<p><span style="color: #000000;">Today's episode of The Drive is a rebroadcast of the conversation with Iñigo San Millán, (released on December 23rd, 2019). This episode with Iñigo was one of the most popular discussions to date and is a prelude to an upcoming follow-up discussion in 2022.</span><span style="color: #333333;"><br /> <br /></span><span style="color: #000000;">In this episode, Dr. Iñigo San Millán, Assistant Professor at the University of Colorado School of Medicine, explains the crucial role of mitochondrial function in everything from metabolic health to elite exercise performance. Iñigo provides a masterclass into the many different energy system pathways, the various fuel sources (including the misunderstood lactate), the six zones of exercise training, and the parameters he uses to measure metabolic health. Additionally, he highlights the power of zone 2 training as both an effective diagnostic tool and, perhaps more importantly, as a treatment for mitochondrial and metabolic dysfunction.</span><span style="color: #333333;"><br /> <br /></span><span style="color: #000000;">We discuss:</span><span style="color: #333333;"><br /></span></p> <ul> <li><span style="color: #000000;">Iñigo's background in sports and decision to focus on education [3:45];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #000000;">The various energy systems and fuels used during exercise [11:15];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #000000;">Iñigo's qualification of energy systems into six training zones [19:30];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #000000;">Lactate as an important fuel source [29:30];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #000000;">Zone 2 training—physiologic characteristics, fuel sources, lactate, and the transition into zone 3 [37:00];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #000000;">Using blood lactate levels (and zone-2 threshold) to assess mitochondrial function [43:30];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #000000;">Accessing mitochondrial function by testing one's ability to utilize fat as fuel [51:30];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #000000;">Athletes vs. metabolically ill patients—mitochondria, fat oxidation, muscle glycogen capacity, "fat droplets", and more [56:30];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #000000;">Physiologic characteristics of zone 3, zone 4, and the lactate threshold [1:16:30];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #000000;">Fueling exercise—dietary implications on glycolytic function [1:27:00];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #000000;">Relationship between exercise and insulin sensitivity (and what we can learn from studying patients with type 1 diabetes) [1:43:00];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #000000;">Metformin's impact on mitochondrial function, lactate production, and how this affects the benefits of exercise [2:00:45];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #000000;">Raising awareness of the risk of "double diabetes" [2:11:30];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #000000;">How to dose zone 2 training, and balancing exercise with nutrition [2:14:30];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #000000;">Proposed explanation of the Warburg Effect: Role of lactate in carcinogenesis [2:23:30];</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #000000;">Doping in cycling, and the trend towards altitude training [2:35:45] and;</span><span style="color: #333333;"><br /></span></li> <li><span style="color: #000000;">More.</span></li> </ul> <p><span style="color: #333333;"><br /></span><a href="https://peterattiamd.com/inigosanmillan/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=211227-pod-inigosanmillan&utm_content=211227-pod-inigosanmillan-podfeed"><span style="color: #000000;">View the Show Notes Page for This Episode</span></a></p> <p><span style="color: #333333;"><br /></span><a href="https://peterattiamd.com/subscribe/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=211227-pod-inigosanmillan&utm_content=211227-pod-inigosanmillan-podfeed"><span style="color: #000000;">B</span></a><a href="https://peterattiamd.com/subscribe/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=211227-pod-inigosanmillan&utm_content=211227-pod-inigosanmillan-podfeed"><span style="color: #000000;">ecome a Member to Receive Exclusive Content</span></a></p> <p><span style="color: #333333;"><br /></span><a href="https://peterattiamd.com/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=211227-pod-inigosanmillan&utm_content=211227-pod-inigosanmillan-podfeed"><span style="color: #000000;">Learn More About Peter Attia</span></a></p> <p><span style="color: #333333;"><br /></span><a href="https://peterattiamd.com/newsletter/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=211227-pod-inigosanmillan&utm_content=211227-pod-inigosanmillan-podfeed"><span style="color: #000000;">Sign Up to Receive Peter's Weekly Newsletter</span></a></p> <p><span style="color: #333333;"><br /></span><span style="color: #000000;">Connect With Peter on <a href="https://nam11.safelinks.protection.outlook.com/?url=https%3A%2F%2Ftwitter.com%2FPeterAttiaMD&data=04%7C01%7Cbrittany%40attiamedical.com%7C7c2c9fb8a7e04f09970908d9b9a25347%7C818179767cb4449aa341c29596a5fcc4%7C1%7C0%7C637744929113154696%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000&sdata=JQNNxygnRD6ezNbG697sp4ltQh7zMlMHG2LmMk3LR%2F4%3D&reserved=0">Twitter</a>, <a href="https://nam11.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.instagram.com%2Fpeterattiamd%2F&data=04%7C01%7Cbrittany%40attiamedical.com%7C7c2c9fb8a7e04f09970908d9b9a25347%7C818179767cb4449aa341c29596a5fcc4%7C1%7C0%7C637744929113164689%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000&sdata=oZyaNi7pkqGTC0RivahBZiO9dlUFZ0toFKBIxnFOHqw%3D&reserved=0">Instagram</a>, <a href="https://nam11.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.facebook.com%2Fpeterattiamd%2F&data=04%7C01%7Cbrittany%40attiamedical.com%7C7c2c9fb8a7e04f09970908d9b9a25347%7C818179767cb4449aa341c29596a5fcc4%7C1%7C0%7C637744929113174689%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000&sdata=vAz2kPeM8IcbF1SxnGAFybi651v6znwCT0P2qXdtEmE%3D&reserved=0">Facebook</a> & <a href="https://nam11.safelinks.protection.outlook.com/?url=https%3A%2F%2Fwww.youtube.com%2Fchannel%2FUC8kGsMa0LygSX9nkBcBH1Sg&data=04%7C01%7Cbrittany%40attiamedical.com%7C7c2c9fb8a7e04f09970908d9b9a25347%7C818179767cb4449aa341c29596a5fcc4%7C1%7C0%7C637744929113174689%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C3000&sdata=YhMM7N8kgoF%2BM9CyS1Xu%2FCyBIjxP%2FT3egFHU5qAYf1g%3D&reserved=0">YouTube</a></span></p>
Actionable Insights
1. Maximize Mitochondrial Function
Engage in Zone 2 exercise, which stimulates slow-twitch muscle fibers to their fullest and maximizes fat oxidation, leading to significant improvements in mitochondrial function and lactate clearance capacity.
2. Identify Zone 2 by Conversation
To gauge Zone 2 intensity without equipment, exercise at the highest level of exertion where you can still comfortably carry on a conversation, indicating optimal aerobic output.
3. Zone 2 Lactate Levels
Aim for lactate levels between 1.5 to 2 millimoles during Zone 2 training, as this range signifies efficient fat oxidation and maximal mitochondrial output without significant lactate accumulation.
4. Zone 2 Training Frequency
To maintain mitochondrial function, aim for at least two days of Zone 2 training per week; to significantly improve it, increase frequency to five days a week.
5. Prioritize Mitochondrial Conditioning
Approach exercise not just as calorie burning, but as ‘mitochondrial conditioning’ or ‘reprogramming’ to enhance fuel partitioning and overall metabolic health.
6. Zone 2 Dose for Diabetics
For individuals with pre-type 2 or type 2 diabetes, aim for one to one and a half hours of Zone 2 training, four days a week, to effectively reverse metabolic dysfunction.
7. Implement Post-Exercise Cool Down
After high-intensity exercise, perform a cool-down period to help reduce post-exercise hyperglycemia, potentially eliminating the need for insulin correction in diabetic individuals.
For individuals with type 2 diabetes, exercise immediately after eating to leverage muscle contraction for non-insulin dependent glucose uptake, reducing the need for insulin.
If taking metformin and performing Zone 2 exercise, consider adjusting the timing or dose (e.g., stopping it the night before) to prevent potential blunting of exercise benefits and reduce elevated lactate levels, as observed in personal experimentation and suggested by recent papers.
10. Adopt Sustainable Health Habits
When choosing health and exercise routines, prioritize practices that you can realistically maintain for the rest of your life, rather than unsustainable extreme measures.
11. Consider Carbohydrate Restriction
For metabolically unhealthy individuals not aiming for elite athletic performance, carbohydrate restriction can be a powerful tool to improve metabolic health.
12. Incorporate Varied Fasting
Implement different types of fasting (e.g., weekly, monthly, quarterly) as a strategy to maintain metabolic balance and sustain long-term health habits.
13. Reduce Insulin Before Exercise (Type 1)
Type 1 diabetics, under clinical guidance, should consider reducing their insulin dose before exercise, as muscle contraction increases non-insulin dependent glucose uptake and insulin sensitivity, helping prevent hypoglycemia.