PAD Oxidative Phosphorylation Training For Peripheral Arterial Disease

The other day, I was riding my bike for 60 miles, at an easy 110 Watts, on a gentle roller course, to encourage mitochondrial growth (biogenesis), and oxidative phosphorylation, for efficient energy (ATP) production. This, and the magic of chemiosmosis, is worth understanding, as PAD oxidative phosphorylation could well be critical for handling peripheral arterial disease.

PAD Oxidative Phosphorylation
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I learned this mitochondrial trick, several years ago, from my great triathlon coach, Chris Hauth. I asked him why he set me a six-hour (not easy), 110-Watt (easy), bike ride. Chris replied, “To encourage mitochondrial proliferation.” Having extensive biochemistry training, and interest, I thought, “Brilliant idea! Perfect for endurance sports.”

You keep the load low, well away from your lactate threshold, to encourage oxidative phosphorylation (efficient energy production, burning fat), rather than glycolysis (inefficient energy production, burning glucose).

I hate to say this, but in order to understand your peripheral arterial disease, aka PAD., you do need to learn a little anatomy, physiology and biochemistry. You could read Harper’s Biochemistry for fun. It’s really interesting, honest, and written for MDs, so it’s easy reading (that’s veterinarian speak). I have that book on my iPhone Kindle app. I’ve been reading every new edition since 1973 (it was a bit of a rag with a different name, back then, but I loved it). You don’t need to read the whole book, unless you want to understand your nutrition, a little better.

You probably don’t need to know how the adrenal medulla might be talking to the intermediate lobe of your pituitary gland, but when it comes to lower limb PAD, you do need to have some idea about the anatomy of the affected structures (hips, thighs, calves, feet – and your heart, btw), and how they receive their blood supply.

But biochemistry?

Back to my 60-mile ride, when I had plenty of time to think. It suddenly occurred to me that mitochondrial growth would lead to more effective use of the limited amount of blood reaching my calf muscles prior to, or during, claudication. And my feet, for that matter, before, and as, they become numb. I wondered, “Am I making progress with my PAD due to my ongoing work on mitochondrial growth for Ironman training?”

I just managed, after three years from my first report, to achieve a 14:30 average pace in a three-mile run.

Run on asphalt rollers, locally, about a week ago. This is a far cry from my Boston qualifier pace (9:19 min. x 26.2 miles), in 2008, but with PAD it seems like a miracle. Luck? No way! Lots of work, and changes to the way I run, to optimize blood flow to (and from) my calves and feet.

I headed for PubMed, and found I wasn’t the first to think about this. A relevant piece of research popped up straightaway, as follows:

“Skeletal Muscle Mitochondrial Dysfunction and Oxidative Stress in Peripheral Arterial Disease: A Unifying Mechanism and Therapeutic Target.”

I vaguely remembered, from my previous studies of bioenergetics, that a ketogenic diet (high fat, moderate protein, low carbohydrate) in the improved mitochondrial function in rats.

PAD oxidative phosphorylation
Happy Rat! I like rats to be happy, as they are wonderful creatures, but not in my house, please.

I thought, “In addition to my mitochondrial growth promoting bike workouts, that a ketogenic diet might also be beneficial.” This is tough to do on a largely vegan diet, but it could well be worth exploring. Years ago, I attempted completion of an Ironman race after one year on a strict ketogenic (Paleo) diet, with some success. I almost made it on three eggs for breakfast, at 4:00 a.m., the morning of the race, as opposed to a massive carbohydrate-heavy, liver glycogen loading, meal the night before, a huge breakfast at 4:00 a.m., and constant eating on the bike (Fig Newtons and bananas) and the run (gels and anything I could scarf at the food and water stops).

I nearly made it: 138.2 miles by midnight (17 hours into the race). I was not quite ketogenic enough.

I’m not about to start eating meat again, but I do try to stick largely to low and intermediate glycemic index foods.

I’m not saying you should do this, but when it comes to PAD oxidative phosphorylation, some research could well be justified. You could experiment on yourself, as I do all the time, but that’s your call.

One of my vascular surgeons, Tara Mastracci, told me during the time I interviewed her after her team fixed my bike-wreck-induced, AAA stent graft dislocation, in 2013, at the Cleveland Clinic, that I should do Ironman my training under medical supervision.

Great surgeon, and a marathoner (once, at least?). Thank you Tara Mastracci, -kev

Great advice, but I’m yet to meet a physician willing to accompany me during my training and races. I doubt they have the time. Fortunately, I do have medical training, as veterinarian and Fellow of the Royal College of Pathologists (largely an MD club, but they accepted me based on my published research).


Next time you are using exercise and/or diet to keep your vascular disease at bay, consider PAD oxidative phosphorylation as one potentially important variable.

You might even consider a Paleo Diet, and see what happens. Preferably a vegetarian paleo diet.

Here’s my recent certificate, just in case you doubt my PAD credentials. You have to embrace and use the pain!

PAD oxidative phosphorylation

Furthermore, Kimberlie McNicholas is a wonderful resource for vascular disease patients.

Thanks again, Kimberlie.

-kev aka FitOldDog

PS Remember, “A life without risk is no life at all.”

PAD oxidative phosphorylation
MRI scans through the thighs of three guys. Grey is muscle, white is fat, clear ring around the central white spot (bone marrow) is the femoral bone. Note the loss of both muscle and bone mass in the sedentary guy.


  1. Bobby Levin says

    I know you prefer a vegetarian diet, but could one include meat and fish and achieve the same benefits from a keto diet? How much protein do you get on a daily basis? I am a little younger than you and based on current recommendations, I should get about double the RDA. Tough to do without meat and fish.
    Do you feel you are taking a risk by avoiding statins?

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Disclaimer: As a veterinarian, I do not provide medical advice for human animals. If you undertake or modify an exercise program, consult your medical advisors before doing so. Undertaking activities pursued by the author does not mean that he endorses your undertaking such activities, which is clearly your decision and responsibility. Be careful and sensible, please.