Dr. Michael Ruscio, DC is a clinician, Naturopathic Practitioner, clinical researcher, author, and adjunct professor at the University of Bridgeport. His work has been published in peer-reviewed medical journals and he speaks at conferences around the globe.
How To Prioritize Diet & Lifestyle Interventions with Dr. Mike T. Nelson.
It can be useful for all of us to have nutrition and fitness guidance every now and then, to pull us out of ruts and encourage greater breadth and balance in our routines. Those who have adopted a paleo-style diet may trend towards a too high fat intake and may be surprised to learn that there are situations where high carbs lead to higher performance. For those who lift weights only, adding endurance/cardio may contribute to greater longevity. Varying one’s nutritional intake and types of activity can also increase metabolic flexibility (the body transitions between using macronutrients more flexibly). Dr. Mike T. Nelson takes us through an optimized hierarchy of the top eight diet and lifestyle interventions.
Dr. R’s Fast Facts Summary
Where to start with Fat and Carb intake
For someone (male) exercising 4-5 days a week, fairly active, more experienced with weight training
Start off with 80-100 grams of fat
Start at 200 grams of carbs (up to 500 grams if athlete has higher cardiac output)
How to add in cardio
Add Anaerobic (30 sec sprints) or Aerobic (jogging, stairs, rowing) to your weekly workout routine
In-depth research shows that longevity can be measured by 3 things
Aerobic VO2 max
Lower body strength
When to fast or eat carbs before a workout
Easy moderate row – do this fasting – teaches the body to use fat as fuel
Heavy weight training – fuel with carbs – recovery and performance are better if carbs higher on that day
Dr. Nelson’s FlexDiet Certification
Provides a hierarchical list of interventions, starting with most important balanced with how easy they are to implement
Episode Intro … 00:00:40 Be Careful Not to Overconsume Fat … 00:07:43 Add More Endurance, Cardio Training … 00:13:51 Alternate Exercises for Longevity … 00:16:20 Vary Your Carb Intake Based on Activity … 00:18:42 Rowing: a High-Return, Safe Activity … 00:25:09 Benefits of Balancing Weights with Cardio … 00:36:22 The Top 8 Diet & Lifestyle Interventions … 00:41:37 FlexDiet Certification Sequence … 00:47:51 How to Optimize Micronutrition … 00:50:48 Combining Interventions for Max Efficiency … 00:54:32 Episode Wrap-up … 00:59:18
Dr. Mike T. Nelson: No. I think that sounds pretty good!
DrMR: That’s the long and short of it. After a while, some of these podcasts tend to blur together. Let me start by just giving Mike some praise. I’ve been working with Mike now as a client for my training and nutrition for a little over six months, I want to say. And it’s been very, very helpful. So Mike, I have to thank you.
DrMN: Oh, thank you, sir.
DrMR: Yeah, you’ve done a great job. And just to share with the audience my own follies, so that they might help inspire you to take a closer look at what you’re doing… what I was doing before wasn’t bad. In fact, I would argue it’s better than most.
DrMN: I would agree.
DrMR: Thank you. But if we’re all on this journey to optimize as best we can, sometimes I think we get a little complacent. When you’re comparing yourself to the standard American, you can’t give yourself too hearty of a pat on the back. But sometimes, when you have that comparison around you so ubiquitously, you forget that you could be doing even better.
For me, I was getting a little lazy with my programming in terms of the gym. And I think a lot of the muscles called my posterior chain, back, glutes, hamstrings, a lot of those weren’t getting enough attention. I did notice one thing that was becoming an annoyance was this somewhat chronic dull knee ache. It was nothing bad, but if I’d be standing for too long, I’d have to kind of move and I’d be like, “Oh geez, my knees are a little achy.” That now is completely gone. And I think that was just derivative of not having this correct balance between the front-side musculature and the back-side musculature, which Mike’s programming has helped to balance out.
I’ve also been more motivated to do a better job with my diet, in terms of not leaning on the healthy foods that are the most convenient, but also trying to broaden my diet out and incorporate new foods in. And Cronometer—which is a tool we’ll talk about shortly, I’m sure—is a nice way to punch all your food in and look at what your micronutrient breakdown is. When you eat poorly, you will see: “Wow, I ate all my calories for the day but I only hit 70% of my nutrients. When I eat in a more broad and healthier way and don’t rely on healthy convenience foods, then I hit 100, or much closer to 100.”
We’ll also be doing a podcast in the future that’s going to go into deep, deep detail about how to really optimize for micronutrition specifically. But just the fact of tracking helped me really open my eyes and realize that I was focusing on maybe too narrow of an offering, specifically of vegetables, and broadening that out really helped.
So those are a few things that I have learned in working with Mike. And Mike’s back today to expand upon some of these things and also talk about a course he has where he teaches this.
Mike, would you briefly tell people about you? And then offer any comments on my follies that you want to, but try to keep it under 30 minutes.
DrMN: Haha. Yeah. Well, thank you very much for the kind words. Appreciate it. And yeah, you’ve done really well with the programming and everything. I think it’s almost easier if you’re someone like yourself who’s been exercising for quite a while, knows what’s going on, obviously been in the gym quite a bit.
Everybody tends to be a creature of habit, even for nutrition. I have someone I work with, not necessarily because I don’t know at all what I’m doing, but it’s easy to fall into habits and to miss some awareness. Because everyone’s kind of human. People tend to want to do the same thing, day in and day out. It’s even harder when they make pretty good progress doing it, because subconsciously they’re like, “I don’t know. I’ve been doing this, and I’ve been doing pretty good.” A lot of times just to get to that next level it just takes a set of outside eyes, and some assessments to see what’s going on. Even small changes can make a pretty big difference.
So yeah, how I got into this…. I did a Bachelor of Arts in Natural Science, minor in Chemistry. I did about two and a half years of pre-engineering work before I did a master’s in mechanical engineering, biomechanics. After that I started working actually for a medical device company for about ten years. And I started doing a PhD program in biomedical engineering. I spent about five years doing that.
But even when I was doing that, I was going to exercise physiology conferences for fun, was literally reading stuff off of PubMed on exercise physiology. I did my master’s, I took a 400 level exercise phys class, literally just for fun, because… I thought it was interesting. Haha.
And about five years into the PhD program, I didn’t really want to do any more math, so I dropped out, went over to the exercise physiology department. Ironically enough, I got assigned two projects that helped a lot with math, looking at heart rate variability and metabolic flexibility. I spent about seven years there and finally finished that. I was about 39 by the time I got done.
Started training clients in about 2006 and worked at a gym for a while. They filed for bankruptcy, so I ended up just putting stuff in my garage. I ended up just training people here, out of my garage, and then later on I moved to training clients online.
Right now, I’m a faculty member at the Carrick Institute. They do a lot of functional neurology, so I do their exercise and human performance program. Adjunct for Rocky Mountain University, Georgia Southern University. I created a course, FlexDiet Cert, which we’ll talk about, coming up. I work with some clients online. And I spend my time going to conferences, reading some research for fun. We got to hang out again at Paleo f(x) in Austin, because we were both presenting there. So yeah, it’s been a good time!
DrMR: Yeah, you’ve had such a great career in terms of an impressive breadth of different areas that you’ve studied. And you can tell that you bring that into the work that you do. I’m sure that’s probably been fairly evident for people who’ve listened to any of your podcasts. I’ve definitely been impressed by the body of knowledge, and certainly the awareness of both sides of the data on a given argument. And that was why I felt good about working with you, because you didn’t seem like someone who was just willing to do whatever looked good, and you’re going to be reasonable and practical.
Be Careful Not to Over Consume Fat
So I’m trying to dig into some of these details that you teach in the Flex certification. And I even love that name. And I think what you’re hinting at is this concept, that you’ve talked about for quite a while now, which is this metabolic flexibility. Which is, it may not be good to always be low-carb or always be high-carb, but perhaps giving your metabolism a little bit of exercise could be very healthy for your metabolism. Which, philosophically, makes so much sense.
There are two things here that I wanted to hinge on, from my personal case, as a springboard into this conversation. Two other things that I was doing incorrectly—for lack of a better term— and that I am suspicious a fair number of people listening to or reading this are also doing. I think I was overly eating fat. And I think we fall into this habituation of thinking that many of the higher-carb foods are unhealthy for you and it’s easier to just do a semi-fast a day and then at night time you’re kind of hungry. And you end up loading up on fat, which, even if they’re healthy fats, can be easy for some people to overconsume. Christopher Gardner also alluded to this last time he was on the podcast.
So I think I was overeating fat. And that’s been evidenced by the fact that I’m now down about 10 pounds from where I was before. And I think some of that was just—as you said before—this gradual slide into doing what you always do and having no good countervailing pressure to prevent me from falling deeper and deeper into what my tendencies are.
So I could come home and have half a block of grass-fed organic cheese, not realizing that was way too easy of a way to consume a ton of calories. And again, not to say that calories are the only measure. But when you’re getting to this point of trying to refine your diet for optimum performance and body composition, that’s when—another point you opened my eyes to—the calories do matter. And sometimes it’s just as easy as changing your food choices to these non-hyper-palatable foods, even if they’re healthy hyper-palatable foods. That was one.
I’ll just pair with that, I think I was not doing enough endurance training. And I think those together were two big things for me to identify, for us to identify and to rectify. Any thoughts there? Do you see this somewhat prevalently in this paleo-ish community, where people maybe think their cardio is just lifting weights quickly, and they’re eating tons of fat because they’ve been told that no fat or healthy fat can never be bad for you?
DrMN: Yeah! To address the first part about fat, I agree. Again, I’m not saying fat is bad. Everyone in the fitness world wants to pick something and demonize it and go from one extreme to the next extreme. But for someone like yourself, who’s exercising four, five, six days a week, fairly active, more experienced with weight training, I tend to find that those people are following more of a paleo-type approach. They gravitate a little bit to high fat at the expense of carbohydrates. And it’s a spectrum. I have some people who are more moderate on the carbohydrates, a little higher on fat, and they seem to do pretty well.
But my preference to start people off with, and see how they perform, is lower on the fat side. So by lower, I’m not talking about extremely low. For a guy your size, 80 to 100-ish grams of fat, probably somewhere around there is a pretty good starting point. I’ve gone down as low as 60. And if you’re a male, even eating 60 grams of fat is on the lower side, but it’s not so low as to impair hormone function or anything like that. It’s not super low, where the only thing you’re eating is egg whites and broccoli. Like, you may remember the ‘80s, the ultra-low fat diets. Oh God, your food tastes horrible.
But I think, sometimes, we’ve swung the other way a little too much in using fat in everything. Some diet logs I see from people are two tablespoons of butter with two scoops of MCT in their coffee in the morning, and just lots and lots of fat. And their performance, in terms of the gym, is tending to go down. Their carbohydrates are pretty low. They’re not low enough where they’re doing a ketogenic diet. I call it the metabolic no-man’s land, where your carbohydrates start getting 100, 110 and below that, and not low enough to be ketogenic. Most people need their carbs to be below 40 or 50 grams a day to be ketogenic and super high-fat, lower-ish protein. So they get stuck in this no-man’s land where they don’t really have quite enough carbs to adequately fuel all the performance they’re trying to do. And I will lower their fat, slowly bump up their carbohydrates.
Then you’re walking the fine line between the performance in the gym, or the sport that you’re doing, and body composition. So you’re trying to find the balance point, where performance is going well, but body comp is also going in the direction that you want to go. I find by having a lower-ish fat, a moderate/higher carbs, and in terms of a gram amount of carbohydrates… a guy your size, 200 grams, maybe go up a little from there. I’ve had guys your size or even a little smaller, at 550 grams of carbs a day. People listening to this are like, “Oh my God, that’s like diabetes waiting to happen.” But they were Crossfit competitors. And you’re training twice a day for three days a week and training almost every day on top of that. So they’re pretty advanced athletes, and they had a massive output. They needed to fuel that output.
Add More Endurance, Cardio Training
Related to that in the cardiovascular: again, I’ve seen some women who have fallen into this too, but it tends to be more males. They usually do weight training like four days per week, and their idea of cardio is: “I’ll just lift weights faster.”
And you can get some benefit from that. But in terms of the classic cardiovascular benefit, the adaptation you get is going to be a little different. It’s more at the peripheral muscle level. And yes, your heart rate does go up, but my bias is to split people into either an anaerobic lifting-type day or, especially to start out, more of a classic aerobic day.
This doesn’t necessarily mean that you have to go out and just start training like you’re going to run a marathon. You don’t even have to run if you hate running. As you know, I’m a big fan of using the Concept2 Rower, but you can use a bike. If you’re efficient enough, you could possibly use swimming. Swimming is a little different because of the resistance of water and there’s a pretty high skill component.
But I really love doing the rower. I get a lot of that stuff from Dr. Kenneth Jay. And the reason I like it is, it gives you all your data automatically. So on the screen, you know power, you know all your outputs, you know all your time, and it’s automatically recorded for you. In terms of tracking, it makes it really easy. Especially with the Crossfit in most gyms now, you can find the rower in almost every gym, so it’s pretty easy to find. There’s not much of an impact to it. So if you’re a bigger guy, and you’re running, especially if you’re not experienced running, you can start to have joint issues just from the impact all the time.
There’s also an interesting power component to it. So if people have never been on a Concept2 Rower before: you’re pulling against a flywheel. And if you pull kind of slow, it just feels harder. So it’s really in your best interest to pull as hard as you can, not really all-out. It’s a different sensation. I kind of equate it to, if you’ve ever done a car push, it takes a little more effort to get the car going. Once the car’s going, it’s not really as bad. But there’s that incentive, with that momentum of the car. You know if you start slowing down, man, to get that thing going again just really sucks. So with rowing, you also get a nice power component.
Alternate Exercises for Longevity
And you can row everything from almost anaerobic sprints of 30 seconds or a 500 meter, all the way to 20-minute capacity row, or even longer than that. So it gives you a nice variety with it.
Back to the difference between that versus just lifting weights faster, what you’re looking for is a little different adaptation. So I like to do more of a pure aerobic adaptation initially. Ideally for lower to moderate intensity, you would be using fat as the main fuel. It’s going to vary a little from one person to the next. And from a cardiac development standpoint, you’re trying to increase something which is called diastolic filling. So you’re trying to get the max amount of blood flow you can get into the chamber of the heart to push out against those walls, and when the heart contracts, it’s pushing out against not much vascular resistance.
But if you imagine rowing… even though you are using your hands, your arms, and your upper body, it’s not the same thing as if you were doing a deadlift or a squat for reps. So when you’re lifting weights faster, you have more extremity and muscle contraction. The heart has to contract harder to push the blood out, and increase and overcome something that’s called afterload. So the vascular pressure that the heart has to put out during lifting is much higher than like, a 20-minute row on the rower. So the adaptations you are getting are a little different. And there’s some pretty good data showing that aerobic fitness is tied to longevity.
Longevity is the really big, key buzzword now. And the top three predictors of longevity that we have very good data on are VO2 max (aerobic capacity), grip strength, and lower body strength. By alternating—like Monday, Wednesday, Friday or Saturday, do some type of lifting, Tuesday, Thursday, maybe Sunday do some type of lighter, moderate cardio—you get a nice benefit of positive adaptations in both. You burn a fair amount of calories. It can increase your aerobic capacity and also gets you closer to longevity markers, all while increasing your performance.
Vary Your Carb Intake Based on Activity
DrMR: A few things that I want to piggyback on. One is the carbohydrate piece. As the audience knows, I haven’t been too ardent on the carb piece in a high- or low-carb direction. I see the nuance. I see a utility in drifting a bit more into lower carb initially when trying to improve one’s gut health, not for any other reason than you have to avoid different types of vegetables and carbs, because people are having a hard time breaking them down. So it’s more a lower-carb by default, rather than it being a lower-carb by design. And that’s also different from ketogenic. I don’t think we need to go ketogenic for most people initially.
Where to start with Fat and Carb intake:
Example for males who exercises 4-5 days a week, fairly active, more experienced with weight training
Start off with 80-100 grams of fat
Start at 200 grams of carbs (up to 500 grams if athlete has higher cardiac output)
Then from there, as people get healthier, I’m pretty open to reading their body in terms of where they feel best on the carb spectrum. Probably no news there. But it doesn’t change the fact that I have personally often gravitated toward a bit more of a lower-carb approach. Not ketogenic, but certainly not 500 grams of carbs per day.
I was very concerned when you had me up my carbohydrate intake to about 200 grams per day. It was like I was going to be back in college, trying to do a gainer session where I ate until I was ready to puke to try to gain weight. Ironically, I upped my carb intake but I lost body fat.
So it was just a good reminder for me not to hold any belief too strongly, like the belief that lower-carb diets are better for weight loss. I still think that’s generally true for most people, although there are nuanced reasons you could argue against that. But it was just a great example for me to not hold too closely to any one belief because, again, I upped my carbs yet I lost body fat, which just seems so counterintuitive to me.
DrMN: Yeah, I don’t want to pin this all on the paleo world, but insulin gets a bad rap. And there are all sorts of mythologies surrounding it. I think insulin is much better thought of as the fuel selector switch. So if you just eat two cups of white rice, for example, or Pop-Tarts or whatever carb you want to pick, your body is going to put out more insulin. And that’s a good thing, because that’s going to push you closer to more carbohydrate oxidation.
Then on the flip side, if insulin is low, like during a period of fasting—or if you’re just only having fat, since fat itself is not insulinogenic—it is going to push you to use more fat as a fuel.
So in all our metabolic flexibility, both of those are good. It just depends on what you’re trying to do at the time. For most athletes I work with, if they’re doing just an easy/moderate row on Tuesday or Thursday, I’ll initially—if they can—then have them do that fast in the morning. If I want insulin a little lower, I want to teach their body to use more fat as a fuel. The intensity of the work isn’t high enough that they need to use a lot of carbohydrates.
Then on the other end of the spectrum, if they’re going to do a heavy weight-training session, doing a lot of volume or heavier lifts, that is going to be fueled primarily by carbohydrates. And while they’re going to have some carbohydrates stored in the liver and in the muscle, I find that their recovery and performance is a little better if carbs are generally higher on that day. So we actually want insulin to go up, we want to push you towards that carbohydrate end of the spectrum. And from a health standpoint, we can argue that your body is more primed to use carbohydrates at that point. You have the GLUT4 translocation: when muscle is contracting, insulin is higher.
You also have a non-insulin mediated uptake. Just muscle contracting by itself can pull glucose out of the bloodstream independent of insulin. So you have those things in your favor at the time when you’re exercising.
So I think in the fitness world, everybody wants to say, “Oh, fat is the best fuel ever.” Well, it depends on what you’re doing. If you’re really trying to do an ultra-endurance event, and you’re not really concerned about winning the ultra-endurance event, or you have to possibly carry all your food and substrates with you, yeah, maybe using more fat, maybe a ketogenic approach might be useful in those circumstances. If, however, your sport has anything to do with speed and power, or you like lifting heavier weights in the gym and setting more PRs, then carbohydrates are going to be your friend. It doesn’t necessarily mean either one is bad. You just want to use both. Again, you want to make sure to use it at the right time.
For most people I work with initially, we’ll just keep increasing their carbohydrates. A lot of them had a similar paradoxical experience to what you had, in that they scratch their head. They’re like, “Wait a minute. I’m eating more carbohydrates.” But their calories are a little less overall. And the part they forget is by doing that and getting more performance in the gym, they’re actually doing more work. So they’re kind of back-end around, burning more calories at the same time.
DrMR: Yep, it’s a great point. Like I said, I was interested in how that was going to pan out, and I was thinking, “I’m definitely going to gain weight.” And I was probably performing better.
It’s hard for me to read that, because I think just starting a new program was very invigorating. Now, it’s not me just going to the gym every day and saying, “Well, what am I going to do? I’ve been working all day, I don’t really feel like thinking anymore about what my programming will be, so I’ll just do whatever.” Once that changes—and someone else is now doing programming for me and I know somebody’s going to be watching—there is something invigorating about having someone else giving you new stuff to do. It’s different, it’s fun, it’s more engaging. So I was definitely performing well. I can’t objectively say if the carbs were a huge help in terms of performance, although I think it’s pretty reasonable to say that they were. But I definitely have that obvious objective measure of the scale and the way my clothes are fitting that improved, which was great.
Rowing: a High-Return, Safe Activity
The other thing that I wanted to touch on here is rowing. I kind of dragged my feet a little when we started rowing because I’m used to playing soccer and moving. When I’m not lifting weights, usually how I’m getting my endurance training in is through some soccer. But I definitely have come to like rowing.
I’ll just share a little story here, at the risk of TMI for the audience. As the audience knows, we have had a few cannabis researchers on the podcast. Medicinal cannabinoids in a CBD-only format is something I’m currently experimenting with in the clinic. Too early for me to report back, in terms of how it’s working for various digestive and autoimmune maladies, but I’ll hopefully have an update there sometime in the near future.
But I’ve also been tinkering myself. And I’ve noticed things about a lower blend of THC with CBD (so you do have some THC). This is something that I thought Jordan Tishler did a very good job of outlining in the podcast that he did with us, where we talked about using medicinal cannabis for enhancing sexual intimacy. He made the remark that many of the types of marijuana you would get in college, or that we’re accustomed to hearing about in the non-medicinal realm, are engineered with extremely high levels of THC. And many people, I think, have bad experiences with cannabis because of that. But if you can use a well-formulated flower or pen or whatever it is, and you have some THC, but not an overwhelming amount, I’ve noticed that it really facilitates my endurance training.
I had two very, very powerful rowing sessions. I also used a Pandora station called “The Interstellar,” for the Interstellar movie, which is scored by Hans Zimmer. So you have all those driving superhero thematic scores, and if you’re doing that plus rowing, plus you have the facilitation of a little medicinal cannabis, I mean, it was incredible. I really felt like I was rowing to save the world. Hahaha. Obviously, I got a great workout from it.
However, to your point about injury, I then did that the following week and I did a running interval session with sprints interspersed. And then I ended with 70, 80 yard sprints, full throttle, which is something I hadn’t been training for. When you play indoor soccer, as I do, you get short sprints, but you never get that. And if anyone here sprints, you know the difference between a short sprint and an open field sprint, where you really open up the throttle. It’s like pedal to the metal, how fast can my body go? Compared to, I’m sprinting from here to that guy, 10 feet away. It’s totally different bio-mechanically. I had the mental drive to do it, but physically I wasn’t quite conditioned up to it and I had a bit of a quad pull from that.
So the point I’m making is, I wouldn’t have been able to injure myself most likely on a rower. But on something like a track field, you’re a little more prone to injury with a movement like a sprint. So I see the utility in rowing for multiple reasons.
Also, tying this into the larger cardiovascular picture, I have heard of a condition—although I don’t know much about it—that can occur in people who are only lifting weights, known as left ventricular hypertrophy. This means that the part of your heart that pushes blood out into the periphery is hypertrophying (becoming larger) because there’s so much peripheral resistance that the heart is having to push against. So it seems like getting some cardio to balance out your cardiovascular stimuli could be helpful for that.
I’ve also noticed that my resting heart rate has actually improved.
And it seems to track with, the better I’m doing with my cardiovascular training, the better my resting heart rate tends to be. So I think there is at least a partial case to be made… you may want to rethink the philosophy that no one needs any cardio.
If I had to choose one exercise modality, it probably wouldn’t be cardio. If you would say to me, “Okay, this person can only do one type of exercise,” I would probably have them do functional lifting of some sort. But if we’re not in that situation where we only get one pick and we can a few different stimuli, it seems that getting some cardio into the mix seems to be pretty health-promoting. And my experiences reinforce that.
DrMR: Hey, everyone. I’d like to thank Aerodiagnostics, my favorite SIBO lab, for making this podcast possible.
Again, Aerodiagnostics is the SIBO lab I use in my clinic. They have impeccable organization, customer service, test quality, and support. Regarding support, if you’re not highly proficient in reading SIBO labs, Gary definitely offers the best clinical support I’ve ever come across. He goes over labs in detail and offers insight analysis and really goes above and beyond.
Aerodiagnostics offers cash pay and insurance billing options, and they do a terrific job at keeping costs low and billing easy. They offer accounts for clinicians and direct-to-consumer testing. Aerodiagnostics, again, is my go-to SIBO lab. Aerodiagnostics, check them out.
DrMN: Yeah, I would agree. And just some insider knowledge. The interesting part is, you had sent me an email the night before: “Hey, can we add some sprinting and some stuff in? Why am I doing all this crazy rowing? I’m trying to get better at soccer.” I wrote back and I’m like, “Yeah, we can slowly add some sprints and things back in, in a controlled manner.”
The reason for doing rowing is you can get pretty high power outputs done in a bio-mechanically very safe position. So FYI, for people listening: there’s a big difference between running, even sprinting 90%, versus close to all-out. Your legs are going through an extremely violent motion of going all the way back and getting whipped all the way back forward again.
I remember the first time I started doing some sprinting, probably 15 years ago. I was going to take a course from Z-Health at the time, and they’re like, “Okay, we’re going to do a bunch of sprinting. We’re going to teach you how to run.”
I’m like, “Oh, this sounds cool. Okay, I’m going to go to the track and just do some light sprints for 100 meters.” And I only went up to maybe 90% of what I felt like was my max. Oh my God, the next day my hamstrings and adductors were so sore. I’m like, “What? Why are my adductors sore? Oh, because you’re stabilizing on one leg.” So lots of violent movements with that.
That’s the reason I do like rowing a little better for that, because… it’s just weird that a lot of people are never taught how to run. I don’t work with a ton of endurance athletes, a couple here and there. And even endurance athletes, I’ll ask them, “Hey, did anyone ever show you how to run?”
They’re like, “What?”
I’m like, “No, did they teach you a skill of how to run?”
They’re like, “No.”
“But you’ve been running marathons.” And it’s just one of those things that’s never really taught.
I’m not a great sprint coach by any stretch of the imagination, but I know a few basic drills and things that can help get someone moving better. And if I work with someone in person on that, even if they’re an endurance athlete, I actually work with them more on sprinting capacity first. Then once they get pretty good at that, they can slow everything down and do more of the endurance end of the spectrum. So I do it a little backwards from that.
But I do like rowing. If you look at rowers in terms of athletes, one, there’s a lot of really good data. Even Concept2 has a very good database that’s updated with self-report data and verified data, so you can look at it and see by doing different tests where you rank against everybody else. That gives a nice baseline. And it also can be motivating to be like, “Oh wow, I’m in the bottom five percent,” which was where I was when I did my first 500 meter, probably three years ago. I was like, “Wow, I didn’t think I sucked that bad!”
And most people with intelligent work can actually get better at it, I would say, within a relatively shorter time compared to lifting. Now again, shorter-ish, we’re talking about months to years. So it’s not really short, per se, but if you look at how long it takes someone to get stronger—especially after the first easy adaptation period of three to six, maybe nine months—you’re talking years to potentially decades for most people. There are always hyper-responders and things of that nature.
So I find with intelligent programming, most people can get to the 75th percentile for most of the rowing metrics. Again, I stole that from Dr. Kenneth Jay, who has done a lot of really good programming on rowing. He’s the guy who changed my mind with respect to rowing.
As I mentioned, rowers as athletes have incredibly high power outputs. They can do 90-plus percent of 1RMs for reps, which is crazy. In terms of physiques, they look very good. They have a fair amount of muscle, they’re relatively lean. So from the average person looking at it from a physique standpoint, it’s a pretty good marker.
At an elite level, there definitely is a lot of skill that’s involved to be a high-level rower. But you can get to be pretty good with not—I would say—a ton of effort. Where if you said, “Hey, I want to be an elite sprinter,” eh, you’re probably going to need a fair amount of coaching. Even to get to a pretty good to moderate level of sprinting, I find that it takes a fair amount of coaching. With rowing, I find you can give people a really basic intro, have them go at it, and practice. They’re not really going to hurt themselves either.
And by looking at the power output, because the metrics show up for each pull, you can almost auto-regulate a little. Like, “Okay, my goal is to hit 220 watts on each pull. Ooh, that one was 190, so definitely low. Oh, if I push with my legs a little more, oh, okay. That’s 221.” You get that automatic feedback each time you’re doing it, which allows you to play around with small tweaks. And you can see the effect of it right away in front of you. So I think having that feedback there is extremely useful.
Benefits of Balancing Weights with Cardio
You had mentioned something about increasing LV thickness, so left ventricular hypertrophy. That is true. So if you look at elite-level powerlifters, weightlifters also, they do tend to have a much thicker myocardium, especially on the left side.
The left side of the heart is the part that’s designed to pump blood out to the rest of the body. And at some point, you can start to develop electrical problems because of the increased amount of tissue. You will start to see a decrease in chamber size, because the tissue is growing into the chamber where the blood is located.
And when I mentioned and talked about just pure cardiovascular training, you’re giving, from a cardiovascular standpoint, the direct opposite reason for adaptation. So if you want to increase perfusion under a very, very heavy load—so if you think of something like doing a leg press, or a squat, especially with that heavy axial loading—you’re going to need a lot of really thick muscle to push that blood out, to get it past all that high amount of vascular resistance.
If you go to the other extreme, and you look at something like aerobic training, you have a lot more blood flow that’s coming back to the heart and you’re looking for that diastolic stretching. You’re trying to push as much fluid into that chamber of the heart as you can, to have it push out against the wall to try to increase that chamber size.
Now how much of that can we change? It’s pretty debatable, because your heart is always working. If I did biceps exercises, I could definitely pick a time and place where I really want to hammer the crap out of my biceps, yeah, it’s going to get some work during the day, but it’s going to be very, very minor. I could purposely not use it a lot the rest of the day. Our cardiovascular system is always working in some capacity, just at different loads. So there is a debate about how much of this can we change over time. But I think doing some form of cardiovascular has been shown to have a fair amount of benefits.
Again, if you go back to rowers, when they’ve done a lot of echo—so we can take an echocardiogram and look at the structure of the heart itself—you can get really fancy and do tissue doppler imaging and look at blood flow and everything else, what we find in rowers is that they’re capable of doing super high power outputs. In terms of ability to generate force, they’re very high. Maybe not the same as a powerlifter or an Olympic weightlifter, but they’re very high.
They also have a high amount of cardiovascular component, aerobic component. Very high VO2 max a lot of the times. Very high lactate tolerance, especially in the lower distance races, 2000 meters, things of that nature. Cardiovascular-wise, they’ve got very good long-term data, especially from some Scandinavian countries. And cardiovascular health is really, really good in rowers. So we know that, for whatever reason—which is debatable about the exact stimulus—with rowing you can get very high power output. It doesn’t really mess up some adaptations you’re trying to get from training, especially lifting weights. But we know from a cardiovascular health standpoint, it’s definitely beneficial also. So it’s a very nice hybrid if you had to pick one.
And the last comment on that is, I don’t really know a lot of people that really enjoy doing the rower, per se. I have very much had this love-hate relationship with it. I like it because it’s extremely effective, but is it the most fun thing I’ve ever done in my life? Not really. Left to my own devices for fun, would I do a lot of rowing? No. But I find the transfer from it is very high. Resting heart rate, especially working in the aerobics, goes down. Heart rate variability goes up. Ability to recover.
The last part too is that people forget that your rest period between your lifting—so, let’s say you’re doing old-school Bill Starr 5 x 5 on deadlifts, when you set the weight down—is aerobic metabolism-based. Meaning, the more fit you are from a cardiovascular standpoint, the higher VO2 max, better aerobic capacity, the more you can then shorten those rest periods.
And while a very randomized controlled trial on that in terms of recovery hasn’t really been done, I know a researcher that’s doing one this fall that should be out. But in theory, it should actually help your anaerobic training because now you can do a greater density. I can do the same amount of work in less time if I have a higher level of aerobic fitness, without sacrificing performance.
DrMR: Right, yeah. You recover better in between sets, essentially, which makes complete sense.
The Top 8 Diet & Lifestyle Interventions
DrMR: So tell us a little about the FlexDiet certification. We’ve hinted at many of the concepts that you teach, but let’s give people an overview on that.
DrMN: Yeah. So a lot of people do pretty well in the gym, but the other 23 hours of the day, eh, it’s kind of a mess. Especially for trainers, once you start talking about nutrition and recovery, everybody has their own bias.
I noticed this from going around to even very high-level gyms and talking to trainers and gym owners. I’m like, “Hey, what do you guys do for nutrition and recovery when your clients aren’t here?” Because most people are looking primarily for body composition and some type of performance.
They’re like, “Well, I don’t know. We just do some 30-day challenges every once in a while.”
You can imagine, if you’re a client, it’s like, “Oh, January is keto month. Oh, wait, February is paleo month.” It’s just very random from one to the next. And part of it was they didn’t really have a system to use. They didn’t really know exactly what to do. There was no tracking, accountability, things of that nature. So that was the reason why I designed it.
What I did was, I took the top eight interventions. One, what would they actually be? And then two, how would I rank them? I know everybody’s very short on time. I put the things that are going to have the greatest benefit to do first. So when someone goes through the course, they’re like, “Oh. I understand the concepts of metabolic flexibility, flexible dieting as a big picture. So I’ve got a good idea of the context of what’s going on and why I would be doing specific things.”
Then I have a specific order of things to start with. So for example, the first one I did is dietary protein. How I ranked them is based on something I just called coaching leverage. In the past, I got a little too hung up on only the physiological response. When you start working with clients in person or as you do in your clinic, you realize very quickly that most of the time you’re limited by their psychological ability to change. That is a big limiter. So I said, “Okay, I’m just going to create something called coaching leverage,” which is the physiological impact times the psychological ability to change.
So something like protein is pretty high in both. There are a lot of good reasons to eat more dietary protein, especially for recovery, for body comps, satiety, a bunch of reasons. And it’s relatively easy to get people to do it. People come in, they think, “Oh my gosh, I got to do a diet. Oh, this crazy trainer’s going to tell me just to eat less.”
I’m like, “No, you want to eat more protein.”
They’re like, “Wait a minute. You’re telling me you want me to eat more of something, not less?”
I’m like, “Yes, exactly.”
They’re like, “Oh, okay.” So they’re kind of interested in doing that.
If you take something like sleep, which is a very hot topic now and for very good physiological reason. There are all sorts of benefit to sleep. It’s definitely something most people are not doing a lot of, definitely helps with recovery, body comp, insulin sensitivity, all sorts of stuff.
Have you ever had a conversation and tried to get a client to sleep, say, two hours more a night? It’s not an easy conversation. Because at some point, that gets into almost a value judgment on their life. They’re like, “Oh, wait a minute. I’ve got two kids, I have a trainer, I’m busy. I drive to work, I do all this stuff. I train, I do the exercises you told me to do, and I have two hours to relax with my spouse and watch Netflix at night. And now you’re telling me I just need to stop doing that and go to bed?” Eh, good luck! Haha.
The psychological ability to change with sleep is very poor. You can do things to increase sleep recovery and quality, but at the end of the day, it’s much harder to get changes in that. So when I did the intervention ranking, sleep was actually number eight. It wasn’t necessarily because of physiological reasons, it was more about the clients’ ability to change.
I then ranked all of them from just one to eight. And in each module you’ve got the big picture. I condensed it down into one hour about that particular intervention, whether that’s protein, carbohydrates, sleep, exercise, NEAT—so non-exercise activity thermogenesis, which is how much you walk around and move that’s not exercise—and different things like that. And then I also included very specific action items to do as a third video. So each of the interventions has three videos.
I said, “Okay, here’s your specific action items—what you want the clients or yourself to do—and then there’s a way to figure out which one is best for them.” The problem I was trying to solve was, how could I lead people in the direction that I wanted them to go but still make it a flexible approach? The analogy I use is bowling. What we’re doing is inflating the bumpers on the side of the bowling alley. You’re still going to weave down the alley, but you’ll make it to the end, you’ll get to where you need to go, and we’ll help guide you to make sure that you don’t end up four alleys down the other way.
The reverse is, if you come in, and I say, “Okay, you’ve never bowled before. Man, you’re going to bowl strikes the first time, all the time.” That’s a very unrealistic expectation.
So it allows clients to start in a progressive manner and to have some variability in their day-to-day life, and then learn as they go, as they make progress.
DrMR: I love the fact that you’re setting this up in a hierarchy. I mean, I’ve found the same thing. Which is, sure, in an ideal world, we’d be able to have everyone do everything right out of the gate. But as you said, most people in most situations are somewhat hindered by the bandwidth of the individual to change.
FlexDiet Certification Sequence
DrMR: So starting with the items that you are going to be both able to do and to utilize a high return on makes a ton of sense. Can you give us some outline about how you’re sequencing these interventions?
DrMR: Let’s list them out first, just so people know. I believe they are proteins, carbs, and fats, micronutrition, fasting, exercise, and then non-planned movements or NEAT, and also sleep. Right? So those are the ones that we have on the board. Now, how are you organizing them in this too important hierarchy of starting with the highest bang for the buck and then working our way down?
DrMN: Yeah. When I actually did the little table and ran the numbers—which are kind of arbitrary—protein turned out to be number one. I guess most people are pretty good at eating more protein. It doesn’t take a lot of education to educate clients or trainers on that.
To my surprise, actually, fasting was the second one. I’ve been working with clients on intermittent fasting for about 10 years now. Initially, when I started that work, I thought, “Oh, this is going to be just a gong show. This is going to suck. No one’s going to want to do this. This is going to be horrible.” And what I found was, as long as you did it in an intelligent, progressive manner, it wasn’t really too bad for most people. A lot of people actually preferred it. So I was kind of surprised by that.
If you look at performance and body comp, there’s pretty good data to incorporate some type of fasting. It doesn’t mean that everybody has to do fasting, but the biggest issue with a lot of people is time. If you go back and you go like old-school ‘80s bodybuilding, “All right, just eat six meals a day to stoke your metabolism, and just eat broccoli, white rice and chicken breast,” that can definitely work. It has its downsides. But you’re asking someone to do a lot more than what they did before. So the ask that you have is relatively high.
With fasting, it’s almost like the inverse. It’s like, “Okay. Take one day a week,” which is my preference, “and push out breakfast. And the following week go a little longer. The following week go a little longer.” You’re actually telling them to do less. You’re taking meals away, so you’re paradoxically almost giving them back time, which is a weird way of thinking about it. But I think that’s also why, in terms of an intervention, I was surprised that most people actually enjoyed it.
How to Optimize Micronutrition
After that, it’s a little messier. But I think micronutrition is very key. So you can use something like Cronometer to get a snapshot of their micronutrition. Another thing I did before I used Cronometer is, I would just look at their dietary logs and write down colors. It sounds a little bizarre. Most people tend to be creatures of habit, even with the amount of colors that they eat.
If you look at what a lot of the micronutrition is—which could be B vitamins to minerals to all the different polyphenols—most of the time they’re associated with different colors, especially the polyphenols. So a lot of your dark reds and purples and berries tend to have a lot of anthocyanins. Your yellows tend to have different compounds in them. So by looking at something as simple as just the color of what they’re eating, you can get a good idea of micronutrition. If people want to go crazy on that, you could do something like, “I’ll just eat from the rainbow.” I don’t know if I stole that from Chad Waterbury or who I stole that from. But just try to get more colors in your food.
Another thing I’ll do with them is I call it the grocery store visit. Go to a grocery store that actually has real food, not this super-processed stuff. Stay towards the outside, away from the inner aisles. Your goal is to walk out this week with just one new item you haven’t had for a couple of years. I don’t really care what it is. If you’ve never tried kombucha, maybe you try kombucha. If you haven’t had broccoli in a while, pick broccoli or bok choy. Whatever. Just try to expand out a little of your variety. If you haven’t eaten any mushrooms in a while, then pick some that look good and cook them for dinner. Just slowly trying to increase the amount of variety. I find that there are a lot of beneficial micronutrients.
One of the downsides that people report is that they tend to be creatures of habit. But paradoxically, they report they get tired of eating the same thing all the time. And there is a time and a place, where if you’re getting really short on calories, yeah, maybe doing the same thing all the time can be beneficial, for a short time. But I think from an overall health standpoint, having more expansion in that area is beneficial.
DrMR: And sleep. What are you finding? Is that one of the harder ones for people to change? And are you reserving that as one of your last conversations to have?
DrMN: Yes. So sleep ended up being number eight just because the ability to change is very low. Where I target with that is, “Do everything you can to increase the quality of your sleep first.”
Combining Interventions for Maximum Efficiency
And the other part I have, as we go through, is a little section where you can do multiple things at the same time. So for example, if I convince a client, “Hey, you just got a new dog. Take Fido out for a walk for 15 minutes in the morning. As you’re doing that, in a perfect world, do it fasted.” One, I want a low level of insulin, so I’m trying to maybe increase the use of fat a little more. Two, I know it’s easier, because you don’t have to answer 1800 questions about what to eat before you go do a walk. You don’t need to worry about calories. It’s not high-intensity.
Also, when you’re doing it, consider not wearing sunglasses as you’re walking around. Why? Because we know that a lot of the sleep architecture is governed by the SCN in the brain. And one of the main regulators of that is the light, both having light exposure at the right time and then reduction of light exposure.
It’s crazy how many clients I see now, who, when I ask them, “How often are you outside on a daily basis?” it’s like five minutes? It’s really not much. It’s walking to their car to their cubicle, walking back to their car, taking their car to the gym, walking to the gym, inside, walking back out. So by taking 15, 20 minutes in the morning, no sunglasses, to get those photons to hit the back of the eye, that helps anchor your circadian rhythm. Meaning that you’ll be more awake during the day and you’ll actually be paradoxically more tired at night when you’re supposed to go to bed.
So something like that, as simple as just an AM walk. Also, if you want to get super fancy, I’ll tell people to look more at the tops of the trees and try to identify different types of trees. Not that you’re going to become an herbologist and be able to say, “Oh, that’s a maple. That’s (whatever).” I just want your brain to try to recognize different patterns.
There’s some super interesting stuff in Japan. They call it forest bathing. So, some very interesting changes in terms of HRV, blood pressure, heart rate, by just having people walk through a wooded area. Now, whether that’s the smell, the fractal patterns, just the eyes looking at something much farther away than a screen in front of them, with something like that you can get two, three, four, interventions done with just a 20-minute timeframe. You can find ways to overlap them. And that also will help them be more tired at night and hopefully even go to bed earlier. So now we’re increasing the quality of sleep. We’re hopefully increasing the duration of sleep.
Another interesting part too is that it wasn’t me the coach yelling at them to go to bed earlier. It’s feedback from their own bodies, saying, “Oh wow, I’m actually tired. Maybe I should go to bed earlier.” So they kind of think, “I came up with this on my own,” which from a compliance standpoint is exactly what you want to do. If I can get clients to think that this was their own idea, the odds of them actually following through on it are much higher.
DrMR: Right. Well, you describe the narrative, I think, you only can arrive at when you are an experienced clinician. You realize people have many things in their lives to contend with outside of just their health care or fitness recommendations. So trying to find a way to make this work for them is huge.
That’s one of the reasons why in Healthy Gut, Healthy You, I explain the same concept to people: if you’re limited in time, then taking a walk in nature with a friend is a very powerful trifecta. So I think we’re singing the same tune there, and I think it’s a fantastic tune because you can get a lot of bang for your buck from that.
Well, Mike, this has been a great conversation. I really encourage people, if you want to dial your nutrition, lifestyle, and fitness in a bit… I think Mike is one of the smartest people in the game, not only because of his knowledge regarding research and his balanced perspective, but also because he works with people and he understands how we can practically apply this.
And I think that’s, again, evidenced by the fact that you’re trying to coach this stuff in a hierarchy where you’re balancing what’s most impactful by what’s most achievable. And that in and of itself is probably just worth doing the certification training, so that people know where to start and really will hopefully set them up for success, rather than starting them with some of the harder interventions. I’ve got nothing but good stuff to say about your work, that’s pretty obvious.
Do you want to tell people where they can find this on the internet, and any other closing thoughts you want to leave people with?
DrMN: Yeah. Thank you very much for that. I appreciate all the kind words, very much appreciated. Your check’s in the mail, so look for that.
DrMN: Haha. Yeah, two sites. Just miketnelson.com. That’s the main home site that has all the information. You can sign up for the newsletter at the top there. For the certification, it opens around three to four times a year. But you can get on the waitlist and on the newsletter list at flexdiet.com.
And if they’ve got their phone there and they’re not driving, they can text 44-222 and then in the text below they can just type in the words “keto ebook”. I’ll send them a keto ebook on the question I get all the time—which is right after “should I use CBD?”—“Should I do a ketogenic diet?” So I actually wrote an ebook on it, and being the nerd that I am, I put a flowchart in there.
DrMN: They’re going to walk through the little flowchart and say, “Hey, is this something I should do? Or should I go a different path?” Then obviously they’ll be on the newsletter there and get all the updates, too. So 44-222, keto ebook.
DrMR: Cool. All right, my friend, well, thank you again.
And guys, check out Mike’s work. Again, I think he’s really doing a good job carrying a very well-researched, real-world and balanced torch out there amidst the fog of confusing and nefarious claims on the internet.
So Mike, thank you again for doing that, and for chatting with us today.
DrMN: Yeah. Thank you very much for all your kind words and having me on here to talk to your audience again. I always appreciate it and appreciate all the dialogue.
I care about answering your questions and sharing my knowledge with you. Leave a comment or connect with me on social media asking any health question you may have and I just might incorporate it into our next listener questions podcast episode just for you!
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