Triathlon and the Missing Link of Nutrition

Stephen Phinney and Jeff Volek have done a tremendous work on nutrition for athletes.  Their seminal work published in 2016, Metabolic Characteristic of Keto-Adapted Ultra-Endurance Runners.  Metabolism, needed a subject to proof that great athletes can follow this adaptation to perform at the highest level.  This athlete was study by Edward Coyle few years earlier.  Maximal blood lactate concentration was remarkably low in the trained state. It appears that an 8% improvement in muscular efficiency and thus power production when cycling at a given oxygen uptake (V̇o₂) is the characteristic that improved most as this athlete matured from ages 21 to 28 yr.

This case describes the physiological maturation from ages 21 to 28 yr of the bicyclist who has now become the six-time consecutive Grand Champion of the Tour de France, at ages 27–32 yr. Maximal oxygen uptake (V̇o_{2 max}) in the trained state remained at ∼6 l/min, lean body weight remained at ∼70 kg, and maximal heart rate declined from 207 to 200 beats/min. Blood lactate threshold was typical of competitive cyclists in that it occurred at 76–85% V̇o_{2 max}, yet maximal blood lactate concentration was remarkably low in the trained state. It appears that an 8% improvement in muscular efficiency and thus power production when cycling at a given oxygen uptake (V̇o₂) is the characteristic that improved most as this athlete matured from ages 21 to 28 yr. It is noteworthy that at age 25 yr, this champion developed advanced cancer, requiring surgeries and chemotherapy. During the months leading up to each of his Tour de France victories, he reduced body weight and body fat by 4–7 kg (i.e., ∼7%). Therefore, over the 7-yr period, an improvement in muscular efficiency and reduced body fat contributed equally to a remarkable 18% improvement in his steady-state power per kilogram body weight when cycling at a given V̇o₂ (e.g., 5 l/min). It is hypothesized that the improved muscular efficiency probably reflects changes in muscle myosin type stimulated from years of training intensely for 3–6 h on most days.

https://journals.physiology.org/doi/full/10.1152/japplphysiol.00216.2005

This subject studied by Coyle developed keto-adaptation even when his nutrition was out of whack.  How do I know this?  I checked his hemoglobin and hematocrit in his biological passport and it appeared he was anemic at one point.  This being anemic can give us a clue regarding caloric intake and fasting states.   When caloric intake is low, anemia could be a side effect but it promotes keto adaptation as well as fasting in this case.  This is an advantage taken by anorexic athletes until the body breaks down due to malnutrition.  Michael Phelps used to have lactates around 20 right after one of his competition; this cyclist can hardly reach 7:

Furthermore, at this time of reduced training, maximal blood lactate concentration measured 4 min after exhaustion was 9.2 mM compared with previously recorded values in the range of 6.3–7.5 mM. Maximal heart rate declined from 207 to 200 beats/min from 1992 through 1999. The V̇o₂ corresponding to the blood lactate threshold was 4.5–4.7 l/min when measured in 1992–1993 and, as expected, it was reduced to 4.02 l/min during the period of reduced training in August 1997.

Phinney tested athletes where the peak of fat oxidation was closed to their Vo2 max (see graph below), but what can we learn following the athlete tested by Coyle?:

1)   Keto-adaptation is a state that last a long time even when we do not pay attention to our nutrition as long as we continue training at the same level with same conditions.  It involves activation of genes and it is difficult to deactivate them.

2)   Keto-adaptation is obtained with five hours rides, fasting and low caloric intake for a long time.  Simulating an anorexic.  No wonder Eufemiano Fuentes said that he was helping cyclists to overcome illness when doping them; he used to give transfusions.

3)   The lactate curves should be interpreted differently depending on the diet the athlete is eating.  The lactate curves are designed for athletes eating a high carbohydrate diet without the training of the champion described by Coyle and/or without the anorexic twist.

4)   Training is directly related to the development of keto-adaptation.  The better we adapt the better engine we have; leaving technique as the other physical aspect of performing at high level.

5)   The used of glucose or fatty acid depending on the diet it is shown by Volek in the two graph below when testing two different groups, high carbohydrate diet vs low carb diet.

6)   Muscle glycogen was the same after exercise for the two groups.  This helps to understand that the keto-adapted athletes were burning fat instead of glycogen.  See the graph taken from Phinney and Volek.

Triathlon and Sports Science (part 2)

 The second part of Sports Science was written before but it was called Triathlon Nutrition.  It was written before Blummenfelt’s ironman, where he ran a new world mark for the distance.  I needed to make the connection with Sports Science because Christian could do much better by changing nutrition.  I am pasting below what was written then, and will give you information on how I started inducing the use of fats in myself.  You should read the beautiful paper lead by Jeff Volek before joining this venture: https://www.sciencedirect.com/science/article/pii/S0026049515003340

People have changed the entire soccer team nutrition with a great success as it happened with the Columbus Crew in Ohio, USA. https://www.virtahealth.com/blog/steve-tashjian-carbohydrate-restriction-soccer

3 mai 2021

Triathlon and Nutrition

A long time ago, when I went to medical school, the concept of glucose production from ketones was considered very small and very rare.  It was like a myth, because glucose level in blood was controlling hormones related to metabolism minute to minute in normal people, and nobody wanted to investigate ketones which were present in patients with diabetes. It was considered irrelevant to study ketone bodies to win a Nobel prize.  Severo Ochoa worked on glycolysis (breakdown of glucose for fuel) and fermentation since 1936 and won the Nobel Prize in 1959 (https://en.wikipedia.org/wiki/Severo_Ochoa). The Krebs cycle was studied from the point of view of glycolysis, I was told that glucose was needed in order to burn fat.  George Cahill lost the political battle in science and his research on ketone bodies was not the one to follow.  Marketing carbohydrates changed our lives and put us in this obesity crisis worldwide, as one of Cahill’s students put it:

This story begins in the early 1960s when the general level of knowledge about whole‐body metabolism during human starvation was grossly deficient. This was partly caused by a lack of accurate and specific methods for measuring hormones and fuels in biological fluids, which became available about 1965.1 Rigidly designed protocols for studying human volunteers or obese patients, who underwent semi‐ or total starvation for prolonged periods of time, were not widely employed, and much of the published data regarding metabolic events during starvation were not readily accessible. To complicate matters further, a great deal of the available data was confusing because much of the supposition regarding mechanisms used by the body to survive prolonged periods of starvation was based upon information that was obtained from nonstandardized and often erroneous procedures for studying metabolism… The pathway to knowledge on the nature and regulation of human fuel metabolism has taken a long and circuitous route. It is easy to understand how physician‐scientists initially formulated erroneous concepts regarding the requirements of the brain and other tissues for fuels such as glucose. Ironically, studies of diabetics and patients with insulin‐induced hypoglycemia complicated (rather than clarified) the understanding of the normal metabolism of the brain. The treatment for diabetes became available with the discovery of insulin at the University of Toronto in 1921–22. This scientific breakthrough was one of the most dramatic events for the management of any disease. By lowering the level of blood glucose, insulin's impact on a diabetic patient was sensational and seemingly miraculous.2 However, initial research of brain metabolism was hindered by the widespread yet erroneous hypothesis that developed as a consequence of treating diabetic patients with insulin.3

https://iubmb.onlinelibrary.wiley.com/doi/full/10.1002/bmb.2005.49403304246

Gluconeogenesis was considered small because we were already eating great quantities of sugar (glucose), and the need to produce our own glucose was not there according to doctors.  Ketones as fuel for the brain was considered just in extreme cases.

But let’s continue with Dr. Oliver Owen narrative:

Early insulin therapy was not perfect; insulin saved the lives of experimental animals and subsequently humans, but researchers initially had no way of knowing how much to administer or how to best administer it. They recognized that in the absence of insulin the concentration of blood glucose rose to high levels and death occurred. Also, injecting too much insulin lowered the blood glucose to a point where a “peculiar” behavior occurred; animals and humans began frothing at the mouth, became unconscious, developed convulsions, and died. Eating carbohydrate‐rich foods (i.e. orange juice or candy) or receiving intravenous glucose reversed these adverse effects. Glucose was clearly the key fuel metabolized by the brain; the possibility that other fuels, such as ketone bodies, were also metabolized by this organ was completely ignored. The presence of ketone bodies in the blood and urine of insulin‐deficient diabetic patients was recognized in the 1880s and was associated with severe disease states. In the 1920s, it became evident that insulin lowered the content of glucose in the blood and urine of diabetic humans, and it also removed ketone bodies. Nonetheless, the idea that insulin controlled only glucose metabolism and that too little glucose in the blood led to brain dysfunction led to the widely held concept that glucose was the only fuel used by the brain. In the 1950–60s, researchers learned that insulin lowered not only the concentration of glucose and ketone bodies in the blood and urine but also a host of other fuels, including free fatty acids and amino acids. Unfortunately, these isolated discoveries did not correct the widely held misconception that ketone bodies were unhealthy and that glucose was the only source of fuel for the brain.

¿Are we over the persecution? Tim Noakes lost his job when he mentioned what it is here (2014), and blamed the high carb diet marketed for the obesity epidemic.  He even was accused in court, in a trial that looked like the Greek trial of Socrates.   No wonder Noam Chomsky says that our civilization is “involuding:”

The trial of Socrates (399 BC)^[1] was held to determine the philosopher’s guilt of two charges: asebeia (impiety) against the pantheon of Athens, and corruption of the youth of the city-state; the accusers cited two impious acts by Socrates: "failing to acknowledge the gods that the city acknowledges" and "introducing new deities".

I started my “low carb way of living” approximately six months ago.  I decreased the amount of carbs without measuring them, I still do not measure the amount of carbs I eat.  I bought a breathalyzer to measure ketones instead, I do not use other things than the breathalyzer. I read an article which mentions that it correlated pretty well with the blood measure of ketones.  You have to learn to use it; how you blow, how frequently you use it (first measure is the highest). At the beginning, my morning ketones levels were 0.1 or so.  I decreased the amount of carbs even more in order to increase the ketones level, slowly over the course of two weeks my ketones levels increase to above 1 in the morning. I started to present “keto flu” after two weeks which I treated with hypertonic solutions (salt in my drinks). I still present mild “keto flu” off and on depending on the salt ingested. 

Increasing the amount of proteins would stop ketosis for several hours, and I noticed that if I take external ketones from coconut (a spoon in my tea) I returned rapidly and easily to ketosis.  I use the ketones from coconut to come back to ketosis if I overeat fruits or proteins.  Six months later my ketones in the morning are between 1.5 to 2.5 without fasting.  I am in my sixties and feel energetic, with a pretty good memory and reasoning (good RAM memory), I feel better than in my fifties.  I am lighter but I am interested in a better life and not to lose weight (BMI 24-25.  BMI is another “subject” to review).  I feel that adapting physiologically to this kind of life takes longer than six months for a man like me following my methodology.  I leave you Jeff Volek:

 https://www.youtube.com/watch?v=TFqjqqJTJQ4

Triathlon and Sports Science (part 1)

Albert Einstein mentioned in 1939: “All of science is nothing more than the refinement of everyday thinking.” "Physics and Reality" in the Journal of the Franklin Institute Vol. 221, Issue 3 (March 1936). It means we have to improve our way of thinking daily: reading, thinking, experiencing and experimenting, reevaluating our way of thinking, knowing our dark sides, etc. Science is related to our frames of thinking; Charles Darwin’s thoughts are according to the British Empire way of conceptualizing. We have our backgrounds with dark sides which are very difficult to see, but we have to see them in order to improve our personal science. 

Covid 19 became the great equalizer. Two thousand people are predicted to die daily in the US a week from now. Science cannot be too political otherwise it promotes death; wear you mask all the time and you will be fine. It is simple, but politicians and doctors have difficulties with this statement. Science needs to be practical, ruthless, knowing that it is like pursuing a record in any sport, knowing that any record will be broken sooner or later. Einstein said it clearly when he mentioned: “We need to bring from the Olympus time and space and look at them differently to improve our science.” Einstein was taking a very different direction from the establishment when he said it in his book related to the Theory of Relativity. 

Following a plan based on science has a great chance of achieving the goal even when it is not the best science; science approaches reality but it is not reality. Science improves when better approaches are taken. Better result if “the map approaches/looks like the territory.” Christian Blumenfeld is an example of following the plan strictly pursuing a goal even when it is not best plan. We have been following what Christian is doing to improve since he was a teenager. We paid attention to his nutrition, and “biological markers” mentioned by his coach. He has followed the old school of thought regarding nutrition and it does work. He has taken this way of thinking to the last consequences following rigorously the plan. We can say that he drained everything from this reasoning, we cannot do any better going this way. I cannot imagine what he could do improving the train of thought regarding nutrition. 

Marketing has done wonders for businesses, including elections in many countries. “Fake news” are not fake news if they are marketed well. Coca Cola and Marlboro dominate the market even when people know the products could be dangerous for our health. Trump in the US has many fans and AMLO in Mexico. Both of them have their own facts, “fake news.” Regardless of how obsolete and awkward they are; people will continue to vote for them in great numbers. The new kids on the block in Medicine are the SGLT2 inhibitors, sodium-glucose cotransporter 2 inhibitors. They are the most potent medications for preserving the function of the heart, kidneys and lives as the end point by decreasing glucose in people with diabetes and people without diabetes. They do it by blocking the reabsorption of glucose in the proximal tubules of the Kidneys as the main mechanism. 

Is glucose a poison? It does appear that it is if we ingest too much of it. Too much could be 20% of our total calories for some people. Tim Noakes ripped many pages of his book, Lore of Running, after he learned it the hard way: He became diabetic. In the pages ripped, he talks about glucose, the main fuel for running and the need to consummate 70% of the total energy for runners. Noakes ripped the pages where Blumenfeld’s nutrition plan was sketched because he knew a much better way to tackle energy consumption for athletes and considered an anomaly to eat that quantity of calories from carbohydrates. 

Should we use SGLT2 inhibitors for improving health and fitness? We know that a compound, beta hydroxybutyric acid, can produce the same effect in the kidney. It is not a doping substance, it is in our diet and we produce it in our body. This production happens when we decrease to 20% the caloric intake of carbohydrates compared to the total consumption of calories during the day. Dr. Stephen Phinney talks elegantly about the subject.

Triathlon: Lessons from Cuba

 We have learned many things from the Island:

1)   Wishful thinking is not enough.

2)   Learning to sweat never finishes.

3)   Working toward the goal never finishes.

4)   Facing reality is inevitable, the sooner the better for someone.

5)   Productivity needs to be present at one point in our lives.

I had a taste of Cuba when working at the University of Geneva (IUPG), where I met Cubans who were selling a useful software called Neurotechnology.  I had the opportunity to test the software and I found it very useful.  I met Guido Diaz and Mitchell Valdés.  Guido was the worker behind the project. Mitchell represented the government, stubborn, self-centered, fluently speaking in English to the Swiss; he looked like Díaz-Canel speaking after the current revolt.  Mitchell was the one selling, but he just had one product.  He came to Switzerland from Havana to sell the software.  He stayed to speak with Jean Michel Gaillard (my boss, already deceased) two days and left.

Doctor in Medicine, PhD in Physiologic Sciences, Senior Researcher. Member of the Cuban Society of Neurosciences, Member of the Cuban Society of Physiology, Member of the International Organization for Psycho-Physiology, Member of the Caribbean Organization for Brain Research, Member of the North American Society of Cognitive Neurosciences. Working Specialty: Cognitive Neurosciences.

The Swiss wanted to buy the software because it was at least three times cheaper than the others in the market.  They had four softwares to test and to choose from.  The Neurotechnology software advantages were multiple: easy to use, Neurotechnology had a data base to compare to normal Cuban subjects (but we had limited access to row data and the Swiss believed the data was not statistically significant to compare with: very few subjects), complicated measures were possible at one touch.  The disadvantages were: limited maintenance because just a very few Cubans were prepared to do so and they had to have freedom to move around; limited access to use the data freely (we could not take pieces of the EEG independently of the software) and we were in a research lab.  We tested the software excessively because the full data was not available to us.

I spent time with Guido and learned more about Cuba.  It was a few years after the falling of the Soviet Union.  I used to invite the team to eat in the cafeteria, five of them.  Guido said that they were a hundred people working in the project but the five of them were doing the whole job. They did not accept to come to my place for dinner.  One time, Guido called me from Cuba and ask me if I could send him a bunch of articles because they did not have them in Cuba, they were close to 100.  I asked the Secretary to send them by fax as Guido said!  I used to call Guido, but the communication faded and I found out he left the island for Venezuela for good in 1995.  Good luck Guido if you read me!

A few years later, I presented in Havana a research done at the lab in Switzerland, using the Cuban software.  I did not see Mitchell or Guido there.  Guido told me that the research using medications and measuring with the software developed by them was not possible because they did not have medications to do it.

Balancing freedom and equality is the key in any system.  Voicing corruption and other related problems is the beginning, but solving the problem, is another thing.  In Latin America we are very good at voicing, but we come very short at solving; Cuba, Venezuela and now Mexico are the examples.  Our Federations in any sport have the same problem in Mexico.  Our triathlon federation controls the athletes as the Cuban government controls the citizens, we even have had an embargo on us, but we managed to have the only triathlon world champion of Mexico.  I leave you with this beautiful analysis done by Claudia Hilb on Cuba:

https://www.youtube.com/watch?v=KGLrwfHg6oo

Valdés speaking on microwaves cooking the brain:

Triathlon and Nutrition

A long time ago, when I went to medical school, the concept of glucose production from ketones was considered very small and very rare.  It was like a myth, because glucose level in blood was controlling hormones related to metabolism minute to minute in normal people, and nobody wanted to investigate ketones which were present in patients with diabetes. It was considered irrelevant to study ketone bodies to win a Nobel prize.  Severo Ochoa worked on glycolysis (breakdown of glucose for fuel) and fermentation since 1936 and won the Nobel Prize in 1959 (https://en.wikipedia.org/wiki/Severo_Ochoa). The Krebs cycle was studied from the point of view of glycolysis, I was told that glucose was needed in order to burn fat.  George Cahill lost the political battle in science and his research on ketone bodies was not the one to follow.  Marketing carbohydrates changed our lives and put us in this obesity crisis worldwide, as one of Cahill’s students put it:

This story begins in the early 1960s when the general level of knowledge about whole‐body metabolism during human starvation was grossly deficient. This was partly caused by a lack of accurate and specific methods for measuring hormones and fuels in biological fluids, which became available about 1965.1 Rigidly designed protocols for studying human volunteers or obese patients, who underwent semi‐ or total starvation for prolonged periods of time, were not widely employed, and much of the published data regarding metabolic events during starvation were not readily accessible. To complicate matters further, a great deal of the available data was confusing because much of the supposition regarding mechanisms used by the body to survive prolonged periods of starvation was based upon information that was obtained from nonstandardized and often erroneous procedures for studying metabolism… The pathway to knowledge on the nature and regulation of human fuel metabolism has taken a long and circuitous route. It is easy to understand how physician‐scientists initially formulated erroneous concepts regarding the requirements of the brain and other tissues for fuels such as glucose. Ironically, studies of diabetics and patients with insulin‐induced hypoglycemia complicated (rather than clarified) the understanding of the normal metabolism of the brain. The treatment for diabetes became available with the discovery of insulin at the University of Toronto in 1921–22. This scientific breakthrough was one of the most dramatic events for the management of any disease. By lowering the level of blood glucose, insulin's impact on a diabetic patient was sensational and seemingly miraculous.2 However, initial research of brain metabolism was hindered by the widespread yet erroneous hypothesis that developed as a consequence of treating diabetic patients with insulin.3

https://iubmb.onlinelibrary.wiley.com/doi/full/10.1002/bmb.2005.49403304246

Gluconeogenesis was considered small because we were already eating great quantities of sugar (glucose), and the need to produce our own glucose was not there according to doctors.  Ketones as fuel for the brain was considered just in extreme cases. Over the years I learned the following:

16.3.5. The Generation of Free Glucose Is an Important Control Point

The fructose 6-phosphate generated by fructose 1,6-bisphosphatase is readily converted into glucose 6-phosphate. In most tissues, gluconeogenesis ends here. Free glucose is not generated; rather, the glucose 6-phosphate is processed in some other fashion, notably to form glycogen. One advantage to ending gluconeogenesis at glucose 6-phosphate is that, unlike free glucose, the molecule cannot diffuse out of the cell. To keep glucose inside the cell, the generation of free glucose is controlled in two ways. First, the enzyme responsible for the conversion of glucose 6-phosphate into glucose, glucose 6-phosphatase, is regulated. Second, the enzyme is present only in tissues whose metabolic duty is to maintain blood-glucose homeostasis—tissues that release glucose into the blood. These tissues are the liver and to a lesser extent the kidney.

This final step in the generation of glucose does not take place in the cytosol. Rather, glucose 6-phosphate is transported into the lumen of the endoplasmic reticulum, where it is hydrolyzed to glucose by glucose 6-phosphatase, which is bound to the membrane (Figure 16.29). An associated Ca²⁺-binding stabilizing protein is essential for phosphatase activity. Glucose and P_i are then shuttled back to the cytosol by a pair of transporters. The glucose transporter in the endoplasmic reticulum membrane is like those found in the plasma membrane (Section 16.2.4). It is striking that five proteins are needed to transform cytosolic glucose 6-phosphate into glucose.

https://www.ncbi.nlm.nih.gov/books/NBK22591/#:~:text=In%20glycolysis%2C%20glucose%20is%20converted,pyruvate%20is%20converted%20into%20glucose.&text=Phosphoenolpyruvate%20is%20formed%20from%20pyruvate,pyruvate%20carboxylase%20and%20phosphoenolpyruvate%20carboxykinase.

But let’s continue with Dr. Oliver Owen narrative:

Early insulin therapy was not perfect; insulin saved the lives of experimental animals and subsequently humans, but researchers initially had no way of knowing how much to administer or how to best administer it. They recognized that in the absence of insulin the concentration of blood glucose rose to high levels and death occurred. Also, injecting too much insulin lowered the blood glucose to a point where a “peculiar” behavior occurred; animals and humans began frothing at the mouth, became unconscious, developed convulsions, and died. Eating carbohydrate‐rich foods (i.e. orange juice or candy) or receiving intravenous glucose reversed these adverse effects. Glucose was clearly the key fuel metabolized by the brain; the possibility that other fuels, such as ketone bodies, were also metabolized by this organ was completely ignored. The presence of ketone bodies in the blood and urine of insulin‐deficient diabetic patients was recognized in the 1880s and was associated with severe disease states. In the 1920s, it became evident that insulin lowered the content of glucose in the blood and urine of diabetic humans, and it also removed ketone bodies. Nonetheless, the idea that insulin controlled only glucose metabolism and that too little glucose in the blood led to brain dysfunction led to the widely held concept that glucose was the only fuel used by the brain. In the 1950–60s, researchers learned that insulin lowered not only the concentration of glucose and ketone bodies in the blood and urine but also a host of other fuels, including free fatty acids and amino acids. Unfortunately, these isolated discoveries did not correct the widely held misconception that ketone bodies were unhealthy and that glucose was the only source of fuel for the brain.

¿Are we over the persecution? Tim Noakes lost his job when he mentioned what it is here (2014), and blamed the high carb diet marketed for the obesity epidemic.  He even was accused in court, in a trial that looked like the Greek trial of Socrates.   No wonder Noam Chomsky says that our civilization is “involuding:”

The trial of Socrates (399 BC)^[1] was held to determine the philosopher’s guilt of two charges: asebeia (impiety) against the pantheon of Athens, and corruption of the youth of the city-state; the accusers cited two impious acts by Socrates: "failing to acknowledge the gods that the city acknowledges" and "introducing new deities".

https://en.wikipedia.org/wiki/Trial_of_Socrates#:~:text=The%20trial%20of%20Socrates%20(399,city%20acknowledges%22%20and%20%22introducing%20new

https://www.youtube.com/watch?v=rtmK8ZBsUJg

I let you with this video from GCN which is well done and illustrates what we should do.  The induction time for the diet should be longer, three weeks at least.

https://www.youtube.com/watch?v=_NdyZ-wIhcU

 

Triathlon and the Superleague

The creation of the Superleague is a sign of our times. Macca came with this solution because, as an athlete, he knew that the control of Federations and ITU was limiting the potential and fun of athletes. He did it for athletes and for himself as athlete and entrepreneur. Good for him! He is setting an example needed for humanity, creativity. He actually developed a different triathlon: ARENA TRIATHLON. 

 ¿What is happening with Football? This is quite different. The solution is not for athletes or footballers in this case, it is for the clubs and owners. Clubs take as a leverage the corruption in the international organizations. We are familiar with the corruption in Concacaf, UEFA, FIFA, etc. This corruption of the ones in power is a problem that Noam Chomsky voiced since Vietnam War, but he falls short when talking about the corruption in the organizations like United Nations and WHO that came after their creation, perhaps because the movements to destroy such organizations is very strong and we need them; and more importantly, we need them to be useful. We got to know how corrupted the WHO is because of the coronavirus pandemic (please see the articles written about coronavirus in this blog). The WHO is full of “amigos” that has very little to do with science and advising people using science. The football clubs use the same pretext for forming the Superleague as Trump used to stay out of WHO: "Chinese officials ignored their reporting obligations to the World Health Organization and pressured the World Health Organization to mislead the world when the virus was first discovered by Chinese authorities," Trump said. "Countless lives have been taken and profound economic hardship has been inflicted all around the globe." 

https://www.youtube.com/watch?v=OEdfJP9S4NE  

 

The problem would come in triathlon if Arena Triathlon wants to be an Olympic sport.

Triathlon Efficacy vs Effectiveness

 We are familiar with these terms from the COVID vaccines.  In triathlon it is quite similar.  Training heroes are not the winners in a competition; and vice versa, champions perform much better in a competition.  Let’s take a look at the vaccines now that we have new information.  Perhaps the post should be called: “Covid 19 effectiveness in Israel.”  I was tempted to put such a title, but I want to make a correlation with triathlon.

We have data from the Pfizer clinical trials related to Covid 19 vaccine.

Bozena Riedel-Baima¹,MD; Roman Zielinski²,PhD; Kornelia Polok²,PhD

Table 3.  Group III: cases between the first and second dose

 

	BNT162b2	Placebo
Cases	39	82
Participants	21669	21686
AR	0.0018=0.18%	0.0038=0.38%
ARR	0.38%-0.18% = 0.2%
NNT	100: 0.2=500	500 people must be vaccinated in order to protect 1 person  from developing symptoms of COVID-19
RR	0.0018: 0.0038= 0.474
RRR=efficacy	1-0.474= 0.526= 52.6%= 53%

The data from Israel is the following:

https://www.youtube.com/watch?v=fo9htB_kXxA

More than 180,000 people inoculated and PCR tested after first dose represented the cohort.  6.6% (more than 12,000) became PCR positive after the first dose, compared to 0.18% in the clinical trials.  In simple terms, the clinical trials represent the efficacy of the vaccine and the Israel experience the effectiveness.  It does not say much about mortality which apparently decreased in Israel after vaccination.  What we have learned from the experience and the questions that followed are below.

1) Measures were not followed after the vaccination: distance between person to person, use of masks and avoiding gatherings. 

2)   Measures could be more effective than the vaccines to stop the propagation of the virus.  Measures were in place before the vaccine and when clinical trial were done.

3)   Due to the degree of people infected after the first dose, the mortality in number of people per 100,000 citizens does not change much.

There are many hard working people in the world but very few aspire to be champions.  The problem of efficacy vs effectiveness is there.  Effectiveness has to do with the mental preparation and the mental work we put into.  The discipline to keep our way of thinking, believing in what we have to believe in order to have an edge, i.e. Mohamed Ali would believe that he was the greatest.  When somebody is born with privileges, he/she does not have to believe like Mohamed.  The mental work is the most important job in underserved environment to overcome it.  Effectiveness is a mental work that starts with administrating our time and efforts after looking carefully at the data available.