The Journey of an Ultra Marathoner and Dietitian: An Interview with Renee McGregor

In this episode, we’re joined by Renee McGregor, a leading sports dietitian, ultra-runner, and expert in eating disorders, particularly in athletes. Renee has spent years bridging the gap between nutrition and endurance sports, working with Olympians and amateur athletes alike to help them fuel their bodies for peak performance. In today’s conversation, we’ll dive deep into her journey—how she became a dietitian, the lessons she's learned from her own running experiences, and how she helps others avoid common pitfalls in nutrition, like underfueling and the dangers of Relative Energy Deficiency in Sport (RED-S). We’ll also explore how to balance proper nutrition with the high demands of endurance training, her thoughts on the rise of personalised nutrition through tech, and why mental health plays such a crucial role in an athlete’s well-being. Whether you’re an endurance athlete or just someone looking to optimise your health, this episode will provide you with actionable insights on longevity, performance, and finding balance.

Highlights:

• Rini's Running Journey
• Pinnacle Moments in Running
• Transition to Dietetics
• Clinical Training and Career Path
• Dietitian vs. Nutritionist
• Understanding REDS
• Understanding Recovery Timelines
• The Role of Social Media in Nutrition Trends
• The Impact of Technology on Athletic Performance
• Critique of Glucose Monitoring and AI in Nutrition
• Challenges with Popular Nutrition Programs
• Mental Health and Eating Disorders Post-COVID
• Nutrition Strategies for Ultramarathons
• Recommended Reads for Better Health
• The Importance of Innovation in Nutrition
• Where to Find More Information

Links:
Click here for additional helpful content mentioned in this episode.
Connect with Renee McGregor on Instagram & Web.

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Episode Transcript

Speaker 2 (00:04):
while it is probably possible for a week to maintain
that the issue will be thelonger term consequences of that
and the potential negativeimplications to that individual,
both psychological and physicalhealth in this episode, we're
joined by the amazing reeneiniMcGregor, a leading sports

(00:27):
dietitian, ultra runner andexpert in eating disorders,
particularly in athletes.

Speaker 1 (00:33):
Rini has spent years bridging the gap between
nutrition and endurance sports,working with Olympians and
amateur athletes alike to helpthem fuel their bodies for peak
performance.
We'll dive into her journey howshe became a dietitian, the
lessons she's learned from herown running experiences, and how
she helps others avoid commonpitfalls in nutrition and the

(00:54):
dangers of relative energydeficiency in sport, which is
known as REDS.
We'll also explore how tobalance proper nutrition with
the high demands of endurancetraining, her thoughts on
personalized nutrition throughtech like the Zoe app, which is
very outspoken on, and whymental health plays such a
crucial role in an athlete'swell-being.

(01:16):
Whether you're an enduranceathlete or just somebody looking
to optimize your health, thisepisode will provide you with
actionable insights on longevity, performance and finding
balance.
So I know you are going to lovethis episode will provide you
with actionable insights onlongevity, performance and
finding balance.
So I know you are going to lovethis episode with Rini McGregor
.

(01:39):
So, rini, welcome to theBusiness of Endurance podcast.
I'm really looking forward tothe conversation between you and
Claire, because obviously youboth have very similar
backgrounds, so this is going tobe interesting.
I feel like I might be theperson in the middle of this
conversation, but I'm sure it'sgoing to lead to some really,
really interesting discussion.
But I always like to start withthe stories.
I really wanted to know how yougot into running and how you

(02:01):
got into being a dietician andnutritionist, so give us those
stories.
Where did both start?

Speaker 2 (02:07):
Yeah, thanks Charlie and thanks Claire for having me
Running started.
20-odd years ago I had just hadmy second daughter, and I say
just she was 11 months old andwe lived on a boat, as you do,
in Bath, with two small children, two small babies.
And my younger daughter hadthis tendency to get up like

(02:29):
really early, have a feed andthen she'd quite happily go back
to sleep.
But I found it really difficultto go back to sleep.
So I decided, just on a whim.
One November morning I was likeoh, do you know what?
I'm just going to go outside,I'm just going to go and get
some fresh air and go for a run.
Yeah, I don't even think I hadany proper kit.

(02:49):
I just had small trainers whoused to use in the gym.
I think I put my ex-husband'srunning shorts on or was like
some sort of shorts, I mightremember and I just went off and
I just ran along the towpathfor like 10 minutes and then ran
back again.
But it was so nice to just havethat time away from the girls
and I love my kids, but it wasjust nice to have that time to

(03:10):
myself, like it was the only bitof time I ever got to myself
and so excited to build up alittle bit over the course of
the following year, like I wasnever mad, I just would go out
two or three times a week.
I got a little bit further anda little bit further and I've
slowly built up to about an hourand I was quite happy with that
, to be honest, for quite awhile.
And then, I don't know, I juststarted, I was running more

(03:32):
regularly.
I entered this local 5k race.
I just didn't know anythingabout it, just oh, I'll just go
along.
It was two quid to enter.
I thought why not?
And I won, won it.
I didn't expect to win it atall, had no concept of whether I
was fast or good or anything, Ijust really enjoyed being out
running.
And it was after that, really,that then the race director who

(03:54):
put that race on she was also abig member of the local running
club and then they invited me tojoin and then I started doing
more and more running andobviously it's built from there
and my running has changed overthe years.
It's interesting.
Actually I've just been writingabout my running in my next
book and, yeah, it isinteresting to see the journey
over 20 years, but it has been20 years, like I would say.

(04:15):
I'm a pretty experienced runner, having run in lots of
different terrains and scenariosand, yeah, distances.

Speaker 1 (04:24):
So, yeah, that's where my running started, anyway
and then sticking with therunning for a minute.
It's amazing how people thatget to a very high level of
whether it's running, triathlon,whatever it is.
Often it's just starting on awhim and it building and
building from there.
So you had some great successesin ultra marathons.
What do you think is thehighlight, what's the pinnacle
of your running being so far?

(04:45):
I'm sure there's more to come,but what's the highlight so far?

Speaker 2 (04:48):
three big moments, I'd say, in my running.
The first one is probably themost recent, which was the
lakeland 50, which I did a monthago, and I think that felt
really important and poignantbecause it was my first race in
my hometown and I had no ideahow I would do, but I was really

(05:08):
happy with the fact that Ifinished in the first 10%.
It's a pretty tough race, youcan imagine, in the lakes, so 50
miles up and down the Lakelandterrain.
Yeah, I was really happy withthat and it did feel really
special to me, especially thatyou run through Ambleside in the
Lakeland 50 and I'm not sayingI know everybody because I don't

(05:29):
, but it it has that sameenvironment as UTMB in the sense
of just the crowds.
It is like the UTMB of the LakeDistrict the Lakeland 50 and
Lakeland 100 and the crowds arephenomenal and I genuinely felt
a bit like a superhero, like Ifelt like one of my professional
athletes that I work withbecause the the crowd was so

(05:49):
amazing and just really cheeringme on.
You're like 30 miles in by thispoint, so you're like you
really need that lift and thatwas really special.
And then I guess the race thatreally stands out for me is
probably the Summer Spine Sprintin 2022, because, again, I
never turn up to a race with anyexpectation.
I just do like running.
I think it's the journey and Ijust go with the journey.

(06:11):
I had a day where everythingcame together and I finished in
third, third lady and ninthoverall.
I was the only person of colorat that race.
Similarly, with Lakeland 50, Iwas pretty much one of the only
people of color at the race.
So it feels important to beable to represent and it's a big
reason why I run.
It's about representation and Iknow that you can't be what you

(06:34):
don't see.
And again, as a role model totwo you know mixed-raced
daughters, I want them to beable to feel like they can do
whatever they want and neverfeel the barriers that I felt
growing up.
So that was a really importantone, and I guess the other one
was one of my many trips toNepal, but probably the first
time I raced in Nepal.
That was really special.
It was the first time I'd donea multi-day event, second time

(06:57):
I'd been at such high altitude,the first time in a racing
environment and, again, that'sjust a very special place.
Nepal is a very special placeand I've been back twice since
and planning to go again.
Charlie and I have got anever-growing list of races that
we want to do.
So when you mentioned the spinesprint, what I know of the

(07:17):
spine is very long.
So what does sprint actuallymean?
The sprint is 72 kilos.

Speaker 1 (07:23):
It is a sprint somebody was having some fun
when they named that, weren'tthey?

Speaker 2 (07:26):
I'd love to come back and touch into the pool and
nutrition strategies in a second, but what I really wanted to
dive into is you've talked abouthow you sort of got into
running, but with the backgroundof being a registered dietitian
and a sports dietitian as well.
How did you get into becoming adietitian?
Because perhaps if you couldexplain, like how that happens,

(07:46):
but also you know the trainingthat you had to go through as
well to get there.
So I was a bit clueless when Iwas a teenager.
I did know what I wanted to do,but I come from quite a strict
Punjabi Sikh family backgroundwhere it was predetermined that
science was the way forward,even if that wasn't really what
you wanted to do.
I actually wanted to do Englishat A-level and I wanted to

(08:07):
become a journalist and get intowriting, but I was persuaded,
shall we say, to stick withscience and I did science and
thankfully I'm not too bad atscience.
So I left school with biology,chemistry, maths, a-level, as
most people who do science do,and had no idea what I wanted to
do.
I just knew I didn't want to bea doctor, even though that was

(08:28):
what was expected of me.
I didn't want to be a doctor.
I didn't want to be a dentistand I literally I didn't want to
be a pharmacist.
I literally had no idea what Iwanted to be, but those are the
three careers that my parentshad gone.
Those are the three careers youshould try and go for.
So I ended up doing a degree inbiochemistry because I do find
the human body reallyfascinating and as a teenager I
had suffered my own history ofeating issues and had quite

(08:51):
severe eating disorder for years, I'd say and I was definitely
interested in understanding whatgoes on at a cellular level,
not just what happens in what welearn on a physiological level,
but I was really quiteinterested in the cellular level
type stuff.
So, yeah, I did biochemistryand absolutely loved the course.
If I'm honest, I thought it wasthe best thing ever.
I'm a bit of a nerd and foundit really interesting.

(09:14):
Again at that point, when I wasgetting to the third year, I was
like what do I do now?
I don't really want to be in alab doing research, it's not my
bag.
And so I had a really goodmentor at uni and he suggested
dietetics to me.
I'd never really heard of itbefore.
I never knew what it was, hadno idea and I was like, okay,
I'll look into it.

(09:34):
So he set me up with someexperience at the local hospital
.
I went and had a chat with adietitian and saw what they did
and thought this could beinteresting seeing how I can
support somebody with a clinicalproblem from a nutritional
point of view, again using thatbiochemical background as well.
So I then applied to do thepostgrad course at Glasgow.

(09:56):
Back then you did a yearstudying and then you had a full
year of placement in a hospitalsetting.
So you basically were again abit like an apprentice in our
second year.
So I went and did myapprenticeship or my placement
year at Guy's of St Thomas's.
So I got a really, really goodgrounding in all sorts of
specialities and then got myfirst job a few months after

(10:19):
qualifying on the diploma and Isay diploma, I was a
postgraduate and I got my firstjob at St George's in
Tutankhamen.
So basically worked my way upfor the next you know, nine, ten
years.
So during that time I'd spentthe first two years doing pretty
much everything, because that'swhat you do, a bit like a
junior doctor.
And then we had rotations.

(10:39):
So then I moved into 18 monthrotations in different
specialities, from like renal togastroenterology, to pediatrics
, and then from that pointonwards I did specialize in
pediatrics.
So I did an extra qualificationin pediatric dietetics and then
moved into adolescent eatingdisorders.

(10:59):
So that was my last job in theNHS, was working in adolescent
eating disorders and I guess atthat point my girls were two and
four and I was reallystruggling with being a mom and
dealing with these really sickindividuals that were coming
into clinic and also justfeeling a little bit frustrated

(11:21):
with the eating disorderservices and how it works in the
NHS.
It was very fixed, it was veryconstrained, there was no room
for innovative thinking ordifferent ways of trying to
engage and get through to theseindividuals and I felt that
wasn't really supportive oftheir care.
So I decided to leave the NHS atthat point and I did a little

(11:47):
bit of private work to keep alittle bit of cash flow coming
in and also did my postgrad inapplied sports nutrition at the
same time and also qualified asa personal trainer.
So did all of those things inthe same year with two children
to the age of five.
Because why not?
Why not just throw it all inthere in the mix.
That's how I moved into sportsnutrition and I've worked in

(12:09):
sports nutrition ever since.
My career has changed a lot.
2011 was when I started workingwith the rhythmic gymnastic
team that went to London andthen I moved into wheelchair
fencing, wheelchair basketballand went out to Rio with them
and then since then have kind ofhad my own consultancy and now
work with a number of differentcontracts, including England
National Ballet, scottish Ballet, oxford University, rowing and

(12:34):
various other NGBs as well, justto provide support.
But a lot of the work I do nowis very much consultancy in
trying to support governingbodies and individuals with REDS
and female athlete health andthat kind of area.

Speaker 1 (12:48):
I think with that context of what it took to get
to where you are now and I knowClaire and I have chatted about
this extensively in the past forthose people that aren't aware
both of you that are clinicallytrained what is the difference
between a nutritionist and adietitian?

Speaker 2 (13:03):
I think the biggest difference is obviously that the
term dietitian is protected.
So you have to have done aminimum of dietetic undergrad
course in order to be adietitian, to be called a
dietitian, whereas obviouslywith a nutritionist, the term is
not protected, so anybody cancall themselves nutritionist.
Now there are registerednutritionists who do have a

(13:24):
degree in nutrition and clinicalnutrition and they have a
different skill set todietitians.
I think dietitians very much.
We do learn about clinicalconditions and how to apply our
knowledge to those clinicalconditions to support health,
whereas technically,nutritionists do tend to work
more in the area of, likewell-being and health and

(13:47):
well-being, so they're nottechnically allowed to work in
clinical conditions.
It doesn't stop some of them,but they're not supposed to, and
I think the biggest problem isthat the term is not protected.
So you're getting individualswho've maybe done a little bit
of nutrition on a pt coursecalling themselves a
nutritionist.
Or you're getting people whoare maybe done a little bit of
nutrition on a PT course callingthemselves a nutritionist.
Or you're getting people whoare doing six-week online

(14:10):
courses and then they callthemselves a nutritionist.
And that's the problem because,as you've seen, it is a journey
like I get asked a lot like howhave you ended up being where
you are and how do I get there?
And I often just turn aroundand say to people it's a lot of
work.
I should have really graftedfor the last 25 years.

(14:30):
It's not like I was handed allthese opportunities.
I do take opportunities whenthey come along, but I have
worked incredibly hard and I'vedone roles that I haven't
particularly enjoyed.
But you do it because you gainexperience I'll never, ever take
for granted.
My clinical training, like myclinical training really helps
me in my day-to-day sportsnutrition practice and work, and

(14:51):
I think a lot of dietitians now, particularly younger, newly
qualified dietitians, areskipping going in and working in
the nhs.
They're setting themselves upas private practitioners because
we have social media platforms.
They're very good at creatingcontent and they can make things
look exciting and pretty.
But I will always say youreally do learn the most when

(15:15):
you're working with people,because humans are not textbook.
Regardless of how much you canread, regardless of how much
theory you can regurgitate, it'snot the same as living and
breathing and and and respondingto what's in front of you, and
I guess that's quite animportant aspect, I think, and
when I'm recruiting individualsfor my clinic, like if I'm
recruiting a new person to joinmy team, experience is really

(15:40):
important, like I will not takeanybody who hasn't worked
hands-on in the field in somecapacity.
Thank you for explaining aboutdietitian versus nutritionist.
It's an ongoing conversationthat we have, isn't it over and
over again?
And we haven't touched onnutritional therapy and
everything else as well.
But you mentioned really aboutREDS over the number of

(16:03):
interviews.
We've talked about relativeenergy deficiency in sport quite
a number of times actually,with another dietitian and a
couple of people that have beenathletes that have been through
that themselves.
It's an ever-expanding area,isn't it of REDS?
And now the question whether itdoes exist or whether it
doesn't exist as well.
I just wondered if you couldfirstly just tell us a little
bit more about REDS and whatthat means, but also why that's

(16:27):
so important that somebody whois clinically trained is working
with somebody with relativeenergy deficiency.
Because the reason that I askthat question is I think there's
many athletes that you comeacross that are on that
continuum and what I mean bythat is do they have an eating
disorder?
Do they have relative energydeficiency?
Is Is it normalized eating?
And I think that's reallydifficult in the world of sport

(16:48):
because some of these sports, asyou know, working in gymnastics
, there's an aesthetics part tothis and efficiency part to it
as well.
So I wonder if you could justtell us about REDS, your
thoughts and why it's importantto be a trained clinician
working with them.
Trained clinician working withthem?
Yeah, of course.
So REDS, as you said, standsfor relative energy deficiency

(17:09):
in sport, but I just tend to nowcall it relative energy
deficiency because I actuallythink it covers a wider aspect
than just sport.
If I'm honest, and as youpointed out, there's intentional
and unintentional.
So unintentional REDS is whereperhaps the athlete doesn't
appreciate just how much fueland how much energy they require

(17:32):
in order to support biologicalprocesses within the body as
well as their training load.
And this is where it can becomea little bit imbalanced and the
body has this tendency toprioritize energy for movement.
So if there's not enough energychronically left over for
biological function, then thebody will start to down regulate
that biological function.

(17:53):
So this is where they maypresent with hormonal changes or
recurrent injuries or digestiveissues, because the human body
is so complicated and we arelike a series of chemical
reactions and there's so manydifferent systems within our
body and I think people justtake their bodies for granted
and don't fully appreciatewhat's going on.
I think that's where mybiochemical knowledge really

(18:13):
comes into play, because it'sunderstanding how all these
reactions interact with eachother, and I know that even now,
in clinic, I'll often pick upinteractions that even sports
medic hasn't picked up, becauseI'm aware of how they interact.
And then you have what we callintentional REDS, which is very
much a conscious decision torestrict your energy intake and

(18:39):
or overtrain.
So it's definitely associatedwith an aspect of disordered
eating, and the worst case is aneating disorder, and I think
this is where it gets verymuddled, because we're
definitely finding a lot ofpeople with very well-known
diagnosed anorexia are cominginto our clinics saying they
have REDS, and I think it'sbecause people there's a big

(19:02):
stigma isn't there attached tohaving an eating disorder,
whereas there's not, for somereason, there's no stigma
attached to having REDS, and yetthey're actually very similar
Because, if you think about whatis going on is you're just not
providing your body with enoughenergy to do the work that it
needs to do.
Before the 2016 IOC consensusstatement came out, I was seeing

(19:24):
so many athletes with lowenergy availability and the
reason I was picking up on itwas because of my clinical
experience in anorexia andeating disorders and I was
seeing the similar sorts ofbiochemical interactions and the
biomarkers and your bloodtesting that you pick up in in
people who have severe eatingdisorders.

(19:45):
They were also the same aswe're seeing in athletes.
The only difference was thatoften athletes weren't always a
very low weight.
That was the key difference andthat was really interesting
again from a metabolic point ofview, understanding what's going
on there.
Why are they not losing weightin the same way as we see in,

(20:05):
say, eating disorders?
So I think, like reds is hugelycomplicated.
Even the people on theconsensus group, the ioc, are
quite confused often and are notalways clear about what they're
working with, because it is amulti-system problem and again

(20:28):
we're seeing a lot of athletescoming forward and talking about
their experiences.
But most of them do have thevery common symptoms we
associate with REDS and lowenergy availability, which is
particularly like in femaleathletes, and menstrual
dysfunction and bone stressinjuries.
But also in males as well wesee hormonal dysfunction, low
testosterone levels, subsequentbone injuries, digestive

(20:48):
problems, but we're also seeingmore and more athletes coming
through with a much wider rangeof symptoms, including cardiac
problems, including autoimmuneconditions, and I think this is
what I'm finding fascinating isthat reds is so much bigger.
Whether we want to call it REDS,we want to call it low energy
availability, whatever we wantto call it Basically, when

(21:09):
you're not giving your bodyenough energy and rest.
I really want to add that inthere because, again, I think
that's often missed and again, alot of athletes will say, well,
just eat a lot more and thatwill sort it out.
Actually, it's really importantto include the rest and the
recovery.
So, if you're under-recoveredand you're under-fueling, that's

(21:30):
where we're looking at thesereally complex problems.
Starting From my point of viewand again the research I've done
, it all seems to be related tothe threat and the stress we're
putting on our nervous systems,related to the threat and the
stress we're putting on ournervous systems, and so, again,
this is why it's also verydifferent, right, like why it's
so individual.
Some people will cope with alot more, other people will not

(21:52):
cope with quite as much.
And it's also, I think, whywe're seeing so much of it, even
in the recreational athleteworld, because we've got
individuals who are trying tobasically be pro athletes and
have a full-time job and beparents and it's too much, it's
too many layers.
I will always say it's a verycomplex problem.

(22:13):
It's definitely not somethingthat I don't believe a newly
qualified person will haveenough experience saying I don't
even think it's enough to saysomebody who has personally
experienced it has got enoughknowledge to be able to offer
support to somebody else.
Because what I do see withathletes that are talking about

(22:35):
their own experience, very fewof them are able to take the
responsibility they've had in it.
So what I mean by that is thatthey're often blaming the
culture.
They're often blaming theculture, they're often blaming
the sporting environment, butthey haven't done enough work
psychologically to understandthey also have a part to play
because they have to appreciatethat their own personality types

(22:58):
has quite a big role to play init.
And you know, as humans we'renot very good at taking
responsibility, are we?
We're very good at blamingother things because it's
uncomfortable to sit there andgo oh yeah, that's me.
I mean I'm very good at sayingI'm a perfectionist and it is
problematic a lot of the time.
I'm not saying it's comfortable, but I'm very, very good at

(23:19):
saying it and I think that's.
Another big problem is I'veheard this narrative again and
again.
I'm not saying sport is notproblematic.
I have worked in highperformance sport and it is
brutal and absolutely theculture needs to shift.
But I also think athletes needto appreciate that they are a
particular type of individualthat is more susceptible to

(23:43):
developing dysfunctionalbehaviors.

Speaker 1 (23:45):
You're absolutely right, and some of what you
described, they might have beentaking that as oh hang on, I'm
overtraining and under-fueling.
That just means I'm going toget better.
What are the long-term impactsof REDS?
You talked about someshorter-term impacts, but what's
the long-term downside ofsuffering from REDS for long
periods?
And it might even be?

Speaker 2 (24:05):
you want to add, in the context of that, to
different categories teenagers,ladies going through menopause
and some other categories thatyou see I'm going to come back
to that in just two secondsbecause I think there's a really
there's a study that's justcome out that explains some of
this as well, just to try andtie it together.
There's a new study that's comeout in the cycling world and
basically they've done a casestudy or a tour de france femme

(24:29):
cyclist and they wanted to provethat you can still get good
performance output even when theindividual is in low energy
availability and the energy islike less than 25 calories per
kilogram of fat free mass.
And I was asked to comment onthis study a few weeks ago and I

(24:54):
said, while it is probablypossible for a week, to maintain
that the issue will be thelonger term consequences of that
and the potential negativeimplications to that individual,
both psychological and physicalhealth.
So what we know is that itdoesn't take too long before we

(25:14):
start to notice theseimplications is usually like
three weeks or more.
It's when you start to seeproblems, and problems can be,
as I said, endocrine issues.
So female athletes startgetting changes to their
menstrual cycle.
Maybe they just become a bitlighter, maybe they become less
frequent, or they become morefrequent or they disappear

(25:37):
completely.
And again, it is quite commonfor endurance athletes, and
specifically female endurance,to lose their menstrual cycle.
It's not acceptable, but it isquite common for them too, and
specifically female enduranceathletes, to lose their
menstrual cycle.
It's not acceptable, but it isquite common for them to.
And again, if they miss one,two, maybe, don't panic quite so
much, but any more than thatactually that's going to have a
significant negative effect ontheir bone health.
And this is where it becomesproblematic from an injury risk

(26:00):
point of view is that you getthese individuals with very
compromised bones that are notjust weak in one place.
That's the thing that I thinkpeople forget that with stress
fractures it's not just aboutthe place where the fracture is
occurring.
If you have a clean breaks, ifyou have somebody who has a
fracture, that's very differentto having a stress fracture.

(26:20):
So stress fracture is where thebone has, over time, become
very weakened due to poorrecovery, poor nutrition and
poor hormonal status, and so thestress fracture occurs in that
weakened spot, due to overuse,basically, and what we find is
often individuals, particularlythose that have got reds and low

(26:43):
energy availability, they'll goback to their training way too
quickly and that hasn't hadenough time for that bone to
heal properly, like it takes along time for bone to recover.
We know that it takes a minimumof six consecutive menstrual
cycles for the bone activity tostart up again.
And then on top of that youneed to make sure you're having

(27:03):
enough energy, you're gettingenough calcium, you're having
enough vitamin k.
You know like it's a big matrixof different things.
So what was interesting aboutthis study was and she won't
mind me saying because she hassaid she's happy for me to share
it the cyclist that was used inthe case study came to work

(27:24):
with me a few weeks ago becauseshe basically said I'm not doing
okay, I haven't been doing okayfor a long time.
I wasn't really happy aboutbeing part of this study, but
they wanted to prove something.
So it's interesting, isn't it,that science was trying to prove
a point but actually hasn'ttaken into consideration that

(27:49):
this poor athlete, this poorcyclist, is now suffering the
effects of that study.
I think the reason I'm makingthis point is because obviously
Claire and I come from this verysort of academic background
with dietetics, and obviouslyeverything does have to be

(28:09):
evidence based.
But I think it's also reallyimportant to understand that not
all studies are equal andactually often studies are
trying to prove a hypothesis orprove something without taking
into consideration all the otherthings that are going on.
Even when we look at studiesaround weight loss, for example,
you may well get an outcome ofweight loss, but nobody's

(28:31):
looking at what effect is thatthen happening on the thyroid
gland or what effect is thenhappening on leptin levels.
And that's the problem withlooking at just one paper and
just one angle.
I think we're definitely notnuanced enough to be able to
look after people properly, andI think that's something I feel
very passionate about.
So sorry, charlie.

(28:53):
To go back to your originalquestion, in terms of the
long-term problems is that withteenagers, the issue will often
be the bone health issue,because if they've got very low
energy availability, it mightmean either menstruation,
particularly in girls, startsand then stops or doesn't start
at all, and the same with boysthat actually their testosterone

(29:16):
levels don't get as high asthey need to, so the bone
doesn't reach its peak fast inwhat it could do.
So even if they do recover fromtheir low energy availability
maybe into their late teens orwhatever potentially, if they
then become professional intheir early 20s, this is when we
still see the effects of thefact that they've had these very

(29:38):
low bone densities from a veryyoung age.
And the other thing is is oftenthat if they have had success
as a younger athlete, especiallybased on being a low body
weight, and again their bonedensity hasn't been strengthened
alongside as they become moreprofessional or as they get

(29:58):
older and their body isdeveloping in the way that it
should do and they are theweight that they should be,
often again those bones, and thepelvic region in particular, it
can't support that volume oftraining.
So this is where it can be.
An issue is that often juniorsreally struggle to become

(30:18):
successful seniors because ofthe mismanagement at a junior
level, which is problematic.
It is possible to recover fromREDS I don't want to be all doom
and gloom, like you canabsolutely recover from it and I
have seen that.
But I think people don'tunderstand how long it takes.
And again, if you listen to theathletes who share their

(30:40):
experience, you'd think that yourecover in three months, but
that's not true.
Like we know that it takes aminimum of 18 months if recovery
is linear and that's for, likemetabolic health to fully get
back to normal and that'sminimal.
So I think I really want tostress that point, because I

(31:01):
think a lot of people assumethat if they stop their activity
for three months and they eat alittle bit more, and maybe
their hormonal health returnsback to normal, that's it,
they're fixed.
It's a lot more complicatedthan that and particularly if it
does have a psychologicalassociation with it, that also
needs to be dealt with.
That ability to manage yourexpectations, to manage your
personality, is also a big partof it.

(31:24):
You gave a fantastic explanationof the long-term and short-term
consequences of REDS, and Ithink the thing with REDS is the
fact that we, as you mentioned,we still don't know enough
about it.
Do we actually really know whatit is?
Because we don't have so manystudies to support that, and I
think it's watched.
The space, isn't it as italways is, with science ever
moving?
You mentioned about highperforming environments.

(31:47):
I know you've worked withinhigh performance for a number of
years and you mentionedgymnastics and a number of the
national governing bodies aswell, thinking about social
media and the environment thatsocial media has created in
terms of the way that we thinkabout food, the fads, the trends
, the diets that we might hop onand off this is one of

(32:08):
Charlie's big loves when we'rethinking about AI technology
here, but I'm just thinking ofeverything that's out there on
social media and the latestthing now is all those different
fantastic technologies that areout there that can support us.
But what do you see aspotential risk when we're
looking at very high performingathletes or busy professionals
who actually are those kind ofpeople that love data, they like

(32:31):
to follow things.
So, whether that's a ring, awhoop, a garmin watch, a glucose
monitor, where do you see therisk lies with some of these
devices and where do you see thebenefits within sport?
Where can it actually help?
Do you see the risk lies withsome of these devices and where
do you see the benefits withinsport?
Where can it actually help?
Do you think?
I'm not sure it can help?
If I'm being brutally honest, Iactually think it is

(32:53):
problematic.
I suppose the only way the onlyplace I'd see it helping is if
you're literally using yourwatch, maybe as a stopwatch.
You know it tells you you'vedone your 30 seconds or your two
minute intervals or whateveryou've got to do you.
You've done your 30 seconds oryour two-minute intervals or
whatever you've got to do, andyou've done it at the pace that
you've been set.
That's probably the only pieceof tech that, personally, I
think is useful.
I think everything else is justcausing more noise and

(33:16):
complication and stoppingwhether we're athletes or
whether we're just mere mortals.
It's stopping us from listeningto our internal monitoring.
The human body knows what it'sdoing.
We do not need to control it.
And yet here we are all tryingto control it.
We're monitoring our glucoselevels, we're trying to measure

(33:40):
the microbiome by sending offstool samples, we're looking at
our heart rate variability onwhoop bands or whatever, and I
think, although that mightprovide some indication of how
you're feeling, it can't beultimate, overriding decision.

(34:01):
The human body has evolved toknow how to survive.
That's why we're all still hereand it knows what it's doing.
You think about it when thetime is right.
Girls have periods when we,when we are pregnant, our body
knows how to have a baby, likewe know what to do when we're

(34:22):
cold.
Our body tells us we put ajumper on, like we know what to
do.
And yet, the more and more welet tech decide and make
decisions for us, the furtherand further away we get from
just listening to our own bodies, which probably have the
answers for us.
I think I do use hrV withcertain individuals because it

(34:45):
does help them to be moreaccountable.
Like these are the individualsthat are more likely to
overtrain, and so I think HRVgives them an indicator of maybe
well, and their body's notgoing to respond to training as
well.
So perhaps it's better to nottrain as hard that day.
But I always say it's a crudevalue, it's not.
Ultimately, I'm not sureanything can measure really

(35:08):
what's going on inside ourbodies at all.
So I personally find it allvery difficult.
The glucose monitoring thing,I'm sure if you have followed me
or read anything about me orheard me talk about it, I have
real problems with it, becauseit suggests that the only thing

(35:31):
that controls your glucose isfood, and that is not true, as,
where you will know as adietician, there are so many
factors that influence our bloodglucose, from stress to
dehydration, to illness, tomenstrual function the list goes
on and even how you respond tofood at different times,

(35:52):
depending on what you're eatingit with or what you're not
eating it with or what you'vebeen doing activity wise all of
these things have an influence.
So to monitor your glucose andthen decide that you shouldn't
eat a certain food because itcauses you to have a spike and
who's to say that spikes aproblem?
Because it's not actually incertain situations.
We want glucose.
Yeah, I have real problems withit.

(36:14):
It feels quite difficult inclinic because you are
fundamentally, as always, upagainst the trends and as soon
as you've got a celebrity orsome sort of influencer who is
promoting a trend that's got amuch bigger following than you,

(36:34):
is much more popular than you,you're on to a bit of a losing
baffle.
But all you can do is make sureyou're there to pick up the
pieces, because ultimatelyyou'll have to, and and that's
what I see time and time again Iknew that you weren't a fan of
zoe, and obviously we can pickup on the fact that that's one
of the things that you'rereferring to there.

Speaker 1 (36:57):
It must be really difficult for both of you,
because there's a couple oftimes where you said that where
you're just like, there justisn't the research, like
particularly in female athletes,there's just not the research,
and yet companies like zoe havemore data on the general
population than probablyanyone's ever had before, and so

(37:17):
it must be really difficult foryou guys to be almost fighting
against the companies that havemore data than perhaps even
you've had access to through theresearch that you get.
How do you see it evolving tothe point where it is a benefit,
or is AI always going to bedetrimental in the area of

(37:40):
nutrition?

Speaker 2 (37:43):
going to be detrimental in the area of
nutrition.
I think it would help if Zoeknew how to actually put the
data forward in an actual mannerthat's not flawed.
That would probably help quitea lot.

Speaker 1 (37:51):
Could you just tell us what is flawed by the Zoe
data, because I'm reallyintrigued by it.

Speaker 2 (37:54):
Firstly, with the Zoe data there's a massive conflict
of interest that the leadauthors are invested in the
company.
So that's a big no when you'relooking at any sort of study.
But the other thing is thattheir most recent study that
they claimed proved it wasn'tcomparable.
The two groups they had theydidn't have a control group.

(38:16):
The two groups they had weregiven completely different
advice.
So, yes, the people on Zoeapparently did better, but the
group they were comparing it tohad not been given different
advice.
So, yes, the people on Zoeapparently did better, but the
group they were comparing it tohad not been given any advice.
So you can't compare that,because that's not how studies
work.
That's like saying I'm going toeat a bar of chocolate and
Claire's going to eat an appleand then we're going to compare

(38:40):
whose blood sugars are better.
You can't do that.
So I think that's some of thevery basic stuff.
My biggest concern is that theymake a number of claims but they
don't actually have the data tomake those claims.
So, for example, when I had aconversation with them, we were
like you're not taking inconsideration the changes in

(39:03):
glucose control in women.
You're not asking women abouttheir menstrual cycle.
There was no questions abouttheir menstrual cycle.
There was no question aboutwhether these women were
perimenopausal or menopausal oreven lactating or pregnant.
Like no questions.
How can you give outinformation if you don't even

(39:23):
know basic information about aclient?
So I do have big problems withit and I'm not just on a massive
vendetta against them.
That's not what I'm here for.
I am here because I,fundamentally, will always
advocate for the vulnerable,always.
I will always advocate forpeople who don't feel able to
say this is not working for meand I'm too scared now to go up

(39:47):
against a big company becausethey're making huge amounts of
money and it's incredibly clearthat they don't care about
people.
They care about making money.
That's what they care about,because, because if they cared
about people, then they wouldn'tcharge so much.
Like, their latest thing isthis ridiculous high-fiber seed
mix that is, I don't know, like£10 or £15.

(40:09):
And it literally blows my mindthat this is allowed.
That's what throws me is thatthis is allowed.
Yeah, we could talk all dayabout Zoe, but I won't get
anywhere because they'll never.
I did have a conversation withthem, but I'll be brutally
honest.
It was probably lip service ontheir part because nothing has

(40:30):
changed and that upsets me.
But at least I gave it a go.
I will keep supporting peopleand I will keep calling them out
if I have to, especiallysomething like Zoe, which
apparently has people fromprofessional backgrounds working
in it.
I think that's the bit that Ifind the hardest.

(40:50):
The other brands that don't haveany academics or nutritionists
or scientists involved.
I'm not saying it's okay, butyou can go.
Okay, they don't have theknowledge.
But when you have the knowledge, I personally don't know how
they sleep at night.
They just don't know how theysleep at night.
Really, it's fantastic to hearyour passion, even though you

(41:12):
know, with what's happening inthe world of nutrition, and I
think, as Charlie mentioned, itis and does feel like you know
I've been qualified for 22 yearslike a constant battle against
even more so now.
I won't even mention that whenI first at university was when
mobile phones first came out, wecertainly didn't have the
Internet on them.
But now it's even more of abattle, and I think it's an

(41:33):
interesting landscape andenvironment, but one that we
have to also help peoplenavigate as well, and I think
that's really important to helppeople understand why and how to
do that as well, but fantasticthat you're out there flying the
flag as well.
Eating disorders and mentalhealth.
We talk quite a bit actuallyabout mental health and have

(41:54):
done in this in the last episodeactually, and lockdown was
obviously a huge time wheneating disorders and mental
health really suffered andcertainly I saw a lot of people.
There was increases in eatingdisorders coming out of
everywhere and certainly withinyoung people.
Where do you think thelandscape is at the moment in
terms of eating disorders?
Have you seen from yourpractice that actually things

(42:17):
have settled down a little bit?
Have eating disorders continuedto increase over that time?
And why do you think COVID wassuch a time where we saw that as
well?
I'll answer that one first,because I think that's probably
easier if we think about what aneating disorder is, regards of
how it presents and also thereare several different types, but
basically an eating disorder isthe way of trying to cope.

(42:37):
It's a method of avoidance.
It's a method of trying tocontain yourself when life feels
chaotic and messy.
Sometimes it's all you've got.
You know, if I think about someof the clients I have, their
eating disorders have developedin the midst of really difficult
scenarios going on for them,whether it's familial
relationships or trauma, orcould say, covid was a very

(42:59):
special circumstance for all ofus.
We have never had so muchuncertainty in our lives from
all aspects, and also there wasthis constant threat, like those
first few months.
Nobody knew enough about COVIDand we still don't.
But if you think back to thattime, I remember being terrified

(43:20):
of touching a gate in casesomeone had COVID, and it's
ridiculous to think about it now.
But when you don't know enough.
I remember one of my friendsringing me when we were first
allowed out and she's like I'vecome home, but I've, I've washed
my clothes, had two showers,because there was so much fear
associated with it.
So we created and generatedthis huge amount of fear and of

(43:42):
course we're not very good atcoping with fear.
Like I said earlier, humans arebiologically hardwired to avoid
threat and they don't want toexperience it and understandably
they find means and ways.
Think about whether you'rerestricting your intake or
whether you're fixating whatyou're eating, avoiding certain
foods.
It's not about that, but thatjust gives you a way of avoiding

(44:06):
what's really going on.
And similarly with exercise,you numb your feelings for a
temporary amount of time.
So all these things give you atemporary relief, but they're
not long standing.
But, of course, if you neverlearn how to deal with all that
uncertainty and threat, then youjust keep going back to the
same behavior because it givesyou this temporary relief from

(44:27):
it.
So I think that's probably whycovid was a platform I think I
can't remember the exact stat,but it was something like,
wasn't it?
Over 200 increase in peopledeveloping an eating disorder,
and I think probably a lot ofpeople already had functional

(44:48):
disordered eating, which thenjust became full-blown because
they lost their routine and theylost their security, and so it
was the one thing that they had.
It was something that theycould manage.
But I think also, we all spentway too much time on social
media.
All you did was compareyourself all day long to
everybody else, and some peopleappeared to be thriving in COVID

(45:12):
and had these wonderful, lovelyfamily scenarios going on and
people making banana bread andall sorts, whereas others of us
we were not thriving at all.
And all you then did was sitthere watching all these people,
and it just kept fulfillingthat sense of I'm falling short,
there's something wrong with me, I'm not good enough.

(45:33):
So again, you go in search fora way of trying to avoid feeling
that way.
So I think COVID definitely hada really negative impact on our
mental health.
In terms of your question around, has it settled?
It's a good question.
I think people are stillaffected by it.

(45:59):
So I think those individualswhere it became heightened in
COVID they are still sufferingthe consequences of that very
acute time.
So I don't know if we've gotmore cases, but I would
definitely say there are still ahigh number of people who can't

(46:19):
get the support they need andare really struggling with
eating disorders.
And again, I don't think socialmedia helps.
I think social media justvalidates.
Sometimes it validates yourbehavior, sometimes it
influences your behaviors andit's fundamentally and there's
no filter is there like you haveto be the filter and if you

(46:40):
haven't developed that abilityto filter content that is
harmful to you or causing youdiscomfort, then it's going to,
it's going to contribute to howyou think and then your
behaviors unfortunately, thealgorithm is designed to give
you put you into an echo chamber, so if you're responding to

(47:01):
something that's going to makeyou feel upset, then it's going
to feed you more of that.

Speaker 1 (47:04):
But, um, it must be a massively challenging area for
both of you guys.
I want to bring it back torunning and let's talk about
some running nutrition stuff.
I'd like to ask you for sometop tips around how you go into
your ultramarathons, maybe inthe lead up to, during and
afterwards.
But I'd also like to throw intothat question have you had a

(47:25):
nutritional calamity in one ofyour races and what did you
learn from that and what haveyou done as a result?

Speaker 2 (47:31):
I have had a nutritional calamity.
I'm a human, I'm comfortable.
In 2019, I did the Monte Rosafour-day stage event and the
Monte Rosa is basically a looparound the Monte Rosa and you go
up to some very high altitudes.

(47:53):
You go up as high as 3,800meters.
High altitudes.
You go up as high as 3,800meters and I really
underestimated my sodium losses.
I hadn't appreciated how muchsodium I lost in terms of when
I'm running through my sweat.
And I remember on the second dayclimbed up this big refuge.

(48:15):
It was like I think we've got2,900 meters and it was a really
tough climb.
It was really hot, it wasthrough a forest, so it was very
humid as well, and I wasabsolutely dripping with sweat.
Got to the top and felt prettyawful, but did manage to eat
some real food at that point andthought, okay, cool, that'll,

(48:35):
that'll get me going.
But was really thirsty and sokept drinking water but hadn't
really appreciated that thebread and cheese I'd just eaten
probably wasn't quite enoughsalt for what I needed and
started running down and thenwas like, oh my God, this is not
good.
Like my stomach was churningproper, like washing machine

(48:56):
situations going on and I knewwhat the problem was I knew I
needed salt and, weirdly, theday before I had helped someone
out who had the same problem andhad been stuck on an aid
station and even the medicsdidn't know what was going on
with him.
And I said how much salt haveyou had?
And he said not anything.
I'm so here, you have two salttablets and make sure you keep

(49:17):
taking them and you'll be fine.
And I remember that the end ofthe day one he bought me a beer
because he's you saved my race.
I said it's all right, it's myjob, it's not a problem.
Anyway.
Obviously, giving him my salttablets meant that I didn't have
any in my back, and so I waslike, oh, this is terrible, I
don't know if I can continue,because I felt so unwell and I

(49:38):
just sat on a rock and thought,okay, I'll just sit here and
hope that someone passes andthey might have some salt
tablets.
And, funnily enough, the sameguy that I'd helped the day
before passed me by and he'slike are you all right?
I was like no, not really, Ineed salt tablets.
Oh, I've got loads today.
And so he gave me some, andthen I was able to continue and

(50:01):
I managed to get on and finishthe day.
It was good karma.
Oh god, I still make mistakes.
I was thinking about this atthe weekend and I was talking to
my partner about it.
Sometimes people get very lockedinto what has worked for them
before and think, okay, I'lljust do that again, and not
necessarily realize that theconditions might be different,

(50:23):
the terrain might be different,particularly if you're a female,
your hormone levels may bedifferent and all of these
things are going to have aneffect on whether that same
strategy is going to work foryou.
And sometimes we just have areally shit day and that's it,
and it doesn't matter what youdo.
It's just a really bad day andI think it's really interesting.
So, yeah, I definitely don'tget it right all the time.

(50:45):
You know Lakeland 50, I didn'tget it too wrong, but there were
points in Lakeland 50 where Idid struggle to eat because,
again, I was drinking loads, Ihad loads of electrolytes and
everything, but when I tried toeat solid food, my mouth was so
dry I really struggled toswallow anything, and so, as

(51:06):
someone who's not, I always keepgels as an emergency, but I
don't tend to use them veryoften in altruists because I
like to be able to eat properfood.
I was actually surviving ongels because it was the only
thing I could actually swallowwithout being too dry.
So I think what I have learnedis always have a contingency and
that is something I alwaysteach the people I work with is

(51:26):
that you can practice andpractice.
You can know exactly what'sgoing to work for you, but
always have a bit of a backupjust in case, because you never
quite know how the day's goingto pan out and how your body's
going to react and respond.

Speaker 1 (51:39):
As part of that backup, are there any particular
food groups or particularthings that you go?
Right, we've got to have someof them in there.
And we've got to have some ofthat in there because there's a
good chance I may need that inthe future, and I think Claire
and I are speaking fromexperience in terms of ultra
running and suddenly needingpeanuts, salted peanuts or salt

(51:59):
and vinegar crisps or whateverit is.
So what are your backup foodsand what do you have in the pack
?

Speaker 2 (52:04):
So in my pack I will always have a mixture of sports
nutrition and real food, becauseI do think there's a place for
sports nutrition.
I don't always want to use itthe entire time, but I
definitely think there's a placefor it.
It the entire time, but Idefinitely think there's a place
for it.
I'm a big fan of active root,so I use a lot of active root
from a drinking point of view,just because I really like the
ginger and it helps with nausea,and I do tend to get a lot of

(52:25):
my energy through drinks because, again, a lot of the races I do
I'm using poles and so ifyou're relying on trying to eat,
sometimes that can beproblematic.
So I do use a lot of liquidenergy.
I always have a Snickers barbecause I always look forward to
that.
I usually have some saltedpeanuts in there or some like

(52:46):
mini cheddars or something likethat.
So, again, salt is somethingyou definitely look forward to,
depending on the race.
Like for the spine sprint, Ihad a bagel with marmite and
cheese which I did eat in smallamounts because, obviously the
spine sprint, you have to carryeverything.
There's no checkpoints so youcan't stock up, so you just have
to have it all with you,whereas with the Lakeland 50

(53:09):
there were checkpoints so youcould grab sandwiches and crisps
and whatever else they hadgoing cheese toasties that was a
good one.
So, yeah, I guess my pack tendsto have a range and I'll always
have some gels and probably somesweets in there as well.
Like board sweets have got meout of a jam quite a few times
when I haven't been able to eatanything.

(53:31):
But if I suck a board sweet itjust helps to again keep the
saliva being produced and thesugar going into the brain.
That's always got me out of apickle at times.
So they're my kind of go-to.
But that's not to say that'swhat everybody else should do,
because that's what I've foundworks for me over the course of
how many years I've been doingultra running.
But when I did marathons andhalf marathons it was always

(53:53):
gels, because you're going fastand so you can't really I can't
chomp and I hopefully can't chewand run fast at the same time.
So it's always a gel usuallywhen I'm doing anything faster.

Speaker 1 (54:06):
I remember hearing you on a podcast talk about the
power of peanut M&Ms.
I was like that's a great ideaI had those at the.
Did you that?
Did you?

Speaker 2 (54:15):
That sounds like a good addition, I tried something
new, which maybe everybodymight.
I actually made my own trailmix up.

Speaker 1 (54:31):
But my trail mix was salted cashew nuts, peanut, M&Ms
, Haribos and mini cheddars,wowzers that sounds very good.

Speaker 2 (54:36):
Yeah, it was a good mix.
I have to admit, like everytime I put my hand in I was like
oh yeah, this is quite cool.
Yeah, I did eat quite a lot ofregistration because I didn't
realize that registration wasgoing to take quite so long, so
then I had to repack my bag.
It's all all fun and gamesbrilliant.

Speaker 1 (54:49):
Now you are the author of of quite a few books
and we always ask on thispodcast for books that have
helped you on your journey.
So what books would you do youfind yourself other than your
own recommending to yourpatients, or what books helped
you?

Speaker 2 (55:06):
so I really like reading books about human
behavior because I think if youunderstand human behavior, you
can definitely help your clientsa lot more.
So I do read quite a lot ofpsychology textbooks and and
things like that.
But I think the two books thatI do recommend quite a lot is
Radical Acceptance by Tara Brack, which, if you don't know who

(55:31):
Tara Brack is, look her up.
She's absolutely phenomenal.
She's a psychologist that hasbrought eastern and western
practices together, and it's alittle bit how I like to
practice myself.
So I actually did mymindfulness training through her
organization and so Idefinitely bring mindfulness
into my practice because I thinkthere's a lot there that can

(55:54):
help individuals.
And then the other book that Ido recommend quite often is the
book by Kimberly Wilson, how tohave a Healthy Brain, which I
think is fantastic.
It's a really well-written book.
She'd be a good person for yourpodcast as well.
But yeah, it's a verywell-written book in that it's
very simple to use.
You think of.
The brain is a very complexorgan and I just love the way in

(56:17):
which she has helped you tounderstand how the brain works,
but also the psychology of thebrain as well.
So I think it's a very goodbook brilliant.

Speaker 1 (56:28):
Those are two books that have not been mentioned
before, and I love the sound.
I've just actually finishedreading headstrong by dave
asprey, which is also aboutbiohacking the brain and
boosting your mitochondria andall that sort of stuff, so that
sounds brilliant.
I'm definitely going to checkboth of those out.
Thank you for that.
We also have a tradition on thepodcast where we get the last

(56:48):
guest to ask the next guest aquestion without knowing who
that is.
So our last guest was DeanKarnasas, so you're getting a
question from a very renownedrunner, and I think Claire's got
Dean's question.

Speaker 2 (56:59):
So this one's going to be an exciting one.
To answer how important isinnovation to you and how do you
innovate?
I think innovation is reallyimportant when you're thinking
about how to get a client toengage.
You know it's not all justhere's a nutrition plan and off
you go.
You have to really get tounderstand that person.

(57:19):
You've got to think about thebest way to get them engaged
with you.
So I find it a really importantaspect of practice.
How do I innovate?
I'm quite good at thinkingoutside the box, like when I
left the NHS I got told I'll bereally good at my own practice
because I think outside the boxtoo much, and I've taken that as
a compliment and moved forwardwith it.
So I spend a lot of time in myhead.
Even my partner says that Ispend a lot of time in my head

(57:41):
thinking about ways in which Ican make the world a slightly
more bearable place for mostpeople.
I don't know if I can think ofan exact technique that I use,
but yeah, I definitely look fordifferent ways.
I suppose more about how tomaybe describe things.

(58:02):
So, for example, I had a younglady I worked with a few years
ago.
She had very severe autism andshe was really struggling with
understanding the importance offueling her body and really just
struggled with it.
And I sort of said if you thinkabout your body as a garden,
you need to tend to your garden,you have to water it, you have
to feed it, otherwise it's goingto go to pot.

(58:23):
And she said she found thatreally helpful way of being able
to visualize looking afterherself and actually fueling
herself and feeding herself in abetter way.

Speaker 1 (58:33):
So I guess that's the kind of thing that I would try
and come up with that'sabsolutely fantastic, and the
beauty of having ultra runningas your sport is that you've got
plenty of time to think andmull over this stuff and process
it, haven't you and in fact,actually that's one of the
conversations we have with DeanKarnasas was this wonderful gift
of thinking time, whether it'slistening to books or whether

(58:55):
it's processing and innovatingaround that.
So, reena, this has beenabsolutely brilliant.
There is so much there.
I've written loads of notes,lots of really great advice for
those people that are listeningthat are maybe thinking they
need help with some of the stuffthat you're talking about,
whether it's eating disorders,reds, or whether it's just
wanting to know more about youand your running.
Where's the best place for themto find you?

Speaker 2 (59:16):
so do our website, which is reena mcgregorcom,
which tells you more about whatwe do from a clinic point of
view.
And then the best place toreally know more about me is my
instagram, which is r underscoremcgregor, which is definitely
more of a educational platform.
Like I definitely don't divulgedeep, dark secrets of my life
on there, it's not that kind ofaccount.

Speaker 1 (59:39):
That's fantastic, Rini.
It's also been reallyinteresting to hear you and
Claire discuss things.
It sounds like you're bothpreaching to the choir so
fantastic.
Thank you very much and thankyou for the work that you've
done.

Speaker 2 (59:49):
Thank you so much for having me.

Speaker 1 (59:54):
It's been a real pleasure.
What did?

Speaker 2 (59:56):
you make of the conversation with reeney.
It's fantastic.
It's good to catch up withsomebody within my own field as
well, so aligned within my ownfield.
So it's really good to to hearsome of her comments around
eating disorders.
We talked a lot, didn't we?
Over covid how that increased.
What about your thoughts?
You're in a differentprofession.
What did you take away from it?

Speaker 1 (01:00:13):
there was loads of really interesting stuff in
there.
For me, the bit I was going toask you about was the Zoe piece
really interested me because Iget why Zoe is.
Clearly having a personalizedapproach to nutrition is better
than an AI app is going todeliver.
And let's be honest, if we takeTridot, the AI coaching

(01:00:33):
platform, if you're aprofessional and you're going to
be paying a coach to trulyrespect, if you're Kristen
Blumenfeld, are you going to geta better program built by a
professional coach?
Yes, you are, but for 99% ofpeople they're not going to be
paying £1,000 a month for a topprofessional coach.
Therefore, the AI does a betterjob.

(01:00:54):
So I'm just really, I was justreally intrigued by that Zoe
conversation.
If Zoe helps people eat a morediverse diet and it gives them
more awareness of how they reactto different foods, that to me
seems like a positive.
But equally I'm appreciative ofthe fact that sometimes those
apps can drive people to excludefoods they should be eating.

(01:01:14):
So that, to me, reallyintrigued me and I suppose I'd
ask, as a professional dietitianand nutritionist what do you
think of the ZOE app and Rini'sapproach to it?

Speaker 2 (01:01:23):
From a clinical perspective, as a dietitian and
working in eating disorders, Isee where Rini's coming from,
and I think there were two partsreally to what Rini was saying
there.
I think, firstly, that she wasquestioning some of the studies
that were coming out.
They're collecting huge amountsof data in science.
It's really difficult to getpeople to do trials.
I think it's amazing howthey've actually managed to get

(01:01:45):
people to pay to collect theirdata actually in the world of
science.
Maybe this is moving into awhole new realms of actually we
can do better clinicalcollection of data because
people are paying for things.
I haven't read all the trialsinside out so I can't comment on
that without reading it, but Ithink she's right to question
when this isn't telling thewhole story.
So I think that's really goodthat we should always be

(01:02:07):
questioning the data that we'rereading, and that's something I
always talk about.
Actually, where's it come from?
Is there any invested interestin the trials, etc.
But think here, like I say, Ithink it gives scope to more
data, as long as that data is.
The trials that are coming outis something we can, you know,
do with.
It's interesting because whenyou collect data, if you're
thinking of eating disorders.
It doesn't have to be eatingdisorders, whether it's a watch,

(01:02:29):
a band, a ring.
We look at the data andactually sometimes it does drive
you to think I need more sleep,rather than listening to your
body.
Sometimes it does drive you todo I need more sleep Rather than
listening to your body.
Sometimes it does drive you todo something because it's almost
telling you that you need tohave more sleep or you need to
rest or whatever, withoutactually thinking do I feel okay
?
Blood glucose monitors, I think, are a way of finding out a

(01:02:49):
little bit more about yourself.
But you're absolutely right, Ithink for some people, truly, it
would really help them, nudgethem in the right direction,
that they need to be making somechanges that potentially they
kind of knew.
So let's take it as an exampleof somebody, maybe, who was
rushing around, they weregrabbing things on the go and
they knew they needed to dosomething about it, but actually

(01:03:09):
having the data in front ofthem nudges them in the right
direction.
And then they see, byintroducing more plant-based
foods or different types ofcarbohydrates, that actually wow
, I can see a change.
So I think for some people,generally, on a general level, I
think, nudging them towardshealth.
I see the flip side.
I see the flip side in terms ofwhen you generalize something

(01:03:30):
and you put something out tosell to the population, you
can't give individualized advice.
You just can't.
And whilst they havenutritionists working for them
that gives them an idea from thedata they're seeing, you can't
go into the nitty-gritty details.
The problem is some people maynot see the full story.
So, for example, poor sleep andthe effect that has on our

(01:03:52):
stress, cortisol levels, thatmay increase blood glucose, but
you may not necessarily knowthat because it's generalized
data.
I think in the world of ai Iknow this is your area, charlie
like in the world of ai, but Ithink in the world of health,
it's about reducing risk forcertain more vulnerable groups,
for example with eatingdisorders.
But it's also how can we use itto our best advantage to help us

(01:04:16):
as dietitians, as nutritionists, be able to actually provide
better support to people.
I can absolutely see how, if youhave an eating disorder, if you
went and did a run, like afasted run as an example, when
you finish you're likely to seeyour blood glucose really rise.
If you were then about to havebreakfast or about to have lunch

(01:04:37):
but you saw, oh well, it's toohigh.
I can't eat because it's high.
That's just a physiologicalresponse.
Your blood is still pumping outglucose from a fasted run.
It doesn't mean you can't eat,but that could be taken as with
somebody with an eating disorderI shouldn't eat because my
blood glucose is too high.
So I think if you teach someoneproperly that sits in a good
place, but also any devices,somebody with an eating disorder

(01:04:59):
looks at the number of stepsthey do.
One day it's 12,000, and now12,000 is where they have to be.
Next day it's 14,000, 15,000.
So I think it's reallychallenging in an environment
now with so many ways to trackthings.
We're not going to get awayfrom that, but I see where
reading is coming from in termsof potential risk, especially
for people more vulnerable withan eating disorder.

Speaker 1 (01:05:21):
It's interesting, isn't it?
Different people do differentthings with it.
Both my daughters are at school, diligent and hardworking, and
so when teachers in their wisdomsay, look, you've only got this
number of months between nowand doing your A levels or GCSE,
they get stressed out.
They would have done the workanyway and they've just been put
under more pressure than theyneeded to be.

(01:05:41):
For the boys, like I was atschool, that are lazy, that do
the bare minimum, they need thekick up the ass to go.
Come on, you've only got thisnumber of months till your exam
because otherwise I do nothing.
One approach for everyonedoesn't work.
Bespoke nutrition advice isalways better, isn't it?
But I suppose for some people,zoe's going to help them.
For some people zoe's not goingto help them, but probably for

(01:06:05):
the majority it's going to putthem a step in the right
direction.
Going back to try not forobsessive, compulsive, like a
typical iron man athlete wouldbe, often actually reduces their
training, because actually alot of iron man athletes over
train and it often the trainingprogram is lighter than it would
have been if you'd bought anoffice, you know, cookie cutter

(01:06:28):
type one or through atraditional coach.
And in some ways ai is reigning.
With another interesting thing,we talked about red s and eating
disorders.
You asked about what calamityhave you had with your own race
nutrition, the salts, theelectrolytes piece.
If your stomach's upset, thatcould be your electrolytes, and
if there's other things goingwrong, that can well be

(01:06:50):
electrolytes and it's thinkingabout.
Am I getting electrolytes right?
If you're feeling low in a race, have you eaten enough?
That was interesting and goodadvice when training or racing.
If you're not feeling like oh,I'm loving this, then the first
questions to ask are is mynutrition right and is my
electrolyte balance right?

(01:07:10):
That's the first thing to fix.
Was there any other quicktakeaways that you got from the
conversation with Rini?

Speaker 2 (01:07:14):
Her biochemistry background is really interesting
.
That is extremely helpful whenlooking at blood biomarkers.
From a training perspective,she explained that well.
Recovering from relative energydeficiency can take a year and
a half and I think it was reallyinteresting to listen to her
talk about actually it's not asquick as you see on the surface
sometimes that actually there'sso much recovery that needs to

(01:07:36):
be done, so that for me Ithought she put that across
extremely well and it does takea long time.
Actually, on the flip side ofthat, there's a period of time
that it takes for you to get inthat position as well.
So it makes sense it takes along time to get back to that
full level of fitness.

Speaker 1 (01:07:51):
I think that ties I think also it's very with
nutrition in particular.
It's very easy to get caught upwith short-term stuff, isn't it
?
Particularly, zoe App isencouraging you to think about
your blood sugar today, whereasactually the long-term impact of
doing this wrong and sufferingfrom red S for longer periods
was an interesting part of theconversation.
I think people do need to thinkabout making sure that their

(01:08:12):
nutrition is right, not just forthe short-term, but the
long-term impacts are so great.
There was loads of greattakeaways, great advice and
really interesting to hear youguys talking about your
professional subject together.
Lots of takeaways for everyoneat home.
And keep on training If youwant us to keep getting amazing
guests onto the Business ofEndurance podcast.

(01:08:33):
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(01:08:54):
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