Pushing The Limits

Have you ever done something without knowing why you connect to it so much? That was how it happened for Tiffanee Cook. Coming into the world of boxing and fitness, a world full of people who have stories and reasons behind their drive, she felt like she was the only one who didn’t have a ‘story’. Tiffanee soon discovered, however, that finding yourself, developing self-awareness and confronting your past can all happen in the boxing ring. In this episode, Tiffanee joins me to share her journey from the corporate world to the fitness industry. She recounts how a traumatic past allowed her to connect with boxing and being in the ring. Tiffanee also talks about how her experiences changed her outlook and helped her learn how to set boundaries. If you struggle with developing self-awareness and finding yourself, this episode is perfect for you.   Get Customised Guidance for Your Genetic Make-Up For our epigenetics health program all about optimising your fitness, lifestyle, nutrition, and mind performance to your particular genes, go to  https://www.lisatamati.com/page/epigenetics-and-health-coaching/. You can also join their free live webinar on epigenetics.   Online Coaching for Runners Go to www.runninghotcoaching.com for our online run training coaching.   Consult with Me If you would like to work with me one to one on anything from your mindset, to head injuries,  to biohacking your health, to optimal performance or executive coaching, please book a consultation here: https://shop.lisatamati.com/collections/consultations   Order My Books My latest book Relentless chronicles the inspiring journey about how my mother and I defied the odds after an aneurysm left my mum Isobel with massive brain damage at age 74. The medical professionals told me there was absolutely no hope of any quality of life again, but I used every mindset tool, years of research and incredible tenacity to prove them wrong and bring my mother back to full health within 3 years. Get your copy here: http://relentlessbook.lisatamati.com/ For my other two best-selling books Running Hot and Running to Extremes chronicling my ultrarunning adventures and expeditions all around the world, go to https://shop.lisatamati.com/collections/books.   My Jewellery Collection For my gorgeous and inspiring sports jewellery collection ‘Fierce,’ go to https://shop.lisatamati.com/collections/lisa-tamati-bespoke-jewellery-collection.   Here are three reasons why you should listen to the full episode: Gain valuable insights from Tiffanee’s journey into boxing and fitness. Discover how finding yourself and developing self-awareness despite the odds is possible. How can you let go of your conditioned responses?   Resources Connect with Tiffanee: Facebook | Instagram Tiffanee & Co. Fitness: Website | Facebook Roll with the Punches Podcast Roll with the Punches on Instagram   Episode Highlights [04:45] How It All Started Tiffanee is from Tasmania, but she moved to Melbourne when she was around 20 years old. She’s been in Melbourne for almost 17 years now and has worked in the corporate world for the majority of those years. She watched a talk on resilience by former British Royal Navy Aircrew Officer, Paul Taylor. Paul showed her around his gym, where she saw a poster about a 12-week corporate boxing challenge. Tiffanee was riddled with anxiety the day before the fight. Despite the odds, she won. [09:14] Finding Her Way in the Fitness and Boxing World Tiffanee ended up buying a Certificate of Fitness from Personal Training Academy at the fundraising event during the first fight. As she was finishing her fitness training qualification, a friend trained with her. The next thing she knew, other friends also started training with her. While initially not interested, Tiffanee felt like she needed to give it a go and grow in that career path. Looking back, Tiffanee can see her transformation from a disengaged employee to an engaged employee, to a coach, to a business owner. She launched an online coaching program three years ago. While it fell away quickly, she loved how people opened up to her and shared their stories. [15:16] Confronting Your Emotions and Finding Yourself The boxing ring is the one place where Tiffanee trusts who she is. She developed more self-awareness. In the boxing ring, you react before your conscious mind catches up. When she was younger, Tiffanee was a victim of sexual abuse. Confronting her doubts and fear in the boxing ring also gave her the opportunity to look back and think about how her childhood experience changed her. [25:42] The Connection Between Her Past and Boxing Through the boxing ring, Tiffanee saw her inability to connect with her emotions at the moment. She copes by compartmentalising, only accommodating what is happening. She resonated with how there was support on the outside but none that could step in the boxing ring to help her. In the ring, she can come out on top and handle what’s happening. It took a lot of reflecting and writing to see how past experience allowed her to connect with boxing. Listen to the full podcast as Tiffanee shares more about taking a break, training and learning more about herself and her emotions. [34:26] Changes in Tiffanee’s Outlook Her story allows Tiffanee to meet and connect with people in the boxing ring. We all yearn for a resolution on some level, especially if we are not happy in all areas of our lives. Boxing has an opinion-based judging system. As a boxer, you are essentially putting your self-worth and identity in the hands of other people. We all want to win. But at the end of the day and in the years and months to come, you’re just the same you. What you do is not who you are. [43:33] Helping and Finding a Connection with Paramedics Tiffanee met a paramedic in one of Craig Harper’s camps. When COVID hit, they started an online fitness program to help other paramedics who are single and need to go in isolation. The project eventually evolved into her podcast. She found herself connecting with the paramedics. To be a great paramedic, you have to learn to suppress your emotions, and she knew how that felt and its repercussions. First responders experience a lot of horrific situations and are working under a lot of stress. This can take a toll on them physically, mentally and emotionally. [51:21] Epigenetics and Your Physical and Mental Health There is no divide between mental and physical health.  Epigenetics allows you to look at the various aspects of your health to get the best out of your body — from improving your performance to finding ways to prevent health problems. For Tiffanee, one of her conditioned responses to signs of conflict is to be accommodating. Now, she has learned to set boundaries. Having boundaries is vital to avoid burning yourself out and depleting your resources.   7 Powerful Quotes ‘The one thing I did love about online coaching was people would just open and bare their soul in a way that you don’t get when they walk in person in the boxing environment’. ‘The boxing ring is the only place where I feel that even for myself I am unmasked. It’s the one place where I can trust who I am’. ‘I resonated with standing inside a boxing ring with somebody standing in front of me that was there as an opponent to inflict pain. I resonated, that there was all of this support on the outside but none that could step inside and help me’. ‘It crossed my mind, “If I touch this area of myself, I'm changing who I am as a boxer”. So how much does it mean to be this boxer? How much of my identity revolves around that’? ‘If things have changed, but that in itself was beautiful. I went back to boxing not for boxing’s sake also, and I box not for boxing’s sake, for the sport, but for getting a handle on who I am’. ‘So it’s like what do we fight for? You’re putting your body on the line. And this one fight, this one result, this means the world to you. But guess what? … At the end of the day, in two month’s time, you’re just the same you’. ‘What you do is not who you are’.   About Tiffanee ‘Everyone has a plan until they get punched in the face’. Tiffanee Cook has learned this as a businesswoman, performance coach and boxer. The comfort, predictability and safety provided by the corporate world, to the lessons and let-downs in and out of the boxing ring. Coming to the realisation that to have one’s hand raised in triumph, adversity, discomfort and combat must be navigated. In the face of the messiness of life, do we fight or do we flee?  Tiffanee speaks openly of her own personal experiences (good and bad) and how those experiences have enabled her to develop self-awareness, resilience, courage, independence and the skill to maximise passion, possibilities, and potential. She talks about getting knocked down (literally and metaphorically) and what it is that makes some of us get back up and some stay down. Working in business, sport, high performance and personal development, Tiffanee explores a range of ideas, tools, skills, resources, philosophies and strategies to empower individuals, teams and organisations to improve everything from productivity, efficiency, culture and communication to physical, mental, emotional and social health.   Enjoyed This Podcast? If you did, be sure to subscribe and share it with your friends! Post a review and share it! If you enjoyed tuning in, then leave us a review. You can also share this with your family and friends so that they can learn as much as you did about self-perception and finding yourself despite the odds. Have any questions? You can contact me through email (support@lisatamati.com) or find me on Facebook, Twitter, Instagram, and YouTube. For more episode updates, visit my website. You may also tune in on Apple Podcasts. To pushing the limits, Lisa   Full Transcript of the Podcast Welcome to Pushing The Limits, the show that helps you reach your full potential with your host Lisa Tamati, brought to you by lisatamati.com. Lisa Tamati: Well, hi, everyone, and welcome back to Pushing The Limits with your host Lisa Tamati. And this week, I have an exciting interview with a young lady Tiffanee Cook, all the way from Melbourne in Australia. And I came across Tiffanee because she's a fellow epigenetics coach, and we bonded and enjoyed over that topic.  And I was just really fascinated with her story. She's an incredible athlete. She's a personal trainer in Australia, has her own podcast, called Roll With The Punches for obvious reasons. She's into her boxing and really incredible. I love watching her on Instagram and doing her thing. She's extremely fit, extremely strong minded and a really intuitive young lady. It was just a fascinating conversation over what it takes to be in the ring. And how it transformed her life from being a non-athlete, at the age of 29, going into the corporate boxing scene for the first time and then completely that revolutionising her life.  And how going into boxing actually opened up a lot of old wounds from her childhood. She had been through some traumatic events in her childhood, which she shares about, which was very nice of her to share, and some reflections on that and some learnings from that. So a really interesting interview ahead for you. Before we head over to the show, though, if you can give us a rating and review, if you enjoyed this content, please do share it with your friends and your family. I do really appreciate you doing that. Slowly, one by one we're trying to build a community of people who love good content, who find value and good content, who want to listen to experts in different areas. And I have some fascinating interviews coming up in the very near future with some really heavy hitters, some big names, and some really extraordinary experts in the field. So make sure you stay tuned for that.  Just a reminder, too, as we head over into the crazy, silly season. I hope you've all survived okay this year 2020. Come out the other end of it. Let's hope that 2021 brings something a little bit better. It's been the toughest year of my life for sure. And I know many, many others have had horrific challenges to face both personally with businesses, with loved ones, with health issues, and fear. There's a lot of fear around in this last 12 months. So I hope you've survived that, okay.   If you are wanting some help with any issues, whether you're dealing with health problems, if you have come to the end of your tether with the sort of standard medical and if you want to get some alternative—looking at some alternative approaches to things and you want some help navigating a health journey, health optimisation, whether you want gene testing epigenetics, whether you just want some help in reaching a huge goal, some mindset support and some mental toughness training, then please reach out to me, lisa@lisatamati.com. You can send me your emails on there. And we can have a conversation and see whether working with us would be something that would be of benefit to you. We also have our standard—other programs that we're running. Our epigenetics coaching programs, which looks at your genes and how to optimise every aspect of your life according to your genes and how they are expressing right now. I know Tiffanee's right into that as well. So it is next level information to help you be the best that you can be.  We also have our online run training system, Running Hot Coaching. We'd love you to come and join our family. We've got over 700 athletes now from all over the world, that we train for various events, whether you're starting from absolute beginning, don't know where to start, want to make sure you do it in a proper structured manner, then come and see us. Or even if you've run hundred hundred miles and you still just want to optimise and reach the next level of performance, Neil and I and our team would love to help you with that. So please reach out to us at that. lisa@lisatamati.com or head on over to lisatamati.com, or our running website which is runninghotcoaching.com. Right. Without further ado, over to Tiffanee Cook. Lisa Tamati: Well, welcome back, everybody. I'm so glad to have you with me. I have Tiffanee Cook with me, and I'm super excited for this conversation. Wow, what an amazing young lady. Tiffanee, welcome to the show. Tiffanee Cook: Hey, Lisa. Thank you. Lisa: It's just so exciting. We connected through our mutual love of ph360 in epigenetics. Tiffanee is also an epigenetics coach and fan. And we have a few mutual friends. So we connected through that. And then I sort of delved into Tiffanee's website and what she was doing and a podcast and thought, ‘Wow, what a What an amazing young lady’. So I wanted to get her on the show.  So, Tiffanee, can you give us a little bit of a background in who you are, and what you do, and all about what you're up to now, that's what we really want to get into the weeds on. Tiffanee: Yes, awesome. Oh, thanks for the intro. So I'm from Tassie. I'm a young Tassie lass Tasmania, that's this, we sit down at the very bottom of Australia floating around. I grew up there, and I screwed it over to Melbourne when I was almost around 20 years old, mainly because I just felt like I was twiddling my thumbs in Tassie. It just wasn't enough air to keep me occupied.  I’ve been in Melbourne for the last 17 years. And I've worked in corporate for the majority of that. At 29 years old, I was at a talk for resilience. Actually, I went and watched a talk on resilience by a former Navy Seal. Actually, he's been on my podcast, Paul Taylor and that was fascinating. And after the talk, we went downstairs to have a look at—he had this gym called Acumotum, and it was all based on human movement. It was quite a forward thinking gym, and associated with PTA global to be honest.  And we went downstairs to the boxing gym. And there's this big poster on the wall with dudes in suits and boxing gloves on and it said, Executive Fight Club. And I looked at that, and I was like, ‘Oh, there's something that gets attention. I’m in’. So on the spur of the moment, I decided to enter corporate boxing challenge, which was kind of crazy, because I certainly was not someone that knew how to throw punches all too well. And so that experience took me in the ring for a 12-week challenge. And then we were to fight on stage, on cameras, on Foxtail, in front of a thousand people and you know all the bells and whistles that you can hear in a professional boxing fight. Needless to say it was an enormous experience—enormous experience. And it brought with it a huge amount of growth. So I can remember my fast forward to the day before and I did not sleep until 6am in the morning. I got to sleep. I had to wake up at 7:30 to go to the airport to pick my mom up, who's coming to watch the fight. So I remember texting my trainer, ‘6am, going home soon. Still no sleep, this is not good’. And he was, ‘Yes’. And then I was just socially useless for the day. Mom went out for lunch and then I was just riddled with anxiety. It hit me all in the last hours, riddled with anxiety. ‘What the hell am I doing’? We get to the fight night and I'm sitting there and I'm watching my best friend. She was the first fight of the night and I watched her. And she won and of course that was amazing. And I was like ‘Yes right we're on the winning team’. Then they handed me the microphone. I remember this second bout of panic hitting me because I thought well, ‘I don't want to win because I can't. What am I going to do’? Now I’m about to get in the ring to win a fight that I don't want to win because I don’t want to speak to people. But long story short I did and I won that fight and you could not get the microphone out of my hand.  After saying before the fight I will never ever ever ever do something like this again because whatever's on the other side could not be worth what I've been through the last 24 hours—that dissipated. And the feeling on the other side of that, the feeling having done it anyway was 10 times stronger. It was amazing. Lisa: So cool. Tiffanee: Yes so continued on. Fought with amateurs, had a great experience, ended up over the next couple years becoming a boxing coach, getting into health and fitness, and the evolution just keeps rolling on. I won't talk about it, it’s two or four o'clock here and we'll have to wrap it up. Lisa: Oh and you've got a couple of titles and some image titles and you've—Victoria titles I think. And yes you came right into the boxing from then on and then dived into this world of fitness and coaching and more or less. So have you left the corporate job? Tiffanee: I have left the corporate job. It was funny when I was doing the qualifications for fitness because in that first fight, we held a fundraiser that went to the Australian Save the Children trick. So held a fundraiser and Personal Training Academy donated a certificate of fitness to be auctioned off. And on the day, no one bid for it. So I purchased it for $500 which was super cheap. Yes, super cheap.  So I ended up doing my qualifications. And as I was finishing them, it took me forever, because I never planned to use them. It was out of interest. And as I was finishing, it was a couple years later I finally realised, ‘I should finish this course’. One of my good friends and a friend that I network with sort of said, ‘Oh when did you finish that course’? And I said, ‘Sunday’. ‘Thank God, because—all right. Well, as of next week, I'm training with you, you just tell me how much and how often’, and I was like... Lisa: Oh my gosh, you're gonna be a trainer. Tiffanee: Yes. And I was like, ‘Oh, okay’. And then a couple of friends did that. And then next minute, within six months, I was like, ‘Something has to give. I have to start saying no’. But I just  looked around and went, ‘There's people that choose this career path that want to be where I am, and grow this quickly’, and I just feel like, ‘I have to give this a go’. I have to feel like I have the right to not throw in the job and give this career path for yes, I've never looked back. Lisa: Wow, that's amazing. And, you know, when I go to your website and what you do, and the videos of you doing boxing, it's like you are a machine. Girl you are a machine. Your one tough nut. And so who wouldn't want to be trained by you? You mean? Yes, I was looking at you doing your boxing exercises that when you jump and go into the band there. Wow, that's really cool. You know I might finally want to get better at boxing. Tiffanee: Oh, yes. It's an amazing sport.  Lisa: Yes it is, I mean, I only dabbled in it when I was looking. I nearly did a corporate fight. And then I didn't end up doing it in the end. But the training was great. It was a great thing. So from the fitness side of it, absolutely love it, absolutely get it. It's really, really awesome. And to say, a kick ass girl like you just doing what you're doing. It's like, ‘Wow, that's so cool’. It's like, ‘Oh’. And diving into the hole, this is now my new passion where I need to be hitting. Obviously, the universe is sort of telling, ‘Here. Go here’. And having the net, the courage to jump out of your corporate job was at a big scary moment. Tiffanee: Yes, look at what it was huge. It was huge on a couple of levels. So there's level number one, where I looked back over a couple of years of doing the corporate fights. And what I saw, when I glanced back was this girl who went from a disengaged employee that just did this job in this industry that she did. And if you ask me now why I did it, I loved it. I always loved my job. And everyone always thought that I was always really passionate and happy at my job, because that's the sort of—whatever I do, I'm pretty into it.  But why I was working at the print industry, just because I fell into it out of school. And so that was my thing. But I looked back and saw this disengaged employee that had over the last couple of years, turned into an engaged employee that turned into a coach and a business owner and an entrepreneur for lack of a better word. I went, ‘Wow’. That wasn't deliberate that happened hand in hand with this stuff that happened in the boxing ring. And I always call the boxing ring walk my metaphor for life.  So my passion when it came to coaching people was understanding. The cool thing was, it gets you super ripped to get you super fit. So people will come to that. They want your energy, and they want your enthusiasm. They want your empowerment and they want your abs. No, that's all this side repercussions. I was like, ‘What I love is that I know that you as a person are changing when I teach you this stuff in the boxing ring, I know what's happening. And you don't even have to know what’s happening’. Lisa: You’ll look back... Tiffanee: Yes. But one day, you'll look back and realize your whole life has changed. Lisa: Very insightful. very insightful. It's really weird, because it isn't about the abs. I mean, like, right. Tiffanee: Yes, it was funny. I did online coaching—I launched online coaching nearly three years ago, super successful. I launched it. And within the first two months, I'd sold $10,000. And I was like, ‘Wow, I don't have a huge following to be selling it like this’. Lisa: That's cool. Tiffanee: But it fell away really quickly, because I found so many people coming to me. I guess I wasn't equipped with my messaging and getting it out there and how to cope with things. But yes, people came to me wanting carbs and counting macros and counting whatever they ate. ‘Wait, we're not counting calories. We're not counting this. That's not my jam. I don't care. Like, yes, you have abs, yes right at the end of this. We're not doing it by measuring stuff and counting things’. So, a passion for that side of things really dissipated.  But one thing I did love about the online coaching was, people would just open up and bare their soul in a way that you don't get when they walk in-person in a boxing environment. You get right to the crux of why am I here. People sitting in front of you saying—you know that they're beautiful, they're not overweight, they're super fit looking, they're gorgeous, and they're saying, ‘Well, I'm fat and when sometimes I don't go out for lunch with my friends, because I'm having a fat day’. I’d be like ‘Wow. I've seen you in the boxing gym for three years. You're so fit and gorgeous. And you’re still sitting there telling me this story’. That's getting stories out of people.  Lisa: And you know, you write them in the online training space. I mean, we have an online run training system and stuff. It’s been through hundred iterations. And it's super powerful in one way, because you can connect with people all over the world, and you can help people... But having their—it's a real struggle to create that energy that you have when you're live in a room with somebody. And so there's this problem between you're only one person and you want to reach a lot of people. You want to help have a massive impact. And then you're struggling with the systems that are available today and the way—and then you're having to learn a whole new language and technology and my God, what. All these marble black things that you have to know what you're doing in the space. And we sort of persevere because we've frickin stubborn.  Neil and I, my business partner and I, had huge learning curves. And by no means have we got it all sussed by any stretch of the imagination. And now we do both. We do the combination of things. And because you need to have one-on-one because you have a high touch and you also hone your skills when you're working one-on-one with people. And when you're in the online space, then you can reach a broader audience. It's more affordable for people. So you want a bit of both. Because when it’s high touch, it costs more, it's just the way it is. And so having that combination of things is really powerful, too. I wanted to dive down a little bit into—we got talking before we started the recording—a little bit about some challenges that you had as a young person, and how that sort of came out in the ring. Are you happy to share a little about that Tiffanee? Tiffanee: Yes, absolutely. Absolutely. I spoke to this—just recently shared it for the first time on my podcast. Roll With The Punches. Lisa: Roll With The Punches, by the way people.   Tiffanee: Roll With The Punches. Lisa: Roll With The Punches is a podcast. Tiffanee: Yes, so I guess I found myself at 29, I was inside the boxing ring and I had some really strong traits. And I had a really strong idea around who I was as a person and my identity. And like I mentioned to you before I had all these strengths. And at points inside that boxing ring—the boxing ring is the only place where I feel that even for myself I am unmasked. It's the one place where I can trust who I am. Because we build this identity. And I think sometimes that that identity is so strong that even we… Lisa: Big believer, aren’t you? Tiffanee: Yes. I can be the master of having stories and reasons that I believe. So what I see in the boxing ring and it’s this developing a self-awareness, is this raw honesty of how you react before your conscious mind can catch up. So if you're scared, you react before you can pretend anything. You see, if you're aggressive, if you're scared, if you have self-love, if you see all of these things. And it's quite confronting.  I found that within two years of the sport, and I'm now questioning—I'd start to go for walks around town and I would have these memories, I would start thinking of memories of when I was a child. And when I was a child for quite a quite a few years, I was at the hands of sexual abuse from a person, a neighbor, a family friend. And it was something that I'd pushed down and I'd never ever spoken of for so long that I guess it really felt like it never even happened. Lisa: You thought you’re over it. Tiffanee: Yes. So here I am strolling along and all of a sudden, that would pop in my head. And I think about running into this person, I'd start to get angry, bad. And I start to think that ‘Why is this coming up. This is weird’. I start to Google it. ‘What are the repercussions of an adult who has experienced childhood sexual abuse’? I had a best friend at the time, who was a clinical psychologist, and we were on a walk and I was like, ‘Oh, so what…’ I explained the question to her, and I remember her answer was like, ‘Ah, no, I haven't dealt with anything’. And I was like, ‘All right’. And then a couple weeks later, we’re there speaking about so and so. And I was like ‘Nah just speaking about myself’?  All these frames feel differently.  But yes, basically, I questioned why am I in this boxing ring? Something is drawing me in on a level, because I'm not someone who keeps coming back. I find the next shiny object pretty quickly. I said to you before, when I was at school I was not—I was smoking when I was 14 like smoking cigarettes. I wasn't turning up to do fitness and things. But when it came to sprinting, I'd come first in that 100, 200, 400 meters and anything jumping and I loved it because I was good at it.  The boxing, I never felt I was good at it. It was a skill I didn't have that I had to work hard for. I'd work hard and consistently and self doubt and fear and all of those hard-to-cope-with, confronting emotions and I was doing it. So, I started writing why, what's going on here. And these emotional breakdowns were coming up. And it really just started peeling back that hard shell and making me look at how that experience as a child had changed me. And it really gave me the opportunity to face that. Lisa: Wow, that's amazing. Because you were digging so deep in some really confronting stuff in the ring. It's sort of opening up your personal—because like you say, you can't run anywhere when you're in the ring, or your boxing, or in your training, and you're pushing your limits and you're feeling fear, and you're feeling anxiety, and you're outside of your comfort zone pretty much the whole freaking time. And that makes you start to think, ‘Well, who the hell am I and what am I doing? And where have I come from? And what am I’?  I mean, for me, and I use ultramarathoning as my metaphor for everything, for obvious reasons. So as you in the boxing ring. I was running. When I started doing ultra marathon, I was running from the pain. And the pain that I felt physically was a metaphor for the pain that I was in internally. For me that's the masochistic side of really pushing my body to the absolute limit in the early days, was about listening in the pain that I was experiencing in my soul, in my heart, in my mind, and the talks of incessant negativity that was in my mind.  I found when I pushed my body and was in pain, and suffering, and pushing to the limits, and achieving things as well, that changed the conversations that I was having with myself, and it opened up avenues for me to let that pain out and to start to work through it and start to heal from it. And then of course, you're surrounded by amazing, incredible people in the sport.  And you're doing incredible things. And then people are starting to say, ‘Hey, that's pretty amazing what you're doing’. And slowly over time, you start to build—rebuild, what's broken inside, and people don't see this on the outside. They don't see the broken heart that's on the inside. When I was young, I had no self esteem, no confidence. I'd never been doing this sort of stuff. Like for God's sake. I was like a timid, very broken person. I hadn't experienced sexual abuse, like you, thank God, in my childhood, but I had been in abusive relationships. And been through that experience, and had some other stuff in my youth, again, through sport, and being pushed too hard, too early in my sport, and things.So I was dealing with a whole lot of crap. In other words, and this was my outlet.  And as time went on, running, rebuilt, who I was and what I thought I could achieve. And when I started to open those doors, just like you've been through in the last few years, it's like, ‘Holy shoot. I can do a heck of a lot of things that I didn't think I could possibly do. And if I can do that, maybe I can do this’. And your horizon starts to open up as to who and what you are and what you're capable of. And in that time, your things are changing as to how you're dealing with stuff because that's the other great thing with sport and training and discipline and perseverance is you start to develop a toolbox of ways of thinking, of skills, of ways of managing your emotions, and you learn all these tricks.  And then when you dive into the whole world of epigenetics and you start to understand your own genes, that's the next level stuff. You start to realize, ‘Hey, I’m on this chemical bomb and I've got to move and I've got to do my breathing and calm myself down. And I know when to turn myself on. When to push and when to pull back’. And you know, come 52. So I'm starting to slowly work stuff out, not touch wood. I can still have breakdowns quite regularly. Don't get me wrong. But you know what I mean? And you start to feel as if like, ‘Ah, this is sort of making sense’. And then you know, as you get older, life’s even more shitty. So you've got stuff to look forward Tiffanee: Yes. I can’t wait. I can’t wait. Lisa: But you know, you've got some—at least some coping mechanisms or some ways of dealing with it. So what started to come out? So how did the sexual abuse as a child? I mean, a lot of people have been through this. And it's so cool that you're willing to share it because it is about how is it affecting you today as an adult, what happened to you back then. Because it's this stuff, that programs your subconscious, and you don't even know it? Tiffanee: Oh, big time, big time. I'm taking it back into the boxing ring. What I saw in there, and it was a real strength in the boxing ring. So what I saw in there was this inability to connect with emotions in the moment. So I was a very technical boxer. I was inside. And I wasn't—definitely wasn't talented. In fact, in that first fight, I think everyone with myself and everyone around me was like, ‘Oh shit, look at this chick. How are we gonna fix this in 12 weeks’? We only sparred once or twice before the fight. And the time that we jumped in and sparred, the trainer came over and he said, ‘Is that the first time you've sparred’? Then he goes, ‘Wow, you did really well’. So you can't tell what you're gonna be like in any situation. So I did really well.  But what made me do really well was this inability to connect and feel and deal with emotion. So I had built this coping mechanism that I guess it was: accommodate what's happening. Accommodate what's happening. Emotions will come back in three days later.  Lisa: Yes, yes. That’s called compartmentalising. And there can be a real strength, compartmentalising, being able to not be emotional in the moment. Tiffanee: Yes. And in most of my early fights, I'll walk back to meet the enemy like, ‘What happened’? Really, my awareness in there was, I was just on full fight or flight. Go. I couldn't feel the punch. It’s winning and losing felt was ours. My defenses weren't great. But I was strong. And I was resilient. And I would just walk in and I would go. I knew I was there for a job and I'd do it.  Over there, what I found really interesting—so I guess let me talk about what connected with me there, was that idea of: I resonated with standing inside a boxing ring with somebody that was standing in front of me that was there as an opponent to inflict pain. I resonated, that there was all of this support on the outside, but none that could step inside and help me. I resonated with the fact though in this ring, they could see, I got a chance to show them that this is happening to me. And I'm going to come out on top and I can handle this. Lisa: Wow. Tiffanee: It was all this stuff. It took a lot of looking at that and writing it out and seeing how it felt to say and think like that, to know whether it connected. Lisa:  Very intuitive. Tiffanee: Yes. So, in 2015, I left work and became a coach. So I stopped competing for a little bit just to adjust and get in three years passed before I hopped back in the boxing ring. And when I did and that was only last year in 2019 or 2018. Sorry. I jumped back in the ring, and simultaneously as I opened two gyms. But mind you, so I don't know who whatsoever. Does it all at once. On that person, whoever it is.  So I jump back and walk through. And my biggest curiosity—I don't say fear, I say curiosity—was in that time, I've done a lot of work. I've done a lot of therapy. I'd sought out help. I knew what I needed to resolve in relationships—and we can touch on that later. You wish but I knew that my biggest strength is inability to connect with emotions had now been tampered with a lot and that I'd worked on that. And I thought—to be honest in working on it, it crossed my mind. ‘If I touch this area of myself, I'm changing who I am as a boxer. So how much does it mean to be this boxer’? Yes. Oh, yeah. ‘How much of my identity revolves around that because of it. Because I don't play in this space’... Lisa: You may not be the boxer that you were prior when you were emotionlessly be. Tiffanee: Exactly. Lisa: Yes. Can resonate with one. Tiffanee: Yes. So I went back and I went to training and I remember I had a hard trainer. I've had a few trainers over time. He was my first amateur trainer, really loved his style of training. But you know, I think million dollar baby. He was brutal. He was… Yes, he did not come without the work.  So I went down and trained with him. And at this gym down in Dandenong. A lot of—mostly male boxers there. Quite an intimidating space, really. I hadn't sparred or done anything for a couple of years. Aside from the—I had to throw the gloves on, hit the bag occasionally.  And I remember jumping in the ring with one of his fighters, and he was a southpaw. He is a heavy hitter, he has a—without even trying he lands these punches that are like a freight train. Hitting like a really strong lad. And I hopped in the ring. And I wore an [31:08 unintelligible] that I thought broke my nose. So I've never had a broken nose. Lisa: Pretty pretty nose. Tiffanee: I know I always thought I've got quite a—for the listeners, I've got quite a sharp pointy straight nose that you just wouldn't think that a boxer could hate this nose. Basically the amount of punches are away. Anyway, he lives in Africa. And I thought, ‘For sure that’s broken nose in it’, quite a lot. I felt anxious. And it was the first time three minutes felt like three years in there. And I remember being hyper aware that my heart was—I felt naked. ‘I knew that you can all see my emotion. I'm feeling it. And I don't want to be here’. And I feel like for the first time I don't even want to finish this round. I felt so exposed. And yes and it told me you know, all I needed to know was ‘Yep, things have changed’, but that in itself was beautiful. I went back to boxing not for boxing sake. Also I boxed not for boxing sake for the sport but for getting a handle on who I am. And saying that—it's like my… Like I said it’s like... Lisa: Like your measuring stick? Tiffanee: Yes, yes, absolutely. Lisa: So, are you competing now. Or are just back from the competitive side so that you can focus on all this sort of stuff? Tiffanee: COVID certainly—well, by the end of last year, I'd burned myself out again because I was the head of all the gyms and all the training. I was doing way too much. Now that I know my about my health side, I understand what has always pushed me to the break point, into that zone. Lisa:  Yes. People, so sorry. We're talking about the language. So we are very similar health type. So we tend to—just for the listeners, we have a lot of adrenaline so we go, go, go until we go bang, and then we’d crash. And recognizing that pattern and because we're both very similar—similar place in the wheel, and is a really important thing so that we don't burn out so that we learn to back off before we have the crash. It’s not great Tiffanee: Yes, as an activator. So I would get up at 4:30 and I would do a five hour shift holding pads in my gyms. Then I'd drive down for an hour and I'd gonna do a two—usually a two hour boxing session but we're talking three minute rounds and probably sometimes up to an hour straight of sparring. So it was two hours of high intensity brutal work yet five nights a week. So I look at that and I'm like, ‘Okay, well activators aren’t built for to last in. It's no wonder’. But before knowing about epigenetics, I was just like, ‘I don't know why I'm burning out’. Lisa: Pretty obvious now. Tiffanee: I mean, it should have been obvious anyway. Lisa: It’s also not born for running for days on end either. As I found that quite later to piece through. Tiffanee: The Crusader coming through. Lisa: The Crusaders a little bit more. But... Tiffanee: Yes, it's kind of nice to be on the cusp of both. Lisa: You get to have the best of both. Tiffanee: Yes. Lisa: You mucked up both ways. But did you see—did it change? Doing this emotional work, and she—and I've never seen this before. But, I often get asked, ‘Why are you not doing ultra marathons now’? And one of the reasons was obvious. My mom got sick and my whole life focus changed. And then you know, life's come at me with a full throttle and I haven't been able to do that. I can't dedicate 20 hours a week to my sport anymore. It's just impossible.  But on the other side of that equation is that I've now spent so long studying the body and human physiology and epigenetics and all the rest of the stuff that I actually don't want to do that to myself anymore because I want longevity and I want health and I am 52. And I did it for 25 years and my body isn't the same. And I've taken some health hits from it. I also have been in a place in my life where I feel like in the early, long part of my career, I felt like I had to prove something to somebody. And I was doing it to be something, prove something that I was tough, that I was strong, that I was able, because I've always been told, ‘You’re useless and weak, and you can't do this’. So that was my reaction to try to prove that I now no longer have that desire, and therefore the hunger is gone. If that makes sense. So I no longer have that absolute desire to go through whatever it takes to the finish line, and you need it in that sport. if that's what you—if you want to reach the top.  And that played with my identity for a long time. ‘Then who am I if I'm not that tough, you know ultramarathon running girl’? And now I'm like, ‘No, actually I've got bigger, different’, or should I say, ‘different things to do on this earth. And that was a great time. I've taken these great experiences that I can now share. And it's okay to be doing—being a badass in other ways’. And that's okay.  And I think a lot of athletes have this real difficult time when they shift from their active career into something else and feeling like you are nobody now. And that is not true. You now have a huge amount of things. You're not starting from scratch, you're starting from a place of wisdom and you've got these experiences that now you can move forward and—just pushing, repeating. I've seen some of this in a few other athletes—really top level athletes, who I've had conversations with and they've said to me, privately, ‘I don't want to be doing this anymore. But I don't know who I am if I'm not doing this’. And that's not a good place to be.  It's time to do something different. We've got a short life, we want to do some—we can move on without feeling like we're losing ourselves. It’s as surprising that as a change in the transition. Does that make sense? Tiffanee: Yes, I love that you asked this question because in my early podcast, I've tried—a couple of times attempted approaching this question. But I felt like I hadn't quite landed where I wanted it to with the people. So my question, because boxing is one... Because of my experience when I say boxers, when I walk into a boxing ring and somebody walks into the boxing club, especially a female. Through the first fight, we got to know everybody so you know everyone that you're training with. And I remember saying—I hadn't said this before—I remember saying in the early days, to like my parents, ‘I'm the only one there without a story. Ah, people have had marriage breakdowns, oh they're on drugs, oh they've got this, oh they've got that. They've got this big story and I'm just there like, this is me little not—no self-awareness me going’. Obviously I have a great time because I'm awesome. You know, like, did I not know what was coming. Lisa: You did have a story. Everyone has a story. Everyone. Tiffanee: Yes. And that's why I really connect with people in the boxing ring and people that walk in all boxing gym. You know that there's this deep story, don't know whether they know it or not. And I asked that question a couple of times to various people in this space, ‘If, do you think that the reason—so we have this we all have this drive to success, but what is the reason that’... The only thing that makes us succeed in one thing is this yearning desire for a resolution on some level.  Lisa: Yes. Tiffanee: And we're either aware of it, or we're not. If we weren't totally fulfilled in all areas of our life, we wouldn't—especially when it comes to things like boxing or ultra marathons where it's attacks on your bollock. I have a friend and she's a really good friend of mine and we both started boxing, Judith Courtney I spoke to her on the first fight. For a couple of years, her life really revolved around boxing, again someone with a story and a metaphor and it was strong. But boxing meant so much it was her identity at that time on such a level.  But when you break it down, especially for boxing, especially for females, especially for Australia, you know like it's sport where the decision is based on a couple of factors sitting around the ring saying whether you want to last. You know, it's an opinion based judging system. And it's often tampered with whoever decides. ‘What are you scoring? And well I like this style of fight, so I’m gonna score it this way.’ So you’re putting your head, your self worth and your identity, and your win right into the hands of other people.  And boxing is a sport, especially for females, especially in Australia, where if you're not in, if you don't have a passion for it, nobody knows anything. If you walk out and say some of the top boxers in Australia's names to 90% of the population, they'll go ‘What? Who’? They take someone in just doing amateurs. You know, I know some of the top amateurs in this space. But if I say their name to most people, they'll go, Lisa: ‘No idea’. You know, famous... Tiffanee: Yes, exactly. So it's like, ‘What do we fight for’? You’re putting your body on the line. Yes, and this one fight this one result? This means the world to you. But guess what? We all want you to win, you might want you to win. Yes, the accolades are all waiting for you. But at the end of the day, too much time, you’re just saying you. Lisa: They don't believe the hype and that's a really good point. Sometimes, when you get even into podcasting, or you're in the public eye, and you get people telling you, ‘you're doing great, and you're amazing, and you're awesome’. Never believe that shit. Totally, they go to your head, because this is real. And you want to take your cues from the people that you love and respect and that are close to you at all times. Never take your cues from people— and this is not to—it's fantastic, having people love what you do and things like that. I’m not saying that. But what I'm saying is don't ever let that stuff get to you because it will change you. Tiffanee: Because what you’re doing is not who you are. And if people are loving you for what you do, you stop doing it and they drop away. Lisa: They drop away, and then all of a sudden you think... So in other words, just like in the boxing ring with the dudes in the corner are judging you and they have control over how you feel about yourself. If you lose, you're nobody you know. And if you don't finish that ultra marathon or you failed, not in my camp, that's not the way I operate it. That's not the way I coach. People who put in the hard work, do the discipline, go through the life-changing training, start on the startline, those are the people that I'm stoked about.  What happens on the actual day, and you're going through the race, that's all up to the gods really. Hopefully, you give it your all. And if you gave it your all, then that's all you had to do. You gave it everything, you prepared your body right, you did that... Whether you won last, didn't finish, whatever, that's all about the learning curve. And then it's about standing back up again. So don't like—failure is— people say, ‘Oh, you know, you learn the most in failure’. Well, it's damn true. You do. And it's not pleasant always. But the journey in other words, the journey as we are doing the changing and developing and stuff. It's not all about race day or boxing day in the ring. It's all about the rest of the stuff. So, Tiffanee, you've done a project recently, and you're talking about on your recent podcast. You've sort of wanted to help people with paramedics. You were talking to—the trauma that they go through and or first responders in general. What was the correlation there between what you do and how you've been helping in that arena? Tiffanee: Yes, cool story. So when COVID hit— so, a couple years ago I did a camp with Craig Harper. I was on Craig Harper's podcast quite a bit. And he does a camp once a year for people to go down and spend three days, bit of luck, self-development camp, it's amazing. And I met one of the paramedics there two years ago. And from that, I'd done some boot camps and things a couple years ago with them. Now when COVID hit, Ryan had put a message in the Facebook group of support to the paramedics who was single, who will go into isolation, and it was gonna be a shitty time.  And I commented on that, and I was like, ‘You're amazing. You're such a good soul’. And so she rang me up, she said, ‘I've got this idea. And she goes, ‘I'm going to get some funding together and give you a gig helping us stay fit online. So we're going to create a wellness hub’. Yes, so I put together this training program. And with that, I said, ‘Let's get together on Friday afternoon and feel good Friday, and we'll have a drink or whatever I have... Honey, soda water or just get together so people don't have to be alone’. And that quickly evolved into getting speakers on which involved into—evolved into this podcast.  But, I found myself connect really strongly with paramedics and it was around this boxing analogy in my experience. But what I connected with is I look at these people, and they've chosen a career where they where they walk into trauma. And into walking into that trauma, in order to be a great paramedical first responder or a law enforcement officer or firefighter, you have to train yourself the ability to suppress emotions.  So the first thing I saw was all you guys suppressing emotions. And I saw what that did to me. And I saw how that played out and the negative repercussions that I had to deal with. So I realized that this connection, there’s curiosity around these people and why do they deal with it, and what are their levels of self awareness? And how is it playing out for them? Is it playing out for them? Is it the same thing? Or am I on the wrong track? I'm still asking that question. And I've had so many conversations around it. And it's funny because I'm like, ‘Oh my god, you just these Tasmanian chicks sitting in front of my phone, zero qualifications in this area, but a huge amount of curiosity’. Lisa: Would you let that stop you Tiffanee? Tiffanee: Well, that's it. And I've sort of gone. I just—from any of the research that I've done, I haven't come across anyone asking these questions. Sometimes you find out great answers from a place of complete ignorance. And that's definitely where I come from in this space. Lisa: You ended up making conversations, and you're living here. Our first responders—I come from a—as I was saying before a family, firefighters, my dad, my brother, my husband, all firefighters. And they are exposed to inordinate amounts of horrific situations, let's just be honest, and the trauma that they go through, and that they see is a very big impact. Without getting into any details, like my husband's lost a few friends over the last few years to suicide. And to say it's not job-related, and we don't know all the details and so on, but it can be bloody well, bet your bottom dollar. A lot of it is what they've seen, what they've been through, and the lack of support around them.  And especially I think, for me, they're expected to be tough and handle the gentle. And when you are—you have to be able to function in these sorts of traumatic situations, which is super, super important. You also need to not suppress our emotions and to realize we're humans that have emotional responses to what we're seeing. And that needs to be dealt with some freaky now, and I don't—you don't have the answers. I don't have all the answers, but we need to shine a light on it. And say, ‘Hey, people in all of these really caring professions—doctors, nurses, first responders, all of these people. We want these people to be compassionate, we want them to have a high level of humanity. And we need to support them in what they're doing and what they're facing and what they're seeing in the aftermath of that’. I don't think I could cope with it. Day in and day out. It's pretty phenomenal the job that they do, Tiffanee: Oh, it's huge, it's huge on an emotional level. And then on top of that, after looking at them, that these guys are—they're working under those conditions. But then just the conditions of shiftwork and which affects their diet, their exercise, their everything that creates a being that is resilient, is getting sorted out the walkthrough. It’s getting poked and prodded in every direction and then put into such a high-performance environment. I sat down with a friend of mine who has just recently joined the police force, and obviously he was getting into the academy and I was like, ‘Oh, no, whoa’. Lisa: What are you doing? Tiffanee: I said to him, ‘We want to have you on a podcast’. He says, ‘Give me a few years in the force’. I'm like, ‘No, right. because this may seem with you having breakfast asking you in your first year of becoming a police officer’, because he said, ‘Uh, yeah, I've become hyper vigilant from day one is now when I walk into a restaurant I check the exits I check the things’. That doesn't happen without your body... Lisa: Responding. Tiffanee: Yes, exactly. Exactly. Your amygdala switched on. You're having these physiological responses. You're putting yourself into hyper awareness all the time. You can hear. When you start responding to things like you said, you hear a certain language or something in a background conversation and you become aware of it like that you switched on, switched on, switched on. Lisa: I can see it on my mind, my husband. you know, like, if I put the smoothie blender on, without telling him, his cortisol is up like that. He's very sensitive to loud sounds. In their job, they're exposed to the sirens and tones going off all the time. And so he's hyper responsive to those noises, the phone going. That in every single time it sends his body into a fight or flight, and trying to help him sort of bring that down really quickly, but that’s what they’re programmed. 23 years of responding to tones.  And in the middle of the night when you're in a deep sleep phase, and then, whatever the case may be, that stuff has an effect on your—you just constantly—and you think about it, like a bus will go past and lead out to your brakes. Immediately the—’what's happening’? It's just because they're good at their job, they're good at responding really quickly. And it keeps them in a state of—for the next couple of hours, the body's got a whole lot of cortisol running around, and that puts up your blood sugar levels, and that causes insulin resistance, and that causes weight gain. And all of these knock on effects. Tiffanee: Yes. A conversation I always have is, there's no divide between your physical and your mental health. I'm a different person mentally, when I'm underslept, undernourished, and your physical body creates the chemicals that give you mental balance and equanimity.  Lisa: Yes. And this is why I think like, why I love epigenetics is in the programs that we both do, because we can help people look at the chemistry and the hormones, it's because they all want to know about the food and the exercise. But actually understanding your hormones, your personality type, what part of your brain you use the most, how you respond in different situations, and from a genetic perspective, really helps you understand how to get the best out of your body and not to play into your problem.  So we both been very close to being very similar body types. We know we need movement. If you stick me at this desk all day, I'm going to be one angry person. I need regular movement breaks, I need little bits of food. I need, throughout the day, I'm burning very high. And I need them to shut down at night. I know all these things. So I'm called constantly aware of those, and that helps me balance out. And I wouldn't say, I've got the site's down because, gee sometimes I still have big meltdowns. But I'm watching myself—even when I have a meltdown, and I lose control whether I'm crying or I'm angry, or whatever the case may be, I'm watching myself, and I'm observing my behavior. And I'm thinking, ‘How did I do that? And why did I do that? And how do I bring myself back down’? So we're really on bringing awareness to the problem, even when I haven't mastered it, if it makes sense. Tiffanee: Hmm. We're talking about conditioning. And you asked earlier how some of this conditioning plays out from the abuses. And what I noticed over the last few years was this accommodating—like my first response to things is to accommodate. So what I would find is I'd have constant—I remember having a conversation. I can't remember conversations. I remember being at work, I was a trainer and the owner of the gym and said, ‘Oh, can we do blah, blah’? And almost before people finished speaking, I'm like, ‘Yes, yes. Yes, cool, cool’. I just—I don't want conflict, I just want to be everything for you. Whatever you need Lisa: Whatever you want me to be Tiffanee: Yes. And then I'd find myself laying around a bit like, ‘Did I just agree to that’? You know and it took me a long time to realize that, ‘Ah, this is a conditioned response that you will accommodate the other person and it doesn't matter what you think or feel because you don't think or feel right now. You just accommodate and deal with it later’.  And so what I've learned to do, which is hard for activators because we like to react and to respond. What I've learned to do is listen, try, and think and feel in the moment and then say, ‘Can you give me a day or so before I commit to that’? So this new setting boundaries. I don't have boundaries before, zero boundaries. So it was kind of a—I used to just dodged through life trying to keep massive distance between people because I didn't know how to set boundaries. So it just would avoid it and avoid conflict. And yes, so that was my way of keeping myself safe then. But now it is, I just say, ‘Hey, I think that that sounds good. But do you mind if I just commit and get back to you’... Lisa: And that though, is a perfect answer. I really, really struggle with this. I'm still struggling with this one as my business partner Neil is like, ‘Just stop doing stuff for people and saving everybody in the planet. You've got to make a living’. And I’m like, ‘I know, but that other situation, that situation, excuse, excuse, excuse’. And I'm like, ‘Listen to yourself. You’re burning yourself out. You can't put your resources into our things. You're not helping them’. But you know, I'm like, ‘I know, I know. I know. But’... It's something I struggle with on a day to day basis, because I just want to heal the world, fix everything. I have to make a living. I have to have money in my bank. Now. I can't just do what I want. And I really struggle with it. I really struggle with saying no. And that no is a perfect answer. And that's definitely a work in progress. You know, on the other hand, it's like, ‘Okay, well, deal with things that you know that you can be’. But it's hitting boundaries because I do burn out because I'm doing too many things with too many people and trying to help, too. And  spreading yourself too thin and then you don't do a good job. That's the other thing Tiffanee: Yes. And maybe beat yourself up over it. Lisa: Yes, then you fail. It’s an ongoing problem. Hey, look, Tiffanee, I've taken up so much of your time already. It's been absolutely fabulous to have you on the show firstly. And to get to know you. I think we'll be doing things in the future together, I hope because you're a pretty cool young lady. I think you're amazing. I want people to go and listen to Roll With The Punches with Tiffanee Cook. And Tiffanee, where else can people can find you if they want to reach out to you after hearing your amazing story and what you do? Tiffanee: They can find me on Facebook, Tiffanee Cook, Tiffanee, with a double E. Or @tiffaneeandco Instagram. More @rollwiththepunches_podcast on Instagram. Yes, all the usual places. Lisa: Okay, we'll grab all those links on getting seen them all over to me and we'll share them in the show notes. Tiffanee, thank you so much for being on the show today. It's been absolutely fabulous. Tiffanee: Lisa, I have loved it. Thank you. That's it this week for Pushing The Limits. Be sure to rate review and share with your friends and head over and visit Lisa and her team at lisatamati.com The information contained in this show is not medical advice it is for educational purposes only and the opinions of guests are not the views of the show. Please seed your own medical advice from a registered medical professional.

In this fast-paced world, it seems the only way to move forward is to push harder and harder. But where is this relentless rat’s race taking us? Never has there been a higher prevalence of chronic disease and mental health disorders globally. If we want to change this dynamic, we must understand that rest, recovery and effective stress management are equally important in driving results. Neil Wagstaff joins me in this episode where he explains the science behind stress. He outlines the various stages in the stress curve to help you identify where you might be in the spectrum. We also talk about the importance of awareness. With a better understanding of stress, it’s possible to make small lifestyle changes to reduce its toll on you and take greater ownership of your health. Don’t miss this episode if you want to develop your resilience and learn effective stress management!   Get Customised Guidance for Your Genetic Make-Up For our epigenetics health program all about optimising your fitness, lifestyle, nutrition and mind performance to your particular genes, go to  https://www.lisatamati.com/page/epigenetics-and-health-coaching/. You can also join our free live webinar on epigenetics.   Online Coaching for Runners Go to www.runninghotcoaching.com for our online run training coaching.   Consult with Me If you would like to work with me one to one on anything from your mindset, to head injuries,  to biohacking your health, to optimal performance or executive coaching, please book a consultation here: https://shop.lisatamati.com/collections/consultations   Order My Books My latest book Relentless chronicles the inspiring journey about how my mother and I defied the odds after an aneurysm left my mum Isobel with massive brain damage at age 74. The medical professionals told me there was absolutely no hope of any quality of life again, but I used every mindset tool, years of research and incredible tenacity to prove them wrong and bring my mother back to full health within 3 years. Get your copy here: http://relentlessbook.lisatamati.com/ For my other two best-selling books Running Hot and Running to Extremes chronicling my ultrarunning adventures and expeditions all around the world, go to https://shop.lisatamati.com/collections/books.   My Jewellery Collection For my gorgeous and inspiring sports jewellery collection ‘Fierce’, go to https://shop.lisatamati.com/collections/lisa-tamati-bespoke-jewellery-collection.   Here are three reasons why you should listen to the full episode: Understand stress better by learning about its symptoms. What is homeostasis, and what are the stages of stress? Discover the importance of awareness in stress management.   Episode Highlights [03:15] Defining Stress Stress is a normal part of life. It can be good if it’s used in the right amount. Picture stress as a bucket. When the bucket is filled in too quickly, it can overflow. With proper balance, stress can be managed, and you can avoid the bucket from tipping over. The Goldilocks Principle shows that the amount of load or stress we put on our body should be well-balanced to get a positive result out of it. Stress should be balanced with recovery to get optimal results. [11:59] Symptoms of Stress Feelings of depression, anxiety and anger start to rise in times of distress. A weak immune system reflects stress in your body. Stress happens when there is a lack of balance between work and recovery, when there is a lack of resilience. Take the time out, time to reflect and to show gratitude so you can move forward. [20:13] Health and Homeostasis The goal is to maintain homeostasis, when the body is well-balanced and stable. The alarm stage usually comes after experiencing homeostasis, especially when you’re anticipating something new or big in your life.  This can bring about an arousal of emotions, which can be overthrown using stress management techniques. Being always on the go can lead to chronic mental health problems like anxiety and depression. The key to maintaining homeostasis is giving yourself time to recover. [24:16] The Resistance Stage of Stress After the alarm stage comes the resistance stage, where you actually put stress on your body. It is when you can feel really stuck. This stage can result in a chronic state of exhaustion. This puts you in the position to address the stressors by changing habits, perceptions and behaviours to bring back homeostasis. [26:41] The Exhaustion Stage of Stress This stage happens when your stress peaks and things get out of control. We want to prevent reaching this stage as much as possible. Stress can activate the body’s fight or flight response, which can have a negative spiral effect on the body, both physically and mentally. It is crucial to bring awareness to your behaviour and decisions when in the exhaustion stage to avoid spiraling down further. [31:41] On Awareness Increasing our awareness around stress and personal wellness has made a big difference on the things we do. Individuals with lower awareness tend to externalise their problems and not have control of their lives. The greater your awareness, the more likely you are able to take ownership of your problems and control your mood, health and how you look at the world. Awareness is also vital for teams. It allows you to help your teammates and prevent things from spiraling out of control. It starts with being aware, but you don’t have to tackle your problems all at once. There is no instant fix, not even coaching. [36:16] 7 Questions to Increase Awareness What is the biggest stress you have at the moment, and how is it expressing in your body? What normally causes stress for your body? How is stress showing up — does it come in certain environments? When is stress showing up? What can be done immediately to alleviate the feeling and support your biology? What can you do to manage your stress response better? Finally, what are the long-term strategies you can implement to lower your residual stress? [42:36] Stress Management: Start with the Small Things Look after your stress like you look out for your body. Do any mobility work (or breathing work) that is right for your biology. Spend time with nature. Perform habit stacking or the art of doing simple things to get complex things done every day. Start doing things in practice to increase your awareness.   7 Powerful Quotes from This Episode ‘...the resilience is found in rest. But society will say to us that resilience is found in pushing harder, pushing, doing more, doing more and doing more, but it's found in rest’. ‘So this is why it’s important to remember, in daily life and business, you need the recovery aspect in there. It should be like a training program’. ‘Finding joy in something is the real key to my mental balance. I’m not being selfish when I take half an hour to paint a picture. I’m not being selfish — I’m being sensible, and I’m looking after my own health, and therefore, the health of my loved ones’. ‘Sometimes the answer isn’t actually just addressing what’s under your nose and addressing your work. It could be addressing your food, your movement, how you’re looking after your mind and all those things. And then change your perception of work totally so you can manage it a whole lot more effectively’. ‘It's really important for corporate teams or sports teams to start recognising signs and others. And if you are more aware than the other person, then you can help them more… so that you can actually prevent things from spiraling out of control’. ‘If you find yourself blaming everybody else for the situation, then you're probably not very aware of things that are going on because you're just externalising. If you're moaning a lot… Then you might want to have a look at the way that you're actually processing things and understanding things and take more ownership’. ‘You don't have to tackle the whole thing at once. But it's being more aware. Am I a person who goes through life blaming everybody else, blaming the system, blaming that? Or am I someone who does something about it, takes ownership, starts to make a change in [my] own life’?   Enjoyed This Podcast? If you did, be sure to subscribe and share it with your friends! Post a review and share it! If you enjoyed tuning in, then leave us a review. You can also share this with your family and friends so they can learn more about effective stress management. Have any questions? You can contact me through email (support@lisatamati.com) or find me on Facebook, Twitter, Instagram and YouTube. For more episode updates, visit my website. You may also tune in on Apple Podcasts. To pushing the limits, Lisa   Full Transcript Of The Podcast! Welcome to Pushing the Limits, the show that helps you reach your full potential with your host Lisa Tamati. Brought to you by lisatamati.com. Lisa Tamati: Welcome back to Pushing the Limits this week everyone. I hope you're having a fantastic December. Can't believe we're already here, Christmas is just around the corner.  I have an interview today with Neil Wagstaff.  He's a repeat offender on this show. And I love having my business partner and my coach, exercise, science men, Neil Wagstaff with me. And we're going to be talking resilience and stress, how to control stress, how to understand what it's doing to your body, and some of the techniques and things that you can do to cope with stress. And I really hope you get benefit from this episode.  It's an ongoing theme. We have lots of stress in our lives generally. We live in stressful environments, we've got families and financials and sicknesses and illnesses, and all sorts of things that we have to deal with on a daily basis. So here's some really good advice and tips around managing stress and being resilient.  Just before we head over to the show, please give the show a rating and review if you enjoy it. And make sure you share it with your friends and family. And if you're looking for stocking fellows, make sure you head over to my shop on lisatamati.com, my website. You can check out my fierce jewelry collection, there you can check out my books.  And of course, if you are having trouble with any sort of health issues, or you've got a big goal, or you want to deal with some mindset issues, I am taking on a very, very small number. I've pretty much meet the quota. But I've got a couple more spots left. If you want to work one on one with me reach out to lisa@lisatamati.com. And I can send you information about my health optimization coaching.  Okay, now over to the show with Neil Wagstaff.  Lisa: Well, hi everyone, and welcome back to Pushing the Limits this week. Today I have my wingman Neil Wagstaff, with us again. My gosh, you're coming on the show a lot, now, Neil.  Neil Wagstaff: Like you make me feel really popular, man. I love it. Lisa: It's really good to have you here because you just got so much knowledge. And it's just fantastic being able to share all your knowledge with everyone out in podcast land. So if you're a new listener to the show, thanks for dropping by. And if you're returning listener, thanks very much for coming back again and please don't forget to give us a rating and review. We love hearing from you guys and you reaching out.  Now today, the subject is stress and how it affects your body and health. A big topic for so many people, especially given 2020, it's been a disastrous year on many, many fronts for many, many people. Certainly been the worst one of my life. So we're going to talk about how to deal with stress, how to recognize the signs and symptoms of when you're getting overstressed, how to just to manage your physiology so that you can get the best out of your life without tipping yourself over the edge. So Niel, over to you. More to say what’s it all about.  Neil: Firstly, it is a normal part of life, it is definitely a normal part of life. And it can be good. It's often given a very negative, negative sort of press and people see it as a negative thing. It can be that definitely, but it's also something we need in our daily life. And something we want—you and I personally we thrive off it and love having things to do, we love being busy and love getting things done. So that's good.  For some of the good stresses that people be aware of when just understanding they're putting them into that stress category is these things will have an impact on our body and can put load on it. And therefore they're putting load on it they can cause inflammation and effectively cause stress of some sort. So exercise is a stress and it's a very good stress if it's used in the right amount. Okay? It can also be bad stress.  Lisa: Dosage. Neil: Yes, exactly the right dosage. Food can be a stress and it puts a load on our body. Again, use well, it's a good one. Work, again, manage well with good balance is a great stress to have and we all should enjoy doing it. Mental challenge can be a good stress. You like being pushed to our limits, you're definitely a great example of someone who loves pushing the limits, Lisa.  Lisa: Yes, mentally and physically.  Neil: So there are good things in that. New environments, new experiences. They're all great stresses that you can put on your body. General ones on the bad list would be things like poor sleep, and lack of exercise, social stress, prolonged challenge—the stuff that goes on for too long without rest and recovery. And then significant physical or mental trauma as well.  Now if you manage those two buckets. We often talk about the bucket of stress and you have heard us discuss that on previous podcasts as well. But these things, if they're thrown in the bucket, and the bucket gets too full too quickly, then some things on the good list can actually be the things that actually cause the overflow and cause too much stress. But manage well, manage those lists well, and you're going to be in a position that is part of normal life, it should be good. Stress needs to be there. The key thing is that you've got balance with it. And that's what we'll go on to talk about a little bit more, a little bit more today. Lisa: Yes, so I think things like exercise people don't often recognize as a stress and it can be added into that same bucket. And we have talked about that principle before on the show, where, that can be the stressor that tips it over, if you've already got a very full bucket. So even though you think, ‘Oh, doing my training today is a good thing’. It is, if your body's ready for it, for example. And if you've had a lack of sleep and lack of social interactions and your food was crappy, then that extra stress of exercise, or doing it too hard on that day might not be a good thing. So it's about balancing it. And it's about recognising when your body is in a state of excessive stress.  So now we're going to talk about the Goldilocks principle. And I love the Goldilocks principle, it's pretty much a metaphor for everything in life. The more I study biology and chemistry, the more I start to understand that everything in the entire world is all about the Goldilocks principle. Not too hot, not too cold, not too much, not too little. Just getting it right. So how do we get it right, and what is the Goldilocks principle in regards to stress, Neil? Neil: What you said, is so true, Lisa. It is so appropriate to so many aspects of life, it really is. One of the examples we often use is quite an easy way to look at it, it is looking from a training perspective, and especially from my background, that's what I understand well.  So when someone goes through a training program, or an exercise program, goes through rigorous exercise classes, you don't want to create a training stimulus in the body. You want to create a effect on the body under load. So you're going to cause some stress, it's going to break it down, so you'll get a response. And it comes up after a period of time and it could be sort of that four or six week period. We then start to get some great results. Otherwise what’s known as super compensation, where your body compensates and responds really well.  Now the reason it does that is because you've put the right load on it. So you put the right amount of stress from an exercise point of view, therefore, you're going to get the nice result at the other side. Now if we do put too much—or sorry—too little stimulus on the body, then the result is going to be smaller, and we won't have such a great result at the other side and four to six weeks time. If we put too much stimulus on, which we see a lot of people doing in our work, and not enough recovery, and you don't get any results at all.  Now stress works in a similar way. And what we're looking at in this example is we want to put stress as in the exercise load on a body to get the result. But in our daily life, should be a similar process. The amount of load we put on our body each day should be enough that we get a great result at the other end.  And we had a, Lisa and I were away doing a court presentation about a week or so ago. And we had a great discussion there with one of the one of the team we're working with. And he gave the example of in sport like I've just given, you've got the chance to recover. Now in business and daily life, you don't often get the chance to recover. So you have these periods which becomes longer and longer and longer, where you're putting yourself under excessive load to get a result. But you missed that super compensation because the amount of load you're putting on means there's no recovery and that means that the result you get it, but you get it it's such a hopper that after a long period of time you end up burning out, and that's what we want to avoid. So this is why it's important to remember there in daily life and business you need the recovery aspect in there, it should be like a training program. Lisa: And there was a really good example last week. High end executives really pushing the limits on a business point of view and in doing that day in day out, year in, year out and leading—but leading to problems. And this is a societal problem where we all under the pump all the time, or a lot of us are. And that does lead and it's trying to manage your—the physiology because our physiology is still old. And the fact that it’s ancient, our DNA hasn't necessarily evolved to our current lifestyle and so trying to manage this as best we can to get the best results. Now talk about super compensation, I did a really hard CrossFit workout yesterday, and I've got very sore ass cheeks today. So I'm not going to go and smash myself again today, and that because I want that super compensation. The fact that I have sore muscles, sore glutes, and sore legs means and I caused a training stimulus. So right now my body is weaker and I need to give it a bit of recovery, and recovery might mean doing a bit of yoga today and a gentle walk and maybe a light jog. But it doesn't mean going and smashing myself again today because that will likely lead to a negative adaptation. And I want to get the most out of that painful workout yesterday. So I know to back off a little bit today.  And that's what hold training plans are about—getting that combination right and that periodisation right for your particular goal. And that's what we do with Running Hot, with all our athletes that we're training is periodisation. So that they peak at the right time, and they get the most super compensation and not the negative adaptations that can happen when you start to go into that overtraining. And it's quite counterintuitive, isn't it? Because as athletes, you just want to go hard and go hard again the next day and then go home. You've had a sleep, you've had some food, you should be good to go again. But you do need that recovery time, both on a 24 hour hourly basis, as on a monthly basis, as on a yearly basis. So we're going to talk a little bit about that as we go through the session. These are micro and macro cycles we're talking about. So let's talk a little bit about this and what it is to get this just right? And how important the accumulation of stress can lead to your downfall? And why resilience is really found in race? So what are some of the symptoms for somebody, either as an athlete, or as a corporate athlete, or someone who's got three kids and two day jobs, what are some of the signs that that stress is starting to take a toll on their physiology and on their psychology as well? Neil: For mental health point of view, we've got people on too much load and too much stress is where depression will start to come in—anxiety, anger. And those feelings, the risk of chronic disease goes through the roof that just jumps up, jumps up massively and puts more load on the body, and then the immune system just starts to drop as well because that additional load, there's no rest on the body.  On the flip side, if you've got the balance just right. So we're talking about that super compensation, you're getting the balance, right, so you're getting that result, then you're going to feel calm, you're going to feel more proactive. There'd be lots of growth and recovery. And from a health point of view, your health is optimised, and your immune system’s strong.  Now, a lot of people we're speaking to in the trap of going hard, going hard, going hard, it’s going hard. And then we get those feelings of anxiety, anger, depression, and more disease issues. As we work through people's blood with them, we're seeing higher risk of disease when we're looking at bloods now than what we have done in the past, which has a bigger impact, obviously, on immune system and future chronic disease as well.  So taking in those and listening, you will have found those times in life where you felt that productivity was good, you felt calm, there was good growth, and you feel on point. I guarantee you, when you look at those times, you'd have had good balance, and you've had enough rest and recovery in the day, in the week, the month, the year. It means that you're getting those benefits you should from a stress management point of view. And some of you listening as well will have experienced the others and most of us—Lisa and I have at some different points in life, where you experienced the anxiety, the anger, because you've got the balance wrong. And that's an easy—easy is the wrong word to use. But once you understand that, it is an easy fix to make.It's just understanding the how to make the fix so you get the resilience. And as you said earlier in the exercise example, it's counterintuitive because the resilience is found in rest. But society will say to us that resilience is found in pushing harder, in doing more, doing more and doing more, but it's found in rest. And that's where a lot of the happy feelings and emotions are found as well, by taking time out, time to reflect time to show gratitude, and to allow you to move forward. And at the end of the day it's in—you've used this example recently as well, if you haven't been healthy.  Lisa: You got nothing. You have zero. Neil: Exactly. So you need it. Lisa: Yes, and I think like that depression, anxiety and anger part of the puzzle. So these are all your neurotransmitters that are at play here. So your dopamine, your GABA, your serotonin, your adrenaline, your cortisol, all of these things that are actual chemical things in your body causing you to feel a certain way.  So when you see yourself—and I mean this is definitely talking to me here. When I see myself getting irritable and angry and snapping and being anxious about the future, then I know, “Hang on.” And Neil will say to me, or my husband will say to me, ‘Hey, you're getting out of control again’. And I’m like, ‘Well, okay, I need to take more time out’. And just sometimes like taking a couple of hours out for yourself is not being selfish. And I really, really struggle with this one because it's for me, it's like a guilt, ‘But I should be doing this’, and ‘I should be doing that’. And I've got a billion things on my to do list. And so I hear the people when they say, ‘But I haven't got time for that’. It's like, yes, but do you want to be an asshole to your friends and family?  Like, if we get down to it, that's what happens, and depressed and miserable and losing the joy of life. When you don't have enough GABA, which is one of your neurotransmitters, and you don't have enough serotonin in your body, that's what you're going to feel. You're going to have lose the love for life, you're going to lose the love for your passions, that your hobbies, you're going to like—not be interested in them anymore, you're not going to have that dopamine hit where you want to get up and go and you're motivated to drive towards something.  So when you feel that those neurotransmitters are off, by just backing off the accelerator pedal, having some time out to do some health and self care, like I love getting into a sauna, or going for a walk, or doing some stretching, or doing some meditation, or breath work for me is huge. All these things help me manage my emotional state and help my body recover. And we often think that, ‘Ugh, I've just got to get over it. And I'll have a good sleep tonight, and I'll be good’. But if you're not giving your body, the right ingredients, the right nutrients, the right time out and play, then you're not going to have the right combination of neurotransmitters running around in your body. And no matter how much willpower you have, you're probably not going to have a positive outlook on life. And it's something I've really had to learn the hard way.  Now, after going through a very stressful few months that I've been through with losing my Dad, I've had to prioritize just doing something I love. And for me that might be—I'm into painting at the moment, following my dad's footsteps, and that gives me joy. And finding joy in something is a real key to my mental balance. I'm not being selfish when I take half an hour to paint a picture. I'm not being selfish. I'm being sensible, and I'm looking after my own health and therefore the health of my loved ones. And that does have an effect on our people around us. And none of us want to be that horrible person that's grumpy all the time. It's not much fun. So.  Neil: Definitely, it’s a great, great example. And thing as well, as people are listening is understanding that what is worked for you won't necessarily work for everyone and vice versa. So it's finding your thing, and your rest and relaxation, self care, it's going to be different for each person. And if you try things, and they're not working for you, resonate with you, then try something else. And once you find your sweet spot, like you described the painting, then you will find those feelings. So, I wouldn't necessarily get it from painting, just because I can't paint.  Lisa: Neither can I. Neil: There’s other things I definitely get it from. So it’s understanding that you find what's your sweet spot, and what's going to have that impact on your body. Once you understand that, then it becomes a lot easier to do. Lisa: And don't think you're being selfish because you're doing it. That's the real key message and trying to prioritize us because it's like where the corporate executives last week. You have to perform. Yes, but underpinning your performance is health. So if you don't have health, it shouldn't be something that you optionally do on the side, it’s one of the things you get around to, it underpins everything.  So this is part of your health, regime, your practice. And if you see health and looking after yourself, and that's nutrition, that's fitness, that’s all of those things. If you see that as the foundation on which to build your house, that's a different approach, than to seeing it as a pillar on the side that you want to get around to, that you never do get around to.  For Neil and I, it is fundamental. It is our priority. It is also our business in our case. And we can't be good examples to you guys if we're not performing the best that we can and looking after ourselves. And just reprioritising—having those conversations in your own head is about, ‘it's not being selfish, this is being sensible’.  So now, I'm going to talk a little bit about the stress curves and the phases that you go through from good health and homeostasis, right through the exhaustion stage. Neil, can you explain this concept a little bit? Neil: Yes, so we look at different stages as we go through the stress curve. So if we're looking at homeostasis, as you saying good health, this is when the body's in balance, and it's stable and hasn't been pushed, there's no stress on it. And we've got in a calm, there's nothing that changes, changing the environment. So that'd be a nice place to be all the time. But most of us would get bored quite quickly, and would generally get anything done. So good space to be for your body but that's the sweet spot. So we want to spend some time in that. And we want to spend ideally some time in that each day, each week, each month, each year, so we manage those peaks and troughs.  The alarm stage, which comes next is where we start thinking, readying ourselves for the future. So this is where we've got heightened awareness, increased speed of thinking, higher attention, and generally a higher state of arousal. Nothing's happening yet, but we're readying ourselves for this. So this one of Lisa’s example, could be getting ready for a marathon, or a race, or a running event. It could be getting ready for a big, big meeting, or big presentation where you're preparing yourself for it. You've been going through the process, your body starts, the blood pressure will go up, heart rate will go up. You get a physiological response going on in your body to prepare yourself to what's to come.  Now that's healthy, if you're not in it all the time. Okay, so that's healthy, it’s good if you're in all the time, we want to be able to ready ourselves for that. Where we're seeing quite a lot of problems at the moment, as people aren't coming out this, they're always on.  Lisa: Staying on the alarm stage.  Neil:  They’re always on, they’re always switched on, they're lively. They're always twitchy and ready to go. And if you don't come out of that, then your body's not going to have the chance to recover and you're going to start to get—from a physiological point of view, those stress hormones flying through your body at a great speed. And that's what starts to put more problems on the body and problems with health. And that's where we see more issues with chronic disease and where we see bigger issues and those feelings of anger, anxiety, depression, and mental health.  Lisa: Mental health. I mean, I've got like an example there with just being open about my life with going through the drama with my dad and losing him. And being in that alarm phase, where we're fighting for his life for a couple of weeks in hospital and going harder, harder, in that absolute. I was in the alarm stage, and then the next stage, which is the resistance stage, where you're actually in the doing. And now we lost the battle, in that case.  And now, the anxiety that comes with being in that state for a few months, means that my body needs a massive amount of recovery right now. It doesn't need to be smashed and smashed with really high intensity workouts constantly and I'm slowly—but rebuilding, but it's the understanding that that's had a trauma on your life. And that has led to a very bad state of affairs, as far as all your exhaustion, all your stress hormones were concerned. And if I don't do something about that now, what that could lead to as real big health issues.  And I saw this when I went through it with my mom, four and a half years ago with her journey. I went hard out for the first 10, 11 months like to the point of like, absolutely blind myself to pieces, and I had to because she needed that. But then my body shut down, and then I was in and out of hospital. And I was in shit creek basically for the next year because my body was in that exhaustion stage, which is what we're going to talk about next. And so it's understanding—just as that's an example of my life, but we are going in and out of these stages on a daily basis, but also on a weekly basis and on a monthly and yearly basis.  So we just talked about the alarm stage where you're ready for action, but nothing's actually happened yet. So you're all anticipating and then you're in the actual resistance stage, which is the doing part of putting stress on your body. So you're taking action, you're making your body adjust and cope with the environment and you're in the fight. You're using the fuel and your body is resisting the stress. So this could be doing a workout. It could be situations like I was in, this is where you're going under slipped, maybe you're tired, you're pushing through, your stress hormones are very, very high. And this is a stage you can also get really stuck, isn’t that Neil? Neil: Yes, it's spending too long here as well. A good example where we see too many people doing it is—I was having this conversation, someone today is just not getting enough sleep. We've all done it where we've had deadline at work or lots going on, but so many people are pushing it further and further and further now. So even though you're tired, you push through, using your stress hormones to stay on it, and there comes a point where your body will just stop producing the stress hormones as it should. And then you're really into the neutral phase. And that's when you start to get the risk of the chronic disease and the other feelings that we talked about—anxiety, depression, and the mental health side of things.  Lisa: There is a reason why chronic disease is just going up exponentially in society today, I mean that and toxins and environment and all that sort of jazz and food chains. But one of the big problems is this chronic state of exhaustion all the time I think, so that actually... Neil: To add to your point earlier, you shouldn’t add the other things in it like poor food. You then add pollution, you add in toxins we've got around us.  Lisa: Heavy metals. Neil: All of those things have all increased, and they've increased massively over previous years. And we're looking after our bodies less than we ever have done. So now we're in a position that they add those other things on top, and all of a sudden, the load just comes more and more and more.  So it's been where as well—where your stress is coming from, like we spoke about the start. It could be that simply by changing your eating habits, or the time of day you're eating, and what you're eating, and when you're eating, all of a sudden, that actually takes a load off your body. So you manage your work a whole lot more effectively. Sometimes the answer isn't actually just addressing what's under your nose and addressing your work, it could be addressing your food, your movement, how you're looking after your mind and all those things and then change your perception of work totally. So you can manage it a whole lot more effectively.  Lisa: Yes, absolutely. So the last stage that we wanted to talk about is going into the exhaustion stage, which is what we just explained, Neil, where you're absolutely been on the go for—God knows how many weeks, months, years, and your body is starting to shut down. And this is where you are starting to get chronic problems, and serious ones.  And this is the phase you don't want to get into because this is where you're going to be set on your ass, whether you like it or not, where your health is going to go down like mine did. And you will be forced to take a break. But we want to prevent that whenever possible. I mean, sometimes life is just going to throw a curveball at you. But if you understand this process, and you can perhaps stop getting to that exhaustion stage and understand that those stress hormones, I think most people think, ‘I've heard stress is bad for me. But how is it bad for me’?  Well, if we just go back, and I have talked about this a couple of times, but your parasympathetic and your sympathetic nervous systems, you've got these two systems, your rest and recovery and your sort of go-go-go state of affairs. And that sure is sympathetic, and most of us are sympathetic dominant. We're not having enough time for that rest and recovery, and our ancient biology is just really not keeping up.  And when you are in that fight or flight state, and you've got lots of cortisol and you've got lots of adrenal and you're taking energy away from your immune system, you are taking energy away from your digestive system, you're taking blood flow away from different parts of your brain, so you're not unable to make good decisions. You're unable to digest your food, and then you're affect your absorption. And that can affect your thyroid and it can affect your immune system, and on and on it goes.  So this is how stress actually has a physical effect on the body. It's not just a mental thing. I think people think often it's just a mental—under stress as a mental—no, it's very much a physical reaction of the body about where the body is putting the resources. You have a limited finite amount of money in the bank, or energy in the body, and their body is going to prioritise the areas that are most important.  So if it thinks that you're running away from the lion, it's going to put all the energy into making stress hormones, to making sure your blood is in your muscles so that you can run and you can fight. It's not going to be—in helping your immune system repair. It's not going to be in fighting infection. It's not going to be digesting and this is where the resources are being put. So it's like you spending all the money that you earn from your job in one particular area of your life and not paying the mortgage. That's what's happening. And you need to be paying that mortgage otherwise you're going to lose the house. That's a really good analogy, actually isn't Neil?  Neil: Yes, it’s a great comparison. And it brings us back to where we were talking about the start is where you're allocating your time to. In that example where you're allocating your money to, but if you're allocating all of your funds, all your time to one particular area, then something else is going to suffer. Lisa: It's going to crash. We like to think we're superheroes and Neil you’re very, very close to being a superhero. But we're not really, we’re not really both. Neil: Thanks. For me, I’m a little bit of one. Lisa: Yes, for your kids. Neil: And understanding as well that these different phases that we've just been talking about. You can go through these levels in one day, which was what we call a micro cycle, or you can over a longer period of time, months, years—go through them as a macro cycle, so a bigger cycle.  So we've talked about what happens if we stay in these phases, each of these phases too long. And Lisa has given some real good examples from her life is what does actually happen, from a mental and physical point of view, as well. So the fact that you can go through them each day, the exciting thing about that is you can put yourself in a position that you can control them each day. So you might feel like it's a big mountain to climb. And you've got to do a lot before you can get a grip of it. But you can actually make some quite significant easy changes each day to mean that you can start going in and out of these.   And sometimes just little micro rests, small rests, small windows opportunity where you actually can switch off the body, switch off the mind. And again, different things work for different people. But once you find your thing, start doing more of it because this will get you longer results in work, family, and sport as well. It applies to every aspect of the puzzle.  We talk a lot as well with getting people become more aware of themselves. So when we talk about awareness, we will look at the load that’s going to put on people's body. And I know that this has made a big difference that hasn't at least just been increasing our awareness around stress and our own personal wellness. And as we've increased that, it's made a big difference to what we're doing. And generally, we've seen those with lower awareness will generally tend to externalize their problems more, lose control more, the factors influencing their mood in life, and often will blame others more—it's someone else's fault, someone else's problem.  The greater awareness is, you’re more likely to take ownership of our problems, more likely to deal with them, and control our mood or health and how we look at the world. So it puts us in a much better position. Generally as well, we've seen that awareness will increase with age, although this isn't always the case.  Lisa: Not always.  Neil: Not always the case, the increase in experience. So as we've dug deeper into the science of what we do, how we do it, is definitely increased our awareness to the point that as we've experienced more things, coach more people through these things, our perspectives changed and as well, the way we self-reflect. And that's all led to low levels of stress because we've now got a better understanding of what's going on, why it's going on, and what load is having on our body so we can do something about it.  Lisa: And we can look after each other better, just as business partners, right?  Neil: Great point. Great point.  Lisa: It’s really important for corporate teams or sports teams to start recognizing signs and others And if you are more aware than the other person is then you can help them more and that is your responsibility then to be aware of other people and their needs around you. So that you can actually prevent things from spiralling out of control, and support each other a little bit better. And back off when things are getting tough for somebody and push a bit harder when someone needs a kick up the jacksy. So it's all about helping others and being more aware.  So if you find yourself blaming everybody else for the situation, then you're probably not very aware of things that are going on because you're just externalizing. If you're moaning a lot, ‘Well this is shit and that is shit. And my boss's this and my things that’, then you might want to have a look at the way that you're actually processing things and understanding things and take more ownership.  I'll give you an example of this with some of the people that come to ask for health problems and health consulting and health optimisation. I can sort of pretty much tell in the first 10 minutes whether this person is taking ownership of the situation, or whether they're just blaming everybody else and they're angry about it, but they want a magic bullet. And the ones who want an instant fix in blaming everyone else and not taking ownership over the situation are very difficult to work with from a coaching perspective and also very unlikely to get great results. And will likely blame you in six week’s time because they didn't get the result.  And they will go through 10 coaches and they'll go through 20 coaches and they will still have no results at the end of it. And it’s not necessarily the coaches’ problems, or the health professional problem, it is often the fact that they are not taking ownership about the things that they can take ownership on, in educating themselves and working on it.  So you can start to work on pieces of the puzzle. You may have a big health issue, for example, and now we work with some people with some pretty serious freaking health issues. And when you can work on a piece of it today and this piece of it, and we can work like a detective, and we can work through problems, you don't have to tackle the whole thing at once. But it's being more aware, ‘Am I a person who goes through life blaming everybody else, blaming the system, blaming that? Or am I someone who does something about it? Takes ownership, start to make change in your own life, and affect what you can as well as trying to influence the world around you’? Does it make sense? Neil: It makes perfect sense, Lisa. It really does. It's a great, great takeaway for the listeners, as well, just ask yourself that question, ‘Where am I at from a self-awareness perspective with regards to my own personal wellness’? And you can use those examples you just went through there, put a scale on it.  But we've got a great list of questions, Lisa. We can start to get the listeners to use to increase their awareness around their own stress. The thing we wanted to point out as well as we start to wrap things up is that everyone will respond to stress in a different way. So therefore, the way we respond to stress is going to be different. So therefore, the way we manage it is going to be different as well.  So as you're going through these questions, there's no right answer, there's no correct answer. It's an answer that should be individual to you and should be personal to you. So ask the question, What is the biggest stress you've got at the moment? And how is it expressing? What is the stress you're expressing in your body?  Number two, what normally causes stress for your body? So you'll be very aware how your body reacts and feels in different situations. So take time to listen to what it's saying, where you feel stress increasing, you feel your anxiety levels climb, and just feel your body tensing? If you start to get signs and symptoms—and again, it's going to be different for everybody and take note of them and do something about them. We work with so many people that get the signs and symptoms, but don't take note of them and don't do anything about them.  How's the stress showing up? Is it coming in certain environments? Is it around certain people? Is it around certain conversations? So again, ask that question, when is it showing up? When is it arriving? Can you change anything there to make sure it doesn't show up? And what can be done immediately to alleviate the feeling and to support your biology? You made the great reference earlier in the conversation about painting and what that does for you. For me going and moving and I know this works for you as well, Lisa, but going in and moving, getting something, going rhythmical is great for my mind. That could be walking, swimming, running, cycling doesn't have to be anything high intensity, but just movement helps massively. Rhythmical movement will help calm my body, calm my mind.  And what can those around you do to support you? Now as we've been throughout our career as coach and athlete, and now in business, we're very aware of how we can support each other. But that's taken time to have the conversations and work through it and talk to each other about it. I know you do with Haisley, and I do it with my wife, Sam. Once you understand those things, and we've set it up with the people we work with around us as well, it makes a massive difference. If people understand how to support you, and are aware that there's different ways that different people are going to get stressed—what stresses you is going to be different for me. So if I don't take the time to understand that, I'm going to be going through thinking, ‘Now it doesn't worry me, it's not going to worry Lisa’, and that work in both directions.  And number six, what can I do to manage my stress response better? So again, just asking the question would increase awareness. The fact that we're drawing attention to it increases awareness, which means we're more likely to do something about it. Then finally, what are the long-term strategies that I can implement to lower my residual stress? So once I work out the answers to the previous questions, then what can I do long term? And it could be as simple as we're big fans, as we always say, of what's the low hanging fruit? Is it simple now that I go to question five and go, right, ‘What can others do to support me? Am going to make those around me—my family, my friends, my close work colleagues—am I going to make them aware of what's causing me stress, so that they can help me and pull me up’?  Like we do with each other will often pull each other up and go, ‘Right. This is clearly getting a bit much’. Going this direction, we'll do this differently, or you give me time to do things and process things because you know that helps keep me calm. And when you're going fast and hard, I say well, ‘Time to slow down. It's great but you’re getting too excited, come back’. And that works for us. So increasing awareness really does help you get results rather than just accepting that, ‘I'm going to carry on with the back pain. I'm going to carry on the inflammation in my body. I'm going to carry on with the upset stomach. And not connect them back to something external that’s causing it.  Lisa: That’s a really good one because like I had a conversation with someone today and I've got repeated inflammation in the body, repeated pains in the neck, and then not connecting the dots. They connected one dot today that I went, ‘Hah, finally something is starting to drop’. When you are having pains every which way in the body, if your initial thing was to go, ‘Well, I've tweaked my back’. Instead of going, ‘Hang on, why am I having ongoing injuries? Or why am I having a stack of things happening to me? Or why am I getting pains here, and then I'm getting pains there, there's something underlying going on’.  And what we're saying is often that underlying thing is an inflammatory response is related to stress, very often you'll find a component at least of stress. And then it can you know, as we see, it can be from a food stress or toxins, through a psychological stress, from lack of movement, stress, or lack of sleep, dehydration, but these are all forms of stress. And so understanding what is the trigger and trying to connect the dots and this is where that self-awareness.  And in using these simple tools that we've been talking about on this podcast and other podcasts that we've done—the breath work stuff, the meditation stuff, and the movement stuff, the routines for habits, the healthy habits that you develop over time, and you start to stack one on another. And these little things that help you manage your biology, and help you manage your dopamine levels and your serotonin, all your good neurotransmitters, and your hormones and all these things. And it is about tweak, tweak, tweak, tweak, until your life starts to look better, feel better, and be better. And then it will be a constant thing. It's not like you're going to do this once and you're good to go.  Neil and I have a whole lot of tools in our kit that we can pull out in times of stress to help us get through. However, we're still going to have times when we tip out of balance, and then we need each other and their family members and other—my friends to put us back in the balance again, and just make us aware. It's not a one and done thing. It's a constant tweaking, learning, growing process, about trying to keep yourself in a good, a good state, both physically and mentally.  Neil: A lot more and more, Lisa. I'm asking people, it should be like with some of these things that you do to look after your body. It should be like brushing your teeth. I ask the people I'm working with one on one, I say, ‘Right, did you brush your teeth today’? Now know what I mean? I've asked two or three people, really say, ‘We brushed our teeth’. And what I meant was, ‘Have you done any mobility work? Have you done the breathing work and what's right for their biology? Have you been out, spent time in nature, and I might get responses like their response that they're actually a bit fluffy today.  But we do those things every day. And you talk about habit stacking. And it's exactly that. If you can brush your teeth every day, then you can do the other things that will control and maximize your health and do them as well, the simple little things, it’s not just about brushing your teeth. So let's start putting some other things in practice that do that crucial awareness. We don’t do it, isn’t it? Lisa: We think we have to have the most expensive piece of equipment or the best supplement or the greatest course or—actually if we just did the basics right, often that will give us a good foundation. Yes, we can get fancy fancy stuff later and get more into it if you want to really tweak your biology which we love doing and testing and trialing and experimenting, but just getting those basics right. And yes, making it the underlying underpinning philosophy of your whole life, that has to be at the core of it. Health, looking after yourself has to be at the core of it, and it is not being selfish.  Again, I had someone else today, very stressful life, a lot going on. I’m telling them the same thing we can week out, they're coming back with this problem and that problem, and they're not hearing what's going on, and they're not willing to invest in the right things, or to buy the right foods, or to sit down and actually go through the process of actually making the small changes. Because they want the quick answer and you have to look after yourself and they also don't prioritise themselves. Everybody else comes before them.  And therefore they are going to be unhealthy ongoing until they can come to that point of self awareness that they have to be doing these small changes and getting the micronutrients and avoiding certain things and changing just little behaviors so that they can actually be a good father, a good husband, a good wife, a good friend, a good colleague, whatever the case may be, put your own oxygen mask on first before you help somebody else. It's not being selfish. So I think that's a pretty good place to wrap it up for today, isn't it Niel? Neil: I agree. Agree. As always good chatting mate, good chatting.  Lisa: Good chatting. And if you enjoyed this, please let us know. We'd love to get here. You know what you thought about the shows that we're putting out, the information that we're putting out. We'd love to get comments and feedbacks, of course rating and reviews are always appreciated. But just yes, if it's helped you let us know.  If you want more information, and of course, we'd love to work with you. Reach out to us as we have our epigenetics program, which is all about understanding your genes and how they interact with the environment and how to optimise and getting rid of trial and error, and knowing what to do for your body. Then we also have our online run training programs, of course, which we love, training athletes, going and doing amazing things all around the place again, or a holistic approach to everything that we do.  So reach out to us, support@listamati.com. We'll find both new life and thanks for listening today. We really appreciate your time and attention. Any last comments, mate?  Neil: I’d like to say good chatting. We're looking forward to another conversation soon. Lisa: Right. I'm going to go and do some movement in nature. Brilliant. We'll see you next week, everybody.  That's it this week for Pushing the Limits. Be sure to rate, review, and share with your friends and head over and visit Lisa and her team at lisatamati.com.  The information contained in this show is not medical advice it is for educational purposes only and the opinions of guests are not the views of the show. Please seed your own medical advice from a registered medical professional.

Whether you are a beginner or experienced ultramarathon runner, you need to be well-prepared for every run you do. Ultra running has its bright side — the uplifting community, the sense of accomplishment, and the goals of becoming stronger. However, there are certain risks involved in the sport, and as an athlete, you need to keep yourself informed. In this episode, Eugene Bingham joins me to explain the dangers of extreme sports and marathons. We share personal stories about the damage it could do to the body — experiences that should serve as a warning to runners. Eugene also discusses things to be aware of before and during races that can endanger us, giving us five specific tips for preparation and self-management. Don’t miss this episode and learn more about the risks of and preparations for ultra running and other extreme sports!   Get Customised Guidance for Your Genetic Make-Up For our epigenetics health program all about optimising your fitness, lifestyle, nutrition, and mental performance to your particular genes, go to  https://www.lisatamati.com/page/epigenetics-and-health-coaching/. You can also join our free live webinar on epigenetics.   Online Coaching for Runners Go to www.runninghotcoaching.com for our online run training coaching.   One-on-One Health Optimization Coaching  If you would like to work with me one to one on anything from your mindset, to head injuries,  to biohacking your health, to optimal performance or executive coaching, please book a consultation here.    Order My Books My latest book Relentless chronicles the inspiring journey about how my mother and I defied the odds after an aneurysm left my mum Isobel with massive brain damage at age 74. The medical professionals told me there was absolutely no hope of any quality of life again, but I used every mindset tool, years of research, and incredible tenacity to prove them wrong and bring my mother back to full health within 3 years. Get your copy here: http://relentlessbook.lisatamati.com/ For my other two best-selling books Running Hot and Running to Extremes chronicling my ultrarunning adventures and expeditions all around the world, go to https://shop.lisatamati.com/collections/books.   My Jewellery Collection For my gorgeous and inspiring sports jewellery collection ‘Fierce’, go to https://shop.lisatamati.com/collections/lisa-tamati-bespoke-jewellery-collection.   Here are three reasons why you should listen to the full episode: Learn about the risks and dangers of extreme sports and ultra running. Gain valuable insight into the things you need to be aware of before and during marathons. Understand the importance of listening to your body.   Resources Death of a runner: The rare condition that tragically claimed a life by Eugene Bingham Desert Runners on TVNZ   Episode Highlights [04:01] The Dangers of Extreme Sports and Ultramarathons Eugene participated in the 2020 Tarawera 100-mile race where an experienced runner died. The runner’s death certificate showed that he had a multi-organ failure, acute respiratory distress syndrome, and rhabdomyolysis. However, it was difficult to pinpoint the true cause of death since it can be a result of accumulated health conditions. [09:50] What Is Rhabdomyolysis? Rhabdomyolysis, or muscle breakdown, is quite common for runners. As the muscle breaks down, myoglobin from the muscle is released into the bloodstream, clogging the kidneys. It can be difficult to tell when this happens since symptoms can be easily mistaken for simple muscle soreness. This can happen to everyone, not just those who do extreme sports and ultra running. [16:27] Importance of Self-Management At some point, we have to ask ourselves if the damage we’re doing to our body is worth it. There are risks, and you have to be prepared for them.  There is a culture of not quitting unless you’re taken by the ambulance. However, we have to listen to our body before it gets to that point. [20:19] Mental Toughness and Listening to Your Body As we grow, our physical abilities and mental maturity changes. Accept that the body may not be able to take what it could years ago. The goal of pushing your limits is good but keep in mind that you also need to train and prepare yourself. Being mentally tough also means knowing when to stop and rest. [22:53] Ultra Running: 5 Tips to Remember Do not take drugs like ibuprofen and Voltaire.  Drink when you’re thirsty and do not over drink.  Be prepared for a range of weather conditions. The race does not end at the finish line. Replenish yourself after every race. Look out for each other. [28:08] Always Have Support Eugene shares his experience of having hallucinations but was kept safe by his companions. Form connections and friendships with the people you meet in races. They are bonds that last forever. Listen to the full episode to hear Eugene and Lisa share more stories about how people have helped them during races! [38:33] Conditions to Be Aware of We need to be careful about dehydration. Symptoms of hyponatremia (having low sodium levels in your blood) are swelling, nausea, and lightheadedness. Low levels of potassium and electrolyte imbalance can result in tetany seizures. Electrolyte tablets are beneficial — make sure they have all the nutrients you need. Having no appetite after a race is dangerous. We need to replenish our bodies straight away.  [47:10] Risks Are Exponential When you exponentially increase the distance you run, you exponentially increase our risks as well. All races are relative to pace. Never underestimate a race by distance. Take every race like a big deal and don’t become complacent. Recovery after a race is also crucial. Don’t succumb to peer pressure and sign up for a race immediately after. [51:53] Quick Checklist Do not expect that you can do it just because you’ve done it once before. Be aware of conditions such as rhabdomyolysis, heat stroke, hyponatremia, dehydration, seizures, electrolyte imbalances, and breaking ankles. Plan well — note altitudes and paths. Running is just like driving. Driving is considered dangerous but we don’t avoid it; we just take extra measures and precautions to make sure that we are safe.   7 Powerful Quotes from This Episode ‘People need to be really conscious of the risks — they need to be prepared to put the time in. You've got to prepare your body and you've got to know your body’. ‘Having lined up at the start line with someone who didn't make it home — that really reinforces that these are real risks and you have to be prepared for them’. ‘The race doesn't end at the finish. Some of the most dangerous time is after that: when people get to the finish line and drive home, they're tired — you can crash easily’. ‘Sometimes there's a bit of competition, isn't there. But, number one, you've got to look out for each other. You are comrades — you've got to have each other's backs’. ‘It is incredible, those connections you make. Even if you don't see each other again, but yes, you've got that bond. That's forever’. ‘Take those precautions. Just be a bit careful. We want to push ourselves. Yes, we want to be out there. Yes, we want to find new limits, but we also want to get back home’. ‘Respect the distance. You cannot run something like this without respecting it’.   About Eugene Bingham Eugene Bingham is a senior journalist at Stuff, co-host of the Dirt Church Radio trail running podcast with his mate Matt Rayment and an ultramarathon runner. In a career of almost 30 years, he’s reported and produced news and current affairs, winning multiple awards as an investigative journalist. His work has taken him to three Olympic Games, and a number of countries including Afghanistan, the Philippines and the Pacific. No matter where he goes, he always packs his running shoes. He has a marathon PB of 2h 43m and his longest event is the Tarawera Ultra 100-mile race which he ran in February 2020. Eugene is married to journalist Suzanne McFadden and they have two grown-up boys. You can listen to their podcast on Dirt Church Radio. You can also follow and support them on Patreon, Instagram, and Twitter.  Have questions you’d like to ask? You can reach Eugene at his email.   Enjoyed This Podcast? If you did, be sure to subscribe and share it with your friends! Post a review and share it! If you enjoyed tuning in, then leave us a review. You can also share this with your family and friends so they can be aware of the dangers of extreme sports and ultra running. Have any questions? You can contact me through email (support@lisatamati.com) or find me on Facebook, Twitter, Instagram, and YouTube. For more episode updates, visit my website. You may also tune in on Apple Podcasts. To pushing the limits, Lisa   Full Transcript For The Podcast! Welcome to Pushing the Limits, the show that helps you reach your full potential, with your host, Lisa Tamati. Brought to you by lisatamati.com.  Lisa Tamati: Well, hi, everyone, and welcome back to this week's episode of Pushing the Limits. Today, I have journalist and ultramarathon running legend, Eugene Bingham, to guest. And Eugene is the host of the podcast, Dirt Church Radio, which I hope you guys are listening to. It's a really fascinating insight into the world of running and trail running. And he has a really unique style, him and his friend, Matt Raymond, run their podcast. So I hope you enjoy this interview.  Today we're talking about the dangers of extreme sports, not just ultramarathon running, but doing—pushing your body to the limits. While, you know I'm definitely a proponent of going hard and mental toughness and pushing the body and all that sort of good stuff. We also need to know about the downside. We also need to know about the risks. And recently there was a death, unfortunately, at the Tarawera Ultramarathon of a very experienced ultramarathon runner. And so we're going to dive into some of the dangers and some of the things that need to be aware of when it comes to pushing the body to the limits. And so you have an informed consent and an understanding of what you're getting into when you're doing these sorts of things.  Before we head over to the show, though, please give them a rating, review to the show if you enjoy the content. Really, really appreciate the comments and the reviews and if you can do that on iTunes, or wherever you're listening, that would be really, really appreciated. And if you haven't sold your Christmas stocking yet, please head over to my shop and check out my books, Running Hot, which is chronicling all my running adventures in my early days, Running to Extremes. Both of those books bestsellers, and my new book, Relentless - How A Mother And Daughter Defied The Odds, which is really a book about overcoming incredible obstacles, the mindset that's required, the stuff that I learned while I was running and how it helped in this very real world situation, facing a very dire situation within the family. I hope you enjoy those books and if you have read them, please reach out to me, give me a review. Again, if you can, I'd really appreciate that you can reach me at lisa@lisatamati.com.  And just a reminder too, we are still taking on a few people, on one on one health optimization coaching, if you're wanting to optimise your health, whether it be with a difficult health challenge, that you're not getting answers to mainstream health and you're wanting some help navigating the difficult waters that can sometimes be, please reach out to us. And we deal with some very intricate cases. And I have a huge network of people that I work with that we can also refer you out to. I am not a doctor, but I am a health optimisation coach and an epigenetics coach. And we use all of the things that we've spent years studying to help people navigate and advocate for them, and connect them to the right places. And this is a very different type of health service if you like and it's quite high touch and it's quite getting into the nitty gritty and being a detective basically. And I'm really enjoying this type of work and helping people whether it be with head injuries, with strokes, with cancer journeys, thyroid problems, or all these types of issues. Not that we have it or every answer there is under the sun. But we're very good at being detectives working out what's going on and referring you to the right places where required. So if you're interested in that, please reach out to us lisa@lisatamati.com. Right, now over to the show with Eugene Bingham.  Well, hi, everyone, and welcome back to the show. I have Eugene Bingham. I know he's so famous, he actually sit down with me to record this session. So fantastic to have you here. Right? How are you doing?  Eugene Bingham: I'm very well, thank you. And thank you for having me on. Such an honour.  Lisa: Fantastic. Yes. Well, I was lucky to be on your show. And you've been on mine, and we just really connected. So I wanted to get you back on because you've just written an article, which was very, I thought was an important one to discuss. And it was about the tragic death of an ultrarunner last year or this year in the Tarawera Ultramarathon. And while we don't want to go too deep into the specifics of that particular case or we'd like to know what you know about it... Eugene: Sure.  Lisa: ...but wanted to have a discussion around the dangers of extreme sport or ultramarathon running and some of the things we just need to be aware of. So, obviously Eugene and I—neither of us are doctors or any of this should be construed as medical advice, but just as—have to give them out there...  Eugene: Absolutely.  Lisa: But as runners and people who have experienced quite a lot in the running scene, and I've certainly experienced enough drama, that it is something that we need to talk about. So Eugene, tell us a little bit about what happened? And what are you happy to share  Eugene: Sure.  Lisa: ...and what you wrote about in your article, which we will link to in the show notes, by the way. Eugene: Yes. Thank you. Sure. Yes, so I was a competitor in the Tarawera hundred mile race in February, which as you said—when you said last year, it does feel like last year, doesn't it? Oh gosh, it feels like it was five years ago. But it was February 2020, all those years ago. And in that race was sort of about 260 of us lined up. And then that race was a runner an older—oh, he’s 52. So from Japan, a very experienced runner, had run Tarawera previously, had run lots of other miles, and ultraraces. And unfortunately, about a kilometre or so from the finish, he collapsed, and about 34 hours into the race. And although people rushed to help them, and he was taken to retro hospital, and eventually to Auckland City Hospital, he died. And I remember, I remember the afternoon we heard about it, and Tarawera put it up on its Facebook page to let us all know that one of our fellow runners had died and I stopped. It was a shock.  Lisa: Yes. Eugene: You know we do this thing, because we love it.  Lisa: Yes. Eugene: And because we get enjoyment from it. And he was someone who paid the ultimate price.  Lisa: Yes.  Eugene: So I—we're a couple of hats, and one of them is a journalist, and so I—but really, what first kicked in was, I really want to know what happened. I really wanted to know what happened. I've had health issues myself, had a few scares and so on. A few wobbles and races, and I thought—just from my point of view, I was really curious to find out. But I also thought it was important to find out for other runners... Lisa: Yes, absolutely. Eugene: ...or say, I listen for others. And so I started to see if I could find out. COVID got the way a little bit and distracted me. But eventually I did manage to track down what happened there. Yes. Lisa: And what was the result of the findings in this particular case? I mean, we're gonna want to discuss a few.  Eugene: Sure. Lisa: I think, in this case, it was a couple of things, wasn't it? But this is without picking—and we're certainly not picking on anybody or any, not race, or anything or saying this is bad or anything. But what was it that you discovered in it?  Eugene: Yes. Lisa: So with that, research.  Eugene: Sure. So initially, I remember the talk was that he might have had a stroke, or there might have been some sort of underlying condition.  Lisa: Yes.  Eugene: But I got a hold of his death certificate and it shows that he had multiorgan failure, and acute respiratory distress syndrome, which are both conditions that they can be in multiple causes of those sorts of things. But the one that jumped out to me was Rhabdo. You're gonna make me say that? The proper name for it. Lisa: Rhabdomyolysis Eugene: Thank you. Lisa: I'm an expert in rhabdo. Eugene: So yes, that was the third one on the list. And that was the one that really jumped out at me.  Lisa: Yes.  Eugene: Months earlier, I'd spoken to Dr Marty Hoffman, who's in a University of California Davis in the States, and he's sort of recognised around the world. Basically, if there's an ultra—there's a paper about medicine involving ultrarunning, you'll find Marty Hoffman's name on it, he knows this stuff.  So I'd run to him months ago, at the suggestion of a friend, Dr John Onate, and I had a good chat with him. And he sort of ran through the list of what we could be looking at here, but he was really—it was a stab in the dark at that point. But he told me then that they’re hipping no deaths from rhabdo, knowing deaths from rhabdo from ultrarunners.  Lisa: Yes. Eugene: Yes. And no knowing deaths from ultrarunners of the AH, exhausted and just talking it, ‘How can I train you’?  Lisa: Yes.  Eugene: So we were kind of that, like, ‘What could it be’? Yes. So when rhabdo appeared on the desk fit, I rang him back and said—I actually emailed him and said, ‘Hey, this is what it says’. And he was very surprised because he keeps track of deaths of ultrarunners around the world. And as he said, there hadn't been one recorded before, doesn't mean there hasn't been one, of course.  Lisa: Yes, it doesn't mean. Eugene: It's just no one, yes, no one knows what causes.  Lisa: And I think a lot of these things will have contributing factors in—completely unrelated but going through the journey with my dad recently it was at the end, he had multiple organ failure.  Eugene: Yes.  Lisa: He had sepsis however, and before that he had an abdominal aneurysm.  Eugene: Yes. Lisa: So it shows the progression like it. What did he actually die off?  Eugene: Yes. Yes.  Lisa: He was born with the failure probably, or zips as chicken or eek scenario. Eugene: Yes. Lisa: So these things, one leads to an acute respiratory syndrome  Eugene: Yes. Lisa: And they all lead on from one to the other when the body starts to shut down, basically.  Eugene: It's a cascade isn’t it?  Lisa: It’s a cascade. That is a very good way of putting it. So rhabdo—and while there is perhaps no documented case of a death from rhabdomyolysis, I don't know if they—I know in my life, I've had rhabdo. I can't even remember the number of times I've had rhabdo.  Eugene: Yes. Lisa: I took away kidney damage from it and the last few years, I've been trying to unravel that damage and undo that.  Eugene: Yes.  Lisa: I'm getting there slowly.  Eugene: Yes, yes.  Lisa: So it is a very as if quite a common thing. Eugene: Yes. Lisa: So we don't know whether in this case that was actual final, what actually did it? It certainly would have been a major contributing factor.  Eugene: Yes.  Lisa: Well, what is rhabdo? I suppose we better explain what rhabdos are. Eugene: Yes. So I mean, well, from your experience, you will know better than me. But I spoke to Dr Hoffman and to Dr Tom Reynolds, who's the race doctor for—one of the race doctors for Tarawera.  Lisa: Yes. Eugene: And they explained it as the muscle started to break down and the myoglobin from the muscle being released into the bloodstream. And then it basically just starts clogging up the kidneys and just causing real damage in your kidneys. The problem with it is the symptoms for sort of sound like a lot of other things and also can just sound like what you might expect running an ultramarathon. Lisa: Yes, the kind of that also. Eugene: Yes, tenderness of muscles, a bit of confusion, and so on. And then even some of the blood tests that you can do to pick it up. So they look for CK—you're much more proficient in the medical world than me. Lisa: Not more. Eugene: But the thing that they test for—it basically there was an experiment at Western States a number of years ago, where they tested bloods of people in Western states and they tested something like 160 runners, all of them had elevated CK levels.  Lisa: Yes.  Eugene: So in part, it's just a function of ultrarunning, your muscles are gonna break down to some extent. So that makes it very, very tricky to find out, to discover it. And Dr Hoffman said, ‘Sometimes the first sign that you get that someone's got rhabdo, is they have a seizure’.  Lisa: Yes.  Eugene: So it can be a tricky, tricky condition to pick up. Yes, that's really—it's hard, isn't it? It's really hard. Lisa: It is hard and—but when you are going for—and some of these races are 24, 36, 50 something hours, you're going to have some breakdown of muscle and you… Eugene: You are. Lisa: I mean, keeping an eye on the colour of your urine or if you are not producing… Eugene: Yes, that’s an important one. Yes. Lisa: It is probably the easiest thing to think about. Because like you say, the nausea and headaches and confusion and fatigue are all very general parts about running anyway. So keeping an eye on it, like getting a pouch of fluid. What I would find is that in the lower abdomen, and I don't know if whether this is an actual medical symptom or not. But in the lower abdomen, I've developed this pot gap running and, it wasn't fat, obviously.  Eugene: Yes.  Lisa: ...within a couple of hours. It was fluid, and would usually coincide with my kidneys—they’re not producing or producing very little output. So I think there might be a sign that something's going on there.  Eugene: Right.  Lisa: In rhabdo, like, we're talking ultramarathons, but I have seen a case of rhabdo in a half marathon in summer.  Eugene: Yes.  Lisa: Yes. So a mild case, but enough to be taken to hospital. So it's not even just people doing the extreme extreme stuff.  Eugene: Yes.  Lisa: But it is a very—and you have to ask yourself, how much damage are we doing every time we do and I often asked, ‘Why are you not running anymore’? ‘Why are you not doing it anymore’? And apart from life's gotten a bit crazy. Am I? Indeed yes.  Eugene: Yes, yes.  Lisa: Should I have not got the time to be doing offers? I want longevity and while I love ultras, and I love the culture. And I love what I got to do. And I'm certainly not, I mean, I train lots of ultrarunners. I for myself, don't want to put myself at that risk anymore. Now that I'm also 50 and I want longevity. And therefore my health comes before my sporting ambitions now. It didn't when I was younger, but now with—unfortunately, one of the side effects of studying medical stuff for the last five years, is that I'm now a little bit more cautious.  Eugene: Yes.  Lisa: Because ignorance is bliss.  Eugene: Yes.  Lisa: What you don't know, you just go and do.  Eugene: Yes.  Lisa: You don’t actually know the implications and sometimes, you don't actually know the implications until well down the track, like, you use to check. Eugene: Yes. yes, sure. Lisa: That's where I'm sitting at the moment, as far as the sort of the dangers and the risks. I mean, how did you feel as a runner, who—you were in the same race doing the same distance? You're a little bit north of 25 now. Eugene: Jump 47. Lisa: You're 47?  Eugene: Yes. 47, yes.  Lisa: And did this make you stop and think about, ‘Do I want to keep doing this stuff? How do I feel about it’? Eugene: Yes, it sure does. It sure does make your family think of that, doesn't that? I think it reinforces that you need to have really good self management. You need to be well prepared. I spoke to—when I spoke to Dr Reynolds, and I said to him, ‘We had this big conversation about all the cold coloured urine and all that sort of stuff’. That sounds a bit odd, and a little different other conditions that can come about. Yes, and so on. And I said to him, ‘Boy listen to all of that. Do you recommend people run ultramarathons’? And he said, ‘Look. At three o'clock when the medical team is full. And I've got my hands full, I look around, and I go, What the hell have we been doing this for’? But he says, ‘But it's a small proportion that gets badly affected. And as long as you manage your risks, and you're aware of it’, he said one of the things that he's really concerned about is people jumping up the distance too quickly. Lisa: Yes.  Eugene: Or the runner suddenly, ‘Wow, I'm gonna run 100 miler’, because it has become, I think it's… Lisa: The new marathon.  Eugene: I told him, I spent more time trying to talk people out of doing milers than I do in trying to talk them into doing milers. I don't think I talk to any other or talked anyone into doing a miler. It's a very personal choice. I spend a lot of time talking to people out of it, makes me so again. But again, I don't know if that's a good idea, mate.  Lisa: Me too.  Eugene: Yes. And it sounds bad.  Lisa: Yes.  Eugene: Try running podcasts. Lisa: I know. You know, my buddy out running. Eugene: Yes. But I just think people need to be really conscious of the risks.  Lisa: Yes.  Eugene: And they need to be prepared to put the time in. And that's one of the things that you've identified. You've got to prepare your body. And you've got to know your body. I mean, I took—I've been running my whole life. And I didn't take the decision to enter the miler, lightly, certainly would now knowing what I do know now. And when I say no, I mean, I'd always heard of rhabdo. I'd heard of AIH, I'd heard of dehydrational systems.    And you sort of think about you sort of like, ‘Yes, yes, yes’. But having lined up at the start line with someone who didn't make it home that really reinforces that these are real risks, and you have to be prepared for them. You have to be ready for them. So, I'm not gonna stop ultrarunning, I don't think. But I'm certainly going to be a hell of a lot more careful. And listen to my body.  Lisa: Exactly.  Eugene: Sometimes you can get that. I find one side of ultra running that I struggle with a little bit is the whole kind of ‘You're not going to quit unless the ambulance takes you off the course’ kind of thing. I don't like that. I don’t really like that. Lisa: I totally agree. Eugene: You know, I agree. I love the whole mental toughness thing out of it. Don't get me wrong. That's one of the things that I enjoy about it. But you have to listen to your body. You have to listen to your body. I've pulled out of a 100k race, where I could have pushed on. You know. Looking back, it's like, ‘Yes, I could have pushed on, at what cost’? You know?  Lisa: Yes.  Eugene: Yes, it just wasn't worth it. Could I push through and be out there for another hours and hours and hours and hours? Putting myself...  Lisa: Yes.  Eugene: Yes, sure. I could have but what was the risk? What could have happened? And what do I get out of it? Instead I actually came away from that race having learned a hell of a lot of lessons. And they prepared me for the miler, actually. Lisa: Yes. And I think that’s some beautiful attitude and in a very wise mind. Some of the things that I did in my younger years or even—I’m talking 40s. Eugene: Yes, yes. Lisa: We're stupid. There is no other word for it. And especially in the 30s, my 30s, I thought I was bulletproof and I could push and I had that mentality, you're going to have to drag me away, framing and I have seen lots of others. And I have nearly pushed my body on a number of occasions to the point of death and I've been very, very lucky not to have died.  I've had tetany seizures, which is where your potassium level and your electrolytes are so out of whack that the whole body cramps and so I'm having a heart attack. I was luckily at that at the point that I head out, I was in Alaska, and I'd been for six weeks out in Yukon with poor nutrition and so on and pushing the body every day. I just come off a mountain when this tetany seizure hit. Luckily, I was two minutes from a hospital, and they saved my life.  Eugene: Wow. Lisa: But that would have been deadly very quickly. I've experienced extreme levels of dehydration in the Libyan desert where we only had like one and a half to two litres of water a day in 40 plus temperatures. And gone to the point where I no longer was in control of my body, and my—not only just hallucinations but the central nervous system starting to shut down. Massive kidney damage, and taking nearly two years to recover from that.  I’ve had food poisoning while running across Niger, and again bleeding at both ends pushing it to the absolute limit I did pull out of that race at 64 hours after 222Ks but that was way too late. I've gotten away by the skin of my teeth. Not to mention going through war zones or military body areas Eugene: Yes. Lisa: Or being in really dangerous situations and that's a whole podcast in itself. But it wasn't worth it. Now I think I was just so afraid of failure I was so afraid of not achieving that, which I'd set out to do that. And I have to think about it now and go I wasn't in—people who are in war scenarios or some survival situation where you have to freakin go to the limit alive. Eugene: Yes. Lisa: But I wasn't in there. This is a—well, Libyan desert ended up like that, but you know what I mean? Eugene: Midnight summer bitches.  Lisa: Oh yes, it’s some stupid shit. It really was. But at what costs? Now, I've had a lot of health issues in the last five to six years and a lot of that comes from—I haven't been able to have children you know and so on and so forth. And these are the contributing factors  Eugene: Sure enough. Lisa: That's the only reason for certain things, but now as a coach and as an older wiser woman, I don't want to see people pushing their bodies to that point where they actually close to dying or causing major damage to the body.  Eugene: Yes, yes.  Lisa: It really is not worth it. Eugene: I mean this pushing the limits isn't there. And mentally, I think there's a lot to be said for having a goal that's going to stretch you when you are going to go for it. But the key is to be prepared, isn’t it? To actually have done the training...  Lisa: The training  Eugene: ...to prepare your body. To test—so that you know when your body's screaming at you, you know it’s saying, ‘Okay, you know what, you know to pull the pen or you know to stop and rest or whatever’. I think there was some good—Tom Reynolds had some five tips which are really good.  Lisa: Yes. Let’s hear them  Eugene: To prepare yourself for an ultra especially ultras but even marathons I suppose  Lisa: Absolutely. Eugene: Number one on his list, and I think he would make this number 1, 2, 3, 4, 5 is don't take drugs like Ibuprofen and Voltaren and those sorts of things.  Lisa: Super important. Eugene: Do not take them. Yes, super important. The second one is drink to thirst. You know that you can have problems—your own problems if you have too much liquid.  Lisa: Yes, which we’re talking about in a sec. Eugene: Yes. Be prepared for the conditions. Have a plan for a range of conditions. So make sure you've got thermals. Make sure you've got your jackets and sawn and layers that you can take on and take off especially if you're going to some of these remote areas that we go to as ultrarunners.  Number four, the race doesn't end at the finish. Pack warm clothes, get some food ready that you can eat, some liquids. And another thing that he pointed out to me is actually some of the most dangerous times is after that finish line. When people get to the finish line, and drive hard, and they're tired. Lisa: It's so true. Eugene: You can crash easily for a second crash.  Lisa: Yes.  Eugene: And number five is look out for each other. and I think that's so important. Sometimes there's a bit of competition isn't there? But number one, you've got to look out for each other Lisa: Yes.  Eugene: You are comrades in this together and you've got to have each other's backs. And there's little relationships that you build up with someone you've never met before. I still remember having a good chat to a farmer from Jordan. I spent a lot of hours with him at Tarawera. Haven't spoken up since, never met him before in my life, but there we were together at Bizmates on the trail. Lisa: Awesome. Eugene: Keeping an eye on each other. Looking out for each other. You make sure they've got their bottles filled at the aid station. You make sure that they're not getting confused or anything like that—just looking out for each other. Simple isn’t it? Lisa: That’s gold. Eugene: And that was the five tips that he gave. Actually, they're pretty good tips. Lisa: They are very good tips, and a couple other ones to pick out like the training. In my early days as a coach, I remember taking an athlete who went from half marathon to running the Big Red Run 250Ks. Eugene: Wow. Lisa: Inside a month.  Eugene: Oh. Lisa: Now on a red mat, that was stupid.  Eugene: YeS.  Lisa: He came over to do 100k to be fair, and he was doing so well. He just decided to carry on and to do the whole thing. And it was an incredible achievement.  Eugene: Oh, yes.  Lisa: However, broken my butt. Like, it never was quite the same afterwards. And he wasn't ready. He wasn't, like, his body wasn't ready. So when you prepare your body, when you're training, you doing these long runs, and you're doing back to back running, and you're doing strength training, you're doing mobility work, all these things are preparing the muscles so that they don't break down so quickly and they don't need—you don't need about rhabdo.  And another big piece of the puzzle is the experience side of things. Because then you can actually start to feel when your body's doing a chick or not. As I run, I used to do like little chickens every half hour or an hour I'd go right I'm doing a control like a pilot would before he flies the airplane. ‘How is everything? How am I feeling? Have I ever drunk in the last 10 minutes? Have I eaten anything? When was the last time I weighed? When was the last time’... Just doing a mental checklist as often as you can.  Now one of the hard things with ultra though is that you start to lose your brain function, so all the blood flow is going away from your executive function up here and you become like a bit of a moron. You’re like, ‘Oh, oh’. Eugene: Absolutely. Solving maths? Impossible. Lisa: Impossible. Or maybe doing a 24 hour race, the one at the Millennium Stadium, and there was some guys they’re testing us just for a laugh, doing Noughts and Crosses as we run around the track and our brain function is a day and night wore on just we weren't even able to add up one plus one anymore. We just completely like, ‘Eh’? He’s got low blood and my brain is not functioning. So what that does mean is that your ability to make good decisions is also impaired. I remember saying to one of my friends who was a paramedic and she was with me in Death Valley, in the second time I did Death Valley. And she says, I said to her, ‘You are responsible for my health’. I was lucky I had a crew in that situation. If you pull me out, you pull me out. I know that you won't pull me prematurely because you know what, it's taken me to get here. But my life is in your hands and I respect that. I respect you. I respect your knowledge as paramedic. If you tell me it's over, it's over. And she will be able to make that decision because I knew from my personality and from my matter that cost me to get there wasn't going to be pulling out anytime soon. So sometimes if you can have in the case where you have a crew have somebody say, ‘This is now getting dangerous’. And it's a fine line. Like I pulled my husband out of a race once, Northburn, a race that I co-founded a few years ago in the South Island. And he was doing the 100k and he actually rang me on the cellphone, and it seem the case, we had a massive storm up in the mountains. It was wild. It was his first 100k, he was in the mountains. He was scared shirtless. He was hypothermic. And I was like, ‘Oh my god, darling, just come home’. You know? So that was—and he could have pushed on.  Eugene: Yes. Lisa: And mentally that cost him a lot because he pulled out, and he didn't push over that hub. So there's this fine line between it should’ve been ours... Eugene: But he lives to tell the story.  Lisa: Exactly, and he's done that, so it wasn’t... Eugene: Exactly, that doesn't matter, you know? We love those stories. I love reading your books. I love reading the things that you've been through. But, my gosh, when you think about the risks as you say and the cost, and that's a common story. You're not alone in there, That's the sport we’re in.  Lisa: Yes. Eugene: It's ridiculous to me. But you know, it's a tough one. And it's, I think that's a really good idea. Having someone who's who's got your back. Someone who you can trust, like you say, they're not going to pull you out you know just because you stub your toe. Oh gosh... Lisa: Just because you’re... Eugene: Exactly. Exactly. Who hasn't? But you can trust them so that when you've gone to that thin line, bang!  Lisa: Yes.  Eugene: Come on my area.  Lisa: Yes.  Eugene: And I was lucky to have a really good mate who phased me. I went through some hallucinations. Nothing major. But he thought it was—I had my mate. And he was looking out for me. In fact, he laughed at me. Lisa: What did you see in your hallucination? Eugene: Oh, I hit home. So we were running around on an unfamiliar course. We were coming around the back of Blue Lake. Up towards the Blue Lake aid station. So about 120km. And it was just before sunrise. So, you get that funny light.  Lisa: Yes.  Eugene: It's still dark, but the light is changing. And I swore coming up to the aid station, I swore I saw a robot sitting off to the side of the trail. And in my photo frame mind, I justified it as ‘Oh, it must be like reading, it must be scanning us telling the aid section that we're coming’. And so I saw it. And said to my mate, ‘James, there’s a robot. It's pretty cool’. And he's like, ‘The what’? ‘The robot there’. And he's like, ‘There’s nothing, man’. And I think it was a tree or something. I don't know what it was. But it's funny how I justified it to myself. So it was fine. And then after the light changed, I got a couple of situations where it's quite unlikely to cause hallucination or is vision going. But I—the ground was just like liquid glass. Lisa: Wow, that’s cool. Eugene: I was like, ‘Oh, should I put my foot down or not’? And James said, ‘What are you doing? Come on’! It was like, ‘What's going on with the ground’?  Lisa: [32:58] inaudible the glass. Well. Eugene: So that was but—people have some great hallucinations, don't know. But the point of that was, I had my mate there. It was never unsafe. And I'm grateful for that. So I think that's a really good tip, Lisa, to have a crew with you. Lisa: I think hooking up. Or if you're in a race where you don't have crew—which most of them are. And that you do hook up with somebody. If you can try and not too many people because then your pacing will be all out. But if you can just hook up with one person or maybe two at the max. I remember running the Gobi Desert in the Sahara with same gash who was in the desert runners movie together and this is great footage and desert runners is playing at the moment on TVNZ if anyone wants to check it out, it’s a cool movie. And yes we're running along holding each other's hands, bawling our eyes out, and but we got each other through both of those messiest days, both in the Sahara, and in the Gobi. And we ran together in India as well but with crews in that case. But that comradeship that we have there was just gold. It just helped.  When you [34:17] escaped shirtless you hit someone the and we did get lost and we did fold our paces and we did have all sorts of dramas and we kept each other going through all those hard times and I think that's one of the beautiful memories for me that I take away from that. And there were other people I've done the things with... And the depth of connection that you have with a human being when you've gone through something like that it's just next level. And that's one of the beautiful things because we’re talking about all our negatives here but it is just like—she’s a very amazing woman that one. She’s done incredible things. Eugene: It is incredible, isn’t it. Those connections you make.  Lisa: Yes.  Eugene: The friendships you forge. Even if you don't see each other again, but you've got that bond. That's forever.  Lisa: Yes.  Eugene: Those moments that you shared when you're vulnerable. Lisa: When you're up [35:11] Creek and literally. Guys who didn't even speak the same language or a woman I remember running in the Sahara at one point with a—I was crying, she was crying. She was from South America somewhere, didn't speak a word of English, or another French guy picked me up in Jordan when I was running across there and I'd passed out and he came along, picked me up, got me into the next checkpoint. The French guy and Niger, it's just like, ‘Wow’. The stuff that you help each other through. It's gold, but does this do happen, you know?  Eugene: They do. They do. Yes. Lisa: We have one in the Gobi Desert. We had a young man, Nicholas Kruse was only like 30 or 31, I think. And he was first time doing it. And he wasn't trained enough, I don't think. And he—I think he underestimated the thing. And he unfortunately probably paid the ultimate price. And then you've got also the dangers. I mean, you got cases like with Turia Pitt, the forest fires in Australia, or there are things that could go wrong. Eugene: Yes, absolutely. Lisa: Even in these organisers' races. You have falls where you've hit your head and concussions and... Just because you're in an organised event, do not think that there isn't an element of danger, or that you're going to have to be self-reliant, you cannot. And inside these countries is beyond the abilities of the organisers actually to cover every base. Eugene: Absolutely. Well, even in races in New Zealand, we go to some remote places, and races route is difficult to get. You're not just going to be able to ring up 111 and get an ambulance there.  Lisa: No. Eugene: It's not like that. I've been in a 100k race where—because there have been lots of runners going through this. It was a narrow bit of the trail. And it was really dry there. And runners have been going over this bit of land. And basically, as the day wore on, it sort of started to break down a little bit. And I was just the unlucky one stick on the trail in a way. And I slid down this bank...  Lisa: Oh my god. Eugene: ...and down, down, down, down down, thinking, ‘Uh-oh, when's this going to stop’? Luckily, I hit, I came to a stop on a tree, not badly. And then basically had to scrape my way back up. Now, I was fine. But you know, those sorts of things can happen if I stumbled in a wrong way as I came off the trail and hit my head, whatever. So you are—yes, you will, I mean, it’s not... Well, I mean, when we've been out on a run in a cotton wool, so [37:57] do we. But we don't want to go everybody. But you don't need to be conscious. Lisa: I'll be conscious of it. I think... Eugene: And even when you're training too, when you're training, when you are going out in remote areas. Make sure you tell someone where you're going. Preferably run with some other mates. Maybe think about taking a locator beacon with you if you're going somewhere really remote.  Lisa: Absolutely. Eugene: Have a phone with you, do those sorts of things. Take those precautions. Just be a bit careful. Yes, we want to push ourselves. Yes, we want to be out there. Yes, we want to find new limits. But we also want to get back home.  Lisa: Yes, we want to come home to our families and not die on the way.  Eugene: Yes. Lisa: If we can. I mean, people can take it to the level that they want to go to, but just don't want people going and thinking that everything's safe because it's an organised event or because hundreds of other people have done it, means absolutely nothing. Eugene: Absolutely.  Lisa: I’ll tell you, like how many thousands of people have climbed Mount Everest, but it's still a frickin dangerous thing to do. Eugene: Absolutely.  Lisa: Doesn't mean it's safe just because lots of people have done it. I think like—if we just went through a bit of a list now of some of your things that you'd like from a medical perspective, that you should gone this research on and find out about.  One of them, so we've talked about rhabdomyolysis. Dehydration is the opposite, is well known, dehydration is what we think about more, and that's certainly something that can then can lead to troubles. And you've got hyponatraemia or EAH, so hyponatraemia let's just talk about that one briefly because it's a biggie. Hyponatraemia is a low sodium level in the body. I've had it. Lots of people give this. And it's again, a hard one to diagnose because it is very similar to the opposite problem, which is dehydration. So hyponatraemia you've actually got too much water on board.  One of the signs of this I'm even doing was 100k, one of those Oxfam ones. And because we'd been walking for so long, it was a walking running situation thing. And I got really bad hyponatraemia in that one. I was drinking a lot. I wasn't having my electrolytes, right. And my hands were like elephant hands.  Eugene: Wow.  Lisa: So that's an indication that there's something going on. So look for signs like that, look for swelling, edema. And yes, that could like...  Eugene: Nausea, lightheadedness, those sorts of things as well. Lisa: Coordination, going haywire. And the problem with hyponatraemia is you don't want to just be thinking it's dehydration and then drinking more. So it's an—it's a low sodium. So, your potassium and your sodium are having antagonistic relationships in your body. And you have, for every three bits of sodium that gets pushed out of the cells, three bits of potassium come into the cells. And it's like, it acts like a pump. And it's actually what helps your muscles contract.  So if you get that sodium, potassium, ainger, other electrolytes out of whack, there's a whole lot of things that can happen. hyponatraemia being one of them. In another one being a tetany seizure, which is what I mentioned what I had in Alaska.  Eugene: Yes, so what's that? Lisa: So this is where—in my case, it was a potassium that was really, really low in the body at 1.4. Like it’s deadly... Eugene: Wow.  Lisa: Deadly low. And I'd had in the couple of weeks building up to this actual seizure. My hands were doing this, and I was cramping all the time. And that was so—if you ever start doing that, like this weird thing where your hands are starting to spin. Eugene: So, like dinosaur hands on. Lisa: Yes, so your fingers—for those listening can't see me do my funny thing here. It's the muscles contracting and your fingers are pulling in. So I remember, swimming at some point, and the lead up to this with this was happening to me. I was like, ‘What the hell's that’? And then it would go off again. But there was a sign that I didn't have enough potassium as I found out later. Eugene: All right. Lisa: So then I had, a couple of weeks later, this tetany seizure, and it started with the whole body. Just like every muscle in the body cramping all at the same time, the most painful thing you can ever—like really bad pain, including your face muscles, including your heart, which is the problem.  And in there, the pain was horrific. I thought I was dying, I was. Luckily I just come off a mountain, or was taking shelter in a public library because it was pouring with rain and freezing cold. And this happened in the library. And there was a paramedic in the library who just happened to be fixing a light bulb. He saw me go down.  Eugene: That’s one of the 43:10 [inaudible] moments. Lisa: Yes, that was very lucky. He put a gel straight into my mouth. He just happened to have a gel on him. And that gave a little bit of glucose and stuff too, and managed to release the seizure for a couple of minutes before it happened again. But by then he got me into the ambulance and around to the hospital pretty quick, smart. And they were able to save me. But that could have been deadly. That could have been a massive heart attack on the way out. I've seen that also happen and we were in the outback of Australia with friend Chris Ord. And he had a seizure at mile, coming in at 90 sort, and we've been running in 40 odd degrees heat and he'd been taking electrolyte tablets. So people electrolyte tablets are absolutely crucial. You've got to have them. The ones he was taking didn't have potassium. They had everything else in them but their ratios weren't right. And he ended up—we had to—again incredible pain, whole body seizing, racing him into the hospital Alice Springs.  What I did do and what you can do in a case like that is give him three cans of Redbull—not advertising for Redbull or because generally that’s a shit thing to be drinking. And this case, with what it's got in it and the sugars and stuff that helped. So yes, but that's just a potassium sodium balance.  Eugene: Yes .That's the thing, isn't it? We're missing with our chemistry. We're missing with the body's chemistry. I don't know what it was but I had one race where I just finished and as soon as I finished, I started shaking.  Lisa: Oh, yes. Eugene: Shaking and shaking. I couldn't stop for hours. And it wasn't cold. I wasn't cold. Lisa: Oh, I know what it is. Eugene: Well, what is it? Because... Lisa: I don't know the name of it. But I've had that many times. It's basically where you've just got nothing left in the body.  Eugene: Yes, somebody said to me, glycogen. Yes, just the glycogen is gone.  Lisa: You just got nothing, you got nothing to heat because you know we heating ourselves all the time with our glycogen supplies and our glucose is running out of their body. And you were just on absolute zero basically, taking your blood sugar, I bet you’re in a really, really low  Eugene: Right.  Lisa: And so like, in Death—I’m telling my bloody stories, but...  Eugene: Why not? Lisa: A member in Death Valley. We be head like 55 degrees during the day, I’ve had heat stroke and had all that. And then at nighttime, it was 40 degrees. And I got shivers. I was doing that. I was like this and it was 40 degrees.And I was like, ‘Really, what the hell is going on? It's 40 degrees’. It was a lot colder than it had been, but I just had nothing left in the tank and therefore I was shaking.  And that can be a real danger when you say in the Himalayas, which I've also done and that's where you just cannot warm up. You can't keep your heat going. And these can run into other problems where you just stuck—your blood sugar just keep dropping, and you can end up when—going into a coma just because your blood sugar is too low, and you got hypothermia. Eugene: The other problem that happens. And I've had this a couple of times after ultras is I just have zero appetite, I can't, I just can't face the thought of food. You got to get something into you, you go start replenishing your body, you got to look at soups or something to get some nutrition back into it. Because like you say, it can be dangerous. Lisa: And that's a recovery too, like, if you can get something in it will help you recover a heck of a lot faster even like just generally fully training runs, if you can get something in within an hour. But usually within an hour, you just do not feel, you just feel like vomiting if you eat too much. So you just have to take a little, little, little nibble, nibble, nibble. And something that you're really—usually savoury salty things that you will get have a taste for. So soup or things or something like that. Just trying to eat something in. My gosh, there's a lot to be worried about. Eugene: And that's the thing, that's the thing. These are all things that you need to be conscious of. But you manage your rests, don't you? You can manage them. And what one of the other things that Dr Reynold said, and I think is pertinent today, what just what we're dwelling on the bad things is that these risks are exponential. So he says, ‘Don't think that you run 100k all year, well, then 160Ks, that's only another 60k’. It's an exponential increase, and an exponential increase in those risks as well. So conscious of those things as well.  Lisa: So watch when you're jumping up in this.  Eugene: Yes.  Lisa: And also don't fall into the trap of thinking, ‘Oh, I did it once. Therefore, it's a piece of cake. I could do it either’. I've run into this where I came off the back of a Himalayan one. I just done 222Ks. I thought it was the bee's knees. And then I went and did it just a couple of weeks later and I hadn't recovered properly a 50k in Australia. And the wheels freakin came off at 25k. It wasn't the—I had to be risky for some beer drinking Ausies in the middle of the bush. I'll tell you your ego suddenly deflated.  Eugene: Yes, absolutely, Lisa and it's—I learned that lesson even just with the map just for the marathon.  Lisa: Don’t say that. Eugene: But just for the marathon. I ran my first marathon when I was 21 and I trained for it. And so I found it actually quite easy. I don't mean that—I wasn't fast but but it was I got to the end of it. I can't keep waiting for the wall. The wall never came. I got—I thought, ‘Ah’! So I made the mistake thinking marathon is easy. A piece of cake. Yes, run up on the next one. [49:13] ecruzi hardly did any training.  Lisa: Oh.  Eugene: My bad, so bad. And it was like it was just the marathon telling me, ‘Sunshine’...  Lisa: Respect. Eugene: ‘Respect the distance’. You cannot run something like this without respecting it. And it was a good listen.  Lisa: Good listen. Eugene: Good listen, I'll let my listen. But I let my listen.  Lisa: And in by that token, respect any distance. People often say to me, I'm just doing it, I'm just doing half marathons, or I'm just doing marathons and because I've done lots of ultramarathons they think, ‘Oh, that would be nothing for you’. And I'm like, ‘Hell no’. Eugene: Hell no. Absolutely. Lisa: Every distance has to respect because it’s sort of basic thing for starters. 100 metres is a long way when you're going at Usain Bolt and 5k is really fast when you're going at your maximum. And a team K is an attunity. It's all relative to pace for status. And the second thing is never think because you did it once. Next time, it's going to be sweet. And Eugene has given us an absolute good example of that. And it is. It’s like take every race is that first is a big deal. And you have to prepare your body for it.  And don't—oh, another mistake I made this was awesome. Another embarrassing thing. So you know. Done 25 years of stupid stuff and then when my mum got sick I didn't train obviously properly for 10 months and then I ran across the north on and raising money for charity a friend who’ve died, Samuel Gibson a wonderful man that we lost. And I was so moved. I decided I'm going to run anyway. And I have not been training for 10 months because I've been looking after my mum and I sort of thought out, this sweet, have done this backwards and upside down. I can do this. Oh my God, my ass got handed to me. And I got through it. But oh, hell, it was hell. It was not funny. So prepare. And even though you've done it a100 times doesn't mean you still got it. Eugene: That's right. That's right. Lisa: I assume I don't got it now. Eugene: And that point you made earlier about recovery, too. I did a 100k race and then you had this plan to recover, to take weeks off, got peer pressure. Mates we're doing a 50k. ‘Come on. Come on, man. I don't want peer pressure. Peer pressure’. ‘Okay. You’re already lined up to this 50k race’. Oh boy. And it just set me backwards. It set me back so far, you know?  Lisa: Mentaly too. Eugene: Yes. Absolutely. Absolutely. Yes. Yes. Yes. So, yes, respect things. Lisa: We've got to respect things. We've got to not expect that our bodies got it just because we've done it once before. Be aware of things like rhabdomyolysis, heatstroke, hyponatraemia, altitude if you're doing altitude, podcasts in itself, be aware of burnout...  Eugene: Hypothermia. Lisa: ...hypothermia, dehydration. All of these things are things that we can and do happen to be seizures, electrolyte imbalances, getting lost, going through dangerous places, breaking ankles, and all that sort of thing. So part, it is, can happen. So, be aware of that. And we're not saying don't go out and have adventures, because that'd be really critical. But prepare for those adventures. Get proper training. Get proper coaching. Know what you're in for. Eugene: It's like driving a car. One of the most dangerous things we do. But we make sure we wear our seatbelts, we make sure our cars have got a Warrant of Fitness and the service, and everything. We make sure there's air in the tires, we make sure there's fuel in the tank, and our bodies have got to be like that as well.  Lisa: Exactly. Eugene: That driving is so so dangerous. You know, so many people a year die on our roads.  Lisa: Yes, more than ultras.  Eugene: Yes, so we don't not drive. We just make sure that when we drive we are prepared and our cars are prepared. Well, that's the same as running. There are risks, not as much as driving. But there are risks, but we just make sure we've got air in the tires, we've got fuel in the tank, that we're serviced, and ready to go when we line up for races. Lisa: Brilliant. Eugene, you've been fantastic today. And now you've got another thing to get to. So I want to thank you for writing that article. And thank you for your honesty and openness about this because it's really important that we do talk about it in our running community and to share the good, the bad and the ugly. So I think it's important. And keep up the great work. Of course, people should go and listen to Dirt Church Radio. It's a fantastic podcast that  Eugene: We have great gear that’s wireless.  Lisa: Honoured to be on your show, mate. And I love talking to you and I love what you do. So thanks very much, mate for being on the show today.  Eugene: Anytime. Thanks, Lisa. That's it this week for Pushing the Limits. Be sure to rate, review, and share with your friends and head over and visit Lisa and her team at lisatamati.com The information contained in this show is not medical advice it is for educational purposes only and the opinions of guests are not the views of the show. Please seed your own medical advice from a registered medical professional.

Exercise gives our body a physical and mental boost. It’s good stress, but it’s stress nonetheless. Thus, doing a running warm-up before an interval run or training is integral to get the most benefits out of running.  Neil joins me in this episode to explain the steps in preparing for a running workout. We emphasise the importance of setting your mindset before training. We also cite different examples of run-specific movements, drills and breathing exercises. If you are a runner wanting to do a running warm-up right, then this episode is for you.   Get Customised Guidance for Your Genetic Make-Up For our epigenetics health program all about optimising your fitness, lifestyle, nutrition and mind performance to your particular genes, go to  https://www.lisatamati.com/page/epigenetics-and-health-coaching/. You can also join their free live webinar on epigenetics.   Online Coaching for Runners Go to www.runninghotcoaching.com for our online run training coaching.   Consult with Me If you would like to work with me one to one on anything from your mindset, to head injuries,  to biohacking your health, to optimal performance or executive coaching, please book a consultation here: https://shop.lisatamati.com/collections/consultations.   Order My Books My latest book Relentless chronicles the inspiring journey about how my mother and I defied the odds after an aneurysm left my mum Isobel with massive brain damage at age 74. The medical professionals told me there was absolutely no hope of any quality of life again, but I used every mindset tool, years of research and incredible tenacity to prove them wrong and bring my mother back to full health within 3 years. Get your copy here: http://relentlessbook.lisatamati.com/ For my other two best-selling books Running Hot and Running to Extremes chronicling my ultrarunning adventures and expeditions all around the world, go to https://shop.lisatamati.com/collections/books.   My Jewellery Collection For my gorgeous and inspiring sports jewellery collection ‘Fierce’, go to https://shop.lisatamati.com/collections/lisa-tamati-bespoke-jewellery-collection.   Here are three reasons why you should listen to the full episode: You will learn about the role of stress levels and mindset when preparing for training. Know more about running warm-up and breathing exercises. Discover the importance of run-specific movements.    Resources Email lisa@lisatamati.com to know more about my health optimisation consulting. Visit my YouTube channel to watch warm-up, workout and training videos for runners.   Episode Highlights [03:47] Understanding Your Bucket of Stress The bucket of stress is filled with things going on in your daily life. You layer exercise on top of it. Having an overflowing bucket and doing high-intensity interval running will cause more stress to the body, causing injuries and pain.  Conduct a wellness check to assess your current state. The checklist includes sleep, nutrition, hydration, movement, energy, body, and stress. Listen to the full episode to learn more about computing your wellness score! Change your warm-up and training to suit how you are feeling. [12:13] Shifting Your Mindset Neil is a father of three. He works out because he wants to be a superhero for his kids.  Figure out what training means for you. Mindset is essential when doing a workout. You need to shift from work mode to training mode. Incorporate diaphragmatic breathing exercises to activate your body’s parasympathetic state. [18:47] Activating Your Muscles Spiky balls, rolling sticks and foam rollers are some of the tools you can use to activate your muscles. Expose your feet to neural stimulation to get them to move freely. Because the feet are connected to other parts of the body, activating it will start to relax the muscles and tissues above it. Activation may vary from person to person. Some people have a lot of tension in their bodies, while others are hypermobile. [22:11] Static vs Dynamic Stretching Static stretching is holding a single stretch in one position for 30 seconds or longer. Doing a static stretch lengthens and switches off the muscles, making them too relaxed. The body thus becomes too floppy. Static stretching has its benefits after a run or during a yoga session but not before a run. Dynamic movements allow the body to move more freely. [25:48] Warm-Ups and Fascia The fascia connects the different parts of our body from our head to toes. Fascia lines run across the body. Warm-ups should help open, lengthen and move the fascia. Stretching and moving the fascia allow you to move better and run more freely. [31:47] Doing Drills It is best to do run-specific movements and drills. Ball of foot hops and carioca are some of the drills to help you warm up. Listen to the full episode to learn how Neil does his warm-ups! Listening to music helps to have cadence. You may create playlists for before and after you run. If you’re doing a recovery run, you can use calmer music.   7 Powerful Quotes from This Episode ‘That's what training is about. It's not about the actual run where you actually get the results. It’s in the recovery phase’. ‘How you prepare your mind is going to be key when you understand your “why” before you warm up’. ‘A lot of people find their toes are bunched together and tight. If we can get some movement through those, we start to get more benefit from our running as well’. ‘Gone are the days of static stretching and standing on the doorstep during your quad stretch, holding. All you're doing there is switching the nervous system off and increasing your likelihood of injury and discomfort’. ‘You take which bits of the tools you want out of the toolbox, and then you start using them from your perspective’. ‘Looking at what you're currently doing, who you are and how much in a warm-up — what percentage you use each tool for will be quite different for each person’. ‘You will have — and I promise you this — a much more fun run, and you'll enjoy it more if you've put the time into this warm-up piece of the puzzle’.   Enjoy the Podcast? If you did, be sure to subscribe and share it with your friends! Post a review and share it! If you enjoyed tuning in, then leave us a review. You can also share this with your family and friends so they can optimise their running warm-up. Have any questions? You can contact me through email (support@lisatamati.com) or find me on Facebook, Twitter, Instagram and YouTube. For more episode updates, visit my website. You may also tune in on Apple Podcasts. To pushing the limits, Lisa   Full Transcript Welcome to Pushing The Limits, the show that helps you reach your full potential, with your host Lisa Tamati, brought to you by lisatamati.com. Lisa Tamati: Hi, everyone, and welcome back to this week's episode of Pushing The Limits. Today, I have Neil Wagstaff, who is my wingman at Running Hot Coaching, and we're going to be talking everything about running and preparation for a good training session — how to tell if you're ready for that session that's on your list today. We're talking about stress levels. We're talking sympathetic and parasympathetic nervous systems. We're talking activating muscles. We're talking lymph and circulation and a whole lot of great info that you don't want to miss if you're into exercising, fitness or running. Before we go over to the show, though, I just want to remind you please give a rating and review to the show if you enjoy it. Share it with your family and friends.  We've been going now for five and a half years, and we've been in the top 200 globally ranked shows in health and fitness genre, and we really appreciate your support. And every one of those reviews and ratings really helps the show get seen by more people, heard by more people, so that they can get this great information that we're getting out. Just want to also let you know, we are taking on a small number of clients on one-on-one health optimisation consulting. If you got a really tricky health situation, if you're not getting the results that you want in the normal world, if you are needing help navigating some complicated situations, then we'd love to help you. We only work with a very, very few people at a time. And that requires quite a commitment from us, from the research side of things in helping people optimise their health or navigate their way back to health. So if it sounds like something like you would like to know about, please email me lisa@lisatamati.com. We only work with a very few people at a time at that level. So just letting you know that that's available.  Now over to the show with Neil Wagstaff in Havelock North. And I hope you enjoy this fantastic interview. Lisa: Hi, everyone, and welcome back to Pushing The Limits. This week, I have my wingman, Neil Wagstaff. Neil, how are you doing? Neil: I'm good. Thanks, mate. I'm very good. How are you? Lisa: It's very hot here. I'm sweating as well. Neil: Here as well. Lisa: Very humid! Right, people. Today, we have a really good webinar for you, podcast episode for you, all around the importance of — this one’s for runners, really — and it's all around runners warm-ups. Why do you need to do one, what's included, why you need to incorporate breathing into that warm-up routine. It's more than just running warm-ups, believe me, you'll get some great value, if you're a runner in this one, or if you're into fitness. And we're going to be talking about the importance of running specific movements to prepare for your run. And we're going to be going over some of our top drills to activate your body and get you ready. So, Neil, we did a fabulous session yesterday on this, and it was so valuable we decided we got to record this for the podcast, so… Over to you, mate. Neil: Thanks, mate. Thanks, and as you say, it is a lot more than just the runners warm-up, but it's… Gone are the days we just lace up your shoes and run out the door. That's what many, you know, we definitely did in the older days. And a lot of our clients we work with do, a lot of people, as you said in the introduction, as well, it’s not just the runners. It's in an exercise environment as well. So we put a lot of emphasis on this in the gym environment. So important, there should be some good nuggets for everyone. So the first thing first before you even think about the warm-up is understanding about what we call your bucket of stress. So the bucket of stress, if you will imagine you've got that bucket sitting in front of you. And within that bucket, there's things that will fill it up. Now some of those things are going to be what's going on in your daily life. They're going to be your kids. They're going to be your work. They're going to be family. They're going to be other stresses that are happening, and then you layer exercise on the top of it. So with the bucket stress, it’s understanding how full yours is. If you're going to go out and do a high-intensity interval run, where you're doing 1K intervals at 80, 90% of your max effort, and your bucket is already overflowing, then that run, those interval runs on top are just going to cause your body more stress or more loads, which will give you a pretty harsh response, which will then result in injuries, niggles and pain. Lisa: Yeah. Neil: On days where your bucket is full, what you want to be doing is really changing your workout or changing your routine to suit how you're feeling. Okay, you know, I've had massive conversations over the years about the bucket. What's your— give us your perspective of it and how you manage your routine a little bit differently now. Lisa: Yeah, and I'm still probably a bad example some days. Neil: You’re a good work in progress. You’re a good work in progress. Lisa: Do what I say not what I preach sometimes. But it's really, I have really adopted the fact that it is important to do a warm-up when you're preparing for a run. And also to understand what we're trying to get across here is that just because stress is good for your body— I mean, sorry, running is good for your body or exercise is a good stressor, if you like, it is still adding to your total stress load. So the level that Neil used to run it when he was not a dad of three little children and had a bit more time and didn't have a massive German, a couple of businesses to run, he could dedicate more intense time to training without breaking himself, if it makes sense. Now, because his energies are split in every which way, he has to be a little bit more careful how he prepares for an event, the time that he takes for it, and the time that he prepares his body.  So if your training plan says today, you should be going out and smashing a really long run or a really intense run, but you haven't got the resources because you had a really shitty night sleep, and you didn't drink enough yesterday, and you didn't eat properly, and the kids have been up all night, and goodness knows what else — you've got a lot of stress and a lot of worries on your mind — then you're probably not going to get to that adaption— adaptation, sorry, when you do that training, which is what you're actually doing it for. It's not just about ticking the box because my coach said or my plan said that I had to do that today. And I've ticked the box, therefore I am good to go. It is about saying, 'Is my body going to respond to this training session today’? Yes or no? Or, ‘Would I be permitted to postpone that really intense workout to a little bit later, maybe tomorrow? And I'll get to bed early tonight. And I’ll drink well, and I’ll hydrate well. An I’ll do all the other bits and pieces as well. And then I might be a bit more prepared for that'. Does it make sense? So you’re not doing things when your body is not going to get the adaptations because that's what training is about. It's not about the actual run where you actually get the results; it’s in the recovery phase. So understanding where your body is at, which is a really good segue into our wellness checklist. Isn't that, Neil? Neil: Yeah. So yes, you go through as well as, just asking yourself each day, where you're at a number of different things and things we get with our wellness checklist. And you can all do it at home as you listen to this. It’s a simple scale of 1 to 10. So 1 to 10 on these things we're going to talk about. How well did you sleep? That's the first one. How well have you eaten, and where you're at from nutrition point of view? Lisa's already mentioned hydration, number three. So how well have you hydrated? How well have you moved? What sort of exercise movement have you done in the past day? On a scale of 1 to 10. And then energy wise, where's your energy score at? 1 being the toilet, 10 being at rock and roll levels, you’re ready to party. And body, any niggles, any injuries? And your stress score, so 1 with the stress will be low and 10 will be good. That gives you a total score. If you've got a score up over 50, and it'd be a good indication that you're ready to go and do a warmup that relates to what's in your program. If it’s saying that, we're doing the example, the 1K, then that puts us in a position that we should be ready to do it. If my score is lower, which some days it is, then I'll look at my program and go right, I've got intervals. But I mean, my score’s down at 40. So those two workouts don't match up then. So what I then do is go, ‘I can still go train, but my training may be a recovery run instead so I feel my energy levels back up’. If you are continuously having low scores with this full stress bucket, it's not a runner's warm-up you want to be considering. It's about— it's really another strategy, which is how am I going to empty some of my stresses out of my bucket? Because your bucket should be managed on a daily basis. So that you, you know, 80, 90% of the time you're doing what your program says, it's just having the confidence and understanding that some days when things don't go perfectly you can tweak it. Okay, so just to recap: sleep, nutrition, hydration, movement, energy, body, and stress, scale of one to 10. 1 being in the toilet, 10 being rock and roll. And we can send the, or add the… Lisa: Yeah, we’ll put this in the show notes, actually, the checklist. Neil: Wellness check to the show notes. Yeah, so that's understanding again really helps you manage your bucket. So before you've even warmed up, you're asking, what's my session I'm going to do? Now, I know what type of warm-up to do. The other bit to consider as well is really, really a little bit about your why. If you are… Many programs out there, what we've looked at over the years, designed by ex-professional runners, often male, without giving them a hard time, and often by men. And in our business, we work with a lot of ladies. Over 70% of our business is working with females. And a lot of our athletes we're working with, mums or dads, and they have got busy work lives, busy family lives. So those programs are running five, six days a week just doesn't work. So ask the question as well, what's your why? And who are you? So for me, personally, as Lisa knows, my three little ones, Ellen, Cameron, Annie, I love the idea of getting dressed up as Superman. Okay, and we shared a couple of pictures of me dressed up as Superman. So it's understanding what your why is and why you're doing it. I want to be a superhero for my kids. Therefore, the type of workout is different now, as Lisa said earlier, than I was doing in my… pre-kids. And when I was back in my 30s, then I was thinking more like a professional parkour athlete and wanted it to be doing. So therefore, the warm-up is going to be different. So what we're trying to do, and the big thing especially from Lisa's perspective as well, is how important mindset is. We're really big on that with what we do as well. So understanding what mindset you're going into this workout in. So for me, I'm going in as a superhero, wanting to be a superhero, for my kids. Some people who are listening will be going in with a professional athlete mentality. So how you prepare your mind is going to be key when you understand your ‘why’ before you warm up. There's no need for me to warm up like a professional athlete if I'm wanting to go and warm up like a superhero. It’s a different mindset as I do that. Does that make sense? Lisa: Yeah, it does make sense. And I mean, like, I'll give you an example out of my sort of, you know, day. So if I'm, like, full on busy with the business all day, and I'm sitting a lot at the computer and meetings, and blah, blah, blah. And then comes five o'clock and I go right, I'm shutting the computer, I'm out the door. And if I go out without any preparation, and we've had arguments with people, they said, ‘Well, I've just slowly increased my pace. Isn't that a warm-up’? No, it's not a warm up. And I'm still guilty of this on occasion when because you're like, you've got half an hour, and you got to get out the door. And you don't want to do a warm-up, and so… But there's a couple of pieces missing out of that puzzle. One, there's a really important reason why you— firstly, you want to shift your mind, you've been in work mode all day. And now you got to, ‘Oh my gosh, I got to go and train’. And the last thing you feel like when you've been sitting for hours in a static position is to go and do a full on workout. So you have to change your mindset because you can fail before you get out the door. And a lot of people have this argument with themselves every single day. It's like, ‘That’s on my list, but I’m knackered from work, and I don't feel like going out the door. And I just want to go home and eat a packet of chips and sit on the couch’. And so there's a couple of tricks that I use to get myself out of that thought process. So the couple of rituals that I do. So when I go and I go, ‘Right, I'm going to get into my training gear, regardless of whether I'm going out the door or not because I'm just going to do that’. And when I just go and do that, I put my training gear on, that is a ritual for me that I am… My body starts to go, ‘Oh, when we're heading for training. We better get ready’. And it gives you enough, a couple of minutes, just to get your mind in that new space. You've been in the work space or the driving space or whatever you've been in, and now you're entering a new phase, and you're bringing yourself into the present moment. You're getting your gear on, and for me, putting my running gear on as always, for me, like putting on my armor, and I'm getting ready for a battle of sorts. It doesn't always have to be a hardcore workout, but I'm getting ready for action. Then the next thing I do once my gear is on, it's like, well, ‘I might as well just do a little bit of a warm-up and see how I go’. Like this is when I'm having those days when I don't want to train, you know, you know those ones. These are the tricks that I do to get myself out the door. So then I start to activate my muscles. And we're going to go through a whole list of things with Neil, right now. But just from a mindset point of view, when I start doing my dynamic stretches and my activation and my thing, and I'm getting my heart rate up. And then by the time I've done that for a few minutes, my mind is ready for the actually going out and then my body is also woken up. So that's just a little bit of a mindset tip to get yourself out the door and bring yourself into the present moment. We also like to incorporate in that some breathing exercises, just, we could talk for hours on breathing. There is so much to learn about breathing. But just to give you just a simple quick exercise that you can do before you go out. So you've just come from work. You're going to do a box breathing exercise, where you're breathing in for four in the inhale, holding it for four, out for four with the exhale — a nice strong exhale — and then holding it for four. And you just do that box rhythm for maybe three, maybe four breaths. And in that time, close your eyes, seem to yourself into your body, start to feel your heart pumping, start to feel how do my arms and my legs feel, and you're just pulling your focus in, and then you'll be ready. Once the time you've opened your eyes, you'll be ready to get underway or get your warm-up sorted. So those are just a couple of little quick mindset tips to help you over that hump, whether it's in the morning and you get out of bed and you're going training or after work or whatever the case may be. Neil: Perfect, Lisa. Let’s go with the breathing just to add in as well, it’s the… often, when you've not just flipping the mindset, you're also flipping things like the diaphragm. A lot of the time, if people have been in a sympathetic state throughout the day, which a lot of us are throughout the day now. Then if we go to, we're breathing through our upper chest and breathing through our shoulders, a lot of people will get massive results, just by them realizing that they can breathe properly into their lungs, and they're actually going out with not having enough energy to run because their breathing patterns, off. So getting that breath going, and as Lisa said, with the nasal breathing is a great thing to add in, a very simple thing to add in as well. As we go through this, this already, we haven't even got to the moving part yet, we've already had quite a long discussion, we want people to realise is we're creating a toolbox for you. That's a toolbox of things that you'll be able to pull out when you need them. Some of you won't need the breathing as much as others, depending on what else has happened in your day already. It's a great thing to do. But some of you may find you've had quite a relaxing afternoon before you go run, and you're already breathing very nicely. So you don't need to use the breathing as much as someone that's been in a stressful situation for the afternoon or is in a very sympathetic state before they head out.  Lisa: Just briefly on the sympathetic and I think I've covered this in a couple of podcasts. But just to recap.. Sorry, took the computer over. You have a parasympathetic and sympathetic nervous system. So you, when you're in a sympathetic state, what we're meaning by that is that you're in a hypervigilant, alert, stressed out state, where you are producing quite a lot of stress hormones. Your cortisol levels might be up. Your adrenaline might be up. And your heart rate might be up, and your breathing, very often, is in the upper third of the chest. And this is telling your body, 'I'm in fight or flight mode. There’s dangerous things happening to me’, even if those dangerous things are just emails and a shitty telephone call from the boss. Yeah, that isn't necessarily a lion or a tiger that, you know, used to be chasing us when we were back in the caveman days. But it's the same response in the body. And so what we’re wanting to do with this breathing exercise is to doing some diaphragmatic breathing, so that's breathing into the belly, and we're going to do sessions on breathing because honestly, that's a couple of bucks worth.  But it's all about flipping it, getting that sympathetic nervous system activated. So you have nerves in the bottom of your lungs. And when you do very good strong exhales are really important in breathing in with the diaphragm, you're actually activating those nerves at the bottom of the lungs and tuning on that parasympathetic state. Now that parasympathetic state is all about rest and digest and recovery and immunity and all those repair processes. Now, we are going into an exercise situation, but to start off in a place of not being stressed is a good place to start. So flipping your mind and flipping your body over from one thing into the next thing. So that's just a very brief touch on sympathetic versus parasympathetic states. Neil: The next piece in the… or the next tool in the toolbox is going to be our rolling or myofascial release. So the tools we use for this are spiky balls, one of our favourites, rolling stick, which like rolling pin and a foam roller. Easy wins and low hanging fruit are always going to be your feet because they spend most of the day wrapped up in a shoe. And generally, our feet don't move as well as they should. Our feet should ideally move like our hands do, and our toes should move like our fingers. For most of us they don't so getting them out, getting them exposed to more neural stimulation and releasing any tight bits in the feet and getting them moving more freely makes a massive difference. You got... Lisa: Can you explain the neural stimulation? I think that's— it’s really why they're activating those fibers in the feet is the connection to the brain and the coordination and… Neil: Connection to the brain. One thing it does, it's like waking your feet up. So if I spent all day with my hand, for example, in a big glove and deprived it of senses and deprived it of being able to feel and touch things, I'd lose connection with what was going on around me. So I start to lose connection with understanding what was hot, what was cold and what things should feel like. If I can have that stimulation through my foot, and the great thing with a spiky ball, we're not going to smash it, is it starts to wake the feet up again. So all I'm saying is, wake up, wake up! I'm sending messages from my feet through my nervous system up to my brain going, ‘Ah, that's how I move my big toe’. Ah, that's the big toe, with running real important. But that's how I move it. And that's how my other toes move. A lot of people find their toes are bunched together and tight. If we can get some movement through those, we start to get more benefit from our running as well. Other people are going to have calves that are locked up and feet that are locked up, everything in your body is connected. So if we start to stimulate the feet, we get massive results with people who've got lower back pain or people who have got shoulder pain or neck pain, because the connection with the fascia in the bottom of your foot, it then runs up the back of your body up across your calf, your hamstrings, your hips, starts to relax a tissue above as well. So simply two things that are going to happen as you do that. One is you're going to get some muscles relax that need to be relaxed. Then the other thing, you can actually start waking the feet up. Okay, depending on where, and it's gonna be very much dependent on where you're at as a person. Some people are carrying loads of tension in their body, and some people are hypermobile. So those that are hypermobile aren’t gonna need these tools as much as those that are rigid and stiff. Yeah, do I make sense? Lisa: Yeah. Neil: You need these tools for what you need. And that's the emphasis we want to make is doing this whole thing when we finish talking about it. And its shortest version would be between five and eight minutes or longer version might be 12 to 15 minutes, but some of you are going to use more tools than others. So some of you, what we've discussed already, may use the breathing more than the rolling. But feet is an easy win, calves are an easy win. Rolling around the hip area, the glutes is a very easy win, the quads and getting those areas both, switching off muscles that needs to be switched off. But also starting to wake up muscles that need to be woken up. And it's easy ways to do that with those tools. Gone are the days of static stretching and standing on the doorstep during your quad stretch, holding. All you're doing there is switching the nervous system off and increasing your likelihood of injury and discomfort. Lisa: So just to explain what static and dynamic is for those who perhaps aren't familiar with that term. So static stretching, where you're holding a single stretch in one position for, I don't know, 30 seconds or something or longer. And that's not a good thing to do prior to a run or exercise because you're actually lengthening that muscle, and you're switching it off and making it too relaxed and then you're going to be able to flop it, for lack of a better description when you go out. And so you want to be waking it up, activating it, getting the blood flowing through it, but not turning it off. The static stretching has its value but that comes after the run or if you're doing, say, a yoga session or something like that, then it's a different thing. But you wouldn't go into a yoga class and then go for a run, for example. That would be a recipe for injury, but you're wanting to activate these different areas. The other thing to note with the foam roller was don't smash the crap out of yourself like, it's not go hard or go home. Cause I used to do that, to be fair, you know, when I first started with foam rolling years ago. It was like, ‘Ah, the more it hurts, the more I have to do it’, and, you know, as with everything, yep, you fight through the pain. But actually, the more we've learned about lymph and all the other stuff that we've learned in activating, you don't need to go full ball hard. If it's that painful, you should be around, what, six and seven, right, Neil, for what you're doing with the foam rolling. And you know, we have lots of videos and stuff on our YouTube channel if anybody wants to check it out, or, of course, joining our club and you'll find out all that sort of detailed information. So that's the activation phase. Your hips, your calves, your feet are a good place to start. Neil: It's a good technique, just simple techniques to work with are released with awareness. So we've already talked about breathing. If you find a sensitive spot, you can apply some pressure to that, getting no more than sort of six or seven out of 10. Use your breath, in through your nose, out through your nose to actually release. Your nervous system, we’ve already talked about and your body is fully connected. So by using my mind to tell my brain and to tell my foot or the muscles in my foot to switch off or switch on, I can have that control over my body. I'm using the spiky ball to stimulate it, which gives me something to feel and then I can say, right, wake up or tone down. So use the breath with awareness or release with awareness by using the breath to actually switch things off. If something feels tight, you can imagine the muscle actually switching off, toning down, almost like it's got a volume button on it and you're turning it down. Okay. The next technique, which is a good one, is a pin and stretch. So if you find a niggly spot, thinking about rolling the calves. I'm sitting on the floor with my calf and leg up on a roller. If I find a niggly spot, then I can actually pin it. And then I can move my foot backwards and forwards. So I'm pinning and then stretching. I'm moving my foot in and out of plantar and dorsiflexion. Okay, and then actually flushing the muscles as well is another great technique. We're rolling up and down and across the muscle and a great way to… almost like imagining like your muscle’s like a sponge, where you're you're wringing it out and then putting it back in a bucket of water so it can absorb again, and wring it out. So you’re flushing out and getting fluid moving backwards and forwards. Lisa: Yep. And so on. Yeah, that's absolutely, that’s key. Neil: Right So next on our list. So now we've breathed, we've worked out where we're at, if we come back from the top, we've worked out more from mindset, breathing, rolling. And now we're going to look at our — the body is all connected — so we're going to look at our fascia. So the body is connected, again, like static stretching — gone are the days where we should be looking at the body in isolation, and looking at warming up or moving specific muscles like our chest on its own, or biceps or triceps on their own, or our thighs on their own. The body is connected from toes to head. So the fact that it’s connected from toes to head, and there is myofascial lines that are running right across our bodies — front, side, back. We want to be in a position that the movements we're doing in our warm-up should help open, lengthen, move. Imagine your fascia like a superhero suit. I love talking about superheroes and the superhero suit. And you can— that superhero suit should move easily; you should be able to move easily in it. So what we're doing with these big fascia movements, is you want to be in a position where you're getting that superhero suit just to fit a little bit better or fit a bit more comfortably. And if you do that, then it fits more comfortably when you start running. You're running more freely, we haven't got any sticky bits. Okay. Lisa: So like, just explain a little bit, you know, in two seconds, it's like the chicken skin is. I know. It's like each of these subjects we could do an hour on that seriously, but the fascia, so we all know we've got ligaments, we've got tendons, we've got muscles, but a lot of people really have a struggle. What the hell is fascia then? And what do you mean it's all over my body? And you get that? Like, you know, that…  Neil: Connects absolutely everything. In two seconds, fascia connects everything. It will connect the tissue, like you described the chicken skin on chicken. It's on the superficial level. It connects muscles, it connects bone, it connects your vital organs. So if there's anything locked up in any of that fascia, it's almost like a, like a web, if you look at it. Lisa: That’s a good analogy. Neil: And have a look at it. And depending on what parts your body you're looking at will depend on how dense that web is. Lisa: Like a spider cobweb’s like. Neil: Exactly, exactly that. You move that to the… To move freely, if I've got something as locked up and my fascia’s sticky, or it's not moving as well as it could, then it could be that I've got a shoulder pain on my left shoulder. And that's actually my right foot. So it’s looking at, and all we're doing with these big fascia movements and looking at myofascial lines, and very simply speaking of the anterior, posterior and downside of the body as well, you’re starting to get that suit to fit more comfortably. We're starting to iron out any of those sticky spots. Now, if you find that as you're moving through some of these movements, that you find that you are stickier in some areas and others, it starts to let you know that you've got some imbalances there. Now on top of that, as part of dynamic movement, you then want to add in some run-specific movements. So if I'm going to run, I'm going to be spending time on a single leg. I want to, at some point in my warm-up, I want to be doing something that ideally is on a single leg and is involving opposite arm and opposite leg, like running will. So the warm-ups and dynamic movements we include as part of our warm-up will include stuff that resembles running, gets blood flow and heart rate up, gets tissue open and ready to move and work and gets me ready for the run. So when I get into the run, I'm not spending the first 2 or 3K trying to iron myself out. Open up my fascia, I'm actually running comfy, my body is now awake; my blood pressure, heart rate, breathing rate and tissue are all up and warmer. And I'm in a position where I can move more freely. Yeah, do I make sense? Lisa: Yep. So without having been able to show you visually here how to do the exercises, what we are working on is giving a little, some sample runner’s warm-ups to do that will show you some of the dynamic movements that we're talking about here to open up and get that fascia going. We haven't got that organised yet, have we, Neil. Hopefully, by the time this comes out, we might have something or coming soon. To give you a bit of an example of the types of things that we're talking about here. So just to recap from the top once again because it sounds like a hell of a lot to do before every single run. But actually, we're talking five to eight minutes. Or if you're doing a really— that's the other thing, if you're doing a super intense workout, you need to warm up longer. Like today I did an interval session, so I spent more time on the rolling and the activating and the getting the heart rate up and doing the drills, which we'll cover in a second. And before I actually went hard, because I don't want an injury. And the harder the training session is, the more I'm going to be engaging all my muscles to sprint, then I need to have everything at operating temperature. If you think about a car on a winter's morning, if you turn the motor off and then jam your foot on the accelerator and tear off, what's going to happen? Your car's not going to be very happy with you because it hasn't been able to warm up, get the blood going or the petrol going or whatever it is in a car, and get it up to warmth, get it up to speed, before you go flat tech if it makes sense. So we've done the mindset, changing your mindset, putting your gear on, getting your head in a good space, tricking yourself into just getting out the blumming door for starters. Then we've covered off some breathing. We've covered off some activation exercises — rolling the feet, rolling the calves, rolling around the hips with the foam rollers and the balls. Then we've gone and looked at some warm-up exercises, which is activating all your fascia or getting your heart rate up and so on. And the last piece of the puzzle — and this should all take you five to eight minutes, 10 minutes if you're doing a hard session — the last part of the puzzle, Neil, what's it? Neil: It’s the drills. So we do some run-specific drills that are same with the dynamic movement. And this becomes part of the dynamic movements, there's quite a lot of crossover here anyways. It's part of that movement. So things like we were talking about — opposite arm, opposite leg movement. So things like, some of our favourite ones are simple things like ball of foot hops, which is like a skipping movement, where we're just bouncing, landing on the ball of the foot with the heel kissing the floor. So warming the body up, starting to get the elasticity and the muscle doing the job it should and getting ourselves ready to roll. We use some other run-specific movements like forward land, which is simple opposite arm, opposite leg movement, where we're starting to really work on the pull of the leg and the action of running. And then another good one that we get some great results with is our carioca, which is a crisscross of the legs. And you can do carioca and have a look, and you'll see that all, we've got videos of these drills, if anyone wants them. Lisa: Yeah, email us. Neil: Please let us know. And the whole idea of these is that, again, everything — hips are open, heart rate’s up, blood pressure's up, we're ready to move. And we've done some movements that are run-specific, so when we go run, we're actually ready to run. So to break it down and give you an example of what my normal warm-up would look like — I'll always run my feet. Okay, I will always go through my breathing, sort of goes from my breathing start and then go through and roll my feet, and I roll my calves, and I roll across the top of my hips and up either side of my back. So they’re my go-tos. From there, I will do three usually big fascia movements, one for the front of the body, one for the solid body, one for the back of the body. And then I go through two or three drills. I’ll go and run. On a recovery run that will take me about five minutes. Okay, on a higher intensity run, as Lisa was saying before, on interval run, that might take me sort of 12 to 15 minutes. But it's you… You take which bits of the tools you want out of the toolbox, and then you start using them from your perspective. The other bit to throw in, just throw the mix, finally, is just looking as well, I'm a big fan of using music. We've talked about this quite a lot before as well as. So music helps me have a cadence. So if I'm doing an interval run, I find music really helps me with cadence to help me keep my cadence up. I'm doing a recovery run, then I don't enjoy using music as much because I'd rather you know, hang out and make it more of a meditative state and chill out from there. So thinking as well about what's in your playlist. Does music motivate you and help add to the mindset? Or does silence help add to the mindset? Working out what you need for each run and should it be part of that session; I use music often in my warm-up. And the music I choose for recovery run is significantly different than one I use when I'm warming up for an interval run. One's going to be really lifting me intensit-wise and mindset wise, the other is going to be letting me know that this is going to be cruising, it's going to be laid back, it's going to be about recovery. Using music as well can make quite a significant difference. Lisa: Because it's… Sorry. It's all about the mind part of the puzzle really. You know, you put, I don't know, Thunderstruck on when you're trying to do an interval session. And you're like, yeah! And you going for it, and the cadence helps you and so on. And that's using your body to activate those that, again, in that case, you're activating some adrenaline and getting that going, which you need for that session. And then you know, you want to calmer ones with you if you're just doing a recovery where you don't want to be smashing yourself and you just want to be cruising, then you want a more cruising music. But just on that note, though, just be aware, if you're in traffic, you know, it can be really dangerous. And I've been hit by a car because I had bloody things in my ears, and I was unaware of the traffic around me. So just being a little bit cautious if you are out running on roads and crossing streets, especially when you come to intersections, and you can’t hear that car coming around the corner. Neil: Pick what you're doing and where you're doing it. Lisa: Be aware, be aware of your environment. Neil: Looking, then you should have that toolbox in place now. Looking at what you're currently doing, who you are and how much of a warm-up — what percentage you use each tool for will be quite different for each person. So as we said at the start, some people will need to spend more time breathing. Some people will need to spend more time rolling. Others might need to spend more time with the dynamic warm-up. You'll all do a little bit of each but it's going to be, the percentage will be different. And when you use each tool, it’s going to depend on what you're doing and what's on your program. Lisa: And one other point here is that you will have — and I promise you this — a much more fun run, and you'll enjoy it more if you've put the time into this warm-up piece of the puzzle. Because I know a lot of us are under time pressure and stress. And we've got like, ‘I've got 30 minutes, I've got to get my running today. That's all I've got, I don't want to spend 10 minutes warming up’. Okay, negotiate with yourself and try to do at least five minutes, because it's better to get that five minutes because that other 25 is going to bring you more than that extra five minutes of running, if that makes sense. Because you— if you talk to runners, most people and if you're a beginner, you might not be aware of this, but the first 20 to 25 minutes are absolute crap for everybody all the time. You know, it's very rare, where you just run out the door, if you haven't warmed up, that you'll be enjoying yourself and your body will be stiff, it'll be sore, it'll be not activated, you won't have a good posture, you'll feel like your heart and your cardiovascular system isn't woken up. All of that can be avoided if you do all of this in the preparation. It's like laying the foundation of a house. If you do it on quicksand, you're not going to have a very stable house. If you do it on concrete and you put your foundations and your poles in properly, you're gonna have a house that stands for a long time. You're going to enjoy your run a lot more. You know, today's session was was a classic example of that, you know, interval session full on, hardcore, big good workout, warm-up prior and the session wasn't nearly so difficult than if I just jumped out the door and done it. So don't underestimate that. Neil: Good polling, Lis. I liked it. Lisa: Don't underestimate a good warm-up. So people, if you've enjoyed this content, please share this with your friends and family. Share it, get it out there, get it out in the world, we really appreciate you doing that. And if you, you know, want to come and join us at Running Hot Coaching, this is what we do. And what we love is to help people with their running journeys and inform people. And as you can see, we take a very holistic approach to our running into our health programs and to all of the programs that we do. Because we look at people as whole people and not as runners or not  as ‘You've got a health issue or specific health issue’. We look at the whole person the whole time so that you can actually get the best performance because there's no optimal performance without optimal health. That's probably a good place to leave it, actually. Neil: I like it. Lisa: Well, thanks for joining us today. Thanks, Neil, for your wisdom as always — epic. Really appreciate you, right. And we'll see you again next week. Thanks, guys! That's it this week for Pushing The Limits. Be sure to rate, review and share with your friends. And head over and visit Lisa and her team at lisatamati.com. The information contained in this show is not medical advice it is for educational purposes only and the opinions of guests are not the views of the show. Please seed your own medical advice from a registered medical professional.

Sepsis is a massive health issue worldwide. According to WHO, nearly 50 million people get sepsis every year, killing 11 million. Here in New Zealand, one in five ICU patients dies because of it. Thus, raising awareness about the role of vitamin C in sepsis can help save lives. Dr Anitra Carr joins us in this episode to expand our understanding of the role of vitamin C in our body. She also explains how vitamin C functions not only as an antioxidant but also as a cofactor in many different mechanisms, particularly in fighting cancer and sepsis. Everything we share in this episode will be helpful for you should you find yourself or a loved one admitted to a hospital, so tune in.   Get Customised Guidance for Your Genetic Make-Up For our epigenetics health program all about optimising your fitness, lifestyle, nutrition and mind performance to your particular genes, go to  https://www.lisatamati.com/page/epigenetics-and-health-coaching/. You can also join their free live webinar on epigenetics.   Online Coaching for Runners Go to www.runninghotcoaching.com for our online run training coaching.   Consult with Me If you would like to work with me one to one on anything from your mindset, to head injuries,  to biohacking your health, to optimal performance or executive coaching, please book a consultation here: https://shop.lisatamati.com/collections/consultations.   Order My Books My latest book Relentless chronicles the inspiring journey about how my mother and I defied the odds after an aneurysm left my mum Isobel with massive brain damage at age 74. The medical professionals told me there was absolutely no hope of any quality of life again, but I used every mindset tool, years of research and incredible tenacity to prove them wrong and bring my mother back to full health within 3 years. Get your copy here: http://relentlessbook.lisatamati.com/ For my other two best-selling books Running Hot and Running to Extremes chronicling my ultrarunning adventures and expeditions all around the world, go to https://shop.lisatamati.com/collections/books.   My Jewellery Collection For my gorgeous and inspiring sports jewellery collection ‘Fierce’, go to https://shop.lisatamati.com/collections/lisa-tamati-bespoke-jewellery-collection.   Here are three reasons why you should listen to the full episode: Learn more about vitamin C’s antioxidant properties. Discover how vitamin C helps patients with pneumonia and sepsis. Learn about vitamin C’s role as a cofactor and how it ensures the proper functioning of different body processes.   Resources Read more about Dr Carr's study on vitamin C levels in patients with pneumonia. Access Dr Carr's review on recommended doses of vitamin C. Health and Immune Function Benefits of Kiwifruit-derived Vitamin C by Dr Anitra Carr Read more about Dr Carr's ongoing clinical trial on vitamin C and its effect on COVID-19 patients. Learn more about Dr Paul Marik's protocol for sepsis using vitamin C and steroids. Learn more about Dr Fowler's Phase 1 safety trial of IV vitamin C in patients with severe sepsis. Watch Professor Margreet Vissers' lecture on her work on vitamin C.   Episode Highlights [04:40] How Dr Carr’s Research on Vitamin C Started Dr Carr’s research began in 1998, where she studied how reactive oxygen species (ROS) produced by white blood cells react with our tissues. White blood cells produce ROS to help kill bacteria. However, they can also react with the tissues and create inflammation. Dr Carr then began investigating how vitamin C’s antioxidant properties help decrease inflammation. She also studied the benefits of vitamin C in preventing atherosclerotic plaques and the development of cardiovascular diseases (CVD). [09:42] Vitamin C as an Antioxidant Vitamin C has real antioxidant properties. Metal ions produce oxidants in the body; vitamin C donates electrons to these ions, converting them to the reduced state. The recommended daily dose to benefit from the antioxidant potential of vitamin C is 60 to 90 milligrammes in men and 75 milligrammes in women. You need a higher dose (120 milligrammes) of the vitamin to protect yourself from CVD and cancer. [17:57] Vitamin C in Food vs. Vitamin C Tablet Dr Carr conducted a comparative dosing study between kiwi fruit and vitamin C tablets. She found no difference in the vitamin C obtained from food and tablets. The body recognises the same molecule and takes up the same amount. [21:36] Vitamin C in Sepsis and Pneumonia Patients with pneumonia can develop sepsis, resulting in multi-organ failure, septic shock and, eventually, death. In observational studies in patients with pneumonia, Dr Carr found that the lower the vitamin C levels, the higher the oxidative stress. The body's requirement for vitamin C goes up by at least 30-fold when you get pneumonia and sepsis; it is hard to get those amounts orally. ICU patients need a vitamin C dose of 100 milligrammes per day. In these patients, the actual levels of vitamin C measured in the blood is lower compared to the amount they are receiving. [25:25] Why Is Vitamin C Testing Not a Protocol in Hospitals? Doctors are not familiar with the importance, recent research and mode of action of vitamin C because it is not taught in medical schools. The hospital system is not set up to routinely measure vitamin C. In trials, vitamin C is treated as a drug rather than a vitamin. We need to know how vitamin C works to create proper and adequate study designs. [32:27] What Are Some of the Future Vitamin C Studies We Can Conduct? We need studies about the frequency, dosing and timing of its administration.  We need to learn about the finer details of the vitamin rather than doing the same study designs. It is tough to obtain research funding due to the misinformation surrounding vitamin C. We also need to educate doctors and patients alike about the science behind vitamin C. [43:16] Vitamin C as a Cofactor Our cells rely on enzymes to carry out chemical reactions. A cofactor helps enzyme function. Vitamin C functions as a cofactor for the enzyme that synthesises noradrenaline and vasopressin. These hormones help in blood pressure regulation. It’s better to give ICU patients vitamin C than giving them vasopressin drugs. This allows the body to naturally produce the hormone, preventing the side effects of getting vasopressin externally. Vitamin C is also a cofactor of collagen, which plays a role in stopping cancer metastasis and wound healing. [54:30] Vitamin C in Epigenetics The expression of DNA may be regulated by adding or removing methyl groups. Vitamin C is a cofactor for enzymes that modify DNA methylation. It controls the switching on and off of genes, playing a possible role in personalised medicine.   7 Powerful Quotes from This Episode ‘I’m much more interested in the whole person and how they're feeling, not what's happening inside a single cell’. ‘Don't wait until they're at death's door and at septic shock. It's hard for a vitamin to do something at this stage, even a really high-dose vitamin’. ‘A lot of these studies were designed to reproduce the first studies that came out to see if they could reproduce it also. That's why they’re using similar regimes. But now that we know more about it, each study adds another piece to the puzzle’. ‘There’s bigger issues at play with the whole pharmacological model that our whole system is built upon, and that nutrients and nutrition isn't taught in medical school. So, we're up against this big sort of brick wall’. ‘People go into a hospital setting or something, and they expect to have the latest and greatest information available, that the doctors know all that. And unfortunately, that's not always the case’. ‘Every person's life that is saved is a family that's not grieving’. ‘It’s the reason I’m doing this podcast, and it's the reason you're doing your research. And hopefully together and with many others, we can move the story along so that people get helped’.   About Dr Anitra Dr Anitra Carr holds a PhD in Clinical Biochemistry/Pathology. She started researching vitamin C when she undertook a postdoctoral research position at the Linus Pauling Institute, Oregon State University, USA, and was also awarded an American Heart Association Postdoctoral Fellowship. Dr Carr produced a number of high-impact publications in the field of vitamin C in human health and disease. Dr Carr is currently a Research Associate Professor at the University of Otago, Christchurch, School of Medicine. She has established her own research group, the Nutrition in Medicine Research Group, and undertakes translational bench-to-bedside research comprising observational studies and clinical trials on the role of oral and intravenous vitamin C in infection, cancer, metabolic health, mood and cognitive health. Dr Carr endeavours to understand the underlying biochemical mechanisms of action as well as improve patient outcomes and quality of life. She also pursues various ways to improve clinician and general public understanding of the roles of vitamin C in human health and disease. You may contact Dr Carr through anitra.carr@otago.ac.nz or call +64 3 364 0649.   Enjoyed This Podcast?  If you did, be sure to subscribe and share it with your friends! Post a review and share it! If you enjoyed tuning in, then leave us a review. You can also share this with your family and friends so they can learn more about the benefits of vitamin C in sepsis and pneumonia. Have any questions? You can contact me through email (support@lisatamati.com) or find me on Facebook, Twitter, Instagram and YouTube. For more episode updates, visit my website. You may also tune in on Apple Podcasts. To pushing the limits, Lisa   Full Transcript Welcome to Pushing the Limits, the show that helps you reach your full potential with your host Lisa Tamati, brought to you by lisatamati.com.  Lisa Tamati: Welcome back to the show! This week, I have another fantastic interview with another amazing scientist. But before we get there, I just want to remind you please give a rating and review to the show if you're enjoying the content and share it with your family and friends. I really appreciate that. And if you haven't already grabbed a copy of my book Relentless, make sure you do, you won't regret it. It's an incredible story that is really about taking control of your own health and being responsible for your own health and thinking outside the box. And it's the story of bringing my mum back to health after a mess of aneurysm. And it will really make you think about those—the way our medical system works and about why you need to be proactive when it comes to health and prevention, preventative health. And it's really just a heart-warming story as well. So, you can grab that on my website at lisatamati.com. Or you can go to any bookshop in New Zealand and order that or get that and it's available also on audiobook for those people who love to listen to books rather than reading them, I know, I certainly do a lot of that.  And just to also remind that if you have any questions around some of the topics that we've discussed on the podcast episodes, please reach out to me lisa@lisatamati.com. And if you want help with one of your health journeys or your performance journeys, or you want to work on some goal setting, on some mindset, please reach out there as well. We'd love to work with you. So today I have the Dr Anitra Carr, who is a scientist at Otago University. She's currently a research associate professor at the University of Otago, Christchurch School of Medicine. She's established her own research group, the Nutrition in Medicine Research Group and undertakes translational bench to bedside research comprising observational studies and clinical trials on the role of oral and intravenous vitamin C in infection, cancer, metabolic health, mood, cognitive health. And she endeavours to understand the underlying biochemical mechanisms of action as well as improve our patient outcomes. So, she's a person who loves to actually not just be in the lab and looking at petri dishes, but to actually help people in human intervention study. She currently has a study underway, which I'm really, really excited and waiting with bated breath to see what comes out. It’s a sepsis study, in the Christchurch hospital with 40 patients. And we talk a little bit about that today.  And we talk about the role of vitamin C  today. Continuing the conversations that we've had with some of the world's best vitamin C researchers. We're looking at the antioxidant properties, we're looking at the pro-oxidant properties, we're looking at vitamin C as a cofactor in so many different mechanisms in the body. We talking about its role in the production of adrenaline and vasopressin, in hypoxia inducible factors, in relation to cancer, and especially in relation to sepsis, which is obviously a very important one for me.  One in five ICU patients in New Zealand dies of sepsis. This is a massive problem. Worldwide, between 30 and 50 million people a year get sepsis. This is something that you really need to know about. You need to understand it and Dr Anitra Carr, also shares why you may not get a doctor in a hospital situation, actually understanding all the information that we're going to be sharing with you today. So, educate yourself, learn from this and enjoy the show with Dr Anitra Carr. Lisa: Well, hi, everybody. And welcome back to the show. Today I have Dr Anitra Carr, and today we're continuing the series around vitamin C. We've had some brilliant doctors and scientists on in the last few weeks and it's been really exciting to share some of the latest research and we have one of our own Kiwi scientists with us today, Dr Anitra Carr from Christchurch. Welcome to the show. Dr Anitra Carr: Hi, Lisa! Lisa: It's fantastic to have you. So, Dr Anitra, can you just tell us a little bit of your background and how you got involved with vitamin C research? Dr Anitra: Well, I first started researching back in the late 90s. So, 1998 and I had just finished a PhD with the University of Otago and I had been studying how reactive oxygen species that are produced by white blood cells react with our own tissues, damage their own tissues because these white blood cells produce these really reactive oxidants, such as hydrogen peroxide, which is hair bleach, and hypochlorous acid, which is household bleach. So very strong oxidants and they produce these to help kill bacteria in our bodies. But these oxidants can also react with their own tissues and that's what contributes to inflammation and the processes of inflammation. And so, I've just been studying how these oxidants react to certain components in our tissues. And when I finished that, I thought it’d be really interesting to investigate how antioxidants, such as vitamin C, which is one of the most potent antioxidants in our body, and help potentially protect against this damage. So, scavenge those oxidants before they react with our tissues, and help decrease the inflammation associated with them and features and conditions. And so, I applied to various people in the United States, I wanted to go to continue my research in the United States. And so I applied to several people over there who are doing research in the area that I was interested in, and they'll write back and say, ‘Yes, we have postdoctoral positions available.’ And so I selected one, on the advice of my PhD supervisor, and this was Professor Balz Frei. He was at the time in Boston. And after I said, ‘Yes, I'd like to work with him.’ He wrote back and said, ‘Oh, by the way, I'm moving to the west coast to Oregon. And I'm going to be the director, the new director of the Linus Pauling Institute.’  Lisa: Oh, wow.  Dr Anitra: Great opportunity it is. I like the West Coast of the United States. I've done a bit of work in California during my PhD. And so, I was quite happy with it. And so Linus Pauling had died just a few years prior to that. And so, the Linus Pauling Institute, which was in California, at the time, kind of needed a new home, I think they're in Palo Alto. And so they ended up going to Oregon State University because that was—for a couple of reasons—that was Linus Pauling alma mater. So, he had done his undergraduate research when he was in a cultural college. And also, because the library there was going to be able to host his papers. And so he has this collection of his writings and papers, thousands and thousands of documents, because as you've stated before, he's one of the only people to have been awarded two unshared Nobel prizes. So one was in chemistry around his work on the nature of the chemical bond. And the other one was a Peace Prize for his anti-nuclear campaign. And so the Oregon State University Library has his complete collection, it's called the Linus Pauling Special Collection. And so I spent a few years at Oregon State University researching how vitamin C can protect against oxidation of low density lipoprotein particles, which are what the body uses to export fat and cholesterol around the body, because the cells need cholesterol. But most people know low density lipoprotein protein as bad cholesterol. I mean, it's not intrinsically bad. But if it becomes oxidized, it can contribute to the development of atherosclerotic plaques and contribute to cardiovascular disease. And so I was looking at how vitamin C can protect against oxidation of this particle, and thereby potentially peak against development of atherosclerosis. And I was... Lisa: What was the outcome of it? That would be really interesting. Dr Anitra: Yes. So, I was particularly interested in the oxidants produced by white blood cells, because these can react with these low density lipoprotein particles and oxidized them. And vitamin C is a great scavenger in particular, and I was interested in how much do you need and how the particulars—is the real biochemical level? And, but also during this time, so late 1990s. We were interested—Professor Balz Frei was interested in the recommended dietary intakes for vitamin C. Because in a lot of countries they are very low—these recommendations, primarily to prevent deficiency diseases, such as scurvy. Whereas, we believe you know, that the recommendations should be high to help reduce the risk of chronic diseases such as cardiovascular disease and cancer and that sort of thing. That's a bit helpful to the outcome. So, in the late 90s, in 1998, the Food and Nutrition board of the Institutes of Medicine was re-examining the recommended dietary intake for the antioxidant vitamins, the A, C, and E in the United States.  And we write a comprehensive review around all the scientific evidence at the time for what sort of doses of vitamin C appear to protect against cardiovascular disease and cancer. And so, we made a recommendation of 120 milligrams a day, which was, at that time twice what the recommended dietary intake in the States, it was 60 milligrams a day at the time. And so we submitted that document, and it was considered by the Food and Nutrition Board. And also another review, I'd written around vitamin C's antioxidant roles in the body versus its pro-oxidant roles. Vitamin C, referred to as pro-oxidant.  Lisa: Yes, I’ve heard that. To get hit around the antioxidant and as a pro-oxidant.  Dr Anitra: Vitamin C is an antioxidant. It's not a not oxidant, pro-oxidant. But what it does is it can reduce—so antioxidants donate electrons, and they reduce oxidized compounds. So, it reduces transition metal ions such as copper and iron. So, these are metals in our body that can read off cycles so they can produce oxidants. Lisa: Yes, and we've talked about redox before in the podcast. Dr Anitra: Yes, so what vitamin C does is it converts these metal ions into a reduced state and metal ions can go on and generate oxidants. Lisa: So it gives ion and copper a longer life, does it? It sort of gives them—ion and copper away to keep going? Dr Anitra: Regenerates them so that these metal ions can keep producing oxidants. But in our body, these metal ions are all sequestered away and protected by proteins, they're not floating around free. In the body, vitamin C doesn't seem to do that, based on the evidence, it seems to just have it’s true antioxidant roles, not this kind of prooxidant by-product, as you might call it. So, this sort of evidence was considered by the Food and Nutrition Board and they decided, ‘Yes, it does have an antioxidant role in the body.’ And, and so they also referred to Mark Levine's seminal work to kind of work out a dose, a daily dose of vitamin C, they thought would be good to help foster this antioxidant potential on the body—potentially protect against these other chronic long-term diseases such as cardiovascular disease and cancer. And so they did end up increasing the RDA for vitamin C instead from 50 to 90 milligrams a day for men, and 75 milligrams a day for women. So that was good, not quite as high as we would have liked to see, but still a step in the right direction. Lisa: A very conservative, aren’t they? They are slow to respond and conservative? Because you think like being the preventative space would be a good thing, if we're trying to... Dr Anitra: It is. Prevention is a lot cheaper, a lot easier to prevent a disease. Lisa: Exactly. But I think New Zealand's even worse, isn't it? I think we're at 45 milligrams, which is I think it is. Dr Anitra: One of the lowest in the world, yes. Lisa: That’s got to change, sorry.  Dr Anitra: So we're trying to generate the evidence to help support them increase in RDA. Lisa: Gosh, so it's also slow, like you've been doing this for what? 20-like years. And still... Dr Anitra: They do say that translation of science into medical research into clinical practice takes 15 to 20 years. Lisa: Wow, that is a really interesting statement. Because this is why I think, like sharing the sort of information direct from the experts, if you like, and I sit this was Professor Margreet Vissers too, that we have to make sort of educated decisions as people in trouble now. Whether you've got cancer or whether like my case who have a dad who had sepsis, you have to make an educated decision now based on you're running out of time. And we're waiting for the research and the research will be great, but it will be another 10 to 20 years down the line before it actually… And then in the medical world, it seems to be a very slow—Doctor Fowler said that beautifully when I had him on last week. It's like trying to shift a supertanker, Critical Care he was referring to is very, very slowly coming around. And I had Dr Ron Hunninghake on as well from the Riordan Institute, another fantastic doctor, and he talked about Medical Mavericks. Dr Hugh Riordan had written three books on people who were really ahead of their time, got in trouble for it and then actually the research and everything caught up with them later.  So that's interesting. So, if you’re listening to this, New Zealand has got 45 milligrams as the RDA, that's just to keep you out of scurvy. Right?  So, okay, so you've done all this antioxidant research and this with RSS and at the Linus Pauling Institute, when did you start to develop an interest in the infectious diseases, sepsis side of that, because I'd really love to... Dr Anitra: Yes, that's, that's more recent.  So, after a few years—three years at the Institute, I decided to have our first child and move back to New Zealand. And I made the decision to quit science and just focus on bringing up our family, ended up having three children. Stayed home for nine years looking out after our children. And I made the decision that they were more important than my career  Lisa: Wonderful. That's an interesting fact, as well as a mom and a scientist, like, an incredibly dedicated career that you'd have spent years getting there and then trying to juggle mum roles with scientist roles, and taking nine years out of your career. Has that hurt your career massively? Or I would have catch up so to speak? Dr Anitra: It hasn't hurt my career. I mean, I'm 10 years behind my contemporaries, my colleagues because I took that time out. But that's the decision I made. And I stand by it because the first three years of a child's life are very important. So I thought I'll dedicate myself to the children in the early years. And after those nine years, right? I've done my time and really can’t get back to work. Lisa: Mum's going to be a working mum from now on.  Dr Anitra: But I just went back to work part time, so, within school hours, so that I'll still be there for them after school hours. And one of the things that drew me back to work—I was recruited back to run a human intervention study. What really excited me because when I was in the lab doing lead-based research, I always felt too removed from the need to be helping. And so I’m much more interested in the whole person and how they're feeling, not what's happening inside a single cell.  Lisa: Yes. Yes, it makes sense.  Dr Anitra: I was really excited and really grateful to be recruited back, especially after taking nine years out for my... Discoveries have been made during that time that I had no idea until I went back and I've got a bit of catching up to do. And... Lisa: So what was that first intervention study, that human...  Dr Anitra: This was a kiwi fruit study. So kiwi fruit is very high in vitamin C. In summary, we're interested in how many kiwi fruit do you need to eat to get adequate and optimal vitamin C level. So it's just kind of a dosing study?  Lisa: Brilliant. Dr Anitra: Then we went on to compare kiwi fruit with tablets. So, animal research had shown our food sources of Vitamin C seemed to be a bit better than tablet sources. And so we would—we thought we'd translate that into a human study. And what we found is there's no difference  Lisa: There's no difference. Uptake of vitamin C from food versus tablets, the body is really good at it. Because we need vitamin C, our body has adapted ways to...   Lisa: Take it wherever it gets it. Dr Anitra: Take it up, regardless of the source. Lisa: Wow, that's... Dr Anitra: The structure of vitamin C's the same in foods as it is in tablets. So the body recognizes it the same, takes up the same amounts. I mean, the benefit of food is that you're also getting all the other vitamins and minerals and fibre. So, we still recommend food. But it is in our daily diets these days, it's very hard to get 200 milligrams a day of vitamin C. Lisa: Just fruits and veggies. Yes. Dr Anitra: That’s just fruit and vegetables. And as you know, different fruits and vegetables have quite different amounts of vitamin C, which a lot of people aren't aware of. Lisa: No. No. Dr Anitra: I mean, people know that kiwi fruit and citrus are high, but they may not realize that apples and bananas are actually quite low in vitamin C. Lisa: Or capsicums are quite high… You wouldn’t think that broccoli… And if you decide to take a supplement, is there a bit of supplement? Like, I have heard concerns about corn-derived vitamin C because of the glyphosate discussion, and that’s a bit hard to track really, the types of vitamin C. But is there any sort of research around—I mean, I've talked previously with a couple of doctors and scientists around liposomal delivery. Have you seen anything in that department or any supplementation method that's better? Dr Anitra: Not convincingly better. I mean, there might be trials that show that’s slightly better than just your normal chewable vitamin C. But I just go for the standard, cheap vitamin. Lisa: Yes, doesn't have to be super special. Like it's a pretty simple molecule, isn't it? Like, the body is pretty, like you say, it needs it, it knows it. Dr Anitra: Liposomal vitamin C kind of wrapped up in lipids, and the body doesn't need it because like you said it’s designed to recognize vitamin C in its natural form, in foods and such like. Lisa: Yes—who was that? I think Dr Thomas Levy was saying it bypasses some of the digestive issues because with vitamin C, you can get digestive stress when you take a bigger... Dr Anitra: When you take a higher dose. Some people, we're talking about more than four grams a day, and some people can get stress, it does but you can use that. Lisa: Okay. So then you've moved into—and forgive me for jumping here—but very keen to talk about the role of sepsis and pneumonia and patients in ICU reasons   Dr Anitra: So, after about five years of doing that research part time, I managed to get at Health Research Council, such as speakers Health Research Fellowship, which allowed me to move into the more clinical arena of studying infection, which was an area I was interested in. And done some observational studies where we have recruited patients who have pneumonia, measured the vitamin C levels, and levels of oxidative stress. And found that they have very low levels of vitamin C and high levels of oxidative stress. And the more severe the condition, the worse it is, the lower the vitamin C levels, and the higher the oxidative stress. So, if those patients with pneumonia are going to develop sepsis, and sepsis is kind of this uncontrolled inflammatory response to a severe infection. And that can develop into multi organ failure and the patient’s taken to the intensive care unit. And it can go on further to develop into septic shock due to failure of the cardiovascular system. And up to half those patients die, it’s the major cause of death in critically ill patients.  Lisa: Yes. And that's what I unfortunately experienced with my dad. And so, with the organs are starting to break down. So, when you get anything like pneumonia or sepsis, the body's requirement just goes up, a hundred-fold or more. Dr Anitra: Yes, at least 30-fold. Yes. So, it's very hard to get those amounts into a patient orally. And so, when the patients are in the intensive care unit, they're generally sedated because they're being mechanically ventilated. And so, they're given nutrition in two different ways because they can't eat. And so, the main way is to drip feed it directly into the stomach, liquid nutrition in the stomach through nasal gastric tube. The other way is to inject it directly into the bloodstream. And so, the recommended amounts of vitamin C by these means is about 100 milligrams a day. Lisa: That’s nothing.  Dr Anitra: But what we did on one of our studies was we looked at how much vitamin C these patients should theoretically have in their blood based on how much vitamin C they're consuming. Because 100 milligrams a day in a healthy person is more than adequate to—provides adequate plasma, what we would consider adequate plasma levels. And so, we mapped out what it would look like in these patients based on how much they were getting. And then we compared it with what we actually measured in their blood, it’s way lower than what theoretically should have been. And so, this, this was an indication that you still need a lot more vitamin C than they're getting in the standard liquid nutrition. And that the body also has these much higher requirements, which has been shown previously by other researchers. Lisa: And so this leading to almost a scurvy-like situation. I mean, some of these severe sepsis people—I mean, seeing one of your [unintelligible 24:53] that sort of normal community cohort of people, young people, middle aged people, and then down into the more severe pneumonia and then sepsis, and severe sepsis. And they are just over the scurvy level. So basically, their bodies are falling apart because of that, as well as the sepsis if you like. and it's... Dr Anitra: And that’s even on top of being given a day of at least 100 milligrams a day, that's still really low. Lisa: That's just not touching the sides.  Dr Anitra: Yes and...  Lisa: Why is this not like—for people going into the hospital, why is it that even though—okay, we may not know the dosages, why is not every hospital testing at least the really sick patients, what their vitamin C levels are, and then treating it the nutrient deficiency only? Even apart from the high dose intravenous stuff, but just actually—with my dad, I was unable to get a vitamin C test done to prove my case. I couldn't prove my case because I couldn't get it tested.  Dr Anitra: Yes, no, it's so true. It's because doctors don't learn about nutrients in medical school, it’s not part of their training.  Lisa: At all, yes.  Dr Anitra: So they're not familiar with how important they are for the body. They're not familiar with all the recent research around all the different functions and mechanisms of action that vitamin C carries out. Over the last 10 years, all these brand-new mechanisms and functions have been discovered, and they think we know everything there is to know about it.  Lisa: Yes, and we don't. Dr Anitra: [unintelligible 26:34] the time. It’s basically exciting. Lisa: Yes, it is.  Dr Anitra: So basically, they don't understand. The hospital system isn't set up to routinely measure it. It is only ever measured if scurvy—if someone comes in with suspected scurvy. And even then, a lot of doctors aren't used to recognizing the symptoms of scurvy. It's not something they're familiar with because it doesn’t... Lisa: They think it no longer exists because it’s what sailors had in the 1800s. Dr Anitra: ...the parents and the wisdom.  Lisa: It’s basically in the sick population. Dr Anitra: It is. But I think... So when I first applied for funding to carry out these studies, in pneumonia and sepsis, there were only a couple of papers have been published at that time looking at vitamin C sepsis, and that was Berry Fowler's safety dosing study.  Lisa: That is phase one trial.  Dr Anitra: And another one, small one in Iran. So, there was very, very little information out there at the time. And so, I put in an application for us to carry out an intervention study in our ICU at Christchurch. So just a small one, 40 people—20 placebo control of vitamin C and 20 getting intravenous vitamin C.  And not long after that, Paul Marik's study came out and that stimulated real explosion and research in this field because of the media interest. So the media picked up on it. And it hit the world. I've been talking about this for years to doctors. I see doctors and they're trying to get to talk about it. But it wasn't until it hit the media, and they heard about it through the media, they thought, ‘Okay, maybe there's something here.’ So that just goes to show how important media can be. Lisa: Exactly why we're doing the show. I have not seen it. But you know what I mean? We've got to get this from the ground up moving.  Dr Anitra: Yes. And so since then, there's been many studies carried out around the world, all of different quality. And so we're learning more and more information, real-time clinical trials, they take a long time to run. Recruitment being the most difficult part.  The other thing is that, a lot of the clinical trials, the clinical researches are used to running drug trials and so they treat vitamin C like a drug, but it's not a drug. It's a nutrient, it’s a vitamin, that the body is specially designed to take up and use very different from drugs. And so they don't always understand how vitamin C works in the body. And it's important to know how it's working in order to design good studies, good quality studies. So a lot of the data that's come out may be impacted by how well the study was done and thought out. So we still don't know all the important essays about the dose, how often should you give it, when should you give it?  I mean, ideally it should be given you know, as early as possible.  Lisa: Early as possible.  Dr Anitra: Don't wait until they're at death's door and septic shock. It's hard for vitamin C to do something at that stage even really high, even a really high dose vitamin. The earlier that you give it, the longer you can get it for digest.  Most of these trials have given it for four days and they stop.  Lisa: Yes, I've wondered that.  Dr Anitra: The whole time, they're in the ICU because once pharmacokinetic study showed that when you stop that vitamin C, some of those patients just drop straight back down to where they were. Now they need to keep that continued input.  Lisa: So why? Why has it been made that it's only—all of those I've seen, I think have been 4-day, 96 hour studies. And occasionally one of them is or for the latest day in ICU, but most of them have been 96 hours and most of them have been very, very conservative dosing. From what I understand conservative dosing. And I know Dr Berry Fowler said where there's some consideration about oxalate in kidney function. And I'm like, ‘Yes, but this is still a very low risk for somebody who's got sepsis.’ Dr Anitra:  If a patient has kidney dysfunction in ICU they put them on haemodialysis anyway, so which clears that excess vitamin C. So it's not such an issue for those patients. But yes, a lot of these studies were designed to reproduce the first studies that came out to see if they are reproducible. so, that's why they’re using similar regimes. But now that we know more about it, each study adds another piece to the puzzle. And so hopefully, future studies will look more into what dose we actually need and it only varies depending on the... Lisa: The severity  Dr Anitra: Severity, etc. How long? And I believe, once they leave the ICU... So patients who survived sepsis, they can go on to have real problems, physical disabilities, cognitive issues, psychological issues, like depression, anxiety. And so, I really believe they keep taking vitamin C when they leave the hospital just orally, that might help with those conditions that hasn't been researched yet. That's a whole area of research that should be carried out to. Lisa: So, if I was to ask you, in your dream world where your resources are unlimited, and you had lots of money, and you had lots of people to help you do all these and you have enough patience to enrol. What are some other things that you would like as a scientist and you understand some of the mechanisms and the cofactors—which I want to get on to as well—what are some of the studies that you would like to see happen? So, we can move this along faster.  What are some of the key things?  So, quality of life afterwards? Yes, like dosages, what?  Dr Anitra: Really practical things that the doctors need to know, I think, what's important, like, how much to give, how often to give it? Most of the studies are done four times a day because that's what was done in the initial studies. Is it better to give it continuously? So, when they're in the ICU, can you just use drugs continuously, rather than this kind of bolus dosing?  So, do more research around that.  So the frequency and dosing and timing like when do you administer it, how long should you administer it for? I mean, there's so many important aspects around that. And we've got the foundational research done now, we can start teasing out the finer details now, I think. Rather than just doing the same study designs over and over again, Lisa: Yes and reproducing.  Dr Anitra: Modify their study designs to start addressing these other issues. And there's some really big studies underway at the moment. One in Canada with 800 people. I mean, they'll give us really good information, those sorts of studies, rather than the little studies. Unless you live in small countries. Lisa: Small countries that can’t afford those things that cost millions and millions of dollars. And is there a trouble with funding because it's not a drug that we're developing here? Does it make it harder to get funding? Dr Anitra: It's extremely hard to get funding because often on the CSUN committee, it's often medical people on these who don't believe in vitamin C. The bad press or the misinformation don't understand the importance, the relevance and so, that's why this outreach is really important. It's just educating people about the science behind it. It's not hocus pocus.  Lisa: Yes, I mean, if I can share—I mean, I've shared a little bit on the past episodes with my case with my dad. I know and I felt they just put me in that, wackery quackery caught and they paid lip service to listening to me. They didn't really and but I’m quite—well in this case, I had to be quite forceful because my dad was dying. And I didn't go away, most people would go away because—and I just wish I knew then what I know now even because I wasn't that deep into the research. And now I am deep into the research and really an advocate for this.  But I was treated like—there was one really good doctor who listened to me, who advocated, he didn't believe in it, he didn't understand the mechanisms of action or any of that sciency stuff. But he did advocate for me at the ethics committee, whereas everyone else would just roll their eyes basically.  And this is why I think it's so important to share this, to come back again and again to the science for science for science, and for them to just open up their eyes just because they didn't learn it in medical school. And it's not in the current textbook for, like you say, because it takes 20 years probably to get it to the textbook. Because it's a vitamin, they just immediately shut down, it’s how I felt. They just immediately, ‘Well, just eat an orange and you're good to go.’ I mean, the surgeon—I had a friend that was going into surgery, and she was like, ‘Should I have intravenous vitamin C, before I go into surgery to prepare my body?’ Very logical thing to do in my eyes. It’s like, ‘You don’t need that, just eat an orange,’ and it's like, ‘Oh, you don't get the whole why and how, and what happens when the body goes through a trauma and a surgery, or a sepsis or any of these things.’And I don't know, like there's a bigger issue at play with the whole pharmacological model that our whole system is built upon. And that nutrients and nutrition isn't taught in medical school. So we're up against this big sort of brick wall.  And when I tell my story to people just, sharing with friends and things, they’ll be going, ‘But where's the downside? He was dying anyway, why couldn't he have it?’ And I said, ‘Well, you're up against machinery, you're up against ethics committees, legal battles, and a system that is just very staid and conservative in its approach.’  And that's not to criticize individual people within the system. I'm not wanting to do that. I'm just trying to make people aware because people go into a hospital setting or something, and they expect to have the latest and greatest information available that the doctors know all that. And unfortunately, that's not always the case. Do you find that frustrating?  Dr Anitra: I mean, it's not the doctors’ fault as such, because they're very busy people, they don't have time to keep up with all the literature, and they're not likely to be going into the nutrition literature in the first place. Which is why we try and publish as much of that stuff and the clinical literature, they're more likely to see it then. And they have the patient's best interests at heart. They've just heard the bad things about vitamin C and the misinformation. And so they don't want to do harm to the patient, I guess. It’s the view that they’re coming from and they don't have time to read all the latest information. And that's why just piece by piece, chip away at theirs, and educate them and hopefully it'll come into the training of the new doctors. And future hopefully, more nutrition courses will be introduced into training because it's not just vitamin C.  The body needs all the vitamins that are all vital to life. That's where the name comes from. You don't hit them, you die. It's as simple as that. So, yes, I think that it is vital that this information gets into the appropriate arenas. Lisa: Yes. And I think that's why I'm passionate about the show is that my sort of outlook on the whole thing is, ‘Yes, I'm not a doctor, but I can give voice to doctors and researchers. And I can curate and I can investigate and I can share.’ And this is a very emotional topic for me or for obvious reasons, but I'm trying to take the emotion out of it because that doesn't help the discussion.  And it’s really hard but I understand the importance—because I know that if I share things in an emotional manner, then I'll get shut down as having mental health problems in a group being a grieving daughter. When actually I’m an intelligent person who's educated herself in this. I've got the best people, and the best researchers, and the best scientists, and the best doctors sharing the latest research. And I hope that by doing that you can get one mind after the other and just get them to understand rather than the emotional side of things. Because what I do want to also share with the story is that every person's life that is saved is a family that's not grieving. These are not statistics.  When Dr Berry Fowler's research, with Dr Merricks research and you see a drop from, I think Dr Merricks was 40%, mortality to 8% and Dr Berry’s was something like 49, down to 29. Don't quote me on the numbers, but big numbers in drops and mortality. And you go, those are just dozens, if not hundreds of lives that are saved. And those families are saved from that grief.  And worldwide, I've heard a couple of estimates between 30 and 50 million people a year who get sepsis. Of those, one in five—I've heard in your research—one in five in New Zealand ICU dies of sepsis. This is a huge problem. This is as big as cancer and actually is one of the complications often of cancer therapies. So, I don't think people understand the enormity of sepsis itself. And then pneumonia, and then we can go into the discussion of COVID, and cancer, and all those other things. It's like we're talking millions of lives every year around the world. So this research is just absolutely crucial. Sorry, I've gotten on my bandwagon a little bit. But I really want to get this information out there. And that I think it's really, really important.  And let’s change track a little bit and just talk a little bit briefly because I haven't covered this subject with the other vitamin C interviews that I've done. Around the cofactor, so vitamin C is a cofactor for so many different areas. So I remember from one of your lectures, it has epigenetic influences and hairs like with collagen synthesis, and that's not just for your skin and your and your nails, but also has implications for cancer. You've got your health, which Professor Margreet Vissers talked about your hypoxia inducible factor, tumor growth. Can you just go and give me a little bit of information around—the vasopressin one would be very good and anything else that pops to mind there. Dr Anitra: Yes, so the cofactor is a compound that helps enzyme function. So everything in our cells relies on the functions of enzymes to carry out reactions in ourselves or the chemical reactions require enzymes. And so a cofactor supports that function.  And so early on when I was just starting in this area of research in the field of sepsis, I was looking at the different cofactor functions of vitamin C, and one of them is a cofactor for the enzyme which synthesizes noradrenaline. And noradrenaline is one of the main drugs, as you might say, that's given to patients who are going into septic shock. So it's given to the patients to try and increase the blood pressure. And it works by making the muscles around the blood vessels contract. Makes the blood vessels a bit smaller, so it increases your blood pressure.  And so vitamin C is a cofactor for the enzyme that naturally synthesizes noradrenaline in our body. And there's another enzyme which synthesizes hormones, one of which is vasopressin.  And this is another drug that's also sometimes given to these patients to help your blood pressure. And it works by increasing the re-uptake of water by the kidney. So, that increases your blood volume and hence, your blood pressure. So, for a lot of ICU patients, they're given noradrenaline and sometimes they're given vasopressin on top of that. Really try and get the blood pressure up. Lisa: Yes, their collapsing cardiovascular system.  Dr Anitra: And I realized, ‘Oh wait a minute vitamin C is also cofactor for this enzyme that synthesizes vasopressin.’ So here it is, a cofactor for two quite different enzymes that synthesize vasopressors naturally in our body. And so, if these patients are coming into the ICU, very low in vitamin C, and going into shock, is one of those reasons because they don't have enough vitamin C in the body to support natural vasopressor function. The doctors have to give them these drugs but if we're able to get them vitamin C, early enough that it can potentially support their own natural synthesis of these vasopressors in the body, which is a much better way to do it. Because if drugs are given from the outside, they're often given in high doses and not regulated, and so can cause side effects. There is a difference being produced in the body, the body knows what it's doing. It regulates how much and how often, all those sort of 46:07 engineering emails and so you don't get the nasty side effects. Lisa: Can I share a bit of a story there? Because both my mom and her case was—she had an aneurysm four years ago, she was on noradrenaline, and could only be given in an ICU. And originally she was in the neurological ward. And they couldn't do it there. And I only realized like she was going into a coma. So she had massive brain damage going into a coma. That when they took her up to ICU, they could give her the noradrenaline that opened up that the vessels in the heat it a little bit, or keep the pressure up, so that the vessels were open to stop the vasospasm in her case, which was killing parts of the brain. But she'd been in the neurological ward where they couldn't give any of that earlier. And so the damage had already been done partly.  And then with the case with my dad, back then I didn't know anything about vitamin C, of course. With the case with my dad in July, this year, I got vitamin C, but it was on day 13 of his 15-day battle, because I had paid to go through ethics committees and all of that sort of jazz. So he was an absolute death's doorstep, should have been dead days ago, according to the doctors. They couldn't believe he was still going but he was one tough man. I don’t know how he was still alive but he was. And the very first infusion that we got a vitamin C, immediately we were able to take him off norad for a period of about eight hours. We needed the vitamin C again, that took me another 18 hours before I could get permission to get the second one. Unfortunately, I couldn't get it in the six-hour bolus, which was ideal.  We gave him initially 15 grams. So this was again, multiple organ failure, fecal matter, and the creatinine, desperate, desperate, desperate straits. His CRP, c-reactive protein dropped from 246 down to 115. His white blood cell count improved and his kidney function went from 27% to 33%. And I was able to take him on vasopressors and noradrenaline for about eight hours. That is incredible for someone who could die at any moment. And we eventually—we failed because I struggled to get the second and I struggled to get the third infusion and it really was too late.  But even at that point, I thought it might be interesting for your research—I have all the medical records by the way, if you want to have a look at the data exactly. But it really was a strong—he doesn't need the noradrenaline, his blood pressure was going up. And that was a really, really good sign. As the dropping of the CRP, which was still very high at 115 but it was way better than where it had been.  So goodness, what would have happened if I'd had him on day one from the surgery? Yes. And, and none of it is understood. So that's one of the cofactors that… And that brings to mind just as someone who's connecting the dots, if you have an HPA axis problem, like your adrenals aren't doing the job well. And your cortisol, vitamin C would probably be a good thing to take to support.  Dr Anitra: And sometimes it’s referred to as a stress hormone because it is involved in the adrenal response. And people who are under stress, or in animal studies who have stress animals they appear, they use more vitamin C, and they generate more vitamin C, the animals they can synthesize it themselves, they generate more vitamin C to compensate for that. We are not there anymore. So we have to take more if we're under stressful conditions. Lisa: Exactly. And that's a really—it's just a funny thing of evolution that we've lost the ability to synthesize more as we like animals, like the goat, especially it can synthesize like a ton more when it needs that. We will give them big brains so that we can make vitamin C so we can take it. What are some of the other cofactors? Just as we start to wrap it up, but just a couple of the other important cofactors.  And collagen? Why is collagen important apart from you want my skin and hair, and your joints? Well, I did hear in one of the lectures about collagen helping stop metastasis of cancers?  Dr Anitra: Right, yes, that's one mechanism. It's also very important in wound healing. And, interestingly, a lot of—a reasonable number of surgeons are aware of this and that they're a lot more open to people taking vitamin C around surgery before and after surgery just to help affect wound healing. Lisa: Oh, wow. Yes.  Dr Anitra: Which is great. And Lisa: And oncologists, are they sort of open to...  Dr Anitra: Least so  Lisa: Least so. Yes. In fact, I've had friends who have told us, if you take intravenous vitamin C, we won't do any treatments. And this is... Dr Anitra: And that is primarily around all the misunderstanding around those early, early trials around intravenous. What I'm seeing is when Linus Pauling showed a feat of vital intravenous vitamin C. The clinicians at the Mayo Clinic who tried to reproduce those studies, they used oral doses, so just small doses over a day.  But back in those days, they weren't aware of the different pharmacokinetics of vitamin C, they thought oral and intravenous, are just the same, like the drug. But it's quite different. Oral uptake is a lot lower, much smaller amounts are taken up versus intravenous, you can get really high doses. And very quickly,  Lisa: Up to 200 times. I heard Professor Gabi Dachs, saying that intravenous is up to 200 times for short periods, but that short periods makes a difference, because you can get that into the tumor cells and to—so that… And this is the problem. Professor Margreet Vissers was saying the original controversy around Linus Pauling’s work and because they didn't have an understanding of how can possibly this mechanism of action been working. They just pursued it, basically. And it caused this big rift, those on the side, and those on that side, and for the next—what are we? 40 something years later—we'll still actually, it's problematic. Dr Anitra: Yes, it wasn't really till Mark Levine did his really detailed pharmacokinetic studies that people realized the big differences between oral and intravenous. And also there’s more recent discoveries of vitamin C's cofactor functions around regulating genes through herbs and through the epigenetic enzymes. These are all mechanisms, which could be involved and its anticancer mechanisms as such. And so the epigenetic area is a very, very exciting, very interesting area of research. And I think it'll enable us to personalize medicine in the future.  Lisa: Oh! I mean, I have an epigenetics program as one of my health programs. And yes, that's looking at okay, how genes being influenced by your environment, and let's optimize your environment to your genes. And the vitamin C helps serve to give people an understanding, so is vitamin C helping produce the enzymes that read the DNA? And then therefore having the reactions. Is that how it works? Dr Anitra: It works as a code. Lisa: the transcription Dr Anitra: Yes, so it helps the function of the enzymes which modify the DNA. So genetics is about the DNA itself. Epigenetics is above the DNA. So it's a way to regulate the DNA as you know. Usually through adding methyl groups to the dynast DNA, adding and subtracting and that affects how the DNA is read by the enzymes that read DNA and transcribe it. Lisa: Turning them on or off, or simplify.  Dr Anitra: So vitamin C, regulates the enzymes which modify the methyl groups and stimulates them coming off or stimulates different mechanisms happening. So switching certain genes on, switching certain genes off, now it can teach you to regulate thousands of genes in our body through stimulation of these enzymes. Lisa: Wow. So yes, I've heard somewhere, I think it was seven or 8000 genes that are possibly affected by this. So we are really at the beginning of the vitamin C journey, as far as the epigenetics mechanisms is concerned. Yes, that's exciting. Dr Anitra: A lot of its functions, not just in cancer, but in all areas of health and disease, these functions could be playing a role. So yes, huge areas of research possible there. Lisa: Yes. Yes. Yes. Is there a—I remember Professor Margaret, talking about Tt? Is that one of the enzymes? The Tt one? Dr Anitra: It is an enzyme, that's right. Lisa: And that's important for cancer in some way? Dr Anitra: Now, the enzyme search modifies the methylated DNA, some regulation that epigenetics. And it's definitely difficult. Lisa: To replicate it in the cancer process. Wow. Okay, we're getting quite technical here.  Doctor Anitra, I just want to say thank you very much for your dedication because I've listened to a couple of interviews with you. And you've actually sacrificed quite a lot to do the research that you're doing because there isn't a heck of a lot of funding and things are out there. So, thank you for doing all that. It's a labour of love, I can imagine. It's a long, slow process, getting the information, getting it to be watertight—scientifically watertight, so that we can actually get people help, who need help. And that at the end of the day it’s the reason I'm doing this podcast. And it's the reason you're doing your research, and hopefully together and with many others, we can move the story along so that people get helped.  Is there anything that we haven't covered that you think would be an important message for people listening today? Dr Anitra: Well, I think—I mean, of course, infection is very relevant these days with COVID. There’s a lot of information and misinformation floating around out there about vitamin C and COVID. And at this stage, the studies are still at the really early, early stages. Americans have done a study which shows that patients with COVID in the ICU do have low vitamin C levels, like other similar conditions. COVID is a severe respiratory infection like pneumonia and sepsis or complications with COVID. And so, I think that the key is to stay healthy, eat a good healthy... Lisa: Boost your immune system, yes.  Dr Anitra: Yes, to support your immune system, it doesn't mean you won't get COVID. But it may decrease the severity and the duration, so it doesn't go on to become the more severe version, the pneumonia and sepsis.  So I think that's an important message and if you do get infection, your requirements, dear God, so you do need to take more vitamin C, you need to take gram amounts, rather than milligram amounts. Want you to prevent getting even more severe. So, I'm all for prevention as much as possible, not leaving it till it's too late. So, I think, yes, just look after yourself, eat well. Lisa: Yes. And get your vitamin C. Come buy some kiwi fruit, and some oranges today, and some lemons, and capsicum. And some supplements maybe. Just as a final thing, you yourself, have a study that's currently underway, which is really, really exciting. And this is based in the Christchurch hospital, I believe, in 40 patients and with sepsis. Can you just tell us a little bit, the parameters of that study and when you think you'll have some results from it? Dr Anitra: So this was patients with septic shock. So once again, at the end. And they were administered either placebo control, so half the patients and the other half were given intravenous vitamin C at a dose of 100 milligrams per kilogram body tissue per day, which equates to about six to seven grams a day. The reason for that, I have wanted to use the high dose, Berry Fowler. But the ethics committee—because when I put this into the ethics committee, there were only the two studies out, which was Berry Fowler's and the small study headed by Iran. And they said, ‘Well, slightly more people have received a lot lower dose versus the higher dose. So we'd rather use the lower dose.’’ Even though there'd be no adverse events at any dose. And subsequently, no adverse events and any studies.  Lisa: No. Dr Anitra: And so, we've used the lower dose, we've only just finished recruiting the last patients. It took a while and we had issues of lockdown. And so now we're in the process of analysing the samples that we've collected analysing the data. And so hopefully, we're about to pull that together, sometime next year and publish the results next year.   Lisa: Brilliant. I can't wait to see that. And yes, that's a little bit frustrating because I would have liked to have seen a study with the 15 to 18. And even that I thought was still very conservative compared to some of the cancer dosages. But I understand from what Dr Berry Fowler said because of the decreased kidney function often in septic patients and so on, but it's just like yes, but the dying often. And it's because that was one of the arguments that was thrown at me, I could damage my dad's kidneys. The sepsis was doing that quite nicely and he was dying anyway. So why the hell?  So, but I think even at those dosages, we’ll hopefully see some fantastic results come out of it. And hopefully, in future we'll be able to do slightly more high-powered dosages. Dr Anitra: Yes. Well, the key is also the size of the study, our study is very small. And we were interested in being a scientist. I'm interested in how it's working in the body because once you understand how it's working, it makes it easier to design better studies and not our future studies.  And so, our study will be too small to show a yes or no, it decreases mortality or not—that we're leaving it up to the large studies to show there. And hopefully, we can put a bit more science behind how it's working, what's happening in the body.  Lisa: And it's such a complicated thing to design a study. People don't probably realize how the parameters and the limitations and the number of variables that you can look at and the primary outcomes and the secondary outcomes and so on.  Dr Anitra: Sepsis is such a complex variable that comes in as unique in this situation. So there's huge variability in the data. And that's where the biggest studies are good, because it helps decrease... Lisa: The statistical...  Dr Anitra: The statistical analyses of those studies. Yes, I'm looking forward to the results of the big studies coming out. Lisa: Yes, but these, these smaller ones are really, really important. So, and it's great that we've got one going in New Zealand. So, thank you very much for your work, Dr Anitra. It’s been absolutely fascinating. And thank you for your dedication to this. I really, really appreciate you. Dr Anitra: Thank you. Thank you for inviting me. That's it this week for Pushing the Limits. Be sure to rate, review, and share with your friends and head over and visit Lisa and her team at lisatamati.com The information contained in this show is not medical advice it is for educational purposes only and the opinions of guests are not the views of the show. Please seed your own medical advice from a registered medical professional

Ascorbic acid or vitamin C is a known antioxidant. Clinicians have conducted numerous studies to discover its role and effectiveness on life-threatening diseases such as sepsis, acute respiratory distress syndrome (ARDS), cancer and COVID-19. Dr Alpha 'Berry' Fowler joins us in this episode to share his work on vitamin C and its role in improving the survival of critically ill patients. He also talks about ongoing trials on vitamin C and its possible benefits on COVID patients. If you want to know more about the research backing up the success of vitamin C in disease treatment, then this episode is for you.   Here are three reasons why you should listen to the full episode: Learn the mechanism of sepsis in lung disease. Discover the role of vitamin C in treating patients with sepsis and ARDS. Find out more about past and ongoing trials on vitamin C.   Resources Learn about Dr Fowler's Phase 1 safety trial of IV vitamin C in patients with severe sepsis. Explanation lecture of the CITRIS-ALI study by Dr Fowler JAMA publication on CITRIS-ALI Article on the sequential organ failure assessment (SOFA) scores and mortality of patients involved in the CITRIS-ALI trials Dr Paul Marik's protocol for sepsis using vitamin C and steroids   Episode Highlights [04:02] How Dr Fowler's Research on Bacterial Sepsis Began Dr Fowler started working on mouse models to investigate sepsis. A solution made from mouse pellets was injected into ten mice, five of which received a treatment of vitamin C. The septic mice in the control group all died while those treated with vitamin C were crawling around, drinking water and eating. Dr Fowler then started using animal models to determine how vitamin C treats sepsis. [09:05] How Sepsis Damages the Lungs In sepsis, the lung barrier is injured. The progression of sepsis traps activated neutrophils in the capillary space of the lungs. Activated neutrophils release their DNA and enzymes, damaging the capillaries. Plasma then fills the air spaces, causing the patient to drown in their fluid. [09:34] The Role of Vitamin C in a Septic Lung In vitamin C-treated mice, the lung’s barrier function is preserved. Vitamin C stops neutrophils from disgorging their DNA into the extracellular space. Free DNA has become a marker to predict mortality. Blood reanalysis showed vitamin C lowered free DNA circulation as a result. Vitamin C completely inhibits the expression and appearance of inflammatory proteins. [16:15] Phase 1 Safety Trial Outcomes In a randomised, blinded trial, 24 patients were enrolled to determine the safety of vitamin C. Organ failure score was tracked in all patients. The higher the score, the higher the incidence of mortality. Patients treated with vitamin C saw a dramatic and significant reduction in their organ failure score. Vitamin C also improved their chance of survival. Intermittent infusion of vitamin C every 6 hours could get the plasma level up to 3000 times the normal level. [25:47] Phase 2 Proof-of-Concept Trial Outcomes Patients enrolled in the study had septic ARDS. The vitamin C treatment resulted in no adverse event. After 96 hours, 19 of 83 placebo patients died while only 4 of 84 patients with vitamin C died. Upon follow-up after 28 days, 46% of placebo patients died while only 30% of treatment patients died. This was the first blinded trial to show vitamin C’s impact on the mortality of patients with ARDS. [28:17] Explaining the Inconsistency of the SOFA Score Jean-Louis Vincent created the SOFA score. Jean-Louis Vincent sent a letter to the editors of Dr Fowler's work that the data was incorrectly analysed. Reanalysis showed the patients who died had the top SOFA score. Vitamin C significantly impacted organ failure scores. Vitamin C treatment resulted in a significant number of ICU-free days, improved mortality and more hospital-free days at day 60. [36:05] Is There Another Trial Underway? The NIH tasked the Prevention and Early Treatment of Acute Lung Injury (PETAL) Network to turn towards COVID treatment.  Dr Fowler started a trial on vitamin C as a treatment for patients with early COVID pneumonia, and the results are dramatic. There is another trial for sepsis and vitamin C planned by the PETAL Network involving 1000 patients across 69 medical centres. [39:48] Why Larger Doses of Vitamin C Are Not Administered The primary concern for higher doses of vitamin C is the formation of renal stones. A safety trial is first recommended before vitamin C treatment for COVID pneumonia can begin.    7 Powerful Quotes from This Episode ‘The cage that the mice got the sepsis and the vitamin C, they were all crawling around, drinking water and eating. And I knew at that point that we had stumbled on something pretty significant’. ‘One of the first things we found was that the lungs of the treated mice that were septic, they weren’t injured’. ‘Most people understand sepsis as being a bacterial infection, but they don't understand that it's actually taking all the organs and causing oxidative damage to multiple organs, not just the lungs’. ‘We had kind of a basic grasp on the immune system and how vitamin C could alter the septic immune response and how vitamin C could protect the lung’. ‘Vitamin C was actually improving the possibility of survival’. ‘The amount of vitamin C that you administer is critical. Dose matters’. ‘You’re going to save not only thousands and eventually more — hundreds and thousands of lives. You’re going to reduce hospital bills enormously’.   About Dr Fowler In his 35 years of service at VCU, Alpha A. ‘Berry’ Fowler, M.D., Professor of Medicine and Director, VCU Johnson Center for Critical Care and Pulmonary Research, has had a profound influence at VCU and beyond. Considering his robust grant support and over 300 publications and abstracts in clinical areas including adult respiratory distress syndrome (ARDS) and sepsis, he might well be lauded for that alone.  Likewise, with over 16 years as Pulmonary Disease and Critical Care Medicine (PDCCM) Division Chair, with numerous ‘Top Doc’ awards and other honours, his pursuit of excellence in clinical care, impacting thousands of patients and their families, might well be the highlight of most careers.  To learn more about Dr Fowler’s research on vitamin C, you may contact him at 804-828-9071 or send a message to alpha.fowler@vcuhealth.org.    Enjoyed This Podcast? If you did, be sure to subscribe and share it with your friends! Post a review and share it! If you enjoyed tuning in, then leave us a review. You can also share this with your friends so that they can learn more about vitamin C. Have any questions? You can contact me through email (support@lisatamati.com) or find me on Facebook, Twitter, Instagram and YouTube. For more episode updates, visit my website. You may also tune in on Apple Podcasts. If you would like to work with Lisa one to one on anything from your mindset, to head injuries,  to biohacking your health, to optimal performance or executive coaching, please book a consultation with Lisa here: https://shop.lisatamati.com/collections/consultations Lisa's latest book Relentless chronicles the inspiring journey about how a mother and daughter defied the odds after an aneurysm left Lisa’s mum Isobel with massive brain damage at age 74 and the medical professionals told her there was absolutely no hope of any quality of life again. Lisa used every mindset tool, years of research and incredible tenacity to prove them wrong and to bring her mother back to full health within 3 years. Get your copy here: http://relentlessbook.lisatamati.com/ For Lisa’s other two best-selling books Running Hot and Running to Extremes chronicling her ultrarunning adventures and expeditions all around the world, go to https://shop.lisatamati.com/collections/books. Go to www.runninghotcoaching.com for Lisa and Neil’s online run training coaching. For their epigenetics health program all about optimising your fitness, lifestyle, nutrition and mind performance to your particular genes, go to  https://www.lisatamati.com/page/epigenetics-and-health-coaching/. For Lisa’s gorgeous and inspiring sports jewellery collection ‘Fierce’, go to https://shop.lisatamati.com/collections/lisa-tamati-bespoke-jewellery-collection. To pushing the limits, Lisa   Welcome to Pushing the Limits, the show that helps you reach your full potential with your host Lisa Tamati, brought to you by lisatamati.com. Lisa Tamati: Hi everyone and welcome to Pushing the Limits. This week I have an exciting interview with intensive care medicine doctor, Dr Berry Fowler, who is an intensivist from the Virginia Commonwealth University. The director of the VCU unit via 35 years of service at the VCU Johnson Center for Critical Care and Pulmonary Research. And he's also the author of a number of studies around vitamin C. So today we're continuing that conversation that we've been having in the last few weeks around the importance of vitamin C. Last week, we had Professor Margreet Vissers on, from Otago University, talking about—who worked with vitamin C in cancer. She's been studying this for 20 years. And Dr Berry Fowler has been studying vitamin C in regards to sepsis and pneumonia and how to use it in COVID. And he's been researching in this area with vitamin C for over 15 years. So some really amazing insights into this incredible vitamin and how it can help with all of these things. So please don't miss this episode. If you enjoy the content, please share it with your family and friends. You know, there’s some important messages that we're wanting to get out in this vitamin C thing that I've been doing, because I lost my father recently and this would have been a major player and I was desperate to get him help with intravenous vitamin C, and I was unable to until way too late. And so I'm desperately wanting to get out the information about this research about the clinical studies that have been done, the research that's been done, to share this really important information.  As always, I really appreciate a rating or review for the show. If you can do that, that'd be so so appreciated. And if you've got any questions, please email me at support@lisa tamati.com, if you want to discuss anything that was brought up in these topics, in this podcast. I'm also doing some one on one consultations. I have a limited number of spaces available for people who are wanting to work with me one on one. If you are facing difficulties in areas from whether it be around some of your health aspects like head injuries, obviously I've spent five years researching head injuries. I have a lot of knowledge around vitamin C. I have a lot of knowledge around biohacking, around epigenetics trained as an epigenetics coach, gene testing, and so on. And I work with a very small number of people who are needing help with these areas. As well as of course run coaching and mindset in high performance. So if you're wanting to get some one on one support with me, please reach out to me it's lisa@lisatamati.com. And I can send you the information there. Right over to the show now with Dr Barry fellow who is sitting in Virginia in the USA. Well welcome everybody to Pushing the Limits. This week. I have a very special interview continuing our series around intravenous vitamin C or vitamin C in general. I have Dr Barry Fowler with me, who is sitting in Virginia and Dr Fowler has agreed to come and have a little chat today about his work in this area. Dr Fowler, I've done a wonderful extra introduction. So we won't go into all your amazing credentials and your achievements, of which there have been many. But Dr Fowler, can you just give us a little bit of background? You are the director of the VCU Virginia University over in the States. Can you tell us a little bit about your work and your background? Dr Berry Fowler: Okay, well, I am professor of medicine in the Division of Pulmonary Disease and Critical Care Medicine and I'm one of the ancient doctors in the division, just turning 71 last week. I trained at the Medical College of Georgia in the US, then went to the Medical College of Virginia in the US, then went to the University of Colorado for pulmonary and critical care disease training, and then came back and joined the faculty at Virginia Commonwealth University which used to be the Medical College of Virginia, it's now VCU, in 1982 and I've been here ever since. Lisa: Wow. Dr Berry: I rose slowly through the ranks. I led the pulmonary division for a number of years, for approximately 17 years, and then stepped aside in 2016. And all during this time, at least for 13 years now, we've had this interest in vitamin C. And it's interesting how our interest in vitamin C developed. It first started at a very molecular level where we were studying cardiac ischemia, but some of the heart attendings. And then slowly began to get back to what we have been doing for years which was bacterial sepsis. And we had some molecular reasons that drove us towards vitamin C. And so first thing we did was we created an animal model of sepsis. And let me explain that. It was pretty straightforward to create. We had 30 gram mice and we went to the mouse cage and collected mouse pellets. Then took them to the laboratory and sonicated them really hard until it became a solution. Lisa:  So this is the fecal matter. Yes. Dr Berry: And we would take that solution and centrifuge it really hard so that all the solid matter went to the bottom of the tube and we just took off the liquid from the top, which contained multiple different kinds of organisms. Lisa:  So all the bacteria. Yes. Dr Berry: Yes. And so we took that, put it in the refrigerator overnight and then came in the next morning. And we had 10 mice. We had 5 control mice and then 5 treatment mice. So all the mice first were injected into their peritoneal space, you mentioned that earlier, with a tenth of an mL of this solution containing all this bacteria. And so all 10 mice. And then in the mice that were going to receive the vitamin C, we injected a tenth of an mL, which was 200 micrograms per gram of bodyweight of the mice and then closed off the light. By that point, it was about 4:00 in the afternoon. And just let the mice sit in the laboratory where we had left them and I always get to work at 6:00 in the morning and I was thinking, ‘Holy cow, I got to see what's going on.’ And so I went into the lab where we had the mice and the cage that was the control mice that were septic. They were all dead. In the cage that the mice got the sepsis and the vitamin C, they were all crawling around drinking water and eating. Lisa:  Wow. Dr Berry: And I knew at that point that we had stumbled on something pretty significant. This take us back to around 2010. Maybe 2009. My laboratory has had this intense interest in sepsis ever since I finished my training at the University of Colorado. And so what we decided is that we would begin to use the treatment animals and some control animals to determine exactly how vitamin C was working. Lisa:  To look at the molecular, the mechanism of action. Why is this happening? Why are they surviving better? Dr Berry: So what we did was—in these studies, we were always comparing the control mice to the treated mice. And one of the first things we found was that the lungs of the treated mice that were septic, they weren't injured. Lisa:  Wow. Dr Berry: And we have a number of ways to determine the way a lung is injured. One of the things that happens in sepsis, and this might have been what you and I were talking about earlier, is the lungs barrier function, which is the ability to keep the blood in the blood and keep the air in the air. Lisa:  Yes. Dr Berry: It gets injured. And so the bloodstream floods into the airspaces of the lung. Lisa: And fills it. Dr Berry: Yes. And one of the things we discovered was lung barrier function was preserved and the vitamin C treated septic mice. Lisa: Wow. So you're perceiving that it’s stopping the plasma and the neutrophils getting into the alveolar space. Dr Berry: Exactly.  Lisa: And the NET— of one of your lectures, you talk about neutrophil extracellular traps (NET). Is that a part of the barrier function?  Dr: Berry: Very nice. When are you starting medical school? Lisa: Thank you, Dr Fowler. Dr Berry: So what happens as sepsis progresses is that there are a bunch of molecules that live in the capillaries of the lung that begin to get expressed. And what they do is they trap neutrophils that are activated in the capillary space of the lung. And one of the things that happens in a highly activated neutrophil is they disgorge their DNA and all of the enzyme systems inside a neutrophil begin to damage the capillaries. And then what happens as the capillaries get injured, the plasma from the lung, just a vein from the bloodstream, just flows into the lungs. Lisa: So you’re basically lost—it's like your skin barrier, if you like, between the ear and your insides is disintegrating. Dr Berry: Well, one injury from sepsis is like drowning. Lisa: Wow, so you fill it with your own fluid. Dr Berry: The airspaces of the lung fill up with your own plasma. Lisa: So when you have, cause sepsis—I don't think most people are not aware of the progression of sepsis to acute respiratory distress syndrome. That this is a sort of a linear progression that happens, isn't it? That you actually get lung—because most people understand sepsis as being a bacterial infection but they don't understand that it's actually taking all the organs and causing oxidative damage to multiple organs, not just the lungs, but particularly the lungs. And so this is a very important finding that what you've had here because this means that if you can stop the vitamin C, if the vitamin C can stop the neutrophils from disgorging their own DNA into the extracellular space, which is then, that's in a marker, isn't it? That cell-free DNA, when you take a plasma drawn and you see that cell-free DNA floating around at a certain level, that's a predictor of mortality, isn't it? Dr Berry: Listen, you've done some fabulous reading. But let me just tell you, it's been known for several years that in septic individuals, one of the unfortunate things that will predict mortality is how high the cell-free DNA arises in the circulation. And I don't want to jump too far here, but I will tell you and the vitamin C trial that we reported one year ago this month, that when we reanalyzed the blood from those individuals, we found that vitamin C dramatically lowered the cell-free DNA in the treated patients. Lisa: Wow. That was in the CITRIS-ALI study? Dr Berry: Exactly. Lisa: Oh, okay. That's a new finding from that study because, yes, we will go through that progression of how you got to do that study. So let's bookmark that for a moment and backtrack because that is a very important finding for that study. So let’s backtrack a little bit. So we are talking about vitamin C being able to protect the lungs if we put it very simply and protect the barrier function of the lungs, stop the neutrophils from disgorging the DNA and causing these traps, which is a predictor of mortality. What are other things is vitamin C doing? And why is a septic patient, without fail, going to be very low in vitamin C? So you’re using that for Vitamin C. Dr Berry: I'll get to that in a minute. But what we demonstrated in a huge number of murine mouse studies is that the septic lung in a control animal, the septic lung began to express many inflammatory proteins. And that's just your endogenous immune system trying to protect itself. But we showed in the next cage, in the septic mice that we had treated with Vitamin C, that the expression and the appearance of those inflammatory proteins was totally inhibited completely.  Lisa: Wow. Dr Berry: Yes. The idea of leaping from preclinical animal studies into humans was that we had kind of a basic grasp on the immune system and how Vitamin C could alter the septic immune response and how Vitamin C could protect the lung. Well, protecting the lung in terms of septic critical illness is very, very important. Lisa: Absolutely. And so then you went to a phase one safety trial, which was really to look at some basic markers. Is this going to be damaging for people if they get vitamin C and look at hypertension? And is it going to affect the kidneys and so on. I think some of those safety mechanisms. Can you tell us a little bit about that phase one safety trial and then the outcomes of that trial? Dr Berry: Well, I can tell you, I had this really close colleague. His office sat right next to mine. He's a molecular biologist, basic scientist. And after we'd done all these murine studies, one day he walked in, he looked at me, said, ‘Fowler, this needs to go into the hospital. We've developed all this data. You've got to make it happen to get it into the hospital’. We designed this little safety trial, enrolled 24 patients. The safety trial was randomized and it was blinded. And so half the trial was just controlled sepsis. The other half was septic patients treated with Vitamin C and we had no idea who the hell was giving vitamin C to people who were critically ill. Lisa: Yes. Dr Berry: And we found it had no impact. But one of the things we were shocked at, and we were just trying to define, was vitamin C safe?  Lisa: Yes. Dr Berry: One of the things we tracked was what is called an Organ Failure Score. And we found that all of the patients treated with Vitamin C, their Organ Failure Score reduced dramatically and significantly. Lisa: Wow. Dr Berry: And the way Organ Failure Scores, basically you're counting numbers. A higher number is a higher incidence of mortality. Lower numbers are improved and that vitamin C was actually improving the possibility of survival. Lisa: So this is like, in my father's case, is the sepsis progressed and I was unable to get him Vitamin C as we discussed earlier, Dr Fowler, early enough for him to get to survive. But as I watched his sepsis progress, more and more organs started to fail. So his liver started to fail. His kidneys started to fail. His heart started to fail. And so this is the Organ Failure Score. If this person's Organ Failure Score is going up, that is a very strong predictor of mortality. Dr Berry: Yes. Lisa: Okay, so this was reduced with the people who received the Vitamin C in the small trial. Dr Berry: So what we did, we took the data, we combined it with our preclinical data, and applied to the National Heart Lung and Blood Institute. They had just published an announcement where they were asking for anybody who could think of some clever trial. And we said, ‘Well’. And so we submitted an application. What the NIH wanted, they wanted the proposal for a phase two, proof of concept trial. Lisa: Right. Dr Berry: And so what we proposed was a trial that had seven medical centers. I have friends in seven medical centers around the US. And with this application in and that was I guess you guys don't remember Hurricane Sandy. Lisa: Yes, I do. Dr Berry: Hurricane Sandy was just—it killed the Atlantic Coast of the US. And the National Heart Lung and Blood Institute happens to sit on the Atlantic Coast in Washington, D.C. And it was a year and a half before we found out that we had received the highest priority score because of the application that we had submitted. And the NIH gave us 3.2 million dollars to do a multicenter, randomized, double blind, placebo-controlled trial, proposing to administer 50 milligrams per kilogram of intravenous Vitamin C every six hours for ninety six hours. Patients were continuously receiving vitamin C. Lisa: Can you explain why that continuous topping up that level is important every six hours? Dr Berry: That's a great question. So from the safety trial that we had performed, we analyzed the plasma Vitamin C levels that we had achieved by infusing. So basically someone your size, for example, would probably get maybe 3 1/2 grams intravenously every six hours for ninety six hours. And what we showed was, we could get the plasma level up to basically three thousand times the normal plasma level. So from a normal diet, human plasma levels of vitamin C are about 70 to 80 micromolar. When you give the protocol that we had settled with, we got the Vitamin C levels up to five millimolar. Lisa: Wow. Dr Berry: Yes. And so that's what we were shooting for in this NIH trial. And that's what we did. We charged into it, the trial. What we had proposed again, was the Organ Failure Score as well as the two biomarkers. We also proposed in the secondary outcomes, days on mechanical ventilation. Lisa: Yes, which is hugely important. Dr Berry: And what we were studying specifically, was patients who were septic, who had gone on to develop acute lung injury called Acute Respiratory Distress Syndrome, ARDS. And so when a patient was septic, like your father, we would become a fly on the wall and visit the patient every day until a lung injury developed. And that's when they would get randomized. Lisa: This was a critical—from my analysis of the data, that was a critical thing in the phase. So you had to wait until I basically had developed ARDS before you were able to put them. So this wasn't really a sepsis trial, but more of an ARDS trial. So the progression of the sickness comes into play here, doesn't it? If you’ve gone through day one, like in the phase... Dr Berry: In the safety trial... Lisa: Yes. Dr Berry: The second aseptic individual walked in the door, that's when they got random. Lisa: Which is a much better, more effective with the timing. Dr Berry: We had a couple of patients who got Vitamin C in the emergency room. Lisa: Yes, wow.  Dr Berry: You know you have to get informed consent. You have to get the pharmacy on board and get the patient enthused. Lisa: I wish I'd had you tending to my father. We could have had that from the moment he got to the emergency. That would have been, I think we would have had a different outcome. But so this was a key point that you had to wait until I had developed ARDS. So in this CITRIS-ALI trial, so here you have, I think it was 47 patients in the control and 47 in the intervention group, was it right? Dr Berry: 83. And 84 in the Vitamin C treatment. Lisa: Oh, 83. I'm sorry. Sorry. So 167. One of the big questions I had in my— why was mortality not one of the primary objectives of the study? Dr Berry: That has been the most frequent question. When we answered the NIH, they had put out a program called, UM1, and we applied to the UM1 program and they were not interested in mortality as a primary outcome. Part of it was this. There had been hundreds of sepsis trials and nobody had ever shown any impact on a treatment for sepsis. And so NIH didn't want to get burned again so they said that they wanted a physiological outcome. That was the Organ Failure Score. And they wanted a biochemical outcome. Those were the biomarkers. Lisa: It's the C-reactive protein, procalcitonin and thrombomodulin. And yes. So the reasoning was that we don't want to shoot for the stars here and automatically hope for a decrease in mortality and a decrease of days in hospital. We're going to go for something else just to see if this has legs, so to speak, if this treatment is possible, possibly going to work. And that's why they went for the safer scores, rather than the mortality. Looking back, do you think... Dr Berry: By the way, we haven't talked about this yet, but SOFA stand for Sequential Organ Failure Assessment Score. Lisa: Thank you. Yes, it's amazing the jargon that you pick up and then forget that you haven't explained yourself. So what actually was the outcome? This was a seven multicenter trial. You did a double blinded. This was incredibly important because I know Dr Paul Marik had also done a study with intravenous Vitamin C, thiamine, and hydrocortisone. And one of the criticisms that was thrown at him was that it wasn’t a double blind, randomized controlled trial, so it didn't have any meaning, which is absolutely tragic. So this was—what was the outcomes of this phase two trial? Dr Berry: So we enrolled 170 patients. One of the placebo patients we had to take out because that patient did not have septic ARDS. They had Acute Eosinophilic Pneumonia. That's something else to discuss later. And then in the Vitamin C arm, we had two patients with Acute Leukemia who had no coagulation in their bloodstream and they were hemorrhaging into their lung and that was not sepsis. So as I mentioned, we had 83 in the control placebo and 84 in the vitamin C-treated group. First of all, we saw no, and I emphasize capital N-O, adverse events. There was not a single adverse event.  Lisa: Exactly. Dr Berry: All right. And so what we showed was in 96 hours, placebo patients in the trial, 19 of 83 died within 96 hours. Lisa: Wow. Dr Berry: In the Vitamin C group, 4 of 84 patients died. And if you look at the statistics and the analysis of that, the difference is P=0.0007. We then followed the patients out because in sepsis trials, there's always this demand to see what is happening to a patient at 28 days. Lisa: Yes. Dr Berry: And what we showed was 46% of placebo patients died and only 30% of the Vitamin C treated septic patients with ARDS died. Lisa: Wow, that's a huge result in my mind. Dr Berry: And that was the first trial. I'm not slapping myself on the back, but I will just tell you, that was the first trial to ever show in a blinded fashion, an impact on ARDS.  Lisa: Yes. On mortality of ARDS. Dr Berry: Yes. Lisa: And this was extremely sick people. Now, unfortunately, the SOFA scores didn't show any difference and the C-reactive protein markers didn't show any difference. Dr Berry: So let me explain. Lisa: Is it because... Yes, is it because of the mortality. Dr Berry: So we thought publishing the results of the trial in probably one of the most important journals on the planet, JAMA, which as it turns out, is a very, very conservative journal. And they had their ideas about what we could and we couldn't say. So we published, and this is very important for you to listen to and all of your listeners, we published that there was no difference in the SOFA scores at 96 hours. And immediately, letters to the editor started coming in and one of the most important letters to the editor was the person who created the SOFA score. His name is Jean-Louis Vincent in Brussels, Belgium. He told us that we had analyzed the data incorrectly and that what we were reporting was a survivorship bias. Lisa: What does that mean? Dr Berry: And what he said we needed to do, and he provided five publications where he had important statisticians tell him that analyzing the data, like we reported, as a worst rank, best rank scenario, that we had to reanalyze it so that the patients who died, what we were reporting was the SOFA scores on the people who had survived. Lisa: Not the ones who died. Dr Berry: We had not considered the SOFA score on the patients who died. Lisa: And because they died so quickly. Dr Berry: So what we did was we went back and the people who died along the way, those 19 patients, they got the top SOFA score. The patients who survived and left the unit, they got a low SOFA score. And so when we reanalyzed the data, according to the way these letters that had come in from Dr Vincent and two or three other colleagues, it turns out that Vitamin C significantly impacted the Organ Failure Score. Lisa: Wow.  Dr Berry: And then we—here's the important thing, we reported that February 25th of 2020. So you can go to JAMA, you can look it up and you can see our response to the SOFA score reanalysis. Lisa: Because this was a key factor in my father's case. They threw the CITRIS-ALI trial at me and the original data from JAMA, which said negative result, which when I analyzed... Dr Berry: That lets you know that the doctors were not reading JAMA. Lisa: Exactly. And they weren't on the up to date and they did not look at secondary outcomes and they did not look at the parameters of the score and I was not able to present the case. They had just read it briefly. Dr Berry: Let me go on. We had a strong trend to ventilator-free days and the people who got the Vitamin C, but it just missed statistical significance. Lisa: Yes. Dr Berry: But we had a strong significance for the people who got Vitamin C in Intensive Care Unit-free days. Lisa: Which is huge. Dr Berry: So the people who got Vitamin C had a significantly higher number of ICU-free days. There was an improved mortality. The other thing is patients who got Vitamin C had significantly more hospital-free days at day 60. Lisa: Wow. So they were actually out of the system altogether. Do you think—now this is controversial, I'm playing devil's advocate here. But do you think the fact that it costs so much for someone to be in ICU when they have sepsis—I think in America it's something like, to the order of 60,000 dollars US a day—and the medications that they are typically on are costing around 20,000 dollars a day, do you think that if you come along with Vitamin C and you start dropping the mortality rate, you start dropping the days? Is that part of the resistance to accept and acknowledge these findings, that the pharmaceutical companies are going to lose out on profit? Dr Berry: Oh no no no. No, no, no. At VCU, Virginia Commonwealth University—that Anitra knows well—the average care cost per day is about 46,000 per day because that accounts for medical care, nursing care, radiology, all laboratory data, respiratory care, caring for the ventilator. All of that is somewhere in the neighborhood of about 45 to 50,000 dollars per day. And so, if you have a treatment, first of all, that gets people out of the ICU earlier and keeps them out of the hospital, think about the impact on the cost of care. Lisa: Yes, it’d be huge. Dr Berry: But here's the other thing. There's not going to be any drug company out there who would argue with that. They are all trying to do the best they can with their different antibiotics, but the common antibiotics that are administered in an ICU when patients are septic levofloxacin, meropenem, vancomycin. Just one day of meropenem is 1500 per day. Lisa: Exactly. It's a lot of money.  Dr Berry: Yes.  Lisa: So you don't think that... Dr Berry: And listen to this. That's the cost of the drug. That's not the cost of pharmacy preparing the drug, cost of nursing administering the drug and so on and so on and so on.  Lisa: Okay, so all right. So if you can work this problem out and if you can get this in all ICUs around the world, we're going to save not only thousands and eventually more hundreds of thousands of lives, you're going to reduce the hospital bills enormously. So this is incredibly important work. And you've proven—so the statisticians proved in that phase two trial that the way that you are measuring it was incorrect because a lot of people, as you said, 19 died in those first four days in the control group and only four, so that skewed—if you like—the statistics to initially look like we hadn't had a win here. Now, that's been rescinded and you've managed to get JAMA to publish it in a different light, that the SOFA score was impacted. What has been the effect now? Have you got another trial underway or have you got one in sight? Because this work’s too important, obviously, not to be taken further into a phase three. Dr Berry: All right, so you are in New Zealand where there's not much COVID.  Lisa: No. Dr Berry: We are in the United States, where it's a pandemic, where we are close to 220,000 people who have died from the virus. We are at 50,000 new cases per day. Lisa: Oh my God. It's so...  Dr Berry: And there are somewhere in the neighborhood of 1,800 to 2,000 patients dying per day of COVID. And so because of that, the network that I'm part of, that unfortunately—I'm going to have to jump off and listen to it, because it's been going on since 2:00, the annual meeting of the Prevention and Early Treatment of Acute Lung Injury Network, abbreviated P-E-T-A-L, the PETAL Network. The PETAL Network was tasked by the NIH to turn sharply towards COVID treatments. Lisa: Yes. That makes sense. Dr Berry: And so we were thinking, ‘Well, maybe vitamin C to treat patients with early COVID pneumonia’. And so what we did was we started a trial. We have studied 20 patients now and that trial is complete, where patients who develop COVID infection and develop early COVID pneumonia, so it's just at the start of an oxygen requirement, are treated with Vitamin C and the results have been pretty dramatic. We are in the midst of writing that up. But again, it's a—open label trial. It's not blinded. Everybody in the world knows that an open label trial does not have the power like we did with CITRIS-ALI. Lisa: Yes. Dr Berry: And so what is happening at a world level is that all of the health organizations around the world have come to bear to try to design treatments for COVID pneumonia. Lisa: Yes. Dr Berry: And that is ongoing right now. And there are like 9 or 10 major networks in, across the world. Probably, I'm not sure if New Zealand is included in that, but Europe, the US, possibly Australia. I don't know if they commit to participating in what is called the network of networks formation. Lisa: Yes. Dr Berry: So right now, the next trial for patients with sepsis that's not COVID is going to be conducted by the PETAL Network where we will be probably next April, starting a trial with a thousand patients. Lisa: Wow.  Dr Berry: Using vitamin C conducted by the PETAL Network. Lisa: Gotcha. Dr Berry: And the PETAL Network has 69 medical centers. So doing a trial that would get a thousand patients can be done within a year. Lisa: Wow. So this is exciting stuff because this is hopefully you'll be able to reproduce and show a strong correlation between intravenous vitamin C and I'd like to see the decrease in the mortality rate. That would be a key factor. Some centers are already using vitamin C because as you mentioned before, there were no adverse reactions. And this is like in all of the studies that I've seen there has never— this is a low risk intervention and my argument when fighting for my father was that, ‘He's dying. There is no other options. Why can't I throw the bus in? Why can't I put intravenous Vitamin C’? And they were like, ‘You still have to go through all the ethics committees’. I had to sign off from every single doctor and every single nurse in the ICU unit of which there are many. Dr Berry: Well, let me make another statement. So Paul Marik, who was using 1.5 grams of Vitamin C, 200 milligrams of thiamine and 50 milligrams of hydrocortisone, administered every six hours. That meant that the patients were only getting 7 grams. Lisa: Very small amount. Dr Berry: In the CITRIS-ALI, I mean, some patients got 16 to 18 or 20 grams. Lisa: Yes. Dr Berry: According to body weights, 50 milligrams per kilogram. In the aftermath of that article that you mentioned that Marik published, there have been efforts to repeat that trial. The vitamins trial came out in January, using that and it failed. Then another trial, the ACTS trial using the Marik protocol failed. And then a trial that I just participated in called the VICTAS trial completely failed. And so the Marik protocol is not an effective treatment for sepsis. And well, look. As I think Anitra Carr mentioned to me a couple of years back, the amount of vitamin C that you administer is critical. Lisa: Absolutely. Dr Berry: So dose matters. And the adult, again, of your size, you probably weigh 120 pounds or something would probably get somewhere in the neighborhood of about 12 and a half to 13 grams, spread out over a 24-hour period. And then you would get it for four days. Lisa: Yes. And that is still a relatively low dose. Dr Berry: It is. Lisa: When I'm doing intravenous vitamin C with my mum, I did it with my dad prior and unfortunately, months prior to his aneurysm. Too little, too late. We were getting 30 grams. We get 30 grams a week. When I take my mum and niece today for an intravenous Vitamin C is a prophylactic as I try to keep her, as a 79 year old healthy, 30 grams. So why—I had this question certainly with Dr Marik’s protocol. It seemed to me to be very low, although the six hourly is obviously a very important point as well. Why not do the bigger dosages? Like in Japan, I know they did a study with up to a hundred grams of Vitamin C in a burns case, a burns trial, where they had some markers of sepsis there. Why are you not trying higher levels? Dr Berry: Let me come in here quick? Because I'm going to have to jump off in about 8 minutes. But listen to this. The major concern for those high doses of vitamin C, and if you talk to the oncologists who have been using it for years, they will give, like you said, they will give massive doses. And I'm talking massive, like in somebody with pancreatic cancer, they will get 60 to 80 grams intravenously, Monday, Wednesday and Friday for seven weeks. Lisa: Yes. Dr Berry: But the major concern, in somebody who's septic, who's hypotensive, in shock, that you're giving vitamin C, one of the major concerns is that it causes a significant rise in oxalate crystals formatiion in the kidneys. Now, I will mention here in the CITRIS trial, we had no evidence of renal stone formation. Lisa: No. And I mean, that was one of the arguments that the doctors had at me, ‘You could have damaged his kidneys’. And I said, ‘Well, the last time I looked, being dead damages your kidneys too’. To me, that wasn't even a consideration. And he had—after the very first vitamin C, and for my dad, his kidney function went from 27 percent to 33 percent. He's actually improved his kidney function overnight. And I know that's just one anecdotal case, but kidney stones are not going to kill you either. So surely that's not the most important consideration here when you've got a septic patient who is on death's doorstep. Dr Berry: With vitamin C struggling in the United States after the CITRIS trial, the Federal Food and Drug Administration, they always have to be concerned about adverse events. And we have put together a trial randomized and double blind using Vitamin C in patients with COVID-pneumonia. That's about to start. Lisa: Wonderful. Dr Berry: And we had, I unfortunately let my IND, Investigational New Drug lapse after CITRIS. And so I've had to claw our way back into the good graces of the FDA. And one of their major, major, major complaints was, ‘You're going to be forming renal stones’. And we're using the same protocol that we used in CITRIS. So FDA got their nephrologists involved and finally gave us the IND. But for us to begin treatment of COVID pneumonia, they have demanded that we first do a small safety trial to show that we are not causing any renal stone formation. We can get that done. We currently have somewhere in the neighborhood of 60 to 70 COVID patients in the MCV hospitals right now. Lisa: Wow. Well, Dr Fowler, look, I know I'd love to spend another five hours with you discussing all this because I think it's incredibly important, both for COVID and for the sepsis and for pneumonia and for obviously, for cancer. I just want to thank you for your dedication to this. I mean, you could be in retirement and sunning yourself somewhere, relaxing, but, you know... Dr Berry: That's right. Lisa: You know that this work is critically important. And I heard one of your lectures is the equivalent of two 747 planes going down every day filled with people. Dr Berry: Every day in the United States. Lisa: In the United States alone. Dr Berry: That’s just in the U.S. Lisa: Yes. And these people, thousands of families being destroyed with losing loved ones. I'm one of those, unfortunately, sitting here all the way in New Zealand. And so this work is incredibly important. So please keep going. And I'm desperate to hear what comes from this COVID clinical trials and the other sepsis trials, obviously. So thank you so much for your work, Dr Fowler, and I really appreciate you. Dr Berry: It's been wonderful meeting you and speaking with you, and your and your audience. And when you have Anitra on a couple of weeks, give her my regards. Lisa: I will definitely do that, Dr Fowler. That's been awesome. Thank you, Dr Fowler. And all the very best there in Virginia. Dr Berry: Take care. Bye. That’s it this week for Pushing the Limits. Be sure to rate, review and share with your friends, and head over and visit Lisa and her team at lisatamati.com. The information contained in this show is not medical advice it is for educational purposes only and the opinions of guests are not the views of the show. Please seed your own medical advice from a registered medical professional

The battle against cancer has been ongoing for hundreds of years now. But recently, interest in using vitamin C to improve outcomes for cancer patients has been growing. And the results of these various studies look promising. Biochemist and medical researcher Professor Margreet Vissers joins us in this episode to explain her current research on vitamin C and how it helps the immune system fight cancer. She also talks about the other health benefits of vitamin C, as well as some of its limitations. Is vitamin C the cancer treatment we’ve been looking for all along? Tune in to find out.    Here are three reasons why you should listen to the full episode: You will learn about vitamin C’s role in controlling tumours. Discover how humans metabolise vitamin C differently from other animals. Know how intravenous vitamin C turned around a leukaemia patient’s relapse.   Resources Watch Professor Margreet Vissers' lecture on her work on vitamin C. “The power of C” on University of Otago Magazine Das, A. B., Kakadia, P. M., Wojcik, D., Pemberton, L., Browett, P. J., Bohlander, S. K., & Vissers, M. C. M. (2019). Clinical remission following ascorbate treatment in a case of acute myeloid leukemia with mutations in TET2 and WT1. Blood Cancer Journal, 9, 82. doi: 10.1038/s41408-019-0242-4 Vissers, M. C. M., & Das, A. B. (2018). Potential mechanisms of action for vitamin C in cancer: Reviewing the evidence. Frontiers in Physiology, 9, 809. doi: 10.3389/fphys.2018.00809 Ang, A., Pullar, J. M., Currie, M. J., & Vissers, M. C. M. (2018). Vitamin C and immune cell function in inflammation and cancer. Biochemical Society Transactions, 46, 1147–1159. doi: 10.1042/bst20180169 Carr, A. C., Vissers, M. C. M., & Cook, J. S. (2015). Parenteral vitamin C relieves chronic fatigue and pain in a patient with rheumatoid arthritis and mononeuritis multiplex secondary to CNS vasculitis. Case Reports in Clinical Pathology, 2(2), 57–61. doi: 10.5430/crcp.v2n2p57 Dachs, G. U., Munn, D. G., Carr, A. C., Vissers, M. C. M., & Robinson, B. A. (2014). Consumption of vitamin C is below recommended daily intake in many cancer patients and healthy volunteers in Christchurch. New Zealand Medical Journal, 127(1390). Retrieved from https://www.nzma.org.nz/journal Carr, A. C., Vissers, M. C. M., & Cook, J. (2014). Parenteral vitamin C for palliative care of terminal cancer patients. New Zealand Medical Journal, 127(1396). Retrieved from http://www.nzma.org.nz/journal Carr, A. C., Vissers, M. C. M., & Cook, J. (2014). Relief from cancer chemotherapy side effects with pharmacologic vitamin C. New Zealand Medical Journal, 127(1388). Retrieved from http://www.nzma.org.nz/journal Pullar, J. M., Carr, A. C., & Vissers, M. C. M. (2013). Vitamin C supplementation and kidney stone risk. New Zealand Medical Journal, 126(1384). Retrieved from http://www.nzma.org.nz/journal Carr, A. C., Pullar, J. M., & Vissers, M. C. M. (2013). Beating the blues: The association between fruit and vegetable intake and improved mood. New Zealand Medical Journal, 126(1384). Retrieved from http://www.nzma.org.nz/journal Carr, A. C., Vissers, M. C. M., Lewis, J., & Elder, P. (2012). Multiple nutrient insufficiencies: Hypovitaminosis D and C in young adult New Zealand males. New Zealand Medical Journal, 125(1364). Retrieved from http://www.nzma.org.nz/journal Carr, A. C., & Vissers, M. C. M. (2012). Good nutrition matters: Hypovitaminosis C associated with depressed mood and poor wound healing. New Zealand Medical Journal, 125(1362). Retrieved from http://www.nzma.org.nz/journal   Episode Highlights [04:50] Vitamin C and White Blood Cells After killing bacteria, white blood cells destroy themselves so that the toxicity doesn’t spill into tissues. Vitamin C plays a role in regulating the cell death pathway. Margreet observed that white blood cells low in vitamin C did not go to resolve the end of the infection. [07:15] How Neutrophil Extracellular Traps (NETs) Work NETs are a variation of vitamin C’s mechanism. Neutrophils are cells attracted to infection and eat hundreds of bacteria. They have oxidants that kill bacteria. Neutrophils eject ‘niche’ or the DNA package inside them. The niche has microbicidal proteins. The niche forms ‘traps’ that localise bacteria on the site of infection. [13:18] Vitamin C Production in Animals All animals make their vitamin C mostly in the liver; some produce the vitamin in the kidney. Animals that can make vitamin C do it on demand. They can increase production a hundred times to keep blood levels saturated. Humans lost the gene to make vitamin C; thus, we are dependent on food for supply. When we are sick or infected, our body consumes vitamin C fast. If we do not replenish our vitamin C, our body levels will decline. [16:35] Route of Vitamin C Administration Plasma vitamin C levels go up to a maximum level of 100 micromolars. Kidneys filter and regulate vitamin C. Saturated tissues will not absorb any more vitamin C; the excess will be released in the urine. Oral intake is suitable for day to day intake while people with severe illnesses will need infusion. Vitamin C infusion results in high plasma levels for a short period. Any excess will pass, and the plasma levels will be back to normal in 8 or 9 hours. [22:01] Function of Vitamin C The enzyme needed to produce collagen needs vitamin C; thus, the vitamin is good for the skin. It plays various roles in inflammation, wound healing, controlling infection, and even brain function. Vitamin C regulates gene expression. Vitamin C supports the production of serotonin, as well as other hormones that regulate mood and reproduction. [27:48] What Vitamin C Dosages Do We Need? The Ministry of Health recommends 200 milligrammes a day for wellness. Foods high in vitamin C, such as kiwi fruit, capsicum, and broccoli, are recommended. But only a few people eat a good range of fresh fruit and vegetables. Margreet says if the aim of vitamin C intake is to alleviate illness, it is usually not achievable through our daily diet. Each condition requires a different recommended intake. [34:17] The Role of HIF Protein in Cancer Hypoxia-inducible factor (HIF) is a transcription factor protein that switches genes on and off. HIF is present in all cells at all times and responds to low levels of oxygen. Under low oxygen levels, areas with poor blood vessels are provided with oxygen by generating new blood vessels. Cancer cells hijack this mechanism to have their supply of blood vessels, making the cells grow more. Hijacking the HIF protein also results in switching the cancer’s energy source to sugar. [39:06] The Role of Vitamin C in Cancer The HIF proteins need to be shut off to prevent cancer from worsening. Enzymes that need vitamin C can switch off HIF proteins that need to be shut down, slowing down the tumour’s growth rate. Though it is tough to prove preventive action, many cancer rates have significantly decreased to half when vitamin C status is good. To maintain your well-being, keep vitamin C levels at optimum levels. [45:07] Does Vitamin C Pose Any Risk? Vitamin C’s oxidation products need to be cleared out of the body. No toxic dose has been identified, provided you have good kidney function. There is no actual risk of kidney stone formation and kidney injury. People getting an infusion must be tested for kidney function. [49:10] IV vs Oral Vitamin C Administration for Cancer Any amount of oral vitamin C has not shown potential to benefit solid tumours. Infusion is more advantageous than oral administration because it gets vitamin C to the core of the cancer to switch HIF protein off. Margreet shares the story of Anton Kuria, a previous leukaemia patient on IV vitamin C who experienced remission for two years. Vitamin C restored the normal functioning of the cells and wiped out most of the cancer cells. He relapsed not because he stopped vitamin C but because the cancer cells acquired new mutations. [59:30] How Vitamin C Contributes to Quality of Life Vitamin C regulates adrenaline and boosts energy because it is key to making molecules that help energy production. It also alleviates the side effects of chemotherapy. Vitamin C also improves brain fog, concentration, mood, pain, nausea and fatigue. It does not interfere with other cancer treatments. [1:06:02] Applications in the Clinical Setting Vitamin C is probably not going to kill cancer, but it can control it. Vitamin C gives an insight on how to manage the disease in the clinic. The excellent response to vitamin C is an opportunity to make it work better with other treatments. There will almost certainly be a quality of life benefit. It can alleviate the side effects of cancer and the disease itself. The beneficial effects manifest, so it is worth doing. [1:16:56] What Needs to Be Done? We need to figure out how to apply vitamin C clinically and under specific circumstances. Give people the best information so that they can make the right choices. With better information, clinicians can also make informed choices for the benefit of their patients.   7 Powerful Quotes from This Episode ‘All of these things that cancers do to promote their survival is mediated by this response, and right at the center of this is the vitamin C off switch’. ‘Vitamin C is a very labile molecule, so very easily lost. And if you're not putting in more supply, then your body level is going to drop’. ‘If there's any wealthy people sitting out there, if you want to support this sort of research — it is absolutely essential because we're losing people left, right and center to these horrible diseases like cancer, like sepsis’. ‘I'm excited about this research, I really am, because it's going to save lives’. ‘That's why we try to do the research — because doctors have the patient's best interests at heart’. ‘Our clinical people, they’re at the coalface, and they're having to make life and choice decisions for their patients all the time’. ‘Many cancer rates significantly decreased by up to half for a number of cancers if your vitamin C status is good rather than bad’.   About Professor Vissers Professor Margreet Vissers is a biochemistry academic from Waikato University and is currently the Principal Investigator and Associate Dean (Research) at the University of Otago in Christchurch, New Zealand. She has written and published journals and books about how vitamin C can help cure and prevent cancer. If you want to learn more about oxidative medicine from Professor Vissers, you may contact her at margreet.vissers@otago.ac.nz.   Enjoyed This Podcast? If you did, be sure to subscribe and share it with your friends! Post a review and share it! If you enjoyed tuning in, then leave us a review. You can also share this with your friends so that they can learn more about vitamin C. Have any questions? You can contact me through email (support@lisatamati.com) or find me on Facebook, Twitter, Instagram and YouTube. For more episode updates, visit my website. You may also tune in on Apple Podcasts. If you would like to work with Lisa one to one on anything from your mindset, to head injuries,  to biohacking your health, to optimal performance or executive coaching, please book a consultation with Lisa here: https://shop.lisatamati.com/collections/consultations Lisa's latest book Relentless chronicles the inspiring journey about how a mother and daughter defied the odds after an aneurysm left Lisa’s mum Isobel with massive brain damage at age 74 and the medical professionals told her there was absolutely no hope of any quality of life again. Lisa used every mindset tool, years of research and incredible tenacity to prove them wrong and to bring her mother back to full health within 3 years. Get your copy here: http://relentlessbook.lisatamati.com/ For Lisa’s other two best-selling books Running Hot and Running to Extremes chronicling her ultrarunning adventures and expeditions all around the world, go to https://shop.lisatamati.com/collections/books. For Lisa and Neil’s online run training coaching, go to www.runninghotcoaching.com. For their epigenetics health program all about optimising your fitness, lifestyle, nutrition and mind performance to your particular genes, go to  https://www.lisatamati.com/page/epigenetics-and-health-coaching/. For Lisa’s gorgeous and inspiring sports jewellery collection ‘Fierce’, go to https://shop.lisatamati.com/collections/lisa-tamati-bespoke-jewellery-collection.   To pushing the limits, Lisa   Welcome to Pushing the Limits, the show that helps you reach your full potential with your host Lisa Tamati, brought to you by lisatamati.com.   Lisa Tamati: Welcome everybody back to Pushing The Limits. This week I have Professor Margreet Vissers with me who is sitting in Christchurch. Now Professor Vissers, I'm just super excited. I'm a little bit nervous and excited to be talking to you today. Margreet, so can you tell us firstly, what your background is? Give us a little bit of context. You have a PhD done, free radical research and oxidant research from what I understand, and now you are very much deep into vitamin C research. Can you give us a bit of your background first? Professor Margreet Vissers: Okay, yeah, yeah. Morena, Lisa. it's lovely to chat with you. I've trained originally as a biochemist. So when I was at Waikato University, I had this lecturer who kind of got me excited about biochemistry, it was a new thing at that time. And so I continued, that's become my passion, just understanding how things work in our bodies. So, I became interested in white blood cells. When I was doing my PhD, my PhD was on white blood cells that fight infections.  And something we know about white blood cells is that they need a lot of vitamin C. They have a lot of vitamin C and we never knew why. So, all our white blood cells have a lot of vitamin C. So, there was always this question as to why do they need that. And that kind of percolated away in the background while we were researching other things. And then one day, these experiments where you added vitamin C and to kind of knock out any oxidant fixed because it's a well-known antioxidant. And it has this remarkable effects on the cells that I was working with which was the complete opposite of what I had expected. And when this happens in the lab, you usually think, ‘Are my samples in the wrong way’? I've got the best hunches.  So instead of acting as an antioxidant, it seemed to be enabling cell death. And which was like really paradoxical. And, and so we did it again. And you know, same thing happened again. And not only was it a really strong effect, which antioxidants usually are, they're usually more graded. It was also an on-off event. So, if there was no vitamin C, it didn't happen. And if there was just a bit, it happened really well.  And so we're looking for another activity. This is not an antioxidant, actually. We're looking for a different kind of function. And so this was in about 2001. And at the same time—so that wasn't work with white blood cells, that I was doing that, and that was a cancer work.  And so, around about the same time, there was a discovery made overseas about this new class of enzymes that regulates hypoxia, the hypoxic responses, survival response, and that those enzymes require vitamin C to function. And I realized that what I’d—because I've been gone on thinking, ‘If it causes cells to die. Maybe it does this in white blood cells because that's the one thing that we need our white blood cells to do’. Apart from kill bacteria, we then need them to die themselves off. Lisa: Yes. Prof. Margreet: And to die tidally. Without, we need them to devastate the tissues around. It's a very controlled process. And I thought, ‘Maybe that's what vitamin C is doing in the cell. That it’s regulating the cell death pathway’. And so I did these experiments with white blood cells that didn't have any vitamin C and essentially showed that exactly to be true. That if white blood cells were low in vitamin C, they did not go on to resolve this what would be the end of an infection. So… Lisa: So they wouldn't end up... Prof. Margreet: They would end up. So, normally you have your white blood cells that kill the bacteria. They then destroy themselves in that process, because it's an endpoint reaction, and we need to clear those white cells. And so you need to clear them. They're full of all kinds of toxic things. You need to clear them in a way that doesn't spill all that toxicity into the tissues. Other white blood cells come along and eat those white blood cells. So they—it's like wrapping your garbage.  So that if they didn't have vitamin C, that didn't happen. So, the other white blood cells would come in, but they basically couldn't see those other cells around them. And so they get the cell death and cell leakage. And I thought, ‘Ah, so scary. There's all kinds of things that happen when you're low in vitamin C’. And so this, and then I realized also that actually, this factor that controls this process, is also the thing that allows cancer cells to grow. And, and so this is a normal response in ourselves, and we need it for survival. You know, I swear, every day survival is dependent on this process working well.  Cancer cells hijack the system to enable them to survive. And so, that means that it allows them to grow outside of an oxygen supply to make new blood vessels, to create a different energy source, so they can live on sugar instead of a more complex energy. It enables them to evade chemotherapy and enables them to undergo metastasis. All of these things that cancers do to promote their survival is mediated by this response, and right at the center of this is vitamin C off switch. Lisa: Code that. So can we just pick up just a tad there. So, I've listened to a lecture by Dr. Berry Fowler that we mentioned earlier, talking about NETs, Neutrophil Extracellular Traps. So, is that what we're talking about here? So the neutrophils are coming along, eating the bugs?  Prof. Margreet: That's a variation on that thing. So yes, neutrophils are astounding cells. And so, their function is to kill bacteria. The primary way that they do that—so they are attracted to any place where there's an infection. The primary way that they act is to first of all, eat the bacterium so that one neutrophil can swallow hundreds of bacteria. And then inside that pocket inside themselves, they pour onto those bugs within minutes, toxic enzymes and oxidants, including chlorine bleach that kills the bug.  So, what they also do is they can inject from themselves, from the cell, they can inject their DNA. They can kind of melt the nucleus inside the cell with the DNA package. They can unpackage that, and then they can inject that from the cells, and that's what we call a niche. And that niche is coated with some of those microbicidal proteins. DNA is, as you might have seen pictures of it, that's a really sticky line… Lisa: Yes, like egg white. Prof. Margreet: …molecule. And so that can basically go a long way, and it doesn't degrade very easily. So, your body doesn't have a lot of DNAs floating around that can chew up DNA. So, these traps can sit there and they trap the back. They literally physically trap the bacteria onto the site of the infection. So, that can basically help localize that infection so that it's not traveling to other parts of the body. Lisa: Does it even cause things like, if this infection was, say in the lungs, you'd get whiteout and that's the whiteout. Actually, what you're saying… Prof. Margreeet: The whiteout in the lungs is either lots of neutrophils, just a lot of neutrophils, or a lot of fluid. Where we're seeing new neutrophil NETs, or their traps, and in the lungs as in COVID patients. So, there are these peculiar things going on in the lungs of COVID patients, where they're seeing quite localized and didn't wash out. So, not the kind of diffused whiteout that you see in a pneumonia, someone with respiratory distress, but very localized pockets. And we think that looking like, as all this information’s unfolding pretty much as we speak. It looks like neutrophil NETs central to that process that enhances that cytokine storm in COVID patients who end up with severe disease. So currently, the literature is jumping with… Lisa: With vitamin C, and what would be helpful or not in the COVID scenario? No one's know it yet? Prof. Margreet: No, it's not jumping with vitamin C and COVID. The Chinese, interestingly, published protocols for how to handle COVID patients. And they have they recommend, as soon as the patient comes into, into the hospital, should be giving them intravenous vitamin Cl to keep them out of ICU. And, or as soon as they get into ICU, to prevent them progressing. They've got very careful protocols about… Actually, their protocols say that helps. This is definitely a helpful step. We haven't taken that up, the rest of the world, despite some people advocating for it. Lisa: So why would that be? Is it because… or we don't want to go into that?  Prof. Margreet: That's a very good question. I've struggled with answering that question we come up against it all the time. That people will give vitamin D before they get vitamin C. Even though people have been—we've shown that patients who are really ill, have low vitamin C, unless you give them more.  Lisa: So, the sicker we get, the more vitamin C—and I've seen some of your lectures where you've shown graphs of people coming into hospital, and then the levels of plasma vitamin C are very low compared to the generally well, population. And I know from other research that I've done too, in this case, like my father's with sepsis. He would have been probably at the level of scurvy. I can't show that because they couldn't explore it, and would have been needing massive dosages of vitamin C. So the sicker we are… so, this is what's funny people is that animals produce their own vitamin C. The goat is the king of vitamin C making. I believe from Linus Pauling’s work. And the goat can produce up to 70 grams a day of vitamin C. We don't Prof. Margreet: So yes. All animals bear a few, make their own vitamin C in the liver, and some animals in the kidneys. There's a few miscellaneous animals, including all primates, of which we have one—so, chimpanzees and gorillas and monkeys in us, who way back, lost the gene to make it. And so we're dependent on eating it. Guinea pigs similar, and fruit bats are the other most common species.  So, we're dependent on eating it for our supply. Now, all animals that make their own, make it according to demand. So, they keep their blood level saturated, no matter what. So if they get sick, and their body starting to consume more, their liver makes more. And so they just keep themselves saturated. And they can increase production up to 100 times, in order to maintain that level. So we can't do that. So we're totally dependent on what we put in our mouth.  And so, once we get sick, and our bodies consuming more, if we're not compensating for that, then our body levels will decline. So it's totally about supply and demand. So, when you're normally well, your body's just ticking over a little bit. A good diet is good to keep you optimal under those circumstances. You get a cold, you're consuming a little bit more. Now most people, when they get a cold, they run off and get some citrus or something because that's what that feels like eating them naturally. If you get a flu, that demand goes out even more. If you get pneumonia, it goes up even more. And so the sicker you are, the more vitamin C your body's consuming. Not all. Some illnesses are more oxidative than others.  But any infection, like the minute you ramp that up, and that can be like a local infection. It can be burn infection. So it doesn't have to be like a whole body infection. We just recently did this—have been doing a study with people with chronic wounds like leg ulcers, and most of those people have low vitamin C status. And that won't be helping the wound. So as soon as your body has a demand to put on it, vitamin C is a very labile molecule, so very easily lost. And if you're not putting in more supply, then your body level is going to drop. Lisa: And then we're also limited out with the oral administration of vitamin C. Our bowels can only tolerate, before we get diarrhea, or something like that. So if our power intake to the levels that we might need if we were severely ill, we wouldn't get up—because our plasma levels only go to 100 micromolar from what I understand. We can't actually get higher than that from all dosing. Prof. Margreet: Oh well, only a little bit transiently. So, if you wouldn't take a one gram tablet, your plasma level would go up to above 100 for a little while. So maybe that might get up to 150. But your kidneys will clear that. And so I always kind of give the analogy of a dry sponge. So if you imagine that you're pouring water on a dry sponge, that your body is... Your blood is only the delivery mechanism, so vitamin C is going to get from your blood into the cells. If your blood levels are low, your tissue levels will be low. So that's a dry sponge.  So if you pour more vitamin C onto there, it will go into circulation. But as soon as it's in the blood supply, it will be sucked out into those tissues. So your kidneys will never see that above 100 micromolar. Once your tissues are saturated, so the whole sponges which you might, if you pour more on and then you touch, and then your blood supply goes up over 100, stays over 100 because your tissues are not taking up any more than they need. Then there's a filter in the kidneys that regulates that all vitamin C passes out, and then it's like, ‘How much is in the bloodstream’? ‘Do I need any more’? ‘And then I'll take it back up’. So it gets taken back up or not. And if the body's got enough, then no more be taken up and end up down the toilet which is fine. Lisa: Yes, it's not going to hurt you. But if so, then intravenous vitamin C has a different mechanism though, isn't it? We can get the micromotors up quite high. Prof. Margreet: Intravenous delivery is such fast, express delivery. And so it's to be what—it can do two things. What we think, it can be useful in under two circumstances. So normally for your day to day health, oral intake, this is ample. If you are really—a lot people in ICU, or who are people with severe pneumonia who are turning over vitamin C at a great rate, it's really hard to get like you might need to give those people seven or eight grams of vitamin C a day, in order to restore, get their plasma level sit close to normal. So it's hard to give that amount of oral intake to people who are that sick.  And so under those circumstances, the easiest thing to do is just to inject that, and that's what we call infusion. So then you bypass the gut, you can just infuse it straight into the circulation. And the rate of infusion determines that that plasma level will be very high for a very short time, then it will go out into the body where it needs to be. And any excess will pass out. And then urine. So after about eight or nine hours, you're back to normal. But your tissues, your sponges. Lisa: Yes, so that they are in what they need. The vitamin C that's actually in the cell will stay around longer than, won't it? And do its actual job, if it's in the mix. Prof. Margreet: It's doing its job, that’s right. So those cells that had become depleted and now have a function restored. And what we've discovered is, it's not just one function anymore. So in the last 10 years, vitamin C has been shown to be involved in supporting... So initially there—everyone will know about... Walk into any chemist and you'll see vitamin C creams for sale, cosmetics. Rub it on your face, or whatever. But because we all believe that vitamin C is good for our skin. And it is good for your skin, actually. It's really good for your skin. But getting a few rubber done, it doesn't actually get into your skin when you rub it on.   Lisa: Right. Don't waste your money on expensive cream. Prof. Margreets: We know that... That's right. We know that it makes collagen juicy. So the enzyme that makes collagen, that needs vitamin C to work, was the first member of a family. Of about at the moment, there's about 60 members of this family. So, and apart from making collagen, they do all kinds of other things. So including regulate all about gene expression. So what we've discovered is that, it's really important to support enzymes that determine how your cell function changes. So… Lisa: It reads the DNA so to speak. So this enzyme, one of these enzymes.. Prof. Margreet: These enzymes apply or remove marks from the DNA that say, ‘Read this gene, or don't read this gene’. And that's changing all the time. As cells respond to different stresses in different scenarios, and go through different growth phases. And vitamin C turns out, is absolutely critical for that process to be working well. And so you know, sort of… Lisa: This kind of fit everything in the body. Pretty much like every single cell in your body. Prof. Margreet: To greater and lesser extent.  And so that said, that's at the most fundamental level. It seems that that process is actually quite extraordinarily sensitive to changes in Vitamin C. So, I kind of make the analogy, about a car running, when running on three cylinders, or two cylinders, instead of four cylinders. Yeah, you can still get it to go along the road. But, you know you're not getting the best ride… Lisa: Not the best of your motor. Prof. Margreet: ...that you might get. And so you know, it is we're discovering so many things, so many fundamental processes that require vitamin C to work optimally. And also that they are responsive to small changes— relatively small changes in vitamin C status. So there are mood enhancing enzymes that do the same thing. We've just published a study with students from Otago, who are all extremely well. Probably one of the wealthiest populations we've ever studied but they don't eat well. When we gave them kiwi fruit today, it just brought their vitamin C levels up. They felt well, then they’re already well.  Lisa: They're already healthy. They don't have... Prof. Margreet: They are surely well. So, they were—and even not at the extremes of deficiency. So it's like you can… we should be where animals are—optimal all the time. The dialogue around vitamin C for decades and decades was about avoiding deficiency. The only thing that became a problem was when you had scurvy, and were dying, and anything else was fine. And so what we're discovering now is that—it’s not fine. You need to be the best you can be in order to avoid all kinds of scenarios. So it's… Lisa: It's about optimizing… Prof. Margreet: Probably the most, of all the vitamins that we've—well actually, vitamin B6 has a very fundamental… But probably the most diverse in that section of all the vitamins. So it's doing many things, in many places that affects an awful lot of functions. Lisa: So we're talking like inflammation, wound healing, infectious states, and controlling infection. We're talking about skin collagen production... Prof. Margreet: Absolutely, our brain is loaded with vitamin C. Lisa: Well, it is one of the biggest users of the vitamin C. Prof. Margreet: Yes, yes. So it's… Our brain is very hungry for vitamin C. So it's near for many reasons, including the support of molecule size serotonin, which is like your feel good moods. The production of other hormones that regulate mood reproduction.  Lisa: Yes. Yes. Yes.  Prof. Margreet: The list goes on and on. Lisa: My mind just goes wow. This could help with things like brain injuries, which I'm heavily into helping... Prof. Margreet: Yes, absolutely. Absolutely. Lisa: And RDA is one of the lowest in the world, isn't it? It is 45, I think milligrams or something ridiculous. That is not okay. Why can't we get this changed? You know we need 200 to 500 at least, don't we? Prof. Margreet: Yeah, there is a recommendation from the Ministry of Health that 200 milligrams a day as the recommended target for wellness. But RDAs are a confusing measure because they're actually the number at which 90% of people will avoid deficiency. So which is, right at the bottom, what do we need, in order to not die, basically? And so that message gets a little bit confused with, ‘This is how much we need, total’. And so 45 milligrams a day is, most countries around the world have up to the limit to at least double federal muster around 100, which is still in the minimum. But we just want bet our aims to get the New Zealand RDA…  Lisa: So maybe say one of your cats in a… I think it was work by Dr. Levine or [29:00] Maggie’s showing the rates from the 45 milligrams type thing up to 2.5 grams a day. It was a steep curve. Well, 50 milligrams in 500, where you get a huge benefit and then, even if you wanted to optimize, you could go even up to two and a half.  And of course then if you have one, oh no some horrible disease, or you have a lot of stress, or you have cognitive issues, or you have sepsis, or you have pneumonia, and then you may need like up to I don't know how many times. And that's one of the questions, isn't it? That you are trying to elucidate is that, ‘What are the dosages that we need’?  Prof. Margreet: That’s right, and I think we were hoping to hit, as instead of seating a whole new RDA for everything, is to have a recommended intake for different conditions.  Lisa: Absolutely. Prof. Margreet: So that you'd know if you hit a few, or if you do have a medical challenge of some sort. They use vitamin C infusions for burns patients. Lisa: Yes. Prof. Margreet: Because we know that burns patients chew through vitamin C. So that kind of massive inflammatory response does require your body who needs to be given a lot more vitamin C. So there is your, I can recommend it to intake for burns patients.  Well, if we knew that, when you have the flu, ‘Here's your recommended intake’. But when you have, if you have issues with this or that, you should be taking this amount. So which I think might be easier for people to get their head around than just one level, because we think that if we sit a daily intake aimed at alleviating illness, then that's normally not that achievable through our daily diet. And so you can't see it as an unachievable target for people to take vitamin C that they can't get from their diet because... So we always recommend food first and that is, so, 200 milligrams a day is what you would get if you did as you were told, an eight five plus. One of those five of the high vitamin C food, then you'll be fine.  Lisa: You're in the range. Prof. Margreet: So easily. So one kiwifruit, or some capsicum or a good amount of broccoli, or just if you can mix it up. But if you are eating a good range of fresh fruit and vegetables, you would be there. Lisa: But if you're eating just bananas or something that is on the five a day, but isn’t  high on the vitamin C level, you won't be meeting those recommendations. So we need to get a little bit more specific.  I want to go now into the cancer story, because I know like in the 1970s, Linus Pauling, who was a brilliant man, double Nobel Prize-winning scientist, sort of jumped in two feet first—if you like—with cancer. His studies that he did with cancer and vitamin C have extended the lives of these cancer patients that he was dealing with, four times as long.  But he sort of started a storm—if you like—of controversy, because back then there was no mechanism of action that was understood as, ‘How could this be happening’? And from there, it was sort of, plucked out of the year. Where is this vitamin C thing’?  You and your colleagues around the world have now sort of elucidated some of the mechanisms of action, and actually given some validity to what Linus Pauling was saying and later researchers. So now if we go into the cancer story, there's still—I mean I've lost two friends this week to cancer. We desperately need this research to be completed or furthered fast. So if there's any wealthy people sitting out there, if you want to support this sort of research, and is absolutely essential, because we're losing people left and right to these horrible diseases like cancer, like sepsis. We know that they're going to be beneficial. But you've actually discovered, so the HIF. I wanted to talk about the HIF protein… the HIF-1. Prof. Margreet: Yeah, that's the protein that I was mentioning… Lisa: Yes, earlier when I'm… Prof. Margreet: It’s also active in the white blood cells.  Lisa: Yes. Can you explain what the HIF protein does in regards to tumor growth, and why vitamin C is so important in regards to that. Prf. Margreet: Okay. So what is that, that's an acronym for Hypoxia-inducible Factor. Scientists are great at giving meaningless acronyms to meaningless terms. So, it’s a protein, it's what we call a transcription factor protein. So it's a protein that travels to the DNA, and switches genes on and off. These are master regulations proteins in these families of transcription factors.  So HIF is a major transcription factor that is present in all our cells all the time. Its role is to respond to low levels of oxygen. And so, if for some reason our oxygen supply is cut off. For example, if you had a tourniquet applied to a part of the end, and you cut off your blood supply, those cells in that tissue would get hypoxic. We need that not to die off. We need that to survive, that tissues, that when you restore the blood supply, that everything's actually fine. That's the normal function of the HIF protein, under conditions of low oxygen, just switch on a survival response.  It also does that, if you know has a lot of responses to basically regulate oxygen around your body. So it will, in areas where there are poor blood vessels, it will regenerate new blood vessel formation. You can't live without this protein. So we can't generate an animal that doesn't have it, doesn't survive beyond birth.  So this process is hijacked by cancer cells. So if you imagine, you will have seen pictures of a growing tumor starts off as a few cells. When that tumor, when that little clump of cells gets to be two millimeters across, it's very small, that doesn't have its own blood supply. And no oxygen will get to them, will get to the center cells, and they'll die. And this two millimeter tumor will die off. So but what happens when those cells run out of oxygen, because they switch on this HIF protein. And so when that switched on, those cancer cells now say, ‘Aha, I can make new blood vessels’. Lisa: They grow. Prof. Margreet: And it does that, it makes new blood vessels, can grow bigger. And as it grows bigger, every time it starts to run out of oxygen in the center, it makes new blood vessels. And so the tumor can grow, and grow, and grow. As well as switching on that formation of new blood vessels, it also turns those cancer cells into, ‘If I'm not getting enough oxygen, I need to get my energy from sugar now. I can't use our oxidative mechanism of energy creation’. So they become glycolytic. So then they start to depend on sugar for energy. We know that this is a property of tumors, that they're totally switched on to that. And when they get switched on to that, they stay on that. And so then they're able to become acidic, and they get all of these properties that cancer cells have. And it's all switched on initially by this protein.  And so the more HIF is expressed in your cancer cells, the worse off—the better off the cancer is, and the worse off patient is. So there's a huge effort being put on to trying to switch HIF off than cancer cells. Unfortunately, switching it off is not as easy as switching it on. And because it's switched off by a mechanism you have to turn on. And so the turning on of that mechanism requires either supplying of these enzymes. The switching off of HIF is done by these enzymes that need vitamin C. So when you supply vitamin C, you're then supplying energy to the off switch. And the off switch will dampen down that tough response. So that means doesn't come on as easily, you know, much how you keep it going...  Lisa: Not grow as fast... Prof. Margreet: And the HIF is ramped down and the cancer will grow more slowly. So that's one mechanism that we have now very good evidence for, indicating that giving vitamin C to cancer cells… Lisa: Slow tumor growth treatment  Prof. Margreet: … is a really good idea.  Lisa: So this, I saw another one of the charts with the mouse model that you had on the tumor growth showing the ones who had the vitamin C, the tumor growth was much slower than the ones who didn't, so that was because the HIF was switched—in effect switched off by the vitamin C. Well, I'm excited about this research, I really am. Because it's going to save lives. And this is the whole point of the call. And I don’t know if this conversation gets a little bit scientific, but hang in there with us people because this stuff's really important for life.  So can this prevent cancer? So if I want to be prophylactic, I want to be like, I don't want I've got cancer, perhaps genetically in the family, and I've got a higher risk. Can I take higher dosages of vitamin C with the hope of keeping the HIF from ever been switched on? Would that mean... Prof. Margreet: We know that having optimal vitamin C makes it harder to switch that HIF on. The other thing we know, it's very hard to prove any kind of preventative action, because you need to have huge studies to do that, with thousands of people. Those studies that… there's a lot of epidemiological work out there that has looked at people's vitamin C status, and their susceptibility to different cancers. And so, but there can be many factors can play a part in that, and we don't know whether that's just the HIF, or whether that's a boost in your immune surveillance, or whatever functions there may be. But many cancer rates significantly decreased by up to half for a number of cancers, if your vitamin C status is good rather than bad.  Lisa: Wow. Being over the 50 micromolar level...  Prof. Margreet: Yes. So if you’re—people who are that kick themselves to optimal level, have lower incidences of many diseases, actually. And they live longer, and just all measures of well-being are improved. But they also have much lower cancer rates. Lisa: Wow, so there's a reason, even if we don't have the whole answer yet for dosages and so on, would be to keep your vitamin C levels at the optimum, not at the minimum, your entire life, if that’s possible. What you mentioned before that there is a technology that's perhaps underway, that will be able to just, with a fingerprint, a prick of blood, be able to tell us what is in our blood, that would be amazing. I want one of those exactly where we are. Prof. Margreet: I think your doctor’s surgery once… Lisa: Yes, they definitely don't, because that would be just gold. I mean, in a situation like with my dad at the hospital, I couldn't get a vitamin C test to prove that he had a nutrient deficiency and so therefore, didn't treat the nutrient deficiency because I couldn't do the test. Prof. Margreet: Yeah, it's very difficult. It's a very… it's not an easy test to do. And so a lot of standard labs don't do it regularly. So you got to be fussy with the blood sample. And it's often a challenge in a clinical setting. Lisa: Okay, I hope that they do manage to do this because this would be very beneficial for everybody's health, because it's everything from heart disease to blood—we mentioned collagen to having good skin, to all of these sorts of things. But we would be well advised to make sure that we are getting our optimal vitamin C dose.  Is there a danger, like I’ll be completely upfront, I have an intravenous vitamin C once a week at the moment and my mum's on it for once a week. I won’t keep that up forever. I'm also taking oral vitamin C as well. I usually take between two and four grams a day, and I'm not saying that I recommend that for anybody but that's just what I'm doing because I want to... There is no toxicity with vitamin C, is there? There's no risk, I mean on one hand an expensive way but that's... Prof. Margreet: Yes well. No, no toxic dose has never been identified, provided you have good kidney function. So you do need to be on the clear. If you can't clear it, or if you're dehydrated, and you're not producing any urine, you'd need to be on the clear because it will oxidize in your body. And when it does, those oxidation products need to be cleared out. And so you know it is, that’s the waiver.  So your body clears it to 100 micromolar for a reason because you don't actually want to have massive amounts running around all the time. And providing your tissues is saturated, any additional excess that you put on, it's not going anywhere, just going out. Lisa: So I had down Dr. Ron Hunninghake on the podcast a couple of weeks ago there. He's a doctor from the Riordan Institute. I don't know if you know the Riordan Institute. And he said he's overseen personally as a doctor over 200,000 IV, vitamin C sessions, if you'd like. And I said to him, ‘Well, you know, one of the arguments that I face with doctors with my dad, was that it could damage his kidneys’. Apart from the fact that they did damage your kidneys too, which was my argument back. They said that kidney stones could be an issue. And that was one of the problems.  Dr. Hunninghake, I posed that question to him. And he said in his 200,000 IVs, he's had three people with kidney stones, but they all had them previously. And he doesn't think there is—again, he hasn't done the clinical studies—but he doesn't think that there is a huge risk for kidney stone formation that is also dependent on the calcium being in the kidneys from what I understand. So that that is one of the arguments. That is… Prof. Margreet: That's right. Yes. Because it’s the thing you will hear. It’s the first reason why you wouldn't want to take vitamin C. And I think we are trying to… it is important that you can clear it. So you do need, and I think for, rather than causing kidney injury, you don't—You need a functioning kidney. You need functioning kidneys to clear it. Otherwise, you will end up with problems. But anyone who's given an infusion is usually tested or checked for that. But... Lisa: Or in a case, like with dad’s, there wasn't any option. So like, it was that or nothing. He wasn't going to survive. Prof. Margreet: You only need to clear... as long as you're making urine. Unless your body is, as you know, completely deficient. It is something that you need to lift. So it's a little bit… do say to people… if our patients are dehydrated, we give them a drink, right? Because we give them fluids if they're dehydrated, we give them fluids. So if your body is missing something that it's supposed to have to function, should give them some. Lisa: Yes, it would be a simple thing, especially if we can test it. Prof. Margreet: It would not, it's not a big deal, really, to give them some. I think the cancer story is a little more complex than that. Because what we think with solid tumors is that,  because any amount of oral vitamin C has not been shown to benefit solid tumors paricularly. And what our hypothesis was, is that if you give intravenous vitamin C, you achieve a higher level in the plasma. So you're basically trying to get the vitamin C to the place where the vasculature is poor, which is that hypoxic center of the tumor. The oxygen can't get to because the blood vessels are poor, vitamin C can't get there either. And you need both to get there. So… Lisa: To kill the chamber basically, Prof. Margreet: ...to switch that HIF off in that place. So we think that if you give infusions, then that increased dose actually gets to that core of the tumor. Lisa: And this is where? Prof. Margreet: So this is where an infusion is an advantage than oral vitamin C. This is where Linus Pauling got into, where he got into strife bit, and he was giving intravenous doses. He maintained that they had an additional benefit. The conditions at the time, didn't believe that. And they repeated his experiments with oral dosing, and found it to have no effect. And so he didn't, that time we didn't know about half, and he didn't. So he was arguing back and forth. And so it just became a bun fight, actually. There was no resolution, and a lot of acrimony, and never did the cause any good for him, or the clinicians either, and certainly not the patients. Lisa: This is such a shame, really, because it is also something. Prof. Margreet: So, kind of tone was set at that time. And, and it's taking a long time to pick that conversation. I think now we have not only the health mechanism, but we have these epigenetic, or the genetic regulatory enzymes that are also involved in many cancers. And in fact in a number of cancers, those enzymes are the mutated enzyme. They're the mutation in those enzymes that will drive the cancer. It's very common in hematological cancers, common in some glioblastoma, so brain cancer, and bowel cancer.  So there are two mechanisms whereby vitamin C might work. And so, we have just recently shown with myeloid leukemia that if you have a mutation in that enzyme, and you give additional vitamin C to those cancer cells, then… So if you have a mutation, you have two copies of every enzyme. If you take one out, 50% left. That 50% is trying to do the job at a hundred percent, and it isn't able to. So if that enzyme, that last 50% needs vitamin C given a vitamin C boost, within upping its level, you can upregulate it. And we think that it's now restoring normal function to those—they didn’t stop behaving like cancer cells...  Lisa: And actually... Prof. Margreet: ...and just behave like normal cells. And so this would be a great treatment adjunct for chemotherapy.  Famous illogical cancers, because you now have cells that would respond normally rather than be these aberrant, crazy cells.  Lisa: I know that you had a case, so I won't mention the name in case and that's not okay. But I know that you… Prof. Margreet:  Oh, it is okay to mention the name.  Because Anton's family have actually asked me to mention his name. Lisa: Okay. So yes, I heard about Anton Kuraia's journey with leukaemia and how he had intravenous vitamin C, and that put him into remission. And he unfortunately lapsed later on and if you pick up the story there, but you got a tissue analysis, or you managed to get some tissue when he relapsed later on. In the two enzymes, the TT2, is it? And the W . . .  Prof. Margreet: That's one of these enzymes. So Anton is the case that we've learned a lot. And he, very generously when he read that… So he had this turn around, like a miracle response to vitamin C. And which really piqued our interest at the time we didn't know about the TT enzymes, and I almost lost my money on that. And thought, he wouldn't surprise me if he had one of these mutations, but he was in complete remission for two and a half years. And while he maintained a vitamin C regime, so he was taking it continued with intravenous vitamin C, each injectable, for couple of weeks, or something during that time. And when I spoke with him, I said, ‘You know what? I'd really like is I'd like to figure out just why this has happened and lapsed some of your cancer cells. But you haven’t got any sign’, which is great. Lisa: Yes, which is great.  Prof. Margreet: And we had no idea, quite what was going on, and how long that remission would hold for. And, unfortunately, two and a half years later, he relapsed. But at that point he said, ‘You know how you wanted some cancer cells? Well, I have some, and I don't want to know that’. But he pushed through and sent us a sample. And it was of his bone marrow, which, we had one sample, and I'm like, ‘Well, we need to think about what we do with this one’. We had a really good plan. And, and we managed to get a bit of funding from the local bone marrow cancer research trust for a project. And they're like, ‘If you got a good project’, and I’m like, ‘I do actually have a really good project’.  So I put a young post-doc onto that, who has been absolutely marvelous, and together with the clinicians in Auckland, we tracked down the risks of Anton samples that were in the Auckland clinic, and ran the DNA analysis, the genetic analysis on his cancer, and discovered that he had not one but two mutations that involved a requirement for TET2 activity. And so both of the clients, so myeloid leukaemia is a clonal disease. One clone can have one mutation, another clone can have another mutation or both. They're two clones, each one with a mutation that required TET2 or a feature TET2 activity. Both of those clones were wiped out by the vitamin C.  Lisa: Wow. So they kicked them alive? Prof. Margreet: Yes, yes. But what we discovered was that, that didn't wipe out the cells completely because that one of the clones came back. Lisa: Was it because he stopped the vitamin C, like if… Prof. Margreet: What we discovered was that when it came back, that clone had acquired additional mutations, as they do often. And so cancers do that, they cause you to be more and more aberrant as it continues. So the original mutation was still there, but so were additional mutations. And so the second time around, the vitamin C treatment worked a little bit. It seemed like it was trying to work. He went and had more chemotherapy. And then that didn't work, got sent home again. With weeks to live anyway, back onto the vitamin C, and got better. But the blood cell count never came down to zero again, and… Lisa: So basically the cancer was stronger the second time with more aberrant mutations. Prof. Margreet: Yes. But he didn't, he didn't seem to know what's going on. But my gut has got really good. Lisa: So something was, so that brings in the quality of life because that's proven, isn't it? If you're having to have chemotherapy, and having vitamin C can be very beneficial for quality of life. Least fatigue, least nausea, all of those sorts of horrible things that happened to poor chemo patients can be... Prof. Margreet: That’s a story we believe, of just replenishing the depleted supply in your body. So basically, you're giving your body these toxic cocktails, you're expecting your body to function, and then respond. And at the same time that's running out of a vital nutrient. And so if you, if you can restore that, then your fatigue levels… so one of the things that vitamin C does is it supports the promotion of energy. So it regulates adrenaline. Absolutely key to making adrenaline, to making molecules that support energy production, energy metabolism.  And so, if you're starting to run low on those things at the same time as you're undergoing the chemotherapy, what can be written off as a side effect of the chemotherapy can be alleviated. A few can restore some of those normal functions. So a lot of the kind of brain fog, things, ability to concentrate, mood things, pain, and nausea and fatigue, a lot of the measures improve. Lisa: Wow. So that alone is a reason to be considering it. Prof. Margreet: It's a very important consideration.  Lisa: Absolutely, it’s quality of life.  Prof. Margreet: Absolutely, as far as we can tell, it does not interfere with any other cancer treatments. Because that's the other worry that people have, doctors have, that, ‘I don't know, because it might interfere with the treatment I'm trying to give you for your cancer’. Lisa: And this is a problem when people go to their oncologist, their local oncologist. They’d be saying, ‘Don't do vitamin C’. This is why this information is so key to be able to share it. Prof. Margreet: Well, that's why we tried to do the research. Because doctors have the patient's best interests at heart. And they worry when patients come in and say, ‘You know, should I take this? Can I take that’?and they're throwing everything they can at the cancer. And they worry that something else that you’re doing might work against that. And so they are always very cautious and rightly so. Because we want our doctors to be working from evidence, from an evidence base.  And currently, we don't have those answers here. That we can absolutely say… I mean, this is why we're working so hard to try and identify the causes, and how vitamin C is working. So that then we can give that information to the clinicians, who can then put that together with their patient information and say, ‘Well, for you on this drug, this will be fine. You do that, you know, and in fact, it will help with this and this and this’. So or, ‘Under these circumstances, now, I'd rather you didn't do that, until you've got this out of the way’, or whatever. So we can manage better advice and give patients an idea as to what they can expect.  So like, with the haematological patients, we’re starting to identify what genetic subgroups of the cancer might respond. So then you might be able to say to you, to a cancer patient, ‘Looks like you've got this mutation. This is very likely to be helpful for you’, or ‘It looks like you don't have this mutation. It's unlikely that it's going to help you. You can try, but it's unlikely’. So we can be a little bit more… Lisa: more nuanced? Prof. Margreet: …real, rather than just a kind of blanket response. Lisa: The hard thing is and when people are in dire straits. You haven't got the luxury of waiting another 10 years perhaps until the research is done. And so you're in this catch 22 type of situation. And you have to, as a patient or looking after a loved one, sometimes make calls on the direction that you are going to go based on this that you acknowledge without actually having 100% proof in. This is an argument that nobody can really win because I mean, it's a really tough situation.  And I certainly, with it with my dad, but in with my mum's story as well. And so I understand the frustration of people and what they’re going. But with Anton for example, he obviously went and got the intravenous vitamin C, prior to it being proven to help, and it obviously gave him a few more years.  Prof. Margreet: That's right. And at the moment, we're at the point where we're learning a lot from patients like that. If he hadn't done that, he hadn't done that, no one would have done it. And we wouldn't know what we know now. And we're learning from other patients like that, as well. So let's see… Lisa: Anecdote versus... Prof. Margreet: So there is anecdotal evidence, what I say to people and often get asked by cancer patients, ‘Should I do this or not’? One of the things that we're learning and we've learned, we are moving the story forward. The things that we've learned, even from Anton's case, is that vitamin C is not probably not going to kill your cancer. So in his case, even when he went into complete remission, the vitamin C was controlling his cancer. That was it. It didn't eliminate it. So that knowledge is gold. Lisa: Yes. Actually. Prof. Margreet: And because that gives us an insight into how we might manage that in the clinic. If we were going to do this in the clinic. We would know that if we're seeing a response from a cancer patient, we're seeing a good response to vitamin C, there’s an opportunity. It buys you more time. But it can give us insights into how we might work better than with other treatments. So that information is gold.  The one thing that you know, I can understand entirely how any individual cancer patients like, ‘Well, I need the answer now. I have this in my own life, with my husband. I'm not waiting for the research. I’m not going to wait for that’. Lisa: Exactly. Prof. Margreet: ‘You need to announce it now’. But suddenly my priorities can then change upfront. I now have voice inside and I want, ‘We want an answer now’. And so, as far as, you know, the vitamin C treatment does, I often think, ‘Well, what would I do myself’? And I think from what we know now, knowing that, we know, there will be a quality of life benefit. Almost certainly. And that in itself would be worth raising payment for. So just to alleviate, as many of the horrible scientific treatments, and the disease itself.  Secondly, is that, if what we know is that if you are going to see a benefit from vitamin C infusions in cancer, you would see it quite quickly. So, this is not something that would take months and months to manifest. So, if it were doing something, you would notice something quite, quite soon. I mean, Anton's case was quite remarkable. In a case with a cancer like that, within two weeks he was beating it. Nearly tears.  Lisa: From nearly dead to better.  Prof. Margreet: A month later, he had a bone marrow biopsy taken. And he was back to normal. So if it's going to work, and I think even with a solid tumor, if it were having a beneficial effect, you will know quite quickly.  Lisa: So it's worth doing.  Prof. Margreet: So if you wanted to try, then you first try, but you have to pay to try.  Lisa: You have to find a doctor to do it.  Prof. Margreet: So it is, there are good people around who . . . It’s an unproven treatment. Lisa: And that's what you're working on.  Prof. Margreet: And so, we're trying to move that story forward. It's inordinately slow. Lisa: And it's a shame that the arguments, or the problems, the controversy that has surrounded the original research, if you like, has colored some of the reactions you get, now. You get this polarizing effect that hopefully reason will calm things down eventually. We can just talk about the scientific evidence, the evidence, the evidence, the evidence. And then perhaps we can just bring it back down to a non-emotional level. Because as a loved one who's just lost somebody, because I believe we could have had a chance to get him back, my dear back, if we had had access to vitamin C from day one, but not day 14. It's hard not to be emotional about that.  Prof. Margreet: Absolutely. It really is. And I can understand that entirely. And this is why we're not giving up. Lisa: Yes. But it's so important, the size, it’s so important. Prof. Margreet: But the controversy around this is what it is. I’m trying very hard to walk a line between that were drawn by either side. And my argument is always, for what do we actually know, and what if we actually measured?  And let's just stay with it? Because we can… I thought that's what I’m trained to do, actually. So that's what I should do. The narrative is being influenced, I think the discovery of the new enzyme activities is helping a lot. Because people are starting to see how it might work. And just showing how it's working, is very key to getting people to accept what just what they need to do. So, little by little.  Lisa: Little by little we’ll get there.  Prof. Margreet: Little by little, I hope I live long enough to... Lisa: Long enough to… yes. In the meantime, we can make our own educated… This is what—that you've coming from a scientific background, I'm coming from an anecdotal background, or a background of I have to make decisions, life and death decisions for my loved ones. I'm going to take certain risks because the alternative was not a good one. And so, I think both—as a loved one of a patient, I desperately need that research to be done. I want that hurried up. We all want it, we want the results.  Prof. Margreet: Me too. I want it hurried up. Lisa: And meanwhile, I'm going to make some educated decisions myself, on what I do for me and my family. And I think that's the best approach that we can do. Because we can't always wait until, when we haven't got the timeline, when we love somebody who's sick. And so we’re headed to make those educated decisions ourselves, and then live with the consequences.  But what I think is important that we have informed consent, informed discussions around these things, and that we try to take the emotions out of the whole thing. And actually, instead of—in the hospital I was sort of shut down because, ‘You're not a doctor, and you don't know anything’. And that's not true. And there was no willingness to even look at the clinical studies that I presented, that they were coming from my doctor friends who are supporting me on the outside, to try to present this on the inside of the hospital. It came down to legal arguments, more than anything else. And that's frustrating to think that perhaps you lost somebody because of a legal situation. The work that Dr. Merrick has done in this area and Dr. Berry Fowler, who’s coming on the show next week. It’s really, really exciting for me. Prof. Margreet: Well, those two clinicians have some very compelling stories to tell. I do, I do understand. I understand entirely, that I sit here in my office just above ambulance bay watching, and above the ICU board, and seeing… Lisa: seeing people struggle every day, Prof. Margreet: …thinking, there are things we could be doing better. And it is about getting those conversations going. So far, I think we're getting good traction in New Zealand with getting with conversations. But it's, it is extremely… Lisa: It is extremely slow. But then you and Doctor Anitra Carr, looked at his stuff as well. And that's exciting that we are making progress. And so I just want to, we've covered a lot of ground today. And we've really gone through in all sorts of places, but I just want to thank you for your sacrifice, because I know this is a huge amount of work. This is your life's work, basically. And I don't know if everybody was recognized for what their contribution, they're actually making to humanity. And I think and what you're doing is just absolutely wonderful. So thank you, because it is going to save lives. It has, has already saved lives.  Prof. Margreet: Well, I don't know that I have. But we have some wonderful colleagues globally as well. And so, there is a network of people who support each other on this, and some very good people doing excellently in a lot of places. Quote Mark Levine. What that man has done is extraordinary. In terms, he has provided the best information that we've ever had on vitamin C. With his own interesting stories to tell about how his colleagues’ treated...  So, some wonderful work has been done, and eventually people will just see. Actually, this is just, I just keep saying, this is just a thing that we need to eat. It's a vitamin that we need, an orange to keep our bodies functioning. Just like we need food, and we need to breathe, and we need water to drink. Now, we don't argue with those things. But this is just one of those things, when we need to figure out how we do this, how we do this piece. And under what circumstances so, you know, let's try to take the emotion out of it… Lisa: Yes, you're very good at it.  Prof. Margreet: I think it's the only way forward. And to give people the best information so they can make fit, so they can make the right choices, so clinicians can be making informed choices that they know is for the benefit of their patients. Because our clinical people, they're at the coalface and, and they’re having to make life and choice decisions for their patients all the time. And so they have high degree of caution around that. And that's what we want from them. So we need to provide them with the best information that we can get for them to make those clinical judgments. Lisa: I think that's a perfect place to wrap it up. Professor Margreet Vissers, you've been absolutely wonderful. Thank you so much for the work that you and your team are doing. Please continue. And if there are any rich people out there listening, please fund this research. Continue to fund this research because it's very, very important work and we desperately need it. So thank you for your time today. Prof. Margreet: My pleasure.  That's it this week for Pushing the Limits. Be sure to rate, review, and share with your friends. And head over and visit Lisa and her team at lisatamati.com. The information contained in this show is not medical advice it is for educational purposes only and the opinions of guests are not the views of the show. Please seed your own medical advice from a registered medical professional

Sepsis, acute respiratory distress syndrome, cancer and COVID-19 are seemingly incurable illnesses. We say ‘seemingly’ because there is a way to battle all of these diseases. Cardiologist and lawyer Dr Thomas Levy joins us in this episode to explain vitamin C's role in disease treatment. He also talks about other essential therapies and nutrients that can help prevent illness and improve our health. If you want to know more about intravenous vitamin C's benefits and how it can save lives, then this episode is for you.   Here are three reasons why you should listen to the full episode: You will learn how oxidation causes disease. Discover how vitamin C fights oxidation. Learn more about the other key players in oxidative therapy and other useful nutrients in health and disease. Resources Join Lisa's free live webinar on epigenetics to know more about personalising health according to your genes. You can also join her free live webinar for runners to learn how to run faster and longer without burnout or injuries. Grab a copy of Lisa's book Relentless from Amazon, her website or in bookshops near you. If you want to develop mental toughness, enrol in Lisa’s online course, MINDSETU. If you love running adventures, stream the documentary Desert Runners on TVNZ. Access Dr Levy's books through his website. Learn more about Dr Paul Marik's protocol for sepsis using vitamin C and steroids.  Access the VICTAS study investigating the efficacy of combined use of vitamin C, thiamine and corticosteroids on patients with sepsis.  Learn more about the controversy surrounding the CITRIS-ALI trial investigating IV vitamin C in patients with sepsis-induced acute respiratory distress syndrome.  Watch Professor Margreet Vissers' lecture on her work on vitamin C.   Read on Dr Rhonda Patrick’s assessment of clinical data on Vitamin C and her findings. Episode Highlights [06:10] How Dr Levy’s Vitamin C Research Began Dr Hal Huggins, a leading biological dentist, asked Dr Levy to do medical consultations on his patients and follow them long-term. Dr Levy saw a patient with an advanced neurologic disease but remained energetic after numerous dental work.  He began his research into vitamin C when he learned that Dr Hal gives the woman 50 grams of vitamin C through an IV. [18:46] What Causes Disease? When you have an excessive amount of oxidation among your biomolecules, it causes disease. Oxidation happens when a molecule loses electrons. A biomolecule in an oxidised state loses some or all of its functionality. Toxins cause toxicity and secondary disease by oxidising biomolecules. Toxins have different physical and chemical characteristics that allow them to penetrate organs and tissues, resulting in various clinical diseases.   [21:52] How Does Vitamin C Work? Vitamin C is a small molecule with a structure similar to that of glucose. It also uses the same cell uptake mechanism as glucose.  Vitamin C battles oxidation by reduction, a process by which electrons are donated to biomolecules. Vitamin C donates two electrons instead of one.  The give and take of electrons induce a microcurrent.  The process of oxidation and reduction helps relocate the energy-containing molecule where it is needed. [26:46] How Is Vitamin C Administered? IV administration gets enormous amounts of vitamin C into the body more quickly and at a higher concentration. It is usually given to patients in dire straits, but if you are needing higher doses due to things like sepsis, ARDs, pneumonia or cancer then IV vitamin is the best method. Liposome-encapsulated vitamin C gets absorbed almost completely into the gut, unlike other oral forms.  Liposome itself is a complementary supplement. It contains a lipid called phosphatidylcholine, which is identical to the natural cell wall of our body.  All modes of vitamin C administration (intravenous, oral, liposome capsules) are equally important, depending on a patient's situation.  In the hospital setting, vitamin C is given at constant levels every six hours. As a result, this keeps a more or less steady state of vitamin C in the body. [31:59] Controversies Surrounding Vitamin C Studies Dr Levy says controlled trials are necessary only when a drug with potentially positive effects also has potential downsides. Since vitamin C is an essential nutrient, Dr Levy thinks it’s not necessary to do a trial with a large sample size. Large trials are designed to support pharmaceuticals. [53:09] What Are the Other Key Players in Oxidative Therapy? Hydrogen peroxide kills pathogens and hydrates and oxygenates tissues to heal them. Nebulisers with 3% hydrogen peroxide or less help with acute viral infection, respiratory problems, and coronavirus. Ozone is the most potent anti-pathogen agent. [58:07] Why Are Vitamin C & Oxidative Therapy Not Mainstream Treatment? Mainstream medicine is ignoring broad-spectrum treatments such as hyperbaric therapy, ozone, hydrogen peroxide and vitamin C. Pharmaceuticals are multibillion-dollar companies. Doctors can only implement treatments in such a fashion that does not threaten those profits. There is more politics in medicine. Patients are being told something that is factually not true and, sometimes, a deliberate lie. [1:06:10] What Are Other Nutrients Beneficial to the Body? Magnesium is the most important single supplement. It antagonises intracellular oxidative stress caused by calcium. The recommended dose of magnesium is 600 to 1000 milligrammes. No other nutrient can substitute for magnesium. Magnesium deficiency can cause and worsen many diseases. People should never take iron supplements unless you have iron deficiency anemia. Keep ferritin levels at 25 or 30 microgrammes per millilitre. Only take enough iron to get the blood level back to normal. 7 Powerful Quotes from This Episode ‘Take responsibility for your own health and understand that we are all humans and that one person’s education may not have included some of the things that are happening now’. ‘We are co-learners with our patients’. ‘If you have a doctor who is annoyed by your questions or not open to explanations don't just walk away, run away from there and find one who is willing to work "with" you’. ‘Deal with your emotions, talk to some family and good friends, start your own research track and be the captain of your health care’. ‘Be preventative, not the ambulance at the bottom of the cliff. And if you are in deep trouble, make sure you are vigilant. Make sure you ask questions’. ‘If everybody on the planet had access to hydrogen peroxide nebulisation and started doing it, there wouldn't be a single case of coronavirus on the planet in a week’. ‘If you're a clinician, and you've given just one patient who is just absolutely on death's doorstep intravenous vitamin C, and the next day they're well or 90% well, you don't need to repeat that with a thousand patients. You don't need to repeat it with five patients’.   About Dr Levy Dr Thomas Levy is a board-certified cardiologist and a bar-certified attorney. After practising adult cardiology for 15 years, he began to research the enormous toxicity associated with much dental work, as well as the pronounced ability of properly administered vitamin C to neutralise this toxicity.  He has now written 11 books, with several addressing the wide-ranging properties of vitamin C in neutralising all toxins and resolving most infections, as well as its vital role in the effective treatment of heart disease and cancer. Others address the important roles of dental toxicity and nutrition in disease and health. Recently inducted into the Orthomolecular Medicine Hall of Fame, Dr Levy continues to research the impact of the orthomolecular application of vitamin C and antioxidants in general on chronic degenerative diseases. His ongoing research involves documenting that all diseases are different forms and degrees of focal scurvy, arising from increased oxidative stress, especially intracellularly, and that they all benefit from protocols that optimise the antioxidant levels in the body.  He regularly gives lectures on this information at medical conferences around the world. His 11th book, Hidden Epidemic: Silent Oral Infections Cause Most Heart Attacks and Breast Cancers, was published in September of 2017. If you want to learn more about oxidative medicine from Dr Levy, you may contact him at televymd@yahoo.com or through his website.   Enjoyed This Podcast? If you did, be sure to subscribe and share it with your friends! Post a review and share it! If you enjoyed tuning in, then leave us a review. You can also share this with your family and friends so they can optimise their health. Have any questions? You can contact me through email (support@lisatamati.com) or find me on Facebook, Twitter, Instagram and YouTube. For more episode updates, visit my website. You may also tune in on Apple Podcasts. To pushing the limits, Lisa   Transcript of the Podcast Welcome to Pushing the Limits, the show that helps you reach your full potential with your host Lisa Tamati, brought to you by lisatamati.com. Lisa Tamati: Welcome, everybody. I'm absolutely excited about this next interview that I have for you today. It is with Dr Thomas Levy who is sitting in Miami in America. And he is a board-certified cardiologist. He's also an attorney at law, and he has written 11 books. Now, talk about overachiever, this man is amazing. But above all, he is a humanitarian. He is someone who writes about what he believes. He's a straight talker. And today we're going to be talking about vitamin C, continuing on this journey after my experiences in hospital recently with my father who died of sepsis, and I was unable to get him vitamin C. I am on a mission to let people know about how intravenous vitamin C works in the cases of things like sepsis, pneumonia and corona.  And I'm getting a series of experts, we've already had Dr Ron Hunninghake on the show a couple of weeks ago. And this is his colleague, Dr Thomas Levy. You know, Dr Thomas has written a book called Curing the Incurable about vitamin C and its history, which is over 80 years old, a huge amount of evidence, a huge clinical experience with vitamin C. And Dr Levy, he knows how it works, the mechanisms of action, some of the reasons why this is not in the mainstream hospital care for these for viruses, and for cancers, and so on. And I really hope you get a lot out of today's episode. You know, he is a man who does say it as it is. And I really, really respect him for doing that. Because, it's very, very hard for a doctor to criticize anything within the medical world and the way things are set up. But Dr Levy sort of tells us how it is—some of the systemic problems we have. And it's a really interesting interview, above all, about vitamin C and its mechanisms of action. So please take a good listen. Take heed of his advice. And make sure you share this with family and friends, especially if anybody is dealing with any major sort of health issues; it would be really beneficial.  Just as a reminder, we are holding every couple of weeks with our company Running Hot Coaching, a running master class every second Tuesday at 12:30pm, New Zealand time. You can register for the next one at runninghotcoaching.com/webinar. On alternate weeks at the same time on a Tuesday at 12:30, New Zealand time, we are holding our Epigenetics webinar, which is all around personalizing health according to your genes and helping you understand this great set of genes that you inherited and what you can do to optimize your life, your fitness, your nutrition, your mindset—everything according to your genes and your epigenetics, how they are expressing right now. So register for that at epigenetics.lisatamati.com. That’s epi—E-P-I—genetics.lisatamati.com And as a reminder, go and grab my book Relentless, my new book. If you haven't read my old books, Running Hot & Running To Extremes and you like running adventures, make sure you check those out. And just as a side note too, Desert Runners, which was a movie that I was involved with, is now playing on TVNZ OnDemand. It's on the Pulse Channel, I believe, under Documentaries. If you haven't seen that movie and you love adventures and running adventures, please go and check that out on TVNZ if you're in New Zealand.  Right before we head over to Dr Levy, just a reminder, please, please, please give the show a rating and review if you enjoy the work that we do. This is a huge amount of work that goes into each one of these episodes. And it is for love, definitely not for money. And I really appreciate a rating and review. We are going to be introducing a way that you can support the podcast as a Patreon if you'd like in the coming weeks, so that you can actually support the work we do and get some bonuses for doing so. So stay tuned for that. Right, over to Dr Thomas Levy in Miami. Lisa Tamati: Well, hi everyone and welcome back to Pushing the Limits. This is Lisa Tamati here. And today I'm absolutely jumping in on my skin from excitement because I have Dr Thomas Levy, who is one of the world's most renowned researchers and doctors in vitamin C among a whole lot of other things. Dr Levy is also a board-certified cardiologist and a lawyer to boot. Go figure that one out. But Dr Levy is sitting in Miami, and he has given up an hour of his time today to share information that I think is absolutely crucial that you guys pay attention. So whatever you are doing, drop it and listen to this interview, because the work that Dr Levy and many of his colleagues have been doing, it’s been 40 years in the making and we're going to be talking today about vitamin C.  Now recently, I had Dr Ron Hunninghake from the Riordan Institute on the show and we had a great interview. And now we're going to continue that conversation with Dr Levy, with his experience. So welcome to the show. Dr Levy. It's fantastic to have you. Dr Levy: Thank you, Lisa. Glad to be here. Lisa: So Doctor, can you tell us a little bit—just in brief—your background and your journey towards vitamin C? Dr Levy: Well, in a nutshell, I was a garden variety, mainstream cardiologist some 25 years ago. And through a bunch of circumstances that I won't go into it's—I don't know, call it karma or destiny or something like that. At the same time, I decided to wind down my cardiology practice, I met Dr Hal Huggins in Colorado Springs, Colorado. Dr Huggins, in my opinion, was the first and the world's leading biological dentist. He just wasn't a tooth mechanic, he took care of the whole body while addressing what was going on to the mouth.  And anyway, to make a long story short, he ended up asking me to do medical consultations with his patients and follow them up long term. But that only occurred after I visited his clinic a few times. And I saw things that, well. In med school, you're taught: don't exist. As an intern and resident in internal medicine, you're taught these responses can’t take place. And in addition to seeing just overall dramatic improvement in patients—and I'm not going to say this is routine, don't get me wrong—but I saw a couple patients that had been wheelchair-bound with MS for over a year. And they took a few steps at the end of two weeks. I mean, so there was clear stuff going on physiologically.  But the thing that really hooked me was, one day, early on, he had this very elderly patient with advanced neurologic disease. He was getting a ton of dental work—extractions. I mean, the type of stuff that puts a college kid in bed for a week. What he did, he gets his wisdom teeth yanked out, he just goes. ‘Ugh, I got to rest’. Well, at the end of several hours of this work, this woman was energetic. I couldn't believe, and I said, ‘Something's wrong here’. I said, ‘Hal, what's going on’? And if you knew Hal, you’d know Hal is a very dry, sarcastic person. I loved it. And he just pointed at the IV, I said, ‘Okay, yeah, that's an IV, Hal. Thanks’. ‘What does that have to do’, I said, ‘What's in it’? ‘Okay Hal, what’s in it’? And he said, ‘50 grams of vitamin C’.  Lisa: Wow. 50 grams... Dr Levy: And that just came from left field, smacked me between the eyes, and I literally and figuratively went rolling across the room. And as the expression goes, ‘I wasn't going to be misled by my lying eyes’. I saw something. It happened. Something was going on here and at that point in time that began my research with vitamin C and just about everything else. Lisa: Wow. So that's the story. And this is coming from dentist—Dr Hal Huggins was very, very famous for making us aware of amalgam fillings from what I understand and root canals. I need to go back and read his books after discovering him in one of your lectures and thinking, ‘Crikey, I've got a heck of a lot of those’. So I need to look into those for myself. Dr Levy: Absolutely. Lisa: Yeah. Got me a bit worried. I've already spent a bloody fortune on this. So I don't know. So, you've come from cardiology and internal medicine and to this. And then you went to a law degree. Just to add to the achievements that you've had. And then... Dr Levy: I might add, Dr Huggins has taught me more real medicine than I ever learned before. So, my really—my second medical education was the one that counted. Lisa: Wow. And so this is really important. So, because people I think, Dr Levy—and we were talking previously—a lot of just people listening, when you go to your doctor, they are not God, and they don't know everything on the planet. And what I try to advocate—and I'm not saying that your doctors paid or whatever—but what I'm saying is take responsibility for your own health and understand that we are all humans, and that one person's education may not have included some of the things that are happening now. Dr Levy: So along those lines, I like to tell people that, just as you pretty much said, you have to take responsibility for your health. And you need to understand and you need to proceed at your comfort level, which means if you have a doctor, he or she who is put off or doesn't want to take the time or is irritated by you asking questions, don't walk out of that office, run out.  Okay, so you need to find physicians, medical care, that will work with you. And as we all know, I mean, hey, physicians like to believe they're brilliant, but it's mostly in their head. Okay, so, you know, they spend their time, they do their time in school, but in my humble opinion—and I know this is somewhat snide and sarcastic, but I gotta say it anyway—I find that most physicians view getting a medical degree as the validation that they no longer need to think the rest of their lives. ‘I'm a doctor, now I don't need to do anything else’. Okay, that's obviously only the beginning. And you should be continuing to learn and realize that you made a lot of mistakes until the day you die or lose cognitive function. Lisa: Yeah. And this is remaining humble in your process to learning. And this is not just for doctors, this is for everybody. You know, like we have to be constantly learning. I love what Dr Hugh Riordon said in one of his talks, that we are co-learners with our patients. And I thought, ‘That is brilliant’. Dr Levy: That’s a good way of putting it. Lisa: That's how a doctor should be approaching this. Okay, let's dive deep into the weeds here with vitamin C. So Dr Levy has written a book called Curing the Incurable, please go out and get this book, among many other books. He's written over 11 books. One was Death by Calcium, The Magnesium Reversing Disease. Yes, I'll find my notes here. Primal Panacea. His website, by the way, before we go any further is peakenergy.com. If you want to find out more about those books, really, really highly recommend people go and do that.  But let's go into Curing the Incurable when I listened to this book, unfortunately, Dr Levy after my father passed. I was just like, ‘What the hell? And why has this been such a battle? And why is my dad not with me still’? Because I am sure if you had been his physician from day one, my father would be still with us. And that's a big call to make, but this is what I believe based on your book and other research that I've done around this. Can you tell us, Curing the Incurable, you talked about Dr Klenner, you talked about Linus Pauling, Dr Iriwn Stone. Can you give us a little bit of background—this is 40 years that you guys have been saying this stuff, you and your colleagues that vitamin C is a cleanser... Dr Levy: Well Klenner in 1940, that's 1940. So that's 80 years. Lisa: 80 years? Wow. Okay, got that wrong. 80 years with Dr Klenner. And then Dr Linus Pauling—Linus Pauling Nobel Prize winner, two times in the 70s I believe, was the next sort of step in the process. Yeah. So like, we’ve known about this for so long, why is it not getting that message across? You know, why? Dr Levy: Well, this is not a medical issue. But you asked a the direct question, I'll give you a direct answer. Money. Money runs everything. And the pharmaceuticals are multibillion dollar industries. So what I've said many, many times is, ‘you don't bump out a billionaire’. Billionaires who will not be excluded, they're not being minimized. The only way you get something done is to hopefully analyze the situation and implement it in such a fashion that it doesn't threaten those profits. Okay? So I mean, if you can put an additive into gasoline to make it a little more efficient, but not eliminate the gasoline, and the companies will probably let you be. But if you come along with something that replaces gasoline, don't think the gasoline, oil companies are gonna take it lying down. It should not come as something surprising to people, except for the fact, and this is what people need to realize, doctors are the same type of people as any other profession. All right. We beat our chest and we try to make ourselves angels, if you will, but we're not even close. You have wonderful politicians, you have vicious politicians. You have wonderful physicians, you have, I won’t say vicious, I'll say physicians that do not place the patient's welfare as their number one concern. Whereas you have other physicians, unfortunately, of  a tiny minority who would give their life for their patient. Lisa: Yeah. And you really put them first, and these are quite rare. And this is why, you know, this is, like, having Dr Ron Hunninghake on, recently. He's one of those, you know.  Dr Levy: Yes, he's spectacular.  Lisa: He’s spectacular. Dr Levy: He is one of my best friends. But that's one of the reasons why he's my best friend. Lisa: Yeah. Because, and we just connected so well, because I could see the heart and the man and the compassion. And, you know, I have had the privilege of having some of those types of doctors, and scientists as well, on the show because I searched those types of people out who are not cowards. I mean... Dr Levy: Let me say this, since you mentioned Dr Hunninghake. I don't have a clinical practice. But I often get emails from around the world of people, ‘How can I see you? How can I do that? Can you recommend somebody’? Well, there's only one person on the planet that pretty much practices the way I would practice, and that’s Dr Hunninghake. So for someone who would be interested in following up on the type of concepts—in our, we're in this day and age of Zoom conferences and everything like that. They have the facility to offer video consultations in which he can analyze the data. And even if you could never see him directly, he can get you going in the right direction. Lisa: Absolutely. That's a really good recommendation, you know, especially if you're fighting something serious. So back to the vitamin C story. So Linus Pauling, or Dr Klenner firstly, was using this in practice back in the 40s. And had some miraculous—and that word is probably not a good one to use because it implies something—but had some incredible recoveries and saw this. And then Linus Pauling’s work where he had cancer patients who lived four times longer in his study. And he was only using quite small doses of vitamin C. And then of course, the Mayo Clinic coming along and replicating his study. But using oral vitamin C, that's not a replication, and that one is still being quoted.  So what is it that vitamin, C does? Let's get into a bit of biochemistry here and help us understand. Why is it such a broad spectrum panacea? Why can it help sepsis, coronavirus, any virus, hepatitis, shingles right through to cancer? Dr Levy: Well, first, I would say let's understand what causes disease. there. And when I say that I mean all disease. I'm not talking about a percentage of the disease. What causes all disease is having an excessive amount of oxidation among your biomolecules relative to their normal state of reduction. So oxidation is when a molecule loses electrons and then it's in an oxidized state. When you have a biomolecule, RNA, DNA, protein, fat—you name it—enzyme, and that molecule gets oxidized, it loses one or more electrons. It either becomes less functional or completely devoid of function. So you completely take one biomolecule out if you will when it’s oxidized.  Now you have different ages that oxidize and they're known as toxins. Toxin is the same thing as a pro oxidant, free radical, they're synonyms. So the enemies of health if you will are toxins no matter how you encounter them, because all toxins cause toxicity and secondary disease by oxidation, nothing else.  Now you might say, well, how could then just that cause so many different diseases? Well, that's because the toxins have different physical and chemical characteristics. One toxin goes in the fat, others goes in water soluble, one penetrates membranes, one's ionic, one concentrates in this tissue—that gives you a variety of clinical disease, because different areas and different biomolecules are being concentrated to varying, in different degrees throughout the body. That's the entirety of what causes the disease.  So when we hear this idea that oxidation causes disease, well, yes, that's true, but it's much more accurate to say, oxidation is disease. Okay? A tissue of a given disease, liver disease, whatever, there's not an additional ill-defined thing that's wrong with that tissue other than the unique array of oxidation. Now, having said that, your basic overall goal of therapy is to reduce—in other words, donate electrons back to biomolecules that have been oxidized. And the extent to which you can do this pretty much dictates the extent to which you can either stop the progression, reverse the progression, and in early stages even resolve chronic disease, no matter what the disease. So this is an antioxidant. Okay, the toxin is a pro-oxidant, an oxidizing agent. And the antioxidant is a reducing agent. A toxin takes away electrons, antioxidant donates electrons.  Now vitamin C, even though there are many, many antioxidants out there, they all have a positive impact. The thing about vitamin C is, number one, it's a small molecule. Number two, it's very closely structured to glucose. Now we know every cell in your body takes up glucose. So vitamin C tags along and uses the same mechanisms as glucose for uptake into the cell, right? Number three, each vitamin C molecule can donate two electrons rather than one. So that makes it doubly important. Number four, it has an intermediate stable state. We know we talked about how vitamin C gets used up quickly, that's true. But it's sort of a biochemical phenomena type thing, when the vitamin C loses one electron it can stay indefinitely in the intermediate state where it can either donate another electron or actually go in the opposite direction. And when you have a lot of vitamin C in the cell, what happens when you reduce, oxidize, reduce, oxidize? Give, take, give, take, give, take? You induce microcurrents. So electron flow is a current. Right. The more effectively vitamin C can do this trillions of times a second, determines as to how well you can establish healthy microcurrents inside your cells with healthy transmembrane voltages across the membrane. Lisa: So this is meaning— oxidation isn't always a bad thing, is it though? Like when I... Dr Levy: No, not at all. Lisa: So when I exercise, I'm causing an oxidative stress onto my body and it's causing a hormetic effect that hopefully my body's going to see more soldiers to build my muscles stronger or whatever the case might be. And so this is like a redox, it’s like a cycle that is important and it's for cycling of the electrons that creates this microcurrent. Dr Levy: The whole thing is designed—you're right—there's oxidation reduction and oxidation is part of it. The thing about a toxin is, a toxin takes electrons and keeps it. Lisa: I gotcha, so yeah.  Dr Levy: Vitamin C gives electrons and then when you take them away from electrons it goes back and forth, back and forth. But the toxin once it takes the electrons it becomes electronically more stable, biochemically more stable, and it doesn't give the electrons up. So that's a net fact of electrons from the tissues. Lisa: Wow. Yeah. So this is stealing your energy. Dr Levy: And the thing about it is with the oxidation, you need oxidation to stay alive. The thing about—one of the things oxidation does is it helps you relocate the energy-containing molecule where you need it. Okay, so, when you have vitamin C in the blood, you need active transport, you need to consume energy to get vitamin C inside the cell. And so the purpose of part of the energy is to get your energy providing substance in an area where it better does its function. So yeah, you absolutely need oxidation to balance back and off this.  And the other thing, too is, when your oxidized vitamin C level gets high in the blood, then you pass into the cell without the consumption of energy, but then you need to consume energy inside the cell to restore the vitamin C back to its reduced state. But the important thing there is, the vitamin C, has unique ways of taking that energy and getting it where it's needed. So just because you're consuming another antioxidant to reduce vitamin C back to its normal state, that's not a loss of energy. It's a translocation of energy. Lisa: Yep. So that's when things like will define we know it's going backwards and forwards. So this is the transporter of—what was that—the SVCT2 transporter that's getting it into the cell, that’s getting the vitamin C into the cell. So if we go and say intravenous versus oral, versus liposomal delivery of vitamin C. Oral has certain limitations, although important for everyday use. Liposomal vitamin C, like we're all hearing about liposomal vitamin C, is that a better way of delivery? What is the difference between intravenous, oral, and liposomal—in short, perhaps? Dr Levy: Well, first of all, when somebody says, what would you use? My answer is all of them. Lisa: All of them, yeah. Dr Levy: Okay. And I'm not going to arbitrarily if I'm sick, just use one and not the other. They all have their own unique contribution. Intravenous, obviously allows you to get an extremely large amount of vitamin C inside the body much more quickly and at a higher concentration than you could by any other form. However, I also just told you that the vitamin C in the blood, you need to consume energy to get the vitamin C inside the cell, and it's reduced for.  Okay, well, when you take liposome encapsulated, vitamin C, because it's like a little cell, a little fat, globule cell-like structure that's got the same construction, around the liposomes as the natural cell membranes in your body. So that gets absorbed almost completely and very properly in the gut, unlike the other oral forms. And then once it's inside there, it's either in the lymph or the blood. The lymph eventually makes its way into the blood. And then as the blood circulates, the liposomes can then get inside the cell without the consumption of energy. Lisa: So if you've got a very sick patient who isn't really responsive to recovery, like can't handle a lot of oxidative stress. This would be a better delivery system, perhaps to get it to them without... Dr Levy:  Well, certainly if you have a loved one who's in the hospital, and… Lisa: He can't get intubated.  Dr Levy: ...the doctors are giving you a hard time and they're don't they don't have a tube down the throat. Lisa: Yes. And I would have done that if I had my case with my father. But he was unfortunately intubated. So I was stuffed in that. I had liposomal in the hospital room ready to go for when he was extubated. But unfortunately, we never got there. So I was really reliant on the intravenous way. And the intravenous is, like you say, a very, very powerful way for someone who is in such dire, dire straits. You know, as my father was in sepsis.  Can we answer just one question on the liposomal? I was concerned about the number of omega-6, like that’s a phospholipid, and there's a lot of omega-6 in the delivery mechanism. Is that going to be a problem when you've got—we tend too many omega-6 and not enough omega-3 in our diet. If you're taking a lot of liposomal vitamin C that way, is there the issue? Well, not really? Dr Levy: I don't think so. The type of lipid that's in the liposome—in this case, we're talking about the LiveOn product, I got to say that because there's a lot of fraudulent liposomes out there. That LiveOn became so prosperous so quick. Everybody wanted to jump on the bandwagon. And in the process, not realizing that it's a very complicated process to make quality liposomes. But those other companies had no problem with it; they just lied.  Waiting to get the letter so that they can stop, but have been made an ungodly amount of profit until they're told to stop. But, the liposome lipid is past the phosphatidylcholine. And this phosphatidylcholine is identical to the phosphatidylcholine that’s in the natural cell walls of your body. So, really it's the liposome itself is a positive supplement in addition to what's inside the lens. Lisa: Uh-huh. Oh, that clears that one up for me. Because I was concerned about the amount of omega-6 that I might be giving to my mom, in this case, recently through liposomal delivery. Okay, so now let's go into—I was fascinated by the work of Dr Marik, Dr Paul Marik. I think you know of his study with intravenous vitamin C in the ICU setting. Unfortunately, it wasn't a double blind, placebo controlled trial. But he had a small trial with 96 patients, 47 in the control and 47 who received vitamin C. Now these were very small doses. And Dr Berry Fowler has also done this similar work. And Dr Berry fellows coming on in a couple of weeks.  So Dr Marik—he reduced—this is the statistic that got me and what I used when I was advocating for my father, a 40% mortality rate was in the control group with sepsis; 8%, when they got the vitamin C, along with hydrocortisone, and thiamine and that's a hell of a drop. And those are all people. Those are people that are still walking around now, and this is a small study. Dr Levy: And the thing that maddens me is when you want to try something different, some of the standard opposition is where you don't have a double blind placebo control bla bla bla. Number one, if you have something, which as a competent clinician, you know has helped, and very importantly, has no defined toxicity, and is not experimental, and is inexpensive. The only time the trials that you're talking about are warranted, is when you're using a drug that has the potential to have a greater or positive effect, but also has the potential downside for negative side effects. So you need to balance one against the other.  When you're talking about something like vitamin C, which is the most important nutrient in your body, it's a ridiculous and foundationless argument. So it's, to me, unethical to the highest degree, if you're a clinician, and you've given just one patient, who is just absolutely on death's doorstep, intravenous vitamin C. And the next day they're well, or 90% well. You don't need to repeat that with 1000 patients. You don't need to repeat it with five patients. Okay, so we really have—if you'll excuse the expression—a back-ass-wards way of approaching research. But it's all designed, as I said before, to do one thing: support the pharmaceuticals. Lisa: And this is a legal thing, isn't it? Because evidence-based, it really was—and this is Dr Ron Hunninghake said this to me, ‘Evidence-based is not evidence-based, it was designed for the pharmaceutical companies so that they could defend their drug in a court case that they did with a placebo controlled group that didn't get it, so that they could prove it’. But it's not a practical approach for all of medicine to do it in this style.    I mean, hyperbaric, I’ll use as an example. I do hyperbaric oxygen therapy. It was a key player in my mother's rehabilitation for her brain aneurysm. Also in the oxidative medicine family. They did a trial—a clinical trial—but the people know if they're getting hyperbaric. So they did, the control was 1.3 atmospheres and the other one was 1.5 atmospheres. 1.3 atmospheres, it's not a placebo, that’s a treatment. So they all got better. And they said, ‘Well, they all got better. So therefore there is no’... And it's just like, seriously? Or in Dr Marik study with a— or in the CITRIS-ALI study, sorry, where the SOFA scores were taken as the primary endpoint and not mortality is sort of backwards in my head. Surely we should be looking, ‘Did these people die or not’? Rather than this sequential multi-organ failure score. I get why they did it, because they were an early stage study, but it did throw a spanner in the works. And that wasn't a sepsis of study. That was an ad study, because they already had sepsis for too long. And that's why we probably didn't see the dramatic results in that one. Because that was one of the studies that was checked back at me when I was fighting for my father, the CITRIS-ALI study, bla bla bla. Didn't help with the SOFA score. Didn't help with the CRP. Didn't help with a couple of the other markers. And I was like, mortality and days in ICU, it did help with. And these people were already extremely sick because when they came into the study, they were already very far along the process. Dr Levy: Which is what Madison likes to do with their prescription drug. Right now with the coronavirus in the US, I suppose elsewhere in the world, they have Remdesivir. And they're doing trials over Remdesivir with the endpoint of looking for less days hospitalized. So I mean that the same thing that they trashed on the one hand, but that's their endpoint with this insufficient drug therapy, if you will. ‘Let's see if it helps a little bit. And now we're going to get all excited. We took our prescription drugs, and we lessen the hospital days by 10, 20, 30, 40%’. Lisa: Yeah, and ‘But we'll ignore vitamin C that could actually get the people and prevent them from dying’.  Dr Levy: Even though it's also been documented by Hackney studies to decrease like the hospitalization as well, Lisa: As well. And they have been studied around the world now with the coronavirus with vitamin C. So, a really sarcastic question. Do you think President Trump is getting vitamin C right now? Or is he on Remdesivir? Dr Levy: Well, I don't have a crystal ball. But I think he is getting what was reported, which was—this is significant. Nobody talks about this but had this happened at the beginning of the pandemic, it would have been just incredible news, but shows like  yours, the articles on the orthomolecular medicine news service, all this stuff… It’s absolutely mind blowing to me that it's in the mainstream news, very casually mentioned, that President Trump was getting zinc, vitamin D, melatonin.  Lisa: Oh, wow. Dr Levy: Yes. Okay, and I mean, that was out there up front. What the medical community must have just choked on their tongue when they saw that our president was getting at least some natural approach to bring his virus under control? I doubt he was using vitamin C. But it's possible. Lisa: Wow. But at least he’s on the melatonin and the zinc. I mean, that is a step forward. So but you know, like, you hear this coming from the head of the FDA, ‘None of that has been proven to help. Vitamins A, B, C, D, zinc, melatonin, vitamin C, none of those has been proven’. Dr Levy: That's where politics gets into medicine. I've often said—and I'm sad to say it, and I don't mean to be sarcastic at all—there's more politics in medicine than there is in politics. Lisa:  Yes, yeah. Dr Levy:You have a better chance of a politician giving you an honest statement about a controversial issue than you have a drug representative or a physician representing a drug company, giving you the straight scoop about drugs. What you just said, and they'll say it all the time, ‘There's no study this. There's no study that’. It's a bald faced lie. What could you say beyond the fact that they're just lying? Now, let me say, let me backtrack with lie. I should say they're telling something that's wrong. Lie means intent. So I can't tell you whether it's their intent to lie, like, ‘I know I'm telling you something that's wrong’. But there's no question that most of the time, they're just telling you something that's factually not true. And I dare say most of the time, a deliberate lie. Lisa: And it's ignorance. Dr Levy: No,  nothing wrong with ignorance, Lisa: So they won't go and look at the damn study and its data. Dr Levy: Ignorance can’t be remedied because ignorance doesn't mean, you have to have a closed mind. It just means you have a mind that hasn't been exposed. Lisa: Yeah. I mean, don't we, you know, with the situation with my father. I had the studies, I was working with doctors outside who were helping me get the studies, present the studies, and they said ‘Don't want to see them. Won't be presenting them. All you're worried about is, is it legal? And with our staff are not trained in doing vitamin C infusions, and whether we are allowed to do it’. It was not about the clinical Dr Levy: Well in New Zealand it was a registered medicine. Lisa: And not in the hospitals. I was told point blank is an unlicensed medicine in our... Dr Levy: I think, I'm not sure but I think you can say that was another lie. A lot of times our pharmacy, they'll do, they'll lie like anybody else. It’s something they don't want to do. So they'll just toss it aside, always not allowed. Until you take the law book, and stick it in their face, and say, ‘You're wrong, Stop lying’. Lisa: But you, you know, as a lawyer, and as someone who's brilliant, can do that. A loved one who's fighting for their family who hasn't slept in two weeks, who doesn't know about the law is buggered to be quite fear [41:16]. And so this is—why I'm doing these interviews because I want people to be just made aware of this sort of situation.  So, okay, vitamin C, can help. And we've seen the studies now. And perhaps we'll link to some of the studies in the show notes with sepsis. And Dr Berry Fowler said, used this analogy, just in the States, ‘Two 747s of people are dying every single day of sepsis who don't need to be dying’, who are crashing into the ground, basically. There are a number of people, are dying daily in the States alone. Let alone the rest of the world from sepsis, which could be drastically helped with intravenous vitamin C. Do you think, like Dr Marik included thiamine and hydrocortisone? Is there a necessary additive or a beneficial additive to that protocol? Or is vitamin C the key player here? Dr Levy: Yeah, no, they're not necessary at all. That's not to say they didn't have a positive impact. I mean, like when people ask about supplements, ‘So what supplements should I take’? And I mentioned something, that they ‘What about this, this, and this’? I said, ‘Well those are all good, too, but as far as being vital to the response, no’. And in fact, predating Dr Marik’s study about a year earlier, they did a study in Iran, of all places, with patients with sepsis getting roughly the same dose of vitamin C every six hours. And that was it. And they got the same response and mortality rate.  One thing about the hydrocortisone that makes it especially unnecessary in sepsis is, sepsis is a state where you have massive infection, massive increased oxidative stress throughout the body. When you have increased oxidative stress, what are you going to do? You're gonna, like we talked earlier, oxidized biomolecules? Well, as it turns out, in addition to oxidizing a lot of biomolecules, you also oxidize the cortisol receptors. Cortisol has receptors they bind to. Well, I just said, what happens when you oxidize a biomolecule that doesn't work? So those receptors aren’t taking up the cortisol anymore, so the body's natural reflex is to produce a large amount of cortisol. In fact it is documented in sepsis patients, that there's already a high level of indiginous hydrocortisone. So then what happens when you give vitamin C? When you give vitamin C, one of the first things it does, is it starts reducing those oxidized hydrocortisone receptors, and then the hydrocortisone that's already circulating in the body can bind to the receptor, gets taken up into the cell. Okay, and one of the primary functions of hydrocortisone—not well known, I don’t believe—is that it profoundly increases the uptake of vitamin C inside the cell. Lisa: In that way it would be beneficial? Is it why Dr Marik perhaps used it in this case? We don't—can't really… Dr Levy: No, I don't think so. Because if that was the case, he wouldn't have given the hydrocortisone at all. I mean, you're already, there’s already present and high amounts of it inside the body. So I can't say for sure what his reasoning was. Lisa: Yeah. Well, maybe it was a limitation of the study. And he had to use a drug. Possibly we conjecture here. So when you release cortisol—just for the people listening—it is an anti inflammatory, isn't it? It is one of the stress hormones and it basically takes energy away from you making inflammatory responses. And that’s its beneficial use Dr Levy: Right and it's my opinion, based on the evidence, as I reviewed over the years is that vitamin C, of course is a powerful anti-inflammatory. And I would tell you that the reason hydrocortisone is a powerful anti-inflammatory, is because it gets the most important anti-inflammatory vitamin C inside the cells where it's needed. Lisa: That makes good sense. Are you aware of... Dr Levy: Remember anti-inflammatory just means you're in an area of increased oxidative stress that needs more electrons brought into it, that's all inflammation is. And another point to just to buttress all of this is when you have inflammation starting anywhere—often talking about the coronary artery getting inflamed, vitamin C levels go down to nil. So you have a lot of oxidative stress inside the blood vessel. Okay. And what's the first immune cell to show up? Lisa: Neutrophil Dr Levy: Neutrophils more specifically, the macrophages. The macrophages has 8,000% more vitamin C inside of the blood. So all you're doing in my humble scientific opinion, I think—personally and scientifically—that the primary role of the immune system since it’s precipitated always by areas of increased inflammation increase oxidative stress. My opinion is the primary—not the only but the primary—role of the immune system, is to bring vitamin C where it's most depleted. Lisa: Wow. And that's what the macrophages are doing. So are you aware of the work of Professor Margreet Vissers? She's a professor here in New Zealand at Otago University and Dr Anitra Carr as well. But Professor Vissers is coming on next week, on the show.  And forgive me, I don't have a scientific background. I'm trying to get my head around all this science, biochemistry, but she had showed on one of her lectures, the neutrophils coming to the site of infection, say, pneumonia or sepsis, eating the bacteria into into the neutrophils, they gorge on those bacteria, it's a good thing. The bacteria then inside the neutrophils and if the neutrophils don't have vitamin C in them, they vomit out—for the want of a better description—their own DNA. Eventually, they sort of explode and leave out and put all this DNA into the cytoplasm? And this is causing—so when you get wiped out on the lungs, that's lungs being filled up with neutrophils. And then the macrophages are made to come along and eat the neutrophils from what I understand. And they will only do that if there is vitamin C in the neutrophils. Dr Levy: Both the macrophages and the neutrophils are phagocytic. Okay. And even though the macrophage has the most, I said 8,000% more vitamin C than the blood. The neutrophils have 4 to 5,000% more vitamin C in the blood. So they're sort of like—with regard to vitamin C content—they're right up there with the macrophage. And both the macrophage and the neutrophil, gave these phagocytic Pac Man like qualities, if you will. Lisa: Yeah. And they're eating the bugs and getting rid of them. So she was talking about—no, Dr Berry Fowler—god I’m mixing my things up. NETS, neutrophil extracellular traps), have you heard of those? And the vitamin C prevents—from what I understand. And we'll have Professor Margaret on next week—that it stops the neutrophils from regurgitating basically their own DNA and poisoning the space around them and then the macrophages won't eat them. And then in the case of say, as acute respiratory syndrome, you've got white out and you can't get rid of it. It's not going to go away and it's not going to be taken out by the macrophages. Yeah, it’d be interesting to work to look at those NETS, neutrophil extracellular traps. That was Dr Berry Fowler that was talking about that. But I've got so much research in my head, I'm probably mixing professors up. I don’t have a biochemistry degree anyway. I'm doing my best. So hopefully I haven't butchered it. Okay, so what should people do—on a practical standpoint—if someone is in hospital with a loved one, they've got pneumonia, they've got coronavirus, they’ve got sepsis, how can they get their doctors to give intravenous vitamin C or liposomal delivered vitamin C? What would be your—so they're not in a situation like I was fighting against the machinery. Dr Levy: So we're talking about someone who's not intubated yet. Lisa: Yes. Because when they're intubated, you’re buggered. But you gave me a couple of things that I never thought to bring into the conversation with the doctors. I brought them the clinical studies, I brought in the evidence. But I was saying to the doctor, ‘I'm going to come after you. And I'm going to sue you if you don't do this, because the evidence is there’. Dr Levy:  And draw the vitamin C level and when it comes back low, ‘This doctor is a nutrient level that's low, please treat it’. Lisa: Yep. Okay, so get the vitamin C treated, by the way, in my local hospital, they were unable to test it. Okay, so that's just ridiculous. So is it a very difficult thing to test for vitamin C levels?  Dr Levy: I think so. Not that I know of. It involves a certain technique, and you either have the technique or you don't, but it's not something sort of exotic or out there. Lisa: Oh wow. So anyone who is in that situation, basically, you need to get vitamin C, in somehow. And ideally, you're having it in six hourly, intermittent, constant levels, so that your, because vitamin C has a very short half Life, can you explain that a little bit? Why the intermittent—the every six hours is crucial? Dr Levy: Well, it's just excreted, that rapidly of the blood, once it's in the—it’s excreted that rapidly in the kidneys, once it's in the blood. Like that, it goes down quickly. And that's why you have every six hours, so that as it starts going down, you have another bump up so that you more or less keep a steady state. Which is also why liposomes are so good because once they get taken up inside the cell, they effectively become a long acting form of vitamin C because they've been taken out of the area where they can be rapidly excreted.  You know, you're talking about what to do for a patient in the hospital. And this would help anybody but it will especially help with the acute viral infection, respiratory problem, and the coronavirus. And believe it or not, it actually relates back to vitamin C. And that's the nebulization or inhalation of hydrogen peroxide. Lisa: Oh, yes, I wanted to ask that. Dr Levy: Hydrogen peroxide. Okay, little known facts, number one inside the body and inside the lungs, after it kills the pathogen, you know what's left? Oxygen and water. That's the breakdown products of hydrogen peroxide. So at the same time, you kill the pathogen. You do the two things that are most important for healing tissue. You hydrate it and oxygenate it. Lisa: Yeah. Dr Levy: Number two is we now know, that the respiratory lining of the lungs naturally produces and excretes hydrogen peroxide 24/7. So that you actually have hydrogen peroxide, existing already endogenously to protect you against new pathogens as you breathe in. And when you get an infection, that production increases, so all you're doing with hydrogen peroxide nebulization is you're augmenting a natural response. Lisa: Wow Dr Levy: And add to that the fact that there's been no infections, pathogens of any type that have been found to be resistant to hydrogen peroxide. Now, vitamin C and hydrogen peroxide. The Fenton reaction, vitamin C goes in, donates the electron to iron which passes along to peroxide, make hydroxyl radical oxidized, kills the cell or the pathogen or whatever.  Another thing, little known fact that vitamin C does, is outside of the cell, it stimulates hydrogen peroxide production. So it causes more peroxide to be produced, which then passes easily into the cell and continues to give the vitamin C inside the cell more fuel to resolve the oxidative reaction that kills the patch. Lisa: Wow. So okay neutralizing hydrogen peroxide. So just a normal 3% food grade hydrogen peroxide that you can buy at the chemists or the... Dr Levy: Right. 3% or less. So only 3% percent is a little potent but if it's not, that's great but you could get a very positive response with half a percent or a 10th of a percent but I said don't I say, why not go up to the percent that you easily tolerate and get the job done a little more quickly’? Lisa: Is there any danger with people you know going out buying nebulizers? So when you buy a little nebulizer, is it like the essential oil sort of thing that you have? You need to have a towel over your face or like you do when you get a cold and you put menthol or something in it. If you've got one for me. Oh, okay. No, that wasn't what I was picturing. Okay. Oh, great. nebulizer. Okay. And you just put it in here. Dr Levy: Put the liquid in.  Lisa: Yeah. Yep. And then you just breathe it. And for 5 to 10 minutes, sort of, a day. Dr Levy: Yeah. Lisa: Yeah. And if you've got a cold or something like that, it would help or flow things like that. Dr Levy: That sounds grandiose. But I want to say to anybody that's listening, if you have this device, if you have your peroxide, you need never suffer from a cold or respiratory virus again, which also means influenza or flu. Wow, you should never suffer from that again. I don't know. I can't make it any clearer than that. Lisa: No, that's amazing. Dr Levy: But once you have the nebulizer, you know, how much the vitamin C cost? To heal your cold or flu? Less than 10 cents. Lisa: Really? Like the vitamin C side of things? Dr Levy: No, it's much cheaper than vitamin C. Lisa: The hydrogen peroxide.Okay, so, hydrogen peroxide and vitamin C... Dr Levy: And if people want protocols or articles, you could give them my email. I don't I don't try to hide from people who I get all upset and agitated about something. And I mean, I can't do consultations. But if people want information, a little guidance, you can give them my email address. Lisa: Wow. Are you sure? Dr Levy: Yeah. No problem. It's been available for many years now. Lisa: Okay. That's, that's amazing. What is the email address that people can get you on the inductance? Dr Levy: It’s my initials, T-E, Thomas Edward. Last name, Levy, L-E-V-Y-M-D. televymd@yahoo.com.  Lisa: Wow, that's very, very, very generous of you. Is ozone, because I have been studying ozone as well. I've got a home ozone machine here. Is it—that’s related to hydrogen peroxide too? Dr Levy: Yes, it’s interesting. Hydrogen peroxide, ozone, ultraviolet light, hyperbaric oxygen therapy. Yep, they're all basically doing the same thing, just but by different routes and different points of access. Well, I gotta say it for the peroxide too. But ozone is probably, if you had to pick one, the single most potent anti pathogen agent, there is. You put ozone in the presence of a pathogen, pathogen’s gone. Okay. But most of these therapies that I'm telling you about have an equal impact if you apply them correctly.  And of course, the only reason that ozone shouldn't be at the number one on top of the list is, access, ozone machine, position, control. What I said with hydrogen peroxide, unless you don't have current, you can use batteries, you can do in the Serengeti in Africa. So you can have access everywhere on the planet to—and the other thing too, is even if you don't have a nebulizer, and you're really want to take it down to bare bones, you can take a little spray and spray the back of your throat several times early on, and that will probably do the trick as well, just not as effectively if you've already let it get down into your lungs, whatever the infection is.  But this is, you're using nature's natural antibiotic. Peroxide is produced in every cell of the body in the extracellular space. And it breaks down into water and oxygen what horrible metabolic byproduct. Lisa: So there's all this whole family of oxidative medicines. I mean, I've studied hyperbaric, I've been in a hyperbaric clinic, I've got ozone here, I'm gonna get the peroxide, I’ll definitely do intravenous vitamin C, and all sorts of vitamin C. These are all in the oxidative family and they all have the ability to get more oxygen delivered to the cells and more nutrients, in the case of vitamin C, to the cells. So they all have a very similar basis or mechanism of action, don't they?  Dr Levy: Yes Lisa: And this is why they work on such a broad spectrum, from corona to cancer in the powerful agents, because I think the pharmaceutical, they don't like broad spectrum things either. Because if you've got something that can fix that, but that and that as well, then ‘Oh, I can't possibly be right. And we can't sell the drug for this, for this, for this if we’ve got that’. And then for this oxidative medicine family it’s just being ignored across the board. So ozone is also facing the same issues. Hyperbaric is facing the same issues. As is vitamin C. I haven't studied UV radiation, but that's next on my radar as well. So it's the same problem right across.  And I have seen with my latest book, telling the story with my mom, bringing her back, that hyperbaric oxygen therapy was a massive part of her brain's recovery. We could get oxygen to the cells. I got into vitamin C later in the piece, and she has an intravenous vitamin C, every week. And we do six grams a day for her orally, as well. And my mom is now 79, and she was at 74 and a half. Or she's turning 79. And we were told she would never do anything, again, never have any quality of life, put her in an institution and she'll be gone within a few months very likely. And I just absolutely refuse to believe this. And not—even though I'm not a doctor, I was able to find all these great things by accessing great minds like yourself, reading the books, doing the hard yards, doing the thousands of hours of retraining the brain, and doing the research, doing the hard yards. And now I've got my mum back. And so that really makes me want to fight for people too, because I get frustrated. I've lost a friend this week to cancer. I've lost parents of friends a few weeks ago. People, unfortunately, when I go to tell them something and send them off in the right area of research very often go, ‘No, my doctor says, ‘That's rubbish. And therefore I'm not listening to you’’. Dr Levy: But I just said let me put a little punctuation mark and an exclamation point of what I just said. But if everybody on the planet had access to hydrogen peroxide nebulization and started doing it, there wouldn't be a single case of coronavirus on the planet in a week. Lisa: Wow, wow. That's a really big call. So we should be getting this in our arsenal at home right now, all around the world, because this is something that's achievable, easy, cheap, and something that we can do proactively. Are there any dangers with people doing peroxide, can we overdose? Can we do anything? Dr Levy: Only if you start going to very high concentrations, anything that's pro-oxidant. And obviously hydrogen peroxide is pro-oxidant. Because it's killing the pathogens. You're not killing the pathogens with an antioxidant effect. If you continue on high dose peroxide, yeah, you can start causing oxidative damage, just like with anything else. But at 3% or below, the only thing you might notice if you're doing too much is you might start getting a little irritation in the nose, a little soreness in the throat where you've really gone too far. But only because you've killed all the pathogens. And now you're starting to irritate the normal tissue. Lisa: Right? So with ozone it's different. So like with ozone, you can't breathe ozone. Dr Levy: You can take it just about anywhere else but the lungs don't like the ozone at all. And the interesting thing too is I told you, too, about peroxide breaking down to water and oxygen, if you use an oximeter. And you read it about 95 and then you start to nebulize after 30 seconds to a minute, you're going to start seeing that oxygenation level go up 96, 97, 98, 99, sometimes 100. Lisa: Wow, that is absolutely—I've got oximeter coming up because breathing techniques are another thing that can actually change your whole chemistry in your body with carbon dioxide and so on. This is also a very interesting and powerful mechanism I don't know if you're aware of the work of Patrick McKeown, the great book The Oxygen Advantage, and again it's helping the body use its own mechanisms, breathing in this case, to optimize the delivery of oxygen by raising our tolerance to carbon dioxide levels, which has been a very fascinating read that I'll be covering off in another episode. Dr Levy you've—just before I let you go because I know we’ve recorded on for a few while [1:05:36] and covered a lot of ground. I heard you talk in one of your lectures and I haven't read this book yet The Magnesium Reversing Disease. Briefly touch, was in the Death By Calcium book as well. This was news to me, that calcium—if we start there—calcium, we need in the body is an essential nutrient, but if it's in the wrong places, we can be running into trouble and this is causing... Dr Levy: It’s a toxic nutrient. Iron, copper, and calcium are your three toxic nutrients. You absolutely need them in low levels. And above those levels, they're all absolutely toxic. Okay, so every disease cell, I don't care what the disease is—whether it’s an infection, toxin, lupus, scleroderma—every disease cell has increased intracellular oxidative stress, which is always caused by calcium.  Increase the calcium, you increase the stress and then magnesium is the yin and yang. You increase your magnesium, you decrease your calcium, They’re physiological antagonists. That's why magnesium is, hey this may shock some, people your most important single supplement. Because when you're magnesium deficient, nothing can substitute for magnesium and most people are deficient. But let's say you're deficient in vitamin C, you can partially compensate by taking other antioxidants.  So when people like to just play well, ‘What's your most important oxidant, supplement’? Yeah, magnesium. Of course, I'm going to take vitamin C and vitamin D and vitamin K, too, as well, and iodine. But magnesium is the only one that cannot be substituted—for well, vitamin D can be substituted for either—but a magnesium deficiency causes many diseases and makes all diseases worse. Lisa: Is there a good type of magnesium? Because there’s like carbonate, threonate… Dr Levy: You know the really good ones, you have the anion and you have the cation. Okay, you've got the magnesium, the cation, and the anion can be of no consequence or major consequence of clinical impact on your body as well. Magnesium Chloride, interestingly, is extremely important in inhibiting and eradicating infections, especially viral. So I'm going to talk about coronavirus. I say your magnesium supplementation should be in the magnesium chloride form. You know when you're dealing with a brain problem, well then your magnesium three and eight, that gets across the blood brain barrier well. But all of the glycinate and the carbonate, they all have their own unique features. And it's just a question of what else you want to take along with it. Lisa: So you take a mixture of different types of magnesium perhaps to cover all your bases ideally. Yeah... Dr Levy: If they’re not covered within the supplements. Yes. Lisa: Okay, so 600 to 1000 milligrams, I've heard you say is a good, is it correct? Dr Levy: Yeah, that's about right. The thing is the magnesium is like the vitamin C orally. You take too much, too quick, you get the asthmatic diarrhea and the loose bowels. So you're probably never going to take enough magnesium if you take a one single dose a day rather than spreading it out. Because if you spread it out, you can get a lot more in without causing the loose bowel Lisa: That’s why you get the diarrhea. So go to that point but just before diarrhea and then have this intermittently throughout the day. You mentioned iron as being a new—essential nutrient but a toxic and higher doses. I'm a little bit concerned because I have suffered with anemia my entire athletic career so I've been an extreme endurance athlete. and I've taken a lot of Iron. Have I done myself damage? Dr Levy: No, you do a lot of aerobic and you do a lot of sweating. And the one study they show way back then was, roughly 50% of young, athletic men and women in different schools in different sports, were able to push them themselves into an iron deficiency anemia by the end of their athletic season. Which it just reflects how much iron you can lose in your sweat. So without looking at your ferritin levels, I would say statistically speaking, unless you just took a ton of iron, you're probably still in a nice low range of iron because of the fact that sweating is part of your lifestyle.  But you should never supplement iron unless you have, got an anemia. But an iron deficiency anemia. Which is not just any old anemia, it has to be an anemia, secondary to iron deficiency, which has a characteristic morphology, what's called hypochromic and microcytic. Tiny, tiny, blood—tiny blood cells with small amounts of hemoglobin inside, that's an iron deficiency anemia. And then you only take enough iron to get your blood level back to normal because you don't want your ferritin going above say 35, 25, 30 or so. Lisa: Wow. Okay, so mine in my mind is always, you know, hovered around the 10 to 12. And it's always been good. Dr Levy: But, the 10 to 12 probably indicates that your anemia was iron deficient. So, just without knowing about detail, it sounds like you're minimal and taking the iron was appropriate for your particular condition. Lisa: Yeah, because I was constantly as an athlete, of course, my ability to carry oxygen, with my hemoglobin being low. And my, iron deficiency, it was always a problem for a competitive athlete, because you just couldn't have the lungs or the ability to carry enough oxygen. Okay, and iodine, is there a danger? Because I've heard Dr Brownstein talk about the essential nature of iodine. If someone has Hashimoto’s, is that a caveat for having iodine though? Because I gave my mother iodine, and she has Hashimoto's. Dr Levy: I can't get a yay or nay on that. I'm not really an expert on that particular thing. So, my inclination is, it's still fine to take the iodine, but I don't have a sophisticated level of knowledge on that. So I don't want to give you an absolute—it's important though, with thyroiditis, inflammation, autoimmune, all autoimmune comes from oral infections. Lisa: Oh, okay. Dr Levy: So the teeth, the gums, the sinuses and the tonsils. In one way or another, with your thyroid gland draining all the garbage in your mouth. It's like a toxin screen for everything that's in your mouth. Lisa: Okay, so get your mouth cleaned up, get your hydrogen peroxide, get your teeth looked at, all that sort of stuff. When we’re going to our dentist, who isn't Hal Huggins? What are we asking them to look for apart from amalgam fillings being removed? That's an obvious one. But so I've got root canals. Have I got an issue there? You know, what are we looking for? Is it something that they've put into it? I haven't read Dr Huggins book. Dr Levy: Well, first of all, 100% of root canals are infected. They're all infected, okay? Because they take out the nerve and the blood supply. So there's no way the body can keep the tooth sterile up there, that's just not a possibility. And this has been documented with toxicological studies and over a 5,000 consecutive extracted root canals that Dr Haley—Dr Boyd Haley—and Dr Huggins did.  Now if your thyroid status is perfect, if your supplementation is perfect, if your CRP is perfect, well below one, like below point five. And interval change shows that the level of infection in your root canal is not changing, they can be of inconsequential impact on your health, but that's a really small percentage. And we're talking about a perfect reverse T3 T3 ratio. Because when that gets out of balance, infections metastasize, just like cancer metastasized. The title of my book Hidden Epidemic, the subtitle is, Silent Oral Infections Cause Most Heart Attacks and Breast Cancers. Lisa: Okay, yeah. Dr Levy: So you send me an email, I'll send you the e-book on there. Because what you need is a 3D Cone Beam examination of the mouth. Because many times even other teeth can be affected but do not hurt. Lisa: That's got me really concerned because I got a really, you know, got a whole lot of implants too. Dr Levy: That's where the 3D would be important too, because it could tell you whether the implants are stable or infected. Lisa: Okay. Wow. So people, Hidden Epidemic get that book as well. You've got a lot of readings after this episode. Dr Thomas Leavy, you've been absolutely amazing. I really just thank you and honor you for your work, the passion you bring, the compassion that you bring, it's phenomenal. And I just wish there were more people like you on the planet. So thank you, so, so much for everything. Dr Levy: You've done a lot of passion in this too. So... Lisa: I do. Dr Levy: We're doing it together. Lisa: Yeah,I'll put my two cents and make a difference in this world. And hopefully we can make it a better place for people.  So if people want to reach out to Dr Levy, in his website and his email, we'll put in the show notes website is peakenergy.com. Go and get those books Curing the Incurable, The Magnesium Reversing Disease, Death by Calcium, Primal Panacea, The Toxic Tooth. There's so many, there's 11, I can't say them. You probably can't say them. Go and get some of them. Start reading, start learning, start educating yourself, and take responsibility for your health. Any last words Dr Levy? Dr Levy: Well, we touched upon it earlier, but just that people realize, it is difficult, I know when you're sick, you're frightened. You don't want to be thinking a lot. You just want to put yourself in the hands of somebody and let them take off with it. All I could say is that's a mistake. You got to collect yourself. Deal with your emotions. Talk to some family and good friends. Start your own research track and be the captain of your health care. Lisa: Love it. And that is everything that I believe in and stand for in a nutshell. Take as much control as your heart can. Even if you're not a doctor, even if you don't have a background, we have access through things like this podcast to get the best information and be proactive in your health. Be preventative, not the ambulance at the bottom of the cliff. And if you are in deep trouble, make sure you are vigilant. Make sure you ask questions. And if you get pushed back from the doctors, find another doctor, if you can.  Okay, Dr Levy, thank you so much for your time. It's been absolutely amazing. Dr Levy: Very good. Thank you for having me, Lisa. That's it this week for Pushing the Limits. Be sure to rate, review, and share with your friends. And head over and visit Lisa and her team at lisatamati.com. The information contained in this show is not medical advice it is for educational purposes only and the opinions of guests are not the views of the show. Please seed your own medical advice from a registered medical professional.

This week Lisa sits down with Major League Baseball Player/ Ironman Athlete and Business Coach Andy Neary to discover  how Andy has taken the habits and rituals he used to compete in professional baseball and Ironman racing to help business professionals EXCEL IN BUSINESS AND LIFE.   When you mix discipline with accountability, you create massive action! The work you put in when no one is watching is the key to professional success.   Andy's Bio Andy Neary is a former Professional Baseball Player, a two-time Ironman finisher, Business Coach, and Founder of the Complete Game coaching program.   Andy's mission is to help business professionals build the mindset, habits, and rituals "off the field" that lead to all-star performance on it. It's about developing a #majorleaguemindset.   As an undersized athlete, Andy's ability to master the daily habits and rituals helped him far exceed expectations on the Pitcher's mound. He attributes all the work he put in when no one was watching, to his successful college career and the opportunity to pitch at baseball's highest level. With discipline and accountability anything is possible. Completing an Ironman race is one of the most grueling tasks on the planet. Swimming 2.4 miles, biking 112 miles, and running a marathon (26.2 miles) in one race, requires a clear mind and high-performing body.   To "show up" on race day, one must put in consistent daily work on the bike, the road, and in the pool. Andy attributes his success in Ironman competitions to the same daily habits and rituals he applied to his professional baseball career.   You can find out more about Andy and his work at www.andyneary.com      We would like to thank our sponsors for this show:   For more information on Lisa Tamati's programs, books and documentaries please visit www.lisatamati.com   For Lisa's online run training coaching go to https://www.lisatamati.com/pag... Join hundreds of athletes from all over the world and all levels smashing their running goals while staying healthy in mind and body.   Lisa's Epigenetics Testing Program https://www.lisatamati.com/pag... measurement and lifestyle stress data, that can all be captured from the comfort of your own home   For Lisa's Mental Toughness online course visit: https://www.lisatamati.com/pag...   Lisa's third book has just been released. It's titled "Relentless - How A Mother And Daughter Defied The Odds" Visit: https://relentlessbook.lisatam... for more Information   ABOUT THE BOOK: When extreme endurance athlete, Lisa Tamati, was confronted with the hardest challenge of her life, she fought with everything she had. Her beloved mother, Isobel, had suffered a huge aneurysm and stroke and was left with massive brain damage; she was like a baby in a woman's body. The prognosis was dire. There was very little hope that she would ever have any quality of life again. But Lisa is a fighter and stubborn. She absolutely refused to accept the words of the medical fraternity and instead decided that she was going to get her mother back or die trying. This book tells of the horrors, despair, hope, love, and incredible experiences and insights of that journey. It shares the difficulties of going against a medical system that has major problems and limitations. Amongst the darkest times were moments of great laughter and joy. Relentless will not only take the reader on a journey from despair to hope and joy, but it also provides information on the treatments used, expert advice and key principles to overcoming obstacles and winning in all of life's challenges. It will inspire and guide anyone who wants to achieve their goals in life, overcome massive obstacles or limiting beliefs. It's for those who are facing terrible odds, for those who can't see light at the end of the tunnel. It's about courage, self-belief, and mental toughness. And it's also about vulnerability... it's real, raw, and genuine. This is not just a story about the love and dedication between a mother and a daughter. It is about beating the odds, never giving up hope, doing whatever it takes, and what it means to go 'all in'. Isobel's miraculous recovery is a true tale of what can be accomplished when love is the motivating factor and when being relentless is the only option.   We are happy to announce that Pushing The Limits rated as one of the top 200 podcast shows globally for Health and fitness.  **If you like this week's podcast, we would love you to give us a rating and review if you could. That really, really helps to show get more exposure on iTunes** The information contained in this show is not medical advice it is for educational purposes only and the opinions of guests are not the views of the show. Please seed your own medical advice from a registered medical professional.

In this weeks episode Lisa sits down to talk with Joe Cohen serial entrepreneur, biohacker, genetics expert and founder of Self Decode a genetic testing website, Lab Test Analyzer and SelfHacked.com   They dive deep into DNA and what it can teach us about ourselves and how to use the latest in scientific information about our genes to improve our daily lives, prevent disease and improve our health.   If you are not knowledgeable about your specific genes you are just guessing in everything that affects your health. From your diet to supplements, to exercise to mood and behaviour influences, to gut health to detox abilities to cardiovascular health, even through to medications.  This world is not a "one size fits all" and having such an approach can never help us optimise our lives, our performance and health.   Learn how you can discover what your genes are doing and how to interpret them using the fantastic program and tools Joe and his team of scientists have put together.   You can find out more at https://selfdecode.com/?a_aid=lisatamati and use the code Lisa10 at checkout and if you want help with your results and implementing a personalised approach to your health visit Lisa and her team at www.lisatamati.com or email support@lisatamati.com for details on working with them.     We would like to thank our sponsors for this show:   For more information on Lisa Tamati's programs, books and documentaries please visit www.lisatamati.com   For Lisa's online run training coaching go to https://www.lisatamati.com/pag... Join hundreds of athletes from all over the world and all levels smashing their running goals while staying healthy in mind and body.   Lisa's Epigenetics Testing Program https://www.lisatamati.com/pag... measurement and lifestyle stress data, that can all be captured from the comfort of your own home   For Lisa's Mental Toughness online course visit: https://www.lisatamati.com/pag...   Lisa's third book has just been released. It's titled "Relentless - How A Mother And Daughter Defied The Odds" Visit: https://relentlessbook.lisatam... for more Information   ABOUT THE BOOK: When extreme endurance athlete, Lisa Tamati, was confronted with the hardest challenge of her life, she fought with everything she had. Her beloved mother, Isobel, had suffered a huge aneurysm and stroke and was left with massive brain damage; she was like a baby in a woman's body. The prognosis was dire. There was very little hope that she would ever have any quality of life again. But Lisa is a fighter and stubborn. She absolutely refused to accept the words of the medical fraternity and instead decided that she was going to get her mother back or die trying. This book tells of the horrors, despair, hope, love, and incredible experiences and insights of that journey. It shares the difficulties of going against a medical system that has major problems and limitations. Amongst the darkest times were moments of great laughter and joy. Relentless will not only take the reader on a journey from despair to hope and joy, but it also provides information on the treatments used, expert advice and key principles to overcoming obstacles and winning in all of life's challenges. It will inspire and guide anyone who wants to achieve their goals in life, overcome massive obstacles or limiting beliefs. It's for those who are facing terrible odds, for those who can't see light at the end of the tunnel. It's about courage, self-belief, and mental toughness. And it's also about vulnerability... it's real, raw, and genuine. This is not just a story about the love and dedication between a mother and a daughter. It is about beating the odds, never giving up hope, doing whatever it takes, and what it means to go 'all in'. Isobel's miraculous recovery is a true tale of what can be accomplished when love is the motivating factor and when being relentless is the only option.   We are happy to announce that Pushing The Limits rated as one of the top 200 podcast shows globally for Health and fitness.  **If you like this week's podcast, we would love you to give us a rating and review if you could. That really, really helps to show get more exposure on iTunes** The information contained in this show is not medical advice it is for educational purposes only and the opinions of guests are not the views of the show. Please seed your own medical advice from a registered medical professional.