#331 ‒ Optimizing endurance performance: metrics, nutrition, lactate, and more insights from elite performers | Olav Aleksander Bu (Pt. 2)

View the Show Notes Page for This Episode https://peterattiamd.com/olavaleksanderbu2/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=250113-pod-olavaleksanderbu2&utm_content=250113-pod-olavaleksanderbu2-podfeed Become a Member to Receive Exclusive Content https://peterattiamd.com/subscribe/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=250113-pod-olavaleksanderbu2&utm_content=250113-pod-olavaleksanderbu2-podfeed Sign Up to Receive Peter's Weekly Newsletter https://peterattiamd.com/newsletter/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=250113-pod-olavaleksanderbu2&utm_content=250113-pod-olavaleksanderbu2-podfeed Olav Aleksander Bu is an internationally renowned sports scientist acclaimed for his coaching prowess with elite athletes spanning a diverse range of sports disciplines. In this episode, Olav returns to dive deeper into his groundbreaking work as an endurance coach, exercise scientist, engineer, and physiologist. The discussion explores his data-driven approach to coaching, unpacking key performance metrics like functional threshold power, VO2 max, and lactate threshold, while emphasizing the importance of consistent testing protocols. Olav shares insights on how training methodologies differ across sports, the impact of nutrition on endurance performance, and the evolving strategies for carbohydrate metabolism in fueling athletes for races. Olav concludes with a discussion on the use of artificial intelligence for optimizing training insights and performance. We discuss: Olav's unique, engineering-driven approach to endurance coaching [2:45]; Definitions and applications of key performance metrics: FTP, power, anaerobic threshold, and lactate threshold [4:45]; Lactate threshold: factors affecting lactate threshold, testing protocols, and how elite athletes' efficiency affects their performance and lactate profiles [14:15] VO2 max: definition, testing, factors affecting its accuracy, and methods for optimizing oxygen utilization in elite athletes [22:15]; Testing VO2 max: common mistakes and key factors to consider—preparation, warm-up, timing, and more [34:00]; VO2 max testing continued: measuring instruments, testing protocols, and advanced insights gained from elite athletes [41:45]; The influence of supplements like beetroot concentrate and adaptogens on VO2 max and performance [49:45]; How respiratory quotient (RQ) reflects metabolic shifts during exercise, the challenges in measuring and interpreting RQ in elite athletes, and the physiological adaptations needed for prolonged endurance events [53:30]; Triathlon training: the challenge of maintaining elite performance across triathlon distances, metabolic efficiency, and swimming challenges [1:03:15]; How reducing drag in swimming could revolutionize performance and the role of biofeedback tools in optimizing efficiency across various endurance sports [1:07:00]; How endurance athletes prioritize effort regulation using RPE, heart rate, and power output, and the role of lactate in cardiac and athletic efficiency [1:20:00]; Lactate's role as a fuel, buffering methods to combat lactic acidosis, and the variability in athlete response to bicarbonate supplementation [1:25:45]; The physiological mechanisms behind differences in performance between two elite athletes: lactate transport, cardiovascular efficiency, and compensatory systems [1:33:00]; Comparing interventions like acetaminophen to enhance performance in high-heat conditions versus natural adaptations to heat [1:37:15]; Advancements in nutrition science, changes in cyclist body composition, and the impact of fueling strategies on athletic performance and growth [1:39:30]; Optimizing endurance performance with utilization of carbohydrates, and the potential role of ketones [1:48:00]; Insights gained from elite performers in the 2020 and 2024 Olympics [1:58:30]; The use of artificial intelligence to optimizing training insights and performance [2:06:30]; and More. Connect With Peter on Twitter https://twitter.com/PeterAttiaMD, Instagram https://www.instagram.com/peterattiamd/, Facebook https://www.facebook.com/peterattiamd/ and YouTube https://www.youtube.com/channel/UC8kGsMa0LygSX9nkBcBH1Sg

Speaker names marked ? are inferred from speaking time and the show’s known hosts — they are not voice-verified.

• 0:11Dr. Peter Attia?

  Hey everyone, welcome to the Drive Podcast. I'm your host, Peter Attia. This podcast, my website, and my weekly newsletter all focus on the goal of translating the science of longevity into something accessible for everyone. Our goal is to provide the best content in health and wellness, and we've established a great team of analysts to make this happen. It is extremely important to me to provide all of this content without relying on paid ads. To do this, our work is made entirely possible by our members, and in return, we offer exclusive, member-only content and benefits above and beyond what is available for free. If you want to take your knowledge of this space to the next level, it's our goal to ensure members get back much more than the price of a subscription. If you

• 0:54Dr. Peter Attia?

  want to learn more about the benefits of our premium membership, head over to peterattiamd.com/subscribe.

• 1:04Dr. Peter Attia?

  My guest this week is Olaf Alexander-Bu. Olaf was a guest in March of 2024, and at the time of that conversation, I realized we hadn't got through the majority of what I wanted to speak about, so it was inevitable that I would have him back. Olaf is an endurance coach, exercise scientist, engineer, and physiologist. He is the head of performance for Norway Triathlon and is best known for coaching two of the world's top triathletes, Christian Blumenfeldt and Gustav Iden. In this episode, we review his work and his approach to coaching and the way that he relies very heavily on data. We talk about and define various performance metrics like FTP, Functional Threshold Peter, Critical

• 1:47Dr. Peter Attia?

  Power, anaerobic threshold, lactate threshold, VO2 max, and the importance of consistent protocols when testing these performance metrics, and how they can vary depending on an athlete's training. We discuss differences in training methodologies across sports and how different sports and activities influence power, pace, and endurance. We look at the

• 2:10Dr. Peter Attia?

  Significance of nutrition in endurance sports, how athletes train to properly fuel themselves for races, and why this is so different from what has been done historically. In fact, we really got into this difference in carbohydrate metabolism. Just like the first time Olav and I spoke, this is a discussion that can be quite complex at some points. We do get a little bit into the weeds, but the truth of it is because of the nature of what we're talking about, it's very difficult to talk about these things meaningfully and superficially. Patience is always appreciated and the rewards are always there if you're able to stick with it. So without further delay, please enjoy my conversation with Olav Alexander-Bu.

• 2:51Dr. Peter Attia?

  Olav, thank you very much for coming to Austin on your way. I guess you're on your way to Arizona?

• 2:57Speaker 01

  Yes, on my way to Flagstaff. So also thank you very much for having me again.

• 3:01Dr. Peter Attia?

  Yeah, well, as I mentioned last time we spoke, I had a lot of notes. We got through, I think, one eighth of them. So there's kind of a lot to cover today. And of course, as we've been sitting here for the last 15 minutes or so, we've already kind of started the podcast, unfortunately, and I want to go right to where we just left off, but I'm going to resist the urge. Last time we spoke really about sort of the most nuanced ins and outs of cardiorespiratory fitness. Maybe just for the person who didn't catch that episode, can you give the one minute version of what you do and why you're certainly one of the few people that would be poised to talk about what we're going to talk about today?

• 3:38Speaker 01

  I'm not very good at the pitches. My background is from engineering and it means also that this principle have guided me quite a lot through my journey in endurance sports or in sports in general. We embarked on a journey 10 years ago, more than 10 years ago, I would say now 15 years ago, where we started to do what I would call extreme in-depth and longitudinal studies on two of the arguably fittest athletes in the whole world. Yeah, I think that pretty much resembles it. Obviously, a large part of that also involves technology development, simply because we are at the edge of basically what we have available information, research on. And that means that even in some cases, we have to develop technology to allow us to even progress

• 4:21Speaker 01

  the understanding of getting a more granular understanding of why things are the way they are.

• 4:27Dr. Peter Attia?

  Yeah, so in many ways, you're kind of an applied scientist.

• 4:29Speaker 01

  Yes.

• 4:30Dr. Peter Attia?

  And your laboratory is both a seapet lab and then a racing environment where most of the athletes you work with are triathletes, correct?

• 4:38Speaker 01

  Yes and no. I would say that it's actually quite spread. It's a mixture between triathletes, cyclists, runners, track and field, to even sailors, which is, let's say, on the explosive end of the domain, actually, and not endurance, but yeah.

• 4:52Dr. Peter Attia?

  Yeah. I feel like we're going to use a lot of terms today. We're going to probably throw out the word anaerobic threshold, lactate threshold, VO2 max, FTP. So I just want to make sure everybody kind of understands those things. So let's just take them one at a time. Can you define FTP or functional threshold power for folks?

• 5:09Speaker 01

  There is a couple of definitions of this already, which is, I have to say that it's bad when you have good terminologies, but they start to get diluted. But the original definition of FTP by the authors, I think, was Andy Cogan. And that was that basically it's, you first actually have to do a five-minute all-out effort. And then basically there's a short pause in between there, and then you go to a 20-minute all-out effort. And then you subtract 5% from that to find your FTP. So typically it would be your 20-minute all-out minus 5%. And the reason for that is to try to get a ballpark-ish idea of what your, let's say, sustainable power output is possible to do over an hour.

• 5:49Speaker 01

  But as we have learned over the years, is that one, we figure out that this is not as accurate always, because there are a couple of other things in there. And also, unfortunately, they have become different ways to doing it. Like, some people, they just do a warm-up and then they do a 20-minute all-out, and then they subtract 5%, and that's already different.

• 6:06Dr. Peter Attia?

  Yeah, we used to sometimes do 20 minutes and subtract 10%. So we would do a gentle warm-up for an hour, then do 20 minutes, and then subtract 10%. So yes. But I guess the spirit of FTP, which is maybe what we want people to think about and not get mired in the details, is it really approximates an energy zone that is more than just an all-out, but clearly less than what you could hold indefinitely. And it's directionally about the highest output you could have for an hour. And there's different ways to approximate it, of course.

• 6:38Speaker 01

  Maybe more importantly to that point is that as long as you do something consistently, so you keep the same protocol, you could say, okay, this one thing is the original thinking and that went into devising this kind of protocol. But I would say more importantly is rather to stay true to the principle of how you do it. So as long as you do it the same way each time, this is more important.

• 7:00Dr. Peter Attia?

  And then how does that differ from another term that is used interchangeably, but I believe erroneously, which is critical power?

• 7:07Speaker 01

  So critical power is something that you normally more extract from that you do multiple all out efforts and then you apply reversed extrapolation to this to basically figure out what is your critical power. So it's a more of a little bit more advanced mathematical approach to it. Typically, you would say that there are different concepts to this. I personally have to say that I like the critical power approach a little bit better.

• 7:32Dr. Peter Attia?

  And what is it trying to approximate?

• 7:34Speaker 01

  So critical power is basically where you try to divide something into two zones. That's a crossover simplification, but you distinguish between, let's say, a non severe and a severe state or basically where you are again, also in the same way as FTP, trying to figure out what is the power you are capable of staying at for a prolonged time and basically where you go into a territory where small changes has a

• 8:02Dr. Peter Attia?

  Huge consequence.

• 8:03Speaker 01

  Yeah, huge consequence on the duration that you're capable of holding it.

• 8:06Dr. Peter Attia?

  And where does critical power typically lie in relation to FTP?

• 8:10Speaker 01

  Again, this depends a little bit on how you test FTP, but I would say that how maybe FTP have been used over the last, or let's say a little bit more deviated from how the authors originally devised it, I would say that it actually is not too different. And normally you would say that the critical or functional threshold power would lie slightly lower in this in power output than critical power. But again, it depends very much on, let's say, also in critical power, there are today, I don't know how many different definitions there are of critical power and how you should do the protocol there. But it means that normally critical power, if you look at it from a metabolic perspective, it sits somewhere between Your maximum lactate steady state, or call it anaerobic threshold and VU2 max.

• 8:53Speaker 01

  So typically more close to VU2 steady state or so on. But that's introducing another term that it just doesn't bring clarity.

• 9:02Dr. Peter Attia?

  We'll define those in a second. So many of these metrics, FTP, critical power are easiest to think about in terms of cycling, because we use power meters. Do the same concepts still apply in swimming and running?

• 9:15Speaker 01

  Yes, I would say. I think for the sake of simplicity, it's sometimes it helps to refer to like, say, one condensed number. So you use, for example, you can say critical pace, for example, in running and swimming. And the way of testing it is not too different to what you would do in cycling. But one thing that actually happens in the process is that you actually have access to more granular information and you are dumping down information a little bit when you call it FTP or you call it critical power. Because more importantly, I would say is that when you present a critical power number only or an FTP number only, you have taken two dimensional information and made it one dimensional, meaning that you only look at the Y axis and you take away the information

• 10:00Speaker 01

  that is quite critical, I would say, and that is how long are you able to sustain something? So for example, for critical power testing, I would say, again, also when you first do critical power testing, it's more interesting to know, let's say, how fast or how far are you able to get over one minute, for example, five minute and 15 minutes? And then actually see what happens in the next time you do it for the one minute, the five minute and 15 minute, because this is actually quite crucial to understand also the balance or what's happening with the different balances in the body. Also FTP, most people think of this as a 20 minute power. So it's even a little bit more condensed or even simpler information. But as we will probably come back to is when you're training, there are two things that normally can happen.

• 10:42Speaker 01

  And one is that you increase your general capacity, meaning that both power and capacity, one or the two are increased. The other thing that happens there is that at some point we are all time limited and this is where we need to pivot. So we need to pivot or as a prioritize what is more important for us. Is it the more explosive or speed or is it more endurance? And then it becomes more interesting for how you guide the training to understand what's happening between this different power or pace and durations.

• 11:10Dr. Peter Attia?

  Okay, you mentioned two other terms there anaerobic threshold. Let's start with that. How do we define it?

• 11:15Speaker 01

  Probably in the same way today that we say something we just say call now in the world of chat GPT and everything, we just call something AI. Basically, an extremely broad term that try to encompass more or less the exact same thing that we already talked about. Basically, let's say the difference between where something is steady and where it goes over to unsteady. Basically, for where you can hold something for a longer duration and where it goes to shorter duration. It's a misconception to think that anaerobic threshold means basically when you become anaerobic, because that's not the case.

• 11:48Dr. Peter Attia?

  Yeah, it's a continuum, of course. It's not a switch.

• 11:50Speaker 01

  Yeah.

• 11:51Dr. Peter Attia?

  Yeah. Where does anaerobic threshold typically, if we're just limiting this to make the discussion easier in talking about, say, cyclist with a power meter? Where does anaerobic threshold tend to sit relative to FTP?

• 12:03Speaker 01

  So again, obviously, because this is a more, but if we then let's say bring it over more to lactate as a tool for trying to figure out where this is. And again, this opens up a whole new world of definitions, but to try to answer it simply, I would say that typically anaerobic threshold. When you use lactate and let's say that you use, for example, gold standard, so maximum lactate steady state. This would normally sit below the critical power of FTP, so at a lower power.

• 12:31Dr. Peter Attia?

  So for keeping track, we've got critical power FTP AT.

• 12:35Speaker 01

  Yeah. Also, what's important here is then when we say anaerobic threshold is that when we talk about the differences here. The differences here depend a little bit on what kind of athlete you are, whether you are a high-power athlete or endurance athlete. So if you're a high-power athlete, typically you'll see that there are larger differences between this. So the percentage difference between this will be larger. Our endurance athletes, it would be smaller. But you could basically call these minute differences. We're talking percent differences. It's not like these are going to be 10% apart in terms of power and things like this. We talk about percentages from a couple of percents to maybe five, worst case, maybe 10.

• 13:10Dr. Peter Attia?

  Okay, and then lactate threshold, just adding more definitions.

• 13:13Speaker 01

  Yes, so lactate threshold, I would say the lactate threshold has probably more of a result of limitations in the measurement method. Because we know that lactate is something you produce all the time, even when you are sleeping. So the difference here is more where you're looking at where you find the first infliction point on a lactate curve when you do as an increase in intensity. So one thing that is maybe easy to get wrong here is that it looks like when you do increasing, so if you start low enough power or low enough pace, it looks like, oh, there is no increase in lactate production. The problem is the way we measure. We don't measure lactate in the muscle. We measure in the bloodstream and for it to basically be reflected on the instrument, there needs to be a large enough lactate production in the muscles where you're not

• 13:58Speaker 01

  able necessarily to metabolize the lactate immediately and it starts to get transported out into the bloodstream and it starts to reflect also as an increase in lactate there. So the difference is also is that depending on protocol, this will change. So that's also a little bit of the challenges when you also start to mix something external with something internal as well.

• 14:18Dr. Peter Attia?

  And so if we did a lactate protocol, a speed or power escalation, right? I think we talked about this on the last podcast, which was kind of the way we used to do it in swimming, is you think we would do 200-yard swims. So you do a 200-yard swim at a very modest pace, come back, check the lactate, rest, do it again, five seconds faster per 200, go and do it again. Lactate, da, da, da, da, and you get a plot. So pace on the x-axis, lactate on the y-axis, and the curve is very distinct. It is very, very flat and then it is not. And we would draw these tangent lines between the two and then that point was the lactate threshold. Where would that typically lie?

• 15:01Dr. Peter Attia?

  Assuming we did it on a bicycle, so it was really easy to do the power checks. First of all, how long a duration would you have an athlete do this if you were doing it on an ergometer? Would you say we're going to do three-minute efforts or something like that? Is that appropriate to generate the lactate performance curve?

• 15:17Speaker 01

  It depends again how you're going to utilize it. If you're going to use it for actively, let's say, controlling the intensity outdoors, for example, using a lactate meter, then I would say it really doesn't matter.

• 15:27Dr. Peter Attia?

  Even taking into account that there's some lag between what's happening in the muscle and what's happening in the blood?

• 15:32Speaker 01

  Exactly, because the thing here is that here you're looking for more, not necessarily, here also it's important just for me to say initially that when you find, for example, a lactate concentration of LT1 and LT2, for example, or basically AT and LT, for example, or AT LT2, but we basically say lactate turn point two and lactate turn point one, so the first one and the second one. And then when you do this, it's also a misconception to think that your LT2 is always a constant value, because this will be influenced by many factors. We measure a concentration in the blood and the blood is influenced by hydration and all things like this. So for example, if you have a change in hematocrit, we won't come into that, but you can easily from the beginning of the session towards the end of the session see changes in hematocrit of more than 10%.

• 16:15Dr. Peter Attia?

  As you get dehydrated?

• 16:16Speaker 01

  Yes, so this will already influence the lactate concentration, but to use it as a guiding principle, it really doesn't matter how long your steps are. Basically, what you're looking for is to find a concentration value and then you go out into the field and you're trying to figure out where this is. You basically said, okay, if you figure this out to be for an endurance, let's say, for sake of simplicity, we say one millimole and two and a half millimole. So one millimole at the lactate threshold or LT1, and then two and a half at LT2 or anaerobic threshold, AT.

• 16:44Dr. Peter Attia?

  We usually saw them a little bit higher than that. Actually, I didn't really differentiate between LT1 and LT2. I kind of looked at the single inflection point, just using a two-line. Usually people were kind of in the three to four range was where that inflection point. You're saying that corresponds to LT2?

• 17:01Speaker 01

  Yes, so and this also comes back to a little bit what kind of athlete you are.

• 17:05Dr. Peter Attia?

  Yeah, this was mostly swimming that we were doing. I found swimmers, by the way, had the highest lactate capacity.

• 17:11Speaker 01

  Basically for how much?

• 17:12Dr. Peter Attia?

  How much lactate they would produce and tolerate.

• 17:14Speaker 01

  And tolerate, yeah.

• 17:15Dr. Peter Attia?

  Yeah, what, any idea? I mean, it could be just a small sample size.

• 17:18Speaker 01

  Very often, it depends on what kind of swimmers. If you look at a hundred meter swimmer, for example.

• 17:22Dr. Peter Attia?

  So call it two to four hundred breaststroke butterfly individual medley. I never saw higher numbers of lactate in myself or other swimmers than in those. I always assumed it was two things. It was individual medley, you're using every muscle in the body. It's not like cycling or running. You're hemorrhaging lactate into the system. And then secondly, at that distance, two to four hundred, I mean, you're really in the pain train of you're clearly not able to do this fully anaerobically. So you're sort of maximizing aerobic and then topping up anaerobic. But that was sort of why I sort of assumed. I mean, literally, I measured on several elite swimmers, lactate's over twenty millimol.

• 18:00Speaker 01

  I think very often it helps to think that metabolism is basically the same. The body is the same, no matter what kind of sport we do. And that's why sometimes it makes it more universally easy to understand. If we think of what kind of sport we do as a function of intensity and duration. So as long as you find a sport, so let's say that you compare a sport that has a certain intensity and duration. So let's say, for example, if it's a two hundred meter or four hundred meter, you could say that then you are typically in the range of, let's say, for the fast swimmer's typical, let's say, two to four minutes, for example. If you take a fifteen hundred meter runner and you look also the lactate concentration of them, you will also find actually pretty much the same values, let's say, among also tracking field athletes that does fifteen hundred meters or eight hundred meters as well.

• 18:45Speaker 01

  As the moment you start to go a little bit longer, then you will actually start to see that this actually is not the case anymore. And this is also where it helps to also distinguish between lactate concentration, let's say, the highest value you're looking for and also lactate production. Because lactate production, it's even more complicated. We can't really measure lactate production. Then we need to integrate for time. So you have to do, let's say, a pre-measurement, a post-measurement. And then also, obviously, here there are, again, many weaknesses to an approach like this. But you have to derive it based, let's say, more on calculations than really that you can measure it directly. How high you can get in lactate concentration is also valuable because it obviously tells you something about how much you are able to buffer in your body too.

• 19:27Speaker 01

  So again, what we see, coming back to the main question of how do you use lactate? And then basically for the sake of where you do a profile and testing. This is where I would say that for endurance athletes, like for example, marathoners, triathletes and others, which has a very, very long duration and they don't have very much top speed. Here it's actually not uncommon even to see where the second inflection points even validated by maximum lactate steady state that actually can even be below two millimoles.

• 19:55Dr. Peter Attia?

  Let's just translate that into English for people. One of the challenges of talking with you is I enjoy it so much and I sometimes forget that there are other people listening who might not care nearly as much as you and I do about some of this minutia, but it's just, I can't get enough of this stuff. So let's make sure people understand what you just said. You just said that when you look at the most elite endurance athletes, these people have either some combination of such low lactate production and/or such high lactate clearance that frankly, the need to buffer it becomes secondary. They're producing such a high degree of power. They're generating so much work with so much aerobic efficiency

• 20:38Dr. Peter Attia?

  that their steady state lactate doesn't even need to hit two millimole, which of course, you can sit at two millimole all day long and not notice it from an acid-base standpoint. Is that a fair assessment of what you said? Or implication of what you said, maybe?

• 20:50Speaker 01

  Yeah, yeah, because I think for those that are a little bit more into the details, I think also again here is important to come back to that is a lactate concentration. And one thing that we also do know in elite athletes is that elite athletes has a higher blood volume, larger plasma volume and other things as well. So this means basically that the

• 21:08Dr. Peter Attia?

  Absolute lactate could still be higher.

• 21:09Speaker 01

  Exactly. So lactate production can be higher, but basically it shows up as a smaller concentration in the body. But what we distinguish between is basically at where comes the point where you are continuing at the same pace or power, but now lactate doesn't stay steady anymore. So if you measure after same pace, same power, but after five minutes, after 10 minutes and so on, basically then you'll start to see that lactate still continues to rise. It doesn't stay stable anymore. This I think is probably one of the few concepts of where you can say. If you test it this way, it becomes very easy to translate. Let's say the communication between people, because at the moment you start to talk about anaerobic threshold. This is more like, okay, how do you define it? This is 20 minute power, it's a 60 minute power. What kind of duration, what kind of protocol and all these kind of things?

• 21:54Speaker 01

  But that's one. And the second point also is that what happens, because obviously when you are an endurance athlete, like a triathlete or a marathoner, for example, is that you need to have a sustainable energy supply for the duration of the event. And obviously, the faster you can go off your potential for that duration, the more beneficial it is. So that means also that your utilization, maybe come back to this a little bit, because VO2 max is one of the terms we're going to define.

• 22:19Dr. Peter Attia?

  Yes.

• 22:19Speaker 01

  So utilization normally, just to take that term then, or let's say partially, let's say define utilization. Utilization is basically, normally you can do it as whatever you want. You can do it as a race pace, oxygen consumption at race pace versus your VO2 max. But very often in scientific literature, we define this as, for example, your oxygen consumption at maximum lactate steady state versus VO2 max. So for example, if it was, then it could be that your maximum lactate steady state, you see the oxygen consumption there is, for example, 80% of your VO2 max.

• 22:51Dr. Peter Attia?

  Is that what you would typically see in an elite athlete?

• 22:54Speaker 01

  That's low.

• 22:55Dr. Peter Attia?

  That's low.

• 22:55Speaker 01

  That's low. For a marathoner, you would go even higher. So for a marathoner, like the elite marathoners, you are talking about 94, 95% of the VO2 max. For Christian Gusta, when they do IRMs, you're also pretty much around there.

• 23:08Dr. Peter Attia?

  Let me just make sure we get people to understand that, because that is, as you know, now that I have a VO2 master, I'm testing my VO2 max all the time and I'm also testing my VO2 at submax levels all the time as well and looking at how that corresponds to lactate levels.

• 23:22Speaker 01

  Yes.

• 23:22Dr. Peter Attia?

  So why don't you define VO2 max? And then we're going to come back to this point, because I want to make sure people can internalize and maybe even one day experience what you just described.

• 23:32Speaker 01

  So VO2 max is normally defined as the maximum oxygen your body is able to consume over a minute, a full minute. But this is also something that is debated, is less of, let's say, protocol influenced. You can still go out and do, for example, efforts out in the field and you will be able to produce higher numbers than what you would be able to do on a standard graded exercise protocol.

• 24:01Dr. Peter Attia?

  That's been the case for me. You know, I've shared my data with you, so I like to do it on my bike on a hill. Take a hill that's going to be not too steep, 6% grade, you're in the saddle the whole time and you're in the big chain ring and it is go for broke and make sure you're dead at the top, four minutes of climbing and that produces a VO2 max. There's going to be a level usually near the very top of the hill in the last minute where I reach the maximum volume of oxygen that I'm consuming. Now indoors, I for some reason hate doing it on a stationary bike, so instead I do it on a Stairmaster. So now I'm just sprinting upstairs, doing the same thing. I get a comparable number, but it's a little bit lower.

• 24:45Dr. Peter Attia?

  Now, what I haven't done yet, and I was going to try to do it before we met today, but I ran out of time, I was traveling last weekend. I have a prediction, which is I think I would have a higher VO2 max running on a treadmill, even though I'm very inefficient running, because my heart rate is always higher when I run than when I cycle. Do you think that would be the case?

• 25:05Speaker 01

  Normally, I would say that should be the case, but it is also where there can also be other factors also involved in it. One of the places where this is something that have quite passed me is that, for example, for Mula1 drivers, they sit in for almost, let's say, one and a half hour with extremely high heart rates.

• 25:26Dr. Peter Attia?

  But having looked at that telemetry very closely, a lot of that is driven by the G-forces. I mean, the first time I looked at an F1 driver's telemetry, I was like, there's a mistake, these are just errors, like these aren't real numbers, because I had never seen. Such rapid changes from low to high to high to low. And then I realized they were all corresponding to either very, very strong break points or very, very fast corners. Obviously, the only thing that's common to that is something about 5G on the body is dramatically doing that. Now, it would be very interesting if we could do it, I don't know how you would do it, would be to measure VO2 and see if it has a commensurate change. What would you hypothesize?

• 26:11Speaker 01

  So this is, I think also when you are doing this, so it could also be like jet fighters as well.

• 26:18Dr. Peter Attia?

  I would imagine that's even more pronounced for them. And we could actually measure that because they're already in a mask.

• 26:22Speaker 01

  Yes, exactly. So you could say that in dogfighting, for sure, then I think you would actually be pretty much maybe same as Formula One. But I think that if you're just pushing really high G-forces in one direction, then it would maybe not be as, even if it's a prolonged one. The reason for that is because I think that the G-forces, obviously you're trying to counteract that. So you're mobilizing every bit of muscles that are in your body in order to stay exactly where you need to stay.

• 26:48Dr. Peter Attia?

  But there's a slight difference, which maybe you're about to get to, so apologize if you are. There's got to be also a part of that heart rate that is coming from the compromised venous return to the heart due to either the Valsalva or the actual impeding of the inferior vena cava. I would think at a high enough G-force, part of that high heart rate is stroke volume has gone way down because preload is way down. Again, I'm sorry, I should make sure everyone understands what we're saying. When you fill the heart less with blood, you don't stretch the muscles out. That's called preload. So the heart needs to be preloaded with lots of blood volume so it can get a good squeeze. And anything that prevents that, either dehydration

• 27:30Dr. Peter Attia?

  or literally forces that are preventing the blood returning to the heart could make that high heart rate really a product of tiny, tiny little ineffective beats.

• 27:39Speaker 01

  Yes, that's also, we've done some studies on that.

• 27:43Dr. Peter Attia?

  In high G-force athletes?

• 27:44Speaker 01

  No, actually in similar, because it's quite interesting to see that what happens also with the muscles. So when you do work, you produce a certain amount of power. Obviously, two, there are forces involved and there is velocity involved. These forces requires a certain amount of recruitment of muscle fibers. And these muscle fibers at a certain point will actually start to cause vascular constriction. So they actually start squeezing off the blood supply. They normally act also as a pump. They actually help pumping blood around in the body, promoting preloading. But the interesting thing is that we do see that where you also get in the area of anaerobic threshold is actually where you are starting to come to the point where you're squeezing off the blood flow as well in the muscles.

• 28:26Speaker 01

  And this happens around ballpark-ish, obviously there is a fairly large range here, but ballpark-ish around thirty percent of your 1RM.

• 28:34Dr. Peter Attia?

  You should never experience that on a bike, right? Because in theory, it's hard to imagine you could ever come close to thirty percent of a 1RM force on a pedal stroke. Could you?

• 28:47Speaker 01

  That's true.

• 28:48Dr. Peter Attia?

  Maybe there's an extreme moment, you're at a sixteen percent grade or something like that, I guess it's possible, huh?

• 28:54Speaker 01

  Yeah, for sustained efforts, for short efforts, you can get very, very close. But for sustained ones, yes, I would agree. But coming back to running versus the bike, which was, let's say, the place where it started. Normally, I would say that, yes, in running, you would at least a submaximal efforts have a higher VO2 max. The only thing is that we see that in people that are, let's say, somewhat balanced trains. So they spend some time on the bike, they spend some time on running. Then normally, there are more muscles involved for a longer duration in cycling than it is in running.

• 29:25Dr. Peter Attia?

  So when you test Christian or Gustav, if you were to have them fresh on two separate days, and on one day you put them on the bike, and on one day you put them on the treadmill, and you have them do a VO2 max test, what would be the approximate difference you would see in them?

• 29:41Speaker 01

  Actually, when I started working with them, then it was close to a significant difference between cycling and running and even more in swimming.

• 29:49Dr. Peter Attia?

  Higher in swimming?

• 29:50Speaker 01

  No, lowest in swimming, actually. And that comes also back to also the one other thing. One thing is also when we talk about preloading and how this also affects it. I actually were stupid enough to teach Christian and Gustav this a long time ago. And that is if they wanted to have a very high VO2 max. Obviously, if you're trained, you will see this immediately on the breathing patterns. But what you can do to create an artificially high VO2 max is that you basically, when you come pretty close to your all out effort, if you try to restrict your breathing, let's say for a short, short time, you will create a depth and this depth will actually boost the numbers even higher.

• 30:23Dr. Peter Attia?

  This is the VO2 max hack for everybody watching us. How do I boost my? Because my hack for boosting VO2 max is weight loss. Just figure out a way to lose five pounds in the week leading up to the test and you're goes up and obviously knowing how to train for it. I mean, if you train in those intervals. So you're saying if you restrict breathing as you get close to that failure point, each breath you take becomes that much more of an oxygen explosion?

• 30:49Speaker 01

  And even there, you can even train yourself also to the point where you're not talking about marginal differences in your VO2. You can spike the numbers up to extreme numbers if you practice this a little bit. That aside, I think it's important here to remember that that's not equivalent to getting fitter. It's just a way of basically manipulating something in the body and you're cheating a protocol. And it's not your, let's say, VO2 max.

• 31:13Dr. Peter Attia?

  But for those listening to this who have a bet with their friends about who's going to have the highest VO2 max, this becomes their little trick.

• 31:18Speaker 01

  Yes, then definitely you can do this and you will get some really nice numbers. That's true.

• 31:23Dr. Peter Attia?

  How much of a boost would you get? Like, let's say you're a person who just doing the protocol normally is 60 with no other change other than this breathing trick, what would you take that to?

• 31:32Speaker 01

  One thing I want to add here just before answering that. VO2 max for me, in the same way as power, you can look at it in relative terms and absolute terms as well. So obviously losing weight.

• 31:41Dr. Peter Attia?

  Yeah, so let's say it's five liters.

• 31:43Speaker 01

  Yes.

• 31:43Dr. Peter Attia?

  Based on the weight that comes out to 60.

• 31:45Speaker 01

  Yeah, I would say that in this case here, it comes very much down to technique, but if you practice this a little bit, that you can boost it above 70.

• 31:53Dr. Peter Attia?

  What?

• 31:55Speaker 01

  Not a problem.

• 31:56Dr. Peter Attia?

  Wow. I thought you were gonna say sixty-four, sixty-five.

• 32:00Speaker 01

  No, no. I've seen some crazy numbers. I don't even have to go into the raw data. You just see it on the screen. I was okay.

• 32:05Dr. Peter Attia?

  But wait a minute, though. Doesn't that sort of fly in the face of our definition of E O two max, which is it's the highest oxygen consumption you sustain for one minute? Cause I know when I do my test, I think I'm always checking for sixty-second average and I'm not ever just looking at the peak. It's very noisy data. So in this breathing technique, don't you just get a really big spike that is otherwise noise in the one-minute best effort?

• 32:32Speaker 01

  No, so it would be a little bit more prolonged than that if you create an oxygen depth in your body. But one thing that I think also here is important to, because this is also one of the things that is a little bit challenging when you read a lot of research too, is that very often we take that research for granted. Well, it's good. There is a lot of things around it that we don't have access to or we don't know. And also one thing that also is sometimes a challenge is for people to understand also whether the technology they are using, one, is it good for what you really are doing here? So you can get a lot of machines that can do measure some kind of oxygen uptake or ratios and other things, but it doesn't mean that it necessarily is a good instrument for what you want to do. And the second part of it also is that we have to understand where are we measuring?

• 33:16Speaker 01

  Obviously, in this case, when we do oxygen measurement, we measure it on the exhaust and not in the muscles. And that's also an important difference here, because if we go to the point, and I think we're gonna run out of time if we continue on this path here. But if basically you look at cellular or basically cell respiration, the numbers you'll see.

• 33:36Dr. Peter Attia?

  Much higher. I remember this from our last discussion.

• 33:39Speaker 01

  It's completely different.

• 33:40Dr. Peter Attia?

  We're not limited at the cell.

• 33:42Speaker 01

  No. Again, here, I think it comes down to just staying true to some principles that can guide us in. The good thing with V U two max testing is that there the generally accepted standard for doing this is a graded exercise test. And you go through that and it will produce fairly comparable numbers for most people to relate to. There will be some differences.

• 34:03Dr. Peter Attia?

  What are some of the mistakes you want people to look out for? Because again, people listening to this podcast are no stranger to VO2 max. We talk about it as if you were going to sort of say, I need to know 10 parameters of my body for optimal health. VO2 max is on that list every day of the week. So even if you are listening to this and you don't care about triathlons or cycling or swimming, but you just have the desire to live as long as you can and as well as you can, you have to know your VO2 max and you need to optimize it and make it frankly, as high as you can with whatever time you're willing to devote to training. That said, most people aren't going to go out and buy a VO2 master and they're not going to geek out and do this stuff on their own. They're going to rely on going to a place where the VO2 max is measured in a stationary fashion, either on a treadmill or on a bike.

• 34:46Dr. Peter Attia?

  What are some things that those folks need to be aware of when they go to a center to test this? As far as mistakes that people make, so for example, I've seen many people go and do a test and I talk to them after and I go, how exhausted were you at the end of the test? And they say, oh, it was okay. I could have kept going and I'm realizing, okay, you didn't do a maximal test. Other mistakes I've seen are people who don't have a long enough warm up time. The total test took five minutes. And I'm like, well, you didn't come close to sufficiently warming up. So are there any other things that you would just have people have in the back of their mind? When they call a place up to say, hey, I want to come into a VO2 max test, but before I give you my hundred bucks, I want to understand the protocol.

• 35:21Speaker 01

  Of course, the question becomes also to what extent you're able to influence this as well? Because there are some practices that they want to done in a very rigorous way. They even almost prescribe what you should do the days leading before. And then other where you just come in and they just put you through a test and then you get what you get.

• 35:36Dr. Peter Attia?

  So what should folks look for? If you were sending somebody to a public place where they could go and do this, they're not coming into your lab where you're going to administer the test. What would you want them to be looking for?

• 35:47Speaker 01

  What I would normally do is the one I would try to create are some standardized protocol from time to time. And that means not only the testing itself, but also what happens a little bit before, without it becomes too invasive into people's lives, like standardizing what you do the days before and all these kinds of things. I think this is impractical for most people. If this is a very important metric for you, like one of the key metrics you use in order to understand how have the previous period. Influence you and you're looking for marginal changes, then it becomes very important also how you standardize the days before. But I would say for a normal person, I would say that I would keep a standardized protocol. So I would come in there, let's say at least trying to eat pretty much the same every time I go there.

• 36:29Speaker 01

  And that means making sure you are well fueled as if you were gonna do important training session. That means normally more carbohydrates, make sure you're well hydrated and obviously also that you are to the extent you can influence it or you can, you should be able to influence it, but make sure that you also had a proper sleep so you don't come in there like completely tired and things like this.

• 36:50Dr. Peter Attia?

  Reasonably well rested, not train the day before, would you say, or like training the day before?

• 36:55Speaker 01

  This is where I would say it's more important to use your experience and to have enough understanding of what makes you set up for a good test the day after. So for some people, exercise is irregular and there are more time in between. Obviously, if you're gonna do a little bit harder exercise the day before or anything like this, you'll come into the session and you even feel sore in the muscles. This is not ideal necessarily for the ability to mobilize. For the athletes that are well trained, then it's completely different. Then it's more like, okay, what would I do the day before a competition or anything like this? Doesn't have to be an elite level, but more like you think a little bit like, what do I want to do in order to make sure that I've gone through the different stuff and I feel ready for the day after? So on the day of the test itself, one is important, timing of the day.

• 37:37Speaker 01

  This is important to try to keep somewhat consistent, I would say, because of this circadian rhythm. We know that, for example, your temperature levels in your body, this fluctuates. This is maybe one of the easiest observable differences in a human. Basically, it's an indirect measure of the circadian rhythm where we basically see that you have a minimum point that happens typically in the morning just before you wake up. And then you have a maximum point typically in the afternoon. And there is, of course, plenty of research suggesting that aerobic exercises are best done normally a little bit in the afternoon when you are typical also around the highest core temperature or natural core temperature. The minimum point is easy to measure, so for people that has the core like now it's become very popular,

• 38:19Speaker 01

  like in the Tour de France and all the places, triathlons, you see these people, they run around with this little Temperature device on their body and it's very easy to observe if you use the twenty four seven, this is very easy to observe basically when your minimum point is. The maximum point is influence, let's say can be masked by noise and other things, activities and other things you do. So it's a little bit harder to see where it is. But let's say you put them twelve hours apart as a guiding tool. But now I'm already getting to the point where it gets a little bit, let's say, more detail, but I would just say, keep the timing of the day the same. So it really doesn't matter if you do it in afternoon or you do it in the morning, as long as you keep it consistent. Then from there, I would do a proper warm up. That's important.

• 38:57Dr. Peter Attia?

  How long do you think that should be for a person who's like modestly trained? Let's assume we're not doing this on someone completely untrained, but someone who's recreationally trained versus relatively elite.

• 39:05Speaker 01

  So again, here I would do a warm up much in the same way I would do a training session. So I would normally stick to a standardized warm up protocol where you start out maybe for example, six minutes, very easy. This can even be walking. Then I would do our basically pedaling, soft pedaling. Then I would do six minutes with a little bit more effort, but it typically should be more something that you would be comfortable doing as your longest sessions that you do. So if you are out and you do, like I said, the longest sessions you do is an hour. Obviously, if they're all out, then it would be a little bit too hard, but then you should more aim for something I could do for like, this would be an easy session for me, but I could do it for some while. You could, for some people, say this is your marathon, let's say, pace or where you do more of a longer rides. And then I would do a short effort around three minutes that

• 39:48Speaker 01

  sits somewhere where at this time I wouldn't look too much on my power meter or my heart rate or anything, but more by feeling where you feel, okay, this is where my normally where my treasure would be. And then I would probably also do, let's say, a couple of short, short efforts that are, let's say, progressively towards view to max. So let's say one, two, three, maybe two to three efforts that are somewhere between ten, fifteen seconds with equal rest in between. And the reason for this is that it's easy to think, ah, but don't you exhaust yourself now before you do the view to max then? Well, no, you don't. The little fatigue or let's say the little fatigue that you possibly would induce with this is easily offset by other factors that will much more contribute to your view to max when you start doing this. So that means also

• 40:33Speaker 01

  After I've done this one, I would just again go back to very short, easy efforts as you get a total warm up of twenty minutes, something like this. In between there, take a toilet break or anything like this, but don't keep this rest too long because obviously now you're gonna cool down again if you don't go to your VO2 max test now. So that means also like have a small sip of water, something like this if you want to do that. Also, before you start your warm up, it can be good things if you have something carbohydrate based, you consume a little bit of that. Some people would say, ah, I don't like this because it could influence.

• 41:01Dr. Peter Attia?

  Yeah, it can influence the RQ.

• 41:03Speaker 01

  Yeah, but then again, this is something I would say that a sub maximal, yes, maximal, it won't do that very much because the closer you get to your metabolic steady state or maximal metabolic steady state and then above, basically things start to homogenize. Yeah.

• 41:17Dr. Peter Attia?

  We tend to do these separately now, so we don't use the day of the VO2 max test to do the fuel partitioning test. So we wanna measure fat oxidation on a totally different day. We'll usually separate by a day even. So you'll do your VO2 max test on Monday. And we'll do it this kind of way where we begin to agree completely, like you should have all the carbs in the world. We actually like to standardize the fat oxidation test to a fasting test. That way, it's just always the same. You're gonna do it in the morning, you're fasted. It's a submaximal effort. We're not pushing you to maximum because we're just pushing to see what your maximum fat oxidation is.

• 41:49Speaker 01

  This is a good way to open up, let's say, a little bit the door to how we, because again, we are the edge cases where basically we have to do the research ourselves. One thing we have to consider is that when we do gas exchange measurements, for example, to understand a little bit substrate metabolism.

• 42:04Dr. Peter Attia?

  What's your preferred in lab test? Do you use Parvo?

• 42:07Speaker 01

  No, we use a device which is still on all device. There are two devices I like to use. One is the Jagger Oxycon Pro with a mixing chamber, and this is important. The Parvo has a mixing chamber as well, but we have the Oxycon Jagger Pro. When I've been testing in the US, for example, on elite athletes or Olympic athletes, then we have used the Parvo simply because that's the one that has been here. Europe is more use the Jagger. We don't use, maybe I shouldn't say that, we don't use the Ventucip X, which is the successor of Jagger Oxycon Pro. This is one of the devices. We use also the AEI Moxus, but this is more of our. For specially interested people. We use also the VO2 Master actually quite significantly. And more and more of the testing actually have gone over to the VO2 Master.

• 42:51Speaker 01

  We have been fortunate enough to working with them for some while. So we have the CO2 version as well. But this is where it has been in alpha mode. And it requires also completely different skills than what you would normally require. But the reason also why we do that is again also for one of the reasons you experienced is that you see that your VO2 max is maybe a little bit different when you are out and cycling and do the efforts and not inside a laboratory. Because also we have to remember that VO2 max is on the one side. We said it's the highest oxygen consumption normally as they normalize over one minute. That is a result of how much muscles that are involved in the work there. So obviously modality will influence this quite a bit as well.

• 43:29Dr. Peter Attia?

  Which is why I was surprised when you said the guys were lower in swimming than cycling and running, even though I realized that their efficiency in swimming is relative to the world's best, less than it is in cycling and running, where they would be closer to the world's elite. But I would have just thought more muscles would have meant higher O2 consumption.

• 43:47Speaker 01

  Let me shed some light on it because that was basically when I started working with Christian and Gustav. Where they are today is that basically there are virtually no difference between swimming, cycling and running.

• 43:55Dr. Peter Attia?

  Same VO2 max.

• 43:57Speaker 01

  More or less on the three disciplines. But it has again to do exactly like you said. You can manipulate your VO2 max by that you are targeting, let's say typically shorter duration efforts. And so you start recruiting more, learn to recruit a little bit more and also train, let's say fibers that you are not normally used to use so much. And this is also something that is highly plastic, much more plastic than we ever have thought it was before. To the point where we have leading researchers in Norway that have solely focused on VO2 max. And let's say they went into schools where they've done this for decades. But where we even sat down and we looked at the data and thought something has to be wrong. And that comes actually from the period when we switched from Tokyo Olympics and then on to Ironman. And basically we saw a decline in VO2 max. From me, not unexpected.

• 44:42Speaker 01

  But more, there hasn't been done on this, so it was actually quite nice to measure.

• 44:46Dr. Peter Attia?

  Was the decline how much?

• 44:48Speaker 01

  So the decline in absolute, or let's say in relative VO2 max, and so it makes more sense for people, is that Christian and Gustav typically, the highest numbers we have had on them are very, very high. Highest numbers ever measured in history.

• 45:00Dr. Peter Attia?

  I mean, ninety?

• 45:02Speaker 01

  Well, Christian, we've had measurements with him actually invalidated. But on him, we have exceeded in absolute terms, seven point seven, seven point eight liters per minute in oxygen uptake.

• 45:15Dr. Peter Attia?

  At what, seventy-five kilos?

• 45:16Speaker 01

  Uh, no, so at that time, he was around eighty kilograms, so just let's say around a hundred milliliter per minute per kilogram in oxygen uptake. So Gustav is a little bit smaller, so he has a little bit lower oxygen uptake than what Christian have. But he has the highest, he clocked in around, let's say, ninety-four milliliter per minute per kilogram, something like this at the highest. But I would say that this is not beneficial for what they are doing.

• 45:40Dr. Peter Attia?

  Of course. I think anybody who's done this type of testing and done this kind of work, they'll have an appreciation for what those numbers mean, which is to say, I'm trying to come up with an analogy for another sport to explain what that would be. That would sort of be like, I don't know how to compare it to non-endurance sports. It's like saying, in an NBA basketball game, occasionally they score a hundred points. It doesn't compute. It doesn't really compute that they could utilize that much oxygen.

• 46:07Speaker 01

  Yeah. So the interesting thing there and the good thing about it is that this was something we reproduced over three months.

• 46:13Dr. Peter Attia?

  But the training at that time was presumably geared specifically towards VO2 maximization. It was short distance, it was interval based?

• 46:21Speaker 01

  Well, actually, yes, it was. But this is also where, one place where we resonate a lot. VO2 max is the single best metric we probably have for anything that is related to human health and performance. But it is also where we understand that it's a little bit more nuanced than that. And now I'm not talking about it as pure as a predictor for your race performance, because that's a different domain. But where you could also say that you could still be healthier with a little bit lower VO2 max. And now I'm not talking because about that you put yourself through some Stress and all the things like this. So this becomes negative longer term. View to max is a one dimensional also unit again. We talk about something on a Y axis. Yes.

• 47:00Speaker 01

  We normalize it as a milliliter per minute. So you could say that it has a second axis to it, an X axis or time axis to as well, but. We don't say how long.

• 47:09Dr. Peter Attia?

  Over what duration? We don't get into capacity.

• 47:11Speaker 01

  Exactly. And this means also that you can trade off some of your view to max. And I would say that the very, very best predictor is capacity, like capacity is maybe the single best one. For everything, but the problem is that testing for capacity is such a brute force endeavor that it's not practical. It is really not practical. That's why view to max is, I would say, is the single best predictor of everything. Measured in a practical way. But for Christian, what was really nice when we did this, this is not only actually. Where we measured and I can say that we are at edge where there are things here. We don't understand. There are still things we are researching and like you said introductory, I'm in the applied world.

• 47:51Speaker 01

  And in the applied world means basically much more experimentation and understanding what happens here with some individuals. My sample size doesn't come from the population. It comes from the sheer amount of data. That I gather on these athletes. So it's not like a single view to max test. It is so many view to max tests that there's probably no other human in history. Where there have been true this testing protocols over time. Where we can correlate it to also a range of other metrics as well, both. Internally, but also external metrics. And that means that, for example, here to put this into context. The good thing is that when we do testing, I normally not only have Christian into the lab, I have also minimum of, let's say, one or two athletes as well into the lab.

• 48:33Speaker 01

  And our protocols are quite extensive. So this is also one thing that you have, we already talked about that protocols can have an influence on testing. And what you do before the protocol will have an influence on your view to max. That's exactly why we're discussing, should you warm up or should you not warm up? Yes, you should, because it will normally give you, let's say, a better result when you are warmed up. But that means also that the protocol will also have, can also then have an influence on your view to max measurements. And we normally do the view to max measurements at the end of our test, which is, you would say, ah, but that's. Normal, yes, well, we also do that simply because it also more normally simulates what they're also gonna see on racing. So normally what happens in racing is that you normally also will go closer to, let's say, complete exhaustion when you get towards the end of the race.

• 49:16Speaker 01

  And this is why it's interesting to test it there. But we don't only test it once, we even repeat it. So we do two view to max test, just ten minutes apart. And even this year, we did even three tests, let's say with less, or ten minutes apart as well. Interesting thing here is that what we see is that you normally don't get your highest view to max on the first one, even though you exhausted. We even see that even on the second one. More interesting need to also deserve here is that then you would think that, I say intuitively, you can say that, okay, you would maybe also then see a higher carbon dioxide production as well. You don't, that's actually lowered. That has to, let's say, call it some priming effects, more in general terms. But also what we do see is that there are some substrates as well that actually do influence or micronutrients also that actually also are can help boost your view to max as well.

• 50:00Dr. Peter Attia?

  Such as?

• 50:01Speaker 01

  Long story short, beetroot's obviously have been something that people have found quite interesting over a long time.

• 50:07Dr. Peter Attia?

  Beetroot?

• 50:08Speaker 01

  Beetroot, yeah. So they use beetroot concentrates. And the main thinking behind is that when you eat nitrate, which beetroot is normally rich in, and the body converts this to nitric oxide. This helps for vasodilation. So vasodilation, you can think of it as almost like a plumbing. In our body, we already said that from our previous conversation, that basically cellular respiration is not the limitation to your view to max. So there are other things that are limiting factor. That means also that, for example, your cardiovascular system, meaning also actually your ability to transport blood around in your body is gonna be important. For example, one of the reasons why, when you then use some supplements like, that are highly enriched in nitrate, so you get a nitric oxide boost,

• 50:52Speaker 01

  is that this was actually, it's almost like the plumbing. You're opening up the plumbing and it allows your blood to circulate faster throughout your body. This is hard to reproduce in elite athletes. Like in amateur athletes, we normally see that this has a positive effect.

• 51:03Dr. Peter Attia?

  How much of an effect? Five percent? Something measurable?

• 51:07Speaker 01

  Let's say something like that and then take that with a grain of salt.

• 51:10Dr. Peter Attia?

  These are not people that are out there literally eating endless beetroot so you could buy as a supplement.

• 51:14Speaker 01

  Yeah, concentrate.

• 51:15Dr. Peter Attia?

  Now, would it be anything that increases nitric oxide?

• 51:18Speaker 01

  So that's the thing, because one thing that we don't see this, we don't see these effects in elites, for example, and this is obviously one of the benefits when we do more longitudinal studies with such, let's say, granularity and in-depth measurements we do. And one of the things we see there is that when they use beetroot concentrate, nitrates are considered ergogenic aid. When you do all these measurements, you leave out the guesswork and we see, well, over all the testing we do, we have not seen a real effect, or at least not on V2Max, maybe other places, but it doesn't seem to have any effect on V2Max.

• 51:51Dr. Peter Attia?

  Because they're already optimized in that regard.

• 51:53Speaker 01

  Probably, or maybe there are other limiting factors instead. We were approached by a company that is called Plasmaid, and they actually focus more on the other part of it. Let's say the catalyst that actually help, because you have to convert nitrate into nitric oxide, and there's a cost to this. So what they did instead is that they made from pine bark extracts, instead they made adaptogen, or they extracted an adaptogen that helps catalyze this process. And the interesting thing with this adaptogen is that, again, now we are a place, we can just look at the observations and repeated observations over time, and we can't necessarily explain 100% yet, so it becomes more speculations. But from those, what we can only speculate or hypothesize is that what happens here

• 52:36Speaker 01

  when they use this Plasmaid is that, I remember when we got this first presented, I was thinking, okay, we have tested nitric oxide or nitrate, it really didn't give any help, so why should this really give a help, or basically give any, make a difference? The interesting thing is that Christian and Gusta were quite positive, so they said, okay, fine, we're gonna use this. We were just gonna test it, we had a bunch of them laying around there, and they said, okay, let's try it. I thought, okay, fine. Gusta was the first one to say immediately that he felt it did something with his respiration. Also, it's a little bit the placebo as well, of like, okay, how much of this is placebo? How much of this is real? Like, you get something new and say, oh, looking for something in your body. And Christian also, but he observed a little bit like a different effect to him. He felt more like he normally felt.

• 53:20Speaker 01

  Quicker ready for the next effort using this. But I would say that these record measurements that we did came in the tail of when we started using this. And that was a little bit of shock because what we also saw at the same time was that the efficiency, so the biochemical efficiency in the body also went down. The interesting thing was the RQ was heavily, on the CO2 side, was slightly reduced. The VO2 were heavily increased.

• 53:43Dr. Peter Attia?

  Tell folks what RQ is and what the reduction would imply.

• 53:47Speaker 01

  At the end, normally you would say that for a VO2 max test to be valid, one of the criteria is that you should meet 1.1 in RQ.

• 53:53Dr. Peter Attia?

  Meaning you have 10% more production of CO2 than consumption of oxygen.

• 53:59Speaker 01

  Yes, in elite athletes, this is sometimes hard. In the best trained elite athletes, bringing them to 1.1 during the test can actually be quite challenging. So if you have a short warmer protocol, they are not well warmed up and all these kind of things, then you would be easily be able to exceed this. But if you do it more in a simulation like we did, or you have longer protocols before, you normally see that this is a little bit suppressed. So let's say that Christian normally on a VO2 max test, or let's say at the end of the VO2 max effort, he would basically click in at, let's say, 105. Then after we started using these supplements, we could see suddenly not 103 or 102, we basically dropped it by 10 points. So basically to 0.95 instead.

• 54:38Dr. Peter Attia?

  Preserving the VO2?

• 54:39Speaker 01

  No, the CO2 was basically not as much changed.

• 54:42Dr. Peter Attia?

  So the VO2 was increasing?

• 54:44Speaker 01

  Yes, so VO2 went up quite a bit. The good thing here is that now I have two other athletes obviously in the lab at the same time. So I have one athlete comes in before Christian, so I already do dynamic calibration of the machines before. We also have a lung simulator just because we are working with edge cases. So we need to independently validate the machines as well. So this means basically we have a large gas tank with a reference gas beyond what is used for just the calibration. But we have a separate system where basically you have a lung simulator where we feed in, for example, 6 liters of oxygen, 6 liters of CO2, and we know this is the exact amount in the bottle, gravimetrically calibrated. And then if we don't get this out of the machine, then there's something wrong with the machine independently of the calibration. But the good thing here is that despite this, first athlete in, numbers are where you expect them to be based on the training we did before. Christian comes in.

• 55:30Speaker 01

  You start to see some numbers that are crazy and you start, did I do something wrong here in the calibration process or anything like this? But then also when you validate it afterwards as well, you basically know this is, the numbers are good. And then this we did then over, this was in December, January and February over nine tests more or less. We saw a little bit over time that actually V two max started to come down a little bit because what this indicated also was that his biochemical efficiency was not optimal either. What that means again is that if you look at basically his oxygen consumption versus his power, so the power. Power was higher as well, but the ratio was not the same as it was before. V two had gone up much more than the power enough.

• 56:11Dr. Peter Attia?

  Suggesting efficiency is going down.

• 56:13Speaker 01

  Yes, efficiency is going down and this was then efficiency go down. Well, can we somehow get an understanding of this? And this is of course, on these tests, they actually are using a temperature pill. So we put a pill up their ass. And also at the same time, we have multiple of core sensors around on the body to also measure the temperature of the body as well. And where we basically see the same thing, we basically see an increased heat production for the same power output. Basically indicating the same. You can basically think of that. The reason why you have gas exchanges is because we call this indirect calometry.

• 56:42Dr. Peter Attia?

  It's not useful oxygen. It's actually the worst thing you could possibly have because you're also utilizing more fuel. So now you've created a scenario where for the same amount of power, not just you need more oxygen, oxygen is free, you're going to need more glucose.

• 56:56Speaker 01

  Well, actually not more glucose because since the RQ here is basically also now in favor, you actually are able to oxidize more fats.

• 57:04Dr. Peter Attia?

  Oh, that's interesting. Yeah. So you're saying because the RQ came in the same. You're going to hold carbohydrate metabolism constant and you're actually increasing fat oxidation.

• 57:15Speaker 01

  Yes.

• 57:16Dr. Peter Attia?

  And that works out perfectly in the stoichiometry?

• 57:19Speaker 01

  Um, pretty close.

• 57:20Dr. Peter Attia?

  It's counterintuitive.

• 57:22Speaker 01

  This is a rabbit hole I would like to go down into, but

• 57:24Dr. Peter Attia?

  We'll delve gently, we'll delve very gently for the four people that are still listening to us.

• 57:28Speaker 01

  Yeah, because also the difficulty with this is that if you just look up purely the RQ of where basically the thresholds is as well for elite athletes or for any athlete that you have in the laboratory. From some literature, you would just say, okay, if you have an RQ, let's say around talking about thresholds, you'll find several places in research literature where they basically just use an RQ of 0.96 as a proxy for your anaerobic threshold, for example. But this is something that you also see is differing. If you basically take an athlete in a training for short course or basically for sprinting, you will basically see that then basically you have an RQ that is higher than 0.96. If you go to extreme endurance athletes, this actually gets closer to 0.94, 93, 92 even. So the implication of this is that if you then measure the lactate threshold, you will actually come into a zone already at 0.92, 0.93,

• 58:13Speaker 01

  where you actually are starting just as a function of time now, you will get a higher lactate concentration in your body. And if you take that lactate concentration now and you calculate the volume of lactate that is available in your body, you'll actually see that the volume of lactate now becomes a significant contributor to actually your energy production.

• 58:31Dr. Peter Attia?

  But you have to know plasma volume pretty well to make that calculation, right?

• 58:34Speaker 01

  Yes, so plasma volume, but this is the good thing. We have our own machine for measuring carbon monosour re-breeder. So we do regularly also testing of basically their blood volume, plasma volume and hemoglobin mass as well. When we do this testing as well. And of course, you want to know also something about the water content in the body as well. There are different ways, a gold standard is probably double label water and we've done this as well. But the point is that to give you an example, you can easily at 0.92, 0.93 go from, let's say that if you consider normal lactate levels, or let's say if we then take it into volumes, it would mean that the energy contribution from lactate could be, for example, five. But if you just stay long enough there, basically you would say that, okay, if these were the levels,

• 59:16Speaker 01

  you're talking about now 13, 14% energy contribution from lactate. And the problem with this is that all the tables we have today, which basically look as a ratio where you use RQ to say something about the ratio between carbohydrates and fats. We normally say that, well, this is good up to an RER of one, but above one, we don't do it anymore because exactly lactate and other things becomes a too large contributor to it. So this already tells us that we have to be also cautious when we look at RQ and just go crudely into a table and just say, okay, this is your fat metabolism, this is your carbohydrate metabolism, because it is

• 59:48Dr. Peter Attia?

  Do you feel we can do that safely up to one?

• 59:51Speaker 01

  No.

• 59:52Dr. Peter Attia?

  Not even.

• 59:52Speaker 01

  No, no, no, not even. I would say that for elite athletes, if you're an endurance athlete, I would already start be skeptical around in the low nineties.

• 1:00:00Dr. Peter Attia?

  Hmm. Very interesting. Sorry, one other question there. What RQ are you typically seeing for maximum fat oxidation? Not obviously percent of fat oxidation, which is low, but in absolute grams per minute max fat oxidation at an elite athlete who's on a high carb diet, you're typically seeing that at what RQ?

• 1:00:21Speaker 01

  That's a longer time since I basically really paid a lot of attention to that.

• 1:00:26Dr. Peter Attia?

  Because I would have to imagine that that corresponds very closely to their race pace.

• 1:00:32Speaker 01

  No, because here it also gets a little bit more complicated simply because one of the things we do, because we also do isotope tracing also of substrates as well. We've used quite a lot of carbon 13 or 13 carbon over the last years. And we added that as a tracer to glucose and fructose, for example, to look at how much of the exogenous carbohydrates, to use a more common term, how much of the carbohydrates that you ingest, that you're able to utilize. Because obviously you have.

• 1:00:57Dr. Peter Attia?

  You have your own glycogen and your own fatty acid.

• 1:00:59Speaker 01

  Yeah. And then you won't understand how much. And this is also where exactly when you look at even view to max, this starts also to become where you understand that in our context, this is a little bit of less valuable, less valuable purely. Because if you took Christian, for example, or Gustav, and you tested just before race. So you did exactly the protocol we just talked about. You did the step to warm up, a short effort, just to make your body ready. Then you did a graded exercise test to view to max. Okay, fine. You went out, you did your racing. And then basically, at the moment you come over the finish line, you test this again, or even half an hour afterwards. It would matter a little bit, but not that much. You will basically see the race pace is actually now coming to the point where it's extremely close.

• 1:01:42Speaker 01

  Like your utilization from the beginning of the race to the end of the race have completely changed significantly.

• 1:01:48Dr. Peter Attia?

  Sorry, you're saying fuel utilization?

• 1:01:50Speaker 01

  Yes, not only your fuel utilization, but also actually would also imply fuel utilization, but also your threshold sits now so much closer to, yeah, yeah.

• 1:01:59Dr. Peter Attia?

  This is hilarious. It was about an hour ago that we got off onto this tangent in response to what you said, which was at the most elite level, their race pace is above 90% of their VO2 max.

• 1:02:14Speaker 01

  For elite marathoners, yes. And also for Christian and Gustav, when they do Ironman racing, this is getting, let's say, indoors domain. We can't push it all the way because it has some implications.

• 1:02:22Dr. Peter Attia?

  This is just impossible for me to wrap my head around. This means that someone whose VO2 max is five liters per minute, if they're elite, which means they're obviously pretty light, they're gonna spend an entire Ironman at 4.5 liters per minute.

• 1:02:39Speaker 01

  No. The thing is that what will happen here is that this will actually come down. So your VO2 max that they don't have.

• 1:02:44Dr. Peter Attia?

  Oh, their VO2 max is declining and therefore it's, okay, okay. That's what I wanted to make sure of. Because I was like, how in the hell can they hold 4.5 liters per minute? Or in their case, 7.2 liters per minute?

• 1:02:55Speaker 01

  So this is the difference. This is the interesting thing, because this is the difference. The consequence of aiming for Ironman is that you want to have a minimal decline in this.

• 1:03:02Dr. Peter Attia?

  Yes, and you need a lower VO2 max.

• 1:03:04Speaker 01

  Because that has to do with priority and training. You can't prioritize having like a high one-minute power or five-minute power, simply because it's too far away from specificity of what you really need there. So if you start building good sessions with, where you basically are looking to increase your one-minute power, five-minute power, that's obviously gonna have a cost for the whole week that you are doing of training.

• 1:03:23Dr. Peter Attia?

  So let's talk about that now in the context of the Olympics. So you talk about an athlete like Christian or Gustav, where in theory, they want to be able to go between three distances, in theory. Olympic distance, half Ironman, Ironman.

• 1:03:37Speaker 01

  Yes.

• 1:03:38Dr. Peter Attia?

  Let's remind people what the distance is. Olympic is 1.5 kilometer swim, 40 kilometer bike, 10 kilometer run. Elites are doing this in an hour 45-ish?

• 1:03:49Speaker 01

  Yeah.

• 1:03:50Dr. Peter Attia?

  Okay, half Ironman. Well, let's just do Ironman. 2.4 mile swim, so 4K swim.

• 1:03:56Speaker 01

  3.8K. Yep.

• 1:03:57Dr. Peter Attia?

  Yep, 112 bike, so 180K bike, marathon run, 42K. The best in the world are doing this in seven-ish, seven and a half. What are they doing it in?

• 1:04:09Speaker 01

  Christian is the record holder still. He actually did it on his debut and it still stands.

• 1:04:14Dr. Peter Attia?

  What was the time? Seven?

• 1:04:15Speaker 01

  Seven twenty-one.

• 1:04:16Dr. Peter Attia?

  Seven and a half to eight hours. And then half Ironman is you take one of those last distances and you cut it in half. So just under two kilometer swim, 90K bike and call it a 21K run. So roughly twice the Olympic distance in some regards, less in others. And again, they're doing this in three and a half hours. So these are three very different events. Is it possible to be elite in all of them?

• 1:04:41Speaker 01

  This is also quite interesting because one of the main differences, I would say, that differs them, call them us or compared to the specialists in the sports is actually not their metabolism. If you look at their V two max on running, cycling and swimming, you will actually see that they are equally or higher than their peers in those sports, but their efficiency is not the same. This comes probably most down to the fact that they have to do three different sports. You don't get the same time of just pure stimulus, mechanical stimulus from doing something and optimizing it because you have to change. And it also has some priorities also as well. In running, you could say you don't want to compromise on your leg stiffness at all. In cycling, this is a little bit more beneficial to do this, for example.

• 1:05:25Speaker 01

  So here you have to strike a balance between the three, which makes it very complex. But in swimming, they are higher than the highest V two max that are measured on elite swimmers in the world. But the difference is also I had the bronze medal.

• 1:05:36Dr. Peter Attia?

  The efficiency is unbelievable.

• 1:05:37Speaker 01

  It is so poor. It is so poor. It's actually funny. I think we talked about this last time. I had one of the best swimmers in the world in the flume and tested him and he is a big guy, 195, 100 kilogram, close to 100 kilograms. Muscles all over. And then Christian into the flume at the same, basically same velocity. I don't remember exactly what this velocity is now, but basically. This big guy.

• 1:06:01Dr. Peter Attia?

  And the flume is an endless pool?

• 1:06:03Speaker 01

  Yes.

• 1:06:03Dr. Peter Attia?

  It's a stationary swimming pool?

• 1:06:05Speaker 01

  The difference here is that endless pool, very often people think of this a counter current, where there's a lot of turbulence. Here we are talking about something which is virtually laminar flow that goes through. So it's a big canal, which is circulating the water on the outside and it comes back in the front. And you have even honeycomb structures in the front and the back.

• 1:06:21Dr. Peter Attia?

  So it truly replicates swimming stationary. So it's the closest thing we have to an aero tunnel for swimming.

• 1:06:26Speaker 01

  Same. Yeah, yeah.

• 1:06:27Dr. Peter Attia?

  Does it allow you to use dye in the water or anything like that? Bubbles, I assume you use to?

• 1:06:32Speaker 01

  You can, yeah, yeah. The thing here is that when you look at these two guys now swimming.

• 1:06:37Dr. Peter Attia?

  So you put them at the same speed?

• 1:06:38Speaker 01

  Same speed.

• 1:06:38Dr. Peter Attia?

  Okay.

• 1:06:39Speaker 01

  The lead swimmer, he is even retired. First of all, Christian, eight kilograms. This guy, closer to a hundred kilograms. And that's not because of fats. He is lean, he is well trained still.

• 1:06:50Dr. Peter Attia?

  All things equal, he should be much higher in his VO2 at that moment in time. He's simply supporting more muscle.

• 1:06:55Speaker 01

  Much more muscles involved and bigger proportions. He's utilizing twenty-five percent less oxygen than Christian.

• 1:07:01Dr. Peter Attia?

  In an absolute term.

• 1:07:02Speaker 01

  Yeah, absolute terms, yeah.

• 1:07:04Dr. Peter Attia?

  On a relative basis, a third less oxygen.

• 1:07:06Speaker 01

  Yeah, which is still crazy. Yeah.

• 1:07:09Dr. Peter Attia?

  Here's my thesis on swimming. Of all the three big endurance sports, I feel like swimming has the most potential for radical change in performance based on drag avoidance. All of these sports, but especially swimming and cycling, come down to propulsion versus drag. Running is less so because these speeds aren't high enough relative to air. Obviously, swimming, just so people listening understand why I would say that, swimming is much slower than running, but the density of water is, what is it, thirteen hundred times that of air. So you don't need a high V squared to get a lot of drag, just based on the density of the medium you're in, which is water. So in that sense, cycling and especially swimming really come down to this ability to avoid drag.

• 1:07:51Dr. Peter Attia?

  And that's why in a time trial, position matters so much on a bike and how can you generate power, even if you have to compromise your power there? So I feel like in swimming, there could be like a massive breakthrough if a technique emerged that reduced output or power or forward propulsion by ten percent, but reduced. Dragged by 20%, you know what I mean? Like, again, I'm so far from this sport, I don't know. But like, to me, I would really be curious as to that. Because again, remember, this happened in cycling in the eighties, where prior to that, nobody was paying attention to bike position. And then Francesco Moser comes along in 1984, smashes the one hour record with all this crazy aero equipment. And then, of course, you got into Boardman and all these guys

• 1:08:35Dr. Peter Attia?

  getting into more and more crazy aero positions, where their actual power went down relative to what they could have been in a less kinked position. But of course, their speed went up because the CDA goes down. And I just wonder, like, do you ever think about that in swimming? Is there some major disruption where we just have this dramatic change in technique to have a bigger positive impact on frontal surface area than the negative effect it might have on propulsion?

• 1:09:00Speaker 01

  Yeah, so this then touches up on one of my favorite areas, and that's biofeedback. In cycling, we have extremely good tools for biofeedback today. You have a power meter and you have a GPS. So just these two combined, for example.

• 1:09:14Dr. Peter Attia?

  Speed and power perfectly.

• 1:09:15Speaker 01

  Like we talked about last time when you were out riding 200 watts constant, and basically you see you're getting faster. So you have this direct biofeedback because you, as long as you ride enough, you will basically start to get a very good feeling for when you sit at a certain power and you start to do different things. Suddenly, you creep up like half a kilometer power or one. Like for a person, when they start cycling or they're cycling a little bit, like for them, it doesn't become interesting enough yet because there are other things that is basically more challenging for them to master. But for people that do a lot of biking like yourself, it's where you exactly start to pay attention to those, let's say even half a kilometer per hour, maybe even you're getting below that as well, where you start to really pay attention to this. And then over time, simply was because wind and other factors makes a difference too.

• 1:09:58Speaker 01

  Running, this is also a place where we have really good biofeedback tools. You have your watch, you're running, and you can have a look at it. And now we have also really good power meters in running as well.

• 1:10:06Dr. Peter Attia?

  How does that work?

• 1:10:07Speaker 01

  So most of these, there are some of these power meters in running today that requires an insole. So you put basically an insole inside and it measures the forces.

• 1:10:14Dr. Peter Attia?

  So it's a force plate?

• 1:10:15Speaker 01

  Yes.

• 1:10:16Dr. Peter Attia?

  Inside your shoe?

• 1:10:16Speaker 01

  Yes, yeah. And then you have other ones that are more motion capture devices. So they basically, you rather input your body weight. And since when you're touching on the ground with one foot, you're basically carrying your whole weight there. So as long as you have a good enough motion capture device that are capable of capture the three dimensional accelerations, you can then basically also say some, well, you know the force because you basically have to carry your weight.

• 1:10:38Dr. Peter Attia?

  So you can directly measure this with a force plate insole, or you could indirectly do it with motion capture. But I assume the motion capture only works on a treadmill.

• 1:10:46Speaker 01

  No, so the motion captures today, they are become so small. They are basically a small device that you attach to your shoe. And they are when we validate these.

• 1:10:53Dr. Peter Attia?

  Are these commercially available products?

• 1:10:54Speaker 01

  Yes, yes. If you go to a laboratory and you basically test this, you will basically see that. So we have been for a long time in working together with Stride. I started working with them when they were in beta stage and we've gone through there. But they are so accurate today that when you measure on an athlete.

• 1:11:11Dr. Peter Attia?

  First of all, do you have any idea how much you just ruined my wife's life? Do you have any? So how many minutes do you think after this podcast, am I going to be on my computer ordering these devices, jamming them on her shoes? You know, she's running the Boston Marathon next year, and I'm convinced she's actually going to run it faster than she did her first Boston Marathon 20 years ago. Cause she actually now works with a running coach. And her qualifying time this year was only one minute slower than her qualifying time 19 years earlier. And again, it's just because she's more structured in her training, not because she listens to a word I say, she doesn't. But she's like finally at least agreeing to use heart rate and velocity for tempo training. She's not listening to this podcast, obviously.

• 1:11:55Dr. Peter Attia?

  One of her friends will probably hear this and tell her to listen. But we're going to implement power training for her running. And she's going to curse me all day long because she doesn't want data. But how is every runner not doing this?

• 1:12:06Speaker 01

  I think this has to do with a lot with tradition. And also that even when power meters were introduced, it's easy to look back and say like, why didn't we have this before? Or even how power, there are so much information we can extract from a single power meter today, which is, I say, beyond people's comprehension. Still, we only use the power number that is there. And we use it even in a one dimensional context. FTP, for example, or critical power. The amount of information you can get out of this is crazy because we are not going to talk about this today.

• 1:12:33Dr. Peter Attia?

  We still kind of use normalized power and other.

• 1:12:36Speaker 01

  No.

• 1:12:36Dr. Peter Attia?

  We never use it?

• 1:12:38Speaker 01

  No, we only go by raw numbers. I only work by raw numbers all the time. So I don't condense it down to a single metric. I use only raw numbers. But the implication here is that even when you look at studies that are looking at. Gross efficiency, for example, in the old days or even today, one thing you consider is the net mechanical power. So the interface between basically looking at your gross efficiency is where you take VO2 and we're already there. Most people understand that, okay, you have a difference between net oxygen consumption and gross oxygen consumption. You would ideally like to have the net oxygen consumption. There are other things there, but in cycling, actually also what we only consider is the net mechanical power. You don't consider the gross mechanical power on your biochemical efficiency. You should not look at the net mechanical power, you should look at the gross mechanical power.

• 1:13:19Speaker 01

  But that's even before we start to get into vectors, power vectors, force vectors and other things, even in a three dimensional plane as you do cycling, because this is something we can extract from the power meters today.

• 1:13:29Dr. Peter Attia?

  So when running, you have more degrees of freedom, there's more inefficiency. There's probably a lower relationship, a more strained relationship between gross and net power.

• 1:13:40Speaker 01

  This is maybe one of the reasons for why it is not as widely adopted in running as it is in cycling, because it is still debated what really is running power, how do you really quantify it? And this is something that I even discussed with the team at Stride. So when we are having our regular calls and we are diving into the topic, even we also sometime have our different opinions on how this really should be looked at. Because if you want to translate this into running, then you have to look at only at the propulsive power.

• 1:14:08Dr. Peter Attia?

  Could you imagine seeing this? Have they put these in Olympic sprinters?

• 1:14:11Speaker 01

  The power numbers there?

• 1:14:12Dr. Peter Attia?

  Yeah.

• 1:14:12Speaker 01

  No, commercially available, this has its limitations because since you do motion capture, you need to do a little bit of filtering. You can't take out because it's going to be so much noise exactly because as you said, you have so many degrees of freedom. If you're going to output all the vectors that basically you were able to measure with strain gauge based power meters on a bike today, people wouldn't be able to utilize. That's why you condense it down to a single number that is there for most people.

• 1:14:35Dr. Peter Attia?

  If you had that force plate chip in their insole, you could at least capture force normalized to weight with each step, right?

• 1:14:42Speaker 01

  Yes. So what you can do, and this is validated. So if you, for example, run on a track, a track which has force plates or you run on specialized treadmills that has force plates integrated in them, you will basically see that the curves are the same. So this is the way, let's say, this is the external validation of the device is good, both in terms of that it captures. The force curves, but also here, when you have motion capture devices, you can also capture the footpath as well. So this is something we can visualize in 3D today after the event when you are doing running. We can see what happened there, fresh, fatigued throughout the race when it's technical and all the things. But I think the reason why this is not as widely adopted is because in science, this is still debated on how do we really capture and quantify mechanical power for running.

• 1:15:23Speaker 01

  Stride have taken a smart approach to this to make it commercially viable. And that is that they output it as a metabolic power. So if you actually went on a treadmill and you went running and you looked at it versus your oxygen consumption, you will basically see that this matches perfectly with cycling. That's without having a bicycle near you at all. So you could say, well, this is what you expect. So when you have the certain power, then this would have a certain metabolic cost. I don't like it because I don't like modeled numbers. I want to have raw numbers. So in my case, I'm extracting the net and the gross mechanical power or the positive and the negative mechanical power, because these are the components I want to have, because I have VO2 master, I have metabolic devices. I don't need a metabolic equivalent. I want to have the raw because I'm using as an interface to gorge the difference.

• 1:16:07Speaker 01

  Like, for example, on a Formula One car, what really matters in the end there? How fast can you go around the track for the full event with a certain amount of fuel? Because there is a limitation to how much fuel you can have in your car. That's the true input and the true output. Your engine output in this kind of thing is actually secondary. It's easy to think, oh, we want to have the biggest engine. But big engine without efficiency is still bad. The engine, it becomes more of a device to measure. Let's say you look at the power and you look at how efficiently are you able to translate this fuel out into speed over, let's say, the event or velocity. For me, having access to the net mechanical power and gross mechanical power, and then you have the metabolic devices, this allow me on the one side, look at when we change something in running. So let's say you change, for example, your shoes or you change your training.

• 1:16:50Speaker 01

  You can now have a much more granular understanding of, am I influencing the biomechanical part of the training? Or is it the biochemical part of the training? But in order to do so, you have to have that interface that distinguishes between gross mechanical power and net mechanical power. And the interface between gross mechanical power and net mechanical power is only the, let's say, work efficiency. How efficiently are you working, but not metabolizing or moving? Because in the end, you have to take this power and be able to output into velocity.

• 1:17:17Dr. Peter Attia?

  If you're looking at a cyclist, for example, can you make a statement using something so simple? So if you had 10 different cyclists and you did a VO2 max test on all of them, and each of them you end up getting a number, which is going to be, let's normalize it to weight. So you line them up in rank order from the lowest to the highest in milliliters per minute per kilogram. And then you look at what power they were at when they achieved that VO2 max, and you normalize that to weight to watts per kilogram. It's not going to be a one-to-one match.

• 1:17:48Speaker 01

  The interesting thing is that when you are getting close to VO2 max, then it's getting close to a one-to-one match, actually. But at submaximal, it doesn't. A submaximal you would normally see in running, simply because it's a weight-bearing sport.

• 1:17:58Dr. Peter Attia?

  Just to make sure I understand that. Are you saying that the rank order will be identical for VO2 max and watts per kilo at VO2 max in cycling?

• 1:18:08Speaker 01

  In running and cycling at maximal effort, so basically at VO2 max, pretty much the same, yeah.

• 1:18:13Dr. Peter Attia?

  But I feel like my personal power at VO2 max is lower than many other people's at a comparable VO2 max. Like, I just feel like I'm very inefficient. I have a higher VO2 max than a PVO2 max, if that makes sense.

• 1:18:27Speaker 01

  Yeah, and that's because probably there is a lot of anaerobic contribution in there as well, that basically supplies that gap that you're observing there, too.

• 1:18:34Dr. Peter Attia?

  Oh, you're saying I'm anaerobically not trained enough, and that's why my power, yeah, I'm too aerobic, not anaerobic enough?

• 1:18:42Speaker 01

  Yeah.

• 1:18:42Dr. Peter Attia?

  Great point. That's a very interesting point.

• 1:18:44Speaker 01

  So the thing here is, for Christian Gusteau, obviously being, or we're trying to keep exactly the training as balanced as possible between the three sports, there you will normally see at maximal effort that actually that the power also is pretty much the same. The mechanical power is pretty much at the VO2 max. But as you go at submaximal effort, then that's where you start to observe the big differences. Because in cycling, you would see that as you go down in intensity, basically because it's a weight-bearing sport, going from 15 to 16 kilometers power, or let's say 17, 18, 19, 20, and so on, basically what you see. But this is also observable exactly from metabolic cart as well. And that is, when you go at, let's say, a low intensity, you will see that your oxygen consumption also is higher at a perceived lower intensity in running. That it is in cycling because cycling is not weight bearing.

• 1:19:29Speaker 01

  So it's easy to go down to a very low intensity. Still keep a normal cadence because you can keep a cadence of eighty, ninety, for example. And it feels comfortable, feels comfortable and easy in this guy. But going down to those cadences is running is impractical because it means walking. You're not running anymore, so you're walking. So the modality is changing more in running. What kind of muscles are changing more in running than it does in cycling? Coming back to the question, original question of why isn't this more utilized in running? It is gradually getting more and more attention there, more and more people using it. I think what is still to be determined is to agree on a common standard for what number should be outputted.

• 1:20:08Dr. Peter Attia?

  In cycling, one could ask the question. So when the guys are on the bike, are they paying more attention? So let's just talk about them doing a four hour ride in an Ironman. Are they more concerned? Because you're triangulating between RPE, heart rate and power. How are they prioritizing those things? How they feel, what the heart rate is and what the power meter says? How are they regulating effort based on those things in a race?

• 1:20:32Speaker 01

  In training or racing?

• 1:20:33Dr. Peter Attia?

  Race.

• 1:20:34Speaker 01

  In racing, I would say that training, we use also many more sensors. And then we limited a little bit more in racing simply because it's not practical to do it there. But I would say that this is also a very interesting topic because then they touch a little bit more psychology, but we'll come back to that another time. But in racing, obviously, first and foremost, Ironman racing is so long, it's so long. And with all this practice, you shouldn't be slave to the numbers for sure. Because you can have suddenly your hero day where you're just able to go faster than what you normally do. So you need to listen to your body. So I would maybe say that RPE is the most important one in some senses. Or RPE is also a place where you can also talk about one dimension, two dimensions. Because RPE is normally, let's say, if you take Kip Shoge, when he did a two hour marathon, sub two hour marathon.

• 1:21:16Speaker 01

  If you put him on a treadmill and you did a normal step test on him and you asked him when he was at twenty one kilometer per hour and you ask him, how does this feel? He would say, for the sake of the discussion, we say that seven is a round threshold or anaerobic threshold. If you relate it to FTP, something you would be able to hold around an hour for a well trained athlete. Or what you would test for when you did a twenty millimeter protocol and then you subtract a five percent to extract. related to that. If you asked him at twenty one kilometre per hour, okay, how do you feel here? And he gives you an RPE score, he would maybe say, ah, this feels like a six when he has a twenty one kilometre per hour, actually slightly above. If you ask him at the end of a marathon, how do you feel? And he's still running the same pace, he will say probably ten, this is a nine to a ten. Because we forget again, there is another dimension, and that is a duration. That's the fatigue component that comes in there.

• 1:21:58Speaker 01

  And that's why it also helps sometimes to ask, I would say that when I ask Christian Gusto, or at least.

• 1:22:02Dr. Peter Attia?

  But also his heart rate might be different there, too. When you throw him on for a minute at twenty one KPH and he says RPE six, his heart rate's probably a lot lower than it would be two hours later at that pace, right?

• 1:22:14Speaker 01

  But that brings us back a little bit also to exactly utilization as well. Because one of the things that you would probably not be able to do, you won't be able to get yourself up to a maximum heart rate at the end of a race even. So your max heart rate, you could say, in many ways are limited at this time. But this is also when you then say, okay, but how on earth is it possible to ride at four point five litres when you have a five litre V two max? This is the key, obviously, in endurance sport, you want to increase this robustness. So when you're finding this optimum of between of where should my V two max is? This is what happens with specificity, that you're tuning this down exactly where you start and where you end becomes far less. And there's a whole range of implications to this.

• 1:22:55Speaker 01

  Because it comes down to, so why is this important? Couldn't you just have a higher V two max, coming into the race and just have a higher V two max? Well, the problem with that is that the heart also is a muscle and it's not very efficient muscle. So even the heart has energy, it's not an insignificant, it's actually a significant energy consumption as well. And if you have a heart that actually is trained for something different than what you really need, it means basically also your heart is gonna use energy more inefficiently.

• 1:23:19Dr. Peter Attia?

  How much lactate does the heart generate?

• 1:23:21Speaker 01

  Probably you are better suited to answering this. I probably read it sometime, but I've never done any research on that. I looked more at, let's say, when we broke down the body into components, it's more like where I looked at it basically as an energy consumption.

• 1:23:33Dr. Peter Attia?

  What's the mitochondrial density of cardiac muscle versus skeletal muscle? I mean, they're both similar in some ways, they're striated muscles. I should know that. I mean, your intuition would be it has to be very rich in mitochondria, right?

• 1:23:44Speaker 01

  Yes, then that's also why the heart obviously uses. Lactate also as a fuel source simply because it is probably full of I've never done a muscle biopsy of the heart itself. It would be interesting just to see what's the ratio between type one and type two fibers there. But I would almost imagine this is probably one of the muscles where you are as close as possible to.

• 1:24:04Dr. Peter Attia?

  Pure type one.

• 1:24:05Speaker 01

  Yeah, yeah, yeah.

• 1:24:05Dr. Peter Attia?

  Yeah, yeah. And I learned recently in the podcast with George Brooks that we can actually shuttle lactate into the mitochondria for oxidative phosphorylation. I was completely unaware of that. That would explain, of course, why the heart could richly use lactate.

• 1:24:19Speaker 01

  Yes, and this also comes down to Michael's constant, where you also look at the affinity for different substrate, also for different muscles as well. And where lactate has the highest affinity for most of these muscles as well, especially like the heart. But if you're going to bring this back up, a lot of the research, when you do apply research like we do, a lot of the times we can't actually use a lot of the research that is there to base our decisions on. I don't know if we talked about monocalic acid transporters last time or not, but one of the things that is there is that this is also a place where if you want to understand something, you can go in and you can do a concentration measurement. The problem very often with research is that we get a partial view of something, but it's only partial and it's not a complete view.

• 1:25:04Speaker 01

  And that means that, for example, most of the time for us to understand what really works and doesn't work, we have to work with just raw numbers. We talk about calometries, so we want to understand like what kind of substrates are being utilized here and how this is. One thing that we basically see when we're using isotope traces and we start to dig into this and we can also talk about actually maybe creating lactate as an artificial fuel. So in the same way that you take glucose and you create the supplements based on fructose and glucose and you use this as a fuel source or ketones or beta hydroxybutyrate. Then basically lactate actually is very interesting in that context, simply because it is extremely energy efficient. And that is in the end limitation for the that meets.

• 1:25:48Dr. Peter Attia?

  How difficult to deliver orally? I assume it's delivered in a salt.

• 1:25:53Speaker 01

  This is actually something we started discussing. The interesting thing of it is in a salt is that it could also then in that sense has a little bit the same effect as bicarbonate. So you could use it as a buffer.

• 1:26:04Dr. Peter Attia?

  Yeah, let's make sure folks understand the chemistry there. So I was going to actually ask you about this and then we got off onto another topic. I want to come back to that exact question, but we'll preface it with this question. People ask me all the time, hey, I understand, Peter, that as my workload increases, my production of lactate increases. And as my production of lactate increases, my capacity starts to fall off because as lactate goes up, it's buffered by a hydrogen ion or it's married to a hydrogen ion. And that's what creates the acid, part of lactic acid. And it's that hydrogen ion that's causing all the trouble. It's not the lactate. We can tolerate endless amounts of lactate.

• 1:26:40Speaker 01

  And lactate is crucial in metabolism.

• 1:26:42Dr. Peter Attia?

  Yeah, we just can't tolerate the hydrogen that comes with it. And it's that hydrogen that actually paralyzes the actin myosin filaments, prevents them from disengaging. And that's what leads to that seizing up that you feel, the rigidity you feel when you exceed your lactate threshold. So the question then becomes, well, can I buffer this? And everybody and their brother talks about, hey, what if we took lots of Tums, anything that we could get sodium bicarbonate into our systems. Looking at that literature, which I haven't done in a while, this strategy didn't really pan out. There wasn't really a great way to orally ingest enough bicarb to make a difference. Obviously intravenously you could, but that's probably illegal anyway. I mean, I don't think water would permit that. But even if you weren't concerned with that and just asking the theoretical question,

• 1:27:26Dr. Peter Attia?

  unless you're on a stationary bike, it's not practical to have an IV drip of bicarbonate to buffer your hydrogen. So what is the state of buffering agents to reduce and lessen the impact of lactic acidosis?

• 1:27:42Speaker 01

  This is a little bit of a complicated domain.

• 1:27:45Dr. Peter Attia?

  Unlike all the other simple domains we've been discussing today.

• 1:27:48Speaker 01

  Yeah, of course. The reason for that, I've been very fortunate over the last decade to be involved in a lot of edge case researchers, plenty that we are years away before this will be published. Not necessarily because we don't want to publish in it, but there are just remaining Work to be done, to understand it. And for example, again, this is also a place where we have some indications now, but where some of my colleagues, they have actually also tested on larger population. But Gustav's highest view to Max actually is done under bicarbonate utilization. Not Christian, but Gustav.

• 1:28:22Dr. Peter Attia?

  How? How is it administered?

• 1:28:24Speaker 01

  So the way it was administered is that there is a company in Sweden called Morton. What they did, this is actually something that is going to be studied now also and actually in health, in medical settings as well, because it actually has some quite interesting applications there too. How this was administered is basically that it is packed in a hydrogel and this allows you.

• 1:28:43Dr. Peter Attia?

  Oh, so you get rid of the gastric, you would bypass the gastric pH and you get it into the intestine?

• 1:28:48Speaker 01

  Medicine, using the same mechanism, you basically pack the agents into a vehicle to deliver it where you need it more efficiently. So this means that we can go to concentrations that are significant.

• 1:29:01Dr. Peter Attia?

  What have you seen is the difference in his lactate tolerance with and without this buffering?

• 1:29:07Speaker 01

  So this is a place again where obviously the sample size is still limited.

• 1:29:12Dr. Peter Attia?

  Sure, but in him, in a world-class elite athlete.

• 1:29:14Speaker 01

  So the interesting thing there is that here we have two different cases. And that's for example, I have some athletes that have almost twice as high lactate concentration in the blood when they're using, this is why I said we are opening a can of.

• 1:29:27Dr. Peter Attia?

  The proverbial can of lactate buffered worms.

• 1:29:30Speaker 01

  Yes, exactly. We also have them to remember because then we have to come back to the technology. Where do we measure?

• 1:29:35Dr. Peter Attia?

  And what is this called again?

• 1:29:37Speaker 01

  So this brand is called Morton.

• 1:29:39Dr. Peter Attia?

  Morton, as in Morton Salt?

• 1:29:41Speaker 01

  It's written M O R T E and Morton. People go crazy over the gels and everything during races. They have a gel that is actually based on the same principle. So we open up that box as well, but basically Christian Gustav sits comfortably not eating 160 grams of carbohydrates per hour and basically this is then quantified using isotope traces as well. So they don't only eat it and it starts packing up in the stomach, they utilize it.

• 1:30:06Dr. Peter Attia?

  Yeah, I'm going to save time to talk about nutrition because I want to ask you about that. So this is a commercially available product, athletes are using it. So do you have a sense of why some people find like Gustav seems to find huge benefit from it? Sounds like Christian does not.

• 1:30:18Speaker 01

  Well, I wouldn't say that Christian doesn't, but it depends a little bit on let's say the setting we are using it in as well. And Tralon is inherently complex in the sense that you have three sports that you put together and with very varying intensity, all the things that are happening there, which makes it a little bit more complicated. And then there also is some benefits, but can also potentially be disadvantages with it. But the benefits that also comes with it is it actually also increases your plasma volume fairly instantaneously as well.

• 1:30:43Dr. Peter Attia?

  You're pulling fluid into the plasma.

• 1:30:44Speaker 01

  Yeah, but early studies that have done on this, which will be published on this, basically shows there's a positive effect of using bicarbonate now. Or using, for example, the Morton product. We have studies now on larger population done by some of our colleagues, which indicates this. Then on top of that, what I would say is that we don't fully understand why it is like this. It's one interesting hypothesis I presented to the research group is that, because on the one side, what we think is that, okay, this increases the buffering capacity. So we think, okay, if it increases the buffering capacity, then you can basically do more, then you can go more anaerobic or more into anaerobic or glycolytic resources. Because one thing that we are fairly sure about is that you're never going to run out of glycogen, really.

• 1:31:28Speaker 01

  You come to a certain level and the body will rather start to sense that it's really, really low. And that's why you shut down. You don't shut down because you basically depleted every gram of glycogen in your body. That's one. And then there are other preserving mechanisms.

• 1:31:40Dr. Peter Attia?

  By the way, that's easy to verify with a muscle biopsy at failure, right?

• 1:31:44Speaker 01

  No, the problem with that is that even in muscle biopsies, you will see that if you basically do sampling just across one muscle, it's so heterogenic.

• 1:31:50Dr. Peter Attia?

  If you wanted to do it, you would need to biopsy multiple times, multiple sites simultaneously.

• 1:31:55Speaker 01

  Or even make somebody radioactive and start to do nuclear resonant measurements on people. Yeah, it's so impractical to really study that you have to go more by, again, coming back to, for example, first order principles, for example, looking at gross efficiency and then calculating as basically how much subsidy you're using, basically is already. Involving inaccuracies to it. That's why you just have to sometimes just say, okay, we are going to look at oxygen consumption versus let's say mechanical power output. And then you just say, we don't care about whether that's RQ correlates to this value. You just have to have the raw values. Back to the bicarbonate, what we can observe, for example, is that when we do blood gas analysis, so when the athletes are exercising, basically a longer protocol, we are taking blood samples to look at pH level in the body.

• 1:32:40Speaker 01

  And what is interesting to see there, even for Christian, he does not have a doubling in his lactate concentration. So Christian have almost unchanged lactate concentration in his blood.

• 1:32:48Dr. Peter Attia?

  At what level of exertion?

• 1:32:50Speaker 01

  Whatever, even all out.

• 1:32:51Dr. Peter Attia?

  Any given power?

• 1:32:52Speaker 01

  Any given power.

• 1:32:53Dr. Peter Attia?

  Or any given VO2? Yeah, okay.

• 1:32:55Speaker 01

  Yeah, but the interesting thing here is that the interesting thing here, this is easy to think now that when an athlete has double their lactate concentration in the blood, then it has to be double the contribution from the glycolysis. We have to remember we measure in the blood, this is a concentration metric, and the state can be completely different other places in the body.

• 1:33:12Dr. Peter Attia?

  Here's just a crazy idea. Have you ever done a muscle biopsy on the two of them to see the relative differences in monocarboxylate transport density on their muscles?

• 1:33:23Speaker 01

  No.

• 1:33:23Dr. Peter Attia?

  Think about this is, I mean, just for the listeners to understand what we're talking about. The MCT transporter on the muscle cell must play a significant role in determining the relationship between intracellular lactate and intraplasma lactate. It would be in an athlete's best interest through training to increase the density of those. Because the more you can get lactate out of the cell, the more presumably you're going to get the hydrogen with it out of the cell. We probably have a greater capacity to buffer acid in the plasma because we have the respiratory drive to adjust bicarb than we do in the cell where it's that hydrogen is really poisonous. So it just makes me wonder as a hypothesis, maybe Christian has more MCT

• 1:34:07Dr. Peter Attia?

  density, and that's why he is less impacted by this buffering strategy. I don't know. Could be the other way around. I wonder if all things equal, that would be, it's just so hard to believe that two world-class athletes could be that different in their response.

• 1:34:22Speaker 01

  One can be MCT transporters, for sure, one can be, but I doubt it to be significant.

• 1:34:27Dr. Peter Attia?

  Yeah, it's hard to imagine that's two X difference.

• 1:34:29Speaker 01

  And the reason why I doubt that to be significant is because if I look at purely the biochemical efficiency, first order principle, looking at oxygen versus power output, cross mechanical power output, this is so close that it can't explain it alone. One other difference that is there, and which is maybe larger, but I don't know, maybe are closer related to this is, for example, exactly plasma and blood volume. Because the blood volume and plasma volume in Christian and Gustav is beyond significant in difference.

• 1:35:01Dr. Peter Attia?

  Why? They're not that different in weight, are they? Eighty kilograms versus...

• 1:35:05Speaker 01

  But still, it is borderline where the word significant doesn't do the difference. One of the places where we don't have any definitive answers, it is just different. But then you can say, well, it wouldn't have had implications on, for example, the VU2max.

• 1:35:18Dr. Peter Attia?

  And stroke volume, cardiac output.

• 1:35:20Speaker 01

  Yeah. Well, actually, that's the interesting thing, because if you talk about stroke volume, I would agree. Yes, there is a massive difference. Again, significant doesn't really do it justice. We would talk about massive differences in stroke volume, but not in cardiac output.

• 1:35:32Dr. Peter Attia?

  What's the max heart rate of each?

• 1:35:34Speaker 01

  Christian ballpark is around one hundred and eighty, maybe, one hundred and seventy, one hundred and eighty. I would say one hundred and seventy-eight, something like this. Gustav around two hundred. So this is one, but also more interesting here as well, is that Christian has a much larger also hemoglobin mass than what Gustav have. One thing we also have to remember is that if we create a performance stream more or less, and we put VU2max on the top of this one, where all these different factors are contributing, let's say, contributing factor to your VU2max in the end. That's why we say the VU2max is the holy grail or such a good metric. Because if there is something broken somewhere in the system.

• 1:36:12Dr. Peter Attia?

  It trickles up.

• 1:36:13Speaker 01

  It trickles up, yeah, but it doesn't mean that if something is broken here, that that's a good metric, even though we could say that it has been used in research and other things. So probably one of the most plausible explanations for why there are such big differences in Christian and Gustav in terms of, let's say, where... The biggest differences comes from more is that Gustav has to circulate his blood much quicker than what Christian does. Not relatively speaking, but in absolute, so the absolute circulation of blood. Cardic output has to be at least the same for Gustav, maybe actually a little bit higher than what it is for Christian. But Christian compensates in other ways. And that's also an interesting thing than basically when we talk about all these different things, whether it's MCT

• 1:36:57Speaker 01

  or other things that are in the body, is that there are so many mechanisms in the body that we see that when you come closer and closer to elite level, other systems have to start to compensate for you to take the next step. In people that are not well trained, then you can basically do whatever is in the body will just prioritize to develop what is the easiest to develop. But at the elite level, it seems like more like now it starts to be like a really hard priority. And that's even before we start discussing epigenetics.

• 1:37:23Dr. Peter Attia?

  Let's go back and say one thing about temperature. There's some reasonable data suggesting that a relatively high dose of acetaminophen can certainly improve heat performance. So tolerance, race pace tolerance in warm temperatures, but it may even perform output. And again, nobody knows why is it improving performance, i.e. absolute output because it's actually reducing and blunting body temperature. And the temperature itself becomes a bit of a governing mechanism on output. Or if it's just blunting pain and pain is part of the wall that we face. But curious if you have any experience with high doses, one to 1.5 grams of acetaminophen in any of these athletes.

• 1:38:04Speaker 01

  No, we don't. We don't use it.

• 1:38:05Dr. Peter Attia?

  Have you experimented with it in training?

• 1:38:07Speaker 01

  No. One of the reasons for why we don't do it is because I believe at the moment you start manipulating what is not manipulated. Like already when you're using exogenious, for example.

• 1:38:18Dr. Peter Attia?

  By carb.

• 1:38:18Speaker 01

  By carbohydrates for that sake or anything like this, you can always say, okay, well, this already also has an effect. But I would say that the problem when you try to go in and you try to acutely, let's say, do something in the body. It means basically that you're trying to target one part of one system of the body and you don't consider the other ones to be important. What I'm more believing is that, for example, if you talk about heat, for example, and heat tolerance. If you have more of a natural approach to this and you build this into your protocols, this means basically that let's say whatever is in the body. That is there in order to help increase your heat tolerance have to adopt to this. So for example, pain is something that is trainable. And there are many mechanisms that are involved with this.

• 1:39:00Speaker 01

  Using, for example, supplements to try to lower the pain, for example, or the perceived pain of something. I think this is a place where talking about, for example, performance enhancing drugs. It's interesting to see that despite posts, big doping scandals that were in cycling. Everybody thought that, okay, now true response will become slower. Did short period and suddenly it just became faster, became faster, became faster. I don't think this is because people are doping more now than what they did before. There are probably some cases where people still do doping or they are really like venturing into the gray area. But obviously we have found techniques and other things that are more powerful than using performance enhancing drugs to get to this level.

• 1:39:45Dr. Peter Attia?

  I'll share two with you. I'm curious to your thoughts. We're going to talk about nutrition in a minute. You already alluded to the fact that your athletes are routinely able to consume 160 grams of carbohydrate per hour on the bike during competition. A hundred years ago, when I was competing in anything, we were stuck at 60. Like it was really hard to get past 60 grams per hour. So for ultra distance things like I did, it really became a bit of an energetics problem. You had to start figuring out ways to get fat in the substance that you were consuming just to get the additional calories. Even though you didn't really need fat because you have enough of it, it's glucose you're limited by. I very recently, literally the other day, asked Lance Armstrong.

• 1:40:27Dr. Peter Attia?

  We were talking about something unrelated and I said, by the way, Lance, back in the tour, how many grams of glucose were you consuming per hour? You know what he said? He said, we didn't even pay attention to it. We just ate when we were hungry. So this is not saying that the only reason those guys were exceptional is because they were using blood products. No, they were using blood products and they were exceptional and they trained really hard. But their knowledge of nutrition was very pedestrian to what it is today. No, if you wait till you're hungry to start fueling, you're not fueling in an optimal strategy at all. So that to me is one enormous advantage in the peloton today.

• 1:41:10Dr. Peter Attia?

  I think that nutrition science has evolved so much. What these guys can do, I've heard rumors that they can put down 200 grams per hour, that they've trained themselves up to that level. I think a second interesting difference in the tour today, and I'd love your point of view on this as well. I think people forget how big cyclists were 20 years ago relative to today. If you look at the GC contenders in the era of Lance Armstrong, if you look at Jan Ulrich, Ivan Basso, Lance himself, I mean, these were guys that weighed 70 kilos. Lance raced at, he'd start the tour at 74 and finish at 72 kilos. These are normal sized human beings. If you look at the GC contenders today,

• 1:41:54Dr. Peter Attia?

  these guys are 58 kilos. I mean, they're very small. So in cycling, if we think about it as watts per kilo, it's not that they've gone up that much on watts. Their absolute wattage is significantly lower than what it was 20 years ago. They've just gone down so much on weight. So I'm wondering what you think about those two factors that are clearly stark differences between the world's best cyclist today and the world's best cyclist 20 years ago, as a way to bridge the gap between the use of drugs then versus not today.

• 1:42:29Speaker 01

  There are also a couple of other interesting topics here as well, but I think, yeah, nutrition, obviously. Fuel in, speed out in order and it's crucial. And it doesn't help if you try to do something with your V2 Max and other things. If you're running out of fuel, it doesn't help to install a larger engine in a car.

• 1:42:45Dr. Peter Attia?

  If you're running out of gas.

• 1:42:46Speaker 01

  If your tank is, yeah, exactly. I think one of the biggest differences is exactly like you point out, their attention to nutrition today in the world tour, for example, is in a completely different level than what it was a long time ago. I know also over the last five years, this have also made like a big, big change as well. Like because it's large teams. So they're even trying to devise tools and methods and other things that allows them to scale this. A little bit more. The benefit I have working with a couple of athletes is that we can go on a completely different level than what they can do again. So we can even use metabolic measurements even out in the field to do measurements, basically just to see what is happening and become extremely detailed on what we do.

• 1:43:24Speaker 01

  Even looking at basically post-exercise, even what's happening there, or pre-meals, post-meals, what even happens with your resting metabolic rate, because even this changes throughout the day. And to keep up the consistency over time, you need to fuel accordingly. Coming back to the question, and that is that I think one nutrition, yes, this is probably one of the main contributors. Of the two, this is the main contributor to why they are racing faster today than what they did five, 10 years ago. Further, I would say that the watts per kilogram, this is a place where I feel that we will see a change again. I think actually that the weight of athletes will start to go up again. But the reason for why we start to see this going there is because if we look at trying to understand like, why did we end up with the training programs we have done and so on?

• 1:44:05Speaker 01

  Obviously, it's a very empirical approach to it, practical approach, which very often is extremely good when it just gets enough time to evolve. But at the same time, also what haven't happened is that we have adopted training strategies intact with the availability of information, technologies, and all things that helps us do better fueling. Because one thing we also do know is that in order for any growth to take place in the body, you need obviously oxygen, we already talked about that, but we use oxygen as a proxy to understand metabolism. Metabolism again is also a function of growth. When you do training over time, you're obviously trying to signal to your body, you need more muscles to be more efficient in one or the other way.

• 1:44:45Speaker 01

  And if you now start to limit or you put a cap on fueling in order to drive down your weight, this will also start to impair most likely ideal growth.

• 1:44:56Dr. Peter Attia?

  Do we see this in triathletes? I mean, cycling is an interesting sport because you don't really get a benefit from weight reduction if you're a time trialist, for example. In fact, it's the opposite. It's watts more than watts per kilo that matters. But obviously, if you're in the grand tours, all three of which are basically built around climbing, watts per kilo is ultimately the metric. Now, we can debate whether you can get a more optimal watts per kilo at a slightly higher weight than a slightly lower weight. But clearly, you're not going to see people winning a grand tour at eighty kilos or seventy-five kilos. I think those days are probably gone. But in triathlon, how much of an effort do these guys put into their weight?

• 1:45:37Speaker 01

  This is actually one of the interesting things because if you talk about watts per kilogram, Christian actually is what per kilogram have gone up with increasing his weight.

• 1:45:44Dr. Peter Attia?

  You said he's eighty kilos?

• 1:45:45Speaker 01

  Eighty kilograms, yeah.

• 1:45:46Dr. Peter Attia?

  And his FTP is?

• 1:45:48Speaker 01

  If I'm gonna convert it to FTP, it would be probably in the range of four hundred and, if I did him on a twenty minute test, probably, let's say for the sake of simplicity, four hundred and twenty for something like this, probably if we tuned him like if that was how we did testing and we started to standardize that, maybe even higher, I don't know, it's really hard to say because we don't do FTP testing.

• 1:46:08Dr. Peter Attia?

  Yep. What would be his average power in a, an Ironman for four hours?

• 1:46:13Speaker 01

  So for four hours, typically there they would be around.

• 1:46:17Dr. Peter Attia?

  Let me see if I can guess. You said before we started the podcast, you mentioned they were holding forty four to forty five KPH?

• 1:46:25Speaker 01

  Or even slightly above, yeah, in the most extreme cases.

• 1:46:28Dr. Peter Attia?

  So he's gotta be at three hundred and sixty to three hundred and seventy watts to do that?

• 1:46:35Speaker 01

  Well, that's where aerodynamics come in and we are able to lower the numbers because obviously staying at three sixty, three seventy will have a quite big impact also on energy utilization and heat production as well. And for example, coming also back to the question of basically using supplements to try to mitigate pain or lower your temperature. We also know that this is not necessarily good, but really also here's a question as I thought of that one, probably we're not going to continue on that path now. But using, for example, supplements to try to lower your temperature, I think this is where it's important to ask is our first order principle. Where does that heat come from? The heat comes from basically mechanical power.

• 1:47:08Dr. Peter Attia?

  Is it lowering mechanical power? Cause I think the argument of the acetaminophen literature is that the body is bumping up against a couple of set points that are acting as governors to output. One of them is pain, one of them is temperature. The body does not want to let you get too hot and obviously doesn't want you to tolerate too much pain. Acetaminophen potentially blunts both of those. You're arguing, yeah, but if part of the way it's blunting energy output or temperature is by reducing mechanical work?

• 1:47:41Dr. Peter Attia?

  Gross mechanical work, then you're going to probably pay a net mechanical work price.

• 1:47:46Speaker 01

  Yes, and also capacity price, you could say, in some regards.

• 1:47:50Dr. Peter Attia?

  I have no idea what the answer is. I would just want to test it in training. Literally, alternate weeks with, without, as a placebo test, with acetaminophen, without acetaminophen, with acetaminophen, without. Because again, at your level, you get a 1% difference. It matters.

• 1:48:05Speaker 01

  This is the wonder of the body. One thing that happens, obviously, if you start to use a lot of carbohydrates, so you go to 160 grams. We even crocked in at the highest numbers. We have measured this in excess of 240 grams per hour of carbohydrate utilization.

• 1:48:17Dr. Peter Attia?

  That is so... Can you tell people what 240 grams of carbohydrates looks like if it were food? Do it in pasta or something like that. How much pasta is 240 grams of carbohydrate?

• 1:48:30Speaker 01

  To make it simple, it would be probably as you took pure gel and you filled this glass and you drank it.

• 1:48:37Dr. Peter Attia?

  Take those pure little nasty disgusting energy gels and fill your 16 ounce glass there with it.

• 1:48:44Speaker 01

  And drink it.

• 1:48:46Dr. Peter Attia?

  And what form are they consuming the carbohydrate in?

• 1:48:48Speaker 01

  Normally, they would do it in the form of drink mix.

• 1:48:51Dr. Peter Attia?

  So how do they get that much liquid in their body?

• 1:48:53Speaker 01

  That's a part of it. Normally, they would consume around, I would say, around minimum of 1.4 liters, but say around two, a little bit more than two liters per hour.

• 1:49:02Dr. Peter Attia?

  Good lord. What's the glucose concentration in that liquid?

• 1:49:05Speaker 01

  In that one, then I have to calculate.

• 1:49:08Dr. Peter Attia?

  So we could just do the math. If you said two liters, 200, that's 12%. That's a 12% mixture.

• 1:49:13Speaker 01

  Yep.

• 1:49:13Dr. Peter Attia?

  Approximately.

• 1:49:14Speaker 01

  Probably, yeah, yeah.

• 1:49:15Dr. Peter Attia?

  Which again, that also completely flies in the face of traditional nutrition science, which says 5 to 6% is the limit for gastric tolerability and is the sweet spot for absorption. At 5 to 6%, your max, now again, that's a different problem. That's optimizing for water absorption into the cell, not your primary point. You're probably overdoing it on liquid and you're trying to maximize glucose into the cell.

• 1:49:44Speaker 01

  But also absorption here, because this is also where it's interesting or important to go back to also a little bit like, what is this research? Like, who is this research done on as well?

• 1:49:52Dr. Peter Attia?

  And it's not done on these trained athletes. Okay, first question, how long did it take you? To train the athletes to be able to tolerate that because if someone's listening to us today and they're saying, I heard these guys talking about the 12% carbohydrate concentration, which again, just means for people listening, that means 120 grams of glucose per liter. That's twice the standard what you'd see in an energy drink. And then I'm going to drink two liters of that every hour. I think within two hours, a normal person is going to be puking their guts out. They simply can't get that volume of glucose out of the upper gastrointestinal tract. So is this just like any other muscle where you can train yourself to exceed capacity?

• 1:50:37Speaker 01

  Seems like it. Seems like most things in our body is actually extremely trainable. That also comes back to the nutrition part as well, where exactly also the training programs we have today have not seen the same change as nutrition strategies have done over the last years as well. So that means also that the power numbers that was output maybe five, 10, 20 years ago. I'm not so sure if that's the limitation we're going to see.

• 1:50:59Dr. Peter Attia?

  Especially late in races.

• 1:51:01Speaker 01

  Yes.

• 1:51:01Dr. Peter Attia?

  This is where it's going to make a bigger difference. It's not going to make a big difference at the beginning of the race, but it could make a huge difference at the end. Talk to me about formulations. Back when I was swimming great distances, one of the challenges I had over a 12-hour event was literally fatigue of the same flavor. So part of the challenge was how do you just mix things up? And after a while, sweet becomes horrible and you actually want something salty, but then salty becomes horrible. Like, how are you managing the actual practical implication of this?

• 1:51:29Speaker 01

  So again, this is a place where more than they made actually their gels to be as neutral as possible. And because it is formed as a hydrogel, it actually encapsulates the sugar inside the hydrogel, meaning that the perception of sweetness is much lower than for any other gels there are. It was still perceived as slightly sweet, but it's much, much less.

• 1:51:49Dr. Peter Attia?

  Wait, sorry, this Morton gel is a significant driver of their calories as well as the bicarb?

• 1:51:54Speaker 01

  No, so they are two different products because Morton has the bicarb product, which actually also is encapsulated in hydrogel, but actually with carbohydrates. But then they have the dedicated fueling products, which is basically consists of a drink mix, which Christian and Gustav are mainly using, but they also have gels as well. So it's more practical, obviously, to have a gel.

• 1:52:12Dr. Peter Attia?

  Silly question, the bicarb capsule, they're swallowing a capsule while they're on a bike drinking?

• 1:52:17Speaker 01

  This is a two component, or actually three component mixture. You have the hydrogel, which is basically in a dry format in Sachet, and then you have the bicarb tablets. And then you basically you take water, so you add water to this. First, you add water to the hydrogel mix and then basically you are forming the hydrogel. And then you take the bicarb and you mix it into the hydrogel. And in this way, whisk it around. And then basically this way, you are able to bring it into the stomach and actually able to deliver it without it actually causes any problems. I can't say actually too much in detail what kind of concentration we are on after the moment. I will come back to this a little bit later because this is probably things that we will publish. But to put it this way, nineteen grams of bicarb, for example, that would be like a standard dosage.

• 1:53:01Speaker 01

  You can go to twenty-two grams of bicarb as pure and you can take this and this doesn't require very much training.

• 1:53:07Dr. Peter Attia?

  What is the base of the carbohydrate in that brand that they seem to like? Is it straight dextrose, multidextran?

• 1:53:13Speaker 01

  No, mainly fructose and glucose.

• 1:53:16Dr. Peter Attia?

  What's the ratio?

• 1:53:18Speaker 01

  It's a little bit of a time since basically we went through details of the law. Let's say looking at the balances between this, but let's say it's a forty sixty.

• 1:53:25Dr. Peter Attia?

  So it's basically high fructose corn syrup?

• 1:53:26Speaker 01

  Yeah, yeah. The genius part of it is actually not the carbohydrates itself.

• 1:53:31Dr. Peter Attia?

  It's the packaging mechanism.

• 1:53:32Speaker 01

  Yes, exactly. That's the difference. So if you were consuming sixty grams per hour, spare the money and buy orange juice or even put honey inside and drink it. Where it differs itself is when you are really starting to push the limit of the concentration. But you can even train yourself today. This is something we know. You can even take honey today and you can mix it and can train yourself to go to higher values than what have previously been published, like pure normal products.

• 1:53:54Dr. Peter Attia?

  If you want to get to one sixty, you need the technology.

• 1:53:57Speaker 01

  Yes, exactly.

• 1:53:59Dr. Peter Attia?

  And no protein, any amino acids throughout that whole race?

• 1:54:01Speaker 01

  No, this is something that was also done research on, but we ended up in the end pure glucose and fructose. And it actually has to do with actually how oxygen is being prioritized in the body. Because we have to consider two things here. It's easy to think that while you're only racing at eighty percent of your V two max or seventy or ninety, whatever percentage it is of your V two max. But that's a little bit of a short circuit, because what we have to think of is that this oxygen, more oxygen is going to contribute to more heat as well. So it's not like you can just go, whatever, I'm racing at a so low percentage of my V two max. So I can go whatever and do and in the beginning, because it always will accumulate towards the end of your race. That means already from the beginning, it's critical how you pace and your efficiency as well.

• 1:54:42Speaker 01

  Because every inefficiency you have, either it's biochemical or anything like this, it will basically end up towards the end of the race. So this means also that at the moment you start putting any other substrates or nutrients into your mixture, that the body have to prioritize somehow in the system. That means also that there are going to be less oxygen available for pure propulsion. And in the end, it's the pure propulsion that really sets the winner apart from the rest of the people there. So you basically want to peel away absolutely everything that doesn't contribute to forward propulsion. Use every milliliter, every mole of oxygen purely for that purpose and nothing else. Because oxygen is one of the limitations.

• 1:55:22Speaker 01

  We talk about different kinds of substrates and these kind of things, which is still also a place where we don't know. We are actually doing quite some interesting research on different kinds of substrates from glucose, fructose.

• 1:55:33Dr. Peter Attia?

  Have you looked at BHB, beta hydroxybutyrate?

• 1:55:35Speaker 01

  Yes, so we looked at BHB as well. And one of the things, if you purely look at the stochimetry, there are interesting thing here. But the problem is that we cannot only do stochimetry. We actually need to know the entalpy and we also need to know the Gibbs free energy that is available and ideally even the entropy.

• 1:55:52Dr. Peter Attia?

  Okay, so the Gibbs free energy, if you're making the BHB yourself, much more complicated. But if you take it purely exogenously and consider it an additional substrate above and beyond glucose, do we have reason to believe that we're going to get more ATP per mole of oxygen?

• 1:56:09Speaker 01

  No, because the practical limitation of this is that when you do racing, if you think of this more first order principle again. So if you do racing, and this was actually one of my first questions, because we have been working together with one of the leading brands, arguably the leading one. They are situated here in the US. But one of the limitations that you have to look at is basically when you are racing, this has a certain fuel demand. So there's a certain amount of fuel that needs to go through the system there. And that means that in the context when we talk about glucose and fructose, we are looking at basically trying to replace as much as possible. We said, okay, glucose, fructose, or basically carbohydrates seems to be a very, very oxygen efficient fuel source when you do movement. But that means also that in order not to run out of this, we are trying to replace as much as possible of this to be able to race faster.

• 1:56:52Speaker 01

  Because if you said, this is the fuel source I have available in my body. I'm going to race this fast. Obviously, I cannot go faster than this. So certain power number, certain duration will deplete this energy source or basically bring me close to depletion of that source. So that means, okay, instead of then switching to other sources, or you're basically always using other sources as well. But trying to get more from that source means basically you have to replace more of the power. So more of the power now, we have to create an environment where more power can come from the same source. Let's say you were originally around at 80 grams or 90 grams. Let's say 80 grams for simplicity, so 80 grams of carbohydrates. And you have a biochemical efficiency of 20%, for example. That means basically you're getting out, or if you say 4.2, let's say, you could get basically so one gram would be then the equivalent of, let's say,

• 1:57:36Speaker 01

  one joule per second or one watt, more or less like this. So you could get from that one. So if you double this from 80 to 160 now, that means basically now you can get double the amount of what's coming from carbohydrates here. The problem with ketones is that the strategy is not to basically fuel the amount you are using in a race. You don't fuel with ketones in the same way. Like if you go to 70, 80, or even 100 milliliters of ketone consumption in an hour, you're gonna have Have so high levels of ketones in your body that you will start to feel almost like you are getting diabetic. There's a feeling of bonking almost. So the thing that is there is more like it's inducing a state in the body rather than you actually fueling using it. Because you, in order to fuel, so they said your idea was that you're going to replace what you're losing from your body.

• 1:58:21Speaker 01

  Because that's driving your body also out of homeostasis as well. You're gonna try to keep homeostasis as much as possible or try to keep the state of the body as unchanged as possible. That would mean that you would need to ingest so large amount of ketones during a race.

• 1:58:35Dr. Peter Attia?

  And then you have the also the issue with the salt, if you're bringing in with a salt versus an ester. Okay, a couple of things I want to chat about. So one, we talked a little bit about this before, but let's kind of go back to it. So remind me, did Christian and Gustav both compete in Tokyo Olympics?

• 1:58:48Speaker 01

  Yeah, both did compete in Tokyo Olympics, yes.

• 1:58:50Dr. Peter Attia?

  And how did they do in Tokyo?

• 1:58:52Speaker 01

  Christian won, Gustav came seventh, eighth, seventh place, yeah.

• 1:58:57Dr. Peter Attia?

  After that Olympics, they went back to Ironman distance for the next three years.

• 1:59:01Speaker 01

  Yep.

• 1:59:02Dr. Peter Attia?

  And then Gustav did not compete in Paris. He had an injury. Christian did, and I think you said he was 12th.

• 1:59:07Speaker 01

  Yes.

• 1:59:08Dr. Peter Attia?

  How much of that was the mismatch in distance? Again, he's much more optimized for Ironman Olympic distances. That's like asking a marathon runner to go and run a 5K. Very unusual. What was the process like to get ready for that? And what was the difference in his personal performance between 2024 and 2021?

• 1:59:29Speaker 01

  We went there for two reasons. One, we thought it was possible to get back on the podium. And I would say even after disappointing results, I would say that we are more convinced today that it's possible to go back than we were. But there are other reasons for that, coming back to that.

• 1:59:43Dr. Peter Attia?

  Sorry, meaning in Los Angeles, you're saying?

• 1:59:45Speaker 01

  In Paris, yeah, even there. Yeah, yeah. So if we then look also back to there, Christian already had in training, put out far better performances than what he was capable of getting out on race day. I would say that there are two things that looking back at, let's say, the process leading into Paris, that for me explains most of this. And one part of it is, one of the differences leading from Rio, leading into Tokyo, was that we took our Massive shift in how we did intensity control. And again, now we talk about intensity control. That doesn't mean necessarily about talking about just threshold or anything like it. This means exactly like pinpointing different intensities and working on them in order to optimize the human body. And then how we find this.

• 2:00:28Speaker 01

  One thing that we did, actually, we got maybe a little bit too complacent the last year. And that is basically we've done so much that it's more like, okay, we had more projects. So it's also one place you just think, okay, you are getting really good at controlling the intensity and these kind of things. So we stress it a little bit. The key that really made a difference between Rio to Tokyo, we became sloppy at.

• 2:00:50Dr. Peter Attia?

  Rio to Tokyo or Tokyo to Paris?

• 2:00:52Speaker 01

  Yeah, for Rio to Tokyo, that was the massive shift going from unknown to basically Olympic champion. To basically where we the last year, I would say in particular, let's say the two, let's say the last year. Were much more sloppy on simply because you just think that, okay, after you've done intensity control for so long time. You would think that you have such a good calibrated body for this. We made the same error actually already in two thousand and seventeen to two thousand and eighteen where two sixteen to seventeen. We saw massive improvements in performance. From seventeen to eighteen, we have done so much measurement, we lacked it and other things like this. Just thinking, okay, they must have a good feeling for this, really good calibrated. To a couple of months, we saw that, okay, this doesn't work, we have to go back to the practice. The same error we did the last year going to Paris.

• 2:01:33Speaker 01

  Purely in terms of performance, Christian basically put out performances that was far exceeding what he did on the run in Paris. In Paris, he lacked around four minutes per kilometer over the ten K. That was the difference between the first place and the twelfth place.

• 2:01:47Dr. Peter Attia?

  Sorry, say that again?

• 2:01:48Speaker 01

  Sorry, four seconds. Four, four seconds per kilometer.

• 2:01:52Dr. Peter Attia?

  Four minutes would be between them and me.

• 2:01:53Speaker 01

  Yeah. So yeah, so four seconds per kilometer.

• 2:01:57Dr. Peter Attia?

  So forty seconds he lost on the run.

• 2:01:59Speaker 01

  Yeah, around there. But one of the differences that also were between Tokyo and Paris was that Christian actually sat. When he came out of the water, Christians, swimming have never been his forte. That's been the worst discipline for him. And the same actually made, this was also, we are an arena where we would see even bigger differences. So the poor swimmers in Paris, some of them even didn't finish.

• 2:02:21Dr. Peter Attia?

  A lot of people heard about how disgusting the river was. How did that create more separation between the excellent and the good swimmers?

• 2:02:28Speaker 01

  It's the current in the water. There was a massive current in the water. Basically, to the extent that if you said it was still water, most of the triathletes basically set four hundred meter record, world records, swimming the first four hundred meters.

• 2:02:39Dr. Peter Attia?

  Usually that closes the gap between people when the current is strong.

• 2:02:43Speaker 01

  The only problem is that you have to turn back up. And then the problem also with this, because this is in a river, you could normally say that if this were basically a place where you just knew you had laminar flow. So you had laminar flow and it was homogeneous all over the place. Then you could say that really it wouldn't make that much of a difference or should not. A little bit it would do, simply because the swim in distance is the same, but the duration becomes slightly longer. And if it's a slightly longer duration, you open up a little bit more of a gap. The challenging part with Paris and the Seine was also that flow is not, especially in the Seine, not homogeneous. It is highly heterogeneous. Meaning, basically, if you look at the swimmers there and you see that they basically come around the first boy, you see, and they are aiming for the boy next to them. Suddenly, people go in a large parabola,

• 2:03:26Speaker 01

  because they underestimate actually how much more up current they have to basically point in order to get around. And then after that as well, when they get closer, because there are two bridges that went across the river as well. And around this one, you would normally think that the current is actually slower next to the pillars that are into the water. The fastest swimmer was suddenly in the front there, suddenly became second or even down into the group, simply because the people that went a couple of meters, two meters further to the right there swam suddenly past them. The fastest swimmer suddenly, it looked almost like they were, came, had good speed and suddenly standing still almost, where they had to deviate out from the pillar and basically, so it becomes a far more tactical race.

• 2:04:09Dr. Peter Attia?

  How far did he come out in the water after the leader in swimming?

• 2:04:13Speaker 01

  I don't remember. That was quite significant. That was, to be honest, the only thing I remember from that is that he came out, I think, let's say, of that long, because also what happens here, instead of that you get a pack that is swimming, it gets a long, long line instead. And that's also challenging in this context as well, because you get a completely stretched out field instead of that people come more like in patches out of the water. I think Christian came out. From the last guy in the first group, he was, I think, seventeen, twenty seconds behind him. But out on the bike, he became, they were, I think, forty, forty seconds down from the lead group. One of the differences that we already anticipated from the first year to the second year also was that

• 2:04:56Speaker 01

  one thing that I think people got a little bit shocked over the first year during, so that was basically during the test event, was how quickly in that course, the groups behind basically catch up with the lead groups on the bike. This one thing, we knew that basically the people that obviously were in the first group, they would benefit everything from basically going a little bit harder and maybe even starting devising strategies where they even got domestics. Like this is an individual race where people actually starting getting domestics and sacrifice people in the races from a nation perspective to be able to keep up, let's say, a different racing strategy.

• 2:05:29Dr. Peter Attia?

  Because they're allowed to draft in triathlon now?

• 2:05:31Speaker 01

  Yeah, so in short course triathlon, you can draft, there you can draft. This is the difference between that and long course like Ironman racing. What did this mean for Christian? It meant for Christian that basically in Paris versus Tokyo, he had to pedal thirty percent harder for three fifths of the race in order to just come back in the group and you don't get thirty percent for free for basically twenty five kilometers. Thirty percent extra power for twenty five kilometers, that has a massive cost. So even though we could say that his fitness have increased beyond what it was before, which made it confident that if this had been a pure time trial in, let's say, where you had like a normal swimming conditions, this kind of thing, he would be faster than what he was in Tokyo.

• 2:06:12Speaker 01

  But because this is a place where obviously the dynamics is completely different, that's extra fitness.

• 2:06:18Dr. Peter Attia?

  Thirty percent. I mean, I'm surprised he could even do that.

• 2:06:20Speaker 01

  Yeah, that has an implication when you get out on the run because obviously here, this is not a time like you where you go all out on a bike.

• 2:06:26Dr. Peter Attia?

  What was his ten K time?

• 2:06:28Speaker 01

  Thirty, high something, I think, let's say around thirty minutes. I have to go back and check sometime or had a little bit different place.

• 2:06:35Dr. Peter Attia?

  Still so fast. Good lord. Last thing I want to just chat with you about is where you are using AI today, or where you see AI going to make your insights better and your efficacy better.

• 2:06:50Speaker 01

  So with all the data we collect, one of the things that I would be able to discover quicker with AI is that his utilization went up too high in the month leading into the Olympics.

• 2:07:04Dr. Peter Attia?

  Utilization.

• 2:07:05Speaker 01

  So meaning basically where you are trading away a little bit on your anaerobic capacity and power, or let's say at least anaerobic power, maybe not capacity, you don't want to trade that away, but let's say anaerobic power, in order to increase your aerobic power slightly more. So let's say off your V to max, you're able to raise sustainably an even higher percentage of your V to max. So that means also substitute utilization would normally then be improved as well. Whether that would make a difference, to be honest, I don't know because of how the race played out. That's one. Where AI really makes a difference is that for me, we have used AI for some while. We started developing our own systems. I think this must have been back in 2020. And that is that with all the data, because

• 2:07:47Speaker 01

  of all the in-depth research we have done, we obviously have a lot of data and interesting findings where we can build AI systems that allows us to take new data that comes into the systems in real time and help us highlight what is important, what is not important. Like if there are things that we need to prioritize more, or I can even put attention to this. So AI for me is also where I think research, just purely in terms of longevity, in terms of human health, everything will really supercharge us to a completely different level. Researchers and other people that I work with today, and one of the main limitations when they come in and they basically see the work we do is they say, okay, the research we do is insane. It has a depth to it that basically is unmatched. But it's not because

• 2:08:32Speaker 01

  they don't have necessarily the competence in a group or anything like this to do it, but it's just the sheer amount of work that is required in order to utilize it or even use it in a study in yourself. And when you have AI, like a lot of work that actually is done in research today. Still manual work, there are plotting that is still done manual, there are measurements that are still done manual. But where instrumentation, AI really can change this, to the point where I'm not talking about. One study can be done with maybe one more instrument or something like this. But where you can use a multitude of extra of instruments and be able to dig into the data. On completely different levels than what you could do before. AI will not replace the decision making, but it will help us in terms of information.

• 2:09:17Dr. Peter Attia?

  Basically extract patterns you might not otherwise be able to direct your own statistical analysis towards.

• 2:09:24Speaker 01

  Yes, you can also imagine here, AI, how we trained it is that for a normal person. I don't have a PhD in mathematics, I don't have a PhD in machine learning. But the good thing is that we can basically take.

• 2:09:36Dr. Peter Attia?

  You're using large language models to do this?

• 2:09:38Speaker 01

  No, we have built an agentic system, so large language models is basically the interface for us. So I would use that, for example, like I would say that I want to look at data in a certain way. So I'm using more the LLM or NLP to inform which agents that should be. Utilized in order to understand or to dig into the data. So I still have to produce the question, I still have to produce the question. AI for me is basically just an autonomous system. I know this is a big debate on whether how intelligent these systems are, but. One of the best cases is that because I work so much in edge cases. So there was a study that just came out now and people say, oh, it seems like AI has the possibility. Came out of Stanford, I think it was, and it was quite a lot of research involved in it.

• 2:10:20Speaker 01

  And they say that AI has the possibility to seemingly to produce quite a lot of novel ideas on par with humanity. But where I would say that, well, it depends on what kind of perspective you look at it. And also where I would say that if it doesn't have data that it's been trained on for this. The best thing you can try to do is interpolate between data it already have access to. That means edge cases are basically cases where you are in the, let's say, in the domain where you need to extrapolate. They greatly suffer, this you can see again and again and again. But the good thing is that you empower a group of people or even a single human. With PhD level capabilities in mathematics in. Physics, all these kind of things. So you use the NLP, you ask a question and basically it can target this kind of data.

• 2:11:04Speaker 01

  Like even programming is a limitation for many people today. They are able maybe to formulate great questions, but they don't have the capability or the resources available to really put or execute and look into it. But when you have AI, suddenly now you can, without necessarily skills in programming or the things, you are able to formulate a question and you can ask the questions into the data. And these different agents can now suddenly employ extreme level competence from multi-domains by the hands of a single user into the data and give you insight back that otherwise would be impossible, even for large research teams.

• 2:11:41Dr. Peter Attia?

  As you think about 2028, if you think about the next four years, if you had to just sort of speculate wildly, what percentage improvement do you think this will bring? Not to the insights, but to the actual performance.

• 2:11:55Speaker 01

  I think that, okay, first to answer it a little bit more high level. I think that today Norway have been a superpower in winter sports. A lot of the reasons has been because of the technology research and all the things that have gone into, for example, purely optimization of skis. You could come to the Olympics, you can be a better trained athlete, but you won't win simply because the way the technology makes a difference on the skis, for example. I think AI will be, or I'm convinced AI and the systems we are building now will have the same implication on purely human performance and training. Meaning that if you basically don't employ AI at some point, you will be at such a deficiency. So you have great people, what is important for me to say here.

• 2:12:35Speaker 01

  Coaches are very often extremely advanced, almost super intelligent in the space of exactly making people fitter. They are maybe not or not even closely remote to the understanding of everything we have talked about today in terms of even knowing exactly the definition of such a widely common expression like or terminology like FTP. But still they produce some excellent athletes because they have observational skills and developed an intuition of what works and not works through a lot of experience, empathy and so on, that they are brilliant. But AI is not conflict to them, rather, again, a superpower where they can employ their level of understanding into much better questions.

• 2:13:19Speaker 01

  Into what is happening here with my athlete. So it shouldn't change the way you do coaching, but it increases the precision of what you do in the coaching. And the biggest change thus in performance will come through even better consistency in the training, not that single workout that is so much more brilliant, but purely in the consistency of the training and adaptations you do to the training programs.

• 2:13:42Dr. Peter Attia?

  Is there an area in particular that you see the biggest gap between where your insights are, your coaching insights are today versus where you hope AI is going to close a gap?

• 2:13:54Speaker 01

  Yeah, being able to be far more proactive than what I am today. I still, even though I would consider myself as one of the leading persons on using technology and also in the applied research when it comes to elite performance, I can still say that I am only able to utilize in the daily life a fraction of the data that we are collecting. Then you can say, well, why do you collect all the other data? Well, very often it becomes insight. You come back, you learn something from it that you otherwise wouldn't be able to do.

• 2:14:20Dr. Peter Attia?

  Well, and you're going to have training data.

• 2:14:22Speaker 01

  Yes, yes, yeah. But being able to be proactive and make adjustments, individual adjustments much more proactively will be one of the biggest differences. And this doesn't go only apply to elites. This applies even to amateurs or normal people.

• 2:14:37Dr. Peter Attia?

  Well, it's been a fascinating discussion. I thank you again for making the time to swing by on the way to Flagstaff and as always, just enjoy talking about this stuff and hopefully folks enjoyed this as well, even though admittedly it was a little technical at times.

• 2:14:51Speaker 01

  Thank you, the same.

• 2:14:53Dr. Peter Attia?

  Thank you for listening to this week's episode of The Drive. Head over to peterattiamd.com/shownotes if you want to dig deeper into this episode. You can also find me on YouTube, Instagram and Twitter, all with the handle peteratiaMD. You can also leave us a review on Apple Podcasts or whatever podcast player you use. This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional healthcare services, including the giving of medical advice. No doctor-patient relationship is formed. The use of this information and the materials linked to this podcast is at the user's own risk. The content on this podcast is not intended to be a substitute for professional medical

• 2:15:38Dr. Peter Attia?

  advice, diagnosis, or treatment. Users should not disregard or delay in obtaining medical advice from any medical condition they have, and they should seek the assistance of their healthcare professionals for any such conditions. Finally, I take all conflicts of interest very seriously. For all of my disclosures and the companies I invest in or advise, please visit peterattiamd.com/about, where I keep an up-to-date and active list of all disclosures.