Zone 2 Training Explained: The Single Best Workout for Your Mitochondria | Dr. Inigo San Millan opens a useful window into steady endurance as cellular training. The conversation is not a shortcut or a spectacle. It is a reminder that healthspan is built through signals the body can understand and repeat.
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 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 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, I really want to ask just a very small quick favor. If you could please hit the subscribe button or leave a review, this helps the show more than you can imagine. It means the world to help growing this show and you all know that I have a huge thing to want to hit 100, 000 on YouTube this year and I can't do that without your support. I really aim to bring you the best guests possible out there and I pride myself in doing that for the show cuz it's so important. But to keep the guests coming
important. But to keep the guests coming to get them to be bigger and to bring more helpful information to your ears and your eyes, I really would love to ask you to subscribe to the show. Thank 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 standard of fitness, the number one metric that every athlete wants to 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 times of longevity right 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 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 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 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
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 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 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 developed a methodology years ago and I've been using it with with athletes uh for for a long time where 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
colloquial form, we call them metabolic carts. They've been used always used 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 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 parameters fat utilization and lactate, you can indirectly see or or measure 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 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 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
now we can use that as a measure to test how well our mitochondria are 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 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 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
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 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 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
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 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 lactate very well. Further yeah furthermore lactate is the mandatory end product of 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
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 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 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 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 that we have is a diagnosis. We have the glucose tolerance test or the hemoglobin A1C. Right? That's a diagnosis, right? There there are no other biomarkers. Unfortunately, same thing for Alzheimer's. We know that uh beyond um you
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 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 very um is very dark is very blue, right? There's not much uh metabol activity because there's not much 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
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. As someone who has spent a long time studying the mind body connection, I'm constantly asked, "What do I use to track my health?" Since April, you've probably seen, if you're watching this show, me wearing a piece of tech on my arm, and that is no watch because I genuinely believe it has been one of the most thoughtful and mind-aware pieces of tech that you can wear. Unlike most wearables that focus just on your steps or your sleep, no watch is a bit different. It gives you real-time insights into your nervous system, the unvisible engine that calibrates everything from your stress to your sleep to your recovery, your rest, and ultimately your health. With its stress recovery metric, it doesn't just show you how long you were stressed for, but also how long you recovered. It shows you your homeostatus. And that to me is where real health begins. And I think it's all something that we're craving. And most importantly, it does this without dragging you back to your phone because that motion just depletes you. It delivers meaningful health insights to you only when something genuinely matters using AI to turn complex signals into clarity that you can understand. And in just 5 days, it calibrates to your body and creates your personalized health fingerprint. You can try it for 30 days completely free. And if you're curious, now's the time because they're giving you guys 15% off with my code lwbw15 if you head to knowwatch. com. And you guys know as listeners of live be well and this whole community that understanding yourself in the most mindful way is one of the most powerful things that you can do for your health. And this little gadget helps you on your
And this little gadget helps you on your journey. 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 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 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 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 one cars right? sort of the gold standard of what a human should be, 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 hand, right? It's about, as I mentioned, about producing ATP fast, producing energy fast, 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 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 about from very low intensity all the way to maximal sprinting, right? So if you put together the do the dots, you're going to see these metabolic events. That being said, uh that's what I created different training zones because I couldn't tell an athlete, hey, you're 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 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 any athlete or seen any athlete winning a a competition in the zone two or low intensities. Never happens. So, but unfortunately people are taking 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 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
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 people with from different pathologies, 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 very high intensity sport you know like uh swimming right uh 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 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, And of course, they do intervals, but it's 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 understand if they don't have a wearable? How can they understand where zone 2 is? Yeah, that's a good question and and 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
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 and uh because they've been trying to lose weight through exercise and and they can't. And then when you do the test, you see that 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 oxidation in grams per minute and 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 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 that tank very well and for that starts using other fuels mainly fat, right? But
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 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
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 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, it counts, right? But uh during rest, yeah, during rest, you burn very little fat, right? So might be burning 0. 1, 0. 15. Um so why not burning 0. 4 0. 5 gram half a gram for doing an exercise for 60 minutes or 90 minutes, right? And uh just you 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 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
quite a hard one for for losing weight 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 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 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 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 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 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 are burning all glucose when they go out. They don't have enough glycogen. They're starting breaking down 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
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 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 a bodybuilder to have a lot of muscle, right? to to maintain your muscle mass to this week should be important. I'm interrupting for one moment to ask one small favor. Please subscribe to the show. This helps it grow more than you
show. This helps it grow more than you know. And I'm so bad at asking this from you. I'm so bad of thinking about this, but you know, my goal was 100, 000 to get to on YouTube. And I really want to bring you more content and better guests and bigger episodes. And we can only do that with your help together. So, please do hit subscribe. Thank you. 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 because obviously you've [snorts] been speaking about zone 2 for such a long 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 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 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 my patients whether they are men or women or
whether they are men 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 prioritizing zone 2. Yet, actually, women will struggle more with HIT 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
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 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 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
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 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 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 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
you go to a swimming and you see that world class swimmers, they swim up and down, and then eventually obviously they do some 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 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 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 level athletes it's 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 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
and come back. You know, it's something that is more to me. Yeah. There's no difference between an active recovery day than just do nothing, 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 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 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 were saying, on top of doing one routine of exercise, they're going through extreme diet, they're struggling through and that has 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 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
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 cannot recover fast enough and therefore it starts breaking down like muscle 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 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
simple way uh it's about the ability you know to switch back and forth between fuels mainly fats and carbohydrates absolutely 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 mitochondria and yes 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 is 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. Yeah. 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 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 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 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 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 pre-diabetes or you have diabetes, right? Um but yeah, it's uh and it's part of that mitochondrial 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.
new discovery. Yeah. So what we we saw 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 everything about glucose transport uptake into the cell. It's about um insulin signaling the cell uh the receptor, hypoglycemia, hyperinsulinemia from the pancreas, right? Everything what happens at the surface. But that's the first part of the trip of glucose being burnt in
the trip of glucose being burnt in mitochondria, right? And there's the assumption that once the glucose enters the cell, it's going to be burnt. 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 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. Yeah. Well, [laughter] that's the fourth part of the 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 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, 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
significantly decreased and then 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 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 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 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 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
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 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 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 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 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.
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 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 oh, I have a heart attack. Uh no, you've been having starting to have that heart attack 20 years ago. uh the same thing uh with type two diabetes and there even the same thing with cancer. Cancer we know
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 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 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, 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 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 and there's a causality in reality, right? The problem is that we might be in in big trouble
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 contributing to society. It's the end is the end of everything. So 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 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 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 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 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 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. 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
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 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 largest disposal 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. 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 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
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 healthy as as very few people in the 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 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 way where we can improve mitochondrial function is 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 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 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 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 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
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 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 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 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
can mutate uh or cause mutations right um a lot of things from 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. I mean sleeping is a pillar and I think we're in society where we need to sleep 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 day, we're more likely to go and do our 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? Yes, that's uh the only way we know that
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 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 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
huh but I think that uh exercise is 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 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 self-care in my brain. And so even when I'm exhausted, knowing that I have that 45 minutes 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 hard, but it's essential. It is. I agree 100%. Couldn't agree 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 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 is the ultimate act of sophistication. I couldn't agree with that more.
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. 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 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. Thanks, Nico.
Transcript auto-generated by YouTube. Verbatim — duplicates intentionally preserved.
Zone 2 sits in the controlled space where breathing is elevated but sustainable. It trains the body to use oxygen and fat efficiently, building the metabolic foundation beneath harder efforts.
Lactate is not simply a sign of fatigue. It is a signal that shows how well the body manages fuel. When lactate stays controlled at higher workloads, the system is becoming more flexible.
The most valuable training is often the work you can return to. Zone 2 supports energy stability, insulin sensitivity, and endurance without asking the nervous system to live in constant strain.
"The body changes when the signal is clear, repeated, and followed by recovery."
Build two to four steady Zone 2 sessions into the week.
Use breath and heart rate as guides rather than chasing intensity.
Let higher intensity sit on top of the aerobic base, not replace it.
The strongest idea running through this conversation is restraint. Longevity is not built by chasing every new lever. It is built by understanding which signals matter, applying them deliberately, and allowing the body enough calm to adapt.
