0:00

Death is inevitable, but the rate of decline

0:02

is very much up to us, but the

0:04

drawback that young people have is they only

0:06

begin to realize the inevitability of the decline

0:08

when it besets them. So your team that

0:10

came in for testing that are in their

0:12

20s when I'm looking at these results, there

0:15

were issues that were uncovered that were a

0:17

concern, and ignoring it doesn't lead to a

0:19

good outcome when you're 65, but a lot

0:21

of people have this issue, so it's okay

0:23

to speak freely about this. Yep. The biggest

0:25

concern is that Dr. Peter Attia is

0:27

the go-to physician for high performers, celebrities,

0:30

and anyone serious about unlocking the science

0:32

behind a longer, stronger, and healthier life.

0:34

I had a big epiphany at a

0:36

funeral of a friend of mine who

0:38

I realized had declined so much during

0:41

their last decade that when they couldn't

0:43

do those things that gave them pleasure

0:45

because of injuries, aches, aches, and pains,

0:47

they weren't enjoying life. I call it

0:50

the marginal decade. Wow, okay, sir. What

0:52

are the most important parts of my

0:54

health that I should be thinking about

0:56

for longevity? So there's muscle mass, muscle

0:58

strength, but we don't have a single

1:01

metric that we can measure that better

1:03

predicts how long they will live than

1:05

how high their CO2 axis, which is

1:07

the maximum amount of oxygen you can

1:10

consume. And if you compare somebody who

1:12

is in the top 2% to someone

1:14

who is in the bottom 25%, there

1:16

is a 400% difference in their all-cause

1:18

mortality over that. way to avoid this

1:21

is to train specifically for that marginal

1:23

decade. And there's so many things that

1:25

we just do wrong. So the sooner

1:27

you start, the better. So rule number

1:30

one... I find it incredibly

1:32

fascinating that when we look at the

1:34

back end of Spotify and Apple and

1:36

Art audio channels, the majority of people

1:39

that watch this podcast haven't yet hit

1:41

the follow button or the subscribe button,

1:43

wherever you're listening to this, I would

1:45

like to make a deal with this,

1:48

or the subscribe button, wherever you're listening

1:50

to this, I would like to make

1:52

a deal with you. If you could

1:54

do me a huge favour and hit

1:57

that subscribe button, I will work tirelessly

1:59

from now until forever to make the

2:01

show better and better and better and

2:03

better. and continue to do in this

2:05

thing we love. If you could do

2:08

me that small favour and hit the

2:10

follow button, wherever you're listening to this,

2:12

that would mean the world to me.

2:14

That is the only favour I will

2:17

ever ask you. Thank you so much

2:19

for your time. Back to this episode.

2:21

Dr. Peter Atia. What is keeping you

2:23

busy at the moment in terms of

2:26

the subjects that you wrote about an

2:28

outlive, but the work that you do

2:30

online and the work you do in...

2:32

the variety of businesses that you have.

2:35

What is keeping you fascinated at the

2:37

moment? What is one's mind focus on?

2:39

I wish I could say one thing.

2:41

There's probably a few things, and maybe

2:43

that's not good. Maybe the most successful

2:46

people in life only think about one

2:48

thing. I would say one of the

2:50

things I'm thinking a lot about is

2:52

how to translate outlive into a delivery

2:55

system, obviously digitally, that... basically operationalizes what

2:57

is in that book in a manner

2:59

that allows people to, with as little

3:01

friction as possible, implement the solutions for

3:04

themselves. So basically, how do you live

3:06

a longer life? How do you age

3:08

as gracefully as possible and maximize your

3:10

health span? I think the other thing

3:13

I'm focused on that is related to

3:15

that, of course, but distinct, which I

3:17

know your team got to participate in

3:19

a little bit this week, was kind

3:21

of how to train people for their

3:24

marginal decade, right? So this idea of

3:26

we're all gonna have a last decade

3:28

of life, I call it the marginal

3:30

decade, just so that we can get

3:33

comfortable talking about something that people don't

3:35

like to think about. And I'm convinced

3:37

that ignoring it and not thinking about

3:39

it doesn't lead to a good outcome.

3:42

Instead, if you prepare for it and

3:44

train for it, like an athlete trains

3:46

and prepares for their sport, you'll have

3:48

the best version of that possible. marginal

3:51

decades and centurion decathlon, did I say

3:53

that correctly? Centenarian decathlon, yep. Centenarian decathlon,

3:55

can you explain these two terms to

3:57

me? Yep. So the marginal decade is

3:59

the last thing. last decade of life,

4:02

again, it's this weird thing where most

4:04

people don't know the day they've

4:06

entered it, but most people

4:08

also realize at some point

4:10

when they're in it. I thought a

4:12

lot about it. This was sort of

4:14

a big epiphany that I had

4:17

in 2018 when I was sitting

4:19

in the church at a funeral

4:21

of the parent of a friend

4:23

of mine who I realized had

4:25

declined so much during the last

4:27

decade of their life that even though

4:29

they were alive, they weren't enjoying

4:32

life. The things that they loved to do

4:34

in the case of this individual, play

4:36

golf and tend to the

4:38

garden, they couldn't do. They just

4:40

physically couldn't do it, right? They

4:43

had injuries, they had aches and

4:45

pains, and when they couldn't do

4:47

those things that gave them pleasure,

4:49

they retreated from life. And I

4:51

don't think there's a person listening

4:53

to us who can't appreciate that,

4:56

because they've witnessed it, right? They've

4:58

seen it in a parent, a

5:01

grandparent, a loved one. And I

5:03

don't know, there was just something

5:05

about that moment, which is

5:07

often the case, right? It's

5:09

usually like years and years

5:11

of thinking about something and

5:13

it crystallizes in an instant. But

5:16

in that moment, I realized, aha,

5:18

the way to avoid this is

5:20

to train specifically for that decade.

5:22

And... The best model for how to

5:24

do that is to look at athletes,

5:27

because every athlete trains with specificity.

5:29

So think of like all the different

5:32

types of athletes you would know. So

5:34

if you think about like a sprinter

5:36

or a basketball player or a football

5:38

player, they are so different and very

5:41

little of their training looks like

5:43

the other guy. And the reason for that

5:45

is they're doing something very specific. The

5:47

sprinter has a goal, which is to

5:49

move 100 meters as fast as possible.

5:51

That's it. And that requires a certain

5:53

set of skills. And the footballer has

5:56

a totally different goal. Yes, he has

5:58

to be able to run fast. for

6:00

short distances, but just being able

6:02

to run fast would not produce

6:04

superior results. And then the basketball

6:06

player would be different. And then

6:08

the skier would have a totally different

6:11

sense of skill. So I said, well,

6:13

who's the most well-rounded athlete out there?

6:15

It's the decathlete, because that guy's got

6:17

to do 10 different things really

6:20

well. Now, he or she doesn't have to be

6:22

the best in the world at those 10. In

6:24

fact, they never are. But overall, they're

6:26

considered the best athlete. because

6:28

of the diversity and breadth

6:30

of what they can do. And so I

6:32

said, that is our model. So what

6:35

is the centenarian decathlon then is,

6:37

I say to you, Stephen, one

6:39

day you are going to be

6:41

in your marginal decade. What do

6:43

you want to be able to

6:45

do physically, athletically in that

6:47

last decade? The answer is so

6:50

clear to me because it's associated

6:52

with all the things that make

6:54

me happy. So it would be being

6:56

able to explore. the world still

6:58

with my partner, my romantic partner. It

7:01

would be... But I would even dig

7:03

further. Tell me what that looks like.

7:05

Okay, so I went to Bali and

7:07

me and my girlfriend wanted to go

7:09

white water rafting. And to get down

7:11

to the white water rafts in Bali,

7:13

we had to walk down and then

7:15

up again. About a hundred meters

7:17

of stairs. And as I went down

7:19

those stairs, I had one of those moments

7:21

that it sounds like you had at the

7:23

funeral, where I realized that my dad could

7:25

not walk down these stairs. He couldn't walk

7:28

down them, and he couldn't walk up them. And

7:30

by the way, it's a different reason. I'm

7:32

going to point this out, and I want

7:34

to come back to your story. Walking down

7:36

is not about endurance. Walking down is about

7:38

eccentric strength in the quads to be able

7:41

to decelerate the body as it's moving down.

7:43

Very important. Coming up is about concentric

7:45

strength in the quads and glutes and

7:47

endurance. All right, but continue. That's a

7:49

really good point because they're two different

7:51

training systems. And then the reason why

7:53

that was so important was because of

7:56

the great time I had in the

7:58

white water raft with my girlfriend. So

8:00

going down that lake through Bali and I

8:02

thought, gosh, if I hadn't, if I'm not

8:04

careful and I don't think about this,

8:06

I won't be able to have

8:08

these experiences when I'm 60. What

8:10

was involved in being in the route? Yeah, so

8:13

a lot of strength required to like row to keep

8:15

us away from the rocks, to push us off when

8:17

we got stuck, fall in the water, get it back

8:19

in the boat. Think about the scapular stability that's required.

8:21

Think about the upper body strength you need to lift

8:24

yourself back into a boat if you fall. I mean,

8:26

the list goes on and on and on. And it

8:28

was, it was, it took a long time. We were

8:30

out there for two hours going through this lake. So

8:32

the other thing I think about is Christmas, and I

8:35

think about my nieces, so my brother's a year older

8:37

than me and he has three kids under the age

8:39

of six. And you know what that's like, these kids

8:41

just sprints, just sprint off, just sprint off,

8:43

just sprint off, sprint off, just sprint off,

8:46

just sprint off in every, just sprint off,

8:48

just sprint off, just sprint off, just sprint

8:50

off, just sprint off, wouldn't be able to

8:52

play with them in the garden the way

8:54

that they would want to play in the

8:56

garden running around and being chased around so

8:59

my dad just watches them from the

9:01

kitchen and so these are just obviously all

9:03

the emotional things come to mind first

9:05

because those are the things that stay

9:07

with us I'll give you one more. The other

9:09

thing that comes to mind as a man

9:12

is just being able to protect my

9:14

family. And I don't necessarily mean wrestle

9:16

an intruder but I mean like lift

9:18

things and... If something falls, being able

9:20

to pick it up and move it.

9:22

So those are the things that come

9:25

to mind first and foremost. It's protection,

9:27

it's memories, it's activities that create relationships

9:29

and connection. That's exactly the

9:31

exercise we do, right? We take people through,

9:33

give us the 10 most important things you

9:36

want to be able to do. So like

9:38

if you start with, I want to be

9:40

able to go back to Bali and I

9:42

want to be able to go down those

9:44

100 stairs, get in the raft, go down

9:46

the river, come back up the river, come

9:48

back up the stairs. That gets broken down

9:50

into very specific movement patterns. Playing football with

9:52

the kids out back gets broken

9:55

down into very specific movement

9:57

patterns. By the way, they're

9:59

very different. That one comes down

10:01

much more to foot reactivity, lateral

10:03

movement, things like that. Being able

10:06

to pick something up off the

10:08

floor is yet another set of

10:10

movement patterns. It turns out there

10:12

are approximately 27 physical requirements that

10:14

are necessary to do the sum

10:16

total of most things people want

10:18

to do. Part of the reason why I

10:20

think people don't care enough is

10:23

because they see aging as inevitable.

10:25

So they look at their parents,

10:27

their grandparents and go... They're

10:29

a mobile, they can't function

10:32

properly, that's my destiny, it's

10:34

genetic. Obviously I don't

10:36

agree with that, though I have

10:38

tremendous empathy for people who might

10:41

feel that way. It's, when you

10:43

see something as ubiquitous as

10:45

the decline of untold numbers

10:48

of people as they age, it would

10:50

be very easy and tempting to

10:52

say that that is the inevitability

10:55

of our species. Death is inevitable.

10:58

despite what some

11:00

biohackers may tell you.

11:02

Decline is inevitable, but the

11:04

rate of decline is very

11:07

much up to us, and

11:09

the preservation of

11:11

strength, stamina, movement,

11:14

capacity, those things are

11:16

largely up to us. In

11:18

fact, there are actual data. that

11:20

demonstrate quite clearly. In fact,

11:22

I was just reading a

11:24

paper yesterday in the journal Cell

11:27

that looked at the role

11:29

of exercise in aging individuals

11:31

to preserve mitochondrial function. So this

11:33

is a study that looked

11:35

at older individuals and it

11:37

randomized one group to... a significant

11:40

amount of exercise and the

11:42

other group was just sort

11:44

of business as usual being largely

11:46

sedentary. And then using pretty elaborate techniques

11:48

where you biopsy the muscle, they look

11:50

at the mitochondria which are the kind

11:53

of the powerhouse of the cell in

11:55

these individuals and it turned out that

11:57

in the people who were exercising there

11:59

was very... decline in the mitochondrial function

12:01

compared to what happened in the

12:03

people who were not exercising. Now

12:05

just because your mitochondria continue to

12:08

function well doesn't mean all aspects

12:10

of aging are offset but it's

12:12

a very important one to demonstrate

12:14

and this is also true by

12:16

the way of strength and endurance.

12:18

There's a big difference in the

12:20

rate of decline of muscle mass,

12:22

muscle strength, and cardiopulmonary fitness in

12:24

people who exercise versus who don't.

12:26

So it's all kind of a

12:28

long-winded way of saying, you have

12:30

as an individual so much more

12:32

under your control than you realize,

12:34

but you have to sort of

12:36

begin to compounding the gains. I'll

12:38

do it when I'm 50. Well,

12:40

look, the good news is 50

12:42

isn't too old, and I've met

12:45

many people who don't begin to

12:47

do this until they're 50, but

12:49

again, the analogy I would use

12:51

here is comparable to that of

12:53

investing for retirement. The longer you

12:55

wait, the less money you're probably

12:57

going to have at the end.

13:00

Springs to mind this graph I saw

13:02

the other day, which I'd sent to my

13:04

friends, which shows that the decline, I think

13:06

it was in muscle mass from when

13:09

you're 30, and it makes the point

13:11

that there's this line on this

13:13

graph called disability, and it shows

13:15

that people who didn't have enough muscle

13:18

mass when they were 30, cross the

13:20

line of disability when they're 70. And

13:22

those that did have more muscle mass

13:25

at 30 don't get close to that

13:27

line. So that for me was shocking because

13:29

it goes to show that what I

13:31

do now is going to determine whether

13:33

I'm, you know, by all intensive

13:36

measures, disabled when I'm 70 or

13:38

if I'm able. The sooner you

13:40

start, the better, the drawback that young

13:42

people have is, I mean, you've

13:44

had a, you've had a

13:46

great experience because you're, you're

13:48

introspective about it and you've

13:51

been able to gather motivation

13:53

without having to experience the

13:56

decline yourself. So that's a

13:58

wonderful position. to be in.

14:00

For many people that's not the

14:03

case. They only begin to realize

14:05

the inevitability of the decline when

14:07

it besets them. But the way to

14:09

think about this again is another analogy

14:12

is that of a glider. So gliders

14:14

eventually all have to come down,

14:16

right? Our health span is basically

14:18

a glider, but we have a lot

14:20

of control about how long it stays in

14:23

the air based on how high we can

14:25

start it. So if you think about, you

14:27

know... would you rather take a glider off

14:29

a really high cliff or off a low cliff?

14:31

That's the decision we get to

14:34

make. And we sort of call

14:36

that concept physiologic headroom. So the

14:38

example you gave is a great

14:41

one, right? So muscle mass, muscle

14:43

strength provide an enormous amount of

14:46

physiologic headroom, as does cardiopulmonary fitness.

14:48

These are huge variables that make

14:50

all the difference. And everyone's coming

14:53

down, but the fitter you are,

14:55

the... slower the rate of decline

14:58

and therefore the longer it takes

15:00

before you cross below a

15:02

threshold. And that threshold differs

15:04

by different metrics, but once

15:06

you're below that threshold, it's

15:09

very difficult to engage in

15:11

activities of enjoyment. Peter, you're

15:13

51 now. 52. 52. What do you wish

15:16

someone had told you when you were

15:18

32? I'm 32 years old. What do

15:20

you wish someone had screamed in your

15:23

face and told you when you were

15:25

my age? It wouldn't have been much

15:27

about exercise. It would have been more

15:30

about other aspects of life, for sure,

15:32

because for whatever reason,

15:34

I've always gravitated towards

15:36

exercise. That's always been

15:38

a very high priority

15:40

for me. So I think my

15:43

advice to 32-year-old Peter would be

15:45

much more about relationships and

15:47

emotional health. But if I

15:49

could go back and speak to

15:51

14-year-old Peter... He wouldn't

15:54

have listened, but I would have begged

15:56

him to go a little bit easier

15:59

on his body. and back off

16:01

on certain things that

16:03

probably have led to injuries

16:05

I have today that could have

16:08

been prevented. Can I ask

16:10

what they sent things up?

16:12

Sure. I think I I

16:15

lifted far too heavy, far

16:17

too often, and probably without

16:19

enough coaching on technique.

16:21

And so, you know, I,

16:23

by the time I was

16:25

27... I had a devastating

16:28

back injury, but it's one

16:30

of those things that happened

16:32

without any incident, which is

16:34

often the case, by the

16:36

way, for a back injury.

16:38

When you really blow out

16:40

a disc in your back,

16:42

it's not necessarily something you

16:44

did in that moment. It's

16:46

usually something that's been built

16:48

up from the past. So this

16:50

injury I had at the age

16:52

of loading done with probably...

16:54

insufficient technique, you know, or technique

16:57

that was at times sloppy and under fatigue,

16:59

because I used to do a lot under

17:01

fatigue. You know, I sort of believed in

17:03

training under a lot of fatigue, and I

17:05

think that that's a mistake. I think

17:07

that training under very heavy load should

17:10

not be done under great fatigue. Interesting,

17:12

we'll talk about that as well. On that

17:14

point of advice that you gave me

17:16

there about emotional health, one of the

17:18

things that's been very front of mind

17:20

for me at the moment is men's

17:22

health, specifically men's emotional health. because I

17:24

read a report that came out in

17:26

March called Lost Boys and it just

17:28

details this pretty horrific picture of men's

17:30

emotional health in the UK at the

17:32

moment in particular but the trend holds

17:35

around the world and it came out

17:37

in the start of March it's been

17:39

in all the newspapers in the UK

17:41

and it details a couple of sort

17:43

of headline stats. The reverse gender pay

17:45

gap amongst young men so women are

17:47

now earning more. You know the stats

17:49

probably around soon for every year. one in

17:51

seven young men are unemployed or out

17:53

of work, all these sort of horrific

17:55

stats and then it compounds with things

17:57

like suicide, suicidal ideation, etc, etc, etc.

18:00

I was thinking about this this morning when

18:02

I was listening to some of your

18:05

work. I was thinking, I wonder what

18:07

Peter's perspective is on what it

18:09

is to be a man. Actually, it does

18:11

kind of dove tell into some of

18:13

your work around testosterone and the decline

18:15

in testosterone. And because one of the

18:18

things I was thinking about is how

18:20

testosterone plays a role and what it

18:22

is to be a man, but if

18:24

you look at the stats around

18:27

testosterone, testosterone, it's a certain

18:29

set of behaviors. in men that

18:31

define and shape what a man is

18:33

and what they want and how they show

18:35

up and even when I said earlier

18:37

on protection as one of

18:40

the three things I cared

18:42

about that's probably in part

18:44

because of the testosterone in

18:46

me this debate around testosterone

18:49

this conversation around testosterone and

18:51

its decline is it declining

18:53

it is why is it declining and

18:55

what is this does it matter Well, I

18:58

think the second question is easier to

19:00

answer than the first. I do think

19:02

it matters. The why is probably

19:04

multi-factorial and the why is just

19:07

as important as the fact that

19:09

it is. In other words, the

19:11

fact that it's declining is both

19:13

relevant for the fact that a

19:15

very, very important hormone that has

19:17

incredible benefit to men and women,

19:20

by the way, is going down.

19:22

And we have to come up with

19:24

an answer to that, right? So how

19:26

do we address that? Do we address

19:28

it medically, where we replace that hormone

19:30

exogenously, meaning we give you that hormone

19:32

directly, or do we try to fix

19:34

the underlying problem? So if you want

19:36

to do the latter, you have to

19:38

know what the underlying problem is. Now,

19:40

at the population level, the best answer

19:42

as to why testosterone levels are declining,

19:44

and unmistakably they are. So the data

19:46

here are unambiguous. There's no debate on

19:48

this fact. The debate is around the

19:51

why. I believe that the best answer

19:53

probably has to do with

19:55

two things. One is increase

19:57

in body weight and fat.

19:59

fat specifically in men

20:02

and some combination

20:04

of reduced quality

20:06

of sleep and sort of

20:09

disruption to sleep. So why

20:11

are those two things relevant?

20:13

So when you increase body

20:16

fat two things are happening.

20:19

One is you're

20:21

increasing inflammation and you

20:23

are reducing... the amount of testosterone

20:25

that gets to stay in the

20:28

form of testosterone because part of

20:30

the testosterone gets converted into estrogen.

20:32

So with body fat comes more

20:34

of this process called aromatization or

20:36

converting testosterone into estrogen. So if

20:39

you think about what those two

20:41

things are doing, if you have

20:43

more inflammation, that reduces your

20:45

ability to make testosterone and

20:47

you have more capacity to turn

20:49

the less testosterone you make into

20:51

estrogen, the net result of that is. both

20:54

of those things are reducing your total

20:56

pool of testosterone. If you couple that

20:58

with less, you know, lower quality sleep,

21:00

and I'm not talking about over the

21:02

last three years, I'm comparing like now

21:04

to say 40 years ago, and what

21:06

are all the reasons that people might

21:08

have poor quality of sleep now? I

21:10

think there are many, but obviously phones

21:12

and social media and just the stimulation

21:14

of the world we live in probably

21:17

plays a greater role in that. Sleep

21:19

is when we make these hormones,

21:21

right? So we make... follicle stimulating

21:23

hormone and lutonizing hormone at their

21:25

maximum amount during sleep and those

21:28

are the hormones that are driving

21:30

the production of testosterone. So what

21:32

we've seen in many of our

21:34

patients when they have low testosterone,

21:36

because there's a test you can

21:38

do to see if their testosterone

21:41

is low because their body can't

21:43

make it or because their brain

21:45

isn't receiving enough of a signal

21:47

to make it. This is a

21:49

very easy thing to determine medically. Unfortunately,

21:52

most people aren't subjected to that level

21:54

of testing because they go to these

21:56

testosterone shops on street corners that are

21:59

just giving everybody... testosterone. But if

22:01

a physician is curious

22:03

enough to understand that, you

22:05

can give a patient

22:07

a drug or a hormone

22:09

called HCG. HCG is

22:11

luteinizing hormone, which is one of the

22:13

hormones made by the brain. So if you come

22:15

in and you see a man who's got very

22:17

low testosterone and you can't understand why,

22:19

you give him luteinizing hormone. If

22:21

he still has low testosterone, you

22:23

know that he has what's called

22:25

primary hypogonadism, which means his testosterone

22:28

is low because his testes can't

22:30

make testosterone. Conversely, if you give

22:32

the man luteinizing hormone and all

22:34

of a sudden his testosterone goes

22:36

up, he has secondary hypogonadism.

22:38

I mean, you could mix

22:40

the primary secondary there, but really

22:42

what the terminology doesn't mean

22:44

anything. What matters is he can

22:46

make testosterone, but for some reason

22:48

his brain isn't giving his body

22:50

the signal to do it. And

22:52

that's a classic finding in a

22:54

person who's under high stress and

22:56

or not sleeping well. So

22:59

that's a long -winded answer

23:01

to your question, but I

23:03

think that those are probably the

23:05

greatest contributors to this. Now, people

23:07

have talked a lot about what

23:09

about microplastics, what about other environmental

23:11

factors, what about other factors in

23:13

nutrition beyond just the ones that

23:16

would contribute to excess body fat. The

23:19

evidence there is less compelling,

23:21

but I don't think we should

23:23

discount it. But I think that

23:25

if those things are playing a role,

23:27

it is probably much smaller than what

23:29

we just talked about. I was thinking

23:31

as you were speaking about sleep and

23:33

testosterone, about how and also the link

23:35

there with bad diets, how if I've

23:37

not slept well, I wake up and

23:39

make worse food choices. For sure. And

23:41

I was like, is that like

23:43

dopamine dysfunction? No,

23:45

it's probably more

23:48

due to insulin

23:50

signaling. So we know

23:52

from really good experimental

23:54

studies that when you

23:56

sleep -deprive people, they become

23:58

insulin -resistant. And

24:00

the more insulin resistant to

24:02

person is, the less they're

24:04

able to access their stored

24:07

energy. So higher insulin

24:09

resistance means greater difficulty accessing

24:11

stored energy. So if you

24:14

wake up and you're, if

24:16

you have successive days of

24:19

poor sleep and you're becoming

24:21

somewhat insulin resistant, you're gonna

24:23

want to eat more because you're

24:26

not able to access your. own

24:28

natural stores of fat, which is

24:30

where we want to go for

24:32

energy. So if you look at

24:35

one experiment that was done at

24:37

the University of Chicago, they took

24:39

healthy subjects, young subjects, and sleep

24:41

deprived them for somewhere between 10

24:44

and 14 days. So not a huge

24:46

period of time. And they only let

24:48

them sleep four hours a night. Which, by

24:50

the way, I know a lot of

24:52

people who are doing that for years

24:54

at a time. In that 10 to...

24:56

14-day period of time, their insulin resistance

24:58

was worsened by 50%. This is, in

25:00

other words, they do an experiment called

25:03

a euglysemic clamp where they

25:05

inject them with glucose to

25:07

see how effectively they can put

25:09

glucose into their cells, which is,

25:11

that's the hallmark of insulin sensitivity,

25:13

is how well you can put

25:15

glucose into your muscles when it's

25:17

infused in you, and their capacity

25:19

to do that was reduced by

25:22

50% after such a short intervention.

25:24

So I think sleep restriction and

25:26

unhealthy sleep is a very underappreciated cause

25:28

of metabolic health and weight gain. And

25:30

then by extension these other things we're

25:32

talking about. It seems to me to

25:35

be the thing furthest upstream in my

25:37

life that then causes this cascading effect

25:39

to how I show up in sort

25:41

of cognitive performance, how well I can

25:43

articulate myself, if I go to the

25:45

gym, how hard my workout is, if

25:48

I choose healthy options versus unhealthy options.

25:50

So it feels like the mood in

25:52

general. Yeah. Yeah, I mean look I I've said this

25:54

before and I'm not the first to say this

25:56

so I'm paraphrasing others, but if you really stop

25:59

to think about it, sleep doesn't

26:01

make a lot of sense

26:03

from an evolutionary perspective.

26:05

Like if you go back in time a

26:07

few hundred thousand years, why

26:10

would we have spent a third

26:12

of our life unconscious? It didn't

26:14

serve our purpose. You can't

26:16

mate, you can't hunt, and you

26:18

can't defend yourself. So

26:20

you have to believe that if we

26:22

could have evolved out of it, we

26:25

would have done it. And we didn't.

26:27

So that means that whatever it's

26:29

doing, it must be really important.

26:31

I mean, core essential to our

26:34

existence. While I will

26:36

completely acknowledge that different

26:38

people have a different

26:40

necessity or requirement for how

26:42

much they sleep, I still think that

26:45

many people underestimate how much they need.

26:47

You know you asked me at the

26:49

start, you said, what are the things

26:51

that you want to do when you

26:53

reach your marginal decade? And I gave

26:56

you my answer. What's your answer to

26:58

that, now that you're a father in,

27:00

have your own different season of

27:02

life? Well, they're very similar to

27:04

the types of things you're thinking

27:06

about, and I love how you've got

27:08

specific examples. So I really like playing

27:11

with my kids, right? So I can

27:13

imagine that in my marginal decade, I'll

27:15

have grandkids that are the age of

27:17

my kids, right? And, you know, maybe a

27:20

bit older, but as I'm even

27:22

getting towards that marginal decade. Playing

27:24

sports is really, really fun. I

27:26

really like playing, especially because when

27:28

I grew up, like I played

27:30

hockey because I grew up in

27:33

Canada, and then I immediately went

27:35

into kind of boxing and martial

27:37

arts and those became my life.

27:39

So now playing sports that I

27:41

didn't play much as a kid

27:43

is really fun. Like I'm really

27:46

enjoying baseball. I'm really enjoying

27:48

soccer. And so when you play these

27:50

things, you realize. This is not an easy

27:52

thing to do when you get old. Like to

27:54

sit in the, you know, to play, to sit

27:57

in the goal and actually like stop a

27:59

ball when a kid is... blasting at you

28:01

full stop, you have to be able to

28:03

move around. So again, I would love to

28:05

be able to play soccer, throw a football,

28:07

throw and hit a baseball as long as

28:10

possible. You can get into movements

28:12

that are much simpler, but if

28:14

I can do all of those things, I'm in

28:16

great shape. Now, of course, to be able to

28:18

do that, I also need to be able

28:20

to do a lot of things that

28:22

many people also can't do in their

28:25

marginal decade, like sit on the floor,

28:27

get up off the floor under their

28:29

own power. X number of flights of

28:31

stairs having the strength to do that. I

28:33

like doing certain things, like I like archery

28:35

a lot. So it's, you know, I want to

28:37

be able to pull a bow back. Obviously not

28:40

at the same poundage as the current bow that

28:42

I pull back, but I would still like to

28:44

be able to pull a 50 pound. bow back

28:46

in the final decade of my life. And when

28:49

you think about all those things you want to

28:51

accomplish, if we were then to sort of codify

28:53

them into a bunch of exercises or areas of

28:55

your health that you had to now be thinking

28:58

about, that I needed to be thinking about, what

29:00

are the most important things? So

29:02

I'm a 32-year-old. What are the most important

29:04

parts of my health that I should be

29:06

thinking about if I want to achieve all

29:09

the things that I said to you in

29:11

my final decade? No one in the final

29:13

decade of their life ever said, I wish

29:16

I had less strength and I wish

29:18

I had less endurance. So you cannot be

29:20

too strong and you cannot be too fit.

29:22

The only time that one would throttle

29:24

back on the pursuit of those is A,

29:26

if doing so, is coming at the

29:29

expense of something else, either with respect to

29:31

your health or your life.

29:33

And two, if the pursuit

29:35

of that at such an

29:38

extreme level produces risk of

29:40

injury. Okay. So, in other

29:43

words, could I be stronger

29:45

than I am today?

29:47

Yes. I'll give you

29:49

an example. We know

29:51

that in resistance training,

29:54

the sweet spot for

29:56

pure strength is one

29:58

to five reps. to maximize

30:00

strength, you need to be pushing

30:02

one, two, three, four, five reps. Once

30:04

you start thinking about hypertrophy, muscle size,

30:07

we're starting to think about seven, eight,

30:09

nine, 10, 11, 12 reps. Once we

30:11

start thinking about muscular endurance, we start

30:13

thinking about north of 15, right? Those

30:16

are the general patterns of resistance training.

30:18

So if I want to build my

30:20

muscles, because I'm going for aesthetic goals,

30:22

then I need to be aiming above

30:25

five reps. I need to be 10

30:27

or five. bigger weights but lower

30:29

reps. That's exactly right. Okay,

30:31

and then if I want

30:33

muscular endurance, we've got to be

30:36

even higher reps. Okay, lower weight. Yep.

30:38

Okay. So again, we could go into

30:40

much more detail around that, but just

30:43

to finish the point here, why do

30:45

I not do much training at one

30:47

to five reps anymore? Why? Because

30:49

to train at one to

30:51

five reps comes... at a

30:54

risk, especially for heavy compound

30:56

movements. So, like, you know,

30:58

I'm okay getting a little

31:00

bit less of a strength

31:02

benefit while still, of course,

31:05

getting stronger, but training at

31:07

a higher rep load. So

31:09

I'm typically, so I'm targeting

31:12

eight to 12 reps with one

31:14

to two reps in reserve is

31:16

basically how I'm doing my

31:19

resistance training. That means. Every

31:21

set I'm doing, I would

31:23

expect to get to within

31:25

about one rep of failure somewhere. So

31:27

today, when I lifted, I don't think

31:30

I did less than seven, I didn't

31:32

do more than 12. and the weight

31:34

was always titrated so that I

31:36

was either failing, almost failing, or

31:38

one rep away from failing somewhere

31:40

in there. And I was adjusting

31:42

the weight constantly on every exercise

31:44

to get there, with the exception

31:46

of one exercise. I did push-ups

31:48

was one of the things I

31:50

did. Push-ups was one of the things

31:52

I did. Push-ups are kind of

31:54

more in the muscle endurance. Obviously

31:57

I'm doing more reps when I was

31:59

doing push-ups. in terms of injury

32:01

risk. Similarly, I'm not strength

32:04

training 24 7 because I

32:06

need to make time to do

32:08

my endurance training and other types

32:10

of training. How often do you

32:12

train resistance training?

32:14

I resistance train three

32:16

times a week. And how often

32:19

do you train generally? I train

32:21

every day. Every day. Why? Because,

32:23

you know, again, the intensity of

32:26

my training is not that high.

32:28

at least three days a week.

32:30

So the three resistance days are

32:32

pretty hard because I'm really only

32:35

doing each body part once a

32:37

week. So when I'm doing it, I'll

32:39

spend that 90 minutes really

32:41

kind of hammering those body

32:43

parts. Three of those days are just

32:45

zone two. So three of my four

32:48

cardio days are zone two days where

32:50

I'm doing, you know, I'm on

32:52

a bike and I am riding at...

32:54

a level of intensity that actually allows

32:56

me to still talk. Some, you know,

32:59

not talk like I am now, but

33:01

talking in a sort of a strained

33:03

way. So for me that's about a

33:05

heart rate of 140 beats per

33:07

minute, and that's just not

33:10

taking a huge toll on me.

33:12

Like that, those are almost like recovery

33:14

days for me. And then one day

33:16

a week... I do a really, really

33:18

hard VO2 Max day, and that's

33:20

a really hard day. That burns

33:22

a lot of matches. That's tomorrow.

33:25

Not looking forward to you all.

33:27

Do you do cardio on your

33:29

resistance training days as well? No.

33:31

I don't. So it's the seven days,

33:33

it's four days of cardio, three days

33:35

of resistance. Now, that's gonna change in

33:37

the summer when I'm gonna add three

33:40

days of swimming. and I will end

33:42

up doing some swims on some resistance

33:44

days. So before you do your resistance

33:46

workout, you don't go on the stepper

33:48

for 20 minutes or cycle for 20

33:51

minutes or something? I don't. Is there

33:53

a particular reason why? It wouldn't really serve

33:55

a purpose. So I know a lot of people

33:57

do that. I know a lot of people will

33:59

say... I'm going to do a little

34:01

bit of a warm-up on this treadmill

34:04

or the stepmaster before I lift, but

34:06

I actually have a pretty strong point

34:08

of view on how we should warm

34:10

up to lift. And I don't think

34:12

walking on the treadmill or running on

34:14

the treadmill or being on the stairmaster

34:17

or on the bike is a great

34:19

prep for the lift. I think it's

34:21

better to warm up for a lift

34:23

doing movements that prepare you to lift.

34:25

So for example, like, if it's a

34:28

leg day... So Monday's leg day, right?

34:30

So what am I going to do?

34:32

I'm going to start by doing a

34:34

bunch of core stabilizing stuff. So I'm

34:36

going to do a whole bunch of

34:39

this dynamic neuromuscular stabilization stuff. So you

34:41

get into basically these baby positions and

34:43

you really learn to activate your core

34:45

as you move around in a six-month

34:47

position and stuff like that. I then

34:49

do a whole bunch of, like you

34:52

know what a 90-90 is or a

34:54

shinbox exercise is, where you're kind of

34:56

on the ground in a position where

34:58

you're really, you know, you can start

35:00

out doing it isometrically, but ultimately going

35:03

through a slow eccentric and concentric phase

35:05

of movement that's kind of activating glutes.

35:07

So I go through basically a whole

35:09

DNS sequence. Then I get into a

35:11

dynamic movement prep. So then I get

35:13

into a bunch of bouncing. a bunch

35:16

of footwork, and then I start with

35:18

really lightweight. So I'll go to a

35:20

leg extension machine and do very, very

35:22

light leg extensions, very, very light leg

35:24

curls, come back, and do more jumping

35:27

and moving and lunging and go back.

35:29

So I'll spend 20 minutes doing a

35:31

warm-up, but the warm-up is geared for

35:33

me to lift. Whereas if I had

35:35

just sat on a bike and peddled

35:38

around, that doesn't actually replicate any of

35:40

the movements I'm going to do when

35:42

I start loading myself myself. now that

35:44

I'm 32, because when I was 30-20

35:46

I could do almost anything it seemed

35:48

and nothing would break, but I had

35:51

a couple of injuries when doing like

35:53

shoulder presses and things like that. And

35:55

one of my friends had a similar

35:57

injury recently which took him out for

35:59

three or four months where he did

36:02

a shoulder press, pulled something in his

36:04

back or something as like neck. And

36:06

then he could like turn his head

36:08

anymore. of injury, if I wanted to

36:10

get injured, am I right in thinking

36:12

that the thing that leads to injury

36:15

is basically just walking straight in and

36:17

trying to lift something heavy? Or is

36:19

there things further upstream that cause injury

36:21

in the gym? No, I mean, that's

36:23

one way to increase your risk of

36:26

injury for sure, but yes, there are

36:28

other ways that it can happen, and

36:30

I think about it a lot. I

36:32

mean, one of the injuries I think

36:34

a lot about are calf injuries, Achilles

36:37

injuries, sort of tendon injuries, tendon injuries.

36:39

This is I think one of the

36:41

things that becomes a real problem for

36:43

people as they age, you know, you

36:45

often hear about people my age tearing

36:47

in Achilles. Yeah, it's a devastating injury.

36:50

Now again, it's not devastating in that

36:52

you won't recover from it, but boy,

36:54

it's going to take you out of

36:56

commission for six months. So... A lot

36:58

of these injuries happen because the individual

37:01

still has strength, but they've kind of

37:03

lost some of the pliability in the

37:05

tendon because they've kind of lost some

37:07

of the jumping. That's why I... always

37:09

start these workouts with low level of

37:11

jumping. And I'll progress to higher levels

37:14

of jumping, but jumping is actually a

37:16

very important part of training. And it's

37:18

one of the things that we take

37:20

for granted, but boy, when your ability

37:22

to jump is gone, and jumping by

37:25

the way can mean like just initiating

37:27

a jump, but it can also mean

37:29

jumping off something and stopping yourself, those

37:31

are really important skills. And so like

37:33

something like jumping rope is really important,

37:36

right. like that, they're acting as shock

37:38

absorbers, cuffs and Achilles have to constantly

37:40

change in length, and that accommodation is

37:42

a really important part of resilience, and

37:44

I think that should be an important

37:46

part of everybody's warm up at a

37:49

minimum, if not part of their workout.

37:51

One thing I'd love you to do

37:53

is to persuade people listening that muscle

37:55

mass matters for longevity, because, and also...

37:57

If you can, within that, that leg

38:00

day matters. Because we all avoid... legday,

38:02

including me, and sometimes I need to

38:04

be told again why it matters for

38:06

me to add it. Well, I mean,

38:08

I think, look, muscle mass

38:11

is probably the second

38:13

most highly correlated finding,

38:16

or third most, to longevity

38:18

after strength and

38:21

cardiorespatory fitness, VO2

38:23

Max. So why is that? So

38:25

first of all, I think that...

38:27

Muscle mass is both directly a

38:29

proxy for strength, in general the

38:31

more muscle you have, the stronger you

38:33

are. We all know exceptions to

38:36

that. We know why are we little

38:38

people who are insanely strong? And I

38:40

have patients like that. They're just naturally,

38:42

you know, thin people, but when we

38:45

put them through the testing protocols, you

38:47

know, they're remarkable in

38:49

terms of their strength. And I tend

38:51

to not worry about the fact that

38:54

they're slight and build. when I

38:56

see that they're strong across the

38:58

board. There is another benefit of

39:00

muscle mass, which is it's the

39:02

place where you dispose of glucose.

39:04

So from a metabolic perspective, the

39:06

more muscle mass you have, the

39:08

more glucose buffering capacity you have.

39:10

And why does that matter as

39:12

I age? Because... One of the

39:14

hallmarks of aging is a reduction

39:16

in the capacity to metabolize and

39:18

buffer glucose. And so as glucose

39:20

levels become less and less regulated,

39:22

all sorts of bad things happen.

39:24

Bad things happen to micro vessels

39:26

in the body. So if you

39:28

think of the most extreme example

39:30

of this is type 2 diabetes.

39:32

So once a person has type

39:34

2 diabetes, what are they at

39:37

risk for? They're at the risk

39:39

of reduced vision and ultimately blindness.

39:41

amputations of their digits, impotence, right?

39:43

The penis has tons of tiny

39:45

blood vessels in it, and the

39:47

more that, you know, glycosylated proteins

39:49

accumulate there, the less they get

39:51

blood flow, and obviously damage to

39:53

the small blood vessels of the

39:55

brain as well. So all of

39:57

these things are hugely problematic when

39:59

glucose is... regulated. And again, the most

40:02

important thing that you can do to

40:04

regulate glucose, in addition to the obvious,

40:06

which is eating in energy balance, not

40:08

eating too much, is making sure you

40:11

have large insulin sensitive muscles, which means

40:13

large muscles in the context of an

40:15

individual who's sleeping well and exercising, and

40:17

you're going to basically have a great

40:20

place to put all of that glucose

40:22

when you consume it. And is that

40:24

going to stave off me getting belly

40:26

fat? because my glucose is going

40:28

to be stored in the muscles as

40:31

opposed to somewhere else. Again, it all

40:33

depends on the total energy balance, but

40:35

yes, it's clearly going to make a

40:38

difference, right? So one of the surest ways

40:40

to reduce your capacity to store

40:42

fat is to add more muscle. Okay. I

40:44

did the grip strength test. I've done it

40:46

twice now. and meaning you did one of

40:48

the like grip meters or you did a

40:51

hanging test the one of the grip grip

40:53

meters actually did it at Brian Johnson's house

40:55

and then I but I also did it

40:57

with Andy Galpin and people tell me

40:59

it's a indicator of longevity but I've

41:01

never really understood why is it just

41:03

testing my strength yeah grip strength of

41:06

all the strength metrics it's one of

41:08

the most highly correlated with longevity we

41:10

actually prefer to do it like a

41:12

10 squared where your colleagues tested yesterday

41:14

we prefer to do it on a

41:16

dead hang So we make them hang

41:18

from a bar and we just time how

41:20

long they can hang. So that's a

41:22

really good metric of your grip

41:25

strength because it's also normalized your

41:27

weight. Okay. So we want to

41:29

see that people can hang for

41:31

at least two minutes on a bar.

41:33

And so the question is why is

41:35

that so highly correlated with longevity? And

41:37

it's what you said. It's it's it's.

41:40

strength and the reason for it is

41:42

it's really hard to be strong anywhere

41:44

in the upper body if your grip

41:46

is weak. Like if you think about

41:48

being able to push especially being able

41:51

to pull like all of the real

41:53

metrics of upper body strength require a

41:55

strong grip and if you have a

41:58

strong grip you have a strong you

42:00

have a strong forearm, you have a

42:02

strong scapula that is connected to your

42:04

ribcage, like it goes up the whole

42:06

chain. And that's another reason why we

42:09

like the dead hang as a way

42:11

to test it, because the dead hang

42:13

is testing everything. It's testing your actual

42:15

grip, it's testing your scapular stabilization, the

42:17

stability of your shoulder, it's basically testing

42:20

that entire chain. And then I also

42:22

think there's a practical side of

42:24

this, right? When, you know, it's

42:26

very underappreciated what frailty does to

42:28

an aging individual, and what sarcopenia,

42:30

loss of muscle mass does to

42:32

an aging person, and what it

42:34

is about falling that is so

42:36

devastating to an older person. And

42:38

the stronger your grip, the easier

42:40

you're able to navigate a lot

42:43

of those things, right? It just

42:45

seems unthinkable that falling is something

42:47

I should be thinking about 32

42:49

in the future. Like it seems

42:51

ridiculous. It seems ridiculous.

42:53

Yeah. Yeah. And yet it is

42:55

devastating. So once you reach the

42:57

age of 65, which that ain't that

43:00

far. I mean, you know 65

43:02

year olds all day long. That's

43:04

not a very old person. Yeah.

43:06

Once you reach the age of

43:08

65, your mortality from a

43:10

fall that results in a

43:12

broken hip or femur is 15

43:14

to 30 percent. Just think it

43:17

is such a staggering number.

43:19

So you're over 65, you fall, and

43:21

that fall results in the break of a

43:23

femur or hip. There's a 15 to 30%

43:25

chance you'll be dead within a year.

43:27

What kills me? It could be something

43:29

very acute, like you bent, you

43:31

know, the fall that's significant enough to

43:34

do that also bangs your head. It

43:36

could be that you get a fat

43:38

embolism, you get a blood clot. It

43:40

could be that, you know, during the

43:42

recovery process of this, you just

43:44

never really get better, you never

43:46

thrive again. I think a more

43:48

disturbing statistic is that of all

43:51

the people who survive, 50% will never

43:53

again regain the level of function

43:55

they had before the injury. So

43:57

they will require a cane for the... of

44:00

their life or something like that. Now

44:02

there are lots of things that account

44:04

for that. Andy Galpin, who you mentioned

44:06

a moment ago, talks a lot about

44:09

this, but a lot of it comes

44:11

down to foot explosiveness, power. So the

44:13

reason you're not really afraid of falling,

44:15

like when was the last time you

44:18

were walking and your foot caught something

44:20

and you slipped? Like yesterday? Yeah, quite

44:22

often. Yeah, exactly. Why don't you fall

44:24

when that happens? Because I can quickly

44:27

readjust. Right. So you have the power

44:29

in your foot to readjust when you

44:31

lose your step. You step off a

44:33

curb not realizing it, it doesn't matter.

44:36

You readjust. Okay. Those are a very,

44:38

very specific muscle fiber that is responsible

44:40

for that. It's called the type 2B

44:42

muscle fiber. That is the first fiber

44:45

that atrophies when you age. In fact,

44:47

you're already at your peak. It's all

44:49

downhill from where you are now. Thank

44:51

you so much. Yes. So I'm already

44:54

20 years past you and my power

44:56

is a fraction of what it was

44:58

20 years ago. Now, I fight like

45:00

hell based on the exercises I do

45:03

to try to make, to try to

45:05

keep it as high as possible. So

45:07

the reason that these people who are

45:09

in their 70s are falling all the

45:12

time is people think it's a balance

45:14

thing. It's not just a balance thing,

45:16

right? It's that they're undergoing the same

45:18

insult you and I undergo on a

45:21

daily basis, but the difference is their

45:23

probability of being able to catch it,

45:25

either through the explosiveness of their foot

45:28

or their lower leg, coupled with maybe

45:30

not being able to grab onto something

45:32

as quickly and adjust, it's a power

45:34

deficit problem. So what do I have

45:37

to train now at 32 to ensure

45:39

that? specifically the example of hitting something

45:41

and quickly being able to adjust, I'm

45:43

able to do that when I'm 70.

45:46

I think jumping is a great way

45:48

to do this, right? So, I mean,

45:50

I use certain specialized pieces of equipment

45:52

that actually have power built into it

45:55

because power is different from strength, right?

45:57

So strength is really the ability to

45:59

move a force, independent of the speed

46:01

at which you move it. Power is

46:04

the maximum... combination of force and speed.

46:06

Okay. So if you on the on

46:08

the on the X axis if you

46:10

were to put force and on the

46:13

Y axis if you were to put

46:15

power the curve is an inverted you.

46:17

So as the force or the weight

46:19

that you're moving goes up, and you're

46:22

trying to move it as fast as

46:24

you can. You're getting more and more

46:26

and more and more power, but then

46:28

at some point, the weight gets so

46:31

heavy that even as you continue to

46:33

move it, it's going slower and slower

46:35

and slower, so your power is going

46:37

down. So there's a sweet spot there.

46:40

So one of the things I do,

46:42

there's a sweet spot there. So one

46:44

of the things I do is, there,

46:46

there's a sweet spot there. So there,

46:49

jumping is a really important. What about

46:51

balance? I was at Brian Johnson's house

46:53

and as he was cooking his, I

46:55

don't know, breakfast or lunch, whatever, he

46:58

was balancing on a half ball. You've

47:00

seen one of those things? Yeah, yeah.

47:02

I don't think I asked him why

47:04

he was balancing on it, but I

47:07

assume it was to do with balance

47:09

and there's certain muscles in the leg.

47:11

There are lots of exercises that are

47:13

great for balance. Anything that produces instability

47:16

is great because it's a... better term.

47:18

I've heard it described as problem solving

47:20

for your foot. Okay. Right. So if

47:22

you think about being on any unstable

47:25

surface, even if you're just walking on

47:27

an unstable surface, so if you if

47:29

you were to look at a person's

47:31

foot, they're lower leg actually as they're

47:34

walking on a surface that's constantly changing.

47:36

So like a gravel path or something

47:38

like that, you're going to see like

47:40

if this were my lower leg, you

47:43

would see the musculature of the lower

47:45

leg constantly adjusting to it. And so

47:47

yeah, I'm I really enjoy things that

47:49

force that type of training. Do you

47:52

do flexibility stuff? Yeah, so I'm actually

47:54

naturally a pretty lax person, so I

47:56

don't do any stretching, if that's what

47:58

you're asking, but all of the sort

48:01

of stability... and dynamic stuff I do

48:03

incorporates movement at end ranges. So I'll

48:05

give you an example of why I

48:07

think the notion of flexibility might

48:10

be a little bit misunderstood.

48:12

If you ask a person

48:14

to stand up and with their

48:16

legs straight touch their toes, most

48:18

people would say that's a great

48:20

test of flexibility in

48:23

the hamstring, right? And most people

48:25

can't do that. What they don't

48:28

realize is everybody's hamstrings are

48:30

long enough to allow them

48:32

to do that. The reason

48:34

they can't do it is their

48:36

central nervous system will not

48:38

release them to do it.

48:40

Does that make sense? Interesting,

48:43

the central nervous system won't

48:45

release them to do it. That's

48:47

right. It doesn't feel safe for

48:49

them to do it. Now how

48:51

do I know this? Because if you take

48:53

a person under general

48:55

anesthesia... you can put them into

48:58

almost any position possible. So if

49:00

you took a person under general

49:02

anesthesia, laid them on the operating

49:04

room table, you could lift their leg

49:06

up to here. When they're awake, you

49:08

couldn't get it past here. When they

49:10

wake up from surgery, will they have a

49:13

torn hamstring? Not at all. They won't even

49:15

know their leg was moved. The difference

49:17

is when they're under general anesthesia,

49:19

their brain is not sending a

49:21

signal to the leg that says don't

49:23

lift. So why is the leg, why

49:25

is the brain doing that to the

49:27

individual? This is how I learned it

49:29

on a personal level. So about six

49:32

years ago, I had tweaked my

49:34

back and had just done a,

49:36

you know, unnecessarily heavy set of dead

49:38

lifts and just pushed it a little

49:40

too far and I was kind of

49:43

nursing this sort of... you know just very

49:45

very tight QL I was completely jammed up

49:47

and I came in to do some training

49:49

with a friend of mine who's one of

49:51

the guys that actually he is really the

49:53

guy that introduced me to this thing called

49:56

DNS dynamic neuromuscular stabilization and I mean I

49:58

was stiff as a board I couldn't

50:00

get past my knees bending

50:02

forward. And I'd been hurting

50:05

for like three days. And

50:07

we went through a series

50:09

of exercises for 40 minutes,

50:12

which included me laying on

50:14

my back with my legs

50:16

up, him leaning on top

50:19

of me, so my feet

50:21

are here on his chest,

50:23

and doing isometric pushes while

50:26

working on generating intra-abdominal pressure.

50:28

And after. and yeah maybe

50:30

40 minutes of this type of

50:33

exercises I was palms on

50:35

the floor. Now how do I

50:37

go from not being able to

50:39

get to my knees to palms

50:41

on the floor in 40 minutes

50:44

with three days of horrible back

50:46

pain? The difference is when my

50:48

back was hurting it was my

50:50

body was not going to let

50:52

me go down, right? The body

50:55

was saying no way you're back.

50:57

I'm protecting you because you are

50:59

not stable. You're not going to

51:02

go any further. And what we

51:04

went through with this exercise and

51:06

a series of exercises was basically,

51:09

I mean, I'm oversimplifying this and sort

51:11

of anthropomorphizing it, but letting my brain

51:13

know it's okay, you're stable, you're stable,

51:15

the back is safe, let him go,

51:18

and then, ah, I'm palms on the

51:20

floor. So... I love testing this. Sometimes

51:22

I'll just wake up in the morning

51:24

and do five minutes of breathing exercises

51:27

when I'm stiff as a board and

51:29

just get into a position on the

51:31

floor. Why the breathing exercises? Because that's

51:33

really how it's the it's the breathing

51:36

is how I kind of create this

51:38

cylinder in my abdomen to sort of

51:40

push the you know push the the

51:42

floor of the cylinder down as the

51:44

pelvic wall the diaphragm is the cylinder

51:46

the top and then the the entire

51:48

you know entirety of my abdomen is

51:50

the wall of the cylinder and so

51:52

I kind of go through these exercises

51:55

every single day usually on my back

51:57

actually that's kind of like part of

51:59

my warm myself. around creating concentric pressure

52:01

in the abdomen. Just to get

52:03

some tips from you around your

52:05

your strength training regime, how many

52:08

exercises do you do? What does,

52:10

I'm really curious, so you train

52:12

three days a week doing strength

52:14

and resistance stuff. Do you do

52:16

like shoulders and back and as

52:18

like a pet, you know, yeah,

52:21

it's just totally, yeah, exactly. So

52:23

on Monday, Monday is is pure

52:25

lower body. Okay. And Wednesday is

52:27

arms and And Friday is a

52:29

chest and back. Okay. Super simple.

52:32

Like, nothing, nothing, no rocket science.

52:34

An hour? I mean, it's, it's

52:36

a, like an hour and a

52:38

half of lifting, plus maybe 20

52:40

minutes of the warm-up stuff. So

52:42

on the chest and back day,

52:45

how many chest exercises are you

52:47

doing? Four? Four, okay. And then

52:49

four and back. Yeah. Okay. And

52:51

I just, I'm just super setting

52:53

them. And I'm gonna do. maybe

52:55

five sets of each, so five

52:58

working sets. So there's a lot

53:00

of warm-up in there too. And

53:02

I'll also do some other stuff

53:04

like some med ball slams or

53:06

things like that as well. It's

53:09

been the huge rise in people

53:11

doing these high-rocks and sort of

53:13

elite endurance events and such. It's

53:15

really interesting that it's become so

53:17

popular. Even things like running clubs,

53:19

I know, but the fact that

53:22

more people are doing marathons now

53:24

than ever before. Why do you

53:26

think this is happening? I don't

53:28

know. I mean, I think it's

53:30

a very net positive thing, though.

53:32

I mean, I do think that

53:35

there's more and more people that

53:37

are taking up things like rucking

53:39

and running and, you know, finding

53:41

camaraderie in these things. The only

53:43

thing I hope is that people

53:46

are doing it in a manner

53:48

that's sustainable and safe and allows

53:50

them to do it indefinitely. So,

53:52

you're, you know, you're, you're, you're,

53:54

you're, you want, the game, the

53:56

name of the game is to

53:59

play the game as long as

54:01

possible. In front of me, I

54:03

have a bunch of... different graphs

54:05

and images, and some of them

54:07

relate to a word you said

54:10

earlier on, which is VO2 Max.

54:12

And this is something I've heard

54:14

you talk about previously, but for

54:16

anyone that doesn't understand what VO2

54:18

Max is or why it's important,

54:20

can you explain what it is

54:23

and why it's so critical to

54:25

longevity and health span? I think

54:27

most people will be familiar with

54:29

the idea that we are obligate

54:31

anaerobes, which in English means we

54:33

cannot survive without oxygen. Okay, so

54:36

why is that? So oxygen is

54:38

absolutely essential to catalyze the chemical

54:40

reaction that turns food into a

54:42

currency for energy called ATP. So

54:44

everybody's probably heard of ATP. ATP

54:47

is the money, the currency of

54:49

energy in our body. Anything that

54:51

interrupts the production of energy in

54:53

our body, anything that interrupts the

54:55

production of So an extreme example

54:57

of that is cyanide. Everyone's heard

55:00

of cyanide as a poison. If

55:02

you take cyanide, you'll be dead

55:04

within seconds because cyanide blocks one

55:06

of the transporters in the production

55:08

of ATP. So it just gives

55:11

you a sense of how critical

55:13

it is to have an infinite

55:15

and abundant supply of ATP. Oxygen

55:17

is also essential for that. That's

55:19

why without oxygen you can only

55:21

survive for a couple of minutes.

55:24

Longer than you can without cyanide,

55:26

but not much longer. So how

55:28

does it work? So we breathe

55:30

in air and that air goes

55:32

into our lungs and that air

55:34

goes through our lungs into these

55:37

distal things called capillaries where Hemoglobin

55:39

is bringing the waste product called

55:41

carbon dioxide back to the lungs

55:43

and there's a gradient of partial

55:45

pressure between oxygen and carbon dioxide

55:48

such that a switch takes place.

55:50

The air that we breathe in

55:52

delivers some of its oxygen to

55:54

the hemoglobin molecules and the carbon

55:56

dioxide diffuses off that in into

55:58

the air and we breathe out

56:01

air that is lower in oxygen

56:03

and higher in carbon dioxide than

56:05

what we breathed in. So if

56:07

I go, that was high oxygen,

56:10

low carbon dioxide, that was

56:12

low oxygen, high carbon dioxide.

56:14

And that's happening every second

56:16

of every day. That oxygen,

56:18

that hemoglobin molecule that's carrying

56:21

oxygen, is carrying it to

56:23

every cell in my body

56:25

because every cell in my

56:27

body needs oxygen. And that

56:29

cell in the body is taking

56:32

the oxygen to run that

56:34

chemical reaction to make ATP

56:36

and it's shuttling back carbon

56:39

dioxide. And it's just the

56:41

most incredible thing in the

56:44

world to imagine how

56:46

frequently this is happening.

56:48

And the more you exercise,

56:50

the more you consume oxygen.

56:52

So oxygen consumption

56:54

is a proxy for energy demand.

56:56

So we can measure this. because

56:59

I have to be able to measure

57:01

very precisely two things. I

57:04

have to be able to measure

57:06

exactly the flow rate of air

57:08

going in and out of your

57:11

mouth, and I have to

57:13

be able to measure very

57:15

precisely the concentration of oxygen

57:18

coming out. If I know those two

57:20

things, I can calculate how

57:23

many liters per minute

57:25

of oxygen you are

57:27

consuming. You and I sitting

57:29

here right now are probably

57:32

consuming less than

57:34

half a liter a minute.

57:36

Call it 500 CC a

57:38

minute of oxygen right

57:40

now because you have to

57:43

consume some to be alive

57:45

and I'm moving my

57:47

arms around and you're

57:49

nodding and taking notes.

57:51

You know, if you're sleeping, you

57:54

might be consuming 300 millil liters

57:56

of oxygen per minute. That's the

57:58

lowest level. If you were

58:00

to get up and we were to

58:03

walk around here, that number might go

58:05

up to 800 millil liters per

58:07

minute. If we were to walk

58:09

a little more briskly, we might

58:11

be at a liter per minute

58:13

of oxygen. If I said, let's

58:15

go out in the parking lot and

58:18

jog, well, we might get up to

58:20

like 1.5 liters per minute. We pick

58:22

up the pace a little bit, we'll

58:24

get to 2 liters per minute. We'll

58:27

get to 2 liters. I am going

58:29

to push you so hard

58:31

that you will achieve your

58:33

maximum level of oxygen consumption.

58:35

And if I push you

58:37

any harder and faster, you won't

58:40

extract more oxygen from the air.

58:42

You may go faster. but you

58:44

will do so through a process

58:47

that does not involve the consumption

58:49

of oxygen. You will do so

58:51

through an anaerobic glycolytic pathway, but

58:54

you will have achieved your maximum

58:56

consumption of oxygen. And that number

58:59

has a very special name. It's

59:01

called VO2 Max. So VO2 Max,

59:03

measured in liters per minute, is

59:05

the maximum amount of oxygen you

59:07

can consume. And the only way

59:09

you can measure that again is

59:11

to have this mask with very

59:13

very fancy apparatus that measures both

59:15

of those things I said and

59:18

you have to be stressed hard.

59:20

We typically do this on a

59:22

treadmill or on a bike. So

59:24

your colleagues that came into 10

59:26

squared yesterday, they did it on

59:28

treadmills. They ran. And they ran

59:30

them and ran them and they

59:32

ran them until they couldn't go

59:34

any faster. And then we measured

59:36

how many leaders per minute of

59:38

oxygen they were consuming. Now, that

59:40

answers what VO2 Max is. So

59:42

the next question is, does this

59:45

matter? Well, the short answer is. We

59:47

don't have a single metric of

59:49

humans that we can measure that

59:52

better predicts how long they will

59:54

live than how high their VO2 Max

59:56

is. And it's not even close

59:58

to be completely. clear. So

1:00:00

if you compare somebody who is

1:00:03

in the top 2% to someone

1:00:05

who is in the bottom 25%

1:00:07

for their age, the difference

1:00:09

in mortality is 5x. 500%?

1:00:12

Yes, 400% technically because with

1:00:14

hazard ratios you go to

1:00:17

a 2x hazard ratio

1:00:19

is 100% yes. So let's look

1:00:21

at you. So I see you've

1:00:23

pulled this chart out which is

1:00:25

one of my favorite charts.

1:00:28

Okay. Oh, by the way, there's one

1:00:30

other thing I should state. We

1:00:32

normalize this by weight. Okay.

1:00:34

Okay. So we always divide

1:00:37

that number of leaders per

1:00:39

minute by how many kilograms

1:00:41

you are. So the number

1:00:44

is actually reported as milliliters

1:00:46

per kilogram per minute. Okay.

1:00:48

Okay. All right. So if we

1:00:50

look at somebody who is your

1:00:52

age, male, 30 to 39. If their

1:00:55

VO2 Max is below

1:00:57

35 millileters per kilogram

1:01:00

per minute, they are

1:01:02

in the bottom 25%.

1:01:05

Conversely, if they

1:01:07

are at 53

1:01:09

millileters per kilogram

1:01:11

per minute, they are in

1:01:13

the top 2.5%. So to

1:01:15

be clear, if you take

1:01:17

a 35-year-old man, and

1:01:20

one of them has a

1:01:22

VO2 Max of... 53, and the other

1:01:24

one has a VO2 max of 35,

1:01:26

there is a 400% difference in

1:01:29

their all-cause mortality over

1:01:31

the coming year. Wow, okay,

1:01:33

so all-cause mortality, anything killing

1:01:36

them over the coming year.

1:01:38

That's right. Now this becomes

1:01:40

more and more profound as

1:01:42

you age, because the all-cause

1:01:44

mortality ratio for a

1:01:46

35-year-old is incredibly low. Yeah. It's

1:01:48

like 1%. So that means you're

1:01:51

comparing 1% to 4% to 4%. It's

1:01:53

not that big a deal. But when

1:01:55

you get up to my age, so I'm

1:01:58

two decades older than you. Now

1:02:00

the low bar, the

1:02:02

bottom quartile, is less than

1:02:04

29. The

1:02:06

high bar is more than 50. Well,

1:02:10

my relative mortality in the next decade

1:02:12

is probably % to 3%. So now

1:02:14

multiply that by 4. When

1:02:17

I get into my marginal

1:02:19

decade, the low bar

1:02:21

is 18. The

1:02:24

high bar is 36. That's

1:02:28

a 2x difference in VO2 max. A

1:02:31

4x difference in mortality

1:02:33

is huge when the

1:02:35

all -cause mortality for an

1:02:37

85 -year -old is going

1:02:39

to be the one -year

1:02:41

mortality for that person

1:02:43

is more than 10%.

1:02:47

So one of the things

1:02:49

that we do is we sort

1:02:51

of think through this not just

1:02:53

through the lens of mortality, which is

1:02:55

what I just walked you through

1:02:57

here, but also health span, which is

1:03:00

kind of what you were talking

1:03:02

about earlier with the graph of strength

1:03:04

and disability. So we have another

1:03:06

figure that we show people that on

1:03:08

the x -axis shows age

1:03:10

and on the y

1:03:12

-axis shows VO2. And

1:03:15

it has a whole bunch of lines that

1:03:17

come across that show various activities. You know, if

1:03:20

you want to be able to run a six

1:03:22

-minute mile, you have to have a VO2 that's

1:03:24

very high. If you want to be able to

1:03:26

run an eight -minute mile, a 10 -minute mile, if

1:03:28

you want to be able to climb a flight

1:03:30

of stairs without getting out of breath, like it

1:03:32

shows all of these different things and you see

1:03:34

what the required VO2 is. I think, in fact,

1:03:36

we might even have these graphs in here. Yeah,

1:03:41

right there. So

1:03:43

we put your.on the graph

1:03:45

and we say, if you

1:03:48

stay where you are, meaning right

1:03:50

at that green curve, you're

1:03:52

in for a great life. Why? Because

1:03:54

even when you're in your 80s, you're still going

1:03:56

to be able to do all of those things. The

1:04:00

results you're looking at here are

1:04:02

Jack's results. Who runs the production

1:04:04

here? He came to your centre. Came to

1:04:06

10 square and Austin. He did the

1:04:08

test. I think he was on the

1:04:10

treadmill for like an hour or something

1:04:12

like that. And can you explain to

1:04:15

me? exactly what his results say as

1:04:17

it relates to what you were just

1:04:19

describing. Yeah, so he did both a

1:04:21

zone 2 and a VO2 Max test.

1:04:23

So Jack got on the treadmill and

1:04:25

you know there's a protocol for how

1:04:27

you warm somebody up. You really want

1:04:29

them to be able to get to

1:04:31

a maximum effort. You don't just put

1:04:33

him in a treadmill and crank it

1:04:35

up. You take your time getting them

1:04:37

up there and he had an amazing

1:04:39

result. So his VO2 Max was 4.1

1:04:41

liters per minute. And he achieved

1:04:44

that at a heart rate of

1:04:46

204 beats per minute, which is

1:04:48

higher than what was predicted

1:04:50

for his age. If you

1:04:53

normalize it by his weight,

1:04:55

he was at 56.5 millileters

1:04:57

per kilogram per minute. So

1:05:00

when you look at his age,

1:05:02

because he's in his 20s, he

1:05:04

was at about the 97th percentile

1:05:06

for his age. meaning his VO2

1:05:08

Max was higher than 97% of

1:05:10

people his age. And so out

1:05:13

of the gate that just tells

1:05:15

us from a longevity standpoint our

1:05:17

goal is to keep him there

1:05:20

as long as possible. I mean

1:05:22

we're so ambitious with our patients

1:05:24

and clients that we actually want

1:05:27

them to be as as an

1:05:29

aspiration to be two decades younger

1:05:32

at the top two percent.

1:05:34

So if you're 50... you want to be

1:05:36

VO2 Max north of 53. And then the

1:05:38

other thing we do is we check on

1:05:40

something called heart rate recovery.

1:05:42

So in 60 seconds post

1:05:44

VO2 Max, how long does

1:05:46

it take? How many beats

1:05:49

does their heart rate come

1:05:51

down in one minute? This

1:05:53

is also a very powerful

1:05:55

predictor of mortality because it's

1:05:57

a huge indication of what's

1:05:59

called parasympathetic. sympathetic balance. So it's

1:06:01

basically a question of how much

1:06:03

is their autonomic nervous system in

1:06:06

favor of sort of a stress

1:06:08

response versus a recovery response. And

1:06:10

so the gold standard here, we

1:06:13

want to see people that can

1:06:15

recover at least 30 beats in

1:06:17

the first minute. He did pretty

1:06:20

well. He recovered 28 beats. You

1:06:22

know, if you're really, really fit,

1:06:24

you're going to be 40, 50

1:06:26

beats of recovery within the first

1:06:28

one minute. It's incredible. Then we

1:06:31

tested his lactate levels and we

1:06:33

ran him for what we called

1:06:36

zone two testing, right? So zone

1:06:38

two is his aerobic base. This

1:06:40

is where he should be spending

1:06:43

80% of his training, 80% of

1:06:45

his cardio training time should be

1:06:47

in this energy system. So it's...

1:06:50

hard enough that it's not just pure

1:06:52

recovery, but not so hard that it's,

1:06:54

you know, pushing energy systems that are

1:06:57

higher. This is a pace he should

1:06:59

be able to hold for an hour,

1:07:01

and he should certainly feel like he's

1:07:03

working, but not feel it too much.

1:07:06

Technically, it's also a place where he's

1:07:08

got maximum fat oxidation. So we do

1:07:10

this also in the same measure on

1:07:12

a treadmill. This is a bit more

1:07:15

of a complicated test, because you're titrating.

1:07:17

between how he feels and what his

1:07:19

blood lactate levels are. Maybe not to

1:07:22

get too complicated in the weeds

1:07:24

on that, but we're simultaneously looking

1:07:26

at the ratio of how much

1:07:29

carbon dioxide he produces to how

1:07:31

much oxygen he consumes. That tells

1:07:33

us how much fat he is

1:07:36

using in his own body, and

1:07:38

we look at that number. and

1:07:40

he maxed out at 0.77 grams

1:07:42

per minute, which is very good.

1:07:45

One gram per minute of fat

1:07:47

oxidation is exceptional. So 0.7677 is

1:07:49

pretty darn good. His lactate hit

1:07:52

about two millimal, and he achieved

1:07:54

this running at 7.3 miles per

1:07:57

hour. So again, there's a lot

1:07:59

to. back in there but that gives

1:08:01

us a pretty good sense of his level

1:08:03

of fitness and for a guy in his

1:08:05

20s that's that's really good fitness. He does

1:08:07

a lot of running. Yes yeah yeah yeah and

1:08:09

but even this test is a body we normally

1:08:11

would separate these two tests on two separate days.

1:08:14

Okay so people you know the people who come

1:08:16

to 10 squared are not from Austin they're from

1:08:18

all over the place so they come in for

1:08:20

two days of testing and you got to sort

1:08:23

of figure out a way to take a way

1:08:25

to take a person who's not necessarily that fit.

1:08:27

and allow them to do these tests. So it's

1:08:29

kind of broken up over to a couple days so

1:08:31

they can mix it with the strength testing

1:08:33

and all the other stuff. And if you were

1:08:36

advising Jack on how to improve some of these

1:08:38

schools here, what would you say? So the truth

1:08:40

of the matter is, looking at his stuff here,

1:08:42

I would say, I think you've got the endurance

1:08:44

thing really covered. In his case, there were other

1:08:46

issues that were uncovered during his intake that

1:08:49

were of more concern. And this is

1:08:51

a matter of like what we think

1:08:53

of his portfolio portfolio management management management,

1:08:56

right. when you're V.O.2. Max is in

1:08:58

the top 2% when you're fat oxidizing

1:09:00

0.7, you know, almost 0.8 grams per

1:09:02

minute, and he's got a heart rate

1:09:04

of 165 to 170 when he's in

1:09:06

zone 2. I mean, this guy's cardio

1:09:08

is dialed in. Just for a second,

1:09:11

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off your first order. These are

1:11:12

Jack's results, so I've invited Jack in because

1:11:14

I feel like he might have some questions

1:11:16

and you might have some questions, so you

1:11:18

guys go ahead. All right. Well, first off,

1:11:20

Jack, thanks for being an awesome guinea pig

1:11:22

yesterday. You hit it out of the park

1:11:25

as far as your cardio training. So tell

1:11:27

me a little bit. What are you doing

1:11:29

for cardio? How often are you running? So

1:11:31

I actually stripped it back quite

1:11:33

a lot. I've probably started maybe

1:11:36

like two years ago going really heavy

1:11:38

on running. And that's all I did.

1:11:40

And then I started getting a little bit injured.

1:11:42

So now I've cut it back, but I'd say

1:11:44

I do like one long run a week a

1:11:46

week. And that's like 20K. Outside of

1:11:48

that, I don't really do much other

1:11:50

cardio. Interesting. I know that the team

1:11:52

talked to you about your left foot.

1:11:55

Yes. And did they show you the

1:11:57

pictures on the treadmill? It did, yeah,

1:11:59

that's super interesting. So interesting.

1:12:01

I sprained my ankle really badly

1:12:03

like six months ago. Yep. So

1:12:05

that could have been something. I think

1:12:07

it's very likely that the ankle

1:12:09

sprain has not, has changed your

1:12:11

gate such that you probably are going

1:12:14

to develop an injury over time with

1:12:16

your running if... if your pattern is

1:12:18

not corrected. So you're over compensating on

1:12:20

the left. And I assume you notice

1:12:22

the difference in the height of your

1:12:24

shoulders and your head and everything while

1:12:27

you were running. So even though the

1:12:29

engine is working insanely well, this test

1:12:31

only measures the performance of your engine.

1:12:33

Your chassis, which is a subjective assessment

1:12:35

to use the car analogy, shows that

1:12:37

the chassis is a bit weak. Okay,

1:12:40

I'll give a bit of context on

1:12:42

what that actually was. So when I

1:12:44

was running on the treadmill, I think

1:12:46

it's Kila. He showed me a picture

1:12:48

afterwards of me running and basically my

1:12:50

head was right in the middle when

1:12:52

I went on my right side. But

1:12:54

then when I went on my left,

1:12:56

my whole body was like a bit

1:12:58

lopsided. So yeah, that's kind of what

1:13:00

you're talking about there. That's right. And

1:13:02

again, like, the good news about running

1:13:04

is each step is each step is very

1:13:06

light is very light. So even something

1:13:09

that's a light impact, but

1:13:11

done thousands of times, will

1:13:13

produce a problem. Okay, so

1:13:15

let's shift from how well the

1:13:17

engine is, which is exceptional. At

1:13:19

both ends, by the way, to

1:13:21

be clear, your peak engine output,

1:13:23

which is VO2 Max, was awesome,

1:13:25

and your engine efficiency, which was

1:13:28

your zone 2, your fat oxidation, exceptional.

1:13:30

we do have this issue in the

1:13:32

chassis that needs to be addressed or

1:13:34

you're going to get a repetitive strain

1:13:37

injury. So then the next thing that

1:13:39

the team did was just a very

1:13:41

simple test called the Dexa scan, but

1:13:44

we do a more comprehensive one. So

1:13:46

we're looking at all the bone density,

1:13:48

left hip, right hip, lumbar spine, and

1:13:50

then total body fat, total muscle mass,

1:13:52

and then visceral fat, which is fat

1:13:54

around the organs. I think the most

1:13:57

surprising aspect of the test was your

1:13:59

bone density. Exoscan measures bone

1:14:01

density very accurately. And

1:14:04

both sort of across the

1:14:06

board in terms of your your

1:14:08

lumbar spine and your right hip

1:14:10

and your left hip, you were

1:14:12

in your lumbar spine

1:14:14

two standard deviations below

1:14:17

the mean for someone your

1:14:19

age. So that means. Basically,

1:14:21

you're in the bottom 10

1:14:23

percentile of bone density for

1:14:25

a guy your age. And

1:14:27

for your hips, you're not

1:14:29

much better. Both on the

1:14:31

left and right hip, you're

1:14:33

about 1.5 to 1.7 standard

1:14:35

deviations below the mean. So what

1:14:37

does that mean? That means

1:14:39

that you're at, you already

1:14:41

have something called osteoporosis. So

1:14:43

when you're T score, which in

1:14:46

your case is almost the same as your

1:14:48

Z score because of your age, but the

1:14:50

Z score compares you to someone your age.

1:14:52

The T score compares you to someone 30

1:14:54

years old. So when your T score is

1:14:56

minus one, you have osteopenia, and when it

1:14:58

gets below minus 2.5, you have osteoporosis.

1:15:00

Those are just technical definitions of bone

1:15:03

density. The problem is your risk of

1:15:05

bone fracture goes up really significantly. Now

1:15:07

because of how young you are, it's

1:15:09

not like I'm worried you're going to

1:15:12

walk out of here, and something's going

1:15:14

to go wrong. But the risk of you sustaining

1:15:16

an injury in sport is not trivial, right?

1:15:18

So if you were out skiing, and Stephen

1:15:20

was out skiing, assuming he had normal

1:15:22

bone density, and you guys both took a

1:15:24

tumble, I would be infinitely more worried about

1:15:27

your bone density. And we have patients in

1:15:29

our practice who do. They're young, healthy people,

1:15:31

and they get these freakish fractures while skiing

1:15:33

or playing sports and things like that. they

1:15:35

have really low bone density. So one, it's

1:15:37

just something we want to address. The bigger

1:15:40

concern is that what's going to, what is

1:15:42

the, what is the story of this going

1:15:44

to be when you're 60 and 65 and

1:15:46

70? And that's the one where we really

1:15:48

want to mitigate it. So I know that

1:15:50

the team talked to you about making

1:15:52

sure you follow up with an endocrinologist,

1:15:55

you want to make sure that there's

1:15:57

nothing here that is medically obvious to

1:15:59

be treated, thyroid hormone or calcium

1:16:01

and things that are medically

1:16:04

obvious to treat. The

1:16:06

most important behavioral thing that

1:16:08

a person can do with

1:16:11

low bone density beyond correcting

1:16:13

all the nutritional deficiencies that

1:16:16

can lead to it is applying heavy

1:16:18

load to the bone. So bones

1:16:20

are active. pieces of tissue, even

1:16:22

though we don't think of them

1:16:25

that way, and they respond to

1:16:27

defamation. So you have to put

1:16:29

strain into a bone for it

1:16:32

to respond and strengthen. And it's

1:16:34

counterintuitive that running is not amazing

1:16:36

at doing that. It's not bad.

1:16:39

So in general, runners have better

1:16:41

bone density than sedentary people, but

1:16:43

not by much, believe it or

1:16:45

not. Swimmers and cyclists, believe it

1:16:47

or not, actually have lower bone

1:16:49

density on average. But resistance training

1:16:51

with heavy weights is actually kind

1:16:54

of what is necessary, grappling as well,

1:16:56

by the way. So people who do

1:16:58

jjitsu, strength training, resistance training, those are

1:17:00

the ways that you're going to increase

1:17:03

this. So I would say that was

1:17:05

the first finding that that is

1:17:07

important and worth discussing. Do you have

1:17:09

any questions on that? Because I've got a

1:17:11

couple. Well, I think my first one was,

1:17:14

so I only actually started lifting weights like

1:17:16

properly, maybe two years ago, so that's probably

1:17:18

why you're seeing that. Maybe, I mean, I

1:17:20

guess, did you have asthma as a child

1:17:22

or anything? No. I know when I, my

1:17:25

mom said something about like when I was

1:17:27

born, I had low calcium. Something about

1:17:29

low calcium, they had to put something on

1:17:31

my teeth, but I don't know what that

1:17:34

is exactly. Well, if you had low, if

1:17:36

there's something that was impacting your calcium levels

1:17:38

when you were little, that would certainly be

1:17:40

a potential risk for it. Our bones are

1:17:43

mostly formed for males in the early 20s,

1:17:45

for girls typically in the late teens. So

1:17:47

anything that disrupted calcium metabolism when you were

1:17:49

young could have played a role in this

1:17:51

for sure. The reason I asked if you

1:17:54

had asthma is a lot of the times

1:17:56

we see folks that... you know, had any

1:17:58

medical condition that required corticostere. prolonged use

1:18:00

of corticosteroids will be another big

1:18:03

risk factor. Of course there's also

1:18:05

genetics so probably worth knowing if

1:18:07

your parents themselves have low bone

1:18:09

density but it sounds like there's

1:18:11

something going on with calcium metabolism as

1:18:13

a kid that might have played a

1:18:16

role. The reason it is really

1:18:18

important to connect with an endocrinologist

1:18:20

now is there are actual medical

1:18:22

treatments that can increase bone density

1:18:24

in addition to all of sort of

1:18:26

the... Total optimization of the nutritional stuff vitamin

1:18:28

D calcium levels things of that nature and

1:18:31

of course the training Their specific exercises I

1:18:33

do to increase that or is it just

1:18:35

an all-round kind of no I mean I

1:18:37

think the the if you think about the

1:18:40

long bones of the body Which are the

1:18:42

the ones that we're basically measuring here? I

1:18:44

mean the short bones in the spine but

1:18:47

the femurs and hips anything that puts those

1:18:49

things under defamation so anything from a

1:18:51

farmer's carry to a step up to

1:18:53

a box squat. I mean, you know,

1:18:55

it's whatever you can do safely that's

1:18:57

loading you and placing these bones in

1:18:59

a manner that forces them to actually

1:19:01

undergo defamation. The way, the way, and

1:19:04

the other thing I would also make

1:19:06

sure of is that someone's checking your

1:19:08

blood levels to look at things like

1:19:10

testosterone and estrogen. So estrogen, believe it

1:19:12

or not. probably the most important hormone

1:19:14

besides vitamin D in bone health. So

1:19:16

you can think of a bone as

1:19:18

something with a strain gauge in it,

1:19:20

and as the bone is deformed,

1:19:22

the strain gauge sends a signal,

1:19:24

a chemical signal to cells that

1:19:26

build the bone. The chemical signal

1:19:28

is estrogen. So the reason women

1:19:31

are so susceptible to osteopenio and

1:19:33

osteoporosis is once they go through

1:19:35

menopause, many of them lose their

1:19:38

estrogen if they're not placed on.

1:19:40

Well, they all lose the restroom, but

1:19:42

if they're not placed on hormone replacement

1:19:44

therapy, they don't get it back. And

1:19:46

so they lose that chemical signal, so

1:19:49

women see a rapid drop-off in bone

1:19:51

density at menopause. Peter, is this graph

1:19:53

accurate, roughly? Yes, this would be accurate.

1:19:55

So if this is broadly accurate, what

1:19:57

is the game, then, for someone like Jack?

1:19:59

Is it... building bone or is it

1:20:01

preventing decline yeah preventing decline

1:20:03

most of us reach our peak

1:20:06

bone mass in our 20s okay

1:20:08

yeah so so the name of the game is

1:20:10

prevent it from getting any

1:20:12

weaker the good news is by the way

1:20:14

I had a woman on my podcast

1:20:16

named Belinda Beck who studies osteoporosis

1:20:19

she's she's from Australia and she

1:20:21

did this amazing study there called

1:20:23

the liftmore study where she enrolled

1:20:25

a bunch of women with osteoporosis

1:20:27

who had never done any resistance

1:20:30

training, and half of them were

1:20:32

randomized to the usual activities like,

1:20:34

you know, yoga and things of

1:20:36

that nature, and then half of

1:20:38

them were randomized to heavy resistance

1:20:41

training. And the women that did the

1:20:43

heavy resistance training actually, first of all,

1:20:45

on DECSA, saw no change in bone

1:20:48

density or saw a very minor reduction

1:20:50

in bone density compared to a significant

1:20:52

reduction in the women who were not

1:20:54

resistance training. But more importantly, on CT

1:20:57

scans, the women who had done the

1:20:59

resistance training actually showed an increase in

1:21:01

cortical thickening of bone, suggesting that it

1:21:04

might even be that Dexa is not by

1:21:06

itself sufficient to fully assess bone health.

1:21:08

It assesses bone density, but not necessarily

1:21:10

bone health. And her hypothesis is that

1:21:13

these women might actually be getting stronger

1:21:15

bones, even if the density is going

1:21:17

down just a little. But either way,

1:21:20

even if density were sufficient, the fact

1:21:22

that their density went down so much

1:21:24

less than the others, it was amazing.

1:21:26

And it's actually, you know, if you

1:21:29

can find the video and link to

1:21:31

it on YouTube, Belinda Beck's, lift more

1:21:33

study. It's just an awesome video to

1:21:36

watch these little old ladies walking

1:21:38

around, picking around, picking their body

1:21:40

weight, and stuff like that. about your

1:21:42

results or anything else may present questions

1:21:44

you have. Yeah, nutrition would be a

1:21:46

good one actually. Yeah, calcium, vitamin D,

1:21:48

protein, everything that's going to support muscle

1:21:50

mass as well because that's the other

1:21:52

thing that we found here. So we

1:21:54

looked at your body fat percentage. Again,

1:21:56

in absolute terms, not that high, but

1:21:58

for your age, pretty high. Right, because

1:22:00

you're young, so you're at the

1:22:02

80th percentile for your age. And your

1:22:04

visceral fat was at the 50th

1:22:06

percentile for your age. We like

1:22:08

to see, so we don't really

1:22:10

care that much about total body

1:22:12

fat. We care a lot more

1:22:15

about visceral fat. So the fact

1:22:17

that your visceral fat was at

1:22:19

the 50th percentile. Vistoral fat is

1:22:21

the fat that's around your organs.

1:22:23

That's the more metabolically derranging, damaging

1:22:25

fat. We actually, we have a

1:22:27

very high standard. We have a very

1:22:29

high standard. your muscle mass. So we

1:22:31

looked at the total muscle mass in

1:22:34

your arms and legs. That's called your

1:22:36

appendicular lean mass and then we looked

1:22:38

at the total fat-free mass in your

1:22:40

body and both of those puts you

1:22:43

at about the 20th percentile. So the

1:22:45

first question I'm asking when I'm looking

1:22:47

at these results is are you adequately

1:22:50

muscled or under muscled? So I really

1:22:52

want to see somebody above the 50th

1:22:54

percentile in muscle mass. So you're under

1:22:56

muscled. The second thing I'm looking at

1:22:58

is with the body fat percentage where

1:23:01

it is both in the visceral fat

1:23:03

is that to me I call that

1:23:05

overnourished. Now I don't have blood tests to

1:23:07

see where you are metabolically but I

1:23:09

want those are the those are what

1:23:11

I could call my three questions. Are

1:23:13

you metabolically healthy or not? I need

1:23:15

a blood test to see it. I

1:23:17

suspect you are though based on your

1:23:19

zone two. So the fact that your

1:23:21

fat oxidation was 0.77 grams per minute.

1:23:24

Very hard and your fasting lactate was

1:23:26

0.5 which is also very metabolically healthy.

1:23:28

We would have to do a bunch

1:23:30

of blood tests to confirm that, but I

1:23:32

bet you would be. But you are overnourished,

1:23:35

meaning body fat is too high and

1:23:37

visceral fat is too high, and you are under-muscled.

1:23:40

Your ALMI and your FFMI are too low.

1:23:42

So that immediately tells me, like,

1:23:45

what do you need to be

1:23:47

doing? You need to be eating

1:23:49

more protein, fewer calories, more resistance

1:23:51

training. You don't need to do

1:23:53

any more cardio. Like that's like

1:23:55

oversimplification, but like that's your path

1:23:57

forward. The last question I had

1:23:59

around... I think genetics play a pretty

1:24:01

big role in that. And I think

1:24:04

in other words, I think that... your

1:24:06

ceiling is probably more dictated by your

1:24:08

genetics than it is the age at

1:24:10

which you started. I think if you

1:24:12

took a, you know, someone who was

1:24:15

just genetically wired to put on muscle

1:24:17

and they don't start lifting until they're

1:24:19

in their 20s, they're still going to

1:24:21

put on a ton of muscle. I

1:24:23

mean, like, I've been lifting weights my

1:24:25

whole life since I was 13 years

1:24:28

old. I'm never going to be like

1:24:30

a monster. Like, it's just not. going

1:24:32

to happen, right? There's no chance I'm

1:24:34

ever going to be on the stage

1:24:36

of bodybuilding, you know, contest. Okay, yeah,

1:24:39

that's just one thing. I was like,

1:24:41

always haunted me. Well, haunted me in

1:24:43

the last two years. Yeah, yeah. But

1:24:45

again, there's, you have to consider a

1:24:47

bunch of variables as you're lifting, right?

1:24:49

So are you training at the right

1:24:52

frequency? Do you have the right selection

1:24:54

of exercises? Is your technique correct? So

1:24:56

lifting weights? It's not a uniform term.

1:24:58

So you really have to dive into

1:25:00

that, right? So to put on muscle,

1:25:03

you probably need to be doing a

1:25:05

minimum of 10, and I would say

1:25:07

ideally closer to 20 sets per week,

1:25:09

per body group. The intensity has to

1:25:11

be sufficient. So we were talking about

1:25:13

that minimum two, ideally one rep in

1:25:16

reserve per working set. So if you're

1:25:18

just doing like three sets of 10,

1:25:20

but you could have done three more

1:25:22

reps if you really pushed, there was

1:25:24

no training stimulus there. I've got a

1:25:27

question on that, which is linked to

1:25:29

one of my friends, but it's something

1:25:31

I've heard you say, which is you

1:25:33

said to me before that you struggled

1:25:35

with gaining weight. Yes. A friend of

1:25:37

mine has said this to me for

1:25:40

the last 10 years. A muscle? Yeah,

1:25:42

he says, yeah, so he says like

1:25:44

he even when he eats a lot,

1:25:46

he has like, feels like he's force-feeding

1:25:48

feeding himself. and it's like not natural.

1:25:51

And then when he goes to the

1:25:53

gym, he hasn't seen the results. Whereas

1:25:55

for me, I've never had the problem

1:25:57

of like, I can eat loads, and

1:25:59

then I go to the gym and

1:26:01

I work out and muscle comes on.

1:26:04

So for those people that struggle with

1:26:06

eating enough calories, and then they go

1:26:08

to the gym and they don't feel

1:26:10

like they're able to gain muscle, you've

1:26:12

experienced this before, you've experienced people that

1:26:15

have said this to you. Sure. It's

1:26:17

actually much more common with women with

1:26:19

women than men than men, but... It's

1:26:21

sort of focusing more on the protein

1:26:23

as opposed to the total calories. I

1:26:25

mean you do need the calories But

1:26:28

it's probably breaking down the protein intake

1:26:30

into smaller servings And that for many

1:26:32

people just means they have to get

1:26:34

shakes or things like that. Like they're

1:26:36

not going to get it through whole

1:26:38

foods all the time. I don't need

1:26:41

to drink shakes because I'm able to

1:26:43

get protein through food enough, but that

1:26:45

shouldn't be viewed as something you don't

1:26:47

want to do. I mean, even I'm

1:26:49

sure some of the most successful bodybuilders

1:26:52

in the world, just based on their

1:26:54

protein requirements, still have to resort to

1:26:56

shakes. So figuring out what it takes

1:26:58

to get one gramm of protein per

1:27:00

pound of body weight of body weight.

1:27:02

and making sure you get that, even

1:27:05

if it takes four servings a day,

1:27:07

is it should be the highest priority.

1:27:09

And again, you don't need more calories

1:27:11

at this point based on your visceral

1:27:13

and body fat. We just need to

1:27:16

make sure you're getting that gram of

1:27:18

protein per pound of body weight and

1:27:20

that you're getting the right training stimulus

1:27:22

in the gym. Okay. Yeah. Thank you.

1:27:24

Okay, thank you for that pizza. I

1:27:26

didn't know we were going to be

1:27:29

doing a little cancel. Yeah, I know,

1:27:31

but it's super fascinating. Even for me,

1:27:33

even though they're not my results, I

1:27:35

learned a ton about that. The question

1:27:37

we... don't necessarily need to go through

1:27:40

all of the results here for Germana,

1:27:42

but how do you see women's results

1:27:44

being different typically as it relates to

1:27:46

bone density, muscle mass, and those things.

1:27:48

I was wondering if even for the

1:27:50

VO2 Max are expecting different results for

1:27:53

women or... Well, we score them on

1:27:55

a different curve, so the results are

1:27:57

going to be a little lower, and

1:27:59

again, part of the reason is women

1:28:01

have less muscle, all things equal, and

1:28:04

muscle is the organ... that is going

1:28:06

to consume the most oxygen outside of

1:28:08

the brain. So if you took a

1:28:10

woman at 25 and a man at

1:28:12

25, there's a different threshold for what

1:28:14

the grade is on the curve. But

1:28:17

I would say the biggest difference we

1:28:19

typically see is, and not so much

1:28:21

at the ages of these guys, because

1:28:23

they're both so young and fit, but

1:28:25

as we get into kind of older

1:28:28

folks. we definitely see more of an

1:28:30

issue with muscle mass in women and

1:28:32

bone density in women. I was quite

1:28:34

surprised with Jack when you talked about

1:28:36

visceral fat. Yeah. There's two types of

1:28:38

fat that I've come to land. Subcutaneous,

1:28:41

which I think is on the outside.

1:28:43

Yep. And then visceral is around the

1:28:45

organs. Right, so the body fat is

1:28:47

mostly measuring his subcutaneous fat. Oh, on

1:28:49

the outside. Yeah. Okay. I've got a

1:28:52

little bit of subcutaneous fat right now.

1:28:54

As we do all. How do I

1:28:56

know if it's an issue or not?

1:28:58

Unfortunately, it's very difficult to know without

1:29:00

further investigation. I say this because I

1:29:02

haven't been able to predict it looking

1:29:05

at somebody. Like I've seen people who

1:29:07

have lots of subcutaneous fat, but when

1:29:09

you look at their liver and look

1:29:11

at their visceral fat, they have virtually

1:29:13

none, and they tend to be quite

1:29:16

metabolically healthy. Maybe aesthetically they've got too

1:29:18

much body fat and there are lots

1:29:20

of reasons why they might want that

1:29:22

might not want that I'm sorry based

1:29:24

on You know excess body weight that

1:29:26

just in general is an impediment to

1:29:29

movement or you know pain in their

1:29:31

knees or joints But it's not actually

1:29:33

causing them harm physiologically and conversely, you

1:29:35

know if you look at Jack like

1:29:37

he's pretty lean-looking guy like nobody would

1:29:40

look at Jack and say he's overweight,

1:29:42

but he's got a little bit too

1:29:44

much fat on the inside and that

1:29:46

If not, I mean, I think his

1:29:48

running and his fitness is probably offsetting

1:29:50

it metabolically, but there might become a

1:29:53

day when that's not the case. So

1:29:55

it, you know, this is something that

1:29:57

I think just needs to be addressed.

1:29:59

And again. And people that are in

1:30:01

their 20s can get away with a

1:30:04

lot and it starts to become something

1:30:06

you don't get away with in your

1:30:08

40s. Is there a genetic component to

1:30:10

this? And also, what has caused it?

1:30:12

What usually causes it? The body fat,

1:30:14

the visceral fat? Visceral fat. Yeah, there's

1:30:17

definitely a genetic component to it, but

1:30:19

the truth of the matter is the

1:30:21

cause of this is just fuel partitioning.

1:30:23

It's just where the body is putting

1:30:25

excess energy, right? All of the fat

1:30:27

we have in our body comes down

1:30:30

to where does our body choose to

1:30:32

store excess energy? Because that's the only

1:30:34

way we store it. We can't store

1:30:36

protein. So we can only store, I

1:30:38

mean we store protein technically in muscles,

1:30:41

but we're basically storing carbohydrates and fat.

1:30:43

So you can store carbohydrates preferably in

1:30:45

the muscle and in the liver as

1:30:47

glycogen, but that's a very finite source.

1:30:49

So most of where you're storing those

1:30:51

things is excess glucose gets stored as

1:30:54

fat. and then in fat gets stored

1:30:56

as fat. So if theoretically if Jack

1:30:58

had a higher muscle mass he would

1:31:00

have less visceral fat potentially? Yeah probably

1:31:02

because first of all muscle is more

1:31:05

metabolically active so more metabolically active tissue

1:31:07

means higher energy expenditure which would all

1:31:09

things equal mean lower fat. That makes

1:31:11

sense and if there were a couple

1:31:13

of things that I could do to

1:31:15

reduce my visceral fat we talked about

1:31:18

exercise there we talked about diet intermittent

1:31:20

fasting. Are you a fan of those

1:31:22

kinds of things? There's no evidence that

1:31:24

intermittent fasting produces any benefits above the

1:31:26

equivalent amount of caloric restriction. So, you

1:31:29

know, whether you're eating in eight hours

1:31:31

or six hours or across 12 hours,

1:31:33

if the same number of calories are

1:31:35

consumed, it's essentially producing the same outcome.

1:31:37

Sleep stress? Absolutely. Dramatic. We've talked about

1:31:39

sleep already, right? If your sleep is

1:31:42

not good, you are going to be

1:31:44

insulin resistant. If you are insulin resistant,

1:31:46

you are partitioning fuel in an unfavorable

1:31:48

way, which in English means you are

1:31:50

more likely to access glucose than access

1:31:53

fat. even at low levels of intensity

1:31:55

when you should be accessing fat. So

1:31:57

if you... That's why by the way

1:31:59

I thought he's probably still insulin sensitive

1:32:01

based on how high as fat oxidation

1:32:03

was. Meaning when he was at 165

1:32:06

beats per minute on a treadmill he was pulling out almost 0.8 grams

1:32:08

per minute of fat. That's really good. That tells me he fuel partitions well.

1:32:10

He knows how to access fat when he needs fat when he needs fat when

1:32:12

he needs fat when he needs fat when he needs fat when he needs fat when

1:32:14

he needs fat when he needs fat when he needs fat when he needs fat when

1:32:16

he needs fat when he needs fat when he needs fat when he needs fat when

1:32:18

he needs fat when he needs fat when he needs fat when he needs fat when

1:32:20

he needs fat when he needs fat when he needs fat when he needs fat when

1:32:22

he needs fat when he needs fat when he needs fat when he needs fat when

1:32:25

he needs fat when he needs fat when he needs fat when he needs fat when

1:32:27

he needs fat when he needs fat when he needs

1:32:29

fat when he needs fat when he needs So that's

1:32:31

still working in his favor. But for many people, once

1:32:33

they're exercising that hard, their fat

1:32:35

oxidation goes to hell. And all

1:32:37

they're doing is accessing glucose. But there

1:32:39

could be a link, in his case,

1:32:41

between sleep and visceral fat. Yep. Especially

1:32:43

if he travels with you. Yeah. And then

1:32:46

alcohol. You mean jactors in your gal

1:32:48

call, but generally visceral fat and alcohol.

1:32:50

Yeah. Bad time. I want to talk to

1:32:52

you about this alcohol point, because I saw

1:32:55

Huberman tweet the other day saying that it's

1:32:57

now pretty well established that. even moderate

1:32:59

alcohol intake is bad for you. But

1:33:01

I sat here the day with someone

1:33:04

else who said to me that they

1:33:06

talked about the Mediterranean diet, the Italians,

1:33:08