Inside the Physiology of Endurance with Mike Weiss: Altitude, Iron, and Smarter Training

In this episode of the Maximum Mileage Running Podcast, I sit down with exercise physiologist Mike Weiss of Alta Health and Performance Solutions to dig into the science behind endurance performance and what it really means to train smarter.

We start by exploring Mike’s background and his specialization in environmental physiology, including how the body responds to altitude and heat. We break down what is actually happening at altitude and why it is not about less oxygen, but less pressure, and how that impacts your performance.

We also get into practical takeaways you can apply right away, like why checking your iron and ferritin levels matters for adaptation, how hydration and fueling needs shift at elevation, and what signs your body might be giving you when something is off.

Then we dive into metabolic testing, a core focus of the work Mike does at Alta Health and Performance Solutions. We talk about what it is, why it matters, and how it gives you a much more individualized and accurate picture than wearable data alone. This is the kind of information that can help you train more efficiently and reach your potential faster.

If you have ever wanted to better understand the why behind your training, this episode is for you.

How to Get in Touch with Mike Weiss

Mike Weiss is an exercise physiologist and the founder of Alta Health and Performance Solutions, where he specializes in environmental physiology and metabolic testing for endurance athletes.

To learn more about Mike and his work:
 🌐 https://www.altahps.com/about-us

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Transcript

SPEAKER_01 0:00

Welcome back to the Maximum Mileage Running Podcast, where we're not just chasing miles, we're building stronger, more resilient runners from the inside out. At Maximum Mileage, we take a whole athlete approach, blending smart training, recovery, and education so you can stay healthy, train with purpose, and keep progressing long term. In today's episode, I'm joined by exercise physiologist Michael Weiss, and we dig into the science behind endurance performance. We cover what's really happening at altitude, why things like iron levels and fueling matter more than you might think, and how metabolic testing can give you a much more accurate individualized roadmap for your training than wearables alone. Here's our conversation.

SPEAKER_00 0:45

Welcome back to the Maximum Mileage Running podcast. Today we have Michael Weiss, who is an exercise physiologist with a concentration in environmental exercise physiology. He is certified through the American College of Sports Medicine as a health fitness specialist and also holds the exercise medicine credential. Michael is, and do you prefer Michael or Mike?

SPEAKER_02 1:12

Mike is fine. Yeah.

SPEAKER_00 1:13

Okay.

SPEAKER_02 1:13

Mike is may I just make one little correction?

SPEAKER_00 1:17

Absolutely.

SPEAKER_02 1:17

Yes, my I am certified with College of Sports Medicine, but they oh some years back, five or six years ago, so they changed it. So I'm actually officially it's called an exercise, exercise physiologist certification. So certified as an exercise physiologist, even though that is my profession and my graduate degree is in, but now the their certification is called exercise physiology certified. So yeah.

SPEAKER_00 1:42

Great. And also my research, you frequently lecture on at well, actually to corporate academic and professional audiences, and you present on topics ranging from health and wellness to applied exercise science and endurance performance. So that's quite impressive. Let's just dive right in. So tell me a little bit about yourself. Like what led you to this line of work?

SPEAKER_02 2:06

Well, I actually had when I entered uh university, I went into um civil engineering. And because I've had always had a love for science and chemistry, physics, and I had a construction background, and so that worked out really well. But since the age of 10, I have been active in endurance sports. And I started running competitively when I was 10. And so it really became a lifestyle for me. And I was introduced to the mountain, mountainous environment, age age six, and and through um the my to the activity of backpacking. And and then later that developed into mountaineering and cross-country skiing. And so the mountains really became a playground for me. So then while I was in college in my civil engineering program, I I noticed that I in my off time, I was taking taking time and energy that I was expending into learning about how the body responds and adapts to to exercise. And I found it very fascinating. And so it was a field that was starting to emerge a little bit more, not just in research, but in the practical side, where universities were having majors so forth in it. And so I actually went to my advisor and I said, I'm I'm going to switch majors. And I was fortunate that the university I was in, I'm at it. And so I became an exercise physiology major. And I just went in hook, line, and sinker, and it has become a real passion of mine and uh something that I thoroughly enjoy continuing to educate myself on, do research on, to educate others and and to present in front of conferences and and community groups, private clients, and also in my roles that I've also had as a university professor. So it's yeah, very exciting for for me. And plus, as I became uh versed in in the science side of it, more so than in in the past, what I did is I've always liked since I said the mountain environment. And so in the mountain environment, you have different elements. Um, certainly altitude is is a big one, and and then heat, and much more prominent now with global warming. And so that became my concentration when I um went to grad school. And so I became an environmental exercise physiologist. That's actually my specialty. And so that marries really well with my love for the athletic side. And um, so now I can I merge the science with the athletic side and my love of being able to extend this to others. Because fundamentally, as an exercise physiologist, my goal, like it is with all exercise physiologists in one form or another, is to promote physical activity to reduce the onset and to manage the symptoms of chronic disease, such as hypertension and obesity and cardiovascular disease. And physical activity is what is a wonderful way of, well, it is a one of the primary ways, along with obviously good nutrition and sleep and so forth, of being to enhance and improve one's health, wellness, and to prevent the onset of disease. So so that here you go. A little more than just in a nutshell, but that's how it started.

SPEAKER_00 5:40

Thank you so much for that explanation. That was very helpful and informative, just kind of unpacking that a little bit. You said you were introduced to the mountain environment when you were, was it six or seven?

SPEAKER_02 5:51

Yeah, I was six years old. Yeah.

SPEAKER_00 5:52

Six years old. Okay. Where had you moved from and where did you move to? I'm assuming it was a move, right?

SPEAKER_02 5:59

So you were no, actually, it wasn't a move because I'm coming to you from the Bay Area. And so I live in the yeah, in the San Francisco Bay Area. So, but only two hours away from me is the foothills of the Sierras. And my father and I started backpacking. Well, he already was, but uh when I got to age six, that he started taking me up into the high country of the Sierras, so eight, nine thousand, ten thousand feet and above. And so that's that was my introduction to wilderness and in the Sierras, that is, and and so it became just really a a staple in in our lives every summer. And I just loved it. And so everything about it. And uh, and and so it was that that's how I got introduced to it. And and since then I've gone to other places in Europe and enjoyed the Alps and whether running or or hiking, but uh yeah, that's how it started.

SPEAKER_00 6:52

Great. So when you were six, do you remember kind of going to that higher altitude and could you feel the effects? Did were you, I guess, body aware enough that you were, oh, maybe it's harder to breathe or anything like that? Did you know what did you notice about altitude even at that young age?

SPEAKER_02 7:11

It was actually yeah, in when we also, my my dad and I, we would um do day hikes up um peaks and up mountains. And it was then that that's where I noticed it. It really wasn't so much in in the hiking side because it would have been hard to discern between am I fatigue because of the mountainous terrain that I'm covering, or is it because of the the weight in my pack upon my back, or is it the length of time? But I definitely noticed the effects of altitude when we would climb, and that was usually at altitudes above 10,000 feet. What I noticed was it was the headaches and the headaches and and sometimes nausea, and and these are very common symptoms of uh of something that's of altitude sickness, and and then there are other forms of it that are far more worse, and and but it is very common to experience headaches simply due to the lack of oxygen perfusion through the the vascular network to our brain. And our brain needs very there's two very important elements that it needs when one is oxygen and the other is a compound called glucose. So without that oxygen, yeah, we can um experience um the headaches and and and it's very it's it really removes it. Is there's a there's a word called lasitude, and lazitude, in case you don't know that means, it means a reduction in desire. And when you get headaches to that extent, it really pulls out the energy from you, the desire to continue on. And consequently, you know, I would I was young at the time, I had no idea I wanted to go into it as a field, but I recalled all these things, and so I learned ways to actually mediate the effects of the low oxygen availability. And and that was simply by expanding my thoracic cavity and allowing more air to enter into my lungs, and that um had uh marked effects in the future when when I was ascending high altitudes to um prevent the onset of those most uncomfortable headaches.

SPEAKER_00 9:26

Okay, so I guess a little bit of perhaps a little misinformation in the endurance community is trying to understand if altitude is causing a kind of concentration in partial press, I'm sorry, partial pressure of oxygen versus lack of oxygen. Can you explain? You did a good job of explaining obviously what's going on in altitude, but on a I guess more physiological scale. Is it because of a pressure difference, or is there simply not as many oxygen molecules in the air at a higher altitude?

SPEAKER_02 10:05

It is the the former, and and it the there is a lack of pressure, and you have to have enough tension built up within the um uh the alveoli of the lungs to provide the transmission of the oxygen, and this is known as diffusion. Perfusion is the transport, and defusion is going across the membrane and the alveoli of the air sacs in the lungs. So, and this is it's an interesting thing, and I'm glad that you brought it up because many people will say, Oh, well, there's less air, less oxygen at altitude, that's the problem. And well, the earth has our air that we breathe is primarily nitrogen, about 79% of it. And about 20.9% is oxygen, and less than 1%, actually, about 0.3 percent is is carbon dioxide. So a very small amount um uh is carbon dioxide, and but with the oxygen, with the you will have the same percentage of oxygen will be experienced at the top of Mount Everest as it is at sea level. So the percentage does not change, but what happens is the density, so that is how compact those atoms are, those molecules in the air, become as you descend towards sea level. And that's because the Earth's gravitational field. And simply if you can imagine a column, a huge column of air going up into the stratosphere. Well, as you at the very bottom level at the surface of the earth, it's carrying that weight, so to speak, of all above. And so gravity pulls those molecules together and makes them more compact, and hence it increases the density and is reflected in the barometric pressure. So as we descend, the barometric pressure goes up, ascend, it goes down. Well, if you can imagine, say, in a box, let's just say a box has a square foot, and you have all these molecules inside there. Well, as the pressure increases because you're descending in altitude, those molecules of oxygen, and I'm actually saying molecule because it occurs in a diatomic state, which means O2, they come together closer and closer and closer and closer. And so as they do that, their random molecular action causes uh increase of pressure on the walls of the container. And so that pressure, if it's in our body, equates to being able to pass through the membrane in our alveoli. And that is known as diffusion pressure. And so that will, when you have a higher pressure, then you can have an exchange of gases, carbon dioxide and oxygen, easier. And so then it can then get into our bloodstream, into our pulmonary network, and then into our systemic network, and then eventually travel to our muscles. And that's a big benefit of being at lower altitude. At higher altitude, you don't have that same pressure. And this is an analogy that I've used with my students, and I think I'm gonna use this with you now here, too. If you could imagine a cylinder, a cylinder, and then above that cylinder, you have a piston, and and then inside is just air. Well, as you push that piston down, you're not creating any more molecules of oxygen. It's whatever is in there is in there, but you're smashing them, you're getting them closer and closer and closer together as you drive that piston down. And if you were to put a gauge on that cylinder, you would see that needle would deflect towards greater pressure as you descend, push that piston down. And that greater pressure is what drives that ability for the oxygen to move across the membrane, which is happening as you descend and get closer to sea level. So bottom line is is there more oxygen at sea level than there is at Everest? No. It's percentage-wise the same, it's just the space is larger, so the diffusion pressure is less, and so our body has a harder time of getting that oxygen eventually to our muscles to generate ATP for energy or to our brain to keep it functioning correctly.

SPEAKER_00 14:27

Interesting. I really appreciate the scientific explanation. I I'm curious about the genetic component that some individuals are able to adapt better when they do altitude training versus some athletes, they don't have as much effect, I guess. And I I'm curious is with your education, with your understanding, just with your line of work, have you found that kind of trend with genetics being indicative of whether people are going to benefit more from altitude training or not?

SPEAKER_02 15:04

Um, good question again. And and yes, um, there is a genetic component to it. There are some people that have um a bit they're they're better able to moderate the the pH, the acid base level in their in their blood. And that can have a a market effect on the health of their system, their ability to not upset what we call homeostasis, that balance to any degree that would be performance limiting. And and so, and also with there's the component of how much hemoglobin they have in their body. And so hemoglobin is a molecule that is the primary oxygen carrying component of the body, it's attached to our red blood cells. So if you look at it in terms of, you know, there's what we call interindividual variability, and that means basically that that from one person to the next, there could be variations in that. And with an increase in hemoglobin, then our oxygen carrying capacities increase because we have more of these like little shuttles, if you want to think about it, they're all carrying that oxygen through. And reference to gender, because men have the androgen testosterone at a higher level than females do, um, it also reflects in their hemoglobin content. And so normally you're gonna have women might be between about 12 and 15 grams of hemoglobin per per deciliter, but with uh men, it could be maybe in that maybe 13 to 16 or 15 to 18. So they have a little bit more in that, and so that would be uh an advantage that way for men, just simply because of that. But women also have testosterone, much lower amounts, so it also so there's variations in that. So the it it it you know, and we know that um there are individuals, for example, who have climbed Everest without oxygen uh support, no oxygen bottles whatsoever, and they have not demonstrated the signs, the symptoms of high altitude uh sickness, or which it's called AMS, which is when I was going back to before about when I had nausea, I had it. That stands for acute mountain sickness. And um that is uh relatively harmless in the sense that it's more or less temporary discomfort, but it can escalate in something called HAP, um high altitude pulmonary edema, and then haste, which is high altitude cerebral edema. And so there are individuals who've managed to go all the way to the top of altitude, uh top of Everest and other high mountains without that issue. So that's where the into individual variability comes in.

SPEAKER_00 17:53

Would you say that to kind of make this more applicable to runners in our audience? Not that I love the science, like I can listen to that, talk about that all day long, but for our running audience who they've signed up for their for their first ultra marathon at a higher altitude location, and do you think that beforehand it would be conducive to bettering their performance to have their hemoglobin check, to have their pH ability to you know keep a homeostatic level for their blood and other you know fluids within their bodies? Is that a good thing for them to do before they just set out for an ultramarathon at a higher altitude?

SPEAKER_02 18:39

I've attended many um conferences on high altitude, and one of them that I've gone to in Boulder, Colorado, and this is with in conjunction with the Olympic Training Center there, it is it is conclusive that that within the coaching, the training community that is science-backed, that they first, when they are taking an athlete to altitude, they need to have that athlete uh have a blood a blood test to determine their ferritin levels. And that's very important because ferritin is is a form of iron. That's what we're talking about here, and iron is bound to uh your red blood cells. And in the hemoglobin, you have four polypeptide chains, and you also have four iron molecules bound to that iron is oxygen. So individuals have low iron, then their ability then to make that those adaptations with an altitude, altitude sessions is going to be repressed. And and so this is why, yeah, it's important to be able to get that iron level up there. So it it this could simply be handled by looking at first person's diet, you know. You know, your iron one of the very good source of iron, of course, is um your meat products. Legumes also have a good source of it, and and and so does fish and and green leafy vegetables are also another source. But the important thing is get the iron up there. If necessary, you take supplements, and that can help get it up there. This way, they're gonna get the biggest bang for their buck and of at altitude. And and somebody, you know, and there are some people who just yeah, they just don't respond positively towards that. So it's not a guarantee ever that altitude camps and altitude training will work. But that would be, I would say, a definite thing. Get the peritone levels checked, hemoglobin checked, and and this then could be modified with good diet if there's an issue, or there could be something you know more serious, more medical there. And so it's a good thing then to have that that looked upon. And um another thing would be along the way, if we're looking at at we call humoral factors, blood, we'll be looking at their vitamin B12, because vitamin B12 supports neural neural health, memory, but it also supports uh the development of uh red blood cells and vitamin B3, which is niacin, also helps your whole blood components. So your red blood cells, white, your leukocytes platelets. So, yeah, very important to look at those things first.

SPEAKER_00 21:13

I was anemic in college, and it literally felt like I was running with cement blocks strapped to my feet. And I never had that sensation before, but I remember that it was not immediate to the doctor to test for ferritin. So even now, when you when you get a blood plant blood panel, it's so important to ask specifically, will you test my ferritin? Because they'll test for red blood cell count, natocrit, white blood cells, obviously, but not necessarily ferritin, which is odd to me. And I'm glad that you mentioned that if somebody does come back with low iron levels and they're athletic, they're they may not necessarily be a runner, but they're an athlete. It's not always as straightforward as, oh, you're a runner, you're an athlete, you have low iron. That's you know, that's typical. There can be other, you know, diseases and things that cause anemia. You know, something interesting that I I read a while back was hemolytic anemia that's caused by the literal pounding of your foot on pavement and red blood cells being destroyed, basically. So have you, do you have any experience about hemolytic anemia or other kind of sources of anemia that people may not immediately associate with the typical low ferritin blood panel?

SPEAKER_02 22:42

Anemia can, yeah, can be uh the origins of it can be varied. There's temporary anemia, and which that may not be a recognized phrase in the medical industry, but I call it temporary anemia because this would then relate to to women during their menstrual period. They're gonna have a loss of blood, but blood, there it goes, you know, your oxygen carrying capacity, your red blood cells, and hemoglobin. So that's a time that I'm sure most women, especially women that are in during that period of their life and have are involved in endurance type of activities, they're gonna feel a bit more fatigued. So there's that type. There's also anemia that is known as pernicious anemia. And pernicious anemia is the I mean, this is where the importance of vitamin B12 comes in, is that there's the that's the in inside the stomach, you have something called the intrinsic factor, which is necessary to help room to move oxygen, vitamin B12 into your into your to your intestinal tract. But if you don't have this thing called the intrinsic factor, that's it has an inability for um this process to occur. And so this is known as pernicious anemia. There's also dietary anemia, too, the induced anemia, because simply a person may not have enough vitamin B12 in you know in their their diet. There's also Crohn's disease and celiac disease that also can be a responsible agent in the reduction of uh vitamin B12 and be able to be transmitted through the intestinal tract. So, you know, how would one know this? They're not going to know this unless they have a blood test. And and I I believe that it is a responsible thing to do, first of all, for one's health, to have a blood test once a year, because you never know. It's like if you you know, with your car, you you don't know, you know, you bring it in to have your annual your maintenance check, whatever, and you don't know until you get in there and you do some investigation. But it's always easier to address an an issue when it's early on than it is when it's gone into late stages. So and it could be oh, another form is for individuals who have had like bariatric surgery and who've had issues um who have had their stomach surgeries done, and uh that also can affect B12 from doing its job being transmitted. So yeah, this is all important reasons to go ahead and to to have a blood draw and to ask your doctor to make sure you're at your B12, your ferritin levels of B3, niacin are checked, especially if one is engaging in endurance sports.

SPEAKER_00 25:21

I appreciate that you gave a very well-rounded answer in saying, you know, you can't really look at one particular level in isolation. And as runners, we like to self-diagnose and self-medicate by looking on Google. Oh, I have this low B12, so I have to do I have to ingest this or take B12 supplement. And you know, different vitamins and minerals in the body work together in conjunction in various ways, and getting to the root of it, having a medical diagnosis so that you know exactly what's going on, so that you don't make something worse. You know, you can you can actually take too much iron and it can be stored in your organs, and that's not good at all. So we don't want that to happen.

SPEAKER_02 26:07

But most definitely, yeah. And that's you know, just quickly I'll just say that it's we we need to to as human beings assess our knowledge and where we are skilled, and to not uh go over and go above and beyond it, whether it's because out of convenience or pride, or because yes, we just want answers now. We we don't know until you have the data to support the type of decisions that you're going to make. And so, unless as a scientist, you know, we that's what we do. We we we look for data and we look for it to be um derived from sound scientific practices. Then we can go ahead and examine that and see where do we go from here? But you can't look at somebody like a book, like the old saying, you can't tell a book by its cover.

SPEAKER_00 26:56

Sure.

SPEAKER_02 26:56

And and that's the same thing with our blood. You gotta take an assessment.

SPEAKER_00 27:01

Right. For athletes who, you know, they don't they don't want to they they want to stay within their scope, right? And the best thing that athletes can do that I try to educate my athletes on is self-awareness and noticing trends for perhaps an athlete who you know may be unsure of whether they're anemic, something like that is going on. What key things would you advise an athlete to look for within themselves to warrant, hey, I need to get a blood test, even though they should be getting one annually, like you said, but what signs of how they're feeling would you say, yeah, you should probably get a blood blood test based on XYZ?

SPEAKER_02 27:46

Well, I would say, first of all, if if they notice fatigue, probably fatigue would be the biggest thing. Earlier onset to fatigue, doing a comparison contrast of say similar um workout sessions that they've had, and finding that they're fatiguing um earlier than what they did in the past or at a higher level. And I'm sure you're familiar with the RPE scale, a rating of perceived exertion. So if they were to do an assessment based on their RPE, if they find that that has um escalated the the number of value they place on a on a workout and they have no reason to really uh answer to um describe why it might be that way, to explain it, then that could be a reason. Discoloration in their um in their skin. If they find that their skin is a little bit more pale, that could be indicative of reduced perfusion of blood. And that's why, for example, when we're in hot environments, it's not abnormal. It is very normal, in fact, to have our faces and our hands extremities to be more red than in non-hot periods because there's a lot of perfusion of blood to help we call conductive heat transfer and convective heat transfer to uh radiate um the heat away. So you want to have that blood there. So if they're if your color seems off, that could be indicative of uh something that they would need to go in and have checked. If they find that their little uh say scrapes and abrasions on their skin is not healing as quickly as it should, that could be indicative of something within their blood. Or if they seem to be bleeding where they get scar easily, that could be something. So those those you know kind of symptoms, you know, I would say that would would warrant going in and and and having you know blood looked at. And yeah, and and yeah, I would say those are those probably are the most immediate ones that I I would say uh come up with that could be telltale that something might not be normal.

SPEAKER_00 29:59

Interesting. Okay, you know, talking about blood levels a little bit more. I maybe two years ago, I had my liver enzymes were elevated, and the nurse was concerned that I had, and I'm probably going to butcher this term, but I think it was rhabdomyel rhabdomyelotin. I can't say it.

SPEAKER_02 30:19

You're very cool.

SPEAKER_00 30:20

I'll give you negative myolysis, is that right?

SPEAKER_02 30:23

There you go.

SPEAKER_00 30:24

Lysis means right. So, you know, I I had just done a training session and then I went to go and get the blood work done because I, you know, an athlete, you have to try and fit things together. But for her to try to say I didn't think that they were that elevated, but I'm not a doctor. But what have you seen in regard to that? Even though I can't pronounce it, it is a term that gets thrown up thrown around a little bit more. So I guess for people who've completed marathons have heavy tissue damage. Can you explain a little bit more about what's happening with that condition?

SPEAKER_02 31:03

It's the it it relates to a dysfunction within the kidneys that can be induced by a loss of water or insufficient water content. And it's the breaking down of a muscle fiber and in an abnormal way. And the inside muscle fiber, there's another oxygen-carrying molecule called myoglobin. And myo stands for muscle, and and globin is is referring to the the oxygen-carrying component here of that molecule. And it the myofers will actually they start to break down, and so that is the myoglobin is released into which provides also the the pigment of your skin and of the of the blood, and so it's the red blood cell. Muscle that is highly aerobic is more reddish color, but the fibers break down, and then that gets into because of the renal dysfunction, you have a greater concentration of that in your urine, and so it can be excreted. Um, and this is one of the telltale signs is that the blood is is tainted red, noticeably red, almost like a Coca-Cola, Coca-Cola color.

SPEAKER_00 32:23

Interesting. That do you find that having elevated? I'm assuming maybe it's kidney enzymes versus liver. I think I might have gotten that confused. Maybe it's both. But when athletes have elevated enzymes like that, is that part of training or is that actually dangerous and something that's medically concerning?

SPEAKER_02 32:46

That's a question I can't answer. I don't know on the elevated enzymes. I think it it definitely warrants you know medical investigation and to see why. But yeah, I have not, as far as raptomyelysis is concerned, I I have not seen any any research that says that it is there is a it's associated with a condition prior to a you know precondition of having elevated enzymes. So yeah, it's it is something that um that it usually it's it's brought on by that combination of um of dehydration with the excessive toll that the kidneys are being subjected to when they don't have when they have this inadequate water flow of going through them.

SPEAKER_00 33:36

I I would think that that condition would be exacerbated by being at a high altitude, just because typically athletes tend to urinate more to kind of level out their blood concentration when they're at higher alt higher altitude, which to me, if you're exerting yourself much more, that in combination with being at high altitude, like I said, urinating more, that would lead to that being worse. But you know, so many endurance races take place, like you said, in Europe, high altitude, high altitude, the Pacific Northwest, and even here in the where I am in the kind of southeast, or some higher mountains. I'm at 5,000 feet elevation, but that's moderate. But so athletes perhaps they have a little bit more to consider in terms of really looking after themselves when they're racing such races. And it's you know, it's not just oh, I need to eat and oh, I need to drink water. Like, what can they do to put themselves in the best position possible to stay out of the red zone when they're at high altitudes and they're racing?

SPEAKER_02 34:45

Well, and this is regarding competing and trading in in mountainous areas, correct? Yeah, yeah. First of all, yeah, you you you you uh highlight an important point at altitude, because of of the lower barometric pressure that exists and the physics behind low density air, the vapor pressure is such that you don't have as much of the water content in the air is less. And this is the same whether it's in uh warm air or cold air, overall your relative humidity is going to be less. And because of that, there is a greater greater toll on the body in terms of retaining water. And we lose water, you know, primarily when we're the most number one means of heat transfer when we are exercising and is through we call evaporative heat transfer, it's our sweat that is evaporating. But we also lose water through respiration, ventilation, that water comes off of um our upper throat respiratory tract through from our lungs, and also what we call transpiration, which is moisture that just comes off of our skin. And I just use the analogy that if you were to take a piece of um plastic wrap that you would put around your food and you put it over your skin, you would see that in in due time, especially in in in when you're at comfortable temperatures, a little bit of moisture building up underneath that. And that's transpiration. And so this is all goes into factors in at high altitude. There is going to be a greater, a greater loss of water. And so then there is the water that, of course, we're losing from sweat and sweat and water that is necessary for metabolic processes to take place. And we also we lose some of that water in our bloodstream from two different ways. One is called osmotic uh pressure because there's an increase of um uh metabolic byproducts that build up inside the muscle and it changes our osmotic pressure. And so we lose water, goes in more and towards the muscle cell during exercise. And we also we're losing it because of hydrostatic pressure, which is increase of blood pressure, use more water that's leaking into our endstitial fluid. So the bottom line is there's a greater toll of water loss at altitude. So, what we what an athlete should do is they should make a more concerted effort, um, really be mindful of getting their water in their in their body and it to almost really to have a regimen instead of just say, Well, I'm gonna I'm gonna drink uh since at the same level that I do that at lower altitude, is to say, okay, I want to go ahead and increase that. Maybe they have a frequency, which is I often do. I'll I'll look at you know, every 10 minutes I take a swig of water from my bottle. And then at altitude, I might say, okay, I'm gonna take that same swig every five minutes. And then and it doesn't have to be a lot, just enough to keep the inside of your mouth, you know, wet. And so this way it becomes a habit and you get that water in. Be mindful of their the color of their urine. I mean, if it is a higher, more intense color of yellow, then that means that that they're probably their their you know their water loss is greater and they need to hydrate a little bit more. It doesn't have to be clear. That's what some people say, oh, I got to get as clear as possible. No, lemonade is is pretty much the the look that we look for there, light yellow. And then also something is important too is glucose, is your simple sugars. Because because there is a lower amount of oxygen availability, the body is going to want to metabolize, put a greater emphasis on carbohydrate metabolism, whether it's oxidative or non-oxidative. And that's the nice thing about glycolysis, is that which is the metabolism of carbohydrate, you can do it with oxygen or without. But at high altitude, because there is less, there's going to be even a less of ability to oxidize lipids, fats, which is what endurance athletes want to do because we practically have an endless supply of fat in subdermal, intramuscular fat, cutaneous fat. So increase your consumption of glucose. So simple sugars. So whatever that might come in, come in your gels, your chews, your drinks, what have you. But that will, that's another great way of keeping the energy levels up to reduce that that onset and and potentially premature onset of fatigue.

SPEAKER_00 39:25

Great. Thank you for that explanation. That's really helpful. You also do a lot of work with heat training, right? Heat adaptation. Can you explain how heat and altitude are different? Maybe how they're similar to it's specifically, okay.

SPEAKER_02 39:44

What was that again? How heat and altitude, what was that?

SPEAKER_00 39:47

When athletes, it's often said heat training is kind of poor man's altitude, right? Most people can they can in some way engineer heat training within their you know their life because perhaps they're not at a high altitude and they don't have you know a hyperbaric chamber to sleep in. So how hypobaric actually, yeah. So how how are altitude training and heat training alike and different?

SPEAKER_02 40:15

Okay, I see what you're saying. Yes. Yes, with with heat, when we when we get initially exposed to exercising and heat, because there is uh a greater sweat output to cool the body, then what happens is is the the blood volume, the blood volume is is break it up into components. One is plasma, which is about 90 percent of our of our body, and then within of the blood volume, and then within that, about seven percent is is uh made up of of uh components such as your nutrients and enzymes, hormones, things like that. And and then about about um excuse me, I said okay, 90% is is is water. You know, we have our in our blood, we have something called the hematic hematocrit. And so about 55-60 percent of that is gonna be made up of your plasma, and about 30, 40, 45 percent is made up of your whole blood components. So red blood cells, white blood cells, leukocytes, uh, white platelets. So what happens is that when we increase our our sweat, a lot of that, since most of our our blood is made up of plasma, we and since most of the plasma is water, about 90% of that, we're going to be losing a lot of the water, which is going to change the hematocrit percentage. And so our blood becomes more, a little bit more thick and more viscous. And there's actually there's a term for it we call it hemoconcentration. So the red blood cells are a little bit more concentrated, which can have a good and bad effect. Good effect is that they can there more, there's a greater amount of them per unit space available for what's known as oxidative phosphorylation, breaking down our our glucose or our lipids with oxygen. But the bad side is because the blood becomes more thick, uh viscous, it flows slower. Flows slower, and so it can't deliver, depending on the intensity of the activity and the amount of oxygen that's required for oxidative phosphorylation, uh, there may not be enough time for it to develop and to metabolize the lipid. So our body is going to switch more towards glucose, which is why, especially now at altitude, you're having a reduction of um of available of air because the perfusion of oxygen is less, and you're losing water because there is a higher degree of evaporation at altitude, then your body's going to want to have more of that that glucose. Okay. So now with the which is why that at altitude, in our training, we tried to go ahead and to increase our red blood cells. And that is a natural adaptation to altitude, is you will increase your red blood cell concentration. And so that is because the body is sensing that there is less oxygen, and so in a protein molecule based molecule called erythropoietin hormone, produced by our kidneys, uh, is increased. And this is a process called erythropoiesis, and it makes more red blood cells. But with uh with heat, uh what happens there when we were losing that water our hematocrit is going to change and so we have in and it's the the the ratio will change in such a way that with low plasma we're getting actually a a higher level um of our of our uh uh hematocrit level and percentage wise so by doing heat training what it will do is it's gonna try to adjust this it we have to increase the the because it's the body that is a thicker thicker solution more viscous your your the availability of the oxygen is not going to be as as great and at the blood cell level and so what it tries to do then is it well increase the the red blood cell uh production to try to compensate for what is being lost in with with the the loss of water to the the heat training and and so but your body though with heat training you can within seven days approximately increase your blood plasma level and to help restore that hematocrit to more typical levels 45 48 percent um roughly and and so there's a thing called pseudoanemia which means that it appears that a person can be low in red blood cells with heat training and and it's only because their plasma levels have increased to a greater degree and and and incidentally hematocrites a ratio between taking the whole like your whole blood components divided by your plasma. And so but if you is a plasma level increases due to heat training which is the denominator of the ratio the whole ratio is going to drop and it can give the the the suggest that a person is anemic when they're really not but the body will start to adjust it will readjust it in time and so that means in the numerator where the whole blood components are if the red blood cells will adapt to this an environment and will start to increase and and then it will return that hematocrit level to more typical values. So this is then a benefit this is a way that one can um absent of a hypobaric chamber or going to which is at normoxia which we call normal barometric pressure as a or going to a high hypo hypoxic environment which is above a low blood low barometric pressure which is a high altitude you can eliminate both of those and you could stay at at sea level um pressures if you want and do heat training and there will be an increase in time of red blood cells. If somebody does heat training like you like you said and they have a race at that altitude do you you think adaptation from their heat training would then be very applicable to that environment would they be better off it seems like the physiological setup is similar so I would assume that heat training would transfer to being able to handle the higher altitude what do you think I would agree with you in theory yes it should I don't have any raw data in front of me that I can report on the efficacy of heat training relative to high altitude but certainly within my research on it I mean altitude training is is the best way to go ahead and increase your blood cell count to him so you increase your oxygen availability but you can get you know um a a positive development in oxygen carrying capacity which will then you know help with the reduction in in generating lactate earlier on in your in in in your the intensity of your run and and so your oxygen capacity if you look at which is known as VO2 your VO2 is going to be suppressed at altitude because of that reduction in oxygen availability. So if you can increase your blood blood cell count uh thus enhancing oxygen availability to the muscle cell it should have a positive effect on being able to defend against low oxygen availability that is at altitude and hence bottom line there there should be a positive effect to it and and now of course it also depends on what the altitude is the higher you go the more the demand will be but if you were to look at say an RPE level you know radiant perceived exertion again a person who's going to be doing a race at um eight nine thousand feet and who has done altitude training you know if we could set this up kind of a of a you know a a an experiment that is um kind of a you know a mind thinking experiment not an actual practical experiment but if we did a before and after I would imagine that individual who had the heat training would do better at that 78,000 feet. They might find themselves at an RP level of say seven whereas the person who didn't do the heat training they might be at an eight or a nine on an RPE scale so definitely would say if you have if you have the the hot weather available to you then take advantage of it when you know you're going to be competing at altitude.

SPEAKER_00 49:47

For an athlete who is traveling to a high altitude race or if they're traveling to a really hot race would you say that and it you know the answer might be different for either of those but would you say that it's better for the athlete to arrive like the day before the race or should they arrive perhaps a few days a week two weeks before so that they can adapt somewhat is the body almost I guess in shock if you just get there and race so it the physiological effects perhaps aren't as severe or what does that kind of timeline look like?

SPEAKER_02 50:28

Yeah good questions on there if the athlete has only a few days prior to arriving at altitude I would suggest to arrive if possible the morning of their event difficult I know if you're doing hundred milers 100 K's because they often start at five in the morning but and the reason I say that is because one of the a very typical problem complaint that people have when they go to altitude is that the experience interrupted sleep. So there then in you know in this period prior to a race you know we go through different recovery and muscle restoration different kind of elements that we apply towards getting ourselves race ready. A real simple one and very and but one that we simply cannot ignore is being well rested for race time and especially with these long events. So I would not challenge one's self to having to be in race ready by coming there a day or two a day before or even the two days before because there's a good chance that they their sleep pattern is going to be interrupted. So if they can move that to say a week five days or so prior to all the better. I know that you know practical practicality with and reasons and sometimes you know life work and whatnot we can't always do that. But if we can get four or five days prior to then hopefully our sleep pattern will be adjusted. So by the time the night before then our race we will be in we'll have more you know substantial and and and concentrated and uninterrupted sleep even more quality sleep. Yeah and that's yeah that would be the big thing. And plus during that time if we're there oh four or five days in advance we can also get used to the have our body get used to a little bit of the lower oxygen levels and so if we do have any type of just discomfort in in the lays that might build up initially upon arrival there we've had a chance with good sleep with nutrition with getting ourselves hydrated that we can meter some of these things out so we'll be in a better position come race morning.

SPEAKER_00 53:04

Great thank you so much for all this information it's been really informative and I think illuminating to help athletes kind of figure out what blood levels they should be aware of, keep an eye on practice self-awareness during their training to keep to make sure that they are not getting into anemia or any other conditions. And also I appreciate your thoughts on the what's going on internally with altitude training and heat training and how athletes can combat those things through arriving at strategic times. That's really helpful. I appreciate so much your time today are there is there anything else that you would like to discuss in terms of how athletes you know if you you work with athletes and how you can help them like I would like to know exactly how athletes can reach out to you if they would like more information.

SPEAKER_02 54:03

Certainly I think you do have yeah my my email contact right there phone of course website I'm redoing it so I'm not even sure if it's up right now but but there's that but certainly email and I do respond in a a a a time efficient manner and exercise my respect towards those who want to reach out to me to to get back to them. And so I'd be yeah more than happy to reach out that way and and of course you know for anybody that that is interested in in doing testing which yeah we didn't even address but that is you know an area that's my my business that I do and and and if they want to have more information on the reasons why what is good about testing and should I do this and what can I expect from it? How often should I get tested? And what does it involve how long is the test? All those kind of questions I would be more than happy to entertain. And certainly you know as an educator you know when I'm in my professional role it's um it really is meaningful and purposeful for me is is to educate the public, educate you know my demographic on you know the science backed information here to help them not to to to help them realize their potential but also not be wasting their time and money and resources on things that are not going to you know assist them in their journey. And so I like to uh dispel some of the myths out there and give them solid information. So it'd be my pleasure for your any of your listeners if they want to reach out to me I'd be more than happy yeah to uh be available for them. And I would if if you don't mind I would like to add one thing here that's a little bit off from what we've been talking about so far but it was in regard of the exercise testing. And there's lots of reasons why and we could leave this for another conversation if you if you like but one thing for sure is that what can an exercise physiologist do for you in testing is and that is um with the advent of the high technology that exists advanced technology in wearable electronics and I'll tell you right now I I love my garment and um so in fact I have two of them that I I have and this is what exercise testing can do for you that that our smartwatches cannot and that these are built or the watches are built and they provide information a lot of information but it's an algorithm most of it is an algorithm and it takes a lot of information your gender your age your weight sometimes even look at at one's race your prof your history of your athletics and it tries to come up with figures and for the most part they're not that far off but it's not going to be what a metabolic test or a test car cardio pulmonary exercise test where they can do that's the money when you put the mask on because those tests are athlete specific. It's providing the blueprint for you the athlete and just as much as I tell people who has that line configuration on your thumb there's only one person in the world who has that and that's you. And this is what the testing can do athlete specific and what we do is we identify your thresholds the thresholds then are used to be able to determine what your training zones are. And then this is what either the athlete or the coach trainer then will take and will be able to then design that training program around what the testing uncovered as far as those thresholds. And that way the athlete instead of going on this bumpy road to get to where they want to go which might extend for many many months or years they can accelerate that pathway so much quicker towards their potential because it's athlete specific of information. So nothing against the watches but we need to be careful of what they can do what they can't do. And just as much as I said in the beginning we have to remember what our skill levels, what our education is and not go beyond those boundaries and we want to do ourselves or anybody else good. And so we go to the people who have that information or we go to the technology that has that so that's something because I know you asked about what exercise physiology what testing is all about and and why one should when we could benefit from it. And so I just I just want people to and to know that about about the watches. Good to have I mean I use as a training device because it can provide that heart rate and that heart rate is what I use to juxtapose you know against the training zones to determine if where I need to be but the training zones came from that hard data that came from the metabolic testing. So just wanted to bring that out there for your listeners.

SPEAKER_00 59:06

Oh thank you so much that that would be an excellent follow-up conversation to go more into metabolic testing and how zones and everything you know what's different between testing somebody actually in person versus relying on a watch's algorithm to determine what zones they may be and what discrepancy there may exist and what's the value in in both. So I appreciate you bringing that up and yeah we'll have to put a date on the calendar for a follow up conversation but thank you so much Mike I really appreciate your time today and you've given the listeners a lot to consider. Thank you.

SPEAKER_02 59:44

The pleasure is mine. Thank you for giving me the honor to enlighten and to educate and hopefully inspire your listeners