Inigo San Millan was formerly a physiologist for teams such as Vitalicio Seguros, ONCE, Saunier Duval, and Astana. For better or worse, he has worked with riders such as Joseba Beloki, Abraham Olano, Chris Horner, Fred Rodriguez, Jorge Jackshe, Leonardo Piepoli, David Millar, and Alexander Vinokourov. I spoke with San Millan recently about the state of the sport, the state of coaching in America, and his decision to leave the sport at the pro level to pursue research at CU-Denver.

Andy Shen: Let’s start with the Bio Passport. Bernard Kohl has been in the news saying that it doesn’t work, that he doped the whole time and wasn’t caught. Is it possible to have an airtight case using a rider’s bio profile?

Inigo San Millan: The thing is that the Biological Passport is based on indirect parameters at this point, aside from the regular blood and urine analysis, the Biological Passport takes a bunch of hematological parameters that could be abnormal and could be an indirect indication of doping. However, some cases are very very clear, extremely clear that someone’s doping. The point now is to bring a case against that rider, and that’s what they are now having extensive meetings among the experts, the passport panel, that they can be 100% sure that a certain rider has tested positive.

AS: I guess the frustrations for the fans is that you have someone coming forward who has been using CERA and transfusions, basically not being caught. There’s always the suspicion that the UCI is not a strong enough enforcement agency, since the catches are being made by the IOC, AFLD, and the BDR, but not the UCI.

ISM: The UCI has done cases as well. As a matter of fact, if you go to a race right now and talk to the riders, the teams in general, the whole doping scene has been decreased dramatically because of the passport. You can see the profiles, the UCI has been showing profiles of the average hematocrit, Hemoglobin, the average testosterone levels, and other hormonal, and for the most part everything’s very normal right now. You wouldn’t see any cases of high hematocrits any more, that’s very well controlled right now.

The degree of doping has decreased so much, the UCI’s doing much more than any other federation, way more advanced than other sports. The UCI conducts far more tests than any other international federation, it’s the only federation in the world that applies all the battery of tests available right now. The more tests you do, the more people you’re going to catch.

Imagine here in Denver, there’s an alcohol test at every traffic light, and there could even be random tests even before you put your key in the car, boom, there’s the police there to test you. In absolute numbers Denver would be the city with the highest index of drunk drivers in the world. Imagine on the other side, in New York City, there’s only two policemen, two traffic lights, and everybody knows where they are. In raw numbers, New York’s positive numbers would pretty much be zero.

At the end of the day, you’d be much safer driving here in Denver because there’s so much control compared to New York. That’s pretty much what happens in sports. We hear about more doping cases in cycling just because they do so much more with the tests. We see in other sports they either never test for foreign substances, or they test for only a few substances, so you don’t see the whole picture there. Many people miss the whole picture there. The statistics for doping in cycling are probably the lowest in sports. They do about 10,000 tests per year and we only see only 4 or 5 cases per year. So we’re talking .04-.05%.

However, I agree with you that there are still some people who are still doping. I don’t know about Kohl, where he says he was taking absolutely everything, which probably isn’t real because they would’ve caught him or found him very suspicious, so I was wondering what kind of substances he was taking, you know what I mean? For sure, the blood doping is a major concern right now, ’cause there’s no catch method right now. I think the community has to come up with a detection method before this gets out of hand.

AS: Is it a low number of positives an indication that it’s clean, or is it an indication that the dopers are very good and they’re very far ahead of the testers?

ISM: Well, I see that in other sports, where they don’t test for anything or they test for very few substances, a low index of positive tests is an indication that there’s doping there. However, in a sport where’s there’s so many tests, a low index probably means they’re cornering the problem.

AS:  Allen Lim said you have a huge database of all the climbing speeds over the years, and that looking at that you’re hopeful, that there’s a good trend in cycling right now. Did you see a spike over the EPO era?

ISM: Yeah, I have data from last year’s Alpe d’Huez, I wrote about that for a Spanish newspaper. Sastre was the winner of that stage, and he went, boom, right from the gun, he attacked and went solo. That’s kinda rare, people usually wait halfway through, right? So he attacked from the gun, he was 100% all the way up. His time up Alpe d’Huez was the 13th or 15th best time ever, and that was right from the gun, full gas.

He was about 3 minutes slower than the record and about 1’30-2min slower than the times from the 90’s, and the followers were 2 minutes behind him. The times were similar to those that Fignon, Lemond did in the 80’s. So definitely you can see there’s a trend, and cyclists are not going as fast as before

AS: Why did you leave the Pro Tour and go into research.

ISM: I was just tired of traveling, up and down. I was spending 100, 150 days per year, and I had a family, it was very stressful. I have been trying to implement new methodologies…yeah, doing pretty well, for the most part…but it was stressful. Because you never know as in some cases you have no control over some riders.

The problem we have in cycling, because you always have 3, 4, 5 riders, they could be working outside the team, behind your back, and that creates a lot of stress. I’d say in the last few years, pretty much all the riders who have been caught positive have been working behind the team, outside the team, and that’s a major concern. We’re talking about some teams, they have 10, 12, 13 nationalities, there’s no way you can control all those people living in different countries, you don’t know what they’re doing outside. So I think the best way to control everything is to provide everything from the team, to give the riders tools, to set up sports performance programs within the teams.

I think, for example, Garmin has done a great job with that. All the riders are supervised, under tighter control within the team. All the riders are provided with excellent tools for training and nutrition, physiological testing… I think that should be the goal for teams. I think the problem now in cycling is that riders need tools, a lot of scientific testing, physiological advice, nutritional training, within the team, so that the riders don’t have to go outside the team to seek that advice.

It’s hard work to try to implement that. All the traveling, I just…I just had to come over here!

AS: Were you concerned that someone was going to sully your reputation? That one of your riders was going to do something illegal and ruin your good name?

ISM: Oh yeah! Of course that’s a big concern. Because all the cases you’re seeing recently, all the riders being caught were working outside the team, but to the general public they were in the team. So yeah, that’s a major concern. I’ve never been with a team with a positive case, but when I left Saunier Duval, they had a positive with Mayo. And then when I quit Astana, knowing that was an accident waiting to happen, a few months later, Vinokourov and Kashechkin.

I was always very concerned about that, that creates stress, ’cause it can hurt your reputation. That’s something that anybody in the ProTour can tell you, that people are very stressed about this. So that’s why it’s even more important to control everything within the team and provide the riders with nutrional advice, phsiological advice, testing, so they don’t have to worry about anything else. The education part is really important as well.

AS: You’re studying physiology in cycling. To me, it’s a field that’s very difficult…is it possible to do a double blind test? You can’t go back in time and test the same person in a different way, to see if this different method is better. Some of these training methods, you need a year of more to validate, and you can’t have two groups because everyone’s different. Is it a difficult field to quantify?

ISM: I don’t think it’s so difficult, especially with the quantification. I think that the problem is most cyclist, they’re not doing the quantification. The physiological testing, for example, here in the US, what I see, it’s pretty much non-existent. I started working here six months ago, I see that the vast majority of cyclists here in the US, they never test, which is coaching 101. So, that’s why the quantification is impossible.

It’s pretty much impossible to difficult to prescribe an accurate training program if you don’t know who you’re working with and have physiological parameters. You’re blindfolded. It’s like if you go to your family doctor and without any diagnosis he gives you antibiotics to cure everything. So that’s why there are many training schools, training methodologies, but if you don’t do previous quantification, physiological testing, how do you know the training is good for that rider, if you never assess the weak points of that rider. Or how efficient this rider is at clearing out lactate, or how efficient this rider is at utilizing fat for energy purposes, or metabolically speaking how efficient that is.

I think that, here, especially in the US, people just have a training program, especially with many cyber coaches, there’s no scientific approach to it.

I think that, here, especially in the US, people just have a training program, especially with many cyber coaches, there’s no scientific approach to it.

AS: That’s sort of my feeling, how do you know? Ok, do these intervals, but how do you know, how are you going to prove to me that they worked? Maybe it was just the volume, how do we not know a different type of training would make me better? It’s so amorphous.

ISM: That would be more difficult to quantify, but that’s why you do a monitorization of these physiological parameters throughout the season. First, if you do a scientific physiological test, then you have something to work with: you have to work on this area, so you work on this area, start to do this training, then two or three months down the road you do the test, and you see this training improves physiological parameters.

Maybe a different training might improve more or less, but you’re improving… However, you can assess if that training is not right one, if you’re not improving or even getting worse, so that you can correct. To have those reference points, just by training, it’s very difficult.

And another thing, it’s a big interference, and it happens all the time, is that there’s no monitorization. You might feel this training is the right one, there’s a huge artifact there because you don’t know if you’re assimilating this training program. These too many intervals might not work for you, maybe not because it’s not the right training, because it might be the right training, maybe you’re not assimilating so well. Maybe the right training for you, but not at this dose.

That’s why it’s important to do more monitorization of these numbers, that’s another scientific approach. We have to do regular blood analyses to see if you’re assimilating training and competition.

AS: What kind of tests do you think a coach HAS to do for his clients?

ISM: It’s important to do blood analysis, there’s many parameters in the blood that can give you very accurate answers of what’s going on. Here in the US, applied exercise physiology is not very clinical, they have brilliant physiologists working at universities, very well prepared, probably better than in Europe, right? But from the applied standpoint, there’s not much scientific approach, and not much clinical aspect.

For example, this blood analysis, for us, in Europe, it’s a must. We even do it to junior athletes, monthly blood analysis to see how well they’re assimilating competition and training, therefore we can detect problems in their training programs, identify them and correct them. Whereas if you never do any tests, you’re going to miss this point, and this is what I’m seeing in the athletes here. Many athletes are overtrained. I’m kinda shocked to see how many cyclists are overtrained, they never have heard about these things. So they get used to this. Sometimes I see someone, "You’re fried! You’re overtrained, you’re fatigued!"

"Yeah, yeah, but I’m a cyclist, I’m supposed to be tired."

Well, not really! You can prevent these situations. You have to do this monitorization. That’s why I think that many cyclists here, even at the professional level, they need to rely more on scientific and clinical resources as well as more qualified professionals in some aspects. Many people rely on coaches, which I think is great, but I think here the coach, as well as the cyclists, may have to find more qualified help in their field.

Maybe not coaches, necessarily, but testing, monitorization.

This blood analysis, there are many hematological and biochemical parameters, there’s also many parameters in blood that can indicate very clearly what’s going on in your body. So now we can detect overtraining, we can prevent overtraining, even differentiate between different kinds of overtraining. We can see exactly where this overtraining comes from and we can correct your training.

AS: What about traditional tests that are more familiar to cyclists? Lactate and VO2? Do you advocate those as well?

ISM: Yeah, of course, especially lactate. With lactate, it’s probably the single most important parameter we have to estimate muscle metabolism, and maximum efficiency. It’s very important to test how an athlete’s physiological parameter’s status is, and to prescribe the right training, and to foresee and predict performance. Categorize athletes into one category or another. I just presented last week at the American College of Sports Medicine conference a study with a new protocol that I have of physiological testing in the laboratory, I am assessing cyclists and the physiological differences with this new protocol between junior athletes, amateur athletes, protour cyclists and world class cyclists, the differences are very big, very important, especially between your average protour and world class cyclist. This is the first study that differentiates between the protour rider and world class riders.

So it’s first possible to differentiate, to discriminate, to categorize cyclists, definitely for training purposes it’s very important. That would be the scientific part related to testing and training. The monitorization is the follow up part, how well can we write the training plan now, how well are you assimilating it?

AS: You’re talking about differences between all these levels of cyclists. What are the parameters that you’re looking at?

ISM: For example, with this protocol, I look at watts/kg instead of watts, it discriminates a lot more. I also use longer stages. Most of the tests that are used right now are cardiology directed protocols, so they’re not cycling specific. So they don’t discriminate very well, this is the typical situation that I see. Tour de France podium rider, coming to me, telling me, "This is the first time they’re telling me I’m a good rider. With this protocol. Because in the rest of the protocols I did before, they told me I was a very average rider, not even an amateur rider." So obviously that doesn’t make sense, right? So you need a test that discriminates better, so I’m looking at watts/kg, and the lactate concentration at watts/kg.

So at 5 watts/kg there’s big important differences already, at low watts/kg, juniors, amateurs, protour riders, professionals, are similar, starting at about 4 watts/kg we see already important differences between juniors and amateurs, protours and world class. At about 4.5 the amateurs, you start to see differentiation between professionals and protours. At about 5 you see a big difference between protour and world class.

AS: These blood tests, I have never heard of a coach doing that.

ISM: Exactly. I was kinda surprised that I hadn’t heard of anyone doing it.

AS: This is common in Europe?

ISM: In Europe we have a tradition of doing this. Again, physiology, it’s very clinical, we do this all the time, and it’s a very powerful tool to assess how cyclists assmilate training and competition. You can not only detect, you can prevent overtraining. Here, for whatever reason, maybe because endurance sports haven’t been very traditional here, or you have coaches that haven’t learned how to interpret these parameters…I’m still trying to figure out why.

AS: I really have never heard of that before. How would you advise someone to select a coach? What do you look for, what do you think makes someone more qualified?

ISM: First, an academic background. More than experience, I would look for an academic background. If you have the academic background, than experience is even better. I’ve worked with many protour cyclists, just because they are protour doesn’t mean they know about cycling. Many protour cyclists, they’re completely lost. You have to teach them how to eat, how to train, everything, you know? So just the fact that they are protour, that doesn’t mean that they can train a lot of people, because many they don’t know themselves how to train.

So I would look for more of an academic background, and as well as experience working with competitive athletes. Something I’m trying to implement here, is for coaches to work with physiology laboratories. For example, in Colorado, I’m trying to be a reference for coaches, so coaches can bring me cyclists, I can give them information about their training zones, information about their physiological parameters, their metabolism, their weak points, their strong points, and give that information to coaches, and the coaches can then just train that individual and do follow up with them. I’m looking for coaches that are open to the scientific approach, the whole picture. Unfortunately, now with the power meters, it’s very easy for many coaches to do an ftp test, 40 minutes, get the results, plug in the numbers, hit enter, and boom boom boom, you have training zones.

That’s not a very scientific approach, it could jeopardize their clients’ performance as well.

AS: Coaching is such a strange profession. I’ve heard so many stories of juniors being horribly coached, not to mention being forced to take unknown substances. But I’ve heard stories of them being told to do 120 miles a day, day after day, no you’re not exhausted, you’ll come around. It seems there hasn’t been a lot of good science.

ISM: You’re exactly right. That’s something I’m seeing as well. I think that many coaches, not all of them of course, many take advantage of this, and also most cyclists, they don’t know what’s out there. They haven’t seen other different methodologies. I see many coaches do a copy and paste type of thing, they give the same training to everyone. It’s absolutely impossible, that should be coaching 101. It’s impossible to prescribe a specific training program to someone if you don’t know the physiological parameters and the right exercise intensities. It’ll be crazy. It’s even crazier to pay 300 bucks for that service, it’s kind of ridiculous. Most of these types of coaches, they wouldn’t be paid more than 20 bucks in Europe for this type of service. Or not even get paid.

That’s the thing. For 300 bucks a month we have physiological testing, blood analysis, month to month consultation to assess body fat percentage, review your training programs, you have daily training programs, with specific training intensities, which are right from the physiological tests. If you pay 300 bucks for that, how in the world are you going to pay 300 bucks for a copy and paste training program from a cycling coach on the other side of the country?

I think among all of us, we have to set up better standards for coaching. I think clients are responsible for that, for asking coaches for better standards. Hey, I’m paying you 200 bucks, and all you’re giving me is a sheet of paper?

I think clients are responsible for that, for asking coaches for better standards. Hey, I’m paying you 200 bucks, and all you’re giving me is a sheet of paper?

AS: This is very shocking to me, I don’t know if you know this, but the general perception that exists in this country is that Europe has these old traditional ways that are all intuitive, and Americans went over there and brought along technology and open mindedness to science. That is a very very pervasive belief here, and you’re telling me the exact opposite.

ISM: Yeah, I think that in Europe you have a little bit of everything. You have very intuitive cyclists, they have never heard of heart rate monitors, but you also have the whole scientific package. Even with kids, starting at 15 years old, it’s very normal for a 15 year old kid to have two or three physiological tests per year, and at least a blood analysis every two months, and a monthly test monitoring your body fat percentage, as well as a daily training program. That’s very normal. I thought as well, going back to Greg LeMond, he did an amazing thing for cycling, he brought so much technology from the US. But we’re talking more about cycling technology, bicycle technology, aerodynamics, things like that.

So I thought when I came here, it’s going to be so advanced, all the physiological follow up and science, and I see data at the university level is extremely advanced, but at least in the business of cycling that doesn’t happen.

AS: Is there a particular country in Europe that’s more advanced than others?

ISM: I would say the five typical countries in Europe, the traditional ones, Italy, France, Spain, Belgium, Holland, they’re very traditional and very old school in many things, but on the other hand they’re the most advanced in the scientific operations, I believe. Also, you see the Australians and British are extremely advanced as well. Australians probably more than the Europeans. The Australians are doing an amazing amount of work in this field from what I have observed. They’re successful with everyone, everyone can enjoy the fruits of the scientific approach, because the Anglo Saxon coaches are very open to this, but in Europe you cannot achieve that with everyone. You’ll have people that don’t even know how to open a laptop.

That’s the irony, ’cause Anglo Saxon countries are more scientific than Europeans. Maybe it’s just here in Colorado, but it’s strange. You see the scientific approach with the power meters, but it all comes down to power meters. Unfortunately, the power meter is just a device that reads power, it doesn’t read physiological parameters, hemoglobin, hematocrit, blood parameters, overtraining, there are a lot of things, lactate, vo2, metabolism, there are a lot of things power meters don’t measure. Many people are using power meters, "wow, this is the only thing that you need", but just going by that, it’s not very scientific.

AS: These blood tests, that’s not something the typical cycling coach can do, right? Does it have to be at a research institute or university?

ISM: Or a hospital, or sometimes your family doctor can give you a regular blood analysis. You also have to interpret it. That’s why in Europe all the coaching businesses involve several people: the coach, there’s the family doctor or physiologist who does the blood test work and interprets that, there might be a nutritionalist involved… Before getting a racing license, it’s mandatory to get a physical, an EKG, so there’s an element of prevention as well. So it involves several aspects.

AS: Come to think of it, all the famous European coaches, good or bad, were doctors. Whether it’s Conconi, Ferrari, Testa…

ISM: Yeah. We’ve seen people with a lof of knowledge, who can do a very fantastic job with their knowledge, and they’re getting into dangerous situations. I think there’s no need for that.

AS: Do you get the same amount of enjoyment working with amateurs as you do with professionals? Or is it all science to you?

ISM: It’s much much better for me working with amateurs, juniors. It’s more fun, it’s better. The great thing with working with juniors is you can start when they’re a kid, so you can give them good advice and create good habits. Working with professionals, sometimes it’s difficult. Some of them, they don’t listen much. It’s a difficult way to work. Amateurs and juniors, they don’t have the stress of professionals, it’s much better.

With professionals, it’s much much easier to work with Anglo Saxon or Central European riders than working with Spanish, Italian, or French riders, because of the culture. It was great, when I was working with American riders, Central European riders, it was excellent. We connect a lot better, more open to new information. They love information. Here in the US now, it is great to work with American riders and pros. They are a bit inexperienced and need to be more scientific but are great to work with. However, many old traditional European countries, they just say, "huh", they don’t trust the scientific approach. Many of them do, but many others, like I said before, they don’t even know how to open up a computer. So how are you going to show them the scientific approach? It’s going to be difficult.

AS: When Allen Lim was here he mentioned that you did some testing with him, because he was just overloaded with the amount of testing at team camp. How’d you find that experience, working with Garmin?

ISM: It was great. It was absolutely great. I think that group of riders is very well educated, which is a key for the anti-doping fight. The whole team knows what a lactate threshold is, what a power meter is, how to use it, everything. Especially with the work of Allen they’re very well educated, so it’s extremely easy compared to a very traditional rider. It’s very easy to work with them, ’cause they understand. And the more a rider understands about how their body works, the better the cyclist they can be, and the less chances of getting involved in doping practices. Vaughters has also done a lot at implementing this new culture. They’re going to be more confident in what they do. And I think that confidence is a big thing for Garmin.

AS: So you want to give them the belief that you’re giving them all the tools to compete even if it’s not an even playing field.

ISM: Exactly. In the 90’s, it could’ve been very difficult to play with just the scientific approach. It wouldn’t matter, if your hematocrit was 55, you didn’t need to eat, to sleep, anything. Now, the situation has changed dramatically, believe it or not. It’s much much easier to compete utilizing the most resources possible, to compete with those who cheat. It happens. You see cyclists, who might be cheating, and they’re not using 100% of their potential, because they think this drug, it’s going to replace my training, my nutrition. Nowadays, that rider won’t be able to use that drug, or if they do they can only use small amounts, so it’s not going to impact their performance as much. So they’re only using 30% of their potential.

Therefore, if you’re a clean rider, if you use a larger percentage of your resources, you’re going to be much better off than that rider. I think that’s the situation we’re in today, and I think it’s great that those riders who really believe in clean sport and utilizing their maximum potential can be very confident and they can compete.