Foreign.

Welcome to the TRIDOC podcast for April 3, 2026.

I'm your host, Jeff Sankoff, the Tridock, an emergency physician, a triathlete, a triathlon coach and a multiple Ironman athlete.

Coming to you as always from beautiful sunny Denver, Colorado.

That kind of is technically a lie.

I'm recording this in Denver, Colorado, but when you're hearing this, I will be firmly ensconced in my beachside bungalow in Belize where I am in the middle of a family vacation, scuba diving, getting my dive master certification.

Tell you a little bit about that just a second or so.

I want to first make note of the voice that you heard at the beginning of the podcast.

That was that of my intern for the last couple of years, Nina Takeshima.

She has been working diligently behind the scenes to provide me with a lot of the references for the work that I'm able to bring to you with my colleague Juliet Hockman to answer your questions about supplements, about gear, about different kinds of strategies for injury recovery.

And she has taken an offer to attend the University of Michigan in a MD PhD program that will beginning in the fall.

And so Nina is finishing with her internship on the TRADOC podcast and moving forward.

And I wanted to acknowledge the amount of amazing work that she's done by having her on the program so that she could meet all of you and tell you a little bit about her background and what working on the podcast has meant for her and now that she's moving forward, what the next stage of her life is going to bring for her.

Before we hear that interview, I want to acknowledge the beginning of the true North American race season.

I know we had Little Elm a couple of weeks ago, but the real North American race season, at least in my mind, begins with the Oceanside 70.3 that takes place every year in Oceanside, California.

It is a bucket list kind of race.

I obviously am not able to bring you the results because I'm recording this before I leave on my vacation, but I know that I have great anticipation for that event.

It's going to feature a couple of life sport athletes, one of them being Luke Tasker, a previous guest on this program, a previous overall age group winner at Oceanside.

He is making his professional debut in a very competitive men's field, a field that's going to feature the likes of all three of the big Norwegians, including Christian Blumenfeld fresh off his win in Geelong.

A very quick turnaround after long travel it the of course Ironman world champion Caspar Stornens and previous world champion Gustav Iden.

It will also feature the likes of Ben Kanute and several other high profile, high powered names.

Sam Long making his season debut.

So it's going to be an incredible event.

We will see how Luke is able to fare in his first ever professional race.

The other life Sport athlete, another former guest on this program is Maya Watson and we wish both of them great luck and I will be following from afar, hoping to see them both have sensational days and the women's field no less impressive.

Taylor Knipp also making a rapid Turnaround from the T100 race in Australia, flying across the ocean and racing in Oceanside.

It's going to be an incredible day.

We're also going to see the women's Ironman champion in Solveik Lofting also racing in Oceanside.

Just an incredible day.

I hope that the race turns out as well as it is predicted.

I hope that the broadcast is going to be better than what we have come to expect from Ironman.

So fingers crossed.

I look forward to discussing the outcome on the next episode of Tempo Talks, which you can listen to also today when this episode of the TRADOC podcast comes out.

So do have a listen.

I also just want to comment again, I'm on a family vacation.

This is obviously not always the best time to be taking a family vacation.

It's really peak training season.

My own first race of the season is coming up in about six weeks.

But you know what, I'm at that point of life.

I think I've talked about this before where, you know, your why is maybe always fluctuating.

And I know for me right now I'm really enjoying watching my two teenage athletes in the house.

A pole vaulter, a runner, really invested in their athletic success, really invested in spending time with them, knowing that they're going to be moving off to college in a couple of years.

So my athletic performance in triathlon has become less important to me.

I definitely put in the time to train.

I definitely want to show up at races and be able to perform as high a level as I can.

But whether or not I come home with a podium position, whether or not I come home with a slot to Worlds, not really the end all to be all that it once was.

I'm sure I'll get back to that again at some point when my priorities shift yet again.

But I think my point in telling you this is that it's okay, it's all right to have your priorities shift over time.

I still remain motivated to train.

I still remain Motivated to be my best.

But I have found the ability to find balance in the different things that are priorities in my life.

And right now, my family and spending time with them and not necessarily carving out as much time to train while on vacation is okay.

I can accept it.

It doesn't stress me as much as it once did.

And if my results don't live up to where I once was, I'm gonna be okay with that.

Because spending the time with my kids, who I know are gonna be leaving in a couple of years, and getting that quality time with my wife and getting that quality time as a family just means a lot to me right now.

And I know that my daughter, who's editing this program is gonna be like, wait a minute.

When I was leaving, you were still training hard.

She's got a point.

She's got a point.

But the reality is that she's gonna be coming on vacation later this year, and I won't be training when she's.

Yeah.

My point in saying this to all of you is some of you are going to be going on vacation with your family, and you're going to want to carve out a lot of time to train, and that's okay, too, as long as you have your family on board and as long as you know what your priorities are, and as long as those priorities don't cause internal conflict with your family members and with yourself, if you can find inner peace, if you can find peace amongst the different people who have a stake in all of the things that you do, then that is perfect.

And that's what we're always seeking.

And when those values change over time, when those priorities change over time, that's all right, too.

Life moves forward.

We find ourselves in different phases.

And while triathlon will always remain a very big part of who I am and a big part of my life, I have found that it's okay if it ebbs and flows in different sort of stages of my life.

Right now, it's receding a little bit.

Although it remains a very high priority, it's not quite the biggest priority that it once was.

And I'm actually very much at peace with that.

I look forward to seeing many of you at races, and I hope as the season begins, if you're racing Victoria, which will be the first race that I'm going to be at, that you will contact me.

I would love to meet up while we're there.

We can chat about all of the things in triathlon, all the things in your life, and all the ways that you can find balance.

If you're looking for a coach for your races that are coming up this season, I have room in my roster.

So do reach out.

I'd love to chat with you about how we can move forward on that journey and help you find the success that you're looking for, if not necessarily with results, but finding balance and helping you figure out a way to make training fit your life, not the other way around.

All right, that's what I've got.

In terms of monologue this episode, let's move forward with the Medical Mailbag.

That's coming up right after this short break.

I'm so excited to be bringing you an episode of the Medical Mailbag in which both of us are healthy.

So yay.

Julia, your running is still coming back, so I don't know if you can.

Count yourself completely well, but we're both healthy from our respiratory ailments that we have recently succumbed to.

We've recovered.

You're right.

I am still dealing with comeback from my running injury, which is.

Although I have to say, you know, big picture, my run today actually went pretty well.

So I have to take the small victories, right?

Absolutely.

Anyways, all of that to say, this is the medical mailbag.

That means that the voice that you're hearing is that of Juliet Hockman, my friend, my colleague, a coach at LifeSport coaching.

Juliet, how are you doing today?

Doing pretty well, thanks.

How about you?

Oh, good.

I gotta say, you know, it's a good day.

It's a good day.

I unfortunately didn't get to swim.

I was supposed to swim today, but Lauren sent me on a hot pursuit of these spikes that she needs.

Needs.

Of course she needs them today because she has a meet tomorrow.

And all of a sudden we became aware that, oh no, my sprinting spikes don't fit.

Her feet have not grown.

She's exactly the same size.

But it turns out that if I don't get these new sprinting spikes now, I'm in big trouble for this meet tomorrow.

And I'm like.

Can I remind you where we just were like two weeks ago?

Nike Indoor Nationals where they had spikes aplenty.

So why this became an emergency.

Wait, so you missed your swim to go and buy your child's shoes when it was her poor planning that resulted in her not having the shoes?

Wow.

I am both a doting father and a sucker pushover.

What happened was, is she bought the shoes to her somewhat credit.

But then I had to drive all the way down to the store to find out she bought the Wrong size and they didn't have her size, so I wasted all of that time.

Wow.

Does she not have a license?

She will be.

No.

Doesn't drive, which is fine with me.

I. I don't mind.

Yeah, that's fine.

Yeah.

So I.

We do what we do.

She will be running in the old spikes tomorrow.

I'm sure she'll do just fine.

I'm sure she will.

But.

Yeah.

Anyways, so that was my afternoon, but honestly missed my swim.

But I honestly.

I'm going on vacation this week.

That's why we're recording a little bit early.

We are recording about 10 days before this episode will come out because I am going to be scuba diving in Belize getting my Divemaster certification.

I'm pretty excited about that.

Yeah.

So.

Wow.

Unfortunately, poor Sandra, my wife, she tore her ACL a couple months ago and she has not been given clearance to dive.

So she's not going to be diving when we're diving.

I think I have to keep that on the DL.

So, you know, she doesn't listen.

So she's kind of sad about.

Doctors are the worst patients.

Right.

Yeah.

But she has strict orders to leave her fins behind so that she won't.

Oh, the finning thing.

Right.

Yep.

Yep.

That's the issue.

Okay.

Yeah, yeah, yeah.

Well, I'm sorry about that.

But there will be other dives.

You guys dive with some frequency.

We have a trip at the end of the year.

Yeah.

Trip at the end of the year.

She's quite excited about.

But anyways, it is this weekend.

You and I are recording this just a couple of days before.

Before Oceanside.

Oceanside, yeah.

So big race.

Big.

One of our friends and colleagues, Maya Watson, professional.

Two of our friends and colleagues.

That's right, Luke Tasker.

On the men's side, Luke Tasker, Maya Watson.

We have a couple of age groupers as well who are pretty speedy, but, yeah, really excited to watch them fly.

And, you know, iconic course, typically the season opener, but now Dallas is kind of snuck in there.

But yeah, very exciting.

Luke has a great pedigree at this race.

He's won the overall age group twice, I think.

For once, for sure.

Yep.

Yeah.

He is no slouch on this course.

And I mean, obviously age group win versus professional ranks quite different.

But he has just been.

Luke has been a previous guest on this program.

He is a previous.

He wasn't an Olympian, but he was training for the British Olympian Pentathlon.

Modern pentathlon.

Modern pentathlon.

So he's quite an athlete.

Yeah.

And I am very excited to see his professional debut at quite an amazing race.

So that's going to be fun.

Yeah, boy, he's picking a tough one.

I mean, that's.

Yeah.

You know, he's not going to go.

Big or go home, right?

Go big or go home.

Absolutely.

Yeah, yeah, yeah.

So when this race, when this episode comes out, the results will be known, hopefully.

Luke, you had a good day, Maya.

And Maya, I hope that you had a great day and also any of the life sport age groupers that are racing.

All right, well, all of that to get us to a listener question.

We have a question.

I just love the fact that we've had so many great questions coming in.

So if you're listening and you have a question you want to hear in a future episode, I do hope you'll send it in.

I will give you the methods to do that at the end of this segment.

But for now, Juliet, we have a listener question.

What is it?

Who is it coming from?

What will we be talking about?

We do, and I'm excited to talk about this because although I know you're going to give us a whole bunch of data to approach the actual question, there's sort of some corollary issues around it, too, which I think we'll talk about.

This one comes from Elliot Hochstra or Hoekstra.

Sorry, Elliot, if I didn't get your last name perfectly right, but he is writing in to ask about breath work and VO2 max, and if really intentional time spent on breath work, in other words, taking up training time that might otherwise be used in another swim, bike, run, lift, pursuit of triathlon, whether that intentional breath work can help advance or improve our VO2 max.

These breathing exercises, can they really strengthen the respiratory muscles, et cetera.

So I know that you uncovered a bunch of studies on this.

So tell us, first of all, what breathing exercises we're talking about, what breath work is and what we know about it as it refers to improving VO2 max for endurance athletes.

Yeah, it's a cool question, right?

Because I.

When I got the question from Elliot, I was a little perplexed at what he was referring to.

And when I actually got into it and read a little bit, it was intriguing to me.

And we'll talk about it.

I want to give props to our intern, Nina Takeshima.

This is the final episode that Nina is working on.

Nina's actually the guest on this episode, so you're gonna hear her voice after this segment as I kind of give her a farewell as she moves on to the next phase of her career, moving into an MD, PhD program.

But she did some amazing work.

Yeah, she's.

She's a superstar.

She did some amazing work on this episode, finding just an incredible plethora of literature to answer this question.

So I think where we should probably begin is with that question of what exactly is breathwork?

Great.

And I came across this great study.

Or I didn't.

Nina did.

She came across this great study.

It's from the Cleveland Clinic in 2023.

It's breathwork for Beginners, what to know and how to get started.

It's the Dummies Guide, the Dummy's Guide.

There you go.

It's really a nice little review of breathwork.

And it points out how Eastern medicine has been using breathing techniques for thousands of years and that mental and emotional stresses can be dealt with by using very purposeful types of breathing techniques.

And I think that is what you were alluding to a little bit earlier when you were talking about kind of parallel or peripheral uses for those other.

Ways that breathing techniques could be useful in endurance sports, but perhaps not be an enhancer.

Yeah, right.

Yeah.

And what this paper goes on to say is that breathwork is a really good.

And there is evidence to support this, a really good stress management technique in that it helps by slowing down your breathing, by being very purposeful, especially using forced exhalation, that your parasympathetic nervous system and calms you and moves you away from a flight or fight mode and deescalates or de stresses you.

And I, as you know, I've been much more involved and invested in track and field.

And I have noticed a lot of the high performing athletes do very purposeful breathing before they do their events.

And I'll see these men, women at the end of the Runway mostly, not so much for the sprinting or distance events, but when they're getting ready to do a real explosive type of thing.

Like a high jump.

Exactly.

Yeah.

And they'll stand at the end of the Runway and they'll be talking out loud and giving themselves a pep talk.

And I've seen these reels where you can actually see what they're saying to themselves.

It's like, I'm going to run fast, I'm going to lift my knees.

And then just before they do it, they kind of pause for a second and they'll take this real deep breath.

They'll often close their eyes to settle themselves.

And then when they open their eyes, they're just like, boom.

They just go.

And even Lauren has adopted this before.

She begins, she takes a deep breath, long exhale, she starts to talk to herself, to kind of get herself ready to go, and then goes.

And I think that it is really fascinating.

So this paper, for anyone who's ever watched.

Anyone who's ever watched gymnastics, right, and the women who are doing the bolt and they're standing there, they're checking their foot position, they're talking to themselves, they're taking big breaths before they go and do this unbelievably explosive movement.

Where they're going from, you know, moving on one plane to moving on another plane.

I mean, yeah, you absolutely see them doing that.

So same idea, right?

And I think that you and I have a real fondness for biathlon, which is.

Yes, absolutely.

Heart rate, respiratory rate super high.

Coming into the shooting range and needing to immediately control your breathing and your heart rate.

And the way they're able to rapidly drop those things so that they can hold the gun and be able to fire at this tiny little target, it's.

It's pretty amazing.

It's extraordinary.

So this paper goes over several different modes of breathing techniques that you can use for breath work.

The first is diaphragmatic breathing, which initially sounds odd to me because to me you're always breathing with your diaphragm.

But I think of this as sort of like, you know, how singing coaches often talk, breathe with your diaphragm.

And I'm like, well, how else do I breathe?

But, well, seven years of playing clarinet, I can tell you, I was always told to breathe from my dive span.

Did it, did it ever resonate or make sense?

No, it really never did, but I kept trying.

Yeah.

So I think, I think what's meant by this is this notion that, you know, when you take a deep breath, you can raise your rib cage because you're using your intercostal muscles, or you can really push down and contract that diaphragm.

It flattens, it lowers, and it pushes out your abdominal contents and makes your belly expand.

And I think that's really what they're referring to.

That's my guess.

Box breathing.

This is where you take a four count and it's a count of one to inhale, one, hold the breath, one to exhale, one hold and then repeat.

So making a little square, I think that's kind of self intuitive.

There is a 4, 7, 8 breathing, which is inhale for four counts, hold for seven counts, and then exhale for eight counts, which sounds challenging.

Wow.

Sounds very challenging.

Yeah.

Alternate nostril breathing, historically said to clear energy Blockages and bring inner balances.

Some studies have suggested it may sharpen focus and energy.

I think what's meant for this, I.

Think snot would just come out of my nose if I did osteoporosis.

I know.

I think what's meant by this is that you breathe in through one nostril and out through the other.

I have no idea what the theory is for this to pursed lip breathing is breathing in through your nose and then keeping your lips pursed and sort of doing a forced exhale.

Because if your lips are pursed, you have to.

You really have to force to breathe out through a small opening.

And you may recall we reviewed a device many, many years ago called the G02, which was like this thing, this valve you kept in your mouth and basically simulated pursed lip breathing because it forced you to breathe out against a closed valve.

So all of those are methods of breath work.

There's a couple others.

Oh, you're going to love this one.

Lion's breath.

Stick your tongue out during exhalation and make a ha sound to relieve anxiety.

Finger breathing.

This is where you trace around your fingers with the finger of your other hand while you're breathing.

I have no idea what this is supposed to do.

Holotropic breathwork.

This is rapid controlled breathing usually led by a facilitator.

And then breathwork meditation combines elements of deep breathing and meditation.

So there.

This article went on at great length to talk about different breath work.

It did note that scientific research or evidence is quite limited or not even found for many of these techniques to support the claims being made by the practitioners.

But that there is some for especially things like pursed lip breathing and for the box breathing.

That shows that there is some psychological and potentially some physiologic benefits.

But we'll talk about those in a second.

Another article that different types of breath work.

This one is an article that came out in 2024.

It was a web article, wasn't published in any particular journal.

This was an article that talks about the benefits of breathwork and was supported principally by testimonials.

So it was a lot of.

Mikey likes it in this article.

But yeah, I mean, that's what a testimonial is.

And I mean, basically what they did is they got into the breathwork modes, the different things that we talked about.

It introduced some other ones as well, such as Pranayama breathing, which is.

I don't even know.

It's again with the nostrils.

And then Wim HOF Breathwork.

Contemporary breathwork, combining breath control, cold Exposure and meditation to improve physical endurance, immune system and build mental resistance.

You know, when they start throwing in stuff like, you know, improve physical endurance, the immune system and build mental resilience, they start to lose me there because it gets a little wonky.

But whatever.

A lot of these different breathwork models are theorized to improve endurance performance in VO2 Max, which is really what we're interested in, by improving the strength and actual mass of the respiratory muscles.

And then also the idea is, is that you make the respiratory system more efficient, so able to bring in more oxygen, able to provide the bloodstream with more oxygen.

So VO2 max then theoretically could go up.

There's no indication that any of this could affect cellular uptake or cellular processes upon which VO2 max is really predicated upon.

But VO2 max is.

There's two, there's two sort of sides of VO2 max.

There's the ability to deliver oxygen to the cells and then there's the ability of the cells to make use of it.

And, you know, if your cells are really, really capable of making use of a ton of oxygen, but you can't deliver it, then it's no good.

So all of this breath work, the idea is that you're improving the ability to deliver oxygen, but whether or not the cells are going to be able to use it remains unclear.

Okay, so the article that Elliot sent in was called VO2 max and breath work for longevity and performance.

It talks about how exercise in general is very good for overall health and well being.

It talks about how breathwork is conscious kind of activity that you can do for relaxation, meditation or therapeutic purposes.

And then makes a lot of claims about this idea that breathwork can provide physical and health benefits, but doesn't really provide any evidence to back it up.

They talk about nasal breathing preferred over mouth breathing.

And there are some scientists who would argue that nasal breathing is better just because nasal breathing filters better.

But when you're running or when you're doing things that require a lot of intake of oxygen, and as we all know, mouth breathing tends to.

Yeah, no one's breathing through their nose when they're running.

A really interesting study from 2022 is the effects of apnea training on aerobic and anaerobic performance.

A systematic review and meta analysis.

This looked at breath hold diving.

So this is like free diving.

So people who are really skilled at holding their breath and being able to go down to really deep depths and looked at different breath holding techniques and different breathing techniques to help divers and measured their VO2 max as well as their ability to tolerate lactic acidosis, and found that the people who did these breathing techniques had an improved ability to tolerate higher levels of carbon dioxide in their blood, had an improved ability to tolerate lactic acid in their blood, but their VO2 max did not budge.

So, not surprising.

I mean, if you train yourself to breathe more slowly, you're going to retain carbon dioxide because you're not blowing it off.

And you will kind of learn to withstand the physiologic forces that are begging you to breathe, and you'll kind of learn to mentally overcome that, and then you'll also become anaerobic at times, and you'll learn to tolerate that lactic acid.

But whether or not that means you're going to be better able to tolerate anaerobic activities or perform better anaerobically, not clear.

Effects of breathing exercises on resting metabolic rate and maximal oxygen uptake.

This is from 2018.

And this really gets to the crux of what I was saying before.

You could do all this breath work to learn how to improve your respiratory system and potentially train your respiratory muscles, but if you can't actually get the cells downstream to be able to do more, then you're not really changing anything.

And this paper looked at training participants, either by doing this diaphragmatic breathing exercise or a feedback breathing exercise using a respiratory training device.

And it had 38 healthy participants who were not trained athletes.

So this was just 21 were doing the diaphragm breathing.

The rest, 17 were doing this feedback breathing.

They measured their VO2 max, they measured their resting metabolic rate before this.

They put them through this whole procedure, and lo and behold, they found.

This was the only paper we found that found this.

But in this paper, they actually found that VO2 max did improve somewhat, as did resting metabolic rate.

It lowered.

So resting metabolic rate went down and the VO2 Max went up in these people, not a huge amount, but a statistically significant amount.

We're talking, like, I mean, 83.7 milliliters per kilogram per minute pre to 92.19 post.

So not huge, but it's there.

But this was the only study we found that found a result.

And again, these were not athletes.

Anything we found that looked at athletes showed no difference in VO2 max, which suggests that.

And I've said this, when we've looked at respiratory training devices, when you're doing athletic training, you're already training your respiratory muscles, because think about how hard you breathe when you're running, biking, swimming, doing whatever you're Getting that training.

I'm not sure breathwork really adds anything to that.

The effects of short term supplemental breathwork protocol and the aerobic performance of recreational runners.

This is another interesting study using some breath work, dividing recreational runners into two separate groups, one group doing breathwork, the other group not, and then looking at their VO2 Max and basically finding no difference whatsoever whether or not you did breath work.

So the group that did breath work had no change in their VO2 max compared to those who did.

And to finish things off, we've got effects of simultaneous aerobic and inspiratory muscle training on diaphragmatic function, respiratory muscle strength, endurance and fatigue index Randomized control trial.

This study basically showed that if you do exercise and some kind of breath work, you can improve your inspiratory muscle strength, endurance and anaerobic performance in a short time, suggesting a potential to support muscle adaptation.

But they found absolutely no changes in VO2 max or actual measurable performance.

So all of this to say that breathwork has some interesting kind of theoretical purpose, but that it hasn't borne out in any changes in actual measurable metrics of endurance exercise, and certainly nothing observable.

But I do want to go back to your point that you made before we were recording, because I think it's important.

So what were you saying?

Right, yeah.

So my point was simply that although the studies had shown that breath work had not improved in athletes or an individual's VO2 max, and so we can't look at that as a measurable difference for endurance athletes, it can help tremendously among the athlete population who experience race anxiety, open water anxiety by giving them some tools to calm themselves on a start line, calm themselves before they charge into the water.

A skill set for if you're in a situation where you find your respiratory rate coming up dramatically, that will inhibit performance to calm yourself down.

So, you know, for those athletes for whom that is a factor and has undermined their performance in the past, breathwork could be potentially very helpful.

I think it's an incredibly important point.

I mean, we've spent a lot of time on many episodes talking about the value of mindset, the value of positive attitude, the value of working with a mental performance coach to deal with all of these things.

But a lot of the things that these coaches will talk about is learning to recognize your own anxiety and learning the tools to control it.

And I believe we've had a couple of different coaches who have mentioned breathing as an important tool.

And I agree with you.

I think if you are the kind of person who gets anxious before a race, Understanding some of these breath techniques can be incredibly valuable.

Finding yourself a quiet place to sit down or stand, whatever is more comfortable for you, and then learning how to do these slow breathing exercises because as we've heard, they activate your parasympathetic system.

Because when you're anxious like this before a race, it is your fight or flight, right.

Is your cortisol, your adrenaline is all ramped up and it's.

Your sympathetic system is through the roof.

And if you could find anything that will allow you to activate the counter parasympathetic system to bring things back into balance, you will feel immeasurably better.

And what better way to start a race than getting those two things back into balance?

I think it's an incredibly important thing that you're saying and one that we cannot discount at all.

Yeah, I mean, I don't know how you feel in the starting shoot, for example, of a triathlon where you're waiting in that swim chute for your turn to go, it's wait, wait, wait, wait, and then bang, all of a sudden you're running towards the water.

But in those moments, I mean, I am incredibly, deeply anxious and I do use not particularly sort of well honed breathing techniques, but I'm definitely tuned into how I'm breathing, what I'm saying to myself in my head and sort of marrying the two to bring myself down off of this incredibly heightened state of.

Again, you feel like you're being chased by the saber tooth tiger, right?

Because it's that flight sort of, you know, fight or flight response.

And so, yeah, I do think that the extent that athletes can practice these before they get into that situation where they're anxious again, it doesn't necessarily.

We have no proof to suggest it improves your VO2 max function, but it can help in other ways.

It will enhance performance.

The race organizers don't do themselves any favor by like, they're pumping up those loud music.

And the guys at the Friday, he's like, come on, guys, who's the first timers?

He's like, trying to get everybody and, and the thing is, there's a lot of people in that crowd who actually would like, let's put on some classical music.

Let's tone things down a little bit here.

Everybody breathe 100%.

Yeah, let's do a little Zen stuff.

And yeah, I agree with you.

I think that.

I know for me, I don't tend to get too nervous anymore, but when I'm standing in that line and inching closer and closer.

I. I mean, it doesn't matter how long you've been doing this.

You get more increasingly anxious, and I try to control it.

It's very hard, though.

I mean, I just know that when I get in the water, I'll get swimming.

After the first few strokes, everything will come back into balance and I'll be okay.

But, yeah, it's tough.

My last few Ironman races, I know that in transition, I will be definitely feeling jittery and I will find a quiet place to sit and really just.

I don't meditate, but I do a meditative breathing kind of thing, for sure.

I have definitely felt that to be helpful.

So I think, while, Elliot, we can't say that there's any science to support this notion that breathwork will help your VO2 max, I definitely think.

And although we didn't cover any of the papers that look at this, I know personally, I have seen evidence that breath work can be very effective in coping with stress and anxiety.

And like we've both said here, stress and anxiety can affect endurance performance.

And you can control that with breathing exercises, then that can only be beneficial.

Yeah.

I mean, when you think about how many athletes you've heard of or you have coached or you have been part of their athletic journey who have had to cut out of a swim regardless of its duration in a race, in a triathlon, because they weren't able to get on top of their breathing when they got super anxious in that first hundred to 200 meters of the swim and they had to bail.

Right.

I mean, just think of if those athletes had been better equipped, they would have been able to finish their day.

So, yeah, definitely some value here for sure.

It's a.

It's a tool, for sure.

And it's something that I think, you know, just think about the box breathing.

Just think about the purse lip breathing.

Those are two easy ones to remember that I think if you just sort of keep in the back of your mind for the next time you're feeling anxious, it doesn't have to be around a race.

Just try it, see if it makes you feel better, and if it does, then carry that with you into your next race and see how it goes.

All right, well, this was a great question.

Thank you so much, Elliot, for sending it in.

We really appreciate it.

I mentioned earlier in this segment that if you had questions, we want to hear from them or we want to hear from you about them, so please do send them in.

You could reach us at the Tridoc podcast, private Facebook group.

If you're not a member, please head on over there on that platform.

Answer the easy questions.

I'll gain you admittance and you can join the conversation.

Ask your questions.

You could also email me@tridocloud.com There are innumerable ways to reach us, so I hope that you avail yourself of one of them and send us your questions because we love answering them.

Juliet, it's been a real pleasure.

I will chat with you after I get back from Belize.

We'll be able to discuss what happened down in California at Oceanside and look forward to the Easter spring weather.

It's going to be super nice.

Coming.

It's coming.

Can't wait to hear about your trip, Jeff.

Have a great time.

Okay, take care.

Bye now.

Okay, bye.

Bye.

My guest on the program today is a name that you should be familiar with if you've been a listener of this program for any amount of time over the past couple of years.

Nina Takashima has been one of the two of the interns that has worked so amazingly hard for me over the past couple of years, working to help inform the medical mailbag of all of the evidence that we use each episode to bring you the answers to your questions that inform supplement choices, gear choices, different training and recovery methods, all the things that we have talked about.

Nina and her colleague Cosette Rhodes have helped me do the research on and be able to give you answers every two weeks.

Well, Nina is about to take the next step in her career.

She's going to be moving on to an MD PhD program.

And so I wanted to have her come on the program and say hello to all of you, the listeners who have benefited from her tireless efforts, because I have been so appreciative, and I know you have as well.

Nina Takeshima, welcome at long last to the Triduck podcast as a guest.

Yes.

Thank you so much.

So, Nina, we met because you were the latest in a string of Grinnell swimmers.

So why don't you tell me about your swimming career and how it got you to Grinnell College and all the things you've done since then.

Yeah, absolutely.

So I've been swimming for over 17 years competitively.

And, you know, one of the reasons why I went to Grinnell was because it offered me an opportunity to continue swimming at the graduate level.

I think being involved in aquatics has really shaped my views on health as well as how I approach my goals.

One of the things I really focused on is maintaining discipline, and that's something I hope to carry on in My future and my career as a citizen scientist.

What was the strokes that you swam when you raced competitively?

So my stroke was breaststroke, and I swam some IM as well.

I've always been a breaststroker.

I think when I first jumped in the pool as a little girl, I naturally was doing, like, the breaststroke kick instead of, like, dolphin or flutter.

It came naturally to me.

And I'm so fortunate to be able to swim Akronault College and meet amazing peers and coaches, two peers who introduced me to this position.

And I'm really excited to be able to continue working on maintaining my health and continuing my academic career and also passing on the podcast role to fellow.

Keeping it all in the family.

Because as I was saying to you earlier today, yeah, we.

My first intern was Maddy Pesch, who was a pro triathlete who swam at Grinnell.

Maddie just graduated from medical school, or she's graduating from medical school very soon.

She just matched to family medicine residency in Minnesota.

So congratulations to Maddie.

If you're listening.

And then Matti handed off to the Johnsons, Ian and Ben, no relation.

And they worked with me for a couple years and then handed off to Ewan Cosette.

Cosette will be sticking around, but our latest intern is gonna be Sarah Lopez, who is a senior at Grinnell on the swim team right now.

So she will be introduced to the podcast listeners very shortly.

But when you were at Grinnell, or actually before you went to Grinnell, when you were applying to colleges, did you know about Grinnell?

Is that a college you were looking for?

Or were you really just looking for swim opportunities?

Like, how did that come to be?

Because I got to say, until I met you guys, I had never heard of Grinnell, didn't know anything about it.

Now I know all about it because of the connection.

Yeah, well, I was originally looking at private liberal arts colleges, not programs that would really give me great access to faculty and different kinds of leadership opportunities, research opportunities.

So my primary factor for deciding a school was class size, student to faculty ratio.

And I didn't even imagine I could swim in college, honestly.

So, you know, swimming was something that was really dear to me, and it's been so instrumental in shaping my entire childhood.

So when I spoke with the Grinnell swim and dive coasts and they recruited me to swim with them, I was overjoyed, and I have to go and visit campus.

And when I visited was when I knew that I wanted to go into this program.

I loved the Midwest welcoming culture, and I really enjoyed everyone I met.

You were looking at the school and it just so happened that they wanted you to come swim.

So it was a really good match then for you.

Yeah.

That's awesome.

Yeah.

Were there any highlights from your swimming career at Grinnell that you want to share?

I would say my swim career at Grinnell was a tough one.

You know, I went through a season where I was cut off of a lot of the travel rafters.

And one year before my last season, I was not invited to go on the Florida training trip, which was devastating.

But I think I got to see two sides of, like, disciplined teams, the group who is always going to these needs and really at the center of the team, and also understand what it's like to be left aside, you know, and we all undergo the same training, so it's really hard to see others who aren't able to come to the meet with us or aren't able to go on the training trip.

But I think it taught me a lot, and I think just going through the ups and downs, that being in the athletics exposed with YouTube is really what built the foundations for how I pursue my goals and how I maintain the discipline in my life.

So I think I've learned a lot, and the friendships and the mentorship I received on the team, and I would say, especially at a small school like Grinnell, there's a lot of critical connections across the different years.

And as you can see on this podcast, we've been passing it along to the people who come after us, and it helps us learn a lot about what alums are doing, and it also helps guide us as we're pursuing different tasks.

So I think that's one of the great takeaways from being in a park.

And can we hope to see you on a bike and running and performing a triathlon at some point, using your swimming prowess?

That's a tough one.

I like to run recreationally, but have never competed in triathlon events.

And the biking component is.

It seems really tough.

Maybe later.

Reserve as a possibility.

Sure, maybe later.

So what's next for you, Nina?

I mean, you're an incredibly affable, incredibly happy person.

That's been a real joy to work with because you're always smiling.

You take every challenge as just something to be just overcome.

I've always been impressed by that with you, and I know this past year has been a bit of a slog with all the applications and interviews and everything else.

So where are you off to and what are you looking forward to in the fall?

Yeah.

So my plan is to attend University of Michigan's MSTP program.

It's a dual degree program for the MD and PhD training.

And you know, it might change, but how I Envision Pursuing my PhD is in the School of Public Health in the Environmental Health Sciences department.

And I'm really interested in looking at how different types of environmental exposures would influence disease development or long term health.

And clinically, one of the things I'm interested in is women's health, maternal and fetal medicine and reproductive health.

So hopefully I can do something where I'm looking at maternal exposures to different types of toxins or contaminants and being able to look at infant data or long term health outcomes to see how these exposures would impact disease development.

So that's the kind of work I'm hoping to do and really looking forward to meeting a whole new group of people of the community at Michigan and honestly kind of excited to move back into a Midwest area and experience some more season.

You've been doing research for the last couple years locally where you are in Los Angeles.

So what have you been working on?

Yeah, I'm an industry researcher right now I'm a research associate too at a biotest company and we make different types of rapid tests.

And some of the projects I've been involved in are development of rapid tests that help to detect sickle cell traits in infants.

We send it out to areas in Africa or India where communities have no access to medical systems or mobile resources.

And they're able to use this rapid test and get a droplet of blood from their fingers to see if they have sickle cell trait.

It's a point of care test.

And I've also been involved in several other rapid tests such as ones that detect UTIs and pets and humans.

And I'm currently working on a project to enhance the detection of metal contaminants and tap water.

So that's something that I'll be passing on to some of my colleagues as.

I that last one is very resonant with the public health sort of mission that you're looking at for environmental kind of toxins and things like that.

So yeah, that's cool.

And the MD, PhD program, MD programs are four years, MD PhD six.

It typically between four and six, but they do encourage us to try to get out of there fairly quickly so we can go back to VMD.

When of course you finish, you'll be Dr. Natakashima.

That's pretty cool.

During your time working together with me and Kazette, are there any subjects that you looked into that you remember, particularly as being either interesting or that maybe changed your view on certain things.

Because we've look at worked on quite a few things together and I'm just curious if any of them really stick out.

Yeah, we looked at a lot of things, but one of the ones that I found really interesting was the power of positivity.

I would consider myself a fairly positive person.

And it's really interesting to see how the body and your emotions are in the feedback system.

So what you're experiencing, what you're feeling would alter the physical response in your body.

If you force yourself to smile, then you're also inducing your body to release hormones that would in turn make you more happy or optimistic.

So I think that was really interesting to look at and I think it can be applied to academics, athletics, figure out focal life.

I think I learned the importance of smiling being positive.

Yeah, we had a few guests who've talked about mindset, but I agree with you.

I remember that medical mailbag.

That's when we were talking about the Roger Federer speech and how it dovetailed to just the mindset during endurance sport.

And I too, was quite surprised at the differences that you could see just from smiling outwardly.

Even if you felt horrible inside, having a smile on your face could trick your body to actually perform better.

And I too agree.

I think that was a pretty remarkable finding and also a memorable episode.

I know that you and I had talked also about cold plunges, something that you were doing at Grinnell as part of the swim team, and you were a little bit surprised to see that maybe the literature wasn't so positive on that.

Yeah.

Were you.

Did you take that back to the coaches or did you pass that along to any of the swimmers and say, hey, if you don't like this, you really don't need to?

I did not.

But I know a lot of athletes do cold punches, especially during conference season, so it's really interesting.

I know some people come out of these cold punches and they're freezing.

To go through all of that for very minimal effect is kind of surprising.

Like so many things we see that we've reviewed.

Right.

So many people will spend so much money and do all kinds of crazy things with not a whole lot of effect.

Nina, I just can't say enough about how much I've enjoyed working with you.

I'm so glad that our paths crossed, and I am going to watch with great interest as you continue on to your career in medicine.

It is well deserved.

And I think that the University of Michigan is going to be so incredibly lucky to have a student like you coming into their incoming class in the fall of 2026.

Congratulations to you.

Congratulations to them.

We will watch eagerly and follow you along and look forward to seeing your name in all kinds of important places because I'm sure you're going to make waves wherever you go, doing good things.

Nina Takeshima has been a terrific intern here on the Tridarc Podcast for the last couple of years and she is moving on.

She's passing the torch to another Grinnell swimmer who will be coming on to the podcast doing the medical mailbag research in a month's time.

The episode today was Nina's last.

We will have Cosette Rhodes doing the research for the next episode and then our new intern Sarah Lopez will pick up and follow in Nina's shoes, which will be hard to fill, but she will do her best and we look forward to welcoming Sarah.

We say a fond farewell to Nina today.

Nina, thank you again for two wonderful years.

All the best going forward.

Thank you Dr. Thanka.

It's been a pleasure.

My name is Stephanie Van Bever and I am a proud Patreon supporter of the Tridock Podcast.

The Tridock Podcast is produced and edited by Jeff Sankoff, along with his amazing interns Cosette Rhodes and Nina Takeshima.

You can find the show notes for everything discussed on the show today, as well as archives of previous episodes@www.do you have questions about any of the issues discussed on this episode or do you have a question for consideration to be answered on a future episode?

Send Jeff an email@tridocloud.com if you're interested in coaching services, you really should please visit trycoaching.com or lifesportcoaching.com where you can find a lot of information about Jeff and the services that he he provides.

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The Tridoc podcast will be back again soon with another medical question and answer and another interview with someone in the world of multisport.

Until then, train hard, train healthy.