Zone 2 Revolution: Unleashing Athletic Performance with Dr. Greib

Join Dr. Joshua Goldenberg and Dr. Adam Sadowski with special guest Dr. Greib from the Sport Lab as they delve into the transformative world of Zone 2 training. Discover the profound impact of the low and slow approach on physiology, unravel the challenges in defining Zone 2, and acquire tools for smart training. Dr. Greib explores cellular benefits, discussing mitochondrial function, stress response, and exercise adaptation. From countering aging effects to scrutinizing fitness tracking devices, we navigate the realms of science and skepticism to guide you in redefining your training for peak fitness.

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Transcript

Introducer
00:02
Welcome to the Dr Journal Club podcast, the show that goes onto the hood of evidence-based integrative medicine. We review recent research articles, interview evidence-based medicine thought leaders and discuss the challenges and opportunities of integrating evidence-based and integrative medicine. Continue your learning after the show at www.drjournalclub.com. 

Josh, Co-host
00:31
Please bear in mind that this is for educational and entertainment purposes. Only Talk to your doctor before making any medical decisions, changes, etc. Everything we're talking about that's to teach you guys stuff and have fun. We are not your doctors. Also, we would love to answer your specific questions. On www.drjournalclub.com you can post questions and comments for specific videos, but go ahead and email us directly at josh@drjournalclub.com. That's josh@drjournalclub.com. Send us your listener questions and we will discuss it on our pod. Hello everyone and welcome to the Dr Journal Club podcast. 

Your host, Josh and Adam are here and we have a special guest today, Dr. Greib from the Sport Lab. He's joining us to talk about zone 2 training, evidence thereof and sports medicine evidence and all that jazz, and we're really, really excited. Dr Greib, do you want to jump in and tell our audience a little bit about who you are and why you're here and how we managed to drag you on to the show? 

Dr. Greib, Guest
01:37
Absolutely. Thank you for having me. It's been a while since I've seen Adam. I'll get to how we know and great to meet you as well, Josh. So my background is in clinical medicine as well as academia. I've been practicing and started a performance medicine clinic called the Sport Lab, as you had introduced, where we use evidence informed medicine to be able to apply that to injury nutrition, recovery, training principles et cetera. And I guess how we've connected is via Adam, who was we've crossed paths in my academic work when I was doing some teaching in Portland several years ago now. So that's, I guess, the connection. And I'm based up in north of the 45th parallel up in Canada and good buddies with Santa Claus and all that kind of good stuff. 

Josh, Co-host
02:39
Well, I have to say, you guys seem to, I don't know about the Santa Claus bit, but I have to say, in the world of naturopathic medicine and evidence, Canada seems to have it down. Actually, in the space of evidence-based medicine in general, I feel like Canada has it down. Like you got McMaster, most of the hospitals are super evidence-based. I've been very impressed. Ccnm is really good with that as well. But anyway, and then so awesome. 

03:02
So Adam and I you probably know this, but Adam's a real athlete, I'm a pretend athlete, but we got into I somehow can, or maybe you were to do it anyway, Adam we were going to do triathlon together and we started doing training together and all this jazz and my coach trainer was like giving me all this zone two stuff. And I said, okay, cool, Like I'm not questioning anything, but I'm just curious, Like what's the evidence for this? I can't find anything looking around online. Is this a thing? And Adam and I started talking about it and I was like we should talk to Dr Greib. He might know what the heck's going on here, so it doesn't have to be just about that. But we were curious in a situation like this where you've got a real athlete and a wannabe athlete trying to train up. What is the evidence behind exercise training getting up to snuff? I can find like nothing online, and maybe it's just I'm not used to these databases. But tell us everything, please. 

Dr. Greib, Guest
04:01
So I think the first thing that is important is to identify what zone two is, and as soon as you jump down that rabbit hole, you'll realize that maybe zone two isn't always the same thing. So there's different ways of measuring zones, and zone two training in its kind of easiest format is low and slow training, and that low and slow training is supposed to be creating effects, physiologically, metabolically, to improve efficiency in the athlete, and it's primarily. You're going to see a lot of zone two training done in endurance exercise and we'll talk about different training methodologies, I think, a little bit later so that are either validated or not validated. They all come back to the same basic kind of science. So I guess the key is what is zone two? And I'm happy to talk about different methodologies if there's questions about that, but I'll leave it to you, Adam, what is zone two in your mind. You're the athlete, I guess yeah. 

Adam, Co-host
05:23
Yeah, zone two in my mind is a lot slower than what most people are used to. It's kind of basically like a very comfortable, if you're running, like a very comfortable jog where you could talk to the person next to you without getting out of breath. And I think the people who are new to zone two training specifically might think that they're under training or they're not really putting in much effort. 

Dr. Greib, Guest
05:52
Fair and you are hit the nail on the head. That's kind of exactly. The perception from many athletes is like, well, I don't even feel like I did anything, but the reality is that you've done a lot biochemically and that's, I think, ultimately what we want to discuss later on today is what are you doing biochemically? But first of all, how do we get there? So zone two, for the kind of general population, would be a calculation. Typically we have our data and our garments or whatever watch we're using or some type of heart rate monitor. Many of us are using a GPS system or a head unit on our bikes if we're triathletes or there's always some data collection and a lot of times that will give heart rate output. So one of the means of measuring a zone two is based on heart rate, and that heart rate or those heart rate zones are usually broken out down into five zones. So we're going to, as we kind of work through the different measuring methodologies. Sometimes there's five, sometimes there's three. 

07:09
When I train athletes, I actually have 10 zones that I use Runners specifically. I have them trained in a variety of pace zones for a variety of reasons. Ultimately, it doesn't matter how many zones there are. The reality is what are you trying to do in that zone? As doctors, we've all had this conversation many times. It's like we got to treat with intent. What are we doing to elicit a response so that, in this particular case, an athlete is getting the output that we want in some way shape or form, and it doesn't mean that they have to be coming back 16 pounds lighter because they sweat so hard, because they just left it all on the road and they feel like they're deaf for the next four days, which is the way a lot of people train. If I don't feel like I'm half dead, I haven't trained hard enough. Well, that's not the weekend warriors, yeah. 

Josh, Co-host
08:10
Well exactly. 

Dr. Greib, Guest
08:12
I got to get it in in one day that was me a year ago. 

08:15
Because the next four days are going to be a write-off. But the low and slow, particularly zone two training you're still very metabolically active. If you're calculating zone two or looking at zone two in terms of metabolic equivalence, you've really enhanced your metabolic rate and we got to think about that. What are we doing to our metabolism, even if we don't perceive like we're working hard? But we are still doing something? If we equate it to something that typically people are constantly talking about, if we talk it in the mobility and movement world, you do some stretching and you feel like I don't really do anything. Well, are you doing something? Yes, because you're eliciting a response in the tissue, stretch response and mechanical pressure, et cetera, et cetera. Similarly, when we're doing training, we are eliciting a response on our metabolism, allowing our metabolism to adapt. 

Josh
Co-host
09:13
Can you? Okay, so I am new to this world of training. I was mostly a couch-lout with a laptop for most of my life. Yes, so can you tell me, but also the audience, what do you mean by that? What is happening when you say metabolic changes? What is happening that will benefit us in the competition that we're training for? 

Dr. Greib, Guest
09:39
Well, there's three or four things. So when we are training low and slow, we are up-regulating ATP synthesis. And, generally speaking, where are our ATP generated? 

Josh, Co-host
09:54
Mitochondria. 

Dr. Greib, Guest
09:55
Right, mitochondria, of course. Right, mitochondria, the powerhouse of the cell, well, and that's usually end-stop. So we're stressing the mitochondria, we're creating an environment where we have to have kind of this allosteric environment, the stressor on the mitochondria. Now, mitochondria, much to the surprise of many people, do a lot more than just generate ATP, like a hell of a lot more. And that's where we run into problems with people not thinking about training their mitochondria If you overstress the mitochondria by forcing it to generate way more energy than they like to all the time. Right, like high intensity training, super threshold training, b02, max training, whatever we want to call it, zone 4, zone 5 training. We're not allowing for adaptations of the mitochondria. We're stressing the mitochondria, right. So, going back to kind of training principles 101, what are we trying to do when we train? We're trying to elicit a response so that we can adapt to the response. Right, so you elicit a stressor in some form physiologically, metabolically, biochemically, neurologically, it doesn't really matter. You create that stressor, you allow the body to adapt to that stressor. We agree. 

Josh, Co-host
11:28
So the basic yes, and so the basic idea if I'm tracking, would be you need to stress enough for long enough periods of time to get the adaptation that you want, to get the super mitochondria or whatever. But too much would, you wouldn't get the adaptation, or you wouldn't be able to do long enough to get the adaptation that you're looking for. And so is the thought that you're creating more mitochondria, or they're just more efficient. Or and has this been studied? Like, where does this come from? Like, how do we get this idea? 

Dr. Greib, Guest
12:01
So it does a couple things. So number one is it allows for the mitochondria to. You're increasing mitochondrial density, so you have more mitochondria. You can make more ATP, so that's good. 

12:14
You're also looking, we can look at the efficiency at which mitochondria are generating ATP and there are seemingly increased efficiencies in ATP generation in those that are trained in zone two training. There is also some interesting effects on what I guess would be considered moderate intensity exercise. If we look at zone two Right. So we have low intensity, moderate intensity, high intensity for the genpot. So although there may not be a lot of literature specifically on zone two, we also want to think about the literature that's been published around genpot, which is that modern intensity exercise, that quote unquote fat burning zone Right, or that fat max zone, if we're looking at it from an exercise science perspective. 

13:08
So when we're looking at modern intensity exercise or what would be considered modern intensity exercise, kind of high zone two, there is an extensive amount of literature around how our body adapts to a stressor. Ie exercise Right. We as athletes like to look at a lot more intricacies but forget that as an athlete competing at him for a triathlon, it's not just about the triathlon, it's about his body functioning 24, 7, 365 in an optimized state. When we talk to our athletes, we usually like to talk to them about being a 24-hour athlete. So you go out and train for an hour, but what do you do in the other 23 hours, right? I think I probably ingrained this in Adam's head way back when, right? And that if you're not taking into consideration all the other stuff you do in the other 23 hours, you're actually eliciting stressors that you can then have an adverse response to, because then you're not allowing for adaptation, right? Who's primarily responsible for cortisol secretion In the body?

Josh, Co-host
The adrenals?

Dr. Greib, Guest
Adrenals, what part of the adrenals? 

Josh, Co-host
14:27
Going back to physiology class. 

Adam, Co-host
14:29
Yeah, save us, rescue us, oh man, we are going way back to wrestling, yeah that's what I was having nightmares of Cross sections of the adrenals. 

Josh,  Co-host
14:40
Thanks for that. 

Dr. Greib, Guest
14:43
Yeah, this is the academic side of me coming out. I just quiz everybody all the time. If you look at the literature, where a lot of this corticosteroids is being generated is in the mitochondria. So there's another component that if you're overstressing the mitochondria, do you think that you're going to have an appropriate stress response? Are you going to be able to secrete some of these minocorticoids and glucocorticoids in the mitochondria or from the mitochondria appropriately? No, so this mitochondrial load that we're putting, if we're doing constantly high stress exercise, does the mitochondria have the ability to be allosteric? Can it adapt to the stressor that's being put on it? Or do we get into that whole you know Han-Seli-A general adaptation syndrome thing where you fatigue and it becomes a distress Rather than a. You stress, right, it's not a tolerable stress anymore, and is that what makes it's an excess stress? 

Adam, Co-host
15:49
Sorry is that what makes zone two sort of this golden child of training where, if you were to be in zone four, zone five, the amount of intensity that you're kind of putting in and say you were doing that on a daily basis, you don't have the adaptation to recover the stressor, you don't have the adaptation to recover from that, whereas with zone two it's an appropriate amount of stress and also recovery, if you will, for lack of a better term. So then this way you can improve from a mitochondrial standpoint that we're just not seeing in zone four, zone five. 

Dr. Greib, Guest
16:28
Yes, exactly, right. So the intent is to influence the mitochondria where most of this zone two training is happening. There's also some DNA sequencing work in the mitochondria that changes the way that we have the ability to secrete proteins. So kind of go looking at mTOR pathways and protein secretion. In fact there is a piece of literature that just crossed my desk today I haven't even read it Looking at mitochondrial dysfunction and the link between mitochondrial dysfunction and sarcopenia. 

Adam, Co-host
17:07
Right. 

Dr. Greib, Guest
17:09
So what's the one thing that we always are asking our aging population to do? Well, go do some more exercise, do resistance exercise, do aerobic exercise. We don't know why per se, we think we know why, but this piece of literature is going to be interesting to read because if you can then stress the mitochondria appropriately modern intensity exercise, zone two training and you have better, more efficient mitochondria, are they then more apt to be able to secrete the proteins, or the precursor proteins, to allow for the nucleus of the cell to do its job more efficiently? Right, and that's where the biochemistry becomes very interesting around zone two training. Do most of our coaches understand the bio, the cellular biochemistry? Probably not, but they know that the athlete, seemingly, is getting better and they're not obliterating them, right? So this accumulated load also decreases because you're not just doing max efforts all the time, but when you go to do a max effort you're getting more quality because now you're more efficient, right? 

18:12
The other thing that zone two seemingly does this low intensity work and there's an abundance of literature on this as it relates to GenPOP is improving insulin sensitivity, right. So that is the insulin dependent mechanisms of glucose metabolism, right, and we know that there's also an insulin independent pathway to be able to get glucose into a cell. And lo and behold, zone two seemingly also improves the insulin independent pathway as it relates to glucose uptake. So it's having some effect in some way, shape or form on those Glucophore transporters that are influential in both the insulin dependent and the insulin independent pathways. 

Adam, Co-host
19:00
Now to play a little bit of devil's advocate here, and I think a lot of people kind of know where I'm going to go with this. Sure, All this biochemistry and mechanistic stuff is great. Are we seeing it also hold up in any sort of clinical trials of, let's say, zone two training purization schemes versus some sort of other training scheme? 

Dr. Greib, Guest
19:22
Well, we do in Genpop for sure, that's for sure.

Josh, Co-host
19:28
Can I just interrupt? What is Genpop? Are you in general population? 

Dr. Greib, Guest
19:31
Just general population, yeah, so the majority, okay.

Josh, Co-host
Okay, I was like is this a phrase I just don't know Okay, the majority of people that we're working with clinically, right? 

Josh, Co-host
19:40
I was pretending like I knew what you guys were talking about, so this is an athlete term. Okay, yeah, okay. 

Dr. Greib, Guest
19:44
Yeah, no, no, no. But we can apply that to athletes, right, I see Athletes. Now there's a certain portion of athlete and exercise science that's being applied back to general population. So this kind of goes both ways. And when we're looking at the literature, sometimes as athletes, we forget about the weekend warrior which most people are. And what are those weekend warriors? Why are they doing what they're doing? Well, they're not too there to get to the next Olympic Games, right? They're generally doing something for health reasons Risk mitigation, general health, disease prevention, and there's plenty of literature that's looking at low intensity, moderate intensity exercise for that group. Now we need to think about if that's working in that group biochemically. You know odds are it's going to also work in the athlete population. 

20:41
Now to Adam's point. It is very difficult to do this research because it's accumulated effects over extended periods of time and that is extremely difficult to measure in a controlled manner in like an RCT, for instance. Right, so you have so many external variables, how are you going to control for that, like even running a 30 day study in this? You know, controlling load and controlling food and controlling sleep, 24 hour athlete, and you know the variance would be extremely difficult to do unless you have them in a closed environment, let alone 60 days, 90 days, 120 days, an entire season, in those real long endurance events, you know, like triathlon or Ironman or the marathon or ultra marathons. So that's, that's, that's a few of that, the outcomes that we're looking at. So, number one, there's some mitochondrial density and the efficiency of mitochondria. There is the insulin sensitivity Leading to some benefit as it relates to the insulin dependent pathway, the insulin independent pathway, and we're not stressing the mitochondria that are responsible for a lot of these people. So we're talking about the evolution of energy, atp, but also those glucocorticoids which we mentioned as well, which is another piece that a lot of people are not thinking about. 

22:16
So, again with the general population is, you know, you throw the athlete population in. Now, imagine throwing the tactical athlete population in. Who's on shift work Police, fire, ambulance, military? Well, they all of a sudden have a messed up metabolism in the first place, because their circadian rhythm is thrown off. Well, what regulates circadian rhythm and what are we measuring? Or what are some of the key influencers? Cortisol secretion. Cortisol secretion is linked back to adrenals, but to mitochondria in the adrenals. So those mitochondria are doing some stuff. If they're stressed, they're not secreting the stuff properly, and then you put external load through exercise on this as well. Now you're creating an environment of chaos, so that's a really specialized population. That's very intriguing, and I haven't seen a whole lot of literature on this, if any. That would be extremely interesting to study as it relates to this. 

Josh, Co-host
23:18
And I think that kind of underlines maybe one of the issues like Adam's question made me start thinking more about like what would be the clinical outcomes, or the clinically relevant outcomes, I guess, and I think it will depend probably on the population too, right. So to your point, if you're elite level triathlete and you're training for the PTO or something like that, or Ironman world or whatever, every second matters and so you could see how that might be your time might measure it in seconds, might be the clinically relevant outcome. But if you're the general population, maybe we're talking about disease prevention and if you're a shift worker, maybe it's completely different. And so, yeah, I guess that even you know it's interesting. 

24:07
Normally I think about the challenges of doing studies because of the challenges of the intervention, but this is also like the outcome will be different too, based on the population and the length of time needed. And then also, when you're training, you're not just doing zone two, you're doing lots of stuff. But I guess you could make an intervention where it's like add in zone two to what you're doing, versus add in I don't know, hit training or something, and then measure an outcome, I guess. 

Dr. Greib, Guest
24:34
Well, and that's an interesting thought, right, and that if we look at training modalities now one of the means of training is polarized training. Where polarized training is where there's a large density of training, usually kind of 80-20 rule, is very, very common. 80% of training is low and slow, like zone two. 20% is high intensity training and that's it right. And that high intensity training it varies depending on some of the coaching philosophy but also on what the physiologic outcomes are supposed to be. So the Norwegian training model, for instance, it's somewhat of a polarized model but they use lactate as the tool to train the lactate threshold or LT2, which is another way that you can identify zone two right. So there are two lactate thresholds. There's lactate one, lt1, lactate threshold one, even though it's not really a threshold and LT2. And LT2 is the measurable lactate threshold. If we talk about this in an aerobic component, that would be your anaerobic threshold versus your aerobic threshold, which would be down around LT1. And so if you've got the capacity to measure lactate LT1, you know, and there's three training zones in lactate Low LT1, between LT1 and LT2 and above LT2. And the Norwegian model does everything down LT1, polarized, and usually one day a week is loaded at LT2, around LT2, actually just below LT2. And once they hit their lactate thresholds, shut her down right, and the principle, or the theory here is that they're eliciting lactate secretion, which is a great indicator metabolite, right. That's all it is. Is it just measures? It's not creating. You know, there's not bio energetics associated with it. Where it's creating fatigue, a lot of people like, oh, it's lactic acid build up and don't believe it. No such thing. Lactic acid dissociates into hydrogen ions and lactate. Lactate is metabolized. In fact, the brain is dependent upon lactate as a fuel source. Guess what metabolizes? Or where it's metabolized? In proximity to the mitochondria, right. It's converted into pyruvate lactate dehydrogenase and then the pyruvate shuttled into mitochondria and then used as an energy source right through that lactate shuttle. So lactate is another means of measuring that zone 2, right. So that's methodology too. So we can do it by heart rate. You know your five zones. Where you get zone 2. You can do it by lactate where zone 2 would be your heart rate, where you hit LT1, right. So you do a lot of training in around LT1. 

28:07
There are other mechanisms, though, of doing this as well, which are your ventilatory thresholds. So these are measured in a traditional like a VO2 max test, where we have two thresholds. The first threshold is where your breathing starts to increase. Going back to atoms, zone 2, training right, it's like you're doing some work but you don't feel like you're dead or you're going to die, right, so breathing is increasing slightly, so that that's kind of the breath test that the you know, general population can do. And ventilatory 2 is the second threshold, where that controlled rhythmic breathing tends to break down and that's where we kind of hit anaerobic threshold, the BT1 or ventilatory threshold. 1 is where that free fatty acid metabolism it's kind of the upper limit of that free fatty acid metabolism or that quote unquote fat burn zone, which is again going back to our zone training, if we're looking at zone 2 same zone. So now we've got lactate measurements, you've got ventilatory thresholds or lactate thresholds, ventilatory thresholds, heart rate or perceived exertion all different ways that you can measure the same thing. 

Josh, Co-host
29:34
Look, the thing is we don't do this for money. This is pro-bono and, quite honestly, the motherships kind of eeks it out every month or so. Right, so we do this because we care about this, we think it's important, we think that integrating evidence-based medicine and integrative medicine is essential and there just aren't other resources out there the moment we find something that does it better, we'll probably drop it. We're busy folks, but right now this is what's out there. Unfortunately, that's it, and so we're going to keep on fighting that good fight. 

30:04
And if you believe in that, if you believe in intellectual honesty and the profession and integrative medicine and being an integrative provider and bringing that into the integrative space, please help us, and you can help us by becoming a member on Dr Journal Club. If you're in need of continuing education credits, take our Nanciac-approved courses. We have ethics courses, pharmacy courses, general courses, interactions, that's on social media, listen to the podcast, rate our podcast, tell your friends. There are all ways that you can help support the cause. 

Josh, Co-host
30:41
So what like? Adam, I'm curious what you've done, since you're way more interested than I am. I'm used to like okay, I'll be honest, my Apple Watch tells me what to do, and so how legit is that and what is in the world? Is that even based on and for the GenPop? What is the best way to do this? What is optimal? Can people go in and get their lactate threshold tested or VO2 max tested, or are we just going to go with exertion, like Adam was saying earlier? Or are they all close enough that it's equivalent, unless you're going for the Olympics? 

Adam, Co-host
31:16
And Josh, when you're saying that your iPod is telling you what to do, is that based on, like, heart rate variability metrics, or could you sort of uh, spin out a little bit more? 

Josh, Co-host
31:29
Yeah, so I don't quite understand it. I tried to look it up once, but the EyeWatch will, like, I think, based upon everyone, whenever you run outside. I think it takes an additional fitness measure and estimates your VO2 max. Like it said, it looks at your heart rate over a mile, or something like that, and I think that's what goes into these calculations, but I could be wrong about that. 

Dr. Greib, Guest
31:51
So these smart watches are doing that. So it can be a percentage of your VO2 max to establish your training zone. Other modalities can just be when you put your age in the system. Some of them are very simplistic and they do the 220 minus your age calculation and spit out here. I remember that one from school yeah Right, here's your five zones and have Adder and hopefully it works for you. So that's the other means of doing it, which is a very traditional max heart rate methodology. There's also a heart rate reserve method where you're looking at the difference between your max heart rate and your resting heart rate and then computing your zones. So you know, and all of these have legitimacy to them. To answer your question, Josh, are they all doing the same thing? If you're off by four beats a minute plus or minus, is it really going to matter? Probably not, Right? So people are like looking at their watch like 122 beats a minute. 

Josh, Co-host
33:16
That's totally me. Is my zone two plus or minus five beats? So I'm like 127. Got to stop. It's totally me. 

Dr. Greib, Guest
33:18
Yeah, well, it's modulate right. Your intent is to be in zone, your kind of zone two-ish, and I mean using lactate as an example. I jumped down this rabbit hole a couple of months ago because I was getting so frustrated reading the literature around lactate thresholds. I think there's now nine different ways All have validation to calculate lactate thresholds and they're all different, like massively different. So it's like again, like what are you trying to do in your training? And if you're trying to do this, then you got to pick the zone and stick with it. Consistency will be key so that you are getting optimum training within your area. So if you're looking, josh, to optimize your mitochondrial efficiencies as you improve your fitness, your zone two will go up right In theory. 

Josh
Co-host
34:23
In theory. 

Dr. Greib
Guest
34:25
If it's based upon your VO2 max, right. 

34:27
So if it's based on your VO2 max, and even if the Apple Watch is doing a calculation, your VO2 max goes up Proportionally, all your zones are going to go up. 

34:36
So now you've got an increased capacity to train, which is going to give you more adaptation, so you're staying within that allosteric capacity of your tissue to be able to take the load and adapt. It's when you go full blast and you don't recover, and full blast and don't recover and you don't get any adaptations, right. So in when we're looking at ventilatory thresholds or lactate thresholds, it's called right shifting. So when you do the test, the whole curve should shift to the right as your fitness improves so that you can work harder at the same metabolic output or the same physiologic metabolic, lactate physiologic output being ventilation, right. Or in the calculation of the watch, if it's calculating VO2 max and if that is validated because there's question on the validity of these back calculations you're going to see your training zone also increase. So then you can train a little bit harder and still get the benefits and not get overloaded and cause this stressor on the mitochondria we're talking a lot about mitochondria today or stressor on your physiology that you cannot adapt to. 

Adam, Co-host
36:01
And one thing, if you can is there sort of a ranking that you have when it comes to training methodologies? Because my concern with like an RPE scale or rating of perceived exertion there's so much subjectivity to it. You might be able to. You know, like my Garmin will say oh yeah, hey, your heart rate variability is looking really good today. You're well recovered. You can have a hard training session today. However, if you know, I'm training in the afternoon and I had a long day at work and I have, you know, a lot of things going on and I'm just not feeling up to training. I feel like my RPE is going to be much different during that session, where I just probably don't feel like training and I'm really just showing up to show up versus sort of like a quote, unquote, like optimal zone, if you will. 

Dr. Greib, Guest
36:51
Yeah, that's an excellent training question. That's a very difficult question and that's you're going to get a different answer from a different coach. So you can also, adam, you brought up the question to Josh. You know how is this calculated? It's based on HRV feedback. 

37:10
I'm a big fan of HRV, I love HRV. I think it's a really good indicator on how our autonomic nervous system is adapting to some of the stressors, because we can't go in and start doing punch biopsies on ourselves and measuring enzyme secretion in our mitochondria, but what we can do is measure our HRV. So at least we've got a surrogate measurement on adaptation as it relates to your neurology. So that's one means that you could, as a coach, you could look at that, because there's a cognitive component too to training which we haven't talked about and we're probably not going to talk about today. But an athlete can feel off cognitively, yet physiologically, neurologically, there should be zero reason why they shouldn't be able to perform. So, as a coach, that's where, adam, it would be important for me to have that discussion with you If I were coaching you. It's like why do you feel this way? Like, do you just feel gassed? Is it cognitive? Because we've all had those and as soon as you get out there and you do your warmup, you're ready to like, take over the world and you can get quality because you've given yourself that reprieve of three or four or five days and you've done that zone two work which is not hard on your physiology so that you're ready to perform that intensity work which, going back to the Norwegian model, that's why they do one day of intensity, they'll do double downs, they'll do doubles on a day, both intensity sessions and that's it. The next six days is all the polarized work at the low end, all zone two. 

38:52
Cross country skiers have been doing this for decades and it's part of their culture and philosophy around coaching and now we're starting to see in literature why it's working. You look at they're arguably some of the best athletes in the world and they're doing a ton of zone two and Blumenthal right, one of the best athletes, triathletes in the world. All Norwegian model, polarized training, loads of zone two, free, controlled lactate threshold training. So there's that metabolic component that when you put your body under load for extended periods of time, you're able to do the output, versus creating the stressor and slowly breaking yourself down metabolically, biochemically and not knowing it, and then you're not getting the output. Just like our sarcopenic patients, they kind of slowly deteriorate because their mitochondria could be dysfunctional. Why would we purposely do that and if influence our longevity in sport, if we know that we can have positive effects on this quote-unquote powerhouse of the cell and all the other molecular mechanisms that are involved, when we're generating the upregulation of mitochondrial influence? 

40:17
right Now you talk a lot about now mitophagy, so mitochondria can self-destruct and they know when to do it. It's really intriguing when you start looking at how these little tiny energy mechanisms in our body are actually functioning. 

Josh, Co-host
40:42
And I can't help but go back to high school molecular biology or whatever, where they were talking about that theory of it. It's from a different organism, right? Isn't there that theory that mitochondria merged with other cells? It's sort of like this alien within us and it does all this really cool stuff. I just can't stop thinking about that. This is amazing and absolutely fascinating. Adam, any other last minute questions you were dying to make sure we get an answer for before we wrap up for today. 

Adam, Co-host
41:18
Yeah, I have a couple of questions. This may need to be sort of like a part two. Part one would be sort of training methodologies and this next part might be like a part two of recovery and supplementation and whatnot. But things that I have sort of concerns for within the field of sports medicine is there is sort of quite a bit of pseudoscience for lack of a better term where a lot of supplements are being recommended based on these mechanisms of action. So you're talking about like oh, can this vitamin C or something like that. It can increase or enhance mitochondria, therefore it'll enhance your physical performance, and I just don't think I'm really quite skeptical of a lot of the supplements that are sort of pushed out there for performance enhancement, outside of something like creatine, which is really well established in the literature, yep. 

Dr. Greib, Guest
42:17
Yep. 

Adam, Co-host
42:17
And something that's that's making its waves quite for quite some time now on social media is this obsession of cold plunges which is behind the scenes. Josh and I have actually kind of been going back and forth on where. 

Josh, Co-host
42:33
That's another paper we have to do. I love cold plunges. 

Adam, Co-host
42:35
I'm very skeptical. 

Josh, Co-host
42:37
Yeah. 

Adam, Co-host
42:38
And I think in the long term they actually. I'm skeptical of cold plunges because I think in the long term they are actually or what the research is showing is that they're actually detrimental from a recovery standpoint long term. 

Dr. Greib, Guest
42:52
Yep, absolutely. 

Adam, Co-host
42:54
But if you are very like short term window of you know we have like we had a game today, we went all out and then we have a game tomorrow, that cold plunge may be beneficial but only in that short term and can help recovery acutely, but long term would be detrimental. 

Dr. Greib, Guest
43:14
Yeah, or is it even helping acutely? 

Adam, Co-host
43:17
Correct. 

Dr. Greib, Guest
43:18
Right, because there's literature suggesting that a cold plunge may actually inhibit tissue recovery. So it's interesting. You ask a really awesome question, adam, and I think there's a lot of hand waving, especially in the supplement world, and there's deduction around these. What they do I mean an example is like vitamin C and how that can help with recovery. Well, why is it like if we talk about the mitochondria we talked a little bit about ATP production, we talked about some of the corticosteroids, minocorticoid secretion pieces, but it's also integral in like intracellular ROSs, reactive oxygen species generation. That all starts with the mitochondria oxidative phosphorylation, as we know. 

44:17
Thermogenesis, like how do you warm up? That's all wasted energy. Well, where's the wasted energy coming from? Guess where? The mitochondria generating energy that we just don't use, right? So thermogenesis is also mitochondrial derived. Calcium homeostasis, mitochondrial derived Right, and then all the cellular metabolism hub, all mitochondrial derived. 

44:39
So you know going and saying well, you know, theoretically, if we give vitamin C or anything else, that's going to quench reactive oxygen species, that's a good thing, because then we're going to down regulate the biochemistry in theory, but it's in theory because we haven't measured it. So I, adam, I'm on the same page. I'm very skeptical, I think, from a dietary perspective. On the other hand, if we are really feeding our athletes, well in the other, in this 24 hour athlete model, and we're giving them low doses of lots of different stuff, that kind of hormesis kind of theory where the body then has lots of different things that it can utilize and help it adapt with, I think that's a good thing Talking, you know, the cold plunge, everybody's like all hopped up on cold plunges. Well, what about the opposite end under the spectrum? Like the fins have been sitting in saunas that are, you know, whatever 75, 80 degrees C for centuries, right? So are we going to create things on the opposite side that could be influential on our body being able to adapt to its environment? Well, of course we can. 

45:58
Right, heat acclimation, we know it's well documented. Why are we, why can we not, as an endurance athlete, you know, going down to Hawaii to race the world championships, or in Europe? Now, I guess, if they're flip-flopping back and forth, why are we not heat adapting? Well, we've got principles that we know that, because it's an adaptive response, right, the people clinically coming back this time of year, you know people are going down to, you know, I think you guys are on the west coast, I'm more on the east coast, so your bunch goes to Hawaii, our bunch goes down to the Caribbean. 

46:31
They come back and they're like, oh, I'm up like five pounds. I'm like, yeah, you have five pounds, or you're just holding on to five pounds more plasma because you've been exposed to heat for the last week. And they look at me like I'm crazy. I'm like, well, it's an adaptive response to help you cool Right. And again it's that it's like cornice, right, you give yourself a dose of something and let yourself that's interesting respond to it and that's really, you know, when I'm coaching and working with my athletes is like you know. 

47:02
It may sound rudimentary and fundamental, but like you need a variety of different foods because we need a lot of these phytochemicals and we're gonna pull it. We're gonna be very intricate in how we do our training so that you don't overload yourself, and I'm an n equals. One example like I train like crazy for marathons and I am gonna break this sub three hour marathon barrier, gonna break it, gonna break it and I don't know. I've run like nine or ten or eleven marathons, wow. And run like three hours and three seconds, three hours and three minutes, three hours and nine minutes. Like everything's between three hours, except my first marathon, the first one I went in, I did a sub three and like what's up three, this is cake walk. Never been able to repeat it. 

47:51
Difference is I got into structured training. That retrospectively, right hindsight, is always the best site. I was training too hard too often and when I was training for that first one, what did I do? I just put loads of volume in Low and slow. And then what did I do? I put in all this training principles. I'm doing like two speed workouts a week and I'm doing this and I'm doing tempo work and you know zone three, zone four, zone five work and not enough zone two. So I'm not actually rooting my metabolism and probably over stressing my body. So then when I look for an outcome, I wasn't quite there yet. The first one, you know, and this is any close one guilty party. But if you look at the, if I look at the differences, that's the main differences. So now I've reverted back to doing everything Low and slow and maybe one hard work at a week or one every two weeks, because I'm not a spring chicken anymore. So takes me a little bit more to adapt. 

Josh, Co-host
48:55
Well, you are reinforcing what my coach told me, which I'm not super thrilled with because I just feel like nothing, like you were saying earlier, like nothing's happening. I'm just kind of like wasting time on this treadmill listening to podcast, but apparently she's right, yeah fair enough, stick with it and it and it's a metabolic game, right? 

Dr. Greib, Guest
49:15
So it's slow, insidious change to your metabolism and that's what's going to help your performance over time. So, although you know you may not be the world class athlete next week or next month or next year, maybe in ten years you're gonna be a world class athlete, right, and you know, if we start looking at endurance, athletes who are are really excelling later in age. They haven't obliterated themselves early in age by overdoing it. They've been putting large volume in and a lot of training in and they've been relatively smart. But now, if you start looking at their training methodology, a lot are doing polarized training and not Completely running themselves into the ground like marathoners. We've got top marathoners in the world that are forty plus, right, they're not twenty something. Well, how does that happen? Right, it takes time for your metabolism to change. 

Josh, Co-host
50:15
Very cool, very, very cool. I'm Adam. Got any other questions, sir, what we got an expert on on the call? 

Adam, Co-host
50:21
No, that is it, I think we gotta break this up into a two partner at least. 

Josh, Co-host
50:26
Yeah, this is amazing. I have like a zillion questions and like I don't know. I feel like I'm Just just super briefly. You were talking about the, the, the Hawaii games and all this, and there's a podcast that Adam and I sometimes was to, that triathlon life, and they do heat training for Kona, so they'll go with for their workout, they will like Get their temperature way up and then go train and they at least according to this podcast, they swear that that's sort of that heat adaptation for Kona. I mean, I can't even imagine. That's just crazy. 

Dr. Greib, Guest
51:03
Well, and now there's wearables. 

51:05
There's a wearable that actually has it measures heat flux what and they have a proprietary algorithm that uses that heat flux to get a core temperature estimation. 

51:22
So then what you can do is you can do a heat training test. 

51:27
So it's a great step test under heat environment and you're looking for power degradation because you're gonna lose power as you get hot right. 

51:37
Your physiology is not gonna work as well at a steady state Heart rate rate, so your powers going down, heart rate stays the same. So then you've got a two variable curve to be able to delineate where you're starting to dramatically influence your performance. So then you've got a window of training to say I'm just like we do with zone to training, like take training, ventillary threshold training. Now you've got heat training because you've got your zone where you start to degrade in your power output and you can do that for running, you can do a for cycling, and then you can get a heat adaptation in an objective manner, rather than just sitting in the sun and cooking yourself and you it doesn't have to be high intensity all you're doing is to modulate your core body temperature. So you put all your sweats on and you do a light ride, get your body into that hurt or into that heat zone. You hang out there for a while and that's your workout. 

Josh, Co-host
52:37
So same general concept, but yeah so it all exists. 

Dr. Greib, Guest
52:40
That's so cool. 

Josh, Co-host
52:41
Yeah, same concept just with heat. 

Dr. Greib, Guest
52:43
Yeah, that's so cool. 

Josh, Co-host
52:45
Well, it's a whole new world for me and, yeah, just fascinating. Well, anyway, thank you so much for Adam, thanks for the idea and thank you for joining us. This was just awesome. I have a feeling we'll be bothering you again soon, so just feel free to ignore us. But no, just absolutely wonderful, any last minute words you want to share with with our listeners. 

Dr. Greib, Guest
53:06
No, it's been great to to catch up at them and glad to hear your crush and try, which is awesome. And Josh, josh, you're going to be crushing, try now. You've got all the tricks of the trade now, as long as they survive. 

Josh. Co-host
53:19
Goal is survival, yeah. 

Dr. Greib, Guest
53:22
Yeah, no, I really appreciate the opportunity and you know, anybody that is interested in speaking to me further than you can always reach out in our social or I think I can leave you my email address as well, guys. 

Josh, Co-host
53:37
So awesome, very cool. Thank you so much. 

Adam, Co-host
53:40
Yeah, thank you. 

Josh, Co-host
53:41
All right, take care. Yeah, thanks. If you enjoy this podcast, chances are that one of your colleagues and friends probably would as well. Please do us a favor and let them know about the podcast and, if you have a little bit of extra time, even just a few seconds, if you could rate us and review us on Apple podcast or any other distributor, it would be greatly appreciated. It would mean a lot to us and help get the word out to other people that would really enjoy our content. Thank you, hey y'all. This is Josh. 

54:05
You know we talked about some really interesting stuff today. I think one of the things we're really excited about today is that we're going to be doing a podcast and we're going to be doing a podcast about some of the stuff today. I think one of the things we're going to do that's relevant. There is a course we have on Dr Journal Club called the EBM boot camp. That's really meant for clinicians to sort of help them understand how to critically evaluate the literature, etc. Etc. Some of the things that we've been talking about today. 

54:33
Go ahead and check out the show notes link. We're going to link to it directly. I think it might be of interest. I know that we have some questions that you would like to ask us about. So we have a lot of questions that we have a lot of questions that we have about Dr Journal Club. Dr Journal Club on Twitter, we're on Facebook, we're on LinkedIn, etc. Etc. So please reach out to us. We always love to talk to our fans and our listeners. Do you have any specific questions you like to ask us about research, evidence, being a clinician, etc. Don't hesitate to ask. 

Introducer, Other
55:02
Thank you for listening to the Dr Journal Club podcast, the show that goes under the hood of evidence based integrative medicine. We review recent research articles, interview evidence based medicine thought leaders and discuss the challenges and opportunities of integrating evidence based and integrative medicine. Be sure to visit www.drjournalclub.com to learn more.