#151 - Alex Hutchinson, Ph.D.: Translating the science of endurance and extreme human performance

1. 0:00 – 0:10

   Intro

   1. PAPeter Attia0:00

      [upbeat music] Hey, everyone. Welcome to the Drive podcast. I'm your host, Peter Attia.

2. 0:10 – 7:15

   Alex’s background and passion for running

   1. PAPeter Attia0:10

      Alex, thanks so much for, uh, making time today to sit down and, uh, be part of our inaugural, uh, video podcast here. This is, uh... I hope it's not a long run for a short slide. So far, it's been a long run, but I have a feeling it's gonna be a long slide, too.

   2. AHAlex Hutchinson0:23

      [chuckles] Well, thanks for having me on, Peter. I, I really appreciate it, and, uh, yeah, this is gonna be fun.

   3. PAPeter Attia0:29

      So about two years ago [clears throat] ... Was it two years ago? God, yeah, it would've been. It would've been in, like, February of '19, I read your book, Endure, which I literally couldn't put down. I think I read it in two days. Um, and I was, uh, just... I mean, it was, it was fantastic. Um, and since that time, I've become such a huge fan. Um, you're, you're a very prolific writer. I don't know how you do it. Uh, if you just go to sort of, you know, search your name and go through all the magazine articles you write, it's, uh, it's, it's just a wonder you can do so much. Uh, there are so many things I wanna talk about today. Um, but I wanna kinda start with just a bit of your background because, y- you know, you don't have a typical background, right? You have a PhD in physics.

   4. AHAlex Hutchinson1:13

      Yeah, yeah, probably the, the least useful PhD in physics anyone has ever, uh, uh, ever attained. But yeah, no, I, I come from a, a different place in some ways, I would say.

   5. PAPeter Attia1:21

      Um, you're a collegiate runner, and I- we, we actually have some friends in common because I think we're of the same generation. Um, r- remind me, did you go to, did you go to Waterloo? Did you go to Guelph? Where did you go to?

   6. AHAlex Hutchinson1:32

      I, I went to McGill for undergrad-

   7. PAPeter Attia1:34

      Okay

   8. AHAlex Hutchinson1:34

      ... and then t- and then grad school in England.

   9. PAPeter Attia1:36

      Okay.

   10. AHAlex Hutchinson1:36

       But yeah, we come from the same, same part of the world. It's a, it's a s- it's a s- small pool, so I think we've interacted with a few of the same people.

   11. PAPeter Attia1:42

       Yeah, and I think, um, some of my friends probably ran cross country against you and, you know, ran track and stuff like that. So, uh, for how long was track sort of your passion?

   12. AHAlex Hutchinson1:54

       I would say it was the most important thing in my life until I was 28. Um, at that point... Un- until that point, I was still-- I would've put anything and everything aside if it meant... I, like, you know, I mean, I'm embarrassed to say it now, I, I made my brother reschedule his wedding for, for a track meet. Um, after 28, I kept training seriously until my early 30s. I still run six days a week, train, race, all that. But yeah, 28 was... It was, until then, it was the most important thing in my life.

   13. PAPeter Attia2:20

       And when did that start? What age were you? Was this, like, sixth grade? You know, I mean, how, how serious were you in grade school?

   14. AHAlex Hutchinson2:28

       Y- yeah, I mean, I, I like to say I, I did win a race in senior kindergarten. I beat Steven Mills, who n- nice kid, but a big kid, and I was like, "Wow, I beat the big kid." Um, so I, I've always been the guy who liked to run around. Then I ran elementary school cross country, uh, which involved showing up for a race once a year, and, and I did well in that. Um, I started... I joined a track club when I was 15, the University of Toronto Track Club, with the idea that I would train for three months because I was in a lucky position 'cause my birthday was a- after September 1st, so I could compete with the people a year younger than myself. And I thought, "Well, let's, you know, let's use, leverage every edge I've got. I'll train hard for these three months, see if I can stomp on these grade nines." And, uh, it worked. I, I, I ran well, and I kinda got hooked and realized that I wasn't gonna quit after three months.

   15. PAPeter Attia3:13

       Where did you go to high school in Toronto?

   16. AHAlex Hutchinson3:16

       I went to a school called University of Toronto Schools-

   17. PAPeter Attia3:18

       Yep

   18. AHAlex Hutchinson3:18

       ... which is a, a very, very small school. It's academically focused. Um, from an athletic perspective, the, the really nice thing is if you wanna be on a team, you're on the team. Like [chuckles] it's, uh, the, the, the qualifying process for school teams was going right through the hallways and basically, like, press gangs trying to get enough people for a team.

   19. PAPeter Attia3:35

       So [clears throat] when you went to college, um, obviously McGill is a great academic school in Canada. They don't have athletic scholarships. Was it a difficult decision to say, "Hey, I'm gonna stay in Canada for university or try to go to a US school where I could sort of parlay some of my running talents to actually get some money for school"?

   20. AHAlex Hutchinson3:55

       Yeah, uh, there's a couple of factors that, that played into that. One is that I got mononucleosis in my last year of high school. I missed basically my entire final year of high school. So I was a very, very good, like, grade 11 runner. Um, and then back then in Ontario, there were 13 grades, but the, the high school I went to, uh, only went up to grade 12, basically. So I graduated from high school without ever having competed at this, at, as a senior in high school. So I wasn't good enough to... Uh, that, that's a long, rambling way of saying I wasn't good enough to get a scholarship to any reasonable place, uh, in the United States. So that, that discussion wasn't even really open to me.

   21. PAPeter Attia4:29

       Mm.

   22. AHAlex Hutchinson4:29

       Um, whether I would have, uh, it's, it's a, it's an alternative scenario that I... I would have been attracted by the idea for sure. Um, but, uh, it, that door wasn't open to me anyway.

   23. PAPeter Attia4:39

       And when you showed up at McGill, what was sort of your specialty? Were you... I know you were a miler. Were you... How, how com- how competitive were you at the 800? How competitive were you at 5K and other distances away from the mile?

   24. AHAlex Hutchinson4:50

       I was a 1,500 meter runner when I showed up, and w- with the assumption that I would be moving up to 5,000, you know, any minute now. But I didn't, I didn't have a lot of sprint speed. I was a strength-oriented 1,500 meter runner. As it turns out, the, the coach at McGill was a ex-400 meter, 400, 800 guy, and his, his training was very, um, sprint oriented. It was, it was long recoveries and all out intervals. And so I actually ran better at 800 than I expected I would. But, uh, it was pretty clear that 1,500 was kind of the low end of my, of my sweet spot.

   25. PAPeter Attia5:24

       I had so many friends who ran, um, and many of them said that the 800 was the most painful race there was. And I, I guess in swimming, that's comparable to the 200. Um, and I, I think there's something to be said for that, that, that, uh, s- sub two minute all out effort is really an unpleasant, uh, physiologic existence, which we're gonna talk a lot about that physiology. But would you agree with that, having run so many distances?

   26. AHAlex Hutchinson5:51

       100%. 100%. The, the most painful race that I could run was the 800. And you know, I, and I also think about this in the context of workouts. And, and specifically, and, and you know, at, at McGill talking about s- more sprint-oriented workouts, longer rest, these sort of hard two-minute efforts, if I wanted an easy workout, the, the, the intuition would be like, oh, you wanna ask your coach for more recovery or whatever, and I-- it was the opposite for me. It's like if, if the workout seemed too hard, I'd be, "Can we cut the rest in half?" Because then I know we're not gonna be in that very high lactate regime, which is, you know, 800 meter-- Two, a two-minute all-out effort is the single way to get the highest possible lactate levels. And so to me, and to me, that's synonymous with, with extreme suffering. Uh, I'd, I'd rather run a marathon than an 800 in some ways.

   27. PAPeter Attia6:38

       Yes. I found, um, when I used to tweak around with lactate levels, I found that my personal best, best as though highest lactate was doing a 200 IM in swimming. So two, 200-

   28. AHAlex Hutchinson6:49

       Oh, man [chuckles]

   29. PAPeter Attia6:49

       ... 200 individual medley because it's upper and lower body with all four strokes. It's that 200, so, you know, two minutes of unbearable pain. Um, you could get your, your personal best lactate could be achieved with that.

   30. AHAlex Hutchinson7:03

       Personal worst, call it. And yeah, I think that's something a lot of people don't... Th- th- there's a, there's an assumption that the longer equals harder, and it's like, man, no, there's a whole different world of, of pain that you can get into in the-- if, if

3. 7:15 – 18:30

   The power of the mind: Alex’s “aha moment” that catapulted his running career

   1. AHAlex Hutchinson7:15

      you're willing to, to push yourself hard in those, those two minute efforts, two to 10 minute e- efforts, call it.

   2. PAPeter Attia7:20

      Now, in your book, Endure, you talk about a very interesting, almost a throwaway meet. You know, we would call these dual meets in swimming, right? Um, and it was sort of-- Again, I don't know if this was the turning point for you, but, but it sort of, as you read it, it comes across as a moment when you first realize there's more to this than just the numbers. Like, there's something going on in my head that is changing the speed that I run in. Was that the-- I mean, I w- I wanna hear the story. I want people to hear the story, but was that a, a big aha moment for you, or was that just the first of many steps along a pathway?

   3. AHAlex Hutchinson7:58

      I'd say it, it was a huge aha moment for me at the, at that time, but I'm not sure I understood what the aha was.

   4. PAPeter Attia8:06

      Mm-hmm.

   5. AHAlex Hutchinson8:06

      I knew that this like, "This is strange." And in hindsight, I realized th- this is what was, uh, that, and I'm sure we'll, we'll, we'll dig into this, but it was, you know, this, this started my m- movement away from just like we can calculate everything from physiology, that, that endurance is a little more complicated than the equations that y- you might start with.

   6. PAPeter Attia8:27

      Well, like tell, tell the story because it's... I mean, again, you write about it so eloquently, but it's, it's kinda hard to believe, especially as someone who... I'm, I'm not a runner, and I'm not, you know, I'm not good at anything, but I still understand physiology quite well. And as the story's unfolding, you're thinking there's a mistake. Um, so, so yeah, walk us through that night.

   7. AHAlex Hutchinson8:48

      So yeah, as you said, t- totally meanings- meaningless meet. Um, didn't have any big goals, but I was, at that point, this was third year university, and for about four years almost, three and a half years, I'd been running between 4:01, 4:02, 4:03 for 1,500 meters. 1,500 meters is about 17 seconds shorter than a mile. So we're talking like, as a, it's kind of like the poor man's four-minute mile. It's a significant barrier for runners, but it's not at the level of a four-minute mile. And so for me, it was like that was kind of a career goal. I wanted to break four minutes. I, I, if I could get into the threes, uh, I, I, I felt like, okay, I could, I, I, I would've achieved something significant. Um, and but like I said, ever since high school, I'd been running very close, couldn't quite do it. And at this meaningless meet, there was no competition whatsoever. It was gonna be-- It w-- I was gonna win the race no matter what. Um, and at sort of at the last minute, I just said, "Well, I might as well go hard and just see what I can do, and, and it's, I'm unlikely to do anything special in this context, but I'll go hard." And, uh, s- indoor, indoor track is 200 meters long, so you get splits every about 30 seconds, and I came through the first lap, and the timekeeper called out 27 seconds for 200 meters, which is, it's about five seconds faster than four-minute pace, which is an eternity, an absolute eternity. 27 seconds is extremely fast, and it's a terrible way to start a 1,500 meters race if you're trying to run sub four minutes. Um, and so I had, you know, conflicting emotions of like, "Oh God, you idiot," with, "Oh, I actually feel surprisingly relaxed, but I need to dial it back."

   8. PAPeter Attia10:24

      Because presumably, Alex, you'd run 27s in practice as splits, and you know what 27 feels like. And so on some level, you're thinking, "I feel really good 'cause this doesn't feel as fast as 27," right?

   9. AHAlex Hutchinson10:37

      I, yeah. So you, you, you absolutely have a, you- you're dialed into what 27 should feel like, but you, and this is a maybe an early clue, the, you also know that nothing feels the same in a race, that there's some magic that happens in a race, and something that should've felt impossible will feel relaxed. And so you can kind of dismiss those, those discrepancies and say, "Well, this is the magic of the race. We don't know where it comes from, but it's the magic." And same thing in the second lap. I came through in 57 seconds, which is way too fast, but I still felt relatively [chuckles] like good. And third lap, 1:27. And so at that point, the two things were happening. One is that I realized I was having a, a really good day, and two, I realized that I, the splits were no longer meaningful to me 'cause, you know, you memorize the splits for the races you think you're gonna run. At that point, I didn't know what 1:27 extrapolated to, and so the, the best decision I maybe [chuckles] have made in my racing life was like, "Stop listening to the splits. This is a special day. Run. J- put your head down and go for it." So I, I did stop listening to the splits, and I, I hammered home and I ran 3:52, um, which was, yeah, nine seconds faster than my personal best at the time. And again, uh, you really have to emphasize that a one second personal best would've been a, a, a huge victory for me. And, you know, you don't m- nobody PBs for, by nine seconds, uh, after they've been training hard for four years, five years. So it was just absolutely mind-boggling. And, and you know, to cut to the chase, the, the, the, the postscript of the story is, you know, chatting to one of my teammates afterwards who had taken my splits for me so that I could, y- as, as you do, you put them in your training log and you Plop them in Lotus 1-2-3, and you analyze them obsessively for months. So I, I wanted to get my splits, and he's like, "Yeah, pretty good race." And I was like, "Yeah, I can't believe I went out in 27 seconds." He's like, "You didn't go out in 27 seconds. You were like 30 seconds." I was like, "What?" Second lap, 60 seconds. "What?" So at the time my, my theory was that, uh, this was a, a, a meet in Quebec in Sherbrooke, and so it's like, oh, the guy was maybe translating from French to English, and there was a three-second lag. Maybe he just missed the start with his watch. I don't know what happened. But he, he ga- he basically tricked me. He fooled me into, into thinking I was having this amazing day, and, uh, a- and, and then I did. And so that was what... And, and in itself that was like a, a very bizarre circumstance. And then the question is, what happens after that? Do I become a four-minute runner again, or can I run 3:52 again? And the answer is neither. I ran 3:49 in my les- next 1500, and I ran 3:44 in the race after that, which qualified me for the Olympic trials that summer. So that's why I say you asked, was, was this an aha moment? And it's like I knew right at the time, it's like something has changed, and somehow... So I knew it, it, it, it changed my career as an athlete. But then in hindsight, I realized it also changed my understanding of, of what this whole endeavor was about and what we were trying to optimize.

   10. PAPeter Attia13:35

       Yeah. Th- that's, uh, I mean, again, I still, I still sort of struggle with that. And of course, you want to extrapolate that. Does the same thing apply to strength sports? Well, presumably it does, right? Could you easily trick somebody into thinking, you know, someone who thinks, "Oh, I could just never break 500 pounds for a deadlift," and they're sort of forever stuck at 495 pounds. But is there anything really preventing them from deadlifting 550 pounds, which would be as much of a breakthrough if they simply believe that that's how much weight was on-- If they simply believed that it was only 475 pounds on the bar? Um-

   11. AHAlex Hutchinson14:06

       So, so I, I, I should add a postscript here is that the book came out, my old coach from high school, who I've just, you know, I continue to stay in touch with, he's a very big influence in my life, he, he read the book and he's like, "Show me your training log." Like, uh, which ma- lots of people have said, right? Like, "Come on, this wasn't all in your head." And I was like, "Okay, here, here's my training log. You, you remember it. Ch- check it out. You, you tell me, was I ready to run 3:52?" 'Cause there wasn't a big discontinuity in my training. It wasn't like a... I knew I was fitter, I knew I should be able to break four minutes, but there wasn't like I, I suddenly, uh, was doing workouts way faster. And he looked through it and, and his conclusion was, "You know what, Alex? You were in shape to run mid 3:50s for sure. You were not in shape to run-- You were not doing workouts that predicted 3:44." So in a way, the first breakthrough might have been a lo- in some ways just catching up to the ways I was holding myself back. The, the, the way, you know, I was g- I was overthinking things, stressing out, all these things that people do in, in competitive s- scenarios. Um, I caught up to what I should be doing, and then that gave me so much confidence that I kind of slingshotted right past where I should have been, and I was able to... You know, there's always a, a conversion between what are you doing in, in workouts versus what can you do in races. Everyone should be able to do more in a competitive scenario than they can do on a rainy Tuesday night in Stoke or whatever. And, uh, I think the, the best conversions I ever had, the, the time when I was competing w- the farthest above my sort of baseline workout fitness was in the months after that breakthrough 'cause I was just riding that high, and I believed I was, you know, semi-invincible.

   12. PAPeter Attia15:39

       And then so this is '96, right?

   13. AHAlex Hutchinson15:42

       Yeah.

   14. PAPeter Attia15:42

       So you go to the Olympic trials for the 1500. How did you run there?

   15. AHAlex Hutchinson15:47

       Uh, it's, it's on YouTube. It's the worst-- It, it's horrible. I, I, I came, uh, I can't remember if it was dead last or 11th in the final. I made the final, which was okay. And the, you know, when I look back to it, you can see me on the, uh, I'm on the standing line next to Graham Hood, who's the Canadian record holder at the time. And so the camera lingers, this, uh, on Graham Hood 'cause so you can see me the whole time, and, and I just look... I, I think I might have written this book. I can't remember. But it, it looks like I, I'm, I'm like waking up from a dream and looking around and, you know, in my pajamas or something like that. I just, you know I don't belong on there. I, you know I don't believe I belong there. A year later, I came back to, to the National Championships, and by that time I'd had a year to consolidate. No, no, I belong. I'm, I'm a guy who runs in the low 3:40s. And that time I ran well. I ran, I ran, I came fourth. That was probably my, that was my best finish at outdoor nationals. Um, and I, it was, it was just took a while for my confidence to fully catch up to me, I think. That was, so there, there was, yeah, that, that was how that played out.

   16. PAPeter Attia16:48

       And did you end up running the actual mile, the like the 16:04 or whatever the, the, the sort of the, the non-metric mile? 'Cause you would have by that point broken the four-minute mile, right?

   17. AHAlex Hutchinson17:00

       If, yeah, you're, you're, you're poking your finger into a raw wound here.

   18. PAPeter Attia17:03

       Oh, God, I'm sorry.

   19. AHAlex Hutchinson17:04

       [laughs] If, if you take my best 1500, uh, and you put, plug it into the official conversions tables, it suggests that I would have run 4 flat .01.

   20. PAPeter Attia17:12

       Okay.

   21. AHAlex Hutchinson17:13

       Uh, I, I, I, I deprecate tho- that entirely. I don't believe it at all. I'm confident that on that day I, I'll go to my grave saying I would have run 3:59.9 that day. But in terms of miles, you know, the thing is there aren't, the mile is just not very frequently run. I ran two competitive miles in my career. Uh, one an indoor mile, uh, indoor like early season when I was in college. And then about four years later, uh, so '97 I ran my best. I was th-- I got a knee injury, was out '98, '99, 2000. 2001, I was trying to come back, um, and it was a slow process, and I ran a, a, a mile in Oregon at, at, uh, Hayward Field, which is the sort of-

   22. PAPeter Attia17:50

       Yeah

   23. AHAlex Hutchinson17:51

       ... uh, most famous place. It's a good place to go sub-4, but I did not. I ran like 4:06. I just wasn't back to my, to my shape yet. And those are the only two miles I, I ran in my career.

   24. PAPeter Attia18:00

       You also-

   25. AHAlex Hutchinson18:00

       And I regret it. I, it's, it's a big thing. Like four-minute mile is it's a very big thing.

   26. PAPeter Attia18:03

       How many people have, uh, broken four minutes for the mile roughly in history?

   27. AHAlex Hutchinson18:08

       It's a good question. I'm, I'm gonna say I think it's a few thousand. It's, it's fewer than more people have stood on top of Everest, I think is the, is, is the thing that people tend to say. I, I, I think that's still true. I think there's something like 800 or 900 Americans, um, and, and globally Two to 4,000. I could, I could be wrong, but that's my, my gut, gut memory.

   28. PAPeter Attia18:29

       So by the time

4. 18:30 – 26:30

   Pursuing a Ph.D. in physics while prioritizing his running career, and doing the hardest thing possible

   1. PAPeter Attia18:30

      you're, you know, in, into the mid, mid to late '90s, you're now a PhD student, I'm guessing?

   2. AHAlex Hutchinson18:35

      Mm.

   3. PAPeter Attia18:35

      Did you go straight into-

   4. AHAlex Hutchinson18:36

      Yeah, I was-

   5. PAPeter Attia18:36

      ... the PhD program?

   6. AHAlex Hutchinson18:38

      I went straight there, and I did a PhD in Britain where PhDs are-- It's kind of a PhD light. Uh, they're, they're-- The, the-- It, it's not as rigorous as a full North American PhD. Uh, I mean, it's, it's hard in many ways, but it's, it's different. So I did a three-year PhD, uh, from '97 to 2000.

   7. PAPeter Attia18:53

      And what, what was the itch you were scratching there? Were you a PhD student in undergrad? Uh, pardon me. I'm sorry. Were you a-

   8. AHAlex Hutchinson18:57

      Was I-

   9. PAPeter Attia18:58

      Were you a physics student in undergrad?

   10. AHAlex Hutchinson19:00

       Yeah. Yeah. So I studied-- At, at McGill, you, you have to choose pretty early, and so I had declare-- from-- I did a, a, pretty much all physics in second, third, and fourth year. Um, not neces- I, I mean, I, I enjoyed it, but this was one of those things for me that I didn't know what I wanted to do, and one of the pieces of advice I got coming out of high school was, "If you don't know wanna-- don't, don't know what you wanna do, do the hardest thing possible because y-you can study physics and then become a journalist, but you cannot study journalism and then become a physicist." Or, you know, and, and, and there's-- it's, so it's-- there are-- there's a gradient, and you can't-- You can-

   11. PAPeter Attia19:32

       You can only slide in one direction

   12. AHAlex Hutchinson19:33

       ... if you start with the hardest thing, it's eas-

   13. PAPeter Attia19:33

       Yeah.

   14. AHAlex Hutchinson19:34

       Yeah, yeah, exactly. So that, you know, and, and the memory the-- I, I have, I have a brother who's, who's five years older than me, so he was finishing university when I was finishing high school, and I had actually applied in-- I think I applied to McGill in history initially, but my brother had a friend who was finishing up in physics at McGill, and she, she told him that in her class, there'd been, like, 60 guys and five-- 60 men and five women starting the program, and they graduated four men and four women. I thought, "That sounds hard. I'm switching my, my, uh, my major to physics." So that, that's kinda how [chuckles] that started. Um, and then coming out of undergrad, uh, I really just didn't know what I wanted to do. I applied to a bunch of things, uh, again, in a variety of fields. But because I'd studied physics in undergrad, the best opportunity I got was to go and do a PhD in physics, and I thought it would be a, a reasonable way of allowing me to continue my running career, and it would be a chance to go overseas and see a new culture and have fun. And, uh, and, you know, and I was, I was certainly w-willing to give physics a shot. I was considering physics as a career, but it-- my decision was, was framed in a way that even if I left physics, which I did end up in, in, in the end doing, uh, I had zero regrets about spending three years in England, uh, studying physics.

   15. PAPeter Attia20:45

       How did your training change when you went to England versus Canada? What were the, what were the sort of most-- What were the biggest changes you experienced?

   16. AHAlex Hutchinson20:53

       Yeah, that's actually a really interesting question because there's some huge culture changes. In terms of the actual, like, how much do you run and stuff, n-not as big a, a deal. But you get to Cambridge, and I, you know, I show up for that first meeting with the team, and I meet the, the, the training secretary, and I'm like, "What do you mean training secretary?" "Well, he's the guy who, who's gonna set our workouts." Like, "What do you mean? What about a-- Don't we have a coach?" It's like, "No." The, the, the student-- The, the athletic scene there is student-run. So there's, there's a kind of a continuum in, in many things between the US at one extreme, Britain in the-- at the other extreme, and Canada is often in the middle. And so sports in the US, collegiate sports are a big, big deal, as, you know, as you know. And, uh, um, uh, sports are not-- collegiate sports are a medium deal in Canada, and they're not a big deal in, in the UK. And so going there was a, you know, an eye-opener, opener in many ways. It's like we're going to the national championships, so we have to hire, you know, we have to rent a van and then arrange a youth hostel where we can sleep the night before the championships. Like, that, that, that's not how collegiate sports work in the US, and it's not even how they work in Canada. But the, the f- the flip side is you, you have a lot of autonomy, and you take responsibility for your training and your success. You, you're not, uh, a, a sort of acolyte or, or baby just being sort of fed what to do from, from day to day. And so I, you know, I don't have a systematic study to s- to support this, but I, I think the, the retention in terms of the lifelong retention, the people-- the way the, the extent to which people develop lifelong habits and lifelong love of sport and activity and competition, I think is much higher because you learn to be autonomous in university as opposed to the classic thing in the US is you're there for four years, you're representing your, your, your college, and then college ends, and it's like, "All right, I'm gonna go work a job." And, and there, there's no feeling that you, you haven't do-- There's no encouragement to, to con- to stay involved in, in sport, and you haven't developed the skills required to self-motivate, self-organize, you know, book that youth hostel or whatever the case may be. So, um, that was the, that was the biggest change, I'd say.

   17. PAPeter Attia22:59

       So as you're wrapping up your, your PhD in physics, um, you have to make another decision, right? Which is am I gonna go back to the US or Canada, do a postdoc, and then get on presumably an academic track? Um, do I want to take this and move into industry where I can utilize this? 'Cause obviously at the time, there was probably no shortage of things a PhD in physics could have been doing in Silicon Valley or Wall Street, right? Both would have been the heydays. Um, what-- You know, or do something altogether different. So how did you, how did you approach that decision?

   18. AHAlex Hutchinson23:27

       Yeah. So I mean, you're right. There w-- This was, you know, making these decisions in '99 and early 2000, and my, my PhD was in semiconductor physics. It was a, you know, it was a good time to be in semiconductor physics. And, and there was also, there's, uh, definitely the pull of both consulting and finance, which is, uh, you know, just the same way that it happens with Ivy League s- uh, students in the States. In Britain, you know, if you're at, at Oxbridge, they're, they're lining up to, to offer you vast sums of money. Um, like I said at the top, running was the most important thing in my life until I was 28. So, uh, I considered some job offers, um, but I wanted to focus on running and, and I was very, very fortunate to, uh... I have parents who, who, who had a house that they were willing to have me move back in and, and see what happens. So I spent-- And at, at this point, I was coming back from this three-year injury process. I was j- I-- So I had been on a trajectory that I thought was pointing, you know, favorably by in '98, but then, uh, by 2000 when I was finished my PhD or early 2001 Um, I'd been out for a few years and it wasn't clear, and I just wanted to give myself one year to see if I could get back on that track of someone who might have a shot of making the Olympics. So I moved back home. I did some tutoring of high school students, but basically I, uh, I ran and I went to the library and I checked out-- They had, they had a couple racks of, uh, world classics. So I basically went through their entire rack of classic books, you know, 19th century literature, uh, 20th century literature, all the stuff that I didn't get to do as a physics student as, you know, as an undergrad. This is not a-- This was not a liberal arts program where I had, had time to pursue a bunch of things. It was all physics and math. So I spent a year running. It was fun. I qualified for some national teams. I read a lot of books, and I did a lot of thinking about what I wanted to do. And after a year, I hadn't made the progress running-wise that could justify like, well, that could pay for an apartment, for example. [chuckles] So I was like, "Yeah, okay, I'm 25 now. It's, it's..." Or 24, whatever it was. Um, I need to do something else. And I-- So at that point, I ended up applying for some postdocs, and I ended up taking one at the University of Maryland, uh, sponsored by the National Security A-A-Agency in quantum computing. And, uh, you know, again, it was sort of a, a, a hedged bet. It was like, I'll, I'll take this and-- 'cause the research sounds really interesting and the people are fun, and it may lead to a physics career. But it sounds fun enough, and the one thing about academic life is if you're-- if, if you choose, you can make oth- other things like running your priority. And so I, I, I went and I trained with a, a very, very good training group led by a guy named Matt Centrowitz Sr. whose, whose son went on to win the Olympic gold medal in the 1500, uh, in 2016. And, uh, so I spent two and a half years there in physics, kind of giving physics an, a, a shot, but also be, uh, as a way of, you know... As much as I say running was the most important thing in my life until I was 28, uh, it was never the only thing in my life. And I als- al- always wanted to be continuing to develop in other ways and, and sort of, um,

5. 26:30 – 41:00

   Career transition to journalism, tips for improving your writing, and insights from the best writers

   1. AHAlex Hutchinson26:30

      making sure that my CV wasn't gonna be too empty, uh, at the inevitable point when I, when I had to move on. So, so yeah. So I took a postdoc at that point and went back into physics.

   2. PAPeter Attia26:41

      And then when you get to the end of that period of time, presumably is that when you pivoted to journalism as the next step? And if so, I mean, how in the world did you gain the confidence to do that? Because, um, that's a-- I mean, we've, we've established that the gradient generally points in one direction, and physics might be harder than journalism, but I don't know that that's necessarily true at the individual level, right?

   3. AHAlex Hutchinson27:04

      And it, yeah, it doesn't, it doesn't impress anybody that you can s- you know, solve the Navier-Stokes equation w- if you, if your, if your job is to write an article.

   4. PAPeter Attia27:11

      Yeah.

   5. AHAlex Hutchinson27:11

      Um, so it's, it's always hard to kind of write history in retrospect because you, you see the patterns that you didn't see at the time. And so I, I'm never sure h- how accurately can I, I can explain why I decided to do this, but there were a couple things. I did have a, a, the starting of an interest in journalism. I hadn't pursued it earlier. I wasn't like doing student p- newspapers in college or anything. But I liked the idea of writing, and I'd actually-- This is one thing that marks me as unusual, I think, is I en- I had enjoyed writing up my Ph.D. Everyone else was like, "Oh, I love doing experiments, but I hate writing it up." I was like, "Man, those experiments were hard," but it's kind of fun trying to explain why I was doing what I was doing, which is very hard to explain. Um, so I'd kind of thought I might like writing, and I'd written a couple of-- It's, it's a stretch to call them freelance pieces because they're basically... Like, I'd written a back-of-the-magazine piece for "Physics World," and I'd written a piece for "Athletics Magazine," which is a track magazine in Canada. And then I apply-- And so I thought, "I'd like to give journalism a shot." So I applied for a bunch of internships. Uh, and as you were saying, um, you know, it, it actually d- doesn't work as clearly as you might think. I, I didn't get any of these internships. And I thought, "Okay, this is my, my hopes of trying journalism are stalling. How am I g- You know, do I, I need to sit up late at night and write articles and prove that I can do it?" And I ended up kind of deciding that it was a credentialing issue. I, I... Both a credentialing issue and an urgency issue. I needed to jump into the deep end and force myself to survive as a journalist and also have some way of showing people that I wasn't just a, a dilettante, even though I was at the time. But I needed to show them that I was serious about journalism, that, that, that I had decided to do it, and that I was gonna learn the basic skills. So from while I was in-- While I was doing my postdoc, I applied to a, uh, a few different journalism schools for, for master's programs. And, uh, uh, that was helped along by the fact that this was 2004 by this time. And, uh, I was, uh, it was gonna-- I was timing it in such a way that it's like, "Well, I'm gonna give one last shot of, to make the Olympics, and if it doesn't, the Olympic trials are end of July. I'll start journalism school, uh, right after that." But what ended up happening is I got a stress fracture in my lower back three months before the Olympic trials, um, which meant I was out for 10 weeks, and then I did about two weeks of jogging and then went to the Olympic trials and just sort of as a farewell to running. Um, but that made it easier because I knew that at that point my Olympic dreams were over, were officially over. You know, some might say they, they were over before they even started. But, um, so the, you know, I'd been deciding that I didn't want to continue on with physics, and I was considering journalism, and then the end of running m-marked a natural transition for me, or at least the end of that part, that my s- my track career, um, s- m- m- left something th-- I wanted something else to be passionate about, to be, um, to, to sort of pour that part of myself into. And I guess the one other s- s- story I'll, I'll relate is that I, I actually remember at some point that year, we were working long hours in the lab. You know, sometimes it was 12, 14 hours in the lab, and I would leave to do my runs or whatever. And I remember coming into the lab one morning, you know, after we'd been there late-- Oh, we'd all been there late the night before, and one of the guys asking me like, "Oh, did you see that story in, in Physics Today about, you know, whatever?" I was like, "No, no. I was in the lab for 16 hour, or, you know, 14 hours or whatever it was yesterday. I went home, I did not think about physics. I had zero interest in reading about physics when I got home." And I kinda realized, oh, wait, that's what some of these other guys do. They're, they love it. It's their passion, and that's great, but it's not mine. And so I needed to find something that, uh... Or I wanted to find something that, that, that I wanted to keep doing where, where the w- you know, where the work and the play overlapped a little bit. And I, you know, I thought about things like music that I care about a lot, and about running that I obviously care about a lot, and I thought, "What is the, a possible way that I can have a chance of maybe pursuing some of these interests of mine in a professional way?" And journalism seemed, that, that's what I think what pointed me to journalism is that it wouldn't be easy, but there may be a chance that I could end up writing about running or travel or music or something like that.

   6. PAPeter Attia31:25

      Now, at this point, Alex, you've obviously got tons of athletic experience as a runner. [clears throat] Your background in physics means you're, there's nothing quantitatively you can't understand. Had you at this point delved into the physiology of running, or was that not yet something you had really fully explored the depths of yet?

   7. AHAlex Hutchinson31:47

      By the standards of what I would say now is, no, I didn't have a clue. I knew nothing. Now, I, I was the kind of guy who when I got into running in high school, I got books about running and, and, you know, one of the first books I got was Tim Noakes' "The Lore," or "Tim Noakes' Lore of Running," which is 900-and-something pages, and the first 300 pages or so are physiology. I didn't really understand the physiology when I went through it, but I was, you know, familiar with the terms. And there's some other, I'm, I'm looking over at my, my shelf right now. I can, you know, like I s- I've still got my original 1990 copy of "Lore of Running" right there, and there's a book called "Better Training for Distance Runners," which is w- written, co-written by a physiologist, which... So I had read all that stuff, and I had this, so I, I could s- I could talk the sort of, uh, I don't know how to put this. Uh, I, I, I could, I could talk about VO2 max and lactate threshold with, with, uh, with other people who were interested in this stuff, but I wouldn't say I had a deep understanding of where it came from. I, I, I had v- I had a superficial, uh, acquaintance with the concepts.

   8. PAPeter Attia32:48

      So begins another apprenticeship, basically, which is now you're, you're getting to learn physiology as you start to write more and more about these topics.

   9. AHAlex Hutchinson32:56

      Yeah, and then there was a b- it, you know, it, it, this, it was not right away, I will say. I did one year of journalism school, and then I had 16 months as a, as an intern at a, a newspaper called the "Ottawa Citizen," which had a great internship program at the time, and I was, you know, covering car accidents and, uh, dog fashion shows and, and, you know, what have you. Uh, I learned to write. I learned to write on deadline. I wrote, you know, 250 stories or something. You, you, you mentioned being prolific. Like, when you're the, the, the lowest man on the totem pole at a daily newspaper, you learn to write fast, you know, multiple stories a day. Um, and then the, you know, my internship finished and I became freelance, uh, not because I had a bold vision, but because there were no jobs. And, you know, initially, uh, I, my first contact through a friend was with, uh, "The Bottom Line," which y- you may, your subscription may have lapsed, but it's Canada's accounting monthly. Um, so I, I went to some conferences on like forensic accounting and stuff like that. Um, and it w- so I didn't immediately, I, 'cause in a sense I was running away from physics, and running was still a bit of a, you know, a tender spot. I'd, I'd sort of poured so much into it. So I wasn't looking to necessarily immerse myself right away in these things, and it's only, I would say it was about 2008, so a couple years after I finished journalism school and, and after I finished my newspaper internship that I started to, to, to get into writing about, uh, the science of running to sort of bring those two interests together.

   10. PAPeter Attia34:15

       Go back to, uh, that internship at the "Ottawa Citizen." I wanna understand a little bit more about what you learned in journalism school as it pertained to teaching you how to write, and then what you learned sort of during that internship where you're, you know, you're, you're on the ground, right? It's the, uh, it's the, uh, it's the rubber meeting the road, so to speak. W- what were the two different skill sets there, and, uh, h- how can somebody, I'm asking this for purely selfish reasons, by the way, how can somebody who's constantly interested in, in improving their writing learn from that if they're neither able to go to journalism school nor, uh, take a, a formal internship for a newspaper where they have an editor that's f- you know, giving them feedback constantly, presumably?

   11. AHAlex Hutchinson34:58

       Yeah. So I, I, I would say what I got out of journal- journalism school was an understanding of the, the, the jargon for one thing, but also the, the forms. We tend to think of writing as, as a, you know, you, you think of what you wanna say, and then you write it down. Um, in high school, a lot of us learned the f- you know, the, the hamburger essay. There's five paragraphs, an introduction, then there's three main points, and there's a conclusion, and in each you have a topic sentence in each paragraph, yada, yada, yada. So there's this really rigid, uh, st- structure. And what I don't think I n- realized until I went to journalism school is that there are underlying forms for most of the articles we read. Um, and a news story has a very specific form u- it's called the inverted pyramid. Uh, and a feature article with the kind of thing you read in "The New Yorker" or something, it also has a certain form. Now, for good writers, that form is invisible, and that form is also played with and your, your expectations are, are, uh, y- you know, dashed sometimes. You th- you, you think you know where the story's going, and then it goes somewhere else, yet, a- and so on, and so on. Y- y- the point isn't that, that you need to be slavishly, uh, uh, sort of following those forms, but you need to understand what the forms are so you can understand when you're deviating from them, you're doing it on purpose, and you can understand what a reader's expectation is, even if the reader himself or herself doesn't realize what that expectation is. And so there's things like, yeah, you, you need to have a billboard paragraph that tells the reader what to expect. And it depends, it depen-- anyway, I'll, I'll, I'll, I'll just sum up by saying that I learned about form. Now, learning about form is not the same as, as mastering the form. And so you go to, to an internship at a daily paper, and actually, you know, good internships, y- hopefully you're getting an editor who's looking at your stuff and you're getting a little feedback. But the real- the reality is it's, it's a, you know, it's a daily beast, uh, and there's not a lot of time for that. But you're writing, um, sometimes three stories in a day, but certainly typically a s- a story a day. You're rarely getting more than a day to write a story. And you're getting a sense from e- from editors and from other people of, of what's working and, and what's not, and you can see what's working and what's not. And so, uh, there's the just doing it part of it. But I think that would've been harder to benefit from if I didn't have a sense of, of, of what the structures are, uh, that, that you're, that you're trying to transcend. You're trying to be more than just plugging in the pieces of a, of a, of a jigsaw puzzle. But I mean, I, I, I gave a talk on science writing a while ago to some, some postdocs and, uh, and some gra- and grad students, and I was... You know, really the, the main point I wanted to get to them is that every piece of writing has form, whether it's a, uh, you know, a grant application or a, uh, a, a, a, you know, a scientific publication, or particular- particularly a lot of scientists are interested in communicating their, their, uh, their results to a wider public, and they have to understand what the f- you know, if they're writing for a newspaper op-ed page, what, what is the form? And I, and I guess the other thing I say, said in that context is also understanding who the audience is. So, and that those two things are, are interlinked. If you, if you understand who the audience is, you understand what their expectations are in terms of what the piece is gonna flow like. So anyway, that's-- what that boils down to is, is obviously doing lots of it, but also tr- trying to look at the writing that you like, the stuff that when y- if you, if you see a book or an article that, that, that you like or that explains things clearly, trying to, trying to break down like, "Uh, so what are they doing here? What, w- w- what makes this work?" You know, did they have a particular, you know, a, a, a particularly good introduction section or, you know, whatever the case may be. Th- so reading critically, I guess, is what I'm saying.

   12. PAPeter Attia39:01

       I, I almost wonder if it's somewhat like athletes where you could have the same debate about good writers being born versus made. You know, I, i- in terms of scientific writers, I, I think Sid Mukherjee is incredible. Um, and I read his stuff and I, I-- it's no different than, you know, watching a remarkable athlete do something and you sort of think to yourself, "There's probably no way ever that I could write like that, even if I devoted the e- every waking moment of my remaining life to this study, any more than I could swim or bike or run as well as, you know, the most amazing athlete I see doing those things." Do you, do you think that there's a parallel there?

   13. AHAlex Hutchinson39:42

       I, I, I think there's a parallel, and I would, I would extend the parallel, which is that, um, we can look at Michael Phelps swimming and say, "I will never be able to swim like that." But it, it's a mistake to then say, "Swimming is all, all genetic, and therefore I am doomed not to get better at swimming than I am right now." And, and m- most people don't come anywhere close to fulfilling their, quote-unquote, "genetic potential." So for sure, and, and I, you know, especially when I read fiction or when I read nonfiction by good fiction writers who know how to write nonfiction, if I-- that's not to get too confusing. And, and the, the, the level of language and, uh, uh, just imagery, it, to be honest, it's, it's sometimes a little depressing to me 'cause it's-- I, I feel the same as you. I'm like, "Yeah, there's nothing, there's no amount of, you know, workshops or practice that it will make me write like that." And so I think another thing is just to kind of... I don't know. Th- this, maybe this is too defeatist, but own who you are. And so I, I know that for me, I'm not a poetic writer, but what I hope to be is a, a very clear expository and explanatory writer. So I will never paint the picture that I, that, that I really admire in some other writer's writing, but hopefully I can, I can excel at a, at another, uh, aspect of

6. 41:00 – 53:40

   Breaking down VO2 max: Definition, history, why it plateaus, and whether it really matters

   1. AHAlex Hutchinson41:00

      it.

   2. PAPeter Attia41:00

      Yeah. No, that, that's actually a great way to compare the two. Um, so, so with that, let's, let's go into some of the stuff around, um... Well, let, let's just start with sort of something you've already alluded to. Let's explain what it is, talk about how much it matters, and then kind of get into some examples. So let's, let's start with a term that many people have heard before, but I, I don't think most people understand what VO2 max really means. And eventually we're gonna talk about running efficiency and lactate threshold, and we're gonna get into all this stuff. But let's, let's make sure people understand what VO2 max is, both in an absolute term and then in a manner that we normalize it by, by weight. Um, and, uh, what it is and what it isn't, how it's measured, and how it matters, and maybe we'll even talk about some notable exceptions.

   3. AHAlex Hutchinson41:45

      Sure. Yeah. So VO2 max is the one physiological parameter that anyone who's involved in endurance has heard of and, and has some sense of. And the, the sort of the first order analogy is it's kind of the size of your engine. So physiologically, VO2 max is telling you how much oxygen or how quickly you can take oxygen from the air into your lungs, uh, pump it, uh, get it into your blood, pump it to your muscles, and then have your muscles use it in the metabolic processes that will provide energy to move you to do whatever you wanna do. So, uh, it's, it's a rate. It's how much oxygen per unit time can you process absolutely flat out. Now, the, the sort of backstory here is it was, it was first sort of discussed or measured in the 1920s by a guy named AV Hill, who was actually a very good runner. And, and The observation that he made is if you have someone, you g- you ask someone to go out and run at a s- at a gentle pace, they'll consume, let's say, two liters of oxygen per m- per minute. Then you tell them to speed up. Now they're, they're doing three liters of oxygen per minute. You tell them to speed up again, and now they're going pretty much maybe not as fast as they can, but they're going fast and they're using four liters of oxygen per minute. And so you tell them to speed up again, and you measure it and you're like, "Oh, they're only using four liters of oxygen a minute just like last time." And you say, "Well, speed up again," and they're still just using four liters of oxygen a minute. There's a plateau. There's a point at which even though you're working harder, you're not using any more oxygen. And so this plateau looks like it's a physiological limitation, and it probably is in, in some s- you know, it's a controversial thing. But basically you've reached a point where no matter how hard you push yourself, you can't get more oxygen. And so you can still go faster 'cause you're starting to use other forms of energy, but this is the limits of your aerobic system. This tells you... Well, what it tells you, uh, we, we can get into. [chuckles] It, it's not clear what it tells you, but it, it tells y- it, it tells you exactly what I just said. It tells you how much, how much oxygen you can use. Does that tell you exactly how fast you can run? No. There's, there's, uh, there are a lot of other factors, but it's... That tells you what sort of aerobic engine you have to play with.

   4. PAPeter Attia43:58

      Now, people have, you know, talk-- I mean, as w- I remember in high school, I mean, we would sort of talk about, well, which athletes have the highest VO2 max? Is it the Norwegian cross-country skiers? Is the professional runners and cyclists and things like that? But, um, people are usually used to hearing these numbers reported not in liters per minute, but in milliliters per minute per kilogram. So m- give an example so people understand those differences, 'cause we usually talk about the outliers is a, is a number that's, uh, a, a bigger number than two liters or five liters. It would be, you know, sort of 75, 80 milliliters per... Just explain to people how, how those are different.

   5. AHAlex Hutchinson44:41

      Sure. So I, I'll, I'll use my own numbers. I, when I... You know, typically when I was tested, I could get about a little bit more than five liters per minute, so 5.1, 5.2 if I remember correctly. Um, now if you compared me to a rower, the rower would make me look pathetic 'cause the rower would be using seven liters a minute or, or, or more. Um, but the rower is also huge, uh, you know, twice my size or whatever, and, and s- and so that doesn't necessarily mean that that rower i- is better at using oxygen than me 'cause the rower has way more muscle, and so the rower is, is, is... Th- the amount of oxygen reaching any given muscle cell may be lower. So if you wanna compare apples to apples between athletes of different sizes, you divide, at least for a crude approximation, you just divide by weight. And so the numbers we usually hear are rather than liters of oxygen per minute, it's milliliters of oxygen per minute per kilogram of body weight. So for me, five liters of oxygen per, per minute works out to something like 80 milliliters of oxygen per minute per kilogram of body weight. Um, so and, and, you know, there's a whole rabbit hole to go into is to say, "Well, why are we dividing by whole body weight?" 'Cause, you know, there's a bunch of things like skeleton, you know, [chuckles] there, there, there's not j- and, and organs and stuff that don't scale.

   6. PAPeter Attia46:09

      Right. Th- the adipose tissue doesn't matter. I mean, you could argue a better comparison would be total liters per minute divided by lean mass divided by time, uh, or normalized to time, and then you're, you know, you're at least getting the, the metabolically active tissue presumably.

   7. AHAlex Hutchinson46:24

      Yeah. And, and, you know, you'll-- there's papers where they do things like let's divide by weight to the power of 0.68-

   8. PAPeter Attia46:31

      Yeah

   9. AHAlex Hutchinson46:31

      ... or .7, which is another way of getting it. Effectively, it's a way of approximating just the lean mass-

   10. PAPeter Attia46:37

       Yeah

   11. AHAlex Hutchinson46:37

       ... the metabolically active tissue. So, and you can go down that rabbit hole, but as, as, as I suspect what you'll, you'll wanna get to is [chuckles] it's like at a certain point it, it, it, it doesn't matter that much anyway, so we don't need to, to, uh... Like v- you can't just measure someone's VO2 max and know how fast they're gonna race. So it's, it's, it's useful, but it's not, it, uh, it re- especially for comparing between people. Now comparing within yourself, it, it tells you something if, if you've increased your, or if your VO2 max has decreased. But in that sense, it doesn't matter what, what you're dividing by.

   12. PAPeter Attia47:08

       I remember there was a guy that I used to ride with, and this was not that long ago, maybe five or six years ago when I was still, you know, somewhat competitive at least with myself. Um, and, uh, actually it's funny, my number was just like yours except I was heavier. So I was about 5.1 to 5.2 liters, but I weighed more, so that worked out to about 70 mils per mig per kg was my VO2 max. His was 55 to 60, but I-- there was never a day that I could ride faster than him, not one. There simply... And, and I always felt like, although we did the test so many times, I kept feeling like the machine must have been broken on him. Like I knew my 70 was about right because I'd been tested so much, and that was lower than it had been when I was younger, so it seemed appropriate. But I was always convinced that that, there's no way he's only 55. The reality of it is he may well have been, and he may have simply been a far more efficient athlete, which w- we're gonna get into. Um, w- before we get to the story of Oskar Svensson, let's talk a little bit about historically what people have believed the limits are of VO2 max.

   13. AHAlex Hutchinson48:18

       Yeah. You know what? We don't e-- I mean, we don't even have to go very far historically to get into a whole mudslide of, of confusion and debate and, and, and disagreement. Um, y- there's a, there's a lot of places along the, the way that, that could in some circumstances be the bottleneck. Uh, normally people tend to assume that, um... So what, what is it that causes VO2 max to plateau is essentially what w- I think what we're talking about. And, and, and just one thing I should add here, it's like, why is that interesting? It's because- You think, well, if you want to measure endurance, just have someone run a mile or whatever, you know, as hard as they can. But any test like that depends on motivation, depends on whether you pace it right. There's all these factors that come into it. The nice thing about VO2 max is that in theory, it's independent of, uh, of motivation. That's why peop- that's why scientists like it, 'cause it doesn't matter if the, if, if, you know, the, the, the subject doesn't really care about the study. If you see a plateau, you know that's, that's a property of their body and not a product of whether they were excited about the study. So the quest- yeah, the question is this plateau, what is it that causes it? And it could be in the lungs, it could be the heart, it could be the circulation, it could be the muscle's ability to extract it. And the, [sighs] I don't want to pretend that I know the answer because it's still controversial. The, the picture that emerges is that almost every part along this cascade is engineered right to the point, more or less to, to what it needs to be. And so if you perturb any of those, uh, those elements, it could... You, you can get limitations. So for example, the conventional wisdom is that your lungs are not a limitation. You can always breathe enough in. And so then the question is, can you, uh, uh, diffuse enough oxygen from your lungs into your bloodstream and so on and so forth? Um, there are situations where e- and, and it's been for decades, it's been conventional wisdom that the lungs don't respond to training because they're overbuilt. Uh, there was just a paper published, a big review, uh, in the last month or two arguing that, you know, in some cases, the lungs aren't overbuilt, and one of the situations is highly trained endurance athletes. They can be limited by their ability to, uh, to, to get enough oxygen in. And you can also run into situations where an athlete is so fit, their heart is so strong, it can, uh, it pumps blood past your lungs so quickly that it doesn't have time to fully stock up on oxygen. You get something called exercise-induced arterial hypoxemia. So this, this is usually an issue at altitude, but in elite endurance athletes is actually about half of them exhibit it even at sea, sea level. So they're already running into a limitation just in getting oxygen from their lungs to their bloodstream. And then at every stage of the way, there can be limitations if anything is knocked off kilter. Uh, and, and certainly right down to the ability of the muscles to first extract the oxygen from the bloodstream and then the, to, to make use of it metabolically in the, in the mitochondria. So it's-- there, there isn't one s-si-single answer, which is why you get these debates because everyone is com- "I have evidence that this is the limit." It's like, "Yeah, but I have evidence that this is the limit and that's the limit, and they're all the limit."

   14. PAPeter Attia51:29

       Yeah, I've always wanted to see the experiment where you took a group of athletes, maybe this has been done, [lip smack] um, and you, you run them all to max, and then you reduce the FiO2 of the incoming oxygen. So normally we do it with room air, so you're getting, uh, uh, uh, the fractional inhalation of oxygen is 21%. And the way, of course, just for the listener, the way these things work is the, the way they're calculating how much oxygen is being consumed is they're measuring the, uh, the concentration of oxygen on the way out. So you're calculating the delta. And so I've always thought, "Well, wouldn't it be interesting to start selectively dropping FiO2 21%, 20%, 19%, 18%?" Now, presumably, if the lungs aren't the limitation, you should still see the same absolute delta, and you could at least start to eliminate one of those variables, which would be FiO2 and capillary exchange. And then you start pointing to some of these other variables. A-again, I'm sure somebody has done this experiment, but, uh, I don't know what it yielded.

   15. AHAlex Hutchinson52:29

       Yeah, pr-pr-pr-pr-probably not with the, the fine-tooth comb that, that, that you're suggesting. People have compared, you know, 21% to 10% or whatever, and 15%. But, and, uh, yeah, it's hard-- I mean, it's interest- it's, it's interesting when you go to altitude or, or, you know, or the equivalent when you reduce-

   16. PAPeter Attia52:45

       Yeah, yeah

   17. AHAlex Hutchinson52:46

       ... the amount of oxygen, uh, funny things happen. Like there's, uh, y-you know, the, the first thing you would think would happen is like you can't get enough oxygen, so you're gonna b- go anaerobic sooner, you're gonna produce more lactate. And yet the opposite happens. There's something called the lactate paradox. If you, if you try and exercise to exhaustion at lower levels of altitude, you actually give up when your lactate levels are lower than you would at sea level. And so, and, and there's debate about what causes this and even whether it's a real thing. But the, the picture that, that makes sense to me is, is that it's-- these things are not just about how much oxygen is making it to the muscle. It's also like what is the, what is your brain oxygen level? And so you're, you're getting these other circuit breakers that are starting to come down that aren't even on this path-

   18. PAPeter Attia53:28

       Mm-hmm

   19. AHAlex Hutchinson53:29

       ... from mouth to lungs to, to blood to, to muscle. There, there's other factors that are saying, "Whoa, wait a second. Oxygen's getting a little low, so we're gonna actually cut off the supply to the muscles

7. 53:40 – 1:07:00

   The case study of Oskar Svensson: Why a higher VO2 Max isn’t always better, and the difference between maximum aerobic capacity and efficiency

   1. AHAlex Hutchinson53:40

      or reduce it in order to make sure that we don't get stupid."

   2. PAPeter Attia53:43

      So like prior to Oskar, how, how... because I wanna talk about this kid. His story is so interesting, and you wrote a, you wrote a great article about it, and I've, I've read many articles about him, including articles in, you know, physiologic journals. Um, you'd had a couple sort of freaks of nature out there in the '90s, right? So 90-plus milliliters per, um, per, per, per kilogram per minute of, of VO2 max. Um, what happens in sort of a, a garden variety day of December 2012? Do you remember? Do you remember when this, uh, when he shows up to a training lab? He's what-- How old is he? He's like 17 or something?

   3. AHAlex Hutchinson54:21

      He's like 17, I think he was.

   4. PAPeter Attia54:22

      Yeah.

   5. AHAlex Hutchinson54:22

      He was a former downhill skier, um, who had taken like a talent screen, uh, to see whether he'd be suitable for something like cycling, and he'd s- I think he'd scored just untrained, just off, off the downhill slopes, he was 74 or something like that, 74 milliliters per kilogram per minute. And, uh, and so that he passed, and s- and so he, he started training as a cyclist as a teenager, and then, you know, pretty quickly scored 83, then 85, then 92. And, uh, that, [chuckles] then he ended up scoring... I, the, the initial reports was he, were that he scored 97.5, but I think when the science, scientific journal came out, they said it was 96.7.

   6. PAPeter Attia55:01

      Yeah.

   7. AHAlex Hutchinson55:02

      Um...

   8. PAPeter Attia55:03

      Which either way-

   9. AHAlex Hutchinson55:04

      So yeah, the-

   10. PAPeter Attia55:04

       ... was still higher than had ever been recorded in human history, and...

   11. AHAlex Hutchinson55:09

       Well, and so, and, you know, one thing we should, we should say is there are reports of people in their 90s. But reports, uh, VO2 max, high, high VO2 max numbers are, they, they sprout very easily, uh, because it's hard to do these tests right. And in fact, a lot of the tests that people... The garden variety machinery used to do these tests is not designed to handle s- seven liters of oxygen per minute. And so, uh, you get spurious results and you get... So the, the, the previous king was a guy named Bjørn Dæhlie, uh, a Norwegian, the, the greatest cross-country skier in history, who in the late '90s reputedly tested 90, 96. 96.0 or 96.6, depending on who you ask. This was never published in a journal. This was basically, uh, the, the Norwegian ski team leaked it to the press as a kind of PR move, and I, I asked a guy who, who was working in Norway at the time, and he said they, they didn't believe the machine... He, he, he didn't believe the machine was correctly cal- calibrated, but he d- he th- he figured they decided that it was a, a good PR move anyway. So, so when we're talking about high numbers, and there's, you know, Matt Carpenter, 92, Kilian Jornet, every... There's a lot of people who have high numbers. Virtually none of them are published in the scientific literature. Uh, the, the highest values, you know, you go back to the '70s where, uh, some, some of the great runners were tested and you get, you know, Steve Prefontaine was 84, and there aren't a lot of published values above the high 80s. So 96.7 is like, it's higher than the rumors, but it's way higher than the verified numbers. So the first thing they did the next day is they disassembled the machine, the, the metabolic cart, and sent it back to the manufacturer to get it calibrated to find out if they, [chuckles] if they were, you know, "Are we nuts? Is this real? Is this true?" And, uh, it came back that, yeah, it's working and all the num- all the, all the tests done that day-

   12. PAPeter Attia57:02

       And all of the other people... Yeah, exactly. All the other tests that were done in that day were all within line.

   13. AHAlex Hutchinson57:08

       Yeah. So, you know, so they figured this is real and so they, uh, they eventually... I mean, the s- the story is longer, [laughs] that after his retirement, they, they, they published the data and, and shared it, which was pretty cool.

   14. PAPeter Attia57:20

       Well, I think the other thing that was very compelling was he was tested again several months later. Um, he'd put on two and a half kilos, so his number came down into the 80s, but his absolute level of maximal oxygen consumption had barely come down. He went from something like 7.2 liters to 7.1 liters, um, but the number came down from, you know, call it whatever it was, 96 and change to 89 and change, which was accounted for by the gain in weight, which again is effectively like repeating the test and getting the same result.

   15. AHAlex Hutchinson57:54

       I, I agree. To me, to me that's the, actually the number one piece of data is that, that test, uh, that off-season test a few months later, later in that year, it's like, okay, well, if he's doing the same amount of oxygen, we understand that people can put on weight and lose weight, but the absolute value of, of 7.2 or whatever is, suggests that this was a real number. Um, and, and, you know, the other thing to say is after he... At, at 17 or whatever it was, after he clocked that 96, couple weeks later he goes to the World Junior Championships and wins the ti- tr- time trial there. So on the surface it's like, uh, that goes to show if you have a big engine you're gonna be a superstar.

   16. PAPeter Attia58:26

       But of course the flip side of that and where I, the reason I brought this up was to say why do most people listening to this who might even be able to recognize the, you know, the best time trialists in the world, the Bradley Wiggins of the world, you know, no longer active, but you know, the, the, the people who go on to win Grand Tours and stuff, why don't we know this guy's name?

   17. AHAlex Hutchinson58:43

       Yeah. So he turned pro, uh, you know, when he turned 20, uh, with an un- he was with an under 23 team called Joker. He was an okay cyclist. He did, he had some good results, he had some bad results. Uh, I think it pr- probably didn't help that, uh, you know, he got a lot of attention for this VO2 max value. So I think the, the expectations were probably out of line with, with what was reasonable both from his own expectations and, uh, and pr- and, uh, other people's. And he ended up retiring, I think he was 23 maybe. Like he took a break and then he officially announced his retirement when he was around 23. Uh, went back to university and he's done. He's, he's gone. Um, so the aftermath was that there was a, a, a paper published, I don't know if, I think it was about a year ago, that sort of reanalyzed or responded to when they published his data and said, "Well, let's look at not just his history of VO2 max values, let's look at his efficiency at each s- point along the line." So over the course of three or f- three years or whatever it was where he had his multiple VO2 max tests, and it, you see this expected pattern. He starts at 74 and he goes 80 something, 80 something, 90 something, 96, and then he comes back down the ladder. He, you know, by the time he, after he retired from cycling, he was back down to 77. So he, he's right back where he started. That's a, that's a simple story, but if you look at the efficiency, you get a much more interesting story, which is that he started out at his most efficient when he was untrained, and the more he trained, the less efficient he got, meaning that, yeah, he could, he could deliver more oxygen or, uh, to his muscles. He could, he could deliver more aerobic energy, but he n- he used more aerobic energy t- in order to maintain a given pace. He needed more energy-

   18. PAPeter Attia1:00:15

       So, so let's, let's make sure folks understand how that's calculated. So now you look at a different graph where on the X axis you show wattage, which is the universal metric of output in cycling, and on the Y axis you show oxygen consumption. And so now you're looking at a graph that says for a given output, how much oxygen, how much input do you need to get this output? And an athlete over time should get better and better. For a fixed wattage, you want to see what's called PVO2 come down. So power at a given VO2 should actually come down as you get better. In running, this would be the VVO2. You want to get faster as o... As, so for a given oxygen consumption, you want velocity to go up just as you would want power to go up. I might have said it backwards earlier, but I think you know what I'm saying. And, and so w- I, I gotta be honest with you, I was actually very surprised by that I, I would've, I wouldn't, I would've been less surprised if it had been unchanged, but I was very surprised that it deteriorated.

   19. AHAlex Hutchinson1:01:16

       Yeah. And there's, there's lots of debates about whether you can improve it, but to actually see it get worse was, was so clearly and so kind of monotonically, there was a, a inverse relationship, was definitely surprising. And it actually plays into, uh, a long-standing debate, which is the question of is there an inverse relationship between VO2 max and economy w- or in efficiency? So if you, if you build your engine bigger, do you necessarily end up with a less efficient engine? And this debate's been going on for a couple of decades now, and there, there's still no consensus. And one-- So one way of... 'Cause i- if you look at, if you just take a bunch of elite athletes and you, uh, measure their economy, whether it's runners or cyclists, and, and you measure their VO2 max, you tend to see an inverse relationship. The people who have the highest VO2 max tend to have slightly lower, uh, slightly worse economies. And, and people, and the, the people who have the best economy tend to have slightly worse VO2 max. There's a lot of possible explanations for this. One is that you don't tend to hit the lottery twice. So if you happen to have a VO2 max that's 92, then y- you're not, y- y- you're, y- you're not that lucky. You're not gonna have the best possible economy. And if you're only looking at elite athletes, that means that everyone else there is gonna have something special. So if they don't have the best VO2 max, by definition, they have to have a great economy 'cause they have to have something that's exceptional. And so you see this inv- inverse relationship that, uh, either you have good economy or you have good VO2 max.

   20. PAPeter Attia1:02:48

       A- and just to be clear, that's because we've selected for people whose dot product of those two things is the best in the world.

   21. AHAlex Hutchinson1:02:54

       Yeah. To be in this, to-- If you're looking at elite athletes, they have to have won at least one lottery, but they're unlikely to win two lotteries 'cause the, we're already looking at the .001%.

   22. PAPeter Attia1:03:04

       Yep.

   23. AHAlex Hutchinson1:03:04

       So it's, it's, it, it's, it's highly unlikely that you're gonna have hit the lottery twice. But so what the Oskar Svensson data points to is, is a, a different explanation, which is that there's actually a trade-off. That if you're optimizing one physiological parameter, it may come at the cost of the other physiological parameter. That, uh, the training he did, which we can sort of surmise must have been pretty good for increas- increasing VO2 max because he got such a high one, may have actually been bad for his economy. Not in the sense that his l- you know, his legs were wobbling or he was m- had bad, you know, motion, but at a metabolic level that, uh... And there was a paper published, um, so the, the, again, in response to the Svensson, uh, case study reanalyzing his data and pointing to a potential, uh, s- cell level explanation of, of what's happening to certain enzymes at a given point. The biochemistry frankly is beyond me, uh, you know, to, to, uh, to, to fully understand. But basically what they're saying is, uh, if, if your mitochondria are being stressed to the... If, if you're, if you're doing a lot of training that requires very high like VO2 max level outputs, your, your, your metabolism, your cells need to make choices to produce high output instead of to be as, uh, be as efficient as possible. And over time, that's what you'll get better at, and you'll lose that efficiency. And so you'll, you'll pay a slight penalty for, for optimizing your training for VO2 max.

   24. PAPeter Attia1:04:32

       Yeah. So that was, that was, that was kind of my take, which was not knowing more about his training was what would happen if you took that engine, if you took that, that genetic gift and instead of maximizing on VO2 max and pushing him from... I mean, a guy that gets out of bed in the morning or falls off a log at 74 is a freak of nature. But instead of pushing him to 96, you train him and he'd, he'd get up to 85 or 90 maybe, but you put much more effort into sort of zone two, where you're right at lactate of two. So you push him... And by the way, for him that would be like if you looked-- I remember looking in the paper in applied physiology, I mean, you know, he's spending a lot of time in the 300 to 400 watt range. But he could have probably been in the sort of 300 to about the 300 watt range where he's still just under two millimole of lactate, but he's dramatically increasing mitochondrial efficiency. And if that represented two-thirds of his volume, um, yes, he'd have a lower VO2 max, but he might have been a better cyclist.

   25. AHAlex Hutchinson1:05:42

       Yeah. I th- I, I think cer- certainly putting on the, the hindsight spectacles, I, I, you know, 100% agree. What- whatever he did, he, he paid too high a price for that VO2 max. I, I mean, just by definition it didn't work out. And, and it, it certainly... Yeah, again, we don't know exactly what his training was, but, um, th- that makes a lot of sense to me. And I think, and I think it, it, it sort of a- agrees, a- and you've talked a lot about this, but, uh, with, with the sort of prevailing wisdom among endurance athletes is that, yeah, you know, 80% of your training should be easy, conversational pace. And, and, you know, what, h- what, what means you use to, to, to figure out what pace that is c- may, may depend, but or may vary. But, uh, yeah, he needed to be doing something that was gonna, uh, at l- at the, at worst, not penalize his efficiency as much as, as much as he did.

   26. PAPeter Attia1:06:32

       I mean, I, I just remember even a- as an adult, like whenever I wanted to go and have a VO2 max test just for ego, you wanted it to be as high as it could. Like, I would alter my training for four weeks and lose a couple kilos. Like, it's lose two kilos and start doing four to six minute all-out intervals. That was the recipe for raising VO2 max. So abandon all low end, and it's four minutes all out, six minutes mild, and but those are killing

8. 1:07:00 – 1:23:10

   The sub 2-hour marathon: The amazing feat by Kipchoge, and what will it take to “officially” run a 2-hour marathon

   1. PAPeter Attia1:07:00

      workouts. Those really crush you. Um, so yeah, there was just like kind of a formula to make it happen. So, so let's, let's pivot now and talk about something you've also written about that I find completely amazing from a physiologic standpoint, which is the sub-two attempt and the incredible effort of Kipchoge. Um, so, um, I don't even know where to begin this story. But again, let's just assume for a moment that listeners aren't familiar with who Kipchoge is, aren't even familiar with the difference between an official marathon versus a contrived Nike marathon. Um, [chuckles] the, start from the beginning.

   2. AHAlex Hutchinson1:07:35

      Okay. So the very beginning... I'll give you the, the, the medium-long version of the story. The very beginning is that in 2014, I wrote an article for Runner's World. It was about 10 pages long. I spent months on it analyzing the prospects for a sub-two-hour marathon and, you know, talking to a bunch of experts, crunching data, blah, blah, blah, what would it take? And the, at the end of that article, my prediction was, uh, that it would be physiologically possible to run a sub-two-hour marathon and that it would happen sometime around 2075. So that, that was my context and, and the con- you know, the, I'm-- I'll, I'll, I'll take ownership of the, of the prediction, but that's, that's the general sense was that, yeah, it's possible, but it's not gonna happen for a long time.

   3. PAPeter Attia1:08:15

      And just to be clear, Alex, what was the world record at the time, and did your prediction speak to an official marathon or any form of marathon?

   4. AHAlex Hutchinson1:08:25

      Yeah. Yeah. So I, I was thinking about marathons as they are currently run, although in my article, what I said is, "Look, if, if we're gon- if it's gonna happen, it's gonna happen on an optimized course." You, you're not just gonna go to any old course. So you're gonna choose a course that optimizes, uh, temperature, it optimizes, uh, terrain, it optimizes curvature. So there's a lot of things y- y- you know, you knew right away the way marathons were run, and, uh, mostly continue to be run, there's fat on the bone in a way that there isn't in sports like track or, uh, uh... You know, if you look at the Tour de France, there's fat on the bone, but no one cares about the time compared to track cycling, where everything is optimized. So marathons i- i- are th- th- this kind of anomaly where they're run in a Tour de France style in a very uncontrolled environment with- which differs from, from race to race, and yet we care about time. So, um, and I think that's maybe an anachronism that's gonna fade away a little bit as we realize that, you know, you can, you can run a lot faster if you optimize the course. But anyway, to answer your question, the, the world record was 2:02:57 by a guy named Den- Dennis Kimetto. So we're talking three minutes away from a sub-two. Um, if you say, how long did it take us to, to come down three minutes? Um, well, one, i- in, in the mid-'80s, I think it was 1986, the world record was 2:06:50 by Abel Antoun Simel. So we're talking a, a timescale '86, 19-

   5. PAPeter Attia1:09:49

      Yeah, call it 30 years-

   6. AHAlex Hutchinson1:09:50

      Thirty-

   7. PAPeter Attia1:09:50

      ... to, to go four minutes.

   8. AHAlex Hutchinson1:09:53

      Yeah. Yeah, or, or th- yeah, exactly. So we're looking at... A- and, and of course the, the, uh, things are getting optimized as we go. So the cur- you expect the curve to be leveling out. Uh, the, the, you know, there's less and less low-hanging fruit to get. So in 2016, uh, I, I heard... I got an assignment from Runner's World to, to go report on this top-secret Nike project, um, which ended up-- It was, it was something they called Breaking2. It's a race they held in spring of 2017, and their mission was basically they'd spent about f- two or three years, 20 people full-time working on it, trying to, uh, I don't h- I don't know how to say it, to engineer a sub-two-hour marathon. And so they had a, started with a huge talent search. They, they sponsor a large fraction of the world's best runners, so they brought 20-something of their best runners to labs to measure their VO2 max and their economy and various other things and, uh, picked three runners, and then they, they, they went around the world, uh, testing possible courses. They ended up settling on a Formula One racetrack in Northern Italy.

   9. PAPeter Attia1:10:57

      It was Monza.

   10. AHAlex Hutchinson1:10:57

       Monza.

   11. PAPeter Attia1:10:58

       Yeah.

   12. AHAlex Hutchinson1:10:59

       I- it was, yeah, with, with the, uh, which, which I think is where they, the, the highest speed ever reached-

   13. PAPeter Attia1:11:05

       That's-

   14. AHAlex Hutchinson1:11:05

       ... on a-

   15. PAPeter Attia1:11:05

       Yeah. So, so-

   16. AHAlex Hutchinson1:11:06

       ... single lap is there

   17. PAPeter Attia1:11:06

       ... so if you... I'm obsessed with Formula One. So if you, uh, if you're interested, Monza is the fastest Formula One circuit. You, you don't look at the maximum speed. You look at the fastest average speed. So Monza-

   18. AHAlex Hutchinson1:11:18

       Okay

   19. PAPeter Attia1:11:18

       ... has the fastest average speed of any Formula One circuit. There are other characteristics that make Formula One circuits interesting, which have the highest G-forces, which have the highest straightaway speeds, those things. But yeah, Monza has the f- fastest, highest average speed and of course doesn't have much elevation change, which is probably even more important, right?

   20. AHAlex Hutchinson1:11:37

       Yeah. So they used the, the junior loop, I think it was called, at the, at, at Monza, so not the full one 'cause that was the straightest possible with just the, the barely perceptible curves. I think it was about a mile-and-a-half loop or something like that. Um, it's also, like, the, you know, the, the, it doesn't have much elevation change. It's, it's close to sea level, but it's not close to the sea, which makes the weather a little more predictable. Um, y- they, they optimized a lot of different things. Uh, you know, they were trying to optimize the nutrition, the in-race nutrition, the aerodynamics. Th- they're, like, doing things like sticking bump, adhesive bumps onto the legs of the runners to, to try and reduce the aerody- the, the, the drag when they're swinging their legs back and forth. Some of it's a little ridiculous. Um, s- s- some of it was significant. Uh, the two significant things were they were gonna have, uh, I think it was one, two, three, four, five, five pace... Was it five or seven pacemakers-

   21. PAPeter Attia1:12:31

       Pa-

   22. AHAlex Hutchinson1:12:31

       ... run-

   23. PAPeter Attia1:12:32

       Yeah

   24. AHAlex Hutchinson1:12:32

       ... running in front of the, the... Yeah, so basically, uh, yeah, uh, blocking the wind for the, the chosen runners for the whole way. Now, you can't hire someone to run a sub-two-hour marathon in order to run a sub-two-hour marathon, so they had to have runners dropping out every couple laps and new runners swapping in. That's not allowed according to, uh, the rule, the official rules of marathoning. So that's the main reason that this race that Nike had planned was, it was not and is not considered a world record, um, because it doesn't obey those rules. And then the other, the other factor, the big factor is they introduced a new, uh, a whole new type of shoe that had a curved carbon fiber plate embedded in the sole that- improves running economy. In other words, it allows you to burn less energy to sustain a given pace by about 4% on average. So put all these things together, and all of a sudden it's like we don't actually need the runners to be that much faster than 2:02:57 if all these things we've come up with work. We should be able to slice three minutes off the time with the shoes and the drafting and the course and the weather and all these sorts of things. Um, w- the three run-- Of the three runners they ended up selecting, Eliud Kipchoge is, was the reigning Olympic champion, and he was also probably the most consistent and the best marathoner in the world at that time. He was-- I think he had the second, second or third fastest time in history at that point. And then they had a couple other guys who had good, good lab values. One of them had the, the best running efficiency ever measured. Um, but neither of those guys ended up being a factor. Kipchoge ended up running two flat 25 at this Nike Breaking2 race, so 25 seconds, uh, two and a half minutes faster than the world record. Didn't run sub-two, but was-- that was considered a, a victory because it was like nobody thought anyone would... E-even with all the sort of science and tech, nobody thought that it would actually add up to a human running that fast. So then there was a, a sequel in, in, uh, 2019, uh, s- funded by the petrochemical company INEOS instead of Nike in, in Vienna, which basically replicated most of what Breaking2 had done. They only brought Kipchoge in. They had a few different things. They had a new pair of shoes, um, which is, w- became very, very controversial. And this time Kipchoge ran 1:59:40. Um, so he ran a sub-two marathon and it, and it's, it, it, uh, has, has sort of galvanized and polarized the running world because, uh, Kipchoge is the, the greatest marathoner in history, I would say. But these, these events, uh, left a bad taste in, in the mouths of a lot of people, both for their, the sort of circus-like quality, but also 'cause of the shoes. The shoes became, uh, uh, very controversial because it's not clear whether shoes that make you 4% more efficient with a carbon fiber plate embedded in them are, are within the spirit of the sport or within the rules of the s- of, of the sport.

   25. PAPeter Attia1:15:29

       I mean, this sounds an awful lot like where swimming was in 2008 and 2009 when the tech suits from basically 2000 to 2008 had gotten so quick that by 2009 FINA said, "This is gonna be the la-- This World Championships in '09 will be the last time there are technical suits," and away they went. And actually there are still some world records that stand, you know, 12 years later, uh, nearly 12 years later from, from those 2000s, yeah.

   26. AHAlex Hutchinson1:15:57

       Although in some sense the, the, the surprising thing to me is that, is that n- all of-- not all of them stand because-

   27. PAPeter Attia1:16:02

       Yeah

   28. AHAlex Hutchinson1:16:03

       ... you know, at the time I, I remember interviewing some swimmers and saying, "So, you know, how does it feel? Do you think you will never again set a personal best?" There was this sense that, uh, banning those suits would, would just completely, uh, ch-change the record book. Um, but it has turned out that swimming has continued to advance. I guess, uh, there's p- advances in pool technology and stuff like that but, uh, um, but yeah, it's an exactly analogous debate. Uh, uh, you know, what role should the equipment play in a sport that s- is not like Formula 1 that is, whose, whose inherent, uh, attraction is its simplicity?

   29. PAPeter Attia1:16:36

       But to play devil's advocate, right? I mean, um, would, would the current running shoes you would wear if you were out to-- if you were to go out and run a marathon, would they offer a 4% efficiency over leather you would strap to your feet?

   30. AHAlex Hutchinson1:16:50

       It's a good question. I, I think they would, they would raise my chance of getting to the finish without get- injuring myself 'cause cushioning is, is the big advance. The, the better ana- or maybe the m- the more sort of pointed analogy is, um, cinder tracks in the, i- were common until the '60s. Then you have all-weather tracks. I mean, it's, it's, it's, it's apples to, to, to, to pears or whatever. Um, so I think-
9. 1:23:10 – 1:29:30

   Comparing the greatest mile runners from the 1950s to today

   1. PAPeter Attia1:23:11

      So if you take away all technology, what is the difference between Roger Bannister and the fastest miler today? Again, get rid of shoes, get rid of-

   2. AHAlex Hutchinson1:23:23

      Yeah

   3. PAPeter Attia1:23:23

      ... all of that. Um, as a species we have not evolved, so how much of that difference is technology? How much of it is training, nutrition, uh, everything else you'd bake into it? I mean, what, what would be the buckets you would, you would classify as the improvements? And what is the... I don't even know what the mile record is today.

   4. AHAlex Hutchinson1:23:43

      Mile record's 3:43, so he's-

   5. PAPeter Attia1:23:44

      So 17 seconds

   6. AHAlex Hutchinson1:23:45

      ... come down 16 seconds.

   7. PAPeter Attia1:23:46

      Yeah, it's... Okay. Yeah.

   8. AHAlex Hutchinson1:23:47

      Y- y- yeah. So the n- for Bannister to today, the biggest bucket bar none is training. Uh, Bannister is, uh, reputedly an under-reporter. He, he, th- there was this sort of whiff of amateurism where, you know, admitting you were training too hard was not, uh, was, was not done. But even if you take with a grain of salt his reports, you know, it was sort of half an hour a day, go out and do 10 by 600, or 10, 10 by 400 meters. So we're talking, like, you know, four or five miles a day, five, six days a week. Maybe he was doing more than that sometimes. But he was training at a level, um, a very, very light level. Um, and even one of his contemporaries was Emil Zátopek, who was a, a Czech runner who-

   9. PAPeter Attia1:24:32

      Just a legend. I mean-

   10. AHAlex Hutchinson1:24:34

       Yeah, absolutely. Like, uh, uh, you know, the m- arguably the greatest-

   11. PAPeter Attia1:24:37

       Arguably the greatest

   12. AHAlex Hutchinson1:24:38

       ... distance runner ever.

   13. PAPeter Attia1:24:39

       Yeah, yeah, exactly.

   14. AHAlex Hutchinson1:24:40

       Uh, he was, uh, push- starting to push the boundaries of how hard you could train. He was a guy who was going out and doing 60 by 400 instead of 10 by 400. And so it's not like nobody understood that training worked, but Bannister versus today, it's training is the difference. Cinders may be a second a lap, like the, the, the track quality. The quality of the spikes, uh, negligible. And the tr- nutrition, eh, pr- for a mile it's not, just not that big a deal for a four-minute race. Um, if you fast-forward to the '60s, by the '60s you've got people like Jim Ryun, who ran 3:51 for the mile as a teenager. He's training like a beast. Um, most people could not handle, even modern milers would not dare to train as ha- as, as hard as he trained. Um, he survived it-

   15. PAPeter Attia1:25:27

       What, what did he do?

   16. AHAlex Hutchinson1:25:27

       ... and as a result He was doing-- So when I say-- So Roger Bannister was 10 by 400 meters. Emil Zatopek was 60 by 400 meters, but they were mostly really slow. He was, it was like a- another form of endurance. Jim Ryan was four- 40 by 400 meters, but they were all hard. They were all, [chuckles] they were all as, you know, close to as hard as, as, as Bannister was doing them.

   17. PAPeter Attia1:25:47

       On, on what recovery?

   18. AHAlex Hutchinson1:25:49

       Uh, you know what? I, I, I, I would, I don't wanna claim that I remember the-- But we're talking like one to two minutes probably, or a 400-meter jog. Uh, like, and, and lots of intervals of... He was, it was a very interval-based program and, but hard, really, really hard.

   19. PAPeter Attia1:26:05

       And what would he run those 400s in? Like, how many of them would be sub-60 seconds? All of them?

   20. AHAlex Hutchinson1:26:10

       No, not, not, not sub-60. He, he, he'd probably be doing those in like, you know, 66, 64. I, I, yeah. I, I, so I don't, I don't know the, the, the exact times, but it's at that volume in the context of high mileage, he was doing them at, at, you know, at, at, at a, at a pace that was extremely challenging, not the sort of Zatopek style of just kind of let's get tough and not, not worry about the pace. Zatopek's the guy who's like, uh, do, you know, in the laundry tub just doing high knees in the laundry tub. He was, uh-- Or holding his breath between, uh, uh, phone poles on his run. So he was all about just do- making stuff hard, whereas Ryan was taking that to a systematic level. "We're gonna train hard, but we're gonna do it systematically" with his, with his coach, Bobby Timmons. And, uh, I, I'd say you can't make much distinction between the training of the 1960s and the, the training of today. There were, there were people who were training probably as hard in the '60s. And if you take Jim Ryan's mile, 351, Sinders, subtract four seconds, 347. The American record's 346.8 or something like that. So by the '60s, training was mature. And all the other stuff that we worry about, all the, you know, nutritional aids and, and, you know, pneumatic compression devices and ice baths and stuff, um, I'm not saying it doesn't help on an individual basis, but you, you, you can't see it in the record curves or anything like that. The, the, the, the, those things don't show up. Those, those don't leave a mark in the big statistical picture.

   21. PAPeter Attia1:27:42

       Um, do you ever fo- do you follow horse racing at all? Do you ever follow, like, the times that horses run and things like that?

   22. AHAlex Hutchinson1:27:48

       That, that's a cl- that's exactly the, the comparison I was thinking of, which is that they've stagnated since the '50s, right? Like-

   23. PAPeter Attia1:27:54

       Well, I mean-

   24. AHAlex Hutchinson1:27:55

       Secretariat's still the best

   25. PAPeter Attia1:27:56

       ... Secretariat is, Secretariat is hands down the fastest horse that's ever run. And, uh, I read a, a very interesting argument on, oh, I don't know, it was probably on Nate Silver's "365" a few years ago that actually made the point that we're getting further from Secretariat now because we're actually seeing less diverse breeding of horses. Um-

   26. AHAlex Hutchinson1:28:14

       Hmm

   27. PAPeter Attia1:28:14

       ... so, so you're just bringing less genes to the gene pool. And of course, Secretariat's genes were pretty unique, right? It was an X-linked, um, so it was a sex-linked X chromosome gift that he had genetically. That's why his male offspring didn't do anything special, but his female offsprings that would go on to pass X chromosomes to males a generation later actually were somewhat special. Um, but Secretariat's-

   28. AHAlex Hutchinson1:28:42

       Huh

   29. PAPeter Attia1:28:42

       ... times were unbelievable. I mean, you know, ooh, and you think about it through the lens of even running, like to run a mile and a quarter and to negative split by mile all five miles, um, you know, the winning, Secretariat's, you know, winning times at, uh, at, at Belmont, I mean, I, I, like, I don't think any horse is-- I don't think any horse will come close to that. Um...

   30. AHAlex Hutchinson1:29:04

       And, and it's important to, to, to note that whatever amount of money we have in the running world that is compelling us to or allowing us to, you know, optimize nutrition and training, and yet there's way more running in horse racing. Like if, if there was, if there were physiological advantages that allowed us to run faster, they, they would be using those on horses. So like the, the, the post, post-training massage or whatever, if that helped horses, they'd be getting it, and they probably are.

10. 1:29:30 – 1:33:30

    How the brain influences the limits of endurance

    1. PAPeter Attia1:29:30

       Yeah. So go- going back to kind of your experience, let's bring it back to this idea of what you're now learning about endurance as you are, are back as, as a journalist now and you're, you're fully ready to go back and visit your running roots. Uh, in the research for your book, what are you learning about your experience on a, on a rainy night in Quebec, and how are you able to put that in the context of what the limits of endurance are?

    2. AHAlex Hutchinson1:29:59

       So I guess the start would be, you know, maybe to pick up the thread even a little earlier is, is, you know, I, I finally started to write about r- running, and I, I was doing it in a very conventional way, the, the sort of what heart rate should you do your tempo run at and, and, and things like that. But it, w- what it meant it, is that I was starting to look at, at the literature and, uh, and, and reading some papers, and I came across a paper, uh, and again, uh, you know, maybe 2007, 2008. It was a debate, and I think it was in "The Journal of Physiology," and the t- topic of the debate was does dehydration impair endurance performance? And I just remember being like, "What is this, like, April Fools? What? Of course dehydration impairs endurance performance." And it was a pro and con, and, and the con w- was Tim Noakes arguing, who's a, who's a, a, a very notable contrarian physio, uh, scientist, let's say, from the University of Cape Town, and he was arguing that, no, we've n- we have not shown that dehydration itself impairs performance. Thirst impairs performance if you're thirsty, but if you drink s- enough that you're, you're not thirsty and even if you're dehydrated, even if you've lost a bunch of weight, that doesn't d- impair performance. And he went through all the literature, all the famous studies that show dehydration impairs performance going back to the Second World War, and you look and it's like, well, they were all thirsty. They were all, like, stuck in a sauna and not allowed to, to drink. So we don't... Anyway, all of which is to say, all of a sudden I was like, "Oh, wait, one of my fundamental tenets of, uh, or one of the things that I thought was beyond debate is debatable." And so I started reading a little more and following this thread And I re-- and I discovered that Noakes, that Tim Noakes had proposed this idea called the central governor model, which was, in a nutshell, it's that when you run as hard as you can or exercise in other, in other forms as hard as you can, the reason you stop or the reason you slow down or the reason you aren't able to go faster is not because your legs aren't capable of going faster. It's 'cause your brain is, uh, protecting you. It's, it's sort of putting on the brakes before you push so hard that, you know, your heart, your heart runs out of oxygen or whatever the case may be. Um, and this was highly controversial. It was, it was a fringe theory at the time. Uh, but that's when I started to make the connection to, like, my race in Quebec, my 1500 breakthrough, and, and my whole-- the whole career of like, why do, why c- why do I have a good race one week and a bad race the next week, even when the, physically there's no- nothing different? Like, why does it feel like sometimes I'm able to dig deeper? If it's just multiply your VO2 max by your running economy, divide by your lactate threshold or whatever, what... Like, there shouldn't be any change. These things don't change from week to week. And so that got me interested in the role of the brain. Now, the central g- I should... Let me just jump ahead and say the central governor model, people don't really talk about that anymore. It's, it's, it was a model that emphasized the importance of the brain in understanding the limits of endurance, which has then led to a whole bunch of further research, which is what captivated me. 'Cause it's like no- nobody needed another article on VO2 Max is about, is, is oxygen or whatever. Although, I sh- I shouldn't say that 'cause I've written a few articles about VO2 Max. But, um, but, but what struck me as interesting and what even in, like, by 2009, I was like, "This is a, this should be a book about this, that tries to explain this, uh, to all the people like me who I know are interested in this stuff, but haven't, don't realize that there's this debate going on in the l- in the literature about how do we bring the brain in, not just in a sense of like, you have to really want

11. 1:33:30 – 1:53:45

    Relationship between exercise volume and health: Minimum dose, optimal dose, and whether too much exercise can shorten lifespan

    1. AHAlex Hutchinson1:33:30

       it to try really hard, but to understand how the brain is, uh, influencing or controlling or playing a part in determining the limits of endurance."

    2. PAPeter Attia1:33:42

       Where do you think this fits into health? So there's... I mean, this is clearly, uh, an important topic when we're talking about sports, right? When we're talking about endurance sports, like, you know, running and cycling and swimming, the purpose of the sport is to be fast, is to have endurance and speed at that right combination. Um, many of the people listening to this podcast are no longer competing. You know, you're still competing, but most people aren't. I don't compete at anything anymore. Um, but I hate the term, but quote-unquote "cardio exercise" or endurance-based exercise s- uh, we would still agree is still an important pillar of health. So w- uh, how do you, how do you think about that? And, and more importantly, how do you think about what you've studied, um, applying to health? And, and one of the things I wanna talk about, 'cause it's so interesting, of course, is at some point, does exercise become counterproductive? And maybe even what are the benefits specifically? Uh, you know, for example, energetics, uh, efficiency with metabolism, and how that can fight disease. So, uh, i- in any way you wanna start that discussion, like how do, how do you start to think about it, uh, both scientifically and even personally?

    3. AHAlex Hutchinson1:34:57

       Yeah. So that's a big bite to chew on. W- with that you, you've mapped out the next, uh, three hours of our conversation.

    4. PAPeter Attia1:35:01

       Yes. [chuckles]

    5. AHAlex Hutchinson1:35:03

       [chuckles] Um, n- so one thing I would say is, I mean, look, I don't wanna oversell it and say y- y- you must understand, you know, your br- y- your absolute limits in order to be healthy. But I, I do think in terms of... If we think about the barriers to exercise, the barriers to being physically active, I think for a lot of people, um, there's a... I- if you interpret the distress signals you feel when you start exercising as signs that your body is reaching its limit, that's a very distressing thing. You, you s- you know, if, if you're like, "I'm gonna start an exercise program, I'm gonna start brisk walking, I'm gonna start running," and you feel you're panting, you're out of breath, your legs are burning, you're like, "I'm gonna die," and you stop. And so I think understanding that these... It, it's not so much about how to change your limits, but understanding what those limits represent, understanding that they are not signs that you're gonna die. These are just, this is just information. This is... A- and because I would say, and I don't, I haven't thought this through, maybe it's not true, but I would say off the top of my head, any meaningful form of exercise that's gonna do you s- substantial amounts of good is gonna involve dealing with discomfort, uh, in, in, in one form or another. And if you can get to a place where you understand that the feelings of discomfort are not signs that something is going wrong with your body, but they are just information, they are telling you where you are on the road t- to reaching your limits, and you don't have to go to your limits, but you also don't have to stop. You're allowed to just interpret that as information and say, "Okay, understood. I'm out of breath, but I can keep going." So I think t- to, to me at least, that, that's a useful insight to take f- to take from this. Now, you know, we can, we can get deeper then into, you, you know, you've raised some, some very interesting and controversial questions about, you know, how much exercise is good, w- what kind of exercise do we need to do. I don't know w- where you wanna start with that.

    6. PAPeter Attia1:37:00

       Well, let's... Because we don't have three hours, although I, I mean-

    7. AHAlex Hutchinson1:37:04

       [chuckles]

    8. PAPeter Attia1:37:05

       [chuckles] When we meet in person and, and share a meal, we, we certainly will take those three hours. But I, let's start with, um, two opposing points of view with respect to exercise. So one point of view says the exercise longevity curve is J-shaped. So at, at, at the, you know, far end of the spectrum, uh, no exercise is, you know, a really bad thing for mortality. Um, as you increase exercise, mortality improves, improves, improves, improves, improves, improves And then it kind of gets to your best all-cause mortality. And if you continue to increase exercising beyond a certain volume, this is generally discussed in volume of exercise, you actually see a little uptick in mortality, suggesting that once you go beyond a certain point, again, I want to stress this is in volume of exercise, you don't get any more benefit, and you may actually have more harm. And a lot of times this is harm that comes in the form of cardiac dysrhythmia. Um, it could be even atherosclerosis through endothelial damage, fibrosis, things like that. There's another body of literature that says, no, it's more or less a monotonically improving curve. And, uh, again, we all agree that at one end of the spectrum, uh, having, you know, really poor cardiovascular fitness, again, we could measure this in VO2 max or something like that, uh, as that improves and you get fitter and fitter and fitter and fitter, all-cause mortality goes lower and lower and lower, and there is no J to that curve. Um, how do you think about reconciling those? And I, I want to point out at the outset, this is a discussion that only really impacts like 1% of the population because 99% of the population are on the side of the curve where they could always benefit from exercising more. But, you know, you, for example, might be one of those people who's in the 1% where... I don't know. What's your weekly mileage right now?

    9. AHAlex Hutchinson1:39:01

       Uh, I, I, fortunately, it's only probably about 20 miles, so-

    10. PAPeter Attia1:39:03

        Okay

    11. AHAlex Hutchinson1:39:03

        ... so even, uh, even James O'Keefe would, would, would give me a pass.

    12. PAPeter Attia1:39:06

        Yeah. Yeah. Yeah. So, um, so walk me through how you think about that, 'cause I have to be honest with you. Um, I'm-- I've seen examples of, you know, those athletes who go a little bit too far, who probably have a genetic susceptibility to dysrhythmia, and then they go on and get these dysrhythmias. Um, but at the same time, they're few and far in between, so I don't, I don't... I, I'm still a bit on the fence about this one. Again, just purely from an intellectual standpoint. I don't think it applies to me anymore. It probably did at some point.

    13. AHAlex Hutchinson1:39:38

        Yeah. So it's, it's, it's, it's a good question and it's an important one, and there's a, a couple, a few things I want to say. First, I'm a runner, right? So, so take, take what I say, under- understand where I'm coming from. I'm also a human. Like, I don't want to die, so I'm tr- I, I'm, I try to look at this data as impa- as dispassionately as possible. So but, but I, I, obviously I-- my knee-jerk reaction is like, let's find holes in this data that suggests running is bad. So I, um, get that on the table. Second, there's no doubt that there is a reverse J curve. I- if you try to run 28, 20 hours a day, it's not gonna be good for you. The, uh, so, like, it's... Nothing is good for you if, if you push it far enough. So the real question is where do the extremes or where does the, the uptick happen? Um, third thing I want to say is the, the, this, this, the data on this, this, this showing that, you know, you do a little bit and you get some benefits, and the more you do, the, it, it gets worse and worse. One really interesting thing, thing that came out of that, and there were a few studies in, uh, about eight years ago that, that showed that, is that actually the, the, the dose you need to get most of the health benefits is very small, and I do think that's an important message. You do not need to train or for or run marathons in order to be optimally healthy, at least to within the, the, you know, the t- 90% or whatever. You're gonna get most of what you get from a very modest amount of exercise, and so that's a great message. So okay, now then-

    14. PAPeter Attia1:41:07

        Can you quantify that, by the way-

    15. AHAlex Hutchinson1:41:08

        ... is running-

    16. PAPeter Attia1:41:08

        ... in terms of, in terms of running? Let's, let's put some numbers to that. If you're talking about a person who maybe was active in high school and college, but, you know, they're, they're 10 or 20 years out of that. They've been caught up in the challenges of starting their career, starting their family, et cetera. They wake up, they're 40 years old, and their waist is five inches bigger. They've got metabolic syndrome. They're not in dire straits. It's not like they're gonna die in the next 10 years. But they've got the message which says, "Hey, the one thing that is really missing is your exercise." What, what would you say if, if, if they came to you and said, "Alex, just tell me the minimum effective dose. I don't want to r- run any weekend races. I like running. I used to love it," uh, or rowing or whatever their activity is. "How ma- how many hours or how many miles do I need to do a week to just get the bene- some of the ben- uh, you know, 80% of the benefits with 20% of the efforts?"

    17. AHAlex Hutchinson1:42:03

        Yeah. So, so the, the Cooper Clinic study, which was like 50,000 people or so, uh, that came out four or five years ago, their number was five to 10 minutes a day. I don't fully believe that, but that, that was their number. So they're talk- you're talking like an hour a week. Um, I, I, I, and, and that's just, you know, going out for a run. I, personally, w- maybe we can get into this in more... That, that's not my definition of an optimal-

    18. PAPeter Attia1:42:30

        No

    19. AHAlex Hutchinson1:42:30

        ... exercise r- routine. I would include some high intensity stuff. I, you know, and strength is another thing. But, um, so they're, there's making some claims about a very, very low minimum effective dose. Personally, I would say... So I, I s- like I said, I'm probably running about 20 miles a week right now, which is six days a week, you know, half an hour with a couple of hard days. I think that's on the-- to me, that's on the low end of, of... I, I think I would be healthier if I did more at this point. Um, and it's just a-

    20. PAPeter Attia1:42:58

        You do?

    21. AHAlex Hutchinson1:42:58

        ... a matter of part of-

    22. PAPeter Attia1:42:58

        You think you would, you would actually be healthier? I know you'd be a better runner, but would you be a healthier... Would you, would you live longer?

    23. AHAlex Hutchinson1:43:05

        I think, I think I would. Now, I think if I, if I had to... The first thing I would do if, you know, if I was, if I had instant motivation powder that I was gonna dust on myself, I would get m- m- I would up my strength routi- my, my strength training routine. That would be the first thing I do if longevity was my first priority. But I think-

    24. PAPeter Attia1:43:21

        Oh, I'm sorry. I misunderstood. So you wouldn't necessarily run more. You would take extra time and add it-

    25. AHAlex Hutchinson1:43:26

        I, I-

    26. PAPeter Attia1:43:26

        ... in the weight room or do something else?

    27. AHAlex Hutchinson1:43:29

        No, I would run more.

    28. PAPeter Attia1:43:29

        Okay.

    29. AHAlex Hutchinson1:43:29

        Like, if, if, if I was prioritizing, I would prioritize strength first.

    30. PAPeter Attia1:43:32

        Okay.
12. 1:53:45 – 2:00:50

    Age-associated decline in aerobic capacity and muscle mass, and the quick decline with extreme inactivity

    1. AHAlex Hutchinson1:53:45

       it goes beyond the, the, you know... If you're s- if you take that away, um, I'm not sure it, it nets out as positive.

    2. PAPeter Attia1:53:54

       You know, one of the things that I, I think is, I don't know that we'll ever know an answer. W- I don't know that we'll ever have an answer to the question, but I think one of the challenges of trying to reconcile all of these disparate data sources is it's all apples and oranges with respect to the metrics, right? It's you're comparing hours of exercise a week to mileage run, to, you know, true measures of fitness like VO2 max. Uh, uh, I guess the question is, and I've thought a lot about this, and I'd be very curious to your thoughts, if you could reverse engineer where you want your VO2 max to be when you're 90, what, what should it be? Because if you have a sense of what your VO2 max should be when you're 90, you kind of know what it needs to be when you're 80, 70, 60, blah, blah, blah, blah, blah, all the way back. And, you know, at that point, it's not necessarily about how fast you want to run a mile, though you may say, "Look, when I'm 90, I still want to run a nine-minute mile." I don't know. But it, it really starts to get into the activities of daily living and how much pain are you willing to tolerate to walk up two flights of stairs with your groceries.

    3. AHAlex Hutchinson1:55:01

       And, and I suspect... So I know for me, and I don't, I don't know for me, I hypothesize for me that when I'm 90, th- the real risk is that I won't be able to get up out of a chair more than that I won't have the, the VO2 max. And, and there are, you know, peop- th- they've... I don't know, I don't remember the exact numbers, but there are thresholds of VO2 max below which they hypothesize that you can't... I, I can't remember if it's like 18 or 9, or maybe it's 9 or something like that, where it's like at this point you're, y- you've crossed the sort of mortality index where we think you're gonna die in a few years because you can't do, uh, activities of daily living. So there is some research into that, but for me, as just my personal, I, I, I can look at myself and say, "You know what, Alex? Y- y- far before your VO2 max is too low, you're gonna be the guy who falls on the floor and can't get up." And so y- you know, again, from a health perspective, that's why I said, you know- The next thing I, if I had, you know, magic motivation dust, it would be like, "You need to put on some muscle mass." And for other people it would be totally different. There are, there are people I know who, who don't necessarily exercise a lot, but who just ha- have a lot more muscle mass than me, and it's like, "You need to, uh, you know, make sure your aerobic fitness is, is, is taken care of, and maybe you don't need to worry as much as, as, as me about muscle mass." So there's... Yeah, but I, I mean, I agree. You, you, you figure out where you wanna be, and for all those different things. So I'm doing exactly what you said, except I'm doing it for muscle mass, and I'm like, "Ooh, this trajectory is not good."

    4. PAPeter Attia1:56:22

       And, and, and of course part of that's predicated on the idea that we know there's an inevitability of decline. So if you do nothing, you're gonna lose X pounds of muscle per decade on a, if you're lucky, with a tailwind. Um, if you train really hard, you might be able to reduce it to this amount of loss. And if you really go crazy, you might even be able to keep it flat, but, you know, here's the scenario under which, um, that occurs. What do you think is the... Are, are, I mean, I assume there are pretty clear tables on what the decade by decade drop of aerobic, maximal aerobic output is.

    5. AHAlex Hutchinson1:56:55

       There are. I mean, the problem with the tables is that they, they, they draw a nice smooth line. You lose, I think it's 9% per decade or something like that, is at least in the... Once you get into your 70s, it, it gets steeper.

    6. PAPeter Attia1:57:07

       Yeah.

    7. AHAlex Hutchinson1:57:07

       There's a inflection point. The, the sort of revised thinking is that that's, that works on a population level. But what actually happens is the decline is not that steep, uh, for any individual. But what happens is you have certain events in your life. You, you have-

    8. PAPeter Attia1:57:22

       You get an injury and you're, you stop training for six months and then you're hosed.

    9. AHAlex Hutchinson1:57:27

       Yeah. So either you have reduced activity for six months or you have bed rest for a week, which can be disastrous. Uh, and you lose 7% in the course of a week, and you only get 2% back. And so it's this punct- punctuated decline. And so that, I mean, that puts a lot of emphasis, uh, that it sort of points to the idea of really taking care to avoid, to the, to the extent possible obviously, to avoid these sort of events. Because you can actually, in the absence of those, those events, the decline doesn't have to be that steep. You can, you can hang on m- m- probably better than people used to think.

    10. PAPeter Attia1:58:01

        Can you say more about that? 'Cause I, I don't, I don't think this point can be stressed enough. Um, realistically, how much aerobic capacity, maximal aerobic capacity can a person lose with a couple weeks of inactivity? And what's the difference between being bedridden versus going on vacation to Europe where you're not, quote-unquote, "training," but you're still walking every day? Like, neither of those is exercise per se, but one is active and one is complete inactivity.

    11. AHAlex Hutchinson1:58:29

        B- bed rest is terrifying. Uh, th- there's a guy named Luke Van Loon in, in the Netherlands who's, h- he, his focus is, is muscle, muscular strength, but he's done a bunch of bed rest studies. And he... I, I saw him give a talk once, and he, he had this great anecdote about, you know, they, they'd spent a whole b- it's really hard to get old people to put on muscle, right? But they'd just managed to finish this two and a half year study where they got, I can't remember, some fairly large number of septuagenarians, octogenarians to do strength training, and they'd put on like two and a half kilograms of muscle-

    12. PAPeter Attia1:58:56

        Yeah

    13. AHAlex Hutchinson1:58:56

        ... which is a huge victory, and they were feeling really good about it. And then the results came in and for their one-week bed rest study, and they'd lost like 2.6 kilograms of muscle in one week. So it's like they did this like Herculean effort to, to shepherd these people through strength training for, for a long period of time with full support. But man, whatever it is, you, you know, grandma gets pneumonia and is in, in hospital for, for a week, bam, she's lost a year of training or, or, or what, you know, whatever the case may be. So I've, I, I don't have the numbers at hand for VO2 max. I, I think it's like up to 20, you know, fif- maybe 10 to 20% in that range if you, if you stop training for a month. Um, it depends where you're starting though.

    14. PAPeter Attia1:59:36

        Yeah.

    15. AHAlex Hutchinson1:59:36

        Like it's a... If you, if you're, if you're well trained for a short period of time, you'll lose it quickly. If you're, if you haven't been training, then resting doesn't make any difference. And if you're well trained for a long, long period of time, then you have structural adaptations that are gonna take a lot longer to disappear. So, um, y- y- you know, there's no one number for ev- anyone. Uh, and, and the one thing I, I, I would add is that this is not a recommendation that you should never take a break from exercise, that you should be obsessive, uh, and, and train 365 days a year. Certainly if you're training hard, like if you're, if you're, if you're training as a, as a marathoner say, man, y- y- you should take a, a c- a week or two off. And off doesn't mean bed rest. It means play a couple games of tennis, go for walks, chill out, go for some bike rides or whatever. But, uh, y- so you shouldn't be terrified of, of like missing a day.

    16. PAPeter Attia2:00:24

        Yep.

    17. AHAlex Hutchinson2:00:25

        But you should be terrified of bed rest and of, uh, and of total... I mean, Luke Van Loon, one of the things he said is like, "If you're on bed rest, y- you know, hospitals should be forcing you, if you're at all possible, to walk down the hallway to get your meal." Even just walking down the hallway is infinitely better-

    18. PAPeter Attia2:00:42

        Mm

    19. AHAlex Hutchinson2:00:42

        ... than not moving at all.

    20. PAPeter Attia2:00:44

        God, ne- never more, um, sort of relevant than what we're seeing today with so many people in hospitals and, and, and

13. 2:00:50 – 2:03:00

    Strength or muscle mass—which is more important?

    1. PAPeter Attia2:00:50

       a lot of the, you know, the isolation stuff that's, that's going on. Um, let's go back to something you said about strength. What, what do you think matters more, strength or muscle mass?

    2. AHAlex Hutchinson2:01:00

       So, uh, there's a study I wrote about recently I, I, I would hesitate to, to claim it as the absolute truth, but, but, uh, that analyzed, uh, uh, I think it put together like six cohort, different cohorts with a total of about 50,000 people, so, so pretty good d- data. Um, a- and they found that s- uh, strength was actually a better predictor than muscle mass. Um, so it's, it's better to have the functionality to be able to push yourself up out of the chair than it is to have a bunch of muscle if you're not good at using it. I'm sure that's, that, that's maybe not true at the margins. If you lose enough muscle mass, um, then, you know, that, that, then you become limited by your actual muscle mass. But I think for a lot of people, they have enough muscle mass, but they're untrained. The neuromuscular connections are not optimized, and so they're just, they're not strong even though they have enough actual flesh there.

    3. PAPeter Attia2:01:47

       And, and was that for all-cause mortality or...? Yeah.

    4. AHAlex Hutchinson2:01:50

       Yeah.

    5. PAPeter Attia2:01:51

       So that's interesting. I mean, I don't, I don't... That, that doesn't sound like an, uh, you know, a crazy conclusion. I, I, I generally try to say, look, I think both of these things are important for different reasons, right? I think of strength as, as you described it, it's that functional... It's the difference between the person who slips down the flight of stairs but has the strength to grab the rail and prevent that, you know, from being a lethal injury or the type of injury that puts them in the hospital for a month. Um, you know, grip strength is just so highly correlated at least with survival, and I think a lot of it has to do with that kind of stuff, getting up out of the chair, getting up off the floor. At the same side or the flip side of that is I think muscle mass speaks to some of the other physiologic things like glycogen stores and glucose disposal, uh, and glucose homeostasis in general, insulin sensitivity. Um, so again, I, I, I, you know, I rail against the idea that, you know, people say, "I just... I, I'm okay being strong, I just don't wanna be big," and it's sort of like-

    6. AHAlex Hutchinson2:02:48

       [chuckles]

    7. PAPeter Attia2:02:48

       ... it's the myth of accidental muscle, you know?

    8. AHAlex Hutchinson2:02:51

       I, I wish I had that problem.

    9. PAPeter Attia2:02:52

       Yeah, yeah.

    10. AHAlex Hutchinson2:02:52

        It's like, "Oh, I looked at a gym and I accidentally put on 10 pounds of muscle."

    11. PAPeter Attia2:02:54

        Yeah, yeah, yeah. I, I hear people saying that and I'm like, "Yeah, I, I wouldn't worry about that." Um,

14. 2:03:00 – 2:10:00

    Avoiding acute and chronic injuries from exercise

    1. PAPeter Attia2:03:00

       anything else about injury? I mean, you, you've, you've written a lot about this in terms of different, you know, competing theories around injury. Um, w- and do you think... How much do you think it varies by sport? And, and, and I guess most importantly, what is the implication for people who tend to get injured in life? Not, you know, they're, they're walking down the street and they pull a calf muscle versus they're, you know, out there doing their tempo run.

    2. AHAlex Hutchinson2:03:25

       Yeah. So I, for me, so I, I've been, you know, willingly or unwillingly embroiled in lots of debates about injuries over the last decade and a half, and a lot of them focus on things like running shoes, the proper running form, uh, you know, uh, is, is, is the height of your insole gonna affect your risk of injury? And that stuff's fun and, and it, it's, it's not, it's not zero impact, but I think to me there, there's a, a guy named Benno Nig who's a sort of famous biomechanist, um, who's do- done a lot of work on running injuries and stuff, and his take in one of his studies was that, look, 80% of running injuries are what he would call training... or, or originally a, a, a result of what he would call training errors. So yeah, it's, it's nice. You know, there's 20% to work with on, you know, shoes or whatever. You know, uh, if... prehabilitation and balance, yada, yada, yada. Most of, most of what we need to worry about is doing too much too soon. That's an, you know, and that's an oversimplification, but, uh, certainly when we're talking about overuse injuries.

    3. PAPeter Attia2:04:28

       Mm-hmm.

    4. AHAlex Hutchinson2:04:29

       Uh, you know, I'm not talking about like getting tackled on the football field. Um, so I mean, I, I really think especially for people who are... So the, for people who are starting out an ex- or, or ramping up an exercise program, just that, that, that, uh, that patience is so important and that understanding that you will probably overestimate what you can accomplish in the short term and you'll probably underestimate what you can accomplish in the long term. But if you do and if you fall into that trap, you're dramatically raising your injury risk 'cause you're gonna try and ramp up too quickly. 'Cause again, you can gain metabolic fitness more quickly than you can alter the structure of your joints and ligaments and, and, and things like that. So th- I mean, that's... If, if there's one takeaway message, it, it would be like it's, it's not about the magical gadget or the, the, the new way of, of running or the, um, you know, the, the measuring device. It's like, just be patient, be smart. You know, you, you get home, you've h- you have something that's aching. You don't wanna miss the next day's session, and you don't wanna become... It, it's always a, a balance, right? Between being, "Am I being lazy or am I being safe?" Well, y- y- you, you wanna err on the side of safe certainly a- until you start getting a better handle on which aches and pains are normal and which ones aren't. Um, I mean, th- there's a whole nother... Y- we, you know, we can get into things like, you know, balance training or m- training load monitoring, you know, acute versus chronic loading.

    5. PAPeter Attia2:05:59

       Well, let, let's... Yeah, let, let's talk about acute versus chronic load training. I mean, I used to have an, um, a program called TrainingPeaks that would track this for me, so it saw every single day how many miles I rode, and it actually did it more by kilojoules than miles, so it was total energy expenditure. But, um, if you were giving someone some guidance, some rules of thumb if they were becoming active, and, and we don't have to get into the formulas, but just using the principles of acute versus chronic-

    6. AHAlex Hutchinson2:06:25

       Yeah

    7. PAPeter Attia2:06:25

       ... load balance, how would you help them think through everything you just said with these metrics?

    8. AHAlex Hutchinson2:06:32

       So the, the, the background is that the, the rule of thumb that they used to teach runners is the 10% rule. Never increase your, your mileage more than 10%, and it's a rule that makes no sense at the, at the margin. So like if you, if you start by running one mile, then, you know, you're never gonna get above five miles in your lifetime or whatever. But, uh, th- this... It's the... Basically, the idea is g- trying to avoid the too much too soon problem. Now, this idea of an acute to chronic workload ratio is a sort of more sophisticated version of that, and the idea is how much are you doing now versus how much is your body used to? Um, and, you know, the, the, the, the way that the papers, the, the academic papers do it is what's your weekly load, whether you do it in joules or miles or minutes, uh, and what's your average weekly load over the last four weeks? And this is... When they started publishing this, uh, th- this, I was like, "Hey, that's..." I designed my own training log back in the '90s and printed it out, and that's... The two things I had at the bottom was kilometers that week and k- average, four-week average kilometers. And it's not because it gives you some magic-

    9. PAPeter Attia2:07:30

       Why did you, why did you settle on four weeks, by the way, as opposed to three weeks or five weeks? How did you arrive at that, do you remember?

    10. AHAlex Hutchinson2:07:36

        Yeah. You know, uh, there was no deep thinking involved. Uh, it was basically a week versus a month. Um, and, and you know, you can, you can argue it that, yeah, you need at least, you know, you need a, a decent amount of time because otherwise you have one week where you miss a couple days due to injury, and then all of a sudden your four-week average is totally skewed.

    11. PAPeter Attia2:07:52

        Mm-hmm.

    12. AHAlex Hutchinson2:07:52

        Or if it's a three-week, you know, if there or something. And five weeks or six weeks, you know, at a certain point you're moving so far back that it, your body don't no longer cares what you were capable of doing Eight weeks ago, or at least not as much. So four weeks is just a, you know, that it's kind of a, the, for if, if you've done something for four weeks in a row, you, and you're feeling okay, then you can k- you kind of assume that yeah, your body's able to handle that load. And so then this allows you... It's just a, a quick way of seeing if there's any deviations. It's like, "Oh, my, you know, my, this week I did 50% more than my four-week average." That's, that's a bad, bad sign.

    13. PAPeter Attia2:08:33

        Yeah.

    14. AHAlex Hutchinson2:08:33

        Uh, it doesn't mean you're gonna get injured. It, it, there's all sorts of contextual things you have to cont- consider in it, but having that as one input into your larger matrix of all the things that you're considering, like, "Do I feel any aches and pains? Am I... What's my absolute load? Not just the ratio, but is this more than I've ever done before?" Uh, y- you know, all the, you consider all those things, and I think that acute to chronic w- ratio, or just to put it s- more simply, keeping track of how much you're, how, how hard you're going now versus how hard you've been going in the, in the previous month, uh, or how much you've been doing, let's say, is useful. I, now I, I should add that there's controversy in the literature. There's a bunch of people who say that the supposed predictive value of acute to chronic worksh- workload ratio is a statistical artifact. Um, it, it may be, it may not be. I'm, I'm not too worried about that. T- to me, this is not about, uh, statistical pr- predictive power. It's just about keeping an eye on, on trends, and, and it's, uh, knowing if you're, if you're way out of whack with what you've been doing, uh, before. And, and as a general rule, you know, let's say if you're 20% higher, that's a time to start making sure you know what you're doing.

    15. PAPeter Attia2:09:48

        Yeah. Or, or just, you know, and backing it off maybe that next week.

    16. AHAlex Hutchinson2:09:52

        Yeah. I mean, I, I, you know, unless you have some compelling reason to think that you can handle that, if, if you're, if you're exceeding 20%, then probably,

15. 2:10:00 – 2:20:15

    High intensity interval training: Evolution of the Tabata protocol, pros and cons of HIIT training, and how it fits into a healthy exercise program

    1. AHAlex Hutchinson2:10:00

       uh, um, yeah, be cautious and ideally back off.

    2. PAPeter Attia2:10:05

       So you alluded to it earlier, but let's talk a little bit about high intensity interval training. Um, it's getting a lot of attention today obviously. Um, you know, most people are familiar with what a Tabata is, though Tabata himself is not the guy that actually designed the, the protocol, but everybody still refers to it by his name. Um, s- where do you think this fits into the hierarchy of, uh, again, not a specific athlete who's, you know, training to run the mile or the marathon, uh, but a person who's trying to be healthy. Uh, how much of a, h- how much of a shortcut efficiency gain is it? Um, again, let's, let's use the Tabata interval as an example where you're going all out for 20 seconds, resting for 10, and repeating it eight times. And by the way, wouldn't we argue from your research in Endure that you can't technically go all out for 20 seconds? That you're-

    3. AHAlex Hutchinson2:10:59

       [laughs]

    4. PAPeter Attia2:10:59

       ... you're, you're really s- I've started, when I do all out intervals, I now limit them to 10 seconds 'cause I-

    5. AHAlex Hutchinson2:11:06

       Right

    6. PAPeter Attia2:11:06

       ... actually started paying attention and realizing I was subconsciously pacing myself at 20 second all outs. Uh, but anyway, that's, that's, I don't know what you think about that, um, that, that idea. But I remember reading in your book that, that wasn't it the case that we technically can't go all out for 20 seconds?

    7. AHAlex Hutchinson2:11:26

       Th- it certainly doesn't seem that way. And, you know, like look, Usain Bolt or world class sprinters don't go as fast... I mean, it, it's complicated by the curve.

    8. PAPeter Attia2:11:33

       Yep.

    9. AHAlex Hutchinson2:11:33

       But they go, they, they don't, they don't set world records on route to 200 meters.

    10. PAPeter Attia2:11:38

        Yeah.

    11. AHAlex Hutchinson2:11:38

        They're, they're pacing themselves even for 20 seconds.

    12. PAPeter Attia2:11:40

        Yeah.

    13. AHAlex Hutchinson2:11:41

        Um, I just have to tell one quick story about Tabata.

    14. PAPeter Attia2:11:43

        Please.

    15. AHAlex Hutchinson2:11:44

        I, uh, I was at, I was at a conference, uh, and, uh, uh, at the, at the poster session where the researchers are in front of their posters talking about it, and I was, it was a research on the, uh, from the McMaster group, which has p- popularized-

    16. PAPeter Attia2:11:56

        Yep

    17. AHAlex Hutchinson2:11:56

        ... uh, high intensity int- interval training, and one of the postdocs was there explaining his interval, high intensity interval training research. And someone came up and, and asked him a question and hand, uh, and handed him his business card at the time. And I, I noticed the postdoc, he looked down. He, as he was answering the question, he glanced down at the business card, and his eyebrows just went like halfway up his forehead. And I peeked over and was like, "Oh, that's Tabata. That's cool. I didn't realize this was a real person." [laughs]

    18. PAPeter Attia2:12:18

        [laughs]

    19. AHAlex Hutchinson2:12:19

        So he was, he was there, uh, you know, asking questions about intervals. Anyway, um, where do I think intervals fit? Um, I think they're super important. When, when t- circa 2008 when high intensity intervals started to be a, a big buzzword, I was like, "How is this a buzzword? That's how runners train." Like, one of the studies out of that McMaster group was like, "Let's do 10 times a minute." It's like, that's the Roger Bannister. That's what he, that's how he broke the four-minute mile in 1954. What, what's new about this? But it was new to a lot of people. A lot of people were like, "I need to go 45 minutes. I need to go an hour. I need to do this. I need to do that." Um, so there, there is... Let me put it this way.

    20. PAPeter Attia2:12:57

        Well, I guess what I was really getting is-

    21. AHAlex Hutchinson2:12:59

        If there's one... Yeah

    22. PAPeter Attia2:12:59

        ... is the, is the compression of that, right? It's the... I, I don't know if you saw this st- Well, I'll, I'll let you finish this, but then I'll, I'll bring it to where I'm going, which is what are the limits of how much you can shrink that?

    23. AHAlex Hutchinson2:13:09

        Oh, how, how low, how low can we go? Yeah.

    24. PAPeter Attia2:13:09

        Yeah, how low can you go? But yeah. But, but keep going.

    25. AHAlex Hutchinson2:13:11

        Yeah, yeah.

    26. PAPeter Attia2:13:11

        Yeah.

    27. AHAlex Hutchinson2:13:12

        Well, I'll, I'll just, I'll just say that, uh, uh, in gen... as, as two general points. One is that as a runner, one thing I know is that you will never, ever run fast relative to your abilities if you don't do interval training. Um, the second thing I would say is you probably won't run as fast as you could if you only do interval training. Now, some people do do only in- interval training, but that's, usually they're doing it so slowly that it's not different from just doing a, a, a sustained thing. So to me, when you look at the studies, it's like let's compare eight weeks of three interval workouts a week to eight weeks of three 45-minute sustained sessions. It's like, okay, that's interesting. It's, it's, it's useful to know. But I, I, I really don't think that's what is optimized, and what, what we should be comparing it to is what, what about one short interval, sprint interval session, one medium interval session, and one 45-minute session? That's, or, or, you know-

    28. PAPeter Attia2:14:04

        Yeah

    29. AHAlex Hutchinson2:14:04

        ... some portfolio is, uh, to me, 'cause there, there's pretty clear evidence that you get You can get to the same or some of the same health outcomes. You can get the same improvement in insulin sensitivity, say, but the mechanisms may be different if you, if you're doing a sprint interval session versus or if you're doing sprint, uh, interval training versus sustained training. And so it's like, well, if you've got two different mechanisms, let's hit them both because presumably we're g- we're gonna get a little one plus one is gonna be at least equal to, you know, 1.2 or something like that. So I'm, I think interval, I would 100% recommend to, to anyone that they should be including some form of interval training in their, uh, routine if they're interested in health or performance. I, I n- wouldn't necessarily recommend it as the only thing unless they, that's what they wanna do. I, I would, I would put it as part of a portfolio. And as far as the sprint stuff goes, we, we can talk about this, but it's like it, it has been funny to watch the, the, uh... It's not like one-upsmanship, it's one-downmanship. How short can we make this? Like, "Okay, I thought about interval training for a millisecond last night. Look, I got fitter. It's amazing."

    30. PAPeter Attia2:15:06

        [laughs] Well, that's only a f- uh, it's only a, a, a slight exaggeration from a study that came out recently from, actually from, from here in UT Austin. Um, Ed Coyle, who is a, is a physiologist and, and published a study looking at four seconds all out, 56 seconds of rest. So, uh, it's on the mi- every minute on the minute, but only four seconds all out, and this was done, I believe, for 15 minutes, and then they progressed to basically four seconds all out twice a minute. So you go four seconds all out, 26 seconds of rest, repeat, you know, for 20 minutes, something to that effect. Um, again, I, I, y- you know, here's my take on these things. It comes down to a concept you raised earlier, which is there's an opportunity cost to them. It-- They're usually comparing that to doing nothing, and is that better than sitting on the couch? Yes. But if you gave a, if you gave me 40 minutes a day, could I come up with a more efficient way to get a benefit? I probably could. And then it becomes a question of what's the efficacy versus effectiveness of this intervention? And I think that's the other piece of this, right? Which is I think people like you and I like exercise so much that we get to focus all of our effort or interest on efficacy. What is actually going to do the best, produce the best results when adhered to perfectly? But I accept the fact that many people don't enjoy exercise, and therefore, the real-world applicability of a problem becomes its effectiveness. It's not what can be done in a laboratory for six weeks when you're a paid subject. It's what are you gonna be willing to do on your own when you have to rely on your own sprinkling of motivation dust day in and day out? And so I guess on some level, that's where I've become a little bit more accepting of the fact that, hey, if people are willing to do shorter interval workouts, provided they don't get injured, that's always the fear I have when people jump right into these high-intensity interval workouts without any of the foundational strength that goes into it. Um, if the alternative is doing nothing, well, then it's better. But I guess secretly I just hope that I can convince people that they're better off learning to love exercise, which again, I think is why a book like yours is so great, right? It explains like how we evolved and, you know, the, the more we can think about reconciling what we are, uh, today with what we spent a million years becoming, uh, perhaps the less foreign that feels.
16. 2:20:15 – 2:22:40

    The importance of understanding why you are engaging in exercise

    1. PAPeter Attia2:20:15

       I love your comment about, "I thought about in- high intensity intervals for a second last night." [laughs] Um, I, I, I will say this. One, one of the things that I think is a big challenge here is most people aren't clear on the, the why. They just wanna do the what. You know, this is sort of the going back to my pet peeve of people confusing strategy for tactics. Um, and I don't-- I think if people don't understand the benefits of the different types of exercises and the why you're doing them, you know, actually reverse engineering what the purpose is. So you're thinking about the 90-year-old version of you in a chair who needs to get up. Well, that gives you the motivation to do strength training. And if you didn't have the aerobic conditioning, you'd start to think, "Well, once I get up out of said chair, what do I wanna do? Oh, I might actually wanna go and walk around the block with my grandchild. Oh, well, what would that involve? Well, uh, at my house there's a hill, and that hill goes from here to there, and what if I wanna stick them in a wagon and pull them?" Like, that's actually going to require aerobic capacity, and that hill is pretty short, so it's actually gonna be pretty intense. Like, it actually requires a, a near maximal effort from me. And so I, I just think that the more people can tether what it is they are doing this for to something real, it, it becomes a little easier to do these abstract workouts, 'cause otherwise, like, what are we doing, right? Like, once you stop competing in something which is, you know, a fraction of the percent of the population, it-- all this exercise stuff becomes abstract. And frankly, you know, the, the, the prac- the, the practice of medicine doesn't do a great job communicating the why, right? I mean, most, most people know they should exercise, but I don't think they've really had a great explanation as to, you know, for example, fighting cancer when you're fit is probably a lot easier than fighting cancer when you're not fit simply based on the energetics of your immune system. You know, most people don't know that, and therefore it's a bit abstract why they should be exercising so much.

    2. AHAlex Hutchinson2:22:15

       Yeah, I mean, you could say the definition of insanity is, is telling people that exercise is good for them yet again and hoping that that on its own is gonna convince people to, to, to exercise. It, it's clear that doesn't work, so I think, uh, you know, what you say is right. You need to, to, to, uh, to make it visceral and, and to relate it to things that people care about and so that it... Pe- people care about different things, so you have to understand what each person cares about and, and then find out what,

17. 2:22:40 – 2:27:57

    How we can encourage better science journalism and reduce the number of sensationalized headlines

    1. AHAlex Hutchinson2:22:40

       what the right exercise for them is that's gonna, that's gonna connect for them.

    2. PAPeter Attia2:22:44

       Last thing I wanna ask you about, Alex, is basically the, the merger of, of the two careers you've had. Um, I, I've probably been pretty critical of your profession, which is, uh, science journalists, um, or journalists who cover science, let's put it that way. Um, because truthfully, I think most of them are really bad, and I think many of them actually border on negligent and, uh, they, I think they cause, on some levels, more harm than good to the public. Um, w- ho- I mean, obviously I don't put you in that category, and there are many people I don't put in that category who I think are excellent at science journalism, but, but they're in the, they're in the, they're really in the minority. Um, so most of the sensationalized, sensationalized headlines, um, uh, you know, and, and frankly even the news stories that just don't have the, the detail that I think should at least be covered in a news story given the understanding that very few people are gonna go back to the primary source and read it, uh, places an enormous responsibility on scientific journalism. Do you think there's a systematic way to make this process better?

    3. AHAlex Hutchinson2:23:54

       Oh, that's a, that's a heavy question. Uh, the problem is, or at least m- my perception is the problem, and this is self-serving since I'm a science journalist, is that journalism now follows the audience. Uh, you know, and I started out in 2006, let's say, just at the point where news organizations were first starting to be able to see how many people clicked on a story. And this was, you know, one of the great catastrophes of, of, of journalism in some ways because it's, it's terrifying to find out what people click on. Uh, it's, it's unhealthy for the news organizations to find out what people click on. I, I can remember, so the, the big newspaper in Canada is The Globe and Mail, and, you know, early on as, as newspapers went online, they started to, y- you know, people realized it's kinda nice to have what are the top 10 most clicked-on stories, so then you can go and... And I remember when The Globe, uh, as far as I remember, I might, I don't know the exact timeline, but m- shortly after they introduced this feature, I was like, "How is it that the top 10 stories o- on The Globe and Mail website, like three of them are about Britney Spears, two of them are about like w-" You know, it was just like... I thought The Globe and Mail is supposed to be the, the kind of highbrow newspaper in Canada, and it looks like it's a bunch of simpering morons who are, who are clicking. But like, then I look at what I click on sometimes, and it's like sometimes you're just tired and you click on the, the sort of craziest thing. So anyway, sorry, I'm drifting off the point here, which is that to fix science journalism, y- you need... Or to encourage good science journalism, y- you need people to read good science journalism. And I th- I think newspapers are realizing that following the audience has turned out to be a bad move because they've ended up losing the trust in audience. But by giving people what they thought they wanted, you ended up, um, basically giving them crap and then having people recognize that they were being fed crap and then, uh, kind of re- rebel against it. So like where I started my journalism, my, my sci- my sports science journalism career in some sense was I started a blog on WordPress in like, I don't know, 2008 or something, where I was just like, "You know what? I can't write this in a newspaper article, but on this blog, I know there are people who are interested in the details of what the study says. I'm gonna have the, the key figure from the study, and I'm gonna say how many people were in the s- were, you know, how many subjects there were and what their characteristics were and what the intervention was." Uh- And that's, that's the blog that became... It, it got taken onto Runner's World in 2012 and then moved over to Outside in 2017. It turned out there was an audience for that, um, which, which is encouraging. So I think, uh, I guess I'm not answering your question at all, which is how do you fix it? But I, I, I think the, the, the finding an audience that appreciates it is, is... Or at least having some... I don't know. Let's see. I, uh... What am I trying to say here? That, that, that news organizations aren't gonna insist on scientifically qualified journalists unless there's, there's, uh, w- repercussions or feedback when there's bad journalism, and th- I think the initial signals were the opposite. They were actually getting feedback that the, the less complicated it was and the more sensational it was, the, the more feedback they got. So maybe, you know, like, to try and actually give one concrete answer to your question is that the move away from advertising and towards subscription-based models I think has helped and hopefully will continue to help move away from, like, just let's do what's most sensational to let's do what's most... Let's give people a filling meal that th- you know, that they're not gonna be hungry t- 10 minutes later. So, so maybe that trend is, is, is a good one in, in some ways.

Episode duration: 2:31:55