Episode 203
Ep. 203- The Great Tylenol Debate: Can It Really Boost Your Endurance?
In this episode:
So, guess what? This week we’re breaking the mold because there’s no guest interview—yep, you heard that right. After 203 episodes, I’m feeling a bit like a kid who shows up to school without their homework. But hey, life happens, right? Instead, we’re diving into a juicy medical mailbag question about the hot topic of whether Tylenol can actually boost your endurance performance. Spoiler alert: the answer isn’t exactly a mic drop moment. We’ll sift through some research that claims it could help, but don’t get too hyped; the benefits are as tiny as my patience during a slow group run. Plus, we’ll touch on some wild stories from the multisport world, including a heartbreaking loss and an awe-inspiring triumph, because, you know, we like to keep it real—life’s a rollercoaster, folks! Buckle up and let’s get into it!
Segments:
[10:39]- Medical Mailbag: Tylenol talk
Links
Transcript
Foreign.
Speaker B:Hello and welcome to the Tridog Podcast.
Speaker B:I'm your host, Jeff Zankoff, an emergency physician, a triathlete, a triathlon coach, and a multiple Ironman finisher.
Speaker B: ,: Speaker B:And I'm coming to you as always, from beautiful, sunny Denver, Colorado.
Speaker B:There was no voice at the top of this episode, no snippet from an interview, because, alas, this is going to be the first ever time in 203 episodes, six whole years, that I don't have an interview for you.
Speaker B:And I'm a little bit sad about that, but circumstances have conspired and I just have not been able to line up an interview.
Speaker B:I had an interview that was supposed to be scheduled and actually brought to you on this episode, but there were all kinds of snaf that came up, first on my part and then on my interviewees.
Speaker B:She had personal issues that caused her to not be able to make our time and the interview fell through.
Speaker B:And alas, I don't have an interview for you on this episode.
Speaker B:I do of course, have a medical mailbag question to answer that in the form of a question that I first addressed.
Speaker B:Would you believe it way back when, on the very first episode of this podcast, episode number one, when I looked at the question of whether or not acetaminoph is something that can benefit endurance performance, that question has been asked again.
Speaker B:I think it's a testament to the fact that I've been around for so long that questions that are old are new again.
Speaker B:And let's face it, there's always new research coming out, new evidence that makes questions worth looking at again.
Speaker B:So if you have heard me address something on this program in the past and you wonder whether or not there are any updates, or you wonder, or maybe you've heard something that suggests that maybe my initial response to the question may have changed, feel free to ask it.
Speaker B:We are always happy to look and see if there's anything new out there that would change our response or inform the response that we gave initially and maybe give more insight.
Speaker B:So the question came up again as to whether or not Tylenol can be beneficial for performance.
Speaker B:This time it was based on a excerpt from the book by Alex Hutchinson.
Speaker B:His book Endure made reference to an article that came out in the intervening time between when I first looked at this question and today where he says that, look, if you take 1,500 milligrams of Tylenol in the 45 to 60 minutes before exercise, you actually get a significant ergogenic effect and I wanted to see whether or not that was true.
Speaker B:Alex Hutchinson, a very respected physiologist, he often speaks the truth to these kinds of things.
Speaker B:So is this in fact true or is this maybe not so much?
Speaker B:We'll have that coming up in just a little bit.
Speaker B:Unfortunately, as I've already said, no interview this time.
Speaker B:I'm hoping to get back to my usual programming where I have interviews for you every two weeks.
Speaker B:But I will say it's been increasingly difficult to do so.
Speaker B:So I'm putting a plea out to all of you, my listeners, if there's someone that you know who you think would be an excellent guest for this program.
Speaker B:It doesn't have to be anybody famous as I've had people on this program from all walks of life.
Speaker B:They don't actually have to be within the world of multisport as long as they're multisport adjacent and have something to to the listeners, something that they can bring to this program that can inform my listeners.
Speaker B:I've had people on here like marriage counselors, I've had lawyers, I've had people who can speak to all variety of things that do touch on our training, our recovery, our life as multisport athletes.
Speaker B:And I am always interested in bringing those conversations to you.
Speaker B:So if you know of anybody who you think would make a good guest, who you think would be of interest for the listeners to hear from, send them my way.
Speaker B:You know how to reach me.
Speaker B:Tridocloud.com and of course there is always the possibility of dropping into the Facebook group if you're not already a member.
Speaker B:I hope that you'll head on over there.
Speaker B:Search for Tridoc podcast on Facebook answers the three easy questions.
Speaker B:I'll gain you admittance.
Speaker B:You can join the conversation about all the things you hear on this program and of course suggest guests and connect them to me where I hope to be able to get them on the program and bring those conversations to you.
Speaker B:Before we get to the medical mailbag, I do want to acknowledge a couple of stories that have come up in the multisport world.
Speaker B:One of them a little bit sad, the other one actually quite exciting.
Speaker B:The sad story relates to ultra swimmer Rebecca Thompson.
Speaker B:This is a woman who was well known in the world of ultra endurance swimming.
Speaker B:This woman has had a very accomplished resume of long distance swimming over decades.
Speaker B:Really.
Speaker B:She is well known within that community and just recently was making an attempt to swim from Los Angeles to the Channel Islands and within sight of her goal suffered a cardiac arrest in the water was pulled from the water and unfortunately resuscitative attempts were not successful.
Speaker B:Her loss at a very young age, in her early 50s, is a huge blow to the ultra swimming community.
Speaker B:And it's a reminder once again of just how perilous that sport can be.
Speaker B:We often hear of the successes of people who undertake these swims in all kinds of environments, conditions, and obviously when they are successful, it is something that we celebrate and that we come to think of as being almost common in a way because they happen so frequently.
Speaker B:It used to be that these long distance swims were not that frequent and that when they occurred they were really big events.
Speaker B:Nowadays it's almost routine that people undertake these things.
Speaker B:But I think this is a reminder that even amongst the most experienced of swimmers, there are still risks involved.
Speaker B:And for somebody who was as experienced and as fit as Rebecca was, this is unfortunately a very sobering reminder of what can happen whenever we undertake the sport that we love.
Speaker B:So condolences to the friends and family of Rebecca Thompson.
Speaker B:I would never bring such a story up to warn people against doing these things, but just as a way of celebrating the life of somebody who had a passion for doing the thing that she loved and succumbed while doing that thing.
Speaker B:I think that we would all hope to live our life to the fullest the way she did.
Speaker B:And if we have to go out, then maybe we go out in the way that she did, doing the thing that we love.
Speaker B:The other story is much more joyous and equally impressive.
Speaker B:It relates to a Paralympian by the name of Mohammed Lana.
Speaker B:Lana, who was originally from Morocco and competed in the Paralympics for Morocco and then for the United States.
Speaker B:His naturalized country, most recently in Paris, just undertook an obscenely difficult challenge where he did a cross country triathlon.
Speaker B:He swam 28.5 miles around the island of Manhattan.
Speaker B:He then got on a bicycle, all with his prosthetic leg, bicycled 3,000 miles across the United States to Las Vegas, Nevada, where he then strapped on his running prosthesis and ran the final 300 miles across the Mojave Desert, across the mountains and into Los Angeles, where he finished his triathlon just this past week.
Speaker B:The accomplishment is phenomenal for a able bodied individual, but for a Paralympian it is that much more impressive.
Speaker B:Muhammad's team, apparently every two miles of his run, stopped to take care of his prosthetic, to take care of his amputated limb and make sure that he was able to continue.
Speaker B:And the accomplishment that this man was able to do was just, I think once again illustrates the ability of the human body to overcome just so many challenges.
Speaker B:The environmental conditions he went through, the ability to persevere with only one leg and a prosthetic is just a testament to human endurance and human capabilities.
Speaker B:And I can't say enough about Mohammed Lana.
Speaker B:I wish I had a connection to him because getting him on this program as an interview would be quite a catch.
Speaker B:So if anybody out there has a connection to him or his team, please do let me know.
Speaker B:Would love to chat with him.
Speaker B:I think he is just somebody who has obviously phenomenal internal strength and he would be just an amazing person to talk to.
Speaker B:But Mohamed Lana, his accomplishment is something that I think flew a little bit under the radar.
Speaker B:I personally had not heard a whole lot about it until he actually finished it.
Speaker B:And then I caught a news story about it.
Speaker B:And if you haven't heard much about it, I urge you to head on out and find stories about it because what he did is just incredible.
Speaker B:All right, that's what I've got to say for this week.
Speaker B:We are just over a month away from the 70.3 World Championships in Nice.
Speaker B:It is shaping up to be a incredible field.
Speaker B:The men's list is shaping up at this point and just looks, we thought it was amazing in Marbella.
Speaker B:It looks even better this year in Nice.
Speaker B:The people who aren't going to be there is enough to make for an incredible field.
Speaker B:And so the people who are going to be there, it just looks that much better.
Speaker B:And the women's field, not yet fully announced, but should be, I think, equally amazing.
Speaker B:And we are going to have two days of sensational racing on the Mediterranean in France in just over a month's time.
Speaker B:Are you excited for this event?
Speaker B:Are you heading there?
Speaker B:Let me know.
Speaker B:I'd love to hear.
Speaker B:I'd love to hear your thoughts about who you think is the athlete to watch for the victory and want to hear all about whether or not you are excited to be participating, wish you were there and anything else you might have to say on this subject.
Speaker B:All right, that's what I've got for you today.
Speaker B:Let's head on to the Medical Mailbag segment where we're going to discuss the use of Tylenol and whether or not it can or cannot do what Alex Hutchinson says, and that is improve your ergogenic effects, improve your ability to produce strength in running and biking when you take Tylenol 45 to 60 minutes before an endurance event.
Speaker B:Truth or fiction?
Speaker B:We'll find out right after this short break.
Speaker B:We have an abbreviated episode of the Tridoc podcast only a medical mailbag segment, which means lots of time for Juliet and I to banter.
Speaker B:And Juliet is here.
Speaker B:So she is both my interview subject and my medical mailbag co host.
Speaker B:Wow.
Speaker B:Yeah.
Speaker B:Welcome back to the Medical Mailbag.
Speaker B:You have a exciting weekend of travel coming up.
Speaker B:We are recording this on Tuesday, August 4th, just a couple of days before the episode will release.
Speaker B:Where are you off to?
Speaker A:I'm off to the garden spot of Milwaukee, Wisconsin, which probably I'm sure is a very nice city.
Speaker A:I don't know if it's a nice city in August, but anyway, I am going there because that is where USA Triathlon is hosting its national championship this year, which involves a sprint length triathlon, a Olympic length triathlon and then the mixed team relay.
Speaker A:Actually it's interesting because they are now, they are now having both a draft legal sprint triathlon and the traditional non draft legal sprint triathlon.
Speaker A:And I will be doing both of those as well as the mixed team relay.
Speaker A:I will not be doing the Olympic.
Speaker A:That would be a bit much.
Speaker A:So three days of racing, Friday, Saturday, Sunday, some interesting sort of equipment issues to deal with this week because of course you can't use a triathlon bike for draft legal races.
Speaker A:And then of course you want aero bars and so some swapping on and off of aero bars because I don't want to take two bikes.
Speaker A:And then you think about things like what's a really fast and furious race?
Speaker A:Am I going to be able to employ two different methods of technology with a bike garment and a non bike garment and just socks, no socks, really short race.
Speaker A:How am I going to get my shoes on with wet feet?
Speaker A:All of the things.
Speaker A:So it's been a fun sort of week of really trying to muddle through all the details.
Speaker A:Switching over from 70.3 Oregon, which is only what, three weeks ago now, I think.
Speaker A:So it's fun.
Speaker A:And there will be six other life sport athletes there as well and that will be fun to be there with them and support them as well.
Speaker A:So be fast and furious.
Speaker B:So the mixed relay, is that something you are selected for?
Speaker B:Is that something you just sign up for with a team?
Speaker B:How does that work?
Speaker A: o the age group ranks back in: Speaker A:But I guess the age groupers complained so much about this that USAT threw up their hands and said, forget it.
Speaker A:From now on you can all sort out your own teams.
Speaker A:So now, unbeknownst to me until a few months ago, it has turned into this dating ritual where people start months ahead of time to figure out who's going and all the shortcuts, people kind of know each other, et cetera.
Speaker A:And I just throw up my hands and say, forget it, I'm just not going to do this.
Speaker A:So there's a spreadsheet out there of people who haven't found a team.
Speaker A:So I'm on a team with people I don't know and it is what it is and it'll be super fun and I'm looking forward to it.
Speaker A:And it is a very quick race.
Speaker A:It is a 250 meter swim, it is a four and a half kilometer bike ride and then an 8, 800 meter run.
Speaker A:So this is about half point of that.
Speaker A:I know, but what you do is you.
Speaker A:Each person does their own mini triathlon before handing off to the next person.
Speaker A:So it's bang.
Speaker A:And it's about half the distance that I remember it being at Worlds.
Speaker A:And so when I looked at the distances, I thought, oh my gosh, this looks like an opportunity for a torn hamstring if I ever saw one.
Speaker A:So it'll be fun, it'll be a lark.
Speaker A:It's always fun to do something with other people.
Speaker A:I'll meet these people for the first time, probably right before the race and it'll be great.
Speaker A:And the idea is that by virtue of just participating in this race, it will give me a spot to do the mixed team relay, should I choose to do so at worlds in Hamburg next year.
Speaker A:And I can make that decision later and perhaps I will engage in the dating ritual.
Speaker A:So I know who my teammates will be at that event.
Speaker A:But that's down the road.
Speaker B:So they do mix team relay for sprint and Olympic.
Speaker A:No, not Olympic, just sprint.
Speaker B:Yeah, they just do sprint.
Speaker A:Yeah, they have an Olympic distance race.
Speaker A:They have a sprint draft legal distance race.
Speaker A:No, non draft legal at Worlds.
Speaker A:And then they have a mixed team relay race.
Speaker A: ad such a fun time with it in: Speaker B:But relay, the relay at worlds is.
Speaker A:Just sprint, a super sprint when you think about it.
Speaker A:Right.
Speaker A:It's these distances that I've just laid out, only probably a little bit Longer.
Speaker A:Yeah.
Speaker B:And at the Olympics, the relay is what distance?
Speaker B:It's Olympics.
Speaker A:That's a good question.
Speaker A:It's not an Olympic distance.
Speaker A:It's much shorter.
Speaker A:But I don't think it's as short as what we are doing at age group nationals.
Speaker A:I don't know what it is.
Speaker A:And it might also.
Speaker A:I don't know if there's a standard distance for mixed team relay.
Speaker A:They might just use what the venue sort of allows.
Speaker A:I'm not sure about that.
Speaker B:Okay.
Speaker C:All right.
Speaker A:Yeah.
Speaker A:Anyway, it'll be different.
Speaker A:It'll be fine.
Speaker B:Tell how much time I spend doing tell how much time I spend doing short course and zero.
Speaker A:Right.
Speaker A:It's a different stimulus.
Speaker A:It'll be fine.
Speaker A:It'll be zone five.
Speaker A:I'm actually a little bit terrified of it because it's so much harder than we go in 70.3.
Speaker A:Right.
Speaker A:Just leave your lungs on the grass type of thing.
Speaker A:So.
Speaker B:And I spend a lot of my time at track meets now in between watching the field event, which I'm there for, we spend a lot of time looking at the track and watching the runners.
Speaker B:Right, right.
Speaker B:It's always.
Speaker B:It's funny when you talk to other parents, it's like, oh, the 400 is the worst.
Speaker B:It's like, oh.
Speaker A:And then someone says, oh, the 800 is the worst.
Speaker B:The 800's the worst.
Speaker B: Oh, the: Speaker B:God, the 15.
Speaker B:And they're all bad as far as I'm concerned.
Speaker B:I do think the 400 is probably the worst just because the 400 is the last of the true sprinting events.
Speaker A:Yeah, I guess.
Speaker B:And it is funny because you watch these kids, the younger the kids are, the faster they go out on the 400, and the faster they die.
Speaker B:And you watch them.
Speaker B:I always say to my wife, and if my son is there watching, we're like, oh, let's watch.
Speaker B:Let's see.
Speaker B:Oh, yeah, no, that kid is not going to make it at that pace.
Speaker B:But then once you get to the 800, most of the kids have an understanding that they can't sprint anymore.
Speaker B:And it doesn't make it easy.
Speaker B:Running a good 800 to even split your four hundreds is really hard.
Speaker B:And that takes maturity.
Speaker B:It takes time to get there.
Speaker B:Listen, all of these track events, I think, are just.
Speaker B:Yeah, they're especially at that level.
Speaker B:They're so hard.
Speaker B:So, yeah, it's.
Speaker A:Well, just sometimes we'll ask, oh, sprint distance, that must be so easy because it's so short.
Speaker B:Right.
Speaker A:And the way I think of it is a sprint distance triathlon it takes, I don't know, depends, an hour to an hour 15, depending on who you are and what the course is.
Speaker A:But it's.
Speaker A:You feel like your heart is exploding, your lungs are absolutely coming out through your mouth.
Speaker A:It is the most painful thing.
Speaker A:It's really awful.
Speaker A:And you come across the finish line and you just fall over.
Speaker A:You collapse, right.
Speaker A:But then sinus lady, your heart rate comes down and you're free.
Speaker A:But Whereas at the 70.3, you just feel like your skeleton's gonna fall apart, your heart rate never.
Speaker A:Your heart rate never really gets that high, at least not for we mortal age groupers, but you just feel like your whole body is just falling apart by the end.
Speaker A:So I don't know which is worse.
Speaker B:It's a very different.
Speaker B:Yeah, it's very.
Speaker B:And our friend Kelly has been talking to me because I've.
Speaker B:I've lamented my inability to get in the same kind of training.
Speaker B:And she's like, you might want to consider short course.
Speaker B:And part of me is like, oh, that might be an opportunity to explore.
Speaker B:And the other part of me is, do I really want to go anaerobic for that long?
Speaker A:I know, I know.
Speaker A:And then you have this draft legal element of it too, which makes it more like bike racing, which I love.
Speaker A:And there are few enough competitors still, at least in the US in draft legal racing, where you don't start in five year age groups, you start under 40 and over 40.
Speaker A:So you're in there with a whole bunch of different women with different drafting abilities and you have to.
Speaker A:And of course, now we have all these youngsters coming up from the NCAA ranks, at least on the women's side, so the younger age group, they actually kind of know what they're doing.
Speaker A:But my age group, certainly not.
Speaker A:And so you get out there and you have to read the field really quickly and decide, am I going to be a follower or am I going to get in there and say, this is what you're doing.
Speaker A:Shut up and listen.
Speaker A:Do what I say.
Speaker A:This is how we work together.
Speaker A:Because a lot of older women at least have no idea how to really properly draft and how to use that.
Speaker A:So it's an interesting dynamic.
Speaker B:And the strategy also comes in too.
Speaker B:As somebody who's a stronger cyclist than runner, obviously want to try to get away as much as you can, although in a draft legal race, that's hard to do.
Speaker B:And.
Speaker B:Yeah, this is all.
Speaker B:Yeah.
Speaker B:Anyways, we'll see.
Speaker B:We'll see if I get there or not.
Speaker A:You should try it.
Speaker B:Yeah, maybe I will.
Speaker B:We'll see.
Speaker B:I still have.
Speaker B:I'm going to get through.
Speaker B:I've got Nice coming up next to you.
Speaker B:I'm going to take a little bit of a layoff after that to try and heal up this leg so I can actually return to running in a real way.
Speaker B:And we'll see.
Speaker B:We'll see what I do next year.
Speaker B:I haven't decided.
Speaker B:We do have a medical question to answer, so why don't we get to that.
Speaker B:We are fortunate once again to have a listener who sent something in.
Speaker B:This came by way of the Tridoc Podcast Facebook group.
Speaker B:If you're not already a member of that private group, we hope that you will head on over to it over on Facebook, answer the three easy questions.
Speaker B:We'll gain you admittance.
Speaker B:You can join the conversation about all of the things we discuss on this program and submit your questions just like our listener did for this topic.
Speaker B:So what are we going to be answering today?
Speaker A:Yes, shout out.
Speaker A:And thank you so much to Michael Flanagan, who sent in this question.
Speaker A:He just finished Alex Ashenson's book called Endure, and Alex talks in this book about the benefit of Tylenol before exercise.
Speaker A:And Michael was curious if this was a thing, if we knew anything about this.
Speaker A:And interestingly enough, I think you covered this topic way, way back at the very beginning, but we're gonna revisit it today.
Speaker B: this podcast way back when in: Speaker B:It was episode number one and the aforementioned friend Kelly was our guest.
Speaker B:My guest on that, bro, I didn't know that.
Speaker B:So, yeah, way back when, episode one looked at the question of acetaminophen in helping in endurance sport.
Speaker B:And it's come back.
Speaker B:I guess all things old are new again, right?
Speaker B:I have great respect for Alex Hutchinson.
Speaker B:He is a physiologist, I believe he's a doctor of physiology, I'm pretty sure, and has written extensively.
Speaker B:He writes for Outside magazine.
Speaker B:We circulate in the same environment.
Speaker B:I write for Triathlete, he writes for Outside, but we have not corresponded in any meaningful way.
Speaker B:But he is basing his assertions on basically a single paper.
Speaker B:And that paper gets bandied about quite a bit.
Speaker B: in I believe this came out in: Speaker B:This issue of Running Magazine says acetaminophen is a popular.
Speaker B:And if you're not familiar, acetaminophen is the trade name of the brand name Tylenol.
Speaker B:So acetaminophen can be the generic name of this drug.
Speaker B:Acetaminophen is a popular choice for pain relief for many runners before and after runs and hard workouts.
Speaker B:For years, researchers have debated whether or not the pain reliever had an ergogenic effect.
Speaker B:But a recent meta analysis has confirmed that when taken 45 minutes to an hour before a big effort, acetaminophen can in fact improve performance.
Speaker B:That is overstating, according to the people who actually wrote the meta analysis, what the meta analysis actually found, and this is something that I think we find a lot in science, which is that a scientific article can report some findings that are, maybe they're there, it's a real signal, but it's not huge.
Speaker B:And yet it's taken out of context and blown into something much bigger.
Speaker B:And that I think has been what we've seen with Tylenol.
Speaker B:And I think Alex has mistakenly bought into this without really digging into it a little bit.
Speaker B:I do not mean any disrespect to Alex whatsoever.
Speaker B:I think he's just one of many who have done the same thing here.
Speaker B: the original paper comes from: Speaker B:It was published in Sports, which is a journal I'm not familiar with, but it's a Swiss journal and basically the title was Effects of paracetamol, which is European name of acetaminophen ingestion on endurance performance.
Speaker B:A systematic review and meta analysis.
Speaker B:Good study by two authors by the name of Grgich and Mikuli.
Speaker B:I believe they must be Croatian or Serbian.
Speaker B:The authors here combined data from 10 randomized double blind crossover studies.
Speaker B:Total of 141 patients or subjects examining whether acetaminophen improves endurance performance.
Speaker B:Overall.
Speaker B:They found that and this is what they got from looking at all these studies.
Speaker B:Acetaminophen does not appear to meaningfully improve endurance performance.
Speaker B:And I think that really should be the take home from this is if the headline is going to be anything, it should be acetaminophen does not improve endurance performance in any meaningful way.
Speaker B:There were, however, some small benefits observed in some of the subgroup analyses.
Speaker B:And look, when you take research like this and you start breaking it down and you start doing these statistical analyses of smaller and smaller subgroups, eventually it's true, you're probably going to find something.
Speaker B:These effects though, didn't translate to improved performance in races and the effect sizes were incredibly small.
Speaker B:There were no statistically significant improvement in endurance performance compared with placebo within the subgroup analysis.
Speaker B:And this is the big one.
Speaker B:When taken 45 to 60 minutes before exercise, there was a very small improvement.
Speaker B:That was the only statistical thing seen.
Speaker B:The thing is, they don't really say what the small improvement was in, which is really interesting.
Speaker B:I think it was just generic overall.
Speaker B:But the effect size is very small.
Speaker B:It was 0.14.
Speaker B:And when we talk about effect sizes, the bigger that number, it's called the D number, D equals 0.14.
Speaker B:You want that to be in an order of magnitude higher.
Speaker B:So it should be at least 1 to 5 or something like that.
Speaker B:When it's 0.14, it means your effect size is so tiny it's basically negligible.
Speaker B:But it was statistically significant.
Speaker B:And it comes back to something I've mentioned to you many times, which is you can have a statistically significant, like a disease oriented outcome or you can have a patient oriented outcome.
Speaker B:And this is an example of a, a disease oriented.
Speaker B:Yes, there's something here statistically significant, but it doesn't mean anything for the athlete.
Speaker B:And that's really the important thing.
Speaker B:But that hasn't stopped people like Running magazine, Alex Hutchinson seizing onto this and being like, oh, this is a big deal.
Speaker B:If you heard stuff about this.
Speaker B:Does this ring any bells to you about Tylenol or.
Speaker A:No, it doesn't.
Speaker A:But I do wonder what you're talking about is that the question of does Tylenol improve athletic performance?
Speaker A:And I understand that's what we're always after on the show, is that can we parse that at all from if the athlete was suffering from some sort of injury and just needed a little bit of pain relief, that it could alleviate the pain during the performance, but that doesn't necessarily mean it improves the performance.
Speaker B:So that gets down to how does this supposedly work?
Speaker B:And we always want some biological premise to how acetaminophen would help.
Speaker B:There's two ways acetaminophen is theorized to help athletes with performance.
Speaker B:Number one is by decreasing core temperature.
Speaker B:As acetaminophen has a antipyretic effect, so it lowers body temperature when you have a fever.
Speaker B:People think if, when you're exercising, you have a fever, you raise your inner temperature.
Speaker B:Could acetaminophen blunt that effect?
Speaker B:Allowing.
Speaker B:And we know also that when your internal temperature is higher, you have a blunting of the ability to produce power.
Speaker B:So is it possible if we lower our internal temperature a little bit, you will have an ergogenic effect, a higher ability to produce power.
Speaker B:So that's number one.
Speaker B:And then second thing is what you're referring to, if you reduce pain, can you perform better?
Speaker B:So we're gonna get to both of those questions because it comes up a little bit later.
Speaker B: But I do wanna just say, in: Speaker B:It was a study that came out in Sports Medicine.
Speaker B:It was titled, what is the Effect of Acetaminophen Ingestion on Exercise Performance?
Speaker B:Current Findings and Future Research Directions.
Speaker B:He concluded that, yeah, acetaminophen may provide small ergogenic benefits under very specific conditions, particularly when you take one and a half grams 30 to 60 minutes before exercise, and its effects are, like, so negligible, but still statistically significant.
Speaker B:We just can't say exactly what it really means.
Speaker B:The author, Girgich, he went out to stress that, look, the evidence here is really inconsistent and very limited, and to make any kind of conclusions based on this at this time is just not.
Speaker B:It's not a great idea because there's too much uncertainty.
Speaker B:There are potential safety and even ethical concerns around this idea that taking this could blunt pain response, could blunt the necessary feedback that we get from injuries that could result in furthering injuries and making athletes actually worse.
Speaker B:So he was concerned.
Speaker B:He said, look, I think we need to tone down this hype around Tylenol.
Speaker B: different authors came out in: Speaker B:The Effect of Acetaminophen on running Economy and Performance in Collegiate Distance Runners.
Speaker B:A study of only 11 collegiate distance runners, only two of whom are women.
Speaker B:They had them look at three kilometer time trials.
Speaker B:They took 1,500 milligrams of acetaminophen and looked at whether or not running economy was improved, not so much their form, but rather their ability to metabolize calories and produce energy.
Speaker B:So, again, looking at this idea, but maybe keeping our temperature under control allows for improved metabolism, improved running economy.
Speaker B:And the main findings, no improvement in running economy at any exercise intensity following Tylenol ingestion.
Speaker B:No significant improvement in overall performance and ratings of perceived exertion.
Speaker B:Ratings of pain and perceived exertion not meaningfully altered by acetaminophen.
Speaker B:Really a negative study.
Speaker B:And then a concerns article, Concerns with acetaminophen and endurance port.
Speaker B:And this comes to what you were talking about.
Speaker B:This narrative review examines the role of pain and thermal perception in limiting endurance performance and discusses whether interventions that reduce these sensations can enhance exercise capacities.
Speaker B:And the authors here, Stevens, Mauger, Houseman.
Speaker B:I'm not reading this right.
Speaker B: And Taylor from: Speaker B:The authors propose that acetaminophen can provide modest performance benefits by reducing exercise induced pain perception.
Speaker B:But they emphasize that the evidence is still very limited.
Speaker B:Analgesic use in sport raises important safety and ethical concerns, particularly because reduced pain perception can mask successive injury or excessive physiologic stress and lead to significant problems.
Speaker B:And, and I think you and I have talked a little bit about this with our own athletes and I always caution athletes to be very careful about taking pain medications because you don't want to overdo something and not realize you're overdoing it because leading to injury, never anything you want.
Speaker B:Right?
Speaker A:Right.
Speaker B:Acetaminophen versus caffeine randomized double blind crossover study examining whether acetaminophen alone, caffeine alone or their combination improved resistance exercise performance in 29 resistance trained participants.
Speaker B:11 Who were men, 18 of whom were women.
Speaker B:About that.
Speaker B:Yeah.
Speaker B:How about that?
Speaker B:And here we see that caffeine alone.
Speaker A:Shocking.
Speaker B:Was the thing to take.
Speaker B:Yeah, Shocker.
Speaker B:So adding acetaminophen did nothing.
Speaker B:There was no synergistic benefits.
Speaker B:There was.
Speaker B:You really just.
Speaker B:If you just took.
Speaker A:I wonder if you even thought of that.
Speaker A:Oh, I know.
Speaker A:Let's mix Tylenol and coffee.
Speaker A:That wouldn't be the first thing I would think of.
Speaker B:It's interesting.
Speaker B:Caffeine is known to improve the absorption of drugs.
Speaker B:We see caffeine mixed into a lot of formulations of over the counter medications because it enhances their absorption.
Speaker B:So I think what probably went on here is, hey, we know caffeine improves ergogenic effects.
Speaker B:We know caffeine improves the absorption of some medications.
Speaker B:Maybe if we put them together, we can get a combined synergy.
Speaker B:Right.
Speaker A:A super painkiller.
Speaker B:Super duper.
Speaker A:Yeah.
Speaker B:Didn't work out so well.
Speaker B:It didn't actually result in anything.
Speaker B:And then at the end of this, Cosette, I should have mentioned at the beginning, Cosette Rhodes was the intern on this subject.
Speaker B:She found a paper.
Speaker B:It was a pre clinical study.
Speaker B:Because what would it be?
Speaker B:What would our conversation be if we didn't get some rats into this?
Speaker B:So she found none.
Speaker A:Are they on a treadmill?
Speaker B:Are they not swimming?
Speaker B:They're not swimming.
Speaker B:They were on a.
Speaker B:What were they on?
Speaker B:They were on a treadmill, I believe.
Speaker B:Yes.
Speaker B:Treadmill.
Speaker B:Maximal treadmill test, Maximum treadmill.
Speaker B:Yeah, it doesn't sound good for them.
Speaker B:Rats randomized to exercise or sedentary conditions with either acetaminophen or placebo.
Speaker B:No effect on endurance performance.
Speaker B:No differences in body weight, food intake, water intake, muscle cross.
Speaker B:Basically, the acetaminophen did nothing.
Speaker B:So Michael and others and Alex, should you ever listen to this, the headline out of that study is not really appropriately taken headline.
Speaker B:The headline should be acetaminophen in a subset or a subgroup.
Speaker B:Analysis of this larger meta analysis seems to suggest there may possibly be a signal here, but.
Speaker B:But to date, there's really no good evidence that acetaminophen does anything whatsoever.
Speaker B:I do want to also say, as we've talked about other medications, a lot of people hear these things and they think 1,500, maybe 2,000 would be better.
Speaker B:Maybe 2,500 would be better even.
Speaker B:And with a lot of medications, there's a pretty wide safety, therapeutic dosing.
Speaker B:It's not a big deal.
Speaker B:Acetaminophen is not one of those medications.
Speaker A:Oh, I didn't know.
Speaker A:That's interesting.
Speaker A:Okay.
Speaker B:Yeah, Acetaminophen you gotta be really careful with.
Speaker B:Look, it's not like 2 grams.
Speaker B:Grams or 3 grams even is going to get you into trouble, but depending on your body size, you don't have to take a huge amount to get into trouble.
Speaker B:And acetaminophen remains the number one cause for acute liver failure in the Western world.
Speaker B:It is the number one cause for the need for liver transplant.
Speaker A:But is that too much?
Speaker A:Is that too much medication over time or is that people taking too much at once?
Speaker B:So for the most part, it's suicidal attempts.
Speaker B:Oh, I take Tylenol.
Speaker B:So there's a reason people take Tylenol in a suicidal gesture, because they believe it to be safe.
Speaker B:And so they're taking it as a suicidal gesture, as in it's a cry for help.
Speaker A:So they really want to kill themselves?
Speaker B:Yeah, they don't intend to kill themselves.
Speaker B:They take a large amount of Tylenol, they feel bad, they regret that they.
Speaker A:Did go to the hospital.
Speaker B:No.
Speaker B:So what ends up happening is they regret that they did it, they don't tell anybody, and 24 hours passes and then the toxicity kicks in.
Speaker B:Oh, my gosh.
Speaker B:And if you treat a Tylenol overdose within about 36 hours, you can prevent the liver failure.
Speaker B:The problem is when people get so sick and they don't tell anybody and they get to about 48 hours, that's it.
Speaker B:Can't do anything.
Speaker B:It is a potentially fatal drug.
Speaker B:One bottle that you buy has more than enough to kill Many people.
Speaker B:So you have to be careful.
Speaker B:We really do.
Speaker A:I did not know that.
Speaker B:Yeah, stick.
Speaker B:And you can get chronic as well, chronic ingestions of Tylenol, especially if you're taking high doses every day.
Speaker B:It does accumulate because you won't clear it as the half life is such that if you keep taking too much, you will eventually get to a toxic dose.
Speaker B:It's important that this is one medication I always tell people, stay within the therapeutic dose and it's safe.
Speaker B:Don't exceed.
Speaker B:And look.
Speaker B:Can you take it when exercising?
Speaker B:Yes.
Speaker B:Just don't expect it's going to benefit you in any way.
Speaker B:It's not.
Speaker B:Yeah.
Speaker B:I'm glad the question came up because it gave us a chance to go over some more recent literature and it gives me a chance to go over this important, I think, safety message yet again.
Speaker B:Yes, we talked about ibuprofen as well in exercise.
Speaker B:Something that I think a lot of people take.
Speaker B:A lot of people think also as being safe.
Speaker B:And for the most part it is.
Speaker B:But when exercising you have to be careful because of its risks for causing damage to the kidneys.
Speaker B:Again, we just always want to be careful.
Speaker B:Everything we take has a risk.
Speaker B:We just have to be careful, that's all.
Speaker A:Gosh.
Speaker A:I remember back in the 80s when I was rowing at a very high level, we used to eat ibuprofen like it was candy everywhere.
Speaker A:In so much pain all the time.
Speaker A:Our backs were so sore all the time.
Speaker A:And we knew we could take up to four 200 milligrams each.
Speaker A:Right.
Speaker A:And we just leave.
Speaker A:It was so bad.
Speaker A:I wish we knew then what we know now.
Speaker A:Fortunately, I guess we were young and stupid but able to clear it.
Speaker B:But yeah, yeah, exactly.
Speaker A:Happy no more.
Speaker C:For sure.
Speaker B:Yeah, yeah, yeah, yeah.
Speaker B:And you wonder how many people are out there just taking what they want and.
Speaker B:Not necessarily.
Speaker B:Especially these days where healthcare is not as accessible and where there is so much disinformation.
Speaker B:Gosh.
Speaker B:What did I just come across?
Speaker B:It's.
Speaker B:I spoke on the last episode about this group of.
Speaker B:Of men that I met at Oregon who were happily taking peptides, thinking that it was helping them.
Speaker B:And despite the.
Speaker B:The absence of information that it does anything.
Speaker B:And now we have the FDA approving a whole bunch of peptides.
Speaker B:That helps because.
Speaker B:Because it's benefiting the people in charge.
Speaker B:Right.
Speaker B:There's a lot of money going to these companies that produce it that, that want to sell it.
Speaker B:All the right wing podcasters who are promoting it.
Speaker B:I just saw today.
Speaker B:This is unrelated to peptides, unrelated to this stuff.
Speaker B:But my favorite Dr. Huberman telling everybody on his podcast that you need to go out and get total body MRIs, because those total body MRIs pick up all kinds of things and we could save you if we pick them up early.
Speaker B:Without disclosing on his podcast that he is an owner and investor in a company that does total body MRIs.
Speaker B:Oh my gosh.
Speaker B:Like just mind blowing disclosed.
Speaker B:Yeah, Mind blowing disinformation.
Speaker B:That is self dealing.
Speaker B:And the thing is, like, people just flock to this stuff.
Speaker B:And here we are trying to give measured, evidence based information.
Speaker B:Look, you want to take Tylenol, go for it.
Speaker B:Just don't expect it's going to help you, but do it in this way, blah, blah, blah.
Speaker B:I have nothing to gain from it.
Speaker B:You have nothing to gain from it.
Speaker B:We just want to help people with the right good, solid information.
Speaker B:And it's.
Speaker B:I feel like we're up against a tidal wave of silliness that we're just never gonna cut through.
Speaker B:Thank you for being here if you're listening.
Speaker A:Yeah.
Speaker A:So these guys, people are gonna go off and get their total MRIs and they're gonna discover so many problems in their body that they have been living with for decades that have never been a problem.
Speaker A:And now they're gonna be hindered or hampered in their emotional ability to move forward because they think they've got this problem and this problem, this shoulder and this hip and whatever.
Speaker A:And in the long run they're going to lose because they're going to think it's the same way.
Speaker A:I feel about those allergy panels that we give kids that tell us that our kids are allergic to 27 different things when actually only one thing we really have to pay attention to.
Speaker A:Right?
Speaker B:Yeah.
Speaker A:And it's like all of a sudden, I'm allergic to 27 things and I can't walk in the grass and I can't eat bananas and I can't.
Speaker A:I don't know, whatever it is, like if sometimes it's just better instead of cook.
Speaker B:I know.
Speaker A:Thanks.
Speaker B:There are a few things I want to know.
Speaker B:I want to know from my listeners.
Speaker B:Are you going to nationals this weekend?
Speaker B:Are you going to look for Juliet?
Speaker A:And there we go.
Speaker B:Are you going to be participating in any of these events?
Speaker B:I want to know what people have planned for the rest of the year.
Speaker B:I am giving.
Speaker B:I'm giving it actually tomorrow.
Speaker B:So people won't hear this.
Speaker B:If they hear this episode, they will have already heard it.
Speaker B:But if you are racing at Reading, I gave the webinar for that and go watch it.
Speaker B:I've heard from a couple of people who heard the webinar and are planning on doing that race.
Speaker B:I think that looks like a really cool race.
Speaker B:Kind of wish I was able to do it.
Speaker A:I was just talking to an athlete yesterday about signing up for it.
Speaker A:Actually, the heat is the big thing, but it just looks like a great race.
Speaker A:Other than that.
Speaker B:Yeah, I think it's going to be good.
Speaker B:And then I'm giving the webinar tomorrow for Santa Cruz, which is coming up in September.
Speaker B:We'll be doing the webinars for the Ironman, California and Sacramento as well as Indian Wells Quinta.
Speaker B:Yeah, I'd love to hear what people still have planned for this year.
Speaker B:There are a lot of races still on the calendar.
Speaker B:Are you going to be in?
Speaker B:Nice.
Speaker B:Let me know.
Speaker B:It'd be obviously fun to meet up with the listeners if they're going to be at the world championships.
Speaker A:Last I just did the webinar for 70.3 Washington and I'll be there.
Speaker B:That's right.
Speaker B:That's coming.
Speaker A:Yeah.
Speaker A:So sad you're not joining me this year.
Speaker A:The last two years we've had a good time there together.
Speaker A:But I'll be there doing a women's activation.
Speaker A:I'll lead cars to kicks.
Speaker A:I'll be speaking at the Ironman Village, so definitely come find me there.
Speaker A:We love hearing from our listeners.
Speaker A:When you come find us at events, it really makes our day.
Speaker A:So please come on up, ask questions.
Speaker B:Absolutely.
Speaker A:And make yourself.
Speaker B:And of course we want to hear more questions.
Speaker B:If you have a question for us to answer in a future medical mailbag, we hope that you will send it on in.
Speaker B:You can email me@tridocloud.com you can pop it into the Facebook group.
Speaker B:I've already mentioned how to do that.
Speaker B:And you can also reach us on Instagram in all the various ways.
Speaker B:I do want to take a moment also to thank a life sport athlete who has recently become a Patreon supporter.
Speaker B:That's Jeff Rippey.
Speaker B:Jeff Than so much.
Speaker B:Yeah.
Speaker B:Thank you so much.
Speaker B:It really means a lot keeping this program going on my own without sponsors.
Speaker B:As you listen to the program, I don't there's a reason for that.
Speaker B:It's because I want to keep these medical mailbags free of any kind of Huberman esque contamination.
Speaker B:So you know that the reviews that we're doing here are always going to be free of any of that kind of bias.
Speaker B:And so to do that, I really do count on the generosity and support of my Patreon supporters and Jeff Rippy is the most recent one to come on board.
Speaker B:So Jeff, thank you for being here.
Speaker B:Really appreciate it.
Speaker B:Means a lot.
Speaker B:And to anybody else who's interested, head on over to patreon.com trydocpodcast and you can learn about the different ways that you can join as well.
Speaker B:All right, Juliet, good luck this weekend at Nationals.
Speaker B:I'll be cheering you on and looking forward to hearing how it goes.
Speaker B:And I will be up in Des Moines for the AAU Track and Field Junior Olympics.
Speaker A:Oh, good luck.
Speaker A:So, Morris.
Speaker A:Yep.
Speaker A:Good luck.
Speaker B:Thank you.
Speaker B:She finished fourth at USATF Junior Olympic Nationals last weekend.
Speaker B:This is the last big national meet of the year and yep, it's gonna be lots of fun.
Speaker B:All right, that's great.
Speaker B:Until we chat again.
Speaker B:I will wish you the best and we'll talk soon.
Speaker A:Thanks, Jeff.
Speaker C:Hi, I'm Sam Sankoff and I'm the proud editor of the Tridock Podcast.
Speaker C:The Tridock Podcast is produced by Jeff Sankoff, my dad, along with his amazing interns Cosette Rhodes and Sarah Lopez.
Speaker C:You can find the show notes for everything discussed on the show today as well as archives of previous episodes@www.tridockpodcast.com.
Speaker C:Do you have questions about any of the issues discussed on this episode or do you have a question for consideration to be answered on a future episode?
Speaker C:Send Jeff an email@tridocloud.com if you are interested in coaching services, you really should.
Speaker C:Please visit tridoccoaching.com or visit lifesportcoaching.com where you can find a lot of information about Jeff and the services that he provides.
Speaker C:You can also follow Jeff on the Tridoc Podcast Facebook page, Tridock Coaching on Instagram and the TriDoc coaching YouTube channel.
Speaker C:And don't forget to to join the Tridoc Podcast private Facebook group.
Speaker C:Search for it and request to join today.
Speaker C:If you enjoy this podcast, I hope that you will consider leaving a rating and a review as well as subscribe to the show wherever you download it.
Speaker C:And of course there's always the option of becoming a supporter of the podcast@patreon.com tridockpodcast the music heard at the beginning and at the end of the show is radio by empty hours and is used with production permission.
Speaker C:This song and many others like it can be found at www.revverbnation.com where I hope that you will visit and give small independent bands a chance.
Speaker C:The Tridock Podcast will be back again soon with another medical question and answer and another interview with someone in the world of multisport.
Speaker C:Until then, train hard and train healthy.
