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Sports Naturopathy: Working with Athletes in Naturopathic Practice with Dr. Damian Kristof and Kate Smyth

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Sports Naturopathy: Working with Athletes in Naturopathic Practice - Dr. Damian Kristof & Kate Smyth

Former Olympic and Commonwealth runner, Kate Smyth shares her knowledge on supporting athletes using naturopathic medicine with us. Combining on her own personal experience with her naturopathic knowledge, Kate and our ambassador Dr. Damian Kristof, discuss the challenges athletes face in maintaining nutritional adequacy when following specific diets relevant to the different sports and demands placed on their body.  

Iron deficiency, B12 deficiency and insufficiency protein or carbohydrates are challenges that may present, along with amenorrhoea and poor gut health. Kate shares with us how she supports her clients to remain healthy and support their performance.  

Covered in this episode

[00:09] Welcoming Kate Smyth
[01:15] Defining who is considered an athlete
[02:37] Qualifications for sports naturopathy
[04:46] Advising different types of athletes
[09:08] Targeting nutrition for the type of training 
[12:27] The importance of protein
[14:54] Iron and B12 deficiencies in athletes
[18:39] Malabsorption and digestive issues
[22:37] Supporting through injuries
[26:16] Amenorrhea in athletes
[30:07] Rapid questions covering 
[33:48] Thanking Kate and final remarks

Key takeaways 

  • Identification as an athlete depends on the individual, from a person who runs regularly in their neighbourhood to someone who competes professionally. 
  • Athletes are highly motivated people and may be challenged by balance in life as they are high achievers and may be burning the candle from both ends. 
  • It is important to tailor your approach to the circumstances of the athlete. It would be inappropriate to tell an athlete training to the Olympic games to stop training, however, bringing the athlete back to their performance goals and how to support these goals may support behaviour change. 
  • It is important to understand the daily, weekly, monthly training load of an athlete. 
  • Tailoring communication to the athlete’s health literacy and age is important, particularly when working with junior athletes. 
  • Sympathetic nervous system dominance may impact recovery. Encouraging an athlete to do more yoga or parasympathetic nervous system activity to support recovery will promote greater compliance than telling the athlete to rest. 
  • Sports nutrition varies for each sport. 
    • Endurance athletes (marathoners, iron men and endurance cyclists) require carbohydrate intake or carb wrap their sessions to support demand during training. 
    • Sports trail running athletes may benefit from restricted diets including the low carbohydrate diet and fat adaptation. 
    • Weight-based, powerlifting, power sports may benefit from the paleo or restrictive diet as thry may not need as much carbohydrates as other athletes. 
  • Plant-based diets for athletes is a challenge for high performance athletes to ensure that they are eating enough food to meet their nutritional needs, and they may need to eat a large quantity. 
    • Plant-based athletes may require support to understand how to combine proteins to obtain all amino acids in adequate quantities. 
  • Training on an insufficient diet may not present as a problem immediately, but inadequate B12 and iron can lead to deficiency and will impair performance and produce fatigue. 
  • Iron deficiency in an athlete can be a result of both a depletion and insufficiency. 
  • Gut health is a consideration in athletes. Hydrochloric levels, parasites and bacteria should be considered when looking for the cause of nutrient depletion. Nutrient absorption is a major consideration of nutrient depletion. 
  • Haemolytic breakdown in addition ot heavy menstrual flow may contribute to low iron in menstruating athletes. 
  • Iron can be lost in sweat in addition to other minerals. 
  • Endurance athletes are at greater risk of microscopic blood loss in urine or faeces and blood constriction, due to inflammation and friction caused by intense workouts. Marathon runners are at increased risk of blood loss in the urine following a marathon. 
  • Counselling athletes on moderation in the diet may ensure compliance and reduce the risk of over/underconsumption of certain foods.  
  • Supporting athletes through nutrition and naturopathy is about returning them to balance, or homeostasis as they are pushing their body beyond its limits regularly.  
  • Amenorrhoea is prevalent in certain sports, in particular endurance sports. Supporting and educating menstruating athletes to understand the importance of hormone regulation, including the risks of missed cycles to bone health later in life. There is evidence to suggest that the performance of female athletes may benefit with hormonal peaks as part of the natural cycle. 
  • Athletes can experience Relative Energy Deficiency in Sports (REDs) or disordered eating. Identifying the need to refer or bring in a practitioner from a suitable modality is important when supporting these athletes. 
  • Turmeric, boswelia and fish oil are beneficial for inflammation in athletes. 
  • An athlete that has had a recent viral infection may benefit from vitamin D, zinc, vitamin C, reishii and shiitake mushrooms both through dietary and supplemental sources. 
  • Sleep is essential to support an athlete’s performance, with requirements between 10-11 hours per day. 

Related Resources

Kate Smyth
The Athlete Sanctuary
Australian Institute of Sport
What is Relative Energy Deficiency in Sport (RED-S)?


Damian: This is FX Medicine bringing you the latest in evidence-based integrative, functional, and complementary medicine. I'm Dr. Damian Kristof, a Melbourne-based chiropractor and naturopath, and joining us today is Kate Smyth, a sports naturopath, holistic health and performance coach, guest speaker, and director of the Athlete Sanctuary. Kate now runs a holistic sports practice designed for female athletes who thrive on challenges. She provides support to sportswomen competing in endurance events, professional team sports, and wild adventures through a balanced health, holistic nutrition, and female-centred approach.

Kate developed her passion for health during her career as an elite runner competing for Australia at the Olympic and Commonwealth Games. And in 2008, she held the fastest time in Australia in the women's marathon and is one of our all-time fastest women over this distance. I want to welcome you to the show, Kate, it's so wonderful to have you on FX Medicine. How are you?

Kate: I'm great. Thank you very much for having me here. It's great to talk to you today and share a bit of insight and a bit of a passion into supporting athletes. So thank you very much for having me.

Damian: Kate, it's such a unique space to work in. And a lot of people have an athlete in their practice, whether you're a naturopath, a chiropractor, a herbalist, an integrative GP, there's an athlete. Whether it's a middle-aged male in lycra, a MAMIL, or whether it's the weekend warrior out on the road. Or whether it's somebody playing netball, or rising the AFL or AFLW ranks, someone's got an athlete in their practice. And I think that everybody who's listening to this today will be excited to learn a little bit more about what they can do to help these people out.

Kate: Yeah, and look, I think it's good to pause and think about what really is an athlete? And it's not necessarily someone...sometimes we can label them as, oh, they're elite. But it's actually just someone who's really passionate about their exercise and fitness. And perhaps they're competing, but perhaps they're not. And I find it's quite interesting as to who identifies as an athlete. And a lot of the time, some people also don't identify as athletes, but they're still doing at least 10 hours of exercise a week. They're pretty committed to the cause.

So we can deal with all kinds of athletes in our daily lives and clinical practice from, as you say, someone who's running around the block once or twice a week, to someone who's fully committed and working towards a major, major sort of event, or a goal that they want to accomplish.

Damian: Yeah. So true. So true. Let's maybe delve into this a little bit because people are wondering, "Okay, so can you just hang up your shingle and call yourself a sports naturopath?” Is that something that you can do? Or should you go and get some further qualifications and do some further training and coaching?

Kate: I think potentially you could if you had a really strong background in sports naturopathy. I think where I came into this line of practice was really because I wanted to focus on supporting athletes. So I did go and do some additional training. I am a qualified athletics coach. And I have come up through several decades of being an athlete and done additional sports nutrition training. 

So it's not like straight out of college you may feel you have enough to specialise in sports. But I think as a naturopath, generally, if we've done a degree in naturopathy, we've covered most of the basic principles of balance and health and well-being. And they really beautifully lend themselves to all athletes, because by far I find those that are highly motivated, they have an issue with balance rather than motivation. So they're not always but typically A type Plus Plus Plus, and they're not trying to achieve in their sport. They're high achievers in life, so they tend to be burning the candle at both ends with a fair amount of gusto.

So sometimes just helping them to take a little bit of a rain check on how much they're jamming into their lives, is as much as we need to give them, because they're really good at, as I said, motivating and exercising, but often it's about the right mix, the right balance. And then fuelling and actually looking after their health so that they can achieve those goals. Because they're very focused on the exercise, not always on the lifestyle and the general principles of overall health. As naturopaths that's our gig, right?

Damian: Yeah, yeah, that's right. We help bring people back into, let's call it homeostasis, for want of a better word.

Kate: That's it. Yeah.

Damian: Or balance. So just thinking about that, Kate, I mean, how does an athlete who's an A Plus Plus Plus, type, how does that person handle you saying, "Hey, cool your jets, let's get back into balance. Let's not burn the candle at both ends?" What sort of athlete is coming to you and is going to accept that sort of advice?

Kate: So it really depends on the level of athlete that I'm dealing with. So those that are in high-performance, i.e., they're trying to get to the Olympics or World Championships, then it's a different kind of language because we're trying to meet their performance goals. So the way that I may language that would be around, "This will help your performance. Do you realise that the overall balance within this approach is perhaps lacking in some of the support that could actually make you perform better?" And I go through the wave of training as well, because typically, they will be in a scheduled system that will give them a training block, and then active recovery as well.

So they'll have some kind of periodisation to their training. And in some situations, that is also broken down into a weekly basis. So I always start the conversation around what they're training for. What is their training load? What is their daily load like? Because one athlete might be doing one session, another athlete might be doing up to three or four sessions a day. So we've got a huge variance in terms of load that an athlete is going through.

And then it also is very age-dependent. A junior athlete, you may be able to have a conversation around the basic principles of fuelling their body. But you're not going to go into as much detail or technical conversation as you could with a mature athlete who knows their physiology, who really is right into their thorough understanding of Krebs cycle with all the detail.

It really depends on the athlete. But I find, if we're having an issue with recovery and rest, I go back to the basics, again, of sympathetic dominance and parasympathetic nervous system. And when I can explain the two sides of the coin, their ears prick up and they go, "Ah, I get it. So if I did actually do some more yoga or parasympathetic-based activity, I'll find I recover better. Therefore, the next day, I can actually perform better in that session or that game, or whatever it is.” And then over time, I describe it a little bit like building a book. So a session or an event, it's just one page in their book. And it's the consistency and the building blocks over time that gets them to their career peak, over many, many years. So it's not even what they're doing on one day, it's the little thing that they're doing frequently, which again, gets back to basic principles of naturopathy. It's just those little things that can make a huge difference if we do them repetitively over time. 

But I do find telling an athlete who is fully committed to the cause, to just have a rest and take a holiday is a bit of a dirty word. So we've got to...instead of having a complete rest and take time off, it's more about let's see how we could change the load. Let's see how we could adjust this balance. And that's the kind of language I tend to use rather than, "Stop, you can't do this. This isn't good for you," because that is quite difficult for an athlete to digest.

Damian: Yeah, totally. I can imagine that it would be, and some of them might actually feel like it's a bit of a fail. If you're listening to this right now and your ears pricked up about sympathetic and parasympathetic dominance, remember that I interviewed Dr. Wayne Todd on FX Medicine a few months ago. And if you want to go back, we talk all about sympathetic dominance, the SD protocol is what he calls it. Learn about all of that because that'll be relevant with what we're about to talk about with Kate. So there's some more information for you to get.

So Kate, coming back to you. If when you're building somebody's nutrition or naturopathy package up, are you doing a diet analysis? Do you look at their diet? I mean, are they doing high carb these days? Are they being keto? Are they being paleo? Are they now drifting back to vegan? What are people doing? And where do people tend to go wrong with their diet?

Kate: Yeah, that's a huge topic unto itself, that one, the nutrition side of things. And I find that it's different for every sport. So the endurance athletes, I tend to work mostly with marathoners, iron men, and endurance cyclists. So that sort of modality tends to be well across the carb side of things. But then there's newer sports, trail running for example, the ultras, where the more restrictive dieting has become quite popular. And I think we have to really be careful.

Damian: Like what? What diets are they doing? What are they doing?

Kate: For example, low carb, the idea of fat adaption, which, to be honest, you can get away with when you're going at very low intensity running for a long period of time. However, a marathoner that's doing road running at high performance will not do so well, because they're actually running a marathon at 320 to 330 pace for a female. That's pretty much for full pelt the whole way along, it's not six minutes pace.

Damian: That's unbelievable. 

Kate: So when we talk about nutrition, it has to be so tailored to that individual, to their training needs, and to what they're trying to achieve. So some of the more popular things that we would all be well aware of is, paleo and restrictive diet. Which you can definitely do in more weight-based powerlifting, power sports, you can do that, because you're not necessarily needing as much carbohydrate. But in endurance things, I still find that athletes do much better if they have the sufficiency of carbohydrates, or they're at least doing carb wrapping around their sessions. So they're having adequacy when they need it the most, and then perhaps reducing it at other times of the day, when they're...if they're only training once, well they're wrapping it around their morning session if that's in the morning. And then they can reduce their load of carbohydrates in terms of the total intake or budget for the day, so to speak, at another point in time, not when they're needing it the most.

And then if we're looking at things like plant-based athletes, that's become extremely popular. That's sort of the area that's growing the most rapidly at the moment. And I find that that is challenging, the further up the performance scale they're going, if you know what I mean.

Damian: I do.

Kate: Like, a recreational athlete could definitely get away with plant-based eating, if they are well educated. But the higher performance levels definitely do not have as many plant-based eating athletes simply because of the demands. It's so hard. Most elite athletes are eating anywhere between five to seven times a day decent amounts of food. It's just, you literally would be just eating continuously to get the right amount of nutrients in. 

Damian: Yeah, how do you get the plant-based athlete to understand the importance of protein? And then the next question following up from that, are plant-based proteins enough?

Kate: Well, that's a really good question. I think that's where we're well placed to educate them on things like protein combining, and explaining the simplicity of okay, you're choosing not to eat red meat, here's the equivalent in plant-based foods. And it might be a palm-size of chicken, for example, you need at least two to two and a half if you're having the equivalent of plant-based proteins. And explaining the combination of the amino acids that are in plant-based foods, so they would at least get some of those building blocks in.

And it's surprising still, how athletes can get away with plant-based eating for at least 6 months to 12 months before they'll even show signs of deficiency. But once they do, once the B12 starts to tank, once the iron starts to tank, then they really notice a difference in their performance. But, the thing is that they can actually get gains initially because they often lose a bit of weight and they can actually feel and train better within their bodies. But then it's a little bit like a leaky balloon. It just slowly, slowly catches up with them. And then at some point, they go, "Oh, I feel tired and I don't know why. I haven't changed anything for six months.”

Damian: Aha. Yeah.

Kate: And that's when we may decide to run some pathology and go, "Well, actually, that makes sense. You haven't had anything, you haven't taken in any iron-rich foods or B12," if they haven't been deliberate about their eating. And I think that's where plant-based eating... And I did it myself as an athlete. I did a block of being vegetarian and strictly vegan for quite a period of time. But, I did absolutely supplement. And I absolutely did have to have a nutrition plan to keep me focused. Because the iron, as well...

Damian: Yeah. You can't wing it.

Kate: ...in plant-based foods, you need so much of it, and then you've got the phytates and the oxalates that then compete, and then… So it's a bit more complex. Yeah, a lot more complex.

Damian: It's a lot more than just boiling your spinach. It's more than just boiling your silverbeet.

Kate: Yeah, yeah.

Damian: Yeah, absolutely. Kate, let's go into that because that's obviously and clearly a passion of yours, and then we'll come back to other stuff in a second. So while we're talking about macrocytosis and microcytosis, why don't we talk about what happens when an athlete becomes depleted or insufficient in iron, or becomes insufficient or depleted in B12? What are the things that go wrong? And is it possible to restore it, can it ever be fixed?

Kate: Yeah, absolutely, you certainly can. And I think there's two sides to what we're talking about. Well, there's many sides. Because we've got to actually identify is this actually just a depletion or an insufficiency going into the body? Or is there, in fact, other things that are going on? And I think sometimes with plant-based athletes we can assume it's their intake. What I tend to find in clinical practice is that there can be underlying issues associated with that individual's gut health. 

For example, if the hydrochloric acid over time has downregulated, they perhaps have been in environments where they have been exposed to other pathogens. And because of that, I kind of liken the hydrochloric acid as a bit of a...or it is one of our first lines of defenses, but it's a little bit like the doors open and so other pathogens can come in. And I find plant-based athletes, their gut health often is frightful after a period of time. So they've got other things going on and they've got bacterias or parasites or H. pylori, that is actually also some of their nutrient depleters. So we can have a bit of a combination that's going on, it may not necessarily be intake. 
Then depending on their actual activity levels and their sport, we can have haemolytic breakdown if they're women and they are heavy bleeders, obviously, we're losing blood. We're also losing iron, for example, through an athlete's sweat. There's a number of other reasons why an athlete can…

Damian: You lose iron through sweat?

Kate: Yeah. Yeah, you can. Yeah.

Damian: Wow. Wow. What? I always thought it was salt.

Kate: Yeah. And obviously, all of these are micro, these are micro losses that I'm talking about here.

Damian: Sure. You know, sweating blood.

Kate: But often I find, especially with endurance athletes, we'll find that they have a lot of microscopic blood loss through urine, urine and faeces. Because if they're doing intense sessions, their gut lumen can have inflammation and a lot of friction and constriction of blood flow as well. So we can get irritation that then leads to microscopic loss. And in some cases, it's not microscopic loss. Marathoners, it's not uncommon to see rusty urine. So they've actually had blood loss as a result of running 42.2 kilometres.

Damian: Yeah.

Kate: Yeah. And if they're doing long runs every week, they losing that every... If they're doing a midweek long run, it's every Wednesday and Thursday that they can actually see it in the toilet bowl. So it just accumulates over time. And I think we just have to, as practitioners, just gather as much information as we can about some of these subtle little possibilities of where an athlete may be losing iron, as well as ensuring that they're actually taking in as much as they possibly can through their nutrition, at the same time as looking after their gut health. It's not just more food. More food is not necessarily going to fix the athlete because it really is what they're absorbing, not what they're putting into their mouth.

Damian: When we go down that line of absorption, obviously, there's some clear things that we look at and we see as naturopaths and nutritionists and integrated GPs, we see a few things. And a few years ago, there was a really big push towards the understanding of gluten enteropathy and zonulin, and so on, and so on and so forth. Non-coeliac gluten enteropathy and coeliac disease, and then FODMAPs have become a big thing. And so, are these the sorts of malabsorptive profiles that you might expect to see with athletes? Or are we talking now about people who are putting their bodies into such significant stress that they're having malabsorption as a result of that?

Kate: I wouldn't make the correlation necessarily between the FODMAPs and the coeliacs with athletes. I wouldn't form that direct correlation. I think athletes who have any of those underlying issues will typically seek out additional help. So we may see them in clinical practice. I certainly do see them in my clinical practice, and that's also because I'm a coeliac, I think. But I think it's general gut inflammation that we can see more of that then impacts an athlete's absorption. I would probably say that's more of the case than necessarily pathology, so to speak.

Damian: Cool. Okay, cool. That's good. I think that's really good for the practitioner to hear because it's very easy to bark up a tree when you think of malabsorption. And you kind of go, "Okay, you got to be gluten-free. Okay, we're going FODMAPs. Okay, we are doing this. Okay, we're doing that.”

Kate: Not necessarily. No, no.

Damian: Yes, that's right. Yeah, I like it.

Kate: And I'd have to say probably 7 out of 10 of the athletes that come into my clinic, if we start with a general...if they've got issues with digestion, if we start on a basic gut healing protocol, involving all the goodies that we have as naturopaths to just help the mucosal lining, to just help those tight junctions, we inevitably find that the gut integrity improves and their ability to absorb their nutrients improve by doing that alone, without worrying about any other nasties going on. And what we're also doing is really preventing. We're preventing any further issues further down the track. But, of course, we rule them out if we're suspecting if there's a family predisposition or genetic line of coeliac, of course, you're going to rule that out but…

Damian: Well, there are other signs and symptoms, whatever else is going on. Using proper...

Kate: Other signs and symptoms, of course. Yeah.

Damian: Yeah, yeah, exactly. So, building up a full case history, just because it's an athlete.

Kate: Yeah, just because it's an athlete, I don’t... like I have athletes who do particularly well on dairy, and I go, "Great, okay, if that's your thing, that's fine. Let's just keep it in moderation and balance." Because that's the other thing with the A-type personality, if they jump onto one thing and think that's a good thing, sometimes they can feel that more is better. And it's all about just explaining, they don't necessarily have to have whey protein isolate protein powders every day. Use it sparingly. Use it when you really need it as a backup instead of using it as a major food group for a meal, why not have scrambled eggs on toast, for example? And I think also we can be...

Damian: Yeah, keep it real.

Kate: Yeah. We can be flexible in our approach, I think, for a lot of athletes. Because generally, they tend to be very healthy. Generally, you know. They don't necessarily have a poor health history, but they're pushing their bodies to a limit. And so we just have to realise that, okay, we just possibly need to rebalance and recalibrate them rather than treat them as if they're a patient with a chronic illness because they're not unwell, they've just gone over the edge, and they're pushing their bodies continuously daily. And it's about just making sure we bring them back into balance again.

Damian: Yeah, yeah. Great points and great advice there Kate, thank you. And I think that's really reassuring for all of our listeners, when we're thinking about the athletes. Okay, cool the jets a little bit, come back to naturopathic principles. 

So we're looking at diet, that's really important. And then we're looking at sleep and rest and parasympathetic tone and all these sorts of things. What else are you looking at? What are the sorts of things that you see athletes present to you within your practice on a daily basis, weekly basis? Are you seeing knee injuries, inflammation? Are you seeing rotator cuff tears? What are the sorts of things that you're kind of seeing that you end up managing? And how would you manage it?

Kate: Yeah, typically on the injury side of things, I find as naturopaths we're not necessarily the first port of call. We can be for chronic inflammation, joint pain, muscle cramps, for example. A lot of athletes are not necessarily great, I find, with their hydration or even just basic mineral loss like magnesium. So the cramping and the general aches and pains, I think, comes along with being an athlete. It's our clinical discretion, I guess, to be able to work out, is this just the athlete pushing themselves? Or is there actually a nutritional depletion issue here or insufficiency here? So not necessarily, again, a condition. It's more what are they depleted in?
And I find working a lot with females that outside of anaemia, yep, they've got aches and pains and sore muscles, and sometimes achy joints. But we also, especially if they're in weight category sports or endurance sports, we need to be very mindful of their body fat and cycle related to that. Because the amenorrhea tends to be quite prevalent within, certainly in certain sports. Not so much in the team sports, but definitely in endurance sports. And in young women, then we can flip into more the RED-S energy deficiency side of things and eating disorders that may come into part of that picture as well.

And I think as clinicians, we just need to not assume but just ask all those questions to see whether there potentially is an underlying issue. And then not necessarily feel that we're in the place that we need to treat them, but just pull the team together or a supportive team of clinicians who can then best support them. So as naturopaths, we're not necessarily the first port of call with eating disorders or RED-S, but we can definitely play a vital role in that team to support the athlete and get them through. 

On the other side with the women's health and the cycles, I find with a lot of athletes, they can sort of let it go, as though it's not a big deal to miss a cycle. And indeed, it may not be...

Damian: Just push it aside.

Kate: It's really common for women to miss a cycle or two leading into a competition. But if that's going on for months, and years, then I think we need to really step in and just help them understand the benefits of actually having a proper hormone cycle for bone protection and for everything else that our beautiful hormones do for us. But from an athlete's perspective, they can get a little bit blinkered and actually potentially see it as a good thing that their cycle switches off. So I think we're stepping into that now, the research in women in sport is definitely increasing, which is awesome, but we still have quite a way to go, I think, in terms of our knowledge and our understanding of how to adapt training loads and nutrition for women to get the most out of that individual.

Damian: Can we go back just a step there, Kate, and just go back to the amenorrhea piece. I've come across a number of female athletes that would purposely create amenorrhea through using the contraceptive pill. And it's very difficult when they've got a concern over their iron levels, or they've been told that they've got heavy bleeding, and they use the pill sometimes to manage that, to kind of have that conversation.
But how do you broach the conversation with a female athlete who is on the brink of an iron deficiency and is maybe using the contraceptive pill? Or is maybe now in a state of amenorrhea because she has lost so much body fat? What are you bringing up? What conversation are you having here?

Kate: Generally, I go back to their performance goals. And I go back to just a really good understanding of what is their understanding of the pill and what it's actually doing, and then linking that to performance, because we know that women who are on the pill, it's not necessarily protective, for example, of bone health. We've got enough research to now say it is not doing that job. We actually need a healthy balanced hormone cycle to be protective in later life. And also, from a sports performance perspective, there's a body of evidence that's now coming to light that females who can actually have the peaks and surges of our hormones can actually really get greater gains by utilising and embracing their cycle.

So flatlining a female is not necessarily all that it's cracked up to be. Yep, they may not be losing the blood. But if there was another way that we could do that and balance them so that they were actually addressing the underlying cause of their problem, rather than necessarily just suppressing it, and we could balance their hormones to minimise the excess blood loss. 

Why else would you be on the pill? Well, they may be on it for contraceptive reasons, understandably, but there are also other options there. And my role is, generally, to just educate them on the options. We can't force anyone to make a decision, we can just give them the information and let them make an informed decision.

But ultimately, I've found that most women…it’s really interesting, the change that I'm finding, even in young women that are coming to me and saying, "Look, I'm on the pill, but I want to come off the pill. I want a more natural approach. I really don't like what medication is feeling within my body and I'd really like to try a more natural, balanced approach.” I find that that's sort of a real groundswell that it's happening at the moment, not necessarily women coming in and saying, "I've got endo, I really want to go on the pill. I really want to just suppress my symptoms." They're seeking options at the moment. And I think as naturopaths we're well placed to say, "Look, there are other options, we can try these other options." And not being blinkered. Our way is not the highway either. For some women, their endo is so advanced, absolutely they do need some medication, and they're bedridden.

Damian: Yeah, yeah. Horrendous.

Kate: And it's a slowly, slowly, gently, gently approach. So we can't say, "Yeah, we're going to fix you." It's just about, "Okay, what if we were to get you in a state of better balance? And what if your blood loss was halved? And what if we improved your absorption and helped you to understand where you could actually get enough in through your diet? Would you be willing to have a look at that as an option?" And inevitably, I find they go, "Hell yes. Yes, please. When do we start?"

Damian: Yeah, totally. Why wouldn't you? Yeah, why wouldn't you? Hey, Kate, we've only got a couple of minutes to go. So I thought what I might do is ask you some questions that kind of almost have a yes or no answer, or a really short answer that goes beyond yes or no.

Kate: Go for it.

Damian: Okay. All right. So, with every athlete that you see, are they all deficient in magnesium?

Kate: No, no.

Damian: Oh, okay. No. All right. Interesting. Interesting. All right. Cool. Great, that's...

Kate: You said all. I said no.

Damian: Yes.

Kate: But I have to say there's a really high percentage.

Damian: All right, next question.

Kate: A really high percentage. But not all.

Damian: If there was a percentage of magnesium deficiency athletes, what would it be?

Kate: I'd say at least 80%.

Damian: Okay, there we go. 80/20 rule, Pareto’s principle, it always works. And now, does every athlete that you see need to be on some kind of nutritional supplementation or support?

Kate: No.

Damian: All right, great. And so primarily, most of the time, they're able to manage their performance with real food. Food first, yeah?

Kate: I always do food first, and then top up the deficiencies for a period of time and then come off them. Nothing permanently.

Damian: Okay. In terms of inflammation, in terms of inflammation, because that's a big...it's still a perpetual buzzword and has been for the last 30 years. Inflammation, right? What are your top three tips for inflammation? What are you using?

Kate: Oh, I still love turmeric.

Damian: No product names, but just ingredients.

Kate: Yeah, tumeric and boswellia are probably my two go-tos.

Damian: Yeah, yep. Have you got a third one?

Kate: Oh, a third one.

Damian: You don't have to. Fish oil doesn't work anymore?

Kate: Look on that slow burn, on a slow level. Yep. Yeah, but not as quick “I've got sore joints and I need help next week." No, I'd do something else for that.

Damian: Okay. And with the athlete that's had a viral infection, and there's been lots of viral infections in this last couple of years. Is there a greater need to do more for their immune system and support them? Or are you seeing that they're just kind of riding it out?

Kate: That's a really good question. I think a lot of athletes with long COVID do not have the same lung capacity six months later. That's very much a case-based assessment, I would have to say, not necessarily across an athlete perspective. But an athlete, if they're at high performance, I'd probably put them on something quite gentle. For example, making sure their vitamin D is sufficient and maybe doing something through their foods. Even if that's supporting them with zinc and vitamin C-rich foods, and reishi or shiitake mushrooms, just something they can include all the time as a management thing.

Damian: I like it. I like it. Really good. Last question and then we're going to finish this off. With regards to sleep, we didn't get a chance to cover it, albeit most naturopaths would recommend that their patients and their athletes get sleep. How important is sleep and rest for the athlete and how much sleep and rest should an athlete be getting on a daily basis?

Kate: Yeah, essential. It's their number one key performance ingredient, ahead of food almost I'd reckon. Depending on again, the athlete's expenditure and training load, a lot of my athletes need anywhere between 10 to 11 hours minimum a day. So the way that we do that is the main bank of sleep. So early to bed, a lot of athletes are in bed by 9:00. And then an afternoon nap when they can, and weekend banking of sleep. Yeah, because it's essential.

Damian: You can bank it? Can you put it on...Can you bank it away, sleep?

Kate: Meaning they are making sure on their weekends they're not jam-packed, you know?

Damian: I get it. All right.

Kate: They are banking.

Damian: I don't think you can make up for lost sleep. You can't do that.

Kate: No, no, no.

Damian: Oh, Kate. What a great interview. Thank you so much for joining me today.

Kate: You're very welcome.

Damian: It's been unbelievable. It's so good and you've got so much knowledge, we could have made a three-part episode of this one, I'd reckon.

Kate: Well we can, if you like.

Damian: Well, maybe. Maybe we might. Kate Smyth, thank you so much for joining me on FX Medicine. Thank you everybody for listening today. And don't forget that you can find out all of the show notes, transcripts and other resources on the FX Medicine website. If you want to find out more about Kate Smyth, go to athletesanctuary.com.au. I'm Dr. Damian Kristof. Thanks for joining us.

About Kate Smyth

Kate is a Sports Naturopath, Holistic Health and Performance Coach, guest speaker and Director at the Athlete Sanctuary. Kate now runs a holistic sports practice designed for female athletes who thrive on challenges. She provides support to sportswomen competing in endurance events, professional team sports and wild adventurers through a balanced health, holistic nutrition and female centred approach. Her areas of interest include anaemia, holistic sports performance for the female athlete, and gut health in athletes.

Kate developed her passion for health during her career as an elite runner competing for Australia at the Olympic and Commonwealth Games. In 2008 she held the fastest time in Australia in the women’s marathon and is one of our all-time fastest women over this distance. Having overcome many of her own health challenges during her journey from fun runner to Olympian, she now educates aspiring athletes on the importance of embracing challenges as opportunities to grow.

Kate holds three university degrees including a Bachelor of Health Science Naturopathy, a Masters and is currently undertaking further studies in sports nutrition. She is a qualified athletics coach, has an elite running group and holds women’s running retreats. Kate also presents to sporting academies, schools and conferences on overcoming challenges and maintaining performance through balanced health. Kate utilises her training
in sports naturopathy, nutrition, and coaching in her clinical practice.

Although now formally retired from competition Kate maintains a daily physical fitness routine and a balanced nutrition approach direct from her edible garden.


The information provided on FX Medicine is for educational and informational purposes only. The information provided on this site is not, nor is it intended to be, a substitute for professional advice or care. Please seek the advice of a qualified health care professional in the event something you have read here raises questions or concerns regarding your health.

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