"Hormones, Health and Human Potential" with Dr Nicky Keay

EPISODE 183

[INTRODUCTION]

[00:00:00] LB: Hello and welcome to the Institute of Performance Nutrition’s We Do Science podcast. This is episode 183. And I am Dr. Laurent Bannock, the host. 

Now, today was a particularly enjoyable discussion. I say particularly. I love all my conversations, which is why I love podcasting. It's such an honor to have fascinating conversations with world-leading experts and practitioners around the world. And today was just such an example where we invited back Dr. Nicky Keay, k a medical doctor and a researcher particularly focused in the area of sport and excise medicine with a particular interest in nutrition, hormones and so on. And it is hormones in particular that we focused our conversation on today. 

In the past, we've done another great conversation that formed a relatively recent podcast all about relative energy deficiency in females in particular. You've got to check that one out. But today we talked about hormones and their impact, their role, their influence on health, human performance and potential. And this was sort of underpinned by Dr Nicky Keay's recent book on the topic. But she's got quite a lot of publications in the peer-reviewed research on this and is well known on the academic and professional speaking circuit on such a topic. 

What do we talk about? Well, we talked about how hormones play a crucial role in determining health. How hormonal networks provide the feedback mechanisms by which our lifestyle, and behaviors and neighbors to reach our personal potential. We delved a little bit into the classics where we talked a bit about Hippocrates, Sophocles, Aristotle, which I particularly enjoyed and how their opinions, their recommendations thousands of years later are just as true now as they were back then. 

And we looked at factors such as lifestyle influences that influence these hormonal networks. The importance of harnessing hormones as sort of a preventative and supportive medicine. We obviously got into the topic of how hormones will mediate athletic performance. We discuss in quite some detail the concept of hormonal imbalance, dysregulation in particular, and how lifestyle habits and behaviors are particularly influential to this as environmental factors that can play crucial roles in supporting or disrupting hormonal balance and function within the body. 

Anyway, you're going to get to learn all about that in our conversation in just a minute. But before you do, I want to use this as an opportunity to make the big announcement I've been inferring in previous introductions to podcasts where my big news is that the IOPN diploma in sports nutrition has achieved international accreditation by CI, OfQual accreditation. It's a regulated program now at the master's degree level. 

It's just an amazing achievement for my team and I to be able to announce this. You can learn all about. It is the only level seven master degree level practice focus program in the world. And we're extremely proud of this. Whatever your background, sports science, sports nutrition, dietetics, personal training, strength conditioning, if you want to upskill, if you want to develop yourself as a specialist, as a practitioner in sport and exercise nutrition, you're going to want to check out our program, which is fully accredited, which opens up a lot more doors in many different ways. 

Anyway, come to our website at www.theiopn.com to learn more about our brand-new version of our diploma, our accredited version of the diploma. And whilst you're there, check out our podcast section where you get to read about the notes and papers and so on that we discussed today, and our previous podcast. And of course, our software platform, SENPRO, which is designed to support your work as practitioners either in private practice, online coaching in team settings to get the most out of your nutrition coaching and your nutrition strategies with your clients. And a bunch of other stuff that you can read about on our website, news, blog, various other things that we're developing. Come check us out, www.theiopn.com. 

Now, without further ado, here is my conversation with Dr. Nicky Keay about hormones, health and human potential. Enjoy. 

[INTERVIEW]

[00:04:53] LB: Welcome back to the Institute of Performance Nutrition's We Do Science podcast. I am Dr. Laurent Bannock. And today my guest, another one of our wonderful repeat visits, and in this case, it's Dr. Nicky Keay. How are you doing, Nicky? 

[00:05:08] NK: Fine. Thanks for having me back, inviting me back. 

[00:05:10] LB: Well, it's your fault really for several reasons, one of which is I really enjoy talking to you generally. You're a minefield of information. And like many of the guests I tend to get on who have, yes, a great deal of academic, training, expertise, research and so on behind them, they've also got extensive backgrounds for the most part in practice. 

As a medical doctor and someone with extensive research and publications and so on, I always know that we're going to have a useful conversation, Nicky. But the reason why it's your fault is because you've gone and written a book now. And we were just joking offline how it's always an interesting thing. We've both delved into publishing peer-reviewed research. You've done a lot more than I have. But we know what's involved in doing that. And it's pretty hard work particularly the peer-review aspect of it when other people start to hammer away at your hard work. Not always improve it, I should say. At least in the opinion of the author. 

But a book's an interesting thing nonetheless. And that goes into the other thing that we were talking about before, which is about this business of impact. And it's rather interesting how books are much easier in terms of access, the barrier to accessing information such as what's in your book both in terms of being available in bookshops and Amazon or whatever. But also, the language that's used. The way in which you communicate.

And there's just something about having a book, a paper that ultimately – and we're not recording the video here. But you've got something that's stapled together and it's a downloaded PDF. But a book, it's so nice. Look, we're going to talk about something slightly different from what we've talked about before. We talked about relative energy deficiency in sport, female-centric particularly, in terms of health and human performance. I'll link to those podcasts because they're well worth listening to, of course. 

But today, we're going to have a chat, which will only be a peek into what is a massive topic, which is hormones. And the title of your book I think sums this up well, Hormones, Health and Human Potential. I read this book. I only finished it a few days ago. So, it was fortuitous or good timing.

What struck me about this book was the way in which that you sort of set it up a bit like a play with acts and scenes. And I thought that was super clever actually because it made it easier for me to get to grips with the sheer magnitude of influence that hormones has on the body. And I got some knowledge on this topic, but it actually – it helped me realize how much I didn't understand about this. I'm really excited to have you back here, Nicky. 

So, look, before I get you to do all the talking here, let's just have you reintroduce yourself because not everyone's heard previous podcasts and may not know who you are. If you could introduce yourself, Nicky, that would be really helpful? 

[00:08:16] NK: I'm Dr. Nicky Keay. I'm a medical doctor. And I'm an honorary clinical lecturer at UCL in London. And like you mentioned earlier, I sort of have two hats on, I suppose? I do love research. And at UCL, of course, that's great to be able to do studies, looking at the effects of exercise nutrition on hormones, funnily enough, and my favorite topic. But it's all about then putting that into practice. 

I'm also a medical doctor practicing. I work with men and women of all ages and all levels of exercise competence, from elites to non-elites, to advise them really on what I've said in my book. How to reach your full potential? Whatever that looks like for you. Whether it's trying to win a gold medal or whether it's just you want to be able to, like me, go and do decent ballet classes four times a week or whatever. Whatever it is. That's what I'm about. 

I love research and delving into all the intricacies. And like you said, getting those hard-earned peer-review published papers. But I also like things to be practical. That's why I'm a doctor. I like dealing with people and helping them to explain and understand what's going on inside their bodies so that they can reach their full potential. 

More and more, as I get older as a doctor, it's not just illness. Because health isn't just the absence of disease. It's about that positive well-being, physical, mental and social health. That's my sort of clinical side of me as well.

[00:09:49] LB: Yeah. Well, also, from your book, apart from some interesting snippets from the classics, I was quite interested in the perspectives of the old masters, so to speak, Hippocrates, Sophocles, Aristotle and so on. And you can't help – particularly if you're involved in things like nutrition, or health, or wellness, you always hear these quotes. They come up periodically. And yet, it's so interesting how some of this stuff really was the ultimate in sort of smartness back in its day. 

But of course, back in its day was a long time ago, and what was sort of normal or typical back in those days is not remotely close to what's normal or typical now. I mean, we live in the most chaotic, bizarre, bonkers world that's also a bit toxic, and weird, and strange and so on. 

And of course, what is relevant, of course, to this conversation that we're going to have today is the human body is this interesting vessel of complex molecules, and organs, and bits and pieces. The sort of eloquent salty bag of hairy soup as I've heard it described, where, of late, there's been some progress on understanding that hairy bag of salty soup, such as genes and genetics. Sort of decoding of the human genome. And of course, the microbiome is an area I'm particularly interested in. And then there's hormones, of course. 

And there's aspects of this that one has been led to believe through evidence-based sources that we may or may not be able to impact some of these things. And then we come full circle now and go, "Actually, maybe we can. Maybe the environment is important." And of course, as a nutritionist, exercise physiologists, etc., we are talking about profound environmental influences. And I find that really exciting, Nicky. But before we get into this topic in any depth, I think it would be useful if you could just give us a little bit of background about why you wanted to write this book. 

[00:11:52] NK: Well, wow! Where do we start? From what you've said already, the thing is my job as a doctor has become more and more, as I say, not just treating illness and disease, of course. That's very important for medicine that we continue to do that. But actually, maybe we have lost sight of the things that Hippocrates suggested were the surest way to health. 

And actually, rather than calling him the father of medicine, really, he's the father of health. It's like there are proactive things that we can do under our control to ensure the safest, surest way to health. And so, that got me thinking. It's like, "Well, what is this mechanism?" Like you say, what do we have control over? 

And actually, it boils down to the things that Hippocrates said; nutrition, exercise, and I'm going to add in their sleep. And so, I wanted to write the book to empower people or give them the power of knowledge about these hormones that are this conduit, this way of shaping our health. And that because hormones are influenced by what we do, our lifestyle choices, our behaviors around exercise, nutrition and sleep, then, lo and behold, we can control. 

As you say, there's the chaotic world outside, the environment and stuff going on. Not all of it good, frankly. But at least we have got control over some of the things that we do in terms of the exercise and nutrition, etc. And so, that's really a positive message. 

And the human genome, as you say, it's amazing and fantastic. But that's just a blueprint. It's just a script. It's just a musical score. It doesn't say how it's going to be produced. How's it going to actually sound or look like? That is very much up to us. 

And also, the other thing you said, "Oh, well, these guys, Hippocrates and co., the staff from ages ago, they were saying this." Is this really relevant today? Yes, the environment has changed. Of course, they didn't have cars and all that sort of thing. But fundamentally, the physiology of our body is the same. I.E., the action of hormones. The hormones were there back then two thousand years ago. The hormones are here now two thousand years later. And they've still got the same mechanisms of action. They go into the cell and they tell the DNA what to do. They tell the DNA, "Right, we want some of this protein, that one, whatever it is. We want this amount of it. We want it right now. We want it in about a week's time or whatever it is." The fundamental things that are happening in our body were indeed happening in Hippocrates' time. 

Although we say, "Well, can that be relevant? All that old-fashioned stuff? Because we're in such a different world." But actually, what's happening inside is constant, which is reassuring. And also, reassuring because now we understand that we can influence our health. That's actually really positive empowering message. That's essentially why I wrote the book. It's kind of putting all the stuff that I have learned over however many years it is. Wait. Not as many as Hippocrates. It's true. But lots of years of being a doctor, I've learned all this – Well, not – when I say learned, I've experienced this. I've seen this in practice. It's like, "Okay. Fine. This is one learned about these things at medical school. There's this hormone that does that and whatever." But then you actually see it in practice, in a person, and working with people and advising them on the timing of when they're going to do their exercise, their nutrition, etc. And seeing the results of that in how they feel in their health, in their performance, that's actually really – Yeah, really satisfying, really positive. So, I wanted to share some of this in the book. 

By the way, one other little thing. Why I wrote the book in the form it is in the sense of I have a prelude and I have act one, act two, and the scenes within that, and a coder, of course, it is – Number one, mainly, because I love ballet, as I've said. I just wanted to give a reference to that. I thought it's a little bit more interesting than the normal thing you see in books. But the hormones are the protagonists. These are the members of the orchestra, because the endocrine system, all the hormones, the network of hormones, that's often referred to the pituitary gland being the conductor of the endocrine orchestra, which one sort of appears at medical school. 

But then I really thought it through, and it's like, "Oh, my goodness, that's so beautifully exactly what it is." Each hormone group, as it were, like the thyroid hormones, they're like the strings, right? That's them. And then all the different hormones you can think in their little bits in the orchestra. And they're all being conducted at the front, or in the brain in this case, by the pituitary gland. And that's what I mean about the school will be the same in each of us. 

But the way it's performed and comes across will be different for each of us and also influenced by what's going on outside. What's the audience reaction going to be to like that and all that sort of thing? That's why I sort of chucked in a few little things to make the book a bit unique. 

[00:17:16] LB: Yeah, but it actually helped one understand what it is that you're trying to explain within the writing. I mean, ultimately, we are talking about something that is insanely complicated science. Sort of the endocrinology, the physiology. I mean, there's a lot here.

And in human performance, which is obviously the focus of where we're at on this podcast, particularly from a nutrition perspective, is all about achieving optimal performance. But of course, as I say many times, we're dealing with human beings, and human beings aren't just athletes. They are men. They're women. They're old. They're young. They've got problems. They've all got hormones. And if we want to get the best out of our athletes out of our human beings, we need to have a better understanding as to what we're dealing with. And it's by understanding the strengths, and limitations and the characteristics, etc., of the tools, the strategies, the advice, whatever it is that we're trying to do. I think it all helps. And that's why I love the way that you've done this. 

[00:18:22] NK: But to go back to that, what you said, Laurent. Just picking up on that. That is a different way of writing, because writing a paper for a journal. Exactly. You've got sort of a set format of putting it. And words are very like this. But in the book, I was trying to do something different. I'm trying to convey the information to people who won't necessarily be doctors. In fact, I suspect not many will. Or in sciences. And maybe it's just sort of a biology level somewhere back in the dim and distance past that they've done, past. Trying to make it more so you can imagine it, that's how I do this for myself. 

I literally imagine I do actually have this orchestra in my mind. And I was explaining this to someone who wasn't medical and wasn't at all scientific. But when they said, "Oh, I see what you mean. If one of the violins is out of tune, that could throw the whole thing." It's like, "Precisely." 

That's why I wrote it like that, like a story, so you can see how it all fits together. And also, why it is essentially very complicated. But it makes more sense if you think of that orchestra. And if one group of instruments or even one individual orchestra is a bit off, it could put the others out of sync. And also, if the conductor isn't up to it, you see something's going wrong there, it kind of makes more sense. There's sort of – the sequence is more easily understood in that context. 

[00:19:55] LB: Yeah, absolutely. Well, look, there's no doubt in my mind that there is a clear need to have the scientific papers and so on, which of course many of my episodes on this podcast, as we delve very, very specifically on very niche topics with researchers doing that very particular bit of research. Sometimes I like to scroll out, zone out a little bit and talk to practitioners working in the field. But ultimately, we need to have an idea about what this means to the whole human being so to speak, which makes me think about some of the conversations I've had on this podcast particularly – I'm going to forget everyone's names, which is a terrible thing to do in a in a live. 

For example, we did a podcast about integrative physiology with Professor John Hawley. And then there was another conversation with John and Louise Burke. Of course, not everyone knows that they're married. This is an interesting thing. But that was a particularly interesting conversation where we talked about the importance of looking at the human body as an integrated system as opposed to just a part, which of course in medicine, for example, it's very easy to pick up a textbook and go, "Right. The endocrine system. The digestive system." Blah-blah-blah. But actually, it is an integrated system, but it's all too easy just to say that also. 

Anyway, coming back to hormones, Nicky, I think it would be really helpful if you could start off with just a bit of an overview or a definition of what hormones actually are. And how that term – who came up with the term hormone and why? Because that was a bit that I found particularly interesting in the book. 

[00:21:41] NK: Hormones, in the textbook that I read as a medical student many years ago, it's like hormones are internal chemical messengers transported in the bloodstream. That's really, really boring description of them, right? It does give you an idea. It gives you a little hint. Okay. These guys could be important because they're traveling around in the bloodstream. We know that circulation goes anywhere, everywhere in the body, all the cells. That's actually interesting. But it does them a massive disservice what do they actually do? 

And where does the word hormone come from? It actually comes from ancient Greek. Sort of homage to Hippocrates and co. Meaning to setting in motion. It's a present participle. That's what they do. They travel around in the bloodstream. Sure. That's how they get around the body. But setting in motion, it refers to their action on DNA. 

When a hormone arrives at a cell, wherever that is, the first thing it does, it needs to get into the cell. Not simple. But anyway, it gets into the cell and it makes a B-line straight for the nucleus where the DNA is and it directs gene expression. I.E., it selects out a particular sequence in the DNA and says, "Right, we want that one. Transcribe please. We want that particular protein made." That is where the word – the derivation of the word hormone comes from, setting in motion. 

You see? It sets in motion your DNA. It brings the DNA to life as I say. And that's pretty crucial. Because going back to your point about the body is this integrated system and not separate systems, my argument would be, of course, that the one integrating all of the systems are the hormones. Because the hormones say direct the gene expression. Which protein to produce when? Which the other systems will use, the heart, the cardiovascular system, "Yeah, we want some of that heart muscle." They'll lean on basically, the endocrine system, the hormones, to give them the goods or whatever it is that they need to carry about their business. The gut, it needs a big – There's a big turnover of cells in the gut. The hormones are busying around telling the DNA to produce more of that protein that we need to replenish the gut cells. You see? 

I'm going to argue, of course, that that is – Thank you. You like the argument so far? 

[00:24:09] LB: I do. Yeah. 

[00:24:11] NK: Yes. Good. They're really the boss. They are setting in motion all of the systems of the body. They're in charge, you know? Anyway, that's my argument. And, yeah, that's where the word comes from. And I think it really sums it up rather nicely. And that was only at the beginning of this – Well, this century, last century. Early 1905 I think, something like that, was when they discovered the first hormone and named it as such. You see? It's only relatively recently that we've realized that these are not just chemical messengers. They're not just careers. They're actually big organizers.

[00:24:47] LB: It's interesting, because if we look at this from the perspective of what's just going on inside of the body, you get a certain perspective. But when you look at how this body, this vessel, is also interacting with its environment, it then becomes absolutely mind-blowing, doesn't it? 

Do you want to just quickly delve into that? Because I think it's very easy for us to look at charts and diagrams in books and infographics. Or people will use simplistic statements as I just did deliberately. Because I think if you listen to an hour's podcast on the concept of the importance of integrated biology, it's more than just two words, you know? It's the same thing with what you're saying. 

But it is such an important thing that you've just said. And like you said, it's only like yesterday, really, that in terms of scientific discovery that we sort of realized this, which repositions how we have to look at everything as scientists or practitioners. But this fact that it's not just an internally-focused mechanism is what I'm particularly interested in. 

[00:25:47] NK: The hormones – I mean, looking at the internal thing. They're doing a really, really important task, as we've described. And trying to keep everything nice and stable, homeostasis, everything working perfectly inside. Fine. Great. They can carry on. But none of us live in hermetically sealed boxes. There's stuff going around. And we've got to eat. We exercise. We do other things. Whatever happens on the outside. It was kind of puzzling. 

If you just stop for a moment and think, "Wow! You're encouraged to go and exercise," for example. Because if you exercise, we know you will be healthier and you will get fitter. You do that for a reason. But how does that translate? How does it actually translate doing the exercise to a few days later you are indeed fitter? What's happening in between? 

And like you say, this is the connection, the communication between the outside, what we're doing, our behaviors, what we eat, etc., exercise, and the hormones. And it is no coincidence, by the way, that the conductor of the endocrine orchestra, the hypothalamus and the pituitary gland are located guess where? Right in the depths of our brain just where the optic nerves cross over, the optic chiasma. 

They're in prime position to monitor not only what's happening in the inside. Of course, that's super important to maintain homeostasis. But they are keeping a watching brief on what we're doing on the outside. They're going to – when I say they, the hypothalamus and pituitary, they're sort of a duet of conducting the endocrine orchestra. And they're going to have a look at what's happening outside. Night and day is the obvious one. How we interpret what's going on in the world? And this is really interesting. 

The exercise and the nutrition I think we can sort of see, "Okay. They can keep a watching brief on that." But also, how we interpret events? People talk a lot about stress. Really, we should say stress order for being strictly scientifically correct. 

For example, if you have a very busy day at work and you've got a whole pile of stuff to do, you perceive feeling, "Oh, my goodness, I've got a lot of stuff to do." But where do – that's just a feeling. That's an interpretation of events. And that is processed, of course, in the brain. And it's right next door to the endocrine axis, that gatekeeper, the neuroendocrine gatekeeper. The hypothalamus and the pituitary, that duet. And so, they will – the interpretation. 

This is the really fascinating bit. Psychology, how interpret events, which is going to be individual for all of us, that will affect your hormones. In terms of responding to a stressful situation, a stressor. If you interpret that as indeed that is a stress, that's a problem, then that will increase your cortisol. You see? 

That's the really interesting integration between the outside and the inside. And I have to say, as an old-fashioned doctor, and I am old now, as my children remind me. In all senses, the word old doctor, I used to – as a youngster, it's like, "Oh, all this psychology stuff. I wasn't like that." Whatever. Now, I want the blood test. I want the facts. I want the thing. But now, the more and more I see of the world, I learn. Just observe. And also, in my practice and in my research, I see truly that how people interpret. For example, athletes that are stressing about they think they're not the right body shape. They think they should be slimmer. They think they're eating too much. Etc., etc. How they process that, that affects their hormones. It lowers T3, for example. 

I mean, if you just think about that for a moment, that is absolutely incredible. How you process information affects your hormones. Hence, I rest my case. But hormones are amazing. Really important things for your internal health. But also, they are the conduit and they communicate with the outside world in terms of what you actually physically do, exercise, nutrition. But also, how you interpret that world. 

[00:30:00] LB: Yeah. And I think particularly if you've studied sports science, exercise science, sports nutrition and so on, we get used to terms like adaptations to training. And we're very into cause and effect. You know, we exert sufficient exercise stressors that elicits a number of influences on the molecular machinery that brings about various adaptations that makes us bigger, faster, stronger hopefully. And we know that nutrition, for example, and lifestyle, and sleep and so on can have an impact on this. 

But again, it's often looked at and described again in textbook chapters and diagrams as a very static thing. But it's this constant – it's just going on all the time. It's sort of chicken or the egg? Egg or the chicken? Chicken or the egg? Egg or the chicken? I mean, it's just going on all the time. And there's just so much going on with all these different stressors which we're just immersed in all these different stresses all day long. It's utterly fascinating. 

And that's something I want to get into in a little bit, is what triggers different hormonal sort of releases, if you like? And how are they received under different circumstances and so on would be something I think would be quite interesting. And of course, there's the idea that there isn't just one single factory in the body for hormones. They are produced in different places. And they have different levels of effect in terms of how proximal their actions are. 

But just quickly to come back to the network, if you like? I think that's particularly interesting, particularly for us as sports nutritionists or sports scientists, given we're interested in the things that affect performance. Tell us a bit more about the network.

[00:31:50] NK: Just as a human being. No individual hormone works in isolation. For example, the thyroid axis, that controls metabolic rate. There are different levels. I'll just give you an example. I don't want to get too technical. But the boss, the conductor of the endocrine orchestra release – the pituitary gland releases TSH, thyroid-stimulating hormone. That goes to the thyroid gland in your neck. And that thyroid gland releases T4 and T3, which go off in the bloodstream to have effects around the body. That works very nicely in a nice little feedback loop, so everything is nice. Homeostasis kept in a really optimal range. 

But you might disrupt that, by the way, if you don't eat enough. Because now the body tries to down-regulate the metabolic rate. That's a hormone, one single hormone loop interacting with the external environment. Okay. That's sort of straightforward. 

But now you're talking about hormone networks. There will also be – if you're not eating enough, particularly carbohydrate by the way, not only will it affect the thyroid axis. It will also be perceived as a stressor by the hypothalamus and the pituitary, which will increase the secretion of cortisol, a hormone we've already mentioned, which is secreted from the adrenal cortex. 

And the effect of cortisol also has an additional effect on the thyroid axis to really downregulate that production. It prevents the conversion of T4 to T3, for example. Okay? That's an example of just two hormone axes interacting. 

Okay. Now, let's talk about all the other axes, right? Now, there's the reproductive axis for men and women, which is going to be interacting with the external world and also with other things going on in other hormone networks within the body. This is what we mean by networks, that they all are talking to each other and influence each other. Because ultimately, they've got to work as an integrated system. As any engineering system, they've got to talk. That's what we mean by the network. 

Doing one small change will have a knock-on effect. Your nutrition, your breakfast, whether it's appropriate or not, will have a knock-on effect on all the hormone networks in your body. And therefore, ultimately, if we're thinking longer term, "How does that manifest itself?" It will – for example, if you continue not eating sufficient or in the correct amount and etc., then ultimately, in the long term, that will have problems for you overall in terms of your performance, if we're talking athletic performance. 

There are multiple levels of hormone interactions with the outside world and with their fellow hormones. And all of those combine to have a net outcome on your health and your performance. I think that's also sort of relevant to sports nutrition, that sometimes in similar sort of situation in medicine, that sometimes people proclaim that one particular thing, "Oh, if you eat this, if you eat X, you will become an Olympic athlete." It's like, "Hold on a second. That cannot possibly be right. Because that is not how the body works." You can't look at anything in isolation, because it will have a knock-on effect on many things. And also, it's the interaction of all the things you put in your body. 

There are so many levels of networks and complications, and sometimes you have to sort of step back, I think, and look at the overview, in the practical point of view. All the theory of it is fantastic and brilliant. But like you say, breaking it too much down, then at some point you've got to put it all back together again. Haven't you? And see what the overall effect is. That's what we mean by hormone networks interacting with the outside world and also within themselves inside the body.

[00:35:52] LB: Yeah. And I love this because we we talk a lot about – I'm obsessed with bridging the gap between science and practice. And one reason for that is because it's very important to understand the translational issues that come with that. And like you use the term disrupter, for example. I think that's a particularly interesting concept particularly when it comes to this exquisite mechanism that, from a very scientific perspective, we would look at. And to use a phrase, my favorite phrase from your book, is you talk about these sort of Goldilocks environments. 

[00:36:32] NK: Mm-hmm. Yeah. 

[00:36:33] LB: In a Goldilocks world, this situation would be what it is. But the reality, as we've discussed, is it's just sort of a very chaotic environment with lots of different disruptors and all sorts of stuff going on. But perhaps you could – now that I've mentioned Goldilocks, maybe you could just quickly go into that and why that's important? Because reductionism is important in science, of course. But that doesn't mean that that's literally how we're supposed to interpret this stuff in the real world. 

[00:37:02] NK: Well, why the Goldilocks? It's like the body is based on biological catalysts, enzymes, which are proteins. And they are indeed fuzzy operators. And they do indeed like a Goldilocks environment. They want it just right. Not too hot. Not too cold. Literally, not too hot, not too cold. Not too acidic. Not too alkali. Etc. 

The body is all the time striving to keep the status quo homeostasis, the Goldilocks environment. But it's got a task on-hand. Hasn't it? Because the environment is changing. And also, our behaviors change. But we shouldn't look on this as a negative. We shouldn't think, "Oh, my goodness, I've always got to do exactly the same thing. And so, I do help – I can maintain homeostasis." 

Listen, millions of years of evolution, the body will do its best and maintain homeostasis and maintain that Goldilocks environment inside, right? In some ways – And so, actually you should throw at it some differences. That's why training works. That's why exercise training works. If you give it a different look, a stimulus, a disrupter, a little bit of a prod on – a little bit of a prod with the cortisol. Like, this is a stressor actually. Then that's fine. Because then the body can and will respond to that. 

And yes, always seeking to get that Goldilocks environment, maintain homeostasis. But it will have some flexibility to do that. It will have a bit of practice literally in doing that. That's why we exercise. That's why we choose what we eat or we should do appropriate, so that we do challenge the system a little bit, a little bit. And that's always the fine tuning, isn't it? What's the balance between optimal exercise stimulus and over-training or under training, right? And what's the optimal level of nutrition? Not too much. Not too little. It's up to us to try and figure out that, the balance of our lifestyle choices, our behaviors. 

This is the other key thing. It's us trying to balance what we do on the outside to give the internal environment, specifically the hormones, just the right amount of – just the right amount of stimulus to up their game. 

[00:39:22] LB: Yeah. But that's what's interesting, is this concept that you refer to as the Goldilocks environment. And again, you talk about the sort of the architecture of a driverless car and all the different things that would be required for you or I to sit in that car, read a newspaper, or actually read your book, of course. 

[00:39:47] NK: Quite right. 

[00:39:48] LB: And be sufficiently able to not be stressed by the many potential accidents that could be occurring, or running out of fuel, or all these other things is of course a very idealistic view of how these things operate. Whereas, of course, if you disengage the the driverless car function and you are yourself as a human being, maybe a bit jumpy, maybe a bit distracted listening to music, or the audio version of your new book, Nicky, is a different setup. And I'm rather interested to know – again, I used the term chicken or the egg. Or is it the hormones or the environment? Or is it the environment or – But at the central part of this of course is the driver. But who is the driver and when? And I think this starts to get rather interesting. I guess if you take it from a mind over matter perspective, at what point do we change drivers? Or do we go to having no drivers like when we're asleep or whatever? Is there a – 

[00:40:49] NK: Yeah, that's the brain. I mean, the brain in general terms. But I think the driver is always the brain. And in terms of hormones, the driver is always that conductor of the endocrine orchestra. Because after all, hormones actually come to really spring into action when we're asleep, which is why sleep is such a crucial behavior, choice. Because, for example, backing up the adaptations to exercise occur when you're asleep. You get fitter when you're asleep. 

Because, especially, for example, growth hormone, the two main stimuli for growth hormone release are exercise and sleep. You need both of them. You need to do the exercise. But you also need the recovery so the hormones – because the hormones got – it takes a bit of time. I've just described the mechanism of actional hormone. Goes into the cell. Got to switch on the DNA, etc. That takes a little bit of time. That needs to happen in the recovery time, especially when you're asleep. Because then the driver can really focus on that bit to set it up for the next time you go and exercise. 

I think the driver is the brain. We have control over our behaviors. And so, it's a case of balancing our behaviors to give the boss, the driver, the brain the best shot at responding. And then the hormones will – I'm going to use the term – I hate this term, balance. Well, equilibriate. We do not balance our hormones. Hormones have had millions of years of evolution to balance themselves. Thank you very much. They know what to do for homeostasis. No problem. No problem. 

Our job is to – if we take the driverless car, you need to actually give your car a good starting point. Start it on a nice clear bit of road. Give it a good run and it will do its thing. If you stick it somewhere really awkward, it's going to have a real jumpy start, you know? We can do our bit by providing the positive combination of stimuli from the outside world. And then the car will, the driver will sort itself out. And the hormones will do their best for you. 

This is what I say about harnessing your hormones. Harnessing the hormones means you give them the best chance they can to do work, their magic, and so you can reach your full potential.

[00:43:03] LB: You got to the harnessing bit before I did. 

[00:43:05] NK: Thank you. 

[00:43:06] LB: Thank for that. I can retire now. I'm in my driverless podcast – 

[00:43:11] NK: Driverless car. Yeah, yeah. 

[00:43:14] LB: I mean, it's such an interesting concept, and mainly because I think you're sitting there going, "These hormones are doing what they're doing." And like, "Well, what can I do? What can I do to help my hormones?" Particularly in the nutrition world and, again, in the medical world, we have alternative realities there, which would be sort of your alternative medicines and so on. And people talk about balancing hormones, your favorite word there. I've even seen people label themselves as hormone-balancing specialists. And there's all the tests and everything that people can do for testing hormones. And then there's treatment modalities. And I'm not talking about things like hormone replacement therapy or whatever. I'm talking about herbs or supplements or whatever. 

I mean, you've talked about harnessing the hormones. But what about manipulating the hormones? What can we do and what can't we do? Because I think in terms of understanding strengths and limitations of our advice and recommendations and so on. And we'll come to lifestyle in a minute, because I know that's a big part of it. But in terms of specifically trying to come up with a strategy to influence them, what does the evidence tell us about that? 

[00:44:29] NK: Well, the hormones – these hormone networks are complicated. Yes. And they also all have their own biochronometers. So, biological clocks. For example, cortisol has a diurnal variation, which tends to go a bit high in the morning then it goes lower down until you go to sleep. 

The top tip to harness that fluctuation of the hormone is kind of work with your hormones. That's what I mean by harnessing them. Try and get in sync with them, right? If you have a scheduling conflict, it's not going to end well. For example, we talk about circadian misalignment, which means what you're doing is in conflict with your internal biological hormone clocks. 

For example, being a junior doctor is really, really bad for your health, because you have to stay awake all night. Or if you sort of just really feel tired and you just put your head down at 2AM, just like, "Oh, I'm just going to have to shut my eyes." And then immediately the crash bleep will go off, you know? 

Having disrupted sleep. And I've said that sleep is very important for hormones, haven't I? Right? That's what I mean by a scheduling conflict. You want to avoid this misalignment of your hormones. Don't do things at times when your hormones are not ready for them. That's the thing about working in sync with your hormones. And therefore, you will be harnessing them. 

If you can schedule your sleep patterns, your exercise, what you're eating, when you're eating, all these things, bearing in mind what your internal timetable is with your hormones, then you will indeed be able to harness them so they can work their magic. You see? 

In practical terms, harness them, whether you can change them. I suppose that's the thing , is that you're not trying to change them. You're just trying to make them do the best job they can. You see what I mean? Because sometimes you wouldn't want to change them. Because actually, sometimes they are meant to be higher than other times. Like, cortisol is meant to be high. They're meant below then. So, you don't want to change them. You really want to harness them. You want to work in synchrony with them ideally. 

Of course, this conversation is excluding know medical conditions. Where the thyroid gland packs in, you've got an underactive thyroid. There's no choice about it eating any number of herbs and I don't know whatever doing, everything. If that is a medical condition, that is it. You need thyroxine replacement. Same for diabetes. Or whatever in the world. It's not going to suddenly – you've got type 1 diabetes. Not going to suddenly make you produce insulin once again. Of course, there are medical conditions where, unfortunately, whatever the hormone system is has thrown in the towel, and we have to step in, right? There's a condition. 

Also, just to touch on, there are some conditions which are physiological like the menopause, where the ovary is just also threw in the towel and they retire. And so, we're talking about a different situation there. Nevertheless, even in those cases, even in those cases, there is still a place for looking at lifestyle behaviors to support what hormones there are and the other ones in the system. Because guess what? Hormones never work in isolation. 

I think I prefer the term – that's why I use the term harnessing of hormones. Rather than trying to change your hormones. Because actually, they've got good practice of what they need to do unless you've got a medical condition. 

[00:48:00] LB: And I just want to stay on this one for a bit because this is an area that I think is particularly interesting. We're not into clinical stuff here. What we're talking about is optimizing performance. And, yes, optimizing health. Because an optimally healthy athlete or exerciser is almost certainly going to have a better outcome at least in the long term. I know there's some short-term strategies that may not be perfectly healthy but they might be necessary to bring about, like making weight within 24 hours. 

[00:48:30] NK: Yeah. Oh, gosh, yeah. 

[00:48:31] LB: Well, we have got into that. But we're not going to go there right now. But there is an obsession in the field of sport and excise nutrition, allied areas of health and – whatever, where people, for mostly good reasons, are trying to help people achieve optimal health and performance. And that's why I referenced earlier, people will talk about helping people balance their hormones and so on. 

I'm just interested in this. Because particularly from the perspective of us as sports scientists, sports nutritionists, and you as medics, for example, love to do some testing. All day long I'm doing things like body composition assessments, ISAC testing. We'll do some blood tests, etc. Looking at certain biomarkers to understand if there's anything there that needs work nutritionally. And/or should we refer out to a medic, or a dietitian, or whatever. 

You talk about the hormones – I mean, we can't see our hormones, Nicky. Yes, there are times when, no joking aside, we might be more aware of our hormones one way or the other. Or at least, in other people, we might be more aware of hormones. But for the most part, it's not something you can see. You don't have sort of a dashboard with dials and red lights and so on. How do we or – or should we even not be worried about this? What's your perspective on that? 

[00:49:56] NK: Well, with my NHS hat on, and indeed there was an article recently in the BMJ saying we shouldn't do unnecessary testing, blood tests specifically, unless we are concerned there is a disease. With my NHS hat on, absolutely, I agree with that. 

But if we're talking about health, I think there is a place for testing not in a fixated why. Because the only problem with that is that men, especially, want to, "Oh, I've got this testosterone of 14 nanomoles per liter. Oh, how do I improve that?" Right? But it's like that's just a number. It's like weight on a scale. It's all of that thing. The number doesn't reflect if you're a good or a bad athlete. Actually, is that level appropriate for you? 

And also, I would never want a single hormone, obviously, right? To such a man, I would say, "Okay. What's your FSH, LH, prolactin?" Now we can talk something and see what's going on. Tell me about your training load. When are you training? How much you're training? What are you eating? When are you eating? And then I can tell you if that level is healthy for you. 

Coming back to your original question, I think there is a place outside of the NHS and disease and all that sort of stuff for somebody, an athlete, to monitor their hormones. But the crucial thing about blood tests is they should be interpreted by a doctor and also in the context of the person. Because I do get people saying, "Oh, how can I improve this?" And I say, "Listen, that's just a number. I need to know way more information. I need to know all the other hormones. But before we even look at that result, I want to know all the things about you." You have to look at them in clinical context. But for an elite athlete, yes, I think monitoring, it can be one of those extra monitoring things. 

But as you alluded to, there are other very simple non-invasive, non-expensive ways of monitoring your hormones. In men, yes, there is an obvious sign that testosterone is doing its thing in the morning, by the way, which has been shown in research to actually be perfectly valid, by the way. That's easy. For women, of course, the free monthly medical check of the period, having a menstrual period. There are lots of ways we can surrogate for hormones we can use. 

It's true, though. Apart from those two specific things, it's true. Because hormones are complicated, then actually they're going to have a variety of effects. We can't say, "Oh, just because I'm feeling tired today, it must be my cortisol isn't very good or something like this." But nevertheless, I think it is useful for people to record. There's nothing wrong with recording well-being and whatever you want to call it, readiness to train, metrics like this. Because at least it gives you some idea. Because then, if you can see, "Well, actually, no wonder I feel exhausted. I've just run the marathon." I mean, it makes more sense. But if, actually, there's no reason why I'm feeling particularly tired and no reason why I haven't eaten anymore, and I have indeed put on weight, then actually maybe, yes, that would be an indication for checking your thyroid. 

The short answer to your question is, yes, there is a place for blood testing. There is a place for looking at hormones. Never, never a hormone in isolation. Never. And never outside of clinical context with correct interpretation. 

[00:53:16] LB: If this was a game show, the minute you said context, that would have been when the dancers were on the stage, the tinsel was everywhere, because that is – that's just my thing. I'm obsessed with context. And I think you Illustrated that particularly well in the context of hormones and so on. And I'm really – Yeah, I'm pleased you said that, because it's one of those things that, well, just because it can be tested, it doesn't mean that you actually understand what it means. And certainly, you certainly – particularly if you're not a doctor or an endocrinologist or whatever, you don't have enough knowledge to understand what it means and what you should do about it, which is why I find, as a nutritionist, for example, it's just something that I will stay away from. It's just not something that I would go into. But nonetheless, understanding that is particularly fascinating.

Look, we talked about imbalances and balancing and so on. And I guess the term that I want to – an allied term I want to move on to is the concept of dysregulation. And this being an area of understanding what are sort of the disruptors? The factors that lead to hormonal dysregulation? 

And given we've now made it clear that we're not testing and prescribing and so on as sports nutritionists, sports scientists and so on, what can we do about it? What are the things that actually can be done to optimize this process? 

[00:54:43] NK: The word I use, dysregulation, is to distinguish it from a medical condition. We go back to the underactive thyroid. I think everyone will be familiar. Underactive thyroid, that's a medical condition. A thyroid doesn't work anymore. Thrown in the towel. Yeah, that needs treating. That's a medical condition, okay? 

But dysregulation means that the thyroid gland is still working fine but it's just trying to adapt desperately to external circumstances. And as I've said, the hormones will do their absolute utmost best to keep that Goldilocks situation going. You can be pretty brutal to your body. I see many athletes with reds who have been skimping on their nutrition, particularly under-fueling with carbohydrates, doing relatively, therefore, high energy demand from that exercise, which leaves them in low energy availability. This will cause a dysregulation of the thyroid axis. 

Or rather than dysregulation, I would say an adaptation. But not the one that you want, by the way, okay? It will change. Try and adapt to the situation. What would it do? Try and save energy. It will downregulate. There will be a dysregulation. It will dial down metabolic rate. Just as you turn down your thermostat in your house to save energy, then exactly, that's what the body does. That's an example of a dysregulated hormone system, okay? 

But it's kind of – because what you've done to it. You see what I mean? But the good news is that that is reversible. In that situation of low energy availability, thyroid gland will downregulate in men. While the reproductive axis will downregulate in men, this will indeed result in lower testosterone levels with low FSH and LH. And in women, it might come that their periods will stop entirely. Again, down-regulation of that or dysregulation. The words are interchangeable in that sense, okay? It's down-regulation. But the one that gets up-regulated is the stress response. The cortisol goes up. 

That's what I mean by hormone dysregulation, it's because you have got unbalanced behaviors and you put too much stress on the system. Like I said, the system will deal with a certain amount of stress and actually thrives on some challenges, right? But if you go too far, there's only so much it can take. You see? And it will just try and keep you alive and survival mode will ensue. 

But the good news about that sort of situation, the dysregulation, hormone dysregulation, it's reversible. It's not a medical condition. That's good news. If you can persuade the athlete that actually they do need to eat carbohydrate and they need to just down the intensity of the training a bit, then this will see a reversal of this, a rebound in the hormones. Yeah, that's what hormone dysregulation is. It's an imbalance in behaviors that you perform. And it has the potential to be reversed. 

[00:57:44] LB: And that's a big relief, frankly. 

[00:57:47] NK: Exactly. No. Exactly. Well, that's the positive news. Because lots of these – I'm sure you see them a lot as well, athletes who have become sort of obsessed or believe that lighter is better, etc., etc. I can be negative and say – and lots of them ask me to be negative. Because some people prefer that as motivation anyway. It's like you will get a stress fracture. You won't achieve your potential, etc. 

But then I say the but on the positive side, you can get these hormones back into gear. You can start performing better and reaching your goals or performing even better, reach your full potential, if you are willing, and I will help you, change these behaviors. Because that's the psychological challenge, to change something, of course, for any of us. But that's my job, to try and explain why and then support them with practical tools. How? 

[00:58:40] LB: Yeah, that's great. And I think particularly for nutritionists and exercise practitioners, we're in a particularly good position to really truly help people because we – 

[00:58:49] NK: Absolutely. For example, I will give them that explanation and the general advice. But I'm not a nutritionist or a dietitian. When it comes to the nitty-gritty, I can give rough outlines, "Look, eat carbohydrate." That's an easy one, right? But if they want more detail, then it's – Yeah, it's people like you who have that clinical experience, that I say, "Okay, if you really want that nitty-gritty from that point of view." I think it's very important to emphasize, not only are the hormones collaborative, but also as practitioners, clinicians, we must be collaborative in a similar vein. 

[00:59:30] LB: Yeah. I mean, there's so much food for thought here, which is why everyone's going to have to read the book and previous podcasts and so on. 

[00:59:35] NK: Quite right. Just a tease up. 

[00:59:38] LB: I mean, the fatalists out there would be very much wanting to go down the path of something we discussed at the beginning, which is you're genetically pre-dispositioned to this particular issue. And of course, you hear phrases where people will say, "Oh, genetics loads the gun. But lifestyle does this." And then blah-blah-blah. Points the gun in a certain direction.

[01:00:02] NK: I don't like the gun analogy, by the way. But this is this nature of nurture argument. And it's true, there are some specific gene defects that we test in newborn children, for example, with the heel prick test. It's true. Sometimes your fate sadly is. If there is a specific pinpoint thing in error, the lesion, whatever it is, then, yeah, that is true. But we're not going back to the gods decide your fate, right? That's not the situation, okay? 

And also, even if you have a predisposition for something, it doesn't necessarily mean it's going to come to pass, you know? We started this conversation saying it's amazing, and the gene mapping, etc. And genetics testing. But again, we have to be wary that people might get – it might not necessarily be such a good thing that people get obsessed and think, "Oh, that's it now. I'm destined for X, Y and Z." There's a lot you can control your health to a certain extent and harness your hormones for the good.

[01:01:07] LB: Nicky, we started this conversation with a reference to Hippocrates. And it seems appropriate that we should end this conversation with your coda there in your book. 

[01:01:15] NK: Why not? 

[01:01:18] LB: I mean, let's just imagine that Hippocrates is now sat down next to us at this podcast and we've asked him to give us his final bit of advice off the back of all this? About what we can do to live long and prosper so to speak? What's he going to tell us? 

[01:01:34] NK: Well, as he said back then, he said, "If we could give each individual just the right of nutrition, just the right amount of exercise, not too little, not too much, we would have found the surest way to health." He was articulating personalized preventative medicine right there over 2000 years ago. And although it sounds, like you said at the very beginning, it sounds so simple almost and straightforward. And how can that possibly be relevant today? That was the whole premise, in some ways, of writing my book starting with that quote and then coming back at the end of the quota and saying, "Well, this guy was really onto something." And we could learn a lot. And now we know why, right? Harness your hormones and you will indeed find the surest way to health. 

[01:02:21] LB: Brilliant. Well, I feel appropriately well-educated, slightly depressed, because sleep's never been my strong point because I've got young children, you know? It's all their fault. They're my disruptors. 

Listen, it's been great to have you back on, Nicky. I know you got a patient coming up soon. And you'll need to get a cup of tea and an NHS biscuit or whatever. But if the listeners want to follow up on your work and learn more about your research, and your practice, and books, and papers and so on, what was the best way of them to find out about you? 

[01:02:55] NK: I've got a website called Nicky Keay Fitness. Maybe you could put the link on [inaudible 01:03:00]Laurent. 

[01:03:00] LB: I will do, yeah. 

[01:03:01] NK: That's my website. And it's got my blogs, a link to my book. I've got my papers on there and stuff that I'm doing. That's my website. That's pretty much got everything. And I also offer virtual appointments, advisory service to, as I said at the very beginning, men and women of all ages, whatever your level of exercise, to try and help you harness, navigate that way to surest health by harnessing your hormone. That's probably the best place to find me. 

And also, the book itself, Hormones, Health and Human Potential, the guide. That's available direct from my publisher, Sequoia Books. Or also, it's on the good old Amazon, so you can – and it's reasonably priced, I think. And what a nice Christmas present. So, there you go.

[01:03:46] LB: Absolutely. Absolutely. Well, I bought my copy and sitting in front of me. And a very worthwhile addition to my library. I appreciate the time and effort you put into writing that book, of course, and all the research and practice experience you've had that went behind it, and your time today. Thank you very much, Nicky. I look forward to having you back on We Do Science at some point.

[01:04:09] NK: Absolutely. Thanks so much. 

[01:04:10] LB: My pleasure. Take care.

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