Feb. 23, 2022

"Food First, But Not Food Only" with Professor Graeme Close

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Episode 169 of the Institute of Performance Nutrition's "We Do Science" podcast! In this episode, I (Laurent Bannock) discuss "Food First, But Not Food Only" with Professor Graeme Close PhD (Liverpool John Moores University, UK).

Discussion Topics Include:

  • Defining the concept of "Food First" 
  • Why a food first approach is important in performance and health focussed nutrition
  • Why context matters
  • The 'food first not food only' approach to sport nutrition
  • Example situations where performance may be compromised with a strict food only approach
  • Example situations where immune health may be compromised with a strict food only approach
  • Guidance on how best to deliver a ‘food first, but not always a food only’ sport nutrition strategy in a safe and evidence-based manner

Podcast Episode Transcript: Download PDF Copy

Key Paper(s) Discussed / Referred to:

  • ‘Food First’ but not always ‘Food Only’: Recommendationsfor using dietary supplements in sport(accepted for publication, link to be provided when available soon)

Related Podcast Episodes:

Check out our other podcasts, publications, events, and professional education programs for current and aspiring sports nutritionists at www.TheIOPN.com and follow our social media outputs via @TheIOPN




[00:00:00] LB: Hi, and welcome to episode 169 of the Institute of Performance Nutrition’s We Do Science podcast, the IOPN podcast. And I am Dr. Laurent Bannock, the host. Now, today I had a great conversation, a wonderful conversation, an awesome, epic, however, which way you want to look at it, I think you're going to get it. I had a chat with Professor Graeme Close, who of course you will be familiar with for probably many reasons. If you're a follower of my podcast, of course, he has been there right from the very beginning. And I'm very pleased to have welcome Graeme back to many subsequent episodes. And of course, Graeme is also a regular contributor over the years since day one, also of our diploma in Performance Nutrition Program, our advanced practice-focused program in performance nutrition. 


But bringing it back to our conversation today, we talked about something, which is a term that you'll have heard on this podcast before. If you are an advocate of or have been involved in the sport and exercise nutrition field, particularly from the evidence-based perspective, the scientific grounded version, you'll have heard this term food first. 


But also, if you have been a fan of my podcast, you'll also be familiar with my obsession over context. And this is where these two terms will collide. This idea of a food first approach to nutritional and performance nutrition, but also where that term may not take into account context is something that we discuss off the back of a paper that is about to come out, which Graeme and his colleagues have authored entitled Food First. But Not Always Food Only. And I think the title speaks for itself. 


And you'll know that Graeme and I are going to have a really engaging, deep, meaningful conversation about this concept. So before I unleash the episode on you, I just wanted to direct you to what we do at the IOPN, of course. I mentioned the various podcasts that we've done. You can access all our back-catalogue information about the podcast, show notes, and so on via www.theiopn.com and just click on podcast on the link at the top there. You can also learn about our advanced level online diploma in performance nutrition. It is a unique practice-focused program, practitioner-led program at the advanced level. Five modules. Module is a postgraduate level module. There is no program out there that has five modules dedicated specifically to sport and exercise nutrition knowledge and skills for practice. 


So please go check that out if that's something you're interested in. Whether you're a nutritionist, a dietician, a sports scientist, strength conditioning coach, personal trainer, nutrition coach, etc. You'll want to go check that out if you wish to become a specialist in sport and exercise nutrition. Even if you have your master's degree in sports nutrition, this will be significant continuing professional development for you to go deeper into the specific topics of sport and exercise nutrition and practice, which you won’t been able to have covered in quite as much detail as you might in our program. 


So anyway, decide for yourself. Check out the course overview and curriculum, etc., at www.theiopn.com Just click on diploma. Whilst you're there, check out our SENPRO, our SEN Professional Software Platform that specifically designed to support sport and exercise nutritionists, sports nutrition coaches, working in private practice, with individuals, online group coaching and/or in team settings like I do in my own practice and many of my team, and you all have heard in the last podcast I did, with an elite level sports nutrition practitioner, whether you use it in that setting. 


So anyway, that's that. As I said, just go to www.theiopn.com for that. Now, I hope you enjoy this conversation about food first, but not food only with Professor Graeme Close. 




[00:04:32] LB: Hi, and welcome back to the Institute Performance Nutrition We Do Science podcast, the IOPN podcast. And today I'm going to bring back a guest. Graeme, we're going to refer to you as a regular at this point. You're almost done this more often than I am. What's going on? [inaudible 00:04:48]


[00:04:48] GC: Yeah. I think I have the unfortunate pleasure of being on your debut on as well long ago.


[00:04:52] LB: That's right. 


[00:04:54] GC: Yeah. It's good to have seen this grow. And delighted that you've had people far more intelligent and interesting than me over the last few years. But yeah, great to be back, Laurent. 


[00:05:03] LB: Well, as you know, mate, that’s debatable. But the fact that this podcast has survived, but beyond that initial podcast we did is testament to our survivability, I guess. Now, you're well known for a lot of things, Graeme. In fact, I haven't even mentioned your surname, because we don't need to anymore, do we? Professor Graeme Close, welcome back. 


Graeme, obviously, you've been on this podcast loads of times. I can't imagine that any of the listeners don't know much about you. And they know that you're a well-known researcher, a practitioner, a former pro rugby player, and a bit of an avid golfer, if anyone's watching you on social media. And you're certainly a busy guy. And you're still doing a great deal of research in various kinds of research, particularly in the applied setting. And thank you so much, because that gives me all these topics to do these podcasts on. 


But the other thing I think you're a master of, which maybe you're not officially recognized for, is the ability to come up with absolutely epic titles for some of your papers, mate. And today, we're going to talk about something, which you're about to get published, I understand, which is on the topic of food first, but not always food only. And you have mentioned about this paper breaking ground on this concept in the past. And I guess, there's no real coincidence purely because the term food first is a phrase that is used a lot. And like a lot of words that we use in sport and exercise nutrition, they're not always associated with a consensus, a definition on what those terms actually mean. And of course, people run with these terms. And this food first has become a major catchphrase for people, not necessarily for bad reasons. But sadly, reduced to two words, is a bit of an issue. 


So Graeme, just walk us through a little bit as to why you wanted to put this paper together. And now it is actually going to come out. I mean, why did you want to tackle this topic?


[00:07:13] GC: Yeah. So the paper is now accepted in the International Journal of Sport Nutrition and Exercise Metabolism. We're just going through that final proof stage. So maybe in time for when this is released, it might actually be out to access for everybody. 


And you're right in what you're saying. But often, I sit in my office and think of a title. And then the paper kind of follows. And that worked in that way when I came up with the Come Back Skinfolds, All Is forgiven. It came with the From Paper to Podium. And certainly, it was this one as well, the Food First, But Not Food Only. 


And the reason for this one is that food first term, it's almost becoming a little bit rhetoric in as much as people using the term. But I don't know if people are thinking about it. And I don't know if people sometimes think of the potential negative consequences of it. 


Now, to caveat all this, I am a big believer in a food first approach to sport nutrition. And I've been championing this for many years. But I remember sitting down speaking with my coauthors on this paper, the likes of Ron Maughan, and saying that no one's ever actually defined it. And if you put people in a room, I'm pretty sure not many people would be able to give you a concise definition of what is a food first approach to nutrition. 


And it really did come to a head when working with one organization, or one team, or I'll try and keep it really wide. So I'm not giving anything away here. But I was having a real heated discussion about whether or not I shall be allowed to correct and diagnose vitamin D deficiency with a supplement. And people suggesting that, because they are a food first organization, that would break the policy, and would be better to leave them with a clinical deficiency then it would be to correct it. And I just thought this has got ludicrous. And whenever someone came up with a food first, I am pretty sure that didn't mean in no situation in any context to quote your favorite term that we should ever consider a supplement. So that's where this paper came from. And because of the respect that Ron Moore has in this world, I thought I need Ron as a coauthor to write this Ron's input was absolutely invaluable. Yeah,






And whenever someone came up with a food first I am pretty sure that didn't mean, in no situation, in any context, to quote your favorite term, that we should ever consider a supplement. So that's where this paper came from. And because of the respect that Ron Maughan has in this world, I thought I need Ron as a coauthor to write this. And Ron's input was absolutely valuable. 


[00:09:40] LB: Yeah. Well, of course, he's another one that's famous for some of these phrases. And he's got that magic statement, which lots of people ask that comes out sometimes about – What is it? If it's banned – You'll be able to say this one. 


[00:09:53] GC: Yeah. It's the three rules of Maughan the asker often puts on his graphics, which it's basically to say, If it works, it's banned. If it doesn't work, it's not banned." But there may be some exceptions. And interestingly, that was maybe 20 years ago, I think, Ron first came up with that type of statement. It was certainly a while ago. And that was before we really knew a lot about what we do know a lot about. So we weren't talking about probiotics then. We weren't talking about fish oils. And we weren't talking about Vitamin D then. We weren't talking about beta-alanine. There's a whole host of supplements. Well, when that quote came out, we probably had creatine and caffeine and maybe sodium bicarbonate. And that was these, but maybe some exceptions. And I do want to know how many exceptions other to the three rules of Maughan. 


And interestingly, Ron put together[inaudible 00:10:50] IOC consensus statement on supplements. And for the first time ever, the IOC backed a position statement, whereby a number of supplements discussed within the evidence and within the constraints of all the limitations. But actually, there are now a handful that do have proven ergogenic benefits that aren't prohibited. And if we want to be a sport nutritionist where, ultimately, one of our key roles is to enhance, and to support, and to drive performance, then are we really doing our job if we go a food-only approach and ignore legal, safe supplements with proven benefits to health and performance? And I would argue that we aren't doing our job if that's the approach we were to take. And that's why I passionately believe in a food first, but not a food only approach to sport nutrition.


[00:11:50] LB: Yeah. And I think it's timely that we unpack that term. But like I said, there's a lot of terms that we're surrounded with, and they're poorly defined particularly in the context of athletes, and performance, and training adaptations, and so on and so forth. And we just used a few right there. What actually constitutes as a food? What constitutes as a supplement? What differentiates a food from a supplement? Maybe you could just delve into some of those areas first, just so that when we're talking about food but not just food, we can be clear what those terms mean.


[00:12:30] GC: Yeah. And there's a few there that are quite hard to define. I was involved in the OIC consensus statement. And I imagine that at least one full day of that workshop where they all got together must have been trying to define what actually is a supplement. And their definition, Laurent, which I think is as good as anything, is that it's a food component nutrients or non-food compound that is purposefully ingested, and I think that's a key word, in addition to the habitual diet with the aim of achieving a specific health or performance benefit. 


So it was quite good that they tried to define it. I don't think there is any perfect definition. And I think there's obviously, even within that, very good definition. There are issues. But yeah, I guess what we're saying is something that's taken above the standard diet with a specific aim of achieving a health or performance benefit. 


Now, with most supplements, I think it's quite easy to get our head around that. If you take a creatine in a powder, I’m pretty sure that we're sure that that is a supplement. And we take a fish oil in a tablet, I’m pretty sure that we're sure that's a supplement. I think where we then start getting into unusual or difficult situations on that side of things is things like what if you take turmeric juice to help with inflammation? Is that a supplement or is that just like having orange juice to help as an antioxidant? Or you could say, if you take orange juice above your habitual diet with a specific reason that you want to help with recovery because of its antioxidants and its Vitamin C, by that definition, that's potentially then a supplement. 


So you can see that where there's nuances. And we just got to keep that as a broad definition and put a little bit of common sense on it, because we are in that unfortunate position now of where the market's developing. We're only going to see more and more of these fortified foods. We're seeing breakfast cereals fortified with Vitamin D. So does that then become a supplement? Because cornflakes with added Vitamin D for example. So there's a lot of grey areas. 


I think we're pretty sure that if you eat a piece of salmon that you've caught yourself swimming down a river, it was happy on Monday, it was on your plate on Tuesday. We're pretty sure that that's not a supplement. And we can call that food. And we're pretty sure that you go to your favorite supplement manufacturer and buy a bag of protein product. That's a supplement. So I think this pretty clears – There's a big gray in the middle. But at some point, we need to get better at defining. But yeah, long answer to a short question. 


[00:15:20] LB: But necessary. And I guess a problem, which is something we try to help solve with things like this podcast, and research, and education in general, is the fact that a lot of this information that exists out there is manipulated in many different directions. And people talk about the noise that exists on social media. You've got all your different experts. I mean, face it everyone fancies themselves in one form or another as bit of a nutritionist. Everyone's got an opinion. It's a topic that not everyone's obsessed with necessarily, but everyone has a degree of knowledge about food and nutrition. And right from day one that we can all remember, our parents were saying, "Oh, don't eat that. It's not healthy." Or your kids are on a sugar high, or whatever. We're just constantly bombarded with the concept of a food is good or bad for you. And of course, we're adding to that by saying it's not just good or bad for your health, but it might be good or bad for performance. And the terms good and bad in themselves need wrestling potentially. What does that mean? 


But we do need to draw a line to a certain extent between what we mean, but what fits within the scope of practice, if you like, of supporting things like body composition goals, performance, training adaptations. And then you've got health, obviously. But human beings – I say this all time. Athletes aren't just athletes. They're human beings. Maybe in the off season they're thinking about what they look like on the beach. Or people want to look good dressed going out for a party or whatever. There are many different reasons to want to play around with one's diet. How do we then fit this in, these messages in particularly? You're saying it's food first, but not food only. When the wider influence, I guess, the wider noise, is not just about sports and performance. Does that make any sense? 


[00:17:30] GC: Yeah, and it's difficult. I think what we need to do in all areas of sport science is actually make sure that we're clearly defining what we mean for a starting point. And I don't think that's been done enough. Even until when we were writing this paper, we even felt we needed to define what actually is a sport nutritionist, because there's not even been a good working definition of that. 


So when we started writing this paper, the introduction had about four definitions thrown in there of different things just to make sure that we're all starting on the same page. So with the food first, we took a while to come up with this. But we said that a food first approach should mean where practically possible nutrient provision should come from standard food and drinks rather than isolated food components, dietary supplements or sports foods. 


And I think the key point in that is where practically possible and not that in every situation, in every context ever to be encountered in the history of your career. Because there's clear times whereby, theoretically, it's possible to achieve it in a food-only approach. But practically, it's not possible. And know what we're doing is a disservice to our athlete. And when I first started in this industry, I came up with like a little code of conduct for myself. And I’m pretty sure there're ones out there. But come up with your own. Make it. Then at times of moral questions, you go back to your own code of conduct. And it pretty much helps you through it. 


And my one was – The first one was do no harm. The second one was improve health. And the third one was improved performance. And I thought, if I work in that order of do no harm, improve health – So that one, do no harm. Don't take someone from healthy to unhealthy. The second one is where I improve the health. And the third one is where I can improve the performance. And I’ve often said, if I did one and two, number three often takes care of itself with some exceptions. 


And then I found that a strict food only approach was going against number one and two and certainly going against number three. So I wasn't able to work by my own code of conduct. And now you've got a problem. So then I was like, "Right." So I’m not actually doing my job properly here. I’ve got an athlete who's got a diagnosed clinical deficiency, and I can't help them. So I’m doing harm, because I’m stopping them doing what they want to do, correct the deficiency. I’m not improving the health. And I’m impairing performance. What is going on here? And that was real that time were, okay, we need to define what food first is with some big hitters, like the likes of Ron Maughan, who then when I’m working somewhere or when anyone else is working – And the amount of people who has thanked me for writing this paper already where people hire up their food chain, haven't let them correct deficiencies, because we're a food first organization. Now, what we've got hopefully is like an instruction manual for what actually is food first. And then we came up with six and probably a lot more, but I tried to simplify it to six. Clear reasons of where introducing a supplement is perhaps the best thing to do for the athlete if you work by my three rules of do no harm, improve health, improve performance. And I don't think anyone can have a go at me as a sport nutritionist if I tell them at all times that's the three things I’m trying to do in that order. That's all I’m trying to do. I’m trying to do no harm, improve health, improve performance.


[00:21:24] LB: Yeah. Now, I know there's a lot of people there writing those down, and they're going to adopt that. And that's great. There are some obvious difficulties, though, of course. Now, you've been doing this a long time. You're immensely well-educated. And part of your education is you've been at the coalface of actually researching this stuff at the highest level of science available to you in your field. But there's a lot of people who are doing things with varying levels of knowledge and various varying levels of – How shall I say this? There are degrees of ignorance of one's limitations. And then there's deliberate ignorance, where people are maybe lured by the concept of alternative practices, alternative testing methodologies that they may or may not make a profit on. They may or may not make a profit on supplementation, that sort of thing. And you know the dark arts that exist down there. And of course, it's appealing. One has to make a living, and that forms potentially part of how you generate revenue as a practitioner. But there are some moral issues and ethical issues there, of course. 


But also, there just is the people that just don't realize that they're treading into waters that they're not aware of. So you can say I'm doing no harm. But what if you don't even know if you're doing harm. I mean, what would you say to people in that regard, I guess, as a safeguarding measure? I mean, I guess the obvious initial answer is go get the appropriate education to put yourself in that position. But I mean, what are your thoughts on that? 


[00:22:57] GC: Yeah. A few years ago, it was – Well, when the likes of – Let's go back in history when you was first starting off in this industry, Laurent. Let's go back a long time.


[00:23:08] LB: Black and white days, yeah.


[00:23:09] GC: Exactly. It was a little bit hard for athletes and teams to get the advice or know where to turn through the advice, because it was a little bit like the Wild West, but it wasn't really credible qualifications, courses, regulations. And I think these days was no excuse, really. First of all, work with an SENr BDA type qualified individual. Look for people who've done reputable courses. But there's amazing master's degrees. I'm not just saying it, but the IOPN course. Again, highly credible. Taught by real credible people. There's no reason anymore to turn to unqualified individuals. So that's the first thing. Let's look to get – Like get the qualified adviser. 


And then if you're working with these individuals who will have training in anti-doping, and safety, and evidence-based practice and everything like that, then hopefully you'll be guided down the right avenue. And also, if you're not, well, report them SENr. We are – I'm saying we, because I am currently the Deputy Chair of SENr. We are there to protect and drive standards. And if there is questionable advice coming, let us look into it. And there is a pathway to do something about it now. 


But I think what I'm saying is that, yes, there are still some[inaudible 00:24:38]out there. But fortunately, the number of credible qualified people has never been higher. It's easy to find these individuals. So it's easy these days, I think, to get great support. What kills me is when I still see elite sporting organizations with big budgets relying on unqualified nutrition support. And by that, I mean, putting pressure on the strength and conditioning staff who have had no training in this to deliver it. And often, they don't want to be, but they've got no option. So I think if I'm going to do anything, it's going to be you know to encourage organizations to actually employ the right people. Spend a little bit of money. And that little bit of money being spent will give you then safety measures that your athletes deserve. 


[00:25:28] LB: Yeah, it is amazing. I know we talked a bit offline about that. And I've got various guests that I'm bringing on, past and upcoming practitioners working in those sorts of organizations. It is amazing how many of them have only just started in roles that are very recent positions. And these are some of the biggest sports clubs in the world, for example. But they're doing it. And I guess there's that greater awareness. 


I mean, like I said at the beginning – I mean, look, we've all been eating food since day one of human existence. So the fact that it hasn't always been a priority, particularly when we're looking at the areas where, as you mentioned, marginal gains has become of such high interest. That they are still not focusing enough on the many fine professionals that exist out there, and the vast number of opportunities that there are, which we discussed with James Morehen in a previous podcast, which is just mind-blowing. But we haven't got time to go down that rabbit hole. 


But Graeme, you'd mention these six things in particular. And obviously the list could increase or decrease depending on how you're going to look at it and so on. But let's walk through these six main reasons. You've already sort of nudged a few of them in there. But what's the overwhelmingly sort of biggest sort of area you think that is going to justify that addition of but not just food only? 


[00:27:03] GC: Yeah, maybe we can work our way through with six. And I can give a few examples as we go along. But the first one we came up with is that there's some nutrients that, whilst present in foods, it's not possible to consume in sufficient quantities to get the benefit without massive overconsumption of foods. 


So the example that I used was creatine. And we could use beta-alanine. We could use a few. So yes, you do get some creatine in chicken and that. But to get around about three grams of it would need a kilogram of chicken breast, and that's raw chicken by the way. I don't know anyone who fancies – And so if you wanted to load on it with 20 grams, we're talking north of five kilograms of raw chicken. 


So the evidence for creatine is pretty strong now. I don't think I need to convince people on this podcast that creatine is one of the few ergogenic aids with proven evidence to enhance performance. So now if we're going on a strict food-only approach, we've got two options. We are to takeaway a proven way of helping an athlete perform better, or we ask them to eat five kilograms a day of raw chicken. I'm not keen on the latter option. I'm not sure how much of my athletes would listen to me at that point. 


But joking aside, and the first option, which is we tell them not to do it. All we're going to do now is drive people, even let's say all credible people had to follow a food-only approach. So we couldn't recommend creatine. All that's going to happen now is we're going to turn to non-qualified people. And that's the worst thing that can happen for this industry. And then you know what? A non-qualified person would be able to get better sports and science adviser than a qualified one. 


So that is one really good example of where a strict food-only approach is not only problematic for performance, but problematic for the industry, because we would drive people to the charlatans, and the charlatans would be doing a better job when it comes to performance in that context than what I could do. So yeah, so that's point number one. 


[00:29:18] LB: Greame, just to stay on that one, because I think that's a great point. And it isn't just a case of it's not only going to be a frightening concept to try and eat that much chicken breast, for example, or that much tofu, or whatever, which way you want to approach this. But as a consequence of that, you're not going to be eating other things, though, are you? 


So ironically, one is focused on trying to hit that macro so to speak, that target is going to be at the consequence of other factors.


[00:29:48] GC: Yeah, precisely. And there's lots of examples of things like that. I think I use that example of casein. So yes, in theory, we could get casein pre-bed. Because there's a nice research out there that around about 40 grams of casein, so double the amount of weight, taken pre-bed could be advantageous. And yes, we could get it in yogurt. So you could have a nice Greek yogurt, something like that. But you might need triple the calories. So you might end up on 600 calories where, actually, you only need 200 if you was going to do it in a supplement form. 


And now if we did that consistently, particularly if you're working with an athlete in a weight-sensitive sport, we've either got to take some calories away somewhere in the day that might be needed for training. So reduce for carbohydrates, for example. Or we've driven our athlete to not be able to make weight and know they're going to have to resort to deleterious weight making practices nearer to the fight. So there's lots of knock-on effects that I don't think we always think through. We say, of course, you can get enough casein-based protein in food. Well, you can. And that's what, in our definition, we changed it and was very careful to write it as where practically possible. Because if we just said where possible, then actually, in that situation it is possible. It's just having a lot of downstream, potentially deleterious knock-on effects. 


Now, in some situations, when I'm working with a rugby player, for example, who might need the calories. Well, actually, we'll probably do it in the food approach, because extra calories are important. But if I was working with a boxer or a jockey, for example, then actually the supplement at that point could be the preferred strategy. And it goes back to something you've talked about a lot of his podcast, Laurent, about tools in the toolbox. And what we can't do is just strip away all our tools and be left with a hammer, because then you've only got a hammer, you see the world as a nail. And we start making some bad decisions that aren't helping our athletes. 


[00:31:56] LB: I love that idea of seeing the world is just a nail. My mind is going off on that one. Graeme, so moving on from that particular point. I mean, it is also clear that different foods have different levels of different nutrients. And we hear all the time about the strengths of this superfood versus that food packed full of protein or packed full of antioxidants, whatever. But of course, we can reduce it back to something quite simple, like somebody just doesn't like to eat a certain food for whatever particular reason, which working a lot in football recently, I have found there's all sorts of foods that people don't like to eat because of the color of it, or the container that it comes in. Or there are many reasons for that being a problem.



[00:32:40] GC: Yeah, and you're exactly right, that if you've got somebody who you know isn't eating vegetables, obviously, the first thing we want to do is put strategies in place to help them without dough. And that's entirely correct. And I think we would all do that. But in the meantime, are we not better to correct that deficiency? And given that there's a growing realization of micronutrient deficiencies in athletes and in young athletes who are now doing more and more training, then, of course – And similar things like omega-3s in oily fish, we've all worked with athletes who just won't touch fish. Never mind the oily fish. Or what happens if we've now got a vegan athlete who we know won't get vitamin B12 from them type of foods? Are we not allowed to correct the B12 deficiency. Even the vegan side will talk about correcting a B12, otherwise you'll get quite severe anemia. So a food first approach there [inaudible 00:33:42]of giving our athlete anemia. Yeah, you're exactly right. But the right thing to do with this course is to try and help the athlete to get what they can in the right type of foods. But at times, that's just not going to be possible. And we need to help them.


[00:34:00] LB: I completely agree. In fact, you made me think of a previous podcast I did with Pete Peeling actually. And we, I mean, managed to spend an entire podcast talking about iron. And it's mind-boggling. And the thing that strikes me about something that came out of that, and you're essentially referring to, is just how hard it can be to correct some of these insufficiencies, let alone deficiencies, particularly in an athlete who isn't just sitting around waiting for the problem to be solved. They're still training. They're still blowing through a lot of energy and stress on the body and so on and so forth. Perhaps you could, for the sake of the listeners, just help illustrate just how big an issue that can be in terms of how long it takes and the sort of the depth of issues there. 


[00:34:49] GC: So iron is a great example, and you've had the right person there, Pete. My goal to all the time when anything iron related. World-class researcher. So well done for introducing Pete to the world for them who've not read his work. But if we think about iron and the RNI, the recommended nutrient intake of iron, and we think about a female athlete, we're looking around about 17 milligrams. It changes based on country to contract. But if we go with the UK, around about 17 milligrams. 


Let's go a little bit more extreme now and let's say what about a plant-based female athlete? And the suggestions are that because of the non-him versus a him and the iron absorption, that potentially a plant-based athlete might need 1.8 times the RNI of iron. So now we're up towards the 30 milligram mark. I challenge anyone to achieve regular 30 milligrams of iron per day in plant-based sources without having a massive over-consumption of certain foods, which then I would imagine if you had so much of these green leafy vegetables to get 34 milligrams of iron, your appetite would be gone for absolutely every other nutrient that you're trying to achieve. 


And you're exactly right. Correcting the deficiencies can be somewhat problematic. And I'm sure Pete talked about it, but we should at least be testing our athletes once per year for iron. And in female athletes, at least twice. And weight making athletes probably three to four times. And when you do that, you come up with statistics, around about 15% of female athletes and about 5% to 10% percent of males will be deficient. And it can be difficult to correct. And we'd never know the precise iron quantities in foods and the precise bioavailability, which we're going to get absorbed. 


So that's a great example of, again, where if you've got a diagnosed clinical deficiency and you've gone through your food diet records, and it's just not possible to get them levels into the athlete, what do you do at that point if we went with a strict food-only approach? Because go back to my definition, theoretically, it'd be possible. Practically, it wouldn't be. We're breaking my first two rules again of do no harm and improving health. So yeah, iron is a really good example in that category, Laurent. 


[00:37:19] LB: Yeah. And you mentioned about precise nutrient content. I always find it interesting that we see these precise figures on the back of packaging of exactly, or insinuating exactly how much is in that food that's inside the cellophane wrapper by weight and content. And on the other side of it, somebody might invest in some form of software to analyze a diet, and they'll go, "Right, I ate this many grams of a food," which they may not even have weighed. So they've made an assumption about the portion size. 


And whatever data is in that piece of software is assumed to be the correct data that applies to the actual food that they ate. Not to mention, what happened to it when it was cooked? The whole digestion chewing, the how fast it goes through the digestive processes and ultimately through elimination, blah, blah, blah, blah, blah. So how precise is precise in the first place? And we're making decisions and judgments on this assumption of an understanding of that level of precision. Is this getting into dangerous waters you think? 


[00:38:36] GC: It's more complicated when you just try to make it. And that's quite hard, because I think [inaudible 00:38:42]and even I got lost. But you are absolutely correct that. Even when it comes to macronutrients, one of the things I've bought – One of my new toys at the university is a bomb calorimeter. And we're throwing all sorts of food into a bomb calorimeter and seeing all sorts of weird and wonderful numbers coming out, which are nowhere near what's often on labels, for example. And that's just macronutrients. 


When you get down to micros and things like that and you bring in digestion, and absorption, and everything like that, then it becomes a whole new level of complexity. And this really came to a head with me. It was about five years ago now. And we're eventually getting ready to publish this study, Laurent. This was one of these random ones where that BBC, "Trust me. I'm a doctor." got in touch with me. And they said they wanted to do some work on looking at the omega-3 content of foods and supplements and how that related to the omega-3 of an individual. 


So that's actually quite an interesting study. So [inaudible 00:39:47 ], we thought, "Right, we'll have a bit of fun with this." So we designed an experiment where – And one of the cool things working with BBC is they put an advert that helped get your participants. So we got quite a well-powered study. And we recruited people, measured their omega-3 content in the blood, and then either give them salmon or omega-3 supplements. Or as a control, it was cod. So it shouldn't have much omega-3 in it. And then we sent the food off for analysis. And the salmon came back, and one portion of the salmon had what you'd expect about 1.2 grams per hundred, or a decent amount of EPA in it. Where the one of the tins of salmon couldn't even measure it. And on the tin of salmon, it said rich in omega-3. So, right. I'm not happy with it. So we get on the phone to a well-known maker of the salmon. I'm trying to be cautious here. I don't want to get sued or anything, Laurent. But they were great.


[00:40:49] LB: I'll pass the legal bills to you, Graeme. Don't worry.


[00:40:52] GC: Yeah. They were really helpful. And then I started getting a lesson on the life cycle of a salmon, and they're we're explaining to me how the life cycle of a salmon will dictate how much omega-3 is in it. And I'm like, "Wow!"

So the crux of a story is that salmon live in sea water, and what they're eating in sea water dictates how much omega-3 they have, because they're eating foods rich in omega-3. They get nice and fat, a bit like many of us in the wintertime. And then off they do, they migrate to the fresh water to spawn. And it's in the fresh water that was spawned. But you're not meant to catch a salmon move into fresh water. You've got to let them spawn. If you did catch them at that point, they'd have buckets of omega-3. 


Now dependent how long it takes them to spawn and migrate back to the sea then we'll dictate how much omega-3 is left within them. So if it's been a quick journey, they'll have the loads of omega-3. If it's taken them ages – Because they live under omega-3 reserves in the fresh water, by the time you catch them, there's very little left. So you have no way when you're eating your tin of salmon despite what it might say on the tin. Not even the manufacturer has got a clue, unless they were to do a nutrient analysis on each fish, which we're never going to do. So long story short, we do not have a clue what is in that food despite what might be printed on a label.


[00:42:30] LB: And that's a shocker, isn't it? I mean that is a real shocker. I bet people are like jaws dropped scenarios. And of course, that – 


[00:42:39] GC: I found it interesting anyway. 


[00:42:40] LB: It is fascinating. But that's the point, is that so many assumptions are made. So many assumptions are made. And they're just sort of this direct correlation between what's written there and what it's going to do. And actually, there isn't – I mean, what you've just said is actually new to most people. I only knew part of that story actually. I didn't realize it was quite that big an issue. I mean, again, a lot of salmon, by the way, is farm produced as opposed to a happy salmon, as you put it at the beginning of this podcast, on one day, and then he's on your plate. We don't know how happy he was. Happy or fatty? I don't know.


[00:43:16] GC: I think I might – It sounds like I'm being funded by the salmon industry. But we're going back to summer quite a bit here today. But maybe a more quick example is caffeine and coffee, because we see infographics out there suggesting that a typical coffee's got 100 milligrams in, which is probably right for like a decent espresso or something. But there's that nice study done on Starbucks, wasn't it? Where they used to have filtered coffee over a week. And I think it ranged from 100 to 600 milligrams in one coffee, the same size serving. 


So if we wanted to give an athlete, pre-exercise, 2 milligrams per kilogram. So we've got 100 kilo athlete. I want to give them a two espressos then. We might give them 200, or we might give them 1200, right? Now, at that point, we've massively overstimulated an impaired performance. Or if they're a big athlete and it's been at the low end one day, and we're presuming a bit higher, we've massively under done it. So that's another example of not knowing the precise content. And by not knowing it, we can either under or even over supplement, which could either have negative effects from not giving enough to help the performance, or negative effects by giving too much in the caffeine case. And I think that's another example of why a supplement in that situation can be handy. 


And similar, we know that about 30-minute-ish pre-exercise is ideal. As much as I've got a good budget within the likes of England rugby where I work, I've still not managed to get a real good coffee machine in the changing rooms where I've measured the bean content before. And actually, is a player really going to start getting a coffee 30 minutes before they go onto the field, rather than just chewing on some caffeine chewing gum for example? So theoretically possible, yes. Practically, not really. Is it? Let's be honest.


[00:45:07] LB: No. No, it is nice to have options though, isn't it? And there are going to be people who absolutely can't stand coffee, but they would do an anhydrous caffeine supplement or a caffeine gum. But likewise, there are people, like myself and you, Graeme, I happen to know, and many of your rugby players based on some photos I recall from a lecture you gave us once about rugby nutrition, the sheer act of being the barista is a bit fun. And there's a process there. But I think you've made it clear that when your strategy has to work and you need to be able to control those variables, then that is something you need to bear in mind. 


But what about this idea where some foods contain nutrients or ingredients, which are actually going to be a problem if consumed, say, close to a race or a specific event? And/or they might be dealing with a particular problem? Okay, we're not trying to fix people's clinical issues. Might be a gastrointestinal problem of some sort, where that food might be a known aggravating factor, for example. And I think that's an area which also warrants, because it is. It's one that's one of the areas that you focus on in this.


[00:46:23] GC: Yeah, I think it was the fifth category that we came up with that some nutrients are hard to consume at the time we want it. So I think the best example that we had there is we know that exogenous carbohydrates can help. Taking carbs during exercise over an hour pretty sure can help performance around somewhere between 60 and 90 grams an hour of exogenous carbohydrates. 


Now, on a bike, yet, you can make an example whereby maybe we can carry a banana or something like that, or munch on a banana mid-race. I personally wouldn't like to. But you could do it. Can you imagine if I was running on Twickenham with 20 minutes to go giving everybody a banana? People would think I'd lost a plot. But actually, getting them a cab drink or a cab gel at that point could help performance and not having to sit down with a dinner plate and have another five course meal or something. 


So yes, without doubt, we can get carbohydrates in food form. But convenience-wise, do we really want to be doing it? And then it goes back to something you said right at the beginning of the podcast as well, that sometimes, by getting the right amount of nutrients in a given food could have that much fiber, for example, within it, but we're causing GI distress if we're taking it at that point. Or it can put us off eating other nutrients that we might need. 


And I think that's probably the example that was people maybe don't think about enough, which is, yes, it's– Of course, we can get 30 grams of carbohydrate in food. But can we get it in anything as convenient as an isotonic gel that you can just knock down in a matter of a second or two and get on do it while it's actually running? You see people knocking a gel down mid-marathon while still not breaking out of the stride. I don't think we're really suggesting that we should be trying to, like I say, eat a banana or something like that at that point.


[00:48:30] LB: Yeah, I completely agree. And you've also got crossovers there where in scenarios like during tournament football, something that presented me with challenges that primarily was about how rapidly can we replace glycogen, where you're not just looking at alternatives to bananas, for example. Where you are going to use carbohydrate supplements. But you also might want to add in things like creatine, not because you want your football soccer players to get big and strong, but because there's a potential impact that the creatine might have on the glycogen repletion. I mean, is that also going to fit into this context, do you think?


[00:49:13] GC: Oh yeah, of course, it does. Of course, it does. And I was just thinking when you was talking, but nitrate is another real good example in this context, whereby, in theory, you could get enough nitrate in green leafy vegetables pre-exercise. But the amount of green leafy vegetables that you'd want to be eating in an hour pre-exercise, would you really want a big plate of rocket, and kale, and spinach, and a lot of rhubarb, all foods rich in nitrates, or eat a load of beetroots one-hour pre-exercise? A time when actually what we probably want is to be topping up liver glycogen with some high GI carbs or even not eating at that point, because we really don't want all that fiber within our gut at that point. So yeah, all these are great examples of where theoretically possible, but practically could actually be pretty detrimental in terms of performance.


[00:50:09] LB: Well speaking of detrimental, that moves us on to the sixth and perhaps final part of this, where you know we've already talked about the issue of assumed precision levels of the quantities of nutrients that we see on labels. But also, there is also the need to avoid either contaminated products on the basis of testing. We don't want any doping violation issues. But also, and there's been many documented cases of athletes not eating certain kinds of foods in a food provision environment because of risk of food poisoning, and/or the food is just cooked so badly that it actually is just awful and they don't want to eat it. Either which way, this then brings back an argument for a supplemental form of food. What did you guys think about that in your paper? 


[00:51:06] GC: Yeah, and you're right. This was the sixth one. And this came from two thought processes. One of mine was working at an event in a hot country, where middle of the day in a plastic tent is what were the players area was. There were oysters being served at room temperature. And I'm just thinking, "This is food poisoning waiting to happen." And then the buffet, all sorts of hands going in it. And then I started thinking, "Where's the nearest toilet?" And there's no hot water facilities. And I'm like, "I don't want my players touching that buffet at this point."


And in that situation – But we know that when it comes to glycogen replacement, eating within that first hour is important. Now, we know that, also, protein taken regular throughout the day is important. Is that an example where the best thing to do there would be a recovery shake? Get away? And then go and eat in somewhere where we're more confident from a food hygiene and safety perspective? And the second example we talked about is about the situations where there's been concerns raised over meat contamination and contamination with [inaudible 00:52:18]in some countries. And if we're not – If we're found we're in a situation where we're a long time between eating rather than just pull up somewhere where we don't know and trust the restaurant, would we be better at that point having, let's say, for example, a muesli bar, a protein shake, and get into our hotel where we are a bit more confident in what we're going to be eating? And we don't know how true it is. And I don't want to speculate. But some pictures are being even seen on social media this week from the Winter Olympics, and the food being offered there. I think I’d prefer to be eating foods I've brought with me than what I’m seeing being offered and then get back to my hotel or wherever I'm staying where I trust the food a little bit more. And that's not necessary from an anti-doping perspective. But there was a debate on social media. 


And again, it might not be true. So I'm going to be careful to say it. But even trying to identify what the food was, it wasn't even clear what it was. And you're like, "Really? Do we want to be eating that? Or are we better to actually take our nutritional boxes of what we need to achieve from an athletic perspective and then go and eat somewhere where we're more comfortable from a food hygiene and a safety perspective?" 


So a lot of the controversial wonder to finish. But I would say, from a safety perspective, are we better taking an informed sport or equivalent batch-tested supplement that's been well-packaged, well-transported and you're in charge of than putting your faith into a roadside hoagie wagon that could have anything within it? That's up to each individual. But I know which one I'd prefer to be trusting.


[00:54:03] LB: Yeah. Look, I think this whole thing just really comes under the headline of a bit of common sense, doesn't it? And no joking apart, but context obviously matters. You just need to, I guess, wrestle a little bit with this and start think through the pros and cons. And in this review paper, when it is out, hopefully. It's coming soon. And I'll link it to the show notes. But either which way, you do give a good decision making or you add to the SENr decision making guide, which we'll end on in a minute. But do you have any guidance on how best to actually deliver a food first, but not always food only strategy sort of a summing up process, I guess, that both fits into your three do no harm, et cetera, process?


[00:54:54] GC: Yeah. I think you're right in what you said. When you started that little section there, Laurent, about a bit of common sense involved here. And I think that what had happened was the food only approach had removed common sense. And that, for me, there is no common sense, whereby somebody has a diagnosed deficiency, and we choose not to correct it because of a fear of supplementation. 


And I think it's important to add, but it's right that we have had a fear of supplementation in the past, particularly years ago when it was like the Wild West. But thanks to organizations like Inform Sport, BSCG, [inaudible 00:55:38] NSF. There are no multiple organizations that third-party batch test supplements. So don't get me wrong. I don't want anyone buying untested supplements or going back where we were 30 years ago. We've cleaned that up considerably of the industry. There are no batch tested supplements whereby. We have done everything possible to reduce the risk. So I think commonsense is the one. 


I still think we advocate food first without doubt. But just remember, it's food first, not food only, as in the title of the paper. So let's try and get it where we practically can in the provision of good quality foods. And then if we move them actually in our decision matrix, where we started off by asking, "Does it help your health or sports performance?" And then the next question is, is there a reason why you can't use a whole food approach? If the answer is yes, well, then fine. If we can use a whole food approach, fine, get to food. But know if it ticks one of our six criteria. Then we move back to the SENr framework, which is have we checked for prohibited substances? If the answer is no, it's of course do not use. 


Then we ask, "Can we get a batch-tested version of it?" If the answer is no, we don't use. So there's still a lot of questions we need to answer. And then once we have done all that, we've made a real good informed decision, we've gone down our SENr matrix, we've gone down the food first matrix. And if we get yes to all of them, only at that point do we consider the product.


[00:57:20] LB: Brilliant. Absolutely brilliant. Thank you, Graeme. Look, we could talk for hours about this stuff, which is why you keep coming back on to the podcast. And like I said, as soon as I can, I'll have this podcast out. And at that time, we'll link to the appropriate papers and things that we've referred to. Graeme, as always, thank you so much for your time, enthusiasm, and just your overall committed work that you do that you share freely, globally. It's just awesome to have these opportunities to have these chats with you. If people want to follow you on social media, check out what you guys are doing at the university and so on, what are the best places to do that, Graeme? 


[00:58:05] GC: Yeah. The university homepage is a good place to start, but Liverpool John Moores University. As I've said a couple of times, I'm not too hard to stalk particularly your Google Close nutrition. I'll be on Twitter or Instagram. I do have my own Close nutrition webpage as well. So yeah, drop me a line, drop me a message. And if I can ever be of help, I always do my best.


[00:58:29] LB: Thank you, Graeme. I very much appreciate your time. And I will add all these links, etc., social media and so on, to the show notes on this podcast, which you can find at www.theiopn.com. Thank you for listening.