes right. And so, um, we were able to get a sample two hours after the race, thanks to grad student, just getting pat actually collected it. And, and then, and then we got another sample two weeks later, um, to look at how his microbiome changed during the race and then how it recovered. And we saw some, uh, really no changes in his gut microbiome as he was getting ready for the race. But after the race, we saw some pretty profound and rapid changes that we thought were pretty exciting and were relating to some other things that were being reported in the scientific literature specifically, uh, ways to enhance his performance by giving him more fuel when he was running, just changes in bacteria that were, that were doing that. Um, and, and so we published that paper in, in December of 2019, uh, it picked up a good amount of traction and, and then, uh, it kind of fell a bit dormant that research, uh, area until, uh, Matt lay.
Greg Grosicki (23:45):
And I were actually chatting on a podcast, uh, one of Ian Sherman’s podcasts during COVID and, and Matt and I were both, you know, uh, bemoaning how, you know, academia was closed. And we were just chatting about the microbiome and the cool research we had done on it. And, uh, Jamie heard it, heard it overseas, like almost six months later and reached out to Matt and I, and he’s like, wow, this is a super cool study. Um, I have some funding to do some microbiome research. Do you guys have any ideas? And Matt and I said, boy, do we have some ideas? Um, and so that’s kind of where this all came from. Uh, Jamie and Matt, and a couple other researchers, uh, uh, Jacob ballon at the university of Illinois and Jimmy Bagley at San Francisco state have been chatting about a couple projects that were doing this year for almost a year and a half now. Um, and so that’s kind of where the Western states thing came from
Corrine Malcolm (24:36):
That’s so that’s so exciting. Okay. So you we’ve mentioned you had 43, um, volunteers, I always call them subjects. I’m like, that’s kind of mean we’ll call them volunteers, um, at Western states, including like, and, and that was additional to you also had controls, is that correct? So you had a little bit, a little bit more than that to look at. What did that look like for those, those volunteers run like running Western states? What were you trying to collect and then kind of what information came out, uh, loosely has come out of that, obviously that’s something that’s still that you guys are still working on, but kind of what takeaways are, are, have you seen thus far from, from that research?
Greg Grosicki (25:12):
Yeah, so we are really lucky. The Western states endurance research board, um, gave us some funding and supported us in doing this what’s so cool is they sent out one email and it wasn’t even at the top of the email, it was at the bottom of the email and we had 43 athletes literally come up to us and do this study totally for free, which I just think, you know, shows, uh, the, of the good will O of this community and like their interests in science. And we’d be chatting with these people and they’d be, you know, PhDs and MDs. And we’re like, man, you guys are way better at doing our jobs than even we are. So was really incredible getting to, to network and, and chat with these athletes. We had 43, um, athletes. And so before the race, uh, two weeks before the race, approximately they filled out a survey.
Greg Grosicki (25:55):
They basically told us their life story in here, um, from very basic things like height and weight to their medical history medications, they take what their training looked like going into Western, what foods they eat, um, how much they slept, uh, all the things we know that can influence the gut microbiome and can also influence gastrointestinal the stress questions on things like, you know, fermented foods and kombucha and, and everything that we thought might influence it. Um, then we met up with all of them, uh, the week of Western and they gave them basically collection kits. And so they all collected a sample, uh, a stool sample within 48 hours of the race start. And then ideally the first ball movement after the race. And as of today, I just look literally every single one of their samples has made it to our lab at Illinois.
Greg Grosicki (26:41):
Jacob’s lab is incredible. Like it’s so cool that they took the, I mean, they went to U they all collected the samples, went to ups, nailed them in. Um, and so we’re, we’re that data’s gonna take some time, um, before we get it all analyzed, but we’re really excited about looking into that. They also filled out surveys, post race. And so we have an idea as to what they actually ate when they were doing the race, um, what their gastrointestinal, uh, you know, health status looked like, um, how many times they pooped and how many times they vomited during the race, um, you know, what role heat and their GI distress played into their race. And so overall, you know, their kind of global purpose of this study is just to get a better understanding of how those bacteria in our gut relate to gastrointestinal distress and just performance during the race.
Greg Grosicki (27:30):
And then if we can figure that out, can we use some of the information that we got from these people going in and try to design targeted really strategies, therapeutic strategies, or interventions to minimize that. So maybe we see something like the people who weren’t sleeping very well. Um, they had more GI distress. And so that could be a very evidence based recommendation. Listen, the people who were sleeping better had a better gut microbiome, and they had less GI distress during the race, or, um, maybe the people who were sticking with a certain food, um, a certain medicine, um, all things like that. Jamie, I know you have some things you could add on here.
Jamie Pugh (28:07):
Yeah. I was gonna say, just to echo some of those early thoughts in the, like how cool is Western state has a race to turn up and do studies at you think we managed. So from that 40, we actually managed to get Greg, if I’m wrong, I think four of the top 10 males and four of the top 10 females. And then when you think we’ve also got athletes all the way through that finished in that final hour, there aren’t many other sports or events in the world where you could go and get the elite of the elite, and then also people doing this recreationally. So we’ve got some, some really cool data, uh, some really cool assessments in the study. Um, I suppose from what we can hopefully get from the data is, is maybe one of two things maybe we can see, okay.
Jamie Pugh (28:50):
If we look at an individual’s microbiome baseline and we’ve, we’ve not just looked at the bacteria, but we’ve also looked at all of the, the metabolites in, in the store samples as well. So that are things like glucose and, uh, different fatty acids, lactate, hormones, different proteins. So maybe it’s that what an individual’s, uh, gut looks like before the race, maybe that can predict, um, the, the chances of them suffering from GI issues during the race, or maybe what we see is that there’s no prediction early on, but what we see is that these symptoms lead to these huge changes, post race, um, microbiome research is really tough in that you’re trying to analyze potentially thousands of different bacterial species. So it’s not like blood glucose where you look at this one, marker, and measure it over time. You’re trying to, to assess all of these, these bacteria and then make a best guess of, okay, which ones of these are important to make it more complicated.
Jamie Pugh (29:54):
I imagine if we took microbiome samples from all three of us, we would probably have species that the others don’t as well. So we’re not even always comparing the same thing. We’re comparing a community of bacteria, but maybe all of us have got a completely different community. So that’s, um, it makes it difficult. It makes it complicated. It makes it fun to study, but it also means that this research could be step four of a five step process, or it means it could be step one of a 20 step process. And, um, it’s why we need to try and do more and more of these types of types of studies. It’d be great to see this data. We’ve got some, some more studies lined up and, um, hopefully we can get some recommendations and hopefully it sort of leads into and informs of, okay, what do we need to look out for next time? Or how can we tweak things to get a better understanding?
Corrine Malcolm (30:47):
Yeah. I feel like a lot, oftentimes good studies just prompt more questions. Um, but I do think it’s really cool that of the 40 some participants that you did really have a whole spread of the field, because I think that is oftentimes like a limitation in these studies. It’s like, well, the results only allow us to make recommendations for this population. And this is once again, I mean, it’s a weird population, but it’s a broad population of people amongst kind of at least performance times. Um, so while the microbiome is basically like a fingerprint, I feel like it’s, there are trends in communities, particularly people who live in the same region, um, and do some of the same things, but it’s, you know, linked to diet and all, you know, to everything you touch. Um, and so I’m wondering, you know, with some of those broad recommendations, is there, you know, is there a hope that this leads to recommendations about, about diet, about lifestyle, about supplements, about like, you know, probiotics and prebiotics and that kind of thing? Like, what is the, what is the hope of be this step four or five or step one of a thousand?
Greg Grosicki (31:50):
Yeah, that’s certainly the overall goal. And, and just one of the things, sorry to go back to touch on thing Jamie talked about is how, um, it’s always changing as well and even throughout the day. And so that’s one of the things we tried to do that had never really been done before is there’s a paper that came out just earlier this year that showed like taking a sample in the morning and taking a sample at night could be totally different. So we had 43 athletes, but we also had 10 controls who followed essentially the same diet, I think, without exercising I nine goose and drunk three bottles of Broan two Stroop waffles, 55 goldfish, 17 pretzels, two red vines and a banana. Uh, no, and
Jamie Pugh (32:28):
Some not that that’s ingrained in your memory for life,
Corrine Malcolm (32:32):
Who, who came up with the, the proposed diet for the controls who, what, what, whose job
Greg Grosicki (32:38):
Is that? I have to take credit for one. Um,
Corrine Malcolm (32:40):
Okay, good. They, we know who to, we know who to send
Greg Grosicki (32:43):
Complaints to. Yeah. Five, five of the people were other researchers who didn’t really have a choice. And then we had five people who good Samaritans and I apologize. Hopefully the good news is once we have that standardized, how much does it change? Just when you eat that diet, we hopefully won’t have to do it too much again. So, um, yeah, but yeah, so, so we’ll be looking at that too, but certainly the eventual goal is something, uh, very applied and I think that dovetails really nicely and the Jamie’s done some fantastic work, um, really, um, kind of seminal looking at probiotics. And there are a lot of other strategies we can use. We have a study, um, we’re currently recruiting for, at the Ironman world championships in Kona, Hawaii. And so I’ll let Jamie talk a little bit about his probiotic research that he is done previously in the lab, and then what we’re gonna do next.
Jamie Pugh (33:34):
Yes. So, like Brexit said, then you were alluding to a little bit, the overall goal is to find something that we can then try and modify. So either we stop something bad from happening at the end of the race, or if there’s, if there are these characteristics pre-race, that may be protective, can we promote them leading into it through diet of sub intervention? Um, we we’ve certainly carried out. We’ve certainly carried out, uh, two or three studies, uh, in our lab looking at prob supplementation. Um, so one of the ones that we did is we got a group of, uh, marathon runners to supplement either with a probiotic or a, a placebo. So double blinded, nobody knew what they were taking. We didn’t know what they were taking and they tracked their, their symptoms during training for four weeks. And then we got them to, to run a marathon race.
Jamie Pugh (34:27):
Uh, but we hosted it ourselves so we could control everything. And we essentially, we did it around an athletics track. So it was like a hundred, five plus a bit lapse. But what it meant was that we did it right outside the exercise physiology lab that was at the university. We took muscle biopsy samples, we took blood samples and it also meant that we could standardize the nutrition as well. So it wasn’t, um, like a field based study as such where you just let people do what they want. We made all of the participants carload in the same way. The day before the race, we made them have all of the same breakfast. We had a, a big PA PA system during the race that I would go on. And I would say, right, this 20 minutes, everybody has to have a drink. Everybody has to have the gel.
Jamie Pugh (35:10):
And so it was completely standardized. And what we found in that was that, uh, what you see in all, all running based sports. So early on, they were next to no GI symptoms. And then for every run out, most runners as the race went on, symptoms progressively got worse. So they rated their, their gut symptoms worse and worse as the race went on those in the probiotic group. It didn’t seem to change between the sort of the second, third and the final third of the race. So it was attenuated a little bit, and I I’d always caveat, caveat this by saying it didn’t completely alleviate the symptoms at all. Like we still had runners in the prob group. We reported symptoms. We still had athletes in the Probio group that reported symptoms during training as well, but they certainly seemed to be, uh, less severe and less frequent than the, the placebo group. So there’s seems to be some sort of protective, uh, effect there. So, which is why we want to try and take this out now to Kona and see, can we measure the, the same effect in a, in a large sample and, and out in the field.
Corrine Malcolm (36:12):
Yeah. And they’ll, they’ll be in adverse conditions and they’ll have a bunch of other issues out there as well. I’m guess, I guess, you know, this is probably a question that might not have a good answer, but do we understand or have any ideas about like the mechanism behind why something like that might be protective?
Jamie Pugh (36:27):
So there could be a few, the, some of the, the stuff that we are working on currently in our lab is can probiotics increase, uh, our ability to absorb and use carbohydrates that we consume during exercise itself. So we’ve done, uh, two lab based studies where we’ve fed cyclists. And then in the second study runners, uh, 90 grams of carbohydrates an hour we’ve then looked, uh, we can use traces essentially to measure how much of that drink are they actually using? How much is being absorbed, goes to the muscle oxidized and, and used. And we found that after they take, after participants take probiotics, they’re using more of the drink, they’re absorbing more and using it more effectively. That could be one of the mechanisms. That’s one, the one that we’ve been looking at there are others. Um, so Greg touched on the fact that when we exercise less blood goes to the gut.
Jamie Pugh (37:25):
One of the things it does is, is slow down digestion, but it also causes, um, a little bit of damage to some of the cells. So some of the cells like can essentially burst or they can die. And this can cause a little bit of inflammation. This is in Western states, especially this is one of the, the seminal, uh, studies that have done this. They found that that damage and that inflammation is one of the factors that leads to nausea in particular, during the latest stages of race. So maybe probiotics or other foods as well. Maybe there are other things that you can do to, to protect that and lessen that damages, the, the race goes on. So that’s one of the things we’ve not studied, but others have, have looked at some of that as well.
Corrine Malcolm (38:07):
There was a study that came out recently, and this is not, I would say it’s adjacent, it’s not tangential that looked at iron absorption with the congestion of symbiotics. So like a prebiotic probiotic combination. And it actually, it seemed to increase the absorption of iron in that test group. I think it was a pretty small test group, which is not uncommon and exercise physiology research, but I thought that was really interesting. And that like, to me, I was like, oh, is this the, is this one of those mechanisms, right? Where you just have this increased absorption capacity and is that, you know, is there, are there links there maybe, or at least there seems to be like a trend of, of what that mechanism might be.
Jamie Pugh (38:44):
Greg Grosicki (38:44):
Not, I think it’s a great point. Cause a lot of it has to do with what bacteria are there. Right. And what are those bacteria doing? Um, Steve Hegar, if Florida state just published a very similar paper and he might have been on this one as well. Cause he’s pretty, um, big in this field showing that after a run like a really hard distance run, our iron absorption was reduced in a cohort. I believe it was of male runners. And so that a lot has to do with the inflammation, but all that has to do at least to some extent with what bacteria are there. If you look at data from people with irritable bowel disease and inflammatory colitis, and I think that’s one of the other kind of bigger picture goals of our research platform is that when you get some of these athletes, um, you know, especially after doing something like Western states where they’re literally telling us, you know, my I’ve like been literally curled up in bed for three days.
Greg Grosicki (39:31):
It’s very similar to these clinical conditions. And so I think we can learn a lot from these athletes about helping clinical states as well. But what we see when we look at the gut microbiome of these people is a very, what they refer to in the literature as a dysbiotic gut microbiome. So there’s this proliferation of all these pathogenic bacteria and pathogenic microbes that create this inflammatory state and lead to this gastrointestinal distress. And conversely, they also have a reduction in some of the good bacteria and good bugs bacteria that produce things like short chain, fatty acids, which is a metabolite that we’re measuring that’s anti-inflammatory. And so kind of using therapeutic intervention, whether it be probiotics or, or, or, or kombucha or, um, fermented foods or fiber to optimize the, the balance and the intestinal Melia, if we can, uh, as a therapeutic strategy for racers, when they’re going into a race or someone with a clinical condition to increase iron absorption or improve carbohydrate metabolism, it’s kind of all really under the same umbrella in a way.
Jamie Pugh (40:36):
And this is one of the areas though, that like essentially we’ve gone into one of the hardest areas of research for sports nutrition, because we can take blood from people. We can take muscle from people. One of the things that we can’t do is go and take samples from, from the gut. So we we’re collecting stool samples, but that’s, that’s the end product of this long, long process that can take like a day or two days. So what we can’t do is measure, okay, what happens in the small intestine when most of this absorption goes on. So what you end up with is lots of studies where you have input, uh, in some way. So you might have some intervention that the only thing we can do is measure the output. And then the black box in the middle is this mystery. We just have to make our best guesses or look at different models to try and see, okay, what, why might that be working?
Greg Grosicki (41:24):
And one of the things we’re doing too is asking the athletes actually a time point when after the raise, the sample is taken. So hopefully by figuring more about that, and then integrating that with like machine learning, we might be able to try to find how the microbiome not only changes after the race, but what does the evolution, um, of that look like? And obviously for that, we’re gonna need some, uh, to enlist the assistance of some people who are, are, are experts in that field. But yeah. Um, lots of things to answer
Corrine Malcolm (41:51):
There. I was gonna say transit time becomes a big, uh, a big issue with, uh, field studies in this, in this realm you were, um, um, at least predicting, we
Greg Grosicki (41:59):
Were doing little blood samples after the race and it was like four in the morning. And I went up to a guy who had just finished. He was like super tired. Right. Um, I think you were back taking a nap at this point, Jamie, we were trading off all night and I was pretty tired as well. And I went up to him, he was, he was exhausted. I’m like, Hey man, like, can I get the sample? And I meant like the blood sample. Right. And his crew was looking at me, they’re like, what are you gonna do? Just take it out of. And I was like
Speaker 4 (42:24):
Corrine Malcolm (42:28):
No, as far
Greg Grosicki (42:29):
As the clubs and everything, right? Like, oh no, I just meant the blood. <laugh>
Corrine Malcolm (42:33):
That’s too funny. Yeah. We did a study. We were using, um, temperature, temperature pills for a, a ultra in Vancouver. And I had to convince the PI that if we made them eat it the night before, like consume it the night before, half the pills were not gonna make it to the race course. And he was convinced, otherwise that transit time could not be that fast. And I was like, no, man,
Jamie Pugh (42:54):
Never met a run out.
Corrine Malcolm (42:55):
These pills are not making it to the race course. If you, yeah. Like you, you don’t know what’s gonna happen race morning. Um, okay. So what I guess, you know, obviously the microbiome is a mystery in some way. I feel like there’s a lot of really cool research in this realm. You all are very much a huge part of that. Is there any like common recommendations that we can give to people confidently right now about what they can do in their day to day lives to try to promote, you know, to put their best foot forward in a way when it comes to their gut health and to their microbiome,
Jamie Pugh (43:32):
Mine are always really boring. And I always feel like there should be something more cutting edge and, and really interested and cool. Like if you you’ve gotta hit the basics first and that you’ve got to be hitting lots of fruits and vegetables, you’ve gotta have a very diet consuming, uh, yeah. A wide variety of foods. If they’re seasonal, fantastic. You don’t have to shy away from, from some of the foods that tend to get a, a bad wrap. You don’t have to completely avoid the, the diet drinks and the artificial sweeteners and things like that. I’m not saying over consume them, but by all means you don’t have to avoid them completely. There’s no good evidence in, in humans, especially that these things are very negative. Um, other than that, it’s, it’s lots, that’s most I’d from my per view. That would be it from the diet.
Jamie Pugh (44:22):
Like if you want to try a probiotic, if you want to try fermented foods. Great. There’s again, no, there’s no amazing research that these are completely transformative. You’re gonna see small benefits on top potentially, um, beyond that in day to day life. And then particularly, uh, in and around exercise, you’re gonna wanna avoid some of the things that can have a, a big negative impact on the gut microbiome and then gut health in general. Um, so maybe some of the medications like Western state is great in that part of the medical briefing now is do not take ibuprofen, do not take non-steroidal anti-inflammatories during the race. And that’s such a good recommendation that should just be echoed at the start of every ultramarathon race. We know they can have a, a big, big, negative impact on the gut, uh, and lead to lots of symptoms. Antibiotics. Obviously, if you have to take course of antibiotics, you have to take course of antibiotics, but maybe that’s a time point afterwards that you really need to be, to be on it. That’s when you’re gonna be at a much greater risk of suffering from an infection or from diarrhea, something like that. So you really need to look after yourselves at some of those times as well. Greg, come on. I wanna hear some of your more exciting recommendations now that I’ve, uh, I’ve laid down the boring ones.
Greg Grosicki (45:43):
No, you crushed it. Um, there was a really cool study actually. Um, and I don’t know if you guys listened to Huberman lab podcast, but there’s another really good episode with Andrew Huberman and Justin Sonenberg, who was at Stanford and, and they chatted about one of Justin’s crowdfund studies, where they compared, um, uh, dietary fiber to fermented foods. So fibers coming in a lot of those fruits and veggies that, uh, Jamie touched on and they actually showed superior adaptations. Um, with which one was it now? Now I brought it up and now I can’t even remember which one it was. Um,
Corrine Malcolm (46:18):
It’s one of the other, and now you have to go listen to another podcast to find, to find the actual answer. That’s that’s
Jamie Pugh (46:23):
That might be, that might be the worst advice on a podcast ever go and listen to this other podcast.
Greg Grosicki (46:29):
Thanks, Jamie. I appreciate it. At least, at least it’s very close to the end, right? Um, I believe it was the fermented foods were more effective, but I could be, I could be wrong there. Um,
Corrine Malcolm (46:43):
You got, you got a 50, 50 chance of getting that, right. And we super
Greg Grosicki (46:46):
Confident guys started talking about it and I forgot which one it was, but this is, but this
Jamie Pugh (46:52):
Probably highlights one of the issues, doesn’t it? That it doesn’t have to be one or the other as well. And I think some people get really hooked on some of this. Like if you, if you like fermented foods, great, if you, if you like one of them or two of them, fantastic. But if it’s not gonna be such a huge benefit that if you don’t like kombucha, if you, if you can’t afford to be going buy all the commercial stuff all the time, you can’t, you don’t have the time to, to ferment some of these things yourself. Then you can still get a lot of benefits from fruits, vegetables, and vice versa. Like the ideal thing is you, you maybe get a little bit of both.
Greg Grosicki (47:25):
It was, it was a fermented foods and not fiber by the way. That was great. Yeah.
Corrine Malcolm (47:29):
Oh, we Googled it real fast. That’s good.
Jamie Pugh (47:31):
But I was buying in time. I thought if I talk long enough, can Google it <laugh>
Greg Grosicki (47:35):
I could no.
Corrine Malcolm (47:38):
Anything, anything else to add to that, Greg, beyond, beyond a
Greg Grosicki (47:42):
One that people don’t think about? So a lot of things that we do, um, from like a physical activity perspective can influence it, our lab and many others have showed, um, cross-sectional associations between both self-reported and graphy derived, uh, sleep and the gut microbiome and people who have, um, on kind of the other end of the spectrum, like a obstructive sleep apnea exhibit, a very despotic gut microbiome. And so that’s one that I think a lot of endurance athletes in particular, uh, a lot of us wake up at four or five in the morning, a lot, cuz it’s we have to work. And that’s when we have to get up to get our training in. And I mean, anecdotally, I can tell you that the mornings, when, or when the long stretches of training, when I’m, um, you know, maybe really trying to train a lot and not getting enough sleep, I feel like I get maybe the most GI stress and that’s no coincidence.
Greg Grosicki (48:28):
So I think sleep may be, um, the novel. One of, probably the most novel one that, uh, that Jamie didn’t touch on. Another one is just, um, probably avoiding, avoiding, changing our diet. When we go to the race, um, at Ironman world championships in Kona, we’re gonna be lucky enough to get a sample at the athlete’s house as well as 48 hours before race start. And every time athletes go to Kona, they’re devouring pokey and eating yogurt. So a whole bunch of different bacteria probably getting into their gut and changing it right before the race is certainly not gonna probably create a very, um, you know, great environment. So things like that as well, being regular.
Corrine Malcolm (49:08):
Yeah. It turns out it’s like doing all the simple things, right? It’s like, you know, it’s it’s yes, you can buy the expensive things, but it turns out it’s like the eating a good diet and getting enough sleep. And I’ve been reading studies recently about like oral health and, and dental stuff because, because of my root canal recently, and it turns out that like good oral health is predictive of better performance. And I was like, okay, I will floss more if I will run faster,
Greg Grosicki (49:33):
Here’s I Flos using mouthwash. May I actually be deleterious to your performance because you have not only a microbiome in your gut, but you have one on your skin and in your oral cavity. So basically in your mouth and you have specific bacteria there that convert dietary nitrate to nit, right. Which can then be metabolized in nitric oxide, which can be extremely important for exercise. So sticking away from mouthwash and, uh, chewing too much, gum can actually get rid deplete those microbes in your oral cavity.
Corrine Malcolm (50:02):
If people have made it this far into the podcast, their lives just got changed just a little bit. Okay. Um, to not keep you both too much longer, cuz we could definitely talk for a very long time about some nonsense and some really good science, um, where people are really interested in this. Um, where should we direct them? Where, where can they find you? Um, if they don’t want them in their inbox or in your inbox, is there somewhere else that they can, they can reach out to you is at Twitter? Um, if you guys can just both plug yourself, that would be wonderful.
Greg Grosicki (50:31):
Um, so yeah, feel free to reach out on email. It’s just my, uh, first initial, my first name G and then last name Corki, G R O S I C K firstname.lastname@example.org. Um, also on Twitter and Instagram. It’s just app, uh, Dr. Greg gross. G R O S I C K I um, yeah. Happy to respond to any inquiries you guys
Jamie Pugh (50:54):
Have. Yeah. And the same, like more than happy for people to, to email and get in touch. Like we, we wouldn’t be here, sat together. Me and Greg, we wouldn’t have done this study if it wouldn’t have been for just random emails out of the blue. So, um, for my, for my email, it’s J dot P L jmu.ac do K as in Liverpool, John Moores university, uh, Twitter, it’s pew underscored, Jamie, uh, people can follow me on Instagram if, if they want, but they might see that one story every few months they might see the occasional picture of, of me and my wife. <laugh> if they’re interested in the science stuff, then the Twitter’s probably the ones to go for.
Corrine Malcolm (51:31):
Wonderful. I will link, uh, the Twitter feeds into our show notes for everyone as well. So they can reach out to you there. I wanna thank you both for giving me so much of your time today, orchestrating the time zones and everyone’s busy lives. Um, I hope people got a lot out of this.
Jamie Pugh (51:47):
Oh, thank you so much for the invite and um, yeah. Thank you.