How to Assess an Athlete: The Best Principles, Methods, and Devices to Use [transcript]

Written by Christopher Kelly

July 19, 2018

[0:00:00]

Tommy:    Hello and welcome to the Nourish Balance Thrive podcast. My name is Tommy Wood and today I'm delighted to be joined by Dr. Mike T. Nelson. Hi, Mike.

Mike:    Hey, how are you? Good to be here.

Tommy:    I'm great. Thanks for joining me. This is a very quick random thing because everybody always mentions you with your middle initial so I feel like I always need to say your full name, Mike T. Nelson. Is there a short version you're happy with? Do you want Mike T? Or is Mike okay?

Mike:    Mike or Mike T is fine. It actually started as a running joke in high school. I literally went to a very small high school and there was two other Mike Nelsons there. There was three of us in the high school which made it incredibly confusing.

Tommy:    That's actually how I ended up being called Tommy. When I started elementary school, actually, there was already a Tom and a Tomas in the class so I became Tommy and I've been that ever since. So, it makes sense to me. This is now the third time, I think, you've done a podcast. Chris has previously talked to you about metabolic flexibility and strength training for endurance athletes. We'll link to those in the show notes. People should go back and listen to those.

    Before we get into today's topic, I wanted to talk about athlete assessment. Maybe you can give a brief synopsis of what you're doing with your work at the moment. You always seem to be jetting off somewhere new and cool for work. So maybe let us know what you've been up to.

Mike:    Yes. So, I was down in Costa Rica basically last week with Dr. Ben House. We've done a program before. So, definitely recommend people to check that out. We were down there for a week, which is just [0:01:26] [Indiscernible] week where we had presentations. I gave one. A bunch of other presenters gave some awesome stuff. We just got to hang out in the afternoon and lift and Pat Davidson put together MASS-II, the [0:01:39] [Indiscernible] which is this pretty horrible thing of exercise--

Tommy:    Yeah. I've done it.

Mike:    Oh, man. We all went through that. What's interesting is it's one of those things in theory, I'm like, "Yeah, I definitely want to train for this. I think it'd be fun just to see if I can do it." And then I was literally home three and a half days. Before I left for Costa Rica, I was at the ISCN, International Society of Clinical Neuroscience Conference in Florida, and then through the Carrick Institute where I'm practically member. We did a cruise for a week. We had a couple of CEU lectures from Dr. Carrick on the receptor based essentials course.

    Previous to that I was gone -- I was home for two weeks and then before that I was gone for 34 days in a row. When I look at my whole schedule I'm like, okay, so what's the highest priority here? I'm spending two weeks in Texas kiteboarding, enter myself in the gym doing something stupid. I'm going to be so pissed at myself. Yeah, I do what I can, train a little bit for it and see if I can survive.

Tommy:    For those who don't know, I can take a little snippet out the MASS-II program the [0:02:45] [Indiscernible] section and we can attach it to the show notes, just going to show sort of a circuit base exercise with short rest periods with compound movements which is pretty fun.

Mike:    And there were some savages down there doing it. They look very impressive.

Tommy:    Bryan Walsh was, obviously, down there in Costa Rica too earlier in the year and he said that everybody walked around with their top off but there was no way that he was going to do that because he felt he's a little bit out of place. I know that at least his knowledge is pretty much better than anybody else's I know.

Mike:    Oh, yeah. Bryan's awesome. So nice I got to be down there with him the whole time he was there, one of those guys I've talked to off and on and just basically literally almost missed each other by days over the years. So, it was super fun to hang out with him and just amazing information he has.

Tommy:    Yeah, absolutely. Interesting segue. Talking about guys with their shirt off, this was a topic that Chris and I had been actually talking about last week and I wanted some of your input on because I know you have some experience with this. But the idea of coaches particularly -- So, personal trainers, I guess, I can understand but doctors and people with higher degrees or something like that, the need for those guys to look the part particularly the need to get naked or be topless on social media is some kind of, well, it's sold as inspiration but I'm pretty sure it often has the opposite effect and it's probably just some kind of ego boost. I know that people have discussed with you about looking the part and whether you look the part. I know you have some interesting thoughts on that so I'd love to hear your perspective.

Mike:    I think it depends upon in your life where do you choose to put most of your focus. I can pretty confidently say pretty much anyone I know who's gone to do an MD or PhD or advanced terminal degree, it's probably the most unhealthy thing you could ever do. I'm not using that as an excuse. I'm just saying that it just tends to go that way.

    I know once I finished mine, I was a wreck for like two and a half years. I actually flew out to visit Dr. Michael Ruscio to get sorted out and all those kind of stuff. But I think when you go down that route you have more advanced training in a particular area and it's not necessarily, "Oh, look at me. I look good naked."

[0:05:00]

    There's some people who can do both and there's, I think, a time and a place for that. If you go the other extreme, we have people who look really good naked but they may not really know anything either. They may be a great coach, they may not. I think on social media, because it's a very visual based platform, it's easier to look at someone and go, "Oh, that guy or gal is in shape, they must know what's going on."

    If you've been in this industry long enough, you know certain people who look really good but they're not all that intelligent and it just came for easy for them. I would say they haven't had to learn a lot along the way. A lot of them may not even necessarily work with a lot of people in person. I go back and forth on that. I guess we're on that, now, I think having the knowledge in the area is definitely going to be helpful. Working with people is definitely going to be a requirement.

    I just look more at where did the person start from, what have they done either as education or practice, and then what are their current goals and what are they trying to do? It would be like looking at Bryan Shaw and saying, "Wow, that guy is obese." No, not really with the amount of fat free mass he carries and he's a Strongman competitor, [0:06:13] [Indiscernible] those people. Grading them on something that they're not necessarily working towards on their own either. But if you grade them on the ability to move massive amounts of weight, they're like the top in the world.

    I think a lot of fitness is a carryover from bodybuilding and physique where we just want to see what you look like. A lot of times you don't know where that person started either. I'm like 6'3" and in college this is well past my growth spurt, and after I had started lifting, I am the same height I am now and weight 156 pounds. Not that I'm not huge now. I was like 224 this morning. But it took a period of time to get up to that point.

    The first time I actually go to 185 which took two and a half years, I was like, "Oh, wow, that's crazy." I think a lot of it depends upon what is your goal and what are you trying to do? I tend to agree that the social pressure is you have to look a certain way and I think even at the extreme that can be demotivating. A lot of people are going to start exercising and they're going to go, "Oh, it's been three-four months, or whatever, and I don't like this guy or that guy. Screw, this is too hard." It's a very weird world.

Tommy:    Yeah. I think that's putting it mildly. One of the important points you brought up is the struggle with the journey that somebody's had. I always think that the best athletes or the guys most naturally gifted, they don't tend to be the best coaches because everything came easy to them. Whereas those who really had to struggle to learn and try lots of different ways to get better, they often tend to be the best coaches.

    You gave some tips looking at people's background, how they got to where they are today. But with, like you mentioned, social media, the visual nature of it, do you have any tips on, so people listening to this, maybe they want to find a coach, they want to reach out, do you have any tips on the best way for them to figure out somebody who might be a really good fit for them?

Mike:    Yeah. I would recommend -- I look at their background and that will give you an idea of how capable they are. Just because they have an advanced degree or an RD or whatever, it doesn't automatically mean that they're really good at coaching. Because when I was in the PhD program, the running joke was people would come in, it was an exercise physiology, and there'd be other people in the program doing their PhD in it and they'd always just point at me and they're like, "What are better, squats or deadlifts?"

    The other people in the lab are like, "I don't know. You go talk to him." It was amazing to me that on one level they couldn't tell the difference. The subside is that it wasn't their area of research and two of them didn't even exercise. It was even more mind-bending. It's an indicator at best. And then personality wise, especially if you're working with them in person, even if they're the greatest trainer and you just don't get along with them personality wise, probably not going to go well. I think that has to be very matching there and some personalities work better for other people.

    And then what have they done for other people? That's what I would look at. Anyone you call up or interview should easily be able to give you references of, "Here's my current client or past clients, by all means, contact them." I've done that on a few occasions. I'm like, "Hey, talk to this person or that person. I don't even have to be on the phone. Here's their phone number. They're nice enough to volunteer 20 minutes of their time. Just call them." If they can't provide that at all I would be very nervous. I think that will give you a pretty good start.

Tommy:    That's a great point. Usually if you have great success with a client, they're often very happy to talk to other people about their successes. If somebody doesn't have those successes then that can become obvious very quickly. That's a good tip. I like that.

[0:10:03]

    So, moving on to the main topic for today, which was athlete assessments, before we started talking you sent an email. It looks like you breakdown the way you assess athletes into sort of four sub-categories. They're physical, nutrition with a bent towards metabolic flexibility, which is obviously something that you're known for, and then also lifestyle events, technology and tools on top of that.

    Maybe we can go through those one by one. I'm particularly interested in how you assess your athletes physically probably because when we work with people that's one of the areas that we have less access to just because we're working with people mainly online rather than in person. Can you give us a bit of an overview of what tools or techniques you are using to assess the physical capabilities of your athlete and then how you might track improvements in physiology or physical performance over time?

Mike:    I'll give the physical one for in person and online. Most of my clients and sessions right now are online but I do see some people here when I'm at home since I converted my garage into a gym. It makes it very convenient. If it's in person, it depends on what the person is coming in for. I have people that come in for, "My deadlift doesn't feel very good." I had a physical therapist who came over the other day which is what we worked on. Pretty advanced lifter. I would say super smart dude. He's just like, "Every time I deadlift I don't feel it in my hamstrings. I feel like the bar is pulling me far forward."

    In cases like that, I'll just run them through just the basic series of old school Kendall Manual Muscle Testing. All I'm looking for is just in the mid-range does the muscle fire and feel like it's working the way that it should? The simple stuff, glute max, glute med, psoas, rectus femoris, all the main muscles.

    When something there is off then I'll probably do some hands on work, usually RPR, reflexive performance reset, and make sure the baseline, all the basic muscles are doing what they need to do and then we'll go to the gym. Sometimes we'll do a pre, just to have an idea of how it feels. We'll go to the gym and, "Okay, let's just work up a load and see how it feels."

    Most of the time that's been pretty successful. They feel a lot better. You just did work up to 315 for reps, pretty easy speed and it's like, "Wow, this is the easiest my deadlifts ever felt. I can feel it in my hamstrings. Our position is actually going more back instead of just up." In person that's relatively easy. If it's online it first depends on what are their goals. So, whatever their goal is, I mean, I have some type of test for that.

    If their goal is to increase their deadlift or their squat or their press, I'm going to need a video of them doing a moderately heavy, one to three rep range type of exercise. I've gotten burned on that in the past where I remember one guy, he's like, "I need to hire you to get my squat to 315." I go, "Okay, it sounds all right." And we went back and forth. I said, "Get me a video with wherever you're at now." And he's like, "It's pretty good. It's just 300."

    This goes back and forth for five emails. He finally sent me an email that he was barely getting 225. It's fine. I don't give a crap where your starting number is but if you think it's 300 and it's actually 225, that's a major discrepancy we need to look at. So, a video of that, usually side view and a front view. And if they can only get one view, just a side view works pretty good.

    Based on that, the goals aside, we're going to test them for what their specific goal is. I usually break it down into roughly aerobic capacity and anaerobic capacity just as general qualities. The aerobic capacity I'll use 12-minute Cooper run test. The reason I like that is you can download apps on your phone now or take a watch. You can get GPS. You can get recording of distance pretty accurately for cheap. You don't need any other fancy equipment.

    

    If you can get a heart rate, that's even better. And then there's an equation you can take that will give you a rough estimation of their VO2 max. It's not super accurate but it's getting in the ballpark. The other one I use for anaerobic right now, I'd just been using the 500-meter row. I like that because I get a little nervous about the mechanical efficiency of clients sprinting. That makes me very nervous and to have something that I know isn't going to have as much physical pounding on their joints, there's not as much technique involved.

    I know there's technique to use a rower correctly. That's one of the things you're probably just not going to hose up so bad you're going to injure yourself. And with the concept too is you get all the nice output in terms of watts in time and everything like that. So, once I have that I'll also look at their resting heart rate. I'll send them the heart rate variability to have an idea both of those at rest. We'll just do about four weeks to get a good baseline on that.

    And then one thing I've done in person that I'll probably incorporate in the online training if I keep doing online training is -- I stole this from Rob Wilson who did the Art of Breath course from Bryan Mackenzie. It's just simply using a balloon that you inflate at different positions in basic exercises. At the top of squat you take a single breath in, see how much you can inflate a balloon, let all the air out, go into the bottom position of the squat and do the same thing again.

[0:15:06]

    You can do that in a hollow position. You can do it in a hanging position also. What that's telling you a little bit is how well is their breathing mechanics at the top and at the bottom of different basic moments. If I know that that's off, that gives me some indication of where that movement mechanics may not be the best without having to put them under a substantial amount of load.

Tommy:    And how might you train that? If you notice deficiency in a certain position, how can people work to get better at that?

Mike:    One of the things I thought about for years, and I've done this probably for about two and a half years now, is -- So, if we take an overhead press, why are some people weaker in certain positions? And an overhead press, I notice that a lot of people are actually kind of weak at the lockout. That's kind of weird because in theory if you get good alignment of your bone structure underneath it, it should be easier to hold at lockout than other positions.

    But if you get someone that's very extended especially through the low back because they're trying to make up for shoulder range in motion, that extended position is not super easy to hold. So, what I started having them do is I'm like, "Okay, I want you to take a lighter load, I want you to hold it at lockout and I just want you to belly breathe in that position."

    My thought being I want to take a little bit of their compensation. It's going to be a sub max load. And from a nervous system perspective, if we belly breathe, we increase parasympathetic tone. So, the more parasympathetic we are the better it is for motor learning because we decrease in that hyper vigilant state. So, I'm getting the two for one. I'm getting a little bit better probably mechanics on it or at least making them more aware of where they're not good, and then an increase in parasympathetic tone at the same time. I started adding that to a week point training on an off day.

    If they use a deadlift as an example, someone may work up to reps greater than 90% say Monday, but I don't really want them doing heavy work again on Wednesday but I can have them use a very sub max load, go to the position where they stall out, say three inches from the bottom, do two belly breaths there, and then finish the load. It's a little bit like pause training.

    My thought being that if they're unable to breathe in that position then, obviously, position specific work which you may have to go all the way down to being unloaded in order to do that so you may sit in the bottom of the squat and just work on specific breathing mechanics. You can obviously do this between lifts. You can do it on an off day. It's not much loading so it's easy to incorporate.

    And then I'll have them start doing their own hands on work, which is primarily from RPR. So they can do a lot of work on themselves around the sternum, around the ribs, top part of pectoralis, bottom part of the ribs, some of their own visceral work, so in the gut area. I'm just trying to get the ribcage to be a little bit more freed up.

    If you watch a lot of breathing mechanics on people, oh man, this is not super efficient. Maybe that's just simply because their ribcage is "locked up." So, trying to get a little bit better diaphragm activation and trying to get to some better moving mechanics at rest.

Tommy:    Would you recommend people get some kind of manual body work? I'm actually asking because of myself. I know I'm a little bit wonky particularly around the shoulders. I know that it's from years of rowing and a couple of injures and I'd been working on my own particularly breath mechanics and the squat. So, kind of like what you mentioned, on the days when I'm squatting heavy I'll just get the bar on my back, get to the bottom of the squat and do 20 big sort of belly breaths to work on that.

    But would you recommend people -- obviously, if you're not getting your hands on them in person, would you recommend that people get somebody to sort of look into that, maybe see if they can improve some of their alignment or free up some of the ribcage?

Mike:    Yeah. I think it's definitely useful. And just like all other professions, there's some body workers who are phenomenal and do a really good job, there are some who are just not really that good. I differentiate them between -- There's a big difference between, okay, I'm going to go in, I'm going to have a nice relaxing massage, don't fix anything, and I tell clients just tell the massage therapist you want to be asleep by the end. That's one type of massage.

    The other type is, okay, like you said, I've got this right shoulder is kind of buggy, I don't know what's going on. It's not bad enough to see a physical therapist. It doesn't show up all the time. In those instances, if you find the right person, it can be super helpful. I find that a lot of shoulder stuff, if we look at what's going on, a lot of times you have scapular dyskinesis, the scapula is not moving the way that it should.

    If you think about breathing, we should have basically 360 expansion of the ribs. With every breath, we've got this fine movement of the ribcage. And, obviously, the scapula is on top of the ribcage and the people can't do that sort of the posterior middle spinal expansion, so breathing into their back. The scapula has the tendency to get more "stuck" in that position because we remove that fine-scale movement from breathing.

[0:20:14]

    If you can restore that I find that mechanics usually work better and also stay a lot longer because you're getting that fine-scale movement all the time so it's less likely the body is going to try to stick a bunch of tissue together. And then what I like about RPR, and Doug Heel has the same system called Be Activated, there's other systems that are similar to it, is that when the client leaves here, I'll say, "Okay, here's these points I want you to work on yourself."

    So, I can hand the responsibility back to the person for them to work on it on their own. I think that's the downside of a lot of really good body workers is they're really good at what they do and sometimes they're so good that they can't explain anything. They're just going the Michael Jordan in his prime and saying, "Okay, how do you shoot free shows?" "Just do this, man." It's very unconsciously competent. They can do it but trying to explain what they're doing is just a whole different level.

    Having someone who can hand stuff back off to the client I think is going to be more beneficial. I have found that the more work I do on people and they do on themselves around the ribcage and visceral areas, so "the core", if I make mental air quotes here, the better everything else just seems to get. I've lost track of how many people come in and say, "Oh, my right knee is just buggy. I can't figure out what's going on." Rarely do everything to their right knee, or very little, that the [0:21:38] [Indiscernible] mechanics is working a lot better, that the psoas muscle is working better. "Oh, wow, I got up and walked and my knee pain is a lot better." I think working on those areas can help. I know Jill Miller has the Coregeous ball which I've used. I think that can be beneficial to do a little bit of your own visceral work also.

Tommy:    Okay. That's great tips. I'll have to hunt some of it down for myself. I wanted to get back briefly to something you mentioned earlier which is this guy that came in to see you and mentioned during the deadlift he wasn't really feeling a muscle activating. Again, I can give an example from my own experience. I again, a long time ago, I fractured most of the bones in my feet, on my right foot.

    Ever since then, it's just sort of led to me being a little bit not quite symmetrical, but one thing that I noticed is that when doing glute dominant activities I don't really feel a contraction in my glutes, if you can call it that. So, I can feel it on the left side but not the right side. Then I was discussing this with Zach who's our head of strength and conditioning. He's been coaching me recently and putting together a really program.

    He sort of pointed out that just because you can't feel the muscle contracting it doesn't mean that it's actually not contracting. Can you give a bit of information on that? Should we be worrying about really feeling a muscle contracting? Because if you're moving in the right plane, in the right muscle, you're doing some kind of flexion or extension, just by doing that movement you know the muscle has to be contracting, right?

Mike:    Yeah. And a lot of it I think is the terminology maybe used which I know I'm guilty of because I tend to drop sometimes into more client speak and say, "Oh, your glutes are kind of off." They're never really off per se. "Hey, your diaphragm is not working. If that's no working, you're dead. I think what we're trying to get across, and I'd been trying to use better language with the clients so I don't confuse them, is that there are, I think, different amounts of activation.

    So, we look at it and there's two components, right? There's the sensory component and there's the motor component. And how I think of these is that they should in a perfect world be very coupled. If I can do something, most of the time from what I've seen, if I can get a muscle to work better, a vast majority of the time that sensory information usually goes up especially acutely. If we take a side step into performance and look at what are we trying to do, the research on this especially from Gabriel Wolf is pretty clear that external cues are vastly superior to internal cues.

    On a deadlift, an internal cue would be, "All right, Doc, I want you to really feel your right glute." It might be beneficial but if I said, "Okay, this time, I just want you to push your feet through the floor." So, external cue, I'm telling you what is that output? What does that look like? I'm kind of allowing your brain to figure out the best half way of activation in order to do that.

    From a performance standpoint we know that external cues are much better. There's maybe one study now that looks at internal cues from a hypertrophy standpoint. It might be better. I haven't seen that it's been published yet or read that yet. But what I've noticed is if I have someone who says, in your case, "I don't really feel that much in my right glute," to me, that's information that, because if sensory should be coupled to motor output, maybe there's something wrong with the motor side of it also.

    So, can I get a better motor output of that muscle and then do you automatically report more sensation? That's usually the route that I would go whether that's doing some hands on work or single leg work or PRI type exercise where I'm just putting you in a very odd position that the only way you can achieve that position is to get high amount of activation from that muscle.

[0:25:14]

     I think that's beneficial. And then over time what I actually want clients to do is focus on an external cue and then just let me know what shows up. So, for the guy who was over here the other day, I didn't give him any cues. We went back out to deadlift. I said, "Okay, let's just warm up and see how you feel. You know, 135." He says, "Man, that feels great." I'm like, "225." He's like, "Oh, cool. That was great." I'm like, 275. He's like, "Oh, sure, what the hell." Go up to 315 and he's, "Oh, man, that felt great."

    I said, "What did you feel?" He's like, "Well, I just felt more sensation in my hamstrings and more in my glutes." I'm like, "Okay, cool." And I'm watching the bar position. I could see that the bar position had moved back a little bit also. So, did I actually tell him, "I really want you to think about those hamstrings this time." No. I'm giving him the same cues I did before which is no cues. Just letting him figure it out on his own. And then I'm always curious to see what does he actually report?

    And even if he said, "Hey, that feels just a lot better and a lot faster and it feels easier," and he doesn't really report a huge hamstring and glute activation or sensation, I'd still be very happy with that. He's still moving in a better direction. I'm always interested to follow up then about 48 hours later and see where they're sore and if that's different. A lot of times they report back, "Oh my god, my hamstrings are so sore. My glutes are actually sore for the first time ever."

    Obviously, DOMS isn't everything. But again, if we're activating more of that muscle tissue, if we assume that it hasn't been activated as much in the past, it makes sense that we're probably going to have, especially on the initial insult, more soreness is going to be reported. With online clients, I use it as a very rough diagnostic also. If they always report, "Oh my god, every time I squat my right adductor is just super sore and my left is never sore," that's making me think something's not going well.

    Their squat may look very symmetric because if they can really overrun that right adductor they may able to hold it up to a point and it may look good but I'm definitely not going to try to push them on that. I'm going to try to figure out what's going on even though the exercise looks good. I think we can use both but I'm much more of a fan of the movement and external cues, that direction, and then asking them what did you feel and not biasing them into, "Okay, let's really feel those hamstrings now." I try to not bias them in that direction.

Tommy:    Yeah. That makes perfect sense and that's exactly what Zack and I have been doing too, is just looking at the movement and focusing on external cues and, obviously, that's back to the research, as you say. So, we're going down the right pathway. That's great.

Mike:    On cue on that too is two things. There's some stuff on gait that I got from Cal Dietz. If you push your big toe down on the ground, that's going to correspond to glute max activation, watch people's feet, and the cue I may give them is, "Okay, when you're coming up on the deadlift now, push your big toe down," especially if I see that their foot's unstable. And some stuff I got from Dr. Cobb at Z-Health years ago shows that the cuboid area may have some activation related to glute meat. So, it's done some damage in that area of the foot, that may be worth looking at that part of the ankle and see if you're missing some functions there. If we get a little bit better function there, does that then transfer to better activation?

Tommy:    That makes sense. I'm ticking some good boxes here because I listen to Cal Dietz on a podcast a while back and he mentioned the toe thing. I've been using that too and that definitely helps me. Great. That was sort of a rundown of your physical assessment of an athlete and so then maybe we can talk about nutrition. I know you've covered some of this ground with Chris before so we don't have to go into huge depth but I'm interested both like how you go over the quality and quantity of somebody's diet, how you determine their level of metabolic flexibility, if you can do that, and then how you might increase that or how you might track changes in that over time?

Mike:    Yeah. I've done everything in this area. I paid for very expensive dietetics programs when I was in college to run the exact amount of magnesium that's in your diet. Bryan Walsh has been on here before and talked about, basically, micronutrient testing isn't really that great. There's exceptions to that but as a whole he's been pretty unimpressed with the data which I would tend to agree on that.

    What I do now is I have people just put it into something like Cronometer or MyFitnessPal. MyFitnessPal, you can potentially have some weird stuff in there because people can enter almost whatever they want. I'm switching more to Cronometer which has its pros and cons. And I just wanted to log these three days during the week and probably at least a weekend and I know by virtue of fact that I'm telling them to log their food and I'm going to look at it.

[0:30:01]

    They're probably going to change some stuff. That's human nature. I actually hired someone to help me with my nutrition lately just because I need more some of these external accountability and just to get out of my own way because I know I'm going to be biased to what I see all the time and I know just even for myself trying to log it, which I like doing this every once in a while to experience what it's like to be a client again too, I'm like, "Oh, I had Moose Tracks last night. I don't really want to put down the ice cream but whatever."

    It's interesting even how you know the process and know what's going on and not really that worried about it. You still have that little thought of, "Oh, boy." So, write that down and then I'll ask them. I said, "Okay, looking at this data, what do you notice?" Because I'm also interested in what patterns do they observe? So, things that may be obvious to me may not be obvious to them or vice versa. It also tends to tell me what they're super worried about.

    If they're like, "Oh my gosh, I just realize I don't even hardly eat any vegetables." I'm like, "Oh, okay." For some reasons, they're actually worried about micronutrition. That's good. Or they're like, they give me a five-minute soliloquy about how they had a pop tart last night and thinking, wow, they're really hung up on this "good versus bad food." The information they give me also tells information that's useful.

    After that, I'll look at just the macro amounts, proteins, fats, carbs. I'll look at what it is in the training day, not training day, during the week versus weekend. I do have a program that you can put stuff through and it will tell me roughly what their micronutrition is. Dietary recall is probably the best we have so far. I've done it so much now I can just pretty much eyeball and get pretty close.

    Because you know if they're not eating anything that's green other than green M&Ms, they're probably going to be low. We know that magnesium tends to be low in pretty much everybody, anyway. You can get pretty darn close just by eyeballing it. I do have a couple -- One test I do right now is I do an omega three test which is an at home test that I send them that they do on their own and that will tell me the levels of fatty acids in their body. I'm especially interested in the fish oils, EPA ad DHA.

    The test will also run red blood cell content, so membrane content of EPA and DHA. And that's what I'm really interested in, is your body assimilating those into the actual cell membranes themselves and is it doing that at a pretty decent rate? So, is it assimilation issue or is it just you don't have enough of the raw material? And the vast majority of the time it's usually the first part but I have seen a couple of cases where their whole blood levels were super high, their cell membrane content was not that high, and I'm like, "Yeah, you need to go talk to someone else beyond my scope of practice and see what's going on."

    Anecdotally, it's been a couple of numbers. It just had horrible digestion issues and a whole bunch of other stuff that maybe gets [0:32:57] [Indiscernible]. And what I like about that test is that it also reinforces that fish oil as a supplement is probably going to be useful and gives you a rough idea about how much. I find that compliance generally is better. On one hand I'm sneaky where I'm using the test a little bit to get compliance. I could easily say, "Okay, everyone, just take one to two grams of fish oil across the board. Probably going to be okay."

    But if someone is super low, it may take them a long time but they may never get back to a normal level. I think just getting them in the ballpark of where the dose could be useful. I'll look at timing and also social cues. If they go out to dinner, does all hell break loose in terms of drinking alcohol and other things and kind of go from there, just take that and then match that to what their goals are.

    Usually you can get more in depth in asking what foods they enjoy, what foods they do not like. They can do what I can color analysis, just look at the vegetables they eat and are they all the same color? If the only fruit and veggie they eat are berries, yeah, that's good. But maybe getting some green and yellow and orange things is going to be beneficial from a polyphenols standpoint and just other micronutrients.

    It's not as hyper analytical as I used to be because most people nutrition they're pretty far off the mark. I don't need to spend all of this time trying to micromanage something that's not going to make that big a difference. Lately I've been seeing more women again who are exercising a fair amount and are just scared to death of carbohydrates again. When you look at it, it's pretty obvious usually what they're missing.

Tommy:    I completely agree. It's so easy to overcomplicate this when the answer is usually fairly clear and it's something that we see all the time too. Well, people are, now they're scared of carbohydrates and protein and fat and they want to train 20 hours a week. It just doesn't work, I'm afraid to say. Moving on to the metabolic flexibility part, do you do any assessments that might give you some clues to that or how do you then both assess and improve and track that?

[0:35:04]

Mike:    Yes. So, what I'm looking at in terms of accrued sense of metabolic flexibility is how well your body can use carbohydrates and also fat. Everyone now is using a ketogenic diet to increase metabolic flexibility which that's my new thing that drives me bat shit crazy. They got half of it right. It is true that if you take the standard American who doesn't exercise much and eats a lot of carbohydrates, you put them on a ketogenic diet, you will definitely increase your body's ability to use fat.

    Jeff Volek saw these on athletes with the faster study. The downside is that, and I think I talked about it in this show before, you will start losing the ability to use carbohydrates to the highest degree. It doesn't mean you lose the ability to use carbs entirely but if you're a strength and power athlete losing that 5% to 10% off the top end or even someone who is doing a lot of endurance training, that's a pretty big deal. Again, it goes back to what's the reason you're doing it for, what are your goals?

    For metabolic flexibility for just accrued assessment that I use, on the end of fat metabolism, I find that how long they can go fasting is a pretty good approximation. They say, "Yeah, I can do ten, 12 hours, that's pretty easy but, oh, man 15 is horrible. I just feel bad. I don't feel good. My energy plummets. I get done. I eat like three meals at once." Okay. So, you're looking at maybe 12 hours you can do pretty comfortably.

    When insulin is lower, going to push your body to use more fat as a fuel and, obviously, there's social cues and food cues and all that stuff wrapped up into there too. But on the other end, I kind of look at all how much of a bolus or a bunch of carbohydrates can they have and how do they feel after that? If I give you a couple of oatmeal and halfway through it you're like face down in it because you feel horrible, I'm going to guess your carbohydrate tolerance isn't that good.

    You can take the next step and look at fasting blood glucose and then you can measure it every half hour if you're doing oral glucose challenge test or just measure in response to different foods. Some foods may be different. [0:37:14] [Inaudible] a couple of years ago from cell metabolism that looked at that. Initially, I'm just thinking, okay, how much carbs can you have in the morning? At that time you're not really that stressed. And then how do you feel after?

    If we want to get fancy, like I said, you can start measuring blood glucose. You can get uber fancy and start sticking continuous glucose monitors on people. Blood work, Bryan Walsh has talked a lot about this. You can look at GlycoMark, if you're looking at those intermediate or the faster portion of the insulin response. Those are markers that I use on that end. Most of the time it's pretty simple, how well do you handle carbohydrates, and then you can play around with the different amounts.

    Rough marker, I've often joked, I call it the pop tart test. If you're going to have two pop tarts in the morning and feel pretty good, you're probably going to be okay. What' the most heavily processed food that's man-made sugar I can find that will stand a nuclear holocaust, let's test that food and see what happens. And if you're doing okay there, probably not going to be too worried about it unless you're someone who's a CrossFit athlete or someone who just really wants to push the end of the spectrum then, yeah, we may do some follow up testing as we start increasing your daily amount of carbohydrates.

Tommy:    Okay. The pop tart test, that's now top of my list of assessments to do on myself. It sounds like fun.

Mike:    And people freak out over that too. It's like one of the emails I get from people are like, "You're a health person and you're telling people to eat pop tarts? Don't you know that's just a horrible food?" I'm like, I'm not saying you eat pop tarts every day. I'm just saying that if all things being equal, two pop tarts put you down for three hours, I think there's some stuff you should work out.

Tommy:    Yeah, I like it. Okay. So then, I guess, moving beyond that to other aspects of lifestyle, and this was the third of your list of the ways that you assess people, how are you going about how every other aspect of an athlete's lifestyle might be affecting their performance?

Mike:    Yeah. So, the main one I'm going to look at is sleep. Sleep is becoming more and more sexy which Dan Pardi has been talking about that for quite a while, Kirk Parsley. Matt Walker's new book is awesome, highly recommend it. With that I usually will pull their Fitbit or their Garmin data if I can because I want to know what time did they go to bed. I'm not so interested about the sleep analysis per se. I want to know what time they get up.

    Because again, just like with food, I've noticed that people, I don't think they lie on purpose, it's just not always super accurate. And I know Dan Pardi has said this before too, that the time you spent in bed is the main thing that you can control from an action standpoint. It's likely to control the amount of sleep quality per se.

[0:40:01]

    So, I look at that. The one that I got from Ben House also that I really like that I've added in, and Bryan Walsh has talked about this too, is just simply what do you do for fun? Do any form of recreation? Do you ever have like a half hour of just by yourself not counting training? It's amazing how often people are just like, "Well, no. I got stuck in a long line at the grocery store once."

    I'm like, "No, I'm talking about something pre planned like you're going to go to a park and you're going to read for a half hour." "No. What are you, crazy?" And pretty much if they don't have something like that, it's almost guaranteed their life is super stressful. I look at that. I look at like, again, heart rate variability. It gives me a pretty good marker for their overall stress. And do they really enjoy what they're doing?

    A lot of people are stuck in a job that they don't like but they feel like they can't change either. So, if that keeps coming up then we have a conversation of, "Do you realize that you make a decision every day to go to work?" "No, I don't. I have to go to work every day." I'm like, "No. If I paid you enough money, you could stay home on Monday." Now, if you do that enough, you probably could lose your job. I'm not saying people go out and be slackers. But I'm just trying to get some leverage for them to admit that, "Okay, I do decide to go to work every day because I need to provide for my family and this is what I feel is the best way to do it."

    Okay, that's cool. I'm not saying you have to like your job now. I'm just saying that we have to get to some point where you agree that you are taking responsibility for your own actions, because I find that that tends to bleed over into everything else. "Oh, I went out to dinner with a client and they ordered desserts so I had to order dessert." No. I agree there's lots of social pressure associated with that but I highly doubt the client put a gun to your head and said, "Eat a hot fudge sundae."

    But this is a little bit into their thought patterns. If you do have to have dessert doesn't make you a bad person either. And then the last part on that is that I do like using the Oura ring to look at sleep and that will do heart rate variability automatically. I found that that's been pretty useful and it also records pretty seamlessly. I can log in to their dashboard and look to see what's going on. I've been using that fair amount lately and I really like that.

Tommy:    You mentioned earlier sending people HRV kits. Is there something in particular you're using or you're encouraging people to get Oura rings? I know some programs and I even like buying bulk Oura rings and like sending them out to people for a short period of time. What are you doing now and what would you ideally do if you're able to do it?

Mike:    Yeah. So I'd been using heart rate variability with just the heart rate strap [0:42:44] [Indiscernible] program. I'd been using that with clients daily for about five years now and I have that as one of the things of the people that work with me, one of the contingencies I have is that you will agree to measure your heart rate variability at least five times a week and I will send you everything you need to do it. It's included in the price.

    The reason I did that is just because if they're training, so let's say they're competitive CrossFit athlete, yeah, their training volume is probably going to dictate most of their stress, if they're high level triathlete. On the flipside, if it's someone who's maybe exercising four times a week but their outside stress is super high, I want some type of leverage to show them that, hey, your stress level is pretty high.

    And consequently, once it starts to get better, I want a similar metric to show them that, yeah, you've been going to bed 20 minutes earlier. I know you probably don't feel a lot better but, look, your heart rate variability is actually starting to get better. I want a positive reward on the other side. With that one also, you have to report the other indicators like self report energy, mood, nutrition, things of that nature. Not just getting resting heart rate. I'm getting HRV, but I'm also getting the other metrics of the context of what's actually going on.

    They say, "Hey, in the past four nights, my heart rate variability is gone to crap. Oh, but I self-reported my sleep is like five points lower than what it has been." Okay, cool. Now I know when I look at this, "Hey, looks like your sleep is probably affecting your heart rate variability. Tell me more about your sleep. What's going on?" It kind of gives you more leverage to have those conversations and to kind of figure out what's going on.

    I found it to be useful on both sides. So, someone who's training or pushing really hard, you maybe modify the training and vice versa, someone who's trying to increase their training and it's their lifestyle, that's the main source of their stressor, it allows us to work on both of those cases.

Tommy:    Absolutely. And now that you sort of mentioned all these things coming together, I wonder about giving yourself a big picture of what things do and don't work in your clients. Do you have some way of documenting all the stuff that you've assessed and then documenting what you've recommended and then whether that works or not?

[0:45:00]

    This is something that I think is part of a bigger problem in many coaching spheres. Some of the stuff that we do too is that you could get all this data and you could recommend these things but how do you start figuring out what's working, what's not working, when do you start to intervene, when do you change? Do you have some way of approaching that?

Mike:    Yeah. So, for a while I used to take everything and aggregate it onto this like massive spreadsheet. So, I would have an assistant in India. So, I'd work with a client. They'd say, "Okay, I've got a Fitbit, you sent me my HRV, cool, and here's my MyFitnessPal data and here's where I'm tracking my training." I had this huge spreadsheet so you could just share the data with me or, if you're okay, give me your login and then the assistant in India, I set it up so he would go in and populate the HRV, their qualitative metrics, their sleep and basically put everything into this huge spreadsheet.

    I did that for probably like two years. I tried to figure out what are the main patterns and what's going on. At the end of the day what I realized was that there's so many things that are moving around and it was hard to figure out what would be next. Because in my head, I'm like, well, if there was some way we could get all this data to play into one system, which I tried for a while via APIs and everything else and it was a debacle. I'm not a programmer. That's definitely not my area. I shouldn't have even attempted that. It was nightmare.

    That's when I hired the guy in India just to mainly put it all together. I think it was some of the more open access platforms that may become easier so as the things like the Oura ring where you're collecting things seamlessly. A person doesn't have to enter it. That makes life a lot easier. And what I found was it's a fine line with clients where they come in initially and they're like, "Okay, I got all these things I'm working on," and you send him a training program, you send him everything, and they're like, "Oh, that's it? You just want me to eat more protein and lift three days a week?"

    Well, yeah. Those are the top two things that are going to be best for your results. And they're like, "And I'm paying you a whole bunch of money just for this?" I'm like, "Well, yeah, because this is what you need right now." And some of them would drop off because they felt like they're not getting what they paid for. The flipside was you, and I did this early on, is I just overloaded the piss out of people.

    "Here's seven things I want you to change." That was a nightmare too. What I do now is I'll say, "Okay, here's your training program. Here's every day, but I really want you to focus on the three days that are strength training. I have all the rest of it programmed out. If you get all your strength training done, you want to do these other two cardio sessions, boom, they're there for you. Here's all your nutrition stuff. Here's all your macros. Here's a template of what eating real food would actually look like." I'm not saying there's anything magical about broccoli but most people don't even know what a decent nutrition plan looks like.

    And I'll say, "But we're only tracking protein on this. Here's your lifestyle thing. I just want you to measure heart rate variability each day. If you want to, take a half hour for yourself this week. Let me know what that is." At the end, I would put a compliance chart and I would force myself to most people to only track four-ish things on the high end. So, maybe weight training protein, HRV and what was the one fun thing they did during the week?

    So that they have all the other stuff. If they feel like they're doing really well and want to go above and beyond, they know exactly what they're going to be "graded on" each week and then they have to send that in to me by Sunday night and I get back to them by sometime on Tuesday. That works a little bit better because they feel like, well, I have all the information if I happen to need it but I'm not overwhelmed on 12 things I have to now incorporate into my life over night.

Tommy:    That makes a lot of sense and sort of give people some firm targets but then also the flexibility to work around things to decrease and increase as they need to. That's a great approach. I think we can certainly learn from that on ourselves. I'll try and incorporate some of that into my own work.

Mike:    It's hard, right? It's hard to do a lot of one off sessions with people now and they'll send me a whole bunch of data and fill out a bunch of stuff ahead of time. The whole point of the hour/hour and a half Skype call is for me to figure out, okay, what are the top three things that you need to do right now? Because I think it's easy for people to get overwhelmed. Like the call I did with a guy a little while ago, awesome guy, had been super successful with weight loss and he had a really good questions.

    But you could tell that he was just trying to piece together a bunch of information from other people. That's not his fault. He doesn't necessarily have a background in physiology. It would be like me going into my accountant and being like, "I don't know. I read these five blog posts. I think I should do this." What are you doing? It's like, I don't know. You don't know what moves those other things, right? You're not looking at it as a complex redundant multifaceted system. You're looking at it as this button, this button and this button.

[0:50:00]

Tommy:    Moving on to, I guess, the last potential bag of tricks that you might have particularly the technology and tools that maybe you don't use with everybody but you do use on some people or things that you might like to use more of in the future. We were talking previously about NIRS, which is near-infrared spectroscopy as a way to sort of measure, you know, your muscles are using up oxygen or extracting oxygen for the blood.

    There's the Omegawave which is the more in depth version of heart rate variability and measures some other things. Is that kind of stuff things that you're using or things that you'd like to use? Is there anything where sort of like the data is very nice but maybe it's not really adding that much to the practice of coaching?

Mike:    Yeah. I think online you're a little bit limited on what you can use. I mean, most people are probably not going to spend the money for an Omegawave and it may provide me some more useful information but, in all honesty, for the price tag of the full system, I just can't justify it. I know people use it and they really seem to like it and they get a lot of use out of it.

    Like you mentioned, Moxy is something I just started using more here locally and briefly for people who don't know what that is. I often thought about if you have a more advanced athlete, what is really the right limiter of their performance? I think you could probably roughly divide it into central and peripheral. It's a little bit of arbitrary division. If we throw the neurologic aspect for now, we could say sensory limited may just be you can't just get enough blood through that actual muscle.

    It may be aerobic base. It's just horrible. You're resting heart rate is 75. You're just not that efficient on the cardiovascular side. Maybe that's actually limiting your performance. If we look at the specific muscle level, which we can do with Moxy using the nearest technology, so people who've seen the little pulse sox that goes onto your finger, it's the same idea except for we're looking at the actual muscle level on the venous side.

    So, simply we're looking at how well can you deliver oxygen to the muscle and how well can the muscle extract oxygen? So, if you've got really good delivery than my case when I was tested, extraction was only about 30% which means that if I could do things in training to drive that down lower, you're never going to hit zero but I would probably get better performance. My main limiter there was extraction of oxygen at the muscle level which gets them the CO2 levels and a bunch of other stuff.

    I think in more advanced athletes, that's super useful because it's giving you information on what is a limiter and then, obviously, what you can do with training and then you can then retest it and see if you're moving in the right direction. If you're an untrained individual, yeah, it might be interesting to know but all three of those things are probably limiting your performance. You just need to eat more, train and sleep.

    You probably don't need to go into that level of detail unless you're that analytical person and that's what actually drives you to be compliant. Some people want to know what's going on before they'll take any action to do it. I find that's useful. I have done some stuff with Dolphin unit which is microcurrent. I initially got into it for scar release on myself. Pretty much like everything else I'm like what can I do to increase my performance? And so I kind of get into everything. It's just basically two handheld units that put a microcurrent from one side to the other.

    I had an open heart surgery when I was four and a half so I've got a huge scar from a thoracotomy. It actually made a big difference. I ended up buying those units and I really use that sometimes on maybe if the soft tissue is really off or like midline scars and there's like no research on this. Midline and C-section scars just seem to do weird stuff to people. That's one of the weird questions I'll ask him. And for whatever reason they just don't seem to be responding, I've made you something like that, and then everything appears to work again, who knows what's actually going on with that? But I found that that can be useful at times.

    I just got literally yesterday the new PUSH device which will allow you to measure velocity and bar speed. I had the previous one before. I got one of the early devices. The nice part about this is you can mount it actually on the bar now so you can get constant read out as you're doing it. That might be useful. After that, you'd get in to really weird esoteric stuff that I don't know if it makes any difference or not.

    So, at the Carrick Institute we did buy one of the halo devices which is basically zapping the motor part of your brain to get increased time to be more neuroplastic, which in theory should allow faster motor learning. I haven't played around with it enough to know if there's anything there or not. Research on it is kind of split and other things like that, I think are interesting but I'm not really sure how they fit in or how I would use them to be honest.

[0:55:02]

Tommy:    Yeah. With the halo, those are -- an interesting article just came out that basically talked about how if you're using, so, transferring of direct current stimulation, basically that current isn't making it to the motor cortex so it's not really stimulating what you think it's stimulating or at least for most commercially available device that is not strong enough. I've played around with it myself, me and a buddy of mine, he's a CrossFit athlete and we basically did a placebo controlled study with the halo on him during an overtraining protocol and we tested his performance multiple times over four weeks.

    The halo didn't make any difference. I mean, it's just an N equals one, but we had fun playing around with that at least. It's one of those things that, you're right, it's interesting but we're not really sure how useful it really is. I guess, you've touched on this but as you discover new things and new technology that comes out, how do you figure out whether it's going to be something that you're going to use with your clients? Is it, like you mentioned, something you'd try out on yourself or maybe hear from other people? How do you start to figure out what's worth incorporating?

Mike:    Yeah. I always look at what is the reason that I'm doing it and is it a measurement or is it an intervention? The halo is something that's more of an intervention. And then what is a way I could actually just set up [0:56:19] [Indiscernible] to kind of test it? So, like the Moxy, I get into that. It turns out they're locally here as I saw them present at the design a medical device conferences like six years ago. I just waited around because I'm like, startups they tend to go out of business pretty fast.

    I don't want to spend a bunch of money on something that's not supported because god knows that's happening to me a lot in the past and stuff. The more I kept digging into the physiology, I'm like, "Oh, well, this does make sense." If I have this bit of data which this device provides, that is useful and it's also actionable. Based on the theory that we understand now, okay, that makes sense. HRV is very similar. I was a researcher when I did my PhD. I was pretty familiar with the literature and the used equipment we had in the lab to measure HRV when I started was like ten grand.

    So, the fact that you could buy a heart rate strap and for a $9 app gets something that is very accurate, that's pretty cool. Because now it solves the biggest problem with that technology was how do I get like almost a daily reading? That's the only time it's really useful. To figure that out I'll look to see what am I missing? A PUSH device. If I had access to velocity data, is that really actionable? Yeah, it's debatable. But I think you could make an argument that you could get prediction, a potential one rep max without having to do a one rep max and some other stuff like that.

    From my own lifting, having some feedback is useful. Interventions I think are harder to figure out because no matter how hard I try to control all the other variables. I know that they're changing so the pro and con, the con is, "I don't know. Maybe it's just noise." Maybe it's not. The pro is, if there's not big of an effect size it should still show up above all the other things.

    So, I'll look at, for example, I'd been looking at a bunch of stuff that will increase parasympathetic tone on heart rate variability. I mean, little things that will destroy it, right, like poor sleep, poor nutrition. But I've always been interested in is there's something I can do from a recovery standpoint that I can get back to a better base line? Yeah, there's a whole bunch of stuff that will make a difference acutely from some nootropics, the meditation, the things like that. But I find that those are very much longer term effects.

    Base line will slowly creep up over time. Things I found that made the biggest difference with that was the Dolphin unit when I had worked out on my midline scar, the RPR work and then some very specific functional neurology and basically three different cold lasers to my brain, which was done through a functional neurologist. I wasn't hooking the [0:59:09] [Indiscernible] up in my house.

    A lot of other things are just hard to tell. With those, and I'll repeat them multiple times. Okay, does it still have the same effect? Oh, it does. In that case, HRV would go up ten to 13 points and would stay elevated for at least two days. That's what I'll use as a weeding out metric. And, of course, I'll look at the literature and see what it says. Is there a plausible physiologic mechanism? Is there any research that's put out that's independent of the company promoting it?

    Not that other research is bad but I'll look into who's actually developing the technology and that usually gives you pretty good insight. So like the Oura ring, a lot of engineers that used to work for Polar. The guys, as far as I can tell, who are doing the halo device seem to be pretty legit, had done some stuff with brain stimulation and stuff in the past.

[1:00:01]

    I don't know if I can say the same thing for a lot of the other smaller biohacking type tech stuff. People running it and getting into supplements, I don't know. It makes me a little nervous because sometimes they don't know what they don't know. And a lot of the new kind of leading edge stuff, it's just not going to be a lot of data. You're not going to have seven randomized controlled trials on it. It just doesn't exist and all that stuff takes time and money.

    I think that's what makes it a little bit harder to try to sift through. The most that I found that's been useful is definitely minor compared to all the stuff that I've tested and I don't usually write anything about all the stuff I've tested that doesn't really work. It's just like, nah.

Tommy:    Sounds like you've been a good testing ground for this stuff. So, things that come out the other end that you're using had been through a rigorous process before they get there which is important. People would definitely appreciate that. So, part of that process and for new tools because I know you've been using the blood calculator recently I'm going to take an opportunity for some shameless self promotion. But I would like you to tell us what you think of it. Be honest. And also what you think is good and what can we do better?

Mike:    Yeah. In all honesty, obviously, I don't have any financial things interested in. I still pay you guys $100 a month and stuff and glad to do that. When I first heard of you guys talk about it, I watched a couple of the videos like super early on and I was like, "Wow, that sounds like a pretty cool idea." But there's something about where it didn't make sense to what it could actually do because I think it's so different than anything else that's out there.

    And then when Bryan was down in Costa Rica in March when I was there, he was basically presenting saying, "Okay, here's exactly how I use it, here's what it tells you, here's some real data I put in, here's the output." I told him afterwards, I was like, "Holy crap. That was super useful." Because you're seeing how it can actually be used and what's actually coming out and it's pretty easy to use. That's what sold it for me, was seeing it that, oh, I just have to put in these basic parameters and then it will give me predictions on the other side.

    What I really like was that you could look up the sensitivity and specificity of each one because that would be like the first question I would ask. I'm like, "Oh, this gives you some cool data and you get a probability number?" Which is good. I like that. But if you ask for sensitivity specificity data, they look at you like a four-headed space alien. That's not a good thing. And the fact that it had been cross checked with actual data that was useful.

    What I do is, I mean, I'll use it with clients. Right now, it's just included in the service. Maybe I'll do this as a one op type thing. I use it as just a very rough screen. Obviously, I'm not a functional medicine person but if it's data they've already collected on themselves, which in most states is legal to do, run it though and be like, oh, okay, there's just a very, very high level do things come up like maybe a lot of environmental pollutants or different things like that.

    They come up with a lot of micronutrient deficiencies that are at a high probability, and then that just promotes just another question. I literally did this last week. I said, "Okay, here's your results. First off, don't freak out about all the data and all the stuff that shows up. Everybody has something that's going on so no one's perfect, no one's last, no one's less, no one's life is perfect. Just don't try to compare yourself to that standard because it doesn't exist."

    And then a lot of the things that show up in plastics were high. I said, "Do you store a lot of your food and you reheat it in plastic containers?" She's like "Oh, yeah, I do." And I go, "Okay. Well, based on this, you may consider, at least for stuff that you're going to reheat, changing to a ceramic or glass." Not that expensive. But the other person, like it was all micronutrient stuff. It's probably half of like the top ten.

    I'm like what do you use? It's a new client, so I say, "What do you use for a multivitamin?" I had her three-day diet log. You know, doesn't really use anything. Nutrition was okay. It wasn't bad. But I'm like, "Hey, let's just try a higher dose, specific multivitamin and let's go from there and see if that helps." I mean, all those things I think are well within the scope of a personal trainer. Obviously, if they want more information, by all means, here's a functional med doc.

    Talk to them. They can give you some more highly specific things, if you talk to Bryan about specific toxins or you guys and things like that. But what I really like is that I think if it's done correctly it empowers trainers to provide a higher level of service and then to also get people to somewhere where they may get more help.

[1:05:03]

    And also to point them in the right direction. Because, I mean, I love the functional medicine space but everyone hears these horror stories of someone who went in and [1:05:14] [Indiscernible] testing and, man, a lot of those poor people are so confused. And you guys see that a lot too. It's something that we can address that's relatively easy. It's like, hey, maybe you don't need an organic acids panel. I'm not saying I'm against that. I don't know enough about it to say yay or nay but I'm saying that the top ten things here, seven of them are micronutrient that we can probably change just by giving you a multivitamin.

    There's very little downside with that. I think enables them and the clients feel like they're doing something that's a little bit better. I don't want to say it's foolproof but it gives you a snapshot of things that are going on without having to know a ton of biochemistry. The more you know is going to be better. And so that's what I think is super useful.

    To me, the only way the whole health prices and all this other stuff going on is remotely even solvable is if trainers are someone towards the bottom, which I don't mean in a negative sense, if they get really good at getting their clients to move and get really good at providing them better nutrition information, maybe there's a couple screens I could have them run and say, "Hey, let's just get some basic blood work, we'll run in through this." "Look, we can work on this and this." "Wow, a lot of that stuff looks pretty weird. You go see my buddy over here." "Maybe we just do a basic functional neurology screen with you also." "Okay, I know enough to run the screen." "Oh, yeah, you're good. Okay, we don't have to worry about it," or, "No, that looks a little bit off. You should go see my friend who's a functional neurology person over here." Because I think there's a lot of very basic stuff we could do to help clients. It's just not being addressed. I think that actually helps fulfill one of those needs.

Tommy:    I think that's great to hear. I know the rest of the team would say the same. We are big fans of all of the stuff that has no downside but with a potential upside, so improving the quality of your food and sleep and movement. And most people don't need a whole bunch of fancy testing and just finding ways. But they do need accountability. They need some coach and it doesn't need to be some functional medicine doc with multiple degrees. It could just be anybody who gives them accountability and some steps in the right direction. That's definitely we're big fans of. There's just so much need for it. We're never going to outstrip demand or the need for this kind of thing. Hopefully, that can help.

Mike:    And the nice part is that that becomes a close loop. Obviously, I'm biased from the fact that I'm member of the Carrick Institute with this functional neurology. And it's the same thing with what you guys are doing too. Client Bob goes in and works with their functional medicine person. They say, "Okay, we're going to do this and this and I really need you to really focus on your sleep," so they just make a note back to the trainer.

    They say, "Hey, this is what we're going to do. Can you help me have and take accountability of the compliance thing with Bob's sleep?" Or whatever it is. "Bob went and saw the functional neurologist. They got these three drills to do each day in the morning. Can you just make sure that they're actually doing drills?" Because that offloads the compliance portion from the other professional and then after a period of time, "Okay, Bob's been doing that 90% compliance," and then you know where to go from there.

Tommy:    Absolutely. This is a pretty good place to start to wrap things up. I think that's a nice summary of how things can and should work. Hopefully, more in this sphere as we try and get more and more people to be as healthy as possible. I'm sure people listening to this will be interested in either working with you or learning all about your work and the other places that you're affiliated with. What's the best way for people to do that?

Mike:    Yeah. The best way is just through the website, which is just miketnelson.com. There should be a way on there that they can contact with more information. All the updated stuff is on there also. I also have a certification, which is just flexdiet.com. That was just the way of putting together what are the top eight interventions, a little bit more on the nutrition, lifestyle side that clients or coaches can then run their clients through and then giving them information and then putting that into a systematic structure. It's everything from proteins, fats, carbs, some basic exercise, sleep, things of that nature.

Tommy:    Great. Absolutely encourage people to look through all of that because I know you have some brilliant resources available. Thanks, Mike. Mike T, this has been really, really fun. Thanks for giving us your time again.

Mike:    Yeah, thank you very much for having me on here, Tommy. I really appreciate it. It's always great to talk to you guys.

Tommy:    Likewise. Thanks.

[1:10:11]    End of Audio

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