The Doc Answers Your Questions

Huge thanks to Dr. Inigo San Millan, Director of the Exercise Physiology and Human Performance Lab at the University of Colorado's Anschutz Health & Wellness Center, for answering your questions from this post. He’s been really busy working with the Pro Cycling Tour here in Denver, but managed to squeeze us in. 

There were so many questions, that I tried to pick the ones that seemed to address most concerns/inquiries.

Why can’t I lose weight?:

I have been exercising 5-6 days a week for a least an hour a day, alternating workouts, and 2x/week doing daily doubles, and my weight is the same as it was last November during my recovery season. I have been stuck at 148lbs forever it feels like. Most of my friends, who just started to run over the past month have been dropping weight like crazy, but I don't seem to be headed anywhere...I pay pretty close attention to my diet and not sure what to do about my weight plateau....

The doctor says…

What probably happens is that at the exercise intensity you run you are not using much fat as you probably use more glucose. This is a very common thing in recreational athletes who exercise several times a week, have a good diet and don't get to lose weight. It may or may not be a caloric intake problem but what I see for the most part is that you don't "burn" much fat when you exercise. Calories in and calories out may not be necessarily the same. Calories can be derived from fat and glucose (and a bit of protein) so calories are not always equal in terms of substrate utilization. When we see caloric expenditure (Kcals) on our heart rate monitor or gym bike screener we can never see whether those calories come from fat, carbohydrate or which % belongs to either one. As an example we can "burn" 700Kcals in a workout session but the majority (let's say 90%) can be derived from carbohydrates and therefore very little from fat. However we can also "burn" 700kcals by exercising at different intensities and levels and therefore can "burn" 70% of all Kcals derived from Fat and the rest from carbohydrates. So the same rate of caloric expenditure does not represent the same metabolic response to exercise and therefore substrate utilization. With the methodology I apply in the lab it is possible to determine fat and carbohydrate metabolism and responses to different exercise intensities and identify that individual training intensity that elicits the highest fat utilization and translate it in heart rate.

Why doesn’t running get easier?

I'd like know why running doesn't seem to ever get easier for me! I'm a race walker (4 full, 5 half marathons) but I've been running more and more over the past 12 months and it doesn't seem to get any easier! I always feel like my lungs are going to explode.

The doctor says…

This could be due to many different reasons but I would guess that your fitness level is not optimum and very possibly you are training at the wrong zones and therefore not improving. I would suggest doing a physiological test to know where you exactly are and to set your training zones.

Is physiological performance testing right for me?

I'd love to know if this testing is right for me. I'm a casual runner - 5ks and 10ks mostly - with weight and resistance training in between.

The doctor says…

This test is not just for the elite athlete but for anybody who wants to improve fitness levels and get to know how his/her body works during exercise and be able to improve and optimize time.

Why do we have to do long runs so slow?

I'd love to hear more about the theory of doing your long runs 1-2 minutes slower than anticipated marathon pace. I don't understand how I can possibly run marathon pace for 26.2 if I haven't at least trained a few long runs near that pace.

The doctor says…

The theory behind this is to improve your Type I muscle fibers (Slow Twitch). These are the fibers with the highest mitochondria density, highest fat utilization capacity, oxidative enzymes and lactate transporters. Training these fibers should be the base of any training and normally this intensity corresponds to a slightly lower than goal pace as goal pace is an intensity that recruits fast twitch muscle fibers (Type II's) and are more glycolytic (use more glucose) have less mitochondria density so also use less fat and produce more lactate. In a way, slow twitch muscle fibers are great assistants to fast twitch muscle fibers both during training and competition so slow twitch muscle fibers must be very robust. By training at specific heart zones we can elicit a higher efficiency in slow twitch muscle fibers.

How the heck can I become a faster runner?

I sure would like to know how to get faster. I have been running for 8 years, have done speed work and just don't get any faster. In fact this past half marathon I was 5 minutes slower than last year after doing more speed work. (2:40 half-marathon)I am over 50 so I know age probably has a lot to do with it.

The doctor says…

Age could be a factor, but believe me you should be able to improve your PR despite being over 50. It is possible that you are not training in the correct way and training zones and therefore not improving performance. It could be also possible that you are over trained and fatigued and therefore your body cannot recover properly and not improve as needed. We can easily monitor and check this through blood analysis and normally can identify the source of overtraining and/or fatigue and correct it.

Can VO2 Max be improved?

Can I improve my VO2? is it true that I can only improve my speed for 7 years (after initiating running) and after that, I will maintain for awhile and then decline in speed? is there a way to determine the minimum mileage I should be running every week in order to increase speed and endurance when NOT training for a marathon?

The doctor says…

Relative VO2max (ml/kg/min) can be increased as weight decreases. Absolute VO2 may increase depending on the fitness levels that you have. However, VO2 max, although it is a great indicator of cardiorespiratory fitness it is a poor predictor for performance. The last runner in a competitive marathon race can have the same or even higher VO2max than the winner. Whatever ultimately makes the difference are the local/metabolic adaptations and events happening at the muscle and cellular level. It is not just about how much O2 you can get into your muscles. It is about how well does muscles can deal with that O2 and how efficient they are at utilizing fats of carbohydrates as well as how efficient the cells and muscles are at dealing with byproducts of muscle metabolism like lactate or hydrogen anions. There are many of events going on at the muscle and cellular level and those are the ones that make the different. We can see your metabolic response and adaptations to exercise through the physiological test and set the right training zones to improve those metabolic and cellular responses and adaptations and therefore optimize your fitness level.

Regarding how many times you should be running per week in order to increase speed and endurance when not training for a marathon, it is quite individual and without physiological testing we cannot have real scientific parameters. But I would say that with 2-3 days of endurance you can maintain a good level of your mitochondria density and oxidative enzymes and with 1-2 days of intensity/interval training you should be able to maintain your glycolytic capacity (that of fast twitch muscles) which is very important during the competition.

How can I figure out my heart rate zones?

I'd like to know if there is a semi-effective way to determine heart rate zones WITHOUT getting this test done. The formulas online seem very standard, so I'm wondering if there's a way that I can tweak it to be more accurate, until I can afford the test.

The doctor says:

That is a good question but unfortunately the only way to know your heart rate zones is by performing a physiological test. As you point out, the formulas out there are very standard and for the most part quite inaccurate which can elicit the wrong training response and therefore jeopardize training and fitness level.

How many calories do I need?

How does one accurately find out their maintenance calorie intake?

The doctor says…

That is a good question. It is possible to do a basal calorimetry test to see your basal metabolic expenditure, although this can be tricky as probably not very accurate to represent the entire 24h caloric expenditure as it can really vary throughout the day and level of activity, stress, etc. I would say that if you are a healthy and fit individual a diet of about 1,500 to 2,000 Kcals depending on your body mass plus 45min to 1:30h of exercise 3-4 times a week should help you maintaining your caloric intake and balance.

 

If you are in the Denver area and would like to schedule a test, contact the Performance Lab at 720-848-8208. They may also be able to tell you how to find a testing option in your area.

I hope this was helpful. I know I learned a lot. Thanks Dr. San Millan!  Me and my slow twitch muscles are gonna grab a heart rate monitor and GO!

How about you? Did you learn anything?

SUAR

How I Could Train Smarter: A Date with Dr. San Millan at the Human Performance Lab.

Warning: Long, yet informative post ahead. And, kind of scientific if you like that sort of thing.

When I started running almost three years ago, I blasted into the sport rigorously and recklessly. This is kind of how I approach life. 100 eff’ing percent.

Not knowing any better, I assumed more was more, so I ran and I ran and I ran. I trained as fast as I could and went as far as my legs would take me. I raced often and hard. Exactly one year after I started running I was sidelined with a stress fracture of the cuboid bone.

I recovered, with some lessons learned. I followed the Run Less, Run Faster program to a tee. I welcomed Bikram yoga (and sweaty crack) into my life. I did not overdo it. During my second marathon, I qualified for Boston only four months after my stress fracture.

Again, I threw caution to the wind and started training hard for my next marathon. No breaks, no down time. I stopped cross training, I forgot about recovery days. I put in  high mileage weeks and never missed speed and tempo workouts. Ten days before my marathon I was stopped dead in my tracks with stress fracture #2, this time of the hip.

Bone tests, blood panels, gait analyses all confirmed what I had suspected: the injury was due to overtraining. Where had I gone wrong? I had some good guesses.

• Little to no cross training
• No recovery weeks
• Not enough attention to nutrition
• Running while fatigued
• Running my long runs at paces that were too fast
• Basically, not giving my body a break.

Never once did it occur to me to try to find out what was going on behind the scenes in this body of mine by having a physiological consultation. I went purely based on feel. If I was tired – well, weren’t you supposed to be tired when you were training for a marathon? If I had aches and pains – well, weren't you supposed to have those when you were training for a marathon? Yes and no. In marathon training you will surely push your body to new limits. However, you always must give your body a chance to recover while adapting to the new stress you're putting on it. This is how you get stronger.

All of this came full circle this week when I visited Dr. Inigo San Millan, Director of the Exercise Physiology and Human Performance Lab at the University of Colorado's Anschutz Health & Wellness Center, for a physiological performance evaluation. Finally, the guess work would be over. I would know what was really going on while I pushed my body to its limits. I would know if I was training correctly. And, most excitingly, I would know what I was truly capable of if I just trained the right way.

Dr. San Millan, a friendly, intelligent, expressive and animated Spaniard, invited me into his office which was decorated with a framed yellow jersey (a Tour de France pro he had worked with in the past) as well as a signed Garmin jersey (San Millan traveled with the Garmin team to oversee the physiological testing of Garmin's riders). San Millan explained the tests that he would perform and what the results of these tests would mean:

• Body Composition: Weight/height check and body fast test (anthropometry)
• VO2 Max: Maximum capacity of an individual's body to transport and use oxygen during exercise. San Millan explained that V02 max used to be the best indicator of an athlete’s fitness and performance. Now it is only good information – there are many other factors to be considered.
• Lactate Profile and Metabolism: Blood lactate concentration is likely the best indicator of athletic performance these days. As exercise intensity increased, blood lactate production increases as well. The net blood lactate accumulation is the result of the lactate production and lactate removal.  Measuring lactate can help predict athletic performance.
• Heart Rate
• Substrate Utilization: The heart rates at which fat and carbs are burned

He also would be giving me training recommendations based on the information he collected.

He emphasized how important he feels it is for the average athlete to have this test done of they want to lose weight or are training for a race. He stated, “These tests are not just for the pros!” The average Joe doesn’t just go out and run around the block. He trains for marathons and maybe wants to place in his age group or qualify for Boston. Yet, he has a job, kids and a life outside of that. He is at great risk for overtraining and fatigue and needs to know how to train properly.

In addition, many people start exercising to lose weight, but are unable to do so. This is because they are not training at the target heart rates in which their bodies burn fat. They are training at higher heart rates where the body is burning glucose. To lose fat, you must train in the correct zone and most people do not know what that is! Enter San Millan!

Let’s get this party started

The Test

You can almost see my crack!

Weight: 110 lbs.
Height: 5’ 5”
Body fat: 10.7%

Yes, this is a very low body fat percentage. I told you I am a lean machine! While he did not seem concerned by my percentage, he did want to make sure I wasn’t burning through calories too quickly while working out and that I was getting enough fuel. Agreed!

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San Millan fitted me with an oxygen mask which would measure input and output. He told me he would be pricking (she said “prick”) my ear lobe every five minutes to collect blood for the lactate metabolism test. I would warm up for a few minutes and then he would start increasing my watts/kg every five minutes. I was to stay at 85 to 95 rpms throughout the test.

As a side note, athletes can choose to be tested on the bike or treadmill. My running is pretty strong, but I have been struggling some on the bike. In the half ironman I will be on the bike for over three hours and I really wanted to find out how I could perform more effectively. I do hope to go back for the run test as well.

I was on the bike for about an hour including the warm-up/c0ol down. The actual test was 25 minutes. That means he increased the watts five times and took blood five times. Near the end of the test I was pushing it almost to my max.

Results:

Go eat a hamburger (just kidding)

Vo2 Max: Way above average. YES!! The average for a woman my age is 31-33 ml/kg/min. I was at 47, the highest range for 35-45 year olds.  This means that I transport and use oxygen very efficiently. San Millan went to far as to say that my Vo2 max was likely as good as the top finishers in a triathlon.

So, then what's the problem?

Lactate profile/metabolism: Although I take in and use oxygen well, things start to break down from there. Initially when my watts were increased, my lactate held steady. Once we took bigger jumps the lactate started to build in my muscles and I was unable to flush it out. That means that I was tiring and quickly.

What to do?

The only way to have a higher lactate threshold is to train your body to flush out the lactate more efficiently. The way to do this is to train and heart rates where you are burning fat, not glucose (you will be building your slow twitch muscles). This is why we are told to do our long runs at such slow paces. This enables us to go stronger for longer during our actual race. This is not to say you don’t need to train the fast twitch muscles as well. That is what hill work, intervals and tempos are for. You need to use both systems to be the most efficient and strong athlete you can be.

Also, if you do want to lose weight, the same would apply. You need to spend more time in the fat burning heart rate zone.

Given that, these are my heart rate training zones:

My long rides should be done in zone 2. Tougher, faster rides in zones 3/4.

Anyone have a heart rate monitor they want to get rid of?

Nutrition: San Millan found that I do not burn calories during exercise any faster than the norm. Given that, the recommendations for carb fueling (he prefers to use grams vs. calories):

Training: 50-70 grams/hour solid and fluid combined
Competition: 80-100 grams/hour

Examples of Solids:
1 sports bar: 30-45g
1 gel: 25 g
1 banana: 51g
1 Fig Newton: 11g
Snickers, Twix, etc: 30-40g
Small PB&J: 18g

Fluid:
1-17 oz sport’s drink: 40-50g

Cost:

$250 for a full physiological test. Includes Vo2 max, lactate test, fat and carbohydrate metabolism, energy expenditure and advice/explanation/recommendations (2.5 hours).

My two cents: For $250 you can gain major insight into the inner working of your body while you train. You can find out your potential as an athlete as well as how you could train more effectively in order to meet your personal fitness goals such as a new PR, a BQ, a place in your age group. Or, maybe you want to avoid injury and just be the strongest, fittest athlete you can be. If you are exercising and cannot lose weight, San Millan can tell you why. Knowledge is power. Consider it. If you’ve got the budget for it, then do it.

For more information or to schedule a consultation, call Dr. San Millan at 720-848-8208. His email is inigo.sanmillan@ucdenver.edu. You can follow him on Twitter @doctorinigo.

Later this week I’ll be doing a Q&A where you can post questions for Dr. San Millan about training, physiology, whatever!

SUAR

Fine print: I was invited by the Human Lab and the Weber Shandwick PR Firm to undergo these tests in exchange for a review/informational post about the testing and the program. I did not pay for the tests.

Human Guinea Pig

People complain they exercise their asses off and don’t lose weight. Or, they train their asses off and can’t shave time off their PR. Want answers? I do.

Today I’m channeling Eleanor Roosevelt who said (my favorite quote ever): “Do something ever day that scares you.”

Because …

Tomorrow I’m going to embark on something that could help make me a stronger, better, feistier athlete. But, it kind of intimidates me too.

I’ve been invited to have a consultation at the CU Sports Medicine Exercise Physiology and Human Performance Lab in Denver. I’ll be tested by Dr. Inigo San Millan, Director of the Exercise Physiology and Human Performance Lab at the University of Colorado's Anschutz Health & Wellness Center, and one of the top sport’s physiologists in the county. The 2.5 hour tests will include:

• maximal oxygen consumption (VO2 max)
• lactate metabolism and threshold, heart rate
• energy substrate utilization and power.

I addition, I’ll be prescribe training zones based on lactate, heart rate and power output. Dr. San Millan will identify my strengths and/or weaknesses, predict my future performance (Olympics, pro, elite for sure), monitor and assess the effectiveness of different training programs (the “drink wine then run as far as you can” program will not be included), and assist in the detection of acute or chronic training-induced fatigue (I specialize in overuse injuries, so this is a good one for me).

This clip was on the news last week about Dr. San Millan and the lab. Seriously, take a moment to watch this to learn more about the science behind what our bodies do when we train:

While pro athletes come to the lab to learn more about how to be efficient in their training and racing, the lab is open to the public. Dr. San Millan encourages everyday athletes to be tested and states that they can improve performance up to 60%.  Consults range from $100-$300.

I find all of this totally fascinating. Most of us jump into training and never really know the behind the scenes picture of what our bodies are really doing minute to minute. Something as basic as fueling more during training (like in the above video) could make all the difference.

As San Millan states,

“An average person can improve 40, 50, 60%. We open the doors to the community, so not just elite athletes like Rory (Sutherland) can do this, but people who want to do their first marathon, their first triathlon or they just want to improve their PR. Many don't know how to train, they don't know how to eat and so we can really help them a lot."

In regards to trying to lose weight from exercising, San Millan says something surprising:

“The notion that a grueling training schedule automatically leads to fitness and good health is a myth. Why? Because an exercise regimen not tailored to your metabolism can leave you feeling fatigued – and leave you stubbornly over your optimal weight.”

Ever had any of these kinds of tests done? Not me. I’ve only had my gait analyzed by the sport’s medicine people. Can’t wait to delve into this world and learn what might have contributed to my injuries and how I can improve efficiency and performance. Also can’t wait to share what I find out with you all.

Have you ever wondered why you can’t improve your performance or why you cannot lose weight while exercising? While I don't exercise to lose weight, I am always trying to improve efficiency and performance. I’m anxious to hear what I could be doing differently. My guess is that I train in heart rates zones that are too high and this has contributed to past injuries. I am also positive that I don’t fuel as well as I could.

SUAR