If you're struggling with your diet just can't sustain those healthy eating habits, you're not alone. Might I suggest the plant power meal, planner our digital tool box of unlimited access to thousands of customizable plant based recipes integrated with grocery delivery expert, support seven days a week and so, much more all for just a dollar 90, a week to learn more and sign up. Visit meals, dot Rich world.com, do it now. Okay, let's do the
show.
So in about 2018, mid-2008, teen was, when I really decided I was 100% all-in on my Centenary and decathlon, not just sort of a name, but this sort of, the ethos of this thing which is, I am no longer making any concessions. I'm really looking forward to kind of spending the rest of my life. Trying to figure out how to be a healthy productive, Kick-Ass ninety-year-old, my insight is how you combine all of these things, right? It's how do you think about aerobic base?
Anaerobic Peak stability, strength, and how do those things matter when you're 90? And what's the standard? We should hold ourselves to like what's a realistic aspiration for someone in their marginal decade, which is the way we talked about the last decade of your life. For me, that is the sort of defining principle of Health span is sort of understanding cognitively physically and emotionally what you want in the last decade of your life and making sure that you work backwards from there.
The Rich Roll podcast
longtime listeners know. Well, that longevity is a recurring theme on this podcast and by longevity, I mean healthspan. How can we what practices? Can we adopt to live? Longer live stronger, be more agile. More cognitively fit and simply better than previously thought possible.
Like me, this piques, your interest, then you are in for a treat because this terrain is the absolute Obsession of today's guest, dr. Peter Atia, who is a physician focusing on the applied science of longevity to reframe and improve how we live while challenging all that we've been taught about the interaction of Health, Human Performance and Medicine. Peter is a graduate of the Stanford School of Medicine. He trained for five years at the
John Hopkins Hospital in general surgery where he was the recipient of several prestigious Awards. He also spent two years at NIH as a Surgical Oncology fellow at the National Cancer Institute, where his research focused on immune based therapies for melanoma. And currently in addition to his medical practice Peter host, the drive podcast, which Dives deep into all facets of longevity health and well-being, it's really fantastic. I rarely
Miss an episode. Peter is incredibly smart. He's truly Innovative and his practice. He is a Relentless self experimenter. And on top of all this, he's also an accomplished endurance athlete. He's among the very few who was swarmed. The Catalina channel, in both directions. And is also the first person to double-cross the Maui channel, which is twenty eight point three kilometers of twenty eight point three kilometers with from Maui
To Lanai. And then back in other words, this is a guy after my own heart and today's conversation the first in what I hope will be many focuses on a few, very specific topics, first Zone to training, what it is, how to do it and why it's important. We also discuss longevity. No surprise parsing knowns from unknowns, hyperbole from evidence supported facts and practices. We talk about
Importance of Mobility, strength and stability, and why we should all be training for what, Peter calls, the centenarian decathlon. Finally, in addition to a few fun, miscellaneous tangents, we cover quite a bit of ground on metabolic Health. What this actually means how to optimize it and the role that a continuous glucose monitor or CGM can play in engaging. You with your own metabolic Health. Peter is a fascinating human.
And this conversation could have literally lasted all day. I loved it and I think in addition to finding this one just super highly educational, you're going to discover a treasure Trove of practical actionable takeaways I'm pretty certain are going to improve your current and future well-being and it's all coming up after a brief word from the sponsors who make this show. Possible today's episode is brought to you by Birch living a longer. I've hosted this
Asked the more aware, the more, I realize the extent to which so many products we use every day are actually not so great for us. Sometimes, toxic for our bodies or harmful to the environment, things by Buddy, and friend of the podcast during noelene calls, fatal conveniences for example mattresses I know it sounds a little bit weird but I was kind of shocked to discover that most mattresses release gaseous.
Has chemicals called off-gassing from the polyurethane, and Flame. Retardants that are harmful to the skin, to your respiratory health, and to the planets. And a mattress is a big purchase. You want it to be comfortable and supportive. Of course, let's face it. Huge percentage of your life is spent on one but that purchase should also be consciously made and not harmful. All considerations taken seriously by Birch living
Mattress company that makes the best and most affordable because they cut out all the middlemen all-natural mattresses around. Made with sustainably sourced materials, including organic cotton grown right here, in America plus Birch. Donates one percent of each purchase to the National Forest Foundation. They also purchase carbon offsets for each mattress. Sold it shipped straight to your door completely free, and you get to try it out for a hundred nights risk-free. And right now Birches offering to
Dollars off all mattress orders for all you guys. Just go to Birch. Bi R CH living.com /, Rich role for $200 off. Your mattress order that's virtue living.com Rich role for $200 off your mattress order. We're also brought to you today by expressvpn. Here's a question. Imagine you're at the airport. You're waiting for your flight suddenly. You need to use the restroom.
Do you ask the stranger sitting next to you to hold your wallet until you return? No. Well, I don't know, maybe you'll be okay, but no, you don't do that. Well, that's the kind of risk. You run going online without expressvpn every time you connect to an unencrypted Network in cafes hotels, airports, basically, any network that's not your own. Your online data, simply isn't safe. Any hacker on the same network can
Access to and steal your personal data, passwords Financial details. You name it expressvpn solves. This problem by creating a secure encrypted tunnel between your device and the internet. So that hackers can't steal your data and cash in on selling your personal information on the dark web plus, it's super easy to use. All you got to do is fire up the app on your laptop, your tablet or your phone, click one button and you're instantly protected securities.
ER, your online data today at expressvpn.com Rich Roll and get three extra months. Free, that's Express VPN.com, Rich Roll expressvpn.com / which role. All right, let's do the show a 85 to 89. You are flyer. So I was 200 butterflier and you know it was a dream come true.
To be on that team. Pablo Morales. Jeff kostov Anthony Moss like Pablo and Anthony being number one, and number two in the world at the time. J Mortensen. I mean it was an incredible unbeatable lineup and just to be training in like Pablo is laying like, chasing his feet was like I can't even believe I'm here, but not the ideal regimen, you know, for me to reach my potential I think and, you know, Skip is a
Placated character. So I'm spoke about it at length on the show. My favorite coach is is John Orban, check from Michigan. I don't know if you've ever met him. I
did, I got to, you know. So Ed Moses was a
49-0, a diaper up. I we were on the same club team in d.c. Oh no way.
Yeah. I mean he's so much younger. Yeah. So in 2012, when Ed was trying to come back to make the Olympic team, I had, we become friends because we met at Masters, right? And at that time,
Once I started transitioning from like ultra distance to pool, I realized the only thing I could swim was butterfly. So basically, it was like, I'm going to from butterfly and I am.
That's unusual. Usually, that's the thing people can't do.
Yeah. And it's totally random. It was like, you know, because I used to swim Masters and all I would do is swim freestyle freestyle, but they were doing. I am, I was just swimming freestyle. And then one day I was like, you know, for reasons we can talk about. I just decided I'm not going to swim alter distance anymore is like a muscle start doing all the stuff that they do and all of a sudden like we're swimming breaststroke
It's like swimming as fast as all the lane one kids. Wow. And then the coach was like, dude, do that again? And he's like, oh yeah, this is your, this is your truck. This is when you should have been doing all along it's just kind of its like it's all about the length of your femur, the flexibility of your hips. Like it's just a weird
stroke. That was the one stroke that I couldn't and still can't
do it sighs. I don't think you make breaststrokers I think you're born a brushstroke. We are not. So I
also grew up with Mike Barrow, man. Who went on to a liquid.
In the breast stroke and was part of revolutionising stroke mechanics. Yeah. At the time
I used to watch the videos. Yeah. And just a
double. Yeah. And his coach Yosef Szabo. I didn't
thought. Yeah, who is a Hungarian guy who really
pioneered like the new way of swimming breaststroke and we were just watching the world championships the other day here at the studio. It's going on in Budapest right now and watching the breaststroke. It's just it's like
totally transformed it for whole different story. Yeah,
and the training. I mean, it's unbelievable. How
Different. The training is now compared to my era. I mean, I grew up in a period where it was just all about volume, you know, two hours in the morning, two hours at night. I mean, my Heist, I want to talk about your insane, High School regimen because I had my version of that
just I'm going to all into everybody. Yeah,
yeah. All in the water. And I learned kind of early and often that I wasn't the most talented kid, but I could bridge that Gap. I just out working everybody. So, I was the most reliable person to show up for morning workout. The coach gave me the
Because I was more likely to show up than him even and I was successful in that regard, but it required just an unbelievable amount of volume and work. And now, when I look at the times, especially world records that are being broken by like 17 year olds a Mike, how is this possible? The times are so much faster than anything. I could have possibly even conceived of in that time. And my only sense of how that's possible is huge strides in training methodology for sure. And I got a taste
Out of that I dropped in from time to time at USC and trained with post-grad kind of Olympic crew. They're like Ryan Lochte and guys like that and I didn't even know what was going on. Well, Orban check was was coaching on the days that I went because I wanted to go see him. I think Dave Marsh was there as well. Yeah. And and I didn't even know it was happening. It was all about power off the wall speed explosive speed like we were just doing wall work.
Entire time and putting like mesh bags around our feet. And I was like, Dragon, parachute, any of the, like what happened to like 20 times 200, you know, stuff that I used to
do? Well, they don't do that to your question about how I met or banachek. It's so I just like, kind of flopped onto Ed's feet and I was like, hey dude, can I come to whatever? Practice is you're doing and he's like yeah sure. It's like me and four other professional swimmers. And I was like great and John was like yeah, cool. So they would do to a days and I would watch morning practice.
Film study. And then I would join the afternoon practice in my own lane. And yeah, I mean, look, it was lots of 75s. Lots of 50s from the middle of the pool to, right? Right. So 50 miles west from the center of the pool dead. Stop, go. Boom back. So right? I just and then and then sort of I became just so obsessed with that, that I kind of brought that back to our master's program and I was like, look, guys, would you guys be willing to do kind of the workouts, like the, you know, the best in the world are doing it. Let's do it one day a week, let's pick Sundays and will kind of do our own
Work out, right? And it's, it's, I mean, they're very hard workouts,
was that when you were living in, Southern California, and San Diego, so swim in Mission Valley, why? Right? Interesting was not there a spark to like compete Masters. Then once you realized like you were a
breaststroker? Yeah, for about a year and a half, I did and loved it, totally loved it. And then
you know, basically
just the cross training, I was doing on the bike, got me a little more excited about being on the
Bike and also kind of I think part of what was so fun about the master's program is what a tight-knit group we were and we loved competing we went to every single meat and it was a bit of a hike. For me, we moved further north in San Francisco so I moved to a different Masters Club and it was just not like nobody wanted to go to meet, right? It was just people were there to exercise which is fine but there wasn't any of that kind of. Like, we're going to, we're going to compete. And so then swimming for me just became kind of a
Back burner thing. And then that's when I really picked up the bike, which was about 2012. Yeah.
When I was living in San Francisco, I would swim with the USF Masters. I mean, I was a pretty hardcore group at that time. I don't know if it's still survives
died. You know, when I was in the Bay Area, I swim at Stanford until I kind of got. Are we recording? Yeah, we're on. Okay yeah I got a little bit of trouble at Stanford and then I watch that because deck, joachim's,
Come to the practice to coach me. Hmm. And because he knew like I wanted to do distant ultra distance swimming. So right I'd have I'd be the Stanford Masters practice and dick would be standing there giving me instruction and afterwards. The Stanford Masters. Go to understandably was like, dude, you can't have dick standing, right? And I was like, all right, well I'm gonna go sir and
classic it to you though. Like you're going to do an end run around, whatever the
protocol is. Yeah. Exactly. You know, in in deference and respect to the program, I went and joined Menlo and they were totally cool, right? You know, so much more mellow program? Yeah. Yeah.
Now, some of the people there that is cool but but, you know, they were like, yeah, we don't care what you
do. Well, what's interesting is you picked up swimming later in life. It's a very difficult thing to do for most people and then distinguish yourself in some pretty impressive. I mean, water performances in your? I know that you're like, you downplay it and all of that but are you not like the only person are you were the first right? I'm sure other people have done it, the double Maui channel
Crossing. Yeah, although I have to be honest with you, I found out a few years later.
That there might have been someone who did it earlier, but I don't know the details of it, but at the time it appeared. I was the first to do
it. Yeah, I mean that's no small feat.
I mean, look, I think you have to put Feats in different categories, right? I think you know, I think many more people could have a potential to do something where the challenge is just, can you grind it out then? The number of people that have the potential to say be the fastest to do something. I think those are just two different things, right? If you're willing to put in
the unbelievable amount of time to prepare for something like that, it's doable essentially is what you're saying. Absolutely. It's not
just about putting your head down and
And actually the the challenge with the Maui swim as I want it to start @midnight. So I originally my plan was to do something even more. Audacious was to go Maui Lanai. Molokai Hawaii. Maui just from the trying right, which is a 30 mile circuit, but there's no way you could do that. If you didn't start at 10:00 at night because you can't be out there during the trade winds, it's just on swimmable and the boat captain, who's a great Captain said, there's just too many tiger sharks out here.
And when we put a glow stick on your suit which we have to be able to do to be able to see you, you're just going to be Chum. Yeah so he's like I can't let you start before 5:30 in the morning and that kind of limited how long I could be out there. So then I said okay well let's let's do this double you know which is was still a great swim. But
I mean there's pretty pretty regular shark encounters during the the Maui Channel swim that they do every year. That's primarily like a relay race. Yeah. That they do in conjunction with the Waikiki Open Water Swim like I'm constantly hearing
I've done tons of friends who've done it. They've it's all fine, but like, it's not without its shark
problems. Yeah, now there's more sharks in the Molokai channel. So that that channel is really Sharky and I've got a friend who's done that in both directions can enforce Nelson. I mean, that's a that's a tough Channel that's about 26 miles. And I mean, there's nothing between you and the ocean. So it's even the the walked out there. Yes, incredibly rough. Yeah, it's all about.
The currents. Yeah, but that kind of thing. I just know from doing the Alcatraz swim. It's all about timing, the start and you can be, you want to, you want to be doing your cross right at the slack between the ebb and the flow and the longer that you're out there, the more susceptible you are to the current kind of going out towards the bridge.
Yeah, yeah, I mean I've done Alcatraz a few times and it's actually I think it's a harder swim to swim into. What's that thing called again. The Cove aquatic Aquatic Park. Yeah, I think it's harder to swim into Aquatic Park, even though it's a
Order swim because you're really threading the needle to get in between those two Brides. Exactly. Whereas, when you go to what's it called, Crissy Field? Yes. Yeah that's a longer swim but it's easy like it's because the currents occur and pushing you in that direction. A direction. Yeah, so you tax straight and you just naturally gravitate. That's
right. At that. Finish Point. Interesting, in addition, a couple Catalina Crossings like, but now you don't swim at
all.
I mean, I don't swim at all because I'm three months out of shoulder surgery so yes, I definitely want some reason now. No, you just I had stopped to me but I'm gonna get back to it. I think. I think I'll never do the, I don't think I mean, the only condition under which I would do a marathon again. As if one of my kids wanted to, when I, when I was in the ocean, last time we were in Hawaii, I think my son was four and we were we were at the sort of Eastern tip, no, the Western tip of of Maui and you can see Molokai
Right. And he was like, what's that? And I told him and he's like, he's really interested in that and I was like, buddy. If you ever decide you want to swim there, I will come out of retirement and we might do it together. That could be an incredible bonding
experience. Yeah, well this is a good kind of way to segue
into one of the main topics that I want to get into with you, which is this
notion of the centenarian decathlon. And I have a very piqued interest
Tourist in this moment around all of these ideas that have become kind of at the Forefront of what you talked about and write about through my own experience of dealing with lower back pain. Suddenly I'm in a position where I can't run without pain and even if I'm on the bike for more than a couple hours, my back becomes intolerable, I've got an L4 that's kind of out of whack and sciatic pain so I was like, all right well swim I'll get in the pool. This should be supportive and I signed up for the
The Key West 20 km swim which was just this past weekend with the intention of competing in that. But when the yardage started to stack up around six or seven thousand yards per workout, like my back, just couldn't deal with it. And
I don't know if even though it was that that in open water with a flip turn. Well, it was do now is flip
turns. So yeah. So I think it was it's all the turns like I just couldn't do a flip turn anymore without pain and so now I'm sidelined in a way that I haven't been in the history of my experience of being
An athlete. And I'm now compelled out of pain to confront and deal with this situation in a meaningful way and it's been really humbling. And so as I think I messaged mesons. Do you like the videos that you're putting up about mobility and and like glute activation and all of these things have been like the most important thing in my life, as I slowly kind of acclimate to a new way of thinking about Fitness through movements Etc.
So I think it would be instructive to explain how this became of interest to you and it's obviously it's part and parcel with your interest in longevity, but maybe kind of walk us through
that.
I mean, there's a story that you probably know, but I think it might be helpful to just explain an unfortunate reality of our species, which is we tend to respond best to pain 100%. I mean any any change I've ever made
is only because I've been forced to extreme pain.
Yeah, so so my first brush with that came in my last year of medical school. So June of 2000 at our alma mater, right? So I'm just on my bike riding to the gym.
Back when it was the Arriaga Center there, I get off my bike getting ready to lock it up and I'm like got something does not feel right in my back. Like a really weird pain and so bad. In fact that I decided, you know what? I'm going to I'm going to get back on my bike and ride back to wherever I live. I think I lived in Escondido Village or something. So I do that and I'm thinking, you know what, I'm going to be fine. I just need to kind of rest today which is not very unusual for me. Like I'm not that guy who takes a day off.
Well, the next day I can't actually get out of bed. So, actually call my roommate, two separate lines. I'm like, dude, you gotta, you gotta get me up and to make a long story short, that that transitioned into kind of two weeks of debilitating, back pain. That ultimately led to what? I didn't realize at the time, was a free fragment. So a fragment of my L5 S1 disk broke off. There's about 4 cm long and it just parked itself on my S1 nerve root. So now I just had the sensation
Of skin being peeled off the bottom of my left foot. So I kind of suck this up for a week and then finally the dean of the medical school saw me limping and he's like what's going on? And I told him and he said we got to get you an MRI. Now took me got an MRI the next morning I was in surgery and and it was just everything went wrong. So was a botched operation, the guy operated on the wrong side. I came out with a foot drop on the right leg. So my right leg Stanford Hospital. Yeah. Wow.
So my right foot had a drop. So now I couldn't walk. As I'm dragging the right foot. This turned into an unbelievably complicated story. That I won't bore everybody with, but the punch line is I needed. Multiple trips back to the operating room to fix this problem. And I was probably three months of only able to lay on a floor or bad. Like those are my only two positions. Mom had to fly down to take care of me to feed me, didn't they? You know, went from
I'm not sure I'll be able to be a surgeon to, I'm not sure. I'll graduate on time to. I'm not sure I'll ever walk again.
And then an amazing doctor. They're actually guy who I'd like to have on my podcast at some point, his name's Sean Mackey he's a pain specialist, he was kind of the guy that broke the cycle and began the treatments that were that got me out of pain enough to then do the rehab and amazingly. Within a year of that incident I was at Hopkins standing on my feet operating, you know, as a surgical resident. But that was a that was like kind of an aha moment and that's actually also it led to me getting into swimming.
Three years later when I'm so that was 28, when that happened. So it by the age of 31 I decided you know, I'm going to mix things up a little bit and try this other thing swimming. So that experience stuck with me and I do think of that as kind of the best worst experience of my life because it gave me a really close up view of what it means to lose your body. And I think most people unfortunately, don't figure that out until it's too late to do anything about it. And I
Why I got a second chance so it which is not to say that. At that moment, I conceived of what I'm doing today. I certainly didn't I would spend the next
You know 18 years pursuing other performance metrics but it's never left my mind and it's now you know completely shaped how I think about taking care of patients and myself. Hmm.
What's unique and interesting about you and the
work that you do is
that your perhaps the only person in the world or at least the only person that I can think of, that has such an in-depth level of expertise in both performance athleticism.
And kind of the mechanisms, you know, behind how to optimize that and Longevity like how to promote that effectively through evidence-based medicine and Science. And it seems like these two worlds are orthogonal to each other and you've seem to find a way to kind of synthesize the best of those. So how do these two worlds intersect and and maybe that's a way to kind of, you know, segue into your kind of real interest and Fascination in longevity.
I think you're astute to pick up on that rich, not the part of my expertise, the the cuz I don't think I actually have much expertise on the performance side, but I think you're astute to pick up on the notion that these are often at odds. Mmm. And it's for that reason that I get contacted a lot by professional athletes and by professional sports teams, probably at least once a month. You know, coach of an NBA team or something or you know performance some high-end performance entity reaches out and outside of the physiologic sports.
Like swimming running cycling where I think I do actually have a pretty good sense of the physio specially cycling. That's probably the one that has the least technique and the most pure physiology. That's probably where I would have the most Insight but what it takes to be exceptional there and what it takes to live a really long life. I wouldn't say they're completely orthogonal but they're certainly nowhere near collinear. So for that reason I just say look I'm not the guy to help you achieve those goals. I'm probably the
Guy to help you when you retire and you want to work towards a different goal.
I would assume though that in, in the Venn diagram between those two worlds that the intersection has to do with promoting kind of the longevity of one's career. Right there are certain things that you can do as a professional athlete, chasing, great and absolutely that can extend the link. I'm sure like a lot of the people that reach out to you are in the kind of Twilight of their career. It's like, how can I eke out a couple more years doing this? Well, now, we have to open ourselves.
Up to these other protocols.
That's absolutely correct. And I think, you know, I have a friend who works most, you know, exclusively with kind of NFL guys and his take is from the day. You sign your first contract after the NFL combine, after you've shown everybody, how fast you can run a 40 and how much you can bench press and all that stuff like you stop, caring about those metrics forever. The only metric now that matters is not getting injured. You know, that's that's effectively going to determine your lifetime earnings and so it's not really
About how much faster can you get. It's how much safer can you continue to run fast, even if it means running a little bit less so so yeah, you're absolutely correct. And in that sense, look again, I don't think I'm, you know, particularly insightful or brilliant on those. I think my, my insight is how you combine all of these things, right? It's, how do you think about aerobic base, anaerobic, Peak stability, strength, and how do those things matter when you're 90? Mmm?
And what what's the standard? We should hold ourselves to like, what's a realistic aspiration for someone in their marginal decade, which is the way we talked about the last decade of your life and the way that you kind of
construct, an architecture around, how to think, and approach. This is by working backwards. Yeah, from a perspective of what your values and your goals are or what you anticipate, you're going to want to be able to do when you're 90 or 80 or 70. And then working back from there to start doing the things that will.
I'll put you in a position to, you know, kind of have that
capacity. Exactly, you know, you we would call it forecasting if you say where you are today. So if you say okay, I'm 50 today and when I'm 55, I want to be able to do this. That works reasonably well for short-term goals, but for really complicated problems, it seems easier to reverse-engineer them and I've borrowed the term backcasting from Annie Duke because I think it's just a better way to
Forecasting and backcasting and I just don't see how you can forecast 40 years. It just becomes too vague, you have to Anchor to what you're talking about, 40 years out. And for me, that is the sort of defining principle of Health span is sort of understanding cognitively physically and emotionally what you want in the last decade of your life and making sure that you work backwards from there. And again, it literally feeds into everything likely, use an emotional example because that's people don't think about that. If your vision,
Of the last decade of your life, is to be surrounded by family, who love you and want to be around you. But 40 years earlier you have no relationships your you know, your kids hate you because you're a jerk and you're working all the time. There's a disconnect like do you really think your kids are going to be around you in 40 years if they don't want to be around you right now? So every one of those things has to have a congruence that comes back now with the emotional stuff, it's not as metric driven, but when it comes to the physical stuff, it's
Very metric driven because we know exactly what these things mean. You know, if someone lays out an aspiration, you can say well, that will require a VO2 of this, many mils per minute per kilogram, you have to be able. Your muscles have to be able to consume this much oxygen per minute. If you actually tell me that you want to be able to hike up that canyon in that many minutes, mmm, if you tell me that you want to be able to stand up and do XY, and Z will require this much strength, and we know the rate at which,
Each those things Decline and therefore we project back, right. So typically
somebody's going to say, I want to be able to play with my grandkids. I want to be able to go on a hike. I want to be able to, you know, get up off the ground or get up off a chair and, you know, get up out of bed and, you know, typical type of stuff. So, how do you think about or, you know, basically, what are the pillars of this? I know you have buckets and how you think about this, like, what are those and then you know, from there like what are the things that?
That, you know, somebody of my age or just, you know, kind of in the middle age sector of Life, what should we be thinking about? And what are some of the practices that we should be starting to adopt? I mean, we would
start by being more specific in the marginal decade. So the one thing we don't know is when your marginal decade is going to be, so I don't, you know, I don't, I can't tell looking at somebody. Is it going to be 80 to 90? Is it going to be 74 to 80 for? Is it going to be 80 92, 99? We don't know when that is and that does play a role, but I think it's worth budgeting.
For it being later because that will force you to hold yourself to a higher standard. But we begin with much more specificity. So we I think we have a little over 50 questions. We ask our patients and this is absurdly specific stuff. I mean, some of it is like things you wouldn't think about like, do you wanna be able to have sex, right? I mean, because if the answer is yes, like there is a certain level of Fitness mobility and strength. That's required to do that. Do you want to be able to walk?
Look up this, many flights of stairs. Do you want to be able to carry this many pounds of groceries? Do you want to be able to place something of this weight above your head? Do you want to be able to pick up a child of this weight from the ground? And we just sort of force people to go through that exercise and you check off the things that don't matter to you and check off the things that do. And what that does is it turns into basically a Consolidated set of metrics for strength and fitness.
Us and other things that are a bit foreign to people like scapular control, you know, lower leg variability. You know, big part of what troubles people when they get older and it gets mistaken a bit for balance, but a lot of it has to do with, not just balance, but with lower leg variability and, you know, not being able to kind of feel with your feet very well, right? And, so Falls. As an example, become an enormous cause of morbidity in are quoted. The stat many times, but if
Over 65 and you fall and break your hip your 12 month, mortality. Meaning the probability you'll be dead within the next 12 months, depending on the study is 30 to 40 percent, right? So, just starting from that as a baseline, like let's try to not
fall or in the event that we do fall. How can we be resilient enough? So that we don't like suffer that type of
consequence. Yeah, so there's a whole bunch of things that you work backwards from there. And
You'd be amazed at how many people even in their 40s and 50s. Don't possess even though they're strong enough to meet the metrics of their 90 year old self, they already show signs of weakness in terms of instability in their hips. Instability in their knees, horrible patterns of walking you know pelvic tilts that are too far forward. All of these things that they can sort of muscle their way through when they're younger, but it becomes problematic later. Yeah. I mean, I check every
single one of those boxes.
Says and I was listening to the podcast that you did with Lance Armstrong and you were talking about this subject and he was basically saying, look, I just want to put on my shoes and go run like I'm not going to do any of that stuff. Like that's 100% me, right? And I did that until I just ran myself into the ground. Couldn't do it anymore. And, you know, a couple things, I mean, first of all, for many years, it was all about power to weight, right? Like your I'm doing these very specific movements, I'm swimming. I'm cycling and I'm running.
So, I had incredible efficiency with certain muscle groups, but I wasn't doing any of the kind of gym work required to be balanced in that regard. And as a result, I have certain atrophies and I have like, misalignment in my posture and all sorts of things that, you know, now, I'm realizing are super problematic, not the least of, which is my balance is terrible. Like if I stand on one foot or I try to put my socks on things like that, like it's hard. And that was like a huge
Revelatory moment for me to realize like there's something terribly awry here and now I'm on a certain type of protocol. Like you tell somebody a back pain, like people come out of the woodwork and everybody's got like the person you should talk to, but you got to pick a Lane, right? So I'm working with a certain PT at the moment and one of the things that that this person is having me, do is a lot of glute activation work. And, you know, I've only been doing this for like a month, but initially, like I had, I had 20 glute. I couldn't, I couldn't even
My brain would signal to that muscle group, and it wouldn't do anything like, that's how bad that situation was. And now I can kind of do these little exercises that are annoying and as somebody who's like, you know, like yourself, like I want to go out and crush it. Like, it's very humbling to kind of have to let go of all of that and focus on these little movements and again, not to rehash this. But you seeing me seeing you do this stuff, like on video is like, okay, well if Peters prioritizing this like I realize this is important and it's
It's given me like permission to really kind of embrace this, but it's been, you know, interesting and I realized like how how kind of much work remains in order for me to really be stable. Look, it took me
Probably three years of backing off to then go forward again. So in about late 2018, mid-2008, teen was, when I really decided I was 100% all-in on my centenarian decathlon, not just sort of a name but the sort of the ethos of this thing which is I am no longer making any concessions because one of the dirty little secrets is and I love in front of mine, Kyler Brown said, this to me, he goes athletes are the best.
Hers.
Right? The more you're a grinder. The better you are at cheating your way around bad movement patterns and you know, I learned this amazingly the my labrum so I tore this labrum growing up boxing you know, multiple subluxation 's further. Exacerbated during my Open Water Swimming days. I was in a swim race. Once when I was in full extension, in the guy in front of me kicked down took the whole shoulder out of socket. So this thing's been shredded for, at least 15 years and
I have managed to fight my way through it and muscle my way through it by cheating. Basically, using my rotator cuff to stabilize the humeral head, using my traps to stabilize it. Now I developed a whole bunch of horrible patterns around it but he's like yeah that's what athletes do, right? And so the
downstream implications of that become
cataclysmic, yeah you have to start to unlearn that stuff. So that's what began for me in 2018. I mean and you know how it presented actually was, I was getting tennis elbow.
And I'm like it's really odd because I don't play tennis so that doesn't seem like a likely injury and that's when I first met a guy who kind of got me on this path, using something called Dynamic neuromuscular stabilization and he watched me do pull-ups. He's like, let me see you do a pull up and I was like, do I own this baby? Watch, you know, that a million Pull-Ups for him and he's like, yeah, it's horrible. Like your Technique is so bad, you have no scapular control whatsoever. You are transmitting so much force into your elbow.
Doing that because you can't keep your scapula in place. Another big, aha moment, which actually, ties into what you said about the glutes. There is a fundamental difference between having a strong muscle and knowing how to recruit it. Hmm, and for me, the aha moment came with my hamstrings. I have always prided myself and having just the strongest legs, right? I mean, you know, cyclists have strong legs. I deadlift tons of weight. I do Insane amounts of stupid.
Like curls all every you name it, I'll do it. But when I was placed on the floor in a very simple position, laying on your back, knees, bent feet flat on the floor. Could I without screwing around in my pelvis just pull back with my feet and pure hamstring recruitment. No, could not, I can't do that either. Couldn't do it. And so what that says is it doesn't actually matter how strong your hamstrings are. You can't recruit them and if you can't recruit them, your pelvis is tilted forward.
You have to be able to keep those hamstrings recruited to keep that pelvis in the right position.
I mean, it took me a year of daily.
I mean just grinding away at these movements and this practice. And now it's hard for me to remember what it was like to not be able to recruit my hamstring so it can't you can unlearn these patterns But the irony of it is the more of an athletic background, you have the longer. It will actually take you to unlearn because you have more bad stuff.
If those neural pathways are so they're so they're so wired. The good news is you have the Reps on how to do stuff. So I think it's a wash taking an untrained person and teaching them versus taking a highly trained person in teaching them takes about the same amount of time, but for different reasons. Yeah, I mean, the athlete knows how to commit to
something and follow through, but the trick is, the light bulb moment, right? Which is usually triggered by an injury that forces them to the mat, right? Yep. That's the situation that I'm in. So, for your
Centenarian Olympics. Like what are what are the events that you're working towards? Like, what are the
categories you know? For me, I think my kids are the greatest source of joy in my life. So you know my hope is that my kids have kids and that we're in proximity to them and I just get to do the kind of stuff with them that I get to do with my kids right now. So again it's silly simple stuff. But again, I'm fortunate that, you know, I still have two boys that are young 5 and 8 and so I realized to play with
Them is hard like they play on the
floor. Mmm.
You know, we're building Lego we're building tracks were pushing trucks, we're doing that stuff. And when I look at, for example, my dad is 85, like, he can't engage with kids like that, and a big part of it is my dad's mentally as sharp as a tack. Can't get on the floor, so something as simple as can you get on the floor?
Spend 30 minutes without your back, breaking and get up. Now that takes a lot of intra-abdominal, stability. It, you really have to be able to initiate intra-abdominal pressure to maintain that position. And of course, getting up requires a whole bunch of coordinated activities. I mean, I have a very lofty aspiration, which if I get there is great, which is I'm gonna be able to get up without using my hands still. Yes, I can do now, obviously, but even if I can just do it on one point of support, that would be fantastic. I
Of archery. It is such a big part of my life and, you know, even though now, I'm pulling a 75-pound bow, I think to be able to pull a 50 pound bow, in my marginal decade would be fantastic. I love driving race cars. Now Paul Newman drove a race car until probably a year or two before the end of his life. And so for me, that's something that, you know, I would love to be able to be able to continue to do and that requires not just the strength and the coordination and the mental acuity to do it. You have to be able to tolerate insanely hot temperatures and
gets so hot inside of a race car that you have to kind of have the kind of cardiovascular fitness to tolerate
that, right? But having clarity about what those things are allows you to then back cast to now and start to build the foundation for that capability.
Yeah, like we were talking about earlier. I mean, that's a big part of why I do what you do which is I do some of my activity like Iraq for five days a week, you know, carrying a weighted backpack but I always do it at like 5:00 or 6:00 p.m. So in Austin that's about the hot.
Time of day so it's 100 degrees. Sometimes it's a hundred five hundred six and you got a 60-pound pack on your back and you go walk three miles in the Hills your ability to tolerate heat. You know you go to somebody's barbecue at 11:00 when it's 90 and everybody's dying. You're like there's nothing right? Yeah. You can acclimate to that. You just have to engage with it and confront it
coming back for more. But first we are supported by Roka the people who
Whydid. You know what? Just because you need prescription, eyewear doesn't mean you have to look like a dork when you're working out or you're racing, or you're playing ball or sitting in the sauna, riding your bike climbing, a mountain because Roca has the perfect pair of stylish eye glasses or sunglasses. That will meet your very specific need and sure you look great doing it and give you that peace of mind that they will never. And I mean, never slip down your nose.
A centimeter let alone fall off your beautiful face. I love them. I've got a couple of their chunky repairs for reading work and podcasting Iraq. The Torino, son. He's on the trail. I've got the CP series shades for the bike, and let's not forget the Phantom aviators. When I want to go all Top Gun on y'all everything, they make is super lightweight, the Optics rule, there's no glare and they have these bendable temples and different size nose pads to
Customize, your fit to your beautiful original face. Nobody else is doing this people. I love them and it's super easy to find your perfect pair. They'll send you glasses at home, so you can try them on and see what looks good. And then you just send them your prescription, place your order and boom, you're done and right now, all you guys can get 20% off with the code, Rich Roll, one word, no space. So go to Roca.com. That's our okay. A.com and check them out. And enter code, Rich role for
20% off. We're also brought to you today by whoop. If you watch the podcast on YouTube or you've seen my videos on Instagram, you might have noticed a strap on my left wrist, that is not a watch. It's a sensor called a whoop, 4.0 that connects to an app. On my phone, that monitors, my recovery, my sleep, my training, and a whole array of biomarkers, like heart rate, heart rate, variability skin temperature and even blood oxygen.
Why is this important well taken together and particularly over time these powerful data sets provide you with a pretty great snapshot of how well you're responding to stress and exercise how rested you are or aren't whether you're fighting off an illness and so much more which in turn allows you to tailor to make adjustments to your daily habits. So you can better optimize your output your productivity and your recovery. I've been using it consistently for
Couple years I never take it off my wrist and I have found it to be incredibly helpful. So sleep, better recover faster, train smarter and now feel healthier with whoop. The all-new waterproof device is free when you sign up for a whoop 4.0 membership. And right now, Loop is offering 15% off when you use the code Rich role at checkout. So, go to whoop, wh oop.com and enter code, Rich role at checkout to say 15% today, okay?
Now back to the show,
one of the things that you've talked about quite a bit is noticing
how natural it is for your children to do, all of these movements that then become so difficult for us as adults because we've unlearned them. And our sedentary Lifestyles kind of detach us from, you know, our kind of natural blueprint and ability to do those things. So, you know, how can we, you know, as most people listening or watching?
This probably have to sit in a chair for their work and we're sitting in chairs right now. What are some of the practices that could be adopted to, you know, help. Keep us connected to that natural ability. That is kind of innate in our unconscious.
I mean, for me, I've taken a very deliberate approach to that. So, 45 years ago, when I got introduced to this pattern of movement called Dynamic neuromuscular. Still talk about that super interesting. Yeah. So it kind of grew out of the, the Czech school. So so
Basically God, I wish I knew the history better. I've forgotten a lot of it about a hundred years ago. A check neurologist was trying to understand how kids with cerebral. Palsy had such difficult times with movements and he basically formulated a hypothesis which was during the first couple of years of their life. They were missing out on some developmental Milestones of movement and when they didn't get those patterns those neuromuscular
Girls weren't developed they could never they just they became hosed movement wise. So he said well if we can identify what those are by looking at kids that don't have CP, can we teach them to the older kids with CP and the answer turns out to be? Yes, you could. So that became the Prague school and that's what they were primarily doing. And then another guy came along, I'm blanking on his name, it might have been vojta or voice. It might have been the original guy. I can't recall who basically said, wait.
A minute, this is actually a tool that would be really valuable for prehab and rehab for, you know, adults and so that kind of morphed the Prague School into this field of dynamic neuromuscular stabilization, which, you know, we abbreviate DNS and it's still based in the in the Czech Republic or Czechoslovakia, I guess whatever we call it now. And having now been connected to a number of these practitioners, I have found this to be.
One of the most important systems that I've Incorporated. So initially my exposure to, it was basically to fix problems, right? Eye was fixed. I had to nagging issues for five years ago. 1ms, this elbow issue which again, I couldn't understand what it was causing it until I realized it was in ability to localize, my uncontrol, my scapula, and the other was just my right SI joint. Nagged. We just had this little nagging pain in the right SI joint. Not certainly didn't ever raised to the level of lower back pain. No. Sigh on
Nothing like that. But whenever I deadlifted really, really heavy 50% of that, 50% of those days, I would be punished with some right SI joint pain. And again, these two things seemed completely unrelated until I got under the hood of what was going on with my movement patterns and I realized you know like every whatever I was 45 year old. I didn't know how to move. So what started out as kind of rehab has then just morphed into life movements so I do an hour a week.
In person with a DNS teacher. So guy named Karla Brown comes to my house once a week. We just Hammer DNS movements together and then I'll spend 10 minutes every day doing them on my own and that has been kind of life-changing. Now, of course with my shoulder injury Kyler is overseeing the rehab there. And so we're now incorporating really good shoulder rehab coupled with the DNS principles of getting my scapula.
Relearn how to move because when you have this type of an injury and you have surgery the the brain really wants to shut off how this thing works. So now we're just going to basically reprogram, right? So what
is an example of a DNS movement or first one, is what we're trying to understand.
Visualize it the very first one is something called learning how to access intra-abdominal pressure. So, you know, I think most people who think about breathing have a pretty good sense that
That you aren't just breathing into your thoracic cavity, right? A good breath. Has to have the diaphragm going down. You have to get into the abdomen. What DNS does is it really explains to you? How a child is breathing? Which is you know if you imagine the waistband of your pants or your shorts, when a child is breathing that thing is fully expanding so they have purely concentric force in their abdomen with with every breath. And again if you look at a really good power lift or something, you'll see the same thing.
I mean, the amount of intra-abdominal pressure that they have to generate to be able to move such heavy. Loads is essential and so that was literally, the very first thing we worked on is just, can you access pelvic floor pressure? Can you create enough pressure into your pelvic floor? Can you maintain it? Well, you breathe. So that first of all, just hard to do that out of the game. And the second thing is, you can do it, but you're not relaxed, so you never be able to do that. Hold it while you can breathe around it.
The next things for me that we're very important, I have a very congenitally narrow c-spine, and if you look at an MRI of my neck, you just, you wouldn't believe what a disaster. It looks like even though I've never really had an issue, but I'm being very preventative about it. And so, one of the other things I'm working on is learning how to use the Deep neck stabilizer. So these are muscles that ride on the back. They're inside. You don't see them. So they're not these scalene muscles that are in front.
They're the muscles that sit on the vertebral body sort of deep in my neck and it's learning how to use those muscles to keep my head forward. So I'm not relying on these muscles here and so that's a lot of muscle. That's a lot of movements where I'm on my back, chin is forward, using the cue of the eyes looking forward, which kind of lights up that circuit and using various pelvic positions, arm, positions and leg positions in there. So it's
very subtle and gentle but it's
More about like, how do I connect the, you know, my intention in my mind to these muscle groups to get them
to just activate the starting positions are. Now it starts to get very elaborate. Basically, if you, you know, someone Google's sort of a DNS progression, you'll see how complicated it will get because you're basically walking through the first two years of development. So the stuff I just described is is like, you know, is the fetus basically and you start moving into a three-month position, a four month, five months, six months,
And we're now a child is learning how to roll well, they roll in a very connected way. So when they're reaching for something with this arm, they're completely connected across their oblique sling, and they're going to initiate that movement and down to their foot. This is the other stuff that was just like, when I look at videos of me for years ago and videos of me now, I just don't know what the hell I was doing before. I like, how I was getting away with the nonsense of being completely disconnected, you know, scapula is all over the place.
Sand and all that sort of stuff. And here's the other thing, the
best athletes in the world, kind of
naturally do this. That's another thing I've learned is that there are some really exceptional athletes out there who have never once spent a minute, learning DNS. But when you look at them, they have somehow managed to preserve those neuromuscular Pathways. And that is essentially a big part of what their athletic gift is. And I would imagine
it's pretty good for injury prevention, right. If you're if you have the
Ability to recruit all of these muscle groups, you're inherently more stable and and resistant to a lot of the injuries that are occurring from those imbalances.
Yeah. And that's why for me it's just it's a it's a once a week you know do the lesson once a week you know, push push. How much further can I get in those things? And then it's part of what we call our dailies. So we have for our patients, we program things called dailies like this is going to be you know, whether today's is own two days, strength day, a rest day, you still have your day.
Eilis, you got your 10 minutes of daily so I assume
there's practitioners trained practitioners who can teach this. But are there YouTube videos? Like if somebody's listening to this, I mean, how should they go about researching this or find? So,
I did a podcast with one of the probably six or seven, most prominent teachers in the United States guy named Michael rent, Allah and we have the video of my interview with him and then also a few introductory movements, probably another hour worth of videos we made. And I suspect there's got to be a ton on
Right. It's the kind of thing where I hate to say it, but I do think at least initially you do need an instructor because at least for me and I think I have decent proprioception and kinesthetic awareness, not amazing, but good. I don't think I could have done it without somebody there to poke and prod and correct. And even today, like I just I get more out of it when Kyler's there and even when he's there, he's filming me to this day filming and
Ting. So that when I'm doing it on my own, I'm watching a video and I'm listening to his cue. Uh-huh.
And would you say that that is
foundational and
a kind of requisite prior to the work that you do with Beth? What's her name? Beth Louis. Yeah. Beth Lewis, who's kind of taking you through some more type of kind of movement, activation type of
exercise. I mean, look, I think I don't think there's anybody who's not going to benefit from DNS, I, but I also acknowledge that I think it fixes every problem. So there's a, you know, a
Other system called PRI postural restoration Institute, which is amazing at fixing. Another huge problem which is when that pelvic tilts forward, the ribs flare up like that's a very common. Athlete problem, Beth has names for kind of Beth has broken. People down into three phenotypes and I can't remember what they all are. There's kind of the loosey-goosey one and then there but then there's the like locked and loaded one, right? So that's me, that's lions and that's you know, right our natural state is chest is up.
Up pelvis is forward back, is arched, back is arched so to excess lordosis and learning how to relax. My ribs has been an insane, like the guy who does my tissue work? Who's been working on me for? I don't know, probably 10 years, eight years. He's shown me pictures of what my lower back looked like five years ago. And I don't recognize it like I didn't. So you have these two, you know, erector spinae muscles that run down your
I mean if you look at my erector spinae five years ago and you look at them now you can't believe it like right now my back is just flat like there is no bulging musculature adjacent to my spine and before it was just that was always on fire. I had these huge muscles running up my back that we're just holding me in that locked position. Yeah, and that's all from being able to just do this, this is
exactly where I'm at right now. You know, it's just, it's so locked up back here. And when I
lie flat and I
I to do pelvic Mobility
exercises. It's so incredibly limited like that pivot is just I have no range whatsoever.
I mean you'll get it, you know, you once you learn to use the hamstrings, once you learn how to activate those hamstrings and we started doing it single leg at a time. I mean this is where Beth's real Brilliance. Shines is just being able to come up with these exercises like you know if you just put your foot on a 1 inch block and Elevate the right foot
Than the left and take turns with the activation. I mean, all of those things start to make it easier for you to initially, get that signal from your brain, to those muscles. Mmm, but I'm just, you know, look, I wish I learned this when I was 18, but I also realize I was too dumb when I was 18 and there's probably no way I would have done it. Yeah, I mean, it's that kind of age. Old
question, what would you tell your younger self? But that presupposes that your younger self would
Be at all, open to like any of this type
of those simply nowhere. You know, version
well beyond this kind of Realm when you think about longevity. And when we talk about longevity, we're really talking about health, spam, like what are the other buckets? And I guess a question that I have is how does this kind of line up with, you know, the ideas of the blue zones? And these other kind of principles that guide, you know how to think about setting ourselves up for longevity success.
Well you said, you know lifespan is sort of a lifespan and health spanner. The two vectors of longevity but I do think most people think more about the health span One. The good news is they're not independent vectors, right? These are these are actually not orthogonal vectors there even though we represent them orthogonally on a graph. If you take all of the steps to live a better life, they're just invariably going to also lead to a longer life. Now, there are exceptions.
Exceptions to this rule. There are certain trade-offs one might make if you were really purely optimizing on one or the other but the but the overlap is so powerful. So I usually tell people not to worry about it, you know, their words, if they say, I don't care how long I live. I just want to live the best life possible. It's like great, you're gonna live longer by the way. So I think of them, as I said in those three buckets, sort of a cognitive bucket of physical, structural bucket, and an emotional bucket, and within that physical bucket, just to kind of round it out, you have everything we've just spoken about which is the stability.
What he component and that's the foundation. Everything has to be built upon that and then there were like sort of think of like three pillars that stand on the foundation strength and aerobic base, which is effectively a proxy for mitochondrial efficiency and you know, exceptional fuel partitioning and then a peak aerobic you know / anaerobic piece of kind of think of your VO2 max your Zone 2 and your strength. And again I think people have a sort of
Intuitive sense of what those look like. But, you know, the devil is in the details and, you know, how much time should you be spending on one versus the other? And it's really kind of a function of how much time does is one willing to devote to this craft, right? I think, you know, I think we for understandable reasons, probably tell people that they don't need to do that much exercise because we're talking to the average person who's doing none. And it's true that if you're doing no exercise just getting you to do three hours a week has an
Believable impact on your life, probably more than anything else, you could tell that person to do, but I would hate for the message to end there because I think, if you're, if you could do 10 hours a week and it's really well structured, you could, you know, you the sky's the limit for what you could achieve.
I want to put a pin in the zone to discussion. I want to get to that later and go deep on that. So maybe set that aside for now and we can kind of parse the the fitness aspect of this that exercise aspect of this. But
when it comes to these other areas the emotional area and the cognitive area, like how are you thinking about practices in that regard. I mean the emotional area that gets kind of a femoral I suppose but maybe we'll start with the cognitive stuff.
So the cognitive one really comes down to a very strong overlap with how we think about the prevention of neurodegenerative disease. Specifically dementia. And so we think of kind of these three areas of cognition executive
In processing speed and memory both short-term and long-term different forms of dementia will take on a different assault on each of those things and that's become a very interesting study in the field of Neurology. You know there was a day when we just thought of Alzheimer's disease is a disease, you know, the joke is already a joke but you know the joke in neurology is if you've seen one patient with Alzheimer's disease, you've seen one patient with Alzheimer's disease. So
So I think we're now starting to realize there's a lot of different subtypes within there but we also realize that there are some commonalities with respect to prevention and unfortunately or fortunately depending on how you think about it. Prevention is kind of our best hope when it comes to that and this is you know even more so than cancer and certainly cardiovascular disease. We really don't have options for patients. Once they have dementia, this has been an area of extensive study that has yielded effectively, nothing if we're going to be
Really honest. It has yielded effectively, nothing. There are some treatments that can probably slow down progression but the reality is you just want to be in a position where you're addressing this. Even before we have what's called mild cognitive impairment. So what do we know about this? Well, I mean, what we know is exercise is the single biggest Elixir for brain health and it's amazing how, you know, how much more powerful it appears to.
Be than nutrition. Even sleep. And those things are very important but exercise is in a league of its own. And we studied this question extensively about eight years ago and I didn't initially just refuse to believe. This was the answer because it seemed too simplistic. I thought there had to be something more powerful, you know, I thought DHA or something else could have had a bigger role, but as important as sleep nutrition are exercise, kind of takes the cake and I suspect, it's because it impacts so many.
Right? So exercise is going to impact. Glucose disposal, insulin, sensitivity, inflammation produces growth factors for neurons, bdnf. So
You know, it's you tell a person that the most important thing they can do for their brain health is to exercise. That's where you get into the haste. If you could do three hours a week, that's great. If you can do seven hours a week, it's even better sleep does matter with sleep. I think we have, you know, the problem of sort of one. Do you have pathology? Yes or no? Right. Do you have sleep apnea? I think there's a lot of undiagnosed sleep apnea out there. So we kind of have to make sure we're catching those patients, because they don't all look the same.
At The Stereotype is somebody with sleep apnea is overweight and they're snoring all the time. But it turns out that there's a lot of sleep apnea that doesn't fit into that bucket. So we definitely want to catch those people and then you get into basically duration and quality. So are you sleeping long enough and are you getting appropriate staging nutrition matters of course but I think mostly as it fits into metabolic health. So metabolic Health becomes a very important part of this and then there's the vascular Health piece. So all the things that are kind of good for the heart.
They're good for the brain Shore and that means kind of having the lowest level of apob or you know we could sort of loosely talk about that as LDL cholesterol the lower. That is the better and the more regulated. Your blood pressure is the better. The brain is a highly vascular organ and it has a lot of the same micro vascular structures that we see in cardiovascular disease. So the overlap between cardiovascular disease and dementia is enormous, sure. And whether it's cardiovascular disease,
or some form of dementia, these are diseases that are being
Bill, you know, bit by bit for decades. So we can't start thinking about this soon enough the earlier in our life that were adopting the lifestyle measures required to sidestep these things, you know, it cannot be
overstated. Yeah. And that's in my view, probably the biggest single failing of our medical system today. What I call medicine 2.0 is medicine, 2.0 is largely predicated on addressing a
ask once it reaches a threshold. So in cardiovascular disease, we typically use the threshold of 5%, a 10-year forward-looking window. So once your risk of heart attack stroke or cardiac death reaches five percent for the next 10 years, you are a treatment priority. And, you know, I'll give you an example of why I think that makes no sense. So we know that smoking causes lung cancer. There's no ambiguity that there's a causal relationship between cigarettes and lung cancer.
So imagine if we said to all smokers out there, the moment we believe your risk of lung cancer exceeds five percent over the next decade. We're going to make you quit smoking. Conversely. Imagine you just said the moment you pick up a cigarette. We're going to tell you to quit smoking because smoking is causally related. Totally different framework and it's the latter framework that I think we have to be thinking about for cardiovascular disease and cerebrovascular disease.
And certainly, when you talk about
You know, he'll spanner longevity. The low-hanging fruit here is dementia. Various forms of dementia, cardiovascular disease, diabetes, obesity, high blood pressure. You're not going to have a long fulfilling life if you don't figure out how to, you know, when your way around these diseases that are really, you know, the the biggest there, the gorillas in the house that are killing most
people. Yeah, we call them The Four Horsemen. So, a SCV D. So atherosclerosis
Erotic, cardiovascular disease, cancer neurodegenerative disease. And then the whole cluster of metabolic diseases which is kind of described as a spectrum from insulin resistance. All the way to type 2 diabetes, and everything in between, including non-alcoholic fatty liver disease, which is poised to become the number. One indication for liver transplants, the United States within the decade.
Wow, wow.
House band medicine. If that is a term, how does that square with some of the stuff that we're seeing? Now in terms of technological and scientific breakthroughs in this area, everything from like, you know, if your how does your sense of it's all about like scanning technology and like I was just at a conference in San Diego, the other month and and there were people who are like 3D printing human lungs and all kinds of crazy stuff that's very different from
From where your focus is. So, how are you thinking about this in a way that perhaps matches or does not match what we're seeing from people, like David Sinclair and his kind of opponent in that realm Charles Brenner.
Yeah, look at me, I think David and Charles basically go back and forth about two different molecules, right? And are an nmn as precursors for NAD. And again I would say
Say no disrespect to them but that's like rearranging the deck chairs on the Titanic compared to exercise. So, like I would say that the data for the efficacy of NR + NM n as a tool to boost longevity, is not as not existing at this point in time. And that's not from a lack of testing. I mean, the interventions testing program at the NIH, which is hands down the most rigorous tool. We have for testing disc different interventions namely
The molecules unequivocally showed that NR did not work. Mmm, so if there are benefits to NR + NM n, we haven't seen them yet. And I would argue that if they do exist, they're not going to be that big. They're certainly not going to be on the order of what we see with exercise. I don't think people and I don't mean not to come back to exercise. I'm not talking about it because it's like fun and it's because it's easy. I'm talking about it because the magnitude is insane, the difference in Risk between a person who's vo2max
Is in the top two point five percent for their age and sex to someone who's in the bottom, 25%. So think about that right here in the bottom, 25% for your age, which is like Europe, you know, you're you're an inactive person. Versus you're in the top two point five percent, which isn't otherworldly, by the way, like, you and I are probably in the top two point five percent for our age group, it's a five fold difference in accruing risk of all-cause mortality. Wow. So let's let's pretend, you don't have to be that extreme. What's the difference in Risk between somebody who's in the bottom?
25%, and someone who's in the third quartile. It's still a 3X difference, right?
And if you're going from completely sedentary, you can get there. Yeah. Very quickly. You like the Improvement? Yeah. It's interesting. How the human you know? Animal is wired though. It's like oh you know here's a compound that's going to solve this problem when really you know the biggest lever is sitting right in front of us the whole time.
Yeah I was kind of joking about this with with Andrew huberman the other day which was I wish they would just create a
A rule that says, you're not even allowed to argue on Twitter about a molecule until you're exercising 10 hours a week. Like once you once you've shown right you can work out 10 hours a week then you have earned the right to bicker about you know whether you know vitamin D or this or that or the other thing is right? So your Twitter account is is sort of Bluetooth linked to your garment
like that and won't activate until you've put that time
and looked this is not for a moment to suggest that I am not incredibly excited about the molecule side of
I think rapamycin is hands-down though, the most important and exciting and promising gyro protecting
employees. Speak about that? Yes. In spend a couple minutes on
that. Sure. Yeah. So rapamycin is a compound that was actually discovered remarkably serendipitously on Easter Island in the 1960s. They didn't know what they had at the time and it was sort of purified from the bacteria that were found in the soil. There in the 1970s and ultimately produced a drug that was a potent immunosuppressant, so it's suppressed the proliferation.
Ocean of T cells and in the late 90s was approved by the FDA for use in patients, with organ transplants. But a decade later, another Discovery was made, which was actually a few dosed it, a little differently. It was a very potent longevity agent so potent, in fact that it did something no drug or molecule had ever done before, or has ever done since which, is it extends life in every organism across the entire spectrum of eukaryotic models? So yeast worms, fruit flies, mice. We now see it in even other organisms.
And again, it does so without contradiction. So we just see this over and over and over again. And that's a that's a very rare feature in science where and just been around for many years decades and plus you might. So there is some data sets on the
impact of human life over time in the context of organ transplants. Yeah it's not FDA approved for any kind of longevity
purpose, correct? Yeah, no, so any so I take it, you know, and a number of my patients do and obviously that's off-label right. So you know
You can you can anything, it's FDA approved. You can use. But the use the way we use, it is very different from the way, a patient uses it for organ transplants. So patient for organ transplants is taking kind of a medium dose everyday based on all of the literature it appear and including human literature that has studied ways to boost immune function. Even function with it. It appears that has a higher dose once a week produces the opposite effect, which is better immune function and and obviously, the longevity phenotype and
How long have you been using it? And our other noticeable
effects? So, I've been probably using it for four years. And for me, there are not any noticeable effects. I have some patients who I would say half the people who take it, maybe a third really claim to feel different, but I don't think that's the norm. And, you know, you can never know how to discount placebo effect. It might, you know, I talked to another Doctor Who prescribed it quite a bit. He has a much sicker patient population than
Me and he claims that many of his patients feel significantly better so it might be a function of your kind of Baseline Health coming in but I don't truthfully feel anything. So in that sense, it is purely a leap of faith based on a legion of data. Yeah,
you've mentioned a couple times, we like we've looked into this were studying this, I mean, one of the other kind of
differentiators
around you and and, and your
practice is that you have
this head of research and you have a whole team of people.
Bolin you're going through all the papers that are getting published all the time and coming up with your own studies to look at the things that interest you in this field. So what are some of the studies that you're currently looking at right now in doing yourself or or what do you think are this? The big studies that we could do or should be doing right now? To really get greater Clarity in this field.
You know, I think one of the interesting questions that we're we've got funding for me. I think we've got the funding to launch it. We're just kind of waiting for the backlog on some of the covid related IRB stuff within you, go. Son Milan is to do a study looking at the use of Metformin in, really metabolically. Healthy people. So, as you know, there's lots of data suggesting that metformin in the in non diabetic patients, could extend life. So, there's
Big study that nir barzilai is leading the charge on called the tame study that is basically asking the question. If you give metformin to people, will they live longer non-diabetics? Okay. So that's that's a very important question. Looks like he just got funding to complete that. Finally, about three weeks ago, that was announced but my experience with metformin has been a little different. So I took metformin for probably eight years on the basis of all of the epidemiologic data that looked really promising that they met for.
Raymond is especially going to prevent cancer. But once I got really nerdy on my zone to training and was really tracking lactate levels and doing all sorts of stuff, I just couldn't help but Wonder, was metformin potentially poisoning. My mitochondria just a little bit, which is again, perhaps part of how it works in the diabetic, but is that counter balancing? What I'm doing? That's positive. In other words, if you take somebody who said it,
In diabetic, that might be a worthwhile trade-off because the net benefit is so positive, but in someone like me, I don't need the glycemic control. Is this a - mmm? So for that reason I just sort of stopped metformin and basically in our practice over the last few years, we have sort of phased out the use of Metformin in patients, who are healthy and who are exercising and frankly, even in patients who are metabolically unhealthy, but whom were able to push down the exercise pathway. I've been on the, let's not even bother with metformin. Mmm.
But the reality of it is I want to know the answer to this question and I want to know it very specifically in a subset of people like you and I so if you take people who are, you know, going to be willing to be the ride, their bike, for hours a week, can we do a complete proteomic metabolomic muscle biopsy based study, where we truly, look at the impact of Metformin, functionally, at the mitochondria, and indigo being
this sort of, Lord of All Things Z2 and, you
know, yeah, yeah. So in you go is super Keen to
This and it was just a question of, could we procure, the funding which we were able to do pretty quickly interesting because we basically, you know, my patients love to figure out ways to fund this type of research because you know, you're not gonna get the NIH to fund,
right? Your your studies are all being privately fund, that's right, you're not part of the whole Grant.
That's what we're basically saying, look, I mean, we can raise this money privately in days, why would we subject the investigators to, you know, beating their heads against the wall to justify?
Nothing
and what is that pitch to the investor like what are they
getting out of it? But knowledge of this, I mean it's actual here early.
Like it's purely a knowledge-based thing. Absolutely
young. Interesting
coming back for more. But first, we're brought to you today by inside tracker figuring out what your body really needs to thrive. That's the question, right? That's the trick. How do you reach Optimal Performance? Feel your best and maintain good health? Well, it can all be
Super complicated and confusing. There's just an abundance of conflicting, misleading information out there, which is why I'm all about inside tracker inside tracker was created by Leading scientists in aging genetics and Biometrics inside tracker is a digital platform and mobile app. That analyzes, your blood, your DNA, and your Fitness, tracking data, to identify specifically, where your optimized and most importantly, where you're not basically inside, tracker takes all of this data, all your body's.
Data and transforms it into easy to understand and graphically Illustrated knowledge, meaningful insights and customized action. Plans of science, back Nutrition Fitness and lifestyle recommendations. You'll get a daily action plan with personalized guidance on the right exercise nutrition and supplementation for your specific body. And when you connect inside tracker with your Fitbit or Garmin, you'll also unlock real-time recovery Pro tips. After you complete your workout, it really is like having your own
Personal trainer and nutritionist in your pocket. I found it to be instrumental in tweaking some basic dietary habits to address a few somewhat subpar blood markers. I might otherwise just might have missed and right now for a limited time you can get 20% off the entire inside tracker store. Just go to inside track or.com, forward slash Rich, Roll. That's inside tracker.com forward slash Rich Roll. We're also brought to you today by seed.
You guys know I talked a lot about the microbiome, the 38 trillion microbes that live in and on us, and all the ways, the microbiome, impacts our health, from our gut, to our skin, and even our brain. But not all probiotics are created equal. I've been using one for a while now that in my opinion is the best that I found. It's the DSO. One daily symbiotic from seed and evidence-based, Prebiotic and probiotic, formulated for systemic benefits, including Digestive Health.
It also contains strains that have been scientifically studied to support benefits beyond your God, like God immune function, cardiovascular health, micronutrients synthesis, and Dermatological Health engineered in a patented via cap tm2 and one capsule. The daily symbiotic includes a probiotic inner capsule nested inside a Prebiotic, outer capsule which Shields against oxygen moisture, heat light and stomach acid the DSO.
Auntie Em. Daily symbiotic is shelf stable as well translation. No Refrigeration necessary, just take two capsules a day on an empty stomach and you're good to go. Use code role on si.com, Rich role to redeem. 20% off your first month of the daily symbiotic that's code. Roll on seee d.com /. Rich
Roll.
Okay. Back to the show.
Let's talk about metabolic Health
in the you know kind of context of technological advances in developments. Now, we have all these wearables, we have the aura ring and I've got the whoop on and I've been playing around with inside tracker and I've got my levels patch of and yeah. And and it's
got me, you know, there's
pluses and minuses to all of these things. I mean, one thing that all of these devices have been really good at is getting me very
With how my health is doing on a day-to-day basis, which is great. But I do feel like I'm suffering from kind of this laypersons condition of not. Knowing what all of this data means or what to do with it. And I think there's a lot of confusion out there about what's meaningful versus what is something, we don't need to be concerned with, but I want to kind of structure this around the subject, matter of metabolic health. So, perhaps, like Define what it is in kind.
Of the context of healthy metabolic function, versus metabolic dysfunction.
You know, I think the easiest way to start is is a very broad definition that would Encompass something called metabolic syndrome. So in the gosh 1980s, maybe even early 90s a very, very famous and amazing endocrinologist at Stanford guy named Jerry R even though he would have been there, when you were there Jerry died, probably about.
Years ago, I was very lucky to meet him several times before he did and the guy was insanely generous with his time. Like I literally just go to his office and hang out with him and ask him questions. He kind of identified something that at the time he referred to as Syndrome X which he said this thing tends to Cluster around all diseases that are kind of metabolic and origin, cardiovascular disease cancer, neurodegenerative disease, diabetes fatty liver although we didn't know about
fatty liver the time, all of these things tend to Cluster around this thing, he called Syndrome X,
And without going through the details of how that migrated what we now know is he was referring to insulin resistance and what we now call metabolic syndrome. So metabolic syndrome is defined like very crude way, but everything that's done at the population. Level is incredibly crude. So it's basically defined by how big your waist is, how high your blood pressure is how high your glucose is, how high your triglycerides are and how low your HDL cholesterol is. And there's sort of a line drawn in the sand that says
As if three four, or five of those metrics are beyond the threshold, you have Mets in, you have metabolic syndrome, of course, it's a Continuum. So, I used to know the stats very well. What fraction of the population had five out of five, which would be, you know, very bad, four out of five and what fraction of the population had, like, zero out of five. And so if you lined up everybody in the country across that Spectrum, you're going from the most metabolically, healthy to the least metabolically healthy, but I haven't really answered the question for you. I've just kind of labeled it so what does it actually mean?
I mean and I think the best way that I can explain it is through fuel partitioning. So feel partitioning is basically a fancy way of saying. How does your body know what to do with the energy you put in it? Where does it put it? And how does it access it later? And someone like you someone like me, like our bodies are pretty good at doing this. You know, we know when you eat glucose fat protein
This part we should use this part, we should store. And when we go to exercise, we know how to access the right one. So this is where kind of Zone to comes back into it Zone. 2 is basically a test of your mitochondrial efficiency and this is, you know, one of the Hallmarks of Aging, right? So there are nine Hallmarks of aging and one of them is mitochondrial dysfunction, we just know that as we get older our mitochondria get less and less effective and what you really want our mitochondria that can access fat stores at
Basically higher and higher levels of work output. So, an example of a metabolically healthy person to a metabolically unhealthy person is have them go for a walk. The metabolically healthy person is accessing exclusively, fat stores to do that. The metabolically unhealthy person is burning through glucose and glycogen to make that happen. That's a fundamental distinction between them. Sure, and the trade-off of that is what's the natural history of that. This person is
Ding fatter and this person is having a harder and harder time regulating their glucose levels,
right? So the more dysregulated you are, the more likely you are to gain weight, it just becomes like a vicious cycle that gets worse and worse.
Yeah, and then it really gets worse and worse because the weight gaining part on the surface is what people kind of get worked up about. Oh my God, like I'm getting fatter. But the reality of it is, it's not this subcutaneous fat, that's the problem. It's not the
Fat that we see on our waist. It's the fact that we don't see that's the problem called, you know, the sort of the extra. You know. So this is called subcutaneous fat. So if you take the extra subcutaneous fat Depots like visceral fat, the fat that surrounds your organs, the fat that accumulates around the pancreas, the kidneys, the heart, within the muscle itself, and I'm talking right within the muscle cells. That's the fat that's incredibly destructive and that can represent a tiny fraction of your total fat.
You know, if a person has 20, you know, 20 pounds of fat a 20s, I'd say, 20, kilos of fat on a 200 pound person would for my body fat perspective. Probably put them at the 25th percentile, they're pretty run-of-the-mill, but if only 10% of that fat were out of there, subcutaneous stores that would place them at the 90th percentile for visceral fat. Mmm, and that's, that's the dangerous fat, that's the inflammatory fat. That's the fat, that's truly, wreaking havoc with respect to metabolic illness.
He's right, so typically if somebody is suffering from metabolic syndrome and they go to their general practitioner that person is likely to say your blood pressure is high your pre-diabetic. We need to put you on this battery of medications, you have patients in which they're they're displaying similar characteristics. You put them on a lifestyle protocol to try to, you know, you know, basically reduce these factors and get their metabolic Health in check. So
Explain a little bit about what that process is and just how malleable metabolic health is.
I mean it fortunately it is quite malleable and there were you know different ways that we go about doing it. Depending on what we think are the contributing factors so, sleep nutrition, exercise and pharmacology would be the main contributing factors. Now we do. There's the fifth thing that we always think about is emotional health and for some people that can be an enormously contributing factor, both directly.
And also, and more commonly indirectly I can is
stress component of that. Mm.
Yeah. And so stress directly just through its endocrine function, right? So hypercortisolism MIA is completely destructive to your metabolic Health in excess. So transient stress, not so much an issue. But this is chronic elevation of cortisol is incredibly destructive for insulin resistance and all sorts of other things. But more importantly and more subtly is it's the emotional health bucket that gets in the way of making some of the
Real changes in these other buckets. I mean, nobody has a hard time taking medicine and the reality was, you can fix a lot of numbers with the medicine. But it's, you're not getting as much of a benefit as if you fix them sort of, with food, sleep, and exercise. So when we're trying to evaluate. So let's say, you know, hypothetical patient comes in and everything is wrong.
So then the next question is, why what are the contributing factors? So, you know, sleep is the first thing we always want to look at because it's the easiest one to assess pretty quickly. And, you know, so again to your point, most of our patients are wearing an aura ring. So that's provides some information. We use some sleep, surveys that are pretty well vetted, so there's probably four or five of them and depending on what we see on the aura data, and what we see in this sleep surveys, we then might move to another
Test to look for like an at-home test. That can give us a very quick view on apnea. And depending on what we see there we might move to a more formal sleep study and so we're kind of going through is their pathology? Yes or no. Are you overslept or underslept? Yes or no. If you're under slept are you also dysregulated with staging? And we kind of have just an entire rabbit hole. We go down with sleep, that involves sleep hygiene that involves supplements and sometimes frankly includes
Tations. I mean, there's a prescription drug called trazodone, that really helps people who are dysregulated in their sleep because rumination. So it's a, you know, non-habit-forming amazing drug. That more importantly preserves sleep architecture. Most sleep drugs, don't really preserve sleep architecture that well right on the nutrition front. We're asking the first order. Question is, are you / nourished or undernourished? And are you, you know, obviously your metabolically unhealthy we wouldn't be having this discussion. So over nursed undernourished, usually if you're metabolically unhealthy, you're also
Nourished. And then the next question is are you under muscled or adequately muscled? And that plays a hugely important role for our protein strategy and our training strategy? And then once we sort of go through the well, presumably you're over nourished. Let's say, you're also under muscled. Let's make it really hard because that's a really difficult reconciliation. Someone's over nourished and under muscled, they have to lose weight and gain muscle. So now you need a lot of protein and a lot of training.
The question then becomes what is the strategy for intake reduction? If three strategies, caloric, restriction, dietary restriction time restriction, and go into all the details of the pros and cons of each one on the exercise front. It really depends on what they're doing to begin with. You know, each type of exercise has its benefit. But if you're talking about a person who starting from zero, we're mostly working on movement, stability in zone 2. You know, I'm not going to push them into vo2max, not going to
Then get hurt trying to do any significant strength training. It's how do we fix the chassis so that we can make the car drive faster and faster, right? And in those patients you know literally just putting them on a treadmill and walking them you know, up an incline can be very
beneficial. So assuming High patient adherence to these protocols. What is the timeframe in? Which you can take somebody, who is fairly dysregulated
into a zone of relative safety. Yeah, again, it's all comes down to
Adherence. I mean, I think back to a patient that join our practice about a year ago, liver function tests, you know on arrival. Were you know, 3/4 x, normal demonstrating, lots of fatty liver disease, you know, very high degree of insulin resistance or we do something called an oral glucose tolerance test with everyone that comes in the door. So they drink a big glucose drink and then we measure glucose and Insulin spikes for the next couple of hours. I mean, I think this patient probably within six months,
Had those things reversed. And in this patient was incredibly, you know, diligent. This patient was doing everything that was asked, but you know, I'm less wed to how long it takes and more wed to can. We create sustainable things that if it takes a year? But you found a Groove? That is sustainable. That's more important to me. I'm trying to fix it in three months. Yeah,
interesting I've had, you know, it's just some interesting revelations in my own experiment.
Station wearing a CGM. Noticing you know when and how I go out of my you know sort of Zone. I noticed that when I was experimenting with one meal a day that was a disaster especially when that one meal a day come away very
late, just regulates
my sleep and the spikes were crazy and they don't come down quickly and I was like and I've been doing that for a while and I was like I have to stop doing this. So there's been really helpful kind of feedback that I've gotten from this but I
So admit to not really knowing how to interpret this data. Like when I Spike, you know, if it comes down relatively quickly, should I be concerned about that or you know, what should I? And I think this is like a danger with a lot of these trackable type types of things is it gives us all this data but there's less focus on like what to do with the data and and really to kind of, you know, figure out, you know, what is Meaningful and all of this. So you know, what should I be thinking about? And what are some of the common misconceptions?
Options or Miss around misinterpretation of wearable
data. So the short answer is we don't know because we haven't had these wearables for long. So it's a really new phenomenon to be able to send people into the wild and measure their glucose continuously. So you know, one has to acknowledge that and then say well based on that how can we extrapolate from what is known? And so our team did some amazing work on this about a year-and-a-half ago was about six.
It's worth of effort to look at all of the literature, around three issues of glucose outside of the setting of type 2 diabetes. So, we absolutely no in the setting of type 2 diabetes, that a higher average, glucose is worse. I mean, that is the definition of the metric that we use to make the diagnosis of the disease. The diagnosis is made based on something called the hemoglobin A1c, which is a crude, but not horrible way to estimate the backwards looking.
Young average, blood glucose of an individual. So, if a person's hemoglobin A1c is 5.0%, that tells you that's giving you an estimate of how much glucose is stuck to their red blood cells. That tells you that for the past three months, their average glucose was about ninety eight milligrams per deciliter, which is excellent. That's your average blood glucose over all your ins and outs. Once that hemoglobin A1c reaches 6.5%, that tells us that the estimated looking back over the past three month, average glucose is 140 milligrams per deciliter.
Now, you have type 2 diabetes. Congratulations. And now, of course to me, this is a Continuum, this is another example of where I think it makes no sense to wait till someone has Type 2 diabetes to sound the alarm, so in our practice, so well, back everything. So then the question became
What do we know about the difference between having a blood sugar that averages 100 versus one that average is 130? Neither of those people have type 2 diabetes is there a difference and I think if you look at the data the answer is unambiguously clear. Lower is better the next question became what can be said about variability. So I don't know if the levels one does this but on the Dexcom meter which is the one we prefer just because
It's you can calibrate it and it's more accurate. Is that the one
that's with
Libre? No Libre. I think is the Abbott one which I'm not particularly fond of because you can't calibrate it. So it's I just think it's a less accurate meter, but the next thing you can look at is not just your average glucose but you can look at the standard deviation. So you can look back and say over the past day the past week, the past month, the past 90 days, how much variability existed. And so then again, we looked at that question, which is can the literature tell us anything about
Variability of glucose. And the answer appears to be yes. Less variability is better. And then the final question which is probably the hardest to ask and I don't think we know an answer to this is, are there downsides of transient spikes. Now a spike is inevitable. Meaning any time you eat glucose or any form of carbohydrate, are going to have your glucose has to go up. So the question is, does it matter how high it goes?
I don't think we know the answer that question truthfully. So, you know, we've basically said, look,
What if we could just arbitrarily say keeping your spikes below 140 to 150 is better than keeping them below. 200 because the reality of it is, I'm not really aware of a scenario whereby you eat good food and your glucose goes to 200, but I'm aware of how to make. I could make my glucose go to 200 like that if you gave me enough raisinets but I can't really make it happen by eating beans
and is that more important or less important than how quickly.
It comes back down to
Baseline. I think it's probably I think of the three metrics that we care about average glucose, variability of glucose and just the number or frequency of spikes, I would say that the frequency of spikes is probably the least important. In other words, I don't think there's any physiologic harm that comes from a transient Spike to 200 by itself. So if I could just sort of robotically, say your glucose went to 200 and then it came back to 100 in an hour find the reality is. It doesn't do that though, what happens is if it goes too,
200. It's going to come, it's going to, you're going to overshoot because you're going to have secreted a pound of insulin into your circulation. When it comes down, it doesn't stop it. 100, yes. Going to go to Fort, probably not 40, pretty, go to 60 and what's the effect of that on your appetite? What's the effect of that on the bounce back? And that's why in my experience and this is just clinical experience just banging away with patients over the last six years. When we suggest to patients that are metric is avoid spikes over 140 to 150.
Try to keep your average at 100. Try to keep your standard deviation below 15, eat around that, let that determine your carbohydrate tolerance. Mmm,
People just do really really well, right? So this is very empirical, and everyone will have a different carbohydrate tolerance, right? It's a function of your sleep, your stress, your metabolic Health, your exercise.
It is interesting. How much sleep comes into play? Like, if I don't sleep? Well, your numbers are horrible, terrible, all over the map and I thought well is that because of the poor sleep or is the or
is the
lack of stability, contributing to the poor
sleep? I mean, if you look at the
Our mental data. So I'm trying to blank under name. I think it's even caught or was a she's a researcher at the University of Chicago. Did a pretty elegant experiment, took a group of people and I'm probably going to get a few of these details wrong because it's been a few years since I looked at it. So did, what's called a, you glycemic? Clamp. So this is the gold standard for measuring measuring glucose, disposal and insulin sensitivity. So people are run with a line that runs insulin and glucose into them and they're given glucose and
Insulin such that they have to maintain a you glycemic or normal glycemic response. There's just no no
blips on a flat
line, right? And then the question is how much insulin do you require to do that? So that now tells you exactly how insulin sensitive a person is and this is this is pinpoint accuracy because that's basically telling you in real time. How effective are this person's muscles at sensing insulin and taking glucose out of circulation because that's your muscles are what? Take your glucose out of circulation in the short run.
You do this test on people and then they were sleep. They were, it was a crossover group. So it control and then a crossover. And the intervention was I want to say two weeks of sleep, deprivation, 24 hours a night,
Which by the way like that was my residency for five years so that's not that's not an unreasonable intervention and then repeat the glycemic clamp and glucose disposal fell by 50 percent. Wow, so in two weeks of, you know, admittedly really bad sleep. You know you're taking somebody halfway to diabetes so now imagine a person whose sleep is compromised for years. So that's why going back to what we said at the outset. I mean, if you're not looking at a person's sleep,
With real seriousness, before you try to address their metabolic Health, you could be missing a wolf standing at your door,
but the good news, of course, being this malleability piece that it can be corrected and, you know, in the context of a culture, where it appears that by 2030, something like 50 percent of Americans are going to be either pre-diabetic or diabetic. Like is this not the most important thing to be thinking about tracking and talking
about? Yeah, look, I've
Got into some real battles with people over this because I've, you know, been a very vocal advocate for the use of continuous glucose monitors and everything from trolls under Sir
with, there's a weird Twitter war going on over this. Yeah, is confusing to me.
Yeah. And and and there was an article written in Jama, a year ago that came down on the side of. There's no role for using continuous glucose monitors and non-diabetics. And again, I think people are not understanding how to use these things things clinically, right? I mean, that's part of why I'm asking is
I do think that there is a lot
of room that remains, you know, in the education space to help people like myself, understand how to interpret the data and
what I'm actually empathetic. And I understand why saying like let's slow down a little bit and let's make sure because again, I think our patients have a very different experience. Like, you know, I've been using one of these things since 2015 on myself almost continuously. You can imagine how many reps I have and by extension our patients and so we know
How to use this data to do two things, one to gain insights into how to change people's eating, and to, to use it as a behavior tool to then create compliance over time. Those are two different things, but they're equally valuable, but that said, I don't think that that experience is shared by somebody, who just goes in order one of these things online. So I so again I can understand why they create a lot of confusion for people if they don't have that that inside. Yeah, I mean it does. There's a weird
psychological
anything that happens because you're essentially gamifying your nutrition, right? And so
you look at this
this interface and you see where you're supposed
to be and you ate this thing
and you're out of it and you're like, you make a mental note, okay? I won't eat that thing. And then it's become like, how flat can I make my curve? And like, how? And but there is an engagement there that I can't imagine is a negative thing like you are connected to what's happening in your body in real time. And not the appropriate amount of Education. Another place to be
The flip side is and and this is a fair criticism. So I think when I, when I wrote a piece on this, a little over a year ago and one of the people who criticize me who I've since engaged with quite a bit and I think he made a fair point, which I could have been more explicit and should have been, which is if a person looks at their CGM data and isolation they can still make a mistake. So I'll use an analogy that I don't know if I've since gone back and Rewritten about this. But I've certainly talked about it.
If I said to you rich, the only metric that matters in life is the number on the scale? And lower is better if I program that into your mind. Look, there's no reason. You wouldn't take up smoking, you're probably going to lose weight, right? So in isolation, maniacally focusing on one metric, can easily lead you to do bad things along the way, and this is no exception. So,
You know, I think the glib example is well, if I literally ate nothing but bacon every single day just nothing but fat, right? You'll keep your keep your glucose low. I'm not convinced that. That's an ideal diet. Sure. So, so, so that's why I think I would say this has to be viewed in the context of everything that you're doing. And there has to be kind of a whole set of Common Sense principles that go into this along. With just, this is the only number that
matters. Right? Got it. Let's
segue into zone two, my
favorite.
Topic of all time. It's so hilarious. That like Zone 2 training is now like a thing that people love to talk about. Like, I've been talking about this forever. I
don't have a tone, has been talking about it on a different names. Yeah.
So I caught on to that Moffat own method, you know, at the beginning of my ultra endurance training and, and I really credit adherence strict, strict, adherence to that philosophy as a vehicle for me, making drastic improvements over the course of
Year period. It's, you know, this stuff doesn't happen overnight and and I'm constantly preaching the benefits of it. And it's so cool and interesting to see people experiment with it, but I think there's also a lot of confusion about what it actually is and why it's effective. So nobody is better except for maybe indigo, is that how you say his name? Indigo Indigo at talking about this. So, you know, please allow me to, you know, indulge you
You in a conversation about Zone 2
training. So I agree. I wish there was a better name for it because as you know because you've trained with a power meter on a bike. If you're if you're a student of you know, cycling power meters, we use seven zones when we're training in cycling. And so the first thing I say to anybody who's coming to this is please forget everything, you know about your numbers and your zones and this has nothing to do with FTP and and you know the sort of Andrew car.
And sort of stuff. So it's just an energy system and the Way San Milan describes, it is really through 5 Energy Systems and Zone 2 is the one that is basically defined as the maximal level of aerobic output that you can generate while keeping lactate below to mmol. So you could argue that's an arbitrary definition. Although physiologically it turns out not to be. So what is lactate?
We have to kind of explain this. I think in some detail for people to understand why this matters because even though most people will do Zone 2 without ever measuring their lactate and that's fine. If you want to be really on the money you do need to measure your lactate at least periodically and I do every day I mean I do Zone to four days a week every one of those four days a week. I'm measuring my Lactaid. There's plenty of
DIY protocols out there that that vary in in terms of efficacy. But I'm always encouraging people to get a property.
Passed on a bike trainer or on a treadmill with a technician who's drawing lactate at those intervals. So you can really dial in on it and I wrote about this in my book and I explained that
my my
the the top of my zone to was a heart rate of of like 145 I think when I was running and 130 on a bike and then people will tweet me and like, I'm keeping my heart rate at 1:45. I'm like, no, this is not what I'm saying. I've expressed
Ali said like, this is me, this is not you. You have to get a proper test to really you know, understand your own physiology.
Yeah. So how this gets back to your question about metabolic Health? Well Zone. To in many ways is the most important functional test. We have for determining a person's metabolic health. So, I talk to patients about how we have Dynamic and static tests for determining their health. So, a static test, is just a blood test. Where, tell me what your
Uric acid is your glucose, your insulin? You know, all of these things your triglycerides. A dynamic test is let me give you a bunch of glucose right now and draw your blood over time and watch. What it does. Another Dynamic test is let me ask you to do. Work ride, a bike run on a treadmill, and let me measure a metabolic by-product called lactate. And that will tell me an unbelievable amount. Perhaps more than anything else about how you function, and this function.
Functional tests is so important. So when our bodies create ATP, they have choices for what fuel they're going to use. So for all intents and purposes, there are two fuels to make ATP glucose and fat. Now with fat, you can only do one thing with it. You can only turn fat into two carbon subunits that get put into the mitochondria where you very efficiently? Make ATP carbon dioxide?
Water vapor. So that's why. When we're, you know, so the input is fat and oxygen and the output is a teepee carbon dioxide water. So we're breathing out CO2 and water vapor. We're using the ATP, we can do the same thing with glucose glucose can be turned from glucose into pyruvate and pyruvate goes into that same pathway. So glucose and fat can both be churned through that super efficient Pathway to make ATP as the body's demand for ATP.
Grows it's going to start out stripping, the capacity of the mitochondria, depending on the fitness of the individual, depending on the efficiency of the furnace. And so it does have an escape valve. It does have a manner in, which it can produce, more ATP, absent, sufficient oxygen, which is the basically the think the utilization of oxygen becomes the bottleneck
So here is a can't do it with fat. So once you tap out on your fat stores, you don't have a way to overspill Fat, oxidation into this other energy source. Instead you turn that glucose into pyruvate, but now you turn the pyruvate into lactate and that does yield a little bit of ATP. Literally about 1/16, the ATP you would have received if you had run that glucose through the mitochondria. So that's a knock on it. That's the trade-off is you got a fraction of the energy, but
Bigger trade-off is that, you're generating lactate, which now pairs with hydrogen and creates an acid that acid effectively makes it very difficult for actin and myosin filaments to uncouple. And if that lactic acid level gets high enough, you start to really feel the inability the burn in the muscle that creates the inability for you to continue effectively. Contracting your muscles. So anybody who's done an all-out effort, knows exactly what that sure.
The other variability being the exhaust ability of the energy source, right? You have like something like 45 minutes worth of glucose output at that higher Zone, training rate, whereas your fat stores are essentially inexhaustible, that's right, right? So if you can develop a vast Zone to capacity, which essentially means being able to be incredibly metabolically efficient at a certain activity, in a certain
Rate of at a certain level of exertion that in turn creates, mitochondrial, efficiency, mitochondrial density and a stent. Basically, an inexhaustible source of energy to propel you through an ultra endurance event or an endurance of that.
Yep. And so I thought about this a lot obviously when I was swimming because even more so than cycling fueling in really long swims, as you
Now know, is just, It's a Grind, especially in the ocean, where the salt water gets in your mouth. If you, you know, on one of my Catalina swims, I remember it was so choppy that on one breath. I turn to breathe. It was the middle of the night so you can't see anything and just ingested like yeah, a gallon of nausea. Is it given? Yeah, you're just puking your brains out. So so anything you can do to minimize the requirement for having to feed the glucose engine, especially when
You can't really take in a solution and excess of about six percent glucose, 60 grams per liter, you're very limited. How much glucose you can take in so absolutely correct. Okay. So now the question becomes what separates the men from the boys?
Basically, when you look at Endurance Sports, one of the most differentiating factors is how high is a person's own to threshold. How much, let's just use cycling as an example, because it's just so easy to metric how many watts can a person generate per kilo of body weight? If we want to normalize it while keeping lactate below 2 and what is it about that lactate below to if lactate stays below to you are at that equilibrium where we know,
That you are in Balance. You are not net accumulating lactate yet. Once lactate gets above to. You will begin to net. Accumulate lactate, meaning, you will accumulate lactate quicker than you can clear it. And that now puts you in a finite strategy of activity. Now, you know, when you and I did races and stuff like that. Like when I was in a time trial, might lactate was definitely above to. It was, you know, I would finish a race at a lactate of 16 and probably 10,
Minutes before the end, my Lactaid was eight and ten minutes before that, my lack of respect for. So I should have budgeted to blow up at the end of that race. But if you said to me, Peter, I want you to go out and do a three hour non-stop ride at your maximum. Like, what's the fastest? What's the greatest distance you could cuddle in three hours? I have to keep lactate below to. In fact, when you look at kipchoge breaking, a two hour marathon record, same thing even though he's running at a Speed, most of us can't run for 100 yards for him.
His lactate was below to sure. Be able to do that or else he couldn't have done that. Yeah, it's interesting that that
terminology like VO2, max gets all the attention and in reality, it's so much less important than what your Z2 maximum is. And a question that I don't know that I've ever heard a good answer for that. I'm curious about is, is the difference between like let's say,
you're let's say the, the top end of your Zone 2 is
is like, I don't know, you know,
150 watts on a bike. What is the difference between an athlete? That can maintain that 250 Watts at below to for three hours. But then Taps out versus the athlete that can maintain that 48 Hours,
you know, at some point, it starts to become a question of like, how much fuels in a because you're still get at the 38 hour difference, you're going to have to start ingesting some fuel it so assume
equality across feeling
you have
Then it probably starts to come down to muscle fibers and things like that. Like, at eight out of conned real density, I don't know. I mean, I don't think I know the answer to that. I think, what I would say is you're going to, you know, because these are fit athletes like their muscles are actually putting out a lot of power. I mean, 250 watts is a lot of shower and so I think you're now starting to get into the limitations of actual fiber damage, you know, for example, like when people feel so our the day after,
Super intense workout where they had that lactate burn. I think they erroneously assumed that. It's the lactate that they're feeling, but they're actually not there feeling the microscopic damage to the muscle fibers. So, I suspect that that's probably going to be the differentiating factor there. So it's some amount of muscle protein synthesis and some amount of, you know, kind of strength that probably factors into it as well. Like actual muscular strength.
I remember, when I was training for, for my first Ultraman, prior to that.
That I'd messed around and Triathlon. Without a coach was pretty fit in my own mind, hired. A coach. He's like, I can't even tell you anything until you get a lactate test. Like, there's no point in us even talking, like, I need you to go do this. I didn't know anything about it, and I was like, I'll be good. Like, I go in that graph was like pathetic. I couldn't believe, like, how quickly I would go out of Zone, 2. And then my whole program was built upon, you know, this church of Zone to wear literally
First year, I don't think I did a single workout that was above sound too. There
was no, how much Dairy Zone to increase during that course of the
Year. Unbelievable. Like the the Improvement was
insane. Yeah. And
that's why I became, I'm such an adherent and a believer in this without doing any threshold or Tempo work whatsoever. I was able to go from somebody who couldn't run faster than 10 minutes per mile without going into Zone 3.
22 years later being able to run like 7:15 in my zone to without any track work. Without any threshold work, any interval work whatsoever just by building that Foundation bit by bit. And it's all about the ability to come back the next day and the next day and the next day. And I think there's something about that consistency. Such that when you develop that robustness, and you do have an F,
Let's say you're attacking a hill or whatever and you're way out of your Zone to to do. So you come back down to that Baseline Zone to very quickly as opposed to like, you know, being winded, for an extended period of time and kind of losing Pace as a
result. Yeah. So when we put our patients through, see Pat testing we have about a four page dashboard that we run them through which is much more extensive than just. You know. It's yeah we show you your VO2 max and
We will tell you why that's important but it's also. What is your fat oxidation, how many grams per minute a fat, can you oxidize and over what power range, and what is the shape of your curve and we Benchmark this against, like, athletes. So Nu goes giving us data, right? So here's the guy who won the Tour de France, here's a masters athlete. Here's somebody with metabolic syndrome. And where do you stack up? So, you can really start to see how you oxidize fat, and how many watts per kilo you can put out at Zone 2
Compared to these varying degrees of spectrum. So now all of a sudden, I'm not just saying yeah, here's your glucose and here's your insulin and here's your triglyceride levels. But I think this is a much more important test because of its functionality, right? It does require a lot of humility though and you have to play the long game with it and
most people like, you know, it's just you know, what your two-year plan. They're like well I want to do this race in a month or three months or something like that. Like you really have to be patient with it.
Yeah.
And again, it fits so well into the Centenary and decathlon. Because if you could be in your 80s and, and by the way, it is theoretically possible to be in your 80s and still put out to watts per kilo. Mmm. I mean, there are examples of people who do this. I think that I think in you go has coached one guy. He's an 81-year old. So he's a world champion at Masters. 81, he's about 2.9 or 3 watts per kilo. Wow, you imagine that? Mmm,
I had a guy in here, recently.
Fremont. He's 100 and he owns all these world records at half marathon. And Marathon distance running when he was like 90 and 91. It's
amazing. Yeah, he's able to do
that talk a little bit about the importance of polarity training. Like we you talked about the different Energy Systems in the context of, of longevity. So this idea of, you know, Z 2 and Z 5. Because what I see and I'm sure you see this all the time is people who spend the vast majority of their
training time in that Gray Zone where there are not going slow enough to develop their aerobic capacity. Their mitochondrial efficiency in density and they're not going hard enough to really reap the
benefits
of strength power, Etc.
Yeah, the No Man's Land the garbage training. It's an important Zone by the way, depending on your sport. Like, when I was time trialling, we did spend a, we just spent a lot of time at 34 crossover, because that's basically where you were Racing for 20K time.
Trial. So you had to spend some time there but not too much time there. Right? So you know, the I would say 80%, I was probably only spending 70. I think in retrospect, I should have been spending a little bit more time there
and at your Peak what was your Zone to threshold
W. 275 pretty good at at yet at 75 kilos. Yeah so it was okay and for contacts for
people that are listening or watching like a Tour de France, Rider is probably a little about
Hundred somewhere in that range.
But much lighter than me. Yeah, so so he would be 320 W zones. I mean, the best of the best would be. Yeah. Yeah. And but they'd be, you know, six wing and
it, you know, 140 pounds.
Exactly. So yeah, I was 275 W for Zone 2 at 75 kilos at my best and, and a better, like, and but a lot of very high FTP, right? So that was, you know, my FTP was only 3, 10
Time trial, or though that becomes important? Yeah, I mean for me because I was amerks time
trial list like which is such a silly little niche thing, it really the Arbitrage on mercs time, trialling became to your CDA. It's like, coefficient drag comes from surface area, like that, that was my obsession. That's why I was so obsessed with it. It is like just figuring out like
because it wasn't so much that my FTP wasn't that high. It's that I could hold that at an uncomfortable position because in a time, probably are in such a compromised position from a vascular, return standpoint that if I could hold 300 watts in a tuck and really meant and really minimize my frontal surface area and coefficient of drag, you know, I could go fast enough,
you're such a geek. I can't imagine all the Mana
data they have every single day. I would come.
Home from Fiesta Island and model calculate based on barometric pressure, right? Son density. Like what was my CD a-- today? Like did I get down 2.2 I have time for anything else. I mean it's like a job. There's a reason. I don't do it anymore. Yeah, right. Like it was it was a, it was a it was a huge commitment to be able to do that. And, you know, I made a joke about this once I was like it kind of occurred to me like how little anybody in the world cared. Like, one day, I was having dinner with my wife.
and I was like,
Do you know what my PR is for 20K? Just out of curiosity. I just, I mean, Richie was off by a factor of 2, like literally couldn't care less and I was like, that's cool. I get like, it's amazing how much I care about this dumb thing. That no human on the planet cares about which is fine. There are a lot of things to this day. I care about like I love precision shooting. So it's like I you know, to be able to shoot a dinner plate. A mile away is such an important thing to me.
It serves no functional purpose on this planet. Yeah. And all
the F1
stuff, right? Which is like we can talk about that later and that's a whole side track. But I think, you know, because I'm an engineer, I just think engineer's like data and I really viewed time trialling as purely an engineering problem. Because it's not if you think of other types of bike racing their strategy involved, there's Nuance, there's complexity, but time trialling is purely an engineering problem, right? The bike is the
perfect instrument to
Out of from a watt is a watt is a watt. Yeah.
And basically, it becomes this like, you know, perfect situation for self-experimentation. Yeah. So now it's crazy, which is interesting. I know that you I saw that you posted you were, you were you were going to get like as GPS watch and you kind of put it out on Twitter, like, which watch should I get? Oh yeah, yeah you made it very clear that you didn't want heart rate strap and I was like that's very you know that a call to your whole thing because wrist heart rate is terrible. Zach
Why would
you not? So you'll love this story, right? So the reason I didn't want a chest strap is because I only want it for rucking and when you're wrecking, you got a 60 pound thing on your back and it's uncomfortable to have a chest strap. When you've got so much weight because you're stacking,
there's nothing comfortable about it. How much more uncomfortable are going to want to get that pristine
data but it is also like I didn't want one more dumb thing. So what did I do? I end up buying for these watches and keep cycling through them. Only to realize that risk-based heart rate sock.
It's terrible. It doesn't.
Our which brand you're wearing, socks. It's just the technology that I return them all in. Got the cheapest one money could buy the Koro space to for 200 bucks. It's a good watch. So fine. And then I got I use on the bike, I use a wahoo armband and that's what that's what I use. Now right now I exercise with the Wahoo armband in this watch so I defaulted into what everybody told me from the beginning, got it. All right well we're starting to fray at the edges here but let's let's kind of put a
pin on the zone to zone 5 thing. In
terms of what an answer, your question actually still
So, I would say if you're, if you're training for a specific sport, you're going to have to understand what zone you need to be and inside the appropriate time there. But if you're talking about health, I think you're talking 90% is zoned to 90 to 95 5 to 10% is zone 5, and that's about it. So I do one vo2max workout a week, that's it.
Yeah. And you're constantly pricking yourself and, you know, figuring out where your zones are. But for the person who's listening
Who might not have access to a lab where they can go and actually do this
properly. Like, how do you care lactate device is all you really need, right? So, you can, you know, I use something called. I think all the lactate plus. So you can, you know, buy these things online, they're not cheap. The device is probably to 300 bucks, and the strips are probably two bucks a piece. So, it's how do you
administer the protocol when you're actually doing the thing?
Like, what is Zone 2, you're not dying right side, but you
still have to go through all the zones to establish.
Yeah. So it's empirical
I mean, the first, you know, the first few times I did, it took me a while to be like, Oh, I'm well below and well below, whoops, I overshot. Okay, back off. So I would just have a table next to me set up and the biggest challenge actually, is that you have to have soapy Rags there because you lactate doesn't wash off with alcohol, so you'll contaminate the whole thing. If your hands aren't
clean. Nobody's going to do this? I know you do. But like they I mean hit the protocol that that I've typically done in a lab and maybe it's different from yours is you get on a bike, you warm.
For a while, it may be 100 watts and then you
basically launched into this
interval workout, yeah, every four minutes, you increase the wattage like
10 water, we do longer intervals because of the lag between lactate in the plasma and in the interstitial. So we'll do if we'll do six to eight minute intervals. And yeah, we'll just have somebody whe When, when our patients go and do the testing, it's a pinprick to the ear to get the lactate, right. But here's the other thing though it's heart
rate power lat.
Lactate and perceived
effort, right? So we try to triangulate on those. So if I'm telling a patient to do this at home, what I'm basically saying is, here's where I think you're going to be. So the first thing I'm asking is what's your resting lactate? Tell me that. So when you wake up and you haven't eaten anything, what's your lactate if that's to then your metabolically. So unhealthy, then we're not, doing lactate testing in you. We're going to do it all off, rpe purely, that's it. But let's assume you tell me on my morning lactate.
One great. Okay, so then I'm going to say, do you know your actual max heart rate not predicted but truly achieved. So you tell me that then I figure out how fit you are. Just by a few questions, the fitter, you are typically the higher percentages. So your Zone to can be as high as eighty four eighty five percent of your max heart rate. If you're really fit, if you're not, it's probably closer to 75 percent. So then I tell them. Okay, your heart rates probably going to be here and that I don't even try to predict W. So then I said ok, once you've done the bike and I want you to ride
I'd in slow increments until heart rate is about here and your RP is such that you can talk but you don't want to rpe rate of perceived exertion yes sir. So then I would just say just do that for 45 minutes and then do a quick lactate check and if they do that and it's 1.6, I say great the next day in two days or the next day, I want you to go out and do it and I want you to add 5 to 10 watts, and if you come out in your 2.5 back off by 10 watts,
So we don't try to answer it all in one day, but you can answer this question over a period of a week, right? And how is the adherence with your patients when you
tell them? Okay, your heart rate is not allowed to go over X and they go out for a walk and the minute there's the slightest incline or they want to put a little bit of kick and anything they're doing, they're out of zone two and they're like well this is
I try to I try to keep them separate. So I've actually found outdoor walking and outdoor running to be very difficult for Zone 2. So just like when I go rucking,
I mean, my heart rate is sometimes. I'll hit max heart rate if I'm going to steep enough. He'll so I just consider that a separate form of exercise, but like a stationary bike, yeah, it is uninteresting as it is. I mean, I'm on a stationary bike when I do it because I can control it and I just we try to have patience. Do it on a treadmill stationary bike. Rowing machine super controlled swimming is good too because you can really control your pace but outdoor cycling and outdoor walking running or Harvey variables. So I which is we don't want to
Courage, people from doing those things, but we do want to acknowledge use those for maybe where you get your zone
5. Hmm. Interesting. All right, our time's running short here and I got to let you go and get to the airport but I can't let you go without hearing a little bit about this crazy TV show. That's coming out this fall Limitless that you did. You did with Chris Hemsworth, under the direction of the great Darren Aronofsky. I've seen the trailer. I know it's coming out in this fall and I don't know how much you can talk about it, but
It looks absolutely epic and like quite the adventure.
It was, it was a ton of fun. Darren is a really close friend and, you know, Darren kind of pitched this idea to me, probably in 2018 is, like, I've got this idea. I'm going to pitch it to natgeo at the time, of course. Now it's Disney and he said, you know, what do you think? And I was like, I think it's a fantastic idea. And he said like, who do you think should be the lead actor?
And we are we have a very close mutual friend in Hugh Jackman and I was like what you think about Hugh and he's like that's perfect. So he went and pitched Hugh to natgeo and they love the idea, talk to hue-hue loved the idea and then it just wasn't going to work out. Hugh had a bunch of other projects that he really wanted to work on including Music Man and things like that. That of course, covid. Messed everything up. Yeah. And then I don't know who suggested Chris it, whether it was Darren or the networks but then, you know, Chris became involved.
And that in some ways changed, I think the focus of the program because I think the I'd quite a bit younger, right? And and you know, Chris is like a superhero and Hugh of course, is I mean just you want to talk about a guy with legendary Fitness. I mean, I'm if you've seen of Music Man. Yeah, he's unbelievable. Yeah. Not only like in his, you know, in his,
you know, superhero Fitness levels but also his ballet and like, I mean his his ability to move his body in space and time is on.
Yeah, we were just in New York too.
Watch music man, spend the weekend with him and we had dinner after, and I was like, dude, I'm tired watching you and I don't know how you do that. Eight times a week. Eight times a week. He does this two and a half hour show for a
year. What is he 57 now? Or something like that? I'm a bit younger than that. Probably, like, maybe
53 54, but with Hugh, the idea we had was kind of the way we opened our discussion, which is you're no longer Wolverine.
What is it going to take to be the best version of you in your 90s? I think with Chris, the focus became a little more, your Thor, right? Like what are the limits of that and how do they jive with kind of longevity? So, yeah, look, it was, it was an amazing experience. It took probably twice as long as anyone expected because of covid. You know, we started filming, we did a like that. We did January and February a ton of work in 2020. Just before covid-19.
And in Australia and in Norway and just by coincidence and by luck, I suppose, those were the months, I was heavily involved in much of what came after I became, you know, less involved in and but you know, there are six episodes and I don't know what I can say about any of them other than I think there's there's some really good stuff in there. I think my involvement is the least interesting part of it. As my personal take like some of the other content that I've seen. I find much more interesting
Than the parts I was involved in and I think people will enjoy it a
lot. I first found out about it when Ross Ashley was sharing some clips from where you guys in Norway. Yeah, yeah. And you know, swimming in the freezing water and all of that and and Ross is like I'm here with Darren and Chris and I'm messaging. I'm friends with Ross and I was like what do you guys do it? Like, how come I was not involved in this? Or how come I wasn't invited. I can't believe you guys are. And and he's like, I can't really talk about it, but it's cool. He's
so I've been joking.
Him about it and
I love Ross to death and I know that he worked really hard and in helping to train Chris for Thor and got him in just in, you know,
insane shape.
But I'm curious on your perspective on Ross and his kind of training protocol and philosophy given that he's, you know, attempting to do these ultra marathon swim Adventures. I'm always like confused by his approach. I'm like, dude, you should lose like 40 pounds.
Of muscle and trim down and you would have a better energy, lose some power, but what you will gain and flexibility and efficiency will completely
outweigh that. So what did Ross look like when he swam in college?
I think he was a water polo player in college. I don't think he even swam competitively and he's always been like, yeah, packing strong. But there are videos of him like from years and years and years ago, like he is definitely progressed as a kind of bodybuilding.
Ask type specimen and he has his whole philosophy around it. This mezzo phasing of the way that he trains, but primarily he's in the gym, doing tons of strength training and the swimming doesn't come until much later. But I just know when I put on upper body bulk, I find it very difficult to swim any distances without a lot of lactate build-up. And when I was at my Peak Ultra conditioning, where, you know, when I was training for Ultraman, which is really a cycling
Race with a long run at the end of it, I made the choice to
sacrifice 224 my so it's yeah it's a three-day
W Iron Man. The first leg though, is a 10-5 or Swim. Yeah, but I was like, I'll just be like, I will sacrifice my swim power to be able to have better power to weight on the bike and be efficient on the run. And I found, I got, I kind of push that too far and got too skinny where I had very little power per stroke, but I was in existence.
Constable like, I just felt like I could swim forever without getting tired. And if he's swimming all the way around, you know, Great Britain, and these other challenges that he's planning on right now, like, doesn't that seem like a smarter way to
go? I mean, Ross is an amazing specimen,
it's incredible. Yeah, you know, so far be it for me to judge what he's doing because it's working for him but I just thought like you as somebody who's interested in this kind of stuff whether you had a perspective. No,
not really. I mean, one of the most interesting things that
Ross and I got really fixated on and was I don't if I could talk about it cause I don't know if he's announced publicly, this kind of swim. He has an aspiration to
do. I know about it. I don't think that he's announced it.
But yeah. So so but what what we talked about that interested him was the Sleep cycling of it. So a friend of mine, a cyclist name, might be Runner, ultrarunner, Ultra cyclist named Mike Trevino lives in San Diego first year. He did Ram, he was second.
Most one ram on his first attempt, he got really into sort of timing sleep. So, how do you know? Because obviously with ram, even for people listening, it's this Race Across America, it's a cycling race where basically says, who can ride their bike Across America that quickest that's going on right now. Yeah. I mean, these guys are doing this in, like, eight days so you can imagine they're not sleeping, a whole heck of a lot and he was talking about how the it's, they're now able to sort of try to wake people up at the right phase of sleep.
Based on, you know, rapid eye movement and so Ross was pretty interested in that which was if he was about to embark on a really long swim. I mean we're talking things that would take weeks and probably months could he really optimize his sleep? Because he what he didn't want to do is sort of sleep eight hours. He's our swim team, it's got to be microsleeps in there which again I can't speak to how healthy or unhealthy that is it just doesn't strike me as a great, you know, longevity play. But in the spirit of sort of pushing the, the extreme limits of what a human can do.
That would be very interesting other than just sort of randomly. Like when we used to do swim relays, which we did a lot of these mean, you'd sort of sleep, three and a half hours between your legs, and it was just within three days. You're dead, right? I feel like we're at the very
beginning of understanding what's going on with that. And it does seem to be very personalized, I know, on the ultrarunning world, like some people, they can do these 15-minute little naps and they seem to function at a pretty high output and other people just can't manage it.
You know, I have such respect for that. I there's there's a part of me that certainly always will miss that, that type of pushing, but I done. Yeah, I'm done. And I don't, I don't, I don't, I'm really looking forward to kind of spend the rest of my life. Trying to figure out how to be a healthy productive. Kick-Ass, 90 year
old? Yeah. Excellent. Well, I think that's a good place to end it for today. I could literally talk to you for six hours about a zillion, different subjects. I really appreciate you, indulging, me, and I hope you'll come back and talk.
To me again, I really enjoyed. Yeah. Yeah. Thank you for having me. Yeah, thanks, man. So everybody check out Peter stuff, the drive podcast, I never miss an episode. I think it's fantastic. It's a great public service that you're giving and I commend you for it. And I just appreciate your openness to. Look at conventional wisdom from a different point of view. But a very objective grounded, science-based perspective. And I've just gotten a lot of value out of out of what you're doing. So, thank you for that. I
Oh, you're working on a book. That will be coming out at some indeterminate time. You sounds like February, pleasing it a little bit so that's exciting. Anything else you want to mention
or you know I have to be polite or in the book. Finally does make its way out here. I can't wait to come back and chat about. Yeah, thanks man. Well seats, open for you. Thank you so much. All right. Cheers.
That's it for today. Thank you for listening. I truly hope you enjoyed the conversation. To learn more about today's guests including links and resources related to everything discussed today. Visit the episode page at Rich world.com where you can find the entire podcast archive, as well as podcast merch. My books Finding Ultra voicing change in the plant power way.
As well as the plant power meal planner at meals Rich Roll.com if you'd like to support the podcast, the easiest. And most impactful thing you can do is to subscribe to the show on Apple podcasts on Spotify and on YouTube and leave a review and/or. Comment supporting the sponsors who support the show is also important and appreciated and sharing the show or your favorite episode with friends or on social media is of course, awesome, and very helpful.
And finally, for podcast updates special offers on books the meal planner. And other subjects, please subscribe to our newsletter, which you can find on the footer of any page at Rich world.com. Today's show was produced and engineered by Jason camiolo, with additional audio engineering by kill. Curtis the video edition of the podcast was created by Blake Curtis with assistance by our creative director, Dan Drake, portraits by David Greenberg and Grayson Wilder.
Graphic and social media assets, courtesy of Jessica Miranda, Daniel Solace, Dan's rake and a jackpoet. A thank you, Georgia. Whaley for copywriting and website management and of course our theme music was created by Tyler Pia Trapper Pyatt and Harry. Mathis, appreciate the love. Love the support. See you back here soon. Peace plants.
