Peter Attia MD365 ‒ Training for longevity: A roundtable on building strength, preventing injury, protein, & more
EVERY SPOKEN WORD
150 min read · 30,006 words- 0:00 – 1:17
Intro
- JCJeff Cavaliere
You can build a great body on six exercises.
- MBMike Boyle
I just don't see any evidence that anything trumps exercise.
- GLGabrielle Lyon
50% of Americans are not training or doing any kind of exercise.
- MBMike Boyle
You don't know you're losing the battle until it's too late.
- PAPeter Attia
Say a little bit about the programming.
- MBMike Boyle
I know that it works, and I know that it doesn't have to be hard, and it doesn't have to be uncomfortable.
- GLGabrielle Lyon
Skeletal muscle health is really what we're talking about.
- PAPeter Attia
Do you think that the average person appreciates the role of nutrition in that?
- GLGabrielle Lyon
The minimum amount of protein I would ever recommend would be 100 grams. It's not sex specific. It's body weight specific.
- PAPeter Attia
Up until about 18 months ago, I was still squatting and deadlifting regularly, though with much less weight. I just sort of decided the risk/reward trade-off wasn't there for me.
- MBMike Boyle
You're not gonna piggyback someone in and take a shit. Like, that's not how it's gonna work. In order to use the bathroom-
- PAPeter Attia
[laughs]
- MBMike Boyle
... you only need to be able to body weight squat.
- PAPeter Attia
Coaches want kids to specialize earlier and earlier.
- MBMike Boyle
If you look at most of these people that are telling you that kids need year-round sports are people who are making their living from year-round sports.
- JCJeff Cavaliere
It's not like injury rates are going down. So we're playing more and getting injured more.
- PAPeter Attia
Is there something, something significant that you've changed your mind on? And not just changed your mind on, but it's changed the way you behave? Hey, everyone. Welcome to the Drive Podcast. I'm your host, Peter Attia. [upbeat music]
- 1:17 – 6:58
Personal career journeys & philosophies of each guest
- PAPeter Attia
Lady and gentlemen, thank you so much for all making the trip out to Austin. Um, been looking forward to this one for a while. Um, as, as some listeners might know, this is our second version of a round table. But unlike the first one where, um, I had interviewed the three guests multiple times previously and they were, you know, very familiar to the audience, um, all, all three of you are people whose work I'm very familiar with, but I've never had the privilege of sitting down with you one-on-one. And as much as I would have loved to have done that first, I think it would have stood in the way of, of doing this today. So before we jump into what we're about to talk about today, which is all things related to resistance training, um, I wanna just ask each of you to, to maybe give the non-bio version of, of who you are and, and, and as such, why I think you're a great part of this. Let's start with you, Gabrielle.
- GLGabrielle Lyon
Certainly. Um, well, my name is Dr. Gabrielle Lyon, and I'm a fellowship-trained physician in geriatrics and nutritional sciences. I did my fellowship at Wash U. And at the time, I was very reluctant to doing geriatrics because it can be a very arduous and sad experience, but I was fascinated by the nutritional research side. And there was a moment we were working on a study looking at body composition and brain function, and I really took to one of the participants, and I m- imaged her brain. And at her mid-50s, she looked like the beginning of an Alzheimer's brain. And in that moment, um, muscle-centric medicine, which is the concept that I practice and founded, was born, and it's really that skeletal muscle is the focal point of all our health and wellness. Uh, I'm an author. Wrote a New York Times bestseller called Forever Strong, and, uh, I continue to do research and work within the space, and, um, I'm honored.
- PAPeter Attia
And you see patients. You're a clinician as well.
- GLGabrielle Lyon
I do see patients.
- PAPeter Attia
Okay.
- GLGabrielle Lyon
I have a medical practice.
- PAPeter Attia
Got it.
- GLGabrielle Lyon
I do see patients, and, um, we actually just, uh, submitted a paper that got accepted for publication on sexual function, the relationship between sexual function and muscle mass.
- PAPeter Attia
Okay. Cool.
- GLGabrielle Lyon
Yeah.
- PAPeter Attia
Mike.
- MBMike Boyle
Um, Michael Boyle. I'm a coach. I've been a coach... This is my 43rd year actually coaching. I was lucky enough to bounce right out of college and into a college job. I started out as an athletic trainer. When you said to be immodest, I think I invented training for the NFL Combine, at least there's a book that says I did invent training for the NFL Combine in the '80s. I worked in the NHL for the Boston Bruins in the '90s, from '90 to '99, while I worked at BU, 'cause strength coaches were basically part-timers at that point, and worked at BU for 30-something years. Opened a business, a for-profit strength and conditioning, probably the first one in the United States, in 1997. And then in 2012, I left BU, where I've kind of always had more than one job, and I jumped over to the Red Sox for two years and was able to get a World Series ring out of the Red Sox in two years, and then realized that that was not very conducive with being a, what I really wanna be, a good father and a good husband, and was like, "Okay, I'm done with pro sports." So now I, I coach still. Coach my son and his friends. I have a son who plays college lacrosse and, uh, I'm still actually functioning as a personal trainer, I guess, in some cases, and as a strength and conditioning coach in some cases. So I'm, I'm more than anything just a practitioner.
- PAPeter Attia
And what type of clients do you see now? What's the range?
- MBMike Boyle
The range is 11 to in their 80s, so that's our, that's our client range. We don't take kids till they're 11, 'cause we really don't want them in the gym before that. And we'll take them as old as we can get them, but I think the oldest right now is, uh, is early... Actually, no, we- 89. And that's actually my son's pediatrician, just turned 89, retired last year, believe it or not. Dr. Leader had still been working all those times. And he's one of... We have a three-- We have a couple three-generation families, of which he's one. We have him, we have his kids, and we have his kids' kids-
- PAPeter Attia
[laughs]
- MBMike Boyle
... that are all training in the same space.
- PAPeter Attia
Good. Well, th- there are a lot of things I want to talk about that are embedded in there, so we'll, we'll come back to it. Um, and Jeff.
- JCJeff Cavaliere
Um, I'm Jeff Cavaliere, so I'm a physical therapist by trade. Um, sort of moved out of the clinic at a, at a e- early stage, um, and got a great opportunity to work in that role for the New York Mets, um, which was a dream come true for me, 'cause I was a diehard Met fan growing up. It was like, you know, presented the dream job. Um, and from there, sort of piggybacked into how could I continue this education of athletes on a, on a broader platform? Was well aware of the power of the internet at that time, so I started a YouTube channel, which by luck, uh, b- beyond just my family members subscribing early on, I got a few others that did along the way, and it sort of piggybacked that into a broader message, which was, okay, so now it's not just about training athletes and empowering athletes, but how do I empower people who wanna be more athletic, feel more athletic, move more athletically in daily life, not just in, in order to kinda pay the paycheck? So that became my, my mission really from that point. Now, beyond having to sort of maintain a certain level of consistency because I want to practice what I preach, I also have two, uh, young boys. I started late, uh, 40 years old. I have twins, and now I feel like I got to make sure I can keep up with them when they're ready to have me [laughs] be able to run and play. So I have a lot of motivation to keep doing what I'm doing and stay in the shape I am, but I believe that it, it requires having an understanding of injury, training around injuries, 'cause no matter what, as we get older, things do start to break down, and I think you have to have strategies to be able to push through that and train around that. And I think that's where my big strength is as a PT to provide that background to help people do that more readily.
- 6:58 – 18:06
Why so few people engage in resistance training despite its benefits
- PAPeter Attia
Let's start with a, a question that probably has an answer, although I actually am a bit embarrassed to say I don't know the answer, so I'm wondering if one of you guys do. Do we have a sense of what percentage of people in the United States do not practice resistance training?
- GLGabrielle Lyon
Well, we know that 50% of Americans are not training or doing any kind of exercise. I... From the research that I've read up until recently, um, it's probably 70% do not meet the criteria for both activities.
- PAPeter Attia
70% in total then?
- GLGabrielle Lyon
Total.
- PAPeter Attia
Or you think it's 70% of people who are doing some form of exercise?
- GLGabrielle Lyon
That's a great question. It-- I believe that it is 70% of people in total.
- PAPeter Attia
Got it. Okay. Is that... I, I can't even fact check that. It's... I mean, that's-
- GLGabrielle Lyon
I mean, I guess that's a-
- PAPeter Attia
... hard for me to imagine-
- JCJeff Cavaliere
Yeah
- PAPeter Attia
... but I can believe it.
- JCJeff Cavaliere
I think it's lower in terms of if you're talking about resistance training, 'cause we were talking about the fact-
- PAPeter Attia
You, you would say lower than 30% would do resistance training then?
- JCJeff Cavaliere
Yeah, because I think 20% of people belong to a gym. If we look at home gym stats aren't very good in terms of people. They're... The home gym person who actually has one and uses it is, is probably more unicorny than we think they are. And so if you start looking at that number, 20% have a membership, 50% of those people use it, which now brings us down to only 10% of people in the United States are actually in a gym. And then you look at that and say, "What percentage of them are resistance training?" Maybe now we're down to 5% 'cause you see a lot more hamster wheel people who are just walking on a treadmill or walking on a stair climber or whatever it is. So I would think the numbers are, are pretty low. We spoke a little bit about this, but we have digital statistics that actually show people who have, uh, signed up to train with our programs, let's say either be at home or at the gym, the percentage of people that make it through our programs is only 20%, and that's very high industry standard.
- PAPeter Attia
That's twice the industry standard for digital.
- JCJeff Cavaliere
Right. Right.
- PAPeter Attia
Yeah.
- JCJeff Cavaliere
Which is usually, like, 10% or so. So those are people who showed the commitment, made a purchase, put their hard-earned dollars behind it, have everything they need, I would think, in terms of the tools and sets and reps and what's supposed to be done, and only 10% will finish a program. So I think that's, that's a pretty, uh, remarkable statement on why, why people can't... I think there's a lot more of a desire to, to do things, but the, the ability to actually follow through is where I think we're having our hardest time.
- PAPeter Attia
So it might be then, Gabrielle, your stat is 70% of 50, be the reciprocal of that, 30% of 50, 15. It might be that our range is somewhere from 5 to 15% if I were gonna sort of triangulate between these three data points. Uh, again, that's, that's kind of a hard thing to digest if you're asking the question, um, and, and I've never been, um, sort of shy about my thesis, which is of all the pillars that we have, um, to embark on improving our health, whether it be changing our nutrition, improving our sleep, taking the medications and supplements that can be actually quite important, I, I don't, I just don't see any evidence that anything trumps exercise. Um, just purely from an actual lifespan perspective and from the standpoint of reducing the risk of chronic disease. When you then layer in the benefits it has on quality of life, I mean, it's just sort of a no-brainer. So what do you think, and Mike, I'm gonna start with you because you've been at this the longest, what do you think explains the disconnect between the fact that we have this incredible tool that will lengthen your life, improve the quality of your life, make you look and feel better, and yet five, 10, at most 15% of people engage in it? What are the barriers?
- JCJeff Cavaliere
I think the biggest barrier is just life, lifestyle, kids, jobs, people thinking... You, you really have to commit to is it getting there early? Is it going there after work? Whatever it is, it's adding hours to your day. I think that's probably the biggest barrier. I, in some ways, I guess that's economic, right? People don't have the economic freedom to say, "Hey, I can devote..." That's why I laugh sometimes when I hear people talking about hours per week of exercise and hours per week of cardio. I just kind of snicker in terms of if I can get someone to do two hours a week, and that's why I like your guideline more of I think you said 75 hard minutes, and I'm like, "75 hard minutes now is realistic." But even 150 minutes, some of the guidelines are crazy. And then there's a lack of awareness. People-- You don't know you're losing the battle until it's too late. That's what we see in our business. We see people coming in and you think, "Wow, thank God you got here now at 50," or, "Thank God you got here now at 55 because the end for you was gonna be bad." But you're... And I'm not, I'm not saying this to flatter you. I've been following you for a while, and, you know, you and you are g- like, you're getting the message out in a way that it hasn't gotten out before. Because the message before was, you know, either geeky or nichey or whatever it was, but it wasn't this, "Hey, this is really good for you, and this is gonna make you live longer and live better," which it's double bonus, right? I mean, you know, you want to live longer, but you don't want to... Who wants a, a long, shitty life? Excuse me. I, I don't know if we're not supposed to swear, but, um-
- PAPeter Attia
[laughs] We swear. Don't worry.
- JCJeff Cavaliere
Okay, good. Okay.
- PAPeter Attia
Yeah.
- JCJeff Cavaliere
But do you know what I mean? Versus looking at it and saying, "Hey, I would like to live longer." And Jeff and I talked about this. I've experienced 50 to 65, and trust me, it's not fun. The decline is rapid, and the decline is significant. And I think if people... Like, if you don't wake up by the time you're 50, you're gonna be in real trouble by the time you're 65
- PAPeter Attia
Gabrielle, how much of a difference do you see between men and women on this front? Not from this standpoint, not from the economic standpoint, but from some other barrier to entry. Do you see differences between men and women who are, who are, um, are new to resistance training?
- GLGabrielle Lyon
I do. And the first thing that I want to say is you're absolutely right. There's nothing more important for maintaining health and wellness than taking care of muscle health, whether it's strength training, mobility, resistance, but skeletal muscle health is really what we're talking about. Where is the disconnect from men versus women or people in general? Part of it is cultural. We live in a society of comfort. It's very easy to take the escalator or take an elevator. When it comes to nutrition, we all have to eat, but we don't all have to move. I literally could sit at my house, order my groceries, Amazon Prime everything, and I never had to take more than 300 steps. For women, typically strength and strength training has not been the focus, and we know that. I mean, even just from a standpoint of walking to the gym, you don't see... Or you're starting to see it more. I, I really do feel like we are on the precipice of women recognizing the importance of strength and muscle, especially with new conversations around menopause and more potent conversations, but they're busy. And the other aspect of that is there are self-imposed limitations. A woman would look at a 40-pound weight and go, "I can't lift that." But she would look at her 40-pound toddler and go, "I'm gonna lift that, and then I'm gonna carry my groceries, and, uh, I got it." And that's really where I think that we can change the disconnect is re-educating the importance of muscle and then also changing the cultural conversation.
- PAPeter Attia
Obviously, you're really fit. Has, has resistance training always been something you have enjoyed? Did you grow up doing it, or it's something you kind of came to, uh, in your 20s or beyond?
- GLGabrielle Lyon
I grew up doing it. By the time I was five, I was riding 10 miles on a bike. And with the conversation around children, if we teach them good habits now, then we don't have to have them spend a lifetime outgrowing old habits because we're not raising children, we're raising adults. And yes, I have always trained.
- PAPeter Attia
So I'm in the same boat, and the-- and I, and I suspect that's true for all of us. And so one of the challenges that I know I have that's a bit of a blind spot is when I'm talking to patients who are perhaps representative of the real world, which is people who are like, "Actually, I don't enjoy the feeling." Like I... You know, I'm sure you've all heard this. "I don't like the feeling of lifting weights. It hurts. I don't like that." I mean, I've-- I can't tell you how many times I've heard that, and I appreciate the honesty, but I can't relate. And it's hard when you can't actually relate to what your patient is saying. I can relate when they complain about having to watch what they eat 'cause that's a struggle I would have. Um, but I truly can't relate to that. So do you think that that's a function of having started early, or do you think that there are literally just-- just as we have people with different eye colors and different heights, there are truly ge- differences in genetic hardwiring that would speak to an individual's appetite for that kind of discomfort?
- JCJeff Cavaliere
I, I, I think it's-- I actually think it's the latter. I think people-- there are some people who are more inclined to enjoy that type of stress. I-- doesn't matter how much I run, I do not enjoy the stress of running. I don't enjoy how I feel. I don't enjoy the, the feeling I get in my lungs when I'm sucking for air. Um, I'll do it 'cause I know I have to, but I don't-- there's no enjoyability about that. Training hard and lifting weights and, and pushing myself to the, to the, to the utmost, uh, level of effort, that's always been something I actually kind of enjoy. And I think that it can be learned, though. You can get better at it, just like I can learn the, the, the, the t- the discipline to continue to push and run when I don't want to. So a- after doing it for a while, when you start to see results, the results actually might become motivating enough to go like, "Well, there is a trade-off here. I'm seeing the r- I'm seeing the trade-off." And I think that's what-- when we were talking about before about people, the, the, the, the start being the, the thing that's stopping people is that the perceived level of what they're gonna have to do is usually bigger than what they have to do. I've, I've mentioned before, you can build a great body on six exercises. Literally, the, the row, squat, deadlift, bench, pull-up, the curl, done. Like, you've got everything you need. You don't have to complicate it. If you keep trying to get stronger at those exercises, now you might get bored to tears, but you can build the, the, the prerequisite foundation to get a, a better body. But people want sometimes to complicate it in their heads so that they have an easier out because it makes it a little easier to say, "Yeah, I don't have time for all that." You know, I, uh-- we, we, we liken it to, um, I've known a few people in my life who've wanted to start businesses, right? And they're like, "I got this great idea," and I'm-- they're gung-ho, they wanna do it, and then they get caught up in, "I don't know if I should f- you know, s- s- uh, set up an LLC or if I should do it as a corporation," or, "I, I wanna get my business cards. I can't figure out my logo."
- 18:06 – 26:16
Mike’s method for training beginners
- JCJeff Cavaliere
that's hard.
- PAPeter Attia
Mike, what percentage of the people that walk into your gym are coming to resistance training for the first time?
- MBMike Boyle
I'd say 50 if I was guessing.
- PAPeter Attia
Okay.
- MBMike Boyle
Because some of them were high school athletes and have some-
- PAPeter Attia
Yep
- MBMike Boyle
... basic relationship with strength training. I, what percentage of them are approaching intelligent strength training for the first time? 100%. So most of them are coming f- you know, let's, we're gonna party like it's 1999. Like, people come in and they kind of look at us like, "What are you doing?" And I think that's where when you were talking about people saying the discomfort, my first thing would be like, "What discomfort? There shouldn't be any discomfort." If you come in and start working out with us, my whole goal, I say to somebody, "You should get out of bed the next day and be like, 'I, I think I worked out.'"
- PAPeter Attia
Yep.
- MBMike Boyle
"I felt okay." I always tell everybody, everything's gauged on how you... If you get up in the morning and you're crippled-
- PAPeter Attia
Yeah, we did something wrong
- MBMike Boyle
... I suck. I'm like-
- PAPeter Attia
Yep
- MBMike Boyle
... I did a, I did a really bad job. You should not be uncomfortable at all. We should be able to... This is whatever, you know, slow and steady wins the race, 1% better, however you want to look at it. And if we can just layer, like I always think I'm a big attendance guy. If I can get you to show up two days a week for a year, you'll be remarkably different, and you might not have ever had, you know, any of the people, you know, balls to the wall or go to failure. Like, we would've done none of that, zero. And yet you would look at somebody and think, wow, like if you came into our place, everybody looks younger than they do. Every single person. One of the... I'm, I am 100% certain, not just of the longevity benefit, but about the physical change that people undergo. Because I'll just show you people and say, "Yeah, that guy's a, you know, an 80-year-old two-time cancer survivor" and people will be like, "He is?" And I'm like, "Yep, they look different." And they all look different. They all look younger. And again, what is that? Is it hormonal? I don't... I mean, I, I, again, I'm, I'm not a scientist, but I know, I know that it works, and I know that it doesn't have to be hard, and it doesn't have to be uncomfortable.
- PAPeter Attia
So let's, let's talk about a, a, an e- an example of somebody that walks in. So somebody walks in, they're 50 years old. Uh, let's pick a male to start with, but we're gonna do many case studies today, I think, 'cause that's how people, I think, can sort of connect. My goal is to make sure everybody listening to this can identify with a person, a theoretical person we're gonna talk about. So 50-year-old guy comes in. Um, he's, he's done a little bit of the trade at his health for wealth thing. So he's, uh, um, he's been working himself to, to death. Um, and he's, he's had some health scare, right? He went to the doctor's office, and they told him, "Your, your blood pressure's really high," or there's something going on. Um, or he's just sort of confronted his own mortality. He's lost a parent, right? That's a big wake-up call for somebody in their 50s. Um, played sports in high school, but, um, that was about it. Um, so doesn't, doesn't really do much of anything now, and somehow has landed himself in your gym. Maybe he, he saw, he saw Jeff on Instagram, and he was like, "That guy looks incredible. I gotta, I gotta do something. And, and, you know, what, what he's doing sounds cool." So, so how do you interview this guy? How do you find out what his goals are? And, and then how do you create that, that show up attendance pattern that's gonna make sure he's... He can give you a year of whatever it is, two days a week.
- MBMike Boyle
The show up attendance pattern is the big thing, and that's... There's a really good book called Never Lose a Customer Again. And one of the thing we talk about, we app- approach our business much more like a restaurant. Um, un- uh, oh my God, what's the name of it? Unreasonable Hospitality, I think, is the Will Guidara book. And, you know, we, we try to get our... We try to train our coaches, we refer to them coaches more than trainers, way more in the customer service skill.
- PAPeter Attia
Mm.
- MBMike Boyle
Because we realize that we want to get the person to come back. That's the goal. Get them to come back. Get them to get through the first workout and come back. And I don't, we don't interview people a lot. I don't talk to people about their goals, 'cause I know what... I look at it, I think your goal is to not be the kind of sad sack of shit that you are right now, unfortunately, and that's, you know, we just want to get you going. So it's like just get them on the conveyor belt and, and carry them through and make them... This is the one thing, and I, one of the things I wrote in my notes that CrossFit did well. They created community. You need to create community where people are comfortable. One of the objec- problems that we had was people would say, "I can't go there. It's all athletes," 'cause they come in, and, you know, just from a marketing standpoint, there's jerseys all over the place, and it looks like a place where athletes train, but 65% of our business are people like us. But just getting them to be comfortable in that environment and getting them to show up again. One, we tell everybody, "If you've got new people in your group, you should text them that day, and you should text them the next day. How was it? How did you feel this morning?" We, we're trying to build a relationship because it's, it's relationship marketing, right? Get the person know, like, trust, all the things that you read about. Get them to know you, like you, trust you, want to come back, want to be part of it, and then we can take care of the training part. But the, the training part to me is, is relatively easy. It's the getting that person to be consistent and to come. And all I want... I, I call them check the box clients. I just want check the box clients. If you check the box, which means I got to Mike Boyle's twice this week, you will get better. You will feel better.
- PAPeter Attia
Say a little bit about the programming. I want to, I want to understand a little bit about how you're doing-
- MBMike Boyle
So the programming for us, very assembly line-ish, very... I always talk about the idea that, uh, it's a, it's a recipe and not a menu. So no one gets to pick what they want to do. You come in, and it's like, no, this is, this is how the cake is made. It's in this order. This is what you get. Don't like it, go someplace else where they let you... You know, go to Planet Fitness, you can make your own cake. You want to come here, you do it the way we do it. Everybody foam rolls, everybody stretches, everybody does their mobility work, everybody does dynamic warm-up, everybody throws medicine balls, everybody does some sort of power training. I want, I, plyometrics, not really, actually. Some sort of jump training. Then they'll go, and they'll lift. The lift takes 36 minutes. And then they'll go, and they'll do some type of conditioning work, and we'll start really, really, again, really easy, try to give them something that's very achievable. Uh, don't get them particularly tired, and then boom, out the door. They're in and out in an hour.
- PAPeter Attia
Hour. Hour door to door.
- MBMike Boyle
Hour, hour door to door.
- PAPeter Attia
Not including the shower.
- MBMike Boyle
Yep.
- PAPeter Attia
Okay. And 36 minutes of that is the actual resistance training, but obviously everything that's leading up to it and on the back of it is, is... I mean, that's clearly training as well, right?
- MBMike Boyle
Right.
- PAPeter Attia
Movement, movement training.
- MBMike Boyle
And the more imp- I think, honestly, as for the older client, more important, we always talk about-
- PAPeter Attia
Yep
- MBMike Boyle
... the first 15 minutes is more important, getting people to To, to roll, to stretch, to start to deal with their tissue limitations, 'cause most everybody that comes in has something. No one comes in healthy. No one comes in and thinks, "Oh, I have nothing that hurts. I have no-"
- PAPeter Attia
And progress is made by advancing weight-
- 26:16 – 29:45
How resistance training enhances metabolic health & body composition even in athletes
- MBMike Boyle
to operate.
- PAPeter Attia
So Gabrielle, what's the biggest thing you're thinking about when a patient is in your practice and they're, you know, they're coming along well on many of the other lifestyle adjustments? Let's just assume this is a person who's a lifelong cardio rat, right? So they love to run. They run two marathons a year. Um, they've been running forever. They've got some nagging injuries though, right? As you know, a runner, especially a female runner, the probability that her proximal hamstring isn't just torn up is pretty low, especially if she's had kids, right? So now her pelvis is tilted a little bit. Um, how do you make the case to her? 'Cause she's lean, right? Doesn't need to lose weight, as though that's the thing that matters, but, uh, what, how are you making the case to her, um, that, that, that this muscle centric approach matters?
- GLGabrielle Lyon
Well, she's gonna want to be active her whole life, and the healthy her, her skeletal muscle mass is... You know, there seems to be somewhat of a disconnect. People talk about strength and then disassociate it from mass, but I believe, you know, and I have patients like this in the practice that are very lean, have always been runners, but we'll see their glucose creep up. We will see an increase in visceral fat. That can be course corrected by addressing skeletal muscle mass. And, um, you know, when you just think about if this woman, and I, I'm thinking about one patient in particular, she's actually in her... She's around 60. She runs 100 miles. She's an ultra.
- PAPeter Attia
Oh, she run, she does actual 100 mile?
- GLGabrielle Lyon
She's... Yes, she does ultras.
- PAPeter Attia
Wow, okay.
- GLGabrielle Lyon
Her body composition was not nearly as good as it is now just by adding in two days a week of resistance training. We added in two days a week. We pulled back on some of the mileage. She's able to move more weight. I mean, and this girl, she is unbel- You know what? Hey, Sharon. She listens to your podcast as a matter of fact. She is incredible. By pulling back her training and increasing her weights and being very specific about... Obviously, I don't program, but we work with coaches that program. By changing up the movement patterns, she was able to really increase her lower body strength but also improve her labs, improve her fasting insulin, her glucose, and that, and her triglycerides.
- PAPeter Attia
And, and so, y- you know, do you think that that's purely a function of having a larger reservoir to put the glucose into, or do you think that it also speaks to the insulin sensitivity? I mean, is it, is it... Does it even make sense to try to disentangle those two?
- GLGabrielle Lyon
It's a great question. I think that the larger reservoir is important for a number of reasons. The metabolic component of muscle, the... You know, as we all know, muscle is the primary site for glucose metabolism, also free fatty acids at rest. However, it enables her to have more dietary flexibility because when we think about nutritional sciences and we think about triglycerides, insulin, glucose, what we're really looking at is the health of skeletal muscle. Metabolic syndrome, the markers of metabolic syndrome are the markers of healthy skeletal muscle. Does it, her activity improve insulin sensitivity? Yes, but her running is... She's gonna be very insulin sensitive as is, but it's really that metabolic component of having healthy skeletal muscle mass,
- 29:45 – 40:25
The dominant role of nutrition in shaping physique & achieving low body fat & the synergistic effect of resistance training
- GLGabrielle Lyon
it, from what I believe.
- PAPeter Attia
So Jeff, you're working with people a lot of times at the opposite end of the spectrum, right? You're looking... Y- People are coming to you often because they want to, um, they want to have 7% body fat.
- MBMike Boyle
Mm-hmm.
- PAPeter Attia
I mean, they... And, and it might be that they're, you know, they're an actor and, like, the- they're, they're, they're about to do a role where they kind of have to look a certain way. Um, alternatively, it might be an athlete who, um, probably doesn't need to be at 7% body fat but might want to be at 7% body fat.
- MBMike Boyle
Wants to be, yeah.
- PAPeter Attia
7% body fat. So, so, so you're kind of dealing with the other end of the spectrum. Is it safe to say that these people that are coming to you are so long on motivation that that's not really an issue anymore?
- JCJeff Cavaliere
Yeah. When your, when your goals start to become 7% body fat, I'm assuming that you're probably not 35 or 40, you know, with, uh, with aspirations to be there. Uh, these guys are usually coming in 12, 13, 14, 15% body fat with want... desires to wanna get leaner for whatever those reasons, like you said, whether it be a role or... I, I always tell, like, the athletes they have to be very conscientious of not falling in love with what they see in the mirror, because ultimately they're not getting paid to look that way, unless they're... I mentioned sometimes we work with WWE athletes who do get paid to look a certain way and perform at a certain level. But, you know, the, the people that have to be conscientious of the level that they are, uh, you know, what level of body fat they are so that they have a, a certain role, I mean, they are usually pretty good at being able to dial in. They've oftentimes done this multiple times before, too. So they've done this and had a history of being able to get down there. They just don't have a b- ability to sustain it. Um, I think that it's always gonna be achieved through nutrition. That level of look is a nutritional, uh, consistency. It does not, has nothing to do with training, has nothing to do with, with exercise you're doing, doesn't matter what split you're following, it doesn't matter any of the, uh, any of that. All you have to do is be able to remain very consistent with nutrition. And the level that you're able to get down to is just a reflection of how many sacrifices you're willing to make. You know, y- y- you wanna still drink a couple times a week? That's fine, just you're gonna have to bump it up a notch or two. Because you really need to be able to make some cuts. Now, I do not believe, I don't do it myself, I do not make sacrifices to the point where I'm eating boiled chicken and broccoli, steamed broccoli. I don't do that. I eat meals that are good meals. I eat... You saw what I eat. I can eat a meal that anybody else can eat. But I'm very disciplined and, and not straying from those meals. And so your ability to kinda stay that way is going to determine how low you're able to get and how low you're able to stay. I always say if, if you're eating, let's say, five times a day, and that's a seven-day week, it's 35 meals. If you can stay 90% or above, you don't have, you don't have to be perfect. If you can stay 90% or above on those meals, you're looking at three meals in a week that aren't perfect. Now, I'm not saying go hog wild and go down to, you know, Buffalo Wild Wings and start eating everything you can. I'm saying that they just aren't perfect meals. Your body almost don't, uh, completely ignores those. It just overlooks it. You keep going and you, and your, the consistency overrides that and you're able to get, you know, to levels that you weren't able to achieve before. But people can't sustain it 'cause either they make it too difficult or, as I said, it is actually difficult. Because getting yourself to the gym for one hour five times a week, two times a week, whatever that might be, even the 36 minutes, that's, that's, that's a, that's one level of commitment. It's what you do in the other 23 hours of the day that determines your, your look because that is the nutritional responsibility that a lot of us don't have the ability to, to manage well.
- PAPeter Attia
How well do you think that's understood? I mean, uh, I'd say that for all of you. This is a, a question for everyone. Um, y- you know, when, when someone looks at a person and says like, "Look at that man, look at that woman, look at how jacked they are," do you think that the average person, person appreciates the role of nutrition in that? Or do you think most of them assume, "I mean, that, that person must be spending 12 hours a week lifting weights"?
- JCJeff Cavaliere
No. I, I, I, I am sorry to jump in, but it is such a, a s- a sore spot for me. [laughs] People, people always think exercise first. They al- in my experience, they always think exercise first, to the point where I have people that will say to me if they see my, my, my abs or something they'll say, "Oh, what exercise did you do for that?"
- PAPeter Attia
[laughs]
- JCJeff Cavaliere
You know, and they pat their, usually in a, it's big belly that they're patting. It's not an exercise. You know, the ex-
- PAPeter Attia
I did less of this exercise.
- JCJeff Cavaliere
Right. [laughs]
- PAPeter Attia
I did the reverse curl.
- JCJeff Cavaliere
Fewer sets of that, more of these, pushing yourself away from the table. I mean, no, they, I don't think they have an appreciation for it at all. And their, their instinct tells them it's, it's exercise, it's movement.
- PAPeter Attia
W- would you guys share that sentiment?
- GLGabrielle Lyon
Yeah. I, I would totally agree. And what's so fascinating is the data supports also the synergistic effect of resistance training activity and a calorie-controlled diet, which if people could connect the dots that it is not simply training... But to be fair, training is the most potent stimulus to muscle, but you cannot... What do they say? You cannot out-train a bad diet.
- JCJeff Cavaliere
Bad diet.
- GLGabrielle Lyon
I, I mean, that, that's true.
- PAPeter Attia
I feel like you could when you were 14.
- GLGabrielle Lyon
[laughs]
- JCJeff Cavaliere
Yeah.
- PAPeter Attia
Like, when I, when I was 14, I did train six hours a day, right? I mean, I was running 13, 15 miles every morning before the day star- you know, before my workouts. So like it was just... And all I did was eat. But I was like a garbage disposal. Like, breakfast was a bowl of... uh, not a bowl, a box-
- GLGabrielle Lyon
[laughs]
- PAPeter Attia
... of Froot Loops in a large-
- JCJeff Cavaliere
Yeah
- PAPeter Attia
... Tupperware bowl. You could put the whole box in the b- it just didn't matter. But, but something changes when you're 20 and you can't do that anymore.
- GLGabrielle Lyon
When you're 13 and, and younger, you're very anabolic. Muscle, the balance between what drives muscle changes as we age. When you're young, you're very driven by insulin. For example, my daughter, who is five, she could have five grams of protein. She doesn't need to have a meal threshold of 30 to get an anabolic response. Because when you are younger and you are still growing, you're very anabolic. After you are done growing, you wanna shift from that, the insulin usage to the stimulus, which then now exercise becomes much more important.
- PAPeter Attia
Ooh, I wanna talk about that, but I want... So I'm gonna come right back to that, but I wanna, I wanna h- hear Mike's point on nutrition and then come back to that, 'cause that's actually a, a very interesting question.
- MBMike Boyle
But, well, think about it. I think about it s- in a simpler sense. We go from being extremely active to extremely sedentary. Suddenly you get into your 20s and you get a job, and you're commuting and maybe eight hours or 10 hours. You might be sitting on your ass 10 hours a week, or 10 hours a day.
- 40:25 – 47:33
Why Jeff advocates for five meals a day, & why meal timing matters less than overall protein intake & caloric consistency
- MBMike Boyle
I guess.
- PAPeter Attia
Jeff, you talked a minute ago about five meals a day. So let's dub- double-click on that a little bit.
- MBMike Boyle
Mm.
- PAPeter Attia
Most people think, "I thought I'm s- only supposed to have three meals a day, or sometimes just one if I'm intermittently fasting." So talk about the five meals per day.
- JCJeff Cavaliere
Yeah, I mean, I actually, I know a lot of people that in- intermittent fast and actually do well with that. Um, the thing that I think why more, more people do better with more frequent meals is simply because they tend to get hungry throughout the day, and they don't have good management of hunger and then therefore portion control, and they don't have willpower to sort of wait to that next meal. So if they are hungry in the mid-morning and they have nothing sort of preplanned or, or prepared for a snack, they'll just go into the kitchen at work and just start picking and grazing. And that's where a lot of the calories throughout the day are consumed, not in those three main meals, but in the grazing that happens 'cause they can't make it to the next meal. So I just found that it's been easier, especially from the athletic world, these guys want to fuel more often, so they want something in between their main meals. But in the world of just, um, the, the regular individual who wants to be more, uh, disciplined with their nutrition, it's easier to actually program in two additional snacks. Nothing big, but just snacks in between that I always think should still focus and center around a protein, 'cause again, I believe that protein is, should be the cornerstone of every, every one of our meals and snacks, 'cause we don't get enough. Um, that's enough just to keep somebody, A, probably m- more metabolically stable to get to the next meal, but also it starts to teach them the willpower to do it. So if you're sitting there, you ate breakfast, it's 8:00, and then now it, your next meal's at, let's say, uh, 12:00 or 12:30, when it's 10:00, if you get hungry and you have a snack there, you don't have to get through four hours of willpower that you don't have right now to get to that m- lunchtime. You only have to get through two hours, and of those two hours, you weren't hungry the whole time anyway, only the la- last half hour. So you're teaching yourself willpower over the course of an hour and a half. Y- and then, you know, I actually have dropped back a little bit to where I'm not necessarily doing five meals in a day now. I'll maybe do four. But I have, uh, easy willpower.
- PAPeter Attia
Yeah, walk me through, walk me through a day in, in the life for you. So if you're... Not, not on a day when you're here and traveling. So you're at home.
- JCJeff Cavaliere
Yeah, yeah.
- PAPeter Attia
You, your first meal is what time?
- JCJeff Cavaliere
Um, it depends on it, it, you know, weekend or not, but usually 7:30, 8:00.
- PAPeter Attia
And what is that meal?
- JCJeff Cavaliere
And usually it's, uh, oatmeal, uh- Egg whites. Um, but again, not... Like, my oatmeal, I, we call it pumpkin oatmeal. Like, it's, it's oatmeal, it's, it's walnuts, it's, uh, Splenda brown sugar, or s- or brown sugar if you don't care about, you know, the, the, the calor- you know, the, the, um, the calories in it. Um, whipped cream. I put whipped cream on top. Uh, pumpkin I mix inside it. Like, it, it's good. Like, it tastes good and it's something that I actually enjoy. If it wasn't, I could never just eat boiled oatmeal for the rest of my life.
- PAPeter Attia
And then egg whites because you're just trying to cut the calories?
- JCJeff Cavaliere
Uh, no. It-
- PAPeter Attia
You want the protein without the total calorie of the egg?
- JCJeff Cavaliere
I- I- yeah. Although I'll mix in... I'll, I, I would, like, just at the hotel here, I'll eat eggs. I... Just the prepared eggs here 'cause they're there. Because I have my egg whites and I keep them in a, in a, in a... Frozen egg whites that I can use.
- PAPeter Attia
Yeah.
- JCJeff Cavaliere
I don't have... Like, I don't want to start cracking full eggs to put into. I'm a little bit simplistic when it comes to my nutrition 'cause I know what works for me, but I have no problem with mixing in one or two full eggs. I think you should, people should. Um, and then I'll have, uh, uh, milk with that or I'll have even a protein shake along with that. So they're not small meals either.
- PAPeter Attia
Okay.
- JCJeff Cavaliere
Um, that will take me through... Now I'll actually go to lunchtime. In the past, I would've had, uh, um, like a, a- another small snack. I'd have some pretzels and, uh, jerky or something. Like, just to, again, some protein and then some carbohydrates. Um, then I'll go to lunchtime. At lunch I'll have either, um... It's funny 'cause I'll either have a chicken wr- grilled chicken wrap with vegetables and yogurt, that would be my preferred me- some fruit. That would be my preferred meal. Or I'll have cereal [laughs] 'cause I am still a cereal addict. And we have lots of cereal choices, but I try not to choose the Cinnamon Toast Crunch that my son prefers, and I'll have something else. But I'll have cereal and yogurt. Um, just some-
- PAPeter Attia
How much protein are you getting in that meal, then?
- JCJeff Cavaliere
Um, from... I'll have, I'll have, uh, usually a protein shake there, too. So I have my protein shake, that's 30 grams, plus the, the yogurt, another 8 to 12 grams. Um, and then in the cereal, a little bit more milk, too. So I get enough protein from the meal, it's just a little bit, uh, less preferential in terms of the, where the carbs come from. I don't really get crazy about the carbs, I just try to pick lower sugar carbs. I try not to be, um, I try to be a little bit more, um, selective when it comes to that, but-
- PAPeter Attia
And then you do an afternoon snack around 3:00?
- JCJeff Cavaliere
That then... A- afternoon snack would be the same, would be the same type of thing as whatever the first snack was, um, in terms of... I, I like jerky, so I'll have some jerky, just pick at it. And again, some, some type of, um, like, crunchy food, just like a, like a pretzel would be easy for me to have a, a handful of pretzels. Then I will have, um, my dinner, wh- which actually... Well, actually, before that I have a, a, another protein shake after I train. So if I train, it will-
- PAPeter Attia
And you train in the afternoon typically?
- JCJeff Cavaliere
Randomly I'll train at 5:00 before I finish up work. Randomly. But most often than that, I wind up, uh, having my shake, and then I'll go train at night, like late, late, late at night. So my whole thing is it's not ideal.
- PAPeter Attia
That's... I, I think, I think we have a, an input into the sleep issue. [laughs]
- JCJeff Cavaliere
We do have input into the sleep issue. But I'm not having... I could fall right asleep after my dinner. The is- the issue for me is that when I get home, my kids have been waiting to see me all day. Um, and I make myself available to them. We play, we run, we go in the pool, whatever it might be. And then they go to bed a little bit late. You know, we have a busy household, so four dogs. It takes a lot to put everybody down, but they go to bed around 9:00, 9:30. And then when I finally get to the gym, it could be 10:30. So now I'll go and I'll train. I don't like to train on a full stomach. I hate the feeling. So I'll, I'll opt to have my dinner afterwards. But that does mean that the dinner could come at 11:30, sometimes even 12:00 at night. And that is not recommended for everybody listening, but, like, that... I, I also, I do think I could dispel the myth, though. I do not believe in the don't eat after 6:00 at all. I don't believe in that at all. Your body, especially if you're carrying a good amount of muscle, which is why we want to, um, can utilize those calories, can utilize the, that protein, can utilize those carbs throughout the day, provide, you know, whenever they do come in. Um, and I don't think that just magically eating after 6:00 is the, is the death knell to having low body fat. So, uh, that, that's not part of my equation. The only part of the equation for me is I could get... Like, it's a little late in the day to be eating.
- PAPeter Attia
Yeah. It might be impacting your sleep more than anything else. It's clearly not impacting, you know, your fuel partitioning.
- JCJeff Cavaliere
No. And I've been, I've, I've been blessed to have the ability to l- you know, hit the pillow and fall asleep within minutes, and stay asleep. 'Cause I don't sleep very long. I sleep five to s- well, six hours. Five to six hours. But my quality of sleep is usually very high. I don't wake up. I don't wake up at all. I wake up when the, when the time to wake up in the morning.
- PAPeter Attia
So
- 47:33 – 56:05
Optimizing protein for every stage of life
- PAPeter Attia
I want to kind of go back to what you were talking about a second ago, because it opened the door towards protein in kids. Um, but before we do that, maybe just for people listening who have been maybe not paying attention to some of the stuff we've, we've all been talking about elsewhere around protein consumption, what type of guidance are you giving your patients on, uh, on protein? Is there any difference between men and women? And are you differentiating it based on age?
- GLGabrielle Lyon
Age, yes. Men and women, no. When we talk about protein, typically we talk about one thing, but it's 20 different amino acids, nine of which are essential. We actually eat for those nine essentials. There is a lot of nuance around protein in general, and, uh, what it does. Each of those amino acids do something different. For example, leucine, which is, I know, our favorite amino acid, is critical for muscle, for muscle protein synthesis, but something like threonine is important for mucin production in the gut. When you are eating a lower protein diet, the organs... Well, I suppose I should start with why are we eating protein? We need about 250 grams a day. We recycle much of that. We don't eat that. A portion of that, probably the largest portion, maybe 75% of that, goes towards visceral tissue for turnover and maintenance. Maybe 25% of that goes to muscle. But we have to continue to get these essential amino acids so that we can maintain rebuilding and repairing, which the efficiency of that changes as we age. Anabolic resistance, protein efficiency decreases. Those are, or that is one reason why we need dietary protein, just to maintain the tissue integrity and the structure. Women and men do not need, at this time from what we know in the literature, a different amount of protein. It is not sex specific. It's body weight specific. The minimum amount of protein I would ever recommend would be 100 grams at a minimum. Men or women, that would be the starting place. Because if you are, say, a 115-pound woman and you are following the RDA at 0.8 grams per kg, what is that? 45 grams of protein or so? That's, that's not enough.
- PAPeter Attia
Right.
- GLGabrielle Lyon
Part of the failure there is that we have to recognize protein is different amino acids. And so when we talk about muscle health, we need to get enough leucine to support muscle health, and that is probably the recommendation is two to three grams a day. It's probably for optimal health around eight or nine.
- PAPeter Attia
And how do you get folks to think about that, right? Which is, um... 'Cause now all of a sudden you get into dramatic differences in terms of protein source. So if you... I don't really think we should go down the PD cast pathway necessarily [chuckles] for everybody today, but, but just in terms of understanding that foods are created different, right?
- GLGabrielle Lyon
Yeah.
- PAPeter Attia
So, um, you can look at an ingredient label of something that says 30 grams of protein, you can look at another thing that says 30 grams of protein, but they don't list out the amino acids. They don't tell you that this one has more leucine or more methionine and this one doesn't. But there are certain themes that we know, right? We know that dairy-derived protein, beef-derived protein, and egg-derived protein seem to have the highest amount of the right amino acids, or let's just say the more important amino acids. So when you're, when you're, when you're saying to that person, "Hey, I want you to eat a minimum of 100 grams per day," does it come with the caveat of assuming you're getting your protein sources here?
- GLGabrielle Lyon
And what you're pointing out is protein quality. The-- there are plant sources of protein and there are animal sources of protein, and just from hard, fast biological numbers, we consider a high quality protein to be eggs and dairy, fish, chicken, any of the animal source proteins. The lower quality proteins would come from plants. When we educate our patients in the practice, we have them choose, and we really don't focus on plant proteins as a source of protein. While they do have amino acids and certainly a combination is wonderful, we like to focus on plant foods for fiber. And s- let's say we take out soy, but we really want to focus on high quality animal source foods because, listen, it makes up, let's say, makes up 30% of our diet. Nearly 100% of our calcium, our bioavailable iron and zinc, selenium come from these animal-based foods. And while we talk about protein, we should also talk about nutrient quality. Whether someone decides to get their protein from plants or animals, it isn't just about protein. It is also about those nutrients of concern. For women, like bioavailable iron. For kids, bioavailable iron. Nutrients that primarily come from animal sources I, I just think are really important. And again, nothing wrong with plant-based proteins, but we eat plants for fiber and phytonutrients.
- PAPeter Attia
And so w- y- presumably you have some patients, as, as I do, who are vegetarians.
- GLGabrielle Lyon
Mm-hmm.
- PAPeter Attia
And in some cases it's ethical, religious, whatever the reason is.
- GLGabrielle Lyon
Certainly.
- PAPeter Attia
Um, w- what are some of the, what are some of the things that you... And, and let's go one step further and let's go ve- 'Cause at least vege- most vegetarians will at least be able to consume the dairy portion. But when you, if you have someone who's vegan and who is purely looking at animal sources of protein, how, how much of an uphill battle is that?
- GLGabrielle Lyon
Well, it's... The challenge is the carbohydrate consumption. So I was listening to what Jeff was saying, and he was absolutely right. He could have... You were saying that you have maybe 100 grams of carbs and you have no problem with it at a meal.
- PAPeter Attia
Mm.
- GLGabrielle Lyon
Did you say that?
- PAPeter Attia
Mm. I, well, I mean, you probably calculated it in your head, but yeah, [laughs] that-
- GLGabrielle Lyon
But [laughs]
- PAPeter Attia
... that's, that's, that... I can do that, yeah.
- GLGabrielle Lyon
And for someone like him, who is super active, he is able to dispose of those carbohydrates. But a normal person, our carbohydrate threshold if you calculate the disposal from skeletal muscle, organ systems, it is not much. It is about 40 grams in a two-hour period. Anything above, say, 40 or 50 grams in a non-exercising adult will result in a robust insulin response. We do not want that. We do not want to be utilizing insulin to help support glucose. We want to use activity or have the health of our skeletal muscle be able to balance that. And, um, I suppose what we're talking about is carbohydrates and unless you are highly active like you are, then we also have to think about the carb portion of this, and designing a diet typically for us, we think a lot about a one-to-one ratio of protein to carbs at a meal, depending.
- PAPeter Attia
Let me think about that in myself. Um, that's pretty tough. You have to be pretty deliberate about withholding carbohydrates to... And, and I eat... I mean, I'm probably eating a gram of protein per pound of body weight, so it's not like I'm skimping on protein. Um, yeah, maybe I, maybe I... I don't know. I would, I would bet I-
- GLGabrielle Lyon
But you're metabolically healthy, and that goes back to this hierarchy of how we should make protein-
- PAPeter Attia
See, I think, I think you have a longer leash-
- GLGabrielle Lyon
Yeah
- PAPeter Attia
... if you're active.
- GLGabrielle Lyon
Absolutely. When we make protein decisions in the practice when we're designing a diet, it's age, it's activity, and it's metabolic health. If you are metabolically healthy, then you can tolerate... There, there's no problem, right? Carbs aren't the enemy. But once we- find out someone is metabolically unhealthy, which you can see from blood work, then you have to begin... You know, you don't change your protein amount because as you restrict calories, you keep protein the same or higher because you must protect lean tissue. And also, it's, it's better. I mean, we've seen this in the data for long periods of time.
- PAPeter Attia
What, what about overweight patients? So if you... Let's say you had a patient who's, uh, uh... Let's say it's a man, 250 pounds, and, um, I know we're gonna talk about body fat, 'cause I'm actually super interested in what you, what you have to say about that. But let's just assume you did a DEXA on this guy. You don't need to do a DEXA, by the way. You can look at his... You can look at him. [laughs] You know, you know this guy's carrying way too much fat. But the DEXA just gives you some numbers. The guy's 40% body fat, okay? Um, so when you're trying to tell him how much protein to eat, are you doing it based on an ideal body weight, or are you doing it based on his 250 pounds that he's carrying around?
- GLGabrielle Lyon
His target body weight.
- PAPeter Attia
Okay. So you're gonna say, "I'm targeting for you 16% body fat. Let's calculate how much lean tissue you have at... What would you, what would be your ideal body weight at 16% body fat, and that's what we're gonna target you at"?
- GLGabrielle Lyon
Yeah.
- 56:05 – 1:06:59
The advantages of unilateral lower-body training over heavy bilateral lifts
- PAPeter Attia
Um, I want to totally pivot and talk about something that you already brought up, Mike, and, and this speaks to how these round tables get totally messy, 'cause I am not done with nutrition. I want to come back to it.
- MBMike Boyle
[laughs]
- PAPeter Attia
But I don't, I, I don't want to forget this idea of unilateral lower extremity training. So this is a topic that's near and dear to my heart. So I grew up, um... And apologies for people in the audience who've heard me talk about this, but this is just context for you. I grew up, power lifting was one of the things I did on the side. It actually wasn't a sp- sport. I mean, I, I... Boxing was my life, but I became hooked on being in the gym, and the gym I belonged to was a dungeon. It was an old man dungeon, two stories underground with no windows. And I didn't realize how lucky I was at the time, but this happened to be, like, the power training, you know, the power lifting epicenter, right? So you basically just had a bunch of middle-aged men who were machines. Like, you know, these are... E- even, even the guys that weighed, like, you know... Everybody could bench press two times their body weight, squat three to- times their body weight, deadlift four times their body weight. So that's what I grew up doing. I was like, we bench, we squat, we deadlift, and we do it really, really heavy. And not surprisingly, over time, like, I started to get injured, right? I injured my back by the time I was in medical school, and, um, kind of decided, like, "I, I don't know if this is worth the risk anymore. Like, I don't, I don't really see that I need to have four plates on my back squatting anymore." And almost through necessity had to discover single leg training. So I want you to say more about that experience and help somebody, 'cause I have patients who really can't believe that you can achieve optimal lower body hypertrophy without a barbell on your back or without picking a barbell up off the floor.
- MBMike Boyle
Yeah, which is amazing. I, same background as you. I got into competitive power lifting in college just 'cause I was no longer an athlete and I was looking for an outlet and it was like, "Okay, I'm good at lifting weights." So started competing in power lifting. Started hurting myself, back problem, shoulder surgery. And athletic training background, get to college as a strength coach, start to see the same things. I've got athletes with back problems. Everybody's back problem seems to come down to one thing, back squatting. Every kid. 'Cause we weren't, we d- weren't deadlift. We were the old school, like, squat, bench, power clean because that was the football-
- PAPeter Attia
Hmm
- MBMike Boyle
... mentality at that time. But the people with back pain had... It always related right back to back squat. We started to look at that and think, "Okay, if we're doing something that we know is hurting 20% of our population, should we continue to do that?" For a while we had to because the football coaches mandated it, but when I got to the point where I was kind of fully in control, I said, "We're, we're not gonna do this anymore." And then we went the unilateral route.
- PAPeter Attia
Sorry. When you say football coaches, are you saying even at the level of the NFL?
- MBMike Boyle
Uh, at, at every level. The football coaches, you know, they want to know how many guys can bench press 400 pounds, and how many guys can squat 500 pounds, and how many guys can, you know, they're... It's, uh, it's still a very old school mentality. It's getting better. NFL level is getting much better because they have, they have-
- PAPeter Attia
Is the bench still, uh, in the combine for anybody-
- MBMike Boyle
Yep
- PAPeter Attia
... but a quarterback? Yep.
- MBMike Boyle
Everybody's still benching and, and still benching 225 as a strength test.
- PAPeter Attia
Yep.
- MBMike Boyle
They do an endurance test for strength. We could talk about the-
- PAPeter Attia
[laughs]
- MBMike Boyle
... the foolishness of the combine, too, but that's another-
- PAPeter Attia
The same combine that you helped develop?
- MBMike Boyle
Invented. [laughs] The same combine that I helped train people for. Yes, it is not... I always tell people it's like getting a copy of the SAT and all you gotta do is cheat. You just gotta practice the event, practice the questions. You know the te- you know the answers. Practice, you'll get good at it. We de- we developed that thought process. But, so we started going just down this sort of unilateral rabbit hole, and then we... But then you start getting into the biggest thing that people have to understand is you s- when you get into the bilateral deficit research, you're stronger on one leg. You have more strength capability on one leg than you do on two because your body, there's... And there's research-
- PAPeter Attia
And it's so interesting. Sorry to interrupt you, Mike.
- MBMike Boyle
Yeah.
- PAPeter Attia
It's so interesting how difficult it is to appreciate that when you're not doing unilateral exercises.
- MBMike Boyle
And people don't try it, and then it's very dogma oriented because we, we've all grown up around kind of the squat poems and all these things about, you know, king of all lifts and all this bullshit that people spout. And I'm always kind of spouting the anti of that. But the reality is we started seeing when we first started testing is what happened was one of my assistants, this guy Jeff Oliver, who's been at Holy Cross for 25 years, said to me, "If we could test uni- one-legged strength, would you stop squatting?" And I was like, "Yes." So then we said, "Okay, let's try to figure out how we test." So we started making up these sort of half-assed one leg squat tests, you know, doing rep maxes in different split squat variations and things. But when we did it, the results blew us away in terms of the first-
- PAPeter Attia
The difference between sides blew you away?
- MBMike Boyle
Uh, no. The, the, the ability to be stronger than we were or as strong as we were bilaterally blew us away.
- PAPeter Attia
Wow.
- MBMike Boyle
So we had guys... The first year I did it with my hockey team, 2000 maybe six or seven, somewhere in there, and everybody Could split squat what they could front squat, same amount. So if I did a, a back split squat test, everybody that could back split squat 300 pounds was a 300-pound front squatter. Everybody that could back split squat, you know, project, project out to a 400-pound max was a 400 front squatter. Right across the board, it was exactly dead even, one leg to two legs. And then people would say, "Well, that's 'cause they're using their back leg." They were trying to come up with all these rationales for why it wasn't, but the numbers were just glaring. You know, then we went to a split squat test, and we had one kid who did, uh, did 240 pounds for 20 reps, which, you know, if you'd bilateraled it out, it's 480 for 20. He's a 200-pound hockey player, 190-pound hockey player. They just, the numbers started to smack us in the face a little bit, and I started to look, and then you start looking at the bilateral. Like, you look at the grip strength research, bilateral deficit. Right hand plus left hand will be more than combined two hand. You look at, you know, and they've done it with leg extension. They've done it with a bunch of different things, and what they realize, I think, this is my own theory, but we neurologically know that we are unilateral. If I said to you, "Try to dunk a basketball," I'm gonna guarantee your right hand-
- PAPeter Attia
Yeah, I'm gonna, I'm gonna jump off one foot. Yeah, yeah.
- MBMike Boyle
You're gonna jump off your left foot. You're gonna hold the ball in your right hand. Everybody here is gonna do it except 10% of us are lefty, so 10% of us are gonna grab it in our left hand. But everybody knows if I say to you, "Throw a baseball..." I always say to somebody, if I say throw a baseball, everyone knows how to throw it. If I say throw two baseballs, somebody would think, "I'm not really sure how I'm supposed to do this right now."
- PAPeter Attia
[laughs]
- MBMike Boyle
We understand neurology, and then we deny it when we start strength training because we want to deny it, and I think it's actually limiting. I think I've said to people, I think, I think I spent a lot of time probably making people less athletic at the higher levels. One of the things that we noticed-
- 1:06:59 – 1:17:56
Rethinking heavy squats & deadlifts: risk-reward, aging bodies, & the case for reverse lunges & other single-leg alternatives
- PAPeter Attia
in your world, training people the way you are, what are the exceptions to those rules for you? When are the times when you're saying, or are you saying, "No, I still see that the risk/reward trade-off for someone in a certain position is there for, you know, a back- a barbell back squat or, you know, a sumo deadlift or something like that? How do you, how do you think about that?
- JCJeff Cavaliere
I think that if... There's, there's always the argument of can you train... See, a lot of times, and especially in, in Mike's world, too, when, when people come to him, they've already learned bad mechanics for squats. So they're bad squatters when they come to him. So they're already demonstrating habits that are gonna totally break down their body by continuing to just pile more and more weight on. I think when you can intervene with somebody at an early age and teach them biomechanically how to squat better, which Mike and I have discussed before a- at length, like, it's not, it's not easy to, to really d- dissect that lift. It's a complicated lift. There's a lot of moving parts. So you have to be willing to spend a lot of time with that person to teach them from the ground up. In those instances when you can, I think you could probably teach somebody how to squat more safely. That doesn't take away the fact that if you can do it and not have to load that way, and especially as we talk about the aging population, then the benefits might still outweigh the, outweigh the risks in terms of it's just better to single-leg squat. But I think that you can probably teach that lift, but you have to be willing to teach that person to either unlearn the bad things that they've already learned or, if they're starting out early, learn how to do it more properly. And you could do it in stages, too. You can, by squatting to a box, you could biomechanically fix a lot of people's issues because having the target or the safety net behind them is enough to sort of get them to actually move in a better, better way. But you don't wanna train that way com- you know, uh, w- without ultimately going to a, a freestanding squat if they're gonna be ultimately, you know, playing, playing sports and, and n- needing to do something like, let's say, an offensive lineman coming off the, off the, uh, the line. But I, again, I'm actually in Mike's camp in terms of the value of, of, of single-leg training. We do so much single-leg training with Athlete X because I believe that it's not just the unloading that we get from the single-leg squat. It's just a, it's just, as Mike said, how we're wired, how we're actually preferred to move. And I, I get... I took some shit along the way because anytime you pick up a, a leg from the ground, it's functional training, and then all of a sudden that has... was a cool thing at one time, it's not a cool thing anymore. [laughs] But you do pick up your leg, and then, yes, that's functional for a reason. So I think doing, uh, lunging and step-ups. We did, we built a whole program in, in our, uh, in, with the Mets around step-ups and lunging 'cause we knew how important that was. And then again, we did other forms of bilateral lifting. We would do trap bar deadlifting, um, to, to clean up some of the issues that people had. I always say that if you wanna learn how to squat, take a dumbbell, um, hold it between your, your hands, or a kettlebell, and just let the ball- let the dumbbell, the weight, go straight down to the ground. It will put you biomechanically in almost a perfect position because you're just letting the, the, the weight drop straight down to your center of mass. That's a great tool for teaching people what it's supposed to feel like. But when you then go put the bar on their back, as soon as the bar- they don't have thoracic mobility, all the things that they're lacking start to change that, that dramatically from just... You think it's the same exercise 'cause you're going straight up and down, but it's a very different exercise 'cause now when your hands are up, and again, thoracic, the, the extension is more required. They don't have that, and the whole system gets thrown out of whack. So it, it's, um, it's done. It's still done in certain cir- circumstances, and you're always gonna still encounter people who, I don't know, Mike, you might just tell them to go to a different gym, but, like, you know, there's gonna be people who will insist that they still have to squat, and they wanna learn how to do it and do it more safely. And I think having the, you know, the, the, the willingness or the ability to still coach them through that is important. But because of guys like Mike and because hopefully stuff that I talk about, like, there, there... people are less reliant on those as the, as the only things that they can do.
- PAPeter Attia
Yeah. I, I f- you know, I'm, I'm a little conflicted. Less, less so now, but I think up until, up until about 18 months ago, I was still squatting and deadlifting regularly, though with much less weight, right? I wasn't... I was never going below five reps, um, [clears throat] and frankly, targeting 8 to 12 most of the time, and my rationale for it was the following: I viewed it as an amazing audit of my chain. So I filmed every set. So I have a tripod in the gym. My phone would sit on it. I would, from the warmup set to the last set, every set was filmed, and my recovery was watching the video. And the truth of the matter is, despite that, about one in every eight workouts, I just screwed something up.
- JCJeff Cavaliere
Mm.
- PAPeter Attia
And I would spend the next four days in pain, and I'd be sitting in the shower, running hot water on my back. Was it anything catastrophic? No, not at all. I got... My erectors just flared up. It wasn't the end of the world. But what it said to me was, uh, I, I mean, people watching us might be offended by the statement, but I'm getting old.
- JCJeff Cavaliere
[laughs]
- PAPeter Attia
I'm getting old.
- GLGabrielle Lyon
You look great for 25. Come on.
- PAPeter Attia
[laughs] And as I think all of us would agree, the name of the game when you're old is never getting out of the game. Like, there's nothing more devastating. It, it's one thing to get injured when you're 20. You're gonna be back. But if a 55-year-old, never mind a 70-year-old, if a 55-year-old has to take a year off because of some devastating injury, it's really difficult to come back. And so I very sadly decided that the risk that I was gonna do something dumb... And actually, I'll tell you the straw that broke the camel's back. I used to do a lot of tire flipping. So I used to have this 450-pound tire, and my favorite, my absolute favorite activity was how many... There were different games you would play, so you would love the gamification of it, right? It's like, how many times could you flip it? How long did it take you to flip it 25 times, or something like that. And so when I moved to Austin, I didn't have my tire 'cause it was out in San Diego. So of course, I had my assistant call and find a guy who could find the closest tire to 450 pounds. We found one that was 407 pounds. The guy delivered it. He's like, "What the hell do you want this thing for?" I start flipping it again. And my friend, who's a really awesome PT, was watching me, and he goes, "Have you ever hurt yourself doing that?" And I said, "Never." He goes, "Y- you are, you are in a remarkable amount of, uh, of lumbar flexion right now. Um, and I would just be careful. Like, it, you know, y- you know, that... The, the lumbar spine does not like to be in this position when it is that loaded." And I was like, "You know, he's right." Like, I can absolutely see how under fatigue I could just, you know, do something too much. So anyway, it's, uh, s- sorry for the ramble, but the point was I basically decided, as much as I love this exercise, as much as it's a great audit, I, you know, this... I'm learning. I'm d- I'm, I'm... I love the idea of critiquing my form between sets. I just sorta decided the risk-reward trade-off wasn't there for me. Um, d- do you think that's sort of a... Do you think that's a mistake? Do you think that I should've stuck with it and, and made other modifications?
- JCJeff Cavaliere
No, I don't... I, I think because you have these options, I don't think there's a compromise in the benefits you're getting from single leg training. Like I said, there's probably more benefits that you're getting from that. Um, I, I will... I'm right in that same boat with you. I spent probably from 35 to 45 wanting so badly to get a... Well, I have bad knees, and I... and that probably comes from my flat feet. But I, I... wanting so badly to not have to squat, because every time I did, it would, it was just... It would kill. My, my knees the next day would be horrifyingly pain- in pain, and my low back would ultimately wind up taking on that same brunt. I know exactly the same spot you're talking about. But yet I kept telling myself, "But you have to squat. You have to squat." Like, it's just what we do. We have to squat. Like, so I would try to get past the point of the things that were bothering me, and then I would ultimately go back under the bar and squat again until I, you know, through [laughs] watching Mike and others said, like, no, you know, it really doesn't... It's not a requirement to get what I'm trying to get out of it. I'm trying to hypertrophy my legs. I'm trying to get stronger hips. I'm trying to, trying to get, uh, stay injury-free. And so my favorite exercise at that point became, uh, a reverse lunge. So I'll do it with a barbell, or I'll do it with dumbbells. And honestly, it's a little easier with the barbell because I don't have to worry about the grip of holding the dumbbells.
- PAPeter Attia
And so reverse lunge meaning you're starting in a standing position and you're doing a step back.
- JCJeff Cavaliere
Step backward.
- PAPeter Attia
Yeah.
- JCJeff Cavaliere
Step backward.
- PAPeter Attia
And you... I've seen a great video on this where you emphasize how wide you're stepping out.
- JCJeff Cavaliere
Yeah. Yeah, you need... Because you don't want... That's the thing, and this is where some of the functional training stuff comes up. Like, oh, it's a balance exercise. That's a ba- It's not a strength exercise. It's a balance exercise. It's not a balance exercise. If you can't keep your feet wide enough, you c- all you have to do is just t- step back and out. You'll maintain a wide enough base where you still have support, and then it's a strength exercise if you're lifting a lot of weight.
- PAPeter Attia
I, I remember where I was when I watched that video of you, and I went to the gym that day. And I was like, "I've never thought about taking a wider stance." I mean, I added 40 pounds.
- JCJeff Cavaliere
Right. And I think it's also my second big tip on that exercise is as you go down, j- I, I call, I call it, like, screwing yourself into place, but, you know, you're really not. You just take a little bit of a rotation towards the front leg. So you're just taking your torso. You take it a little bit over the front leg. It'll, it'll basically stabilize that front leg a little bit more, and again, with, with enough contact. I think... What, what do we, when we doing those r- um, reverse split, like, uh, situations is about 75% on the front leg or so?
- PAPeter Attia
Yeah, about.
- JCJeff Cavaliere
So, yeah.
- PAPeter Attia
Yeah, give or take.
- JCJeff Cavaliere
So, I mean, you still got 25% going back on that back leg, and that's enough to support you and, and m- make sure that you're not falling all over the place. But that, that is my, my favorite way, and I recommend for people all the time to do that. Lunging forward is fine, but people that have knee issues like myself, um, that doesn't feel too good either. So it's like why not do it this way? Because this is a safer way that has less orthopedic issues for people, and it's still a great... You can go, you can go pretty heavy.
- PAPeter Attia
Yeah.
- JCJeff Cavaliere
Again, if you're gonna use a barbell there, too. So, uh, that's my favorite substitute. And since I learned that there were other things I can do and not compromise whatever it was that I was chasing at the time, um, I have since sort of backed away from that. And, and y- you can ask Jesse. Every now and then I'll s- I'll go back and try again, and inevitably, in a few days, I start... things start, you know, clicking [laughs] in my hip or things that didn't pop or click before. And I, I do believe that there's a path away from that.
- PAPeter Attia
So, so Gabrielle, for you, before I wanna talk about your patients, but personally, because we're all telling personal stories, what have you changed in your training, resistance training specifically, as you've aged, as you've increased wisdom-
- GLGabrielle Lyon
[laughs]
- PAPeter Attia
... whatever, whatever, whatever the case
- 1:17:56 – 1:27:28
Adapting with age: Gabrielle on injuries, hip dysplasia, & the shift to smarter training
- PAPeter Attia
might be?
- GLGabrielle Lyon
I wish I could say I get less hurt. Um, before we started the podcast, I said that I had a right torn hamstring and a quad fem-
- PAPeter Attia
Proximal or distal?
- GLGabrielle Lyon
It is proximal and quad fem, which is very unusual. Glute med and glute min that I love to overachieve. I thought it was a great idea about eight years ago to keep up with my husband, who my husband was a former SEAL who's now at Baylor. I thought we would do a 50-hour event, and I was not physically capable or prepared to do that. It's just another Tuesday for him. And I tore my left hamstring on a sprint. Since that time, I think that it changed my ability to squat. I kept going back to the squat. I am not able to do that at all now. But that changed probably, I don't know, six months ago. I stopped squatting six months ago. I also found out that I hip dysplasia. All of these injuries, all of these patterns which, you know, as I think as, as someone who is listening or watching this, if something doesn't feel right, you talk about taking that wide step back. If someone is doing something that people will say, "Okay, this is a squat pattern," but it doesn't feel right to you. I had been squatting in a much too narrow position for someone that has hip dysplasia, and so I ground out my hip and... But I'm somewhat stubborn, for those people that, that know me. I just kept doing it because I believe that we should squat. Needless to say, I'm now in a position where I am doing only single leg movements and really trying to pull back, probably be doing some PRP for this now new injury. And I say that all about, um, somewhat in a roundabout way that as we age, like you said, Peter, the worst thing that you can do is stop, you know? And I think about Doug Patton Jones's work, the catabolic crisis model. This isn't a catabolic crisis, but a catabolic crisis model is when you're off the table, you lose muscle mass and strength rapidly. Over 40, you're... A- and that continues per decade. So my training has changed dramatically. I do more high intensity, um, on, say, the bike or the AirDyne, AirDyne versus any kind of long, slow, steady state, which I would love to get back into. And then also the lifts are all-
- PAPeter Attia
So you're able to do high intensity stuff on a bike with a high hamstring tear?
- GLGabrielle Lyon
Well, this is new. This-
- PAPeter Attia
Okay
- GLGabrielle Lyon
... this new tear just happened. I got my MRI back two days ago.
- PAPeter Attia
Got it.
- GLGabrielle Lyon
So I, I won't be able to now.
- PAPeter Attia
So when you're recovered, so let's just say we're, we're sitting here in nine months, which-
- GLGabrielle Lyon
No, I'll be recovered before then
- PAPeter Attia
... all right, very well. Um, when you're recovered, how is it going to change what you do going forward, and how will that impact what you modify in terms of your patients? 'Cause I think all of us are practitioners here-
- GLGabrielle Lyon
Yeah
- PAPeter Attia
... and therefore we're kind of, we're students. We, we do a lot of self-experimenting. We make a lot of mistakes on ourselves that gets us curious about, you know, [laughs] "Okay, what's the lesson here? How do I make sure that my client, my patient, doesn't make the same mistake?" So what's, what are you gonna change, and how is it gonna impact what you tell patients now?
- GLGabrielle Lyon
Definitely it doesn't have to be these big lifts. We don't all have to squat. And for me personally, having to deal with that, I, prior to injuring my hamstring just recently, I was starting to do more unilateral work, and I will go back, and also just being much more particular about form. I think as lifelong exercisers, we can compensate a lot. People that are somewhat athletic compensate very well. I think I have to hold myself to a much higher standard, otherwise I know I will continue to get injured. And also I want to add in more zone two. I struggle-
- PAPeter Attia
By the way, it's so funny you say that. Um, I remember, um, a trainer, and I can't remember who it was, um, but he was showing me videos of some incredible athletes doing workouts, and he was just pointing out all of the horrible mistakes they were making. And he goes, "They're not great athletes because of how they're training. They can get away with training that way because they are such great athletes." How, how much did you see that, Mike, when you were training pros?
- MBMike Boyle
I literally just wrote down, "The better the athlete, the better the compensator." That was the note that I just wrote.
- PAPeter Attia
Masters of compensation is what we used to call them. [laughs]
- MBMike Boyle
Yeah, I used to look at these guys and think like, "My God, it's amazing what they can get away with at that level." But I want to go back to the adult, 'cause it's really funny, the squat thing, because I wrote an article one time, and I forget what I called it, but it was basically about slamming your hand in a car door. I said, "If you substituted slamming your hand in a car door for squatting, and then had the same conversation with yourself saying, 'Hey, I just hurt my hand. I slammed it in the car door, and I can't wait till my fingers heal up, 'cause I'm gonna go back and slam my hand-
- PAPeter Attia
[laughs]
- MBMike Boyle
... in the car door.'" Right?
- GLGabrielle Lyon
[laughs] That-
- PAPeter Attia
That's what you'd be saying to me in the shower every eighth leg curl
- GLGabrielle Lyon
... but we've all done that, which is unbelievable.
- MBMike Boyle
Exa- we all, we've all... Exactly, and that's why I wrote the article-
- GLGabrielle Lyon
Unbelievable
- MBMike Boyle
... because people do it all the time. And you just realize that if you just... And that's where being rational and substituting something really stupid-
- PAPeter Attia
Although in fairness-
- MBMike Boyle
In fairness
- 1:27:28 – 1:34:03
Exercises that belong in the “iron graveyard”
- PAPeter Attia
sport.
- JCJeff Cavaliere
It, it, it's also not as if that the alternatives are sacrifices in terms of what they're delivering.
- PAPeter Attia
Right.
- JCJeff Cavaliere
That is the problem. Like I always talk about people get on me because I have what I call the iron graveyard, right? There's a few exercises that just belong in there, and one of them for me is the upright row. It's a garbage exercise. It's, and, and you could tell me, "No, there's no bad exercises." That's a bad exercise. And the reason-
- PAPeter Attia
Talk about it
- JCJeff Cavaliere
... well, it sucks.
- PAPeter Attia
First of all, not everybody knows what it is. So show, yeah.
- JCJeff Cavaliere
So the upright row is when, is, you know, done the way that people, you know, old school taught how to do the, the lift, you hold the barbell, and you lift it up here, up, up under your chin. Your elbows are much higher than your wrists are. You've got lots of weight usually on the exercise, so more fully pushing your arms down into internal rotation. The funny thing about that is that, that, that position is literally the test as a physical therapist that we would put somebody in to try to see if they have impingement in their shoulder. We would put them in this position, push down. If it gets a lot of pain in there, likely something's getting pinched. Supraspinatus tendon, something. Why am I doing that exercise when, not because I dislike the exercise. I never got hurt on it. I never did, I've did it for years. I've done it for 40 years. There's always the outliers, like we talked about before. But when I can just simply tell you, "I just want you to drop your elbows lower than your wrist. I want you to do something called a high pull. I want you to go this way." By doing that, now instead of internally rotating the shoulder, I'm externally rotating the shoulder. I'm still working my delts. I'm still working my traps. I get zero sacrifice of what I'm trying to do the exercise for in the first place, and I eliminate the part that I don't like, that I don't care if you haven't gotten hurt this time, but ultimately doing it over and over and over again can potentially cause a problem down the road, even just the potential of it. I'm not saying that you can't get injured on any exercise. You can. But on, on this exercise, I'm lowering the risk and not sacrificing the benefit. I think when, when Mike talks about squatting, the fact is if you can do something that's giving you a better or even equal benefit and it takes away some of those down- downsides to the exercise, especially as the population who's performing it is less appropriate to be performing the exercise and more appropriate to be doing the alternative, what, what's, what's the whole point?
- GLGabrielle Lyon
You know, it makes me think about how do we re-educate people? Because we've all suffered from these narratives of you have to squat, you have to deadlift, and it's just similar to nutrition. Do you think that there's a way, i- if I can ask, do you think there's a way that we re-educate getting to our youth potentially so the younger that we can educate, the less likely we're going to have adults in their 50s having to have serious injuries? And then Mike, you won't have to have this conversation about no more squatting.
- MBMike Boyle
No, I think we're doing it right now, actually. I mean, these things are really th- the, are, the ability to mass produce this and to have people hear it and see it is something that we weren't really able to do before. I, I talk about the fact when I was a kid coming up, I had to wait for the new Strength and Health to come out to the newsstand. And I, I mean, I waited. I visited the newsstand daily.
- PAPeter Attia
We lived, we lived by these magazines.
- JCJeff Cavaliere
Loved it.
- MBMike Boyle
Oh, yeah. Absolutely. Str- I, I waited for Strength and Health and Iron Man. I would walk into the store and I would say, "Did those magazines come in?" And the guy would be like, "Nope, they're not in yet." 'Cause that was our only connection to the training world.
- PAPeter Attia
Yeah.
- MBMike Boyle
And now you think, you know, you've got 14 million subscribers or something like that on YouTube and I had someone ask one time, they said, "What's the greatest thing you've seen or the greatest change in strength and conditioning?" And I was like, "The computer." [laughs] And they're like, "What do you mean?" I was like, "There was no computer."
- PAPeter Attia
Hm. Such a good point.
- MBMike Boyle
A- and so you start thinking we've got this ability now, podcasts, YouTube, we can educate people, but our problem is that we copy dumb people. There's too many dummies on the internet and not enough people... I've taken a little bit more in my old age to kind of calling out the bullshit. Sometimes I'll just say on Twitter, "That's a bad, that's a bad take." Because if you don't- Then people get to establish themselves as experts because this is the loudest voice situation now in terms of who's going to, who's going to influence. And now there's a lot of AI. Like, if you look at Twitter's got all these AI things going that are showing people, and sometimes I'll just write total garbage, and I'll just click and send the reply.
- PAPeter Attia
Mm.
- MBMike Boyle
It... Because I'm like, "It's total garbage. It, this is shit. Like, it, it shouldn't be on the internet. It shouldn't be anywhere." And, uh, so... But I'm gonna be that, I guess. I'm gonna probably-
- PAPeter Attia
We need that. We need-
- MBMike Boyle
I'm getting close to the grumpy old man stage.
- PAPeter Attia
[laughs]
- MBMike Boyle
Like when your, when your grandfather would say inappropriate things at meals, I'm, I'm like-
- PAPeter Attia
[laughs]
- MBMike Boyle
... I'm, I'm inches away.
- PAPeter Attia
Um, Jeff, give us a couple more things in the graveyard.
- JCJeff Cavaliere
Oh, what else do I have in the gra- Um, Cuban press for the same reason, which is when the elbows, you know, the arms come down and then press from there. It's kind of an unnecessary adaptation that we don't need. Um, what else do I have in the graveyard? Um, I'm drawing a blank. I had at least five or six in the b- Oh, the, uh, the chest fly. I, I put the unsupported bench fly in the graveyard simply because, probably because of my history working with, with pitchers and knowing how susceptible the, the shoulder capsule can become from chronic overstretching, and then we apply a load in that position at the same time. And even Arnold himself-
- PAPeter Attia
Whereas a fly machine would be safer-
- JCJeff Cavaliere
Yeah, a fly machine-
- PAPeter Attia
... 'cause you're not loaded
- 1:34:03 – 1:43:42
The downside of early sports specialization in children
- PAPeter Attia
I wanna talk a little bit about kids. So, um, I have three kids. They all love playing sports. Um, but one of them in particular has, has taken a real love of baseball, the youngest. So he just turned eight about a month ago. And I, I grew up never playing baseball. It's not... It just wasn't a sport that was particularly popular where I grew up. I have to say, it i- I have become obsessed with baseball. I can really, fully understand how people can get obsessed with this sport. It's not just the numbers and the data. There's just, there's so much art in nuance, in, like, learning about all these different pitches and how they hold the ball and all this kind of stuff. Okay. But, you know, we live in, we live in a world now, it seems, where, uh, coaches want kids to specialize earlier and earlier. And I was a little bit surprised at the end of his seven-year-old se- Like, you know, they're playing three seasons a year, by the way, in baseball right now, right? So you've got fall ball, spring ball, and then, like, there's this, like, little summer ball tournament. And the kids are playing one position now. Um, and most of the kids have a coach, an a- a coach outside of, like, a position coach outside of the team. Now, my intuition is that just doesn't make sense. So, so what, what... Tell me what you guys think of that.
- MBMike Boyle
[laughs] Do you have a soapbox available-
- PAPeter Attia
[laughs]
- MBMike Boyle
... um, for the, for me to jump up on? Absol- One, I always say follow the money, right? If you look at most of these people that are telling you that kids need year-round sports are people who are making their living from year-round sports. If you look at what most professional athletes are doing, they're not doing that with their kids. If you look at what most coaches are doing, they're not doing that with their kids. What you usually find is some entrepreneur who has developed Joe's Baseball, and he needs income year-round because he doesn't have Joe's Baseball and lacrosse. He just has Joe's Baseball. So as a result, they're, they start telling you, they start giving you that early specialization myth like, "Hey, you gotta get started early, and if you get started early, you do better. And if you, you get st- seen earl- I just saw somebody, Twitter the other day. Somebody said that, you know, scouting starts now at 10U. This was a woman who runs, uh, a softball development program. And I just... I literally, I, I typed these. I said, "No, that's, that's absolutely bad information." It's... They start using words like development and exposure. The reality is, if you said, "I have an eight-year-old who really likes baseball," the f- number one thing I would tell you is make him do something else besides baseball. My daughter was a full scholarship ice hockey player. Very, very good. Played a year in the Women's Professional League. Had a scholarship when she was 15 years old. I didn't let her play in a summer tournament until she was 13. And people would say all the time, "Can M- can Mikaela play in this tournament? Can she play in that tournament?" I'm like, "Nope." And they're like, "What is she, what's she doing?" I said, "She's gonna go to the lake. She's gonna water ski. She's gonna be on the swim team." She took up diving one summer because they needed a diver, and she became the U12 diver because she... The guy saw her throwing herself off the diving board and said, "Oh, she's fearless. I'll teach her to dive." And I was like, "How many hours will you take her for?" [laughs] And he's like, "Oh, a couple hours a week." I was like, "Awesome But so I, we made her do that. We made her play soccer. She, she did judo. She was state judo champion when she was 12. The kids that are better athletes do better in the long run. You end up with, there's a whole early succeeder phenomenon that we deal with, and early succeeders, generally they won the, uh, the genetic Olympics. They generally tend to be from, uh, from groups that, that develop earlier [laughs] and they will tend to be ahead when they... For us, from in my years, it was the Greeks and the Italian kids. They always mature. They, they were the ones that were shaving in junior high school, and they were much better in junior high at football than the rest of us were because they weighed 190 pounds and we weighed 130 pounds. And you just look at that and think, "That's not going to have any bearing on the end." You have to look, this is the literal marathon versus sprint argument in terms of you've got to look at this and think, "No, this is a, this is a developmental marathon." And the kids who sample tend to do better. Like, your kid loves baseball now, but you don't necessarily know that that will be... My son loved hockey. He's playing college lacrosse. He was playing baseball and lacrosse at the same time, and eventually we realized-
- PAPeter Attia
And, and do you feel this way even if the kid is themselves wanting to play all the time? Would you sort of force the kid?
- MBMike Boyle
I, yeah, I forced my daughter. My daughter was hockey only. She was, "That's all I want to do," and I said, "I don't care if that's-"
- PAPeter Attia
So she was not thrilled about the idea that you weren't letting her play in a summer tournament?
- MBMike Boyle
Yep. Angry at times with me, fights about, "Why can't I do this?" Because she knew she could go and be the best player, and I said, "I don't care if you're the best player when you're 12. I care if you're the best player when you're 18." Uh, and so being the best player at 12, I'm not getting any ego gratification by going to this tournament and realizing that you made the 12-year-old all-stars or something like that. So yeah, we had fights. We had fights about soccer. I made her play her U14 year soccer, and I did. But the specialization thing, I always think up to 12, broadest sampling possible. The more things they can possibly do, the better, the more, because we're, we're trying to develop general athletic attributes. You'll see the kids in hockey that played soccer because they're kids that can pick up pucks in their feet. My son picked up lacrosse really fast 'cause he played baseball and he played hockey, and he understood the whole idea of, oh, we score, there's a net, I can catch things, extended. All that stuff made perfect sense to him when he went to lacrosse, and lacrosse ended up coming together. But if you weren't sampling, you don't know. You just think, I always say, and I, this is a terrible analogy, but I'm gonna use it anyway. I said, "If your son came to you and said, 'I really like cocaine at this point. It's the only thing that I want to do,' you would be like, 'No, we're not gonna do that.'"
- PAPeter Attia
[laughs]
- MBMike Boyle
Right? But suddenly, because you use the-
- PAPeter Attia
You have to do a little heroin.
- MBMike Boyle
Right, exactly.
- PAPeter Attia
You have to do a little meth.
- MBMike Boyle
Yeah, exactly.
- PAPeter Attia
I mean, you have to- [laughs]
- MBMike Boyle
I would like you to drink a few beers. I just don't want you to be... But you know what I mean? If you substitute that for-
- PAPeter Attia
Yeah, just because they want to do it doesn't mean it's right for them
- MBMike Boyle
... Right, if you substitute that for baseball, you think, you know, you s- I, like, I'm, I like absurd analogies, but I think there, you see the absurdity of that and you think, yeah, you love baseball, that's great, but hey, you really should, you know, you should learn to swim, and you really should learn to do some sort of, you know, sport that involves your f- feet. You know, you should play soccer. You should, I think, you know, kids should do s- I think some sort of combative sport is really good for kids because you should learn what it's like. Like, it's really funny. My, took my daughter to... The instructors when my daughter was doing judo were Ronda Rousey and Kayla Harrison, which, like, what are the odds that you go to the best judo school in America that is 15 minutes from your house, and that's who's teaching the classes in judo? So my daughter can still say that, you know, she was taught by Ronda Rousey and Kayla Harrison. But g- having to go out on a mat and fight another kid, I think fight's the word, I guess, right, is really good for a 12-year-old girl, and that feeling, I remember her looking at me the first time like, you know, and I'm like, "Sorry, I can't come out." [laughs] Like, "You're on, you're on your own. You better figure it out." And she did. So I just, you, sampling is the key, and specialist, specialization, if we can think of the worst possible thing you can do for your kid, it is to let them specialize, even if it gets to the point where they think, "Dad, I don't like you. You're mean. You're, you're not a good person because you're not letting me do what I want to do." You've got to look at them and think, "That's why I'm the parent. That's why I'm in charge." Sorry, soapbox, uh, soapbox down. I'll let somebody else talk.
- GLGabrielle Lyon
I will say that our kids are both in gymnastics and jujitsu. My daughter hates jujitsu, and she excels in gymnastics. And we chose gymnastics because it allows for her fine motor skills, all of this development very young, and also the development of her musculature. She's, and again, she loves it, and we know that the healthier, fitter, and more active these kids are, the greater their metabolic health as adults is. But, um, to your point, what we see is I think in the US we see a lot more injuries than in other places because of this always having a season. And, um, from a standpoint of longevity, definitely, again, make our kids do the same thing.
- JCJeff Cavaliere
I don't know why we haven't stopped and questioned it a little bit sooner, because it's not like injury rates are going down. So we're playing more and getting injured more. Like, that's what we've seen, um, a- across all levels of sport. Mike and I were discussing the Achilles tendons and the rash of Achilles tendon injuries, or at least it seems to be in prominent players. Um, but a lot of it has to go back to just the, the, the repetitions and the mileage. And one thing that Mike brought up that I thought was really interesting was the way the style of the game is played now, let's say basketball, there's so much more, because it's really come down, chuck up a three, go down, chuck up a three, come down, chuck... There's a lot, a lot less of that inside game going on. The game is faster, and they run more, and there's a lot more mileage. How many miles extra was it?
- MBMike Boyle
200 more miles a year per team.
- JCJeff Cavaliere
Right, just because of just the way-
- MBMike Boyle
In the last 10 years
- JCJeff Cavaliere
... the style of the game is played. And they're not all linear miles. They're start, stop, start, stop, start, stop. So there's a lot of cumulative stress on the Achilles tendon doing that, that can, you know, again, on top of the fact that the, as, as, as, as teenagers, they're playing all year long too, not like it used to be when Larry Bird was playing, when he played his season, and he probably went home and, and did something completely different, um, I, or just, just shot around a little bit. So the We need to start looking at these extensive seasons and these multiple seasons per year because it's not changing, it's not helping. If it was helping, we wouldn't have all these athletes being injured. Things are worse now than they've ever been.
- PAPeter Attia
Say more
- 1:43:42 – 1:52:45
Advice for preventing an Achilles injury
- PAPeter Attia
about the Achilles. That is the injury I personally fear the most at this point because when you're... You know, I play with my kids a ton, right? So it's usually soccer and baseball that we're playing. Uh, and especially with soccer, I'm always worried, like, is this gonna be the day when despite all of the training I do, despite all the jumping, despite all the multilateral training I'm always doing, I don't know what it is. I think I've just seen so many of them. It's the injury that keeps me up at night, is like I'm just literally diving for a soccer ball and ping.
- JCJeff Cavaliere
It's the beef jerky injury, right? I mean, that's-
- PAPeter Attia
What, what is the protocol?
- JCJeff Cavaliere
The tissue is changing.
- PAPeter Attia
How do you, how do you think about maximizing the odds of survival, um-
- JCJeff Cavaliere
Rolling and stretching, one. I, I'm a huge foam roll and stretch person. I think everybody should be rolling, everybody should be stretching, everybody should be doing calf stretching-
- PAPeter Attia
So specifically-
- JCJeff Cavaliere
Everybody should... Yeah
- PAPeter Attia
... you're talking about the soleus, you're talking about rolling all the way down onto the tendon.
- JCJeff Cavaliere
Yeah, yeah.
- PAPeter Attia
Okay, so you're talking about calf.
- JCJeff Cavaliere
Calf, and then doing, you know, just ankle mobility work, basic ankle rocks. And then now the... It's really interesting 'cause this way you talk about dogma, right? All of a sudden the front foot elevated stuff is becoming popular. And when you think about from a preventative standpoint, it makes perfect sense. We were always told, "You have to have your whole foot on the ground," like that's the correct technique if you're on your toes.
- PAPeter Attia
When you say front foot elevated, do you mean like toe on a plate?
- JCJeff Cavaliere
Yeah, like toe on a plate kind of thing.
- PAPeter Attia
Yeah, yeah, yep, yep.
- JCJeff Cavaliere
But, but initially when I first saw that, I was like, "I don't get it." And then a physical therapist friend of mine, David Gray, was like, "Yeah, well, if you want to get your foot engaged and you want to get your gastroc engaged, it just makes sense to put your foot on there." And that's where some of the stuff... It always goes back to I- when I wrote Functional Training for Sports and they asked me to define it, I said, "Functional training is training that makes sense when you think about things." So that's why when you're talking about flies, like flies don't make any sense to me. I said, "Unless you're a professional face slapper, I don't know why you would do flies." So like we don't do-
- PAPeter Attia
Still probably better on the pec deck.
- JCJeff Cavaliere
[laughs] We don't, we don't do that. Like I look and think, "I don't know why you would do that." Maybe if you were like, you know, if you went to University of Florida, like if there was-
- PAPeter Attia
Yeah
- JCJeff Cavaliere
... there are certain things where you might be required to perform that action, but you have to look at stuff in terms-
- PAPeter Attia
But from a hypertrophy standpoint, there's a lot of reasons to do it, right? I mean, it adds... It... There's a, there's a, a, there's something you must be getting out of that movement, uh-
- JCJeff Cavaliere
Well, it-
- PAPeter Attia
... that you can't get out of just that movement, correct?
- JCJeff Cavaliere
Yeah. Well, I mean, you look at the, uh, the amount of abduction that you're getting. So any press, any dip, any pushup, it's all limited to about this range of motion. But if I can actually open it up even further and get more stretch, we know the benefit hypertrophy-wise of, of applying stretch to a muscle. But that's a, that's an exercise where you are also entertaining end range shoulder mobility, and then again-
- PAPeter Attia
Yeah
- JCJeff Cavaliere
... excess stress on the anterior capsule. So like is it really worth-
- PAPeter Attia
So it's like if you're a bodybuilder, if you're a, if you're a, if you're a wrest- like if you're in certain sports where the aesthetic matters enough-
- JCJeff Cavaliere
Yeah, it could be... Right, it could be the difference between first and second place if you're a competitive bodybuilder. Um, but that's not, that's not my world. And, and I think that at least educating people about what those risks might be, um, is at least an important first step to having a discussion of whether they should do it or not. And again, if I, if I can provide an alternative for them where I think you could get additional benefits without the risk, then, then why do it?
- PAPeter Attia
What, what else do you think is important in the playbook of minimizing the risk of the Achilles injury?
- JCJeff Cavaliere
I, I was... When Mike said mobility, I think a- ankle mobility is something that we don't... No one pays attention to their ankles. We don't, we don't try to mobilize our ankles at all. I think that, um, tight calves are, are, are common in people, and they don't really ever address them. And, and it all starts at the ground. Everything starts at the ground. If you have any compensation, if you lack ankle mobility, um, your knee is gonna pay the price for sure. 'Cause the knee, I always say the knee is like that consequential joint in between the hip and the foot, and it's just reacting to what's happening above and below. And the poor knee, my knees in, in, in particular, like they got beat up and they never really were to blame. Um, all they were trying to do is just hinge back and forth, and they couldn't do a good job because they were being betrayed by flat feet and weak hips. Um, but I think if people pay more attention to strengthening their hips and to mobilizing their ankles, um, you can feed that chain up and down. And if your calf isn't tight or if your mo- your ankle is more mobile, then there's less of that tension being put, placed down through the tendon itself. Um, you're already doing a big, uh, s- taking a step forward in terms of decreasing your risk of actually snapping that thing.
- 1:52:45 – 1:55:35
Shoulder pain: how to keep training the upper body when shoulder pain limits pressing movements
- PAPeter Attia
wrong.
- MBMike Boyle
Right. We need to-
- PAPeter Attia
What's your movement pattern?
- MBMike Boyle
And figure out what, uh, you know, uh, Jeff was alluding to, like, you know, upright rows and rotator cuff. Like, what is it that's making your shoulder sore? What's the movement that's aggravating? And for some people, like, we find that standing, you know, people, it's functional. Standing cable pressing is the one thing that everybody can do that doesn't hurt. So if we have people with shoulder pain, they standing cable press 'cause it's the one thing they can do that doesn't hurt. And I don't care whether people think functional, non-functional. You can label it any way you wanna label it, but I just know I can get you to press pain-free. And my goal, that's my goal all the time. I wanna be able... You can look at me and say, "I can do that, and it doesn't hurt at all." Then I think, "Okay, we can build off that."
- JCJeff Cavaliere
What people don't understand, too, is that it's okay to go through periods of restriction to a single movement like that, right, a standing cable press, to actually allow the shoulder to heal to a point where you actually could get back to doing other variants of the press if that was your desire. Um, I told you a story myself where I had a, a, I have a labrum tear, and I had a, a inability to do any type of pressing. I had to restrict myself simply to a variation of a, of a crossover that, um, wasn't even a pure crossover, but just something that I could do where I could actually pull in a little bit and then cross over my body 'cause that was the only thing I could do pain-free. But I could still work my chest in a way that, m- you know, allowed me to do, to do something. I also knew that I could do something completely different. Like, I could, I could horizontal row. By doing that, I'm getting shoulder movement in a way that was different, right? It's almost like the specialization in sport, right? Not just doing all chest stuff, but trying to actually attack the chest through a different way by still looking at the shoulder joint. And I would do a lot, a lot of rowing, which probably was good just posturally to balance out some of the, the imbalance I had in the shoulder, but also to just give me more joint range of motion in the shoulder 'cause I'm getting all this extension. The combination of those two things got me to a point where my shoulder doesn't, I gotta knock on wood now, but my shoulder doesn't hurt. I can actually be able to go and, and go back to pressing, again, in a smart way, with dumbbells. I don't, I don't barbell bench press, but I do it with dumbbells. And I have none of the pain that I had years ago when that was going on. So it's okay to, to understand that this is a long game, and you might wanna take a step back and s- and stay with the exercises that don't cause pain and allow yourself a chance to be actively mobile to still recover at the same time, um, instead of sitting on the sidelines, like you said, is, which is not a, a, a preferred choice. That's not gonna w- turn out well.
- PAPeter Attia
So I wanna pivot and talk a little bit about, um, strength training women across kind of the transition from perimenopause into menopause. Do you have any experience with that? I'm guessing you do. Uh, but, and Mike, you must just by the fact that-
- MBMike Boyle
Yeah
- PAPeter Attia
... they're coming in, you're do- so w-
- 1:55:35 – 2:03:41
Effective strength training strategies for women before, during, & after the menopausal transition
- PAPeter Attia
Oh, start with you, Gabrielle. What, what are you, what are you noticing is the most important things as women are making the transition from perimenopause straight on into menopause?
- GLGabrielle Lyon
The first thing is to don't, don't wait until they start to feel that their body composition is changing. The fitter they are going into perimenopause and menopause, the better they're gonna be both metabolically and just activities of daily life, everything. Those women seem to suffer much less. When hormones are changing, I think what I end up seeing is that maybe sleep is poor, their tendons... You know, one of the signs of menopause is this frozen shoulder. So if someone is a candidate for HRT, we do certainly believe in that, or, um, menopause, uh, therapy. When it comes to training, in the literature I haven't seen huge evidence or a variation evidence that good training doesn't incl- it's not sex specific. There is not something specific for women that needs to happen rather than following good foundational principles of strength training, hypertrophy, and cardiovascular activity.
- PAPeter Attia
So you don't say, "Hey, now that you're making this transition, we have to m- alter your periodization or change the way... change the amount of time you're spending doing one form of training, say cardio versus resistance, or even the number of reps you would do." We're, we're not changing any of that stuff.
- GLGabrielle Lyon
I don't. Um, one of the things that we do look at, though, is if they are at risk for injury for tendons or joints, 'cause we do see that that changes. But then once we treat them, um, I do not see a reason to change. Good programming is good programming. Progressive stimulus is progressive stimulus.
- MBMike Boyle
No, and it was great 'cause when I read your book, it was very reinforcing for me 'cause where I'm getting that question more and more now from our female clients just because, because of people like you who are talking about it more, people are more comfortable then talking to us about it, and it's exactly that. It's... The whole thing I c- I always come back, it always comes back to strength and conditioning, right? Get stronger, get in better shape, get them to challenge themselves more with weights and not be content. The, the females are very... I always think there's, there's an ego component that's absent in females that is very present in, in males. Like, males will look at... You know, if I looked at what Jeff did, I might think, "Oh, I gotta try that." Females just don't have that. They're just very internally driven, and sometimes that will cause them to underachieve in the weight room because they're not, they're not worried about being top dog. They're not worried about who lifted the most weight. It just isn't... I don't see it.
- PAPeter Attia
Makes them better snipers, you know?
- GLGabrielle Lyon
[laughs]
- MBMike Boyle
I believe it. It makes them better clients. Trust me, if I could, I would do nothing. I have a lot of really elite females, like, that are great hockey players and lacrosse players and stuff, and they are the best people to train by far because they don't have a lot of the, the kind of the extra baggage sometimes that the guys have. They're just way more compliant. They just listen to what you say. They don't argue with you. They don't... Again, they, they don't worry about what Jeff is doing. But just encouraging them to continually get stronger and encouraging them to continue to... And we would look at it as conditioning versus cardiovascular work. That's just kinda how we s- always use the term, but pushing them to, to do more intervals, pushing them to do... I want more aggressive intervals. So, you know-
- GLGabrielle Lyon
Yeah, that's-
- MBMike Boyle
... you would call it a VO2 max workout, but I wanna get that. Like, I love Andy Galpin's idea. Like, Andy Galpin's thing was like, "Hey, you just wanna get your heart rate up really high once a week." I think that's a really good concept, and starting to just get people to think, "Hey, get your heart rate up. Wear a heart rate monitor. Don't be afraid to push your heart rate to, uh, to X," you know, whatever that is, and don't be afraid to be, you know, out of breath or get off the bike and feel like you wanna lay on the floor kind of thing, 'cause we're big assault bike AirDyne people because it's just the m- I think it's the most efficient way to, to hit your cardiovascular system with what I would code no orthopedic cost. Like, I can kill you on the bike and nothing bad is gonna happen. Even like you were saying with the hamstring, I'm gonna bet you can, gonna be able to bike with that hamstring.
- GLGabrielle Lyon
I'm, I'm planning on trying it later today, so, you know. [laughs]
- MBMike Boyle
And then, and then you'll be perfectly fine because you're non, you're non-weight bearing and you're not getting a lot of aggressive hip extension and a lot of aggressive hip flexion, and you can probably torture yourself on there f- for a long time without having any negative effects. But the biggest thing, like I said, with women is just getting them over that, "I'm gonna get big so I don't push myself" kind of thing. And so it's funny, I film a lot of my women and ask them to talk about how much they weigh and how much weight they've haven't gained. So I have s- I have two of the best lacrosse attackers on our US team that are in their mid-20s now, and they've been here for five years and they've gained no weight. They're stronger, they're faster, but females gaining lean mass is really difficult. You have to really be a super responder. And usually I always say apples end up like apples, oranges end up like oranges. It's not like suddenly s- one day the apple's gonna wake up and the, the next day gonna be an orange. Like, you're gonna be... If you're an ectomorph, you're an ectomorph. Y- you will get the occasional really mesomorphic female where you do think, "Oh, wow, she really does respond to weights," but they're rare. They're super rare.
- PAPeter Attia
So Jeff, what about you? What are you seeing in women specifically that you're training, especially during that transition, uh, through menopause?
- JCJeff Cavaliere
I, I think, a- as Gabrielle pointed out, like, the training specifics are, are pretty much the same. What applies and what is good, smart training for, for men is equally, uh, uh, appli- applicable to women. Um, the only thing that I would say from a, a PT standpoint, biomechanically there are some differences in terms of something called the Q angle, right? The, the, the angle of the hip of the femur coming down to the knee. It does create a lot more valgus at the knee for, for women than, than, uh, than it does for, for men. So I think you just have to be aware of those things, so when you're doing certain activities, you wanna be able to coach better in terms of being aware of positioning. So, like, the tendency for a lot of women when they jump is to land in a, in a much more valgus knee state, which could put more and more stress. And even if it's not... Like, we're not fearful of them blowing out in a training session, but as we talked about before, that cumulative stress of every time you land, you're getting more and more stress on the MCL.
- PAPeter Attia
or the ACL, that would be something that you'd wanna coach around and make them aware of because you could strengthen that. You could work on biomechanic- uh, biomechanically improving those things. You know, if you put a band around their knees and have them jump that way and land that way, they're, they're learning how to activate their abductors in their hip. Um, that is probably something that isn't even really a require- uh, w- well, men could benefit from that, but it's not an additional requirement because we're not dealing with the same biomechanical angles. Also, um, because of, of hormones, women will have more laxity of hormones at different times o- a- of the month that will s- be, make them susceptible to different stresses. So y- I think you just have to be aware of the education side of it and, and coaching through that. But as far as the exercises, the programming, um, we also found that, you know, women just tend to be much stronger than men in terms of their, their, their output pound for pound. And, and given the, the differences in, in sex, they're able to proportionally push more weight, especially with their lower body, than men can. So-
- MBMike Boyle
Interesting
- PAPeter Attia
... yeah, very strong. [laughs] Much, much stronger. Have you found that too, Mike? The, the women are, are incredibly strong in terms of their, their, their output and strength comparative to, to men when you account for the difference.
- MBMike Boyle
I haven't really thought about it in terms of pound for pound. The one thing we found is that they're much stronger in their upper body than they think they are. [laughs]
- PAPeter Attia
Well, that too.
- MBMike Boyle
That's the one thing that we've seen is that-
- PAPeter Attia
That too
- MBMike Boyle
... we've got more, we've got women doing weighted chins with s- you know, 45 pounds for five. And-
- PAPeter Attia
What?
- MBMike Boyle
Oh, yeah.
- PAPeter Attia
Wow.
- MBMike Boyle
I've seen a few. Our best one is the 45 for seven is the best I've seen.
- PAPeter Attia
45 pounds wrapped around her waist and she's doing seven chin-ups?
- MBMike Boyle
Yeah. Alex Carpenter, who's one of our-
- PAPeter Attia
I mean, how, how many men can do that?
- MBMike Boyle
Oh, every... In our gym, we, we really emphasize it, like, uh, most of ours.
- 2:03:41 – 2:14:32
Best practices for strength training & athletic development in children, & the pitfalls of early sports specialization
- PAPeter Attia
I wanna come back to something you said at the outset, Mike. You were talking about kids. The youngest you train is 11. You drew a hard line in the sand. How come?
- MBMike Boyle
Uh, I always say I don't wanna be in the childhood-stealing business, and I think there's some people in our industry that are in the childhood-stealing business. I want... I think kids should be kids, and they don't need a strength and conditioning coach when they're seven, eight, nine, 10 years old. They probably need a playground and a bike and a swing set and a slide. There's a lot of things that kids could be doing that are way more fun than being in my gym. So we, we actually drew the line at 12 initially, but the sports brackets are 11, 12. So when we realized that we drew the line at 12, people then started coming and wanted to bring a team, and suddenly it was kind of like, well-
- PAPeter Attia
Half the team. Yeah
- MBMike Boyle
... we'll take Peter, but Jeff can't come 'cause he's 11. [laughs] So eventually we kind of bumped it down, and then we just resisted bumping it down more because I don't wanna run a, a kinder gym kind of program. I don't want people running around. I don't want birthday parties. That's not what I'm looking to do. So we just said 11. I think at 11 you're going into middle school, you can start to understand that there may be some commitment involved in terms of, hey, if I wanna make a team, I'm gonna probably have to learn to work at this thing, and I'm gonna have to learn to train. And it's a very good... If you kind of look at the, um, long-term athletic development models, that 11, 12 is a good learn to train age to get kids in and get them kind of oriented to, hey, here's how you do the exercises. And we're very learn to train oriented at that stage. I tell our coaches all the time, "I don't care if any of these kids get stronger. I could care less. I really care that they're good lifters. If they've been here 10 weeks and by the end I can look at them and think, 'Wow, they can goblet squat and they can sumo deadlift, and they can do a clean, and they can do a chin-up, and they can do a pushup,' then mission accomplished."
- PAPeter Attia
That's amazing. I mean, all of that is, is fantastic, right? And again, it still flies in the face of what many people would think, which is, "Oh my God, an 11-year-old lifting weights? It's gonna stunt their growth, Mike. Aren't you crazy?"
- MBMike Boyle
And that's the b- that's what w- that really... I, I literally wrote that down. It's funny you hit it. That was in my notes in the beginning. But the misconception stuff, we're still dealing with the stunted growth thing, and you'd brought up New York Times. But New York Times did an article where they tried to, to pull the string on that. Where did the stunted growth thing come from? And it actually came from a study. The only study they could find was on Japanese forced child labor, that kids who were forced into child labor tended to be smaller than their age-matched peers. And you think-
- PAPeter Attia
Who were malnourished.
- MBMike Boyle
Right, exactly. [laughs] Malnourished and not working at eight in a factory. And as a result... But that was sort of... But yeah, you still have doctors, people will say, uh, I don't... You know, they talk about growth plate stuff. There's no growth plate damage evidence. There's... None of those things are there. And then you talked about gymnastics, Gabrielle. I always tell people figure skating and gymnastics are 10,000 times more aggressive than anything that we would do in the gym. I look at, and I, I'll get myself in trouble, but I always say organized child abuse, right? I mean, it's not even good for kids when you look at what they're trying to do with these young bodies, because you need, I always think you need little people that rotate, right? I mean, that's the key to those sports. And you look at that, and then you think what we're doing in the gym, okay, hold 10 pounds, squat up and down, and that's gonna be bad for you. But spin around three times and land is okay. That just, that's physics denying, science denying, where you look and think, "No, I can show you the physics of that is way, way worse."
- PAPeter Attia
So, so what are the things, uh, and this is a question for all of you 'cause y'all have kids. So, um, uh, my, my, we haven't pushed our boys into... We haven't pushed any of our kids. Our daughter just decided at some point she wanted to start lifting weights, so that was great. Um, but our boys kind of like to come in the gym with us, um, and we just sort of play goofy games with them. So you're, I know you're friends with Jocko and Leif, and they have this fun little card game that they-
- MBMike Boyle
Mm-hmm
- PAPeter Attia
... play where you, you get... Have you seen this game? So-
- MBMike Boyle
No.
- PAPeter Attia
It's, it's basically-
- MBMike Boyle
Can't
- PAPeter Attia
... like you designate what, you know, what is, uh, what's a spade, what's a heart, what's a-
- MBMike Boyle
Okay
- PAPeter Attia
... diamond, et cetera.
- MBMike Boyle
Like an exercise?
- PAPeter Attia
Like you pick an exercise.
- MBMike Boyle
Mm-hmm.
- PAPeter Attia
Like this is a pushup, this is a burpee, this is a sit-up. And then obviously if you flip it and you get a 10 of that thing, you do 10 of them.
- MBMike Boyle
Gotcha. Yeah, we've done that.
- PAPeter Attia
If you get a seven, you do seven of them and blah, blah, blah. So we'll just... Usually they'll just come in the gym with us and play that game. They really s- they... And this is the problem with boys. They wanna one-up each other. So- You know, once one of them goblet squats this amount of weight, the next guy wants to go to the heavier kettlebell, and the next guy wants to go to the heavy kettlebell. And actually, I do get a little worried 'cause I see their form deteriorate, right? They go into what I call turtle back, right? So they go from lumbar extension, they start getting into lumbar flexion, and then I'm like, "Guys, enough." So, so what, what advice would you have for trying to help little boys who wanna start lifting, um, but, but just, you just want them to develop the form?
- JCJeff Cavaliere
I think it's really funny because w- if you were to ask them to do... to, to jump onto something or to, or to, um, even to do, like, to, to walk upstairs two steps at a time, their form usually is going to look quite good when it's just a naturally occurring activity that they're doing in, in their life. When you then say, "Hey, let's do this as an exercise. Let's do something called a step-up where we step up onto a box, or let's even do a pushup," right? The pushup, if they were to get themselves off the floor, it would probably look a lot prettier than it does when they ask them to do a pushup. Their, their ass is up in the air, their shoulders are wide, they're kinda moving in all different kinds of segments. So to me, it's this disconnect. It's not that they lack the athletic skills or the strength to do what it is you're asking them to do. They lack the awareness of what it is you're asking them to do. So they don't... Like, when it's packaged as an exercise, they're sort of like, "Not really sure what that is." So it's, it's our responsibility to kind of make it seem easy to understand and tell them where they're supposed to be feeling it. You know, the number one question that people ask when they are, are starting out an exercise program, not just kids, anybody. When they do an exercise, surprisingly, 'cause w- this is what we all do and we are so passionate about it, "What am I supposed to work? What am I feeling here? When am I supposed to feel this?" And to me, I'm like, "Well, where do you feel it?" [laughs] You know? But that's... They wanna know 'cause they wanna know where, "Okay, 'cause if I'm not feeling it there, what do I have to do to get it to feel, to feel it there?" Kids need to learn the pr- the, the proper form and biomechanics of how to do the exercise. Again, I think they possess a lot more athletic skill and natural abilities than we give them credit for, and when we just have them start doing exercises, it breaks down. So take the time, do the exercises right. Who cares about the weight that's in their hand first? Start with body weight, and then have them learn the mechanics of that. As I said before with that little drop squat, the drop squat will actually... is, is where they can actually add weight and, and learn better than it could be if they were trying to learn a body weight squat. In this case, that, that actual implement would ins- assist them in learning how to do it properly 'cause it's just gonna take their, their center of mass straight down. So the form is everything when it comes to kids, and when we've worked with kids in, in the 11 and 12-year-old bracket, that's what we try to focus on, is learn the movement, go slow, right? Don't speed through it. Go slow. Speed is something that usually breaks down any good, any attempt at good form. So learn the movements, and then we can always speed them up, and we could always add weight. But if you don't learn the form, you're gonna basically set up a foundation that's gonna ultimately crack, especially if they get away with that for their teen years and now they're in their 20s, and then really now that competition starts to, to kick in and, you know, competing with your buddies, and then things get really ugly.
- PAPeter Attia
And are either of you guys doing sport-specific training for these 12-year-olds? For example, if you got a 12-year-old who's a pitcher versus a 12-year-old who's a basketball player, are you having them do different exercises?
- MBMike Boyle
No. Nothing. I don't... But I think sport-specific training... I always, I always say sport-specific training is bullshit. It's absolutely nonsense. Baseball is sport-specific training. [laughs] Like, if you wanna go get better at baseball, then go play baseball. If you come to the weight room, I mean, I- I've trained guys in every major professional sport, and it's at most 80/20, probably 90/10. Like, 90% of what we do is the same, 10% of what we do is different, and that 10% is totally irrelevant to a 8, 9, 10, 11, 12-year-old. It makes absolutely no difference. It could. It may be baseball.
- PAPeter Attia
That's super... That's really counterintuitive. I would thought that, I mean, God, if you're a pitcher, you've got to be taking more care of the rotator cuff than maybe the guy who's, you know, than, you know, the hockey player, for example. But-
- MBMike Boyle
Right, and that's what... That would be the 10%.
- PAPeter Attia
Yeah.
- MBMike Boyle
Literally, like, the 10% with baseball would be that shoulder care stuff that you might not really worry about with your hockey players or your football players. So there's gonna be... That's where your difference in programming would be, like, that one spot.
- 2:14:32 – 2:19:12
How to foster healthy habits & an interest in fitness beyond playing sports
- MBMike Boyle
their thesis.
- PAPeter Attia
But to me, the more important thing is, like, virtually no kid is going to be a professional athlete, right? So, so i- i- it, you know, my interest is in how do you use the interest in sports, first, to fuel the spark that says lifelong activity is an important pillar of health? Second, how do I make sure that when you are done playing sports, which for most people is the end of high school, then there's a narrow subset that'll say, "Well, actually, it's the end of college," and then there's virtually nobody who's playing sports after that. 'Cause to your point, pickleball with your buddies on Sunday, that ain't sports. So we all stopped playing sports pretty young, and yet we are going to need to train for the rest of our lives. And, um, I think that's the thing that I'm still trying to better understand is how do we use youth sports as a tool to set you up to be an athlete for life where the sport changes to life?
- MBMike Boyle
And I think that's the difference in terms of using it to teach life lessons. Uh, you know, they say sports can build character or it can build characters. Uh, you have to use it, uh, to, to build the kid's character, and sometimes that may be saying, "You're not just gonna get what you want. I, I get it that you just like baseball, but we're gonna play soccer in the spring because we think you need to be exposed to more things." And the kid learns that lesson, like, because sometimes they, they just learn this, uh, kind of microfocus really early on, and then later on when they don't achieve, they think, "Oh, if I... I wish I'd done more things. I wish I'd sampled more. I wish I'd explored more." I think the... It's just, it's looking at the real body of evidence versus looking at the evidence that's presented to you by the person [laughs] who's trying to get your money, which is what usually happens now, sadly.
- JCJeff Cavaliere
The, the, the issue I think, though, is that where we're going off track is that the coaches and the parents of these children are overemphasizing the importance of what it is they're actually competing in, uh, to the point where they, they... Why do you think we have, you said because of money, that we have all these additional leagues throughout the year? But it's also because everyone thinks their kid's gonna be a pro when it's, they're not.
- PAPeter Attia
And they don't want their kid to be left behind.
- JCJeff Cavaliere
That, too, and, and it's, there's all these social pressures behind this, you know? And I think that is what's feeding, that is what's feeding the problems that we see and also taking away from the, the fact that this is intr- introducing lifelong habits to them to the point where it's, it's degenerating something that should be very positive into something that becomes, at worst, destructive because you're, you're, you're over, you're overdoing something and you're actually, a lot of times, also making a lot of these kids hate athletics by the time they're 17, 18, 19.
- PAPeter Attia
Yeah. That, that's another issue, which is I can't tell you the number of people I met who grew up collegiate swimming who cannot stand swimming, and it's such a shame because swimming is... I mean, while it's not good for bone density, it's pretty much good for everything else. So by itself I would say it's not the only exercise you should do, but boy, if I think about if there's one exercise I could insert into everybody's life, it would be some amount of swimming. And, uh, yeah, you, you... Somebody who swam through high school and college, they'll, they're like, "I just, I could never do it again."
- MBMike Boyle
It was my best sport. I went to the first swimming meeting at Springfield College, and the coach, I still remember, Red Silvia, famous Division III coach. The first words out of his mouth were, "The first practice is at," and I was thinking, "He's talking per day here right now." They prac- They're swimming twice a day. They're swimming before school and after school. And I sat politely through the whole meeting like this and nodded and went to the football meeting and tried out for freshman football [laughs] 'cause I was like, "There is no way I'm going in the pool twice a day." It was the end of my swimming career, and I, now I, I have terrible shoulders. I don't even... I can't stand swimming 'cause it hurts.
- GLGabrielle Lyon
You know, I think, uh, when you're talking about becoming a lifelong athlete, that for us, so again, our kids are four and five. They train with us. They might not be doing the same lifts, but we let them play with a, um, you know, kettlebell, pick things up, put them down, and we let them run. We let them do things that they would physically be able to do without a lot of cueing. And as I just think about some of the data on tendon health, we know that the earlier people start, the better and more resilient those tendons are because they're not starting later in life, not getting injured. Um, and I just think, again, it's just a great place to start. The earlier, the better, which is a bit counterintuitive because we've heard all of this information how kids shouldn't lift weights or train, and maybe it's not a standardized training program, but they're in there, they're doing stuff with us, like every day.
Episode duration: 2:31:26
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