I think it's the desire I want to do it.

I'll do anything to figure it out.

So if I get injured, I'll figure out how to get over the injury.

I'll do what I need to do.

I'll go to the right person to see if I can figure it out or I'll rest or I'll do what I need to do.

It's just this desire to do it.

And as I say, if it's not meant to be that I race, that's okay.

I just, I will do something every day as long as I'm alive.

I know that.

I just love to move.

I think it feels great to be strong.

It feels great mentally, it feels great.

The feeling of challenging yourself to something and to achieve that.

Hello and welcome to the scary, very spooky Halloween Edition, the October 31, 2025 episode of the Tridock Podcast.

I'm your host, Jeff Zankoff, the T.R.

an emergency physician, a triathlete, triathlon coach and ironman finisher multiple times over, and a denizen, a big time fan of my favorite holiday of the year, Halloween.

But I'm coming to you as always from beautiful, sunny, if somewhat scary Denver, Colorado.

The voice you heard at the top of the program today was that of my guest and somebody who I know you're going to love hearing from.

It's someone who's really taken the triathlon world by storm in the last few weeks since her unprecedented finish at the Ironman World Championships in Kona.

And that is the voice of Natalie Grebo.

Natalie was the first ever female finisher who was in the 80 to 84 age group and she did so with the usual customary smiles, class and demure that she brings to all of her racing.

I've had the good fortune to know Nat for many, many years.

We both coached by the late Steve Johnson.

That's how I got to meet her originally.

I've kept in touch with her over the years and it's been a real pleasure watching her have the success that she's had and I really enjoyed having her as a guest on the program and I think you will very much appreciate that conversation.

That will be coming up a little bit later on.

Before we get to that, we will of course have a medical mailbag segment and this one features a listener submitted question, a question that came across on the Facebook group, the private Try Doc Facebook group.

If you're not already a member, I hope that you will consider becoming one.

You can look for Try Doc podcast on that platform answer the three very easy questions.

I'll gain you admittance.

You can submit questions there for future medical mailbags and just join the conversation.

We have a lot of interesting dialogue and discussion about things that have been discussed on the show, things that maybe we should discuss on the show, and just triathlon banter in general.

In any case, today's question came in through that platform and it relates to the use of glucosamine supplements.

Specifically, can those supplements encourage cartilage repair in those who have had injuries, and does it promote cartilage health?

Coach Juliette Hockman and I, my good friend and colleague, we will take a look at what the evidence shows for that and consider whether or not glucosamine should be something we consider, especially if you are one of the many who have some kind of cartilage injuries in your past or are concerned about potentially getting into trouble with cartilage damage in your future.

Now, this episode is coming out just a couple of short days before I depart for Marbella, Spain, and I am sure you won't be surprised to hear that I'm very excited about the trip.

Not just for the race itself, but also just for the fact that I get to rekindle my acquaintances and rekindle some of my friendships in person with many of the people that I've had the very good fortune to meet through this sport across the years at various races, at various world championships, and I'm really looking forward to seeing many of the familiar faces yet again.

I hope that if you are going to be there, you will let me know and I would love to make time to try and get some facetime with you because I love to meet listeners wherever I am and if I have the chance to exchange some feedback in order to make the program better, I would love that opportunity.

If nothing else then just to say hi and I will be bringing a few of the Tridoc podcast BOCO hats, so if you'd like to get one, just let me know where you're going to be.

We will definitely arrange to meet up and I can make sure that you get one of those hats.

The other thing of course to be excited about is the race itself.

It looks to be a sensational course.

I was interested that when I entered the race course or the bike course into my Garmin because I'm planning on pre riding it when I get there.

The elevation gain is a lot less than what is advertised on the Ironman site and I was watching today a Facebook video put out by the race organizers where they were claiming it was more elevation gain than what's on the Ironman website.

And I find myself wondering, why is this so hard to get it right?

So the GPX file that came from the Ironman website that I put into my Garmin shows about 5,000ft of elevation.

The map on the race course site shows about 5,700ft of elevation.

And today a Facebook video that was put out by the race organizers as a preview of the course said 5,900ft.

Now, these are wildly different numbers.

Personally, at the end of the day, I don't care.

I'm prepared for whatever it's going to be.

But I know that a lot of athletes would probably like to know in advance what they're getting into and what to expect.

And I don't know, why is it so hard?

Everybody's got these devices.

You can just punch it into a map and it will give you a pretty accurate sense of what the elevation gain is actually going to be.

I don't know, it just seems a little bit odd that if the 5,700ft isn't right, then they could have corrected it on the website a long time.

And why it just persists out there, who knows?

Anyways, all that to say it's going to be an amazing day.

And the women's race, of course, is on Saturday, the men on Sunday.

I have not really heard whether or not we can expect to see Taylor Knibb and Lucy Charles Barkley on the start line.

I know they're on the start lists, but it wouldn't surprise me at all if they don't come, or even if they do come, that they aren't able to perform well.

They went through just monumentally difficult challenges because of heat stress at the recent Kona race.

And so it wouldn't surprise me if either of them just didn't come at all.

Or if they do come, they have trouble.

And even people like Kat Matthews, who did exceptionally well, she also really had to undergo quite a heavy physiologic stress in order to succeed.

So one wonders, will these athletes be able to reproduce their success, or will these athletes be able to come back from what was not being able to complete the race and be able to now find success on a very challenging course in Spain.

One athlete that I'm particularly interested to see is Paula Findlay.

She has been relatively quiet of late as she really focuses on preparing for this race.

She's an incredibly strong cyclist and this course might be something that suits her.

We'll have to see.

She's Someone to watch for.

If you're interested in hearing a full breakdown of the start lists and my picks in a preview show, you can take a look or take a listen to the sister podcast of this program that is Tempo Talks.

On that program, professional triathlete Matt Sharp and myself will look at the start lists of the women.

That show is coming out today, October 31st, and then we will preview the men's start list a week from today on the Friday before the races.

The men's race is going to be just unbelievable.

The start list is super stacked and it's going to be very interesting to see how the men attack this course because as we know, it's a very difficult bike course, but you have to be able to run well in order to win 70.3 world championship.

And the run course is pretty flat, so it does favor the fast runners.

Who's going to be able to tackle that bike course and then have the legs to be able to have a fast run.

Time will tell.

We're going to have to see.

It's going to be super interesting.

I'm looking forward to the whole thing.

I'm going to try and send some content from the ground while I'm there, so keep an eye on my Instagram page.

Try coaching.

I hope that you will enjoy what I have to bring you while I'm there.

Anyway, I think it's time to get into the program.

So after this short break, we are going to talk about glucosamine just on the other side of this.

It is that time once again and I am joined by my friend and colleague, Juliet Hockman.

Juliet on the east coast this week.

I am so glad she's been able to make some time for the medical mailbag.

How are you doing?

I'm great.

But talk about time.

Boy, you are screaming into the last week here.

You've.

You're leaving for Worlds on this weekend.

You're cranking out a webinar tonight.

We've got two podcast recordings.

You're a busy man.

I know.

I try not to think about it too much because I'm just gonna keep plugging away and keep my head down.

I still have a whole bunch of things I have to do today.

I better write some notes because I gotta.

I gotta get the last payment for our Airbnb that came through today, the email.

So I gotta do that before I forget.

And yeah, just a whole bunch of stuff going down.

And remember the number one performance enhancer.

Sleep.

Yeah.

God be getting a workout this week.

Oh, my new lumos mask.

So we'll be trying that out and I'll be letting everybody know my n of 1.

We'll see how that works out.

And I know, yeah, that'll be good.

I gotta pack the bike.

And we had a good conversation.

I thought the men's MTN feed, which is something that a lot of the guys are part of for life sport.

We had a good chat about, I don't know, something it always comes up about tubeless and Tubeless.

Yeah, yeah.

My feeling is there's really no point in running tubeless for road or tt.

I feel like it's a mess.

It's like it's.

You don't really gain any benefit.

You certainly benefit for gravel and mountain bike, no question.

But you're not running the kinds of tire widths or the low pressures that are really going to benefit you running tubeless.

And I think the puncture protection, I don't know.

To me it seems overblown.

If you're going to get a nail in your tire, all the sealant in the world's not going to help anyways.

It opened up a can of worms because one of our colleagues, Dan Smith, he mentioned the TPU tubes, which are these.

I can't remember what the T stands for, but it's polyurethane.

And I don't know if people are familiar with these tubes.

Their tubes come in traditionally butyl, which are the black rubber tubes, then latex, if you want to be fancy and go a little bit faster.

Because latex tubes offer a.

They're more supple, they.

They offer better rolling resistance when coupled with a good tire.

And then there are these TPU tubes and TPU tubes.

The advantage to TPU tubes is they're very small, they really don't weigh very much.

They can run, you know, similar pressures as latex tubes.

And I asked a question about whether or not TPU tubes offered similar rolling resistance profile as latex.

And Dan linked that to an article that basically suggested, yeah, they're pretty similar TPU and latex, much better than Butyl.

So that got me reading.

And now I'm running clinchers for Worlds because I The bike that I need to use for Marbell, I didn't have good gearing on my usual tri bike that has disc brakes.

So I'm using my old tri bike that I was able to put a bigger cassette on, but that runs clinchers.

It turns out that latex tubes are not recommended for really big descending courses because if you're running clinchers, the rims can heat up and that can result in problems for latex tubes which don't.

Yeah.

Which don't run, which don't work well with heat.

And I was trying to remember if I had done a course with my latex tubes on my clinchers and the only one I could think of was Austria.

And I don't remember if I had latex tubes back then.

That was 2014.

So I might not have had latex tubes back then.

Anyways, long story, short story short, TPU tubes, certain ones are also not good for clinchers on a lot big breaking courses, but other ones are.

And so Silca, maker of very expensive bike products, but TPU tubes that are actually no more expensive than anybody else.

I purchased some TPU tubes and I am going to replace my latex tubes for this race with TPU tubes and also my spares so I'll have much smaller spares to carry around.

Wow.

Yeah.

So I got a lot out of that conversation.

I thought it was a very helpful.

You sure did.

My goodness.

Yeah.

So you're now going to get 20 questions on the podcast or the Facebook feed about TP tubes.

Yeah, I hope so.

I think we spend a lot of time talking about things that you can take or things that you could spend a lot of money on tech wise, to try and make yourself faster.

And you and I have talked here as well as elsewhere about the small things you can do to make yourself faster.

Obviously focusing on things like transition.

Right.

That's a big one that you love to come back to.

I love that one and understandably so.

I think it makes a lot of sense.

But there are little tech things that you can do that are not expensive.

When you look at a tri bike, no question being on a tri bike is going to get you more aero.

But just getting an aero helmet is better than having a regular road helmet.

That is a much cheaper purchase.

And already you're getting something and getting proper tires.

Getting proper tires and proper tubes they talk about versus butyl tubes.

Just having the same wheels, same tires.

Switching from butyl tubes to latex tubes is like 7 watts.

That's a lot.

That's a lot.

And tpu tubes, it's 5 watts.

It's not quite the same, but it's pretty similar.

That's a lot.

When you spend a lot of time trying to raise your FTP.

What if you could just change a tube and be able to get that kind of benefit?

It's interesting that the tube on the inside, which doesn't even have any contact with the road saves that many watts.

That doesn't really make any sense.

So it has to do with how the tube interacts with the tire.

Tire.

So as the tire deforms against the ground, there is friction between the tire and the tube.

And it also has to do with how the tube itself deforms.

So if the tube is very stiff, if there's a lot of resistance to the tube deforming properly, then the tube also adds to the rolling resistance of the tire.

And with TPU tubes and latex tubes, they tend to be more supple.

They tend to deform much more easily and allow for the tire to deform in a way that takes away from this when it's interacting with the road surface, you'll tend to have less of rolling resistance.

The other thing is those tubes give a more supple feel because they will deform to smaller imperfections in the road surface.

That's something that people that run tubeless are always talking about.

They like the fact that, oh, I have a nicer ride.

Comfy?

Yeah.

Yeah.

But the thing is, like I said to.

I can't remember who it was that was in the feed that was talking about tubeless this time.

Tubeless is really the big.

The big advantage of tubeless is when you're running 50 psi and below, you're never running 50 psi on a road or TT bike.

You just can't.

The bead will not stay on the rim.

Right.

The lowest you should be riding most of the time is generally 70 for a very light person.

But most people are going to be running 80 to 90 and you could go, there's tire pressure calculators that'll help you figure that stuff out.

So for the most part, tubeless.

I don't know.

Not for me.

Yeah, no.

Boy, I've had to change a couple on roadside, put a tube into a tubeless tire and what a mess.

But if a lot of the courses in particular parts of at least the US have those little thorns, for example, and if they will seal around that, like if you can, if you get one of those.

And people flat and races all the time in places like Washington and, oh, gosh, I don't know, Boise, that type of area with those bugger little thorns and I mean, that case is good to have tubeless.

Listen, there's no question there is going to be the other random cases where, yes, the goat horn, the goat head thorns, but I think for the most part, if you puncture the two, if you puncture the tire, the sealant is you're hit and miss if you're going to really seal that, especially as your weight is compressing the tire every time it rolls around.

But the pinch flat is really the big thing.

So you will avoid the pinch flats with sealant, but you got to be running enough pressure that you're not to have those compressions where you're going to bleed the sealant out the sidewalls anyways.

We could have a whole conversation about this, but then we wouldn't be able to get to the medical mailbag, which is really why we're here.

I do want to take a moment to thank Daniel Frings, who was the person who submitted the question for L Theanine.

I think that was last.

I'm pretty sure that was last episode.

I think so, too.

I didn't remember who it was.

So I apologize, Daniel.

I very much appreciate everybody who submits their question.

I have started doing a much better job of recording who it is that asks the questions.

So I promise send in your questions, I will make note of it and call out my thanks on the program.

And today we have a question from a listener who put that question.

And you remembered to record it?

Yeah, I recorded it.

They put it into the Facebook group.

So who's the question from and what are we going to be talking about?

Yes.

So from our Facebook group, thank you very much to Matthew Llewellyn, who sent in a question about glucosamine supplements.

Glucosamine supplements have been looked at over the years in term, in cases of osteoporosis, osteoarthritis.

Sorry, you tell me.

The doctor is here and who's nuts?

Arthriarthritis, in terms of helping to reduce issues related to that.

But is glucosamine helpful in terms of endurance athletes when it comes to cartilage repair, preventing cartilage injuries, et cetera.

So that was Matthew's question.

What did your team find out?

It's a really good question.

And I have Nina Takashima to thank for that for the research on this.

She's the intern that looked into it this week.

And the idea behind using glucosamine for this is not new.

This goes back quite a ways.

Glucosamine is basically one of the building blocks of cartilage.

It's.

We have tiny little cells that live within the joint spaces of our body.

And the problem with cartilage is avascular.

So at the end of all of our bones, wherever there's an inter articular surface, wherever there is going to be One bone interacting with another bone.

So the knees, the elbows, the wrists, the finger joints, anywhere you have a jo joint, wherever you're going to have a bone having to interact with another bone, the lining of the bone there is going to be covered with a cushioning, lubricating substance called cartilage.

And it's an amazing substance.

The only problem with this substance is it is completely avascular.

There are no blood vessels that run within it.

And as a result, when it becomes injured, it just does not repair itself.

It is a major problem.

The other issue is that over time with wear and tear, that cartilage can be worn away.

And again, it does not repair itself.

And we see this all the time with runners in their knees, right?

As we all age, it always seems to be a runner's knees, cartilage issues in the knees that stop us from running.

And I have talked about that in the past, it's not the running itself.

So there is this kind of misconception that if you run, you know, a lot for all of your life, you're gonna end up with osteoarthritis of the knees.

There is actually two sides to it.

So exercising and impacting on your joints is actually one of the things that makes cartilage more healthful.

It actually allows so that continuous like impact on the cartilage actually stimulates the cartilage to be more youthful and more healthful.

Injury to the cartilage, however, which can come about from running, that is problematic.

So there is this sort of double edged sword from running.

We know that runners actually preserve their cartilage and actually will have healthier knees for longer.

But runners are also more prone to injuring their cartilage and it's those injuries that lead to problems.

So when you tease out runners who have not had actual injuries, they've never torn their cartilage, they've never had a major knee problem or anything.

They actually do better, they will live longer and have more healthy sort of movement type years than people who are sedentary.

So running is actually protective for our knees.

Unless you get an injury.

If you get an injury, that's, that's it.

Now with all of these things being said, we need to look at this question of whether or not taking glucosamine can be helpful.

And I know there are several listeners who have had knee injuries and right now are probably in a quiescent period where they've had a repair of some type, they've had the cartilage cleaned up and they are continuing to exercise and not having any pain.

But we know that over time, because of the injury, because of the change in the dynamics and the change in the mechanics of the knee joint, that there is new wear and tear being new forces occurring within the knee that result in gradual wearing away of cartilage.

And so people have thought maybe we could take these building blocks of cartilage, the glucosamine, to prevent the disruption and improve the healthiness of cartilage.

So glucosamine comes in two forms.

It comes in glucosamine hydrochloride.

It comes in glucosamine.

Is it monohydrate?

I gotta find it here, it's in my notes.

Glucosamine hydrochloride and glucosamine chondroitin.

No, chondroitin is a different thing.

I'm sorry, you have to edit this part.

I have to edit this part.

Too many words.

It's.

Where is it?

It's glucosamine.

Sorry, let me find.

Oh, here it is.

Okay.

So glucosamine comes in two forms.

There's glucosamine sulfate and glucosamine hydrochloride.

They are not interchangeable.

And the reality is that glucosamine hydrochloride is the one that's been looked at pretty much exclusively.

So if you're out there taking glucosamine sulfate, I can't really tell you whether or not there's any benefits or not because it's really not been looked at.

There's no reason to think that they'll necessarily be a major difference.

But without any specific research on glucosamine sulfate, it's hard to know.

But glucosamine hydrochloride is one that gets the most looks.

There's also chondroitin, which is a totally different thing.

It's also a product that is used often and promoted as a cartilage protector.

But it's not something we're looking at today.

Okay, so glucosamine building block of cartilage.

There are studies.

One of the studies we found shows that if you tag the glucosamine molecules with a specific radioactive molecule, you can actually see that it does get taken up and it does end up in the cartilage.

So dietary glucosamine, which, by the way, is obtained from the shells of shellfish.

So all of the shrimp that you get that has been shelled, those shells are not just disposed of, they're reduced.

And the glucosamine tends to.

And I think other things also are taken out of it.

Glucosamine if you have a shellfish allergy, you have to be a bit careful because there's often some cross contamination and people can, with shelf.

Severe shellfish allergies, sometimes have problems with.

With glucosamine supplements.

At any rate, glucosamine does get taken up from dietary sources and does end up in the cartilage.

However, when people have looked at whether or not it actually helps.

So people with osteoarthritis?

No, unfortunately, taking glucosamine when you have osteoarthritis, it seems to be that there's not a significant delay in the worsening of symptoms.

There's no prevention of the development of osteoarthritis.

And a lot of that is probably just because osteoarthritis is very multifactorial and osteoarthritis, as opposed to osteoporosis.

So osteoporosis is a loss of calcium from the bones and it's a weakening of the bones.

Osteoarthritis is a loss of cartilage from the joint linings, and it's bone on bone inflammation.

And that's just very painful and is the number one cause of the need for joint replacements later in life.

So taking glucosamine, unfortunately, does not help with osteoarthritis.

When we look at athletes, and there have been a few studies that have looked at this glucosamine injury prevention and recovery.

The idea here is, since athletes experience joint strain, could glucosamine help repair cartilage and reduce pain, aiding recovery and potentially enhancing training potential?

This was a study that basically looked at two different studies, pooled the results.

It reviewed the results from cyclists and soccer players.

And here there was really no benefit.

There was no significant changes.

They found, oh, knee flexion and extension seemed to be a little bit better in the people who took glucosamine, but that didn't seem to prevent injuries or really cause that wasn't able to tie to anything.

Did you take glucosamine when you had your surgery?

No.

Was it suggested to you?

No, it was never recommended.

It's the first I've heard of it, to be honest.

I know it's often suggested by orthopedic surgeons, but often without any real reason, found another one here, effects on recovery for acute knee injury, which is why I ask.

And this was 1500 milligrams per day of glucosamine for four weeks.

And they looked at swelling, and they basically were comparing swelling in the injured knee versus swelling in the uninjured knee.

So it was an intra person control.

And they looked at swelling on day 7, 14, 21 and 28.

They looked at passive range of motion and then also was there pain when you walked?

And glucosamine treatment showed a statistically significant improvement in knee flexion compared to placebo on day 28.

And that was it, the only thing out of the whole thing.

And interestingly, it didn't show any improvement in swelling, which for me the reason people can't flex their knee with an injury is usually because they have swelling.

Right?

Since swelling didn't change, I wouldn't think there'd be much change in flexion.

But anyways, no change in pain, no change in overall outcomes.

There was another study we looked at that looked at glucosamine and biomarkers of injury and this one was interesting.

It basically showed that people who take glucosamine tend to show less of the markers of cartilage turnover.

So they tend to show less of the markers of cartilage resorption, suggesting that glucosamine is contributing to a net positive effect on cartilage growth and being laid down.

But again, without any actual symptom improvement, without any actual disease improvement, it's hard to know what to do with that kind of result.

And didn't a couple of the studies that she found towards the end were related to just like safety?

And she found one study that I thought was particularly interesting, which was total mortality risk in relation to the use of less common dietary supplements.

And this was just, this was not a controlled study.

This was like a total, just sort of rando study.

Just what are you taking and following people?

It was very large.

They followed a lot of people for quite a few years, five years.

And people who were taking glucosamine and chondroitin had like a 17% decreased risk of death.

I wonder if there isn't a confounder here.

So a confounder is when there is something you're not measuring that affects both the thing you're measuring and the outcome.

So for example, if you want to look at alcohol and lung cancer and you say, oh wow, people who drink beer are much more likely to get lung cancer, but you don't control for smoking.

Okay, People often who drink beer will often happen to smoke.

So smoking impacts the likelihood of drinking beer, but it also impacts the likelihood of getting cancer.

And so therefore that is called a confounder.

I wonder with this glucosamine.

People taking glucosamine may be more likely to exercise because they're interested in Preserving their knees, they're interested in movement.

And so therefore that would be the confounder.

That's the confounder because it affects their likelihood of taking the glucosamine, but it also affects their likelihood of mortality because exercise, as we know, especially as you get older, decreases your likelihood of death.

But all of that being said, interesting.

Glucosamine having a protective effect on death.

I thought it was worth pointing out.

And I think the other thing to point out is just that, look, we didn't find any, anything that suggested any downside to this.

The only downside is if you're allergic to shellfish.

Right.

And in the absence of a downside and a supplement that doesn't cost very much, where there really isn't any great evidence that it does anything, fantastic.

But there's a hint that maybe, possibly if you squint and look at the data a certain way, there might be something there.

But I feel like there's a lot of things that land in that category.

And so if you're, if we're putting all the things land in that.

Yeah, you might as well take it because it doesn't hurt you category.

Then all of a sudden people are choking back all these pills morning, noon and night.

And I don't know.

I think my point when I say stuff like that is if you, if you, if you have early osteoarthritis, I'm talking to people in our age group who maybe are concerned or if I wouldn't say not to take it, I just don't think there's a reason not to.

I don't, I wouldn't.

I'm not going to jump on this.

There's certainly.

There's no compelling evidence here.

There is zero compelling evidence to suggest this does much of anything.

But it's one of those things where if you're taking it and you're like agnostic about the whole thing, I wouldn't say not to, but again, I just don't know that it does a whole lot.

Like you said, it falls into a lot.

A lot of things fall into this.

But it's not a no, it's not a hard no.

I've had a lot of things that are hard nos, and this is not one of them.

This is more of a. I don't think it's gonna do a whole lot, but it's.

I certainly don't have anything overwhelming about it.

I did.

I sent you an interesting overview of a study.

Did you see it?

Wait, what about creatine?

Oh, you sent it On Facebook messenger, right?

Yeah.

Oh, you didn't see it?

Yeah, I didn't know.

Okay.

So I think it's worth pointing out because creatine, although we covered it, you weren't around.

You were in Europe.

I think we were, yeah.

It's my friend Griffin joined me and we talked about creatine.

And I know you've heard a lot of this, but I'll sum it up again, just the creatine for endurance, no benefit at all for muscle mass?

Yes, if you want to build muscle mass, sure, go for it.

Do you want to get stronger creatine?

Likely improve some strength as well, at least for doing, like, repetitive, quick, short things.

But it's not going to make you a stronger cyclist, it's not going to make you a stronger runner.

It's certainly not for a triathlete type of performance gain.

We did, however, find several studies that looked at creatine for brain health, specifically as it related to post concussion and aging related things, where we saw some signal in early studies that seemed to suggest that taking creatine can have some important impacts for cognitive abilities in those who are in early onset Alzheimer's, things like that.

Well, a recent study just came out.

It is extraordinarily preliminary, so I think there are a lot of caveats.

But I did want to mention it because it kind of dovetails on some of the other things we talked about.

And it looked at postmenopausal women, perimenopausal and postmenopausal women specifically.

And it was a very small study, only nine women.

And they took creatine not in a dosage that was related to their weight, but rather just a fixed dose.

So I think they were all taking.

I think it was 1500 milligrams each.

And like, the weight of the women was all over the place.

So the amount per kilo was very different.

At any rate, the women showed pretty important improvements in their cognitive abilities over the course of the study in terms of memory and in terms of mood stabilization, which is what we saw with some other papers that we looked at with creatine.

And I think there's a growing body of evidence that suggests that what this paper showed is probably there's some kernel of truth to it, if not entirely true, that creatine is going to prove to be very beneficial for brain function.

Yeah.

And it has to do with this idea that the neurons, as we age, are less able to rapidly turn over ATP.

And by bolusing the creatine, by keeping creatine levels within that's part of the creatine phosphate pool within our neurons that allows for that rapid turnover of ATP and allows for more rapid neuron function.

So if people are.

You don't have to be taking the huge amounts of that you need for muscle mass.

So it's smaller doses.

So that means you don't have to worry about the big weight gain and the water gain that is negative for endurance performance.

So if people are considering creatine for brain health, it's definitely something to keep your ears open for.

And I think we will probably be talking about it more.

Yeah, let's do that as more of these come out.

So that the study that, the new study that's this preliminary one that's just come out was 1500 milligrams a day.

Believe it was.

Don't misquote me.

We'll, we'll correct it.

Maybe we'll take, we'll talk about it in more depth because our next episode, we're going to be talking about something that's very frivolous.

Yes, we are.

So I think we could take some time to actually go into a little more detail on this particular study and just bring it back.

So on the next episode, folks, we will have a discussion and our frivolous topic is courtesy of one of our listeners.

I didn't bring it to.

So we'll have fun.

I just want to know whoever this listener was.

You subjected me to almost an hour long video which was agonizing to watch for background on this particular topic.

I had to play it at 1.5 and then 2.0 speed and then advance it just to get through it.

It was so you're welcome.

In his defense, he told me it was his wife watching it and he begged us to review this so that we could debunk his wife's.

We'll just debunk it in advance right now.

All right.

We will revisit this creatine discussion because I want to make sure I get the right numbers and the facts.

I'll go look at that study.

Yep.

All right, cool.

All right, Juliet, thanks so much for taking time out of your east coast family visit.

And we will talk to you once you're back on the west coast.

And it'll be post worlds next time, people.

I know.

So good.

Yes, this is, this podcast is coming up with four worlds.

So we'll all say a collective huge good luck to you, Jeff and the other, the rest of the Life sport crew, but particularly you since you put so much work into this podcast and all you do for life support.

So good luck.

We'll be cheering for you.

Go climb up, go descend.

Down, up and down and up and.

A lot of up.

A lot of up.

Yeah.

All right, we'll talk to you soon.

Okay, bye.

Well, I am absolutely tickled pink to welcome to the program somebody who I've known for quite a while now.

I actually don't remember how long, but it's been a while.

And someone who probably, if you are listening or watching, then you will likely be familiar with her as well because she really took the triathlon world by storm just a few weeks ago.

Nat Grabow is 80 years old.

She has been married for 56 of those years to her husband Paul.

They have two daughters who each themselves are married with two children each, so four grandchildren.

Nat has always been athletic.

She's loved sports for as long as she can remember.

She played tennis when her two girls were young.

She started running in her late 30s and early 40s and learned to swim at the tender young age of 59.

So I keep thinking about how as an adult onset swimmer, I had to struggle so much learning how to swim in my 30s.

And once again, yeah, once again you just show us all how it's done by coming into it at 59.

She did her first triathlon in 2005, the year she turned 60, and she's been training and racing for the past 21 years.

She has competed in the Ironman World Championship 11 times, at the 70.3 World Championship four times.

You undoubtedly saw her this year when she became the oldest woman to complete the Ironman World Championship in Hawaii and of course win her age group yet again.

She is signed up for 270.3 races next year and likely will add another because she loves to race and that is her favorite distance.

But for now, I think we're finished.

For now I have been able to slow her down just long enough to get her to join me here to chat about her life in triathlon, about her recent accomplishments in Hawaii and what it is that got her into this craziness and keeps her going.

Nat Grabow, thank you so much for joining me on the triadoc podcast.

It's a real pleasure to have you here.

When we first met at the Boulder race several years ago, we were both being coached by Steve Johnson, who has since passed away and he had told me many times about Nat.

I have to meet Nat.

Nat is really quite amazing.

And when I finally met Nat, I was astonished, given all of your amazing accomplishments, that you were just this diminutive both in stature but also in personality.

Just quiet, humble.

Just such a.

A unassuming woman who has accomplished so very much.

Do you look back at your 21 years and all of the things you've accomplished?

And at any point do you just go, holy smokes, what have I done here?

No, I think I've always been competitive and I had very good results in just running for the 20 years that I ran.

And I competed in New Jersey and all over the place within 5Ks, 10Ks up to the half marathon.

And I always did well with that.

I knew that if I learned to swim, I would be good in the triathlon because I love to run and I love the bike and I'm so competitive that I. I saw where, when I started to race, that I was having good results.

I felt like I found my sport.

So I.

There have been ups and downs, but.

But I really.

I just love it and I love pushing myself.

I love the training, of course, more than the racing.

If I didn't race again, that would be okay.

I love getting up and moving and doing something and having a hard bike workout to do.

And you mentioned Steve, and he really pushed me with the bike workouts.

And I feel like I really got so much stronger with his workouts.

I still miss him.

Yeah, we all do.

Did you at any point think you would find yourself here where you are Today, competing at 81 and finishing the world championship in Kona?

No, really, With COVID I had qualified for Kona in 2019, and then 2020 and 2021 went by, and so then it was 2022 going back, and I just felt out of sorts in that race.

I went in with a foot injury.

It was the first time my husband wasn't able to travel with me because he's having some health problems and I had to travel by myself.

And I just was ready to say goodbye.

I was so close to the cutoff time too, because I had to walk a lot of the marathon with my foot problems.

I really said goodbye to Kona flying away that.

That time, and I didn't think I'd ever come back.

But then I had really some good 70.3 races and feeling great.

And I thought, nobody's.

Very few people have done an Ironman, just in general at 79.

So I challenged myself to do Ironman, Maryland, which is an easier course at 79.

And I had two of my friends go with me and support me, and they were wonderful.

And.

And I had a flat tire and the roads flooded from the tides and we were walking through knee deep water and my friend Katie kept saying, natalie, you're going to Kona.

And I kept saying, no, I'm not.

And that wasn't my goal for that race.

But the next day I talked to my coach and I talked to my friends and I thought, I'm excited about that challenge.

I felt good and I thought, I don't want to go back if I'm not excited about it.

And I was really excited about the challenge of doing it at 80.

So that's how I ended there.

I do want to spend some time talking about the race in Kona this year, but before we get there, I just want to ask, what do your kids think about this?

What do they think about mom being out there at 79?

I've actually coached some athletes in your age group, and I always hear from those athletes, oh, my kids are concerned, they don't want me doing this.

And inevitably that seems to be what makes them stop.

It's not that they feel like they have to stop, it's that their children feel like they have to stop.

I would never let my children determine what I did.

I have one daughter who lives around here and she's, she's non competitive.

She's an excellent athlete.

She was a gymnast her whole life and she runs and bikes and she's in great shape, but she does not like competition.

So she doesn't understand what drives me a lot of the times.

And she's the one that says, just be safe, mom.

Just, just be safe.

And then I have another daughter who lives on the west coast and I think you met her at Boulder at that time.

So she was racing at that time.

Since then she's stopped racing.

But she's competitive and she has come out to support me many times in Kona and she's totally opposite.

Go, mom, go.

What are you gonna do next?

And so kids are so different and, and she loves the whole thing and I couldn't do it without her.

She's a sweetheart.

And she, she, it's, it's something that you want to share with people that you love.

And she came out and we had such a great time, just laughing and she gets me my traditional breakfast the next morning.

And we have so many traditions that we do, and it's just wonderful to share that with her.

Now you've been there 11 times.

How many times have you walked away with a bowl?

10.

10 times.

So it's a lot of bowls, that's.

A lot of bowl.

You have two full sets there.

That's Incredible.

A dinner party.

Yeah, exactly.

That's amazing.

The, the rest of us mere mortals, we there, there are several.

Now, you do very well in triathlon.

I do okay, but I aspire to be like some of the people that I look up to.

And when I say that, I think we all have this sense, especially at my age.

I'm 58 now and I, I, I find myself going, how long can I really do this?

I still do well at it.

I still fortunately have my health.

I haven't had any major things come up and anticipate that I could be doing this for a little while longer.

But I think all of us look at you and there are several others who I've mentioned on this program before, people I've met in my own races who are in the older age group, still performing, still enjoying it.

And we all aspire to be that way, knowing full well that the age groups get smaller as you go higher up in age, simply because people have various things that come up that keep them from doing it.

What do you think has been your secret to success?

Is it just good fortune?

Is it genetics?

I mean, what is it, do you think that has contributed to your ability to be able to continue to do this, a sport that you love and as grind, as much of a grind as it can be?

I think it's the desire I want to do it.

I'll do anything to figure it out.

So if I get injured, I'll figure out headache, get over the injury, I'll do what I need to do.

I'll go to the right person to see if I can figure it out, or I'll rest or I'll do what I need to do.

So I think it's said it's just this desire to do it.

And as I say, if it's not meant to be that I race, that's okay.

I just, I will do something every day as long as I'm alive.

I know that.

I just love to move.

I think it feels great to be strong.

It feels great to mentally, it feels great.

The feeling of challenging yourself to something and to achieve that, it could be a workout that no one else knows about, but I know about it and I know how hard I worked and I feel really good.

So it's a personal thing that is just that satisfaction of.

And maybe because I didn't have the opportunity to compete when I was young and I always wanted to, and I would look at, even I would look at cyclists on the road, riding in a group, and I'd say, oh, that's so cool.

And actually, I got to do it.

I got to ride with a group and do things that I never thought I would be able to do, run with people and do a race.

And so it's still new to me even.

And maybe kids that start out competing very young, maybe they get tired of it and they've done it and been there, done that, and they don't want to continue, but for me, it's still fresh.

Yeah.

And for you, was the reason that you didn't start young, Is it just because when you were younger, the opportunities weren't there for women?

Right.

Yeah, they weren't there.

We went outside and played in the woods and ran around and rode bikes, and our parents said, come in at dinner time, and we didn't have organized sports.

Girls didn't have anything.

I was a cheerleader in high school.

That was the most physical thing that I could have.

In college, I just studied all the time and we had no sports anyway.

But I just walked to class, and that was extent.

But once I started working, then I had the.

The time to do things and the way to meet people was to join the ski club.

I worked at Bell Labs, and so I'd never skied before, but I read about it and looked at videos or something, and I. I joined the ski club and did that.

And then when I had my daughters, I had never played tennis before.

I figured that out and took some lessons and played tennis.

So I didn't have the opportunity to take any lessons.

We just lived in a town where nobody took lessons economically.

It wasn't a thing that you did.

My parents would never have thought of giving us lessons in anything.

Was there any specific race that you saw or any particular athlete that made you think about triathlon as something?

I know you said that you enjoyed biking and running, but you had to be introduced to the triathlon somehow.

And I'm just curious if there was a race or potentially a female athlete or just any athlete that maybe got you thinking about doing this.

No, not particular.

It was just that my friends were doing it and.

And as I said, I needed to do some cross training of some sort because I was running too fast and getting injured.

I always liked to be part of a group, so my friends were doing it, so I wanted to do it.

We had a sprint triathlon nearby, and everybody was doing it and said, come on, Natalie, do it.

And then I had to be embarrassed and say, I never learned to swim.

I really can't do it.

And I think the year before I said I was busy or something.

Then I finally admitted I didn't know how to swim.

So I had my younger daughter, the competitive one, come from D.C. where she was working.

I said, Amy, just do the swim for me.

I don't care how slow you are, just don't drown and give me the chip so that I can do the bike.

And I just loved it.

I loved the competitiveness.

I loved the whole thing.

Getting on my bike and passing people and then running.

I just loved it.

I said, I gotta learn to swim, I'm gonna do this.

So I don't think it was a particular person or it wasn't a pro.

There are people that I've admired along the way, but it was just to be part of that whole community of like minded people out there pushing yourself the hardest you can to be the best that you can.

So that's always driven me.

And what tips do you have for those of us who are looking at you?

Because clearly as you get older, your training has to change, your, your race frequency has to change, your nutrition probably has to change.

So what are some of the tips that you would have for people who aspire to be able to do this as long as you have?

I don't think I'm that wise to say, but I just know I pay attention.

If I have something that bothers me, I really try to address it quickly.

And I, I always just want to do something every day.

So I want to nip anything in the bud.

If I'm so if I feel like I've got an injury due to cycling or whatever, then I'll do the other sports or pay attention.

I think it's just the desire to, to, to keep going and moving in some way.

If you can't run, then you walk.

It's just, it's just the desire to do it, I think is, is foremost.

I think people quite often say to me, oh, I can't run because of my knees or I can't do this because of this.

But did you really try?

I have really flat feet.

I have so many issues too, but I don't.

I want to figure out way to get past them and to still do it, even though I have those issues.

So I think the mind is so strong that if you really want to do it and you want to excel or just be.

I think the important thing is just my kids growing up, I would just say just be the best that you can be.

It's not always going to be first or whatever, but just make the most out of what you have, and that's what I've always tried to do.

Those are, I think, very sage words.

So let's revisit your historic day in Kona, because I think it's something that people would like to hear about.

You obviously were looking forward to it.

As the day came closer, things obviously were working in your favor.

When you were getting into the water this 11th time, did you have any sense that this was gonna be more difficult than usual?

Did you just feel like this was just another go at it?

How are you feeling?

I was feeling fine.

About the swim?

No.

I have to say that five weeks before Kona, I really aggravated my hamstrings.

Upper hamstring and into the middle.

I ended up taking about six days off here and there and getting some therapy on it.

And I was.

So I was nervous about the bike, which is my favorite thing and the thing that I usually make up time on.

So the swim I was pretty comfortable with.

I've done it so many times that I knew that I just tried to follow some feet.

And then, unfortunately, the.

The next wave came along and they were fast and they pushed me off my line and knocked my goggles as few and.

But I'm used to that.

I'm pretty brave in the water, and even though I'm not that fast, I can keep going.

So I was fine there and I got on the bike and my hamstring bothered me from the very start.

So it was a mind over matter with that.

Trying not to aggravate it too much because I was just concerned at that point how my run was going to be.

So I really stopped a lot on the bike, not only at the aid stations, but even here and there just to relax it.

I didn't stretch it.

I just tried to just stop the aggravation.

And I think that really helped because I ended up taking in a lot of fluids and a lot of nutrition, and I was really very conscious of how much salt I took in with the three races I did this past summer.

At the start of the run, I cramped every time, and that just sets you back that you can't even move then.

So I knew that with the heat and humidity that might be the case, I took a lot more salt than I usually do, and so I got through the bike okay.

It wasn't as enjoyable as I would have liked it because of the hamstring thing, because that's really my favorite thing.

And the hamstring is almost resolved now, so it was just a matter of time.

And I just ran out of time.

But once I started to run, it felt just fine.

It didn't bother me a bit.

And I think because I eased up a little bit on the bike and I took in my fluids really well, the run felt great.

So I was so pleased that I was running.

And then I had planned to just walk up on each.

And the announcer was there and spotted me and said, oh, here comes.

Oh, no, I've got a run.

So I had to run that thing.

I felt like he was looking at me.

So anyway, I. I pretty much ran everything except for the aid stations, of course.

And that's how I do my long runs.

I run a mile and then I'll walk a minute or a minute and a half and then I run again.

So that's how I train.

And I have a very strong stomach, so I'll take in whatever.

If a potato chip looks good to me, I'll have a potato chip.

So I'm not fanatical about what I take in.

I. I just take what I feel like.

And there must have been a huge amount of support for you out on the.

Oh, yeah, my daughter.

My daughter is my biggest support out there, and so I rely on her.

It was so funny in 2022 when I had my foot thing, I was walking a lot.

And she's very sweet, though.

She says, mom, you're not going to make it if you continue to walk like this.

I would start running if I were you.

But she was good because I was running and I was right on pace.

My coach was there too, so she came out and so she.

She told me I had.

I was in good shape.

Shape if I kept up to the pace.

Now, I didn't think I would keep up the pace that I started out with, but I felt like I was going to keep a decent pace up pretty much the whole time.

I knew I was in good shape to finish in time.

I didn't want to finish right at the very last.

I wanted to finish as well as I could, though.

Yeah.

Were you out there alone at any point or did you.

Were there people around?

Most of the time, I think I.

Was by myself, like, even in the bike.

I'm looking around saying, do I go straight here?

And I shouldn't have the course by now, but really I'm saying to the volunteer, do I go straight?

Yeah, because there's nobody around.

And, you know, the energy lab, there's just no one there with me.

I'm thinking, I know I'm not the last one.

What was really fun, though, is because I was the oldest.

I had the motorcycle guys follow me twice on the bike which was really nice.

It really uplifted my spirits.

And how you doing?

I'm doing good.

I felt like a pro or something.

And then in the energy lab right before the turnaround he found me again.

So how you doing?

Oh, pretty good.

I'm hoping to make the cut off.

So that was fun.

Yeah, it is nice.

And you were greeted at the finish by the previous oldest winner.

And I'm blanking.

Sheree, did you know that she was going to be there?

She had texted me when I got to Kona.

She said, oh, I hear you're here and racing.

And I was surprised that she didn't know that ahead of time because on Tracker it showed an 80 to 84 year old who was going to be there.

So I was surprised that she seemed surprised.

But she said, wow, that's great.

80, good luck.

I'll be at the finish line from what she said.

And she's, she's a strong part of Ironman and she's usually there or part of it.

So yeah, she was there and it was fun.

Just very gracious and very supportive and just a lot of compliments afterwards.

So she, she was really great.

Very great.

You're not one to like being the center of attention and you have very much been the center of attention.

At least it seems to.

Like you said before we started talking, it died down a little bit and you're happy for that.

But did you get any?

It hasn't.

Oh, no.

Oh, people, they must be tired of seeing me and hearing about me.

But anyway.

Yeah, but you have to take, you have to.

I, I hope that you take it for what it is, which is people are very inspired by what you're doing.

Yes, we.

And of course you're such a lovely person so that it's wonderful to see someone like yourself doing what you're doing and enjoying it and, and being really a beacon for so many others.

Yeah.

What have you taken away from the whole experience besides, oh my gosh, I don't want to be the center of attention.

I just, I honestly, I'm enjoying everything.

I'm saying to myself, wow, this is a once in a lifetime opportunity and the people that I've talked to like you are just wonderful.

They're just so nice and I really enjoyed number one.

Everybody likes to talk about themselves a little bit and, but everybody's just been so great and fun and, and I look forward to talking to everyone.

Really.

It's been a fun experience.

I just feel a little funny that people are going to say, wow, we've heard her story already, why are we hearing it again?

So I feel a little self conscious that, that I had.

I have one friend, I saw him in the pool the other day.

It says, I feel like I've been living with you for the last two weeks.

I could tell you why people want to hear it over and over again.

It's because in these times right now, everybody wants a feel good story.

Yeah.

And this is a really nice feel good story.

And what's not to like about you and about what you've accomplished and the fact that we all got to share in it, I think is, has really been wonderful.

That's wonderful.

Is there any interaction you can remember specifically that really resonated with you?

Anybody who came up to you or any kind of conversation you might have had where you feel like you really had an impact on someone or anything like that really has stuck with you?

I think so.

I think the comments that I've gotten and I talked to my town's cross country team the other day and that I.

There was an article in our local paper today and the writer of the article apparently interviewed some of the kids, some of the girls and they made some really nice comments that my talk had really affected them and they aspired to do things and they had previously looked at their grandmother who wasn't doing anything and they had a new outlook on that.

And I'm really grateful for that, that I can give people a sense of, you don't have to stop.

At a certain age you can keep going.

Some people just joke about it, but I think a lot of people take it to heart and will get up and try to do more than they previously thought they could do.

And that's great.

It is great.

It's wonderful.

So next year you said you'll be at Eagleman.

What's the other race you're signed up for?

Nestle Man.

Muscle Man.

Okay, that's in New York, right?

New York City, Neva, Finger Lakes area.

Yeah.

Awesome.

For anybody who's going to be at those races, you keep an eye out for Nat.

She is always smiling, always enjoying herself and she is going to be around, as far as I know, for as long as she.

Certainly for as long as she can.

She wants to be.

So we can all look forward to seeing her smiling face on a podium near you sometime soon.

Nat, I can't thank you enough for taking time to speak with me today.

This has been really wonderful and it's so great to have connected with you again.

Yeah.

Watch you go through this experience.

It's really been enjoyable and like I said, we all aspire to be just as good as you somehow.

So congratulations.

Yeah, congratulations and look forward to chatting with you again after some other major accomplishment that you can do in the next.

Great talking to you.

Hope you come east for a race sometime.

Maybe I'll see you.

Yeah, I have to get out that way.

I tend to end up a lot out this way, but every once in a while I make it out there.

So yeah, I'll try.

Yeah, I think I saw you Montrembl one year, right?

Oh, that was the year of the world.

Yeah.

Yeah, yeah.

Oh yeah.

All right.

All right now.

Take care.

Thanks.

Hi, my name is Denise Haslik and I'm a teammate of the Tridoc and a proud Patreon supporter of the Tridoc Podcast.

The Tridoc Podcast is produced and edited by Jeff Sankoff, along with his amazing interns Cosette Rose and Nita Takashima.

You can find the show notes for everything discussed on today's episode, as well as archives of previous episodes@www.tridocpodcast.com.

do you have questions about what was discussed on this episode?

Have a question about some hot new gadget or trend that sounds too good to be true that you'd like the Tridoc to sanity check on a future episode?

Send Jeff an email@tridocloud.com if you're interested in coaching services services, be sure to check out tridoccoaching.com or lifesportcoaching.com where you can find information about Jeff and the services that he provides.

You can also follow Jeff on the Tridoc Podcast Facebook page, Tridot Coaching on Instagram and the TriDoc coaching YouTube channel.

And don't forget to join the Tridoc Podcast private Facebook group group search for it and request to join today.

If you enjoyed this podcast, do the Tridoc a solid and leave a rating and a review.

And if you haven't already, be sure to subscribe to the show wherever you download it.

And of course, there's always the option to become a supporter of the podcast@patreon.com Tridock podcast the music heard at the beginning and end of the show is radio by empty hours and is used with permission.

This song and many others like it can be found at www.reverbnation.com.

be sure to visit and give small independent bands a chance.

The Tridot Podcast will be back again soon to answer another medical question and chat with another amazing person in the world of multisport.

Until then, train hard, train healthy.