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Peter Attia MD#144 - Phil Maffetone: Optimizing health and performance through maximal aerobic function
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CHAPTERS
- 0:11 – 4:40
Intro and Guest Background
Peter Attia introduces the podcast and his guest Phil Maffetone, an author, coach and health practitioner. He previews the topics: maximal aerobic function, fuel partitioning, and marathon times.
- •Phil's background in biology, chiropractic, Chinese medicine and kinesiology
- •Maximal aerobic function overlaps with zone two, but uses heart rate rather than lactate
- •Preview of fuel partitioning and marathon discussion
- •Phil joins from Lisbon, Portugal
- 4:40 – 11:05
Phil's Running Career and Strategy for a Six-Day Race
Phil describes his path from track runner to marathoner and his training for a six-day race. He explains the strategy used with ultra runner Stu Middleman: start by walking, keep a low aerobic heart rate, and individualize rest and sleep.
- •A six-day race rewards the most distance covered, with athletes free to rest or sleep
- •Strategy was to start slow, run at the maximum aerobic heart rate, and avoid hard running
- •Stu Middleman chose a 36-hour stretch without sleep, and Phil served as clinician and coach
- •Sleep deprivation can cause hallucinations; Stu ran about 100 miles a day
- 11:05 – 15:30
From Treating Injured Runners to Working with Pros
Phil explains that his goal was always helping people with health, and that the athlete side grew from treating injured runners. He describes working his way up to national-class and professional athletes, including triathletes in the 1980s.
- •His undergraduate goal was to help people with their health
- •Injuries during the 1970s running boom brought him athletes
- •Triathlon fascinated him; he met athletes like Mark Allen in the early '80s
- •By the mid-'80s he was traveling, lecturing and writing, mostly with competitive athletes
- 15:30 – 18:21
Fit but Unhealthy: Why Fitness and Health Differ
Phil explains that he saw runners who were fit yet broken down and sick, which led him to separate fitness from health. He says the MAF test was meant as a functional test for average people, not just athletes.
- •Runners could finish marathons yet get sick and break down
- •Crossing the 1980 New York City Marathon finish line crystallized 'fit but unhealthy'
- •Fitness and health must be balanced for everyone from grandmothers to pros
- •The MAF test is a functional measure: walking or running faster at the same low heart rate
- 18:21 – 24:07
Aerobic vs. Anaerobic and Why VO2 Max Is Overrated
Phil gives his working definition of aerobic as fat burning and anaerobic as the glucose side. Peter explains how VO2 max is measured, noting it reflects muscle oxygen use rather than heart and lungs and doesn't predict marathon time.
- •Phil rejects the 'without oxygen' definition and ties aerobic to fat burning and mitochondria
- •Peter describes the VO2 max test as measuring oxygen consumed as exertion ramps up
- •VO2 max is largely a test of the muscles, not the heart and lungs
- •Research cannot predict marathon finish time from VO2 max, and Phil says we are worshiping the wrong thing
- 24:07 – 33:34
Maximum Aerobic Function and the 180 Formula
Phil defines MAF and links it to ancestral lifestyle, then recounts how he found his aerobic heart rate by watching athletes' gait at different heart rates. He explains the 180 Formula and its adjustments for health status, and how early heart rate monitoring evolved.
- •MAF stands for maximum aerobic function, built by eating more fat and jogging rather than sprinting
- •The heart rate was first set through exams, labs, and watching gait on the track
- •The 180 Formula starts at 180 minus age, then subtracts 10 or 5, or adds 5, depending on health and training
- •Being honest, including about medication, is the hardest part
- •Early monitors were manual checks, clips, and bulky chest straps before wireless units arrived
- 33:34 – 43:03
Coaching Volume, the MAF Test, and Sub-Max Predicting Max
Phil describes becoming a coach after seeing athletes over-train, and cutting their volume and intensity. He explains how runners get faster at the same heart rate, why he keeps them at their MAF heart rate, and why sub-max performance predicts maximum performance.
- •Excessive training schedules caused repeated injuries, which pushed him into coaching
- •Less training at lower intensity let people race better, as with a taper
- •Example progression: a nine-minute mile at the MAF heart rate becomes 8:30, then eight minutes
- •Phil keeps the athlete at the same MAF heart rate and expects a plateau after several months
- •Going faster at a sub-max pace means going faster at a max pace
- 43:03 – 49:48
Fat Oxidation and the Limits of Sports Nutrition Dogma
Peter shares how his own fat oxidation rose to 1.73 grams per minute after years on a ketogenic diet, contradicting the old medical-school limit. Phil agrees that research on carbohydrate-eating subjects distorted findings, and describes his path from clinician to publishing scientist.
- •Peter was a glucose oxidizer even at low intensity while eating very high carbohydrate
- •After three years of ketosis his max fat oxidation was 1.73 g/min
- •Peter says world-class low-carb athletes reach 2 to 2.2 g/min
- •Phil says carbohydrate-heavy research subjects distorted the science
- •Phil says he later wrote a textbook and scientific papers after leaving his clinic
- 49:48 – 58:11
Carbohydrate Intolerance and the Two-Week Test
Peter asks how to account for individual and age-related changes in carbohydrate tolerance. Phil prefers the term carbohydrate intolerance to insulin resistance and describes his two-week food challenge, which lets patients see how their symptoms respond.
- •Peter's tolerance for carbohydrate fell between his teens and his 30s
- •Phil says we all become more insulin resistant with age and prefers the term carbohydrate intolerance
- •The two-week test removes junk food and cuts natural carbohydrates, then compares symptoms
- •Carbohydrates are reintroduced gradually so patients learn their own thresholds
- •Individualization and holism are central to his approach
- 58:11 – 1:04:55
Low-Carb Diets and High-Intensity Performance
Peter asks about a four-week study Phil took part in that found no performance difference for athletes doing high-intensity intervals on a very low carbohydrate diet. Phil explains the rationale, its limits, and why the MAF test is his bottom-line measure.
- •Peter had concluded glycolytic athletes should not restrict carbohydrate as much
- •The study showed no impairment in high-intensity interval performance and no adverse effect on inflammation
- •Phil says high-intensity effort can still burn a lot of fat, and he would have run it longer
- •Participants were students, and larger and more varied samples are needed
- •If you run faster at the same sub-max heart rate over months, what you're doing is working
- 1:04:55 – 1:13:31
The Sub-Two-Hour Marathon and Lessons from Elite Runners
Peter raises Phil's 2014 book on the sub-two-hour marathon and Kipchoge's 1:59:40 run. Phil explains why he thought it achievable, criticizes the staged event, and discusses burnout among Kenyan runners and the benefits of an endurance base in the mid-30s.
- •Phil's 1:59 idea began as a 1990s article, based on elite times that kept improving
- •Factors considered included lighter shoes, body weight, body type, and better fat burning
- •Phil thought the Kipchoge event was an advertisement and took away from the sport
- •Phil believes Kenyan runners burn out from racing constantly
- •A sub-two marathoner would likely be in the mid-30s or later, with a great endurance base
- 1:13:31 – 1:22:19
Overfat, Health vs. Performance, and Closing Message
Phil explains why he prefers 'overfat' to overweight, linking excess body fat to chronic disease, immune impairment and injury, and to declining age-group performance. He and Peter discuss why people mistake training for events as health, and Phil closes with simple advice on food and exercise.
- •Excess body fat is tied to blood fat, blood sugar and blood pressure abnormalities that lead to chronic disease
- •Excess fat impairs the immune system and increases pain and injury
- •Peter says nothing is especially healthy about doing an Ironman and no one needs to do one to be healthy
- •Phil says walking around the block brings big fat-burning benefits
- •Phil says food is key, along with exercise and stress: don't eat junk food and take it easy
