The Dr. Hyman Show - What Men Don’t Know About Their Health Can Hurt Them

Episode Date: May 17, 2024

View Show Notes From This Episode Get Free Weekly Health Tips from Dr. Hyman Sign Up for Dr. Hyman’s Weekly Longevity Journal There’s a common misconception that getting older means getting weaker, but what if you could improve your fitness level at any age? The truth is, you can.  In today’s Health Bites episode, I’m joined by my dear friend and colleague, Dr. George Papanicolaou, a highly sought-after Functional Medicine practitioner on my team at the Ultra Wellness Center. Together, we explore the incredible benefits of exercise—a free, universally accessible powerhouse drug—from a functional medicine perspective.  We discuss the crucial, often-overlooked aspects of fitness for enhancing longevity, such as VO2 max, how to optimize our levels, and the role our mitochondria play. We also dive into the importance of resistance training and nutrition for enhancing body composition, strength, and muscle mass, vital for metabolic health, recovery from illness, and so much more. If you’re looking to leverage your exercise routine to enhance your overall health and quality of life, no matter your age, this episode is for you.  This episode is brought to you by AG1, Neurohacker, and Cymbiotika Get your daily serving of vitamins, minerals, adaptogens, and more with AG1. Head to DrinkAG1.com/Hyman and get a year's worth of D3 and five Travel Packs for FREE with your first order. Decrease your "zombie cells" with Qualia Senolytic. Visit Neurohacker.com/Hyman to get 50% off and use code HYMAN for an additional 15% off your order. Upgrade your supplement routine with Cymbiotika. Get 20% off with free shipping on all orders. Head to Cymbiotika.com and use code HYMAN.

Coming up on this episode of The Doctor's Pharmacy. My little mantra is, I want to be at the level of fitness that I can do anything I want to do physically at any moment in time. Hey everyone, it's Dr. Mark here. No matter your genetics or lifestyle choices, as humans, we all share the same basic needs like adequate nutrition, for example.

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

and he's also an IFMCP certified doctor, a functional medicine certified doctor. He has worked in the health service, the Navajo Reservation, and he's been working at our practice at the Ultramedic Center for many years now and is one of our great team there. And today we dive into the topic of fitness for middle-aged men, particularly talking about what we need to measure and why it's important, including something called VO2 max, which is a measure of your fitness level and your body composition, learning about your muscle mass, which is a critical measure of fitness, and your body fat composition. And we're going to talk about how to fix those things. We're going to talk about some great cases where we use those measurements to address

people's health. And we're going to talk about a whole area of fitness and health and aging and what you can do about it. So let's dive into this conversation with Dr. George Pepinicklaou, one of my colleagues and friends from the Ultra Wellness Center in Lenox, Massachusetts. Welcome back, George, to the doctor's pharmacy. Appreciate having you back again. Mark, it's always a pleasure to be here. Now, for those of you listening who may not know George, who are just joining the podcast, George is one of my colleagues at the Ultra Wellness Center in Lenox, Massachusetts. We

have a practice of five physicians, pas physicians assistants seven nutritionists a great staff and we take care of people from all over the world with chronic difficult conditions or people who want to just up level and optimize their health and find out how to basically hack the code of biology and understand how their bodies work how to work with it and how to upgrade your biological software so that's what i'm talking about today is how do we upgrade our biological software with a very important drug that has the power to do almost everything you'd want it to do to treat depression to improve your lifespan your healthspan to reduce inflammation to optimize your hormones to balance pretty much everything in your body and this drug i'm talking about is available at no cost to all of you everywhere on

the planet and it's called exercise now that's it you know we learned medical school did not learn a heck of a lot about exercise in fact we probably learned nothing about exercise except to tell our patients to eat less and exercise more which is about the most useless piece of advice i've ever heard a doctor say uh eat what and how do i exercise and why does it matter and so forth so today we're going to get into the science of why it's important to understand the nature of exercise what it does to our, and particularly how do we measure our fitness level? How do we measure the way our bodies are responding to exercise and why that's important for overall health? Now, we in medicine don't really think about how to measure someone's fitness very well. We have the six minute walk test,

and we have grip strength, and we have certain biometrics we use, and certain physiatrists will use it, or certain doctors will use it, but it's kind of marginal. And at the Ultra Wellness Center, we really take a deep dive into every aspect of someone's health, including their fitness,

because it plays a role in everything. Huge. From heart disease, diabetes, to cancer, to dementia to depression to add i mean the list goes on and on so um george you you yourself are you know big big exerciser i'm jealous of your biceps to be honest with you he's got weights in his office he's got like i'm like i think he's seeing patients actually they're pumping iron in the back in the back of his office mark you're my motivation mark you are my motivation though

you are one fit man i don't know i'm doing okay but i think i think you know we we have the capacity at any age uh to maintain or even gain a tremendous amount of fitness and we do and i you know i um you and i are both in our mid-60s and uh you know we're pretty damn fit uh and i i just i don't know there's a story i don't know if you saw it in the news george about this guy who was like in the 70s or something and he was hanging around some jammer somewhere and he saw a rowing machine or maybe there was one in the garage and he basically started in his 70s started rowing on a machine and now he's like a world champion right the 90-year-old plus category. And his fitness level, measured by something called VO2 max, which is what we're going to get into, actually got better.

And not only got better, but was equivalent to people in their 30s and 40s. So what that speaks to is that we see this steady decline as we age, but we don't really know what to do to avert it. And we see this all the time that patients we were chatting before about these guys who come in the office and are our age and look like they're, you know, 20 or 30 years older, right? So George, how did you get so into exercise? And tell us a little bit about your own sort of background and kind of focus on fitness and health. You know, this is fascinating. We had this conversation a long time ago,

and it's more or less, how did I get into functional medicine? I just always wired to think that way. My parents, when I grew up, it was the early 60s, and they were smokers. And I just had an adversity to that lifestyle. From the very beginning, it was just innately in my dna yeah and so i was reading i remember it was a dr mandel's vitamin book and supplements and i remember that way back then i was reading that like when i was like an adolescent yeah so i was just like into that stuff and then i met my my wife when i was 18 and her mother was brilliant she was a homemakermaker, stayed at home in Western Pennsylvania, but she would read nutrition action letter. And she was already talking about the toxins of Teflon. And she was already talking about omega threes.

And she could tell you at the dinner table, like what vegetables had how much calcium and magnesium. So that's the whole nutrition part how about the exercise well so that but that was the whole piece of that whole i was always in intrigued by fitness and nutrition but the fitness piece i just was always an athlete from the very beginning i always like to be athletic i talked about this many times and i've written blogs about it and I have ADHD and exercise is my medicine. So it's actually when I have ADHD patients, whether they're kids or adults,

the first thing I write for them is their exercise prescription. Because when I exercise, it increases my ability to concentrate. And when I exercise, I feel much better. I sleep much better. I'm in a better mood and I'm more able to serve the people around me. So exercise is just my all round drug. It's such an incredible drug, right? I just got back from Patagonia and I was trekking 10, 15 miles a day up and down mountains. And I felt amazing. My nervous system felt great. My energy was great great i had no mood issues which i usually don't have but i just felt more i just felt more at peace and more right everything was like wow this is amazing i mean literally you know i if i'm you know using my brain for 10 hours a day i'm like tired but if i'm using my body i actually feel better one of my you know so one of my internal

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

I could do it. And I could do it well. I'm not going to slow anybody down yeah and i'm going to enjoy it and so will the people around me that's my goal is always to be at a level of fitness where i can get on my bike and ride 25 that's right do whatever you want remember remember that time united's got on our bikes and we rode 25 miles we had a great time and you were pretty good on the hills by the way yeah yeah well george you know the truth is we have that capacity there's this guy who i love to watch on instagram and i'm gonna stop who's a french dude i don't understand anything

about it's all in french but i watch him he's like he's like basically goes out he's 78 years old on his deck on his mountains and somewhere in the mountains of france and he just he does like 25 pull-ups he's incredibly ripped and fit he makes us look like 98 pound weaklings i mean this guy is unbelievable i'm thinking you know and he does it in the winter with no clothes on like it's basically no shirt and and it just speaks to the fact that our bodies have the capacity but the problem is right you know we we decline as we so tell us george what starts to happen to men and women as they start to get you know over 30 what's the the physiological process

because you know we think we don't think of 30 as old but it's actually when the decline starts to happen that leads to frailty disability dysfunction and disease which exercise can can completely prevent for the most part. Right. As I thought about this, I just want to make this point that my mother-in-law, she's going to be 92, right? And when I ask her how she's doing, she tells me, I'm doing well, George, but what's the alternative, right? So what's the alternative to not exercising? It's inactivity.

And inactivity at any age will cause something called anabolic resistance. Okay. Anabolic resistance is the muscle's inability to grow in mass or in strength. And so we talk about it happening with older adults, but it can happen when you're younger. And so we want to fight off the anabolic resistance. And the way you do that is through strength, you know, through exercise. Yeah. Right.

And so when we think about, you know, what we need to be doing, one of the things I think about when we think about chronic disease and aging, longevity, and mortality is when does it become a problem? Well, it becomes a problem very early on in life. And as you said, you see a shift between 30, 40, 50 years old. And that's when we really need to be focusing on exercise. And what do we need to be focusing on? We need to be focusing on? We need to be focusing on our cardio-respiratory fitness and also making sure that we're doing some form of resistance training.

Because we know both of those through lots of different studies, randomized clinical trials, data, we've seen that both aerobic fitness and resistance training and strength training are directly related to decreasing the chronic diseases and chronic conditions that are associated with decreasing our quality of life and our length of life. We know that. So those are the things that we tend to stop doing, particularly men who are in their breadwinning years, building their careers, they'll tend to be a little bit more sedentary. And when that happens,

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

at the Ultra Wellness Center is to work with people very early on in their treatment plans, if they're at that place where they're well enough to be focusing on fitness and exercise. Sometimes they're not well and we have to get them to that point, but we want to get them to that point but we want to get them to that point and what we want to focus on is getting measurements like the vo2 max and like a body composition which become their baseline information for where they're at and then

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

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

And all of that is something that's completely under our control. And if you, if you look at the data, it's quite striking. You see a steady loss of muscle all the way through life, but it's totally reversible. And I saw this in myself. Like I saw it and then I was able to completely reverse it and actually have more muscle now than I did when I was 25, which is quite amazing. And I'm like, well, how did that happen? And it's totally possible, but it's, it's something that most people don't focus on as a thing. Like, okay, diet, diet, diet. And yeah, I know I need to exercise, go to the gym. I know, but maybe I may not be doing the

right things in the gym. I may not be exercising the right way. And so it's, it's like anything. If you want, like you take a drug or a supplement or whatever, you need to know the right way and so it's it's like anything it's if you want like you take a drug or a supplement or whatever you need to know the right dose and the right quantity the right frequency you know and the right web absolutely mechanism so it actually does what you want i think one of the things that we know you you mentioned earlier on and we always talk about is what happens in conventional medicine for years you know i had a conventional practice. I've gone to my conventional doctor for years, and they would bring up my weight or my BMI. And I think the point that you just made is that the BMI is just your body mass index.

That mass can be anything. It can be fat. It can be muscle. And that's not really, we're finding that that's not really a good measure of your metabolic fitness. So in a sense, what you're saying is the thing that everybody talks about with relation to obesity which is body mass index is kind of a poor measurement for what's really going on under the hood that you can be for example you know shaquille o'neal or a bodybuilder and have an extremely high body mass index so you've like 35 and maybe that's considered severely obese but actually you're just solid muscle right or you could be a body mass of 22 which is perfectly normal right a body mass index of 22 and be metabolically obese and diabetic because you have no muscle and you you're eating

tons of crappy food but you're not you haven't gained the weight and so that it's sort of an inaccurate measurement and i absolutely want to talk to you about how do we actually measure this. And at the Ultralaw Wellness Center, we do a number of different measurements that can quantify your level of fitness and your level of muscle and your level of fat and quality of it. We can even look at mitochondrial function, which is a critical aspect of your health. So we look at things that most physicians and practices don't

do as a way of creating a customized, personalized set of recommendations to optimize your health. And of course, it's not just around exercise. It's around everything. We look at your nutrition. We look at your hormones. We look at your immune system. We look at your gut. We look at toxin levels. We look at all of it as it affects all of it, right? But today we're just talking about this whole issue of fitness and why we need to think more carefully and nuanced about it. So let's talk about how do we measure the two most important aspects of fitness, which is basically your cardiovascular fitness and your muscle fitness. So let's talk about cardiovascular fitness first.

Right. How do we measure that? So cardiovascular fitness is measured using something called your VO2 max. And essentially, that's basically the maximum amount of oxygen you can deliver to your cells during your maximal amount of activity. And so that can be done in a lab. And you do a VO2 max. You can get on a bike.

You can get on a treadmill. And they're going to put a mask on you, which is going to then be able to measure your oxygen utilization so you'll start exercising and then you'll increase your exercise until you get your maximum amount of activity or exhaustion yeah and then they've been measuring your o2 metabolism the entire time and then they'll be able to then determine the maximum amount of oxygen uptake and utilization. And that will be your VO2 max. Yeah. Did you know that vitamin C is a super powered antioxidant that plays a critical role in immune

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quality ingredients and they're extremely transparent about how and where they source their ingredients. I love that I'm helping my immune system, boosting collagen production, and so much more by getting sufficient amounts of vitamin C daily. We have an exciting offer for my listeners. Symbiotica is offering my audience 20% off their entire order. Just go to symbiotica.com slash hymen and use the code hymen. That's symbiotica, C-Y-M-B-I-O-T-I-K-A.com forward slash hymen and use the code hymen for 20% off plus free shipping. So essentially that's measuring how much oxygen

you breathe in and how much carbon dioxide you breathe out, which is an indirect measure of your metabolic rate. And it determines how many calories you can burn a minute, how much oxygen you can burn a minute. So basically your metabolism, because I have a slow slow metabolism well they might be right because if you have a low vo2 max you're burning far less calories per minute because the rate limiting step of burning calories by the way is how much oxygen you can process per minute that's called the vo2 max the volume of oxygen it's ml in liters per minute it's ml ml per minute per kilogram

right so it's basically how much oxygen can you utilize yeah and so a guy like lance armstrong right who's you know wins a tour de france can maybe have a much higher utilization his vo2 max maybe 90 so whereas the average guy who's like a diabetic might be 15 and someone who's fit might be 45 i might my watch says I'm 46 and I'm superior. I don't know at this age, but I used to be 55. I'm 55, but I actually measured it last time. I don't know if my watch is accurate. But it's really a critical measurement for everything,

like for longevity. If you look at the longevity trajectory, it's probably the thing that that is most correlated with longevity so i i this is i talking about vo2 max and body composition and muscle mass are two of my favorite things to talk about with my patient because they're correlated to so many things both of them there's a vast amount of data for both your cardio respiratory fitness which is measured by your VO2 max, and your muscle mass and muscle strength to the top 10 leading causes of death in the United States. Also to the 35 chronic conditions that lead to them. Yeah.

And two of the chronic conditions that are listed near the top are sarcopenia, which is loss of muscle mass, and decrease in your cardiorespiratory fitness or your aerobic fitness. Which are two things that traditional doctors never look at or measure or treat. They never look at, and they're highly correlated. Because if you look at the traditional markers of cardiovascular disease, which are going to be hyperlipidemia, hypertension, and inflammation. If you look at the markers of metabolic disease, which are going to be insulin resistance, obesity.

Inflammation. Inflammation, again. Basically, what happens is that they lead to atherosclerotic vascular disease. Meaning cardini of the arteries, clogged arteries in your brain, in your heart, in your body. Which means that you're going to be getting less blood flow to your muscles and if there's less blood flow to your muscles there's going to be less what oxygen delivery yeah and then then what happens is now if you're not aerobically fit then you're getting less oxygen to your muscles then your muscles stop growing

yeah okay and so then that leads to some of that loss of muscle mass so your aerobic fitness and your and your your ability to maintain your muscle mass and strength are very much correlated and they're interconnected and that's why we have to pay so much attention to them because going back to it i want to emphasize it one more time both of, through vast amounts of data since 1950, have been highly correlated to chronic disease, decreased health span, and increased immortality. Yeah. That's why we've got to focus on them. I really agree. And I want to sort of bring it back to that kind of geeky science for a minute.

Yeah, I want to go there too. Because when I wrote my book Young Forever, I talked about one of the key hallmarks of aging which not my deficiency sort of the scientists have come together what happens as we get older like what are the what are the the hallmarks what are the criteria what are the phenomena we see as we get older and and one of the things we see is a dysfunction and a decline in our mitochondria absolutely now as medical school we learned about mitochondria in first year medicine and the biochemistry and the Krebs cycle, and then we were basically all told to forget about it,

because it has no relevance for clinical medicine. And so most physicians have no clue how to diagnose problems with mitochondria or to actually treat them. And yet, mitochondrial function is critical to almost everyone in the chronic disease, whether it's diabetes have declined mitochondrial function is critical to almost everyone in the chronic disease, whether it's diabetes, have declined mitochondrial function, autism, Alzheimer's, Parkinson's, heart disease.

I mean, you name it. It's there. It's a mitochondrial disease. Yeah. And yet we learn nothing about it. And so we actually now have a window into how to look at mitochondria through things like VO2 max testing, body composition. Some of the other tests we do at the ultra wellness center like organic acids mitochondrial

swabs which we can look at your actual mitochondrial function so there's a lot of ways we can diagnose what's going on and then we have really clear ways to treat it through diet and lifestyle exercise which we're going to get more into and and very supplementary so getting back to the vo2 max i know we want to go into the weeds on that. We could spend the whole day just talking about VO2 max. You brought the mitochondrial piece. Well, the whole point of getting oxygen to the cell is to get it into the mitochondria to produce energy. Yeah.

Right? And so when you talk about the Krebs cycle, there's not a day that goes by that I'm not looking at the Krebs cycle at least 10 times. There's not a day that goes by that I'm not looking at the Krebs cycle at least 10 times. There's not a day that goes by that I'm not looking at the four respiratory chains of the mitochondria because we do that testing in our office. And people are like shocked, like, wow, what are you talking to me about? Oh, I'm talking about like the most important thing to your health, right? Your mitochondria are not really working out well, right? And why? There's a host

of various reasons. We're going to focus on exercise piece today, right? But we know there's a nutritional piece, right? And we know there's some other pieces to that, including genetics. Just to go back to our athletes, an Olympic cross-country skier or a Tour de France winner, they're born with VO2 maxes like 85, 90, right? You and I, we're born 40 vo2 max is like 85 90 right you and i were born 40 to 60. right we might be able to get a little higher through training which we'll talk about later but there is a genetic piece to all of this right but you can train it and it's really important to know that vo2 max

it declines with age just as muscle mass does and, both declines are associated with decrease in health span and decrease in longevity and increased mortality. So we want to, the whole point, what I want to hopefully we really get to our listeners today and our viewers is that you have to at a very early age, begin to incorporate exercise into your lifestyle. Because if you come to me at age 50 and you are metabolically imbalanced, or you're obese, or you already have metabolic syndrome, and you're not an exerciser, it would be easier for me to get you off a crack than to get you to start exercising. It's an extraordinarily difficult habit to begin late in life.

Yeah. But you can. You can. You can. You can. And you have to, by the way. And you have to. It in life. Yeah. But you can. You can. You can. You can. You can. Absolutely. And you have to, by the way. And you have to. It's not an option. And at the Ultra Wellness Center, all the doctors are versed in this.

All the PAs are versed in this. We work with nutritionists and we work with exercise physiologists to help you get over any barriers that may exist for you. Yeah. And that's why people come. And since you published your last book, Forever Young. from young forever um bob dylan that was that was young you're so much into rock and roll than i am but needless to say um we've been getting a lot more you know patients and clients that want to really focus on their longevity and health

span so this is this is something i spent a lot of time reading about thinking about and then finding ways to reduce the barriers for my patients so with the vo2 max getting back to that we get that measured we either have people get that done local to their environment or there's a you know there are some places near the ultra wellness center that we can have them get their vo2 max measured and for many people it's brand new information but it then becomes a really great marker for them because we can then give them a fitness program that's designed specifically to improve your oxygen delivery and oxygen utilization which will then improve your vo2 max and give you that cardiorespiratory health that you're going to need as you age.

And by the way, the side effect is you feel much better. Oh my gosh. You have more energy. Oh gosh. And you burn more calories sitting down doing nothing. And the reason I like it, I get to eat more. I mean, I like to eat, but when you increase your VO2 max, you basically just burn more calories sitting down doing nothing.

It's a vital sign. You know, in my way of thinking for my patients patients i don't want to see them in the room unless they've had a vo2 max and they've had their body mass um composition done yeah because those are two to me those are vital signs that if i don't know them i can't give you everything that you need to be healthy yeah i mean, I don't know if there's good data on this, but I think your VO2 max is probably as important or if not more important than measuring your blood pressure or your cholesterol or your blood sugar. It's that important. And we don't look at it in medicine. Well, they're highly correlated. I mean,

VO2 max is correlated to your lipid levels and also blood pressure. So there are some studies that make that correlation. And I don't want people to feel listening to that that you know they can't start late in life because they can't there's this guy uh i read about who was a french dude who basically decided he he he was a post office worker and retired at 65 and he was gonna take up cycling and now and at 105 he could cycle basically a 14 minute mile which is really fast yeah and and his vo2 max was that of a 30 year old and he decided i think at 103 or something that he wanted to improve his vo2 max so he basically got a training program to improve his vo2 max even at 103 years old you can absolutely yeah so george take through, we basically measure it through a lab,

essentially a cardiometabolic lab with a cardiometabolic cart that measure your oxygen and carbon dioxide exchange, and you get a number. And there are other sort of surrogate ways you can do it through various watches and I don't know how you're doing calculations, but basically it's a really important number to know.

We get your number. Okay, the average person that I see who's not that healthy is in their 20s even teens it should be kind of you know typically as you get older it gets lower but typically in your 30s it's in the 30s it starts to go down you know when i was you know 45 mine was 55 so it's possible to keep it high yeah at any age so um when you start to sort of see these people and you do this testing what is what is the sort of strategy then around cardiometabolic fitness and soon we're going to get into body

composition in a minute but it's i want you to stay tuned for that because it's a really important conversation and i think it's it's again one of those unmeasured vital signs which is muscle you talked about sarcopenia which is a condition that is correlated with almost every feature of aging. And in fact, it's probably the reason we age so much. And yet we don't ever measure it or talk about it in medicine either. These are big gaps. And again, this is what we've been doing in my practice for 30 years at Kenya Ranch before, and then here at the Ultra Wellness Center. And so how do you approach someone who comes to your office and maybe you can tell us the story of a patient

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

to their history with exercise to any injuries that they may have to their current state status in terms of their work environment to social environment and any disease process they may be struggling with so it's always going to be personalized but there's a general approach so the general approach is you need to have an aerobic baseline so you start with zone two zone two is basically 60 to 70% of your maximal heart rate. It doesn't sound like very much. No, it's not. But that is your base. So can you have a conversation when you're working at that level? Yeah. So that's a conversational exercise I explain to people. If you and your wife are

on a treadmill and you're next to each other, you can have a conversation where you can get one or two sentences out and need to take a breath yeah if you get more than a sentence or two out then you're not working hard enough and if you can't breathe you're working too hard the reason why that's important is that's your aerobic capacity that's your you're going to maintain a a metabolic rate in which you're using up oxygen and you're and you're not beginning to create too much lactate because once you go through that threshold then you become a little more anaerobic and you can't maintain that long enough and that that aerobic level allows you to develop that oxygen delivery system that's very important to maintaining your vo2 max on a mitochondrial level so you need to get

that baseline and that should make up the majority of your training of your vo2 max on a mitochondrial level so you need to get that baseline and that should make up the majority of your training of your vo2 is that like a brisk walk or is that you can be well it has to be brisk enough it has to be brisk enough that your heart rate is up you're sweating a bit and you're definitely can't have a full conversation yeah it's not like you know you know walking the dog and you and talking about your investment portfolio with your buddy, right? Okay. So how does somebody figure out their zone two? Because there's a calculation in medicine, which is your maximal heart rate is 220 minus your age. That's the maximum heart rate that you should get at your age. Now, let's say I'm going to be 65 this year.

So that's- 155. One what? Well, I think it's 155. 155. Okay. Now, I'm highly trained. So I often get my heart rate to 180.

This is great. This is great. And when I get it to 180, I'm like, oh, am I going to die? No, I'm not going to die. I'm just fitter. And so my maximal heart rate is younger than I would calculate. But for most people, it's 220 miles per hour, which is their maximal. And then it's basically 60% to 70% of that.

Now, there are devices, like I have a Garmin watch, and there's many other devices, Samsung, Apple, so forth, Fitbit. And a lot of them measure your cardio metabolic health. And this watch tells me when I'm in zone two, when I'm in zone one, one to five. And I can see where I'm in my exercise routine. And that's really helpful. But for most people, how do they determine what's their true maximal heart rate and their true zone two? So for most everybody, it's really going to be that calculation. The way I work with people is you do that calculation, but to your point,

there's something called the rating of perceived exertion. And it's your ability to understand where you're at in your fitness. So I can get my heart rate up still into the 180s. So my max heart rate, I mean, I get into 188, 190. I'm like, I'm not, you know, I'm okay. I don't know if it's a glitch in my watch, but the other day it said 199. I'm like, I don't think that's right. But the reality is that if I go to my calculated zone two, I'm not working hard enough. So I go by my rating of perceived exertion. I'm not in zone two until I'm at that point where I'm getting one sentence out. So I always tell my patients, correlate your calculation with your experience. That's one sentence out and then you have to take a breath and do another one.

Pretty much. Is that the idea? Yeah, pretty much. One to two sentences out. I mean, for all intents and purposes on a practical level, which I'm truly trying to make it for my patients, make this as, lower the threshold as much as we can, make it as practical as possible. So you, you know know the only real tools that you won't have you'll get from us that will be your vo2 max and your body comp but after that i want you to be able to do everything else at home yeah so so when you're telling someone to zone two how long do they have to do it okay how many days a week and and then what else do you do to increase your vo2 max okay so

the recommendation is about 150 minutes of zone 2 activity just for basic cardiovascular health will 300 be better you know it's it's the law of diminishing returns 150 or more maybe between 150 to 200 that's about 30 minutes to 45 minutes of zone 2 activity per day that could be swimming that could be running that could be treadmill that could be rowing whatever you. That could be swimming, that could be running, that could be treadmill, that could be rowing, whatever you like. It could be biking. Okay. Then, what then is going to increase your VO2 max?

There's, zone two is considered moderate. Oh, by the way, that's more exercise than like probably 85%. 86%. 86%. 86% of Americans do not meet that goal. Yeah yeah yeah so 80 86 percent of america you gotta get moving yeah so 86 of america is sedentary yeah and inactivity leads to disability and mortality so go back there anyhow so so then you have that baseline and at at least 10% to 20% needs to be high-intensity interval training.

That baseline is more of your moderate-intensity training. When you compare the two, high-intensity interval training is far superior. I think I read the numbers, like eight times more superior in improving your VO2 max than moderate cardiorespiratory training or intensity training so the high intensity interval training is when you get up to 90 85 to 90 percent of your max and then you maintain that for an interval period rest and do that interval again especially like the speed you'd be at if you're running from a tiger for like 30 to 60 seconds, as long as you can maintain it. And then you take a break and you kind of go slow, really slow for three minutes.

And then you do it again. There's all these different approaches, right? So what you want to do with your high-intensity interval training is that you start with your baseline. So you warm up. And then you do your baseline training. And you do it on a different day. So you'll do your zone'll do your your zone two activities monday through friday or let's say

like monday tuesday wednesday and then you know on tuesday saturday you do your high intensity your high intensity the intervals will be you can go one to one one to three so let's say you do 30 seconds of running as fast as you can. Yeah. Then you can rest for 90 seconds. Yeah. Right. As you increase your fitness level, you can increase the duration of your intensity. So instead of 30 seconds, you can go up to three minutes. Yeah. And so as you're able to do that, that is your subjective measure that your vo2 max is improving right so then you can increase so so you start 30 seconds you rest 90. then you know as you get more and more fit you may go one minute and rest three minutes so do this on a treadmill on a bike and then if you get really fit by the way then you can do like one to two, one to one. So then you do like one minute really hard,

only rest one minute, one minute really hard. And that way, so that's progressive. And how long do you have to do that for? Like 10 minutes, half an hour? 20 to 30 minutes. Yeah, so it's 20, 30 minutes twice a week. Twice a week at most. Not that much.

No. Right. And you're saying it has a dramatic effect. Dramatic effect. Yeah. Yeah, you'll definitely see an increase. Yeah, I saw a paper years ago, I wrote about think in my book ultra metabolism that that if you compared traditional aerobic training to vh max training and people would exercise less minutes less duration higher intensity they would exercise far less and

get far more fit and burn like nine times more calories than if they actually were just, and it's basically burning more while you're sitting on the couch watching TV is what we're talking about here, right? So, and one of the concepts I want to bring up is the idea of what we call exercise snacks. And you can think about it in regards to aerobic training, and you can think about it in regards to your strength strength training as well and these exercise snacks you can get just as much benefit doing a five minute high intensity interval training three times a day or four times a day than doing it all all 20 minutes at one time so you can in the course of your day instead of like napping or just you know or just keep working or eating you know you can just take one to three

minutes and do a high intensity interval workout you can do you know right in your office like do burpees yeah do burpees you know um and do intervals of them 30 seconds on 30 seconds off and you can do that for three to five minutes recover and if you do that four times a day there's your 20 minutes that's amazing and it doesn't have to be all at once. Yeah, it doesn't have to be all at once. And that's what I really want to emphasize to our viewers and listeners is that we want to try and find ways to get you to exercise that lower the threshold, lower the bar, make it less confusing, make it less complicated.

Use your own body, use minimal amount of equipment, and that way you're more likely to do it. So that's how you take a 40 year old who's lost their way and get them back on track. Tiny steps, tiny changes that lead to bigger changes and then ultimately hugely improved fitness, longer life, healthier life. Yeah, no, I absolutely agree, George. And I think what's quite amazing is studies I've seen on people who had dementia using VO2 max training, they put them on a bike and they do VO2 max training and they cognitively improve dramatically. Yeah. And part of it's

because it basically creates this thing called miracle grow in the brain or called BDNF, which is one of the things that gets triggered by exercise. So I think it's quite amazing when you see the power of this, when there's no drug that can do it, but you get on a stationary bike and you go as fast as you can and your brain wakes up. Pretty damn good. Pretty damn good. And just as another, just looking at more data, there are studies that have been done that looked at people that have cardiovascular disease, have had MIs, have had catheterizations, and they compare their improvements in functionality using moderate intensity exercise versus high intensity exercise.

They're able to do high intensity exercise, and they make vast improvements in their vo2 max and their functional capabilities doing high intensity exercise so even if you've had a cardiovascular event you can do high intensity training and increase your your vo2 max and your your functional capability and it's not just a vanity metric it's actually a really important metric absolutely how you're aging what your metabolic health is what your fitness level is and how it's going to determine everything that happens going forward. So again, you know, this is something you're not going to get at your regular doctor. You're not going to get the right prescription. You're not going to know exactly what to do. And it's the kind of stuff we do at the Ultra Wellness Center. I want to talk about the other important measurement that

you mentioned earlier, which is something we also do at the ultra wellness center called body composition. Now what is body composition? So, so body composition is really, what are you made up of? We've just been talking about cardiovascular fitness. You're talking about heart and talking about blood vessels, but when we're talking about your body comp, we're talking about fat and we're talking about muscle. Those are your two major, you're talking about fat, and we're talking about muscle. Those are your two major body parts or body subtypes. So they're really important because they're metabolically active.

And fat has its role in providing us energy, but when we have too much fat, we have certain types of fat, it's inflammatory and it alters our insulin sensitivity which has a significant role in metabolic syndrome and then the development of you know cardiovascular disease which is the leading cause of death in men and women so we need to really be aware of fat but we're not always aware of fat because when we go to our conventional doctor's office we get a bmi yeah and bmi is not telling us anything about body comp. It's just telling us about your total mass compared to your surface area. Yeah, right. Whoever thought that would make any type of sense,

right? So when we do a body composition, we can actually look and see how much muscle mass do you have, particularly axial muscle mass, muscle mass in your arms, muscle mass in your legs. They're highly correlated to your health span. Then we could also look at your body fat. So when we look in the mirror, we see our fat. If we do a waist to hip ratio, which is actually better than BMI when it comes to identifying what your body count might be because it really represents your visceral adiposity and visceral

adiposity belly fat belly fat in english so you know you know you're smart yeah so belly fat yeah so so that's obvious but you also can get your your visceral your visceral adiposity not your centripetal adiposity but your viscera is around your organs inside right that's the fat inside around your organs in your belly yeah and that's a really like that's a measurement that really opens up people's eyes because when they see on their body composition that their visceral fat is like above what it should be they're like yeah i can't see that so well that's the really dangerous stuff yeah and so so when we do a body composition the the one the body composition that's really used most in research and in in um uh in practical medical uh and exercise physiology settings is your um bioelectrical impedance and that's when you send an electrical signal through

the body and the electrical signal at a low-level frequency will pass through the different tissues. And it passes through the tissues at different rates because each tissue is going to impede the flow of that electricity based on what it's made up of. So we're at 70% water. The electrical signal is going to go pass quickly through the water versus fat. It's going to go pass quickly through the water where versus fat it's going to go slower and so using you know a uh you know a computer algorithm

you can then begin to define what a person's made up of based on the electrical signals that you got from the test so we use an in body in the practice, and it has multiple electrodes. It's a pretty fancy machine. It was very expensive, but we got it because we think it's such an important vital sign. Yeah, and it's a really good one. It's a really important one. Everybody gets it when they come in. And it has eight electrodes that are spread between your hands and your feet.

And so it's very sensitive, and it can pass multiple different frequencies. So it's very sensitive and it's very accurate in being able to determine how much fat, how much of it is visceral, how much of it is not, and also look at your muscle mass. And when you compare it to DEXA, it actually will... DEXA is sort of what's used a lot of research yeah that's an x-ray which is some low-level radiation that's used to check bone density but also can check body composition and fat and muscle and distribution so that's also used to measure it's also used but as bai so it used to be the gold standard but as bai has really increased in the technology has really improved, BAI actually-

BAI is body impedance- Body impedance- Analysis. Analysis. Right, so it's basically using what we just talked, the in-body machine, right? In-body machine, yep. Thank you for helping me make this simple for people.

That's okay. That was my goal, make it simple for you. Okay, so in doing that, the BIA will actually more accurately determine your muscle mass because DEXA doesn't account for any fat that might be in the muscle. So it will overestimate your muscle mass. So BIA is actually really effective. And if you can get that done, you can certainly get it done in our office.

But if you can get it done, that's a really good baseline for knowing, okay, where am I at with my body composition? And what does that mean? It means I would actually distill it down to being able to say, where am I at metabolically? Yeah. Because how much fat and how much muscle you have in comparison to one another really does determine if you're going to be metabolically flexible and metabolically stable. That's right. And metabolic health is such a huge issue because it's a problem across America in a way we've never seen before. According to data I've talked about before out of Tufts,

90% of Americans are metabolically unhealthy. And it has to do with some degree of problem with body composition, with fitness, with nutrition. It's all there. But, you know, this is a huge factor. I just want to sort of emphasize what you said. Everybody who comes to the Ultra Wellness Center, when they check in and get their vital signs done, they get their blood pressure, they get their respiratory rate,

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

And yet it's one of the most important things we need to look at. And it's important because we can do something about it. We can actually change it, and we can alter our body composition at any age. No, Mark, we could, you know, as you're talking to me and my little ADHD brain is just firing off in 10 different directions, I'm thinking about not even the doctor's No, Mark, we could, we could, you know, as you're talking to me and my little ADHD brain is just firing off in 10 different directions.

I'm thinking about not even the doctor's office, Mark, how about schools? Oh yeah. How about, what is this thing about having kids in a classroom all day long? Right. And then,

and then like, like, you know, they're want to put me on a leash when I'm in third grade because I want to get up and move. Yeah. Anyhow, people have EDD, exercise deficiency disorder, not ADD. So yeah, you know, so I, you know, so once you have

your body composition, then we can start some real serious work. And I, and as I tell everybody, just as a quick aside, you know, I have patients come into the ultra wellness center and they seem to be really proud of like one piece of their medical record yeah and that's their supplement list yeah they love their supplement list right and i get people that come in with like like 23 different supplements that they've gotten from different podcasts and and you know the health and wellness space and they're really proud and they think i'm going to tell them, well, that's great. But when I look at what they're doing for exercise, I say, you know what?

Let's put that piece of paper aside. Because you cannot supplement your way out of no exercise. Or a bad diet or anything else. Or a bad diet, right? It's called a supplement, not a replacement. Yeah, exactly. So the reality is that I tell people, we're going to spend our time on lifestyle because if I can't fix your lifestyle, it's going to be really hard for me to help you reach your goals. Or if you're ill, to get you to be healthier.

So lifestyle is critical. We've talked about the cardiovascular aerobic piece. And now there's the body comp that lets us begin to understand, okay, what do we do to change that body composition? Specifically, if we look at the data around muscle, we understand that you need muscle mass and you need strength. Muscle mass provides you that metabolic center where so much of your metabolism is going to occur.

And it has a lot to do with glucose metabolism. I just want to emphasize that. What George just said is so important. Your muscle is where your metabolism happens for the most part. It's in other parts, obviously your heart, your brain, your organs, but the vast majority of your metabolic function

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

taken a step down and you have no ladder to get back. So it happened to a lot of elderly people when they got COVID, they just had no capacity to deal with it and they had no protein reserve. And they're often protein malnourished. and that protein is required to make your immune system for example your antibodies are made from proteins your immune system functions on protein so if you have not the right amount of protein you're in trouble and if you don't have the reservoir in your muscles you're doubly in protein right i'm doubly in trouble and so then so that's the muscle mass piece but then there's the strength piece so so there's muscle mass but you need to have strength with that muscle so the strength is your functionality

so you can't just have big muscles they have to actually be functional right right right because they have to be strong and so so there's there you have to think about it in both ways and and you have to and and then when you think about it that way then you have to think about you know protein and its role in helping to build and repair muscle but protein by itself is not going to lead to strength that's when you need resistance training it's like putting uh right ingredients for soup on the stove but not turning the heat on exactly right right so protein is the ingredients but right the heat is the exercise right and that's and then and that's resistance training and there's

just a lot of otherwise known as weight lifting strength training band training body weight training there's a million ways to do it yep and so there is resistance to resistance training people just don't like to do it when i talk to my patients they're just like oh my god i hated it i was like this is painful this is uncomfortable i used to i couldn't do two push-ups when i was 50 years old i did 10 push-ups i would be sore for a week was like, this is painful. This is uncomfortable. I couldn't do two pushups when I was 50 years old. I did 10 pushups. I would be sore for a week. I'm like, this is ridiculous.

I don't want to do exercise. It makes me feel horrible. So I just never did it. And then I started when I was like 59. I'm like, all right, I know I'm supposed to do this. I tell everybody to do it. I'm not doing it. I better do it.

And it just changed my life. Dude, when I see you on Instagram pumping iron in the gym, I am impressed. I mean, you seriously, you work hard when you work, man. dude when i see you on instagram pumping iron in the gym like i am like impressed i mean you seriously you do you work hard when you work man and you know i try i try but you know what's so important to realize right now is there's a huge problem in our society which is the ozempic craze oh yes and and the reason i'm bringing it up is ozempic makes you lose fat and muscle and if you're on ozempic or wagovi or manjar or any one of these drugs and new ones coming around every minute

you have to pay attention to what we're saying today you have to have the right amount of protein more than you think about a gram per pound we'll talk about that per day and you need to focus on resistance training if you're need to focus on resistance training if you're going to be on those drugs absolutely and if you don't what will happen is you will lose muscle and fat but muscle burns seven times more calories than fat so when you get to the weight you want you'll have a slower metabolism and eating a lower amount of food will actually make you gain weight. So this is a huge problem.

This is why often people can't get off the drugs, and they don't do it properly. And I'm not opposed 100% to these drugs. I just think they're overused, and they're also not prescribed in a way that's taking care of the side effects of these drugs by properly addressing the protein needs and the resistance training needs that are increasing when you're of these drugs by properly addressing the protein needs and the resistance training needs that are increasing when you're taking these drugs i can't agree with you more

and if you hadn't made the point i would have these are called glp1 agonists and they have a role they have a role but our bodies make it by the way There's a lot of ways to increase our body making jump. Yeah. And they have a role. Our body makes it. But they're being co-opted from weight loss specifically. And when you lose weight rapidly or lose weight ever, you can lose 20% to 30% of that muscle. well no zempic i think it's it's higher it can be 40 to 50 absolutely 50 of the weight you're losing is muscle which is a disaster and that is a disaster and so in in regards to using these drugs for weight loss the way we are now

using them in our country it's very difficult for me to find a rationale for that i've always been about and that's why we're having this conversation it's about lifestyle it's about and and capturing that lifestyle early in life so that it means so that you can maintain it and improve it and excel as you get older so glad we took that little journey over i think it's important dark side because it sort of speaks to why, for example, everybody who knows Empik needs a body composition before they start. Track them every month to see what's going on. These machines are easy.

You just stand on it. It's like a scale, a fancy scale that you stand on for a few minutes and it measures everything. And I think if we don't do that, in my view, as someone who would be prescribing one of these drugs, I would consider malpractice if you don't focus on muscle health and prevention of muscle loss when someone are on these drugs i think it's akin to malpractice and if you don't measure body composition and

track it it's it's like it's like you know it's like putting people on a on a diuretic where you you lose potassium and not checking your potassium, right? It's like, well, you know as a doctor, if you're on a certain drug, you need to check liver function tests because it affects the liver function. So you just know to track the things that are the problems. And we don't do that with these drugs.

And to me, it's criminal. And I think it's a quick fix, boom, boom, lose weight. But we're creating a whole society of people who are going to become more sarcopenic, have more muscle wasting, and lower metabolism. And then there's a vicious cycle of getting the weight back, eating less food, and being in this horrible, horrible tailspin that it's hard to get out.

It's absolutely. And we are so body shape centric, and we are so fat centric that we're losing sight of the fact that you emphasize I want to emphasize again because I've had this conversation recently with colleagues and with you as well that using these drugs using GLP ones have a real downside to them and using particularly for weight loss is an issue because you're losing fat but you're losing muscle and that is even more important you may look good but now you're you know

you're skinny fat you're gonna be well I don't know how what skinny muscle like so like skinny might mean you look thin but you're actually fat yeah that's what we call skinny fat right yeah so yeah you're in bad shape so i i think you and i totally 100 agree on that and and have the same viewpoint um and then there's also the complications that we've talked about before that can come with those drugs including you know intestinal obstruction and yeah there's a whole yeah we i've done a whole podcast on that we'll link to the show notes but yeah let's talk about let's talk about body composition and and resistance training in particular i think you know there's two parts of body composition what you eat and and i always say you can't exercise your way out of bad diet

so if you don't get your diet sorted and i'm going to spend a few minutes on that a minute you're going to have trouble right there's people who are in the gym all day long and overweight i actually had a guy who was my trainer at equinox when i lived in new york who was like ripped he could do he was so strong i mean he could he could literally go put like i don't know 150 pounds on him and do like pull-ups and i'm like you know like basically two body weights and do pull-ups i could i can't even do one pull-up and and he kind of had this thick layer of fat all over him and i said why don't you try eating this way for a little bit and he i have a before and after picture of him right which is quite amazing and he was was even more wrecked but had lost that layer of fat and it was metabolically more healthy even though he was so strong he still he still hadn't had his diet sorted so diet really plays a role huge let's

talk about what is the dose and frequency of resistance training what are the types available and what what should people do because it's a little bit intimidating oh my gosh yes you know if you're a bodybuilder i mean i would go to these gyms with all these bodybuilders and it's a skinny guy i'm like i'm sort of intimidated here i don't know what to do i don't want to hurt myself i'm like worried about this you know how do you address the the problem of just getting started if you've never done this before that's the million dollar question and this is where people this is why people don't go this is why people don't do resistance training because the bar is really high. It means they need to buy equipment.

They don't, because we're going to a gym. Then when you get to the gym and then you see all these machines, which ones do I use? A lot of confusion. Out of making an afforded trainer, right? Right, right, right. And then when I get on the machine, how much weight do I use? Do I use a little weight and do lots of reps? Do I use a heavy weight and not so many reps? You know, what's my range of motion? Do I do a through the entire science of strength training, but I'm going to try and just distill it down. So what we want to do is we definitely need to do progressive resistance training in order to gain muscle mass and strength okay so progressive resistance training means that you start out

whatever exercise you choose one that everybody might know there's a curl all right so you're going to start out with five pounds well you you do it the first time you do it man i i could barely get to eight yeah okay all right. All right. So then you're going to go back three days later, or maybe go back the next day, do a different body part. But three days later, you're going to go back and do your curl. And you know what? You're going to notice that you actually do two more reps. It's not necessarily because you got stronger. It's because you actually got more efficient. Biomechanicallyically the message from your brain to your muscle some of the metabolic efficiencies occurred already not necessarily stronger not necessarily bigger

muscle mass yet but more efficient but three weeks down the road you're going to find that it's really easy now it's time to increase your your weight and so now you're going now you're going to 7.5 pounds so by the time three months comes if you've been really now you're going to 7.5 pounds. So by the time three months comes, if you've been really consistent, you're going to find that you've progressively increased your resistance. And now you're at from five pounds, you went up to 15 pound curl. That is going to correlate to increased strength and increased muscle mass as long as you're eating correctly. You're going to need to fuel that with the right amount of carbohydrates and healthy fats, and you're gonna also have to supply

the building blocks with protein. If you're not getting the protein, then you're not gonna be able to repair, you're gonna get injured, and you're not gonna build the muscle mass and strength that you're looking for. So that's just the really basic. So progressive resistance training,

I think that's an easy concept to understand you slowly build up the amount and yeah but but how many days a week should you do this i mean what are the different types people can do what are the low friction ways for example i i didn't really ever do any weight training so i went to the gym and i got a trainer and i could afford it thank god and i was i learned a lot and i kind of started uh and then covid happened and kind of fell off and then i happened and kind of fell off. And then I went and learned about band training, resistance bands, because I'm traveling a lot.

I move around a lot. And I can't always get to a gym or I'm busy and I don't have time to go to the gym, get there, change, do the thing, change again, shower, come back, drive home. Like, it's a whole thing. So I'm like, I just need to be efficient. And I learned about TB12, which is Tomady's band resistance training program when tom did this solely and he ended up being you know being a seven-time super bowl world champion so i think

he knows what he's doing and i started doing these bands and i could do them anywhere i can hook them to a doorknob i need a floor and a door and i'm good and i'm able to literally build my strength and it's so easy and i just it i can do you know light bands at first heavier bands heavier bands i can do about 20 30 minutes um three or four times a week i like to do five if i can but even that keeps me going and so it doesn't have to be like a big project no and there's a lot of apps there's a tb12 app you can use um but i i think you know how do sort of people just think about getting getting kind of started on yeah so so what you you know sort of referred to are you know some of the

alternatives to our classic understanding of progressive resistance using weights so there there are bands there are kettlebells there there are body weight exercises. All of these can increase strength. They might be more difficult to increase the muscle mass and hypertrophy because you might not be able to get to the number of, you know, get to the amount of resistance you need or the number of reps you need effectively to increase hypertrophy. So I will generally suggest to people that they move towards using weights for the resistance training. And you can do that at home. You can do that in the gym. Usually recommend that you do at least two days a week. I think if you're doing two days a week, you're just breaking...

You're staying even. You're breaking it. You're breaking in. I think if you're doing three days a week, you're going to be able to accomplish your goals. Four days a week, you're going to be able to squeeze a little bit more water out of the sponge.

Five days a week, you're now probably nearing addiction. How many do you do, George? Three to four. Three to four. There are weeks I get one or two. I mean, quite honestly, again, a quick aside, you cannot maintain the same exercise level throughout the year.

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

Well, that'll help from his friend. Yeah. We can put that aside for now, but he still really worked hard, and I had a huge amount of respect for Lance. But needless to say, I could probably, in the middle of winter, when I was really riding hard, probably gone to Austin and ridden with Lance. Because he probably wasn't doing intervals and sprints. He was probably doing five, six, seven hours on the bike. And I could just hang on his wheel and let him drag me around. But I wouldn't be able to hang

with him. Because you're working on something different. He then changes his program so that as he's getting closer and closer to spring classics and finally to the Tour de France, where he's getting more specific into power and sprinting, then I'm just taking pictures, right? Same thing with strength training, right? Yeah, the same thing with strength training. To get back to it is I'm not going to sit here and tell everybody, 365 days a year,

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

Get to the gym. You know, I do think getting to a gym is probably going to be the most effective way to begin the process. You can, once you understand how to do it using kettlebells, I'll take one thing back. One thing you can do is the Instagram and YouTube are huge resources for exercise programs. So I will take this back. My wife has turned me on to this recently. She has a whole catalog on her phone of Instagram posts of different resistance training and weight training programs that involve kettlebells, body, bands, everything. So the bar for doing those things actually is so much lower than it used to be.

Yeah. And body weight. I'm actually going to take back what I just said. I don't think you need to go to the gym to start. I don't know. Go to start. Go to YouTube. Go to YouTube and Instagram. Pick your favorite. Pick your favorite, whether it's bands, whether it's kettlebells, whether it's body weight. And you'll be able to find a plethora of different exercises

that you can do at home in the office. So you can just start there. You've got to be careful to not overdo it and be like where you injure yourself because you have to start slow. Yeah gonna hope that everybody's gonna be using common sense but well you know what mark twain said right no problem with common sense is not too common right you know i've heard you say that before i should have known um so yeah so you always start low go slow there's no rush you'll make your gains with time but when it comes to actual if you're going to use weights which is my favorite approach um then here are the things that

people always wonder about like which exercises should i do well you want to do exercises that use more than one joint they they they're going to give you the the most metabolic response for example for example would be a squat squat squat a deadlift even a bench press you're using multiple joints of the bench press you know a um if you do bench press, squat, deadlift, you know, you're, you're, you know, bench press, squat, deadlift, you're talking about the power lifts. And those, if you just concentrate on those, you're going to get a full body workout that's going to put you in a really good position of health. Yeah.

Right. Now, now those are, those, they take a bit. So it doesn't take a lot is what you're saying. It doesn't take a lot. I mean, I mean, you don't have to go crazy. You don't have to be like in the gym all the time. And you can actually learn a few key exercises that build large muscle strength

and core strength and stability. Really, really important. And that's why I love bands because they're so easy and portable and they do all those things. So on the weight piece again, people are always wondering, should I do, you know, how much weight

and how many reps? So it really depends. I would say that if you want a good, solid middle-of-the-ground program, then you want to try to do anywhere from 8 to 12 reps. Should I go to exhaustion or should I not go to exhaustion? Should my last rep be completely, I can barely get it up or not? Well, there's some mixed data and some recent data indicates that getting to two to three reps before exhaustion is going to give you the same benefit.

So you don't have to go to exhaustion. You don't have to have so much pain. Right? Right? to have so much pain. Right. Right. And so, so eight to 12, your last one can be one to two to maybe three reps from exhaustion. There's that, there it is. There's your repetition number, right? Your weights should be weights that allow you to do eight to 12 reps. So you just find a weight. You have to, you know, test it out and figure out, you know, your first couple of times you go, which, you know, what are you going to use um and then here's here's a here's something that's transformed my recent weight

lifting so um there's long length partials there's full range of motion and then there's short length partials so when they compared so full range of motion is when you do a curl like this, full range of motion from that position. A short length partial is you start here and go like this. You start halfway and then you finish, yeah. Long length partial, you start with the muscle fully extended and stretched and just go partway. Partway. One third to half, right?

And what does that do? So recent data has shown that when you compare the long length to the short length partial, the long length partial, there's not even a comparison in terms of strength. So short length is better than long length? No, no. Long length. Long length. Long length. And when you compare long length to full range of motion, long length is still superior. Amazing. So you can do a long length partial and get the same

benefit as if you're doing a full range of motion the benefit i find for me in that regard and for people that are going to be lifting is that why your biceps are bigger than mine i don't know i don't know mark i just i'm look yeah i'll write your next program for you make sure you get your biceps um so so when you do the long length partial, what I like about it is I can actually use more weight. I can actually, you know, and I just find it's much less stress on my overall body. Right?

And I, so. So this is basic things I want people to get. Your weight, you pick weights that you can do, 8 to 12 reps. You don't have to go to exhaustion, but if you want to, you can. One to three reps before exhaustion is all you need to go to. You need to progressively increase your weights over time. And then you can use any type of format. You can use bands.

You can use kettlebells. You can use body weight. And again, as we talked about with aerobic training yeah you have these exercise snacks you can do exercise snacks with your resistance training as well as you mentioned i have dumbbells in my office and i use those as for my exercise snacks every day no i mean i just i just talked to lee hood who's uh one of the world's premier scientists in systems biology and medicine and he's a 85 years old. He does 150 push-ups a day. So not all at once, obviously, but maybe drops in 30 here, drops in 30 there. You do that five times a day, that's 150 push-ups.

Very impressive. So George, this has been a great conversation about how do we look at things that are often missed with traditional medicine, what we do at the Ultraman Center to look deeply into someone's health and well-being and actually optimize their health and even treat diseases using exercise. How do we measure the fitness level using VO2 Max? How do we measure body composition using our in-body diagnostic machine we have in the office?

And using that data to help inform people about what's going on with their body and how to adjust their lifestyle to correct the problems so they don't get into trouble in the long term the one thing we didn't talk about i just want to touch on for a few minutes before we finish is diet yeah because body composition in particular and cardiovascular fitness to a lesser degree is is so correlated with our diet and part of the challenge we've had is that we don't, one, eat enough

of the right kinds of protein, and two, we eat too much of the wrong kinds of carbohydrates. And that will lead to increasing belly fat, visceral fat, fat marbled in your muscles, which you said we couldn't measure with the DEXA. You don't want a ribeye muscle. You want a filet mignon muscle, right?

No Wagyu. No Wagyu beef muscles. But that's basically what everybody in America is walking around with. Yeah, it's true. And so we need to really help people understand that they need to reduce their refined starches and carbohydrates in their diet. They need to increase the good fats. And they need to increase the quality protein when

i say quality protein uh we've talked a lot about this in the podcast with gabrielle lion with don layman and others and we'll link to those shows but but the quality protein matters and if you want to build muscle you need muscle it's sort of if you want to build muscle you need to eat muscle and if you eat beans it doesn't work as well can, if you eat massive amounts or you have highly processed bean powders or grain powders, you can concentrate the proteins and then they add extra amino acids. They add extra, basically synthetic amino acids to jack up the quality of the protein, which, you know, if you are committed vegan you can do but you have to do that like a garden of life sport protein for example

has 30 grams of protein but they also add all these other amino acids which aren't naturally in the products that are exactly so you you have to eat either whey protein you know beef chicken fish uh lamb these protein bison whatever you want to eat and make sure it's the right kind it's regeneratively raised there's great sources and we'll link to absolutely you can get to like force of nature whether regenerative meats or cetopia dot fish with with the great quality fish it's not toxic and so forth go away i like but you need the right amount of protein and the right amount of protein is is more than we typically think if you're resistance training and you're doing the exercise you need about a gram per pound,

which is almost double what is considered the requirements. And just so people know, the requirements that we have are based on avoiding protein malnutrition. So to avoid protein malnutrition, which is what was more prevalent when these guidelines were established, you need about.8 grams per kilo, which is about half of what I'm talking about

it's not the amount you need to put on muscle or optimize your health and secondly as we get older you mentioned earlier in the show we have anabolic resistance which means we are more resistant to putting on muscle so we need to overcome that resistance with more protein more exercise so really nutrition plays a huge role we deal with all all that at the Ultra One-O Center. We look at your metabolic health through multiple lenses, including the body composition measurements and VO2 max measurements. Yep.

So yeah, I would 100% agree with that. And you mentioned the different speakers you've had on your show talking about protein. And so the literature on protein, the number that seems to have floated out in the last year or so has been like 1.6 grams per kilo. And so, you know, you know, I would say that, you know, having looked at literature, definitely want to be somewhere between 1.2 to 1.6 depending on your

exercise activity do you need to get above 1.6 maybe probably not even if you're lifting i think 1.6 if you think about 1.6 milligrams grams per kilo for me is 130 grams per day. Yeah. That is a lot of protein for me. I mean, I definitely need to use a protein powder shake, right? Yeah, but before, you know, we had the show here, we just had a protein shake. Yeah, yeah, yeah. And that was about 40 grams each. Yeah.

Boom, like that. And it was just a protein shake. So I can't get to 130 without a protein shake. Yeah. Right? And so, and I think going back to your point. Well, you can if you had steak for breakfast. You know, I had a really good steak last night.

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

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

digest and get out the amino acids that we need yeah so now and they eat all day i mean i was in i was in rwanda people like oh my gosh you know gorillas they're they're so strong and all they do is eat plants i'm like yeah and they basically have intestines that are two or three times larger than ours and all they do all day is eat and they eat you know 50 pounds of food a day are you gonna eat 50 pounds of food probably not you know if you ate 50 pounds of grass you'd be fine like i said you can overcome the the issue with a plant protein if you eat enough of it but it's almost impossible to do that so george thanks so much you know for for enlightening us about the role of exercise the role of measuring the the biomarkers of health and fitness, metabolic

health, VO2 max, body composition. Again, it's just part of what we do at the Ultra Wellness Center. We took a deep dive into all your biomarkers, into your full spectrum of health. We are really in the practice of creating health. And what I say is no matter how sick you are, we help you get healthy. And as a side effect, disease goes away. So George, thanks so much for being on the podcast again. Hopefully, if those listening were inspired to come see us at the Ultra Wellness Center, just go to ultrawellnesscenter.com to learn more about what we're doing. And I hope we see you soon. That'd be great. Thanks, Mark. Thanks, George.

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