Peter Attia MD205 - Energy balance, nutrition, & building muscle | Layne Norton, Ph.D. (Pt.2)
EVERY SPOKEN WORD
150 min read · 30,043 words- 0:00 – 0:08
Intro
- PAPeter Attia
[upbeat music] Hey, everyone. Welcome to the Drive podcast. I'm your host, Peter Attia. [upbeat music]
- 0:08 – 6:16
Defining energy balance and the role of calories
- PAPeter Attia
Hey, Layne. Good to see you again, man.
- LNLayne Norton
Yeah, I'm happy to be back. I'm stoked for this. I know we had our... We had the marathon session the first time, and I think we got through, like, a third of the topics that you were interested in, so [laughs] we'll see how we do this time.
- PAPeter Attia
Yeah, yeah. Well, and of course, a lot of people had a bunch of follow-up questions, so it's sort of some combination of all the things we didn't get to talk about the first time, plus some new things I thought about and that you and I have had a bunch of emails e- exchanged over the last few months, um, coupled with, you know, some of that residual stuff. Um, but one of the topics that people really want to hear you and I talk about, because I think there's this belief that we are gonna be so orthogonal in our views and we will have not a single thing in common, although I'm pretty sure this isn't gonna be the case, is on energy balance and the role-
- LNLayne Norton
Hm
- PAPeter Attia
... of calories in weight gain. So why don't we just lead with the fireworks that everyone is hoping for? So-
- LNLayne Norton
[laughs]
- PAPeter Attia
Talk to me about energy balance, calories, and weight gain.
- LNLayne Norton
So I think one of the big misunderstandings is people don't really understand what energy balance truly is. So if we look at what the... what most people think it is is, "Well, I track my calories and I... my ch- calories in and I track my calories out. Therefore, if I am, you know, burning 2,500 calories a day and I'm eating, and I'm tracking 2,000 calories a day, I should lose one pound of body weight per week linearly, and, and that's just how it should go, perfect math." And when that doesn't happen, they go, "Well, see, this does- this doesn't work." And there's a lot of different reasons for that, but before we get into that, let's talk about what energy balance actually is. So you have... It is calories in versus calories out, or the energy you consume versus the energy you expend. And it's worth talking about real quick before we get into that, what do we mean by energy? A lot of, when people say, "Well, it's calories. You... They're, they don't even exist. You can't look at them on a mi- under a microscope." No, you can't look at them under a microscope. What we're talking about is the chemic- the, the energy stored in the chemical bonds of food, and when you break that food down, when that, when those molecules go through metabolism and they go through glycolysis, the Krebs cycle, that energy is liberated, but captured ultimately as mostly ATP, which is our high energy phosphate. Uh, but you can't just store a bunch of ATP. It's not practical for the body, and ATP is very unstable molecule. So we evolved to have fat stores or adipose tissue basically to store excess energy. Now, you can store some in glycogen. Um, I would argue that you really can't store some as protein. Some people will say, "Well, you can break down, you know, lean tissue." To me, that's kinda like saying, "Let's build a house so it's a reservoir for wood."
- PAPeter Attia
[laughs]
- LNLayne Norton
I, I don't really think that that's a, you know-
- PAPeter Attia
That's a great analogy. [laughs] I built this amazing teak table such that if I need firewood, I've got it right there.
- LNLayne Norton
Right. Like, in, in practicality, are you right? Sure. Yeah, you could, but that's not why you built the table, right?
- PAPeter Attia
Yeah, that's, that's the nu- that's the nuclear option. Yeah.
- LNLayne Norton
Right. For, for sure. Uh, but and if you look at the, the contribution of glycogen to your relative energy stores, it's actually really small. I mean, you're talking about, you know, 1,500 to 2,000 calories of energy. Um, so your adipose is by far the, the biggest store, and you store it that way because, one, it's, it's, it's economical for space because you can fit a large amount of lipid in a small area, um, and it's energy dense, and it's relatively easy to convert to ATP.
- PAPeter Attia
A- and it's anhydrous, so therefore it's, you know, incredibly well packed, as you said, right? That's-
- LNLayne Norton
Bingo
- PAPeter Attia
... a glycogen has to track with all that water. It's, it's, it's not a very efficient way to store energy.
- LNLayne Norton
Correct. You would be 800 pounds if you were trying to store the same amount of energy as glycogen.
- PAPeter Attia
Yep.
- LNLayne Norton
So, um, there's a lot of really practical reasons why the body evolved that way. Now, when we say calories, calories are literally a measurement of energy, and so this is really important to understand. When people say, "Well, are all calories created equal?" That's like saying, "Are different notches on your speedometer different?" No. This is just a m- this is just a unit of measurement, literally all that is, and you, you h- you truly have to think of it as energy. So if we think of it as the energy stored in the chemical bonds that can be transferred, uh, throughout these various metabolic processes, and that's what metabolism really is, is trying to capture that energy. When we look at what the energy inside of things is, that is essentially the metabolizable energy in food. Now, there's a couple important caveats to that. Notice I said metabolizable energy, because not everything in food is metabolizable, especially with regards to fiber, and specifically insoluble fiber. Um, it used to be thought that insoluble fiber is completely... You can't digest it at all. Um, it's absolutely zero calories. And I wouldn't say that there's good evidence, but there's starting to be some evidence that suggests that our gut microbiome can actually extract some calories from the insoluble fiber you eat. Um, that's coming from a friend of mine, Suzanne Devkota, who's one of the premier gut microbiome experts in the world. Um, she actually did her master's at the same lab I was doing my PhD in. Very smart person, has been to, like, the Nobel ceremony, you know, like, incredibly well-respected scientist. So there is some evidence of that. And then when you come to soluble fiber, it's pretty, pretty variable. It's, like, anywhere from one to four calories per gram, so anywhere from a normal carbohydrate amount to one calorie, and it also probably depends on your individual gut microbiome, right? So even before we get to the calories outside of thing, we see that there is some variability And probably some individual variability in how many calories one person can consume and then actually have available as energy.
- 6:16 – 10:57
Defining a calorie, whether they are all created equal, and how much energy you can extract from the food you eat
- PAPeter Attia
Layne, I like that you started with this. I'm just going to add a couple of points so that we can build off this together. So-
- LNLayne Norton
Mm-hmm
- PAPeter Attia
... let's even give people the definition of a calorie, and I think we should remind people that when you and I and most people are talking about calories, we're really talking about kilocalories. Um, and some people will get those confused. So big-
- LNLayne Norton
Yep
- PAPeter Attia
... C calorie is equal to 1,000 little C calories or a kCalorie. But regardless of that nomenclature, I think most people when they're saying, "I eat 2,000 calories," are of course referring to kilocalories. [smacks lips] Each of these, one of those, if I'm not mistaken, and you're going to be probably remembering this better than me, Layne, one calorie I believe is the energy required to heat one gram of water from 14.5 to 15.5 degree Celsius at, at one atmosphere. Correct? That sound about right?
- LNLayne Norton
Bingo.
- PAPeter Attia
Yeah.
- LNLayne Norton
Yeah. About, about right. I, I, I actually have specifically forgotten the exact definition, but it's basically the amount to re- decr- um, increase the degree of water by one degree Celsius.
- PAPeter Attia
Yeah. So, so again, to your point, it's simply a unit of energy, just as we would think of a joule as a unit of energy. And [clears throat] I also want to highlight something you said which I, um, I think is a very important thing for people to understand, which is when we talk about the conservation of energy, that also implies when you change forms of energy. So when you eat food, the energy, as you said, is stored within the bonds. It is chemical energy. We turn that into electrical energy via the electron transport chain, and then we turn it right back into chemical energy, both in the immediate sense of ATP where you, again, now create the energy in the phosphate bond. But more importantly as you said, when you're storing it, you're putting it right back into a hydrocarbon, and it's those carbon-carbon, carbon-hydrogen bonds that if my memory serves me correctly are the most energy dense bonds within our body. Much more than, say, a carbon-oxygen bond would be.
- LNLayne Norton
Correct. And, and that's why, you know, we see fatty acids have much more calories or much more energy per gram compared to carbohydrate because carbohydrate has more oxygens, um, whereas fats through beta oxidation where you're having lopping off two carbons with hydrogens, you can pretty much... I mean, it's not direct, but you can pretty much create acetyl-CoA right from that which go, which then goes in, directly into the Krebs cycle. Whereas glucose, there's a lot more, um, more involved in getting the, uh, ATP or generating ATP from that. Um, now glucose does have benefits in terms of amount of oxygen required to generate the same ATP. It just depends on the metric you're looking at, right?
- PAPeter Attia
And, and then of course the, the final point you make there, Layne, I think is worth restating 'cause it is so important, which is, and this'll come up later I think when we talk about genetic differences and tolerance to amounts of macronutrients and things like that. But you can really liberate different amounts of energy from the same foods depending on many things, but presumably based on your gut microbiome. That's probably one of the things that's going to create a pretty sizable delta when it co- when it comes to how much food you're capturing. In other words, how much of that chemical energy you're able to recoup and repurpose into electrical energy.
- LNLayne Norton
Yeah. I mean, th- there, there is evidence, for example, that obesity prone people, um, that they have a flora of gut microbiome... Or sorry, a gut microflora that is better able to extract energy from the foods they eat. Now, that could be reverse causation as well. It could be that obese people eat a diet that causes this kind of m- gut microflora to bloom, you know, so on and so forth. So we got to be careful about establishing, you know-
- PAPeter Attia
Yeah
- LNLayne Norton
... correlation ver- versus causation. Um, and I will say that when they look at... 'Cause they can actually assess how much energy is lost in, in fecal matter. Um, it's, it's usually around 5 to 10%, depending on people. A- and most of your 95% of your Gaussian distribution falls in there, right? So it, it is a significant difference, but what I would tell people is be cautious about saying, "Well, th- this is why we see huge differences between individuals." It pro- maybe for certain individuals, but I think for the vast majority of people, unless you're literally an outlier, uh, it's probably gonna be somewhere relatively close, right? Uh, so I think establishing that, okay, we've al- we already, we, we understand that there is some variability in how much energy you can extract from the food you eat. And I'm gonna come back to that as well because there's another aspect, uh, the tracking portion that we need to talk about as well that confuses
- 10:57 – 23:45
Factors influencing total daily energy expenditure
- LNLayne Norton
people. Now let's talk about the energy outside of things, because this is way more complicated. So there's different ways people have broken it down, but essentially you have your, your, your BMR, which is your basal metabolic rate. And w- what that, that's usually about 50 to 70% of the energy people expend per day, and it, the way I tell it is it's basically the cost of keeping the lights on.
- PAPeter Attia
A- and we would determine that if you were putting somebody in a metabolic chamber. I believe that we don't require them to be sleeping, but it's laying, uh, laying there but being awake. Correct?
- LNLayne Norton
Yeah.
- PAPeter Attia
And that's slightly different from your energy expenditure while sleeping.
- LNLayne Norton
Yep. And there are some... Like, you have RMR and you have BMR, and there are-
- PAPeter Attia
Mm-hmm
- LNLayne Norton
... some subtle differences between the two, but I mean, essentially it's, it's very similar. Um, I've had my RMR assessed, which it is basically you go into a lab, you lay down, they m- make sure you're stable for 20 minutes. You don't talk, you don't listen to music, you don't do anything. You just sit there and brea- or you lay there and breathe. Um, and I mean, RMR and BMR are gonna be very similar. I'm gonna simplify it for our audience just 'cause it's an already complicated subject. But, um, those are, that's basically y- you know, the cost of keeping the lights on. So e- uh, what, what the other way to think about it is if you were in like a coma per se, um, where you're awake, having some brain activity, that sort of thing, um, but you're not- You're not moving. You're not physically moving. That's still about 50 to 70% of people's total daily energy expenditure, and that's what we refer to, refer to as me- metabolic rate.
- PAPeter Attia
A- and when you had yours measured, Layne, did you have it done using indirect calorimetry?
- LNLayne Norton
Yeah. So mine was... When I had it done, I'm anywhere between 1,900 and 1,950 calories per day pretty consistently.
- PAPeter Attia
Tell folks how that works, 'cause I think when most people say, "I just had my BMR measured," uh, it's usually not the rigorous way that we're talking about using indirect calorimetry.
- LNLayne Norton
Yeah.
- PAPeter Attia
It's usually relying on heart rate and respiratory rate, which-
- LNLayne Norton
Yeah
- PAPeter Attia
... you know, can probably give some approximation, but, um-
- LNLayne Norton
Yeah
- PAPeter Attia
... it's probably important for people to understand that there's an enormous error that's introduced when you make that approximation.
- LNLayne Norton
Yeah.
- PAPeter Attia
So what's the rigorous way to determine energy expenditure?
- LNLayne Norton
So direct calorimetry is the most rigorous way, and that is literally, um, you know-
- PAPeter Attia
Burning
- LNLayne Norton
... kind of in a bomb calorimeter.
- PAPeter Attia
[laughs]
- LNLayne Norton
Right. You're, you're, you're in a metabolic chamber, and they are looking at, um, you know, how much heat you're generating essentially. And from that heat that you generate, they're able to determine your total daily energy expenditure. And then using an equation based on your oxygen consumption versus your CO2 production, they can determine what from that is your BMR, which is actually the same way they, they do it for indi- indirect calorimetry. So you're wearing... You're inside this, like, hood, and you're breathing into a tube essentially. And w- basically, your metabolic rate is very closely associated with how much oxygen you consume. So how much oxygen you consume versus how much CO2 you expire will, one, give you a really good idea of your metabolic rate because the end products of metabolism are CO2 and water. So, so when everything goes through this process of breaking down carbohydrates and fats, it all... If, if you talk about, like, what happens to body fat, it ends up as CO2 and water. Okay? So if they know that, and you can use a constant for water, if they know that, it's also why they can use doubly labelled water to estimate energy expenditure. We'll get to that later. Um, but if you know that and you know these constants and you make several assumptions... I mean, again, this isn't direct. You're making assumptions. You're making assumptions about how much is being generated. Um, you can come up with a relatively accurate, um, estimation of your, uh, metabolic rate.
- PAPeter Attia
And for reasons that I can't re- explain, this is something I can never forget, which is the coefficients for that equation, uh, the Weir coefficients.
- LNLayne Norton
[laughs]
- PAPeter Attia
Right? So energy expenditure is, uh, 3.94 times VC- VO2 plus 1.11 times VCO2. So as you said, it's heavily weighted to oxygen consumption. It's nearly four times the consumption of oxygen plus about one times the production of carbon dioxide, and that gives you that. And for anybody listening to this who's ever had a VO2 max test, I would encourage you to ask the lab that does it for you to give you the raw data. Because what they'll spit out for you, usually in 15-second intervals, is VO2, VCO2. And while the purpose of that test might be to determine your maximal VO2, you can also plug in these two variables to the Weir equation and get how many calories per minute you're consuming or requiring to maintain that energy output all the way to your max. It's actually quite remarkable when you consider that a highly trained individual will easily get to 20 calories per minute of energy demand.
- LNLayne Norton
Yeah. I mean, i- if you think about, you know, when we say lean mass is by far the biggest correlate with, uh, total daily energy expenditure and, and resting metabolic rate, um, lean mass requires quite a bit of oxygen, uh, compared to, like, adipose tissue, which is relatively non-vascular. So it makes a lot of sense that you would see that. And then if you think about activity, obviously if you start doing activity, it requires a lot of oxygen. So we have our BMR, which is about, in terms of the energy outside of things. And I guess I should define that. Energy out is your total daily energy expenditure, so all the energy you expend in a day. That's your TDEE, we call it. And the biggest c- portion of that is your BMR for most people. Now, if you're an elite athlete who trains, like, six, eight hours a day, you can get to the point where your physical activity is actually greater than your BMR. So don't, don't be... Those listening, don't be dogmatic about these numbers. But for most people, uh, 50 to 70% is a relatively accurate representation. For me, it's probably about 55 to 60% of my total daily energy expenditure because I do train, like, two, two and a half hours a day, so that is a significant contributor. So we have that. Then we have what's called TEF, which is the thermic effect of food or diet-induced thermogenesis, and this is anywhere from 5 to 10% of your total daily energy f- expenditure for most people. Very, very hard to measure. Um, usually it's expressed in terms of, you know, calories per minute, uh, because they're only looking at it in the short term. And when we do studies of total daily energy expenditure, I mean, usually what they're doing is using a constant for TEF. They're, they're making an assumption because it's just so hard to measure unless you're just measuring that over, like, the course of a couple of hours or maybe a day at most. But we feel relatively confident based on the, the studies out there that it's about 5 to 10% of your total daily energy expenditure. So not a, not a big contributor, but still.
- PAPeter Attia
But it also seems to be macronutrient dependent, correct? Do-
- LNLayne Norton
It is.
- PAPeter Attia
Yeah.
- 23:45 – 36:39
The challenge of tracking energy expenditure accurately, and the thermic effect of different macronutrients
- LNLayne Norton
people. The other thing that really will kind of confuse people is thinking that they can track their energy expenditure accurately. So these watches, there was a, a recent study done in 2018. I guess some people might not consider that recent. I do, 'cause the years tend to blend together for me now. [laughs] But they me- they looked at about 20 different devices and found that these overestimate your exercise energy expenditure by 23, or sorry, 28% to 93%. So if it says you burned 500 calories, you probably actually burned more like 260 to 400 calories, right? And so again, people will say, "Well, I, you know, I, I burned 1,000 calories on the treadmill today." Like, you know. And I always tell people, "What do you think is more likely, that you have found a way to violate the laws of thermodynamics or that this watch might not be accurate? 'Cause I'm gonna go with the latter." So there, there's that. It's very funny how, like, people are very distrustful of certain things, and then other things they're just like, "Oh yeah, I totally trust this thing." Um, so there's that, and then there's also the fact that we can't completely accurately track calories in either because there is up to a 20% error label that's allowed in foods. So I think that's where some of the confusion comes in. The other thing I will say that's worth saying that will really upset some people is people are horrible estimators of their energy intake. Horrible. There was a study done, um, I think it was back in the '90s, where they took self-report, people who were self-reportedly resistant to weight loss. Th- These were people who said, "I, I eat 1,200 a calorie a day. I can't lose weight." They put them in a, uh, in a metabolic ward, and they also had them do, um, doubly labeled water, which is, is basically a free living way of determining energy expenditure. Plus they had the direct calorimetry. And they said to them, "We, we want you to track your food and report it to us, but we will know if you're, if you're incorrect. Like, we wi- we will know." So the average underreporting was by 50%. So they were underreporting their energy intake by 50% on average. Um, and that's right in line with a lot of the other studies. Most... I- If we look at people who are overweight and obese, most of them underreport by 30 to 70%. Um, the demographic of obese women tend to be at the higher end of that. Uh, obese men tend to be at the lower end of that. And then e- even, even lean people o-
- PAPeter Attia
Yeah, I was about to say, for lean people, would the same, uh, bias... I mean, bias might be the wrong word, but would the same, uh, error in reporting still exist?
- LNLayne Norton
Uh, th- so there, there is an error. It's less. It's, I think it's around 18%, but even dieticians underreport by about 10%. Now-
- PAPeter Attia
That's kind of amazing that they could be within 10%.
- LNLayne Norton
Yeah. So the, the, well [laughs] the, some of the subjects actually argued with the researchers about it, which is funny. Um-
- PAPeter Attia
[laughs]
- LNLayne Norton
... but people don't, they don't like that kind of self-accountability sort of thing. Um, and what I'll tell people is now the message people will hear when they hear that is, "You're saying I'm a liar." And I don't think that people were necessarily lying. I think people are horrible estimators of their food intake. Because if I put a salad in front of you and I dump 50 grams of oil on it versus 20 grams of oil, you will have absolutely no idea of the difference. You might be able to taste, like, a little bit of difference in mouth feel, but most people go, "Ah, it's a salad. It's got some dressing on it. It's probably 200, 300 calories." Meanwhile, it's got nuts, it's got bacon, eggs, it's got oil. You know, all that kind of stuff. And I'm not saying any of th- those things are inherently bad, I'm just saying it's all energy, right? So I think that's another big component, is people are just horrible estimators of their food intake. And, and what I'll tell people is, "If you really believe that you are not able to eat in a calorie deficit and lose weight, I want you to just for one week track every single piece of food you put in your mouth. Like no, no licks, no bites, no snacks not unaccountable. I'm not saying you gotta do this for the rest of your life, but just do this for one week." And usually I'll come back with people who are mind blown. They'll say, "Well, I thought I was eating 600 calories. I was eating 2,700." Because they didn't realize that, like, they grabbed that handful of nuts, or they grab a handful of potato chips or, or whatever it is. Or they took a, a bite of a candy bar, you know? And yeah, in isolation none of that stuff is a big deal but, you know, when you accumulate it throughout the course of a day, it can be a big deal.
- PAPeter Attia
Yeah. About, about, um, eight years ago, um, I, when I was really, really interested in this topic, I had the, the, the luxury of being able to spend a couple of da- probably about a total of six days in total inside a metabolic chamber in two-day blocks.
- LNLayne Norton
Oh, cool.
- PAPeter Attia
So, so three two-day blocks or four two-day blocks inside a metabolic chamber.
- LNLayne Norton
Probably wasn't actually very much fun at the time, but [laughs]
- PAPeter Attia
Actually, it was the most fun thing ever, Layne, because-
- LNLayne Norton
Oh, really?
- PAPeter Attia
... it was everything I love. First of all, I got to be in a room.
- LNLayne Norton
Yeah, no stuff. Yeah.
- PAPeter Attia
Nobody could bug me, and we had-
- LNLayne Norton
[laughs]
- PAPeter Attia
... arranged it so that I could do all my exercising. So I had my bike-
- LNLayne Norton
Okay
- PAPeter Attia
... on a fluid trainer. I had tons of weights in there, plyometric box, a bed. Like, it was a dream. Like, it was literally a vacation. Um, and so... And I had, uh, this amazing food being prepared by a metabolic kitchen. Like, you've got this staff that is making to the gram everything that we had agreed at the outset we were gonna be testing. And then after the fact, I went and did the 10-day doubly labeled water experience, which I guess we could explain-
- LNLayne Norton
Oh, cool
- PAPeter Attia
... for people what that is, right? So you, you... So water everybody knows is H2O, hydrogen two, oxygen one. But it turns out there's a heavy form of hydrogen called deuterium, and there's another form of oxygen that doesn't have 16 pr- oh my God, I'm so bad in my chemistry now. Is it 16 protons or is it s-
- LNLayne Norton
The neutrons
- PAPeter Attia
... neutrons. 16 neutrons. So instead they have one with 18 neutrons. And so you drink a D2 regular O, and then an H2 heavy O. When you drink this, you basically get to exploit a trick, which is by collecting your urine, you're measuring the hydrogen that's coming out without measuring the carbon that's coming out. So you can impute what your VCO2 is effectively, and you collect urine serially, and over the course of 10 or 12 days you get an estimate. And so the only instruction to me when doing this was try to be weight stable for that period of time Which I was able to do. Um, and it was interesting. A- that was a time in my life when I was really tracking ins and outs pretty well. Um, mostly just out of curiosity, not because I was trying to lose weight or gain weight. I wasn't. Um, and by my calculations I was about 4,400 calories in, which would imply-
- LNLayne Norton
Mm-hmm
- PAPeter Attia
... about 4,400 calories of energy expenditure. The, the DLW ended up being 4,200. Um-
- LNLayne Norton
Yeah
- PAPeter Attia
... so I was surprised it was pretty close, 'cause I agree. I expected-
- LNLayne Norton
Yeah
- PAPeter Attia
... it to be way far off. Um, but it was such an amazing experience and it, it's, it's like I almost wish stuff like that could be done commercially, 'cause of course I had to do this with a, a, a, an awesome guy named Aaron, uh, Eric Ravussin at the Pennington, uh, Biomedical Research Institute, and Eric's staff had done this for me. So it was, you know, I was able to do this in a research lab, not... But i- this would be an amazing thing that I wish you could order a home kit, drink this stuff down, run it out for 10 days, and truly get a sense of your energy expenditure.
- 36:39 – 43:00
Challenges of sustained weight loss: metabolic adaptation, set points, and more
- PAPeter Attia
you said that. [clears throat] Um, one of the challenges when thinking about weight loss, sustainable weight loss over a long enough period of time, is how much is enough on a daily basis before an adaptation would take place that would correct it? So for example, if we were talking a-
- LNLayne Norton
You're asking the right questions.
- PAPeter Attia
[laughs] Yeah.
- LNLayne Norton
You're asking the right questions.
- PAPeter Attia
Yeah, yeah. So, so if we were talking about let's just say one of your dieticians came to you and said, "Layne, I've got this idea. I've got this patient who is truly by every metric 50 pounds overweight." Like, th- you know, we could do it on lean body mass, body fat, whatever. But th- this... If this guy's 50 pounds lighter in a year, everything about his life has gotten better from a health perspective. And this person said, "Look, [clears throat] I'm gonna double their protein intake." And let's not make it the extreme example of where you're getting an extra 150. Let's just say it's 100 calories or 75 calories.
- LNLayne Norton
Mm-hmm.
- PAPeter Attia
If you could create an energy deficit, and this again assumes that you can change nothing [laughs] else and, uh, I mean, there's so many silly assumptions, but think of this almost more as a thought experiment. If you could create an energy debt of 75 calories per day by a macronutrient shift to more protein, over a long enough period of time could it be relevant?
- LNLayne Norton
It could. However, what we're neglecting to talk about is, is something I briefly mentioned, which is metabolic adaptation.
- PAPeter Attia
Yeah.
- LNLayne Norton
And so I think this is the other big thing that confuses people. They think energy in, energy out, these are static things that do not affect each other, and the reality is they are intrinsically tied to each other. So anybody who's ever tried to lose weight, if you went on a, let's say a 500 calorie deficit per day, which is a, a pretty significant deficit, um, do you just lose linearly one pound per week until you no longer exist-
- PAPeter Attia
[laughs]
- LNLayne Norton
... and you die 'cause there's no more body weight? No. We all know that eventually, like, that plateaus, right? Now, part of that is just because you have less body mass, so your body has to expend less energy in order to just m- you know, maintain upright posture and those sorts of things. But then there's also the NEAT component. As you lose weight, you become spontaneously less active. We see this in animals all the way up to humans. Then not just that voluntary exercise tends to go down past a certain point. Like, if you're very obese and you start to lose weight, it's not really gonna affect this that much 'cause you have such an energy surplus. Um, but especially people who are going average to lean, your vol... like, your will to exercise will go down. Um, I've definitely experienced that during contests, perhaps getting very lean, you know, just having to, like, will myself to get up off the couch. Um, and then if you look at their BMR, you actually get a reduction in BMR above what you would expect based on the loss of lean tissue and fat tissue, 'cause fat tissue is rel- somewhat metabolically active. There's actually up to, like, on average a 15% reduction in BMR. So almost at every level of energy expenditure, your body is kind of fighting you to get back to homeostasis, to reestablish homeostasis. And so we see this in people who lose weight. So if we take people with the same lean body mass and fat mass, people who have never been obese, people who have been obese and weight reduced, the weight reduced people will have a lower BMR than the people that have never had to lose fat. And so it's like this evolutionary, uh, uh... John Speakman had a really good, uh, paper on this, thinking about w- this kind of getting into set point theory, that we have this kind of native set point that the body likes to be at, and the idea is kind of, okay, what are, what are... what's regulating the ends of that set point? So we understand that if we get too lean and lose too much fat mass, we die. That's a really negative outcome for evolution, right? You can't pass on your DNA if you're dead. Um, at the higher ends, 'cause there are, there are things that work against obesity, li- like we already talked about, that NEAT goes up if you overfeed. Your BMR also goes up if you overfeed. But obviously based on what's happening in society with this shift towards adiposity, the, the regulations on the going up are not as strong as going down. And so if you think about it from an evolutionary perspective, the, the risk of getting too overweight in the short term, because obesity is not gonna kill you when you're 40. You know, it's gonna, it's gonna be the difference between you dying at 80 versus 70. That, that's what the research tends to suggest. The, the risk in the short ter- the risk in the short term is predation or, or, you know, fighting or, or that... some sort of physical altercation where you can't defend yourself very well or you can't run away. The risk of predation after man learned how to use tools pretty much went to zero. Uh, I mean, yes, you have shark attacks and you have these things, but, I mean, they're essentially lightning strikes when humans get killed by animals or even other people. I mean, it's very, very rare. But then we look at the risk of starvation is very real even now in some parts of the world, and was very real in this country until the 1900s, I mean, even into probably the early 1900s. And so it makes sense that the regulatory mechanisms were more powerful on that bottom end to prevent people from becoming too lean than they are on the top end. And so bringing this back to energy balance, you have to think of energy balance like a car that changes its gas efficiency based on how full the tank is. So think about if you had a car that when you have the gas tank filled all the way up, it gets horrible gas mileage. But as that gas tank starts to go down, and think about your gas tank as your, your body's adipose stores, your energy stores. As that gas tank starts to go down, you become more and more and more efficient to by the time there's very little gas left, it's just sipping gas. It really is kind of a dramatic comparison, but it, it is an apt comparison.
- 43:00 – 56:28
Weight loss strategies: tracking calories, cheat meals, snacks, fasting, exercise, and more
- LNLayne Norton
And I think the, the biggest thing to take away is we cannot know at a sn- we can know at a snapshot in time what your energy expenditure probably is, but it's likely to change, and it's a sliding scale, and it depends on a lot of variables. And so that's also led people to say, "Well, see, we can't accurately track calories in. We can't accurately track calories out. There's no point in tracking calories." And what I would say is that you're kind of throwing the baby out with the bath water. I'm not saying you have to track calories to lose weight because obviously you don't, because there's all kinds of methodology that people use to lose weight that doesn't involve tracking calories. But it would be like saying, "Well, keeping a budget is worthless because I have multiple streams of revenue, and I have investments, and so I can't know exactly how much income I'm getting. And also, you know, things pop up, like your car breaks down. You know, you have repairs to your house, so you can't exactly know what your expenses are gonna be. So therefore, keeping a budget is, is, is worthless." And what I'll always... So the comparison I make is you don't have to keep a budget to save money, but it's a useful tool. It, it gets you in the ballpark, and it gets you a baseline, and I would say the same thing about tracking calories.
- PAPeter Attia
And, and it might be that the act of keeping a budget alone is what ali- enables you to think twice before a frivolous purchase, as, as one example, right?
- LNLayne Norton
Absolutely. And we know this too. When people tr- so what's so funny is the parallels here. So did you know that the average person... I, I'm kind of a finance nerd. A, a average person underreports their debt by about 155%. Um, and again, it may not even be a lying thing. It might just be they have really horrible ideas about how much debt they actually have. Um, and so same thing when you, when you have people track their budget, well, now all of a sudden they're on their best behavior because not only do they not wanna admit to anybody else, they don't want to admit to theirselves where they're actually spending their money. And so I, I use that comparison a lot when it comes to tracking calories, and we use it a lot with our clients is, "Hey, look at this thing like a budget." So Peter, you made the example that you were maintaining your body weight on 4,400 calories a day.
- PAPeter Attia
And, and by the way, for the listener wondering, I was training a heck of a lot more than I train now. That's when I was pr- I mean, truthfully, probably exercising three hours a day.
- LNLayne Norton
So you had a very large budget, right? Now, if you have a large budget, if I'm talking monetary, can I... Is it, is a sports car a good purchase? I mean, you know, if it brings you happiness and joy, sure, but not if you can't afford it, right? But if you can... If you make a... If you have a large enough budget that you can pay your mortgage, and you can pay your utilities, and you can, you know, do all the, the responsibilities that you need to, and you still have some left over to buy that sports car and it brings you happiness, I would say go for it, right? By the same token, if you make, you know, 50,000 a year and you're gonna buy a $70,000 or $100,000 sports car, I would say that's probably a really bad idea, right? Unless you've got a ton of money socked away in the bank. And so by the same token, when people see, you know, kind of like the, you know, what I, what I really tend to utilize, flexible dieting for myself and a lot of our clients, people say, "Well, they're, they're just eating junk food all the time." No, no. What you're seeing is people are posting this because they're so shocked that they can eat some junk food and lose weight, um, that they tend to post that stuff, and people will say, "Well, you know, that can't be good for them." And my response is, "No, everything is on a continuum here." You know? There's a big difference between somebody having like a small bowl of ice cream that they fit into their budget for the day, uh, that allows them to kind of feel less restricted and feel like they're, they're not missing out, that prevents them from having a huge binge session, you know, down the road when their willpower eventually breaks. And it doesn't work for everybody, but it works for some people. If they can have that little ice cream but they're still getting enough dietary fiber, they're still hitting their protein, they're not going over calories, they're getting micronutrients in, I would say what's the problem with that, right?
- PAPeter Attia
This is probably the question I actually get asked the most, Layne, from patients, and I'm guessing you do a lot [clears throat] which is, "Peter, do you think it is better to be completely restrictive, uh, or to have frequent cheat meals, like one meal a week or one day a week where you go completely off the rails, or just to have a little bit of stuff that is an indulgence every single day?" And I, I actually, I don't have a great answer for them other than there, there is no right answer here. And even for an individual, that might change. And I'll use always my example which was for three years I was on a ketogenic diet with the exception of one day. So in one, in whatever 365 times three is, for that many days I never deviated from a ketogenic diet except for one meal when I had about seven pieces of cake at my wife's birthday.
- LNLayne Norton
[laughs]
- PAPeter Attia
And I said that was really interesting. Like, I'm amazed I was able to do it. I look back at that period, which was 2011 to 2014, and I think, "I don't know how you did it. I could never do it again." It would be very hard for me to go on a ketogenic diet for more than a o- two weeks now. Um, so and if I did, I'm, if I try, if I, if someone put a gun to my head and said, "You, I really want you to do this for a year," I, I just can't imagine I could. I mean, the, the reality of it is like that would be a very difficult thing to do. And, um, so for me, like I, I don't know what the word is, but like I can definitely get away with [clears throat] a daily indulgence or a weekly indulgence, and it's very easy for me to get right back on program because I basically follow a very simple rule which is never do two bad things back to back. Right? Like if you ever-
- LNLayne Norton
[laughs]
- PAPeter Attia
... if you ever miss a workout ... the, which sometimes is gonna happen, the single most important thing is making sure the next day you work out.
- LNLayne Norton
Yeah, get back on the horse.
- PAPeter Attia
Yeah. If, if you, and if you ever have, like, a complete blowout meal, the single most important meal is the next one. So-
- LNLayne Norton
Mm-hmm
- PAPeter Attia
... so that works for me. But I also realize in working with so many people, there are some people who do very well in a highly, highly restricted environment, and when they deviate from that restricted environment, it, it sets them off a, on a, on a path that doesn't make sense. So I, I mean, do you have any insights for helping someone predict where they're going to be? Or do you just say, "Nah, you know what? Just try them all out. Try all of these approaches, and let's revisit it in a month"?
- LNLayne Norton
I think part of it depends on s- person's personality and their individual psychology. What we know is that if you want to lose weight specifically, you are going to have to use some form of restriction, right? Whether it's calorie counting, points, uh, carb restriction, fat restriction, you know, unprocessed food, whatever. You're gonna have to use... Fasting. You're gonna have to use some form of restriction.
- PAPeter Attia
Right. Either some form of dietary restriction, calorie restriction, or time restriction. You have to do something there.
- LNLayne Norton
Correct. And, and all of them, when we say calorie restriction, we talk about counting calories and actively... But all of these things work because they restrict calories. That's, that's also important to note.
- PAPeter Attia
I want to come back to that, by the way, because this is, to me, the crux of where I think people will assume you and I don't agree, but I, I'm pretty sure we do agree. But let's go with that thread-
- LNLayne Norton
Yeah
- PAPeter Attia
... and then I'm gonna come back to the jugular question around that.
- LNLayne Norton
Very simple. You have to have some form of restriction. But you should pick the form of restriction that feels least restrictive to you as an individual, and this is where people get really crossed up, and I'll give you an example. People find, will find that form of restriction that felt really unrestrictive to them, and you hear it all the time. "I tried intermittent fasting. It felt like I wasn't even dieting. I lost 50 pounds, and it wasn't even hard." Then they will assume that this is the right one, that this is the right approach for everyone because it was the right approach for them. And we tend to retroactively then try to justify why physiologically that also is the best approach, and this is why you hear people make kind of crazy claims about whether it's low carb or intermittent fasting or, or, or any one of these diets, which are all excellent tools. Uh, you know, people think that I don't like ketogenic diets or that I don't like intermittent fasting or anything like that, and that's not true. I just am not a fan of insane claims about those particular diets. And n- I think part of the problem is people will say something like, "Well, I went a... I tried restricting calories. That didn't work. I went on a ketogenic diet, and I was eating more and lost weight." You probably felt like you were eating more. But unless you were weighing out, again, you were weighing out... And the other thing that we should talk about is when you go to a ketogenic diet where you have really, you know, limited food choices, there's not a whole lot of options for snacking. Like, there's not really... Like, you're, you're mostly eating kind of, like, defined meal foods, right? Intermittent fasting, you're not really snacking, right? You're, you're having defined meals. By the way, that is a very, very, very vigorously present characteristic of people who lose weight and keep it off, is they don't really snack. They have defined meals. And there is... I realize I'm going on a tangent here, but there is something to be said for snacks do not appear to be as satiating, not just because of the food, but because of the mindset. Because when you snack, you tend to do it, like, not being mindful about it, and it doesn't have the same satiety effect. So one of the things we tell our clients is, "Hey, stop snacking." Not that... Again, if you like snacks and they work for you and, and you can fit them in your calories, it's fine. But if you're having trouble, try stop, stop snacking, and they say, "Oh my gosh," like, "I didn't even really feel like I was that less hungry, and all of a sudden I'm losing weight again." You cut 300, 400 calories out.
- PAPeter Attia
Yeah. I'll add one point to that, Layne, which is, um, w- when... So, so I, I agree just empirically that if you can absolutely eliminate what you eat between defined meals, and that could be two or three meals per day, um, most people will have not just an improvement of body weight and body composition, but biomarkers get better. I mean, you, it, you tend to not be snacking on the best things to begin with. And actually, this is where one of the things where I have found fasting to be a valuable tool because if you put somebody through a three, five, or even longer day fast, I'm talking a water only fast, even once in their life, they learn a very important lesson, which is I'm not going to die if I'm hungry acutely. [clears throat] Um, if I made you fast for 40 days, you might die, but I pretty much don't think there's a human being on this planet outside of the most, you know, sick, you know, individual who couldn't go five days without food and, you know, subsiding only on water and, and minerals. And something about doing that, even if you do it once, for no other reason, it teaches you a couple of things. One, you can do it. That's a big aha moment. Two, hunger comes in waves. So that-
- LNLayne Norton
Yes
- PAPeter Attia
... five-day period of eating nothing, you will have periods of time when you literally want to eat your arm, and you will have periods during that five days when you have forgotten that you're fasting.
- LNLayne Norton
Yeah.
- PAPeter Attia
And so when you take that mindset into, [lip smacks] "Okay, Layne, I just put you through this five days of, you know, very difficult fasting. Now we're gonna go to a regimen where I just don't want you to eat any snacks. And that means from noon till 6:00, I don't want you eating anything." And now all of a sudden you're like, "At 3:00, I'm really hungry." But you now anchor that to something that was so much more severe, which is, "Wait a minute I'm really hungry because I haven't eaten in three hours. I'm gonna eat in three hours. I think I can make it. And, uh, at least for me and for a number of patients that I've used this sort of method with, it's a very powerful tool, and you don't need to become a fasting guru to do this, right? You don't have to do a quarterly fast to experience this. I think just one fast will teach a person this lesson, and I, I certainly remember the first time I really had that aha moment when I did my first really long fast and realized everything that I knew intellectually, but all of a sudden it emotionally made sense as well.
- LNLayne Norton
Well, people confuse hunger and appetite a lot. So there's a... Here, here's the other big thing is people say, "Well, you don't get as hungry on the ketogenic diet, or you don't get as hungry on the plant-ba- a plant-based diet. You don't get as hungry on XYZ." I say, "That's true, but there's a lot more reasons people eat other than hunger." In fact, I would argue that some of the major reasons people eat has nothing to do with physical hunger, that it's actually societal cues, um, stress, and various other things. And so one of the things we'll, we'll tell our clients-
- PAPeter Attia
Boredom is a big one for me. [laughs]
- LNLayne Norton
Absolutely. One of the reasons that exercise... People... One of the reasons exercise works so well is, one, it sensitizes you to satiety signals. That's actually the, the most powerful effect it has on weight loss. You actually become more sensitive to your satiety hormones. But two, you're spending an hour doing something physical where you're, you're, you're not bored and eating, right? So it, it, it makes a difference.
- 56:28 – 1:07:07
Sitting in discomfort, focusing on habits, and other lessons Layne learned as a natural bodybuilder
- LNLayne Norton
Uh, but one of the things we tell our clients is like, "Listen, if you want to lose weight, you're going to be hungry at some point." Like, this, this is just something... Like, physically hungry. You, you will be. And I... Like, this is coming from somebody who has been stage lean as a bodybuilder with absolutely minimal amounts of body fat. When I talk about the level of discomfort, it is an all-consuming, you cannot think about anything else other than when you're going to eat next. When you finish your meal, you're hungry five minutes later and already thinking about your next meal, and the level of fatigue is so high that the best way I can describe standing up off a chair is a monumental effort. I, I... There's no other way to describe it.
- PAPeter Attia
And, and we talked about this in the first podcast, but just 'cause I find it so amazing, can we, can we relive a, a few minutes of that, Layne? So going into a show, we're obviously referring to your bodybuilding stuff, not your power lifting stuff, [lips smack] um, you'll be what? 4% roughly on stage?
- LNLayne Norton
It depends on what the metric you... I mean, I've, I've calipered at 2%. Um, and DEXA is the gold standard, but again, it's still... I tell people, "Unless you're a cadaver and they're excising your adipose tissue, you'll never know exactly what your adipose tissue is," because all of these measurements make assumptions.
- PAPeter Attia
Yeah.
- LNLayne Norton
On DEXA, I was probably 5 or 6%. That's where a lot of stage lean bodybuilders end up, end up being.
- PAPeter Attia
So how many days leading to that moment on stage are you really in the throes of this type of discomfort that you're describing?
- LNLayne Norton
I will tell you that on calipers I can get to about 7%, come down from, like, 14 or 15, which is where... If I'm up to, like, 230 pounds, I'll be 14 or 15, probably more like 15 on calipers. Get to seven, no problem. Like, that d- doesn't even hardly phase me. I've done it so many times. From 7 to 2 or 3% is exponentially more difficult.
- PAPeter Attia
And that'll, that'll take you how many weeks?
- LNLayne Norton
Oh, probably 12 to 16.
- PAPeter Attia
[laughs]
- LNLayne Norton
To, to go for those, so it's from seven to two. Um, you know, because again, it's not just losing the weight. It's also-
- PAPeter Attia
Sort of maintain the lean mass too.
- LNLayne Norton
Maintaining the lean mass as a drug-free athlete is extremely difficult. That's conversations I have with, you know, our client, our Team BioLayne clients all the time that if they want to do a show is 12 weeks is not gonna do it if you're drug-free, unless you're already extremely lean. Um, uh, uh, the, the best natural bodybuilder I ever coached, his name was Brian Whitaker, and he won the WNBF Lightweight World Title six times, and is the only man to win the WNBF Overall World Title and the IFPA Overal- World Title, which were the two biggest federations, the only man to ever unify them. Um, and this guy at 12 weeks out, you would say, "He's ready," and then he would lose 10 more pounds from that.
- PAPeter Attia
And of those 10 pounds, how many would be fat?
- LNLayne Norton
Probably six or seven. This is, this is the problem is, is the loss of body fat and lean mass, what we see in... I realize we're going off on a tangent, but this is really interesting-
- PAPeter Attia
Yeah, yeah
- LNLayne Norton
... is when you're looking at people who are, like, overweight and obese, it's... they'll... they can lose almost 100% fat tissue.
- PAPeter Attia
Yeah.
- LNLayne Norton
Now, what people don't realize is adipose is actually about 13% lean tissue, so it is very normal to see about a 13 to 20% loss of lean tissue, uh, when dieting. Because even if you lost just adipose tissue, you would lose some lean mass.
- PAPeter Attia
You mean lean mass in terms of some of the water loss?
- LNLayne Norton
Water and, uh, adipose also has protein in it as well.
- PAPeter Attia
It do.
- LNLayne Norton
And, and part of that is lost during the, during the remodeling of the tissue. So you have that, but then as a drug-free bodybuilder, again, it's important to make that distinction because if you're on steroids, that obviously changes the physiology and, and tilts things much more towards retention of lean mass, if not building some. Um, as you get leaner and leaner, you are going to have a progressive shift of more and more lean body mass loss for a few reasons. One, because your adipose stores are lower. Your, your body is sending out hormones to, to try and conserve fat tissue. So think about it from this perspective. If you are 200 pounds and 190 of that is lean body mass because you're, you're just in that-
- PAPeter Attia
You're 5% body fat
- LNLayne Norton
... last little bit.
- PAPeter Attia
Yeah, yeah.
- LNLayne Norton
That last little bit of body fat. Now guess where the biggest reservoir of energy is It's the wood table-
- PAPeter Attia
Yeah
- LNLayne Norton
... now, right?
- PAPeter Attia
[laughs]
- 1:07:07 – 1:09:25
Commonalities in people who maintain long-term weight-loss
- LNLayne Norton
There was a really great, um, systematic review by a gal named Marie Spreckley. Um, she's doing her PhD over in England. And humble brag, she actually messaged me and said that r- reading my book is what inspired her to go do her PhD, and now she's done this great systematic review. So that's always, like, the most cool thing when I hear that. Um, she did a systematic review and looked at people specifically who lost weight and kept it off. What did they have in common? What were their... What were the things they identified as being really difficult? And what were the things that they identified as being really motivating? And the things that came up weren't dietary really. It was their environment. It was their habits, their behaviors, you know? One of the big things that came up was support, either good or bad, that, that support made a big difference. Um, and specifically support in terms of, like, "I believe in you. I know you can do this. How can I help you?" You know, those, those sorts of things versus, like, the criticism, micromanaging type of support, right? And then also, uh, you know, stress was a big one. Trauma was a big one. Binge eating was a big one. That's a really underappreciated part of this, is the binge eating component. I, I, I think a lot more people struggle with that than would like to admit 'cause if you look at people, I would say Monday through Friday, a lot of people do great. Then they get to the weekend and they, you know, they get the pancakes in the morning. They're drinking throughout the day. By the way, everyone, alcohol has calories, and it's really calorie dense and also causes you to make not so great food choices. And so a lot of people eat 1,500 calories through the week, and then they'll easily go 4,000 calories on the weekends. So a lot of this is just reprogramming habits and behaviors, and that's what really came up in that systematic review was it was not, "Hey, this diet came out as this was what these people were using." No, there was no one diet that came up as being superior to the others. What came up repeatedly was these series of habits and behaviors that people had that helped them do
- 1:09:25 – 1:22:23
Does a ketogenic diet result in greater energy expenditure?
- LNLayne Norton
this.
- PAPeter Attia
Yeah. And I think, you know, bringing it back now to the energy balance question, I think today we know a lot more than we did 10 years ago.
- LNLayne Norton
Oh, yeah.
- PAPeter Attia
I think 10 years ago, at least for me personally, there was still an open question about the impact of different macronutrients on energy expenditure, both deliberate and non-deliberate. So-
- LNLayne Norton
Yep
- PAPeter Attia
... um, but I think when you look at the body of literature and, and the... You know, I have to declare my conflict here, right? So I used to be part of an organization that actually funded two of the, you know, really big studies in this space, one out of Boston Children's Hospital by David Ludwig, and then one was a consortium of people that included Rudy Leibel, who you mentioned a moment ago.
- LNLayne Norton
Yep.
- PAPeter Attia
Kevin Hall was the PI, Eric Ravussin, Steve Smith, et cetera.
- LNLayne Norton
That's like the heavy hitters name of metabolism right there.
- PAPeter Attia
This was... The six PIs on this study were six of the biggest names in, in all of this space, and this was a very rigorously done study. And look, was it a perfect study? No. It was a pilot study. It was really designed to be the study to work out the kinks to do the enormous study that actually never got funded. But it was still a very good study, and it still answered an important question, which was at least comparing a relatively clean standard American diet to a ketogenic diet. It'd be hard to make the case that there was more than 50 to 150 calorie difference in energy expenditure at an isocaloric swap. Now, there's different ways to interpret that. Some would say that's huge. If you have a 50k, which is what the difference was in the chamber, versus 150 or 160, which is what the doubly labeled water showed, that could still be very significant over a long enough period of time. There has been a significant debate about the validity of doubly labeled water in a ketogenic diet. You mentioned John Speakman. He and Kevin Hall wrote a review about this suggesting that doubly labeled water really doesn't, uh, apply. There's an artifact in a ketogenic diet. Um, so if you just look at the chamber data and say, "Well, you know, 50 kcal per day, does that really matter?" Not sure. But regardless, it wasn't 250 or 500 kcal per day. And to me, that was a very important insight because prior to that point, I didn't really know because if you look back at, you know, the Vermont study from the 1960s, if you look back at Ancel Keys' stuff where they didn't have metabolic chambers. They were on wards, but it wasn't quite the same. It was really unclear to me. I would say today the evidence has to be overwhelming that if, for example, a ketogenic diet produces remarkable weight loss, it has to be doing it through intake reduction, not through an increase in energy expenditure.
- LNLayne Norton
I think that you're 100% right, and I'm gonna take that kind of piecemeal. So the first thing I will say is let's throw out the energy expenditure stuff for now. And I know we just spent a lot of time talking about energy balance. It's important, but we're assuming that these measures are accurate. There's even error in direct calorimetry because you can only measure as accurately as your equipment that you have to measure it.
- PAPeter Attia
That's right. And, and that... those numbers I just touted, you could argue that were... they were at the limit of detection, at least for the indirect calorimeter.
- LNLayne Norton
Absolutely.
- PAPeter Attia
The f- the 57 kcal per day was probably right at the detection, so it could have been zero. It could have been 100. It's... we're, we're really, you know, we're really on a, on a razor's, uh, uh, edge of-
- LNLayne Norton
Right
- PAPeter Attia
... of detection.
- LNLayne Norton
And I think the, the point you made was that, you know, the carbohydrate-insulin model of obesity would predict a much bigger change in energy expenditure. So therefore at least that version of it, it has to be falsified based on that. And even with the 150 calories, that would not explain the difference. And again, if we look at studies that assess loss of body fat under controlled environments, we just don't see differences between low carb and low fat when calories are controlled, when calories and protein are controlled. We don't see it. In fact, there's actually a very small favoritism towards low fat. But again, I think that that's probably a data artifact and not actually a real difference. There was, you mentioned David Ludwig, there was a more recent meta-analysis he did that got a lot of buzz because basically his assertion was that, well, if you look at the short-term data, yes, there doesn't appear to be much difference. But if you look at after 17 days, there appears to be a large difference in the energy expenditure, anywhere from like 150 to 300 calories per day favoring low carb.
- PAPeter Attia
Was that with doubly labeled water again?
- LNLayne Norton
That's it. So the issue was, and I went through this with a fine-tooth comb. And again, the meta-analysis itself was very well done. The statistics were very good. But when there was metabolic chamber data available or doubly labeled water, they used doubly labeled water. Now, what I would tell you is that's like saying, I've got caliper data available and DEXA data available, but I'm going to use the caliper data. Well, that's fine. But keep in mind that DEXA is what calipers are validated against. So you're talking about a primary measure versus a secondary measure.
- PAPeter Attia
By the way, I've already forgotten Kevin Hall and John Speakman's primary criticism of DLW in a KD. Do you remember the gist of the thesis, where the artifact comes from?
- LNLayne Norton
Yes. So basically, there's more CO2 produced than is accounted for in the constant of the equation.
- PAPeter Attia
The 1.11 is probably too low a number.
- LNLayne Norton
Yeah. So you overproduce CO2 compared to what the prediction would be based on that equation. And so basically what that means is that in a low carb setting, you're probably getting an artificial increase in energy expenditure.
- PAPeter Attia
Oh, so the 1.11 would actually be too big. It's probably too big a coefficient.
- LNLayne Norton
What I went back to is I said, okay, you know what? Let's say that this isn't an artifact or effect of the differences in measures. And again, direct calorimetry, if you're on a standard diet, the association with double labeled water is an R of 0.8, which is pretty good for like free living stuff.
- PAPeter Attia
Yeah, but it ain't 0.99 either. Like 0.8 is good, but not exceptional.
- LNLayne Norton
And then a low carb is 0.5, which is a pretty big difference from a 0.8. It basically just means it's not as tightly correlated. Let's throw all that out. I went through every single one of those studies that Ludwig looked at and then looked at, did they measure body composition? And what did the body composition stuff say? Because what do we really care about? Do we care about what energy expenditure says on a readout? Or do we care about losing body fat, right? I mean, I think most people would say we care about losing body fat. Not one study saw a difference between the low carb conditions or the low fat or balanced diet when calories and protein were equated. So to me, that's truly the metric and that's what we care about. So to me, that's actually great news because what it says is, hey, do whatever diet you prefer. If you like low carb, heck yeah, it's certainly not any worse than doing a low fat diet. If you don't like low carb, there's other options. By the way, you can just do a balanced diet too. There's nothing wrong with that. I think balanced diets sometimes can be a little bit harder for people to moderate unless you're doing some kind of portion control. But yeah, it says that pretty much you can do what you want and still lose body fat. So I'm not trying to throw shade at David Ludwig, even though I have on Twitter before. But it just goes to show you that if you change the inputs for a study, and this is one of the really fundamental problems I think is out there, is people and even like some doctors and scientists just aren't equipped to understand studies, to interpret studies correctly. And people have asked me like, how can I get better at reading this stuff? And I hate to be somebody who sits in an ivory tower, but I'll tell them like, if you really feel so passionately, go to grad school. Because that's, I can tell you sitting down with my PI, Don Lehman, who I'm sure you're very familiar with, and just talking about studies and having him like literally not in a nasty way, but just crush me so many times based on my hypotheses and everything and say, well, have you considered this? That was so enlightening for me. I mean, the best part of grad school was just sitting around a table with graduate students and Don and just rapping back and forth and doing these studies. And you just really get a good idea for how to like look critically at this stuff. And now I'm to the point where I tell people, I'm like, I don't get excited about one study. Wake me up when there's 10. You know what I mean? Wake me up when there's 10. And even then I'm going to look at the, how it was done and make sure. And I tell people, I hear this a lot. You know, I don't trust science because this study says this thing and this study says that thing. I said, if you truly understand what you're looking at, you understand statistics, you understand research design. When you go into the methods and you look at the results, don't read the conclusions of the authors. Look at the actual results, look at the methods, and you can usually understand why they seemingly found different results.
- PAPeter Attia
Yeah. I'll put in one shameless plug for something we did. We have a, a series on the blog called Studying Studies, where we go through all of this methodology. But I agree with you, it's not a substitute for getting reps on the field. In other words, that's sort of like reading everything about playing a sport, but you actually have to play. Um, and, and one of the things we've done internally, and we've, we've toyed with the idea of if we should just put them out there, is journal club. So-
- LNLayne Norton
Oh, yeah
- PAPeter Attia
... what you describe is basically journal club. That's really how you learn how to read studies. You sit around with a bunch of people, and it's formal, right? You know, you, you... We had it every Monday morning, I think, or maybe Thursday afternoon, I can't remember. But, you know, twice a year, depending on the size of the lab, or four times a year, you present a paper for an hour, and everybody else's job is to see how you've maybe missed something or misunderstood something and really poke and pry. And so every single week you're getting those reps on the field, and you get pretty darn good at reading the fine print. Um, so we, we do this once a month internally with our team, um, in part because it's just such a fun experience, and two, it gives us a chance to pick a paper a month and, and really dissect it. So, you know, maybe at some point we'll, we'll put those out there just so people can at least watch. It's one step closer, I guess, to, to doing the reps. But yeah, you kind of have to do it.
- 1:22:23 – 1:28:17
The metabolic benefits of exercise, muscle mass, and protein intake
- PAPeter Attia
Let's, let's pivot to another application of this. Everything we've talked about so far has really set the stage for understanding the role that macronutrients, um, but more specifically calories, uh, and energy intake and expenditure play in weight loss. Let's now talk about a very specific macronutrient, which is protein, and its importance in... Yeah, exactly, its importance in muscle acquisition. So, um, I have a saying that I'm sure many others have said, and I'm sure I'm paraphrasing it from somebody, but never in the history of civilization, I will assert, has a 90-year-old person said, "I wish I had less muscle."
- LNLayne Norton
[laughs]
- PAPeter Attia
Like it can't... Like, the, the, the... ca- that can't be uttered, right?
- LNLayne Norton
If you want to be metabolically healthy, the best thing you can do is have lots of lean body mass. It is a metabolic sink, is the best way to describe it. You, if you look at people who are even like obese who are powerlifters, they might have like some elevations in like blood lipids and whatnot, but usually their insulin sensitivity and blood glucose is still okay. Um, if you, if you look at people who train really hard, even with excess adiposity. I, I mean, they see this with people who are obese, who they start them just exercising. Without exercise, one of the only things that we know of that without even weight loss improves metabolic health, and substantially, really substantially. And I think I, I was actually on the Rogan podcast, and one of the points I, I, I made a few years ago was I said, "You know, if we're-"
- PAPeter Attia
This was the one with Dom?
- LNLayne Norton
Yes.
- PAPeter Attia
Yeah.
- LNLayne Norton
So I said, "You know, a lot of people get real caught up in carbs and fats and all this, and they're not even exercising." I'm like, "You're literally... You're, you are stepping over dollars to pick up fractions of pennies right now." Like, if you just got active... And it, it's not even a high dose that's required. It's not. I mean, a high dose is great. But just going and being sedentary and walking, you will see improvements in, in health markers for, you know, 100 minutes a week. That's it. And then obviously there's, there can be a linear effect. Um, but you know, people will look at me, and I remember I, I had my blood work done a while back. Now I do have familial hypercholesterolemia, so my LDL tends to run a little bit high. But you know, people were speculating that I would have like really high inflammation because I talk about, you know, I still will eat, you know, um, probably around 70 to 80 grams of sugar a day, but I'm also getting, you know, 60, 70 grams of fiber along with that. They'll say, "Oh, your CRP is gonna be a little bit..." My CRP wasn't hardly detectable. It, [laughs] it was on the low ends of detection. And again, that just speaks to the fact that there is a big difference between somebody who is a athlete training hard who has a lot of muscle mass Versus somebody who's sedentary with excess adiposity. The, it, it's just, it's not even comparable when you talk about, like, food choices and whatnot. You have a lot more you can get away with, with, with a lot of muscle mass. And you, your point that being older and frail, people don't think about this. Th- th- this is something that, you know, everybody's kind of like, "Well,"... Uh, well, the, the funniest thing I get, Peter, is people say, "Oh, you do all that heavy lifting, you're gonna be in pain when you're older." You're gonna be in pain when you're older regardless.
- PAPeter Attia
[laughs]
- LNLayne Norton
You might as well be in pain and strong-
- PAPeter Attia
[laughs]
- LNLayne Norton
... versus in pain and weak. I have members of my family, who I love dearly, who have been sedentary for a long time, who have all kinds of sciatica and back issues. I mean, I have had back issues from heavy lifting, but they come and they go and, you know, I'm still here. I'm still able to lift.
- PAPeter Attia
A- and honestly, I find most people who have experienced activity and inactivity will almost always tell you if they're being deliberate in how they recall it. You're generally in more discomfort when you're inactive.
- LNLayne Norton
Oh, for sure.
- PAPeter Attia
I mean, sitting down... I, I, r- again, I, I don't remember where these zingers came from, but none of them are mine. But, uh, this is one of my favorites, right? "Sitting is to lower back pain what bourbon is to alcoholism."
- LNLayne Norton
Hell yeah. Um, the, the, the worst thing you can do is be immobile. It-
- PAPeter Attia
I say as I'm sitting here, right?
- LNLayne Norton
[laughs] Well-
- PAPeter Attia
I notice you're standing.
- LNLayne Norton
Yeah.
- PAPeter Attia
Yeah.
- LNLayne Norton
So part of journal club in grad school, we had, uh, seminars every week where people would either present their exit seminars for their PhD or we'd have outside speakers come in, and one of them interestingly was a lower back pain specialist, and this would've been circa, like, 2007, 2008. And one of the interesting things he said was, "If we," which is now kind of common knowledge, "If we MRI an elite athlete, a lot of times I'll look at their MRI and go, 'Oh my God, you must be in horrible discomfort.' And they go, 'Really? No, I feel fine.'" You know, and they've got all these disc bulges and herniations and whatnot, and they're completely asymptomatic. And then he'll s- he said, "We'll have sedentary people come in, and they'll be in excruciating pain-
- PAPeter Attia
Mm-hmm
- LNLayne Norton
... and I'll pull up their MRI and they've just got a little, tiny disc bulge."
- PAPeter Attia
Th- there is probably no more diagnostic test that is uncorrelated from clinical outcome than an MRI of the lumbar spine.
- LNLayne Norton
Again, not a specialist, but I've, you know, I've spoken with lumbar specialists like Stu McGill. Um, you know, they say, you know, "It's, it's data. It's kind of like a DEXA. It's like it's data, but, you know, it shouldn't really dictate treatment. Tr- treatment should be based on pain and what triggers your pain." And that's a whole nother rabbit hole. The pain, the pain world is a whole nother rabbit hole. Uh, the idea that people think the human body is like a, a bag of meat that's just connected to your brain, and now we know that pain is more like an emotion than anything. But
- 1:28:17 – 1:37:03
The impact of lean muscle and strength on lifespan and healthspan
- LNLayne Norton
I digress.
- PAPeter Attia
So let's talk about it now through this lens, though, right? So I want to talk about it whether we're dealing with a 50-year-old woman who comes to you who's never lifted a weight in her life, okay? So she's the mom of three, has never touched a weight. Um, she's going through menopause, so now she's actually starting to put on a little bit of weight, maybe for the first time in her life, so she's actually starting to get a little chubby and, you know, she... You wouldn't... She's not overweight, but she just feels she's... You know, her clothes are getting a little bit snug. And her assumption is, "I need to do more cardio. I need to be more active, and it probably needs to be disproportionately cardio." And so, so you look at her and you make the diagnosis, "Ma'am, we can do some cardio. We got to put some muscle on you." So you do a DEXA on her, and she comes back 30% body fat, but it's kind of skinny fat. Her ALMI is six, right? So meaning it, it puts her at the 10th percentile of muscle mass. Um, what are you gonna do with her, and what are you gonna make her eat? [laughs]
- LNLayne Norton
Yeah, so I think the f- first thing to say is that muscle is a lot like bone in that you want to lay down as much as possible, 'cause eventually it's gonna start receding.
- PAPeter Attia
Mm.
- LNLayne Norton
Uh, but it is still possible to add muscle at... So people will hear that and go, "Well, I'm 50. I might as well not even-"
- PAPeter Attia
I'm 50. That's exactly.
- LNLayne Norton
Yeah. No. The, the... In fact, right across the street from my lab at the University of Illinois... Sorry, not my lab, the lab I was in. [laughs] Uh, right across the street, uh, at the exercise physiology building, they did a study on 80-year-old frail elderly. Well, they basically had them start where they would squat to a high chair and come up. Gradually, they put the chair down. This was, like, a 16-week study, and I don't have the citation, but I just remember talking to the other grad student about it, so please forgive me, everyone out there. But they said they were amazed, because by the end of it, one, these people, as a percentage of their body weight, increased their lean body mass pretty much the same amount that a 20-year-old does. Okay? So the, the relative increase was similar. Now, their, their less overall... They had less overall mass they put on because their weight was lower to start.
- PAPeter Attia
Mm-hmm.
- LNLayne Norton
And they said by the end, some of them were actually able to add weight, like-
- PAPeter Attia
Squat with weight
- LNLayne Norton
... extra weight-
- PAPeter Attia
Yeah
- LNLayne Norton
... and squat all the way down to a parallel chair, which the people in the study were completely mind-blown that this was possible for them. And it's 16 weeks. It's not even a long time, you know? And we're talking about people who, like, probably think that they're heading for a wheelchair. You know, like, it is never too late to get active. So th- that's the first thing.
- PAPeter Attia
Right. And, and let's bring it back to your finance example. It's never too late to start saving.
- LNLayne Norton
Absolutely.
- PAPeter Attia
It's true that you're better off if, if you can im- if you can be one of the fortunate people who right out of college or who doesn't even go to college and goes straight to work out of high school, whatever, and you can start saving right away, well, that's fantastic. But just because you've made it to 40 and you've been scrapping by and you haven't been able to save, but now you come into a little bit of disposable income and you can start saving There is zero downside to that.
- LNLayne Norton
Better late than never. Absolutely. That's a great comparison. I actually never thought about that before, so I'm gonna steal that for later.
- PAPeter Attia
Take it.
- LNLayne Norton
So [laughs] I'll give c- correct attribution. Um, and then as far as diet wise-
- PAPeter Attia
So give me a typical... 'Cause I, I can tell you what, when I see that woman in my practice, which I see all the time, I'll tell you what she looks like, and I want you to compare it to your version of that. But when I see that woman, she looks exactly as I've said, right? So she's 50, she's going through menopause. She still looks normal, but the composition of her body is really changing. You do that DEXA, she's 30, 35% body fat, very little muscle mass. Um, you take a scro- close scrutiny of what she's eating. She's getting 50 to 60 grams of protein a day on a good day. Um, and when you do a strength metric assessment on her, she is incredibly weak, even-
- LNLayne Norton
Yep
- PAPeter Attia
... as, even if you were to compare her to, you know, another female at an appropriate age adjustment. And, and, you know, I, I have a very stark conversation with her when I pull up something called the death bars. So the death bars are this analysis that Bob Kaplan did for me, mm, God, probably about six months ago, a year ago, which is basically just causes of death by decade. And, um, I double-click on accidental deaths. So I have a... We, we, you know, this, this death bars is so cool 'cause you can double-click on it all over the place. And once, once you call out accidental deaths, you realize something really interesting. Unlike cardiovascular disease, cancer, Alzheimer's disease, which are very age dependent, meaning the older you get, the more the incidence goes up, generally. With cancer, it actually comes down a little bit in the last decade. Accidental deaths are basically the same forever once you are, reach the age of 10. So from 10-year-olds to 20-year-olds, and 80-year-olds to 90-year-olds, they all have the same number of accidental deaths per year, more or less. What differs dramatically is the type of accident. So in young people it is disproportionately, sadly, overdoses that are the lion's share, followed by automotive accidents. In the oldest subset of the population, it becomes a- almost entirely accidental falls. It is... And when you show somebody this graph, 'cause it's so pronounced, I've, I've never seen a person who doesn't just stop in their tracks because they cannot believe how much morbidity and mortality results from falling and frailty once you reach about the age of 70, 75.
- LNLayne Norton
I mean, the data's there to back it up. The, the, I believe, I may butcher this citation, but I believe there was a study by Bob Wolfe that was kind of a review that showed essentially after age 65, you could tie the majority of deaths to some kind of lack of muscular strength or lack of muscle. And if you look at... They, they've done these, um, meta-analyses of mortality-
- PAPeter Attia
Mm-hmm
- LNLayne Norton
... showing that your lean body mass is inversely, inversely proportional to your, uh, risk of mortality after age, like, 50.
- PAPeter Attia
And by the way, strength is even slightly higher corr- so-
- LNLayne Norton
Yep
- PAPeter Attia
... so the hazard ratio for being strong to not strong is about 3.2 for all cause mortality. Think about that.
- LNLayne Norton
Which is a big hazard ratio.
- PAPeter Attia
It's a fricking staggering hazard ratio.
- 1:37:03 – 1:41:07
Hypothetical case study #1: Training program for 50-year-old female
- LNLayne Norton
life.
- PAPeter Attia
So tell me what you would do. So let's use this, again, this generic but rather very specific example of this 50-year-old woman who, um, is not completely unfit. So let's even give it to her that she's, she still does yoga-
- LNLayne Norton
Doing some cardio. Yeah
- PAPeter Attia
... walks, does some stuff, but she's never lifted weights before. Tell me what her first four-month program looks like from you.
- LNLayne Norton
... probably gonna see what, first off, what's reasonable for her lifestyle. Like, what can she actually do?
- PAPeter Attia
So let's say she says, "Layne, I'm willing to commit to 45 minutes three times a week in the, in the weight room."
- LNLayne Norton
Great. I think that probably lower body strength is a little bit more important than upper body strength in terms of preventing falls. I mean, we always think about falls from a bone density perspective. We don't want people to fall and break their hip-
- PAPeter Attia
Mm-hmm
- LNLayne Norton
... because that s- that specific fall is pretty much a death sentence if you're over the age of 65. Um, so but w- people worry about the bone density. Well, if they didn't fall in the first place, if they had the muscle mass to, to catch themselves, um, you wouldn't have to worry about that. And also, by the way, bone density is increased by lifting weights much more than anything you'd ever get through your diet. So I would say let's just see what you can do, and then I would probably do two lower body days, one upper body day. Could even flip-flop it on alternating weeks if you wanted to even it out. Uh, and it'd mostly be, honestly, uh, just some machine stuff that's very easy for her to do to get in there. Because honestly, she's never trained before, everything's gonna cause an adaptation.
- PAPeter Attia
Mm-hmm.
- LNLayne Norton
And that's what we're looking to get. Like, I'm not gonna have her come in and try and free squat or deadlift or anything like that. Like, that's a really horrible idea. It's just gonna frustrate her and, and, and not actually apply the load where we want it because she's not gonna be able to balance it very well.
- PAPeter Attia
So when you say machines, would you be thinking, like, look, you'd be happy with her doing a leg extension, a leg curl, a leg press?
- LNLayne Norton
Absolutely.
- PAPeter Attia
Yeah. Would you have her do anything that's a little more compound and complicated? For example, holding dumbbells and stepping up onto a bench, where now she has to manage grip strength with a bit of balance and also getting the leg load, or is that not first cycle?
- LNLayne Norton
I probably wouldn't do that in the initial weeks just because the soreness is gonna be so high. It's gonna impede a lot of that movement, you know, well. And people tend to think about soreness in the wrong way. It's correlated with muscle growth and strength, but it is not causative. And so what I'll tell people is, "If you're sore all the time, you're probably training incorrectly. If you're never sore, you're also probably training incorrectly." So it's something that if you're doing an appropriate amount of volume and intensity, there probably should be some soreness from time to time, but if you're getting sore all the time, then your programming is pretty bad. So what I'm trying to do in the initial stages is just actually get enough to adapt and not cause, like, enormous amounts of soreness because, one, it's gonna be-
- PAPeter Attia
Can discourage her as well
- LNLayne Norton
... it can be discouraging. That's it. I mean, and you, if you can't go about... Like, everybody's known that, like, feeling after their first, like, hard squat day. Like, good luck doing anything, you know? Um, and so that's gonna be a discouraging thing, especially if somebody's got life. Like, not all of us are meatheads who love that feeling. And also, it's gonna impede her subsequent sessions, right? So she's not... A- a- especially if you're talking about something like a step-up that requires more coordination. If you're overly sore, that's gonna be really, really difficult. So I'm probably gonna try and get her through, like, four to six weeks, which if we look at the data on muscle protein turnover, I think we talked about this last time a little bit.
- PAPeter Attia
Right.
- LNLayne Norton
Um, you don't really see increases in hypertrophy during the six weeks, the first six weeks of resistance training. What you're getting is actually a remodeling of the tissue to be stronger, more resilient, uh, and it starts protecting itself against damage. And so that seems to be where muscle protein synthesis goes up, but muscle protein degradation also goes up. And so basically you're kind of in this futile cycle where it's just turning over the tissue.
- 1:41:07 – 1:47:50
Muscle protein synthesis in a trained athlete vs. untrained individual following a resistance training program
- LNLayne Norton
After about six weeks, muscle protein degradation tends to go down, muscle protein synthesis stays up, and that's where you start seeing those, those, those increases in hypertrophy and lean mass.
- PAPeter Attia
Now, does a trained athlete also go through that, or have you long since passed through that and are you now generally at the point where degradation is not having this disproportionate rise relative to synthesis?
- LNLayne Norton
So it's great question, and I actually have a... I thought you might ask this, so I actually have a paper from Damas et al pulled up, which is really interesting. So if we look at myofibrillar protein synthesis in response to resistance exercise, we see what tends to happen is the amplitude of muscle protein synthesis in trained people is a little bit lower than untrained, so you don't have quite the same response. Um, the, it depends on when you measure. If you measure at 16 hours post, you're, they're about the same. They're about a 40% increase. If you measure at four hours post, there's about a, a, trained is still about 40%, untrained is about 70%. So you've got a, a little bit of difference in amplitude, but what really is the difference is the duration. So in trained people, it's back down to baseline about 10 to 20 hours after the initial resistance training bout, whereas the untrained people still have elevated rates of protein synthesis even, like, three day, or even, like, two, three days later.
- PAPeter Attia
And sorry, Layne, this is just synthesis or this is net accumulation?
- LNLayne Norton
This is just synthesis.
- PAPeter Attia
Got it. So it could be offset by degradation.
- LNLayne Norton
It could be, and degradation is much more difficult to measure, unfortunately. We, we, we do have some... So the, if we get into the techniques that are used to measure this, what you'll find is you really can't measure all three things at one time, unfortunately. So you can measure kind of the net balance.
- PAPeter Attia
Yep.
- LNLayne Norton
We do that with what's called an AV balance. So you're looking at, you take a labeled amino acid, you're infusing it, and you're looking, you're sampling in the arterial of a muscle bed and then the venous of the muscle bed. And so basically, depending on how much of that label shows up in the vein versus the artery, we know how much is being retained in muscle, so that we know what the net is. You can infuse a second label To presumably get synthesis as well, and then you can figure out the difference of degradation, but the problem with this is it requires a steady state. You can't do it when you've trained or had a meal or anything like that. It's pretty much exclusively fasted because there's too many assumptions you have to make about the rate of appearance versus rate of disappearance and those sorts of things. Um, you can measure synthesis very easily. [smacks lips] Well, I wouldn't say very easily, but much easier than, um, degradation. And you can measure degradation, but the, the problem with degradation is how you're measuring it because it's... We know that, for example, out of every amino acid that's used for protein synthesis, seven out of eight of them are actually from degradation. So it's amino acids being recycled.
- PAPeter Attia
Yeah, I rem- this, of all the things we talked about in our first episode, Layne, this was the most novel to me, and it's the one thing that I literally find myself thinking about every day when I finish a workout and go and get a protein shake is I wonder how many of these amino acids in said shake [chuckles] versus these amino acids that I've just eviscerated from deadlifting are actually going to be the ones that formate, you know, that, that form through the summation of new myofibril synthesis.
- LNLayne Norton
What I would say is don't think about it that way. What I would say is if you want to maximize muscle mass, you want to maximize protein synthesis obviously and maximize deposition. And so kind of the theory at first was, all right, if it's only one out of every eight and you can only really deposit about 5 to 10 grams per day net in muscle overall of amino acids, I mean, that's, that's kind of the max.
- PAPeter Attia
Wow. Say that again.
- LNLayne Norton
Yeah, so, so about 5 to 10 grams a day. Um, now think about if you do that over the course of a year, every single day... I've done this calculation before, so I don't remember it exactly, so I'm gonna estimate.
- PAPeter Attia
That, that, that would be about... Look, if you do the math on 10 grams a day, that's 8.5 pounds.
- LNLayne Norton
But what do we know about muscle tissue? It's about 70% water.
- PAPeter Attia
It's like water, yep.
- LNLayne Norton
So you're, we're just talking about the actual protein content. So if you take that, you know, 8 pounds and we divide it by point s- or-
- PAPeter Attia
0.3
- LNLayne Norton
... if you take-
- PAPeter Attia
Yeah
- LNLayne Norton
... yeah, 0.3. Take, uh-
- PAPeter Attia
Yeah, it's about 26 pounds
- LNLayne Norton
... 8 divided by 0.3. About 26. That's a lot of lean body mass.
- PAPeter Attia
Yeah.
- LNLayne Norton
Right? So I would say that's a lot of lean body mass even for a novice trainer. So we know that it's, like, the max is probably about 5 to 10 grams per day in, in terms of drug-free.
- PAPeter Attia
Do you know how much that can go up to with anabolic steroids?
- LNLayne Norton
I'm not sure, quite honestly. Um, there's just a dearth of information about that just 'cause it's hard to get, um, IRB approval for [chuckles] doing research on steroids.
- PAPeter Attia
Yeah, I mean, it would simply be basically the anecdotal evidence of looking at a-
- LNLayne Norton
Right
- PAPeter Attia
... professional bodybuilder and asking, you know, from Nate to-
- 1:47:50 – 1:54:00
Protein and amino acids needed to build and maintain muscle mass
- LNLayne Norton
But she probably, she probably did gain some. Most people's lifestyles aren't that volatile that you see that difference. Um, so she probably did gain some. But in terms of muscle protein synthesis and how much you deposit muscle, people say, well, if you only need 50 grams to meet your requirement in terms of being a positive nitrogen balance, 'cause that's how that's determined is nitrogen balance.
- PAPeter Attia
You mean the, the RDAs are based on just that-
- LNLayne Norton
Correct
- PAPeter Attia
... yeah, which are-
- LNLayne Norton
Correct
- PAPeter Attia
... I mean, let, can we dismantle the RDA in a minute? We'll, we'll come back to that.
- LNLayne Norton
It'll kind of get to that.
- PAPeter Attia
Yeah, yeah.
- LNLayne Norton
So people say, "Well, then just throw 10 grams of amino acids on top of that." That's, or, "Just go 10 grams-
- PAPeter Attia
Yeah, yeah
- LNLayne Norton
... of protein on top of that 'cause you're, I mean, you're there, right?" That's, that's not how it works. You're, you're assuming that every single amino acid after that just goes straight to lean tissue.
- PAPeter Attia
You've already mentioned the, the thermogenic effect. How much of that-
- LNLayne Norton
Correct
- PAPeter Attia
... how much of that is actually coming from the protein itself being inefficiently metabolized versus a stored energy source? Do we know that?
- LNLayne Norton
I would say it's more about the oxidation of the protein-
- PAPeter Attia
Mm
- LNLayne Norton
... and where it's going, but [chuckles] I'll, I'll get to that in a moment. Um, the, the thing to keep in mind is that in order to maximize your deposition, to get that 5 to 10 grams, you need to maximize protein synthesis. But to maximize protein synthesis requires a disproportionate amount of total protein. So in order for you to maximize protein synthesis, we, we think it's around 1.6 to 2.4 grams per kilogram of body weight.
- PAPeter Attia
Sorry, say that again. 1.6 to-
- LNLayne Norton
2.4 grams per kilogram.
- PAPeter Attia
Of lean body weight or total body weight?
- LNLayne Norton
Uh, the meta-analysis on this was total body weight.
- PAPeter Attia
Okay.
- LNLayne Norton
But if you wanna say lean body mass, then you could pump it up to, like, 2 to 2.8 grams per kilogram of lean body mass-
- PAPeter Attia
Okay
- LNLayne Norton
... and you're pretty much at the same number unless you're, like, obese or super lean.
- PAPeter Attia
Yeah.
- LNLayne Norton
And people will, like, quibble about that, and I'm like, "Listen, just, just getting the, just getting the ball park," right?
- PAPeter Attia
Yeah, exactly. [chuckles]
- LNLayne Norton
Um, which, which kind of winds up with that old, like, one gram per pound of body weight number, right? So you, you need a disproportionate amount of protein to maximize the deposition. And so yeah, it, it's just kind of an interesting fact. And the other thing people will say is we have this, um, one of the ways that protein is assessed or needs are assessed is what's called the, uh, um, indicator amino acid method or, uh, they also look at direct amino acid oxidation, but usually the indicator is kind of the one that's the, the gold standard. Um, but if you look at direct amino acid oxidation, so I, I did this. I, I pulled up a bar of direct amino acid oxidation, which basically is like if you feed a certain amount of protein, or if you're feeding increasing levels of protein and you look at the oxidation levels of a specific amino acid, it'll be kind of flat, and then you'll hit an inflection point, and it'll kind of go up linearly. And they've said, okay, that inflection point right there where you start increasing amino acid oxidation, that's obviously wasteful, right? That, that, that's extra protein. You don't need any more than where that inflection point is. And then if you look at what actually increases muscle protein synthesis, it's right at where amino acids start getting oxidized.
- PAPeter Attia
And do you think that that's just an association or do you think there's any cor-
- 1:54:00 – 2:08:53
Nutrition plan for the hypothetical 50-year-old woman starting a program to build lean muscle
- LNLayne Norton
here, but-
- PAPeter Attia
No, no, no, this is actually great background. So let's go back to our woman. She is now, you got her in the gym. She's there three days a week, 45 minutes at a time. We're doing kind of two days lower body, one day upper body to start. For the first six weeks, the goal is don't, don't get hurt, don't get too sore.
- LNLayne Norton
Yep.
- PAPeter Attia
Build up the, build up the habit of doing this thing.
- LNLayne Norton
Yep.
- PAPeter Attia
Find some enjoyment.
- LNLayne Norton
And tissue resilience.
- PAPeter Attia
Get the tissue resilience. You're probably overly degrading muscle and not so much synthesizing, so don't expect to actually add lean mass. When you do your intake assessment on her, you find out she... So let's say she weighs 135 pounds, um, so that's what? 60-ish kilos.
- LNLayne Norton
Yep.
- PAPeter Attia
And you find out she's eating 50 grams of protein a day. So, um, she says, uh, and, and I, I don't even, I, I'm, you, you can probably think better through how many calories she's probably getting on average, but let's say she's getting 2,300 calories per day, of which only 200 is coming from her protein. How do you change her macros with obviously the most important being the protein?
- LNLayne Norton
Yeah, so I think the, one of the biggest things that I really work on people who they say, well, you know, I, you know, if I can't... I, especially with like our, our, uh, our app Carbon Diet Coach, um, a lot of the people are like, "Man, these protein recommendations-"
- PAPeter Attia
Tell me what the app is again. I've seen it on Instagram.
- LNLayne Norton
Yeah, it's called Carbon Diet Coach.
- PAPeter Attia
Okay.
- LNLayne Norton
So basically, it's, it's for if people feel like they have a little bit more independence or, uh, they can't afford a one-on-one coach. So basically the app is a nutrition coaching app. If you put in your metrics, it will give you macros to follow, has a food tracker, and then every week you check in with the coach, which is an algorithm, and it will adjust your macros based on your progress. So we have like, we've had Thousands of awesome testimonials. So it's, it's pretty cool to see. But one of the big things we'll get, especially from, like, gen pop is, "How do I hit these protein recommendations?" And when I go in, most of their protein sources are really fatty cuts of meat, that's, that's one thing, and so I'll say, "Okay, one, pump up your portion size, but let's select leaner cuts of meat." Right?
- PAPeter Attia
Because you're not necessarily trying to increase their calories.
- LNLayne Norton
There you go.
- PAPeter Attia
You're trying to basically keep them almost isocaloric, but shift more to protein.
- LNLayne Norton
Absolutely. And, and sometimes even, like in her case, I wouldn't necessarily recommend it 'cause she's already kind of small, but if people do have a little bit of excess body fat, especially if they're new to training, they can recomp.
- PAPeter Attia
Mm-hmm.
- LNLayne Norton
They, they absol- absolutely can recomp, lose fat and gain muscle at the same time. And in that case, that might be a place where I would do it, just 'cause it sounds like she has a little bit more body fat than she probably should for her body weight.
- PAPeter Attia
That's right. She's probably by BMI, let's assume her height is such that by BMI she's totally fine. She's a BMI of 25. Um, but we, we would love to see her be at 22% body fat in two years-
- LNLayne Norton
Yep
- PAPeter Attia
... instead of 35% body fat, and we would, in two years I'd like to see her have, you know, 10 more pounds of muscle.
- LNLayne Norton
Yep. And that's pretty reasonable goals. Um, and so one of the things I would say is, "Okay, let's look at the portions of, if you are eating meat, let's look at the portions of meat you are eating."
- PAPeter Attia
And, and sorry, what's your, what's your protein target for her?
- LNLayne Norton
You know, a lot of it's gonna be, one, what can I get her to eat, right? Like, if I-
- PAPeter Attia
Mm-hmm
- LNLayne Norton
... I can throw-
- PAPeter Attia
But starting fr- starting from theoretically exceptional, and then-
- 2:08:53 – 2:18:39
Dispelling myths that excess protein intake increases cancer risk through elevations in mTOR and IGF
- LNLayne Norton
Now I wanna come back to your, your, what this person might say about mTOR and IGF-1. "I've heard these things are bad." You know, what, what, what, what would you say? And there's been a lot of... I, I know David Sinclair has, has brought a lot of stuff and, and saying, you know, I'm really trying to limit mTOR and IGF-1, and it will never cease to amaze me how many scientists do not understand the difference between a short-term, truncated, acute response to a stressor versus dysregulated signaling that persists indefinitely. And what I mean is when you look at mTOR elevations that, that lead to cancer and whatnot, those originate at m- what I would say mostly insulin resistance. So you're having elevations in insulin, you're having elevations in insulin signaling through AKT, which, which can then transmit to mTOR. And so it's like this chronic kind of low level pushing that button, right?
- PAPeter Attia
As opposed to a pulsatile-
- LNLayne Norton
That is a big difference-
- PAPeter Attia
Mm
- LNLayne Norton
... between a sh- a dose of protein that causes mTOR to rise, go back down in a natural rhythm, okay? Also tissue specific. We're talking about in skeletal muscle, not liver, not brain necessarily-
- PAPeter Attia
Mm-hmm
- LNLayne Norton
... those sorts of things. IGF-1, same deal. And what I will say is where are all the resistance-trained people that are getting cancer by the droves? Because if you wanna talk about amplitude of response from mTOR, resistance training dwarfs what protein does. If we look at the meta-analysis on cancer incidents amongst resistance trainers, and there's getting to be some now, we see lower levels of cancer in people who resistance train. So what that tells me is there's a difference between these two signals.
- PAPeter Attia
And I wanna point out something there because I think it would be very quick to say, "But Layne, there's a healthy user bias there," blah, blah, blah, blah, blah. I don't think what you're saying is that that proves that lifting makes you live longer. I think what you're actually saying is, no, it's the contrapositive. It demonstrates-
- LNLayne Norton
It disproves
- PAPeter Attia
... that lifting doesn't increase mTOR to the point of it being detrimental to your health. That can be asserted, I think, from that observation.
- LNLayne Norton
Or that it's tissue, also tissue specific. Um, that- that's part of it. Um, let's, let's, let's use, use a different example. So let's look at exercise in general. So if you were... Peter, if you got educated medical school but knew nothing about exercise-
- PAPeter Attia
Yeah, I'd love this to... Yeah, this is one of my favorite discussions
- LNLayne Norton
... you know where I'm going with this.
- PAPeter Attia
I, it, yeah
- LNLayne Norton
I, I t- and I told you, "I'm gonna do something that's gonna make you elevate your heart rate, elevate your inflammatory markers, elevate your reactive oxygen species, raise your blood pressure-"
- PAPeter Attia
Increase hepatic glucose output, output.
- LNLayne Norton
Yep.
- PAPeter Attia
Yeah.
- LNLayne Norton
What, what would you say to me about that?
- PAPeter Attia
Yeah, of course I'd say, "Yeah, this is, this can't be good for you."
- LNLayne Norton
Horrible. Don't do that.
- PAPeter Attia
Yeah.
- LNLayne Norton
And what is exercise? It does all those things.
- PAPeter Attia
Sure, yeah.
- LNLayne Norton
Right? So why is exercise good for us? Because that is a short-term stressor, I mean, we use the term hormesis if you want, um, that the body responds to and it actually acts kind of like a vaccine. I realize that's like a really triggering term for a lot of people right now.
- PAPeter Attia
[laughs]
- LNLayne Norton
But it's like, it's like a vaccine, right? It's a controlled dose of a stressor that your body can handle. And I kind of look at protein, this... I wouldn't say protein's a stressor necessarily, but again, it's this acute response versus a chronic hum, right? Your inflammatory markers, like people who deal with like elevated inflammation, it's not actually super high elevations, but it's just all the time. That chronic pulse on that, that is the problem. That is the issue. And again, you, you said it. They might say, "Well, there's healthy user bias there," and I would say, "Well, so what? Okay. Um, so you're saying that people who have high rates of IGF-1 and mTOR who are healthy... Okay, well, show me them getting higher incidents of cancer." You, you can't. [laughs]
- PAPeter Attia
Right.
- LNLayne Norton
You can't because all these things are tied together because people who have high levels of mTOR activation and IGF-1 typically have insulin resistance, they have poor dietary habits and poor lifestyle habits. So I would say that it, okay, that's a, a fair point. There, there's confounding variables, but all these things are tied up together. You can't really separate them. Um, and again, am I, am I saying that mTOR plays absolutely no role? No. But you know, you're ki- again, it can be cart before the horse sort of thing. Like, um, people say, "Well, rapamycin is an mTOR inhibitor and that's a cancer treatment drug." And I would say, "Yes, but do you think it's a good idea to take, do chemotherapy to prevent cancer? I don't think so. I, I don't think radiation is a good idea to prevent-"
- PAPeter Attia
Well, well, it's, it's not even really true because rapamycin is not really... I mean, it's never really been a particularly successful cancer therapeutic. It used constitutively, which is how it would be used. Uh, obviously I'm I think rapamycin does have significant longevity benefits in basically all models that aren't humans. So the extrapolation would be pulsatile rapamycin is probably beneficial, but it's ... In, in that application, it's not really being taken to constantly suppress mTOR, because remember, if you took it all the time, you're suppressing mTOR complex 2 and mTOR complex 1. So, um, yeah, no, I, I agree with that point actually completely, which is that tissue specificity and time course are very difficult things to, um, infer from the outside.
- 2:18:39 – 2:27:20
Hypothetical case study #2: Training program for a 50-year-old, trained male wanting to increase muscle mass
- LNLayne Norton
we saw.
- PAPeter Attia
So let's now talk about a different example of a person who comes to you. So now let's just use a male instead of a female, the last one, and let's talk about kind of a, a 40, 50-year-old male who's trained ... So they have a training background.
- LNLayne Norton
Mm-hmm.
- PAPeter Attia
Um, but, you know, they are also realizing what you said earlier, which is, "Hey, I'm gonna start losing muscle mass as a pr- at a pretty good clip once I'm in my 50s, and certainly by the time I'm 65, it really starts to nosedive." So the aha moment is, "I need to build up as much of a reservoir as possible." So this is a person who says, "Look, I've always been an athlete. I've always done X, Y, and Z, but I've never really thought about muscle mass. I want to start thinking about it now. Maybe I've got a decade to pack as much on as possible before I'll go into that just maintain it as long as I can mode." Okay, so this is a person who they're lifting weights three days a week, an hour at a time. They even do some ... You know, they squat, they deadlift. They do a whole body sort of ... They, let's say they do a whole body split every day for those three days. Um, and let's say their DEXA scan is 20% fat, so they're probably middle of the pack. Maybe they're pr- probably 20% fat would probably be 25th percentile actually for a 50-year-old. Um, and now they come to you and they say, "Layne, okay, I want to go all in. Like, I want to know, can I be 10% body fat?" So they're not trying to be a bodybuilder, but they, they want to be 10% body fat in two years and Uh, let's just assume that their BMI is 25 as well. No, let's say it's not. Let's actually say their BMI is 27, so they're technically a little bit overweight and they've got a little extra body fat. Um, how are you gonna change their training? How are you gonna prescribe nutrition?
- LNLayne Norton
Yeah, so [sighs] let me ask a question back.
- PAPeter Attia
Yeah.
- LNLayne Norton
Have, have they been training consistently up to this point?
- PAPeter Attia
Yeah, they've been training relatively consistently, but when you look at it, you realize they're not really in a progressive overload mindset, right?
- LNLayne Norton
Mm. Okay.
- PAPeter Attia
Like, they've, they've become a little comfortable in their training. Um, if you, if you, if you dig under, you know, you'll, you'll notice that they haven't really increased the weight in anything they're doing in five years.
- LNLayne Norton
The first thing is looking at the resistance training is, okay, just what you said. All right, you're doing three sets of 10 on everything.
- PAPeter Attia
That's right.
- LNLayne Norton
And you slap a plate on, or you slap two plates on, and you do the same thing you've been doing. Adaptation is never comfortable, so what you're trying to do to grow muscle, you're trying to induce adaptation. It... Hyper- muscular hypertrophy is an adaptation to a stressor placed on the body. In this case, the stressor is volume and mechanical load, right? So either you need to increase the weight, the repetitions, or the number of sets, and doing so is going to be uncomfortable. [chuckles] Your body is going to tell you it's uncomfortable. Um, and I- I've had this, even my own coach, who I... You know, is coaching me for, for nationals this year for power lifting. Uh, it's so funny. I was like, you know, starting to kind of have this linear effect coming back from these injuries I've had, and, uh, then one week, you know, I kind of had a dip in performance, and I also, um, also was feeling really beat up, and he just responded one line, said, "Adaptation is never comfortable." [laughs] And, uh, it's so true. It really is. And, and we talked about this sort of thing. So just, uh, mentally gearing this person up for the idea that, "Hey, you know, you've been comfortable. We're gonna go start doing some things that are uncomfortable." [lips smack] And whether it's, it's those particular exercises he's been doing, and it sounds like he's been doing big compound movements, so probably gonna keep him on that. Um, I would like to get, you know, video feedback to see what his form is like, especially with, you know, injury considerations as we age, uh, and pain. So getting some feedback on those, making sure that, you know, he is getting the requisite amount of load, progressive overload. And also at this age, and with trying to push now, it's also about knowing when do we build in some tapers so that he can actualize those gains and recover as well. Because here's the thing about adaptation at a certain point. If you've been training for long enough and you're old enough, the amount that you need to cause adaptation versus what is gonna cause you to overreach is gonna become closer and closer and closer, right? When you first start, when you first get into training, you need almost nothing to adapt, right? Like, you come in and do one set of leg extensions.
- PAPeter Attia
[laughs]
- LNLayne Norton
You will get an adaptation from that, right? If you do it consistently for several weeks. Been training five years, one set of leg extensions is gonna do absolutely nothing. It might maintain what you have. That's it. [lips smack] And so if you want to push adaptation, you have to push harder, which is gonna create more of a recovery deficit. And so while your recovery is going, your recovery, recovery capacity is gonna increase as you get older and have a greater training experience, it's not gonna increase as much as the amount of stress that you're gonna have to apply to adapt. So again, I think having built-in tapers is really important, and whether you do 'em responsively in terms of, okay, this, this person who's been getting, like, week to week, we've seen he's adding five pounds. And oh, this week we had a dip in performance. Now maybe we reactively do a taper. That's possible. Or whether you build them in systematically to try and get ahead of that curve, either way can work.
- PAPeter Attia
In, in the latter lane, what is the typical, uh, duration of a, of a build cycle, taper cycle?
- LNLayne Norton
It's probably gonna get progressively closer together the more advanced you get. So I'll, uh, I'll give you... My situation's kind of unique, so I'll get my, I get my kids week on and week off, and we have s- noticed that the weeks I get my kids, I get less sleep, I have a little more stress, and I'm, uh, my performance goes down a little bit, and we see that in... I also, I track bar velocity as well, so-
- PAPeter Attia
How do, how do you do that? What, what equipment do you use for that?
- LNLayne Norton
I use a device called Rep One, which is a, um, [lips smack] a accelerometer. Uh, it's available for purchase by private individuals. It's about $400, so it's, it's really... Honestly, it's nerd stuff [laughs] if you're really dialed in. But I like to use it because I, if I don't push the weight, I can try and look at the speed and see, you know, comparatively, okay, compared to last time, did I move the same weight faster or slower? And so when we look at my performance in terms of strength, RPE, um, speed, all those measures consistently show that on, typically on weeks that the kids are with me, I'm, I'm just not quite as good. I'm about 90% to 95% as good. So we've actually built in micro cycles of tapering.
- PAPeter Attia
So it's sort of a push week, a slightly back off week-
- LNLayne Norton
Bingo
- PAPeter Attia
... at, at one week at a time. Yeah.
- LNLayne Norton
Now, overall, through these micro cycles, we're trying to walk up the volume and the progressive overload.
- PAPeter Attia
Mm-hmm.
- LNLayne Norton
And then after, you know, probably four to eight weeks, we'll do a much bigger taper where we pull back on everything, but we do micro tapers in between. Now-
- PAPeter Attia
So for this guy-
- LNLayne Norton
For this guy-
- PAPeter Attia
If you... And, and-
- LNLayne Norton
... probably four to-
- PAPeter Attia
And yeah, and-
- 2:27:20 – 2:32:38
Maximizing hypertrophy while minimizing fatigue—is it necessary to train to muscular failure?
- LNLayne Norton
is disproportionate to the stimulus. So what we really-
- PAPeter Attia
Hmm
- LNLayne Norton
... wanna do is maximize hypertrophy while, and stimulus while minimizing fatigue. Because if you're... Yes, sure, you can get a similar, um, stimulus by going to failure, and maybe even just a little bit more, but if it then causes you to have performance decrements the following week or not be able to push as hard overall, we have to think about this as an overall training program and not just isolated workouts. And that's... I'm very purposeful when I tell people-
- PAPeter Attia
Hmm
- LNLayne Norton
... I go in to train, I don't go in to work out, right? Like, working out is just an isolated workout. [smacks lips] And I've had so many people with big egos who say, "Well, I couldn't possibly not train to failure." First of all, I've watched them, they're not actually training to failure. Like, I know what actual-
- PAPeter Attia
[laughs]
- LNLayne Norton
... muscular failure feels like on a squat. For example, a free bar squat. So people... [laughs] I've, I've, I've seen this on, uh, Dr. Mike Israetel's Instagram too, 'cause he talks about, uh, training shy of failure a lot as well. And people will say something like, "Oh, you train like a wuss. You know, this isn't that hard." And what I wanna say to them is, "I have done..." So probably one of my most impressive squat sets is I did 480 pounds for 14 reps, and I've done, uh, 405 pounds for 21 reps before. I couldn't move afterwards. It probably took me... First off, it probably took me five minutes just to get my breath back, just to breathe enough to, like, be a functional human after that. Then as far as, like, going to do another set, first off, when I hit that 480 and I grinded out that last rep, that 14th rep, I was so fatigued I couldn't rack the right side of the barbell. Because for whatever reason, I'm a little bit lopsided and it sits just a hair lower there. I could not fully lock out my glutes and lower back, and I couldn't rack it. And there was actually somebody had to run over from across the gym to help me rack it, even though normally it's no problem. And then I laid down for five minutes just trying to get my breath back. And then when I got up, if you told me I had to go squat 480 again, I c- I t- I'm telling you, I couldn't have gotten a single rep. Even after resting 10, 15 minutes. There's not a chance-
- PAPeter Attia
Hmm
- LNLayne Norton
... in hell. So this idea... So you're telling me if I'd stopped two reps shy of that, that that would've felt easy?
- PAPeter Attia
Or, or that it would've failed to produce-
- LNLayne Norton
Bingo
- PAPeter Attia
... the benefit, yeah.
- LNLayne Norton
And actually, with, uh, compound movements specifically, we, you don't have to get as close to failure to get the benefits with compound movements.
- PAPeter Attia
By the way, I feel so much better hearing this. Today, um, [smacks lips] uh, today was a deadlift day, and, uh, th- this cycle I'm doing trap bar, which I actually don't like very much. But I did sort of my trap bars, and then I was supposed to go to hip thrusters after, and I was not feeling great on it, in a really... It just didn't feel like it was gonna... So I was like, you know what? I really miss doing sumo deadlifts, so I went and did sumo deadlifts, and they felt great. But on the very last set I added a bunch more weight on, and at the sixth rep or eighth rep I was like, "I feel really good, but something tells me if I try to get to 10 today, I'm gonna push just a little too much." So I sort of bagged it at eight. And afterwards I was like, "I'm really proud of myself." Like, I didn't do something stupid. 'Cause today's one of those days. 'Cause, you know, to deadlift two different deadlifts on one day, and it's at the end of the workout, like, that's, those are the moments when you make mistakes.
- LNLayne Norton
Yeah.
- PAPeter Attia
Um, but, but I like knowing that... And that was probably truthfully, I think I probably had four reps in me left.
- LNLayne Norton
Yeah.
- PAPeter Attia
So that might have only been a six or a seven RPE. [smacks lips] Um, but you still get benefit.
- LNLayne Norton
Absolutely. And the research shows that... So what was popular a few years ago was kind of the effective reps hypothesis. I don't know if you've heard of this.
- PAPeter Attia
No. What, what's that?
- LNLayne Norton
So basically the idea is that the majority of the stimulus that you get that, for muscle growth-
- PAPeter Attia
Oh, yes, yes, yes
- LNLayne Norton
... is in the, the last five reps before failure.
- PAPeter Attia
Mm-hmm.
- LNLayne Norton
So whether you're doing 20 reps means you need to get to at least 15 reps to really get a similar stimulus.
- PAPeter Attia
Yep.
- LNLayne Norton
Um, and in terms of volume and progressive overload, you really need to think about volume in terms of just number of hard sets within, like, a five RPE. But the research shows that that's much more accurate for isolation stuff than it is for compound.
- PAPeter Attia
Hmm.
- LNLayne Norton
So compound lifts are kind of a, their own beast. You, you can train at a sub five RPE and still get, like, maximal, um, EMG recruitment and quite a bit of hypertrophy, [smacks lips] whereas with isolation you pretty much have to take it close to failure. And then the other thing I would say is that, you know, exercises are not equivalent, you know? That, that's a big thing [laughs] is like, all right, let's do a five RPE on a squat, and then a nine RPE on a, on a leg extension. I'll tell you, the nine RPE on leg extension, I can do that all day.
- PAPeter Attia
I, I'll take that all... I was just about to say, that is infinitely [laughs] less painful.
- 2:32:38 – 2:39:34
Ideal sets and reps for the hypothetical 50-year-old male interested in hypertrophy
- PAPeter Attia
Yeah, so tell me about sets and reps here. So, um, uh, again, let's pressum- let's assume he's much more interested in hypertrophy than strength, uh-
- LNLayne Norton
Yeah
- PAPeter Attia
... he's, he's not, he's, he's, he's not gonna power lift. Um, what's the rep range you're going to keep him in for compound movements and for isolated movements?
- LNLayne Norton
Variety is the spice of life, and, um, the research s-
- PAPeter Attia
Okay
- LNLayne Norton
... shows that from one rep to 30 reps, you can build very similar amounts of muscle.
- PAPeter Attia
So this is amazing, right? Because the conventional wisdom says, "Oh my God, if you're doing fewer than..." I don't know what the number is that they would say. "If you're doing fewer than six reps, there's no hypertrophy, it's all strength," right? That's what-
- LNLayne Norton
Right
- PAPeter Attia
... that's what conventional thinking would say.
- LNLayne Norton
And, and what I will say is there, you know, there are benefits to being in that hypertrophy rep range of, you know, 6 to 15 reps that's kinda like traditional. Um, so here, here's, here's the benefits and downsides. One of the nice things about the 6 to 15 reps is you can accumulate quite a bit of metabolic fatigue, you can use relatively heavy loads, and you can get quite a bit of volume in that rep range. If you're doing, uh, like, really heavy weights for low reps, say under five reps-
- PAPeter Attia
You functionally would have to double your number of sets just to get the volume, right?
- LNLayne Norton
Probably not because it's, it's more about the number of hard sets.
- PAPeter Attia
Okay.
- LNLayne Norton
But doing a hard set of five is not the same thing as doing a hard set of 10.
- PAPeter Attia
You have fewer of them in you presumably, right?
- LNLayne Norton
Probably.
- PAPeter Attia
Yeah.
- LNLayne Norton
There's probably a greater fatigue effect. But some people, again, like me, if you told me I couldn't train, you know, under five reps, I'd be like, "Ah, I'm, I'm just gonna be bored," you know? I [laughs] I don't like doing high reps. It's just, uh, I get bored.
- PAPeter Attia
Mm.
- LNLayne Norton
So for me, and the same thing with clients, a- again, adherence is number one, right? So if he says, "Oh, I'm not worried about creating strength, but I really like lifting heavy weights," okay, we're gonna find a way to incorporate that. But it might be where, hey, we're touching one set that's under five reps, and the rest are gonna be, you know, 6 to 10 on these compound exercises, and then on the isolation exercises, you know, we'll go 15, 20, um, you know, just for some variety and whatnot. But really, the research, at least in the short term, and when I say short term, I mean like 12 weeks, we don't see differences in hypertrophy, um, be- between anywhere from, you know, low reps to thir- up to 30 reps, uh, as long-
- PAPeter Attia
Right
- LNLayne Norton
... as the number of hard sets are equated. So really it says, "Do what you like. Do what you enjoy."
- PAPeter Attia
And what is that s- what is that sweet spot for hard sets if we just pick 10 reps, so then we can do the math and go up or down?
- LNLayne Norton
So the sweet spot is what maximizes per body part is probably about six to 10 sets in a session, okay? So they don't really, they don't really see incr- be- you know, improvements above 10 sets. Now, th- here's where th- [laughs] this gets a little bit complicated because, um, if you rest longer, each set actually becomes more effective as a stimulus for hypertrophy, presumably because you perform better and you can use more weight and do more reps on that individual set. So the number based on the meta-regressions out there, and I think James Krieger did a really good one, the number seems to be like if you're resting kind of like, you know, more than three minutes between sets, six sets. If you're resting like one to two minutes, it might be more like 10 sets.
- PAPeter Attia
Wow.
- LNLayne Norton
Um, but again, the other thing to re- keep in mind is you don't have to just jump to, like, 10 sets immediately, you know, per body part, you know, whatnot. That, that's a lot of sets. Um, y- you should probably use what is ever allowing you to adapt at the time. If you're somebody who is, you know, relatively new to training and you start doing 10 sets per body part, like, one, what's gonna happen once you plateau? That's a lot more sets you're gonna have to add on top of that. And two, you're probably gonna outpace your recovery capabilities, right? You, you, you... Like, when people tell me they're gonna do... I know you, you talked about covering, uh, squatting and deadlifting every day. Um, what I would say is you better be in a re- you better be in very good physical condition to do that. Um, and even then, there is a expiry date on that.
- PAPeter Attia
And, and I've talked to people who have done this. Uh, to be clear, I've never d- done this. I, I, I look at the people who have tried it in awe, but I, I just, I'm not willing to give up so many other things I do exercise-wise to just make sure I squat and deadlift every single day. But what I notice that they're doing is they're being very clever in that they're not... Every day is not a crushing set of that, right? I mean-
Episode duration: 3:17:32
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Transcript of episode R-Ltg1dl2jM
