0:00

Coming up on this episode of The Duchess

0:02

Pharmacy, my little Marjorie is I want to

0:04

be at the level of fitness. The I

0:06

can do anything I want to do physically

0:09

at any moment in time. Before

0:12

we get into today's episode, I'd like to

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The largest I'm Doctor Mark Hyenas farmers

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who enough place for conversation. The matter if

3:24

you're guy other listening or view a woman

3:26

who's gonna guys you're gonna find this conversation.

3:28

Sad thing about how to actually look as

3:31

fit as in middle aged man in

3:33

a way that really matters Things we don't

3:35

typically look our in fact that we're to

3:37

Max and Body composition. The special episode of

3:40

Health By It's with one of my

3:42

colleagues had the ulcer one The Center Great

3:44

physician Doctor George Peppard Nicolau who's a graduate

3:46

of the Philadelphia College of Osteopathic Medicine is

3:48

Board certified Family. Medicine and he's

3:50

also and I F M C

3:53

P Certified Doctor Approximation Certified doctor.

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He has worked in the mail

3:58

service on Ambrose Ration. It's

4:00

been working at our practice is also center

4:02

for many years now and hundred great team

4:04

there and today we dive into the topic

4:06

of fitness for middle aged men to the

4:09

talking about what we need to measure and

4:11

why it's important including cynical view to max

4:13

which is a measure of your fitness level

4:15

and your body composition, learning about your muscle

4:17

mass which is a critical measure fitness and

4:19

your body fat composition and were in talks

4:22

about how to fix those things for in

4:24

type as a rape cases where we use

4:26

those measurements to it i'd dress people's health

4:28

and were in talk about. The whole area

4:30

of fitness and health and aging and what

4:33

you can do about it. So it's dive

4:35

in. His conversations with Doctor George, Kevin Macleod,

4:37

one of my colleagues and friends from the

4:39

Ultra on the Center in Linux messages by

4:41

Malcolm backs yards to the Doctor Sarasi present.

4:44

Have any back against Marked as always a

4:46

pleasure to be here. Now who's Usa may

4:48

not know Giorgio just during the podcast The

4:50

Georges one of my colleagues as else one

4:52

a center linux Massachusetts we have a practice

4:54

or. Five. Positions Three P

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the planet. And his colleagues exercise

5:50

now as yards you know it.

5:52

we'll in medical school. did not

5:55

learn. A heck of a

5:57

lot about exercise and sappy. Probably learned nothing

5:59

about it. Except

6:01

this is our patients to eat less and

6:03

exercise more Which is about the most useless

6:06

piece of advice I've ever heard. Doctor states

6:08

ah the heat what and how to exercise

6:10

and will rise of matter and so forth.

6:12

So still a when you get into the

6:15

science of why it's important to understand the

6:17

nature of excise what it does to a

6:19

biology and for did we had a we

6:21

measure. Or. Fitness level hurry

6:24

measure. The. Way our bodies

6:26

who are responding to exercise and

6:28

why that's important for overall health

6:30

now we we, I'm we and

6:32

in medicine. don't really think about.

6:35

How to measure someone's sickness very well we

6:37

know we have the six minute walk tears

6:39

to him a grip strength and we have

6:41

citizen by mattress who use in certain. In

6:43

of resides her so use it or said doctors

6:46

lawyers but it's it's kind of marginal and we

6:48

are just too honest and are we really take

6:50

a deep dive into every aspect of someone's health

6:52

including their. If. It is for

6:54

the plays a role in every the

6:57

pseudonym heart disease, diabetes to cancer dementia

6:59

to depression. To. A D D

7:01

I mean the list goes on and on.

7:03

So I'm George. You yourself are no big

7:05

big exerciser. I'm jealous of your biceps. Yeah

7:08

so this is got weights in his office.

7:10

He's got like I'm like I they see

7:12

a face, executive pumping iron the that and

7:14

baggers off as affects affects our mark. You

7:17

my most this might have. You are my

7:19

motivation. Oh. Man are

7:21

now I'm doing okay Well I

7:23

think I think in a we

7:25

we have the capacity at any

7:27

age, Add to it, maintain or

7:30

even gain. A tremendous amount of fitness

7:32

and see Do night and I are you

7:34

in I both in our mid sixties and

7:36

out in a were pretty damn fit or

7:38

and I just I don't is a story

7:40

and Simon is George by the Sky was

7:42

like in the seventies or something and he

7:44

was. Hanging. Around some jammer somewhere

7:46

in he saw rowing machine images

7:48

on the garage and he basically

7:50

started his seventies, started rowing on

7:52

a machine and now he's like

7:54

a world champion right in the

7:56

nine year old plus category and

7:58

his his several men fbi something

8:00

called V to max which is

8:03

great into this are actually got.

8:06

Better and only got better, but was

8:08

equivalent to people in their thirties and

8:10

forties. So. With. A speaks

8:12

to is that we we see the settings high as

8:14

we age but we don't. Really? Know

8:17

what to do to avert and and

8:19

we see is also their policies are

8:21

chatting four bucks the as you can

8:23

be the office and or our age

8:25

and look like they're know twenty or

8:27

thirty years older radio so to George

8:29

the have you get so an exercise

8:31

and then sell that i your own

8:33

so background in and instead focus on

8:35

fitness and health. He knows the sassy

8:37

least. We had this conversation a long

8:39

time ago and it soon more or

8:41

less how did I get into functional

8:43

medicine? Iso is wired to think that

8:45

way. My parents. I grew up

8:47

who's the early sixties and they

8:49

were smokers and itis Adam and

8:51

Vs to that lifestyle very beginning

8:54

was his innate least. In

8:56

my Dna here and so I was reading.

8:58

I remember was a doctor men dell's blade

9:00

him in book in Soviet Us in a

9:03

hurry remember we were advising their pets. I

9:05

was reading that like when I was like

9:07

in adolescence vs I was just like into

9:09

that self and then I met my it's

9:12

my wife and as a teen and her

9:14

mother. Was. Brilliant!

9:16

She was a homemaker seeded homes

9:18

in western Pennsylvania which she would

9:20

read Nutrition Action letter. I read

9:22

that Rasmussen sex and Rates and

9:24

she was already talking about the

9:26

toxins is tough line and shoes

9:29

were talking about omega threes and

9:31

she gets are you at the

9:33

dinner. Table. Like what

9:35

vegetables had? How much calcium and magnesium?

9:37

less own nutrition? Probably of exercise? Well,

9:39

so that, but that was the whole

9:41

piece of that whole. I've also always

9:43

in. Intrigued by fitness

9:45

and nutrition but the sickness pisa.

9:48

I just as always an athlete.

9:50

From the very beginning I always

9:52

liked to be athletic. I've.

9:55

Talked about as many times and I britain blogs

9:57

about it and I have a D H D.

10:00

And exercises my medicine yellow. It's

10:02

actually when I have a D

10:04

C patients with kids or adults

10:06

the first thing I write for

10:08

them is or exercise prescription is

10:10

only exercise, it increases my buddies

10:12

concentrates and when I exercise. I.

10:15

Feel much better I sleep much better,

10:17

I'm a better mood and I'm more

10:19

able to serve the people around me

10:21

to exercises is my all round drug

10:23

is such an incredible drug idea of

10:25

our from Patagonia and I was new

10:27

tracking ten fifty miles a day up

10:29

and down mountain death and I felt

10:31

amazing play at my nervous system so

10:34

gray mans he was grade my I

10:36

had no mood issues what's a zoom

10:38

habit I just felt more i just

10:40

somewhere see some of more raised everything

10:42

was like wow this is amazing a

10:44

me a little. S you know I

10:46

if I'm in a use my brain

10:48

for ten hours a day and my

10:50

car by running through my body i

10:52

cheese softened better one am I use

10:54

one of my it's internals. Lines

10:57

as I speak to myself Muslim mod for

10:59

his I went to be at the level

11:02

of fitness the I can do anything I

11:04

want to do physically at any moment in

11:06

time within reason. no threat select so it

11:08

would say you called me up See George

11:11

Got a flight of Patagonia we have is

11:13

great fracturing think this is amazing. I. Got

11:15

a plane, I could do it and I could

11:17

do well. The I'm not gonna slow anybody down

11:19

here and I'm going to enjoy it and so

11:21

will the people around me. That's my goal was

11:24

always to be it. It's a level of fitness

11:26

where. I. Can. Get

11:28

on my bike and ride Twenty Five three

11:30

do what am I right? memory members at

11:32

some you nice guy or bikes and we

11:34

read twenty five Miles We had a great

11:36

time and you're pretty good on the by

11:38

the way he i thought that was your

11:40

see you know this is as we have

11:42

that capacity to this guy who I love

11:45

to watch on Instagram among the stars as

11:47

a friend's dude I don't know anything about

11:49

his own friends but hydra resist. He's like

11:51

evasive goes out his seventy years old on

11:53

his deck of it's mountains and someone in

11:55

the mountains of friends. And he

11:57

just he does by twenty five pull

11:59

ups he's incredibly read the feds. He

12:01

makes us look like many upper weaklings.

12:03

I mean this guy is unbelievable and

12:05

thinking how and he does in the

12:07

winter it with no clothes are expecting

12:09

though shirks of/get sick sense and a

12:12

deceased the fact that a of our

12:14

bodies have the capacity for the promised

12:16

rain up near we we define as

12:18

we supposed to woodlands to happen to

12:20

men and women as a start to

12:22

get no over thirty. What's this the

12:24

physiological process Because. Now. We think

12:26

we don't think of thirty years old

12:29

but in then she when the decline

12:31

starts a half and that leads to

12:33

frailty, disability, dysfunction in disease which exercise

12:35

can can completely prevent the most part.

12:40

Because I thought about this I just

12:42

want to make the is make this

12:45

point that's know my mother in law

12:47

should been Two. right? Am I

12:49

ask how she's doing? She tells

12:51

me I'm doing, I'm doing well,

12:54

George. But what's the alternative rates?

12:56

So what's the alternative to not

12:58

exercising? It's an activity and in

13:00

activity at any age will cause

13:03

something Caught anabolic resistance. Okay, Anabolic.

13:06

Resistance is the muscles in

13:08

ability to grow in in

13:10

mass or in strength and

13:12

so that can have in

13:14

a we talk about happening

13:16

with an older adults but

13:18

it can happen when you're

13:20

younger. And so we want

13:22

to fight off the and about

13:24

resistance. And we do. That's his

13:26

shoe string. able to exercise your

13:28

rights. And so when we think

13:30

about. You. What we

13:32

need to be doing. One

13:34

of the things I think about losing

13:36

a chronic disease and aging. Longevity and

13:39

mortality is wind has become a problem.

13:41

Yeah, for becomes a problem very early

13:43

on in life. As you said, it's

13:45

easy see shift between thirty forty fifty

13:48

years old and that's when we really

13:50

need to be. So. kissing

13:52

on exercise and would we need

13:54

to be focusing on we need

13:57

to be focusing on or cardiorespiratory

13:59

fitness and also making

14:01

sure that we're doing some form of resistance

14:04

training because we know both of those through

14:07

you know, lots of different studies randomized

14:11

clinical trials data we've

14:14

seen that both aerobic

14:16

fitness and resistance training and strength

14:19

training are directly related

14:21

to decreasing the chronic diseases

14:24

And chronic conditions that are associated with decrease in

14:26

our quality of life and our length of life

14:29

We know that so those

14:31

are the things that we tend to

14:33

stop doing particularly men who are In

14:37

their bread winning years building their

14:39

careers. They'll tend to be a little bit

14:41

more sedentary Yeah, when that happens you begin

14:43

to begin to build up that anabolic resistance

14:46

You stop making the muscle you lose

14:49

you start to steadily lose muscle and

14:51

when you lose muscle you lose metabolic

14:53

ability And you lose this this this

14:55

protein Reservoir that will

14:57

protect you if you become ill as

15:00

you get older and it's very hard

15:02

to overcome the anabolic resistance So one

15:04

of the goals that we have at the Ultra Wellness Center is

15:07

to work with people very early on in

15:09

their treatment plans If they're at

15:11

that place where they're well enough to

15:13

be focusing on fitness and exercise Sometimes

15:15

they're not well and we have to get them to that point

15:18

But we want to get them to that point

15:20

and we want to focus on is Getting

15:23

measurements like the VO 2 max

15:26

and like a body composition which

15:28

become their baseline Information

15:31

for where they're at and then

15:33

we can design a program for

15:35

them to improve their aerobic

15:37

fitness Which and

15:39

and then also help them begin to build back

15:41

that muscle mass if they've lost it Yeah, I

15:43

mean this is your critical point George that you

15:46

know We we don't realize what happens to us

15:48

slowly and inexorably as we get older and we

15:50

can be the same weight As

15:52

we were 25 at 55 at 65 and actually be twice as fat You're

15:57

metabolically unhealthy even if you're in normal way, and

15:59

there's a great word for it. It's

16:01

called skinny fat or toffee, thin on

16:03

the outside fat, the insider, metabolically obese,

16:05

normal weight. And this is a well-recognized

16:08

medical condition and it's completely caused by

16:10

the lack of attention to one of

16:13

the most important organs in our body

16:15

which is muscle and muscle fitness and

16:17

muscle mass and muscle quality. And all

16:20

of that is something that's completely under

16:22

our control. And if

16:24

you look at the data, it's quite striking.

16:26

You see a steady loss of muscle all

16:28

the way through life but it's totally reversible.

16:30

And I saw this myself like I saw

16:32

it and then I was able to completely

16:34

reverse it and actually have more muscle now

16:36

than I did when I was 25 which

16:38

is quite amazing. And I'm like, well how

16:40

did I like it? It's totally possible. And

16:42

it's totally possible but it's something that most

16:45

people don't focus on as a thing like

16:47

diet, diet, diet. I know I need exercise

16:49

to go to the gym. But

16:51

maybe I may not be doing the right thing at the

16:53

gym. I may not be exercising the right way. So it's

16:55

like anything if you want like to

16:57

take a drug or a supplement or whatever you

16:59

need to know the right dose and the right

17:02

quantity, the right frequency and the right what?

17:05

Absolutely. I

17:07

think one of the things that you mentioned earlier

17:09

on and we always talk about is what happens

17:12

in conventional medicine? For years,

17:14

I had a conventional practice. I've

17:16

gone to my conventional doctor for years and

17:19

they would bring up my weight

17:21

or my BMI. And

17:23

I think the point that you just made is

17:26

that the BMI is just your body mass index.

17:28

That mass can be anything. It can

17:30

be fat, it can be muscle. And

17:33

that's not really we're finding that that's not

17:35

really a good measure of your metabolic fitness.

17:38

So it says what you're saying is the

17:40

thing that everybody talks about with relation to

17:42

obesity which is body mass index is kind

17:44

of a poor measurement for what's really going

17:46

on under the hood. That you

17:48

can be for example Shaquille, Anil or

17:50

a body builder and have an extremely

17:52

high body mass index so you have like

17:55

35 and maybe that's considered severely obese but

17:57

actually you're just solid muscle. Right.

18:00

be a body mass of

18:02

22 which is perfectly normal, right?

18:04

Body mass index of 22 and be

18:07

metabolically obese and diabetic because you

18:09

have no muscle and you're eating

18:11

tons of crappy food but you

18:13

haven't gained the weight. And

18:15

so that's sort of an inaccurate measurement. And

18:18

I want to talk to you about how

18:20

do we actually measure this. And at the

18:22

Ultra Wellness Center we do a number of

18:24

different measurements that can quantify your level of

18:27

fitness and your level of muscle and

18:29

your level of fat and quality of it. We

18:31

can even look at mitochondrial function which is a

18:34

critical aspect of your health. So

18:36

we look at things that most physicians and

18:38

practices don't do as a way of creating a

18:40

customized, personalized set of recommendations to optimize your health.

18:42

And of course it's not just around exercise, it's

18:44

around everything. We look at your nutrition, we look

18:47

at your hormones, we look at your immune system,

18:49

we look at your gut, we look at toxic

18:51

levels. So we look at all of it as

18:53

it affects all of it. Today

18:56

we're just talking about this whole issue of fitness

18:58

and why we need to

19:01

think more carefully and nuanced about it. So let's

19:03

talk about how do we measure the two

19:07

most important aspects of fitness which

19:09

is basically your cardiovascular fitness

19:12

and your muscle fitness. So

19:15

let's talk about cardiovascular fitness first. How

19:17

do we measure that? So cardiovascular fitness

19:19

is measured using something called your VO2

19:21

max. Essentially that's basically

19:24

the maximum amount of oxygen you

19:26

can deliver to your cells during

19:28

your maximum amount of activity. And

19:31

so that can be

19:34

done in a lab and you do a

19:36

VO2 max, you can get on a bike,

19:38

you can get on a treadmill and they're

19:40

going to put a mask on you which

19:42

is going to then be able to measure

19:44

your oxygen utilization. So you'll start exercising and

19:47

then you'll increase your exercise until you get

19:49

your maximum amount of activity or exhaustion. And

19:52

then they've been measuring your

19:54

VO2 metabolism the entire time

19:56

and then they'll Be

19:58

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20:00

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20:02

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20:04

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21:20

says he has measuring how much auction

21:22

you breathe in and how much carbon

21:25

dioxide you breathe out with as an

21:27

indirect measure room at metabolic rate? Yes

21:29

and and and it it determines how

21:31

many calories you can bring a minute,

21:34

how much. Rt any

21:36

Timberman. So basically you're a cop metabolism

21:38

he alive a slow metabolism when we

21:40

might be right because if you how

21:43

a lo veo to max you're burning

21:45

far less calories per minute at a

21:47

rate limiting staff of burning calories by

21:50

the way is how much auction you

21:52

can process per minute as colors the

21:54

vo to max volume of auction. is

21:57

semi yet and liters per minute yet right

21:59

amount to MLs per minute per kilogram.

22:01

Right. So it's basically how much oxygen

22:03

can you utilize? Yeah. And so a

22:05

guy like Lance Armstrong, right? Who's you

22:07

know, when the Twitter friends can maybe

22:09

have a much higher Utilization his

22:12

view it's max maybe 90. So whereas the average

22:14

guy was like a diabetic might be 15 Right

22:17

someone who's fit might be 45. I might my

22:19

watch says I'm 46 and I'm superior I don't

22:21

know at this age, but I used to be

22:23

55 55 inch max when

22:25

actually measure my son Watch is accurate. But

22:27

yeah, you know, it's really a Critical

22:31

measurement. I think I think for a

22:33

max for everything like for longevity It's

22:35

like if you look at the longevity

22:38

trajectory, it's probably the thing that that

22:40

is most correlated with longevity. So I

22:44

This is I talking about via to max

22:46

and body composition muscle mass or to my

22:48

favorite things to talk about with my patient

22:51

because they're Correlated to so many things both

22:53

of them There's a vast amount of data

22:55

for both your cardio respiratory fitness Which is

22:57

measured by your view to max and

23:00

your muscle mass and muscle

23:02

strength to the top

23:04

ten leading causes of death in the United States Also

23:07

to the 35 chronic conditions that lead to

23:09

them Yeah, and two of the chronic conditions

23:12

that are that are listed at the near

23:14

the top are sarcopenia, which is loss of

23:16

muscle mass and decrease

23:19

in your cardio respiratory fitness or your aerobic

23:21

fitness Which are two things that traditional doctors

23:23

never look at and never look at and

23:25

they're and they're and they're highly Correlated

23:28

because if you look at the

23:30

traditional markers of cardiovascular disease, which

23:32

are going to be hyperlipidemia

23:35

Hypertension and inflammation if you look at the

23:37

markers of metabolic disease, which are going to

23:40

be insulin resistance

23:42

obesity You their

23:44

inflammation inflammation again, you know, basically

23:46

what happens is is that they

23:48

lead to? atherosclerotic

23:51

vascular disease Getting

23:53

cardi the arteries fog guard which means

23:55

that you're going to be getting less

23:57

blood flow to your muscles And

24:00

if there's less blood flow to your muscles, there's

24:02

gonna be less what? Oxygen delivery.

24:05

Yeah, and then then what happens

24:07

is now if you're not

24:09

aerobically fit Then you're getting less oxygen

24:11

to your muscles then your muscles stop

24:13

growing Yeah, okay And

24:16

so then then that leads to some

24:18

of that loss of muscle mass So

24:20

your aerobic fitness and your and your

24:22

your ability to maintain your muscle mass

24:24

and strength are very much correlated They're

24:27

interconnected and that's why we have to pay so

24:29

much attention to them because going back

24:31

to it I want to emphasize it one more time both

24:34

of them through vast amounts of data since

24:36

1950 have been highly correlated

24:40

to chronic disease

24:42

Decrease health span and increase

24:45

in mortality. Yeah, that's why we got to

24:47

focus on I really agree And I want to start bring

24:49

it back to that kind of geek. Yeah, it's permitted I

24:51

want to go I'm gonna go there too because yeah, you

24:53

know when I when I wrote my book

24:55

young forever I talked about one of the

24:58

key hallmarks of aging Which

25:00

not my division. This is sort of the scientists

25:02

have come together. What happens as we get older?

25:04

What are the what are the hallmarks? What are

25:06

the criteria? what are the phenomena we see as

25:08

we get older and and one of the things we

25:10

see is a dysfunction and

25:12

a decline in our mitochondria Absolutely

25:15

now as medical school we

25:17

learned about mitochondria in the first year medicine and

25:19

the biochemistry and the crevices cycle and then we're

25:21

basically all told to forget about it because it

25:23

had no relevance for clinical medicine and And

25:26

so most physicians have no clue

25:28

how to diagnose problems We let

25:30

a conjure or to to actually

25:32

treat them and yet Mitochondrial

25:35

function is critical to almost everyone

25:37

in the chronic disease whether it's

25:39

diabetes have declined mitochondrial function autism

25:42

Alzheimer's Parkinson's heart

25:44

disease. I mean you name it. It's there. It's

25:46

my Mitochondrial disease. Yeah, and and and

25:48

yet we learn nothing about it And

25:51

so it's we we actually now have

25:53

a window into how to look at

25:55

Mitochondria through things like the o2 max

25:57

testing body composition some of the other

26:00

that we do at the Ultra Wellness Center like

26:02

organic acids, mitochondrial swaps which we can look at

26:04

your actual mitochondrial function. So there's a lot of

26:06

ways you can diagnose what's going on and then

26:08

we have really clear ways to treat it through

26:11

diet and lifestyle exercise which we're going to get

26:13

more into and very supplement. So getting back to

26:15

the VO2max, I know we want to go into

26:17

the weeds on that. We could spend the whole

26:19

day just talking about VO2max. You

26:22

brought the mitochondria piece. Well, the whole point

26:24

of getting oxygen to

26:26

the cell is to get it into the

26:29

mitochondria to produce energy. And

26:31

so when you talk about the Krebs

26:33

cycle, there's not a day that goes by that

26:35

I'm not looking at the Krebs cycle at least 10 times. There's

26:38

not a day that goes by that I'm not

26:40

looking at the four respiratory chains of the mitochondria

26:42

because we do that testing in our office and

26:45

people are shocked like, wow, what are you

26:47

talking to me about? I'm talking about the

26:49

most important thing to your health, your mitochondria

26:51

are not really working out well. And

26:54

why? There's a host of various reasons.

26:57

We're going to focus on exercise

26:59

piece today, right? But we know there's a

27:01

nutritional piece, right? And we know there's some

27:04

other pieces to that including genetics. Just

27:07

to go back to our athletes, an

27:09

Olympic cross-country skier or a

27:12

Tour de France winner, they're born

27:14

with VO2max is like 85, 90. You

27:18

and I, we're born 40 to 60. We

27:21

might be able to get it a little higher through

27:23

training which we'll talk about later. But there is a

27:25

genetic piece to all of this, right? But you

27:28

can train it. And it's really

27:30

important to know that with VO2max,

27:32

it declines with age just as

27:34

muscle mass does. And again, both

27:36

declines are associated with decrease in

27:38

health span and decrease in longevity

27:40

and increase mortality. So we want

27:42

to – the whole point –

27:45

what I want to hopefully we really

27:47

get to our listeners today and

27:49

our viewers is that you

27:51

have to at a very early age

27:53

begin to incorporate exercise into your lifestyle.

27:56

Because if you come to me at age 50 and you are

27:59

– metabolically imbalanced or you're

28:01

obese or you already have

28:03

metabolic syndrome and you're not

28:05

an exerciser, it would be

28:07

easier for me to get you off a crack than

28:11

to get you to start exercising. It's

28:13

an extraordinarily difficult habit to begin late

28:15

in life. But you can. You can.

28:18

You can. You can. You

28:20

can. Absolutely. By the way.

28:23

And you have to. And you have to.

28:25

And you have to. And you have to.

28:27

And you have to. And you have to.

28:29

And it's when we work with exercise physiologist

28:31

to help you get over any barriers that

28:33

may exist for you. Yeah. And

28:36

that's why people come and we get a. And since

28:38

you're, since you published your last book Forever Young. Young

28:41

Forever. Young Forever. Bob Dylan. That was

28:43

perfect. You're so much into rock and

28:45

roll than I am. But needless to

28:47

say, we've been getting a

28:49

lot more, you know, patients

28:52

and clients that want to really focus

28:54

on their longevity and how to spend.

28:57

This is something I spend a lot of

28:59

time reading about, thinking about and then finding

29:01

ways to reduce the barriers for my patients.

29:03

So with the VO2 max getting

29:05

back to that, we get that measured. We

29:07

either have people get that done local to

29:09

their environment or there's a, you know, there

29:11

are some places near the Ultra Wellness Center

29:13

that we can have them get their VO2

29:16

max measured. And for many

29:19

people, it's brand new information. But

29:21

it then becomes a really great

29:23

marker for them because we can

29:26

then give them a fitness program

29:28

that's designed specifically to improve your

29:30

oxygen delivery and oxygen utilization, which

29:33

will then improve your VO2 max

29:35

and give you that, that, that,

29:38

uh, cardiorespiratory health that you're going to need as

29:40

you age. And by the way, the side effect

29:42

is you feel much better. Oh my gosh. You

29:44

have more energy. Oh gosh. And

29:46

you burn more calories sitting down doing nothing. And the

29:48

reason I like it, I get to eat more.

29:51

I mean, I like to eat, but when you

29:53

increase your, your, uh, VO2 max, you basically just

29:55

burn more calories sitting down doing nothing. It's a

29:57

vital sign. You know, you know, in, in, in,

29:59

you know, in my. My way of thinking for

30:01

my patients, I don't want to

30:03

see them in the room unless they've had a

30:05

VO2 max and they've had their body mass composition

30:08

done. Because those are two,

30:10

to me, those are vital signs that if

30:12

I don't know them, I can't give you

30:15

everything that you need to be healthy. Yeah.

30:17

I mean, I don't know if there's good data on this, but

30:19

I think your VO2

30:22

max is probably as important or

30:24

if not more important than measuring your blood pressure

30:26

or your cholesterol or your blood sugar. It's that

30:28

important. And we don't look at it. Right. Well,

30:31

they're highly correlated. I mean, VO2 max is

30:33

correlated to your lip levels and also blood

30:35

pressures. So there are some studies that make

30:38

that correlation. And I don't want people to

30:40

feel, listening to that, that they can't start

30:42

late in life. Oh, no. There's

30:44

this guy I read about who was a

30:46

French dude who decided he

30:48

was a post office worker and retired at

30:51

65 and he was going to take up

30:53

cycling. And

30:55

at 105, he could cycle basically a

30:57

14 minute mile, which is really

30:59

fast. And his VO2

31:02

max was that of a 30 year old. And

31:05

he decided, I think at 103 or something, that

31:07

he wanted to improve his VO2 max. So

31:09

he basically got a training program to improve

31:11

his VO2 max even at 103 years old.

31:15

You can absolutely. So George, take us

31:17

through. We basically measured through a

31:20

lab, essentially a cardio metabolic lab with a

31:22

cardio metabolic heart that measure oxygen and

31:24

carbon dioxide exchange. And you get a number. And

31:27

there are other sort of surrogate ways you

31:29

can do it through various watches and I

31:31

don't know, hockulations. Calculations, yes. But basically, it's

31:33

a really important number to know. We get

31:36

your number, okay, the average person that I

31:38

see who's not that healthy is maybe their

31:40

20s, even teens. It should be kind

31:43

of, typically as you get older, it gets lower. But

31:45

typically in your 30s, it's in the 30s, it starts

31:47

to go down. When I was 45, mine was 55.

31:51

So it's possible to keep it high at

31:53

any age. So when you

31:56

start to sort of see these people

31:58

and you do this testing, what is the best What

32:00

is the sort of strategy then around cardiometabolic

32:02

fitness? And soon we're going to get into

32:04

body composition in a minute but I want

32:07

you to stay tuned for that because it's

32:09

a really important conversation and I think it's

32:11

again one of those unmeasured vital signs which

32:13

is muscle. You talked about sarcopenia which is

32:16

a condition that is correlated with almost

32:18

every feature of

32:20

aging and in fact it's probably the reason

32:22

we age so much and yet we

32:25

don't ever measure it or talk about it in medicine

32:27

either. These are big gaps and again this is what

32:29

we've been doing in my

32:31

practice for 30 years at Kenya Ranch

32:33

before and here at the Ultra Wellness

32:35

Center. And so

32:37

how do you approach someone who comes to

32:39

your office and maybe you can

32:41

tell us a story of a patient who has measured

32:44

the VO2 max, it's low and what

32:47

do you find in those patients? What do

32:49

you do for them? How do you tell

32:51

them to increase their VO2 max? What is

32:53

the scientific method essentially for

32:55

increasing scientifically your VO2 max

32:57

and your metabolism and your

32:59

mitochondria and your fitness level?

33:02

Sure. So as

33:04

with everything in functional medicine, it's all personalized.

33:06

There's just so much that goes into how

33:08

I'm going to create a program from somebody

33:10

to their

33:12

history with exercise, to any

33:14

injuries that they may have, to their current

33:16

status in terms

33:18

of their work environment, their social environment and

33:22

any disease process they may be struggling with.

33:24

So it's always going to be personalized but

33:26

there's a general approach. So the

33:29

general approach is you

33:31

need to have an aerobic baseline.

33:33

So you start with zone two. Zone

33:36

two is basically 60 to 70 percent of

33:38

your maximal heart rate. It doesn't tell me

33:41

very much. No, it's not. And so but

33:43

that is your base. So can you have

33:45

a conversation when you're working at that level?

33:47

Yeah, so that's a conversational exercise

33:49

I explain to people. If you and your wife

33:52

are on treadmill and you're next to each other,

33:54

you can have a conversation where you can get one or

33:56

two sentences out and you need to take a breath. more

34:00

than a sentence or two out then you're

34:02

not working hard enough and if you can't

34:04

breathe you're working too hard. The reason why

34:06

that's important is that's your aerobic capacity. You're

34:09

going to maintain a metabolic

34:12

rate in which you're using up

34:14

oxygen and you're not

34:17

beginning to create too much lactate because

34:19

once you go through that threshold then

34:21

you become a little more anaerobic and

34:23

you can't maintain that long enough. That

34:26

aerobic level allows you to

34:28

develop that oxygen delivery

34:31

system that's

34:33

very important to maintaining your VO2 max on

34:35

a mitochondrial level. So you need to get

34:37

that baseline and that should make up the

34:39

majority of your training of your VO2 max.

34:41

Is that like a brisk walk or is

34:43

that like a job? It

34:46

has to be brisk enough that your heart

34:49

rate is up, you're sweating a bit and

34:51

you definitely can't have

34:53

a full conversation. It's

34:55

not like walking the dog and

34:57

talking about

35:00

your investment portfolio with your buddy. How

35:04

does somebody figure out their zone too because

35:06

there's a calculation in

35:08

medicine which is your maximal heart rate

35:11

is 220 minus your age. That's the

35:13

maximum heart rate that you should get

35:15

at your age. Now I'm let's

35:17

say I'm going to be 65 this year so that's I

35:21

think it's 1.55. 1.55.

35:24

Okay. Now I'm highly trained so I often

35:26

get my heart rate to 180. This is

35:29

great. I get it to

35:31

180. I'm like am I going to die?

35:33

No, I'm not going to die. I'm just

35:35

bitter and so my maximal heart rate is

35:37

younger than I would calculate. But for most

35:39

people it's 220 minus your age is maximal

35:42

and then it's basically 67% of that. Now

35:44

there are devices like I have a Garmin

35:46

watch and there's many other devices, Samsung, Apple,

35:48

Fitbit and a lot of them measure your

35:51

cardio metabolic health and this watch tells

35:53

me when I'm in zone two, when I'm

35:55

in zone one, one to five and I

35:57

can see where I'm in my exercise routine.

36:00

And that's really helpful. But

36:02

for most people, how do they determine what's their true

36:05

maximal heart rate and their true zone too? So

36:08

for most everybody, it's really

36:10

going to be that calculation. The

36:12

way I work with people is you do

36:14

that calculation, but to your point, there's something

36:17

called the rating of perceived exertion. And

36:20

it's your ability to understand where you're at

36:22

in your fitness. So I can

36:24

get my heart rate up still into the 180s.

36:27

So my max heart rate, I mean, I get into 188, 190. I'm

36:30

like, I'm not, you know, I'm okay.

36:34

I don't have a glitch in my watch, but the other day it

36:36

said 199. I'm like, I don't think that's right. But

36:39

the reality is that if I go to my

36:42

calculated zone two, I'm not working

36:44

hard enough. So I go

36:47

by my rating of perceived exertion.

36:49

I'm not in zone two until

36:51

I'm at that point where I'm

36:53

getting one sentence out. So I

36:55

always tell my patients correlate your

36:57

calculation with your experience. That's

37:00

one sentence out and then you have to take a breath and

37:02

do another one. Pretty much. Yeah, pretty much.

37:04

One to two sentences out. I mean, for all intents

37:06

and purposes on a practical level, which I'm truly trying

37:08

to make it for my patients, make this lower

37:11

the threshold as much as we can, make

37:13

it as practical as possible. So you

37:16

know, the only real tools that you

37:18

won't have, you'll get from us. That will

37:20

be your VO2 max and your body

37:22

comp. But after that, I want you

37:24

to be able to do everything else at

37:28

home. Yeah. So what you're telling someone

37:30

to do zone two, how long do they have to do it?

37:32

How many days a week? And then

37:34

what else do you do to increase your VO2 max? Okay.

37:37

So the recommendation is about 150

37:39

minutes of zone two activity, just

37:41

for basic cardiovascular health. Will

37:44

300 be better? You know, it's

37:46

the law of diminishing returns. 150 or more, maybe 150 to

37:48

200, that's about 30 minutes to 45 minutes of zone two

37:50

activity per

37:55

day. That could be swimming, that could

37:57

be running, that could be treadmill, that could be

37:59

rowing. whatever you like, it could be biking, okay.

38:02

Then what then is going

38:05

to increase your VO2 max? Zone

38:09

two is considered moderate. Oh by the way, that's

38:11

more exercise than like probably 80, 5%. 86,

38:15

86% of Americans do not meet that goal. Yeah.

38:20

Yeah. So 86% of Americans are-

38:22

America, you got to get moving. 86, yeah. So

38:25

86% of America is sedentary. Yeah. And

38:28

activity leads to disability and mortality.

38:30

So go back there. Anyhow.

38:33

So then you have that baseline

38:36

and at least 10 to

38:38

20% needs to be high intensity interval training.

38:42

That baseline is more of your moderate intensity

38:44

training. When you compare the two, high

38:47

intensity interval training is far

38:50

superior. I think I read

38:52

a number as like eight times more

38:55

superior in improving your VO2 max than

38:57

moderate cordial

38:59

respiratory training or intensity

39:02

training. So the high intensity interval training is when

39:04

you get up to 85 to 90% of your max and then

39:09

you maintain that for an interval period, rest

39:11

and do that interval again. Especially

39:13

like the speed you'd be at if you're running from

39:15

a tiger for like 30 to 60

39:18

seconds as long as you can maintain it. And then you

39:20

take a break and you kind of go slow, really slow

39:22

for three minutes and then you do it again. There's

39:25

all these different- Yeah. So

39:27

there's- Correct, right? So what you want to

39:29

do with your high intensity interval training is

39:31

that you start with your baseline so you

39:33

warm up and then you do your baseline

39:35

training and you do it on a different

39:37

day. So you'll do your

39:40

zone two activities Monday through Friday or let's

39:42

say like Monday, Tuesday, Wednesday

39:44

and then on Tuesday, Saturday

39:46

you do your high intensity.

39:48

Your high intensity, the

39:51

intervals will be, you can go one to one,

39:53

one to three. So let's say do

39:55

30 seconds of running as fast as

39:57

you can. Yeah. rest

40:00

for 90 seconds. As

40:03

you increase your fitness

40:05

level, you can increase the

40:07

duration of your intensity. So instead of 30

40:09

seconds, you can go up to three minutes.

40:12

And so as you're able to do

40:14

that, that is your subjective measure that

40:17

your VO2 max is improving. So

40:19

then you can increase. So you

40:22

start 30 seconds, you rest 90. And

40:24

as you get more and more fit,

40:26

you may go one minute and rest

40:29

three minutes. So do this on

40:31

a treadmill and a bike. And then if you get

40:33

really fit by the way, then you can do

40:35

like one to two, one to one. So then

40:37

you do like one minute really hard, only rest

40:39

one minute, one minute really hard. And

40:41

that way, so that's progressing. And all you have to

40:43

do for like 10 minutes, half an hour. 20 to

40:46

30 minutes. Yeah. So 20, 30 minutes, twice

40:49

a week. Twice a week at most. Not

40:51

that much. No. Right. And you're saying

40:54

it has a dramatic effect. Dramatic effect. Yeah.

40:56

Yeah. You will definitely see an increase. Yeah.

40:58

I saw a paper years ago, I wrote

41:00

about, I think in my book, Ultra Metabolism,

41:02

that if you compared traditional aerobic

41:05

training to VO2 max

41:07

training and people would exercise less

41:09

minutes, less duration, higher intensity, they

41:12

would exercise far less and get far more fit

41:14

and burn like nine times more calories than

41:17

if they actually were just, and it's basically burning

41:19

more while you're sitting on the couch watching TV

41:21

is what we're talking about here. Yep. Right. So,

41:24

and one of the concepts I want to bring

41:26

up is, is the idea of

41:28

what we call exercise snacks. And you

41:30

can think about it in regards to

41:32

aerobic training and you can think about

41:34

it in regards to your, your strength

41:37

training as well. And these exercise snacks,

41:39

you can get just as much benefit

41:41

doing a five minute high intensity interval

41:43

training three times a day or four times

41:45

a day than doing it all, all 20

41:47

minutes at one time. So

41:49

you can, in the course of your day,

41:51

instead of like napping

41:54

or just, you know, or just keep working

41:56

or eating, you know, you can just take

41:59

one to three minutes. minutes and do a high

42:01

intensity interval workout. You can do it right

42:03

in your office. So like do burpees. Yeah,

42:05

do burpees. You know, and

42:07

do intervals of them. 30 seconds on, 30 seconds off.

42:09

And you can do that for 3 to 5 minutes,

42:12

recover and if you do that 4 times a

42:14

day, there's your 20

42:16

minutes. That's amazing. And it doesn't have to

42:19

be all at once. Yeah, it doesn't have to be all at once.

42:21

And that's what I really want to emphasize to our

42:23

viewers and listeners is that we want to

42:25

try and find ways to get you to

42:28

exercise that lower the threshold, lower the bar,

42:30

make it less confusing, make it less complicated.

42:32

Use your own body, use a minimal amount

42:34

of equipment and that way you're more likely

42:37

to do it. So that's how you take

42:39

a 40 year old who's lost

42:41

their way and get them back

42:43

on track. Tiny steps, tiny

42:46

changes that lead to bigger

42:48

changes and then ultimately

42:51

hugely improved fitness, longer

42:53

life, healthier life. Yeah,

42:55

I absolutely agree, George. I

42:57

think what's quite amazing is

43:00

studies I've seen on people who had dementia using

43:03

VO2 max training. They put them on a

43:05

bike and they do VO2 max training and

43:07

they cognitively improved dramatically. And

43:09

part of it is because it basically creates this

43:11

thing called miracle grow and the brain are called

43:13

BDNF which is one of the things that gets

43:16

triggered by exercise. So I think it's just, it's

43:18

quite amazing when you see the power of this.

43:20

When there's no drugs, we can do it but

43:22

you get on a stationary bike and you go

43:25

as fast as you can and your brain

43:27

wakes up. Pretty damn good. Pretty

43:29

damn good. And just as

43:31

another, just looking at more data, there

43:34

are studies that have been done that

43:36

looked at people that have cardiovascular disease,

43:38

have had MIs, have

43:41

had catheterizations and

43:43

they compare their improvements in

43:45

functionality using moderate intensity exercise

43:48

versus high intensity exercise. They're

43:50

able to do high intensity

43:52

exercise and they make vast

43:55

improvements in their VO2 max

43:57

and their functional capabilities intensity

44:00

exercise. So even if you've had

44:02

a cardiovascular event, you can do

44:05

high intensity training and

44:07

increase your VO2 max

44:09

and your functional capability. And it's not

44:11

just a vanity metric. It's actually a

44:13

really important metric of how you're aging,

44:16

what your metabolic health is, what your fitness level is,

44:18

and how it's gonna determine everything that happens going forward.

44:20

So again, you know, this is something you're not gonna

44:22

get at your regular doctor, you're not gonna get the

44:25

right prescription, you're not gonna know exactly what to do,

44:27

and it's the kind of stuff we do at the

44:29

Ultra Wellness Center. I want to talk

44:31

about the other important measurement that you mentioned

44:33

earlier, which is something we

44:36

also do at the Ultra Wellness

44:38

Center called body composition. Now what

44:40

is body composition? Hmm. So body

44:42

composition is really, what are

44:44

you made up of? We've just been talking about cardiovascular

44:47

fitness, you're

44:50

talking about heart, you're talking about blood

44:52

vessels, but when we're talking about your

44:54

body comp, we're talking about fat, and

44:56

we're talking about muscle. Those are

44:58

your two major, you know, body

45:02

parts or body subtypes.

45:05

So they're really important

45:07

because they're metabolically active. And

45:09

you know, fat has its role in

45:11

providing us energy, but when we have

45:13

too much fat, we have certain types

45:15

of fat, it's inflammatory, it alters our

45:17

insulin sensitivity, which has a significant role

45:19

in metabolic syndrome, and then the development

45:21

of, you know, cardiovascular disease, which is

45:24

the leading cause of death in men

45:26

and women. So we need to really

45:28

be aware of fat, but we're not

45:30

always aware of fat because when we

45:32

get our conventional doctor's office, we get

45:34

a BMI. And BMI isn't telling us

45:36

anything about body comp. It's just telling

45:38

us about your total mass compared to

45:40

your surface area. Yeah. Whoever

45:43

thought that would make any type of sense, right?

45:46

So when we

45:48

do a body composition, we can actually

45:50

look and see how much muscle mass

45:52

do you have, particularly axial

45:54

muscle mass, muscle mass in your

45:57

arms, muscle mass in your legs.

45:59

They're highly correlated to your health

46:01

span. Then we could also look

46:03

at your body fat. So when we look in

46:06

the mirror, we see our fat, you know. If

46:08

we do a waist to hip ratio, which is

46:10

actually better than BMI when it comes to identifying

46:12

what your body count might be because it really

46:16

represents your visceral adiposity.

46:19

And visceral adiposity. Belly

46:22

fat. Belly fat. In English. So,

46:24

you know. You're not your smart

46:26

guy. Yeah, yeah, yeah. My eyes. Yeah.

46:29

So belly fat. So that's

46:31

obvious. But you also can get your

46:33

visceral adiposity, not your centripetal adiposity, but

46:35

your visceral adiposity. Your visceral is around

46:37

your organs. Inside. Right. Your visceral is

46:39

around your organs and your belly. And

46:41

that's a really, like that's a measurement

46:44

that really opens up people's eyes because

46:46

when they see on their body composition

46:48

that their visceral fat is like above

46:50

what it should be. They're like, I

46:52

can't see that. So well, that's the really

46:54

dangerous stuff. Yeah. And

46:56

so when we do a body composition, the

46:59

one, the body composition that's really

47:01

used most in research and

47:06

in practical medical and

47:08

exercise physiology settings is your bioelectrical

47:13

impedance. And that's when you send an

47:15

electrical signal through the body and the

47:17

electrical signal at a low level frequency

47:21

will pass through the different tissues. And

47:23

it passes through the tissues at different

47:25

rates because each tissue is going to

47:28

impede the flow of that electricity based

47:30

on what it's made up of. So

47:32

we're at 70% water. You know, the

47:34

electrical signal is going to go pass

47:37

quickly through the water versus fat. It's

47:39

going to go slower. And

47:41

so using a

47:44

computer algorithm, you can then begin

47:46

to define what a person's made

47:48

up of based on the electrical

47:50

signals that you got from the

47:53

test. So we use an in

47:55

body in the practice and

47:57

it has multiple electric machine

48:00

is very expensive but we got it because we think

48:02

it's such an important vital sign. Yeah and it's a

48:04

really good one. It's a really important one. Everybody

48:07

gets when they come in and

48:09

it has eight electrodes that are

48:11

spread between your hands and your

48:13

feet. And so it's

48:15

very sensitive and it can

48:17

pass multiple different frequencies. So

48:20

it's very sensitive and it's very accurate

48:22

in being able to determine how much

48:24

fat, how much of it is visceral,

48:26

how much of it is not and

48:28

also look at your muscle mass. And

48:31

when you compare it to DEXA it

48:34

actually will... DEXA

48:37

is sort of what's used in a lot of

48:39

research. It's kind of an x-ray which is some

48:42

low-level radiation that's used to check bone

48:44

density but also it can check body

48:46

composition and fat and muscle and distribution. So

48:49

that's also used to measure body composition. And

48:51

as BAI, so it used to be

48:53

the gold standard but as BAI has

48:56

really increased and the technology is really

48:58

improved, BII actually... BII

49:00

is body impedance analysis. Right. So

49:03

it's basically using what we just talked

49:05

about the embodied machine. Embodied machine. Yep.

49:08

Thank you for helping me make this simple for people. That's okay. That's

49:11

my goal, make it simple for you. Okay.

49:16

So in doing that, the

49:18

BII will

49:20

actually more accurately determine

49:22

your muscle mass because

49:24

DEXA doesn't account for

49:27

any fat that might be in the muscle.

49:30

So it will overestimate your

49:32

muscle mass. So BII is actually really

49:34

effective and if you can get that done, you can

49:36

certainly get it done in our office but if you

49:38

can get it done, that's a really good baseline

49:41

for knowing, okay, where am I at

49:44

with my body composition? And what does that

49:46

mean? It means I would

49:49

actually distill it down to being able

49:51

to say, where am I at metabolically? Yeah. Because

49:54

how much fat and how much muscle you

49:56

have in comparison to one another really does

49:58

determine if you're going to be metabolically

50:00

flexible and metabolically stable. That's

50:03

right. And metabolic health is

50:05

such a huge issue because it's

50:07

a problem across America in a way we've

50:09

never seen before. According to data I've

50:12

talked about before out of TUS, 93% of

50:15

Americans are metabolically unhealthy. Right.

50:17

And it has to do with some

50:19

degree a problem with body composition, with

50:21

fitness, with nutrition. It's all there. But

50:24

you know, this is a huge factor. I just want to sort of

50:26

emphasize what you said. Everybody who comes

50:28

to the Ultra Wellness Center, when they check

50:30

in and get their vital signs done, they

50:32

get their blood pressure, they get their respiratory

50:34

rate, their heart rate, their temperature, and

50:37

their body composition. It's just basically one of the

50:39

vital signs that we check in on everybody. And

50:42

I think we learn so much about our patients and it's

50:44

such an important tool to help them understand where they are

50:46

in their overall health and it's

50:48

such a critical measurement. It should be done

50:51

as part of every doctor's study. Absolutely.

50:53

Especially since 93% of people have. So

50:56

imagine we have a problem with 93% of the

50:58

population. We don't have a really good way

51:01

of measuring that in the average doctor's office and

51:03

we don't even pay attention to it. And yet

51:05

it's one of the most important things we need

51:07

to look at and it's important because we can

51:09

do something about it. We can actually change it

51:12

and we can alter our body composition at any

51:14

age. No, Mark,

51:17

as you're talking to me and my little ADHD brain

51:20

is just far more in ten different directions, I'm thinking

51:22

about not even the doctor's office, Mark. I'm

51:24

thinking about schools. Oh, yeah. But what

51:26

is this thing about having kids sit in

51:28

a classroom all day long? And

51:31

then they want to put me on a leash when

51:34

I'm in third grade because I want to get up

51:36

and move. Yeah. And

51:38

yeah. People have EDD, Exercise Deficiency Disorder.

51:41

It's not ADD. So

51:44

yeah. So once

51:47

you have your body composition, then we

51:49

can start some real serious work. And

51:52

as I tell everybody, just as a quick aside,

51:54

I have patients come into the Ultra

51:56

Wellness Center and they seem to be

51:58

really proud. like one piece of

52:01

their medical record. Yeah. And that's their supplement

52:03

list. Yeah. Ha ha ha. They love their

52:05

supplement list, right? Yeah. And I get people

52:08

that come in with like 23 different

52:10

supplements that they've gotten from different podcasts

52:12

and you know, the health and wellness

52:15

space. And they're really proud and

52:17

they think I'm going to tell them, wow,

52:19

that's great. But when I look at what

52:21

they're doing for exercise, I

52:23

say, you know what, let's put that piece of

52:25

paper aside because you cannot supplement your way out

52:28

of no exercise. Or a bad diet

52:30

or anything else. Or a bad diet,

52:32

right? It's called a supplement, not a

52:34

replacement. Yeah, exactly. So the reality is

52:36

that I tell people we're going to

52:38

spend our time on lifestyle because that,

52:40

if I can't fix your lifestyle, it's

52:44

going to be really hard for me to help

52:46

you reach your goals. Yeah. Or if

52:48

you're ill, they get you to be healthier.

52:50

So lifestyle is critical. We've talked about

52:53

the cardiovascular aerobic

52:55

piece and now there's the body

52:57

comp that let's us begin to

52:59

understand, okay, what do we

53:01

do to change that body composition? Specifically,

53:03

if we look at the data around

53:06

muscle, we understand

53:08

that you need muscle mass and

53:10

you need strength. Muscle

53:12

mass provides you

53:14

that metabolic center

53:17

where so much of your metabolism

53:19

is going to occur. And it

53:21

has a lot to do with

53:24

glucose metabolism. I

53:26

just want to emphasize that. What George has said is

53:28

so important. Your muscle is where your

53:30

metabolism happens for the most part. It's in other

53:32

parts, obviously your heart, your brain, your organs. But

53:35

the vast majority of your metabolic

53:37

function happens in muscles where

53:39

you produce. Your muscle is the biggest organ in your

53:41

body. It also becomes not

53:43

only that metabolic reservoir, but it's

53:46

a protein reservoir and the amino

53:48

acid reservoir. So if we

53:50

take it down to the point where you get

53:52

older and maybe you

53:54

get sick or you fall, you have an accident

53:56

in your sedentary for a while, you need a

53:59

reservoir of protein. protein and amino acid

54:01

to recover. If it's

54:03

not there, then you've just taken a step

54:05

down and you have no ladder to get

54:07

back. It's what happened to a

54:10

lot of elderly people when they got COVID. They just had

54:12

no policy to deal with it and they had no protein

54:14

reserve and they're often protein malnourished. And

54:16

that protein is required to make your immune system, for

54:19

example, your antibodies are made from proteins. Your immune

54:21

system functions on protein. So if you have not

54:23

the right amount of protein, you're in trouble. And

54:25

if you don't have the reservoir in your muscles,

54:27

you're doubling protein. Right. I'm doubling

54:29

in trouble. So then, so that's the muscle mass piece,

54:31

but then there's the strength piece. So

54:33

there's muscle mass, but you need

54:36

to have strength with that muscle. So

54:38

the strength is your functionality. So you

54:40

can use that big muscles, they have

54:42

to actually be functional. Right. They

54:44

have to be strong. And so, so

54:46

there's, you have to think about it in

54:49

both ways and, and you have to, and, and

54:51

then when you think about it that way,

54:53

then you have to think about, you know,

54:56

protein and its role in helping to build

54:58

and repair muscle. But

55:00

protein by itself is not going to

55:02

lead to strength. That's

55:04

when you need resistance training. It's like putting,

55:06

uh, right. Ingredients for soup on the stove,

55:08

but not turning the heat on. Exactly. Right.

55:12

Right. Right. Right.

55:16

And that's, and then, and that's resistance training. And

55:19

there's just a lot of, otherwise known as weightlifting,

55:21

strength training, band training, body weight training. There's a

55:23

million ways to do it. And

55:26

so there is resistance

55:28

to resistance training. People

55:30

just don't like to do it. When I talk to my

55:32

patients, they're just like, Oh my God, I hated it. I

55:34

was like, this is painful. This is uncomfortable. I used to

55:36

do, I couldn't do two pushups when I

55:38

was 50 years old. I did 10 pushups. I would be sore

55:41

for a week. And I'm like, this is ridiculous. I don't want

55:43

to do exercise. It makes me feel horrible. So I just never

55:45

did it. And then I started when I was

55:47

like 59. I'm like, all right, I know, I know I'm supposed

55:49

to do this. I tell everybody to do it. I'm not doing it.

55:52

I better do it. And it just changed my life. Dude,

55:54

when I see you on Instagram pumping iron

55:56

in the gym, like I am like impressed.

55:58

I mean, you seriously. You

56:01

work hard when you work, man. I

56:04

try. I try. But you

56:06

know what's so important to realize right now is there's a huge

56:09

problem in our society which is

56:11

the ozmpic craze. Oh yes. And

56:14

the reason I'm bringing it up is ozmpic makes

56:17

you lose fat and muscle.

56:21

And if you're on ozmpic or wagobi or

56:23

manjaro or any one of these drugs and

56:25

the ones coming around every minute,

56:28

you have to pay attention to what we're saying

56:31

today. You have to have the right amount of

56:33

protein more than you think about a gram per

56:35

pound and we'll talk about that per day and

56:37

you need to focus on resistance training if you're

56:40

going to be on those drugs. Absolutely. And

56:42

if you don't, what'll happen is you'll lose muscle

56:46

and fat but muscle burns seven

56:48

times more calories than fat. So

56:51

when you get to the weight you want,

56:53

you'll have a slower metabolism and eating a

56:55

lower amount of food will actually

56:58

make you gain weight. So this is a

57:00

huge problem. This is why often people can't

57:02

get off the drugs and they

57:04

don't do it properly. And I'm not opposed

57:06

100% to these drugs. I

57:08

just think they're overused and they're also

57:10

not prescribed in a way that's taking

57:13

care of the side effects of these drugs

57:15

by properly addressing the protein needs

57:17

and the resistance training needs that are

57:20

increasing when you're taking these drugs. I

57:22

can't agree with you more and if

57:24

you hadn't made the point, I would

57:26

have. These are called

57:29

GLP1 agonists and they

57:31

have a role. They have a role but... Our

57:34

bodies make it by the way. There's a lot of ways

57:36

to increase our body making GLP1. Yeah, you

57:38

know and they have a role our body makes it but

57:43

they're being co-opted

57:47

from weight loss specifically.

57:50

And when you lose weight rapidly

57:53

or lose weight ever, you can lose 20

57:55

to 30% of that muscle.

58:00

Well in those MPIC, I think it's a higher 40

58:02

or 50 percent of the weight. It can be

58:04

40 to 50, absolutely. 50 percent of the weight

58:06

you're losing is muscle, which is a disaster. And

58:08

that is a disaster. And so in regards to

58:10

using these drugs for weight loss, the way we

58:12

are now using them in our country, it's

58:16

very difficult for me to find

58:18

a rationale for that. I've always

58:20

been about, and that's why we're

58:22

having this conversation, it's about lifestyle.

58:24

It's about capturing that lifestyle early

58:27

in life so that you can

58:29

maintain it and improve it and

58:31

excel as you get older. So

58:33

I'm glad we

58:35

took that little journey over to the dark side. Yeah,

58:37

I think it's important because it sort of speaks to

58:40

why, for example, everybody in those MPIC needs a body

58:42

composition before they start. You track them every month to

58:44

see what's going on. The machines are easy. You just

58:46

stand on it like a wet scale, a fancy scale,

58:48

you stand on it for a few minutes and it

58:51

measures everything. I think if

58:53

we don't do that, in my view,

58:55

as someone who would be prescribing one

58:57

of these drugs, I would consider malpractice.

58:59

If you don't focus on

59:01

muscle health and prevention

59:03

of muscle loss when someone are on

59:05

these drugs, I think it's a

59:08

kind of malpractice. And if you don't measure body composition and

59:10

track it, it's like

59:12

putting people on a

59:15

diuretic where you lose potassium and not

59:17

checking your potassium. Right? Absolutely.

59:19

And you know as a doctor, if you're on

59:22

a certain drug, you need to check liver function

59:24

test because it affects the liver function. So you

59:26

just know to track the things that are the

59:28

problems. We don't do that with these drugs. To

59:31

me, it's criminal. And I think it's

59:33

a quick fix, boom, boom, lose weight. But

59:36

we're creating a whole society of people

59:38

who are going to become more

59:41

sarcopenic, have more muscle waste. Everybody eat lower

59:43

metabolism and then it's a vicious cycle of

59:45

getting the weight back, eating less food and

59:47

being in this horrible, horrible tailspin that it's

59:50

hard to get out. It's

59:52

absolutely. And we are so

59:54

body shape centric

59:58

and we are so fat centric. that

1:00:02

we're losing sight of the fact that

1:00:04

you emphasize, and I want to emphasize

1:00:06

again because I've had this conversation recently

1:00:08

with colleagues and with you as well,

1:00:11

that using

1:00:14

these drugs, using GLP-1s have

1:00:18

a real downside to them.

1:00:20

Using particularly for weight loss

1:00:22

is an issue because you're

1:00:24

losing fat but you're losing muscle

1:00:27

and that is even more important.

1:00:30

You may look good but now you're... You'll

1:00:33

be a skinny fat. You're going to

1:00:35

be... Well, I don't know. What's skinny muscle

1:00:37

like? Skinny might be you look thin but

1:00:39

you're actually fat. That's what we call it

1:00:41

skinny fat. Yeah, yeah, yeah, yeah. Skinny fat,

1:00:43

right. Yeah. So, yeah, you're in

1:00:45

bad shape. So, I think you and I totally 100% agree

1:00:47

on that and have the same viewpoint. And

1:00:50

then there's also the complications that we've

1:00:52

talked about before that can come with

1:00:54

those drugs including intestinal obstruction. Yeah. There's

1:00:56

a whole... Yeah, yeah. I think that's what I think

1:00:59

is shown us but... Yeah, yeah, yeah. Let's talk

1:01:01

about... Let's talk about body composition and

1:01:04

resistance training in particular. I think, you know, there's

1:01:06

two parts of body composition. What you eat and

1:01:08

I always say you can't exercise your weight out

1:01:10

of a bad diet. So if you don't get

1:01:12

your diet sorted and I'm going to spend a few minutes on that in

1:01:14

a minute, you're going to have trouble,

1:01:16

right? There's people who are in the gym all day

1:01:19

long and overweight. I actually met a guy who was

1:01:21

my trainer at Equinox when I was in New York

1:01:23

who was like rep he could do... He

1:01:25

was so strong. I mean he could

1:01:28

literally go put like, I don't know, 150 pounds on

1:01:30

him and do like pull ups and I'm like, you

1:01:32

know, like basically two body weights and do pull

1:01:34

ups. I can't even do one pull up there. And

1:01:38

he kind of had this thick layer of fat all

1:01:40

over him. And

1:01:42

I said, why don't you try eating this way for

1:01:45

a little bit? And he... I

1:01:48

have a before and after picture of him which is quite amazing.

1:01:51

And he was even

1:01:54

more wrecked but had lost that layer of fat

1:01:56

and it was metabolically more healthy even though he

1:01:58

was so strong. He still

1:02:00

hadn't had his diet sorted. So diet really

1:02:02

plays a role. So let's talk about what

1:02:04

is the dose and frequency of

1:02:07

resistance training? What are the types available and

1:02:09

what should people do? Because

1:02:11

it's a little bit intimidating. Oh my gosh, yes. You

1:02:13

know, if you're a bodybuilder, I mean I would go

1:02:15

to these gyms and all these bodybuilders and it's a

1:02:18

skinny guy. I'm like, I'm sort of intimidated here. I

1:02:20

don't know what to do. I don't want to hurt

1:02:22

myself. I'm like worried about this. How

1:02:25

do you address the problem of

1:02:27

just getting started if you've never done this

1:02:29

before? That's

1:02:32

the million dollar question. And

1:02:35

this is why people don't do

1:02:38

resistance training because the bar is really

1:02:40

high. It means they need to buy

1:02:42

equipment because we're

1:02:44

good to a gym. Then when you

1:02:47

get to the gym and then you see all these

1:02:49

machines, which ones do I use? A

1:02:52

lot of people can afford a trainer, right? Right. And

1:02:55

then when I get on the machine, how much weight

1:02:57

do I use? Do I use a little weight and

1:02:59

do lots of reps? Do I use the heavy weight

1:03:01

and not so many reps? What's

1:03:03

my range of motion? Do I do full range of motion?

1:03:07

Do I do short length partials? Do I do long

1:03:09

length partials? What do I do? Right,

1:03:11

right. And what do I do? Yeah.

1:03:14

So in preparation for today's talk, I

1:03:16

said to myself, okay, I can't go

1:03:18

through the entire science of strength

1:03:20

training, but I'm going to try

1:03:22

and just distill it down. So

1:03:27

what we want to do is

1:03:29

we definitely need to do progressive

1:03:31

resistance training in order to gain

1:03:35

muscle mass and strength.

1:03:39

Okay. So progressive resistance

1:03:41

training means that you start out

1:03:44

whatever exercise you choose, and

1:03:46

that everybody might know there's a curl. All

1:03:49

right. So you're going to start out with five pounds. Well,

1:03:53

you do it the first time you do it, man, I

1:03:55

could barely get to eight. Yeah. Okay.

1:03:59

All right. you're gonna go back three

1:04:01

days later or maybe go back the next day

1:04:03

do a different body part but three days later

1:04:05

you're gonna go back and do your curl and

1:04:07

you know what you're gonna notice that you actually

1:04:10

do two more reps. It's not necessarily because you

1:04:12

got stronger, it's because you actually got more efficient.

1:04:15

You know, biomechanically the message from

1:04:17

your brain to your muscle,

1:04:19

some of the metabolic efficiencies

1:04:21

occurred already, not

1:04:23

necessarily stronger, not necessarily bigger muscle

1:04:25

mass yet but more efficient. But

1:04:28

three weeks down the road you're gonna

1:04:30

find that it's really easy. Now it's

1:04:32

time to increase your weight

1:04:35

and so now you're going to 7.5

1:04:37

pounds. So by the time three months

1:04:39

comes if you've been really consistent you're

1:04:42

gonna find that you've progressively increased your

1:04:44

resistance and now you're from five pounds you went

1:04:46

up to 15 pound curl. That

1:04:48

is going to correlate to increase

1:04:50

strength and increase muscle mass as

1:04:53

long as you're eating correctly.

1:04:55

You're gonna need to fuel that with

1:04:57

the right amount of carbohydrates and healthy

1:05:00

fats and you're gonna also have to

1:05:02

supply the building blocks of protein. If

1:05:05

you're not getting the protein then you're not going to

1:05:07

be able to repair, you're going to get injured and

1:05:09

you're not going to build the muscle mass and strength

1:05:11

that you're looking for. So that's just a really basic.

1:05:15

So progressive resistance training, I think that's an

1:05:17

easy concept to understand as you slowly build

1:05:19

up the amount. But how

1:05:21

many days a week can you do this? I

1:05:24

mean what are the different types people can do? What

1:05:26

are the low friction ways? For example, I didn't really

1:05:28

ever do any weight training so I went to the

1:05:31

gym and I got a trainer and I could afford

1:05:33

it thank God. And I learned a lot and

1:05:35

I kind of started and then COVID

1:05:37

happened and kind of fell off and then I went

1:05:40

and learned about band training, resistance

1:05:42

bands. Because I'm traveling a lot, I move

1:05:44

around a lot and I

1:05:47

can't always get to a gym or I'm busy and

1:05:49

I don't have time to go to the gym, get

1:05:51

there, change, do the thing, change again, shower, come back,

1:05:53

drive home, like a whole thing. So I'm like I

1:05:56

just need to be efficient and

1:05:58

I learned about TB12 which is Tom

1:06:00

Brady's band resistance training program. Tom did this solely

1:06:02

and he ended up being a seven time Super

1:06:04

Bowl World Champion. I didn't even know what he

1:06:06

was doing. I started doing these bands and I

1:06:08

could do them anywhere. I could hook them to

1:06:11

a doorknob, I could use a floor and a

1:06:13

door and I'm good. I'm able

1:06:15

to literally build my strength and it's

1:06:17

so easy. I

1:06:19

can do light bands at first, heavier bands, heavier

1:06:21

bands. I can do about 20 to 30 minutes,

1:06:24

three or four times a week. I like to do five if I can. Even

1:06:27

that keeps me going. It doesn't have

1:06:29

to be like a big project. There's

1:06:32

a lot of apps and there's a TB12 app you

1:06:34

can use. How do people just

1:06:36

think about getting started? What

1:06:43

you referred to are some

1:06:45

of the alternatives to our

1:06:47

classic understanding of progressive resistance

1:06:49

using weights. There

1:06:52

are bands, there are kettlebells,

1:06:54

there are body weight exercises.

1:06:56

All of these can increase

1:06:58

strength. They might be

1:07:01

more difficult to increase the muscle mass

1:07:03

and hypertrophy because you might not be

1:07:05

able to get to the

1:07:09

amount of resistance you need or

1:07:11

the number of reps you need effectively

1:07:14

to increase hypertrophy. I

1:07:17

will generally suggest

1:07:21

to people that they move

1:07:23

towards using weights

1:07:26

for the resistance training and

1:07:29

you can do that at home, you can do that in the gym.

1:07:32

I usually recommend that you do at least two

1:07:34

days a week. I think if you're doing

1:07:36

two days a week, you're

1:07:39

just breaking. Stay even.

1:07:42

You're breaking it. You're breaking in. I think if

1:07:44

you're doing three days a week, you're

1:07:46

going to be able to accomplish your goals.

1:07:48

Four days a week, you're going

1:07:51

to be able to squeeze a little bit more water

1:07:53

out of the sponge. Five days a week, you're

1:07:56

now probably nearing

1:07:58

addiction. How many do you

1:08:00

do, George? Three to four. There

1:08:03

are weeks. I get one or two. I

1:08:05

mean, quite honestly,

1:08:08

you know, again,

1:08:10

a quick aside, you

1:08:12

cannot maintain the same

1:08:14

exercise level throughout the

1:08:16

year. Whether you're a

1:08:18

world champion or a national champion or

1:08:21

a really high level collegiate, you just

1:08:23

can't and you shouldn't, right?

1:08:25

You have to concentrate on different

1:08:27

areas of your physical health,

1:08:30

whether it be nutrition or your fitness,

1:08:32

and there's various forms of fitness that

1:08:34

you need to train at different times

1:08:36

of the year. You know, one of

1:08:38

my favorite bike riders of all time

1:08:40

is Lance Armstrong. I just think that

1:08:43

regardless of anybody may say Lance Armstrong

1:08:45

worked harder than anybody. And

1:08:48

so... Well, that'll help from his friend. Yeah.

1:08:51

Well, we can put that aside for now, but he still really

1:08:53

worked hard and I had a huge amount of respect for Lance.

1:08:56

But needless to say, you know, I could probably, when he

1:08:58

was an all... I could probably be in the middle of

1:09:00

winter, you know, when I was really riding

1:09:02

hard, probably gone to Austin and ridden with

1:09:04

Lance. Yeah. Because he probably wasn't, you know,

1:09:07

he probably wasn't doing intervals in spring. He

1:09:09

was probably doing five, six, seven hours on

1:09:11

the bike, right? Yeah. And

1:09:13

I could just hang on his wheel and let him drag me around, but

1:09:15

I wouldn't be able to hang with him, right? Yeah. Because

1:09:18

you're working on something different. He then

1:09:20

changes his program so that as he's

1:09:22

getting closer and closer to spring class,

1:09:24

and finally to the Tour de France,

1:09:26

where he's getting more specific into power

1:09:28

and sprinting, then I'm

1:09:31

just taking pictures. Yeah. Right?

1:09:34

Same thing with strength training, right? Yeah. The

1:09:36

same thing with strength training. To get back to it is, I'm not going to

1:09:38

sit here and tell everybody 365 days a year, I have

1:09:41

the consistently same program. It's impossible. I

1:09:44

don't. But I stay at that level

1:09:46

where if I am too busy and

1:09:48

I have, you know, I'm on vacation,

1:09:50

I can take that break and get

1:09:52

very quickly back into my routine without

1:09:54

that much of a loss and get

1:09:56

right back to my physical fitness level

1:09:58

and then continue to. to build as I need

1:10:01

to for my next challenge in my life. So

1:10:04

strength training 101, I'm gonna give it to you, right simple, get

1:10:07

to the gym. I

1:10:09

do think getting to a gym is probably gonna be

1:10:12

the most effective way to begin the process. Once

1:10:16

you understand how to do it using

1:10:18

kettlebells, I'll take one

1:10:20

thing back. One thing you can do is

1:10:23

the Instagram and YouTube

1:10:26

are huge resources

1:10:28

for exercise programs.

1:10:31

So I will take this back. My wife is

1:10:34

turning me on to this recently. She has

1:10:36

a whole catalog on her phone

1:10:39

of Instagram posts of different

1:10:41

resistance training and weight training

1:10:43

programs that involve kettlebells, body,

1:10:46

bands, everything. So the bar for

1:10:48

doing those things actually is so

1:10:51

much lower than it used to

1:10:53

be. So I'm actually gonna take

1:10:55

back what I just said. I don't think you need to

1:10:57

go to the gym to start. Go

1:10:59

to YouTube, go to YouTube and Instagram,

1:11:01

pick your favorite, pick your favorite, whether

1:11:03

it's bands, whether it's kettlebells, whether it's

1:11:05

body weight, and you'll be able to

1:11:07

find a plethora

1:11:10

of different exercises that you can do at home

1:11:12

in the office. So you can just start there.

1:11:14

You gotta be careful to not overdo it and

1:11:16

be like where you injure yourself, because you have

1:11:18

to start starting to go home. Yeah, we're gonna

1:11:20

hope that everybody's gonna be using common sense, but.

1:11:23

Well, you know what Mark Twain said, right? No. The

1:11:26

problem with common sense is not too common. Right.

1:11:28

Now I've heard you say that before, I should've

1:11:30

known. So yeah,

1:11:32

so you always start low, go slow.

1:11:35

There's no rush. You'll make

1:11:37

your gains with time. But when

1:11:40

it comes to actual, if you're going

1:11:42

to use weights, which is

1:11:44

my favorite approach, then

1:11:48

here are the things that people always wonder about. Like

1:11:50

which exercises should I do? Well,

1:11:53

you wanna do exercises that use more

1:11:55

than one joint. They're

1:11:57

gonna give you the most. metabolic

1:12:00

response. For

1:12:03

example? So, for example, would be a squat.

1:12:05

Squat. Squat. A

1:12:08

deadlift. Even a bench press.

1:12:10

You're using multiple joints, but you want to do the bench press.

1:12:14

If you do bench press,

1:12:16

squat, deadlift, you're

1:12:19

bench press, squat, deadlift. You're talking about the power

1:12:21

lifts. And if

1:12:25

you just concentrate on those, you're going to

1:12:27

get a full body workout that's going to

1:12:29

put you in a really good position of

1:12:31

health. Yeah. Right. Now, those

1:12:34

are those, they take a bit.

1:12:36

So it doesn't take a lot is what you're saying.

1:12:38

It doesn't take a lot. I mean, and you don't

1:12:40

have to go crazy. You don't have to be like

1:12:42

in the gym all the time. And you can actually

1:12:44

learn a few key exercises that build large muscle strength

1:12:46

and core strength and stability. Really, really important. And that's

1:12:48

why I love bands because they're so easy and

1:12:50

portable and they do all those things.

1:12:52

So on the weight piece, again, people

1:12:54

are always wondering, should I do how

1:12:56

much weight and how many reps? So

1:12:59

it really depends. But I

1:13:01

would say that, you know,

1:13:04

or getting, if

1:13:06

you want a good solid middle of

1:13:08

the ground program, then you want to

1:13:10

try to do, you know, anywhere from

1:13:12

eight to 12 reps. Should

1:13:15

I go to exhaustion or should I not go

1:13:17

to exhaustion? Should my last rep be completely, I

1:13:19

can barely get it up or not? Well, there's

1:13:21

some mixed data and some recent data indicates that

1:13:24

getting to like two to three

1:13:27

reps before exhaustion is

1:13:29

going to give you the same benefit. Yeah. So,

1:13:31

so you don't have to get an exhaustion. You

1:13:33

don't have so much pain. Right. Right. And

1:13:36

so, so eight to 12, your

1:13:39

last one can be one to

1:13:41

two to maybe three reps from exhaustion.

1:13:44

There's that there it is. There's your repetition

1:13:46

number, right? Your weights

1:13:48

should be weights that allow you to do eight to

1:13:50

12 reps. So you just find the weight, you have

1:13:52

to test it out and figure out, you

1:13:54

know, your first couple of times you go, which,

1:13:57

you know, what are you going to use? And

1:13:59

then, Here's something

1:14:01

that's transformed my recent

1:14:03

weightlifting. So there's

1:14:06

long length partials, there's full range of

1:14:08

motion and then there's short length partials.

1:14:11

So when they compared, so full range

1:14:13

of motion is when you do a

1:14:16

curl like this, full range of motion

1:14:18

from that position. A

1:14:20

short length

1:14:22

partial is you start here and go like

1:14:25

this. You start halfway and then you finish

1:14:27

out. Short length partial, you start with the

1:14:29

muscle fully extended and stretched and

1:14:31

just go part way. One third

1:14:33

to half. Right? And what does that

1:14:36

do? So recent data has shown

1:14:38

that when you compare the

1:14:40

long length to the short length partial,

1:14:42

the long length partial, there's not even

1:14:44

a comparison in terms of strength. So

1:14:48

short length is better than long length? No, no,

1:14:50

long length. Long length. Long length. Long

1:14:52

length, the full range of motion, long

1:14:55

length is still superior. Amazing.

1:14:58

So you can do a long length partial and

1:15:00

get the same benefit as if you're doing a full range

1:15:02

of motion. The

1:15:05

benefit I find for me in that regard and for

1:15:07

people that are going to be lifting. Is that why

1:15:09

your biceps are bigger than mine? I

1:15:11

don't know. I don't know Mark. Look,

1:15:14

I'll rate your next program for you. Make sure you

1:15:16

get your biceps. So

1:15:19

when you do the long length partial, what I like about

1:15:21

it is I can actually use more weight and I can

1:15:23

actually, you know, and I just

1:15:26

find it's much less stress on

1:15:28

my overall body. Right?

1:15:32

And I, so. So this is kind

1:15:34

of a basic thing I want people to get. Your

1:15:38

weight, you pick weights that you can do eight to

1:15:40

twelve reps. You don't have to go to

1:15:42

exhaustion but if you want to, you can. One

1:15:45

to three reps before exhaustion is all you need to go

1:15:47

to. You need to progressively increase

1:15:49

your weights over time and

1:15:51

then you can use any type of format.

1:15:54

You can use bands, you can use kettlebells,

1:15:56

you can use body weight and you can,

1:15:58

and again as we talked about. with

1:16:00

aerobic training, you have these exercise snacks,

1:16:02

you can do exercise snacks with your

1:16:04

resistance training as well. As you mentioned,

1:16:07

I have dumbbells in my office and

1:16:10

I use those for my exercise snacks. I

1:16:12

just talked to Lee

1:16:14

Hood who's one of the world's premier scientists

1:16:16

in systems biology and medicine and

1:16:18

he's 85 years old. He does 150 push-ups a day. So not all

1:16:23

at once obviously but he drops in 30 here, drops in 30 there,

1:16:25

you use that five times

1:16:27

a day, that's 150 push-ups. Yeah. Very impressive.

1:16:30

So George, you know, this has been a great

1:16:32

conversation about how do we look at things that

1:16:34

are often missed with traditional medicine. What

1:16:36

we do at the Ultra Wanna Center to look

1:16:38

deeply into someone's health and well-being and actually optimize

1:16:41

their health and even treat diseases using exercise. How

1:16:43

do we measure the fitness level

1:16:46

using VO2 max? How do we measure

1:16:48

body composition using our in-body diagnostic machine

1:16:50

we have in the office and

1:16:52

using that data to help inform people about what's going on

1:16:55

their body and how to adjust their

1:16:57

lifestyle to correct the problems so they don't get into

1:16:59

trouble in the long term. The one thing we didn't talk

1:17:01

about, I just want to touch on it for a

1:17:03

few minutes before we finish, is

1:17:07

because body composition in particular and

1:17:11

cardiovascular fitness to a lesser degree is

1:17:14

so correlated with our diet

1:17:17

and part of the challenge we've had is

1:17:19

that we don't one eat enough

1:17:21

of the right kinds of protein

1:17:23

and two we eat too much

1:17:25

of the wrong kinds of carbohydrates.

1:17:27

Right. And that will lead to

1:17:29

increasing belly fat, visceral fat, fat

1:17:31

marbled in your muscles, which you

1:17:33

said we couldn't measure the DEXA.

1:17:36

You don't want to ribeye muscle,

1:17:39

you want a filet mignon muscle. Right?

1:17:41

No wagyu. No wagyu-themed muscles. But that's

1:17:43

basically what everybody in America is walking

1:17:46

around with. Yep. And so we need

1:17:48

to really help people understand that they

1:17:50

need to reduce the refined starches in

1:17:52

carbohydrates in their diet, they need to

1:17:55

increase the good fats and

1:17:57

they need to increase the quality

1:17:59

protein. quality protein. We

1:18:02

talked a lot about this in the podcast with Gabrielle

1:18:04

Lyon, with Don Lehman and others and

1:18:06

we'll link to those shows. But

1:18:08

the quality protein matters and if

1:18:10

you want to build muscle, you

1:18:13

need muscle. If you want to

1:18:15

build muscle, you need to eat muscle and if you eat

1:18:17

beans, it doesn't work as well.

1:18:19

You can, if you eat

1:18:21

massive amounts or you have highly

1:18:23

processed bean powders or

1:18:26

grain powders, you can concentrate the

1:18:29

proteins and then they add extra

1:18:31

amino acids. They add extra basically

1:18:33

synthetic amino acids to jack up

1:18:36

the quality of the protein which if you are

1:18:39

a committed vegan, you can do but you have

1:18:41

to do that. Like Garden of Life Sport protein

1:18:43

for example has 30 grams of protein but

1:18:46

they also add all these other amino acids which aren't

1:18:48

naturally in the products that are

1:18:50

in it. So you have to eat either whey

1:18:52

protein, beef, chicken, fish, lamb,

1:18:54

these protein, bison, whatever you want to

1:18:56

eat and make sure it's the right

1:18:58

kind, it's regenerally raised, there's great sources

1:19:01

and we'll link to it. You get

1:19:03

the force of nature, what the regenerative

1:19:05

meats or Ctopia.fish with that great

1:19:07

quality fish that's not toxic and so forth go

1:19:09

away I like. But you need the right amount

1:19:11

of protein and the right amount of protein is

1:19:14

more than we typically think. If you're resistance

1:19:16

training and you're doing the exercise, you need

1:19:18

about a gram per pound which is almost

1:19:21

double what is considered the requirements. And just

1:19:23

so people know, the requirements that we have

1:19:26

are based on avoiding protein

1:19:28

malnutrition. So to avoid protein

1:19:30

malnutrition which is what was

1:19:32

more prevalent when these guidelines were established, you

1:19:35

need about 0.8 grams per

1:19:37

kilo which is about half of what I'm talking

1:19:39

about. It's not the amount you need to put

1:19:41

on muscle or optimize your health. And secondly as

1:19:43

we get older, you mentioned earlier

1:19:46

in the show, we have anabolic resistance

1:19:48

which means we are more resistant to

1:19:50

putting on muscle. So we need to

1:19:52

overcome that resistance with more protein, more

1:19:55

exercise. So really nutrition plays a huge role. We

1:19:57

deal with all that at the UltraWanna Center. We

1:19:59

look at your metabolic health through multiple lenses including

1:20:01

the body composition measurements

1:20:03

and VO2 max measurements. Yep. So

1:20:05

yeah, I would 100%

1:20:08

agree with that and you know you you mentioned

1:20:10

the the difference because you've had on your show

1:20:14

talking about protein and so, you know

1:20:16

the literature on protein The

1:20:19

the number that seems to have floated out

1:20:21

in the last year or so has been

1:20:23

like 1.6 grams per kilo and

1:20:28

so you know You

1:20:32

know, I would say that you know having looked

1:20:34

at literature Definitely want to

1:20:36

be somewhere between 1.2 to 1.6 depending on

1:20:38

your exercise activity Do

1:20:42

you need to get above 1.6? Maybe Probably

1:20:45

not even if you're lifting I think 1.6 if

1:20:48

you think about 1.6 milligrams grams

1:20:50

per kilo for me is

1:20:53

130 Grams

1:20:56

per day. Yeah, there's a lot of protein

1:20:58

for me I mean, I definitely need to

1:21:00

use a protein powder shake, right? Yeah, but

1:21:02

before you know, we can show here we

1:21:05

just had approaching shake. Yeah. Yeah, and that

1:21:07

was about 40 grams each Yeah, boom like

1:21:09

that. It was a protein shake. I can't

1:21:11

get to 130 without approaching. Yeah, right And

1:21:13

so and I think going back to your

1:21:15

point where you can if you had steak

1:21:17

for breakfast You

1:21:19

know, I had a really good steak last night. I made it myself anyhow

1:21:24

Yeah, high quality proteins when

1:21:26

you grass-fed beef, you know farm raised poultry

1:21:29

Get fish at least two to three times a week

1:21:31

get it from good clean sources And

1:21:34

you can you can get your protein but God

1:21:36

gave us cattle and bison for a reason and

1:21:38

he gave us canines for a reason Right cattle

1:21:41

and bison they are protein factories. They eat

1:21:43

the plants They now take all the amino

1:21:45

acids and all the proteins from all of

1:21:47

the plants and combine them into one muscle

1:21:49

that we can eat Yeah, they have four

1:21:51

stomachs. That's why they can do it. We

1:21:53

only want stomach Because

1:21:56

because you know plant proteins are a little

1:21:58

bit harder for us digesting the amino acids

1:22:00

that we need. So now, they eat all

1:22:02

day. I mean, I was in Rwanda and people

1:22:04

were like, oh my gosh, you know, gorillas, they're

1:22:06

so strong and all they do

1:22:08

is eat plants. I'm like, yeah, and they

1:22:11

basically have intestines that are two or three

1:22:13

times larger than ours and all

1:22:15

they do all day is eat and they eat, you know,

1:22:17

50 pounds of food a day. Are you going to eat

1:22:19

50 pounds of food? Probably not.

1:22:21

You know, if you ate 50 pounds of grass,

1:22:23

you'd be fine. Like I said, you can overcome

1:22:25

the issue with plant protein if you eat enough

1:22:27

of it but it's almost impossible to do that.

1:22:30

So George, thanks so much for

1:22:33

enlightening us about the role of

1:22:35

exercise, the role of measuring the

1:22:37

biomarkers of health and fitness, metabolic

1:22:39

health, VO2 max, body composition. Again, it's just

1:22:42

part of what we do at the UltraWANAS

1:22:44

Center. We took a deep dive into all

1:22:46

your biomarkers into your full spectrum of health.

1:22:49

We are really in the practice of creating

1:22:51

health. And what I say

1:22:53

is no matter how sick you are, we

1:22:55

help you get healthy and as a side

1:22:58

effect disease goes away. So George, thanks so

1:23:00

much for being on the podcast again. Hopefully

1:23:02

those listening were inspired to come see us

1:23:04

at the Ultra Wellness Center. Just go to

1:23:06

ultrawellnesscenter.com to learn more about what we're doing

1:23:09

and hope we see you soon. That'd

1:23:11

be great. Thanks Mark.

1:23:14

Thanks George. Thanks for listening today. If

1:23:16

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1:24:02

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