Tue 24 Nov 2015
I went down to UE after closing for the following workout:
SuperSlow Systems Overhead Press
Nautilus Plate Load Biceps with SS retrofits
Nautilus Plate Load Triceps with SS retrofits
EZ Bar Reverse Curl
SS Systems Leg Press
Recently, while listening to a continuing medical education podcast, I became aware of another way the high intensity exercise could prove enormously beneficial when you least expect it. Suppose you go for a day at the beach. You are unloading the jet ski off a trailer when you slip and scrape your shin on the tongue of the trailer. You hop up and down, cussing, but eventually you walk it off and go on to have fun in the surf and sand. A few days later you note that the area on your shin has become red, painful and has some red drainage. You wait it out for a day, and it gets worse…bad enough for you to go to the local urgent care where you are prescribed some antibiotics. You fill the prescription and take them dutifully, but the area only gets worse. The redness has spread, and the entire front of your leg is exquisitely painful. This time, your wife brings you to the local ER where you are given a dose of IV antibiotics and you are written for an additional oral antibiotic. The ER bandages your IV site and asks you to come back the next day for a recheck and another dose of IV antibiotics. That night the leg becomes so painful that even air passing over it is excruciating. About 2am you have shaking chills and you spike a fever of 104.5. Your wife wakes to soaked bed sheets and decides you are going back to the ER NOW, but when you try to stand up, you faint and collapse in a ball on the floor. An ambulance is called and the paramedics find you with a blood pressure of 83/38 and a heart rate of 140. Your cellulitis has turned into necrotizing fascitis and you are in septic shock.
The bacterial toxins circulating in your bloodstream and the cytokine storm that they induced have caused all variety of organ dysfunction. Vascular tone is lost and your blood pressure plummets as your blood volume is now circulating in a much larger container. When your lactic acid is measured, it is astoundingly high (a level of 4.5, where normal is less than 2.0). In current sepsis management, lactic acid is the major biomarker for the severity of sepsis. What had always been assumed was that as blood pressure dropped, and oxygen delivery to organs and tissues decreased, these organs and tissues reverted to anaerobic metabolism, the end product of which was lactic acid. It all made perfect sense. Except, like many things that make perfect sense, that is not what turns out to be going on. It turns out that in sepsis oxygen levels and delivery can be supra-normal and excess lactic acid is still generated. It turns out that this overproduction of lactic acid is due to the body’s major surge in catecholamines as it struggles to survive. See the article below for details on how this was figured out.
As epinephrine and norepinephrine pour out in response to the stress of infection an amplification cascade of glycogen mobilization is triggered, accelerating glycolysis. In addition to generating ATP more rapidly through glycolysis, the end substrate of glycolysis, pyruvate is presented to the mitochondria at a rate that maximizes aerobic metabolism as well. The catch is, as we discussed in BBS, pyruvate can be generated at a rate much faster than the mitochondria can handle. As pyruvate stacks up, unable to enter the mitochondria, it is acted upon by lactate dehydrogenase and turned into lactic acid. This is a necessary side effect of the need to crank up energy production in the body’s massive effort to fight off infection. However, in the right conditions, and up to a certain point, the lactate can actually be used as fuel. Circulating lactate can be carried back to the liver where it can undergo gluconeogenesis and serve as new substrate to keep the whole process going (A process known as the Cori Cycle). For those of you who have read BBS, this should sound vaguely familiar. It is the exact same process we described in the chapter on global metabolic conditioning, where catecholamines released during high intensity exercise pushed glycolysis to deliver pyruvate to the mitochondria faster than it could be utilized, simultaneously ramping aerobic metabolism to its maximal extent and driving elevated lactic acid levels, which in turn up-regulated the Cori Cycle and blood buffering systems to offset the ensuing acidosis.
Eventually, in sepsis, as in a high intensity workout, these systems eventually become overwhelmed. In sepsis, it is septic shock. In high intensity exercise, it is carpet time. In sepsis when shock ensues the first step is to aggressively administer IV fluids to correct fluid losses from fever, vomiting, respiration as well as to fill the now dilated vascular tree. When this fails, IV norepinephrine can be given. This raises blood pressure by constricting the dilated vessels, but it also stimulates beta receptors and further drives glycolysis and pyruvate production-paradoxically raising already high lactic acid levels. Much of the ability to survive sepsis, it seems, is the ability to “go there” in terms of accelerating glycolysis, as well as making productive use of the lactate that is generated.
This is where high intensity exercise comes in…and this is true for interval training, Crossfit and for HIT. The degree to which we can improve our ability to absorb this “metabolic whallop” as Greg Glassman calls it, is the degree to which we might be better able to survive the sepsis process. Now please don’t mistake me as saying that one should seek out “carpet time” as a goal, because I am not. It is not necessary to provide a good stimulus and done regularly will lead to stagnation and overtraining. But, I think it is important to realize that you can become capable of easily handling workloads and a pace of work that would previously would have made you quite ill. What can make the average person vomit or pass out, can easily be handled by someone who has gone through an appropriate progression of metabolic conditioning. This can be achieved without ever pushing beyond the brink, if you approach it intelligently. If you do want to push up to, or even beyond, the brink it is easy to do. If you pick the right movements and do them at an aggressive pace, you can make anyone vomit and require “carpet time”. The relationship between glycolysis (the more ancient part of our metabolism), will always be able to outpace the mitochondria (a relative newcomer as a symbiotic proto-bacteria that ate the waste products of the cell).
Someone that has trained this metabolic systems to run at peak capacity, and has also up-regulated the pathways that make productive use of lactic acid, the way a drag car uses nitrous, is much more likely to survive a bout of sepsis. Once again, HIT offers more than just aesthetics.
Post your WOW’s and your thoughts.