A (3:05)

Yeah, I think. Okay, so there's so many different correlations between you understanding physiology from a physician standpoint. And since I've been studying, you know, I'm a neurophysiologist, but I studied. My undergraduate degree was exercise physiology and I was an athlete. We spoke just prior to the podcast. And so I think there is so much to unpack when it comes to exercise. And I want to get into it because right now I'm. I'm actually writing a systematic review. It's taking me so long, but I'm really digging into the weeds of myokines and how they can have an effect on the brain. So exercise is just so multifaceted. I think it's better than medication. And I want to first start with really understanding what the correlation is between longevity and we can, we can unpack certain facets of that.

B (3:58)

Right. So, so basically it's been, you know, known since ancient times. The quote, exercise is good for you, and people have certainly been advocating for it. After World War II, the epidemiologists got into exercise and lifestyle related things because infectious disease had largely been conquered in many, many ways. What happened is the epidemiologists stopped studying infectious disease because vaccination, sanitation, and antibiotics had done a pretty good job and started to study or try to understand chronic diseases, especially cardiovascular disease and cancer. So very early on, they began to notice with famous studies, particularly in London, on bus drivers and bus conductors, sedentary drivers and conductors that were walking up and down the buses. They noticed that the people who had physically active jobs have fewer heart attacks. Later on, people studied the Harvard alumni, people who did a lot of recreational physical activity or worked out, played handball, racquetball, tennis, and so forth, had fewer heart attacks. This collection of studies began to show that people who were physically active in their jobs or exercise trained had much lower risk of cardiovascular disease and probably some cancers. When you total it all up, when you total it all up and look at all the studies that are out there, if people meet the guidelines, which is about 30 minutes a day of moderately vigorous physical activity, which would be brisk walking, they probably add about five years to their life so you increase life expectancy by about five years. If people do a collection of other lifestyle related things. Don't smoke, don't drink too much, watch your body weight, get enough sleep and stay engaged in life, it's probably closer to 8 or 10 years total. So a suite of lifestyle changes. And we hear a lot about the blue zones and different things like that. But really this sort of information was available in some ways by during the middle 1960s or certainly early 1970s.

A (6:03)

Yeah, I think, I think epidemiology has come a long way. Ever since then. I don't, you know, you mentioned current guidelines. What do you think about the current physical activity guidelines? Because I know that they state somewhere around the 10,000 step rule. But I've actually been digging into that research and I've been reading a lot from Daniel Lieberman and he believes that we should be doing way more than 10,000 steps.

B (6:28)

Right. And I think what you have, when you look at those sorts of data, when you look at the big population data, they plot on the X axis something related to physical activity. And then they plot on the Y axis reductions in all cause mortality or increases in life expectancy by year. And at those guideline levels you get about 80% of the total. 70, 80% of the total. You begin to accumulate things with just a few thousand steps a day. So any physical activity is better. Better. But I would tend to agree with Professor Lieberman that probably, you know, two or three X. That those guideline levels are reasonable. That's certainly what I do. Yeah, I try to exercise hard for 30 minutes to an hour almost every day. In fact, when we get done here today, I'm gonna go work out hard.

A (7:15)

I've been thinking about that, the word exercise as an intervention, because evolutionarily, it was never an intervention.

B (7:23)

Well, and that's been the point of Frank Booth, Louisa. Yeah, the normal situation is to be physically active. And one argument is thinking about food production is that all of our food production used to be muscle powered, either through farming, hunting, gathering, whatever it was. And we've replaced in large part occupationally related physical activity via fossil fuel driven mechanical aids. And I don't know if you know who the Amish are, but they're a religious group that practices really old school, non mechanized agriculture. They've really kind of rejected many of the tools of modernity. And if you look at the Amish who are doing old school kind of family farming with horses and plows and things like that, they end up walking about 20,000 steps a day. They're lifting bales of hay, they're doing this, they're doing that. And, and in a large group that were studied about 15, 20 years ago, there were some people that were overweight in terms of bmi, but they were muscular. But there were very few obese people. Very, very few obese people. Minimal.

A (8:30)

I would love to unpack the understanding. You know, we mentioned if you exercise, it obviously reduces or cause mortality by 5 to 10 years. But I want to understand what that is and go really deep on it. Is it better stroke volume, Is it stronger muscles? Like what exactly is happening that the mechanism of action.

B (8:53)

People first started thinking about traditional risk factors. What does it do to your cholesterol? What does it do to your blood pressure? What does it do to the risk of diabetes? And all of those things are reduced. And those would be three of the big traditional risk factors. Right. But when you look at the total effect on those risk factors, they're while significant, they're relatively modest and don't account for, for all of this improved health and longevity. So Danny Green, one of your countrymen, Perth, Western Australia, and I started to look at this more in more detail about 15 years ago and we said, what else could account for these things? Well, a couple of things. One, if people are doing vigorous exercise, their coronary arteries are bigger. So even if there's blockage, it takes a whole lot more to really restrict flow and have an infarct or a heart attack, that's one thing to think about. The second thing is that the blood vessels make more of what's called endothelial derived relaxing factor. So the lining of the blood vessels works a lot better and favors dilation versus constriction and or clot formation. And then the other thing is, is that there's something called vagal tone. We hear about heart rate variability, but anytime your heart rate's a little bit lower and your vagal nerve, which slows your heart rate down and causes the blood vessels in the heart to dilate, anytime you have more vagal tone, that tends to protect you against arrhythmias, tends to protect you against myocardial infarction. So it's probably obviously cholesterol, obviously blood pressure, obviously things like diabetes, but also endothelial function, vagal tone, larger blood vessels, and then of course, the psychological factors. If you're physically fit and have good health habits, individuals like that tend to see themselves as a little bit more in control of their own destiny. And I think that psychologically those people are maybe a little bit better able to deal with the ups and downs of life. And as you know, it's got a profound antidepressant effect as well.

A (10:57)

Oh, 100%. I think that this. When you started speaking about stroke volume and arterial formation, it was just, it's really interesting to me because, you know, I look at Alzheimer's disease patients and mild cognitive impairment, and we can now, we can now suggest that Alzheimer's disease is somewhat a vascular disease.

B (11:21)

Correct.

A (11:22)

And what I think we don't really know too much of, and I'd love for you to explain the difference in arteries, capillaries and veins as it relates to blood flow.

B (11:33)

Right. So, you know, you have these big arteries, you can feel them and palpate them in your neck. You're right here, your brachial area or your wrist. Right. And those are pretty large, but you really have a kind of an arterial so called tree. And they go down and get smaller and smaller and smaller tree. You get to these very tiny capillaries which are just big enough for a single red blood cell to kind of wind its way through. But it turns out that blood flow to different organs is controlled primarily by things a couple of generations upstream from that. What are called arterioles, small branches of the arteries. Right. And they're innervated by nerves. And the thing I mentioned earlier in the field drive relaxing factor acts on them to either constrict or dilate those blood vessels, and they really control blood flow to different organs. And what happens when people exercise is that the factors which control blood flow in those little arterioles, they just operate more efficiently. The vessels themselves are more flexible. The aligning of the vessels is, quote, healthier and favors dilation as opposed to constriction. And in addition to that happening in muscles that are where the exercise is occurring, it also probably happens in the brain and other tissues that are not trained in terms of specifically trained. Like we're not contracting our brain when we exercise. So the point is that these small vessels are in better shape. And what you see happening is that a lot of diseases where there's chronic kidney disease, for example, heart disease and heart failure and Alzheimer's disease, or in some ways brain failure, really require these small blood vessels to work well to deliver the oxygen, take the carbon dioxide away. And Dr. Jill Barnes, who's now at the University of Wisconsin, I was in my lab about 10 years ago, and she's got a very sophisticated program on the. On issues of exercise and cognition. Dr. Barnes showed that in response to CO2, normally blood flow to your Brain goes up, the ability of that blood flow to go up as you age goes down. But in fit older people, it's retained. It's retained. So again, the blood vessels and fit older people look more like the blood vessels in young, healthy people. And that may be one of the reasons that exercise is protective in general, but probably protective against cognitive decline as you age.

A (13:58)

That could probably also be because larger or more capillaries, because we know that even hypertension can kill off the little capillaries as we get older.

B (14:11)

So many chronic diseases, kidney disease, probably brain disease, certainly heart failure, are associated with dysfunction of these very small blood vessels that you mentioned. And exercise is a good way to keep them healthy.

A (14:25)

Yeah, I would love to talk about VO2 max, because we know that VO2 max now is strongly correlated with longevity. But I think it's hard for a lot of people to understand what exactly it is. We can say it's a measure of cardio respiratory fitness. But what exactly is is it? And can you explain how one does a VO2 max test?

B (14:48)

Sure. Well, I think the first thing is let's just step back and say what we want to do is find out whether you have a four cylinder engine, a six cylinder engine, an eight cylinder engine, or a 12 cylinder engine. So let's just think about it that way.

A (15:01)

This is a car analogy.

B (15:03)

A car analogy or an engine analogy. And I think with you as a former elite triathlete, we'll give you a 12 cylinder engine. Okay, so what you do is we breathe air in and we exhale air. The air we breathe in is about 21% oxygen. The air we breathe out, depending on what we're doing, is maybe 17, 18 or even 16% oxygen. So that difference, the difference between the oxygen in and the oxygen out, and we can calculate the volume is our oxygen consumption. So at rest, that's about 3.5 milliliters. So not very much mls per kilogram per minute. So for a 70 kilogram person, that would be about 300, 300 mls, or 250 ML. So about 8 ounces, 8 ounces of oxygen per minute. Now, what happens when we exercise is that goes up because mostly because our muscles start using a lot more oxygen to fuel metabolism. And so we can take people, put them on a treadmill or a bike, slowly, slowly increase the workload, measure how much you're breathing with a mouthpiece or a face mask, and we can measure the amount they're breathing in, the amount they're breathing out, and how much. We go from 21% oxygen to whatever the value is when we come out and we can calculate how much oxygen is being consumed. Now, a young, reasonably healthy person should be able to go from 3.5 mls per kg per minute to maybe 35, 40 or 45 mls per kg per minute. And it will be different depending on how big they are, male, female, that sort of thing. But that's sort of the ballpark normal value. Now with training, most people can increase that 20, 30, 40, even 50%, some even more than that, but and really become much fitter. Now elite athletes, instead of being able to increase their VO2 tenfold above risk and sometimes go 20 or 25. So anyways, you go and measure this, you get on a treadmill or bike, the technician or the scientist doing the test increases the workload, you're breathing and these calculations come out. Then if you're an epidemiologist, you take this data and say, okay, we're going to look at all cause mortality versus VO2 max. Just like we looked at all cause mortality versus, you know, steps, for steps per, per day or physical activity per day. And people that, that can do 10 minutes or more have a much, much lower chance of dying in the next five to 10 years. And even if you can do more than 10 minutes, 11, 12, 13, 14, 15, that risk goes down even more. So basically the question is, do you have, you know, a four cylinder engine, a six cylinder, an eight or a ten? And especially if you get to very low values, you know, 15, 20 MLS per kilogram per minute, it's just not a good thing. And it puts you really at high risk for, for catastrophic health problems in the next five, 10 years.

A (18:06)

But why is there such a steep decline in VO2 max when we reach around 40, 45?

B (18:13)

Well, I think that's really. A couple of things happen. One, people gain weight. Two, is people become less physically active normally. The idea is that people's VO2 max falls about 10% per decade starting at age 30. If people train, they can put that off until about age 40. We see that currently with a number of elite athletes who have been able to train and continue to compete much longer than used to happen more frequently. So we have more aging athletes then with heavy training, people can reduce theoretically that decline in VO2 max about 5% per decade. So there are examples of, there's a tremendous small cohort of former world class cross country skiers in Sweden, men, all men who were Olympic champions, world champions, medalists and so forth, who are in their 80s, who would have had very, very high VO2 max values in their 30s and 20s, but still in their 80s. They have values that are above average for young, healthy people because they remain physically active. And there's example after example of this. So now not everybody can continue to train as hard as they did. Not everybody can remain as lean as they did. But the point is, is that you can really slow the decline in your fitness with aging through regular physical activity and training. And there's two things you need to do. One is you need to do some intense exercise or interval training. And two is you probably want to try to keep your muscle mass up. And those are the two things you want to do to minimize or slow the rate of physiological aging. From a, from an exercise perspective, Peter.

A (19:52)

Attia talks a lot about building your base through zone two training, which then builds the peak which you know is your VO2 max. And I always think about the fact that are people just over training in this, you know, that just, you know, I know a lot of people who every single day they feel as though they need to do their max, you know, max heart rate because then they may not get any effects. But I see people not doing a lot of zone to training and it just doesn't have an effect.

B (20:21)

Yeah, well, I think you gotta, you gotta zoom out and say that for the vast majority of people who are doing very little or nothing, any training is helpful. But I think if you look at the enthusiast, you know, there's always a question about how hard your training should be, how often you should go hard. And I think that there's a couple of things to think about there. One is that once you start getting, you know, maybe five hard efforts every really hard efforts every two weeks in, you probably put yourself at the risk of over training or some injury, depending on what you're doing. And I think the other thing people need to remember is hard, easy. So you need recovery days. And when you say recovery, that doesn't mean don't do anything. But people need to learn how to build in what's called active rest. That used to be the name for it back in the good old days in the 60s and 70s, when, which is essentially something just a little bit more than a warm up. And so you go out, you warm up, you loosen up, you do a jog, you do a short cycle, it's going to be 30 or 45 minutes, not particularly intense, you can talk the whole time. And the goal is to kind of get rid of the soreness from the day before and prepare yourself to Go hard again the next day or the day after. So I think really that's a very, very important thing. And if you talk to coaches, if you talk to experienced people, they'll tell you to make your hard days hard, but make your easy days easy. And again, for every hard day, you should have one or two easy days, but they shouldn't be nothing. It shouldn't be nothing.

A (21:56)

Those hard days are essentially what we have to do to maintain or improve our VO2 max.

B (22:03)

Right. That's what you do. Which is typically accomplished through there some sort of very hard steady state training, but frequently through mostly or primarily interval training. Right.

A (22:14)

Yeah, I'm, I'm working on the 4x4 principle where, you know, just going for sure. Are you doing that as a minimum each week for yourself?

B (22:23)

Oh, what I do, you know, I mean, I've done intervals every possible way you can do them. Right?

A (22:28)

Yeah.

B (22:28)

And, and I, you know, certainly longer intervals are probably better to get your VO2 max as high as it'll go. But I come from an era when people used to run 20 times 400 meters with a 200 meter jog. Right. That used to be sort of a signature workout. And, you know, if you do that the right way and you what we call descend the workout, so the 400s get faster and faster as you go along. In addition to getting in tremendous condition, you have a chance to meet God toward the end. And so what I try to do sometimes when I get on my bike is do one minute easy, two minutes hard. And if you do that for an hour, that's equivalent to that workout earlier in the week. I did a minute easy, four minutes hard, times nine. And I always try to descend the workout. So you start off relatively easy. And each interval gets faster and faster, harder and harder. So I've done this long enough, I don't have to really be formulaic about it, but certainly the 4x4 is a critical way to go. The other thing people need to recognize is once you get to a high level, it just takes a few times a week to do a few hard sessions to keep your max quite high.

A (23:40)

Yeah, I find when I head to the gym, because I live in Manhattan, I run often, but sometimes I just go and do my 4x4 intervals on the step machine because that just raises my heart rate. I get it up to about 190 and it just, it burns well.

B (23:55)

And the thing is, the most important thing is just to do it and bike, you know, treadmill out in the real world, elliptical, stereo, whatever it is. You know, just, just, just accomplish those longer intervals. We did a, we did a, what's called a meta analysis. You were talking about doing a, I think, some type of review that you're currently doing about Myokines, a critical review of the entire data. We looked at this back about 10 years ago at all the interval training studies had ever been done at the time. And it was clearly shown that you want your VO2 max to go up. You need to do the long intervals, typically three to five minutes. The rest can vary from, like you say, four by four to people taking two or three minutes rest. So. Yeah, but longer intervals are the way to go for sure.

A (24:44)

But are those longer intervals because it takes a while for your heart rate to get up to zone five.

B (24:50)

Oh, who. You know, the zone stuff is interesting and is a way to think about these things. But if you think about what happens when your VO2 max goes up, your stroke volume gets bigger, so your heart grows and the ability of your muscle to use the oxygen goes up as well. And so probably what happens is when you, when you're exercising that hard, catecholamines, epinephrine and norepinephrine are operating in your heart, your heart is also being stretched because all of the venous return is coming, stretching the heart out. And those things provide a stimulus for the heart to grow. And I think just empirically people have found that those are, that combination of intensity and duration is what works. If you look at some of the oldest exercise physiology textbooks from the 50s, 60s and 70s, they will point out that longer intervals are a good way to increase people's VO2 max. And they will say, we're not sure why, but the coaches know this. So this is something that the coaches had kind of discovered empirically as they worked with their athletes to get them in as good a shape as possible.

A (25:58)

Yeah. Could you actually explain the role of stroke volume and the role of cardiac remodeling and its effects on long term health and longevity?

B (26:10)

So again, we were talking about oxygen consumption. Oxygen minus oxygen out equals oxygen consumption. Well, there's another way to look at it is you have to deliver that oxygen to the muscle. And that happens through something called cardiac output, which is the liters per minute of blood that your heart can pump, and that's your heart rate times your stroke volume. So normally at rest, cardiac output is, quote, five liters a minute. So people have a heart rate of, say, 60 or 70, and they have a stroke volume of 70 or 80. So 70 or 80 mls per beat. Now, when people start to exercise, that may go up to about 100, and then the heart rate will go close to 200 and their cardiac output may be in the high teens or for example, 20. And again, this will vary depending on body size. Smaller people will be a little bit smaller, bigger people will be a little bit bigger. But if you look at people who've trained, that value can be about maybe 20, 30% higher. And that explains. So they can deliver more oxygen and the muscle can use it. So instead of 200 times 100 for a 20 liter cardiac output, heartbeat of 20, 200, excuse me, stroke volume of 100 mls per beat or 20, literally cardiac output. So if you still have a heart maximum heartbeat of around 200, but now your stroke volume's 125, that means your peak cardiac output is 25 liters per minute, and you will be proportionally fitter in terms of your VO2 max. Now, if you look at elite athletes, they have stroke volumes of 150 to 200among the men and slightly lower among the women. So it's possible for people to have a cardiac output of 30 liters a minute. And I've actually seen values as high as like 35 or 38 in people that are quite fit and reasonably sized. So again, it's that stroke volume that allows you to have a bigger VO2 max. And it's the intense interval training, especially the longer intervals, that seem to make your stroke volume grow the most.

A (28:17)

What do you think we're struggling with in society when it comes to exercise? Like, why do we have this obesity epidemic? Why do we have this diabetes epidemic?

B (28:29)

I like to flip it and just say to people, why? Why isn't everybody obese and why doesn't everybody have diabetes? Because we live in a world over the last several hundred years where work, where physical work has been replaced by by automation and the energy we burn and the oxygen we consume has been replaced by other forms of energy, most notably fossil fuels, starting with the, you know, the industrial revolution. And if you look at the data about how much physical activity is required per day to stop people from gaining weight, if people use about 600 calories a day, which would be the equivalent of walking or running six miles, they're unlikely to have a whole lot of weight gain as they get older, Right? But we've made it possible for people to have very, very little physical activity during the day. Food has become extremely plentiful and cheap, and it's also been almost engineered with combinations of salt, fat and sugar and spices. To really stimulate us to eat a lot of it. So if you look at. Throughout the animal kingdom, if you, you know, you go out on a farm and there are not fat dogs because they're out running around and chasing this and chasing that. But if you look at dogs who live in a house and don't get much exercise and eat a lot, they get bed and. And so that's what's happened. We have a high calorie, low physical activity environment and we're all very good at storing calories. And that was probably at least the, you know, the theory is, is that gave people a survival advantage many, many hundreds and thousands of years ago when, when the food supply or our ability to get enough to eat was maybe up and down a little bit. And there's been this theory of the thrifty gene hypothesis that there were certain groups of people that were able to put on weight quickly when there was a surplus of food around, so they would be ready to go during a periodic famine or inadequate food supply. But it probably turns out all humans have thrifty genes.

A (30:34)

Wow. What do you think about people who say, my genetic makeup, it just doesn't allow me to lose weight?

B (30:40)

Right. Well, I think we. There's some really interesting studies by Professor Nick Christakis at Yale, a really interesting medical sociologist. And Nick looked at some of the gene variants that have been associated with obesity. And he looked at cohorts of people born in different times. And basically the genes associated. The genetic variants associated with obesity only show up as having a major effect in people born after World War II.

A (31:12)

Oh, wow.

B (31:13)

So, yeah. So people that were born earlier, when we had a high physical activity, less food available society, were protected from. Were protected against obesity by the simple facts they were physically active and didn't have too much to eat. Now that's been looked at again through something called the UK Biobank, where about 500,000 people in the United Kingdom have donated blood. So they can have their genes measured. But they've also done extensive questionnaire work to figure out what these people are doing, you know, in the rest of their life. And people who are physically active or who do a lot of active commuting, ride their bike to and from work. Again, the effect of gene variants that are usually worth one or two units of basal metabolic or, excuse me, body mass index, those the effect sizes go way, way down among people who do active transportation. So I think what I would say to people who say, my genes don't let me do this or do that, I would say it's the environment that just makes it very, very challenging to stop from getting big in the first place, but also then to lose weight once people decide to go on a diet or become more active. So again, I'm more surprised that not everybody is large.

A (32:33)

Well, I think that we're completely underestimating the amount of work that we need to be doing each day. Physically forcing ourselves to get into, you know, get on the train, go to the gym. You know, again, I live in Manhattan. Rather than just running to the gym, walk into the gym. I think that we've manufactured this word exercise too much rather than just speaking about what it actually is. And not to mention the. Actually the American guidelines use the word physical activity. But what we now know from the literature is physical activity isn't the same as exercise. They're two different things.

B (33:07)

They're related. They're related, they're related and there's a lot of overlap. But exercise typically, you're right, is some sort of conscious thing to do something either to improve your health or to, you know, get ready for an athletic event if you're typically a younger person, some sort of sports training. And I think that is a great thing to point out. I think structured exercise, where people actually do some program is a great thing. But the question is, what other opportunities do you have to increase your physical activity? Can you park farther away from work? What sort of active transport is available to you? Can you take the stairs instead of the elevator? A few, step a few ways, that sort of thing. Dr. Mike Jensen, who has an office around the corner from mine, one floor up, he and Jim Levine did a great study where they overfed people by about 1,000 calories a day. And they showed that some people gained a lot of weight and some people didn't gain hardly any. And the people who didn't gain hardly any had become more physically active during the day. So when you go up to visit with Mike, there's sort of a long hallway connected to another long hallway. So you don't sit in Mike's office and chat. When you're talking about a grant or a study protocol or whatever, you walk around these hallways and just sort of stroll. And that adds up over the day. If you take a few laps, it's just a few hundred calories here. A few hundred calories there's are really protective against weight gain.

A (34:40)

Yeah, sometimes I think about what's the, you know, how does, how does exercise play a role not in the acute phase, but in the long term phase of inflammation?

B (34:54)

Well, yeah, I think that that gets back to what we talked about earlier about endothelial function and one of those things, one of the things that causes blood vessels to not work well is when they get chronically inflamed. And these are the small blood vessels we talked about that deliver oxygen blood to the heart, the brain, the kidney and other places. So exercise can have a profound anti inflammatory effect, probably in large part because it, it is good for the lining of the blood vessels, as I mentioned early, the vascular endothelium. So I think that that is, that is the sort of thing that people, people need to think about when they think about the anti inflammatory effects of exercise.

A (35:44)

Yeah, it's, there's definitely something to be said in that. Like right now, I don't know if you've experimented with any recovery tools, but I've been using a cold plunge each day, an ice bath and it's actually, you know, it's doing wonders for me in many.

B (36:01)

Right. You know, and I've tried things in the past, but basically I just try to get up, get my workout in and then get on with the rest of my day. But you know, the thing is, it's changed too because what I would be doing if I were actively training, trying to compete, do this, do that, it would be different than what I do now where, you know, get up early, get the workout in and get on with the rest of your life. Now this afternoon I have a bit of a break and I just did a tiny bit this morning. So I'm going to go at it hard and do a nice circuit. A bit of circuit training.

A (36:34)

Yeah.

B (36:36)

Before the weekend starts. So that'll give me something to look forward to here in a few minutes.

A (36:40)

I'd love to get your opinion on doping when it comes to elite sport. And I don't know if you've been watching the tennis updates between Serena Williams and Simona Halep and I don't know if you really looked into what actually happened there. I'm kind of on, you know, Simona's bandwagon.

B (36:59)

You know, I, I try not to comment on any specific person in any specific situation because A, you typically don't have all the information and B, you know, sometimes I get pinged by various organizations about X, Y and Z. So I would just say this about doping. One is, is the. With, with so much money, prestige and other things involved, the temptation to dope is extremely high. And that's been going on for a long, long time. Back when I was younger, you know, it was our system is better than your system because, you know, in the Cold War there was state sponsored doping going on as the Eastern Europeans and others wanted to show that the communist system was a superior way to go. That doesn't mean there weren't people in the free world doping, but it just was one of those things. And so what's happened is that what you saw in the 60s and 70s, and we even saw again during the world track championships a couple of weeks ago, there's a tremendous amount of world records, especially on the women's side, that are still held by people from the state sponsored doping era, late 70s, early 80s, when really anything goes. And there are also some other records that have hung around for a while. And again, you have three things that have been used in doping. One is anabolic steroids and growth hormone, which make you add muscle. Two is stimulants like amphetamines, and three is erythropoietin or drugs that increase your ability to carry oxygen. It turns out testing people for amphetamines is pretty straightforward and that's been solved, more or less. So there aren't a lot of people using stimulants anymore because it's easy to test. And doping control has gotten a lot better. The testing has gotten a lot better. And I think what you can say is that industrial strength high dose doping is done. But are people micro dosing? Are people, is there a cat and mouse game going on with the regulators so that people try just to get a little, little here, a little there? Yes, I think that's still going on. And people are also looking for novel compounds that can't be, can't be detected by current anti doping technology. So what I would say is that the era of industrial strength doping is over. There's probably some micro dosing going on, the way that the samples are retained so that when new tests come on board, people can be tested, the drugs can be tested. You know, five, ten years down the road to do look back testing that's improved. And so you see people that are getting kicked out six years later because they find a new drug or a new compound. So I think the doping control landscape is vastly improved over the last 20 years. But I think, you know, human nature hasn't changed and people will try to find ways to circumvent the rules. Not everybody, but at least a few people.

A (39:56)

Yeah, I often find it such a controversial topic that I actually don't. You just can never understand what happens behind closed doors or understand somebody's psychology or what really happened.

B (40:07)

But, you know, once people begin. Once people begin to believe real or imagine that somebody else is doping and they've made this huge commitment to train, to try to be the best, you get into this situation, we said, where you get into this almost no unilateral disarmament mentality that everybody's doing it, so I might as well do it. And you hear a little bit about that, as with Lance Armstrong's justifications and rationalizations. So it becomes sort of a slippery slope. What's normal and you have what's acceptable in the real world, but what happens in a subculture. And there are some. Some forms of sports, like, you know, hardcore bodybuilding, where it's just sort of accepted as, as part of the. As part of the, you know, part of the. Part of the whole scene.

A (40:57)

Yeah. Okay. So, Mike, as we're moving towards the end, I'd love to understand some of your practical tips for the average person to get started, or not even get started, but work their way towards improving both zone 2 and VO2 max for longevity purposes.

B (41:12)

Well, I think the main thing is, is a couple things. One is find something you like to do. Find a time that works for you. I usually go early in the morning because, again, the day can catch up with you, but that's not for everybody. And I think the main thing is consistency, consistency, consistency. Hard, easy. And what I like to tell people is to be a maximalist, you first must be a minimalist. So I think what everyone needs to do is to ask themselves, what can they stop doing? You know, we are just drowning in a sea of choices, in a sea of distractions, and in a sea of just other things we can do? And so how can we stay focused on a few fundamentals which are essential to health? And if we can declutter our world and reduce our distractions, I think everybody will be a lot happier, be able to achieve these goals and then bear the fruits of the goals in terms of the other things that they do in life.

A (42:17)

I couldn't agree more. Mike. Thank you so much for your time and thank you for coming on the Neuro Experience podcast.

B (42:24)

Yep. And I look forward to. I look forward to your review article.

A (42:27)

Thank you so much.

B (42:29)

Yep. Nice to visit.