<p><a href="https://peterattiamd.com/inigosanmillan2/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=240608-pod-inigosanmillan2&utm_content=240608-pod-inigosanmillan2-podfeed"> View the Show Notes Page for This Episode</a></p> <p><a href="https://peterattiamd.com/subscribe/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=240608-pod-inigosanmillan2&utm_content=240608-pod-inigosanmillan2-podfeed"> Become a Member to Receive Exclusive Content</a></p> <p><a href="https://peterattiamd.com/newsletter/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=240608-pod-inigosanmillan2&utm_content=240608-pod-inigosanmillan2-podfeed"> Sign Up to Receive Peter's Weekly Newsletter</a></p> <p>Iñigo San-Millán is an internationally renowned applied physiologist and a previous guest on The Drive. 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><strong>We discuss:</strong></p> <ul type="disc"> <li>The amazing potential of cyclist Tadej Pogačar [2:00];</li> <li>Metrics for assessing athletic performance in cyclists and how that impacts race strategy [7:30];</li> <li>The impact of performance-enhancing drugs and the potential for transparency into athletes' data during competition [16:15];</li> <li>Tadej Pogačar's race strategy and mindset at the Tour de France [23:15];</li> <li>Defining Zone 2, fat oxidation, and how they are measured [26:00];</li> <li>Using fat and carbohydrate utilization to calculate the mitochondrial function and metabolic flexibility [35:00];</li> <li>Lactate levels and fat oxidation as it relates to Zone 2 exercise [39:15];</li> <li>How moderately active individuals should train to improve metabolic function and maximize mitochondrial performance [51:00];</li> <li>Bioenergetics of the cell and what is different in elite athletes [56:30];</li> <li>How the level of carbohydrate in the diet and ketogenic diets affects fuel utilization and power output during exercise [1:07:45];</li> <li>Glutamine as a source for making glycogen—insights from studying the altered metabolism of ICU patients [1:14:15];</li> <li>How exercise mobilizes glucose transporters—an important factor in diabetic patients [1:20:15];</li> <li>Metrics for finding Zone 2 threshold—lactate, heart rate, and more [1:24:00];</li> <li>Optimal Zone 2 training: dose, frequency, duration, and type of exercise [1:40:30];</li> <li>How to incorporate high intensity training (Zone 5) to increase VO2 max and optimize fitness [1:50:30];</li> <li>Compounding benefits of Zone 2 exercise and how we can improve metabolic health into old age [2:01:00];</li> <li>The effects of metformin, NAD, and supplements on mitochondrial function [2:04:30];</li> <li>The role of lactate and exercise in cancer [2:12:45];</li> <li>How assessing metabolic parameters in long COVID patients provides insights into this disease [2:18:30];</li> <li>The advantages of using cellular surrogates of metabolism instead of VO2 max for prescribing exercise [2:25:00];</li> <li>Metabolomics reveals how cellular metabolism is altered in sedentary individuals [2:33:00];</li> <li>Cellular changes in the metabolism of people with diabetes and metabolic syndrome [2:38:30]; and</li> <li>More.</li> </ul> <p>Connect With Peter on <a href="https://twitter.com/PeterAttiaMD">Twitter</a>, <a href="https://www.instagram.com/peterattiamd/">Instagram</a>, <a href="https://www.facebook.com/peterattiamd/">Facebook</a> and <a href="https://www.youtube.com/channel/UC8kGsMa0LygSX9nkBcBH1Sg">YouTube</a></p>
Actionable Insights
1. Exercise for Mitochondrial Health
Recognize exercise as the most effective ‘medication’ for improving mitochondrial function, which is crucial for metabolic health and longevity.
2. Embrace Compounded Zone 2 Gains
View Zone 2 training as a long-term investment, focusing on consistent, compounded gains over years rather than quick fixes, to achieve significant and sustainable metabolic health improvements and longevity benefits.
3. Optimal Zone 2 Training Frequency
Engage in Zone 2 training 3-4 days per week as a minimum for improvement, with 4-5 days being ideal for most individuals, and 5-6 days for maximal benefit. Less than 3 days may lead to deterioration or just maintenance.
4. Optimal Zone 2 Training Duration
Aim for 60-90 minutes per Zone 2 session for significant mitochondrial and metabolic adaptations. Beginners can start with 20-30 minutes and gradually increase duration.
5. Gauge Zone 2 by Conversation Test
Determine Zone 2 intensity by maintaining a conversation where you can talk, but it requires noticeable effort, and the person you’re speaking with would recognize you are exercising.
6. Use Lactate Meter for Zone 2
Utilize a lactate meter to identify Zone 2 by ensuring blood lactate levels remain below 2 millimoles/liter, as exceeding this indicates a transition into Zone 3.
7. Estimate Zone 2 by Heart Rate
Estimate Zone 2 heart rate by aiming for 70-80% of your realized maximum heart rate, then fine-tune based on the conversation test (RPE).
8. Combine Zone 2 with End-Session HIIT
Incorporate high-intensity intervals (e.g., a 5-minute interval) at the end of a Zone 2 session to stimulate both oxidative and glycolytic systems, without blunting the Zone 2 benefits. Avoid starting with high-intensity work.
9. Prioritize Recovery, Carb Intake for Fatigue
If experiencing fatigue (e.g., inability to reach target heart rate during exercise), prioritize recovery by taking a day off, increasing sleep, and boosting carbohydrate intake to restore glycogen stores and improve subsequent performance.
Acknowledge that high mental workload and stress can significantly impact physical performance and recovery, even with low training volume. Prioritize rest, sleep, and adequate carbohydrate intake on such days to prevent overtraining and aid recovery.
11. Exercise Post-Carb Meal for Glucose Control
For individuals with insulin resistance or pre-diabetes, exercise immediately after consuming carbohydrates to leverage insulin-independent glucose uptake, helping to lower blood glucose levels.
12. Use Indoor Trainer for Consistent Zone 2
Utilize an indoor trainer for Zone 2 exercise to maintain a constant, precise intensity without interruptions from external factors like traffic, wind, or varied terrain.
13. Stimulate Glycolytic Capacity
Include high-intensity training to stimulate glycolytic capacity, which is important as it declines with age.
14. Maintain Muscle Health for Systemic Benefits
Maintain good muscle health through exercise, as it may contribute to overall metabolic health and potentially release beneficial exosomes that could counteract cancer’s glycolytic phenotype.
Undergo indirect calorimetry (metabolic cart) to precisely measure fat oxidation capacity and determine personalized training zones, especially for those with metabolic dysregulation, by starting at very low wattages (e.g., 25-50 watts).
16. Structured Exercise for Long COVID
For individuals with long COVID experiencing severe mitochondrial dysfunction (resembling Type 2 Diabetes), consider a carefully structured exercise program aimed at stimulating mitochondrial function, potentially under medical guidance.
17. Exercise Caution with NAD Precursors
Exercise caution with NAD precursor supplements (e.g., NR, NMN) due to theoretical and preliminary experimental concerns that they might potentially favor the growth of undiagnosed tumors by increasing glycolytic flux.
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