Peter Attia MD335 ‒ The science of resistance training, building muscle, and anabolic steroid use in bodybuilding
EVERY SPOKEN WORD
150 min read · 30,010 words- 0:00 – 1:07
Intro
- PAPeter Attia
To be lean, you probably need to understand what bodybuilders are doing.
- MIMike Israetel
Train for roughly half an hour, two times a week, Monday and Thursday. If you do it properly, it can comport an unbelievable amount of benefits.
- PAPeter Attia
What's our two 30-minute day workout look like?
- MIMike Israetel
One of my absolute pet peeves is to see personal trainers in major cities having her do like rear delt cable fly one at a time. I'm like, "Oh my God, is that woman made of time?"
- PAPeter Attia
Are you saying that there are people out there that would routinely take 800 to 1,600 milligrams of testosterone in a week?
- MIMike Israetel
Oh, yeah.
- PAPeter Attia
Do you think about the trade-offs of long-term health?
- MIMike Israetel
Incessantly. It just doesn't matter why your blood pressure is high. Fucking control it with drugs.
- PAPeter Attia
Are we seeing more bodybuilders now use GLP-1 agonists to-
- MIMike Israetel
Yes. In the early to mid-2030s, we will see the fusion of informatics and biology. How adult does the humor on here go?
- PAPeter Attia
[laughs] I'm gonna defer to you on that.
- MIMike Israetel
That's a bad idea.
- PAPeter Attia
[upbeat music] Hey, everyone. Welcome to the Drive podcast. I'm your host, Peter Attia.
- 1:07 – 7:25
Mike’s academic journey, early experiences in powerlifting, personal training, & sports physiology
- PAPeter Attia
Mike, thank you very much for making the trip to Austin.
- MIMike Israetel
Thank you so much for having me.
- PAPeter Attia
I saw something on social media. You were here a week ago. Have you been here the whole time or?
- MIMike Israetel
Yes, week and a half long-
- PAPeter Attia
Okay
- MIMike Israetel
... social media collaborative trip.
- PAPeter Attia
Got it. So what, you weren't here for F1?
- MIMike Israetel
No, and, uh, loud noises scare me, so I would stay away from that sort of thing. I'm kidding.
- PAPeter Attia
[laughs]
- MIMike Israetel
Uh, it, it sounds awesome. I've never actually been to a Formula race in real life, and my videographer and a business partner on YouTube, huge Formula One fan. He has the app and everything, and he looks at, livestreams all the races and stuff. Are you, are you big into that sort of thing?
- PAPeter Attia
Of course. I not only have the app, I'm the premium subscriber-
- MIMike Israetel
My God
- PAPeter Attia
... so I can listen to all the chatter of every moment between every car and their mechanic and-
- MIMike Israetel
Wow.
- PAPeter Attia
Yes, of course.
- MIMike Israetel
That's really cool. Yeah. I make a lot of race car analogies when it comes to athletics and stuff, so if I make them here, you can correct me and say I'm using them wrong.
- PAPeter Attia
[laughs] Well, Mike, there, there's gonna be some folks listening and watching us who are probably very familiar with your work, and they've probably come to, to learn about you as I have through just, uh, you know, endless years of being, um, both amused and educated by your content on YouTube. Um, but there's probably a group of people here just in my audience that aren't overlapping with yours. So I wanna, I wanna just give folks a chance to kinda get to know you. I will have introduced you already in the introduction, but, um, let's talk just a little bit about your background. Remind me, you, you came to the US from Russia when you were eight or-
- MIMike Israetel
Seven
- PAPeter Attia
... seven, okay.
- MIMike Israetel
Mm-hmm.
- PAPeter Attia
Um, where'd you grow up?
- MIMike Israetel
Uh, so Moscow, Russia before that, and I do have memories of it and all that stuff. And then the metropolitan Detroit area after that, all the way until college, so a place called Oak Park, Michigan, which you can find on a map, and that's about it.
- PAPeter Attia
[laughs] Um, what'd you study in undergrad?
- MIMike Israetel
Movement science, kinesiology at the University of Michigan.
- PAPeter Attia
W- what sports were you playing then? Were you into grappling at the time?
- MIMike Israetel
I had wrestled in high school, and then, um, I just wasn't very good at it, and I just absolutely was not dedicated to it for a, a few reasons, which are k- sort of boring. But, um, I got into lifting hardcore towards the middle and end of high school. And then by the time I was in college, I was gearing up to start competing in powerlifting.
- PAPeter Attia
Hmm.
- MIMike Israetel
And so I actually started the Michigan Powerlifting Club. We started kind of a team, and we went to meets and all that stuff, so I was a competitive powerlifter in my undergraduate years.
- PAPeter Attia
And just for folks who m- might be confused about all the different disciplines, powerlifting is the sport where there are three and only three lifts.
- MIMike Israetel
Correct.
- 7:25 – 13:28
Mike’s transition from powerlifting to bodybuilding, & his scientific & artistic approach
- PAPeter Attia
And then just kinda going back to your personal evolution, um, as you're going through this journey of master's, PhD, industry, um, are you still focusing on powerlifting personally?
- MIMike Israetel
So I was focusing on powerlifting up until I got into my master's program, and actually towards the end of undergrad, I did this thing where, like, I was in a grocery store, and I picked up a magazine. It was a muscle magazine. It was the Flex magazine issue that had summarized the prior 2002 Mr. Olympia contest with all the pictures of the bodybuilders.
- PAPeter Attia
So Ronnie.
- MIMike Israetel
Ronnie won again.
- PAPeter Attia
Yep.
- MIMike Israetel
Though, um, he-
- PAPeter Attia
That was his fourth?
- MIMike Israetel
Yeah, f- yeah, fifth or something like that.
- PAPeter Attia
Fifth or sixth.
- MIMike Israetel
And he didn't look his best, and it was, uh, oh, and just not enough people showed up to really take him down. Everyone had suspected Jay Cutler could have beat him if he showed up that year. Jay Cutler almost beat Ronnie in 2001.
- PAPeter Attia
That's right.
- MIMike Israetel
Um, but, uh, he sat out 2002, and so I just remember reading the magazine and looking at the pictures and, uh... Oh, also, real quick, how would, how adult does the humor on here go? Or are we trying to keep it semi-professional?
- PAPeter Attia
[laughs] I'm gonna defer to you on that.
- MIMike Israetel
I shouldn't ponder that. That's a bad idea-
- PAPeter Attia
Yeah, okay
- MIMike Israetel
... Peter. Okay, so I'll just keep it semi-pro. Ha-ha. Um, it was enlightening because I realized that I had an eye for aesthetics, and by an eye for aesthetics, it doesn't mean I knew anything about what looks good or what looks not great on a human body, but I did have, um, a very distinct aesthetic preference. Like, some people will see muscular physiques, and they kinda all look the same, like giant, veiny, overcooked hot dogs, which is not wrong. But, uh, I looked at the physiques, and I was really taken aback, especially by some of them, of like, um, what probably normal people get when they look at very good art, that like, uh, "Whoa, I'm looking at something very special. I'm looking at something that's emotive."
- PAPeter Attia
Mm-hmm.
- MIMike Israetel
And I started to pursue my own hypertrophy training, muscle growth training.
- PAPeter Attia
And what, what were you looking like at the time?
- MIMike Israetel
Um, I was roughly 190 pounds at 5'6", uh, fairly lean but not anything crazy, and so muscular but not like, um, you know, if I had some clothes on, people would be like, "Oh, it's just a short person." But, uh, shirtless I looked like clearly I had lifted weights for some time. And, uh, I really also realized that while there's a huge passion for me in lifting heavy, I also had a passion for getting pumps and doing higher reps and doing lots of volume and seeing my body change visually. That was a huge trip. And it basically became this thing where I'm like, "Oh, I am an artist in muscle growth and fat loss. My canvas is my own body, and I wanna learn how to sculpt very well," most selfishly just so I could occupy a superhero-looking body. I ended up looking more like a villain, but whatever. Uh, balding will do that. List of bald superheroes includes mm, bald supervillains, all of them maybe. A huge fraction in any case.
- PAPeter Attia
[laughs]
- MIMike Israetel
But, um, it was just a, a real personal journey for me at first and still is to a huge extent.
- PAPeter Attia
And just by comparison, what do you weigh right now?
- MIMike Israetel
235 pounds. A substantial leanner.
- PAPeter Attia
And I know we'll talk, we'll talk a lot about bodybuilding and the cycles and where you are.
- MIMike Israetel
Sure, sure.
- PAPeter Attia
But, but are you in a cycle now, and if so, are you on the way up or on the way down in terms of mass?
- MIMike Israetel
Um, I'm kind of at the top of where I'll be for a little bit, um, maybe up but just very slowly.
- PAPeter Attia
Okay.
- MIMike Israetel
So this is the f- roughly the fattest I'll get.
- 13:28 – 26:38
Value of strength training, time efficiency, & how it differs from endurance training
- PAPeter Attia
All right. So I wanna try to bring this up to the present. So right now, you, you compete in bodybuilding. Um, you, you obviously provide a lot of education to folks. So, so I think, you know, my audience is, is, is, is clearly interested in exercise, um, clearly interested in strength training, clearly interested in the aesthetics of strength training.
- MIMike Israetel
Mm-hmm.
- PAPeter Attia
Because again, I think, y- you know, I think it's very easy to look at bodybuilders and say, "Gosh, that's, that's a little odd."
- MIMike Israetel
It's a lot.
- PAPeter Attia
But what is obvious, if not self-evident, is, um, that's just a spectrum, and anybody who wants to have more muscle and less fat probably has something they can learn from a bodybuilder. I, I often say to my patients, um, if you really wanna understand how to manipulate nutrition to be lean, you probably need to understand what bodybuilders are doing. Uh, there's probably no athlete, there's no person out there that truly understands how to manipulate exercise and nutrition in the context of body composition. And, and that's true even in the presence of anabolic steroids, right? So it doesn't-- anabolic steroids don't preclude that. They might make that a little easier, which I think we should talk about. Um, so maybe we just start with kind of where you see the value of strength training. Do you think that there is a diminishing return at some point? Do you think that there is a diminishing return in the amount of muscle? I've said very tongue in cheek, um, that the list of 90-year-olds out there complaining that they, uh, wishing they were not as strong and not as muscular is a very short list.
- MIMike Israetel
Very short list.
- PAPeter Attia
Right? So, uh, but again, why am I saying that? I'm saying that to say that most people at the end of life are saying the exact opposite, right?
- MIMike Israetel
Yes.
- PAPeter Attia
"I wish I was stronger. I wish I had more muscle." Um, but from a practical standpoint, Mike, what, what is your view on muscularity and strength, um, at the expense of what it might take to achieve them? Are there extremes that people should be mindful of?
- MIMike Israetel
It's a great question. If you have to be mindful of extremes, in almost every case you have already been on a multi-years long, very immersive, very infatuated, very disciplined journey of resistance training and focused nutrition, and the organization of many variables and parts of your life around that task. It's unlikely to be something you pick up a lifting hobby and just find yourself excessively muscular.
- PAPeter Attia
[laughs]
- MIMike Israetel
Oops. Um, so that's probably my best answer for that. It's just insanely unrealistic in most cases to wander into that sort of thing. You know, the, the, um-
- PAPeter Attia
The myth of accidental muscle.
- MIMike Israetel
Yes. Well, you know, pe- people say more money, more problems. First of all, I, um, m- various philosophical grounds, I think that's absurd, but, um, you don't accidentally become ultra wealthy, and by God, I wish you the best if that happens to you. I'll cry a tear for you. But in much the same way, almost nobody accidentally becomes hyper muscular to the extent that they're on that side of the spectrum, that trade-offs are starting to become apparent. Probably the biggest trade-off in the short to medium term is, um, opportunity cost, things you could have spent doing outside of being in the gym. But the way that the science of resistance training works is for almost all of the health benefits and the longevity benefits and the quality of life benefits, the amount of time you need to be training per week is measured in the one to three hour range, with three being like you're really full sending it.
- PAPeter Attia
Mm-hmm.
- MIMike Israetel
One to three hours per week, if we took... If you went on ChatGPT and did, like, a time use question, I mean, like, can you list all the things the typical American does for X number of hours a week and throw in, uh, you know, you just look, read down the list, top 100 time use cases, you may find that one to three hours a week is somewhere in, like, the 50 or 60 rank, and there's so many things people do that are way more than that. I mean, social media consumption, television watching, uh, a- and the list goes on. There are dozens of things you do that take way more time. And so if you really fully invest yourself, like I'm relatively fully invested into getting as jacked as possible, it's gonna take some time. It's gonna take, it could take eight hours a week, which is still like, well, it's not forever, you know? People will jog for 40 minutes every morning and think nothing of it. Um, and then when you present to them the idea of resistance training, they're like, "Well, now that's gonna take some time." You're like, "Well, yes, actually it does not take nearly as much time," 'cause the intensity of the effort's so grotesquely high and the recovery demands are so high that you have to be very pulsatile with it. It's not even something you have to do every day. As a matter of fact, people get incredible benefits. Probably the biggest return on investment the average person can make is to train for roughly half an hour two times a week, Monday and Thursday. If you do it properly, it can comport an unbelievable amount of benefits just across the board. And so for most people, the consideration that they can begin to do this successively is just not something realistic until and unless they're really into it like a huge hobby. Like, if you are watching Formula One for 30 minutes a day every other day on your phone, realistic considerations of this is taking up too much of your time, kind of out the window. Now, if you start, like, canceling podcast guests because you're following the circuit around the world and staying in five-star hotels and booking the, the hyper-rich guy suite for all the races, yeah, like, someone could say, "Whoa, you're really into this." You're like, "No, nonsense. It's only costing me 3 million a year." So then, yes, but it's, it's obvious when you're gonna be so involved. Uh, you don't just walk into that sort of thing.
- PAPeter Attia
So let's unpack this a little bit because, um, well, there's, there's actually two things I wanna go into, but one of them I think will be a better entry into it, which is you talked about how, boy, if you were gonna put eight hours a week into your strength training, you're kind of at the upper limits of what a person might do. Um, conversely, if your goal is to be a really good endurance athlete, you're not getting-- you're not at that level yet if you're only putting in eight hours a week, right? A, a, a world-class cyclist is... I mean, God, they're probably on their bike 30 hours a week.
- MIMike Israetel
Something like that.
- PAPeter Attia
Easily, right?
- MIMike Israetel
Full-time job.
- PAPeter Attia
Now, of course, not all of that is at maximum intensity. A lot of that, in fact, probably 70 to 80% of it, it also varies a little bit by gender, but let's just say 70 to 80% of that time is gonna be at zone two. Um, and they're really only burning matches in 20% of the time. Yet there's something very different about strength training, which is are you really getting benefit at the equivalent of whatever we would call zone two in the gym? Like, if you're at that far of a submaximal effort, um, what is the training stimulus? And is this just where the comparison between cardiopulmonary training, where there's a clear benefit from submaximal efforts and strength training don't, uh, jive?
- MIMike Israetel
That's definitely the case. Strength training, um, I, I like to use the term resistance training. It's the general term for going into the gym and applying-
- PAPeter Attia
Makes sense
- MIMike Israetel
... things to your muscles.
- PAPeter Attia
Right, because that, th- that's why, you know, you would say hypertrophy and strength are outputs of resistance training.
- MIMike Israetel
Correct.
- PAPeter Attia
Yeah.
- MIMike Israetel
Yes. Um, so you can get some benefits from very submaximal efforts, but resistance training is based on applying high forces and high levels of fatigue as its primary modality of how it makes you better. And so it's kind of when you get into that world, that's what's gonna happen. It's like if you, um, if you're trying to be a special operator eventually, you know, a, a Navy SEAL type of person, but you don't like, uh, the sound of gunfire freaks you out, you're kind of in the wrong place. [chuckles] So, uh, we get almost all the benefits from pushing either very heavy loads or lighter loads but very close to muscular failure, which people have described as unpleasant. Uh, a burn in the muscle, um, a lot of pain, uh, the weights slow down, so it takes a lot of psychological effort to keep going. There is not really an equivalent of just getting on the bike and putting in the miles. Getting to a pace or zone two, you can breathe, you can talk a little bit still.
- PAPeter Attia
Yep.
- MIMike Israetel
That's not weight training. But precisely because weight training is so intensive, you need lots of recovery time between sessions, and you can do lots of disruption and damage in each session. And also the total yield on how much it changes your physiology is very high for each session and actually per unit time, and that means if you're not working super hard per any one unit time, you're gonna need a lot of work. That's endurance training. If you're working insanely hard per unit time, you won't need a lot of work, nor can you recover from that much work, which is why the top end is eight or 10 hours or something for even professional bodybuilders of time spent in the gym every week. But for people that just want the basic benefits, yeah, we're talking about an hour or two hours a week, and that's really all you need. If you're pushing sufficiently hard, that's both all you need and realistically, like, you can recover from more if you make time in your schedule and really prioritize recovery. But yeah, any much more than that and it gets to be like, "Oh, wow, I'm kind of sore and tired a lot more."
- 26:38 – 36:06
Neurological fatigue in strength training: balancing recovery & pushing the limits
- PAPeter Attia
Can you say more about the neural part of this? I find this to be a very interesting piece, and out of all the pieces you've described, uh, and I agree with everything you've said, I, I know the least about that component yet. I've heard people talk about this, right? Which is you cannot discount the CNS fatigue, literally, that, that comes from doing this type of work.
- MIMike Israetel
Sure.
- PAPeter Attia
And, and I remember as an example, um, watching sprinters train, and obviously people understand that sprinters, I shouldn't say obviously, but, but if you unders- if you, if you, if you study the mechanics of sprinting, you realize it really comes down to force per unit mass.
- MIMike Israetel
Oh, yes.
- PAPeter Attia
Uh, it's how f- it's how hard they can hit the ground with their foot relative to their mass. And so, you know, these are athletes who need to be, you know, almost comically strong without gaining-
- MIMike Israetel
Yeah
- PAPeter Attia
... any excess weight. So even though we look at sprinters and we think, gosh, they're very muscular, um, it's their strength to weight ratio that's really profound. And so they have to train in a way that minimizes hypertrophy and maximizes strength. So for example, they'll focus heavily on exercises where they can push the eccentric phase, uh, pardon me, the concentric phase and not the eccentric phase. And it was explained to me once that doing this allowed them to also spare themselves from some of the neurologic fatigue. Uh, is there any validity to that, or is that just true, true, and unrelated? Um, and, and what is actually happening in, in both the, the, the central and peripheral nervous system during the recovery phase between those, say, three-day or six-day bouts when you're trying to recover a system after the set you just described?
- MIMike Israetel
Yeah. I'm glad you brought up the peripheral. One of the big, um, misconceptions is that there's muscular fatigue, connective tissue, systemic fatigue, blood vessels and everything still have to, heart has to pump. But then people just say, "Oh, and then the cen- central nervous system." Well, the peripheral nervous system is a thing too, and it also takes substantial amount of fatigue. So I would just say, um, the nervous system takes fatigue, and it takes fatigue in the same way you would expect any system that's pushed to its limits to take. Various components of it experience wear and tear. Various substrates deplete and need to be repleted. So I can bring up two examples. And, uh, in the, just generally kind of the, the axon of any single given nerve, you have a balance of electrolytes in an, inside and outside, which allows the excitation contraction, or sorry, which allows the proliferation of the electrical signal. But, uh, you run that system long and hard enough, and it starts to get out of whack to where-
- PAPeter Attia
Hmm
- MIMike Israetel
... you try to get another impulse going, and it's like, "Uh." [laughs] So it needs to do a lot of pumping to take what's supposed to be inside the cell that's now outside the cell to get back in there to a level of concentration that would, would be fully recovered. Now, typically that happens quickly, but if you run that system a lot, there are various points at which some of the structures that are supposed to do that, they're also proteins. You use them enough, and they start to kind of break a little bit, and you need to produce more proteins to replace the channels themselves that do that pumping back and forth. And so that, you know, typically protein construction is measured on the order of minutes, hours, and days, not seconds. So that is a very... You could imagine it as, like, a transatlantic cable, and, like, you throw enough current through a cable, and the fish nibble at the cable enough, you need to start replacing the cable.
- PAPeter Attia
Hmm.
- MIMike Israetel
Now, if you're really, really using the crap out of that cable, yeah, it's gonna, like, un- undergo some not so great things. And then closer to neuron to neuron junctions or the neuromuscular junction between the neuron and the, the muscle itself, you have vesicles of neurotransmitter. You pump enough of those in, you get the cool stuff of communication. You can run low on neurotransmitter, and then, like, the electrical signal arrives and the neurotransmitter's like, "Sorry, not enough of us to do anything." And so you experience profound weakness, which is expressed as, uh, or fatigue expressed as weakness, [lip smacks] and you need time to reconstruct a lot of those neurotransmitters. place them into vesicles, have those vesicles translocate to the synaptic cleft, and then, like, sit there and get ready. And that is a process that typically happens rapidly, but if you really exhaust it, it can happen over some time. A really austere illustration of that is... And I've never done this, I've just heard about it. I, I will take credit for doing many other drugs, but I've never tried ecstasy. But if you clear enough of that neurotransmitter, you don't feel the same the next day. You feel different, and it takes a day or two to get back up to those levels. Similar types of mechanisms are at work when you are going to very close to true failure on, let's say, a squat or a leg press. I mean, you're cooking your muscles, but every single capacity of the nervous system to say, "Push, push, push," is at maximum. And so you end up doing quite a bit of homeostatic disruption all the way along the axon, all the way through the cell body, and in the synaptic cleft. Neurotransmitters getting everywhere, gunk building up. That's gonna take some time to fix, which is why we see typically that people don't regain their prior strength after fatiguing in resistance exercise for, depending on how hard you go, anywhere from several hours to several days.
- PAPeter Attia
Mm-hmm.
- MIMike Israetel
And so if you have really, really hard workouts, it just might take several days for you to be able to have a really, really hard workout again for that same muscle group. Luckily, because a lot of this is peripheral nervous system based and local musculature based, if you train the living crap out of your chest one day and your triceps, you can train back and biceps, which have nothing much to do with those movements, pretty robustly the next day. Much of the fatigue is local. It's not all local. The central nervous system, brain and spinal cord, specifically the brain, has a variety of mechanisms by which it controls your central fatigue. Um, I remember, I think Tim Noakes was a big proponent of the central governor model.
- PAPeter Attia
Central governor, yeah.
- MIMike Israetel
And, uh, though in the explicit terms which he described it might not be the case or somewhat close, there's absolutely central governing going on. And when your body can tell through a variety of mechanisms that like, "Yeah, pretty messed up here," it's gonna pull back on how hard you can do anything. And some of those neural structures might even be operating at full bore, but they're just degraded enough to where full capacity isn't full capacity anymore. And so in all those variety of ways and many others, your body, after accumulating a certain amount of fatigue, will need to back off. And if you think you can train ultra-hard for the same muscles twice a day every day, you are welcome to try it. In medical supervised context, you won't last. Uh, so it's really good that we have breaks planned in, but it's also really cool because weight training is one of those things where you get a dose of it, and for days after, under the hood, it's upgrading your body and your nervous system and your muscles and your tendons. So it's really neat that you can do 20 to 30 minutes of intense physical activity and resistance training, and then for days later be experiencing the actual accrued benefits. Not a lot of things in life like that. It's kind of like getting a college degree for which you pay money, and then earning money with it years later. Ostensibly, anyway. I've never earned any money or had a college degree. But, um, that's kind of how it works. And, and you have to understand that when you're entering the gym, if you're training properly, you are asking a lot of your physiology. You are pushing it to its limits. If you're not, you're not using your time best and you're not getting the best outcomes, because a lot of the absolute best results come from pushing very, very hard. Not necessarily to limits, but you have to test the limits, right? Like, uh, from what I understand, you have a history of boxing. Is that correct?
- PAPeter Attia
Mm-hmm.
- MIMike Israetel
So, like, if you just shadow box, it's nice. It helps. But going hard rounds against multiple fresh opponents, even if you're not, like, collapsing on the floor after, you know that, like, you're looking at the clock and you're like [pants] If you don't push it to that level at some point, you're not fight ready. So in order to be your best boxing version, every now and again, you have to push it to discomfort, grotesque discomfort. Same with the body. It's nice that you get to do that every now and again, and then you collect the benefits afterwards.
- PAPeter Attia
It's so interesting how what we could do up to a certain age, and I don't know what that limit was, because I really stopped pushing to those limits at about the age of 19.
- MIMike Israetel
Mm-hmm.
- PAPeter Attia
So I don't know if the limit was actually 20 or 21 or 24, but, but I never trained maniacally after the age of 19.
- MIMike Israetel
Okay.
- PAPeter Attia
Everything I've done since 19 has been smoking and joking.
- MIMike Israetel
Okay. [laughs]
- PAPeter Attia
But what I could get away with then was ridiculous. Um, and I attribute it only to two things, right? Youth, obviously with youth I mean stupidity and inexperience and all the things that come with youth-
- MIMike Israetel
It's happening
- PAPeter Attia
... but also, like, um, having started very young. So age 13 to 19, I was training literally six hours every day except Sunday. Sundays I only trained two hours per day. And I look back at the workouts I did and I think, like, I don't know how I did it, and more importantly, like, how much better could I have been if I didn't train that much? But-
- MIMike Israetel
It's a good question
- PAPeter Attia
... these, like, it wouldn't be uncommon for me to do six super hard rounds of sparring with two, with three fresh opponents.
- MIMike Israetel
Yeah.
- 36:06 – 41:46
Relationship between training intensity & volume, why muscle growth is not linear, & how different approaches affect results
- PAPeter Attia
I wanna go back and just put a bow on something you said before, 'cause I think it's so important, and it's gonna come up again and again, and I wanna make sure people understand the point. 'Cause I think your example was great, by the way. Um, the non-linearity of force is very counterintuitive. It is not obvious why, for example, being on a bike, even if you are riding at a very high level of power... So remember, on a bike, your leg is going around at 90 times per minute. So Even if you did a one-minute all out, that's 90 reps or call it 45 reps. That's nothing compared to when you're doing an all-out set for 10 reps in the gym. It's such a difference in force. And the, I love the example of the wiffle ball going by you versus a .50 cal.
- MIMike Israetel
Mm-hmm.
- PAPeter Attia
Right? The .50 cal could kill you without hitting you.
- MIMike Israetel
Mm-hmm.
- PAPeter Attia
Uh, the wiffle ball you wouldn't notice. So I think this idea of the profound level of difference in, in tissue destruction is, is a very important one. Um, I was on Dorian Yates' podcast a few months ago, and poor Dorian, he wanted to interview me because it was his podcast, but I just wanted to interview him.
- MIMike Israetel
Yeah, I'd be the same way.
- PAPeter Attia
Like how, how, how... I mean, who... I have nothing interesting to say.
- MIMike Israetel
[laughs] Yes.
- PAPeter Attia
Let's just talk about you right now, right? Um, it was very interesting to me to understand how little time he spent in the gym, um, for a bodybuilder of that era, right?
- MIMike Israetel
Mm-hmm.
- PAPeter Attia
He was very, uh, I guess progressive in, even though he was really going back to kind of Arthur Jones and Mike Mentzer and those guys.
- MIMike Israetel
Mm-hmm.
- PAPeter Attia
But he was really just sort of doing one set to failure per body, per exercise, and he was doing each body part once a week.
- MIMike Israetel
Mm-hmm.
- PAPeter Attia
I mean, I guess the, the, the, the question I sort of posed to him, but I'll pose it again to you is, are most people even capable of pushing that hard? And, uh, 'cause, 'cause I wanna bring it back to where we were a minimum, a, a moment ago, which was, hey, for a person who just wants to train 30 minutes twice a day, they can get all the benefit in the, in the world. But there's an asterisk there, right? Which is that 30 minutes twice a week is gonna be the most difficult 60 minutes total of your week.
- MIMike Israetel
Mm-hmm.
- PAPeter Attia
So going back to Dorian for a second, you know, what is, what has to be true to be able to only train that much in terms of total hours, volume, however you wanna measure it? How much work needs to be done in that window of time?
- MIMike Israetel
For the, uh, not the Dorian Yates example. For the-
- PAPeter Attia
No, for the Dorian. Let's start with Dorian. Like why, why could he produce such a massive physique? And, and again, let's just normalize all the drugs. We're gonna talk about drugs later, so we'll, we'll explain where the drugs are and aren't helping. But all the drugs in the world aren't going to give you that physique if you can't-
- MIMike Israetel
Mm
- PAPeter Attia
... generate the, the destruction of the muscle.
- MIMike Israetel
Yeah.
- PAPeter Attia
Like is that just the sort of thing where virtually nobody can actually push that hard that consistently, or was it just that nobody thought to do it the way he was doing it at the time?
- MIMike Israetel
Plenty of people thought that's how it works. Mike Mentzer did that only in a more extreme version than even Dorian did. Lots of Mentzer acolytes did it. It's not the most efficient or the most effective way to train, but it is quite effective because if you go very close to failure with heavy, very heavy loads, all of the subcomponents of your musculature, your motor units, which is the motor neuron and all of the cells that it, um, activates, they'll get recruited, and they will be asked to work to their limits. They'll take on a great deal of damage and disruption. They'll sense a ton of tension, and they'll produce great results for you. The other thing is that the relationship between both intensity and volume of how much you do work in the gym, especially volume, is curvilinear and hyperbolic. So it looks like this. And if people are just listening to this, it means if you do one all out hard set per muscle group per week, which is not what Dorian did-
- PAPeter Attia
No
- MIMike Israetel
... he did roughly 14 of those per week-
- PAPeter Attia
Yep
- MIMike Israetel
... per muscle group, um, you get maybe something like 30% of what you could have gotten with five sets. With-
- PAPeter Attia
Why is that?
- MIMike Israetel
It doesn't. Because your body has very good sensing mechanisms for tension and metabolites and all these other things that cause muscle growth. And when it detects that you're pushing on the pedal, it'll give you a real good wallop of result. You keep pushing on the same pedal over and over, and the systems are greatly desensitized to giving you more muscle growth.
- 41:46 – 51:16
Sustainable & effective approaches to maximizing muscle growth: training close to failure while minimizing fatigue
- MIMike Israetel
So Dorian, from what I understand, did roughly 14 sets per week per muscle group-ish, and, um, that gets into that territory of a very robust signal of growth to the muscle. It's not the highest signal of growth. If you decided not to train your legs very hard or your back very hard, and the amount of systemic fatigue that's imparted to you week by week is much lower, because fatigue isn't just local, it spills over into everything else. You could push your arms, shoulders, and chest not to 14 or 15 or 20 sets per week, but in many cases 25, 30, 35 sets per week and experience very meaningful growth enhancements that you would never have seen only ever training those 15 sets a week. But 15 sets a week might bring you to 70 or 85% of what all of those muscles could eventually have hypertrophied if you only ever specialized in them. And so Dorian was insanely jacked, but He was jacked all over and probably could have, in retrospect, benefited from more specialization phases on various weak points that he had. His back was startling. His arms were excellent. Now, by mortal standards, they were the biggest arms you've ever seen in your life. By competitive bodybuilders of his era standards, relative to the rest of his physique, he could have had bigger arms, could have bigger shoulders, and so he could have poured much more volume into those muscle groups and less into everything else. But Dorian seemed to have a kind of all-around approach, which up until about a year ago, so did I, and so I had never looked very aesthetic, but boy, were my legs super big 'cause they could just eat up the growth all the time. So if you wanna do not a ton of volume for any one muscle, if you work really hard and bring yourself very close to failure, you can already do super, super well just with that alone. If you get a really good cook, someone who really knows how to make food, and you give them an hour in the kitchen w- with a variety of menu items versus three hours, within an hour, they can wow you with what you're eating. Within three, they can wow you more, but it's not three times more. Like, uh, you know, Matrix Reloaded orgasmic brownie or whatever. They ain't gonna make that. That is gonna take them a lot longer than three hours. They can make a difference, but probably only people who are very culinarily attuned can tell. Like, if he-- if someone makes me chicken fingers, gourmet chicken fingers if there is such a thing, I'm sure Austin has something like that, um, then, you know, an hour versus three, to me, it all tastes same-same. It's amazing. To someone really, really with a refined palate, they'll be able to tell, but they can't lie to you and say, "Look, this three-hour chicken finger, this is just categories above the one-hour one." So in a lot of processes in general, and luckily in the human body, getting some of the way to your body's maximum ability to recover actually brings you most of the way as far as results, and that's why Dorian could do what he did.
- PAPeter Attia
Now, if Dorian was doing 14 sets per body part per week, um, would that mean 14 sets to failure of 14 different exercises, so we're not counting the warm-up sets and things of that nature?
- MIMike Israetel
It's a complex question. It's not 100% clear exactly what Dorian did or if he even did everything exactly as it was written on paper all the time.
- PAPeter Attia
Hmm.
- MIMike Israetel
You see his training videos. You don't always see just one set. He would also have this thing, like a warm-up set, that for him was a warm-up, but for most people would absolutely be a work set. [chuckles]
- PAPeter Attia
Right. Right.
- MIMike Israetel
So it may be more like two or three equivalents of a working set per exercise-
- PAPeter Attia
Yeah. Yeah
- MIMike Israetel
... with three or four exercises there.
- PAPeter Attia
Sort of maybe, like, may- maybe there's, like, a total throwaway set, and then there's, you know, a modest set, and then there's a two rep in reserve set that, again, that's a real working set-
- MIMike Israetel
Sure
- PAPeter Attia
... which then just wasn't failure.
- MIMike Israetel
And for him wasn't. Right, yes.
- PAPeter Attia
Yeah.
- MIMike Israetel
So according to his categorization, the only work set was the one that was absolutely to true muscular failure-
- PAPeter Attia
Okay
- MIMike Israetel
... sometimes with forced repetitions, which you would also have to integrate because forced reps is when someone helps you lift the rest of the weight, or if you do a drop set-
- PAPeter Attia
Yeah
- MIMike Israetel
... you use less weight right after you went to failure. We, we shouldn't count that as just one set.
- PAPeter Attia
Yep. Yeah.
- MIMike Israetel
Uh, it wouldn't be the most correct way to think about him, so.
- PAPeter Attia
And when you compare that to the example of the three-hour chef, so now the person who's willing to put in 30 sets per body part per week, do any of those sets need to be to failure, or are you counting those as, hey, these would be sets of two reps in reserve, one to two reps in reserve?
- MIMike Israetel
Almost all of the literature that has found out that if you don't systemically fatigue the whole body too much, any given muscle or several muscles you can push into the 30, 40, 50 plus set range per week, almost every single study done to elucidate that understanding was done with, uh, muscular failure studies, true failure, truer failure than you'll see in the gym because these people are, uh, training in laboratory conditions with master students screaming at them to keep going. And most of us have never trained that hard consistently.
- PAPeter Attia
Yeah.
- MIMike Israetel
So people can still recover. Now, these are undergraduates, um, that are recreationally trained typically, so they can neither do a lot of damage, um, nor are they impeded by age and prior injury and all this other thing. So I would say that whatever amount of sets you have to do to get a certain amount of, whatever amount of growth you want, you can get there in a few different ways. You can get there with, let's say, 30 sets that are four reps shy of failure. You can get there with 22 sets that are one or two reps shy of failure, and you can get there with 20 sets that are all the way to absolute muscular failure. So if you are really training not so super hard for reps in reserve, you'll have to do substantially more sets to see the same hypertrophy. But study after study after study illustrates that when you're getting one or two reps away from failure, it is often statistically undifferentiable on raw growth than going all the way to failure. However, the fatigue of true failure training, probably mostly because of that nervous system component, is exponentially higher. And so as far as an efficiency and long-term sustainability strategy, training all the way to muscular failure every session as a matter of principle is probably, on the margin, suboptimal and should probably-- most of your sessions should be one or two reps in reserve. Like, if you're doing dumbbell presses, you think... You finish your last rep, and you're like, "Gun to my head, I could do one or two more, but that's it," most times it's probably best to stop at that point because what you're getting if you go north of that is m- a 10 to one fatigue to stimulus ratio, whereas everything before was, like, one to one, two to one, three to one, five to one, and all of a sudden it's 10 to one. It's a lot of fatigue cost to pay for what in the literature chronically ends up being either tiny, tiny bit better or not better at all.
- PAPeter Attia
Which says nothing of the risk of injury when you drop that dumbbell on your pec, which I don't know anybody that's done that, but I've been told it really hurts when you fail in a set of dumbbell presses-
- MIMike Israetel
Oh, boy
- PAPeter Attia
... and totally collapse with a-
- MIMike Israetel
Just avoid your head
- PAPeter Attia
... with a dumbbell on your pec that turns black and blue.
- 51:16 – 1:10:14
Efficient & effective resistance training program for beginners with limited time
- PAPeter Attia
Let's go back to the sort of the, the person who's listening to us who wants to take the plunge, wants to start doing resistance training. Um, they're clinging to what you said a while ago, that, "Hey, I can get some really good results if I'm in the gym 30 minutes twice a week. And I know that Mike trains eight hours a week, but I don't need to be Mike." Um-
- MIMike Israetel
It's a lot
- PAPeter Attia
... so tell me what a program looks like. Let's construct the program for the pic- let, let's do it as a young, let's start with a young person. Let's start with a young person who actually has been somewhat active throughout their life, but it's, it's mostly been in sports, right? They play tennis. They play, you know, uh, they, they did cross-country in high school. Um, they've just never been a gym rat.
- MIMike Israetel
Sure.
- PAPeter Attia
But they've listened to this podcast enough, they've listened to you enough to know, like, "Hey, there's value in, in, uh, developing strength."
- MIMike Israetel
Sure.
- PAPeter Attia
"And, and, and I'd like to have some hypertrophy. I wanna, I wanna look a little better."
- MIMike Israetel
Sure.
- PAPeter Attia
Okay, so I'm coming to you. I'm 40 years old. Um, kind of a little intimidated if I'm truthful, right? Don't know what to do.
- MIMike Israetel
Good, I have a whole pec bounce to make you more intimidated.
- PAPeter Attia
[laughs] So what's our, what's our, what's our two 30-minute day workout look like?
- MIMike Israetel
Yeah. So I'll describe to you what week one could look like-
- PAPeter Attia
Okay
- MIMike Israetel
... and then I'll tell you how to scale that afterwards, 'cause it's not just the same every single week.
- PAPeter Attia
Yep.
- MIMike Israetel
So what you wanna do is if you're training twice a week, let's call it Monday and Thursday for simplicity, you do want some symmetry. So you don't want a situation in which you train with weights Monday, Tuesday, and then you take the rest of the week to do other stuff. If you only train twice a week, you want it to be roughly evenly spread. So Monday, Thursday, Wednesday, Friday, that sort of thing. And because your muscles don't take usually a whole week to recover, but if you push them hard, maybe at most half a week, you can train every major muscle group of your body in every single session that you do. So both Monday and Thursday will have every major muscle group being trained. Routines that have the muscle groups separated are called split routines. You know, chest one day, back the next. Mostly pro bodybuilders are the only ones that benefit from that sort of thing, and there's a lot of nuance about how to execute that sort of thing. So whole body training is probably best for almost everyone who is trying to get the health benefits, longevity benefits, the aesthetic benefits, and so on and so forth. So the next thing you wanna do is you wanna conserve time, but you want a high degree of effect, and that's gonna impose some recommendations on us that do both of those things. One recommendation is to choose lifts, to choose exercises that involve two components. One is large muscle masses. So you're not gonna be doing a lot of, like, forearm curls or tibialis anterior calf raises, where, like, the muscle you're training is, like, as much muscle as your pinky finger and that's about it. You're gonna be training muscles like the quadriceps, the glutes, the hamstrings, the musculature of the back, the chest, the shoulders, the arms, et cetera. And choosing exercises that train those muscles, preferably not just one muscle at a time. So then we're using muscles, uh, very efficiently because we're pushing multiple muscles to their limits in one exercise. This is generally gonna be compound movements, multi-joint movements, things like pull-ups, pull-downs, barbell and dumbbell bent over rows, that, for the back at least, engage the forearm flexion muscles, the biceps, et cetera. They engage actually the muscles of the forearm themselves through your grip. They engage the posterior aspect of your deltoids, the rear delts. They engage almost every muscle in the back all at the same time. Now, you do one set of bicep curls, but I do one set of underhand pull-ups, I got my biceps checked off and I got three other muscles checked off. You just have one. One of my absolute grotesque pet peeves is to see personal trainers in major cities Training the regular clients, housewife who's 55, and having her do like rear delt cable fly one at a time. I'm like, "Oh my God, is that woman made of time?" And also, is there some kind of physique show which the judges said she needs bigger rear delts but nothing else? That's the only reason you should be doing that nine times out of 10.
- PAPeter Attia
[laughs]
- MIMike Israetel
So compound movements, close grip bench presses, pushups, overhead presses, upright rows, squats, deadlifts, et cetera, et cetera, et cetera. These are the kind of movements that train multiple muscles at the same time, and thus they are insanely time efficient because you do a few exercises and you're like, "Holy crap, that's all of my upper body." If you do some kind of rowing machine, you do some kind of machine or barbell or dumbbell that's a close grip press, you do some kind of upright row situation, then you've technically trained kind of every single muscle in your upper body to a substantial extent because every single exercise trains three or four muscles at a time. So those are the kind of movements we're gonna be leaning into the most.
- PAPeter Attia
What about for the lower body?
- MIMike Israetel
Same idea. So if-
- PAPeter Attia
Besides a deadlift and a squat, RDL
- MIMike Israetel
... so various stiff-legged deadlift or good morning, RDL is the same category of movement. That trains your entire back, uh, s- specifically your spinal erector musculature, which is insanely important for healthy aging. I could talk about that ad nauseam. And, um, then it trains your glutes, and it trains your hamstrings, and it trains your sartorius and parts of your adductors, and it actually trains your calves, too. Holy crap, that's one, that's one exercise. You integrate some kind of lunging pattern into that or some kind of squatting pattern, be it a hack squat, leg press, barbell squat, you name it, and all of a sudden you've run out of muscles to train in your lower body because everything has been, uh, done to a high degree of diligence. Again, compound movements. Uh, again, I see 45-year-old financial advisors who don't have a lot of time. They have family obligations, they have work obligations, they have other hobbies, and they're doing like leg extensions in the gym. I'm always like, "Man, I hope that guy's hurt and has a good reason to be doing those," because if he's not squatting or lunging or doing leg presses or something, he's just using up time in the gym training one thing at a time for no good reason at all.
- PAPeter Attia
So invariably, you've been asked this 1,000 times, but, um, when this person's coming into this situation and they don't have high training history, what are the tools you use to teach them how to do these compound movements safely, especially the lower body ones, right? So squats and deadlifts, admittedly they're not gonna be starting out with a ton of weight, but-
- MIMike Israetel
That's the biggest tool-
- PAPeter Attia
Yeah
- MIMike Israetel
... is starting out with low weight. There's no movement the human body can do which unloaded and doesn't, and not pushing the muscles and tendons to their extreme, has any higher risk probability than any other movement. So you can start with a deadlift or a squat that's body weight or less. You can brace your arms on a Smith machine and unload yourself while you squat. That may be where you have to start. You take multiple sets like that that are very submaximal. Ideally, you're there with a personal trainer. If not, you can just go to YouTube and type in the name of your exercise and it'll pop up. We have a huge library for free on YouTube. Actually, the RPI Hypertrophy app, which is one of our apps in our app suite, has every exercise you'll ever see in there, has a video demonstration one click away. So you look at that. Ideally, you would have a personal trainer because, uh, live communication about how to exercise, uh, is irreplaceable. Because on a video, we're assuming that your assessment of what that is is your assessment of what you're doing.
- PAPeter Attia
Which is very difficult.
- MIMike Israetel
Oh my God, you walk into a gym and they're like, "I'm squatting," and you're like, "That, that's not a squat. I don't know what the hell someone told you or what video you're looking at, but that ain't it." If you have a personal trainer, they can be like, "Ooh, that's really good, but I want you to move your hips back more. I want you to move down more," so on and so forth. But basically, the first time you're ever with someone in a session, all you do is you take them through those movement patterns, fine-tune their technique with lots of encouragement, and you're not seeking perfection, you're just seeking basic competency. Get your heels on the ground, get you squatting all the way down, get your back nice and straight. Listen, that's all we want. And you'll do three or four of those what are really warm-up sets, and you'll just kick them out of the gym. Three or four warm-up sets per exercise. It's a teaching session. They never even lifted heavy, they never pushed to failure, but because they're so unaccustomed to lifting, they'll get sore, and it's enough tension and disruption that they will grow muscle. The next time they come in, you work them through a different series of movements, let's call it Monday-Thursday movements. The next week they come in and you do the same workout except maybe that last set of every movement after a few technique-oriented sets, you, uh, ask them to go for slightly more repetitions. Maybe not five, but now 10. Or you put a little bit of weight on the bar, something that gets them like, "Oof, okay, I feel it. This is a challenge." And then over time, slowly every week, you increase the weight a little bit more, a little bit more, a little bit more, until several weeks later their technique looks real good, which most people can learn really good technique 'cause it's not that complicated, in a few weeks. And now they're like kind of struggling with their weights. We're finally up to a weight and rep combination that's challenging them physiologically every set, not just neurologically for how to do the technique. That three or four week sort of entry period is amazing because it takes the probability of injury and just c- almost completely eliminates it, 'cause you're not just going in there and seeing how strong you are on the first day. Which believe it or not, a lot of people are inclined to do. It's profoundly stupid. That's reserved for like high school or junior high kids.
- PAPeter Attia
[laughs]
- MIMike Israetel
If you're ninth grade, fuck it, max out. Don't do that when you're an adult. It's profoundly stupid, especially if you're in your 40s and 50s and 60s and like you don't want a torn pec. It's, you drive a truck for a living. Th- your pec is re- required for that sort of thing. After that sort of, um, easing in period, you're now competent with the movements. You feel yourself competent as a member of general gym culture. You don't feel lost. A big part of a problem of getting people to go to gyms and actually stick with it is there's this understanding that people have, which is itself relatable but inaccurate, that, um, the gym is for people that know things. It's their place. It's for that jacked guy. It's not for me. The thing is that jacked guy, to paraphrase another comedian, like he's been in the gym enough. You should take a few days off. You're big. You did it, buddy. The people who really need to be in the gym are the ones who aren't in the gym. So the gym is an, an infinitely welcoming place. Almost all the jacked people are super nice in real life, and they're not judging you. They're just staring off into space. They're ultra-selfish. They don't care about you.
- 1:10:14 – 1:18:03
Advice for finding a good trainer
- PAPeter Attia
There's a lot there I wanna go back and, and touch on. Um, let's start with the idea of how does a person find a good trainer because this is... You know, it's hard enough to find a good doctor, and that's a highly, highly regulated industry, right? Like, you either are [chuckles] an MD or you're not. Um, and y- y- you know... But still, there are lots of different flavors of doctors, and there are some who really think a lot about prevention and really care about how you exercise and how you eat. And there are others who I think, you know, do, but frankly don't have the time to really noodle that, right? So, so, um, as difficult as it might be to find a great doctor, it's probably even more difficult to figure out a trainer who's really good. So what are the questions that a person can be asking when they go into their gym or are looking online for a trainer to say, like, "Is this the person who's going to help me learn to do a squat and a deadlift safely? Is this a person who can integrate whatever preexisting injuries I have and r- really help me?" 'Cause I, I... Again, I've, I've worked with people who, you know, I've watched people coach, and I'm like, "Wow, that person really knows what they're doing."
- MIMike Israetel
Yeah.
- PAPeter Attia
They have picked up the absolute subtle art of how to cue somebody-
- MIMike Israetel
Sure
- PAPeter Attia
... to lift. They can focus on the non-obvious and get that person-- And there's other people who literally have no clue. They look like they just watched the YouTube video, and they're sort of parroting the YouTube video to you, but they have no real intuition about it.
- MIMike Israetel
It's very tough, very tough, because if you aren't an expert or a very knowledgeable person yourself, it's very difficult to figure out who is knowledgeable and an expert, who's doing a good job. Like, if you're finding a good doctor, I don't know what that means. I have no idea how to measure a good doctor versus not a good doctor. Most doctors are equally confident in telling you what they think is going on and very differentially accurate, so it's a tough question. I would say that if you have an opportunity to chat with them and ask them a few questions, you could find out some things that'll h- uh, be helpful. These are all marginal pieces of advice. There's no absolute. I'd say the thing that comes close to the absolute of having a high guarantee that they're good at what they do is if they're, um, certified in the Menno Henselmans PT course. Menno is an expert in our field. He knows his stuff, and his trainers that he certifies have a high probability of being able to deliver to you what it is that you want out of them. There are other fine certifications out in the world, but, um, a lot of certifications, you're just reasonably intelligent and you studied for an hour, and voilà, you're certified, so the certification doesn't go very far. It helps if your trainer has an undergraduate in kinesiology or some related field. That is not by itself ensuring you that they're gonna be good, but it sloughs off a lot of back end if you know what I mean, like you're gonna get rid of a lot of not great trainers. You can almost entirely ignore what they look like. Because the preponderance of the reason people look like they do is genetics. The other is diet, and the other is just how long have they been doing stupid or smart things to their body, but grinding away. So if you look at a trainer that just looks kind of like a normal person, maybe a little muscular, a little bit leaner, you look at another trainer in the same gym that's just, like, got six-pack on his face, you know, just ripped. Don't be like, "Well, well, that guy seems to know what he's doing. He's ripped." Like, he can't give you his genetics, and almost the biggest contribution to why he's ripped is genetics. And so people get hung up on this all the time. They work with preposterously under-qualified trainers who just look the part. People cannot, uh... there's not, like, a transitive property by which you can just, like, give someone your, your results.
- PAPeter Attia
Jackedness.
- MIMike Israetel
Yeah, I wish, right? You just touch their skin and you're like, "I, I feel it." You wake up the next day super jacked. It is... It was that easy. Um, you can ask them if, uh, how they integrate science into their practice. Not a guarantee, 'cause you can be evidence-based and still have all sorts of poor practices. And, uh, if they go mostly on personal experience and feel, you can be assured that they're probably not the greatest trainer for you. If they have a lot of personal experience that they use in their training, but also they're very adept at understanding the scientific literature, and especially just the broad strokes basics, you're probably in better hands than not. Someone that can explain to you the reasons for why you're doing certain things, and you just voice note record them and ask them, uh, "Is it okay if I record your reason? I just kinda wanna think about it at home later," wink. And then you just copy that and feed it into Claude 3.5 or GPT-4o and be like, uh, "Give me a steelman and a red team for this." It'll do both based on the sort of texture of its responses. 'Cause all these LLMs are designed to be insanely agreeable and very kind. But when you're wrong, wrong, they'll be like, "That's a good point. However," eight-point list. You're like, "That guy's an idiot. This is all wrong."
- PAPeter Attia
[laughs]
- MIMike Israetel
So luckily, you know, GPT-4o, if it was embodied in a robot currently, would probably make a great trainer. And so how your trainer and various claims of their scores against a, a GPT is probably one of the better ways to do it. And also say this, there's a big factor of how, uh, you get along with the trainer, because you're gonna wanna find the training at least as n- not unpleasant as possible, and ideally as pleasant as possible. If the trainer is someone that you just kind of vibe with, they can dig into you and really get you going, but they're also super fun to talk to outside of when you're, you're, you're not dying during training. If they can get you to become responsible for showing up on time in a sense of, uh, you know, "The trainer and I are on the same team. He's on my team, and when he says, 'Are you gonna make it Monday?' I just don't wanna let him down, 'cause he's my buddy, and I, I, I... I'm in this together. We're in this process together. I don't wanna give up on myself." If you have a trainer where you connect with like that, you got yourself a great trainer. Even if they're not super evidence-based, they just get you in and get you moving. That's like half the battle right there. So let's say those things are things to consider. And the last thing I'll say is have a trainer for a few weeks, few months, and maybe learn up about what's going on, and then see, like, oh, does my trainer know things or not? I mean, I had a person I was doing just nutrition for while my colleague Nick Shaw was, um, doing training and not for her. And I was in, um, my PhD program in Tennessee. I was training her or nutrition coaching via distance over the internet, and Nick was training other clients in New York, and she was in New York at the time. And she told the trainer kind of the diet that I had written her, and he was like, "Oh, that's, that's stupid. That's wrong." And she was like, "Why?" And the answer he gave her was so bereft of, um, a systematic approach to knowledge that she texted me. She's like, "Do you have any trainers you can recommend to me? I think my guy's an idiot." [laughs] And sure enough, gave, uh, her over to a colleague of ours, and Nick didn't have any room. And she's like, "Oh my God, this guy is beating my ass in the best way possible. I love him." Yeah, some of your trainers will suck, and you might need a few weeks or a few months to realize, like, "Man, everything I've heard about how this whole process works, my trainer doesn't even agree with me." Yeah, you might have to switch it up. Uh, you know, you might not have the perfect car. The first car you buy might just be a thing that has a steering wheel and, and wheels and goes places. And after you've kind of appreciated what it is you do and don't like about your car, your next car can be a bit more of a educated purchase.
- PAPeter Attia
So
- 1:18:03 – 1:33:54
Troubleshooting training plateaus: optimizing exercise selection, intensity, & recovery for muscle growth
- PAPeter Attia
what about the, the person who's been lifting weights for a long time? They're, you know, they're in there, they're doing this stuff, but they're, they're not happy with their progress, right? So they're, you know, they're, they're in the gym. Let's just say they're in the gym, uh, three, four times a week, an hour at a time.
- MIMike Israetel
How hard are they working? Are they really trying or are we saying that maybe they're trying, maybe they're not? It's a very different answer-
- PAPeter Attia
Yeah
- MIMike Israetel
... if they're trying or if they're not.
- PAPeter Attia
Let's say they are. They're actually trying quite hard.
- MIMike Israetel
Mm-hmm.
- PAPeter Attia
Um, and you, you actually look at them and you think, you know, gosh, they might actually be slightly over-training. They might actually be... And by over-training, I mean not giving themselves-- Let's say they're training three days a week and they're doing whole body three days a week, and they're in there 90 minutes at a time. Um, and they're, they're kind of going to one to two rep in reserve on every set, and they're hitting kind of 20 to 30 sets per, per body part, per workout. Um, what, what's, what would be your, your... So and, and to be clear, like, they're doing okay, but they're just saying, "You know what? I wanna be really jacked."
- MIMike Israetel
Okay. [laughs]
- PAPeter Attia
Yeah. Uh, what do I need to do?
- MIMike Israetel
Yeah. You would need to go down a checklist, uh, a troubleshooting checklist. And we actually do have on the RP Strength YouTube channel, we have multiple videos of how to troubleshoot your muscle growth, how to troubleshoot your diet, how to troubleshoot your recovery. So if you throw those on in the car during your drive to work, you're gonna learn a lot about how to troubleshoot.
- PAPeter Attia
Mm-hmm.
- MIMike Israetel
But you can concern yourself with variables that occur in the gym. You can concern yourself with variables that occur outside of the gym Both are very important. In the gym variables, w- starting from the beginning would be, um, exercise selection. Sometimes people say, "You know, my arms aren't as big as I want them to be," and I look at their plan, and it has no isolation work for their arms whatsoever. And I tell them, "This is not a surprise." And they say something like, "Well, I thought underhand pull-ups and close grip bench was good enough to get big arms." And I would say, "Yes, it is. Both of those exercises are great to get big arms, but you want bigger arms."
- PAPeter Attia
Hmm.
- MIMike Israetel
Which means, like every bodybuilder ever, you're gonna have to start working a few sets of curls in and a few sets of tricep extensions of some sort regularly, and hard. So a lot of times people don't have the specific exercise selection for what it is they want. Um, they're just doing the kind of general training you and I just described, but they're sometimes not even honest to themselves at a deep, introspective level of what it is they want. Like, a lot of those people that want better results, you look at them and you're like, "You look great." And like, "Yeah, but I wanna look better." And you go, "How?" "Well, I just want fucking gigantic arms." And you go, "Oh, okay. Well, like, your workout is absolutely not designed to do that. It's designed to get you arms that look big to someone who, like, sees you lifting your suitcase into an airplane. But other than that, like-"
- PAPeter Attia
[laughs] Right.
- MIMike Israetel
"... you don't have big arms." And then you go, okay, exercise selection. Another variable to consider is technique. Some people have just not so great technique. A good technique involves putting the muscle into high force positions at a very deep stretch, long muscle lengths and high forces. So if you're doing pec flies, for example, but you're only going all the way down to, like, here, you need to open up like crazy and take a few seconds down there in the deep stretch. That's really gonna help you out. And technique is so s- exercise specific and so individual that you really should get a qualified trainer or someone you trust or videos, uh, on your own analysis to go like, "Okay, am I really doing this right?" 'Cause you think, "Oh, I'm hack squatting," and then you see an RP Strength video about hack squats and you're like, "I have never hack squatted a day in my life." You try it our way, and you're like, "Oh my God, my legs." For the first time in months or years, they get sore, they get tired, and you're like, "Oh, wow." A couple weeks later, your quads are visibly bigger. "Okay, now finally I fixed my technique." Another question you have to ask is volume-wise... I mean, like, I s- I suppose you already said they're doing one or two reps in reserve, so we're not gonna question that. We'll say they're training hard, which is good. Uh, uh, that's another thing to ask if someone isn't getting great results.
- PAPeter Attia
But volume intensity would be on the checklist.
- MIMike Israetel
Yeah, 100%.
- PAPeter Attia
Yeah.
- MIMike Israetel
Like, am I really pushing hard? How hard? If I think I'm pushing hard enough, I should push a little harder and see what happens.
- PAPeter Attia
So for intensity you would say if they're at least hitting two reps in reserve, you're okay with it.
- MIMike Israetel
Golden.
- PAPeter Attia
Okay.
- MIMike Israetel
No need to improve above that.
- PAPeter Attia
Yeah. But if you went in there and you observed them, at the end of their set, if you said, "L- let me see you do a few more," and they were constantly getting four more reps-
- MIMike Israetel
Yeah
- PAPeter Attia
... so they're four reps in reserve, you would say the literature says you're not hitting in a training-
- MIMike Israetel
Correct
- PAPeter Attia
... enough, a high enough training stimulus.
- MIMike Israetel
Correct. Yeah.
- 1:33:54 – 1:37:28
Impact of genetics, age, & lifestyle on muscle growth
- MIMike Israetel
The other thing is genetics. Um, the most important factor, other than time spent in the gym, about how jacked and lean you gonna get is genetics, and it is a hugely, hugely important factor. And so you, you have to understand that your goals have to be referenced to what your genetic likelihood of achieving them are. The only way you'll find that out is if you work at it for a while and see what happens. But some people work at resistance training for three years. They'll accrue five pounds of muscle, burn three pounds of fat, and they'll be like, "This next year, I wanna gain 10 pounds of muscle." And you go, "Whoa, that's not how hyperbolic curves and asymptotic curves work. You got it backwards." If in three years you gain 10 pounds of muscle, in the next three years, maybe you can gain five. That's realistic. Does not work in reverse. So it's really, really important to contextualize multiple qualities. One is how much recovery and rest and relaxation time do you get compared to work and being underslept? Another is genetics, and the other is age. And so if people say, "I wanna get more jacked," and I've... The reason I'm ranting about this, uh, Peter, is because I've had many clients who were willing to put in whatever work it was gonna be necessary to put in, but they were older, they did not have particularly great genetics, and they had already gotten most of the muscle gain that they were gonna get. Not all, but most. And they requested a formulation from me of their exercise plan that would get them categorically better gains. And outside of pharmaceutical enhancement, I had to tell them in some way or another that was impossible. I ended up telling them that after many years of struggling myself to try to optimize for them and get them those gains, 'cause I'm like, "Look, I'm a science guy. Cl- I know things, I think. I've been s- fairly successful in my own body. Why can't I get these people to gain muscle?" And those, that trifecta of age, genetics, and how much of a professional bodybuilder or fitness person do you wanna be for the next several months, they are s- the biggest factors for results. And people seem to think that you can just kind of like hack your way to the best plan, and if you just do the right things, you'll get amazing results. It has to be in context, unless you like setting yourself up for really unfortunate experiences where you get quite upset that you couldn't do the thing. People will arbitrarily assign themselves an amount of muscle they want. It does not work like that. Put in the diligence, put in the time, see how it goes. Things are going well, you can crank it up a little bit and get a little bit better gains, and just it's gonna take time. If things are not going so well, you have to optimize to make them go a little better. But there's, outside of the basics, nothing you're gonna be able to do that is going to be a category leap of results, short of what I estimate in the early 2030s will be the, the great pharmaceutical renaissance, and then you can just turn myostatin off and get as jacked as you want. Till we get that, realism can be a, a painful pill to swallow.
- PAPeter Attia
Well, it'll be interesting to see if even if we can turn myostatin off as adults, if it will have the same impact that it has in the cartoons, right? Like, when we look at the-
- MIMike Israetel
Sure
- PAPeter Attia
... animals that have myostatin knockouts, which are just some of the most enjoyable things to look at, truthfully. It's like, [laughs] you know?
- MIMike Israetel
It's pleasant.
- PAPeter Attia
Our favorite things in med school were looking at the myostatin-
- MIMike Israetel
Yes
- PAPeter Attia
... knockout chickens and cows.
- MIMike Israetel
Yes.
- PAPeter Attia
Um, but it's not clear if you took, uh, you know, a, a mature adult, um, and inhibited myostatin if you would get the same benefits. Um,
- 1:37:28 – 1:42:57
Importance of nutrition, protein intake, & consistency in both training & diet for muscle growth
- PAPeter Attia
but let's go back to out of the gym. One more thing we didn't discuss I just kinda wanna hear your thoughts on when, when something out of the gym is playing a role in your unjackedness.
- MIMike Israetel
Mm-hmm.
- PAPeter Attia
Is nutrition often a factor, or is that generally not? In other words, are, is, is it so rare that someone is not getting enough protein or not getting enough calories that that's the problem? Is that just not something you see much?
- MIMike Israetel
It's a thing.
- PAPeter Attia
Okay.
- MIMike Israetel
It's a thing.
- PAPeter Attia
I would assume it's more a thing with women than with men, um, and maybe more with older women than men, and maybe even older men when you just see more anabolic resistance.
- MIMike Israetel
All of those are true.
- PAPeter Attia
Okay.
- MIMike Israetel
It's not difficult to align your nutrition well Eat mostly healthy foods. Some junk here and there is totally fine. Getting in enough protein. If you wanna be real serious about optimizing your muscle gains, something like a gram per pound of protein per day. So if you weigh 150 pounds, 150 grams of relatively high quality protein. Um, if it's difficult for you to meet those goals, uh, Amazon sells, uh, your bars already, don't, don't they?
- PAPeter Attia
Uh, I don't, I don't know if... I don't think they're on Amazon yet, but they will-
- MIMike Israetel
My wife got them somehow
- PAPeter Attia
... if not, they are, they are soon. Yeah.
- MIMike Israetel
So get you a, a couple boxes of David bars and put them between meals, and, uh, that t- kinda takes care of protein. The other thing is muscle size is, um, philosophically concordant with being bigger. I know that sounds crazy, but muscle's made of stuff. So when someone wants to be 165 pounds jacked at 150 pounds, it's curious how they think that's ever gonna happen. Some people just don't eat enough, and what I would say is the biggest problem I've seen with what I assume is your target demographic for this podcast is intermittency, lack of consistency. I've had so many clients in the professional realm, older folks, folks that are practicing doctors, lawyers, so on and so forth, tell me, "Hey, listen, the last couple days, every three or four hours, I've been getting in high protein meals. I've been getting good sleep." Dope. See them a week later, you go, "Hey, how was last weekend?" They're like, "Well, the parts I remember were fun, I think."
- PAPeter Attia
[laughs]
- MIMike Israetel
"Then I was throwing up a lot in the toilet." And you realize that, you know, they're, quote-unquote, good. It's not beneficial to moralize these things, but they're on track for a few days here and there, and then they fall completely off the wagon for days at a time. That is a surefire way to guarantee that you don't get very good gains is if you lack consistency. So if you wanna get as jacked as possible within the realm of several months' time, seek to eat enough food to get the scale to go up about half a pound per week. So if you're training hard for 12 weeks, you should gain maybe six pounds or so, consistent six pounds. And if you're eating a gram per pound, uh, per day of protein spread into roughly three to four evenly spaced meals, roughly, very roughly, a lot of wiggle room there, that really is, um, kind of all you need to know about nutrition for how to get jacked that covers probably 90% of the variance. So I'll tell you this. If you describe to me a scenario where you were training for 12 weeks, you gained seven pounds, almost every day you had a gram per pound, per protein, almost every day it was three or four meals, and you're like, "Look, I know it's my nutrition that's the problem," I'd be like, "It's probably not. It's probably something else." That great thing about what we talked about earlier with Jordan Yates and how he could do so few sets and get so many results is that 80/20 si- type of rule applies to almost everything else in the human body, including nutrition. So if you're getting enough protein regularly, and you're getting enough calories to gain body weight, the... If you don't get really the muscle gains that you were expecting, there aren't a lot of knobs and levers for us to pull that are gonna get these enormous results, right? Um, that's kind of the situation for nutrition, but consistency is... I cannot say enough things about. Because you ask people, "Hey, how's your diet?" Especially if you're a personal trainer or diet coach, there's this kind of halo effect situation where they wanna be seen as a good person, and diligent, and worthy of your time. "So well, yeah, you know, like, breakfast I'll have egg whites, and for lunch I'll have a chicken sandwich, and for dinner it's usually a piece of fish, and then I have a protein shake and go to sleep." Shut up, Bob. That's one day a week-
- PAPeter Attia
[laughs]
- MIMike Israetel
... you lying asshole. And he's like, "Ah, fuck, damn it. You got me. Okay, that was Tuesday, but Wednesday I don't think I ate anything until we closed that one business deal and I got really drunk with their CMO. It was a great time. I think we had chicken fingers, but honestly I can't remember." Inconsistency, especially when you're older, especially when you have lots of stress from your professional endeavors, inconsistency is something that professional bodybuilders cannot afford. You for sure cannot afford it. Now, if you do everything right five or six days of the week and one day's kinda meh, you'll do great. But if the good days are outnumbered by the, "I sure hope my trainer doesn't find out about these days," you're not doing due diligence. So that's a big, big part of the equation, and that can a segue if you'd like into a conversation of sleep and stress management, all these other things that can also be the difference between lots of gains or no gains at all.
- PAPeter Attia
I'd like to
- 1:42:57 – 2:01:51
Anabolic steroids to boost muscle growth: doses, drug combinations, & side effects
- PAPeter Attia
come back to it, but we've now twice sort of broached the topic of anabolics as another tool, 'cause a couple times you've made the point which is, look, this is gonna be about the limit. Your genes are going to start to become your limit. Um, so I guess my question is, well, let's, let... You know, you, you, you've spoken very openly about anabolic steroids. I've, I've had several podcasts where I've covered this in detail, but, but again, let's, let's kind of tell people what we're talking about for reasons that are, um, m- maybe a little bit elusive. There's some con- confusion about is testosterone an anabolic steroid and, and of course the answer is absolutely yes it is. And so-
- MIMike Israetel
Wait a minute.
- PAPeter Attia
[laughs]
- MIMike Israetel
No, yeah, you're right.
- PAPeter Attia
So, so let, let's talk about, um, anabolic steroid use in the context of non-medical use. So let's take testosterone replacement therapy where testosterone in a hypogonadal man is restored to typically the upper limit of a normal physiologic range.
- MIMike Israetel
It's nice that they do the upper limit, right?
- PAPeter Attia
Yes.
- MIMike Israetel
Give everyone good genetics.
- PAPeter Attia
And then, and then we'll just sort of take that off the table for a moment, park it in the context of what is, what is anabolic androgenic steroid use look like in the ... physique, bodybuilding community. Let's talk about the different drugs. Let's talk about your experience with it. Uh, let's talk about how much it can unleash, and let's, let's frankly talk about what the, what the pros and cons are, um, because, um, y- you know, we-- I personally have no experience with this. Um, we, you know, we just, that's not our patient population, right? We don't have patients that are coming in saying, "My goal is to be jacked-"
- MIMike Israetel
Right.
- PAPeter Attia
"... and I want some D-Ball," and-
- MIMike Israetel
[laughs]
- PAPeter Attia
... you know, it, so, so there's, this not something we, we just have any understanding of.
- MIMike Israetel
Yeah. So anabolic androgenic steroids are all derivatives of the testosterone molecule, manipulated in various ways to accentuate some characteristics and de-emphasize other characteristics. They're typically taken by athletes, uh, in the competitive sphere, bodybuilders, physique athletes, and gym people who want a super physiological level of muscle mass and sometimes, uh, super physiologically low levels of body fat concomitant with that. And so they'll take anywhere between, um, high-end testosterone replacement therapy dose to 10 or 20 times that amount per week, and they will do-
- PAPeter Attia
Let, let me just pause there for a moment and just give some people some doses because we've talked about TRT before on the podcast. So, um, we typically dose patients twice a week to try to get a smoother level as opposed to once a week. So if the, if the, if the ideal dose for a given individual to get them in the right spot is 100 milligrams of testosterone cypionate weekly, we would always prefer that the patient take 50 milligrams intramuscularly twice a week or subQ.
- MIMike Israetel
Yeah.
- PAPeter Attia
Um, I will tell you, Mike, I don't think we have ever given a patient more than 70 milligrams twice a week or 140 milligrams a week. Probably median dose for physiologic replacement is 40 milligrams twice a week or 80 milligrams a week. So are you saying that there are people out there that would routinely take 800 to 1,600 milligrams of testosterone in a week?
- MIMike Israetel
Oh, yeah, and sometimes that's not all testosterone. It's other steroids in combination. Usually people take at least that replacement level of testosterone, often more, um, because testosterone does some really good things for health and general function, and it tends to aromatize into estrogen quite readily, which is good because estrogen's cardioprotective, neuroprotective, um, increases your strength. It's actually increasing your-
- PAPeter Attia
Helps you move.
- MIMike Israetel
Uh, tons, sex drive. Um, it actually increases your, um, anabolism in the presence of androgenic steroids, uh, and testosterone. So estrogen by itself, not very anabolic. Estrogen in the presence of testosterone is more anabolic than if you had all the testosterone in the world but were unable to aromatize to estrogen. [lips smack] And so a baseline level of testosterone is often taken at somewhere between 250 milligrams a week and all the way up to 1,000 milligrams a week, depending on how you're handling the side effects of that ex, um, excess estrogen production at the higher levels.
- PAPeter Attia
And that's usually taken as, as cypionate?
- MIMike Israetel
Uh, enanthate, cypionate. Some people prefer propionate if they inject every day.
- PAPeter Attia
Mm-hmm.
- MIMike Israetel
Um, enanthate and cypionate are by far the most commonly used seemingly. Um, oftentimes people inject differentially, but, uh, once-daily injections seem to provide the smoothest curve.
- PAPeter Attia
Yeah.
- MIMike Israetel
Uh, if you put in half a week's worth of super physiological testosterone at one time, your mood for the next several hours is curious. Uh, it's not fun.
- PAPeter Attia
I mean, I... Yeah, help me understand what that even feels like. So, so let's just say you're taking 700 milligrams a week, 100 milligrams a day, so 7X physiologic. W- do you feel something different?
- MIMike Israetel
Most people feel something, but it's probably a normally distributed population of experiences where some people just can't tell. Some people feel something for sure that they can describe, and some people have panic attacks and will never use again, or they are driven to extreme violent thoughts and extreme sexual thoughts and actions. And those folks are quite rare, but they do happen. So there's a large distribution about which people can have experiences, but I'd say the median experience is you take everything... The easiest way to understand the average effect of a high degree of anabolic steroids and, for simplicity, testosterone on the psychology is to imagine that what is the average psychological proclivity of a female? What is the average psychological proclivity of a male? Different in many regards. And then you move the needle over one notch into a magical new gender-
- PAPeter Attia
Third category. Yep
- MIMike Israetel
... called, uh, enhanced male, and you just typically exhibit more male-like patterns of thought and behavior than even males do. But males compared to females is the best way to figure that one out, because if you, like, just know what a male pattern of behavior is like 'cause you're a male, you're like, "What the hell is it like to be more like me?" It's like, "Everything about me?" Well, it's not everything. We actually just had a recent, um, video on the RP Strength channel. I think it's called, um, Ro- Roid Rage Is Real. We talk about, like, that steroids don't accentuate every quality you have, just the more masculine qualities. So what are the most masculine qualities? Again, this hits everyone a little bit differently, but on average, a, um... You become quieter. Men typically are not as expressive as women. You become to show, you come to show fewer facial expressions of emotion. Um, you don't process other people's emotions as well. You can't fine-tune what they feel as much, and you don't care as much.
- 2:01:51 – 2:11:06
Long-term impact of steroid use: muscle retention, genetics & individual variability, & impact after discontinuation
- PAPeter Attia
So how old are you, Mike?
- MIMike Israetel
40.
- PAPeter Attia
Okay.
- MIMike Israetel
I know I look 50.
- PAPeter Attia
[laughs] Not where I was going. Um, w- what would you look like now? I'm gonna just posit, I, I'm guessing that you have good genes. Uh, you eat well, you train very hard, and you're using enough anabolic steroids to fuel a small country. Um, if we subtracted that last one out of the equation, because I don't have a sense of what the relative contribution is, what would you look like if you did everything the same minus the anabolic steroids? Or if you, if you run like regular TRT, you are taking 100 milligrams of Cypionate a week How, how much of a... Do you have a sense to quantify how many pounds lighter you would be in terms of total muscle mass?
- MIMike Israetel
Me personally or the average person?
- PAPeter Attia
No, you personally. Yeah, I want to get a sense of we could-
- MIMike Israetel
Having had used steroids before at high doses or not having ever had used them?
- PAPeter Attia
Oh, good question.
- MIMike Israetel
Very different answer.
- PAPeter Attia
Yeah, good question. Let's do both.
- MIMike Israetel
I can do both, yeah.
- PAPeter Attia
Yeah, let's do both. So let's assume you n- When did you start using high doses of anabolic steroids?
- MIMike Israetel
When I was 27 years old.
- PAPeter Attia
Okay. So let's say we go back to 27 years old, and y- we put you on the same path of doing everything you're doing in terms of your training intensity, uh, all of the scientific principles that come into it, et cetera. But you've just, you've never gone down the path of taking mega doses of steroids. And if you've ever taken testosterone, it's literally to bring-
- MIMike Israetel
Yeah
- PAPeter Attia
... your total T up to 800 nanograms per deciliter.
- MIMike Israetel
Yeah, yeah, yeah. F the, at this body fat, I would probably weigh about 200 pounds.
- PAPeter Attia
Versus 230.
- MIMike Israetel
Versus 230, 235.
- PAPeter Attia
Okay. Um-
- MIMike Israetel
35 pounds of muscle
- PAPeter Attia
I know. That's a lot, that's a lot of muscle.
- MIMike Israetel
Yeah. But I would still be very jacked. I mean, um, before I had ever started taking anabolic steroids, um, I was already, uh, an elite powerlifter. I weighed 270 pounds at probably 30 something odd percent body fat. But I probably, well, I've DEXA'd myself, um, in a master's program when I had been totally drug free, and I had 100 and, somewhere between 175 and towards the end of my drug free era, close to 185 pounds of fat free mass. Uh, for someone who's 5'6" like myself, though if anyone asks, I'm 5'9", haha.
- PAPeter Attia
So your FFMI would've been north of 30.
- MIMike Israetel
Uh, ooh, not quite, but up there.
- PAPeter Attia
Yeah. FFMI, for folks not familiar with it, is, um, fat free mass index. So it's total fat free mass in kilograms divided by height in meters squared.
- MIMike Israetel
Yep.
- PAPeter Attia
And just for reference, you know, it's pretty hard to be above 25-
- MIMike Israetel
Yeah
- 2:11:06 – 2:19:05
Trade-offs of long-term usage of supraphysiologic doses of testosterone
- PAPeter Attia
it sure sounds like it.
- MIMike Israetel
Not that anyone ever does that. [laughs]
- PAPeter Attia
[laughs] What, um, what is your personal calculus for the, the, the number of years remaining where you want to be doing supraphysiologic doses of testosterone? Um, do you, do you think about the trade-offs of long-term health, um-
- MIMike Israetel
Incessantly
- PAPeter Attia
... yeah. And, and, and so how do you sort of think about it? Um, because o- obviously everything has a trade-off, right? And-
- MIMike Israetel
Yeah
- PAPeter Attia
... um, I suppose if you're, you know, winning Mr. Olympia and you're, you know, you're one of the top five bodybuilders in the world-
- MIMike Israetel
As I am
- PAPeter Attia
... uh, you know-
- MIMike Israetel
JK
- PAPeter Attia
... the, the, the... then the trade-offs might be worth it. Um, but yeah, just how... what's your personal calculation on it? 'Cause I... there, there have to be, I don't know, hundreds of thousands of people that are using supraphysiologic doses of testosterone in the country, I would guess.
- MIMike Israetel
Sure.
- PAPeter Attia
And, um-
- MIMike Israetel
It seems reasonable
- PAPeter Attia
... for many of them, it's for themselves, right? It's like they're not getting paid to do it.
- MIMike Israetel
Almost all of them.
- PAPeter Attia
Right? Yeah.
- MIMike Israetel
Almost all of them.
- PAPeter Attia
Okay. They're not... It's not because of how they look in a movie or [laughs] whatever other reason, you know, someone's gonna do. So yeah, what's your, what's your calculation?
- MIMike Israetel
Yeah. So my calculation, it has many fold variables that go into it. Some of them include my blood work. I get regular blood work. I always have. I did it before I got on. I did it during. I still do it all the time. It would be funny if I croaked in a few weeks and then you release the podcast. This was gonna sound hilarious. It's all statistics and probability. [laughs]
- PAPeter Attia
We'll posthumously release this episode.
- MIMike Israetel
Please do release it, though. Um, I've got, uh, bad genetics for all sorts of things. Um, but I have damn good genetics for health resilience. So I've never actually had blood work a single time that was like, "You need to stop." The last time I had blood work, I was on 1,500 milligrams total. Gnarly stuff, trenbolone acetate, the whole works. My lipids, my overall total cholesterol was, like, 79 or something.
- PAPeter Attia
Total cholesterol?
- MIMike Israetel
Yeah.
- PAPeter Attia
Total cholesterol of 79?
- MIMike Israetel
Total, yeah.
- PAPeter Attia
That's almost impossible to imagine. You're on lipid-lowering drugs, though.
- MIMike Israetel
Nope. [laughs]
- PAPeter Attia
That's, that's really hard to believe.
- MIMike Israetel
Now, mind you, I'm at, like, 7% body fat.
- 2:19:05 – 2:32:58
The potential for AI-driven medical breakthroughs to reverse aging & disease
- MIMike Israetel
hedge to all this that most people don't, and I'm gonna sound like a total insane person when I say it. I believe it is a high probability that in the early to mid 2030s, we will see the fusion of informatics and biology powered by AI, such that we will be able to kind of point by point re-engineer the entire human organism at a variety of levels and undo damage like was never possible before. So I never exposed myself to as much statistical risk as would have made an even chance of me making it to, like, 50. I have a, I think, even chance of making it into my 60s. I'll be in my 60s around the mid 2040s, and most of the future prediction models say that our ability to contend with our biology will be so absurd that there may not be a line between biology and technology anymore. So to put this in, uh, simpler terms, I think major categories of disease will be completely solved in the 2030s. I think aging reversal will be mastered in the, or in the mid to late 2030s, if I had to take a guess. And I think that, um, if I make it to the early to mid 2030s, then I'm at longevity escape velocity, and looks like I succeeded. If I die before then, I'm totally comfortable with all of the choices that I've ever made, and it's been one hell of a run. And I think understanding your own mortality and coming to grips with it is important as any human person, but especially with the risks I've taken with my body. I was never, uh, it never surprised me if I croak from a heart attack an hour after we finish filming this, I won't die surprised. Uh, I'll die from a heart attack, and I'll be like, "This is it." So, um, I, I-- And that's to say, not to wave my own flag or anything, don't do shit to your body without really thinking through what you're doing. Like a race car driver, nobody gets into that car and goes, "This is the safest thing I could be doing." What are you, nuts? Nah. But most of them have come to grips with the fact that, "Look, I could die, but I'm good." And they're well compensated, it's been worth it to them, and most importantly, they did what they really wanted, right? Um, up until recently, that has become, at least to me and many futurists, apparent that some of us listening to this, probably most people listening to this, may never die. Uh, up until recently, that was not apparent, and you kind of had to figure out, like, "How do I want to live my life?" And some cases require a longevity/quality of life trade-off, and I made that early. Um, would I have made it the same again? On the margins, probably would've been safer. But also, there's a lot of crazy shit that they do in bodybuilding that I just never did categorically, uh, or tried once and was like, "Fuck that. That's not for me." Um, and, uh, my blood work and everything was pretty good the entire time. So I feel okay about it. Not great, but okay. I don't know if that makes any sense.
- PAPeter Attia
Yeah, it does. I mean, I, I'm way less optimistic than you, Mike, about, uh, longevity escape, um, certainly on that time horizon. Um, and so I think of hedging in the exact op- I think of the hedge as the exact opposite, right? So my hedge is it would be wonderful if in a decade we had technology that treated disease in a way that, that could truly reverse, you know, restore my, I mean, restore my heart to the heart it was when I was 20. Because, you know, like, I think about the, the, the, the, um, reduction in function, right? So my coronary arteries are still clean as a whistle.
- MIMike Israetel
Mm-hmm.
- PAPeter Attia
But, like, my heart's nowhere near what it used to be, right? Like, I know this, for example, because my maximum heart rate is 30 beats, uh, 40 beats per minute lower than it was when I was a teenager.
- MIMike Israetel
Directly an aging thing.
- PAPeter Attia
Right, directly an aging thing. If you look at, if you look at the electrical system of my heart, and these are things I can't treat, right?
- MIMike Israetel
Mm-hmm.
- PAPeter Attia
Like, I don't-- I can do all the things possible to not have my blood pressure go up, so I don't get, you know, LV, you know, left ventricular hypertrophy. I can keep my coronary arteries clean as a whistle indefinitely. We have the modern pharmacology to do that. Um, but I can't-
- MIMike Israetel
Isn't that crazy that you can say that point, right?
- PAPeter Attia
Yeah, it's wonderful. It's incredible. But I can't change the architecture of the muscle yet.
- MIMike Israetel
Mm-hmm.
- PAPeter Attia
Right? Like, we don't have that ability. Now, my hedge is, you know, how about I just stave off chronic disease as long as possible, stay as healthy as possible, stay in the game as long as possible, so that if it turns out that that was for nothing, we're sitting here, it's 10 years from now, I'm in my early 60s, and someone comes along and says, "Peter, all that stuff you did was totally unnecessary."
- MIMike Israetel
Yeah.
- PAPeter Attia
"You could've been eating Cheetos, drinking margaritas all day long."
- MIMike Israetel
Sure.
- PAPeter Attia
"I have a pill that's gonna make you 20 years old again," I would have no regrets.
- MIMike Israetel
Yeah.
- PAPeter Attia
I would be like, "I don't care. I am really glad-"
- MIMike Israetel
I love that
- PAPeter Attia
... "I did what I did." Um, but I would have regret if I put my eggs in the basket that said, "I'm gonna drink the margaritas all day. I'm not gonna exercise. I'm gonna wait for the exercise pill to come along," and it just doesn't come along.
- MIMike Israetel
Sure.
- PAPeter Attia
I also think we just have to, you know, accept... You know, one of my favorite thought experiments, um, I forget, I was talking about this with a friend a couple of weeks ago. So if you just consider modern human history, right? We're just talking about 250,000 years. I don't, let's, let's forget everything that came before Homo sapiens. You go back in time 250,000 years ago, 200,000 years ago, 150,000, you do this in, like, 50,000 increments until you hit 10,000 years ago and then 5,000 years ago and then 2,500 years ago and then 1,000 years ago, da da da. And you go in and you ask them to predict the future, uh, letting them see everything that's happened before 'cause of course that would be a difficult thing to do most points in time. They don't even know anything beyond their-
- MIMike Israetel
They're like, "What's the future?"
- PAPeter Attia
Yeah.
- MIMike Israetel
You're like, "Oh shit, I went back too far." [laughs]
- PAPeter Attia
Yeah, yeah. And it's sort of like it would be impossible to imagine because the pace of change during that 250,000 years was pretty much nothing, right? Then, you know, 5,000 years ago, we get agriculture. Um, then, you know, a couple hundred years ago, we get, you know, the Industrial Revolution. Like, we really start to get these-
- MIMike Israetel
The first Industrial Revolution.
- PAPeter Attia
Yeah.
- MIMike Israetel
There have been two more since.
- PAPeter Attia
We start to get these big step function changes, but even if you go back in time 100 years, so 100 years, we're in the Roaring '20s. Life couldn't be any better.
- 2:32:58 – 2:38:51
Role of AI in accelerating drug development, advancing human longevity, & overcoming biological limitations
- MIMike Israetel
Um, the solutions to the problems that we're seeking to systems that intelligent, should they choose to solve them, can be, uh, for lack of a better term, pedestrian in nature, and they're going to be dealing with problems that are much more complex than the re-engineering of human biology. So for me, when the raw compute and the raw understanding of how to manipulate matter and energy to get kind of any kind of shape you want at a given energy input, when that's there, the only question is like, are, are we gonna try to do it or not? And that's where I come back to the incentives and constraints problem. The biggest hurdle to the development of advanced pharmacology and genetic engineering and so on to do this kind of thing is gonna be regulatory in nature, hands down. FDA, everything's off by five or 10 years. It sucks. But once AI has enough time to cook on these problems, the candidate drugs released will run through trials with just an unreal record.
- PAPeter Attia
But why?
- MIMike Israetel
Because if you have very not so good at things AI, it's decent.
- PAPeter Attia
No, but, like, AI is gonna do a great job at the first step of the process, which is what's the molecule, right? Like, right now, it's trial and error. It's brute force. It's super painful.
- MIMike Israetel
Yeah.
- PAPeter Attia
AlphaFold-
- MIMike Israetel
Not anymore. Right now, you can't say that about AlphaFold.
- PAPeter Attia
Right, exactly. AlphaFold changes that.
- MIMike Israetel
Yep.
- PAPeter Attia
How is AI gonna streamline the phase one trial where we have to prove once we have the IND that, that this-
Episode duration: 3:06:53
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