Transcript of Interview with Phil Skiba: When Math Meets Sports Performance

This is a transcript of the video interview titled "Phil Skiba: When Math Meets Sports Performance."

00:00:37       Q:   Hi, welcome to Inside Science Conversations. I'm Chris Gorski, the Senior Editor at Inside Science, a website produced by the American Institute of Physics. I studied geology in college and then science filmmaking in graduate school, before working in cable television and coming to the AIP to work on a science news video program. Soon after I got here I started writing news stories and I was hooked. I was given the privilege to talk to scientists about, you know, really fantastic discoveries and new thought and got to break my brain over and over again.

00:01:22       But something was missing. And it was the chance to figure out who these people are and why they do what they do. And that’s what this show is about. For our first episode we have Dr. Phil Skiba joining us. He works in sport medicine with two Chicago area hospital systems. He’s been a coach. He’s worked with top athletes. He’s also worked at the frontline fighting the Coronavirus and more recently with athletes who are trying to recover from long Covid. Phil, welcome to Inside Science Conversations.

00:01:54       A:   Well, thanks for having me.

00:01:55       Q:   Looking forward to talking to you, you know, as a doctor and a sports physiologist, a general expert on these thing s it’s really exciting to get a chance to talk to you. So just wanted to kind of ask when you were like 10 or 12 years old what did you think you were going to be when you grew up?

00:02:13       A:   I was going to be an astronaut.

00:02:14       Q:   Wow. Okay. How long did you go for that?

00:02:18       A:   I mean, for a good long time. The main challenge was that I'm both too tall to fly fighter aircraft and too blind. So in the late 80s, early 90s I was told in no uncertain terms that this future was not for me. And, in fact, think a couple of years ago I applied again to the space program and it turns out that I'm also too tall for a space suit. You got to be under six three. So this was not for me.

00:02:55       Q:   That’s funny. I remember having a little bit of that experience as well where they were like we do need you to have a certain kind of vision and I just went oh, deflated. So was the doctor the next thing? Or was there something else?

00:03:08       A;   You know I mean I always liked science. It was really growing up it was kind of my thing. But as I got through my education it’s funny I ended not thinking I was particularly good at math, because I didn’t have any particularly good teachers until I was really a senior in high school and I had a great pre-calculus teacher and all of a sudden the penny kind of dropped. I went away to college as a biology major and you know I started taking things like physics and calculus and I was, you know, I was crushing them, you know, and my grades were getting sent home and my father was looking at me, my father is really a talented mathematician and he was like who are you, what did you do with my son kind of thing, you know?

00:03:51       That’s kind of the problem, right, is that a lot of things in American education are taught by memorization. And that’s not how I work. I have to understand something. And so my pre-calc teacher taught things in terms of physics. Here’s a problem, you’ve got this bowling ball you’re going to drop off the roof, you know, and how are you going to figure out how long it takes to get to the ground? And when you put it in those terms, oh, that’s easy to figure out versus giving me a bunch of things I'm supposed to memorize, you know. That wasn’t for me.

00:04:19       Q:   Wow, yeah, teachers make all the difference, right?

00:04:22       A:   Yeah, absolutely.

00:04:23       Q:   So you had math going and then you also had an interest in medicine?

00:04:27       A:   Yeah, you know. When I first came out of college I also started out, I come from a family of dentists and so when I first got out of college I went into a program in New Jersey where I would get my dental degree and I would get my PhD in microbiology. And it took me just a few months to realize that dentistry really wasn’t for me. So I began working towards my PhD.

00:04:47       And then within just about a year of getting started I had a cancer scare and so I had to go through this process of surgery and meeting all these doctors and stuff. And I very quickly realized that there’s a lot of really just crummy doctors in the world and I was like I can do this better. And so I applied to medical school, which maybe not surprisingly didn’t go particularly well at first, because you know I'm going on these interviews and these guys are saying to me, you went to dental school and you didn’t like that and you’re leaving your PhD program, how do we know if we let you into medical school that you’re going to stay?

00:05:22       And I was like it’s kind of this or the priesthood at this point so, you know, give me a break and, you know, no one thought that was particularly funny. So I was just getting wait listed a lot of places, so no one thought that was particularly funny. So I was just getting wait listed a lot of places and I'm thinking, oh, man, I'm in trouble. And then I had the very good fortune, I interviewed a medical school in Missouri and I was being interviewed by this guy named Max Gutensohn who was the Dean Emeritus of the school and he was older than dirt at the time, I mean, I think he was in his mid-80s at least.

00:05:50       So he’s adjusting his hearing aids and he asked me the one question no one had asked, which was, you know, when did you first think about medicine as a career? So I told him that my grandad was Charlie Mayo of the Mayo Clinic’s surgical tech during World War Two in the South Pacific. And so I said, you know, I had heard these incredible stories about operating with Dr. Mayo and all these kinds of things. And Dr. Gutensohn’s eyes like light up. He was from Minnesota. He goes Charlie Mayo, he goes, I knew Charlie Mayo. He was a hell of a guy, your grandad worked for him, you’re working for me, you’re coming to Missouri.

00:06:24       And I went no fooling, right? And so I leave at the end of my interview and I get this phone call at the hotel just like an hour later and they said you’re Mr. Skiba, Dr. Gutensohn’s not taking no for an answer. If we gave you the papers would you just sign today? And that’s how I got into medical school.

00:06:44       Q:   Holy moly. That’s something else.

00:06:47       A:   Yeah, you know. It’s pretty surreal when you think about it.

00:06:53       Q:   Was he your kind of advisor through things? Or was that …

00:06:57       A:   You know, in the beginning he was a little bit of a mentor, you know, because he always wanted to kind of check up on me, you know, and see how I was doing. And he gave me a lot of, you know, he was so old, he really wasn’t practicing medicine anymore, but he would still do social rounds at the hospital, because he knew everybody in town. But one of the most important pieces of advice he ever gave me, he said, Dr. Skiba, in the first two minutes you meet a patient you have two important decisions to make and they’re going to guide the rest of your treatment plan is the patient sick or not sick and is the patient crazy or not crazy, which is a little bit of a, I mean, he was a country boy, so it was a little bit of a harsh way of putting it.

00:07:38       But it’s true in a way, because people often look at mental health and physical health as though they’re separate things when they’re really dimensions of the same thing and so if you’re dealing with someone who both has some physical illness and has some element of mental illness and cannot necessarily relate to you, you know, exactly what’s going on with them or they can’t be a good historian you’re really got your work cut out for you.

00:08:03       And so he taught me from very early on that you have to kind of learn how to meet the patient where they are right away otherwise things are not going to go well for them.

00:08:11       Q:   Are those first impressions something that, I mean, is that a skill that you develop or is that something that you have to figure out when you’ve been wrong? Or how does that, how do you get into that part of things?

00:08:22       A:   You know, it’s an interesting challenge, because I think there are people in the world who are just good at reading other people. And I think I am. But there are definitely times when I’ve been fooled or led down the wrong path or something like that, you know. I can remember one case where I had a patient come in who had a knee injury, and there were some lawyers involved on things like this, and I was convinced that this guy had a bonafide injury and I'm examining him and he’s making the right noises at the right time and he’s, you know, he seems really sincere.

00:08:58       And then as he was leaving the building I just happened to look out between my blinds and I watched him throw him crutches over his shoulder, walk to the car, throw them in the trunk of his car and drive away. And so, yeah, you know, you can be fooled. And you don’t always know what the other person’s agenda is. So I mean medicine is always going to be both an art and a science. And that’s what makes it challenging, and rewarding.

00:09:25       Q:   Well, the art and the science part sounds like you kind of continue to move into the science as well after you got your medical education.

00:09:36       A:   Yeah, you know, when I was in … you know, because my background had been in microbiology I always figured, you know, well, maybe I’ll do infectious disease or something like that. But when I was in medical school I got involved in doing triathlons. There were a couple guys, one guy who was a former pro cyclist and then a pro triathlete, another guy who was a pro cyclist and they kind of got me into it, you know.

00:09:58       And one of my lists of things to do after my cancer scare, you know, because you make that bucket list, right, one of them was to do a triathlon. I had been a lifeguard and stuff, I had grown up on the summers on the beach in New Jersey, so I thought this would be something that I needed to do. And so they kind of started helping me train. And I was terrible. I mean, really awful. I mean, I'm six foot four, you know, on a good day I weigh 250. I really wasn’t meant to do things like run marathons.

00:10:23       So as we’re going through this process, and they’re slaughtering me on these bike rides and things, I'm thinking there’s got to be an easier way to do this. And one of my professors, Bill Sexton, was like, Skiba you like math and stuff, here, you know, and started throwing papers at me that had to do with the kind of mathematical aspects of how you properly train somebody, because there’s people who’ve done that work.

00:10:44       And I looked at it and I was like oh, yeah, I get it, this something I can do. I built up this working model of it and my first experiment was on myself and I knocked about ten minutes off my 5K time in about six months. And so I'm like, which still didn’t make me fast, I was still abysmally slow, but I was way faster than I used to be. And so I'm just thinking that, you know, this is something I could do, because my friends are saying to me, hey, can you help me like this like this?

00:11:09       So I started helping some of my friends and they started winning things. And they got very excited. And so, you know, I filed for a patent on that. And I continued kind of developing this and training athletes and then I had an athlete win a world championship and set a world record and then my career was kind of, snowballed. So I ended up realizing at that point that the kind of science that needed to be done to continue this work, you know, there weren’t very many people doing it, so I kind of made a career decision that that’s what I was going to do.

00:11:45       So I, you know, I did my fellowship in sports medicine and after working a couple of years I moved to the UK and went to work at the University of Exeter where I ran their sports medicine program and did my PhD developing through new mathematical models of fatigue that really allow you to predict when say during a race or during a workout someone’s going to become exhausted and how to strategize to make sure that doesn’t happen at an inopportune time.

00:12:08       And while I was doing all that I was also, you know, developing some of these tools for the British Olympic movement because the 2012 games were coming. So it was really just, it was some element of serendipity and some element of just, it was really just being in the right place at the right time and being the right guy to answer the question. So, yeah, it was … no one’s more surprised than me that things have turned out the way they have, to be honest.

00:12:33       Q:   Wow. Wow. So how does something as seemingly as complex as endurance performance, right, how does math come into play in that and the other factors that you’re calculating?

00:12:49       A:   Yeah, you know, it’s interesting. If you look across the animal kingdom all critters exhibit this kind of behavior, from things like lungless salamanders and frogs to things like horses up to humans, dogs. All these creatures that have been studied have the same thing. And what they show is that as you go longer, you get slower, necessarily. And it’s not a straight line, it’s a curve. So going from say, you know, a 400 meter run or a 100 meter run to a mile you go way slower.

00:13:26       And then that curve kind of levels out, so your 5K pace isn’t much faster than your 10K pace and your 10K pace isn’t that much slower than your half marathon pace and so on. This is called the critical power curve or the power duration curve. And it has a basic biochemistry to what those conserved across the animal kingdom. And for me that’s what makes it kind of so interesting, it’s very nice that I can use this to help athletes train better.

00:13:53       But it’s a fundamental aspect of animal life and animal energetics. And so for that reason I think it’s work study, because it’s seems to be a rule.

00:14:02       Q:   So if somebody comes to you and says I want to get faster, how do you start pursuing that?

00:14:07       A:   Well, you know, the first question is how fast are you now, right? And so we can do that by either say looking at their race results or going out and testing them a little bit and kind of seeing what they have under the hood. So, you know, if I'm dealing with a runner I might send them out and have them run a 5K race and a 10K race and a shorter race, you know, maybe a mile or something.

00:14:28       And I can make one of these curves. And then I can take that curve and put it up against other known good athletes whose results we have and see, you know, is your goal reasonable, you know? Like I once used some slightly different models to figure out how hard or how much training would I have to do to catch Lance Armstrong going up the El Dewese. And the answer was about 95 hours of training a week, which is quite obviously impossible, right?

00:14:58       And that’s part of the challenge of using these models is that, you know, you have to use them within certain bounds otherwise they give you ridiculous information. But once I have this model I can then start advising them, you know. Like one really easy thing to do or when [unintelligible] patients come into my office is they end up saying, hey, I can’t keep up with people at swim practice anymore, you know, when they’re 14, 15 years old.

00:15:23       And so what I do is I ask them to give me their training paces in the pool and I have them swim some test efforts so I can make one of these curves and then I see are these paces you’re trying to swim, do they fall above this curve, which indicates you’re not physiologically capable of doing it? Or do they fall below this curve, in which case there’s something else going on and we need to figure out what that something else is. Do you have a problem with your lungs or your heart or something else?

00:15:50       And so it’s an interesting way of approaching it, because sometimes it’s as simple as, yeah, you’re not physiologically capable of swimming this pace for a 300 yet. But you can swim it for 100. So let’s alter your training program, so that you start swimming this pace for 100s for a while and then we’ll change it up so that you try to swim it for 200s for a while and so on. So we’re going to try to build you up to where these other people are.

00:16:14       And so it’s nice, because it kind of, if you just follow the data, it kind of tells you what you need to do, you know, yeah, you’re not that fast yet. But you’re that fast for this period of time, so let’s start there and stretch it out. And it’s really not more complicated than that.

00:16:32       Q:   No?

00:16:34       A:   You know, it’s funny like I said I was never a great athlete. I played some volleyball in college and that was about it. But if you study exercise physiology there are some golden rules, you know, that seem to be very conserved, and if you follow those rules you end up getting a particular results. And, you know, I think part of the challenge is there’s a lot of sort of guru-ism, right, in sports training.

00:17:01       I'm the coach, I know the secrets, you should pay me a gazillion dollars to make your team win the Super Bowl or whatever. And certainly in terms of strategy and things like that that’s a different story. But when you’re talking about, you know, functionally training a human to be better at performing in a certain way, that’s actually not that complicated an enterprise. And I tell people, you know, within a couple of years of starting out working as a coach kind of in the elite field, I mean, my athletes were regularly winning world championships, I was already advising Olympians. I mean, I was hired by Nike to work on Breaking 2 to make, you know, guys like Eliud Kipchoge run faster.

00:17:38       And it’s just, once you have mastered this kind of, this body of knowledge, it becomes relatively easy to advise people in an appropriate way.

00:17:51       Q:   That’s amazing. I am curious about the kind of how insights you might have might run up against people who have other coaches or, you know, you talk about the swim team or these other groups. So how does that, do you get a variety of responses? Or is it just any help we can get is great? Or something else?

00:18:14       A:   It depends on who you’re working with, you know. For example, when we went to work on Breaking 2 when I was traveling to Africa and meeting these really talented coaches who were coaching guys that were already getting world records and things in the marathon, they couldn’t get enough information from us. They were like, you know, they were really interested, you know, what can you do to help us, you know, tell us more.

00:18:36       Which was fascinating to me, because my experience in the Western world very often coaches are kind of standoffish or a little bit, I don’t want to say adversarial, but, you know, a little bit adversarial, because they view your kind of knowledge as some sort of threat, which is their kind of rule over their team. And my thing was always, hey, you know, I'm a coach too and my goal is not to replace you. I view you as a carpenter and I want to give you better tools and that’s it.

00:19:06       And some people are really amenable to that and some people want nothing to do with it. And part of that is the element of accountability. See, if you start measuring how athletes are training every day and you start measuring how they’re performing every day and the athlete is doing what you’re telling them to do, but they aren’t getting any better, then that’s your problem as the coach. It’s not the athlete’s fault.

00:19:35       Whereas if you don’t measure those things then you always have the opportunity as a coach to say oh, the athlete wasn’t, you know, executing my workouts properly or the athlete wasn’t doing this or wasn’t doing that. And there is a population of people who don’t want that element of accountability. They don’t want someone to look over their shoulder and say, hey, wait a minute. You know, the Emperor has no clothes here kind of thing. And it’s been interesting just to find this kind of breadth of personalities across the profession.

00:20:04       Q:   I can imagine that some people would say, this isn’t Money Ball, this is track or this is triathlons or whatever, you can’t just plug in a bunch of numbers and get, and spit out a better athlete guaranteed. You’ve got to worry about the nutrition, you’ve got to worry about whether they’re getting enough recovery, you got to do all this and all that.

00:20:21       A:   But you can put numbers to those things, right? So like we know that, for example, a human can process between one and two grams of carbohydrate per minute exercise, right? And by doing that, we’re going to lengthen their time to fatigue, we’re going to make them faster, and we’re going to give them a better chance of doing well. So even things like nutrition, there are numbers there that we can rely on to say there’s a better way of doing this.

00:20:46       Now is there an art to it? Absolutely. You know, for example, certain people don’t tolerate certain kinds of carbohydrates. You know, I used to coach Joanna Ziger [phonetic], who was already an Olympian for the 2000 games in Sydney in Triathlon. She finished fourth when she came to me. And she was like I’ve had a lot of injuries. I'm not doing well. I think you might be the guy that can help me. And so I made a number of changes to her training and stuff. But one of the most important things we figured out is she was intolerant to fructose. And fructose intolerance is almost as common as lactose intolerance in the population.

00:21:23       Only we don’t talk about it, because there’s fructose in literally everything, right, everything has high fructose corn syrup in it. I mean, English muffins have high fructose corn syrup in it. Why is that? But that’s the way it is. And so what we did was we said, okay, this is part of your problem. So we mixed her up a custom beverage. We went to a brewery supply place, we malted dextrin, which is a glucose polymer and we mixed that up with some flavoring and we had her drink that and so she’d get enough calories in and it wouldn’t upset her stomach.

00:21:54       And lo and behold, you know, we completely turn around her triathlon career, you know, and in the 2008 season she won or got on the podium in almost every race she entered. And then at the World Championship she won and also set a world record. Again, you had to know that fructose is in everything. Fructose intolerance is a problem and there’s a way to mix something up that’s not going to cause that kind of GI upset. And again, so part of that was the art of, you know, I'm going to cook something up in my kitchen for this athlete.

00:22:23       But part of it was just having that background knowledge, having read enough to know that, yeah, fructose intolerance is a problem and that’s probably what her problem is, we ought to figure that out. I mean, one of the other things Dr. Gutensohn said to me a million years ago was if you talk to the patient long enough they will tell you what’s wrong with them. And it wasn’t actually her that told me. It was her father. We were chit chatting at a race and he told me about how when she was little she would have a glass or orange juice and have terrible GI problems.

00:22:49       And that’s when the penny dropped for me, you know. Okay, so there’s something going on here and I started thinking about that and that’s what led me down that fructose path.

00:22:59       Q:   Wow. Wow. So it sounds like, I mean, you know, the struggle here is to make people, you know, get the most out of their bodies and do the most that they can. And that’s going to be unique for everybody. Is that…

00:23:14       A:   Yeah. Yeah. You know, early on in my career, my sort of tagline has always been that the secret is there is no secret. And so relatively early in my career I wrote two books that basically I just told everyone how I did this. They were both about 150 pages or something. It wasn’t a lot. I mean, this is what you need to know to do better. And again both of those sold really, really well.

00:23:42       And that’s just it. Like I try to take all the stuff that I’ve gathered and put it in a really digestible conversationally written thing that anyone can understand it. You know, this is all you got to do. Just be willing to be honest with yourself, be willing to measure what you do, be willing to measure how you do and then these are all the potential interventions you can try. Which makes sense? Which of these things make sense given your situation? You know, this is how much you should be eating. Are you eating that much? And so on.

00:24:12       And, you know, it’s been very gratifying over the years, because it’s a lot of fun when you get to go to the Monza race track with Eliud Kipchoge and watch him try to run the marathon in two hours. Like that’s, I mean, that’s pretty cool. Not a lot of people get to do that kind of thing. But for me it’s like maybe even more gratifying sometimes when, you know, someone is like, hey, you know, I followed what you said and I placed in my age group in my local 5K or something, you know.

00:24:43       Because at the end of the day I'm a doctor. I want people to be healthy. And if I can do things that make you enjoy exercise more and keep you healthier, then I have made a way bigger impact than I could just make in my office all by myself, because now I have a reach to people who never would have known my name.

00:25:02       Q:   So how do you look, you know, you’re working in Africa with people who are going to break two hours in a marathon, which I can’t even, the concept of trying to keep that pace for like 200 meters blows me away, right?

00:25:18       A:   I tried. At the red dirt track they train on an el dorette [phonetic], a bunch of us tried to sort of run with them. And we lasted like 50 yards. And I was laying on the infield of the track among these like cow pies and stuff just positive I was about to die, because we were also at altitude and I thought my heart was going to like explode out of my chest like an alien. It was terrible. Oh, man.

00:25:46       Q:   Yeah, I mean, these tough athletes it’s just another … it’s just a level beyond anything I can imagine. And so you can work with those people and then you’re also getting satisfaction out of being the Sports Medicine Director out of the Chicago area hospital. Like is that …

00:26:02       A:   I mean, look it’s all the same thing. We all have the same basic plumbing. I mean, Greg Lamont [phonetic] back in the day had a great quote, he said, it doesn’t get any easier, you just get faster. And that’s the truth, you know, because when you look physiologically speaking, you know, Eliud Kipchoge and a well-trained endurance runner, right, are running a 10K at roughly the same percentage of their max. It’s just that Eliud is way faster when he’s doing it.

00:26:35       But both people are hurting just as bad, because their physiology is suffering the same insult, relatively speaking. And that’s kind of the trick of training is realizing that you need to run relative to your own physiological thresholds, you know, where is your maximum oxygen uptake? Where do you start to produce lactate? Where does your physiology become unstable? And when you train relative to that whether to someone else’s numbers you start getting a lot better a lot faster, because if you just start, you know, trying to go out and putting in the kind of heroic mileage that like an Eliud Kipchoge or Paul Radcliff do, you know, that’s going to injure you and kill me, right?

00:27:20       But if I train relative to my own limits, you know, percentage wise I may achieve very similar improvements, even if it’s not the same in obsolete terms.

00:27:33       Q:   Are there things that people, you know, the equivalent of weekend warriors can do without labs and access to equipment and experts …

00:27:44       A:   Absolutely.

00:27:44       Q:   That can help out?

00:27:45       A:   Absolutely. Absolutely. The most important thing is what I already told you about where you do a different length races and you plot one of these curves, because what that curve tells you when you figure out where that curve levels out. If you’re running it’s called the critical speed, if you’re riding a bike or something with a power meter it’s called the critical power. But that turns out to be a dividing line between what’s termed stable physiology and unstable physiology. It’s around 10K pace.

00:28:13       So if you stay slower than that, and I watch you in my laboratory what I find is that your oxygen use stays very stable. Your lactate production stays very stable. Your body can maintain that level of exercise for a considerable length of time. But if we go just a little bit faster and we cross that critical threshold what happens is that everything goes off the rails. Slowly your oxygen use rises, despite the fact that you are not running any faster.

00:28:42       Lactate in your blood rises despite the fact that you’re not running any faster. And if you look inside the muscle you can see a variety of things associated with fatigue, also trending towards maximum or minimum values. And eventually all these things hit some limit and you’re forced to quit. But you can find out where this threshold exists with nothing more complicated than a stop watch.

00:29:06       And that’s the beautiful part about it. That’s kind of what I get into in the book is that you don’t have to come to the lab and spend a bunch of money to work with me. Like you can go to the track, you can take your stop watch with you, you can get a power meter for your bicycle and you can figure this out all by yourself. Like there’s no mystery here. There’s no secret to this.

00:29:25       Q:   That’s really cool. I feel like it would be missing a chance to ask you a little bit more about the Breaking 2 which was, I guess that was a Nike project designed to help the best marathoner in the world to get under two hours in a marathon.

00:29:40       A:   Yeah.

00:29:40       Q:   So what kind of things did you do, because this guy’s already running 2.03 or 2.04 or something. And that’s super. That’s incredibly fast. So how do you take an elite guy and get that extra percent off or whatever the number is?

00:29:58       A:   These guys are super-fast. One of the easiest things to intervene with early on was in terms of nutrition. And a few of us had this … Zerseney Tadese who at the time was the world record holder in the half marathon, he and I are having dinner, and we’re chatting a bit. He’s such a nice guy. Such a genuinely nice guy. And so I'm asking him, I'm like, Zerseney, when you’re running, you know, what are you drinking?

00:30:29       And he said, he looks at me for a second, he goes I don’t understand the question. I said, Zerseney, when you’re running I mean what’s in your body? What do you drink? I thought maybe we were having like a language barrier issue. And he says, doctor, when I am running I am not drinking, I am running. And, you know, we’re kind of looking at each other. And I said, you’re telling me you try to run the marathon without taking a sip of water. It’s basically yes.

00:30:53       And all of a sudden that makes sense why this guy can run, you know, under 60 minutes for a half marathon, but never ran faster than about 2.12 or 2.13 for a marathon, right? Because, you know, if you drop your hydration by more than about two percent body weight you begin to suffer a significant performance decrements.

00:31:12       And so like one of the most important things we did in that effort was get Zerseney Tadese to start drinking more and to put some carbohydrate and a little bit of caffeine in there. And all of a sudden he goes from like a 2.12 guy to like a 2.06 guy or something, which is a big deal. So that was the kind of thing was looking at … you know, people assume because you’re the fastest guy in the world that you got this figured out. Oftentimes I find that elite athletes that they’re succeeding in spite of their training and nutrition, not because of it and that you can find little places to intervene and take guys who are even really fast and make them even faster.

00:31:49       And that’s kind of what we were able to do, which is just a profoundly cool experience to feel like you had something to offer those guys.

00:31:59       Q:   Is that the cap? Like people talk about there being a cap on the marathon time, a limit. What do you think?

00:32:06       A:   Yeah, my friend Mike Joyner who’s up at the Mayo Clinic, he wrote a very simple equation, more than 20 years ago now, that’s how Breaking 2 got started, where he said that given human physiology if you put all these numbers together in terms of what’s the maximum oxygen uptake we can theoretically see, what’s the lactate threshold, what’s the exercise economy we can see, he came up with a number that was like 157 and change.

00:32:29       And that’s probably pretty close to what’s possible. And it will probably take 100 years to get there or something. Because the thing is all these things tend to be balanced, right? So, for example, Andy Jones, my friend and former PhD advisor he has the 80/80/180 rule, which is that, you know, you have to roughly a vo2 max of 80 milliliters per kilogram per minute, your lactate threshold, meaning the point where you start making lactate has to be around 80 percent of that 80 milliliters per kilogram per minute of oxygen use and your running economy has to be about 180 milliliters per kilogram per kilometer.

00:33:09       And so you can horse trade, because if you’ve got a very high v02 max, like let’s say you have a v02 max of 85, it’s kind of like a Ferrari, you don’t get very good gas mileage, right? So your economy might be lower. So you can trade the slightly lower economy for the slightly higher v02 max. Or vice versa.

00:33:29       If someone’s very economical they don’t need to have as big an engine to go that fast. So what you’re really doing is, and that was the beginning of Breaking 2, it was [phonetic] in Exeter, the lab in the UK we were testing, you know, dozens and dozens of Nike’s athletes to see who had roughly the plumbing that would make this possible if we helped them, you know, train the right way.

00:33:50       And so again there’s this element of there are numbers that we can put to this, you know, it’s you have to do a little bit of screening and then you try to see what you can manipulate. And part of that was the shoes, you know, we were able to improve exercise economy by giving them a shoe that returned more energy.

00:34:10       Q:   Take me inside your head of the actual trials happening. Is that a sustained level of excitement and terror for two hours? Or what’s going on?

00:34:18       A:   I was terrified from the beginning. I had been working for Nike and they weren’t telling me a whole lot of what we were doing until, you know, one day they’re like, okay, this is the project, and I'm kind of like you want me to do what, you know. And it’s not just the idea of working with these super, super duper athletes, it’s the idea that I'm a doctor and I know all the horrible diseases that can kill me in Africa. So when they bring me to Portland, to Oregon, I go up to Beaverton, I'm at the place and I'm talking to Eliud Kipchoge and he says, doctor, he says you’re going to come to Africa and we’re going to train together.

00:34:58       And then we kind of looked at each other and I start laughing, he goes, well, he goes, maybe you will ride in the car and I will train. And I said, Eliud, I said, I'm a doctor, I spent my whole career learning what’s going to kill me in Africa, I'm not going to Africa, you know, and the Nike guys were like Skiba, check your contract, you’re going to Africa, you better go get your shots.

00:35:19       So two weeks later I'm on this plane to Africa, you know, I'm thinking this is totally insane. And as we’re flying over the Rift Valley of Kenya, which is gorgeous, but there’s terrible turbulence, we’re in this little puddle jumper, I’ve never been a great flyer to begin with, and so this nice Kenya lady’s sitting next to me and she goes you look afraid. I said, yeah, I'm afraid. She goes, would you like me to teach you the Hail Mary in Swahili? I said that sounds great, thank you, you know.

00:35:52       So right from the beginning this was terror. But once I got to Africa it was an incredible experience. I would go back tomorrow if I could. As for the real tragedy of this, personal tragedy of this pandemic for me is that I was hoping to get back much sooner. But once we started working and we saw how genuinely interested everyone was in this project. You know, people on the outside often looked at it as though it was some kind of stunt. For those of us on the inside this was a really kind of exciting and important, you know, enterprise.

00:36:28       And all the guys in Africa were just as excited. And that wore away my fear relatively quickly. And their kind of enthusiasm was infectious. And so, yeah, it turned out to be initially kind of butt clenching terror, but very quickly it turned into just excitement. And I think all of us, you know, kind of when the project wrapped up at the end, you know, all of us were very sad to see it end, because it was such a cool experience.

00:37:02       Q:   Wow. Well, hopefully you’ll get a chance to do something like it again.

00:37:06       A:   There’s always more stuff coming down the pike. But, yeah, I would do it again tomorrow if I could.

00:37:12       Q:   Thanks, Phil. We’ll have to break here and we’ll come back in a next episode and that’s when we’ll have a chance to talk about your experiences at the Covid frontlines and working with athletes who have lung [phonetic] Covid. But thanks for sharing all your experience and thoughts with us today in this first episode and we’ll see you next time.

00:37:33       A:   Thanks for having me Chris. It was a pleasure.

00:37:35       Q:   Thanks everyone for joining us for this episode. Please make sure to like and subscribe to our channel so that you don’t miss any episodes, including that next conversation with Phil, which I promise is really, really gripping. So we’ll see you next time. Thanks. I'm Chris Gorski.