[Thomas Summer, MD]

Thomas Summer, MD on March 23, 2021 at 7:23 am · in reply to: Brain Bonk versus Muscle Bonk (N-Zone Topic) #52304

What is the point of hidden replies? Especially if I can read them anyway? That makes no sense;-)

[Thomas Summer, MD]

Thomas Summer, MD on March 22, 2021 at 2:13 pm · in reply to: Brain Bonk versus Muscle Bonk (N-Zone Topic) #52283

Hey Steve!

Good topic. Some quick first thoughts:

Method 1: likely to bonk because of low blood sugar. muscle glycogen is still full the next morning, but liver glycogen will be more depleted because it is used to stabilize blood sugar during the night. So it’s likely that low blood sugar (brain bonk) occurs.

Method 2: is this with breakfast? ether way this training regime will be probably more beneficial for training adaptation. As it has been shown, that the longer you wait with replenishing the glycogen stores in your muscles the more mitochondria and other adaptations for aerobic fat metabolism will occur. Bonking in the second training session is likely. Probably both ways.

BUT: isn’t it always the brain that senses fatigue and causes you to slow down or even bonk?

Good fat metabolism plays a huge role. And also the ability to produce ketones.

The 80/20 “rule” is only defined by intensity. If you train below AeT it doesn’t matter if you fasted before or not. Fasted maybe feel harder, but it’s not higher intensity (probably even lower). That doesn’t mean that the stress on the body isn’t higher. You don’t count it as higher intensity, but you have to be careful about the training load.

I don’t have any exact numbers in mind, but muscle glycogen is never totally depleted (even with a ketogenic diet). It’s always the brain that senses if something is getting low or out of balance. As it senses this as a risk for the body, it shuts down before serious damage occurs (in most cases)

lg!
Thomas

[Thomas Summer, MD]

Thomas Summer, MD on March 21, 2021 at 6:13 am · in reply to: Long term covid chest pain with exercise #52252

Hi Diana,

I’m sorry to read that your symptoms are not getting better.

Did you also get bloodwork done? An appointment with a throat specialist is a good idea. He will probably tell you how to go on. Maybe also see a lung specialist!?

I would recommend taking vitamin D, Zink, vitamin C, and quercetin.
Try if inhaling essential oils help. I would use rosemary and peppermint.

I hope you get better soon!
Thomas

[Thomas Summer, MD]

Thomas Summer, MD on March 20, 2021 at 4:03 am · in reply to: Long term covid chest pain with exercise #52224

Hi Diana,

how are you doing? I hope you are getting better?!
If you want to share your progression, I would be very happy to read from you.

all the best from Austria!
Thomas

[Thomas Summer, MD]

Thomas Summer, MD on March 20, 2021 at 3:05 am · in reply to: Meniscus #52222

Hi Oliver!

Why do you think that it is the meniscus? Did you have any injury in this knee? How old are you? I would doubt that it is really the meniscus. Your intention of seeing a physio was good, to clarify what the problem is. Any chance of seeing an orthopedic/sportsmed doc?
How do you feel the lack of stability? I would target that with specific strength training like squats and stepups. Do them in front of a mirror, or with someone to correct you, and focus on good form. Also, balance training would be a good thing. Again with good form and a straight leg axis.
I wouldn’t prescribe a rest period. It looks like you can handle it well at the moment. As long as it is not getting worse, I would continue with training. But be very careful and honest with yourself. And ad the strength training. See how it progresses. If you are short on time better skip a run instead of some strength or balance training.

I hope that helps!?

Have a great weekend and a satisfying long run!
Thomas

[Thomas Summer, MD]

Thomas Summer, MD on March 17, 2021 at 3:34 am · in reply to: MET Podcast #52112

1) preferable HR will depend on the individual metabolic parameters and the goals of the athlete.

2) Warmup 15-20min with very low intensity. Each step should be at least 3min. Most protocols use steps between 3 and 5min. It’s important to have the same gradient throughout and also the same increase in speed on each step, to compare it with following tests. By UA an increase in 5pbm HR on each stage is recommended as a target. But that will also depend on the specific protocol of the lab.

3) good question. If a runner does not train fasted then Fatmax is probably lower in training, because of sooner and more carb burning

4) as AshRick describes. But “speedwork” is also important to train the glycolytic (carb-burning) enzymes. But the training will depend on the specific goals

5) if you train in the “fat-burning zone”, fat burning will be improved, also if you have a diet high in carbs. But if you train in a state with low glycogen availability, then your fat burning will be improved even more. There are different ways to achieve that and it’s always depending on the individual athlete and the goals. Fuel for the work required!

I hope that helps!?

P.S. is it allowed to eat gummy bears while writing this?;-) …But I have to do some heavy strength training now. …fuel for the work required;-)

[Thomas Summer, MD]

Thomas Summer, MD on March 16, 2021 at 2:04 pm · in reply to: The N-Zone #52089

I like that! The longer you run the more you have to deal with exercise pathophysiology. But that’s what we enjoy, isn’t it!?;-)

[Thomas Summer, MD]

Thomas Summer, MD on March 16, 2021 at 2:03 am · in reply to: The N-Zone #52061

Hey Steve!
I think it’s really a bit too reductive;-)
Especially the assumption that they have equal AeT. If we assume that, then we also assume that the whole point about training without carbs is useless. Train low, race high…
But if we assume that they have the same AeT, then we could also assume that Fred trained and races with ketone esters. So also an additional fuel source for him.
Who wins now?

[Thomas Summer, MD]

Thomas Summer, MD on March 15, 2021 at 6:04 am · in reply to: The N-Zone #52033

Hey Steve!

First of all: I like the idea of the N-Zone!

interesting scenario. I think Chad would win. If he gets the carbs during the race, he will have an additional fuel source. His aerobic system and fat metabolism will be trained almost like the one of Fred. Probably even better, because he was able to run with better intensity and recover better with the carbs. I could argue in the other direction too;-) but in the scenario, where he gets the carbs during the race, he will win (when he doesn’t get sick from the sugar). In a scenario where there are no carbs at the race, then he will have no chance.

I think it’s not a question of carbs or fat. It’s about how well you can use both.
Maybe we should bring ketones into the discussion!?;-)

[Thomas Summer, MD]

Thomas Summer, MD on March 15, 2021 at 5:51 am · in reply to: GO2 device #52032

Thank you very much Steve! You shifted my attention back to sports medicine. The advertisement of the go2 managed to fool me into shifting my focus to intensive care medicine. Luckily that’s not our topic here;-)
I agree with everything you wrote. Except that your blood oxygen saturation stays at 100% all the time during exercise. There is a phenomenon called “exercise-induced arterial hypoxemia” – EIAH. It’s not totally understood why that occurs. But PEEP will probably increase the hypoxemia and not reduce it. That’s because the constraint of breathing out will lead to air trapping (as you wrote), and increase CO2 and prevent adequate hyperventilation.

conclusion: Don’t let the advertisement fool you. And never trust your doc;-)

[Thomas Summer, MD]

Thomas Summer, MD on March 14, 2021 at 4:29 am · in reply to: How to lose muscles #52002

Are you still doing strength training? Most of the adaptation comes with specific training. Of course, body shape is individual. Some have more muscle and gain muscle easily. Some are thinner and almost can’t gain muscle. Some are small and don’t grow, some are tall and don’t shrink;-) So you can change your constitution with training. Train like a runner and you will look more like a runner, train like a bodybuilder and you will look more like a bodybuilder. Of course, there are individual limits. We can’t play basketball and expect to grow;-)
I hope you get the point!?
I wouldn’t recommend cutting calories, because you are already really low in body fat.
A question you have to ask yourself, is why you are comparing yourself with the guys who are winning the competitions? Do you want to win, or do you want to have fun? And even, if you want to win, I know some very good runners with big muscles.
Anyway, I like Colin’s advice. You should follow that!;-)

[Thomas Summer, MD]

Thomas Summer, MD on March 12, 2021 at 8:22 am · in reply to: vertical speed records #51954

I would like to know Steve’s record;-)
The WR is 28:53min set in Fully. (that seems to be the best location)
It’s very doubtful that Messner and Habeler came even close to 30min. But they had other limits to break!

I must be crazy to recommend a podcast by Jason Coop (the man against ADS;-) https://uphillathlete.com/forums/topic/suggestion-renaming-ads-to-fods/
But he has actually some really good content. Although he is too smart for everyone else;-)
and this recent podcast is perfect for the topic:
https://www.jasonkoop.com/podcast/how-to-optimize-steep-running-with-rodger-kram-phd

uphill regards!
Thomas

[Thomas Summer, MD]

Thomas Summer, MD on March 12, 2021 at 8:04 am · in reply to: GO2 device #51953

That’s indeed quite interesting!

https://www.sciencedirect.com/science/article/pii/S2666337620300275?via%3Dihub

this is the study that is cited on the website. It’s interesting but there are some caveats:
– very small sample since
– not really fit subjects
– no real time trial
– comparison against another mouthpiece!?!? – maybe that impaired the performance?!?
…

anyway, I would like to test it;-)

[Thomas Summer, MD]

Thomas Summer, MD on March 1, 2021 at 3:04 am · in reply to: Suggestion: Renaming ADS to FODS #51400

Deficiency should be understood as weakness, not as a shortage of the aerobic pathway. Your aerobic system always contributes the most to the energy expenditure, but so does the motor of a tractor compared to a Ferrari. And would you like your anaerobic system to contribute sooner or later? If that wouldn’t matter then we could hold our highest intensity forever. All the acidosis and metabolic byproducts, out of the anaerobic pathway, wouldn’t contribute anything to fatigue.
I think we shouldn’t focus so much on the words, but more on understanding what it is about. It’s not a disease (so it’s unlikely that you find something on pubmed), but it’s a risk factor for poor athletic performance and development in long endurance sports.
I would like Jason Koop to join the discussion. He is so much smarter than we are, so I think we could learn something;-))
Bottom line: any term is made up. Why should we fear high intensity work?

[Thomas Summer, MD]

Thomas Summer, MD on February 28, 2021 at 4:15 am · in reply to: Suggestion: Renaming ADS to FODS #51345

Can you eat a ketogenic diet (and be in ketosis) and have FODS? Or can you have ADS?
Anyway, what about BDS… Base Deficiency Syndrome?;-)

All models are wrong;-) it’s probably better to understand what it’s about!?

Cheers!
Thomas