00:00:00
Death is inevitable, but the rate of decline is very much up to us. But the drawback that young people have is they only begin to realize the inevitability of the decline when it besets them. So
00:00:12
your team that came in for testing that are in their 20s, when I'm looking at these results, there were issues that were uncovered that were a concern. And
00:00:18
ignoring it doesn't lead to a good outcome when you're 65. But a lot of people have this issue. So it's okay to speak freely about this. Yeah. The
00:00:25
biggest concern is that Dr. Dr. Peter Aia is the go-to physician for high performers, celebrities, and anyone
00:00:31
serious about unlocking the science behind a longer, stronger, and healthier life. I had a big epiphany at a funeral
00:00:37
of a friend of mine who I realized had declined so much during their last decade that when they couldn't do those
00:00:43
things that gave them pleasure because of injuries, aches, and pains, they weren't enjoying life. I call it the
00:00:49
marginal decade. Wow. Okay. So, what are the most important parts of my health that I should be thinking about for
00:00:54
longevity? So there's muscle mass, muscle strength, but we don't have a single metric that we can measure that
00:00:59
better predicts how long they will live and how high their V2 max is, which is a maximum amount of oxygen you can
00:01:05
consume. And if you compare somebody who is in the top 2% to someone who is in the bottom 25%, there is a 400%
00:01:13
difference in their all-c cause mortality over the coming year. But how do I know if it's an issue or not? We'll go into much more detail around that,
00:01:19
but the way to avoid this is to train specifically for that marginal decade. And there's so many things that we just
00:01:25
do wrong. The sooner you start, the better. So, rule number one, this has always blown my mind a little bit. 53% of you that listen to the show regularly haven't yet
00:01:37
subscribed to the show. So, could I ask you for a favor before we start? If you like the show and you like what we do here and you want to support us, the
00:01:44
free simple way that you can do just that is by hitting the subscribe button. And my commitment to you is if you do that, then I'll do everything in my
00:01:50
power, me and my team, to make sure that this show is better for you every single week. We'll listen to your feedback.
00:01:55
We'll find the guests that you want me to speak to and we'll continue to do what we do. Thank you so
00:02:03
much. Dr. Peter, what is keeping you busy at the moment in terms of the subjects that you wrote about and outlive, but the work that you do online and the work you do in the variety of businesses that you have? What is
00:02:15
keeping you fascinated at the moment? Like what is what does one's mind focus on? I wish I could say one thing.
00:02:21
There's probably a few things and maybe that's um not good. Uh maybe the most successful people in life only think about one thing. I would say one of the things I'm thinking a lot about is how
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to translate outlive into a delivery system uh obviously digitally that basically operationalizes what is in that book in a manner that allows people to with as little friction as possible
00:02:48
implement the solutions for themselves. So basically how do you live a longer life? How do you age uh as gracefully as
00:02:55
possible and maximize your health span? I think the other thing I'm focused on that is related to that of course but
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distinct um which I know your team got to participate in a little bit this week was kind of how to train people for
00:03:11
their marginal decade right so this idea of we're all going to have a last decade of life I call it the marginal decade
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just so that we can get comfortable talking about something that people don't like to think about and um I'm
00:03:24
convinced that ignoring it and Not thinking about it doesn't lead to a good outcome. Instead, if you prepare for it
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and train for it like an athlete trains and prepares for their sport, uh you'll have the best version of that possible.
00:03:39
Marginal decades and centurion decathlon. Did I say that correctly? Centinarian decathlon. Yep. Centinarian
00:03:45
decathlon. Can you explain these two terms to me? Y. So, the marginal decade is the last decade. Last decade of life. Again, it's this weird thing where most
00:03:52
people don't know the day they've entered it, but most people also realize at some point when they're in it.
00:03:59
Um, I thought a lot about it. This was sort of a big epiphany that I had in 2018 when I was sitting in the in the
00:04:07
church at a funeral of the parent of a friend of mine who's who I realized had declined so much during the last decade of their life that even though they were
00:04:20
alive they weren't enjoying life. The things that they loved to do in the case of this individual play golf and tend to the garden they couldn't do. they just
00:04:31
physically couldn't do it right. They had injuries. They had aches and pains. And when they couldn't do those things
00:04:38
that gave them pleasure, they retreated from life. And I I I don't think there's a person listening to us who can't
00:04:45
appreciate that because they they've witnessed it, right? They've seen it in a parent, a grandparent, a loved one.
00:04:52
And I don't know, there was just something about that moment, which is often the case, right? It's usually like
00:04:58
years and years of thinking about something and it crystallizes in an instant. But in that moment, I realized
00:05:03
aha the way to avoid this is to train specifically for that decade. And the best model for how to do that is to look
00:05:14
at athletes because every athlete trains with specificity, right? So think think of like all the different types of
00:05:20
athletes you would know. So if you think about like a sprinter or a basketball player or a football player, they are so
00:05:29
different and very little of their training looks like the other guy. And the reason for that is they're doing something very specific, right? The sprinter has a goal which is to move 100
00:05:40
meters as fast as possible. That's it. And that requires a certain set of skills. And the footballer has a totally
00:05:47
different goal. Yes, he has to be able to run fast for short distances, but just being able to run fast would not
00:05:53
produce in, you know, superior results. And then the basketball player would be different. And then the skier would have a totally different set of skills. So I
00:06:00
said, "Well, who's the most well-rounded athlete out there?" It's the decathlete because that guy's got to do 10
00:06:06
different things really well. Now, he or she doesn't have to be the best in the world at those 10. In fact, they never are. But overall they're considered the
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best athlete because of the diversity and breadth of what they can do. And so I said that is our model. So what is the
00:06:25
centinarian decathlon then is I say to you Stephen one day you are going to be in your marginal decade. What do you want to be able to do physically athletically in that last
00:06:38
decade? It's the answer is so clear to me because it's associated with all the things that make me happy. So it would
00:06:44
be being able to explore the world still with my partner, my romantic partner. It
00:06:50
would be But I would even dig further. Tell me what that looks like. Okay. So I went to Bali. Mhm. And me and my
00:06:57
girlfriend wanted to go white water rafting. And to get down to the white water rafts in Bali, we had to walk down
00:07:03
and then up again. Mhm. About a 100 meters of stairs. And as I went down those stairs, I had one of those moments that it sounds like you had at the funeral where I realized that my dad could not walk down these stairs. He
00:07:15
couldn't walk down them and he couldn't walk up them. And by the way, it's a different reason. I'm going to point this out and I want to come back to your
00:07:21
story. Walking down is not about endurance. Walking down is about eccentric strength in the quads to be
00:07:28
able to uh decelerate the body as it's moving down. Very important. Coming up is about concentric strength in the quads and glutes. and endurance. Okay. All right. But continue. No, that's a
00:07:40
really good point because they're two different training systems. And then the reason why that was so important was
00:07:45
because of the great time I had in the white water raft with my girlfriend. So going down that lake through barley and
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I thought, gosh, it hadn't if I'm not careful and I don't think about this, I won't be able to have these experiences when I'm 60. What was involved in being in the raft? Yeah.
00:08:02
So, a lot of strength required to like row um to keep us away from the rocks um to push us off when we got stuck. Um
00:08:09
fall in the water, get it back in the boat. Absolutely. Think about the scapular stability that's required. Think about
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the upper body strength you need to lift yourself back into a boat if you fall. I mean, the list goes on and on and on.
00:08:21
And it was it was it took a long time. We were out there for two hours going through this lake. So, the other thing I think about is Christmas. And I I think
00:08:28
about my nieces. So, my brother's a year older than me and he has three kids under the age of six. And you know what
00:08:33
that's like? These kids just sprint off in every direction. And they'll say to my dad, they'll say, "Come and play in the garden." And my dad um wouldn't be
00:08:41
able to play with them in the garden the way that they would want to play in the garden, running around um being chased around. So, my dad just watches them
00:08:47
from the kitchen. And so, these are just obviously all the emotional things come
00:08:52
to mind first because those are the things that stay with us. I'll give you one more.
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Um, the other thing that comes to mind as a man is just being able to protect my family. And I don't necessarily mean
00:09:04
wrestle an intruder, but I mean like lift things. And um, if something falls, being able to pick it up and move it. So those are the things that come come to mind first and foremost. It's protection, it's memories, it's
00:09:16
activities that create relationships and connection. I mean, that's exactly the exercise we do, right? we take people through, give us the 10 most important
00:09:27
things you want to be able to do. So like if you start with, I want to be able to go back to Bali and I want to be able to go down those hundred stairs,
00:09:34
get in the raft, go down the river, come back up the stairs, that gets broken down into very specific movement
00:09:41
patterns. Playing football with the kids out back gets broken down into very specific movement patterns. By the way, they're very different, right? That one comes down much more to foot reactivity, lateral movement, things like that.
00:09:53
Being able to pick something up off the floor is yet another set of movement patterns. It turns out there are
00:10:00
approximately 27 physical requirements that are necessary to do the sum total of most things people want to do. Part of the reason why I think people don't
00:10:11
care enough is because they see aging as inevitable. Mhm. So they look at their their parents, their grandparents, and
00:10:17
go they're immobile. They can't function properly. That's my destiny. It's genetic. Obviously, I don't agree with that. Although I have tremendous empathy for
00:10:29
people who might feel that way. It's uh when you see something as ubiquitous as the decline of untold numbers of people as they age,
00:10:41
it would be very easy and tempting to say that that is the inevitability of our species. Death is inevitable despite
00:10:48
what some biohackers may tell you. Um decline is inevitable but the rate of decline is very much up to us and the
00:10:59
preservation of strength, stamina, movement capacity, uh those things are largely up to us. In fact, there are actual data that demonstrate quite
00:11:12
clearly. In fact, I was just reading a paper yesterday in in the journal Cell that looked at the role of exercise in
00:11:20
aging individuals to preserve mitochondrial function. So, this is a study that looked at older individuals
00:11:27
and it randomized one group to a significant amount of exercise and the other group was just sort of business as usual being largely sedentary. And then using pretty elaborate techniques where
00:11:38
you biopsy the muscle, they look at the mitochondria which are the kind of the powerhouse of the cell in these
00:11:44
individuals. And it turned out that in the people who were exercising, there was very little decline in the
00:11:50
mitochondrial function compared to what happened in the people who were not exercising. Now, just because your
00:11:57
mitochondria continue to function well doesn't mean all aspects of aging are offset. But it's a very important one to
00:12:04
demonstrate. And this is also true by the way of strength and endurance. There's a big difference in the rate of
00:12:09
decline of muscle mass, muscle strength, and cardiopulmonary fitness in people who exercise versus who don't. So, it's
00:12:17
all kind of a long-winded way of saying um you have as an individual so much more under your control than you realize, but you have to sort of begin to compounding the gains. I'll do it
00:12:29
when I'm 50. Well, look, the good news is 50 isn't too old. And I've met many people who
00:12:36
don't begin to do this until they're 50. But again, the analogy I would use here is comparable to that of investing for
00:12:43
retirement. The longer you wait, uh, the less money you're probably going to have
00:12:49
at the end. Springs to mind this graph I saw the other day which I'd sent to my friends which shows that, um, the the decline, I
00:12:56
think it was in muscle mass from when you're 30. And it makes the point that there's this line which on this graph
00:13:03
called disability. And it shows that people who didn't have enough muscle mass when they were 30 cross the line of
00:13:09
disability when they're 70. Uh and those that did have more muscle mass at 30 don't don't get close to that line. Um so that for me was shocking because it
00:13:20
goes to show that what I do now is going to determine whether I'm, you know, by all intents of measures disabled when I'm 70 or if I'm
00:13:27
able. The sooner you start, the better. The drawback that young people have is I
00:13:34
mean, you've had a you've had a great experience because you're you're introspective about it and you've been able to observe it in somebody older.
00:13:41
So, you've been able to gather motivation without having to experience the decline yourself. Um, so that's a
00:13:48
that's a wonderful position to be in. For many people, that's not the case. They only begin to realize the
00:13:54
inevitability of the decline when it besets them. But the way to think about this again is another analogy is that of
00:14:00
a glider. So gliders eventually all have to come down, right? Our health span is
00:14:07
basically a glider, but we have a lot of control about how long it stays in the air based on how high we can start it. So if you think about, you know, would you rather take a glider off a really
00:14:19
high cliff or off a low cliff, that's the that's the decision we get to make. And and we sort of call that concept physiologic headroom. So the example you gave is a great one, right? So muscle
00:14:32
mass, muscle strength provide an enormous amount of physiologic headroom as does cardopulinary fitness. These are
00:14:39
huge variables that make all the difference. and everyone's coming down, but the fitter you are, the slower the
00:14:47
rate of decline and therefore the longer it takes before you cross below a threshold. And that threshold differs by
00:14:54
different metrics, but once you're below that threshold, it's very difficult to engage in activities of enjoyment.
00:15:01
Peter, you're 51 now. 52. 52. What do you wish someone had told you when you were 32? I'm 32 years old. What do you wish um someone had screamed in your face and told you when you were my age?
00:15:14
It wouldn't have been much about exercise. It would have been more about other aspects of life for sure. Um
00:15:21
because for whatever reason, I've always gravitated towards exercise. That's always been a very high priority for me.
00:15:29
So, I think my advice to 32-year-old Peter would be much more about um relationships and emotional health. But
00:15:36
if I could go back and speak to 14-year-old Peter, he a he wouldn't have listened, but I would have begged him to go a
00:15:47
little bit easier on his body and back off on certain things that probably have led to injuries I have today that could
00:15:54
have been prevented. Can I ask what they said things are? Sure. Um, I think I I think I lifted far
00:16:03
too heavy far too often and probably without enough coaching on technique. And so, you know, I by the time I was 27, I had a devastating back injury, but
00:16:17
it's one of those things that happened without any incident, which which is often the case, by the way, for a back
00:16:22
injury. When you really blow out a disc in your back, it's not necessarily something you did in that moment. It's
00:16:28
usually something that's been built up from the past. So, this injury I had at the age of 27 really was the result of
00:16:36
years of unnecessarily heavy axial loading uh loading done with probably insufficient technique, you know, or technique that
00:16:47
was at times sloppy and under fatigue because I used to do a lot under fatigue. You know, I sort of believed in
00:16:53
training under a lot of fatigue and and I I think that that's a mistake. I think that training under very heavy load
00:17:00
should not be done under great fatigue. Interesting. We'll talk about that as well. On that point of advice that you
00:17:05
gave me there about emotional health. One of the things that's been very front of mind for me at the moment is men's
00:17:11
health, specifically men's emotional health because I read a report that came out in March called Lost Boys and it
00:17:17
just details this pretty horrific picture of men's emotional health in the UK at the moment in particular, but the trend holds around the world. and it came out in the start of March. It's
00:17:28
been in all the newspapers in the UK and it details a couple of sort of headline stats. The reverse gender pay gap
00:17:33
amongst young men. So women are now earning more. You know the stats probably around um soon for every yeah
00:17:39
suicide and one in seven young men are unemployed or out of work. All these sort of horrific stats and then it
00:17:45
compounds with things like suicide suicidal ideation etc etc. I was thinking about this this
00:17:51
morning when I was listening to some of your your work. I was thinking I wonder what Peter's perspective is on what it is to be a man. Actually, it
00:17:59
does kind of dovetail into some of your work around testosterone and the decline in testosterone. And because one of the
00:18:05
things I was thinking about is how testosterone plays a role in what it is to be a man, but if you look at the stats around testosterone, um it appears
00:18:12
to be declining. Yes. And I say this in part as well because testosterone causes a certain set of behaviors
00:18:19
um in men that define and shape what a man is and what they want and how they show up. And even when I said earlier on protection as one of the three things I cared
00:18:32
about, that's probably in part because of the testosterone in me. This debate around testosterone, this conversation
00:18:37
around testosterone um and its decline, is it declining? It is. It is. Why is it declining and what and is this does it matter? Well, I think the second question is easier to answer than the
00:18:49
first. I do think it matters. Um the the the why is probably multiffactorial and
00:18:56
the why is just as important as the fact that it is. In other words, the fact that it's declining is both relevant for
00:19:02
the fact that a very very important hormone that has incredible benefit to men uh and women by the way is going down. And we have to come up with a an
00:19:13
answer to that, right? Like so how do we address that? Do we address it medically where we replace that hormone
00:19:18
exogenously, meaning we give you that hormone directly or do we try to fix the underlying problem? So if you want to do
00:19:24
the latter, you have to know what the underlying problem is. Now at the population level, the best answer as to
00:19:30
why testosterone levels are declining and um unmistakably they are. So the data here are unambiguous. There's no debate on this fact. Um the debate is around the why. I believe that the best
00:19:41
answer probably has to do with two things. Uh one is uh increase in body weight and fat, body fat specifically in men. Um and uh some combination of uh
00:19:56
reduced quality of sleep and um and and and sort of disruption to sleep. So so why are those two things relevant? So when you increase body fat, two things
00:20:08
are happening. One is you're increasing inflammation and you are reducing the amount of testosterone that gets to stay in the form of testosterone because part of the testosterone gets converted into
00:20:21
estrogen. So with body fat comes more of this process called aromatization or converting testosterone into estrogen. So if you think about what those two things are doing, if you have more
00:20:32
inflammation, that reduces your ability to make testosterone and you have more capacity to turn the less testosterone you make into estrogen, the net result
00:20:42
of that is both of those things are reducing your total pool of testosterone. If you couple that with less, you know,
00:20:50
lower quality sleep, and I'm not talking about over the last three years, I'm comparing like now to say 40 years ago.
00:20:57
And what are all the reasons that people might have poorer quality of sleep? Now I think there are many but obviously
00:21:02
phones and social media and uh just the stimulation of the world we live in probably plays a greater role in that.
00:21:08
Sleep is when we make these hormones, right? So so so we we make follicle stimulating hormone and luteinizing hormone at their maximum amount during sleep and those are the hormones that
00:21:19
are driving the production of testosterone. So, what we've seen in many of our patients when they have low
00:21:26
testosterone, because there's a test you can do to see if their testosterone is low because their body can't make it or
00:21:34
because their brain isn't receiving enough of a signal to make it. This is a very easy thing to determine medically.
00:21:41
Unfortunately, most people aren't subjected to that level of testing because they go to these testosterone
00:21:47
shops on street corners that are just giving everybody testosterone. But if if if a physician is curious enough to
00:21:53
understand that you can give a patient a drug or a hormone called hCG. HCG is luteinizing hormone which is one of the hormones made by the brain. So if you come in and you see a man who's got very
00:22:06
low testosterone and you can understand why you give him luteinizing hormone. If
00:22:11
he still has low testosterone, you know that he has what's called primary hypogonatism, which means his
00:22:17
testosterone is low because his testes can't make testosterone. Conversely, if you give the man luteinizing hormone and
00:22:24
all of a sudden his testosterone goes up, he has secondary hypogonadism or I mean, you could mix the primary
00:22:30
secondary there, but really what it the terminology doesn't mean anything. what matters is he can make testosterone, but
00:22:37
for some reason his brain isn't giving his body the signal to do it. And that's that's a classic finding in a person who's under high stress and or not sleeping well. So that's a long-winded
00:22:49
answer to your question, but I think that those are probably the greatest contributors to this. Now, people have talked a lot about what about microplastics, what about other environmental factors, what about other
00:23:02
factors in nutrition beyond just the ones that would contribute to excess body fat. The evidence there is less
00:23:10
compelling, but I don't think we should discount it. But I I think I think that that if those things are playing a role,
00:23:16
it is probably much smaller than than what we just talked about. I was thinking as you were speaking about sleep and testosterone about how and
00:23:23
also the link there with bad diets, how if I've not slept well, I wake up and make worse food choices for sure. And I was like, is that like dopamine
00:23:33
dysfunction? Probably more due to insulin signaling. So um we know from ex really good experimental studies that when you
00:23:45
sleepdeprive people they become insulin resistant and the more insulin resistant
00:23:51
a person is the less they're able to access their stored uh energy. So higher insulin resistance means greater difficulty accessing stored energy. So, if you're if you wake up and you're if
00:24:08
you know if you have successive days of poor sleep and you're becoming somewhat insulin resistant, um you're going to
00:24:14
want to eat more because you're not able to access your own natural stores of fat, which is where we want to go for
00:24:20
energy. So, if you look at one experiment that was done out of the University of Chicago, they they took uh
00:24:27
healthy subjects, young young subjects, and sleepd deprived them for somewhere between 10 and 14 days. So, not a huge period of time. And they only let them sleep four hours a night, which by the
00:24:39
way, I know a lot of people who were doing that for years at a time. In in that 10 to 14 day period of time, their
00:24:47
insulin resistance was worsened by 50%. This is in other words they they do an experiment called a uglycemic clamp where they inject them with glucose to see how effectively they can put glucose
00:25:00
into their cells which is that's the that's the hallmark of insulin sensitivity is how well you can put
00:25:05
glucose into your muscles when it's infused in you and their capacity to do that was reduced by 50%. after such a
00:25:12
short intervention. Um, so I think sleep uh restriction and unhealthy sleep is a
00:25:18
is a very underappreciated cause of metabolic health and weight gain and then by extension these other things
00:25:24
we're talking about. It seems to me to be the thing furthest upstream in my life that then causes this cascading
00:25:29
effect to how I show up in sort of cognitive performance. How well I can articulate myself if I go to the gym,
00:25:35
how hard my workout is, if I choose healthy options versus unhealthy options. So it feels like the and mood
00:25:41
in general. Yeah. Yeah. I mean, look, I I I've said this before and I'm not the first to say this, so I'm paraphrasing
00:25:47
others, but if you really stop to think about it, sleep doesn't make a lot of sense from an evolutionary perspective.
00:25:54
Like, if you go back in time a few hundred thousand years, why would we have spent a third of our life
00:26:01
unconscious? It didn't serve our purpose. You can't mate, you can't hunt, and you can't defend yourself. So you have to believe that if we could
00:26:12
have evolved out of it, we would have done it and we didn't. So that means that whatever it's doing, it must be really important. I mean core essential
00:26:25
to our existence. While I will completely acknowledge that different people have a different necessity or
00:26:32
requirement for how much they sleep, I still think that many people underestimate how much they need. You
00:26:39
know, you asked me at the start, you said, um, what are the things that you want to do when you reach your marginal decade? And I gave you my answer. What's
00:26:46
your answer to that now that you're a father in heaven or in a different season of life? Well, they're very
00:26:51
similar to the types of things you're thinking about. And I love how you've got specific examples. So, I really like
00:26:57
playing with my kids, right? So, I can imagine that in my marginal decade, I'll have grandkids that are the age of my kids. Yeah. Right. And and you know,
00:27:09
maybe a bit older, but but as I'm even getting towards that marginal decade. Okay. So, playing sports is really,
00:27:15
really fun. I really like playing especially because when I grew up like I played hockey because I grew up in Canada and then I immediately went into kind of boxing and martial arts and
00:27:27
those became my life. So now playing sports that I didn't play much as a kid is really fun. Like I'm really enjoying
00:27:33
baseball. I'm really enjoying soccer. And um and so when you play these things, you realize this is not an easy thing to do when you get old. Like to
00:27:45
sit in the, you know, to play to sit in the goal and actually like stop a ball when a kid is blasting at you full stop.
00:27:51
You have to be able to move around. So again, like I would love to be able to play soccer, throw a football, throw and hit a baseball as long as possible. you
00:28:03
can get into movements that are much simpler. Uh, but if I can do all of those things, I'm in great shape. Now,
00:28:08
of course, to be able to do that, I also need to be able to do a lot of things that many people also can't do in their marginal decade, like sit on the floor,
00:28:15
get up off the floor under their own power, um, you know, walk up x number of flights of stairs, having the strength
00:28:21
to do that. I like doing certain things like I like archery a lot. So it's, you know, I want to be able to pull a bow back. Obviously not at the same poundage as the current bow that I pull back, but
00:28:32
I would still like to be able to pull a 50 lb bow back in the final decade of my life. And when you think about all those
00:28:38
things you want to accomplish, if we were then to sort of codify them into a bunch of exercises or areas of your
00:28:44
health that you had to now be thinking about that I needed to be thinking about, what are the most important
00:28:50
things? So, I'm a 32-year-old. What are what are the most important parts of my health that I should be thinking about if I want to achieve all the things that I said to you in my final decade? No one in the final decade of their life ever
00:29:01
said, "I wish I had less strength and I wish I I wish I had less endurance." So,
00:29:06
you cannot be too strong and you cannot be too fit. The only time that one would
00:29:12
throttle back on the pursuit of those is a if doing so is come at the expense of something else either with respect to
00:29:19
your health or your life and two if the pursuit of that at such an extreme level produces risk of injury. Okay. So in
00:29:30
other words, could I be stronger than I am today? Yes. Uh I'll give you an example. We know that in resistance training, the sweet spot for pure
00:29:41
strength is one to five reps. When your goal is to maximize strength, you need to be pushing 1 2 3 4
00:29:54
five reps. Once you start thinking about hypertrophy, muscle size, we're starting to think about 7 8 9 10 11 12 reps. Once
00:30:01
we start thinking about muscular endurance, we start thinking about north of 15, right? Those are the general
00:30:06
patterns of resistance training. So, if I want to build my muscles because I'm going for aesthetic goals, then I need
00:30:12
to be aiming above five reps. I need to be 10 or 12. But if I'm just purely thinking about strength, bigger weights,
00:30:18
but lower reps. That's exactly right. Okay. And then if I got muscular endurance, which be even higher reps.
00:30:23
Okay. Lower weight. Yep. Okay. So, again, we could go into much more detail around that, but just to finish the point here, why do I not do much training at one to five reps? In fact,
00:30:34
these days I don't do any training at 1 to five reps anymore. Why? Because to train at 1 to five reps
00:30:41
comes at a risk. Okay? Especially for heavy compound movements. So like I'm, you know, I'm okay getting a little bit less of a strength benefit
00:30:53
while still of course getting stronger, but training at a higher rep load. So I'm typically so I'm targeting 8 to 12
00:31:03
reps with one to two reps in reserve is basically how I'm doing my resistance training. That means every set I'm doing I would expect to get to within about
00:31:15
one rep of failure somewhere. So today when I lifted I don't think I did less than seven. I didn't do more than 12.
00:31:22
And the weight was always titrated so that I was either failing, almost failing, or one rep away from failing
00:31:28
somewhere in there. And I was adjusting the weight constantly on every exercise to get there with the exception of one exercise. I did. Push-ups was one of the
00:31:35
things I did. Push-ups are kind of more in the muscle endurance. Obviously, I'm doing more reps when I was doing push-ups, but pretty much everything
00:31:40
else was in that range. So again, I'm not fully maximizing strength anymore because the cost of it might be a little bit high in terms of injury risk. Similarly, I'm not strength training
00:31:54
24/7 because I need to make time to do my endurance training and other types of training. How often do you train uh resistance training? I resistance
00:32:05
training three times a week. And how often do you train generally? And I train every day. Every day. Yeah. Why?
00:32:11
Because, you know, again, the the intensity of my training is not that high. At least three days a week. So the three resistance days are pretty hard because I'm really only doing each body
00:32:23
part once a week. So when I'm doing it, I'm really I'll spend that 90 minutes really kind of hammering those body
00:32:29
parts. Three of those days are just zone two. So, my three three of my four cardio days are zone two days where I'm doing, you know, I'm on a bike and I am
00:32:42
riding at a level of intensity that actually allows me to still talk some, you know, not not talk like I am now, but talking in a sort of a strained way. So, for me, that's about a heart rate of
00:32:54
140 beats per minute. And that's just not that's just not taking a huge toll on me. like that. Those are almost like recovery days for me. And then one day a
00:33:06
week I do a a really really hard V2 max day and that's that's a really hard day.
00:33:12
That burns a lot of matches. That's tomorrow. Not looking forward to it already. Do you do cardio on your
00:33:18
resistance training days as well? No, I don't. So, it's the seven day. It's four days of cardio, three days of uh of
00:33:26
resistance. Now, that's going to change in the summer when I'm going to add 3 days of swimming. Um, and I will end up
00:33:33
doing some swims on some resistance days. So, before you do your resistance workout, you don't go on the stepper for
00:33:39
20 minutes or cycle for 20 minutes or something. I don't. Is there a particular reason why? It wouldn't really serve a purpose. Um, I So, I I
00:33:47
know a lot of people do that. I know a lot of people will say, "Hey, I'm going to do a little bit of a warm up on this treadmill or the stepmaster before I
00:33:53
lift." But I actually have a pretty strong point of view on how we should warm up to lift. And I don't think
00:33:59
walking on the treadmill or running on the treadmill or being on the stairmaster or on the bike is a great prep for the lift. I think it's better
00:34:06
to warm up for a lift doing movements that prepare you to lift. So for example, like if it's a leg day, so
00:34:14
Monday's leg day, right? So what am I going to do? I'm going to start by doing a bunch of core stabilizing stuff. So,
00:34:20
I'm going to do a whole bunch of this dynamic neuromuscular stabilization stuff. So, you get into basically these
00:34:25
baby positions and you really learn to activate your core as you move around in a six-month position and stuff like
00:34:31
that. I then do a whole bunch of um like do you know what a 9090 is or a shinbox
00:34:37
exercise is um where you're you're kind of on the ground in a position where you're really is you know uh you can
00:34:44
start out doing it isometrically but ultimately going through uh a slow eccentric and concentric phase of
00:34:50
movement that's kind of activating glutes. So I go through basically a whole DNS sequence. Then I get into a
00:34:57
dynamic movement prep. So then I get into a bunch of bouncing, a bunch of footwork. Um, and then I start with
00:35:03
really light weights. So I'll go to a leg extension machine and do very, very light leg extensions, very, very light
00:35:08
leg curls. Come back and do more jumping and moving and lunging and go back and forth. So I'll spend 20 minutes doing a
00:35:16
warm-up, but the warm-up is geared for me to lift. Whereas if I had just sat on a bike and pedal around, that doesn't
00:35:23
actually replicate any of the movements I'm going to do when I start loading myself. I've got particularly concerned
00:35:28
about injury. Yeah. Now that I'm 32, because when I was bloody 20, I could do almost anything, it seemed, and nothing
00:35:34
would break. But I had a couple of injuries when doing like shoulder presses and things like that. And one of my friends had a similar injury recently
00:35:40
which took him out for three or four months where he did a shoulder press, pulled something in his back or something, his like neck. Yeah. And then
00:35:46
he couldn't like turn his head anymore. In terms of injury, if I wanted to get injured, am I
00:35:53
right in thinking that the the thing that leads to injury is basically just walking straight in and trying to lift something heavy? Or is there things
00:35:59
further upstream that cause injury in the gym? No, there's I mean that's one way to increase your risk of injury for
00:36:06
sure. Uh but but yes, there are other ways that it can happen and I think about it a lot. I mean one of the
00:36:12
injuries I think a lot about are calf injuries, Achilles injuries, sort of tendon injuries. This is, I think, one of the things that becomes a real
00:36:22
problem for people as they age. You know, you you often hear about people my age, uh, tearing an Achilles. It's a
00:36:29
devastating injury. Now, again, it's not devastating in that you won't recover from it, but boy, it's going to take you out of commission for 6 months. So, a
00:36:36
lot of these injuries happen because the individual still has strength, um, but they've they've kind of lost some of the pliability in the tendon because they've kind of lost some of the jumping. That's
00:36:48
why I always start these workouts with low level of jumping and I'll progress to higher levels of jumping. But jumping is actually a very important part of training and it's one of the things that
00:37:01
we take for granted. But boy, when your ability to jump is gone, and jumping, by the way, can mean like just initiating a
00:37:07
jump. But it can also mean jumping off something and stopping yourself. Those are really important skills. And so like
00:37:14
something like jumping rope is really important, right? Your feet are just kind of moving like that. They're
00:37:20
they're acting as shock absorbers. Calfs and Achilles have to constantly change in length. And that accommodation is a
00:37:26
really important part of resilience. And I think that should that should be an important part of everybody's warm-up at
00:37:32
a minimum, if not part of their workout. One thing I'd love you to do is to persuade people listening that muscle
00:37:38
mass matters for longevity because um and also if you can within that that leg day matters because we all avoid leg day including me and sometimes I need to
00:37:51
be told again why why it matters for me to add it. Well, I mean, I think look, muscle mass
00:37:58
um is is probably the second most highly uh correlated finding uh or third most to longevity after strength and cardiorespiratory fitness V2 max. So,
00:38:14
why is that? Um so, first of all, I think that muscle mass is both directly a proxy for strength in general. The more muscle you have, the stronger you are. We all know exceptions to that. We
00:38:26
know wiry little people who are insanely strong. And I have patients like that. They're just naturally, you know, thin people. But when we put them through the testing
00:38:37
protocols, you know, they're remarkable in terms of their strength. And I tend to not worry about the fact that they're slight in build when when I see that they're strong across the board. There
00:38:48
is another benefit of muscle mass which is it's the place where you dispose of glucose. So from a metabolic
00:38:53
perspective, the more muscle mass you have, the more glucose buffering capacity you have. And why does that
00:38:59
matter as I age? Because you know, one of the hallmarks of aging is a reduction in the capacity to metabolize and buffer glucose. And so as as glucose levels
00:39:12
become less and less regulated, all sorts of bad things happen. uh bad things happen to micro vessels in the body. So we if you think of the most extreme example of this is type two
00:39:22
diabetes. So once a person has type two diabetes, what are they at risk for? They're at the risk of reduced vision
00:39:28
and ultimately blindness, amputations of their digits, impetence, right? The penis has tons of tiny blood vessels in it and the more that you know glycosillated proteins accumulate there,
00:39:39
the less they get blood flow and obviously damage to the small blood vessels of the brain as well. So all of
00:39:46
these things are hugely problematic when glucose is disregulated. And again, the
00:39:51
most important thing that you can do to regulate glucose in addition to the obvious, which is eating energy balance,
00:39:59
not eating too much, is making sure you have large insulin sensitive muscles, which means large muscles in the context of an individual who's sleeping well and exercising. And you're going to
00:40:10
basically have a great place to put all of that glucose when you consume it. And is that going to save off me getting
00:40:15
belly fat because my glucose is going to be stored in the muscles as opposed to somewhere else or again it all depends
00:40:21
on the total energy balance. But yes, it's clearly going to make a difference, right? So one of the shest ways to um
00:40:29
reduce your capacity to store fat is to add more muscle. Okay. Um I I did the grip strength test. I've done it twice now. And meaning you did one of the like grip meters or you did a hanging test.
00:40:41
The uh one of the grip grip meters. actually did it at Brian Johnson's house and then I but I also did it with Andy Galpin and people tell me it's a
00:40:48
indicator of longevity but I've never really understood why is it just testing my strength. Yeah. Um grip strength of
00:40:55
all the strength metrics it's one of the most highly correlated with longevity. We actually prefer to do it like at 10
00:41:01
squared where your colleagues tested yesterday. We prefer to do it on a dead hang. So, we make them hang from a bar.
00:41:09
Um, and we just time how long they can hang. So, that that's a really good metric of your grip strength because
00:41:14
it's also normalized to your weight. Okay. So, uh, so we we want to see that people can hang for at least two minutes
00:41:21
on a bar. And so, the question is why is that so highly correlated with longevity? And it's what you said. It's it's it's strength. Uh, and the reason
00:41:31
for it is it's really hard to be strong anywhere in the upper body if your grip is weak. Like if you think about being
00:41:39
able to push, especially being able to pull, like all of the real metrics of upper body strength require a strong grip. And if you have a strong grip, you have a strong hand, you have a strong
00:41:50
forearm, you have a strong scapula that is connected to your rib cage, like it goes up the whole chain. That's another
00:41:56
reason why we like the dead hang as a way to test it because the dead hang is testing everything. It's testing your
00:42:03
actual grip. It's testing your scapular stabilization, the stability of your shoulder. It's basically testing that
00:42:09
entire chain. And then I also think there's a practical side of this, right? when when you know it's very
00:42:15
underappreciated what frailty does to an aging individual and what sarcopenia loss of muscle mass does to an aging person and and what it is about falling
00:42:25
that is so devastating to an older person and the stronger your grip the easier you're able to navigate a lot of those things right it just seems unthinkable that falling is something I
00:42:36
should be thinking about at 32 in the future like cuz my seems ridiculous it seems ridiculous yeah and yet it is
00:42:43
devastating. So once you reach the age of 65, which that ain't that far. I mean,
00:42:50
if you you know 65 year olds all day long, that does that's not a that's not a very old person. Yeah. Once you reach
00:42:55
the age of 65, your mortality from a fall that results in a broken hip or femur is 15 to 30%. Think just think that is such a staggering number. So,
00:43:09
you're over 65, you fall, and that fall results in the break of a femur or hip. There's a 15 to 30% chance you'll be dead within a year. What kills me? It
00:43:20
could be something very acute like you bang, you know, the fall that's significant enough to do that also bangs your head. It could be that you get a
00:43:27
fat embolism, you get a blood clot. It could be that, you know, during the recovery process of this, you just never
00:43:34
really get better. You never thrive again. I think a more disturbing statistic is that of all the people who
00:43:41
survive, 50% will never again regain the level of function they had before the injury. Wow. So they will require a cane
00:43:49
for the rest of their life or something like that. Um now there are lots of things that account for that. Andy Galpin, who you mentioned a moment ago,
00:43:55
talks a lot about this, but it's a lot of it comes down to foot explosiveness, power. So the reason you're not really
00:44:02
afraid of falling like when was the last time you were walking and you your your foot caught something and you you
00:44:07
slipped like yesterday. Yeah, quite often. Yeah, exactly. Why don't you fall when that happens? Because I can quickly
00:44:14
readjust, right? That's power. Okay, so you have the power in your foot to readjust when you lose your step. You step off a curb not realizing it, it doesn't matter. You readjust. Okay,
00:44:27
those are a very very specific muscle fiber that is responsible for that. It's called the type 2B muscle fiber. That is
00:44:34
the first fiber that atrophies when you age. In fact, you're already at your peak. It's all downhill from where you
00:44:40
are now. Thank you so much. Yes. So, I'm I'm already 20 years past you and my power is a fraction of what it was 20
00:44:46
years ago. Now, I fight like hell based on the exercises I do to try to make to try to keep it as high as possible. So the reason that these, you know, people who are in their 70s are falling all the
00:44:58
time is people think it's a balance thing. It's not just a balance thing, right? It's that they're undergoing the
00:45:05
same insult you and I undergo on a daily basis. But the difference is their probability of being able to catch it
00:45:11
either through the explosiveness of their foot or their lower leg coupled with maybe not being able to grab onto
00:45:17
something as quickly and adjust. Uh it's a power deficit problem. So, what do I have to train now at 32 to ensure that
00:45:24
specifically the example of hitting something and quickly being able to adjust? Um, I'm able to do that when I'm 70. I think jumping is a great way to do
00:45:31
this, right? So, so I mean I use certain specialized pieces of equipment that actually have power built into it
00:45:36
because power is different from strength, right? So, strength is really the ability to is is just the ability to
00:45:43
move a force independent of the speed at which you move it. Power is the maximum
00:45:49
combination of force and speed. Okay? So if you on the on the on the um x axis if
00:45:56
you were to put force and on the y-axis if you were to put power the curve is an
00:46:03
inverted u. So as the force or the weight that you're moving goes up and you're trying to move it as fast as you can, you're getting more and more and more and more power. But then at some point the weight gets so heavy that even
00:46:15
as you continue to move it, it's going slower and slower and slower. So your power is going down. So there's a sweet spot there. So one of the things I do is
00:46:21
there's certain specialized pieces of equipment that allow you to train in that way. So I definitely rely on a lot
00:46:27
of those. But even if you don't have access to that machine, jumping is a really important way to generate power.
00:46:32
So if you're just doing a vertical jump, that's a that's power. What about balance? I I was at Brian Johnson's
00:46:38
house and as he was cooking his I don't know breakfast or lunch or whatever, he was balancing on a half
00:46:46
ball. You've seen one of those things. Yeah. Yeah. I I don't think I asked him why he was balancing on it, but I assume
00:46:51
it was to do with balance and the certain muscles in the in the leg. There are lots of exercises that are great for
00:46:57
balance. Um, anything that produces instability is great because it's uh, you know, for lack of a better term,
00:47:04
I've heard it described as problem solving for your foot. Okay? Right? So, so if you think about being on any unstable surface, even if you're just
00:47:11
walking on an unstable surface, so if you if you were to look at a person's foot, their lower leg actually, as
00:47:17
they're walking on a surface that's constantly changing, so like a gravel path or something like that, you're
00:47:23
going to see like if this were my lower leg, you would see the musculature of the lower leg constantly adjusting to
00:47:30
it. And so, yeah, I'm I really enjoy things that force that type of training. Do you do flexibility stuff? Yeah. So, I'm actually naturally a pretty lax
00:47:42
person. So, I don't do any stretching if that's what you're asking. But all of the sort of stability and dynamic stuff I do incorporates movement at end
00:47:55
ranges. So, um I I'll give you an example of why I think the notion of flexibility might be a little bit misunderstood. If you ask a
00:48:05
person to stand up and with their legs straight touch their toes, most people would say that's a great test of flexibility in the hamstring, right? And most people can't do that. What they
00:48:17
don't realize is everybody's hamstrings are long enough to allow them to do that. The reason they can't do it is their central nervous system will not
00:48:30
release them to do it. Does that make sense? Interesting. The central nervous system won't release them to do it. That's right. It doesn't feel safe for them to do it. Now, how do I know this?
00:48:42
Because if you take a person under general anesthesia, you can put them into almost
00:48:48
any position possible. So, if you took a person under general anesthesia, laid them on the operating room table, you
00:48:53
could lift their leg up to here. When they're awake, you couldn't get it past here. When they wake up from surgery, will they have a torn hamstring? Not at all. They won't even
00:49:05
know their leg was moved. The difference is when they're under general anesthesia, their brain is not sending a
00:49:10
signal to the leg that says don't lift. So why is the why is the leg why is the brain doing that to the individual? This is how I learned it on a personal level. So about six years ago, I had tweaked my
00:49:24
back and had just done a, you know, unnecessarily heavy set of deadlifts and just pushed it a little too far. And I was kind of nursing this this sort of, you know, just very very tight QL. I was
00:49:36
completely jammed up. And I came in to to do some training with a friend of mine who's one of the guys that actually
00:49:42
he is really the guy that introduced me to this thing called DNS, dynamic neuromuscular stabilization. And I mean,
00:49:47
I was stiff as a board. I couldn't, you know, get past my knees bending forward and I'd been hurting for like three days. And we went through a series of
00:49:58
exercises for 40 minutes, which included me laying on my back with my legs up, him leaning on top of me, so my feet are here on his
00:50:09
chest and doing isomemmetric pushes while working on uh generating intraabdominal pressure. And after an yeah maybe 40 minutes of this type of
00:50:22
exercises, I was palms on the floor. Now, how do I go from not being able to get to my knees to palms on the floor in 40 minutes with three days of
00:50:36
horrible back pain? The difference is when I my back was hurting, it was my body was not going to let me go down,
00:50:43
right? The body was saying, "No way. your back. I'm protecting you because you were you are not stable. You're not going to go any further. And what we went through with this exercise and a
00:50:55
series of exercises was basically I mean I'm oversimplifying this and sort of anthropomorphizing it, but letting my brain know it's okay. You're stable. You're stable. You're stable. The back
00:51:06
is safe. The back is safe. Let him go. And then ah I'm palms on the floor. So I love testing this. Sometimes I'll just wake up in the morning and do five minutes of breathing exercises when I'm stiff as a board and just get into a you
00:51:20
know position on the floor. Why the breathing breathing exercises? Because that's really how it's the it's the the
00:51:25
breathing is how I kind of create this cylinder in my abdomen to sort of push the you know push the the the floor of
00:51:31
the cylinder down as the pelvic wall. The diaphragm is the se cylinder uh the top and then the the entire you know
00:51:38
entirety of my abdomen is the wall of the cylinder. And so I kind of go through these exercises every single
00:51:43
day, usually on my back actually. That's kind of like part of my warm-up and and it's just a way to kind of ground myself
00:51:49
around creating uh concentric pressure in the abdomen. Just to get some tips from you around your your strength
00:51:56
training regime. Um how many exercises do you do? What does I'm really curious. So you train three days a week doing
00:52:02
strength and resistance stuff. Do you do like shoulders and back and um as like a pet like you know people it's just totally Yeah. Yeah. Exactly. So on Monday Monday is uh is pure lower body.
00:52:14
Okay. And uh uh Wednesday is arms and shoulders and Friday is uh chest and back. Okay. Super simple like nothing nothing no rocket science. An hour uh I
00:52:28
mean it's it's a like an hour and a half of lifting play plus maybe 20 minutes of the warm-up stuff. So on the chest and
00:52:35
back day, how many chest exercises are you doing? Four. Four. Okay. And then four on back. Yeah. Okay. And I just I'm just super setting them. And I'm going to do maybe five sets of each. So five
00:52:48
working sets. So there's a lot of warm-up in there, too. Um and I'll also do some other stuff like some medball
00:52:53
slams or things like that as well. There's been this huge rise in people doing these um high roxes and sort of
00:53:00
elite endurance events and and such. really interesting that it's become so popular. Even things like running clubs,
00:53:06
I know, but the fact that people are more people are doing marathons now than ever before. Why do you think this is happening? I don't know. I mean, I think
00:53:13
it's a very net positive thing, though. I mean, I I I I do think that there's um more and more people that are taking up
00:53:20
things like rucking and running and and you know, finding camaraderie in these things. The only thing I hope is that
00:53:26
that people are doing it in a manner that's sustainable and safe and allows them to do it indefinitely. So I, you know, I just I'm always hopeful that
00:53:32
whatever thing that people are doing, they're not injuring themselves cuz again, rule number one is don't get
00:53:39
injured. So So you're, you know, you're you're you're playing uh you're playing, you want the game, the name of the game
00:53:45
is to play the game as long as possible. In front of me, I have a bunch of different graphs and images. Um, and
00:53:51
they some of them relate to a word you said earlier on, which is V2 max. And this is something I've heard you talk about previously, but for anyone that doesn't understand what V2 max is or why
00:54:03
it's important, um, can you explain what it is and why it's so critical to longevity and health span? I think most people will be familiar with the idea that we are obligate anorobes, which in
00:54:15
English means we cannot survive without oxygen. Okay. So why is that? So oxygen is absolutely essential to
00:54:27
catalyze the chemical reaction that turns food into a currency for energy called ATP. So everybody's probably heard of ATP. ATP is the money, the currency of
00:54:42
energy in our body. Anything that interrupts the production of ATP is fatal. So an extreme example of that is cyanide. Everyone's heard of cyanide as
00:54:52
a poison. If you take cyanide, you'll be dead within seconds because cyanide blocks one of the transporters in the
00:55:00
production of ATP. So that just gives you a sense of how critical it is to have an infinite and abundant supply of
00:55:06
ATP. Oxygen is also essential for that. That's why without oxygen, you can only survive for a couple of minutes. Longer
00:55:13
than you can without cyanide, but not much longer. So how does it work? So we breathe in air and that air goes
00:55:22
into our lungs and that air goes through our lungs into these distal things called capillaries where hemoglobin is
00:55:30
bringing the waste product called carbon dioxide back to the lungs. And there's a
00:55:35
gradient of of partial pressure between oxygen and carbon dioxide such that a switch takes place. The air that we
00:55:42
breathe in delivers some of its oxygen to the hemoglobin molecules and the carbon dioxide diffuses off that into
00:55:49
the air and we breathe out air that is lower in oxygen and higher in carbon dioxide than what we breathed in. Mhm. So if I go that was high oxygen, low
00:56:00
carbon dioxide, that was low oxygen, high carbon dioxide. And that's the that's happening every second of every day. That oxygen, that hemoglobin molecule
00:56:11
that's carrying oxygen is carrying it to every cell in my body because every cell
00:56:16
in my body needs oxygen. And that cell in the body is taking the oxygen to run that chemical reaction to make ATP. and it's shuttling back carbon dioxide. And it's just the
00:56:28
most incredible thing in the world to imagine how frequently this is happening. And the more you exercise,
00:56:35
the more you consume oxygen. So oxygen consumption is a proxy for energy demand. So we can measure this. Now to do so, you have to put a mask on because
00:56:49
I have to be able to measure very precisely two things. I have to be able to measure exactly the flow rate of air going in and out of your mouth and I have to be able to
00:57:02
measure very precisely the concentration of oxygen coming out. If I know those two things, I can calculate how many lers per minute of oxygen you are
00:57:14
consuming. So you and I sitting here right now are probably consuming less than half a liter a
00:57:29
minute. So call it 500 cc a minute of oxygen right now because you have to consume some to be alive. And look, I'm moving my arms around and you're nodding and taking notes. So, you know, if
00:57:42
you're sleeping, you might be consuming 300 milliliters of oxygen per minute. That's that's the lowest level.
00:57:49
If you were to get up and we were to walk around here, that number might go up to 800 milliliters uh per minute. If
00:57:58
we were to walk a little more briskly, we might be at a liter per minute of oxygen. If I said, "Let's go out in the
00:58:03
parking lot and jog." Well, we might get up to like 1.5 L per minute. we pick up
00:58:09
the pace a little bit, we'll get to two liters per minute. If I start really, really running us hard, we're going to
00:58:14
get to three and a half, four liters per minute. Well, at some point, I am going
00:58:19
to push you so hard that you will achieve your maximum level of oxygen consumption. And if I push you any harder and faster, you won't extract more oxygen from the air. You may go
00:58:33
faster but you will do so through a process that does not involve the consumption of oxygen. You will do do so
00:58:40
through an anorobic glycolytic pathway but you will have achieved your maximum consumption of oxygen. And that number
00:58:47
has a very special name. It's called V2 max. So V2 max measured in liters per minute is the maximum amount of oxygen you can consume. And the only way you
00:58:59
can measure that again is to have this mask with very very fancy apparatus that measures both of those things I said. And you have to be stressed hard. So we
00:59:10
typically do this on a treadmill or on a bike. So your your your colleagues that came into 10 squared yesterday, they did
00:59:17
it on treadmills. They ran and they ran them and ran them and they ran them until they couldn't go any faster. And then we measured how many liters per minute of oxygen they were consuming.
00:59:30
Now that answers what V2 max is. So the next question is does this matter? Well the short answer is we don't have a single metric of humans that we can measure that better predicts how long
00:59:41
they will live than how high their V2 max is. And it's not even close to be completely
00:59:49
clear. So if you compare somebody who is in the top 2% to someone who is in the bottom 25% for their age uh the difference in mortality is 5x 500%. Yes.
01:00:03
400% technically because with hazard ratios you you you go two two a 2x hazard ratio is 100% I guess. Yeah. So let's look at you. So I see you've pulled this chart out which is one of my
01:00:15
favorite charts. Okay. So you Oh, by the way, there's one other thing I should state. We normalize this by weight.
01:00:22
Okay. Okay. So, we always divide that number of liters per minute by how many kilograms you are. So, the number is
01:00:29
actually reported as milliliters per kilogram per minute. Okay. Okay. All right. So if we look at somebody who is your age, male 30 to
01:00:43
39, if their V2 max is below 35 milliliters per kilogram per minute, they are in the bottom 25%. Conversely, if they are at 53
01:00:59
milliliters per kilogram per minute, they are in the top two and a half percent.
01:01:06
So to be clear, if you take a 35-year-old man and one of them has a V2 max of 53 and the other one has a V2 max of 35, there is a
01:01:19
400% difference in their all-c cause mortality over the coming year. Wow. Okay. So all cause mortality, anything killing them over the coming year. That's right. Now, this becomes more and
01:01:30
more profound as you age because the all cause mortality ratio for a 35-year-old is incredibly low. Yeah, it's like 1%. So, that means you're comparing 1% to 4%. It's not that big a
01:01:43
deal. But when you get up to my age, so I'm two decades older than you. So now the low bar, the bottom quartile is less than 29. The high bar is more than 50.
01:01:59
Well, my relative mortality in the next decade is probably 2 to 3%. So now multiply that by four. Okay. When I get
01:02:07
into my marginal decade, the low bar is 18. The high bar is 36. That's a 2x difference in V2 max. A 4x difference in mortality is huge. when
01:02:24
the all-c cause mortality for an 85y old is going to be, you know, the one-year annual, you
01:02:31
know, the one-year mortality for that person is, you know, more than 10%. Yeah. So, one of the things that we do
01:02:39
is we sort of think through this not just through the lens of mortality, which is what I just walked you through
01:02:46
here, but also health span, which is kind of what you were talking about earlier with the graph of strength and
01:02:52
disability. So we have another figure that we show people that um on the x axis shows age. Yeah. And on the y ais shows
01:03:03
V2. And it has a whole bunch of lines that come across that show various activities. You know, if you want to be able to run a six-minute mile, you have to have a V2 that's very high. If you
01:03:14
want to be able to run an 8-minute mile, a 10-minute mile. If you want to be able to climb a flight of stairs without getting out of breath, like it shows all
01:03:21
of these different things. And you see what the required V2 is. Mhm. I think in fact we might even have these graphs in here. Yeah. Right there. So we put your dot on
01:03:35
the graph and we say if you stay where you are, you're meaning right at that green curve, you're in for a great life. Why? Because even when you're in your
01:03:45
80s, you're still going to be able to do all of those things. So the results you're looking at here are Jack's
01:03:52
results. Yep. Who runs the production here. He came to your center. Yep. Came to 10 squared in Austin. He did the test. I think he was on the treadmill for like an hour or something like that. And can you explain to me exactly what
01:04:04
his results say as it relates to what you were just describing? Yeah. So he did both a zone 2 and a V2 max test. So
01:04:12
Jack got on the treadmill and you know there's a protocol for how you warm somebody up. really want them to be able
01:04:18
to get to a maximum effort. You don't just put them on a treadmill and crank it up. You take you take your time getting them up there. And he had an
01:04:25
amazing result. So, his V2 max was 4.1 lers per minute. And he achieved that at a heart rate of 204 beats per minute,
01:04:38
which is higher than what was predicted for his age. If you normalize it by his weight, he was at
01:04:44
56.5 milliliters per kilogram per minute. So when you look at his age, because he's in his 20s, he was at about the 97th percentile for his age, meaning
01:04:58
his V2 max was higher than 97% of people his age. And uh so out of the gate that just tells us from a longevity standpoint,
01:05:09
our goal is to keep him there as long as possible. I mean, we're so ambitious with our patients and clients that we
01:05:16
actually want them to be as as an aspiration to be two decades younger at the top 2%. So if you're 50, you want to be V2 max
01:05:27
north of 53. And then the other thing we do is we check on something called heart
01:05:33
rate recovery. So in 60 seconds post V2 max, how long does it take uh how many beats does their heart rate come down in one minute? This is also a very powerful predictor of mortality because it's a
01:05:47
huge indication of what's called parasympathetic sympathetic balance. So, it's basically a question of how does
01:05:53
the how how much is their autonomic nervous system in favor of sort of a stress response versus a recovery response. And so, the gold standard here, we want to see people that can
01:06:04
recover at least 30 beats in the first minute. He did pretty well. He recovered 28 beats. You know, if you're really, really fit, you're going to be 40, 50 beats of recovery within the first um
01:06:17
one minute. It's incredible. Incredible. Then we tested his um lactate levels and
01:06:25
we ran him for what we called zone 2 testing. Right? So zone 2 is his aerobic base. This is where he should be spending 80% of his training. 80% of his cardio training time should be in this
01:06:37
energy system. So it's hard enough that it's not just pure recovery, but not so hard that it's, you know, uh pushing energy systems that are that are higher. This is this is a pace he should be able
01:06:49
to hold for an hour and he should certainly feel like he's working but not feel it too much. Technically it's also
01:06:56
a place where he's prod he's got maximum fat oxidation. So we do this also in the
01:07:01
same measure on a treadmill. This is a bit more of a complicated test because you're titrating between how he feels
01:07:07
and what his blood lactate levels are. Maybe not to get too complicated in the weeds on that, but we're simultaneously
01:07:15
looking at the ratio of how much carbon dioxide he produces to how much oxygen he consumes. That tells us how much fat he is using in his own body. And we look
01:07:27
at that number and he maxed out at.77 grams per minute, which is very good. One gram per minute of fat oxidation is exceptional. So
01:07:38
7677 is pretty darn good. His lactate hit about 2 mill and he achieved this running at 7.3 miles hour. So So again, that's there there's a lot to unpack in
01:07:50
there, but that gives us a pretty good sense of his level of fitness. And for a guy in his 20s, um that's that's really
01:07:57
good fitness. He does a lot of running. Yes. Yeah. Yeah. Yeah. And and but even this test is a body of work. We normally
01:08:02
would separate these two tests on two separate days. Okay. So people, you know, the the people who come to 10 squared are not from Austin. They're
01:08:09
from all over the place. So they come in for two days of testing. And you got to sort of figure out a way to take a
01:08:14
person who's not necessarily that fit and and allow them to do these tests. So it's kind of broken up over to a couple
01:08:20
days so they can mix it with the strength testing and all the other stuff. And if you were advising Jack on
01:08:25
how to improve some of these scores here, what would you say? So the truth of the matter is looking at his stuff
01:08:32
here I would say I think you've got the endurance thing really covered in his case there were other issues that were
01:08:38
uncovered during his intake that were of more concern and this is a matter of like now what we think of as portfolio
01:08:44
management right so when your V2 max is in the top 2% when your fat oxidizing 7 you know almost8 grams per minute and he's got a heart rate of 165 to 170 when
01:08:55
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for 10% off your first order. These are Jack's results. So I've invited Jack in because I feel like he might have some
01:11:05
questions and you might have some questions. So you guys go ahead. All right. Well, uh, first off, Jack, thanks
01:11:11
for being an awesome guinea pig yesterday. You hit it out of the park, um, as far as your cardio training. So,
01:11:17
tell me a little bit like what are you what are you doing for cardio? How often are you running? So, I actually stripped it back quite a lot. I probably started
01:11:24
maybe maybe like two years ago going really heavy on running and that's all I did. And then I started getting a little
01:11:30
bit injured. So, now I've cut it back, but I'd say I do like one long run a week and that's like 20k. Outside of
01:11:37
that, I don't really do much other cardio. Interesting. I I know that the team talked to you about your left foot.
01:11:44
Yes. And did did they show you the pictures on the treadmill? They did. Yeah. That's super interesting. Super
01:11:49
interesting. I sprained my ankle really badly like 6 months ago. Y said that could have been something. I think it's
01:11:55
very likely that the ankle sprain has not has changed your gate such that you probably are going to develop an injury over time with your running. if the if
01:12:07
your pattern is not corrected. So, you're overcompensating on the left and did I I assume that I assume you noticed
01:12:12
the difference in the height of your shoulders and your head and everything while you were running. So, even though the engine is working insanely well,
01:12:19
this test only measures the performance of your engine, your chassis, which is a subjective assessment to use the car
01:12:26
analogy shows that the chassis is a bit weak. Okay, I'll give a bit of context on what that actually was. So, when I
01:12:31
was running on the treadmill, um I think it was Kyler was it? He he showed me a picture afterwards of me running and
01:12:37
basically my head was right in the middle. When I went on my right side, but then when I went on my left, my
01:12:44
whole body was like a bit lopsided. Y So yeah, that's kind of what you're talking about there. That's right. And again,
01:12:49
like the good news about running is each step is very light. Mhm. But if you're running 20k, that's a lot of steps. So even something that's a light impact but
01:13:00
done thousands of times will produce a problem. Okay, so let's shift from how well the engine is, which is exceptional at both ends. By the way, to be clear,
01:13:12
your peak engine output, which is V2 max, was awesome, and your engine efficiency, which was your zone 2, your
01:13:19
fat oxidation, exceptional. We do have this issue on the chassis that needs to be addressed or you're going to get a repetitive strain injury. Mhm. Um, so
01:13:26
then the next thing that the the team did was just a very simple test called the DEEXA scan, but we we do a more
01:13:32
comprehensive one. So we're looking at all the bone density, left hip, right hip, lumbar, spine, and then total body
01:13:38
fat, total muscle mass, and then visceral fat, which is fat around the organs. I think the most surprising
01:13:43
aspect of the test was your bone density. So, um, a DEXA scan, uh, measures bone density very accurately and both, uh, sort of across the board
01:13:56
in terms of your your lumbar spine and your right hip and your left hip, you were in your in your lumbar spine two
01:14:03
standard deviations below the mean for someone your age. So, that means basically you're in the bottom 10 percentile of bone density for a guy
01:14:14
your age. And for your hips, you're not much better. Both on the left and right hip, you're about 1 and a half to 1.7 standard deviations below the mean. So what does that mean? That means
01:14:28
that you're at you you already have something called osteoporosis. So when your T-core, which in your case is
01:14:35
almost the same as your zcore because of your age, but the zcore compares you to someone your age. The t-core compares you to someone 30 years old. So when
01:14:43
your T-core is minus1 um you have osteopenia and when it gets below minus 2.5 you have osteoporosis. Those are just technical definitions of bone density. The problem is your risk of
01:14:54
bone fracture goes up really significantly. Now because of how young you are. It's not like I'm worried
01:15:01
you're going to walk out of here and something's going to go wrong. But the risk of you sustaining an injury in
01:15:07
sport is is not trivial. Right? If you were out skiing and Steven was out skiing, assuming he had normal bone
01:15:12
density, and you guys both took a tumble, I would be infinitely more worried about your bone density. And we have patients in our practice who do.
01:15:19
They're young, healthy people, and they get these freakish fractures while skiing or playing sports and things like that and they have really low bone
01:15:26
density. So, so one, it's just something we want to address. The bigger concern is that what's what is the what is the
01:15:32
story of this going to be when you're 60 and 65 and 70? And that's that's the one where we really want to mitigate it. So,
01:15:37
I know that the team talked to you about making sure you follow up with an endocrinologist. You want to make sure that there's nothing here that is
01:15:43
medically obvious to be treated, such as vitamin D deficiency, anything that has
01:15:48
to do with parathyroid hormone or calcium and things that are, you know, medically obvious to treat. Um the most
01:15:55
important behavioral thing that a person can do with low bone density beyond correcting all the nutritional
01:16:01
deficiencies that can lead to it is applying heavy load to the bone. So bones are active pieces of tissue even though we don't think of them that way
01:16:12
and they respond to deformation. So you have to put strain into a bone for it to
01:16:19
respond and strengthen. And it's counterintuitive that running is not amazing at doing that. It's not bad. So on in general, runners have better bone
01:16:30
density than sedentary people, but not by much, believe it or not. Uh swimmers and cyclists, believe it or not, tech
01:16:37
actually have lower bone density on average. But resistance training with heavy weights is is actually kind of
01:16:45
what is necessary. Grappling as well, by the way. people who do jiu-jitsu, strength training, resistance training,
01:16:50
those are those are the ways that you're going to you're going to increase this. So, I would say that was the first finding that that that is, you know,
01:16:56
important and worth discussing. Do you have any questions on that? Cuz I've got a couple. Uh well, I think my first one
01:17:02
was so I I only actually started lifting weights like properly maybe two years ago. So, that's probably why you're
01:17:07
seeing that. Maybe. I mean, I guess did you have asthma as a child or anything? No. I know when I my mom says something
01:17:14
about like when I was born I had low calcium something about low calcium they had to put something on my teeth but I don't know what that is exactly. Well if you had low if if there's something that was impacting your calcium levels when
01:17:25
you were little that would certainly be a potential risk for it. Um the the our bones are mostly formed for for males in
01:17:33
the early 20s for girls typically in the late teens. So, anything that disrupted calcium metabolism when you were young
01:17:39
could have played a role in this for sure. Um, the reason I asked if you had asthma is a lot of the times we see
01:17:45
folks that you know had any medical condition that required corticosteroids, prolonged use of corticosteroids would
01:17:51
be another big risk factor. Of course, there's also genetics. So, probably worth knowing if your parents themselves
01:17:57
have low bone density. Um, but but it sounds like there's something going on with calcium metabolism as a as a kid
01:18:03
that might have played a role. Um the reason it is really important to connect with an endocrinologist now is there are
01:18:10
actual medical uh treatments that can increase bone density in addition to all of sort of the total optimization of the
01:18:17
nutritional stuff vitamin D calcium levels things of that nature and of course the training. M are there
01:18:23
specific exercises I would do to increase that or is it just an all round kind of No, I mean I think the the if
01:18:29
you think about the long bones of the body which are the the the ones that we're basically measuring here I mean the short bones in the spine but the
01:18:35
femurss and hips anything that puts those things under deformation. So anything from a farmer's carry to a step
01:18:42
up to a box squat. I mean, you know, it's whatever you can do safely that's loading you and placing these bones in a
01:18:48
manner that that forces them to to actually undergo deformation. The way the way and the other thing I would also
01:18:55
make sure of is that someone's checking your blood levels to look at things like testosterone and estrogen. So estrogen,
01:19:00
believe it or not, probably the most important hormone besides vitamin D in bone health. So you can think of a bone
01:19:07
as something with a strain gauge in it. And as the bone is deformed, the strain gauge sends a signal, a chemical signal to cells that build the bone. The chemical signal is estrogen. So the
01:19:21
reason women are so susceptible to osteopenio and osteoporosis is once they go through menopause, many of them lose
01:19:28
their estrogen if they're not placed on well, they all lose their estrogen, but if they're not placed on hormone replacement therapy, they don't get it
01:19:33
back. And so they lose that chemical signal. So women see a rapid drop off in bone density at menopause. Peter, is
01:19:39
this graph accurate roughly? Yes, this would be accurate. So, if this is broadly accurate, what is the game
01:19:46
then for someone like Jack? Is it is it building bone or is it preventing decline? Yeah. Preventing decline. Most of us reach our peak bone mass uh in our
01:19:58
20s. Okay. Yep. So, so the name of the game is prevent it from getting any weaker. The good news is, by the way, I had a woman on my podcast named Belinda Beck who studies osteoporosis. She's
01:20:10
she's from Australia and um she did this amazing study there called the Lyftmore study where she enrolled a bunch of
01:20:17
women with osteoporosis who had never done any resistance training and half of them were randomized to the usual activities
01:20:25
like you know yoga and things of that nature and then half of them were randomized to heavy resistance training.
01:20:31
And the women that did the heavy resistance training actually first of all on DEXA saw no change in bone
01:20:37
density or saw a very minor reduction in bone density compared to a significant reduction in the women who were not
01:20:42
resistance training. But more importantly on CT scans the women who had did done the resistance training
01:20:48
actually showed an increase in cortical thickening of bone suggesting that it might even be that DEXA is not by itself
01:20:55
sufficient to fully assess bone health. It assesses bone density, but not necessarily bone health. And her
01:21:02
hypothesis is that these women might actually be getting stronger bones even if the density is going down just a
01:21:08
little. But either way, even if density were sufficient, the fact that their density went down so much less than the
01:21:14
others, uh, was amazing. And it's it's actually, you know, if you can find the video and link to it on YouTube, Belinda
01:21:19
Beck's lift more study. It's just an awesome video to watch these little old ladies walking around picking up, you
01:21:26
know, deadlifting their body weight and stuff like that. Is there anything else you wanted to ask Jack or about your
01:21:31
results or anything else pressing questions you you have? Yeah, nutrition would be a good one actually. Yeah,
01:21:37
calcium, vitamin D, protein, everything that's going to support muscle mass as well because that's the other thing that
01:21:42
we found here. So, we we looked at your body fat percentage. Again, in absolute terms, not that high, but for your age,
01:21:48
pretty high, right? Because you're because you're young. So you were at the 80th percentile for your age and your
01:21:53
visceral fat was at the 50th percentile for your age. We like to see so we don't
01:21:58
really care that much about total body fat. We care a lot more about visceral fat. So the fact that your visceral fat
01:22:04
was at the 50th percentile. Visceral fat is the fat that's around your organs. That's the more metabolically deranging
01:22:10
damaging fat. We actually we have a very high standard. We want to see that below the 10th percentile. I'll hit pause on
01:22:15
that for a second. But then to relay the next thing that we looked at was your muscle mass. So, we looked at the total
01:22:21
muscle mass in your arms and legs. That's called your appendicular lean mass. And then we looked at the total
01:22:26
fat-free mass in your body. And both of those put you at about the 20th percentile. So, the first question I'm
01:22:34
asking when I'm looking at these results is, are you adequately muscled or undermuscled? So, I really want to see
01:22:41
somebody above the 50th percentile in muscle mass. So, you're under muscled. The second thing I'm looking at is with
01:22:49
the body fat percentage where it is both and the visceral fat is that to me I call that overnourished. Now I don't
01:22:56
have blood tests to see where you are metabolically but I want those are the those are what I call my three questions. Are you metabolically healthy
01:23:02
or not? I need a blood test to see it. I suspect you are though based on your zone 2. So the fact that your fat
01:23:08
oxidation was 77 grams per minute very hard and your fasting lactate was 0.5 which is also very good. So my bet is you are metabolically healthy. We would have to do a bunch of blood tests to
01:23:19
confirm that, but I bet you would be. But you are overnourished, meaning body fat is too
01:23:25
high and visceral fat is too high. And you are under muscled, your ALMI and your FFMI are too low. So that
01:23:32
immediately tells me like what do you need to be doing? You need to be eating more protein, fewer calories, more
01:23:39
resistance training. You don't need to do any more cardio. Like that's like oversimplification, but like that's the
01:23:44
that's your path forward. And the last question I had around uh I think I've heard you speak about it before, but
01:23:50
it's around like the potential of what your muscles mass can be. If you lift as a teenager versus if you start lifting
01:23:57
and you're I'm 29. So if I start lifting at like 27, the potential is a lot less, right? Is that true or is that uh I'm
01:24:04
I'm I'm not sure. I think I think genetics play a pretty big role in that. Um, and I think, in other words, I think
01:24:12
that your ceiling is probably more dictated by your genetics than it is the age at which you started. I think if you took a, you know, someone who was just genetically wired to put on muscle and
01:24:24
they don't start lifting until they're in their 20s, they're still going to put on a ton of muscle. I mean, like, I've
01:24:29
been lifting weights my whole life since I was 13 years old. I'm never going to be like a monster. Like, it's just not
01:24:35
gonna happen, right? there's no chance I'm ever going to be on the stage of a bodybuilding, you know, contest. Okay.
01:24:41
Yeah. That's just one thing that's like always haunted me. Well, haunted me in the last two years. Yeah. Yeah. Yeah. And now you but but but I don't again
01:24:48
there's you have to consider a bunch of variables as you're lifting. Right. So, are you training at the right intensity?
01:24:54
Are you training at the right frequency? Do you have the right selection of exercises? Is your technique correct?
01:25:00
So, lifting weights, it's not a uniform term. Um, so, so you really have to dive
01:25:05
into that, right? So, to put on muscle, you probably need to be doing a minimum of 10 and I would say ideally closer to
01:25:12
20 sets per week per body group. The intensity has to be sufficient. So, we were talking about that minimum two, ideally one rep in reserve per working set. So, if you're if you're just doing
01:25:25
like three sets of 10, but you could have done three more reps if you really pushed, there was no training stimulus
01:25:31
there. I've got a question on that which is linked to one of my friends, but it's something I've heard you say which is
01:25:37
you you've said to me before that you struggled with gaining weight. Yes. A friend of mine says has said this to me
01:25:42
for the last 10 years that muscle. Yeah. He said yeah. So he says like he even when he eats a lot he has like feels
01:25:48
like he's force-feeding himself um and it's like not natural and then when he goes to the gym he hasn't seen the
01:25:53
results. Whereas for me I don't I've never had the problem of like I I can eat loads and then I go to the gym and I
01:26:00
work out and muscle comes on. So, for those people that struggle with a eating enough calories and then they go to the
01:26:07
gym and they don't feel like they're able to gain muscle, you've you've experienced this before, haven't you? You've experienced people that have said this to you. Sure. It's actually much
01:26:14
more common with with women than men, but um it it's sort of focusing more on the protein as opposed to the total calories. I mean, you do need the calories, but it's probably breaking
01:26:24
down the protein intake into smaller servings. Um, and that for many people just means they have to get shakes or things like that. like they're not going to get it through whole foods all the time. I I I don't need to drink shakes
01:26:35
because I'm able to get protein through food enough, but that shouldn't be viewed as as something you don't want to
01:26:40
do. I mean, even I'm sure some of the, you know, most successful bodybuilders in the world just based on their protein
01:26:46
requirements still have to resort to shakes. So, figuring out what it takes to get one gram of protein per pound of
01:26:52
body weight and making sure you get that, even if it takes four servings a day, is a it should be the highest
01:26:58
priority. And again, you don't need more calories at this point based on your visceral and body fat. Um, we just need
01:27:04
to make sure you're getting that gram of protein per pound of body weight. Um, and that you're doing the you're getting
01:27:10
the right training stimulus in the gym. Okay. Yeah. Thank you. Okay. Thank you for that, Peter. I
01:27:17
didn't know we were going to be doing a little consult here. I know, but it's super fascinating. Even for me, even though they're not my results, I learned
01:27:22
a ton about about that. Um the question we don't necessarily need to go through all of the results here for Jamaima but
01:27:28
how do you see women's results being different typically as it relates to bone density muscle mass and those
01:27:33
things. I was wondering if even for the V2 max are expecting different results for women or well we we score them on a
01:27:39
different curve. So the the results are going to be a little lower and again part of the reason is women have less
01:27:44
muscle all things equal and muscle is the organ that is going to consume the most oxygen uh I mean outside of the brain. So, um, so you know, if you if
01:27:55
you took a a woman at 25 and a man at 25, there's a different threshold for what a what the grade is on the curve.
01:28:03
But I would say the biggest difference we typically see is, and not so much at the ages of these guys because they're both so young and fit, but as we as we get into kind of older folks, we we
01:28:16
definitely see more of an issue with muscle mass in women and bone density in women. I was quite surprised with Jack
01:28:22
when you you talked about um visceral fat. Yeah. There's two types of fat that I've come to learn. Subcutaneous which
01:28:27
is I think is on the outside is and then visceral is around the organs. Right. So the body fat is mostly measuring his subcutaneous fat. Oh, on the outside. Y.
01:28:35
Okay. I've got a little bit of subcutaneous fat right now. As we do all, how do I
01:28:41
know if it's if it's an issue or not? Unfortunately, it's very difficult to know without further investigation. Um,
01:28:49
I say this because I haven't been able to predict it looking at somebody. Like I've seen people who have lots of
01:28:55
subcutaneous fat, but when you look at their liver and look at their visceral fat, they have virtually none. And they
01:29:02
tend to be quite metabolically healthy. So maybe aesthetically they've got too much body fat. And there are lots of
01:29:09
reasons why they might want that, might not want that, I'm sorry, based on, you know, excess body weight that just in general is an impediment to movement or,
01:29:16
you know, pain in their knees or joints. Um, but it's not actually causing them harm physiologically. And conversely,
01:29:24
you know, if you look at Jack, like he's he actually looks he's a pretty lean-look guy. Like nobody would look at Jack and say he's overweight, but he's
01:29:30
got a little bit too much fat on the inside. and that if not I mean I think his running and his fitness is probably offsetting it metabolically but there might be come a day when that's not the
01:29:43
case. So it it you know this is something that I think just needs to be addressed and and again people that are
01:29:50
in their 20s can get away with a lot and it starts to become something you don't get away with in your 40s. Is there a
01:29:55
genetic component to this and also what has caused it? What usually causes it? the body
01:30:02
fat, the visceral fat. Visceral fat. Yeah, there's definitely a genetic component to it, but the truth of the
01:30:07
matter is the cause of this is is just fuel partitioning. It's just it's just where the body is putting excess energy,
01:30:14
right? So, so all of the fat we have in our body comes down to where does our body choose to store excess energy
01:30:20
because that's that's the only way we store it. We can't store protein. So, we can only store I mean, we store protein
01:30:26
technically in muscles, but we're basically storing carbohydrates and fat. So you can store carbohydrates
01:30:32
preferably in the muscle and in the liver as glycogen, but that's a very finite source. So most of where you're
01:30:38
storing those things is excess glucose gets stored as fat and then in fat gets stored as fat. So if theoretically if Jack had a higher muscle mass, he would have less visceral fat potentially.
01:30:51
Yeah, probably because first of all muscle is more metabolically active. So more metabolically active tissue means
01:30:57
higher energy expenditure which would all things equal mean lower fat. That makes sense. And if there were a couple of things that I could do to reduce my visceral fat, we talked about exercise
01:31:08
there. We talked about diet. Intermittent fasting, do they are you are you a fan of those kinds of things?
01:31:13
There's no evidence that intermittent fasting produces any benefits above the equivalent amount of caloric restriction. So you know whe whether you're eating in eight hours or six
01:31:24
hours or across 12 hours if the same number of calories are consumed it's essentially producing the same outcome.
01:31:31
Sleep stress absolutely dramatic. We've talked about sleep already right if your
01:31:36
sleep is not good you are going to be insulin resistant. If you are insulin resistant, you are partitioning fuel in
01:31:42
an unfavorable way, which in English means you are more likely to access glucose than access fat even at low
01:31:50
levels of intensity when you should be accessing fat. That's why, by the way, I thought he's probably still insulin
01:31:57
sensitive based on how high his fat oxidation was. Meaning when he was at 165 beats per
01:32:04
minute on a treadmill, he was pulling out almost 0.88 gram per minute of fat. That's really good. That tells me he fuel partitions well. He knows how to access fat when he
01:32:18
needs fat. So that's that's still working in his favor. But for many people, once they're exercising that
01:32:24
hard, their their fat oxidation goes to hell and all they're doing is accessing glucose. But there could be a link for
01:32:30
in his case between sleep and visceral fat. Yep. Especially if he travels with you. Yeah. And then alcohol. You mean Jack doesn't drink alcohol? But generally visceral fat and alcohol. Yeah. Bad sign. I want to talk to you
01:32:42
about this alcohol point because I saw Huberman um tweet the other day saying that it's now pretty well established
01:32:48
that even moderate alcohol intake is bad for you. But I sat here the other day with someone else who said to me that
01:32:53
they talked about the Medit Mediterranean diet, the Italians, they seem to be fine, etc. And I wanted to kind of get your perspective on whether
01:33:00
small amounts of alcohol intake are okay or not because some people still think it's healthy to have moderate alcohol intake. It's better for the heart. I think that is pretty abundantly not
01:33:12
true. So I don't think I am aware of any real evidence and we've scrutinized the heck out of this. We so the subscribers to our podcast get these premium newsletters
01:33:24
every month where we do an ultra insane deep dive into a topic and alcohol was one of them. So this is like you're getting a treaties right a 20page research report on a topic. So uh for
01:33:36
anybody who's interested in that they should go and get the alcohol piece but I'll link it below. Yeah, the TLDDR is
01:33:43
that there is no compelling evidence whatsoever that there is a health benefit that comes from ethanol consumption. The molecule of ethanol is
01:33:53
not healthy at any dose and I believe that is unambiguously true. That said, it does not appear to be linearly toxic, meaning low doses, probably sub
01:34:11
15 gram per day. 15 grams of ethanol would be what you would get in a standard drink. Standard drink, not a
01:34:18
generous drink. So, you know, whatever. Like 3 4 ounces of wine would be 15 grams of ethanol, 14 grams of ethanol.
01:34:26
It appears that for most people the toxicity of that amount of ethanol is very difficult to measure. And this is where you get into the area of for some people there might
01:34:39
actually be enough of a pro-social benefit from that amount of ethanol if consumed in an otherwise healthy environment. Right? So if you talk about
01:34:50
the individual who comes home and has a glass of wine while he's with his wife and they kind of unwind in the backyard
01:34:58
and talk about their day and things like that, there might be benefits from doing that that outweigh the very very small
01:35:05
amount of toxicity that came in that ethanol. Once you reach about 30 grams of ethanol
01:35:10
a day, I don't see and I have not seen a shred of evidence that there is any amount of pro-social behavior that can
01:35:17
offset the toxicity of that ethanol. So, while I would not go as far as the World
01:35:24
Health Organization, which has condemned ethanol as a carcinogen at every dose, I
01:35:31
just don't see the data to make that case for every dose. I tell my patients in a very measured,
01:35:38
nuanced way, kind of what I just told you, like, you know, I drink alcohol and I I but I but I think about it every time I do, like, is it worth it? Is it worth it? Is it worth it? Like, I'm not
01:35:51
just drinking for the sake of drinking. I have this expression, don't drink on airplanes because the alcohol sucks.
01:35:56
Like, I'm not just drinking to numb myself, right? Like, if I'm going to drink, there's a reason. It's going to
01:36:02
be really freaking good. And that for me amounts to probably like four drinks a week. Just for a second, I want to talk about a company I've invested in and who sponsored this podcast called Zoey. Like
01:36:13
me, many of you are big on tracking your fitness and your sleep. But how many of you understand how your body handles
01:36:18
food? Metabolic fitness is all about understanding your metabolism's response to food. And we all react differently.
01:36:25
So Zoe created a test to help you understand how your body responds. And it starts with their famous test
01:36:30
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01:36:37
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01:36:42
levels. I've done this test, and it left me wondering how my metabolic fitness compared to others like me, and my
01:36:48
results revealed everything. So, if you'd like to learn about your body's response to food, head over to zoey.com
01:36:54
to order your test kit now. And if you want a discount, use code Stephen 10 at checkout for 10% off your membership. As
01:37:01
a Zoey member, you'll get an athome test kit and personalized nutrition program to help you make smarter food choices
01:37:07
that support your health. That's zoe.com with code stephven10. You're just talking about
01:37:13
airplanes there. I was thinking about electrolytes. There's been a huge boom over the last couple of months year of
01:37:20
people consuming more and more um electrolytes. Everyone's launching an electrolyte drink and consuming much
01:37:26
more salt and sodium. What do you make of this? Are we electrolyte deficient? Um, well, first of all, as a disclosure, I'm an investor in a company that sells electrolytes, so LMT. Um, so I'm an
01:37:37
investor in that company, which I always want to disclose stuff like that if it's pertinent. Um, the short answer is it
01:37:44
depends. So, why did I get interested in electrolytes? Well, I historically never consumed electrolytes when exercising. I
01:37:51
was pretty much always consuming water and or water plus carbohydrate depending on the intensity and duration of the
01:37:56
exercise. I also tend to have very low blood pressure and a couple of years ago I had a really really bad fall when I woke up in the morning and I was jet-lagged. So I had just flown to
01:38:08
Brazil. So obviously you get a little bit dehydrated on a plane and then the first like you know you get in whatever
01:38:15
that night and then the next morning I woke up got out of bed and faceplanted into a table. You can probably still see the scar on my forehead. And I got back home and you know my doc measures my
01:38:27
blood pressure. It's like 95 over 60. And he's like yeah you're just you're really dehydrated man. Like you we need to get a little more. And it's not like I don't eat salt. I make zero effort to
01:38:39
restrict sodium in my diet, but clearly I was just exercising too much, you know? I mean, especially living in
01:38:45
Texas, like when I'm exercising outdoors, I'm sweating like crazy. So, it was like, you just got to get more salt, man. So, I just went I literally
01:38:52
then did a super deep dive on hydration and realized that there's basically two ways to maximize hydration. Either you consume water with a high enough not
01:39:03
just a high enough with the absolute correct concentration of glucose in it and the correct concentration is between
01:39:08
five and 6%. So that's 50 to 60 grams of glucose per liter of fluid will maximize
01:39:14
water uptake through the sodium water transporter or you consume um what's called osmotic sodium in water. Those are your two options uh with the with the glucose one being slightly better.
01:39:28
And so what I realized is look, I don't exercise long enough anymore to justify it. And the only workout I do a week
01:39:34
that is intense enough to justify it is that V2 max one where I'm I actually am using glucose and water. But for the
01:39:40
rest of my workouts, I don't I don't need it. I just need sodium and water. And then I just went through every
01:39:46
product on the market. Like literally went to Amazon, click click click click click click click order every one of
01:39:52
them and realize at the end of the day it's a commodity product. Get the one that tastes the best because that's the one you're going to have to suck down
01:39:58
every day. Peter, what's the most important thing we didn't talk about that we should have talked about as it relates to your work, the science that
01:40:04
you're obsessed with at the moment, and anything that my audience might and should need to know that we haven't yet
01:40:10
discussed. May maybe just the idea that it's really tempting in in the world I live
01:40:19
in to want to find single sources of problems, right? So there's always a there's always a a boogeyman and I think unfortunately the the entire landscape
01:40:33
of health influencing and social media has has created a very unhelpful narrative around many of these things. And so, you know, there's an effect called
01:40:46
the Dunning Krueger effect, which can be sort of, you know, put into a cartoon, right? Where it shows, you know, experience on the, uh, x-axis and
01:40:57
confidence on the y- axis. So, you've seen this graph, I'm sure, where it starts out like it just skyrockets up to
01:41:03
what's called the peak of stupidity, and then it kind of comes down into the valley of humility, and then as you
01:41:08
become more and more of an expert, you gradually rise, right? So, so this idea of like the deeper you go out from shore, the further from shore, the
01:41:14
deeper the water gets. And yet, and most of what you're what what I'm sure your audience is is going to be exposed to
01:41:20
because we all are if we're on social media or whatever is like people preaching from the peak of Mount Stupidity. And so, I think maybe maybe
01:41:27
the thing to be thinking about is like what are the signs of that, right? And it's usually people that are like
01:41:33
there's one thing that is the thing, right? like it's this additive in food or it's this particular oil or it's this sugar or it's this that and it's like
01:41:44
the truth of the matter is it isn't one thing like it's it's really really complicated and it's hard to talk about
01:41:52
things that are complicated and we tend to just want to focus on one thing and I've been guilty of this myself if I
01:41:58
look at stuff I was writing 15 years ago I'm like man you really oversimplified that too much like you overindex on that and you ignored this thing and and so I
01:42:08
I just think that you know try try to identify people out there who are talking about things in a nuanced way
01:42:14
and you're generally going to be closer to the direction of reality and how do you deal with that as a podcast host
01:42:19
because you must sit there you know so much about the subject matter and you must sit there and hear people say to you on your podcast things that you
01:42:26
don't agree with. Well, on my podcast, it's easy because again, the nature of my podcast is super inquisitive. So,
01:42:32
it's just very easy to to push back and sometimes I don't. Sometimes I'll, you know, I I was recently interviewing somebody and they they made a comment and and I just knew it was wrong, but I
01:42:42
I was like, you know, I I'll make an editorial comment later about this for the audience to understand that he's he's he's confusing cause and effect. And I didn't push
01:42:54
back. and afterwards I thought I probably should have I probably should have pushed back on what he said a little bit. Um but again on my podcast
01:43:01
it's easy. I think the bigger issue is when people send me links to podcasts like what do you think of this and I
01:43:07
have to go through and like explain why what this person said is completely wrong. I mean just completely unfounded
01:43:14
in any scientific uh basis whatsoever. But they're a very compelling speaker and so I get it like I get why you know that that you would you know as as my
01:43:24
friend send that to me with concern. One of the things we've introduced recently well in the last 3 four months is just
01:43:30
we put um we have some independent scientific individuals who have a look at some of the things that are being said just to cross reference and provide context. We call it kind of context checking. Nice. just because some of the
01:43:42
bigger things obviously there's so many big as you were saying so many terms like seed oils and this and this and
01:43:48
this that have started a bit of a nutrition war on the internet and so we just want to make sure that we provide
01:43:53
more context to these things so that a person at home who isn't going to take it upon themselves to apply that context
01:43:59
or do the research has more more of a wide opinion but it's difficult because as you say oftent times it's the best
01:44:05
speaker or the person with the most conviction that gets heard. um you've managed to break through all of that and
01:44:11
provide an tremendous amount of nuance and complexity to these subjects, but also to achieve the same focus and
01:44:17
articulation and resonance and accessibility that some of those individuals have achieved. I would
01:44:23
highly recommend anybody who has not read this book to read this book because this is the book on this subject. And I say that I've interviewed many hundreds of people, but this is the book on this
01:44:34
subject. It's been a global phenomenon for all the reasons I've described about it being so accessible. It's so nuanced,
01:44:40
but so um easy for someone like me to understand even though I'm not a scientist. And it's the book that I
01:44:46
recommend to my friends, to my family when they're trying to understand the subject matter of longevity in a world where there is just so much information.
01:44:53
And that's why this book did so well and it continues to do so unbelievably well. But I'd also recommend everybody go check out your podcast, which I love
01:44:59
watching. And also if they want um other resources from you, where do we send people? Peter, I think our website probably. So Peter Aia MD the the website will probably direct people to
01:45:10
all the different sort of places where we have unbelievable amounts of free information. So we have a newsletter
01:45:15
that comes out every single week. It's free. It's really valuable. People, you know, the open rate on that is through
01:45:21
the roof because it's not junk. like it's it's we're putting something in your inbox every single Sunday that you're going to want to read about the
01:45:28
exact topics you're asking. So, I'm going to link all of that below. So, put all of the links below for for Peter's work if you if you haven't become
01:45:35
obsessed like we all are here with Peter's work. And I really mean that. We're all massive fans of yours. Jack was saying before you came, he said,
01:45:40
"Oh, I love Peter." You were saying this the other day. I was saying this about a week ago. And that's something that I think we all feel because of the impact
01:45:46
you've had on our lives of demystifying this information, but bringing it to us in a way that's so so accessible, so
01:45:51
smart, and so trustworthy. So Peter, thank you for what you're doing because you're demystifying a very complicated
01:45:56
world for all of us. And it's a world that if demystified, we stand a better chance of living happier, healthier, longer lives. And there's probably
01:46:02
nothing more important to to what makes life meaningful and fulfilling. And me being able to walk up and down those
01:46:08
stairs in Bali when I'm 75. So thank you, Peter. It's tremendous. Really, really tremendous. And I appreciate you
01:46:13
very very much. Peter, I I was so caught up in um admiration of you that I forgot that we have to ask you this question,
01:46:19
which is the question left by the last guest. And that is what would you do if you weren't
01:46:27
afraid? Why that face? Oh. Um because I've been dealing with that for a long I've been dealing with something for for a couple of weeks that that is is is incredibly uh frightening,
01:46:45
but I think I've finally worked up the courage to do it. Um but I can't speak about it, unfortunately. Oh, really?
01:46:51
um at least not yet. I will be able to one day. There will be a day when I will be able to tell this story and it it
01:46:58
will it will be one of the most important decisions I've ever made in my life. Oh, I'm so curious and so
01:47:04
intrigued. Yeah. And it's um I can tell by your reaction that it's going to be profound for both you and all of us. I
01:47:12
could tell by your reaction because I can tell that there's some element of struggle there. So, yes, whatever it is, best of luck and maybe we'll talk again
01:47:18
in the future once you've uh been able to talk about it. I can't wait. Thank you, Peter.
01:47:24
We launched these conversation cards and they sold out and we launched them again and they sold out again. We launched them again and they sold out again
01:47:29
because people love playing these with colleagues at work, with friends at home, and also with family. And we've
01:47:34
also got a big audience that use them as journal prompts. Every single time a guest comes on the diary of a CEO, they
01:47:40
leave a question for the next guest in the diary. And I've sat here with some of the most incredible people in the world, and they've left all of these
01:47:47
questions in the diary. And I've ranked them from one to three in terms of the depth. One being a starter question. And
01:47:54
level three, if you look on the back here, this is a level three, becomes a much deeper question. That builds even
01:48:00
more connection. If you turn the cards over and you scan that QR code, you can see who answered the card and watch the video of them answering it in real time. So, if you would like to get your hands
01:48:12
on some of these conversation cards, go to the diary.com or look at the link in the description below. This has always
01:48:17
blown my mind a little bit. 53% of you that listen to the show regularly haven't yet subscribed to the show. So,
01:48:24
could I ask you for a favor? If you like the show and you like what we do here and you want to support us, the free simple way that you can do just that is
01:48:29
by hitting the subscribe button. And my commitment to you is if you do that, then I'll do everything in my power, me
01:48:35
and my team, to make sure that this show is better for you every single week. We'll listen to your feedback. We'll
01:48:40
find the guests that you want me to speak to, and we'll continue to do what we do. Thank you so much. Heat. Heat.
01:48:47
[Music] I Wow. [Music]