Dr. Phil Maffetone's "Big Book of Endurance Training and Racing" Review

Thanks to some of the participants on Barefoot Ted's Google group, I recently became aware of the work of Dr. Phil Maffetone.  We spend a good bit of discussing a various topics on that group, but a most of it concerns barefoot and barefoot-style running, and peripheral topics to running.  Diet comes up very often, because runners are either concerned with increasing performance or losing weight. A good diet is obviously important on either front.

Given my personal history, diet is of particular concern, and over the last 2+ years, researching diet and barefoot-style running have become my intellectual hobby.  So I've spent quite a bit of time learning about the science behind barefoot-style running and the paleo diet, since, respectively, reading Born to Run and discovering that I'm acutely wheat-intolerant.
So with that background, and my skeptical nature, I'm pretty impressed with Dr. Phil's book.  (As he's known in his online posts.)

The cons of this book are: Dr. Phil's credentials.  He's not a medical doctor, and he comes from an "alternative" medicine background [update: see the P.P.S. below].  That said, based on the reading I've done, he's pretty spot on for almost all of his suggestions.  And for whatever strange reason, most of the "alternative" doctors seem to be more open to diet as a cause for common medical maladies.  Examining the reasons behind that fact are fodder for another long post, but I will say that if the suggestions seem scientifically sound, you shouldn't discard them just because they come from a chiropractor.  That said, I'd recommend this book to anyone, with the following caveat (and the second con):

It's not well-sourced.  One of the compelling aspects of the Jaminet's Perfect Health Diet is that there book is well-footnoted with online resources that you can look up to learn more about why they make a specific recommendation.  Dr. Phil's book is not well footnoted.  You've got to take him on faith if you're not familiar with the research behind it.  The fact that the foreword is written by Mark Allen, the famed triathlete, and the afterword is written by Dr. Timothy Noakes, the famed exercise physiologist, should give you skeptical types some comfort.  For myself, I've already done enough reading to realize that Dr. Phil's work is well-founded, and don't have to rely solely on the testimonials.  But it would be good if he presented better evidence, as some of his ideas are pretty out there; while being correct, in my view.

The pros of the book are pretty simple.  You can save yourself my two years of diligent reading to achieve a much healthier approach to fitness and health just by following the recommendations of this book. 

I've been following most of the recommendations on diet and barefoot-style running for long enough (and before reading the book) that I'm a big fan.  The one part the book added for me was a detailed explanation of Dr. Phil's 180-formula for training intensity.  I'm now using this as my guide, and have definitely noticed benefits so far.  It's not magic, but it's definitely improved my training in the few months I've been using it.  I hope to continue through the winter, and start seeing the benefits of this approach come spring.

In a nutshell, Dr. Phil argues that you should train for most of your miles by keeping your heart rate low enough that you're primarily burning fat, and not carbohydrates, as fuel.  Dr. Noakes observes that following this approach helped Mark Allen to become one of the most fit and successful athletes in the world.  It's a pretty well-tested, if counter-intuitive, approach.  The formula is simply 180 - your age = the heart rate at which you should do most of your training.  (There are some complications based on fitness and injury status, but that's the basics.)  In my opinion, this is a training program for broken humans, who've been following the bad diet advice of the modern era, and not getting the sort of vigorous exercise that our bodies evolved to expect.

So I would highly recommend this book to anyone looking to get a better and comprehensive view of how to be fitter and healthier.  Or if you don't feel like poking around on this or any other blog that covers healthy diets and barefoot-style running, you can just buy Dr. Phil's book and be done with it.  I've already loaned my copy out to a good friend, along with Mark Sisson's The Primal Blueprint and the afore-mentioned The Perfect Health Diet.  (Happily I also got the Kindle version.)

Here are a bunch of segments that I highlighted in my Kindle and manually typed in here, since the Kindle doesn't allow copying [update: see the P.S.].  Sigh.

"Aspirin, ibuprofen (such as Advil), naproxen (such as Aleve), and other non-steroidal anti-inflammatory drugs (NSAIDSs) are commonly used for pain relief. If taking NSAIDs lessens your pain, it probably indicates your fats are not balanced."

Makes a lot of sense to me.  Excess omega-6 intake and insufficient omega-3 are pretty obivously indicated in a lot of maladies, most especially joint pain and weak cartilage.

"The most popular shoe in this category is the basketball sneaker.  Plain high-top sneakers were popular for many years, but today they have become fancy over-supported, overpriced high-top shoes. Supposedly, the added ankle support, the key feature of this shoe, protects against ankle sprain and other injuries. But studies don't verify this. Actually, these shoes can do just the opposite, as basketball players may have the highest rates of ankle sprains of any sport. When the ankle, or any area of the body, is supported, we run the risk of weakening that area. This is the result of muscles that sense the support and no longer have to work as much; the result is loss of some of their strength."

Again, makes perfect sense to me.  I think basketball players, and most other athletes, have been sold a bill of goods by the sneaker companies.  There's no evidence for any of the sneaker-company claims, except lots of injuries.

"Perhaps the first published scientific evidence describing the harm from shoes came in 1954 when researchers Basmajian and Bentzon measured the electrical activity in foot muscles using an electromyographic (EMG) device. This study showed that when shoes were placed on the feet, certain muscles lost significant function."

Well, Dr. Munson predates this by quite a stretch, as The Soldier's Foot and the Military Shoe was published in 1912, and tested on millions of feet by 1954.

"This is because shock absorption in the feet occurs at the same level of intensity whether we wear shoes or not."

It's even worse than that: shock absorption is worse when wearing shoes, not better, or even equal.

"For acute foot problems - recent injuries such as a fall, twisted ankle, or stubbed toe - the traditional RICE remedy of rest, ice (or cold), compression, and elevation can be very effective."

I'm not a big fan of RICE.  It's been tested, and found to be ineffective.  But if it makes you happy, or keeps your mind off your pain, go for it.  I never take pain killers or use RICE for my frequent falls and stubbed toes.  And I don't miss it.  (Twisted ankles are a thing of the past since going barefoot-style.)

"Other important factors included balancing fats, eating ten servings of vegetables and fruits each day, and controlling stress."

OK, sorry.  Ten servings of fruit and vegetables a day?  I think this is ridiculous.  I generally eat three meals a day, and may have a snack.  I think that if you eat more frequently you're probably doing something wrong.  This is one area where Dr. Phil is conveying ill-considered conventional wisdom.
He also has a chapter on oral pH, which is interesting, but about which I know very little...  But given the solid character of the rest of the book, something I will take into consideration.

So I have a couple of quibbles with Dr. Phil.  Big deal. I highly recommend this book.

P.S. Sean points out that one can access highlights via the Kindle web site.  I was using the Kindle for PC software to try to copy the text.  Live and learn.  This will make my next review a lot easier, as I love using the Kindle highlight functionality.

P.P.S. Luis notes this page where Dr. Phil describes himself thusly:

"While Tim’s essay seemed to focus on so-called alternative medicine, my practice style was not alternative. Instead, it was a physiologically based approach of evaluating and treating an athlete in an individual way rather than a cookbook style that is still common today. Properly stated, I practiced complementary sports medicine. Alternative medicine is an alternative to this approach, and especially one departing from more traditional or conventional medicine. (Many in the alternative medicine community say that I’m too scientific.)"

I like this description, and think it's 100% accurate.  Lots of reasonable practices are decribed as "alternative", complementary is a much better term for what Dr. Phil does.

P.P.P.S.  Sean has some additional thoughts.

P.P.P.P.S. Here's an update. Pretty remarkable improvements, IMHO. In addition, I did a regular warmup at the gym. I found a speed on the treadmill that would reliably keep my HR under the MAF rate (137 at the time), and then did my warmup run at that speed. I initially had trouble keeping it below 137. Now, I don't even get close to 137, and have finished my warmup run with HRs as low as 121. Pretty incredible. The treadmill warmup is a part of my gym routine that I've been doing for about 4 years prior, but I would also try to run fast. So this recent improvement in HR is not simply because I've started doing a warmup run, my routine was pretty consistent for years prior to starting Maffetone.