Peter's takeaways on aerobic exercise and VO2 max, insulin resistance, rising healthcare costs, treating children with autism and ADHD, and strength training | Quarterly Podcast Summary #4

**Peter Attia** (0:11)
Hey, everyone, welcome to a sneak peek, Ask Me Anything or AMA episode of the Drive podcast. I'm your host, Peter Attia. At the end of this short episode, I'll explain how you can access the AMA episodes in full, along with a ton of other membership benefits we've created. Or you can learn more now by going to peterattiamd.com/subscribe. So without further delay, here's today's sneak peek of the Ask Me Anything episode.
Welcome to another special AMA episode of The Drive. Today's episode will be the fourth installment of the quarterly podcast summary. In this conversation, I discuss what I learned from the last quarter of interviews, and what I think were some of the most important insights, as well as things that have resulted in a change in my work and behavior. Please note that I do not think listening to the quarterly podcast summary even remotely constitutes a substitute for listening to the actual episodes. My hope is that it basically helps you think about refining what you might have learned there, and if something you hear in one of these summaries is of interest and you miss the original episode, I hope you'll go back and listen to it. In today's episode, we cover the interviews that I did with Olav Aleksander Bu, Ralph DeFronzo, Saum Sutaria, Trenna Sutcliffe, and Mike Israetel. And throughout these, we talk on various topics, VO2 max, power at VO2 max, insulin resistance, metformin, SGLT2 inhibitors, GLP-1 agonists, US healthcare costs, diagnosis and treatment approaches to autism, ADHD and anxiety, zone 2, resistance training, and learning all of the effects of anabolic steroids. And yeah, that sounds like a hodgepodge of topics, but that's because it's pulled from all of these discussions. If you're a subscriber and you want to watch the full video of this podcast, you can find it on our show notes page. If you're not a subscriber, you can watch the sneak peek of the video on our YouTube page. So without further delay, I hope you enjoy this special quarterly podcast summary AMA of The Drive.

**SPEAKER_1** (2:19)
Peter, thanks for joining us on another AMA on your own podcast. We appreciate you coming by.

**Peter Attia** (2:25)
I always appreciate being here. Thank you for having me.

**SPEAKER_1** (2:27)
Anytime, anytime. So today is going to be another quarterly podcast summary episode. A lot of words, basically what it means is, we look at past episodes, cover what the main takeaways are, what your favorite insights were, any changes you made based on behavior to yourself, how you work with patients, how you think about things, anything of that nature from those episodes. The other thing to say is reminder, it's meant as more to augment the episodes, not necessarily as a replacement. And we get a lot of feedback where people will listen to this and then re-listen to some of the original episodes and find a lot of value in it. Today we'll look at Olav talking about training, performance, VO2 max, Ralph looking at insulin resistance, type 2 diabetes, metformin, SGLT2 inhibitors, other drugs, Saum looking at healthcare, trying to understand why healthcare in the US is nearly two times per capita of any other developed nation, Trenna looking at autism, ADHD, anxiety. We have Mike looking at resistance training and kind of diving into everything revolving that. So huge variety of topics, a lot of different things that I think people should find interest in. And I think we'll get it started with Olav. So do you kind of want to start going through your episode with Olav? This was obviously the second time he was back on. A little behind the scenes, we talked beforehand about, hey, let's try and make it a little less technical because the first one was pretty technical. And I think looking back, you probably made it more technical in the first. So I think that's just by nature, how you and Olav are always going to be. So maybe break down for people what you learned and what your biggest insights were from that.

**Peter Attia** (4:09)
Yeah, and before we dive into this, at least in as long as we've been doing quarterly podcast summaries, I will say this might end up being the longest because just by the nature of coincidence and which podcasts fall into the past quarter, this is probably the most voluminous set of notes I've ever taken across a set of podcasts. In fact, I would say that two of the episodes that we've covered here, the one with Ralph and the one with Saum, were easily three to four X the volume of notes I normally take. Impute from that way you will. I've done my best to try to synthesize that. But nevertheless, there's a lot going on in this past quarter. Okay, you're right. I wanted to make the Olav one at the outset just straight into less technical things. And I could not resist the tractor pull of trying to at least explain some technical things. So we started the discussion by explaining the difference between things like functional threshold power and critical power. I hesitate to bring these up now because I just don't think they're relevant unless you are a cyclist. But if you are interested, I'll just state it. The functional threshold power or FTP is the power that you can hold for one hour. That is one way to test it. You literally get on a bike, usually on an ERG, so it's a stationary bike, and you ride as hard as you can without blowing up for one hour. And whatever the average power is that you held as your FTP, much more typically, for example, when I was a cyclist, we would do this in a 20-minute test and we would discount it by typically 10%, although Olav suggested only 5% in my experience, 10% was necessary. There's something called critical power, which is very similar, but rather than it being the power you can hold for an hour, it's the power you can hold for 30 to 40 minutes. I think the more important distinction here is that you can calculate critical power much easier. You can do it from a set of curves that are derived from three to four individual tests that are much shorter. Why is this relevant? This is relevant because if you want to have other metrics beyond VO2 max for higher end aerobic efficiency, you might want to know your FTP or critical power, and critical power is much easier to measure. These days, and this ties into another insight, by the way, these days I don't spend a lot of time worrying about my FTP. In fact, I don't know what it is because I haven't done a 20-minute power test since NAMM. Don't necessarily think I'm going to do one anytime soon, probably because I don't want to see how low it is, but it made me realize maybe I ought to do a critical power test just so that I have another benchmark to be tracking. So we talked about a few other things which I'm not going to go into, anaerobic threshold and stuff. We covered a little bit of that in the first podcast. Another very interesting insight that came up for me in this podcast, which was really just a personal insight, and I hesitate to spend too much time on it, was talking about the relationship between VO2 max and PV02 max or VVO2 max. So if you're a cyclist, what does that mean?