Misunderstood Dichotomies

Some thoughts on some observed errors of reason in health and performance

Image: Thinker Vectors by Vecteezy

Over my time observing health and performance, consistent misunderstandings seem to prevail. I am certainly not immune to these (or others) but in general it’s less about “being right” and more about “getting it right.” It is in this spirit that this article is intended; so we can all move closer to getting it right, not so that we can point fingers of criticism.

Possible or Optimal

Just because something is possible, does not mean it is optimal by any means. You may be able to function on 4-6 hrs per night of sleep, but that doesn’t make it optimal. In fact, this is quite clearly the opposite as far as what the research suggests, of note, it also suggests insight into impaired performance and decision making is impaired too! That’s right, you’re worse and worse at knowing you’re worse - real meta.

This mistake seems to be made particularly prevalent in the nutrition space. It is worth noting that the human body is quite adaptable and able to cope with periods of less optimal nutrition - it’s evolved this way to cope with periods of increased and decreased availability of food. Remember, food was not always a few taps of your phone away from being delivered.

Optimising or Adapting

This is a concept I’ve understood for a while but the phraseology, at least as I became aware of it, is with credit to Dr Andy Galpin. Whilst it sounds similar, and in part relates to the previous point it is a little different.

Certain decisions need to be considered through this lens given the ‘correct’ decision hinges on the goal of the outcome. Something that may be optimal may mean you are sacrificing some adaptation. An example from the strength training world is anti-inflammatory use, specifically NSAIDs (non-steroidal anti-inflammatory drugs), which may impair adaptations. Said differently, it looks like the blunting of inflammation may impair the training response. This has implications beyond anti-inflammatories, for example ice bathing/cold plunging etc. That’s not to say these modalities or drugs shouldn’t be used, it is to say that understanding the goal at the time dictates whether using them makes sense, if the goal is adapting - they should be avoided, if it is optimising (think, pre competition) then they should be used.

In a health space, we often think of optimal being ideal and to a degree it is probably is more that way than in performance. That said, as discussed in this article, perfection (or optimisation) may be a fool’s errand. There’s another argument, that some level of stress may be helpful as covered here and thus there’s a role for adaptation in a health realm too. This may look like fasting to be able to better cope when food choices are particularly bad (hello plane travel) or something else you decide is important.

Success Timeline

This dovetails very well with the possible vs optimal discussion. They’re very similar in some senses, but the nuance is being timebound vs not. In this case we are all about timeline for evaluating whether something is optimal, for example something may be optimal in the short term but long term be suboptimal or worse.

A good example I’ve seen quite regularly the blurry line between health and performance is body mass/body fat - don’t worry we aren’t going into this too much I promise. Athletes are often trying to optimise body composition for competition periods (well illustrated in this paper that Trent Stellingwerf wrote on his wife!), and some at times will look to optimise it more generally (because of the belief that lighter is faster). Part of the challenge in the latter approach, which effectively boils down to losing weight as a means to go faster, is that it may (and often is) initially successful. The problem is this is unsustainable in many cases, so on a longer term timeline these athletes can end up with “low energy availability” (the label says it all) which can even progress to “RED-S” (Relative Energy Deficiency in Sport) and resulting issues such as stress fractures.

The classic ‘all nighter’ form college may be another example of a timeline issue when evaluating success - it may actually work on a shorter term timeline but perhaps it is not so successful if you zoom out, specifically when contrasted with more regular study and sleep schedules. This is likely even more evident if we zoom out of exam results and zoom in on retention post exam.

Due to or Despite

This may be the most damaging of the bunch, but again relates or is at least a cousin of “Optimal vs Possible” seen above. It relates in part to causality, and the human propensity to misattribute causation where correlation is actually in existence (the classic example here is the association of drownings and ice cream consumption - this is not causal it is associative or correlated). Let’s also not forget that Usain Bolt famously loved his chicken nuggets - nobody’s idea of a health or performance food, his success was despite these, take my word for it.

I see this error in the performance realms with respect to coaches and athletes often. My favourite example is probably Hicham El Gerrouj who went, and I quote commentators at the 2004 Athens Olympics; “from the best never to the best ever”. You see, Hicham was undeniably the best middle distance runner in the world for close to a decade, almost unbeaten in the 1500m between Olympic games and the world record holder in numerous distances. A fall in the Atlanta Olympics and Silver in the Sydney games meant that in the twilight of his career, in Athens, the pressure was never greater. Of course he had the fairytale ending, winning the 1500m (and the 5000m for a very rare historic double). Yes being an athlete is about performing at certain times, and the Olympic Games is the pinnacle, but surely he’s not materially a better runner for having won these races. What if he’d done so via all his greatest rivals being injured, sick or falling? He then beats a second class field to a degree… You get my point here.

A better example is probably from the coaching realm. Andy Reid, the recent Superbowl winning coach, is now in the conversation for greatest coach of all time. But not too long ago, he was fired because he wasn’t performing as a coach with the Philadelphia Eagles, yes he’s no doubt developing as a coach but I doubt it is this stark. He just so happens to have players who can help him win. To use another NFL example, Bill Belichik, widely considered greatest coach of all time, has an objectively bad record when his quarterback isn’t Tom Brady (the greatest quarterback of all time). I am sure he’s still coaching well, but other factors are at play in his team winning or loosing (including player talent). A coaching mentor of mine once told me the best advice he got from his coaching mentor was “don’t coach bad teams” - this probably says enough.

In the health realm, this mistake is unbelievable simple to make. Especially with the challenges we have in terms of technology and enhancement. That’s to say, someone can look very healthy (what even is that) but this could be due to the myriad of filters, photo editing etc rather than actually looking as such. So perhaps that six pack is not a result of their workout, supplement or diet regime. In fact, it may be due to something they’re not sharing that they are doing (anyone remember the Liver King?)

So when reading about the protocols of the latest most interesting person in the health or performance realms, or evaluating advice, remember to think through these dichotomies. Perhaps also use some of these lenses when deciding whether to experiment too.

References:

1. Honn KA, Hinson JM, Whitney P, Van Dongen HPA. Cognitive flexibility: A distinct element of performance impairment due to sleep deprivation. Accid Anal Prev. 2019 May;126:191-197. doi: 10.1016/j.aap.2018.02.013. Epub 2018 Mar 15. PMID: 29549968.

2. Alhola P, Polo-Kantola P. Sleep deprivation: Impact on cognitive performance. Neuropsychiatr Dis Treat. 2007;3(5):553-67. PMID: 19300585; PMCID: PMC2656292.

3. Csipo, T., Lipecz, A., Owens, C. et al. Sleep deprivation impairs cognitive performance, alters task-associated cerebral blood flow and decreases cortical neurovascular coupling-related hemodynamic responses. Sci Rep 11, 20994 (2021). https://doi.org/10.1038/s41598-021-00188-8

4. Lilja M, Mandic M, Apro W, et al. High doses of anti-inflammatory drugs compromise muscle strength and hypertrophic adaptations to resistance training in young adults. Acta Physiol (Oxf), 2017; 222:e12948.

5. Stellingwerff T. Case Study: Body Composition Periodization in an Olympic-Level Female Middle-Distance Runner Over a 9-Year Career. Int J Sport Nutr Exerc Metab. 2018 Jul 1;28(4):428-433. doi: 10.1123/ijsnem.2017-0312. Epub 2018 May 25. PMID: 29140157.

6. Cabre HE, Moore SR, Smith-Ryan AE, Hackney AC. Relative Energy Deficiency in Sport (RED-S): Scientific, Clinical, and Practical Implications for the Female Athlete. Dtsch Z Sportmed. 2022;73(7):225-234. doi: 10.5960/dzsm.2022.546. Epub 2022 Nov 1. PMID: 36479178; PMCID: PMC9724109.

7. Mountjoy M, Ackerman KE, Bailey DM, et al. 2023 International Olympic Committee’s (IOC) consensus statement on Relative Energy Deficiency in Sport (REDs). Br J Sports Med 2023;57:1073–1097