<p class="p1"><span class="s1"><a href="https://peterattiamd.com/inigosanmillan2/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=220314-pod-inigosanmillan&utm_content=220314-pod-inigosanmillan-podfeed"> View the Show Notes Page for This Episode</a></span></p> <p class="p1"><span class="s1"><a href="https://peterattiamd.com/subscribe/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=220314-pod-inigosanmillan&utm_content=220314-pod-inigosanmillan-podfeed"> Become a Member to Receive Exclusive Content</a></span></p> <p class="p2"><strong>Episode Description:</strong></p> <p class="p2">Iñigo San-Millán is an internationally renowned applied physiologist and a <a href="https://peterattiamd.com/inigosanmillan/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=220314-pod-inigosanmillan&utm_content=220314-pod-inigosanmillan-podfeed"><span class="s2">previous guest on The Drive</span></a>. His research and clinical work focuses on exercise-related metabolism, metabolic health, diabetes, cancer metabolism, nutrition, sports performance, and critical care. In this episode, Iñigo describes how his work with Tour de France winner Tadej Pogačar has provided insights into the amazing potential of elite athletes from a performance and metabolic perspective. He speaks specifically about lactate levels, fat oxidation, how carbohydrates in food can affect our lactate and how equal lactate outputs between an athlete and a metabolically unhealthy individual can mean different things. Next, he discusses how Zone 2 training boosts mitochondrial function and impacts longevity. He explains the different metrics for assessing one's Zone 2 threshold and describes the optimal dose, frequency, duration, and type of exercise for Zone 2. Additionally, he offers his thoughts on how to incorporate high intensity training (Zone 5) to optimize health, as well as the potential of metformin and NAD to boost mitochondrial health. Finally, he discusses insights he's gathered from studying the mitochondria of long COVID patients in the ICU.</p> <p class="p2"><strong>We discuss:</strong></p> <ul class="ul1"> <li class="li2">The amazing potential of cyclist Tadej Pogačar [3:00];</li> <li class="li2">Metrics for assessing athletic performance in cyclists and how that impacts race strategy [8:30];</li> <li class="li2">The impact of performance-enhancing drugs and the potential for transparency into athletes' data during competition [17:00];</li> <li class="li2">Tadej Pogačar's race strategy and mindset at the Tour de France [24:00];</li> <li class="li2">Defining Zone 2, fat oxidation, and how they are measured [26:45];</li> <li class="li2">Using fat and carbohydrate utilization to calculate mitochondrial function and metabolic flexibility [35:45];</li> <li class="li2">Lactate levels and fat oxidation as it relates to Zone 2 exercise [40:00];</li> <li class="li2">How moderately active individuals should train to improve metabolic function and maximize mitochondrial performance [51:45];</li> <li class="li2">Bioenergetics of the cell and what is different in elite athletes [57:30];</li> <li class="li2">How the level of carbohydrate in the diet affects fuel utilization and power output during exercise [1:08:30];</li> <li class="li2">Glutamine as a source for making glycogen—insights from studying the altered metabolism of ICU patients [1:15:00];</li> <li class="li2">How exercise mobilizes glucose transporters—an important factor in diabetic patients [1:21:00];</li> <li class="li2">Metrics for finding Zone 2 threshold—lactate, heart rate, and more [1:25:00];</li> <li class="li2">Optimal Zone 2 training: dose, frequency, duration, and type of exercise [1:41:15];</li> <li class="li2">How to incorporate high intensity training (Zone 5) to increase VO2 max and optimize fitness [1:51:15];</li> <li class="li2">Compounding benefits of Zone 2 exercise and how we can improve metabolic health into old age [2:01:45];</li> <li class="li2">The effects of metformin, NAD, and supplements on mitochondrial function [2:05:15];</li> <li class="li2">The role of lactate and exercise in cancer [2:13:30];</li> <li class="li2">How assessing metabolic parameters in long COVID patients provides insights into this disease [2:19:00];</li> <li class="li2">The advantages of using cellular surrogates of metabolism instead of VO2 max for prescribing exercise [2:25:45];</li> <li class="li2">Metabolomics reveals how cellular metabolism is altered in sedentary individuals [2:33:45];</li> <li class="li2">Cellular changes in the metabolism of people with diabetes and metabolic syndrome [2:39:15]; and</li> <li class="li2">More.</li> </ul> <p class="p1"><span class="s1"><a href="https://peterattiamd.com/newsletter/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=220314-pod-inigosanmillan&utm_content=220314-pod-inigosanmillan-podfeed"> Sign Up to Receive Peter's Weekly Newsletter</a></span></p> <p class="p2">Connect With Peter on <a href="https://twitter.com/PeterAttiaMD"><span class="s2">Twitter</span></a>, <a href="https://www.instagram.com/peterattiamd/"><span class="s2">Instagram</span></a>, <a href="https://www.facebook.com/peterattiamd/"><span class="s2">Facebook</span></a> and <a href="https://www.youtube.com/channel/UC8kGsMa0LygSX9nkBcBH1Sg"><span class="s2">YouTube</span></a></p>
Actionable Insights
1. Prioritize Exercise for Longevity
Recognize that exercise is the single most potent tool or agent available to impact longevity, ranking above all other interventions.
2. Zone 2 Training Frequency
Aim for 3-5 (ideally 4-5) Zone 2 training sessions per week to achieve optimal mitochondrial and metabolic adaptations, especially for those new to exercise.
3. Gauge Zone 2 by Conversation
Determine your Zone 2 intensity by your ability to talk: you should be able to maintain a conversation, but with some noticeable strain, where the person on the other end knows you are exercising.
4. Zone 2 Session Duration
Target 1 to 1.5 hours per continuous Zone 2 training session, gradually building up from shorter durations (e.g., 20-30 minutes) if new to exercise.
5. Compound Gains in Zone 2
Approach Zone 2 training with a long-term mindset, understanding that significant mitochondrial improvements are achieved through small, compounded gains over years, not months.
6. Add High-Intensity Post-Zone 2
Incorporate a high-intensity interval (e.g., a good 5-minute effort) at the end of a Zone 2 session to stimulate the glycolytic system without interfering with fat oxidation.
7. Monitor Heart Rate for Fatigue
Pay attention to your resting heart rate (if higher than normal) and your heart rate response during exercise (if it’s hard to get up) as indicators of fatigue or low glycogen stores.
8. Manage Overwork & Recovery
Recognize that mental stress and overwork can lead to fatigue and poor exercise performance, even with low physical training volume; respond by taking a day off, sleeping more, and increasing carbohydrate intake.
9. Zone 2 Heart Rate Range
As a starting point for Zone 2, aim for 70-80% of your realized maximum heart rate, then adjust based on your perceived exertion.
10. Exercise Post-Carb Meal (Diabetes)
For individuals with type 2 diabetes or pre-diabetes, consider exercising right after a carbohydrate-containing meal to utilize muscle contraction for insulin-independent glucose uptake and lower blood glucose. For type 1 diabetics, avoid injecting insulin before exercise.
11. Ensure Continuous Zone 2
Ensure your Zone 2 training is continuous and sustained within the target intensity, avoiding oscillations (e.g., from hills or stops) that dilute the metabolic effect.
12. Use Indoor Trainer for Zone 2
Utilize an indoor trainer for Zone 2 cycling to maintain consistent intensity and maximize efficiency, as it isolates variables like wind and terrain.
13. Prioritize Low-Intensity Training
Even when training for high-intensity sports, prioritize lower intensity (Zone 2) training, as elite athletes dedicate the majority of their sessions to this zone.
14. Be Wary of Longevity Supplements
Be cautious about relying on single supplements like NAD precursors for longevity, as it’s a complex process, and there’s a theoretical risk they might promote tumor growth if an undiagnosed cancer is present.
If on a low-carbohydrate diet, be aware that indirect calorimetry may show artificially high fat oxidation numbers due to gas exchange artifacts; lactate levels might be a more reliable indicator in such cases.
16. Maintain Good State of Mind
Cultivate a good state of mind and practice eating what you like in moderation, as these are important components for overall longevity and enjoyment of life.