The Peter Attia Drive - #144 - Phil Maffetone： Optimizing health and performance through maximal aerobic function

00:00:00.000 Hey, everyone. Welcome to the drive podcast. I'm your host, Peter Atiyah. This podcast,

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00:00:41.720 head over to peteratiyahmd.com forward slash subscribe. Now, without further delay,

00:00:47.740 here's today's episode. I guess this week is Phil Maffetone. Phil is an author, a coach,

00:00:55.540 health practitioner. He wears many hats and many of you will probably recognize him as he's written

00:01:00.520 a number of books, the eighties, nineties, and today, basically covering a number of aspects

00:01:06.360 of exercise, sports medicine, biofeedback, nutrition. I first probably came across Phil's

00:01:12.180 work when I was in college and I was interested in aerobic training, trying to improve my cycling

00:01:17.020 performance at the time and became pretty interested in the way he was advocating for a very low intensity

00:01:23.540 relative to what I was doing approach, which of course today in hindsight seems to be quite the

00:01:28.640 logical thing to do. Phil's background is in biology. He has a doctorate in chiropractic and

00:01:34.320 he also has trained in Chinese medicine and kinesiology. He was in private practice for about

00:01:40.320 two decades and he's now a consultant along with continuing to write, doing independent research

00:01:45.600 and lecturing. In this episode, we talk about his journey, you know, how he became interested in this,

00:01:49.540 both as an athlete himself and then ultimately as a coach, we get into what is maximal aerobic

00:01:54.780 function. And this overlaps very closely. In fact, you could argue this is a very similar way to

00:02:00.280 describe zone two, something we speak about in a previous podcast, but coming at it through a sort

00:02:05.760 of different lens and using heart rate as opposed to lactate to measure it. We get into the importance

00:02:13.240 of fuel partitioning. In addition to different levels of intensity, we talk a little bit about

00:02:18.400 marathon times and how they've changed over time and what that probably tells us about training. So

00:02:23.700 I hope you'll enjoy this episode and without further delay, please enjoy my conversation with Phil

00:02:28.340 Mavito.

00:02:34.220 All right, Phil, thanks so much for making time so late in your day. You're in, where are you? Are you

00:02:39.140 in Portugal right now?

00:02:40.900 I'm in Lisbon, Portugal. And you know, they don't have dinner here till nine or 10 at night,

00:02:45.680 which I usually skip. So it's just past lunch for me. It's great to be with you. So thanks, Peter,

00:02:52.520 for having me.

00:02:54.040 Well, I've been wanting to speak with you for quite some time. And we've got a lot of listeners who

00:02:58.160 have been excited about getting you on. A lot of questions have come about. We've talked a lot about

00:03:03.400 aerobic efficiency on this podcast because obviously it's such an important part of delaying the aging

00:03:10.080 process. So even if you take it out of the context of performance, I think today we'll sort of talk

00:03:16.260 about both of these things, sort of performance and health. But it's obviously something that you've

00:03:21.380 been working on for such a long time. It's been kind of central to the work you've done. But I kind

00:03:26.640 of want to go back and give folks a bit of a sense of how you cut your teeth on this stuff. So

00:03:31.720 you're obviously an avid runner yourself, correct?

00:03:34.060 I've been running since, yeah, since high school, I guess. And from track and field in high school

00:03:40.560 and college. And then when I got out and into practice, I thought, you know, this road running

00:03:47.460 stuff looks interesting. I'm starting to see patients. Let me see what's going on. And I, you know,

00:03:54.640 I jumped into a 5K and it was a complete disaster because I was a track runner. And what do we know

00:04:01.720 about distance? And gradually I progressed to the marathon. I trained for a six-day running race

00:04:08.380 on a track because I had been working with some ultra runners, Stu Middleman in particular.

00:04:14.780 And it looked like such an exciting event. I thought this, you know, I'm going to do this.

00:04:20.280 Then I can, you know, my bio could read, I've run everything from 200 meters to six days.

00:04:25.000 I thought that was cool. Of course, I was, by that time, I was so busy with, with treating other

00:04:31.280 athletes that I was just not able to get the time on the training. All the training was on a track

00:04:38.340 because the race was on a track. Yeah. Tell people what a six-day race is.

00:04:43.020 Yeah. A six-day race is a running race where you run on the track and the person who accumulates the

00:04:49.640 most miles or kilometers is the winner. You can run as you please. You can start and stop anytime.

00:04:57.120 You can sleep if you want. If you can stay awake, good luck. And I, I trained some people and it was

00:05:04.420 for me, a fascinating thing. Clinically, it was really akin to having a, a mouse in a lab where you,

00:05:13.720 you know, you do something to this mouse and then you put them back in the cage and have them run on the,

00:05:18.820 on the wheel for a while. And then you take them out and you do something else, measure something.

00:05:24.640 And, you know, it was such a great learning experience for me. And it was a great opportunity

00:05:30.920 to really hone my skills of observation in terms of gait and talking to an athlete, finding out when

00:05:39.660 they really were tired, unlike what they said. It was just so many really fascinating things. And then

00:05:45.960 the idea of doing the race seemed quite interesting. And I just ran out of training time.

00:05:51.740 And so what is the ideal strategy in my mind right now, I'm going through multiple ideas for how one

00:05:57.860 could approach a six day race. And, you know, one idea that comes to mind is you simply walk 18 hours

00:06:05.100 a day and sleep six hours a day, or, you know, you walk 20, sleep four and never put yourself under

00:06:11.400 incredible duress, but also never go too fast. The sort of slow and steady wins the race approach.

00:06:18.020 And then alternatively, you can see something crazy where you, you know, actually take out a

00:06:22.940 reasonable clip and run for, you know, an hour and take an hour off. But of course, in that scenario,

00:06:28.880 you don't really get a full recovery. So what did you discover was the optimal scenario for covering

00:06:33.960 the most amount of ground in six days? What I discovered was you, you start the race by walking.

00:06:41.300 And now you're the only runner who's walking. The gun goes off, everybody starts running,

00:06:48.080 you're left walking. And that was always a kind of a comical scene for me. And the runners I worked

00:06:54.880 with, Stu Middleman in particular, who has the, maybe still has the American record for that distance.

00:07:00.660 They were a little embarrassed in the beginning, but the strategy was to start slow, gradually run

00:07:07.580 faster, start jogging, gradually hit a certain plateau using the heart rate, that maximum aerobic

00:07:16.240 heart rate that we can talk about at some point. So very easy, relatively easy, relatively low heart

00:07:23.880 rate. And then now you're two hours into the first run, maybe three hours, and then you start cooling

00:07:30.200 down. And you take a half an hour to cool down, basically just the opposite of what you did in

00:07:35.560 the beginning. And now you can get off the track and take a very short break and then get back on

00:07:41.720 the track and do the same thing. And that segment would sometimes be elongated in the beginning in

00:07:48.200 particular, because people are kind of jittery and they want to do something. Taking a break is not

00:07:53.380 something they want to do. And so there's no hard running. Certainly there's no high heart rate,

00:07:59.400 high intensity training. You do see that in other athletes. And that's how the days go by. That's it.

00:08:08.960 So you spend a fair amount of time walking. And with Stu in particular, as an example, Stu really liked

00:08:16.460 the idea of going for 36 hours without sleep. And I said, okay, let's try it. And it worked out well.

00:08:25.140 So we did that. And then we took a longer break before getting back into a 24 hour cycle. I'll tell

00:08:31.980 you the interesting thing for me is that it was exhausting for me, because I really had to be awake

00:08:40.800 longer than, than he did because I couldn't sleep when he slept because we had a specific time frame

00:08:47.560 for him to sleep sometimes as short as seven minutes. And I needed to be awake when he was

00:08:53.200 waking up because sometimes he didn't know where he was. And so for me, it was quite a stress. It was

00:08:59.480 quite, I mean, the circuit, you know, you're interfering with your circadian rhythm so much that

00:09:03.980 you could literally hallucinate after day four by day five potentially. And I've, I've done that.

00:09:12.480 So it's a very different kind of event than most runners have ever experienced.

00:09:17.240 Yeah. It sounds a lot like Ram, the race across America in cycling, which I interviewed a guy named

00:09:23.280 Mike Trevino a while ago, who has done Ram a number of times and his stories are very similar to that.

00:09:29.080 And again, very different strategies that many cyclists will take, but there's nobody at the

00:09:34.880 end of that. That's not in a significant world of pain and the hallucinations can lead to crashes

00:09:40.680 and all sorts of crazy things. And it's pretty high stakes racing. It's a obvious indication of

00:09:46.680 significant brain stress, but I think the key is to like with everything else, individualize it with

00:09:53.240 your athlete. And like I said, Stu had this idea that he wanted to go for 36 hours, which we had

00:09:59.800 talked about a lot beforehand. And that became part of the strategy because that's something that he

00:10:04.760 wanted to do. And the way we did, it seemed like we weren't going to sacrifice his health much. And so

00:10:11.500 it was okay for me. And I think in, in whether you're on a bike or running or whatever you, you,

00:10:18.320 you need to, as a coach, as a clinician. And in that kind of race, I served as a clinician because

00:10:24.920 I did things like biofeedback, neuromuscular biofeedback. Obviously there's significant

00:10:31.420 stress in that area of the body. You still want to allow the athlete to voice, you know, how they

00:10:38.520 would like to do this race. And then you want to voice how you think it should be done. You come to some 0.98

00:10:42.960 meeting of the minds. But for me, it was always, I'm not willing to sacrifice the health of this

00:10:51.080 athlete because that's, that's against what I do as a clinician. As a coach, I want him to perform

00:10:58.060 his best. And he was running about a hundred miles a day for six days. That's, that's not a bad

00:11:03.560 performance. Wow. At what point did your thinking start to transition from the training of peak

00:11:11.960 athletes to sort of a broader set of metrics or parameters that could be applicable to health?

00:11:19.820 Or did that not occur in sort of the fashion I've sort of described it?

00:11:24.060 It occurred the opposite way. I always loved sports. I loved sports myself. I competed at a very high

00:11:31.220 level. I played other sports and in undergraduate school, my goal was, Hey, I want to study and get out

00:11:39.980 into the world. And my goal is to help people. It was, my goal was to help people with their health.

00:11:47.320 And I knew there was this fitness thing and I wasn't sure how it goes together, but I, I, I didn't

00:11:52.900 focus it. The athlete component was not really there. And in those early, early days, when I got into

00:12:01.000 practice and started seeing athletes who were injured, they were local athletes who were,

00:12:05.540 you know, they were, they were five, 10 K runners, half marathon runners. Some of them were marathoners.

00:12:11.940 You know, this was the, the boom in the seventies. And there were a lot of patients because there were

00:12:19.340 a lot of injuries. And so my focus was, why are they getting injured? And I would gradually see

00:12:26.880 better and better athletes locally. That led to two things. One, some of those athletes got really good

00:12:33.460 and attained a national class level. And, and then they referred people that they knew who were

00:12:39.680 professionals. And I started seeing pro athletes who were in running, of course, because that was the

00:12:46.860 big thing back then. But there was this thing on the West coast called the triathlon, which just

00:12:52.300 fascinated me to death because I was a swimmer and I was a cyclist and a runner. And to have three events

00:12:59.820 to work with was just, it was exciting. And I started seeing some local people who were,

00:13:07.640 you know, I was in the New York city area. So I was on the East coast where it took a while for the

00:13:12.340 word of triathlon to get there. And when it did, there were some athletes and that was a lot of fun as

00:13:18.680 well. So this is now sort of late seventies, right? When the triathlon movement starting in Hawaii,

00:13:26.240 kind of migrating over to California and the West coast.

00:13:29.920 Yep. And it was still new. It was crazy. And all we, all we really knew about it were these,

00:13:35.720 these three guys in a bar who were arguing about who's the better athlete, the swimmer,

00:13:41.160 the cyclist or the runner. And, you know, blah, and that, I don't know how accurate that story is,

00:13:45.980 but supposedly that's, that's how the event started. And interestingly enough, early on,

00:13:51.900 there was a double Ironman. I worked with somebody who did that, but yeah, that was late seventies and

00:13:58.600 then into the eighties. And by then I was seeing some professionals in most sports by then, certainly

00:14:04.200 by the, by the mid eighties, I had seen professionals in all sports. And by the mid eighties, what fraction

00:14:11.460 of your practice is professional athletes or athletes competing at a very high level versus normal

00:14:18.500 people who are coming to you saying I'm overweight or I have diabetes or something like that?

00:14:25.100 Gosh, I have to, you know, by then my clinic was so busy. I was taking on associates. So I had other

00:14:31.860 doctors in the clinic. You know, my goal was for them to treat the local patients I had because I was

00:14:39.000 now starting to travel with athletes, which I hadn't, hadn't done. Mark Allen was a patient of mine by that

00:14:45.920 point. And I think it was 83. I had been doing some sports clinics on the road in various cities. San

00:14:54.660 Diego was one. And that's where I first met Mark and Paul and Newby Frazier and some of those other

00:15:00.860 folks who were just getting going. And so by the mid eighties, I was on the road a lot. And certainly

00:15:08.460 by the mid eighties, I was in Boulder every summer because that's where a lot of athletes went.

00:15:15.520 And so I went there. So by that point, most of the patients I had were competitive athletes who I

00:15:22.960 was working one-on-one with. And I was doing a lot of lecturing, starting to do a lot of writing as

00:15:29.520 well. So at what point did you sort of, I would say, congeal the idea that said, Hey, we need to train

00:15:38.380 at a lower level of intensity for longer periods of time. You know, we're going to get into obviously

00:15:44.980 the methodology, but I want to talk even broader than that, which is, did you look at athletes and

00:15:51.240 say, wait a minute, something is a muck here. These people are training too much or either, either

00:15:57.240 volume is too high or intensity is too high, but something is off and we need to do something that's

00:16:02.820 sort of counterintuitive, which is dial this back in one or both of those metrics. Was there,

00:16:07.980 did you sort of see that in the eighties? Oh, I saw it before the eighties. I saw it quite early

00:16:13.160 because I was seeing these people who were, were able to run a marathon in whatever time. And that was

00:16:19.580 like, wow, this guy could run a marathon. What an example of optimal health. Well, it wasn't because

00:16:27.160 they were broken down. They were getting sick. You may remember, I mean, back then, you know,

00:16:33.220 it was a badge of courage to have a high white blood count because you are a runner. And I, I started

00:16:40.160 putting all these things together and it was pretty clear that something wasn't right. Cooper's aerobic

00:16:46.580 revolution was not, something wasn't working. You don't just go out and train and everything falls into

00:16:52.720 place. These people were falling apart. So that, that was in the seventies when I started seeing

00:16:58.000 that. And I was having a hard time understanding that relationship between being healthy and being

00:17:03.960 fit. And when I ran the, the New York city marathon in 1980, and I crossed the finish line,

00:17:09.540 it just hit me. These athletes are fit, but unhealthy. And that whole concept of fit, but unhealthy

00:17:15.840 and fitness and health are two separate definitions and they need to be balanced. Whether you're

00:17:22.500 a grandmother who goes out for a walk four or five times a week, or you're training for the race of 0.99

00:17:30.000 your life as a professional, it's all the same. And many of the things that I developed, like the,

00:17:36.160 the MAF tests, for example, were never meant for athletes. They were meant for the average person,

00:17:41.320 because I thought whatever we're doing to this person to help them get healthier,

00:17:46.240 we need an indication, not just a blood test. We don't want to know if they're

00:17:51.440 blood picture looks better. You want a functional test.

00:17:56.040 We want a functional test that at the time didn't really exist. And so the functional test for me was

00:18:02.340 that they were going to be able to walk faster at the same low heart rate than they could a month or

00:18:06.740 two earlier. And that was, that was the big thing. And then soon after that, I said, Hey, wait a minute,

00:18:12.160 these guys are running faster now at the same heart rate. And I thought, wow, this is,

00:18:17.620 this is interesting. Can you give folks an explanation? Let's assume that people aren't

00:18:24.240 entirely clear on the nomenclature between aerobic and anaerobic fitness. This will allow us to, I

00:18:30.280 think, more accurately talk about what submaximal means and maximal and all of these things. People

00:18:35.700 have heard the term VO2 max, but I think it's important to give a bit of a context for where

00:18:41.800 that'll fit on the spectrum. So can you explain to folks what we mean by aerobic and anaerobic

00:18:46.760 systems? Yeah. And, and, and I don't want to go into the, the microbe definition, which is where

00:18:53.740 a lot of us have learned those terms, you know, there are aerobic microbes and anaerobic microbes.

00:19:00.220 So the anaerobic microbes are without oxygen. And when patients would say, well, I, I want to do some

00:19:07.160 anaerobic training. I'd say, well, what is, what is that? Is it that, well, what's without oxygen? I said,

00:19:12.340 you mean you can hold your breath while you're doing the intervals. And so we need a better

00:19:17.360 definition. And my definition became fat burning was, was associated with aerobic and all of the

00:19:24.580 factors that are associated with fat burning. So the aerobic muscle fibers and the mitochondria and

00:19:31.440 the ability to convert fatty acids into energy, into ATP and anaerobic was the glucose side.

00:19:39.020 And that was simple enough. It wasn't scientific enough, but it was simple enough for what people

00:19:46.200 needed to understand. And especially when we can come up with a heart rate that says, well, if you

00:19:52.400 go over this heart rate, you're drifting into that anaerobic state. And if you stay under it,

00:19:57.860 you're in an aerobic state and therefore you're training your body to burn more fat as an energy

00:20:03.800 source. And therefore you're going to store less fat and, and you're going to get rid of any excess

00:20:08.840 fat and so on and so forth. Can you explain to folks what the VO2 max is? Because I want to

00:20:15.220 spend some time explaining why it's not a great predictor of much, despite the fact that it

00:20:20.700 certainly produces boasting rights. It produces for sure boasting rights. It's a number that people

00:20:27.960 talk about. Everybody talks about it and hardly anybody gets tested and almost nobody gets tested

00:20:33.620 with some regularity so they could do something with the numbers. We can define it academically,

00:20:39.840 which doesn't tell you much, but it's a test that is, was developed a long time ago. And so there's a

00:20:45.700 lot of tests around. And the real question is, what does it really mean? And I'm not sure it means a

00:20:53.720 whole, I didn't do many of those tests. So I, you know, I had an academic education and, and I knew about

00:21:01.600 VO2 max and I knew about all this traditional stuff, the 220 formula, which I used in the very

00:21:08.840 beginning, because I thought that was the science of, of exercise physiology and quickly learned it

00:21:16.180 wasn't. And VO2 max was right there. And, and VO2 max became the tradition. I think it was the

00:21:22.560 tradition back then. I don't remember when it was first developed. It was by Hill, wasn't it? Back in.

00:21:29.740 I actually don't know who developed it. The 1920s. But for listeners, I think it's,

00:21:34.720 it's a relatively straightforward test to administer, provided you have the machinery and

00:21:40.800 the machinery is complicated because you have to be able to isolate gases very well, specifically

00:21:47.780 oxygen and carbon dioxide. So the test is normally done on either a treadmill or a stationary bike

00:21:55.200 where you can control the resistance or the, the load that the athlete is under. The challenge is

00:22:02.800 creating an airtight seal around their nose and their mouth, because what you're really doing with

00:22:07.660 the test is you want to measure how much oxygen is coming out of their respiratory system and how much CO2

00:22:17.440 is coming out because you know, how much is going in. And therefore the difference is the amount of

00:22:24.260 oxygen consumed. Now, if you're sitting here at rest, you have a VO2, an amount of oxygen that's consumed.

00:22:33.180 And the purpose of the test is to ramp up the level of exertion until you reach the maximum level

00:22:40.360 of oxygen consumption. So VO2 max is simply the maximum amount of O2 consumed. And the difference

00:22:48.240 between a very fit person and a non fit person is the fitter you are, the more oxygen you're able to

00:22:55.540 consume. And that's basically a function of your muscles. It's what can the muscles do? So I think a

00:23:01.120 lot of people erroneously think this is a, a test of the heart and lungs, but it's not really a test of

00:23:07.160 the heart and lungs, right? The lungs is where the gas exchange is happening. The heart is the

00:23:11.140 circulatory pump. It's really a test of what your muscles can do in terms of utilizing that oxygen.

00:23:17.540 And to your point, it's how much fat oxidation can happen because that's where you're utilizing the

00:23:24.340 oxygen is in the mitochondria to oxidize fat. But all of that said, the research actually says that

00:23:32.880 you can't predict marathon finish time by VO2 max.

00:23:37.600 You're right. And people don't like hearing that because they have this idea that this set,

00:23:42.760 now this VO2 max is directly associated with performance. So they need to rev up their VO2 max

00:23:49.740 by doing hard training, which will get them performing better. And that, you know, that's where the whole

00:23:55.100 system breaks down. That's the problem we have. This VO2 max is a, it's something we,

00:24:01.600 we have been worshiping and we're worshiping the wrong thing.

00:24:07.500 So tell folks what MAF stands for.

00:24:11.280 MAF stands for maximum aerobic function. And in essence, the goal of being healthy,

00:24:18.020 the goal of being fit is to develop the aerobic system. This is what our ancestors did. This is how

00:24:25.880 we got here. We developed a really incredibly powerful aerobic system by doing the things in

00:24:34.340 our lifestyle that drive that aerobic system to develop, which includes eating more fat,

00:24:42.320 not eating much carbohydrate, eating moderate amounts of protein, maybe even relatively small

00:24:48.420 amounts of protein for the earlier humans, because we were, we were not the hunters in those early

00:24:54.520 stages, but we, we certainly ate a large amount of fat and we didn't sprint after animals. We jogged

00:25:01.880 after animals. And so all of that is how we, we developed, we developed bigger brains, bigger bodies.

00:25:12.220 We developed bodies that had great longevity and a higher level of health to match that longevity.

00:25:19.560 And it doesn't take long when you start reading about this. And, and, and it was really an anthropology

00:25:25.580 course, I think that I first started reading this kind of stuff. And it was really quite fascinating because

00:25:32.400 they said, well, if that's what they were doing, why are we doing all this other stuff now? And that sort of

00:25:39.020 got me thinking about this as an undergraduate student, because it seemed pretty clear what our ancestors were

00:25:46.580 doing and the fact that they were doing it for so long, you know, just what happened between some

00:25:54.180 time ago and now, how did we get into the mess we're in? And so the concept of maximum aerobic function

00:26:01.860 has been really with me for, for quite some time. When I was working with runners, which is almost

00:26:08.660 all the athletes I worked with, certainly in the seventies, I started talking about the pace that these

00:26:15.580 athletes could run at with this given heart rate that I had come up with this aerobic heart rate.

00:26:23.440 And I called it the maximum aerobic heart rate. And so the pace they were running was the maximum

00:26:28.480 aerobic pace. And how did you come up with that heart rate? That heart rate was derived in combination of

00:26:36.220 a physical exam in my office. I want to know how healthy they were. I want to know about their history.

00:26:42.680 What did their labs look like, their posture, their strength, and so forth. And then I would go out

00:26:49.780 to the track and I would monitor their heart rate. I'd monitor their gait while we use different

00:26:57.520 heart rates. And so I'd see them at a 120 heart rate. I'd look at their gait. I'd say, this is,

00:27:03.540 it's a pretty good gait. And then we'd go to 130. That's a pretty good gait, maybe even a little

00:27:09.400 better. And then they'd go to 140 and I'd start seeing irregularities. And then I'd bring them

00:27:15.780 back to 130 and I'd see a nice smooth gait again. And I'd put all that together and I'd assign them

00:27:23.060 a certain MAF heart rate and they would go train. And then I would test them again to see if it

00:27:29.500 correlated. And it was a long process. And it was, it would not be for two or three years when

00:27:35.520 I developed a formula, which I never used personally because I always wanted to do it

00:27:41.040 manually, but they correlated so well. And you may have heard me say, I was lecturing one day about

00:27:47.520 this and how I came up with this heart rate and what it meant and how people were benefiting from

00:27:53.660 it. And somebody said, well, how do we come up with that heart rate? And I, I didn't have an answer.

00:27:58.240 And I started realizing that, well, there's probably some simple mathematical process that

00:28:04.180 I can go through to use the athletes I had. I already know their heart rate. Let's plug in the

00:28:12.180 numbers. And the 180 formula was born. I tweaked that for a couple of years. And the formula you see

00:28:20.300 today is basically the same formula that existed in the early 80s. Let's go through it in a bit more

00:28:26.760 detail. Just to make sure folks understand what we're saying. You're saying that a person is going

00:28:33.500 to be at their maximum aerobic output. So meaning they're going to be maximally fat oxidizing at an

00:28:41.960 approximate heart rate of 180 minus their age, plus or minus a few modifications. So I believe there are

00:28:50.000 a handful of these. If you're recovering from an illness or you're kind of in an overtrained situation,

00:28:56.100 you might actually need to discount that by another 10, right? That might be 170 minus your

00:29:01.640 age. Correct. The key is that you want to individualize it. So you, you begin with 180 minus

00:29:07.840 the age, which has no meaning like the, the 220 formula that, you know, you subtract your age from

00:29:13.460 220 and they say it's your maximum heart rate or whatever. Yeah. Your max heart rate. And of course it's

00:29:18.760 not most of the time. So 180 minus the age has no meaning. It's just a means to the end,

00:29:24.700 but you now want to individualize it to your health and fitness needs. So if you're recovering from an

00:29:31.680 illness, if you're severely overtrained, if you're in rehab, you want to subtract another 10 from that.

00:29:38.860 But if you're not in that category and you only have the typical two or three colds a year, you might have

00:29:46.840 asthma or seasonal allergies, you might be over fat. You might be training for a while and then you kind of,

00:29:55.580 you lose time, you can't train and then you get back into it. And not in that category, you subtract another

00:30:01.820 five all the way to the competitive athlete who has no health problems, who has been progressing quite

00:30:10.000 well. They can add five to that number. So in the, you know, that formula, what's important for people

00:30:17.380 is to follow the formula and be honest. That's the hardest part is to be honest. So if you're on

00:30:24.000 medication, for example, you've got to subtract your age from 180 and you've got to subtract another 10.

00:30:29.880 And what kind of meditation? Does it matter?

00:30:33.080 Doesn't matter. That's the thing. People will say, well, I'm only on this and that's not really

00:30:38.780 affecting my heart rate or, or I don't have to be on it. Or I, I don't know what, you know,

00:30:44.840 if you're on medication, you subtract 10. And if you get healthy along the way by training this way,

00:30:51.400 and now you can get off your medication, well, now you could redo the formula because now you're no

00:30:56.340 longer on medication, you're healthier. Let's have a look at the 180 formula again and modify it as

00:31:02.900 needed. You know, it's like doing a history on a patient. The most important thing is that they be

00:31:09.300 honest because if you don't get the right information, you're, you're in trouble.

00:31:14.740 So it's kind of amazing to me, by the way, that you were able to do so much with heart rate back in

00:31:18.980 the seventies and eighties. What, what did you even use for heart rate monitors or were people just

00:31:23.460 manually checking their heart rate doing these tests?

00:31:27.540 Well, yeah, I began manually checking heart rates. Uh, there were some finger units that were

00:31:34.000 not very accurate. There's some clips you put on the ear. They were not accurate. Unlike the ear buds

00:31:40.460 that are used today, picking up the heart rate in the ear, in the ear canal is, is a good measure.

00:31:46.220 And I finally got a heart monitor that was used in cardiac rehab in hospitals. And it was a big

00:31:55.400 obnoxious, you know, double strap. One went over the shoulder, one went around the chest and it had

00:32:00.760 this box that was in the middle and it, you know, all you got was the heart rate. You could see it in

00:32:06.640 this tiny window and you can hear the thing beeping. And it would be several years before the wireless

00:32:14.740 monitors came out, which I think was late in 83 maybe. And when I first started using this heart

00:32:23.240 monitor, I had one in my office. It was like having, you know, I had a stethoscope. Okay. And I used it

00:32:29.800 when I needed to use it. And so I had this heart monitor and I would use it, go to the track, put it

00:32:34.460 on an athlete. We'd use it, take it off, put it on another athlete. And I, silly me, I thought, well,

00:32:41.320 okay, once they feel what 130 heart rate or 150 heart rate is like, they'll be able to train that

00:32:50.800 way. Well, that didn't work. So then I started lending out the heart monitor and then I had to

00:32:56.340 buy another one. And then I had like three of them, you know, it was like, you have three heart

00:33:02.120 monitors. Yeah. I have three in my office. It was like the old, you know, 1950s people had one

00:33:07.520 television. And if somebody had two television, it was like, you mean you have two TVs? Wow. That's,

00:33:13.480 you know, you know, then people started buying them. They said, I'm going to train with this.

00:33:18.040 Cause when I trained with it, I feel better. I'm not tired. I'm, you know, my back doesn't hurt

00:33:22.880 anymore and blah, blah, blah. It progressed that way. And then when the wireless heart monitors came out,

00:33:29.060 everybody wanted to buy one, which was interesting. So the formula, the math formula of 180 minus age,

00:33:39.480 and then adjusted based on all the factors is a way to basically gauge the intensity.

00:33:47.360 How did you then prescribe volume and how did you not only prescribe the volume there,

00:33:54.600 but determine how much volume to add in that was at a higher intensity?

00:34:00.140 That's an interesting question. It really began early on when I had no intention of coaching.

00:34:07.100 I didn't want to be a coach. I, you know, I wanted to be a clinician and fix people's knees and help

00:34:13.980 them, you know, get off blood pressure medications or whatever. And with athletes,

00:34:19.980 I thought if I could just keep them from getting injured, they'll just perform better because,

00:34:24.560 you know, that seemed to be the thing that slowed them down, getting some physical injury.

00:34:30.040 And I realized that I was treating symptoms. I was, I was really, you know, it was against

00:34:38.260 my nature to, to do that. I was, I was fixing some runner's knee and they'd go out and train.

00:34:46.000 And then I'd see them again in my clinic a month later with the same knee problem. I said, well,

00:34:50.960 what, what did you do? He said, well, I just did my normal training. And, you know, eventually I said,

00:34:56.960 well, let me look at your training and people would write down their schedules and I would start

00:35:01.420 looking at it. And I realized that I didn't, I needed to have some input on this schedule because

00:35:08.080 what they're doing was excessive. They were literally over-training. And so I became a coach

00:35:16.020 and I didn't want to be like a regular coach where I'd give out a schedule. I wanted them,

00:35:22.640 like I said earlier with, with, with Stu Middleman, I wanted the athlete to be part of the process.

00:35:30.680 You know, I wanted to say, well, what would you like to do with your training? And they'd bring

00:35:36.580 in their schedule and I'd look at it and I would just say, let me get this straight. You work 60

00:35:42.520 hours a week. You have three kids and a house and you do all these social things and you're trying to

00:35:49.180 run a hundred miles a week. That doesn't make sense. You either have to get rid of your kids,

00:35:55.280 get rid of your family, get rid of your job, or reduce the number of miles you're running.

00:36:00.680 And so, you know, I got a lot of laughs and we, we went on and I found that people could do a lot

00:36:09.240 less training at a lot less intensity and perform in a race a whole lot better. And it didn't take

00:36:20.060 long to see that, you know, it's like a taper. When you taper, you get stronger. Well, when you cut

00:36:27.900 somebody's schedule down, they can get more out of their training. And so it, it, it worked that way.

00:36:33.600 And so the, the big issue was really this aerobic system stuff. How do you build the best aerobic

00:36:42.480 system? Of course, I had been familiar with Arthur Lyddiard, who was a patient in my clinic actually at

00:36:49.760 one point. And so I knew about this concept of the aerobic base and, and it just seemed to make a lot

00:36:56.540 of sense. And what I found through working with a number of patients that if they, if they do their

00:37:02.920 traditional two days a week of interval training on the track, they never got faster at the same heart

00:37:11.000 rate. Like these other people did who seem to excel quite quickly from, from one month to the next,

00:37:19.120 they could be running starting at a nine minute, a mile pace at their MAF heart rate. They might be

00:37:25.380 running eight 30 a month later, same heart rate months later. Now they're running at an eight minute

00:37:30.980 pace. Okay. So I want, I want to pause there for a sec. So when the athlete makes progress, when they're

00:37:36.180 doing their MAF test, which again, I just want to remind everybody, cause we're, we're talking about

00:37:41.700 both an MAF heart rate, but then the MAF test, and these are very important concepts. So let's go back.

00:37:47.400 So I figure out either through a very bespoke manner or using the formula that my MAF heart rate is one

00:37:55.820 30. I go out and I'm going to do my training at one 30 and I'm running a nine minute mile. The question

00:38:03.980 becomes while keeping my heart rate at one 30, can I get faster? Can I go from a nine minute mile to an

00:38:11.760 eight 30 mile to an eight minute mile? And if I can do that while staying at one 30, by definition,

00:38:17.800 I have become aerobically fitter and more efficient. Correct? Correct. Now, is there a point at which you

00:38:26.260 begin to adjust up the heart rate and say, Peter, I want you to now train at one 32, or do you keep me

00:38:34.580 at one 30 and see how far we can drive that down until I plateau? How do you make that decision?

00:38:41.080 I keep you at one 30 because I've determined that one 30 is a good number for you because you're

00:38:48.640 progressing now. Can we cheat a little bit up to one 32 and one, one 33 and only to find out two months

00:38:55.900 later that you're back to where you were. I don't want to spend that time because at some point I've

00:39:00.760 had enough experience to know that's not a good use of our time. So we're going to stay at one 30

00:39:07.040 and we're going to allow your body to develop that aerobic system. The question people often have is,

00:39:15.240 well, how do I run faster at the same heart rate? It doesn't make sense. And the answer is that

00:39:19.780 you're, you're, you're able to generate a lot of energy from fat. You're, you're building the

00:39:25.600 aerobic system. So you're, you're increasing fat burning. Now you have more energy. You have,

00:39:31.580 you have the steam engine, the more wood or coal you throw in there, the more that engine can,

00:39:38.640 can go and the faster it can go. And you will progress and you'll month after month get faster and

00:39:44.980 faster. At some point you will hit a plateau. And, and early on, I realized it took three,

00:39:52.680 four, five, six months before people hit a plateau. So there are two issues. One is,

00:39:59.600 do we keep allowing the body to get faster and faster, which for an endurance athlete is the greatest

00:40:06.840 benefit they can obtain? Because if they can go faster at a sub max pace, they can go faster at a max

00:40:14.080 pace. Let's unpack that for a minute. That let's, let's unpack that. That's a very, very important

00:40:20.080 statement. Can you talk about some of the experiences you've had to establish that? And again,

00:40:27.820 actually, before we do that, Phil, let's talk about why that's relevant. You're running a 10 K let's

00:40:33.940 say at the very competitive level, a 10 K is, you know, depending on how competitive, obviously it can

00:40:38.620 be sub 30 minutes. But if you're kind of a recreational athlete who's running competitively,

00:40:43.420 you're going to be in the, you know, 32, 33, 34 minute range, by definition, you're running well

00:40:49.960 above your math target. Is it necessarily true that if you take the top 10 finishers of that race,

00:41:00.780 and then a week later have them run at their math heart rate, they'll cover greater distances

00:41:10.080 as a function of what they ran in the 10 K race. In other words, do you, we do have evidence that

00:41:16.040 that's true? Cause if it is, it's a remarkable statement, right? We do have evidence that that

00:41:21.100 is true. Hypothetically, you have the outlier who's this guy who can't run nine minutes without

00:41:28.820 hitting a one 80 heart rate. These are the people who are over-trained enough to be in that sympathetic

00:41:35.780 state. They get into a 10 K and they run a PR and amazing feet. How could, you know, I've run a minute

00:41:43.880 and a half faster. My, you know, these are the people that are ready to fall apart at any minute.

00:41:49.820 And I've seen them. These are also the people who are ready to drop dead of a heart attack.

00:41:56.080 And so if we take those outliers away, then yes, we have this hierarchy of, of athletes who have a

00:42:03.620 increasingly better sub max condition that corresponds to their race pace.

00:42:11.640 If that's true, then Phil, it would really lend credence to the idea that even if you're training

00:42:18.260 for a five K or a 10 K, you still want to push your math protocol. It's still matters how much you can,

00:42:27.800 how, how much distance you can cover at that lower heart rate and lower intensity where you

00:42:33.580 are running at your maximum fat oxidation and maximum aerobic capacity.

00:42:39.600 Yeah. And I think it's pretty clear now that sub max performance predicts maximum performance.

00:42:47.660 How far down can you go even for a miler? I think it comes down to how much fat burning do we need?

00:42:57.320 And even for a mile, there's a lot of fat burning taking place in a one mile race.

00:43:02.780 I want to ask you about fat. When I was in medical school, the conventional wisdom was that fat

00:43:09.120 oxidation could not exceed one gram per minute. Now I didn't think much of it, but many years later,

00:43:18.300 when I underwent a enormous dietary switch and I went from being a kind of ultra distance

00:43:26.400 athlete, basically mainlining carbohydrates. So probably consuming, I would say five bottles

00:43:37.060 of power aid a day. So let's say if I was training four hours a day, I would go through five liters of

00:43:43.480 power aid plus Cytomax plus hammer perpetuum, like basically all of these very high carbohydrate

00:43:49.900 formulas, you know, rotting my gut. And when I would do my VO2 max testing, which I did pretty

00:43:58.100 frequently, you get a lot of data on the way up to VO2 max. You're getting all of your fuel

00:44:03.760 partitioning data because you're getting VO2 and VCO2. So I know how much, I know how many calories I'm

00:44:10.760 expending at every level of intensity. And I know what the mixture is of carbohydrate versus fat.

00:44:16.780 So clearly in that state, I was nowhere near oxidizing one gram of fat per minute. In fact,

00:44:24.900 I was pretty much only oxidizing glucose the entire level. In other words, even at my low intensity,

00:44:32.540 I was still a glucose oxidizer. Fast forward years, several years, I've tried something totally radical.

00:44:39.420 I've gone on a ketogenic diet. I've done it for not just a while, but actually for three years.

00:44:44.380 And I've become very adapted to it such that I can function at high and low intensity.

00:44:50.640 And I'm now doing the same thing. I'm repeating VO2 max testing, but on this ketogenic diet.

00:44:57.280 And I hit a fat oxidation, which is still submaximal. So it's just below my VO2 max,

00:45:06.180 but my max fat ox was 1.73 grams per minute. Wow. And I remember thinking, how is that even

00:45:14.640 possible? Now, of course I would go on to learn that world-class athletes training on a very low

00:45:21.080 carbohydrate diet were able to hit two, 2.1, even 2.2 grams per minute, which I found interesting.

00:45:29.440 It basically said that this conventional wisdom we have about sports nutrition and sports science

00:45:37.280 is largely predicated on assumptions of what people are eating that aren't necessarily the optimal way

00:45:43.440 to go about doing it. It's a very good point. And I mean, you and I came to that same conclusion in

00:45:49.040 different ways. And we also had the same studies to look at the same lab tests to do. And unfortunately,

00:45:58.400 we had a lot of the same subjects or we read about studies that use the same subjects, which were big

00:46:04.800 carbohydrate eaters that distorted the research completely. But all along the way, I knew there

00:46:13.200 was something about fat. And the question is, well, how could we really measure it? And I knew we could do it

00:46:18.620 in the lab. My clinic was in the middle of, I mean, I was in the New York City suburbs at the time. So

00:46:25.760 I occasionally had access to a lab, occasionally could get somebody in there to test. And occasionally

00:46:33.660 they would say, wow, this is amazing. How could this person burn so much fat? We don't understand

00:46:39.220 this. It must be a problem. And then, you know, as the months and years went by, you know, it was

00:46:46.020 not a problem anymore. This was great. And so all along the way, for me, it was always,

00:46:52.200 I know what's going on. I know this athlete's getting healthy. I know they're burning more fat

00:46:56.760 because they're running faster at the same MAF heart rate. And now we're starting to see it be

00:47:02.880 measured. And it was a point where I said, I can't be the scientist. I'm not really a scientist.

00:47:10.820 I do wear that hat, but I'm too busy being a clinician and coming up with all these crazy

00:47:17.820 tests. And still my primary concern was helping people get healthy and fit. And if it was an

00:47:25.780 athlete, it meant they were going to perform better, but not by sacrificing their health.

00:47:30.680 And if they were not an athlete, we still had a lot of work to do. And it was only after a while

00:47:37.000 that I started thinking more scientifically, I always thought scientifically, depending on who

00:47:43.520 you ask. You know, if you ask a scientist, they would say, well, I'm not being very scientific when

00:47:49.420 I explain this MAF heart rate. And if I ask a clinician, they say, you know, you're too scientific

00:47:55.180 about this. So I gradually became more and more scientific only because A, it was fun, especially

00:48:03.700 reading the new research. And B, it was much better for me as a clinician to explain things

00:48:11.720 in scientific terms. I still had that scientific mentality of this is how we communicate to the

00:48:22.940 rest of the world from a scientific standpoint. So the fat burning component became that factor that

00:48:29.620 we can measure more and more. And like the story you told of the changes you made and how it

00:48:36.560 affected fat burning, you know, I started gathering that kind of data and started writing more.

00:48:44.980 As a clinician, you can't publish papers. You just can't, you know, your brain is unable to

00:48:50.240 spend time doing that because you're spending so much time doing other things. And it wasn't until

00:48:56.400 after I left my clinic because healthcare was getting so bad. I just couldn't do that anymore.

00:49:03.140 And I, I ended up only working with, with athletes. And so healthcare was really out of the picture

00:49:10.620 in, in many ways. And then I was able to spend more time thinking and writing scientifically and

00:49:18.820 start publishing more. I wrote a textbook. I started publishing more scientific papers and

00:49:25.640 talking about all this with a scientific hat on rather than merely a clinical hat. Although a lot

00:49:33.640 of the scientific things I've written are clinical oriented because that's still my goal is to help

00:49:40.460 people. And one of the ways of helping people is to help other clinicians who can then in turn

00:49:45.180 help their patients. There's something about this nutritional component that I think creates a lot

00:49:52.440 of confusion for people, which is that it tends to be in flux. So it's not constant. When I was young,

00:49:59.780 so call it the first athletic phase of my life, which I would say is about age 13 to 18. So between

00:50:06.660 the ages of 13 to 18, I was indestructible, just like most 13, you know, to 18 year olds are, you can do

00:50:12.680 anything. There is no such thing as overtraining, nor is there such a thing as overeating. I could consume

00:50:19.200 such comical amounts of food and they were really not of high quality at all, right? So, you know,

00:50:26.700 breakfast would be a box of cereal into a large Tupperware bowl, the entire box. I mean,

00:50:32.380 six or seven sandwiches for lunch every day. So a whole loaf of bread turned into sandwiches,

00:50:37.920 plus French fries, plus a one gallon thing of orange juice. I mean, just disgusting quantities of food,

00:50:46.120 food, but absolutely no impairment of performance or health, at least by any measurable amount.

00:50:54.460 But by the time I'm in the sort of second and third phase of my life into my late twenties and my

00:51:01.040 thirties, my tolerance for that amount of carbohydrate went down. And so even though I was

00:51:07.760 still exercising a lot, certainly by, by any normal standard, you know, I metabolically became quite sick

00:51:14.740 and I became the example of that guy who can't outrun his bad diet. Although in my case, I was out

00:51:23.980 swimming it. I was trying to out swim it or out ride it. And so how did you then either as a coach

00:51:31.480 or as a clinician trying to help just a normal person calibrate, not just the intensity of exercise,

00:51:41.460 not just the duration of exercise, but now this third layer, which is specifically, what is the

00:51:48.960 carbohydrate tolerance of the individual? Given that one, two people can be similar in very,

00:51:56.220 in a number of ways and yet be different in that regard. And secondly, any given individual is likely

00:52:01.360 going to see a deterioration of that over time. Sure. And we, we all become more insulin resistant

00:52:07.740 as the years go by. I like to call it carbohydrate intolerance because as soon as you say insulin

00:52:14.140 resistance to the average person, they either shut down or they panic or they totally ignore you

00:52:20.800 because that's a hard, it's a hard term to relate to because they can't relate to it. Carbohydrate

00:52:27.760 intolerance, at least when you say you're not tolerating the level of the amount of carbohydrates

00:52:34.040 you're reading. So you need to cut down. They can relate to that. They may not be happy,

00:52:39.100 but they can relate to that. But the more important factor was one that I already knew about, although

00:52:47.460 I didn't know how to apply it to patients, but I already knew going again, going back to undergraduate

00:52:53.920 school where this idea of wholism, you know, it came from philosophy really for me, this holistic idea

00:53:04.440 showed up one day. And I think out of that came this idea that we're all individuals and we all have

00:53:11.660 uniquenesses. And I carry that with me into my clinical world. And there wasn't much to do,

00:53:20.600 you know, to measure insulin resistance back then meant going into the hospital and having a

00:53:25.700 glucose clamp test. That was just unheard of. They laughed at me when I sent patients to the

00:53:32.360 cardiologist because I wanted to see, I want to measure heart rate variability in this patient

00:53:36.440 because I think there's an autonomic problem. Well, half of them didn't have any problem, but

00:53:41.040 the other half did. And they said, well, gee, how do you know that? You know, these things as a

00:53:46.080 clinician, because you do a good evaluation, you assess the patient and you spend a lot of time

00:53:53.920 talking to the patient, something that's not done anymore, wasn't done much back then either. But

00:53:59.480 by doing that, you learn about the patient. You learn about so many things, including insulin resistance.

00:54:09.240 How sensitive are they to insulin? How do they respond?

00:54:12.800 An obvious example is a New York City executive works in an office all day, training for a marathon,

00:54:21.000 goes out for lunch, comes back, and is so tired that he has to put his head on the desk and literally

00:54:27.400 fall asleep. Obviously, Bob, what did you have for lunch? Well, you start putting two and two together

00:54:35.260 and it's not that hard. And then just like the MAF test where you want to see what is this person

00:54:42.200 capable of doing at this given heart rate, I came up with another challenge, which was a food challenge

00:54:49.680 called the two-week test. Okay, Bob, I want you to not eat those things at lunch anymore. I don't even

00:54:57.000 want to have you eat those things for breakfast. In fact, let's take away all the junk food from your

00:55:05.680 diet and take and cut way down on the natural carbohydrates like lentils and beans and rice and

00:55:12.540 fruits and fruit juice, etc. And we'll do it just for two weeks. It's a challenge. We want to see how

00:55:19.240 you respond. So we gather all the signs and symptoms that are not normal. I fall asleep after meals. I fall

00:55:27.780 asleep easily at night because I'm so exhausted, but I wake up at 2 a.m., etc., etc. Okay, let's put these

00:55:35.220 things on the table. Let's do this two-week test after the two weeks of eating that way. Let's look

00:55:39.960 at all these signs and symptoms. Are any of them better or any of them worse? Well, yeah, three-quarters

00:55:46.140 of them are better. Of all the miracles I've seen in clinical practice, the two-week test is one of them

00:55:52.940 because you see these people become new people after a very short period of time. And it's really

00:55:58.540 amazing. I mean, it's because insulin is involved. Insulin has immediate effects. Carbohydrates have

00:56:04.620 immediate effects. The two-meal effect with, you know, it's just, it's almost an instant change. So

00:56:11.880 now you've gathered more information. You're still assessing the patient. But now we can start

00:56:18.400 individualizing things more and more. And that process was just ongoing. And again, I always wanted

00:56:26.520 to enlist the patient. So I wanted to say, okay, you've done this two-week test. You're feeling so much

00:56:32.220 better after two weeks. Now we want you to add some lentils to your midday meal or add a small piece of

00:56:41.540 fruit at breakfast or whatever. And let's see how you feel. Let's see if some of those signs and

00:56:46.980 symptoms come back with just one piece of fruit. Or let's see if you've lost 10 pounds, you're starting

00:56:54.620 to gain after a couple of weeks of only having a little bit of carbohydrate, whatever. But I want to

00:57:01.400 enlist them in the process. I want them to use their instincts and intuition, which we all have,

00:57:06.920 to understand what it feels like to eat too much carbohydrate before you've gotten there.

00:57:15.000 One more bite of this apple and I'm in trouble. I want you to know that. I think it's a very important

00:57:21.980 thing. It's a very human thing. And so that holistic component, that individualizing aspect of my work

00:57:31.100 has always been there. And in many ways, it makes it easier. People might say, well, if you just give

00:57:37.240 somebody a diet, it doesn't get any easier than that. Well, it doesn't get any rewarding when you do

00:57:42.640 that either. So it was a very important part, and it still is a very important part, even though I'm not

00:57:49.580 sitting with patients one-on-one anymore, usually. I may do some consulting, but I am writing. I am

00:57:56.980 still lecturing. And I could take that component of individualization, of holism, and get those points

00:58:05.760 across to people so they can take that and run with it, so to speak. Now, I, again, mentioned that I spent

00:58:14.060 all this time on a very low-carbohydrate diet and saw, you know, enormous improvements in my aerobic

00:58:20.160 fitness. When it was all said and done, my anaerobic fitness, my higher-level intensity fitness did not

00:58:27.500 deteriorate, but it took a very long time for that to come around. And the conclusion I drew from that

00:58:34.420 was athletes who were heavily involved in glycolytic activity really ought not restrict

00:58:43.620 carbohydrates as much as, say, athletes who are doing things that can be done at a much more

00:58:50.540 aerobic level. Now, a couple of years ago, you were part of a study that sort of flew in the face of my

00:58:56.880 assumptions because it was a very short study. It was a four-week study, and it put athletes on a very

00:59:03.440 low-carbohydrate diet. They averaged less than 10% and maybe 15% protein. So they were, you know,

00:59:09.280 if they weren't on a ketogenic diet, they were very close to it, and they were doing high-intensity

00:59:15.020 interval training. And you guys didn't find any difference between the groups suggesting that this

00:59:23.220 amount of carbohydrate restriction did not impair performance. What can you say about that study?

00:59:28.480 It was a good study. Part of it, actually, we published a separate paper on it showing that the

00:59:34.280 high-fat diet did not have any adverse effect on inflammation. But that study really came from this

00:59:41.860 idea that athletes can still burn high amounts of fat when they do interval training. Paul Larson did,

00:59:51.020 you know, that's how I met Paul. They did a study some time ago. They showed that high-intensity training

00:59:57.120 can still produce large amounts of, relatively speaking, fat burning, as opposed to, you know,

01:00:04.040 burning 100% carbohydrate, like you were mentioning earlier. I sent him an email, and I said, yeah, well,

01:00:10.980 I sent him an athlete I had worked on who we had done some lab studies on. And at, I don't remember

01:00:18.120 the numbers, but at about a 180 heart rate in this 36-year-old athlete, he was burning a lot of fat,

01:00:25.720 relatively speaking. And I said, yeah, here, you know, here's a, here's an example of what I found

01:00:31.220 clinically. And, you know, and so we've known this for a long time. It's good to see that you're doing

01:00:35.860 this. And, and he wrote me back and, you know, we've been colleagues ever since. And he was in that

01:00:42.340 study. So it was a study that showed what we are already knew clinically in, in a sense. And we wanted, we

01:00:50.020 wanted to demonstrate it from a lab standpoint. Do you remember how many participants were in that study?

01:00:55.720 I want to say 20, but I, I, that seems so long ago.

01:01:00.860 Okay. Yeah. So, I mean, it would be interesting to see if with a larger sample size, that is still

01:01:07.920 the case. And obviously at different levels of the athletes incoming, right? In other words,

01:01:14.600 is that true of recreational athletes only? Is it also true of high level athletes?

01:01:19.020 Yeah. These were students. I think Jeff has done, Jeff Volek has done some, some studies with the

01:01:25.020 higher level athletes, with some ultra athletes. Again, they're, they're not running as fast,

01:01:30.780 but they're running at a max level. These were students. And these were subjects who, the ones who,

01:01:38.980 who were on the very low carbohydrate diet were only there for a month. And my feeling is we really

01:01:47.360 should have gone longer. I think we could have seen different results, but, but they're only

01:01:52.680 there for a month. A month is long enough for some people, but not long enough for others. And

01:01:57.160 there's a good argument to make that, you know, it should be two months or even three months to really

01:02:02.500 stabilize that metabolic change, but whatever. It was a good study. And, you know, like other studies,

01:02:11.080 somebody will see it and say, Hey, this should be done with more people. Just like you said,

01:02:16.160 let's get more numbers. Let's get a wider age group. Let's get beginners, athletes, you know,

01:02:22.500 middle of the pack runners, professional athletes, professional athletes are really hard to get

01:02:27.480 because they don't want to do this. They don't want to go into a lab and do that.

01:02:31.980 But from a clinical standpoint, I love all these studies. I love being involved with them.

01:02:37.700 But for me, the bottom line is, can you, the athlete run faster at the same sub max heart rate?

01:02:48.080 In fact, I don't care what you do with your training or your diet. If you could run faster

01:02:54.280 at the same heart rate as the months go by, whatever you're doing is working, keep doing it.

01:03:01.480 So that MAF test is so powerful that that's really the only thing you have to sell people on.

01:03:10.780 And then when they start seeing that they're, they're not getting faster or when they see

01:03:16.060 they've gotten faster and now they're going to start doing some weight training, fatiguing type

01:03:21.880 weight training, or they're doing some intervals and then they get slower. You know, now you've got

01:03:27.580 their attention. Now you say, yeah, see, do you understand what's happening? And, you know,

01:03:32.380 they, they start feeling it because they say, well, you know, I, I felt it wasn't quite right.

01:03:38.640 Or I didn't feel comfortable doing that. Or I didn't, you know, so when I first started using

01:03:43.660 a heart monitor, I thought this is, this is interesting. This is biofeedback by definition.

01:03:49.440 We're, we're going to listen to, or we're going to look at our heart rate and we're going to respond

01:03:54.240 to what that heart rate does. And the goal is to be able to do that without this heart monitor.

01:04:01.600 So I thought really these heart monitors were just a one use, maybe for, maybe spend a whole week

01:04:07.480 doing it. Now you, you know how to run at one 30 heart rate. It never happened. Once in a while,

01:04:15.240 I see an athlete who knows exactly where they are. They know exactly when they could run at that max

01:04:21.820 fat burning level. And I've always been amazed by that. And there's some good ones and some mediocre

01:04:27.420 runners who, who were able to do that. But most people, we are in a no pain, no gain world. And

01:04:34.140 we're seeing injuries because someone watches the New York city marathon on TV. And the next day they go

01:04:42.160 out and they want to run like that lead pack runner. They want to stride out like, you know, come on,

01:04:50.100 man, you can't even break four hours in the marathon. No wonder you got injured.

01:04:55.380 Speaking of the marathon, I want to talk about this, this book you wrote in 2014, which was just

01:05:00.880 such a brilliant idea. The title of the book is one 59. The sub two hour marathon is within reach.

01:05:07.460 Here's how it will go down and what it can teach all runners about training and racing.

01:05:12.800 And of course, five years later in October of 2019, Kipchoge goes and runs one 59 40. Now we can

01:05:22.440 explain to people who care about the nuance that it was not technically a sub two in a world record

01:05:27.280 pace. It was sort of a contrived example of what could be done under the most optimal conditions. It

01:05:33.360 was not a race, but there's simply no denying that what Kipchoge did was unbelievable. He had tried a year

01:05:41.920 earlier and I believe came very close, was probably two double O I don't know, 40 seconds or something.

01:05:50.900 Yeah. Yeah. He was, he was pretty close. He was under 201. So let's put aside the, the technicality

01:05:57.900 of how this wasn't a, you know, a world record in the typical sense of how world records are run in

01:06:03.040 marathons, but instead just focus on what you thought needed to happen in 2014, why you thought

01:06:11.700 this was achievable and, and maybe what we learned from Kipchoge. Well, I had originally written an

01:06:18.440 article called the one 59 marathon back in the nineties. It was half, I wouldn't say that it was a kind of a

01:06:28.780 joke, but it was half goof, but half serious because the lead pack runners were running faster and

01:06:35.540 faster. World records were, were being broken all the time. There was no evidence that said,

01:06:43.440 this is going to stop. We're going to hit a plateau and we're not going to get any faster. There were

01:06:47.680 people who thought that I don't know where they got those ideas from, but we started seeing the fact

01:06:54.440 that age group runners were not getting faster. And I thought that was interesting. And, and when you

01:07:00.440 start putting numbers together, such as what if you wore a lighter shoe or what if you were three pounds

01:07:11.140 lighter, or what if you were shorter, or what if your body type was this? And of course, what if you were

01:07:19.020 a better fat burner, how much more energy would you have? And then again, the next obvious step is,

01:07:26.220 well, what is your MAF test need to be to run under two hours? And I was getting some runners who were,

01:07:36.980 who were starting to hit five minute pace for their MAF test. They're running five minutes a mile

01:07:46.460 at their MAF heart rate. And so I thought there's no indication that, that they're reaching a limit,

01:07:54.600 that they're hitting a plateau in, in performance. So why couldn't it keep going? And that's really

01:08:00.720 where the idea went and it turned into a book. And I'm not sure it was a book that sold very well. I think,

01:08:09.880 you know, in the nineties, when I wrote that article, a lot of people just asked me why I even wrote it,

01:08:15.680 you know, this is silly. What, you know, we're not going to see a 159 marathon in our lifetime.

01:08:23.400 And I said, well, how long do you plan on living?

01:08:28.380 So I think what this runner did was amazing. I don't like what he did. I don't like the whole

01:08:34.840 idea behind it. I still know that a runner is going to do it in Berlin or, or London on the right day.

01:08:42.580 And it's relatively soon it's going to happen. And I'll be much happier to see that.

01:08:49.480 And you're just saying, you're not happy with the way it was done because of the sort of contrived

01:08:53.200 nature of it.

01:08:54.980 Yeah. It was, it was an advertisement. I'm not opposed to advertising, but it was,

01:09:00.300 it was more like a circus. And I think it took away from professional running as a sport.

01:09:07.620 So that's what I didn't like about it. Yeah. It was, it was a Nike commercial for sure.

01:09:13.900 Do we know much about Kipchoge's nutrition or other factors that, that we could, you know,

01:09:22.520 extrapolate from, uh, for example, in a two hour race, you know, even at the level he's exerting

01:09:29.920 himself, he technically didn't, doesn't really need calories. Fluids should be enough. Do we know if

01:09:35.240 he actually consumed glucose during that race?

01:09:39.060 I'm not aware of what, what he consumed, if anything, you know, if properly trained,

01:09:45.000 obviously he was burning a lot of fat. If properly trained, he wouldn't have needed any added

01:09:49.780 nutrition, maybe not even water. You know, water is this interesting thing because it has a lot of

01:09:56.880 weight. And if you dehydrate a small amount, the time factor is significant enough where you're,

01:10:05.040 you're running faster. There's this window and I don't know if it's, if it's 2% dehydration from a

01:10:12.220 weight standpoint or, or what it might be. You have this game of dehydrating, but not impairing

01:10:20.540 performance. And as a result, you're getting lighter. And so you're going to, you're going to run,

01:10:25.840 be able to run faster. It's all about performance. If you can prevent impairment of performance,

01:10:32.060 that's where you want to be. But I don't have information. My, my impression with the, the

01:10:38.200 Kenyans, with the East Africans is that if you look back in history, we've got all these areas of the

01:10:45.700 world that have taken their place on the world stage of great runners. And now it's the Kenyans.

01:10:53.900 The question is number one, who's going to be next? Cause somebody else will be next.

01:11:00.740 But the real question is why have all these countries come and gone? And my feeling is that

01:11:06.880 in Kenya, you know, it's a very poor country. These young men and women have an opportunity to become

01:11:15.700 kings in their own country with the money they make on racing. And they go from race to race and they 0.98

01:11:22.620 race all the time and they burn out. And it's really sad, but I think that's what's happened.

01:11:31.860 And the ones I've met along the way at, you know, at the races and at different events,

01:11:37.140 a lot of them are, are burned out, but they're going to make as much as they can make as a job.

01:11:43.260 And, and that's it. Imagine being able to take one of those athletes and train them. I'd want to

01:11:50.220 say properly, but train them more effectively. I think you'd have a two hour marathon broken already

01:11:56.180 in a real race.

01:11:57.760 When you look at somebody like Kipchoge or guys at this top level, though, there is a longevity to

01:12:03.480 them, which is they're, you know, I've spoken with really world-class marathoners and many of them

01:12:09.880 will sort of acknowledge they might only have a dozen marathons in them, you know, in their entire

01:12:14.680 career where they're going to really be able to run at a certain level. And that's, you know,

01:12:20.640 that says, look, I might only have 12 marathons over 15 years in me that are truly world-class

01:12:26.900 performances. And that's, that's sort of a different philosophy than the churn and burn

01:12:31.800 philosophy. Like look at Meb when he won the Boston marathon. I mean, he was what? 39.

01:12:37.540 How old was Kipchoge when he went under two? I mean, he was in his mid thirties, wasn't he?

01:12:42.540 Yeah. And that's what, that's what I, you know, in the book, I wrote this, this is the makeup of a

01:12:47.160 one 59 marathon or someone who's in their thirties, not someone who's, who's in their twenties,

01:12:52.100 not somebody who could run a great 10 K. They had almost had to have run a

01:12:56.840 great 10 K when they were younger, but now that they're 35 and they've, they've built this great

01:13:02.720 endurance base. Now they've got the best of everything. And so, yeah, I, my feeling is that

01:13:08.920 you're, you're in your mid to late thirties and maybe even forties, man. I've just, I've worked

01:13:15.040 with some incredible 40 year olds who have won some races and, you know, history has shown these

01:13:22.000 people and people are, you know, often say, well, these are amazing people. They're outliers.

01:13:27.460 I don't think they're outliers. I think it's, I think it's the norm.

01:13:31.120 So I want to talk a little bit about a term that you were, you've used it a couple of times today.

01:13:37.120 And I, and I've heard you, you know, or seen you write about it before, which is you don't like the

01:13:41.400 term overweight. You like the term over fat. You, you, you're, you're very clear to talk about

01:13:48.740 it's adipose tissue. We should be concerned with not mass. How do you think about that in the

01:13:54.500 overall context of health? You know, we, we tend to focus on weight. You know, if we get one more

01:14:00.180 layer of sophisticated, we look at body mass index, which of course is a highly flawed metric,

01:14:04.780 but where do you see the trends in fatness and how does that factor into maybe what you said earlier,

01:14:12.980 which is at the level of recreational athletes, we're not really seeing much improvement in

01:14:19.300 performance. Are those related? I think they're related in terms of the diminishing performance

01:14:26.620 of age group athletes. The problem, clearly the over fat condition can typically add weight to the

01:14:35.100 body. So that's going to affect a running performance, but more significantly, those people

01:14:40.940 with excess body fat have some downstream problems that can be very serious. We're talking about

01:14:48.060 chronic disease. So along the way to chronic disease, you have blood fat abnormalities, blood

01:14:55.960 sugar abnormalities, blood pressure abnormalities, and these things then lead to chronic diseases. So

01:15:02.900 of course, in that situation, people are not going to be performing their best over fat, excess body fat,

01:15:10.000 also impairs the immune system. So people tend to get sick more often. And Paul Larson and I wrote a

01:15:17.940 paper on this regarding COVID early, early on in the spring, actually. And people with excess body fat

01:15:26.120 also have physical impairment problems more frequently. And so we're talking about the basic,

01:15:34.280 simple injury that plantar fasciitis and also pain patterns. So low back pain on the less serious all

01:15:42.040 the way to the arthritities that are affecting runners. But again, in an injured athlete, you're not going to

01:15:50.040 perform your best. So these things are going to, over the years, show diminishing performance in age

01:15:58.540 groupers. And it's number one, that's really sad to see. Number two, it's even more sad to not be

01:16:05.540 acknowledged. I just don't see people talking about this. I don't understand why.

01:16:11.180 I think people are starting to acknowledge that it always takes longer. I guess someone like you,

01:16:17.540 who's sort of been clinically at the forefront of a lot of these things, it seems like what's taking so

01:16:24.440 long because you're seeing these things many years before. But for example, sugar consumption is

01:16:31.520 actually declining. But it sometimes takes a while for this decline to necessarily translate into some

01:16:38.780 of the health benefits. And furthermore, these things are so multifaceted, right? I think that,

01:16:44.940 I don't actually know the data on this, so I'm kind of making this up, but I would guess that you can

01:16:48.600 sometimes see an improvement in one parameter and a deterioration in others. For example, activity levels

01:16:53.440 might be declining, even while certain elements of nutrition improve. And so the net effect of that

01:16:59.360 could be a reduction or something we didn't talk about, sleep. Quality of sleep could be declining,

01:17:04.580 and that can sort of offset any benefit that we see. But this idea that health and performance are not

01:17:13.200 necessarily the same thing is something I see a lot of people struggle with it, right? I see a lot of

01:17:19.480 people who are not very healthy believe that the key to getting healthier is to train for a marathon

01:17:28.100 or train for an Ironman or train for this bike race or train for this event. And it usually puts me

01:17:36.520 in a bit of an awkward position because on the one hand, I'm so grateful that they have found something

01:17:40.520 to do to be active and to train for. And I don't want to discourage that.

01:17:43.980 But I also want them to understand that there's nothing especially healthy about doing an Ironman

01:17:50.880 and that one doesn't need to do that to be healthy. So do you have a message for folks around that?

01:17:58.440 Well, I have a lot of messages for them around that, but the main one is that they don't have

01:18:02.340 to do it just like you said. And in fact, all they have to do is start walking around the block

01:18:07.800 and the benefits, the fat burning benefits that they'll get from that are huge, but also

01:18:16.520 that the food is more important. And so they need to look at the big picture. And of course,

01:18:23.520 they need to look at stress also, but the food is such a key factor in all of this. And going back to

01:18:31.560 the question you asked me, what is MAF, maximum aerobic function? How can we maximize our aerobic

01:18:37.680 system? Well, two of the components of lifestyle are food and exercise. And sure, stress is a very

01:18:46.760 important factor. And yeah, you can't smoke cigarettes and drink too much alcohol, but food

01:18:52.520 and exercise are keys. And it's really, really simple. Just don't eat junk food and take it easy out

01:18:59.640 there. Well, Phil, on that note, I think we've given folks a lot to think about today. And I want

01:19:04.720 to thank you for your time. You're going to be ready for dinner soon, which it sounds like you skip

01:19:09.220 anyway, right? Yeah, I'm here when they will be starting to eat dinner soon and I'll be watching,

01:19:17.720 which is okay because I'm not hungry. But thank you, Peter. I enjoy your work. I have for quite some

01:19:25.240 time and thanks for having me on. It's been great. Thank you, Phil.

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The Peter Attia Drive - January 11, 2021

#144 - Phil Maffetone： Optimizing health and performance through maximal aerobic function

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