#338 ‒ Peter's takeaways on aerobic exercise and VO2 max, insulin resistance, rising healthcare costs, treating children with autism and ADHD, and strength training ｜ Quarterly Podcast Summary #4
Episode Stats
Words per Minute
186.94276
Summary
In this episode, I discuss what I learned from the last quarter of interviews, and what I think were some of the most important insights, as well as things that have resulted in a change in my work and behavior. Please note that I do not think listening to the quarterly podcast summary even remotely constitutes a substitute for listening the actual episodes. My hope is that it basically helps you think about refining what you might have learned there, and if something you hear in one of these summaries is of interest, I hope you go back and listen to it.
Transcript
00:00:00.000
Hey everyone, welcome to a sneak peek, ask me anything or AMA episode of the drive podcast.
00:00:16.320
I'm your host, Peter Atiyah. At the end of this short episode, I'll explain how you can access
00:00:20.780
the AMA episodes in full, along with a ton of other membership benefits we've created,
00:00:25.400
or you can learn more now by going to peteratiyahmd.com forward slash subscribe.
00:00:31.100
So without further delay, here's today's sneak peek of the ask me anything episode.
00:00:39.400
Welcome to another special AMA episode of the drive. Today's episode will be the fourth
00:00:44.360
installment of the quarterly podcast summary. In this conversation, I discuss what I learned
00:00:49.540
from the last quarter of interviews and what I think were some of the most important insights,
00:00:53.520
as well as things that have resulted in a change in my work and behavior. Please note that I do not
00:01:00.080
think listening to the quarterly podcast summary even remotely constitutes a substitute for listening
00:01:06.200
to the actual episodes. My hope is that it basically helps you think about refining what you might have
00:01:12.120
learned there. And if something you hear in one of these summaries is of interest and you missed the
00:01:17.400
original episode, I hope you'll go back and listen to it. In today's episode, we cover the interviews
00:01:22.040
that I did with Olav, Alexander Boo, Ralph DeFranzo, Sam Sutaria, Trenna Sutcliffe, and Mike Istratel.
00:01:30.980
And throughout these, we talk on various topics, VO2 max, power at VO2 max, insulin resistance,
00:01:37.160
metformin, SGLT2 inhibitors, GLP-1 agonists, U.S. healthcare costs, diagnosis and treatment approaches
00:01:43.840
to autism, ADHD and anxiety, zone 2 resistance training, and learning all of the effects of
00:01:52.280
anabolic steroids. And yeah, that sounds like a hodgepodge of topics, but that's because it's
00:01:56.800
pulled from all of these discussions. If you're a subscriber and you want to watch the full video of
00:02:01.580
this podcast, you can find it on our show notes page. If you're not a subscriber, you can watch the
00:02:06.740
sneak peek of the video on our YouTube page. So without further delay, I hope you enjoy this special
00:02:11.520
quarterly podcast summary AMA of The Drive. Peter, thanks for joining us on another AMA
00:02:22.440
on your own podcast. We appreciate you coming by. I always appreciate being here. Thank you for
00:02:26.800
having me. Anytime, anytime. So today is going to be another quarterly podcast summary episode. A lot
00:02:33.940
of words. Basically what it means is we look at past episodes, cover what the main takeaways are,
00:02:39.800
what your favorite insights were, any changes you made based on behavior to yourself, how you work
00:02:45.920
with patients, how you think about things, anything of that nature from those episodes. The other thing
00:02:51.420
to say as a reminder, it's meant as more to augment the episodes, not necessarily as a replacement.
00:02:57.480
And we get a lot of feedback where people will listen to this and then re-listen to some of the
00:03:01.700
original episodes and find a lot of value in it. Today, we'll look at Olav, talking about training,
00:03:08.260
performance, VO2 max. Ralph, looking at insulin resistance, type 2 diabetes, metformin, SGLT2
00:03:14.900
inhibitors, other drugs. SOM, looking at healthcare, trying to understand why healthcare in the U.S.
00:03:21.000
is nearly two times per capita of any other developed nation. Trenna, looking at autism, ADHD,
00:03:27.280
anxiety. We have Mike looking at resistance training and kind of diving into everything
00:03:33.680
revolving that. So huge variety of topics, a lot of different things that I think people should find
00:03:39.400
interest in. And I think we'll get it started with Olav. So do you kind of want to start going
00:03:45.800
through your episode with Olav? This was obviously the second time he was back on, a little behind
00:03:50.440
the scenes. We talked beforehand about, hey, let's try and make it a little less technical because the
00:03:55.460
first one was pretty technical. And I think looking back, you probably made it more technical in the
00:04:00.440
first. So I think that's just by nature how you and Olav are always going to be. So maybe break down
00:04:06.040
for people what you learned and what your biggest insights were from that. Yeah. And before we dive
00:04:11.160
into this, at least in as long as we've been doing quarterly podcast summaries, I will say this might
00:04:16.060
end up being the longest because just by the nature of coincidence and which podcasts fall into the
00:04:22.160
past quarter, this is probably the most voluminous set of notes I've ever taken across a set of
00:04:28.220
podcasts. In fact, I would say that two of the episodes that we've covered here, the one with
00:04:33.560
Ralph and the one with Psalm, were easily three to four X the volume of notes I normally take.
00:04:40.720
Impute from that what you will. I've done my best to try to synthesize that. But nevertheless,
00:04:45.940
there's a lot going on in this past quarter. Okay. You're right. I wanted to make the Olav one at the
00:04:50.900
outset just straight into less technical things. And I could not resist the tractor pull of trying
00:04:58.840
to at least explain some technical things. So we started the discussion by explaining the
00:05:03.480
difference between things like functional threshold power and critical power. I hesitate to bring these
00:05:08.580
up now because I just don't think they're relevant unless you are a cyclist. But if you are interested,
00:05:14.580
I'll just state it. The functional threshold power or FTP is the power that you can hold for one hour.
00:05:20.900
That is one way to test it. You literally get on a bike, usually on an ERG. So it's a stationary bike
00:05:26.300
and you ride as hard as you can without blowing up for one hour. And whatever the average power is
00:05:32.100
that you held as your FTP, much more typically, for example, when I was a cyclist, we would do this
00:05:37.480
in a 20 minute test and we would discount it by typically 10%, although Olav suggested only 5%. In my
00:05:44.380
experience, 10% was necessary. There's something called critical power, which is very similar,
00:05:49.900
but rather than it being the power you can hold for an hour, it's the power you can hold for 30 to 40
00:05:54.340
minutes. I think the more important distinction here is that you can calculate critical power much
00:05:59.880
easier. You can do it from a set of curves that are derived from three to four individual tests that
00:06:08.700
are much shorter. Why is this relevant? This is relevant because if you want to have other metrics
00:06:15.340
beyond VO2 max for higher end aerobic efficiency, you might want to know your FTP or critical power
00:06:23.200
and critical power is much easier to measure. So these days, and this ties into another insight,
00:06:29.300
by the way, these days, I don't spend a lot of time worrying about my FTP. In fact, I don't know what
00:06:33.040
it is because I haven't done a 20 minute power test since NAMM. Don't necessarily think I'm going
00:06:37.620
to do one anytime soon, probably because I don't want to see how low it is, but it made me realize
00:06:42.380
maybe I ought to do a critical power test just so that I have another benchmark to be tracking.
00:06:49.220
So we talked about a few other things, which I'm not going to go into anaerobic threshold and stuff.
00:06:52.860
We covered a little bit of that in the first podcast. Another very interesting insight that came up
00:06:57.860
for me in this podcast, which was really just a personal insight, and I hesitate to spend too much
00:07:01.820
time on it, was talking about the relationship between VO2 max and PVO2 max or VVO2 max. So if
00:07:08.440
you're a cyclist, what does that mean? PVO2 max means what is your power when you are at VO2 max?
00:07:15.960
Again, VO2 max, just to make sure everybody knows what I'm talking about. This is maximum ventilation,
00:07:20.280
meaning maximum oxygen consumption. It's usually sustained for at least a minute when you're doing
00:07:25.160
the test. So what's the highest amount of oxygen in liters per minute that can be consumed
00:07:29.280
for a minute. And this is achieved during a ramp exercise, almost exclusively done on a bike or
00:07:36.840
on a treadmill, stationary bike. And when you hit that VO2 max, if you're on a treadmill,
00:07:41.820
you will note that, hey, there's a velocity, assuming you're running flat, or you might see,
00:07:45.900
oh, actually I'm on a bike and my PVO2 max is the power that I've achieved. Now, some have argued
00:07:52.040
that VVO2 max or PVO2 max are actually more predictive of sports specific performance than
00:07:59.300
just the number VO2 max. And I think there might be something to that because I shared my numbers with
00:08:05.860
Olaf. And the truth of it is, I have always had a very low PVO2 max to VO2 max. Stated another way,
00:08:15.160
I have always had a VO2 max that is higher than many people who are much better cyclists than me.
00:08:22.240
It wasn't uncommon when I was training that my VO2 max was 15 points higher than people
00:08:28.200
who had a higher FTP than me, for example. And what Olaf suggested there is it speaks to
00:08:33.820
really inefficient, probably over-training aerobically, under-training anaerobically.
00:08:38.800
So there's an inefficiency there. And that inefficiency means that I am actually requiring
00:08:45.160
more energy across the board to put out more power. Now, something very interesting that comes
00:08:51.000
from that is there might be an association between people like that and a lesser propensity to gain
00:08:57.140
weight. And it is true that every time I've done a resting metabolic expenditure test, or anytime I've
00:09:04.460
done the more elaborate stuff, I've actually done the doubly labeled water test in the metabolic
00:09:07.960
chambers, I always seem to have a through-the-roof energy expenditure for my body weight.
00:09:14.020
So I guess for the first time that all kind of came together, which was, wow, on the one hand,
00:09:18.000
I have an advantage, perhaps, in that I have a very high energy expenditure. So relative to somebody
00:09:23.080
else who eats as much as I do, I'm going to be leaner. But the flip side of that is I'm actually
00:09:27.600
quite inefficient at utilizing energy. So again, I found that very, very interesting. One of the other
00:09:32.840
things we talked about was, hey, is there anything that a person can do besides the obvious,
00:09:37.540
which is training to boost their VO2 max? He mentioned something about beetroot. Wasn't
00:09:42.200
familiar with this, but beetroot concentrate, he said, is rich in nitrates. Body converts it into
00:09:46.860
nitric oxide. And that, of course, helps with vasodilation, opens up capillary beds. It should
00:09:51.680
be stated then, of course, that anything that impairs nitric oxide synthase, and there are many
00:09:56.180
things that do from homocysteine to insulin resistance, is going to impede it. Again, he said at the elite
00:10:01.880
level, this doesn't have much of a difference. But in amateur athletes, like the rest of us,
00:10:07.040
can be about a 5% boost. The other thing he talked about that I thought was really interesting
00:10:10.840
was, and again, this was to me just more gamesmanship than anything else. And I can't
00:10:14.580
wait to try it the next time I do a VO2 max test, which, by the way, is probably going to be this
00:10:18.340
weekend or next. He said, as you approach failure, do a few breath holds. And he said that that produces
00:10:25.320
a significant boost in VO2 max. Again, it's just a reactive overconsumption of oxygen. I don't know
00:10:30.600
if that means anything. One of the other things that I asked him about was the use of acetaminophen.
00:10:37.360
Again, there are some data that suggests that acetaminophen use can boost peak endurance
00:10:42.960
performance by 1% to 2%. I asked Olaf if Christian or Gustav used acetaminophen themselves during
00:10:50.000
Ironman, and he said they did not. And he raised a point that I thought was interesting, which is,
00:10:54.900
well, acetaminophen or Tylenol can obviously reduce the perception of pain, which has been one of the
00:10:59.800
arguments for why it boosts performance. It may impair the athlete from giving off heat from heat
00:11:05.380
dissipation. And so he just questioned whether or not that might be a worthwhile trade-off. Of course,
00:11:10.000
for me, that begs the desire to do an experiment and find out. Another area that we talked about,
00:11:14.980
which, again, isn't relevant to me and the way I train, but if any of you are listening and you are
00:11:19.260
really high-performance athletes, I think this is arguably probably the single most important takeaway
00:11:24.180
from this podcast, is what the upper limits of carbohydrate consumption are while doing cardio
00:11:30.100
activity and racing. So again, if you're a triathlete, if you're a cyclist, if you're a
00:11:35.000
runner, less applicable in running because the races are typically so short. But of course, if you're an
00:11:39.120
ultramarathon runner, that would not be the case. So everybody's kind of done this math, which is if
00:11:43.580
you're doing an Ironman or something like that, you're probably, depending on your level of fitness,
00:11:47.800
expending somewhere between 700 and 1,000 kilocalories per hour. Let's even be conservative
00:11:56.420
and say you're really, really just going easy. You'd be at 600 to 700 kcal per hour. Now, we don't
00:12:02.920
have that much stored glycogen. You've got maybe 50, 100, maybe 200 grams of glycogen if you have
00:12:11.860
really big muscles stored, which you're going to run out of pretty quickly. That's going to supply
00:12:17.420
you for maybe an hour and a half. So thereafter, you have to meet your needs from body fat and
00:12:23.640
intake of carbohydrates. And the conventional thinking has always been that you can only
00:12:27.860
consume about 60 grams of glucose per hour. And 60 grams of glucose, of course, is only about 240
00:12:33.980
kilocalories. This has always been one of my main arguments for why being fat adapted is very important
00:12:40.180
because if you're consuming that 60 of glucose and that's giving you whatever it's giving you,
00:12:44.600
you have to get the balance from fat and you're only going to do that if you're heavily fat adapted.
00:12:48.160
So you get into this cycle. Well, what we've seen unquestionably is I think the biggest,
00:12:53.220
honestly, the biggest innovation in endurance sports like the Tour de France and Ironman
00:12:57.800
over the past decade is the amount of glucose that these guys are able to consume.
00:13:02.800
He talked about numbers I had never heard before. As some of you may recall, I interviewed
00:13:07.120
Tadej Pogacar recently, the greatest cyclist on the planet. His numbers blew my mind of the type
00:13:12.600
of carbohydrate intake that he was tolerating, 150, 180 grams per hour. Olaf said that they're now
00:13:20.140
pushing triathletes at the world-class level to 240 grams per hour. Again, this is unbelievable to
00:13:26.720
me. And what that basically tells you is you can meet all of your glycolytic needs indefinitely
00:13:32.240
through that. Now, again, just as Tadej said, you have to train this system. These are athletes that are
00:13:39.800
required to now consume gels and eat carbohydrates at a 12% mixture. What does that mean? 12% mixture
00:13:48.160
means 120 grams per liter. 10% mixture is 100 grams per liter, etc. Conventional wisdom is that we can't
00:13:58.220
tolerate, meaning our gastrointestinal system cannot tolerate more than a 5% mixture. And I know for me
00:14:04.560
personally, when I used to be doing ultra distance stuff, I had a hard time going above 5% to 6%
00:14:10.020
myself. But what Olaf said and what Tadej has also said separately is you can actually train your GI
00:14:16.760
system to double that. And so how these guys are drinking two liters per hour of a 12% mixture,
00:14:23.420
which would be 240 grams, I simply can't fathom. But clearly that's what they're doing. Or they're doing
00:14:28.920
it in some combination. So they're consuming gels plus water that amounts to that mixture. But I
00:14:34.340
think when you look at the hyperbolic performance of endurance athletes today, it's very quick and
00:14:40.500
tempting to just say, ah, they must be just using drugs we haven't figured out yet. Yeah. It's also
00:14:44.620
the fact that I think another explanation and the one that I find more appealing is that they literally
00:14:50.420
figured out how to double the octane of the fuel. I mean, that's effectively what's happening.
00:14:55.080
It's like a car that went from racing at 70 octane to 140 octane. And I'm not going to bother explaining
00:15:02.540
what octane is. I'm not even sure if there's a 140, but you know what I'm getting at. So I would say
00:15:06.640
those are probably the most important things. I guess the last thing that I would take away from
00:15:12.180
this is he offered a great protocol for how to make sure you're giving it your best when you do a
00:15:19.340
VO2 max test. This has already been something that I've started implementing a little bit more with
00:15:25.000
our patients and making sure that, for example, if they do a VO2 max test, I've always asked people
00:15:30.280
to describe the protocol. And many times I'm not pleased with the protocol, but this was the kind
00:15:34.580
of, I think, really super duper protocol. You want to do this at the time of day that is a normal time
00:15:40.960
that you would be training. So you want to be well rested, et cetera. Minimize traveling the day
00:15:45.020
before. So we try to tell our patients the same thing. If you're coming into Austin for a VO2 max test,
00:15:50.740
boy, it would be really great if it was just a short flight the day before. And if it's
00:15:54.280
international, please come in more than a day before, if you want to maximize the test,
00:15:58.080
the warmup should be basically six minutes. Very, very easy. Six minutes zone two, three minutes at
00:16:06.680
threshold or FTP two to three times at a 10 to 15 second burst at about what you expect your PVO2 max is
00:16:15.680
then a relatively short rest of 10 to 15 minutes, get a drink and then get on with it. Yeah. So I would
00:16:22.700
say that those are probably the most important things, Nick, that I took away from this podcast.
00:16:26.120
So Peter, just a few follow-up questions there. Let's just start with the VO2 max training. So
00:16:33.280
in that protocol, it actually is like a decent warmup that you're having people do.
00:16:38.040
I remember when I've done VO2 max testing, I don't know if they even really had me do
00:16:42.680
any type of warmup. You just kind of went, hit the treadmill and then started going. So you're
00:16:47.640
having people go through a little bit of a workout before they get going.
00:16:52.560
Yeah. And I'll tell you this. I do most of my VO2 max testing outdoors. Now I use that VO2 master
00:16:57.360
device, which I love. I'm going to leave from my house. I'm going to ride 10 to 15 minutes to the
00:17:03.700
place where I do my hill repeat. So that's a warmup in and of itself. And by the way, getting there,
00:17:08.660
there are a couple of short little climbs where I'll do 30 seconds of relatively high power just to
00:17:13.440
get up over a little pitch. I will do two to three full runs of the hill at escalating power
00:17:21.220
before I'm truly going to hit my max. So I'll do like a four to five minute up, maybe 85% of what
00:17:29.280
my maximum power would be for that climb, come down for the same amount of rest period, go up again
00:17:35.440
at maybe 90% of what my maximum power would be, come back down, and then maybe I would go and give
00:17:41.680
it. The third one would be out there. So by the time I've done it, I've really warmed up. And so
00:17:45.120
the other day I was talking to a patient who did his VO2 max test at a facility. It was at a university
00:17:50.200
that he went to do it. It was just like a place where you can go and pay to do it. And I was kind
00:17:53.940
of surprised at what his number was. It was lower than I expected given his training. I said, tell me
00:17:59.100
about the protocol. And he's like, yeah, I just got on the treadmill and they just started cranking it.
00:18:02.340
And I was like, and how long after you started on the treadmill, did you hit VO2 max? And he's like,
00:18:06.280
I don't know, five minutes. And I was like, yeah, that's a garbage protocol. You were not warmed up and ready to do
00:18:11.500
that. You mentioned you have a VO2 max coming up. When was the last time you tested prior to this?
00:18:17.260
In the spring. And the reason is because I like doing it outdoors. I have noticed because I live
00:18:23.360
in Texas, how much of a performance hit I take in the summer. Like it's a noticeable difference in
00:18:29.780
the summer. So I'm like, yeah, I just would rather do it in the spring. Fall, winter, spring is when I
00:18:34.060
prefer to test. Let's say the month leading up to it. So the past month, have you changed your
00:18:38.860
training at all? Are you doing anything in particular for it? Not at all. This is just
00:18:43.120
a data check. It's just like, I had my blood drawn this week, had my DEXA scan a couple of weeks ago.
00:18:48.160
I'm doing a VO2 max. In general. So if you haven't changed anything, just as a reminder for people,
00:18:53.720
what is your VO2 max training look like in a typical week? Is that one day a week?
00:19:00.080
Just one day a week. Yeah. It's three days a week of zone two and one day a week of interval training.
00:19:05.700
But interval training at that specific four, five, upper limit, eight minute intervals.
00:19:13.160
And I always like when we talk VO2 max training, I think back to one of the actually first video
00:19:17.860
podcasts we ever did with Alex Hutchinson. Do you kind of want to walk people through,
00:19:21.740
I think a lot of times when you think of VO2 max training or Tabata training or like going all out,
00:19:27.960
a lot of times people kind of lose sight at how hard that actually is. Do you kind of want to walk
00:19:34.620
through if you're doing actual intervals, real VO2 max training, what that feels like?
00:19:40.700
VO2 max training hurts less than a true Tabata. I mean, a true Tabata, that's where I think people
00:19:48.060
have a hard time understanding what all out means. I mean, technically, I don't think the human body is
00:19:52.640
capable of going all out for more than 10 seconds. So even at the level of a Tabata, which is a 20 second
00:19:59.000
effort followed by a 10 second rest repeated eight times or done eight times, even a 20 second,
00:20:06.000
there's just a governor that is self-regulating how hard you go. The reverse Tabata, where you go 10
00:20:12.620
seconds all out, 20 seconds rest for eight rounds. That's about the closest thing that I think we're
00:20:18.380
capable of doing as a truly all out. You will increase your VO2 max doing that type of an exercise,
00:20:24.480
but not nearly, not nearly as much as if you're doing intervals in the three to eight minute range.
00:20:30.940
And by definition, if you're doing something for three to eight minutes, you're not going all out.
00:20:34.860
What you're trying to do is go as hard as you can for that distance and for that time. So it's a
00:20:42.640
different animal. Obviously, I think it hurts more because it's a lower level of peak pain, but it's
00:20:47.380
spread out over a longer period of time. So the area under the pain curve is greater, but it's far from
00:20:53.240
all out. And at any moment in time, the pain is not the same. Can you remind people, let's say you're
00:20:59.600
doing a four minute interval. You're not starting at four minutes, going as hard as you can, and then
00:21:05.700
trying to sustain it. Can you walk through how you think about the energy you put out spread across
00:21:11.200
four minutes? Yeah. Technically the power is constant throughout the four minutes. So I know in my mind
00:21:17.660
how many watts I want to produce and what I want my average wattage to be over the five minutes. So
00:21:24.080
let's just say I want to do five minutes at 300 watts. Of course you're outdoors, so you don't have
00:21:30.380
complete control. It's always jumping around, but I'm really watching the three second power tracing and
00:21:35.720
the average power to keep it there. Well, after the first minute, I barely know I'm on the bike.
00:21:40.360
It should be really easy after a minute. If you're dying after the first minute, you've set your target
00:21:45.820
too high. Two minutes in, you know, or two and a half minutes in when I'm halfway done, I still feel
00:21:51.280
pretty good. My heart rate is now going to be within about five beats of what its maximum is,
00:21:57.940
but I still feel pretty good. It's really at about minute three, three and a half that the pain train
00:22:03.920
starts to leave the station. And that's when it really starts to feel miserable. And that last minute
00:22:09.040
is really, really difficult. If you've done this right, when you finish this, you're really going to need
00:22:14.940
that four or five minutes of very, very easy peddling to let your heart rate come back down
00:22:20.560
to then repeat it. But again, the goal is not to have killed yourself in that five minutes such that
00:22:26.140
you can't do it again. Because what I'm trying to do is actually preserve that power across all the
00:22:31.420
intervals. Got it. Last follow-up on this is you talked about the consumption and like the increase in
00:22:38.160
performance as a result of what they're able to consume when they're performing. How much of a
00:22:43.240
difference do you think that makes? Or how can you explain it? A lot of lay people probably aren't
00:22:48.380
thinking about that consumption or their mixture. I know a lot of endurance athletes are, but
00:22:52.440
how much of a game changer do you think it is to have that increase in what they're able to put in
00:22:58.200
their body during events? Well, again, for people like me and probably most people listening to this
00:23:04.620
podcast, this is not something that should be on our radar. I don't think there's ever going to be a
00:23:08.960
day when I'm doing a 10-hour endurance event again. And therefore, I don't really need to worry about
00:23:14.100
it. If I'm exercising for two hours, that's kind of a long time. So at two hours, I'm fine with just
00:23:19.640
water. I'm living off my own glycogen and whatever. But it's very difficult now to think about people
00:23:26.260
competing at a world-class level in cycling and Ironman because what Olaf and many others have now
00:23:32.820
argued is the problem of peak endurance is effectively an energetic problem. It's basically a
00:23:39.320
question of how much chemical energy in the form of food can you convert into electrical energy
00:23:46.580
via the metabolism of food back into chemical energy in the form of ATP, back into mechanical
00:23:53.420
energy. It's just an energy transfer problem. And more energy input means more energy output. The more
00:23:59.840
logs you can put into the fire, the hotter the fire burns, the more steam it makes, the faster the
00:24:06.760
wheel turns. That's basically what it comes down to. And what we've seen over the past decade is
00:24:11.360
quite literally a more than doubling of the feedstock that goes into the furnace.
00:24:18.140
Got it. All right. Anything else on Olaf before we move on?
00:24:22.500
Perfect. So next is Ralph on insulin resistance, which I think you said was one of the more
00:24:29.840
interesting interviews you've ever done, correct?
00:24:32.760
Thank you for listening to today's sneak peek AMA episode of The Drive. If you're interested
00:24:38.520
in hearing the complete version of this AMA, you'll want to become a premium member. It's
00:24:43.800
extremely important to me to provide all of this content without relying on paid ads. To do this,
00:24:49.060
our work is made entirely possible by our members. And in return, we offer exclusive member only content
00:24:55.140
and benefits above and beyond what is available for free. So if you want to take your knowledge
00:25:00.060
of this space to the next level, it's our goal to ensure members get back much more than the price
00:25:04.880
of the subscription. Premium membership includes several benefits. First, comprehensive podcast
00:25:11.020
show notes that detail every topic, paper, person, and thing that we discuss in each episode.
00:25:16.580
And the word on the street is nobody's show notes rival ours. Second, monthly ask me anything or AMA
00:25:24.180
episodes. These episodes are comprised of detailed responses to subscriber questions, typically focused
00:25:29.740
on a single topic and are designed to offer a great deal of clarity and detail on topics of special
00:25:35.420
interest to our members. You'll also get access to the show notes for these episodes, of course.
00:25:40.400
Third, delivery of our premium newsletter, which is put together by our dedicated team of research
00:25:45.900
analysts. This newsletter covers a wide range of topics related to longevity and provides much
00:25:51.580
more detail than our free weekly newsletter. Fourth, access to our private podcast feed that provides
00:25:58.960
you with access to every episode, including AMA's sans the spiel you're listening to now and in your
00:26:05.080
regular podcast feed. Fifth, the Qualies, an additional member only podcast we put together that serves as a
00:26:12.520
highlight reel featuring the best excerpts from previous episodes of the drive. This is a great
00:26:17.720
way to catch up on previous episodes without having to go back and listen to each one of them. And
00:26:22.600
finally, other benefits that are added along the way. If you want to learn more and access these
00:26:27.720
member only benefits, you can head over to peteratiamd.com forward slash subscribe. You can also find me on
00:26:35.060
YouTube, Instagram, and Twitter, all with the handle peteratiamd. You can also leave us review on Apple
00:26:41.420
podcasts or whatever podcast player you use. This podcast is for general informational purposes only
00:26:47.720
and does not constitute the practice of medicine, nursing, or other professional healthcare services,
00:26:52.520
including the giving of medical advice. No doctor patient relationship is formed. The use of this
00:26:58.540
information and the materials linked to this podcast is at the user's own risk. The content on this
00:27:04.680
podcast is not intended to be a substitute for professional medical advice, diagnosis, or
00:27:09.180
treatment. Users should not disregard or delay in obtaining medical advice from any medical condition
00:27:14.580
they have, and they should seek the assistance of their healthcare professionals for any such
00:27:19.180
conditions. Finally, I take all conflicts of interest very seriously. For all of my disclosures and the
00:27:25.280
companies I invest in or advise, please visit peteratiamd.com forward slash about where I keep an up-to-date