Busting Cryotherapy, Cupping, K-Tape, EMS, & Red Light Therapy w/ Dr. Nick Tiller (SSOF Ep 70)

James de Lacey2:15

Nice. Yeah, there's definitely a lot in the health and wellness space. As you mentioned, a lot of marketing, influential people kind of pushing products and things like that, and that's kind of where they make their bread and butter with all their sales. But what made you, I guess, write that piece about the UFC and kind of the practices that they're using, and maybe being skeptical about what's happening there?

Dr. Nick Tiller2:48

Well, I started—I'm a martial artist myself. I started doing karate when I was about eight years old. I got my black belt in karate and then went off to do different styles, did Wing Chun, kickboxing, then got into MMA. And I was captain of my university MMA club back when I was doing my PhD. This is a few years ago now. And so I love the sport, I love martial arts, and I love sport MMA. And I have martial arts in my heart, even though I don't have a lot of time for it nowadays.

And so, naturally, I'm a big MMA fan, and I've been watching, mostly UFC rather than some of the other organizations, for as long as I can remember. And it just became very, very obvious to me—I guess the key thing that I remember is seeing a lot of MMA fighters now coming out with cupping bruises all over their backs and shoulders. That was the sort of trigger for me that got me to think about it a little bit more actively, that you see these athletes and they've got cupping bruises.

We know that cupping, really, in scientific terms, there's not a strong evidence base behind it. It's broadly considered by scientists to be what we call a pseudoscience—something that is pretending to be real science but actually isn't based on any evidence or any physiological mechanisms. And the more I looked into it, if you watch enough MMA, and particularly UFC, you see fighters having cryotherapy and jumping in ice baths and taking more supplements than they can realistically even get their hands on.

A lot of this stuff is advocated directly by the UFC, and it just seemed like something that needed to be explored in a little bit more of a formal article. So that's when I wrote the piece in Skeptical Inquirer. And if anybody's not read it, then I urge people to—you can find the link through my website, nbtiller.com, and you can link to the piece there. There's also the podcast that you can listen to. And it just really explores the pseudosciences, or the pseudoscience practices, that seem to be most prevalent, particularly in the UFC.

James de Lacey5:00

Yeah, the cupping run has obviously been around for a long time. You see that always. But is there a case for it does no harm, athletes feel good, so why stop them? I know Dr. Chris Kirk has an opinion on that, saying maybe it does cause harm because it's pulling blood away from the muscles, maybe you're slowing down the recovery process. What's your take on that, with regarding cupping?

Dr. Nick Tiller5:28

Yeah, and I know Chris quite well. He's a good guy, and we agree on lots of things. And this is something that comes up a lot. It essentially comes down to, "What's the harm?" Right? If it provides athletes with some kind of perception that they're recovering better, or even some kind of psychological advantage, then what's the harm? Why can't they use it?

And there's obviously an argument to be made for that. The flip side to that argument is that, in many instances, there is direct harm. There is evidence of direct harm, particularly with cupping. There are lots of published case reports of cupping-related burns, for example, which can be very nasty, can cause infection and sepsis and so forth. And you can look in the published literature—there are many examples of this.

That's just with cupping. With other things that we broadly consider to be pseudoscience, like chiropractic, again, you can look in the mainstream media, in the scientific literature—there are lots of cases of arterial dissection and neck breaks and things like this from spinal and neck manipulation. So these things can cause direct harm in some circumstances. Okay, these cases are relatively rare, but what we have to remember is that these alternative therapies really work only in the context of placebo.

Of course, all medical interventions come with risks, right? But when it's a real medical intervention, something that we know is quite likely to have a positive effect on the body, physicians will tend to balance the risks with the benefits in what we call the risk-benefit analysis. So they make an informed, educated decision on whether this thing is more likely to provide a benefit than harm.

But with alternative therapies, when the benefits hinge only on placebo—that is, imagined effects—then the risks become very difficult to justify. The other thing that we have to consider, and I've written about this at length, is that high-level athletes tend to pioneer population trends in alternative therapies.

So if you see a Conor McGregor using cupping therapy, which he has done numerous occasions, then a lot of other people, a lot of his fans, a lot of MMA followers are going to think, "Well, if it's good enough for a superstar like McGregor, it's good enough for me." We saw something very similar with Michael Phelps—the classic example. American Olympic swimmer, the most successful Olympian of all time, not just the most successful swimmer but the most successful Olympian of all time.

And when he came out to the 2016 Rio Games with cupping bruises all over his back and shoulders, if you actually look at the Wikipedia searches for cupping therapy, they reached an all-time high the day after he appeared at the Olympic finals. So he's really—people like him and people like Conor McGregor, when you see high-profile athletes using these interventions, it really does spark a population interest in the use of these therapies.

And again, these things are not necessarily benign. We have to think about the risks associated as well. So "what's the harm" is valid only in some cases when there actually isn't a harm. But in many cases, there is.

James de Lacey8:28

Obviously, you mentioned as well ice baths and cryotherapy. I think those are probably, at least right now, probably the most prevalent and most popular, at least within the combat sports. I mean, even within general population, the ice bath is like—I don't know if you've been on Facebook and you see an ice bath ad every second thing that comes up. Or everyone's doing an ice bath challenge, or doing morning ice baths when they get up. It's kind of like the big thing, even bigger than, I think, when Wim Hof was pushing it, to be honest.

So maybe dive into a little bit of maybe—let's go into why people ice bath. Is there any—

Dr. Nick Tiller9:25

Sure. Well, as you rightly said, ice bathing has been around for a long time, and it seems to be largely popular for two reasons. Firstly, there's something called the exposure effect: the more people see it, the more popular it becomes, just purely because it's something with which people are familiar. And when people become familiar with something, it just becomes part of their habitual day-to-day life. So it seems to be popular just because high-level athletes use it, and it's something that we just associate with recovery.

The other thing, of course, is that when we see people get injured, the first thing that we do is apply ice. This whole idea of rice: rest, ice, compression, elevation. And this, again, is now a little bit contentious. There are some suggestions that that might not be the best way to treat injuries. But in any case, there is this idea that applying cold to something can facilitate recovery, so it's almost conventional wisdom now.

Now, ice bathing has been around for a while, and it seems that you can't look at the Instagram feed of any athlete, regardless of the sport, especially in MMA, without seeing somebody using an ice bath. And there is almost some kind of virtue to suffering for your craft. Ice baths—I'm sure a lot of people listening and watching have tried ice baths for themselves.

I used to do it frequently. It can be unpleasant, especially for the first couple of minutes until you acclimate. And so there's this idea that you're going through some kind of discomfort or pain or sacrifice for the art, for the craft. And so that feeds into the whole idea as well.

But actually, when we look at the evidence, there isn't a great deal of evidence that ice baths are beneficial. And actually, some really good studies now are emerging in journals like the Journal of Physiology, which is a very mechanistic journal publishing high-quality studies, showing that ice bathing could actually be detrimental to recovery, specifically following resistance-type training or training that places an emphasis on muscular strength and power development.

So specifically, I can think of three studies off the top of my head that have shown that if you immerse yourself in cold water or an ice bath—so anything less than about 10, 11 degrees Celsius, I guess that's about 50 Fahrenheit, maybe between 40 and 50 Fahrenheit—then it actually suppresses the anabolic signaling pathway. So when we think of anabolism, this is building up; catabolism is breaking down.

So as strength and power athletes, if you want to recover from training, you want to be in an anabolic state. And immersing yourself in an ice bath actually suppresses anabolic signaling pathways, so that actually can inhibit the recovery of the muscle.

Other studies have shown that it can also suppress muscle protein synthesis. So of course, when we damage the muscle, when the muscle becomes stressed during a particular training session, we want to upregulate muscle protein synthesis. This is one of the mechanisms for how we recover the muscle following training. And ice bathing can suppress that.

So there are two independent mechanisms for why ice bathing probably isn't beneficial for MMA fighters who place such an almost over-emphasis on muscular development and strength and power and lean muscle mass. All of these things are really important for a good MMA fighter. I can't think of a really good scenario where immersing yourself in cold water or an ice bath is going to be beneficial. I can only think that it would have a net negative effect on recovery. And it just, for some reason, the science just isn't trickling through to practice.

I think there's a lot of tradition that's in there. I think MMA, in a similar way to boxing, we have to look at MMA in the broader context of combat sports. These things have a very historical underpinning. They've been around for a long time. The coaches of today are often the athletes of yesterday, so they just pass down—almost nepotism—they pass down what they know to their athletes, who in turn pass them on to their athletes.

And when you have tradition that is immersed, that is inherent within the sport, that's a great way to insulate the sport from outside scientific influences. So I think that's part of the problem.

James de Lacey13:44

I mean, just to really highlight that point, you still see some fighters drinking their own pee, right? To the extreme. So yeah, it's interesting that the ice bath one is very interesting.

I've got a friend that did a great PhD using ice baths around recovery. I see one area where it could be useful if it was in a congested fight camp. So we actually had—I don't know if you've seen this study—they used it with professional rugby in Super Rugby, and they had athletes ice bathe four times a week after the end of each day's training. And the group that did ice baths through that preseason, they were able to attenuate the decline in countermovement jump performance near the end of the week versus a group that didn't.

So there might be some potential maybe in performance stuff when you're not looking to maybe make long-term adaptations. I don't know what your take on that is. If you see maybe there is a use case within maybe a congested fight camp schedule when physiological adaptation isn't the main priority?

Dr. Nick Tiller14:35

Yeah, I'm glad you brought that up, because it's important that we don't just throw out the baby with the bathwater, right? So there are some potential advantages to this kind of thing, and most of them lie, as you said, in the context of when you have repeated performance requirements in a short space of time. So athletes in competition where they're having to perform heats—so when the short-term adaptation isn't so important, but recovery is more of the emphasis—then there might be a role for it there.

I'm very much of the opinion that I can't think of a scenario where muscle recovery isn't going to be the priority. When you have some kind of muscle damage because you've introduced micro-tears into the muscle or you have some kind of local inflammation, you always want to upregulate muscle protein synthesis and anabolic signaling. So my personal position is, I think if that's always going to be the priority for any athlete—whether you're doing strength training or endurance training—we've all gone out for a run and been sore the next day, right?

That's because you've damaged the muscle. And in that scenario, you haven't done strength training per se, you still want to upregulate anabolic signaling, you want to increase muscle protein synthesis.

So I think, yeah, maybe if you have to do multiple competitions in a very short space of time, but these are quite rare scenarios.

James de Lacey15:55

Nice. And with cryotherapy, is the mechanism the same, even though you're not submerged in water and it's—I guess it's shorter time frames when you're in cryotherapy as well, with the full-body mist and everything like that?

Dr. Nick Tiller16:24

Yeah, so I guess the more correct term is whole-body cryotherapy, because cryotherapy can be anything associated with—it can be local as well. Or if you apply ice to an injured knee, that in theory is cryotherapy.

But whole-body cryotherapy is essentially when you step into something that resembles a closet from the future. It looks and is shaped like a closet, but inside, the air has been cooled to something like between minus 150 to minus 200 degrees Celsius—I can't make the conversion to Fahrenheit, but you can do that if you're interested—using argon and liquid nitrogen. So the air has actually been cooled to very, very low temperatures, and then the athlete will stand and immerse themselves in this very cold air for a maximum of a couple—usually between two and four minutes maximum.

And the premise is similar in that you are exposing the athletes to very, very cold temperatures, which supposedly suppress inflammation and facilitate recovery. But cryotherapy actually makes some claims that are extrapolating from the literature and really don't have a scientific basis. So for example, one of the major premises for whole-body cryotherapy is that when you step into this very, very cold environment, the blood and the oxygen and nutrients are held in the core because the blood flow to the periphery is restricted because of this cold environment.

And then when you step out of the chamber, there is this dramatically increased flood of oxygen and nutrients to the muscle as in sort of an overcompensation.

But actually, this is not something that's been demonstrated in the literature. This is not a mechanism that we're familiar with. And when you look at the studies—this has been quite extensively studied—it doesn't seem to have any effect really on objective measures of recovery. There is a very, very tiny, if any, effect on reducing inflammation. So inflammatory mediators, when these things are measured in the blood—when it does exert an effect, it doesn't seem to be any better than just doing an active cool-down or going for a swim or just doing something to facilitate recovery that isn't going to cost a fortune.

Like, these cryotherapy chambers can—these things can often cost a quarter of a million dollars. A single exposure can be between $100 and $200, depending on where you go.

This is not an affordable intervention for most people, and most of the benefits seem to be perceptual. So in poorly controlled studies that haven't accounted for expectation and belief effects that we call placebo, there seems to be some kind of perceptual effect. So athletes feel that it's working, but most of the objective benefits are either non-existent or very tiny, and it just can't be justified by the expense.

James de Lacey18:50

Yeah, those cryo sessions are stupidly expensive for two to four minutes to stand in the freezing cold, and you're paying for very little, for seemingly very little benefit.

Dr. Nick Tiller19:22

This is what's frustrating for me when, again, I love MMA as a sport and I want it to be taken seriously as a sport. But when you have places like the UFC Performance Institute and the UFC have an official partnership with a cryotherapy vendor, with a cryotherapy supplier, and all of the athletes have immediate access to this stuff through the Ufcpi, and it's really not evidence. The UFCPI is supposed to be an evidence-based research and development center where they support high level elite athletes, but this is not really evidence-based. There's a very weak evidence underpinning for this.

And so when they have an official partnership with something that is broadly considered to be bad science, it doesn't really bode well for the wider reputation of the sport, I guess.

James de Lacey19:51

I'm living in Austin; there's almost like a cryotherapy clinic on every corner popping up. They've got bodywork, place stretching clinics, all sorts of the wellness stuff they can sell to the general public. But I used to live in LA, and it's just probably just as bad if not even worse. Like every other store is cryotherapy or intravenous nutrient drips, or you know.

Dr. Nick Tiller20:22

Exactly. These things are everywhere. It's another thing that's not evidence-based. And I guess what's frustrating for me is that there are plenty of interventions that do work that are evidence-based that are going to improve performance objectively and subjectively.

So it frustrates me that we are wasting a lot of time. Resources are not infinite, especially for UFC fighters who, the vast majority of fighters on the roster get paid less than the minimum wage. They're almost below the poverty line, and so they don't have endless resources. They're not Conor McGregors. They're not UFC champions, most of them. They don't have endless resources to spend on these things, so we really want our elite athletes to be spending their limited time and resources and money on things that actually work.

James de Lacey21:23

Before getting back to the podcast, I want to let you know there's a link down in the description for the Sweet Science of Fighting Underground Community. You can get all the help you need for your combat sports training. You get every single Sweet Science of Fighting training program, online course, and you get access to a range of coaches within the private Discord community. So go check that out, and back to the podcast.

That's kind of fair. And we'll dive into some of those things that work a little later, because I've still got some more myths to bust. But let's jump into the IV one. I didn't have that on my list, but obviously we just talked about IVs. Those have become very popular. I would probably put it down to Joe Rogan talking about it a lot on his podcast is what really blew it up. Do you want to maybe dive into what are the perceived benefits of getting an IV and what is it actually doing?

Dr. Nick Tiller22:08

So for those people who don't know, we have these intravenous nutrient drips, which is basically a banana bag of nutrients, and it goes in intravenously through, I'm pointing to a vein on my forearm here for the people that are listening and not watching. So it goes in through an antecubital vein in the forearm. And these things have been inadvertently endorsed by athletes and celebrities all over the world, and these things have become very popular as a result. And the idea is that by bypassing the digestive, by bypassing the gut, the digestive system, you can increase the availability, the bioavailability, of various nutrients.

But if you actually look at any of the products that are produced by some of these nutrient drip vendors, there are no really active ingredients. You've got, they'll have like a fitness drip and a detox drip and a wellness drip and an energy drip, and the first four or five ingredients are basically identical. There's usually some kind of sodium chloride, which basically makes saline. There'll be a few vitamins in there, and just things that are to every single drip. They're there just to make up the ingredients.

And then you have the so-called active ingredients. So the immunity drip, for example, just has a lot of vitamin C in it. It has between one and two grams of vitamin C. Well, we know as physiologists, nutritionists, dietitians, and people who understand how the body works that taking high dose vitamin C on a day-to-day basis is not going to boost your immune system.

There is no such thing as boosting your immune system unless you get a vaccine. A vaccine is the only way to actually boost your immune system. You can strengthen your immune system by eating well and being physically active, but short-term boosting of the immune system is not a thing. You can ask any immunologist and they'll tell you the same thing.

So just taking high dose vitamin C, and especially on a one-off occasion like these drips are offering, it's not going to provide you any benefit. Give you one more example. They have something called the fitness drip, and the fitness drip contain, the only active ingredients, and I'm doing this in quotes, the active ingredients are L-carnitine and an amino acid, I forget which one it is.

It doesn't really matter. I think it's glutamine, actually. And glutamine doesn't make you fit. Okay, it's important not to be deficient in any particular amino acids, but having, I think they give you one and a half grams of glutamine, and you get three or four times that amount of glutamine by just eating a chicken breast. So this isn't even a particularly high dose of glutamine.

And L-carnitine, decades of research has shown that L-carnitine doesn't have any effect on fat metabolism unless under very specific scenarios. It certainly doesn't make you fit. And when I contacted these manufacturers and I asked them specifically why is L-carnitine in there, they responded by saying that it activates the metabolism. That is a cheap filler. It doesn't really activate the metabolism, nor would activating the metabolism necessarily make you fit. So this is definitely considered a pseudoscience that has no effect on the body, no positive effect on the body. But it's just become very popular.

And I do a lot of running races as well, and if you go to the exhibitions for these races, you see lines and lines of athletes all waiting 45 minutes, 60 minutes, just to get their intravenous nutrient drip under the misapprehension that it's going to improve their performance. But it's going to do nothing of the sort. But this is a perfect example of marketing over science.

And those IV drips are damn expensive. They're very expensive, between $300 and $400 each. This is, and the other thing that a lot of people don't consider is that the World Anti-Doping Association actually prohibit the use of intravenous nutrient, of intravenous drips of any kind. I think it's if it's over, I can't remember exactly what the volume is, but if it's over a conservative volume, so there's a good chance that if you go and have one of these drips then you're actually in violation of the World Anti-Doping Association code.

It's probably not relevant for most people who are competing at a recreational level because they're not going to be drug tested, they're not going to be subject to follow-up. But if you're a high level athlete, especially if you're an elite athlete, you could be inadvertently doping without knowing it.

James de Lacey26:29

That's true. And another intervention, or I guess a recovery intervention, that's not as prevalent today, but you still see around is K-tape. And I don't know if people are still, I'm sure people are still using it. I mean you see people with color tape all the time. But what are the purporting mechanisms behind that, and is there any harm to using K-tape? Or if someone likes it, they can wear it, whatever.

Dr. Nick Tiller26:58

Most of the users of K-tape are in team sport and track and field as well. I mean, if you tune into any track and field event, particularly the Olympics or the Diamond League that's been on recently, you'll see a lot of athletes with this bright colored tape all over the shoulders and knees. And this is something that was made popular back in the 70s, actually, was the first time that K-tape. It's been around for a long time.

And in a stroke of marketing brilliance, when the product was first developed, the manufacturers donated something like 20,000 rolls of tape to different athletes and sports teams around the world, saying, look, here's some tape, use it for free on us, and it's going to do X, Y, and Z. Of course, the athletes and coaches and the sports teams use this thing, and then they're all on TV and they're all playing professional sport with this brightly colored tape. So again, this comes back to what I said right at the start: it's the exposure effect. The more people see something being used—

The more familiar they become with it, the more subconsciously they think, well, it must be effective. And it was a stroke of absolute marketing brilliance. There's quite a lot of data now on K Tape and really taping the muscles and joints. And I'm not an injury expert, I'm a physiologist, not a physiotherapist, so I'm not an injury specialist. But I am a specialist in looking at data and evaluating literature.

And taping the muscles and joints can be beneficial because it can help restrict range of motion, help provide stability to certain joints, particularly if they're injured. But K Tape doesn't do this any better than any other brand of tape. The problem with K Tape specifically is that the manufacturers make claims above and beyond what you see with regular tape.

So for example, one particular vendor claims that K Tape can help to raise the skin off the muscle to improve blood flow and facilitate lymph flow as well to facilitate recovery and oxygen delivery and nutrient delivery to the muscles. And again, this is not a mechanism that's been identified in the literature. It's actually just science-sounding word salad. It doesn't mean anything, it's just total nonsense. But it sounds sciency enough to convince enough people that maybe this is a real effect.

And when you look at the literature on K Tape, there are half a dozen systematic reviews and meta-analyses now, all on different parts of the body, showing that it doesn't seem to result—what in well-rolled studies, it doesn't reduce pain perception, it doesn't facilitate injury management, it doesn't improve performance whether somebody is injured or not. And it's looked at various body parts including the shoulder, the hip, the knee, the ankle.

It doesn't seem to have any effects that you wouldn't see with just regular taping. So again, there is a nugget of science in there, but it seems to be extrapolated beyond any recognition from the basic science.

James de Lacey30:24

Yeah, because they use it almost like they have to line it up with the muscles, like on the hamstrings, right? So they have the hamstring and it comes down, and that's supposed to support the muscle somehow with training and whatever else. But I think it's more almost like a tactile sensation, like the feeling of it on the skin might—a lot of people like the way that it feels.

Dr. Nick Tiller30:24

And to answer your question, actually, there doesn't seem to be any negative effect directly of using K Tape. I guess one speculative problem of using it is that it could provide athletes with a false sense of security. If they're suffering from some kind of injury and you tape it up, on the one hand that could give them a little bit of confidence to actually go and train and compete with the injury, which might be a good thing.

The flip side is that they could end up doing more damage. So it depends what your philosophy on that is. And I guess you'd have to—I know most physiotherapists will be more than happy to use K Tape. Most of them know that it only works in the context of placebo. They're more than happy to use it anyway, and that's a decision that each physio is going to have to make for themselves.

James de Lacey31:10

Yeah, for sure. And there's one that I've been excited to get into, and that's red light therapy. It's become more popular, people red light therapy in their balls and their buttholes, all sorts of things they're doing with it. So I want to know around, what are people trying to achieve? What are I guess what is marketing trying to say about it? And what does it actually do? Does it actually do anything? Is it worth someone investing in something like that or going down that road?

Dr. Nick Tiller31:35

Yeah, I think you can largely blame people like Tucker Carlson for kind of the popularity for this thing, because he was saying that everybody should be getting UV rays onto their balls and it's going to cure the masculinity crisis that we have in the West and this kind of thing.

It's an emerging area of research, and certainly there isn't enough literature at the moment to make a call one way or another. Most people think that it's largely ineffective, and it's another perfect example of there being a little bit of data there showing some kind of benefit in certain scenarios, perhaps in clinical scenarios, and then it's extrapolated beyond all recognition from the basic science. And people now think that it can be used to facilitate recovery, it can enhance performance. We really don't have the literature, we don't have the evidence to say that with any kind of degree of confidence.

So again, the problem is people don't like that. People don't generally like it when people like me come out and say, well, this thing doesn't work and this thing may work but we need more data. We always need more data. And people like simple solutions to complex problems. Well, health and wellness and fitness and athletic performance, these are complicated problems. There is not going to be a simple solution.

You can't just jump in a nice bath and it's going to help your muscles recover. You can't just jump in a cryotherapy chamber and it's going to improve your performance. You can't just have red light therapy every day and it's going to cure you of all your medical ailments. Sport and performance and health and longevity, these are complex questions, and there are going to be complicated answers as well.

But people like—I've termed this the quick fix fallacy. We have this ingrained yearning for the quick fix. And people need to get it into their heads that there are no quick fixes. We have to invest time and resources in playing the long game. That is the best way to get performance outcomes really.

So again, red light therapy is much like most of these other interventions. There is probably a nugget of good science in there, but a lot more literature is needed. As Llas and Sean said, extraordinary claims require extraordinary evidence, and the evidence is far from extraordinary.

James de Lacey33:45

Yeah, but you can't sell long-term goals, can you? You can't package that up. And it's much harder to sell long-term lifestyle and dietary interventions that are going to take six months, a year, two years.

Dr. Nick Tiller33:45

What you can do is sell fad diets and supplements and claim that it's going to help people expedite their health and performance goals. These are the things that are most commercially viable, for sure.

James de Lacey34:17

Yeah. And on supplements, I don't know if you have much I guess background knowledge or reading on green supplements. I'll throw it to you anyway, and if you don't, feel free to pass on this one. But obviously Athletic Greens is probably the big company. All Huberman, Rogan, all these I guess big podcasters are promoting it within their health and wellness stacks. That company is now huge. I mean, green supplements have been around for a long time, but I think that company just kind of nailed the marketing.

Is there anything behind green supplements for being beneficial to someone? Is it worth someone taking? And then are there any I guess harmful effects of using a green supplement?

Dr. Nick Tiller35:13

Well, I've not personally done a deep dive on the literature on this stuff, so I'll reserve making any kind of judgment. I'll sit on the fence and get up my ass. I'm happy to do that. And it's important—that's an important kind of message for people listening: if you actually, if you don't have the answer to something, say, I don't know. That's perfectly fine.

But what I will say is that pretty much all of the dietitians and expert nutritionists that I know will generally say these things are not necessary if you're eating well and if you're training well and if you just put a little bit of thought and consideration into what you're eating on a day-to-day basis. You shouldn't need any of these supplements. Certainly with—think of Athletic Greens, and I can think—again, I haven't really looked into this specific supplement, so I won't comment on that particularly.

But I guess it's the appeal for that is that everyone knows that eating greens and eating vegetables is good for you, right? But very few people do it. In the UK, we have this initiative, the five-a-day initiative, that we should all be trying to eat at least five different pieces of fruit and veg every day. But the studies show actually that if you can get ten or more—the more the better, right, for all sorts of reasons—most people don't do that.

So the idea that you can just take a supplement and get your greens and get your vegetables and get all this roughage and this kind of—and the idea that it's natural and it's green and grass is green and this is all 100% natural stuff, then it feeds into this appeal to nature fallacy. Everybody has this natural affinity for natural things. So I can imagine that the marketing, that they've managed—that they've hit the marketing nail on the head there because it fits into that whole appeal to nature fallacy.

So most—like I say, I'll just reiterate—I'll defer to the judgment of dietitians and nutritionists I know. They will say that supplements generally, very, very few people need supplements if you just put a little bit of thought and planning into your diet.

James de Lacey36:59

Nice. And another one, I think you actually wrote an article on EMS. I think that's where I pulled it from. Obviously it's been around for a while that hasn't—

Nice. And another one, I think he actually wrote an article on EMS. I think that's where I pulled it from. Obviously it's been around for a while that hasn't really hit mainstream. I think it's actually starting to come through mainstream now with some training. Obviously Charlie Francis has used it many many years ago with his sprints and things like that. So can we dive into, okay, what the hell is even EMS for the listener? And then what do people even using it for?

Dr. Nick Tiller37:56

So I wrote specifically about EMS, which is electric muscle stimulation. There are lots of different sort of components within muscle stimulation. So you can have direct muscle stimulation using electrical currents, you can have magnetic stimulation of the muscles, then you have TMS and transcranial magnetic stimulation, which is sort of a whole different thing where you're stimulating different brain regions. But we're talking specifically about EMS, which is applying an electrical stimulus directly to the muscle to get it to twitch, to get it to contract.

And this has been around. If any of the listeners or people watching are old enough to remember TV ads from the 70s and 80s, they'll probably remember adverts, and particularly magazines and things like this, of people strapping some kind of electrical device to their abdomen or to their biceps and causing the muscles to twitch. It was made relatively famous by the Bruce Lee story with, I think it was Jason Scott Lee who portrayed Bruce Lee in one of the biopics of his life, and it showed Bruce Lee in the movie using electric muscle stimulation on his abs and chest and triceps. Bruce Lee famously used it as well.

And there are still vendors that are using bits of text that Bruce Lee wrote from his books and clips from the movie to then try and sell EMS to prospective clients. Again, as a scientist I always point my nose in the direction of the literature. And there seems to be some kind of evidence that electric muscle stimulation might be able to help with strength development, particularly if people use it during trainings.

Because you can get what's called a superimposed twitch, where you do a maximal, some kind of maximal or near-maximal muscle contraction, you then apply the electrical stimulus to the muscle and you can get the muscle to contract with greater force than if you were to just rely on central nervous system activation. So it may help in some context to improve strength, but even those claims are a little bit contentious.

What I've taken issue with is that most of the manufacturers, most of the commercial claims surrounding EMS, are on weight reduction. Because you think about it, most of the people that are going to buy this thing are people that either can't exercise for some reason or are too lazy to exercise or don't have time to exercise. And most of them want to do this thing because they think it's a quick and easy way to lose weight and get in shape. And there is not a single shred of evidence that this thing can actually increase calorie expenditure in a meaningful way to help with weight reduction.

And most of the claims, most of the commercial claims around using EMS, are on increasing muscle size and reducing body fat. And it doesn't do any of those things. If anything, like I said, it might be able to help facilitate strength during training, so facilitate strength training in some contexts. The jury is still out on that. But it definitely doesn't increase muscle size, it doesn't increase calorie expenditure enough to reduce body fat percentage. So again, the claims are not supported by the evidence.

James de Lacey41:04

Within sports performance it has a place of—do you know you can represent Sweet Science of Fighting while you're training? We're more than just a membership, we also have rash guards and shorts. If you're watching this on YouTube, you'll see that we have the SSoF Fighting 2.0 shorts and we also had the Sweet Science of Fighting short and long sleeve rash guard. There's another design coming soon, but you can get those on XMartial.com and you can go down the description and you can find that. And back to the podcast.

And rehab, potentially, for example ACL injury and you chuck on the quads, kind of thing, right?

Dr. Nick Tiller41:35

Yeah, another good point. So in for some individuals, if they can't exercise for some reason, so if they've got some kind of injury, if they've got a mobility problem, then using these kinds of devices to bypass the nervous system and cause a muscle contraction, then it can be beneficial.

And actually EMS has been used in a process called FES, functional electrical stimulation. So it's been applied to people with spinal cord injuries. So people with spinal cord injuries, obviously there is some kind of damage or a complete disconnect between the central nervous system and the nerves that actually innervate the muscles. And this has been used quite successfully in rehabilitation settings, as you said, to help people with spinal cord injuries to actually get some kind of whole body exercise.

So somebody with a low cervical or thoracic lesion, for example, they have, they usually have some kind of use of the arms. If it's a low lesion, they can use the arms and shoulders, but they can't activate the legs. But actually by applying an electrical current to the legs, you can get the quads to contract and you can get a whole body exercise session. And there's lots of very interesting literature on that.

But in most other cases, again, that's in a research or a clinical setting. We're talking about the commercial electrical muscle stimulation, which is sold for an entirely different purpose.

James de Lacey43:00

Yeah. Because a lot, you mentioned obviously with the losing weight, I think a lot of them market towards recovery as well, right? They have like almost like recovery presets on the devices that I think CrossFit was a big market at one point with it for that recovery purpose.

Dr. Nick Tiller43:27

Yeah, and really, when we're talking about recovery, we're talking about increasing blood flow, increasing oxygen delivery, increasing nutrient delivery and removing waste products. Well, you can do all of those things by just by moving around, just by going for a walk. I don't think that applying any kind of electrical muscle stimulation or compression or hydrotherapy, this is all just a way of getting the muscle pump working to squeeze blood vessels to increase circulation.

So you can do that just by moving around, by going for a walk, by sitting on a bike and just doing some low-intensity cycling. If you find hydrotherapy, go for a swim. You can even maybe even get a massage that might even help. But there are lots of ways to achieve this that don't require you to necessarily spend money.

James de Lacey44:30

Nice. And I've got one more potential myth here. I don't know if you've done much research into respiratory training. So obviously you see a rise in these devices to train the lungs, train the diaphragm. There's obviously an increased interest in breath work. I've had a few people on talking about breath work, and I can see the benefits of doing breath work things, not maybe for strengthening the diaphragm or improving lung capacity, but for calming down and essentially almost like doing meditation kind of things with it.

But regarding respiratory trainers, is there any evidence for the claims they make? Is it something that someone could use to essentially, I mean people using it to improve their cardio conditioning, right? So does it do what it says?

Dr. Nick Tiller44:57

So this is actually a very, it's a huge complicated subject. And we published, not to pass the buck, but we published a study earlier this year. The full title of the study is Distinguishing Science from Pseudoscience in Commercial Respiratory Interventions. It was published in the European Journal of Applied Physiology and I was honored to work with a bunch of expert scientists. First author is Dr. Camila RI. And we basically, we tackled this huge can of worms. It's like a 30-page article, it's a big subject.

I'll try and answer your question without taking up the whole rest of the time. Specifically on respiratory muscle trainers, this is one area where there does seem to be some very compelling research. And we're talking specifically about inspiratory muscle training. So these are handheld devices with a mouthpiece and then it provides some kind of resistance to inspiration. So it's almost like weight training for the diaphragm and for the inspiratory muscles.

Obviously you can't provide a resistance directly to the diaphragm and the inspiratory muscles, particularly diaphragm, because it's deep in the thorax. But by providing a resistance to inspiration, then you can progressively increase the overload, just like you would if you were doing squats or bench press or anything else. You can get the muscle to adapt over time.

And there's lots of research showing that this is beneficial for certain clinical populations. It can be beneficial for athletes as well. It can help to prevent what we call respiratory muscle fatigue. So just like during high-intensity exercise your legs can fatigue or your arms can fatigue through various mechanisms, your respiratory muscles, when you're breathing very hard for a prolonged period of time, your respiratory muscles can fatigue as well.

This can obviously reduce the amount of air that you can circulate into the lungs and it can affect your ability to take in the air that you need. But it can also trigger what's called the respiratory muscle metaboreflex, which is where we get increased blood flow being diverted to the respiratory muscles. And of course there's only a certain amount of blood flow to go around. And when that happens it diverts blood and oxygen and nutrients away from the local motor muscles like the legs or...

The arms. So you can actually get fatigue of the leg muscles, for example, because the blood flow is being redirected to the respiratory muscles. And so by increasing the strength and the work capacity of the respiratory muscles by training them, it can help improve performance via those means.

There are lots of different respiratory muscle trainers on the market, and the vast majority of research has only really been done in one product. So you got to be careful about which products you invest in. And there are lots of unsupported claims about inspiratory muscle training. Like, you can't increase lung size, for example. Your lung capacity is set. It is dependent largely on your stature, your height, your frame, whether you're male or female. And this is something that you can't really improve by training the respiratory muscles.

It definitely can't protect you from COVID, for example. When COVID hit a few years ago, people were making all sorts of outrageous claims about how you can protect yourself from COVID or facilitate recovery from COVID by training the respiratory muscles and by improving lung strength. And it doesn't do any of those things.

It very specifically can help you train the respiratory muscles like the diaphragm and the intercostals and we have the scalenes and the sternocleidomastoid in the neck. All of these are inspiratory muscles. If you take a deep breath in, you can see that, again, if you're watching the video, you're elevating the shoulders, you're elevating the expanding the rib cage. And this isn't just dependent on the diaphragm. There are all these muscles that attach to the rib cage that have this very important functional role, and all of these things can be trained by inspiratory muscle training.

But there are lots of false claims as well, so you've got to be careful that you don't get sucked in by some of these false claims. And in terms of other respiratory interventions, again, I think it's probably best if I just defer you to the article that we wrote. And if you're interested to learn more about science and pseudoscience commercial respiratory interventions, then check out that paper. We go into a lot of detail and it's free online, so I'm not selling anything. You can access it for free.

James de Lacey49:39

Nice. Is there any data to show any transfer to actual performance, or is it more just showing, hey, the diaphragm was strengthened through these interventions?

Dr. Nick Tiller49:39

Oh yeah, absolutely. I mean, it's mostly going to be endurance type performance, any kind of exercise where you have to breathe very hard for a prolonged period of time. I guess you could probably factor something like MMA into that because athletes do get gassed. There is a high demand on the cardiovascular system.

But generally, the respiratory system is not the limiting factor for performance in MMA. It's the ability to deliver oxygen to the muscles and the ability for the muscles to recover from these short-term explosive type movements. But in endurance type sports, when the respiratory muscles are having to work very, very hard over a prolonged period of time, they're contracting constantly to ventilate the lungs. Then it only takes about 6, 7, 8 minutes of very high intensity breathing for these muscles to become fatigued.

And yeah, there's plenty of research showing that you can actually improve exercise performance. You can improve time trial performance in cycling events, in running events as well. So this is one intervention actually where there does seem to be a pretty good evidence base that it can enhance performance. But we just have to be very specific with the claims that we make and not get sucked in by all of the additional pseudoscientific stuff.

James de Lacey51:15

Yeah. And if anyone's interested in improving, I guess, the muscle oxidation capacity, you can go back and listen to Andrew Kastor and Dr. John Babraj. Maybe a month or so ago, and they cover a lot of things I've been doing and research they've done in that area too with their sprint interval training.

But I want to bring this back to practical things fighters can do to help facilitate recovery. I'd like to always mention, tell people, you can't rush the adaptation process. Within strength training, whatever it is, you can't get there faster just because you do more work or whatever. I think the same goes with recovery unless you're adding artificial recovery means, but obviously it comes with a plethora of potential harm, issues slowing down other things.

So what can people do to potentially enhance recovery? Should they do anything? Obviously, you've mentioned a few things around just moving and things like that, but is there anything in particular you like to see people do or advise people to do?

Dr. Nick Tiller52:13

Well, most of the advice that I give just aligns with not just scientific consensus, but usually it's what people already know. This is why I haven't sold 100,000 books. Whereas, if you look at some other authors, they're claiming to offer some kind of breathing intervention can change your life, or cryotherapy can change your life, or this particular diet or this particular pill is going to cure you of all your medical ailments and improve your performance. And it's never the case.

If you ask any exercise professional, any exercise scientist, they will tell you the same thing. The best way to improve performance and maximize recovery—and of course recovery in turn is going to improve performance—is to, first of all, make sure that your training is aligned. To make sure that you are very carefully treading that line between adaptation and recovery. And really high level sports performance is about training as hard as you can and as smart as you can to maximize the physiological adaptation, but stopping short of the overload before you get injured or pick up some kind of infection.

And every day as a high level athlete, you're riding that wave. You are coming very, very close to that line. And often there's a mismatch in the balance. Tip the scales a little bit too much on the side of the stress, of the strain, and they get injured or they pick up some kind of infection.

So it's thinking very carefully about your training, knowing yourself, knowing your athletes if you're a coach and you're working with the athlete. Knowing what they can take, what they can't. Putting in recovery days and recovery sessions into the program. Not everyone is on board with periodization, but making sure that you can't just put in 100% of effort all of the time. You have to make sure that the training load waxes and wanes to get athletes in peak condition. So putting a lot of thought and consideration into the training program.

And outside of that, it's about getting good sleep. Again, this isn't news to anyone, but making sure that you're getting, depending on the individual, it's going to be between seven and nine hours, for example, of high quality sleep. So that's restful sleep.

And then thinking very carefully about nutrition. So maximizing protein intake, making sure that the athlete is getting, is meeting their protein demands. And as very broad brush strokes, we're looking at somewhere between 1.5 grams to 2 grams per kilo per day. Again, you can convert that into pounds if you like. But that's sort of the recommended range for high level competitive athletes. For larger individuals, they might need a little bit more protein than that. But making sure you're hitting your protein demands.

And supplements and other kind of commercial interventions that might give you 5% of a recovery, it might facilitate recovery and performance by 5%, it's considered the cherry on the cake. It's the top of the pyramid. But we should never be jumping to those things first.

Think about building a pyramid. The foundation level has to be your training. Then the next level is maybe sleep and nutrition and hydration. Get all of these things optimized first. And if you really feel that you can't do anything else to maximize performance, to maximize recovery, you're sleeping well and you're training smart, then you can think about adding in a few supplements.

Then you can think about protein supplements, or you can think about beta-alanine or creatine or some of these other supplements that might show beneficial effects according to the literature. But that really should be the last thing that you do. All of this other stuff has to come first.

James de Lacey56:15

Nice. And you mentioned recovery days. Just to finish this, obviously we talked a little bit about just moving, maybe cycling easy, going to the pool. Do maybe dive into, okay, going, doing a pool session, potentially be more beneficial than maybe just sitting on a bike or moving because of that hydrostatic pressure of the water? Is there something to maybe dive into, any other mechanisms or potential benefits of that over doing other forms of, say, active recovery?

Dr. Nick Tiller56:43

Yeah. Well, obviously when you immerse yourself in the pool, there's a, the volume of water creates quite a high hydrostatic pressure which squeezes the blood vessels to increase circulation, which is generally considered to be good for recovery. And you're also, it's low load, so there's no impact stress. It's not like you're going out for a run and you're putting impact stress through the joints of the lower body. And so swimming is generally considered to be a good form of recovery.

Having said that, if you never swim and you go out and you do a hard swim session, you're still going to be sore, right? So it can very easily turn from a recovery session into an additional stress. So you got to think about being smart with this. So go for a nice easy swim, go for a paddle. Spend at least 10, 20, 30 minutes.

In the pool, so the hydrostatic pressure of the water will be beneficial and it's whole body as well. And it's also good for just the psychological rest as well. We all need time off in training. I train six days a week and I always try and make sure that I have one day off just so I can, just psychologically, it's nice to do a little bit of cross-training if you're doing one sport the whole time or if you're doing MMA and you're training three or four different disciplines, it's nice to do something different.

Don't go start playing basketball and tear your ACL like a certain light heavyweight, former light heavyweight champion. But the point is that a little bit of cross-training can be beneficial because it gives you a psychological break as well. So generally, swimming is considered to be a good, safe sport and low stress. Cycling is good as well. You're going to get the circulation going for a walk.

And generally, I think it's a good idea to have recovery weeks every five or six weeks. It's difficult if you're doing training camp, but if you're not in camp, then typically recovery weeks will be reducing the volume and the intensity by about 50%. And you're still training. It's not like you're just having a week off. You're not going to detrain during this time. But having a sort of an easy week or a recovery week can help, can really fit into the periodized program and can help you to optimize adaptation in the long term.

James de Lacey58:55

Perfect. And if anyone's interested in more periodization stuff, John Kiely episode a while back and Martin Buchheit, both awesome people to listen to. But Nick, where can people find you and follow you, see all your pseudoscience breakdowns and everything?

Dr. Nick Tiller58:55

Okay, well, reach out to me on Twitter first of all, NB Tiller, and I tweet about science and performance and critical thinking and all the good stuff. You can find all of the work that I do and you can link to my book, The Skeptic's Guide to Sports Science, through my website, which is nbtiller.com. And you can find out all my publications are on there, pretty much for free, and you can link to all my articles in Skeptical Inquirer as well. So all of the work that I do is updated on the website.

James de Lacey59:48

Perfect. I'll link those in the description as well. Yeah, your Twitter's good. I saw you posted the other day, the one I commented on, about what was it, that thing that removes fat cells or something? It was like a stone or something.

Dr. Nick Tiller59:48

So this month's column in Skeptical Inquirer, it will be published online in a few days, again for free, is all about magic jewelry. So the different necklaces, bracelets, rings and so forth, and the ridiculous claims that some of these manufacturers make. And this was an ear stud that supposedly emits infrared radiation which helps to shrink fat cells and increase lymph flow, which helps reduce appetite and all sorts of other crazy things.

And of course, this isn't even ancient Chinese medicine. This isn't even misappropriated science. This is straight up New Age nonsense. This is total, it's completely made up. And it was a fun article to write, actually, because when you're faced with absurdity, sometimes the only valid response is extreme sarcasm. And this is probably the most sarcastic and slightly condescending article I've written. So your listeners will get a kick out of that, I'm sure.

James de Lacey1:00:50

No, awesome. No, thanks for coming on, Nick. I really appreciate you sharing everything and all your knowledge.

Dr. Nick Tiller1:00:50

Thanks for having me. That was a lot of fun.