228‒Improving body composition, female-specific training principles, & overcoming an eating disorder

1. 0:00 – 0:08

   Intro

   1. PAPeter Attia0:00

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

2. 0:08 – 3:07

   Holly’s background and passion for sports and nutrition

   1. PAPeter Attia0:08

      Holly, thanks so much for making time to sit down today. Look forward to talking about a lot of things. My wife has already peppered me with [laughs] 100 questions for you today.

   2. HBHolly Baxter0:16

      I'm really excited to be here. Thank you so much for having me on the show.

   3. PAPeter Attia0:20

      Um, so tell us a little bit about yourself. I know you grew up in Australia, and I know that you-- I think you ran track growing up.

   4. HBHolly Baxter0:26

      Yes, I did. So yeah, grew up in, uh, Tasmania, uh, Australia. So for those that may not be, uh, geographic a- aware of that where, where that is, uh, it's the little island that sits just south, um, of the mainland. So, um, it's a pretty small place, and I think part of the evolution of me now being where I am in Florida, um, was just having such a big open mind, and I, I didn't wanna stay there [laughs] . So, uh, I moved away, uh, to do college. So, uh, I moved over to Melbourne, uh, Deakin University, uh, where I did an undergraduate in nutrition science, uh, food science and nutrition, and then a master's in dietetics. So-

   5. PAPeter Attia1:05

      And w- how, how... I know Tasmania by land mass looks pretty big, but what's... Is it a tiny population?

   6. HBHolly Baxter1:10

      It's tiny. I think at the moment it's probably, like, 500,000. Um, where I grew up specifically, when I was living there, the population of Launceston, um, was about 90,000, so pretty small.

   7. PAPeter Attia1:21

      So in high school you ran track or in college?

   8. HBHolly Baxter1:23

      Uh, all the way through. So I started track, um, at about age eight, uh, and I went right through till age 18. So I finished, uh, by the time I got to, like, second or third year of university. Um, I guess at that point, that was when I could either go for a sporting career or choose academics. So, uh, I ended up choosing academics because unfortunately in Australia for females, there just isn't a whole lot of opportunity to, um, you know, have a successful career in sport. Uh, for males, it's a little bit different. We have Aussie rules football, which is incredibly popular and absolutely can make a killing. And I think perhaps now that social media has grown to, you know, to be where it is, maybe, um, some femal- females have an opportunity to, to have a good career in sport. But, uh, yeah, academics was kind of the only option really for me at that time.

   9. PAPeter Attia2:10

      Uh, what did you run in track?

   10. HBHolly Baxter2:12

       So I was a sprinter, 100 meters, long jump, triple jump, and if someone dare ask me to do a relay [laughs] or a 400, uh, I might do that. So lots of, you know, fast twitch, anything explosive and powerful and short.

   11. PAPeter Attia2:25

       And did you lift weights in high school? Was, was that your exposure to it?

   12. HBHolly Baxter2:29

       So not in high school. I actually only started lifting weights, um, probably in year 11. So we call that college, uh, at home.

   13. PAPeter Attia2:37

       Mm.

   14. HBHolly Baxter2:38

       Um, so grade 11 I started, um, or introduced, uh, lifting weights, and that was with-- uh, that was when I was part of the, uh, the Tasmanian Institute of Sport. So, uh, my coach at the time, uh, Peter Fortune, was also Olympic, uh, 400 meter runner, uh, Cathy Freeman. So she, um, won the gold medal at the 2000 Olympics, and everybody loved her. So, uh, I worked with him. Um, and, uh, yeah, that's where I kind of had a lot of my, um, I guess, experience in track

3. 3:07 – 19:49

   Holly’s struggle with depression and an eating disorder

   1. HBHolly Baxter3:07

      sprinting.

   2. PAPeter Attia3:07

      So why did you choose nutrition in college?

   3. HBHolly Baxter3:11

      Good question. So, uh, I think most people would probably say, "Oh, you know, I'm really passionate about sport and da, da, da, da, da," but, um, my reasoning, um, was probably not a good one. I, I got into the sport purely because of my, uh, I guess, desire for control of my nutrition. Uh, and it probably begs the question, you know, where, what's that all about? So I have only very recently overcome a 15-year-long, uh, eating disorder. Uh, I struggled with, um, anorexia for a short period of time, and that went on to become a binge eating disorder and bulimia. So, uh, before I even thought about going off to college, um, I was already in the depths, um, of that disorder. Um, I was also struggling a lot with depression. Um, at age 16, I had already attempted suicide twice, uh, and I was hospitalized for a good part of my year 11 schooling, which looking back at that now, like it's, it's really sad actually. And, uh, I just didn't have the supports. Um, I didn't have the, uh, mentors or people in my life that really, um, helped me to feel what I needed to feel and I think experience, uh, as a child. And it kind of escalated into my adulthood and really very recently have I only started to work on, uh, my mental health. Um, and I think that's where a lot of my advances have come, um, especially as it relates to, like, feeling like I have a sense of purpose in life, um, and really ultimately finding my happiness, so.

   4. PAPeter Attia4:43

      Um, so are you the-- You have one sibling?

   5. HBHolly Baxter4:46

      Yes.

   6. PAPeter Attia4:46

      Uh, older or younger?

   7. HBHolly Baxter4:47

      Younger sibling.

   8. PAPeter Attia4:48

      A, a sister?

   9. HBHolly Baxter4:49

      Yes.

   10. PAPeter Attia4:50

       So, um, when, when did the eating disorder start? And did that sort of, uh, uh, precede the, what you describe as depression, or do you think the two are kind of hand in hand and inter- intertwined?

   11. HBHolly Baxter5:02

       They, uh, ki- kind of came on simultaneously, I think, um, for multiple reasons. So, um, I don't wanna, you know, say n- negative things about my family or my parents or how they raised me because gosh, my mother was just an incredible woman. She basically raised us as a single mom. Uh, I did have a father in my life, but, uh, he was a very hard worker, uh, very disciplined and so career focused that, you know, we were kind of invisible to him. So my mom, uh, I think she'd grown up in an, a similar situation where her mother, um, was completely absent. She was a single mom. So I think her life experiences where she didn't have somebody that even cared about her or would take her to do anything, do sports, you know, she had to do it all herself. She'd catch the bus to after school training. She'd take herself, you know, to athletics on the weekends. So, um, my mother was a wonderful woman, but she, she did what she did based on her own personal experiences. So it probably wasn't the best thing looking back at it, but you know, we all have our flaws. But our relationship was really strained. Um, I think she wanted to control me, um, to protect me. I think, um, you know, in that kind of put a lot of friction between us, so I felt like I had no control in my life. Uh, I think up until, like, year 10 I wasn't even allowed to have, like, a sleepover at a friend's without there being, like, serious, like, arguments, and there was just a lot of hostility and confrontation growing up. So-

   12. PAPeter Attia6:29

       So y- year 10 is about 15?

   13. HBHolly Baxter6:31

       Yes.

   14. PAPeter Attia6:32

       And so g- give me a little bit more of an understanding of that. So was the focus before that age, was it sort of a h- heavy emphasis on your academics and on your sports, and that was it?

   15. HBHolly Baxter6:41

       Absolutely, yes. So we were doing, uh, dancing, like tap, jazz, ballet, uh, piano, music, guitar, like, drums. Um, then we were in basketball and, uh, athletics. So we did a lot of, um, you know, activities. Um, and I think the only kind of praise and recognition or, like, you felt like you were cared for or loved was when you excelled at something. So, you know, if I came home and I did really well in my grades at school, that was about the only time that I would get, you know, "Oh, wow, you know, we really love you," or, "Well done." Um, and I know my mom loves me. Like, it's, it's just how people communicate is so important. Um, so yeah, I really kind of grew up with this idea that unless I was the best at something or did everything and I excelled at everything, I didn't really have value as a human. So that's kind of one aspect, um, I think of where all that depression and the eating disorder started. Um, but sadly, I also, um, experienced some sexual trauma, uh, around that age, and I think that there were two instances, and it happened with people that I really respected, that I trusted. Um, and that coupled with this toxic, you know, home environment where you can't really even go to your parents because there's this, you know, uh, fear of being judged, you know, from the community. Um, you know, everything was about keeping up with appearances, so it wouldn't be, you know, "Are you okay? Talk to me. Let's, let's have a discussion about this." It was, "Well, what, what, what did you do to deserve that?" Or, "What were you wearing? How were you dressed? What, what kind of makeup did you have on?" Like, "You're asking for this," you know? So yeah, I-

   16. PAPeter Attia8:23

       So you didn't, you didn't disclose any of this to your parents?

   17. HBHolly Baxter8:26

       Uh, I spoke to my mother about it, um, but that was kind of the feedback that, that I got.

   18. PAPeter Attia8:31

       Mm-hmm.

   19. HBHolly Baxter8:32

       Um, she didn't know how to, to support me, and she did, granted, you know, try to look for therapy, um, at the time. But, uh, I think at that point I was so far down, like, the rabbit hole of depression, um, and just feeling like I was a lost cause that, like, it... nothing even, nothing worked. Certainly the behavioral therapy that I did, um, at that time was uneffective, and the medication that I had actually, um, made it worse, significantly worse, um, for a period, so I consequently came off that.

   20. PAPeter Attia9:02

       And so, um, help me understand a little bit more about how one, um, sort of... 'Cause I, I, I, I think that eating disorders are probably a lot more common than we are led to believe.

   21. HBHolly Baxter9:14

       Mm-hmm.

   22. PAPeter Attia9:15

       Um, I don't actually... This is not something I know a lot of the statistics about. We've actually been trying to find an expert on eating disorders for the podcast 'cause I think it is a very important topic. So I don't know if you are familiar with these statistics, but I'm not.

   23. HBHolly Baxter9:26

       Mm-hmm.

   24. PAPeter Attia9:27

       Uh, but do you have a sense of, of, um, how often they afflict young women versus young men?

   25. HBHolly Baxter9:32

       Mm-hmm. So the prevalence is a lot greater in females than men, but it's actually increasing over the last 10 years, uh, in young boys as well. Um, I hope I don't butcher the statistics. I did actually... There is a couple of studies that I'd like to reference, but I don't have them with me. Um, but I believe 60% of, um, high school students in the US, um, females have reported to struggle with, um, low confidence, uh, negative, um, sense of self and body image. Um, prevalence of eating disorders, uh, I, I guess it's a little bit lower, but I, I wouldn't know the exact statistics. But it is scarily high, and we can also then look into some of the, the younger studies in children, um, and it is higher than it should be, absolutely.

   26. PAPeter Attia10:16

       And so when you think back to how this started in you, I think you mentioned that it started first with anorexia-

   27. HBHolly Baxter10:21

       Mm-hmm

   28. PAPeter Attia10:21

       ... before binging and purging.

   29. HBHolly Baxter10:23

       Mm-hmm.

   30. PAPeter Attia10:24

       Um, did you gain a sense of control by limiting what you were eating? Did it, did it in the short term satisfy something that-
4. 19:49 – 30:23

   Reflecting on her eating disorder, body image, and a wake up call

   1. PAPeter Attia19:50

      I wanna kinda go back to still the understanding the eating disorder a little bit more. Um, did you, did your, um, self-image of your body seem [clears throat] sort of, um, inaccurate with what you now look back at as reality? In other words, does, does everyone with an eating disorder necessarily also have a skewed view of their body image, or can, can that be uncoupled and the eating disorder is simply a, a control tool that can be unrelated to, um, a, a misbelief, a, a misguided belief about body image? I don't know if that question makes sense.

   2. HBHolly Baxter20:24

      Yeah, like just dysfunctional thoughts. Yeah.

   3. PAPeter Attia20:25

      Yeah.

   4. HBHolly Baxter20:26

      So I think it really depends on the individual. Um, I don't... Uh, I couldn't recall all of the exact criteria, um, or like characteristics, behaviors that, um, you know, clinically define, um, anorexia or binge-eating disorder or the like, 'cause they are all slightly different in their own way. Um, but for me at least, I can say that initially it wasn't, um, my body image that I was concerned about.

   5. PAPeter Attia20:51

      Mm.

   6. HBHolly Baxter20:52

      It was control. Um, and I think that's kind of then developed into like obsessive compulsive for some things. It was like anytime I felt stressed, uh, anxious, drop in whatever emotion, um, as I grew, that, um, control, the desire to control came back. And I'd kind of crafted this little environment where when I lived on my own at school, uh, and then, um, post school, past- post masters when I went off and started my career, um, my environment was built in such a way that I basically shielded myself from stresses, potential like triggers, whether it was food, environmental, social, um, so that I could live in control, and that gave me comfort. So reality check, when you become an adult and you have to be flexible and nimble and pivot and, you know, learn to adapt under stress, which, my goodness, I feel like my life was extremely stressful for a lot of different reasons, but I just had no coping skills. [lip smacks] So I didn't-- it didn't start as a negative body image. It was simply, um, the desire for control. However, as I kind of found myself, you know, more and more involved in sport and as my physique did change, um, and as I started to connect the dots with my train-- uh, athletic performance with superior physique, low body fat, more muscle, uh, and then the praise that I would get externally from people, that then became the obsession. It was, you know, it's how I look, and that was where I found my self-worth. That was where I, uh, felt valued and appreciated and, you know, people respect me, and for a good part of my life, I think it became my identity. And it was impossible to break, and that just fueled the disorder.

   7. PAPeter Attia22:42

      Yeah. So I can only imagine. Which then leads to the inevitable question of how, how do you break that cycle?

   8. HBHolly Baxter22:48

      [laughs] Um, [lip smacks] oh, through a lot of hard work, and this is one of the practices, I guess, that I've incorporated only very recently into my own like nutrition coaching, um, and with our team as well, and that is really, um, working in collaboration with allied health, um, particularly mental health experts. So for me, until I actually, uh, started having regular therapy, and I'm not talking like once every six weeks for a review, which is kind of the expectation, I guess, in the clinical world. I know for me as a dietician, um, we would see our patients, um, you know, maybe you do a four, four, a four-week review or a six-week review. Um, so it was really infrequent, but that's kind of how I had been exposed to it with my parents when mom had gotten me into therapy.

   9. PAPeter Attia23:35

      When was that?

   10. HBHolly Baxter23:36

       That was when I was about 16, when I was still living in Tasmania.

   11. PAPeter Attia23:38

       So right after-- So after the suicide attempt-

   12. HBHolly Baxter23:39

       Yes. Yeah

   13. PAPeter Attia23:40

       ... they put you into kind of an infrequent therapy.

   14. HBHolly Baxter23:42

       Yeah. So I would have to travel to Hobart. I, I saw a specialist down there, um, who, you know, worked with f- females predominantly, any women's health issues, but eating disorders and, uh, nutrition. So, um, it was infrequent, but I remember loving those little trips because it was like the one time that I was like, "Oh, my mom cares. Wow, we get to go and stay in Hobart, and we get to go and spend time together, and she cares about me." And it was just... Like, it's a sick relationship to think like that was so exciting for me, but that was what was fuel. It was almost like that attention was good attention because I never felt like anyone cared like about me outside of like your credentials and that kind of thing.

   15. PAPeter Attia24:24

       Now- As you think about sort of the post-college life-

   16. HBHolly Baxter24:28

       Mm-hmm

   17. PAPeter Attia24:28

       ... um, did you think that you had things under control, or did you think that this is a dirty little secret that is totally out of control?

   18. HBHolly Baxter24:36

       I think it kind of came in waves. Um, and I think like any kind of condition, you know, it's a, it works along a spectrum. So I definitely had periods where I felt like, um, I was managing the symptoms, um, and the feelings, the emotions that kinda came along with that disorder, uh, okay. Um, but as soon as things got a little bit stressful or I had, you know, extra assignments due, or if I needed to, like from, from a financial perspective, you know, I need to do two full weekends of work back to back, and that's the only way that you're gonna be able to have groceries next week or put gas in your car, um, you know, when anything extra kind of came into my life, I just lost it. It was, um, like extreme, um, you know, binging, purging, secret eating, um, was really something that I struggled with. Um, you know, I would go out for dinner with friends, and I would try to, like, enjoy myself and, like, partake in the food. But because I would restrict so aggressively, um, you know, any time that I did get, uh, outside my four walls of, like, comfort foods and things that were on my list of, you know, these are okay to eat, um, I was terrified. No one would know it on the outside, but, like, I'd go out for dinner, and it was just this uncontrolled, like I- it was like I had no control to slow down my eating, so I ate so extremely fast. Um, and [laughs] so many of my friends as adults, like, have said to me, "Yeah, you really eat fast, but I've noticed a massive change, you know, over the last few years." This is certainly for the, like, longer term friends. But, you know, that habit stuck around, so I'd eat extremely quickly, and I would almost binge eat. And then I would usually order something else and take it home with the idea that I was going to have it, you know, tomorrow, um, and I'll, you know, portion it out appropriately. Um, but again, because of that extreme restrictive behavior, it just meant I'd go home and then binge eat more.

   19. PAPeter Attia26:32

       Hmm.

   20. HBHolly Baxter26:32

       And it was absolutely spiraled out of control. And I think, again, my stress response at that time, the only way I knew how to manage stress was to eat, and it completely, um, countered, like, the goals that I had for my sport and my training. So yeah, it was hard.

   21. PAPeter Attia26:49

       So h- how were you, um, able... Well, actually, there's... Let me start with a different question. What was the wake up call? What was the, um, event or set of events that led you to think, "I have to do something different", and it's-

   22. HBHolly Baxter27:04

       Yeah

   23. PAPeter Attia27:04

       ... sounds like, "I'm going to have to take therapy very seriously"?

   24. HBHolly Baxter27:06

       Yeah, absolutely. So it wasn't until I got to probably about age 25. At that point, I had moved from, um, state, so finished my schooling in, uh, Melbourne, moved to Gold Coast, where I opened my own business. So luckily I already had my business, uh, in Melbourne, but, you know, I basically was starting from scratch. So a new clinical practice, um, and then also, uh, working, I guess, 50% of my work week was also in-person training. Um, 'cause at that point I'd discovered, like, the love for resistance training, and I wanted to be able to incorporate those two things together.

   25. PAPeter Attia27:40

       Mm-hmm.

   26. HBHolly Baxter27:41

       So, um, uh, my business was going crazy, like busy, busy, busy, busy. Um, I'd just had some success in the bodybuilding space, and I got to the point where my anxiety was so high. And I, I'd, I didn't even know what anxiety was. Like, I'd never had... I didn't, wasn't able to identify or put a word with the feeling that I had. It just... Like, it, it sounds so silly to, to think about it now because of course it was anxiety. But, like, I couldn't even open my laptop, um, because I was so stressed at the amount of work that I knew I had to do. So I actually got to a point in business where I was experiencing some burnout, and I took myself to a therapist at that point. Um, so that kinda started it, and then I ended up having to, uh, admit myself to, like, a rehab. So I traveled to, back to Melbourne to, uh, a very well-known, like, rehabilitation therapy s- uh, location in, like, country Victoria. And it was, um, I guess incorporated, um, I guess counseling, uh, yoga practices, different relaxation, um, type techniques. And then, um, one of the owners, I guess, would kind of come and work through just different nutrition things with you, and it was-

   27. PAPeter Attia28:53

       And this was specifically for people with eating disorders?

   28. HBHolly Baxter28:55

       Yes. Yeah.

   29. PAPeter Attia28:56

       And how long did you commit to go to this place?

   30. HBHolly Baxter28:59

       So, uh, I, I was there for seven days. Um, so it was pretty short, uh, but it was very intense. Like, you had a schedule mapped out from the minute you woke up to the moment you went to bed, so-
5. 30:23 – 43:58

   Road to recovery: therapy, meditation, self-compassion, and a breakthrough

   1. PAPeter Attia30:23

      So how much of an impact did that seven-day, um, inpatient, uh, rehab, uh, have on you?

   2. HBHolly Baxter30:32

      Not as much as I would've hoped. Um, I think to think that any- anything, you know, that that's, that's that short in duration is going to cure you is, you're very foolish. But it opened my eyes to the benefits of, um, you know, relaxation, meditation, um, and the value of communication and being transparent and open. And that was not a behavior that I was good at. Um, for that 10-year period prior, I was very closed off, very reserved, didn't share very many things at all. I was very private. Um, so I think I saw the value in, you know, what it's like to kind of work through issues rather than suppress them. Um, and once I finally moved to America, uh, I got myself straight into weekly therapy. So I have had therapy sessions every week since 2016. I've probably missed, I don't know, maybe 20 weeks just through travel and business. So it, it got me on the right path.

   3. PAPeter Attia31:36

      And then what were sort of the breakthroughs that occurred with that type of much more consistent therapy?

   4. HBHolly Baxter31:42

      Mm-hmm. So I think number one, it made me accountable and it made me speak, made me talk, um, and helped me kind of reflect back on, you know, my past, which I'd, I'd never done. I had never given two thoughts about my upbringing. Um, I feel like now it's all I talk about and all I think about, but so much of what I experienced was bottled up in, you know, the past traumas and, uh, those, those different styles of communication. So I think gaining an appreciation and understanding for why I felt the way that I did was incredibly valuable. It was like, ah, I've now got some data. It m- at least it made sense to me. And then I, I think we started kind of discussing, you know, where are the dysfunctions in these beliefs? Let's start picking up these, um, you know, different sets of thoughts that you have, um, and let's deconstruct them, and how might these look different for a healthy mind? And through so much self-development, reading, also finding myself spiritually, which is another major part of this piece, uh, this story, um, it really helped me to understand that I was enough as a human, despite my, um, accolades and sporting accomplishments, and that, like, I'm loved and I don't need to keep proving myself to, you know, all the people in my life. And it was like this huge weight had lifted off my shoulders. And part of that was, um, one of our staff, um, invited me to go to church one day, and I'd only been to church once when I was young, uh, with a boyfriend whose family were, uh, Christian. So my experience with, like, religion was not negative. I'd say I grew up, like, um, agnostic. So I don't think my parents were anti, you know, religion, but they certainly didn't hold any beliefs of their own, and it was not something we discussed. So going to church, and this was a non-denominational church, very progressive, the pastor was just, like, incredible. And every message, every week I kept going back, um, and I was like, "Wow, this is so relatable." There's so many things out of the Bible that, like, it's just so good. It's, like, such good information. It was like, this is what I've been missing my whole life because I felt, felt for a long time that I didn't have purpose. And part of my decision to keep moving and traveling was to feel like s- what's missing? Maybe it'll be here, or maybe if I go to this country, you know, the people will be different and I'll resonate with them better. Um, but it was something in here that was missing. And yeah, going to church and reading, it just ... that was probably the one thing that changed my life. Um, and since then I have never been happier. Sorry.

   5. PAPeter Attia34:38

      So I, I think there's sort of two things that are interesting in this story that I think are, are important and illustrative for, for anybody struggling with anything.

   6. HBHolly Baxter34:47

      Mm-hmm.

   7. PAPeter Attia34:47

      And one is that the improvements didn't happen quickly-

   8. HBHolly Baxter34:51

      Mm-mm

   9. PAPeter Attia34:51

      ... and that it's kind of non-linear.

   10. HBHolly Baxter34:53

       Mm-hmm.

   11. PAPeter Attia34:54

       So, you know, you ... I, I, I'm actually struck by the fact that, uh, you know, you said, "Look, I did this seven-day intensive thing and it helped, but it didn't help as much as maybe I wanted it to."

   12. HBHolly Baxter35:03

       Mm-hmm.

   13. PAPeter Attia35:04

       Um, but I think the encouraging point is here, uh, you kept sort of at it, right?

   14. HBHolly Baxter35:09

       Mm-hmm.

   15. PAPeter Attia35:09

       You know, it, it was, you know ... It would be years before you would find yourself in daily or re-

   16. HBHolly Baxter35:14

       Mm-hmm

   17. PAPeter Attia35:14

       ... weekly therapy. Um, I guess the other thing is, uh, when I think of my, uh, addictions and struggles, I, I think like any addict, um, let's just pick alcohol 'cause it's an easy one for people to identify with externally.

   18. HBHolly Baxter35:31

       Mm-hmm.

   19. PAPeter Attia35:31

       You know, they say that an alcoholic is always an alcoholic. It's just a question of if you're in recovery or not. But if, if, if an alcoholic commits to no longer drinking-

   20. HBHolly Baxter35:39

       Mm-hmm

   21. PAPeter Attia35:40

       ... um, they still need to be mindful of their-

   22. HBHolly Baxter35:42

       Mm

   23. PAPeter Attia35:42

       ... behaviors and, and still need to be cognizant of the fact that they can slip back into drinking.

   24. HBHolly Baxter35:46

       Yes.

   25. PAPeter Attia35:47

       And that doesn't mean they can't be around people who are drinking, but they have to understand themselves and understand those limits.

   26. HBHolly Baxter35:52

       Mm-hmm.

   27. PAPeter Attia35:53

       Um, uh, that's certainly gonna be true for me for the rest of my life. I'm, I know what my addictions are-

   28. HBHolly Baxter35:58

       Mm-hmm

   29. PAPeter Attia35:58

       ... and I, and I, I know how they need to be managed.

   30. HBHolly Baxter36:01

       Yep.
6. 43:58 – 52:55

   The effect of competitive bodybuilding on women

   1. PAPeter Attia43:58

      Part of what is so interesting about your story makes it so hard to reconcile, which is, um, everything we just talked about, which then coexists with one of your passions, which is bodybuilding.

   2. HBHolly Baxter44:12

      [laughs]

   3. PAPeter Attia44:12

      Which, y- you know, seems to me to be the single activity that would most raise the risk-

   4. HBHolly Baxter44:22

      Mm-hmm

   5. PAPeter Attia44:22

      ... of the one thing you're trying to prevent, right? I mean, I guess if you were a jockey, uh, or a gymnast, that might be close on the list as well.

   6. HBHolly Baxter44:31

      Yeah.

   7. PAPeter Attia44:31

      But, but even those entities wear more clothing than a bikini, right?

   8. HBHolly Baxter44:36

      [laughs]

   9. PAPeter Attia44:36

      So, so you've, you've chosen to have this hobby outside of your job, but it's really related to your job, right?

   10. HBHolly Baxter44:43

       Mm-hmm.

   11. PAPeter Attia44:43

       I mean, it's, in many ways it's the pinnacle of exercise and nutrition-

   12. HBHolly Baxter44:49

       Mm-hmm

   13. PAPeter Attia44:49

       ... as it pertains to aesthetics. And you've also chosen to do it in the drug-free category, so you, you don't get to rely on any additional biochemistry. You have to do this just through training and nutrition. Um, there's an... I don't know if irony is the word, but, but-

   14. HBHolly Baxter45:09

       [laughs]

   15. PAPeter Attia45:09

       ... but there's something in there that's worth exploring, and I, I imagine this has come up repeatedly with your therapist.

   16. HBHolly Baxter45:15

       Absolutely. So yeah, it's, um, [smacks lips] it's been a really long journey, and there was a point just a few years ago where I really questioned my, uh, decisions to remain a coach and to be in the, you know, nutrition and, uh, exercise space, um, [smacks lips] because of the hypocrisy that I felt with, you know, what I was, you know, coaching on. So again, I think I can say that for the first 10 years of my practice, I had no desire to change my beliefs. I believed truly, um, from the bottom of my heart that in order for me to be successful in business, to, um, you know, support others the best that I, I possibly could, and to be taken seriously in an industry that is largely, you know, dominated by males, um, I needed to not only talk the talk but walk the walk.

   17. PAPeter Attia46:13

       Mm-hmm.

   18. HBHolly Baxter46:14

       So I never addressed that belief. I believed that I needed to be lean, so I never did anything about it. I felt uncomfortable that whole time, like the psychological stress that I had-

   19. PAPeter Attia46:24

       Can you, by the way, give me some examples on this? For... I mean, I don't... What body fat are you at when you're on stage?

   20. HBHolly Baxter46:31

       Um, it depends. So I compete in, or have competed in figure for IFBB, which is, um, a non-drug tested federation. Um, and I have since moved away from that. Um, but for those girls, you're probably looking at just on 10% body fat. They're extremely lean. Um, [smacks lips] and now the, the division that I compete in, which is the fitness category, and it's for a different federation, it's a slightly, um, smaller body, um, but still very, um, muscular and very lean. Um, I probably get down to about, you know, 10 or 11% body fat.

   21. PAPeter Attia47:08

       And just to make sure I understand, at 10 to 11% body fat, does your menstrual cycle still continue?

   22. HBHolly Baxter47:14

       So for majority of my competition history and competing life, yes, it would completely stop. Uh, in fact, for about five years, I did not have a period. Uh, and that was even with the return of, you know, calories back to a normal amount, even with the return of body fat, you know, back to-

   23. PAPeter Attia47:35

       Wow

   24. HBHolly Baxter47:35

       ... you know, normal healthy levels. Um, I think it was just the years of, uh, you know, binging and purging and-

   25. PAPeter Attia47:42

       I mean, think about just from an evolutionary standpoint what that's telling you.

   26. HBHolly Baxter47:45

       Mm-hmm.

   27. PAPeter Attia47:45

       That is telling you that, again, evolution has one purpose for you.

   28. HBHolly Baxter47:50

       Mm-hmm.

   29. PAPeter Attia47:50

       And it's saying-

   30. HBHolly Baxter47:51

       Procreate. [laughs]
7. 52:55 – 1:05:05

   Holly’s competition prep and how she guides her clients wanting to improve their physique

   1. HBHolly Baxter52:55

      space.

   2. PAPeter Attia52:56

      So I wanna just kinda walk through, let's say, your most recent contest. You just had a contest a couple of weeks ago, right?

   3. HBHolly Baxter53:02

      Mm-hmm. Yep.

   4. PAPeter Attia53:03

      Um, so I wanna walk through the training and the nutrition for the entire prep. So-

   5. HBHolly Baxter53:11

      Mm-hmm

   6. PAPeter Attia53:11

      ... let's just say six months leading up to the contest, so kind of a bulking, building phase-

   7. HBHolly Baxter53:16

      Mm-hmm

   8. PAPeter Attia53:16

      ... and then a cutting phase, and then a post phase or a recovery diet phase.

   9. HBHolly Baxter53:21

      Yep.

   10. PAPeter Attia53:21

       Um, and even though in your case the stakes are really high, it's a professional b- bodybuilding competition at the highest level, right? It's a world-

   11. HBHolly Baxter53:29

       Mm-hmm

   12. PAPeter Attia53:29

       ... federation. But for someone listening to this, it could be, like, their wedding.

   13. HBHolly Baxter53:34

       Mm-hmm.

   14. PAPeter Attia53:35

       Right? It's like-

   15. HBHolly Baxter53:36

       Yep

   16. PAPeter Attia53:36

       ... you know, a woman who wants to look her best at her wedding, um, and might acknowledge that, like, sh- it's going to not be the most sustainable she can be-

   17. HBHolly Baxter53:47

       Mm-hmm

   18. PAPeter Attia53:47

       ... but wants to do it in a way that's not harmful. So, um, g- let's go back as far as we need to, six months, nine months, a year.

   19. HBHolly Baxter53:57

       Yeah. What does that look like?

   20. PAPeter Attia53:58

       What... Yep. What is the training? How do you periodize it? What are the principles of nutrition?

   21. HBHolly Baxter54:03

       Mm-hmm.

   22. PAPeter Attia54:04

       Um, and, and everything. I wanna understand what the cutting phase looks like, and I wanna know what this, this... 'Cause my wife was telling me, 'cause you guys were talking about this, the, the recovery phase is also very important, how you come out of the competition without doing what would be natural-

   23. HBHolly Baxter54:18

       Mm-hmm

   24. PAPeter Attia54:18

       ... given that you're starving-

   25. HBHolly Baxter54:20

       [laughs]

   26. PAPeter Attia54:20

       ... is just to go, you know, go wild. So let's go back to the beginning. Uh, it's time to start adding muscle-

   27. HBHolly Baxter54:28

       Yep

   28. PAPeter Attia54:28

       ... and, uh, and bulking up.

   29. HBHolly Baxter54:31

       Yeah. So I think... Well, first and foremost, I'd say majority of the people that, you know, our team work with are just gen pop, you know?

   30. PAPeter Attia54:37

       Right.
8. 1:05:05 – 1:10:16

   Training principles for muscle hypertrophy

   1. PAPeter Attia1:05:05

      some of the people listening to this podcast, I'm guessing, will be more women than men, uh, won't be as familiar with RPE. Do you mind explaining to people what that is? 'Cause it's gonna be an important concept as we talk about resistance training.

   2. HBHolly Baxter1:05:16

      Yeah, absolutely. So RPE, uh, is or stands for a rate of perceived exertion, so it's a measure of training intensity, and training intensity is one of the principles that need to be, uh, increased over your, um, training lifespan in order to facilitate hypertrophy. So, uh, I guess I can reflect back on my early training days, and I didn't even have a training RPE. There was no training intensity. Um, you know, there's, I guess, another one that we can refer to which we use on our Workout Builder programs is the RIR, which is repetitions in reserve. So you're basically, uh, an IRR, RIR of three would mean that you've got three repetitions in reserve all the way up to an RIR of zero, you're hitting failure. So whatever weight or load you select for your lift, you are going to your drop [laughs] essentially. So my training when I first started lifting, um, incorrectly, um, was so low. Like, I never challenged myself, uh, and again, I know that we wanted to talk today about, uh, bodybuilding versus power lifting and how they may be beneficial for, you know, females. Um, I am so grateful for the time that I spent power lifting because that style of training, um, kind of threw me into understanding training intensity and what my true strength was. So there was a lot of carryover to, you know, how quickly I was able to, um, you know, select weights for my bodybuilding style of workouts, um, and that advanced me so quickly.

   3. PAPeter Attia1:06:51

      So just to make sure I understand, you're saying when you were younger-

   4. HBHolly Baxter1:06:54

      Mm-hmm

   5. PAPeter Attia1:06:55

      ... and you were doing fitness training and even training for track and field-

   6. HBHolly Baxter1:06:59

      Mm-hmm

   7. PAPeter Attia1:06:59

      ... you were never pushing yourself in the weight room.

   8. HBHolly Baxter1:07:01

      No.

   9. PAPeter Attia1:07:01

      Your R- your, your RPE was below five. Your RIR was above five.

   10. HBHolly Baxter1:07:05

       Yep, absolutely, yeah. We... and we were never even given a training intensity. It was just do three sets of 12.

   11. PAPeter Attia1:07:11

       Yeah.

   12. HBHolly Baxter1:07:11

       [laughs]

   13. PAPeter Attia1:07:11

       So right now when you say in these, in this building phase-

   14. HBHolly Baxter1:07:15

       Yes

   15. PAPeter Attia1:07:15

       When you say RPE eight-

   16. HBHolly Baxter1:07:17

       Yep

   17. PAPeter Attia1:07:17

       ... meaning you stopped and you had two in the tank.

   18. HBHolly Baxter1:07:20

       Mm-hmm.

   19. PAPeter Attia1:07:21

       Um, you could have potentially squeezed out two more.

   20. HBHolly Baxter1:07:23

       Yep.

   21. PAPeter Attia1:07:24

       And you said, so if you're doing RPE eight to nine-

   22. HBHolly Baxter1:07:26

       Mm-hmm

   23. PAPeter Attia1:07:26

       ... these are near failure sets-

   24. HBHolly Baxter1:07:28

       Mm-hmm

   25. PAPeter Attia1:07:28

       ... all the way through.

   26. HBHolly Baxter1:07:29

       Yep, absolutely.

   27. PAPeter Attia1:07:31

       Focus on, uh, how would you split those five days? Was it a leg day, a push/pull day? H- how-

   28. HBHolly Baxter1:07:38

       Mm-hmm

   29. PAPeter Attia1:07:39

       ... how are you splitting those days?

   30. HBHolly Baxter1:07:40

       Yeah, so look, I think, um, if we look at how I kind of set up a training program, there are so many ways that you can go about this. Um, and but they all do need to follow, you know, the principles of hypertrophy, and I guess number one is, you know, exercise specificity. We need to be ma- making sure that we're training in such a way or a modality that is going to have the desired outcome, so obviously building muscle and then choosing muscle groups that you want to build during that f- timeframe. So for me, that looked like, uh, glute, glute hypertrophy. Um, that's kind of the main area that most women, or at least those that I'm experienced in working with, uh, really wanna improve, um, because that has a lot of benefits for many things from normal day-to-day activities, bending down, squatting, um, through to, you know, improved strength across all sports, jumping, da, da, da, da, da, da. You know, there's so many benefits. So, um, glute hypertrophy took up a big part of my training volume. Um, shoulder hypertrophy was another one that I really, uh, focused a lot of my training volume on to kind of create the, um, you know, the capped shoulders and the illusion of a narrower r- waist. Um, [lips smack] so thinking back to that build, most of the training that I was doing was lower body, so I actually did four lower body sessions, believe it or not, per week and then one upper body session. [laughs] So it sounds crazy.
9. 1:10:16 – 1:13:15

   Training advice for an inexperienced person wanting to build muscle

   1. HBHolly Baxter1:10:16

      reduced. [laughs]

   2. PAPeter Attia1:10:16

      Okay, so what would it look like for a person who has some exercise background?

   3. HBHolly Baxter1:10:22

      Mm-hmm.

   4. PAPeter Attia1:10:22

      Like, they, they go to, you know, Orange Theory Fitness twice a week-

   5. HBHolly Baxter1:10:27

      Mm-hmm

   6. PAPeter Attia1:10:27

      ... and they, you know, they're, they're a relatively active person, but they don't have any power lifting experience-

   7. HBHolly Baxter1:10:33

      Mm-hmm

   8. PAPeter Attia1:10:33

      ... and they've, they don't know the difference between RPE nine and RPE five, right? So they're not, they're not there. How would you... But they still have this ambition of-

   9. HBHolly Baxter1:10:43

      Yep, of building

   10. PAPeter Attia1:10:43

       ... they wanna put on five pounds of muscle in the next year and lose three pounds of fat. Like, that's the physique goal.

   11. HBHolly Baxter1:10:51

       Yep. [lips smack] So first and foremost, I would say, like, again, if, if this is, like, literal, liter- literal, practical takeaways, I would say, number one, find somebody that's evidence-based [laughs] first and foremost. Ideally, uh, find somebody that can also, that's evidence-based, uh, be with you in a gym setting, they do one-on-one training, because there is so much value and knowledge to be learned just one-on-one, spending time with someone that's got more knowledge than you in that space. Um, developing optimal training techniques, m- developing the right movement pathways, and boy, I have seen some doozies. Um, you know, clients, uh, being trained in the gym by someone that has no idea how to squat or deadlift.

   12. PAPeter Attia1:11:29

       Right.

   13. HBHolly Baxter1:11:30

       So another little plus if you can find somebody that does power lifting or has done bodybuilding and power lifting, um, I think that is like the, a little golden egg. They, there's not a lot of these [laughs] people out there, but, um, incorporating that evidence-based approach with, um, experience with women and power lifting and bodybuilding, that's, like, the perfect ideal.

   14. PAPeter Attia1:11:53

       And experience with women w- because of what difference specifically? Is it anatomic differences in movements, or is it just the assumption that women are coming in with lower training volume?

   15. HBHolly Baxter1:12:07

       No, I think... Look, there's plenty of men out there that can do that as well, but I think you've gotta connect with the person that you're working with-

   16. PAPeter Attia1:12:14

       Mm

   17. HBHolly Baxter1:12:14

       ... and I think, now if you've got a male that's extremely experienced, um, you know, in all of those things, then of course a ma- a male can be great. But I think, um, having gone through different body image issues, having that understanding and appreciation for maybe body dysmorphia, uh, having an appreciation for the menstrual cycle, you know, I think men that are in the fitness industry, and I don't wanna generalize 'cause I know there's a lot of really intelligent guys out there, but there isn't a lot of work, like, just at the general personal trainer, um, and the amount of time that they spend, you know, learning about the reproductive system and how that can impact strength and, you know, subjec- subjective performance and, um, you know, the implications that that can have on your mood, your psychological state, and just the plethora of, like, what being a woman encompasses. I just think that women tend to do better with female trainers, but again, it's, it's harder to come by. [laughs] So that's what I mean by that.

10. 1:13:15 – 1:24:10

    Training program for a hypothetical woman wanting to add lean muscle and lose body fat

    1. PAPeter Attia1:13:15

       So what would you design for a client in that situation?

    2. HBHolly Baxter1:13:19

       Mm-hmm.

    3. PAPeter Attia1:13:19

       So-

    4. HBHolly Baxter1:13:20

       Yeah

    5. PAPeter Attia1:13:20

       ... l- and let's just make the... I'm just gonna make it e- even harder. This is a woman who wants to gain five pounds of muscle-

    6. HBHolly Baxter1:13:25

       Mm-hmm

    7. PAPeter Attia1:13:25

       ... and lose five pounds of fat in a year.

    8. HBHolly Baxter1:13:27

       Mm-hmm.

    9. PAPeter Attia1:13:27

       In other words, they wanna weigh-

    10. HBHolly Baxter1:13:29

        Mm-hmm

    11. PAPeter Attia1:13:29

        ... they're not, they're fine weighing the same-

    12. HBHolly Baxter1:13:31

        The same

    13. PAPeter Attia1:13:31

        ... amount next year-

    14. HBHolly Baxter1:13:32

        Yep

    15. PAPeter Attia1:13:33

        ... but the change in body composition is gonna be dramatic.

    16. HBHolly Baxter1:13:36

        Yeah, absolutely. Okay, so first and foremost I would be looking at, okay, what realistically can we gain in, you know, an eight-month timeframe? So-

    17. PAPeter Attia1:13:43

        Okay, 'cause that's the period of time you wanna build up.

    18. HBHolly Baxter1:13:45

        Yes, absolutely.

    19. PAPeter Attia1:13:46

        Okay.

    20. HBHolly Baxter1:13:46

        So first off, from a program design standpoint, um, we would want to start with a fairly low training volume if this is somebody that has not, um, you know, done a whole lot of resistance training. So we would start by selecting the muscle groups and the exercises that target the areas they wanna build, um, and we would progressively overload that, um, training. So it might start with, you know, one working set for every exercise in week one.

    21. PAPeter Attia1:14:13

        That little?

    22. HBHolly Baxter1:14:13

        Yep, that little.

    23. PAPeter Attia1:14:14

        Wow.

    24. HBHolly Baxter1:14:14

        So, uh, typically I would start with a program that is, like, 40 minutes maximum, 30 or 40 minutes maximum.

    25. PAPeter Attia1:14:20

        How many warmup sets to get to that working set typically?

    26. HBHolly Baxter1:14:22

        Probably one or two.

    27. PAPeter Attia1:14:23

        Okay.

    28. HBHolly Baxter1:14:24

        Um, and th- part of that would also be just helping with the demonstration of technique and kind of getting that movement pattern.

    29. PAPeter Attia1:14:29

        And what would be the RPE of the one working set?

    30. HBHolly Baxter1:14:31

        Starting off, like, an RPE six or seven-
11. 1:24:10 – 1:36:32

    Lower body lifts: Holly’s approach to leg workouts with clients

    1. HBHolly Baxter1:24:10

       Mm-hmm.

    2. PAPeter Attia1:24:10

       Um, w- what about, uh... Where do, where do split squatting and lunging fit in-

    3. HBHolly Baxter1:24:14

       Mm-hmm

    4. PAPeter Attia1:24:14

       ... fit in?

    5. HBHolly Baxter1:24:15

       Yeah. So typically I will, uh, incorporate, you know, at max, you know, two c- large compound multi-joint, uh, exercises. Typically, they are, like, the first, you know, six to eight sets are your best sets. They are, like, working sets. And then what we tend to see is that any volume that's accrued, you know, after those eight first working sets tend to... You start to have, like, diminishing returns. So big movers first, isolation accessory exercises second. So again, the way that I would structure in something like lunges or leg extensions or hamstring curls or calf raises, it depends on what that person is wanting to build, truly. That's, that's all it is. So again, if we look at the, um, I guess minimum, uh, dose for, uh, hypertrophy, when we look at, like, total set number, we wanna be shooting for somewhere around, you know, probably the 10 to 15 range per muscle group. Um, there are a lot of-

    6. PAPeter Attia1:25:09

       When you say per muscle group, you're counting quads-

    7. HBHolly Baxter1:25:12

       Mm-hmm

    8. PAPeter Attia1:25:12

       ... distinct from hamstrings-

    9. HBHolly Baxter1:25:14

       Mm-hmm

    10. PAPeter Attia1:25:14

        ... distinct from glutes-

    11. HBHolly Baxter1:25:15

        Yes

    12. PAPeter Attia1:25:15

        ... distinct from calves.

    13. HBHolly Baxter1:25:16

        The trouble is, and I guess a lot of people have a difficulty, um, you know, trying to write their own program, is that certain movements is-

    14. PAPeter Attia1:25:22

        Are hitting multiple

    15. HBHolly Baxter1:25:23

        ... both.

    16. PAPeter Attia1:25:23

        Yeah.

    17. HBHolly Baxter1:25:24

        So I will often just give a s- you know, yep, that counts as this exercise and that muscle group-

    18. PAPeter Attia1:25:29

        Yeah. So, so a, a dead-

    19. HBHolly Baxter1:25:29

        ... and it counts as that

    20. PAPeter Attia1:25:30

        ... a deadlift is gonna Triple everything

    21. HBHolly Baxter1:25:33

        Mm-hmm

    22. PAPeter Attia1:25:33

        It's hitting everything

    23. HBHolly Baxter1:25:34

        Yep

    24. PAPeter Attia1:25:34

        But when you do the leg extension, it only counts for quads

    25. HBHolly Baxter1:25:36

        Isolate your glutes. Yep

    26. PAPeter Attia1:25:37

        Leg curl only counts for hamstring.

    27. HBHolly Baxter1:25:39

        Exactly.

    28. PAPeter Attia1:25:40

        Okay, so you're gonna s- you're saying we want, by the end of this workout, we wanna have 10 to 15 boxes checked for each of those muscle groups.

    29. HBHolly Baxter1:25:47

        Mm-hmm. Yep.

    30. PAPeter Attia1:25:48

        So let's just go through some of them. So your, your favorites for glutes, obviously a squat and a deadlift.
12. 1:36:32 – 1:47:03

    Upper body exercises: Holly’s approach with her clients

    1. PAPeter Attia1:36:32

       On their upper body day, how do you focus? Now, I know you... I mean, I'm still surprised to hear that you're not doing a lot of upper body for-

    2. HBHolly Baxter1:36:38

       [laughs]

    3. PAPeter Attia1:36:38

       ... for a woman, and what you're saying is the most important thing is taking the fat off to-

    4. HBHolly Baxter1:36:43

       Mm-hmm

    5. PAPeter Attia1:36:43

       ... let the muscles show.

    6. HBHolly Baxter1:36:44

       Yeah.

    7. PAPeter Attia1:36:45

       Um, but in that one day, what are they-

    8. HBHolly Baxter1:36:48

       Mm-hmm

    9. PAPeter Attia1:36:49

       ... going to do for, for chest, for back-

    10. HBHolly Baxter1:36:51

        Yeah

    11. PAPeter Attia1:36:51

        ... for shoulders and arms?

    12. HBHolly Baxter1:36:53

        Yeah, so I think one of the main things, again, that does differ between men and women's training programs is chest volume. So men typically wanna have jacked biceps, jacked triceps, big chest. Um, there's less of an emphasis on that. So the-

    13. PAPeter Attia1:37:05

        So the women in, even in the fitness categories seem to be judged a lot on glutes-

    14. HBHolly Baxter1:37:11

        Mm-hmm

    15. PAPeter Attia1:37:11

        ... hams-

    16. HBHolly Baxter1:37:12

        Mm-hmm. Shoulders

    17. PAPeter Attia1:37:13

        ... shoulders, quads.

    18. HBHolly Baxter1:37:15

        Back is so... Like, it's, it's less important.

    19. PAPeter Attia1:37:17

        Okay.

    20. HBHolly Baxter1:37:17

        They wanna see a conditioned back-

    21. PAPeter Attia1:37:19

        Yeah

    22. HBHolly Baxter1:37:19

        ... but it's not really where a lot of the judging and time is spent, unlike, you know, traditional bodybuilders where, like [laughs] you look at your Kai Greens where he's just got lat on lat on lat.

    23. PAPeter Attia1:37:29

        Yeah.

    24. HBHolly Baxter1:37:29

        So- I will incorporate, um, I guess different back exercises, um, more predominantly in a program than I would for chest. I defer back to the client, "Do you want to do chest training?" I love bench press. Like again, I've done power lifting, so to me, like that's so empowering, like trying to hit a one-rep max on a bench. I love that, but I'm not everybody. So again, I defer to person, the person that I'm working with.

    25. PAPeter Attia1:37:54

        And let's assume that she has no interest-

    26. HBHolly Baxter1:37:57

        Mm-hmm

    27. PAPeter Attia1:37:57

        ... in her strength on a bench.

    28. HBHolly Baxter1:37:58

        Mm-hmm.

    29. PAPeter Attia1:37:59

        It's really coming down to how she's gonna look in the dress.

    30. HBHolly Baxter1:38:01

        Aesthetic. Some people really need, um, you know, a lot of chest training, or conversely, they need a lot of back training due to their posture.
13. 1:47:03 – 1:54:20

    Importance of nutrition and protein during the muscle building phase

    1. PAPeter Attia1:47:04

       Okay. So let's say we've progressed the intensity of all of this, uh, which means we've, we've overloaded.

    2. HBHolly Baxter1:47:10

       Mm-hmm.

    3. PAPeter Attia1:47:10

       So we've added sets, we've added reps-

    4. HBHolly Baxter1:47:13

       Mm-hmm

    5. PAPeter Attia1:47:13

       ... we've added intensity.

    6. HBHolly Baxter1:47:15

       Mm-hmm.

    7. PAPeter Attia1:47:15

       We're eight months in.

    8. HBHolly Baxter1:47:16

       Mm-hmm.

    9. PAPeter Attia1:47:17

       W- and let's assume we've hit our hypertrophy goals.

    10. HBHolly Baxter1:47:20

        Mm-hmm.

    11. PAPeter Attia1:47:21

        Uh, you do another DEXA, and remember, the initial goal was gain five pounds-

    12. HBHolly Baxter1:47:25

        Five pounds. Mm-hmm

    13. PAPeter Attia1:47:25

        ... of muscle, lose five pounds of fat. If she has met her hypertrophy goal-

    14. HBHolly Baxter1:47:30

        Mm-hmm

    15. PAPeter Attia1:47:30

        ... and gained five pounds of muscle-

    16. HBHolly Baxter1:47:32

        Mm-hmm

    17. PAPeter Attia1:47:32

        ... how much fat do you think has changed at that point?

    18. HBHolly Baxter1:47:35

        Um-

    19. PAPeter Attia1:47:35

        Do you think she's up, neutral?

    20. HBHolly Baxter1:47:38

        Absolutely, uh, it depends on their dietary intake, to be honest.

    21. PAPeter Attia1:47:42

        Yeah.

    22. HBHolly Baxter1:47:42

        So, um, I think we can go through a, you know, a period of progressive overload with an intentional building phase, um, and do all the right things when it comes to the resistance training, but the other key piece to the success of that build is diet. So how much was the client able to adhere to their dietary requirements during that time, um, you know, is probably like 50% of the, the outcomes. So I think-

    23. PAPeter Attia1:48:11

        So going back to the beginning-

    24. HBHolly Baxter1:48:12

        Mm-hmm

    25. PAPeter Attia1:48:12

        ... if, um... I'm gonna just create a stereotype, which is she was sort of reasonable in total energy intake, but protein deficient-

    26. HBHolly Baxter1:48:22

        Mm-hmm

    27. PAPeter Attia1:48:23

        ... relative to your goals. So what would be your protein goals for her?

    28. HBHolly Baxter1:48:26

        Yeah. So it's, uh, honestly exactly the same as it is, um, males to females. Um, the only difference is going to be the absolute total target that we have for a female because our body, lean body mass is a little bit lower. So the required, um, or the, uh, the protein reference ranges to optimize, um, hypertrophy are anywhere from, say, 1.8 grams of protein per kilogram of lean body mass, uh, all the way up to 3 grams of protein per kilogram of lean body mass. So, um, based on the individual's dietary preferences, um, and what foods they like, some people love protein. I've had clients that can't stand it-

    29. PAPeter Attia1:49:04

        [laughs]

    30. HBHolly Baxter1:49:05

        ... uh, and it's a real struggle with them to... which blows my mind, 'cause I would probably live on meat if I had to pick one food group [laughs] that I'd have to survive on m- for the rest of time. But, um, I would pick something that is realistic for them within that range. So, you know, for some-
14. 1:54:20 – 2:04:54

    Changes to nutrition and training during a fat loss phase

    1. PAPeter Attia1:54:21

       Okay, so now it's eight months in.

    2. HBHolly Baxter1:54:23

       Yep.

    3. PAPeter Attia1:54:23

       We're two-thirds of the way to our goal. She's on target for lean mass. She's also, of course, added a little bit of fat mass. [clears throat] You now have four months to get that fat off and keep the lean tissue on.

    4. HBHolly Baxter1:54:37

       Mm-hmm.

    5. PAPeter Attia1:54:37

       What changes in nutrition, and then what changes in the gym?

    6. HBHolly Baxter1:54:41

       Yeah. So changes in the gym initially are negligible. I think there's a mis- uh, misconception that suddenly everything changes when you start dieting. The goal for dieting is truly to be able to keep you on as higher calories as possible with as little increase in activity as possible whilst still achieving a targeted rate of weekly weight loss. So to begin with, their training may stay exactly the same. It might make... We might make a couple of tweaks because they're bored and they need s-

    7. PAPeter Attia1:55:12

       Mm-hmm

    8. HBHolly Baxter1:55:12

       ... need a change up, but the concept, the principles of that training program and the structure does not change, unless suddenly they decided that they no longer want those giant glutes and we put back in, you know, chest training. But, you know, the principles stay the same. From a diet perspective, um, that is again, we kind of look at, okay, now that we've acquired a little bit of body fat, uh, we wanna get all of that off, you know, in time for this, um, pros- this, the wedding ... or whatever the event is, um, I basically do a back calculation. Um, so... And I, I pick a targeted weekly rate of weight loss that does not exceed more than 1.5% of their body weight. So-

    9. PAPeter Attia1:55:52

       Per what unit? Week?

    10. HBHolly Baxter1:55:54

        Per week.

    11. PAPeter Attia1:55:54

        Okay.

    12. HBHolly Baxter1:55:55

        Yeah. If we... If... Again, if you look at the-

    13. PAPeter Attia1:55:57

        That still sounds like a lot potentially

    14. HBHolly Baxter1:55:58

        ... It is, it is. It can be a lot, and some people may not have the phy-

    15. PAPeter Attia1:56:01

        That could be two pounds a week.

    16. HBHolly Baxter1:56:02

        Yeah.

    17. PAPeter Attia1:56:03

        That's huge.

    18. HBHolly Baxter1:56:03

        Again, but it would be relative to the individual.

    19. PAPeter Attia1:56:06

        Okay.

    20. HBHolly Baxter1:56:06

        So, you know, 200-pound male, that's a lot, [laughs] um, but for a-

    21. PAPeter Attia1:56:09

        But even this 140-pound woman, I mean, that's-

    22. HBHolly Baxter1:56:11

        Yeah, 1.4 pounds.

    23. PAPeter Attia1:56:12

        Yeah.

    24. HBHolly Baxter1:56:12

        That's 1%, so we're looking at close to two pounds. So, um, again, we've gotta be realistic with how much can be achieved in a seven-day period for that person. So, um, choosing that percentage rate of loss is important. Why it's important is because we... when we see extreme dietary interventions carried out, um, continuous diet, uh, interventions that push weight loss beyond those numbers, we are increasing the risk of metabolic adaptation, so now we're starting to look at, um, you know, more, um, I guess adaptive mechanisms, a greater, uh, n- response to, um, dieting, or our self-defense system really, you know, ramps up. Um, we become far more efficient. So we wanna keep the rate at that, at that level, and that will help to keep your BMR, your basal metabolic rate, nice and high, and it's protective of your muscle mass. Beyond that 1.5%, that's when we really start to see people actually losing a greater percent of muscle ba- muscle mass, uh, and lean tissues as opposed to fat loss. So, you know, I, I think a lot of people will argue with me in the first few weeks when we, you know, put together a program for them, and they're like, "That just doesn't seem like enough weight loss. I'm used to seeing, you know, two kilos a week." And I'd say to you, "So if you're worried about the number on the scale, if that's all you're worried about, what if I said to you that that two kilos you lost not a single bit of fat, it was mostly lean tissue? Is that still okay?" And they're like, "Oh, okay."

    25. PAPeter Attia1:57:41

        Hmm.

    26. HBHolly Baxter1:57:42

        So, you know, we've gotta be realistic with what you can do in a week and how it might impact muscle loss, [lips smack] um, and then determining what calorie deficit that actually requires. So, um, we have a really wonderful, uh, I guess calculation in one of our books, uh, The Complete Contest Prep Guide, and I believe it's also in Fat Loss Forever. Um, [lips smack] and that outlines what amount of calories is required to lose a certain amount of body weight in grams. So it's a really neat little equation, um, and we can calculate very accurately for the average person that doesn't have crazy... you know, a really fast metabolism or really slow metabolism, what the deficit is that they need to lose that 1.5% or whatever number it might be. So it's, it's really neat. I can pretty much forecast exactly what someone would lose.

    27. PAPeter Attia1:58:32

        And how, how does a person do this practically? So there's... on the one hand, there's, there's the calculation-

    28. HBHolly Baxter1:58:37

        Mm-hmm

    29. PAPeter Attia1:58:37

        ... which let's just say it comes out and says, "Okay, [clears throat] we're gonna reduce your intake from what was 2,400 now down to-"

    30. HBHolly Baxter1:58:43

        Mm-hmm.
15. 2:04:54 – 2:08:53

    A “reverse diet” after a cutting phase to help prevent weight gain

    1. HBHolly Baxter2:04:54

       So if you can slowly reintroduce your calories post-diet, um, and unfortunately, that means that that whole process still feels like the diet. And I can say, like, as somebody that has, you know, just a few weeks ago finished my competition, I didn't get as lean, so the hunger response was not as severe as it's been in the past, but it's still there. It is really hard to continue to regulate when the goal is now out of sight, or at least the, the goal that you were getting close to is leaving. Because doing a reverse diet, there you're not getting that positive visual response. This is intrinsic, and you can't see your metabolism improving. The only data or evidence that you have when you're reversing is seeing the small little increases in calories. Like, "Oh, cool, I get to eat 100 more calories this week. Whew." You know? So it takes a good number of weeks to be able to get your calories back up to a point where it's like, "Oh, it's me- it's made a meaningful difference to my life." You know? "I can have, you know, a couple of glasses of wine now with, you know, my friends," and, "Oh, I've been able to incorporate my dessert again." So it's a really difficult, um, process, and a lot of people-

    2. PAPeter Attia2:06:11

       And how many weeks does that last?

    3. HBHolly Baxter2:06:13

       It depends. And again, it, um... for a lot of folks, you're trying to get them... Initially, rule number one for setting a reverse diet after you've finished being in a deficit is just finding your new maintenance calories. Um, and you can assess that by looking at how much weight you have lost over, you know, the weeks, the, the final couple of weeks in your, um, fat loss phase. So we can go back and predict what tho- they are for our clients.

    4. PAPeter Attia2:06:39

       So for this woman, technically, if her maintenance was 2,000 coming in-

    5. HBHolly Baxter2:06:43

       It's probably gonna be a lot lower

    6. PAPeter Attia2:06:44

       ... it's probably gonna be... Oh, I was gonna say a little bit higher because even though her weight is the same-

    7. HBHolly Baxter2:06:48

       Mm-hmm

    8. PAPeter Attia2:06:48

       ... she has more muscle.

    9. HBHolly Baxter2:06:50

       She may have more muscle mass, but it depends how lean she wants to get because-

    10. PAPeter Attia2:06:54

        Oh, yeah, yeah. But this is saying, um... You're, you're saying if she wants to continue to get leaner.

    11. HBHolly Baxter2:06:58

        Mm-hmm.

    12. PAPeter Attia2:06:59

        Not... I'm saying if she's happy to stay at that 140-

    13. HBHolly Baxter2:07:02

        Mm-hmm

    14. PAPeter Attia2:07:02

        ... for another six months before she-

    15. HBHolly Baxter2:07:05

        Mm-hmm

    16. PAPeter Attia2:07:05

        ... begins her next cycle-

    17. HBHolly Baxter2:07:06

        Yep

    18. PAPeter Attia2:07:06

        ... she might actually come in at 2,100 or 2,200 calories before you then say, "Okay, now the time is. We're gonna take off another-

    19. HBHolly Baxter2:07:13

        Yeah

    20. PAPeter Attia2:07:14

        ... five pounds of fat."

    21. HBHolly Baxter2:07:14

        So I, I completely understand what you're saying. However, the problem is even if she has added five pounds of muscle mass, which we know, um, in theory, you know, muscle is very energetically demanding tissue-

    22. PAPeter Attia2:07:26

        Yep

    23. HBHolly Baxter2:07:26

        ... it requires more calories, so you would expect there to be a, an, a shift, a positive shift in their BMR. Yes. When she did that at the end of the build, yes. But that fat loss phase that someone did to get the weight back down, again, depending how long it took, how extreme we had to go, um, and how- ... uh, equipped they were to execute the deficit we needed, and what I mean by that is, did we need to do a whole lot more cardio to create the deficit?

    24. PAPeter Attia2:07:54

        Mm-hmm.

    25. HBHolly Baxter2:07:55

        What was the intensity of that cardio like? She could have lost some of that muscle-

    26. PAPeter Attia2:07:59

        Yeah, yeah

    27. HBHolly Baxter2:07:59

        ... during the fat loss phase, and evidently you will lose muscle anyway. Like, it's... You will always lose muscle mass when you attempt a fat loss phase. Um, but how... The leaner you get, the greater the risk of that muscle loss is, because you no longer have that caloric cushioning to, um, support that. So, um, her metabolism, even when we go back to her new maintenance calories, after she's added more muscle, so physically she's gonna look better, she still may st- be lower [laughs] at the start of that reverse diet, which is really interesting to think. So there may be some work that's needed to be done reversing just to get her back to maybe that 2,000 calories that she was on. She may not be able to go straight back to that.

    28. PAPeter Attia2:08:40

        Yeah.

    29. HBHolly Baxter2:08:41

        It takes weeks. So the way that you do that is slow and incremental increases week by week, um, and you observe the w- the weight gain, and then you adjust respond accordingly.

16. 2:08:53 – 2:23:34

    Female-specific training considerations: programming, reps, volume, sex hormones, and more

    1. PAPeter Attia2:08:53

       So I guess before we wrap, um, are there any other specific differences in sort of male and female training that we could shed light on?

    2. HBHolly Baxter2:09:03

       Yeah, so I think, you know, outside, like the specificity of like putting together an actual program and targeting certain muscles, muscle groups rather, um, people may have actually heard, um, somewhere along their fitness journey that women tend to do better with higher rep ranges and males do better with, uh, lower rep ranges. And traditionally I think there's a, there's a reason why we tend to see that, that style of programming, um, you know, more prominent, you know, in the gym scene. And part of that is due to, I guess, some of the differences in sex hormones, um, and that kind of has an impact on our muscle fiber type. So females actually have a greater percentage of type one muscle fibers than do males. Um, and the positive consequence of that, um, difference there for females is that it means that we're better able to transport nutrients, uh, into the tissues and also clear, um, different metabolites, um, you know, during activity. So the benefit there is that women tend to be less fatigueable, um, when it comes to training. And, uh, another thing that kind of coincides really nicely with that is that women, um, again, in e- both the fed and the fasted state, tend to do better at utilizing, um, fatty acids. So again, it means that we're less reliant upon some of those glycolytic, um, you know, pathways or anaerobic processes. So, um, we do better, um, in as... when it comes to f- recovery from, um, different types of training. So when it comes to building out that training program, again, I'm being pretty meticulous here, but men I would often opt for a little bit more strength-specific training. Um, and I guess if you look at the definitions of strength training, it's the rep range is between one to six. Um, then you've got your moderate rep ranges, or we call that the hypertrophy rep range. Um, I'll have more of that with females and then the endu-

    3. PAPeter Attia2:11:08

       Which is about 8 to 12.

    4. HBHolly Baxter2:11:09

       8 to 12, 8 to 15, and then we've got our endurance strength training, which is, you know, your 15 to 20 reps. So some, like women will, um, say that they, uh, enjoy that type of training and they're able to tolerate it better, um, more so than some of the strength based training. But I would, I would still argue that females when you're, you know, put in the right hands with a good qualified coach, um, that they could equally enjoy that style of training too. But again, that's thinking about like the actual differences, you know, that muscle fiber type and part of that's due to, I believe it's estrogen, um, you know, women having a higher level of estrogen. We've got more estrogen receptors, I believe, on our skeletal tissues, and that's one of the benefits, um, for, you know, the nutrient transport, so...

    5. PAPeter Attia2:11:54

       How... That's interesting. Wouldn't that also suggest that women would have an easier time training without ingestion of glucose?

    6. HBHolly Baxter2:12:03

       Mm-hmm.

    7. PAPeter Attia2:12:03

       Right? Um, at least in theory.

    8. HBHolly Baxter2:12:07

       Mm-hmm.

    9. PAPeter Attia2:12:08

       And yet I feel like, maybe it's just looking at my wife-

    10. HBHolly Baxter2:12:10

        [laughs]

    11. PAPeter Attia2:12:10

        ... she does not like to train on an empty stomach.

    12. HBHolly Baxter2:12:13

        Mm-hmm.

    13. PAPeter Attia2:12:14

        She, she needs something to... You know, she needs to be drinking or eating something beforehand.

    14. HBHolly Baxter2:12:19

        Yeah, I think that-

    15. PAPeter Attia2:12:19

        But I think you mentioned you like to train on an empty stomach.

    16. HBHolly Baxter2:12:22

        I'm the opposite. So a- again, I think it's really subjective. Um, we can... The science can always say certain things, but we've also then got to take into the, into account I think the individual's, you know, perception and often it's, you know... It is very subjective. So for me, as somebody that has struggled with like irritable bowel syndrome for, you know, the last 10 years of life, I can't think of anything worse than trying to s- train with anything in my stomach.

    17. PAPeter Attia2:12:48

        Right.

    18. HBHolly Baxter2:12:48

        I might have a couple of coffees in the morning, um, but I'm keeping, you know, pretty low gut irritant type foods because the minute I feel some kind of, you know, distension or, you know, pain in my stomach, I cannot train. I would rather train hungry with a rumbling stomach than try to have to execute with a full stomach [laughs] . So, but again, endurance training, very different to, you know, more anaerobic training.

    19. PAPeter Attia2:13:13

        Yeah.

    20. HBHolly Baxter2:13:13

        Like the resistance training that I do is probably more, um, you know, anaerobic. So it might be just due to the differences in, um, you know, exercise type.

    21. PAPeter Attia2:13:23

        Any other differences that we should be aware of as far as female and male, uh, either through respond to nutr- nu- response to nutrient or load?

    22. HBHolly Baxter2:13:32

        I think, again, with sp- speaking to sex hormones, I think the menstrual cycle's probably the only other thing that kinda springs to mind, and, um, there's been a lot more, um, information becoming available on, um, that topic as it relates to, um, hypertrophy outcomes and strength training. And again, there's probably four studies, um, that are, you know, high quality at the moment that I can think of that, um, again, tend to be kind of on the fence. Um, half of them show that, um, you know, during the second phase, the luteal phase of your menstrual cycle, um, when progesterone is high and, uh, proj- uh, estrogen is low, that subjectively, uh, strength decreases-

    23. PAPeter Attia2:14:15

        Mm

    24. HBHolly Baxter2:14:15

        ... for females during training. Um, [lips smack] and then during the earlier parts of training when progesterone's low, um, you know, people report to feel, uh, a lot better with their training, their performance is better, their strength is improved. But again, it's like it's a 50/50 for clients.

    25. PAPeter Attia2:14:32

        Wow.

    26. HBHolly Baxter2:14:33

        So when it comes to female programming, [lips smack] I, as a default, and if it's ... it doesn't seem to impact them, that's great, but I will default to setting deloads, um, on or around their menstrual cycle.

    27. PAPeter Attia2:14:46

        So you might go two weeks on, two weeks... Like, you could upload two weeks, download two weeks.

    28. HBHolly Baxter2:14:51

        Mm-hmm, yep.

    29. PAPeter Attia2:14:52

        Wow.

    30. HBHolly Baxter2:14:52

        Yeah, it might be in the middle of a mesocycle, but again, it, it depends on how serious they are about their progression. But my default-
17. 2:23:34 – 2:26:19

    Holly’s future in bodybuilding and helping struggling women

    1. PAPeter Attia2:23:34

       Where, where do you think this, this goes from here for you? Do you plan to continue bodybuilding?

    2. HBHolly Baxter2:23:41

       I don't know. I think that part of me feels really compelled to stay in the industry and keep, keep showing up maybe on a yearly basis to be an advocate for the people that are still suffering in silence. I think that there's so many people that have difficulties, you know, sharing their struggles, um, you know, reaching out for help, gaining, getting support. And I've seen a massive shift in the type of work that I'm doing and the education that I'm sharing now because, um, it's a really hard life to live, and it's ... It can be very unrewarding. It can feel like, what's the point if, if you can't keep, you know, making progress and ... or if you never really, if you never really work on the psychological dysfunction that might be happening. Like what's the why? So I feel a little bit conflicted coming back and staying because I don't have the same f- uh, I guess the same feeling towards competing anymore. I don't ... I no longer desire the leanness. I really don't. I don't ha- I, I can do the process now, and I was really worried about my last competition because I thought, "Now that I don't have this eating disorder, am I gonna have what it takes to execute?" Like or was that previously just driven by a psychological condition? So that was ... It was nerve-wracking, but I was able to do it. But I'm, I'm no longer attached to the body. So I want to be somebody that can be an advocate to help people realize that if you do the work, you can do these together. They don't, they don't exist, you know, exclusive of each other. I think you can do a bodybuilding show and not have some kind of eating disorder but also recognize that it's, it's an extreme sport. [laughs] It's an extreme sport, and it requires a lot of sacrifice. And personally right now, I'm so passionate about mental health and the idea of potentially stepping back from everything that I do in the fitness industry and going back and doing a PhD in the area of neuropsychology or mental health and eating disorders, that, um- It may not be something that I have in my foreseeable future. I, I just don't know. But I wanna, I wanna help people. I know that there is so many women that would benefit from learning that, hey, I struggled with all of these feelings and, you know, low self-confidence and low self-esteem, um, and that there's another way aside from calorie restriction and dietary restriction that can lead me to the same positive, you know, outcomes and value as a human

18. 2:26:19 – 2:32:06

    Looking forward: Holly’s focus on longevity, bone mineral density, and wellness

    1. PAPeter Attia2:26:20

       So how do you think about aging yourself? I mean, how do you think about being 50, being 60-

    2. HBHolly Baxter2:26:28

       [laughs]

    3. PAPeter Attia2:26:29

       ... not looking like you do today-

    4. HBHolly Baxter2:26:31

       Yeah

    5. PAPeter Attia2:26:31

       ... given the, the journey you've been on and the struggle you've been through and how closely those have been intertwined?

    6. HBHolly Baxter2:26:38

       Mm. My approach is all about longevity. I think, um, if you had of asked me that two years ago, I would still be, "I'm still gonna look amazing." [laughs] But I think my perception or my ideals about what my life should be, um, in order to truly, you know, be happy, um, it doesn't look like me slaving away in the gym anymore, and it doesn't look like me being a, a lifelong competitor. That doesn't mean that I wanna let myself go and-

    7. PAPeter Attia2:27:06

       Yeah

    8. HBHolly Baxter2:27:06

       ... you know, not have any interest in exercise at all. But I think I would like to remain, and I hate using this word, like functionally fit. But I want my body to be able to move. Like, I wanna be able to... If someone says to me, "Hey, let's go for a 5K run," like I wanna be able to do that. If I, you know, need to be fast and agile for something. So I think my training is probably going to gravitate a little bit more away from the gym, um, and incorporate just some more hobbies and things that keep me active and functioning well. Um, but I will always lift because I know the benefits, um, that resistance training can have on your body.

    9. PAPeter Attia2:27:41

       But you're okay with the changes that are going to come, which is, you know, you're not gonna be 12% body fat.

    10. HBHolly Baxter2:27:48

        Yeah, absolutely.

    11. PAPeter Attia2:27:49

        Yeah.

    12. HBHolly Baxter2:27:49

        I- and I think even in like six weeks I will no longer even look like I do now. Like, I'm very content with the idea that, um, I can still be healthy at a much higher body fat percentage. Um, and as long as I have the muscle mass underneath that body fat, I know that that is protective in so many ways. You know, I'm thinking about, you know, reducing my risk of like bone degenerative conditions like osteoporosis when I get old.

    13. PAPeter Attia2:28:13

        Right

    14. HBHolly Baxter2:28:13

        Like resistance training, anything that applies, you know, tension and stress on the bone, you know, those little bone creating cells, you know, they ramp up and now I've got greater bone density. Like I think about that. My dad s- struggles severely with osteoporosis and arthritis.

    15. PAPeter Attia2:28:29

        Your dad?

    16. HBHolly Baxter2:28:30

        Yeah, very much so. He's, he needs a double shoulder re- construction and he won't do it. [laughs] But-

    17. PAPeter Attia2:28:36

        Yeah, I, I... You know, I think that's, that's kind of the message we, we give to our patients, both men and women.

    18. HBHolly Baxter2:28:41

        Mm-hmm.

    19. PAPeter Attia2:28:41

        But I think it's more important for women to hear-

    20. HBHolly Baxter2:28:42

        Mm-hmm

    21. PAPeter Attia2:28:42

        ... because I think, um, sometimes women are a little bit more governed by the scale-

    22. HBHolly Baxter2:28:48

        Mm-hmm

    23. PAPeter Attia2:28:48

        ... than by what's, what's underneath.

    24. HBHolly Baxter2:28:49

        Mm-hmm.

    25. PAPeter Attia2:28:49

        And again, that's a stereotype, but-

    26. HBHolly Baxter2:28:51

        It is

    27. PAPeter Attia2:28:51

        ... I see it more-

    28. HBHolly Baxter2:28:51

        But, but it's real

    29. PAPeter Attia2:28:52

        Yeah.

    30. HBHolly Baxter2:28:52

        It's real.

Episode duration: 2:32:06