Show Notes

Paul and Howard have a special guest, the amazing Dr. Inigo San Milan from the School of Medicine at the University of Colorado, one of the top researchers in the world on this topic. We talk about all aspects of mitochondrial health, from what that means, to what we can do about it, to how mitochondrial health differs between us and top athletes.

Topics: 

  • What are mitochondria and what do they do
  • Mitochondrial health for longevity and for performance 
  • How top athletes differ from you and me in terms of mitochondrial health
  • The merits of Zone 2 training 
  • Dr. San Milan’s role as a fitness coach for 2020 Tour de France winner Tadej Pogačar

Readings:

Music:

“Crossing the Chasm” by Kevin MacLeod (incompetech.com) licensed under Creative Commons: By Attribution 3.0

Disclaimers apply (at the end of the episode).

About The Show

Paul Kedrosky is a frequently injured athlete and a venture capitalist. Howard Luks is a top sports orthopedic surgeon. Smart, candid, and experienced analysis, ideas and tips about health, fitness, and longevity from two athletes and sports orthopedic surgeon—and guests.

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Transcript

Paul: [00:00:00] So we’ve got a special guest today.

Inigo: [00:00:07] my name is Inigo san Milan  and I’m an associate research professor at the university of Colorado.

Howard: [00:00:12] I’ve marveled at his science for years.

Inigo: [00:00:14] I work in the department of human physiology, nutrition in Colorado Springs  ,  and also our Anschutz medical campus, where I work in the division of endocrinology and metabolism and diabetes.

Paul: [00:00:26] what got you interested. Well in human physiology in general, and maybe mitochondria function in particular.

Inigo: [00:00:33] I have been an athlete all my life. And, I played six years in  the Academy for Real Madrid in Spain when I was a kid, but I was never a good one, so I never got to do. And then I discovered cycling and then I, I turned into cycling and I left everything and I started cycling and and  I raced professional for two years about a very low level, so I was never either a top pro . So I was a frustrated and truncated professional athlete cause he never got to be to the top level, but I, I was always very curious about,  how to improve performance, how the human limits, how to improve recovery, PCL, the lactate.

When I was already 15 years old, I did test to myself with heart monitor. I bought. Nobody had a heart monitor, like I’m talking about oof 84 or 85, or had my heart monitor. I, I used all my savings to buy a heart rate monitor that, back in the days were about $200 or $400 something

Paul: [00:01:34] Yeah. Yeah. Yeah. .

Inigo: [00:01:35] So that was very, I was very interested, always in. In understanding this. And, so when I was still with my career, I, I say, Hey, I would love to do this as a professional career, once I leave cycling, which will be soon, cause I don’t have much future. So that’s what I, yeah, it was, it was a smooth transition. because, as I was studying, I was still being a cyclist. Well, when I started doing internships at our,  it was the top sports medicine clinic in Spain. That was the place where PRP was developed. and, and,  I learned a lot and I started running the exercise physiology laboratory there. being able to, to speak with the cyclist. of the runners of that, of the soccer players, because,  I was one of them, he has been helping me a lot to, to be able to work in this field, understand very well.

Paul: [00:02:22] knowing what you know now, was it mostly in the head or was it mostly environment or genetics that stood between you and becoming a, a higher performance professional athlete at the time, whether it was soccer or maybe cycling, do you, do you have a better sense now of what stopped you?

 Inigo: [00:02:40] I think  I do. Yeah, my head. Was not,  I, I didn’t, I didn’t check the box. No, I was,  it’s been other aspects now that,  I used to overthink things too much. I had anxiety,  like I really wanted to perform, but ,I,  I was, I felt the pressure in my head was not what it should be and, and also I, I trained way too much. I didn’t eat enough. I didn’t have a, this, I mean, eating disorder, but I definitely like many athletes, like I would say 70% of the athletes out there. I had a disorder eating.  I was looking always not, Oh man, I’m eating too much fat,  or, Ah crap, that’s like five grams of fat. I should just try to find a food that has only one

Paul: [00:03:34] what does mitochondria function sit in terms of being one of the drivers of human performance? where does it sit in terms of the hierarchy of things?

Inigo: [00:03:41] So to me, it is at the epicenter. That’s where you generate energy. And, bio energetics it’s key for performance. it’s about, first how well utilized fuels, for energy purposes, like how well your glycolytic capacity is. And then how well your oxidative phosphorylation is, how well your fat oxidation is even how good your, this is something that we’re seeing now with another throw through the research, how well your protein metabolism is.  So everything happens in the mitochondria, .

Paul: [00:04:14] people say that mitochondria is the powerhouse of the cell, but it’s  such a limited answer it’s it’s that plus plus is the, is, is really the more expansive view of the role of mitochondria these days. It has, it has a lot more, and its role in immunology has a role in cancer, and on and on.

Inigo: [00:04:29] Absolutely. And, yeah, w when mitochondria are, are working well, and incredible, not just to generate energy, but also, it’s  the best way to clear lactate, but, also when they’re not working properly, they can cause disease. And this is what we’re seeing now in different cardiometabolic diseases, like type 2 diabetes, cardiovascular disease, as well as in other diseases like cancer and even Alzheimer’s,

Paul: [00:04:51] mitochondria occur in different proportions, in different parts of the body, and we see more in more active tissues, less in less active tissues. w why don’t you talk a little bit about that 

Inigo: [00:05:00] so normally, the more oxidative a tissue is that is the more, fatty acids that, that tissue utilizes, the more mitochondria there is. And, and for that,  that the heart is, is probably  the organ in the body with the most mitochondria density,  then the, the, the least oxidative and the more glycolytic a tissue is the less mitochondria there is there.

And for that, we have, for example the brain . And,  the brain because the brain is very glycolytic and they don’t necessarily need a lot of mitochondria, although  mitochondrial dysfunction is a key part of Alzheimer’s disease.

And then,  we have other places were extremely oxidative, like the skeletal muscle and, there’s a big  number of mitochondria and they’re very, very active. And since  skeletal muscle as, as an organ because now we’re starting to look more at the muscle as an organ because the crosstalk with other organs, which is big deal right now. And a very important thing that not many people talk about is that 80% of the carbohydrates that we metabolize postprandial, that is after a meal, they’re metabolizing  through the muscle and skeletal muscle in the mitochondria. And also the first tissue that sees type two diabetes is a skeletal muscle as well. So it’s a very important organ.

Howard: [00:06:29] I’ve,  been fascinated by the science of the mitochondria, mainly by reading your work and then diving beyond that, as I’ve  tried to optimize my own lifestyle for longevity, and,  I’ve always. Known, that low heart rate zone two training is important to our health yet it seems that the whole fitness world is moving to a Peloton style yeah. Rise where you’re riding in zone four, zone five and killing yourself every day and being pushed every day. Perhaps you can just break the ice on how important a zone two training and what exactly is zone two heart rate training.

Inigo: [00:07:20] many people out there, they’re, training very high intensity is, and now it’s a, it’s a big deal,  The whole high intensity interval training HIIT. and,  people want to get like, very fast, improvements in short period of time. but this is not what we see working with the best athletes in the world. whether he’s a rower, which is a very high intensity, or a swimmer, , or a, or a marathon runner or a cyclist about 80% of the total workload throughout the year is in that lower intensity. More like towards a zone two, and also recovery days, even, about 20% is in the high intensity. zones. this is also a very interesting concept that is called the polarized training, which is about,  the 80 20, roughly, which is  what we see in athletes. I always say that, we can’t be so naive to think that the best athletes and coaches in the world  who, who are always trying to find, the edge, trying to find what’s the latest out there, how we can improve training, how we can push the limit, they haven’t thought about these concepts before. Of course they have, but there has never worked.

So these concepts we see for us working in the elite professional sports arena. We know these for many years,  but unfortunately, what, what, what many people are there in the society, more at the recreational level, if you will, those concepts are lost in translation somehow. .

Howard: [00:08:46] So what are the changes that are occurring, at the mitochondrial level in zone two. that makes it so beneficial to us.

Inigo: [00:08:58] this is something that, I don’t think we still have the answer, because this is something that we’re working on doing studies and looking at more at the, biopsy level. But in the meantime, we, what we have is a lot of experience and many surrogates for mitochondrial function, which is your lactate clearance capacity, as well as your fat oxidation.  And now I am correlating all these parameters with directly with mitochondrial function. we’re getting at the university muscle biopsies from people and we inject  in those muscle biopsies, different substrates to see what’s the utilization by the mitochondria. We’re also looking at, the, the respiration of the mitochondria general and the function of the mitochondria. But going back to the question, what, what I’ve seen over 25 years working with athletes is that, the way I look at how mitochondria function, improved or not improved is by looking at surrogates, as I said earlier,

So there are two main surrogates we see, which is fat oxidation and also lactate clearance capacity. So, both fat and lactate are mitochondrial substrates. Fat can only be oxidizing in the mitochondria during exercise and lactate is oxidized by the mitochondria as a fuel,  And that’s the way you clear that out.

So by looking at those two parameters, you can indirectly look at the mitochondrial function. So that’s when we see like an athlete who trains are always a high intensity. I don’t see changes in those numbers. Athletes who train too easy, maybe that will be like the zone one, you don’t see much of a change. In what I’ve seen over and over again, not just in rowers or swimmers, but  in football players, but also obviously in endurance athletes, is that that zone two is their exercise, intensity the sweet spot where the magic happens. It seems to be an intensity where you stimulate those mitochondria the most.

Paul: [00:10:46] we never really talked about the  220 minus age   in terms of trying to dictate whether you’re in zone two or not. I know that’s a pretty equivocal and messy way of doing things, but is it of any use at all for people

Inigo: [00:10:58] No that that’s, that doesn’t have any scientific validation. In fact, the 220 minus your age, was, I think  50, 60 years ago, and it was so observational. But  that, that is, we see all the time,  two people with the same age and one people, a maximum heart rate is 190 and the other one is 70,  So this is why 22 minus your age can really confiuse people . And it’s like saying the average American man is, is, Five nine and 175 pounds. He’s like, well, good luck with that. .

Human physiology is the same. it seems  awkward to say this, but if you don’t have the tools to go to a laboratory, and get your soon to. It’s much more accurate than 220 minus your age, or even  VO2max that talk test.   if you’re talking and breathe perfectly without a person we’re zone one, you can not talk at all or barely can talk while exercising you’re in zone three, zero four. If you can talk in any way, you, you need an effort . Probably zone two. And that  is probably more accurate than any of these formulas.

Howard: [00:12:02] And then,  in the people that we see in our everyday lives too, and those of us who, who are  athletes, but have other comorbidities such as diabetes. they have unique issues because of their mitochondria, such as, the metabolic inflexibility, et cetera.

Inigo: [00:12:21] Yes, absolutely. We have finalized the first phase of the study and we should publish the results within the next month . We see that people with type two diabetes, they’re on the opposite metabolic pole or those elite athletes. And this is why I’m bringing the elite athletes to the table as the reference , because we can learn a lot from these elite athletes. I always say you can never understand imperfection, if you don’t know perfection in the first place. And we see that these metabolic diseases like type two diabetes, they’re characterized by a metabolic inflexibility, as well as mitochondrial dysfunction and what are the mechanisms and how we can monitor them and diagnose them and even improve them. So this is what we why the elite athletes. They don’t have any forms of obesity or acquired type two diabetes or acquired cardiovascular disease. And yet they have the highest carbohydrate diet in the planet.  And I’m not saying that everybody else should have carbohydrates as much as they have. but we’re seeing incredible differences across the board from substrate  utilization to metabolic flexibility, to free radicals. 

Howard: [00:13:25] so the fatty acids, are these local, or,  within the muscle or are these being mobilized by the liver? What’s the primary source.

Inigo: [00:13:35] this is something that is called the athlete’s paradox. So what he started to look into that, what was the interim, muscular triglycerides, fatty acids inside or fat inside the muscle,   well, what is that? he looked at.  like elite athletes or what train athletes, and also people with type 2 diabetes and obesity and then control people he uses sedentary that didn’t have any disease .  But while he’s still about that, the sedentary without any form of disease, they didn’t have what’s called the fat droplet.  both the athlete and the person with type two diabetes they have the same fat droplet. That was called the athletes paradox.

 Now further research had shown that there’s a big difference between two fats. So the fat from the well trained athlete, it’s, it’s an adaptation, process probably because it’s an extra risk reward for fat oxidation. So it’s, it’s very plausible to think that human evolution of those athletes has now taken them to a place where they have an extra reservoir of fat right by the mitochondria. And in about 15 to 20% of all the fat oxidation during exercise is probably from that by dropping the mitochondria. Whereas the person with type two diabetes, and this is what we’re seeing in our research they cannot oxidize fats properly. They have a downregulation of the fat oxidation. So it’s very possible that that fat is building up outside of the mitochondria. Now, the content of the fat is completely different. The content of a fat droplet around the mitochondria in people with type two diabetes has a lot of, inflammation mediators, and some substances called  ceramides. Probably, they’re like a released from that fat and may end up in other tissues. And this is why we believe there’s a connection between mitochondria dysfunction and cardiovascular disease. people who have looked at the atheroma plaque or the main composition of the atheroma plaque are the ceramides but to come from the liver

Paul: [00:15:43] you mentioned, lactate gets a pretty bad rap. So can you  get into that a little bit deeper? It’s it’s not the lactate that we should be worried about it. It’s  it’s a byproduct of a reaction that’s going on and is actually, is hugely important. Not something necessarily to be fearful of per se.

Inigo: [00:15:59] Yeah, lactate is a fascinating thing. in the 1920s, several Nobel prizes, they were very fascinated by metabolism. And, but the old thought that lactate was a waste product  and it kept embedded in, in medical books, in chemistry, biochemistry books, as a, as a waste product of anaerobic metabolism .Until, in the eighties, 1980s, where my colleague and mentor good friend, George Brooks, from the university of California, Berkeley, he started to delve into this and we decided to prove everybody was wrong.

And he’s been showing us the way and demonstrating that lactate is not just a waste product. It’s a, it’s a major fuel for the body. It’s a major, gluconeogenic component. That is, it can be recycled back to glucose. for example, has been proven that the brain under stress, in ICU patients with traumatic brain injury, the brain prefers lactate and glucose, it’s a way in a way, like to see like a cleaner energy. The heart is a great user of lactate as well. And, and also what we know now, and this is something that Bruce and I are doing in cancer, we know that it is a regulator of many processes in the body. the problem with lactate is that when it builds up right away, like it’s an exercise, is not lactate per se, but he’s a hydrogen ions associated to lactate to decrease that increase the acidosis of the muscle. But in other diseases like cancer, it’s characterized by a very large production of lactate.

And that’s the Warburg effect that Otto Warburg discovered in 1923, almost a hundred years ago. And what struck Warburg was that cells use a lot of glucose, and they produce a lot of lactate. And back then over hundred years ago, Warburg already saw that, Oh, there’s lactate production that’s gotta be a mitochondrial injury in cancer cells. And that’s why he proposed that cancer is a mitochondrial disease or a metabolic disease caused by an injury of the respiratory system, which is mitochondria. But we see very well nowadays that, that lactate, it’s a key feature in cancer, and that regulates all the major genes involved in different cancers.

Paul: [00:18:14] to what degree would you attach a genetic  versus an environmental component to mitochondrial efficiency, angiogenesis, oxidation, these drivers of physiological efficiency with respect to being a top athlete, as opposed to simply having the discipline, to be able to do the kinds of things that you need to do to become a top athlete. So try to parse that out so that we can understand the balance.

Inigo: [00:18:39] I, in my modest opinion to become a, a very good athlete and even a professional athlete, you need some forms with genetics,  But you they’re not the main player. I think that to be maybe at the level of Tadej Pogacar who  won the Tuur de France, I think that, that level, yeah, the genetics. And we clearly see these guys from a different planet. . But to become a regular pro cyclist or regular, marathon runner, I think that genetics is it’s there, but, there are other players,  like  the way you train, the way you recover, your nutrition, your mind, your mentality.  So I always give this analogy that.  like a pizza without tomato sauce is not a pizza.  it doesn’t discriminate one pizza from the other, . It Is the toppings the that make the difference. the genetics is that tomato sauce for pizza, it has to be there somehow. it’s, what you do with that.  The toppings in the toppings are the training, the nutrition, recovery, your mental capacity, your will, your power, your desire, and your passion.

Paul: [00:19:40] you were involved in an advisory capacity with UAE team Emirates, who a rider for which won the tour de France this year, you just alluded to his name and I’m going to say it poorly, but Tadej Pogacar — by the way, I was, I’m glad he wasn’t watching the coverage because every announcer pronounced his name differently. So it was like a different guy on each stage, but it turned out to be the same guy, just depended on how they pronounce his name.

So, back in the Lance Armstrong era — ignoring Lance’s other problems — we used to talk about certain fitness parameters like watts per kilogram and things like that, that if I got to certain hurdle levels, I was probably going to be competitive in this year’s tour. Were there things that you knew or saw that told you in advance of this year’s tour that Tadej Pogacar was likely to be a contender?  Were there some measures that you could identify that told you boy, this guy is going to be special this year.

Inigo: [00:20:29] Yeah, absolutely. This is something that we already saw last year. And, and this year we, this has been more confirmed. So, one thing is like with Tadej, specifically,  first his lactate clearance capacity is off the chart: at an intensity of let’s say 5.5 Watts per kilogram a Tour pro has about seven millimoles of lactate. Tadej might be two or three

Howard: [00:20:51] wow. Wow.

Inigo: [00:20:53] But, yes,  to be a top, top competitor, in a climb you need about 6.3, 6.2 to 6.4 Watts per kilogram. . It depends on your weight,  a little heavier riders, they might be by 6.2; lighter riders might be about 6.4.

Paul: [00:21:08] Which is a bananas number, by the way, just to put that on the record right now, that’s just crazy.

Inigo: [00:21:14] Yeah, exactly.  but, but this is what we, I already saw last year,  that he had, close to those numbers. in  fact, I mean, he, he won  the Tour de  l’Avenir, which is the baby Tour.

Paul: [00:21:24] Tour of the future or whatever. Yeah.

Inigo: [00:21:26] Exactly. So, and we know from history that the majority of the riders who win that tour they’re destined to be, to be one of the best riders in the professional category. So he won it, and then last, last year in the Vuelta, he was third overall . And then this year  we saw that his numbers were kept improving.  We expect, . As I said, any 21 year old kid, or 22, that he’s going to be keeping improving. He was doing in fact, in may those numbers;  he’s doing 6.3, 6.4 watts while climbing, after five hours on the bike.

Paul: [00:21:58] Oh God.

Inigo: [00:22:00] And all knew it,  and this is may I had to tell him to stop.  He was way too strong and that’s the uncertainty we haven’t been in these times. . It was four months away. And so we needed to, okay. Let’s let’s, let’s take a shot and just take a week off. Cause I I’m, I’m a little bit scared that he’s not going to maintain that form for four months.  But these numbers, absolutely. we can, we could see that already in training.

Paul: [00:22:27] is that not unusual at that age? My, my sense of the tour historically, it’s an endurance sport and like many endurance sports, 18 year olds weren’t at their best 21 year olds were getting better. 22, 23, 24. Does that still hold that there’s a curve in terms of endurance athletes, generally speaking, peaking a little bit later than they might in other sports, or is that not really true?

Inigo: [00:22:49] I would say that all these things are changing. And as we see, these new generation,  many riders they’re in they’re in their t eens and they’re dominating it, but this is something that we see in other sports. my take on that, is that these athletes, they start training earlier. Like in America first example,  and any many places in Europe, although they start earlier training, but in the United States,  it’s very, very rare to see a 17 year old kid with a coach. They start getting a coach when they’re 19,20, 21. In Europe they might start earlier, but still on with 13, 14, not many of these kids have a coach. But now all these kids have been having a coach for years. So I think that’s a very important thing. It’s like, I would say if you have talent to play a piano and you start at the age of nine, by the time you’re 16, 17, you’re going to be very good and you might go to a good piano school. But if you start at the age of 16, you, you might miss the boat. And these guys now they’re start training more structure at a, at a much higher, a much earlier, age. And by the time they’re 19, they’re much better off than, than, than someone who’s near the age of 17.

Paul: [00:24:00] Yeah. It’s, it’s, it’s remarkable. Having watched the Tour since before the Indurain era I’ve, I’ve never seen anything quite like it in terms of this cohort of young endurance athletes appearing on the scene.

Inigo: [00:24:10] Exactly. And this is the other thing too, that. I mean, like every sport, every 20, 25 years, there’s someone, exceptional. . and, and I think this was due: the last big champion that we saw was probably Miguel Indurain. . And we were, we were due. Also, we have another kid, called Evenpoel

Paul: [00:24:26] Yup.

He’s remarkable. Yeah.

Inigo: [00:24:29] remarkable and he might be another two contenders as well.

Howard: [00:24:38] I’d like to turn it back to Paul and I, selfishly, and those who we love to share this podcast with, I like to stress the importance of zone two training. I’m not against hard trainings. I think that’s important, for all of us, whether we want to just sweat or, or get better. how does the average a runner or racer bicyclist know that they are in zone two?

Inigo: [00:25:10] The best way to know this is by doing a metabolic test. And it’s,  where we can look at different parameters, that I hope that more and more laboratories throughout the country, come up and, they can offer this because it’s very important. And there not many laboratories and resources out there to help  athletes. But if you don’t have that, it’s difficult.

I would say that.  going by the feeling and breathing test,  or, I mean the breathing, whatever perception. Yeah.  where you can not talk and breathe,  with some effort exercising that could be close to your zone. Two, if you can’t talk at all, you’re way off. And if you can. And it’s hard,  very high,  you’re not there. You might be doing one or so.

Howard: [00:25:57] How, how relevant is checking your lactate levels? 

Inigo: [00:26:02] So I do this a lot.  in the laboratory. I look a little bit of a compendium of different parameters, like the, your five max, which is the exercise in Tanzania, when you will burn the most fat. and that, that coincides with the recruitment of the type one muscle fibers, once that the tech to muscle fibers are recruited, which are one of the ones they use glucose for the most part, you  losing the a M fat oxidation in those muscles. So,  by looking at these that you’re not anymore type one muscle fibers you’re already in the glycolitic system, which is not in zone two anymore. So I look at max and also we’ll get the first inflection point of lactateand they usually tend to coincide.And this is where we establish that training zone, that is, for a person, 

Howard: [00:26:48] I think after Paul and I get a vaccine, w we need to come out to your university for some tests. but if you’re talking to Paul and I,  as cyclists,  with an FTP of, I don’t know, 200. Two 25. We want to live longer, but maybe get a little better. how should we train? should we do three long slow rides a week and one, sprint session?

Inigo: [00:27:17] And  I would mention that whole 80 /20 which is where we work with the best athletes out there.,regardless of the sport. there are three basic principles. One is the, to establish the exercise intensity,  the one you train Zone Twp, for example, as we have mentioned, that’s the first one.

The second one is the, frequency,  How many days a week you stimulate the energy system? so what I’ve seen is that two times a week maintains it,  but if you want to improve it, you want to start talking about three days a week, four days a week.  Four days is ideal.

And how have I learned that? Because you mentioned,  getting people’s training and seeing, Oh, they have done.  like only do two days a week with Zone Two,or only one day a week with Zone Two. What I’ve seen is like, there’s np improvement in these people,  Whereas someone who does four days, five days, now we’re talking.

And the third point or principle is that, is that duration. And this is important because  there’s still a misconception that if you do endurance or low intensity, you need to be doing very long miles. That’s not necessarily, I think that someone to go to the Tour de France then yeah, sure. It’s stage we’re talking about is for six hours or seven hours long.  So you need to spend that time on there, but to improve the amount of  functional these energy systems, we do not need to do five hours, four hours, three hours. What I’ve seen very well it’s specifically on the bike about an hour and a half does it. I’m running, I would say an hour, an hour and 15 minutes,  and this is why it’s important concept that you need to do five hours. And many people, Oh, I don’t have an hour and a half to train. It’s going to go full gas.

And then it’s very important to improve the glycolytic capacity because first as we age, we lose it and that, and that’s  the total capacity. The high intensity is very important to train it. And, and,  whether you competing or not, this is where you win the the races at the high intensity. . You never win the races because you are the best Zone Two guy.  But, I think that to, to stimulate those once or twice a week, that’s enough , from what I’ve seen even two days a week for a competitive athlete, could be.  You can either have a specific day a week where you can not do intervals that day. And the intervals can be two minutes, three minutes, five minutes, 10 minutes. Depends on your specialty. But then also build some intensity days within the long day. And this way you, you kill two birds with one stone. That is you can do, let’s say yeah, an hour and a half day, you didn’t have much time to train at zone two, and then at the end of the training, you can do, let’s say two intervals for five minutes, each, full gas or one, one 10 or 15 minutes full gas,  So that day you stimulate two energy systems: that is your Zone Two, and the fat oxidation and the glycolytic system. That’s how we break it up. That’s  what I do with this high elite athletes and does the 80 to 80 20 model pretty much, or the polarized straining.

Paul: [00:30:07] And  the opposite of what I think an awful lot of people do, they’re 80/20, but the other way around.

Inigo: [00:30:12] Yeah. And the other thing,  I’m seeing personally, people more in the age groups, . Masters, et cetera. Yeah. they train very high intensity. And as I’m sure you guys have seen, especially you Howard as a physician is that you see people are getting injured. And high intensity exercise has always, for someone who might not be prepared, I mean, not even elite athletes do that. No, you didn’t see elite athletes, as you said earlier,  putting those routines through those routines of like five days a week or six days a week, high intensity training. Elite athletes don’t do do that. why recreational athletes they have to do that. No. And the inflammation in there, the repair that is needed,  to do that. I see, I do a lot of blood blood analysis for biomarkers and see a lot of that age athlete, age group athletes with extensive muscle damage, because they’re always overtrained, fatigued and they push it to the limits. Is that good for health? I don’t think so. Is that sustainable? I don’t think so either.

Howard: [00:31:06] I completely agree. I think that, I think that recovery is a weapon. I think it’s horribly underutilized, even at our levels.

Paul: [00:31:14] I always joke Inigo that, I think more than 80, 90% of my best performances in various races and things have come from, for whatever reason I had to rest, I thought too long before the event because of something else getting in the way. And almost every time I did far better than I thought I would. And I mostly entered it thinking, Oh my God, I’m screwed because I haven’t been able to train the way I wanted to, or I had to take four or five days off before the event.

Inigo: [00:31:39] Yeah, and I use all the time. I see typical athlete, who’s, he’s very stubborn or she’s very stubborn and eventually gets injured with a stress fracture, for example, of a runner, . Or a teninopathy. And,  if I have a, a relationship with them, I tell them, Hey, thank goodness you got injured. And they say, what the hell are you talking about? Well now, finally, you can frigging rest. They rest and they come out zooming, as you mentioned.  So it’s very difficult.

Howard: [00:32:06] Well, rest is a relative term. I mean, rest doesn’t have to be an absolute stay off the bike day, it can be, a relaxed ride.

Inigo: [00:32:17] I agree. when I see a rest it’s this mental component as well. If you’re a high level athlete, to train, well, you need to train by yourself. That’s ideal. If you’re an individual sport, let’s say you’re a runner or a cyclist, for example, or even a swimmer over, usually it’s motivated by that. But, but if you train a lot by yourself, mentally is hard. So that’s why one day, a week minimum, you need to do a very easy ride and the coffee ride where you get together, you get a coffee or ice cream, and just hang out. That’s good for the head. But I also  is very important to do a day off. because it’s a full recovery day. I see this, especially with runners that they might say, Oh, I’m going to take an easy day, a recovery day today. And they end up doing an hour easy running. that that’s not a recovery day. I’m not saying that you can do one of those a week if you will, but I, I think you should be completely off the bike or the shoes , like full biological recovery, mental recovery day. And there’s nothing wrong with that. In fact, I started doing these like 25 years ago. one day off completely. And, people would throw tomatoes at me. . Now this is a very common thing to do.

Paul: [00:33:33] thanks again for doing this. It’s been outstanding.

Inigo: [00:33:35] Oh my pleasure. Thank you so much.

Howard: [00:33:37] Really, happy to talk to you tonight. Thanks.

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About the author:

Paul Kedrosky & Howard Luks

Paul Kedrosky & Howard Luks

Paul Kedrosky is a frequently injured athlete and a venture capitalist. Howard Luks is a top sports orthopedic surgeon. Smart, candid, and experienced analysis, ideas and tips about health, fitness, and longevity from two athletes and sports orthopedic surgeon—and guests.