Exercise gives our body a physical and mental boost. It’s good stress, but it’s stress nonetheless. Thus, doing a running warm-up before an interval run or training is integral to get the most benefits out of running.
Neil joins me in this episode to explain the steps in preparing for a running workout. We emphasise the importance of setting your mindset before training. We also cite different examples of run-specific movements, drills and breathing exercises.
If you are a runner wanting to do a running warm-up right, then this episode is for you.
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‘That's what training is about. It's not about the actual run where you actually get the results. It’s in the recovery phase’.
‘How you prepare your mind is going to be key when you understand your “why” before you warm up’.
‘A lot of people find their toes are bunched together and tight. If we can get some movement through those, we start to get more benefit from our running as well’.
‘Gone are the days of static stretching and standing on the doorstep during your quad stretch, holding. All you're doing there is switching the nervous system off and increasing your likelihood of injury and discomfort’.
‘You take which bits of the tools you want out of the toolbox, and then you start using them from your perspective’.
‘Looking at what you're currently doing, who you are and how much in a warm-up — what percentage you use each tool for will be quite different for each person’.
‘You will have — and I promise you this — a much more fun run, and you'll enjoy it more if you've put the time into this warm-up piece of the puzzle’.
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To pushing the limits,
Lisa
Welcome to Pushing The Limits, the show that helps you reach your full potential, with your host Lisa Tamati, brought to you by lisatamati.com.
Lisa Tamati: Hi, everyone, and welcome back to this week's episode of Pushing The Limits. Today, I have Neil Wagstaff, who is my wingman at Running Hot Coaching, and we're going to be talking everything about running and preparation for a good training session — how to tell if you're ready for that session that's on your list today.
We're talking about stress levels. We're talking sympathetic and parasympathetic nervous systems. We're talking activating muscles. We're talking lymph and circulation and a whole lot of great info that you don't want to miss if you're into exercising, fitness or running. Before we go over to the show, though, I just want to remind you please give a rating and review to the show if you enjoy it. Share it with your family and friends.
We've been going now for five and a half years, and we've been in the top 200 globally ranked shows in health and fitness genre, and we really appreciate your support. And every one of those reviews and ratings really helps the show get seen by more people, heard by more people, so that they can get this great information that we're getting out.
Just want to also let you know, we are taking on a small number of clients on one-on-one health optimisation consulting. If you got a really tricky health situation, if you're not getting the results that you want in the normal world, if you are needing help navigating some complicated situations, then we'd love to help you. We only work with a very, very few people at a time. And that requires quite a commitment from us, from the research side of things in helping people optimise their health or navigate their way back to health. So if it sounds like something like you would like to know about, please email me lisa@lisatamati.com. We only work with a very few people at a time at that level. So just letting you know that that's available.
Now over to the show with Neil Wagstaff in Havelock North. And I hope you enjoy this fantastic interview.
Lisa: Hi, everyone, and welcome back to Pushing The Limits. This week, I have my wingman, Neil Wagstaff. Neil, how are you doing?
Neil: I'm good. Thanks, mate. I'm very good. How are you?
Lisa: It's very hot here. I'm sweating as well.
Neil: Here as well.
Lisa: Very humid! Right, people. Today, we have a really good webinar for you, podcast episode for you, all around the importance of — this one’s for runners, really — and it's all around runners warm-ups. Why do you need to do one, what's included, why you need to incorporate breathing into that warm-up routine. It's more than just running warm-ups, believe me, you'll get some great value, if you're a runner in this one, or if you're into fitness.
And we're going to be talking about the importance of running specific movements to prepare for your run. And we're going to be going over some of our top drills to activate your body and get you ready. So, Neil, we did a fabulous session yesterday on this, and it was so valuable we decided we got to record this for the podcast, so… Over to you, mate.
Neil: Thanks, mate. Thanks, and as you say, it is a lot more than just the runners warm-up, but it's… Gone are the days we just lace up your shoes and run out the door. That's what many, you know, we definitely did in the older days. And a lot of our clients we work with do, a lot of people, as you said in the introduction, as well, it’s not just the runners. It's in an exercise environment as well. So we put a lot of emphasis on this in the gym environment. So important, there should be some good nuggets for everyone.
So the first thing first before you even think about the warm-up is understanding about what we call your bucket of stress. So the bucket of stress, if you will imagine you've got that bucket sitting in front of you. And within that bucket, there's things that will fill it up. Now some of those things are going to be what's going on in your daily life. They're going to be your kids. They're going to be your work. They're going to be family. They're going to be other stresses that are happening, and then you layer exercise on the top of it.
So with the bucket stress, it’s understanding how full yours is. If you're going to go out and do a high-intensity interval run, where you're doing 1K intervals at 80, 90% of your max effort, and your bucket is already overflowing, then that run, those interval runs on top are just going to cause your body more stress or more loads, which will give you a pretty harsh response, which will then result in injuries, niggles and pain.
Lisa: Yeah.
Neil: On days where your bucket is full, what you want to be doing is really changing your workout or changing your routine to suit how you're feeling. Okay, you know, I've had massive conversations over the years about the bucket.
What's your— give us your perspective of it and how you manage your routine a little bit differently now.
Lisa: Yeah, and I'm still probably a bad example some days.
Neil: You’re a good work in progress. You’re a good work in progress.
Lisa: Do what I say not what I preach sometimes. But it's really, I have really adopted the fact that it is important to do a warm-up when you're preparing for a run. And also to understand what we're trying to get across here is that just because stress is good for your body— I mean, sorry, running is good for your body or exercise is a good stressor, if you like, it is still adding to your total stress load.
So the level that Neil used to run it when he was not a dad of three little children and had a bit more time and didn't have a massive German, a couple of businesses to run, he could dedicate more intense time to training without breaking himself, if it makes sense. Now, because his energies are split in every which way, he has to be a little bit more careful how he prepares for an event, the time that he takes for it, and the time that he prepares his body.
So if your training plan says today, you should be going out and smashing a really long run or a really intense run, but you haven't got the resources because you had a really shitty night sleep, and you didn't drink enough yesterday, and you didn't eat properly, and the kids have been up all night, and goodness knows what else — you've got a lot of stress and a lot of worries on your mind — then you're probably not going to get to that adaption— adaptation, sorry, when you do that training, which is what you're actually doing it for.
It's not just about ticking the box because my coach said or my plan said that I had to do that today. And I've ticked the box, therefore I am good to go. It is about saying, 'Is my body going to respond to this training session today’? Yes or no? Or, ‘Would I be permitted to postpone that really intense workout to a little bit later, maybe tomorrow? And I'll get to bed early tonight. And I’ll drink well, and I’ll hydrate well. An I’ll do all the other bits and pieces as well. And then I might be a bit more prepared for that'. Does it make sense? So you’re not doing things when your body is not going to get the adaptations because that's what training is about. It's not about the actual run where you actually get the results; it’s in the recovery phase. So understanding where your body is at, which is a really good segue into our wellness checklist. Isn't that, Neil?
Neil: Yeah. So yes, you go through as well as, just asking yourself each day, where you're at a number of different things and things we get with our wellness checklist. And you can all do it at home as you listen to this. It’s a simple scale of 1 to 10. So 1 to 10 on these things we're going to talk about. How well did you sleep? That's the first one. How well have you eaten, and where you're at from nutrition point of view? Lisa's already mentioned hydration, number three. So how well have you hydrated? How well have you moved? What sort of exercise movement have you done in the past day? On a scale of 1 to 10. And then energy wise, where's your energy score at? 1 being the toilet, 10 being at rock and roll levels, you’re ready to party. And body, any niggles, any injuries? And your stress score, so 1 with the stress will be low and 10 will be good. That gives you a total score.
If you've got a score up over 50, and it'd be a good indication that you're ready to go and do a warmup that relates to what's in your program. If it’s saying that, we're doing the example, the 1K, then that puts us in a position that we should be ready to do it. If my score is lower, which some days it is, then I'll look at my program and go right, I've got intervals. But I mean, my score’s down at 40. So those two workouts don't match up then. So what I then do is go, ‘I can still go train, but my training may be a recovery run instead so I feel my energy levels back up’.
If you are continuously having low scores with this full stress bucket, it's not a runner's warm-up you want to be considering. It's about— it's really another strategy, which is how am I going to empty some of my stresses out of my bucket? Because your bucket should be managed on a daily basis. So that you, you know, 80, 90% of the time you're doing what your program says, it's just having the confidence and understanding that some days when things don't go perfectly you can tweak it.
Okay, so just to recap: sleep, nutrition, hydration, movement, energy, body, and stress, scale of one to 10. 1 being in the toilet, 10 being rock and roll. And we can send the, or add the…
Lisa: Yeah, we’ll put this in the show notes, actually, the checklist.
Neil: Wellness check to the show notes. Yeah, so that's understanding again really helps you manage your bucket. So before you've even warmed up, you're asking, what's my session I'm going to do? Now, I know what type of warm-up to do. The other bit to consider as well is really, really a little bit about your why. If you are… Many programs out there, what we've looked at over the years, designed by ex-professional runners, often male, without giving them a hard time, and often by men.
And in our business, we work with a lot of ladies. Over 70% of our business is working with females. And a lot of our athletes we're working with, mums or dads, and they have got busy work lives, busy family lives. So those programs are running five, six days a week just doesn't work. So ask the question as well, what's your why? And who are you? So for me, personally, as Lisa knows, my three little ones, Ellen, Cameron, Annie, I love the idea of getting dressed up as Superman. Okay, and we shared a couple of pictures of me dressed up as Superman.
So it's understanding what your why is and why you're doing it. I want to be a superhero for my kids. Therefore, the type of workout is different now, as Lisa said earlier, than I was doing in my… pre-kids. And when I was back in my 30s, then I was thinking more like a professional parkour athlete and wanted it to be doing. So therefore, the warm-up is going to be different. So what we're trying to do, and the big thing especially from Lisa's perspective as well, is how important mindset is. We're really big on that with what we do as well.
So understanding what mindset you're going into this workout in. So for me, I'm going in as a superhero, wanting to be a superhero, for my kids. Some people who are listening will be going in with a professional athlete mentality. So how you prepare your mind is going to be key when you understand your ‘why’ before you warm up. There's no need for me to warm up like a professional athlete if I'm wanting to go and warm up like a superhero. It’s a different mindset as I do that. Does that make sense?
Lisa: Yeah, it does make sense. And I mean, like, I'll give you an example out of my sort of, you know, day. So if I'm, like, full on busy with the business all day, and I'm sitting a lot at the computer and meetings, and blah, blah, blah. And then comes five o'clock and I go right, I'm shutting the computer, I'm out the door. And if I go out without any preparation, and we've had arguments with people, they said, ‘Well, I've just slowly increased my pace. Isn't that a warm-up’? No, it's not a warm up. And I'm still guilty of this on occasion when because you're like, you've got half an hour, and you got to get out the door. And you don't want to do a warm-up, and so…
But there's a couple of pieces missing out of that puzzle. One, there's a really important reason why you— firstly, you want to shift your mind, you've been in work mode all day. And now you got to, ‘Oh my gosh, I got to go and train’. And the last thing you feel like when you've been sitting for hours in a static position is to go and do a full on workout. So you have to change your mindset because you can fail before you get out the door. And a lot of people have this argument with themselves every single day. It's like, ‘That’s on my list, but I’m knackered from work, and I don't feel like going out the door. And I just want to go home and eat a packet of chips and sit on the couch’.
And so there's a couple of tricks that I use to get myself out of that thought process. So the couple of rituals that I do. So when I go and I go, ‘Right, I'm going to get into my training gear, regardless of whether I'm going out the door or not because I'm just going to do that’. And when I just go and do that, I put my training gear on, that is a ritual for me that I am… My body starts to go, ‘Oh, when we're heading for training. We better get ready’. And it gives you enough, a couple of minutes, just to get your mind in that new space. You've been in the work space or the driving space or whatever you've been in, and now you're entering a new phase, and you're bringing yourself into the present moment. You're getting your gear on, and for me, putting my running gear on as always, for me, like putting on my armor, and I'm getting ready for a battle of sorts. It doesn't always have to be a hardcore workout, but I'm getting ready for action.
Then the next thing I do once my gear is on, it's like, well, ‘I might as well just do a little bit of a warm-up and see how I go’. Like this is when I'm having those days when I don't want to train, you know, you know those ones. These are the tricks that I do to get myself out the door. So then I start to activate my muscles. And we're going to go through a whole list of things with Neil, right now. But just from a mindset point of view, when I start doing my dynamic stretches and my activation and my thing, and I'm getting my heart rate up. And then by the time I've done that for a few minutes, my mind is ready for the actually going out and then my body is also woken up.
So that's just a little bit of a mindset tip to get yourself out the door and bring yourself into the present moment. We also like to incorporate in that some breathing exercises, just, we could talk for hours on breathing. There is so much to learn about breathing. But just to give you just a simple quick exercise that you can do before you go out. So you've just come from work. You're going to do a box breathing exercise, where you're breathing in for four in the inhale, holding it for four, out for four with the exhale — a nice strong exhale — and then holding it for four. And you just do that box rhythm for maybe three, maybe four breaths. And in that time, close your eyes, seem to yourself into your body, start to feel your heart pumping, start to feel how do my arms and my legs feel, and you're just pulling your focus in, and then you'll be ready. Once the time you've opened your eyes, you'll be ready to get underway or get your warm-up sorted. So those are just a couple of little quick mindset tips to help you over that hump, whether it's in the morning and you get out of bed and you're going training or after work or whatever the case may be.
Neil: Perfect, Lisa. Let’s go with the breathing just to add in as well, it’s the… often, when you've not just flipping the mindset, you're also flipping things like the diaphragm. A lot of the time, if people have been in a sympathetic state throughout the day, which a lot of us are throughout the day now. Then if we go to, we're breathing through our upper chest and breathing through our shoulders, a lot of people will get massive results, just by them realizing that they can breathe properly into their lungs, and they're actually going out with not having enough energy to run because their breathing patterns, off. So getting that breath going, and as Lisa said, with the nasal breathing is a great thing to add in, a very simple thing to add in as well. As we go through this, this already, we haven't even got to the moving part yet, we've already had quite a long discussion, we want people to realise is we're creating a toolbox for you. That's a toolbox of things that you'll be able to pull out when you need them.
Some of you won't need the breathing as much as others, depending on what else has happened in your day already. It's a great thing to do. But some of you may find you've had quite a relaxing afternoon before you go run, and you're already breathing very nicely. So you don't need to use the breathing as much as someone that's been in a stressful situation for the afternoon or is in a very sympathetic state before they head out.
Lisa: Just briefly on the sympathetic and I think I've covered this in a couple of podcasts. But just to recap.. Sorry, took the computer over. You have a parasympathetic and sympathetic nervous system. So you, when you're in a sympathetic state, what we're meaning by that is that you're in a hypervigilant, alert, stressed out state, where you are producing quite a lot of stress hormones. Your cortisol levels might be up. Your adrenaline might be up. And your heart rate might be up, and your breathing, very often, is in the upper third of the chest.
And this is telling your body, 'I'm in fight or flight mode. There’s dangerous things happening to me’, even if those dangerous things are just emails and a shitty telephone call from the boss. Yeah, that isn't necessarily a lion or a tiger that, you know, used to be chasing us when we were back in the caveman days. But it's the same response in the body. And so what we’re wanting to do with this breathing exercise is to doing some diaphragmatic breathing, so that's breathing into the belly, and we're going to do sessions on breathing because honestly, that's a couple of bucks worth.
But it's all about flipping it, getting that sympathetic nervous system activated. So you have nerves in the bottom of your lungs. And when you do very good strong exhales are really important in breathing in with the diaphragm, you're actually activating those nerves at the bottom of the lungs and tuning on that parasympathetic state. Now that parasympathetic state is all about rest and digest and recovery and immunity and all those repair processes. Now, we are going into an exercise situation, but to start off in a place of not being stressed is a good place to start. So flipping your mind and flipping your body over from one thing into the next thing. So that's just a very brief touch on sympathetic versus parasympathetic states.
Neil: The next piece in the… or the next tool in the toolbox is going to be our rolling or myofascial release. So the tools we use for this are spiky balls, one of our favourites, rolling stick, which like rolling pin and a foam roller. Easy wins and low hanging fruit are always going to be your feet because they spend most of the day wrapped up in a shoe. And generally, our feet don't move as well as they should. Our feet should ideally move like our hands do, and our toes should move like our fingers. For most of us they don't so getting them out, getting them exposed to more neural stimulation and releasing any tight bits in the feet and getting them moving more freely makes a massive difference. You got...
Lisa: Can you explain the neural stimulation? I think that's— it’s really why they're activating those fibers in the feet is the connection to the brain and the coordination and…
Neil: Connection to the brain. One thing it does, it's like waking your feet up. So if I spent all day with my hand, for example, in a big glove and deprived it of senses and deprived it of being able to feel and touch things, I'd lose connection with what was going on around me. So I start to lose connection with understanding what was hot, what was cold and what things should feel like. If I can have that stimulation through my foot, and the great thing with a spiky ball, we're not going to smash it, is it starts to wake the feet up again.
So all I'm saying is, wake up, wake up! I'm sending messages from my feet through my nervous system up to my brain going, ‘Ah, that's how I move my big toe’. Ah, that's the big toe, with running real important. But that's how I move it. And that's how my other toes move. A lot of people find their toes are bunched together and tight. If we can get some movement through those, we start to get more benefit from our running as well.
Other people are going to have calves that are locked up and feet that are locked up, everything in your body is connected. So if we start to stimulate the feet, we get massive results with people who've got lower back pain or people who have got shoulder pain or neck pain, because the connection with the fascia in the bottom of your foot, it then runs up the back of your body up across your calf, your hamstrings, your hips, starts to relax a tissue above as well.
So simply two things that are going to happen as you do that. One is you're going to get some muscles relax that need to be relaxed. Then the other thing, you can actually start waking the feet up. Okay, depending on where, and it's gonna be very much dependent on where you're at as a person. Some people are carrying loads of tension in their body, and some people are hypermobile. So those that are hypermobile aren’t gonna need these tools as much as those that are rigid and stiff. Yeah, do I make sense?
Lisa: Yeah.
Neil: You need these tools for what you need. And that's the emphasis we want to make is doing this whole thing when we finish talking about it. And its shortest version would be between five and eight minutes or longer version might be 12 to 15 minutes, but some of you are going to use more tools than others.
So some of you, what we've discussed already, may use the breathing more than the rolling. But feet is an easy win, calves are an easy win. Rolling around the hip area, the glutes is a very easy win, the quads and getting those areas both, switching off muscles that needs to be switched off. But also starting to wake up muscles that need to be woken up. And it's easy ways to do that with those tools. Gone are the days of static stretching and standing on the doorstep during your quad stretch, holding. All you're doing there is switching the nervous system off and increasing your likelihood of injury and discomfort.
Lisa: So just to explain what static and dynamic is for those who perhaps aren't familiar with that term. So static stretching, where you're holding a single stretch in one position for, I don't know, 30 seconds or something or longer. And that's not a good thing to do prior to a run or exercise because you're actually lengthening that muscle, and you're switching it off and making it too relaxed and then you're going to be able to flop it, for lack of a better description when you go out. And so you want to be waking it up, activating it, getting the blood flowing through it, but not turning it off.
The static stretching has its value but that comes after the run or if you're doing, say, a yoga session or something like that, then it's a different thing. But you wouldn't go into a yoga class and then go for a run, for example. That would be a recipe for injury, but you're wanting to activate these different areas. The other thing to note with the foam roller was don't smash the crap out of yourself like, it's not go hard or go home.
Cause I used to do that, to be fair, you know, when I first started with foam rolling years ago. It was like, ‘Ah, the more it hurts, the more I have to do it’, and, you know, as with everything, yep, you fight through the pain. But actually, the more we've learned about lymph and all the other stuff that we've learned in activating, you don't need to go full ball hard. If it's that painful, you should be around, what, six and seven, right, Neil, for what you're doing with the foam rolling. And you know, we have lots of videos and stuff on our YouTube channel if anybody wants to check it out, or, of course, joining our club and you'll find out all that sort of detailed information. So that's the activation phase. Your hips, your calves, your feet are a good place to start.
Neil: It's a good technique, just simple techniques to work with are released with awareness. So we've already talked about breathing. If you find a sensitive spot, you can apply some pressure to that, getting no more than sort of six or seven out of 10. Use your breath, in through your nose, out through your nose to actually release. Your nervous system, we’ve already talked about and your body is fully connected. So by using my mind to tell my brain and to tell my foot or the muscles in my foot to switch off or switch on, I can have that control over my body.
I'm using the spiky ball to stimulate it, which gives me something to feel and then I can say, right, wake up or tone down. So use the breath with awareness or release with awareness by using the breath to actually switch things off. If something feels tight, you can imagine the muscle actually switching off, toning down, almost like it's got a volume button on it and you're turning it down.
Okay. The next technique, which is a good one, is a pin and stretch. So if you find a niggly spot, thinking about rolling the calves. I'm sitting on the floor with my calf and leg up on a roller. If I find a niggly spot, then I can actually pin it. And then I can move my foot backwards and forwards. So I'm pinning and then stretching. I'm moving my foot in and out of plantar and dorsiflexion. Okay, and then actually flushing the muscles as well is another great technique. We're rolling up and down and across the muscle and a great way to… almost like imagining like your muscle’s like a sponge, where you're you're wringing it out and then putting it back in a bucket of water so it can absorb again, and wring it out. So you’re flushing out and getting fluid moving backwards and forwards.
Lisa: Yep. And so on. Yeah, that's absolutely, that’s key.
Neil: Right So next on our list. So now we've breathed, we've worked out where we're at, if we come back from the top, we've worked out more from mindset, breathing, rolling. And now we're going to look at our — the body is all connected — so we're going to look at our fascia. So the body is connected, again, like static stretching — gone are the days where we should be looking at the body in isolation, and looking at warming up or moving specific muscles like our chest on its own, or biceps or triceps on their own, or our thighs on their own.
The body is connected from toes to head. So the fact that it’s connected from toes to head, and there is myofascial lines that are running right across our bodies — front, side, back. We want to be in a position that the movements we're doing in our warm-up should help open, lengthen, move. Imagine your fascia like a superhero suit. I love talking about superheroes and the superhero suit. And you can— that superhero suit should move easily; you should be able to move easily in it. So what we're doing with these big fascia movements, is you want to be in a position where you're getting that superhero suit just to fit a little bit better or fit a bit more comfortably. And if you do that, then it fits more comfortably when you start running. You're running more freely, we haven't got any sticky bits. Okay.
Lisa: So like, just explain a little bit, you know, in two seconds, it's like the chicken skin is. I know. It's like each of these subjects we could do an hour on that seriously, but the fascia, so we all know we've got ligaments, we've got tendons, we've got muscles, but a lot of people really have a struggle. What the hell is fascia then? And what do you mean it's all over my body? And you get that? Like, you know, that…
Neil: Connects absolutely everything. In two seconds, fascia connects everything. It will connect the tissue, like you described the chicken skin on chicken. It's on the superficial level. It connects muscles, it connects bone, it connects your vital organs. So if there's anything locked up in any of that fascia, it's almost like a, like a web, if you look at it.
Lisa: That’s a good analogy.
Neil: And have a look at it. And depending on what parts your body you're looking at will depend on how dense that web is.
Lisa: Like a spider cobweb’s like.
Neil: Exactly, exactly that. You move that to the… To move freely, if I've got something as locked up and my fascia’s sticky, or it's not moving as well as it could, then it could be that I've got a shoulder pain on my left shoulder. And that's actually my right foot. So it’s looking at, and all we're doing with these big fascia movements and looking at myofascial lines, and very simply speaking of the anterior, posterior and downside of the body as well, you’re starting to get that suit to fit more comfortably. We're starting to iron out any of those sticky spots.
Now, if you find that as you're moving through some of these movements, that you find that you are stickier in some areas and others, it starts to let you know that you've got some imbalances there. Now on top of that, as part of dynamic movement, you then want to add in some run-specific movements. So if I'm going to run, I'm going to be spending time on a single leg. I want to, at some point in my warm-up, I want to be doing something that ideally is on a single leg and is involving opposite arm and opposite leg, like running will.
So the warm-ups and dynamic movements we include as part of our warm-up will include stuff that resembles running, gets blood flow and heart rate up, gets tissue open and ready to move and work and gets me ready for the run. So when I get into the run, I'm not spending the first 2 or 3K trying to iron myself out. Open up my fascia, I'm actually running comfy, my body is now awake; my blood pressure, heart rate, breathing rate and tissue are all up and warmer. And I'm in a position where I can move more freely. Yeah, do I make sense?
Lisa: Yep. So without having been able to show you visually here how to do the exercises, what we are working on is giving a little, some sample runner’s warm-ups to do that will show you some of the dynamic movements that we're talking about here to open up and get that fascia going. We haven't got that organised yet, have we, Neil. Hopefully, by the time this comes out, we might have something or coming soon. To give you a bit of an example of the types of things that we're talking about here.
So just to recap from the top once again because it sounds like a hell of a lot to do before every single run. But actually, we're talking five to eight minutes. Or if you're doing a really— that's the other thing, if you're doing a super intense workout, you need to warm up longer. Like today I did an interval session, so I spent more time on the rolling and the activating and the getting the heart rate up and doing the drills, which we'll cover in a second.
And before I actually went hard, because I don't want an injury. And the harder the training session is, the more I'm going to be engaging all my muscles to sprint, then I need to have everything at operating temperature. If you think about a car on a winter's morning, if you turn the motor off and then jam your foot on the accelerator and tear off, what's going to happen? Your car's not going to be very happy with you because it hasn't been able to warm up, get the blood going or the petrol going or whatever it is in a car, and get it up to warmth, get it up to speed, before you go flat tech if it makes sense.
So we've done the mindset, changing your mindset, putting your gear on, getting your head in a good space, tricking yourself into just getting out the blumming door for starters. Then we've covered off some breathing. We've covered off some activation exercises — rolling the feet, rolling the calves, rolling around the hips with the foam rollers and the balls. Then we've gone and looked at some warm-up exercises, which is activating all your fascia or getting your heart rate up and so on. And the last piece of the puzzle — and this should all take you five to eight minutes, 10 minutes if you're doing a hard session — the last part of the puzzle, Neil, what's it?
Neil: It’s the drills. So we do some run-specific drills that are same with the dynamic movement. And this becomes part of the dynamic movements, there's quite a lot of crossover here anyways. It's part of that movement. So things like we were talking about — opposite arm, opposite leg movement. So things like, some of our favourite ones are simple things like ball of foot hops, which is like a skipping movement, where we're just bouncing, landing on the ball of the foot with the heel kissing the floor.
So warming the body up, starting to get the elasticity and the muscle doing the job it should and getting ourselves ready to roll. We use some other run-specific movements like forward land, which is simple opposite arm, opposite leg movement, where we're starting to really work on the pull of the leg and the action of running. And then another good one that we get some great results with is our carioca, which is a crisscross of the legs. And you can do carioca and have a look, and you'll see that all, we've got videos of these drills, if anyone wants them.
Lisa: Yeah, email us.
Neil: Please let us know. And the whole idea of these is that, again, everything — hips are open, heart rate’s up, blood pressure's up, we're ready to move. And we've done some movements that are run-specific, so when we go run, we're actually ready to run. So to break it down and give you an example of what my normal warm-up would look like — I'll always run my feet. Okay, I will always go through my breathing, sort of goes from my breathing start and then go through and roll my feet, and I roll my calves, and I roll across the top of my hips and up either side of my back. So they’re my go-tos. From there, I will do three usually big fascia movements, one for the front of the body, one for the solid body, one for the back of the body. And then I go through two or three drills. I’ll go and run. On a recovery run that will take me about five minutes.
Okay, on a higher intensity run, as Lisa was saying before, on interval run, that might take me sort of 12 to 15 minutes. But it's you… You take which bits of the tools you want out of the toolbox, and then you start using them from your perspective. The other bit to throw in, just throw the mix, finally, is just looking as well, I'm a big fan of using music. We've talked about this quite a lot before as well as. So music helps me have a cadence. So if I'm doing an interval run, I find music really helps me with cadence to help me keep my cadence up. I'm doing a recovery run, then I don't enjoy using music as much because I'd rather you know, hang out and make it more of a meditative state and chill out from there.
So thinking as well about what's in your playlist. Does music motivate you and help add to the mindset? Or does silence help add to the mindset? Working out what you need for each run and should it be part of that session; I use music often in my warm-up. And the music I choose for recovery run is significantly different than one I use when I'm warming up for an interval run. One's going to be really lifting me intensit-wise and mindset wise, the other is going to be letting me know that this is going to be cruising, it's going to be laid back, it's going to be about recovery. Using music as well can make quite a significant difference.
Lisa: Because it's… Sorry. It's all about the mind part of the puzzle really. You know, you put, I don't know, Thunderstruck on when you're trying to do an interval session. And you're like, yeah! And you going for it, and the cadence helps you and so on. And that's using your body to activate those that, again, in that case, you're activating some adrenaline and getting that going, which you need for that session.
And then you know, you want to calmer ones with you if you're just doing a recovery where you don't want to be smashing yourself and you just want to be cruising, then you want a more cruising music. But just on that note, though, just be aware, if you're in traffic, you know, it can be really dangerous. And I've been hit by a car because I had bloody things in my ears, and I was unaware of the traffic around me. So just being a little bit cautious if you are out running on roads and crossing streets, especially when you come to intersections, and you can’t hear that car coming around the corner.
Neil: Pick what you're doing and where you're doing it.
Lisa: Be aware, be aware of your environment.
Neil: Looking, then you should have that toolbox in place now. Looking at what you're currently doing, who you are and how much of a warm-up — what percentage you use each tool for will be quite different for each person. So as we said at the start, some people will need to spend more time breathing. Some people will need to spend more time rolling. Others might need to spend more time with the dynamic warm-up. You'll all do a little bit of each but it's going to be, the percentage will be different. And when you use each tool, it’s going to depend on what you're doing and what's on your program.
Lisa: And one other point here is that you will have — and I promise you this — a much more fun run, and you'll enjoy it more if you've put the time into this warm-up piece of the puzzle. Because I know a lot of us are under time pressure and stress. And we've got like, ‘I've got 30 minutes, I've got to get my running today. That's all I've got, I don't want to spend 10 minutes warming up’. Okay, negotiate with yourself and try to do at least five minutes, because it's better to get that five minutes because that other 25 is going to bring you more than that extra five minutes of running, if that makes sense.
Because you— if you talk to runners, most people and if you're a beginner, you might not be aware of this, but the first 20 to 25 minutes are absolute crap for everybody all the time. You know, it's very rare, where you just run out the door, if you haven't warmed up, that you'll be enjoying yourself and your body will be stiff, it'll be sore, it'll be not activated, you won't have a good posture, you'll feel like your heart and your cardiovascular system isn't woken up.
All of that can be avoided if you do all of this in the preparation. It's like laying the foundation of a house. If you do it on quicksand, you're not going to have a very stable house. If you do it on concrete and you put your foundations and your poles in properly, you're gonna have a house that stands for a long time. You're going to enjoy your run a lot more. You know, today's session was was a classic example of that, you know, interval session full on, hardcore, big good workout, warm-up prior and the session wasn't nearly so difficult than if I just jumped out the door and done it. So don't underestimate that.
Neil: Good polling, Lis. I liked it.
Lisa: Don't underestimate a good warm-up. So people, if you've enjoyed this content, please share this with your friends and family. Share it, get it out there, get it out in the world, we really appreciate you doing that. And if you, you know, want to come and join us at Running Hot Coaching, this is what we do. And what we love is to help people with their running journeys and inform people. And as you can see, we take a very holistic approach to our running into our health programs and to all of the programs that we do.
Because we look at people as whole people and not as runners or not as ‘You've got a health issue or specific health issue’. We look at the whole person the whole time so that you can actually get the best performance because there's no optimal performance without optimal health. That's probably a good place to leave it, actually.
Neil: I like it.
Lisa: Well, thanks for joining us today. Thanks, Neil, for your wisdom as always — epic. Really appreciate you, right. And we'll see you again next week. Thanks, guys!
That's it this week for Pushing The Limits. Be sure to rate, review and share with your friends. And head over and visit Lisa and her team at lisatamati.com.
The information contained in this show is not medical advice it is for educational purposes only and the opinions of guests are not the views of the show. Please seed your own medical advice from a registered medical professional.
Sepsis is a massive health issue worldwide. According to WHO, nearly 50 million people get sepsis every year, killing 11 million. Here in New Zealand, one in five ICU patients dies because of it. Thus, raising awareness about the role of vitamin C in sepsis can help save lives.
Dr Anitra Carr joins us in this episode to expand our understanding of the role of vitamin C in our body. She also explains how vitamin C functions not only as an antioxidant but also as a cofactor in many different mechanisms, particularly in fighting cancer and sepsis.
Everything we share in this episode will be helpful for you should you find yourself or a loved one admitted to a hospital, so tune in.
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‘I’m much more interested in the whole person and how they're feeling, not what's happening inside a single cell’.
‘Don't wait until they're at death's door and at septic shock. It's hard for a vitamin to do something at this stage, even a really high-dose vitamin’.
‘A lot of these studies were designed to reproduce the first studies that came out to see if they could reproduce it also. That's why they’re using similar regimes. But now that we know more about it, each study adds another piece to the puzzle’.
‘There’s bigger issues at play with the whole pharmacological model that our whole system is built upon, and that nutrients and nutrition isn't taught in medical school. So, we're up against this big sort of brick wall’.
‘People go into a hospital setting or something, and they expect to have the latest and greatest information available, that the doctors know all that. And unfortunately, that's not always the case’.
‘Every person's life that is saved is a family that's not grieving’.
‘It’s the reason I’m doing this podcast, and it's the reason you're doing your research. And hopefully together and with many others, we can move the story along so that people get helped’.
Dr Anitra Carr holds a PhD in Clinical Biochemistry/Pathology. She started researching vitamin C when she undertook a postdoctoral research position at the Linus Pauling Institute, Oregon State University, USA, and was also awarded an American Heart Association Postdoctoral Fellowship. Dr Carr produced a number of high-impact publications in the field of vitamin C in human health and disease.
Dr Carr is currently a Research Associate Professor at the University of Otago, Christchurch, School of Medicine. She has established her own research group, the Nutrition in Medicine Research Group, and undertakes translational bench-to-bedside research comprising observational studies and clinical trials on the role of oral and intravenous vitamin C in infection, cancer, metabolic health, mood and cognitive health.
Dr Carr endeavours to understand the underlying biochemical mechanisms of action as well as improve patient outcomes and quality of life. She also pursues various ways to improve clinician and general public understanding of the roles of vitamin C in human health and disease.
You may contact Dr Carr through anitra.carr@otago.ac.nz or call +64 3 364 0649.
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To pushing the limits,
Lisa
Welcome to Pushing the Limits, the show that helps you reach your full potential with your host Lisa Tamati, brought to you by lisatamati.com.
Lisa Tamati: Welcome back to the show! This week, I have another fantastic interview with another amazing scientist. But before we get there, I just want to remind you please give a rating and review to the show if you're enjoying the content and share it with your family and friends. I really appreciate that.
And if you haven't already grabbed a copy of my book Relentless, make sure you do, you won't regret it. It's an incredible story that is really about taking control of your own health and being responsible for your own health and thinking outside the box. And it's the story of bringing my mum back to health after a mess of aneurysm. And it will really make you think about those—the way our medical system works and about why you need to be proactive when it comes to health and prevention, preventative health. And it's really just a heart-warming story as well. So, you can grab that on my website at lisatamati.com. Or you can go to any bookshop in New Zealand and order that or get that and it's available also on audiobook for those people who love to listen to books rather than reading them, I know, I certainly do a lot of that.
And just to also remind that if you have any questions around some of the topics that we've discussed on the podcast episodes, please reach out to me lisa@lisatamati.com. And if you want help with one of your health journeys or your performance journeys, or you want to work on some goal setting, on some mindset, please reach out there as well. We'd love to work with you.
So today I have the Dr Anitra Carr, who is a scientist at Otago University. She's currently a research associate professor at the University of Otago, Christchurch School of Medicine. She's established her own research group, the Nutrition in Medicine Research Group and undertakes translational bench to bedside research comprising observational studies and clinical trials on the role of oral and intravenous vitamin C in infection, cancer, metabolic health, mood, cognitive health.
And she endeavours to understand the underlying biochemical mechanisms of action as well as improve our patient outcomes. So, she's a person who loves to actually not just be in the lab and looking at petri dishes, but to actually help people in human intervention study. She currently has a study underway, which I'm really, really excited and waiting with bated breath to see what comes out. It’s a sepsis study, in the Christchurch hospital with 40 patients. And we talk a little bit about that today.
And we talk about the role of vitamin C today. Continuing the conversations that we've had with some of the world's best vitamin C researchers. We're looking at the antioxidant properties, we're looking at the pro-oxidant properties, we're looking at vitamin C as a cofactor in so many different mechanisms in the body. We talking about its role in the production of adrenaline and vasopressin, in hypoxia inducible factors, in relation to cancer, and especially in relation to sepsis, which is obviously a very important one for me.
One in five ICU patients in New Zealand dies of sepsis. This is a massive problem. Worldwide, between 30 and 50 million people a year get sepsis. This is something that you really need to know about. You need to understand it and Dr Anitra Carr, also shares why you may not get a doctor in a hospital situation, actually understanding all the information that we're going to be sharing with you today. So, educate yourself, learn from this and enjoy the show with Dr Anitra Carr.
Lisa: Well, hi, everybody. And welcome back to the show. Today I have Dr Anitra Carr, and today we're continuing the series around vitamin C. We've had some brilliant doctors and scientists on in the last few weeks and it's been really exciting to share some of the latest research and we have one of our own Kiwi scientists with us today, Dr Anitra Carr from Christchurch. Welcome to the show.
Dr Anitra Carr: Hi, Lisa!
Lisa: It's fantastic to have you. So, Dr Anitra, can you just tell us a little bit of your background and how you got involved with vitamin C research?
Dr Anitra: Well, I first started researching back in the late 90s. So, 1998 and I had just finished a PhD with the University of Otago and I had been studying how reactive oxygen species that are produced by white blood cells react with our own tissues, damage their own tissues because these white blood cells produce these really reactive oxidants, such as hydrogen peroxide, which is hair bleach, and hypochlorous acid, which is household bleach. So very strong oxidants and they produce these to help kill bacteria in our bodies. But these oxidants can also react with their own tissues and that's what contributes to inflammation and the processes of inflammation.
And so, I've just been studying how these oxidants react to certain components in our tissues. And when I finished that, I thought it’d be really interesting to investigate how antioxidants, such as vitamin C, which is one of the most potent antioxidants in our body, and help potentially protect against this damage. So, scavenge those oxidants before they react with our tissues, and help decrease the inflammation associated with them and features and conditions.
And so, I applied to various people in the United States, I wanted to go to continue my research in the United States. And so I applied to several people over there who are doing research in the area that I was interested in, and they'll write back and say, ‘Yes, we have postdoctoral positions available.’ And so I selected one, on the advice of my PhD supervisor, and this was Professor Balz Frei. He was at the time in Boston. And after I said, ‘Yes, I'd like to work with him.’ He wrote back and said, ‘Oh, by the way, I'm moving to the west coast to Oregon. And I'm going to be the director, the new director of the Linus Pauling Institute.’
Lisa: Oh, wow.
Dr Anitra: Great opportunity it is. I like the West Coast of the United States. I've done a bit of work in California during my PhD. And so, I was quite happy with it. And so Linus Pauling had died just a few years prior to that. And so, the Linus Pauling Institute, which was in California, at the time, kind of needed a new home, I think they're in Palo Alto.
And so they ended up going to Oregon State University because that was—for a couple of reasons—that was Linus Pauling alma mater. So, he had done his undergraduate research when he was in a cultural college. And also, because the library there was going to be able to host his papers. And so he has this collection of his writings and papers, thousands and thousands of documents, because as you've stated before, he's one of the only people to have been awarded two unshared Nobel prizes. So one was in chemistry around his work on the nature of the chemical bond. And the other one was a Peace Prize for his anti-nuclear campaign.
And so the Oregon State University Library has his complete collection, it's called the Linus Pauling Special Collection. And so I spent a few years at Oregon State University researching how vitamin C can protect against oxidation of low density lipoprotein particles, which are what the body uses to export fat and cholesterol around the body, because the cells need cholesterol. But most people know low density lipoprotein protein as bad cholesterol. I mean, it's not intrinsically bad. But if it becomes oxidized, it can contribute to the development of atherosclerotic plaques and contribute to cardiovascular disease. And so I was looking at how vitamin C can protect against oxidation of this particle, and thereby potentially peak against development of atherosclerosis. And I was...
Lisa: What was the outcome of it? That would be really interesting.
Dr Anitra: Yes. So, I was particularly interested in the oxidants produced by white blood cells, because these can react with these low density lipoprotein particles and oxidized them. And vitamin C is a great scavenger in particular, and I was interested in how much do you need and how the particulars—is the real biochemical level?
And, but also during this time, so late 1990s. We were interested—Professor Balz Frei was interested in the recommended dietary intakes for vitamin C. Because in a lot of countries they are very low—these recommendations, primarily to prevent deficiency diseases, such as scurvy. Whereas, we believe you know, that the recommendations should be high to help reduce the risk of chronic diseases such as cardiovascular disease and cancer and that sort of thing. That's a bit helpful to the outcome.
So, in the late 90s, in 1998, the Food and Nutrition board of the Institutes of Medicine was re-examining the recommended dietary intake for the antioxidant vitamins, the A, C, and E in the United States. And we write a comprehensive review around all the scientific evidence at the time for what sort of doses of vitamin C appear to protect against cardiovascular disease and cancer. And so, we made a recommendation of 120 milligrams a day, which was, at that time twice what the recommended dietary intake in the States, it was 60 milligrams a day at the time. And so we submitted that document, and it was considered by the Food and Nutrition Board. And also another review, I'd written around vitamin C's antioxidant roles in the body versus its pro-oxidant roles. Vitamin C, referred to as pro-oxidant.
Lisa: Yes, I’ve heard that. To get hit around the antioxidant and as a pro-oxidant.
Dr Anitra: Vitamin C is an antioxidant. It's not a not oxidant, pro-oxidant. But what it does is it can reduce—so antioxidants donate electrons, and they reduce oxidized compounds. So, it reduces transition metal ions such as copper and iron. So, these are metals in our body that can read off cycles so they can produce oxidants.
Lisa: Yes, and we've talked about redox before in the podcast.
Dr Anitra: Yes, so what vitamin C does is it converts these metal ions into a reduced state and metal ions can go on and generate oxidants.
Lisa: So it gives ion and copper a longer life, does it? It sort of gives them—ion and copper away to keep going?
Dr Anitra: Regenerates them so that these metal ions can keep producing oxidants. But in our body, these metal ions are all sequestered away and protected by proteins, they're not floating around free. In the body, vitamin C doesn't seem to do that, based on the evidence, it seems to just have it’s true antioxidant roles, not this kind of prooxidant by-product, as you might call it.
So, this sort of evidence was considered by the Food and Nutrition Board and they decided, ‘Yes, it does have an antioxidant role in the body.’ And, and so they also referred to Mark Levine's seminal work to kind of work out a dose, a daily dose of vitamin C, they thought would be good to help foster this antioxidant potential on the body—potentially protect against these other chronic long-term diseases such as cardiovascular disease and cancer.
And so they did end up increasing the RDA for vitamin C instead from 50 to 90 milligrams a day for men, and 75 milligrams a day for women. So that was good, not quite as high as we would have liked to see, but still a step in the right direction.
Lisa: A very conservative, aren’t they? They are slow to respond and conservative? Because you think like being the preventative space would be a good thing, if we're trying to...
Dr Anitra: It is. Prevention is a lot cheaper, a lot easier to prevent a disease.
Lisa: Exactly. But I think New Zealand's even worse, isn't it? I think we're at 45 milligrams, which is I think it is.
Dr Anitra: One of the lowest in the world, yes.
Lisa: That’s got to change, sorry.
Dr Anitra: So we're trying to generate the evidence to help support them increase in RDA.
Lisa: Gosh, so it's also slow, like you've been doing this for what? 20-like years. And still...
Dr Anitra: They do say that translation of science into medical research into clinical practice takes 15 to 20 years.
Lisa: Wow, that is a really interesting statement. Because this is why I think, like sharing the sort of information direct from the experts, if you like, and I sit this was Professor Margreet Vissers too, that we have to make sort of educated decisions as people in trouble now. Whether you've got cancer or whether like my case who have a dad who had sepsis, you have to make an educated decision now based on you're running out of time. And we're waiting for the research and the research will be great, but it will be another 10 to 20 years down the line before it actually…
And then in the medical world, it seems to be a very slow—Doctor Fowler said that beautifully when I had him on last week. It's like trying to shift a supertanker, Critical Care he was referring to is very, very slowly coming around. And I had Dr Ron Hunninghake on as well from the Riordan Institute, another fantastic doctor, and he talked about Medical Mavericks. Dr Hugh Riordan had written three books on people who were really ahead of their time, got in trouble for it and then actually the research and everything caught up with them later.
So that's interesting. So, if you’re listening to this, New Zealand has got 45 milligrams as the RDA, that's just to keep you out of scurvy. Right?
So, okay, so you've done all this antioxidant research and this with RSS and at the Linus Pauling Institute, when did you start to develop an interest in the infectious diseases, sepsis side of that, because I'd really love to...
Dr Anitra: Yes, that's, that's more recent. So, after a few years—three years at the Institute, I decided to have our first child and move back to New Zealand. And I made the decision to quit science and just focus on bringing up our family, ended up having three children. Stayed home for nine years looking out after our children. And I made the decision that they were more important than my career
Lisa: Wonderful. That's an interesting fact, as well as a mom and a scientist, like, an incredibly dedicated career that you'd have spent years getting there and then trying to juggle mum roles with scientist roles, and taking nine years out of your career. Has that hurt your career massively? Or I would have catch up so to speak?
Dr Anitra: It hasn't hurt my career. I mean, I'm 10 years behind my contemporaries, my colleagues because I took that time out. But that's the decision I made. And I stand by it because the first three years of a child's life are very important. So I thought I'll dedicate myself to the children in the early years. And after those nine years, right? I've done my time and really can’t get back to work.
Lisa: Mum's going to be a working mum from now on.
Dr Anitra: But I just went back to work part time, so, within school hours, so that I'll still be there for them after school hours. And one of the things that drew me back to work—I was recruited back to run a human intervention study. What really excited me because when I was in the lab doing lead-based research, I always felt too removed from the need to be helping. And so I’m much more interested in the whole person and how they're feeling, not what's happening inside a single cell.
Lisa: Yes. Yes, it makes sense.
Dr Anitra: I was really excited and really grateful to be recruited back, especially after taking nine years out for my... Discoveries have been made during that time that I had no idea until I went back and I've got a bit of catching up to do. And...
Lisa: So what was that first intervention study, that human...
Dr Anitra: This was a kiwi fruit study. So kiwi fruit is very high in vitamin C. In summary, we're interested in how many kiwi fruit do you need to eat to get adequate and optimal vitamin C level. So it's just kind of a dosing study?
Lisa: Brilliant.
Dr Anitra: Then we went on to compare kiwi fruit with tablets. So, animal research had shown our food sources of Vitamin C seemed to be a bit better than tablet sources. And so we would—we thought we'd translate that into a human study. And what we found is there's no difference
Lisa: There's no difference. Uptake of vitamin C from food versus tablets, the body is really good at it. Because we need vitamin C, our body has adapted ways to...
Lisa: Take it wherever it gets it.
Dr Anitra: Take it up, regardless of the source.
Lisa: Wow, that's...
Dr Anitra: The structure of vitamin C's the same in foods as it is in tablets. So the body recognizes it the same, takes up the same amounts. I mean, the benefit of food is that you're also getting all the other vitamins and minerals and fibre. So, we still recommend food. But it is in our daily diets these days, it's very hard to get 200 milligrams a day of vitamin C.
Lisa: Just fruits and veggies. Yes.
Dr Anitra: That’s just fruit and vegetables. And as you know, different fruits and vegetables have quite different amounts of vitamin C, which a lot of people aren't aware of.
Lisa: No. No.
Dr Anitra: I mean, people know that kiwi fruit and citrus are high, but they may not realize that apples and bananas are actually quite low in vitamin C.
Lisa: Or capsicums are quite high… You wouldn’t think that broccoli… And if you decide to take a supplement, is there a bit of supplement? Like, I have heard concerns about corn-derived vitamin C because of the glyphosate discussion, and that’s a bit hard to track really, the types of vitamin C. But is there any sort of research around—I mean, I've talked previously with a couple of doctors and scientists around liposomal delivery. Have you seen anything in that department or any supplementation method that's better?
Dr Anitra: Not convincingly better. I mean, there might be trials that show that’s slightly better than just your normal chewable vitamin C. But I just go for the standard, cheap vitamin.
Lisa: Yes, doesn't have to be super special. Like it's a pretty simple molecule, isn't it? Like, the body is pretty, like you say, it needs it, it knows it.
Dr Anitra: Liposomal vitamin C kind of wrapped up in lipids, and the body doesn't need it because like you said it’s designed to recognize vitamin C in its natural form, in foods and such like.
Lisa: Yes—who was that? I think Dr Thomas Levy was saying it bypasses some of the digestive issues because with vitamin C, you can get digestive stress when you take a bigger...
Dr Anitra: When you take a higher dose. Some people, we're talking about more than four grams a day, and some people can get stress, it does but you can use that.
Lisa: Okay. So then you've moved into—and forgive me for jumping here—but very keen to talk about the role of sepsis and pneumonia and patients in ICU reasons
Dr Anitra: So, after about five years of doing that research part time, I managed to get at Health Research Council, such as speakers Health Research Fellowship, which allowed me to move into the more clinical arena of studying infection, which was an area I was interested in.
And done some observational studies where we have recruited patients who have pneumonia, measured the vitamin C levels, and levels of oxidative stress. And found that they have very low levels of vitamin C and high levels of oxidative stress. And the more severe the condition, the worse it is, the lower the vitamin C levels, and the higher the oxidative stress.
So, if those patients with pneumonia are going to develop sepsis, and sepsis is kind of this uncontrolled inflammatory response to a severe infection. And that can develop into multi organ failure and the patient’s taken to the intensive care unit. And it can go on further to develop into septic shock due to failure of the cardiovascular system. And up to half those patients die, it’s the major cause of death in critically ill patients.
Lisa: Yes. And that's what I unfortunately experienced with my dad. And so, with the organs are starting to break down. So, when you get anything like pneumonia or sepsis, the body's requirement just goes up, a hundred-fold or more.
Dr Anitra: Yes, at least 30-fold. Yes. So, it's very hard to get those amounts into a patient orally. And so, when the patients are in the intensive care unit, they're generally sedated because they're being mechanically ventilated. And so, they're given nutrition in two different ways because they can't eat. And so, the main way is to drip feed it directly into the stomach, liquid nutrition in the stomach through nasal gastric tube. The other way is to inject it directly into the bloodstream. And so, the recommended amounts of vitamin C by these means is about 100 milligrams a day.
Lisa: That’s nothing.
Dr Anitra: But what we did on one of our studies was we looked at how much vitamin C these patients should theoretically have in their blood based on how much vitamin C they're consuming. Because 100 milligrams a day in a healthy person is more than adequate to—provides adequate plasma, what we would consider adequate plasma levels. And so, we mapped out what it would look like in these patients based on how much they were getting. And then we compared it with what we actually measured in their blood, it’s way lower than what theoretically should have been. And so, this, this was an indication that you still need a lot more vitamin C than they're getting in the standard liquid nutrition. And that the body also has these much higher requirements, which has been shown previously by other researchers.
Lisa: And so this leading to almost a scurvy-like situation. I mean, some of these severe sepsis people—I mean, seeing one of your [unintelligible 24:53] that sort of normal community cohort of people, young people, middle aged people, and then down into the more severe pneumonia and then sepsis, and severe sepsis. And they are just over the scurvy level. So basically, their bodies are falling apart because of that, as well as the sepsis if you like. and it's...
Dr Anitra: And that’s even on top of being given a day of at least 100 milligrams a day, that's still really low.
Lisa: That's just not touching the sides.
Dr Anitra: Yes and...
Lisa: Why is this not like—for people going into the hospital, why is it that even though—okay, we may not know the dosages, why is not every hospital testing at least the really sick patients, what their vitamin C levels are, and then treating it the nutrient deficiency only? Even apart from the high dose intravenous stuff, but just actually—with my dad, I was unable to get a vitamin C test done to prove my case. I couldn't prove my case because I couldn't get it tested.
Dr Anitra: Yes, no, it's so true. It's because doctors don't learn about nutrients in medical school, it’s not part of their training.
Lisa: At all, yes.
Dr Anitra: So they're not familiar with how important they are for the body. They're not familiar with all the recent research around all the different functions and mechanisms of action that vitamin C carries out. Over the last 10 years, all these brand-new mechanisms and functions have been discovered, and they think we know everything there is to know about it.
Lisa: Yes, and we don't.
Dr Anitra: [unintelligible 26:34] the time. It’s basically exciting.
Lisa: Yes, it is.
Dr Anitra: So basically, they don't understand. The hospital system isn't set up to routinely measure it. It is only ever measured if scurvy—if someone comes in with suspected scurvy. And even then, a lot of doctors aren't used to recognizing the symptoms of scurvy. It's not something they're familiar with because it doesn’t...
Lisa: They think it no longer exists because it’s what sailors had in the 1800s.
Dr Anitra: ...the parents and the wisdom.
Lisa: It’s basically in the sick population.
Dr Anitra: It is. But I think... So when I first applied for funding to carry out these studies, in pneumonia and sepsis, there were only a couple of papers have been published at that time looking at vitamin C sepsis, and that was Berry Fowler's safety dosing study.
Lisa: That is phase one trial.
Dr Anitra: And another one, small one in Iran. So, there was very, very little information out there at the time. And so, I put in an application for us to carry out an intervention study in our ICU at Christchurch. So just a small one, 40 people—20 placebo control of vitamin C and 20 getting intravenous vitamin C.
And not long after that, Paul Marik's study came out and that stimulated real explosion and research in this field because of the media interest. So the media picked up on it. And it hit the world. I've been talking about this for years to doctors. I see doctors and they're trying to get to talk about it. But it wasn't until it hit the media, and they heard about it through the media, they thought, ‘Okay, maybe there's something here.’ So that just goes to show how important media can be.
Lisa: Exactly why we're doing the show. I have not seen it. But you know what I mean? We've got to get this from the ground up moving.
Dr Anitra: Yes. And so since then, there's been many studies carried out around the world, all of different quality. And so we're learning more and more information, real-time clinical trials, they take a long time to run. Recruitment being the most difficult part.
The other thing is that, a lot of the clinical trials, the clinical researches are used to running drug trials and so they treat vitamin C like a drug, but it's not a drug. It's a nutrient, it’s a vitamin, that the body is specially designed to take up and use very different from drugs. And so they don't always understand how vitamin C works in the body.
And it's important to know how it's working in order to design good studies, good quality studies. So a lot of the data that's come out may be impacted by how well the study was done and thought out. So we still don't know all the important essays about the dose, how often should you give it, when should you give it? I mean, ideally it should be given you know, as early as possible.
Lisa: Early as possible.
Dr Anitra: Don't wait until they're at death's door and septic shock. It's hard for vitamin C to do something at that stage even really high, even a really high dose vitamin. The earlier that you give it, the longer you can get it for digest. Most of these trials have given it for four days and they stop.
Lisa: Yes, I've wondered that.
Dr Anitra: The whole time, they're in the ICU because once pharmacokinetic study showed that when you stop that vitamin C, some of those patients just drop straight back down to where they were. Now they need to keep that continued input.
Lisa: So why? Why has it been made that it's only—all of those I've seen, I think have been 4-day, 96 hour studies. And occasionally one of them is or for the latest day in ICU, but most of them have been 96 hours and most of them have been very, very conservative dosing. From what I understand conservative dosing. And I know Dr Berry Fowler said where there's some consideration about oxalate in kidney function. And I'm like, ‘Yes, but this is still a very low risk for somebody who's got sepsis.’
Dr Anitra: If a patient has kidney dysfunction in ICU they put them on haemodialysis anyway, so which clears that excess vitamin C. So it's not such an issue for those patients. But yes, a lot of these studies were designed to reproduce the first studies that came out to see if they are reproducible. so, that's why they’re using similar regimes. But now that we know more about it, each study adds another piece to the puzzle. And so hopefully, future studies will look more into what dose we actually need and it only varies depending on the...
Lisa: The severity
Dr Anitra: Severity, etc. How long? And I believe, once they leave the ICU... So patients who survived sepsis, they can go on to have real problems, physical disabilities, cognitive issues, psychological issues, like depression, anxiety. And so, I really believe they keep taking vitamin C when they leave the hospital just orally, that might help with those conditions that hasn't been researched yet. That's a whole area of research that should be carried out to.
Lisa: So, if I was to ask you, in your dream world where your resources are unlimited, and you had lots of money, and you had lots of people to help you do all these and you have enough patience to enrol. What are some other things that you would like as a scientist and you understand some of the mechanisms and the cofactors—which I want to get on to as well—what are some of the studies that you would like to see happen? So, we can move this along faster. What are some of the key things? So, quality of life afterwards? Yes, like dosages, what?
Dr Anitra: Really practical things that the doctors need to know, I think, what's important, like, how much to give, how often to give it? Most of the studies are done four times a day because that's what was done in the initial studies. Is it better to give it continuously? So, when they're in the ICU, can you just use drugs continuously, rather than this kind of bolus dosing? So, do more research around that.
So the frequency and dosing and timing like when do you administer it, how long should you administer it for? I mean, there's so many important aspects around that. And we've got the foundational research done now, we can start teasing out the finer details now, I think. Rather than just doing the same study designs over and over again,
Lisa: Yes and reproducing.
Dr Anitra: Modify their study designs to start addressing these other issues. And there's some really big studies underway at the moment. One in Canada with 800 people. I mean, they'll give us really good information, those sorts of studies, rather than the little studies. Unless you live in small countries.
Lisa: Small countries that can’t afford those things that cost millions and millions of dollars. And is there a trouble with funding because it's not a drug that we're developing here? Does it make it harder to get funding?
Dr Anitra: It's extremely hard to get funding because often on the CSUN committee, it's often medical people on these who don't believe in vitamin C. The bad press or the misinformation don't understand the importance, the relevance and so, that's why this outreach is really important. It's just educating people about the science behind it. It's not hocus pocus.
Lisa: Yes, I mean, if I can share—I mean, I've shared a little bit on the past episodes with my case with my dad. I know and I felt they just put me in that, wackery quackery caught and they paid lip service to listening to me. They didn't really and but I’m quite—well in this case, I had to be quite forceful because my dad was dying. And I didn't go away, most people would go away because—and I just wish I knew then what I know now even because I wasn't that deep into the research. And now I am deep into the research and really an advocate for this.
But I was treated like—there was one really good doctor who listened to me, who advocated, he didn't believe in it, he didn't understand the mechanisms of action or any of that sciency stuff. But he did advocate for me at the ethics committee, whereas everyone else would just roll their eyes basically.
And this is why I think it's so important to share this, to come back again and again to the science for science for science, and for them to just open up their eyes just because they didn't learn it in medical school. And it's not in the current textbook for, like you say, because it takes 20 years probably to get it to the textbook. Because it's a vitamin, they just immediately shut down, it’s how I felt. They just immediately, ‘Well, just eat an orange and you're good to go.’
I mean, the surgeon—I had a friend that was going into surgery, and she was like, ‘Should I have intravenous vitamin C, before I go into surgery to prepare my body?’ Very logical thing to do in my eyes. It’s like, ‘You don’t need that, just eat an orange,’ and it's like, ‘Oh, you don't get the whole why and how, and what happens when the body goes through a trauma and a surgery, or a sepsis or any of these things.’And I don't know, like there's a bigger issue at play with the whole pharmacological model that our whole system is built upon. And that nutrients and nutrition isn't taught in medical school. So we're up against this big sort of brick wall.
And when I tell my story to people just, sharing with friends and things, they’ll be going, ‘But where's the downside? He was dying anyway, why couldn't he have it?’ And I said, ‘Well, you're up against machinery, you're up against ethics committees, legal battles, and a system that is just very staid and conservative in its approach.’
And that's not to criticize individual people within the system. I'm not wanting to do that. I'm just trying to make people aware because people go into a hospital setting or something, and they expect to have the latest and greatest information available that the doctors know all that. And unfortunately, that's not always the case. Do you find that frustrating?
Dr Anitra: I mean, it's not the doctors’ fault as such, because they're very busy people, they don't have time to keep up with all the literature, and they're not likely to be going into the nutrition literature in the first place. Which is why we try and publish as much of that stuff and the clinical literature, they're more likely to see it then.
And they have the patient's best interests at heart. They've just heard the bad things about vitamin C and the misinformation. And so they don't want to do harm to the patient, I guess. It’s the view that they’re coming from and they don't have time to read all the latest information. And that's why just piece by piece, chip away at theirs, and educate them and hopefully it'll come into the training of the new doctors. And future hopefully, more nutrition courses will be introduced into training because it's not just vitamin C.
The body needs all the vitamins that are all vital to life. That's where the name comes from. You don't hit them, you die. It's as simple as that. So, yes, I think that it is vital that this information gets into the appropriate arenas.
Lisa: Yes. And I think that's why I'm passionate about the show is that my sort of outlook on the whole thing is, ‘Yes, I'm not a doctor, but I can give voice to doctors and researchers. And I can curate and I can investigate and I can share.’ And this is a very emotional topic for me or for obvious reasons, but I'm trying to take the emotion out of it because that doesn't help the discussion.
And it’s really hard but I understand the importance—because I know that if I share things in an emotional manner, then I'll get shut down as having mental health problems in a group being a grieving daughter. When actually I’m an intelligent person who's educated herself in this. I've got the best people, and the best researchers, and the best scientists, and the best doctors sharing the latest research. And I hope that by doing that you can get one mind after the other and just get them to understand rather than the emotional side of things. Because what I do want to also share with the story is that every person's life that is saved is a family that's not grieving. These are not statistics.
When Dr Berry Fowler's research, with Dr Merricks research and you see a drop from, I think Dr Merricks was 40%, mortality to 8% and Dr Berry’s was something like 49, down to 29. Don't quote me on the numbers, but big numbers in drops and mortality. And you go, those are just dozens, if not hundreds of lives that are saved. And those families are saved from that grief.
And worldwide, I've heard a couple of estimates between 30 and 50 million people a year who get sepsis. Of those, one in five—I've heard in your research—one in five in New Zealand ICU dies of sepsis. This is a huge problem. This is as big as cancer and actually is one of the complications often of cancer therapies. So, I don't think people understand the enormity of sepsis itself. And then pneumonia, and then we can go into the discussion of COVID, and cancer, and all those other things. It's like we're talking millions of lives every year around the world. So this research is just absolutely crucial. Sorry, I've gotten on my bandwagon a little bit. But I really want to get this information out there. And that I think it's really, really important.
And let’s change track a little bit and just talk a little bit briefly because I haven't covered this subject with the other vitamin C interviews that I've done. Around the cofactor, so vitamin C is a cofactor for so many different areas. So I remember from one of your lectures, it has epigenetic influences and hairs like with collagen synthesis, and that's not just for your skin and your and your nails, but also has implications for cancer. You've got your health, which Professor Margreet Vissers talked about your hypoxia inducible factor, tumor growth.
Can you just go and give me a little bit of information around—the vasopressin one would be very good and anything else that pops to mind there.
Dr Anitra: Yes, so the cofactor is a compound that helps enzyme function. So everything in our cells relies on the functions of enzymes to carry out reactions in ourselves or the chemical reactions require enzymes. And so a cofactor supports that function.
And so early on when I was just starting in this area of research in the field of sepsis, I was looking at the different cofactor functions of vitamin C, and one of them is a cofactor for the enzyme which synthesizes noradrenaline. And noradrenaline is one of the main drugs, as you might say, that's given to patients who are going into septic shock. So it's given to the patients to try and increase the blood pressure. And it works by making the muscles around the blood vessels contract. Makes the blood vessels a bit smaller, so it increases your blood pressure.
And so vitamin C is a cofactor for the enzyme that naturally synthesizes noradrenaline in our body. And there's another enzyme which synthesizes hormones, one of which is vasopressin. And this is another drug that's also sometimes given to these patients to help your blood pressure. And it works by increasing the re-uptake of water by the kidney. So, that increases your blood volume and hence, your blood pressure. So, for a lot of ICU patients, they're given noradrenaline and sometimes they're given vasopressin on top of that. Really try and get the blood pressure up.
Lisa: Yes, their collapsing cardiovascular system.
Dr Anitra: And I realized, ‘Oh wait a minute vitamin C is also cofactor for this enzyme that synthesizes vasopressin.’ So here it is, a cofactor for two quite different enzymes that synthesize vasopressors naturally in our body. And so, if these patients are coming into the ICU, very low in vitamin C, and going into shock, is one of those reasons because they don't have enough vitamin C in the body to support natural vasopressor function. The doctors have to give them these drugs but if we're able to get them vitamin C, early enough that it can potentially support their own natural synthesis of these vasopressors in the body, which is a much better way to do it. Because if drugs are given from the outside, they're often given in high doses and not regulated, and so can cause side effects. There is a difference being produced in the body, the body knows what it's doing. It regulates how much and how often, all those sort of 46:07 engineering emails and so you don't get the nasty side effects.
Lisa: Can I share a bit of a story there? Because both my mom and her case was—she had an aneurysm four years ago, she was on noradrenaline, and could only be given in an ICU. And originally she was in the neurological ward. And they couldn't do it there. And I only realized like she was going into a coma. So she had massive brain damage going into a coma. That when they took her up to ICU, they could give her the noradrenaline that opened up that the vessels in the heat it a little bit, or keep the pressure up, so that the vessels were open to stop the vasospasm in her case, which was killing parts of the brain. But she'd been in the neurological ward where they couldn't give any of that earlier. And so the damage had already been done partly.
And then with the case with my dad, back then I didn't know anything about vitamin C, of course. With the case with my dad in July, this year, I got vitamin C, but it was on day 13 of his 15-day battle, because I had paid to go through ethics committees and all of that sort of jazz. So he was an absolute death's doorstep, should have been dead days ago, according to the doctors. They couldn't believe he was still going but he was one tough man. I don’t know how he was still alive but he was. And the very first infusion that we got a vitamin C, immediately we were able to take him off norad for a period of about eight hours. We needed the vitamin C again, that took me another 18 hours before I could get permission to get the second one. Unfortunately, I couldn't get it in the six-hour bolus, which was ideal.
We gave him initially 15 grams. So this was again, multiple organ failure, fecal matter, and the creatinine, desperate, desperate, desperate straits. His CRP, c-reactive protein dropped from 246 down to 115. His white blood cell count improved and his kidney function went from 27% to 33%. And I was able to take him on vasopressors and noradrenaline for about eight hours. That is incredible for someone who could die at any moment. And we eventually—we failed because I struggled to get the second and I struggled to get the third infusion and it really was too late.
But even at that point, I thought it might be interesting for your research—I have all the medical records by the way, if you want to have a look at the data exactly. But it really was a strong—he doesn't need the noradrenaline, his blood pressure was going up. And that was a really, really good sign. As the dropping of the CRP, which was still very high at 115 but it was way better than where it had been.
So goodness, what would have happened if I'd had him on day one from the surgery? Yes. And, and none of it is understood. So that's one of the cofactors that… And that brings to mind just as someone who's connecting the dots, if you have an HPA axis problem, like your adrenals aren't doing the job well. And your cortisol, vitamin C would probably be a good thing to take to support.
Dr Anitra: And sometimes it’s referred to as a stress hormone because it is involved in the adrenal response. And people who are under stress, or in animal studies who have stress animals they appear, they use more vitamin C, and they generate more vitamin C, the animals they can synthesize it themselves, they generate more vitamin C to compensate for that. We are not there anymore. So we have to take more if we're under stressful conditions.
Lisa: Exactly. And that's a really—it's just a funny thing of evolution that we've lost the ability to synthesize more as we like animals, like the goat, especially it can synthesize like a ton more when it needs that. We will give them big brains so that we can make vitamin C so we can take it.
What are some of the other cofactors? Just as we start to wrap it up, but just a couple of the other important cofactors. And collagen? Why is collagen important apart from you want my skin and hair, and your joints? Well, I did hear in one of the lectures about collagen helping stop metastasis of cancers?
Dr Anitra: Right, yes, that's one mechanism. It's also very important in wound healing. And, interestingly, a lot of—a reasonable number of surgeons are aware of this and that they're a lot more open to people taking vitamin C around surgery before and after surgery just to help affect wound healing.
Lisa: Oh, wow. Yes.
Dr Anitra: Which is great. And
Lisa: And oncologists, are they sort of open to...
Dr Anitra: Least so
Lisa: Least so. Yes. In fact, I've had friends who have told us, if you take intravenous vitamin C, we won't do any treatments. And this is...
Dr Anitra: And that is primarily around all the misunderstanding around those early, early trials around intravenous. What I'm seeing is when Linus Pauling showed a feat of vital intravenous vitamin C. The clinicians at the Mayo Clinic who tried to reproduce those studies, they used oral doses, so just small doses over a day.
But back in those days, they weren't aware of the different pharmacokinetics of vitamin C, they thought oral and intravenous, are just the same, like the drug. But it's quite different. Oral uptake is a lot lower, much smaller amounts are taken up versus intravenous, you can get really high doses. And very quickly,
Lisa: Up to 200 times. I heard Professor Gabi Dachs, saying that intravenous is up to 200 times for short periods, but that short periods makes a difference, because you can get that into the tumor cells and to—so that… And this is the problem. Professor Margreet Vissers was saying the original controversy around Linus Pauling’s work and because they didn't have an understanding of how can possibly this mechanism of action been working. They just pursued it, basically. And it caused this big rift, those on the side, and those on that side, and for the next—what are we? 40 something years later—we'll still actually, it's problematic.
Dr Anitra: Yes, it wasn't really till Mark Levine did his really detailed pharmacokinetic studies that people realized the big differences between oral and intravenous. And also there’s more recent discoveries of vitamin C's cofactor functions around regulating genes through herbs and through the epigenetic enzymes. These are all mechanisms, which could be involved and its anticancer mechanisms as such. And so the epigenetic area is a very, very exciting, very interesting area of research. And I think it'll enable us to personalize medicine in the future.
Lisa: Oh! I mean, I have an epigenetics program as one of my health programs. And yes, that's looking at okay, how genes being influenced by your environment, and let's optimize your environment to your genes. And the vitamin C helps serve to give people an understanding, so is vitamin C helping produce the enzymes that read the DNA? And then therefore having the reactions. Is that how it works?
Dr Anitra: It works as a code.
Lisa: the transcription
Dr Anitra: Yes, so it helps the function of the enzymes which modify the DNA. So genetics is about the DNA itself. Epigenetics is above the DNA. So it's a way to regulate the DNA as you know. Usually through adding methyl groups to the dynast DNA, adding and subtracting and that affects how the DNA is read by the enzymes that read DNA and transcribe it.
Lisa: Turning them on or off, or simplify.
Dr Anitra: So vitamin C, regulates the enzymes which modify the methyl groups and stimulates them coming off or stimulates different mechanisms happening. So switching certain genes on, switching certain genes off, now it can teach you to regulate thousands of genes in our body through stimulation of these enzymes.
Lisa: Wow. So yes, I've heard somewhere, I think it was seven or 8000 genes that are possibly affected by this. So we are really at the beginning of the vitamin C journey, as far as the epigenetics mechanisms is concerned. Yes, that's exciting.
Dr Anitra: A lot of its functions, not just in cancer, but in all areas of health and disease, these functions could be playing a role. So yes, huge areas of research possible there.
Lisa: Yes. Yes. Yes. Is there a—I remember Professor Margaret, talking about Tt? Is that one of the enzymes? The Tt one?
Dr Anitra: It is an enzyme, that's right.
Lisa: And that's important for cancer in some way?
Dr Anitra: Now, the enzyme search modifies the methylated DNA, some regulation that epigenetics. And it's definitely difficult.
Lisa: To replicate it in the cancer process. Wow. Okay, we're getting quite technical here.
Doctor Anitra, I just want to say thank you very much for your dedication because I've listened to a couple of interviews with you. And you've actually sacrificed quite a lot to do the research that you're doing because there isn't a heck of a lot of funding and things are out there. So, thank you for doing all that. It's a labour of love, I can imagine. It's a long, slow process, getting the information, getting it to be watertight—scientifically watertight, so that we can actually get people help, who need help. And that at the end of the day it’s the reason I'm doing this podcast. And it's the reason you're doing your research, and hopefully together and with many others, we can move the story along so that people get helped.
Is there anything that we haven't covered that you think would be an important message for people listening today?
Dr Anitra: Well, I think—I mean, of course, infection is very relevant these days with COVID. There’s a lot of information and misinformation floating around out there about vitamin C and COVID. And at this stage, the studies are still at the really early, early stages. Americans have done a study which shows that patients with COVID in the ICU do have low vitamin C levels, like other similar conditions. COVID is a severe respiratory infection like pneumonia and sepsis or complications with COVID. And so, I think that the key is to stay healthy, eat a good healthy...
Lisa: Boost your immune system, yes.
Dr Anitra: Yes, to support your immune system, it doesn't mean you won't get COVID. But it may decrease the severity and the duration, so it doesn't go on to become the more severe version, the pneumonia and sepsis.
So I think that's an important message and if you do get infection, your requirements, dear God, so you do need to take more vitamin C, you need to take gram amounts, rather than milligram amounts. Want you to prevent getting even more severe. So, I'm all for prevention as much as possible, not leaving it till it's too late. So, I think, yes, just look after yourself, eat well.
Lisa: Yes. And get your vitamin C. Come buy some kiwi fruit, and some oranges today, and some lemons, and capsicum. And some supplements maybe.
Just as a final thing, you yourself, have a study that's currently underway, which is really, really exciting. And this is based in the Christchurch hospital, I believe, in 40 patients and with sepsis. Can you just tell us a little bit, the parameters of that study and when you think you'll have some results from it?
Dr Anitra: So this was patients with septic shock. So once again, at the end. And they were administered either placebo control, so half the patients and the other half were given intravenous vitamin C at a dose of 100 milligrams per kilogram body tissue per day, which equates to about six to seven grams a day. The reason for that, I have wanted to use the high dose, Berry Fowler. But the ethics committee—because when I put this into the ethics committee, there were only the two studies out, which was Berry Fowler's and the small study headed by Iran. And they said, ‘Well, slightly more people have received a lot lower dose versus the higher dose. So we'd rather use the lower dose.’’ Even though there'd be no adverse events at any dose. And subsequently, no adverse events and any studies.
Lisa: No.
Dr Anitra: And so, we've used the lower dose, we've only just finished recruiting the last patients. It took a while and we had issues of lockdown. And so now we're in the process of analysing the samples that we've collected analysing the data. And so hopefully, we're about to pull that together, sometime next year and publish the results next year.
Lisa: Brilliant. I can't wait to see that. And yes, that's a little bit frustrating because I would have liked to have seen a study with the 15 to 18. And even that I thought was still very conservative compared to some of the cancer dosages. But I understand from what Dr Berry Fowler said because of the decreased kidney function often in septic patients and so on, but it's just like yes, but the dying often. And it's because that was one of the arguments that was thrown at me, I could damage my dad's kidneys. The sepsis was doing that quite nicely and he was dying anyway. So why the hell?
So, but I think even at those dosages, we’ll hopefully see some fantastic results come out of it. And hopefully, in future we'll be able to do slightly more high-powered dosages.
Dr Anitra: Yes. Well, the key is also the size of the study, our study is very small. And we were interested in being a scientist. I'm interested in how it's working in the body because once you understand how it's working, it makes it easier to design better studies and not our future studies.
And so, our study will be too small to show a yes or no, it decreases mortality or not—that we're leaving it up to the large studies to show there. And hopefully, we can put a bit more science behind how it's working, what's happening in the body.
Lisa: And it's such a complicated thing to design a study. People don't probably realize how the parameters and the limitations and the number of variables that you can look at and the primary outcomes and the secondary outcomes and so on.
Dr Anitra: Sepsis is such a complex variable that comes in as unique in this situation. So there's huge variability in the data. And that's where the biggest studies are good, because it helps decrease...
Lisa: The statistical...
Dr Anitra: The statistical analyses of those studies. Yes, I'm looking forward to the results of the big studies coming out.
Lisa: Yes, but these, these smaller ones are really, really important. So, and it's great that we've got one going in New Zealand. So, thank you very much for your work, Dr Anitra. It’s been absolutely fascinating. And thank you for your dedication to this. I really, really appreciate you.
Dr Anitra: Thank you. Thank you for inviting me.
That's it this week for Pushing the Limits. Be sure to rate, review, and share with your friends and head over and visit Lisa and her team at lisatamati.com