Peter Attia MD294 ‒ Peak athletic performance: How to measure it and how to train for it
EVERY SPOKEN WORD
150 min read · 30,011 words- 0:00 – 1:29
Intro
- OBOlav Aleksander Bu
I could not agree more with you on that VO2 max is probably or still today the holy grail for understanding basically longevity or, or, or let's say the best marker or metric we have in order to quantify it. Because to, to j- to just elaborate a little bit further on that, you can also say that, well, VO2 max is a measure of something, so we are measuring something i- in the end there. Uh, but we c- and [laughs] to be a little bit crude, uh, you could say that, okay, fine. You... Some people could say, well, having a good, having a good heart, having a good heart i- is a good predictor of, of, of, of, uh, longevity, for example. But I'm pretty sure we can find people that are in the bed and they are r- really sick that still have a really good heart. So obviously that, then, then you understand that, well, there have to be more nuances to this than just the heart itself. You can have people that has a great heart and, uh, everything looks good, lungs perfect, everything like this, but they have neurological diseases, for example. All of these will limit you from reaching a high VO2 max, which is again, so integral. It basically just encompasses all this kind of... Because you can't reach a high VO2 max if any of these functions here are not good.
- PAPeter Attia
[upbeat music] Hey everyone, welcome to the Drive podcast. I'm your host, Peter Attia.
- 1:29 – 8:03
Olav’s background, expertise in exercise physiology, coaching experience, and interest in the extremes of human capability
- PAPeter Attia
Olav, thank you so much for making time to sit down with me today. Um, I ha- I'm, I'm really excited about this, uh, episode, and I'm gonna try to contain my own enthusiasm such that the, uh, people listening to this will understand what we're talking about. Because, um, the topic we're gonna go into today is really one that fascinates me to no end. Um, but more than that, you are someone who brings a level of expertise that is so high that it really allows me to, um, kind of engage at a level of curiosity that I rarely get to engage in. And I don't think I've taken more notes coming into a podcast than I have for this one. I fully expect we will not get through half of what I've written down in terms of topics that I want to explore. But, um, nevertheless, I'm going to apologize in advance to you and to everybody else for just how, uh, enthusiastically I want to address the subject matter of human performance. Perhaps before we get into that though, maybe you could just tell folks who ass- let's assume pe- you know, people don't know anything about you and who you are, Olav. Um, just tell them who you are, what you do, and the types of athletes that you work with.
- OBOlav Aleksander Bu
Uh, okay. So to try to make a liner story, uh, I actually grew up on a farm on the west coast of Norway. Uh, I had to participate in, uh, uh, a lot of work at the farm when I was a kid. I did... Uh, let's say ag- against my will.
- PAPeter Attia
[laughs]
- OBOlav Aleksander Bu
Because I saw my, my neighbors and others were playing and, uh, I would very much like to do that as well. But I think in, uh... or for sure in my, uh, now today and already s- long time ago, I already started to really appreciate all, uh, all the wor- or, or the hardship more or less. But, uh, fast forward, f- fast forward, I, I already developed a very, uh, keen interest for, uh, technology already as a kid, and I was extremely curious. I, I lo- I liked to really pick things apart and, and understand how things were put together. Uh, fascinated about everything from the universe and rockets and, a- and, and so on. And of course, uh, living at the farm, you also get, uh, the possibility to pick apart a lot of machineries and all the things and see how this is working. And so being with animals, I, I have a very strong connection with animals. Uh, but, um, I, uh, I also started to develop, as I started to grow a little older, I started to get, uh, get very interested in more, uh, things that were more extreme. I had an attraction towards things that were extreme. So extreme sports typical were a thing that I really, uh, that resonates, uh, a lot with me. Uh, um, I... Um, there are probably no extreme sport I haven't participated in on, uh, call it on a okay level. Um, uh, but, uh, yeah. Then I, uh, took my degree in, uh, electro techniques, uh, went on to engineering, found out that, um, I was not cut for the four... or let's say eight to four, uh, working style. Uh, for me it was more about entrepreneurship. I, I like to build things, innovate new things, solve things that nobody have solved before, that, that... those, again, a little bit extreme. Things that basically are abstract really, really fascinates me. So in, uh, in 2011, there was an event happening in my life. This was after I actually started my... I had started my second company. We were into the mountains. Uh, we... there we were... we had to use helicopter to get into the mountains. Uh, there was a big, uh, or basically had, um... Yeah, half my family died, uh, on this, uh, trip into the mountains. Uh, again, uh, um, it made a shift in my life. Uh, and, um, uh, I decided, uh, to, uh, um, for, for, for various reasons, I got into more int- even more into sports. So I was then asked to start to combine the field of exercise physiology and technology, or my, my strength in, uh, uh, in technology and see whether we could start to take more of, let's say more research. A lot of the research that typically happens in laboratory settings and/or even in microbiology, where you're taking out components and looking at how does it react. But we very rarely are able to transform that back into humans in a way that makes us the same difference. So how could we now study people, use technology to study people, uh, especially elites, for example, in the setting where they normally exercise and even use that to co- to continue to drive performance. And then- Of course, today, uh, uh, two of my personal athletes, or three of my personal athletes, uh, Kristian Blummenfelt, Gustav Iden, Kenji Nino, and they are, uh, they hold, uh, all the records that are, are in, in triathlon. Short course, long course, uh, Olympic medal, uh, world championship medal, short course, um, are- the Ironman World, uh, World Championship, 70.3, and full distance from, uh, from Kona and St. George, uh, last year. And, um, yeah, it's been an incredible journey because I... One thing is, of course, what I have contributed to with them, but I really like a collaborative, collaborative way of working, so I learn always from them as well because I'm very curious about how they, how they feel, what they see, how they perceive different things, because there is a lot of things we can measure with data, and there is a lot of things we can't measure with data still. So you need also to that conte- that context as well. And, uh, mainly today, I, I have, um, I- we are actually building a company where we're scaling these companies using AI, so numerical models, large language models, into a company called Enthalpy. I like physics, of course, so enthalpy and, and, and, and, and, uh, and thermodynamics are some fundamental laws humans can't escape-
- PAPeter Attia
[laughs]
- OBOlav Aleksander Bu
... no matter how unique we think we are. And then on the other side, I work also as a coach for coaches mainly, so I'm more coaching coaches at Olympic level, uh, world tour level, um, racing, uh, at the highest levels. So, uh, yeah, that's, uh, um, a long introduction, uh, uh, yeah, on, on me.
- 8:03 – 19:50
The processes of energy conversion within the human body and its implications for performance
- PAPeter Attia
Well, let's start with some fundamentals because we're gonna spend a lot of time today talking about extreme performance, uh, and peak performance around the types of sports in which you're coaching athletes. So, you know, the triathlete is kind of a remarkable athlete in several levels. The first being that he or she must be very good in three disciplines that are related, but quite distinct. Uh, different body types. If you look at the world's best swimmers, the world's best cyclists, and the world's best runners, they actually have quite different physiology depending on the distances they race, and certainly different methods of training. And the triathlete therefore has to be really respected because they have to be almost world-class in each of those things to be world-class in their sport. Um, and, and their physiology as a result of that is remarkable, and there are so many things that we're gonna talk about today, including temperature management, energy expenditure, energy consumption, all of these things. That said, I'm gonna... You know, I, I wanna make sure that the listener is able to follow where we go, and we're gonna get into some really serious weeds, right? We're gonna talk about MCT transporters for shuttling lactate out of cells and all of those things.
- OBOlav Aleksander Bu
[laughs]
- PAPeter Attia
Um, because that's where I wanna go, but I wanna make sure people understand the fundamentals, the very basics. So, um, humor me as we go through kind of the 101 of ATP production and utilization. So, um, you and I are sitting here right now having a discussion. And, of course, our body is converting all the while chemical energy into electrical energy back into chemical energy, and it requires the substrates of oxygen and hydrocarbons to do that. Can you explain a, you know, in a little bit of detail exactly what that process looks like for us right now as we're sitting here under obviously a very low physiologic demand?
- OBOlav Aleksander Bu
So you... On, on a very deep level, or do, do you want more like a high level?
- PAPeter Attia
Let's start high level.
- OBOlav Aleksander Bu
Okay. Uh, so, um, w- I think one of the things, uh, Roche, uh, they made, um... There, there's a really beautiful, uh, map, call it a map, uh, made by Roche. I think it's called Roche. Roche, Roche. They, they are a medical supplier of m-
- PAPeter Attia
You mean the, uh, the, the Swiss pharmaceutical company?
- OBOlav Aleksander Bu
Yes.
- PAPeter Attia
R-O-C-H-E. Yeah. Yep.
- OBOlav Aleksander Bu
Yeah, exactly. So they, they made a really beautiful, uh, a really beautiful, uh, map, which is still not exhausted. We, we, we all-- We are s- We are continuously learning new things that we can add to this, uh, map, and this map is called... There are two maps they basically distinguish between, and there's one that they call the metabolic pathways, another one they call the signaling pathways. And on the metabolic pathways, we have, of course, many ways that we can, uh, convert energy from, uh... So we-- Mainly, of course, it's, it's, it's proteins, it's, it's fats, it's carbohydrates that we are converting basically from a substrate or from the food that we, we ingest and we store in our body to then basically ATP, which is the main fuel source that the muscles or different muscles in the body are using or different functions your body is using in order to survive. And of course, to convert those substrate also into ATP, also there's oxygen required. But there are many, many different pathways, and the problem a little bit-- a problem a little bit with this as well is that even though, even though this is a field which we have, uh, studied quite a lot, we are still learning more, and we don't fully understand it still either. And that's why very often actually to, to bring it up maybe to where I think is more useful very often to work on this, is that if you dig too much into some of these different things that you lose track- You start to lose track exactly of how do you increase performance of somebody as well. Because it, to, to use another example, today we have, for example, smartwatches and other things as well that are trying to say something about our sleep, and it's, it's derived or inferred basically from movement from your, from your wrist, for example, and it's based on HRV. But the problem is also when we're looking at, okay, what is performance? So if you say the calorimetry... So again, back to thermodynamics or fundamental laws. On the one side, humans needs to move. That's what we do. So we're sitting here now in these chairs. We're moving around. We're mo- I'm moving my, or gest- gesticulating with my hands and these kind of things. We are nodding with our heads. Um, and all this requires energy in order to do that, and that's movement. You could, you, you can track this movement. You could even have quantified it, uh, i- in centimeters or meters or whatever over a day for each of our components or globally when we are running, for example, uh, the distance we cover. Um, but in order to do so, of- obviously there's, we need an energy source. We need energy from somewhere, and of course, the currency for the muscles or for anything in our body is basic ATP. But in order to create ATPs, then basically we need, we need different substrate to be broken down. And in order for combustion to take place, we need oxygen. This is the f- like most people probably remember the fire tri- triangle, where basically you need, you need oxygen, you need a temperature, and then we need something to combust. And of course, uh, oxygen is probably the most practical way today, of course, to measure exactly how much energy are we using at a any given time. And then, of course, we can always start to break this down and try to understand how much ATPs, uh, th- this release or what is the energy yield from, from that amount of oxygen. But this is also highly diff- different also in humans. Some humans will be more efficient, and typically elites are very efficient at this, while, while normal population will probably be less efficient at this, uh, to create energy. So typically then to, to round that up, I would say that very often, or the way that I very often do it work today, is to, to not lose track. Because on the same o- on one side, of course, I have a large team around me with people that are, uh, extremely, uh, good at this. One of the researchers that, uh, that I work with, he was just actually now recognized as the number one researcher in the cycling world, uh, this year. Uh, um, uh, but, uh, and they are digging a lot into everything from enzymatic activities to how energy is being released and so on. How can we do this better? But one thing that I found very much more useful i- is actually that we need sometimes just to black box this, and we have to remember what is important there.
- PAPeter Attia
Mm.
- OBOlav Aleksander Bu
So we know, we know movement is the most important part to humanity, so being able to move. If we can sit at work, we can sit at the podcast, but then basically a- afterwards this, we still have an energy surplus that allows us to come home and move around with our kids and play and be kind to our wives and, and help them out at home and so on. That is, that's a situation we all feel good with. That's what we all want. So then the question is, how do we do that? So how, how can we, how can we track different parameters to understand how we can get there? And this is where I think very often that looking at more of, let's say, humans as an engine or as, as a machine, where you say, okay, there's an, there's a fuel and an energy input. So you look at oxygen consumption, for example, because this you can do with a car, uh, even with a car. And then you look at, okay, you have power. So most people will probably have a power meter, but if they are cycling and a little bit more. If you don't have, it does- it really is not that important because anyway the, the, the output from this process will be distance per time. And one thing that we see also between, let's say, less trained people or people that are... Yeah. Or put, put another way, people are putting in less volume into their training is also that very often in order to con- to do a certain amount of work, or let's say moving a certain distance, has a higher, has a higher oxygen cost or basically a higher calorie cost for them to move that distance as well, distance as well. So I think on the one side, I'm very fascinated about breaking down things into the, let's say, the smaller details. But the problem is that we have a limit to how much time we have available, and how do, how do we then make sure that we get the best? Or how can we then make sure that the things that we do, the interventions we plan, the, the, the changes we make to, uh, our lives, how can we then quantify what it has an effect? One, of course, is the ultimate measurement of, of, of this is ultimately distance per time. But in order to understand what mechanism are actually happening here now, we can measure, of course, if you have a power meter or power meter technology, we can start, is it biomechanically driven? So are you improving your biomechanics? Or we can look between power, so work basically, and, and, and, uh, and calorimetry. Is it the biochemical part that is improving? And we can even then decide just to say, okay, we black box it. We don't necessarily need to understand it because we can see whether things are improving or not improving. If it, it does improve, continue to do more of it. If it doesn't improve, then we basically say, okay, uh, fine. Uh, we can dig more deeper into it. And that's where, of course, we have, uh, specialists and others around us that basically are trying to understand exactly what is happening on a deeper level. Uh, yeah.
- PAPeter Attia
So let's, let's use some real examples on that, and I wanna just kind of synthesize what you said a little bit 'cause it's, it's very interesting. So one of the first things you said is, look, um, the metric that matters is velocity. You, you described-
- OBOlav Aleksander Bu
Yeah
- PAPeter Attia
... it as distance per unit time, but of course that's-
- OBOlav Aleksander Bu
Yeah
- PAPeter Attia
... that's, that's, that's velocity.
- OBOlav Aleksander Bu
Exactly.
- PAPeter Attia
So, um, if you're a runner, if you're a cyclist, if you're a swimmer, if you're a triathlete, the winner and loser is determined by velocity, not power output, not any other metric.
- OBOlav Aleksander Bu
Exactly.
- PAPeter Attia
Yeah.
- OBOlav Aleksander Bu
Exactly.
- PAPeter Attia
So, um, obviously there's a very strong correlation between power normalized to weight and velocity, but it is not one-to-one, and, um, I, I'll use an example. Um- Especially in a triathlon or a time trial where aerodynamics matters significantly, you can have people that put out more power, but they create more drag, and obviously that's very true in swimming as well. In running, obviously there's running efficiency that can speak to energy expenditure versus velocity. So velocity is king. [lips smack] I like the way you kind of broke it down into two drivers, right? You can have how efficient are you at using the energy source to make the ATP, what is your loss ratio there. So presumably, majority of that energy is lost in the form of heat, uh, but some of it, of course, is... And we typically, I remember, used to use like a one to five ratio, so you could sort of take the number of kilojoules, divide by five. That was approximately going to be your energy expenditure, but let's come back to that because that's obviously very crude. But then you said, "No, no, no. Look, you also have to be equally focused on your mechanical efficiency." That gets to what I just talked about. Uh, first of all, is that a reasonable th- synthesis of what you just said?
- OBOlav Aleksander Bu
Yeah, and you can split that also into... Because here it, it helps to, when you look at mechanical part, it's also when you s- look between power and velocity, then you can, of course, say that one component is, of course, the biomechanical part, but another part of it is also the, is also the work economy or where you basically look at equipment, for example, so aerodynamics and other things as well. So there are two, two, two component. But, but purely if you look at the human locomotion, it then basically it's ex- exactly like you, you, you break it down. Yeah.
- 19:50 – 36:34
Improving movement efficiency, and the importance of mindfulness in training to optimize performance
- PAPeter Attia
I'm gonna share with you one really funny example before we come back to this. So, so 10 years ago, back when I used to ride a bike and, and the only thing I would do was time trial. That was my favorite event to do. And one of our favorite-- I had two partners that I trained with who were both much better than me, collegiate cyclists. Um, [lips smack] and we used to do this workout every Saturday, which was a f- an 80-kilometer s- ride on a time trial circuit. So it's, you know, closed off, it's flat, it's, you know, it's a... I think the, each loop was maybe seven or eight kilometers. But here was the thing we used to do. [lips smack] We used to not allow our, l- allow ourselves to go over 200 watts, so we had a power meter, and, you know, the SRM will tell you exactly what your wattage and your average wattage is. So you had to keep that average watt at 200, not 201, not 199, and each week we would see if we could get faster and faster while keeping the wattage at 200. And as you know, 200 watts is not a lot of watts, of course, so it was not hard to hold that for the 80 kilometers. But, you know, over the span of a year, I think, if I remember correctly, we were able to increase our velocity from maybe, [lips smack] I wanna say, like 20 and a half miles per hour to maybe 22 miles per hour, which is a very significant improvement in efficiency. And I'm curious, how much of that do you think we did by getting better in our CDA, our coefficient of drag times frontal surface area, uh, which I, I will tell you didn't require new equipment? And then how much of that do you think we did metabolically? In other words, that we metabolically got better at turning energy into, uh, power.
- OBOlav Aleksander Bu
Uh, so first of all, of course, when you have a power meter, you don't know how more metabolically, uh-
- PAPeter Attia
Right
- OBOlav Aleksander Bu
... equi- uh, say, uh, uh, how much the meta- metabolic efficiency increased-
- PAPeter Attia
Right. We're, we're missing-
- OBOlav Aleksander Bu
Because-
- PAPeter Attia
We, we missed the VO2 data
- OBOlav Aleksander Bu
Yeah. Yeah. Exactly.
- PAPeter Attia
We have no idea what oxygen consumption did in that year. That's right.
- OBOlav Aleksander Bu
Exactly. So, so that part is, is, is, is not a part of the equation. But if you look at, uh, work economy, then I think there are, there are a couple of things there. Mainly, of course, since a power meter on a bike, like the SRM, only measures the, let's say, the net mechanical power. So it basically only measures the, the, the component of power that actually goes in the direction that you are actually moving the crank arm.
- PAPeter Attia
Yep.
- OBOlav Aleksander Bu
And of course, already there are two, there are two components, but that, that, we don't have to focus on that here, but that's where the difference between net mechanical power and gross mechanical power comes in, of course. And, and, uh, and maybe, I don't know, maybe we touch even further on this because there are also several ways to produce 200 watts as well, because you can also have a very large intra-cyclic power also to-
- PAPeter Attia
Oh, no. We-- Sorry, I should make this point. We-- The goal was to keep average power and normalized-
- OBOlav Aleksander Bu
Exactly
- PAPeter Attia
... power the same.
- OBOlav Aleksander Bu
Yeah.
- PAPeter Attia
So no bursts of power. Yep.
- OBOlav Aleksander Bu
Yeah. No, but, but even there, actually, what most people don't realize is that when basically your power meter shows 200, 200 watts, and you keep it super steady around 200 watts as well, um, you'll actually have inside one second or one revolution, for example-
- PAPeter Attia
Yeah
- OBOlav Aleksander Bu
... you'll already there have a variation of, uh, of, of power that is mo- that is, uh, closer to, uh, where you're... Let's say it's 200 watts. You will have a peak power production, I would say probably for you because of your focus and how determined you were there. Probably you were sitting on the n- on the nicer side of it, but I wouldn't be surprised for some people riding 200 watts to be pushing, uh, 1,000, uh, 1,200 watts, for example, peak throughout every single revolution.
- PAPeter Attia
Wow.
- OBOlav Aleksander Bu
Yeah.
- PAPeter Attia
Wow.
- OBOlav Aleksander Bu
So this is something we, this is something we already quantify by the power meters. But-
- PAPeter Attia
Got it
- OBOlav Aleksander Bu
... since we don't s- but since we don't have to focus on that part here because you're measuring the locomotive part of the power component, then I would say there is a couple of things that is very interesting. One is, of course, that you say that you are already riding at the power output which is very comfortable, and I think that is important in many senses when you really want to work on your work economy for here. Because here we also talk-- Here we are main- we have already excluded the biomechanical part of it. Because since you are not looking at the difference between gross mechanical power and net mechanical power, then we are already said that, okay, we don't care even about the biomechanical part. We are only looking now basically on, let's say, what is transferred into forward propulsion or velocity. So in this, in this sense, I would say that, I would say that, uh... But when you're riding 200 watts, what I think is really important and undervalued is that as the harder we go- More of our oxygen and blood will basically prioritized towards, one, driving the muscles forward, secondly also even more for cooling.
- PAPeter Attia
Yeah.
- OBOlav Aleksander Bu
And, and, and, and you hit it pretty, pretty spot on when you say there's a 20% efficiency. 80% heat, 20%. That's what we see pretty much for elites, not for, for, for, for, for, for people less, but as you said, we'll come back to that probably. So then basically, basically, uh, when you are focused on this, I think there, there are no better setting when you have, when you, when you ride at a little bit lower power, it allows you to be very mindful and cognitive present to your movement and how you are in the bike there and everything there, and this is some things that I, I see very often is a different between also the specialists and the triathletes as well. Because the triathletes are much more inclined to solve task brute force-
- PAPeter Attia
Mm
- OBOlav Aleksander Bu
... than the specialists are. The specialists are, because they, they simply have more time on lower intensity, medium intensity, and high intensities, or let's say especially lower intensities-
- 36:34 – 47:36
The relationship between VO2 max, power output, and endurance performance in different sporting contexts
- PAPeter Attia
Super interesting. Well, let's, let's start talking about some of these things. We've already alluded to VO2 and, and VO2 max. Um, and you've already made a very bold claim, which in the pool is easier to accept, but let's extend it now and let's talk about what it means on the bike and on the run. Because people who listen to this podcast have heard me say over and over again that VO2 max is the greatest predictor of lifespan. This is kind of a remarkable statement. Again, and I, and I'll repeat it because it is so profound. Whether you smoke or don't smoke, whether you have diabetes or don't have diabetes, whether you have end-stage kidney disease or don't, heart disease not, hypertension or not, all of those things play an important role in predicting the length of your life, but not as much as having a very high VO2 max. This rises above every other biomarker we have to predict the length of life. And the reason I argue that that's probably the case is that VO2 max is an exceptional integrator of work that is done. So for the few times I have patients that will tolerate the mathematical equation, I would say loosely speaking, VO2 max equals the integral from T1 to T2 of work as a function of time DT. And we know that that work is very valuable for your health, right? We can quantify why it is that exercise helps you live longer. Why is it good for the brain? Why is it good for the heart? Why is it good for the immune system? And therefore, VO2 max becomes a very reproducible way to document that work, and it can't be changed quickly, right? So it's not a cheap biomarker like vitamin D, where you can just take a bunch of, you know, vitamin D supplements and immediately change your vitamin D level. So with all of that said, when we get into the minutiae of exceptional human performance, VO2 max is not the best predictor. So l- l- let's put swimming aside because it's so obvious there, but why would it not be the best predictor of performance in something like cycling, for example, or running, where the aerodynamic contribution are-- in the case of cycling is easier to mitigate, still nowhere near as bad as swimming, and where the efficiency maybe isn't as important? So, so where do we see VO2 max not become the most important driver of endurance performance?
- OBOlav Aleksander Bu
So first of all, I, I could not agree more with you on that VO2 max is probably or still today the holy grail for understanding basically longevity or, or, or let's say the best marker or metric we have in order to quantify it. Because to, to, to just elaborate a little bit further on that, you can also say that, well, VO2 max is a measure of something, so we are measuring something i- in the end there. Uh, but we c- and [laughs] to be a little bit crude, uh, you could say that, okay, fine. You-- some people could say, "Well, having a good, having a good heart, having a good heart i- is a good predictor of, of, of, of, uh, longevity," for example. But I'm pretty sure we can find people that are in the bed and they are r- really sick that still have a really good heart. So obviously, that, then, then you understand that, well, there have to be more nuances to this than just the heart itself. You can have people that has a great heart and, uh, everything looks good, lungs perfect, everything like this, but they have neurological diseases, for example. All of these will limit you from reaching a high VO2 max, which is again, so integral. It basically just encompasses all this kind of... Because you can't reach a high VO2 max if any of these functions here are n- not, not good. So I, I, I c- I couldn't agree more with you. VO2 max is the absolute best predictor, uh, of mostly everything, uh, just because that it encomp- encompasses all these kind of things. Then on to why doesn't VO2 max become a very good predictor of performance in, in cycling? I would argue it does, but then we are also starting to reach some more limitations as well. You want to have as a high VO2 max as possible, even as a cyclist. The only problem is that we are now facing some other problems as well when you are, when you are an elite athlete, and that is something we call maximum sustainable energy expenditure. So obviously, to turn around more calories per time, that's, that obviously means also that over time you will use more calories as well. And this, in order now to support growth, you obviously have to input more calories also. Because you're burning more, you need to, to bring more in, otherwise you are starting to run into deficit and you worst case end up with problems. So feeding that, let's say, calorie consumption becomes crucial. Further, the problem is that, uh, VO2 max is closely related. So if we wanted to have a surrogate metric for, for VO2 max, we could typically do-- make an athlete run all out for, let's say, a couple of minutes, one to five minutes. Let's say three minutes-
- PAPeter Attia
Mm-hmm
- OBOlav Aleksander Bu
... to make it simple. Or we can have a, a cyclist do a three minute or four, five minute, but something, something short. Uh, not too short, but absolutely not too long. But like typically, typically-
- PAPeter Attia
Yeah, like four minutes is a pretty good spot.
- OBOlav Aleksander Bu
Exactly.
- PAPeter Attia
Yeah.
- OBOlav Aleksander Bu
Yes, exactly. This is again, a very good proxy to understand or as a s- or as a surrogate to understand, of course, what is your VO2 max as well. But then what we have to understand as well, that this is not necessarily what you need in, in Tour de France. You don't need to be the best four-minute, uh, four-minute athlete. This is more important for a track cyclist. A track cyclist that has the working time for four hour-- for four minute, then VO2 max becomes maybe the best predictor of per- performance again. So it's a little bit depending on context.
- PAPeter Attia
Yeah.
- OBOlav Aleksander Bu
But because we already said now there is another limitation here as well, and that is the maximum sustainable energy expenditure. How much energy can you expend on different, let's say, intensities in order to increase, let's say, this, the, the, the speciality of what you're gonna be good at? So if you are gonna be best in the world at riding 160 kilometers and then sprinting towards the finish line over a couple of hundred meters, you can even not argue that it's a sprint even. But let's say you are really going fast the last, last kilometers. The problem with this is that if you spend most of these en- that energy that you have available now to increase your, your VO2 max, you're spending obviously less time on specializing on what you're really gonna be good at. And you won't find a track cyclist that you can put into Tour de France and think that he will win Tour de France, and you won't find a Tour de France rider that you can put on a track and become the one kilometer or f- or, or one kilometer, uh, winner there, obviously because they are specializing on two different, two different durations. So simply because we have a limitation for how much energy that we can turn around per day, per week, and so on sustainably, because that's the key here, sustainably, it basically means also that we have to focus more on that exactly specificity that we are looking to excel in, and then, yes, VO2 max will still be the best predictor, but not necessarily having the highest number. That is maybe the, the, the, the, the diff- or let's say the, the, the, the nuance, uh, the nuance to it.
- PAPeter Attia
Y- yeah, and, and l- let's, let's stay with cycling, um, and even keep it simple and just talk about not include the track, right? Which is, you know, far more, far closer to an anaerobic effort. Uh, it, it's sort of on the anaerobic side of a peak aerobic effort. But even if you think about, let's go back to the, the, um, the, the distance of the 112-mile time trial that a triathlete is doing in an Ironman, right? So for the most part, I mean, it's, there's no sprinting in there. He's not sprinting at the very end. In fact, he's probably trying to keep that relatively constant in effort to prepare himself or herself to do the, the marathon run that's following. Um, even in that system, let's go back and talk about two athletes. If there are two athletes that have the same VO2 max, does power at VO2 max give you another layer of insight? So if, let's just say Kristian and Gustav each have a VO2 max of 80 milliliters per minute per kilogram, but one of them is doing that at 450 watts, and one of them is doing it at 425 watts, does that give you a new piece of information, or is it still limited because that's really only speaking to a four-minute, five-minute effort?
- OBOlav Aleksander Bu
Um, yes and no. Um, th- that is, of course, where you can black box, of course, a little bit. Now we, we, we just talk purely about VO2 max, may focus on that. But of course, there will be a fairly good lu- a, a fairly good correlation also between oxygen consumption, let's say, at VO2 max, because you, you could argue that there's really no power at VO2 max because it, like, as long as you are above, uh, what we call VO2 steady state. So y- you, you have a couple of different steady state situa- sc- scenarios. You have typically one that a lot of people knows about, which is the maximum, like the steady state. But then, of course, above there again, you have something called VO2 steady state, and at the moment you start to exceed over VO2 steady state, then basically it's just a matter of duration before you will basically elicit VO2 max. But obviously, the lower, the closer you stay to your VO2 steady state, the lower the power you will basically outputting. If you put out a too high power, obviously you won't be able to reach VO2 max because you will basically start, um, you will, you will start, uh, um, you will not be able to contract your muscles effi- efficiently anymore, and you won't be able to bring your ventilation or oxygen consumption up to a max. But there's a sweet spot there, more or less, where basically any power that sits between, let's say, uh, VO2 steady state and, and, and a higher, uh, um, let's say a higher power number, will elicit VO2 max. It's just the amount of duration that is needed in order to get there. So of course, this adds, let's say, a, um, um, a s- uncertainty because you need to know this, and you need to know this. I think it's important just as sort of listeners understands that you can't necessarily just go out and then you-- people start talking about power at VO2 max and their VO2 max because then suddenly people will get confused because you don't, you have to know also then what, what was the duration of it as well.
- PAPeter Attia
Yeah. How, how did you get there, and yeah, yeah, exactly.
- OBOlav Aleksander Bu
Exactly.
- PAPeter Attia
Yep,
- 47:36 – 58:15
How VO2 max is measured in the lab, and why it’s a crucial predictor of both lifespan and quality of life
- PAPeter Attia
yep.
- OBOlav Aleksander Bu
Yeah, yeah.
- PAPeter Attia
Um, so let's, uh, actually, maybe let's take a s- a, a quick aside because you and I are speaking about this with such a degree of familiarity. I want to make sure the listener understands how you're measuring VO2 max in the lab. This is a test that I believe every human being, athlete and non-athlete, should have done because everybody needs to know their number, and everybody needs to know where they stack up against people their age and their sex because, again, it is one of the most important, if not the most important modifiable metric we have to speak to both the length and quality of life. So if I came into your lab tomorrow to have my VO2 max measured, tell me what we would do.
- OBOlav Aleksander Bu
So the good thing now, of course, is that also VO2 max is being, or let's say metabolic measurements are being democratized as well. There is, uh, for example, we work very closely with a Canadian company called, uh, VO2 Master that allows you basically to put now a mask. So it's like, you know, the old age basically when you have these big computer towers and everything. Today, we have iPhones and Androids that basically have computational power that exceeds millions of times even what the Apollo 11 expedition had landing on the moon.
- PAPeter Attia
Right. Yes.
- OBOlav Aleksander Bu
Yeah. So the same thing is, of course, happening also to, to the, to the metabolic, uh, let's say to, to metabolic analyzers as well, from basically being these huge towers that were basically exclusive to labs to basically where it's now being democratized, and you basically have, like, this port- super portable analyzer just sitting on your face measuring your basic, your, your oxygen uptake. But to bring it to the lab setting, and, uh, what happens there is that you come into the laboratory setting. Uh, I don't work so much with relative values, but a lot of people will do. So obviously we're gonna, we're gonna measure your weight, so we get your weight there. And as you just said bri- uh, you mentioned Kristian or let's say an elite athlete, you said 80 milliliters per minute, but Per kilogram. So we have normalized this to k- to, to kilogram, and that's why we need to measure your weight. So now when you're running, uh... So what we do is that depending on what kind of modality that's important to you, so let's say that it's running, for example, what you'll do is that you get on a treadmill, and basically there, there is a couple of different, let's say, uh, ways to do this. Uh, whereas the, let's say the method is pretty much the same, but it can be a little bit of different gear. Some people will use, uh, something that we call mixing chamber system, and some people will use what we call breath-to-breath systems. But it would basically involve basically you having either a mouthpiece in your mouth, where there sits a, sits a, um, analyzer. Uh, or not an analyzer, but it's a turbine with a, a sample line from it. So wa- basically, when you're exhaling in this mask there or through this mouthpiece, we are measuring the flow, uh, or how much air you are breathing in and out per time as a function of, uh, yeah. Um, yeah, if it's a turbine, then basically we correlate it to how many tur- how many RPMs this turbine is spinning at. So now we know whether you are breathing, for example, 50 liters or 100 liters, 150 liters per, per, per minute. But then, of course, now we only measure your ventilation. We don't know anything about your oxygen consumption yet. We only know something about your ventilation. So then what we also have to do is we need a sample line that s- that sticks in there as well, that basically collects now the concentration of oxygen and carbon dioxide as well. So what we then do is that because we know that the ambient, ambient oxygen condition and ambient, uh, ambient, uh, CO- CO2 conditions is basically, let's say, 20.9% oxygen, and then 0.05% CO2, more or less, f- speak, yeah, roughly speaking. While you are now running and you're breathing, you are obviously breathing in a certain amount of oxygen into your lungs, and then you're consuming some of... No. Or, or let's say air into your lungs, uh, which contains basically 20.9% oxygen. When that comes into your lungs, parts of that oxygen, far from all of it, actually only closer to 25% of that oxygen, you are ac- actually taking up in your lungs, and it's being now transported through your body. And you're exhaling actually 75%, roughly speaking, 75% oxygen, you actually exhale out again now. And then basically, be- since we are measuring now the oxygen concentration with this device here, we can measure-- we know now the delta concentration that sits between how much-- what is the oxygen concentration when it goes in, how much is oxygen con- concentration that goes out. And since we also measure the volume of air, we know we can now extrapolate that and say, "Okay, this is the amount of oxygen you're actually extracting from there, and this is how we know your oxygen consumption." So why is oxygen consumption, uh, important? Well, this comes back to basically calorimetry. Uh, and calorimetry actually is very often th-- people think then immediately of nutrition and, and foods and these kind of things. But it's actually just a unit. It's actually just a unit, a scientific unit, actually, for, for knowing how much energy is needed to heat water from, from, from 14 to 15 degrees, for example, a certain amount of that, and then how many, how much calories is needed. So we could even use gasoline for this. But it basically comes back to the fire triangle. You need something to combust. You need oxygen, and you need temperature. And basically, when we know when you combust, there, there's a field. Now I'm getting really nerdy here. But there's a field. So there's a field in biochemistry, uh, which is called, or actually not only biochem... Yeah, well, biochemistry, or chemistry in general, which is called stoichiometry. So in stoichiometry, there we can basically look at how much, uh, uh... So when we have, like you mentioned initially in the call as well, you talk about hydrocarbons, for example. But let's say carbohydrate, carb- carbon, hydrogen, and oxygen, and then we know how many molecule or how many atoms there are of each of these in that molecule there. And then basically, when we want to convert this into ATPs, for example, then we are bre- breaking this down. So for example, if you look at the glycolysis, we are taking, for example, glucose, which is C6H12O6, and we are breaking that down into two, uh, two, uh, pyruvates, or basically C3, C3H5O3. But we've got two of them now. But in this process of releasing ATPs there, at the same time, what happens is also we are releasing hydrogen i- uh, hydrogen ions. And this is actually when you feel a burning sensation in your muscles, this is actually, it is not the lactate. It's actually this that you are feeling in your muscles. Lactate is actually a super fuel. It's su- it is f- it's, uh, if the muscles get access to both lactate and, and, and glucose, it will actually use lactate as a preferred source before even glucose. But then basically, because C3H5O3 basically lacks one hydrogen molecule now, as long as you have an excess of this, then basically you're able to bind back that hydrogen molecule in there, and you get C3H6O3, which is lactate molecule. We've got two of them. So you split one glucose molecules effectively now down to two lactate molecules. So this, so but then basically when you're looking how now-- when you're looking now at the, the energy yield here, basically we know that when you burn, when you convert, basically, let's say, from glucose to, to lactate, for example, there is a certain amount of energy or joules that is released in this process. We can even say, "Okay, let's forget about even ATPs and make it even a little bit simpler. What is the potential joules that sits in a glucose molecule? And then when we split this glucose molecule, how many joules are we releasing in this process?" And basically, because it says C3 or basically C6H12O6, we know there are six oxygen molecules there. And now we can actually calculate or we can know actually from your oxygen consumption, because that's O2 molecules going in, and then there comes out CO2 molecules, or b- both O2 molecules, but also CO2 molecules.
- SPSpeaker
Mm-hmm.
- OBOlav Aleksander Bu
But what we can know now is that we can know exactly because we can use stoichiometry, and we can basically calculate how many, how much joules has been now released in this process. And that ties back to VO2 max. The more oxygen you are capable of turning around per time, the more calories, or let's say the more fats, proteins, carbohydrates you are able to break down and release energy that you can use for forward propulsion in the process. And that's why VO2 measurement is, is a holy grail metric because it's-- we, we can always talk about direct calorimetry, but that's so, let's say, call it intrusive into a process and so little, um, it's, uh, impractical to do. So indirect calorimetry measured with VO2 max or VO2 and VO2 max is, uh, is a superior method to understand How much energy are you able to release in this process? And also then just to come back a little bit to your field as well, medicine, if you have a low VO2 max, it basically means also at the moment you start to have stress in your lives, you have infections in your lives, anything like this, you are utilizing a much higher percentage of that ability to, to, to, to... Because to get healthy as well, you need energy to get healthy as well in, uh, as well to, to, to, yeah, do whatever, transporting blood around in your body or whatever.
- PAPeter Attia
Right.
- OBOlav Aleksander Bu
So, so ba- basically, an athlete that has a huge VO2 max that becomes sick, they will-- there's a fractional change basically or, or, or a relatively small change of their capacity or reserve that is u- or let's say utilized now in this process. So at the moment they release basically their training or they, they, they, they, they reduce the training volume, they get a huge excess of energy or, or ability to recover now. Um, and if you're quick enough to do it, you won't almost get any effectua- or, or, or, or, um, increase in infection at all because the body gets so much energy excess to help aid in the recovery process now, compared to a person which has a so low VO2 max that even walking up the stairs start to, to, to, to bring them to a level where they are even, yeah, trying to catch their breath.
- PAPeter Attia
Yeah. I, I, I think that's such a great point, and I, and I don't think people fully appreciate what a physiologic stress significant illness is. So y- y- you know, again, I, I won't bore people with all of the details, but if you go and do the chemistry on what it takes to raise the body's temperature from 98 Fahrenheit to 103 Fahrenheit, that is an enormous energy cost. When you, you know, when we look at cardiac patients, when we look at any patients in the ICU, and you look at the change in cardiac output that might be required to support, um, a systemic inflammatory response syndrome, it, it is profound. So, um, I think this is ab- absolutely spot on, and it really comes down to just having
- 58:15 – 1:10:35
Absolute vs relative VO2 max, the significance of functional threshold power in cycling, and the importance of longer duration tests for accurate assessments
- PAPeter Attia
more reserve. I want to ask you, um, t- several questions. Let me try to take them in order. First, um, you mentioned that you prefer to look at VO2 max in absolute terms. So, uh, you know, I'm guessing that, you know... How, how, so how much does, does Kristian and Gustav weigh? Th- those guys probably weigh 75 kilos?
- OBOlav Aleksander Bu
So the funny thing is that, uh, l- leading into the Olympics, one of the things we actually looked even at is basically what happens, because we have tried to reduce the weight very conservatively by global standards even in sports, to, to reduce the weight because w- we had already ingrained in our heads from basically a past and other people saying that, "Well, uh, you, you need to bring up your relative VO2 max. You need to br-," and that, and, and, or, and that is done very simply by reducing the weight.
- PAPeter Attia
Yep.
- OBOlav Aleksander Bu
The interesting thing was we found after we had done this a couple of times, a little bit by accident, because we do so much measurements, is that we saw, uh, saw actually that, well, the relative VO2 max, that didn't come up, and the absolute VO2 max came down even more than the weight came down. And these were, these were not-
- PAPeter Attia
They, they, in other words... So let's just make sure people understand exactly what you said. It's very important. Um, and we should use some numbers so people understand. So I'm making this up, but if they weigh 80 kilograms and are putting out six liters, or their, their maximal oxygen consumption is six liters, you take six liters or 6,000 milliliters divided by 80, and you're gonna get a big number. And you're saying, "Well, gosh, I mean, the tried and true method here is we have to lower that body weight. Why don't we take that body weight from 80 kilos to 75 kilos? And now 6,000 divided by 75 is a much bigger number. All things equal-
- OBOlav Aleksander Bu
Mm
- PAPeter Attia
... we're much better." The problem is it's not all things equal because that 6,000 milliliters of oxygen might have come down to 5,500 milliliters per oxygen, and now that ratio has actually gone down.
- OBOlav Aleksander Bu
Exactly. So both absolute have gone down, and also relative have actually gone down.
- PAPeter Attia
Yep.
- OBOlav Aleksander Bu
Which is a little bit, a little bit of, uh, I think, uh, sh- shocking, uh, because most people, this is-- You can imagine-- We of course have a lot of theories of why, uh, one, why this is happening, but also why do people still, uh, um, cling to the idea of reducing? So you come up to a certain level. So you br- let's say that you were, you, you had hundreds of athletes through your program. Suddenly comes this really good, like, this guy that just responds, or girl that just responds to, to your training. He goes to junior level, starts to win, senior level, starts to win, starts to go to the championships and wha- whatever. But now you're starting to really, like, have to fight, fight for the, for the, for the spot. Okay, what do you do? Okay, my training program is perfect. That's, that's something that's very easy to sometimes think, or you're afraid of making changes to the program because you don't necessarily understand exactly why you got there. But we have got ingrained with that, "Okay, fine, let's reduce the weight now," because that will be the next step now. Because we are not able to make you more powerful, so let's start now to reduce your weight. There are two things happening now, or one thing is, of course, the things we have observed, the VO2, VO2 max starts to come down. Absolute and relative value starts to come down.
- PAPeter Attia
And sorry, G-, uh, well, does that happen because you're unable to control where you're taking the weight off? So for example, are you losing disproportionately lower body muscle mass, which is, I think, disproportionately contributing to VO2 max relative to upper body?
- OBOlav Aleksander Bu
No, I don't. I, uh, uh, unfortunately, it is more complicated than that because it is without even losing muscle mass.
- PAPeter Attia
So it is related then to basal energy expenditure. If your b- total body mass is coming down, your basal energy expenditure is coming down. That is probably altering fundamental metabolic pathways at rest that must be translating to what's happening under stress.
- OBOlav Aleksander Bu
Most probably yes, because there, i- this is of course something we, I haven't had enough time to dive into because on the one side I'm looking more to drive performance.
- PAPeter Attia
Yeah.
- OBOlav Aleksander Bu
So we sometimes there are, there are some findings that we really want to understand better, but we have to say, "Okay, that's gonna happen in the next life or next period," or whatever.
- PAPeter Attia
I mean, an interesting experiment to do here, sorry to interrupt, would be to actually use doubly labeled water under the weight reduced setting compared to the previous setting. Obviously, you could do indirect calorimetry during rest. You wouldn't be able to get total energy expenditure, which is what you want, um, and see if that drop proportionately corresponds to the drop you saw in VO2 max absolute.
- OBOlav Aleksander Bu
Yeah, so, so this is also something because you can think of it that maybe this is just a temporary phase. So maybe this is a temporary phase before, uh, before you stabilize the weight, and then at some point it will start to come up again as well, but it doesn't either. So that's a little bit the thing here. Also, we can, we can venture a little bit into doubly labeled water because we spent a fortune on doing several doubly labeled water pe- or blocks, and this is, it's, it's, uh, it's a nice method, but it also has several pitfalls. So actually what we have started to do much more of lately is exactly doing resting metabolic rates. So again, having the portable metabolic analyzer like the VO2 Master, it allows us basically we do measurements before dinner, we do it after dinner just to look at the-
- PAPeter Attia
Yeah
- OBOlav Aleksander Bu
... the thermic effect of foods, for example.
- PAPeter Attia
Yeah.
- OBOlav Aleksander Bu
We do after training to see basically what happens there, and we even see that it even sometimes dips below normal, normal resting levels, for example, even. We can only theorize on why that is happening. But the thing is that there's a couple of mechanisms that we just need to control, and we need to become even better at it. But back to, back to a little bit to VO2 max and these. So why do I work on, on absolute values versus relative values? One of the things that we do see is that, first of all, Kristian and Gustav now, they, they weigh 70, 73, 74 for Gustav, and 80 kilograms for, for Kristian, and he's 175 tall.
- PAPeter Attia
Yeah.
- OBOlav Aleksander Bu
So y- you would almost say that, hey, uh, he's-
- PAPeter Attia
He's stocky, right? 100 and, 175 centimeters at 80 kilos, he looks like a muscular guy. He's not a-
- OBOlav Aleksander Bu
Yeah
- PAPeter Attia
... he's not a bean pole.
- OBOlav Aleksander Bu
Yeah.
- PAPeter Attia
Yeah.
- OBOlav Aleksander Bu
Exactly, but you'll also see that he actually a little bit of extra fat on his body compared to what you would expect to have from an elite athlete. But we j- we, we can't look at it that way because I'm not looking to build aesthetic machines. I'm look-
- 1:10:35 – 1:22:19
Portable VO2 testing devices as a practical alternative to lab-based tests
- PAPeter Attia
back to another thing you said. Twice now you've alluded to less technical, more portable indirect calorimetry devices than what I'm used to in the lab if I'm doing a VO2 max test. Now, I was under the impression, and I'd love to be corrected here, that these portable devices are probably decent for measuring VO2, i.e., the consumption of oxygen, but their accuracy is sorely lacking for measuring VCO2, the production of carbon dioxide. And therefore, it might be a good tool for estimating VO2 max, but it's not a great tool for estimating total energy expenditure, which is calculated by using VO2 and VCO2, and nor is it a great tool for measuring, uh, fat oxidation because there you must be able to look at a very accurate ratio of VCO2 and VO2.
- OBOlav Aleksander Bu
Yeah.
- PAPeter Attia
So are there devices out there that we could be buying that, you know, we could be testing ourselves on every month at home that would meet the criteria of being accurate enough in those domains?
- OBOlav Aleksander Bu
Yes. So, uh, one, I think the accuracy of the devices are starting to become, uh, fairly good. We do very often back to back testing between the devices. Of course, in a laboratory setting we are using mixing chamber system, which is, of course, is, is, uh, uh, validated a- against many different methods.
- PAPeter Attia
Which system do you use in your lab?
- OBOlav Aleksander Bu
So I am actually sticking still to a old system. Uh, I'm not, I-
- PAPeter Attia
Which one? Parvo?
- OBOlav Aleksander Bu
No, no. Actually, no, not, not a Parvo. I'm actually using an, a Jaeger Oxcon, uh, probe with a mixing chamber system.
- PAPeter Attia
Okay.
- OBOlav Aleksander Bu
Um, but I also really like the AEI Moxus as well, uh, simply because it has, uh, some superior technologies, uh, in it, uh, compared to most of the other devices on the, on the market. Most of the device on the market, we're not gonna go into this, but they're using, uh, most of them are using galvanic fuel cells, uh, to measure, uh, oxygen and then use infrared sensors to measure the, uh, the CO2. But one of the things that the, the, for example, the AEI Moxus is doing, is that it actually measures it using a zirconia cell instead, and zirconia cell is actually one of the most sensitive cells that we have, and it's... You can't use a... For example, if you want to look at the photosynthesis, for example, you can't use a galvanic fuel cell because it's not ac- or it's not sensitive enough, while a zirconia cell is-
- PAPeter Attia
Hmm
- OBOlav Aleksander Bu
... uh, sensitive enough. But nevertheless, uh, the same technology now sits in the portable devices, so it's, it's still using it. Uh, also the portable devices now, uh, are using galvanic fuel cells, uh, and, uh, we... Of course, I mentioned the VO2 Master. One of the benefits we have had is that we enter into a partnership with them to, to advance the technology. Several years back, I did a screening on the market of all kinds of different metabolic or portable metabolic devices. What I am in need of is that I need to find a compromise. It doesn't help me necessarily to find a device that is a little bit more accurate than, for example, than the VO2 Master, for example, if the athletes doesn't want to use it because it has a rucksack and it has a lot of procedures, it is a horrible user interface, and all this kind of thing. Then you... Then basically I bought a super nice device. I'm able to get the athletes to measure it one or twice time, but that's not where the strength-
- PAPeter Attia
Yeah
- OBOlav Aleksander Bu
... of data come. The strength of data comes exactly from what you say. You need to measure regularly all the time there, and it has to be done in a way that the athlete doesn't feel it as intrusive or invasive into their lives.
- PAPeter Attia
So tell, tell me, tell me a little bit about the VO2 Master, because I'm aware of some of the other portable devices, but not this one. So obviously the hallmark of this is you're, you're gonna be plugging the nose. You've got a mask that creates a perfect seal, and therefore very clearly, at a minimum, can measure the air flow rate in and out, correct?
- OBOlav Aleksander Bu
Yeah. So, so the thing is actually you don't need to plug your nose. It actually uses a Hans Rudolf mask, so the, in most, in most labs you'll very often see athletes are using these blue masks-
- PAPeter Attia
Yeah
- OBOlav Aleksander Bu
... more or less.
- PAPeter Attia
Okay.
- OBOlav Aleksander Bu
So actually, so, so the cool thing is that what, what they did is they actually designed a device that sits, actually mounts on this, uh, Hans Rudolf mask that is around in the labs, and then basically what it does is the same as you do with a metabolic cart. It sits in the laboratories. It has the gal- galvanic fuel cells because this is ba- made, made by maybe there are five manufacturers of gal- of ga- of galvanic fuel cells in the world, and, uh, basically everybody purchases from more or less these five different manufacturers there. So it's the same galvanic fuel cells that sits in the VO2 Master, and then basically the main differences between this device is that they have removed the turbine, and they're using the same way of measuring flow that you do in Formula 1 and aerospace. So they use differential pressure instead to, to quantify the flow of what you're doing. So basically this is a device that just sits here. There's a headgear. There's no wires. There's no nothing. It's basically connects to your phone, watch, whatever that you have, and then basically this is how you now collect your oxygen consumption.
- PAPeter Attia
So I could go out for a bike ride. If I'm gonna go and do VO2 max intervals and hill repeats, my favorite workout is the four to five-minute hill repeat, I could be wearing this thing, and that's it.
- OBOlav Aleksander Bu
Yeah, you could.
- PAPeter Attia
And I come home, and it's going to say, if I did 10 sets, it's going to tell me peak oxygen consumption for each set.
- OBOlav Aleksander Bu
You can even connect it to your Garmin computer, and you can go into your Garmin account, and you can see it there. There's all the view. So you can see your breathing frequency, tidal volume. You can see your fraction of expired O2, your VO2, all the values basically combined there in the same, together with your power, with your velocity, with your position, everything there, like, in one place. You don't need to look at once, like, a separate report for your VO2 numbers and then basically looking at your Garmin numbers. Basically, they are, they are overlaid. You get the-
- PAPeter Attia
So it's gonna show me heart rate versus power versus VO2 at every moment in time.
- OBOlav Aleksander Bu
Exactly.
- PAPeter Attia
And how accurately is it measuring VO2 relative to what you can do in the lab? And how about VCO2?
- OBOlav Aleksander Bu
So VCO2 is, of course, some, some... That's a place where we have been very fortunate because we are a little bit ahead of the curve there. So we have had their device that has CO2 now for, this must be soon two years, I think. W-
- PAPeter Attia
The VO2 Master also does VCO2?
- OBOlav Aleksander Bu
Yeah, in the prototype. This is probably gonna be released to the market, uh, sometimes during next year. Then basically the whole market will have access to it.
- 1:22:19 – 1:30:54
The complexities of measuring ventilation and its impact on performance metrics like VO2 max and heart rate
- OBOlav Aleksander Bu
No. So y- one thing that of course you also start, which is a little bit interesting there, obviously because we use mixing chamber system, that's where we come from, the whole-
- PAPeter Attia
Yeah
- OBOlav Aleksander Bu
... let's, the, the, yeah. Uh, um, uh, I, yeah, you, you, you'll ask the question if you think it's interesting to, to, to, to your listeners whether they want to understand why there are mixing chamber systems and so on, and so, but, uh, to spare them for that for now, basically what we do know is that when you have a mixing chamber system, ex- it's just because you have a little bit the higher resistance in a system like that.
- PAPeter Attia
Yep.
- OBOlav Aleksander Bu
Typically we see also more stable breathing pattern, just because they're actually be- be- they are being reminded more about exactly how they're breathing because they feel a little bit more-
- PAPeter Attia
Yeah
- OBOlav Aleksander Bu
... the resistance. What you do see is, um, uh, as a system gets less resistance, you'll naturally also start to see a little bit of more variation going up and down and these kind of things. Because even though, if you look at the power meter, people that ha- are not used to ride with a power meter, they're only used to use heart rate, and you give them suddenly a power meter. The first time they get a power meter, they, they, they, they, they, they don't understand anything because power goes all over the place there, because they are not used to, to focus on the power, and it becomes almost like they are chasing a number that d- is almost, uh, they, they don't have, they don't have the coordination or the skills to basically keep it and then basically find a, or, or relax around that very stable power and how to basically r- read it. Breathing is even worse.
- PAPeter Attia
Mm.
- OBOlav Aleksander Bu
Breathing is even worse than power because now you're even one, one order further away from performance. So velocity obviously is the, like the first pri- first printer, first order. Th- th- that's where exactly the performance happen. Power, you're one step further away, and this is of course a system that is very responsive as well to what you do. You won't necessarily see, like if you suddenly get a spike, you are, let's say you're riding 200 watts. If you went to 210 watts for a second and back down to 190 to 200 watts, your speed wouldn't change at all. Your velocity would-
- PAPeter Attia
Right
- OBOlav Aleksander Bu
... be the same more or less. But still you have a- the volatility there. So if you now are using velocity as the gauge for whether a system is correct or not, you will always say, "Hey, this cannot be correct. I went to 210 watts. It should be i- im- immediately giving me this." But again, the sensitivity to velocity, how the velocity is measured, is not good enough necessarily to capture the small changes that are happening intracyclic in the power production there in between there. It's being smoothed out because of inertia, measurement, uh, weaknesses, and so on. This gets even worse when you get to velocity, because what we know is the body, exactly because of all this-
- PAPeter Attia
You mean when we, when we get to ventilation.
- OBOlav Aleksander Bu
Yeah, ventila-
- PAPeter Attia
Yeah, yeah.
- OBOlav Aleksander Bu
Yeah, yeah, exactly.
- PAPeter Attia
Yeah.
- OBOlav Aleksander Bu
Ventilation, yeah. So i- i- yeah, that's good, g- good, uh, a good, uh, clarification because exactly we are measuring on the exhaust to even here. And b- between basically we- where we are doing work and basically when we are breathing in and we are exhaling out again, there are so many compensating regulatory mechanisms in the body that are compensating for the lack in one place and here, a- back and forth all the time, more or less, to make sure that we deliver energy as efficiently as possible to sustain the propulsion that we are doing. And now when you are measuring VO2 here, you can have a quite a bit of fluctuation in this, and there are s- there are, let's say, kinetics involved here. So for example, one thing that people, uh, to, to, to give an example, if you are running at, let's say you're running 15 kilometers per hour, and you have a certain oxygen, uh, oxygen consumption now at 15, uh, 15. So I'm just making up a number. Let's say that you are, uh, or to use power. You're riding at, you're riding at a constant power, to make a simple, constant power of 300 watts, and you're consuming now four and a half liter of oxygen. If you, you can still output, you can still output that, those th- did I say 300 watts? Yeah, 300 watts.
- PAPeter Attia
Yeah.
- OBOlav Aleksander Bu
You can still output those 300 watts there, but if you hold your breath now, what happens? VO2 comes down, ventilation comes down, or, or tidal volume and breathing frequency comes down. But you start to s- feel that something builds up in your body. You're still able to p- output those 300 watts there. At the moment you start, at some point you either are forced now to stop or you have to start breathing and you're forced to start breathing again. And at the moment you start breathing again now, you have a huge debt in your body, and what will happen is that basically you get a huge spike in ventilation, huge spike in VO2. But what you also see is that when you break this down, is that of- obviously, your, the, the big spike comes from both that you're driving a much larger tidal volume, breathing frequency goes up a lot, but also your fraction of expired O2. So the delta between how much of the oxygen you are consuming now, you are going much deeper than the 25% we said initially. But then basically because there are, things are not reacting extremely quickly on the exhaust part here, you'll see basically that here is almost like a regulate, like a PAD regulator that are trying to bring this back to that stable settings there. And it happens, okay, yes, your breathing comes down again, but still maybe you have a high VO2, and then suddenly VO2 undershoots a little bit because fr- fraction of expired O2 comes up a little bit higher, but then says, "Oh, this is not enough. This is, this is too little oxygen, so I need to increase the extraction a little bit again" before it comes back again. And this just tells to basically that, yes, 300 watts there, but you can still have a lot of variations there just by the fact that you're sitting on a bike and you're sipping that bottle there. You're holding your breath when you're sipping that bottle there.
- PAPeter Attia
Mm-hmm.
- OBOlav Aleksander Bu
That will already influence your breathing and your VO2 for the next half minute on there. If you are swallowing, just the fact that if you start to have a lot of spit, for example, in your mouth and you're swallowing there, you are building a miniature debt there now that you have to pay for again afterwards there. So again, there, th- what we have to, what one have to be careful about there, I don't like standardize and say, "You can't drink, you can't swallow, you can't do it. You have to be a machine," because that's not who we are. We have to look, learn to look past the noise of the data by collecting a lot of data and knowing exactly what peop- we, we are, we are, we are not machines. Well, you could maybe say that we are machines as well, but, but there are so many things happening in between here that you can't necessarily, exactly like you also say, you can't one-to-one ratio
- PAPeter Attia
Well, we're much more complicated machines, right? I mean, we talk-
- OBOlav Aleksander Bu
Yes
- PAPeter Attia
... you know, you, you've alluded to F1 twice now. That happens to be my favorite sport.
- OBOlav Aleksander Bu
[laughs]
- PAPeter Attia
And as much as we can look at those cars and say they are the most remarkably engineered things with wheels that have ever been produced, right? Everything from the engines that they build, these hybrid internal combustion engines, uh, through the chassis and the aerodynamics. Again, most people are shocked to learn that the aerodynamics of that car are such that it can drive upside down at 100 kph. Um, [clears throat] all, all of those things are remarkable. I still think we're far more complex. I mean n- hands down, right? Because every-
- OBOlav Aleksander Bu
Yeah
- PAPeter Attia
... element of that car can be modeled. [clears throat] There is an equation that explains every piece of it, whereas there is no equation to explain what you just described. And by the way, it's, there's, there's an element of chaos in that system. Um, one, one thing that I'll, I'll suggest listeners try if they have power meters, and it's just a, it's just a, a great example of what you said. So if you have a heart rate monitor and a power meter, next time you're on your bike, make a deliberate effort to change your ventilatory rate. So vent a lot and vent a little and watch what the heart rate does, even as you hold the power constant. And of course, this is because that CO2 is very soluble, and CO2 is tracked by the brain very closely as a proxy for pH. And the body is very particular about keeping the pH at 7.4. And so as you're, as you slow down your ventilation rate and hold your breath and your carbon dioxide levels rise and your pH falls, you will see that heart rate start to spike with no additional input in power output. And of course, the reverse is true. And it's just a great example of what you said, but it's one where you can sort of be the guinea pig and watch it. Uh, and it's, it's just, you know... I, I still to this day get a kick out of playing that game to see how much I can move my heart rate just by interfering with my ventilatory rate.
- OBOlav Aleksander Bu
But I can say that I think that that's also why some people become better also and others not. Because I think that a, a, a, uh, one thing that we very often tend to lose as we get older or we go through, for example, different training, is that we lose that ability to play.
- PAPeter Attia
Mm-hmm.
- 1:30:54 – 1:41:15
Training interventions to increase VO2 max, and factors that impact performance outcomes
- OBOlav Aleksander Bu
awareness of that. Because one of the things is that I, I, I've, I've learned, um, with, also with elites, is that elites are not necessarily, um, uh, perfectly calibrated either. They need to actually be calibrated. Because you have some athletes that typically if you ask them to go out and do, call it a threshold workout, or let's say a workout that has, let's say, intervals, a combined duration of intervals that li- that are between 60 to 80 minutes and that should be fairly close to all out, or let's say to, to bring it to exhaustion on the last interval. You'll see that some athletes, elite athletes, they, um, they are ending up going out too hard, and they end up dropping the power towards the end. Some athletes, they go out a little bit too, too light, and they have to go really hard towards the end to bring it up there. But both scenarios, if you were able to keep it a, at a very calibrated or accurate level there, you would see that the total amount of kilojoules you were able to accumulate on those 80 minutes or 60 or 80 minutes or whatever the length there would be, would be higher than if you ended up going progressive, or worst case, you end up ending up going regressive because you go too hard in the beginning-
- PAPeter Attia
Mm-hmm
- OBOlav Aleksander Bu
... and are forced to come down towards the end there. But, um-
- PAPeter Attia
What standard do you use, by the way? So let's, let's use that as a quick example. So, um, a- again, I said I'll use myself 'cause I'm trying to get as much, uh, free coaching as I can here. So if I love doing my VO2 max sets on a bike, on a hill, and, uh, I have a fixed distance that I ride, so it really depends on the wind. So if I have a headwind, it'll take about five minutes. Um, and if I have a tailwind, it could take, you know, 3:45. That's how much the wind can play a role on this hill. Um, but basically, it's not an all-out effort because you wanna be able to do it multiple times, but it's a very hard effort followed by about a one-to-one ratio of recovery, and that's the workout. A- after a warmup, it's over and over and over and over again, and it's like an hour of doing that. Now, I typically, and I think this is because I've become softer in my old age, I typically ascend in power. So I will typically start out at a very conservative power where at the very end I am not dead. But by the end, by the last s- one, I might be doing 10% more power than on the first set, and I'm absolutely at my limit. What would you... How would you recommend I change that? Would you recommend... Well, yeah, do, do you want that to be within 5% the whole way through, or, or how would you recommend that? I- if, if-
- OBOlav Aleksander Bu
No, no
- PAPeter Attia
... again, the goal is maximizing that workout to maximize VO2 max and to increase the engine size
- OBOlav Aleksander Bu
You want to, uh, maybe we should add one more dimension to this now because I think that very often we confuse, for example, also when we talk about FTP, just FTP, and we black box a metric as FTP instead of saying 60-minute power or-
- PAPeter Attia
Yes
- OBOlav Aleksander Bu
... 20-minute power, whatever. What's really accurate with the 20, when you say 20-minute power, 60-minute power, you basically know that, okay, you can hold that power for that duration. That's the maximum, for example, before you basically end up dropping too much-
- PAPeter Attia
Yeah
- OBOlav Aleksander Bu
... and we just call it, call it, uh, a day with. Very often when we talk about VO2 max, it's very often confused with aerobic capacity, while in reality it's not. It's a- aerobic power.
- PAPeter Attia
Yes.
- OBOlav Aleksander Bu
Uh, so basically what you're measuring there, you're measuring how much oxygen for, for, let's say, for a undefined time. Yes, we have normalized this as milliliters per minute, but you can have a big range between athletes that has the same VO2 max. Some can do that for several minutes. Some can only do that for, let's say, one minute, for example. So now when you, uh, uh, and, and this is where the important is because we are looking for to provide signal, signaling and/or the stimulus to the body. If you go out and you do one five-minute interval more or less, then basically, okay, fine, that's the stimulus that you're providing yourself there. So this is about how, okay, you've got a certain amount of time available to go out and do that VO2 max session, uh, today, for example. Let's say that's 90 minutes. Then basically, of course, now I'm, now this is one-dimensional because I'm not, we- of course we're not talking only about the single, single, uh, workout as well. I think the most undervalued thing, which is not very sexy to talk about, and also the most undervalued thing is that basically it's consistency, consistency in the training over time.
- PAPeter Attia
Mm.
- OBOlav Aleksander Bu
And that means that you need to leave a little bit in reserve there, and we haven't even touched on the topic of psychology yet either because we are very much now talking about the things in physiology that we are good at measuring and these kind of things, but there are also plenty of things that we are not able to measure. And even the things that we like to say that we, oh, we are so good in stoichiometry or we're so good in understanding metabolic pathways or signaling pathways, there are still things added to this where we basically understand that no, we don't. And then we haven't even dived into the topic of microbiome or basically how basically we are... Yeah. It, it, it's, it's a world, undiscovered world that we are basically taking on now. So one, one of the things that is that when you're doing this exercise, then I think that, uh... But the good thing with VO2 is that of course that we are m- measuring a quantity. We're measuring a volume of something. It's much in the same way when we, when we talk about power versus work. So you talk about work, for example. So when you say... To, to, so to make this a little bit more practical. So when you said, "Okay, I want to basically do my VO2 max work- workouts," I go, I go a little bit progressive. I would normally say that's a good, that's a good thing to do.
- PAPeter Attia
Okay.
- OBOlav Aleksander Bu
Because also what happens is there is a priming effect also happening in the body as well. So if you go out l- like where you think that you maybe would be able to sustain throughout the workout, you might fi- figure out that you still are able to go a little bit higher. At some point it's the opposite. But we, uh, one thing that we have done multiple times over the last half decade is, is that very often people think that, okay, when I've done a VO2 max effort, then basically I'm done. I won't be able to repeat that. I need, uh, two days of rest or maybe a week of rest or whatever before I can do that. That's not true either. We know that, for example, if you do a VO2 max effort and then basically you give a adequate time of rest in between there, you are able to go even harder on the n- next one now, even though that was completely to exhaustion on the first one. Completely-
- PAPeter Attia
So let's say more about that. So g- put some time and numbers to it so I can understand what you're saying. So you could take one of your athletes, and what duration of an interval would you have them push to?
- OBOlav Aleksander Bu
So for example here, let's say that we are using as a old-fashioned, uh, way of quantifying VO2 max. So you say that you do a graded exercise test. So you increase the power by, uh, 5%, for example, every minute that goes there-
- PAPeter Attia
Yeah
- OBOlav Aleksander Bu
... until you basically come to exhaustion.
- PAPeter Attia
Yes.
- OBOlav Aleksander Bu
So let's say that, let's say that now that, uh, the athlete finishes around, uh, 500 watts, uh, and around seven liters of oxygen.
- PAPeter Attia
And for, for, for the listener, that's a world- those are world-class numbers that are obscene. Like, that's, that's, there's no, there's... You're not running into people on the street that can do that, but carry on. [laughs]
- OBOlav Aleksander Bu
Yeah. And, uh, here already I haven't told what's happening before there as well because if I only took them fresh doing this, then the power number would be different. So again, this comes back a little bit to talking about power at VO2 max, where this is already manipulated depending on what you've done before this as well. So now basically, uh, they, they do this. So let's say that they last for six minutes, and then if they finish the last one on, let's say, 500 watts, uh, 500, last minute on 500 watts. Maybe they go a couple of seconds longer into the next one, and this is also important. So when you do a graded exercise test, if you come to the next step now and you feel that, oh, this is too hard, push as long as you can because every second counter, because it's more work. It's more work, it's more oxygen consumed. They're strongest stimulus, more or less. I wouldn't advise doing this very often, but we can come back to that a little bit later because I'm not a big fan of doing very often, like, to exhaustion workouts, that you should put them in very sparingly into your program.
- PAPeter Attia
Yeah.
- OBOlav Aleksander Bu
And that ties back to consistency. But anyways, now given in between the, let's say, you, we, we, if we give 10 minutes of rest in between and now a little bit more rest in between there, then basically if you do now a new VO2 max, you'll bring the athlete up to, uh, the same athlete we bring now to more than seven liters, so 7.1, or maybe even a little bit high- little bit higher, and power output is also now, for example, f- come, comes up now maybe one more minute at one, one higher power output. So now we are already at maybe 525 watts for one minute as well.
- PAPeter Attia
And you're saying that that's happening because they've been primed by the first set to be able to do that with only 10 minutes of rest?
- OBOlav Aleksander Bu
With only... If it goes too long rest in between there, then basically you start to lose the effects. So if the, if the, if, if the duration or the rest in between there, then you, you are not able to draw the effect of that anymore. That can be, I think, you could probably extend it up to 15 or maybe 20 minutes, but when you get past 20 minutes, then I would be a little bit, uh, I, I'm not so sure whether that would hold true anymore. So it needs to be short. And this can also come back to because we know also that oxygen, how, w- when we, when we think about hemoglo- hemoglobin as well, the affinity for, of, of oxygen and CO2 to the hemoglobin is also affected by the temperature of the blood or the body and, and, and the hemoglobin as well. So this is also improving actually with a higher temperature then it is at a cola. So when you get 20 minutes, obviously temperature of your body will also come further down-
- PAPeter Attia
Mm
- 1:41:15 – 1:50:30
The respiratory exchange ratio (RER) and endurance sports, and how factors such as diet composition and exercise intensity influence RER values and performance
- OBOlav Aleksander Bu
equally more now of carbon-
- PAPeter Attia
Can, can you... Let's, let's explain this to people because I, I, I, we, you and I already alluded to this very briefly, but I, we didn't make a big point of it. So the RER is calculated instantaneously at any moment in time as the ratio of VCO2 to VO2. So, um, let's go back to, um, y- you're, you're gonna put one of your athletes on the bike, and he starts riding really slowly. In that moment, what is his st- he's at 100 watts, so he's, he's n- he, he's not even breaking a sweat. What is his RER at that moment?
- OBOlav Aleksander Bu
Yeah, o- o- one more time. At which, which, which power?
- PAPeter Attia
100 watts. He's just starting out.
- OBOlav Aleksander Bu
The thing is that this is actually a little bit, uh, little bit, uh, funny because here it's very easy when we look at the values. When you look at RER, we typically look as a, at a ratio of concentration, and we, and we now already exclude a little bit the volume oxy- of oxygen and volume of CO2 that is there. And of course, there is, there's a requirement for a certain amount of energy to be turned around per time. That's why, for example, if you look at lactate as, let's say, as an indi- or, or, or as a, or, or, or, or as a surrogate, because we can now re- again, if you go back all the way to stoichiometry, and we've said, we already said C6H12O6 glucose broken down to lactate and these kind of things, we already know here how much CO2 that is being produced in this process there at certain ratios. But since we also know the ratio between, uh, glucose and lactate as well, we can use that also surrogate to have more or less the same confirmations as well or the same indications a- as well. The difference is only that VCO2 is a volumetric measurement, while lactate-
- PAPeter Attia
Mm-hmm
- OBOlav Aleksander Bu
... is a concentration metric, and concentration metrics are influenced by many other factors as well. So that's why lactate can be a little bit more unpredictable, and it's not as a good indicator as VCO2 is. But, uh, but coming back to that, basically at 100, typically there you won't, you won't see necessarily a very good ratio between VO2 and VCO2. So RER value there can actually be quite high because two things that are playing into account there.
- PAPeter Attia
Hmm.
- OBOlav Aleksander Bu
Your resting metabolic rate already plays a much bigger factor or a relatively larger percent of the total oxygen consumption and carbon dioxide production now, as opposed to when you start to go to a higher number. So the higher the number are, the l- the smaller the percentage of the resting. Because when we measure VO2 and VCO2, we measure actually the gross oxygen and gross CO2 product. We're not measuring only oxygen as a function of exercise, but actually of both exercise and-
- PAPeter Attia
Yes, and basal resting. Okay.
- OBOlav Aleksander Bu
Yeah.
- PAPeter Attia
So now this, of course, is gonna be heavily influenced by their diet and the carbohydrate content of their diet, but I'm assuming your athletes are on a pretty high carbohydrate diet. So that means-
- OBOlav Aleksander Bu
Oh, yeah
- PAPeter Attia
... Yeah, so that means that their resting RER is probably 0.85 to 0.9.
- OBOlav Aleksander Bu
Or higher.
- PAPeter Attia
Okay. So that means that they get a nadir in their-
- OBOlav Aleksander Bu
Yes
- PAPeter Attia
... RER when energy expenditure gets high enough that it starts to dwarf basal energy expenditure, and you're really achieving maximal fat oxidation.
- OBOlav Aleksander Bu
Yes.
- PAPeter Attia
Which is probably occurring at, I don't know, about 75... At, at a wattage that probably corresponds to 75 or 80% of their best one-hour power. I'm b- I'm guessing that in a, in at about that wattage, they are at maximum fat oxidation, and they probably are at minimum RER.
- OBOlav Aleksander Bu
So actually, it's even higher for endurance athletes or especially triathletes or long course triathletes.
- PAPeter Attia
Okay.
- OBOlav Aleksander Bu
Because this comes back also a little bit to now we are getting a little bit deeper into it, but this also comes back to why it's not necessarily VO2 max a good predictor of performance, especially the longer the events becomes. So for example, to let people in on a little bit of our, let's call it, um, secret-
- PAPeter Attia
Secret sauce. Yeah
- OBOlav Aleksander Bu
... Yeah, so it's a, no, not secret sauce, but secret. Uh, and, and that is that, uh, actually for Kristian and Gustav to win the World Championships in, uh, so, uh, in 20-- so last year, basically we had w- a consequence of the specialization we did. VO2 max came down significantly. So from the, from, from them basically racing the Olympics, clocking in, so using relative values, which is maybe a little bit more easier to relate to, both of, both of Kristian, both Kristian and Gustav would typically test in around, let's say, close to 90 milliliters per minute per kilogram. But at, but at IRONMAN, in order to set new records in IRONMAN, we had to bring it down to actually below 80 milliliters per minute per kilogram.
- PAPeter Attia
And you did this purely because of energy demand and energy consumption?
- OBOlav Aleksander Bu
And purely because you can't sustain, you can't... Because think of it more like a, a, a curve, more or less, where you, you have a curve that you have to push-
- PAPeter Attia
Yeah, you had to, you had to, you had to detune the engine, basically. You had to bring the fuel flow rate and oxygen flow rate in the engine down to do Le Mans versus do a Formula 1 race.
- OBOlav Aleksander Bu
Exactly. And, and, and, and that, that basically because you can't now prioritize keeping doing those five-minute p- uh, power surges or, or, or micro intervals anymore because it's too far away from basically what you need in an Ironman, and you need to build more, let's say, towards the higher energy m- demands or, let's say, higher power outputs in an Ironman, the lower ones or the sustainable ones and so on, and maybe even building a little bit longer as well. So you basically don't have the time anymore, or basically that's not right. You have the time, but you actually are not able to consume enough energy over weeks and months to sustain a program that allows you to both increase your VO2 max at the same time as you're building up that long duration power output. Let's say the four-
- PAPeter Attia
Yeah
- 1:50:30 – 2:14:28
Science-guided training for versatile athletes: maximizing VO2 max, power, torque, and cadence in cycling, and the importance of incorporating diverse stimuli to enhance performance
- PAPeter Attia
Now, given these huge energetic differences, you know, let's just make sure people understand the distances we're talking about. At the Olympics in Paris next, you know, July or August, that's a, it's an Olympic distance triathlon, so we won't need to go into the distances, but let's just tell people a world-class athlete is doing that in what, um, an hour and 40 minutes or maybe even less at this point? Where are they?
- OBOlav Aleksander Bu
No, 1, 1:40, 1:45 is basically where you need to be, and it, that's basically 51.5 kilometers, 1,500 meters swimming, 40 kilometers biking, and then basically 10 kilometers running.
- PAPeter Attia
Conversely, if you look at Ironman distance at the other end of the spectrum, we're 2.4 miles in the water, 112 on the bike, full marathon run. The world-class guys are doing that in what, seven and a half hours, 7:40-ish?
- OBOlav Aleksander Bu
Yeah, seven and a half. Chri- Kristian, Kristian went, Kristian went 7:21, uh, on the fastest, so yeah. But 7:30 is, is, is a good, uh, good-
- PAPeter Attia
Se- uh, uh, it's-
- OBOlav Aleksander Bu
Yeah
- PAPeter Attia
... again, it's simply unfathomable to anybody who's done any [laughs] of those things that they're going that fast. But the energy demand, if you're trying to do something all out for an hour and 40, that is a much easier fueling strategy than if you have to go at a submaximal effort for seven and a half hours. So is it surprising to you that you can have one athlete who can be exceptional and world-class at both? It, it... Because I have to be honest with you, it's a little counterintuitive to me based on this discussion that you could be the best in the world at both of those. That, is there another sport where we would see such disparity?
- OBOlav Aleksander Bu
[laughs]
- PAPeter Attia
Like, we wouldn't, we wouldn't expect that the best 400 meter runner is also gonna be the best 10K runner, and we wouldn't expect that the best 5K runner would be the best marathoner.
- OBOlav Aleksander Bu
So this, this is, this is where I think that we have hugely benefited from using science because it allowed us to break down the RMN distance and understand where basically we could gain much more time than what had been done before. Because what we have to think is that the training, the tr- let's say the method for training, um, y- y- you, we can come back a little because you, you told, you, you mentioned the five-minute intervals and how you were executing this to basically do your VO2 max session. We can come back to that because this is also, w- if you're thinking of it, if you're thinking of it, we are organic, we are organic creatures, so we respond to stress by normally getting stronger, uh, uh, given that we are providing the conditions to get it to, to allow it to grow stronger. So now basically when you are out and you are doing your five-minute efforts, and you have a, you have a, you have a finite time, uh, you have a f- a finite amount of time that you can do this exercise. So let's say you have 90 minutes. Now, basically you can, you can twist this around instead and say that in the same way that you go out and you play a little bit with your, your breathing to see what you can do with your heart rate at a certain power. Now you can just say that, "Okay, fine. I'm actually now looking to provide the maximum amount of stimulus to my, to, to, to, to increase my VO2 max." We already said that, for example, five-minute power or three-minute power is a f- is a good proxy or a surrogate to understand how high your VO2 max is. Now think of it this way instead, that when you go out, you're looking actually to accumulate the maximum amount of work that you can do at a certain output. That is actually a better way of looking at how can I actually, yeah, provide the best possible stimulus for me now to grow my engine, to grow my VO2 max? And you might find-
- PAPeter Attia
Sorry, just to be clear, you're saying you might go out and say, "For an hour, what's the most number of kilojoules that I can, uh, expend," as opposed to, "What's the highest VO2 max I could sustain for that period of time?" Uh, uh, t- is, uh, are you basically saying we should just use kilojoules or we could just use kilojoules as the metric?
- OBOlav Aleksander Bu
Yeah, because you can think of it this way, that the further away we are from... Because in the end you can say that, okay, velocity is the ultimate measurement of, of, of, uh-
- PAPeter Attia
Yes
- OBOlav Aleksander Bu
... performance. Yeah. And the further away we move from this, the le- the more gray it becomes because-
- PAPeter Attia
Yeah
- OBOlav Aleksander Bu
... there are more mechanisms compensating and, uh, that has an influence on what is happening there. So we could think of it this way, that, okay, the reason why we want to grow an engine is because we want to become faster on the one side. But then, then w- w- the w- the, when you go out, we, we, you are not measuring VO2 max when you're... You're not, you're not measuring milliliters per minute or how much oxygen you're consuming when you are doing your exercise now. But we know that the higher intensity you go, the more oxygen you will consume per time.
- PAPeter Attia
Mm-hmm.
- OBOlav Aleksander Bu
Okay? So then we are saying that now we are providing a stimulus to the body to say that we need more oxygen. You need to respond, you need to respond to this and basically facilitate this moving forward because this guy, he might be crazy enough to go out and do this session again next week or something like this. So again, the theory of super compensation. That's why normally we would say that, okay, the reason why we get strong is because we exercise or we provide a, a controlled stress to the body that the body is able to respond to and grow from. So now when you are out and exercising and you are doing these hill repeats there, now you can instead think of it this way. "Okay, so when I did my five minutes, my five-minute efforts," and I... Let's say you, you, you accumulated, how many, how many repeats would you do during an hour? Or let's say, how many repeats would you do during a session?
- PAPeter Attia
Six.
- OBOlav Aleksander Bu
Right.
- PAPeter Attia
Six to 10.
- OBOlav Aleksander Bu
Six to 10. So then basically when you do six to 10, that means basically then you are accumulating between 30 to 50 minutes of, let's say, that high intensity-
- PAPeter Attia
Of work. Yes, that's right
- OBOlav Aleksander Bu
... yeah, of, of work there.
- PAPeter Attia
Yeah.
- OBOlav Aleksander Bu
So you, of course you do more work, but you do that specific work there with the idea of that this will give you a bigger engine, but ultimately actually what you're really looking for is to become faster. That's what you're really looking for. Uh, and that can be done, like we also mentioned in- initially as well. If you... In one sense you can say you don't really care either. If your VO2 max comes down but you just come faster, okay, well efficiency have increased. But okay, that's most likely not gonna be the ratio. The, the, the, the, the, the, the, the outcome of it, it will probably be a mix between a lot of things here. But now you can think of it this way, and that is that when you go out and you do... So let's say that you ride now at 400 watts and you accumulate 30 minutes at 400 watts, so let's say something like that.
- PAPeter Attia
Th- those days are over, by the way. [laughs]
- OBOlav Aleksander Bu
Okay. [laughs]
- PAPeter Attia
That used to, that, that used to be the case when, when... I, I'm nowhere, I, I, I wish I could still do 400 watts for five minutes, but anyway. [laughs]
- OBOlav Aleksander Bu
Let's say 300 watts. It, it-
- 2:14:28 – 2:19:07
Physiological limitations on VO2 max
- OBOlav Aleksander Bu
intervals, there are many benefits of doing longer intervals as well. But now we are purely looking at one thing here, so we just said, "Okay, fine. Let's see how can we bring the VO2 max the highest," and we, we, we, we, we disregard everything else. We don't talk about necessarily about endurance, uh, fatigue resistance, all these kind of things that we, we, we, we just neglect that for now. So now you can think of it this way, that h- what, what is the driving? What, what does, or what is it that causes us to, to bring up the oxygen? Or the, uh... W- why does it come up? Here I think it is useful to think of also what is the measurement method that we're using as well-
- PAPeter Attia
Mm
- OBOlav Aleksander Bu
... very often to quantify this. And I'm... W- if you... We have to remember that this oxygen apparatus, when we are meas- measuring oxygen consumption, we are not measuring what's happening inside the muscle, we are measuring what comes out in the end in the exhaust here, and then we are quantifying VO2 max as a function of that. If we go into... So for example, if you do mitochondrial re- respiration, so if you take the mitochondria, so you do a biopsy, you take out now the mitochondria and you put it into chambers, specific chambers is to measure now the mitochondrial respiration. We are not talking about 90 milliliters per minute per kilogram anymore. We know that-
- PAPeter Attia
Mm
- OBOlav Aleksander Bu
... already for well, for even for fairly m- for not well-trained athletes, you're already at 200 milliliters per minute per kilogram. We know that for elites you are more than 300 to 500 milliliters per minute per kilogram if you go into what the m- mitochondria is capable of using of oxygen, yeah.
- PAPeter Attia
Sorry, just to make, just to make sure we understand that, Olav, what you're saying is we are never limited at the level of the mitochondria?
- OBOlav Aleksander Bu
I would say statistically speaking, so if you're not talking about people with-
- PAPeter Attia
I mean, not talking about people with mitochondrial disease.
- OBOlav Aleksander Bu
Yes.
- PAPeter Attia
But if you're, if you're, if you're talking about you and me and your athletes and most of the people listening to this, when we ask the question, "Where is the rate limiting step in oxygen consumption," or more to the point, oxygen utilization, it is not at the mitochondria. It's not that we are unable to put more oxygen through the system at the final point where it is needed for combustion. Uh, uh, by the way, I've always thought it's at the level of stroke volume, that it's actually-
- OBOlav Aleksander Bu
Uh-
- PAPeter Attia
... at getting the plasma to the muscle. Is that what you believe?
- OBOlav Aleksander Bu
Yeah. Getting, getting, getting the blood, getting the oxygen, getting the hemoglobin transported to the cells is the most, most important thing more or less. So, so it's basically it's a, it's more of a central limitation than a peripher- peripheral limitation we're talking about there. Because the perip- the peripheries, where if you look at it-
- PAPeter Attia
Yeah
- OBOlav Aleksander Bu
... for example from mitochondrial perspective, it is so... The, the ratio between what it can use is so extreme compared to what we are able to pump around or, or take up in our lungs and pump around to, to the body compared to what we can, what we can use. So then, so then, and that's actually f- not without touching into that. That actually goes also from, uh, when we look at it, uh, for example, you, you mentioned it, our athlete or my athletes are, are, are, um- Uh, using a lot of carbohydrates, uh, for, for fueling and so on. We also know that basically the 60 to 90 grams per hour, that's not a limitation either. It's much, much, much higher than that. We, we race, and we use this... I use... So how do we quantify this? We use isotope tracers. So we add isotope-
- PAPeter Attia
Yeah
- OBOlav Aleksander Bu
... tracers to the carbohydrate, and then basically we... So m- similar concept as double labeled water, but here we add it actually to the carbon instead to look at the carbohydrate uptake. So we know that that's also is much higher. This is a lot of research that we have done with, with Morton, es- specifically on Christian and Gustav. Um, uh, and we know that, again, if you do muscle biopsies, then we see basically that the carbohydrate uptake or, or, or, or, uh, of, of, of, uh, is so much higher than what we are able to supply to our system. So again, it is a supply problem.
- PAPeter Attia
So sorry, meaning you're limited in what the gastrointestinal tract can tolerate, not at the substrate utilization in the mitochondria?
- OBOlav Aleksander Bu
Exactly.
- PAPeter Attia
Yeah.
- OBOlav Aleksander Bu
And w- w- I'm gonna be a little bit... Now I'm gonna be very crude here. But we can think of, put it this way, what brings us to VO2 max? It's not because we're thinking that we want to have a high VO2 max. "Oh, now I want to." You can add, you can start, you can start to breathe, increase your ventilation now as high as you want, but you won't increase. You will for s- you will, yes, you will increase your oxygen uptake, but you-
- PAPeter Attia
Right, but you'll never get to your maximum level without-
- OBOlav Aleksander Bu
Exactly
- PAPeter Attia
... sufficient work. You need work.
- OBOlav Aleksander Bu
Exactly. Not even close to it. You will bring it up, but it will not be... Be- just because you're breathing more and you are, you, you're working more when you're doing that.
- 2:19:07 – 2:24:03
The different energy systems used during work, and other things to monitor like VCO2 and heart rate
- OBOlav Aleksander Bu
Um, but then coming back to, coming back to, uh, micro intervals and whether you are, whether this is glycolytic or not, I think that if you go into the muscles and you measure in the muscles, you'll see that basically what happens there is that basically muscles are trying to use all, absolutely all basically energy systems immediately, instantly. But because we have a lot of buffer mechanisms in our body, if the sh- if the burst is short enough, then basically it won't show up as something here because you are basically just feeding it to the body.
- PAPeter Attia
Yeah.
- OBOlav Aleksander Bu
And then basically you have a long taper, or let's say you will never get the spike in VO2, but you can have a, you can see that you have an elevated VO2 consumption over a little bit longer time if you measure longer. If you just measure during the interval, it won't show up on the exhaust because you take off the mask before it basically shows up there. But if you keep the mask on now, and you keep it on there for, let's say, a couple of minutes after, you will see that now that basically you have an elevated oxygen consumption compared to, compared to, uh, before you did that interval there. So basically, we can say that when you do a burst, it will use most likely all energy systems instantaneously, all of them as much as possible. Because I think, like, i- if you, if you say that, okay, now it's first ATPs, be- fir- first we use stored ATPs, and then we shift to PCR, and then it becomes glycolytic, and then basically we go off to beta oxidation. Th- th- th- uh, this is rather more, I think the more correct way to view this basically. The reason why you can have a high power output, short and high power output, is because you are able to supply from all the energy systems instantaneously. But then you're depleting the different energy systems like-
- PAPeter Attia
Yeah. Then all of a sudden the, the phosphorylated creatine comes down immediately, and then the glycolytic-
- OBOlav Aleksander Bu
Yeah
- PAPeter Attia
... and then, yeah, yeah, yeah. Then that's where you're-
- OBOlav Aleksander Bu
Exactly.
- PAPeter Attia
Yeah, that, that makes sense.
- OBOlav Aleksander Bu
Yeah. So now, so now basically coming back then to micro intervals versus longer intervals, as long as you start to accumulate enough, enough work during that session there. Because we also talk about VO2 and VCO2. VCO2 is really, what is really useful for is to do a, get an instantaneous picture of, of course, what kind of substrate are you using. And whether you are at an RIR value of, let's say, s- even 0.8 or even, let's say, below 0.8, for example. But let's say that you are 0.8 or you're 0.9 or you're 1 in RIR value, basically it doesn't make that much of a difference in your energy yield. So one milliliter of oxygens you, if, if you use 20 joules of energy, 20 joules as an, as, as a, as a, as a pr- or, or, uh, as a number to basically understand your energy demand there, you won't go very wrong whether you had been using. So if you put this into a, in- into the formula, and you start to look again, h- h- how much big of a difference it is there, it's not a massive difference. Yes, there is a difference, but it's not massive. So if you want to be accurate, obviously you want to do this. But if you want to understand more of a fueling strategy perspective, then of course you need CO2 to better understand, okay, where are you? How are you using the, the, how say, fuels at different times? But here also we have to remember now that when we go into a lab and we test there as well, this is a completely different picture than what it would be if you brought somebody into the lab at the moment they went over the finish line in a race. Because now you would basically see that the velocity that they hold there at the end, or the power they hold at the end there, even though maybe it's much lower, it's still very close to their VO2 max because basically they are not able.
- PAPeter Attia
Yeah.
- OBOlav Aleksander Bu
So the VO2 max anything will come down. Yeah. So there, there's a missing time component into this very often when we look at research papers, when we talk about this, because we talk about it very often as a spot picture of something that happened in a fresh state-
- PAPeter Attia
Yeah
- OBOlav Aleksander Bu
... rested state or whatever, yeah. Or ideal state. Um, then coming back to, uh, th- then to the question and, and to round that up, I think exactly that when you do micro intervals and so on, and we, we talk about glycolytic and so on, basically you can use here also your heart rate as a gauge. If you start to see that when you do micro intervals and you're packing in, let's say, that you did 310 watts, 310 watts, uh, and, and, and, and you were able to accumulate, uh, yeah, that 30 minutes of that during those, uh, during that session there. If you now do micro intervals, so let's say you're able now to bring it to 330 watts, for example, and you do 30 minutes of that. Or you even do, maybe you even are able to do 330 watts average, and you even accumulated now, for example, uh, 35 minutes of that. What you'll see there, because now it starts to become quite a lot of them there, is that most likely you see that you also have a very high heart rate and maybe equally high heart rate as you did when you did, when, when you did the five-minute intervals, and as you look at accumulated heart rate there. Because you can here also use heart rate as, as an indicator of how much time you have accumulated close to VO2 max. Because we know that one of the conditions that has to be met also for you to reach VO2 max is that you also are thinking, then you need to pump as maximum amount of oxygen around in your body at the sa- uh, uh, uh, Uh, i- i- in order to do that. And we do, we, we do know that that is a combination of a very, very high heart rate, close to maximum heart rate, and stroke volume as well.
- 2:24:03 – 2:38:48
Lactate threshold and other metrics to guide your training
- PAPeter Attia
So it's just occurred to me that I've got eight pages of notes here of things I wanna talk about with you.
- OBOlav Aleksander Bu
[laughs]
- PAPeter Attia
And we are halfway through the first page. So clearly this is part one of many podcasts we're gonna have to do together. Hopefully, the next one will be in person. There are, however, a few things I wanna discuss before we part today. Um, we have yet to do kind of a more thorough discussion around lactate, and if I can only discuss one more thing with you for maybe another 15 to 30 minutes before we go, I'd like to do a little bit of a deep dive into lactate. Now, for some background, since I kind of abandoned any athletic goals and the only thing I train for now is my health, right? It's for my longevity. It's for something I call the centenarian decathlon, so being as fit and strong as I can be in my 80s and 90s w- without necessarily worrying about what I'm doing today, um, in, in terms of trying to maximize my performance today. I'm trying to maximize my performance tomorrow. A very important part of my training, because my training volume is now so much lower than it used to be when I lived on a bike or lived in the water, um, I'm, I'm trying to be maximally efficient, which is always risky because, you know, sometimes you just have to put the miles in. But what I do spend is about three hours a week in zone two, and, and again, there's so many different ways to describe zones, so I'm not doing this in terms of heart rate. I'm really defining this in terms of mitochondria. So zone two is my highest work- my highest power output where my lactate stays below two millimole. So this is v- very sustainable from an RPE perspective. You know, it's, it's, it's RPE six to seven. I can talk, but I'm not comfortable talking, but I can talk. It's definitely below my one-hour functional threshold power. Um, but it's more challenging than that 200 watts riding around in circles, having fun, trying to just purely focus on position. Um, and I do use my lactate, I do check my lactate constantly to make sure that I'm really hitting that spot. Um, now, what's the rationale for that? Well, the rationale for that is that two millimole is about the tipping point about which you can be in a steady state of producing lactate, clearing lactate, and once lactate starts to get into the three and four m- four millimole range, you, you wouldn't have indefinite access to that energy system. You're going to start accumulating so much hydrogen that at some point your, your perf- your, your, your, your physics of performance are going to be compromised. So, you know, I'm guessing, like, l- let's now talk about this in terms of world-class athletes. So if you had a continuous lactate sensor on an Ironman, um, in his seven hours and 30 minutes, give me a sense of what his lactate tracing looks like.
- OBOlav Aleksander Bu
So this is where I differentiate between volumetric measurements and concentration metrics, because concentra- lactate is a concentration metrics. We don't measure the volume of lactate, we measure-
- PAPeter Attia
Right, and the plasma volume-
- OBOlav Aleksander Bu
Yeah
- PAPeter Attia
... is decreasing-
- OBOlav Aleksander Bu
Yeah
- PAPeter Attia
... as the athlete is running, so you would expect-
- OBOlav Aleksander Bu
Yeah
- PAPeter Attia
... the lactate concentration to go up slightly even if the production of lactate is constant.
- OBOlav Aleksander Bu
Yeah. Uh, and also further here is that, uh, we have made some discoveries over the last years as well, which is when we start to do, um, Ironman training, for example, which also, uh, are very different from a lot of the understanding that currently is there. It, it, there, there is, there is some things there that are changing and, uh, we, we can, we, we will definitely touch on this, uh, in, in, uh, let's say an upcoming, uh, podcast. But f- to give you the trace now, uh, first of all, I think that two millimoles, when you have little time to train during a week, I, I'm, I'm very... Uh, for me, if, for example, you came to me and say, "Hey, Olav, I need some training advice." Uh, for me, longevity, uh, of course, uh, th- that's the most important for your wellness. But we can always say that, well, in the end, it's about whether you have a high VO2 max really doesn't matter if you're not capable of moving very efficiently around-
- PAPeter Attia
Sure
- OBOlav Aleksander Bu
... just because you're wasting energy. So we can say that for, like, universally, maybe more universally, it's about being able to move more per time.
- PAPeter Attia
Yeah.
- OBOlav Aleksander Bu
Uh, so like we said in the beginning, even moving your head is around, is movement. It's just better we break it down to a global movement of the body, or we break it down to basically as a local movements, uh, of parts of our body. But movement is actually the most important thing in the end here for all of us. Um, then, uh, uh, I would say that, uh, if you have... For me, if you came to me, I would probably, I would have a, my, m- I would very much look at, okay, most important thing would be to bring joy of exercising and sense of achievement into your training-
- PAPeter Attia
Mm
- OBOlav Aleksander Bu
... moving, moving forward, because that's what's gonna get you out in the day. That's what's gonna get you out of the bed. If you look forward to exercising because you find it enjoyable, you'll do more of it. That's the easier way to get you out, and even where you would start to prioritize it over other things you are doing instead of pushing it always in front of you, and then finally you get out and exercise it because you, you know you should do exercising-
- PAPeter Attia
Right
- OBOlav Aleksander Bu
... exactly to, to meet your, uh, your, your, uh, expectations. Um, so that would be the most important thing. But if we look away from that, so I, I would say that it, it mo- like, the differences between riding also at one millimoles versus two millimoles, as long as one millimole is more sustainable for you over, let's say, over months and years because it brings more joy to you, it allows you to maybe be more present or, let's say-
- PAPeter Attia
Mm
- OBOlav Aleksander Bu
... almost use it as a, as a mindfulness session, if that becomes more sustainable, you can think about what, what you accumulate. Because we very often, again, this is a problem very often with research and many things, is that we give a spot picture of something. We look at something in one session over a couple of session, instead of actually looking at over, over a lifespan or over, over a long, long, long period. And then this is where I think exactly that we very often we undervalue the joy of exercising because we go out with an expectation that, okay, I have to go hard, I have to go all out, and this kind of thing, which is very demanding and taxing on the body, especially if you're not prepared for this.
- PAPeter Attia
A- a- and by the way, I just-- I'll, I'll interject there that I can completely relate to that, and I've accepted that as a part of the transition in my life, right? So there was a day, there were many days, there were many years where I had a belief system that said every single day, without exception, "You must burn the pack of matches fully at least once." So it didn't matter what the workout was.
- OBOlav Aleksander Bu
[laughs]
- PAPeter Attia
There was still an all-out effort of about three to five minutes somewhere in the day that would probably, when I measured it, I wouldn't always measure it, but it would take lactate into the 16 to 18 millimole range.
- OBOlav Aleksander Bu
[laughs]
- PAPeter Attia
Like, incredible pain.
- OBOlav Aleksander Bu
Yeah.
- PAPeter Attia
And truthfully, I can't do that anymore because I don't have the mental fortitude for that much suffering anymore. So I still-- I love to exercise. There's never a day that I don't want to, but I also don't have to look forward to that degree of suffering anymore, and I think that that's okay, right? That's the difference between being 50 and being 30. Um, and I also don't think I need to suffer that much, certainly on a daily basis, maybe once in a while. Um, but that said, you know, I still really enjoy quantifying my training.
- OBOlav Aleksander Bu
Yeah.
Episode duration: 2:47:03
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Transcript of episode FOhb_D-5cgw
