There's a lot of people who will do cycling all summer and then come and ski all winter.

It's a lot easier on the body than running.

So there will be 70, 80 year old people out skiing and in some of our citizens races they'll be beating a lot of the younger people out there.

So it's a great sport for all ages.

Hello and welcome once again to the Tridar Podcast.

This is the August 22, 2025 edition and I'm your host, Chuck Sankoff, a tridoc, an emergency physician, a triathlete, a triathlon coach and a multiple Ironman finisher.

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

The voice that began the podcast today was that of Silas Eastman.

Silas is the director of a cross country ski park located in the northeast of the country, but he is joining me today to talk about something very different.

He is endeavoring to begin the first ever roller ski competition on the beautiful Caribbean island of Ceiba.

Now Ceiba is an island that I have talked about before on this podcast.

I had a guest on the program to discuss the Ceiba Triathlon.

And Ceiba, as you may recall, is a location that's near and dear to me.

A place that I have toyed with as a locale al for my very own retirement place I am still considering quite seriously.

And so when the opportunity came to talk to somebody about an endurance sport activity again taking place on that beautiful island, I couldn't, couldn't resist in having that conversation.

So Silas will be on a little bit later to talk about what that looks like, but also to talk about why roller skiing might be something that endurance athletes and why roller skiing and why cross country skiing might be something that endurance athletes like triathletes might want to consider incorporating into their off season activities.

Something that unfortunately is coming up far too quickly for us in the Northern hemisphere.

Here we are almost at the end of August.

It just seems to be flying by far too quickly.

Before we get to that interview though, I will have a Medical Mailbag segment.

As always, I will not, however, be joined by my usual colleague, Juliet Hoffman.

Juliet is away on vacation this week with her family in Switzerland.

Instead, I will be joined by a very capable substitute in the form of Griffin McMast.

Griffin is the sometimes host of the Fast Talk Labs podcast and I have collaborated with her on in the past on that program.

I am looking forward to having her join me on the Medical Mailbag where we are going to talk about a subject that has been talked about to deaths pretty much everywhere.

But this show, I have reviewed this subject once before, but I've been asked about it so many times I thought that it was time to bring it back.

And so today we are going to go deep into the world of creatine supplementation.

Is this supplement the one that you hear about all the time from coaches and from nutritionists and gosh, I don't even know who else.

Is this supplement something that really is going to help you get that much faster?

Is it something that you really have to be taking?

Why is everybody else around you taking it and you're not?

Well, we're going to get to the bottom of it and I'm going to give you a little bit of the punchline right now.

You probably don't, but we'll go down that rabbit hole together.

We'll see if you agree at the end of it.

Before we get there though, I do want to share with you a little bit of a story from my recent vacation in Bonaire.

Hey, I talked on my Sister podcast with professional triathlete Matt Sharp last week on Tempo Talks.

I discussed what it's like to train on vacation and especially what it's like to have a travel bike and how that makes cycling in your destination so much easier.

I have owned a travel bike now for over a decade and it has paid for itself many times over just by virtue of the fact that it's given me the freedom to ride easily wherever I go.

The bike packs itself up into a suitcase sized box, makes it very easy to travel with.

I don't have to pay exorbitant bike fees, I just pay a standard bag fee and it's easy to take for even short trips as short as a weekend.

I'm going to Salt Lake City in a couple of weeks for just a Labor Day weekend and I'm going to pack it up and bring it with me and do some riding there.

I understand that a travel bike may not be something that everybody wants to get, but I will tell you that if you're in the market for a road bike and if you're somebody who does like to travel frequently and likes to train when they travel, and likes to bike wherever they go, paying the premium to get couplers inserted into the frame of a custom bike is something that you really should look into.

There are several bike companies that make them.

Mine is made by seven cycles, but when I looked into it there were many others and now that has expanded it more still and it is just such a joy to be able to get to wherever you're going take about 15 minutes to build up your bike and then get out there on the roads and ride and see a place in a way that you otherwise can only dream of.

Again, I understand this may not be something that people are going to just add to their quiver of bikes, but if you're in the market for a bike and you want a very high performance type of bicycle, but something that you can bring with you easily wherever you're going to make sure that you're able to get in your training and see a place, really see a place.

This is something that you might want to explore.

If you want to know more about this, reach out.

I'd be happy to share my experience.

I have a video on YouTube where I actually show how I break down my bike and pack it and how easy it is and the benefits of having it when I get to the other end.

So just reach out.

You can send me an email@triodocloud.com I love to talk bikes, I love to talk travel and when I can marry the two.

Better still.

With that out of the way, let's move on to the Medical Mailbag.

We're going to talk about creatine.

That's coming up right now.

It's time again for the Medical Mailbag, that segment of the program when I am usually joined by my friend and colleague and coach at Life Support coaching Juliette Hockman.

But if you are watching on the video then you will note that it is not the visage of the fair Juliet who is joining me.

Juliet is off in Switzerland this week.

She is on a vacation with her family where she is in the Alps listening to the Sound of Music.

I know that was Austria, not Switzerland still.

And so I have asked a good friend, a often colleague over at Fast Talk Laboratories, Griffin McMath to join me and fill in for Juliet this week as we discuss a medical subject.

Griffin, thank you so much for being a part of the Tridoc podcast this week.

It's a pleasure to have you here.

Thank you.

I'm so excited.

This is my inaugural episode with you on your podcast.

This is a big moment for you.

I know.

I'm very excited.

I know it's been quite a while since we've known each other.

I've had a great pleasure of working with you on Fast Talk.

So why don't you tell the listeners a little bit about you and how we know each other and what you do on a day to day.

What has to happen for someone to say, oh my God, Get Griffin patience.

And enthusiasm is what it probably takes.

So I'm a naturopathic doctor.

So Dr. Griffin McMath.

I'm not clinically practicing right now.

I have in the past, I've had a really beautiful, very diverse career in the last however many years that I've been having a career.

I stopped counting out of desire.

But my last couple of years, I've lived in Colorado and had a really awesome exposure to the endurance sports community by way of my expertise in nutrition and integrative medicine, both from the prevention lens and that longevity lens.

So I was hired by coach Trevor Connors, some of you may have heard of him, to be the chief content officer of the Paleo Diet.

And he also owns Fast Talk Labs, which is just an incredibly amazing community.

How I met you.

And so by working through both of those companies now, Chris Case has taken over and I've stepped more into the Paleo Diet.

But I still am a host on the Fast Talk podcast, and that's where I get to talk to just such brilliant people.

And thankfully, you're local.

And so I have had a chance to have coffee with you in real life and work with you through your knowledge, both as physician, not both as physician, athlete and coach.

And that's what I do now from day to day, is I occasionally bring my unique perspective to podcasts.

I work with athletes and different scientific experts through that.

And then day to day outside of that, I'm heavy into health literacy and nutrition and different partnerships that help bring that to life both on the individual basis and systemic societal basis.

Well, I just have a lot of fun talking to people like you.

Yeah, yeah, yeah.

And I have very much enjoyed all of our collaborations.

And you are perfectly well suited for the subject that we are going to be discussing today.

This is a subject that has.

It's something I actually discussed quite a while ago.

I have to look back and see what episode it was, but I have been asked about it repeatedly.

It is if it is everywhere.

It is continuously brought up by nutrition, nutritionists and coaches as something that athletes need to be taking, that need to be incorporating.

And every time I'm asked about it, I say, look, I've looked at this.

There's really not great evidence for it, but I get asked so frequently that I thought, you know what, maybe I should take another look.

And so here we are.

The latest person to ask about it, and she did so very eloquently, is a longtime supporter of the podcast, Xenia Parker.

She reached out and she wanted to know whether or not there is evidence to support the usage of creatine as a supplement for endurance athletes.

In the past, when I've looked at this, the evidence I felt was a mixed bag.

Some of the evidence was very glowing, overwhelmingly positive.

But you could invariably find that all of the positive papers were basically either sponsored by or actually done by the makers of the supplement creatine.

And the good studies that were untainted by industry tended to show that in fact, for endurance athletes, specifically creatine, not particularly useful.

But I wanted to go back and so I asked my intern Nina Takeshima, who was assigned this particular topic, to do a deep dive and she went to town, she found quite a bit, and I asked her this time to also look and expound not just at creatine for athletics, but creatine has been bandied about as good for cognitive health.

It's been looked at even for other kinds of health situations.

And so she came back with an overview and a summary and some papers that look at creatine in a few major areas.

So we're going to talk about creatine for endurance sport, we're going to talk about it in non endurance athletics, we're going to talk about for cognitive brain health, and then we're going to talk about it for mental health.

Those are the four or.

Yeah, 1, 2, 3, 4 areas that we're going to be talking about.

Griffin, have you had this kind of conversation with people as well?

Are people like, is creatine on your radar?

I'm guessing in fast talk labs it must have been talked about as well.

It pick a circle that I've been in over the years and it's been in the conversation.

Even people.

I don't say near end of life care, but so many different population, patient populations or indications, as you mentioned, the different areas that we'll go through, including some that weren't on that list.

And in fact, in preparation for this episode, I was on a call with a friend earlier who's a Boulder cyclist just now getting into running, and I told her what the podcast was going to be on and she goes, okay, wait a minute, you have to tell me about this, because everyone is talking about it right now.

And I found it so interesting because I feel like creatine made popular again in the 90s is something where I think finally, creatine's science is greater than the hype, which is not true for all supplements.

And I think creatine is an exception there.

And so I'm particularly excited to talk about it today.

As you mentioned, it's one where we can talk about it from the lens of not just athletics, but as a whole person.

What are the benefits?

Where is it myth?

Let's start first just about how creatine, or what creatine does.

So creatine comes as a couple of different supplement forms.

It comes as a monohydrate, it comes as a salt in the form of creatine hydrochloride.

The monohydrate is not particularly water soluble.

It comes, you have to, you can add it to things, but it tends to remain as a powder.

So it's a powdery substance, it's gross.

It can be packed into little capsules.

You could take it that way, but you have to take large amounts of this stuff.

There is a hydrochloric acid salt, as I mentioned, creatine hydrochloride, and that is a little bit more soluble, but even that doesn't dissolve that well.

And so when people try to put this stuff into smoothies or into whatever it is they're trying to take it, it still has a very chalky sort of resid, this kind of grittiness.

It adds to things that it's taken in, but again, it can be packed into capsules and that's a more convenient way of taking, is converted into phosphocreatine once it gets into the cells.

And there it is basically incorporated into muscle.

And it is involved in the biochemical process in which ATP is made.

It also has a role in the anaerobic metabolism in that it can help in the.

I'm not going to get into all the biochemistry, but the phosphocreatine process also is involved in buffering lactic acid.

So it helps with the production of ATP, but it helps specifically when you're anaerobic, when you're aerobic, when you have plenty of oxygen, and when you're operating in an aerobic capacity.

The phosphocreatine process does not really activated quite as much.

Now, creatine does get incorporated into muscle mass and it does contribute to the formation of muscle.

It also, because it is, it's an ester, it drags with it quite a bit of water.

So when it comes into the cells, it tends to contribute to enlarging muscle mass, which is really why it got its start in the bodybuilding sphere, because bodybuilders found that by using it, it would really help build muscle mass.

And indeed, there are a host of studies that if you take creatine supplements, you will build muscle mass, you will improve muscle definition and you will improve muscle strength.

Especially when it comes to doing repetitive anaerobic types of things.

So lift like bicep curls, which are done very rapidly.

And when they're done before you can re oxygenate the muscle, having extra creatine can really help that process.

So anaerobic, those kinds of strength related kinds of activities have been shown with good quality research to benefit from creatine supplementation.

The problem is that's not what we do as triathletes and it's not what cyclists or runners do.

Cyclists, runners, triathletes are for the most part operating in an aerobic range.

We don't now cyclists, you could argue, especially like crit racers, even some cyclists who are road racing, they are going to be for the most part aerobic, but they are going to need to go into these anaerobic sections, sprints for example, trying to make a breakaway, that kind of thing.

So you could argue that very specific types of conditions for cyclists will, they will need to surge into this anaerobic sort of area.

But there is this caveat that cyclists are also very wary of the amount of weight that they're carrying with them because there is a, an equation of watts per kilo.

And if you have extra kilos, you may be taking away from the fact that you're generating extra watts.

So for us as triathletes who are operating really within our aerobic capacity entirely, the benefits of creatine are not really being gotten.

We are not getting into our anaerobic capacity, at least not very much, if at all.

We are not using muscle mass to produce the kinds of activity or strength that we want.

It's not, this is not an isometric sort of activity.

We want to be producing locomotion and therefore it's a matter of elongating our muscles continuously.

And we know that carrying around extra kilograms of water, which is what a lot of these people who are taking large amounts of creatine are getting, is definitely a negative when you're cycling and certainly a negative when you're running.

So all of the studies that we could find showed essentially that.

And there were basically studies were pulled together to create these meta analyses.

And you'll recall that a meta analysis is where you have like several studies that are small studies, you pool all the data together and then you reanalyze that data to see whether or not there's an effect in a larger population.

Creatine just does not seem to be effective for long duration endurance sports, period.

Any endurance sports that rely on aerobic metabolism just don't benefit from creatine supplementation.

I don't think I could say it any more clearly than that, but.

This isn't going to help you podium.

This is not going to be the thing that gets you over the edge.

It's not going to give you a benefit.

And for people who are taking this, they have to remember that the creatine is associated with these gains in muscle mass and is associated with water retention.

The water retention, some people have argued, goes away over a period of time, but that's debatable.

But definitely muscle mass goes up and we're talking like people are taking like 20 grams a day.

This is a lot.

There's a fair that's on the upper end.

Some people are taking five to seven grams a day.

There's all kinds of different protocols, but up to 10 to 20 grams a day is what some people are taking of this stuff, which is really extreme.

There's no downside to taking it.

There's never been any health risks of taking creatine.

I think that's important to point out.

But for those people who.

Unless you have severe kidney issues.

But you wouldn't be on that, right?

We wouldn't be participating in these sports.

But I think that most people who are thinking that and are buying into the hype because creatine is pushed more than anything I've seen and it is just continually being told that this is going to give us positive and it's just not.

It's just the evidence is very clear and I have a host of studies here.

Creatine for exercise and sport performance with recovery considerations for healthy population Taking creatine will definitely improve muscle mass.

It can help with ergogenic effects, but it doesn't seem to improve recovery.

It doesn't allow for repeated efforts in any way.

Effects of creatine supplementation on athletic performance in soccer players A systematic review and meta analysis 20 to 30 grams of creatine supplement per day of one to nine weeks.

Significant improvements in anaerobic performance and soccer players will have to do some sprinting and so therefore will have some anaerobic performance there.

But their aerobic performance was completely unchanged.

And there were several studies that showed that.

And even the anaerobic performance improvement was small, but it was there.

It was statistically significant.

It was just small Creatine supplementation and endurance performance from 2023.

This was a study that looked at all the other studies and it was a review article that said, hey, creatine seems to help with surges and sprints.

So if you are A cyclist.

Maybe this would help.

It was a theoretical paper but in summarizing the results very clearly said look, there's nothing out there that shows that in endurance sports this is going to do anything.

And then effects of creatine monohydrate on endurance performance in a trained population Systematic review and meta analysis Creatine supplementation ineffective on the endurance performance of trained population and this was a very large meta analysis that looked at thousands of athletes and just found absolutely no results whatsoever.

In fact seemed to trend towards negative.

And the authors felt that that likely was a reflection of the increased body mass that these athletes were carrying around because of the creatine they were supplementing with.

Something you just said there too reminds me of something that Trevor's gonna Trev.

Wherever Trevor is, he'll get like a little feeling his ears will be ringing.

That he often says when it comes to various supplementation or even sometimes more eccentric training techniques for the beginner athlete, for the amateur, someone who's just getting out started it might make a noticeable difference because the baseline for success is so low.

But for someone who's been training quite a bit, it's going to be pretty minute differences or to your point, even potentially negative because of what it's throwing off.

And I think also the thing with creatine and you talk about how it's one of the things that's been hyped the most is because one you talk about aerobic versus anaerobic, it really impacts those type 2 muscle fibers.

And because it has impacted that in such a way, like I said especially in the 90s for the bodybuilding competitions, we were able to see such a clear difference night and day.

And so the human mind wants to be able to take something that has a clear difference and then apply it to anything else.

But endurance athletes aren't using type 2 muscle fibers in the way that those sports like you said soccer body lift.

I always.

I don't want to call it like body weightlifting.

Weightlifting, thank you.

Bodybuilding weightlifting are going to be using those muscle fibers.

Unless we talk about these small moments during the race like surges or attacks or mountain bikers might be using them at certain points.

But those moments for trained athlete you're already going to have a strategy for them.

So that little tip that you that of the scale that you might experience there could be so many other things that could pinpoint to what your success was in that moment anyway than it being creatine.

Now if it comes to not something that's going to help you podium but something that's going to take care of you as a whole person and the different things that you have going on in your life or your body and rehabilitation or you talked about cognitive activity or cognitive capacity, then that might be a contributor, but it's not going to be the thing that makes such a difference like we're used to seeing it on the soccer field or in the gym.

It's just not right.

And what has really been a mystery to me is why, given the abundance of evidence that shows that this is just not useful for endurance athletes, why this continues to be pushed as aggressively as it is by nutritionists, by coaches and by supplement manufacturer supplement manufacturers because they want to make a buck.

But I've seen innumerable coaches and dietitians pushing creatine for endurance athletes and I have never understood it because I have yet to see.

And now again, after looking at this again, there is still not any compelling evidence to show that this does anything.

And I'm mystified why there is such infatuation with creatine as a supplement for endurance athletes.

It just, I've.

I just don't understand it because clearly it doesn't work.

Are you seeing this more for athletes who are vegetarian or vegan receiving this recommendation?

No, no, it's just across the board.

It's really interesting.

But we are going to come back to that question that you just raised.

When we talk about mental health, I want to shift with the time we have left to talk about the other, the neurocognitive and then the mental health questions because those are interesting.

I didn't touch on them the first time I talked about creatine and.

But I want to touch on them now because we looked at the research and we found a couple of papers.

The first one was the effects of creatine supplementation on cognitive function in adults.

A systematic review and meta analysis that was from 2024.

Basically, the problem with a lot of these studies is that they don't tend to use a standardized protocol.

So they give adults varying amounts of creatine and it's hard to know how much is the right amount and whether or not there are confounding variables.

Are they taking other things at the same time?

It's hard to.

This was an interesting study where they looked at or they.

What they said to start was individual studies have showed varying degrees of the effects of creatine on cognitive function, executive function and how as adults age, creatine may be protective on some of these things.

So when you think about dementia and memory loss and just how confusion progresses with age.

There have been some studies that have suggested that creatine can be protective, but it's not clear whether or not, as I said, creatine was alone.

So they looked at paper, where they systematically looked at all of the papers that have looked at this and basically showed that alas, unfortunately there, there doesn't seem to be a dramatic impact of creatine in this way.

It doesn't actually reverse any neurocognitive declines.

There is some evidence that suggests that it's possible that people who take creatine supplementation may have a protective effect in the 18 to 60 year old age sort of range.

But it's not 100% clear.

There's nothing.

Basically all of the studies that have looked at this have not come to any overall great conclusion.

But there is a sort of signal here that suggests that it's possible that creatine may be protective against developing some of these neurocognitive declines in healthy 18 to 60 year olds.

It does not do anything to reverse existing cognitive deficits.

I think that's what you have to, we have to be really cognizant of is are we holding it to the expectation that it's going to be the.

This miraculous reversal or are we saying, hey, use this and it can pump the brakes or it can put a little protective buffer.

And many would argue, hey, I'm not going to ask for the world and ask for a reversal, but I'll take something that will slow this down as still being a really awesome impact, especially for women, especially women through going through variety of different stages later in life.

People who are depressed will take that and I think I have seen it in circles be recommended to the one thing I will say to this, when it comes to endurance athletes and this overlapping indication we're talking about here, is it being recommended and highly stressed out or high?

I don't know how else to be like really polite about this, but like high executive functioning people who are really putting a cognitive stress on their lives day to day.

So students, very strategic executives, people who are really using their brains a lot during the day, they may be recommended creatine to help them in that aspect.

So when it comes time for training, this kind of cognitive depletion that they've had throughout the day isn't impacting their training or something else.

So I feel like those situations, you see it and then because of the weight issue, people are even you talk about people microdosing other things.

The people who are starting to micro dose creatine instead of going straight for the 20 that they'll start with two or three over time.

And I, I think that research is pretty nascent and so I'm really curious to see what happens with that.

Yeah.

As it goes on and this study, this study actually it found 16 articles that it ended up including.

There was only about 500 participants that were analyzed.

But in the studies, in those 16 studies the dosages ranged anywhere from 0.3 grams per kilogram a day, all the way up to 10 grams, sorry.

To 20 grams a day.

So there's a wide range of what people can take for this neuro protective potential, neuroprotective benefits.

And it gets back to what you were saying earlier, which is there are various reasons to take this and it could be a whole body kind of thing.

I just want to be very clear if you're taking it for neuroprotective kind of things, the science is not 100% clear.

There's certainly, as I said before, there's no downside except that you will probably retain some water, gain some weight, but you're not going to get a benefit for your endurance sport.

Will you get a benefit for your neurocognitive capabilities?

Probably not a benefit, but you will potentially see less decline as you age.

Maybe, maybe that's still to be determined.

So interesting.

There's another study we came across that came out just this year.

Creatine shows potential to boost cognition in Alzheimer's patients.

Really small study, no control group, so really hard to know whether or not this is anything but clearly a sort of study that is to generate hypotheses and will probably be followed up by something randomized, controlled.

And basically what they showed is that patients who took 20 grams a day of creatine for eight weeks seemed to have some improvement in their cognitive function.

So that'll be again something to follow and could be very interesting because not a drug, just something, a nutritional supplement that could have an impact on Alzheimer's patients.

Conversely, when they've looked at patients with Parkinson's disease over an eight year period, a very well designed study, 860 participants in a control group, 860 in the experimental group over eight years, 10 grams of creatine a day, no benefits at all.

They stopped the study because clearly creatine does not help with Parkinson's and that's not terribly surprising.

Parkinson's, Alzheimer's, two very different diseases, they operate completely separately in very different ways.

So just because creatine helps in one doesn't mean it should help.

And another so not that surprising.

And I'm curious for you too, and I know we're talking about mental emotional health in a separate juncture or separate section here, but post tbi.

So that was one I was going to bring up next.

And there have been a couple of studies on that, but the studies are very preliminary and we didn't include them because we felt they were so preliminary.

That keeps being brought up as creatine seems to be protective against post concussion syndrome.

But those studies were very small.

They the results were very equivocal.

So we are not convinced.

We would like to see more research on that.

But it is another potentially promising area where creatine may have benefit is in post concussion, post TBI in being neuroprotective.

And again, it's this whole area where creatine may have an impact in the brain that we just don't understand.

Absolutely.

And I will only say this as anecdotal, obviously, but the I think I've had a variety.

The moose, not just the moose.

I've had so many tumbles on this cranium, but nearly every neurological provider.

And I say that widely because I've seen so many specialists at this point, several of them over the last decade would typically recommend creatine be part of my post concussion regimen for the neuroprotective aspect aspects, but also for the mental emotional impact.

I honestly, it's the kind of thing I would probably take and recommend to people as well because there is some early evidence that it may help.

There's certainly no downside to it.

And why not?

Right post concussion we don't understand it.

There is absolutely nothing you can take or do for it.

If creatine turns out to help, then why not give it a try?

I would certainly say say, yeah, go for it.

Absolutely.

And I think you met me too, after the moose thing too.

I was for some reason really underweight.

So I was like, yes, let's go to town on this creatine.

No worries about slow loading.

I just went full dose that.

You'Re N of one.

I'm n of.

And that's the important thing to remember is.

But as I've said many times, just because the research shows X, if your experience was Y, that's really all that matters.

All right, we'll finish this up by talking about the last study, which was, I thought, particularly interesting and that was dietary creatine intake and depression risk among US adults.

This was a purely observational study.

So it does not tell us anything definitive, but it's really interesting and basically shows that if you take into account lifestyle variability, if you take into account a whole bunch of different things, you control for a whole bunch of different factors.

Creatine intake is inversely associated with the risk of depression, but it is sex specific.

So it really, it seems to matter much more in women than it does in men.

Men.

And it's fascinating, but basically the highest quartile of creatine consumption, so the people taking in the highest amounts of creatine had a 31% lower risk of depression.

All things taken into consideration, which I think is fascinating.

Now I don't really know what to do with this.

It's not saying that if you take creatine you'll be less depressed.

Because I brought up the point when we were discussing this paper.

I'm like, people who are in good mental health probably have better diet and better dietary choices and might be taking in more creatine naturally, but presumably they tried to control for some of those things.

So I'm not really 100% sure.

But as an observation and the table, which our lovely and talented editor Lauren will remind me and we will put the table over the video here so people can see.

The table is really remarkable.

It shows in a very stepwise fashion how increased creatine in decreased depression out.

It's quite amazing.

And that goes back to what you were asking about vegan diets and should vegans supplement with creatine?

I don't know what the answer is.

You can get creatine by eating eggs, taking in dairy products and fish.

But if you are strictly vegan, you may not be getting enough creatine to forestall depression, if indeed the two are linked in a causal relationship.

And this paper does not tell us that.

Yeah, and that's one of the things that people need to keep in mind, especially if you're listening to this and you or someone you know has clinical depression or a sustained depressed mood is.

It's one of those things that's so complex and to your point, there are all these different systemic inputs.

It's like this vicious cycle for depression.

And that can be really soul crushing for someone who's experiencing it.

But here is the benefit or the silver lining of that is if you are able to get one entry point in, you can typically have this domino effect.

So if someone isn't having a good diet because they're not motivated or they're having some of these issues and one domino starts to fall and they have a little motivation to choose something different that like it is one of these things that over time and with certain resources, some of these things are worth exploring and talking to your physician or your registered dietitian about.

And so it's one of those things where you don't want to look at nearly anything when it comes to mental health as the magic cure all.

But what you can look at it as is this a unique entry point for me and this loop that is is my particular situation and starting to put the pieces together and creatine as we you discussed with this pretty awesome result here can be one of those entry points for a variety of women experiencing depression.

Very well said.

And I can't think of a better way to finish than on that note, a positive note.

If you or someone you know is suffering from from mental health issues and certainly if that person or yourself is suffering from any thoughts of self harm, I hope that you will do us a solid and reach out for help because I promise you, you are valued.

That's all we have for the Medical Mailbag this week.

I cannot thank you enough, Griffin, for being here and joining me for this segment.

I hope that we will have the chance to get you back on here again.

If not on the Medical Mailbag, we'll have to have you as a guest because I always enjoy chatting with you.

Nobody came through with our trip to Italy.

I'm very, very disappointed about that.

Listen, this is not over.

I've been scoping things out.

We'll discuss this later.

This is not, this has not come to pass.

All right, all right.

And if you don't know what we're talking about, Griffin and I did an episode on Fast Talk Labs where we talked about caffeine and we posited that someone should send us to Italy on an exploratory trip to check out Italian cafes.

Hasn't happened yet, but we can hope.

Griffin McMath, thank you so much for joining me.

I will include a link to where you could find Griffin on Fast Talk Labs in the show Notes.

Until next time, I hope that you have enjoyed this segment of the podcast.

I'll have the interview coming up in just a second, but if you have a question you'd like to hear answered on the Medical Mailbag in the future, I hope that you'll reach out.

You could send me an email@triodocloud.com you can drop a question into the Facebook group, the private Facebook group for the podcast.

What?

You're not a member?

How can that be if you're not a member look up the Tridoc podcast on Facebook.

Answer the three easy questions will gain you a admittance and we would love to have you join the conversation and ask your questions there.

Until next time.

We'll be back then.

Thanks again, Griffin.

Thank you.

My guest on the podcast today is Silas Eastman, somebody I know none of you will have ever heard of.

But by the time we are finished with our conversation, I'm pretty sure you're going to find him quite interesting and somebody who you might be interested in knowing more about.

Silas competed in cross country running and Nordic skiing from middle school through college.

Now he manages the grooming and trail maintenance at the Jackson Ski Touring foundation in New Hampshire where they have around 150km of Nordic backcountry and snowshoe trails.

In the summer he works at a farm as well as as builds furniture and does some timber farming.

This year, though, he's hoping to he's helping to put together a week of roller ski racing in probably the most unlikely location you could imagine.

You may remember I spoke several episodes ago about the triathlon in Ceiba, which is the smallest island in the Caribbean.

It is one of the Dutch Antilles and it is a volcanic island such that it goes from the ocean straight up about a thousand meters, three thousand feet to the peak of Mount Scenery.

It is not the most hospitable place for a triathlon.

It is definitely not the most hospitable place for cross country skiing.

All that to say that Silas is actually working on putting together a week of roller ski racing on that very island of Ceiba he first visited a couple of years ago.

He wanted to see if it was feasible to do this.

They also are actually going ahead with it.

He came to my attention from my friends in Ceiba and I had to have him on.

Not just to talk about these roller ski races, but also to talk about just cross country skiing in general, roller ski roller skiing in general, to see how that can help us as triathletes improve our cardiovascular fitness and be a potential outlet that we can all look to when we have issues potentially running or biking.

So Silas, thanks for being here and thanks for joining me on the Tridog podcast.

Thank you for having me.

All right, Silas, let's begin first with your background.

What is it that you do up there in New Hampshire at the Jackson Ski Touring Foundation?

So I've been running the grooming and trail maintenance and snowmaking for the past four or five seasons.

I think we've been making snow for only three seasons now.

So in the Summer, I'm not doing too much up there, but starting pretty soon here in the fall, I'll be doing all of our trail prep, mowing all the trails.

And then in late November, early December, we'll start making snow on a small, about one to two kilometer loop near our touring center.

And then hopefully soon after that, we get enough natural snow and start expanding our network.

And we groom every night.

We have three to four groomers, two on per night.

And we we maintain one of the largest cross country skiing networks in the northeast.

Now, for those who might not be familiar, cross country skiing comes in two flavors.

There's classic and skate skiing.

Are you catering to both of those and if so, how much of your trail network is dedicated to each?

Pretty much all of our trail network.

You can do both.

Some trails, if they are too windy or too steep, we won't put the classic tracks because you would be doing a herringbone technique anyway, which is with your skis spread out in a V to climb more easily.

But you can do both on almost all of our trail network.

The backcountry trails would be more classic geared trails, but we have pretty even split between what people are doing now.

New Hampshire is of course known for downhill skiing.

How popular does Nordic skiing remain in that area?

It's pretty popular on a good weekend.

Our parking lot will be overflowing midweek.

We still stay very busy.

We have a lot of people who will buy cedar passes and just ski ski all season long.

A lot of people or some people will ski almost every single day that we're open.

And we know how expensive.

Maybe some people don't, but I live in Colorado, so I am well aware how expensive a ski pass is for downhill skiing.

How much does the ski pass for Nordic skiing?

Off the top of my head, I'm not sure.

Fortunately, I get to stay out of the office and I don't have to deal with that too much directly.

But I think it's in a $20 range, so it's very affordable.

And we have rental equipment that you can and rent for the day, but you can also get used equipment very affordably.

Compared to alpine skiing, it's a lot easier to get into.

Yeah, I'll say orders of magnitude cheaper.

Yeah.

I assume you are a cross country skier yourself.

Yes.

I grew up skiing out in some agricultural fields behind my house on snowmobile trails or breaking our own trails.

But I started before I can remember.

I think my parents were dragging us out to get us out of the house to do something.

So I don't know that I enjoyed those first few years as much, but I got into racing in middle school and raced all the way through college.

Is racing also divided between classic and skate ski disciplines or is it all skate skiing?

It's both.

So weekend for.

I'll talk about college more.

But college race weekend will have one skate race and then one classic race.

And then within that you can vary the distances.

They'll do anywhere from the 5 kilometer.

Actually they'll do a sprint, which is about a little over one kilometer, one to one and a half kilometers, all the way up to 20 kilometers.

And then you can also do individual start with a 30 second interval or mass start.

And is it common for athletes to do both techniques or will they?

It's required themselves.

Oh, it's required.

Interesting.

Did you have a favorite skate or classic?

I always preferred classic skiing.

I think because of my running background it came a little more naturally.

And skate skiing, I've tried it a little bit.

I can't say I've done that much, but seems to me to be significantly more more aerobically demanding than does.

Or maybe it's just because I wasn't doing it right.

But you really have.

Your whole body is much more involved from stride to stride.

It just seems much more aerobically demanding.

Is that an accurate kind of assessment?

Yeah, I think so.

The ski skiing has only been really around for 40 or 50 years, maybe in popularity.

So clash of skiing is much more traditional and you can go out and classic ski all day long and it's definitely still a workout.

But ski skiing can be a bit more of a full body workout at times.

And you mentioned your running background.

So I have also heard that cyclists also gravitate to cross country skiing.

It's just a great aerobic workout.

It's just a fantastic way to ground out your cardiovascular fitness.

Do you have a lot of cyclists or runners who come to do cross country skiing for that reason?

Yeah, there's a lot of people who will do cycling all summer and then come and ski all winter.

It's a lot easier on the body than running.

So there will be 70, 80 year old old people out skiing and in some of our citizens races they'll be beating a lot of younger people out there.

So it's a great sport for all ages.

And does the Jackson Ski Touring foundation, do they offer biathlon courses as well?

We don't at the moment.

We've been looking into it.

There isn't a lot of biathlon around us.

I think the closest area would be up in Northern Maine, but there are some at Vermont as well.

But it's something we've been looking at.

I had as a former guest on the program, an Olympic biathlete who joined me and talked about his experience participating in the Olympics and now is a retired cross country skier, but does triathlon.

So that's why I ask.

All right, let's talk about roller skiing.

So roller skiing is obviously what some cross country skiers will do in the off season.

What we triathletes would consider our on season.

What is the equipment like?

Does the roller ski have sort of one way wheels so that they don't roll backwards?

How exactly do they work?

So they have ski roller skis and classic roller skis.

And the ski roller skis have no brakes, no ratchets to keep you from going back.

They have a narrower wheel and both sets are about 2ft long wheel, front and back.

And then you're using just your regular ski poles with a special tip that is more hardened steel through on pavement.

And then the classic roller skis, they do have a ratchet and either front or back wheel so that it mimics having your kick wax.

Because with the classic, you're pushing off the ski to actually glide forward.

It's like a bounding movement.

So you're hopping is the right term, but yeah, kicking from ski to ski.

All right, so with knowing what Ceiba is like with its 20 plus percent gradients, is this going to be your ski race?

Is going to be classic only then?

Yes.

So we briefly tried ski skiing and because of how steep the roads are, it's just not really feasible.

So classic racing or classic skiing only and uphill only because we don't have brakes and some of the corners are so tight that we wouldn't make it around.

So we've been working to find courses that are uphill only or have easier short downhill sections that are manageable on the roller ski.

We don't end up over the bank.

And so with my recollection, I would imagine you can go from the port up through the bottom, the bottom being the top of the road that goes from the port.

But it's actually the name of the town that lies in kind of the valley there.

And then I imagine you could probably climb up from there to the windward town.

I think that the longest race that we'll be doing is either we're doing one from the harbor up to the Crispin trailhead, and then we're doing another one from the COVID down at the airport up to the Upper Hells Gate, which I'm not sure which one of those would be longer, but got it.

A ton of climbing.

Yeah.

I was gonna ask, so over the duration of the distance, what kind of elevation gain are we talking for each of those?

Those?

Oh, I'm not actually sure, but it's enough that we're not going to be moving very fast.

It's going to be a lot of pacing and we'll see what kind of race strategy comes into it if someone tries to take it right from the start, or if we're going to be bunched up and wait, when is this.

When is this plan to take place?

This is going to be the last week in September.

And how many competitors do you have right now?

So right now we have.

Have six, but we're trying to round it out and get two to four more.

So it'll be small for this test run.

And are these all high level skate skiers or, sorry, roller skiers?

It's quite a mix, actually.

We have everywhere from former collegiate racers to more recreational skiers or people who raced in high school.

And we'll see who we round out the teams with with.

But we're casting a pretty wide net because we're just trying to introduce more people to SEVA and what it can.

Offer and do they all know what they're getting into?

I've told them we'll see.

Just duping them and letting them know, oh, it's going to be beautiful.

Oh, yeah, no, it won't be that hard.

No, we're not telling them every detail, but they know what they're getting into for the most part.

What are the benefits to the skiers besides getting to go to a beautiful place and be feted by the locals?

One of the things that I loved about CEIBA and one of the reasons I want to go back is that in general, Norwich skiers aren't necessarily the beach resort type of people.

We're looking for a challenge.

So everything that SABA has to offer, between all the hiking and running and then also, hopefully roller skiing down the road, it's a great opportunity for Newark skiers to get out and do all the different types of training that we always love to do all in one place.

And we've talked about a little bit about how runners and cyclists can get into Nordic skiing.

Skiing.

How hard is it to learn?

It depends.

Some people can pick it up really quickly, but anyone can do it if you can.

May take a little bit of time to get used to the balance on the skis, on Snow, these skis are less or around 2 inches wide.

And same with the roller skis.

So balance is a factor.

That ski area I work at, we do lessons every day.

Within an hour someone can go, having no idea what they're doing to going out on some of our easier trails, and they can handle it just fine.

And you say within an hour they can go out and ski.

But presumably in order to get a good workout out of it, you have to be a little bit more than just a novice.

So in your experience, and the reason I bring this up is because while this is going to be coming out in the summer, really the prime time for triathletes to be doing what they generally do.

I'm always mindful of the fact that the end of the season is not that far away.

And I always counsel people to look for alternative ways to stay fit during the off season.

And I have mentioned skiing in the past.

I am a downhill skier myself, but I know many people have toyed with the idea of participating in other winter sports.

And cross country skiing is just one of those amazing cardiovascularly taxing sports.

Look at the Norwegians.

And many of our Norwegian triathlete professionals came from either came from cross country skiing or actually do cross country skiing during the off season.

So when I talk to my listeners about this, I want them to get a sense of how long they would need to actually be doing it before they actually can use this as a good workout.

So how proficient does someone need to be before they can really consider that they're going to get a good, solid workout from it?

I don't think it would take that long because if you're already doing triathlons, you're a competent athlete, you can pick things up pretty quickly, I would assume.

So if you do it, give it a few sessions, give it a, a couple of weeks.

And I think that, that you'd be able to do it at a level where you could get a workout in and then from there you can work on improving your technique and getting more efficient at it.

But it really is a full body workout.

When you're classic skiing, you're doing a lot of either striding and pulling with your arms or just straight double pulling.

So it can be a really good upper body workout.

And then skate skiing, the same thing.

You're constantly in your upper body and you can really get a lot out of it quickly.

Yeah, and I want to echo what you just said about the total body workout, because the polling motion is very similar, uses similar muscles to swimming.

So for People who have ever thought about doing cross country skiing, it really is a phenomenal way to get a cardiovascular workout, to get it to work your legs and to work those swimming muscles as well.

So you're really getting the whole thing together.

For athletes who want to try roller skiing and use that as a way to maybe they have a running injury and they can't run, how easy it is to find that equipment and how easy is it to learn how to use it?

You can find used equipment pretty easily.

And I think new equipment runs the skis are 2 to $300.

And then if you already have boots or you'd have to get boots and poles.

So for all new equipment, mid range would be maybe around $1,000.

But you can get used equipment for so much less.

And then I would recommend trying it on a.

Don't start out with any hills.

Try it out in a parking lot and all.

We wear bike helmets, but that's about the extent of our protective gear.

And once you get the balance and you have a ski pole to help you with that, you can start picking it up pretty quickly.

You said something about there not being brakes.

So if you're going down a hill and you need to stop, is it just a matter of falling or jumping onto.

I wouldn't recommend falling as your first option.

You can imitate a snowplow sort of and push outwards on the skis.

And the added resistance on the wheels will help you slow down some.

If you're on a steep hill, it won't do that much.

But you can also use the poles to slow you down a little bit if you're not going too fast yet.

And then, yeah, the last ditch effort is you can try and drag a ski just off the road in the gravel and that can slow you down a bit.

If you're careful, you do run the risk of getting caught up and falling.

I'm at that age side Silas.

I'm at that age where I worry a lot more about stopping than I do about getting going.

So, yeah, I have to think about these things.

The better option would be save the big hills until you're comfortable enough that you can ski all the way down without needing to come to a full stop.

Now, one of the things I remember growing up, my parents took us cross country skiing and one of the things I remember was the message and the difficulties involved with waxing.

Has that changed?

My understanding is the equipment has changed.

The whole waxing process has changed.

I remember using scrapers and these cork things and having to get Rid of old layers of wax.

It was just a huge mess.

What is the waxing process like now?

And do you need to do it for both skate skiing and classic?

That has changed quite a bit in the last 15 or 20 years.

You still have to do glide wax on both pairs of skis just so the bases don't dry out, or if you're dealing with different snow temperatures and conditions.

And you can still go with waxable classic skis, where you're waxing the kick zone that's about 18 inches to 2ft under your foot.

But the additions that they, they've come out with in the last 15 years, waxless classic skis have made a really big difference.

So there are a few different options.

And of course, the fish scale classic skis have been around forever, where they have sort of fish scale texture under your foot so you don't have to use any wax.

But those have always been slow, so they've gone along with different.

They call them skins skis.

But it's.

If you are familiar with backcountry skiing and skinning uphill, it's just, it's taking that same type of material and just putting it right under your foot.

So still glides really well.

But you do have that kick, and you never have to worry about the classic wax.

That's always been a bit of a nightmare.

And just to clarify for listeners, what Silas is talking about is when you do classic skiing, you really do need to put.

Put your weight on one foot and you are pushing off of that foot to glide the other foot forward.

If the foot that you are waiting on and pushing off of, if that ski slips, then that foot is just going to slide backwards.

You're not going to get anywhere.

So when I was growing up, we had to put wax on the ski so that it would be tack.

It would actually be sticky, so it would stick to the snow so you could push up off.

And then what came around was these fish scale textured ski bases so that instead of using wax, there would be almost this grip, grippiness, almost like a tread of a shoe on the bottom of the ski.

And that would allow you to grip so that when you.

The ski wouldn't slide backwards, you could push off, but then it would slide forwards.

And that's what he's talking about now.

And so with skate skis, it's not much of an issue because you have edges.

Right?

Right.

So you're pushing off those metal edges some.

We don't have any metal edges.

There are backcountry Touring skis that are classic skis, those have metal edges, but most cross country skis don't have metal edges.

But it does have a somewhat sharp plastic base edge that you can, that'll dig into the snow and you can push off of it, but you're pushing off perpendicular to the ski, so it's not going to slide back like it would with classic skiing.

All right.

For people who aren't in New Hampshire, if you are in New Hampshire, Jackson Ski Touring foundation is definitely what you want to be looking into.

But for people who aren't there and maybe want to learn more besides just Googling cross country skiing, are there any resources you can think of or that people can look for to learn more about the sport and find out more information if they want to get involved?

If you're in a winter climate, I'm sure that there is going to be some more skiing areas within driving distance.

There's a lot of different places of varying sizes that you can check it out.

There is an app that we started using a few years ago called Nordic Pulse that has grown in popularity and different ski areas will use that to track their grooming.

So you can look all over the country, all over the world and see real time, what the conditions are like, what trails are open, and even where the groomers are at any point.

So that's a really nice way to, to pull up.

And if any skier is nearby, you are using that app to be able to see them and see what their trails are like and read about their trail conditions.

All right.

And do you have an online presence for the ski races taking place in Ceiba, or is this really just a test event and once you see how that goes, then you'll build out something online.

We will be posting about as we're doing it.

I'm not sure the extent of that yet.

It may be more after the fact, after we see how it goes.

But based on our, our testing of it a few years ago, it's.

It'll run pretty smoothly and we're really looking forward to it and introducing some more people to the, to those, to those roads and the views that we'll experience while we're out there roller skiing.

All right.

I look forward to hearing about it once it's done, so you'll have to let me know how it goes.

Yes, definitely.

And for any of my listeners who are interested in incorporating cross country skiing as part of your offspring season training, I hope that you will reach out to any of your local cross country skiing locales that you might have or send me a note and I'd be happy to help you out with that because I think cross country skiing is a great way to incorporate or a great activity to incorporate into your off season training and make sure that you really get a whole body workout and improve your cardiovascular fitness.

Silas Eastman is an ex cross country run runner and now a Nordic skier.

He is a grooming and trail maintenance guy up at Jackson Ski Touring foundation in New Hampshire and he's putting together a week of roller ski racing on the island of Ceiba in the Caribbean at the end of September.

I hope to hear all about how that goes so I can bring you an update on that once it's done.

Silas, thank you so much for joining me today on the Tridek Podcast.

It was fun learning all about this event.

Thank you.

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