"Plant-Based Sports Nutrition" with Professor Enette Larson-Meyer

EPISODE 184

[INTRODUCTION]

[00:00:00] LB: Hi, and welcome to episode 184 of The Institute of Performance Nutrition's We Do Science podcast. I am Dr. Laurent Bannock, the host. And my guest earlier today was Professor Enette Laron-Mayer. And Enette is a new guest on this podcast. But the topic itself today was not a new one. We got back into the concept of plant-based sports nutrition, and we covered this topic about one year ago. Almost exactly one year ago with Dr. Nanci Guest, which I'll link to in this podcast because they're both complementary and in certain ways additive to each other where we did discuss some similar concepts plant-based eating. What actually does that term even mean? The various approaches to these things, whether it's fully plant-based, plant-focused, vegan, vegetarian and so on. 

The different reasons why people might want to approach a plant-based diet. It might be personal preference. It could be religious preferences. It could be certain specific health requirements. And/or it could be just jumping onto a certain – I use the word fad carefully here because there's a lot of great things about a plant-based diet. 

But like with most things in sport and exercise nutrition, a lot of these things have their strengths and limitations. And it's ultimately down to very much a case of context. And that is the purpose of today's conversation, is to unpack this concept of plant-based eating for athletes in particular. 

We talk about this concept of gaining a plant-based advantage. And Professor Larson-Meyer will argue her perspective in that regard, which is a very strong argument. We got into some of the concerns that this approach can have for athletes such as getting adequate calories from a plant-based diet. The concept of relative energy deficiency and how that could be a bigger problem for those following a plant-based diet. 

Combining certain foods like carbohydrates, smart fats as opposed to no fat. And the big topic, of course, is protein. You know, is plant-based protein adequate or not? And is there a sound argument for a plant-based protein diet for those looking to benefit in terms of things like muscle protein synthesis, strength and power. And all sorts of gems came out of this conversation where we talk about nutrient quality and just some caveats from a well-known researcher who, yes, has written a book on this but is a well-known researcher in areas within clinical physiology and metabolism at the highest level. And is a published author in many consensus statements, IOC consensus statements, for example, on sports and excise nutrition.

Anyway, I know that you'll get a lot out of this conversation. But before you do, check out our website where you can get the specific episode of this podcast and get access to the various papersm, etc., previous related podcasts. And also, all the other things that we do at the IOPN. And as I recently announced, our now fully accredited postgraduate diploma in sports nutrition, the IOPN Diploma in Sports Nutrition. The only practice-focused program of its kind at the fully internationally accredited level. 

Come check that out. It's 100% online. Whatever your background. Whether you've got research-based master's, MSC and sports nutrition, sports science, strength conditioning, extensive personal training type backgrounds, or nutritionist dietitian, etc., etc. Our program is there to really upskill your abilities as a specialist in sport and exercise nutrition in practice at www.iopn.com. Just click on IOPN diploma. 

Check out our software, SENPRO. That is designed by sports nutritionist. My team and I, for example, to assist you in working with your athletes, your private clients, online group coaching and in team settings as I do myself. Anyway, go check that out at www.theiopn.com. And now, here is my conversation with Professor Enette Larson-Meyer. All about plant-based sports nutrition. Enjoy.

[INTERVIEW]

[00:04:34] LB: okay. Welcome back to the Institute of Performance Nutrition's We Do Science podcast. I've got a new guest for you today. It's not a new topic. We've got into this before. But there is no topic that can't be discussed a million times because there's always different views and perspectives. And I'm sure we'll unravel that concept in this conversation today. But I'm delighted to bring to you today Dr. Enette Larson-Meyer. Welcome, Enette. How are you? 

[00:05:03] ELM: I am good. Thank you for inviting me and having me on the show.

[00:05:06] LB: Yeah. Brilliant. Well, look, we're just going to have a chat. And there's a few people that will be listening. But I'm unashamedly selfish in saying, I just like doing these podcasts because I get to talk about stuff that the rest of my family don't want me to be talking about basically. 

As I had inferred before, this is a topic that we're going to get into again because it has been discussed before on the podcast, which is essentially the concept of a plant-based sports nutrition approach to health and performance in athletes. But before we get into that and discuss why I wanted to get back into that topic. Enette, why don't you give us just a little bit of a background on yourself? Tell us who you are and what you've been up to as a researcher and a practitioner? 

[00:05:51] ELM: Sure. Sure. Yes, I'm a professor now currently at Virginia Tech in Human Nutrition Foods and Exercise. And that was a recent move for me. I was about 14 years at the University of Wyoming. And so, I am both a registered dietitian in States and also exercise physiologist. I've always been really passionate ever since the very beginning. 

In fact, it was Jim Fixx's book, if you remember, a way that the running boom that kind of got me started on the importance of both diet and exercise. And so, I followed a path after completing my dietetic internship at Massachusetts General Hospital. Just really got passionate about research. Predominantly, my career has really been doing research that's related to the benefit of diet and exercise. 

And then on the side, interesting participants will come up, participants, interesting people. I do see like people on the side. And then for a while, after getting my doctoral degree, I worked as the sports dietitian. And this was really, really early on for the University of Alabama at Birmingham. And at that point, I don't think they knew what to do with the sports dietitian. It kind of formulated that area. It was really a lot of fun. 

And then, really, after I left there, really got into [inaudible 00:07:06] and working with vegetarian athletes [inaudible 00:07:09] meat. But predominantly, my research is really focused on, I guess, get done that topic. I started and I was trained in energy metabolism. Worked with Dr. Eric Robison and some other well-known individuals in that energy metabolism area. And then, really, most recently, became interested in vitamin D, and now iodine. And then overall, encompassing interesting food. Really, anything related to exercise and nutrition metabolism and things that combine diet and exercise. But mainly my interests are in energy metabolism. Recently, weight gain, vitamin D and iodine. 

[00:07:46] LB: Wow. Okay. There's even more topics I want to talk to you about. I don't know if we'll have time. We'll certainly tie those in some of those areas from the perspective of a plant-based approach to sport and excise nutrition. 

One of the things that I had done was I had read your book not very long ago, Plant-Based Sports Nutrition. Your newest version of that book. And there was some really interesting content in there, including sort of a bit of background about your own upbringing and how you got into this is a way of life yourself. It's not just been an area of research. It is an actual thing that you do. And also, how you met your husband, which I thought was quite funny actually, some of that story. 

But I love that angle because – I mean, look, we all like our science and our nutrition and so on. But these things bring it into the context of the real world, which of course is where we need to apply a lot of this. 

And what I find interesting about plant-based diets is there are many different reasons for following a plant-based diet. And there are many different interpretations of what that term means. And there's a lot of misinterpretations or misunderstandings about the relative strengths or weaknesses of these approaches. And that's why I like to have these conversations, so that we can delve into these areas from an evidence-based perspective and understand what does the evidence say. But also, take it away from the lab or the classroom and start looking at this stuff from a practitioner's perspective or, indeed, through the lens of the consumer, the athlete, the client. So, you being both a very experienced researcher, but also a practitioner, is always helpful in these conversations. 

But let's just quickly go back to that beginning. As I mentioned, you yourself had sort of stumbled into this plant-based approach to nutrition yourself. Do you want us to give a little bit of background on that? Because I think it's interesting.

[00:09:50] ELM: Oh, thanks. Yeah. Yeah, it was funny, I was one of those probably strange kids that when we go out to dinner I wanted two scoops of mashed potatoes. And I always put the carbohydrate, the rice, potatoes, whatever, on top of the meat and eat it. I never enjoyed a hamburger. And it was really in anatomy lab that very first time. I think I was a junior in college. 

And [inaudible 00:10:12] was dissecting the cat back then. I noticed the striation patterns and then came back that day – And I was in a sorority, and that was our formal dinner. And they served a piece of meat and I was like, "Oh, my gosh, that looks like the cat," which of course looks like meat. And, yeah, it was just a really turning point. Immediately, I became vegetarian, realizing that I didn't like meat very much all along anyway. And then really had to learn. 

And at the point, we had – In fact, I used to have the figure hanging over on my bulletin board. But I guess it's gone. It was this leaf where you had to do complimenting, which that's an interesting topic to go back to because it kind of went away. But for athletes, I think we're realizing we need to think about that, but when we're maybe in the post-exercise time point. 

What I did was I carried around sunflower seeds and I would sprinkle them on everything and then cheese. I was trying to like go overboard to make sure I was making complimenting my protein. And at the point, I actually gained about five pounds. I'm like, "Huh? What am I doing." And then just slowly learned and dove into the literature on what's really out there and how do you eat well? 

I guess I'll say one more thing. At the time, too, you would run into people that would tell you, "Well, you can't be a dietitian if you're a vegetarian." You're like, "What?" It's like you know that's not good for you. Like, really? At the same time, the academy has this very position statement that said we support. And you can actually adequately obtain all nutrients on a, they like to say, well-chosen or a well-balanced vegetarian diet. 

[00:11:46] LB: Yeah, you raised some interesting points there, which I want to come back to, because I think it's relevant to how we understand the concept of a plant-based diet through the evolution of the body of knowledge that's linked to it. And also, how it's disseminated not just by researchers. In fact, very little of it gets out to the masses that way. It's very noisy stuff that comes from social media, and journalists, and books, and Netflix documentaries and various other things. 

Quite frankly, most people seem to be seriously confused about what these things mean. And what position we should take as it relates to is it a healthy approach? Is it good for performance? Is it detrimental performance? All the things that I want to get into with you. 

But I found myself preparing for this podcast and another podcast on a similar topic was sort of 10, 12 papers that I looked at. They all had a different description, a different definition of what plant-based even meant. Not only are the public confused. Albeit, most of them don't realize that they're confused. But so are the researchers and the practitioners. 

Now, I guess from what you just said, you had this sense of I don't like meat. But you didn't feel that it should be a negative factor in your own health and performance. And I guess when that started to combine with your training in education, and physiology, and biochemistry and so on, there probably was some conflicting stuff going on. Particularly, if we factor in that main body of knowledge, including things like your book and so on, it's only a few years old, really. I mean, this is super new, this stuff. How did that affect you? And was that a factor in making you want to come out with something like this book, for example? 

[00:13:34] ELM: I think, all along, yeah, because I knew it was possible. And if you read and heard about other individuals and even looked at what was happening counties outside of the U.S., that people we're successfully vegetarian. And they weren't checking themselves in the hospitals. And, I guess, emaciated type. 

But it could be a struggle in your training. And you would get common questions, like, once they started training, people would be like, "Oh, you're a vegetarian. How are you so meaty? Ha! Ha! Ha!" You know, jokes that they wanted to say. And it was mainly related to protein. The nutrients that I think are the most important that you have to really be careful about at least in choosing are really iron and zinc. But iron's an issue really for most females and endurance athletes. It's just another thing to think about. But it becomes part of your lifestyle and it doesn't become a big deal. 

And I always disliked worked on that position statement from the Academy of Nutrition and Dietetics. Mostly I would review them periodically. And I always wanted them to change the well-chosen vegetarian diet just thinking that they I sit down every day and go like, "Oh, what am I going to eat today that's going to balance it to make sure I get my iron?" In the beginning, there's an educational process that occurs and you think, "Well, I need to make sure that I do this." But then after that it becomes a habit. 

I don't know. Little things like that. And then, also, individuals in the internship where you're training that were dietitians themselves that we're not bought into it and really thought that it wasn't a good thing.

[00:15:05] LB: Yeah, absolutely. Well, look, I mean – Look. If you look at this planet that we live in and if we just ignore the immense mess in many ways that it's currently in. But if we look at it from the perspective of how human beings feed and sustain themselves, you can clearly see that there are many people that have different approaches to how they eat and drink. 

And, yes, there are influences like religion, and to a certain extent where they're based, location and access to different foods. And then there's sort of cultural aspects to it and so on. But ultimately, an awful lot of it still comes down to choice. The choice might well be influenced by people or whatever. But ultimately, it does come down to knowledge. Specifically, on the topic of plant-based nutrition, not to specifically sports nutrition. I mean, where do you think we are in terms of the evolution of that body of knowledge? 

[00:16:02] ELM: It's been interesting and exciting to see the development of a lot of new products and having a lot more interest. Being able to go out to a restaurant and have plant-based foods and seeing chefs that are now preparing really amazing combinations of, again, plant-based dishes. 

But on the other hand, I feel that we are going – the pendulum is, I guess, swinging a bit to the ultra process side. And I know a lot of us are really uncomfortable with that aspect. And now, it's almost like, "Well, if it's plant-based, it must be good." But you can take a number of those even veggie burgers, or example are the protein supplements, and they're so highly ultra-processed that they are probably not any better than any other diet. And what our original intent was was really eating plant-based, mostly whole foods. And then, certainly, it was always nice to have a commercially available veggie burger to have if you wanted to consume it. But that isn't the way that I eat or that most people who started initially on following vegetarian diets. I don't eat processed plant foods every single day. And that would be an interesting study to see what the health of those individuals look like compared to what vegetarians are eating, mostly with whole foods. 

[00:17:24] LB: Well, I can assure you there are plenty of potential PhD students listening right now. And also, these are the things that we need to know. I mean, like I said it comes back to being a matter of choice for a lot of people. But there are many factors that influence why people will make that choice. I mean I, for example, work and have worked for some time with professional football players, soccer players, who are not immune to fads. No one's immune to fads. But a lot of them do tend to get into this. 

And I've always been both blown away, but also slightly amused for hopefully the right reasons, as to how a lot of people misinterpret these things particularly as it relates to what's appropriate for health. And in particular, for athletes, what's appropriate for performance? We'll come back to that in a minute because that is the focus of this podcast, is sport and exercise nutrition in particular. 

But I mentioned before that there's a lot of confusion as to what these terms even mean. I think we should probably establish what you mean by the term plant-based and what some of the associated terms are. And that way, we can understand where we're at in this conversation.

[00:18:33] ELM: When I'm talking about plant-based, I think I'm really talking about more of the broader spectrum. And you mentioned that, in fact, if I step back to the newest edition of my book, instead of being vegetarian, which was in the title before, the publisher really wanted it to open up and to include anybody who is really on that spectrum of following a diet that contained really less meat overall. Somebody that might have been include it a couple times a week, to people, pescatarians technically, vegetarians who are not consuming any type of flesh foods, but do eat eggs and dairy products. And then the real strict vegetarians or vegans that really try and avoid all animal products, including things like honey and things that might be made from insects. That's kind of the the working definition. 

I really did like that because, over time, the more that I've learned about, say, vegetarian plant-based diets, I've relaxed a little bit. I was probably one of those annoying people in the beginning that was like, "Oh, my gosh, you're eating meat." So, Thanksgiving in the U.S., we just had that. And people would say, "Oh, you don't eat turkey for Thanksgiving?" And I'll be like, "Of course, I don't eat turkey." 

But then on the other hand, a lot of people really do like turkey that are mostly plant-based. If you enjoy turkey, eat turkey as a celebration or something like Thanksgiving, or Christmas, or something that really means a lot to you as part of your culture and custom. So, we don't have to necessarily be black and white. And that's where why I like the definition of plant-based. Because I think, also, from the perspective of you want to get into saving the planet, eating more plant-based foods is really the way that we need to go. 

But a lot of people, again, do like meat. Bacon always comes up at the joke about. That's the reason why most people would be kind of vegetarian because they love vegan. But whatever it is, a meat product that our ideas of society is to eat less meat. To eat more palnt-based food. And it doesn't mean that we have to completely give it up. Some people will that are vegetarian. Some people will give up all dairy products. But swinging, again, towards that eating or plant-based.

[00:20:42] LB: And in that, look, as nutritionists, dietitians, etc., one thing that we're trying to do with our patients, our clients, our athletes is encourage them to adopt a new set of habits and behaviors or at least modify and adapt from where they are to a fairly significant change. And a black and white change, a really rigid shift from one approach to another can often result in failure, can't it? 

Having a more flexible approach to that transition I think is a really nice way to position it, which is why I think things like titles and definitions are quite useful because it does give people an idea that, "Okay, it's plant-based. It's not plant only necessarily." And depending on your own personal needs and preferences, there's a way this can work. But ultimately, it is about having a very plant-dominant based diet. 

But it's not all – for all the wonderful attributes, there are some risks, which is more to do with risks associated with a lack of understanding in terms of the difference between raw and cooked, for example, or the timings or the combinations of food, which is some of the things that I wanted to get into. 

But your book starts off with an opening piece about gaining the plant-based advantage. And I thought that was a very interesting sort of title. But I like it, too. I think you sold it well in the book. But maybe you could just open that up for us by what do you mean by gaining the plant-based advantage. 

[00:22:17] ELM: Yes. There are probably two aspects of that. And the one that's most obvious is really the health benefits. And studies coming from the Seventh Day, or the Adventist health study, that have really shown that it looks like that if you follow a plant-based diet, that your risk for most chronic diseases is going to be lower. That's probably sort of the underlying, I guess, health benefit. And that includes so many things from certain types of cancer, cardiovascular disease, hypertension, lipid profiles. And for athletes, it probably is less of a performance advantage, at least as far as we know than it is of it's not going to be detrimental. 

The one place that potentially it could be advantageous is probably in the content of phytochemicals or phytonutrients that are in all the fruits and vegetables and whole grains. And right now, that's so hard to study. And how that might be beneficial is within a combination of exercise or maybe in that recovery period or overall diet that there's probably things in those, in all the the plants that we know or don't know about, that are – all the flavonoids, just for example, that are probably reducing our risk of disease and maybe helping us recover better. 

But I keep saying probably we have a small handful of studies that have, I guess, taken out things like maybe beetroot, or dark cherry juice, or a number of other different foods probably because they've been funded by specific food companies that suggests that there may be some benefits, say, for recovery. But what happens if you did that same thing in another study here with having someone follow an ultra-processed food and look at that recovery aspect compared to a diet that's rich in all of these different fruits and vegetables that have a variety of different colors, a variety of different phytonutrients? That's probably one of the advantages. But there's not a lot of research out there even supporting that right now. 

The third benefit that was obvious when they started doing the studies early on was that the diets that were vegetarian had higher amounts of carbohydrates. Athletes that were doing more endurance type of exercise where – no matter what with these ketogenic diets, if you're going to do endurance exercise or exercise that is prolonged but of a certain intensity, the biochemistry tells you need carbohydrates. And that carbohydrate will eventually run out. And that carbohydrates sustained that high level of intensity of exercise. 

In the beginning, that looked like an advantage because those diets, again, were higher in carbohydrates. But since those studies have been done, everything's changed differently than we did back then. Can you remember in the 40s, 50s, 60s? Some of those studies were pretty old. 

[00:25:06] LB: Yeah, when you look at the more sort of public health medical-focused literature on plants generally, plant-based diets and the attributes that that has to sustaining health generally, there's a lot out there. And I feel that's kind of a – it's sort of difficult to argue against the benefits of fruits and vegetables and plant compounds. 

And of course, when we talk about our athletes, athletes are also human beings. They can suffer from problems just like everyone else. And as they age, they're not immune to age-related issues and so on. But of course, there are increases of unique types of stress that will be training stress travel sort of the accumulated combinations of competition, training, anxiety and all the different things, particularly with traveling athletes and so on. But I guess there are a number of areas that are of particular interest. 

And you've mentioned the protein one. We'll come back to that in a minute. But with things like relative energy deficiency, which is a hugely important area particularly as an area that us as practitioners are trying to help prevent relative energy deficiency syndromes occurring. You've mentioned already about the fact that carbohydrate, you're likely to get a good source and quantity of carbohydrates from following a plant-based diet. 

But just generally speaking, the concept of calories, the energy adequacy, all these different foods, they all bring something different to the table. What are your thoughts about that? And what does the evidence tell us from a plant-based perspective? 

[00:26:47] ELM: As far as consuming and meeting energy needs, yeah, I think that that's always my number one go-to with it. I think the biggest mistake that people often make when they switch to a vegetarian diet, athletes included. And then, also, even part of – you always hear that are vegetarians at risk for disordered eating? And there is that subgroup of individuals that recognize that if I say I'm vegetarian, that that's like now a socially way that I can mask the – unfortunately, mask that [inaudible 00:27:18] needing. 

But one of the first things that I do with the vegetarians is really work with them on how they can continue to eat the same amount of energy that they did before. Because you think you switch completely to a new type of diet and you don't know where to eat. And you've now set these artificial boundaries of what you think you can eat and can't eat. And it's not what you can't eat might not be available at your grocery store. Or you're at work and you're running at lunch, and they don't have a good vegetarian sandwich on the menu. You have to be a little bit more prepared. 

And then, of course, all of the nutrients that the micronutrients that we're concerned about, if you're not eating enough energy, the intake of all those micronutrients is going to go down. That kind of sets you up almost for failure from the beginning if you aren't meeting your energy needs. Again, most important thing. 

And then, of course, it's a side topic about why athletes are not consuming enough energy. And in so many different reasons, it's disordered eating patterns. It's also being too busy to eat. Not being educated. Maybe even now we're recognizing that a lot of athletes may not have adequate income source. They might be food insecure. And it's nice to see that out there, too, that there's a variety of different reasons. But number one thing all athletes should do is really fuel themselves and just eat and not the energy. 

[00:28:39] LB: Yeah. I mean, all the food insecurity one in there is a very interesting one. It's become very topical of late here in the UK. We have a cost of living crisis that's going on with inflation and taxes and everything all going. The usual problems. But of course, a lot of athletes aren't professional highly paid millionaire soccer players. An awful lot of them are people who don't have the sort of money and resources behind them. And nor is there the provision by the team, the club, whatever. It can become challenging. And that is a factor in what influences the food choices that people make. 

And you talk about food types. But food quality, that term can be interpreted in different ways. But of course, cheaper food relative to more expensive food. What are your thoughts on that? And maybe skewed as an advantage towards plant-based diets possibly? I don't know. What are your thoughts? 

[00:29:37] ELM: I think that, overall, if you're eating reasonable local and not going out of your way to get a food that you think is part of a vegetarian diet that you need that's more expensive, then plant-based diets have to be more economical. 

But on the other hand, a lot of those things that I'm mentioning, like say if you take a pack of legumes and you go and cook them from scratch at the store, or even eggs that even come from sustainable sources are great sources of protein that should overall be inexpensive. But then you add that twist of, "Well, I need eggs that have omega-3 fatty acids that are this sort of way." And then whether they're really more expensive or not or whether that's like the marketing scheme. So, companies that produce them can gain more, more money. 

But the superfoods that become, I don't know, really popular. And I think a lot of an athlete, I need to get this type of berry that shipped in from somewhere else. Or dragon fruit. It looks like a very interesting fruit. But I'm not going to pen five dollars to eight dollars for some dragon fruit that's like the cost of my whole meal. 

Within the concept of basic foods, definitely. And setting aside some of the cheap foods that is so interesting. Like, the cost of cheap chicken. How can we replace chicken so inexpensively that it is such an inexpensive source of protein, but yet it has to have an impact? Probably, overall, vegetarian diets, if you make really good selections, are going to be overall less expensive. 

[00:31:15] LB: Yeah. Well, I mean, look, it's like anything. Isn't it? It depends what you buy and where you buy it from. There are expensive sort of whole foods market type, all the way down to your sort of budget stores. And it is true, these foods do come from different sources. And they're not all raised, grown, farmed with the same degree of care and control. And that is part of this. 

But I'm pleased that you mentioned that issue of superfoods. Because I guess when you're wanting to go down the plant-based approach, you're more sensitive, you're more you're more aware of all these different specialty plant-based foods. And of course, you get taken advantage of by the commercial forces that are out there. Just like everything else. I mean, there's another podcast frankly, I think. So, I think we'll move past that particular one. 

But when we look at plant-based diets, yes, we know that there's a lot more plants. And with a lot more plants, there's going to be a lot more fiber. And there's some angles there that I wanted to get into. We've done quite a few podcasts on the microbiome. I've contributed to some research on this topic in probiotics and so on. And there's just no doubt that that plants, particularly fiber, has a really powerful positive impact on the microbiome. But again, depends on the types and when you consume it and so on and so forth. 

But fiber, there's different kinds of fiber, and there's different things that is found within these fibers. And there's different effects that these fibers can have on the gut and absorption of nutrients. And then we start to talk about whether it's cooked or not. And then we start introducing things like tannins, phytates and so on. 

Maybe you could just quickly discuss this area? Because if you're going to go plant-based, you're going to get more fiber. What are sort of the pros and cons of this that you feel are relevant particularly from a sports nutrition perspective? 

[00:33:15] ELM: Yeah, when you think about the amount of fiber that somebody can get when they're eating 2,000 calories versus you have athletes that really, you know, 3,000, 4,000 calories, and if everything that you're consuming is a whole food, that you can't end up with a lot of fiber. And that can actually be a disadvantage both from trying to get in all the energy that you need on one. 

When you have a lot of – I mean, like without – I guess, taking your meals and spreading them out through the day. But if you're trying to eat on a bunch of one single meal, you get full. And so, diets that have a, again, high energy demands, 3,000, 4,000 calories, let's just say. 

The fiber in and of itself, we do know that certain types of fibers. And then you mentioned phytates and oxalates and all those components can bind a lot of minerals. Iron is very susceptible to that. Zinc is, too. We know less than calcium. That's certainly one disadvantage. As well as athletes who have kind of sensitive stomachs as you're approaching performance. And then you don't want to give up all your fiber because you might end up being constipated. 

But then on the other hand, if you're having issues with a gut that leaves you a little queasy or you have to run off to the bathroom or slight stomach aches before competition, then you have to be really sensitive of the fiber as well. 

Overall, usually when I'm working with athletes that have high energy demands, I really do want them to eat foods that are a little less processed in combination with foods that are processed. You can have whole grain pasta and regular pasta. Have some fruit juice to help meet your energy needs. It doesn't have to all be whole fruit. 

I think the microbiome, I'll have to listen to that podcast. I am just fascinating watching this all evolve and worrying about when you just think about how this topic started and what we're learning and what we still need to know. Obviously, what we eat is serving as the food source for all these little microbes in our gut. And it's fascinating. 

I don't know too much about it. I've tried to follow it a little bit. But then on the other hand, sometimes it's so overwhelming that you almost want something to come out and result before you start to get into it. Because there's so much out there and it seems to be linked to everything. But yet, on the other hand, what's really driving it is really what I eat. At least it seems that that's a really major factor. 

[00:35:41] LB: Yeah. No. Well, I mean, that – Look, it's like so many areas of nutrition, particularly as it relates to health and performance of athletes, is things like microbiome appears to be important. But we know almost nothing about it. What we do know is that what you eat and certain environmental factors, it can have an impact. It almost certainly isn't supplements, by the way. But it is certainly foods. 

And fiber, a lot of people don't eat enough fiber generally. So, there's this concept known as the fiber gap, which is obviously it relates to the lack of fiber found in people's diets, which is why a plant-based diet has a particularly strong advantage as it relates to supporting the microbiome. 

But associated with this whole fiber topic, and that is something else that's associated with foods that deliver a lot of fiber. And of course, that is foods that provide a lot of carbohydrate. And you've already mentioned before how important carbohydrate is depending on what angle you'll have having in terms of training adaptations or performance. But normally, carbohydrate is going to be king. 

There are certain arguments for certain training low approaches, but as part of a periodized approach. Again, it's not this business of you only go low carb or high carb. It's all about how you choose your well-chosen strategies, a term that you may or may not liken it. But it is very much about using the right strategies at the right time for the right reasons. 

But if we use another popular phrase in sports nutrition, which is using the right fuel for the work required. Fueling for the work required. What do we need to know about this from the perspective of a plant-based diet, is it profoundly different from sort of a more omnivorous type of diet where we're still throwing in sort of pasta and rice or whatever? Or what are your thoughts on this? 

[00:37:36] ELM: I think it really is the same concept. And I do like that, I'm sure you have seen the athlete plates that were developed by the University of Colorado Springs with the USOTC where it's a shift of increasing the amount of, say, vegetables that are more non-starchy when you're doing those lower training periods. Or maybe when you're trying to drop a little bit of weight, restrict your energy, you're not in that high energy demand training where you really do need carbohydrates. 

And I think those plates are a great model. And they are – I'm trying to remember the state of what the plates are. But if they're in the process of being developed the vegetarian aspects. But I could use the regular plates in working with somebody who was vegetarian. I mean, that regular educational series, and do those same concepts. 

I realy think that it's too much more coming from. Or the educational aspects of that is different on a plant-based diet compared to what would be more of a non-vegetarian omnivorous type diet. 

[00:38:37] LB: And I've done a lot of podcasts on that topic. You mentioned before about certain food like phytates and so on. And/or there are certain nutrients that particularly maybe females and/or endurance athletes might be at greater risks of. And I'm thinking things like iron. 

Iron bioavailability or iron status in athletes is a fascinating error generally. I know you know a lot about this topic. Do you want to just talk about that a little bit particularly from the perspective of pros and cons of a plant-based approach to this? 

[00:39:13] ELM: I think that, overall, that iron is probably – if I were to say one thing, apart from meeting energy needs, it really is going to be the biggest struggle for some but not all vegetarian athletes. 

If I start with the personal story, when I first became vegetarian, I was anemic when I was in doing my dietetic internship. And it was one of those embarrassing moments where at that point we wore this little white dress and we had these patches that said ‘dietetic intern’. And I went in to give blood and they said, "Oh, you're anemic. You can't give blood." And then I sat with my patch dietetic interim, I'm like, "Oh, my God, I'm so embarrassed." 

But then when I looked at the way I was eating, it was we got free food in the hospital. I ate a lot of macaroni and cheese. It really fueled you. I did have fruits and vegetables. But I wasn't eating a lot of legumes. And probably my whole grain intake wasn't so good. And then I was drinking a lot of coffee. A lot of those things, when you're thinking about iron overall, you have to think about not only consuming iron, but well-absorbable sources of iron. 

Iron in and of itself, it's – let me set back for a second. If you look at the literature, it will often suggest that individuals that are both athletes and non-athletes can eat the same amount of iron. And often, some studies show more, coming from a plant-based diets. But it's just that they're eating Inhibitors and not eating cancers. 

When you consume a source of iron, things like vitamin C, any type of organic type of acid, will also enhance the absorption of vitamin C. And then things like phytates in whole grains, oxalates in a lot of green leafy vegetables like spinach. If Popeye made us think that, "Yeah, that's a great source of iron." Well, it is but hardly any is absorbed because of that. Now, there are good things about spinach. But absorbable iron isn't one of those. It's really just a balance. 

I kind of started back to the habit of thinking that, “Well, when I have beans, then I should have something with them.” It's a tomato that creates an acid, or peppers. But then when you think about if you sit down and eat just the beans plain, they're really not all that good. But if you enhance them with vegetables, that's going to also enhance the absorption. Or if you're having a bean burrito, just have a little small amount of orange juice with it. So, little things like that will help with the iron. 

If we go back to athletes, however, there are some athletes that have increased losses due to a variety of different things. And it could be – and I'm sure maybe this came out previously on the show. But a little bit of iron in sweat. So, iron losses that way. Iron when individuals are pounding doing marathon training or military individuals wearing boots, they would have some destruction of red blood cells that some of it's recycled, but you might lose iron that way. Iron loss in the urine from marathon runners or long distance events, ultra marathons. 

But I think for women, some women, the biggest issues are menstrual losses. And also, interesting personal story about that, because as soon as my book was published – I said in there, which I do believe for most individuals, that you can meet iron needs on a vegetarian diet. Again, well-chosen, well-educated for most people without taking an iron supplement. 

But it turns out my own daughter was in high school. She's training. And unlike my oldest daughter who told me things about menstrual cycles, she never said anything. And it turns out she was one of those people who had severely high menstrual losses and did become anemic and lost like – Really, her junior and senior year were recovering from anemia. 

And it's like really sad when that happens and you think you know what you're doing. And then you realize within your own house that you have the situation. For her and other athletes that really have these losses, vegetarian or not, likely an iron supplement is going to be needed at least at certain times of training or life. 

[00:43:11] LB: You know, what's important about what you said is that that just makes it clear that going vegan, plant-based, whatever, isn't a panacea for a particular approach. It's something that it's a concept that still requires personalization to the individual needs and preferences and so on. And of course, we'll be the first people to say, "Look, you really need to work with a well-trained, educated, appropriate professional who can help identify what those problems are." Because the chances are, you being able to work all this out on your own, at least right off the bat is pretty unlikely. And there's going to be a lot of trial and error. And yes, you might eventually end up with a patch on your arm when you become a dietitian in the hospital one day and it suddenly presents itself as life does. 

Speaking of these sorts of things, what about iron – it's not iron. Sorry. Vitamin D? Vitamin D is an interesting one. We've done podcasts about this. Absolutely fascinating topic. And yes, we're aware that the overwhelming percentage of this is something that the body will manufacture from exposure to sunlight. 

If you listen to the podcast and the papers that were written by my various guests on this topic, you then start to realize that there are things like, "Well, depends what time of day. The zenith angle of the sun." And there's blah-blah-blah. All sorts of stuff. Is there a plant-based perspective on this? Because, yes, there are certain foods that are fortified with things like iron, vitamin D and so on that might compensate for the fact that we may not be outside as much, or we're not in the right zenith angle of the sun or whatever. But is there a plant-based aspect to this that we should also factor in? 

[00:44:51] ELM: Yeah, it's funny, because my first answer is there should not be. Mainly because the way that we get, and your guests have said that before, our greatest source of vitamin D comes from sunlight exposure. But yet because of things that happen way back when we set vitamin D requirements, that industrial times, industrial revolution times, that it became a source that we recommended the diet. If you're not getting adequate sun, you should think about what's in your diet. But then the diet overall in the studies that we've done in athletes and then also reviewing the literature of what others have done on vitamin D intake of athletes, nobody meets their vitamin D even close to the RDA of 600 international units. 

I guess I shouldn't say nobody. I think our results said five to six percent of our college athletes met the RDA of vitamin D from diet alone. If you're not getting out in the sun, you probably do need to take a vitamin D supplement. 

But there are a couple papers out there that say that vitamin D status is lower in vegetarians. There's always that. Maybe some vegetarians avoid the sun because of their risk of skin cancer. There is probably some confounders in there. But it really isn't a plant-based diet situation.

[00:46:06] LB: Yes. I mean, of course, when we factor in that the body is in itself this sort of – I've said this in the last podcast. Some people will describe it as a hairy bag of salty soup. But of course, it's a very complex setup. All the way from genes, the whole genetic thing. You've course got the impact of hormones, hormonal networks. And there's all sorts of stuff that goes on there. The way the body interacts with its environment, including as just discussed. Connection with sunlight has an interesting impact. But then the body has to then respond to that and then manufacture stuff, process stuff. And that requires associated resources, which may be impacted by our lifestyle perhaps. And I'm thinking in terms of – well, it's not just having adequate resources for managing to other nutrients, healthy functioning liver, kidneys and so on. But there can be a wide variety of other things going on, which the body's got to deal with, which is all the challenge of life, I guess. 

But we've talked about you know plant-based diet. There are many benefits clearly. The abundance of things like vitamins and minerals, fibers, so on and so forth. But I guess the one area that people really like to jump on the plant-based approach for is the protein topic. And whether or not that is a valid argument in any form or whatever in sedentary people is one thing. 

And as my previous guests have argued, it is most definitely not a problem either in the plant-based approach. But I'm interested to know what your views are. Because if you do spend time on sort of forums or social media that's related particularly to people that are obsessed with gaining muscle, body composition, that sort of thing, that's where people start to throw their toys out of the bath when it comes to things like protein quality. And they'll argue about the importance of certain kinds of essential amino acids and how certain diets don't provide it. But then somebody else will come up with a completely different perspective. From your research and from your awareness of this, what are your views on the plant-based diet and protein adequacy particularly for athletes? 

[00:48:25] ELM: Yeah, I would agree with your – It sounds like your previous guests. That it is – the first step would be meeting your energy needs and then also being aware of what plant-based sources of proteins are. And that if you consume a healthy plant-based diet, that really both the amount of protein that you might typically get in a diet, like percent wise. And then also on top of that, just making sure that you choose protein-rich plant foods that it should not be a big deal. 

I think that I've gone – I've changed my thinking a little bit in thinking that times that maybe it might be more important, is that maybe when you're recovering from a big event or you're actually trying to put on some muscle protein, that you really think about in that meal, "Well, what am I eating now? And do I have a grain with some nuts? Or do I have legumes also with a grain?" 

But that's one of those things too that's so cultural that you hardly ever sit down. Like, almost that comment back about just eating beans. You don't just sit down and eat a bowl of beans. You might need beans with rice. You need beans inside of a burrito with some cheese on it if you're vegetarian. And that those naturally will kind of form that well-balanced protein. I guess, protein source. Sort of a blended protein that's now more of the term lately. 

I think that there's times, I guess, that I would say I might work with athletes a little bit more to think about what they're eating if they really at that time point in their training need a little bit more protein. But I don't think you need a protein supplement, whatsoever. 

When you think about good sources that, again, soy proteins, legumes, adding a little bit of nuts. And then now we're discovering a lot of grains may indeed in and of themselves. Not rice and wheat. But might actually be more high-quality protein than what we thought.

[00:50:16] LB: Yeah, I think it doesn't help that, over the years, the bulk of research on these topics of, for example, types of protein and their impact on muscle protein synthesis particularly that which relates to certain kinds of supplements, which of course are much more practical for a research study. And/or might be what was provided or donated by the sponsors of the study is a fact. 

And I was very lucky that, for the last year, I had the honor of Professor Kevin Tipton being on our team. And obviously, sadly, he's no longer with us. But we did a lot of podcasts together all about protein and interviewed lots of world-famous experts. We've managed to get a paper out on making a sense of muscle protein synthesis with Dr. Oli Witard, which everyone's got to read, please. And I think it's that fundamental lack of understanding about how these things actually work. And what is required, the substrates, the building blocks, that helps to get us there? 

And there is an agenda, frankly, that exists out of there. And I very much participated that in the years back in the day. I believed. Statistically, it was significant that said supplement had a greater impact than the other. But of course, when we start bringing it into what's actually relevant and realistic in the real world, there isn't any difference at all. Not really. Not really. The bigger picture is something that I think is very important as it relates to the plant-based diet, of course. 

Because if you narrow everything down to the strengths and weaknesses of everything, you're going to find problems of everything, aren't you? If we sort of get closer to wrapping things up here, because I think we could talk for hours about this stuff. But I say this a lot on this podcast. We like using terms like protein, amino acids, calories and so on. But we don't eat protein. We don't eat calories. We eat food. And it is a combination of things. And there are reasons why we eat food, which isn't necessarily just to fuel our training. We eat food because we like to eat food. Or we eat food because it's the only thing that's available at that time. 

As it relates to combining foods from the perspective of plant-based diets, what do we need to know about that? What are your thoughts? I know you've inferred a few things. But it'd be interesting to hear how you reply to that.

[00:52:41] ELM: Yeah. To step back for a second, I know that we're kind of starting to run out of time. But thinking a little bit about how initially there is a paper. And I don't know if you ever read it. It was a review of some of the work of – Oh, my gosh! Peter [inaudible 00:52:53]? Oh! And, oh, my gosh! I'll think of it in a second, though. Anyway, where they discussed that complimenting was not needed in vegetarians. And part of the whole concept that was missing was the amino acid pools. 

And that for a certain amount of amino acids, our amino acids are circulating in the blood for so long, and then those could buffer. Some of the foods that were consumed in the diet that might have an amino acid was lacking. That, in combination of the fact that we have all these digested enzymes that are being digested [inaudible 00:53:24] proteins because they were enzymes and then the slumping off of the gut. And that for these reasons, people who weren't training really hard, it was just meant for the general general public, don’t need to think about complimenting within the same meal. But think about consuming a variety of plant foods over the course of the day. You couldn't live by legumes alone. You couldn't live with meat alone. But by not thinking about it every meal, I need to compliment. That was a nice change. 

But I think my comment earlier was in thinking about shifting back a little bit, where in that period after exercise recovery or when you're in that phase where you really want to gain, that may be thinking about doing those combinations and buffering. So, what you're eating, like buffering one amino acid by what's in the other amino acid. 

And so, I have this little figure that I found somewhere that it has the beans and rice, and it's like we belong together. Oh, my gosh! Young was his last name. Young and [inaudible 00:54:22] was the article. [inaudible 00:54:24]. Oh, my gosh. Terrible. 

Then what I'm really thinking about them is thinking about combining a grain with a legume. Nuts are a nice source to – just an ounce of nuts or even a half of nuts when sprinkled on either a legume or consumed with any type of grain or grass food, like wild rice, would be considered a protein that might be complementary. 

You now have pea protein being popular. And of course, that that in and of itself is not a complete protein. Whereas the soy protein is. With the pea protein, also consuming, having a source of grain or rice or grass in there will be good. 

It's mainly just thinking about a combination of different sources of protein in that period, or in that time period where if you were going to train for, say, eight weeks to train and bulk up a little bit. Maybe during that time period, focusing a little bit more on consuming more mixed protein sources. I think I rambled on – 

[00:55:26] LB: No. You did. You did great. No. You did great. You did great. I guess one of the areas that has to be discussed when it comes to plant-based or having a plant-based approach to sports nutrition is not necessarily from the perspective of you know what's better. I think we've established, there are many reasons for doing this. And, yes, there's the whole impact on environment and so, which I sort of steer clear of because it's an area that's too big a topic for us to get into on this particular type of podcast. 

However, let's come at it from a different perspective. Is it likely to impede performance? Not is it good for your health? Is it can you be the world's greatest Olympic athlete? I think we know the answer to that. But what's the alternative viewpoint on that? What are your thoughts on that? 

[00:56:15] ELM: I think that, overall, it shouldn't matter. And we have plenty of examples related to that. I think that, again, some of the things that we've already discussed about is switching over and not eating healthy plant-based diet is certainly possible. Plant-based diets in and of themselves are not necessarily healthier than anything else. But the food choices within a plant-based diet are really going to drive that question. 

And if you're eating well in a plant-based diet, it should not impede your performance. And does it benefit? The way that it could benefit potentially is like eating more phytonutrients. But there's no evidence that would suggest that that would be the case right now. 

And then you could also argue that more of – if you're looking back that plant-based on the Spectrum where you're consuming a little bit of meat, maybe that's, I'd say, more ideal overall from the perspective of thinking balance and getting a little bit of meat that's going to provide a more absorbable source of iron and zinc. So, it's all on the spectrum, but it's all about good food choices no matter what type of diet that you're following. And we're always going back to eating more fruits, vegetables whole grains and plant-based proteins. Whether it has a little bit of dairy products, a little bit of meat, a little bit of eggs, it's all just kind of the diet that we're aiming for now.

[00:57:32] LB: And that's great. Like I said at the beginning, there are lots of different reasons for wanting to do this. But we should always respect individual needs and choice. And preference is important. But particularly, if you do want to help support somebody transitioning from one way of doing things to another, they don't necessarily need to be doing it 100% overnight. That could have its problems. 

And I guess, for me, my own perspective on this is whether you're plant-based, omnivorous or however which way you want to approach your diet and label it, it's not difficult to make it unhealthy by making bad choices. I think you know anyone can do that. Anyone can make bad choices with their diet. 

I guess for me, particularly as it relates to supporting optimal training adaptations, supporting optimal performance, the plant-based diet is just a little bit trickier, which is where your sports nutrition and sports dietitian has particular value. Do you have any sort of finishing comments about that? About the importance of maybe getting the right information from the right sources? Which of course includes your book, Plant-Based Sports Nutrition, as the essential component of your bookshelf if you want to go down this path. But do you have any sort of thoughts about where one acquires knowledge and support on this type of approach? 

[00:59:00] ELM: Yeah, I think that, as you mentioned, it's one of those things that doesn't happen overnight. And depending upon where you are as an athlete. And I think about the division one right now, at least in the U.S. schools. Some of them have beautiful cafeterias where you can walk in and anything you want is available. You can talk to a dietitian to walk around and help you make good food choices. 

But a lot of athletes are eating on their own. They don't have time. Or even the difference between male and female teams, like D1, D2 and D3. How do you learn to make those choices? And it is nice to have access to a dietitian. 

I think before my book came out, the number one book I would recommend is Nancy Clark's Sports Nutrition Guidebook. I mean, just a great book of her years of wisdom both personal and working with athletes. And I think the original idea from my book was to provide a lot of practical tips. 

It is full of a lot of different things in their tables. And then they this most recent edition, we added some recipes. Although, even beyond the recipe, there's two chapters that really talk about sort of thinking about your own diet. And then, slowly over time, learning to either cooking in the kitchen. One of those concepts that I realized not every athlete has time to do right now. But making simple things in the kitchen for more whole foods that don't take a lot of time. And then when you do have time, making things and freezing them so they're available. So, after you leave your training, you can probably pop something healthy into the microwave oven to warm it up. 

And then also learning to look at the products that are out there and which ones are healthy versus which ones are also processed. And then also restaurants in your area that actually make really good vegetarian foods that they made from scratch as opposed to also ultra-processed, which you can get at restaurants as well and when you eat out.

It's such a long thing. It is a little bit of a training thing. But over time, just slowly educating yourself. Starting within two recipes that you like to make. And then you can set a goal like, every week I'm going to come up with a new recipe. And if you don't like it, don't save it. If you do – And then one more thing is also to sort of get better of always not thinking you have to make a recipe. What's a simple thing? Like a bean with a grain? And whatever vegetables are around and seasoned in the refrigerator, just accent with those and then slowly over time you learn the combinations and you should be able to go walk in and make something that at least is enjoyable. It's tough. I wish I had better suggestions. 

[01:01:40] LB: No. Well, look, but that's no pun intended, but it's food for thought. And you've done a great job today. I love having these conversations. I know that our listeners got a lot out of that conversation. And I will point them towards your book and some of your peer-reviewed work that I think is relevant to this conversation. And some of the other podcasts and so on I've done that we've, in one form or another, referred to today. 

But for the listeners that want to follow you and your work, do you have a website? Are you into social media? Or is it more of your department website? Where would you like to point the listeners towards to keep up with your work? 

[01:02:15] ELM: At the moment, my department website is really where I have most of my stuff. I am on Twitter, it's Enette Meyer RD. I don't post very much. It's kind of every new year – 

[01:02:26] LB: You're too busy, that's why.

[01:02:29] ELM: I need to post more. But I do read and catch up. It's amazing one's available on Twitter. 

[01:02:34] LB: Yeah, great. Well, I'll link to all of those things. I'll do the hard work on that and put it into the show notes that will be on our website. 

Well, look, thank you so much for your time today. And yeah, I look forward to catching up with you again at some point. I know there's other areas that you're into with your research. And maybe I'll convince you to come back on in due course and we can talk about some of those other areas of research. But thank you very much, Enette, it's been a pleasure.

[01:03:01] ELM: Well, it's been a pleasure thank you both for having me, but also for just this whole series that you do. It's very valuable. And you're doing great job. So, thank you. 

[01:03:09] LB: Well, thank you. I do appreciate that. Thank you so much.

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