Peter Attia MD235‒Training principles for mass & strength, changing views on nutrition, & creatine supplementation
EVERY SPOKEN WORD
150 min read · 30,013 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 – 12:34
The sport of powerlifting and Layne’s approach during competitions
- PAPeter Attia
Well, Layne, we're back for another round of this, but this time we finally get to do it in person.
- LNLayne Norton
Yeah. I'm, I'm looking forward to this. This will be a ... I said it'd be a little bit different.
- PAPeter Attia
So let's talk about your training, 'cause right now you are training for, uh, the Worlds in powerlifting.
- LNLayne Norton
Mm-hmm.
- PAPeter Attia
We had a great chance to kind of catch up on some of your training yesterday. I probably won't get into as much detail as you and I got into last night, 'cause-
- LNLayne Norton
Yeah
- PAPeter Attia
... that might be more detail than the average n- non-nerd is interested in. Um, but maybe just briefly kind of explain the sport of powerlifting, uh, uh, you know, there are three lifts, how it works. Uh, and then I wanna talk about kind of how you're training for that and, and some of the challenges of that.
- LNLayne Norton
Yeah. So powerlifting is a very basic sport. Like you mentioned, there's three lifts, the squat, the bench press, the deadlift, and they go in that order. Uh, you get three attempts on each, and, uh, they're progressive. So for example, once you put in an attempt ... Like, let's say you put in a squat attempt of 550 pounds for your opener. If you miss it, you can't go down. So usually the way people do it is, you know, first attempt is a pretty conservative weight, kind of like a last warm-up. Second attempt is getting close to something that's, you know, pretty reasonable, like, you know, RPE 9, 9 1/2, and then your last one you're hoping to get kind of your true maximum. [lips smack] Um, and it's, I mean, basically highest total wins. Um-
- PAPeter Attia
Between the three different lifts.
- LNLayne Norton
Correct. So, um, at Worlds they will give medals for individual lifts. So, um, there'll be a gold, silver, and bronze for squat, gold, silver, bronze for bench press, and gold, silver, bronze for deadlift, and then there'll be those medals also for the overall. And the overall is just the summation of the total of the number of lifts you hit. So- [sighs]
- PAPeter Attia
And when you do your three squat, three bench, three dead, are you doing them in that order, or are you going-
- LNLayne Norton
Yeah.
- PAPeter Attia
Yeah.
- LNLayne Norton
Yeah. So it's you do all three squats go, then all three bench press, then all three deadlift.
- PAPeter Attia
Typically how much time in between each attempt?
- LNLayne Norton
Yeah, so it just ... It, it can really depend. Uh, the last time I did Worlds in 2015, uh, that was a very, very fast meet. So in our flight there was only 11 people. So meaning, you know, you have, uh ... The person who has the lightest squat will go first up to the heaviest squat, and then those will continue to cycle through. Uh, same thing for bench press, same thing for deadlift. And the whole meet took over just, just over two hours. But I've been in meets that have taken as long as three and a half. So it really just depends on your flight, how quickly the spotters and the-
- PAPeter Attia
But if I'm, but if I'm doing the math, I mean, that means you might only have 15 minutes between lifts?
- LNLayne Norton
Uh, usually you'll get about at least 30.
- PAPeter Attia
Okay.
- LNLayne Norton
Because the way they run it is there's, there's no real breaks for people who are spectating, so they'll have two flights going at the same time.
- PAPeter Attia
Ah, I see. Okay.
- LNLayne Norton
So what'll happen is, uh, they'll have an A flight and a B flight typically. Sometimes they'll have C flights as well if they're re- if it's a really, really packed meet like nationals. Um, but at Worlds it's usually just an A and a B flight, and they just separate those based on opening squats. And usually the, the, the B flight will have the, the top lifters in it. [lips smack] Um, so you have some time. So you're ... While the other folks are lifting, you're typically warming up, getting ready, and then once, for example, um, the squats are finished, A flight will start for bench, and then if you're in B flight you can have time to warm up.
- PAPeter Attia
So what are you doing between? So let's just say between lift one and two, um, lift one shouldn't have been that stressful if you did it correctly.
- LNLayne Norton
Mm-hmm.
- PAPeter Attia
Is ... Does your ... Does what you eat matter much? Does how you re- Are you getting any tissue work? Like, what, what do you need to do? Let's just say you have 30 minutes between those attempts. What do you need to do to maximize your odds?
- LNLayne Norton
So usually between the lifts themselves, like between squat and bench press, we'll have 30 to 60 minutes, depending on how quickly things are going.
- PAPeter Attia
But what about between the squat attempts, like between the first-
- LNLayne Norton
Yeah, so-
- PAPeter Attia
... second and second and third?
- LNLayne Norton
... between the actual attempts themselves, I mean, I'll take a drink of water. I, I might, like, throw some candy in or something like that really quickly if I feel like I need it, but for the most part I'm just mentally trying to get myself in the right zone. And it is a little bit tricky, because you can't keep yourself at that really high level of arousal the entire time, 'cause you'll just wear out really quickly. Um, so for me the trick is bringing that arousal down for about, you know, five minutes or so, so that I can just relax just enough and then start to focus back up, and it's almost like, um, it's like a wave. You're kind of letting yourself come down, and then when the time is right ... And really timing is a big thing in this, because once the bar is loaded and they call, "Bar is loaded," you'll have one minute to get the down command for squat or-
- 12:34 – 23:55
Training for strength: advice for beginners and non-powerlifters
- PAPeter Attia
um, what can the rest of us who aren't powerlifters learn just about strength? Because if I wanted to frame this for a listener, 'cause people have heard me talk about this, but the two metrics that are most significantly associated with longevity, uh, so if we were to stack up every possible known risk factor, uh, smoking, type 2 diabetes, high blood pressure, coronary artery disease, end-stage kidney disease, whatever, and we were to talk about how much of a hazard ratio do these bring to you in terms of all-cause mortality, they're, they're quite big. You know? It, it... hypertension is about a 20%, uh, type 2 diabetes is about a 30% increase in mortality. Smoking is about 50%, uh, increase. Being weak relative to being strong is about 250%. Having a very low VO2 max in the bottom 25% of the population versus being in the top two and a half percent of the population is about 400%.
- LNLayne Norton
Wow.
- PAPeter Attia
So when you line everything up, the two things that stand out the most are incredible cardiorespiratory fitness as measured by VO2 max, and strength, and then a third is muscle mass. But I think when you look at the data, you realize muscle mass is so coupled to strength that that association is tight. [lip smack] The point being is if you're listening to this podcast and, uh, thus far into this podcast, your eyes are sort of glazing over as we're sitting here talking about powerlifting, it's probably worth pointing out that even if you never once care to do a heavy squat or a heavy bench press or a heavy deadlift, you have to be strong. And in these studies where these associations continue to show up over and over and over again, you know, they're using things like grip strength, bench press, leg extension, things that are a little less technical.
- LNLayne Norton
Mm-hmm.
- PAPeter Attia
But the point remains, anybody who's going to a power meet and crushing a deadlift has pretty strong grip strength.
- LNLayne Norton
Right.
- PAPeter Attia
So, um, [lip smack] I think it becomes important for people to understand how to train for power. Uh, and so, so let's now talk a little bit about that, right? So if, if a person comes to you and says, "I want to get stronger, uh, and that's my primary objective in the weight room," it's more so than the aesthetic, [lip smack] uh, 'cause we're gonna talk about that later.
- LNLayne Norton
Mm-hmm.
- PAPeter Attia
What are some of the principles they need to keep in mind?
- LNLayne Norton
So what's interesting is the principles are pretty much the same, it's just the, the level to which they're applied, right? And I think it's important to point out that, you know, there, there are diminishing returns with strength in term- uh, well, I'm sure there are. I don't think the studies are refined enough to pick this out at this point, 'cause it's not like they're getting a population of powerlifters-
- PAPeter Attia
Right. That's right. Yeah
- LNLayne Norton
... and looking at their longevity. Um, so but my guess is that at a certain point, you pretty much get all the benefits, and just getting even stronger is probably not gonna give you more.
- PAPeter Attia
Especially if it comes at the risk of injury that can-
- LNLayne Norton
Sure
- PAPeter Attia
... later on in life. Yeah.
- LNLayne Norton
Sure. And then I think, like you also see with like running, there's kinda like a J-shaped curve. Part of me thinks that just the people that take it so far, whether it be powerlifting, running, whatever, that it's not that their sport makes them more prone to more, to early mortality, but more so that they probably have other behaviors of being an extremist that probably contribute to that.
- PAPeter Attia
Hmm. Yeah, interesting.
- LNLayne Norton
Um, but as far as strength goes, I mean, really what we're talking about is progressive overload. I mean, that, that is the most important core principle, and, uh, it actually really applies to a lot of things in life, to be quite honest. But when it comes to lifting weights, a lot of people hear progressive overload, and they just think weight on the bar, and that is the most simple way to explain it, right? So if you come in, you've never done some sort of squat movement before, [lip smack] and you do 95 pounds, uh, for five reps, and then the next week you come in, you do 100, and the next week you come in and do, you do 100, 105.
- PAPeter Attia
At the same number of reps.
- LNLayne Norton
At the same number of reps.
- PAPeter Attia
Yeah.
- LNLayne Norton
Right. You know, that is a form of progressive overload, and most people, when they enter the gym, that's kinda their experience. They don't need to increase set number. They don't need to really... They can increase the reps, but for the most part, when you first start going to the gym, you're just gonna be able to put more weight on the bar pretty much every week, and that is a perfectly reasonable way to progress. And I mean, even, you know, I know we haven't gotten here yet, but people will say, "Well, you know, I'm post-menopausal woman," or, "I'm a 75-year-old male," like, "It's too late for me." No, it's not. It, [chuckles] now is the best time. Um, in fact, when I was at, uh, University of Illinois, where I was in an d- department of nutritional sciences, right across the street in the exercise physiology department, they were conducting a study on, um, frail elderly.
- PAPeter Attia
Hmm.
- LNLayne Norton
So people who basically almost couldn't, couldn't really walk. Like, they could, but it was very tough for them. Uh, and they just started progressively overloading them, and that looked like basically squatting to a really high chair to start, right? And what they saw was incredible. In like 12 weeks, they actually had people who could squat down to like a below parallel chair and come back up, which may not sound like much for the average person, but when you're talking about somebody who's, you know, frail elderly, the difference in functionality and their lifestyle is gonna be incredible in terms of what they can do. So what I'll tell people is What you can learn from powerlifters is that progressive overload, one, in terms of weight on the bar, but nobody's able to increase weight on the bar forever. That, that's just, it's not gonna happen, and the, the longer you get into it, the more nonlinear it's gonna be. It's gonna be, you're gonna go down and come up, and go down and come back up. Um, but there's also other ways to progressively overload, uh, one being more repetitions, um, and the other being adding more hard sets. So the latter, adding more hard sets, is really something you only need to get to as you get to be more advanced because, like I said, you're, you're not gonna be able to add strength forever, and you're not gonna be able to add reps forev- ever either. So-
- PAPeter Attia
By the way, this is one thing that from one of our earlier discussions that really started to change my training. I started, um, adding a little bit more set at slightly lower RPE-
- LNLayne Norton
Mm-hmm
- PAPeter Attia
... to net increase volume.
- LNLayne Norton
Mm.
- PAPeter Attia
So I was, I think, doing a lot more RPE eight, nine stuff, but you can only get a few sets at that level. Like, you're really, really spent. And instead I was saying, "Well, wait a minute. Why don't we do a little more RPE six and seven and add more sets, more volume?" Um, one, I feel like it's lowering my risk of injury, uh, and two, as you said, it's really just another way to progressively overload.
- LNLayne Norton
Yeah, and you're always weighing those two things, kind of your stimulus versus fatigue ratio.
- 23:55 – 29:40
Low-rep training, compound movements, and more tips for the average person
- PAPeter Attia
So for a person who, again, is not planning to go to a power meet, um, is there a need for them to go below four reps in training?
- LNLayne Norton
I would say prob-
- PAPeter Attia
That's an arbitrary number, but you know what I'm getting at.
- LNLayne Norton
Yeah. I would say probably not. I mean, you can get plenty strong, uh, even doing, you know, sets of 10, those sorts of things.
- PAPeter Attia
Oh, that's interesting. I wouldn't ... Uh, so, so that ... I would have thought you needed to get at least into the fives and sixes sometimes, but
- LNLayne Norton
So you can get really strong doing sets of 10, 15, those sorts of things. Now, you will not be as strong even per cross-sectional area as somebody who trains for strength, because strength is a specific skill. And even, like, myself, um, you know, my best squat ever is, uh, 668, and when I was, you know, six months out from that, it's not like I, uh, you know, I added weight to the bar that I was able to squat, but it's not like I added that much more lean body mass, because I didn't. Uh, I was practicing the skill of a one-rep max, which allowed me to better do the one-rep max.
- PAPeter Attia
And you were practicing at what percent of ultimately became 661?
- LNLayne Norton
Usually around 90, 95, um, but not very much at 95. Mostly at 90 for, like, singles.
- PAPeter Attia
And what was your RPE when you did those singles?
- LNLayne Norton
So usually a- about-
- PAPeter Attia
Eight?
- LNLayne Norton
... eight and a half or nine. Yeah.
- PAPeter Attia
Okay.
- LNLayne Norton
So it's-
- PAPeter Attia
And so you would do multiple of that... Just doing-
- LNLayne Norton
Yes
- PAPeter Attia
... the math, let's just say that's 620 or something like that or-
- LNLayne Norton
Yes
- PAPeter Attia
... yeah. So let's say it's... call it 600 pounds. So you would do a 600-pound single three times in a workout.
- LNLayne Norton
Something like that.
- PAPeter Attia
Okay.
- LNLayne Norton
Yeah. And what you're, what you're kind of making gains on at that point is just your... One, it just teaches you how to grind through a lift, uh, because a lot of people have never had the experience of really sticking with a lift. And interestingly, the more advanced somebody gets in terms of strength, the slower their one-rep max velocity will be. And, and we see this in, uh, research studies all the time. Um, somebody who's kind of new will come in. They will absolutely smoke a weight. You put five pounds on, and then they get stapled because it's just, they-
- PAPeter Attia
They don't have that grind capacity
- LNLayne Norton
... they don't, they don't know how to do it. And part of that may be-
- PAPeter Attia
Hmm
- LNLayne Norton
... psychological, but part of that's probably physiological too-
- PAPeter Attia
So interesting
- LNLayne Norton
... in terms of you just haven't trained your body to recruit all the fibers that it can get. So, you know, lean body mass and strength are very closely tied together, but when it gets to those finer levels of strength, it's kind of just practicing the actual, you know, one-rep max. So when it comes to, uh, you know, getting strong, you can absolutely get strong, you know, doing sets of 10, 15 because you're increasing your lean body mass. Do you need to do sets of three, four? No, but what I would say is, like, don't necessarily count them out because, uh, a lot of people actually just do really well with variety. So, you know, periodization was kind of a, a big thing for lifting back in the day, and now we've kind of shown that, at least in the research studies, it doesn't appear to produce greater gains in lean body mass. Maybe a little bit better strength gains, but that's probably just because people peak better when you're periodizing things. But what tends to actually be shown is that people just tend to like periodization better because they're varying the repetitions. They're not as bored.
- PAPeter Attia
Yeah.
- LNLayne Norton
Right? So you never wanna kind of poo-poo the psychological effects of those things. I talk about this with diet as well. Uh, adherence is the most important thing, just getting people to come in and do it. So especially for people who are coming into the gym, you know, if they... you know, if, if they're just trying to get stronger and be healthy, well, for me, if I'm, like, talking to them or coaching them or whatever it is, it's like, "Well, what do you enjoy? What's gonna get you to show up consistently," right? "Oh, you don't, you don't want to free squat? That's fine. Let's leg press." You know, there's, there's many ways to skin a cat. Uh, you don't want to barbell deadlift? Okay, no problem. Let's do some RDLs. You know, those sorts of things. Uh, you know, slightly less technical lifts that are still gonna produce really great, uh, gains in terms of strength, lean body mass, those sorts of things. So if you're not gonna specifically compete in a strength sport, there's so many paths to Rome in terms of getting stronger and increasing lean body mass. So, um-
- 29:40 – 35:19
How strength training supports longevity and quality of life: bone density, balance, and more
- LNLayne Norton
but I also just thinking about, like, again, if we're kind of like looking at the longevity or the quality of life piece, what is, you know, most analogous to what these people are gonna be doing and where they're gonna be needing it? Well, if it's bending over and picking something up, that's-
- PAPeter Attia
It's a compound movement
- LNLayne Norton
... some kind of hinge.
- PAPeter Attia
Sure.
- LNLayne Norton
Right? Some kind of hinge. Um, if it's, you know, sitting down and standing back up, some kind of squat. Now, you can use variations, right? And I would never... I don't want to say never 'cause it's a, it's a superlative. Uh, but I very rarely would take somebody who's like fresh off the street and just, and just put a barbell on their back and say, "Okay, learn how to squat," because, I mean, it's gonna be like Bambi trying to stand up, right?
- PAPeter Attia
Yeah.
- LNLayne Norton
Um, ideally, you're probably gonna, you know, maybe even start them off with no weight and just teach them how to hinge. You know, how to use their hips, how to use their knees. Um, how to track, you know, their, their legs with their feet and those sorts of things, and just balance. Because if you've never, like, put a barbell on your back, I mean, it's, it's not a comfortable position. Um, and honestly, to do it well, you shouldn't feel comfortable. You should feel very tight, you know, most places. Uh, and then, like, once they're established with that, then moving to where they're, like, holding a kettlebell in front of them, and then you can progress with weight with that, and then maybe you progress to something like a safety bar, you know, where they're not having to worry so much about hands and whatnot, uh, to a box, and then eventually take the box away, and then maybe then you can progress to a barbell squat. Um, but I would say that, you know, the Puritan in me would be like, "Yes, everybody should barbell squat," but I know that that's not true. I think the biggest thing is just, just getting something close and analogous to the things that are gonna be important in your day-to-day life if you get... as you get older, especially if, you know, quality of life is important to you. And I mean, when we talk about, you know, people who fall as elderly, I think I read something insane, like half the people over age 65 who go in the hospital for a fall never come out. Or, or I think it's something of that nature.
- PAPeter Attia
Yeah, I mean, I've seen many studies on this. The, the, the one that sticks out in my mind was 30% to 40% of people over the age of 65 who break their hip, uh, will not live... uh, will be dead within a year of that insult.
- LNLayne Norton
Yeah, 'cause you got infection, and then you have a... that you're also, like, they're gonna have to be immobilized for so long.
- PAPeter Attia
Right, and then they get pneumonia or atelectasis pneumonia or something like that. So yeah, it's, um, it's, it's awful. I mean-
- LNLayne Norton
Yeah
- PAPeter Attia
... I, I, I think. You know, uh, there's a study, and I, I think I even mentioned this on a previous podcast, but we, we should link to it. It's a... It was an Australian study that took a group of older women, I don't remember exactly how old they were, but they certainly looked like they were in their 60s or above, uh, who all had osteo- at least osteopenia, if not osteoporosis, and it put them on a, a relatively unsophisticated lifting program.
- LNLayne Norton
Mm-hmm.
- PAPeter Attia
Unsophisticated in that there wasn't a lot of instruction other than-
- LNLayne Norton
Yeah
- PAPeter Attia
... just pick up weights.
- LNLayne Norton
Mm-hmm.
- PAPeter Attia
It was mostly just pick up weights. And, uh, so I saw the video on YouTube of the PI discussing this.
- LNLayne Norton
I've seen this.
- PAPeter Attia
Isn't it fantastic?
- LNLayne Norton
Yep.
- PAPeter Attia
It... 'Cause they're in this j- totally old-school gym, and you've got these old ladies picking up weights, walking around, some of them getting really... I remember one lady was picking up her body weight.
- LNLayne Norton
Yeah.
- PAPeter Attia
I mean, she was basically deadlifting her body weight.
- LNLayne Norton
Yep.
- PAPeter Attia
These are women who had never lifted a weight before, and their symptoms just got so much better.
- LNLayne Norton
Absolutely. And I mean, the best thing you can do for, like, bone density is lift weights. So this isn't, like, a mutually exclusive thing.
- PAPeter Attia
Yeah.
- LNLayne Norton
In fact, people get really focused on the bone density portion of this when we talk about falls and whatnot. So they get very focused on-
- PAPeter Attia
Yeah
- 35:19 – 39:40
Peak capacity for strength as a person ages and variations in men and women
- PAPeter Attia
So what do we know about the, um, [lips smack] peak capacity for strength as a person ages? Does this differ between men and women? And I'm sure there's variability for people, but I mean, on a per pound basis, are you stronger today than you were at 20?
- LNLayne Norton
Yeah, I am stronger today than I was at 20. Um-
- PAPeter Attia
Are you stronger than you were at 35?
- LNLayne Norton
No. No, that's come off my peak a little bit.
- PAPeter Attia
Okay.
- LNLayne Norton
But that's... I don't think that's, like, a sarcopenia thing. I just think that that's accumulation of injuries and not being able to train the way I used to be able to train.
- PAPeter Attia
Okay.
- LNLayne Norton
So I used to be able to train much harder than I can train now. Like, my, uh-
- PAPeter Attia
Yep
- LNLayne Norton
... my governor is not the work ethic. It's the, it's the, "Okay, how hard can I train before the pain level gets too high?"
- PAPeter Attia
So it's not that you're losing type, uh, two fibers, that you're losing some of the 2A or 2B fibers, and that that's why you're not quite as strong. You... Would you... Do you believe that on a muscle biopsy basis, you're, you could be as strong now as you were at 30?
- LNLayne Norton
I think I probably could.
- PAPeter Attia
Yeah. Interesting.
- LNLayne Norton
Um, it's, it's... If you look at the research literature, you do see differences between young and old, but most of those get ameliorated when you start adding in resistance training. And t- more to your point, you know, the idea how much strength could I gain? How much lean mass could I gain? Based on what I've seen, so let's take men and women, for example. [lips smack] Um, women ha- have been shown to gain just as much lean mass as a percentage of their starting lean mass. It is the relative increase. So, for example, if people add 10% lean mass-
- PAPeter Attia
Yep
- LNLayne Norton
... something like that. Well, if you're a male and you have, you know, 70 kilos of lean mass, now you're 77. If you're a female and you had 50 kilos of lean mass, now you're 55, right? So the male added seven kilos, the female added five kilos, but relative to their start, they added the same. And that's what the research literature says, is they pretty much can add the same amount as a percentage of their starting lean mass, and the same thing for strength. Uh, and actually, there's some evidence that women may be able to tolerate higher training volumes than men, too. Now, I'm not sure if that's-
- PAPeter Attia
Is that across all ages, you think, or is that within a certain age?
- LNLayne Norton
They've only really looked at it in kinda young adults-
- PAPeter Attia
Okay
- LNLayne Norton
... um, like 20s and 30s, so it's hard to say. But I wonder if that's just more of a function of they're just smaller bodies handling less weight. I do-
- PAPeter Attia
My wife would tell you that no one can handle a cold less than me.
- LNLayne Norton
[laughs]
- PAPeter Attia
Because, and I think it's true, I have an insanely high pain tolerance, except for when my sinuses are congested-
- LNLayne Norton
Uh-huh
- PAPeter Attia
... and I have a miserable cough. Then I turn into a little baby.
- LNLayne Norton
[laughs] Um-
- PAPeter Attia
[clears throat] So there might be something about women just being tougher, too.
- LNLayne Norton
Yeah. Uh, I think... So I've, I've thought about this quite a bit. So if you look at, um, like let's look at super heavyweight powerlifters, just as an extreme example, right?
- PAPeter Attia
Yeah. And these are guys that weigh over what? What's the-
- LNLayne Norton
Oh, like Ray Williams, for example. So he's one of the greatest, um, drug-tested powerlifters in history. First man to raw squat over 1,000 pounds. Uh, he was a college football player. They DEXA'd him. He had 308 pounds of lean mass, and he's probably over 400 pounds of, of total body weight. The man-
- 39:40 – 47:58
Effects of testosterone (endogenous and exogenous) on muscle gain in the short- and long-term
- PAPeter Attia
talking about. [clears throat] And I've heard people use that study to suggest that testosterone is not important in muscle gain, [lips smack] the idea being if women can add 10% to their base and men are adding 10% to their base, clearly men and women have a log full difference in testosterone, therefore testosterone doesn't matter. But of course, you only need to look at tested versus untested powerlifters and bodybuilders to know testosterone's doing something. So how do you reconcile these?
- LNLayne Norton
I think part of it is... So if we look at, like, let's take the men and women example. Um, there... One of the main benefits to testosterone is the increase in satellite cell number that you get, which is going to increase your potential for increasing muscle mass. So, um, I don't wanna talk about this like it's hard and stone proven, but there's a theory out there I tend to agree with called the myonuclear domain theory. So for those people who aren't familiar with satellite cells, satellite cells are quiescent cells that sit on kind of the outside of a muscle fiber. And through various ways, resistance training, testosterone, whatever, uh, you can get those satellite cells to be donated to the muscle fiber, and muscle fiber is the only cells that are multinucleated. And we think the reason is, is that each myonuclei can only control protein synthesis for a certain area. So you can only get... The muscle fiber can only grow as big as it has myonuclei. So the more myonuclei you can donate, the greater your potential is. And so one of the things that we think is a reason that men have more lean mass than women, you know, is during puberty, because up till puberty, males and females tend to have similar amounts of lean mass.
- PAPeter Attia
Right.
- LNLayne Norton
But during puberty, that's when we start to see these hormonal differences emerge, and that exposure to testosterone, um, increases that myonuclei number and just gives them a greater overall potential for lean mass, which again, makes sense if you think about it r- as a relative percentage. Um, so now when you talk about taking exogenous levels of testosterone, now you're donating even more myonuclei, and so you can, uh, reach a higher ceiling. [lips smack] So I think, honestly, I mean, this, this might get me in a little bit of trouble, but I think that's actually the strongest argument against kind of the, um, the crossover of transgender sports of, um, you know, people who previously were male now identify as female, is you can't really get rid of-
- PAPeter Attia
Can't get rid of those extra nuclei
- LNLayne Norton
... of, of the, of the [lips smack] long-term benefit that's conveyed by the fusion of those myonuclei. So for example... And we see this with, like, muscle memory, for example. So we know that when you stop... If you've trained before, but you stop training, you can gain back muscle much faster than it takes to build it. And they've even shown this in people who have stopped training for years, that they gain it back faster than it originally took to build it. The other interesting thing is they, uh, did a study where they looked at Uh, giving testosterone to, it was either rats or mice, I can't remember which one. So they, they were able to resistance train them, and I, it's funny to see these, like, rat resistance training setups. I'm sure you've seen them.
- PAPeter Attia
Yeah.
- LNLayne Norton
Um, so one group, they did not give testosterone. The other group, they gave testosterone. Now, of course, both gained strength, both gained lean body mass, but the group getting testosterone obviously gained more. Then they had a complete washout period, and basically for as long as it took for them both to get back to kind of their original lean mass number. Then they both had them-
- PAPeter Attia
Repeated
- LNLayne Norton
... train again.
- PAPeter Attia
But no testosterone.
- LNLayne Norton
No drugs-
- PAPeter Attia
Yep
- LNLayne Norton
... in either group, and the group that originally had testosterone just that once gained muscle significantly faster than the other group. And our best understanding is it's probably these myonuclei that got fused through that extra testosterone that confers that long-term benefit. So that's kind of how we think about mass potential.
- PAPeter Attia
And, and do we think that that's kind of, like, only during a critical window of development, or does that happen if you're 40 years old and you're taking exogenous testosterone?
- LNLayne Norton
See, that's where it gets more tricky. We don't, we don't really know. Um, I, I think part of it may be, you know, if you're, if you have a certain ex- testosterone... And I'm, there's no data on this, so I'm, I'm speculating 100%. But if you have a certain level of testosterone, you've had that, you know, through puberty, and now you're an adult, and you kind of maintain that, that's just kind of your native, natural, let's say you don't get too obese or too underweight, whatever, um, you've probably fused the amount of mu- myonuclei that you're going to fuse, at, at least from testosterone, right? But now if you start taking it exogenously, you've now ramped that up another notch. Now you can fuse more myonuclei, which again, anecdotally would make sense, because if we look at the drug use in bodybuilding, it's continued to go up, up, up, up, up. And now we're getting to the point where, you know, these guys really aren't getting much bigger because, uh, there's just only so many drugs they can take before... I mean, and we're seeing it now. Many of them are... I think last year there was something like a half dozen, uh, professional bodybuilders who died. So it's getting to the point where they really can't go any higher in drugs, and you're seeing that lean mass start to cap out.
- PAPeter Attia
And this is why, because you compete in tested or drug-free powerlifting, as good as it is, they make you guys take a polygraph that says, "Have you used drugs in five years?" And that's an interesting window of time, right? 'Cause you'd think, like, why would they care if you used performance-enhancing drugs five years ago? But in theory, they do care because you may still confer a benefit five years later, even if you've actually been drug-free.
- LNLayne Norton
So that's what we did in natural bodybuilding, when I competed in natural bodybuilding. In powerlifting, they don't do the polygraph.
- PAPeter Attia
Oh, they don't.
- LNLayne Norton
So you just, you cannot test positive for... So we're completely under WADA. So basically the way-
- PAPeter Attia
Hmm
- LNLayne Norton
... the WADA drug testing works is once you enter the WADA drug testing pool, so you've qualified for some kind of international competition, um, you could be drug tested at any time.
- PAPeter Attia
Hmm.
- LNLayne Norton
So you have to provide, you have to use a whereabouts form, you have to provide your whereabouts, all that kind of thing. And if they, if it's during your window and they say, "Hey, you need to be drug tested," and you don't do it, you can get a strike, uh, against you and be out of competition for a certain period of time. So there's pluses and minuses to both methods, right? Like polygraph obviously is not something that's crazy accurate, right?
- PAPeter Attia
Right.
- LNLayne Norton
There, there's a... I, I don't think they allow it in a court of law.
- PAPeter Attia
No. No.
- LNLayne Norton
Um, but just the, the idea that you are going to be asked that, and it could be, you know, something that you fail, probably keeps quite a few people from doing it. And the other thing I tell people is there's just not really any money in this stuff, so it's, you know... Are there cheaters? Absolutely. Is it rampant? I would kind of be surprised, 'cause there's just not that much money. Now, when you talk about sports where you can make millions of dollars, yeah, I, I would not be surprised if there's rampant cheating because you're talking about millions of dollars. Uh, I think the most money that's ever been on the line for me competing was, like, $2,000 or $3,000. So it's, you know, I love to do it.
- PAPeter Attia
It's not being done for the money.
- LNLayne Norton
No, no, for sure.
- 47:58 – 1:00:16
How Layne is prepping for his upcoming IPF World Masters Powerlifting competition
- PAPeter Attia
So y- y- you know, you've, you've mentioned that, you know, you're, as you're getting ready to train for Worlds, just I think it was a couple day-- yesterday you, you said to me, you know, your back kind of hurt. You really backed off. Um, also, this is your first, uh, major meet, international meet in about seven years.
- LNLayne Norton
Yep.
- PAPeter Attia
And a lot of that was due to injuries.
- LNLayne Norton
Yep.
- PAPeter Attia
Of which back was the most prevalent, but I think you also mentioned a little bit of knee pain as well, right?
- LNLayne Norton
Hip, knee.
- PAPeter Attia
Hip, yeah.
- LNLayne Norton
Yep.
- PAPeter Attia
So how do you think about this personally? How much longer do you want to be loading yourself at the, you know, basically putting cars on your back and lifting cars off the ground, right? Which is effectively what you're doing.
- LNLayne Norton
Yeah. I mean, candidly, if I went out and I won Masters Worlds, I'd probably give a, a real hard thought about, like, "Okay, I, I think I'm done at least competing in this." Uh, but the other part of me is kind of like, I think that part of my problem is I love to train so much, I never really gave myself the time to get pain-free. As soon as I started feeling better, I would just start-
- PAPeter Attia
Go right back
- LNLayne Norton
... pushing again.
- PAPeter Attia
Mm.
- LNLayne Norton
[lips smack] And I do think I've slowly gotten more intelligent, because I used to think I was basically Superman. So I think I've just matured a little bit, and even like yesterday, like getting to a certain point, warming up on squats and saying, [lips smack] "All right. It's not happening today. Um, there's no reason to try and force this." I think previously I would kind of create a narrative in my mind of, "I'm gonna power through this because it's what it takes." And yeah, at some points, like you have to... I think one of the, the most important things is knowing when to press the gas pedal and knowing when to back off a little bit. And sometimes discretion is the better part of valor. And for me, I'm probably a little bit weird in that, like I would train three, four hours a day, 'cause I just love to train. I love the way it makes me feel.
- PAPeter Attia
Yeah.
- LNLayne Norton
I love feeling strong. Uh, part of me, the egocentric part of me probably loves to feel like a badass loading up, you know, 500, 600 pounds in the gym and whatnot. Um, but I've kind of gotten to the point now where I'm like, "All right. If it's there today, we take it. If it's not there, we take what's there, and then we live to fight another day." Because I've just had so many experiences where I've tried to press on this, and with the way pain works, the more pain you have, the more pain you're going to have. Because you just end up getting fixated and ruminating on it, and the research actually shows that the more you ruminate on it, the more you think about it, and the more times you trigger it, the worse it's going to get. And so it's like this delicate balance between y- you know, I kind of know how far I can press something before I'm making it worse, because the research also shows that you don't want to completely just stop lifting because you detrain, and then when you come back, even if you're pain-free, you're more likely to re-trigger it because you've lost that adaptation. So it's kind of like when you have those pain triggers, trying to find either a weight amount or a movement pattern or something similar to what you're trying to do, but that's low enough pain that you can start to build back from that. So like for example, yesterday, um, ideally I would've done some squats and deadlifts. Couldn't do them. Okay, I'm gonna go in and do some leg press. I'm still gonna get some stimulation for my quads, the primary movers of the squat. Uh, I'm gonna go do single leg dumbbell RDLs. I was able to do those with no pain. Is it loading it as much as I would like? No. But I'm still using my hamstrings, I'm using my lower back, I'm getting in some of that movement pattern, and, uh, I'm still getting a training effect, some adaptation, without further triggering that pain. So-
- PAPeter Attia
And then so what did you do today?
- LNLayne Norton
So today I j- I just kind of was like, um, pretty much just cleaning up stuff I missed throughout the week. Um, so I just had some dumbbell pressing. Um, I did some more single leg RDLs, and I did some mobility work. So not, not a whole lot of intensive stuff. Um, but you know, really when you consider like what I do, ideally all I would do would be squat, bench press, and deadlifts-
- PAPeter Attia
Right
- LNLayne Norton
... 'cause it's completely specific to what I'm going to express on competition day. But those are also very fatiguing movements. I think, and I think part of that too is just when you know how much you can do and you know how much you've done, you kind of have like this anxiety, um-
- PAPeter Attia
Yep
- LNLayne Norton
... about those movements, because it's like you're almost being tested and comparing them to what you've previously done. So sometimes just creating, you know, a little bit of a, a variation of that movement where you're not... You can kind of just let the weight happen and pick your RPE, and if, if it's not, you know, a previous set weight, it doesn't bother you. So I've started using a lot more variations to build that baseline level of strength. And then again, when it comes to the actual competition lifts, I'm mostly just focusing on doing like heavy singles and building my volume through other areas.
- PAPeter Attia
And how many times a week will you do those heavy single workouts?
- LNLayne Norton
Uh, once or twice.
- PAPeter Attia
Okay.
- LNLayne Norton
Once or twice, just depending on how I feel.
- PAPeter Attia
I've, I've often thought there would be a really interesting experiment I'd like to do. Uh, I wouldn't do it, but I'd, I'd like to oversee it.
- LNLayne Norton
[laughs]
- PAPeter Attia
I'd like to see it being done, I guess. Which is, um, you take a powerlifter and their entire training cycle, like six months building up to a competition, they have no idea what's on the bar.
- LNLayne Norton
Hmm.
- 1:00:16 – 1:12:47
Creatine supplementation
- PAPeter Attia
Okay. Well, let's... Actually, let's talk a little bit more about creatine. Um, we talked about it really briefly on one of our podcasts, but we, we were kind of at the end. So I wanna kind of go back and make sure people understand that it's one of the supplements we get the most questions about. It's also one of the supplements that we feel the most confident telling patients, like, if, you know, this is a supplement worth taking. It's clearly passed test number one, which is it's safe, uh, and it passes test number two, which is it's probably got efficacy. Um, well, I shouldn't say... It's got efficacy. The real question is, you know, are you okay with a little bit of weight gain 'cause that's, you know, you're gonna pull more water in.
- LNLayne Norton
Yeah.
- PAPeter Attia
So, um, explain to people a little bit about why creatine is so important, and presumably this is something that's really important in powerlifting. I'm guessing going into a bodybuilding meet, you probably don't want creatine for that extra weight, or do you?
- LNLayne Norton
So I think it's actually great for bodybuilding. So-
- PAPeter Attia
Okay, great. I want to hear about it. 'Cause I, I assumed it would... You'd have a little more water, but maybe the water's all in the muscle, and that's where you want it.
- LNLayne Norton
Yeah. So, uh, so creatine is a high-energy phosphate donor. So it... In, in muscle, it exists as phosphocreatine, and when you take supplemental creatine, uh, you'll... It'll come into the muscle, it'll get a phosphate attached to it, phosphocreatine. And originally, the, the only mechanism we thought of, well, it's a high-energy phosphate donor, so people-
- PAPeter Attia
Yep
- LNLayne Norton
... perform better. But then we saw people increase their lean body mass, increase their strength, uh, and there's even, like, benefits in terms of... Cognitive benefits appear to be pretty clear that there's some cognitive benefits as well. Uh, so as you mentioned, like, in terms of safety and efficacy data, I mean, to me-
- PAPeter Attia
There's no strikes, really
- LNLayne Norton
... I, I tell people, I'm like, "I don't even know why we're having this conversation anymore." And it's also, you know, it's gone up in price a little bit recently because of the supply chain stuff. But-
- PAPeter Attia
It's, it's still relatively inexpensive
- LNLayne Norton
... it's incredibly inexpensive for, for what you're getting.
- PAPeter Attia
Yep.
- LNLayne Norton
So, you know, when I see people talk about, like, some of these other supplements and they're not even taking creatine monohydrate, and I'm like, "Well, you're, you're stepping over pennies..." Or sorry, "You're stepping over dollars to pick up pennies." Because this is just the lowest-hanging fruit, uh-
- PAPeter Attia
But are you still, even at your size and even at your demand, is there any benefit to taking more than about five grams a day?
- LNLayne Norton
Some people have postulated there might be. I haven't seen really clear evidence for it yet. You could argue that there's really no downside to taking the extra. The, the downside might be some GI irritation.
- PAPeter Attia
Mm-hmm.
- LNLayne Norton
For some people, creatine can be a GI irritant, which I, I think we'll circle back to. Um, but we know it, it can act as a high-energy phosphate donor. So when you are exercising or just doing anything, you... Your energy currency of your cell is ATP, and in order to drive muscular contraction, your ATP donates a phosphate, and that liberation of that phosphate to form ADP and a free phosphate is energetically favorable and helps drive these muscular contractions. Um, so creatine can act, or phosphocreatine can act as a high-energy phosphate donor to reform, uh, ATP and allow you to perform better. But it's also a really powerful osmolyte, and so it pulls water into muscle tissue, which in and of itself may actually be anabolic. So, uh-
- PAPeter Attia
Mm
- LNLayne Norton
... like just a muscle cell being more hydrated, there's some evidence that that can actually improve the, that it's more anabolic environment. Uh, but regardless of the mechanism, we do know that when you take creatine, you see improvements in lean mass, and some people will say, "Well, that's just water." Well-
- PAPeter Attia
But that's what muscle mostly is, isn't it?
- LNLayne Norton
But muscle is 70% water.
- PAPeter Attia
Yeah.
- LNLayne Norton
So whether it's... And there's actually research to show that even non-contractile, just water improves, may improve strength and contractibility. So, so we're not sure exactly how-
- PAPeter Attia
Mm
- LNLayne Norton
... but it could just be like the volumization of the cell is just a benefit.
- PAPeter Attia
There's also sort of a... You, you could also kind of make up, at least conceptually, a framework that says a more hydrated cell is more able to calculate, uh, more, more able to carry out its function, right?
- LNLayne Norton
Right.
- PAPeter Attia
So if the function of a myofibril is contractile release, contract release, and it has more water, y- it sort of seems logical to me that it's going to be better at clearing metabolic waste-
- LNLayne Norton
Mm
- 1:12:47 – 1:21:02
How important is rep speed and time under tension?
- LNLayne Norton
to cycle it.
- PAPeter Attia
So something else that kind of bridges the world between bodybuilding and powerlifting is this, this question I wanted to ask you about, which is basically one of Newton's laws, right? So force equals mass times acceleration. Okay, so, um, let's just say I'm on the ground, I've got my dumbbells, or I'm on a bench and I've got my dumbbells and I'm gonna press them. One school of thought is press them as quickly as possible because force equals mass times acceleration. The mass of this thing is fixed, so any speed with which I lift it is accelerating because I'm moving against gravity, but the faster I can do it, the greater the force. But of course, at some point the weight becomes so heavy that ... you increase the effort more on the mass variable than on the acceleration variable. So in other words, we can manipulate mass and acceleration to reach maximum force. Now, an extreme example of that is you doing a one-rep max.
- LNLayne Norton
Right.
- PAPeter Attia
But as you pointed out, the more elite a powerlifter becomes, the slower that is. In other words, the lower the acceleration is, and therefore the more they're emphasizing the mass, which is, of course, what you get scored on. No one's scoring you on the acceleration.
- LNLayne Norton
Right.
- PAPeter Attia
How does, how do we think about that in terms of mixing and matching the mass versus the acceleration variable in an effort to optimize force? Because of course, we also don't wanna go to maximum force every time, because if I did maximum force with a lightweight, I'd probably move it too quickly, I could injure myself as well. So d- do you think about the variation of mass and acceleration when you're moving weight?
- LNLayne Norton
So yeah, so if you think about what the expression of strength is, it's basically force. Um, so as you mentioned, if it's a very heavy weight, it'll just move slower. If it's a lightweight, you can still apply the same force and it will just move more quickly. Uh, so this is actually a, a concept that, um, I heard, uh, my coach Zach talk about on a podcast-
- PAPeter Attia
Mm
- LNLayne Norton
... was they do quite a bit of we'll do a heavy single or double or whatever it is, and then our back-off sets are relatively light, like talking RPE four or five, but trying to move them as quickly as possible.
- PAPeter Attia
On both... I, let's just talk about the concentric now-
- LNLayne Norton
Yeah
- PAPeter Attia
... and then I wanna actually come and have the discussion about the eccentric. So yeah.
- LNLayne Norton
Yeah, on the concentric.
- PAPeter Attia
Yeah, yeah, yeah.
- LNLayne Norton
Yeah, exactly. And because that is, in terms of strength, that is the closest expression of that.
- PAPeter Attia
So in other words, what, if I'm understanding you correctly, you're saying your coach is saying, "Look, on the heavy weights, we'll... They're gonna move slow because they have to. But to keep training strength, I want you to move as quickly as possible as we come down on weight."
- LNLayne Norton
Bingo. Bingo. And that... So the idea is while we're still applying the same force, it's gonna move more quickly, but it's gonna be less fatiguing because it's lighter weight. So that's kind of the, the concept behind it. Now, in terms of-
- PAPeter Attia
Is that happening with you? So for example, when you did... Let's just say your back wasn't hurting yesterday. If you were out there doing, today was an RPE six day, do you think that your speed would have increased sufficiently that you would have almost matched 90% of the force you'd put out on a one-rep max best?
- LNLayne Norton
It's hard to tell, uh, 'cause I've never actually done-
- PAPeter Attia
Okay
- LNLayne Norton
... a calculation of the force.
- PAPeter Attia
Yeah, yeah.
- LNLayne Norton
I, I imagine there's probably a sweet spot somewhere in there where, like, too heavy probably has less force than-
- PAPeter Attia
Yeah
- LNLayne Norton
... you know. Um, but yeah, I'm not, I'm not sure where that is. Um, as far as, like, um, hypertrophy, I think that force is probably less important. I think it's more about just having suf- enough sufficiently hard sets, however you slice that. So, uh, for example, like the whole idea of time under tension training was very-
- PAPeter Attia
Yes
- LNLayne Norton
... uh, popular. Um, and if you look at some of the initial research, um, I think there was a study where they had people doing curls, and I may butcher the study, so I apologize, but it was kind of like a six-second eccentric, six-second concentric, and they had them go to failure, and they had another group that just did normal kind of cadence, and they had them match the number of reps and found that the group that was, uh, doing the slow eccentrics and slow concentrics gained more muscle. And so people said, "Well, see, there you go." Well, the problem is they were using, like, 30% of, of their one-rep max for, like, 10 reps going really slow. Well, if you're going at a normal pace, how many times could you do 30% of one-rep max? I mean, you could do 30, 40, 50 reps, right? So it wasn't... I don't wanna say the study was bad. It's not bad. It answered the question it wanted to answer. But if you're gonna compare them straight up, really what it needs to be is if you take both of these things to failure, so the same level of intensity or sufficient difficulty-
- PAPeter Attia
Mm
- LNLayne Norton
... what does the outcome look like then? And so when they do that, they really see very little difference between, uh, slow lifting and fast lifting. Um, there was a study that just came out that looked at fast eccentrics versus slow eccentrics and found that there was actually a little bit better, uh, outcomes with fast eccentrics compared to slow eccentrics. And that actually relates back to-
- PAPeter Attia
For, with respect to muscle mass?
- 1:21:02 – 1:33:10
Validity of super slow rep protocols, and the overall importance of doing any exercise
- PAPeter Attia
Now, there are a couple of patients that I've had over the years whose disdain for exercise is so great that the most I can negotiate them doing is one 20 to 30-minute workout per week doing the super slow protocol.
- LNLayne Norton
Ooh.
- PAPeter Attia
Where they go to... Have you... You know, they have these specific gyms that have very specific types of equipment.
- LNLayne Norton
Yep.
- PAPeter Attia
And they're gonna do, I don't know, maybe eight to 10 different machines, and they're only going to do one set, and it's gonna be to failure. Um, and the sets are typically titrated to be somewhere between 90 and 105 seconds, so about a minute 30 to a minute 45 is the sweet spot, right?
- LNLayne Norton
Yeah.
- PAPeter Attia
So if you're going more than that, the weight's too heavy. If you're... Uh, the weight's too light if you're less than that, the weight's too heavy. And they might do, like, four simple upper body, four upper... lower. So there might be a press, a pull, a bicep, a tricep, a leg press-
- LNLayne Norton
Mm
- PAPeter Attia
... you know, all that kind of stuff. Now, the reason I sort of negotiate that is my alternative is they'll do nothing, and I'm thinking I probably can't get any better benefit in 30 minutes once a week than I can there, um, if it's done right. Now, the challenge that I've realized with that type of exercise, 'cause I've done this many times myself, [smacks lips] it's actually really hard to go to failure. At the end of the day, it can be done, but it can't be done often. And I actually think it's really hard to do it eight consecutive times, which is basically what you're asking a person to do in 30 minutes, to truly go to failure. Um, so, so what is your take on the super slow protocols? Which clearly guys like Mike Mentzer have, you know... Like, there are really famous bodybuilders who have taken these protocols to the limits, but what's your take both on the physiology of it and then the psychology of it?
- LNLayne Norton
Yeah, so I think that just kinda shows that there's, you know, there's many ways to skin a cat, right? Um, and when it comes to hypertrophy, uh, you really have a lot of options. And certainly y- no one will argue that you can grow... can't grow muscle that way because you can. Um-
- PAPeter Attia
It is kind of remarkable, isn't it? To think that, like-
- LNLayne Norton
Yeah
- PAPeter Attia
... these people could do 30 minutes once a week and grow muscle.
- LNLayne Norton
Yeah. In fact, there was, there was actually, um [smacks lips] ... So a friend of mine, Jeremy Loenneke, he's a professor at Ole Miss, uh-
- PAPeter Attia
Oh, yeah. Jer- Jeremy's been on the podcast.
- LNLayne Norton
Yeah. He's great.
- PAPeter Attia
BFR. Yeah.
- LNLayne Norton
Yeah. He's great. Um, my, my claim to fame is I actually introduced him to BFR. [laughs] So, but they actually published a paper where they looked at, um, just flexing, like isometric contraction.
- PAPeter Attia
Mm.
- LNLayne Norton
And were actually able to show, like with long isometric contractions, like some hypertrophy. Which before that we always thought, oh, isometric doesn't actually grow muscle, right? Like there's, there's very little benefit to it. So yeah, I, I think that we just... I hate to be the, the, the typical tools in a toolkit, but things are tools in a toolkit.
- PAPeter Attia
Yeah.
- LNLayne Norton
And we're, we're talking about people who are [smacks lips] you know, they don't wanna be bodybuilders. They just wanna get some of these benefits from resistance training. It really is what can we do to get them in the gym consistently? And is it as good as like, you know, compound movements with free bar and, you know, training at a normal pace? Maybe not, but it's a heck of a lot better than them sitting at home and doing nothing.
- PAPeter Attia
Yeah.
- LNLayne Norton
So I th- I think that's really important to understand. And when it comes to like the super slow phy- phys- the physiology of the hypertrophy response, [inhales] what's wild is we still don't fully understand how the process of muscle hypertrophy occurs. Like-
- PAPeter Attia
Hm
- LNLayne Norton
... we know that you need to progressively overload to continue, uh, causing the hypertrophy response. We know what things are associated with hypertrophy, but every time they try to get really granular with it, we still have a lot of gaps in our understanding.
- PAPeter Attia
Hm.
- LNLayne Norton
Now, one of the things we do think matters is, uh, metabolic stress. So this idea that you're accumulating these metabolic byproducts inside the muscle as you work it out, so that kinda like the whole-
- PAPeter Attia
Hence the BFR
- LNLayne Norton
... the, the pump.
- 1:33:10 – 1:47:43
Navigating social media: advice for judging the quality of information from “experts” online
- PAPeter Attia
picking up where you went, where, where do you see, you know, kind of the general role of fitness experts in social media? Um, how can a person sort of make sense of the, the never-ending sea of experts out there?
- LNLayne Norton
Man. So a couple of years ago, we had a guy on our podcast named, uh, Alan Levinovitz. He's been on Joe Rogan's podcast too, and he's a religious studies expert. But, uh, he had a, he had a, he wrote a book on kind of like the naturalism fallacy. And we were talking about like how hard it is for people to identify experts. And he said something that I thought was really insightful. He said, "What you should look for in an expert is the exact opposite of what you probably think you should look for. If somebody sounds really confident, they're probably not an expert."
- PAPeter Attia
[chuckles]
- LNLayne Norton
It... What you really want to look for is people who sound kind of doubtful and they say things like probably, maybe, possibly. You know, if you s- when you speak to true experts, usually if you ask them a, a question, the first thing they'll do is ask you a question back, unless the question is very contextual, right? So I'll get people who say, "Hey, uh, what are your thoughts on X?" Right? And usually I'll say, "Okay, well, as it pertains to what? Like hypertrophy or strength or fitness or..." You know, like I need context in order to be able to answer the question correctly. And so I think looking for people, like people ask me like, "What do you think about like credentials, this and that?" I'm like, [sighs] credentials help. Like if I see somebody has a Ph.D. in a certain subject, I'm probably gonna give them a lot more leeway in terms of, okay, if they say something I disagree with, let me see why they said that. You know, let's, let's dig a little bit deeper. But I've seen some Ph.D.s say, say some really dumb stuff. Um, I've seen people from Harvard say really dumb stuff. I've probably said really dumb stuff, right? Like [chuckles] it, it doesn't stop you. Um, credentials aren't a... They're a nice thing, but they're not foolproof. So really I try to listen to how people speak, um.
- PAPeter Attia
But given that you have such a knowledge background, it's, it's a lot easier for you to kind of look at, you know, someone's Instagram account and pretty quickly realize this person knows nothing. They might look good. They might, uh, be a great marketer, but they don't really know anything.
- LNLayne Norton
Yeah.
- PAPeter Attia
Um, but you know, the average person doesn't have your knowledge base.
- LNLayne Norton
Correct.
- PAPeter Attia
And so what, what else can they rely on? So clearly that's one great criteria or two, right? Is, you know, some sense of credentialing can be helpful. Uh, some sense of speaking with nuance and being comfortable with uncertainty, I, I think that's also helpful. Are there any other tools that a person can use to disentangle this world?
- LNLayne Norton
People who say the magic words, I don't know.
- PAPeter Attia
Mm.
- LNLayne Norton
You know? [chuckles] Like that again, sounds counterintuitive.
- PAPeter Attia
Right.
- LNLayne Norton
But, uh, I remember when... So when I was, uh, part of getting my Ph.D., I had to do what was called a qualifying exam. And so that is a four-hour, uh, oral examination in front of four professors. And when I was prepping for this, uh, Dr. Layman, who you've had on the podcast, he, um, he said, "They're going to push you in whatever subject they start out on until you don't know, and you need to be able to say, 'I don't know.'" And so they did exactly that. Like I, I'll still never forget the way they started off the qualifying exam was, "Let's talk about vitamins. What's your favorite?" So, uh, vitamin D. "Okay, well, where is it synthesized?" And they kept pushing until I just didn't know. And I'll still never forget, they asked me like an acid-base balance question in the lung, and I started to get up on the wipe-off board and like try to draw, and I just turned around and said, "I, I don't know this one." Said, "Okay, move on." And when I got done, they said, "You were actually one of the best students we've had the last few years because you knew what you knew, and you knew what you didn't know." And they... That division put such an emphasis on not going outside your lane, not speaking about something, not specula- not speculating about something that you didn't know and trying to pass it off like you did. So I think that just got hammered into me. So when it comes to looking at other folks- One, if they're willing to like know their scope and not feel the need to comment on every single thing, that's a good, that's a good metric. Also, you know, I, I'm gonna paint with a broad brush, and there's always exceptions to this. But people who use like tips, tricks, hacks-
- PAPeter Attia
Mm
- LNLayne Norton
... uh, five things to never do, five things to always do, the best, worst, people who use a lot of superlatives, that's not typically the way that experts talk. Um, you know, it's... I, I say a lot, there's no solutions, there's only trade-offs, right? There's certain tools that make a lot more sense depending on somebody's goals and where they're at, um, than compared to somebody else, and, and vice versa. So, um-
- PAPeter Attia
But that almost suggests that social media is negatively selecting because a lot of those things that you said, certainty, you know, a flair for showmanship, uh, tips, tricks, and listicles, um-
- LNLayne Norton
That's what gets attention
- PAPeter Attia
... I think the, I think the algorithm likes those things because they get a lot of attention, even if some of that attention isn't warranted. So, um, that, that adds another layer of confusion to this, which is it is difficult, and it's... Y- you know, even when I scroll through Instagram, um, I'm amazed at how much it's trying to push to me. You know, I miss the day when all I saw on Instagram were the 40 people I followed.
- LNLayne Norton
Yep.
- PAPeter Attia
Like, those... I feel like that was the good old days.
- LNLayne Norton
And in the sequence of the way things were posted too.
- PAPeter Attia
Yeah. It was like, oh, here's what this friend of mine did. Here's what this friend of mine did. Here's what this person who I don't know but who I respect d- da, da, da, da, da, da, da. And now it's, it's insane the barrage of stuff that Instagram thinks I want to see. And admittedly, sometimes it's right.
- LNLayne Norton
Yeah.
- PAPeter Attia
But so many times it's just wrong, and it makes me think, well, if that's my experience, that's gotta be everybody's experience.
- LNLayne Norton
And, and it is. And I, I think, you know, Alan talked about this as, uh, information silos, and this is a broader problem, but it is a problem in nutrition and fitness specifically. Uh, you know, people don't really... If you just follow the people you follow and the accounts that get suggested to you, you're actually not broadening anything, right? So you're, you're sitting in an informa- in- information silo, and what happens is, or at least what I think is happening, is, you know, previously, '90s, 2000s, '80s, whatever, you know, you'd come across people with differences of opinion to you, and you could have a conversation with them, and it usually was... You know, sometimes it could be contentious, but for the most part, I would say like when you can sit down and look a human being in the eyes and talk about your differences, it's usually not as confrontational, right? Now we have whole generations of people who are not used to seeing opinions different than their own or, or thoughts or beliefs that are different from their own because they're in those information silos. And when they get exposed to something different, they just don't know how to handle it. And so I mean, like, like you see some really like extreme responses even to stuff like nutrition. You know, like, um, I can't name how many times I've been called a shill for, you know, [chuckles] XYZ, uh, you know, uh, big meat, uh, big dairy, uh, artificial sweeteners, big sugar, you know. Because it, it's almost like, well, it can't possibly be a, a, somebody who just has a different opinion based on this data. They have to be a bad person. So I do think it's a real problem, and what you said is very well taken that is, you know, you almost have to be willing to do clickbait to really get your stuff out there. And so I, as a business owner who does a lot of the business through Instagram, I really have to try to skirt a fine line of I am trying to get people's attention and not lose the nuance and the context and all those things that are important. And, you know, trust me, there's days where I'm like, man, I could make so much money if I just, you know... But, uh, that isn't how I wanna live my life or leave my legacy or anything like that.
- PAPeter Attia
And, and so y- you're, you're an interesting person because your personality on Twitter and your personality on Instagram are quite different.
- LNLayne Norton
Yeah.
- PAPeter Attia
And your personality in real life is totally different.
- LNLayne Norton
Yeah.
- 1:47:43 – 1:56:27
Layne’s views on low-carb diets, the tribal nature of nutrition, and the importance of being able to change opinions
- PAPeter Attia
w- what is the view about you and low carbohydrate diets? Because, you know, I, I, uh, I, I've never heard you say anything that is uniquely, uh, anti-low carb other than, you know, the stuff we've already talked about on the previous podcasts.
- LNLayne Norton
Yeah. So what I always tell people is I'm like, "How could I be anti-low carb?" If you go to my, our, our nutrition coaching app, Carbon Diet Coach, two of the s- two of the six settings are low carbohydrate. There's low carbohydrate and there's ketogenic.
- PAPeter Attia
Yeah.
- LNLayne Norton
So how could I possibly be low carb or anti-low carb?
- PAPeter Attia
Yeah.
- LNLayne Norton
And I think that this is just an example of, uh... I call this the Tim Tebow effect.
- PAPeter Attia
Mm-hmm.
- LNLayne Norton
So, uh, but it's just, like, polarization. So do you remember when, uh, Tim Tebow was playing-
- PAPeter Attia
Of course
- LNLayne Norton
... NFL football? My hypothesis was there is very few people, there are very few people in the middle about Tim Tebow.
- PAPeter Attia
Right.
- LNLayne Norton
You either love him or you hate him. And the way this kinda comes up is, like, if you watch this guy and you're like, "Eh, you know what? He's not really that good. He's got weird mechanics. He's more of a running back than he is a quarterback, and he's kinda preachy, but, you know, he's all right." But then you see all these people saying, "He's the Heisman. He's, you know, he's going to the playoffs." Like, you know, "He's better than your quarterback." Like, you know, this, that. You go, "What are you talking about? Like, his completion percentage is, like, 45%. How, how can you say he's g-" But then you have the other side, which people like, like me, I actually was kind of a Tim Tebow fan, 'cause I'm like, you know, he seems like a nice guy who works hard. Um, d- maybe not the best genetics to be a quarterback, but, like, you know, he's been successful. Like, that's, that's admirable. And then you look over here and you, you see all these people going, "He sucks. He's terrible." And it's like, well, he did win a playoff game, you know? So I think this happens in, with many different subjects. And even, right, like we were talking about this the other day, you know, you're, uh, a car guy. I'm not a car guy.
- PAPeter Attia
Mm.
- LNLayne Norton
Right? So I've posted many times, in fact, when we bought our, our new house, I'm gonna take a picture of me with the car outside the house. It's gonna be the greatest picture that ever goes up on my social media. 'Cause I've still got my grad school car, which is a 2003 Alero, and I've just never, I just never felt the need to get rid of it, right? So you got this- ... really dinky old car with me on the hood sitting outside this, you know, wonderful, you know, big house, and sure enough, it got, like, 1,500 comments. But some of the comments were-- And I was talking about how basically saying, you know, my ability to delay gratification is what got me here, and, uh, you can do it too. Like, delaying gratification in anything is so essential for success in almost any goal. 'Cause it's so crazy how in almost anything, whatever provides you, like, short-term relief or happiness almost always makes it worse in the long term, and vice versa. But people would say, "Why do you, why do you hate people who buy nice cars?" I'm like, "Where did I say I hate people who buy nice cars? I never said that," you know? Same thing with low carb, that my messaging has consistently been... Usually there'll be some kind of insane claim, you know, like calories don't matter or, you know, you can eat as much on low carb as you want and not gain fat. And then I'm like, "Well, here's citation, citation, citation. Low carb does not appear to be better for fat loss than, you know, calorie/protein equated, uh, diets that are not low carb." But that means choose what you prefer, because it's not worse. So by all means, like, if you like low carb, go right ahead. I don't enjoy low carb, but I know many people that do. And so I think one of the reasons people get so tribal about this is they find something that worked for them, and they then retroactively try to find the evidence to show that it's the best thing that there is.
- PAPeter Attia
And which, which of the two landscapes, nutrition and exercise, do you think is more culty?
- LNLayne Norton
Oh, definitely.
- PAPeter Attia
My impression is nutrition.
- LNLayne Norton
Definitely nutrition.
- PAPeter Attia
Yeah.
- LNLayne Norton
Definitely nutrition.
- PAPeter Attia
And, and do you think that that's because of the ubiquity of food in our lives and the fact that we all have almost equally a personal relationship with food, whereas not everybody exercises the same amount and, uh, do you think that that's...?
- LNLayne Norton
So there's two things. Um, especially here in America, we, we come from a Puritan background, and I think that there's this kind of thinking that anything that is pleasurable at all must be bad for you, and you cannot have it, and you should feel bad about it, right? So I think that causes people to get a little bit tribal in terms of, like... I mean, I've had people, like, say horrible, like, moral judgments because, like, I'll post me eating a bag of Skittles or something like that. You know, never mind the fact that I just went and trained for three hours, you know? Um, yeah, I think somebody, like, called me a disgusting sugar addict one time. [laughs] Um, so that's, that's, that's one part of it, but I think it's the s- the smaller part. I think the bigger part is what you just said. If... It's funny, whenever I meet new people, I'm always kind of hesitant to, you know, if they don't know anything about me, to tell them that, you know, I have a background in nutrition, PhD in nutrition. 'Cause usually one of a couple things happens. They either clam up real quick, like if we're out to dinner, and they get very self-conscious about what they're eating, which, bro, I just ordered the fries. Like, you know, you're good.
- PAPeter Attia
[laughs]
- LNLayne Norton
Um, I get... or I get, like, blitzkrieg-ed with questions, but mostly people wanting me to validate what they already believe to be true. But if I was, if I sat down and I said, "You know, I'm a theoretical astrophysicist," we might talk about space a little bit, but they're probably not gonna question my beliefs or my, my opinions on string theory, right?
- PAPeter Attia
Yeah.
- LNLayne Norton
But I think because everyone eats and everyone knows something about their body, right or wrong, they have drawn certain conclusions about what they put in their body and what happens to their body. And so I think because of that, because everybody has an opinion about nutrition, it makes it really tough, 'cause people are already, like, just natively have certain beliefs. And we know how hard it is to change people's beliefs. There was a classic study, it was in politics. It was a classic study where they showed hard data, and this was for both parties, that would either refute a preconceived belief or, uh, support it. I think one of them was, um, uh, with, uh... I can't remember what they used for Republicans, but for Democrats, uh, the belief was that, uh, I think George W. Bush stopped or outlawed funding for stem cell research or something like that. Um, the reality was he just stopped federal funding. He didn't outlaw it. So they sh- they showed people this, this, um, these facts. By the way, again, if I butchered that, I apologize to anyone watching, but I think that was it. They showed people these facts, and it didn't matter. Like, if, if they, um, if they believed that he had outlawed it, even if they showed them the facts that he didn't, they still... it still reinforced their preexisting belief. It actually made their belief stronger.
- PAPeter Attia
Hmm.
- LNLayne Norton
And, uh, the same thing was true for Republicans, by the way, so... [chuckles] And I, and I don't think it's a Republican or Democrat problem. I think it's a people problem, to be honest. And I think one of the benefits I had very early on in grad school was Dr. Layman just absolutely dismantling so many beliefs I had. But then, but doing it in a way that wasn't judgmental or made me feel bad. And what I tell people now, it's like, being wrong about something is a beautiful thing. Because if I'm already right about everything, then I'm already doing everything the best I can, and I can't get better. But if I'm doing something, if I'm wrong about something, that's actually awesome because now I have something I can improve on. So now I tell people, "I like being right." Right? Like, I'll do cartwheels in my living room if I'm right. But if I'm wrong, I d- I don't really take that much offense to it because it's just data. It's not... There's no ethical judgment, and I've changed my mind about a myriad of things over the years.
- 1:56:27 – 2:12:16
Where Layne has changed his views: LDL cholesterol, branched-chain amino acid supplementation, intermittent fasting, and more
- PAPeter Attia
Yeah, I was gonna, I was gonna ask you, what are three of the most impactful things that you have changed your opinion on in nutrition specifically? Um, and let's make it recent, 'cause I know for any of us, if we go back a decade, it's an eternity in terms of our understanding of nutrition science or something like that. But let's pick a narrower window of maybe, like, three or four years.
- LNLayne Norton
Mm-hmm.
- PAPeter Attia
What would be sort of three areas where your, your opinion has really changed in a manner that actually leads to either a different behavior in you or a different, um, coaching input to your clients?
- LNLayne Norton
I can think of three things right away.
- PAPeter Attia
All right.
- LNLayne Norton
So first thing being, uh, LDL cholesterol. So, uh, when I got to grad school, um, the, the kind of the, the narrative, and even out of the lab I was in, was, uh, it's really... We don't think it's LDL. It's more the HDL to LDL ratio and the particle size and those sorts of things. And I, I kept that probably until about five years ago, four years ago, and I just saw enough of these Mendelian randomizations come out, and it's like, wow, that's pretty powerful when you look at the mortality rate and it is, like, linear with the exposure, the lifetime exposure to LDL. I'm like, "Eh, can't really hold this belief anymore because it's just not supported by the data." Uh, and it actually, um, changed my opinion on, like, you know, now I'm a little bit more conscious about the saturated fat I consume. Uh, we talked about, like, I actually started taking a low dose of a statin, um, and that's helped. That's pro- So I've never had super high LDL, but I've always been around 150 to 125, even if I reduce my saturated fat, increase my fiber. And I eat probably 60, 70 grams of fiber a day.
- PAPeter Attia
Mm.
- LNLayne Norton
So, um, you know, I think people get that one twisted a little bit because they'll hear things like, "Well, it doesn't consider HDL. It doesn't consider this." They... No, you have to understand what an independent risk factor means. It means that all things being equal, are you better off having higher HDL? Yeah. But HDL is more of a marker of metabolic health because we have some drug trials and, and Mendelian randomizations now where they modulate HDL, and it doesn't really seem to make a difference.
- PAPeter Attia
Yeah.
- LNLayne Norton
Um, whereas if you modulate LDL, so even at high HDL or low HDL, in both stratifications, lower LDL is almost always better for cardiovascular disease and mortality.
- PAPeter Attia
I feel like I need to do a podcast on Mendelian randomization. Um, I write about it in my book, um, and I actually-
- LNLayne Norton
It's very powerful.
- PAPeter Attia
Yeah. It's, uh... And, and I understand why it doesn't get more attention because you do have to really get into the weeds of genetic sorting and the statistical methods that are involved. But I actually in the book write about it as one of the five pillars of evidence that we should be relying on as we formulate, uh, insights with respect to anything that we do. So that's an interesting one. Um, and, uh, and, and obviously it has a parallel piece, which is around the, your relationship to saturated fat.
- LNLayne Norton
Yeah.
- PAPeter Attia
Yeah.
- LNLayne Norton
And I think, you know, one of the things to keep in mind is when you're looking at mortality, cardiovascular disease, this is where nutrition science can become so limited, and the power with Mendelian randomization is you're kind of looking at a lifetime randomized control trial.
- PAPeter Attia
That's right.
- LNLayne Norton
Right? So people will point out things like the, the Minnesota Coronary study, um, and I think there was another Australian study, and they said, "Well, look at this randomized control trial where they, you know, looked at high saturated fat versus low saturated fat, and there wasn't a difference," or, you know, that sort of thing. And one of the biggest problems with those studies is, you know, they're two years, which is a really long time for a randomized control trial. But when you're talking about a disease that is a, a lifetime exposure, two years in people that are in their 40s, I mean, you're just not gonna have that many incidences to pick up on. So when you're looking at Mendelian randomization, you can get around that because you're looking at people across their lifetimes. And the way I kind of explain... A- and I don't consider myself a lipid expert, but the way I try to explain, like, lifetime exposure risk is imagine if you and I start investing.
- PAPeter Attia
Yeah.
- LNLayne Norton
Right? And you get in at 8%. We both invest $10,000. You get in at 8%, I get in at 6%. If we look after a year or two, I mean, you'll have more, but it, it won't-
- PAPeter Attia
Barely, yeah
- LNLayne Norton
... it won't be, like, statistically different, right? But if we look at 40 years, you're gonna have a lot more, and I don't know how much exactly, but my guess is it's gonna be magnitudes of times greater because you're, again, lifetime exposure.
- PAPeter Attia
Actually, I've done this exercise, and it was initially in my book. I actually used this exact analysis.
- LNLayne Norton
Oh, really?
- PAPeter Attia
Was $1,000 invested at, I think I chose 6% versus 4%.
- LNLayne Norton
Uh-huh.
- PAPeter Attia
Or maybe it was even six versus five. It was something that was small enough that at five and 10 years wasn't enormous, but at 40, 50, and 60 years was staggering.
- LNLayne Norton
Yep.
- PAPeter Attia
And that was the exact point, which is the cumulative effect of compounding over a lifetime is so nonlinear that I don't think we are capable of understanding it. Like, I don't think we can ever cognitively realize it until we literally just do the calculations and they're-
- LNLayne Norton
Yeah
- 2:12:16 – 2:18:18
The carnivore diet, elimination diets, and fruits and vegetables
- PAPeter Attia
What is the argument? Uh, uh, let's talk for a moment about the carnivore diet.
- LNLayne Norton
Mm-hmm.
- PAPeter Attia
Uh, obviously for people listening, it's a pretty straightforward explanation. It's a diet where you only eat meat.
- LNLayne Norton
Right. And I've, I've heard some versions now where people eat honey and fruits and whatnot, which I'm not sure how that's carnivore anymore, but-
- PAPeter Attia
Okay
- LNLayne Norton
... in any case, um, I would say that's a little better. Uh, but so the argument against-
- PAPeter Attia
Or what's the argument in favor of that? What do they propose as the reason to do it?
- LNLayne Norton
So the reason to do it is, I mean, it's basically anecdotal. People have done this and they've seen this, right? And of course, like you could absolutely lose weight doing something like that. Um, some people have said-
- PAPeter Attia
Seems pretty easy to see how you would lose weight only through the lens of dietary... A strict enough dietary restriction is going to ultimately reduce intake.
- LNLayne Norton
Yeah. I mean, how much meat can you eat-
- PAPeter Attia
Yeah
- LNLayne Norton
... even if it's fatty meat, right?
- PAPeter Attia
Yeah.
- LNLayne Norton
Like so... And, and the justification being, "Well, I, I still go to the bathroom just fine." It's like, well, that's not why you should eat fiber. I mean, yeah, it helps, but that, that's, that's the last reason to eat fiber in my opinion. Um, so the, the, they also... Some people have said, "Well, it helped clear up some autoimmune issues." That's hard to quantify. Um, and some people say, "Well, like it lowered my inflammation and, and, and, uh, my GI problems." So this is one thing a lot of people get mixed up. They'll get like bloated or have GI discomfort, and they equate that with inflammation. Yeah, you may have like some cis- you might have some like some localized inflammation, although it's probably based on what we know about like IBS and whatnot, it's probably just like, like barrow sensitivity. But that's not the same thing as like, uh, uh... What I'll usually say is, "Well, did you get your CRP measured? Like, did you get your IL-6 measured?" You know, that's inflammation. When we talk about inflammation, that's what we're talking about. Now-
- PAPeter Attia
But, but how do you make... Let's assume that they, that all those things are true. Let's assume that I went on a carnivore diet and my actual biomarkers of inflammation improved and my symptoms improved I don't know what the number is, but if you think of the average number of foods a person will eat in a given week, different foods, let's posit that it's in the tens.
- LNLayne Norton
Mm.
- PAPeter Attia
Maybe 100.
- LNLayne Norton
Yeah.
- PAPeter Attia
If you eliminate all but one of them, it's not a good experiment to... Y- you haven't really learned a lot. You've learned that something in those 99 might have been the problem.
- LNLayne Norton
Yep. So-
- PAPeter Attia
That's a, that's a hard way to learn that
- LNLayne Norton
... so one of the things I've said that I think a lot of people are getting benefits is they're basically doing an elimination diet.
- PAPeter Attia
Yeah.
- LNLayne Norton
Right? So the, the... For the most part, most people don't have sensitivities to meat. Um, but, like, I think many people just not being in tune with their body probably have, uh, you know, IBS, um, FODMAP sensitivities, where they're, uh, fermenting a lot of fructans and oligosaccharides, you know, those sorts of things, and that fermentation for people with IBS is, is even though it's a, um, a healthy thing because, you know, bacteria getting fuel from fiber is a healthy thing, if it's causing pain, they're equating that with being, you know, something negative, which obviously we don't want anybody to be in pain.
- PAPeter Attia
I still believe that there are a lot of people who have wheat sensitivities that are not full-on gluten sensitivities, that don't rise to the level of celiac disease.
- LNLayne Norton
Yeah, it's possible. So it's one of those things where they eliminate all plants-
- PAPeter Attia
Everything, yep
- LNLayne Norton
... and they go, "Well, I feel better." Okay. Well, now the next step should be-
- PAPeter Attia
Should be addition, yeah
- LNLayne Norton
... let's start adding things back in one by one, and let's figure out what's actually causing those problems. So what I would submit to people is, like, still try to include fruits and vegetables and just slowly add them back in and, and see what works for you, um, because I think, a- and this gets into kind of like dietary protein and longevity, I, I think a lot of this, this negative perception of animal protein with longevity and, uh, health is people who eat high amounts of animal protein, these aren't people, for the most part, they're not eating, like, lean cuts of sirloin and chicken breast and whatnot. People who are eating high meat are typically eating high amounts of processed meat, and they eat less amounts of fruits and vegetables. In fact, there's a really classic study, uh, in my opinion, from Maximoff in 2020, and they looked, I think it was quintiles, so four, uh, different, uh, serve- like serving amounts of fruits and vegetables and four serving amounts of meat, so lowest to highest, right? And when you look at, like, low vegetable intake, there is, like, a linear effect of, uh... Or sorry, if you look at, like, going from high to low vegetable intake, linear effect on the incidence of cancer. Um, and meat, as you go up in meat, not correcting for fruits and vegetable intake, you have a linear effect of, of meat on cancer. But guess what happens when you couple the highest quintile of meat intake with also the highest quintile of fruits and vegetable intake? There's no effect. Like, the, the... You have the same risk for, uh, cancer with high meat and high fruit and vegetable intake as you do with low meat and high fruit and vegetable intake. So to me, that suggests it's less about the meat you're eating and more about what you're eating it instead of.
- 2:18:18 – 2:24:02
Fiber: Layne’s approach to fiber intake, sources of fiber, benefits, and more
- LNLayne Norton
mitigate your risk.
- PAPeter Attia
Now, you said you're getting about 40 grams of fiber a day?
- LNLayne Norton
Uh, I'm around 60.
- PAPeter Attia
60.
- LNLayne Norton
50 or 60.
- PAPeter Attia
And that's total soluble and insoluble?
- LNLayne Norton
Yeah, it's total soluble and insoluble.
- PAPeter Attia
And so what are your sources? Where do you get the, the... Like, what's the main foods that are contributing to that?
- LNLayne Norton
So, uh, I'll do, like, a lot of riced cauliflower. Um, I'll do quite a, you know, broccoli, uh, some beans. I'll also do, uh... I love apples, so that's kind of my go-to fruit source.
- PAPeter Attia
How many grams of fiber in an apple?
- LNLayne Norton
Um, I want to say it's like three or four grams.
- PAPeter Attia
Oh, that's it.
- LNLayne Norton
Maybe a little bit less than that.
- PAPeter Attia
Okay.
- LNLayne Norton
It's not a huge amount, but, like, if you want something a little bit more packed, you know, like berries. Berries tend to be really fiber dense-
- PAPeter Attia
Mm
- LNLayne Norton
... uh, compared to something like apples. Uh, you know, like something like ban- like a banana is a fruit, but relatively low fiber, all things considered. Uh, but even, like, the, the higher sugar, lower fiber fruits are still, like, relatively well associated with good health outcomes. So a- and then honestly, like, people are gonna laugh and be judgmental, I love popcorn. So popcorn actually is pretty darn high fiber.
- PAPeter Attia
More than corn on the kernel per kernel basis?
- LNLayne Norton
Uh, I don't know about that, but-
- PAPeter Attia
'Cause I feel like you could eat more corn than popcorn.
- LNLayne Norton
Oh, yeah.
- PAPeter Attia
Yeah, yeah.
- LNLayne Norton
Yeah, yeah. So popcorn's actually very filling. That, that's one reason I li- I got into eating it during bodybuilding competitions. Like, obviously, like, um, I would just, like, air pop popcorn.
- PAPeter Attia
Mm.
- LNLayne Norton
And I'll usually, like, put a little bit of cinnamon and Splenda over that, and then, like, a little bit of, like, the, the butter spray. I mean, it takes you, you know, for 50 grams of carbohydrate from popcorn, it'll take you, like, 20, 30 minutes to eat it, you know? So I just found that that, like, helped me control my hunger. Uh, and in 50 grams of popcorn, you're getting around, like, 6 to 10 grams of fiber, depending on the specific, you know, brand you're using.
- PAPeter Attia
[laughs]
- LNLayne Norton
So that's actually, like, I love that as a snack because it's like, it's, it's, you know... Is it as healthy as if I had some fruits and vegetables? Probably not, but, you know, as far as a snack goes, it's, you know, pretty good and, and very filling. So I do that. And then like just miscellaneous sources throughout the day. Um, but I think one of the things to really look at is, you know, people... I, I was in a debate with Paul Saladino one time, and we were talking about fiber, and one of the things he said, well-
- PAPeter Attia
And he's a big carnivore advocate
- LNLayne Norton
... big carnivore advocate. One of the things he said was, "Well, you know, this stuff with fiber is just healthy user bias. People who eat more fiber are, you know, they just have other health-promoting behaviors." Now, that's a real thing in terms of like cohort studies and cross-sectional data, observational data. It is a real thing. But when you're dealing with something that's kind of a healthy user bias, typically you'll see, like, the data's not consistent, right? Like some-- one study will say one thing, one study might have no effect, one study might say a different thing.
- PAPeter Attia
Yep.
- 2:24:02 – 2:33:18
Confusion around omega-6 polyunsaturated fatty acids and the Minnesota Coronary Experiment
- PAPeter Attia
So let's, let's talk about one other sort of macronutrient or subset of macronutrient, which is polyunsaturated fatty acids, right?
- LNLayne Norton
Mm-hmm.
- PAPeter Attia
So, so this is one of those things I always tell people, um, there's nothing in nutrition that I'm more confused about-
- LNLayne Norton
[chuckles]
- PAPeter Attia
... than the role of, uh, omega-6 PUFAs.
- LNLayne Norton
Yeah.
- PAPeter Attia
So let's go back to that Minnesota Coronary Experiment that you mentioned. It's, it's a very unique experiment, probably never to be replicated.
- LNLayne Norton
No, no IRB would ever approve it again.
- PAPeter Attia
And, um, I'm still trying to track down Chris Ramsden, who wrote the f- like paper that looked at all of the data that were never published in Franz's first study. But I'll, I'll retell the study to the best of my recollection, which is r- super foggy at this point. So this was a study carried out in Minnesota. Please correct me if I'm missing any details. [lip smacks] Um, it was carried out in, um, an assisted living or mental facility.
- LNLayne Norton
Mental facility.
- PAPeter Attia
And it might've been two arms.
- LNLayne Norton
Yeah.
- PAPeter Attia
I can't remember. Um, what makes this special then is that the subjects in this study were fed every meal. So what makes this a really unique study is that it was not a free-living study, though it had free-living duration. I wanna say the average duration was three years.
- LNLayne Norton
It was just over two, I think.
- PAPeter Attia
Was it? Okay.
- LNLayne Norton
Yeah, just over two.
- PAPeter Attia
So-
- LNLayne Norton
The study was five years.
- PAPeter Attia
Yes. Yeah.
- LNLayne Norton
But the average-
- PAPeter Attia
But the feeding intervention was only two, two-ish
- LNLayne Norton
Well, I think because people were kinda going in and out of the facility-
- PAPeter Attia
Uh, got it
- LNLayne Norton
... the average subject duration was about two-
- PAPeter Attia
Okay
- LNLayne Norton
... two and a half years.
- PAPeter Attia
So for this period of time, every meal is being fed, and there's... Patients are randomized into two groups. Isocaloric, isomacro, but at the fat level, one group was high saturated fat, one group was low saturated fat. If I recall, the, the reduction in saturated fat was not trivial. It was 30%. Uh, what was it? Uh, 18.5 is a number that sticks out in my mind, and I can't remember, but do you remember the exact-
- LNLayne Norton
It was significant.
- PAPeter Attia
Yeah.
- LNLayne Norton
I don't remember the exact number, but you're... Like it, it was-
- 2:33:18 – 2:39:30
Layne’s views on fats in the diet
- PAPeter Attia
So what... How do you think about the breakdown, not the breakdown, but what I mean is the distribution of how one should think about distributing their fats?
- LNLayne Norton
So I've actually have seen some epidemiology that showed that PUFAs were actually lowering events more.
- PAPeter Attia
No, that's what I'm saying. Yeah.
- LNLayne Norton
Yeah.
- PAPeter Attia
That's what I'm saying. The PUFA data look like it's more favorable than, than the, the SFA.
- LNLayne Norton
Well, even then, uh, monounsaturated too.
- PAPeter Attia
Ah, okay, okay.
- LNLayne Norton
I've seen some of that as well.
- PAPeter Attia
Yeah, yeah, got it.
- LNLayne Norton
But I mean, again, you're dealing with cohort data and whatnot.
- PAPeter Attia
Yep.
- LNLayne Norton
We all know the limitations there. Uh, as far as the Minnesota, uh, coronary study, I think... I get really... [sighs] I'm probably gonna s- it's probably gonna sound like a cop-out, but I've really gotten to the point after seeing just so many random events and studies where I go, "I don't know what one study means."
- PAPeter Attia
Yeah.
- LNLayne Norton
No matter, no matter how well done it is.
- PAPeter Attia
How well it goes. Yeah.
- LNLayne Norton
Um, now I have seen studies that were so compelling that it, I swayed my opinion a little bit, but it was usually because there was also other contextual data that made sense. The way this one kinda came about, it's like, like you said, we don't really know how to reconcile this because even if you look at some of these omega-6 fats-
- PAPeter Attia
Yeah
- LNLayne Norton
... and I think one of the, one of the big mechanisms that's been proposed is, well, they're gonna increase inflammation because those, uh, those double bonds can be oxidized, and oxidation cause inflammation. But if we look at the hard outcome data in randomized control trials where they give like linoleic acid or alpha-linolenic acid or whatever, I mean, you just don't see inflammation go up if, if they're not increasing total calories, right? Um, in fact, you usually, especially if you're replacing it for saturated fat, sometimes you see inflammation go down.
- PAPeter Attia
Mm.
- LNLayne Norton
So I just don't... Honestly, this is one of those things where I go, "I don't really know what it means." And I think, um-
- PAPeter Attia
So I don't feel bad now saying I literally don't know what the answer is.
- LNLayne Norton
Yeah. [chuckles] Yeah, I mean-
- PAPeter Attia
I, I just have no clue on this one.
- LNLayne Norton
Uh, I think it's one of those things where it's you kinda have to look a- at the weight of the evidence and then couple that with some of the mechanistic evidence and look at the, you know, the, the human outcome mechanisms we can see, which is, okay, maybe we can't do a two-year randomized control trial, but 12 weeks is enough time to see differences in inflammation if something's gonna cause a difference in inflammation.
- PAPeter Attia
Mm-hmm.
- LNLayne Norton
So we can look at that. I don't know if that was, um, his main mechanism that he proposed for how it was occurring.
- PAPeter Attia
It was absolutely one of them. Yeah. Um, God, it's been so long since I looked at his bigger BMG pap- uh, uh, BMJ paper. Um, so I don't, I don't wanna... We'll attach to the paper in the show notes so people can kinda go through it. He actually, if I recall, I can almost picture it. There's a figure that kind of actually kind of nicely walks through what the proposed mechanisms are.
- LNLayne Norton
So I think the other thing to consider is, like, we just talked about how when you suggest cutting something out, you replace it with other things. And I think, I think in the last 20 or 30 years, the biggest contribution to added calories in the diet is actually added oils. So on a per calorie basis, I, I don't think that there's like... You know, the, the big demon right now is seed oils. Like, that is like... I haven't even done a post about it yet because the anti-seed oil crowd is just so vitriolic and so nuts that I'm like, "All right. How, how, when do I wanna wade into this conversation?" But, um, I think that-
Episode duration: 3:13:40
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