The Nutrition Science thread

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Originally Posted by bennymac

Consider your situation - you think neuropsychology evals are easily obtainable and available everywhere? Have some perspective.

There’s a lot more complexity in the medical system than your anecdotal situation vs everything else is substandard pill mills.

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Considering I work critical access in Alaska and Montana, I'm fully aware of limitations to access in arguably some of the most remote places in the country. It is my personal prescribing preference for kids to get neuropsych eval for the best possible care. I don't/won't prescribe to adults without that either. Many of these evaluations are done via tele-medicine in the places I have worked, so access is generally pretty good. (This is for new patients/new diagnosis, not established patients)

Regardless of our prescribing opinions, there ARE pill mills for ADHD meds just like there were for pain meds back in the day.

Never denied there are pill mills out there - my point that you missed is that I don’t see it as your particular situation vs everything else is bad medicine.

And the nutrition thread isn’t the right place for a dick measuring contest about who is more north/remote - but I got you beat in that department.

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Originally Posted by bennymac

Never denied there are pill mills out there - my point that you missed is that I don’t see it as your particular situation vs everything else is bad medicine.

And the nutrition thread isn’t the right place for a dick measuring contest about who is more north/remote - but I got you beat in that department.

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These threads are inherently opinionated with responses almost always coming from a place of personal experience. You're right, my initial response was too blunt, my apologies.

In regards to performance enhancing, yeah, no experience. But I would assume ADHD meds might be kinda nice to help get the job done on a protracted alpine route with sketchy conditions and being mentally fried. Although I doubt potential athletes are getting them on the sly from pill mills. I have no idea.

ADHD meds are schedule II for a reason. ADHD is also frequently associated with many other overlapping mental health comorbid conditions. For me personally, I prefer patients to be evaluated by experts in the field before initiating these meds. Others have different comfort levels for prescribing, which is fine.

Neuropsych eval is the standard for ADHD meds here, kids and adults.

The irony is that the ADHD meds aren’t really performance enhancing in the same way for people who actually have ADHD.

I’ll let everyone here know that they should do the 12 hour round trip and pay $2500 out of pocket to have a neuropsych ask the same questions any MD can ask in order to be trialed on medications for a condition with purely subjective symptoms and subjective responses to treatment.

This is off topic for this thread, but diagnosing and managing ADHD in adults is often times more nuanced than a 5 minute ADHD questionnaire. Neuropsych evals are WAY more detailed and thorough than any primary care doc would ever have time for.

Wow I will have to reflect on the multiple 30 minute apts I use to diagnose adult or pediatric ADHD. So great that you guys can project out from your anecdotal experiences to teach us about the reality everywhere.

I guess I should send all my patients to Resp if considering a COPD diagnosis since that is going to always be a “more detailed and thorough” assessment. Or to cardio for hypertension etc.

My question is: what makes ADHD so special versus say depression or anxiety? There’s no diagnostic tests - yet no one reasonable is advocating ALL potentially depressed patients get psychiatric evaluation before starting any treatment.

And if your response is “well there is overlap with ADHD and Anxiety symptoms” - the same questions can be asked of the patient by anyone to tease that out - and if an anxiety sufferer gets put on ADHD meds they will feel worse - for the 1-2 days until they stop the medication as instructed since their symptoms worsened. This isn’t rocket surgery.

Yeah, I would guess it's valuable to do the evaluation because sometimes people discover it's not just ADHD but also X, Y or Z and have an 'aha' moment. ADHD seems like the go-to culprit for uneducated people. Saying that as a non-therapist/psychologist/doctor and also uneducated person on the subject....

So, I just got diagnosed with ADHD in the last year, and I had a 3 hour evaluation with a specialist to confirm what I had been getting in the shorter evals. I think one of the issues is the screening had been built for kids so applying it to adults is not always 1:1, and they adjusted some of my self-reported scores after discussing my answers with me.

My regular doc also said it’s easier to get insurance sign off on meds and other treatments with the full evaluation.

You win Bennymac. Good points.

Thanks, DTM and Viva.

While I can understand the reason for prescription pills in ultras, it seems to go against a lot of the common reasons for doing ultra-endurance events, so I'm inclined to think they're not that prevalent. Even most of the "pros" aren't making that much money from the activities, so you have to have a good reason to do something for 24+ hours straight. Maybe it's my ignorance, optimism, or something else, it just doesn't make sense to me given what I have experienced/felt/seen in the ultra world.

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Originally Posted by fool

Thanks, DTM and Viva.

While I can understand the reason for prescription pills in ultras, it seems to go against a lot of the common reasons for doing ultra-endurance events, so I'm inclined to think they're not that prevalent. Even most of the "pros" aren't making that much money from the activities, so you have to have a good reason to do something for 24+ hours straight. Maybe it's my ignorance, optimism, or something else, it just doesn't make sense to me given what I have experienced/felt/seen in the ultra world.

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I would imagine most are clean, but even amateur sporting events bust dopers. So who knows?

I have heard of some long distance athletes that will take lsd to push through nights and tediousness. But none of these are mainstream events

I read a magazine article about an ultra athlete that takes low dose THC to numb the pain and be lightly stoned through the events. Performance enhancing? Probably depends on the person. Me I’d quit at the first aid station so I could go home and eat a burrito while watching Interstellar.

Exactly- I would get too involved in looking at a flower and cease all progress.

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Originally Posted by fool

Maybe it's my ignorance, optimism, or something else, it just doesn't make sense to me given what I have experienced/felt/seen in the ultra world.

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Not drugs, per se, but I have seen quite a bit of athletes chasing the latest fad or, in some way, trying to leverage, even if just infinitesimally, their innate abilities. This was usually in the form of nutritional / hydration developments, and sometimes it was just fucking stupid. Mostly just wishful thinking. And some of these folks were pretty damn good runners or cyclists!

But they wanted (needed, really) to run some course or distance just a little faster.

And that's fine.

So fucking train harder!

People were so vetted in the "I only train at race pace" doctrine that improvement could only occur via supplements or gym work, or so they reasoned. This one gal was so pleased about doing stairmaster twice a week for thirty minutes because it would really help her on uphill sections of races. And maybe you could just fucking run the uphills during your training runs ya dumb bitch!

Yeah, I lost a few friends.

I also knew a number of folks who would schedule a race known to be easy so they might earn a PR at that distance. St. George Marathon was very popular (downhill course) due to that. A lot of friends ran Vermont or Rocky Raccoon 100 miles for the same reason, as they were two of the easiest 100s back in the nineties.

Ego's thing, I guess.

Just about to hit "Submit", and I recall when glycerol gels hit the scene about twenty five years ago. This one guy I rode with for Swamis, "Dickhead Ron", was going on during a ride about how he had just started taking glycerol. I asked why, and what his goal was. He went on about increased performance and some other bullshit about finally getting on the podium. I nonchalantly answered "How about training a little harder?". Jonsey (Michellie Jones) laughed so hard, she came very close to falling over. She had tears in her eyes afterwards.

Fun Times!

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Originally Posted by fool

Thanks, DTM and Viva.

While I can understand the reason for prescription pills in ultras, it seems to go against a lot of the common reasons for doing ultra-endurance events, so I'm inclined to think they're not that prevalent. Even most of the "pros" aren't making that much money from the activities, so you have to have a good reason to do something for 24+ hours straight. Maybe it's my ignorance, optimism, or something else, it just doesn't make sense to me given what I have experienced/felt/seen in the ultra world.

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I'm not saying it's a majority or anything, but if you just look at how many students, tech bros, and other high-performer types are taking these drugs "off label" and how much they've been used historically in numerous sports statistically it just has to be happening.

Also, there's tons of gym bros out there taking steroids. Don't assume people won't take PEDs unless there's a financial incentive.

High altitude mountaineering with Diamox, oxygen, dexamethasone
. Pretty much doping. But two camps, one doing with, the other without oxygen. But nobody deletes or puts an asterisk on those achievements with oxygen. Sort of an interesting paradox.

Sorry, bit off topic but have to say my eyes are finally open to the harm seed oils do and also what seems like we've been duped into believing highish cholesterol is a bad thing. Pretty confident this country wants us sick.

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Originally Posted by cinnepa

Sorry, bit off topic but have to say my eyes are finally open to the harm seed oils do and also what seems like we've been duped into believing highish cholesterol is a bad thing. Pretty confident this country wants us sick.

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Pharma is a big big industry and they make a whole lot more money off of sick people than they do healthy people.


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That’s like saying oil and gas companies make more money off drivers than walkers.

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Originally Posted by cinnepa

Sorry, bit off topic but have to say my eyes are finally open to the harm seed oils do and also what seems like we've been duped into believing highish cholesterol is a bad thing. Pretty confident this country wants us sick.

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With how utterly awful the majority of people's diet and lifestyle are physicians have to alter their messaging away from what is ideal, to what is realistic and will effect the largest good. Telling people to not eat high cholesterol/sodium/fat foods is intended for bubba and betty who need to cut back on their 6night/week fast food diet. Getting into the nuanced weeds doesnt work when the majority are too dumb to know that maple syrup isnt fruit juice.

This shit truly isnt rocket science. If people simply followed the OG food pyramid (which is by no means perfect), our country would almost completely eliminate obesity. Just eat the food that appears on the fucking pyramid, in the quantities it says.

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Originally Posted by bennymac

That’s like saying oil and gas companies make more money off drivers than walkers.

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Exactly. Except big pharma doesn’t have any real competitors. Using your example of driving, where’s the Tesla in the big pharma world?


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from some of rabbit holes i went down - that food pyramid above should be the opposite of what's shown - whole foods/meats/veggies/fruits.....then really limit to almost zero grains

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Originally Posted by PeachesNCream

Exactly. Except big pharma doesn’t have any real competitors. Using your example of driving, where’s the Tesla in the big pharma world?


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Supplements, essential oils, crystals, prayer, weightwatchers.

Tons of unemployed life coaches out there looking for work.

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Originally Posted by cinnepa

from some of rabbit holes i went down - that food pyramid above should be the opposite of what's shown - whole foods/meats/veggies/fruits.....then really limit to almost zero grains

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Oh boy. Beware, a lot of rabbit holes are filled with bullshit.

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Originally Posted by cinnepa

from some of rabbit holes i went down - that food pyramid above should be the opposite of what's shown - whole foods/meats/veggies/fruits.....then really limit to almost zero grains

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I think your ratio of meat to carbs to veggies varies a lot on your body and what your goals are, and there’s many healthy diets. For example, most runners do well on a high carb diet, but then Zach bitter broke the record for 100 miles on a low carb diet, just gotta find what works for you. But if we as a country could eat more whole foods than processed foods we’d solve a whole lotta problems


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I think the food pyramid isn't necessarily wrong or right. Whole grains aren't inherently bad or inherently good. But the notion that a healthy diet must include them as the base source of energy and nutrition seems wrong.

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Originally Posted by PeachesNCream

just gotta find what works for you. But if we as a country could eat more whole foods than processed foods we’d solve a whole lotta problems

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This

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Originally Posted by californiagrown

With how utterly awful the majority of people's diet and lifestyle are physicians have to alter their messaging away from what is ideal, to what is realistic and will effect the largest good. Telling people to not eat high cholesterol/sodium/fat foods is intended for bubba and betty who need to cut back on their 6night/week fast food diet. Getting into the nuanced weeds doesnt work when the majority are too dumb to know that maple syrup isnt fruit juice.

This shit truly isnt rocket science. If people simply followed the OG food pyramid (which is by no means perfect), our country would almost completely eliminate obesity. Just eat the food that appears on the fucking pyramid, in the quantities it says.

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FYI, the new USDA guidelines use MyPlate instead of the pyramid.

https://www.dietaryguidelines.gov/

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Originally Posted by ghosthop

FYI, the new USDA guidelines use MyPlate instead of the pyramid.

https://www.dietaryguidelines.gov/

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Im aware. Just pointing out that the if people simply followed the OG version that EVERYONE knows and has seen, our society would be 10x healthier. This isnt rocket science. And i think its counterproductive to say that a diet, which is objectively far healthier than what 90% of folks eat, is Wrong, or is Bad, or is Outdated, etc. It just muddies the waters and allows people the excuse of "healthy eating is so complicated because i just dont know whats good information".

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Originally Posted by PeachesNCream

But if we as a country could eat more whole foods than processed foods we’d solve a whole lotta problems

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For most people most of the time, this is the answer. I actually think you can explain the obesity epidemic in just three steps:

1. Obesity rates track with total calorie consumption, with the average person consuming ~500 kcal/day more than they did circa 1980 (https://1.bp.blogspot.com/-dk9E5c-ks...00/sugar+1.jpg).
2. When given ad libitum access to highly-processed vs. minimally processed diets, people eating the highly processed diet consume ~500 kcal/day more than people eating a minimally processed diet (https://www.cell.com/cell-metabolism...19)30248-7.pdf this is an *extremely* high quality metabolic ward study).
3. Ultra/highly-processed foods now comprise 60% of calories consumed in the USA (https://bmjopen.bmj.com/content/6/3/e009892 in 2010, probably higher today).

Yes, people should exercise more and there's all manner of edge cases and exceptions that prove the rule, but those three get you at least 80% of the way there.

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Originally Posted by Dantheman

For most people most of the time, this is the answer. I actually think you can explain the obesity epidemic in just three steps:

1. Obesity rates track with total calorie consumption, with the average person consuming ~500 kcal/day more than they did circa 1980 (https://1.bp.blogspot.com/-dk9E5c-ks...00/sugar+1.jpg).
2. When given ad libitum access to highly-processed vs. minimally processed diets, people eating the highly processed diet consume ~500 kcal/day more than people eating a minimally processed diet (https://www.cell.com/cell-metabolism...19)30248-7.pdf this is an *extremely* high quality metabolic ward study).
3. Ultra/highly-processed foods now comprise 60% of calories consumed in the USA (https://bmjopen.bmj.com/content/6/3/e009892 in 2010, probably higher today).

Yes, people should exercise more and there's all manner of edge cases and exceptions that prove the rule, but those three get you at least 80% of the way there.

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And, processed foods are easy to eat, require zero prep, and come out in fist fulls.......instant gratification of calorie dense garbage.

My neighbor came back from Europe and said something to the effect of "I can hardly even eat the food in the US after what I just experienced in Europe" referring to the quality of the meat fruit and vegetables.

I can say the same from being there as well....this country is evil....at least the FDA and big pharma.

Anyone doing biofluid exchanges with your offspring to stay young? Believe it or not, of all the people in the world, a tech CEO is trying it with his son, and his dad is also doing his grandson. Nice! Those guys are cool futurists IMO.

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Also seeing when the younger rodents are literally stitched together to share a circulatory system with old rodents, a study says the elders do seem to have some improvements in cognition and circulation. Anyone stitch themselves to a teenager? Couldn't hurt to try, right?

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Originally Posted by muted reborn

Also seeing when the younger rodents are literally stitched together to share a circulatory system with old rodents, a study says the elders do seem to have some improvements in cognition and circulation. Anyone stitch themselves to a teenager? Couldn't hurt to try, right?

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https://uploads.tapatalk-cdn.com/202...a2b9ef23a8.jpg


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Nothing brand new but a few interesting tidbits from this article: Maybe Endurance Athletes Should Take Creatine After All
. The article is based on primarily on this review.

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When the International Olympic Committee published a consensus statement on dietary supplements in 2018, it identified a grand total of four substances whose performance-boosting effects were backed by a reasonable body of evidence. Three of those substances are very familiar to endurance athletes: caffeine, nitrate (as found in beet juice), and baking soda (possibly along with beta alanine, which does roughly the same thing).

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– There are plenty of fancy creatine variants on the market. None have been shown to outperform the cheapest and most basic version, creatine monohydrate.

– You can max out your creatine levels in a week by taking 20 grams per day, split into four daily doses, then switch to a maintenance load of 3 to 5 grams per day. You can also skip the loading phase and just stick to 3 to 5 grams, in which case it will take about four weeks to max out. This latter approach may be less likely to cause water-related weight gain.

– Once your creatine levels are high, if you stop supplementing they’ll take about a month to drift back down to baseline levels. You can cycle on and off creatine depending on your training or racing goals.

– Aim to take creatine close to your workout (e.g. right after), ideally with some carbohydrates.

– There’s some evidence that women have higher baseline creatine levels, and thus get less benefit from supplementation. More generally, as with everything in life, there’s plenty of individual variation, so the only way to know how you’ll respond is to try it.

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Originally Posted by alias_rice

https://uploads.tapatalk-cdn.com/202...a2b9ef23a8.jpg

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https://youtu.be/_Gwvc6VON2Y?si=W09J6-El7FZThg2h

"Kyle I believe in you" I like saying that to friends that love this episode.