#335 ‒ The science of resistance training, building muscle, and anabolic steroid use in bodybuilding | Mike Israetel, Ph.D.

Summary

Podcast Summary: The Peter Attia Drive – Episode #335: The Science of Resistance Training, Building Muscle, and Anabolic Steroid Use in Bodybuilding with Mike Israetel, Ph.D.

In Episode #335 of The Peter Attia Drive, Dr. Peter Attia engages in an in-depth conversation with Dr. Mike Israetel, a renowned Sports Physiologist, competitive bodybuilder, and co-founder of Renaissance Periodization. The episode delves into the intricacies of resistance training, muscle hypertrophy, and the controversial use of anabolic steroids in the bodybuilding community.

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1. Guest Introduction and Background

Dr. Peter Attia opens the episode by introducing Dr. Mike Israetel, highlighting his extensive background in sports physiology, competitive bodybuilding, and academia. Israetel's multifaceted career includes serving as a professor at Temple University and managing a popular YouTube channel dedicated to debunking fitness myths.

Peter Attia [00:11]: "My guest this week is Dr. Mike Israetel. Mike holds a PhD in Sports Physiology and is currently the Head Science Consultant for Renaissance Periodization."

2. Dr. Mike Israetel’s Personal Journey

Israetel shares his evolution from a high school wrestler to a powerlifter and eventually an academic specializing in exercise science. His transition from undergrad studies at the University of Michigan to advanced degrees underscores his commitment to understanding the science behind strength and conditioning.

Mike Israetel [05:55]: "I learned anatomy and physiology very well, but much more general curriculum... I started the Michigan Powerlifting Club."

3. Fundamentals of Resistance Training

The discussion transitions to the core principles of resistance training—exercise selection, volume, intensity, and frequency. Israetel emphasizes the importance of compound movements that engage multiple muscle groups, advocating for efficiency in training routines.

Mike Israetel [53:25]: "Compound movements... are insanely time efficient because you do a few exercises and you're like, holy crap, that's all of my upper body."

4. Debunking the Myth of Accidental Muscle Growth

Peter and Mike tackle the common misconception that strength training can inadvertently lead to excessive muscularity. Israetel clarifies that significant muscle gain typically requires dedicated effort and a structured approach, making accidental hypertrophy highly unlikely.

Mike Israetel [17:09]: "It's just insanely unrealistic in most cases to wander into that sort of thing."

5. Designing Effective Training Programs

Israetel provides practical guidance for individuals new to the gym or those looking to optimize their training. He recommends whole-body workouts over split routines for most people, incorporating compound exercises like squats, deadlifts, and bench presses to maximize muscle engagement within limited timeframes.

Mike Israetel [49:58]: "Choose lifts, to choose exercises that involve large muscle masses... compound movements like pull-ups, bench presses, squats, deadlifts."

6. Anabolic Steroid Use in Bodybuilding

A significant portion of the conversation delves into the use of anabolic steroids in the bodybuilding community. Israetel openly discusses his personal experiences with steroids, outlining their impact on muscle growth, mental health, and long-term health risks. He distinguishes between therapeutic testosterone replacement therapy (TRT) and supraphysiologic steroid use aimed at maximizing muscle mass.

Mike Israetel [33:58]: "I employ anabolic steroids, Growth hormones... It was really worth pointing out here that Mike is one of the most candid individuals..."

7. Health Implications and Risks of Steroid Use

Israetel elaborates on the physiological and psychological effects of steroids, including increased muscle mass, changes in mood, and potential cardiovascular impacts. He candidly shares his own health metrics and the measures he takes to mitigate adverse effects, such as managing blood pressure and lipid profiles.

Mike Israetel [99:31]: "It's designed not really to convert into estrogen, hardly at all... if you have a lot of estrogen, it's just never getting up to velocities that are really crazy."

8. Training Volume and the Risk of Overtraining

The conversation examines optimal training volumes to prevent overtraining while maximizing hypertrophic gains. Israetel discusses the balance between intensity and recovery, advising listeners to monitor signs of excessive fatigue and adjust their training volumes accordingly.

Mike Israetel [81:26]: "Between 10 and 20 sets per week is fine, but for many people, you have to use a second qualifier."

9. Nutrition’s Role in Muscle Growth

Nutrition emerges as a critical factor in achieving muscle hypertrophy. Israetel stresses the importance of consistent protein intake, suggesting approximately one gram of protein per pound of body weight daily. He highlights the challenges of maintaining dietary consistency amidst busy lifestyles and advocates for practical solutions like protein supplements.

Mike Israetel [91:21]: "Get in enough protein if you want to be real serious about optimizing your muscle gains. Something like a gram per pound of protein per day."

10. The Use of GLP-1 Agonists in Bodybuilding

The episode touches upon the emerging trend of using GLP-1 agonists, such as Ozempic, in the bodybuilding community. Israetel discusses the benefits of these drugs in managing appetite and facilitating fat loss, while also addressing the moral panic surrounding their use among non-professional athletes.

Mike Israetel [155:59]: "Most of the people that are morally panicking will tell you why... they're just having a lot of feelings."

11. Ethical and Moral Considerations

Addressing the ethical debates, Israetel explains the differing perspectives within the fitness community regarding the use of performance-enhancing drugs versus pharmacological aids like GLP-1 agonists. He argues for a nuanced understanding, recognizing that enhancing physical capabilities can complement, rather than detract from, personal discipline and effort.

Mike Israetel [156:58]: "Some people use enhancement in so many different ways. Why not use enhancement in this other way?"

12. Future of Fitness and Longevity

In the closing segments, both Peter and Mike speculate on the future intersections of technology, AI, and human physiology. Israetel expresses optimism about advancements in biotechnology potentially overcoming the limits imposed by genetics and aging, while Pierre Attia remains cautious, emphasizing the unpredictability of such breakthroughs.

Mike Israetel [166:20]: "I believe major categories of disease will be completely solved in the 2030s... If I die before then, I'm totally comfortable with all of the choices that I've ever made."

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Notable Quotes with Timestamps

• Mike Israetel [17:09]: "It's just insanely unrealistic in most cases to wander into that sort of thing."
• Peter Attia [53:25]: "These are the kind of movements we're going to be leaning into the most."
• Mike Israetel [81:26]: "Between 10 and 20 sets per week is fine, but for many people, you have to use a second qualifier."
• Mike Israetel [91:21]: "Get in enough protein if you want to be real serious about optimizing your muscle gains."

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Conclusion

This episode of The Peter Attia Drive offers a comprehensive exploration of resistance training and the complex role of anabolic steroids in bodybuilding. Dr. Mike Israetel provides both scientific insights and personal anecdotes, shedding light on effective training methodologies while transparently discussing the benefits and risks associated with performance-enhancing drugs. The discussion underscores the importance of a balanced approach to training, nutrition, and supplementation, tailored to individual goals and physiological responses.

For those interested in delving deeper into the topics discussed, additional resources and visual demonstrations are available through Renaissance Periodization’s platforms.

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Disclaimer: This summary is intended for informational purposes only and does not constitute medical advice. Consult with a healthcare professional before making any changes to your fitness or health regimen.

Transcript

[Peter Attia]

Hey everyone. Welcome to the Drive Podcast. I'm your host Peter Attia. This podcast, my website and my weekly newsletter all focus on the goal of translating the science of longevity into something accessible for everyone. Our goal is to provide the best content in health and wellness and we've established a great team of analysts to make this happen. It is extremely important important to me to provide all of this content without relying on paid ads to do this. Our work is made entirely possible by our members and in return we offer exclusive member only content and benefits above and beyond what is available for free. If you want to take your knowledge of this space to the next level, it's our goal to ensure members get back much more than the price of a subscription. If you want to learn more about the benefits of our premium membership, head over to peterattiamd.com subscribe My guest this week is Dr. Mike Istratel. Mike holds a PhD in Sports Physiology and is currently the Head Science Consultant for Renaissance Periodization. He's a competitive bodybuilder and was formerly a professor of Exercise and Sports Science at the School of Public Health at Temple University in Philadelphia. As a co founder of Renaissance Periodization, Mike has coached numerous athletes and busy professionals in both diet and weight training. Mike also has a very popular YouTube channel where he loves to do debunking videos that are both informative and endlessly amusing. In today's conversation, Mike shares his personal journey from his early experiences in powerlifting and bodybuilding to his academic training in exercise science. We discuss the core principles of resistance training, including exercise selection, volume, intensity and frequency. Mike debunks the common fear that strength training will make people overly muscular without intention. He explains why this belief is unfounded and highlights the dedication required to build significant muscle mass. We outline what a resistance training routine could look like for someone new to the gym or transitioning from sports. For more experienced lifters, we explore how to optimize resistance training for muscle growth. Mike shares his personal experience with anabolic steroids, outlining their impact on muscle growth, mental health and performance. He discusses the pros and cons, including the significant physical changes and potential long term health risks. It's really worth pointing out here that Mike is one of the most candid individuals I've ever met when it comes to discussing his use of anabolic steroids, growth hormones and things of that nature. What is remarkable to me, and you can see this in the podcast, is just how jaw dropping the numbers are in terms of usage when you're talking to an individual like me who's prescribed testosterone for many patients under physiologic circumstances. It was impossible to fathom just the types of doses that bodybuilders are using. We discuss the role of genetics in muscle growth and strength, as well as the influence of age and other lifestyle factors. This conversation offers insights into the science of resistance training and practical advice for anyone looking to build muscle, while also exploring the experience of someone who has been in the bodybuilding world. So without further delay, please enjoy my conversation with Mike Istratel. Mike, thank you very much for making the trip to Austin.

[Mike Istratel]

Thank you so much for having me.

[Peter Attia]

I saw something on social media. You were here a week ago. Have you been here the whole time or. Yes.

[Mike Istratel]

Week and a half. Long social media collaborative trip.

[Peter Attia]

You Weren't here for F1?

[Mike Istratel]

No. Loud noises scare me. So I would stay away from that sort of thing. I'm kidding. It sounds awesome. I've never actually been to a formula race in real life. And my videographer and business partner on YouTube, huge Formula One fan. He has the app and everything. Live streams, all the races and stuff. Are you big into that sort of thing?

[Peter Attia]

I not only have the app, I'm the premium subscriber, so I can listen to all the chatter of every moment between every car and their mechanic. And yes, of course.

[Mike Istratel]

That's really cool. Yeah, I make a lot of race car analogies when it comes to athletics and stuff. So if I make them here, you can correct me and say I'm using them wrong.

[Peter Attia]

Well, Mike, there's going to be some folks listening and watching us who are probably very familiar with your work, and they've probably come to learn about you, as I have through just endless years of being both amused and educated by your content on YouTube. But there's probably a group of people here just in my audience that aren't overlapping with yours, so I want to give folks a chance to kind of get to know you. I will have introduced you already in the introduction, but let's talk just a little bit about your background. Remind me, you came to the US From Russia when you're eight?

[Mike Istratel]

Seven.

[Peter Attia]

Seven. Okay. Where'd you grow up?

[Mike Istratel]

Moscow, Russia, before that. And I do have memories of it and all that stuff. And then the metropolitan Detroit area after that, all the way until college. So a place called Oak Park, Michigan, which you can find on a map. And that's about it.

[Peter Attia]

What'd you study in undergrad?

[Mike Istratel]

Movement science. Kinesiology at the University of Michigan.

[Peter Attia]

What sports were you playing then? Were you into grappling?

[Mike Istratel]

At the time, I had wrestled in high school, and then I just wasn't very good at it. And I just absolutely was not dedicated to it for a few reasons which are sort of boring. But I got into lifting hardcore towards the middle and end of high school. And then by the time I was in college, I was gearing up to start competing in powerlifting. And so I actually started the Michigan Powerlifting Club. We started kind of a team and we went to meets and all that stuff. So I was a competitive powerlifter in my undergraduate years.

[Peter Attia]

And just for folks who might be confused about all the different disciplines, powerlifting is the sport where there are three and only three lifts. There's a deadlift, a bench press, a squat, and you win by having the highest total weights across the three, I believe.

[Mike Istratel]

Correct? Yes. I'll add it up. So squat plus bench plus deadlift equals total. And the person with the biggest total for their weight class, absolute or by formula, wins the whole thing.

[Peter Attia]

So you were not at that point into bodybuilding or anything yet?

[Mike Istratel]

No.

[Peter Attia]

Got it.

[Mike Istratel]

No.

[Peter Attia]

And then you went off and did your PhD right away after undergrad.

[Mike Istratel]

Got it. A master's in the exercise science field. Going straight from undergraduate to a PhD is very rare. Usually you need a lot more preparatory work because the undergraduate curriculum typically just doesn't teach you a whole lot of applied, super specialized exercise science. I learned anatomy and physiology very well, but much more general curriculum, especially at an R1 school like Michigan, they didn't super hyper specialize. I learned almost nothing about sports whatsoever. I must have had like two bullet points of how to resistance train in any one of my classes in Michigan. Michigan. Oh, absolutely, yeah. Resistance training wasn't even the big focus. There was chronic disease management, health, stuff like that, clinical application. And so right after that, I went to get my master's degree at Appalachian State University under Dr. Travis Triplett and Dr. Jeff McBride. And that was a swell time. That was a subspecialty of exercise science. It was actually strength and conditioning. So much closer to what I was super passionate about. And then I did one year as a personal trainer. It's like jail. I did a year upstate, so a year in Manhattan with my colleague Mr. Nick Shaw, who's now the co founder and CEO of our company RP. And we got a chance to train folks at a private personal training studio in Manhattan, you know, like CTOs of major companies. Really crazy stuff. Like, I had never met like a truly, truly rich person up until I met someone who was worth like 50 million and I was like, oh my God. Turns out there's just really nice, cool people that are really chill and have the same problems everyone else does, trying to get in shape. So did that for a year, realized I didn't know enough, and then was enrolled into the PhD program at East Tennessee State University under Dr. Mike Stone. And that was in sport physiology, which Dr. Stone described as the science of taking good athletes and making them better. And that was really, really amazing time. I probably learned more in that three years than I had in, I don't know, outside of learning how to read and how to do math, probably more than I ever learned at school ever. Totally immersive. Got to work with teams, got to work with athletes. Strength and conditioning coach. Truly sports science work. We integrate all of the variables. Sport coaching, strength and conditioning, sports medicine, nutrition, the whole gamut. Incredible experience. Got a PhD there and then taught at the University of Central Missouri for a while, taught at Temple University in Philadelphia for a while, and then went full depth into private industry. Because we had founded RP, our company. During the time that I was in PhD program. And sometime during the Temple years, it became apparent that I was much more productive not teaching than I was teaching because there was so much to do with the company. Took some time away from teaching, came back to teach under my friend Dr. Brad Schoenfeld, who's kind of the world's expert scientifically in muscle hypertrophy. I taught at his master's program for a while and then I left that recently to just do private industry full time.

[Peter Attia]

And when did you start putting out these videos on YouTube? That I probably only discovered a couple of years ago, but I think you've been doing this much longer, right?

[Mike Istratel]

So YouTube. I haven't doing too long. 2020 is when we started. Okay, Peak Covid. Sorry if I get your podcast canceled by mentioning that term. Honestly, when we record YouTube videos at our at home studio, which is where most of them happen, if I drop the C word. Scott, the video guys like different. Take we one take almost everything and that we roll back the algorithm will flag. Put a Covid morning and have to cut this out. Unlikely. Well, it's just a medical podcast. If you can't talk about COVID I have no idea where we are anymore.

[Peter Attia]

Okay. I wish I knew more about how the algorithm worked. I clearly don't.

[Mike Istratel]

The ever mysterious algorithm and then just.

[Peter Attia]

Kind of going back to your personal evolution as you're going through this journey of Master's PhD Industry, are you still focusing on powerlifting?

[Mike Istratel]

Personally, so I was focusing on powerlifting up until I got into my master's program. And actually towards the end of undergrad, I did this thing where like I was in a grocery store and I picked up a magazine. It was a muscle magazine. It was the Flex magazine issue that had summarized the prior 2002 Mr. Olympia contest with all the pictures of the body holders. Ronnie won again, though. He.

[Peter Attia]

That was his fourth.

[Mike Istratel]

Yeah, fifth or something like that. And he didn't look his best. Not enough people showed up to really take him down. Everyone had suspected Jay Cutler could have beat him if he showed up that year. Jay Cutler almost beat Ronnie in 2001.

[Peter Attia]

That's right.

[Mike Istratel]

He sat out 2002. And so I just remember reading the magazine and looking at the pictures. Also, real quick, how adult does the humor on here go? Or are we trying to keep it semi professional?

[Peter Attia]

I'm going to defer to you.

[Mike Istratel]

That's a bad idea, Peter. Okay, so I'll just keep it semi pro. It was enlightening because I realized that I had an eye for aesthetics. And by an eye for aesthetics, it doesn't mean I knew anything about what looks good or what looks not great on a human body. But I did have a very distinct aesthetic preference. Some people will see muscular physiques and they kind of all look the same, like giant, veiny, overcooked hot dogs, which is not wrong. I looked at the physiques and I was really taken aback, especially by some of them. What probably normal people get when they look at very good art that, whoa, I'm looking at something very special. I'm looking at something that's emotive. And I started to pursue my own hypertrophy training, muscle group training.

[Peter Attia]

What were you looking like at the time?

[Mike Istratel]

I was roughly £190 at 5 foot 6, fairly lean, but not anything crazy, and so muscular. But you know, if I had some clothes on, people would be like, oh, it's just a short person, but shirtless. I looked like clearly I had lifted weights for some time. I really also realized that while there's a huge passion for me in lifting heavy, I also had a passion for getting pumps and doing higher reps and doing lots of volume and seeing my body change visually. That was a huge trip. Then it basically became this thing where I'm like, oh, I am an artist in muscle growth and fat loss. My canvas is my own body and I want to learn how to sculpt very well. Most selfishly, just so I could occupy a superhero looking body. I ended up looking More like a villain, but whatever. Balding will do. That list of bald superheroes includes bald supervillains. All of them. Maybe a huge fraction in any case, but it was just a real personal journey for me at first and still is to a huge extent.

[Peter Attia]

And just by comparison, what do you weigh right now?

[Mike Istratel]

£235. Substantially lean.

[Peter Attia]

We'll talk a lot about bodybuilding and cycles. And are you in a cycle now? And if so, are you on the way up or on the way down in terms of mass, I'm kind of.

[Mike Istratel]

At the top of where I'll be for a little bit. Maybe up, but just very slowly. So this is roughly the fattest I'll get.

[Peter Attia]

I didn't want to say anything, Mike, but, yeah, you're looking a little chubby too. Looking pretty fat.

[Mike Istratel]

Yeah. I'll cry about it later.

[Peter Attia]

I normally don't let people of your chubbiness in the studio, but yes, and.

[Mike Istratel]

You can't let us out without letting us know, like, hey, you're fat, by the way. Just want to let you know, no big deal. I mean, it's kind of a big deal. It's a really big deal. You should.

[Peter Attia]

And your body fat right now, if you had to guess, would be what, 8%, maybe 9ish.

[Mike Istratel]

I still have some striations in my glutes. I have, like, one of the least aesthetic physiques imaginable. But thank you, genetics for that one. And I did some things earlier in my career. I gained a ton of weight. It was muscle and fat. Stretched my skin out, gave me massive love handles. When you lose that weight, the skin still sticking around. So I'm actually planning on some extensive cosmetic surgery in about a few months here to address that issue finally. So, yeah, I've gained a lot of muscle over the years. For me, the whole journey fundamentally is a personal journey of wanting to occupy a body. That is two things. One, that I aesthetically enjoy being in, and two, one that I had a large hand in creating or curating. And the curation is almost as fun as the creation. Like, you see an artist draw something on a canvas, and a huge amount of joy comes from creating the main arc of everything you're doing. The main shapes, main lines, main coloring. But, you know, when artists have something almost complete and they do little pencil and pencil, there's. Once you have something that looks amazing and you're optimizing, oh, there's something super beautiful about that. It's like watching someone take a very finely tuned F1 car and just wrench A couple of the screws in and polish it off. It's just, oh, this is so beautiful. Not that my body's attractive. It's not grotesque, but less grotesque is what I'm aiming for. And I don't know if it's working or not. My hairiness kind of precludes any of that.

[Peter Attia]

Well, whenever I think of an artist mucking around with a canvas, of course I only think of Bob Ross because I don't have much experience watching an artist create something. You know, usually I'm seeing the finished product. But I still, like most people who grew up in the 70s and the 80s, recall watching Bob Ross on Saturday mornings with great fondness. He makes it look so easy.

[Mike Istratel]

Oh, my God. He not only makes it look so easy, he's communicating an empowerment about creating art.

[Peter Attia]

Yes. Like, everybody could be doing this. He's like, you're doing this with me right now, right?

[Mike Istratel]

And you're like, oh, I sure am. And he's like, you see this cloud in the way we're making it a tree, and you try it at home, and you're like, I just messed up everything. This looks terrible. If I had to describe my physique and my genetics, it would be like a lot of Bob Ross style having to fix things are like, oh, that looks terrible. Let's pretend I was drawing something else.

[Peter Attia]

All right, So I want to try to bring this up to the present. So right now you compete in bodybuilding. You obviously provide a lot of education to folks. So I think my audience is clearly interested in exercise, clearly interested in strength training, clearly interested in the aesthetics of strength training. Because, again, I think it's very easy to look at bodybuilders and say, gosh, that's a little odd.

[Mike Istratel]

It's a lot.

[Peter Attia]

But what is obvious, if not self evident, is that's just a spectrum. Anybody who wants to have more muscle and less fat probably has something they can learn from a bodybuilder. I often say to my patients, if you really want to understand how to manipulate nutrition to be lean, you probably need to understand what bodybuilders are doing. There's probably no athlete, there's no person out there that truly understands how to manipulate exercise and nutrition in the context of body composition. And that's true even in the presence of anabolic steroids. Anabolic steroids don't preclude that. They might make that a little easier, which I think we should talk about. So maybe we just start with where you see the value of strength training. Do you think that there is a diminishing return at some point? Do you think that there is a diminishing return in the amount of muscle? I've said very tongue in cheek that the list of 90 year olds out there complaining, wishing they were not as strong and not as muscular is a very short list.

[Mike Istratel]

Very short list, right.

[Peter Attia]

But again, why am I saying that? I'm saying that to say that most people at the end of life are saying the exact opposite. I wish I was stronger, I wish I had more muscle. But from a practical standpoint, Mike, what is your view on muscularity and strength at the expense of what it might take to achieve them? Are there extremes that people should be mindful of?

[Mike Istratel]

If you have to be mindful of extremes, in almost every case you have already been on a multi years long, very immersive, very infatuated, very disciplined journey of resistance training and focused nutrition and the organization of many variables and parts of your life around that task. It's unlikely to be something you pick up a lifting hobby and just find yourself excessively muscular. Oops. So that's probably my best answer for that. It's just insanely unrealistic in most cases to wander into that sort of thing.

[Peter Attia]

The myth of accidental muscle yes, people.

[Mike Istratel]

Say more money, more problems. First of all, I met various philosophical grounds. I think that's absurd. But you don't accidentally become ultra wealthy and by God I wish you the best. If that happens to you, I'll cry a tear for you. But in much the same way, almost nobody accidentally becomes hypermuscular to the extent that they're on that side of the spectrum. That trade offs are starting to become apparent. Probably the biggest trade off in the short to medium term is opportunity cost. Things you could have spent doing outside of being in the gym. But the way the science of resistance training works is for almost all of the health benefits and the longevity benefits and the quality of life benefits. The amount of time you need to be training per week is measured in the one to three hour range. With three being like you're really full sending it one to three hours per week. If you went on chat GPT and did like a time use question being like, can you list all of the things the typical American does for X number hours a week? Read down the list, top 100 time use cases, you may find that one to three hours a week is somewhere in like the 50 or 60 rank. And there's so many things people do that are way more than that. Social media consumption, television watching and the list goes on. There are Dozens of things you do that take way more time. And so if you really fully invest yourself, like I'm relatively fully invested into getting as jacked as possible, it's going to take some time. It could take eight hours a week, which is still like, well, that's not forever. People will jog for 40 minutes every morning, think nothing of it. And then when you present to them the idea of resistance training, like, wow, now that's going to take some time. They're like, well, yes, actually does not take nearly as much time. Is the intensity of the effort so grotesquely high and the recovery demands are so high that you have to be very pulsatile with it. It's not even something you have to do every day. As a matter of fact, people get incredible benefits. Probably the biggest return on investment the average person can make is to train for roughly half an hour two times a week, Monday and Thursday. If you do it properly, it can comport an unbelievable amount of benefits just across the board. And so for most people, the consideration that they can begin to do this excessively is just not something realistic until and unless they're really into it, like a huge hobby. If you are watching Formula One for 30 minutes a day, every other day on your phone, realistic considerations of this is taking up too much of your time, kind of out the window. Now if you start canceling podcast guests because you're following the circuit around the world and staying in five star hotels and booking the hyper rich guy suite for all the races, someone could say, oh, you're really into this. You're like, no, nonsense, it's only costing me 3 million a year. So then, yes, but it's obvious when you're going to be so involved, you don't just walk into that sort of thing.

[Peter Attia]

So let's unpack this a little bit because there's actually two things I want to go into, but one of them I think will be a better entry into it, which is you talked about how, boy, if you were going to put eight hours a week into your strength training, you're kind of at the upper limits of what a person might do. Conversely, if your goal is to be a really good endurance athlete, you're not at that level yet. If you're only putting in eight hours a week, a world class cyclist, I mean, God, they're probably on their bike 30 hours a week, something like that.

[Mike Istratel]

Easily full time job.

[Peter Attia]

Now, of course, not all of that is at maximum intensity. A lot of that, in fact, probably 70 to 80% of it, it Also varies a little bit by gender, but let's just say 70 to 80% of that time is going to be at zone two, and they're really only burning matches 20% of the time. Yet there's something very different about strength training, which is, are you really getting benefit at the equivalent of whatever we would call Zone two in the gym? Like, if you're at that far of a submaximal effort, what is the training stimulus? And is this just where the comparison between cardiopulmonary training, where there's a clear benefit from submaximal efforts, and strength training don't jive?

[Mike Istratel]

That's definitely the case. Strength training. I like to use the term resistance training. It's the general term for going into the gym and applying things to your muscles.

[Peter Attia]

Because that's why you would say hypertrophy and strength are outputs of resistance, Correct?

[Mike Istratel]

Yes. So you can get some benefits from very submaximal efforts, but resistance training is based on applying high forces and high levels of fatigue as its primary modality of how it makes you better. And so it's kind of when you get into that world, that's what's going to happen. If you're trying to be a special operator, eventually a Navy SEAL type of person, the sound of gunfire freaks you out. You're kind of in the wrong place. We get almost all the benefits from pushing either very heavy loads or. Or lighter loads, but very close to muscular failure, which people have described as unpleasant. A burn in the muscle, a lot of pain, the weights slow down. So it takes a lot of psychological effort to keep going. There is not really an equivalent of just getting on the bike and putting in the miles, getting to a pace where Zone two, you can breathe, you can talk a little bit. Still, that's not weight training. But precisely because weight training is so intensive, you need lots of recovery time between sessions, and you can do lots of disruption and damage in each session. And also the total yield and how much it changes your physiology is very high for each session and actually per unit time. And that means if you're not working super hard for any one unit time, you're going to need a lot of work. That's endurance training. If you're working insanely hard per unit time, you won't need a lot of work, nor can you recover from that much work, which is why the top end is eight or 10 hours or something, if you're even professional bodybuilders, of time spent in the gym every week. But for people that just want the basic benefits, yeah, we're talking about an hour or two hours a week, and that's really all you need. If you're pushing sufficiently hard, that's both all you need. And realistically, like, you can recover from more if you make time in your schedule and really prioritize recovery. But yeah, any much more than that gets to be like, oh, wow, I'm sore and tired a lot more.

[Peter Attia]

And Mike, do you think this is simply a consequence of the fact that endurance training relies more on type 1 muscle fibers and strength and hypertrophy training are more dependent on the actions of type 2 fibers? Is that why? I don't know why. Philosophically, I just think this is such an interesting contrast to make of how optimization of one is a totally different philosophy than optimization of the other. And the only reason I'm harping on it is I just know that when you take people who are very used to doing endurance training, it's a hard switch for them to adopt. What you just said in the gym, sometimes it's not the way they're wired, but is the best way to explain to that person the why. That's the difference between a type 1 and a type 2 fiber.

[Mike Istratel]

That is probably the core difference. I would say there are two other things that can be put into that equation. One is the physical forces are just much higher in magnitude. You're going to be putting a lot of tension through your connective tissues and through your muscles when you're resistance training than you are when you're doing bicycle work, for example. And so with high absolute forces, the proximate damage and disruption to the body is graded exponentially and not linearly. It's like if a Wiffle ball flies past you, you might not even hear it. If a 50 caliber bullet flies past you, it's going to tear parts of you off and it's never even touched you. Very, very different amount of damage from much, much higher forces. And the other one is some combination of neural and psychological drive, the kind of drive it requires to be good at endurance. At least the base building part, the aerobic base work that you do is kind of being in a state of calm equanimity. You get your flow going, you get your music going, you get your breathing going, you look at the road ahead of you and you can just crank. But in lifting, you have to turn up the juice to really feel the maximum situation. Another quick analogy offhand is if you are a trillionaire like I am, and you have a fleet of Cessna private aircraft at your Back and call. I never fly the same plane twice. I always crash the thing. You fly a Cessna, you can fly it for some time. It requires a decent amount of maintenance, but decent amount of maintenance and it'll fly for a long time. It's just never getting up to velocities that are really crazy. You take an SR71 Blackbird out for a spin at Mach 3, you have to do 10 times the number of maintenance hours per flight hour on that thing or something to that magnitude. Because at Mach 3, what's happening to the plane is just running through subsequent brick walls. That's what the sound barrier is like three times faster than the sound barrier. You're just rattling that thing into dust. That's what you're trying to do to it. When you're pushing your body really hard and the weights are slowing down, and there's sets of five or sets of eight or sets of 10, your body's very close to its limits. So both your faster twitch muscle fibers which are required, they take way more damage. They're also not as well proliferated with blood supply, and they heal slower. And the amount of absolute force is higher and the amount of neural drive it takes. You can hop on a bike for an hour at Zone 2 every day. And afterwards people are like, are you tired? And you're like, a little bit. I kind of feel like also a little bit refreshed in a sense. You don't really feel refreshed after, like grinding the leg press for five sets of 15, you feel like someone beat the crap out of you and you don't owe anyone money. What the hell is going on? So that intensity, that absolute intensity of lifting and high relative intensity, that's what tends to make the big, big fatigue cost.

[Peter Attia]

Can you say more about the neural part of this? I find this to be a very interesting piece. And out of all the pieces you've described, and I agree with everything you've said, I know the least about that component yet. I've heard people talk about this, right? Which is you cannot discount the CNS fatigue, literally, that comes from doing this type of work. And I remember as an example, watching sprinters train. And obviously people understand that. Sprinters, I shouldn't say obviously, but if you study the mechanics of sprinting, you realize it really comes down to force per unit mass. It's how hard they can hit the ground with their foot relative to their mass. And so these are athletes who need to be almost comically strong without gaining any excess weight. So even though we look at sprinters and we think, gosh, they're very muscular. It's their strength to weight ratio that's really profound. And so they have to train in a way that minimizes hypertrophy and maximizes strength. So for example, they'll focus heavily on exercises where they can push the concentric phase and not the eccentric phase. It was explained to me once that doing this allowed them to also spare themselves from some of the neurologic fatigue. Is there any validity to that or is that just true? True and unrelated. And what is actually happening in both the central and peripheral nervous system during the recovery phase between those, say, three day or six day bouts when you're trying to recover a system after the set you just described?

[Mike Istratel]

I'm glad you brought up the peripheral. One of the big misconceptions is that there's muscular fatigue, connective tissue, systemic fatigue, blood vessels and everything still after heart has to pump. But then people just say, oh. And then the central nervous system, well, the peripheral nervous system is a thing too. And it also takes substantial amount of fatigue. So I would just say the nervous system takes fatigue. And it takes fatigue in the same way you would expect any system that's pushed to its limits to take various components of it, experience wear and tear, various substrates deplete and need to be repleted. So I can bring up two examples. In the axon of any single given nerve, you have a balance of electrolytes inside and outside, which allows the proliferation of the electrical signal. You run that system long and hard enough and it starts to get out of whack to where you try to get another impulse going. And it's like. So it needs to do a lot of pumping to take what's supposed to be inside the cell that's now outside the cell to get back in there to a level of concentration that would, you would be fully recovered. Now, typically that happens quickly, but if you run that system a lot, there are various points at which some of the structures that are supposed to do that, they're also proteins. You use them enough and they start to kind of break a little bit. And you need to produce more proteins to replace the channels themselves that do that pumping back and forth. And so that typically protein construction is measured on the order of minutes, hours and days, not seconds. So that you could imagine it as like a transatlantic cable. You throw enough current through a cable and the fish nibble at the cable enough, you need to start replacing the cable. Now, if you're really, really using the crap out of that Cable. Yeah, it's going to like undergo some not so great things. And then closer to neuron, to neuron junctions or the neuromuscular junction between the neuron and the muscle itself, you have vesicles of neurotransmitter. You pump enough of those in, you get the cool stuff of communication. You can run low on neurotransmitter and then like the electrical signal arrives and neurotransmitters like, sorry, not enough of us to do anything. And so you experience fatigue expressed as weakness. And you need time to reconstruct a lot of those neurotransmitters, place them into vesicles, have those vesicles translocate to the synaptic cleft and then like sit there and get ready. And that is a process that typically happens rapidly, but if you really exhaust, it can happen over some time. A really austere illustration of that is, and I've never done this, I've just heard about it. I will take credit for doing many other drugs, but I've never tried ecstasy. But if you clear enough of that neurotransmitter, you don't feel the same. The next day, you feel different. And it takes a day or two to get back up to those levels. Similar types of mechanisms are at work when you are going to very close to true failure on, let's say a squat or a leg press. I mean, you're cooking your muscles, but every single capacity of the nervous system to say push, push, push is at maximum. And so you end up doing quite a bit of homeostatic disruption all the way along the axon, all the way through the cell body and in the synaptic cleft. Neurotransmitters getting everywhere, gunk building up. That's going to take some time to fix. Which is why we see typically that people don't regain their prior strength after fatiguing and resistance exercise. For depending on how hard you go, anywhere from several hours to several days. And so if you have really, really hard workouts, it just might take several days for you to be able to have a really, really hard workout again for that same muscle group. Luckily, because a lot of this is peripheral nervous system based and local musculature based, if you train the living crap out of your chest one day and your triceps, you can train back and biceps, which have nothing much to do with those movements pretty robustly the next day. Much of the fatigue is local. It's not all local. The central nervous system, brain and spinal cord, specifically the Brain has a variety of mechanisms by which it controls your central fatigue. I remember, I think Tim Noakes was a big proponent of the central governor model. Though in the explicit terms which he described, it might not be the case or somewhat close. There's absolutely central governing going on. And when your body can tell through a variety of mechanisms that like, pretty messed up here, it's gonna pull back on how hard you can do anything. And some of those neural structures might even be operating at full bore, but they're just degraded enough to where full capacity isn't full capacity anymore. And so in all those variety of ways and many others, your body, after accumulating a certain amount of fatigue, will need to back off. And if you think you can train ultra hard for the same muscles twice a day, every day, you are welcome to try it in medical supervised context. You won't last. So it's really good that we have breaks planned in, but it's also really cool because weight training is one of those things where you get a dose of it and for days after under the hood, it's upgrading your body and your nervous system and your muscles and your tendons. So it's really neat that you can do 20 or 30 minutes of intense physical activity and resistance training and then for days later be experiencing the actual accrued benefits. Not a lot of things in life like that. It's kind of like getting a college degree for which you pay money and then earning money with it years later. Ostensibly, anyway, I've never earned any money or had a college degree, but that's kind of how it works. And you have to understand that when you're entering the gym, if you're training properly, you are asking a lot of your physiology, you are pushing it to its limits. If you're not, you're not using your time best and you're not getting the best outcomes. Because a lot of the absolute best results come from pushing very, very hard. Not necessarily to limits, but you have to test the limits. From what I understand you have a history of boxing, is that correct? If you just shadow box, it's nice, it helps. But going hard rounds against multiple fresh opponents, even if you're not like collapsing on the floor after, you know that, like you're looking at the clock and you're like, if you don't push it to that level at some point, you're not fight ready. So in order to be your best boxing version every now and again, you have to push it to discomfort, grotesque discomfort. Same with the body. It's nice that you get to do that every now and again and then you collect the benefits afterwards.

[Peter Attia]

So interesting how what we could do up to a certain age. And I don't know what that limit was because I really stopped pushing to those limits at about the age of 19. So I don't know if the limit was actually 20 or 21 or 24. But I never trained maniacally after the age of 19. Everything I've done since 19 has been smoking and joking.

[Mike Istratel]

Okay.

[Peter Attia]

But what I could get away with then was ridiculous. And I attribute it only to two things. Right? Youth, obviously with youth, I mean stupidity and inexperience and all the things that come with youth, but also like having started very young. So age 13 to 19, I was training literally six hours every day except Sunday, Sundays I only trained two hours per day. And I look back at the workouts I did and I think like, I don't know how I did it. And more importantly, like, how much better could I have been if I didn't train that much? It wouldn't be uncommon for me to do six super hard rounds of sparring with three fresh opponents. One guy a weight class below me, one guy in my weight class, and then one guy for two rounds a weight class above me.

[Mike Istratel]

In sequence.

[Peter Attia]

Yes. Six straight rounds.

[Mike Istratel]

You definitely did that backwards, but you probably know that now.

[Peter Attia]

Yes, and I would mix it up sometimes, but actually it was much harder and more dangerous to do it in that way. And I kind of liked that. Oh, that idea that the guy that could hit the hardest was my last guy.

[Mike Istratel]

Yeah. When you were the most fatigued, your defenses are the less accurate.

[Peter Attia]

But I would be in the weight room six days a week. Like it was just running hard anyway. It was kind of crazy. But I want to go back and just put a bow on something you said before because I think it's so important and it's going to come up again and again. I want to make sure people understand the point. Your example was great, by the way. The non linearity of force is very counterintuitive. It is not obvious why. For example, being on a bike, even if you are riding at a very high level of power. So remember on a bike your leg is going around at 90 times per minute. So even if you did a one minute all out, that's 90 reps, or call it 45 reps, that's nothing compared to when you're doing an all out set for 10 reps in the gym. It's such a difference in force. I love the example of the Wiffle Ball going by you versus a 50 cal. The 50 cal could kill you without hitting you. The Wiffle Ball, you wouldn't notice. So I think this idea of the profound level of difference in tissue destruction is a very important one. I was on Dorian Yates podcast a few months ago, and poor Dorian, he wanted to interview me because it was his podcast, but I just wanted to interview him. Like, I have nothing interesting to say. Let's just talk about Yates right now, right? It was very interesting to me to understand how little time he spent in the gym. For a bodybuilder of that era, it was very, I guess, progressive, even though he was really going back to Arthur Jones and Mike Mentzer and those guys. But he was really just sort of doing one set to failure per exercise and he was doing each body part once a week. The question I sort of posed to him, but I'll pose it again to you, is, are most people even capable of pushing that hard? Because I want to bring it back to where we were a moment ago, which was, hey, for a person who just wants to train 30 minutes twice a day, they can get all the benefit in the world. But there's an asterisk there, which is that 30 minutes twice a week is going to be the most difficult 60 minutes total of your week. So going back to Dorian for a second, what has to be true to be able to only train that much in terms of total hours, volume, however you want to measure it, how much work needs to be done in that window of time?

[Mike Istratel]

For the. Not the Dorian Yates example? For the.

[Peter Attia]

No, for the Dorian. Let's start with Dorian. Like, why could he produce such a massive physique? And again, let's just normalize all the drugs. We're going to talk about drugs later. So we'll explain where the drugs are and aren't helping, but all the drugs in the world aren't going to give you that physique if you can't generate the destruction of the muscle. Is that just the sort of thing where virtually nobody can actually push that hard that consistently? Or was it just that nobody thought to do it the way he was doing it at the time?

[Mike Istratel]

Plenty of people thought that's how it works. Mike Mentzer did that only in a more extreme version than even Dorian did. Lots of Mentzer acolytes did it. It's not the most efficient or the most effective way to train, but it is quite effective because if you go very close to failure with very heavy loads, all of the sub components of Your musculature, your motor units, which is the motor neuron, and all of the cells that it activates. They'll get recruited and they will be asked to work to their limits. They'll take on a great deal of damage and disruption. They'll sense a ton of 10 and they'll produce great results for you. The other thing is that the relationship between both intensity and volume of how much you do work in the gym, especially volume, is curvilinear and hyperbolic. So it looks like this. And if people are just listening to this, it means if you do one all out hard set per muscle group per week, which is not what Dorian did. He did roughly 14 of those per week for muscle group, you get maybe something like 30% of what you could have gotten with five sets. Because your body has very good sensing mechanisms for tension and metabolites and all these other things that cause muscle growth. And when it detects that you're pushing on the pedal, it'll give you a real good wallop of result. You keep pushing on the same pedal over and over, and the systems are greatly desensitized to giving you more muscle growth. The biggest reason that is is probably because the human body is attuned and evolved almost entirely in hundreds of millions of years, before we were even human, of what is in the modern context called food insecurity. And so in order to make a real good case for allocating that much to muscle growth, you're going to have to have a real distinct signal to ask your body to put more and more into that process. So it kind of auto caps itself. If you are myostatin deficient, then actually just existing, you just grow muscle all the time. So it seems to be that for a variety of reasons, including that one, that if you do one set close to failure, you get a lot of gains. You do three sets close to failure, you get substantially more gains, but not three times as many gains. You do five sets close to failure, and you do just a little bit better than three. You do seven or eight sets close to failure in one workout, and it's statistically undifferentiable from five. So that's kind of how that chart looks. So Dorian, from what I understand, did roughly 14 sets per week per muscle group. Ish. And that gets into that territory of a very robust signal of growth to the muscles. It's not the highest signal of growth. If you decided not to train your legs very hard or your back very hard, and the amount of systemic fatigue, that's imparted to you week by week is much lower because fatigue isn't just local, it spills over into everything else. You could push your arms, shoulders and chest not to 14 or 15 or 20 sets per week, but in many cases, 25, 30, 35 sets per week and experience very meaningful growth enhancements that you would never have seen only ever training those 15 sets a week. But 15 sets a week might bring you to 70 or 85% of what all of those muscles could eventually have hypertrophied if you only ever specialized in them. And so Dorian was insanely jacked, but he was jacked all over and probably could have, in retrospect, benefited from more specialization phases on various weak points that he had. His back was startling. His arms were excellent. Now, by immortal standards, they were the biggest arms you've ever seen in your life by competitive bodybuilders of his era. Standards relative to the rest of his physique. He could have had bigger arms, could have bigger shoulders, and so he could have poured much more volume into those muscle groups and lessened everything else. But Dorian seemed to have a kind of all around approach, which up until about a year ago, so did I. And so I had never looked very aesthetic. But boy, were my legs super big because they could just eat up the growth all the time. So if you want to do not a ton of volume for any one muscle, if you work really hard and bring yourself very close to failure, you can already do super, super well just with that alone. If you get a really good cook, someone who really knows how to make food, and you give them an hour in the kitchen with a variety of menu items, versus three hours. Within an hour they can wow you with what you're eating. Within three, they can wow you more, but it's not three times more. Matrix Reloaded, Orgasmic Brownie or whatever, they ain't gonna make that. There's gonna take them a lot longer than three hours. They can make a difference. But probably only people who are very culinarily attuned can tell if someone makes me chicken fingers, gourmet chicken fingers, if they're even such a thing. I'm sure Austin has something like that. An hour versus three. To me, it all tastes same, same. It's amazing to someone really, really with a refined palate, they'll be able to tell, but they can't lie to you and say, look, this three hour chicken finger, this is just categories above the one hour one. So in a lot of processes in general, and luckily in the human body, getting some of the way to your body's maximum ability to recover actually brings you most of the way as far as results. And that's why Dorian could do what he did.

[Peter Attia]

Now, if Dorian was doing 14 sets per body part per week, would that mean 14 sets to failure of 14 different exercises? So we're not counting the warmup sets and things of that nature.

[Mike Istratel]

It's a complex question. It's not a hundred percent clear exactly what Dorian did or if he even did everything exactly as it was written on paper all the time. You see his training videos, you don't always see just one set. He would also have this thing like a warm up set that for him was a warmup, but for most people would absolutely be a work set. So it may be more like two or three equivalents of a working set per exercise.

[Peter Attia]

Maybe there's like a total throwaway set and then there's a modest set and then there's a two rep in reserve set. That again, that's a real working set, which is a failure, right?

[Mike Istratel]

Yes. So according to his categorization, the only work set was the one that was absolutely to true muscular failure. Sometimes with forced repetitions, which you would also have to integrate because forced reps is when someone helps you lift the rest of the weight, or if you do a drop set, you use less weight right after you went to failure. We shouldn't count that as just one set. It wouldn't be the most correct way to think about it.

[Peter Attia]

And when you compare that to the example of the three Hour Chef. So now the person who's willing to put in 30 sets per body part per week, do any of those sets need to be to failure or are you counting those as, hey, these would be sets of two reps in reserve, one to two reps in reserve.

[Mike Istratel]

Almost all of the literature that has found out that if you don't systemically fatigue the whole body too much, any given muscle or several muscles, you can push into the 30, 40, 50 plus set range per week. Almost every single study done to elucidate that understanding was done with muscular failure studies. True failure, truer failure than you'll see in the gym, because these people are training in laboratory conditions with master students screaming at them to keep going. Most of us have never trained that hard consistently. So people can still recover. Now these are undergraduates that are recreationally trained typically. So they can neither do a lot of damage nor are they impeded by age and prior injury and all this other thing. So I would say that whatever amount of sets you have to do to get a certain amount of whatever amount of growth you want. You can get there in a few different ways. You can get there with, let's say, 30 sets that are four reps shy of failure. You can get there with 22 sets that are one or two reps shy of failure, and you can get there with 20 sets that are all the way to absolute muscular failure. So if you are really training not so super hard for reps in reserve, you'll have to do substantially more sets to see the same hypertrophy. But study after study after study illustrates that when you're getting one or two reps away from failure, it is often statistically undifferentiable on raw growth than going all the way to failure. However, the fatigue of true failure training, probably mostly because of that nervous system component, is exponentially higher. And so as far as an efficiency and long term sustainability strategy, training all the way to muscular failure every session, as a matter of principle, probably on the margin, suboptimal and should probably most of your sessions should be one or two reps in reserve. If you're doing dumbbell presses, you finish your last rep and you're like gone to my head. I could do one or two more, but that's it. Most times it's probably best to stop at that point because what you're getting if you go north of that is a 10 to 1 fatigue to stimulus ratio. Whereas everything before was like 1 to 1, 2 to 1, 3 to 1, 5 to 1, and all of a sudden it's 10 to 1. It's a lot of fatigue cost to pay for, when in the literature chronically ends up being either tiny, tiny bit better or not better at all.

[Peter Attia]

Which says nothing of the risk of injury when you drop that dumbbell on your pec, which I don't know anybody that's done that, but I've been told it really hurts when you fail in a set of dumbbell presses and totally collapse. Avoid your head with a dumbbell on your pec that turns black and blue.

[Mike Istratel]

Oh, good God, yeah, I would never know all sorts of things. I just like to aim for the gentle at that point. Might as well have a cool story. But yeah, the training to failure. The vast proportion of people that really propose that training to failure are somehow special for results. They didn't reason their way into that, they emoted their way into that. Training to failure is something the 13 to 19 year old you would have really found a lot of spirit energy in. As I like to say, it's adult male putting on his hat off. I'm a mountain goat and I run into shit. That's what I do. I saw an adorable video of some folks that own a few goats and a few dogs. Their pitbull is like not hiding but sitting under this like little thing. And there's like a teenage goat that's looking at him and he jumps up on his hind legs and tries to like hit him in the head. And the pitbull backs up and he's like, ah. And the goat just tries to do that again. He's just trying to get it on. Like he just wants to hit stuff. That's all he wants. And so when you're a young male, when you are prone to wanting success for yourself, you're the type of sort of type A personality that wants to look back on their life. And if you had to roll the dice and say the reason you weren't optimally successful is that you work too hard, they'd be like, ah, sweet, whatever, that's kind of cool. But if they saw the dice roll and say the reason you weren't optimally successful in life is because you didn't work hard enough, they would not live with themselves. Those kinds of folks generally tend to go to muscular failure for just that spirit energy. It feels right, damn it, and it feels good. And it's purifying almost at an existential level to be able to have given something your all in the face of challenge, in the face of injury risk, in the face of grotesque pain. And you know this from sport experience, when you're really, really tired, your whole existence is screaming at you to stop ignoring those things and going all the way until you know you've pushed it as far as your body can go. There's something very magical there for the soul, for results. In the gym. There's not much magical there. You have to get close to it. You just don't have to go all the way.

[Peter Attia]

So let's go back to the person who's listening to us, who wants to take the plunge, wants to start doing resistance training. They're clinging to what you said a while ago, that hey, I can get some really good results if I'm in the gym 30 minutes twice a week. And I know that Mike trains eight hours a week, but I don't need to be Mike. So tell me what a program looks like. Let's construct the program. Let's start with a young person. Let's start with a young person who actually has been somewhat active throughout their Life, but it's mostly been in sports. They play tennis, they did cross country in high school. They've just never been a gym rat. But they've listened to this podcast enough, they've listened to you enough to know like, hey, there's value in developing strength and I'd like to have some hypertrophy. I want to look a little better. Okay, so I'm coming to you. I'm 40 years old, kind of a little intimidated if I'm truthful. Don't know what good.

[Mike Istratel]

I have a whole pack bounce to make you more intimidating.

[Peter Attia]

What's our two 30 minute day workout look like?

[Mike Istratel]

So I'll describe to you what week one could look like and then I'll tell you how to scale that afterwards. It's not just the same every single week. So what you want to do is if you're training twice a week, let's call it Monday and Thursday, for simplicity. You do want some symmetry. So you don't want a situation in which you train with weights Monday, Tuesday, and then you take the rest of the week to do other stuff. If you only train twice a week, you want it to be roughly evenly spread. So Monday, Thursday, Wednesday, Friday, that sort of thing. And because your muscles don't take usually a whole week to recover, but if you push them hard, maybe at most half a week, you can train every major muscle group of your body in every single session that you do. So both Monday and Thursday, we'll have every major muscle group being trained. Routines that have the muscle group separated are called split routines. Chest one day, back the next. Mostly pro bodybuilders are the only ones that benefit from that sort of thing. And there's a lot of nuance about how to execute that sort of thing. So whole body training is probably best for almost everyone who is trying to get the health benefits, longevity benefits, the aesthetic benefits, and so on and so forth. The next thing you want to do is you want to conserve time, but you want a high degree of effect. And that's going to impose some recommendations on us that do both of those things. One recommendation is to choose lifts, to choose exercises that involve two components. One is large muscle masses. So you're not going to be doing a lot of forearm curls or tibialis anterior calf raises, where like, the muscle you're training is like as much muscle as your pinky finger. And that's about it. You're going to be training muscles like the quadriceps, the glutes, the hamstrings and musculature. Of the back, the chest, the shoulders, the arms, et cetera, and choosing exercises that train those muscles, preferably not just one muscle at a time. So then we're using muscles very efficiently because we're pushing multiple muscles to their limits in one exercise. This is generally going to be compound movements, multi joint movements, things like pull ups, pull downs, barbell and dumbbell bent over rows that for the back at least engage the forearm flexion muscles, the biceps, et cetera. They engage actually the muscles of the forearm themselves through your grip. They engage the posterior aspect of your deltoids, the rear delts, they engage almost every muscle in the back all at the same time. When you do one set of bicep curls, but I do one set of underhand pull ups, I got my biceps checked off and I got three other muscles checked off. You just have one. One of my absolute grotesque pet peeves is to see personal trainers in major cities training their regular clients. Housewife who's 55 and having her do like rear delt cable fly one at a time. I'm like, oh my God, is that wound made of time? And also, was there some kind of physique show which the judges said she needs bigger rear delts, but nothing else. That's the only reason you should be doing that nine times out of 10. So compound movements, close grip, bench presses, push ups, overhead presses, upright rows, squats, deadlifts, et cetera, et cetera, et cetera. These are the kind of movements that train multiple muscles at the same time. Thus they are insanely time efficient because you do a few exercises and you're like, holy crap, that's all of my upper body. If you do some kind of rowing machine, you do some kind of machine or barbell or dumbbell, that's a close grip press, you do some kind of upright row situation, then you've technically trained every single muscle in your upper body to a substantial extent, because every single exercise trains three or four muscles at a time. So those are the kind of movements we're going to be leaning into the most.

[Peter Attia]

What about for the lower body besides a deadlift and a squat?

[Mike Istratel]

Various stiff legged deadlift or good morning, RDL is the same category of movement that trains your entire back, specifically your spinal erector musculature, which is insanely important for healthy aging. I could talk about that ad nauseam. And then it trains your glutes and it trains your hamstrings, and it trains your sartorius and parts of your adductors, and it actually trains your calves too. Holy Crap, that's one exercise. You integrate some kind of lunging pattern into that or some kind of squatting pattern, be it a hack squat, leg press, barbell squat, you name it. And all of a sudden you've run out of muscles to train in your lower body because everything has been done to a high degree of diligence. Again, compound movements again. I see 45 year old financial advisors who don't have a lot of time. They have family obligations, they have work obligations, they have other hobbies and they're doing like leg extensions in the gym. I'm always like, man, I hope that guy's hurt and has a good reason to be doing those. Because if he's not squatting or lunging or doing leg presses or something, he's just using up time in the gym, training one thing at a time for no good reason at all.

[Peter Attia]

So invariably you've been asked this a thousand times, but when this person's coming into this situation and they don't have a high training history, what are the tools you use to teach them how to do these compound movements safely, especially the lower body ones. So squats and deadlifts, admittedly they're not going to be starting out with a ton of weight.

[Mike Istratel]

That's the biggest tool, is starting out with low weight. There's no movement the human body can do, which unloaded and not pushing the muscles and tendons to their extreme, has any higher risk probability than any other movement. So you can start with a deadlift or a squat. That's body weight or less. You can brace your arms on a Smith machine and unload yourself while you squat. That may be where you have to start. You take multiple sets like that that are very submaximal. Ideally you're there with a personal trainer. If not, you can just go to YouTube and type in the name of your exercise and it'll pop up. We have a huge library for free on YouTube, actually, the RPI perchrophy app, which is one of our apps in our app suite. Every exercise you'll ever see in there has a video demonstration one click away. So you look at that. Ideally you would have a personal trainer because live communication about how to exercise is irreplaceable. Because on a video we're assuming that your assessment of what that is is your assessment of what you're doing, which is very difficult. Oh my God. You walk into the gym and they're like, I'm squatting. You're like, that's not a squat. I don't know what the Hell, someone told you or what video you're looking at, that ain't it. If you have a personal trainer, they can be like, ooh, that's really good, but I want you to move your hips back more, I want you to move down more, so on and so forth. But basically, the first time you're ever with someone in a session, all you do is you take them through those movement patterns, fine tune their technique with lots of encouragement. And you're not seeking perfection, you're just seeking basic competency. Get your heels on the ground, get you squatting all the way down, get your back nice and straight. Listen, that's all we want. And you'll do three or four of those, what are really warm up sets, and you'll just kick them out of the gym. Three or four warm up sets per exercise. It's a teaching session. They never even lifted heavy, they never pushed to failure. But because they're so unaccustomed to lifting, they'll get sore. And it's enough tension and disruption that they will grow muscle. The next time they come in, you work them through a different series of movements, let's call it Monday, Thursday movements. The next week they come in and you do the same workout, except maybe that last set of every movement. After a few technique oriented sets, ask them to go for slightly more repetitions, maybe not five, but now 10. Or you put a little bit of weight on the bar, something that gets them like, ooh, okay, I feel it. This is a challenge. And then over time, slowly every week, you increase the weight a little bit more, a little bit more, a little bit more. Until several weeks later, their technique looks real good, which most people can learn really good techniques. It's not that complicated in a few weeks. And now they're like kind of struggling with their weights. We're finally up to a weight and rep combination that's challenging them physiologically every set, not just neurologically, for how to do the technique. That three or four week sort of entry period is amazing because it takes the probability of injury and just almost completely eliminates it. Because you're not just going in there and seeing how strong you are on the first date, which, believe it or not, a lot of people are inclined to do profoundly stupid, as reserved for like high school or junior high kids. Whatever your ninth grade, max out, don't do that. When you're an adult, it's profoundly stupid, especially if you're in your 40s and 50s and 60s and like, you don't want a torn peck, you drive A truck for a living. Your pec is required for that sort of thing. After that easing in period, you're now competent. The movements you feel yourself competent as a member of general gym culture, you don't feel lost. A big part of a problem of getting people to go to gyms and actually stick with it is there's this understanding that people have, which is itself relatable but inaccurate, that the gym is for people that know things. It's their place. It's for that jacked guy. It's not for me. The thing is that jacked guy, to paraphrase another comedian, like, he's been in the gym enough, he should take a few days off. You're big. You did it, buddy. The people who really need to be in the gym are the ones who aren't in the gym. So the gym is an infinitely welcoming place. Almost all the jack people are super nice in real life, and they're not judging you. They're just staring off into space. They're ultra selfish. They don't care about you. And if you don't know what you're doing, you can always ask them, and they almost certainly will give you free advice until you're blue in the face. So after a few weeks of being in the gym with a trainer, you're like, this is my place, I belong here. And I'm starting to push a little hard. And then over time, you just increase the load on the bar a little bit. And if you're no longer getting sore or really tired and sore and tired in such a way that you need until next Thursday to get sore and tired, you start increasing the number of working sets that you're doing. Because working sets wise up until this point, was just one working set, really, if you think about it, in the first week or two, zero working sets, they're all practice sets. Because you're so untrained, they're work sets for you, but they're not to anyone else that's watching a few weeks in one works and a few weeks after two work sets, and so on and so on and so on until you're doing anywhere between three and six working sets per exercise. There's another twist here. For the person that wants to save a lot of time and actually get some cardiovascular benefits as well. You take exercises that are responsible for training muscles that can be paired with other exercises which train muscles that are totally or mostly unrelated. If I do a seated dumbbell shoulder press, I rack those dumbbells, I can walk over and do some goblet squats, and essentially there's almost no muscle overlap. Or I can do some deadlifts and there's just no muscle overlap whatsoever. And so I could do some seated dumbbell shoulder presses. Put it down. Nice, hard set. Good job. Two sets left and I could sit for the average of 1 or 2 minutes and scroll on my phone. But if you're really time conscious and you want extra cardiovascular benefit, what you can do is as soon as you've finished with one group of muscles, you take five or ten seconds, shake it out, breathe it out, hit the next working set for that paired exercise. While you're doing that exercise, the muscles for the first exercise are actually recovering locally. And so when you're done with that exercise, five or 10 seconds later, it's set two for the first exercise. So you pair these unrelated work sets together, unrelated exercise, such that when you've done four sets of one exercise, let's say a close grip bench press that trains the pushing muscles of your body, if you've paired that with a row or a lat pulldown, then really you've done eight total working sets and you've just knocked off 80% of your entire upper body in an amount of time that the dumbbell press by itself guy has just finished only his front delts and triceps. So rest times in the gym, outside of getting a drink or just trying not to faint, are probably not your best friend. If you're just going for general health, general aesthetics, this kind of stuff, especially beginning. So you're either working one muscle group or several with one exercise, or you're transitioning between exercises, or you're working the other one, or you're setting up your weights for your next machine that you're going to be doing, which means as soon as you get in and warm up, it's go, go, go, go, back to back to back to back, five or 10 seconds for transition to catch your breath, barely. You're not going to be talking to a lot of people at the gym other than how many sets do you have left in that machine? That kind of stuff. And so that allows us to condense a lot of work. Most people will need something like 15 to 30 total working sets for their whole body per session. You can condense that into 30 minutes, but you're working almost the entire time. And it's generally a good idea to do sets of 10 to 30 repetitions because those kinds of loads, you don't need a ton of time to have your best performance. You can get good enough Performances with a short time for recovery. And because it's a lot of reps, not only does it get you very meaningful strength increases because the absolute load is lower. Much lower injury risks. Look, you do one rep maxes all the time. You're going to have it coming one way or another. You never touch any weight that's heavier than a 10 rep max. The probability of injuring anyone given set is much, much smaller. And because it's a higher volume of work, you get a great hypertrophy stimulus and you get great cardiometabolic benefits. If you're breathing insanely heavy the entire time and sweating like a insert favorite analogy here, then you will be kind of one and twoing that session for a resistance training check mark and a pretty decent cardiovascular training check mark. Especially if these are compound multi joint exercises that require you supporting our body and space. You do a set of 15 barbell squats followed by a set of 15 push ups. Your cardio is working. I mean, that's what they torture boxers with. Their cardio is outlandish. Back to back to back to back. It's resistance training, it's cardio, it's both. You have two sessions like that per week, each one lasting 30 minutes. You have two sessions of zone two, zone three cardio where you're really trying and four sessions total like that per week. With good sleep and good body weight, good nutrition, you're well on your way to. When you see your healthcare provider every year and he asks you trying to die sooner or later and you tell them what you do, most of them be like, well, that's way more than most of my patients do. And if you look at the American College of Sports Medicine requirements, various requirements of what constitutes rigorous physical activity, you're getting well into the mix with a sum total, if we think about it, of two to three hours of difficult physical activity of any kind in a week. So when people say I don't have time for exercise, I get it, I get it. I don't have children. I've heard that when you have children, time dilates like black hole type of stuff. But you can probably make time at least for that resistance training session. Will it be ultra easy? No way. It's going to be really tough. I don't train like that. I need my break, dammit. I'm trying to be lazy and scroll on Instagram between sets. But if I wanted to get the maximum results for the minimum amount of time, we're working all the time. And over time, you start with one or two paired Sets like that, you get up to three or four paired sets like that on five to eight exercises per session. Holy crap, that is a lot of work. And it will train your entire body in one session. And you will require one to three days of rest afterwards. Guess what? You rest for three days, you come back. You rest three days, you come back. There's two workouts in a week. Each one takes about half an hour. And if you ever want the workouts to take less time, work faster and rest less. And a lot of people want to hear like the hack for how to get really awesome results with very little time spent in the gym. But they don't want to hear how to get the hack actually going because they're like, whoa, hold on, hold on. What's going to hurt? Like, yeah, it's going to hurt, it's going to be miserable. Unless you accept the fact that you know all the benefits of endorphins and everything like that. It's kind of like, you know, how do you become a millionaire? You're very, very good at something. You get very, very good people skills and you grind for years at starting your empire. Like, ah, man, I wanted like a win a lottery ticket or something. I didn't want all this. Like, everyone knows that's how you become a billionaire. I don't want that. So yeah, you can thumbnail and title this how you like, but it's cool to say, yeah, listen, one hour a week and you can have amazing benefits of health, quality of life. But I'm here to tell you real talk. Because at rp, that company that I represent, we just have a policy of never lying to people ever. Because we're doing this to honestly help people. And business wise, if you start lying to people, it's hard to unweave the rainbow after that is going to be tough. But also there is now more and more research accumulating that doing difficult things physically is good for your mental health. There's a lot of publicity lately to cold plunges, huberman and all that stuff. And a cold plunge, because it's so annoying, makes you more grateful for the not pain you're engaging in the rest of the day. And it's really good for you. I have one better. You do a 30 minute session of back to back to back compound free motion or dumbbell or barbell or even machine work and sweat your balls off and huff and puff the rest of the day seems like a breeze and the endorphin kick is massive. It's like surviving a traumatic episode so the cold plunge has some benefits. Not entirely sold that they're enormous or extent whatsoever in many cases. But this kind of resistance exercise has benefits that if we just took one by one time to talk about on this podcast, we could talk about nothing else and do four podcasts in a row. That kind of massive benefit.

[Peter Attia]

There's a lot there I want to go back and touch on. Let's start with the idea of how does a person find a good trainer? Because it's hard enough to find a good doctor and that's a highly, highly regulated industry. You either are an MD or you're not. But still there are lots of different flavors of doctors and there are some who really think a lot about prevention and really care about how you exercise and how you eat. And there are others who I think do, but frankly don't have the time to really noodle that. As difficult as it might be to find a great doctor, it's probably even more difficult to figure out a trainer who's really good. So what are the questions that a person can be asking when they go into their gym or are looking online for a trainer to say like, is this the person who is going to help me learn to do a squat and a deadlift safely? Is this a person who can integrate whatever pre existing injuries I have and really help me? Because again, I've worked with people who have watched people coach and I'm like, wow, that person really knows what they're doing. They have picked up the absolute subtle art of how to cue somebody to lift. They can focus on the non obvious and there's other people who literally have no clue. They look like they just watched the YouTube video and they're sort of parroting the YouTube video to you, but they have no real intuition about it.

[Mike Istratel]

It's very tough, very tough. Because if you aren't an expert or a very knowledgeable person yourself, it's very difficult to figure out who is knowledgeable and an expert who's doing a good job. Like if you're finding a good doctor, I don't know what that means. I have no idea how to measure a good doctor versus not a good doctor. Most doctors are equally confident in telling you what they think is going on and very differentially accurate. So it's a tough question. I would say that if you have an opportunity to chat with them and ask them a few questions, you could find out some things that'll be helpful. These are all marginal pieces of advice. There's no absolute, I'd say the thing that Comes close to the absolute of having a high guarantee that they're good at. What they do is if they're certified in the Menno Henselman's PT course. Menno is an expert in our field. He knows his stuff. And his trainers that he certifies have a high probability of being able to deliver to you what it is that you want out of them. There are other fine certifications out in the world, but a lot of certifications, you're just reasonably intelligent and you studied for an hour and voila, you're certified. So the certification doesn't go very far. It helps if your trainer has an undergraduate in kinesiology or some related field that is not by itself ensuring you that they're going to be good, but it sloughs off a lot of backend, if you know what I mean. Like you're going to get rid of a lot of not great trainers. You can almost entirely ignore what they look like because the preponderance of the reason people look like they do is genetics. The other is diet. And the other is just how long have they been doing stupid or smart things to their body, but grinding away. So if you look at a trainer that just looks kind of like a normal person, maybe a little muscular, a little bit leaner, you look at another trainer in the same gym that's just like got six pack on his face just ripped, don't be like, well, that guy seems to know what he's doing. He's ripped, he can't give you his genetics. And almost the biggest contribution to why he's ripped is genetics. And so people get hung up on this all the time. They work with preposterously under qualified trainers who just look the part. There's not like a transitive property by which you can just like give someone your exactness. Yeah, I wish, right? You just touch their skin and you're like, I feel it. You wake up the next day super jacked. It was that easy. You can ask them how they integrate science into their practice. Not a guarantee, because you can be evidence based and still have all sorts of poor practices. If they go mostly on personal experience and feel, you can be assured that they're probably not the greatest trainer for you. If they have a lot of personal experience that they use in their training. But also they're very adept at understanding the scientific literature and especially just the broad strokes basics, you're probably in better hands than not someone that can explain to you the reasons for why you're doing certain things. And you just Voice note, record them and ask them, is it okay if I record your reason? I just kind of want to think about it at home later, wink. And then you just copy that and feed it into Claude 35 or GPT4O and be like, give me a steel man and a red team for this. It'll do both based on the sort of texture of its responses. Because all these LLMs are designed to be insanely agreeable and very kind. But when you're wrong, wrong, they'll be like, that's a good point. However, eight point list, you're like, that guy's an idiot. This is all wrong. So luckily, GPT4O, if it was embodied in a robot currently would probably make a great trainer. And so how your trainer and various claims of their scores against GPT is probably one of the better ways to do it. And also say this, there's a big factor of how you get along with the trainer because you're going to want to find the training at least as not unpleasant as possible and ideally as pleasant as possible. If the trainer is someone that you just kind of vibe with, they can dig into you and really get you going. But they're also super fun to talk to outside of when you're not dying during training. If they can get you to become responsible for showing up on time, in a sense of, you know, the trainer and I are on the same team, he's on my team and when he says, are you going to make it Monday? I just don't want to let him down because he's my buddy and we're in this process together. I don't want to give up on myself. If you have a trainer you connect with like that, you got yourself a great trainer. Even if they're not super evidence based, they just get you in and get you moving, that's like half the battle right there. So let's say those things are things to consider. And the last thing I'll say is have a trainer for a few weeks, few months, and maybe learn up about what's going on and then see like, oh, does my trainer know things or not? I mean, I had a person I was doing just nutrition for while my colleague Nick Shaw was doing training and not for her. I was in my PhD program in Tennessee. I was training her or nutrition coaching via distance over the Internet and Nick was training other clients in New York and she was in New York at the time and she told the trainer kind of the diet that I had written her and he was like, oh, that's stupid. That's wrong. And she was like, why? And the answer he gave her was so bereft of a systematic approach to knowledge that she texted me. She's like, do you have any trainers you can recommend to me? I think my guy's an idiot. And sure enough, gave her over to a colleague of ours, and Nick didn't have any room. And she's like, oh, my God, this guy is beating my ass in the best way possible. I love him. Yeah, some of your trainers will suck. And you might need a few weeks, a few months to realize, man, everything I've heard about how this whole process works, my trainer doesn't even agree with me. Yeah, you might have to switch it up. You might not have the perfect car. The first car you buy might just be a thing that has a steering wheel and wheels and goes places. And after you've kind of appreciated what it is you don't like about your car, your next car could be a bit more of a educated purchase.

[Peter Attia]

So what about the person who's been lifting weights for a long time? They're in there, they're doing this stuff, but they're not happy with their progress. They're in the gym. Let's just say they're in the gym three, four times a week, an hour at a time.

[Mike Istratel]

How hard are they working? Are they really trying, or are we saying that maybe they're trying, maybe they're not? It's a very different answer if they're trying or if they're not.

[Peter Attia]

Let's say they are. They're actually trying quite hard. And you actually look at them and you think, you know, gosh, they might actually be slightly overtraining. And by overtraining, let's say they're training three days a week, and they're doing whole body three days a week, and they're in there 90 minutes at a time. They're going to one to two rep in reserve on every set, and they're hitting 20 to 30 sets per body part per workout. To be clear. Like, they're doing okay, but they're just saying, you know what? I want to be really jacked.

[Mike Istratel]

Okay. Yeah.

[Peter Attia]

What do I need to do?

[Mike Istratel]

Yeah, you would need to go down a checklist, a troubleshooting checklist. And we actually do have, on the RP Strength YouTube channel, we have multiple videos of how to troubleshoot your muscle growth, how to troubleshoot your diet, how to troubleshoot your recovery. So if you throw those on in the car during your drive to work, you're going to Learn a lot about how to troubleshoot. You can concern yourself with variables that occur in the gym. You can concern yourself with variables that occur outside of the gym. Both are very important in the gym. Variables, starting from the beginning would be exercise selection. Sometimes people say my arms aren't as big as I want them to be. And I look at their plan and it has no isolation work for their arms whatsoever. And I tell them, this is not a surprise. And they say something, look, well, I thought underhand pull ups and close grip bench was good enough to get big arms. And I would say, yes, it is. Both of those exercises are great to get big arms, but you want bigger arms, which means, like every bodybuilder ever, you're gonna have to start working a few sets of curls in and a few sets of tricep extensions of some sort regularly and hard. So a lot of times people don't have the specific exercise selection for what it is they want. They're just doing the kind of general training you and I just described. But they're sometimes not even honest to themselves at a deep introspective level of what it is they want. Like a lot of those people that want better results, you look at them and you're like, you look great. And like, yeah, but I want to look better. And you go, how? I just want gigantic arms. You go, oh, okay, well, like, your workout is absolutely not designed to do that. It's designed to get your arms that look big to someone who like sees you lifting your suitcase into an airplane, but other than that, you don't have big arms. And then you go, okay. Exercise selection. Another variable to consider is technique. Some people have just not so great technique. Good technique involves putting the muscle into high force positions at a very deep stretch, long muscle lengths and high forces. So if you're doing pec flies, for example, but you're only going all the way down to like here, you need to open up like crazy and take a few seconds down there in the deep stretch. That's really going to help you out. And technique is so exercise specific and so individual that you really should get a qualified trainer or someone you trust or videos on your own analysis to go like, okay, am I really doing this right? Because you think, oh, I'm hack squatting. And then you see an RP strength video about hack squats and you're like, I have never hack squatted a day in my life. You try it our way and you're like, oh my God, my legs. For the first time in months or years, they get sore, they get tired, and you're like, oh, wow. A couple weeks later, your quads are visibly bigger. Okay, now finally, I fix my technique. Another question you have to ask is volume wise. I mean, I suppose you already said they're doing one or two reps in reserve, so we're not going to question that. We'll say they're training hard, which is good. That's another thing to ask. If someone is a volume intensity would be on the charts 100%. Like, am I really pushing hard? How hard? If I think I'm pushing hard enough, I should push a little harder and see what happens.

[Peter Attia]

So for intensity, you would say if they're at least hitting two reps in reserve, you're okay with that? Golden.

[Mike Istratel]

No need to improve above that.

[Peter Attia]

But if you went in there and you observed them at the end of their set, if you said, let me see you do a few more, and they were constantly getting four more reps. Yeah. So they're four reps in reserve. You would say the literature says you're not hitting in a.

[Mike Istratel]

Correct.

[Peter Attia]

A high enough training stimulus.

[Mike Istratel]

Correct.

[Peter Attia]

This is a very important one.

[Mike Istratel]

Very important.

[Peter Attia]

Because I think I talked about this once on Instagram and if I didn't, I meant to and I just forgot. Which is equally likely. In fact, more likely.

[Mike Istratel]

Yes.

[Peter Attia]

But the point I wanted to make was, at least for me, it might be that I'm just not good enough. You don't know what two reps in reserve means until you go to failure. Yeah, you have to fail many times to actually know how bad two reps in reserve is and one rep in reserve.

[Mike Istratel]

Yeah.

[Peter Attia]

And they're not the same every workout. That's the other thing. You could have the same weight on their different days and you fail at a different number of reps. But there's like a signal, there's a twitch, there's a discomfort that you have to experience it, but you can't experience it until you blow past it.

[Mike Istratel]

Yeah, that's largely true. See, every now and again, you have to test the waters. There's actually a really good system of doing that, and it's incorporated into our hypertrophy app. The app will ask you to put in your weights roughly 10 to 20 rep maxes, and you'll do as many reps as you think is 3 reps or 4 reps to failure, depending on what it's wanting you to do. And you'll write your repetitions in for every single set. Well, I got 16 reps at 90 pounds on this exercise. The next week, the app auto programs a progression for you. So it'll either ask you to do 17 reps at 90 pounds, something like that, or it'll ask you to do 95 pounds again or 95 pounds anew for the 16 reps you did last time. It does that every single session. It pushes you a little bit ahead. Your only job is to do what is written. If you consistently do what is written and at the end of your cycle, before you have one week of easy training called a deload, and you start a new cycle at the end of your cycle, you never actually failed at a weight. Like you tried to get 17, but you got 16. The 17 wouldn't move and you put the bar down. You're like, holy crap. Hopefully nobody saw that. That never happens to you. You've never trained close to failure, but that's okay. The next time you program in your weights and you do three reps in reserve for that first week, go a little harder than you think you should be or you typically did. And then at some point during the middle or end of that cycle, you will actually hit failure trying to get to those objective targets. Because here's a big problem with trying to estimate failure. If you go based on how hard something feels, it's kind of different. Like you said, you had a tough day at work versus easy day at work. You ate well versus you didn't, slept well versus you didn't. And it's all perceptual, which is nuts. It's kind of like not having a mirror, but asking someone to stand in front of you and help you put on makeup. Thanks for your input, but I need a friggin mirror because I don't know if you're just messing with me. I look like a clown. I put lipstick over here instead of on my lips. Who knows? But if you have objective criteria of this is what I did last week and I just want to go a little bit beyond. It is inevitable that one of two things happen over the long term. One, you will reach muscular failure and you will be unable to do a repetition. Or the other is you'll get infinitely strong forever and now you're Superman. One of those is more realistic than the other. So when people say, I don't know what's close to failure or not, my answer is very easy. Download the rpi. No, sorry, wrong sales pitch. Oops. Put some numbers on the board and just by a little two and a half or five pounds or one rep each week, beat those numbers week upon week, commit yourself. I must hit 18 reps. That's the goal. If you can't do it, success, you went to failure. Now you know where the limit is. Now you're building an intuition. But if you did get those numbers next week, you go higher and you go higher and you go higher versus if just like, oh, I think I went hard, I don't know what that means. You could be very wrong and oftentimes are.

[Peter Attia]

So is it safe to say that if a person is already. And by the way, we talked about what's sufficient for exercise selection, technique, intensity, we didn't specify volume. What would be a red flag for you in that individual? If their volume sets per body part was below X, where would you say? Well, it should be expected per week.

[Mike Istratel]

I mean, if you're beginning a few.

[Peter Attia]

Sets, yes, but this is for this.

[Mike Istratel]

Kind of intermediate person, below 5 or 10 sets per week is not a sufficient effort to expect your best results. Between 10 and 20 sets per week is fine, but for many people you have to use a second qualifier, which is what's actually happening to you. If you aren't getting super sore or super mega tired in your muscles for a day or two after training, if your strength continues to be stable or increases session to session to session, and you're on that fewer than 20 work sets per muscle per week, per muscle.

[Peter Attia]

Not per body part, in other words, bicep would need to be 20 sets per week.

[Mike Istratel]

Correct. Wow. Yeah.

[Peter Attia]

I think we have a pretty good explanation for why somebody at this table has small biceps. Yes. I'm not saying how dare you.

[Mike Istratel]

I take that offensively, by the way. So then, if all of the signs show that you're not actually excessively fatigued, your volume is either okay or less than it could be. If you're not getting great results visually, but you're always running into strength plateaus, if you're always tired and sore, and if you're north of 20 sets per muscle per week on average hard sets, then probably doing less is good because you have almost every indicator of doing too much. And so you'll be able to intuit rather quickly if it's too little or too much. Those are most of the variables involved in the gym part, except for one, and that is when is the last time you took a break? Because there's a concept called accumulated fatigue or cumulative fatigue. Your muscles and the rest of your body recover very well between sessions, but not 100%, maybe 90 or 95. And if you're a mathematics fan, if you multiply 0.95 by 0.95 by 0.92 by 0.9 by 0.95. Enough. You're down to 50% recovery within like six or eight weeks. And then how could you possibly be making gains? So every, for the average person cranking away, probably the person listening to this podcast, one week out of every eight, one week every two months, don't go to the gym, stay active. Maybe do a bodyweight squat or a push up or two in your hotel room or something. Ideally try going on vacation. If not, try to not exercise. And be a little easier at work. Be a little easier on family stuff, have some fun, cheat foods, eat a little more than usual. Be a little less active so that your body can recover in a way that it can never recover between sessions. But it gets a whole week to do this. And once a year, at least take two whole weeks like that. We call that active rest. So that first thing, one week off is called a deload. And the second thing off, where you take two weeks in a row of basically just not even coming to the gym. And if you do just do the lightest, easiest stuff ever, it takes 10 minutes. That reduces your systemic cumulative fatigue so much that it brings it back down to zero or almost zero. Some people will say, look, 16 weeks I've been cranking. First 12 weeks, great results. Last four weeks, I don't know if I'm moving the needle. Maybe you're just really tired. Pushing the pedal down harder is usually not the best way to do things. It might be time for a break. People come back and your muscles resensitize to the stimulus if you take time off. So when you come back, go back to two or three sets of everything, not four or five sets of everything. You're gonna get really sore and really pumped from just a few sets and you're gonna be growing again. You do that for another six to eight weeks, you get tired again, your strength starts to plateau. Take another week of easy training or no training at all. And that's how the cycle repeats itself. It's probably most of the stuff I would say about how to analyze your training inside the gym to get closer to your optimum. There's lots to say about external gym variables, but one thing I'll say really quick is this. Before I ever consult people nowadays about how to pursue incrementally more optimal outcomes for their muscle, people who want to gain muscle but are frustrated if they aren't jacked enough, nowadays I always take time to find a Reference frame of what have your gains been like, how much work have you been putting in, how long have you been training? And to see if, how do genetics play a role in this and how does age play a role in this? I've consulted with people before who are in their 60s, weighing something like 150 pounds, fairly lean. They aspire to be in the low to mid-200s. Fairly lean. I told them that outside of an anabolic steroid cycle, that's probably got an even chance of killing you, as it does of getting you jacked. You're not going to get that jacked and your progress rate is just going to be much slower than the 20 year olds at your gym. But sometimes we forget that age has such a profound effect on our results. And we look around and there's all young people like, well, I want to look like that. Well, guess what? 1982 was a long time ago. So unless you have a time machine or age reversal, which I think age reverse.

[Peter Attia]

And do you think, do you attribute this to the hypertrophy of type 2 fibers which are necessary for the power generation that's necessary for producing the gains we're talking about?

[Mike Istratel]

That's definitely a component of it. Another component is overall systemic ability to recover. You have so much DNA methylation and all this other kind of damage and accretion of the wear and tear of age that your organelles and your cells don't work as well as they used to, your organs don't work as well as they used to. A lot of times you're taking for granted the fact that now in your mid-60s, you run a top 500 corporation and you have more stress than most people can handle in a day. You have that in an hour. But back when you were making the gains of your life when you were 18, your job was to show up to school, go to the gym, eat at the cafeteria and smoke weed. And that's all you did every day. Of course you have the gains of your life. People discount that. They also look to athletes and they go, oh, my God, like that bikini competitor. She looks amazing. I want that body. Well, check this out, Linda. You're 56. You have three children, one of them is in college, two or not. You are CTO for a major company and you sleep five hours a night. That bikini competitor trains a few clients, she posts on OnlyFans, and she does nothing else other than train, recover and watch Netflix and sleep nine hours a night of an uninterrupted sleep. It's two completely different worlds. She's also 27, by the way. Strange times, I know, but especially with social media, there is nothing that surprises me anymore about how unmoored some people can be from realistic expectations. The other thing is genetics. The most important factor, other than time spent in the gym about how jacked and lean you're gonna get, is genetics. And it is a hugely, hugely important factor. You have to understand that your goals have to be referenced to what your genetic likelihood of achieving them are. The only way you'll find that out is if you work at it for a while and see what happens. But some people work at resistance training for three years, they'll accrue five pounds of muscle, burn three pounds of fat, and they'll be like this next year, I want to gain 10 pounds of muscle. And you go, whoa, that's not how hyperbolic curves and asymptotic curves work. You got it backwards. If in three years you gain 10 pounds of muscle, in the next three years, maybe you can gain five. That's realistic, does not work in reverse. So it's really, really important to contextualize multiple qualities. One is, how much recovery and rest and relaxation time do you get compared to work and being underslept? Another is genetics, and the other is age. And so if people say, I want to get more jacked, the reason I'm ranting about this, Peter, is because I've had many clients who were willing to put in whatever work it was going to be necessary to put in, but they were older, they did not have particularly great genetics, and they had already gotten most of the muscle gain that they were going to get, not all, but most. And they requested a formulation from me of their exercise plan that would get them categorically better gains. And outside of pharmaceutical enhancement, I had to tell them in some way or another that was impossible. I ended up telling them that after many years of struggling myself to try to optimize for them and get them those gains. Because I'm like, look, I'm a science guy. I know things. I think I've been fairly successful in my own body. Why can't I get these people to gain muscle? And those that trifecta of age, genetics, and how much of a professional bodybuilder or fitness person do you want to be for the next several months? They are the biggest factors for results. And people seem to think that you can just hack your way to the best plan. And if you just do the right things, you'll get amazing results. It has to be in context. Unless you like setting yourself up for really unfortunate experiences where you get quite upset that you couldn't do the thing. People will arbitrarily assign themselves an amount of muscle they want. It does not work like that. Put in the diligence, put on the time, see how it goes. Things are going well. You can crank it up a little bit and get a little bit better gains. It's going to take time. If things are not going so well, you have to optimize to make them go a little better. But there's outside of the basics, nothing you're going to be able to do that is going to be a category leap of results short of what I estimate in the early 2000-30s will be the great pharmaceutical renaissance. And then you can just turn myostatin off and get as jacked as you want until we get that realism can be a painful pill to swallow.

[Peter Attia]

Well, it'll be interesting to see if, even if we can turn myostatin off as adults, if it will have the same impact that it has in the cartoons. Right. Like when we look at the animals that have myostatin knockouts, which are just some of the most enjoyable things to look at. Truthfully. It's like our favorite things in med school. We're looking at the myostatin knockout chickens and cows.

[Mike Istratel]

Yes.

[Peter Attia]

But it's not clear if you took a mature adult an inhibited myostatin, if you would get the same benefits. But let's go back to out of the gym. One more thing we didn't discuss. I just kind of want to hear your thoughts on when something out of the gym is playing a role in your unjackedness. Is nutrition often a factor or is that generally not? In other words, is it so rare that someone is not getting enough protein or not getting enough calories that that's the problem? Is that just not something you see much?

[Mike Istratel]

It's a thing.

[Peter Attia]

Okay. I would assume it's more a thing with women than with men and maybe more with older women than men and maybe even older men. When you just see more anabolic resistance.

[Mike Istratel]

All of those are true. It's not difficult to align your nutrition. Well, eat mostly healthy foods. Some junk here and there is totally fine. Getting in enough protein if you want to be real serious about optimizing your muscle gains. Something like a gram per pound of protein per day. So if you weigh 150 pounds, 150 grams of relatively high quality protein, if it's difficult for you to meet those goals. Amazon sells your bars already, don't they?

[Peter Attia]

I don't think they're on Amazon yet. If not. They are. They are soon. Yeah.

[Mike Istratel]

So get you a couple boxes of David Bars and put them between meals. That takes care of protein. The other thing is muscle size is philosophically concordant with being bigger. I know that sounds crazy, but muscle's made of stuff. So when someone wants to be 165 pounds jacked at 150 pounds, it's curious how they think that's ever going to happen. Some people just don't eat enough. And what I would say is the biggest problem I've seen with what I assume is your target demographic for this podcast is intermittency. Lack of consistency. I've had so many clients in the professional realm, older folks, folks that are practicing doctors, lawyers, so on and so forth. Tell me, hey, listen, last couple days, every three or four hours I've been getting in high protein meals. I've been getting good sleep, dope. See them. A week later you go, hey, how was last week? And they're like the parts I remember were fun. I think then I was throwing up a lot in the toilet. You realize that they're quote, unquote good. It's not beneficial to moralize these things, but they're on track for a few days here and there and then they fall completely off the wagon for days at a time. That is a surefire way to guarantee that you don't get very good gains is if you lack consistency. So if you want to get as jacked as possible within the realm of several months time, seek to eat enough food to get the scale to go up about half a pound per week. So if you training hard for 12 weeks should gain maybe 6 pounds or so consistent 6 pounds. And if you're eating a gram per pound per day of protein, spread into roughly three to four evenly spaced meals. Roughly, very roughly. A lot of wiggle room there. That really is all you need to know about nutrition for how to get jacked. That covers probably 90% of the variance. So I'll tell you this. If you described to me a scenario where you were training for 12 weeks, you gained 7 pounds almost every day. You hit a gram per pound per protein almost every day it was three or four meals. And you're like, look, I know it's my nutrition that's the problem. I'd be like, it's probably not. It's probably something else. That great thing about what we talked about earlier with Jordan Yates and how he could do so few sets and get so many Results is that 80, 20 type of rule applies to almost everything else in the human body, including nutrition. So if you're getting enough protein regularly and you're getting enough calories to gain body weight, if you don't get really the muscle gains that you were expecting, there aren't a lot of knobs and levers for us to pull that are going to get these enormous results. That's kind of the situation for nutrition. But consistency is. I cannot say enough things about, because you ask people, hey, how's your diet? Especially if you're a personal trainer or diet coach, there's this kind of halo effect situation where they want to be seen as a good person and diligent and worthy of your time. So. Well, yeah, you know, like breakfast I'll have egg whites, and for lunch I'll have a chicken sandwich. And for dinner, it's usually a piece of fish. And then I have a protein shake and go to sleep. Shut up, Bob. That's one day a week, you lying asshole. And he's like, oh, damn it, you got me. Okay, that was Tuesday, but Wednesday, I don't think I ate anything until we closed that one business deal and I got really drunk with their cmo. It was a great time. I think we had chicken fingers, but honestly, I can't remember. Inconsistency, especially when you're older, especially when you have lots of stress from your professional endeavors, Inconsistency is something that professional bodybuilders cannot afford. You for sure cannot afford it. Now, if you do everything right five or six days of the week and one day is kind of meh, you'll do great. But if the good days are outnumbered by the. I sure hope my trainer doesn't find out about these days, you're not doing due diligence. So that's a big, big part of the equation. And that kind of segue, if you'd like, into a conversation of sleep and stress management, all these other things that can also be the difference between lots of gains or no gains at all.

[Peter Attia]

I'd like to come back to it, but we've now twice broached the topic of anabolics as another tool. Because a couple of times you've made the point, which is, look, this is gonna be about the limit. Your genes are going to start to become your limit. So I guess my question is, you've spoken very openly about anabolic steroids. I've had several podcasts where covered this in detail. But let's kind of tell people what we're talking about for reasons that are maybe A little bit elusive. There's some confusion about is testosterone an anabolic steroid? And of course the answer is absolutely yes it is. And so wait a minute. So let's talk about anabolic steroid use in the context of non medical use. So let's take testosterone replacement therapy where testosterone in a hypogonadal man is restored to typically the upper limit of a normal physiolog logic range.

[Mike Istratel]

It's nice that they do the upper limit right, give everyone good genetics and.

[Peter Attia]

Then we'll just sort of take that off the table for a moment, park it in the context of what is anabolic androgenic steroid use look like in the physique bodybuilding community? Let's talk about the different drugs, let's talk about your experience with it, let's talk about how much it can unleash and let's frankly talk about what the pros and cons are because I personally have no experience with this. That's not our patient population. We don't have patients that are coming in saying my goal is to be jacked, I want some D ball. So there's this, not something we just have any understanding of.

[Mike Istratel]

So anabolic androgenic steroids are all derivatives of the testosterone molecule manipulated in various ways to accentuate some characteristics and de emphasize other characteristics. They're typically taken by athletes in the competitive sphere, bodybuilders, physique athletes and gym people who want a super physiological level of muscle mass and sometimes super physiologically low levels of body fat concomitant with that. And so they'll take anywhere between high end testosterone replacement therapy dose to 10 or 20 times that amount per week.

[Peter Attia]

Let me just pause there for a moment and just give some people some doses because we've talked about TRT before in the podcast. So we typically dose patients twice a week to try to get a smoother level as opposed to once a week. If the ideal dose for a given individual to get them in the right spot is 100mg of testosterone Cypionate weekly, we would always prefer that the patient take 50 milligrams intramuscularly twice a week or sub Q. I will tell you Mike, I don't think we have ever given a patient more than 70mg twice a week or 140mg a week. Probably median dose for physiologic replacement is 40mg twice a week or 80mg a week. So are you saying that there are people out there that would routinely take 800 to 1600 milligrams of testosterone in a week.

[Mike Istratel]

Oh yeah, sometimes. That's not all testosterone. It's other steroids in combination. Usually people take at least that replacement level of testosterone, often more, because testosterone does some really good things for health and general function and tends to aromatize into estrogen quite readily. Which is good because estrogen's cardioprotective, neuroprotective, increases your strength, helps your mood tons sex drive. It actually increases your anabolism in the presence of androgenic steroids and testosterone. So estrogen by itself, not very anabolic. Estrogen in the presence of testosterone is more anabolic than if you had all the testosterone in the world but were unable to aromatize to estrogen. And baseline level testosterone is often taken at somewhere between 250mg a week and all the way up to a thousand milligrams a week, depending on how you're handling the side effects of that excess estrogen production at the higher levels.

[Peter Attia]

And that's usually taken as cypionate, ananthate, sipionate.

[Mike Istratel]

Some people prefer propionate if they inject every day. Ananthate and sipionate are by far the most commonly used. Seemingly oftentimes people inject differentially, but once daily injections seem to provide the smoothest curve. If you put in half a week's worth of super physiological testosterone at one time, your mood for the next several hours is curious.

[Peter Attia]

Yeah, help me understand what that even feels like. So let's just say you're taking 700 milligrams a week, 100 milligrams a day, so 7x physiologic. Do you feel something different?

[Mike Istratel]

Most people feel something, but it's probably a normally distributed population of experiences where some people just can't tell. Some people feel something for sure that they can describe. And some people have panic attacks and will never use again, or they are driven to extreme violent thoughts and extreme sexual thoughts and actions. And those folks are quite rare, but they do happen. So there's a large distribution about which people can have experiences, but I'd say the median experience is the easiest way to understand the average effect of a high degree of anabolic steroids. And for simplicity, testosterone. The psychology is to imagine that what is the average psychological proclivity of a female? What is the average psychological proclivity of a male? Different in many regards. And then you move the needle over one notch into a magical category called enhanced male, and you just typically exhibit more Male like, patterns of thought and behavior than even males do. But males compared to females is the best way to figure that one out. Because if you're like, just know what a male pattern of behavior is like because you're a male. You're like, what the hell is it like to be more like me? It's like everything about me. What's not everything? We actually just had a recent video on the RP Strength channel. I think it's called Roid Rage is Real. We talk about, like, that steroids don't accentuate every quality. You have, just the more masculine qualities. So what are the most masculine qualities? Again, this hits everyone a little bit differently. But on average, you become quieter. Men typically are not as expressive as women. You come to show fewer facial expressions of emotion. You don't process other people's emotions as well. You can't fine tune what they feel as much, and you don't care as much. Less empathy, way less empathy, all the way to similar levels of empathy, but on average, definitely less. And you become more likely to be irritable. You become more likely to have anger and aggressive sorts of thoughts. You become more attuned to the dominance hierarchy in general, and you become someone who thinks more about where you stack up in the dominance hierarchy in a way that you take affronts and slights more poorly than otherwise. So if someone on social media says you're a bad person, if you're not on a lot of testosterone, you're like, just having a bad day. That's okay. We all have a bad day. We need to rage out on someone. If you're on a lot of testosterone, you're more likely to be like, I wonder if he'd say that to my face. I wonder if he would be real quiet around me because he would know that I'm not someone to be messed with. Weird, weird thoughts like that. Women almost never have thoughts like that. Men have regular thoughts like that in the right context. People on steroids have more thoughts like that in almost every context than on average they would like to have. Another one is you become linguistically less expressive and your fluidity of communication falls. So a lot of times when someone is using high levels of anabolic steroids in a relationship and that person happens to be male, the degree of communicative throughput falls substantially, just generally not good for most relationships. Another one is sex drive. It's difficult for women to appreciate what the male sex drive is like on a quantitative and qualitative level. Both of those tend to magnify Especially if you're not bringing your estrogen down. You bring estrogen low enough, you don't even remember what the hell sex is for or why people are even in that sort of thing. But if you have a lot of androgens, a lot of estrogen, the hunger, the thirst becomes very annoying.

[Peter Attia]

Now, at that level of testosterone, are you taking an aromatase inhibitor or are you literally letting the estradiol get. I can't imagine how high the estradiol level becomes at that.

[Mike Istratel]

As high as you want.

[Peter Attia]

So typically estradiol would be over a hundred at that point that's left alone.

[Mike Istratel]

It depends. It depends on a few things. One is different. People respond differently, both physique and psychology to high levels of estrogen. High levels of estrogen for some people are like swimming in a pool of magical clouds and they love it. And their physique looks great, they get nice and watery, their joints feel amazing, their recovery is awesome, their sleep is awesome, sex drive is awesome, Everything's great. For some other people, they get a lot of estrogen and it actually prevents them from getting good sleep at higher levels. They're water buffalo bloated and they can't even see their abs anymore, even though they're 8% body fat. And they get mood swings, all this crazy stuff. And so it really is very individually dependent.

[Peter Attia]

This is actually quite amazing. And this is not entirely unlike women. If they're undergoing hormone replacement therapy in perimenopause, it's not a one size fits all. They can have tremendous variability in their response to estrogen and of course progesterone.

[Mike Istratel]

Yes, huge, huge, huge. The other thing is what we're learning in evidence based approach to anabolic steroid utilization and performance enhancing drug utilization. It's called the Safer use model. Probably the biggest promulgator of it is a gentleman named Joe Jeffrey in the United Kingdom. Super, super expert, exceptional bodybuilding coach, great bodybuilder's own, right, Just reads literature all day long. And folks like him tend to espouse that probably the best way to manage estrogen is to use some combination of exogenous drugs that are androgens themselves. To get the estrogen level. You have the best notable metrics at how you feel, how you look, how your blood work is, health, et cetera. So here's an example. You take a thousand milligrams of testosterone.

[Peter Attia]

I'm still wrapping my head around this.

[Mike Istratel]

It actually goes into your thigh in a needle. You don't have to wrap your head around. So it's Intense. It's a lot. You take a thousand milligrams of testosterone and that comes with a concomitant aromatization. So you have a lot of estrogen. Some people, they feel totally great. For some people it's too much. For those that it's too much estrogen, they might be able to take 500 milligrams of testosterone and then 500 milligrams of primobolin. Primabolin is a synthetic anabolic androgenic steroid developed in, I think, the 60s and 70s. And it's designed not really to convert into estrogen, hardly at all. Other steroids like it or master on, they not only don't convert into estrogen, but they actually antagonize estrogen conversion for the testosterone you're shooting in to some extent. And so if someone's like way too much estrogen for them, they can do a 50, 50 split of testosterone and Primobolin so that now they get all the good estrogen from testosterone, but not too much of it. But they get most of that anabolic drive from the rest of the Primobolan. But without any more estrogen addition, it could be 250 testosterone and 750 milligrams of primo. It can be 750 test, it can be 250 primo. And anything between. And you kind of experiment that in a lot of bodybuilding coaches, what they're really good at is starting you on a certain cycle that they have the wisdom to know works for most people, and then leveling up one drug, leveling down another to get, among other things, kind of that testosterone, that androgen to estrogen ratio, to be something that you have your best performance at, best health, so on and so forth. But the sex drive component, especially if you have a lot of estrogen going on, qualitatively it can change. Quantitatively it can change. Now, huge variation. Me personally, I never got like enormous sex drive upregulation. I did get some, but nothing crazy. I've been up to as much as just north of 2000 milligrams per week. Currently I'm only 250 milligrams per week. But my sex drive is more or.

[Peter Attia]

Less the same, which to me makes me wonder, is there any difference in androgen receptor expression that you're able to appreciate between 250 and 2000? Are you so saturated in your androgen receptors already that do we actually know if there's a benefit to all the additional testosterone that you could have been on at at almost 10x your current dose 8x.

[Mike Istratel]

You won't know until you try.

[Peter Attia]

Did you appreciate a difference in positive effects? I don't doubt that there could be a difference in negative effects, but if the positive effects are accrued through testosterone binding to the androgen receptor, that complex leading to more nuclear transcription, wouldn't what you said suggest that you might have already hit maximum benefit at 2,50?

[Mike Istratel]

There are some reasons to believe that your androgen receptor density escalates up when exposed to more androgens and not down in some cases. And so that means the more gear you take, the more benefit you have, rather linearly in my experience, the experience of most people you talk to, it's again, slow newsreel, same asymptotic curvilinear relationship. For me personally, and this is something I didn't discover until quite recently, I would say, unfortunately. So I get probably almost the same gains at a thousand milligrams that I do at 2000. Anything north for me of 1500 just drives me insane, mentally insane, and seems to not really affect my physique, hardly at all.

[Peter Attia]

How much water retention do you get at these doses?

[Mike Istratel]

Considerable. Although if you manage your estrogen well, it's not as much as you would think.

[Peter Attia]

Managing estrogen with aromatase inhibitors.

[Mike Istratel]

Oh yes, that's right, sorry, I had a point there back then. Aromatase inhibitors in many cases are incredibly toxic drugs and you generally want to avoid taking them if you can. Sometimes you have to to get really dry for a contest. But that's only a few weeks out from the show. And so the modern wisdom, so to speak, with the evidence based crowd, the safer use crowd, is to manage your estrogen with differential amounts of testosterone and non estrogenically converting compounds like Primobol and mastron versus taking just as much testosterone as you ever would, but taking an aromatase inhibitor on top of that. Because aromatase inhibitors in an unbelievable range of circumstances fuck you up. They're neurotoxic, they're cardiovascularly toxic. It's bad, bad news. These are the compounds you use when you have breast cancer and they're like, you're gonna die if you don't take these. They are gigantic hammers for a very small nail. If you want to see who's done the worst to their health across the body meal industry, it's whoever runs the most AIs as we call them, aromatase inhibitors. And there are various other pharmaceutical ways to control estrogen. Probably the best way for health and effect is only use as much estrogenically converting drugs, nandrolone derivatives and testosterone as you need to get whatever estrogen you feel best at. And the rest of the anabolic load should come from things like Primobolin and Masteron that don't really do much to estrogen at all, but increase your androgen and anabolism, so on and so forth.

[Peter Attia]

So how do you differentiate between when you're using testosterone versus nandrolone?

[Mike Istratel]

Mostly by experience. Nandrolone has some really cool positive effects, kind of exaggerated versions of testosterone. Some people are naturally very dry and so if they don't take anandrolone for their very hard training cycles, they will have insufficient body and joint water hydration. Joints will creak and they'll get hurt a lot and it's just really bad recovery. But you put them on nandrolone variant and all of a sudden they have enough intramuscular and intra joint water to where they feel great, everything's working. Other people will get on nandrolones and have so many of the side effects that they're like, this is way too much estrogen conversion for me. I'm a giant water buffalo. If I just take testosterone, I'm plenty hydrated, so I don't need to do that. Nandrolones also have this curious side effect. It's colloquially termed deca Dick Nandrolone decanoate does a substance called deca. It is erectile dysfunction, approximately caused by the presence of nandrolones. And it's curious because nandrolones, typically with their estrogenic effects, elevate sex drive kind of the more estrogen you have to a point, the more sex drive you have. If you have presence and so you're horny, but little, little Billy down there doesn't work as well as he used to or at all. And so if you're in that boat, you're like, well, look like it's just trade off. How much of a benefit do I get in training versus how much is my wife or girlfriend gonna hate me or hookup culture doesn't work for me anymore, so on and so forth. So lots of considerations there. Nothing generally better than to start out with a solid plan that makes sense with a coach that knows what they're doing at very low doses of everything and slowly play with compounds and scale up the very notable, highly note your beneficial effects and highly note your deleterious effects or downsides and see where you can strike a balance that's acceptable to you and considers long term consequences, et cetera, et cetera, et cetera.

[Peter Attia]

So how old are you, Mike?

[Mike Istratel]

40. Okay, I know I look 50.

[Peter Attia]

Not where I was going. What would you look like now? I'm going to just posit, I'm guessing that you have good genes, you eat well, you train very hard, and you're using enough anabolic steroids to fuel a small country. If we subtracted that last one out of the equation because I don't have a sense of what the relative contribution is, what would you look like if you did everything the same minus the anabolic steroids or if you run regular TRT, you are taking 100mg of Cypionate a week. Do you have a sense to quantify how many pounds lighter you would be in terms of total muscle mass?

[Mike Istratel]

Me personally or the average person?

[Peter Attia]

No, you personally. Yeah, I want to get a sense.

[Mike Istratel]

Having had used steroids before at high doses or not having ever had used them.

[Peter Attia]

Oh, very good question. Yeah, good question. Let's do both.

[Mike Istratel]

You can do both?

[Peter Attia]

Yeah, let's do both. When did you start using high doses of anabolic steroids?

[Mike Istratel]

When I was 27 years old.

[Peter Attia]

Okay, so let's say we go back to 27 years old. We put you on the same path of doing everything you're doing in terms of your training, intensity, all of the scientific principles that come into it, et cetera. But you've never gone down the path of taking mega doses of steroids. And if you've ever taken testosterone, it's literally to bring your total t up to 800 nanograms per deciliter.

[Mike Istratel]

@ this body fat. I would probably weigh about 200 pounds versus 230 versus 230 to 35. Okay, now 35 pounds.

[Peter Attia]

I know that's a lot of muscle. That's a lot of muscle.

[Mike Istratel]

Yeah. But I would still be very jacked. I mean before I had ever started taking anabolic steroids, I was already an elite powerlifter. I weighed 270 pounds at probably 30 something odd percent body fat. But I've dexed myself in a master's program when I had been totally drug free and I had a hundred and somewhere between 175 and towards the end of my drug free era, close to 185 pounds of fat free mass. For someone who's 56 like myself though if anyone asks, I'm 5 9.

[Peter Attia]

So your FFMI would have been north of 30?

[Mike Istratel]

Oh, not quite, but up there, yeah.

[Peter Attia]

FFMI, for folks not familiar with it, is Fat Free Mass index. So it's total fat free mass in kilograms divided by Height in meters squared. And just for reference, it's pretty hard to be above 25 without anabolic steroids.

[Mike Istratel]

Unlikely, right?

[Peter Attia]

That right there suggests some interesting genetics, that you were probably 29ish, 28, 29, something.

[Mike Istratel]

It's easier to do when you're really fat though.

[Peter Attia]

But your ALMI was probably very high as well, I'm guessing.

[Mike Istratel]

Sure, I have very elite genetics, not swagger. It's just stating a fact. Anyone who sees this on video will notice that my head is curiously shaped like my mastication muscles are absurd. I looked like this before I ever took any steroids. I have a picture of myself on Facebook from the side before, for sure I took anything. And I was like, holy crap. I usually wasn't bald back then, but I shaved bald. And I was like, yep, there they were, those weird masticating muscles. And so, yeah, I was kind of built for the shit. But also I got plenty out of steroids, but not as much as some other people. Some people without steroids are not overly jacked, but with steroids, it's a total transformative event. And then when they retire and they come off of steroids, they're like, holy, did your back to mortal sized How? Whereas other people come off of steroids and like they keep most of their muscle mass and they're on TRT and they just look so jacked for forever. Huge, huge variation. But for me, steroids did a lot, but nothing crazy. I didn't gain 70 pounds of muscle, but I gained, yeah, 30ish, something like that, over 13 years. Been a while.

[Peter Attia]

And so now the reverse question, which I guess is tomorrow you just decide, you know what, I'm going to keep doing everything I'm doing, training wise, I'm going to gradually taper this thing down because at this point you're going to need to be on testosterone for the rest of your life.

[Mike Istratel]

I assume I don't have to be. My testicular shrinkage has been zero. My spermatogenesis so seemingly zero. Some people just don't suppress.

[Peter Attia]

How many weeks a year are you completely, completely off any anabolic agent?

[Mike Istratel]

Zero.

[Peter Attia]

And how many years has that been?

[Mike Istratel]

Thirteen.

[Peter Attia]

I find it hard to believe you would continue to make testosterone hugely, genetically variable.

[Mike Istratel]

And in addition to that, even if I make not making any now, within several weeks, my testosterone production would likely resume. Now, if I had balls the size of capers, yeah, you'd be like, it's an uphill battle. Most people can resume normal testosterone production after the cessation of anabolic androgenic steroids but not all. Maybe like 90 10. You don't want to be that 10. Which is why it's a huge thing for me to say, don't just start steroids or TRT without a real long hard think about what the hell you want out of life, especially if you have yet to have children, but want children. Because I know people personally who've done one of two things. I know people who on full steroid cycles during that time father children I now call my friends. They're real humans I can point to and be like, you're a steroid baby. They're freaky. They're pissed. I'm kidding. Obviously doesn't go into the germline cells. The other thing is, I know some people who you blasted for a long time cannot have children. Tried everything. It's just not in the cards. Their spermatogenesis just gone. Yeah.

[Peter Attia]

I can't imagine it's 90 10, though, Mike. I cannot imagine that 90% of people that use anabolic steroids for more than two years would be able to resume.

[Mike Istratel]

I may be incorrect.

[Peter Attia]

Testosterone production.

[Mike Istratel]

I would look into it. I think that most of the stuff you hear about how the comeback is difficult is from people for whom the comeback is difficult. And having been in the bodybuilding powerlifting space for a long time, most people come off and they're just normal after. Almost everyone know that's come off completely is just normal after.

[Peter Attia]

So what do you think? Back to the original question. If you were to come off today, how much of the. To call it the 35 going down.

[Mike Istratel]

To regular TRT, not super TRT, correct.

[Peter Attia]

You went down to 100 milligrams a week or none. If you were able to make that on your own.

[Mike Istratel]

Sure.

[Peter Attia]

Of the 35 pounds of Delta Supplemental muscle, how much of it would you keep?

[Mike Istratel]

You think about half?

[Peter Attia]

Yeah. So in other words, there is a difference between the muscle you gained versus the muscle you never had.

[Mike Istratel]

Huge. Which is why if you have a natural body muscle and federation that allows.

[Peter Attia]

You to compete after you've used steroids is fair.

[Mike Istratel]

Yeah, yeah. Now let me back that up. If that's the explicit rule of the federation, I don't like that. I call it a natural federation. I respect every athlete in it. I think it's wonderful that they're doing what they're doing. And in a sense this is a very different category, so it's cool. If I was making a natural bodybuilding federation myself, you would have to sign paperwork that says, I've never used anabolic steroids because the literature we have now on how much muscle you gain and keep forever is unequivocal. We even have mechanistic data on how it happens. Your satellite cells that are incorporated into your musculature, which are kind of dormant and then they get in and then they grow big. We have no reason to believe they ever leave. It's like letting your aunt come live with you for a few weeks and like Aunt Linda's here for forever. Here's our children. It's like that. So having done higher doses of androgens ever for weeks or longer on end can give you a higher level of muscularity, Especially only if you've gone beyond your natural limit. People generally can gain only so much naturally and only so much on steroids. Steroids are not unlimited for gains. If you were Gonna ever have 160 pounds of fat free mass and you went from 150 to 160 with steroids, but you could have gotten there and would take you three times longer without steroids, then the inherent advantage you don't have because you just got there faster. But if you got to 180 on steroids and then you quit all the steroids and now you're back down to 170, you could walk around and maintain that 170 on a normal secretion of testosterone or normal TRT, you would have never been able to do that without the steroids. So it's a permanent advantage. If you've ever been hyper muscular from steroids, you will probably never be as small as you would have normally been ever again. And that's a big deal, very big deal in Olympic sports because you can just kind of hide out. Don't get into the doping pool. Crank it. Get into the doping pool. You drug free but you have muscle, it'll never leave you. That's a massive advantage.

[Peter Attia]

Yeah, it sure sounds like it.

[Mike Istratel]

Not that anyone ever does that.

[Peter Attia]

What is your personal calculus for the number of years remaining where you want to be doing supraphysiologic doses of testosterone? Do you think about the trade offs of long term health?

[Mike Istratel]

Incessantly?

[Peter Attia]

Yeah. And so how do you sort of think about it? Because obviously everything has a trade off. I suppose if you're winning Mr. Olympia and you're, you know, you're one of the top five bodybuilders in the world.

[Mike Istratel]

As I am, jk, then the trade.

[Peter Attia]

Offs might be worth it. What's your personal calculation on it? There have to be, I don't know, hundreds of thousands of people that are using super physiologic doses of testosterone in the country. I would guess for many of them it's for themselves. It's like they're not getting paid to do all of them. Right?

[Mike Istratel]

Almost all of them.

[Peter Attia]

It's not because of how they look in a movie or whatever other reason. So. Yeah. What's your calculation?

[Mike Istratel]

So my calculation has many fold variables that go into it. Some of them include my blood work. I get regular blood work. I always have. I did it before, I got on, I did it during. I still do it all the time. It would be funny if I croaked in a few weeks and then you release the podcast. This was going to sound hilarious. It's all statistics and probably release this. Please do release it though. I've got bad genetics for all sorts of things, but I have damn good genetics for health resilience. So I've never actually had blood work a single time. That was like, you need to stop. The last time I had blood work, I was on 1500 milligrams. Total gnarly stuff. Trend balloon acetate. The whole works. My lipids. My overall total cholesterol was 79 or something.

[Peter Attia]

Total cholesterol? Yeah, total cholesterol, 79. That's almost impossible to imagine. You're on lipid lowering drugs though?

[Mike Istratel]

Nope.

[Peter Attia]

That's really hard to believe.

[Mike Istratel]

Now, mind you, I'm at like 7% body fat and leanness is a humongous variable for health. Humongous. I can get into all that if you want. Humongous. Am on blood pressure medication.

[Peter Attia]

Yeah. I was going to ask you about your blood pressure.

[Mike Istratel]

Humongous variable that I've always been controlling. My wife is a medical doctor, so we don't play games. Always checking the blood pressure, always making sure it's on the low end.

[Peter Attia]

What would your blood pressure be if you weren't treating it with medication, Peter?

[Mike Istratel]

I have absolutely no idea. Don't give a shit and won't ever try.

[Peter Attia]

But do you have to come off the blood pressure medicine when you're off the testosterone or anabolic agent?

[Mike Istratel]

I'm never off.

[Peter Attia]

I see. Okay, so what's the lowest you're on then?

[Mike Istratel]

I'm currently on 250 milligrams.

[Peter Attia]

And that's your nadir.

[Mike Istratel]

And that's my sports TRT. We call it super TRT.

[Peter Attia]

I see. But your BP at 250 and your BP at 2000, you would be on the same dose of a blood pressure drug.

[Mike Istratel]

I took double the blood pressure medication roughly at that dose, and I titrated it so that it would always be below the normative values for best health. 120 over 70, that sort of thing. When I took the most drugs, I was almost always in a fat loss phase because you're just not eating much food and you're very lean and you're doing lots of physical activity. Those are all hugely antagonistic variables to high blood pressure. And so if I was massing and weigh 280, I would have to take the kitchen sink of blood pressure meds. And it would still be worth it to do that if I can make a public service announcement. It just doesn't matter why your blood pressure is high. Fucking control it with drugs and then look to lifestyle or whatever. Or whatever. So many people are totally backwards on this where they're like, oh man, I want to clean up my lifestyle so that I can get off these blood pressure meds. Why? Why? We're what, Gen 9 of blood pressure meds? They don't even have side effects anymore. If I'm taking them or not taking them, I can't tell. And so like if I take a pill that reduces almost every single health malady and extends my lifespan by a generation, why the hell wouldn't I do that? And it's so funny when you get this from steroid people because they're like, dude, you're doing Trenbolone that was manufactured in a bathtub in China, but you're not going to take Novo Nordisk's best blood pressure drug. Are you insane? The answer is yes, of course. Making sure blood pressure is good, making sure all the lipid values and things like that are really good.

[Peter Attia]

Is your blood pressure the only noticeable deviation, deviation from normal health that you experience, that you and your wife were able to measure in this?

[Mike Istratel]

I mean, my lipid values probably aren't as good when I'm bulking up, but I'm also on fewer drugs then, so they're not crazy. The last time I've ever had a total cholesterol of over 200 was when I was 13 years old and I had spent a whole summer playing video games, being totally inactive. And I was a portly child. And it was like 202 and they're like, bro. And I was like, oh. And then I turned 14 and began to do sports.

[Peter Attia]

Why were they checking blood on the.

[Mike Istratel]

13 year old basic screening panel? I think maybe it was sports or something, I don't know. Yeah, they do like basic lipid panel for like a lot of people.

[Peter Attia]

Yeah, maybe. Yeah.

[Mike Istratel]

And so I just remember I Can't ever forget that number because I was like, oh, oh, I'm in the red on something. Like you're not supposed to be in the red on something. But for me, my body was always really responsive to body fat levels. If I have a high body fat, I'm probably not an amazing health. If I'm a low body fat, I can take a lot of steroids to the face and still be relatively okay on the numbers. Now there's lots of stuff we can't measure. So my body has taken a considerable amount of damage over the years from anabolic androgenic steroid.

[Peter Attia]

And what do you think some of those damages are?

[Mike Istratel]

Cardiovascular damage, no doubt. My left ventricular wall is probably larger than it should be. I have not had.

[Peter Attia]

You had an echo.

[Mike Istratel]

So I've had plenty of echoes. Most of them were quite some time ago and they're all great. The overall inflammatory exposure to the crazy training volumes, stress levels and independent psychological stress that the anabolic steroids voiced upon me, no doubt has been bad for brain and bad for everything else and so on down the line. Luckily I was smart enough at the beginning to always control my blood pressure and that's a huge, huge killer for people on drugs. I always paid attention to lipid values. That's another huge killer. And I just really got lucky there. And I eat healthy almost all the time. That's a big deal.

[Peter Attia]

By the way, do you use a five alpha reductase inhibitor to manage DHT?

[Mike Istratel]

No.

[Peter Attia]

So your DHT must be 200.

[Mike Istratel]

Yeah, who knows? I could give a shit for hair on my head.

[Peter Attia]

So no, I just think about your prostate.

[Mike Istratel]

Yeah, nobody lost, nobody found on that one. I never cared to check that. No Doubt has taken a hell of a beating over the years. And so while I did it relatively intelligently, I probably did too much. I mostly didn't use super high doses by bodybuilding standards. Like I kind of only a few times used high doses. I would have used less had I had another chance to go around. And in the future, as I continue to compete in bodybuilding into my early 40s, I'm probably never gonna go much over 500 total milligrams because to me it seems my anabolic sensitivity so high that I just don't need much more than that. And north of that, my psychological side effects are so nasty, it's absolutely just not worth it to me anymore, especially with career and stuff like that. And I a little bit more known for my brain than my body. And so it's important to Keep higher levels of intelligence. No doubt I've degraded my fluid intelligence substantially from what it could have been. Sad. I do have one hell of a hedge to all this that most people don't. And I'm going to sound like a total insane person when I say it. I believe it is a high probability that in the early to mid-2030s we will see the fusion of informatics and biology powered by AI such that we will be able to point by point, re engineer the entire human organism at a variety of levels and undo damage like was never possible before. So I never exposed myself to as much statistical risk as would have made an even chance of me making it to like 50. I have a think even chance of making it into my 60s. I'll be in my 60s around the mid-2040s. And most of the future prediction models say that our ability to contend with our biology will be so absurd that there may not be a line between biology and technology anymore. So to put this in simpler terms, I think major categories of disease will be completely solved in the2030s. I think aging reversal will be mastered in the mid to late2030s if I had to take a guess. And I think that if I make it to the early to mid-2030s, then I'm at longevity escape velocity and looks like I succeeded. If I die before then, I'm totally comfortable with all of the choices that I've ever made. And it's been one hell of a run. And I think understanding your own mortality and coming to grips with it is important. As any human person, but especially with the risk I've taken with my body never surprised me. If I croak from a heart attack an hour after we finish filming this, I won't die surprised. I'll die from a heart attack and I'll be like, this is it. And that's to say, not to wave my own flag or anything. Don't do to your body without really thinking through what you're doing. Like a race car driver. Nobody gets into that car and goes, this is the safest thing I could be doing. What, are you nuts? Nah. But most of them have come to grips with the fact that, look, I could die, but I'm good and they're well compensated. It's been worth it to them. And most importantly, they did what they really wanted. Up until recently, that has become, at least to me and many futurists, apparent that some of us listening to this, probably most people listening to this, may never die. Up until recently, that Was not apparent. And you kind of had to figure out, like, how do I want to live my life? And some cases require a longevity, quality of life trade off. And I made that early. Would I have made it the same again on the margins? Probably would have been safer. But also, there's a lot of crazy shit that they do in bodybuilding that I just never did categorically or tried once and was like, fuck that. That's not for me. And my blood work and everything was pretty good the entire time. So I feel okay about it. Not great, but okay. I don't know if that makes any sense.

[Peter Attia]

Yeah, it does. I mean, I'm way less optimistic than you, Mike, about longevity escape. Certainly on that time horizon. I think of the hedge as the exact opposite. So my hedge is, it would be wonderful if in a decade we had technology that treated disease in a way that could restore my heart to the heart. It was when I was 20, because I think about the reduction in function. So my coronary arteries are still clean as a whistle, but my heart's nowhere near what it used to be. I know this, for example, because my maximum heart rate is 30 beats, 40 beats per minute lower than it was when I was a teenager.

[Mike Istratel]

Directly an aging thing, right?

[Peter Attia]

Directly an aging thing. If you look at the electrical system of my heart, and these are things I can't treat, I can do all the things possible to not have my blood pressure go up so I don't get lv left ventricular hypertrophy. I can keep my coronary arteries clean as a whistle, indefinitely. We have the modern pharmacology to do that.

[Mike Istratel]

Isn't that crazy that you can say that?

[Peter Attia]

Yeah, it's wonderful. It's incredible. But I can't change the architecture of the muscle yet. We don't have that ability. My hedge is, how about I just stave off chronic disease as long as possible, stay as healthy as possible, stay in the game as long as possible, so that if it turns out that that was for nothing, we're sitting here, it's 10 years from now, I'm in my early 60s, and someone comes along and says, peter, all that stuff you did was totally unnecessary. You could have been eating Cheetos, drinking margaritas all day long. I have a pill that's gonna make you 20 years old again. I would have no regrets. Yeah, I would be like, I don't care. I am really glad I did what I did. But I would have regret if I put my eggs in the basket that said, I'm gonna drink the margaritas all day. I'm not gonna exercise. I'm gonna wait for the exercise pill to come along, and it just doesn't come along. I also think we just have to accept one of my favorite thought experiments. I was talking about this with a friend a couple of weeks ago. So if you just consider modern human history, we're just talking about 250,000 years. I don't let's forget everything that came before Homo sapiens. You go back in time 250,000 years ago, 200,000 years ago, 150,000. You do this in like 50,000 increments until you hit 10,000 years ago and then 5,000 years ago and then 2,500 years ago and then a thousand years ago. And you go in and you ask them to predict the future, letting them see everything that's happened before. Because, of course, that would be a difficult thing to do. Most points in time, they don't even know anything beyond that.

[Mike Istratel]

They're like, what's the future? You're like, oh, shit, I went back too far.

[Peter Attia]

Yeah, yeah.

[Mike Istratel]

And it's sort of like it would.

[Peter Attia]

Be impossible to imagine because the pace of change during that 250,000 years was pretty much nothing. 5,000 years ago, we get agriculture. Then a couple hundred years ago, we get the Industrial Revolution. Like, we really started to get the first Industrial Revolution.

[Mike Istratel]

We started to get two more steps.

[Peter Attia]

Big step, function changes. But even if you go back in time a hundred years, so 100 years, we're in the roaring twenties, life couldn't be any better. Nobody knows that there's this depression coming. Nobody knows what technology is coming, all of these things. So we couldn't predict anything. You go back in time 40 years. I don't think anybody could have predicted what we're doing today.

[Mike Istratel]

Ray Kurzweil successfully did.

[Peter Attia]

What did Ray predict?

[Mike Istratel]

Almost everything. If you're conservative, 60 to 70% accuracy, which is wild because the baseline accuracy is zero. If you're not conservative and you give him a little leeway.

[Peter Attia]

This was when he predicted this, when.

[Mike Istratel]

Throughout the 80s and 90s, he was able to predict a substantial amount of correct predictions all the way through the 2020s. And he was almost the only person to predict the arrival of artificial general intelligence as, interestingly enough, specifically the year 2029. And now there is a debate of he was probably too conservative and AGI will be here by 2027. In the early 2000s, they did a lot of asking questions of AI experts, people working in the space, and almost all of Them said Ray was an insane person. And about half of them said we could never actually create artificial general intelligence. The other ones were like, oh, in 2100 or 2070, every five years that you ask this, everyone trends closer and closer to Ray Kurzweil's original prediction. He's not doing magic. So earlier you said something kind of interesting. You said, we started 250,000 years ago, then we got into 125, then 50, and so on. As you said that things get faster, progress happens exponentially quicker. But if you plot every single event on human and animal history and geological history, it all plots on the same logarithmic scale. Very, very tight clustering. And right around 20:45, the line's vertical. And so when I make predictions which are not mine, I'm just parroting what other, smarter people have said of possibly getting traction on almost every kind of disease in the 2000-30s. This isn't the wishful thinking of a child, though. Mentally, I'm below the average child, at least in my own heart. This is something that is inevitable based on our incremental understanding and manipulation of the world. It is the most accurate type of prediction that you could make, bereft of exact knowledge, because it's the thing that tracks on that exponential progression. If we're pessimistic about it, we're actually estimating that things will somehow progress substantially less than they have been. Computing power is an easy one. That curve of computing power. In the early 2000s, people were like, that's it. Moore's Law is dead. But then AI picked up the pace and it's outpacing Moore's Law. Like crazy. Exactly. On the trajectory that Ray Kurzweil was the first one, probably the best to formalize. So when I'm saying crazy shit like we're going to kibosh aging, we're going to kibosh disease, and all this other stuff, it's tantamount to someone in the 1930s, peak depression era days to hear that in the 2000s you can make 16 an hour working at McDonald's. And that in the United States, the poorest people are the fattest. They'd be like, you're out of your fucking mind. And you're like, no, no, no, no, it's totally true. Like, I'm in the future. It's totally true. So what do you do for a living? Can you imagine describing to a person in 1930s what you do for a living? Well, social media. And they're like, what's that you're like, oh God, how do we even put this to you? And we're still working in the same physical world, we're really the same humans, but anytime we think, oh geez, there's no way it's going to get this good, all disease eradicated. Hold on a second. When's the last time you've treated a patient with cholera? Do we have cholera in the modern Western world anymore?

[Peter Attia]

This is where I'm less optimistic, no, more confident to be clear. I want to be very clear.

[Mike Istratel]

I could be wrong about all this, by the way.

[Peter Attia]

Yeah, but just as a point of discussion, my optimism is less. Everything you said, I agree with. In terms of compute, velocity, et cetera. It comes down to the manipulation of biology. I think certain things would need to be true. I'll give you a silly example. Do we believe that in 10 years we will be able to take an egg that has been put into a frying pan, fried, the clear part has turned white, and make the white part clear again? Do we think 10 years will bring the technology to do that?

[Mike Istratel]

Yeah. Hell yeah.

[Peter Attia]

But why? Why do we think that we'll be able to unfold proteins again?

[Mike Istratel]

Because Google's DeepMind project just mastered protein folding last year. And this earlier this year, it took the first open contracts with major pharmaceutical companies.

[Peter Attia]

Again, I'm very famil with it, but that's a remarkable problem for which obviously a Nobel prize was awarded, but a very different problem, like I'm just not sure that the entropy will allow the reversal. Right. So what DeepMind did again, it's incredible that they could actually take an amino acid sequence and predict the protein structure in folding. But when the protein has folded, which is why the egg goes from clear to white in the pan. How do we un denature that?

[Mike Istratel]

Through industrially designed enzymes, which we do not have the brain power to design, but for which I'll put this as well as I can. For which in the 2030s AI will be comically overpowered for. Because we think we're very complex and by our own standards we're insanely complex. But AI is so much smarter than us already in many of the relevant ways and soon to be smarter than us to a degree that most of us have difficulty conceptualizing. Just a quick analogy. Imagine explaining to your dog why the only season inside of your house is a light summer day. Peter doesn't know what seasons are. Its total communicative throughput involves gestures and emotions. It knows its name, it knows sit. It knows a few other Things you can't do it. It's impossible. AI, as predicted by these very simple equations, which have never steered us wrong of how smart it's going to be in 10 years. In 10 years will be like probably several orders of magnitude smarter than us, than we are, than dogs. So it sounds like wishful thinking and hope. No doubt many of the comments in this will be like, this guy's an idiot lunatic. Fair play.

[Peter Attia]

I don't necessarily think that. I think that's unveilable. But they might look like me and say, peter, you are so pessimistic. How can you be so pessimistic? Like, it's not that I'm pessimistic, it's how can you not be more optimistic?

[Mike Istratel]

But nevertheless, sure, sure, the solutions to the problems that we're seeking to systems that intelligent, should they choose to solve them, can be, for lack of a better term, pedestrian in nature. And they're going to be dealing with problems that are much more complex than the re engineering of human biology. So for me, when the raw compute and the raw understanding of how to manipulate matter and energy to get at kind of any kind of shape you want at a given energy input, when that's there, the only question is like, are we going to try to do it or not? And that's where I come back to the incentives and constraints problem. The biggest hurdle to the development of advanced pharmacology and genetic engineering and so on to do this kind of thing is going to be regulatory in nature. Hands down, FDA, everything's off by five or 10 years. It sucks. But once AI has enough time to cook on these problems, the candidate drugs released will run through trials with just an unreal record.

[Peter Attia]

But why?

[Mike Istratel]

Because if you have very. Not so good at things, AI that's decent.

[Peter Attia]

No, but like AI is going to do a great job at the first step of the process, which is what's the molecule right now it's trial and error. It's brute force. It's super painful.

[Mike Istratel]

Yeah, not at 4 right now, exactly.

[Peter Attia]

AlphaFold changes that. How is AI going to streamline the phase one trial where we have to prove, once we have the ind.

[Mike Istratel]

Oh yeah, no, no, it doesn't streamline it at all. It just flies through it like knocks out phase one, knocks out phase two, knocks out phase three market. So you can say, right, but phase.

[Peter Attia]

One to phase two to phase three, it's still going to take a decade totally.

[Mike Istratel]

But at the end of that decade we have super drugs hitting the market all at the same Time as opposed to the incremental process. The increments are all handled up front by the AI. And that last decade is just like, we just gotta do this.

[Peter Attia]

Yeah. So your example would be, it's like coming up with retatrutide in 2014 when we had liraglutide as the first generation GLP. One that sucked.

[Mike Istratel]

Yep. We already knew how to build ratatrutide back then. And we could have just done it. No one cared because the money wasn't there. Slash, there's lots of other Candida drugs you could work on.

[Peter Attia]

That's interesting. Yeah, I hadn't really thought of that.

[Mike Istratel]

Yeah. And so if the AI is powerful enough, it'll just give you candidates that are just killers. Right off hand.

[Peter Attia]

It's like, but how will it know that? Because again, this is such a silly philosophical discussion. But didn't we kind of need to see that, okay, semaglutide was better than liraglutide, but we had to see. I don't know if this was predictable. You had to actually see the experience to then go from semaglutide to tirzepatide and realize that, oh, maybe it's the GIP as well as the glp. That's really good. And yes, now when we look at the pipeline, it's different. So I do wonder. It's a very tantalizing proposition. But I wonder how much of it can be figured out through simulation. Which is what would be necessary eventually.

[Mike Istratel]

All of it. But I'll give you the second rung of what's starting to happen now. The second rung. The first rung is candidate drugs based on protein structure alone. And will that protein structure fold into the receptor we're targeting well enough to give us some activity. The second phase is. This sounds funny to say, but it's computationally going to be tractable quite soon. Simulating every single protein in the human body and seeing how that candidate drug interacts with every single other protein. And then you just optimize the selection criteria for dial up the effect, dial.

[Peter Attia]

Down the side effect.

[Mike Istratel]

Are you familiar with Geparon, AKA Exua, a new major depressive disorder medication? So, Jepyrone. The trade name is Exua.

[Peter Attia]

What class?

[Mike Istratel]

Tarragoni. Ssri, I think. And it only targets the serotonin receptors in specific parts of the brain, as opposed to just like, you're gonna get it all. And so it has seemingly no more probability to reduce sex drive or alter consumption of food patterns than a placebo that's not even developed with AI, that's just a more selective targeting. We can get almost 100 to zero ratio targeting with that phase two approach. Now you just want muscle growth and skeletal muscles only. You got it entirely AI driven. And when the first phase one participant takes that first pill, there's an almost 100% chance they're just gonna be like, holy crap, what else do you feel? How's your blood work? Everything's totally normal. Because we've tested it on every single other receptor in the human body. There are definitely bumps in the road with that. It's not quite just that simple, but it's on the way there. And the last thing in the world I'd ever want to do is to think, oh, AIs. Every now and again you hear like, oh, AI is overrated, it's overhyped. In my view, there is no overhyping AI, short of like, it's magical and it's going to be here tomorrow and we'll never die. Fine, okay. It's a few years too off center. But the power of computing all of this and then using that computation to test it in the human body and getting iterative loops on that is to me not to be understated. And if somehow biology is somehow magically intractable for older folks or whatever, I think that scanning of the human brain and brain machine interface and mind uploading is going to happen by the 2000-40s anyway. And then it doesn't matter what the hell your body's like, you live in the cloud.

[Peter Attia]

Yeah, I've thought about that a bunch. I'm not sure I like it.

[Mike Istratel]

Why not? You can always just unplug.

[Peter Attia]

Yeah. Let me ask you an interesting question. So if you had to choose in the Matrix whether you wanted to just stay in the Matrix and be completely oblivious to the swamp that you actually live in, or would you rather be like unplugged from the Matrix and eat the porridge every day and hang out with Morpheus?

[Mike Istratel]

I have a worse answer. I'd fight on the side of the machines. I want the machines to win.

[Peter Attia]

Machines are choice in or out of the Matrix.

[Mike Istratel]

Oh, well, however they best can use me, I guess. The Matrix is an unbelievable series of films until the last one was the third one.

[Peter Attia]

How could they possibly have ruined that franchise?

[Mike Istratel]

I'd never say that. The 100 million other people. I haven't even seen it, Peter, to be completely honest. Because my friend, someone I Trust Very dearly, Dr. James Hoffman, I was like, so. He's like, just don't watch it. I was like, nope, not gonna see it. I've seen the last three Star wars films, and I wish I could unsee those.

[Peter Attia]

Well, what you have to do when you see the final version of the Matrix, you have to go and watch the first two three times over again to purge.

[Mike Istratel]

It never happened, honestly. Just the first and second and the second one isn't a very deep movie. It's just the greatest action film ever made. Like the freeway scene, you just can't beat that. That's the only reason that movie is any good. The Matrix presupposition is preposterous on almost every ground that you think about it. The machines had, in the plot of the Matrix, a type of fusion, but they also used us as batteries. Are you kidding me? That's like 10 orders of. How are they feeding us? Like, you just burn the wheat, for the love of God, stop feeding it to humans. That whole thing is ridiculous. The other thing is, they said that we tried to make the Matrix sublime and angelic. Entire crops were lost. People rejected it. Bullshit. You put someone unknowingly into a Lord of the Rings fantasy in which they're like the king and they get to win the game. They're just going to play that for forever. I actually anticipate a high probability that vast fractions of the human race will disappear into the simulation willingly. Imagine a place where you can run your brain at 1000x normal speed and live like a thousand lives in the span of a regular human lifetime. You're a vampire in one of them, you're Superman, another one. Are you living a whole lifespan where you're totally unaware of that you made yourself forget, and then you wake up after you die and you're like, holy, this is all a game. Oh, my God. Oh, my God. And I mean, I remember that I played that as a game. You could do all of that for forever. Who's gonna look at reality and then go, I'm good on that. I want to live in Lord of the Rings fantasy. A lot of people, a lot of people play World of Warcraft right now for most of their waking life anyway. That's going to be a choice. Now, some people aren't going to want to do that. And that's total respect. But also, our real world is going to change. I mean, look at modern Austin, Texas. It's like kind of an idyllic place if you think about it, compared to like 1900 London. God, there's no air pollution, there's no crime, relatively speaking, et cetera, et cetera. So in the 2000 and 30s, here's another little gem of optimism. The era of robotics is coming. If the average robot costs a fifth less of inputs to sustain per year, maintenance, etc than a human, but produces roughly the same output as a human, and this is a sick joke, because robotics will exceed human production very quickly. You can make as many robots as you want and that multiplies the GDP linearly with each robot. Elon Musk has spoken about this. There's a potential for robots in the 2000 and 30s or 40s to be 10 to 1 to the average human. You institute a 10% tax on the robotics industry and no human ever has to work again. Universal basic income, completely solved. So then what will humans do? They're going to do a lot of stuff. Some people will engage in productive activities, some people will live their awesome lives in the reality of the physical world. And a lot of people, incrementally more and more are going to plug in to increasingly more, well, simulated virtual reality and spend a lot of time over there, I think the kind of stuff that's coming in the future is either like World War Three and everything dies. The machines choose to kill us, which would be really bad. It won't be terminators, laser guns, they won't be anthropomorphic looking or something that is so sublime we can barely understand it. And I will couch this with one other thing. If you describe to the average person in 1300s England how the average American lives today, they would be like, what the hell are you talking about? Like kings don't live like this. Like, oh yeah, like Uber Eats. Can you explain to a subsistence farmer what Uber Eats is?

[Peter Attia]

No. I mean, look, you couldn't explain it to the king of France, no 500 years ago what it is. And so the only thing I will say on this entire point is I agree completely that, well, maybe this is not what you're saying, but I would argue I have absolutely no idea. I can't fathom. And I spend very little time trying to imagine what a world looks like in a hundred years, whether I'm easy or not. Because. Because the only thing I know is it will be more difficult to predict than going back a hundred years and trying to predict today was. That's the only thing that I know is capital T. True. If you go back in time 100 years or 500 years and try to predict today, that is easier than what's going to happen in the next hundred to 500 years based on the trajectory of growth. And I guess I just bring it back to, what can I do today?

[Mike Istratel]

And I think that your approach to your health and wellness has been infinitely more wise than my own. You're hedging to say, look, maybe crazy 20, 40 stuff, it'll be, we're all immortal or whatever, we're machines, dope. But I want to give myself the best possible chance to make it to that. So everything that I do is longevity oriented. I think everyone should be living like that. Because, look, if in 2032, they solve reverse aging, a few months later, all of us take the pill, we're all 22, biologically, we can all have the biggest fucking party of all time. It'll be great. But you might not make it to that party if you're like throwing back Cheetos right now. In my own personal mild defense, although it's not the right term, yeah, I used some drugs, but I was incredibly health conscious in that context and still am in my current context. So if I don't make it to that era, someone from that era might watch this and be like, oh, this guy saw it coming. Or not. But I think your approach of, listen, back in the 1940s, there's a serious discussion of quality of life versus longevity. You tried to sell someone, no more beer, no more cigarettes. Like, why? So I could live 20 years longer. For what?

[Peter Attia]

Yeah, exactly.

[Mike Istratel]

So I could work in the fucking factory 20 years longer and grind my fingers off on the stamping press. You're like, okay, noted. Here are your cigarettes and beer. Back in the mid-2020s, legitimate thinkers in the space are talking about longevity, escape velocity, are talking about true immortality, not capital I, immortality, lowercase I. Like you still get hit by a bus. An asteroid could still break the earth into pieces. But like, yeah, like brain in the cloud type of stuff. Now is probably the most pertinent time where reading your book, consuming your material, listening to your stuff and your experts that you have on is the smartest thing, especially people in their 40s and 50s and 60s could do. Because, look, if you're in your 20s, whatever, rock on. If you're in your 40s, 50s, 60s, you might make it to this paradise stuff in the2030s, but barely. And tell yourself, thank God I ate some freaking broccoli and went to bed at 9pm Whereas an alternative, you could have had one too many margaritas and Cheetos and not made it that far.

[Peter Attia]

If you had kids. And it's a dumb question, because you don't. And you don't know until you do. But Would it change your philosophy around training anabolic steroid use? I want to be really clear. This is not a moral question at all. It's really a question of trade off questions. Right. It's a trade off question. Right. At the doses you're taking them, do you have any concerns and would you play it differently if you had kids?

[Mike Istratel]

Up until a few years ago I thought I was going to have kids and I was very aware of all the trade offs and I played it the exact same way, so probably not. It's all statistics again. I could die tomorrow. I could never die. Who knows anything between I'm statistically likely with my current exposure and no increase in biotechnology throughput to croak in my 70s or 80s, probably more like 70s, maybe late 60s.

[Peter Attia]

You do think that even with your great genes, which it sounds like based on everything you've said, you really have have wonderful genes. That suggests that your steroid use by your calculation is a 20 year reduction of lifespan.

[Mike Istratel]

Worst case, realistic. Worst case. Yeah.

[Peter Attia]

Yeah. Okay, that's interesting.

[Mike Istratel]

Always.

[Peter Attia]

How are you quantifying that?

[Mike Istratel]

Very heuristically, but I'm familiar with what kind of cycles other people have done, what kind of body weights they've gotten to, body fats, health metrics. And I've seen and noted and heard of lots of people in our industry look like most bodybuilders from Arnold's era are still ticking.

[Peter Attia]

And you attribute that to the fact that they were just using a fraction of the drugs?

[Mike Istratel]

It's by no means clear they were using a fraction of the drugs. Some of that's true, some of it's not true. Some of those guys were cranking it. Yeah. It does not take a rocket scientist to realize that when you take more of something and grow more muscle, you're going to do a lot of it. They were using fewer drugs on average, but with many exceptions. I attribute that to the fact that as long as your blood pressure is not chronically elevated and as long as you don't have shitty genetics for longevity, longevity genetics are very robust and you can do a lot of shit to yourself and still make it quite far. Whereas other people take great care to do everything and they croak in their mid-50s because that's just the card they were dealt. Most pro wrestlers, bodybuilders, etc, most of them are older and they're still with us. Some pretty decent fraction of them have died. Many because like people just die in their mid-70s, but some of them because of grotesque abuses. I mean, pro wrestling, it's mostly a cocaine problem, to be completely honest. The steroids are just a drop in the bucket at that point. Right. But it's just not true to say that anabolic androgenic steroid use, even in extreme circumstances, just straight up drops you like a fly. It doesn't. Severe alcoholism, that'll do you in. Not a lot of 70 or 80 year old severe alcoholics. Anabolic steroid abuse is just a category of risk. Lower than that now. It's gnarly and it can get you. It's just not as likely. So I assess. Yeah, there's a 5 to 20 year lifespan reduction that I've engaged in and.

[Peter Attia]

I just want to make sure people listening haven't lost the plot. We're not talking about physiologic replacements of testosterone because the evidence is abundantly clear that we do not see any reduction in lifespan. We don't see any increase in the risk of cardiovascular disease, cancer or these other things.

[Mike Istratel]

But huge quality of life increases concomitantly. So it really makes sense. I don't like the term abuse. It has a moral connotation. Intelligent, purposeful, high dose androgen exposure, we'll call it that. Yeah, it's definitely taken years off my life, but I think it'll probably peg me into my 60s somewhere. And again, I was born in 1984, so I'll be 60 in 2044. If every variable has lined up like the one so far through all of measured history, 2044 is not going to be a time where there are biological humans that die short of them choosing to do so.

[Peter Attia]

Sort of unrelated but related. Are we seeing more bodybuilders now use GLP1 agonists?

[Mike Istratel]

Yes.

[Peter Attia]

Yeah, I was about to say. Right. Like why wouldn't you? It would make the most difficult part of bodybuilding easier, which is the calorie restriction. Right.

[Mike Istratel]

You said that in a way I cannot say any better. There are three groups of people in bodybuilding today, people that have emphatically adopted the use of GLP1s. Group two are people that either use or don't use but don't say much about them either. Don't care, don't know, or they're using but they're kind of shush about it. And then there's another group that is just absolutely viciously opposed to them for reasons that are almost always wildly irrational but moralistically understandable.

[Peter Attia]

Just to be clear, there is a category of bodybuilder who fully endorse the liberal use of anabolic steroids but oppose the use of GLP1 agonists vehemently. And the moral argument is you have.

[Mike Istratel]

To suffer through the hunger to earn your right to call yourself a competitive bodybuilder. What do you think about that? It could probably steel Madda.

[Peter Attia]

Yeah. I mean, look, I think having never done bodybuilding, I'm probably not a good person to offer a point of view on that. You could argue that if the stripes are earned through that type of suffering. Let's take a step back. If the stripes are earned through suffering, there's two types of suffering. There's the suffering you do in the gym, the pain of the gym, and then there's the pain of the second one, the starving lifestyle, the calorie restriction. And if they're saying you have to have both of those to be one of us, then steroids are not a problem. In fact, they allow you to suffer more. Potentially, they allow you to push yourself harder. So maybe in that sense, steroids are an important part of bodybuilding if the suffering is the card and the GLP1 agonist is not. So maybe that's the argument. I probably wouldn't have come to that argument. I probably would have said, well, if we're in the business of using any form of pharmacology to enhance our physiques, we should take whatever we can get, provided it's safe.

[Mike Istratel]

Yes, I'm in that camp as well. There are at least two things those folks aren't considering. Thing number one is that if you can achieve a certain level of body fat through caloric restriction without GLP1s, when you use any given dose of GLP1s to reduce your hunger, you get two things out of that. One is now you can push to even more exotically lean levels, which you should be. We're not trying to race to the same point. The destination changes. If you can get some faint glute striations and win a few shows without GLPs, maybe you can get completely stripped out of your mind with them. It's just as hard. You're just as hungry. But just as hungry at 3%, body fat is a very different look than just as hungry at 6%. One is GLP enhanced, one is not. That's a big deal to remember. The other thing is you have to deal with side effects of GLPs. They give you heartburn. There is a certain amount of food focus they don't eliminate. Watching TV shows and watching people on them eat tasty foods when you're in prep is not as difficult because you're not physiologically as hungry, but you still have cravings. Cravings are lower, but they're still there. And you still dream about food and the whole gamut. It's not complete kiboshing of hunger Now. I hope one day very soon we'll achieve that and that'll be a miraculous thing. That'll save, I don't know, hundreds of millions of people from the obesity epidemic. Footnote in history, but that'll be cool. And then your job will be like, if you have more bandwidth because shit is easier, just push your conditioning further, get even leaner. That's a big deal that people seem to forget. The other deal is there is a preposterous amount of assuming that work and diligence are the big variables that separate bodybuilders. Usually that assumption is made by people with elite genetics, and it's just not true. My jiu jitsu coach, a gentleman named Mr. Will Starks, phenomenal professional MMA athlete. Will eats a very clean diet, very healthy diet, but he has tons of freebies. Potato chips, pizza here and there. No big deal. He trains for mixed martial arts, he's a pro, he has glute striations, he walks around and lives his life at 7% body fat. That's just how he exists in the world. It would take him one cycle of training to turn pro. He's drug free. If you look at him in the gym and if you put on some posing trunks and you looked at his glutes, you ask some people in the gym, what's that all about? The bad man. It must take a lot of hard work. Took no work at all. He trains his ass off in mma, but how many MMA guys do you see with stride of glutes? It's almost not a thing. She would look at that and be like, let's say he diets for six weeks and actually starts resistance training for hypertrophy for the first time in his life, I might add, in his mid-30s. This is our plan for Will. Once he's ready, he's going to turn drug free pro. His first or second show, no problem. And people are going to go, man, I must have taken a lot of work. And he'd be like, ha. Well, actually not really. And so if you have someone on stage against him, who takes second place, but they started their diet at 20% body fat and their diet took 18 weeks. Who worked harder? People will tell you the guy with striated glutes did, and they would be fucking wrong, wrong, wrong. So when you look at people using GLPs, you assume everyone has kind of decent genetics. That's not true. And people who have been fatter before have a much harder time getting leaner for a bunch of different reasons. They're dealing with the same genetics that got them fat, and they have excess fat cells that scream hunger signaling into the ether all the time. So the idea that bodybuilding is about earning your keep and grinding and suffering is true. But we already use enhancement in so many different ways. Why not use enhancement in this other way? I never gotten a clear answer on that, because most of the people that espouse such opinions don't have the patience or intellectual capacity to deal with such issues. Just something you scroll by on Instagram and go note it scrolling on to the next thing or turning my phone off and flushing it down the toilet.

[Peter Attia]

So, Mike, what do you think that tells us about the morality of GLP1 use much more commonly? Because obviously the majority of people using GLP1 agonists and dual agonists, et cetera, are not bodybuilders and are professional people whose livelihoods depends on their physique. It's normal people. Again, let's also take out the category of people with type 2 diabetes or with such significant obesity that it's impacting their health in ways that are direct and measurable through the excess adiposity. Let's talk about what is probably the majority of people who would use a GLP1 agonist right now, which are people who might actually even be healthy, they might be overweight, but still be perfectly.

[Mike Istratel]

Healthy ones right now.

[Peter Attia]

Yeah. Tell me, why do you think that there is a bit of a moral panic about this?

[Mike Istratel]

Yeah, most of the people that are morally panicking will tell you why. Most of what they say is that you have to earn your fitness. And if you are lazy and you just take a pill and you lose all the weight, you haven't addressed the root cause of the issue, which is your poor diet. And there's something to say there. But I don't understand much further about their own logic. I would say they're not thinking a lot, they're just having a lot of feelings. Like, if you talk to most people about politics, you'll realize that most people are not geopolitical strategists or econometricians. They just feel a lot. And so this is one of these things where people have a lot of feelings, but if they pulled it back and actually logic through it, they would conclude that, like, oh, these modern anorectic drugs are tools to accomplish something and whatever tools you use that make sense for you should be a valid consideration for the goal. But a lot of people use physical fitness, especially external, as a proxy for conscientiousness, the ability to organize your life, to delay gratification, so on and so forth. And the reality is that probably the two biggest predictors of how obese someone is are your genetic hunger drive and your degree of conscientiousness. So the only thing that the GLPs eliminate as a category of problem is the hunger drive. They eliminate it, but they do a great job, reduce it substantially. So now we're left with people that are leaner, some of whom just have average conscientiousness, but not low food drive. And now they're leaner. And this especially upsets people that have lost weight themselves on their own, and they took a certain moral worthiness, a certain gold star on their chest for it. Say I was conscientious and willful enough to do this. And to those people, they're absolutely correct. Like, what they did was monumental and ultra impressive. And they feel sort of ripped off because other people are now doing it by just like taking a weekly injection. But that belief in yourself, that flexing of your conscientious muscle that you did, it's your benefit for yourself to keep. And the other way to think about it is if you had to lose 20 pounds and really focus yourself to do it, and to keep the weight off, you're focused all the time. What you could do is take an anorectic drug, GLP1, for example, and now you don't have to try as hard to limit yourself, because your food, your natural, your appetite is like normal. And you can take all of that bandwidth of willpower and effort and conscientiousness and apply it to something else, business, family, life. If you have to diet hard enough to lose a bunch of weight, your bandwidth for your work, your bandwidth for family, your bandwidth for enjoying your life have to go down. Otherwise you're just not dieting hard enough. And if you now have a solution to the hard dieting problem, in which you can actually do much better job with less input, that doesn't mean you're on the couch eating Cheetos, though it could if you choose. What it means is now you have more bandwidth that opens up for all of these other wonderful things in which you can express your conscientiousness, build your business better, spend more time with your family.

[Peter Attia]

So has that been your experience? Which is it hasn't actually changed what you're eating, it's just given you the privilege of focusing less on the starvation and the management of diet.

[Mike Istratel]

That's exactly been my experience. My wife was either genetically epigenetically geared to just get fat. One point she was almost 200 pounds at 4 foot 11. And she probably has more willpower than I've ever seen in a single human being. She'll break herself before she quits at stuff. And her hunger signaling was so profound that she battled it her whole life, had lots of victories, lots of defeats. And her introduction to GLPs, to Ozempic, was the kind of thing that borders on the religious experience for the first time ever. To be like, oh, this is how normal people live their lives. And now she's whatever body weight she wants to be and lives at a category level of life experience she was unable to access before because especially if females of reproductive age having 70 pounds extra adiposity, how the world sees you, how you see yourself, is totally different. She almost failed out of medical school because she was dieting so hard to try to stay at a certain body fat. Their brain just wasn't working. And it's easy for bodybuilders and other folks to say, like, we just gotta gut through it. Like, guy, you don't do anything except shoot steroids, play PlayStation and train with weights. Thank God for your supplement contract. There was somebody on social media that she sort of opened up about her journey. And this, like, bodybuilder is not even competitive. He's just a guy who lifts weights. He's a personal trainer. He said something like, you failed at life if you needed the Ozempic. Like my friend, if we start listing off my wife's accomplishments, it's gonna be a 10 to 0 against you. You're nothing to her. She had every bit more willpower. Whatever it is you got good at, she could recreationally get good at faster than you, better than you, just as a joke, and then quit and then come back and do it again. But because you have no idea what it's like to want food that much, you're out of touch. For me became very easy to connect with my wife on food drive after I had dieted down to body fat. That was competitive bodybuilding appropriate enough times, you feel what it's like to be obsessed.

[Peter Attia]

All you're thinking about is all you're thinking about.

[Mike Istratel]

Food tastes good to a level. If you're like, am I eating drugs? Like, what the hell is going on? And you're in pain physically from the expansion of your abdominal tract and you're still eating and your eyes are this wide, like a hungry, ravenous dog who like is tortured and not allowed to eat for a long time. That's how a lot of people live in the world. And again, there's two variables that come into determining how fat you are primarily. One is food noise, one is conscientiousness. So if we just end the food noise, some people will still be overweight even if they're autozempic because they're like, ah, whatever. Just Reese's Cups. Enough. Reese's Cups can defeat any amount of pharmacology so far for those people. All those discussions about like, hey, you should be more diligent, you should be planning, yeah, they're all still valid, but if we can just remove one impediment. Amazing. People come at this from a morality. You have to earn your keep. Now in sport competition, hell yeah, it's cheating. Now in bodybuilding competition, they don't test for drugs at all. It's not cheating at all. But people take this morality, this cheating stuff and they put it out in the real world.

[Peter Attia]

Do you think it should be. I've talked about this before in cycling, a sport where they're very clear on what the rules are. No performance enhancing drugs. But to date, all of the performance enhancement has been on the generation of power. Epo, testosterone, things like that. But anybody who's ever ridden a bike knows it's half power, half weight. Cyclists spend a lot of time being hungry.

[Mike Istratel]

Many of them do, some of them don't you. Also, your total calorie expenditure throughout the week is so preposterous. Sometimes cyclists have trouble keeping up their weight. So you see all the whole range. But if there is a drug that solves a very big problem for you that makes you better and you're purporting to be a drug free federation. Yes, you should be testing for it and it should be a banned substance.

[Peter Attia]

Mike, thank you very much for making the trip and for explaining a lot of things that I think a lot of people are going to find super interesting. I think we should probably sit down and do this again because I had a list of topics, not questions, but just topics I wanted to go through of which I didn't really get through many, although tangentially we did talk about a few things.

[Mike Istratel]

So sorry for blabbing so much.

[Peter Attia]

No, no, it was always a pleasure.

[Mike Istratel]

Thank you so much for having me on. If you want to ever have a round to you, just let me know.

[Peter Attia]

Sounds great. Thank you for listening to this week's episode of the Drive. Head over to Peteratti md.com if you want to dig deeper into this episode. You can also find me on YouTube, Instagram and Twitter, all with the handle PeterAttiaMD. You can also leave us a review on Apple Podcasts or whatever podcast player you use. This podcast is for general informational purposes only and does not constitute the practice of medicine, nursing or other professional healthcare services, including the giving of medical advice. No doctor patient relationship relationship is formed. The use of this information and the materials linked to this podcast is at the user's own risk. The content on this podcast is not intended to be a substitute for professional medical advice, diagnosis or treatment. Users should not disregard or delay in obtaining medical advice from any medical condition they have, and they should seek the assistance of their healthcare professionals for any such conditions. Finally, I take all conflicts of interest very seriously. For all of my disclosures and the companies I invest in or Advise, please visit PeterAttiamD.com about where I keep an up to date and active list of all disclosures.