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Understanding Sports Nutrition with Kira Sutherland

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Understanding Sports Nutrition with Kira Sutherland

How and what should elite athletes eat and drink, and what supplements are appropriate when preparing for competition?

How do athletes protect themselves from injury and maintain a robust immune response under the pressures of training?

Today we're talking to Kira Sutherland, an accomplished naturopath and sports nutritionist who is an expert at preparing elite athletes and weekend warriors to perform at their best. Kira brings a unique balance of clinical skills and personal insight to the practice of sports medicine, having herself competed in Ironman triathlons and other endurance events.

Kira takes us through the many nuances that exist within sports nutrition, why one size doesn't fit all, and how she blends holistic, naturopathic approaches into the traditional methods of sports nutrition. 

Covered in this episode

[00:49] Introducing Kira Sutherland
[03:34] Why sports nutrition?
[04:34] Sports supplement testing
[09:51] What should athletes be eating?
[13:02] Nuances of carb-loading
[18:07] Training: Men vs. Women's needs
[20:54] Circadian Rhythms & body types
[21:44] The role of glycemic Index in sports nutrition
[23:10] Matching macronutrients to sport or body type
[26:16] Master's athletes
[28:01] Options for injuries and recovery
[32:53] Supporting overtraining
[36:32] Meeting protein demands
[39:03] Salt and mineral demands
[42:17] Individualising hydration needs
[46:24] Not all sugar is evil in sports nutrition
[49:53] Final thanks to Kira
[50:25] A message from Dr Penny Caldicott from AIMA

Andrew: This is FX Medicine, I'm Andrew Whitfield-Cook. Joining us in the studio today is Kira Sutherland who's an experienced naturopath and sports nutritionist with more than 20 years in clinical practice and lecturing. 
She's the previous Department Head of Nutritional Medicine at one of Australia's leading naturopathic colleges and is currently completing her masters in sports nutrition. She's passionate about working with athletes of all levels and has a special interest in endurance nutrition as she herself competes in Ironman triathlons. 
Kira consults with private clients, as well as writing and speaking around the world on all things complementary medicine and sport-related nutrition. Kira also runs an online education platform mentoring other practitioners in holistic sports nutrition. And you can find out more about this at kirasutherland.com.au
Welcome so warmly to FX Medicine Kira, how are you? 
Kira: I'm good. Thanks for having me. 
Andrew: Now, we're going to be speaking about something that is, I have to say, quite alien to me. I am a rather sedentary older male. My younger years of volleyball and athletics have gone. I need to reclaim them. So, I'm going to get you to lead me. We're going to be talking about optimized sports nutrition for competition, but also talking a little bit about injuries and how to avoid them. So, I think first of all, can you take us all through where you began because you are a rather tall lady. 
Kira: Yes. 
Andrew: So have you always been in triathlons or have you done other sports as well? 
Kira: So, growing up, I was heavily into skiing, volleyball, mainly basketball and swimming. So, kind of, I basically played any sport that was offered to me, you know, as much as I could, and coached basketball even as a teenager. That was like my high school job coaching little 7th grade girls. And so, always involved in sports, very sporty. I've come from a very sporty dad and unsporty mum who wishes she played more sport, but didn't. And, yeah, always continued doing lots of sports. 
And then I hit my late 20's and that's when I heavily got involved in triathlon. I've never competed at a very super high-level or anything like that, I didn't really focus on any sport enough to do that, but triathlon got me in ultra running and all kinds of endurance sport, which then, as I was already a practitioner by my mid-20s. So, it kind of led me down the road of working with athletes and sports nutrition because that really wasn't involved in studying naturopathy when I went through. 
Andrew: You base your practice around nutrition a lot. 
Kira: Yes. 
Andrew: And there's a pointed reason behind that. Can you take us through that? 
Kira: Yeah, well. So, I'm a naturopath and I love my herbs and I love, you know, all things naturopathy, but with sports nutrition, it becomes very food-based first. Because if you're not fueling a body properly...as a girl, to use a car analogy, it seems funny, but you do you have to fuel the body properly with those macronutrients first. 
So, I do become very macronutrient-based because if you're not getting those right foods in first, you're not going to perform. You cannot get there. Uou can't recover. You know, adaptation starts to struggle for different sports. So, always food first and then I'll add on nutrients sometimes later or herbs. But it also depends if you're working with a person just trying to run their first 10K or marathon, I can give them anything I want. Or if I'm working with a high-end, drug-tested athlete then your hands are tied to almost anything but foods. 
Andrew: Can you take us through the testing that Australian supplements have to go through, where they fail with regards to sports? What are the extra things that would be required to satisfy, you know, elite sport, elite athlete? 
Kira: Yeah. So, the way we test in Australia, you know, from our debacles in the early 2000's. Which I was a practitioner when that all went down and there was problems with supplements and pharmaceuticals. The TGA actually is doing a phenomenal job of keeping our supplements very clean. We're considered in Australia to have some of the cleanest, most thoroughly tested supplements in the world as far as I'm aware, and from what I understand through research and talking to other practitioners and professors. 
So, there's TGA testing of supplements which we're all aware of as practitioners. But then when you work with drug-tested athletes, there's a whole other...well, there's two other sides to this. There's supplements or constituents or things that are specifically banned like drugs, and steroids, and amphetamines, and things like that. So, there's that issue. And then, there's the issue of, even if a supplement doesn't contain something that's banned, it doesn't mean it's a safe supplement for an athlete that's drug-tested because you have the issue of contamination. 
And so, we now, luckily in Australia, and starting to be around the world as well. We have third party testers. Where after you go through all your TGA testing, you can also send your supplements or certain supplements to third party testers who are going to put it through screening of, I think, it's around 300 or 400 specific substances that they're looking for as a banned substance. Just to make sure there's no contamination going on from the manufacturing process. And then that supplement, if it goes through all those tests...and they have to test every single batch. So you have to send a certain...They test, I think, three separate batches first before they get the seal of approval, and then you have to actually get every batch tested. 
And so that's quite expensive for supplement companies to do. So, even if companies are doing it they're only testing a few products, but they're considered safe in sport. And that's a big process, but we finally have this over the just the last couple years. Whereas, before this, you know, 20 years of clinical practice I didn't have supplements I could legally...well, I couldn't safely use, because you never know if it's contaminated or not. And I'm not willing to risk my career and I'm not willing to risk a two-year to a lifetime ban for an athlete. I don't need to. 
Andrew: No, that's right. 
Kira: No supplement creates such an enhancement of performance that it's worth a ban. 
Andrew: So what do practitioners need to know about it? Just basically hands off with supplements in elite athletes? 
Kira: In my opinion, yes. You always want to be safe. Like I said, it's not worth your career, it's not worth their career. You don't want to have to use your insurance. 

So, really, unless it's been approved, unless it's that third party approved. And at the moment, in Australia, we have two companies. We have HASTA and we have Informed Sport. And those are the two companies, at this point, that I know, that are doing that third party testing. And unless it has that actual seal of approval, it'll be on the actual packaging, I wouldn't go anywhere near it. Nobody needs vitamin C that badly or herbs that badly. 
Andrew: So, even if it was not on the ASADA list, if it was approved by...Who was one of the one of the...? 
Kira: HASTA or Informed Sport. 
Andrew: Informed Sport. So, if it was approved by Informed Sport they could still take that supplement? Is that what you're saying? 
Kira: Yes, they can take it. Yes, absolutely. And there's, you know, probiotics, and zinc, and vitamin C... 
Andrew: Magnesium, electrolytes.  
Kira: Magnesium. There is now magnesium that's been tested, supplements. You know, a lot of protein powders, you definitely want tested. And the big thing, to go back to the international issue, is certain countries don't nearly have the regulations like we do with the TGA. And so, certain countries, who shall not be named, have very poor record of contamination... 
Andrew: With whey or milk. 
Kira: ...or purposeful contamination. You know, if I... 
Andrew: Baby food. 
Kira: ...accidentally have extra stuff in my whey that makes it work better, you know, I'm going to sell it more because it's not about the athlete it's about the business. So, yeah. 
Andrew: Yeah. So, for athletes, make sure that it's got the correct approval. 
Kira: Yeah. And just because it's not on the banned list, doesn't mean it's safe. If it's on the banned list it's not banned but it doesn't mean it's not contaminated. And that's a big difference and I spend my life on blogs and things kind of clarifying that for practitioners and just calling a company. I've had this multiple times people are like, "Oh, I called such and such company and their hotline practitioner said it didn't have any banned substances." And I'm like, "Yeah. Well, that's great."
Andrew: That's not going to stand up in court. 
Kira: And the other problem is, you know, if athletes test positive, did they really purposely take something or not? They often won't...Yeah, there's a whole controversy of did they really take anything or not? Are they going to even admit that are they going to blame...? The easiest thing to do would be to blame a supplement. I'm not saying people do that, but it has happened. 
Andrew: Well, pass on blame. 
Kira: Yeah, absolutely. 

Andrew: Yeah and deflect blame.

Kira: And I don't need to be that scapegoat. No practitioner does. 
Andrew: No, that's right. 

About the eating guidelines for athletes. Now, you know, we have so much marketing, TV marketing rammed down our throats for sponsorship stuff. What really should we be learning about the real health of nutrition for athletes? 
Kira: Look, it really depends on what sport someone's doing. You know, if you've got a strength sport, if you have a power sport, if you're doing endurance sport? You know, sometimes the nutrition is different for each sport . 

But the big thing I focus on with athletes is recovery nutrition. So, getting in your macronutrients in the right ratios for whatever sport you're doing right after training. There's all these theories around, "Do you have this window of opportunity to get your fueling in?" 
And it's a little bit controversial, but if you go back and listen to most of the professors talk about it and the research, you know, there are these better windows of opportunity of properly refueling within an hour of training, let's say. And, yes, sometimes the window can actually be two hours, but in reality, you'll hear all the professors in nutrition say it's about eating as soon as possible to get the fueling process started... 
Andrew: And would this be weighted towards protein to aid in that amino acid thing or is that whole balance? 
Kira: No, it's often around carbohydrates after training. And the big controversy over the last decade is everyone's carb-phobia. And then, it depends on… nutrition after training really depends on what your goal of the training is and where you are in your season. So, I'm going to talk endurance because that's my real specialty. 
So, often you have people that are exercising twice a day. And how you need to fuel someone after their first session in order to really get them going for their second session later in the day, you're going to have a bigger carbohydrate focus. And you will always have...not always, but you'll often want protein right after training as well. But they're doing two different things. You got the protein there for the, you know, supporting the muscle damage and rebuilding, but then you also need the carbohydrate for the glycogen replacement. Because that really is your fuel tank. And if you're not replacing that, you're going to run into trouble at your next hard training session.  
But there's also research now where you're picking certain times of the week, or of the day, in training, where you're purposely not replenishing carbohydrates in order to have a, what we call, a train low state. So, you're pushing the body for different adaptations in a train low state, but people are misunderstanding that. And I'm not anti-low-carb, I'm not pro super high-carb, I'm a 'middle carber'. 

It's about knowing when to be low carb and when to be high carb. Oh, it's a controversial topic. Ketosis, training, and... 
Andrew: Because you've just created a new tag, "I'm a middle carber." 
Kira: "I'm a middle carber." Yeah. Nobody doesn't like carbs. But it's about fueling at the right time, for the right outcome. And that's what we often don't study in naturopathy. We're not studying sports nutrition and fueling different styles of training. 
Andrew: Can I ask? And this is more of a… to get a question out of my head... 
Kira: It's all right. 
Andrew: ...that was taught to me by a lecturer. One of my first physiology, anat and phys lecturers. And he was questioning whether the, you know, immediate carb load before a race. And there was a lot of conjecture, very...Now, this is 30 odd years ago… 
Kira: That's okay. 
Andrew: And it was basically, does a Mars bar... I know, bad example, but does a Mars bar before a race cause an increase in glucose or a reactive decrease in glucose? 
Kira: Yeah. No, that's a great question. 
Andrew: What's the current thinking now? 
Kira: Well, Mars bar is kind of fat-loading too, let's be honest, right?  
Andrew: I know. That was an example. 
Kira: Yeah. So, you know, there's the whole idea...you know, carb loading came in in the '70s and it was really extreme and we were doing almost ketosis for a while, and then a super compensation phase. And it was very hard on people's bodies. As we all know we get very cranky when we're in first few days of ketosis. And we now know to do more of an abbreviated carb loading where we don't put people really low, we just, for the last couple days before an event, take up the carbohydrate and slightly drop protein, and fats, and fiber. And we get almost the same result. So it's much easier these days to abbreviated carb-load. 

Whereas, what you're talking about is ingesting something right before an event. 
Andrew: Yeah. 
Kira: And there is theories because there is what's known, you know, like a reactive hypoglycemia. And what the most of the research says and Professor Asker Jeukendrup, who's kind of one of the gurus of sports nutrition. He has done quite a bit of research on this, because this is where people will have a big hit of, you know, 15 minutes before starting a marathon, people will have a sports gel or a banana. They'll have around 25 grams of carb. Usually, they're doing carb, not Mars bars. Maybe that's you? 
Andrew: It was a bad example. 
Kira: Yeah, yeah. It's all right. 

So, you have that with some water. And the theory is once you start your race you don't tend to have these huge spikes of blood sugars and then a drop because of the hormone profile and everything going on with you actually starting to move. It will keep blood sugar levels more stable and the body will use that carbohydrate as fuel. 

But what it turns out is there are responders and non-responders to that. Or there are certain people who do get that reactive hypoglycemia. So, really it's about trialing it for yourself. But Asker's research over the last couple years is showing it's a lot more rare than we think to be one of those reactive responders. 
Andrew: Gotcha. And how would you differentiate? Like, do you think something like, you know, CYP testing, genetic profiling through SNP testing... 
Kira: Oh, that's really interesting... I haven't thought about it that way, you know, because the genetic testing is so new... 
Andrew: I really don't know if that's a good question or not but I just went, hmm?
Kira: No. Well, it's called trial and error. N equals one. Sports nutrition has its, you know, are there rules or are there guidelines? Really, it gets down to working with patients. There are guidelines and you need to trial and error them and play around with people's race nutrition, long before their actual race day. You know, the number one thing is you never try anything new on a race day right? 
Andrew: No, that's right. 
Kira: And it's amazing how many people do. So, you would get someone in a long...like say they were running a marathon and you wanted to know, weeks before their marathon, you get them to take a banana or their gel or you know my favorite, which is a bit more holistic, as you know, two Medjool dates has about the same quantity of carbs as a gel. Without… not quite the electrolyte profile. And you get them to trial that, so they have it 15 minutes before their run with enough water to help dilute it so you can absorb it quickly. And you see how they feel? 
And people with that reactive drop will feel really weak about 10 to 15 minutes into their run. And it's good to trial it in training, because you don't have all the hype and adrenaline of being in a race. Because often, people can feel quite weak and a bit nervy and anxiety, with a race. So that can often feel like a low, but is it a low? Or is it more their nerves in the beginning of a race? 
Andrew: The thing that would happen there also is that performance on that day, you know, your personal best or you're just not switched on, on that day. So, you'd have to do it like two or three times, I would imagine, to say, "No, that really doesn't work for me." 
Kira: Well, the people I know that have had that reaction, really know they've had that reaction. 
Andrew: Oh, okay. So, it's traumatic? 
Kira: So, most of the time with athletes you can kind of say, "Do you do this before? You know, "Do you eat before you go training or not?" That's a really good indicator right there, of how they're going to go. Some people will go, "No, I absolutely feel sick if I early-morning train with food in my stomach." And then other people are the complete opposite. They're like, "I absolutely have to eat before I train." 
And there is research coming out or, you know, people are looking at research at the moment that, you know, sometimes women are actually, we think, better off at having something small before training more so than men. And this is really new stuff. And there's not a lot of depth around it yet but it's a very interesting thing to look at. Because fasted training is such a hip and popular thing at the moment. And doing long fasted training which is going along with intermittent fasting, and ketosis training, and things like that. 
And sometimes, for women, you know, we're looking at a lot of research that's been done on men and we don't have that depth of research on women and we're starting to question, "Do they actually feel better eating before training?" 
Andrew: Why are there not more studies... 
Kira: I know. 
Andrew: ...specifically on women and timing around the period? 
Kira: There is more research happening now. Until the 1970s, there was almost no research done on women, especially in sport. But just in general. I think we had to invent the pill in the '50s before we actually started trialing women on stuff. But that's that's a general statement, that's not fact. That's a curious statement. 
Andrew: But the fact is that women are largely excluded from many sports trials, and yet we're supposed to extrapolate the results and apply them back to women. 
Kira: Yeah, there's some female researchers out there writing some great regular books. And there is also research actually finally being done on women specifically, their hormone cycles, and how they should be training, and how different it is between the follicular and the luteal phase, and where you're going to get your performance benefit. So that's a real space to look at. 
I think, statistically, I read, 39% of sport science trials, are done… women are included in the trials. And the reason we don't or we haven't included women for a lot of the years is because you would need to put them, you know, a lot of what people say is you'd need to put them on the pill to regulate how their performance is going to make it similar to men. But then what you're doing is you're really testing women and their performance on the pill, you're not testing women and their performance. Or their reaction to certain nutrients. 
So, it's tricky because if you regulate it, then we're not actually getting real results. And the problem is too, with a lot of clinical trials is you have such a time constraint for when you can actually do the clinical trial to wait and, you know, test a woman in her follicular phase, the trial is going to extend a lot longer time-wise, and often you don't have the funding for that. So, it just makes it too tricky to wait for every woman to get on to her follicular phase to do certain blood tests, and strength tests, and things like that. 
Andrew: The converse would be the assumption that men, therefore, have unwavering levels of testosterone. 
Kira: Very true. 
Andrew: Do men's levels of testosterone and other anabolic hormones have a cycle? So, let's say due to their circadian rhythm, and why is this not discussed?
Kira: Maybe… There is research starting to look at circadian rhythms, and performance, and different body types. You know, the ectomorph, endomorph, mesomorph is actually coming back. And we're looking at...there's research looking at how they perform differently depending on their circadian rhythms, depending on what quote...I can't think about what it's called. Body Type, it's not the right, you know, scientific term. 

We are looking at how their neurotransmitter were more dominant, certain neurotransmitters. Yeah, I was reading research on that recently which is kind of oh, my god, it's crazy. 
Andrew: Let's talk about glycemic index as a manager of diet, if you like. Is that something that you adhere to or is that something that you discuss or do you find it just gets too convoluted? And as you've said, you have got to do the N equals one. Does that work for you?  
Kira: Look, there is a place for it and it has progressed over the years between glycaemic index, glycaemic load, then there's people that are like, "Should we even be looking at this or not? Is this old school? You know, has that been put to bed now altogether?"  
With sports specifically, there is a place where you want fast digesting food. If you're in a recovery phase, post-training, and you have more training to back up for four or six hours later. There is a place where you want readily digestible food. So, you know, there is a time where you're suggesting slightly higher GI foods because you don't want to inhibit the speed of absorption and utilization of, say, carbohydrates. 
So, sports nutrition still does use it to an extent. I don't really talk…you know, if we're looking at my clients, do I talk GI a lot? No, but I'm not letting them add avocado, and chia seeds, and tons of fibre to maybe a post-training smoothie, if I know they're going to back up five hours later with more training. 

Whereas, someone who's only training once a day, then we're going to look more at holistic nutrition and I'm not going to focus so much on that super-fast glycogen recovery. 
Andrew: To a great extent, various body types would be attracted towards various sports. For instance, you don't tend to get too many short people playing basketball. You don't tend to get too many tall skinny people, doing weightlifting. Certainly, not the heavy weights. 

Do you find that you really have to waiver the ratio of carbs, fat, protein, to this specific type of sport? Like, for instance, you know a weightlifter, big muscles, retention of muscle mass, particularly after straining those muscle fibers, and, you know, let's say leading to DOMS [Delayed Onset Muscle Soreness]. Do you have to make sure that you're providing them, you know, quite, what we would consider, a massive amount of protein to carbs, say? 
Kira: Yeah. Each sport definitely has its profile of carb to protein ratios. But then it is really dependent on body weight and body structure. So are they that big muscle mass-type person or are they the really lean? 

And also, if you're not working with the high-end athletes who usually are in specific sports for their body type, otherwise they're going to really struggle. If you're dealing with, you know, I want to say like Joe Schmoe, running a marathon for their first time. I have 110-kilogram men that want to run marathons, and I have 65-kilo-men that want to run marathons. So, they're both doing the same sport but they metabolically operate a bit differently. 
So, yeah, you know, sports nutrition it has its ideas and suggestions of carbs and protein. But then you really have to regulate it for their body type or their sex. You know, women tend to, you know, operate a little bit less carbs, sometimes women tend to get away with, versus the men. But we don't have that, you know, our metabolic rates aren't what? I'm a little jealous of male metabolic rates, at times. 
Andrew: Not of mine. 
Kira: It's also about exercise, right? 
Andrew: Yeah, that's right. There was that component. 
Kira: Yeah. So, it's very individual. But I do have my guidelines and, you know, the protein research over the last five-seven years is amazing. In our realizing our need for higher protein volumes is becoming...we're getting very specific with when we actually give protein. And there's research now of "Do you give it in three lots during the day or should you give it over six littler periods?" And especially protein at night, right before bed, for muscle adaptation and protein synthesis. 

There's some really fascinating stuff. And the RDA for protein is still very low...or it's not low it's what the average human has, you know, needs to stay out of protein deficiency. But we are now starting to have actual amounts for athletes come out and they're much higher than the RDA. And we are having research now looking at large protein amounts and is that causing problems with bones and all that stuff? And so, that's really, the mythology around some of that is actually being dispelled. 
Andrew: What about stage of life as well? Like, you know, at no time in history are you getting so many... 
Kira: They're called Masters athletes. 
Andrew: Yes, masters athletes. Thank you very much for the politically correct term. Doing these, you know, elite athletic performance things. Particularly, marathons, and ultra marathons, and things like that. What about the relative protein deficiency, and you know, the nitrogen balance versus the phosphate balance? If you're talking about bones. 
Kira: Yeah. Well, and a lot practitioners, and dieticians, and naturopath nutritionists are looking at, you know, when you take someone's protein levels up really needing to buffer it. And getting in, you know, the biggest thing is, getting all your greens in. And those large volumes of more alkaline foods, but we...there is research that came out in the last year too on the older we get the more protein we're needing for sports and for retaining muscle. 
So, the masters' athletes, let me just qualify to. I think masters athletes is over 50, but in the swimming world, I think you only need to be 25 to be considered a Master's athlete. 
Andrew: Oh, really? 
Kira: Yeah, each sport has a different regulation on that. And I was having a good chuckle that once you're over 25 you're a Master's swimmer. 
Andrew: You're a master? What a cracker?  
Kira: Because there's like Masters Olympics and stuff like that, right? 

There are actually, rumor has it, that they're doing more performance enhancing things than the 'elites'. 
Andrew: Oh really? They want to retain their youth. 
Kira: They drug test at Master's competitions as well. 
Andrew: They're the begrudging masters. They don't want to be 50. 
Kira: Yeah. So, we now know for holding, you know, muscle mass, as you age, protein needs are really going up. 
Andrew: When you're talking about performance, and injuries, and, you know, recovery. One of the most common conditions is DOMS; delayed onset muscle soreness. You know, a bit of achy pains for those people who may go for a run and we think, "Oh yeah, it's doing us good because we've just ripped the muscle fibers." Tell me if I'm physiologically correct or incorrect please? 
Kira: Yeah, yeah. 
Andrew: So, that you've just ripped a myofibral and it now has to heal, and you now then, well, that's what? The recovery...? 
Kira: That's muscle repair. Yeah, yeah. 
Andrew: Yeah, that muscle repair. Yeah. Traditionally, if we weren't in an elite athletic association or anything. Or we weren't beholden to anything. We'd just take some bromelain, and maybe a little bit of zinc, and perhaps a methylsulfonylmethane. So, we take some supplements and we might, you know, even take something like an aspirin or an NSAID. 

What can you do and can't you do when you're talking about elite athletes with regards to nutrition and/or can you use supplements it at all? 
Kira: Look, you can if they've been tested. You can use supplements, and this is also where you go food first. 

And a woman I studied with came out a year or two ago with a great article on muscle recovery and foods. And what foods actually, you know, the muscles responded best.  
So, delayed onset muscle soreness really peaks three to four days after that big damaging output that you've done. And this is where you're going to use pineapple, and you can use tumeric as a food, and ginger, and there's also a point, you know, and people do go for, you know, non-steroidal anti-inflammatories. But the problem is as well, part of the cascade in DOMS is, well, you've got this inflammation and then the body is repairing. There's theories on, do you actually want to inhibit that inflammation? Because the inflammation, if you block all the pathways... 
Andrew: Are you inhibiting repair? 
Kira: ...are you inhibiting repair? 

Andrew: Yeah! 

Kira: And that's always the big question there as well. And that's where I will go proper food first. And nutrients, you know, as long as you're using the core of the pineapple you're getting good amount of bromelain, turmeric powders, tart cherry is another one, and then people are also looking at pomegranate. 
Andrew: Oh, really? 
Kira: You know, high antioxidant or high phytonutrient food... 
Andrew: But food, not supplements. 
Kira: ...is where I go first because, well, it's safer, right. 
Andrew: Yeah, right. So, if you can take tart cherry as the drink? 
Kira: Yeah, there's research on that, yeah. 
Andrew: So you're allowed to do that, but as a supplement, in a bottle, you're not. 
Kira: Yeah. Well, the question is, is your juice tainted. I don't know? You know, it's the million dollar question. And it is a really tricky thing to have to look at. But there are starting to be, you know, drinks and tart cherry juice. Yeah, it's like using...I'm slightly changing the subject. But there's now research on using pickle juice for cramping. And they're starting to be produced…. 
Andrew: Pickle juice. Hang on. So, gerkin juice? 
Kira: Yeah. Pickle juice, like gerkin, like, the juice…and we're not…
Andrew: So, the vinegar? 
Kira: It's a vinegar, but there's a lot of salt, and you know, we're not even... 
Andrew: Nitrates? 
Kira: Yeah. And they're not even sure, in the research...I can send you through some of the papers. They're not… the minute the juice hits the mouth, it somehow releases the cramp. 

And they're using this in a lot of high-end rugby as far as...so I've heard. And for these chronic cramping people, you know, the whole idea of cramps is the million dollar question as well. Magnesium, calcium, sodium, dehydration? A lot of my clients cramp and it's really that they've changed their position on their bike and it has nothing to do with nutritional issues. But they, you know, famously pushed too hard in a race beyond where they've trained and then their muscles start cramping up and then they want to blame it on nutrition protocols and it's not. It's their own ego racing too hard. 
Andrew: But I do remember years ago I ran into some researcher at QUT who was doing work on cramps. And they were doing biopsies of the gastrocnemius. Like, there's a horrible test... 
Kira: Oh, yeah. I've seen... 
Andrew: ...because this is a troper, this is not a little...It's not fine needle aspiration, it's a hurty one. 
Kira: No. A professor I study under has a few, you know, sometimes you get caught out. He does a lot of weight training and he's a big build. And, you know, he's got a few scars on his thighs and gastroc and he talks about, yeah, you want to avoid muscle biopsies. 

You know, it's the big problem, too. Elite athletes don't want the biopsies because it's going to injure the muscles. Yet then we end up having to test on, you know, beer drinking university guys and people that need the money. So yeah, it's an interesting thing but, yeah, I won't be… I've seen the scars from muscle biopsies. I will not be volunteering for muscle biopsy. 
Andrew: What about overtraining? You know, we all want to perform better. There's that risk of going way too far, as you said and, you know, causing cramps and other deleterious effects, even injuries. 

How do you ward against overtraining? Where do you teach people about the limit? And how do you recover high-end athletes, at least? And, what about weekend warriors from overtraining? 
Kira: Yeah, absolutely. And you know, high-end athletes have whole governing bodies behind them, and physios, and strength and conditioning coaches. So, you have doctor… sports physicians and they have a whole team making sure that they're not going into overtraining or you know… There is a point where you are over-reaching and you need to for certain adaptation processes, but then they have to pull it back. 

So, the high-end athletes, as a practitioner, as a naturopath/ nutritionist, you're not going to see it that often but you will see it in your weekend warriors who are, you know, your type-A personalities who are, you know, running big companies and working really hard, and then they're waking up... you know, I had a client come in the other day and she said, "I'm training for this ultra and I had to get up at 3:30 in order to get in my long run before my kids woke up." And then I'm talking about her needing to have a smoothie after her run before she does… and she's, "I don't have time." I mean, it's like, "Well then, you're not going to have time to run later if you don't." You know. 
So, it's your weekend warriors are in a big problem with overtraining. And this is where, holistically, our industry is amazing. And we need to really focus on our holistic principles of health. Overtraining is about fueling properly after eating, fueling properly before eating, if you need it, or during eating. And it's about sleep, it's about rest and recovery. And athletes are shocking at getting enough sleep. Sleep and hydration are the two things people fall down on more than anything. 
And that's stuff we know. So, if you're a practitioner that doesn't specialize with athletes and you haven't done a lot of study on that, this is where you can come in with your holistic principles because they're still the same and they're almost more important. Because they are all going to have slightly higher cortisol and going to be very fatigued. And then, overtraining, unfortunately, leads to poor sleep quality. And so it's this vicious cycle of how to break that. And then we've got arsenal of our holistic tricks to use with people to hopefully get them back to a better place to be able to train harder. 
Andrew: But there's a real issue with supplementing during training, and then you'd have to have a certain graceful gap before any competition took place. So, any supplementation that you gave for beneficial effects, would that then be negated by that gap that you have to give them before competition or do you...? 
Kira: I go for it anyway because you're just trying your best. And often, people don't give you enough time. So, you're, you know, you're throwing everything at them in the hopes that they are doing better. And hopefully, they have come in before they're in that really bad place. 

But one of the things I see a lot with athletes is immune suppression. You know, because training strengthens your immune system, it actually works better. But it does also suppress it to an extent. And what a lot of people don't understand is it's not just about supplements for the immune system. How you fuel your body with your macronutrients and your timing of fueling around sport goes a long way to keeping cortisol levels low and to supporting the immune system. And there is whole ways to look at your nutrition to support the immune system as well as nutrients. But people dig themselves holes and then they keep training while they're sick, which is my pet hate. 
Andrew: You mentioned whey earlier on and the issues with, you know, whey that's sourced from overseas. Australia, as you say, you know, has a very good reputation for supplements, but then whey is the food? So, how does this sit? 
Kira: How's my naturopath field with that? Yeah. So, if you are a not allergic, sensitive, whatever word we're going to use. You know, everyone has… anyway, reactive. 
Andrew: It's intolerant, it's not allergy. 
Kira: Yeah, intolerant. Yeah.  
Andrew: Allergy is IgE, by definition. 
Kira: Yeah, yeah. Absolutely. But I'm just saying what the clients come saying. You know. And so with intolerances, you know, if you're intolerant to something, I'm not going to make them have it. We have a lot of other protein powders accessible these days. We've got hemp, and pea, and rice protein and you have your bevvy of more vegan or vegetarian-style ones. 

But in the research, so let's leave intolerances aside. Because that's an individual thing with each of your clients. Intolerances aside, whey protein outperforms other protein powders. Whey protein outperforms most other proteins in studies for sports nutrition. So, whey does have its place, if there is no intolerance with athletes. And it makes it very easy. And, you know, recovery smoothies when people don't have time are fantastic. And, you know, there's this whole controversy of are people overeating or under eating protein? And a lot of athletes are under-eating protein and it's an easy way...you know, the RDA for protein is like 0.8., 0.75, 0.8. Many athletes, you know, the ranges for how much protein they need average between 1.2 grams per kilogram of body weight, all the way up to two. Recommendations are in this huge, huge... 
Andrew: So a minimum of 30% above the RDA? 
Kira: Yeah. And we're starting to finally have research with set amounts for athletes. And there was research that came out, I think was just last year, on if your whole body training, taking in a larger volume of protein, like 40 grams. These are for specific men in this research. But they were looking at a 40-gram bolus of pure protein versus if you're only training smaller parts. So, it's a leg day, then 20 grams of protein in that post-training meal being sufficient. 
Andrew: And so it even varies depending on which muscle group they're training? 
Kira: Yeah, absolutely. 
Andrew: My god. 
Kira: So, whole body training has this much higher requirement. That's research that came out last year. 
Andrew: So, this is really nuanced? Oh my god. 
Kira: Yeah. Oh, sports nutrition is very nuanced. And it's why sometimes when practitioners take on sports clients but they don't have that understanding, you can have big holes in what you're actually telling a client to do because it's performance nutrition. Which...And then the other thing is...and I tell this to students when I'm teaching sports nutrition, performance nutrition, unfortunately, isn't always under the holistic nutrition guidelines. There are times where... 
Andrew: You're outside the... 
Kira: You know, you're recommending, you know, maybe not a coloured sports drink. But you're recommending, you know, high volumes of fast digesting carbohydrates or sugars if I can say the "S" word and... 
Andrew: What about the other "S" word? Salt. 
Kira: Yeah, absolutely. And salt is a massive one that they need. And I, you know, because I'm involved with endurance nutrition. I'm giving out salt tablets. I make them go buy electrolyte tablets which are super high sodium. There's events where people are on up to a gram of sodium per hour. 

Andrew: Whoa!

Kira: Yeah. If you're running, you know, Hawaiian Ironman... 
Andrew: Per hour of event. 
Kira: Yeah, yeah. Not a daily life. 
Andrew: Not training or anything, dang. 
Kira: Yeah, if you're in Hawaii and you're in a gazillion levels of humidity... 
Andrew: Yeah, or Death Valley, yeah. 
Kira: ...and 30-degree heat. For… you're racing for 9 to 17 hours… Sodium is the number one. You know, all the electrolytes are important, obviously, for all kinds of physiology. But it's the sodium that's the real crux. And in research it's what, you know, we know is absolutely the most vital. 
Andrew: Let's talk about salt. You're talking about elite athletes, what about people like weekend warriors? They have to be very careful of the amount of salt, not as high? Look at a more balanced salt, magnesium, potassium, calcium?
Kira: Well, I'm pretty good at supplementing magnesium. I'm just going to say that now. That's probably my favorite supplement is a good magnesium powder with lots of co-factors in it. 

But, no, if you have, you know, your Master's athlete running marathons and ultra marathons, they're in need of the sodium as well, maybe often to a similar level. The interesting thing with doing sports nutrition is you're looking at optimum nutrition, and you're looking at optimum performance. I'm not dealing as often with chronic disease. And so, it's a really different picture of the client that I'm working with. 

So, do I have a ton of athletes with high blood pressure on my books at the moment? I can only think of two. But they've become athletes after having heart attacks and all kinds of crazy stuff in their 40s. So, you know, there is a point where what elite athletes do, your weekend warrior, depending on what events they're doing, they have to do similar stuff. Not to that level because they're not racing as hard. You know, they're finishing in 16 hours not 9 hours. 

Andrew: Right. 

Kira: But if you're out there for 16 hours, your nutrition is more vital than the 9-hour. 
Andrew: And the water as well. 
Kira: And the water as well. And hydration is a huge thing, and the biggest issue is hyperhydration, not just dehydration. Everyone worries about dehydration but the biggest issue with your weekend warrior is over hydrating and then depleting blood sodium levels, and potentially, leading...Our incidence of hyponatremia in endurance events is on the increase. And it's not the elite athletes it's on the increase with it, it's the weekend warriors that go out and they have no idea about their sweat losses per hour, and they chug down way too much fluid without enough sodium. 
Andrew: Because they're scared of fluid losses. 
Kira: They're scared of it. And every few years, there's somebody dies in a marathon or an Ironman because they have literally water-logged themselves. 
Andrew: You know, I spoke with Professor Tim Noakes about it
Kira: Yeah. Brilliant. 
Andrew: He was saying, you know, nobody ever died of dehydration. I'm like, "Really?" 
Kira: You collapse first. 
Andrew: Yeah. However, it wasn't too long ago, we're talking December 2017, January 2018, somebody died in a marathon. 
Kira: The problem with dehydration is you lose temperature control, you know, or thermal regulation, if you want me to be scientific. Sorry, I'm quite the lay persons when I speak to people. I'm too used to talking with clients.  
Andrew: Which is temperature control? Yeah. 
Kira: Yeah, temperature control. 

So, you know, if you were swimming in the ocean, and that's colder than your body temperature, and your dehydrating, you're going to start to lose body temperature and you have hypothermia. But if you're in the heat, i.e. Australia, every day except two months of winter. You have, you know, heat stroke issues and all kinds of stuff. So, somebody's collapsing might have been...and I don't know that story, I was too busy skiing but... 
Andrew: Fine. 
Kira: Yeah. But you've got heat stroke, getting too hot, you know, all kinds of stuff. But you also have the issue, as Tim Noakes has written, a whole book called "Waterlogged," the recommendations of how much to drink. His book on waterlog is about the American College of Sports Medicine, I think it was them, their recommendation was too vague and people were misunderstanding it and over hydrating and causing problems with hyponatremia. Which can also lead to hospitalization and death. 

So, there's that fine line between how much you should drink. And when I was doing my graduate diploma in sports nutrition, my final year project/ research was looking at guidelines of how much to drink in marathons and what should we be actually suggesting to people to drink or not. And it's really around education because we're all individual. I've had clients who...So, one of the things to do with clients and everybody should do this if they're working with athletes is to get them to go out, you weigh yourself naked before training on a digital scale, write it down because you'll forget. Go out for your one hour race pace. If you're a runner, you go out your one-hour race pace. Don't drink or at least measure what you drink. Come home, dry off, weigh yourself again. And yes, there's a 10% variation, we know that because you've lost glycogen which is body weight as well. But they say and the IOC says it's close enough. However much, so say you lost 700 grams, that's the equivalent to 700mls of fluid you need per hour. 
And you wouldn't think it would vary that much between people but I had three 80-kilogram men that were all different ethnicities. And they were doing a 24-hour endurance race. And so I made them go to sweat tests at night, in the day. One of them lost 400mls an hour, and another one, same body weight, not same body type, 1.2 litres an hour. 

Andrew: Whoa!

Kira: So, had I said 800 mls an hour… 
Andrew: Three times, 300% difference. 
Kira: And they were going the same pace, right? Because they were running together. So, had I said 800 mls, I would have hypohydrated and I would have hyperhydrated somebody else. And that's how individual sports nutrition is. 
Andrew: N equals one is the message of today. 
Kira: Oh my god. It's crazy.  
Andrew: And we talk about, you know, how we shouldn't be lumping all proteins together, all fats together, all… you know, the whole dietary issue. Fat does not equal fat. So, when you're talking about sugars. Now, you get dextrose, sucrose, fructose, maltodextrose, which I've seen in one endurance thing and very smartly labeled as a...was it a slow release carbohydrate? 

Kira: Yep, yep. 

Andrew: I think it was the... I've also had that question. Some people time maltodextrin is actually very quickly absorbed. What's happening? 
Kira: So, again, Professor Jeukendrup, Asker Jeukenrup, if you go on...I think his website, you can just Google him or mysportscience.com, I think is his website. He has incredible infographics. I actually use them a lot in teaching because you can purchase them as a teacher to use. But he has incredible infographics on specifically what you're asking about. And there are times where you want more fast digesting carbohydrates and there's other times where you want slower ones. And the whole fructose thing comes up because our industry is very anti-fructose, high fructose corn syrup, and people, you know, issues with the liver, and, you know, fat and all that stuff. I don't have time to go into that. 

But, in sports nutrition, now I remember I said race day nutrition is not about perfect health nutrition. 
Andrew: Yeah, it's about performance. 
Kira: Race days are performance. And, you know, people drink...I'm not saying I'm a fan. But do people drink soda pop...you know, Coca-Cola, at the, you know, in marathons? Absolutely. Because they're looking for a flavour change, a sugar hit, and a caffeine hit. I know it's bad for them, but I'm not… that's what people do. 
So, with the different sugars, there's actually research on...And in sports products, sometimes they're made just maltodextrins, sometimes they make glucose, sometimes you're going to see glucose and fructose together. And our industry will go up in arms and say, "Absolutely not. No." And there are products that are specifically marketed that they have no fructose, which can be great. But we know that through the gut lining, so when you're racing you want easily absorbable sugars. And maltodextrin is absorbed very quickly through the gut lining because of its molecular structure. But what we now know is you have 60 grams an hour of glucose that can go across your gut lining. You know, through… And fructose goes through a different absorption pathway than glucose. And sometimes, in endurance sport, you're trying to get in more than 60 grams an hour of fuel. 
Andrew: So, you need that active pathway. 
Kira: And so there is research on using what's known as...you'll see it in sports literature, 'multiple transportable carbohydrates'. And you're looking at giving different ratios of different carbohydrates because you have a saturation of certain, you know, pathways, that you're trying to bypass to get in up to 90 grams an hour. But, you know, these are your guys doing the Tour de France and things like that. 
So, there is sports products that will contain both and we all react to different things. So people go, "Oh no, fructose causes all these gastrointestinal issues, you're going to have all this trouble with racing." And again, N equals one. If your body can handle it, It's why you trial your race nutrition long before race day so you don't end up in the port-a-potties. 
Andrew: I'm amazed at your knowledge. And thank you so much for exploding so many myths that I had. That I've held on to for decades. 
For all of our listeners, Kira's going to help us with putting some of these papers up on the fxmedicine.com.au website and we'll certainly put your website up there. So that they can contact you and learn more, so if they're treating or want to treat elite athletes or indeed become involved themselves. 
So, thank you so much for joining us on FX Medicine today. 
Kira: It was good fun. It was exciting to come.  
Andrew: This is FX Medicine. I'm Andrew Whitfield-Cook.

Additional Resources

Kira Sutherland
TGA - The Therapeutic Goods Administration (Australia)
HASTA - Human and Supplement Testing Australia
Informed Sport
ASADA - Australian Sports Anti-Doping Authority
Professor Asker Jeukendrup

Research Explored in this podcast

**Coming soon, check back soon. 


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