Dhru Purohit Show - Longevity Expert Andy Galpin Shares the Number One Predictor of Health-span, And It’s Not What You Think!

Episode Date: April 10, 2024

This episode is brought to you by Birch Living, Lifeforce, and Plunge.  We’ve heard of tests that are used as traditional measures of longevity. Still, a lesser-known but equally important test that should be factored into longevity and long-term independence is VO2 max. This test measures how well your body uses oxygen during exercise, which ultimately translates into how efficiently your body uses oxygen in daily activities as you age. According to today’s guest, increasing VO2 max can significantly reduce your risk of all-cause mortality.  Today, on the Dhru Purohit Show, Dhru sits down with Dr. Andy Galpin to dive deep into VO2 max and why he believes it is one of the best predictors of longevity. Dr. Galpin breaks down the research behind this test and why it's critical for everyone to know their VO2 max baseline. He also shares why a low VO2 max can cause chronic fatigue, making it challenging to engage in daily activities, and shares his top tips on increasing your VO2 max if you are starting your exercise journey. If you are looking for a deep dive into VO2 Max, this episode is a must-listen.  Andy Galpin is a tenured professor at California State University, Fullerton. He is the Co-Director of the Center for Sport Performance and Founder/Director of the Biochemistry and Molecular Exercise Physiology Laboratory. He is a Human Performance scientist with a PhD in Human Bioenergetics and over 100 peer-reviewed publications and presentations. He is also a Co-founder of Absolute Rest, BioMolecular Athlete, and RAPID Health & Performance.   In this episode, Dhru and Dr. Galpin dive into (audio version / Apple Subscriber version): Why VO2 max is a critical factor in longevity (1:05 / 1:05) What is VO2 max and getting your baseline (10:00 / 7:05) Challenges with daily activities that demonstrate a low VO2 max (18:00 / 14:56) Stimulants and the cycle of fatigue (26:00/ 23:07) The impact of diet on energy (27:00 / 24:33) Are smartwatches accurate in calculating VO2 max (32:00 / 26:44) Methods of testing your VO2 max and guidance on choosing the right test (34:00 / 29:50) Average and optimal VO2X max levels (39:00 / 34:05) Increasing your levels and the impact on longevity (47:00 / 42:07) How to get started in improving your levels (49:00 / 44:53) How often should you test (55:00 / 50:22) Also mentioned in this episode: Dr. Galpin’s Published Work RAPID Health Absolute Rest To learn more about Dr. Galpin, follow him on Instagram, Twitter, or his website.  To get 20% off your Birch Living mattress plus two free eco-rest pillows, head over to birchliving.com/dhru today. Right now, you can save $250 on your first diagnostic and get personalized suggestions. Optimize your longevity and track your progress go to mylifeforce.com/dhru!  Right now, Plunge is offering my community $150 off cold plunges and their core products. Just go to plunge.com/dhru or enter code DHRU to revolutionize your wellness journey today.  Learn more about your ad choices. Visit megaphone.fm/adchoices

Dr. Andy Galpin, you've shared something mind-blowing, which is you could take any test in the world you want. Full body MRI, blood pressure, smoking history, cholesterol, familial background for any kind of disease. You could put all those tests on a roulette table, you call this health roulette, and spin it around. And almost nothing, nothing in the world predicts how long somebody's going to live. compared to your VO2 max number. On today's podcast, you're breaking down all things V02 max, including what it is, how to get it measured, what to do if it's low, which it's going to be low for a lot of people listening potentially, and most importantly, why it's so important to get the number up, not just

to feel better, but to potentially add decades. Yes, decades to your life if you get it into the optimal ranges. turn it over to you to talk about V-O-2 Max. You go back to the late 1980s. 1989, I think actually, Stephen Blair, who's this legendary exercise epidemiologist, if you want to call them that from University of South Carolina. He's done a ton of research. I actually think the paper you're talking about specifically came out in JAMA, the Journal of American Medical Association, one of these top tier ones. And that's kind of like this classic paper that we refer to. But again, it's not one study. I'm not cherry picking and trying to overestimate the

importance here. Like you literally have 30 plus years of studies that are that are saying the same thing. Now in exact detail, no, of course. Like every studies, the numbers are a little bit different and the populations. But if you collectively look at that research, you can kind of fast forward all the way also up to Jonathan Myers' work at Stanford. And that actually paper with 700,000 people or so, was U.S. veterans because he used Jonathan worse than his Stanford VA appointment up there. And so you're talking about, you know, you've pick your study. Blair's study had about the same numbers. Jonathan's paper from like early 2000s showed the same thing. You know, you're talking about database pools of hundreds of thousands of

people. And what they do in this is they look at and they calculate what's called hazard ratios. So what that is, it's a little bit complicated. But the effect of this is if you set everybody in the group, let's just say we have 100,000 people in a study. And these typically, sometimes they isolate. So they want to look at 100,000, you know, 40 to 60 year olds. Okay, great. Sometimes it's like, hey, 18 to 95 year olds. Right. And so again, I'm kind of combining a number of different papers in this explanation here to make it a little bit simpler to digest. So if you look across all those papers, it's the same general point here that I'm making. The exact numbers don't matter per se because they are tweaked and varied. But effectively, you put all these people in these databases

and when what you look at is, well, how many people died? And so, A lot of the times you either look like look retrospectively. So you look back through hospital records and stuff like that. Or in the case of some of the study, you literally track these people for 20 plus years. Right. So when you look at that in Jonathan's paper, I think there was 750,000-ish people in that study and 174,000 died over the course of the study.

Now, again, it's like they're not giving them a drug and the drug killed them or anything. It's just sort of like, hey, you're enrolled in the study, you do this test, and then we just monitor your medical records. And then when you die, we get an alert and we put it in. And then, you know, after 20 years, we look back and say, what are the things consistent with the people that died versus those that didn't die? And so they look at typically lots of stuff. And those metrics you mentioned a second ago, smoking, history of coronary artery disease, familial concerns, diabetes, all these things. And it's clear that stuff's all bad.

All that stuff increases your HR ratio, right? And so typically the study will look at something like if your HR goes from, you know, At 1.0 is baseline, right? So everyone is set to a standard of 1.0. If you're below one, you've reduced risk, above one, you've increased risk. So in the studies you're pulling from the data there, you're looking at like diabetes and cholesterol, blood pressure, hypertension, stuff like that.

Now, the HR on those is typically like 1.3, 1.4, 1.2, which represents 1.2 would be a 20% increase. 1.3 would be a 30% increase. 1.8 would be an 80% increase. That's how you interpret those numbers. And what that is is an increased risk. It doesn't mean you're going to die, but it's just an increased risk. Well, when you compare that to the numbers on V02 Max,

when you look at the group who is the most fit in this database, and you compare them to the least fit, the ones that are the least fit, their HR is not 1.4. It's like 4.5, 5.0, 6.1s. It is enormous. And so if you want to look at like the risk, of diabetes is typically like, hey, 1.3, 1.4. Smoking, 1.4. Great. Being super unfit, 5.0. It's just

way, way, way higher on this. In fact, you can get even more granular. So typically what these studies will do is they'll break people in the entire study up into either quintiles or quartiles or something like that, which is this says, I think everybody in study, whether the 25, the highest 25% most fit, and who are the next 25%? Who are the next 25%? And then, who's the bottom 25%, right? And the bottom versus the top is what I just explained. But even if you look at like the second highest level to the next, to the absolute highest level, you're still seeing like doubling of your risk factor.

And so as an order of effect, it's this is not even close how much more VOT2 Max will explain survival. Now, there is multiple factors here going on. So obviously people who live longer than to be fitter, but then there's clearly a causal explanation here between having a higher VOTU maximum in this case and having an increased risk of survival. None of those other things that I mentioned are good for you. Diabetes is a really big problem and all the other stuff,

but that's the stuff you're referring to. So when I say, like, you can put it all on the table and you should definitely pay attention to your diabetes and smoking and all that stuff, and you should pay attention to your cholesterol if it matters and to you and blood pressure, like absolutely, that stuff can absolutely kill you and take decades off your life. But if you really want to get an honest answer

of how close to, you know, you're out on that desk door, your view to Max is going to be very, very, very, very insightful. And you could argue, you know, as I said earlier, that it's probably the number one thing to look for. Today's episode is brought to you

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for 20% off plus two free eco-rest pillows at birchliving.com backslash drew. So get ready for the best most most most. most eco-friendly sleep of your life, visit Birch, B-I-R-C-H-L-I-N-G-G-com slash Drew. That's D-H-R-U to get 20% off plus two eco-rest pillows today. So for a lot of my audience who's listening, they've definitely heard the term V-O-2 Max. I've gone on my own journey to improve my own V-O-2 Max, getting it measured in a laboratory.

But for the person that's listening today, and they're not a professional athlete, You know, there's somebody that wants to work out. They want to eat healthy and they want to age well. Could you give them a reminder of what VOT2 max is? And then is it important for them to get a baseline? And if so, how would you recommend going about getting a baseline? Yeah, absolutely important to get a baseline. How do you get it? And then I'll come back to the previous one. You can do like what you've done and you can look out and just kind of Google search in your area. Is there a laboratory that offers a VOTOMX test? There are, more and more of these and they are continuing to increase.

In fact, you're seeing a lot of just commercial gyms put these things into place, and you're going to see more of that because the word on this information has gotten out, and it's, I don't know why it took 30 years. It just, it did. I actually foresee a future where it's going to be really, really common, as common as it is to get almost a blood drop because of how important this stuff is. So you can do that. Typical cost there, depending on the area you live,

somewhere between $75 to maybe $250 if you live in Manhattan or Chicago or Dallas or downtown or something. But a couple of $100, which is more than some people can afford. I get it. But a lot of people, I think, can scratch out $150. Yeah, so you could have that conversation. But hopefully we could, again, many can't at all.

I understand that. But if you can't, if you can't at all, there are a number of scientifically validated both sub-maximal as well as maximal estimate tests. So what do I mean by that? You can do something like a Cooper's 12-minute test. This is a maximal test. You're going to basically run for 12 minutes as far as you possibly can.

Record that distance. Take that distance, and then you can plug it into calculators. There's tons of them online. Just Google that test and enter that score you got, and it will tell you an estimate of your VOTMX. And again, that has been scientifically validated. It's been around for decades. It's not new at all.

It's been around for very, very long time. exercise physiology community. So you can do that. That's totally free. If you're like, man, I can't run, I've got a knee injury, or I'm just really nervous or apprehensive about going that hard. I've never done that or any number of reasons. Then you can do a submaximum test. And so, again, many, many, many variations of these. There are bike tests you can do. There are rowing tests. There are swimming tests. There are walking tests. So there are VOTM X estimate equations for whatever you're thinking of like, oh, I can't do it because of this. Snow on the ground. I can't go around outside. Okay, great. There's tons of ways you can do it and estimate

equations and all of them are free online. Like, you can go on there because they've been around for 25 years so that they're no longer behind like even paywalls and journals. They're just, they're out there because they've been around for so long. The submax test are typically two minutes or so. And what this typically looks like is something where you take your resting heart rate and then you do, you step up onto a box. And these boxes are typically like 18 inches tall. So not like a big cross-fit, you know, box jump thing. Like you're just stepping up and down. And you do it to a metronome.

So, you know, you have a rhythm, step, step, step, step, step. And so the reason we're doing that is so we can kind of lock in effort, if you will. But even that part's not critical. And you do it for two minutes and then you check your heart rate at the end of the two minutes. That score, then that resting heart rate, you enter that end of exercise heart rate. Enter that in and it will estimate your Vio 2 max. Now, as you leave the laboratory and you go into the field, the accuracy of the test starts to come down, right? And then as you go from maximal to sub-maxima comes down.

So if you want perfect, you want to know exactly what this number is, you know, find a lab and go get it done. But those other ones are going to get a lot of people close and they hopefully meet everyone who's listening where they're at on some level, right? So depending on what exercise you want to do, depending on your income, depending on what's available to you or where you should. be able to get pretty close to those numbers. So in terms of practical application, those are your first two answers here a little over. Now going all the way back to the first part of your question, it is technically your, it is V-O-2 stands for the V is volume of oxygen. O2. It is how much air or oxygen you can bring in and utilize. And it has two major components. One is what we call central, one is peripheral. And what I mean by that is, it is V-O-2 max is calculated as your

cardiac output, which is we call Q, multiplied by your A-V-O-2 difference. And so cardiac output is specifically how much blood can be pumped out of your heart per pump, that's called your stroke volume, multiplied by how many beats, your heart beats per minute, your heart rate. Right. So what's the heart rate? How often is it pumping? Multiply by how much blood is coming out per pump, and that tells you your cardiac output. Okay. And again, that's the output of blood. Think about that way. That's the central version. Now, the peripheral version is then when that blood is pumping through your body,

ideally, your muscles that are exercising are able to get that blood into them. And then specifically, they can take the oxygen out of the blood and get into the muscle tissue. And they can take the waste products like carbon dioxide and other things like that and take them from muscle and put it into blood. So that when your blood comes into muscle, it's oxygenated. and when it comes full of glucose and things like that. And then when it leaves muscle, it is deoxygenated and full of waste products and carbon dioxide.

That then goes back to your heart, goes back to your lungs, you breathe out the CO2. You take another breath in, that O2 comes back in, and we repeat that cycle, right? So you're breathing in oxygen, you're breathing out CO2, and you're cycling there. So the second half of our equation, remember we had our cardiac output, our Q,

multiplied by what's called AVO2 difference. So AVO2 difference is the difference. is the difference in the amount of oxygen in the arterial side minus the venous side. That's a fancy way of saying how much oxygen went into your tissue, and then how much was in the blood after it left your tissue. That's the arterial side versus the venous side. And so the better you are extracting oxygen into your tissue, the higher that number becomes.

And since it's a multiplier, a high AVO2 multiplied by a cardiac output, but both those numbers go up, then the VOTMX goes up. And so that was technically what that functionally means, and I can translate it at all, how well can you bring in oxygen, how much of that blood can you pump through your system, and how effective are you at getting the oxygen out of your blood into your working muscle?

That tells us exactly the volume of oxygen you can utilize. And we typically express that number in units of milliliters, that's milliliters of oxygen, so, you know, measurement. per kilogram of body weight per minute. So when you see like a kind of heuristic we use a lot as 50 at 50, which means you should, you know, strive for a VO2 max of 50 milliliters, so 50 milliliters of oxygen per kilogram of body weight per minute, right?

That's the CO2 max of 50. At age 50. So that's kind of a number we want to get to. It's pretty high. But that would be for men, for women. It's probably 45. that 50 would be great. So VOTMX 45 and 50 would be a solid number to go after. And that scales with age and stuff like that. But that's really what VOTOMX honestly truly is. And it can sound a little technical. And I appreciate the technical explanation. But just to make sure people really understand and this point drives home is that any activity that you're going to be doing as you age, especially as you get into your 60s, 70s, 80s, 90s and beyond, hopefully knock on wood that we all make it there, you know, are. capacity to take in oxygen, turn it into energy is a key factor into that. What are some examples of

some things? Let's take for your, you know, your average 70 year old, which is not even really that old, right? Like, there's some things and activities that you can share that commonly are things that people struggle with. That is a good indication that, hey, actually their VO2 max is not good and that's why they can't do this normal everyday activity. Can you think of any? Yeah. I mean, I can think of a ton. The way to think about it is this. You use carbohydrates and fat for the most part for your cellular energy. Oxygen is not used for energy. Oxygen is simply used because it is required to be there to aerobically use fat and carbohydrates as a fuel. Why that matters is the following.

If you are doing a function in which your V-O-2 max is so low that you can no longer produce energy at that rate, then you can no longer continue the activity. So you don't have enough oxygen to allow your body to actually metabolize carbohydrates in fat. That becomes an issue. And so that metabolic process then is leveled out. What's that functionally mean? Think about it this way. If your VO2 max for men, it's about 18 milliliters per kilogram per minute.

For women, it's about 15 or 16. Those lines are called the line of independence. Below that line, it becomes challenging to live independently. That's why we call them that. So if you're a male listening and your VO2 max is 15, you're probably not living by yourself. Or if you are, your days of doing that are fairly limited. If you're a woman and you're at 13, it's the same answer. These numbers are just slightly lower because I'm a number of physiological reasons that don't matter per se right now.

If you are not at that level and you're like, I live by myself, like, I'm fine. Okay, what you can actually do is you can calculate how long is going to be at your current VO2 max before you cross that line of independence. There are known rates of decline is typically about 1% per year, especially after the age of 40, 45 or something like that. And so you can just run a little simple calculation that says, all right, if I'm at 30, right now, my Milo, my Fiotto Max is 30, and I'm 40 years old. How long until I cross below 20? Well, it ain't going to be very long. So you might be fine now, but by the time you're 65, you're going to be below 20. And so your numbers you're worrying about now are to be like, well, what do I have to do to keep myself above that line for as long as possible?

What does 20 milliliters per kilogram per minute look like? Well, getting dressed in the morning is, 12, something like that. Like walking around, like walking upstairs is 13, 14, depending, something like that. So you're staring on the barrel of going, okay, great. You know, a light jog, 15 to 20. Something like, like you can't even jog for a couple of steps. Is this what 20 means?

So right now you're like, oh, I can jog. Okay, a little bit, but if you're at 30, How long until that number again crosses below 20? So the reason we, again, when we're talking to call that independence is you can think about it as functional independence because you can't even function independently because basic what are called activities of daily living, like getting dressed in the morning, like going upstairs, like walking around a carnival or a fair or something like that for a few hours is stabilitating because it requires such a high percentage of your energy. if maybe I'll give you one more example. If your V-O-2 max is 25 as a woman, okay, great. And walking around the baseball field watching your nephew or grandkid or your own child play, and that takes you to 15, you can do it.

But you're actually running at about 60, 65% of your VOT2 max. That's like the rest of us, like jogging for seven straight hours. that's going to be exhausting to you, right? You're going to be completely exhausted, which means you're going to want to do less stuff. You're going to be bringing the chair. You're going to have to take a break and sit down. Or you're not going to want to do it next time.

You're not likely to enroll the kid or go to the next event. You're just like, oh, my God, I got so tired last time. It completely crushes you. And so you just don't want to do things, and it's really physically exhausting, not because it's a higher than you've used to max, and you're not saying they're thinking like, I literally can't do it.

That's not what I'm talking about. I'm talking about everything just is so demanding. where this often manifests itself is people are just going, man, my energy is so low. Why is your energy so low? You're running around every day at 65% of your VO2 max. You don't have thyroid dysfunction. Your testosterone is not low. You don't like have all these things.

I mean, that obviously can't happen. But a lot of times it's like you're just unfit. You don't have something going on here. And if you do, sometimes it is because you are so unfit that you are overtraining, effectively. You're over-training so much because everything requires such a high percentage of your V-O-2 max, your system is shot. That's a concept that I've never heard. Sorry to just jump in. That's literally mind-blowing. I never heard that concept shared in that way that people are literally inactive so much that just their normal day-to-day function is overtraining because they're so

unfit. I've never heard that and that is like mind-blowing. Like that makes total sense. Yeah, I would we have a coaching program that we've been running for a long time. Of course, we've worked with and still work with a ton of professional athletes, but the coaching program I'm referring to is called rapid health and performance. And it's almost exclusively for non-athletes. Most of our clients are 40 to 50, you know, plus reals or so, like, right in this realm. Probably the biggest driver we've had of people coming in the program is my energy is down. My energy is down.

Right. It can be a number of different things. things. We test everything. It's a very comprehensive program. Sometimes it's sleep related. Sometimes there's all kinds of micronutrient imbalances. There's all kinds of things that can be explaining it. But one of the large ones we see is it's like, okay, yeah, you're just unfit. And this is like your energy will come way back once you get a little more fit. And every time, every time we improve somebody's view to max, like the number one most consistent feedback in addition to everything else is my energy is way up.

Like, yeah, you didn't need testosterone. You didn't need hormone replacement therapy. When your view of max is at a certain number, it is simply an issue of why would you not, why would you have a ton of energy if you have no oxygen availability? What makes you think you would have a ton of energy? You know what the next one we get is probably?

It's brain fog clarity. Like focus, attention, memory, and it's like, I'm getting old. I'm like, you're 50. Like, your brain's not deteriorating at 50. Like, you're 60 for that matter. Your brain is not deteriorating. at 60, unless you have something else going on, but most people almost never do.

It's the fact that you don't have energy. You don't have cellular energy because your O2 is really, really low. And when that starts to go up a little bit because you get excited in a meeting, or you do a little bit of movement parts and you're up and, like, you get really exhausted because you're burning a lot of gas at a really high percentage of your O2 max. Where the rest of us are cruising at 20%, you're at 50%. And so, yeah, like, you're going to feel low energy. And to take it back to a point that you mentioned at the beginning of the podcast is that

it becomes a downward spiral. You're low in energy. You continue to age. You start to feel totally exhausted doing normal activities. You pull back. Then that turns into sort of this rapid decline, especially towards the later stages of life, where as you mentioned,

you start to feel like you're a burden. You start to feel like people have to help you out of the car. You start to feel that you can't walk as fast or keep up with people. So you exclude yourself from social activity, participation. and now all of a sudden we're rapidly going downhill. Yep. And we also see this is where stimulants will come in a lot.

So your energy is low. And so you really get crushing on coffee. You really get crushing on tea and energy drinks or whatever they happen to be. Not that any of those things are bad per se. When in this particular cycle, you get crushing on those things. Or potentially you go to hormone therapy with very poor guidance. Right. So you're not listening to your doctor or your doctor is kind of half paying attention to this

right to the script. And why those things become an issue is the over the stimulus in particular is because now you're you're crushing stimulants to get throughout the day. And then when you get to the evening, you can't fall asleep. Or you fall asleep, but you wake up in the middle of the night. Like, I was consistently wake up at one. Or you wake up, you toss and turn a bunch and you're just really, and so the next day what happens? You're even more fatigued. You're even like your energy is low because you are not sleeping well. And so then it is back to inactivity. It is back to stimulants and we're on that cycle. And so yeah, like it adds a whole bunch of stuff. And so we got to come back all the way to go, yo, you got to get you off the stimulants. But then I won't be productive.

I still have a company to run. I still have a company to run. Great. We're going to get your VO2 max up and then we're going to do that. And so we're going to run this program of like we're going to get you off of those synthetic energies and get you on to a natural energy, if you will here. And then as a result, your sleep will improve and then that'll make your natural energy better. And then that whole thing spins up is what we call it. Like your life spins. down when you do things like that, we want to turn the whole thing around and start spinning things up. So life just gets easier. It gets even better, though, because there's a lot of data on what happens with things like nutritional choices, with insufficient sleep, with low energy status.

We know this will directly lead to worse and poorer nutritional choices. You're likely to have a little more alcohol than you normally would. Maybe you don't drink that much, but you know, you're drinking 50% more than you normally would. We know that food quality choices, total amount of choices, physical activity choices, all this stuff gets worse, right? And so you're eating a little bit more than you should. You have me, you eat pretty good, but like you have a couple of more treats. You get a little bit sloppier, 20% more, right? 10% more. That stuff gets magnified over times and all of a sudden you're a little bit overweight. You don't like how you look and now you're thinking like, oh my gosh, but I'm so tired all the time. How am I going to ever work out? And like,

you can see this. It spins into multiple areas and now you're just like, oh my gosh. That often Lazy Lentz, like, well, I'm just going to live my life and like the logic and discussion kind of or not. I'm still trying to get after it and you train hard, but you're just not getting anywhere because you're so tired and it's so excited. Okay. I get it. Like that's what happens in these spend down situations.

So we want to make sure that we are correcting that train and that we are solving as much as possible. What was, we call these performance anchors. So what was the real anchor here? Not necessarily what was the symptom. Like what is the thing that's really as best. we can tell driving or what are the two or three or four, you know,

whatever case is, things that are driving this and how do we correct those so that this entire ship starts to write itself. And then we're not just really going out and putting every single finger and every hole in the ship. Let's figure out why we keep having holes in the ship and fix that. And then, you know, be a little patient,

be little consistent and watch the results come in as the months go on. And then a year or two from now, like you can't believe how your life has changed and maintenance is pretty low. You know, to continue down this pathway of V-O-2-Max, because it's so important, and that's not just your opinion, that's the summary of the data that's out there.

You've been one of the people that's been championing it in a way that's really brought it to popularity. Question for you, which is that more and more individuals now have things like Apple watches and smart watches. A lot of those will have some sort of V-O-2-Max sort of proxy measure inside of there. can individuals that are listening today that might be intimidated to go to a lab particularly or maybe like a hospital setting can they use these watches or is that is that data good data yeah it's a really hard question because the answer is a little bit of both some of the products seem to be okay especially at moderate to low real two maxes but they tend to get pretty wonky at moderate to high ones so they tend to overestim is one way to think about it.

So if you're like, you don't really exercise, you kind of exercise a little bit, and you go out and you do something and your Apple Watch tells you your VOTMX is 46, probably not. Like, probably not, right? If you're 40 years old, 50 years old, 60 years old, it's telling you that number,

it's possible. Like, we have seen it. We've had people actually in our program, like don't exercise. And it's like we get a test and it's like 48. Like in the lab. And we're like, oh, shit, okay. So it can't happen, but it's unlikely.

So what I would typically say is, you know, if you're getting numbers there, just be cautious that you're getting over and interpreted there. But I don't want to take away the barrier to entry here. And so if that's the thing you got already, I wouldn't go out and buy one for that purpose. Maybe that's the way to think about it.

Don't go buy one for that purpose. But if you already have one or you already use one or you like it for other reasons, you like the accountability, you like the awareness. It's fun. It's making it more joyful. Those are tremendous reasons to use a wearable, and I do not want to take you away from that.

Great. If you're tracking your view, to max on it and you see it's going up and it's a motivator, then that's a win. I don't care if that number is telling you your Vita max is 6 or 6,000. It doesn't matter. You're getting better. That's all where that's, you know, key thing number one, don't kill motivation with information. Okay. If you're going in the right direction and you're motivated to do it, let's not worry about nitpicking, you know, 20% accuracy or something like that. That said, um, typically I will defer to companies who's primary and sole goal are fitness. You think of, I don't have any

relationship to them, but think of Garmin. Like, Garmin is polar. Like, these are companies who have made heart rate monitors as their primary product for 50 years. This is what they do. They're better. Apple sort of throws some stuff on there. Other companies, like, but they're, cell phone companies. They're other stuff. Like, this is a thing that they can do and they can do it okay. But I tend to defer to things like, again, like the Garmin on the polar strap, where it's like this is literally the core of your company. This is your core competency. This is what you do. And those products, not surprisingly, are more scientifically accurate. So also at the same time, you don't need to go spend $400 on a polar if you don't want,

if you don't care, like if you already have it. So hopefully that kind of helps everyone, because I hate just having people go buy hundreds of dollars with this stuff. I also don't want to tell you like, hey, all the progress and the good work you're doing, it sucks. don't do it. I don't want that message either. Yeah. For those individuals that do live nearby a gym. I'm based here in Los Angeles. There's a gym in Santa Monica that I went to. No affiliation with them. They're called TriFit. I went and did my V-O-2 Max in person with the whole setup and the machine and the mask. If somebody wants to go do that, from my understanding that there's a couple ways of doing that. You could do that running is probably one of the most common ways. The next one

would be rowing and then also a bike. One thing in particular that I struggle with is that I don't run a lot. And so I didn't even run in proper running shoes. And so I scored of 47, but I ended up having to stop early because my knees were hurting, probably because I was wearing the wrong shoes. And I didn't even know that we were going to do running. So is there any guidance you want to share for individuals here who are like, okay, you know what? I want to go into a gym. I want to get a benchmark so that I can know then what activities I can do to improve it, which we'll get to in a second. Do you have any preference of any of those activities, running, rowing, biking, or anything else that might be there?

Running is by far the most common. The overwhelming majority of our scientific studies and databases are on running. But second is biking. Tons and tons and tons and tons of research on biking, rowing rowing and rowers. Rowing is newer. Way, way, way, way less data. but that's fine. You know, do whatever you want to do there. In terms of the way VOT2 max works, remember, it's how much auction you can bring in and utilize. That is determined by how much tissue and how much muscle you're using.

And so the more muscle mass involved in your testing, the higher your score will be. You will see a higher score on about 10% higher on running than you will on biking because there's more muscles involved. You do other activities scales up. This is why you typically see, on average, cross-country skiers are the highest folks in terms of VO2 max because they're using their legs as well as their upper body. So if you do it on a bike, it's fine, but you can take whatever score you have

and you can add 10% and that's probably what we'll call more of your true VO2 Max. Okay. That said, specificity matters and there's lots and lots of research on this. If you are a cyclist and you cycle, you will probably score higher on a cycling test and you will a running test. Okay, so that whole 10% higher in running, like I said, a second ago, goes out the window. Same thing with the rowing. If you are a rower, and we actually have a couple of rowers that are getting ready for Paris in the Olympics, you're going to score way higher in a row than you want to run. We will sometimes use even like an assault bike.

So this is a bike with like the pedals and the handles. I know this is my friend Roman, who runs the kind of actualized science department at the UFC's Performance Institute in Vegas. He has an entire protocol for the assault bike, and that's, that's, that's, how they do all their view to max testing because in MMA, number one, many of those fighters don't run. And so they get on the treadmill and it looks really, really bad. But more importantly, it's a lot closer to their sport using their arms and their legs and there's more muscle mass involved and all that. So any of them are options. If you have a preference towards one, that's great. If you have a hatred towards one, avoiding it is no problem whatsoever.

You should be able to do it. Last context I'll give you here is if you have a known issue with one, you have an injury, you know you aren't good at running, things like that, then I would choose, you know, don't pick the one that you're going to have, you know,

problems with. So if you were to go in and say, hey, like, man, I'm not a runner. I'm not good at running. My technique is off. My knee hurts when I do it.

Okay, just don't do it. Because none of those tests matter unless you get to full maximum output. That's what we're trying to test. So if you have to stop at 80% or 90%, or you feel apprehensive or you start getting nervous because your back hurts when you run too much or whatever the case is, then don't do it because whatever percent loss we're going to get in effectiveness there, we're going to lose out on effort. And that's not really what we're after. So just don't pick things that you're worried about or don't want to do or otherwise think gives you nerves and pick a different route.

That's great. You know, when you go online, there's all these incredible charts that are out there. I'll just pull up one that's there. You know, there's these V-O-2 Max charts. This in particular is for women. And it has the, you know, the highest. So, sorry, just to give you a little bit of thing. You see the bottom, those comparative references. You see where it says Kaminsky and Harbor? Uh-huh.

Yeah. So those are my friends, Lenny Kaminsky and Matt Harbor. That was actually, those are data from the cardiac rehab laboratory that I did my PhDDN. Oh, incredible. Yeah. Fantastic. So those guys were there and I was there during. collection of all those data and all that.

Oh, that's amazing. That's awesome. Nice random choice there. Yeah. What's that the Kevin Bacon game that people used to play with movies? Yeah. We can do that with Dr. Andy. Yeah, and just another thing actually, just so the audience, I know some of you're probably

not watching this, but just a little bit of context. That's the other source down there, that Madsanger one, that 2018 paper, that's the very, very common standard one that people pull up for. our current databases. So I say that to say, you can pull up random charts and equations on the internet. And you're always like, yeah, man, this is this one real or not. If this one is truly based on those data points, this is the scientific old standard right now. So correct choice to go off. So whatever numbers we get into right now, they're going to be pretty legit. Fantastic. So connecting this to the chart here, and for those that are watching on

YouTube, you can see the chart. We'll link to the show notes. If you're listening on podcast, you can come back to it. So your statement earlier was you could pick any test in the world you want, full body MRI, blood pressure, smoking history, et cetera, et cetera, et cetera, almost nothing in the world will predict how long you're going to live, you know, compared to your VO2 max. So let's say a woman in her 40s today listening to my podcast here and listening to you talk decides to go in and get her benchmark done. And they come in, you know, not too different than the clients that work with you.

And they, what would, looking at this chart here, what would be an average? score that you would expect from somebody who's not, you know, a trainer, not an elite athlete, not regularly doing that, but just somebody who's just doing normal activities in their 40. Where would you expect them to be scoring based on this chart? So you're asking me what would be the most common number? Most common, yes. Yeah. So a 40-year-old woman, probably in the mid-30s, you know, to max 35, something like, yeah,

yeah, right there. Yeah, okay. So we're highlighting in the category that says good, which is the 64. percent lower section. We definitely would not call that good, but the chart says. The chart says good. And this is why I wanted to bring it up is that good or normal isn't optimal. And your work and your team's work and the coaching you do and everything you talk about is how do we get to optimal?

If we look around and everybody is overweight, obese in the society, just because that's normal doesn't mean that's what's actually healthy. So let's say they come in and they score in that sort of, you said 40, you said mid 30s, sorry, mid 30s. Yeah, for sure. Yeah. Where would you want them to be knowing that they're heading in the right direction and that they're aging, you know, in a place that's not going to leave them in a troubling situation as they get into their 50s, 60s, 70s and beyond? Yeah, sure. So if you look at that chart, if you're able to watch this right now, and it's not, I'll try to do it. verbally.

If you are in the mid-30s as a 40-year-old, again, you're pretty average, which would be great. And in all of our women that have come in in our program that look like that in terms of age range, seeing someone between 25 and 30 is very, very common. We have had countless, countless women that are under 25. And these are women, again, in your 40s, you don't have a disease, you're not severely obese. you don't maybe you're probably working out a couple times a week you don't feel like terrible or crazy maybe don't feel great all those stuff and we have had plenty of these women who are under 25 and

we're like yo and I have to walk them through the data and be like this is what you're staring down the barrel of and they're just like holy hell so I would it's I wanted to say that because even that bottom 25 percent off that's not some random rare fluke things that like you have to be really really it'd be obvious right you're super unhealthy healthy. That's not the case. It is very, very common to see people at that level. We've had plenty that are like 21, 22. And you're like, woof. And you'd look at them from the outside and you wouldn't necessarily know that they're an unhealthy or unfit person, right? Dingo. Yes, exactly right. Thank you. That's on the point I was trying to make. Because you don't necessarily know these things. When you look at something like body fat and body composition, this is obviously very associated with health, like very clearly. It's also something. something that you can, as you're kind of alluding thing, like, you'll see it. Right. Like, okay, I'm not healthy.

But this case, a lot will tell you, like, you're not healthy either. In fact, if you want to look at the data, if you look at the risk of death because of being overweight, whether you go from overweight to obese or extremely morbidly obese, what they call it, and you stack that against fitness, fitness will out predict by 2x obesity. Wow. This is what I'm saying. Like, yo, and so we'll say a lot of times to folks, like, why you're working on the overweight thing, whatever, that's cool, that's great, like super important and all that. But this is more important, actually.

Like, just be fit. Let's get fit. Let's make sure we're fit first. This is our first step. We will say a lot of times, people will come in and they'll say things like, hey, I need to lose weight to get healthier. Like, okay, again, great. That's a true statement. But we'll say is, but we got to get healthy first.

right we got to get healthy first to help weight loss like that typically our first step and so yeah we want to go off for that um want to make sure i laid that foundation very very common what where we want people to actually be i mentioned earlier right uh 50 of 50 for men 45 50 for women so what's that mean for 40 year old women on this chart you can see the superior group which means the top two percentile is above 45 i still want to see that i think um Peter Attia has said this very well. You want to be in the elite category for the decade before. Now, elite in this chart is like way off. So think of this as like superior. In this phraseology, it'd be superior. What does that mean? So for somebody 48 years old, 49 years old,

I want that VOT2 max ideally to match their age. 48, 49. Let's see it above 50. Like that's my gold standard. If you look at any of those papers I'm talking about earlier, not only is there all that benefit, but one of the things you'll see consistently is that there appears to be no upper limit to benefit, such that you continue to increase your view to max, you continue to reduce your risk of all cause of mortality, and your survival chances continue

to rise. Now, this differs for some other metrics where if you would imagine someone like their squat strength. It's like, hey, if you're, if you're, let's use leg press. It's a little easier. let's say you can leg, you're 180 pounds and you can leg press 100 pounds. I can tell you right now, getting stronger will enhance your life quality and lifelike. If you are 180 pounds and you increase your leg press from 200 to 250, you'll still see an increase in both those metrics, right? It still matters.

If you're 180 pounds and you can leg press 600 pounds and I increase you to 700 pounds, I can't promise you you're going to live a single day longer, right? So there's kind of a law of like, well, when is good enough enough? With VOTMax, we don't see that number. It's just, it's higher. That number cannot go up more where we don't continue to see benefits. And so when we say things like be superior for the decade before, it's because of that. The data say, even if you're superior and you go from superior to more superior that reduces your risk of all cause mortality, it enhances survivability. Like, all the studies, like they just continue to show that.

So we get greedy as hell here. We get whatever number you tell me basically, I'm going to say, go higher. This is like, which is like our clients and our athletes love it, right? Because like they know my answer. They'll share with me, whatever. And I'm just like, great, not good enough. Like they just know the answer because I'm like, well, this is good. But there's only more benefit for getting higher.

So I want to see numbers like that. And if I got to add one more thing, something that you talk about is that, yes, we can go higher and higher and higher. And for some people that can feel intimidating. but if you truly do come in at the lowest end, just a modest improvement has a massive improvement in your life and longevity. Can you talk about that? Yeah, if you go from the bottom 20th percentile to just the bottom 40th percentile.

So what I'm saying here is going from the lowest possible score to the second lowest possible score, you generally are talking about a 2x hazard ratio. you've doubled your chance of surviving over the next 10 years. Just going from like the least fit person in the entire room to the second least fit category is the biggest magnitude of effect we see in VOTOMX. The bottom category to the second bottom category is the biggest magnitude of benefit. And so what we will often say is like can I just get you to the next ladder?

If you want to then go from like superior to elite, it is helpful. But now you're talking about like 1.2 on that HR score. right great the other ones going from least to second least is a two x right it's two point ohs it's two point five stuff like that so it is by far the biggest benefit we get there is to taking the people who are the least fit people in the entire room and getting them to the you know next 20th percent on or next 25 percent on wherever we want to break up the data well andy i want to be respectful of your time but i feel like if we don't at least touch on this for a moment we'll be leaving people hanging a little bit so you've gotten people excited about VO2 max and maybe doubling down

on something that they feel like they've heard but didn't understand all the weeds of it. We've talked about benchmarking it and the different ways to go about that process using smart watches, laboratory, et cetera. Now, once you have a benchmark and you generally see where you're at, if we talk about exactly your statement there, which is getting you to the next wrong, what are? I mean, you've done multiple hour episodes on this topic, but if we want to leave people with some sense of optimism that regardless of where they are, they can get to that next level, what are some core principles when it comes to that idea that you want to leave them with,

you know, training, types of exercises or just any kind of guidance that they might need to get to that next run. Yeah, sure. I actually really appreciate the fact that you want to bring this up in the way you phrased it because all of this conversation, I hope, though I'm maybe I'm thinking back and I maybe didn't portray it this way, I hope this is a positive story. this is not a reminder of how you're failing and how unfit you are or how much you're disrespecting. That's not the story here. The story is if you want to get better, if you want to increase your chance of living and living well,

you have a huge opportunity to do so in something that is very controllable like your VOTMX. And so while you can't necessarily always control your genome, you can't control, and you can't always control your environment, and you can't always control your income, and access to food and maybe obesity risk, like there are plenty of things that you can't control. This is one where I can say, hey, if you just go after this one first, if you only have a time or resources or energy

or whatever else, and you can just do one thing for your health, don't smoke, don't drink, don't think they got, but go after this, right? Just make sure this one gets higher as much as you possibly can. So how do you do that? Well, if we go back at the very beginning,

we talk about, well, what is VOTMax? It's your ability to bring in and utilize oxygen. All you have to do is anything that challenges that and it will improve. I can give you some specific examples, but please do recognize. Those are just examples. We will say the methods are many, but the concepts are few. As long as you hit these concepts, the methods are infinite. So what are methods?

You like to be on a bike. Great. You like to be in the pool. Great. You want to use walking only. You want to go to a gym. You want to go to a group activity class. You want to go to a Pilate?

Like, sure, sure, sure. All of it. All of it, all of it can work, right? You like kettlebells. You like dumbbellbells. You want to do it in your garage. You want to do it with weights only. You want to never touch weights.

Great. The answer can be all of these things. You can absolutely improve your view to max with any of those. Those are the many and many different methods to get your heart rate up. Okay. Pick the ones you are most familiar with, the ones you like the most, the ones you'll be the most consistent with. The research will show most successful weight loss, strength,

and improvements of year 2 max, the number one predictor for all three of those outcomes is adherence to your program. So pick the one you will actually do and be the most consistent with. You want to do low intensity. You want to do walking. You want to do hiking. You want to do rucking. You want to go jogging. You want to go, you're right up bike. Fine. Great. What zone are you in? I don't care. Zone one, two, three, six. Don't care. Don't care. Don't care. Don't care. Don't care. all of those things can work. A low intensity component. Awesome. As I mentioned, you want to do like my wife does. My wife is 42. We have two young kids. Her primary mode for her cardiovascular exercise is she goes to a local spin class. She loves it. She loves it because she spends most of her

day communicating with a three and five year old. And sometimes she wants to be around adults. and like she doesn't she's all this so she's like she wants to get out of the house number one she wants to be around other people kind of she's pretty introverted but that like gives her there and she doesn't want to like she wants to check out a little bit right so you lead the workout program you do the other stuff like so someone else is guiding her running her and all that okay great i you you couldn't pay me enough money to be in a spin class like i would rather be in my garage by myself i'll do the exact same workout like get me the heck away from these people and I want, I have the opposite. My job is to interact with the world. Her job is not.

So she needs to interact with people. I need time away from people. Okay. So we're doing that. Okay, great. Whatever fits for you. That's amazing. You want to, you want to do high intensity intervals. Sure. That's great. You want to do sprints. You want to do a salt bike. You want to push a sled. You want to do a CrossFit or F-45 client. All of it, all of it. All of it is flying. you want to do a combination. You want to do one day a week, low intensity, one day a week, some weights, one day a week some intervals.

That's awesome. So all of those things are possible. There are differences, of course, between the programs. I'm not indicating just going to make up your workouts. What I'm trying to again tell you is like, you have the ability to really gear this thing to fit your lifestyle and income and everything else,

an injury pass and all that stuff. There are programs that can be made for all of you to meet you all where you're at. The color context are you guys. got to challenge your heart. You have to do it consistently. You have to be able to stick to your program over time and do that again over time. Then you have to be able to do the final thing here which we call progressive overload. Right. So you have to continue to train hard to challenge the system. And you continue to do that stuff and you give enough time, your view of two maxes are going to

go up. Powerful. And just off that note, you know, when you say train hard, the reminder that I'll often heard you share is that it's hard for you. You know, they don't have to be hard for somebody else. It's hard for you. And that's progressive overload. It's tough for you. And that's how your body adapts over time. Last question on that, Andy, is then how long till somebody retest, right? So let's say they've been following a program. When should they retest to get another benchmark to see, are they heading in the right direction? I would do a VOTM max minimum once a year. Once a year. Yeah, every six months, it's fine. But once a year for this. client because really what I want you to think about is you actually asked earlier in the

conversation about should I start with the test done to get a benchmark? And that's really, really important. I want to be able to look back and say, okay, you're 50 years old and your VOTMX is 25. Hmm, okay. Well, I wonder, is the best it's ever been is 28 or is the best that's ever been 60? Like, that tells me different information about what's happening to your health. right if it's like hey this is the highest you've ever been and we go to work out it's probably going to shoot way up because it's never really been challenged but if it's been there and it's coming down it's like oh man five years ago it was 50 and then it went to 40 and then it went to 30 geez you are something's going on like you are rapidly declining that is a different story than

somebody who's just been there their entire life so having something that you can look back that your medical team can use your coaches or your trainers or whatever you're working with now is really, really helpful. I want you to also think about what's happening in the future of human performance here. Maybe there's not much to do with these data now. What do you think is going to look like

in 20 years, technology-wise? If we can look back and go, oh, look, you have 20 years of this testing. What can they do with that data? We don't even know. But data is going to be needed, right? And so the more information you have about your body and your physiology,

and the same thing would be true, for your testosterone, like stuff like that, right? Like, you don't know your testosterone is low if I don't know what it's been like the last 20 years. I don't know though. Maybe it's normal. I don't know. So having serial tracked information about your health for critical variables is very, very important. That's why you do a physical every year and that's why they keep records.

Now you just need to add things like this, like your grip strength and your view to max and your body composition and some other stuff, some extent of blood work. And that will give you a ton of information as the years go on. If you are 40 or 50, you're staring at the same. the barrel of 50 to 60, 70 more years. So we got a lot more information to collect than you. Andy, this has been fantastic. You know, so many people feel confused often by the decisions that they're making in life and they're not sure. Is this supplement working? Is this dietary change working? And obviously when experts like yourself come on and they provide an actual biomarkers, something that people can look at to know that has a ton of data. Nothing has, as you've

shared with us more data than V-O-2 Max, you providing this breakdown and explanation for our audience is literally adding years, decades, potentially to people's lives who take action. So I want to acknowledge you and thank you for all your work in this space and for coming on today's podcast. Oh, my pleasure, man. I also want to mention, I'm a huge geek on your content. Love your series with Andrew Huberman. And for our audience, they should stay tuned because I believe it's this summer your podcast is launching. Yeah. Actually. be a little bit earlier than that. Okay. Amazing. Well, we'll have the link in the show notes below, as well as to all your social and the companies that you mentioned that you're part of as well.

Andy, thank you so much for coming on the podcast today. I appreciate it, man. It's been great. Hi, everyone. Drew here. Two quick things. Number one, thank you so much for listening to this podcast. If you haven't already, subscribe, just hit the subscribe button on your favorite podcast app. And by the way, if you love this episode, it would mean the world to me. And it's the number one thing that you can do to support this podcast is share with a friend, share with a friend who would benefit from listening. Number two, before I go, I just had to tell you about something that I've been working on that I'm super excited about.

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