#365 ‒ Training for longevity: A roundtable on building strength, preventing injury, meeting protein needs, guidance for women and youth athletes, and more | Gabrielle Lyon, Mike Boyle, Jeff Cavaliere

View the Show Notes Page for This Episode https://peterattiamd.com/trainingforlongevity/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=250922-pod-trainingforlongevity&utm_content=250922-pod-trainingforlongevity-podfeed Become a Member to Receive Exclusive Content https://peterattiamd.com/subscribe/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=250922-pod-trainingforlongevity&utm_content=250922-pod-trainingforlongevity-podfeed Sign Up to Receive Peter's Weekly Newsletter https://peterattiamd.com/newsletter/?utm_source=podcast-feed&utm_medium=referral&utm_campaign=250922-pod-trainingforlongevity&utm_content=250922-pod-trainingforlongevity-podfeed In this special episode of The Drive, Peter hosts a strength and conditioning roundtable with three experts in the field—Gabrielle Lyon, Jeff Cavaliere, and Mike Boyle. Together they explore why maintaining muscle mass, strength, and power is essential for healthspan and longevity, and examine how resistance training supports metabolic resilience and injury prevention across the lifespan. The conversation covers practical strategies for getting started and staying consistent, the importance of a protein-centered diet tailored to age and activity level, and approaches to resistance training for peri- and post-menopausal women—including tendon care and optimal programming. They debate single-leg training versus heavy bilateral lifts, share knee-friendly lower-body options, and highlight exercises that belong in the "graveyard" due to poor risk-reward ratios. Finally, the group discusses youth sports specialization, emphasizing the long-term value of variety for developing lifelong athletes. We discuss: Personal career journeys and philosophies of each guest that shaped their approaches to strength, conditioning, and lifelong health [3:30]; Why so few people engage in resistance training despite its proven health benefits [8:30]; Mike's low-stress, high-consistency method for training beginners to resistance training [18:45]; How resistance training enhances metabolic health and body composition even in lean, highly active endurance athletes [25:30]; The dominant role of nutrition in shaping physique and achieving low body fat, the synergistic effect of resistance training, and the unrealistic expectations about muscle growth and fat loss [28:30]; Why Jeff advocates for five meals a day, and why meal timing matters less than overall protein intake and caloric consistency [38:00]; Optimizing protein for every stage of life: quality, quantity, and guidelines for diverse diets and body types [44:15]; The advantages of unilateral lower-body training over heavy bilateral lifts: impact on strength, athleticism, recovery, and functional movement [51:45]; Rethinking heavy squats and deadlifts: risk-reward, aging bodies, and the case for reverse lunges and other single-leg alternatives [1:01:15]; Adapting with age: Gabrielle on injuries, hip dysplasia, and the shift to smarter training [1:10:15]; Exercises that belong in the "iron graveyard": unnecessarily risky exercises and their safer alternatives [1:19:15]; The downside of early sports specialization in children and the long-term benefits of encouraging kids to play multiple sports [1:25:00]; Advice for preventing an Achilles injury: calf strength, ankle mobility, and listening to pain signals [1:33:15]; Shoulder pain: how to keep training the upper body when shoulder pain limits pressing movements [1:40:45]; Effective strength training strategies for women before, during, and after the menopausal transition [1:43:15]; Best practices for strength training and athletic development in children, and the pitfalls of early sports specialization [1:50:30]; How to foster healthy habits and an interest in fitness beyond playing sports [2:00:00]; Something each guest has changed their mind about in the last five years [2:04:00]; 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 the subscription.

• 0:54Dr. Peter Attia?

  If you want to learn more about the benefits of our premium membership, head over to peterattia MD dot com forward slash subscribe.

• 1:04Dr. Peter Attia?

  Welcome to a special episode of The Drive, another roundtable conversation devoted, this time entirely, to strength and conditioning. My guests this week are Dr. Gabrielle Lyon, a fellowship-trained physician in geriatrics and nutritional sciences, founder of Muscle Centric Medicine and author of the New York Times bestseller, Forever Strong. She runs a clinical practice in Houston and continues to publish research on skeletal muscle health and metabolism. Jeff Cavalier, a physical therapist and former head strength coach and physical therapist for the New York Mets, who relayed that experience into his incredibly popular YouTube channel using an injury-smart approach to make athletic training accessible

• 1:46Dr. Peter Attia?

  to literally millions. And Mike Boyle, a pioneering strength and conditioning coach, now in his 43rd year. Mike popularized NFL Combine training in the 1980s and spent the 1990s with the Boston Bruins and opened the first for-profit strength and conditioning facilities in the US. He was also part of one of the Boston Red Sox championship-winning team. In this episode, we discuss The critical importance of strength training for longevity, how muscle mass, strength and power protect health span as we age, the participation gap in strength training and why closing it is crucial for lifelong health, injury prevention, metabolic resilience, plus the barriers that keep most people from getting started and staying consistent, the importance of building a protein-centered diet, how age, activity and metabolic health

• 2:31Dr. Peter Attia?

  drive, how much protein and carbohydrate each individual really needs, resistance training across peri and post-menopause, including tendon care strategies, and why good programming matters, single-leg training versus heavy back squats and deadlifts, the risk-reward calculus that led Mike to swap most bilateral lifts for unilateral work, reverse lunge mechanics, and other knee-friendly lower-body substitutes that still let you load heavy and grow stronger, the exercise graveyard, why unsupported chest flies, Cuban presses, and other classics may be more risk than reward, and what you should be doing instead, early sports specialization myth for kids, why variety in sports at a

• 3:15Dr. Peter Attia?

  young age is still valuable and necessary to becoming a lifelong athlete. So, without further delay, please enjoy this roundtable conversation with Dr. Gabrielle Lyon, Mike Boyle, and Jeff Cavalier.

• 3:32Dr. Peter Attia?

  Lady and gentlemen, thank you so much for all making the trip out to Austin. Been looking forward to this one for a while. As some listeners might know, this is our second version of a roundtable, but unlike the first one where I had interviewed the three guests multiple times previously, and they were very familiar to the audience, all three of you are people whose work I'm very familiar with, but I've never had the privilege of sitting down with you one-on-one. And as much as I would have loved to have done that first, I think it would have stood in the way of doing this today. So, before we jump into what we're about to talk about today, which is all things related to resistance training, I want to just ask each of you to maybe give the non-bio version of who you are, and as such, why I think you're a great part of this. Let's start with you, Gabrielle.

• 4:17Speaker 01

  Certainly. My name is Dr. Gabrielle Lyon and I'm a fellowship-trained physician in geriatrics and nutritional sciences. I did my fellowship at Wash U and at the time, I was very reluctant to doing geriatrics because it can be a very arduous and sad experience. But I was fascinated by the nutritional research side. There was a moment, we were working on a study looking at body composition and brain function, and I really took to one of the participants and I imaged her brain. And at her mid-50s, she looked like the beginning of an Alzheimer's brain. And in that moment, muscle-centric medicine, which is the concept that I practiced and founded, was born. And it's really that skeletal muscle

• 5:00Speaker 01

  is the focal point of all our health and wellness. I'm an author, wrote a New York Times bestseller called Forever Strong. I continue to do research and work within the space.

• 5:11Dr. Peter Attia?

  And you see patients, your clinician as well?

• 5:12Speaker 01

  I do see patients. I have a medical practice. I do see patients. We actually just submitted a paper that got accepted for publication on sexual function, the relationship between sexual function and muscle mass.

• 5:22Dr. Peter Attia?

  Okay, cool. Mike?

• 5:24Speaker 02

  Michael Boyle. I'm a coach. I've been a coach. This is my 43rd year, actually, coaching. I was lucky enough to bounce right out of college and into a college job. I started out as an athletic trainer. When you said to be immodest, I think I invented training for the NFL Combine, at least there's a book that says I did invent training for the NFL Combine in the 80s. I worked in the NHL for the Boston Bruins in the 90s, from 90 to 99, while I worked at BU, because strength coaches were basically part-timers at that point. Worked at BU for 30-something years, opened a business for profit, strength and conditioning, probably the first one in the United States in 1997. And then in 2012, I left BU, where I've kind of always had more than one job, and I jumped over to the

• 6:08Speaker 02

  Red Sox for two years and was able to get a World Series ring out of the Red Sox in two years, and then realized that that was not very conducive with being what I really want to be, a good father and a good husband, and was like, okay, I'm done with pro sports. So now I coach still. Coach my son and his friends. I have a son who plays lacrosse. I'm still actually functioning as a personal trainer, I guess, in some cases, and as a strength and conditioning coach in some cases. So I'm more than anything, just a practitioner.

• 6:34Dr. Peter Attia?

  And what type of clients do you see now? What's the range?

• 6:37Speaker 02

  The range is 11 to in their 80s. That's our client range. We don't take kids till they're 11 because we really don't want them in the gym before that. And we'll take them as old as we can get them. But I think the oldest right now is 89. That's actually my son's pediatrician, just turned 89, retired last year, believe it or not. Dr. Leader had still been working all those times. We have a couple, three-generation families, of which he's one. We have him, we have his kids, and we have his kids' kids that are all training in the same space.

• 7:04Dr. Peter Attia?

  Good. There are a lot of things I want to talk about that are embedded in there, so we'll come back to it. Jeff?

• 7:09Speaker 03

  Jeff Cavalier. So I'm a physical therapist by trade. Moved out of the clinic at an early stage. Got a great opportunity to work in that role for the New York Mets, which was a dream come true for me because I was a diehard Met fan growing up. Presented the dream job. And from there, it piggybacked into how could I continue this education of athletes on a broader platform? Was well aware of the power of the internet at that time. So I started a YouTube channel, which by luck, beyond just my family members subscribing early on, I got a few others that did along the way. And it piggybacked that into a broader message, which was, okay, now it's not just about training athletes and empowering athletes, but how do I empower people who want to be more athletic, feel more athletic, move more athletically in daily life,

• 7:54Speaker 03

  not just in where they're getting paid a paycheck? So that became my mission, really, from that point. Now, beyond having to sort of maintain a certain level of consistency because I want to practice what I preach, I also have two young boys. I started late. I'm 40 years old. I have twins. And now I feel like I got to make sure I can keep up with them when they're ready to have me be able to run and play. So I have a lot of motivation to keep doing what I'm doing and stay in the shape I am. But I believe that it requires having an understanding of injury, training around injuries, because no matter what, as we get older, things do start to break down. And I think you have to have strategies to be able to push through that and train around that. And I think that's where my big strength is as a PT, to provide that background and help people do that more readily.

• 8:37Dr. Peter Attia?

  Okay. Let's start with a question that probably has an answer, although I actually am a bit embarrassed to say I don't know the answer. So I'm wondering if one of you guys do. Do we have a sense of what percentage of people in the United States do not practice resistance training?

• 8:52Speaker 01

  Well, we know that 50% of Americans are not training or doing any kind of exercise. From the research that I've read up until recently, it's probably 70% do not meet the criteria for both activities.

• 9:06Dr. Peter Attia?

  70% in total then, or you think it's 70% of people who are doing some form of exercise?

• 9:13Speaker 01

  I believe that it is 70% of people in total.

• 9:15Dr. Peter Attia?

  Got it. I can't even fact check that. I mean, that's hard for me to imagine, but I can believe it.

• 9:20Speaker 02

  I think it's lower if you're talking about resistance training, because we were talking about.

• 9:24Dr. Peter Attia?

  You would say lower than 30% would do resistance training then?

• 9:26Speaker 02

  Yeah, because I think 20% of people belong to a gym. If we look at home gym stats aren't very good in terms of people, the home gym person who actually has one and uses it is probably more unicorn-y than we think they are. And so if you start looking at that number, 20% have a membership, 50% of those people use it, which now brings us down to only 10% of people in the United States are actually in a gym. And then you look at that and say, what percentage of them are resistance training? Maybe now we're down to 5% because you see a lot more hamster wheel people who are just walking on a treadmill or walking on a stair climber or whatever it is. So I would think the numbers are pretty low.

• 10:01Speaker 03

  We spoke a little bit about this, but we have digital statistics that actually show people who have signed up to train with our programs, let's say, either be at home or at the gym. The percentage of people that make it through our programs is only 20%, and that's very high industry standard.

• 10:17Dr. Peter Attia?

  That's twice the industry standard for digital.

• 10:19Speaker 03

  Right, right. Which is usually like 10% or so. So those are people who showed the commitment, made a purchase, put their hard-earned dollars behind it, have everything they need, I would think, in terms of the tools and sets and reps and what's supposed to be done, and only 10% will finish a program. So that's a pretty remarkable statement on why people can't. I think there's a lot more of a desire to do things, but the ability to actually follow through is where I think we're having the hardest time.

• 10:44Dr. Peter Attia?

  So it might be then, Gabriel, your stat is 70% of 50, the reciprocal of that, 30% of 50, 15. It might be that our range is somewhere from 5 to 15%. If I were going to sort of triangulate between these three data points. That's kind of a hard thing to digest if you're asking the question. And I've never been shy about my thesis, which is of all the pillars that we have to embark on improving our health, whether it be changing our nutrition, improving our sleep, taking the medications and supplements that can be actually quite important. I just don't see any evidence that anything trumps exercise, just purely from an actual lifespan perspective. And from the standpoint of reducing the risk of chronic disease, when you then layer in the benefits it has on quality of life. I mean, it's just sort of a no brainer.

• 11:29Dr. Peter Attia?

  So what do you think? And Mike, I'm going to start with you because you've been at this the longest. What do you think explains the disconnect between the fact that we have this incredible tool? That will lengthen your life, improve the quality of your life, make you look and feel better. And yet, 5, 10, at most 15% of people engage in it. What are the barriers?

• 11:54Speaker 02

  I think the biggest barrier is just life, lifestyle, kids, jobs, people thinking. You really have to commit to, is it getting there early? Is it going there after work? Whatever it is, it's adding hours to your day. I think that's probably the biggest barrier. In some ways, I guess that's economic. People don't have the economic freedom to say, hey, I can devote. That's why I laugh sometimes when I hear people talking about hours per week of exercise and hours per week of cardio. I just kind of snicker in terms of if I can get someone to do two hours a week. So I like your guideline more of, I think you said 75 hard minutes. And I'm like, 75 hard minutes now is realistic, but even 150 minutes, some of the guidelines are crazy. And then there's a lack of awareness. You don't know you're losing the battle until it's too late. That's what we see in our business.

• 12:38Speaker 02

  We see people coming in and you think, wow, thank God you got here now at 50 or thank God you got here now at 55, because the end for you was going to be bad. I'm not saying this to flatter you. I've been following you for a while and you're getting the message out in a way that it hasn't gotten out before. Because the message before was geeky or nichey or whatever it was, but it wasn't this, hey, this is really good for you. And this is going to make you live longer and live better. It's double bonus, right? You want to live longer, but who wants a long shitty life? Excuse me, I don't know if we're not supposed to swear, but.

• 13:10Dr. Peter Attia?

  We swear, don't swear.

• 13:11Speaker 02

  Okay, good, okay. But do you know what I mean? Versus looking at it and saying, hey, I would like to live longer. And Jeff and I talked about this. I've experienced 50 to 65, and trust me, it's not fun. The decline is rapid and the decline is significant. And I think if people like, if you don't wake up by the time you're 50, you're going to be in real trouble by the time you're 65.

• 13:31Dr. Peter Attia?

  Gabrielle, how much of a difference do you see between men and women on this front? Not from this standpoint, not from the economic standpoint, but from some other barrier to entry? Do you see differences between men and women who are new to resistance training?

• 13:43Speaker 01

  I do. And the first thing that I want to say is you're absolutely right. There's nothing more important for maintaining health and wellness than taking care of muscle health, whether it's strength training, mobility, resistance, but skeletal muscle health is really what we're talking about. Where is the disconnect from men versus women or people in general? Part of it is cultural. We live in a society of comfort. It's very easy to take the escalator or take an elevator. When it comes to nutrition, we all have to eat, but we don't all have to move. I literally could sit at my house, order my groceries, Amazon Prime everything, and I never had to take more than 300 steps.

• 14:24Speaker 01

  For women, typically, strength and strength training has not been the focus. And we know that. I mean, even just from a standpoint of walking to the gym, you're starting to see it more. I really do feel like we are on the precipice of women recognizing the importance of strength and muscle, especially with new conversations around menopause and more potent conversations. But they're busy. And the other aspect of that is there are self-imposed limitations. A woman would look at a 40-pound weight and go, I can't lift that. But she would look at her 40-pound toddler and go, I'm going to lift that and I'm going to carry my groceries. I got it. And that's really where I think that we can change the disconnect is

• 15:08Speaker 01

  reeducating the importance of muscle and then also changing the cultural conversation.

• 15:13Dr. Peter Attia?

  Obviously, you're really fit. Has resistance training always been something you have enjoyed? Did you grow up doing it? Or is something you kind of came to in your 20s or beyond?

• 15:22Speaker 01

  I grew up doing it. By the time I was five, I was riding 10 miles on a bike. With the conversation around children, if we teach them good habits now, then we don't have to have them spend a lifetime outgrowing old habits because we're not raising children, we're raising adults. And yes, I have always trained.

• 15:41Dr. Peter Attia?

  So I'm in the same boat, and I suspect that's true for all of us. And so one of the challenges that I know I have that's a bit of a blind spot is when I'm talking to patients are perhaps representative of the real world, which is people who are like, I don't enjoy the feeling. I'm sure you've all heard this. I don't like the feeling of lifting weights. It hurts. I don't like that. I can't tell you how many times I've heard that, and I appreciate the honesty, but I can't relate. And it's hard when you can't actually relate to what your patient is saying. I can relate when they complain about having to watch what they eat because that's a struggle I would have, but I truly can't relate to that. So do you think that that's a function of having started early? Or do you think that there are literally

• 16:25Dr. Peter Attia?

  just, just as we have people with different eye colors and different heights, there are truly differences in genetic hardwiring that would speak to an individual's appetite for that kind of discomfort?

• 16:37Speaker 03

  I actually think it's the latter. I think there are some people who are more inclined to enjoy that type of stress. Doesn't matter how much I run, I do not enjoy the stress of running. I don't enjoy how I feel. I don't enjoy the feeling I get in my lungs when I'm sucking for air. I'll do it because I know I have to. There's no enjoyability about that. Training hard and lifting weights and pushing myself to the utmost level of effort, that's always been something I actually kind of enjoy. And I think that it can be learned, though, you can get better at it, just like I can learn the discipline to continue to push and run when I don't want to. So after doing it for a while, when you start to see results, the results actually might become motivating enough to go like, whoa, there is a trade off here. I'm seeing the trade off. And I think that's what we were talking

• 17:21Speaker 03

  about before about people, the start being the thing that's stopping people is that the perceived level of what they're going to have to do is usually bigger than what they have to do. I've mentioned before You can build a great body on six exercises. Literally the row, squat, deadlift, bench, pull up, curl, done. You've got everything you need. You don't have to complicate it. If you keep trying to get stronger at those exercises, now you might get bored to tears, but you can build the prerequisite foundation to get a better body. But people want sometimes to complicate it in their heads so that they have an easier out because it makes it a little easier. So yeah, I don't have time for all that. We liken it to, I've known a few people in my life who've wanted to start businesses. And like, I got this great idea and I'm, they're gung ho, they want to do it.

• 18:06Speaker 03

  And then they get caught up in, I don't know if I should set up an LLC or if I should do it as a corporation. I want to get my business cards. I can't figure out my logo. They're doing all that stuff and they never take the step of actually just starting what their service is going to be and they never get going. And I think people do the same thing in terms of fitness. They make it bigger and they make the commitment larger so that they can almost have a safe landing spot to be like, yeah, I just couldn't get it going. So it's our job to educate them as to how simple it can actually be. Simple being what you need to do. But I think the commitment to actually showing up and doing it, that's hard.

• 18:42Dr. Peter Attia?

  Mike, what percentage of the people that walk into your gym are coming to resistance training for the first time?

• 18:50Speaker 02

  I'd say 50 if I was guessing. Some of them were high school athletes and have some basic relationship with strength training. What percentage of them are approaching intelligence strength training for the first time? 100%. So most of them are coming, we're going to party like it's 1999. Like people come in and they kind of look at us like, what are you doing? And I think that's where, when you were talking about people saying the discomfort, my first thing would be like, what discomfort? There shouldn't be any discomfort. If you come in and start working with us, my whole goal, I say to somebody, you should get out of bed the next day and be like, I think I worked out. I felt okay. I always tell everybody, everything's gauged on how you, if you get up in the morning and you're crippled, I suck. I did a really bad job. You should not be uncomfortable at all. This is slow and steady wins the race, 1% better, however you want to look at it. And if we can just layer, like I always think, I'm a big attendance guy.

• 19:35Speaker 02

  If I can get you to show up two days a week for a year, you'll be remarkably different and you might not have ever had balls to the wall or go to failure. We would have done none of that, zero. And yet you would look at somebody and think, wow, like if you came into our place, everybody looks younger than they do. I am 100% certain, not just of the longevity benefit, but about the physical change that people undergo. Because I'll just show you people and say, yeah, that guy's an 80-year-old, two-time cancer survivor. And people will be like, he is? And I'm like, yep, they look different. And they all look different. They all look younger. Again, what is that? Is it hormonal? I don't, I mean, not a scientist. I know that it works, and I know that it doesn't have to be hard, and it doesn't have to be uncomfortable.

• 20:19Dr. Peter Attia?

  So let's talk about an example of somebody that walks in. So somebody walks in, they're 50 years old. Let's pick a male to start with, but we're going to do many case studies today, I think, because that's how people, I think, can sort of connect. My goal is to make sure everybody listening to this can identify with a person, a theoretical person we're going to talk about. So 50-year-old guy comes in, he's done a little bit of the traded his health for wealth thing. He's been working himself to death. He's had some health scare. He went to the doctor's office and they told him, your blood pressure's really high, or there's something going on. Or he's just sort of confronted his own mortality. He's lost a parent. That's a big wake-up call for somebody in their 50s. Played sports in high school. That was about it. So doesn't really do much of anything now. And somehow has landed himself in your gym. Maybe he saw Jeff on Instagram, and he was like, that

• 21:04Dr. Peter Attia?

  guy looks incredible. I gotta do something. What he's doing sounds cool. So how do you interview this guy? How do you find out what his goals are? And then how do you create that show-up attendance pattern that's going to make sure he can give you a year of whatever it is, two days a week?

• 21:21Speaker 02

  The show-up attendance pattern is a big thing, and that's, there's a really good book called Never Lose a Customer Again. We approach our business much more like a restaurant. Unreasonable Hospitality, I think, is the Will Greddar book. And we try to train our coaches, we refer to them, coaches more than trainers, way more in the customer service skill, because we realize that we want to get the person to come back. That's the goal. Get them to come back. Get them to get through the first workout and come back. We don't interview people a lot. I don't talk to people about their goals. I look at, I think, your goal is to not be the sad sack of shit that you are right now, unfortunately. And we just want to get you going. So it's like, just get them on the conveyor belt and carry them through. This is the one thing, and I have one of the things I wrote in my notes, that CrossFit did well. They created community. You need to create community where people are comfortable.

• 22:04Speaker 02

  One of the problems that we had was people would say, I can't go there. It's all athletes because they come in and, you know, just from a marketing standpoint, there's jerseys all over the place and it looks like a place where athletes train, but 65% of our business are people like us. But just getting them to be comfortable in that environment and getting them to show up again. What do we tell everybody? If you've got new people in your group, you should text them that day and you should text them the next day. How was it? How did you feel this morning? We're trying to build a relationship because it's relationship marketing. Know, like, trust, all the things that you read about. Get them to know you, like you, trust you, want to come back, want to be part of it. And then we can take care of the training part, but the training part to me is relatively easy. It's the getting that person to be consistent and to come. And all I want, I call them check the box clients. I just want check the box clients. If you check the box,

• 22:49Speaker 02

  which means I got to Mike Boyle's twice this week, you will get better. You will feel better.

• 22:55Dr. Peter Attia?

  Say a little bit about the programming.

• 22:56Speaker 02

  The programming for us, very assembly line-ish. I always talk about the idea that it's a recipe and not a menu. So no one gets to pick what they want to do. You come in, this is how the cake is made. It's in this order. This is what you get. Don't like it? Go someplace else where they'll let you know. Go to Planet Fitness, you can make your own cake. You want to come here? You do it the way we do it. Everybody form rolls, everybody stretches, everybody does their mobility work, everybody does dynamic warm-up, everybody throws medicine balls, everybody does some sort of power training plyometrics, not really actually some sort of jump training. Then they'll go and they'll lift. The lift takes 36 minutes. And then they'll go and they'll do some type of conditioning work and we'll start really, really, again, really easy. Try to give them something that's very achievable.

• 23:40Speaker 02

  Don't get them particularly tired. And then boom, out the door. They're in and out in an hour.

• 23:44Dr. Peter Attia?

  Hour door to door?

• 23:45Speaker 02

  Yep.

• 23:46Dr. Peter Attia?

  Okay. 36 minutes of that is the actual resistance training, but obviously everything that's leading up to it and on the back of it is, I mean, that's clearly training as well, right?

• 23:54Speaker 02

  Right. I think honestly, for the older client, more important, we always talk about the first 15 minutes is more important. Getting people to roll, to stretch, to start to deal with their tissue limitations because most everybody that comes in has something. No one comes in healthy. No one comes in anything. So I have nothing that hurts.

• 24:09Dr. Peter Attia?

  Progress is made by advancing weight, advancing reps, advancing sets, jumping higher.

• 24:16Speaker 02

  Mostly by advancing weight. I mean, if you're going to look at it the simplest way, it's just try to get them, because again, females, right? You're just trying to get them to engage in progressive resistance. I always think what someone said, I've been doing the five pound dumbbells for the last year. I'm like, oh, you only wasted like 50 weeks. Our thing is just get them to pick up something that's a little heavier. We try to figure out ways, could be isometrics, could be eccentrics. We try to vary it because with our adult clients, we're in the entertainment business a little bit in terms of, we've got to keep it interesting. Like you said, you can do six exercises, but we have to figure out are there 14 different versions of those six exercises that we can do to keep somebody not thinking they're doing the same thing over and over again. If we get one complaint, it might be that we do the same exercises a lot. It's kind of like, yeah, because we do the good ones. But our adults don't touch a barbell.

• 25:00Dr. Peter Attia?

  Okay, I was gonna ask you, are there any things that are off limits?

• 25:03Speaker 02

  They don't barbell bench press, they don't barbell deadlift, they don't barbell squat. No one squats anyway. That's another whole conversation. But almost all of our lower body stuff is unilateral. We'll do goblet squats, basic stuff with people that are really deconditioned because we need them to be capable with two legs before they're going to be capable on one leg. But people were really smart and really safe. And I think that's what you want to be if you want to keep people coming back. I think you can be really smart and not be really safe, and you can be really safe and not be really good. And the mid-ground is where we want to operate.

• 25:33Dr. Peter Attia?

  So Gabriel, what's the biggest thing you're thinking about when a patient is in your practice and they're coming along well on many of the other lifestyle adjustments? Let's just assume this is a person who's a lifelong cardio rat. So they love to run. They run two marathons a year. They've been running forever. They've got some nagging injuries, though. As you know, a runner, especially a female runner, the probability that her proximal hamstring isn't just torn up is pretty low, especially if she's had kids. So now her pelvis is tilted a little bit. How do you make the case to her? Because she's lean, doesn't need to lose weight, as though that's the thing that matters. How are you making the case to her that this muscle centric approach matters?

• 26:18Speaker 01

  Well, she's going to want to be active her whole life. And the healthier her skeletal muscle mass is, there seems to be somewhat of a disconnect. People talk about strength and then disassociate it from mass. But I believe, you know, and I have patients like this in the practice that are very lean, have always been runners, but we'll see their glucose creep up. We will see an increase in visceral fat. That can be course corrected by addressing skeletal muscle mass. When you just think about if this woman, I'm thinking about one patient in particular, she's around 60, she runs 100 miles. She's

• 26:57Speaker 01

  an ultra. Her body composition was not nearly as good as it is now, just by adding in two days a week of resistance training. We added in two days a week, we pulled back on some of the mileage. She's able to move more weight. I mean, and this girl, hey, Sharon, she listens to your podcast, as a matter of fact. She is incredible. By pulling back her training and increasing her weights and being very specific about, obviously, I don't program, but we work with coaches that program, by changing up the movement patterns, she was able to really increase her lower body strength, but also improve her labs, improve her fasting insulin, her glucose, and her triglycerides.

• 27:39Dr. Peter Attia?

  And so, do you think that that's purely a function of having a larger reservoir to put the glucose into? Or do you think that it also speaks to the insulin sensitivity? Does it even make sense to try to disentangle those two?

• 27:53Speaker 01

  I think that the larger reservoir is important for a number of reasons. The metabolic component of muscle, as we all know, muscle is the primary site for glucose metabolism, also free fatty acids at rest. However, it enables her to have more dietary flexibility. Because when we think about nutritional sciences and we think about triglycerides, insulin, glucose, what we're really looking at is the health of skeletal muscle. Metabolic syndrome, the markers of metabolic syndrome are the markers of healthy skeletal muscle. Does it, her activity improve insulin sensitivity? Yes, but her running is, she's going to be very insulin sensitive, as is. But it's really that metabolic component of having healthy skeletal muscle mass, from what I believe.

• 28:38Dr. Peter Attia?

  So Jeff, you're working with people a lot of times at the opposite end of the spectrum. People are coming to you often because they want to have 7% body fat. And it might be that they're an actor and they're about to do a role where they kind of have to look a certain way. Alternatively, it might be an athlete who probably doesn't need to be at 7% body fat, but might want to be at 7% body fat. So you're kind of dealing with the other end of the spectrum. Is it safe to say that these people that are coming to you are so long on motivation that that's not really an issue anymore?

• 29:08Speaker 03

  When your goals start to become 7% body fat, I'm assuming that you're probably not 35 or 40 with aspirations to be there. These guys are usually coming in 12, 13, 14, 15% body fat, desires to want to get leaner for whatever those reasons, like you said, whether it be a role. Or I always tell the athletes, they have to be very conscientious of not falling in love with what they see in the mirror because ultimately they're not getting paid to look that way unless they're... I mentioned sometimes we work with WWE athletes who do get paid to look a certain way and perform at a certain level. But the people that have to be conscientious of what level of body fat they are so that they have a certain role, I mean, they're usually pretty good at being able to dial in. They've oftentimes done this multiple times before too.

• 29:53Speaker 03

  So they've done this and had a history of being able to get down there. They just don't have the ability to sustain it. I think that it's always going to be achieved through nutrition. That level of look is a nutritional consistency. It has nothing to do with training. It has nothing to do with the exercise you're doing. It doesn't matter what split you're following. It doesn't matter any of that. All you have to do is be able to remain very consistent with nutrition. And the level that you're able to get down to is just a reflection of how many sacrifices you're willing to make. You want to still drink a couple of times a week? That's fine. You're going to have to bump it up a notch or two because you really need to be able to make some cuts. Now, I do not believe, I don't do it myself. I do not make sacrifices to the point where I'm eating boiled chicken and broccoli, steamed broccoli. I don't do that.

• 30:36Speaker 03

  I eat meals that are good meals. You saw what I eat. I can eat a meal that anybody else can eat. But I'm very disciplined in not straying from those meals. And so your ability to kind of stay that... That way is going to determine how low you're able to get and how low you're able to stay. I always say if you're eating, let's say, five times a day and that's a seven day week, it's 35 meals. If you could stay 90% or above, you don't have to be perfect. If you could stay 90% or above on those meals, you're looking at three meals in a week that aren't perfect. Now, I'm not saying go hog wild and go down to Buffalo Wild Wings and start eating everything you can. Saying that they just aren't perfect meals. Your body almost completely ignores those. It just overlooks it. You keep going and you're the consistency overrides that.

• 31:19Speaker 03

  And you're able to get to levels that you weren't able to achieve before. But people can't sustain it because either they make it too difficult. Or as I said, it is actually difficult because getting yourself to the gym for one hour, five times a week, two times a week, whatever that might be, even the 36 minutes, that's one level of commitment. It's what you do in the other 23 hours of the day that determines your look because that is the nutritional responsibility. That a lot of us don't have the ability to manage well.

• 31:49Dr. Peter Attia?

  How well do you think that's understood? I mean, I'd say that for all of you. This is a question for everyone. When someone looks at a person and says, look at that man, look at that woman, look at how jacked they are. Do you think that the average person appreciates the role of nutrition in that? Or do you think most of them assume that person must be spending 12 hours a week lifting weights?

• 32:09Speaker 03

  And sorry to jump in, but it's such a sore spot for me. People always think exercise first. In my experience, they always think exercise first to the point where I have people that will say to me, if they see my abs or something, they'll say, oh, what exercise did you do for that? You know, they pat there. Usually it's big belly that they're patting. It's not an exercise, you know?

• 32:28Dr. Peter Attia?

  I did less of this exercise. I did the reverse curl.

• 32:31Speaker 03

  Fewer sets of that, more of these, pushing yourself away from the table. No, they, I don't think they have an appreciation for it at all. Their instinct tells them it's exercise, it's movement.

• 32:39Dr. Peter Attia?

  Would you guys share that sentiment?

• 32:41Speaker 01

  I would totally agree. And what's so fascinating is the data supports also the synergistic effect of resistance training activity and a calorie controlled diet, which people could connect the dots that it is not simply training, but to be fair, training is the most potent stimulus to muscle.

• 33:03Speaker 01

  But you cannot, what do they say? You cannot out-train a bad diet? That's true.

• 33:09Dr. Peter Attia?

  I feel like you could when you were 14. When I was 14, I did train six hours a day. I mean, I was running 13, 15 miles every morning before my workouts. And all I did was eat, but I was like a garbage disposal. Breakfast was a bowl, not a bowl, a box of Fruit Loops in a large Tupperware bowl. You could put the whole box in the bowl. It just didn't matter. But something changes when you're 20 and you can't do that anymore.

• 33:36Speaker 01

  When you're 13 and younger, you're very anabolic. The balance between what drives muscle changes as we age. When you're young, you're very driven by insulin. For example, my daughter, who is five, she could have five grams of protein. She doesn't need to have a meal threshold of 30 to get an anabolic response. Because when you are younger and you are still growing, you're very anabolic. After you are done growing, you want to shift from the insulin usage to the stimulus, which then now, exercise becomes much more important.

• 34:10Dr. Peter Attia?

  Oh, I want to talk about that. So I'm going to come right back to that, but I want to hear Mike's point on nutrition and then come back to that because that's actually a very interesting question.

• 34:19Speaker 02

  I think about it in a simpler sense. We go from being extremely active to extremely sedentary. Suddenly you get into your twenties and you get a job and you're commuting and maybe 10 hours, you might be sitting on your ass, 10 hours a day, every day. And then you might go to a bar with your friends after. And I don't think people sense the shift. I think our problem is that the shift is happening and then people don't pick up on it until it's too late. Suddenly you look down at yourself and think, oh my God, what happened? I gained 40 pounds and I'm in horrible shape and I'm completely sedentary. Then they think, oh, I have to do something about this. But then they tend to revert back to whatever information they might have had. And think about, what's your relationship with exercise in high school? If you're not an athlete, you have a terrible relationship with exercise in high school because it's something that you're made to do.

• 35:04Speaker 02

  It's not fun. You probably don't understand strength training. You go to the gym. I saw a great presentation one time at a seminar. I forget, someone did it in New York and they brought. They said, I'm gonna bring in the most important person in fitness. And they brought in a woman who was a member and had her do a half hour talk. And she talked about just having the money to join the gym and learning how to train. She said, I followed this pretty girl who seemed to know all the machines around. She said, and I would stay like two machines behind her. So she didn't realize that I was following her, but I would watch what she did. And then she'd move two more machines and then I'd do what she did. And then you just realize like this is how people are learning. We all learned to exercise somewhere along the way. Somebody created kind of that initial imprint on us. And most people's initial imprint is really bad.

• 35:49Speaker 02

  What I learned to do when I was in my teens was just moronic in terms of the way I would look at it now. I would tell everybody and that's why I say the reason I say the things that I say is because I've done everything conceivably wrong that you can do. And I have all the orthopedic maladies to show for it.

• 36:04Dr. Peter Attia?

  What do you guys do? Do you guys have nutritionists in your business that also help people when they're also trying to lose weight? In addition to improve strength and other metrics?

• 36:15Speaker 02

  We've tried a whole bunch of different ideas and none of them have ever really stuck, to be honest. We still have another one going right now. One of the guys that works for us is trying to do nutritional consults. And truthfully, we've never found one that we felt really was sticky that a lot of people would do it. But we deal in the most basic nutritional information that we can with people in terms of, hey, we want you to hydrate better. We want you to eat more protein. That's why I said, that's why your message is great. Like your book is perfect. It's like, okay, if we can just get people to eat not even more protein, never mind eat protein. We still have people say, what's protein? Adults who don't really even understand. Again, we're so sometimes up here and then realizing that our consumer is somewhere, even our intelligent consumer

• 36:56Speaker 02

  is way down here with these incredible, you said disconnect, I had disconnect written down. Incredible disconnects, incredible misconceptions. I have women, well, I don't want to start lifting because I don't want to get too big. And I'm kind of like. Trust me, buddy, that is not what we're worried about right now. Yeah, I'm still trying. Right, exactly. You're trying like, hell, and you're whatever, 125 pounds or something like that. Hundred and ten. Hundred and ten? You're killing, but you know what I mean? You're killing yourself in the gym to build muscle. It's not easy to do. It's not easy to do for anybody. It's not easy to do for males. But we see too much steroid use and then we see too much responders. Like you look at NFL guys. I mean, I think there's people that are way higher responder levels than other people. And I think we look at responders or we look at, like when I was a kid coming up, I was looking at people taking drugs, but I didn't know they were taking drugs.

• 37:40Speaker 02

  I thought I could look like, I can remember, I'd go to bodybuilding shows. I can remember looking at Boyer Co. and thinking, I can look like that. And Frank Zane, I can look like that. And then suddenly in my twenties, realizing that these guys were taking drugs and that was why they looked like that. But I spent years frustrated, why don't I look that good? I'm doing all the right stuff. So I think that's why these things are good, trying to get people to see reality, I guess.

• 38:04Dr. Peter Attia?

  Jeff, you talked a minute ago about five meals a day. I will click on that a little bit. Most people think, I thought I'm only supposed to have three meals a day or sometimes just one if I'm intermittently fasting. So talk about the five meals per day.

• 38:15Speaker 03

  I know a lot of people that intermittent fast and actually do well with that. The thing that I think why more people do better with more frequent meals is simply because they tend to get hungry throughout the day and they don't have good management of hunger and then therefore portion control. And they don't have willpower to sort of wait to that next meal. If they are hungry in the mid morning and they have nothing pre-planned or prepared for a snack, they'll just go into the kitchen at work and just start picking and grazing. And that's where a lot of the calories throughout the day are consumed, not in those three main meals, but in the grazing that happens because they can't make it to the next meal. So I just found that it's been easier, especially from the athletic world.

• 38:57Speaker 03

  These guys want to fuel more often, so they want something in between their main meals. But in the world of just the regular individual who wants to be more disciplined with their nutrition, it's easier to actually program in two additional snacks, nothing big, but just snacks in between that I always think should still focus and center around a protein. Because again, I believe that protein should be the cornerstone of every one of our meals and snacks. Cause we don't get enough. That's enough just to keep somebody, A, probably more metabolically stable to get to the next meal. But also it starts to teach them the willpower to do it. So if you're sitting there, you ate breakfast, it's eight o'clock. And then now your next meal is at, let's say 12 or 12:30.

• 39:39Speaker 03

  When it's 10 o'clock, if you get hungry and you have a snack there, you don't have to get through four hours of willpower that you don't have right now to get to that lunchtime. You only have to get through two hours and of those two hours, you weren't hungry the whole time anyway, only the last half hour. So you're teaching yourself willpower over the course of an hour and a half. I actually have dropped back a little bit to where I'm not necessarily doing five meals in a day. Now I'll maybe do four, but I have easy willpower.

• 40:05Dr. Peter Attia?

  Walk me through a day in the life for you, not on a day when you're here and traveling. So you're at home, your first meal is what time?

• 40:10Speaker 03

  It depends on weekend or not, but usually seven 38 o'clock.

• 40:14Dr. Peter Attia?

  And what is that meal?

• 40:15Speaker 03

  Usually it's oatmeal, egg whites, my oatmeal, we call it pumpkin oatmeal. Like it's oatmeal, it's walnuts, it's Splenda brown sugar or brown sugar. If you don't care about the calories in it, whipped cream, put whipped cream on top, pumpkin, I mix inside it. It's good, like it tastes good and it's something that I actually enjoy. If it wasn't, I could never just eat boiled oatmeal for the rest of my life.

• 40:35Dr. Peter Attia?

  And then egg whites, because you're just trying to cut the calories. You want the protein without the total calorie of the egg?

• 40:40Speaker 03

  Yeah, although I'll mix in like just at the hotel here, I'll eat eggs, just the prepared eggs, because they're there. Because I have my egg whites and I keep them frozen egg whites. I don't have, like, I don't want to start cracking full eggs to put into. I'm a little bit simplistic when it comes to my nutrition because I know what works for me. But I have no problem with mixing one or two full eggs. I think you should, people should. And then I'll have milk with that, or I'll have protein shake along with that. So they're not small meals either. That will take me through now, I'll actually go to lunchtime. In the past, I would have had another small snack. I'd have some pretzels and jerky or something like just again, some protein and then some carbohydrates.

• 41:18Speaker 03

  Then I'll go to lunchtime and at lunch I'll have either, it's funny because I'll either have a chicken, grilled chicken wrap with vegetables and yogurt. That would be my preferred meal, some fruit, that would be my preferred meal. Or I'll have cereal because I am still a cereal addict. And we have lots of cereal choices, but I try not to choose the cinnamon toast crunch that my son prefers. And I'll have something else, but I'll have cereal and yogurt.

• 41:42Dr. Peter Attia?

  How much protein are you getting in that meal then?

• 41:45Speaker 03

  I'll have usually a protein shake there too. So I have my protein shake. That's 30 grams plus the yogurt, another eight to 12 grams. And then in the cereal, a little bit more milk too. So I get enough protein from the meal. It's just a little bit less preferential in terms of where the carbs come from. I don't really get crazy about the carbs. I just try to pick lower sugar carbs. I try to be a little bit more selective when it comes to that.

• 42:07Dr. Peter Attia?

  And then you do an afternoon snack around three?

• 42:10Speaker 03

  Afternoon snack would be the same type of thing as whatever the first snack was. I like jerky, so I'll have some jerky, just pick at it. And again, some type of crunchy food, just like a pretzel would be easy for me. Have a handful of pretzels. Then I will have my dinner. Well, actually before that, I have another protein shake after I train. So if I train.

• 42:29Dr. Peter Attia?

  And you train in the afternoon typically?

• 42:31Speaker 03

  Randomly, I'll train at five before I finish up work randomly. But most often than that, I wind up having my shake and then I'll go train at night, like late, late, late at night.

• 42:42Dr. Peter Attia?

  I think we have an input into the sleep issue.

• 42:44Speaker 03

  We do have input into the sleep issue, but I'm not having, I could fall right asleep after my dinner. The issue for me is that when I get home, my kids have been waiting to see me all day. I make myself available to them. We play, we run, we go in the pool, whatever it might be. And then they go to bed a little bit late. We have a busy household, so four dogs. It gets a lot to put everybody down, but they go to bed around nine, nine thirty. And then when I finally get to the gym, it could be 10:30. So now I'll go and I'll train. I don't like to train on a full stomach. I hate the feeling. So I'll opt to have my dinner afterwards, but that does mean that the dinner could come at 11:30, sometimes even 12 o'clock at night. And that is not recommended for everybody listening, but like, I also do think I could dispel the myth though.

• 43:25Speaker 03

  I do not believe in the don't eat after six at all. I don't believe in that at all. Your body, especially if you're carrying a good amount of muscle, which is why we want to, can utilize those calories, can utilize that protein, can utilize those carbs throughout the day, provide whenever they do come in. And I don't think that just magically eating after six is the death knell to having low body fat. That's not part of my equation. The only part of the equation for me is I could get like, it's a little late in the day to be eating there.

• 43:53Dr. Peter Attia?

  Yeah, it might be impacting your sleep more than anything. Anything else is clearly not impacting your fuel partitioning.

• 43:57Speaker 03

  No, and I've been blessed to have the ability to hit the pillow and fall asleep within minutes and stay asleep because I don't sleep very long. I sleep five, six hours, five to six hours. But my quality of sleep is usually very high. I don't wake up. I don't wake up at all. I wake up when the time to wake up in the morning.

• 44:15Dr. Peter Attia?

  So I want to kind of go back to what you were talking about a second ago because it opened the door towards protein in kids. But before we do that, maybe just for people listening who have been maybe not paying attention to some of this stuff we've all been talking about elsewhere around protein consumption. What type of guidance are you giving your patients on protein? Is there any difference between men and women? And are you differentiating it based on age?

• 44:37Speaker 01

  Age, yes. Men and women, no. When we talk about protein, typically we talk about one thing, but it's 20 different amino acids, nine of which are essential. We actually eat for those nine essentials. There is a lot of nuance around protein in general. Each of those amino acids do something different. For example, leucine, which is, I know, our favorite amino acid, is critical for muscle, for muscle protein synthesis, but something like threonine is important for mucin production in the gut. I suppose I should start with why are we eating protein? We need about 250 grams a day. We recycle, much of that, we don't eat that. A portion of that, probably the largest portion, maybe 75% of that goes towards visceral tissue

• 45:23Speaker 01

  for turnover and maintenance. Maybe 25% of that goes to muscle. But we have to continue to get these essential amino acids so that we can maintain rebuilding and repairing, which the efficiency of that changes as we age. Anabolic resistance, protein efficiency decreases. That is one reason why we need dietary protein, just to maintain the tissue integrity and the structure. Women and men do not need, at this time, from what we know in the literature, a different amount of protein. It's not sex specific. It's body weight specific. The minimum amount of protein I would ever recommend would be 100 grams at a minimum. Men or women, that would be

• 46:05Speaker 01

  The starting place because if you are say 115 pound woman and you are following the RDA at 0.8 grams per kg, what is that 45 grams of protein or so? That's not enough. Part of the failure there is that we have to recognize protein is different amino acids. And so when we talk about muscle health, we need to get enough leucine to support muscle health. And that is probably the recommendation is two to three grams a day. It's probably for optimal health around eight or nine.

• 46:35Dr. Peter Attia?

  How do you get folks to think about that? Cause now all of a sudden you get into dramatic differences in terms of protein source. I don't really think we should go down the PD cast pathway necessarily for everybody today, but, but just in terms of understanding that foods are created different. So you can look at an ingredient label of something that says 30 grams of protein. You can look at another thing that says 30 grams of protein, but they don't list out the amino acids. They don't tell you that this one has more leucine or more methionine and this one doesn't. But there are certain themes that we know. We know that dairy derived protein, beef derived protein and egg derived protein seem to have the highest amount of the right amino acids, or let's just say the more important amino acids.

• 47:18Dr. Peter Attia?

  So when you're saying to that person, hey, I want you to eat a minimum of a hundred grams per day, does it come with the caveat of assuming you're getting your protein sources here?

• 47:28Speaker 01

  What you're pointing out is protein quality. There are plant sources of protein and there are animal sources of protein. And just from hard, fast biological numbers, we consider a high quality protein to be eggs and dairy, fish, chicken, any of the animal source proteins. The lower quality proteins would come from plants. When we educate our patients in the practice, we have them choose and we really don't focus on plant proteins as a source of protein. While they do have amino acids and certainly a combination is wonderful. We like to focus on plant foods for fiber. Let's say we take out soy, but we really want to focus on. High-quality animal source foods because, listen,

• 48:11Speaker 01

  it makes up, let's say, makes up 30% of our diet. Nearly 100% of our calcium, our bioavailable iron and zinc, selenium, come from these animal-based foods. And while we talk about protein, we should also talk about nutrient quality. Whether someone decides to get their protein from plants or animals, it isn't just about protein. It is also about those nutrients of concern. For women, like bioavailable iron. For kids, bioavailable iron. Nutrients that primarily come from animal sources. I just think are really important. And again, nothing wrong with plant-based proteins, but we eat plants for fiber and phytonutrients.

• 48:51Dr. Peter Attia?

  Presumably, you have some patients, as I do, who are vegetarians. And in some cases, it's ethical, religious, whatever the reason is. What are some of the things that? And let's go one step further. And let's go, most vegetarians will at least be able to consume the dairy portion. But if you have someone who's vegan and who is purely looking at animal sources of protein, how much of an uphill battle is that?

• 49:12Speaker 01

  The challenge is the carbohydrate consumption. So I was listening to what Jeff was saying, and he was absolutely right. He could have, you were saying that you have maybe 100 grams of carbs and you have no problem with it.

• 49:21Speaker 03

  I mean, you probably calculated it in your head. But yeah, I can do that, yeah.

• 49:24Speaker 01

  For someone like him, who is super active, he is able to dispose of those carbohydrates. But a normal person, our carbohydrate threshold, if you calculate the disposal from skeletal muscle, organ systems, it is not much. It is about 40 grams in a two-hour period. Anything above, say, 40 or 50 grams in a non-exercising adult will result in a robust insulin response. We do not want that. We do not want to be utilizing insulin to help support glucose. We want to use activity or have the health of our skeletal muscle be able to balance that. And I suppose what we're talking about is carbohydrates. And unless you are highly active, like you are, then we also have to think about the carb portion of this.

• 50:08Speaker 01

  And designing a diet typically for us, we think a lot about a one to one ratio of protein to carbs at a meal, depending.

• 50:17Dr. Peter Attia?

  Yeah, which is, let me think about that in myself. That's pretty tough. You have to be pretty deliberate about withholding carbohydrates. I mean, I'm probably eating a gram of protein per pound of body weight, so it's not like I'm skimping on protein.

• 50:29Speaker 01

  But you're metabolically healthy. And that goes back to this hierarchy of how we determine.

• 50:33Dr. Peter Attia?

  Yeah, I think you have a longer leash if you're active.

• 50:36Speaker 01

  Absolutely. When we make protein decisions in the practice when we're designing a diet, it's age, it's activity, and it's metabolic health. If you are metabolically healthy, then you can tolerate, there's no problem. Carbs aren't the enemy. But once we find out someone is metabolically unhealthy, which you can see from blood work, you don't change your protein amount. Because as you restrict calories, you keep protein the same or higher because you must protect lean tissue. And also, it's better. I mean, we've seen this in the data.

• 51:06Dr. Peter Attia?

  What about overweight patients? Let's say you have a patient who's, let's say it's a man, 250 pounds. And I know we're going to talk about body fat because I'm actually super interested in what you have to say about that. But let's just assume you did a DEXA on this guy. You don't need to do a DEXA, by the way. You can look at him. You know this guy's carrying way too much fat. But the DEXA just gives you some numbers. The guy's 40% body fat. So when you're trying to tell him how much protein to eat, are you doing it based on an ideal body weight? Or are you doing it based on his 250 pounds that he's carrying around?

• 51:36Speaker 01

  His target body weight.

• 51:37Dr. Peter Attia?

  Okay. So you're going to say, I'm targeting for you 16% body fat. Let's calculate how much lean tissue you have. What would be your ideal body weight at 16% body fat? And that's what we're going to target you at?

• 51:47Speaker 01

  Yeah.

• 51:48Dr. Peter Attia?

  Okay. I want to totally pivot and talk about something that you already brought up, Mike. And this speaks to how these round tables get totally messy because I'm not done with nutrition. I want to come back to it. But I don't want to forget this idea of unilateral lower extremity training. So this is a topic that's near and dear to my heart. So I grew up, and apologies for people in the audience who've heard me talk about this, but this is just. Context for you. I grew up, powerlifting was one of the things I did on the side. It actually wasn't a sport. I mean, boxing was my life, but I became hooked on being in the gym and the gym I belonged to was a dungeon. It was an old man dungeon, two stories underground with no windows. And I didn't realize how lucky I was at the time, but this happened to be like the powerlifting epicenter. So you basically just had a bunch of middle aged men who were machines.

• 52:33Dr. Peter Attia?

  Everybody could bench press two times their body weight, squat three times their body weight, deadlift four times their body weight. That's what I grew up doing. I was like, we bench, we squat, we deadlift and we do it really, really heavy. Not surprisingly, over time, I started to get injured. I injured my back by the time I was in medical school and kind of decided, I don't know if this is worth the risk anymore. Like, I don't really see that I need to have four plates on my back squatting anymore. And almost through necessity, had to discover single leg training. So I want you to say more about that experience.

• 53:07Dr. Peter Attia?

  Help somebody, because I have patients who really can't believe that you can achieve optimal lower body hypertrophy without a barbell on your back or without picking a barbell up off the floor.

• 53:20Speaker 02

  Yeah, which is amazing. I had the same background as you. I got into competitive powerlifting in college because I was no longer an athlete and I was looking for an outlet and it was like, okay, I'm good at lifting weights. So. Started competing in powerlifting, started hurting myself, back problem, shoulder surgery, athletic training background, get to college as a strength coach. Start to see the same things. I've got athletes with back problems. Everybody's back problem seems to come down to one thing, back squatting. Every kid. During deadlift, we were the old school like squat bench power clean because that was the football mentality at that time. But the people with back pain, it always related right back to back squat. We started to look at that and think, okay, if we're doing something that we know is hurting 20% of our population, should we continue to do that?

• 54:03Speaker 02

  For a while we had to because the football coaches mandated it, but when I got to the point where I was kind of fully in control, I said, we're not going to do this anymore. And then we went the unilateral route.

• 54:12Dr. Peter Attia?

  Sorry, when you say football coaches, are you saying even at the level of the NFL?

• 54:16Speaker 02

  At every level, the football coaches, they want to know how many guys can bench press 400 pounds and how many guys can squat 500 pounds. It's still a very old school mentality. It's getting better. NFL level is getting much better because-

• 54:25Dr. Peter Attia?

  Is the bench still in the combine for anyone but a quarterback?

• 54:28Speaker 02

  Everybody's still benching and still benching 225 as a strength test. They do an endurance test for strength. We could talk about the foolishness of the combine too, but that's another-

• 54:36Dr. Peter Attia?

  The same combine that you helped develop?

• 54:38Speaker 02

  The same combine that I helped train people for, yes. I always tell people, it's like getting a copy of the SAT and all you gotta do is cheat. You gotta practice the event, practice the questions, you know the answers, practice, you'll get good at it. We developed that thought process. But we started going just down this unilateral rabbit hole. But then you start getting into, the biggest thing that people have to understand is when you get into the bilateral deficit research, you're stronger on one leg. You have more strength capability on one leg than you do on two.

• 55:03Dr. Peter Attia?

  It's so interesting, sorry to interrupt you, Mike. It's so interesting how difficult it is to appreciate that when you're not doing unilateral exercises.

• 55:11Speaker 02

  People don't try it and then it's very dogma oriented because we've all grown up around the squat poems and all these things about, you know, king of all lifts and all this bullshit that people spout. And I'm always spouting the anti of that. But the reality is, we started seeing when we first started testing is what happened was one of my assistants, this guy Jeff Oliver, who's been at Holy Cross for 25 years, said to me, "If we could test you in one-legged strength, would you stop squatting?" And I was like, "Yes." So then we said, "Okay, let's try to figure out how we test." So we started making up these half-assed one-leg squat tests, you know, doing rep maxes in different split squat variations and things. But when we did it, the results blew us away in terms of-

• 55:49Dr. Peter Attia?

  The difference between sides blew you away?

• 55:52Speaker 02

  No, the ability to be stronger than we were, or as strong as we were bilaterally, blew us away. So we had guys, the first year I did it with my hockey team, 2000, maybe six or seven, somewhere in there. Everybody could split squat what they could front squat, same amount. So if I did a back split squat test, everybody that could back split squat 300 pounds was a 300-pound front squatter. Everybody that could back split squat, project out to a 400-pound max, was a 400-pound front squatter. Right across the board, it was exactly dead even, one leg to two legs. And then people would say, "That's because they're using their back leg." They were trying to come up with all these rationales for why it wasn't- But the numbers were just glaring. Then we went to a split squat test and we had one kid who did 240 pounds for 20 reps, which, you know, if you bilateral did out, it's 480 for 20.

• 56:37Speaker 02

  He's a 200 pound hockey player, 190 pound hockey player. They just, the numbers started to smack us in the face a little bit. And then you start looking at the bilateral, like you look at the grips, you have to research. Bilateral deficit, right hand plus left hand will be more than combined two hand. They've done it with leg extension. They've done it with a bunch of different things. And what they realize, I think, this is my own theory, but we neurologically know that we are unilateral. If I said to you, try to dunk a basketball, I'm going to guarantee you right hand.

• 57:03Dr. Peter Attia?

  I'm going to jump off one foot.

• 57:04Speaker 02

  You're going to jump off your left foot, you're going to hold the ball in your right hand. Everybody here is going to do it, except 10% of us are lefty. So 10% of us are going to grab it in our left hand. But everybody knows if I say to you, throw a baseball, I always say to somebody, if I say throw a baseball, everybody knows how to throw it. If I say throw two baseballs, somebody would think, I'm not really sure how I'm supposed to do this right now. We understand neurology and then we deny it when we start strength training because we want to deny it. And I think it's actually limiting. I think I've said to people, I think I spend a lot of time probably making people less athletic.

• 57:35Dr. Peter Attia?

  You think that you did that in the past?

• 57:37Speaker 02

  In the past, yes. Because we had some of our super elite NFL wide receiver type guys would be very resistant to really heavy back squats and deadlifts and things like that. And they would always, they were like cats. I don't like it. I don't like it. It makes my back sore. I don't feel right. And what you realize is you were probably dampening their nervous system a little bit because the analogy I always use, if you think like the mountain, the guy from Game of Thrones, he was an Icelandic basketball player, decent, mid-level Icelandic basketball player. When he became one of the world's strongest men, he was a worse basketball player. And I can remember, I went to, I used to go to powerlifting meets and I'd look at the powerlifting meets and I would be like, nobody here looks athletic, no one. And then I'd go to an Olympic lifting meet and I'd be like, ooh, these cats are athletic. They can jump and they can sprint and they've got big traps and big asses. So they looked more like what I wanted my athletes to look like.

• 58:22Speaker 02

  Whereas powerlifting, it was sort of like a semi-mobile refrigerator imitation, you know, just people lumbering and even little people lumbering around. The little people lumbered just as bad as the big people. And then you go to a track meet and go watch the sprints and the jumps and you're like, oh, wait, that's what I want. That's what I'm trying to get everybody to. So I became a big Charlie Francis guy in the nineties. Started looking at this and saying, okay, let's look at how the fastest people in the world, the people that jump the highest in the world, what are they doing for training? And again, you started to see more unilateral work, unilateral plyo work, unilateral strength work. So it was sort of this rabbit hole that I just went down and never came back from.

• 59:02Dr. Peter Attia?

  It's interesting. Charlie Francis, of course, a lot of people will sort of just have a negative thought associated with him because of the association with Ben Johnson, but I don't think a lot of people realize his coaching genius. Can you say a little bit more about Charlie, who sadly passed away, I think, due to cancer, kind of young, right?

• 59:17Speaker 02

  Yeah, kind of young. Luckily, one of the guys, I said, someone said, anybody you've never met in the field that you would have liked to have met? And I said, yeah, I wish I had met him at that time. But when you think about, he developed world-class sprinters in Canada, almost all of them from Toronto, Greater Toronto Area. The probability of doing that is really, really low. And so you think, and he was so far ahead of his time. If you read Charlie Francis Training System right now, it was originally published as Charlie Francis Training System. Then after he got in trouble, they republished it as Training for Speed. So it's the same book. You can just get it on the internet. But he's talking about recovery, regeneration, massage. Now, this book was written in the 80s. You would read it right now and think, my God, this thing was written a month ago. He was using words that I hadn't even seen yet. It was the first time I encountered even

• 1:00:01Speaker 02

  the word. That's where we started to do massage work with our athletes. That's where we started foam rolling, because we realized, we can't get massage done for every single athlete, but we can get everybody to foam roll. And he was always talking about tissue quality and tissue resets. And they would bring therapists to training camps that they were doing. And it was so forward-thinking. I mean, imagine, because now, well, 45 years ago, right, I guess, 35 years ago, whatever it was, it was a long time ago. And he was so far ahead of the field, frighteningly, to the point where it still encourages people to read his stuff now. I started reading, I read everything he wrote. I read Speed Trap, which was more about what had happened to them in the process. And then I read this, Angelia Sijenko, who was one of his sprinters, wrote a book. I read that book. I just read

• 1:00:43Speaker 02

  everything I could consume about Charlie Francis to see, you know, is there another little nugget of something that I'm missing? I guess from the track and field thing, I never looked back. I never looked and said, I don't care what powerlifters are doing. I don't really, I care what Olympic lifters are doing. I really athletically. And then we started to look at rehab, and we realized that from a rehab standpoint, it was all unilateral, and it was all what they were calling functional, and it was all what they were calling closed chain. And suddenly, to me, it all made sense. It all came together for me at that point in time. So we've been doing that for 30 years.

• 1:01:15Dr. Peter Attia?

  So Jeff, in your world, training people the way you are, what are the exceptions to those rules for you? When are the times when you're saying, or are you saying, no, I still see that the risk reward trade off for someone in a certain position is there for a barbell back squat or a sumo deadlift or something like that? How do you think about that?

• 1:01:37Speaker 03

  I think that there's always the argument of, see, a lot of times, especially in Mike's world too, when people come to him, they've already learned bad mechanics for squats. So they're bad squatters when they come to them. So they're already demonstrating habits that are going to totally break down their body by continuing to just pile more and more weight on. I think when you can intervene with somebody at an early age and teach them biomechanically how to squat better, which Mike and I have discussed before at length, it's not easy to really dissect that lift. It's a complicated lift. There's a lot of moving parts. So you have to be willing to spend a lot of time with that person to teach them from the ground up. In those instances, when you can, I think you could probably teach somebody how to squat more safely. That doesn't take away the fact that if you can do it

• 1:02:21Speaker 03

  and not have to load that way, and especially as we talk about the aging population, then the benefits might still outweigh the risks in terms of it's just better to single leg squat. But I think that you can probably teach that lift, but you have to be willing to teach that person to either unlearn the bad things that they've already learned, or if they're starting out early, learn how to do it more properly. And you could do it in stages too. You can, by squatting to a box, you can biomechanically fix a lot of people's issues because having the target or the safety net behind them is enough to sort of get them to actually move in a better way. But you don't want to train that way without ultimately going to a freestanding squat if they're going to be ultimately playing sports and needing to do something like, let's say, an offensive lineman coming off the line. But again, I'm actually in Mike's camp

• 1:03:06Speaker 03

  in terms of the value of single A training. We do so much single A training with AthleanX because I believe that it's not just the unloading that we get from the single A squat. It's just, as Mike said, how we're wired, how we're actually preferred to move. And I took some shit along the way because anytime you pick up A leg from the ground, it's functional training. And then all of a sudden that has was a cool thing at one time. It's not a cool thing anymore, but you do pick up your leg. And then, yes, that's functional for a reason. So I think doing lunging and step ups, we built a whole program with the Mets around step ups and lunging because we knew how important that was. And then, again, we did other forms of bilateral lifting. We would do trap bar deadlifting to clean up some of the issues that people had.

• 1:03:51Speaker 03

  I always say that if you want to learn how to squat, take a dumbbell, hold it between your hands or kettlebell and just let the dumbbell, the weight go straight down to the ground. It will put you biomechanically in almost a perfect position because you're just letting the weight drop straight down to your center of mass. That's a great tool for teaching people what it's supposed to feel like. But when you then go put the bar in their back, as soon as they don't have thoracic mobility, all the things that they're lacking start to change that dramatically. You think it's the same exercise because you're going straight up and down, but it's a very different exercise because now when your hands are up and again, thoracic extension is more required, they don't have that and the whole system gets thrown out of whack. So it's done, it's still done in certain circumstances and you're always going to still encounter people who, I don't know, Mike, you might just tell them to go to a

• 1:04:34Speaker 03

  different gym, but like there's going to be people who will insist that they still have to squat and they want to learn how to do it and do it more safely. And I think having the willingness or the ability to still coach them through that is important, but because of guys like Mike and because hopefully stuff that I talk about, people are less reliant on those as the only things that they can do.

• 1:04:56Dr. Peter Attia?

  I'm a little conflicted, less so now, but I think up until about 18 months ago, I was still squatting and deadlifting regularly, though with much less weight. I was never going below five reps and frankly, targeting eight to 12 most of the time. And my rationale for it was the following. I viewed it as an amazing audit of my chain. So I filmed every set. So I have a tripod in the gym. My phone would sit on it from the warm up set to the last set. Every set was filmed and my recovery was watching the video. The truth of the matter is despite that, about one in every eight workouts, I just screwed something up and I would spend the next four days in pain and I'd be Sitting in the shower, running hot water on my back.

• 1:05:38Dr. Peter Attia?

  Was it anything catastrophic? No, not at all. I got my erectors just flared up. It wasn't the end of the world. But what it said to me was, people watching us might be offended by the statement, but I'm getting old. I'm getting old.

• 1:05:49Speaker 01

  You look great for 25. Come on.

• 1:05:51Dr. Peter Attia?

  As I think all of us would agree, the name of the game when you're old is never getting out of the game. There's nothing more devastating. It's one thing to get injured when you're 20. You're going to be back. But if a 55 year old, never mind a 70 year old, a 55 year old has to take a year off because of some devastating injury, it's really difficult to come back. And so I very sadly decided that the risk that I was going to do something dumb. Actually, I'll tell you the straw that broke the camel's back. I used to do a lot of tire flipping. So I used to have this 450 pound tire and my absolute favorite activity was there were different games you would play. So you would love the gamification of it, right? It's like, how many times could you flip it? How long did it take you to flip it 25 times or something like that?

• 1:06:36Dr. Peter Attia?

  And so when I moved to Austin, I didn't have my tire because it was out in San Diego. So of course I had my assistant call and find a guy who could find the closest tire to 450 pounds. We found one of those 407 pounds. The guy delivered. He's like, what the hell do you want this thing for? I start flipping it again. And my friend, who's a really awesome PT was watching me and he goes, have you ever hurt yourself doing that? And I said, never. He goes, you are in a remarkable amount of lumbar flexion right now. And I would just be careful. The lumbar spine does not like to be in this position when it is that loaded. And I was like, you know, he's right. I can absolutely see how under fatigue I could just do something too much. Sorry for the ramble, but the point was, I basically decided, as much as I love this exercise,

• 1:07:17Dr. Peter Attia?

  as much as it's a great audit, I'm learning. I love the idea of critiquing my form between sets. I just decided the risk reward trade off wasn't there for me. Do you think that's a mistake? Do you think that I should have stuck with it and made other modifications?

• 1:07:32Speaker 03

  Because you have these options, I don't think there's a compromise in the benefits you're getting from single leg training. Like I said, there's probably more benefits that you're getting from that. I'm right in that same boat with you. I spent probably from 35 to 45, I have bad knees. That probably comes from my flat feet, but wanting so badly to not have to squat because every time I did, it would kill. My knees the next day would be horrifyingly in pain and my low back would ultimately wind up taking on that same brunt. I know exactly the same spot you're talking about. But yeah, I kept telling myself, but you have to squat. You have to squat. It's just what we do. We have to squat. Like so I would try to get past the point of the things that were bothering me and then

• 1:08:15Speaker 03

  I would ultimately go back under the bar and squat again until I, through watching Mike and others said, it's not a requirement to get what I'm trying to get out of it. I'm trying to hypertrophy my legs. I'm trying to get stronger hips. I'm trying to stay injury free. And so my favorite exercise at that point became a reverse lunge. So I'll do it with a barbell or I'll do it with dumbbells. Honestly, it's a little easier with the barbell because I don't have to worry about the grip of holding the dumbbells.

• 1:08:38Dr. Peter Attia?

  So reverse lunge, meaning you're starting in a standing position and you're doing a step back.

• 1:08:42Speaker 03

  Step back or a step backward.

• 1:08:43Dr. Peter Attia?

  I've seen a great video on this where you emphasize how wide you're stepping out.

• 1:08:49Speaker 03

  That's the thing. And this is where some of the functional training stuff comes up. Oh, it's a balance exercise. That's a bad sign of strength exercise. It's a balance exercise. It's not a balance exercise. If you can't keep your feet wide enough, all you have to do is just step back and out. You'll maintain a wide enough base where you still have support. And then it's a strength exercise.

• 1:09:04Dr. Peter Attia?

  I remember where I was when I watched that video of you and I went to the gym that day and I was like, I've never thought about taking a wider stance. I mean, I added 40 pounds.

• 1:09:14Speaker 03

  Right. My second big tip on that exercise is as you go down, I call it like screwing yourself into place, but you're really not. You just take a little bit of a rotation towards the front leg. So you're just taking a torso, you take it a little bit over the front leg. It will basically stabilize that front leg a little bit more and then get with enough contact. I think when we're doing those reverse split situations, it's about 75% on the front leg or so.

• 1:09:37Dr. Peter Attia?

  Yeah, about.

• 1:09:38Speaker 03

  Yeah. So I mean, you've still got 25% going back on that back leg. And that's enough to support you and make sure that you're not falling all over the place. That is my favorite way, and I recommend for people all the time to do that. Lunging forward is fine, but people that have knee issues like myself, that doesn't feel too good either. So it's like, why not do it this way? Because this is a safer way that has less orthopedic issues for people. You're pretty heavy again, if you're gonna use a barbell there too. So that's my favorite substitute. And since I learned that there were other things I can do and not compromise whatever it was that I was chasing at the time. I have since backed away from that. You can ask Jesse every now and then I'll go back and try again. And inevitably in a few days, things start clicking in my hip or things that didn't pop or click before.

• 1:10:22Speaker 03

  I do believe that there's a path away from that.

• 1:10:25Dr. Peter Attia?

  For you, before I want to talk about your patients, but personally, because we're all telling personal stories. What have you changed in your training, resistance training specifically? As you've aged, as you've increased wisdom, whatever the case might be.

• 1:10:39Speaker 01

  I wish I could say I get less hurt. Before we started the podcast, I said that I had a right torn hamstring.

• 1:10:45Dr. Peter Attia?

  Proximal or distal?

• 1:10:46Speaker 01

  It is proximal and quad fem, which is very unusual. Glute, mead and glute min. I love to overachieve. I thought it was a great idea about eight years ago to keep up with my husband. Who my husband was a former SEAL who's now at Baylor. I thought we would do a 50 hour event and I was not physically capable or prepared to do that. It's just another Tuesday for him and I tore my left hamstring on a sprint. Since that time, I think that it changed my ability to squat. I kept going back to the squat. I am not able to do that at all now, but that changed probably, I don't know, six months ago. I stopped squatting six months ago.

• 1:11:30Speaker 01

  I also found out that I had hip dysplasia. All of these injuries, all of these patterns, which, you know, as I think as someone who is listening or watching this. If something doesn't feel right, you talk about taking that wide step back. If someone is doing something that people will say, okay, this is a squat pattern, but it doesn't feel right to you. I had been squatting in a much too narrow position for someone that has hip dysplasia. And so I ground out my hip. I'm somewhat stubborn, for those people that know me. I just kept doing it because I believe that we should squat. Needless to say, I'm now in a position where I am doing only single leg movements and really trying to pull back. Probably be doing some PRP for this now new injury.

• 1:12:12Speaker 01

  And I say that all about someone in a roundabout way that as we age, like you said, Peter, the worst thing that you can do is stop. And I think about Doug Patton Jones's work, the catabol crisis model. This isn't a catabol crisis, but a catabol crisis model is when you're off the table, you lose muscle mass and strength rapidly. And that continues per decade. So my training has changed dramatically. I do more high intensity on, say, the bike or the aerodyne versus any kind of long, slow, steady state, which I would love to get back into, and then also the lifts.

• 1:12:46Dr. Peter Attia?

  So you're able to do high intensity stuff on a bike with a high hamstring tear?

• 1:12:50Speaker 01

  Well, this is new. This new tear just happened. I got my MRI back two days ago.

• 1:12:55Dr. Peter Attia?

  Got it.

• 1:12:56Speaker 01

  I won't be able to.

• 1:12:57Dr. Peter Attia?

  When you're recovered, so let's just say we're sitting here in nine months.

• 1:13:01Speaker 01

  I'll be recovered before then.

• 1:13:02Dr. Peter Attia?

  All right, very well. When you're recovered, how is it going to change what you do going forward? And how will that impact what you modify in terms of your patients? Because I think all of us are practitioners here and therefore we're students. We do a lot of self experimenting. We make a lot of mistakes on ourselves that gets us curious about what's the lesson here? How do I make sure that my client, my patient, doesn't make the same mistakes? What are you going to change and how is it going to impact what you tell patients?

• 1:13:30Speaker 01

  Definitely, it doesn't have to be these big lifts. We don't all have to squat. And for me personally, having to deal with that, prior to injuring my hamstring, just recently, I was starting to do more unilateral work. And I will go back and also just be much more particular about form. I think as lifelong exercisers, we can compensate a lot. People that are somewhat athletic compensate very well. I think I have to hold myself to a much higher standard. Otherwise, I know I will continue to get injured. And also, I want to add in more of zone two.

• 1:14:02Dr. Peter Attia?

  It's so funny you say that. I remember a trainer, and I can't remember who it was, but he was showing me videos of some incredible athletes doing workouts. And he was just pointing out all of the horrible mistakes they were making. And he goes, they're not great athletes because of how they're training. They can get away with training that way because they are such great athletes. How much did you see that, Mike, when you were training pros?

• 1:14:27Speaker 02

  I literally just wrote down the better the athlete, the better the compensator. That was the note that I just wrote.

• 1:14:30Speaker 03

  Masters of compensation is what we used to call them.

• 1:14:32Speaker 02

  Yeah, I used to look at these guys and think like, my God, it's amazing what they can get away with at that level. But I want to go back to the adult because it's really funny, the squat thing, because I wrote an article one time, and I forget what I called it, but it was basically about slamming your hand in a car door. I said, if you substituted slamming your hand in a car door for squatting and then had the same conversation with yourself saying, hey, I just hurt my hand, I slammed it in the car door, and I can't wait till my fingers heal up because I'm going to go back and slam my hand in the car door, right?

• 1:14:58Dr. Peter Attia?

  That's what you'd be saying to me in the shower every eighth workout.

• 1:15:00Speaker 01

  But we've all done that.

• 1:15:01Speaker 02

  We all, exactly. And that's why I wrote the article, because people do it all the time. And you just realize that if you just, and that's where being rational and substituting something really stupid.

• 1:15:11Dr. Peter Attia?

  Although in fairness, the analogy is more like this. The analogy is I love slamming the car door because I love the noise. But I like to also reach in the car when I'm doing it. And normally, it's fine, but on every eighth slam, oh!

• 1:15:25Speaker 02

  I might edit the article for that and say, okay, even if it was only every eighth time you did it, would you go back and slam the car door eight more times? You wouldn't. You would be like, no, that's absolutely stupid. The risk reward doesn't work. But for some reason, squatting has such a visceral attachment in strength and conditioning. And that's why, I mean, people, you should go look at some of the old YouTube comments about me, the things people were saying about me were unbelievable. And I was kind of like, I'm just telling you.

• 1:15:50Dr. Peter Attia?

  It's religious, right?

• 1:15:50Speaker 02

  It's religious. It's absolutely religious.

• 1:15:52Speaker 03

  An exercise like the clean doesn't have that type of religion because I think. Functionally, again, everyone can relate to the squat. The squat is something we do every day. Every time we get out of a chair, every time we go to the bathroom. So I think there's the attachment.

• 1:16:06Dr. Peter Attia?

  But your point, Jeff, sorry to interrupt, is a very good one, which is people are confusing a goblet squat or effectively a sumo deadlift with a goblet, which is it's all the same hip hinge. They're confusing that with this. This is the unnatural part, I think.

• 1:16:23Speaker 02

  We teach everybody to goblet squat. We teach everybody to sumo deadlift. But I always tell everybody, and people are like, well, you know, you've got to be able to go to the bathroom. I won't use the in delicate. And I said, yes, but you're not going to piggyback someone in and take a shit. Like, that's not how it's going to work. You don't have to be able to do that. Like, in order to be able to use the bathroom, you only need to be able to bodyweight squat. So, once you can bodyweight squat, you're good. Let's do unilateral stuff for loading, because and this is where we get into adults versus athletes. Like, I always see people say, what's an adult? What's an athlete? I'm like, an adult has a job that does not involve playing sports. And I was doing this presentation for Perform Bad. I was writing it up, one of the things is, you know, pickleball players aren't athletes. People that are adult recreational athletes, they're not athletes, because if they get hurt, like you said, you get hurt at 50 or 60, it's really debilitating.

• 1:17:08Speaker 02

  You don't heal. Even the rate of healing, you're seeing that now, the rate of healing is totally different. I look at my son and his friends, they'll get hurt, and two days later, they'll be like, I'm fine. And I look at them and think, I'd be six months crippled if I did what you did. And people don't see, I always say, life is this gradual transition of filet mignon to beef jerky, right? And I'm in the beef jerky stage of life, firmly in the beef jerky stage of life.

• 1:17:32Dr. Peter Attia?

  I'm thinking I'm at a New York strip at the moment, just getting a little firmer.

• 1:17:36Speaker 02

  But, you know, you think, like, you're getting crustier and a little bit more salinated, and you're not what you used to be. And I actually posted a thing on my Instagram. They say the number one cause of injury in old men is thinking they are young men. And that's why when you get into, should they squat? Should they do it? I always say no, because I wrote down ego. The problem with that is when you start letting people do these things, you then have to become the ringmaster in the circus. So for us, we just eliminate the events. Like, nope, we're not doing those events, because I'm not going to be able to figure out, well, you can squat and deadlift. You can't squat and deadlift. You can't, it's like, no. If nobody squats and deadlifts in our adult program, then we're just better off. And again, by professional athletes, I had one guy in the Red Sox who squatted,

• 1:18:19Speaker 02

  insisted to me after I really fought with everybody about it, every single guy except one.

• 1:18:24Dr. Peter Attia?

  What position?

• 1:18:24Speaker 02

  Pitcher.

• 1:18:25Dr. Peter Attia?

  A pitcher?

• 1:18:26Speaker 02

  Like a real, you don't get John Lester, he was a, I mean, he looks like a linebacker. He looked like Brian Urlacher. He was like, no, I have to do this. The rest of the guys were like, oh, I'll do the whatever. I'll do split squats. I'll do whatever you want me to do. But in that situation, I was like, okay. Our college kids, we have to squat, squat. So if you came in, someone came in the gym that day and they were like, that kid's squatting. They were like, looking like, oh, my God, like there's a defector in our midst here. And I was like, no, he has to squat. He's got to go back to college. He's got to go to his college weight room in his college program. Those kids squat because we want them to be able to go back to school and be able to participate in the program the way they're supposed to participate.

• 1:18:59Dr. Peter Attia?

  I feel like people don't appreciate the nuance of what you're saying. I feel like it can easily be turned into Mike thinks no one should squat. And what you're saying is no, there's a threshold, there's a risk reward trade off. I completely agree with you, this idea like if you're not getting paid to play a sport, you have to reconsider how you're treating that sport.

• 1:19:18Speaker 03

  It's also not as if the alternatives are sacrifices in terms of what they're delivering. That is the problem. Like I always talk about, people get on me because I have what I call the iron graveyard. There's a few exercises that just belong in there. And one of them for me is upright row. It's a garbage exercise. You could tell me, no, there's no bad exercises. That's a bad exercise.

• 1:19:38Dr. Peter Attia?

  Talk about it.

• 1:19:39Speaker 03

  So the upright row is done the way that old school taught how to do the lift. You hold the barbell and you lift it up here, up under your chin. Your elbows are much higher than your wrists are. You've got lots of weight usually on the exercise. So fully pushing your arms down to internal rotation. The funny thing about that is that that position is literally the test as a physical therapist that we have put somebody in to try to see if they have impingement in their shoulder. We put them in this position, push down. If it gets a lot of pain in there, likely something's getting pinched, supraspinatus tendon, something. Why am I doing that exercise? When? Not because I dislike the exercise. I never got hurt on it. I never did. I've did it for years. I've done it for 40 years. There's always the outliers like we talked about before. But what I can just simply tell you, I just want you to drop your elbows lower than your wrists. I want you to do something called a high pull. I want you to go this way. But doing that now.

• 1:20:24Speaker 03

  Now, instead of internally rotating the shoulder, I'm externally rotating the shoulder. I'm still working my delts. I'm still working my traps. I get zero sacrifice of what I'm trying to do the exercise for in the first place. And I eliminate the part that I don't like, that I don't care if you haven't gotten hurt this time, but ultimately doing it over and over and over again, can potentially cause a problem down the road, even just the potential of it. Not saying that you can't get injured on any exercise, you can, but on this exercise, I'm lowering the risk and not sacrificing the benefit. I think when Mike talks about squatting, the fact is if you can do something that's giving you a better or even equal benefit. And it takes away some of those downsides to the exercise, especially as the population who's performing it is less

• 1:21:07Speaker 03

  appropriate to be performing the exercise and more appropriate to be doing the alternative, what's the whole point?

• 1:21:13Speaker 01

  It makes me think about how do we re-educate people? Because we've all suffered from these narratives of you have to squat, you have to deadlift, and it's just similar to nutrition. Do you think that there's a way, if I can ask, do you think there's a way that we re-educate? Getting to our youth, potentially so the younger that we can educate, the less likely we're going to have adults in their 50s having to have serious injuries. And then, Mike, you wouldn't have to have this conversation about no more squatting.

• 1:21:43Speaker 02

  No, I think we're doing it right now, actually. I mean, these things are really, the ability to mass produce this and to have people hear it and see it is something that we weren't really able to do before. I talk about the fact, when I was a kid coming up, I had to wait for the new strength and health to come out to the newsstand. I mean, I waited, I visited the newsstand daily.

• 1:22:01Dr. Peter Attia?

  We lived by these magazines.

• 1:22:02Speaker 02

  Loved it. I waited for strength and health and Ironman. I would walk into the store and I would say, did those magazines come in? The guy would be like, nope, they're not in yet. Cause that was our only connection to the training world. And now you think you've got 14 million subscribers or something like that on YouTube. And I had someone ask me one time, they said, what's the greatest thing you've seen, or the greatest change in strength and conditioning? And I was like, the computer. And they were like, what do you mean? And I was like, there was no computer.

• 1:22:27Dr. Peter Attia?

  Such a good point.

• 1:22:28Speaker 02

  So you start thinking, we've got this ability now, podcasts, YouTube, we can educate people, but our problem is that we copy dumb people. There's too many dummies on the internet and not enough people. I've taken a little bit more in my old age to kind of calling out the bullshit. Sometimes I'll just say on Twitter, that's a bad take because if you don't, then people get to establish themselves as experts because this is the loudest voice situation now in terms of who's going to influence. And now there's a lot of AI, like if you look at Twitter, it's got all these AI things going that are showing people. And sometimes I'll just write total garbage and I'll just click and send the reply because I'm like, it's total garbage. This is shit. It shouldn't be on the internet, it shouldn't be anywhere. So, but I'm going to be that, I guess I'm going to probably.

• 1:23:11Dr. Peter Attia?

  We need that.

• 1:23:12Speaker 02

  I'm getting close to the grumpy old man stage, like when your grandfather would say inappropriate things at meals, I'm like, I'm inches away.

• 1:23:20Dr. Peter Attia?

  Jeff, give us a couple more things in the graveyard.

• 1:23:22Speaker 03

  Cuban press for the same reason, which is when the elbows, you know, the arms come down and then press from there. It's kind of an unnecessary adaptation that we don't need. What else do I have in the graveyard? The chest fly. I put the unsupported bench fly in the graveyard simply because of my history working with pitchers and knowing how susceptible the shoulder capsule can become from chronic overstretching. And then we apply a load in that position at the same time. And even Arnold himself.

• 1:23:49Dr. Peter Attia?

  Whereas a fly machine would be safer because you're not loaded.

• 1:23:52Speaker 03

  Much safer, much safer. And we'll do a floor fly. The floor fly, we're getting the eccentric overload. Matter of fact, the benefit of a floor fly is that you're going to have the safety net of about here on the floor and I could use a heavier weight. But if I'm doing the exercise, because I like the eccentric overload I get on it, I can actually apply a little bit more weight, a little bit more eccentric stress to the chest because the benefit of the exercise is the stretch of the exercise. So I can apply a heavier load, but in a much safer, and again, my shoulders aren't going to be vulnerable there too. But again, because it's an Arnold favorite and it's an Arnold classic, and I believe he tore his pack once on the fly. So it's like, was his favorite, but it did have repercussions for him too. It's not something that I believe you can't reproduce the benefits of in other ways.

• 1:24:35Speaker 03

  Again, nothing is in my graveyard that doesn't have. Have an alternative that's equally good. The only reason why I would ever throw an exercise into that category is because there's something that could be done that just eliminates some of that risk that's just as good in terms of delivering what it's supposed to deliver. So, yeah, I mean, it's not an extensive graveyard, but people are very vocal about their favorites when one finds their way into that graveyard. And you have to sort of explain your way out of it.

• 1:25:00Dr. Peter Attia?

  I'll talk a little bit about kids. So I have three kids. They all love playing sports. One of them in particular has taken a real love of baseball, the youngest. So he just turned eight about a month ago. I grew up never playing baseball. It wasn't a sport that was particularly popular where I grew up. I have to say, I have become obsessed with baseball. I can really fully understand how people can get obsessed with this sport. It's not just the numbers and the data. There's so much art in nuance in learning about all these different pitches and how they hold the ball and all kinds of stuff. Okay. But we live in a world now, it seems, where coaches want kids to specialize earlier and earlier. And I was a little bit surprised at the end of his seven-year-old.

• 1:25:45Dr. Peter Attia?

  They're playing three seasons a year, by the way, in baseball right now. So you've got fall ball, spring ball. There's this little summer ball tournament. And the kids are playing one position now. Most of the kids have a coach, a coach outside of, like a position coach outside of the team. My intuition is that just doesn't make sense. Tell me what you guys think of that.

• 1:26:09Speaker 02

  Do you have a soapbox available for me to jump up on? One, I always say follow the money. If you look at most of these people that are telling you that kids need year-round sports are people who are making their living from year-round sports. If you look at what most professional athletes are doing, they're not doing that with their kids. If you look at what most coaches are doing, they're not doing that with their kids. What you usually find is some entrepreneur who has developed Joe's baseball and he needs income year-round because he doesn't have Joe's baseball and lacrosse. He just says Joe's baseball. So as a result, they start telling you, they start giving you that early specialization myth like, hey, you gotta get started early and if you get started early, you do better. And if If you get seen earlier, I just saw somebody Twitter the other day, somebody said scouting starts now at 10 U.

• 1:26:53Speaker 02

  This was a woman who runs a softball development program. They said, no, that's absolutely bad information. They start using words like development and exposure. The reality is if you said, I have an eight year old who really likes baseball. The number one thing I would tell you is make him do something else besides baseball. My daughter was a full scholarship ice hockey player, very, very good played a year in the women's professional league. Had a scholarship when she was 15 years old. I didn't let her play in a summer tournament until she was 13. And people would say all the time, can Mikayla play in this tournament? Can she play in that tournament? I'm like, nope. And they're like, what's she doing? Said she's gonna go to the lake, she's gonna water ski, she's gonna be on the swim team. She took up diving one summer because they needed a diver and she became the U12 diver. Because the guy saw her throwing herself off the diving board and said, oh, she's fearless. I'll teach her to dive.

• 1:27:37Speaker 02

  And I was like, how many hours will you take her for? And he's like, oh, a couple of hours a week. I was like, awesome. We made her do that. We made her play soccer. She did judo. She was state judo champion when she was 12. The kids that are better athletes do better in the long run. You end up with, there's a whole early succeeder phenomenon that we deal with. And early succeeders, generally they won the genetic Olympics. They generally tend to be from groups that develop earlier. And they will tend to be ahead when they, for us, from in my years, it was the Greeks and the Italian kids. They always matured. They were the ones that were shaving in junior high school and they were much better in junior high. Football than the rest of us were because they weighed 190 pounds and we weighed 130 pounds. You just look at that and think that's not going to have any bearing on the end.

• 1:28:21Speaker 02

  You have to look, this is the literal marathon versus sprint argument in terms of you've got to look at this and think, no, this is a developmental marathon. And the kids who sample tend to do better. Like your kid loves baseball now, but you don't necessarily know that that will be. My son loved hockey, he's playing college lacrosse. He was playing baseball and lacrosse at the same time.

• 1:28:39Dr. Peter Attia?

  And do you feel this way even if the kid is themselves wanting to play all the time? Would you sort of force the kid?

• 1:28:45Speaker 02

  Yeah, I forced my daughter. My daughter was hockey only. She was, that's all I want to do. And I said, I don't care.

• 1:28:50Dr. Peter Attia?

  So she was not thrilled about the idea that you weren't letting her play in a summer tournament?

• 1:28:54Speaker 02

  Yep. Angry at times with me. Fights about why can't I do this because she knew she could go and be the best player. And I said, I don't care if you're the best player when you're 12. I care if you're the best player when you're 18. Being the best player at 12, I'm not getting any ego gratification by going to this tournament and realizing that you made the 12-year-old All-Stars or something like that. So yeah, we had fights. We had fights about soccer. I made her play her 14-year soccer. And the specialization thing, I always think up to 12, broadest sampling possible. The more things they can possibly do, the better because we're trying to develop general athletic attributes. You'll see the kids in hockey that played soccer because they're kids that can pick up pucks in their feet. My son picked up lacrosse really fast because he played baseball and he played hockey and he understood the whole idea, oh, we score.

• 1:29:39Speaker 02

  There's a net. I can catch things extended. All that stuff made perfect sense to him when he went to lacrosse. And lacrosse ended up coming together, but if you weren't sampling, you don't know. You just think, I always say, and this is a terrible analogy, but I'm going to use it anyway. I said, if your son came to you and said, I really like cocaine at this point. It's the only thing that I want to do. You would be like, no, we're not going to do that. Right? But suddenly because you.

• 1:30:00Dr. Peter Attia?

  You have to do a little heroin. You have to do a little meth.

• 1:30:03Speaker 02

  Exactly. I would like you to drink a few beers. You know what I mean?

• 1:30:05Dr. Peter Attia?

  Yeah, just because they want to do it doesn't mean it's right for them.

• 1:30:08Speaker 02

  If you substitute that for baseball, I like absurd analogies, but I think there, you see the absurdity of that and you think, yeah, you love baseball. That's great, but you should learn to swim and you really should learn to do some sort of sport that involves your feet. You know, you should play soccer. I think kids should do some sort of combative sport is really good for kids because you should learn what it's like. The instructors when my daughter was doing judo were Ron DeRozie and Kayla Harrison. What are the odds that you go to the best judo school in America that is 15 minutes from your house? And that's who's teaching the classes in judo? So my daughter can still say that, you know, she was taught by Ron DeRozie and Kayla Harrison. Having to go out on a mat and fight another kid, I think fights the word, I guess, is really good for a 12-year-old girl.

• 1:30:51Speaker 02

  And that feeling, I remember her looking at me the first time like, "Sorry, I can't come out." Like, "You're on your own, you better figure it out." And she did. Sampling is the key. And specialization, if we can think of the worst possible thing you can do for your kid, it is to let them specialize, even if it gets to the point where they think, "Dad, I don't like you. You're mean. You're not a good person because you're not letting me do what I want to do." You've got to look at them and think, "That's why I'm the parent. That's why I'm in charge." Soapbox down. I'll let some guests talk.

• 1:31:16Speaker 01

  I will say that our kids are both in gymnastics and jiu-jitsu. My daughter hates jiu-jitsu, and she excels in gymnastics. And we chose gymnastics because it allows for her fine motor skills, all of this development very young, and also the development of her musculature. She loves it, and we know that the healthier, fitter, and more active these kids are, the greater their metabolic health as adults is. But to your point, what we see is, I think in the US, we see a lot more injuries than in other places because of this always having a season. And from a standpoint of longevity, definitely, again, make our kids do the same thing.

• 1:31:59Speaker 03

  I don't know why we haven't stopped and questioned it a little bit sooner because it's not like injury rates are going down. So we're playing more and getting injured more. That's what we've seen across all levels of sport. Mike and I were discussing the Achilles tendons and the rash of Achilles tendon injuries, or at least it seems to be in prominent players. But a lot of it has to go back to the repetitions in the mileage. And one thing that Mike brought up that I thought was really interesting was the way the style of the game is played now, let's say basketball. There's so much more because it's really come down, chuck up a three, go down, chuck up a three, come down, chuck. There's a lot less of that inside game going on. The game is faster, and they run more. And there's a lot more mileage. How many miles extra was it?

• 1:32:39Speaker 02

  200 more miles a year per team.

• 1:32:41Speaker 03

  Right. Because of just the way the style of the game is played. And they're not all linear miles, they're start, stop, start, stop, start, stop. So there's a lot of cumulative stress on the Achilles tendon doing that. Again, on top of the fact that as teenagers, they're Playing all year long too, not like it used to be when Larry Bird was playing when he played his season and he probably went home and did something completely different, just shot around a little bit. So we need to start looking at these extensive seasons and these multiple seasons per year because it's not changing, it's not helping. If it was helping, we wouldn't have all these athletes being injured. Things are worse now than they've ever been.

• 1:33:17Dr. Peter Attia?

  Say more about the Achilles. That is the injury I personally fear the most at this point. Because I play with my kids a ton, so it's usually soccer and baseball that we're playing. And especially with soccer, I'm always worried, is this going to be the day when despite all of the training I do, despite all the jumping, despite all the multilateral training I'm always doing, I don't know what it is. I think I've just seen so many of them. It's the injury that keeps me up at night. I'm just literally diving for a soccer ball and ping.

• 1:33:49Speaker 02

  It's the beef jerky injury.

• 1:33:51Dr. Peter Attia?

  What is the protocol? How do you think about maximizing the odds of survival?

• 1:33:57Speaker 02

  Rolling and stretching, one. I'm a huge foam roll and stretch person. I think everybody should be rolling, everybody should be stretching, everybody should be doing.

• 1:34:04Dr. Peter Attia?

  Cifically, you're talking about the soleus, you're talking about rolling all the way down onto the tendon.

• 1:34:10Speaker 02

  Yeah.

• 1:34:10Dr. Peter Attia?

  Okay, so you're talking about calf.

• 1:34:11Speaker 02

  Calf and then doing, you know, just ankle mobility work, basic ankle rocks. And then now it's really interesting because this is where you talk about dogma. All of a sudden, the front foot elevated stuff is becoming popular. And when you think about from a preventative standpoint, it makes perfect sense. We were always told that you have to have your whole foot on the ground. Like that's the correct technique.

• 1:34:29Dr. Peter Attia?

  When you say front foot elevated, do you mean like toe on a plate?

• 1:34:32Speaker 02

  Toe on a plate kind of thing. But initially, when I first saw that, I was like, I don't get it. And then a physical therapist friend of mine, David Gray, was like, yeah, well, if you want to get your foot engaged and you want to get your gastroc engaged, it just makes sense to put your foot on there. And that's where some of the stuff, it always goes back to when I wrote functional training for sports and they asked me to define it. I said, functional training is training that makes sense. When you think about things. So that's why when you're talking about flies, like flies don't make any sense to me. I said, unless you're a professional face slapper, I don't know why you would do flies.

• 1:35:00Speaker 03

  Still probably better on the pack deck.

• 1:35:02Speaker 02

  We don't do that. Like I look and think, I don't know why you would do that.

• 1:35:05Speaker 03

  You went to University of Florida, like if there were certain things where you might be required to perform that action.

• 1:35:11Dr. Peter Attia?

  But from a hypertrophy standpoint, there's a lot of reasons to do it. There's something you must be getting out of that movement that you can't get out of that movement.

• 1:35:19Speaker 03

  Yeah, well, I mean, you look at the amount of abduction that you're getting. So any press, any dip, any push up, it's all limited to about this range of motion. But if I can actually open it up even further and get more stretch, we know the benefit hypertrophy wise of applying stretch to a muscle. But that's an exercise where you are also entertaining end range shoulder mobility. And then again, excess stress on the anterior capsule. So like.

• 1:35:43Dr. Peter Attia?

  So it's like, if you're a bodybuilder, if you're in certain sports where the aesthetic matters.

• 1:35:48Speaker 03

  Right. It could be the difference between first and second place if you're a competitive bodybuilder. But that's not my world. And I think that at least educating people about what those risks might be is at least an important first step to have in the discussion of whether they should do it or not. And again, if I can provide an alternative for them where I think you could get additional benefits without the risk, then why do it?

• 1:36:07Dr. Peter Attia?

  What else do you think is important in the playbook of minimizing the risk of the Achilles injury?

• 1:36:12Speaker 03

  When Mike said mobility, I think ankle mobility is something that no one pays attention to their ankles. We don't try to mobilize our ankles at all. I think that tight calves are common in people and they don't really ever address them. And it all starts at the ground. Everything starts at the ground. If you have any compensation, if you lack ankle mobility, your knee is going to pay the price for sure. Cause the knee, I always say the knee is like that consequential joint in between the hip and the foot. And it's just reacting to what's happening above and below. And the poor knee, my knees in particular, like they got beat up and they never really were to blame. All they were trying to do is just hinge back and forth and they couldn't do a good job because they were being betrayed by flat feet and weak hips. But I think if people pay more attention to strengthening their hips and to mobilizing their ankles,

• 1:36:57Speaker 03

  you can feed that chain up and down. And if your calf isn't tight or if your ankle is more mobile, then there's less of that tension being placed down through the tendon itself. You're already doing a, taking a step forward in terms of decreasing your risk of actually snapping that thing.

• 1:37:13Dr. Peter Attia?

  And in terms of strengthening the calf, do we think the soleus or the gastroc plays a greater role? Do you need both? Do you need to have both knee bent and knee straight?

• 1:37:22Speaker 03

  We always focus on both. A lot of people will always talk about the gastroc, specific strengthening with the knee straight, just because it's the one that gives you the better contraction. But I don't care about that. I care about making sure that all the muscles in the body are strengthened. So we'll do equal amounts of seated versus standing calf raises. So if you're doing three sets in a day of standing, you're doing three sets seated as well. So every time we program calf training, it's seated and standing together. I don't think one versus the other is more responsible for the tears. I think as a group together, our ankles are lacking mobility. And because the ankles are lacking mobility, we've talked about like in sleeping. In sleeping at night, your feet are down, especially if you keep those blankets tight at the end of your bed.

• 1:38:04Speaker 03

  They're down quite a bit and you're spending six, seven, eight hours in that position. You're not doing yourself any favor in terms of encouraging mobility at the ankle and flexibility through your calves. So we need to be much more aware of those areas and do more work towards that. And again, that's more work that people have to do. And when you're talking about from the very beginning, when we're saying, what do I have to do to be in shape? Or what do I have to do? Sometimes you have to own little mini parts of your program because specific to you, they're important. So for you, this big fear of that Achilles tendon tear, which I'm right there with you. I think it's a devastating injury that will take you out for quite a while. That would be part of your program that you have to add another five minutes of mobility work for your ankle and do that three, four times a week to make sure that you're doing something about it.

• 1:38:49Speaker 03

  That starts to add up and people start making choices. And their choices, okay, I'm cutting all the little stuff because that's not going to really, no one's going to see my ankle development. And I want to see my arms or my chest or something. So I'm going to do more work there. But when you make those decisions to cut those little parts of the program, those are the ones that usually keep you injury free.

• 1:39:07Dr. Peter Attia?

  Speaking of single leg, the difference between doing calf raises with two feet versus single leg, that was one of the most profound eye openers for me was the difference in strength and how much less weight you could do one leg at a time. It's not half the weight. There's some sort of interesting compensation when you're doing it two legs at a time.

• 1:39:27Speaker 02

  We started adding that back into our adult program. We never put calf work in and then suddenly we started thinking, I remember trying to do some calf raises and I was so sore and I thought, my God. But again, you realize it's kind of a use it or lose it scenario where if you're no longer sprinting and jumping, then that flexibility, the mobility of that complex and the ability of that thing to absorb force. But the other two things, one, avoid doing it if your calves are sore because if you look at both Tatum and Hal Burton had previous calf strains that they were playing with, ended up with Achilles tendon tears. And I think sometimes, I'm a meme guy, there was a great meme yesterday and the guy said, the doctor was like, how much does that hurt? And he said, oh, the usual amount. And the doctor said, the usual amount is zero. So you've got to be able to look at that and

• 1:40:10Speaker 02

  realize that it shouldn't hurt at all. If you're thinking, oh, my calves, my shins, they're sore, that's indicating to you that you were doing something that wasn't kind and that now you've got to give that enough time to recover so that that's not sore anymore. And I think sometimes we get into the kind of hard guy stuff. I tell everybody, I wrote an article in Time called, Does It Hurt? And I said, it's all about the idea that does it hurt is a yes, no question. If I ask you, does it hurt? You can only answer yes or no. And any equivocation is yes. Well, after I warm up, yes. Or only yes. And I always say that with people when they start qualifying, like, yeah, that's a yes. How much does it hurt? Bench press, after I warm up, it doesn't hurt at all. That means it hurts.

• 1:40:49Dr. Peter Attia?

  But you're using that then as a sign that says, I need to understand why it hurts? It's not, you don't train. It's, we need to figure out what's going wrong. What's your movement pattern?

• 1:40:57Speaker 02

  And figure out what Jeff was alluding to, like, you know, upright rows and rotated cuff, like, what is it that's making your shoulders sore? What's the movement that's aggravating? For some people, like, we find that standing, you know, people, it's functional. Standing cable pressing is the one thing that everybody can do that doesn't hurt. So if we have people with shoulder pain, they stand and cable press because it's the one thing they can do that doesn't hurt. And I don't care whether people think functional, non-functional, you can label it any way you want to label it, but I just know I can get you to press pain-free. And my goal, that's my goal all the time. I want to be able, you can look at me and say, I can do that and it doesn't hurt at all. And I think, okay, we can build off that.

• 1:41:34Speaker 03

  What people don't understand too is that it's okay to go through periods of restriction to a single movement like that, a standing cable press, to actually allow the shoulder to heal to a point where you actually could get back to doing other variants of the press if that was your desire. I told you a story myself where I had a, I have a labrum tear and I had an inability to do any type of pressing. I had to restrict myself simply to a variation of a crossover that wasn't even a pure crossover, but just something that I could do where I could actually pull in a little bit and then cross over my body. Cause that was the only thing I could do pain free, but I could still work my chest in a way that allowed me to do something. I also knew that I could do something completely different, like I could horizontal row.

• 1:42:17Speaker 03

  By doing that, I'm getting shoulder movement in a way that was different. It's almost like the specialization in sport, not just doing all chest stuff, but trying to actually attack the chest through a different way by still looking at the shoulder joint. And I would do a lot, a lot of rowing, which probably was good just posturally to balance out some of the imbalance I had in the shoulder, but also to just give me more joint range of motion in the shoulder. Cause I'm getting all this extension. The combination of those two things got me to a point where my shoulder doesn't, knock on wood now, but my shoulder doesn't hurt. I can actually be able to go and, and go back to pressing again, in a smart way with dumbbells. I don't barbell bench press, but I do it with dumbbells and I have none of the pain that I had years ago when that was going on.

• 1:43:00Speaker 03

  So it's okay to understand that this is a long game and you might want to take a step back and stay with the exercises that don't cause pain and allow yourself a chance to be actively mobile to still recover at the same time. Instead of sitting on the sidelines, like you said, this is not a preferred choice. It's not going to turn out well.

• 1:43:19Dr. Peter Attia?

  Sort of pivot and talk a little bit about strength training women across the transition from perimenopause into menopause. Do you have any experience with that? I'm guessing you do. Mike, you must just by the fact that they're coming in your, so start with you, Gabriel. What are you noticing as the most important things as women are making the transition from perimenopause straight on into menopause?

• 1:43:43Speaker 01

  Thing is, don't wait until they start to feel that their body composition is changing. The fitter they are going into perimenopause and menopause, the better they're going to be, both metabolically and just activities of daily life, everything. Those women seem to suffer much less. When hormones are changing, I think what I end up seeing is that maybe sleep is poor. One of the signs of menopause is this frozen shoulder. So if someone is a candidate for HRT, we do certainly believe in that, or menopause therapy. When it comes to training, in the literature, I haven't seen huge evidence or a variation of evidence that good training, it's not sex specific.

• 1:44:26Speaker 01

  There is not something specific for women that needs to happen, rather than following good foundational principles of strength training, hypertrophy, and cardiovascular activity.

• 1:44:36Dr. Peter Attia?

  So you don't say, hey, now that you're making this transition, we have to alter your periodization or change the amount of time you're spending doing one form of training, say cardio versus resistance, or even the number of reps you would do. We're not changing any of that stuff.

• 1:44:52Speaker 01

  I don't. One of the things that we do look at, though, is if they are at risk for injury, for tendons or joints, we do see that that changes. But then, once we treat them, I do not see a reason to change. Good programming is good programming. Progressive stimulus is progressive stimulus.

• 1:45:09Speaker 02

  No, it was great because when I read your book, it was very reinforcing for me because we're getting that question more and more now from our female clients, just because of people like you who are talking about it more. People are more comfortable than talking to us about it. It's exactly that. It always comes back to strength and conditioning. Get stronger, get in better shape, get them to challenge themselves more with weights and not be content. Females are very, there's an ego component that's absent in females that is very present in males. Like males will look at, you know, if I looked at what Jeff did, I might think, oh, I'm going to try that. Females just don't have that. They're just very internally driven. And sometimes that will cause them to underachieve in the weight room because they're not worried about being top dog. They're not worried about who lifted the most weight. It just isn't.

• 1:45:52Dr. Peter Attia?

  Makes them better snipers, you know?

• 1:45:53Speaker 02

  I believe it. It makes them better clients. I would do nothing. I have a lot of really elite females that are great hockey players and lacrosse players and stuff, and they're the best people to train by far because they don't have a lot of the extra baggage sometimes that the guys have. They're just way more compliant. They just listen to what you say. They don't argue with you. They don't worry about what Jeff is doing. But encouraging them to continually get stronger, and we would look at it as conditioning versus cardiovascular work. That's just kind of how we always use the term, but pushing them to do more intervals, pushing them to do, I want more aggressive intervals. So you might call it a VO2 max workout, but I want to get that. Like, I love the Andy Galpin's idea. Like, Andy Galpin's thing was like, hey, you just want to get your heart rate up really high once a week.

• 1:46:35Speaker 02

  I think that's a really good concept. And starting to just get people to think, hey, get your heart rate up. Wear a heart rate monitor. Don't be afraid to push your heart rate to X, whatever that is. And don't be afraid to be out of breath, or get off the bike and feel like you want to lay on the floor kind of thing, because we're big assault bike, airdyne people. I think it's the most efficient way to hit your cardiovascular system with what I would call no orthopedic cost. Like, I can kill you on the bike, and nothing bad is going to happen. Even like you were saying with the hamstring, I'm going to bet you can going to be able to bite with that hamstring.

• 1:47:04Speaker 01

  I'm planning on trying it later today.

• 1:47:06Speaker 02

  And then you'll be perfectly fine, because you're not weight bearing, and you're not getting a lot of aggressive hip extension and a lot of aggressive hip flexion, and you can probably torture yourself on there for a long time without having any negative effects. But the biggest thing, like I said, with women is just getting them over that, I'm going to get big so I don't push myself kind of thing. And so it's funny, I film a lot of my women and ask them to talk about how much they weigh and how much weight they've haven't gained. So I have two of the best lacrosse attackers on our US team that are in their mid twenties now. And they've been here for five years, and they've gained no weight. They're stronger, they're faster. But females gaining lean mass is really difficult. You have to really be a super responder. And usually, as I always say, apples end up like apples, oranges end up like oranges. It's not like suddenly, one day the apple's

• 1:47:49Speaker 02

  going to wake up and the next day it's going to be an orange. If you're an ectomorph, you're an ectomorph. You will get the occasional really mesomorphic female where you do think, oh, wow, she really does respond to weights, but they're rare. They're super rare.

• 1:48:00Dr. Peter Attia?

  So Jeff, what about you? What are you seeing in women specifically that you're training, especially during that transition through menopause?

• 1:48:07Speaker 03

  As Gabriel pointed out, the training specifics are pretty much the same. What applies, what is good, smart training for men is equally applicable to women. The only thing that I would say from a PT standpoint, biomechanically, there are some differences in terms of something called a Q angle, the angle of the hip or the femur coming down to the knee. It does create a lot more valgus at the knee for women than it does for men. So I think you just have to be aware of those things. So when you're doing certain activities, you want to be able to coach better in terms of being aware of positioning. So like the tendency for a lot of women, when they jump is to land in a much more valgus knee state, which could put more and more stress. We're not fearful of them blowing out in a training session, but as we talked about

• 1:48:50Speaker 03

  before, that cumulative stress of every time you land, you're getting more and more stress on the MCL or the ACL. That would be something that you'd want to coach around and make them aware of because you could strengthen that. You could work on biomechanically improving those things, put a band around their knees and have them jump that way and land that way. They're learning how to activate their abductors in their hip. That is probably something that isn't even really a requirement. All men could benefit from that, but it's not an additional requirement because we're not dealing with the same biomechanical angles. Also because of hormones, women will have more laxity of hormones at different times of the month that will make them susceptible to different stresses. I think you just have to be aware of the education side of it and coaching through that.

• 1:49:32Speaker 03

  But as far as the exercises, the programming, we also found that women just tend to be much stronger than men in terms of their output pound for pound. And given the differences in sex, they're able to proportionally push more weight, especially with their lower body than men can. Much stronger, have you found that too? The women are incredibly strong in terms of their output and strength comparative to men.

• 1:49:55Speaker 02

  I haven't really thought about it in terms of pound for pound. The one thing we found is that they're much stronger in their upper body than they think they are. That's the one thing that we've seen is that we've got women doing weighted jins with 45 pounds for five.

• 1:50:06Dr. Peter Attia?

  What? Wow.

• 1:50:08Speaker 02

  Forty-five for seven is the best I've seen.

• 1:50:10Dr. Peter Attia?

  Forty-five pounds wrapped around her waist and she's doing seven chin-ups.

• 1:50:14Speaker 02

  Alex Carpenter, who's one of our-

• 1:50:15Dr. Peter Attia?

  How many men can do that?

• 1:50:16Speaker 02

  In our gym, we really emphasize it, most of ours.

• 1:50:19Dr. Peter Attia?

  Wow.

• 1:50:19Speaker 02

  Son's did 90 for two the other day. He weighs 180. A bunch of kids on his team. We really push, we push pulling. That doesn't sound right, but we emphasize pulling.

• 1:50:28Dr. Peter Attia?

  We like to push pulling.

• 1:50:29Speaker 02

  I'm leading the league in redundancy.

• 1:50:31Dr. Peter Attia?

  I want to come back to something you said at the outset, Mike, you were talking about kids. The youngest you train is 11. You drew a hard line in the sand. How come?

• 1:50:40Speaker 02

  I always say I don't want to be in the childhood stealing business. And I think there's some people in our industry that are in the childhood stealing business. I think kids should be kids and they don't need a strength and conditioning coach when they're seven, eight, nine, 10 years old. They probably need a playground and a bike and a swing set and a slide. There's a lot of things that kids could be doing that are way more fun than being in my gym. So we, we actually drew the line at 12 initially, but the sports brackets are 11, 12. So when we realized that we drew the line at 12, people then started coming and wanted to bring a team and suddenly it was kind of like, well,

• 1:51:12Dr. Peter Attia?

  Half the team, yeah.

• 1:51:13Speaker 02

  Peter, Jeff can't come because he's 11. So eventually we kind of bumped it down and then we just resisted bumping it down more. Because I don't want to run a kinder gym kind of program. I don't want people running around. I don't want birthday parties. That's not what I'm looking to do. So we just said 11. I think at 11, you're going into middle school. You can start to understand that there may be some commitment involved in terms of, hey, if I want to make a team, I'm going to probably have to learn to work at this thing and I'm going to have to learn to train. And it's a very good, if you kind of look at long-term athletic development models, that 11, 12 is a good learn to train age to get kids in and get them kind of oriented to, hey, here's how you do the exercises. And we're very learn to train oriented at that stage. I tell our coaches all the time, I don't care if any of these kids get stronger. I could care less.

• 1:51:58Speaker 02

  I really care that they're good lifters. If they've been here 10 weeks and by the end I can look at them and think, wow, they can goblet squat and they can sumo deadlift and they can do a clean and they can do a chin up and they can do a push up, then mission accomplished.

• 1:52:09Dr. Peter Attia?

  I mean, all of that is fantastic, right? And again, it still flies in the face of what many people would think, which is, oh my God, an 11-year-old lifting weights? It's going to stunt their growth, Mike. Aren't you crazy?

• 1:52:19Speaker 02

  I literally wrote that down. It's funny you hit it. That was in my notes in the beginning, but the misconception stuff, we're still dealing with the stunted growth thing. And you'd brought up New York Times, but New York Times did an article where they tried to pull the string on that. Where did the stunted growth thing come from? And it actually came from a study, the only study they could find was on Japanese forced child labor. The kids who were forced into child labor tended to be smaller than their age matched peers.

• 1:52:42Dr. Peter Attia?

  Who were malnourished.

• 1:52:43Speaker 02

  Right, exactly. Malnourished and not working at eight in a factory. But yeah, you still have doctors. They talk about growth plate stuff. There's no growth plate damage evidence. There's none of those things are there. And then you talked about gymnastics, Gary. I always tell people, figure skating and gymnastics are 10,000 times more aggressive than anything that we would do in the gym. I'll get myself in trouble, but I always say organized child abuse, right? I mean, it's not even good for kids when you look at what they're trying to do with these young bodies, because you need, I always think, you need little people that rotate. And that's the key to those sports. You look at that and then you think, what we're doing in the gym, okay, hold 10 pounds, squat up and down, and that's going to be bad for you, but spin around three times and land is okay. That's physics denying, science denying, where you look and think, no, I can show you the

• 1:53:28Speaker 02

  physics of that is way, way worse.

• 1:53:30Dr. Peter Attia?

  So what are the things, and this is a question for all of you, because y'all have kids. So we haven't pushed any of our kids. Our daughter just decided at some point she wanted to start lifting weights, so that was great. But our boys kind of like to come in the gym with us, and we just sort of play goofy games with them. So I know you're friends with Jaco and Leif, and they have this fun little card game that they play where you, have you seen this game? So it's basically like you designate, what's a spade, what's a heart, what's a diamond, et cetera. Like you pick an exercise, like this is a push-up, this is a burpee, this is a sit-up. And then obviously, if you flip it and you get a 10 of that thing, you do 10 of them. If you get a seven, you do seven of them, and blah, blah, blah. Usually they'll just come in the gym with us and play that game. And this is the problem with boys. They want to one-up each other. So once one of them goblet squats this amount of weight, the next guy wants to go to the

• 1:54:15Dr. Peter Attia?

  heavier kettlebell, and the next guy wants to go to the heavy kettlebell. And actually, I do get a little worried, because I see their form deteriorate. They go into what I call turtle back. So they go from lumbar extension, they start getting into lumbar flexion, and then I'm like, guys, enough. What advice would you have for trying to help little boys who want to start lifting, but you just want them to develop the form?

• 1:54:37Speaker 03

  It's really funny, because if you were to ask them to jump onto something, or to even to walk upstairs two steps at a time, their form usually is going to look quite good when it's just a naturally occurring activity that they're doing in their life. When you then say, hey, let's do this as an exercise, let's do something called a step-up, where we step up onto a box, or let's even do a push-up. The push-up, if they were to get themselves off the floor, it would probably look a lot prettier than it does when they ask them to do a push-up. Their ass is up in the air, their shoulders are wide, they're kind of moving in all different kinds of segments. So to me, it's this disconnect. It's not that they lack the athletic skills or the strength to do what it is you're asking them to do. They lack the awareness of what it is you're

• 1:55:18Speaker 03

  asking them to do. When it's packaged as an exercise, they're sort of like, not really sure what that is. So it's our responsibility to kind of make it seem easy to understand and tell them where they're supposed to be feeling it. The number one question that people ask when they were starting out an exercise program, not just kids, anybody, when they do an exercise, surprisingly, this is what we all do and we are so passionate about it. What am I supposed to work? What am I feeling here? When am I supposed to feel this? And it's like, well, where do you feel it? They want to know because they want to know where, okay, because if I'm not feeling it there, what do I have to do to get it to feel it there? Kids need to learn the proper form and biomechanics of how to do the exercise. Again, I think they possess a lot more athletic skill and natural abilities

• 1:55:59Speaker 03

  than we give them credit for. And when we just have them start doing exercises, it breaks down. So take the time, do the exercises right. Who cares about the weight that's in their hand first? Start with body weight and then have them learn the mechanics of that. As I said before, with that little drop squat. The drop squat is where they can actually add weight and learn better than it could be if they were trying to learn a body weight squat. In this case, that actual implement would assist them in learning how to do it properly because it's just going to take their center mass straight down. So the form is everything when it comes to kids. And when we've worked with kids in the 11 and 12 year old bracket, that's what we try to focus on is learn the movement, go slow, don't speed through it, go slow. Speed is something that usually breaks down

• 1:56:43Speaker 03

  any attempt at good form. So learn the movements and then we could always speed them up and we could always add weight. But if you don't learn the form, you're going to basically set up a foundation that's going to ultimately crack, especially if they get away with that for their teen years and now they're in their twenties. And then really now that competition starts to kick in and competing with your buddies and then things get really ugly.

• 1:57:03Dr. Peter Attia?

  And are either of you guys doing sports specific training for these 12 year olds? For example, if you've got a 12 year old who's a pitcher versus a 12 year old who's a basketball player, are you having them do different exercises?

• 1:57:14Speaker 02

  Nothing. I always say sports specific training is bullshit. It's absolutely nonsense. Baseball is sports specific training. Like if you want to go get better at baseball, then go play baseball. If you come to the weight room, I've trained guys in every major professional sport and It's at most eighty, twenty, probably ninety, ten. Ninety percent of what we do is the same, ten percent of what we do is different. And that ten percent is totally irrelevant to a eight, nine, ten, eleven, twelve year old. It makes absolutely no difference.

• 1:57:41Dr. Peter Attia?

  That's really counterintuitive. I would thought that, I mean, God, if you're a pitcher, you've got to be taking more care of the rotator cuff than maybe the guy who's the hockey player, for example.

• 1:57:50Speaker 02

  Right, that would be the ten percent. Literally, like, the ten percent with baseball would be that shoulder care stuff that you might not really worry about with your hockey players or your football players. That's where your difference in programming would be, like, that one spot, rotator cuff. But with kids, like, I always look at, I think, you shouldn't be a pitcher. You're not a pitcher. You're a baseball player. And you might end up being a catcher, you might end up being a shortstop, because Nomar Garcia-Parr, Nomar Garcia-Parr went to Georgia Tech and tried to kick on the football team. Yeah, and he loved soccer, he married Mia Hamm. He's a huge soccer fan. He told me one time, I used to train him, he said, "I would absolutely be playing soccer if I didn't live in the United States," he said, "but I realized the best use of my athleticism was Major League Baseball." And that playing in the MLS would never have given me the type of career that I would have had in Major League Baseball.

• 1:58:34Speaker 02

  But most, every great athlete that I've seen was a great multi-sport athlete. But we've got this self-fulfilling prophecy now of specialization, where people can now point, and they'll point to Tiger Woods or somebody and say, "Oh, Tiger Woods specialized." And it's like, you can find me one specialist, I can find you a thousand generalists who all have achieved. But you'll continue to use the specialist as the example, because that's what you want to believe. We, as achievement-oriented people, for you to be a great doctor, for you to be a great doctor, for you to be great at YouTube, that's what you gotta do. Kids, it's the polar opposite. For them to be great at something down the road, they probably need this super broad-based skill set. The base of the pyramid versus the height of the pyramid. The bigger the base, the larger the height.

• 1:59:16Speaker 02

  You know, if you build an obelisk out of the gate, you're probably not going to accomplish much.

• 1:59:22Speaker 03

  You mentioned Carl Crawford, like, he didn't get those scholarship offers for three different sports because he started playing at 18 or 17. He obviously was playing all those sports at a young age and developing all those athletic skills to where he could select the one that was most appropriate for him, either financially or...

• 1:59:38Speaker 02

  And he was just the best. Some of this is genetic lottery. Carl Crawford could do a standing backflip at 230 pounds. He's still the most athletic person I've ever seen. But he would have been that in any number of sports. I don't think, you know, it's just the fact that he chose baseball, and that's what's interesting in terms of, people say, oh, you look at the Europeans, they specialize in soccer. And it's like, yeah, because they don't have the choices that we have over here. We've got a lot of opportunities that maybe aren't present in other countries. So people will cherry pick because they want to support their thesis.

• 2:00:08Dr. Peter Attia?

  But to me, the more important thing is virtually no kid is going to be a professional athlete. My interest is in how do you use the interest in sports, first, to fuel the spark that says lifelong activity is an important pillar of health. Second, how do I make sure that when you are done playing sports, which for most people is the end of high school, then there's a narrow subset that'll say, well, actually, it's the end of college. And then there's virtually nobody who's playing sports after that. Because to your point, pickleball with your buddies on Sunday, that ain't sports. So we all stopped playing sports pretty young, and yet we are going to need to train for the rest of our lives.

• 2:00:49Dr. Peter Attia?

  I think that's the thing that I'm still trying to better understand, is how do we use youth sports as a tool to set you up to be an athlete for life, where the sport changes to life?

• 2:01:02Speaker 02

  I think that's the difference in terms of using it to teach life lessons. They say sports can build character or can build characters. Do you have to use it to build the kid's character? And sometimes that may be saying, you're not just going to get what you want. I get it that you just like baseball, but we're going to play soccer in the spring because we think you need to be exposed to more things. And the kid learns that lesson because sometimes they just learn this micro-focus really early on. And then later on, when they don't achieve, they think, oh, I wish I'd done more things. I wish I'd sampled more. I wish I'd explored more. I think it's looking at the real body of evidence versus looking at the evidence that's presented to you by the person who's trying to get your money, which is what usually happens now.

• 2:01:42Speaker 03

  The issue I think, though, is that where we're going off track is that the coaches and the parents of these children are over emphasizing the importance of what it is they're actually competing in, to the point where, why do you think we have, you said because of money that we have all these additional leagues throughout the year, but it's also because everyone thinks their kid's gonna be a pro. They're not.

• 2:02:02Dr. Peter Attia?

  And they don't want their kid to be left behind.

• 2:02:04Speaker 03

  That too, and it's all these social pressures behind this. That is what's feeding the problems that we see and also taking away from the fact that this is introducing lifelong habits to them, to the point where it's degenerating something that should be very positive into something that becomes, at worst, destructive. You're overdoing something and you're actually, a lot of times, also making a lot of these kids hate athletics by the time they're 17, 18, 19.

• 2:02:29Dr. Peter Attia?

  That's another issue, which is, I can't tell you the number of people I met who grew up collegiate swimming who cannot stand swimming. And it's such a shame because swimming is, while it's not good for bone density, it's pretty much good for everything else. So by itself, I would say it's not the only exercise you should do, but boy, if I think about, if there's one exercise I could insert into everybody's life, it would be some amount of swimming. Somebody who swam through high school and college, they're like, I could never do it again.

• 2:02:54Speaker 02

  It was my best sport. I went to the first swimming meeting at Springfield College. Coach, I still remember, Red Sylvia, famous Division III coach. The first words out of his mouth were, "The first practice is at?" And I was thinking, "He's talking per day here, right?" They're swimming twice a day. They're swimming before school and after school. And I sat politely through the whole meeting like this and nodded and went to the football meeting and tried out for freshman football, because I was like, "There is no way I'm going in the pool twice a day." It was the end of my swimming career. And I, now, I have terrible shoulders. I can't stand swimming, because it hurts.

• 2:03:25Speaker 01

  When you're talking about becoming a lifelong athlete, for us, so, again, our kids are four and five. They train with us. They might not be doing the same lifts, but we let them play with a kettlebell, pick things up, put them down, and we let them run. We let them do things that they would physically be able to do without a lot of queuing. And as I just think about some of the data on tendon health, we know that the earlier people start, the better and more resilient those tendons are, because they're not starting later in life, not getting injured. And I just think, again, it's just a great place to start. The earlier, the better, which is a bit counterintuitive, because we've heard all of this information on how kids shouldn't lift weights or train. And maybe it's not a standardized training program. They're in there, they're doing stuff with us, like, every day.

• 2:04:10Dr. Peter Attia?

  If you think back to the last five years, you're obviously all in a constant state of learning. Is there something you have changed your mind on? Something significant that you've changed your mind on? And not just changed your mind on, but it's changed the way you behave, the way you help other people. I'll start with you, Gabrielle.

• 2:04:27Speaker 01

  This is a big one. I don't think body fat percentage is nearly as important as we think it is. I think that it is going to be somewhat of an outdated metric. I believe that inter muscular adipose tissue, this IMAT, is going to be much more predictive of disease. And this came from, I interviewed on my podcast, Melanie Kree. We were talking about PCOS. And I'm thinking metabolic PCOS, what is the body fat percentage that's going to change the outcome? And she looks at me and she goes, Gabrielle, it has nothing to do with body fat percent. It had to do with their inter muscular adipose tissue. And that, I think, is going to be an upcoming theme. It's much more specific to insulin resistance and these metabolic outcomes that we care about.

• 2:05:12Dr. Peter Attia?

  And commercially, obviously, it can be measured quite easily with CT scans and with MRIs. To my knowledge, it's very difficult for DEXA to approximate it.

• 2:05:22Speaker 01

  That's right.

• 2:05:23Dr. Peter Attia?

  Is ultrasound viable? Obviously, you wouldn't be able to get whole body, but you could sample the quads.

• 2:05:27Speaker 01

  Yes.

• 2:05:28Dr. Peter Attia?

  That would probably be the canary in the coal mine is if you're accumulating muscle in your quads.

• 2:05:31Speaker 01

  Yes, and I think it's also very difficult.

• 2:05:33Dr. Peter Attia?

  So accumulating fat.

• 2:05:34Speaker 01

  Yes, very difficult to test. MRI seems to be where a lot of the data is. We're not there to measure it. But this is something that I think we are going to see so much more of. And we're all focused on a muscle centric approach. And for the last 50 years, it's been all about obesity. And this is the same thing. It's almost that we're looking where it's obvious, but it doesn't mean that that's where it's effective.

• 2:05:58Dr. Peter Attia?

  I really agree with you, actually. And I think pharmacologically, for what it's worth, I think that's the next frontier. So I think what the GLP-1 agonists have done over the past five years with the introduction of the third and fourth generations of those drugs, the first two were largely failures. But because of how successful the third and fourth generations were, we're really at a point where I think people can see You can address the crisis of overabundance from a nutrition standpoint. But what people realize, the new problem that is yet to be undressed is sarcopenia. When I'm looking at what's at the leading edge and the frontier of biotech right now, it's all around anti-sarcopenia drugs. Now, of course, we have another great drug that works against sarcopenia.

• 2:06:43Dr. Peter Attia?

  It involves holding iron and eating certain types of foods. But if where billions of dollars are being invested is any indication of what people realize is the next frontier, I think people are waking up to the idea that it's not enough to solve the adiposity problem. You must address the sarcopenic problem.

• 2:07:03Speaker 01

  Yes, I couldn't agree more.

• 2:07:05Dr. Peter Attia?

  What about you, Mike? What have you changed your mind on?

• 2:07:07Speaker 02

  I'm glad you gave me a head start to think about this. You know something? Digestive health. I had a bowel resection done nine months ago. So they took a foot of my colon out. And I realized, I actually did a really good presentation for our staff called You Don't Know Shit. Because I think that's the most neglected area of health right now because we don't want to talk about it. It's uncomfortable. Until you experience it firsthand, you don't realize how important fiber is, how important water is. Chronic dehydration seems like a, oh, it's a big deal, but it's really not a big deal, but it suddenly is a big deal. I liken it to, it's like you have a dumpster your whole life that's out in the back of your house and it just gets emptied all the time. And then suddenly, one day you realize that they can't empty the dumpster anymore. Like, I'm in trouble.

• 2:07:49Speaker 02

  And that's us. Like, we're worried about our muscular system, we're worried about our nervous system, we're worried about our endocrine system. And our digestive system is just this thing that's supposed to be this dependable system that's just going to take care of us forever. And then suddenly, in our 50s and 60s, it starts to fail. And we don't want to talk about it. Like, I was in the hospital. I was sick. And the guy was like, this is major surgery. We've got to take a foot of your colon out and put you back together again. I won't go into the gory specifics, but it made me realize that, I mean, I take a fiber supplement all the time. I put fiber in my shakes all the time now. I look at how much fiber is in everything that I eat now, but you start about protein numbers. Look at the fiber numbers. Our people are way more fiber deficient than protein deficient. But they're going to suffer the effects way down the road.

• 2:08:30Speaker 02

  And it'll be too late for them to realize. So if I would say to anybody, I'd be like, drink more water, eat more fiber, because you don't want a bowel resection.

• 2:08:38Dr. Peter Attia?

  All right. What about you, Jeff?

• 2:08:40Speaker 03

  Breaking the rules, I have a couple, but personally, I think I have two twin nine-year-old boys. And so in the last five years, they've gone from four to nine, which for a dad is the phase where mom was definitely the favorite for the first four years. And then I sort of step in and become the fun guy. So I've realized through their interactivity with me, number one, to appreciate things I didn't appreciate before. In the first half of my adult life, I was so focused on professionally achieving whatever I could, whether it be working for the Mets, or then starting this business and really going all hours of the night to try to build a business. Not that I just still don't do that, but I really have learned to better prioritize my time with my kids to the point where it's difficult for me to make

• 2:09:21Speaker 03

  travels out to do podcasts because I really try to be around them. And I have learned to appreciate because they're on the spectrum, I've learned to appreciate their wins every day. So it's like, wow, I don't take anything for granted. That's a thing that I am so grateful for that I've been able to benefit from because if I think if the situation was different, I probably would just continue to work, work, work the way I did. But I think from a professional standpoint, kind of oddly, one of the things that I think is really overlooked is balance training. And I think that it's an area that people are going to probably have to spend a little bit more time focusing on because like we just talked about digestive health, like it's another one of those things that's going to get worse as you get older for a number of reasons. Number one, your reaction times will get worse. Number two, your proprioceptive

• 2:10:05Speaker 03

  sense is going to get worse, which is essentially your sense of body position. Number three, your strength is going to get worse, as we talked about inevitably decade by decade. When we consider what all that leads to ultimately falling, we talked about these fears. I don't have the fear of falling right now. I'm sure if you don't have the fear of falling right now, we have the Achilles tendon stage right now, but 20 years from now, 30 years from now, our biggest fear should be falling because when you do, you're likely going to live a pretty difficult end of your life and it might lead to a much faster end of life. I think that actually training balance is another one of those things that's going to have to get kind of sectioned into that five minutes of extra work that you're going to want to have to do for yourself. And the most important thing

• 2:10:48Speaker 03

  When you're training your balance, even if it's just simple standing on one leg and drawing an alphabet with your other foot is to close your eyes. Because I think that when you don't close your eyes, you're actually one dimensionally creating an environment that's not actually what we're going to face. Most people fall in the dark because they don't have that visual feedback to correct. By the time you send that signal down to your ankle to make an adaptation is too late. If our reaction times are delayed too, it's going to be even worse. So it's just a thing that I think people that are already older should start working on because as a skill you can improve it. And as somebody who is looking down the line here and seeing things change, including my eyesight, which used to be so perfect up close, that changes. I know all of these things are happening under the hood. Making a dedicated effort is something I think people should probably invest some

• 2:11:33Speaker 03

  time into because it's well worth the investment for that long range safety.

• 2:11:37Dr. Peter Attia?

  I think the theme here is, I think we would all agree in the gravitational pull of aging, despite the fact of what some of the popular biohackers might have you believe. None of us are getting out of this alive. I would bet each of us can remember what it would be like, what it was like to be 10 years younger, regardless of whatever age we are today. But this idea, if I could take what you're all saying and impart one thing to a listener, it would be you do have a choice at the rate at which this glider is going to come down. The glider will come down. Gravity always wins, but you can train to reduce the rate of decline. You can train to reduce the rate of decline. It won't happen by accident. The training you have to do has to be specific.

• 2:12:22Dr. Peter Attia?

  It's not obvious or intuitive that you should do some of these exercises. A lot of the things that you guys have talked about today are exercises I just love. The front foot on a plate, on a 45 pound plate, putting the front foot up there, going into a lunge, taking a plate and doing little twists. The amount of stress that that puts on the proprioceptive capacity of that front foot is insane. What a dumb looking, unsexy exercise that never shows up in the mirror and yet what a phenomenal exercise. I'm with you 100% on all of these sorts of balance drills with eyes shut. They're frustrating. It is frustrating. To be on one foot with your eyes shut. Third layer is turn your head when you're doing that. Oh, my God, the way you feel and you don't want to do things you suck at,

• 2:13:07Dr. Peter Attia?

  but you kind of have to do this. I don't know. I just hope that people realize that ignoring it won't make it less likely. It's a relatively small price to pay. You're not asking people to be in the gym 12 hours a week. Last I checked, some of us choose to be in the gym or exercise 12 hours a week, but that's probably because we're weird and we do that just like other people might enjoy watching TV. But yeah, if someone could give two great hours a week. It breaks my heart that there are people who don't do it for whatever reason, for whatever belief system that says it's too late or it's too hard or I'll do it tomorrow. So, guys, I really, really appreciate this. I don't know where the time went because we didn't actually cover a single thing I had written down,

• 2:13:53Dr. Peter Attia?

  which is okay, because I had good stuff written down, but I thought we talked about good stuff. So I'm incredibly grateful for all of you making the trip out here. I only wish we had another three hours, although we'd have to take another bathroom break or something. So, thank you all for coming.

• 2:14:08Speaker 02

  Thank you. A pleasure, honestly.

• 2:14:11Dr. 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 advice,

• 2:14:56Dr. Peter Attia?

  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.