What Men Don’t Know About Their Health Can Hurt Them
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coming up on this episode of The Doctor's Pharmacy. - My little mantra is I wanna be at the level of fitness that I can do anything I wanna do physically at any moment in time.

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Welcome to Doctors Pharmacy. I'm Dr. Mark Hyman. That's Pharmacy with an F, a place for conversations that matter. And if you're a guy out there listening, or if you're a woman who's got a guy, you're going to find this conversation fascinating about how to actually look at fitness in middle-aged men in a way that really matters, things that we don't typically look at. We're going to talk about VO2 max and body composition in this special episode of Health Bites with one of my colleagues at the Ultra Wellness Center, Dr. Mark Hyman.

Great physician, Dr. George Papanikolaou, who's a graduate of the Philadelphia College of Osteopathic Medicine. He's board certified in family medicine.

And he's also an IFMCP certified doctor, a functional medicine certified doctor. He has worked in the health service, the Navajo reservation, and he's been working at our practice at the Alzheimer's Center for many years now and is one of our great team there. And today we dive into the topic of fitness for middle-aged men, particularly talking about what we need to measure and why it's important, including something called VO2 max, which is a measure of your fitness level and your body composition, learning about your muscle mass, which is a

critical measure of fitness and your body fat composition. And we're going to talk about how to fix those things. We're going to talk about some great cases where we use those measurements to address people's health. And we're going to talk about the whole area of fitness and health and aging and what you can do about it. So let's dive into this conversation with Dr. George Pepiniklaou, one of my colleagues and friends from the Ultra Wellness Center in Lenox, Massachusetts.

Welcome back, George, to the Doctor's Pharmacy. Appreciate having you back again. Mark, it's always a pleasure to be here. Now, for those of you listening who may not know George, who are just joining the podcast, George is one of my colleagues at Delta Wellness Center in Lenox, Massachusetts. We have a practice of five physicians, three PAs, physicians assistants, seven nutritionists, a great staff. And we take care of people from all over the world with chronic, difficult conditions, and

or people who want to just up level and optimize their health and find out how to basically hack the code of biology and understand how their bodies work, how to work with it and how to upgrade your biological software. So that's what we're gonna talk about today is how do we upgrade our biological software

with a very important drug that has the power to do almost everything you'd want it to do, to treat depression, to improve your lifespan, your healthspan,

to reduce inflammation, to optimize your hormones, to balance pretty much everything in your body. And this drug I'm talking about is available at no cost to all of you everywhere on the planet, and it's called exercise. Now, George, we in medical school did not learn

heck of a lot about exercise. In fact, we probably learned nothing about exercise except to tell our patients to eat less and exercise more which is about the most useless piece of advice I've ever heard a doctor say. Eat what and how do I exercise and why does it matter and so forth. So today we're gonna get into the science of why it's important to understand the nature of exercise, what it does to our biology and particularly how do we measure

our fitness level? How do we measure the way our bodies are responding to exercise and why that's important for overall health? Now, we in medicine don't really think about

how to measure someone's fitness very well. We have the six minute walk test and we have grip strength and we have certain biometrics we use and certain physiatrists will use it or certain doctors will use it, but it's kind of marginal. And at the Ultra Wellness Center, we really take a deep dive into every aspect of someone's health, including their fitness, because it plays a role in everything from heart disease, diabetes, to cancer, to dementia, to depression, to ADD. I mean, the list goes on and on.

So, George, you yourself are a big exerciser. I'm jealous of your biceps, to be honest with you. He's got weights in his office. I think he's seeing patients. He's actually there pumping iron in the back of his office. Mark, you're my motivation. Mark, you are my motivation, though. You are one shit man. I don't know. I'm doing okay. But I think we have the capacity at any age to...

maintain or even gain a tremendous amount of fitness. You do. You and I are both in our mid-60s, and we're pretty damn fit. I don't know if there's a story, I don't know if you saw it in the news, George, about this guy who was in his 70s or something, and he was

hanging around some jammer somewhere and he saw a rowing machine or maybe there was one in the garage and he basically started in his 70s started rowing on a machine and now he's like a world champion in the 90 year old plus category and his fitness level measured by something called VO2 max which is what we're getting into actually got better and not only got better but was equivalent to people in their 30s and 40s so

What that speaks to is that we see this steady decline as we age, but we don't really know what to do to avert it. And we see this all the time. There are patients who are chatting before about these guys who come in the office and are our age and look like they're 20 or 30 years older, right? So George, how do you get so into exercise?

and and tell us a little bit about your own sort of background and and kind of focus on fitness and health you know this is fascinating we've we had this conversation a long time ago and it's more or less how did i get into functional medicine i just always wired to think that way my parents when i grew up it was the early 60s and they were smokers and i just had an adversity to that lifestyle from the very beginning it was just innately

in my DNA. And so I was reading, I remember it was a Dr. Mendel's vitamin book and supplements. I was reading that like when I was like an adolescent. So I was just like into that stuff. And then I met my wife when I was 18 and her mother,

was brilliant. She was a homemaker, stayed at home in Western Pennsylvania, but she would read Nutrition Action Letter back in the day. Oh, yeah, I remember that. Yeah, Nutrition Action Letter. And she was already talking about the toxins of Teflon, and she was already talking about omega-3s, and she could tell you at the dinner table what vegetables had how much calcium and magnesium. So that's the whole nutrition part. How about the exercise part? Well, but that was the whole piece of that whole, I was always in...

intrigued by fitness and nutrition. But the fitness piece, I just was always an athlete from the very beginning. I always liked to be athletic.

I talked about this many times and I've written blogs about it and I have ADHD and exercise is my medicine. So it's actually when I have ADHD patients, whether they're kids or adults, the first thing I write for them is their exercise prescription. Because when I exercise, it increases my ability to concentrate. And when I exercise...

I feel much better, I sleep much better, I'm in a better mood, and I'm more able to serve the people around me. So exercise is just my all-around drug. - It's such an incredible drug, right? I just got back from Patagonia and I was trekking 10, 15 miles a day up and down mountains, and I felt amazing.

yeah my nervous system felt great my energy was great i had no mood issues which i usually don't have but i just felt more i just felt more at peace and more right everything was like wow this is amazing i mean literally you know i i if i'm you know using my brain for 10 hours a day i'm like tired but if i'm using my body i actually feel better one of my you know so one of my internal um

that I speak to myself, my little mantra is, I want to be at the level of fitness that I can do anything I want to do physically at any moment in time within reason. That's right. So let's say you would call me up and say, George, you got to fly to Patagonia. We're having this great trek. You're going to think this is amazing. I get on a plane. I could do it and I could do it

Well, I'm not going to slow anybody down and I'm going to enjoy it. And so will the people around me. That's my goal is always to be at a level of fitness where I can get on my bike and ride 25, 30, 40 miles. Remember that time the United's got on our bikes and we rode 25 miles? Yeah.

We had a great time and you were pretty good on the hills by the way. - Yeah, yeah. Well, George, you know, the truth is we have that capacity. There's this guy who I love to watch on Instagram, Alain Gustave, who's a French dude. I don't understand anything about, it's all in French, but I watch him. He's like, basically goes out, he's 78 years old, on his deck of his mountains and somewhere in the mountains of France.

And he just, he does like 25 pull-ups. He's incredibly ripped and fit. He makes us look like 98 pound weaklings. I mean, this guy is unbelievable. And I'm thinking, you know, and he does it in the winter with no clothes on. Like it's basically no shirt, just some sweatpants. Yeah.

And it just speaks to the fact that our bodies have the capacity, but the problem is we decline as we age. So tell us, George, what starts to happen to men and women as they start to get over 30? What's the physiological process? Because we don't think of 30 as old, but it's actually when the decline starts to happen that leads to frailty, disability, dysfunction, and disease, which exercise can completely prevent for the most part. Right.

As I thought about this, I just want to make this point that my mother-in-law, she's going to be 92, right? And when I ask her how she's doing, she tells me, "I'm doing well, George, but what's the alternative?" Right? So what's the alternative to not exercising? It's inactivity. And inactivity at any age will cause something called anabolic resistance. Okay. Anabolic resistance

is the muscles inability to grow in mass or in strength. And so that can, you know, we talk about it happening with older adults, but it can happen when you're younger. And so we want to fight off the anabolic resistance. And the way you do that is through strength, you know, through exercise. Right? And so when we think about, you know, what we need to be doing

One of the things I think about when we think about chronic disease and aging, longevity and mortality is when does it become a problem? Well, it becomes a problem very early on in life. And as you said, you see a shift between 30, 40, 50 years old. And that's when we really need to be focusing on exercise. And what do we need to be focusing on?

We need to be focusing on our cardiorespiratory fitness and also making sure that we're doing some form of resistance training. Because we know both of those through lots of different studies, randomized clinical trials, data. We've seen that both...

Aerobic fitness and resistance training and strength training are directly related to decreasing the chronic diseases and chronic conditions that are associated with decreasing our quality of life and our length of life. We know that.

So those are the things that we tend to stop doing, particularly men who are in their breadwinning years, building their careers, they'll tend to be a little bit more sedentary. And when that happens, you begin to build up that anabolic resistance.

you stop making the muscle mass. And you start to steadily lose muscle. And when you lose muscle, you lose metabolic ability and you lose this protein reservoir that will protect you if you become ill as you get older. And it's very hard to overcome the anabolic resistance. So...

One of the goals that we have at the Ultra Wellness Center is to work with people very early on in their treatment plans if they're at that place where they're well enough to be focusing on fitness and exercise. Sometimes they're not well and we have to get them to that point, but we want to get them to that point. And what we want to focus on is

getting measurements like the VO2max and like a body composition, which become their baseline information for where they're at. And then we can design a program for them to improve their aerobic fitness,

and then also help them begin to build back that muscle mass if they've lost it. Yeah, I think this is just your critical point, George, that we don't realize what happens to us slowly and inexorably as we get older. And we can be the same weight as we were at 25 and 55 and 65 and actually be twice as fat. You're metabolically unhealthy even if you're a normal person.

weight and there's actually a word for it. It's called skinny fat or toffee, thin on the outside, fatty inside or metabolically obese normal weight. And this is a well-recognized medical condition and it's completely caused by the lack of attention to one of the most important organs in our body which is muscle and muscle fitness and muscle mass and muscle

quality and all of that is something that's completely under our control and if you if you look at the data it's quite striking you see a steady loss of muscle all the way through life but it's totally reversible and i saw this in myself like i saw it and then i was able to completely reverse it and actually have more muscle now than i did when i was 25 which is

quite amazing. And I'm like, well, how did that happen? It's totally possible. And it's totally possible, but it's something that most people don't focus on as a thing. Like, okay, diet, diet, diet. And yeah, I know I need to exercise to go to the gym. But maybe I may not be doing the right things in the gym. I may not be exercising the right way. And so it's like anything. If you want...

like you take a drug or a supplement or whatever you need to know the right dose and the right quantity the right frequency you know and the right way absolutely so mechanism so it actually does what you want i think one of the things that we know you you mentioned earlier on and we always talk about is what happens in conventional medicine for years you know i had a conventional practice i i've gone to my conventional doctor for years and they would bring up my my weight or my bmi

And I think the point that you just made is that the BMI is just your body mass index. That mass can be anything. It can be fat, it can be muscle. And that's not really, we're finding that that's not really a good measure of your metabolic fitness. So in a sense what you're saying is the thing that everybody talks about with relation to obesity, which is body mass index, is kind of a poor measurement for what's really going on under the hood.

that you can be for example you know Shaquille O'Neal or a bodybuilder and have an extremely high body mass index so you're like 35 and maybe that's considered severely obese but actually you're just solid muscle right or you could be a body mass of 22 which is perfectly normal right a body mass index of 22 and be

metabolically obese and diabetic because you have no muscle and you're eating tons of crappy food, but you haven't gained the weight. And so that's sort of an inaccurate measurement. And I want to talk to you about how do we actually measure this? And at the Ultraluna Center, we do a number of different measurements that can quantify your level of fitness and your level of muscle and your level of fat and quality of it. We can even look at mitochondrial function, which is a critical aspect of your health. Yes, absolutely.

So we look at things that most physicians and practices don't do as a way of creating a customized, personalized set of recommendations to optimize your health. And of course, it's not just around exercise. It's around everything. We look at your nutrition. We look at your hormones. We look at your immune system. We look at your gut. We look at toxin levels. We look at all of it as it affects all of it, right? But today we're just talking about this whole issue of

of fitness and why we need to think more carefully and nuanced about it. So let's talk about how do we measure

you know, the two most important aspects of fitness, which is basically your cardiovascular fitness and your muscle fitness. So let's talk about cardiovascular fitness first. How do we measure that? So cardiovascular fitness is measured using something called your VO2 max. And essentially that's basically the maximum amount of oxygen you can deliver to your cells during your maximal amount of activity. And so, uh,

That can be done in a lab and you do a maximum, you do a VO2 max, you're going to get on a bike, you're going to get on a treadmill and they're going to put a mask on you, which is going to then be able to measure your oxygen utilization. So you'll start exercising and then you'll increase your exercise until you hit your maximum amount of activity or exhaustion. Yeah.

And then they've been measuring your O2 metabolism the entire time, and then they'll be able to then determine the maximum amount of oxygen uptake and utilization, and that will be your VO2 max. Yeah.

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So essentially that's measuring how much oxygen you breathe in and how much carbon dioxide you breathe out, which is an indirect measure of your metabolic rate. Yes. And it determines how many calories you can burn a minute, how much

you know oxygen you can burn a minute so basically your metabolism yeah i have a slow metabolism well they might be right because if you have a low vo2 max you're burning far less calories per minute because the rate limiting step of burning calories by the way is how much oxygen you can process per minute that's called the vo2 max the volume of oxygen

It's ML. In liters per minute. It's ML per minute per kilogram. Right. So it's basically how much oxygen can you utilize. And so a guy like Lance Armstrong, who wins the Tour de France, can maybe have a much higher utilization. His VO2 max would be 90. Whereas the average guy who's like a diabetic might be

15 and someone who's fit might be 45. I might, my watch says I'm 46 and I'm superior. I don't know at this age, but I used to be 55, 55, but actually measure the last time I don't want to watch as accurate. But you know, it's really a, uh, a critical measurement for everything. Like for longevity. It's like, if you look at the longevity trajectory, it's probably the thing that is most correlated with longevity. So

I, this is, talking about VO2max and body composition and muscle mass are two of my favorite things to talk about with my patient because they're correlated to so many things. Both of them, there's a vast amount of data for both your cardiorespiratory fitness, which is measured by your VO2max and your muscle mass and muscle strength to the top 10 leading causes of death in the United States.

also to the 35 chronic conditions that lead to them. And two of the chronic conditions that are listed near the top are sarcopenia, which is loss of muscle mass, and

decrease in your cardiorespiratory fitness or your aerobic fitness. Which are two things that traditional doctors never look at or measure or treat. They never look at and they're highly correlated because if you look at the traditional markers of cardiovascular disease, which are going to be hyperlipidemia, hypertension and inflammation. If you look at the markers of metabolic disease, which are going to be insulin resistance, obesity,

-Inflammation. -Inflammation, again. Basically what happens is that they lead to atherosclerotic vascular disease.

meaning carding the arteries clogged arteries which means that you're going to be getting less blood flow to your muscles and if there's less blood flow to your muscles there's going to be less what oxygen delivery yeah and then then what happens is now if you're not aerobically fit then you're getting less oxygen to your muscles then your muscles stop growing yeah okay

Okay, and so then that leads to some of that loss of muscle mass. So your aerobic fitness and your ability to maintain your muscle mass and strength are very much correlated. - Interconnected, yeah. - And they're interconnected and that's why we have to pay so much attention to them because going back to it, I want to emphasize it one more time, both of them through vast amounts of data since 1950,

have been highly correlated to chronic disease, decreased health span, and increased immortality. That's why we've got to focus on that. I really agree, and I want to sort of bring it back to that kind of geeky science for a minute. Yeah, I want to go there too. Because when I wrote my book Young Forever, I talked about one of the key hallmarks of aging is

which not my division is sort of the scientists have come together say what happens as we get older like what are the what are the the hallmarks what are the criteria what are the phenomena we see as we get older and and one of the things we see is a dysfunction and a decline in our mitochondria absolutely now

As medical school, we learned about mitochondria in first-year medicine and the biochemistry and the Krebs cycle. And then we were basically all told to forget about it because it has no relevance for clinical medicine. And so most physicians have no clue how to diagnose problems with mitochondria or to actually treat them. And yet, mitochondrial function is critical to almost everyone in the chronic disease, whether it's diabetes have declined mitochondrial function, autism, Alzheimer's, Parkinson's,

heart disease, I mean, you name it. - It's there. - It's a mitochondrial disease. - Yeah. - And yet we learn nothing about it. And so we actually now have a window into how to look at mitochondria through things like VO2 max testing, body composition, some of the other tests we do at the Ultra Wellness Center like organic acids, mitochondrial swabs, which we can look at your actual mitochondrial function. So there's a lot of ways we can diagnose what's going on. And then we have really clear ways to treat it through

diet and lifestyle exercise which we're gonna get more into and and very supplementary so getting back to the vo2 max i know we want to go into the weeds on that i we could spend the whole day just talking about vo2 max you brought the mitochondrial piece well the whole point of getting

to the cell is to get it into the mitochondria to produce energy. Yeah. Right? And so when you talk about the Krebs cycle, there's not a day that goes by that I'm not looking at the Krebs cycle at least 10 times. Right. There's not a day that goes by that I'm not looking at the four respiratory chains of the mitochondria because we do that testing in our office. That's right. And people are like shocked, like, wow, what are you talking to me about? Oh, I'm talking about like the most important thing to your health. Yeah.

Your mitochondria are not really working out well. And why? There's a host of various reasons. We're going to focus on exercise piece today, right? But we know there's a nutritional piece, right? And we know there's some other pieces to that, including genetics.

Just to go back to our athletes, an Olympic cross-country skier or a Tour de France winner, they're born with VO2 maxes like 85, 90. You and I, we're born 40 to 60. We might be able to get a little higher through training, which we'll talk about later, but there is a genetic piece to all of this.

you can train it. And it's really important to know that VO2 max, it declines with age, just as muscle mass does. And again, both declines are associated with decrease in health span and decrease in longevity and increased mortality. So we want to-- the whole point, what I want to hopefully we really get to our listeners today and our viewers is that you have to at a very early age begin to incorporate exercise into your lifestyle.

Because if you come to me at age 50 and you are metabolically imbalanced or you're obese or you already have metabolic syndrome and you're not an exerciser, it would be easier for me to get you off a crack than to get you to start exercising. It's an extraordinarily difficult habit to begin late in life. But you can. You can. You can. You can. And you have to, by the way. And you have to. It's not an option. And at the Ultra Wellness Center,

where all the doctors are versed in this, all of the PAs are versed in this. We work with nutritionists and we work with exercise physiologists to help you get over any barriers that may exist for you. And that's why people come and we get a... And since you published your last book, Forever Young. Young Forever. Bob Dylan, that was forever. You're so much into rock and roll than I am. But needless to say, we've been getting a lot more

you know, patients and clients that want to really focus on their longevity and healthspan. So this is something I spent a lot of time reading about, thinking about, and then finding ways to reduce the barriers for my patients. So with the VO2 Max getting back to that, we get that measured, we either have people get that done local to their environment, or there's a, you know, there are some places near the Ultra Wellness Center that we can have them get their VO2 Max measured.

And for many people, it's brand new information. But it then becomes a really great marker for them because we can then give them a fitness program that's designed specifically to improve your oxygen delivery and oxygen utilization, which will then improve your VO2 max efficiency.

and give you that cardiorespiratory health that you're going to need as you age. And by the way, the side effect is you feel much better. -Oh my gosh. -You have more energy. And you burn more calories sitting down doing nothing. And the reason I like it is I get to eat more. I mean, I like to eat, but when you increase your VO2 max, you basically just burn more calories sitting down doing nothing. It's a vital sign. You know, in my way of thinking for my patients,

I don't want to see them in the room unless they've had a VO2 max and they've had their body mass composition done. Yeah. Because those are two, to me, those are vital signs that if I don't know them, I can't give you everything that you need to be healthy. Yeah. I mean, I don't know if there's good data on this, but I think, you know, your VO2 max is

probably as important or if not more important than measuring your blood pressure or your cholesterol or your blood sugar. It's that important. And we don't look at it in medicine. - Well, they're highly correlated. I mean, VO2 max is correlated to your lipid levels and also blood pressure. So there are some studies that make that correlation. - And I don't want people to feel, listening to you, that they can't start late in life. - Oh, no. - There's this guy I read about who was a French dude

who decided he was a post office worker and retired at 65 and he was going to take up cycling. And at 105, he could cycle basically a 14-minute mile, which is really fast. And his VO2 max was that of a 30-year-old. And he decided, I think at 103 or something, that he wanted to improve his VO2 max.

So he basically got on a training program to improve his VO2 max even at 103 years old. - You can absolutely, yeah. - So George, take us through, we basically measure it through a lab, essentially a cardiometabolic lab with a cardiometabolic cart that measure your oxygen and carbon dioxide exchange and you get a number.

And there are other sort of surrogate ways you can do it through various watches and I don't know how you're doing calculations. But basically, it's a really important number to know. We get your number. Okay, the average person that I see who's not that healthy is in their 20s, even teens. It should be kind of, you know, typically as you get older, it gets lower. But typically in your 30s, it's in the 30s, it starts to go down. You know, when I was 45, mine was 55. So it's possible to keep it high at any age. So

When you start to sort of see these people and you do this testing, what is the sort of strategy then around cardio metabolic fitness? And soon we're going to get into body composition in a minute, but I want you to stay tuned for that because it's a really important conversation. And I think it's, again, one of those unmeasured vital signs, which is muscle. You talked about sarcopenia, which is a condition that is correlated with almost every physical

Feature of aging and in fact, it's probably the reason we age so much and yet we don't ever measure it or talk about it in medicine either is there big gaps and and again, this is what we've been doing in my practice for 30 years at Kenya Ranch before and then and then at here at the ultra wellness center and so how do you approach someone who's who comes to your office and maybe you can tell us a story of a patient who has Measured the VO2 max. It's low

And what do you find in those patients? What do you do for them? How do you tell them to increase their VO2 max? What's the scientific method, essentially, for increasing scientifically your VO2 max and your metabolism and your mitochondria and your fitness level? Sure. So as with everything in functional medicine, it's all personalized. There's just so much that goes into how I'm going to create a program from somebody

to their history with exercise, to any injuries that they may have, to their current status in terms of their work environment, their social environment, and any disease process they may be struggling with. So it's always going to be personalized. But there's a general approach.

So the general approach is you need to have an aerobic baseline. So you start with zone two. Zone two is basically 60 to 70% of your maximal heart rate. It doesn't sound like very much.

No, it's not. And so, but that is your base. So can you have a conversation when you're working at that level? Yeah, so that's conversational exercise. I explain to people, if you and your wife are on treadmill and you're next to each other, you can have a conversation where you can get one or two sentences out and need to take a breath.

If you get more than a sentence or two out, then you're not working hard enough. And if you can't breathe, you're working too hard. The reason why that's important is that's your aerobic capacity. You're going to maintain a metabolic rate in which you're using up oxygen

and you're not beginning to create too much lactate. Because once you go through that threshold, then you become a little more anaerobic and you can't maintain that long enough. And that aerobic level allows you to develop that oxygen delivery system

That's very important to maintaining your VO2 max on a mitochondrial level. So you need to get that baseline. And that should make up the majority of your training of your VO2 max. Is that like a brisk walk? Or is that like a jog, light jog? Well, it has to be brisk enough. It has to be brisk enough that your heart rate is up, you're sweating a bit, and you definitely can't have a full conversation. Yeah.

It's not like walking the dog and talking about your investment portfolio with your buddy. Okay, so how does somebody figure out their zone two? Because there's a calculation in medicine, which is your maximal heart rate is 220 minus your age. That's the maximum heart rate that you should get at your age. Now, let's say I'm going to be 65 this year, so that's...

- 155. - One what? - I think it's 155. - 155, okay. Now, I'm highly trained, so I often get my heart rate to 180. - This is great, this is great. - And when I get it to 180, I'm like, oh, am I gonna die? No, I'm not gonna die, I'm just fitter, and so my maximal heart rate is younger than I would calculate. But for most people, it's 220 miles per day, so they're maximal. - Yeah. - And then it's-- - 60 to 70% of that. - 60 to 70% of that. Now, there are devices, like I have a Garmin watch, and there's many other devices, Samsung, Apple, so forth, Fitbit, and a lot of them measure,

your cardio-metabolic health. And this watch tells me when I'm in zone two, when I'm in zone one, one to five. And I can see where I'm in my exercise routine. And that's really helpful. But for most people, how do they determine what's their true

maximum heart rate and their true zone too. So most for most everybody, it's really going to be that calculation with the way I work with people is you do that calculation, but to your point, there's something called the rating of perceived exertion and it's your ability to understand where you're at in your fitness. So I can get my heart rate up still into the one eighties, you know? So my max heart rate, I mean, I get into one 88, one 90. I'm like, I'm not, you know, I'm okay.

I don't know if it was a glitch in my watch, but the other day it said 199. I'm like, I don't think that's right. But the reality is that if I go to my calculated zone two, I'm not working hard enough. So I go by my rating of perceived exertion. I'm not in zone two until I'm at that point where I'm getting one sentence out. So I always tell my patients, correlate your calculation with your experience.

That's one sentence out and then you have to take a breath and do another one. Pretty much. Is that the idea? Yeah, pretty much. One to two sentences out. I mean, for all intents and purposes on a practical level, which I'm truly trying to make it for my patients, make this as, lower the threshold as much as we can, make it as practical as possible. So you, you know, the only real tools that you won't have, you'll get from us. That will be your VO2 max and your body comp. But after that, I want you to be able to do everything else that,

-At home? -Yeah. So when you're telling someone to do Zone 2, how long do they have to do it? How many days a week? And then what else do you do to increase your VO2 max? Okay, so the recommendation is about 150 minutes of Zone 2 activity, just for basic cardiovascular health.

Will 300 be better? You know, it's the law of diminishing returns. 150 or more, maybe between 150 to 200, that's about 30 minutes to 45 minutes of zone two activity per day. That could be swimming, that could be running, that could be treadmill, that could be rowing, whatever you like. It could be biking. Okay. Then what then is going to increase your VO2 max? There's

Zone 2 is considered moderate... By the way, that's more exercise than probably 85%. 86%. 86% of Americans do not meet that goal. Yeah. So 86% of Americans are... America, you got to get moving. So 86% of America is sedentary. Yeah. And inactivity leads to disability and mortality. So go back there. Anyhow. So then you have that baseline and...

At least 10% to 20% needs to be high-intensity interval training. That baseline is more of your moderate-intensity training. When you compare the two, high-intensity interval training is far superior. I think I've read the numbers, like eight times more superior in improving your VO2 max than moderate cardiorespiratory training or intensity training.

so the high intensity interval training is when you get up to 90 85 to 90 percent of your max and then you maintain that for an interval period rest and do that interval again especially like the speed you'd be at if you're running from a tiger yeah for like 30 to 60 seconds as long as you can maintain it right and then you take a break and you kind of go slow really slow for three minutes and then you do it again there's all these different yeah so there's so so the the the

So what you want to do with your high intensity interval training is that you start with your baseline. So you warm up and then you do your baseline training and you do it on a different day. So you'll do your zone two activities Monday through Friday, or let's say like Monday, Tuesday, Wednesday. And then, you know, on Tuesday, Saturday, you do your high intensity. Your high intensity, that's

intervals will be you can go one to one one to three so let's say do 30 seconds of running as fast as you can yeah then you can rest for 90 seconds yeah right as you increase your fitness level you

you can increase the duration of your intensity. So instead of 30 seconds, you can go up to three minutes. And so as you're able to do that, that is your subjective measure that your VO2 max is improving. So then you can increase. So you start 30 seconds, you rest 90. Then as you get more and more fit, you may go one minute and rest three minutes.

- So do this on a treadmill, on a bike? - Yep. And then if you get really fit by the way, then you can do like one to two, one to one. So then you do like one minute really hard, only rest one minute, one minute really hard. And that way, so that's progressive. - And how long you have to do that for? Like 10 minutes, half an hour? - 20 to 30 minutes. - Yeah. So it's 20, 30 minutes twice a week. - Twice a week at most. - Not that much. - No. - Right. And you're saying it has a dramatic effect. - Dramatic effect. - Yeah. - Yeah, you'll definitely see an increase.

- Yeah, I saw a paper years ago, I wrote about it, I think in my book, Ultra Metabolism, that if you compared traditional aerobic training to VH2 Max training and people would exercise less minutes, less duration, higher intensity, they would exercise far less and get far more fit and burn like nine times more calories

than if they actually were just... And it's basically burning more while you're sitting on the couch watching TV is what we're talking about here. And one of the concepts I want to bring up is the idea of what we call exercise snacks.

and you can think about it in regards to aerobic training and you can think about it in regards to your strength training as well. And these exercise snacks, you can get just as much benefit doing a five-minute high-intensity interval training three times a day or four times a day than doing it all 20 minutes at one time. So you can, in the course of your day, instead of like,

or just keep working or eating, you can just take one to three minutes and do a high intensity interval workout. You can do it right in your office. - So like do burpees? - Yeah, do burpees. And do intervals of them, 30 seconds on, 30 seconds off. And you can do that for three to five minutes

recover, and if you do that four times a day, there's your 20 minutes. That's amazing. And it doesn't have to be all at once. Yeah, it doesn't have to be all at once. And that's what I really want to emphasize to our viewers and listeners is that we want to try and find ways to get you to exercise that lower the threshold, lower the bar, make it less confusing, make it less complicated.

Use your own body, use minimal amount of equipment, and that way you're more likely to do it. So that's how you take a 40-year-old who's lost their way and get them back on track. Tiny steps, tiny changes that lead to bigger changes, and then ultimately hugely improved fitness, longer life, healthier life. Yeah, I absolutely agree, George. And I think what's quite amazing is

studies I've seen on people who had dementia using VO2 max training. They put them on a bike and they do VO2 max training and they cognitively improve dramatically. Yeah. So part of it is because it basically creates this thing called miracle grow in the brain or called BDNF, which is one of the things that gets triggered by exercise. So I think it's just, it's quite amazing when you see the power of this, when there's no drug that can do it, but you get on a stationary bike and you, you know, you go as fast as you can and your brain wakes up pretty damn good.

Pretty damn good. And just as another, you know, just looking at more data, there are studies that have been done that looked at people that have cardiovascular disease, have had MIs, have had catheterizations and they compare their improvements in functionality using moderate intensity exercise versus high intensity exercise. They're able to do high intensity exercise and they make vast improvements

in their VO2 max and their functional capabilities doing high intensity exercise. So even if you've had a cardiovascular event, you can do high intensity training and increase your VO2 max and your functional capability. And it's not just a vanity metric. It's actually a really important metric. Absolutely. How you're aging, what your metabolic health is, what your fitness level is and how it's

It's going to determine everything that happens going forward. So again, you know, this is something you're not going to get at your regular doctor. You're not going to get the right prescription. You're not going to know exactly what to do. And it's the kind of stuff we do at the ultra wellness center. I want to talk about the other important measurement that you mentioned earlier, which is something we also do at the ultra wellness center called body composition. Now what is body composition? So, so body composition is really, what are you made up of? We've just been talking about cardiovascular fitness and,

you're talking about heart, you're talking about blood vessels, but when we're talking about your body comp, we're talking about fat and we're talking about muscle. Those are your two major body parts or body subtypes. So they're really important because they're metabolically active.

And fat has its role in providing us energy, but when we have too much fat, we have certain types of fat, it's inflammatory and it alters our insulin sensitivity, which has a significant role in metabolic syndrome and then in development of cardiovascular disease, which is the leading cause of death in men and women. So we need to really be aware of fat, but we're not always aware of fat because when we go to our conventional doctor's office, we get a BMI. And BMI is not telling us anything about body comp.

It's just telling us about your total mass compared to your surface area. Yeah, right. Whoever thought that would make any type of sense, right? So when we do a body composition, we can actually look and see how much muscle mass do you have, particularly axial muscle mass, muscle mass in your arms, muscle mass in your legs. They're highly correlated to your health span.

Then we could also look at your body fat. So when we look in the mirror, we see our fat. If we do a waist to hip ratio, which is actually better than BMI when it comes to identifying what your body count might be, because it really represents your visceral adiposity. And visceral adiposity- Belly fat. Belly fat, yes. In English.

You know you're smart, Joe. You can use English. Yeah, so belly fat. So that's obvious, but you also can get your visceral adiposity, not your centripetal adiposity, but your viscera. Your viscera is around your organs. Inside, right. That's the fat inside. Around your organs and your belly, yeah. And that's a measurement that really opens up people's eyes.

Because when they see on their body composition that their visceral fat is like above what it should be, they're like, wow, I can't see that. So, well, that's the really dangerous stuff. Yeah. And so when we do a body composition, the body composition that's really used most in research and in research

in practical medical and exercise physiology settings is your bioelectrical impedance. And that's when you send an electrical signal through the body and the electrical signal at a low level frequency will pass through the different tissues.

and it passes through the tissues at different rates because each tissue is going to impede the flow of that electricity based on what it's made up of. So we're at 70% water, you know, the electrical signal is going to go pass quickly through the water versus fat, it's going to go slower.

And so using a computer algorithm, you can then begin to define what a person's made up of based on the electrical signals that you got from the test. So we use an in-body in the practice

and it has multiple electrodes. It's a pretty fancy machine. It was very expensive, but we got it because we think it's such an important vital sign. Yeah, and it's a really good one, and it's a really important one. Everybody gets it when they come in, and it has eight electrodes that are spread between your hands and your feet.

And so it's very sensitive and it can pass multiple different frequencies. So it's very sensitive and it's very accurate in being able to determine how much fat, how much of it is visceral, how much of it is not, and also look at your muscle mass. And when you compare it to DEXA, it actually will...

- That's sort of what's used in a lot of research, yeah. It's kind of an x-ray, which is some low-level radiation that's used to check bone density, but also can check body composition and fat and muscle and distribution. So that's also used to measure body composition. - It's also used, but as BAI, so it used to be the gold standard, but as BAI has really increased and the technology's really improved,

BII actually-- - BII is body impedance-- - Body impedance analysis. - Right, so it's basically using what we just talked about, the in-body machine, right? - In-body machine, yep. Thank you for helping me make this simple for people. - That's okay. - That was my goal, make it simple for you. Okay, so,

So in doing that, the BIA will actually more accurately determine your muscle mass because DEXA doesn't account for any fat that might be in the muscle. So it will overestimate your muscle mass. So BIA is actually really effective. And if you can get that done, you can certainly get it done in our office, but if you can get it done, that's a really good baseline for knowing, okay, where am I at now?

with my body composition. And what does that mean? It means I would actually distill it down to being able to say, where am I at metabolically? Because how much fat and how much muscle you have in comparison to one another really does determine if you're going to be metabolically flexible and metabolically stable. That's right. And metabolic health is such a huge issue because

it's a problem across America in a way we've never seen before. According to data I've talked about before out of Tufts, 90% of Americans are metabolically unhealthy. Right. And it has to do with some degree of problem with body composition, with fitness, with nutrition, it's all there. But you know, this is a huge factor. I just want to sort of emphasize what you said.

Everybody who comes to the Ultra Wellness Center, when they check in and get their vital signs done, they get their blood pressure, they get their respiratory rate, their heart rate, their temperature,

and their body composition. It's just basically one of the vital signs that we check on everybody. And I think we learn so much about our patients and it's such an important tool to help them understand where they are in their overall health. And it's such a critical measurement. It should be done as part of every doctor's visit. And it's especially since 93% of people have. So imagine we have a problem, 93% of the population, we don't have a really good way

of measuring that in the average doctor's office and we don't even pay attention to it. And yet it's one of the most important things we need to look at. And it's important because we can do something about it. We can actually change it and we can alter our body composition at any age.

- No, Mark, we could, you know, as you're talking to me and my little ADHD brain is just firing off in 10 different directions, I'm thinking about not even the doctor's office, Mark. How about schools? - Oh yeah. - What is this thing about having kids sit in a classroom all day long? - That's a great idea. - Right? And then like, you know, they're gonna put me on a leash when I'm in third grade because I wanna get up and move. - Yeah. - Anyhow. - People have EDD, exercise deficiency disorder. Not ADD.

So yeah, you know, so once you have your body composition, then we can start some real serious work. And as I tell everybody, just as a quick aside, you know, I have patients come into the Ultra Wellness Center and they seem to be really proud of like one piece of their medical record. Yeah. And that's their supplement list. Yeah. Yeah.

They love their supplement list, right? And I get people that come in with like 23 different supplements that they've gotten from different podcasts and the health and wellness space. And they're really proud and they think I'm gonna tell them, "Wow, that's great." But when I look at what they're doing for exercise,

I say, you know what, let's put that piece of paper aside because you cannot supplement your way out of no exercise. -Or a bad diet or anything else. -Or a bad diet. It's called a supplement, not a replacement. Yeah, exactly. So the reality is that I tell people we're going to spend our time on lifestyle because if I can't fix your lifestyle,

it's going to be really hard for me to help you reach your goals. Or if you're ill, to get you to be healthier. So lifestyle is critical. We've talked about the cardiovascular aerobic piece, and now there's the body comp that lets us begin to understand, okay,

What do we do to change that body composition? Specifically, if we look at the data around muscle, we understand that you need muscle mass and you need strength. Muscle mass provides you that metabolic center where so much of your metabolism is going to occur. And it has a lot to do with glucose metabolism.

- I just want to emphasize that. What George just said is so important. Your muscle is where your metabolism happens for the most part. It's in other parts, obviously your heart, your brain, your organs.

But the vast majority of your metabolic function happens in muscles where you produce. Your muscle is the biggest organ in your body. Yeah. It also becomes not only that metabolic reservoir, but it's a protein reservoir, an amino acid reservoir. So, you know, if we take it down to the point where you get older and maybe you get sick or you fall, you have an accident and you're sedentary for a while, you need a reservoir of protein and amino acid to recover. Mm-hmm.

If it's not there, then you've just taken a step down and you have no ladder to get back. - It's what happened to a lot of elderly people when they got COVID. They just had no capacity to deal with it and they had no protein reserve and they're often protein malnourished.

Protein is required to make your immune system. For example, your antibodies are made from proteins. Your immune system functions on protein. So if you have not the right amount of protein, you're in trouble. And if you don't have the reservoir in your muscles, you're doubly in protein. Doubly in trouble. And so then, so that's the muscle mass piece, but then there's the strength piece. So there's muscle mass,

but you need to have strength with that muscle. So the strength is your functionality. So you can't just have big muscles. They have to actually be functional. Right. They have to be strong. And so, so there's, there, you have to think about it in both ways and, and you have to, and, and then when you think about it that way, then you have to think about, you know, protein and its role in helping to build and repair muscle.

But protein by itself is not going to lead to strength. That's when you need resistance training. It's like putting ingredients for soup on the stove, but not turning the heat on. Exactly. Right? So protein is the ingredients, but the heat is the exercise. Right. And that's resistance training. And there's just a lot of... Otherwise known as weightlifting, strength training, band training, body weight training. There's a million ways to do it. Yep. And so...

There is resistance to resistance training. People just don't like to do it. When I talk to my patients, they're just like, I don't like to get into it. Oh my God, I hated that. I was like, this is painful. This is uncomfortable. I couldn't do two pushups when I was 50 years old. If I did 10 pushups, I would be sore for a week. I'm like, this is ridiculous. I don't want to do exercise. It makes me feel horrible. So I just never did it. And then I started when I was like 59. I'm like, all right, I know I'm supposed to do this. I tell everybody to do it. I'm not doing it. I better do it. And it just changed my life.

Dude, when I see you on Instagram pumping iron in the gym, like I am like impressed. I mean, you seriously, you do, you work hard when you work, man. And you know. I try, I try. But you know what's so important to realize right now is there's a huge problem in our society, which is the Ozempic craze. Oh, yes. And the reason I'm bringing it up is Ozempic.

makes you lose fat and muscle. And if you're on Ozempic or Wegovi or Manjaro or any one of these drugs and new ones coming around every minute, you have to pay attention to what we're saying today. You have to have the right amount of protein, more than you think, about a gram per pound. We'll talk about that per day. And you need to focus on resistance training if you're going to be on those drugs. Absolutely. And if you don't, what will happen is you will lose

muscle and fat, but muscle burns seven times more calories than fat. So when you get to the weight you want, you'll have a slower metabolism and eating a lower amount of food will

will actually make you gain weight. So this is a huge problem. This is why often people can't get off the drugs and they don't do it properly. And I'm not opposed 100% to these drugs. I just think they're overused and they're also not prescribed in a way that's taking care of the side effects of these drugs by properly addressing

the protein needs and the resistance training needs that are increasing when you're taking these drugs. - I can't agree with you more. And if you hadn't made the point, I would have. These are called GLP-1,

Agonists. Agonists. And they have a role. They have a role, but... Our bodies make it, by the way. There's a lot of ways to increase our body making you up. Yeah. And they have a role. Our body makes it. But they're being co-opted

from weight loss specifically. And when you lose weight rapidly or lose weight ever, you can lose 20 to 30% of that muscle. - Well, in Ozempic, I think it's about 40 or 50% of the weight. - It's higher. It can be 40 to 50, absolutely. - So 50% of the weight you're losing is muscle, which is a disaster. - And that is a disaster. And so in regards to using these drugs for weight loss the way we are now using them in our country,

It's very difficult for me to find a rationale for that. I've always been about, and that's why we're having this conversation. It's about lifestyle. It's about, and capturing that lifestyle early in life so that it maintains, so that you can maintain it and improve it and excel as you get older. So-

I'm glad we took that little journey over to the dark side. -I think it's important because it sort of speaks to why, for example, everybody who knows Empig needs a body composition before they start. You track them every month to see what's going on. These machines are easy. You just stand on it. It's like a scale, a fancy scale that you stand on for a few minutes and it measures everything. And I think if we don't do that, in my view, as someone who would be prescribing one of these drugs, I would consider malpractice. If you don't focus on muscle health,

and prevention of muscle loss when someone are on these drugs i think it's akin to malpractice and if you don't measure body composition and track it it's like it's like you know it's like putting people on a on a diuretic where you you lose potassium and not checking your potassium right absolutely it's like well you know as a doctor if you're on if you're on a certain drug you need to check liver function test because it affects the liver function

So you just know to track the things that are the problems. And we don't do that with these drugs. And it's it's it to me, it's criminal. And I think it's like it's a quick fix. Boom, boom, lose weight. But we're creating a whole society of people who are going to become more sarcopenic, have more muscle, everybody lower metabolism. And then it's a vicious cycle of getting the weight back, eating less food and being in this horrible, horrible tailspin that is hard to get. It's absolutely. And I

We are so body shape centric and we are so fat centric that we're losing sight of the fact that you emphasize, and I want to emphasize again, because I've had this conversation recently with colleagues and with you as well, that

Using these drugs, using GLP-1s have a real downside to them and using particularly for weight loss is an issue because you're losing fat but you're losing muscle and that is even more important.

You may look good, but now you're-- - You'll be a skinny fat. - You're gonna be, well, I don't know, what's skinny muscle like? - Skinny might mean you look thin, but you're actually fat. That's what we call a skinny fat. - Yeah, skinny fat, right. So yeah, you're in bad shape. So I think you and I totally 100% agree on that and have the same viewpoint. And then there's also the complications that we've talked about before that can come with those drugs, including intestinal obstruction.

There's a whole, yeah, I've done a whole podcast on that. We'll link to the show notes, but let's talk about, let's talk about body composition and, and resistance training in particular. I think, you know, there's two parts of body composition, what you eat. And I always say you can't exercise your way out of a bad diet. So if you don't get your diet sorted and I'm going to spend a few minutes on that in a

you're going to have trouble, right? There's people who are in the gym all day long and overweight. I actually had a guy who was my trainer at Equinox when I lived in New York who was like ripped. He could do, he was so strong. I mean, he could literally go put like, I don't know, 150 pounds on him and do like pull-ups. And I'm like, you know, like basically two body weights and do pull-ups. I can't even do one pull-up. And he kind of had this thick layer of fat all over him.

And I said, "Why don't you try eating this way for a little bit?" And I have a before and after picture of him, which is quite amazing. And he was even more wrecked, but had lost that layer of fat and it was metabolically more healthy, even though he was so strong, he still hadn't had his diet sorted. So diet really plays a role. - Huge. - Let's talk about what is the dose and frequency

of resistance training, what are the types available and what should people do? Because it's a little bit intimidating. -Oh my gosh, yes. -If you're a bodybuilder, I mean, I would go to these gyms with all these bodybuilders and it's this skinny guy, I'm like, "I'm sort of intimidated here, I don't know what to do, I don't want to hurt myself, I'm worried about this." How do you address the problem of just getting started if you've never done this before?

That's the million dollar question. And this is where people, this is why people don't go, this is why people don't do resistance training because the bar is really high. It means they need to buy equipment. They don't, because we're going to a gym. Then when you get to the gym and then there, you see all these machines, which ones do I use? Um,

A lot of confusion. Not everybody can afford a trainer, right? Right, right. And then when I get on the machine, how much weight do I use? Do I use a little weight and do lots of reps? Do I use a heavy weight and not so many reps? You know, what's my range of motion? Do I do full range of motion? You know, do I do short length partials? Do I do long length partials? What do I do? Right, right. What do I do? Yeah. So...

So in preparation for today's talk, I said to myself, okay, I can't go through the entire science of strength training, but I'm going to try and just distill it down. So what we want to do is we definitely need to do progressive resistance training in order to gain muscle mass and strength.

Okay. So progressive resistance training means that you start out, whatever exercise you choose, one that everybody might know, there's a curl. All right? So you're going to start out with five pounds. You do it the first time you do it, man, I could barely get to eight. Yeah. Okay? All right. So then...

you're going to go back three days later, or maybe go back the next day, do a different body part. But three days later, you're going to go back and do your curl. And you know what? You're going to notice that you actually do two more reps. It's not necessarily because you got stronger, it's because you actually got more efficient. Biomechanically, the message from your brain to your muscle, some of the metabolic efficiencies occurred already, not necessarily stronger, not necessarily bigger muscle mass yet, but more efficient.

But three weeks down the road, you're going to find that it's really easy. Now it's time to increase your weight. And so now you're going to 7.5 pounds. So by the time three months comes, if you've been really consistent, you're going to find that you've progressively increased your resistance. And now you're at from five pounds, you went up to 15 pound curl. Yeah. That is going to correlate to increased strength and increased muscle mass as long as

as you're eating correctly. You're gonna need to fuel that with the right amount of carbohydrates and healthy fats, and you're gonna also have to supply the building blocks with protein. If you're not getting the protein, then you're not gonna be able to repair, you're gonna get injured, and you're not gonna build the muscle mass and strength that you're looking for. So that's just the really basic-- - So progressive resistance training, I think that's an easy concept to understand, is you slowly build up the amount,

But how many days a week should you do this? I mean, what are the different types people can do? What are the low friction ways? For example, I didn't really ever do any weight training. So I went to the gym and I got a trainer and I could afford it, thank God. And I learned a lot and I kind of started. And then COVID happened and kind of fell off. And then I went and learned about band training, resistance bands. Because I'm traveling a lot. I move around a lot.

And I can't always get to a gym or I'm busy and I don't have time to go to the gym, get there, change, do the thing, change again, shower, come back, drive home, like a whole thing. So I'm like, I just need to be efficient. And I learned about TB12, which is Tom Brady's band resistance training program. Tom did this solely and he ended up being a seven-time Super Bowl world champion. So I think he knows what he's doing.

And I started doing these bands and I could do them anywhere. I can hook them to a door knob, I need a floor and a door and I'm good. And I'm able to literally build my strength and it's so easy. And I just, I can do, you know, light bands at first, heavier bands, heavier bands. I can do about 20, 30 minutes, three or four times a week. I like to do five if I can, but even that keeps me going. And so it doesn't have to be like a big project. And there's a lot of apps and there's a TB12 app you can use.

But I think, you know, how do people just think about getting kind of started on this? Yeah, so what you sort of referred to are some of the alternatives to our classic understanding of progressive resistance using weights.

So there are bands, there are kettlebells, there are body weight exercises. All of these can increase strength. They might be more difficult to increase the muscle mass and hypertrophy because you might not be able to get to the number of, you know, get to the amount of resistance you need or the number of reps you need effectively to increase hypertrophy. So when it, I will generally recommend

suggest to people that they move towards using weights for the resistance training. And you can do that at home, you can do that in the gym. I usually recommend that you do at least two days a week. I think if you're doing two days a week, you're just breaking... Staying even. You're breaking it. You know, you're breaking in. I think if you're doing three days a week...

you're going to be able to accomplish your goals. Four days a week, you're going to be able to squeeze a little bit more water out of the sponge. Five days a week, you're now probably nearing addiction. How many of you do, George?

three to four, three to four. There are weeks I don't, I get one or two. I mean, quite honestly, you know, again, a quick aside, you cannot maintain the same exercise level throughout the year. Whether you're a world champion or a national champion,

or a really high-level collegiate athlete, you just can't and you shouldn't. You have to concentrate on different areas of your physical health, whether it be nutrition or your fitness. And there's various forms of fitness that you need to train at different times of the year. One of my favorite bike riders of all time is Lance Armstrong. I just think that regardless of anybody may say... Despite all his problems. Regardless of anybody may say, Lance Armstrong...

worked harder than anybody um and so a little help from his friend yeah well we can put that aside for now but he still really worked hard and i had a huge amount respect for lance but needs to say you know i could probably when he was not i could probably in the middle of winter you know when i was really riding hard probably gone to austin and ridden with lance because he probably wasn't

you know, he probably wasn't doing intervals and sprints. He was probably doing five, six, seven hours on the bike. Right. And I could just hang on his wheel and let him drag me around, but I wouldn't be able to hang with him. Right. Because you're working on something different. He then changes his program so that as he's getting closer and closer to spring classics and finally to the tour de France where he's getting more specific into power and sprinting, then I'm, then, you know, I'm just taking pictures. Yeah.

Same thing with strength training, right? Yeah, the same thing with strength training. To get back to it is, I'm not going to sit here and tell everybody,

365 days a year, I have the consistently same program. It's impossible I don't. But I stay at that level where if I am too busy and I'm on vacation, I can take that break and get very quickly back into my routine without that much of a loss and get right back to my physical fitness level and then continue to build as I need to for my next challenge in my life. So strength training 101, I'm going to give it to you right simple. Get to the gym, you know,

So I do think getting to a gym is probably going to be the most effective way to begin the process. Once you understand how to do it using kettlebells, I'll take one thing back. One thing you can do is the Instagram and YouTube

are huge resources for exercise programs. So I will take this back. My wife has turned me on to this recently. She has a whole catalog on her phone of Instagram posts of different resistance training and weight training programs that involve kettlebells,

body, bands, everything. So the bar for doing those things actually is so much lower than it used to be. Yeah. And body weight. I'm actually going to take back what I just said. I don't think you need to go to the gym to start. Go to YouTube. Go to YouTube and Instagram. Pick your favorite workout.

Pick your favorite, whether it's bands, whether it's kettlebells, whether it's body weight, and you'll be able to find a plethora of different exercises that you can do at home in the office. So you can just start there. You've got to be careful to not overdo it and be like where you injure yourself because you have to start slowing down. Yeah, we're going to hope that everybody's going to be using common sense. Well, you know what Mark Twain said, right? No. The problem with common sense is...

It's not too common. Right. You know, I've heard you say that before. I should have known. So, yeah, so you always start low, go slow. There's no rush. You'll make your gains with time. But when it comes to actual, if you're going to use weights, which is my favorite approach, then here are the things that people always wonder about. Like, which exercises should I do?

Well, you want to do exercises that use more than one joint. They're going to give you the most metabolic response. For example? For example would be a squat. Squat. Squat. A deadlift. Even a bench press. You're using multiple joints of the bench press. You know, a...

If you do bench press, squat, deadlift, you know, your bench press, squat, deadlift, you're talking about the power lifts. And those, if you just concentrate on those, you're going to get a full body workout that's going to put you in a really good position of health.

-Yeah. -Right? Now, those are... -They take a bit-- -So it doesn't take a lot, is what you're saying. It doesn't take a lot. And you don't have to go crazy. You don't have to be in the gym all the time. And you can actually learn a few key exercises that build large muscle strength and core strength and stability. Really, really important. And that's why I love bands, because they're so easy and portable, and they do all those things. So on the weight piece again, people are always wondering, "Should I do..." How much weight and how many reps?

So it really depends. But I would say that, you know, for getting-- if you want a good solid middle of the ground program, then you want to try to do, you know, anywhere from 8 to 12 reps.

should I go to exhaustion or should I not go to exhaustion? Should my last rep be completely, I can barely get it up or not? Well, there's some mixed data and some recent data indicates that getting to like two to three reps before exhaustion is going to give you the same benefit. Yeah. So, so you don't have to go to exhaustion. You don't have to have so much pain. Right. Right. And so, so eight to 12, your last one can be one to two to maybe three reps from exhaustion. Mm-hmm.

There it is. There's your repetition number, right? Your weights should be weights that allow you to do 8 to 12 reps. So you just find a weight. You have to test it out and figure out your first couple times you go, what are you going to use. And then here's something that's transformed my recent weightlifting. So there's long-length partials, there's full range of motion, and then there's short-length partials.

So when they compared, so full range of motion is when you do a curl like this, full range of motion from that position. A short length partial is you start here and go like this. You start halfway and then you finish. Long length partial, you start with the muscle fully extended and stretched and just go partway. Partway. One third to half, right? And what does that do? So recent data has shown that when you compare

the long length to the short length partial, the long length partial, there's not even a comparison in terms of strength. So short length is better than long length? No, no, long length, long length, long length. And when you compare long length to full range of motion, long length is still superior. Amazing. So you can do a long length partial and get the same benefit as if you're doing a full range of motion.

The benefit I find for me in that regard and for people that are going to be lifting-- Is that why your biceps are bigger than mine?

- I don't know, Mark. Look, I'll write your next program for you. Make sure you get your biceps. So when you do the long length partial, what I like about it is I can actually use more weight. I can actually, you know, and I just find it's much less stress on my overall body. - All system, yeah. - Right? And I, so. - So this is a fabulous story. - There's basic things I want people to get.

your weight, you pick weights that you can do eight to 12 reps. You don't have to go to exhaustion, but if you want to, you can.

one to three reps before exhaustion is all you need to go to. You need to progressively increase your weights over time. And then you can use any type of format. You can use bands, you can use kettlebells, you can use body weight. And again, as we talked about with aerobic training, you have these exercise snacks. You can do exercise snacks with your resistance training as well. As you mentioned, I have dumbbells in my office.

And I use those from exercise snacks during the day. - I just talked to Lee Hood, who's one of the world's premier scientists in systems biology and medicine.

And he's 85 years old. He does 150 push-ups a day. So not all at once, obviously, but maybe he drops in 30 here, drops in 30 there. You do that five times a day, that's 150 push-ups. Very impressive. So George, this has been a great conversation about how do we look at things that are often missed with traditional medicine, what we do at the Ultraman Center to look deeply into someone's health and well-being and actually optimize their health and even treat diseases using exercise. How do we measure...

the fitness level using VO2max? How do we measure body composition using our in-body diagnostic machine we have in the office? And using that data to help inform people about what's going on with their body and how to adjust their lifestyle to correct the problems so they don't get into trouble in the long term. The one thing we didn't talk about, I just want to touch on it for a few minutes before we finish, is

diet. Yeah. Because body composition in particular and cardiovascular fitness to a lesser degree is, is so correlated with our diet. And part of the challenge we've had is that we don't want eat enough of the right kinds of protein. And two, we eat too much of the wrong kinds of carbohydrates. Right. And that will lead to increasing belly fat, visceral fat, fat,

marbled in your muscles, which you said we couldn't measure with the DEXA. You don't want a ribeye muscle. You want a filet mignon muscle, right? No Wagyu. No Wagyu beef muscles. But that's basically what everybody in America is walking around with. It's true. And so we need to really help people understand that they need to reduce their refined starches and carbohydrates in their diet. They need to increase the good fats.

and they need to increase the quality protein. When I say quality protein, we talked a lot about this in the podcast with Gabrielle Lyon, with Don Lehman and others, and we'll link to those shows, but the quality protein matters. And if you want to build muscle, you need muscle. It's sort of, if you want to build muscle, you need to eat muscle. And if you eat beans, it doesn't work as well. You can, if you eat massive amounts or you have highly processed beans,

bean powders or grain powders, you can concentrate the proteins and then they add extra amino acids. They add extra basically synthetic amino acids to jack up

up the quality of the protein, which if you are a committed vegan, you can do, but you have to do that. Like a Garden of Life sport protein, for example, has 30 grams of protein, but they also add all these other amino acids, which aren't naturally in the products that are in it. So you have to eat either whey protein, beef, chicken, fish,

Lamb, these, bison, whatever you want to eat, make sure it's the right kind, it's regeneratively raised, there's great sources, and we'll link to the places you can get to, like Force of Nature with regenerative meats or Seatopia.fish with great quality fish that's not toxic and so forth. Go away, I like. But you need the right amount of protein, and the right amount of protein is more than we typically think. If you're resistance training and you're doing the exercise, you need about a gram protein.

per pound, which is almost double what is considered the requirements. And just so people know, the requirements that we have are based on avoiding protein malnutrition. So to avoid protein malnutrition, which is what was more prevalent when these guidelines were established,

you need about 0.8 grams per kilo, which is about half of what I'm talking about. It's not the amount you need to put on muscle or optimize your health. And secondly, as we get older, you mentioned earlier in the show, we have anabolic resistance, which means we are more resistant to putting on muscle. So we need to overcome that resistance with more protein.

more exercise. So really nutrition plays a huge role. We deal with all that at the Ultra One-Off Center. We look at your metabolic health through multiple lenses, including the body composition measurements and VO2 max measurements. Yep. So yeah, I would 100% agree with that. And you mentioned the different speakers you've had on your show talking about protein. And so the literature on protein is

the number that seems to have floated out in the last year or so has been like 1.6 grams per kilo. And so, you know,

I would say that having looked at literature, definitely want to be somewhere between 1.2 to 1.6 depending on your exercise activity. Do you need to get above 1.6? Maybe, probably not. Even if you're lifting, I think 1.6. If you think about it, 1.6 grams per kilo for me is 139.

grams per day yeah it is a lot of protein for me i mean i definitely need to use a protein powder shake right yeah but before you know the show here we just had a protein shake yeah and that was about 40 grams each boom like that right so i can't get to 130 without a protein shake yeah right and so um and i think going back to your point well you can if you had steak for breakfast

You know, I had a really good steak last night. I made it myself. Anyhow, yeah, high quality proteins with grass fed beef, farm raised poultry, get fish at least two to three times a week, get it from good clean sources and you can get your protein. But God gave us cattle and bison for a reason and he gave us canines for a reason, right?

Cattle and bison, they are protein factories. They eat the plants. They now take all the amino acids and all the proteins from all of the plants, combine them into one muscle that we can eat. Yeah, they have four stomachs. That's why they can do it. We only have one stomach. Right.

Because plant proteins are a little bit harder for us to digest and get out the amino acids that we need. And they eat all day. I was in Rwanda, people were like, oh my gosh, gorillas, they're so strong and all they do is eat plants. I'm like, yeah, and they basically have intestines that are two or three times larger than ours and all they do all day is eat. And they eat 50 pounds of food a day. Are you going to eat 50 pounds of food? Probably.

Probably not. If you ate 50 pounds of grass, you'd be fine. Like I said, you can overcome the issue with a plant protein if you eat enough of it, but it's almost impossible to do that. So George, thanks so much for enlightening us about the role of exercise, the role of measuring the biomarkers of health and fitness, metabolic health, VO2 max, body composition. Again, it's just part of what we do at the Ultrawanus Center. We took a deep dive into all your biomarkers, into your full spectrum of health. We are really in the

in the practice of creating health. And what I say is no matter how sick you are, we, we help you get healthy. And as a side effect, disease goes away. So George, thanks so much for being on the podcast again. Hopefully, uh, if those listening were inspired to come see us at the ultra wellness center, just go to ultra wellness center.com to learn more about what we're doing. And, uh, and I hope we see you soon. That'd be great. Thanks Mark. Thanks George.

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