Zone 2 Training Explained: The Single Best Workout for Your Mitochondria | Dr. Inigo San Millan

Does nutrition in my humble opinion not reverse mitochondrial function? I don't

think so. The only way where we can improve mitochondrial function is through exercise. If mitochondria don't

through exercise. If mitochondria don't work, that cell and that organ is not going to function very well.

Mitochondrial function and health is next level.

>> How, can, one, actually, measure, their mitochondrial health?

>> By, measuring, fat, oxidation,, fat, burning, we can indirectly have a proxy for mitochondrial function.

>> Why, is, zone, 2, training, [music], so important for our mitochondrial health?

Zone two improved the most two parameters fat oxidation and lactate clearance capacity which both are surrogates of mitochondrial function.

>> Introducing, exercise, physiologist, Enigo San Milan.

>> If, you, have, higher, blood, lactate, levels is a sign that your mitochondria are not processing that lactate or clearing it or recycling it properly.

>> A, lot, of, people, would, just, think, that lactate is a waste product. You know

it's [music] kind of you go to the gym and your muscles hurt and that's how people resonate with lactate. Lactate

without a doubt it's an amazing biomarker that has been there in front of our eyes. Lactate is the best fuel for the cells and even in cancer we know that it is a master regulator for

carcinogenesis. So the way is about to

carcinogenesis. So the way is about to combine and as I said if you do four days a week zone 2 in combination with high intensity at least two or so towards the end that's when you start hitting some sweet spot.

>> Is, there, [music], differences, between, men and women when it comes to zone two?

Well, that's a good question and I think things get mixed up because of >> if, you, are, a, regular, listener, to, this show or live well be well or this is your first episode you're listening to

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you. I want to start with V2 max because it's a big buzzword especially in the last I would say 3 to 5 years. It's

become at the forefront of many health conversations. It's become the gold

conversations. It's become the gold standard of fitness, the number one metric that every athlete wants to improve. But you've said that V2 max

improve. But you've said that V2 max really only scratches the surface. So

why doesn't it tell us the full story?

We've been knowing uh about V2 max for for decades and we've been using it for decades with especially with athletes.

uh it dates back more than 100 years at least since we have uh more standard ways to measure it and it's been always linked to uh fitness to performance

therefore to health and uh now in the in the times of longevity right it's it's it's one more parameter that is plugged in uh longevity right and it's a great

measurement uh however uh it doesn't uh tell the whole story there's more than that uh V2 max It's a representative of the central cardiorespiratory

adaptations, right? But there's more

adaptations, right? But there's more because ultimately that oxygen is utilized by the cells and is utilized by the cells in mitochondria as well as

fuels and this is where the area of physiology in general has evolved from V2 max to uh what happens at the

cellular level. and uh in the same

cellular level. and uh in the same manner that we've been using you know with athletes v2 max for decades right and now it's mainstream we have already

passed that time we we we work now at the cellular level and this is what I see uh the mainstream mainly in the area of longevity getting into in fact

already people are talking about mitochondrial function metabolic health right and this is the next level uh and this is what we've been working with athletes uh for performance ments you

need to produce ATP energy and that's produced in mitochondria and for health if mitochondria don't work uh that

health that cell and that organ is not going to function very well because doesn't produce IITP um well enough for

longevity as we age our cells age our mitochondria age and our energy production overall ages as well and decreases and that resides in

mitochondria. Therefore, is the

mitochondria. Therefore, is the mitochondrial function and health is the next level.

>> Okay., So,, this, is, kind, of, like, the, next stage of where we're exploring now with I would say I mean longevity is a buzz word, but mitochondrial health I think

many people will have known from GCSE biology and then forgotten about it. But

the way that I always think about it is a powerhouse of the cells. But how can one actually measure their mitochondrial health? because the VA2 max is yes a bit

health? because the VA2 max is yes a bit easier um to attain and to get to but mitochondrial health how do we even measure that?

>> Well, um, we, can, do, it, through, a, muscle biopsy >> and, get, a, chunk, of, muscle, and, uh, look under the microscope or do a bunch of things to to that and and but it's I

don't think it's a very convenient way to [laughter] do >> um, [gasps], because, you, will, have, a, chunk of like a big scar and you know but um >> that, sounds, quite, painful., Yeah,

[laughter] I don't think you won that.

But the other way, I I I developed a methodology years ago and I've been using it with with athletes uh for for a long time where we we we have uh two uh

proxies for that. On one hand, um with the same device that you measure V2 max which uh um it's, you know, like in a colloquial form, we call them metabolic

carts. They've been used always used

carts. They've been used always used metabolic carts. uh we can look at gas

metabolic carts. uh we can look at gas exchange right and uh so when we look at gas exchange we look indirectly through some complicated equations we can see

how much uh fat and carbohydrates you're burning in grams per minute we can see that now when it comes to fat we know

that fat can only be burned in mitochondria okay so by looking at fat by measuring fat oxidation is called fat

burning we can indirectly have a a proxy for mitochondrial function. Then lactate

can only be burnt in mitochondria.

Right? So by by pricking your finger or your earlobe and getting a small sample of lactate and measuring it, we can have

an idea of how well your your cells are processing uh glucose and uh which under resting conditions it happens in mitochondria. But the fact is that if

mitochondria. But the fact is that if you have higher lactate blood lactate levels, it's a sign that your mitochondria are not processing that lactate or clearing it or recycling it

properly. Therefore, with the two

properly. Therefore, with the two parameters fat utilization and lactate you can indirectly see or or measure mitochondrial function. We published

mitochondrial function. We published that study a few years ago and now we have already published a pre-print about an extension of that study where we look

at muscle biopsies and in the muscle biopsies we we look directly how they work and we correlate them with this methodology. So it's quite robust to do

methodology. So it's quite robust to do it in a non-invasive way and an ambulatory manner where a lot of people can do it um out there.

>> Wow,, that's, fascinating., So,, I, think, a lot a lot of people would just think that lactate is a waste product. You

know, it's kind of you go to the gym and your muscles hurt and that's how people resonate with lactate. But you're saying now we can use that as a measure to test how well our mitochondria are

functioning. Is that ready available?

functioning. Is that ready available?

Can people go and access that quite easily or is it still quite hard to get our hands on?

>> Yeah., So, to, to, look, at, your, uh, V2, max, you have to go usually to an exercise physiology laboratory um at a your your local university if

they have one or your local hospital.

More hospitals have those devices then uh and and that's was as I mentioning that's the same machine or device that measures fat oxidation as well but

lactate you can do it with a handhandle device. you know, now they're very

device. you know, now they're very common. It's kind of the glucose meters

common. It's kind of the glucose meters but they measure lactate. You can even do it yourself with a little bit of technique, but uh the combination of both is very accurate. Uh but even only

one alone like in this case lactate uh it's uh it's yeah, you can a lot more people can do it uh without going to a hospital or university.

>> Wow., Okay., So,, we, should, be, maybe looking more our lactate levels than we have been previously.

Yes, lactate uh without a doubt it's an amazing biomarker that has been there in front of our eyes is uh uh lactate it uh it's everywhere in the body and uh and

what we know uh very well from uh the pioneer studies uh from 40 from over 50 years ago from Dr. George Brooks from the University of California, Berkeley

who's my mentor and my great friend and and a colleague. Uh he has been discovering everything we know pretty much about lactate. and he was uh

swimming upstream for for decades trying to prove that lactate was not first an uh a waste product as a result of

anorobic metabolism and second that lactate is the best fuel for the cells and then the lactate is a signaling hormone that is needed for the

homeostasis of many cells in the body and Yahi has been proving all these concepts throughout the years which have been transformational to understand cellular metabolism whether for exercise

or for other diseases and now we we've been taking that lactate a little bit further and even in cancer we know that um it is a master regulator uh for

carcinogenesis some idea that we proposed in 2017 through our what we call our lactenesis hypothesis that it was rejected seven or eight times and

finally got on because it was a crazy concept and even two editors wrote us back saying, "You guys are crazy." Yeah

you know what you're doing. And now, and I mean, we're talking about seven, eight years later now. Our article has uh about 850 citations in the literature.

So, people have been paying attention entering that door. And now, I mean without a doubt, lactate is a major component in cancer. Um, and uh it's going to become just a bigger one. But

it's a it's it has a complicated role in the body and it's a great fuel. If you

give a cell lactate or glucose or ketones or uh fat, it's going to prefer lactate. It's is the preferred fuel for

lactate. It's is the preferred fuel for the cells and because it's the fastest one to be burnt and it's a signaling molecule. It's a main very important as

molecule. It's a main very important as I said for homeostasis for the good and for the bad because if it builds up in the cells and you don't have enough clearing capacity, it can become

pathological.

But uh but and it's a great aid and assistant to exercise. People think that the buildup of lactic acid which doesn't doesn't exist in the first place that

the body produces lactate but lactate um it's it's necessary for the continuation of uh of energy processes in in the cell

and in fact uh it removes one proton that cause acidosis. So what happens in our muscles is that as we increase exercise intensity that burning

sensation that we feel that's not from lactate it's from um the production of ATP and what we call the ATP hydraysis which is the the burning of ATP for uh

producing energy and that's what liberates a lot of uh acid particles called protons and they make the the the muscle very acidic and that's the

acidosis that decreases the contraction.

and it feels that burning sensation.

Lactate, it helps by removing a proton.

So, it's it's a removing protons. It's a

instead of adding, but it's it's a concept that it's been taking decades to explain and hopefully now that it's a little bit more uh mainstream, we can

get to understand it better.

>> Wow., So,, okay., So,, when, you, just, said, it there about the mitochondria runs better on lactate, how do we then produce more lactate, is it just exercise or is there

other forms of how we can be making sure that we're feeding ourselves to what you're telling us?

>> Well,, it's, not, that, mitochondria, run better on lactate. Lactate is uh it's uh burnt in mitochondria, right? Okay.

>> So,, if, you, don't, have, a, good mitochondrial function, you're not going to be burning be burning lactate very well. Further yeah furthermore lactate

well. Further yeah furthermore lactate is the mandatory end product of glucose utilization. So when you burn glucose

utilization. So when you burn glucose you always produce lactate always. The

higher the glucose burning right the more lactate you produce. So it gets to a point that lactate if you want to burn it inside mitochondria during exercise

or even at rest first has to go glucose the first door that is a at the entrance of the cell. Okay. Then that glucose is

transformed in a substance called pyuvate which ultimately has to enter the furnace of the cell to be burn and

produce ATP or energy right but that furnace has another door right and that is the one that it has to be also

working and if the flux of glucose is too much into the cell uh whether because there's very high intensity

or there's a pathological state, glucose cannot be burned. That pyuvate cannot enter that door into mitochondria into the furnace and be burnt and the only

way they have is to be transformed to lactate. Right? So when you see and that

lactate. Right? So when you see and that lactate go escapes to the blood. So when

you see high lactate, high blood lactate levels, it it's telling you that that glucose is not be fully oxidized or

burnt right in mitochondria and is being transformed to lactate because otherwise you would see very low blood lactate levels. Uh meaning that the glucose is

levels. Uh meaning that the glucose is very well oxidized or burnt.

>> Got, you., Okay., So, if, people, really, want to make sure that how can people apart from taking a lactate test, is there any physical signs that one person will know if they're having good mitochondrial health before they get to testing their

lactate levels?

>> I, think, that, this, is, one, of, the, areas where wouldn't have biomarkers, you know, let's say um people have type 2 diabetes for example, right? Um it's

it's it's a metabolic disease characterized by a poor capacity to burn glucose but not just to transport it through the cell but to burn it and then

resting conditions you burn in mitochondria. Right now the biomarker

mitochondria. Right now the biomarker that we have is a diagnosis. We have the glucose tolerance test or the hemoglobin

A1C. Right? That's a diagnosis, right?

A1C. Right? That's a diagnosis, right?

There there are no other biomarkers.

Unfortunately, same thing for Alzheimer's. Alzheimer's.

We know that uh beyond um you [clears throat], know, the, um, amoid, plaque hypothesis we know that no drug has been able to target that plaque and that now

the new thinking in Alzheimer's is looking at brain metabolism right and that Alzheimer patients are or Alzheimer's disease is characterized by

two hallmarks insulin resistance and mitochondrial dysfunction which are the same two hallmarks of type 2 diabetes which is now given the name or rename it

you know like a more colloially type three diabetes or brain diabetes or endstage type 2 diabetes right but without a doubt there's there's a big

part of its um pathology um is a um it's a mitochondrial dysfunction and and uh insulin resistance so there a poor glucose utilization but again we don't

have any biomarker Right? The biomarker

that we have is the PET scan that has been in front of us forever. Right? You

look at the PET scan of a typical Alzheimer's and most of us have been either seen one or looked at internet how they look like. we see the very

bright um images right the the very bright orange or red and yellow especially the the the orange or red that's metabolic activity right of the

brain and that specifically it is a glucose activity in the brain that's a normal brain a norm a brain with early Alzheimer Alzheimer's has uh reduced

activity reduced metabolic activity and it's reduced glucose activity an advanced Alzheimer Alzheimer's uh disease. You can see the image that is

disease. You can see the image that is very um is very dark is very blue right? There's not much uh metabol

right? There's not much uh metabol activity because there's not much glucose utilization. But again, that's

glucose utilization. But again, that's not a biomarker. It's a diagnosis. And

this is what one of the areas that we need to focus is on developing novel biomarkers so that we can see metabolic or cellular disregulations at the

mitochondria level a decade or even two before it becomes a full disease because then we can intervene whether is with a lifestyle interventions exercise

nutrition or we can intervene therapeutically through targeted therapies.

Noville targeted therapies.

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Well, it's so interesting that you mentioned about Alzheimer's there because in the UK, dementia is the number one killer and it's interesting that I've spoken to Chris Palmer on this

show about metabolic health and and mental health and the mitochondria is always at the center of these conversations so much, but I think so many of us are confused about how we can

improve our mitochondrial health. So we

we started at the beginning about talking about V2 max as looking as a one predictor, but you talk so much and you've pioneered this whole sector with

exercise to help support mitochondrial functioning. So although we're in a bit

functioning. So although we're in a bit of an explosive of chronic disease right now, there is a lot of things that we can do. We got to have hope to get our

can do. We got to have hope to get our mitochondrial health like pumping back.

So you have pioneered and I know that you know there's a lot more to it but you have pioneered zone 2 training. So I

thought it's important to start there.

Why is zone 2 training so important for our mitochondrial health?

>> Well, I, mean, everything, starts, with, uh professional athletes. They have taught

professional athletes. They have taught us a lot right. I always say we cannot understand imperfection if we don't understand perfection in the first place. Those are the the uh the formula

place. Those are the the uh the formula one cars right? sort of the gold standard of what a human should be right? Metabolically speaking, right?

right? Metabolically speaking, right?

And this is what I've been fortunate for almost 30 years to to be able to work with these kind of humans and be able to understand them very well. So they have taught us a lot in order to understand

other uh concepts in in different pathologies characterized by these functions at the metabolic cellular level. Right? So performance on one

level. Right? So performance on one hand, right? It's about, as I mentioned

hand, right? It's about, as I mentioned about producing ATP fast, producing energy fast, and and and lasting as long as you can. Competition is that being as

fast as you can for as long as you can right? That's whether whether we're

right? That's whether whether we're talking about swimming or rowing or cycling or football, basketball, you need to be fast and you need to sustain

that effort, right? So for that you need to produce ATP at very high levels and have a very metabolically efficient engine right which is what happens at

the cell and that furnace that powerhouse that central part of that engine uh the cell is mitochondria right so what do we need need to do with

athletes improve their mitochondrial function so uh for that back in the days I I developed these methodologies to try to understand how we can translate what

we were learning about cellular metabolism into training. So we know that different exercise intensities elicit different metabolic results. It's

not the same result when you go for an easy spin on the bike for example than if you do a uh a 30 second sprint.

You're mobilizing different energy systems, right? So that's what I I saw

systems, right? So that's what I I saw in the laboratory with these methodologies with the metabolic heart with the um lactate and I start to define different training zones because

there were different metabolic events.

If you do a maximal I mean an incremental exercise intensity, you see this beautifully and anybody who has done this test or performed this test as

an as as an operator, you can see these events happening in front of your eyes right? And uh therefore, we're talking

right? And uh therefore, we're talking about from very low intensity all the way to maximal sprinting, right? So if

you if you put together the do the dots you're going to see these metabolic events. That being said, uh that's what

events. That being said, uh that's what I I I created different training zones because I couldn't tell an athlete, hey you're in a in a high glycolytic

intensity or you're in a 100% oxidative phosphorilation state. That's why you

phosphorilation state. That's why you have to train, right? You cannot speak that language, right? So I I had to do something that was very easy to understand. And that's what I decided

understand. And that's what I decided zone one through zone six, right? Then I

started by trial and error. Okay, now

let's try the next step. Okay, what is the intensity that elicits the best effect not just for mitochondria but for other intensities, right? Because we we

always have to remember that when it comes to for athletic performance, you always win competitions at the high intensities. I have never heard about

intensities. I have never heard about any athlete or seen any athlete winning a a competition in the zone two or low intensities. Never happens. So, but

intensities. Never happens. So, but

unfortunately people are taking to the to, the, extremes, now, and, all, of a, sudden high intensity is gone. It's worthless.

Well, it depends if you're an athlete.

You must train high intensity and my athletes train very high intensities. In

fact, you know, like um about 50% of all the best times the PRs happen during training, not competition, right? So

it's very high intensity because you need to stimulate that. So anyways

that's why you set up all these training zones and that's what I started to see people in the responses back in the laboratory where you can study that metabolic response very closely and see

which trainings have improved the most.

So what I saw is that that zone two that was the one they improved the most. Two

parameters that I mentioned earlier fat oxidation and lactate clearance capacity which both are surrogates of mitochondrial function. I was seeing

mitochondrial function. I was seeing this over 25 years ago and and then obviously working with athletes you saw that also in the competition that's when

you saw that the action right and uh so that's why the zone 2 came along but of course you have higher intensities some four five which are you know that that

turbo you you need to improve that that turbo right the important thing is that you also have to train that turbo which are like the high intensities the zone five zone four because you need to

stimulate that tour because that's where you're going to improve uh the competition as well but then you need to stimulate also the sprint because sometimes you need to sprint you know anyways but when it comes to

mitochondrial function that's important but when it comes to V2 right which is uh the cardiorespiratory adaptations training high intensity is very

efficient that's probably more efficient if if not more efficient than training at zone two but as I said from the beginning that's that's the how you express your cardiorespiratory

adaptations to exercise right and and uh but another thing is like how well mitochondrial function works. So anyway

so this is what now from from the lessons that we have learned from elite athletes. Then I started working with

athletes. Then I started working with people with from different pathologies right? and our chronic diseases

right? and our chronic diseases including uh type two diabetes uh cardiac rehab patients oncology patients and uh metabolic syndrome and that's

what I saw in these these people also improved mitochondrial function the most that that training >> and, also, people >> yes, that's, what, I, was, seeing >> and, also, with, people, who, just, wanted, to

get fitter >> typical, person, who, hadn't, has, been struggling forever because they only did heat for example and First they see results but eventually they get injured

or they get discouraged or they lose patience with that because it's it's not sustainable for many people not for all of course huh so and I'm not saying that

you have to disregard high intensity at all but I think that you need to reduce the amount and this is what we know very well again from the lessons we learned from athletes that you cannot sustain

high intensity training all the time and we don't see that I mean in that when Any of us who has been working with athletes at the high level can confirm

this you know you don't see a let's say like very high intensity sport you know like uh swimming right uh it's under a minute okay it's under a minute okay

what do I have to do to training what's what's your intuition tells you let's just do 40 50 second sprints all day right okay we can't be so nice to think

that the best coaches in the world and the Uh swimmers have thought about this right? Of course they have. Does it

right? Of course they have. Does it

work? Well, just go around any swimming pool around the world with the best swimmers in the world. They spend hours a day, two, three, four hours a day

swimming up and down, up and down. And

of course, they do intervals, but it's not sustainable. And you can take this

not sustainable. And you can take this to any sport out there, right? So, the

same thing, you know, for for regular life, high intensity is important, but uh but it's not sustainable. And uh uh and then zone two the characteristic that has had is that it works uh and is

sustainable.

>> So, when, we, think, about, zone, two, and, tell me if I'm wrong but I'm think I always think about zone two in training that I can just about talk but not in a

comfortable way. How can someone

comfortable way. How can someone understand if they don't have a wearable? How can they understand where

wearable? How can they understand where zone 2 is? Yeah, that's a good question and and this is this is about about it and it it resembles closely to what we

see in the laboratory when we establish the parameters for for that zone 2 and the other the rest of the zones right yes that's an intensity where definitely we cannot keep this conversation this

would be resting as we are but it's a conversation that uh you can sustain I mean you you can sustain but it takes an effort right it's a forced conversation

ation that you have to breathe, you have to talk, but you can't sustain it by with an effort. If you can't sustain if you cannot sustain that conversation for

for more than a few seconds, right, that you're already in very high intensity and this is due to glycolysis, uh, which is another event that you see very well

in the laboratory. When when you're working in zone two, you're burning glucose, but you're burning fat. And

that's the intensity of the one you burn the most fat, which is another concept now getting very popular, which is the fat max, right? That's intensity of the one you burn the most fat. I've been

using that concept for 25 years at least and and using for weight loss purposes too. People would come to the laboratory

too. People would come to the laboratory and uh because they've been trying to lose weight through exercise and and they can't. And then when you do the

they can't. And then when you do the test, you see that they've been they've been exercising at two high intensities where you burn zero fat. And you show that to them because in the laboratory

you see very well where you burn the fat. You see the grams per minute, the

fat. You see the grams per minute, the fat oxidation in grams per minute and carbohydrate oxidation. So there gets to

carbohydrate oxidation. So there gets to a point that you get to your fat max and then as exercise intensity increases the fat disappears and you burn zero

fat. And why is that? is because as you

fat. And why is that? is because as you go on to a higher exercise intensities the the cells the muscles need uh faster

ATP faster energy and uh that energy cannot be supplied by fat anymore because while fat can give you more overall energy it's slower it's like a

diesel gasoline right it's lower way it takes more time to give you that energy which when you're at lower intensity is great right this It's part of the

evolution, right, of humans because we can only store about half a kilo, 500 grams, uh like 2 lbs of glycogen, no one

pound of glycogen, sorry. Uh which is how we store glucose, carbohydrates right? So the body tends to preserve

right? So the body tends to preserve that tank very well and for that starts using other fuels mainly fat, right? But

when exercise intensity is very high fat cannot be cannot give you energy fast enough and you need to switch to carbohydrates. And then and

sorry I've been going the wrong way.

This is what happens is like uh you suppress fat and uh this is why a lot of people were not burning fat because they were always in in carbohydrate burning.

They were not burning adipos tissue. But

then through the talk test to your point, the fact you're speaking fast is because you're burning a lot of carbohydrates, you're producing a lot of lactate and you start buffering that

lactate and that CO2 that's part of produc of buffering the lactate and that forces you to breathe faster, right? So

when you're breathing faster, you're at a higher metabolic stress and uh you you start decreasing significantly the amount of fat burning. So when you can't

stop at all, when you can't speak at all, you're not burning fat, you're burning glucose.

>> Wow., Okay., So, sometimes, people, might just be doing too much high intensity and that's why they're not losing any weight.

>> Yes., We've, been, knowing, that, for, for decades as well in working with athletes.

>> But, I, don't, think, that's, a, normal conception in in the public. I think a lot of people today will go to the gym to want to sweat and burn a lot of energy and wonder why they're not losing

weight and this is the exact reason why.

So you're saying if they can balance that with more zone 2 and recovery their mitochondrial health will improve.

>> Yes., Uh, yes,, it, it, it, pays, off., People

would say of course yeah. But if you do high intensity, you increase your basal metabolic rate and you burn fat down the

road in the next uh 6, 12, 24 hours.

Sure, of course you can do that. Of

course, but why not burning fat while you're exercising so they instead of burning fat after you exercise relying on what you think that

you're going to be burning at rest because of the high intensity that you did, right? I think there's room for

did, right? I think there's room for both concepts obviously but again why not burning fat during exercise because you're going to burning more fat during

exercise you're burning it depends right uh but you depend it depends on your fitness level and your mitochondrial function level you burn between 0.2 0.3

to 0.8 eight or nine close to one gram per minute, right, of fat. That uh

doesn't seem quite a quite much, but day after day after day after day, it counts, right? But uh during rest, yeah

counts, right? But uh during rest, yeah during rest, you burn very little fat right? So might be burning 0.1, 0.15.

right? So might be burning 0.1, 0.15.

Um so why not burning 0.4, 4 0.5 gram half, a, gram, for, for for, doing, an exercise for 60 minutes or 90 minutes right? And uh just you get a

right? And uh just you get a calculation. People can do get a

calculation. People can do get a calculator uh you know just plug some numbers in and you're going to see that if you have about four days a week uh

about five four to five hours a week um burning fat 0.4 4 0.5 you know every month you're going to be losing it depends on the time you know and you're

fat burning but you can be losing one kilo if you want to lose weight right so along with the diet it can really help you know but anyways that that fat that

fat max coincides also with zone 2 that's that's a good parameter to see >> wow, okay, so, I, guess, I, mean, I, find, this really interesting as well from a nutritional perspective because there's

also the the argument that if you're training being at high intensity all the time, you're also going to be eating a lot more as well. So, if you are on a a fat loss mission and you're consuming

more calories and and you're having more of a nutrition load, that also is also quite a hard one for for losing weight as well. So, there's I mean, and I'm not

as well. So, there's I mean, and I'm not saying that's right or wrong, but there's also eating more and exercising more. And I do see that a lot within

more. And I do see that a lot within clinic where people are just exhausted and they're kind of eating their way through the day because they're doing so much HIT training.

>> Yes., I, mean,, we, have, to, also, think, that, yeah, if you do high intensity training you're going to burn a lot of energy and you're going to have to reynthesize it

right? And that's uh important to know

right? And that's uh important to know that uh uh you're going to be burning a lot of energy and you're going to have a to eat a lot more to reynthesize it. And

this is the problem sometimes. It's like

how much you have to eat. Some people

they think they have to eat more than what they need. Some people they think they have to eat less, right? Then when

you have low um imagine that you have low glycogen content because you're having a low carbohydrate diet and you can only store about half a kilo, one

pound. Then people with high intensity

pound. Then people with high intensity training, you can be burning somewhere between four, five, seven grams per minute of carbohydrates, right? So you

can run out of glycogen pretty fast especially over a few days and then the body tries to defend that. The body does not like to lose glycogen right so it

starts adapting to that. The first line of adapt of adaptation from an evolutionary standpoint is muscle breakdown that happens uh in dur in

athletes. We know that happens very well

athletes. We know that happens very well that happens to ICU patients uh and then it happens at cancer patients. So the

more glucose you use and and once you hit uh a depleted glycogen stoages the body is very wise because can break down different proteins in the muscle

converting different amino acids in the muscles like the branching amino acids.

It can become glucose can go to the liver and become glucose and also glutamine. It goes directly into

glutamine. It goes directly into mitochondria but you pay a price because those amino acids are derived from muscles. So the muscle starts eating

muscles. So the muscle starts eating itself to feed itself. It's like a it's like an oxymoron in a way, right? But

it's an evolutionary mechanism. Then you

move on to the next phase which is using keto ketones, right? Which is much longer adaptation time, right? But uh

but right away the many people is what happens. They they they are burning all

happens. They they they are burning all glucose when they go out. They don't

have enough they don't have enough glycogen. They're starting breaking down

glycogen. They're starting breaking down protein. they don't lose weight, they

protein. they don't lose weight, they get tired, fatigued and also increase the chances of getting injured and uh so

I am not obviously I am not saying that heat is bad but if you do heat you need to be very very well monitored right otherwise can be tricky so when we do

heat training with athletes we need to monitor very well because they can get overtrained like that you know and that's why it's very the events in a week where an athlete does highintensity

training are very limited because of you can get uh overtrained.

>> So, with, like, a, normal, person, listening to this and I say normal because you know you do work with elite athletes like people from tour to France and stuff that you have done with them is

incredible but obviously the normal average person doesn't have the time that an athlete has or the expense. So I

think the general like conversation online which I was trying to find for this conversation is that most people are saying four to five times a week of exercise where how much zone 2 should that be for

an average person if they're going to the gym four or five times a week. How

should they be looking at their exercise to support mitochondrial health and what would you suggest?

>> An, ideal, dose, should, be, somewhere, around 200 to 300 minutes a week. Right. That's

uh that's somewhere somewhere around three I think three to four hours a week of zone two uh it works really well and

if on top of that um maybe towards a zone 2 session you do high intensity at least two days a week that's important so you can do let's say

ideally you do one hour to an hour and a half uh at zone 2 on the bike for example or one hour on the rowing machine or you do 40 minutes to an hour

running or fast walking, right? Uh if

you do four days a week, two days a week, you can do high intensity, right?

Towards your V2 max, right? To stimulate

V2 max also and to stimulate what we call the turbo that I was mentioning the glycolytic adaptations, right? But

you just have to touch it, right? If you

can first, if you can, can you uh or if you enjoy it, can you do a sprint or can you do two two minutes maximum exercise?

If you're um a cardiac patients, you're not going to be able to probably do it.

If you're an oncology patient, you're not going to be able to do it, right? If

you're longevity person, uh you might not have the the stamina yet. Uh or you might not enjoy it or you might enjoy it very well, right? But I think it's important to try to stimulate that high

intensity twice a week.

>> Yeah.

>> And, and, then, resistance, training obviously. Yes. And then resistance

obviously. Yes. And then resistance training two or three days a week. Two

the research shows that if you do like a a well-rounded strength training program about two days a week is enough or should be enough at least to maintain

muscle health. Not to become not to

muscle health. Not to become not to become a bodybuilder to have a lot of muscle, right? to to maintain your

muscle, right? to to maintain your muscle mass to this week should be important.

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>> And, so,, it's, interesting, because, I've had Dr. Stacy Sims on this show who talks a lot about women's health um and talks a lot about zone 2 training as well. Um, and it's really interesting

well. Um, and it's really interesting because obviously you've [snorts] been speaking about zone 2 for such a long time. Is there differences between men

time. Is there differences between men and women when it comes to zone 2? A lot

of are a lot of these studies mostly based on men. What does the women's health sector show? Do we need to be doing less or more of zone 2 training? I

think Stacy's argued on the show that she agrees with zone 2, but maybe we need to be doing a bit less of it um as women, but she's still a massive advocate for it. Um but she says it's in

its infancy. What's like now I have you

its infancy. What's like now I have you on, what is your view on like women versus men and zone 2 training? Is there

any evidence that you can like share with us or or even like that you've worked with athletes yourself in this sector?

Well, that's a a good question and I think that um I think get things get mixed up because of the uh of the perception that everything is on two and

therefore whether you're a men or a women that's not it you need to do high intensity and this is this is when when I started with the concept of zone two I I was the zone four and zone five also

and as I mentioned I have never heard anybody winning a race in zone two for you need to do a high intense city now everything comes to the extreme right that it's only zone two and that's not

true so maybe when Stacy refers that you need to do less zone two is because you need to do more high intensity I agree with that because that's what I

recommend uh to uh to my patients whether they are men or or or women or my athletes also so that's that's important thing um that you need to have

and as we just talked we need to do some like one or two times a week you need to you know get those incursions into into high intensity because are necessary for

that glycolytic capacity. The one thing too women have a decreased glycolytic capacity and by glycolytic capacity I mean that turbo capacity and that's the

high intensity they have lower muscle mass they have lower capacity for those fast twitch muscles to produce ATP fast right and uh therefore uh there's a

reason for women they can try to stimulate that more that being said when it comes to um mitochondrial function men and women are equal

or should be equal, right? And

therefore, um any exercise that in that increases, you know, mitochondrial function should be applied like zone 2.

>> It, sounds, very, similar., So,, I, guess you're saying that men and women shouldn't have this really any differently. We should both be

differently. We should both be prioritizing zone 2. Yet, actually

women will struggle more with HIT because of these because of these muscle fibers to produce the ATP. And that

makes so much sense because I went through a phase probably about eight years, ago, when, HIT, was, I, don't, know if you remember there was a huge surge in HIT and everybody every studio was

opening and everyone was doing HIT and I felt worse than I've ever felt before like awful and also what what was coming up at that time and I'd be really interested to ask you about this with

exercise and also how you train athletes and if it's different for men and women I was also fasting before I was doing those sessions as well. So you can imagine I had like no energy in me and I

was going off to do these ridiculously expensive classes for an hour and raising into zone 4, zone 5 and I've never felt worse in my life. Yeah

you're you're totally right and this is one one of the things that yeah, I mean HIT was uh was a hype and uh you know it

was very popular 10 years ago but uh you know very few people from 10 years ago they're still doing it or not not that many people uh because uh or at least people who were pursuing health benefits

through HIT you know it's not sustainable and can lead to injuries again I am not saying that heat is bad for you but any exercise program based

on HIT, right, is not sustainable. There

are no athletes in the world who ba who all that uh training they do is hit. It

doesn't exist. And believe me, I know a little bit about what athletes train but it doesn't exist. And in fact now and I'm not saying if it's a tendency or

not but what we have seen historically is the 8020 whereas uh the proportions of of of the time or not not the time

the sessions not the time because that you know the sessions that that you dedicate to different intensities about

80% is a lower intensity call it zone two maybe and about 20% is higher intensity. This is the approach that

intensity. This is the approach that we've been using with athletes forever and it has worked. Any other approach of

doing 2080 like 20% lower intension 80% hit it doesn't tend to work. It causes

overtraining fatigue and I was mentioning earlier but that's kind of what we do with athletes. So the whole thing of now the 8020 it comes from from again like like as many concepts come

from what we have learned with athletes.

They're now becoming mainstream, right?

But at 8020 is not about minutes or percentage of minutes because in fact if we go by the minutes it's even less. If

you look at the volume just observationally if you look at the volume of any athlete whether it's a a very high intensity athlete uh like a

swimmer 100 meter swimmer or a rower or a marathon runner uh about 5 to 10% of the entire minutes per season are in

high intensity right so but we need to think more about sessions so uh it's about 80% of the sessions you contemplate maybe zone two and about 20% of the

sessions cont should contemplate high intensity and the way we break it down is to yes so so many times we isolate a session because they have more time to

specifically do high intensity because of the demands of competition uh other sessions specifically is zone to training and they can be four five hours but Mer models don't have four or five

hours or they even can do four five hours at at four zone or high intensity.

So the way is about to com combine it as I as I said but if you do four days a week zone two in combination with high intensity at least two or so towards the

end that's when you start hitting some sweet spot and then that was like the the um um the the the the distribution

right it's more like 8020 but that again like you know hit uh it's something that yeah just a lot of people you know did it but it's it's Many people don't enjoy

it, didn't enjoy it.

>> Have, you, had, to, change, a, lot, of, these athletes mindsets on this approach to more an 80% like lower intensity and the 20% high intensity? Like have you seen

them have some resistance to that?

Because obviously you've seen these insane changes. I'd love for you to

insane changes. I'd love for you to share some of these stories for for our listeners, but how is the mindset approach when you're working with with athletes in the sector?

>> Not, much, to, be, honest, because, that's been the mentality always like that. In

fact, you know, for uh um as I mentioned earlier, right, uh if you watch what uh swimmers do and have done forever and they continue breaking records is that

you go to a swimming and you see that world class swimmers they swim up and down, up and down, and then eventually obviously they do some intensities, right? But it's not the

intensities, right? But it's not the other way around. So you don't have to convince them to, hey, you can't do 1,000 sprints a day. It's bad for you.

Do five or do 10, right? Well, they're

already they're already there, right? In

fact, what I had to convince him more is that the zone two is a much harder intensity than just cruising, which was what a lot of people were doing because

that 8020, they didn't know it 20, but in, you know, that's what they were doing was like more aerobic training long endurance run or right, it was too

easy, right? And it was too easy. it was

easy, right? And it was too easy. it was

close to recovery intensity and that doesn't stimulate uh that ben energetics of uh mitochondrial function as much. So

it was about convincing them that they had to go faster. And if you look at well you look at if you talk to some of the people that I've been working with at zone two especially at high at high

level, athletes, it's, really, really really demanding very demanding and until they get used to that but it's not an easy training at all for that we have recovery days

>> okay, and, what, does, the, recovery, days look like nothing >> no, I'm, not, active, recovery, I, mean, you yeah you have to do nothing it's important to that's what I think I remember

>> when, I, introduced, also, the, concerts, are off days in uh you know like back a long time ago to to the athletes I was working with it was a crazy idea to have

an off day or even a recovery week like a active recovery right but now every everybody does an off day completely and uh and at least a recovering active

recovery day which is you know like a light run with friends to to to grab a coffee right or a light uh bike ride you know to grab another coffee with friends and come back. You know, it's something

that is more to me. Yeah. There's no

there's no difference between an active recovery day than just do nothing right? Because when you do nothing, uh

right? Because when you do nothing, uh you just rest and we do active recovery days maybe more psychological because uh to break down the to break out of the routine of training hard because you

need to train by yourself many times in individual sports. So that day where

individual sports. So that day where you're going to have fun and just gather with some friends, uh that's your recovery day for a coffee ride, for example, or a coffee run. But um yeah

you need you need those two >> to, make, sure, you're, performing,, but, also to make sure I guess your immune system and everything, you need recovery for so many different dimensions. You know

your immune system plays such a big role in in exercise.

>> Yeah., And, this, is, something, that, um, to me it's it's a it's an area of uh of importance because I have seen a lot of people let's not talk about athletes now but uh obviously you see that overt

training but you see a lot of people there um you know whether it's for longevity or for fitness they are completely crushed and they don't know

it. you know, people who have uh as you

it. you know, people who have uh as you were saying, on top of doing one routine of exercise, they're they're they're going through extreme diet, they're struggling through and that has

consequences. You can pay for those and

consequences. You can pay for those and that has consequences in the long term.

For example, and I've seen looking at biomarkers. I do a lot of biomarkers to

biomarkers. I do a lot of biomarkers to uh look at how athletes are assimulating training and competition. But again we can use these biomarkers for people you know for longevity purposes people with

different diseases and how they are simulating that dose of training is it too much or is the right one right so I see biomarkers and we see a lot of

muscle damage for example in people and uh low I mean low grade inflammation chronic low grade inflammation when you have muscle damage or where when you are

working so hard and not enough nutrients and not enough rest the body uh fights it because you're it's an aggression to the body. It's an insult. The body

the body. It's an insult. The body

cannot recover fast enough and therefore it starts breaking down like muscle mass. Um and uh one of the the ways that

mass. Um and uh one of the the ways that the body has to heal is inflammation.

It's a physiological process but uh that inflammation usually should be acute according to the damage. When that

damage is chronic, that inflammation becomes chronic and that's why you start seeing also you know some biomarkers of uh telling you that that person has

chronic lowgrade inflammation which as we know from epidemiological studies uh is uh it's important uh because it's been related to multiple diseases.

>> Yeah., I, mean, inflammation, is, the, star, of of every chronic disease, right? And I I think like when we we don't sometimes always are aware of how much pressure our immune system is under, but it's not

just exercise, it's all the other things in the day. Like I know if I'm doing an intense session and then I've got an intense workday and I've not slept well and then my nutrition is not great, I'm not going to get the outcome of that

session that I want, which is really important to think about. And I mean, I want to make sure that we touch on metabolic flexibility because this might also be connected to this as well. You

were saying just earlier before this that it's quite a new term. Can you

explain metabolic flexibility because my understanding is how you can how easily you can switch from fats to carbohydrates which I feel like women do

pretty well in their menstrual cycle phases. But can you talk to us a little

phases. But can you talk to us a little bit about this term and get us to understand it better?

>> Yeah., So, metabolic, flexibility, is, is, um it's not a new term necessarily but it's we've been known for maybe 20 25 years but yeah now it's mainstream like a lot of things and uh but yeah it's it's

about that right uh uh I mean in a simple way uh it's about the ability you know to switch back and forth between fuels mainly fats and carbohydrates

absolutely and and and where does it happen where do you burn fuels in mitochondria right you burn the fuels because you have to produce ATP and that

ATP happens in mitochondria and when you burn those fuels are in in in mitochondria and and and yes this is this is why metabolic flexibility and mitochondrial

function are pretty much identical terms at least in my view right because if you have a good mitochondrial function like athletes you're going to be switching back and forth fuels very well you want

to burn fat now okay let's burn fat you want to burn high amounts of glucose okay let's do That's being metabolically flexible right? And that's pretty much what what

right? And that's pretty much what what what is the the the same terms metabolic flexibility and mitochondrial function are uh for these purposes of bionetics

are very important. And when

mitochondrial dysfunction happens or mitochondrial decay happens, the first thing that you start seeing is a decrease in the

capacity to burn those fuels, right? And

that's you start become inflexible. And

we can talk about that in more detail.

That's the study that we exactly what we were talking about the other day about that transporter that we have identified that that's the in it's the root or one of the roots of the issues.

>> This, is, the, gut, floor,, right?, The

transporter that we were talking about in the study.

>> Yes., Yes., Yes.

>> Yeah., So,, so, you, just, mentioned, there which we should definitely go to study but you just mentioned there before that mitochondrial decay.

Sounds obviously cellular death terrifying, but it happens all the time.

So, let's like how do people know if they're getting mitochondrial decay?

>> Well,, that's, a, good, point., So,

mitochondrial decay is like you don't know, you know, that's no, you you don't know. I mean, so a mandal decay is going

know. I mean, so a mandal decay is going to lead down the road some form of dysfunction. And I think we talk about

dysfunction. And I think we talk about mitochondrial dysfunction quite lightly me included, because we we try to talk you know like a um in in you know in uh ayman's terms but um mitochondrial

dysfunction means that the that mitochondria don't work you know or they're aberant right I I I like to call it more a mitochondrial decay right as

we age for example our mitochondria are not as solid as when we were younger or as we become sedentary our mitochondria don't work as well and we become more

and more inflexible, metabolically inflexible. And this is this is one of

inflexible. And this is this is one of the things that at this point we I mentioned that the methodology that I developed looking at fat and I mean fat

oxidation and lactate it tells you because when you have a mitochondrial decay that is not pathological you see a decrease in the function of uh of

oxidation or burning fats and and also lactate and and that's a signature right but again it's not you you don't wake up one day like oh I think I have like

under decay, right? No, you wake up one day and and you go like, "hm, there's something funky. I don't I don't know.

something funky. I don't I don't know.

I've been feeling strange for a while. I

don't, know what's, going, on.", You, go, to your doctor, you get blood analysis your your uh um blood glucose is uh 150 and your A1C is uh is seven and a half

or eight, right? Like boom, you you have you have pre-diabetes or you have diabetes, right? Um but yeah, it's uh

diabetes, right? Um but yeah, it's uh and it's part of that mitochondrial decay. As I said earlier, if we were

decay. As I said earlier, if we were able to identify biomarkers 10, 15 years because it's a decay, right? Um then we should be able to um uh intervene much

faster and efficiently.

>> Yeah., So, talk, to, me, about, this, paper that every we were talking about before.

Tell me about what you Well, not you just found you're kind of rewriting it again, but um tell everyone about the new discovery.

>> Yeah., So, what, we, we, saw, we, we we, wanted to see what are the uh um u you know metabolic responses of sedentary health

individuals right uh versus people who are moily active that is they do exercise about at least 150 minutes a week right which are the recommendations

right out there. So we wanted to see if there are differences. Uh so what we did in this study we we looked at mitochondrial function of both groups

through muscle biopsies. So we looked at muscle biopsies in the skeletal muscle and we were looking at how those mitochondria were working. So we we looked at a a wide range of uh areas

from like uh how well they burned fats and carbohydrates uh how well they transported carbohydrates and um how well the electron transport chain which

is the apparatus where central apparatus to mitochondria to the furnace where you produce the ATP works and how well they they and how much they produce ATP.

Right? So what we saw is that they have a significant reduction in the mitochondrial function compared to active individuals morally active not

sedentary healthy and this is what I call the inside out hypothesis that I'm starting to develop from that and that originated this study

>> when, it, comes, to, uh, pre-diabetes, or, type two diabetes uh we clinically and at the research level we see this or contemplate this as a peripheral at a

peripheral level. That is it's

peripheral level. That is it's everything about glucose transport uptake into the cell. It's about um

insulin signaling the cell uh the receptor hypoglycemia hyperinsulinemia from the from the pancreas, right?

Everything what happens at the at the surface. But that's the first part of

surface. But that's the first part of the trip of glucose being burnt in mitochondria, right? And there's the

mitochondria, right? And there's the assumption that once the glucose enters the cell, it's going to be burnt. No

no, no, no, no. That's only the first part of the trip. And glucose, as we know, enters through the cell through these transporters, that door that is called the glad force or glute force.

Uh, and there's they're they're signaled by insulin, right? [snorts] But then once glucose enters the cell, it has to be broken down through pyuvate. It's

another component through 10 steps.

That's the second part of the trip. The

third part of the trip is that pyuvate needs to enter the furnace through another door, right? We call it the NPC.

Don't worry about the name, but it's another door. And then once pyuvate

another door. And then once pyuvate enters through another door, that's the fourth part of the trip. That pyuvate

has to be converted. It has to enter the the KB cycle, the the famous thing that we know from uh biology. Oh

>> the, lovely, KB, cycle., Take, me, back, to, my biochemistry days. Thank you for that.

biochemistry days. Thank you for that.

Yeah. Well, [laughter]

>> that's, the, That's, the, fourth, part, of, the trip. And the fifth part of the trip is

trip. And the fifth part of the trip is that then eventually uh you need to produce the ATP in the electron transport chain. Right? So it's a long

transport chain. Right? So it's a long trip. So what we were looking is that

trip. So what we were looking is that all these different parts of the trips and what we saw is that every everywhere you looked except for the entrance everything is disregulated

>> in, the, sedentary, individuals >> in, the, sedentary., So, you, see, the, first thing is disregulated is the entrance of pyrovate. into the furnace, right? So

pyrovate. into the furnace, right? So

sorry, the the entrance of glucose is normal because the the number of or the expression of that door at the cell surface for glucose, the glute force

they're the same. They have the same amount of uh expression. But then that door of uh the second part, the door of par of pyuvate entering mitochondria is

decreased by about 50%.

significantly decreased and then the the the that's the door and the entry of pyuvate into mitochondria is about 38% something sampling, that, decreased, and

then um the the capacity for the electron transport chain to produce ATP is about 35 to 38% decrease so it's a

significant decrease in the production of energy right just for glucose right and then that's that's where is we call the inside out. These these these people

already they have a very strong signature of mitochondrial decay that not dysfunction mitochondrial decay probably 10 15 20 years before they're

going to show at the surface levels that glucose cannot get in which is what we see nowadays as a diagnosis that's on one hand regarding glucose

>> can, I, just, ask, how, sedentary, these individuals were that you saw it in these like they just didn't do any exercise at all.

>> Exactly., Well,, maybe, they, walk, to, the supermarket, right? But the typical

supermarket, right? But the typical person that that you we see in a lot of our today's uh societies, right? They

they get in the car, go to work, office go back to the car, maybe go to the supermarket and walk. That's Yeah.

That's sedentary people. Yeah. So, but

the the paradox of that is that health they're healthy. They don't have any

they're healthy. They don't have any clinical symptoms. But you know like uh historically in in biomedical research the control has been that group the

healthy sedentary individuals who metabolically are a disaster compared to the real control right and this is what even at the university when I needed to

clear this uh the all the permissions to get this the okay to give this data uh I I I, told, them, that, the, sedentary individuals are the intervention group

and the control are they the uh the motor active individual that at first was a no no we're not going to let you go with this study at the University of Colorado this is crazy idea but actually

is the reality because and this is what I wanted to be provocative on purpose for this because our genes are made to

be active right this is ingrained in our in our brains you know I mean in our genes being active right we haven't evolved to become sedentary yet, right? Our

control status except for the last 200 years or so has been to be active always, right? And uh and that's how our

always, right? And uh and that's how our genes are. But the perception that

genes are. But the perception that exercise is the intervention is new to humans and is wrong because the real intervention was to become

sedentary as a result of progress. And

that sedenturism is what's causing a lot of diseases right so I wanted to provoke with that the real control are people who are morally active they have the

good well functioning mitochondria where people who are sedentary they already have a decay significant decay at the mitochondrial level which down the road is going to let them it's going to take

them to uh different diseases.

>> I, mean, it's, so, interesting, that, you, put it like that because that's everything about our health system. we're not

preventative in any way. So, the fact that we're having to look at sedentary as our as our control group is actually a little bit frightening. I mean, it's

interesting, you know, exercise is is part of who we are, the DNA, but we all pay to go and pay to do exercise in gyms. I mean, I'm one of them. But it's

it's like kind of taking us out of our normal environments. Like obviously

normal environments. Like obviously that's such an an obvious thing but just hearing you say it makes it even more obvious [laughter] which I which is just quite funny and

the fact that we're studying people who aren't moving their bodies who aren't eating well and calling them the controls.

>> Yes,, you're, right, and, that's, why, it's, uh I don't think it's the real control.

Right. And I think that morally active people are the control in the same way that if we want to understand perfection uh the formula ones are the perfect cars

and those are the elite athletes right I think it's a it's a paradox that we still call uh sedentary people healthy when they're not and we know down the road you know now more and more

epidemiological studies we know that people with s who are sedentary uh the majority the vast majority end up having some diseases Where do you think our health status is going to go from where we are now? Like

what are you most interested in with within this area of research? Cuz we're

in an interesting time.

>> I, think, that, we're, already, in, a, you know, we're in in a in deep [laughter] as it is already. Um and that yeah um I think there's a good movement

of of definitely trying to be conscious about exercise, right? more people are exercising probably more than in the last 100 years or 50 years at least right there's a conscious there's a

science to that there's still a lot of movements if it's hit or if it's zone two or if it's a 8020 or whatever right I think the important thing is to get going and to be supervised that's

important [snorts] but what I'm more concerned now and uh it's about Alzheimer's and the thing that uh frightens me is that uh I mentioned earlier we we

starting to call it type three diabetes or brain diabetes or endstage type two diabetes and um as most of the non-communicable diseases in our society

whether is cardiovascular disease, type two diabetes, cancer, uh it takes 20 to 25 years to develop, right? You don't

wake up one day and and and oh, I have a heart attack. Uh no, you've been having

heart attack. Uh no, you've been having starting to have that heart attack 20 years ago. uh the same thing uh with

years ago. uh the same thing uh with type two diabetes and there even the same thing with cancer. Cancer we know is a disease that progresses over time

and it takes 20 to 25 years for most cancers, right? That first aberant cell

cancers, right? That first aberant cell that becomes uh then an irregular cell and then starts mutating some more genes and eventually becomes an an adenoma and

then uh that's that's eventually uh how the evolution you know cancer it takes 20 25 years. But my worry it is that um

so our generations and our parents in previous generations right were diagnosed with type two diabetes right or pretype two pre-type two diabetes or

type two diabetes in their 50s or 60s right uh that you know epidemiologically speaking that was the norm and people were diagnosed with Alzheimer's when

they were in the high 70s low 80s something like that right Yeah, that was my grandmother. So, yeah.

my grandmother. So, yeah.

>> Yeah, >> exactly, that, age.

>> Yeah., So,, but, we, know, um, more, from epidemiological studies the the relationship between type 2 diabetes and Alzheimer's is just getting stronger and

stronger. Mayo Clinic using all this big

stronger. Mayo Clinic using all this big data from medical records, right? about

80% of their Alzheimer's patients they had problems with uh either diabetes or pre-diabetes right so there's a very strong correlation and as I mentioned

earlier looking at the brain of Alzheimer's they have insulin resistance and mitochondrial dysfunction and a big problem to utilize glucose right so that

the thing is like we know if u uh the u there's a correlation between Alzheimer's and type two diabetes And that goes beyond a correlation because it seems to be very strong at

this point and getting stronger and stronger and and there's a causality in reality, right? The problem is that we

reality, right? The problem is that we might be we might be in in big trouble because if uh it takes about 20 to 25

years for a person with type two diabetes to develop Alzheimer's, right?

That's kind of want to chronologically speaking in the 50s 60s people are diagnosed with pre-diabetes or type two diabetes 70s 80s they develop

Alzheimer's for the first time in human history or humankind we're seeing teenagers or younger than teenagers with pre-type

2 diabetes or type two diabetes fullblown type 2 diabetes when they're 15 or 20 years old right if the evolution is 20 25

Are we going to see a a lot of people in the millions uh with Alzheimer's in their 40s or their 50s if chronologically speaking it keeps

making sense and I I hope I'm wrong but uh and I don't think I'm the only one thinking this although not many people are talking about it and I think it's time to have a conversation but if it's

true it's the end of societies as we know it because people in their 70s and 80s, they already have retired. There's

money allocated to that. They have

produced when they were 40s or 50s. But

if they get Alzheimer's in their 40s or 50s, we don't have money located for them. They're not producing and

them. They're not producing and contributing to society. It's the end is the end of everything. So that's what that's what the thing that worries me in the next uh decade or two because this

is coming to us quite soon.

>> Yeah., Well,, I, mean,, there's, already children in America and and in the UK but more so in the States that are being diagnosed with it from the age of five.

So, >> exactly.

>> I, mean,, it's, it's, young., And, and, it's interesting because I I listened to that. My grandmother had Alzheimer's and

that. My grandmother had Alzheimer's and and and she lived with it for years and she died very late in her 80s, but she was diagnosed with it late 70s, early 80s. So, she'd had a predominantly most

80s. So, she'd had a predominantly most of her life without having this condition. Think about my father who's

condition. Think about my father who's been diagnosed with type 2 diabetes in his 50s and we've been luckily his daughter's a nutritionist so she's got that under control and we've reversed

it. But there's you know now I look at

it. But there's you know now I look at that situation and that's the thing it is reversible but I think the conversations that we're having in public health aren't the correct ones to help reverse it. It's just to maintain

it and then it just progressively gets worse and we go on metformin and you know that's that's kind of the end. But

children as young as five now, it's completely a new whole era. And there's

also, and some of this is genetic, but gestational diabetes as well is on the rise. And there's also a link, we don't

rise. And there's also a link, we don't know for sure, but there's also a lot of research connecting to autism.

And so all of this is connected to metabolic health and mitochondrial function. But it's so interesting that

function. But it's so interesting that there's all of these sectors and it's now affecting from in utterro to children of five to you know up to my

parents age and beyond yet we still can't seem to kind of all collectively come together on this as in what they're all still treated so differently like

how do you think we get past that because for me a lot of it is about our food systems. It's the bigger picture.

>> The, food, systems, you, say., Yeah., Yeah., I

I I get definitely nutrition is very important but again I I insist as I mentioned earlier where do we burn food mitochondria and that's the only place

that we burn it uh during postbrand after a meal under um uh a

glycemic clump about 80% of uh glucose derived from carbohydrates is burnt in skeletal muscle And during skeletal muscle is burning

mitochondria.

This is where we also talking about muscle health nowadays, right? And we we tend I mean I I was the other day talking to I've been giving a bunch of

talks lately to medical students uh to um u medical specialists from oncology to to uh endocrinology to

internal medicine putology. None of them told me when I asked the question, "What is the largest organ in the body?"

Everybody said the skin.

>> You'll, say, skelly, to, muscle,, won't, you?

>> The, the, the, muscle, is, the, largest, organ in the body. Not only the largest, but the most active metabolically speaking.

And as I mentioned, about 80% of the glucose under glycemic clump is oxidized in skeletal muscle within mitochondria.

So it's the it's the largest disposal for for for food staff because it's very active metabolically speaking. So this

is why it comes the other paradox of the world-class athletes for example the cyclist they threw the friends right if you look at their diet right it's uh they have somewhere between 6 to 9,000

calories a day >> for, 21, days >> carb, yeah, around, 2,000, and, that's because they need to to exist >> it's, not, because, oh, I, want, to, eat, no, no

if you don't have that at the through the front you're dead meat >> right, and, they, have, tried, before, believe me.

>> And, it's, so, hard, for, them,, isn't, it?

It's like the one thing where they're they're forcing to get this food down them. Yeah.

them. Yeah.

>> And, and, eventually, they, adapt, because they're professionals, right? And they

have an amazing stomach in intestinal I mean tract and they have an amazing microbiota as well because you have to right? But the thing is that their

right? But the thing is that their average intake of simple sugars is about 2,000 calories a day. So imagine someone

you give to two like a big bowl of sugar worth 2,000 calories a day and you have to eat that for 21 days. Many people

will die or be end up in the hospital.

Your only source of food 2,000 calories is cane sugar, right? It's crazy. Well

that's what these guys have for 21 straight days. And metabolically they're

straight days. And metabolically they're healthy as as very few people in the planet, right? Wow.

planet, right? Wow.

>> And, that's, metabolic, flexibility., They

can switch back and forth wherever they want to, right?

>> But, what, I, mean, about, and, this, is, an extreme case of course, but >> nutrition, is, is, completely, related, to mitochondrial function because that's

what you burn. And this is I think when when, you, have, a, a a, problem, whether, at the glute four level or as I described at the inside out model right which is

the NPC in the mitochondria you're not going to be able to to burn glucose efficiently it's you're going to make the problem worse right that's why nutrition works

very well does nutrition in my humble opinion does nutrition reverse mitochondrial function I I don't think The only the only way where we can

improve mitochondrial function is through exercise. Can nutrition reverse

through exercise. Can nutrition reverse the severity of the problem, right? Of

course, because you're not making it worse. And if you have that mandal

worse. And if you have that mandal dysfunction, you need to decrease carbohydrates for sure because you already have a decay as we have shown right? And we were talking about this

right? And we were talking about this study and uh but yes, I think that um both need to be under control. exercise

and nutrition. That's what I think.

>> Yeah,, I, think, it's, I, I, think, it's, kind of a it's a it's a chicken and egg in in my brain because I think people will go to the gym and exercise, but then we're surrounded, you know, with so many

ultrarocessed foods and not real foods.

And so it then kind of has a compounding effect. Um, unless you're literally

effect. Um, unless you're literally spending your entire day, which 90% or 95% of the population aren't exercising, um, they're surviving, going to work, stressed out, all of the things

of hierarchy of needs. And then we just load ourselves with, you know, what's on offer because that is, you know, that's the most easy convenient foods. And so I think, you know, it must have some

impact on mitochondrial health, right?

your diet. That's from my understanding in kind of biology and as nutritionist that the food that you eat does impact on a cellular mechanism the health of a cell.

>> Yeah., And, we're, in, a, society, I, think you're right. But yeah, I think we are

you're right. But yeah, I think we are in society also that you know these these foods have a lot of uh conservatives uh additives, colorants

and uh and and as you look at you know both European Union which is much more uh strict than the US uh AD

um you know they regulate a lot of these conservatives or colorants that might be carcinogens right in large amounts

>> but, you, can, only, have, per, food, an, x amount of level per food, but you have many of these foods with the same colorant. So you have a lots of that u

colorant. So you have a lots of that u those carcinogens entering through your bus through your body every day and that's that's where like um we see for

example colorectal cancer among uh young people. uh it's uh it's increasing like

people. uh it's uh it's increasing like it's never done before and in uh 15 20 years is calculated to be the number one cause of mortality of cancers of all

cancer of of yeah of all cancers among the people who are young now by the time they're older is going to be considered the number one cancer because colurectal

cancer numbers are off the chart. It's

already very very prevalent among these people and uh why um something is happening in maybe what they eat those those proc ultrarocessed foods these uh

carcinogens meats uh or or who knows you know plastics etc and and that's the thing you know like uh how many things

can mutate uh or cause mutations right um a lot of things from what we what we breathe what we eat our stress levels our sleep right can definitely have an

impact on our metabolic health for sure and I think you know like not many people talk about sleep although more and more right but as sleep is the

pillar of everything right I think that if you don't sleep you can't exercise because you're too tired and you're eating you're going to eat in survival

mode right because you don't have energy and you end up eating whatever So exercise is is and you're going to be more stressed. So exercise is a pillar.

more stressed. So exercise is a pillar.

I mean sleeping is a pillar and I think we're in society where we need to sleep way more. Don't you think?

way more. Don't you think?

>> I, agree., No,, I, believe, that, it's, like one of only as a nutritionist. Nutrition

is one of my core pillars, but sleep I think is the foundation. If you don't get sleep, everything in your day is a little bit harder. the food choices that you make because your adrenaline levels

which is your hunger hormones, higher you don't have the energy and motivation to want to go and exercise. You're a bit cruer to yourself. All of it's like compounding effects on your your

lifestyle decisions, which we know is the like predisposing factor of health because if we have good lifestyle decisions, then we have a better health outcome. Basically, at the end of the

outcome. Basically, at the end of the day, we're more likely to go and do our exercise. So, I guess like on on leaving

exercise. So, I guess like on on leaving this, the one thing that you would say to everyone listening to this to help improve their mitochondrial health is to get exercising

six times a week, five times a week if they can from what I'm hearing. Having a

good recovery day, couple of zone twos resistance training one to two times of hit roughly through the week. That's

kind of your I would say my leaving statement from this conversation to get people to connect to their mitochondrial health. Would you say that's right?

health. Would you say that's right?

>> Yes,, that's, uh, the, only, way, we, know, that uh the only medicine that works for mitochondrial function is exercise because it's the stimulus that we have

since we humans were conceived. But uh

yeah, exercise um yeah just four or five uh days a week uh 200 300 minutes and uh yeah a combination of uh zone two uh

three to four days a week uh one to two days a week intensity which you can combine within a session of zone two and then uh two days a week resistance training that doesn't have to be full hour and a half there are many routines

that you can do in 20 I mean in 30 40 minutes right but I think it all puts together about four or five hours maybe

closer to 5 hours 300 minutes. I think

that uh we all should thrive for that.

uh and we live in in very uh stressful times and uh but at the same time you know how much time we dedicate to our Instagram or our phones or you know

WhatsApps or so right uh people say many time I can't exercise I I don't have time we do have time at least we we can

get 150 200 minutes a week you know uh it's not easy uh but we can another yeah so I think that uh it's important to

focus on that and and have a look into this. I I I force myself. I I'm very

this. I I I force myself. I I'm very super busy at work and um especially in the last two years. So my my ability to exercise has decreased significantly

but I I really really try to push myself, right? And uh I try to do a

myself, right? And uh I try to do a minimum of about 200 minutes a week and I annotate it every week, week one, week two, week three of the year. and I need

to meet that uh you know hit of uh 200 minutes a week. Uh I force myself. Um

but anyway, I think we and I'm not saying I do everything right by no means huh but I think that uh exercise is important. Uh it's key for metabolic

important. Uh it's key for metabolic health and for mental health which is a whole different area right I'm not an expert but uh definitely mental health and exercise are so important.

>> I, completely, agree., I, also, I, now, take exercise as time for me. And actually

you say about the phone, it's the it's the one time I think that we can all agree that we get away from that as well, which is why I mean there's many reasons why it's also good for your mental health, but that is just one

reason of putting your phone in a locker and not being on your phone for 45 minutes. That feels like the ultimate

minutes. That feels like the ultimate self-care in my brain. And so even when I'm exhausted, knowing that I have that 45 minutes away from my away from my phone is kind of a really compassionate

act as well. So I think there's always these times if we can. It's also carving it out for yourself, which I think when you're busy and stressed is is is hard, but it's essential.

>> It, is., I, agree, 100%., Couldn't, agree more. Amen to that. [laughter]

more. Amen to that. [laughter]

>> So, Nico,, [gasps] I've absolutely loved having you on.

Thank you for coming on. and I know how busy you are and I always have one last question which is obviously the name of the show live well be well. So what does

live well be well mean to you?

>> For, me, live, well, be, well, is, to, uh, be, at first happy with yourself. Um it's it's important to have metabolic health

mental health, socialize, have friends have family, and uh have interior peace and um yes and be able to to enjoy life

and be simple >> I, guess, >> which, is, super, difficult, to, do,, right?

[laughter] Takes time. Simplicity in the SLE is a

Takes time. Simplicity in the SLE is a very hard concept to to get our heads around, but um but yeah >> Davinci, said, simplicity, is, the, ultimate

art. I mean is the ultimate simplicity

art. I mean is the ultimate simplicity is the ultimate act of sophistication.

>> I, couldn't, agree, with, that, more.

>> Absolutely., We, need, more, simplicity, in our life for sure. I'm sure that's also quite good for mitochondrial health at the same time. Um any thank you so much.

has been I feel like I've learned a lot about mitochondrial health and function and zone 2 and Alzheimer's three all of it. So, thank you so much for coming on.

it. So, thank you so much for coming on.

I'll put everything in the show notes.

I'd love if you could send us that paper um when it's out and we will show all of our all of our listeners. Um but thank you so much.

>> Yeah,, thank, you, so, much, Sarah., I, really appreciate your time and your invitation and uh yeah, just had a great time as well. Thank you very much.

well. Thank you very much.

>> Thanks,, Nico.