Ever want to see how you’d stack up against Lance Armstrong, Levi Leipheimer and Alberto Contador climbing up Tour de France classic mountain climbs like Mount Ventoux?

Well now you can!

On San Diego’s first Computrainer MultiRider Center at Coastal Sports and Wellness, you can now climb some of the classic Tour de France climbs in our indoor door cycling classes!

Watch on our two giant screen televisions as you climb up Mount Ventoux and suffer through the ride that Lance Armstrong calls the toughest climb in the Tour de France.

Find out more about our San Diego indoor cycling center.

Hi this is Dr. John Martinez, Medical Director of Coastal Sports and Wellness Medical Center in San Diego, California.

Today, we’ll be talking about some myths and facts about both lactate testing as it applies to our endurance training—we’re talking about:

• The lactic acid myth
• The muscle burn myth and lactic acid
• The muscle pain myth
• The lactic threshold myth

Now the first myth is about “lactic acid” and that lactic acid actually appears during exercise, so it’s really the true things, it’s more of a misnomer and that lactate is actually the proper term and it’s actually a by-product of glucose utilization and a lot of coaches and athletes are taught or told that lactic acid is something that’s actually bad, when in fact that if we look at the whole breakdown of exercise metabolism, it’s that as glucose breaks down, it’s broken down to a by-product called pyruvate and eventually into a pathway that produces lactate.

There may be some true lactic acid that’s formed very briefly, but then the lactate is actually a salt by-product that’s produced and importantly, for athletes and coaches to understand is that lactate is actually used by the body specifically, the brain and the heart for fuel and this falls into a concept termed the lactate shuttle as first proposed by Dr. George Brooks up in University of California, Berkley who’s done a lot of research on this concept.

The next myth that we’re going to talk about is that muscle burn myth and this is something that I think most athletes have been told, if you’ve ever been in a spin class, ever gone out to the track and done track workout or a speed workout and told that that burn is that that lactic acid building up and again, if you go back to that first myth that we’d already talked about, the true term we should be using is lactate, but it’s actually also false that lactic acid build up causes that muscle burn that athletes experience at the high intensity exercise.

The fact is that that muscle burn is actually more of an acidosis that occurs when hydrogen ion build up and probably some other by-products in the intense exercise. Lactate itself doesn’t seem to cause that muscle burn and if you look at the research studies, we have athletes that have much different levels of blood lactate levels that have different experiences or different complaints as far as how much muscle burn and muscle discomfort there is.

So again, that lactic acid or that lactate build up doesn’t cause that muscle burn.

The third myth we’ll be talking about is muscle pain myth and that lactate or lactic acid build up causes the muscle pain most athletes experience 24 to 48 hours after a hard workout. Well, the truth is that, lactate is actually cleared from the muscles usually within an hour of most exercise, even the more high intensity exercises, and we know this because when we do a lactate testing on our athletes, we plot out the increase in the lactate levels as we increase the exercise intensity and then as we have a recovery period after exercise, we actually do a recovery lactate test to watch how quickly the athlete’s body is able to metabolize that excess lactate.

So the truth is that, a lot of that muscle damage and muscle pain that occurs 24 to 48 hours actually probably do more to micro tearing of muscle and usually, we see more muscle pain and more micro tears when there is more eccentric muscle contraction and this should be something, as far as downhill running and the eccentric lengthening of the quadriceps muscle and if you’re in the gym during a bicep curl, this would be the negative that a lot of body builders do when they slowly extend out the bicep under a heavy weight and you get more micro tearing and therefore, more inflammation and damage to the muscle and that’s what we think that delayed onset muscle soreness is that occurs, a couple of days after a hard workout.

The final myth we’ll talk about is the lactic threshold myth and that myth is that there’s a defined point where the body switches from an aerobic to anaerobic metabolism called the lactate threshold. Well, the truth is that there’s really no defined switch from aerobic to anaerobic metabolism. There’s actually more of a mixture of aerobic and anaerobic metabolism in most exercise intensities and if you think about this at a lower intensity, you do use mostly fat as your main source of energy.

But there’s always just a little bit of glucose metabolism that’s occurring and as you slowly increase your exercise intensity, there’s more of a slow transformation or slow transition to a more heavily anaerobic metabolism, but there’s no true flip of the switch where you go completely aerobic to completely anaerobic, it’s more of a transition zone that we hit.

One of the other things that we try to measure with our athletes is what we call the maximum lactate steady state, which is that steady state exercise level for either running or cycling where the athlete can maintain a constant lactate production and lactate metabolism and that’s probably the level that most athletes can race a long distance, race out over an hour.

Interested in finding out out more about blood lactate testing?

We offer blood lactate testing in San Diego at our sports medicine center and sports medical director.

Give us a call at 858-678-0300

Dr Martinez has been part of the USA Triathlon Team USA support staff for the Age Group World Championships since 2004. He has also been part of the medical staff of the Hawaiian Ironman World Championships since 1999.

This is his first year as part of the medical staff supporting the USA Triathlon elite athletes. Dr Martinez will be covering the ITU triathlon races in Madrid Spain and Kitzbeuhl, Austria with Alex Keith, DC, a Palm Beach Florida sports chiropractor.

For more information about our San Diego sports medicine clinic, call us at 858-678-0300

 
Demonstrators:
Although not protesting the race itself, many of the local villagers tried to disrupt the activities, including blocking all traffic to and from the host hotel and blocking the swim course on days leading up to the race.  There was talk about them trying to block the run course as well, so the day before the race the course was changed.  Even though it was inconvenient, it is very sad that the land that they have lived on and have there ancestors buried on is being taken from them to build hotels and having to work in such poor conditions.

Swim:
The swim was a 2 loop course in a river close to the city.  Although it didn’t feel polluted, is was so muddy that you couldn’t see past your elbow with your arm in the water.  The current was extremely strong so the race director decided to cut that one leg about in half, have people exit the water and run along the shore.  Even then, then strategy of most people seemed to be to swim close enough to the shore so you could walk that leg.  I had to hold on to a buoy line to rest and it felt like you were being pulled through the water.

Bike:
The bike was also a two loop course with most of it being on nice paved roads.  There was about a 3 mile stretch that went through a small village, and even though it had the worst road conditions, it had the best crowd support.  There was virtually none on the rest of the course. The steepest part was similar in grade and length to Torrey Pines inner loop.  The rest was rolling hills, like riding along the coast.  Despite putting on zinc oxide sunscreen that was supposed to last all day, I noticed my arms and legs getting sunburned by 11am.  I tried putting on more at the aid stations, but by then it was too late.  I almost think that putting more on just trapped the heat in.  There was a pretty significant side wind that felt to be up to 20 mph, and with the high temperature it was a hot wind.  It was an interesting sensation having trained my legs to go harder, but my body just not letting them.  They ran out of water on the bike course about 4 hours in to it.  They had some cold water you could dump on yourself, but nothing you could drink.  I personally thought they should have more aid stations closer together, or at least stagger them so your could access them more frequently.  There was also little roaming support as I saw a couple of athletes walking there bike, and I all I could do was tell the next aid station.

Run:
With my legs feeling good after the bike I thought I would be able to make up some time on the run, but that was not the case.  Again there was no shade and even the pros were walking.  Someone told me that 17 of the pros dropped out, and if that is true, then that would have been half of them.  The course was really flat, but it was too far in between aid stations.  At every one I was dumping cold water on my neck, arms, and legs, but just couldn’t seem to get my body to cool down.  I wasn’t able to take in much nutrition.  I only went through about 5 oz of what I brought with me, and then some cups of water or cola at a few of the aid stations.  There didn’t seem to be any walkie-talkies on the course as some athletes were trying to drop out of the race and they were told they had to walk another 2 km to the next aid station to do it!  Most of the medical staff didn’t speak English.  There were a number of times that I had to translate for an athlete as I was going through an aid station about where they hurt, or what they wanted done.  Even at the finish they were reluctant to give IVs.  Athletes were asking for them but were told that since their vitals weren’t dangerous, they had to just rest and drink water.

Despite the conditions of the day, I am glad that I did it.  My feet are blistered, I lost a few toenails, and my arms and legs are fried, but at least I was able to finish.  It was definitely not the time I wanted, but crossing that finish line after all that happened was unforgettable.  Thanks for all of the support and I’ll see you guys when I get back in the states!

- Scott

More info on the Velonews website 

Steve Larsen’s athletic career crossed from road cycling, into mountain biking and then into triathlons. He managed to win two NORBA National Mountain Biking Championships as well as taking the 2001 Ironman USA Triathon title in Lake Placid, New York and a 9th place in the Ironman Triathlon World Championships.

His road cycling career include time on the US-based Motorola cyling team with appearances in the Giro d’Italia and other top European cycling races.

Recently he was living in Bend, Oregon with his wife and 5 children and working in the real estate field.

I had the opportunity to meet Steve several times through out his career(s). First was way back in the 1990′s when he was competing on the pro mountain bike circuit and the last time out in Kona at the Ironman triathlon. Very gracious both times, one when he wasn’t feeling too well after Ironman. Also watched him completely destroy the field at Ironman Lake Placid in 2001 where he shattered the bike course record (and my first Ironman triathlon)

A very talented athlete and person – our hearts, thoughts and prayers go out to his family and friends.

The original topic was supposed to be about the recent 50 game suspension of Los Angeles Dodgers outfielder Manny Ramirez, but sports anchor Rick Willis is a big marathon fan and decided to focus more on the healthy aspects of running and training for running races from the local 5 km fun runs to the San Diego Rock and Roll Marathon.

Note that Dr Martinez had to slouch down to fit in the camera shot, and if the beginning seems a little disjointed – apparently the wireless microphone box kept unclipping and falling to to ground as they were about to come back from the commerical break!

SANTALLA, NARANJO, J and  TERRADOS, N, Muscle Efficiency Improves over Time in World-Class Cyclists , Medicine & Science in Sports & Exercise. 41(5):1096-1101, May 2009.

Goes to show that even at the elite/profression level of cycling, performance gains can still be made by improving the basics.

A new study out of the University of Birmingham, (England – not Alabama) may have found another reason for the performance boost. Researchers published a paper in the Journal of Physiology that looked at the effect on cycling time trial performance in trained cyclists that simply rinsed their mouth with either a sports drink containing carbohydrates or water with added artificial sweeteners for 10 seconds before spitting out the solution.

Surprising, there was a 2-3% improvement in performance in the sports drink “swish and spit” group compared to the water and artificial sweetener group. The researchers hypothesized that there may be separate receptors in the mouth that are specific to carbohydrates. The researchers also studied the brain activity response to the different solutions and discovered that the carbohydrate solutions triggered increased activity in the part of the brain associated with pleasure and reward.

Apparently this is the same area of the brain that lights up in triathletes when the cash register drawer at B&L Bikes or Nytro opens up during a purchase. Not surprisingly, its also the same area of the brain in triathletes that leads to later targeting for elimination by upset non-triathlete spouses reviewing the monthly credit card purchases…

Looking for another way to improve your cycling performance? Check out our San Diego indoor cycling classes.

It may not be just to prevent potential caffeine withdrawal in one of the java-junkies on the ride.

Researchers at the University of Illinois have published a study in this month’s issue of the International Journal of Sport Nutrition and Exercise Metabolism looking at the effect of caffeine on muscle pain and soreness after exercise.

The researchers studied 25 healthy college students and measured the amount of quadriceps (thigh) muscle soreness after a 30 minute high intensity cycling session. The cyclists were given either no caffeine or a caffeine tablet equivalent to about 2-3 cups of coffee (5 mg caffeine/kg) 60 minutes before the exercise session. 

The interesting finding was that both students that never drank caffeine on a regular basis and those that were routine caffeine drinkers both noted a decrease in muscle soreness compared to when performing the cycling test without caffeine. This finding suggests that there may not be much habituation to chronic caffeine use.

How much of a reduction in pain was noted? 

A previous 2006 study in the journal of Pain looking at caffeine and its effects on muscle soreness after eccentric (muscle lengthening) exercises reported a 48% decrease in the level of pain reported on a 0 to 100 point scale when compared to a placebo. How does that stack up to the typical pain medicines like  naproxen (Aleve), aspirin and ibuprofen?

Use of naproxen resulted in a 30 per cent decrease in soreness, aspirin use reduced in a 25 per cent decrease and ibuprofen produced inconsistent results.

Written while sitting in a coffee shop…

-Doc John

PS – My favorite coffee shop in San Diego? Zumbar Coffee and Tea in Sorrento Valley.

What’s your favorite coffee shop for the pre and post-ride caffeine consumption?

Let us know by posting a comment.

Many news agencies are reporting on a research study  presented at the American College of Cardiology annual meeting that suggested that triathletes have a significantly higher risk of heart attacks (myocardial infarctions) while participating in a triathlon. Having had a chance to read a copy of  the presented study, the news accounts are a little misleading. The actual study looked at the incidence of sudden death in triathletes, not “heart attacks” as is being widely reported.

The study looked at reported deaths at USA Triathlon-sanctioned races over a two year period (2006 and 2007). Out of 922,810 triathletes in 2,846 triathlons there were a total of 14 deaths – roughly an incidence of  15 in 1 million participant. According to the study, 13 of these deaths occurred during the swim while the fourteenth fatality occurred due to a bike accident. Out of the 14 deaths, autopsies were performed on only 6 of the triathletes, and from that group of 6, four of the triathletes were found to have underlying heart disease. The other two autopsies reported normal hearts with no evidence of heart damage.

The lead study author commented that the cause of the fatal cardiac events may be due to coronary artery vasospasm, potentially a combination of the high intensity effort during the swim and cold water temperatures. However, its not evident if the water temperatures of the events were the fatalities occured were compared to the water temperatures at triathlons where there were no fatalities, or if the deceased triathlete’s open water or cold water swimming experience was also compared to the rest of the triathletes participating in the races during that same time.

I think that the reality is that some of the deaths are due to the “cold shock” response which is more of a respiratory problem – that gasp that you get when you jump into cold water and has been well-studied in dive medicine. For some people, they have a more severe breathing response to cold water and start gasping and lose control of their normal breathing. In the chaos of a mass triathlon start, that could result in aspiration of water and drowning without any significant cardiac involvement. Additionally, a recent study out of Penn State suggests that coronary blood flow is actually increased during cold water exposure, which would contradict the coronary vasospasm/constriction hypothesis of the triathlon heart attack researchers.

If you want to find out more about the effects of cold shock, the US Coast Guard has a great YouTube video

How does the number of triathlete fatalities compare to other sporting events? The incidence of fatal events at marathons has been estimated to be between 4 to 8 marathon runners per 1 million race participants.

Another study in the medical journal Circulation looked at the impact of training volume of marathon runners on heart function and found that runners with lower weekly running volume (less than 35 miles/wk) had a higher incidence of elevated proteins in the blood that may indicate heart muscle damage compared to marathon finishers that trained more than 45 miles/week leading up to the race.

What does the American Heart Association have to say about the risk of  heart attacks during exercise? Check out the American Heart Association Scientific Statement on Exercise and Acute Cardiovascular Events.

If you’re still looking for more information, check out this editorial in the European Heart Journal that looks more in depth at possible reasons for some of the increased cardiac events seen in marathon runners.

The Peak Performance web site also has a good review about the risk of dying from a heart attack during exercise.

What’s my take?

Any death is tragic.

The fact that someone dies during an event that promotes exercise and a healthy lifestyle (well, if reading Slowtwitch.com all day at work and worrying about the aerodynamics of the latest tri-bike to be released is considered “healthy”) doesn’t make it any less (or more) tragic.

However, the reality is that these individuals that did have cardiac events during the triathlon probably had significant cardiac disease despite their triathlon lifestyle – similar to Jim Fixx’s too early death, the author of the Complete Book of Running that many credited with kicking off the running and health revolution during the 1970′s.

While they may have shuffled off this mortal coil before their time, hopefully they enjoyed the experience beyond what they would have if they had never found triathlons.

-Doc John