Raena Morgan: Hi, I'm Raena Morgan with iHealthTube, visiting with Dr. Rapaport. Dr. Rapaport, for people who feel a lack of energy because fatigue is a common complaint today, how would ATP, Peak ATP affect them, help them out? Dr. Eli Rapaport: The major fact on which Peak ATP acts is its stimulation of blood flow, and the stimulation of blood flow does stimulate the disposal of oxygen, nutrients, mostly glucose, into skeletal muscle, along with the removal of waste products, such as lactic acid and ammonia. Now, the stimulation of oxygen disposal, of course, has a major effect on fatigue. The other factor is the perception of fatigue and this has to do with the stimulation of the cerebral circulation. In other words, the brain has the major effect or the affect the circulation on metabolism and function has a tremendous effect on the perception of fatigue. But let's talk about the physical aspects of fatigue itself. Raena Morgan: Okay, that would be good. Dr. Eli Rapaport: One aspect is of course, oxygen. We have seen and we can talk about it long enough, the stimulation of blood flow means the stimulation of oxygen disposal into hypoxic muscles. Muscles, when they work continuously what we call endurance seem to be in the demand of oxygen and sugar. The reason that sugar is so important or glucose is so important for the endurance type exercise that produces fatigue is because the energy inside the muscles is generated by three different ways of beta oxidation of fatty acids, oxidation of pyruvate. Those two will carry the mitochondria, which is an organelle inside the muscle, inside the muscle fiber or by the oxidation of glucose that produces ATP, but can produce ATP anaerobically, in other words, without the presence of oxygen. Raena Morgan: Without oxygen. Dr. Eli Rapaport: So it does not depend on blood flow. And this is really the preferred way to produce energy. Not only is it the preferred way, but this is the normal way in which skeletal muscle produces energy not for the recovery period with the external fast contraction with a millisecond range. Raena Morgan: Oh really? And that takes place without oxygen? Dr. Eli Rapaport: That takes place without oxygen, by the breakdown of glycogen into sugar, and then the sugar is broken down in the three, the sugar, the glucose has 6 carbon units and it's broken down into 2 3-carbon units which then provide the energy to produce ATP. Raena Morgan: Which will alleviate the perception of fatigue? Give us the sensation of more energy? Dr. Eli Rapaport: It would give us the sensation of more energy, but the perception of fatigue also has to do with the effect of recovery. Raena Morgan: Recovery? Okay. Dr. Eli Rapaport: The recovery is also dependent on the oxygen-induced ATP synthesis inside muscle cells and the beta oxidation of fatty acids and oxidation of pyruvate, along with the removal of waste products. The removal of waste products is extremely important in the perception of fatigue, or in the fatigue itself, because the lactic acidosis, the accumulation of lactic acid in the muscle, is one of the major causes of fatigue and muscle pain. Raena Morgan: Okay. Dr. Eli Rapaport: Along with the presence of ammonia that is due to the synthesis of NO from arginine. Now, stimulation of blood flow has to do with the enhanced removal of these two agents. Now again, I'd like to emphasize this, the stimulation of blood flow and the stimulation of sugar optic into the muscle cell are the major, major factors that enhance the removal of waste products and the disposal of oxygen and excess of glucose into the muscle. Raena Morgan: Okay, thank you, Dr. Rapaport.